Reference is to the bill as introduced.
Amend the bill, as and if amended, by deleting all after the enacting words and inserting:
/ SECTION 1. Article 7, Chapter 47, Title 40 of the 1976 Code is amended by adding:
"Section 40-47-938.
(A) A physician currently possessing
an active, unrestricted permanent license to practice medicine
under the provisions of this chapter, who accepts the
responsibility to supervise a physician assistant's activities,
must enter into a supervisory relationship with a physician
assistant licensed pursuant to this article, subject to approval
of a scope of practice guidelines by the board. The physician
must notify the board, in writing, of the proposed supervisory
relationship and include the proposed scope of practice
guidelines for the relationship. Upon receipt of board
approval, the physician assistant may begin clinical practice
with the named supervising physician and alternate physicians.
(B) A supervising
physician may determine that there are additional medical acts,
tasks, or functions for which a physician assistant under his
supervision needs additional training or education to meet the
needs of the physician's practice and that the physician would
like to incorporate into the physician assistant's scope of
practice guidelines. The physician must determine, in
consultation with the physician assistant, the means of
educating the physician assistant, which may include training
under the direct supervision of the physician, education or
certification of proposed practices, or other appropriate
educational methods. The physician must notify the board in
writing of the requested changes to the physician assistant's
scope of practice guidelines and must provide documentation to
the board of the competence of the physician assistant to
perform the additional medical acts, tasks, or functions. Upon
receipt of board approval of the requested changes, the
physician assistant may incorporate such additional medical
acts, tasks, or functions into practice.
(C) The board shall
review and determine whether to approve these proposed scope of
practice guidelines or requested changes to the scope of
practice guidelines within ten business days after receipt of
notice from the supervising physician as required by subsections
(A) and (B) of this section. If the board needs additional
information or clarification, a physician member of the board
must contact the supervisory physician within ten business days
of receipt of the physician's notice. If the board requests
additional information or clarification to consider approval of
scope of practice guidelines or changes to these guidelines, it
must be provided by the supervising physician in a timely manner
and, upon receipt, a determination regarding approval must be
made within ten business days."
SECTION 2. Section 40-47-910 of the 1976 Code is amended to read:
"Section 40-47-910.
As used in this article:
(1) 'Alternate
physician supervisor' or 'alternate supervising physician'"
means a South Carolina licensed physician currently possessing
an active, unrestricted permanent license to practice medicine
in South Carolina who accepts the responsibility to supervise a
physician assistant's activities in the absence of the
supervising physician and this physician is approved by the
physician supervisor in writing in the scope of practice
guidelines.
(2) 'Board' means the
Board of Medical Examiners of South Carolina.
(3) 'Committee' means
the Physician Assistant Committee as established by this article
as an advisory committee responsible to the board.
(4)
'Immediate consultation' means a supervising physician
must be available for direct communication, telephone, or other
means of telecommunication.
(45)
'NCCPA' means the National Commission on
Certification of Physician Assistants, Inc., the agency
recognized to examine and evaluate the education of physician
assistants, or its successor organization as recognized by the
board.
(56)
'Physician assistant' means a health care professional
licensed to assist in the practice of medicine with a physician
supervisor.
(67)
'Physician supervisor or supervising physician' means a
South Carolina licensed physician currently possessing an
active, unrestricted permanent license to practice medicine in
South Carolina who is approved to serve as a supervising
physician for no more than two three
full-time equivalent physician assistants. The physician
supervisor is the individual who is responsible for supervising
a physician assistant's activities.
(78)
'Supervising' means overseeing the activities of, and
accepting responsibility for, the medical services rendered by a
physician assistant as part of a physician-led team in a
manner approved by the board."
SECTION 3. Section 40-47-940(A) of the 1976 Code is amended to read:
"(A) An
application must be submitted to the board on forms supplied by
the board. The application must be complete in every detail
before it licensure may be
approved granted and must be accompanied
by a nonrefundable fee. As part of the application process, the
supervising physician and physician assistant must specify
clearly in detail those medical acts, tasks, or functions for
which approval is being sought. The specific medical acts,
tasks, or functions must be included in the scope of practice
guidelines, and the scope of practice guidelines must accompany
the application."
SECTION 4. Section 40-47-945 of the 1976 Code is amended to read:
"Section 40-47-945.
(A) Except as otherwise provided in
this article, an individual shall obtain a permanent license
from the board before the individual may practice as a physician
assistant. The board shall grant a permanent license as a
physician assistant to an applicant who has:
(1)
submitted a completed application on forms provided by the
board;
(2)
paid the nonrefundable application fees established in
this article;
(3)
successfully completed an educational program for
physician assistants approved by the Accreditation Review
Commission on Education for the Physician Assistant or its
predecessor or successor organization;
(4)
successfully completed the NCCPA certifying examination
and provide documentation that the applicant possesses a
current, active, NCCPA certificate;
(5)
certified that the applicant is mentally and physically
able to engage safely in practice as a physician assistant;
(6)
no licensure, certificate, or registration as a physician
assistant under current discipline, revocation, suspension,
probation, or investigation for cause resulting from the
applicant's practice as a physician assistant;
(7)
good moral character;
(8)
submitted to the board other information the board
considers necessary to evaluate the applicant's qualifications;
(9)
appeared before a board member or board designee with
the applicant's supervising physician and all
original diplomas and certificates and demonstrated knowledge of
the contents of this article. A temporary authorization to
practice may be issued as provided in Section 40-47-940 pending
completion of this requirement and subject to satisfactory
interview as provided below; and
(10)
successfully completed an examination administered by the
committee on the statutes and regulations regarding physician
assistant practice and supervision.
(B) Not later than
ninety days from the date a temporary authorization is issued,
each applicant shall appear before a board member or board
designee with the applicant's supervising physician and
scope of practice guidelines and demonstrate knowledge
of the contents of this article. Failure to appear within the
prescribed time automatically results in the immediate
invalidation of the authorization to practice pending compliance
and further order of the board. If approved, a permanent
license may be issued immediately. If not approved, the
application must be reviewed by the committee and may be
recommended to the board for approval as presented to or
modified by the committee.
(C) The supervising
physician of a limited licensee physically must be present on
the premises at all times when the limited licensee is
performing a task. No on-the-job training or task not
listed on the application may be approved for a limited license
holder."
SECTION 5. Section 40-47-950 of the 1976 Code is amended to read:
"Section 40-47-950.
(A) The board may issue a limited
physician assistant license to an applicant who has:
(1)
submitted a completed application on forms provided by the
board;
(2)
paid the nonrefundable application fees established by
this regulation;
(3)
successfully completed an educational program for
physician assistants approved by the Accreditation Review
Commission on Education for the Physician Assistant or its
predecessor or successor organization;
(4)
never previously failed two consecutive NCCPA certifying
examinations and has registered for, or intends to register to
take the next offering of, the NCCPA examination;
(5)
certified that the applicant mentally and physically is
able to engage safely in practice as a physician assistant;
(6)
no licensure, certificate, or registration as a physician
assistant under current discipline, revocation, suspension,
probation, or investigation for cause resulting from the
applicant's practice as a physician assistant;
(7)
good moral character;
(8)
submitted to the board any other information the board
considers necessary to evaluate the applicant's qualifications;
(9)
appeared before a board member or board designee with
the applicant's supervising physician and all
original diplomas and certificates and demonstrated knowledge of
the contents of this article; and
(10)
successfully completed an examination administered by the
committee on the statutes and regulations regarding physician
assistant practice and supervision.
(B) A limited license
is not renewable and is valid only until the results of a
limited licensee's two consecutive NCCPA certifying examinations
are reported to the board. When a limited licensee has failed
two consecutive NCCPA certifying examinations, or fails one exam
and does not take the NCCPA certifying examination at the next
opportunity or, after applying for a limited license, fails to
register for the next offering of the examination, the limited
license immediately is void and the applicant is no longer
eligible to apply for further limited licensure.
(C) The supervising
physician of a limited licensee physically must be present on
the premises at all times when the limited licensee is
performing a task. No on-the-job training, or task not
listed on the application, may be approved for a limited license
holder."
SECTION 6. Section 40-47-955 of the 1976 Code is amended to read:
"Section 40-47-955.
(A) The supervising physician is
responsible for all aspects of the physician assistant's
practice. Supervision must be continuous but must not be
construed as necessarily requiring the physical presence of the
supervising physician at the time and place where the services
are rendered, except as otherwise required for limited
licensees. The supervising physician shall identify the
physician assistant's scope of practice and determine the
delegation of medical acts, tasks, or functions. Medical acts,
tasks, or functions must be defined in approved
written scope of practice guidelines which must be
appropriate to the physician assistant's ability and knowledge.
(B) In an
on-site practice setting, the supervising physician or alternate
supervising physician physically must be present at the same
location as the physician assistant at least seventy-five
percent of the time each month the physician assistant is
providing services at the same location as the supervising
physician or alternate supervising physician. The physician
assistant may not provide services in the absence of the
supervising physician or alternate supervising physician for
more than seven consecutive days each month without the prior
written approval of the board. The board may grant in writing
exceptions to the seventy-five percent direct supervision
requirement provided for in this subsection Pursuant
to scope of practice guidelines, a physician assistant may
practice in a public place, a private place, or a facility where
the supervising physician regularly sees patients, may make
house calls, perform hospital duties, and perform any functions
performed by the supervising physician if the physician
assistant is also qualified to perform those functions.
(C) For
off-site practice, a A physician assistant must
have six months of clinical experience with the current
supervising physician before being permitted to practice at a
location off site from the supervising physician, except that a
physician assistant who has at least two years continuous
practice in South Carolina in the same
specialty will be permitted to may
practice at a location off site from the supervising physician
after three months clinical experience with the supervising
physician and upon request of the supervising physician. This
three-month requirement may be waived for experienced physician
assistants and supervisors upon recommendation of the committee
and approval by the board. The off-site location may not be
more than forty-five sixty miles
or sixty minutes of travel
time from the supervising physician or
alternate supervising physician without written approval of the
board. The supervising physician or alternate
supervising physician must be physically present at the off-site
location not less than twenty percent of the time each month the
physician assistant is providing services there.
Notice of off-site practice must be filed with the
administrative staff of the board before off-site practice may
be authorized. The supervising physician or alternate must
review, initial, and date the off-site physician assistant's
charts not later than five working days from the date of
service if not sooner as proportionate to the acuity of care and
practice setting periodically as provided in the
written scope of practice guidelines, provided he must review
and verify the adequacy of clinical practice of ten percent of
these charts monthly.
(D) A supervising
physician may not simultaneously
supervise no more than two three
physician assistants providing clinical service at one
time.
(E) Upon written
request, and recommendation of the committee, the board may
authorize exceptions to the requirements of this section."
SECTION 7. Section 40-47-960(7) of the 1976 Code is amended to read:
"(7) situations that require direct evaluation by or immediate referral to the physician, including Schedule II controlled substance prescription authorization as directed in Section 40-47-965."
SECTION 8. Section 40-47-965 of the 1976 Code is amended to read:
"(A) If the
written scope of practice guidelines authorizes the physician's
assistant to prescribe drug therapy:
(1)
prescriptions for authorized drugs and devices shall
comply with all applicable state and federal laws;
(2)
prescriptions must be limited to drugs and devices
authorized by the supervising physician and set forth in the
written scope of practice guidelines;
(3)
prescriptions must be signed by the physician assistant
and must bear the physician assistant's identification number as
assigned by the board and all prescribing numbers required by
law. The preprinted prescription form shall include both the
physician assistant's and physician's name, address, and phone
number and shall comply with the provisions of Section 39-24-40;
(4)
drugs or devices prescribed must be specifically
documented in the patient record;
(5)
the physician assistant may request, receive, and sign for
professional samples of drugs authorized in the written scope of
practice guidelines, except for controlled substances in
Schedule II, and may distribute professional samples to patients
in compliance with appropriate federal and state regulations and
the written scope of practice guidelines;
(6)
the physician assistant may authorize
prescriptions for an orally administered Schedule II controlled
substance, as defined in the federal Controlled Substances Act,
pursuant to the following requirements:
(a)
the authorization to prescribe is expressly
approved by the supervising physician as set forth in the
physician assistant's written scope of practice guidelines;
(b)
the physician assistant had directly evaluated
the patient;
(c)
the authority to prescribe is limited to an
initial prescription and must not exceed a seventy-two hour
supply;
(d)
any subsequent prescription authorization must
be in consultation with and upon patient examination and
evaluation by the supervising physician, and must be documented
in the patient's chart..
(7) the
physician assistant may authorize a medical order for parenteral
administration of a Schedule II controlled substance, as defined
in the federal Controlled Substances Act, pursuant to the
following requirements:
(a)
the authorization to write a medical order is
expressly approved by the supervising physician as set forth in
the physician assistant's written scope of practice
guidelines;
(b)
the physician assistant is providing patient
care in a hospital setting, including emergency and outpatient
departments affiliated with the hospital;
(c)
an initial patient examination and evaluation
has been performed by the supervising physician, or his delegate
physician, and has been documented in the patient's chart;
(d)
the physician assistant has directly evaluated
the patient; and
(e)
the written medical order may not exceed a
one-time administration within a twenty-four hour period.
(B) When applying for
controlled substance prescriptive authority, the applicant shall
comply with the following requirements:
(1)
the physician assistant shall provide evidence of
completion of sixty contact hours of education in
pharmacotherapeutics acceptable to the board before application;
(2)
the physician assistant shall provide at least fifteen
contact hours of education in controlled substances acceptable
to the board;
(3)
every two years, the physician assistant shall provide
documentation of four continuing education contact hours in
prescribing controlled substances acceptable to the board;
and
(4)
the physician assistant must have a valid Drug
Enforcement Administration (DEA) registration and prescribe in
accordance with DEA rules; and
(45) the
physician assistant and supervising physician must read and sign
a document approved by the board describing the management of
expanded controlled substances prescriptive authority for
physician assistants in South Carolina which must be kept on
file for review. Within the two-year period, the physician
assistant and the supervising physician periodically shall
review this document and the physician assistant's prescribing
practices to ensure proper prescribing procedures are followed.
This review must be documented in writing with a copy kept at
each practice site.
(C) A physician
assistant's prescriptive authorization may be terminated by the
board if the physician assistant:
(1)
practices outside the written scope of practice
guidelines;
(2)
violates any state or federal law or regulation applicable
to prescriptions; or
(3)
violates a state or federal law applicable to physician
assistants."
SECTION 9. Section 40-47-970(3) of the 1976 Code is amended to read:
"(3) prescribe,
under any circumstances, controlled substances in Schedule
II, except as authorized in Section 40-47-965;
or"
SECTION 10. Section 40-47-995 of the 1976 Code is amended to read:
"Section 40-47-995.
If the supervisory relationship between a physician
assistant and the supervising physician is terminated for any
reason, the physician assistant and the supervising physician
shall inform the board immediately in writing of the
termination, including the reasons for the termination. The
approval of the practice setting terminates coterminous with the
termination of the relationship, and practice shall cease until
a new application is scope
of practice guidelines are submitted by a supervising
physician and is approved by the board."
SECTION 11. Section 40-47-980 of the 1976 Code is repealed.
SECTION 12. This act takes effect upon approval by the Governor. /
Renumber sections to conform.
Amend title to conform.