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SENATE FLOOR VERSION
February 29, 2024
COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 1613 By: Garvin of the Senate
and
Stinson of the House
[ medicine - graduate physician practice -
supervision requirements - rules - licensure -
standards - titles - collaborative practice
arrangement - disciplinary actions - information -
identification badges - course - codification -
effective date ]
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new sectio n 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:
This act shall be known and may be cited as the “Graduate
Physicians Act”.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.2 of Title 59, unless there
is created a duplication in numbering, reads as follows:
As used in this act:
1. “Graduate physician” means a medical school graduate who:
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a. is a resident and citizen of the United States or a
legal resident alien in the United States, and
b. has successfully completed Step 1 and Step 2 of the
United States Medical Licensing Examination (USMLE),
or the equivalent of Step 1 and Step 2 of any o ther
medical licensing examination or combination of
examinations that is approved by the State Board of
Medical Licensure and Supervision or the State Board
of Osteopathic Examiners, within the two -year period
immediately preceding the date of the person ’s
application for licensure as a graduate physician, but
not more than three (3) years after graduation from a
medical school or school of osteopathic medicine;
2. “Graduate physician collaborative practice arrangement ”
means an agreement between a licens ed physician and a graduate
physician that meets the requirements of this act;
3. “Medical school graduate ” means any person who has graduate d
from a medical school as described in Section 493.1 of Title 59 of
the Oklahoma Statutes or a school of osteopathic medicine as
described in Section 630 of Title 59 of the Oklahoma Statutes ; and
4. “Primary care services ” means medical services in
pediatrics, internal medicine, and family medicine.
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SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.3 of Title 59, unless there
is created a duplication in numbering, reads as follows:
A graduate physician collaborative practice arrangement shall
limit the graduate physician to providing primary care se rvices in:
1. A medically underserved area of this state as designated by
the Health Resources and Services Administration ;
2. A rural community of this state as determined by the Health
Care Workforce Training Commission ; or
3. A rural health clinic as defined under Sections 1861 and
1905 of the federal Social Security Act (42 U.S.C. , Sections 1395x
and 1396d).
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.4 of Title 59, unless the re
is created a duplication in numbering, reads as follows:
Graduate physicians shall be subject to the supervision
requirements established in any controlling federal law, any
supervision requirements provided in this act, and any supervision
requirements established by the State Board of Medical Licensure and
Supervision. Graduate physicians are not subject to any additional
supervision requirements, other than the supervision requirements
provided in this section.
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SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.5 of Title 59, unless there
is created a duplication in numbering, reads as follows:
A. The State Board of Medical Licensure and Supervision, in
consultation with the State Bo ard of Osteopathic Examiners, may
promulgate rules:
1. To establish the process for licensure of graduate
physicians, supervision requirement s, and additional requirements
for graduate physician collaborative practice arrangements;
2. To set fees in an a mount greater than or equal to the total
costs necessary to facilitate the graduate physician collaborative
practice arrangement each year; and
3. To address any other matters necessary to protect the public
and discipline the profession.
B. A graduate physician’s license issued pursuant to this act
and the rules promulgated by the State Board of Medical Licensure
and Supervision shall only be valid for two (2) years from the date
of issuance and is not subject to renewal. The State Board of
Medical Licensure and Supervision or the State Board of Osteopathic
Examiners may deny an application for licensure or suspend or revoke
the license of a graduate physician for violation of the standards
provided in the Oklahoma Allopathic Medical and Surgical Licensu re
and Supervision Act or the Oklahoma Osteopathic Medicine Act, or
such other standards of conduct established by the State Board of
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Medical Licensure and Supervision or the State Board of Osteopathic
Examiners by rule.
SECTION 6. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.6 of Title 59, unless there
is created a duplication in numbering, reads as follows:
A graduate physician shall clearly identify himself or herself
as a graduate physician and shall be permitted to use the
identifiers “doctor” or “Dr.” A graduate physician shall not
practice, or attempt to practice, without a gr aduate physician
collaborative practice arrangement, except as otherwise provided in
this act.
SECTION 7. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.7 of Title 59, unless there
is created a duplication in numbering, reads as follows:
The licensed physician collaborating with a graduate physician
shall be responsible for supervising the activities of the graduate
physician and shall accept full responsibility for the primary care
services provided by the graduate physician.
SECTION 8. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.8 of Title 59, unless there
is created a duplication in numbering, reads as follows:
A. This act applies to all graduate physician collaborative
practice arrangements. To be eligible to practice as a graduate
physician, a licensed graduate physician must enter into a graduate
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physician collaborative practice arrangement with a licensed
physician no later tha n six (6) months after the date on which the
graduate physician obtains initial licensure.
B. Only a physician li censed by the State Board of Medical
Licensure and Supervision or the State Board of Osteopathic
Examiners may enter into a graduate physician collaborative practice
arrangement with a graduate physician. Graduate physician
collaborative practice arrangem ents shall take the form of a written
agreement that includes mutually agreed -upon protocols and any
standing orders for the delivery of prima ry care services. Graduate
physician collaborative practice arrangements may delegate to a
graduate physician the authority to prescribe, administer, or
dispense drugs and provide treatment, as long as the delivery of the
primary care services is within the scope of the graduate
physician’s practice and is consistent with the graduate physician ’s
skill, training, and competence and the skill, training, and
competence of the collaborating physician; except that a graduate
physician shall not prescribe contr olled dangerous substances. The
collaborating physician shall be board -certified in the specialty
that the graduate physician is practicing, which may only include
pediatrics, internal medicine, or family medicine.
C. The graduate physician collaborative practice arrangement
shall contain the following provisions:
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1. Complete names, home and business addresses, and telephone
numbers of the collaborating physician and the graduate physician;
2. A requirement that the graduate physician practice at the
same location as the collaborating physician;
3. A requirement that a prominently displayed disclosure
statement informing patients that they may be seen by a graduate
physician, and advising patients that the patient has the right to
see the collaborating physician, be posted in every office where the
graduate physician is authorized to prescribe;
4. All specialty or board certifications of the collaborating
physician and all certifications of the graduate physician;
5. The manner of collaboration between the collaborating
physician and the graduate physician, including how the
collaborating physician and the graduat e physician will:
a. engage in collaborative practice consistent with each
professional’s skill, training, education, and
competence, and
b. maintain geographic proximity. However, the graduate
physician collaborative practice arrangement may only
allow for geographic proximity to be waived for no
more than twenty-eight (28) days per calendar year for
rural health clinics, as long as the gradua te
physician collaborative practice arrangement includes
alternative plans as required by the State Board of
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Medical Licensure and Supervision . The exception to
the geographic proximity requirement applies only to
independent rural health clinics, provider -based rural
health clinics if the provider is a critical access
hospital as provided in 42 U.S.C. , Section 1395i-4,
and provider-based rural health clinics if the primary
location of the hospital sponsor is more than twenty -
five (25) miles from the clini c. The collaborating
physician shall maintain documentation related to the
geographic proximity requirement and present the
documentation to the State Board of Medical Licensure
and Supervision upon request;
6. A requirement that the graduate physician shall not provide
patient care during an absence of the collaborating physician for
any reason;
7. A list of all other graduate physician collaborative
practice arrangements of the collaborating physician and the
graduate physician;
8. The duration of the graduate physician collaborative
practice arrangement between the collaborating physician and the
graduate physician;
9. A provision describing the time and manner of the
collaborating physician ’s review of the graduate physician ’s
delivery of primary care services. The provision shall require the
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graduate physician to submit to the collaborating physician a
minimum of twenty-five percent (25%) of the charts documenting the
graduate physician’s delivery of primary care services for review by
the collaborating physician or by any other physician designated in
the graduate physician collaborative practice arrangement every
fourteen (14) days after the initial observation year. For the
first three (3) months of the initial observation year, the
collaborating physician shall review one hundred percent (100%) of
the charts documenting the graduate physician’s delivery of primary
care services. For months four (4) through twelve (12), the
collaborating physician shall review seventy -five percent (75%) of
the charts documenting the graduate physician ’s delivery of primary
care services; and
10. A requirement that a collab orating physician be on premises
if the graduate physician performs services in a hospital or
emergency department.
SECTION 9. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.9 of Title 59, unless there
is created a duplication in numbering, reads as follows:
A. The State Board of Medical Licensure and Supervision, in
consultation with the State Board of Osteopathic Examiners, shall
promulgate rules regulating the use of graduate physician
collaborative practice arrangements for graduate physicians. The
rules shall specify:
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1. The geographic areas to be covered;
2. The methods of treatment that may be covered by the graduate
physician collaborative practice arrangement;
3. The educational metho ds and programs to be performed during
the collaborative practice service, developed in consultation with
deans of medical schools and primary care residency program
directors in this state, which shall facilitate the advancement of
the graduate physician ’s medical knowledge and capabilities, the
successful completion of which may lead to credit toward a future
residency program that deems the documented educational achievements
of the graduate physician through the methods and programs
acceptable; and
4. Require review of the services provided under a graduate
physician collaborative practice arrangement.
B. A collaborating physician shall not enter into a graduate
physician collaborative practice arrangement with more than three
graduate physicians at th e same time.
SECTION 10. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.10 of Title 59, unless there
is created a duplication in numbering, reads as follows:
A. The State Board of Medical Licensu re and Supervision, in
consultation with the State Board of Osteopathic Examiners, shall
promulgate rules applicable to graduate physicians th at are
consistent with the guidelines established for federally funded
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clinics. The rulemaking authority granted to the State Board of
Medical Licensure and Supervision in this subsection does not extend
to graduate physician collaborative practice arrangements of
hospital employees providing inpatient care within hospitals.
B. The State Board of Medical Licensure a nd Supervision or the
State Board of Osteopathic Examiners shall not deny, revoke,
suspend, or otherwise take disciplinary action against a
collaborating physician for primary care services delegated to a
graduate physician as long as the provisions of thi s section and any
applicable rules promulgated by the State Board of Medical Licensure
and Supervision are satisfied.
C. Within thirty (30) days of any licensure change, the State
Board of Medical Licensure and Supervision or the State Board of
Osteopathic Examiners shall require every physician to identify
whether the physician is engaged in a graduate physician
collaborative practice arrangem ent, and to report to the physician ’s
licensing board the name of each graduate physician with whom the
physician has entered into an arrangement. Each board may make the
information available to the public. The State Board of Medical
Licensure and Supervision shall track the reported information and
may routinely conduct reviews or inspections to ensure that the
arrangements are being carried out in compliance with this act.
D. A contract or other agreement shall not require a physician
to act as a collaborating physician for a graduate physician against
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the physician’s will. A physician has the right to refuse to act as
a collaborating physician, without penalty, for a particular
graduate physician. A contract or other agreement shall not limit
the collaborating physician ’s authority over any protocols or
standing orders, or delegate the physician ’s authority to a graduate
physician. However, this subsection does not authorize a physician
in implementing protocols, standing orders, or delegation to vi olate
applicable standards for safe medical practice established by a
hospital’s medical staff.
E. A contract or other agreement shall not require a graduate
physician to serve as a graduate physician for any collaborating
physician against the graduate physician ’s will. A graduate
physician has the right to refuse to collaborate, without penalty,
with a particular physician.
F. All collaborating physicians and graduate physicians under a
graduate physician collaborative practice arrangement shall wear
identification badges while acting within the scope of the
arrangement. The identification badges shall prominently display
the licensure status of the collaborating physician and the graduate
physician.
SECTION 11. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 479.11 of Title 59, unless there
is created a duplication in numbering, reads as follows:
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A. The collaborating physician shall complete a certification
course, which may include material on th e laws pertaining to the
professional relationship. The certification course must be
approved by the State Board of Medical Licensure and Supervision or
the State Board of Osteopathic Examiners.
B. A graduate physician collaborative practice arrangement
shall supersede current hospital licensing regulations governing
hospital medication orders under protocols or sta nding orders for
the purpose of delivering inpatient or emergency care within a
hospital as defined in Section 1 -701 of Title 63 of the Oklaho ma
Statutes, if the protocols or standing orders have been approved by
the hospital’s medical staff and pharmaceut ical therapeutics
committee.
SECTION 12. This act shall become effective November 1, 2024.
COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
February 29, 2024 - DO PASS AS AMENDED BY CS