Introduced Version
SENATE BILL No. 190
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 16-42-27-1; IC 25-1; IC 25-27.5.
Synopsis: Physician assistants. Amends current requirements for a
collaborative agreement between a physician and a physician assistant
with the following: (1) the collaborative agreement must include
limitations; (2) the collaborative agreement must set forth the method
of collaboration between the physician and physician assistant; and (3)
the collaborative agreement must be signed, updated annually, and
made available to the medical licensing board of Indiana upon request.
Amends the definition of "prescriber" for purposes of electronically
transmitted prescriptions for controlled substances, overdose
intervention drugs, and telehealth services and prescriptions. Provides
that a written collaborative agreement between a physician assistant,
who is employed by a certain health care facility or center, and a
particular collaborating physician is not required. Requires a physician
assistant employed by a certain health care facility or center to enter
into a practice agreement with the health care facility or center that
employs the physician assistant. Eliminates: (1) a prohibition against
a physician collaborating with more than four physician assistants at
the same time; (2) a requirement that a physician submit a collaborative
agreement to the medical licensing board; and (3) a requirement that
a collaborating physician and physician assistant submit a list of
locations the physician and physician assistant will practice to the
medical licensing board.
Effective: July 1, 2023.
Charbonneau
January 10, 2023, read first time and referred to Committee on Health and Provider
Services.
2023 IN 190—LS 6746/DI 147 Introduced
First Regular Session of the 123rd General Assembly (2023)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
Constitution) is being amended, the text of the existing provision will appear in this style type,
additions will appear in this style type, and deletions will appear in this style type.
Additions: Whenever a new statutory provision is being enacted (or a new constitutional
provision adopted), the text of the new provision will appear in this style type. Also, the
word NEW will appear in that style type in the introductory clause of each SECTION that adds
a new provision to the Indiana Code or the Indiana Constitution.
Conflict reconciliation: Text in a statute in this style type or this style type reconciles conflicts
between statutes enacted by the 2022 Regular Session of the General Assembly.
SENATE BILL No. 190
A BILL FOR AN ACT to amend the Indiana Code concerning
professions and occupations.
Be it enacted by the General Assembly of the State of Indiana:
1 SECTION 1. IC 16-42-27-1, AS AMENDED BY P.L.247-2019,
2 SECTION 1, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 JULY 1, 2023]: Sec. 1. As used in this chapter, "prescriber" means any
4 of the following:
5 (1) A physician licensed under IC 25-22.5.
6 (2) A physician assistant licensed under IC 25-27.5. and granted
7 the authority to prescribe by the physician assistant's collaborating
8 physician and in accordance with IC 25-27.5-5-4.
9 (3) An advanced practice registered nurse licensed and granted
10 the authority to prescribe drugs under IC 25-23.
11 (4) The state health commissioner, if the state health
12 commissioner holds an active license under IC 25-22.5.
13 (5) A public health authority.
14 SECTION 2. IC 25-1-9.3-5, AS ADDED BY P.L.28-2019,
15 SECTION 9, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
16 JULY 1, 2023]: Sec. 5. As used in this chapter, "prescriber" means any
17 of the following:
2023 IN 190—LS 6746/DI 147 2
1 (1) A dentist licensed under IC 25-14.
2 (2) A physician licensed under IC 25-22.5.
3 (3) An advanced practice registered nurse licensed and granted
4 the authority to prescribe under IC 25-23.
5 (4) An optometrist licensed under IC 25-24.
6 (5) A physician assistant licensed under IC 25-27.5. and granted
7 the authority to prescribe by the physician assistant's supervisory
8 physician in accordance with IC 25-27.5-5-4.
9 (6) A podiatrist licensed under IC 25-29.
10 SECTION 3. IC 25-1-9.5-4, AS AMENDED BY P.L.85-2021,
11 SECTION 14, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
12 JULY 1, 2023]: Sec. 4. As used in this chapter, "prescriber" means any
13 of the following:
14 (1) A physician licensed under IC 25-22.5.
15 (2) A physician assistant licensed under IC 25-27.5. and granted
16 the authority to prescribe by the physician assistant's collaborating
17 physician in accordance with IC 25-27.5-5-4.
18 (3) An advanced practice registered nurse licensed and granted
19 the authority to prescribe drugs under IC 25-23.
20 (4) An optometrist licensed under IC 25-24.
21 (5) A podiatrist licensed under IC 25-29.
22 (6) A dentist licensed under IC 25-14.
23 (7) A veterinarian licensed under IC 25-38.1.
24 SECTION 4. IC 25-27.5-5-2, AS AMENDED BY P.L.247-2019,
25 SECTION 13, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
26 JULY 1, 2023]: Sec. 2. (a) Except as provided in section 2.1 of this
27 chapter, a physician assistant:
28 (1) must engage in a dependent practice with a collaborating
29 physician; and
30 (2) may not be independent from the collaborating physician,
31 including any of even in conducting the activities of other health
32 care providers set forth under in IC 25-22.5-1-2(a)(1) through
33 IC 25-22.5-1-2(a)(19).
34 A physician assistant may perform, under a collaborative agreement,
35 the duties and responsibilities that are delegated by the collaborating
36 physician and that are within the collaborating physician's scope of
37 practice, including prescribing and dispensing drugs and medical
38 devices. A patient may elect to be seen, examined, and treated by the
39 collaborating physician.
40 (b) If a physician assistant determines that a patient needs to be
41 examined by a physician, the physician assistant shall immediately
42 notify the collaborating physician or physician designee.
2023 IN 190—LS 6746/DI 147 3
1 (c) If a physician assistant notifies the collaborating physician
2 under subsection (b) that the physician should examine a patient
3 needs to be examined by the collaborating physician, the
4 collaborating physician shall:
5 (1) schedule an examination of the patient, unless the patient
6 declines; or
7 (2) arrange for another physician to examine the patient.
8 (d) A collaborating physician or physician assistant who does not
9 comply with subsections subsection (b) and or a collaborating
10 physician who does not comply with subsection (c) is subject to
11 discipline under IC 25-1-9.
12 (e) A physician assistant's collaborative agreement with between a
13 collaborating physician and a physician assistant must:
14 (1) be in writing;
15 (2) include all the tasks delegated to the physician assistant by the
16 collaborating physician; any limitations;
17 (3) set forth the collaborative agreement for the physician
18 assistant, including the emergency procedures that the physician
19 assistant must follow; method by which the physician assistant
20 and the health care medical team of which the physician
21 assistant is a member may collaborate with the collaborating
22 physician to deliver patient care; and
23 (4) specify the protocol the physician assistant shall follow in
24 prescribing a drug.
25 (4) be signed by the collaborating physician and the physician
26 assistant;
27 (5) be updated annually; and
28 (6) be made available to the board upon request.
29 (f) The physician shall submit the collaborative agreement to the
30 board. The physician assistant may prescribe a drug under the
31 collaborative agreement unless the board denies the collaborative
32 agreement. Any amendment to the collaborative agreement must be
33 resubmitted to the board, and the physician assistant may operate under
34 any new prescriptive authority under the amended collaborative
35 agreement unless the agreement has been denied by the board.
36 (g) A physician or a physician assistant who violates the
37 collaborative agreement described in this section may be disciplined
38 under IC 25-1-9.
39 SECTION 5. IC 25-27.5-5-2.1 IS ADDED TO THE INDIANA
40 CODE AS A NEW SECTION TO READ AS FOLLOWS
41 [EFFECTIVE JULY 1, 2023]: Sec. 2.1. (a) This section applies to a
42 physician assistant who is employed by a:
2023 IN 190—LS 6746/DI 147 4
1 (1) health care facility or an affiliate of a health care facility;
2 (2) physician-owned or private medical facility or practice; or
3 (3) federally qualified health center or rural health care clinic
4 (both as defined in 42 U.S.C. 1396(d)(l)).
5 (b) The following apply to a physician assistant described in
6 subsection (a):
7 (1) A written collaborative agreement between the physician
8 assistant and a particular collaborating physician is not
9 required.
10 (2) The physician assistant shall enter into a practice
11 agreement with the entity described in subsection (a)(1),
12 (a)(2), or (a)(3) that employs the physician assistant.
13 (3) The practice agreement described in subdivision (2) must
14 set forth the manner in which the physician assistant is
15 required to cooperate, coordinate, and consult with the other
16 health care workers in providing health care to patients of the
17 entity.
18 SECTION 6. IC 25-27.5-6-2 IS REPEALED [EFFECTIVE JULY
19 1, 2023]. Sec. 2. A physician may enter into a collaborative agreement
20 with more than four (4) physician assistants but may not collaborate
21 with more than four (4) physician assistants at the same time.
22 SECTION 7. IC 25-27.5-6-4, AS AMENDED BY P.L.247-2019,
23 SECTION 19, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
24 JULY 1, 2023]: Sec. 4. (a) A physician collaborating with a physician
25 assistant must do the following: under IC 25-27.5-5-2 must:
26 (1) be licensed under IC 25-22.5;
27 (2) Register with the board the physician's intent to enter into a
28 collaborative agreement with a physician assistant.
29 (3) (2) not have a disciplinary action restriction that limits the
30 physician's ability to collaborate with a physician assistant; and
31 (4) (3) maintain a written collaborative agreement with the
32 physician assistant that states the physician will: as specified in
33 IC 25-27.5-5-2.
34 (A) work in collaboration with the physician assistant in
35 accordance with any rules adopted by the board; and
36 (B) retain responsibility for the care rendered by the physician
37 assistant.
38 The collaborative agreement must be signed by the physician and
39 physician assistant, updated annually, and made available to the
40 board upon request.
41 (5) Submit to the board a list of locations that the collaborating
42 physician and the physician assistant may practice. The board
2023 IN 190—LS 6746/DI 147 5
1 may request additional information concerning the practice
2 locations to assist the board with considering the written
3 agreement described in subdivision (4).
4 (b) Except as provided in this section, this chapter may not be
5 construed to limit the employment arrangement of a physician
6 assistant with a collaborating physician under this chapter.
7 SECTION 8. IC 25-27.5-6-5 IS REPEALED [EFFECTIVE JULY
8 1, 2023]. Sec. 5. (a) Before initiating practice the collaborating
9 physician and the physician assistant must submit, on forms approved
10 by the board, the following information:
11 (1) The name, the business address, and the telephone number of
12 the collaborating physician.
13 (2) The name, the business address, and the telephone number of
14 the physician assistant.
15 (3) A brief description of the setting in which the physician
16 assistant will practice.
17 (4) Any other information required by the board.
18 (b) A physician assistant must notify the committee of any changes
19 or additions in practice sites or collaborating physicians not more than
20 thirty (30) days after the change or addition.
2023 IN 190—LS 6746/DI 147