Amendment SSA1-SB515

LRBs0254/1

MED&TJD:kjf&wlj

2019 - 2020 LEGISLATURE

SENATE SUBSTITUTE AMENDMENT 1, TO SENATE BILL 515

February 11, 2020 - Offered by Senator Bernier.

SB515-SSA1,2,6 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., 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 the 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 substitute amendment differs from 2019 Senate Bill 515 in the following respects:

1. The substitute amendment creates the Physician Assistant Affiliated Credentialing Board attached to the Medical Examining Board, instead of creating the Physician Assistant Examining Board. As with other affiliated credentialing boards attached to the Medical Examining Board, the Physician Assistant Affiliated Credentialing Board must submit any proposed permanent administrative rules to the Medical Examining Board, consider any comments from the Medical Examining Board, and include in its final rules submitted to the legislature any comments on the proposed rule submitted by the Medical Examining Board.

2. The substitute amendment adds additional requirements and stipulations for written collaborative agreements between physician assistants and physicians.

3. The substitute amendment includes an express prohibition against the Physician Assistant Affiliated Credentialing Board promulgating any rules that would permit a broader scope of practice than that which may be exercised in accordance with the other provisions in the bill and requires the Physician Assistant Affiliated Credentialing Board to revise a proposed permanent rule that the Medical Examining Board determines would do so.

4. The substitute amendment requires that a physician assistant working with a podiatrist practice under the supervision and direction of the podiatrist, as under current law, instead of under the provisions in the bill. The substitute amendment retains authority for the Podiatry Affiliated Credentialing Board to establish practice standards for physician assistants practicing under podiatrists and requirements for podiatrists supervising physician assistants and retains a limitation that a physician assistant acting under the supervision and direction of a podiatrist be limited to providing nonsurgical patient services.

5. The substitute amendment deletes references to “physician associates" and “associate physicians" for purposes of a provision restricting the use of titles.

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

SB515-SSA1,1 Section 1. 15.08 (1m) (b) of the statutes is amended to read:

SB515-SSA1,3,11 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.

SB515-SSA1,2 Section 2 . 15.085 (1m) (b) of the statutes is amended to read:

SB515-SSA1,3,17 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.

SB515-SSA1,3 Section 3. 15.406 (7) of the statutes is created to read:

SB515-SSA1,4,2 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:

SB515-SSA1,4,3 (a) Eight physician assistants licensed under subch. VIII of ch. 448.

SB515-SSA1,4,4 (b) One public member.

SB515-SSA1,4 Section 4. 15.407 (2) of the statutes is repealed.

SB515-SSA1,5 Section 5 . 16.417 (1) (e) 3m. of the statutes is amended to read:

SB515-SSA1,4,8 16.417 (1) (e) 3m. A physician assistant who is licensed under s. 448.04 (1) (f) 448.974.

SB515-SSA1,6 Section 6 . 46.03 (44) of the statutes is amended to read:

SB515-SSA1,4,18 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).

SB515-SSA1,7 Section 7. 48.981 (2m) (b) 1. of the statutes is amended to read:

SB515-SSA1,4,22 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 (3), or a nurse holding a license under s. 441.06 (1) or a license under s. 441.10.

SB515-SSA1,8 Section 8 . 49.45 (9r) (a) 7. a. of the statutes is amended to read:

SB515-SSA1,4,25 49.45 (9r) (a) 7. a. A physician or physician assistant licensed under subch. II of ch. 448.

SB515-SSA1,9 Section 9. 49.45 (9r) (a) 7. e. of the statutes is created to read:

SB515-SSA1,5,2 49.45 (9r) (a) 7. e. A physician assistant licensed under subch. VIII of ch. 448.

SB515-SSA1,10 Section 10. 50.01 (4p) of the statutes is repealed.

SB515-SSA1,11 Section 11. 50.08 (2) of the statutes is amended to read:

SB515-SSA1,5,9 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.

SB515-SSA1,12 Section 12. 50.39 (3) of the statutes is amended to read:

SB515-SSA1,5,19 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.

SB515-SSA1,13 Section 13 . 55.14 (8) (b) of the statutes is amended to read:

SB515-SSA1,6,6 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.

SB515-SSA1,14 Section 14 . 69.01 (6g) of the statutes is amended to read:

SB515-SSA1,6,10 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.

SB515-SSA1,15 Section 15 . 69.18 (1) (ck) of the statutes is created to read:

SB515-SSA1,6,15 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.

SB515-SSA1,16 Section 16. 70.47 (8) (intro.) of the statutes is amended to read:

SB515-SSA1,7,4 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:

SB515-SSA1,17 Section 17. 97.67 (5m) (a) 3. of the statutes is amended to read:

SB515-SSA1,7,6 97.67 (5m) (a) 3. A physician assistant licensed under subch. II VIII of ch. 448.

SB515-SSA1,18 Section 18. 118.2925 (1) (f) of the statutes is amended to read: