Pennsylvania Act 2008-45 — MEDICAL PRACTICE ACT OF 1985 - STATE BOARD OF MEDICINE, JOINTLY PROMULGATED REGULATIONS, PHYSICIAN ASSISTANTS, RESPIRATORY CARE PRACTITIONERS, PHYSICIANS ASSISTANTS LICENSE AND RESPIRATORY CARE PRACTITIONER CERTIFICATES AND PERMITS

Act text

MEDICAL PRACTICE ACT OF 1985 - STATE BOARD OF MEDICINE, JOINTLY
     PROMULGATED REGULATIONS, PHYSICIAN ASSISTANTS, RESPIRATORY CARE
    PRACTITIONERS, PHYSICIANS ASSISTANTS LICENSE AND RESPIRATORY CARE
                  PRACTITIONER CERTIFICATES AND PERMITS
                  Act of Jul. 4, 2008, P.L. 580, No. 45               Cl. 63
                             Session of 2008
                               No. 2008-45

     HB 1804

                                  AN ACT

     Amending the act of December 20, 1985 (P.L.457, No.112),
        entitled "An act relating to the right to practice medicine
        and surgery and the right to practice medically related acts;
        reestablishing the State Board of Medical Education and
        Licensure as the State Board of Medicine and providing for
        its composition, powers and duties; providing for the
        issuance of licenses and certificates and the suspension and
        revocation of licenses and certificates; providing penalties;
        and making repeals," further providing for definitions and
        for the State Board of Medicine; providing for jointly
        promulgated regulations; and further providing for physician
        assistants, for respiratory care practitioners, for
        physicians assistants license and for respiratory care
        practitioner certificates and permits.

        The General Assembly of the Commonwealth of Pennsylvania
     hereby enacts as follows:

        Section 1.  The definitions of "board regulated practitioner"
     and "respiratory care practitioner" in section 2 of the act of
     December 20, 1985 (P.L.457, No.112), known as the Medical
     Practice Act of 1985, amended or added July 2, 1993 (P.L.424,
     No.60) and December 10, 2001 (P.L.859, No.92), are amended to
     read:
      Section 2.  Definitions.
        The following words and phrases when used in this act shall
     have the meanings given to them in this section unless the
     context clearly indicates otherwise:
        * * *
        "Board regulated practitioner."  A medical doctor, midwife,
     physician assistant, respiratory [care practitioner] therapist,
     certified athletic trainer or drugless therapist or an applicant
     for a license or certificate the board may issue.
        * * *
        "Respiratory [care practitioner] therapist."  An individual
     who is [certified] licensed to practice respiratory care by the
     State Board of Medicine.
        * * *
        Section 2.  Section 3(a) and (b) of the act, amended June 11,
     2008 (P.L.154, No.19), are amended to read:
      Section 3.  State Board of Medicine.
        (a)  Establishment.--The State Board of Medicine shall
     consist of the commissioner or his designee, the Secretary of
     Health or his designee, two members appointed by the Governor
     who shall be persons representing the public at large and seven
     members appointed by the Governor, six of whom shall be medical
     doctors with unrestricted licenses to practice medicine and
     surgery in this Commonwealth for five years immediately
     preceding their appointment and one who shall be a nurse
     midwife, physician assistant, certified registered nurse
     practitioner, respiratory [care practitioner] therapist,
     certified athletic trainer or perfusionist licensed or certified
     under the laws of this Commonwealth. All professional and public
     members of the board shall be appointed by the Governor, with
     the advice and consent of a majority of the members elected to
     the Senate.
        (b)  Terms of office.--The term of each professional and
     public member of the board shall be four years or until his or
     her successor has been appointed and qualified, but not longer
     than six months beyond the four-year period. In the event that
     any of said members shall die or resign or otherwise become
     disqualified during his or her term, a successor shall be
     appointed in the same way and with the same qualifications and
     shall hold office for the unexpired term. No member shall be
     eligible for appointment to serve more than two consecutive
     terms. The Governor shall assure that nurse midwives, physician
     assistants, certified registered nurse practitioners,
     perfusionists and respiratory [care practitioners] therapists
     are appointed to four-year terms on a rotating basis so that, of
     every four appointments to a four-year term, one is a nurse
     midwife, one is a physician assistant, one is a certified
     registered nurse practitioner and one is a respiratory [care
     practitioner] therapist.
        * * *
        Section 3.  The act is amended by adding a section to read:
      Section 8.1.  Jointly promulgated regulations.
        The State Board of Medicine and the State Board of
     Osteopathic Medicine shall jointly promulgate regulations
     implementing sections 13.1 and 36.1, relating to the licensure
     and practice of respiratory therapists.
        Section 4.  Section 13 of the act is amended by adding
     subsections to read:
      Section 13.  Physician assistants.
        * * *
        (c.1)  Except as limited by subsection (c.2), and in addition
     to existing authority, a physician assistant shall have
     authority to do all of the following, provided that the
     physician assistant is acting within the supervision and
     direction of the supervising physician:
            (1)  Order durable medical equipment.
            (2)  Issue oral orders to the extent permitted by a
        health care facility's bylaws, rules, regulations or
        administrative policies and guidelines.
            (3)  Order physical therapy and dietitian referrals.
            (4)  Order respiratory and occupational therapy
        referrals.
            (5)  Perform disability assessments for the program
        providing Temporary Assistance to Needy Families (TANF).
            (6)  Issue homebound schooling certifications.
            (7)  Perform and sign the initial assessment of methadone
        treatment evaluations in accordance with Federal and
        State law and regulations, provided that any order for
        methadone treatment shall be made only by a physician.
        (c.2)  Nothing in this section shall be construed to:
            (1)  Supersede the authority of the Department of Health
        and the Department of Public Welfare to regulate the types
        of health care professionals who are eligible for medical
        staff membership or clinical privileges.
            (2)  Restrict the authority of a health care facility to
        determine the scope of practice and supervision or other
        oversight requirements for health care professionals
        practicing within the facility.
        * * *
        Section 5.  Section 13.1 of the act, added July 2, 1993
     (P.L.424, No.60), is amended to read:
      Section 13.1.  Respiratory [care practitioners] therapists.
        [(a)  Certificate required.--Eighteen months after the
     effective date of this section, it shall be unlawful for any
     person to hold himself out to the public as a respiratory care
     practitioner and to practice or offer to practice respiratory
     care unless he holds a valid, current temporary permit or
     certificate issued by the board.
        (b)  Use of title.--A respiratory care practitioner who holds
     a valid, current temporary permit or certificate issued by the
     board may use the title respiratory care practitioner or
     respiratory care practitioner-certified or an appropriate
     abbreviation of that title such as "R.C.P." or "R.C.P.-C."]
        (a)  Qualifications.--An individual shall be eligible to
     apply for licensure as a respiratory therapist if that
     individual satisfies all of the following:
            (1)  Submits evidence satisfactory to the board, on forms
        approved by the board, that the applicant has met one or more
        of the following criteria:
                (i)  Has graduated from a respiratory care program
            approved by the Committee on Accreditation for
            Respiratory Care and passed the Certified Respiratory
            Therapist Examination as determined by the National Board
            for Respiratory Care.
                (ii)  Holds a valid license, certificate or
            registration as a respiratory therapist in another state,
            territory or the District of Columbia which has been
            issued based on requirements substantially similar to
            those required by the Commonwealth, including having
            successfully passed the entry level examination.
            (2)  Has paid a licensure fee as established by the board
        by regulation.
            (3)  Has proved to the satisfaction of the board that the
        individual is of good moral character and is not unfit or
        unable to practice as a respiratory therapist by reason of
        physical or mental impairment.
        (a.1)  License required.--It shall be unlawful for any
     individual to hold himself out to the public as a respiratory
     therapist or to practice or offer to practice respiratory
     therapy unless the individual holds a valid, current license
     issued by the board or the State Board of Osteopathic Medicine.
        (a.2)  Use of title.--It shall be unlawful for an individual
     to use the title of "licensed respiratory therapist" or to use
     the letters "LRT" or "RT" or to hold oneself out as a licensed
     respiratory therapist unless that individual is licensed to
     practice respiratory care as provided under this act or the act
     of October 5, 1978 (P.L.1109, No.261), known as the Osteopathic
     Medical Practice Act.
        (b)  Licensure without examination.--For a period of two
     years following the effective date of this act, an individual
     shall be eligible to apply for licensure without examination if
     the individual meets the qualifications for licensure under
     subsection (a) and holds valid certification as a respiratory
     care practitioner as issued by the board or the State Board of
     Osteopathic Medicine.
        (c)  Regulations.--The board is authorized to promulgate
     regulations to implement this section.
        (d)  Supervision and scope of practice.--A respiratory [care
     practitioner certified] therapist licensed by the board may
     implement direct respiratory care to an individual being treated
     by either a licensed medical doctor or a licensed doctor of
     osteopathic medicine upon [physician] prescription or referral
     by a physician, certified registered nurse practitioner or
     physician assistant, or under medical direction and approval
     consistent with standing orders or protocols of an institution
     or health care facility. This care may constitute indirect
     services such as consultation or evaluation of an individual and
     also includes, but is not limited to, the following services:
            (1)  Administration of medical gases.
            (2)  Humidity and aerosol therapy.
            (3)  Administration of aerosolized medications.
            (4)  Intermittent positive pressure breathing.
            (5)  Incentive spirometry.
            (6)  Bronchopulmonary hygiene.
            (7)  Management and maintenance of natural airways.
            (8)  Maintenance and insertion of artificial airways.
            (9)  Cardiopulmonary rehabilitation.
            (10)  Management and maintenance of mechanical
        ventilation.
            (11)  Measurement of ventilatory flows, volumes and
        pressures.
            (12)  Analysis of ventilatory gases and blood gases.
        (e)  Exemptions.--This section shall not prevent or restrict
     the practices, services or activities of:
            (1)  A person licensed or certified in this Commonwealth
        to provide another health care service, including, but not
        limited to, physicians, physical therapists, chiropractors,
        nurses, dentists, physician assistants and podiatrists.
            (2)  A person rendering respiratory care services
        pursuant to employment by a Federal agency.
            (3)  A person pursuing a course of study leading to a
        degree or certificate in respiratory care in an accredited
        educational program, if he is clearly designated as a student
        and provides care under supervision implemented through that
        program.
            (4)  A person executing or conveying medical orders
        pursuant to lawful delegation by a physician.
            (5)  A person who, pursuant to lawful delegation by a
        physician, delivers, installs, monitors or maintains a device
        which enables an individual to self-administer respiratory
        care.
            (6)  A person qualified by academic and clinical
        education to operate extracorporeal circulation equipment in
        a medical or surgical setting which requires support to or
        the temporary replacement of a patient's circulatory or
        respiratory functions.
        (f)  Referrals to State Board of Osteopathic Medicine.--
     Information or allegations filed with the board against a
     respiratory [care practitioner certified] therapist licensed by
     the State Board of Osteopathic Medicine shall be referred to
     that board for appropriate action.
        Section 6.  Section 36 of the act, amended December 9, 2002
     (P.L.1344, No.160), is amended to read:
      Section 36.  Physician assistant license.
        (a)  General rule.--A physician assistant license empowers
     the holder to assist a medical doctor in the provision of
     medical care and services under the supervision and direction of
     that medical doctor as provided in this act.
        (b)  Requirements.--No physician assistant license may be
     issued to the applicant unless the requirements set forth by
     this act and such rules and regulations issued by the board are
     met, including requirements for the physician assistant training
     and educational programs which shall be formulated by the board
     in accordance with such national criteria as are established by
     national organizations or societies as the board may accept.
        (c)  Criteria.--The board shall grant physician assistant
     licenses to applicants who have fulfilled the following
     criteria:
            (1)  Satisfactory performance on the proficiency
        examination to the extent that a proficiency examination
        exists.
            (2)  Satisfactory completion of a certified program for
        the training and education of physician assistants.
            (3)  For candidates for initial licensure after January
        1, 2004, obtainment of a baccalaureate or higher degree from
        a college or university and completion of not less than 60
        clock hours of didactic instruction in pharmacology or other
        related courses as the board may approve by regulation.
        (d)  Biennial renewal.--A physician assistant license shall
     be subject to biennial renewal by the board. As part of biennial
     renewal, a physician assistant shall complete continuing medical
     education as required by the National Commission on
     Certification of Physician Assistants.
        (e)  Description of manner of assistance.--The application
     shall include a written request from the applicant's supervising
     medical doctor who shall file with the board a description of
     the manner in which the physician assistant will assist the
     supervising medical doctor, which description shall be subject
     to the approval of the board.
        (f)  Professional liability.--
            (1)  A licensed physician assistant in this Commonwealth
        shall maintain a level of professional liability insurance
        coverage in the minimum amount of $1,000,000 per occurrence
        or claims made. Failure to maintain insurance coverage as
        required shall subject the licensee to disciplinary
        proceedings. The board shall accept from physician assistants
        as satisfactory evidence of insurance coverage any of the
        following:
                (i)  self-insurance;
                (ii)  personally purchased liability insurance; or
                (iii)  professional liability insurance coverage
            provided by the physician assistant's employer or similar
            insurance coverage acceptable to the board.
            (2)  A license applicant shall provide proof that the
        applicant has obtained professional liability insurance in
        accordance with paragraph (1). It is sufficient if the
        applicant files with the application a copy of a letter from
        the applicant's professional liability insurance carrier
        indicating that the applicant will be covered against
        professional liability in the required amounts effective upon
        the issuance of the applicant's license to practice as a
        physician assistant in this Commonwealth. Upon issuance of
        the license, the licensee has 30 days to submit to the board
        the certificate of insurance or a copy of the policy
        declaration page.
        Section 7.  Section 36.1 of the act, amended or added July 2,
     1993 (P.L.424, No.60) and July 2, 2004 (P.L.484, No.55), is
     amended to read:
      Section 36.1.  Respiratory [care practitioner certificates]
                    therapist licenses and permits.
        (a)  General rule.--A respiratory [care practitioner
     certificate] therapist license issued by the board empowers the
     holder to practice respiratory care under the supervision of a
     licensed medical doctor or a licensed doctor of osteopathic
     medicine. In a health care facility, that supervision may
     consist of standing orders or protocols approved by the
     institution, consistent with acceptable and prevailing medical
     standards, which may include services rendered directly to the
     patient in his home or other residence.
        (b)  Temporary permits.--The board shall issue temporary
     permits for the practice of respiratory care to individuals who
     have applied for [certification] licensure from the board and
     who meet any of the following requirements:
            (1)  Graduation from an accredited respiratory care
        training program recognized by the board.
            (2)  Enrollment in an accredited respiratory care
        training program recognized by the board, if the individual
        is expected to graduate within 30 days from the date of
        application.
            (3)  [Designation as a "Certified Respiratory Therapist"
        or a "Registered Respiratory Therapist" by a nationally
        recognized credentialing agency approved by the board.
            (4)  Continuous provision of respiratory care services
        for a minimum of 12 months immediately preceding the
        effective date of this section.
            (5)  Holding certification, licensure or registration as
        a respiratory care practitioner issued by another state, the
        District of Columbia or a territory of the United States,
        where the requirements for licensure, registration or
        certification are substantially similar to those required by
        the board.] Recognition as a credentialed respiratory
        therapist as approved by the board.
        (c)  Duration and effect of temporary permits.--Temporary
     permits shall be valid for a period of 12 months and for such
     additional period as the board may, in each case, specially
     determine, except that a temporary permit shall expire if the
     holder fails the examination. An appropriate fee for a temporary
     permit shall be established by the board by regulation. If [he]
     the temporary permit holder is not in violation of any other
     provision of this act, a holder of a temporary permit qualifies
     for admission to the examination and shall apply for the next
     regularly scheduled [certification] licensure examination
     administered by the board. The board is authorized to promulgate
     regulations to establish procedures for application, credentials
     verification, examination and [certification] licensure,
     together with appropriate fees.
        (d)  Examination.--Pursuant to section 812.1 of the act of
     April 9, 1929 (P.L.177, No.175), known as The Administrative
     Code of 1929, the board shall contract for the development and
     administration of an examination for the [certification]
     licensure of respiratory [care practitioners. At least one
     administration of this examination shall be given within 12
     months of the effective date of this section, and the]
     therapists. The examination shall [thereafter] be given at least
     twice per year. [An individual qualifying for a temporary permit
     under subsection (b)(5) shall be issued a certificate by the
     board without examination. An individual qualifying for a
     temporary permit under subsection (b)(3) shall be issued a
     certificate by the board without examination if the individual
     passed an examination in order to obtain designation as a
     "Certified Respiratory Therapy Technician" or a "Registered
     Respiratory Therapist" and that examination was comparable to
     the examination developed and administered pursuant to this
     subsection.]
        (e)  Biennial renewal.--A respiratory [care practitioner
     certificate] therapist license shall be renewed biennially upon
     application on a form prescribed by the board and upon payment
     of a renewal fee adopted by the board by regulation.
        (f)  Continuing education.--
            (1)  The board shall adopt, promulgate and enforce rules
        and regulations consistent with the provisions of this act
        establishing requirements of continuing education to be met
        by individuals holding [certification] licensure as
        respiratory [care practitioners] therapists under this act as
        a condition [for certificate] of biennial license renewal.
        The regulations shall include any fees necessary for the
        board to carry out its responsibilities under this section.
            (2)  Beginning with the [license period designated by
        regulation, certificate] first biennial license renewal
        period following promulgation of regulations, license holders
        shall be required to attend and complete [20] 30 hours of
        mandatory continuing education during each two-year
        [certificate] license period. At least one credit hour shall
        be in ethics, and one credit hour shall be in patient safety.
            (3)  An individual applying for the first time for
        [certification] licensure in this Commonwealth shall be
        exempted from the continuing education requirement for the
        biennial renewal period [following initial certification] in
        which licensure is obtained.
            (4)  [The board may waive all or a portion of the
        continuing education requirement for biennial renewal for a
        certificate holder who shows to the satisfaction of the board
        that he or she was unable to complete the requirements due to
        serious illness, military service or other demonstrated
        hardship. The request shall be made in writing, with
        appropriate documentation, and shall include a description of
        circumstances sufficient to show why the certificate holder
        is unable to comply with the continuing education
        requirement. Waiver requests shall be evaluated by the board
        on a case-by-case basis. The board shall send the certificate
        holder written notification of its approval or denial of a
        waiver request.] The board shall, by regulation, provide for
        the waiver of continuing education requirements in case of
        illness, hardship and armed services duties. A request for
        waiver shall be evaluated on a case-by-case basis.
            (5)  A [certificate holder] licensee seeking to reinstate
        an inactive or lapsed [certificate] license shall show proof
        of compliance with the continuing education requirement for
        the preceding biennium.
            (6)  All courses, locations, instructors and providers
        shall be approved by the board. No credit shall be given for
        any course in office management or practice building.
            [(7)  The board shall initiate the promulgation of
        regulations to carry out the provisions of this section
        within one year of the effective date of this section.]
        Section 8.  (a)  The State Board of Osteopathic Medicine and
     the State Board of Medicine shall jointly promulgate regulations
     to implement the amendment or addition of sections 2, 3(a) and
     (b), 8.1, 13.1 and 36.1 of the act within 18 months of the
     effective date of this section.
        (b)  The State Board of Medicine, the Department of Public
     Welfare and the Department of Health shall promulgate
     regulations to implement the addition of section 13(c.1) and
     (c.2) of the act within 18 months of the effective date of this
     section.
        Section 9.  The following acts and parts of acts are repealed
     insofar as they are inconsistent with the addition of section
     13(c.1) and (c.2) of the act:
            (1)  Section 9(a) of the act of October 10, 1975
        (P.L.383, No.110), known as the Physical Therapy Practice
        Act.
            (2)  Section 14 of the act of June 15, 1982 (P.L.502,
        No.140), known as the Occupational Therapy Practice Act.
        Section 10.  This act shall take effect as follows:
            (1)  This section shall take effect immediately.
            (2)  Section 8 of this act shall take effect immediately.
            (3)  The remainder of this act shall take effect in 60
        days.

     APPROVED--The 4th day of July, A. D. 2008.

     EDWARD G. RENDELL