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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
SENATE BILL 1613 By: Garvin
AS INTRODUCED
An Act relating to the practice of medicine ; defining
terms; providing for scope of practice of
provisionally licensed physicians ; directing the
State Board of Medical Licensure and Supervision and
the State Board of Osteopathic Examiners to
promulgate certain rules; specifying professional
terms; making collaborating physician responsible for
provisionally license d physicians; requiring
collaborative practice arrangement; specifying
certain protections for rural hea lth clinics;
stipulating requirements for collaborative practice
arrangements; providing for promulgation of certain
rules and approval of rules; prohibiting certain
disciplinary action under certain circumstances;
requiring certain notice by collaborating physician ;
imposing certain limit on collaborative practice
arrangements; requiring certain documentation;
providing certain construction; requiring
identification badges; sett ing forth provisions
related to prescriptive authority for certain
controlled substances; amending 59 O.S. 2021, Section
725.2, as amended by Section 2, Chapter 149, O.S.L.
2022 (59 O.S. Supp. 2023, Section 725.2) , which
relates to use of professional term s; modifying
applicability of certain provisions; providing for
codification; and providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.1 of Title 59, unless there
is created a duplication in numbering, reads as follows:
As used in this act:
1. “Graduate of an Oklahoma school or college of osteopathic
medicine” means any person who has graduated fro m an Oklahoma school
or college of osteopathic medic ine as defined in this section;
2. “Medical school graduate ” means any person who has graduated
from an Oklahoma medical school or Oklahoma school or college of
osteopathic medicine as defined in this se ction;
3. “Oklahoma medical school ” means a legally chartered
allopathic medical school located in this state recognized by the
Oklahoma State Regents for Higher Education or the Liaison Committee
on Medical Education;
4. “Oklahoma school or college of o steopathic medicine” means a
legally chartered and accredited school or college of osteopathic
medicine located in this stat e requiring:
a. for admission to its courses of study, a preliminary
education equal to the requirements established by the
Bureau of Professional Education of the American
Osteopathic Association, and
b. for granting the D.O. degree, Doctor of Osteopathy or
Doctor of Osteopathic Medicine, actual attendance at
such osteopathic school or college and demon stration
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of successful completio n of the curriculum and
recommendation for graduation ;
5. “Provisionally licensed physician ” means a graduate of an
Oklahoma medical school or an Oklahoma school or college of
osteopathic medicine who:
a. is a resident and citizen of the United States or is a
legal resident alien,
b. (1) has successfully completed Step 1 and Step 2 of
the United States Medical Licensing Examination
or the equivalent of such steps of any other
medical licensing examination approved by the
State Board of Medical Licensure an d Supervision
within the two-year period immediately pre ceding
application for licensure as a provisionally
licensed physician, but in no event more than
three (3) years after graduation from a medical
school, or
(2) has successfully completed Level 1 and Level 2 of
the Comprehensive Osteopath ic Medical Licensing
Examination of the U nited States or the
equivalent of such steps of any other medical
licensing examination approved by the State Board
of Osteopathic Examiners within the two-year
period immediately preceding application f or
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licensure as a provisionall y licensed physician,
but in no event more than three (3) years after
graduation from a school or college of
osteopathic medicine,
c. (1) has not completed an approved postgraduate
residency and has successfully completed Step 2
of the United States Medical Licensing
Examination or the equivalent of such step of any
other medical licensing examination approved by
the State Board of Medical Licensure and
Supervision within the immediately preceding two -
year period unless when su ch two-year anniversary
occurred he or she was serving as a residen t
physician in an accredited residency in the
United States and continued to do so within
thirty (30) calendar days prior to application
for licensure as a provisi onally licensed
physician, or
(2) has not completed an approved postgraduate
residency and has successfully completed Level 2
of the Comprehensive Osteopathic Medical
Licensing Examination of the United States or the
equivalent of such step of any other me dical
licensing examinatio n approved by the State Board
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of Osteopathic Examiners within the i mmediately
preceding two-year period unless when s uch two-
year anniversary occurred he or she was serving
as a resident physician in an accredited
residency in the United States and continued to
do so within thirty (30) calendar days prior to
application for licensure as a provisionally
licensed physician, and
d. has proficiency in the English language; and
6. “Provisionally licensed physician collaborative practic e
arrangement” means an agreement between a physician and a
provisionally licensed physician that meets the requirements of this
act.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.2 o f Title 59, unless there
is created a duplication in numbering, reads as follow s:
A. A provisionally licensed physician collaborative practice
arrangement shall limit the provisionally licen sed physician to
providing only primary care services.
B. The licensure of provisionally licensed physicians shall
take place within processes established by rules of the State Board
of Medical Licensure and Supervision or of the State Board of
Osteopathic Examiners . The State Board of Medical Licensure and
Supervision and the State Board of Osteopathic Examiners shall
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promulgate rules establish ing licensure and renewal procedures,
supervision, collaborative practice arrangements, and fees and
addressing such other matters as are necessary to protect the public
and discipline the profession. An application for licensure ma y be
denied or the licensure of a provisionally licensed physician may be
suspended or revoked by the State Board of Medical Licensure and
Supervision or by the State Board of Osteopathic Examiners in the
same manner and for violation of the standards as set forth by the
Oklahoma Allopathic Medical and Surgical Licensure and Supervision
Act or the Oklahoma Osteopathic Medicine Act, or such ot her
standards of conduct set by the State Board of Medical Licensure and
Supervision or the State Board of Osteopathi c Examiners by rule.
C. A provisionally licensed physician shall clearly iden tify
himself or herself as a provisionally licensed physician and shall
be permitted to use the terms “doctor”, “Dr.”, or “doc”. No
provisionally licensed physician shall practice or attempt to
practice without a provisionally licensed physician collaborative
practice arrangement, except as otherwise provided in th is section
and in an emergency situation.
D. The collaborating physician is responsible at all times for
the oversight of the activities of and accepts responsibility for
primary care services r endered by the provisionally licensed
physician.
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E. The provisions of Se ction 3 of this act shall apply to all
provisionally licensed physician collaborative practice
arrangements. To be eligible to practice as a provisionally
licensed physician, a provisionally licensed physician shall ent er
into a provisionally licensed physician collaborative practice
arrangement within six (6) months of his or her initial licensure
and shall not have more than a six-month time period between
collaborative practice arr angements during his or her licensure
period. Any renewal of licensure p ursuant to this section shall
include verification of actual practice under a collaborative
practice arrangement in accordance w ith this subsection during the
immediately preceding licensure period.
F. For a physician-provisionally licensed ph ysician team
working in a rural health clinic under the feder al Rural Health
Clinic Services Act, P.L. 95 -210:
1. A provisionally licensed physician shall be considered a
physician assistant for purposes of regulations of the Centers for
Medicare and Medicaid Service s (CMS); and
2. No supervision requirements in a ddition to the minimum
federal law shall be required.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 47 9.3 of Title 59, unless there
is created a duplication in numbering, reads as follows :
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A. A physician may enter into collaborative practice
arrangements with provisionally licensed physicians. Collaborative
practice arrangements shall be in the form of written agreements,
jointly agreed-upon protocols or standing orders for the delivery of
health care services. Collaborative practice arrangements, which
shall be in writing, may delegate to a provisionally licensed
physician the authority to administer an d dispense drugs and pro vide
treatment as long as the delivery of such health care se rvices is
within the scope of practice of the provisiona lly licensed physician
and is consistent with that provisionally licensed phys ician’s
skill, training, and competence and the skill and training of the
collaborating physician.
B. The written collabo rative practice arrangement shall
include, but not be limited to:
1. Complete names, home and business addresses, zip codes , and
telephone numbers of the collaborating ph ysician and the
provisionally licensed physician;
2. A list of all other offices or locations besides those
listed in paragraph 1 of this subs ection where the collaborating
physician authorized the provisionally licens ed physician to
prescribe;
3. A requirement that there shall be posted at every office
where the provisionally licensed p hysician is authorized to
prescribe, in collaboration with a physician, a promi nently
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displayed disclosure statement informin g patients that they may be
seen by a provisionally licensed physician a nd have the right to see
the collaborating physician;
4. All specialty or Board certifications of the collaborating
physician and all certifications of the provisionally licensed
physician;
5. The manner of collaboration between the collaborating
physician and the provisi onally licensed physician, including how
the collaborating physician and the provisionally licensed physician
shall:
a. engage in collaborative practice consistent wi th each
professional’s skill, training, educat ion, and
competence,
b. maintain geographic proximity; provided, the
collaborative practice arrangement may allow for
geographic proximity to be waived for a maximum of
twenty-eight (28) calendar days per calendar year for
rural health clinics as defined by P.L. 95 -210, as
long as the collaborative p ractice arrangement
includes alternative plans as required in subparagraph
c of this paragraph. Such exception to geog raphic
proximity shall apply only to independent rural health
clinics, provider-based rural health clinics if the
provider is a critical access hospital as provided in
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42 U.S.C. Section 1395i-4 and provider-based rural
health clinics if the main location of the hospital
sponsor is not less than fifty (50) mile s from the
clinic. The collaborating physician shall maintain
documentation related to such requirement and present
it to the State Board of Medical Licensure and
Supervision or the State Board of Ost eopathic
Examiners when requested, and
c. provide coverage during ab sence, incapacity,
infirmity, or emergency by the co llaborating
physician;
6. A description of the provision ally licensed physician’s
controlled substance prescriptive authority in collaboration with
the physician, including a list of the con trolled substances the
physician authorizes the provisionally licensed physician to
prescribe and documentation that it is consistent with each
professional’s education, knowledge, skill , and competence;
7. A list of all other written practice agreements of the
collaborating physician and the provisionally licensed phys ician;
8. The duration of the written practice agreemen t between the
collaborating physician and the provisionally l icensed physician;
9. A description of the time and manner of the collab orating
physician’s review of the provisionally licensed physician ’s
delivery of health care services. The description sh all include
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provisions that the provisionally licensed physician shall submit a
minimum of ten percent (10%) of the charts documenting the
provisionally licensed physician ’s delivery of health care se rvices
to the collaborating physician for review by the collaborating
physician, or any other physician designated in the collaborative
practice arrangement, every fourteen (14) calendar day s; and
10. A requirement that the collaborating physician, or any
other physician designated in the collaborative practic e
arrangement, shall review every fourteen (14) calendar days a
minimum of twenty percent (20%) of the charts in which the
provisionally licensed physician prescribes contr olled substances.
The charts reviewed pursuant to this paragraph may be counted in the
number of charts required to be reviewed under paragraph 9 of this
subsection.
C. The State Board of Medical Licensure and Superv ision and the
State Board of Osteopathic Examiners shall promulgate rules
regulating the use of collaborative practice arr angements for
provisionally licensed physicians. Such rules shal l specify:
1. Geographic areas to be covered;
2. The methods of treatment that may be covered by
collaborative practice arrangements;
3. In conjunction with deans of medical schools and pr imary
care residency program directors in the state, the deve lopment and
implementation of educa tional methods and programs undertaken during
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the collaborative practice service which shall facilitate the
advancement of the provisionally licensed physician ’s medical
knowledge and capabilities, and which may lead to credi t toward a
future residency program for programs that deem such documented
educational achievements acceptable; and
4. The requirements for review of services provided under
collaborative practice arrangements, including delegating authority
to prescribe controlled substances.
D. Any rules relating to dispensing or distri bution of
medications or devices by prescription or prescription drug orders
pursuant to this section shall be subject to the approval of the
State Board of Pharmacy. Any rules relating to dispensing or
distribution of controlled substances by prescription or
prescription drug orders pursuant to this section shall be su bject
to the approval of the State Board of Pharmacy and the Oklahoma
State Bureau of Narcotics and Dangerous Drugs C ontrol. The State
Board of Medical Licensure and Supervision and the Sta te Board of
Osteopathic Examiners shall promulgate rules applicable to
provisionally licensed physicians that shall be con sistent with
guidelines for federally funded clinics.
E. The State Board of Medical Licensure and Supervision and the
State Board of Osteopathic Examiners shall not deny, revoke,
suspend, or otherwise take disciplinary action against a
collaborating physician for health care services delegated to a
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provisionally licensed physician, provided the provisions of this
section and the rules p romulgated thereunder are satisfied.
F. Within thirty (30) calendar days of any chan ge and on each
renewal, the State Board of Medical Licensure and Supervision and
the State Board of Osteopathic Exam iners shall require every
physician to identify whether the physician is engaged in any
collaborative practic e arrangement, including but not limited to
collaborative practice a rrangements delegating the authority to
prescribe controlled s ubstances, and also report to the State Board
of Medical Licensure and S upervision or the State Board of
Osteopathic Examiners the name of each provisionally licensed
physician with whom the phy sician has entered into such arrangement.
The State Board of Medical Licensure and Supervision and the State
Board of Osteopathic Examiners may make such information available
to the public. The State Board of Medical Licensure and Supervision
and the State Board of Osteopathic Examiners shall track the
reported information and may routinely conduct random reviews of
such arrangements to ensure that arrangements are carried out for
compliance pursuant to this section.
G. A collaborating physician shall n ot enter into a
collaborative practice arrangement with more than three full -time-
equivalent provisionally licensed physicians.
H. The collaborating physician shall determine and document the
completion of at least a thirty -calendar-day period of time dur ing
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which the provisionally licensed physician shall practice with the
collaborating physician continuously present before practicing in a
setting where the collaborating physician is not continuously
present.
I. No agreement made pursuant to this section shall supersede
current hospital licensing regulations governing hospital medi cation
orders under protocols or standing orders for the purpose of
delivering inpatient or emergency care wi thin a hospital as defined
in Section 1-701 of Title 63 of the Oklah oma Statutes if such
protocols or standing orders have been ap proved by the hospital’s
medical staff and pharmaceutical therapeutics c ommittee.
J. No contract or other agreement shall require a physician to
act as a collaborating physician for a provision ally licensed
physician against the physician ’s will. A physician shall have t he
right to refuse to act as a collaborating physician, without
penalty, for a particular provisionally licen sed physician. No
contract or other agreement shall limit the colla borating
physician’s ultimate authority over any protocols or standing orders
or in the delegation of the physician ’s authority to any
provisionally licensed physician, but such requirement shall not
authorize a physician in implementing such protocols, st anding
orders, or delegation to violate applicable standards for safe
medical practice established by a hospital ’s medical staff.
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K. No contract or other agreement shall require any
provisionally licensed physician to serve as a collaborating
provisionally licensed physician for any collaborating physician
against the provisionally licensed physician ’s will. A
provisionally licensed ph ysician shall have the right to refuse to
collaborate, without penalty, with a partic ular physician.
L. All collaborating physicians and provisionally licensed
physicians in collaborative practice arr angements shall wear
identification badges while acting within the scope of their
collaborative practice arra ngement. The identification badges shall
prominently display the li censure status of such collaborating
physicians and provisiona lly licensed physicians.
M. 1. A provisionally licensed physician with a certificate of
controlled substance prescriptive authority as provided in this
section may prescribe any controlled sub stance listed in Schedule
III, IV, or V of the Uniform Controlled Dangerous Sub stances Act and
may have restricted authority in Schedule II, when delegated the
authority to prescribe controlled substance s in a collaborative
practice arrangement. Prescript ions for Schedule II medications
prescribed by a provisionally licensed physician who has a
certificate of controlled substance prescr iptive authority are
restricted to only those medications containing hydrocodone. Suc h
authority shall be filed with the State Board of Medical Licensure
and Supervision or the State Board of Osteopat hic Examiners. The
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collaborating physician shall maintain the right to limit a specific
scheduled drug or scheduled drug category that the provisionally
licensed physician is p ermitted to prescribe. Any limitations shall
be listed in the collaborative practice arrangement. Provisionally
licensed physicians shall not prescribe controlled substances for
themselves or members of their families. Schedule III controlled
substances and Schedule II hydrocodone presc riptions shall be
limited to a five-day supply without refill. Provisionally licensed
physicians who are authorized to prescribe controlled substances
under this section shall register with the federal Drug Enforcement
Administration and the Oklahoma State Bureau of Narcotics and
Dangerous Drugs, and shall include the federal Drug Enforcement
Administration registration number on prescriptions for controlled
substances.
2. The collaborating physician shall be responsible to
determine and document the completion of at l east one hundred twenty
(120) hours in a four-calendar-month period by the provisionally
licensed physician during which the provisionally licensed physician
shall practice with the collaborating physician on -site prior to
prescribing controlled substances when the collaborating physi cian
is not on-site.
3. A provisionally licensed physici an shall receive a
certificate of controlled substance prescriptive authority from the
State Board of Medical Licensure an d Supervision or the State Board
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of Osteopathic Examiners upon verification of licensure pursuant to
Section 2 of this act.
SECTION 4. AMENDATORY 59 O.S. 2021, Section 725.2, as
amended by Section 2, Chapter 149, O.S.L. 2022 (59 O .S. Supp. 2023,
Section 725.2), is amended to read as follows:
Section 725.2. A. The following ten classes of persons may use
the word “Doctor”, or an abbreviation thereof, and shall have the
right to use, whether or not in conjunction wi th the word “Doctor”,
or any abbreviation thereof, the following designations:
1. The letters “D.P.M.” or the words podiatrist, doctor of
podiatry, podiatric surgeon, or doctor of podiatric medicine by a
person licensed to practice podiatry under the Podiatric Medicine
Practice Act;
2. The letters “D.C.” or the words chiropractor or doctor of
chiropractic by a person licensed to practice chiropractic under the
Oklahoma Chiropractic Practice Act ;
3. The letters “D.D.S.” or “D.M.D.”, as appropriate, or the
words dentist, doctor of dental surgery, or doctor of dental
medicine, as appropriate, by a person licensed to practice dentistry
under the State Dental Act ;
4. The letters “M.D.” or the words surgeon, medica l doctor, or
doctor of medicine by a person licensed to practice medicine and
surgery under the Oklahoma Allopathic Medical and Surgical Lice nsure
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and Supervision Act or by a person licensed as a provisionally
licensed physician under this act ;
5. The letters “O.D.” or the words optometrist or doctor of
optometry by a person licensed to practice optome try under Sections
581 through 606 of this title;
6. The letters “D.O.” or the words surgeon, osteopathic
surgeon, osteopath, doctor of osteopathy, or doctor of osteopathic
medicine by a person licensed to practice ost eopathy under the
Oklahoma Osteopathic Medicine Act or by a person licensed as a
provisionally licensed phy sician under this act ;
7. The letters “Ph.D.”, “Ed.D.”, or “Psy.D.” or the words
psychologist, therapist, or counselor by a person licensed as a
health service psychologist pursuant to the Psychol ogists Licensing
Act;
8. The letters “Ph.D.”, “Ed.D.”, or other letters representing
a doctoral degree or the words language pathologist, speech
pathologist, or speech and language pathologist by a person licensed
as a speech and language pathologist pursuant to the Speech -Language
Pathology and Audiology Licensing Act and who has earned a doctoral
degree from a regionally accredited institution of higher learning
in the field of speech and language pathology ;
9. The letters “Ph.D.”, “Ed.D.”, or other letters representing
a doctoral degree or the word audiologist by a person licensed as an
audiologist pursuant to the Speech-Language Pathology and Audiology
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Licensing Act and who has earned a doctoral degree fr om a regionally
accredited institution of higher learning in the field of audio logy;
and
10. The letters “D.P.T.” or the title Doctor of Physical
Therapy by a person licensed to practice physical therapy under the
Physical Therapy Practice Act who has earned a Doctor of Physical
Therapy degree from a program approved by a national a ccrediting
body recognized by the State Board of Medical Licensure and
Supervision.
B. Unless otherwise specifically provided in a particular
section or chapter of the Oklahoma Statutes, the word “doctor” or
“doctors” shall mean and include each of the ten classes of persons
listed in subsection A and the word “physician” or “physicians”, as
provided in subsection C of this section. Any other person using
the term doctor, or a ny abbreviation thereof, shall designate the
authority under which the title is used or the college or hon orary
degree that gives rise to use of the title.
C. Unless otherwise specifically provided in a particular
section or chapter of the Oklahoma Statut es, the word “physician” or
“physicians” shall mean and include each of the clas ses of persons
listed in paragraphs 1 through 6 o f subsection A of this section and
the word “doctor” or “doctors” as provided in subsection B of this
section. The term “physician” shall not include any person
specified in paragraphs 7 through 10 of subsection A of this section
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unless such person is otherwise authorized to use such designation
pursuant to this section.
D. For purposes of this section, “provider” means and includes:
l. Each of the ten classes of persons listed in subsection A of
this section and referred to in subse ctions B and C of this section;
and
2. Any other person us ing the term doctor or any abbreviation
thereof.
E. Persons in each of the ten classes listed in subsection A of
this section, and referred to in subsections B and C of this section
shall identify through written notice, which may include the wearin g
of a name tag, the type of license under which the doctor is
practicing, utilizing the designations provided in subsections A, B
and C of this section. Each applic able licensing board is
authorized by rule to determine how its license holders may comply
with this disclosure requirement.
F. 1. Any advertisement for health care services naming a
provider shall:
a. identify the type of license of the doctor utilizing
the letters or words set forth in this sectio n if the
person is one of the classes of p ersons listed in
subsection A of this section, and referred to in
subsections B and C of this section, or
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b. utilize appropriate, accepted, and easily understood
words or letters, which clearly show and in dicate the
branch of the healing art in which the person is
licensed to practice and is engaged in, if the person
is not one of the ten classes of persons listed in
subsection A of this section, or referred to in
subsections B and C of this section.
2. The term “advertisement” includes any printed document
including letterhead, video clip, or audio clip created by, for, or
at the direction of the prov ider or providers and advert ised for the
purpose of promoting the services of the doctor or provider.
G. 1. It shall be unlawful for any medical doctor, doctor of
osteopathic medicine, doctor of dental surgery, doctor of dental
medicine, doctor of optome try, doctor of podiatry, or doctor of
chiropractic to make any deceptive or misleading statement, or
engage in any deceptive or misleading act, that d eceives or misleads
the public or a prospective or current patient, regarding the
training and the license under which the person is a uthorized to
practice.
2. The term “deceptive or misleading statement or act ”
includes, but is not limited to:
a. such statement or act in any advertising medium,
b. making a false statement regarding the education,
skills, training, or licensure of a pe rson, or
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c. in any other way describing the profession, skills,
training, expertise, education, or licensure of a
person in a fashion that causes the public, a
potential patient, or current patient to believe that
the person is a medical doctor, doctor of o steopathic
medicine, doctor of dental surgery, doctor of dental
medicine, doctor of optometry, doctor of podiatry, or
doctor of chiropractic when that person does not hold
such credentials.
H. Notwithstanding any other provisio n of this section, a
person licensed in this sta te to perform speech pathology or
audiology services is designa ted to be a practitioner of the he aling
art for purposes of making a referral for speech pathology or
audiology services pursuant to the provisio ns of the Individuals
with Disabilities Education Act, Amendment of 1997, Public Law 105-
17, and Section 504 of the Rehabilitation Act of 1973.
SECTION 5. This act shall become effective November 1, 20 24.
59-2-3094 DC 1/11/2024 5:36:15 PM