Bill Text: HI SB2445 | 2022 | Regular Session | Amended

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Bill Title: Relating To Physician Assistants.

Spectrum: Partisan Bill (Democrat 9-0)

Status: (Engrossed - Dead) 2022-03-10 - Referred to HHH/CPC, JHA, FIN, referral sheet 24 [SB2445 Detail]

Download: Hawaii-2022-SB2445-Amended.html

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THE SENATE	S.B. NO.	2445
THIRTY-FIRST LEGISLATURE, 2022		S.D. 2
STATE OF HAWAII

A BILL FOR AN ACT

 

 

RELATING TO PHYSICIAN ASSISTANTS.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 

     SECTION 1.  The legislature finds that the critical physician shortage continues to limit residents' access to timely, high quality health care in Hawaii.  According to the 2021 annual report on findings from the Hawaii Physician Workforce Assessment Report, Hawaii has an unmet need for seven hundred thirty-two full time physicians across the State, with the most severe shortages reaching almost forty per cent in Maui county and Hawaii county.  Predictions are that this need will only increase over time.

     Paradoxically, physician assistant practice in Hawaii has grown by thirty-six per cent between 2016-2020.  This is most noticeable on the neighbor islands, where physician assistants' presence has grown by one hundred five per cent in Hawaii county, one hundred fourteen per cent in Kauai county, and thirty-five per cent on Maui county.  However, because Hawaii has some of the nation's most restrictive scope of practice laws for physician assistants, these providers are prevented from meeting many of their patients' needs, such as certifying need for temporary disability insurance, disability parking permits, and provider orders for life sustaining treatment forms, for example.

     The legislature also finds the intensive physician assistant program curriculum is modeled on the medical school curriculum and produces highly skilled practitioners.  The typical physician assistant program lasts twenty-seven continuous months and begins with classroom instruction in basic medical sciences.  This is followed by rotations in medical and surgical disciplines, including family medicine, internal medicine, general surgery, pediatrics, obstetrics and gynecology, emergency medicine, and psychiatry.  Physician assistant students complete at least two thousand hours of supervised clinical practice in various settings and locations by the time of graduation and must pass a national certification exam to be licensed to practice medicine.  Like physicians and advanced practice registered nurses, physician assistants must also complete extensive continuing medical education throughout their careers.

     Because of their rigorous medical training, physician assistants are skilled health care providers who routinely take medical histories, perform physical examinations, order and interpret laboratory tests, diagnose illnesses, develop and manage treatment plans, prescribe medications, and assist in surgery.  Studies have shown that when physician assistants practice to the full extent of their abilities and training, hospital readmission rates and lengths of stay decrease and infection rates go down.  Physician assistants can work in a multitude of clinical settings, locations, and specialties, and because physician assistants can work off-site from their collaborating physician as long as the physician remains available via telecommunication, physician assistants have been helping to fill Hawaii's rural health care gap with high quality care.

     Further, the legislature finds that as interprofessional health care team practice evolves and research repeatedly shows the quality and safety of physician assistant-provided care, a physician assistant's scope of practice can safely be determined at the practice level.  Broadening physician assistants' scope of practice so that the scope is determined at the practice level, responds to the needs of the collaborating physician, facility, medical specialty, and patient population, thus increasing efficiency and delivery of health care and lessening the administrative burden.

     Therefore, the legislature finds that the solution to the crisis of accessible health care in the State will be multi-faceted, and broadening the scope and utilization of physician assistants is a vital part of it.

     The purpose of this Act is to broaden the scope and practice of physician assistants in the State to improve patient access to health care services and provide optimal care for Hawaii patients, especially in rural and underserved areas.  However, this Act does not seek to authorize independent practice for physician assistants.

     SECTION 2.  Section 291-51, Hawaii Revised Statutes, is amended as follows:

     1.  By amending the definition of "certificate of disability" to read:

     ""Certificate of disability" means a medical statement issued by a licensed practicing physician, physician assistant, or advanced practice registered nurse, which verifies that a person is disabled, limited, or impaired in the ability to walk."

     2.  By amending the definition of "person with a disability" to read:

     ""Person with a disability" means a person with a disability that limits or impairs the ability to walk, and who, as determined by a licensed practicing physician, physician assistant, or an advanced practice registered nurse:

     (1)  Cannot walk two hundred feet without stopping to rest, and who has been diagnosed with:

          (A)  An arthritic, neurological, orthopedic, renal, vascular, or oncological condition;

          (B)  Lung disease to such an extent that the person's forced (respiratory) expiratory volume for one second, when measured by spirometry, is less than one liter, or the arterial oxygen tension is less than sixty mm/hg on room air at rest; or

          (C)  A cardiac condition to the extent that the person's functional limitations are classified in severity as Class III or Class IV according to the standards set by the American Heart Association; and

     (2)  Because of a condition identified in paragraph (1):

          (A)  Cannot walk two hundred feet under the person's own power without stopping to rest;

          (B)  Cannot walk without the use of, or assistance from, a brace, cane, crutch, another person, prosthetic device, wheelchair, or other assistive device; or

          (C)  Uses portable oxygen."

     SECTION 3.  Section 291-51.4, Hawaii Revised Statutes, is amended to read as follows:

     "§291-51.4  Fraudulent verification of an applicant as a person with a disability; penalty.  A physician, physician assistant, or advanced practice registered nurse who fraudulently verifies that an applicant is a person with a disability to enable the person to represent to the issuing agency that the person is qualified to obtain a disability parking permit shall be guilty of a petty misdemeanor.  Each fraudulent verification shall constitute a separate offense."

     SECTION 4.  Section 327K-1, Hawaii Revised Statutes, is amended by amending the definition of "patient's provider" to read as follows:

     ""Patient's provider" means a physician licensed pursuant to chapter 453, a physician assistant licensed pursuant to chapter 453, or an advanced practice registered nurse licensed pursuant to chapter 457 who has examined the patient."

     SECTION 5.  Section 327K-3, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  No physician, physician assistant, advanced practice registered nurse, health care professional, nurse's aide, hospice provider, home care provider, including private duty and medicare home health providers, emergency medical services provider, adult residential care home operator, skilled nursing facility operator, hospital, or person employed by or under contract with a hospital shall be subject to criminal prosecution, civil liability, or be deemed to have engaged in unprofessional conduct for:

     (1)  Carrying out in good faith, a decision regarding treatment orders, including cardiopulmonary resuscitation by or on behalf of a patient pursuant to orders in a form and in compliance with the standards and procedures set forth in this chapter; or

     (2)  Providing cardiopulmonary resuscitation to a patient for whom an order not to resuscitate has been issued on a form; provided the person reasonably and in good faith:

          (A)  Was unaware of the issuance of an order not to resuscitate; or

          (B)  Believed that any consent to treatment orders, including the order not to resuscitate, had been revoked or canceled."

     SECTION 6.  Section 338-9, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

     "(b)  In preparing a certificate of death or fetal death the person in charge of the disposition of the body shall:

     (1)  Obtain and enter on the certificate the personal data and other information pertaining to the deceased person required by the department from the person best qualified to supply them;

     (2)  Present the certificate of death to the physician, physician assistant, or advanced practice registered nurse last in attendance upon the deceased, or to the coroner's physician, who shall thereupon certify the cause of death to the physician's, physician assistant's, or advanced practice registered nurse's best knowledge and belief, or present the certificate of fetal death to the physician, physician assistant, advanced practice registered nurse, midwife, or other person in attendance at the fetal death, who shall certify the fetal death and such medical data pertaining thereto as can be furnished; provided that fetal deaths of less than twenty-four weeks or intentional terminations of pregnancy performed in accordance with section 453-16 may be certified by a nurse or other employee based upon the physician's records; and

     (3)  Notify immediately the appropriate local agent, if the death occurred without medical attendance, or if the physician, physician assistant, or advanced practice registered nurse last in attendance fails to sign the death certificate.  In such event the local agent shall inform the local health officer, and refer the case to the local health officer for immediate investigation and certification of the cause of death prior to issuing a permit for burial, or other disposition of the body.  When the local health officer is not a physician or when there is no such officer, the local agent may complete the certificate on the basis of information received from relatives of the deceased or others having knowledge of the facts.

     If the circumstances of the case suggest that the death or fetal death was caused by other than natural causes, the local agent shall refer the case to the coroner for investigation and certification."

     SECTION 7.  Section 338-17.7, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

     "(a)  The department of health shall establish, in the following circumstances, a new certificate of birth for a person born in this State who already has a birth certificate filed with the department and who is referred to below as the "birth registrant":

     (1)  Upon receipt of an affidavit of paternity, a court order establishing paternity, or a certificate of marriage establishing the marriage of the natural parents to each other, together with a request from the birth registrant, or the birth registrant's parent or other person having legal custody of the birth registrant, that a new birth certificate be prepared because previously recorded information has been altered pursuant to law;

     (2)  Upon receipt of a certified copy of a final order, judgment, or decree of a court of competent jurisdiction that determined the nonexistence of a parent and child relationship between a person identified as a parent on the birth certificate on file and the birth registrant;

     (3)  Upon receipt of a certified copy of a final adoption decree, or of an abstract of the decree, pursuant to sections 338-20 and 578-14;

     (4)  Upon receipt of an affidavit from a United States licensed physician or physician assistant attesting that:

(A)  The physician or physician assistant has a bona fide [physician-patient] provider-patient relationship with the birth registrant;

(B)  The physician or physician assistant has treated and evaluated the birth registrant and has reviewed and evaluated the birth registrant's medical history;

(C)  The birth registrant has had appropriate clinical treatment for gender transition to the new gender and has completed the transition to the new gender; and

(D)  The new gender does not align with the sex designation on the birth registrant's birth certificate; or

     (5)  Upon request of a law enforcement agency certifying that a new birth certificate showing different information would provide for the safety of the birth registrant; provided that the new birth certificate shall contain information requested by the law enforcement agency, shall be assigned a new number and filed accordingly, and shall not substitute for the birth registrant's original birth certificate, which shall remain in place."

     SECTION 8.  Section 392-26, Hawaii Revised Statutes, is amended as follows:

     1.  By amending its title and subsection (a) to read:

     "§392-26  Care by physician, physician assistant, advanced practice registered nurse, or equivalent required.  (a)  An individual shall be ineligible to receive temporary disability benefits with respect to any period during which the individual is not under the care of a person duly licensed to practice medicine, surgery, dentistry, chiropractic, osteopathy, or naturopathic medicine[,]; a physician assistant; or an advanced practice registered nurse, who shall certify, in the form and manner specified by rule of the director, the disability of the claimant, the probable duration of the disability, and such other medical facts within the person's knowledge as required by rule."

     2.  By amending subsection (c) to read:

     "(c)  The proof of disability duly certified by a person licensed to practice medicine, surgery, dentistry, chiropractic, osteopathy, or naturopathic medicine[, or]; a physician assistant; an advanced practice registered nurse[,]; or an authorized or accredited practitioner of any group that depends [for] on healing upon prayer or other spiritual means shall be submitted by the certifying person to the disabled employee within seven working days after the date on which the employee was examined and found disabled.  If the certifying person fails to submit the required proof within seven working days, the director, upon notification by the insurer, may levy a penalty of $25 for each delinquent certification where the certifying person fails to show good cause for the person's failure to file on time."

     SECTION 9.  Section 453-5.5, Hawaii Revised Statutes, is amended to read as follows:

     "[[]§453-5.5[]]  Physician assistant; authority to sign documents.  Any physician assistant who holds a current, valid, and permanent license to practice medicine pursuant to this chapter, and who is under the supervision of a licensed physician or osteopathic physician, shall have the authority to sign the following documents:

     (1)  Certification of psychiatric medical condition of the parents of a child applicant for aid from the temporary assistance for needy families program;

     (2)  Evaluation forms for Hansen's disease patients;

     (3)  Orders for physical therapy and plans of care;

     (4)  Pharmacist orders to assist in monitoring and management of anticoagulation anemia and atrial fibrillation;

     (5)  Orders for speech therapy and plans of care;

     (6)  Applications for bracelets indicating compassionate care only;

     (7)  Admissions applications for foster homes;

     (8)  Dietary consultations forms; [and]

     (9)  Medicaid application forms for nursing care facility admission[.] and

    (10)  Orders for occupational therapy and plans of care."

     SECTION 10.  Section 461-1, Hawaii Revised Statutes, is amended by amending the definition of "practice of pharmacy" to read as follows:

     ""Practice of pharmacy" means:

     (1)  The interpretation and evaluation of prescription orders; the compounding, dispensing, and labeling of drugs and devices (except labeling by a manufacturer, packer, or distributor of nonprescription drugs and commercially legend drugs and devices); the participation in drug selection and drug utilization reviews; the proper and safe storage of drugs and devices and the maintenance of proper records therefor; the responsibility for advising when necessary or where regulated, of therapeutic values, content, hazards, and use of drugs and devices; and the interpretation and evaluation of prescription orders to adjust the supply dispensed for purposes of medication synchronization pursuant to section 431:10A-606, 432:1-621, or 432D-30;

     (2)  Performing the following procedures or functions as part of the care provided by and in concurrence with a "health care facility" and "health care service" as defined in section 323D-2[, or]; a "pharmacy" [or a]; licensed physician, licensed physician assistant, or  licensed advanced practice registered nurse with prescriptive authority[,]; or a "managed care plan" as defined in section 432E-1, in accordance with policies, procedures, or protocols developed collaboratively by health professionals, including physicians and surgeons, pharmacists, physician assistants, and registered nurses, and for which a pharmacist has received appropriate training required by these policies, procedures, or protocols:

          (A)  Ordering or performing routine drug therapy related patient assessment procedures;

          (B)  Ordering drug therapy related laboratory tests;

          (C)  Initiating emergency contraception oral drug therapy in accordance with a written collaborative agreement approved by the board, between a licensed physician, physician assistant, or advanced practice registered nurse with prescriptive authority and a pharmacist who has received appropriate training that includes programs approved by the Accreditation Council for Pharmacy Education (ACPE), curriculum-based programs from an ACPE-accredited college of pharmacy, state or local health department programs, or programs recognized by the board of pharmacy;

          (D)  Administering drugs orally, topically, by intranasal delivery, or by injection, pursuant to the order of the patient's licensed physician, physician assistant, or advanced practice registered nurse with prescriptive authority, by a pharmacist having appropriate training that includes programs approved by the ACPE, curriculum-based programs from an ACPE-accredited college of pharmacy, state or local health department programs, or programs recognized by the board of pharmacy;

          (E)  Administering:

              (i)  Immunizations orally, by injection, or by intranasal delivery, to persons eighteen years of age or older by a pharmacist having appropriate training that includes programs approved by the ACPE, curriculum-based programs from an ACPE-accredited college of pharmacy, state or local health department programs, or programs recognized by the board of pharmacy;

             (ii)  Vaccines to persons between fourteen and seventeen years of age pursuant to section 461-11.4; and

            (iii)  Human papillomavirus, Tdap (tetanus, diphtheria, pertussis), meningococcal, and influenza vaccines to persons between eleven and seventeen years of age pursuant to section 461-11.4;

          (F)  As authorized by the written instructions of a licensed physician, physician assistant, or advanced practice registered nurse with prescriptive authority, initiating or adjusting the drug regimen of a patient pursuant to an order or authorization made by the patient's licensed physician, physician assistant, or advanced practice registered nurse with prescriptive authority and related to the condition for which the patient has been seen by the licensed physician, physician assistant, or advanced practice registered nurse with prescriptive authority; provided that the pharmacist shall issue written notification to the patient's licensed physician, physician assistant, or advanced practice registered nurse with prescriptive authority or enter the appropriate information in an electronic patient record system shared by the licensed physician, physician assistant, or advanced practice registered nurse with prescriptive authority, within twenty-four hours;

          (G)  Transmitting a valid prescription to another pharmacist for the purpose of filling or dispensing;

          (H)  Providing consultation, information, or education to patients and health care professionals based on the pharmacist's training and for which no other licensure is required; or

          (I)  Prescribing and dispensing an opioid antagonist pursuant to section 461-11.8;

     (3)  The offering or performing of those acts, services, operations, or transactions necessary in the conduct, operation, management, and control of pharmacy; and

     (4)  Prescribing and dispensing contraceptive supplies pursuant to section 461-11.6."

     SECTION 11.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 12.  This Act shall take effect on January 1, 2023.

 

 

Report Title:

Physician Assistant; Scope of Practice

 

Description:

Expands the authorized scope of practice for physician assistants.  Effective 1/1/2023.  (SD2)

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.