Introduced Version
SENATE BILL No. 191
_____
DIGEST OF INTRODUCED BILL
Citations Affected: IC 25-0.5-1-2.4; IC 25-4.5; IC 25-22.5-1-2;
IC 35-52-25-2.8.
Synopsis: Associate physicians. Establishes the licensure of associate
physicians and sets forth requirements for licensure. Sets forth
collaborative agreement requirements between a physician and an
associate physician.
Effective: July 1, 2023.
Charbonneau, Brown L
January 10, 2023, read first time and referred to Committee on Health and Provider
Services.
2023 IN 191—LS 6966/DI 104 Introduced
First Regular Session of the 123rd General Assembly (2023)
PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana
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between statutes enacted by the 2022 Regular Session of the General Assembly.
SENATE BILL No. 191
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 25-0.5-1-2.4 IS ADDED TO THE INDIANA
2 CODE AS A NEW SECTION TO READ AS FOLLOWS
3 [EFFECTIVE JULY 1, 2023]: Sec. 2.4. IC 25-1-1.1-4 applies to an
4 individual licensed or certified under IC 25-4.5 (associate
5 physicians).
6 SECTION 2. IC 25-4.5 IS ADDED TO THE INDIANA CODE AS
7 A NEW ARTICLE TO READ AS FOLLOWS [EFFECTIVE JULY 1,
8 2023]:
9 ARTICLE 4.5. ASSOCIATE PHYSICIANS
10 Chapter 1. Definitions
11 Sec. 1. The definitions in this chapter apply throughout this
12 article.
13 Sec. 2. "Associate physician" means an individual who:
14 (1) meets the qualifications under this article; and
15 (2) is licensed under this article.
16 Sec. 3. "Board" refers to the medical licensing board of Indiana.
17 Sec. 4. "Collaborating physician" means a physician licensed by
2023 IN 191—LS 6966/DI 104 2
1 the board who collaborates with and is responsible for an associate
2 physician.
3 Sec. 5. (a) "Collaboration" means overseeing the activities of,
4 and accepting responsibility for, the medical services rendered by
5 an associate physician and that one (1) of the following conditions
6 is met at all times that services are rendered or tasks are
7 performed by the associate physician:
8 (1) The collaborating physician or the physician designee is
9 physically present at the location at which services are
10 rendered or tasks are performed by the associate physician.
11 (2) When the collaborating physician or the physician
12 designee is not physically present at the location at which
13 services are rendered or tasks are performed by the associate
14 physician, the collaborating physician or the physician
15 designee is able to personally ensure proper care of the
16 patient and is:
17 (A) immediately available through the use of
18 telecommunications or other electronic means; and
19 (B) able to see the person within a medically appropriate
20 time frame;
21 for consultation, if requested by the patient or the associate
22 physician.
23 (b) The term includes the use of protocols, guidelines, and
24 standing orders developed or approved by the collaborating
25 physician.
26 Sec. 6. "Physician" means an individual who:
27 (1) holds the degree of doctor of medicine or doctor of
28 osteopathy, or an equivalent degree; and
29 (2) holds an unlimited license under IC 25-22.5 to practice
30 medicine or osteopathic medicine.
31 Chapter 2. Licensure
32 Sec. 1. (a) An individual must be licensed by the board before
33 the individual may practice as an associate physician. The board
34 may grant an associate physician license to an applicant who meets
35 the following requirements:
36 (1) Submits an application on forms approved by the board.
37 (2) Pays the fee established by the board.
38 (3) Has:
39 (A) successfully completed the academic requirements for
40 the degree of doctor of medicine or doctor of osteopathy
41 from a medical school approved by the board but has not
42 completed an approved postgraduate residency; and
2023 IN 191—LS 6966/DI 104 3
1 (B) passed step two (2) of the United States Medical
2 Licensing Examination or the equivalent test approved by
3 the board not more than three (3) years before graduating
4 from a medical school and applying for licensure under
5 this chapter.
6 (4) Agrees to practice only primary care services:
7 (A) in a medically underserved rural or urban area; or
8 (B) at a rural health clinic (as defined in 42 U.S.C.
9 1396d(l)(1));
10 and under a collaborative agreement with a physician as
11 required under this article.
12 (5) Submits to the board any other information the board
13 considers necessary to evaluate the applicant's qualifications.
14 (6) Presents satisfactory evidence to the board that the
15 individual has not been:
16 (A) engaged in an act that would constitute grounds for a
17 disciplinary sanction under IC 25-1-9; or
18 (B) the subject of a disciplinary action by a licensing or
19 certification agency of another state or jurisdiction on the
20 grounds that the individual was not able to practice as an
21 associate physician without endangering the public.
22 (7) Is a resident and citizen of the United States or is a
23 lawfully admitted alien.
24 (8) Is proficient in English.
25 (9) Is of good moral character.
26 (b) The board may not require an applicant or an individual
27 licensed under this article to complete more continuing education
28 than that required of a physician licensed under IC 25-22.5.
29 Sec. 2. The board may refuse to issue a license or may issue a
30 probationary license to an individual if:
31 (1) the individual has been disciplined by an administrative
32 agency in another jurisdiction or been convicted for a crime
33 that has a direct bearing on the individual's ability to practice
34 competently; and
35 (2) the board determines that the act for which the individual
36 was disciplined or convicted has a direct bearing on the
37 individual's ability to practice as an associate physician.
38 Sec. 3. (a) If the board issues a probationary license under
39 section 2 of this chapter, the committee may require the individual
40 who holds the probationary license to meet at least one (1) of the
41 following conditions:
42 (1) Report regularly to the board upon a matter that is the
2023 IN 191—LS 6966/DI 104 4
1 basis for the probation.
2 (2) Limit practice to services prescribed by the board.
3 (3) Continue or renew professional education.
4 (4) Engage in community restitution or service without
5 compensation for a number of hours specified by the board.
6 (5) Submit to care, counseling, or treatment by a physician
7 designated by the board for a matter that is the basis for the
8 probation.
9 (b) The board shall remove a limitation placed on a
10 probationary license if after a hearing the committee finds that the
11 deficiency that caused the limitation has been remedied.
12 Sec. 4. (a) Subject to IC 25-1-2-6(e), a license issued by the
13 board expires on a date established by the Indiana professional
14 licensing agency under IC 25-1-5-4 in the next even-numbered year
15 following the year in which the license was issued.
16 (b) An individual may renew a license by paying a renewal fee
17 on or before the expiration date of the license.
18 (c) If an individual fails to pay a renewal fee on or before the
19 expiration date of a license, the license becomes invalid and must
20 be returned to the board.
21 (d) Before the board may issue a renewal license, the board shall
22 ensure that the licensee is operating under a collaborative
23 agreement as required by this article.
24 Sec. 5. (a) If an individual surrenders a license to the board, the
25 board may reinstate the license upon written request by the
26 individual.
27 (b) If the board reinstates a license, the board may impose
28 conditions on the license appropriate to the reinstatement.
29 (c) An individual may not surrender a license without written
30 approval by the board if a disciplinary proceeding under this
31 article is pending against the individual.
32 Sec. 6. The board may do any of the following:
33 (1) Suspend or revoke a license of a licensee who commits a
34 serious violation of this article.
35 (2) Discipline a licensee for a less severe violation of this
36 chapter.
37 Chapter 3. Collaborative Agreements
38 Sec. 1. (a) In order to be licensed under this article, an associate
39 physician shall enter into a collaborative agreement with a
40 physician licensed under IC 25-22.5. The associate physician may
41 not practice independently from the collaborating physician.
42 (b) The collaborating physician is responsible at all times for the
2023 IN 191—LS 6966/DI 104 5
1 oversight of the activities of, and accepts responsibility for,
2 primary care services provided by the associate physician.
3 (c) Except in an emergency situation, an associate physician
4 shall clearly identify to a patient that the patient is being treated by
5 an associate physician.
6 (d) If an associate physician determines that a patient needs to
7 be examined by a physician, the associate physician shall
8 immediately notify the collaborating physician or physician
9 designee.
10 (e) If an associate physician notifies the collaborating physician
11 that the collaborating physician should examine a patient, the
12 collaborating physician shall:
13 (1) schedule an examination of the patient unless the patient
14 declines; or
15 (2) arrange for another physician to examine the patient.
16 (f) A collaborating physician or an associate physician who does
17 not comply with this section is subject to discipline under
18 IC 25-1-9.
19 (g) An associate physician's collaborative agreement with a
20 collaborating physician must:
21 (1) be in writing;
22 (2) include the services delegated to the associate physician by
23 the collaborating physician and limited to those allowed under
24 this article;
25 (3) set forth the collaborative agreement for the associate
26 physician, including the emergency procedures that the
27 associate physician must follow; and
28 (4) specify the protocol the associate physician shall follow in
29 prescribing a drug.
30 (h) The collaborating physician shall submit the collaborative
31 agreement to the board. Any amendment to the collaborative
32 agreement must be resubmitted to the board.
33 (i) A collaborating physician or an associate physician who
34 violates the collaborative agreement described in this section may
35 be disciplined under IC 25-1-9.
36 Sec. 2. (a) Collaboration by the collaborating physician or the
37 physician's designee must be continuous but does not require the
38 physical presence of the collaborating physician at the time and the
39 place that the services are rendered.
40 (b) A collaborating physician or physician's designee shall
41 review patient encounters, including at least twenty percent (20%)
42 of the charts in which the associate physician prescribes a
2023 IN 191—LS 6966/DI 104 6
1 controlled substance, not later than ten (10) business days, and
2 within a reasonable time, as established in the collaborative
3 agreement, after the associate physician has seen the patient, that
4 is appropriate for the maintenance of quality medical care.
5 Sec. 3. (a) A physician collaborating with an associate physician
6 must meet the following requirements:
7 (1) Be licensed under IC 25-22.5.
8 (2) Register with the board the physician's intent to enter into
9 a collaborative agreement with an associate physician.
10 (3) Not have a disciplinary action restriction that limits the
11 physician's ability to collaborate with an associate physician.
12 (4) Maintain a written agreement with the associate physician
13 that states the physician will:
14 (A) work in collaboration with the associate physician in
15 accordance with any rules adopted by the board; and
16 (B) retain responsibility for the care rendered by the
17 associate physician.
18 The collaborative agreement must be signed by the physician
19 and the associate physician, updated annually, and made
20 available to the board upon request.
21 (b) Before initiating practice the collaborating physician and the
22 associate physician must submit, on forms approved by the board,
23 the following information:
24 (1) The name, the business address, and the telephone number
25 of the collaborating physician.
26 (2) The name, the business address, and the telephone number
27 of the associate physician.
28 (3) A list of all the locations in which the collaborating
29 physician authorizes the associate physician to prescribe.
30 (4) A brief description of the setting in which the associate
31 physician will practice.
32 (5) A description of the associate physician's controlled
33 substance prescriptive authority in collaboration with the
34 collaborating physician, including a list of the controlled
35 substances the collaborating physician authorizes the
36 associate physician to prescribe and documentation that the
37 authority is consistent with the education, knowledge, skill,
38 and competence of both parties.
39 (6) Any other information required by the board.
40 (c) An associate physician shall notify the board of any changes
41 or additions in practice sites or collaborating physicians not more
42 than thirty (30) days after the change or addition.
2023 IN 191—LS 6966/DI 104 7
1 Sec. 4. (a) An associate physician who is granted controlled
2 substances prescriptive authority by a collaborating physician
3 under this chapter may prescribe, if agreed to by the collaborating
4 physician:
5 (1) any controlled substance listed in Schedule III, Schedule
6 IV, or Schedule V; and
7 (2) a limited authority of Schedule II controlled substances
8 and only if the Schedule II controlled substance contains
9 hydrocodone.
10 (b) The collaborating physician shall specify in the collaborative
11 agreement whether the associate physician has authorization to
12 prescribe a controlled substance and any limitations on the
13 prescribing placed by the collaborating physician.
14 (c) An associate physician with prescriptive authority for
15 prescribing controlled substances shall register with the United
16 States Drug Enforcement Administration and include the issued
17 registration number on prescriptions for controlled substances.
18 (d) The board may adopt rules under IC 4-22-2 governing the
19 prescribing of controlled substances by an associate physician.
20 Sec. 5. If an associate physician is employed by a physician, a
21 group of physicians, or another legal entity, the associate physician
22 must be in collaboration with and be the legal responsibility of the
23 collaborating physician. The legal responsibility for the associate
24 physician's patient care activities are that of the collaborating
25 physician, including when the associate physician provides care
26 and treatment for patients in health care facilities.
27 Sec. 6. A collaborating physician may not enter into a
28 collaborate practice agreement with a total of more than six (6)
29 associate physicians and physician assistants under IC 25-27.5.
30 Sec. 7. The board may adopt rules under IC 4-22-2 specifying
31 requirements and regulation of the use of collaborative agreements
32 under this article.
33 Chapter 4. Unauthorized Practice; Penalties; Sanctions
34 Sec. 1. An individual may not:
35 (1) profess to be an associate physician; or
36 (2) use the title "associate physician";
37 unless the individual is licensed under this article.
38 Sec. 2. An individual who violates this chapter commits a Class
39 B misdemeanor.
40 Sec. 3. In addition to the penalty under section 2 of this chapter,
41 an associate physician who violates this article is subject to the
42 sanctions under IC 25-1-9.
2023 IN 191—LS 6966/DI 104 8
1 SECTION 3. IC 25-22.5-1-2, AS AMENDED BY P.L.128-2022,
2 SECTION 3, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
3 JULY 1, 2023]: Sec. 2. (a) This article, as it relates to the unlawful or
4 unauthorized practice of medicine or osteopathic medicine, does not
5 apply to any of the following:
6 (1) A student in training in a medical school approved by the
7 board, or while performing duties as an intern or a resident in a
8 hospital under the supervision of the hospital's staff or in a
9 program approved by the medical school.
10 (2) A person who renders service in case of emergency where no
11 fee or other consideration is contemplated, charged, or received.
12 (3) A paramedic (as defined in IC 16-18-2-266), an advanced
13 emergency medical technician (as defined in IC 16-18-2-6.5), an
14 emergency medical technician (as defined in IC 16-18-2-112), or
15 a person with equivalent certification from another state who
16 renders advanced life support (as defined in IC 16-18-2-7), or
17 basic life support (as defined in IC 16-18-2-33.5):
18 (A) during a disaster emergency declared by the governor
19 under IC 10-14-3-12 in response to an act that the governor in
20 good faith believes to be an act of terrorism (as defined in
21 IC 35-31.5-2-329); and
22 (B) in accordance with the rules adopted by the Indiana
23 emergency medical services commission or the disaster
24 emergency declaration of the governor.
25 (4) Commissioned medical officers or medical service officers of
26 the armed forces of the United States, the United States Public
27 Health Service, and medical officers of the United States
28 Department of Veterans Affairs in the discharge of their official
29 duties in Indiana.
30 (5) An individual who is not a licensee who resides in another
31 state or country and is authorized to practice medicine or
32 osteopathic medicine there, who is called in for consultation by an
33 individual licensed to practice medicine or osteopathic medicine
34 in Indiana.
35 (6) A person administering a domestic or family remedy to a
36 member of the person's family.
37 (7) A member of a church practicing the religious tenets of the
38 church if the member does not make a medical diagnosis,
39 prescribe or administer drugs or medicines, perform surgical or
40 physical operations, or assume the title of or profess to be a
41 physician.
42 (8) A school corporation and a school employee who acts under
2023 IN 191—LS 6966/DI 104 9
1 IC 34-30-14 (or IC 34-4-16.5-3.5 before its repeal).
2 (9) An associate physician practicing in compliance with
3 IC 25-4.5 and under a collaborative agreement.
4 (9) (10) A chiropractor practicing the chiropractor's profession
5 under IC 25-10 or to an employee of a chiropractor acting under
6 the direction and supervision of the chiropractor under
7 IC 25-10-1-13.
8 (10) (11) A dental hygienist practicing the dental hygienist's
9 profession under IC 25-13.
10 (11) (12) A dentist practicing the dentist's profession under
11 IC 25-14.
12 (12) (13) A hearing aid dealer practicing the hearing aid dealer's
13 profession under IC 25-20.
14 (13) (14) A nurse practicing the nurse's profession under
15 IC 25-23. However, a certified registered nurse anesthetist (as
16 defined in IC 25-23-1-1.4) may administer anesthesia if the
17 certified registered nurse anesthetist acts under the direction of
18 and in the immediate presence of a physician.
19 (14) (15) An optometrist practicing the optometrist's profession
20 under IC 25-24.
21 (15) (16) A pharmacist practicing the pharmacist's profession
22 under IC 25-26.
23 (16) (17) A physical therapist practicing the physical therapist's
24 profession under IC 25-27.
25 (17) (18) A podiatrist practicing the podiatrist's profession under
26 IC 25-29.
27 (18) (19) A psychologist practicing the psychologist's profession
28 under IC 25-33.
29 (19) (20) A speech-language pathologist or audiologist practicing
30 the pathologist's or audiologist's profession under IC 25-35.6.
31 (20) (21) An employee of a physician or group of physicians who
32 performs an act, a duty, or a function that is customarily within
33 the specific area of practice of the employing physician or group
34 of physicians, if the act, duty, or function is performed under the
35 direction and supervision of the employing physician or a
36 physician of the employing group within whose area of practice
37 the act, duty, or function falls. An employee may not make a
38 diagnosis or prescribe a treatment and must report the results of
39 an examination of a patient conducted by the employee to the
40 employing physician or the physician of the employing group
41 under whose supervision the employee is working. An employee
42 may not administer medication without the specific order of the
2023 IN 191—LS 6966/DI 104 10
1 employing physician or a physician of the employing group.
2 Unless an employee is licensed or registered to independently
3 practice in a profession described in subdivisions (9) through
4 (18), nothing in this subsection grants the employee independent
5 practitioner status or the authority to perform patient services in
6 an independent practice in a profession.
7 (21) (22) A hospital licensed under IC 16-21 or IC 12-25.
8 (22) (23) A health care organization whose members,
9 shareholders, or partners are individuals, partnerships,
10 corporations, facilities, or institutions licensed or legally
11 authorized by this state to provide health care or professional
12 services as:
13 (A) a physician;
14 (B) a psychiatric hospital;
15 (C) a hospital;
16 (D) a health maintenance organization or limited service
17 health maintenance organization;
18 (E) a health facility;
19 (F) a dentist;
20 (G) a registered or licensed practical nurse;
21 (H) a certified nurse midwife or a certified direct entry
22 midwife;
23 (I) an optometrist;
24 (J) a podiatrist;
25 (K) a chiropractor;
26 (L) a physical therapist; or
27 (M) a psychologist.
28 (23) (24) A physician assistant practicing the physician assistant
29 profession under IC 25-27.5.
30 (24) (25) A physician providing medical treatment under section
31 2.1 of this chapter.
32 (25) (26) An attendant who provides attendant care services (as
33 defined in IC 16-18-2-28.5).
34 (26) (27) A personal services attendant providing authorized
35 attendant care services under IC 12-10-17.1.
36 (27) (28) A respiratory care practitioner practicing the
37 practitioner's profession under IC 25-34.5.
38 (b) A person described in subsection (a)(9) through (a)(18) (a)(19)
39 is not excluded from the application of this article if:
40 (1) the person performs an act that an Indiana statute does not
41 authorize the person to perform; and
42 (2) the act qualifies in whole or in part as the practice of medicine
2023 IN 191—LS 6966/DI 104 11
1 or osteopathic medicine.
2 (c) An employment or other contractual relationship between an
3 entity described in subsection (a)(21) (a)(22) through (a)(22) (a)(23)
4 and a licensed physician does not constitute the unlawful practice of
5 medicine or osteopathic medicine under this article if the entity does
6 not direct or control independent medical acts, decisions, or judgment
7 of the licensed physician. However, if the direction or control is done
8 by the entity under IC 34-30-15 (or IC 34-4-12.6 before its repeal), the
9 entity is excluded from the application of this article as it relates to the
10 unlawful practice of medicine or osteopathic medicine.
11 (d) This subsection does not apply to a prescription or drug order for
12 a legend drug that is filled or refilled in a pharmacy owned or operated
13 by a hospital licensed under IC 16-21. A physician licensed in Indiana
14 who permits or authorizes a person to fill or refill a prescription or drug
15 order for a legend drug except as authorized in IC 16-42-19-11 through
16 IC 16-42-19-19 is subject to disciplinary action under IC 25-1-9. A
17 person who violates this subsection commits the unlawful practice of
18 medicine or osteopathic medicine under this chapter.
19 (e) A person described in subsection (a)(8) shall not be authorized
20 to dispense contraceptives or birth control devices.
21 (f) Nothing in this section allows a person to use words or
22 abbreviations that indicate or induce an individual to believe that the
23 person is engaged in the practice of medicine or osteopathic medicine.
24 SECTION 4. IC 35-52-25-2.8 IS ADDED TO THE INDIANA
25 CODE AS A NEW SECTION TO READ AS FOLLOWS
26 [EFFECTIVE JULY 1, 2023]: Sec. 2.8. IC 25-4.5-4-2 defines a crime
27 concerning associate physicians.
2023 IN 191—LS 6966/DI 104