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TO AMEND SECTIONS 40-47-940, 40-47-945, 40-47-950, 40-47-955, 40-47-965, 40-47-970, 40-47-1015, CODE OF LAWS OF SOUTH CAROLINA, 1976, ALL RELATING TO THE SOUTH CAROLINA PHYSICIAN ASSISTANTS PRACTICE ACT, SO AS TO UPDATE AND CLARIFY THE PROCEDURE FOR ISSUANCE OF AUTHORIZATION TO PRACTICE AND FOR CHANGE IN SUPERVISING PHYSICIAN; TO CLARIFY THE PERMANENT LICENSURE FOR PHYSICIAN ASSISTANTS AND CLARIFY APPEARANCES IN THE APPLICATION PROCESS; TO CLARIFY THE LIMITED LICENSURE FOR PHYSICIAN ASSISTANTS AND CLARIFY APPEARANCES IN THE APPLICATION PROCESS; TO CLARIFY SUPERVISION RESPONSIBILITIES WHEN A PHYSICIAN ASSISTANT AND A PHYSICIAN PRACTICE AT THE SAME LOCATION; TO CLARIFY THE REQUIREMENTS FOR OFF-SITE PRACTICE; TO PROVIDE THAT PATIENT CHARTS FOR PATIENTS SEEN BY A PHYSICIAN ASSISTANT IN A SUPERVISOR'S ABSENCE MUST BE REVIEWED BY THE SUPERVISING PHYSICIAN OR ALTERNATE WITHIN FIVE WORKING DAYS AND TO PROVIDE AN EXCEPTION; TO PROVIDE LIMITED CONTROLLED SUBSTANCE PRESCRIPTIVE AUTHORITY; TO CLARIFY THAT THE PHYSICIAN ASSISTANT PRACTICE IS LIMITED TO THE SUPERVISING PHYSICIAN'S SCOPE OF PRACTICE; TO PROVIDE REFERENCES; TO CHANGE CERTAIN REFERENCES FROM BOARD TO COMMITTEE; AND TO PROVIDE THAT MONETARY FEES MAY BE DECREASED OR INCREASED BIENNIALLY FOR PHYSICIAN ASSISTANTS.
Be it enacted by the General Assembly of the State of South Carolina:
SECTION 1. Section 40-47-940 of the 1976 Code, as added by Act 359 of 2000, is amended to read:
"Section 40-47-940. (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 may be approved and must be accompanied by a nonrefundable fee. As part of the application process, if the applicant intends to begin practice immediately upon issuance of a license, the supervising physician and physician assistant must clearly 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. If a practice is not to begin immediately upon issuance of a license, scope of practice guidelines must be submitted to the administrative staff at the time the licensee files notice of practice.
(B) When the administrative staff of the board has reviewed the entire application for completeness and correctness, and has found the applicant eligible, and the supervising physician and physician assistant have appeared before the committee or a designated board member or change of supervising physician appropriate, a temporary license may be issued immediately or a change of supervising physician approved immediately. At the next committee meeting the entire application, including scope of practice guidelines, must be considered and, if qualified acceptable, the committee may recommend be recommended to the board that a permanent license be issued to the physician assistant for approval as presented to or modified by the committee. If the committee, board member, or board designee declines to recommend issuance of a permanent license approval of an application or scope of practice guidelines, the committee may extend or withdraw the temporary license authorization pending final decision by the board."
SECTION 2. Section 40-47-945 of the 1976 Code, as added by Act 359 of 2000, is amended to read:
"Section 40-47-945. (A) Except as otherwise provided in this article, an individual must 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 Commission on Accredited Allied Health Education Programs Accreditation Review Commission on Education for the Physician Assistant or its predecessor or its successor organization;
(4) successfully completed the NCCPA certifying examination and provide documentation that he or she the applicant possesses a current, active, NCCPA certificate;
(5) certified that he or she 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 any other information the board considers necessary to evaluate the applicant's qualifications; and
(9) appeared before a board member with his or her supervising physician and all original diplomas and certificates and demonstrated knowledge of the contents of this article;
(10) successfully completed an examination administered by the committee on the statutes and regulations regarding physician assistant practice and supervision.
(B) Not later than thirty days from the date a permanent license was issued or practice was begun with a supervising physician, each licensee shall appear before a board member or board designee with the licensee'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."
SECTION 3. Section 40-47-950 of the 1976 Code, as added by Act 359 of 2000, 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 American Medical Association Counsel on Medical Education 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 he or she is 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 with his or her supervising physician and all original diplomas and certificates and demonstrated knowledge of the contents of this article;
(10) successfully completed an examination administered by the committee on the statutes and regulations regarding physician assistant practice and supervision.
(B) Not later than thirty days from the date a permanent license was issued or practice was begun with a supervising physician, each licensee shall appear before a board member or board designee with the licensee'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.
(C) 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 is immediately is void and the applicant is no longer eligible to apply for further limited licensure.
(C)(D) The supervising physician of a limited licensee must be physically must be present on the premises at all times when the limited licensee is performing any a task. No on-the-job training, or task not listed on the application, may be approved for a limited license holder."
SECTION 4. Section 40-47-955 of the 1976 Code, as added by Act 359 of 2000, 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. All Medical acts, tasks, or functions must be defined in approved written guidelines which must be appropriate to the physician assistant's ability and knowledge.
(B) The supervising physician or alternate supervising physician must be physically must be present at least seventy-five percent of the time each month the physician assistant is providing services at the same location as the physician or alternate supervising physician. A physician assistant must have six months' clinical experience with the current supervising physician before being permitted to practice in the absence of the supervising physician. The physician assistant may not provide services in the absence of his or her the supervising physician or alternate supervising physician for a period not to exceed more than seven consecutive days each month without the prior written permission approval from the board. The physician assistant may provide services in the absence of the supervising physician or alternate supervising physician for a period of up to fourteen consecutive days in a two month period in which the supervising physician or alternate supervising physician is present at least seventy-five percent of the time.
(C) A physician assistant may not practice at any location 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 this State in the same specialty will be permitted to practice at a location off-site from the supervising physician after three months clinical experience and upon request of the supervising physician. This 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 miles or sixty minutes travel time from the supervising physician or alternate supervising physician without written approval of the board. The supervising physician or alternate supervising physician physically must be 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 department before off-site practice may be authorized. The supervising physician or alternate must review, initial, and date the off-site physician assistant's charts within seventy-two hours of patients seen by the physician assistant when the supervising physician or alternate was not present at the practice site not later than five working days from the date of service if not sooner as proportionate to the acuity of care and practice setting.
(D) A supervising physician may not supervise more than two physician assistants.
(D)(E) Upon written request, and recommendation of the committee, the board may authorize exceptions to the requirements of this section."
SECTION 5. Section 40-47-965 of the 1976 Code, as added by Act 359 of 2000, is amended to read:
"Section 40-47-965. (A) If the written scope of practice guidelines authorize 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 pre-printed on the form 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 Schedules Schedule II through IV, and may distribute professional samples to patients in compliance with appropriate federal and state regulations and the written scope of practice guidelines.
(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 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, supervising physician and the alternate 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 or alternate 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.
(B)(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 6. Section 40-47-970 of the 1976 Code, as added by Act 359 of 2000, is amended to read:
"Section 40-47-970. A physician assistant may not:
(1) perform a medical act, task, or function which has not been listed and approved on the scope of practice guidelines currently on file with the board;
(2) prescribe drugs, medications, or devices not specifically authorized by the supervising physician and documented in the written scope of practice guidelines;
(3) prescribe, under any circumstances, controlled substances in Schedules Schedule II through IV;
(4) perform a medical act, task, or function that is outside the scope of practice of the supervising physician."
SECTION 7. Section 40-47-1015 of the 1976 Code, as added by Act 359 of 2000, is amended to read:
"Section 40-47-1015. (A) Fees for physician assistant licensure are established as follows:
(1) initial licensing fee, not to exceed five hundred dollars;
(2) renewal of license fee, not to exceed one hundred and fifty dollars;
(3) late renewal fee, not to exceed the renewal fee doubled;
(4) reactivation application fee, not to exceed two hundred dollars;
(5) change in supervisor fee, not to exceed one hundred and fifty dollars;
(6) additional primary supervisor for dual employment fee, not to exceed one hundred and fifty dollars.
(B) Fees may be adjusted biennially pursuant to Section 40-1-50 to ensure that they are sufficient but not excessive to cover expenses including the total of the direct and indirect costs to the State for the operations of the board committee."
SECTION 8. This act takes effect upon approval by the Governor.
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