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1 AN ACT relating to physician assistants.
2 Be it enacted by the General Assembly of the Commonwealth of Kentucky:
3 Section 1. KRS 311.840 is amended to read as follows:
4 As used in KRS 311.840 to 311.862:
5 (1) "Board" means the Kentucky Board of Medical Licensure;
6 (2) "Complaint" means a formal administrative pleading that sets forth charges against
7 a physician assistant and commences a formal disciplinary proceeding;
8 (3) "Physician assistant" means a person licensed under KRS 311.840 to 311.862 who:
9 (a) Has graduated from a physician assistant or surgeon assistant program
10 accredited by the Accreditation Review Commission on Education for
11 Physician Assistants or its predecessor or successor agencies and has passed
12 the certifying examination administered by the National Commission on
13 Certification of Physician Assistants or its predecessor or successor agencies;
14 or
15 (b) Possesses a current physician assistant certificate issued by the board prior to
16 July 15, 2002;
17 (4) "Supervising physician" means a physician licensed by the board who supervises
18 one (1) or more physician assistants;
19 (5) "Supervising physician in anesthesia" means a physician licensed by the board who
20 has completed postgraduate training in anesthesiology at an anesthesiology program
21 accredited by the Accreditation Council for Graduate Medical Education or its
22 equivalent; and
23 (6) "Supervision":
24 (a) Means overseeing the activities [of ]and [accepting of responsibility for the
25 ]medical services rendered by a physician assistant. Each team of physicians
26 and physician assistants shall ensure that the approved[delegation of] medical
27 tasks are[is] appropriate to the physician assistant's level of training and
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1 experience, that the identifications of and access to the supervising physician
2 are clearly defined, and that a process for evaluation of the physician
3 assistant's performance is established; and
4 (b) Does not require the physical presence of a supervising physician when
5 medical services are rendered by a physician assistant.
6 Section 2. KRS 311.844 is amended to read as follows:
7 (1) To be licensed by the board as a physician assistant, an applicant shall:
8 (a) Submit a completed application form with the required fee;
9 (b) Be of good character and reputation;
10 (c) Be a graduate of an approved program; and
11 (d) Have passed an examination approved by the board within three (3) attempts,
12 or have been granted a waiver by the board.
13 (2) A physician assistant who is authorized to practice in another state and who is in
14 good standing may apply for licensure by endorsement from the state of his or her
15 credentialing if that state has standards substantially equivalent to those of this
16 Commonwealth.
17 (3) A physician assistant's license shall be valid for two (2) years and shall be renewed
18 by the board upon fulfillment of the following requirements:
19 (a) The holder shall be of good character and reputation;
20 (b) The holder shall provide evidence of completion, during the previous two (2)
21 years, of a minimum of one hundred (100) hours of continuing education
22 approved by the American Medical Association, the American Osteopathic
23 Association, the American Academy of Family Physicians, the American
24 Academy of Physician Assistants, or by another entity approved by the board.
25 The one hundred (100) hours of continuing education required by this
26 paragraph shall include:
27 1. During the first two (2) years of licensure or prior to the first licensure
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1 renewal:
2 a. One and one-half (1.5) hours of continuing education in the
3 prevention and recognition of pediatric abusive head trauma, as
4 defined in KRS 620.020, except that graduating physician assistant
5 students may apply pediatric abusive head trauma curriculum
6 taught in their physician assistant graduate education to count
7 towards the required one and one-half (1.5) hours; and
8 b. As a part of the continuing education requirements that the board
9 adopts to ensure continuing competency of present and future
10 licensees and the evolving needs of the growing senior population,
11 the board shall ensure physician assistants licensed under KRS
12 Chapter 311 complete a one (1) time course of one (1) hour of
13 continuing education approved by the board. The course shall be
14 completed one (1) time and count towards the current number of
15 required continuing education hours, except that graduating
16 student physician assistants may submit Alzheimer's and other
17 forms of dementia course curriculum taught in their programs of
18 study towards the required one (1) hour for approval. The course
19 topics shall include but not be limited to:
20 i. The warning signs and symptoms of Alzheimer's disease and
21 other forms of dementia;
22 ii. The importance of early detection, diagnosis, and appropriate
23 communication techniques for discussion of memory
24 concerns with the patient and his or her caregiver;
25 iii. Cognitive assessment and care planning billing codes;
26 iv. The variety of tools used to assess a patient's cognition; and
27 v. Current treatments that may be available to the patient; and
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1 2. If the license holder is authorized, pursuant to KRS 311.858(4)[KRS
2 311.858(5)], to prescribe and administer Schedule II, III, IV, or V
3 controlled substances, a minimum of seven and one-half (7.5) hours of
4 approved continuing education relating to controlled substance
5 diversion, pain management, addiction disorders, use of the electronic
6 system for monitoring controlled substances established in KRS
7 218A.202, or any combination of two (2) or more of these subjects; and
8 (c) The holder shall provide proof of current certification with the National
9 Commission on Certification of Physician Assistants.
10 Section 3. KRS 311.850 is amended to read as follows:
11 (1) The board may revoke, suspend, deny, decline to renew, limit, or restrict the license
12 of a physician assistant, or may fine, reprimand or place a physician assistant on
13 probation for no more than five (5) years upon proof that a physician assistant has:
14 (a) Knowingly made or presented or caused to be made or presented any false,
15 fraudulent, or forged statement, writing, certificate, diploma, or other
16 document relating to an application for licensure;
17 (b) Practiced, aided, or abetted in the practice of fraud, forgery, deception,
18 collusion, or conspiracy relating to an examination for licensure;
19 (c) Been convicted of a crime as defined in KRS 335B.010, if in accordance with
20 KRS Chapter 335B;
21 (d) Been convicted of a misdemeanor offense under KRS Chapter 510 involving
22 a patient or a felony offense under KRS Chapter 510, KRS 530.064, or
23 531.310, or has been found by the board to have had sexual contact, as
24 defined in KRS 510.010, with a patient while the patient was under the care of
25 the physician assistant or the physician assistant's supervising physician;
26 (e) Become addicted to a controlled substance, as defined in KRS 311.550(26);
27 (f) Become a chronic or persistent alcoholic, as defined in KRS 311.550(25);
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1 (g) Been unable or is unable to practice medicine according to acceptable and
2 prevailing standards of care by reason of mental or physical illness or other
3 condition including but not limited to physical deterioration that adversely
4 affects cognitive, motor, or perceptive skills, or by reason of an extended
5 absence from the active practice of medicine;
6 (h) Knowingly made or caused to be made or aided or abetted in the making of a
7 false statement in any document executed in connection with the practice of
8 medicine or osteopathy;
9 (i) Performed any act or service as a physician assistant without a designated
10 supervising physician;
11 (j) Exceeded the scope of medical services described by the supervising
12 physician in the agreement[applications] required under KRS 311.854;
13 (k) Exceeded the scope of practice for which the physician assistant was
14 credentialed by the governing board of a hospital or licensed health care
15 facility under KRS 311.856 and 311.858;
16 (l) Aided, assisted, or abetted the unlawful practice of medicine or osteopathy or
17 any healing art, including the unlawful practice of physician assistants;
18 (m) Willfully violated a confidential communication;
19 (n) Performed the services of a physician assistant in an unprofessional,
20 incompetent, or grossly or chronically negligent manner;
21 (o) Been removed, suspended, expelled, or placed on probation by any health care
22 facility or professional society for unprofessional conduct, incompetence,
23 negligence, or violation of any provision of this section or KRS 311.858 or
24 311.862;
25 (p) Violated any applicable provision of administrative regulations relating to
26 physician assistant practice;
27 (q) Violated any term of probation or other discipline imposed by the board;
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1 (r) Failed to complete the required number of hours of approved continuing
2 education;
3 (s) Engaged in dishonorable, unethical, or unprofessional conduct of character
4 likely to deceive, defraud, or harm the public or any member thereof, as
5 described in KRS 311.597; or
6 (t) As provided in KRS 311.824(2), been convicted of a violation of KRS
7 311.823(2).
8 (2) All disciplinary proceedings against a physician assistant shall be conducted in
9 accordance with the provisions of KRS 311.591, 311.592, 311.593, 311.599, and
10 KRS Chapter 13B and related administrative regulations promulgated under KRS
11 Chapter 311.
12 Section 4. KRS 311.854 is amended to read as follows:
13 (1) A physician shall not supervise a physician assistant without approval of the board.
14 Failure to obtain board approval as a supervising physician or failure to comply
15 with the requirements of KRS 311.840 to 311.862 or related administrative
16 regulations shall be considered unprofessional conduct and shall be subject to
17 disciplinary action by the board that may include revocation, suspension,
18 restriction, or placing on probation the supervising physician's right to supervise a
19 physician assistant.
20 (2) To be approved by the board as a supervising physician, a physician shall:
21 (a) Be currently licensed and in good standing with the board;
22 (b) Maintain a practice primarily within this Commonwealth. The board in its
23 discretion may modify or waive this requirement;
24 (c) Submit a completed application and the required fee to the board. The
25 application shall include but is not limited to:
26 1. A description of the nature of the physician's practice; and
27 2. A statement of assurance by the supervising physician that the scope of
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1 medical services and procedures of the physician assistant[described in
2 the application or in any supplemental information] shall not exceed the
3 normal scope of practice of the supervising physician[;
4 3. A description of the means by which the physician shall maintain
5 communication with the physician assistant when they are not in the
6 same physical location;
7 4. A description of the scope of medical services and procedures to be
8 performed by the physician assistant for which the physician assistant
9 has been trained in an approved program; and
10 5. An outline of the specific parameters for review of countersignatures].
11 (3) A physician assistant shall not render any medical service or procedure unless
12 the required supervision agreement is completed and signed by the supervising
13 physician and physician assistant, and in effect. The supervision agreement shall
14 include[Prior to a physician assistant performing any service or procedure beyond
15 those described in the initial application submitted to the board under subsection
16 (2)(c) of this section, the supervising physician shall supplement that application
17 with information that includes] but is not limited to:
18 (a) The scope of medical services and procedures approved by the supervising
19 physician to be performed by the physician assistant;
20 (b) The level and method of supervision to be provided by the supervising
21 physician;
22 (c) Any applicable requirements for review and countersignature of the
23 physician assistant's medical notes, orders, or prescriptions;
24 (d) Procedures governing communications and clinical decision-making
25 between the supervising physician and the physician assistant;
26 (e) The primary practice location and any additional sites where the physician
27 assistant is authorized to provide services; and
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1 (f) Any alternate physician supervision arrangements authorized under KRS
2 311.840 to 311.862[A description of the additional service or procedure;
3 (b) A description of the physician assistant's education, training, experience, and
4 institutional credentialing;
5 (c) A description of the level of supervision to be provided for the additional
6 service or procedure;
7 (d) The location or locations where the additional service or procedure will be
8 provided; and
9 (e) Any changes to the specific parameters for review of countersignatures.
10 The initial and supplemental applications required under this section may be
11 submitted to the board at the same time].
12 (4) (a) The board shall develop and make available a standardized supervision
13 agreement form to be used by supervising physicians and physician
14 assistants.
15 (b) A copy of the completed and signed supervision agreement, and any
16 subsequent amendments, shall be furnished to and maintained on file by the
17 board and shall be maintained, in a readily accessible physical or electronic
18 form, at the primary practice location where the physician assistant provides
19 patient care.
20 (5) The supervision agreement may be amended at any time upon the mutual
21 agreement of the supervising physician and physician assistant. All amendments
22 shall be submitted to the board and maintained in accordance with this section.
23 (6) A licensed health care facility utilizing alternate supervising physicians may
24 satisfy the filing requirements of this section through an alternative filing method
25 approved by the board. Compliance with a board-approved alternative filing
26 method shall be deemed compliant with the filing and amendment requirements
27 of this section.
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1 (7) A licensed health care facility may designate one (1) or more physicians to serve
2 as alternate supervising physicians for the purpose of providing supervision to
3 one (1) or more physician assistants when the primary supervising physician is
4 unavailable. A health care facility's designation of alternate supervising
5 physicians may be structured to allow for rotating, shift-based, or department-
6 based supervision, provided that all supervising physicians:
7 (a) Are licensed and in good standing with the board;
8 (b) Have been designated in the applicable supervision agreement described in
9 this section; and
10 (c) Fulfill the responsibilities of a supervising physician under this section and
11 Section 5 of this Act.
12 (8) A supervision agreement shall not be required to name an alternate supervising
13 physician. Alternate supervising physician designations shall comply with
14 administrative regulations promulgated by the board in accordance with KRS
15 Chapter 13A and the supervision agreement.
16 (9)[(4)] A physician who has been supervising a physician assistant prior to July 15,
17 2002, may continue supervision and the physician assistant may continue to
18 perform all medical services and procedures that were provided by the physician
19 assistant prior to July 15, 2002. The supervising physician shall submit the initial
20 application and any supplemental application as required in this section by October
21 15, 2002.
22 (10)[(5)] A physician may enter into supervision agreements with no more than four (4)
23 physician assistants and shall not supervise more than four (4) physician assistants
24 at any one (1) time. Application for board approval to be a supervising physician
25 shall be obtained individually for each physician assistant.
26 (11) The board shall promulgate administrative regulations in accordance with KRS
27 Chapter 13A to implement and enforce this section, including:
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1 (a) Procedures for the submission, review, modification, and renewal of
2 supervision agreements; and
3 (b) Alternative filing methods for licensed health care facilities to utilize
4 alternate supervising physicians[(6) The board may impose restrictions on
5 the scope of practice of a physician assistant or on the methods of supervision
6 by the supervising physician upon consideration of recommendations of the
7 Physician Assistant Advisory Committee established in KRS 311.842 after
8 providing the applicant with reasonable notice of its intended action and after
9 providing a reasonable opportunity to be heard].
10 Section 5. KRS 311.856 is amended to read as follows:
11 A supervising physician shall:
12 (1) Restrict the services of a physician assistant to services within the physician
13 assistant's scope of practice and to the provisions of KRS 311.840 to 311.862;
14 (2) Prohibit a physician assistant from dispensing controlled substances;
15 (3) Prohibit a physician assistant from prescribing or administering controlled
16 substances, except as provided in KRS 311.858(4)[KRS 311.858(5)];
17 (4) [Inform all patients in contact with a physician assistant of the status of the
18 physician assistant;
19 (5) Post a notice stating that a physician assistant practices medicine or osteopathy in
20 all locations where the physician assistant may practice;
21 (6) ]Require a physician assistant to wear identification that clearly states that he or she
22 is a physician assistant;
23 (5)[(7)] Prohibit a physician assistant from independently billing any patient or other
24 payor for services rendered by the physician assistant;
25 (6)[(8)] If necessary, participate with the governing body of any hospital or other
26 licensed health care facility in a credentialing process established by the facility;
27 (7)[(9)] Not require a physician assistant to perform services or other acts that the
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1 physician assistant feels incapable of carrying out safely and properly;
2 (8)[(10)] Maintain [adequate, active, and continuous ]supervision as outlined in the
3 supervision agreement requirement described in Section 4 of this Act[of a
4 physician assistant's activities] to ensure[assure] that the physician assistant is
5 performing as directed and complying with the agreement[requirements of KRS
6 311.840 to 311.862 and all related administrative regulations;
7 (11) Review and countersign a sufficient number of overall medical notes written by the
8 physician assistant to ensure quality of care provided by the physician assistant and
9 outline the specific parameters for review of countersignatures in the application
10 required by KRS 311.854. Countersignature requirements shall be determined by
11 the supervising physician, practice, or institution. As used in this subsection:
12 (a) "Practice" means a medical practice composed of two (2) or more physicians
13 organized to provide patient care services, regardless of its legal form or
14 ownership; and
15 (b) "Institution" means all or part of any public or private facility, place, building,
16 or agency, whether organized for profit or not, that is used, operated, or
17 designed to provide medical diagnosis, treatment, nursing, rehabilitative, or
18 preventive care;
19 (12) (a) Reevaluate the reliability, accountability, and professional knowledge of a
20 physician assistant two (2) years after the physician assistant's original
21 licensure in this Commonwealth and every two (2) years thereafter; and
22 (b) Based on the reevaluation, recommend approval or disapproval of licensure or
23 renewal to the board]; and
24 (9)[(13)] Notify the board within three (3) business days if the supervising physician:
25 (a) Ceases to supervise or employ the physician assistant; or
26 (b) Believes in good faith that a physician assistant violated any disciplinary rule
27 of KRS 311.840 to 311.862 or related administrative regulations.
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1 Section 6. KRS 311.858 is amended to read as follows:
2 (1) A physician assistant may perform medical services and procedures within the
3 scope of medical services and procedures described in the supervision
4 agreement[initial or any supplemental application received by the board] under
5 KRS 311.854.
6 (2) [A physician assistant shall be considered an agent of the supervising physician in
7 performing medical services and procedures described in the initial application or
8 any supplemental application received by the board under KRS 311.854.
9 (3) ]A physician assistant may initiate evaluation and treatment in emergency situations
10 without specific approval.
11 (3)[(4)] A physician assistant may prescribe and administer all nonscheduled legend
12 drugs and medical devices to the extent approved[delegated] by the supervising
13 physician. A physician assistant who is approved and has[delegated] prescribing
14 authority may request, receive, sign for, and distribute professional samples of
15 nonscheduled legend drugs to patients.
16 (4)[(5)] (a) A physician assistant who has been approved by the board pursuant to
17 paragraph (b) of this subsection, may prescribe and administer Schedules II,
18 III, IV, and V controlled substances, as described in KRS Chapter 218A, to
19 the extent approved[delegated] by the supervising physician and as permitted
20 under paragraphs (c), (d), [and ](e), and (f) of this subsection.
21 (b) Before a physician assistant engages in prescribing or administering
22 controlled substances, the physician assistant shall:
23 1. Have at least one (1) year of experience as a licensed and practicing
24 physician assistant;
25 2. Submit to the board a completed application for prescriptive authority
26 for controlled substances signed by the physician assistant's supervising
27 physician in accordance with KRS 311.856;
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1 3. Receive from the board, or its executive director, a notice that the
2 application for prescriptive authority has been approved; and
3 4. Obtain a Controlled Substance Registration Certificate through the
4 United States Drug Enforcement Administration and register with the
5 electronic system for monitoring controlled substances established in
6 KRS 218A.202 and any other applicable state controlled substance
7 regulatory authority.
8 (c) Prescriptions issued by a physician assistant for narcotic Schedule II
9 controlled substances classified under KRS 218A.060, except for
10 hydrocodone combination products as defined in KRS 218A.010, shall be
11 limited to a seventy-two (72) hour supply without any refill.
12 (d) Prescriptions issued by a physician assistant for hydrocodone combination
13 products as defined in KRS 218A.010, nonnarcotic Schedule II controlled
14 substances, and Schedule III controlled substances, as defined[described] in
15 KRS 218A.060 and 218A.080, shall be limited to a thirty (30) day supply
16 without any refill.
17 (e)[(d)] Prescriptions issued by a physician assistant for Schedule IV or V
18 controlled substances, as defined[described] in KRS 218A.100 and 218A.120,
19 shall be limited to the original prescription and refills not to exceed a six (6)
20 month supply.
21 (f)[(e)] Notwithstanding paragraph (e)[(d)] of this subsection, prescriptions
22 issued by a physician assistant for benzodiazepines or Carisoprodol shall be
23 limited to a thirty (30) day supply without any refill.
24 (5)[(6)] A physician assistant shall not submit direct billing for medical services and
25 procedures performed by the physician assistant.
26 (6)[(7)] A physician assistant may perform local infiltrative anesthesia under the
27 provisions of subsection (1) of this section, but a physician assistant shall not
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1 administer or monitor general or regional anesthesia unless the requirements of
2 KRS 311.862 are met.
3 (7)[(8)] A physician assistant may perform services in the offices or clinics of the
4 supervising physician. A physician assistant may also render services in hospitals or
5 other licensed health care facilities only with written permission of the facility's
6 governing body, and the facility may restrict the physician assistant's scope of
7 practice within the facility as deemed appropriate by the facility.
8 (8)[(9)] A physician assistant shall not practice medicine or osteopathy independently.
9 Each physician assistant shall practice under a supervision agreement as described
10 in Section 4 of this Act[defined in KRS 311.840].
11 Section 7. KRS 186.577 is amended to read as follows:
12 (1) (a) The following persons shall submit to a test of visual acuity and visual field at
13 the time of application or renewal:
14 1. All persons applying for an initial or renewal operator's license;
15 2. All persons applying for an initial or renewal instruction permit; and
16 3. Any person required to complete an examination under KRS 186.635.
17 (2) Vision testing under this section shall be administered to any person:
18 (a) Applying for an initial operator's license, an initial instruction permit, or
19 reinstatement of a license when vision must be tested as required in KRS
20 186.480:
21 1. Prior to the time of application under subsection (5) of this section; or
22 2. By the Department of Kentucky State Police at the time of application;
23 (b) Applying for operator's license renewal or instruction permit renewal:
24 1. Prior to the time of application under subsection (5) of this section; or
25 2. By the Transportation Cabinet at the time of application; or
26 (c) Identified in Kentucky administrative regulations promulgated by the
27 Transportation Cabinet or the Department of Kentucky State Police as being
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1 required to undergo the exam required by KRS 186.480.
2 (3) (a) Persons whose visual acuity is 20/40 or better and who meet or exceed the
3 visual field standard established by the Transportation Cabinet without
4 corrective lenses shall not have a restriction placed on their driving privileges.
5 (b) Persons whose visual acuity is 20/40 or better and who meet or exceed the
6 visual field standard established by the Transportation Cabinet with corrective
7 lenses shall have their driving privileges restricted to mandate the use of the
8 corrective lenses.
9 (c) If a person fails to meet a 20/40 visual acuity standard or the visual field
10 standard established by the cabinet, the person shall be referred to a vision
11 specialist for examination.
12 (4) A person referred to a vision specialist under subsection (3) of this section whose
13 visual acuity is 20/60 or better and who meets or exceeds the visual field standard
14 established by the cabinet shall be eligible to test for an instruction permit or
15 operator's license, or shall be eligible for operator's license renewal. If corrective
16 lenses were prescribed by the vision specialist, the person's driving privileges shall
17 be restricted to mandate the use of the corrective lenses.
18 (5) Vision tests administered under subsection (2)(a) of this section shall be deemed to
19 meet the testing provisions outlined in subsection (3) or (4) of this section, if the
20 person submits a driver vision testing form that complies with the provisions of
21 subsection (6) of this section and the form has been completed by:
22 (a) A vision specialist; or
23 (b) An osteopath, physician, physician assistant, or advanced practice registered
24 nurse who is credentialed by the cabinet to perform vision testing under this
25 section.
26 (6) All driver vision testing forms completed under subsection (5) of this section shall:
27 (a) Attest that the applicant meets or exceeds the visual acuity standard and visual
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1 field standard established by the cabinet;
2 (b) Only be valid if the vision specialist or the credentialed osteopath,
3 credentialed physician, credentialed physician assistant, or credentialed
4 advanced practice registered nurse signed and completed the vision testing
5 form less than twelve (12) months prior to the date of application or renewal;
6 (c) State whether the driving privileges of the applicant shall be restricted to
7 mandate the use of corrective lenses; and
8 (d) Clearly indicate that the vision testing under this section is a screening for
9 minimum vision standards established in this section and is not a complete
10 eye examination.
11 (7) Any person seeking application or permit under subsection (1) of this section shall
12 attest that he or she has submitted to and passed the visual acuity and visual field
13 tests required under this section.
14 (8) Any person renewing an operator's license under KRS 186.416 shall be exempt
15 from the vision testing requirements outlined in this section.
16 (9) Persons who meet the requirements of KRS 186.578 and are issued operator's
17 licenses under KRS 186.579 shall:
18 (a) Have their driving privileges restricted to the use of a bioptic telescopic
19 device; and
20 (b) Be exempt from this section.
21 (10) The Transportation Cabinet shall promulgate administrative regulations pursuant to
22 KRS Chapter 13A to implement the provisions of this section, including but not
23 limited to establishing visual field standards, the creation of a driver vision testing
24 form, and establishing a credentialing process for osteopaths, physicians, physician
25 assistants, and advanced practice registered nurses to conduct vision testing under
26 this section.
27 (11) The Transportation Cabinet may promulgate administrative regulations pursuant to
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1 KRS Chapter 13A to:
2 (a) Implement a system for electronic transmission of driver vision testing forms
3 and accompanying documentation; and
4 (b) Assess a fee to an applicant to cover the administrative costs of performing
5 on-site vision testing. Any funds received from this fee shall be deposited into
6 the photo license account established in KRS 174.056.
7 Section 8. The following KRS section is repealed:
8 311.860 Services performed in location separate from supervising physician --
9 Nonseparate location -- Definition and exceptions.
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