SENATE BILL 23-083
BY SENATOR(S) Winter F. and Simpson, Cutter, Exum, Jaquez Lewis,
Pelton B., Pelton R., Priola, Will;
also REPRESENTATIVE(S) Winter T. and Michaelson Jenet, Amabile,
Bockenfeld, Bradley, Brown, deGruy Kennedy, Dickson, Duran, English,
Epps, Frizell, Froelich, Hamrick, Jodeh, Lieder, Lindsay, Marshall,
McCormick, Parenti, Ricks, Titone, Velasco, Weissman, McCluskie.
C
ONCERNING AN EXPANSION OF A PHYSICIAN ASSISTANT 'S ABILITY TO
PRACTICE
, AND, IN CONNECTION THEREWITH , CHANGING THE
RELATIONSHIP BETWEEN A PHYSICIAN ASSISTANT AND A PHYSICIAN
OR PODIATRIST FROM SUPERVISION TO COLLABORATION
.
Be it enacted by the General Assembly of the State of Colorado:
SECTION 1. In Colorado Revised Statutes, 12-240-107, amend (6)
as follows:
12-240-107. Practice of medicine defined - exemptions from
licensing requirements - unauthorized practice by physician assistants
and anesthesiologist assistants - penalties - definitions - rules - repeal.
(6) (a) A person licensed under the laws of this state to practice medicine
may delegate to a physician assistant licensed by the board pursuant to
NOTE: This bill has been prepared for the signatures of the appropriate legislative
officers and the Governor. To determine whether the Governor has signed the bill
or taken other action on it, please consult the legislative status sheet, the legislative
history, or the Session Laws.
________
Capital letters or bold & italic numbers indicate new material added to existing law; dashes
through words or numbers indicate deletions from existing law and such material is not part of
the act. section 12-240-113 the authority to perform acts that constitute the practice
of medicine and acts that physicians are authorized by law to perform to the
extent and in the manner authorized by rules promulgated by the board,
including the authority to prescribe medication, including controlled
substances, and dispense only the drugs designated by the board. The acts
must be consistent with sound medical practice. Each prescription for a
controlled substance, as defined in section 18-18-102 (5), issued by a
physician assistant licensed by the board shall be imprinted with the name
of the physician assistant's supervising physician. For all other prescriptions
issued by a physician assistant, the name and address of the health facility
and, if the health facility is a multi-speciality organization, the name and
address of the speciality clinic within the health facility where the physician
assistant is practicing must be imprinted on the prescription. Nothing in this
subsection (6) limits the ability of otherwise licensed health personnel to
perform delegated acts. The dispensing of prescription medication by a
physician assistant is subject to section 12-280-120 (6) A PHYSICIAN
ASSISTANT MAY NOT PROVIDE CARE UNLESS THE PHYSICIAN ASSISTANT HAS
ENTERED INTO A COLLABORATIVE AGREEMENT WITH A PHYSICIAN LICENSED
IN GOOD STANDING PURSUANT TO THIS ARTICLE
240 OR ARTICLE 290 OF THIS
TITLE
12 OR A PHYSICIAN GROUP.
(b) (I) If the authority to perform an act is delegated pursuant to
subsection (6)(a) of this section, the physician assistant to whom the act is
delegated shall not perform the act except under the personal and
responsible direction and supervision of a person licensed under the laws
of this state to practice medicine. A licensed physician may be responsible
for the direction and supervision of up to eight physician assistants at any
one time. A licensed physician shall not be made responsible for the
direction and supervision of more than four physician assistants unless the
licensed physician agrees to assume the responsibility. A licensed physician
has sole discretion to assume or refuse such responsibility, and an employer
shall not require a licensed physician to assume such responsibility as a
condition of employment. The board, by rule, may define what constitutes
appropriate direction and supervision of a physician assistant; except that
the board shall not promulgate a rule that is inconsistent with section
12-240-114.5 WITH A COLLABORATIVE AGREEMENT IN PLACE , A PHYSICIAN
ASSISTANT LICENSED BY THE BOARD PURSUANT TO SECTION
12-240-113 MAY
PERFORM ACTS WITHIN THE PHYSICIAN ASSISTANT
'S EDUCATION,
EXPERIENCE, AND COMPETENCY THAT CONSTITUTE THE PRACTICE OF
MEDICINE AND ACTS THAT PHYSICIANS ARE AUTHORIZED BY LAW TO
PAGE 2-SENATE BILL 23-083 PERFORM TO THE EXTENT AND IN THE MANNER AUTHORIZED BY RULES
PROMULGATED BY THE BOARD
, INCLUDING PRESCRIBING AND DISPENSING
MEDICATION
, INCLUDING CONTROLLED SUBSTANCES .
(II) For purposes of this subsection (6), "personal and responsible
direction and supervision" means that the direction and supervision of a
physician assistant is personally rendered by a licensed physician practicing
in the state of Colorado and is not rendered through intermediaries. The
extent of direction and supervision shall be determined by rules
promulgated by the board and as otherwise provided in this subsection
(6)(b); except that, when a physician assistant is performing a delegated
medical function in an acute care hospital, the board shall allow supervision
and direction to be performed without the physical presence of the physician
during the time the delegated medical functions are being implemented if:
(A) The medical functions are performed where the supervising
physician regularly practices or in a designated health manpower shortage
area;
(B) The licensed supervising physician reviews the quality of
medical services rendered by the physician assistant by reviewing the
medical records to assure compliance with the physicians' directions; and
(C) The performance of the delegated medical function otherwise
complies with the board's rules and any restrictions and protocols of the
licensed supervising physician and hospital.
(c) Pursuant to section 12-240-135 (7), the board may apply for an
injunction to enjoin any person from performing delegated medical acts that
are in violation of this section or of any rules promulgated by the board THE
COLLABORATIVE AGREEMENT MUST BE KEPT ON FILE AT THE PHYSICIAN
ASSISTANT
'S PRIMARY LOCATION OF PRACTICE AND BE MADE AVAILABLE TO
THE BOARD UPON REQUEST
.
(d) This subsection (6) shall not apply to any person who performsdelegated medical tasks within the scope of the exemption contained in
subsection (3)(l) of this section AN ACT BY A PHYSICIAN ASSISTANT THAT
CONSTITUTES THE PRACTICE OF MEDICINE MUST BE CONSISTENT WITH
GENERALLY ACCEPTED STANDARDS OF MEDICAL PRACTICE
. A PHYSICIAN
ASSISTANT SHALL COLLABORATE WITH THE APPROPRIATE HEALTH
-CARE
PAGE 3-SENATE BILL 23-083 PROVIDER AS INDICATED BY THE CONDITION OF THE PATIENT , THE STANDARD
OF CARE
, AND THE PHYSICIAN ASSISTANT'S EDUCATION, EXPERIENCE, AND
COMPETENCE
.
(e) A
N EMPLOYER SHALL NOT REQUIRE A LICENSED PHYSICIAN TO
ENTER INTO A COLLABORATIVE AGREEMENT AS A CONDITION OF THE
PHYSICIAN
'S EMPLOYMENT.
(f) A
LL PRESCRIPTIONS ISSUED BY A PHYSICIAN ASSISTANT MUST
INCLUDE THE PHYSICIAN ASSISTANT
'S NAME, THE NAME AND ADDRESS OF
THE HEALTH FACILITY
, AND, IF THE HEALTH FACILITY IS A MULTISPECIALTY
ORGANIZATION
, THE NAME AND ADDRESS OF THE SPECIALITY CLINIC WITHIN
THE HEALTH FACILITY WHERE THE PHYSICIAN ASSISTANT IS PRACTICING
. THE
DISPENSING OF PRESCRIPTION MEDICATION BY A PHYSICIAN ASSISTANT IS
SUBJECT TO SECTION
12-280-120 (6)(a).
(g) W
HILE PERFORMING ACTS INCLUDED IN THE PRACTICE OF
MEDICINE
, AS DEFINED IN SUBSECTION (1) OF THIS SECTION, A PHYSICIAN
ASSISTANT SHALL CLEARLY IDENTIFY ONESELF
, BOTH VISUALLY AND
VERBALLY
, AS A PHYSICIAN ASSISTANT. AN EMPLOYER, PHYSICIAN, OR
PHYSICIAN GROUP MUST IDENTIFY TO PATIENTS THAT A PHYSICIAN
ASSISTANT PROVIDING CARE IS A PHYSICIAN ASSISTANT
.
(h) P
URSUANT TO SECTION 12-240-135 (7), THE BOARD MAY APPLY
FOR AN INJUNCTION TO ENJOIN ANY PERSON FROM PERFORMING MEDICAL
ACTS THAT ARE IN VIOLATION OF THIS SECTION OR OF ANY RULES
PROMULGATED BY THE BOARD
.
(i) T
HIS SUBSECTION (6) DOES NOT APPLY TO ANY PERSON WHO
PERFORMS MEDICAL TASKS WITHIN THE SCOPE OF THE EXEMPTION SPECIFIED
IN SUBSECTION
(3)(l) OF THIS SECTION.
(j) A
PHYSICIAN ASSISTANT IS LIABLE FOR THE CARE PROVIDED BY
THE PHYSICIAN ASSISTANT
.
(k) A
PHYSICIAN ASSISTANT SHALL COMPLY WITH THE FINANCIAL
RESPONSIBILITY REQUIREMENTS SPECIFIED IN SECTION
13-64-301 (1) AND
RULES ADOPTED BY THE BOARD PURSUANT TO THAT SECTION
.
(l) P
URSUANT TO SECTION 12-240-138 (1)(d)(I), A PHYSICIAN
PAGE 4-SENATE BILL 23-083 ASSISTANT IS NOT AUTHORIZED TO OWN A MAJORITY OF A MEDICAL
PRACTICE
.
SECTION 2. In Colorado Revised Statutes, amend 12-240-114.5
as follows:
12-240-114.5. Physician assistants - collaboration requirements
- proof of practice hours from another jurisdiction - liability -
definitions. (1) As used in this section, unless the context otherwise
requires:
(a) "C
OLLABORATION" MEANS, AS INDICATED BY THE PATIENT'S
CONDITION
, COMMUNITY STANDARDS OF CARE , AND A PHYSICIAN
ASSISTANT
'S EDUCATION, TRAINING, AND EXPERIENCE:
(I) C
ONSULTATION BETWEEN THE PHYSICIAN ASSISTANT AND A
PHYSICIAN OR PHYSICIAN GROUP
; OR
(II) REFERRAL BY THE PHYSICIAN ASSISTANT TO A PHYSICIAN , OR, IF
THE REFERRAL IS TO A PHYSICIAN PRACTICING IN A DIFFERENT PRACTICE
AREA THAN THE PHYSICIAN ASSISTANT
, A PHYSICIAN'S PRACTICE GROUP.
(b) "C
OLLABORATIVE AGREEMENT " MEANS A WRITTEN AGREEMENT
THAT DESCRIBES THE MANNER IN WHICH A PHYSICIAN ASSISTANT
COLLABORATES WITH A PHYSICIAN OR A PHYSICIAN GROUP
.
(a)
(c) "Performance evaluation" means a document that includes
domains of competency relevant to the practice of a physician assistant,
uses more than one modality of assessment to evaluate the domains, and
includes consideration of the physician assistant's education, training,
experience, competency, and knowledge of the specialty
PRACTICE AREA in
which the physician assistant is engaged.
(b) "Practice agreement" means a written agreement between a
physician assistant and a supervising physician that defines the
communication and decision-making process by which the physician
assistant and the supervising physician provide care to patients.
(c) "Supervisory plan" means a document that allows a supervising
physician to follow the ongoing professional development of a physician
PAGE 5-SENATE BILL 23-083 assistant's clinical practice, promotes a collaborative relationship between
a physician assistant and his or her supervising physicians, and allows a
supervising physician to address any deficiencies that have been identified
in the physician assistant's clinical competencies during the initial
performance period.
(d) "PHYSICIAN" MEANS A PHYSICIAN LICENSED IN GOOD STANDING
PURSUANT TO THIS ARTICLE
240 OR ARTICLE 290 OF THIS TITLE 12,
INCLUDING A PHYSICIAN IN A PHYSICIAN GROUP .
(2) (a) A physician assistant licensed pursuant to this article 240
who has practiced for less than three years is subject to the followingsupervisory requirements SHALL ENTER INTO A COLLABORATIVE AGREEMENT
WITH A PHYSICIAN OR A PHYSICIAN GROUP
. THE PHYSICIAN ENTERING INTO
A COLLABORATIVE AGREEMENT MUST BE ACTIVELY PRACTICING IN
COLORADO WITH A REGULAR AND RELIABLE PHYSICAL PRESENCE IN
COLORADO. THE COLLABORATIVE AGREEMENT MUST INCLUDE :
(a)
(I) The physician assistant's first one hundred sixty working
hours shall be supervised by a supervising physician who works at the same
location as the physician assistant. The physician assistant's primary
supervising physician shall provide at least forty hours of supervision, and
the remaining hours may be provided by a secondary supervising physician
who is designated by the primary supervising physician. THE PHYSICIAN
ASSISTANT
'S NAME, LICENSE NUMBER, AND PRIMARY LOCATION OF PRACTICE;
(b)
(II) After the physician assistant completes one hundred sixty
working hours, a supervising physician must remain available to the
physician assistant via a telecommunication device at all times when the
physician assistant is working. THE SIGNATURE OF THE PHYSICIAN
ASSISTANT AND THE PHYSICIAN OR PHYSICIAN GROUP WITH WHOM THE
PHYSICIAN ASSISTANT HAS ENTERED INTO THE COLLABORATIVE AGREEMENT
;
(c) (III) Not more than thirty days after the physician assistant
completes one hundred sixty working hours, the primary supervising
physician shall complete an initial performance assessment and a
supervisory plan for the physician assistant. A DESCRIPTION OF THE
PHYSICIAN ASSISTANT
'S PROCESS FOR COLLABORATION , THE DEGREE OF
WHICH MUST BE BASED ON THE PHYSICIAN ASSISTANT
'S PRIMARY LOCATION
AND AREA OF PRACTICE AND MAY INCLUDE
:
PAGE 6-SENATE BILL 23-083 (A) DECISIONS MADE BY THE PHYSICIAN OR PHYSICIAN GROUP WITH
WHOM THE PHYSICIAN ASSISTANT HAS ENTERED INTO A COLLABORATIVE
AGREEMENT
; AND
(B) THE CREDENTIALING OR PRIVILEGING REQUIREMENTS OF THE
PHYSICIAN ASSISTANT
'S PRIMARY LOCATION OF PRACTICE;
(IV) A
DESCRIPTION OF THE PERFORMANCE EVALUATION PROCESS ,
WHICH MAY BE COMPLETED BY THE PHYSICIAN ASSISTANT 'S EMPLOYER IN
ACCORDANCE WITH A PERFORMANCE EVALUATION AND REVIEW PROCESS
ESTABLISHED BY THE EMPLOYER
; AND
(V) ANY ADDITIONAL REQUIREMENTS SPECIFIC TO THE PHYSICIAN
ASSISTANT
'S PRACTICE REQUIRED BY THE PHYSICIAN ENTERING INTO THE
COLLABORATIVE AGREEMENT
, INCLUDING ADDITIONAL LEVELS OF
OVERSIGHT
, LIMITATIONS ON AUTONOMOUS JUDGMENT , AND THE
DESIGNATION OF A PRIMARY CONTACT FOR COLLABORATION
.
(b) (I) E
XCEPT AS PROVIDED IN SUBSECTION (2)(b)(IV) OF THIS
SECTION
, FOR A PHYSICIAN ASSISTANT WITH FEWER THAN FIVE THOUSAND
PRACTICE HOURS
, OR A PHYSICIAN ASSISTANT CHANGING PRACTICE AREAS
WITH FEWER THAN THREE THOUS AND PRACTICE HOURS IN THE NEW PRACTICE
AREA
, THE COLLABORATIVE AGREEMENT IS A SUPERVISORY AGREEMENT
THAT MUST INCLUDE THE PROVISIONS DESCRIBED IN SUBSECTIONS
(2)(a)(III)(A), (2)(a)(III)(B), (2)(a)(IV), AND (2)(a)(V) OF THIS SECTION AND
MUST ALSO
:
(A) R
EQUIRE THAT COLLABORATION DURING THE FIRST ONE
HUNDRED SIXTY PRACTICE HOURS BE COMPLETED IN PERSON OR THROUGH
TECHNOLOGY
, AS PERMITTED BY THE PHYSICIAN OR PHYSICIAN GROUP WITH
WHOM THE PHYSICIAN ASSISTANT HAS ENTERED INTO THE COLLABORATIVE
AGREEMENT
;
(B) I
NCORPORATE ELEMENTS DEFINING THE EXPECTED NATURE OF
COLLABORATION
, INCLUDING: THE PHYSICIAN ASSISTANT'S EXPECTED AREA
OF PRACTICE
; EXPECTATIONS REGARDING SUPPORT AND CONSULTATION
FROM THE PHYSICIAN OR PHYSICIAN GROUP WITH WHOM THE PHYSICIAN
ASSISTANT HAS ENTERED INTO A COLLABORATIVE AGREEMENT
; METHODS
AND MODES OF COMMUNICATION AND COLLABORATION
; AND ANY OTHER
PERTINENT ELEMENTS OF COLLABORATIVE
, TEAM-BASED PRACTICE
PAGE 7-SENATE BILL 23-083 APPLICABLE TO THE PHYSICIAN ASSISTANT'S PRACTICE OR ESTABLISHED BY
THE EMPLOYER
; AND
(C) REQUIRE A PERFORMANCE EVALUATION AND DISCUSSION OF THE
PERFORMANCE EVALUATION WITH THE PHYSICIAN ASSISTANT AFTER THE
PHYSICIAN ASSISTANT HAS WORKED WITH THE EMPLOYER FOR SIX MONTHS
,
AGAIN AFTER THE PHYSICIAN ASSISTANT HAS WORKED WITH THE EMPLOYER
FOR TWELVE MONTHS
, AND ADDITIONAL EVALUATION THEREAFTER AS
DETERMINED BY THE PHYSICIAN OR PHYSICIAN GROUP WITH WHOM THE
PHYSICIAN ASSISTANT HAS ENTERED INTO THE COLLABORATIVE AGREEMENT
.
(II) T
HE PERFORMANCE EVALUATION MAY BE COMPLETED BY THE
PHYSICIAN ASSISTANT
'S EMPLOYER IN ACCORDANCE WITH THE
PERFORMANCE EVALUATION AND REVIEW PROCESS ESTABLISHED BY THE
EMPLOYER
; EXCEPT THAT THE PERFORMANCE EVALUATION MUST BE
COMPLETED WITH AT LEAST THE MINIMUM FREQUENCY REQUIRED IN SECTION
(2)(b)(I)(C) OF THIS SECTION.
(III) E
XCEPT AS PROVIDED IN SUBSECTION (2)(b)(IV) OF THIS
SECTION
, AFTER A PHYSICIAN ASSISTANT HAS COMPLETED THE NUMBER OF
PRACTICE HOURS REQUIRED PURSUANT TO THIS SUBSECTION
(2), THE
ADDITIONAL COLLABORATIVE AGREEMENT REQUIREMENTS DESCRIBED IN
THIS SUBSECTION
(2)(b) NO LONGER APPLY.
(IV) N
OTWITHSTANDING THE PROVISIONS OF THIS SUBSECTION (2):
(A) F
OR A PHYSICIAN ASSISTANT ENTERING INTO A COLLABORATIVE
AGREEMENT WITH A PHYSICIAN OR PHYSICIAN GROUP IN THE EMERGENCY
DEPARTMENT OF A HOSPITAL WITH A LEVEL
I OR LEVEL II TRAUMA CENTER,
THE COLLABORATIVE AGREEMENT REMAINS A SUPERVISORY AGREEMENT
AND CONTINUES INDEFINITELY
.
(B) F
OR A PHYSICIAN ASSISTANT CHANGING PRACTICE AREAS TO
PRACTICE IN AN EMERGENCY DEPARTMENT OF A HOSPITAL THAT IS NOT A
LEVEL
I OR LEVEL II TRAUMA CENTER, THE SUPERVISING PHYSICIAN OR
PHYSICIAN GROUP MAY INCREASE THE NUMBER OF HOURS FOR WHICH THE
COLLABORATIVE AGREEMENT IS A SUPERVISORY AGREEMENT PURSUANT TO
THIS SUBSECTION
(2)(b).
(3) (a) The supervision of a physician assistant licensed pursuant to
PAGE 8-SENATE BILL 23-083 this article 240 who has practiced in this state for three years or more is
determined by a practice agreement that shall be created by the physician
assistant and his or her primary supervising physician not later than thirty
days after the physician assistant begins practicing under the supervision of
the primary supervising physician. A practice agreement must include A
PHYSICIAN ASSISTANT MAY PROVIDE THE BOARD WITH A SIGNED AFFIDAVIT
OUTLINING PRACTICE EXPERIENCE FOR THE PURPOSES OF MEETING THE
REQUIREMENTS DESCRIBED IN SUBSECTION
(2)(b) OF THIS SECTION, AS
APPLICABLE
, IF THE PHYSICIAN ASSISTANT:
(a) H
ELD AN UNENCUMBERED LICENSE IN ANOTHER STATE OR
TERRITORY OF THE
UNITED STATES BEFORE BECOMING LICENSED IN THIS
STATE PURSUANT TO SECTION
12-240-113; OR
(b) WAS INITIALLY LICENSED IN THIS STATE PRIOR TO THE EFFECTIVE
DATE OF THIS SUBSECTION
(3), AS AMENDED.
(I) A process by which a physician assistant and a supervising
physician communicate and make decisions concerning patients' medical
treatment, which process utilizes the knowledge and skills of the physician
assistant and the supervising physician based on their respective education,
training, and experience;
(II) A protocol for designating an alternative physician for
consultation when the supervising physician is unavailable for consultation;
(III) The signatures of the physician assistant and supervising
physician; and
(IV) A termination provision that allows the physician assistant or
the supervising physician to terminate the practice agreement after
providing written notice of his or her intent to do so at least thirty days
before the date of termination. If a practice agreement is terminated, the
physician assistant and the physician assistant's primary supervising
physician shall create a new practice agreement within forty-five days after
the date the previous practice agreement was terminated.
(b) In addition to the components described in subsection (3)(a) of
this section, a practice agreement may impose conditions concerning
specific duties, procedures, or drugs.
PAGE 9-SENATE BILL 23-083 (c) If the terms or conditions of a practice agreement change, both
the physician assistant and the supervising physician shall sign and date the
updated practice agreement.
(4) A physician assistant licensed pursuant to this article 240 who
has practiced for at least twelve months and who is making a substantive
change in his or her scope of practice or practice area is subject to the
following supervisory requirements:
(a) The physician assistant's first eighty working hours shall be
supervised by a supervising physician who works at the same location as the
physician assistant. The physician assistant's primary supervising physician
shall provide at least twenty hours of supervision, and the remaining hours
may be provided by a secondary supervising physician who is designated
by the primary supervising physician.
(b) After the physician assistant completes eighty working hours, a
supervising physician shall remain available to the physician assistant via
a telecommunication device at all times when the physician assistant is
working.
(c) After the physician assistant has worked for six months, and
again after the physician assistant has worked for twelve months, the
primary supervising physician shall complete a performance assessment and
discuss the performance assessment with the physician assistant.
(5) (a) A physician assistant licensed pursuant to this article 240
who has practiced for at least three years may be liable for damages
resulting from negligence in providing care to a patient; except that a
physician assistant is not liable for any damages that occur as a result of the
physician assistant following a direct order from a supervising physician.
(b) A physician assistant who has been practicing for at least three
years shall comply with the financial responsibility requirements specified
in section 13-64-301 (1) and rules adopted by the board pursuant to that
section.
(c) A physician assistant's supervising physician may be liable for
damages resulting from the physician assistant's negligence in providing
care to a patient if the physician assistant has not practiced for at least three
PAGE 10-SENATE BILL 23-083 years as described in subsection (5)(a) of this section.
SECTION 3. In Colorado Revised Statutes, 12-240-119, amend
(2)(c) as follows:
12-240-119. Reentry license - period of inactivity - international
medical graduate - competency assessment - board rules - conversion
to full license. (2) (c) If, based on the assessment and,
IF PRESCRIBED, after
completion of an educational program, if prescribed,
the board determines
that the applicant is competent and qualified to practice medicine without
supervision, or
practice as a physician assistant, or PRACTICE as an
anesthesiologist assistant with supervision, as specified in this article 240,
the board may convert the reentry license to a full license to practice
medicine, practice as a physician assistant, or practice as an anesthesiologist
assistant, as applicable, under this article 240.
SECTION 4. In Colorado Revised Statutes, 12-240-122, amend (1)
as follows:
12-240-122. Prescriptions - requirement to advise patients. (1) A
physician
OR PHYSICIAN ASSISTANT licensed under this article 240 or a
physician assistant licensed by the board who has been delegated the
authority to prescribe medication, may advise the physician's or the
physician assistant's patients of their option to have the symptom or purpose
for which a prescription is being issued included on the prescription order.
SECTION 5. In Colorado Revised Statutes, 12-240-128, amend
(7)(c) as follows:
12-240-128. Physician training licenses. (7) A physician training
licensee may practice medicine as defined by this article 240 with the
following restrictions:
(c) A physician training licensee shall not: have the authority to
(I) Delegate the rendering of medical services to a person who is not
licensed to practice medicine pursuant to section 12-240-107 (3)(l);
OR
(II) and shall not have the authority to supervise
ENTER INTO A
COLLABORATIVE AGREEMENT WITH
physician assistants as provided by
PAGE 11-SENATE BILL 23-083 section 12-240-107 (6) DESCRIBED IN SECTIONS 12-240-107 (6) AND
12-240-114.5.
SECTION 6. In Colorado Revised Statutes, 12-280-103, amend
(39)(c)(II)(B) as follows:
12-280-103. Definitions - rules. As used in this article 280, unless
the context otherwise requires or the term is otherwise defined in another
part of this article 280:
(39) "Practice of pharmacy" means:
(c) The provision of a therapeutic interchange selection or a
therapeutically equivalent selection to a patient if, during the patient's stay
at a nursing care facility or a long-term acute care hospital licensed under
part 1 of article 3 of title 25, the selection has been approved for the patient:
(II) By one of the following health-care providers:
(B) A physician assistant licensed under section 12-240-113; if the
physician assistant is under the supervision of a licensed physician; or
SECTION 7. In Colorado Revised Statutes, 12-280-502, amend
(1)(b)(II) as follows:
12-280-502. Therapeutic interchange and therapeutically
equivalent selections for nursing care facility or long-term acute care
hospital patients - rules. (1) A pharmacy used by a nursing care facility
or a long-term acute care hospital licensed under part 1 of article 3 of title
25 may make a therapeutic interchange or a therapeutically equivalent
selection for a patient if, during the patient's stay at the facility, the selection
has been approved for the patient:
(b) By one of the following health-care providers:
(II) A physician assistant licensed under section 12-240-113; if the
physician assistant is under the supervision of a licensed physician; or
SECTION 8. In Colorado Revised Statutes, 12-290-110, amend (5)
as follows:
PAGE 12-SENATE BILL 23-083 12-290-110. Podiatry training license. (5) A person with a
podiatric training license shall only practice podiatry ONLY under the
supervision of a licensed podiatrist or a physician licensed to practice
medicine within the residency program. A person with a podiatry training
license shall not delegate podiatric or medical services to a person who is
not licensed to practice podiatry or medicine and shall not have the
authority to supervise
COLLABORATE WITH physician assistants.
SECTION 9. In Colorado Revised Statutes, amend 12-290-117 as
follows:
12-290-117. Use of physician assistants - collaboration
requirements - affidavits of practice experience - rules - definitions.
(1) A person licensed under the laws of this state to practice podiatry may
delegate to a physician assistant licensed by the Colorado medical board
pursuant to section 12-240-113 the authority to A PHYSICIAN ASSISTANT
LICENSED PURSUANT TO ARTICLE
240 OF THIS TITLE 12 MAY perform acts
that constitute the practice of podiatry to the extent and in the manner
authorized by rules promulgated by the Colorado podiatry
board. The acts
shall be consistent with sound practices of podiatry. Each prescription for
a controlled substance, as defined in section 18-18-102 (5), issued by a
physician assistant must have the name of the physician assistant's
supervising podiatrist printed on the prescription. For all other ALL
prescriptions issued by a physician assistant MUST INCLUDE THE PHYSICIAN
ASSISTANT
'S NAME, the name and address of the health facility, and, if the
health facility is a multi-speciality
MULTISPECIALTY organization, the name
and address of the speciality SPECIALTY clinic within the health facility
where the physician assistant is practicing. must be imprinted on the
prescription. Nothing in this section limits the ability of otherwise licensed
health personnel to perform delegated acts. The dispensing of prescription
medication by a physician assistant is subject to section 12-280-120 (6).
(2) If the authority to perform an act is delegated pursuant to
subsection (1) of this section, the act shall not be performed except under
the personal and responsible direction and supervision of a person licensed
under the laws of this state to practice podiatry, and the person shall not be
responsible for the direction and supervision of more than four physician
assistants at any one time without specific approval of the Colorado
podiatry board. The board may define appropriate direction and supervision
pursuant to rules PRIOR TO PRACTICING PODIATRY, A PHYSICIAN ASSISTANT
PAGE 13-SENATE BILL 23-083 MUST ENTER INTO A COLLABORATIVE AGREEMENT WITH A LICENSED
PODIATRIST
.
(3) The provisions of sections 12-240-107 (6), and
12-240-113, AND
12-240-114.5 governing physician assistants under the "Colorado Medical
Practice Act" shall apply to physician assistants under this section.
SECTION 10. In Colorado Revised Statutes, 13-64-301, amend (1)
introductory portion as follows:
13-64-301. Financial responsibility. (1) As a condition of active
licensure or authority to practice in this state, every physician, dentist,
dental therapist, or dental hygienist; every physician assistant; who has been
practicing for at least three years; and every health-care institution as
defined in section 13-64-202, except as provided in section 13-64-303.5,
that provides health-care services shall establish financial responsibility, as
follows:
SECTION 11. In Colorado Revised Statutes, 15-18.7-103, amend
(1) introductory portion and (1)(i) as follows:
15-18.7-103. Medical orders for scope of treatment forms - form
contents. (1) A medical orders for scope of treatment form shall
MUST
include the following information concerning the adult whose medical
treatment is the subject of the medical orders for scope of treatment form:
(i) The signature of the adult's physician, advanced practice
registered nurse, or if under the supervision or authority of the physician,
physician assistant.
SECTION 12. In Colorado Revised Statutes, 15-18.7-104, amend
(5) as follows:
15-18.7-104. Duty to comply with medical orders for scope of
treatment form - immunity - effect on criminal charges against another
person - transferability. (5) An adult's physician, advanced practice
registered nurse, or if under the supervision of the physician,
physician
assistant may provide an oral confirmation to a health-care provider who
shall annotate on the medical orders for scope of treatment form the time
and date of the oral confirmation and the name and license number of the
PAGE 14-SENATE BILL 23-083 physician, advanced practice registered nurse, or physician assistant. The
physician, advanced practice registered nurse, or physician assistant shall
countersign the annotation of the oral confirmation on the medical orders
for scope of treatment form within a time period that satisfies any applicable
state law or within thirty days, whichever period is less, after providing the
oral confirmation. The signature of the physician, advanced practice
registered nurse, or physician assistant may be provided by photocopy, fax,
or electronic means. A medical orders for scope of treatment form with
annotated oral confirmation, and a photocopy, fax, or other electronic
reproduction thereof
OF THE FORM, shall be given the same force and effect
as the original form signed by the physician, advanced practice registered
nurse, or physician assistant.
SECTION 13. In Colorado Revised Statutes, 23-21-803, amend (6)
as follows:
23-21-803. Definitions. As used in this part 8, unless the context
otherwise requires:
(6) "Physician assistant" means a person licensed as a physician
assistant by the Colorado medical board in accordance with section
12-240-113 who is authorized, in accordance with section 12-240-107 (6),
to perform acts constituting the practice of medicine, including prescribing
controlled substances. and who is under the supervision of a physician
trained in MAT.
SECTION 14. Act subject to petition - effective date. This act
takes effect at 12:01 a.m. on the day following the expiration of the
ninety-day period after final adjournment of the general assembly; except
that, if a referendum petition is filed pursuant to section 1 (3) of article V
of the state constitution against this act or an item, section, or part of this act
within such period, then the act, item, section, or part will not take effect
unless approved by the people at the general election to be held in
PAGE 15-SENATE BILL 23-083 November 2024 and, in such case, will take effect on the date of the official
declaration of the vote thereon by the governor.
____________________________ ____________________________
Steve Fenberg Julie McCluskie
PRESIDENT OF SPEAKER OF THE HOUSE
THE SENATE OF REPRESENTATIVES
____________________________ ____________________________
Cindi L. Markwell Robin Jones
SECRETARY OF CHIEF CLERK OF THE HOUSE
THE SENATE OF REPRESENTATIVES
APPROVED________________________________________
(Date and Time)
_________________________________________
Jared S. Polis
GOVERNOR OF THE STATE OF COLORADO
PAGE 16-SENATE BILL 23-083