BILL REQ. #:  H-0996.3 

Read first time 02/06/13.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to supervision of physician assistants; amending RCW 18.57A.030, 18.57A.040, 18.57A.080, and 18.71A.030; reenacting and amending RCW 18.71A.040; adding a new section to chapter 18.57A RCW; adding a new section to chapter 18.71A RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   The legislature finds that failure to review and approve delegation agreements in a timely manner is harmful to patient access to care. It is therefore the intent of the legislature that delegation agreements, found to be without issue, be processed in no more than one business week.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.57A RCW to read as follows:
     (1) No licensee may be utilized in a remote site without approval by the board or its designee. A "remote site" is defined as a setting physically separate from the sponsoring or supervising physician's primary place for meeting patients or a setting where the physician is present less than twenty-five percent of the practice time of the licensee.
     (2)(a) Approval by the commission or its designee may be granted to utilize a licensee in a remote site if:
     (i) There is a demonstrated need for the utilization;
     (ii) Adequate provision for timely communication between the primary or alternate physician and the licensee exists;
     (iii) The responsible sponsoring or supervising physician spends at least ten percent of the practice time of the licensee in the remote site unless the sponsoring physician demonstrates that adequate supervision is being maintained by an alternate method such as telecommunication.
     (b) The names of the sponsoring or supervising physician and the licensee must be prominently displayed at the entrance to the clinic or in the reception area.
     (3) No physician assistant holding an interim permit may be utilized in a remote site setting.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.71A RCW to read as follows:
     (1) No licensee may be utilized in a remote site without approval by the commission or its designee. A "remote site" is defined as a setting physically separate from the sponsoring or supervising physician's primary place for meeting patients or a setting where the physician is present less than twenty-five percent of the practice time of the licensee.
     (2)(a) Approval by the commission or its designee may be granted to utilize a licensee in a remote site if:
     (i) There is a demonstrated need for the utilization;
     (ii) Adequate provision for timely communication between the primary or alternate physician and the licensee exists;
     (iii) The responsible sponsoring or supervising physician spends at least ten percent of the practice time of the licensee in the remote site unless the sponsoring physician demonstrates that adequate supervision is being maintained by an alternate method such as telecommunication.
     (b) The names of the sponsoring or supervising physician and the licensee must be prominently displayed at the entrance to the clinic or in the reception area.
     (3) No physician assistant holding an interim permit may be utilized in a remote site setting.

Sec. 4   RCW 18.57A.030 and 1993 c 28 s 2 are each amended to read as follows:
     An osteopathic physician assistant as defined in this chapter may practice osteopathic medicine in this state only with the approval of the ((practice arrangement plan)) delegation agreement by the board and only to the extent permitted by the board. An osteopathic physician assistant who has received a license but who has not received board approval of the ((practice arrangement plan)) delegation agreement under RCW 18.57A.040 may not practice. An osteopathic physician assistant shall be subject to discipline by the board under the provisions of chapter 18.130 RCW.

Sec. 5   RCW 18.57A.040 and 1993 c 28 s 3 are each amended to read as follows:
     (1) No osteopathic physician assistant practicing in this state shall be employed or supervised by an osteopathic physician or physician group without the approval of the board.
     (2) Prior to commencing practice, an osteopathic physician assistant licensed in this state shall apply to the board for permission to be employed or supervised by an osteopathic physician or physician group. The ((practice arrangement plan)) delegation agreement shall be jointly submitted by the osteopathic physician or physician group and osteopathic physician assistant. The secretary may charge a fee as provided in RCW 43.70.250 to recover the cost for the plan review. The ((practice arrangement plan)) delegation agreement shall delineate the manner and extent to which the physician assistant would practice and be supervised. Whenever an osteopathic physician assistant is practicing in a manner inconsistent with the approved ((practice arrangement plan)) delegation agreement, the board may take disciplinary action under chapter 18.130 RCW.
     (3) An osteopathic physician may enter into practice arrangement plans with five physician assistants, but may petition the board for a waiver of this limit. However, no osteopathic physician may have under his or her supervision more physician assistants than the osteopathic physician can adequately supervise.

Sec. 6   RCW 18.57A.080 and 2007 c 264 s 2 are each amended to read as follows:
     An osteopathic physician(('s)) assistant may sign and attest to any certificates, cards, forms, or other required documentation that the osteopathic physician(('s)) assistant's supervising osteopathic physician or osteopathic physician group may sign, provided that it is within the osteopathic physician(('s)) assistant's scope of practice and is consistent with the terms of the osteopathic physician(('s)) assistant's ((practice arrangement plan)) delegation agreement as required by this chapter.

Sec. 7   RCW 18.71A.030 and 1994 sp.s. c 9 s 320 are each amended to read as follows:
     A physician assistant may practice medicine in this state only with the approval of the ((practice arrangement plan)) delegation agreement by the commission and only to the extent permitted by the commission. A physician assistant who has received a license but who has not received commission approval of the ((practice arrangement plan)) delegation agreement under RCW 18.71A.040 may not practice. A physician assistant shall be subject to discipline under chapter 18.130 RCW.

Sec. 8   RCW 18.71A.040 and 1996 c 191 s 58 and 1996 c 191 s 40 are each reenacted and amended to read as follows:
     (1) No physician assistant practicing in this state shall be employed or supervised by a physician or physician group without the approval of the commission.
     (2) Prior to commencing practice, a physician assistant licensed in this state shall apply to the commission for permission to be employed or supervised by a physician or physician group. The ((practice arrangement plan)) delegation agreement shall be jointly submitted by the physician or physician group and physician assistant. Administrative procedures, administrative requirements, and fees shall be established as provided in RCW 43.70.250 and 43.70.280. The ((practice arrangement plan)) delegation agreement shall delineate the manner and extent to which the physician assistant would practice and be supervised. Whenever a physician assistant is practicing in a manner inconsistent with the approved ((practice arrangement plan)) delegation agreement, the commission may take disciplinary action under chapter 18.130 RCW.
     (3) A physician may enter into practice arrangement plans with five physician assistants, but may petition the commission for a waiver of this limit. However, no physician may have under his or her supervision more physician assistants than the physician can adequately supervise.