Substitute House Bill No. 5962
Substitute House Bill No. 5962
PUBLIC ACT NO. 95-74
AN ACT CONCERNING PHYSICIAN ASSISTANT TRAINING
PERMITS AND REIMBURSEMENT.
Section 1. Section 20-12a of the general
statutes is repealed and the following is
substituted in lieu thereof:
As used in sections 20-12a to 20-12g,
inclusive:
(1) "Accredited physician assistant program"
means a physician assistant program accredited, AT
THE TIME OF THE APPLICANT'S GRADUATION, by the
Committee on Allied Health Education and
Accreditation of the American Medical Association,
THE COMMISSION ON ACCREDITATION OF ALLIED HEALTH
EDUCATION PROGRAMS OR SUCH SUCCESSOR ORGANIZATION
FOR THE ACCREDITATION OF PHYSICIAN ASSISTANT
PROGRAMS AS MAY BE APPROVED BY THE DEPARTMENT.
(2) "Board" means the Connecticut Medical
Examining Board, established pursuant to section
20-8a.
(3) "Department" means the department of
public health and addiction services.
(4) "National commission" means the National
Commission on Certification of Physician
Assistants or a successor organization for the
certification or recertification of physician
assistants that may be approved by the department.
(5) "Physician assistant" means an individual
functioning in a dependent relationship with a
physician and licensed pursuant to section 20-12b,
AS AMENDED BY SECTION 3 OF THIS ACT, to provide
patient services under the supervision, control,
responsibility and direction of a physician
licensed in accordance with the provisions of this
chapter.
(6) "Supervising physician" means a physician
licensed pursuant to this chapter who is
registered with the department pursuant to section
20-12c, AS AMENDED BY SECTION 4 OF THIS ACT, and
who assumes responsibility for the supervision of
services rendered by a physician assistant.
(7) "Supervision" means the exercise by the
supervising physician of oversight, control and
direction of the services of a physician
assistant. Supervision includes but is not limited
to: (A) Continuous availability of direct
communication either in person or by radio,
telephone or telecommunications between the
physician assistant and the supervising physician;
(B) active and continuing overview of the
physician assistant's activities to ensure that
the SUPERVISING physician's directions are being
implemented and to support the physician assistant
in the performance of his services; (C) personal
review by the supervising physician of the
physician assistant's practice at least weekly or
more frequently as necessary to ensure quality
patient care; (D) review of the charts and records
of the physician assistant on a regular basis as
necessary to ensure quality patient care; (E)
delineation of a predetermined plan for emergency
situations; and (F) designation of an alternate
licensed physician in the absence of the
supervising physician.
Sec. 2. (NEW) No person shall participate in a
resident physician assistant program until he has
received a license or temporary permit issued
pursuant to section 20-12b of the general
statutes, as amended by section 3 of this act, or
a training permit issued by the department. The
training permit shall be issued solely for
purposes of participation in postgraduate
education as a resident physician assistant in a
short-term hospital, as defined in the regulations
of Connecticut state agencies and licensed
pursuant to subsection (a) of section 19a-491 of
the general statutes, that provides a postgraduate
medical education program accredited by the
accreditation council for graduate medical
education. No person shall receive a training
permit until a statement has been filed with the
department on his behalf by the hospital
administrator certifying that he is to be
appointed a resident physician assistant in such
hospital and that he has satisfied the
requirements of subdivisions (1), (2) and (5) of
subsection (a) of section 20-12b of the general
statutes, as amended by section 3 of this act.
Such training permit shall authorize the holder to
participate in clinical educational activities
only when the supervising physician is physically
present on the premises and is immediately
available to the physician assistant when needed,
but shall not authorize the holder to prescribe or
dispense drugs.
Sec. 3. Section 20-12b of the general
statutes is repealed and the following is
substituted in lieu thereof:
(a) The department may, upon receipt of a fee
of one hundred fifty dollars, issue a physician
assistant license to an applicant who: (1) Holds a
baccalaureate or higher degree in any field from a
regionally accredited institution of higher
education; (2) has graduated from an accredited
physician assistant program; (3) has passed the
certification examination of the national
commission; (4) has satisfied the mandatory
continuing medical education requirements of the
national commission for current certification by
such commission and has passed any examination or
continued competency assessment the passage of
which may be required by the national commission
for maintenance of current certification by such
commission; and (5) has completed not less than
sixty hours of didactic instruction in
pharmacology for physician assistant practice
approved by the department.
[(b) The department may, upon receipt of a
fee of one hundred fifty dollars, issue a
physician assistant license to an applicant who:
(1) Passed the certification examination of the
national commission not later than December 31,
1982; and either (2) has been employed since
December 31, 1985, as a physician assistant in
Connecticut, with no lapse of such employment of
longer than twelve consecutive months or (3) has
been employed in Connecticut since not later than
January 1, 1991, and has been employed for at
least eighteen years as a physician assistant with
no lapse of such employment of longer than twelve
months and not less than ten years of such
employment were in Connecticut. Such license shall
become void March 1, 1992, or in the case of a
license issued under the criteria set forth in
subdivision (3) of this subsection, March 1, 1994,
unless such applicant, on or before such date (A)
has satisfied the mandatory continuing medical
education requirements of the national commission
for current certification by said commission and
has passed any examination or continued competency
assessment the passage of which may be required by
the national commission for maintenance of current
certification by said commission; and (B) has
completed not less than sixty hours of didactic
instruction in pharmacology for physician
assistant practice approved by the department.
(c) The department may, upon receipt of a fee
of one hundred fifty dollars, issue a physician
assistant license to an applicant who: (1) Has
graduated from an accredited physician assistant
program; (2) has passed the certification
examination of the national commission; (3) has
satisfied the mandatory continuing medical
education requirements of the national commission
for current certification by said commission and
has passed any examination or continued competency
assessment the passage of which may be required by
the national commission for maintenance of current
certification by said commission; (4) has
completed not less than sixty hours of didactic
instruction in pharmacology for physician
assistant practice approved by the department; (5)
resides in Connecticut at the time of application
for licensure; and (6) has applied and been found
eligible for such licensure not later than October
1, 1993.]
[(d)] (b) The department may, upon receipt of
a fee of seventy-five dollars, issue a temporary
permit to an applicant who (1) is a graduate of an
accredited physician assistant program; (2) has
completed not less than sixty hours of didactic
instruction in pharmacology for physician
assistant practice approved by the department; and
(3) if applying for such permit on and after
September 30, 1991, holds a baccalaureate or
higher degree in any field from a regionally
accredited institution of higher education. Such
temporary permit shall authorize the holder to
practice as a physician assistant only in those
settings where the supervising physician is
physically present on the premises and is
immediately available to the physician assistant
when needed, but shall not authorize the holder to
prescribe or dispense drugs. Such temporary permit
shall be valid from the date of issuance of same
until the date of issuance of the results of the
first certification examination scheduled by the
national commission following the applicant's
graduation from an accredited physician assistant
program. Such permit shall become void and shall
not be reissued in the event that the applicant
fails to pass such examination. Violation of the
restrictions on practice set forth in this
subsection may constitute a basis for denial of
licensure as a physician assistant.
[(e)] (c) No license or temporary permit
shall be issued under this section to any
applicant against whom professional disciplinary
action is pending or who is the subject of an
unresolved complaint.
[(f)] (d) No person shall practice as a
physician assistant or represent himself as a
physician assistant unless he holds a license or
temporary permit pursuant to this section OR
TRAINING PERMIT ISSUED PURSUANT SECTION 2 OF THIS
ACT.
Sec. 4. Section 20-12c of the general
statutes is repealed and the following is
substituted in lieu thereof:
(a) Each physician assistant practicing in
this state OR PARTICIPATING IN A RESIDENT
PHYSICIAN ASSISTANT PROGRAM shall have a clearly
identified supervising physician who maintains the
final responsibility for the care of patients and
the performance of the physician assistant. No
physician assistant issued a license or temporary
permit by the department shall practice until such
time as a supervising physician has been
registered with the department. An individual may
register with the department as a supervising
physician provided he: (1) Possesses a current
unrestricted license to practice medicine issued
pursuant to this chapter or chapter 371; and (2)
has submitted a completed application, on such
forms as the department may require, with a fee of
thirty-seven dollars and fifty cents. No physician
shall function as a supervising physician unless
so registered with the department. THE DEPARTMENT
SHALL NOT REGISTER ANY APPLICANT AGAINST WHOM
PROFESSIONAL DISCIPLINARY ACTION IS PENDING OR WHO
IS THE SUBJECT OF AN UNRESOLVED COMPLAINT IN THIS
OR ANY OTHER STATE OR TERRITORY.
(b) No physician shall function as a
supervising physician for more than two physician
assistants concurrently, unless such physician
assistants are directly employed as staff of an
institution licensed as a hospital pursuant to
subsection (a) of section 19a-491 OR ARE
PARTICIPATING IN A RESIDENT PHYSICIAN ASSISTANT
PROGRAM.
(c) Nothing in this chapter shall be
construed to prohibit the employment of physician
assistants in a hospital or other health care
facility where such physician assistants function
under the direction of a supervising physician.
(d) A supervising physician shall notify the
department in writing within thirty days of
termination of a physician-physician assistant
supervisory relationship. Nothing in this
subsection shall relieve a supervising physician
of his responsibility to report pursuant to
section 20-12e, AS AMENDED BY SECTION 5 OF THIS
ACT.
Sec. 5. Subsection (b) of section 20-12e of
the general statutes is repealed and the following
is substituted in lieu thereof:
(b) Any health care facility licensed
pursuant to subsection (a) of section 19a-491
which terminates or restricts the staff membership
or privileges of any physician assistant OR HOLDER
OF A PERMIT ISSUED PURSUANT TO SECTION 2 OF THIS
ACT OR SUBSECTION (b) OF SECTION 20-12b, AS
AMENDED BY SECTION 3 OF THIS ACT, shall, not later
than fifteen days after the effective date of such
action, notify the department of such action.
Sec. 6. Section 20-12f of the general
statutes is repealed and the following is
substituted in lieu thereof:
The board shall have jurisdiction to hear all
charges of conduct which fails to conform to the
accepted standards of the physician assistant
profession brought against persons licensed to
practice as a physician assistant OR HOLDING ANY
PERMIT ISSUED PURSUANT TO SECTION 2 OF THIS ACT OR
SUBSECTION (b) OF SECTION 20-12b, AS AMENDED BY
SECTION 3 OF THIS ACT. The board may take any
action set forth in section 19a-17 if it finds
that a person licensed as a physician assistant OR
HOLDING A PERMIT ISSUED PURSUANT TO SECTION 2 OF
THIS ACT OR SUBSECTION (b) OF SECTION 20-12b, AS
AMENDED BY SECTION 3 OF THIS ACT, fails to conform
to the accepted standards of the physician
assistant profession. Conduct which fails to
conform to the accepted standards of the physician
assistant profession includes, but is not limited
to, the following: Conviction of a felony; fraud
or deceit in professional practice; illegal
conduct; negligent, incompetent or wrongful
conduct in professional activities; emotional
disorder or mental illness; physical illness
including, but not limited to, deterioration
through the aging process; abuse or excessive use
of drugs, including alcohol, narcotics or
chemicals; wilful falsification of entries into
any patient record; possession, use, prescription
for use, or distribution of controlled substances
or legend drugs, except for therapeutic or other
medically proper purposes; misrepresentation or
concealment of a material fact in the obtaining or
reinstatement of a physician assistant license OR
PERMIT; or violation of any provisions of this
chapter and section 21a-252. The commissioner may
order a license OR PERMIT holder to submit to a
reasonable physical or mental examination if his
physical or mental capacity to practice safely is
the subject of an investigation. The commissioner
may petition the superior court for the judicial
district of Hartford-New Britain* to enforce such
order or any action taken pursuant to section
19a-17. Notice of any contemplated action under
said section, the cause of the action and the date
of a hearing on the action shall be given and an
opportunity for hearing afforded in accordance
with the provisions of chapter 54.
Sec. 7. Section 38a-499 of the general
statutes is repealed and the following is
substituted in lieu thereof:
(a) For the purposes of this section:
(1) "Certified nurse practitioner" means any
registered nurse licensed under chapter 378 who
has completed a formal educational nurse
practitioner program and is certified by the
American Nurses' Association, the National Board
of Pediatric Nurse Practitioners and Associates or
the Nurses' Association of the American College of
Obstetricians and Gynecologists;
(2) "Certified psychiatric-mental health
clinical nurse specialist" means any registered
nurse licensed under chapter 378 who has completed
a formal educational program as a
psychiatric-mental health clinical nurse
specialist and is certified by the American
Nurses' Association;
(3) "Certified nurse-midwife" means any
individual certified as nurse-midwife pursuant to
sections 20-86a to 20-86e, inclusive;
(4) "PHYSICIAN ASSISTANT" MEANS AN INDIVIDUAL
LICENSED PURSUANT TO SECTION 20-12b, AS AMENDED BY
SECTION 3 OF THIS ACT.
(b) Every individual health insurance policy
providing coverage of the type specified in
subdivisions (1), (2), (4), (6), (10), (11) and
(12) of section 38a-469 delivered, issued for
delivery or renewed in this state on or after
October 1, 1984, shall provide coverage for the
services of PHYSICIAN ASSISTANTS, certified nurse
practitioners, certified psychiatric-mental health
clinical nurse specialists and certified
nurse-midwives if such services are within the
individual's area of professional competence as
established by education and LICENSURE OR
certification and are currently reimbursed when
rendered by any other licensed health care
provider. Subject to the provisions of chapter 378
and sections 20-86a to 20-86e, inclusive, no
insurer, hospital or medical service corporation
or health care center may require signature,
referral or employment by any other health care
provider as a condition of reimbursement, provided
no insurer, hospital or medical service
corporation or health care center may be required
to pay for duplicative services actually rendered
by both A PHYSICIAN ASSISTANT OR a certified
registered nurse and any other health care
provider. The payment of such benefits shall be
subject to any policy provisions which apply to
other licensed health practitioners providing the
same services. Nothing in this section may be
construed as permitting (1) any registered nurse
to perform or provide services beyond the scope of
practice permitted in chapter 378 and sections
20-86a to 20-86e, inclusive, OR (2) ANY PHYSICIAN
ASSISTANT TO PERFORM OR PROVIDE SERVICES BEYOND
THE SCOPE OF PRACTICE PERMITTED IN CHAPTER 370.
Sec. 8. Section 38a-526 of the general
statutes is repealed and the following is
substituted in lieu thereof:
(a) For the purposes of this section:
(1) "Certified nurse practitioner" means any
registered nurse licensed under chapter 378 who
has completed a formal educational nurse
practitioner program and is certified by the
American Nurses' Association, the National Board
of Pediatric Nurse Practitioners and Associates or
the Nurses' Association of the American College of
Obstetricians and Gynecologists;
(2) "Certified psychiatric-mental health
clinical nurse specialist" means any registered
nurse licensed under chapter 378 who has completed
a formal educational program as a
psychiatric-mental health clinical nurse
specialist and is certified by the American
Nurses' Association;
(3) "Certified nurse-midwife" means any
individual certified as nurse-midwife pursuant to
sections 20-86a to 20-86e, inclusive;
(4) "PHYSICIAN ASSISTANT" MEANS AN INDIVIDUAL
LICENSED PURSUANT TO SECTION 20-12b, AS AMENDED BY
SECTION 3 OF THIS ACT.
(b) Each group health insurance policy
providing coverage of the type specified in
subdivisions (1), (2), (4), (6), (11) and (12) of
section 38a-469 delivered, issued for delivery or
renewed in this state on or after October 1, 1984,
shall provide coverage for the services of
PHYSICIANS' ASSISTANTS, certified nurse
practitioners, certified psychiatric-mental health
clinical nurse specialists and certified
nurse-midwives if such services are within the
individual's area of professional competence as
established by education and LICENSURE OR
certification and are currently reimbursed when
rendered by any other licensed health care
provider. Subject to the provisions of chapter 378
and sections 20-86a to 20-86e, inclusive, no
insurer, hospital or medical service corporation
or health care center may require signature,
referral or employment by any other health care
provider as a condition of reimbursement, provided
no insurer, hospital or medical service
corporation or health care center may be required
to pay for duplicative services actually rendered
by both A PHYSICIAN ASSISTANT OR a certified
registered nurse and any other health care
provider. The payment of such benefits shall be
subject to any policy provisions which apply to
other licensed health practitioners providing the
same services. Nothing in this section may be
construed as permitting (1) any registered nurse
to perform or provide services beyond the scope of
practice permitted in chapter 378 and sections
20-86a to 20-86e, inclusive, OR (2) ANY PHYSICIAN
ASSISTANT TO PERFORM OR PROVIDE SERVICES BEYOND
THE SCOPE OF PRACTICE PERMITTED IN CHAPTER 370.
Sec. 9. This act shall take effect July 1,
1995.