FIRSTREGULARSESSION
HOUSEBILLNO.1010
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEOVERCAST.
0776H.01I JOSEPHENGLER,ChiefClerk
ANACT
Torepealsections334.035and334.036,RSMo,andtoenactinlieuthereofthreenew
sectionsrelatingtoassistantphysicians.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections334.035and334.036,RSMo,arerepealedandthreenewsections
2enactedinlieuthereof,tobeknownassections334.035,334.036,and334.039,toreadas
3follows:
334.035.Exceptasotherwiseprovidedin[section] sections334.036and334.039,
2everyapplicantforapermanentlicenseasaphysicianandsurgeonshallprovidetheboard
3withsatisfactoryevidenceofhavingsuccessfullycompletedsuchpostgraduatetrainingin
4hospitalsormedicalorosteopathiccollegesastheboardmayprescribebyrule.
334.036.1.Forpurposesofthissection,thefollowingtermsshallmean:
2 (1)"Assistantphysician",anygraduateofamedicalschoolaccreditedbytheLiaison
3CommitteeonMedicalEducation,theCommissiononOsteopathicCollegeAccreditation,or
4anorganizationaccreditedbytheEducationalCommissionforForeignMedicalGraduates
5who:
6 (a)IsaresidentandcitizenoftheUnitedStatesorisalegalresidentalien;
7 (b)HassuccessfullycompletedStep2or3oftheUnitedStatesMedicalLicensing
8Examinationortheequivalentofsuchstepofanyotherboard-approvedmedicallicensing
9examinationwithinthethree-yearperiodimmediatelyprecedingapplicationforlicensureas
10anassistantphysician[, orwithinthreeyearsaftergraduationfromamedicalcollegeor
11osteopathicmedicalcollege,whicheverislater];
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 12 (c)Hasnotcompletedanapprovedpostgraduateresidencyandhassuccessfully
13completedStep2or3oftheUnitedStatesMedicalLicensingExaminationortheequivalent
14ofsuchstepofanyotherboard-approvedmedicallicensingexaminationwithinthe
15immediatelyprecedingthree-yearperiod[unlesswhensuchthree-yearanniversaryoccurred
16heorshewasservingasaresidentphysicianinanaccreditedresidencyintheUnitedStates
17andcontinuedtodosowithinthirtydayspriortoapplicationforlicensureasanassistant
18physician]; and
19 (d)HasproficiencyintheEnglishlanguage.
20
21Anygraduateofamedicalschoolwhocouldhaveappliedforlicensureandcompliedwiththe
22provisionsofthissubdivisionatanytimebetweenAugust28,2014,andAugust28,2017,
23mayapplyforlicensureandshallbedeemedincompliancewiththeprovisionsofthis
24subdivision;
25 (2)"Assistantphysiciancollaborativepracticearrangement",anagreementbetweena
26physicianandanassistantphysicianthatmeetstherequirementsofthissectionandsection
27334.037.
28 2.(1)(a)Anassistantphysiciancollaborativepracticearrangementshalllimitthe
29assistantphysiciantoprovidingonlyprimarycareservicesandonlyin:
30 a.Medicallyunderservedruralorurbanareasofthisstate;or
31 b.Afederallyqualifiedhealthcenter,asdefinedunder42U.S.C.Section1395x,
32locatedinanyareaofthisstate.
33 (b)Theprovisionsofthissubdivisionshallnotapplytoanassistantphysician
34receivingpostgraduatetrainingunderanauthorizedpreceptorundersubdivision(3)of
35subsection2ofsection334.039.
36 (2)Foraphysician-assistantphysicianteamworkinginaruralhealthclinicunderthe
37federalRuralHealthClinicServicesAct,P.L.95-210,asamended, orinafederally
38qualifiedhealthcenterasdefinedunder42U.S.C.Section1395x:
39 (a)Anassistantphysicianshallbeconsideredaphysicianassistantforpurposesof
40regulationsoftheCentersforMedicareandMedicaidServices(CMS);and
41 (b)Nosupervisionrequirementsinadditiontotheminimumfederallawshallbe
42required.
43 3.(1)Forpurposesofthissection,thelicensureofassistantphysiciansshalltake
44placewithinprocessesestablishedbyrulesofthestateboardofregistrationforthehealing
45arts.Theboardofhealingartsisauthorizedtoestablishrulesunderchapter536establishing
46licensureandrenewalprocedures,supervision,collaborativepracticearrangements,fees,and
47addressingsuchothermattersasarenecessarytoprotectthepublicanddisciplinethe
48profession.Nolicensurefeeforanassistantphysicianshallexceedtheamountofany
HB1010 2 49licensurefeeforaphysicianassistant.Anapplicationforlicensuremaybedeniedorthe
50licensureofanassistantphysicianmaybesuspendedorrevokedbytheboardinthesame
51mannerandforviolationofthestandardsassetforthbysection334.100,orsuchother
52standardsofconductsetbytheboardbyrule.Noruleorregulationshallrequireanassistant
53physiciantocompletemorehoursofcontinuingmedicaleducationthanthatofalicensed
54physician.
55 (2)Anyruleorportionofarule,asthattermisdefinedinsection536.010,thatis
56createdundertheauthoritydelegatedinthissectionshallbecomeeffectiveonlyifitcomplies
57withandissubjecttoalloftheprovisionsofchapter536and,ifapplicable,section536.028.
58Thissectionandchapter536arenonseverableandifanyofthepowersvestedwiththe
59generalassemblyunderchapter536toreview,todelaytheeffectivedate,ortodisapprove
60andannularulearesubsequentlyheldunconstitutional,thenthegrantofrulemaking
61authorityandanyruleproposedoradoptedafterAugust28,2014,shallbeinvalidandvoid.
62 (3)Anyrulesorregulationsregardingassistantphysiciansineffectasoftheeffective
63dateofthissectionthatconflictwiththeprovisionsofthissectionandsection334.037shall
64benullandvoidasoftheeffectivedateofthissection.
65 4.Anassistantphysicianshallclearlyidentifyhimselforherselfasanassistant
66physicianandshallbepermittedtousetheterms"doctor","Dr.",or"doc".Noassistant
67physicianshallpracticeorattempttopracticewithoutanassistantphysiciancollaborative
68practicearrangement,exceptasotherwiseprovidedinthissectionandinanemergency
69situation.
70 5.Thecollaboratingphysicianisresponsibleatalltimesfortheoversightofthe
71activitiesofandacceptsresponsibilityforprimarycareservicesrenderedbytheassistant
72physician.
73 6.Theprovisionsofsection334.037shallapplytoallassistantphysician
74collaborativepracticearrangements.Anyrenewaloflicensureunderthissectionshall
75includeverificationofactualpracticeunderacollaborativepracticearrangementin
76accordancewiththissubsectionduringtheimmediatelyprecedinglicensureperiod.
77 7.Eachhealthcarrierorhealthbenefitplanthatoffersorissueshealthbenefitplans
78thataredelivered,issuedfordelivery,continued,orrenewedinthisstateshallreimbursean
79assistantphysicianforthediagnosis,consultation,ortreatmentofaninsuredorenrolleeon
80thesamebasisthatthehealthcarrierorhealthbenefitplancoverstheservicewhenitis
81deliveredbyanothercomparablemid-levelhealthcareproviderincluding,butnotlimitedto,
82aphysicianassistantoracertifiednursepractitioner.
83 8.Thedepartmentofcommerceandinsuranceshallenforcetheprovisionsof
84thissection.
HB1010 3 334.039.1.Anassistantphysicianwithalicenseingoodstandingshallbe
2eligibletobecomealicensedphysicianiftheassistantphysicianmeetstherequirements
3ofsubsection2ofthissectionortherequirementsofsubsection4ofthissection.
4 2.Anassistantphysicianwithalicenseingoodstandingshallbeeligibleto
5becomealicensedphysicianunderthissubsectioniftheassistantphysicianhasnotbeen
6thesubjectofanydisciplinaryactionandhas:
7 (1)CompletedStep3oftheUnitedStatesMedicalLicensingExaminationorthe
8equivalentofsuchstepofanyboard-approvedmedicallicensingexaminationinfewer
9thanthreeattemptsandwithinaseven-yearperiodofcompletingSteps1and2ofthe
10UnitedStatesMedicalLicensingExamination;
11 (2)Completedsixtymonthsofcumulative,full-time,hands-on,active
12collaborativepractice.Thesixty-monthperiodshallbeginonthedatetheassistant
13physicianenteredintoacollaborativepracticearrangementandbeganpracticing.Any
14timetheassistantphysicianwasnotworkingwithinacollaborativepractice
15arrangementwithacollaboratingphysicianshallnotcounttowardthesixty-month
16requirement;
17 (3)Completedthefollowingpostgraduatetrainingunderapreceptorwithinthe
18sixty-monthrequirementundersubdivision(2)ofthissubsection:
19 (a)Onehundredtwentyhoursfromeachofthefollowingfiverequiredcore
20categories,foratotalofsixhundredhoursofcorecategories:
21 a.Familymedicine;
22 b.Pediatrics;
23 c.Inpatientoroutpatientpsychiatry;
24 d.Internalmedicine;and
25 e.Gynecology;and
26 (b)Onehundredtwentyhoursfromsevenofthefollowingelectivecategories,
27foratotalofeighthundredfortyhoursofelectivecategories:
28 a.Primarycare;
29 b.Emergencymedicine;
30 c.Urgentcare;
31 d.Dermatology;
32 e.Geriatrics;
33 f.Sportsmedicine;
34 g.Woundcare;
35 h.Imaging;
36 i.Urology;
37 j.Nephrology;
HB1010 4 38 k.Endocrinology;
39 l.Cardiology;
40 m.Surgery;
41 n.Pulmonology;
42 o.Rheumatology;
43 p.Obstetrics;
44 q.Familymedicine;
45 r.Neurology;
46 s.Addictionmedicine;
47 t.Painmanagement;
48 u.Vascularmedicine;
49 v.Gastroenterology;or
50 w.Infectiousdiseases.
51
52Thepostgraduatetrainingrequiredunderthissubdivisionshallconsistofon-the-job,
53hands-ontraining,includingperformingmedicalprocedures,andshallnotconsistof
54merelyobserving.Thepostgraduatetrainingrequiredunderthissubdivisionmaybe
55completedatanytimeduringtheapplicant'slicensureasanassistantphysicianaslong
56asitiscompletedduringthetimeframetheapplicantisworkingwithinacollaborative
57practicearrangementwithacollaboratingphysician;
58 (4)Completedatleastonehundredhoursofcontinuingmedicaleducationevery
59twoyears;and
60 (5)Submittedtotheboardlettersofrecommendationfrom:
61 (a)Thephysicianwhoservedastheassistantphysician'scollaboratingphysician
62forthecollaborativepracticerequirement;and
63 (b)Oneotherphysicianwhohasalicenseingoodstandingfromthisstate.
64 3.Thefollowingprovisionsshallapplytoassistantphysicianscompletingthe
65requirementsofsubsection2ofthissection:
66 (1)Allpostgraduatetrainingundersubdivision(3)ofsubsection2ofthissection
67shallbecompletedunderthesupervisionofapreceptorwhois:
68 (a)AccreditedbytheAccreditationCouncilforGraduateMedicalEducation;
69 (b)Aphysicianpracticingunderaprogramorcommunityclinicaffiliatedwith
70theAccreditationCouncilforGraduateMedicalEducation;or
71 (c)Anindependentphysicianwhoisboardcertifiedintheparticulardiscipline
72orpostgraduatecategorythattheassistantphysicianisstudying;
HB1010 5 73 (2)Thepostgraduatetrainingmaybeadministeredbythecollaborating
74physicianifthecollaboratingphysiciansatisfiesparagraph(a),(b),or(c)ofsubdivision
75(1)ofthissubsection;
76 (3)Assistantphysiciansshallobtainmedicalmalpracticeliabilityinsurance
77duringtheirpostgraduatetraining;
78 (4)Assistantphysiciansshallcompleteafinalresearchreport,whichshallbe
79approvedbythepreceptor,foreachcategorychosenundersubdivision(3)ofsubsection
802ofthissection.Theassistantphysicianshallretainallresearchreportsforfiveyears;
81 (5)Duringassistantphysicians'postgraduatetrainingperiod,collaborating
82physiciansshallstilloverseetheassistantphysicianswhiletheyarepracticingbutnotin
83postgraduatetraining.Postgraduatetrainingshallnotpausethesixty-month
84collaborativepracticerequirementundersubdivision(2)ofsubsection2ofthis
85section;and
86 (6)Inordertomeetthesixty-monthcollaborativepracticerequirementof
87subdivision(2)ofsubsection2ofthissection,anassistantphysicianshallpresent
88bimonthlydidactictrainingreportstothecollaboratingphysicianduringthesixty-
89monthperiod.Thereportsmayconsistoftheworkupofacurrentcaseoftheassistant
90physicianorasubjectrelevanttotheclinicalpractice.Thecollaboratingphysicianshall
91keepthedidactictrainingreportsonfileduringthesixty-monthperiod.
92 4.(1)Anassistantphysicianwithalicenseingoodstandingshallbeeligibleto
93becomealicensedphysicianunderthissubsectioniftheassistantphysicianhas:
94 (a)CompletedStep3oftheUnitedStatesMedicalLicensingExamination;
95 (b)Completedsixtymonthsofcumulative,full-time,hands-on,active
96collaborativepractice.Thesixty-monthperiodshallbeginonthedatetheassistant
97physicianenteredintoacollaborativepracticearrangementandbeganpracticing.Any
98timetheassistantphysicianwasnotworkingwithinacollaborativepractice
99arrangementwithacollaboratingphysicianshallnotcounttowardthesixty-month
100requirement;
101 (c)Completedatleastonehundredhoursofcontinuingmedicaleducationevery
102twoyears;and
103 (d)Submittedtotheboardlettersofrecommendationfrom:
104 a.Thephysicianwhoservedastheassistantphysician'scollaboratingphysician
105forthecollaborativepracticerequirement;and
106 b.Oneotherphysicianwhohasalicenseingoodstandingfromthisstate.
107 (2)TheprovisionsofthissubsectionshallexpireonAugust28,2030.
108 5.Uponcompletionoftherequirementsofsubsection2ofthissectionorthe
109requirementsofsubsection4ofthissection,theassistantphysicianshallbeeligiblefor
HB1010 6 110licensureasaphysicianwiththestateofMissouriandeligibletositforboard
111certificationoranyotherappropriateadvancedfellowshipsorcertifications.
112 6.Anyassistantphysicianobtaininglicensureasaphysicianunderthissection
113shallbefullylicensedasaphysicianandshallbesubjecttoallstatutesandregulations
114pertainingtophysicians.
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