Amendments for HB19-1095
House Journal, March 8
11 HB19-1095 be amended as follows, and as so amended, be referred to
12 the Committee of the Whole with favorable
13 recommendation:
14
15 Amend printed bill, page 9, before line 20 insert:
16
17 "SECTION 6. Appropriation. For the 2019-20 state fiscal year,
18 $4,650 is appropriated to the department of regulatory agencies for use by
19 the division of professions and occupations. This appropriation is from
20 the division of professions and occupations cash fund created in section
21 24-34-105 (2)(b)(I), C.R.S. To implement this act, the division may use
22 this appropriation for operating expenses.".
23
24 Renumber succeeding section accordingly.
25
26 Page 1, line 104, strike "AND".
27
28 Page 1, line 106, strike "BOARD." and substitute "BOARD, AND MAKING
29 AN APPROPRIATION.".
30
31
House Journal, March 12
30 Amendment No. 1, Health & Insurance Report, dated February 19, 2019,
31 and placed in member's bill file; Report also printed in House Journal,
32 February 20, 2019.
33
34 Amendment No. 2, Appropriations Report, dated March 8, 2019, and
35 placed in member's bill file; Report also printed in House Journal, March
36 8, 2019.
37
38 Amendment No. 3, by Representative(s) Cutter.
39
40 Amend the Health and Insurance Committee Report, dated February 19,
41 2019, page 1, line 20, strike "RESPONSIBILITY."." and substitute
42 "RESPONSIBILITY. A LICENSED PHYSICIAN HAS SOLE DISCRETION TO
43 ASSUME OR REFUSE SUCH RESPONSIBILITY, AND AN EMPLOYER SHALL NOT
44 REQUIRE A LICENSED PHYSICIAN TO ASSUME SUCH RESPONSIBILITY AS A
45 CONDITION OF EMPLOYMENT.".".
46
47 Amendment No. 4, by Representative(s) Cutter.
48
49 Amend printed bill, page 7, line 17, strike "and one physician assistant"
50 and substitute "and one physician assistant".
51
52 Page 8, strike lines 1 and 2 and substitute "APPOINTMENT. Thereafter, the
53 terms of the members of the board shall be ARE four years.".
54
1 Page 9, strike lines 20 through 27 and substitute:
2
240 3 "SECTION 5. In Colorado Revised Statutes, add to article
4 of title 12 as relocated by House Bill 19-1172 12-240-114.5 as follows:
5 12-240-114.5. Physician assistants - definitions - supervisory
6 requirements - liability - definitions. (1) AS USED IN THIS SECTION,
7 UNLESS THE CONTEXT OTHERWISE REQUIRES:
8 (a) "PERFORMANCE EVALUATION" MEANS A DOCUMENT THAT
9 INCLUDES DOMAINS OF COMPETENCY RELEVANT TO THE PRACTICE OF A
10 PHYSICIAN ASSISTANT, USES MORE THAN ONE MODALITY OF ASSESSMENT
11 TO EVALUATE THE DOMAINS, AND INCLUDES CONSIDERATION OF THE
12 PHYSICIAN ASSISTANT 'S EDUCATION, TRAINING, EXPERIENCE,
13 COMPETENCY, AND KNOWLEDGE OF THE SPECIALTY IN WHICH THE
14 PHYSICIAN ASSISTANT IS ENGAGED.
15 (b) "PRACTICE AGREEMENT" MEANS A WRITTEN AGREEMENT
16 BETWEEN A PHYSICIAN ASSISTANT AND A SUPERVISING PHYSICIAN THAT
17 DEFINES THE COMMUNICATION AND DECISION-MAKING PROCESS BY WHICH
18 THE PHYSICIAN ASSISTANT AND THE SUPERVISING PHYSICIAN PROVIDE
19 CARE TO PATIENTS.
20 (c) "SUPERVISORY PLAN" MEANS A DOCUMENT THAT ALLOWS A
21 SUPERVISING PHYSICIAN TO FOLLOW THE ONGOING PROFESSIONAL
22 DEVELOPMENT OF A PHYSICIAN ASSISTANT'S CLINICAL PRACTICE,
23 PROMOTES A COLLABORATIVE RELATIONSHIP BETWEEN A PHYSICIAN
24 ASSISTANT AND HIS OR HER SUPERVISING PHYSICIANS, AND ALLOWS A
25 SUPERVISING PHYSICIAN TO ADDRESS ANY DEFICIENCIES THAT HAVE BEEN
26 IDENTIFIED IN THE PHYSICIAN ASSISTANT'S CLINICAL COMPETENCIES
27 DURING THE INITIAL PERFORMANCE PERIOD.
28 (2) A PHYSICIAN ASSISTANT LICENSED PURSUANT TO THIS ARTICLE
29 240 WHO HAS PRACTICED FOR LESS THAN THREE YEARS IS SUBJECT TO THE
30 FOLLOWING SUPERVISORY REQUIREMENTS:
31 (a) THE PHYSICIAN ASSISTANT'S FIRST ONE HUNDRED SIXTY
32 WORKING HOURS SHALL BE SUPERVISED BY A SUPERVISING PHYSICIAN WHO
33 WORKS AT THE SAME LOCATION AS THE PHYSICIAN ASSISTANT. THE
34 PHYSICIAN ASSISTANT'S PRIMARY SUPERVISING PHYSICIAN SHALL PROVIDE
35 AT LEAST FORTY HOURS OF SUPERVISION, AND THE REMAINING HOURS MAY
36 BE PROVIDED BY A SECONDARY SUPERVISING PHYSICIAN WHO IS
37 DESIGNATED BY THE PRIMARY SUPERVISING PHYSICIAN.
38 (b) AFTER THE PHYSICIAN ASSISTANT COMPLETES ONE HUNDRED
39 SIXTY WORKING HOURS, A SUPERVISING PHYSICIAN MUST REMAIN
40 AVAILABLE TO THE PHYSICIAN ASSISTANT VIA A TELECOMMUNICATION
41 DEVICE AT ALL TIMES WHEN THE PHYSICIAN ASSISTANT IS WORKING.
42 (c) NOT MORE THAN THIRTY DAYS AFTER THE PHYSICIAN
43 ASSISTANT COMPLETES ONE HUNDRED SIXTY WORKING HOURS, THE
44 PRIMARY SUPERVISING PHYSICIAN SHALL COMPLETE AN INITIAL
45 PERFORMANCE ASSESSMENT AND A SUPERVISORY PLAN FOR THE PHYSICIAN
46 ASSISTANT.
47 (3) (a) THE SUPERVISION OF A PHYSICIAN ASSISTANT LICENSED
48 PURSUANT TO THIS ARTICLE 240 WHO HAS PRACTICED IN THIS STATE FOR
49 THREE YEARS OR MORE IS DETERMINED BY A PRACTICE AGREEMENT THAT
50 SHALL BE CREATED BY THE PHYSICIAN ASSISTANT AND HIS OR HER
51 PRIMARY SUPERVISING PHYSICIAN NOT LATER THAN THIRTY DAYS AFTER
52 THE PHYSICIAN ASSISTANT BEGINS PRACTICING UNDER THE SUPERVISION
53 OF THE PRIMARY SUPERVISING PHYSICIAN. A PRACTICE AGREEMENT MUST
54 INCLUDE:
55 (I) A PROCESS BY WHICH A PHYSICIAN ASSISTANT AND A
1 SUPERVISING PHYSICIAN COMMUNICATE AND MAKE DECISIONS
2 CONCERNING PATIENTS' MEDICAL TREATMENT, WHICH PROCESS UTILIZES
3 THE KNOWLEDGE AND SKILLS OF THE PHYSICIAN ASSISTANT AND THE
4 SUPERVISING PHYSICIAN BASED ON THEIR RESPECTIVE EDUCATION,
5 TRAINING, AND EXPERIENCE;
6 (II) A PROTOCOL FOR DESIGNATING AN ALTERNATIVE PHYSICIAN
7 FOR CONSULTATION WHEN THE SUPERVISING PHYSICIAN IS UNAVAILABLE
8 FOR CONSULTATION;
9 (III) THE SIGNATURES OF THE PHYSICIAN ASSISTANT AND
10 SUPERVISING PHYSICIAN; AND
11 (IV) A TERMINATION PROVISION THAT ALLOWS THE PHYSICIAN
12 ASSISTANT OR THE SUPERVISING PHYSICIAN TO TERMINATE THE PRACTICE
13 AGREEMENT AFTER PROVIDING WRITTEN NOTICE OF HIS OR HER INTENT TO
14 DO SO AT LEAST THIRTY DAYS BEFORE THE DATE OF TERMINATION. IF A
15 PRACTICE AGREEMENT IS TERMINATED, THE PHYSICIAN ASSISTANT AND
16 THE PHYSICIAN ASSISTANT'S PRIMARY SUPERVISING PHYSICIAN SHALL
17 CREATE A NEW PRACTICE AGREEMENT WITHIN FORTY-FIVE DAYS AFTER
18 THE DATE THE PREVIOUS PRACTICE AGREEMENT WAS TERMINATED.
19 (b) IN ADDITION TO THE COMPONENTS DESCRIBED IN SUBSECTION
20 (3)(a) OF THIS SECTION, A PRACTICE AGREEMENT MAY IMPOSE CONDITIONS
21 CONCERNING SPECIFIC DUTIES, PROCEDURES, OR DRUGS.
22 (c) IF THE TERMS OR CONDITIONS OF A PRACTICE AGREEMENT
23 CHANGE, BOTH THE PHYSICIAN ASSISTANT AND THE SUPERVISING
24 PHYSICIAN SHALL SIGN AND DATE THE UPDATED PRACTICE AGREEMENT.
25 (4) A PHYSICIAN ASSISTANT LICENSED PURSUANT TO THIS ARTICLE
26 240 WHO HAS PRACTICED FOR AT LEAST TWELVE MONTHS AND WHO IS
27 MAKING A SUBSTANTIVE CHANGE IN HIS OR HER SCOPE OF PRACTICE OR
28 PRACTICE AREA IS SUBJECT TO THE FOLLOWING SUPERVISORY
29 REQUIREMENTS:
30 (a) THE PHYSICIAN ASSISTANT'S FIRST EIGHTY WORKING HOURS
31 SHALL BE SUPERVISED BY A SUPERVISING PHYSICIAN WHO WORKS AT THE
32 SAME LOCATION AS THE PHYSICIAN ASSISTANT. THE PHYSICIAN
33 ASSISTANT'S PRIMARY SUPERVISING PHYSICIAN SHALL PROVIDE AT LEAST
34 TWENTY HOURS OF SUPERVISION, AND THE REMAINING HOURS MAY BE
35 PROVIDED BY A SECONDARY SUPERVISING PHYSICIAN WHO IS DESIGNATED
36 BY THE PRIMARY SUPERVISING PHYSICIAN.
37 (b) AFTER THE PHYSICIAN ASSISTANT COMPLETES EIGHTY
38 WORKING HOURS, A SUPERVISING PHYSICIAN SHALL REMAIN AVAILABLE TO
39 THE PHYSICIAN ASSISTANT VIA A TELECOMMUNICATION DEVICE AT ALL
40 TIMES WHEN THE PHYSICIAN ASSISTANT IS WORKING.
41 (c) AFTER THE PHYSICIAN ASSISTANT HAS WORKED FOR SIX
42 MONTHS, AND AGAIN AFTER THE PHYSICIAN ASSISTANT HAS WORKED FOR
43 TWELVE MONTHS, THE PRIMARY SUPERVISING PHYSICIAN SHALL COMPLETE
44 A PERFORMANCE ASSESSMENT AND DISCUSS THE PERFORMANCE
45 ASSESSMENT WITH THE PHYSICIAN ASSISTANT.
46 (5) (a) A PHYSICIAN ASSISTANT LICENSED PURSUANT TO THIS
47 ARTICLE 240 WHO HAS PRACTICED FOR AT LEAST THREE YEARS MAY BE
48 LIABLE FOR DAMAGES RESULTING FROM NEGLIGENCE IN PROVIDING CARE
49 TO A PATIENT; EXCEPT THAT A PHYSICIAN ASSISTANT IS NOT LIABLE FOR
50 ANY DAMAGES THAT OCCUR AS A RESULT OF THE PHYSICIAN ASSISTANT
51 FOLLOWING A DIRECT ORDER FROM A SUPERVISING PHYSICIAN.
52 (b) A PHYSICIAN ASSISTANT WHO MAY BE LIABLE FOR DAMAGES AS
53 DESCRIBED IN SUBSECTION (5)(a) OF THIS SECTION SHALL MAINTAIN
54 PROFESSIONAL LIABILITY INSURANCE IN AN AMOUNT NOT LESS THAN ONE
55 MILLION DOLLARS PER CLAIM AND THREE MILLION DOLLARS FOR ALL
1 CLAIMS.
2 (c) A PHYSICIAN ASSISTANT'S SUPERVISING PHYSICIAN MAY BE
3 LIABLE FOR DAMAGES RESULTING FROM THE PHYSICIAN ASSISTANT'S
4 NEGLIGENCE IN PROVIDING CARE TO A PATIENT IF THE PHYSICIAN
5 ASSISTANT HAS NOT PRACTICED FOR AT LEAST THREE YEARS AS DESCRIBED
6 IN SUBSECTION (5)(a) OF THIS SECTION.
7 SECTION 6. In Colorado Revised Statutes, 12-240-107, amend
8 as relocated by House Bill 19-1172 (6)(b)(I) as follows:
9 12-240-107. Practice of medicine defined - exemptions from
10 licensing requirements - unauthorized practice by physician
11 assistants and anesthesiologist assistants - penalties - definitions -
12 rules - repeal. (6) (b) (I) If the authority to perform an act is delegated
13 pursuant to subsection (6)(a) of this section, the PHYSICIAN ASSISTANT TO
14 WHOM THE act IS DELEGATED shall not be performed PERFORM THE ACT
15 except under the personal and responsible direction and supervision of a
16 person licensed under the laws of this state to practice medicine. A
17 licensed physician may be responsible for the direction and supervision
18 of up to four EIGHT physician assistants at any one time. and may be
19 responsible for the direction and supervision of more than four physician
20 assistants upon receiving specific approval from the board A LICENSED
21 PHYSICIAN SHALL NOT BE MADE RESPONSIBLE FOR THE DIRECTION AND
22 SUPERVISION OF MORE THAN FOUR PHYSICIAN ASSISTANTS UNLESS THE
23 LICENSED PHYSICIAN AGREES TO ASSUME THE RESPONSIBILITY. A
24 LICENSED PHYSICIAN HAS SOLE DISCRETION TO ASSUME OR REFUSE SUCH
25 RESPONSIBILITY, AND AN EMPLOYER SHALL NOT REQUIRE A LICENSED
26 PHYSICIAN TO ASSUME SUCH RESPONSIBILITY AS A CONDITION OF
27 EMPLOYMENT. The board, by rule, may define what constitutes
28 appropriate direction and supervision of a physician assistant; EXCEPT
29 THAT THE BOARD SHALL NOT PROMULGATE A RULE THAT IS INCONSISTENT
30 WITH SECTION 12-240-114.5.
31 SECTION 7. In Colorado Revised Statutes, 12-240-105, amend
32 as relocated by House Bill 19-1172 (1)(a) introductory portion,
33 (1)(a)(II), (1)(b), and (2) as follows:
34 12-240-105. Colorado medical board - immunity - subject to
35 termination - repeal of article. (1) (a) There is hereby created the
36 Colorado medical board, referred to in this article 240 as the "board". The
37 board shall consist of sixteen SEVENTEEN members appointed by the
240 38 governor and possessing the qualifications specified in this article
39 and as follows:
40 (II) One member TWO MEMBERS licensed under this article 240 as
41 a physician assistant PHYSICIAN ASSISTANTS; and
42 (b) The terms of the members of the board shall be ARE four years.
43 For the two physician and one physician assistant appointees added to the
44 board during the calendar year beginning January 1, 2010, the term for
45 one of the physician member appointees shall expire EXPIRES four years
46 after the appointment; the term for the other physician member appointee
47 shall expire EXPIRES three years after the appointment; and the term for
48 the physician assistant appointee shall expire EXPIRES two years after the
49 appointment. THE TERM OF THE PHYSICIAN ASSISTANT APPOINTEE ADDED
50 TO THE BOARD DURING THE CALENDAR YEAR BEGINNING JANUARY 1,
51 2019, EXPIRES TWO YEARS AFTER THE APPOINTMENT. Thereafter, the terms
52 of the members of the board shall be ARE four years.
53 (2) The board shall be comprised MUST INCLUDE at all times of
54 eight members having the degree of doctor of medicine, three members
55 having the degree of doctor of osteopathy, and one physician assistant
1 TWO PHYSICIAN ASSISTANTS, all of whom shall have been licensed in
2 good standing and actively engaged in the practice of their professions in
3 this state for at least three years next preceding their appointments, and
4 four members of the public at large.
5 SECTION 8. In Colorado Revised Statutes, 12-240-116, amend
6 as relocated by House Bill 19-1172 (1)(a) as follows:
7 12-240-116. Licensing panel. (1) (a) The president of the board
8 shall establish a licensing panel consisting of three FOUR members of the
9 board as follows:
10 (I) One panel member shall be WHO IS a licensed physician having
11 the degree of doctor of medicine;
12 (II) One panel member shall be WHO IS a licensed physician
13 having the degree of doctor of osteopathy; and
14 (III) One panel member shall be WHO IS a public member of the
15 board; AND
16 (IV) ONE MEMBER WHO IS A PHYSICIAN ASSISTANT MEMBER OF
17 THE BOARD.
18 SECTION 9. Act subject to petition - effective date -
19 applicability. (1) (a) Except as otherwise provided in subsection (1)(b)
20 of this section, this act takes effect at 12:01 a.m. on the day following the
21 expiration of the ninety-day period after final adjournment of the general
22 assembly (August 2, 2019, if adjournment sine die is on May 3, 2019);
23 except that, if a referendum petition is filed pursuant to section 1 (3) of
24 article V of the state constitution against this act or an item, section, or
25 part of this act within such period, then the act, item, section, or part will
26 not take effect unless approved by the people at the general election to be
27 held in November 2020 and, in such case, will take effect on the date of
28 the official declaration of the vote thereon by the governor.
29 (b) Sections 5 through 8 of this act take effect only if House Bill
30 19-1172 becomes law, in which case sections 5 through 8 take effect
31 October 1, 2019.
32 (2) This act applies to the supervision of persons who practice as
33 physician assistants on or after the applicable effective date of this act.".
34
35 Strike page 10.
36
37 Strike "MUST" and substitute "SHALL" on: Page 3, lines 21 and 23; Page
38 4, line 12; Page 5, lines 6, 14, 21, and 23; and Page 6, line 1.
39
40 As amended, ordered engrossed and placed on the Calendar for Third
41 Reading and Final Passage.
Senate Journal, April 4
After consideration on the merits, the Committee recommends that HB19-1095 be
amended as follows, and as so amended, be referred to the Committee on Appropriations
with favorable recommendation.
Amend reengrossed bill, page 9, strike lines 10 through 15.
Renumber succeeding sections accordingly.
Page 16, after line 6, insert:
"SECTION 9. Appropriation. For the 2019-20 state fiscal year,
$4,650 is appropriated to the department of regulatory agencies for use
by the division of professions and occupations. This appropriation is
from the division of professions and occupations cash fund created in
section 24-34-105 (2)(b)(I), C.R.S. To implement this act, the division
may use this appropriation for operating expenses.".
Renumber succeeding section accordingly.
State,
Veterans, &
Military
Affairs