SB184: Bill Text

2021 Senate BILL 184

March 9, 2021 - Introduced by Senators Bernier, Ballweg, Bewley, Carpenter, Cowles, Darling, Felzkowski, Jacque, Kooyenga, Pfaff, Ringhand, Stafsholt, Smith, Testin and Wimberger, cosponsored by Representatives VanderMeer, Anderson, Andraca, Armstrong, Baldeh, Considine, Dittrich, Doyle, Edming, Gundrum, Hong, James, Kerkman, Krug, Loudenbeck, Magnafici, Milroy, Moses, Mursau, Oldenburg, Ramthun, S. Rodriguez, Rozar, Sinicki, Skowronski, Spiros, Steffen, Stubbs, Summerfield, Tauchen, Tittl, Thiesfeldt, Vruwink and Spreitzer. Referred to Committee on Health.

SB184,2,6 An Act to repeal 15.407 (2), 50.01 (4p), 252.01 (5), 448.01 (6), 448.03 (1) (b), 448.03 (3) (e), 448.04 (1) (f), 448.05 (5), 448.20, 448.21, 448.40 (2) (f) and 450.01 (15r); to renumber 448.970, subchapter VIII of chapter 448 [precedes 448.980] and subchapter IX of chapter 448 [precedes 448.985]; to amend 15.08 (1m) (b), 15.085 (1m) (b), 16.417 (1) (e) 3m., 46.03 (44), 48.981 (2m) (b) 1., 49.45 (9r) (a) 7. a., 50.08 (2), 50.39 (3), 55.14 (8) (b), 69.01 (6g), 70.47 (8) (intro.), 97.67 (5m) (a) 3., 118.2925 (1) (f), 146.81 (1) (d), 146.82 (3) (a), 146.89 (1) (r) 1., 146.997 (1) (d) 5., 154.01 (3) (intro.), 154.03 (2), 154.07 (1) (a) (intro.), 165.77 (1) (a), 255.07 (1) (d), 343.16 (5) (a), 440.035 (2m) (b), 440.035 (2m) (c) 1. (intro.), 448.015 (4) (am) 2., 448.02 (1), 448.03 (2) (a), 448.03 (2) (e), 448.03 (2) (k), 448.03 (5) (b), 448.035 (2) to (4), 448.037 (2) (a) (intro.) and (b) and (3), 448.62 (7), 448.695 (4) (a) and (b), 450.01 (16) (hm) 3., 450.11 (1), 450.11 (1g) (b), 450.11 (1i) (a) 1., 450.11 (1i) (b) 2. c., 450.11 (1i) (c) 2., 450.11 (8) (b), 462.02 (2) (e), 462.04, 961.01 (19) (a) and 971.14 (4) (a); and to create 15.406 (7), 49.45 (9r) (a) 7. e., 69.18 (1) (ck), 146.81 (1) (eu), subchapter VIII of chapter 448 [precedes 448.971], 450.11 (1i) (b) 2. cm., 450.11 (8) (f) and 990.01 (27s) of the statutes; relating to: regulation of physician assistants, creating a Physician Assistant Affiliated Credentialing Board, extending the time limit for emergency rule procedures, providing an exemption from emergency rule procedures, granting rule-making authority, and providing a penalty.

Analysis by the Legislative Reference Bureau

This bill makes changes with respect to the licensure, regulation, and practice of physician assistants (PAs).

Under current law, PAs are defined as individuals who are licensed to provide medical care with physician supervision and direction. The Medical Examining Board licenses and regulates PAs as well as physicians and certain other professions. The Medical Examining Board is composed of ten physicians and three public members and is authorized to promulgate rules establishing licensing and practice standards for PAs. However, the Podiatry Affiliated Credentialing Board has the authority to establish practice standards for PAs practicing under podiatrists.

This bill creates the Physician Assistant Affiliated Credentialing Board attached to the Medical Examining Board. The new board is composed of eight PAs and one public member. In addition, the bill makes various changes to the licensure, regulation, and practice of PAs, including all of the following:

1. Instead of requiring that a PA practice under the supervision and direction of a physician, requires, subject to certain exceptions, that a PA who provides care to patients maintain and provide to the board upon request either 1) evidence that, pursuant to the PA's employment, there is a physician who is primarily responsible for the overall direction and management of the PA's professional activities and for assuring that the services provided by the PA are medically appropriate or 2) a written collaborative agreement with a physician that must describe the PA's scope of practice and include other information as required by the board. However, the bill provides that a PA is individually and independently responsible for the quality of the care he or she renders. The bill maintains the current requirements for PAs practicing under podiatrists and the authority of the Podiatry Affiliated Credentialing Board to establish practice standards for PAs practicing under podiatrists.

2. Defines a PA's practice similarly to the definition of the practice of medicine and surgery for purposes of physician licensure under current law. The bill also explicitly provides that a PA may prescribe, dispense, and administer drugs and may serve as a primary or specialty care provider. The bill requires a PA to limit his or her practice to the scope of his or her experience, education, and training, and retains a number of current law limitations on the practice of PAs.

3. Includes a number of additional provisions with respect to the obligations of PAs. These include a requirement that a PA have in effect malpractice liability insurance coverage when practicing, subject to certain exceptions and other provisions.

4. Establishes licensure requirements for PAs, which differ in a number of respects from the requirements under current law, including that PAs submit additional information, including an employment history, with a licensure application. Under the bill, the board must require continuing education for PAs. Currently, PAs are not required to complete continuing education.

5. Specifies various grounds for professional discipline of a PA by the board and allows the board to impose professional discipline consistent with other professions.

Because this bill creates a new crime or revises a penalty for an existing crime, the Joint Review Committee on Criminal Penalties may be requested to prepare a report.

For further information see the state fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB184,1 Section 1 . 15.08 (1m) (b) of the statutes is amended to read:

SB184,3,11 15.08 (1m) (b) The public members of the chiropractic examining board, the dentistry examining board, the hearing and speech examining board, the medical examining board, the physical therapy examining board, the perfusionists examining council, the respiratory care practitioners examining council and council on physician assistants, the board of nursing, the nursing home administrator examining board, the veterinary examining board, the optometry examining board, the pharmacy examining board, the marriage and family therapy, professional counseling, and social work examining board, the psychology examining board, and the radiography examining board shall not be engaged in any profession or occupation concerned with the delivery of physical or mental health care.

SB184,2 Section 2 . 15.085 (1m) (b) of the statutes is amended to read:

SB184,4,5 15.085 (1m) (b) The public members of the podiatry affiliated credentialing board or, the occupational therapists affiliated credentialing board, and the physician assistant affiliated credentialing board shall not be engaged in any profession or occupation concerned with the delivery of physical or mental health care.

SB184,3 Section 3 . 15.406 (7) of the statutes is created to read:

SB184,4,10 15.406 (7) Physician assistant affiliated credentialing board. There is created in the department of safety and professional services, attached to the medical examining board, a physician assistant affiliated credentialing board consisting of the following members appointed for staggered 4-year terms:

SB184,4,11 (a) Eight physician assistants licensed under subch. VIII of ch. 448.

SB184,4,12 (b) One public member.

SB184,4 Section 4 . 15.407 (2) of the statutes is repealed.

SB184,5 Section 5 . 16.417 (1) (e) 3m. of the statutes is amended to read:

SB184,4,16 16.417 (1) (e) 3m. A physician assistant who is licensed under s. 448.04 (1) (f) 448.974.

SB184,6 Section 6 . 46.03 (44) of the statutes is amended to read:

SB184,5,2 46.03 (44) Sexually transmitted disease treatment information. Prepare and keep current an information sheet to be distributed to a patient by a physician, physician assistant, or certified advanced practice nurse prescriber providing expedited partner therapy to that patient under s. 448.035 or 448.9725. The information sheet shall include information about sexually transmitted diseases and their treatment and about the risk of drug allergies. The information sheet shall also include a statement advising a person with questions about the information to contact his or her physician, pharmacist, or local health department, as defined in s. 250.01 (4).

SB184,7 Section 7 . 48.981 (2m) (b) 1. of the statutes is amended to read:

SB184,5,6 48.981 (2m) (b) 1. “Health care provider" means a physician, as defined under s. 448.01 (5), a physician assistant, as defined under s. 448.01 (6) 448.971 (2), or a nurse holding a license under s. 441.06 (1) or a license under s. 441.10.

SB184,8 Section 8 . 49.45 (9r) (a) 7. a. of the statutes is amended to read:

SB184,5,9 49.45 (9r) (a) 7. a. A physician or physician assistant licensed under subch. II of ch. 448.

SB184,9 Section 9 . 49.45 (9r) (a) 7. e. of the statutes is created to read:

SB184,5,11 49.45 (9r) (a) 7. e. A physician assistant licensed under subch. VIII of ch. 448.

SB184,10 Section 10 . 50.01 (4p) of the statutes is repealed.

SB184,11 Section 11 . 50.08 (2) of the statutes is amended to read:

SB184,5,18 50.08 (2) A physician, an advanced practice nurse prescriber certified under s. 441.16 (2), or a physician assistant licensed under ch. 448, who prescribes a psychotropic medication to a nursing home resident who has degenerative brain disorder shall notify the nursing home if the prescribed medication has a boxed warning under 21 CFR 201.57.

SB184,12 Section 12 . 50.39 (3) of the statutes is amended to read:

SB184,6,3 50.39 (3) Facilities governed by ss. 45.50, 48.62, 49.70, 49.72, 50.02, 51.09, and 252.10, juvenile correctional facilities as defined in s. 938.02 (10p), correctional institutions governed by the department of corrections under s. 301.02, and the offices and clinics of persons licensed to treat the sick under chs. 446, 447, and 448 are exempt from ss. 50.32 to 50.39. Sections 50.32 to 50.39 do not abridge the rights of the medical examining board, physician assistant affiliated credentialing board, physical therapy examining board, podiatry affiliated credentialing board, dentistry examining board, pharmacy examining board, chiropractic examining board, and board of nursing in carrying out their statutory duties and responsibilities.

SB184,13 Section 13 . 55.14 (8) (b) of the statutes is amended to read:

SB184,6,15 55.14 (8) (b) Order the individual to comply with the treatment plan under par. (a). The order shall provide that if the individual fails to comply with provisions of the treatment plan that require the individual to take psychotropic medications, the medications may be administered involuntarily with consent of the guardian. The order shall specify the methods of involuntary administration of psychotropic medication to which the guardian may consent. An order authorizing the forcible restraint of an individual shall specify that a person licensed under s. 441.06, 441.10, or 448.05 (2) or (5), or 448.974 shall be present at all times that psychotropic medication is administered in this manner and shall require the person or facility using forcible restraint to maintain records stating the date of each administration, the medication administered, and the method of forcible restraint utilized.

SB184,14 Section 14 . 69.01 (6g) of the statutes is amended to read:

SB184,6,19 69.01 (6g) “Date of death" means the date that a person is pronounced dead by a physician, coroner, deputy coroner, medical examiner, deputy medical examiner, physician assistant, or hospice nurse.

SB184,15 Section 15 . 69.18 (1) (ck) of the statutes is created to read:

SB184,6,24 69.18 (1) (ck) For purposes of preparation of the certificate of death and in accordance with accepted medical standards, a physician assistant who is directly involved with the care of a patient who dies may pronounce the date, time, and place of the patient's death.

SB184,16 Section 16 . 70.47 (8) (intro.) of the statutes is amended to read:

SB184,7,13 70.47 (8) Hearing. (intro.) The board shall hear upon oath all persons who appear before it in relation to the assessment. Instead of appearing in person at the hearing, the board may allow the property owner, or the property owner's representative, at the request of either person, to appear before the board, under oath, by telephone or to submit written statements, under oath, to the board. The board shall hear upon oath, by telephone, all ill or disabled persons who present to the board a letter from a physician, osteopath, physician assistant, as defined in s. 448.01 (6), or advanced practice nurse prescriber certified under s. 441.16 (2) that confirms their illness or disability. At the request of the property owner or the property owner's representative, the board may postpone and reschedule a hearing under this subsection, but may not postpone and reschedule a hearing more than once during the same session for the same property. The board at such hearing shall proceed as follows:

SB184,17 Section 17 . 97.67 (5m) (a) 3. of the statutes is amended to read:

SB184,7,15 97.67 (5m) (a) 3. A physician assistant licensed under subch. II VIII of ch. 448.

SB184,18 Section 18 . 118.2925 (1) (f) of the statutes is amended to read:

SB184,7,18 118.2925 (1) (f) “Physician assistant" means a person licensed under s. 448.04 (1) (f) 448.974.

SB184,19 Section 19 . 146.81 (1) (d) of the statutes is amended to read:

SB184,7,21 146.81 (1) (d) A physician, physician assistant, perfusionist, or respiratory care practitioner licensed or certified under subch. II of ch. 448.

SB184,20 Section 20 . 146.81 (1) (eu) of the statutes is created to read:

SB184,7,23 146.81 (1) (eu) A physician assistant licensed under subch. VIII of ch. 448.

SB184,21 Section 21 . 146.82 (3) (a) of the statutes is amended to read:

SB184,8,7 146.82 (3) (a) Notwithstanding sub. (1), a physician, a physician assistant, as defined in s. 448.01 (6), or an advanced practice nurse prescriber certified under s. 441.16 (2) who treats a patient whose physical or mental condition in the physician's, physician assistant's, or advanced practice nurse prescriber's judgment affects the patient's ability to exercise reasonable and ordinary control over a motor vehicle may report the patient's name and other information relevant to the condition to the department of transportation without the informed consent of the patient.

SB184,22 Section 22 . 146.89 (1) (r) 1. of the statutes is amended to read:

SB184,8,13 146.89 (1) (r) 1. Licensed as a physician under ch. 448, a dentist or dental hygienist under ch. 447, a registered nurse, practical nurse, or nurse-midwife under ch. 441, an optometrist under ch. 449, a physician assistant under subch. VIII of ch. 448, a pharmacist under ch. 450, a chiropractor under ch. 446, a podiatrist under subch. IV of ch. 448, or a physical therapist under subch. III of ch. 448.

SB184,23 Section 23 . 146.997 (1) (d) 5. of the statutes is amended to read:

SB184,8,17 146.997 (1) (d) 5. An occupational therapist, occupational therapy assistant, physician assistant or respiratory care practitioner licensed or certified under ch. 448.

SB184,24 Section 24 . 154.01 (3) (intro.) of the statutes is amended to read:

SB184,8,20 154.01 (3) (intro.) “Health care professional" means who is, or who holds a compact privilege under subch. IX of ch. 448 any of the following:

SB184,25 Section 25 . 154.03 (2) of the statutes is amended to read:

SB184,9,14 154.03 (2) The department shall prepare and provide copies of the declaration and accompanying information for distribution in quantities to persons licensed, certified, or registered under ch. 441, 448, or 455, persons who hold a compact privilege under subch. IX X of ch. 448, hospitals, nursing homes, county clerks and local bar associations and individually to private persons. The department shall include, in information accompanying the declaration, at least the statutory definitions of terms used in the declaration, statutory restrictions on who may be witnesses to a valid declaration, a statement explaining that valid witnesses acting in good faith are statutorily immune from civil or criminal liability, an instruction to potential declarants to read and understand the information before completing the declaration and a statement explaining that an instrument may, but need not be, filed with the register in probate of the declarant's county of residence. The department may charge a reasonable fee for the cost of preparation and distribution. The declaration distributed by the department of health services shall be easy to read, the type size may be no smaller than 10 point, and the declaration shall be in the following form, setting forth on the first page the wording before the ATTENTION statement and setting forth on the 2nd page the ATTENTION statement and remaining wording:

SB184,9,15 Declaration to health care professionals

SB184,9,16 (WISCONSIN LIVING WILL)

SB184,9,23 I,...., being of sound mind, voluntarily state my desire that my dying not be prolonged under the circumstances specified in this document. Under those circumstances, I direct that I be permitted to die naturally. If I am unable to give directions regarding the use of life-sustaining procedures or feeding tubes, I intend that my family and physician, physician assistant, or advanced practice registered nurse honor this document as the final expression of my legal right to refuse medical or surgical treatment.

SB184,9,25 1. If I have a TERMINAL CONDITION, as determined by a physician, physician assistant, or advanced practice registered nurse who has personally examined me, and if a physician who has also personally examined me agrees with that determination, I do not want my dying to be artificially prolonged and I do not want life-sustaining procedures to be used. In addition, the following are my directions regarding the use of feeding tubes:

SB184,10,5 .... YES, I want feeding tubes used if I have a terminal condition.

SB184,10,6 .... NO, I do not want feeding tubes used if I have a terminal condition.

SB184,10,7 If you have not checked either box, feeding tubes will be used.

SB184,10,12 2. If I am in a PERSISTENT VEGETATIVE STATE, as determined by a physician, physician assistant, or advanced practice registered nurse who has personally examined me, and if a physician who has also personally examined me agrees with that determination, the following are my directions regarding the use of life-sustaining procedures:

SB184,10,14 .... YES, I want life-sustaining procedures used if I am in a persistent vegetative state.

SB184,10,16 .... NO, I do not want life-sustaining procedures used if I am in a persistent vegetative state.

SB184,10,17 If you have not checked either box, life-sustaining procedures will be used.

SB184,10,22 3. If I am in a PERSISTENT VEGETATIVE STATE, as determined by a physician, physician assistant, or advanced practice registered nurse who has personally examined me, and if a physician who has also personally examined me agrees with that determination, the following are my directions regarding the use of feeding tubes:

SB184,10,23 .... YES, I want feeding tubes used if I am in a persistent vegetative state.

SB184,10,24 .... NO, I do not want feeding tubes used if I am in a persistent vegetative state.

SB184,10,25 If you have not checked either box, feeding tubes will be used.

SB184,11,3 If you are interested in more information about the significant terms used in this document, see section 154.01 of the Wisconsin Statutes or the information accompanying this document.

SB184,11,5 ATTENTION: You and the 2 witnesses must sign the document at the same time.

SB184,11,6 Signed ....   Date ....

SB184,11,7 Address ....   Date of birth ....

SB184,11,11 I believe that the person signing this document is of sound mind. I am an adult and am not related to the person signing this document by blood, marriage or adoption. I am not entitled to and do not have a claim on any portion of the person's estate and am not otherwise restricted by law from being a witness.

SB184,11,12 Witness signature ....   Date signed ....