| 1 | 1 | | |
|---|
| 2 | 2 | | |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | 2025 -- S 0703 |
|---|
| 6 | 6 | | ======== |
|---|
| 7 | 7 | | LC001802 |
|---|
| 8 | 8 | | ======== |
|---|
| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
|---|
| 10 | 10 | | IN GENERAL ASSEMBLY |
|---|
| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
|---|
| 12 | 12 | | ____________ |
|---|
| 13 | 13 | | |
|---|
| 14 | 14 | | A N A C T |
|---|
| 15 | 15 | | RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANTS |
|---|
| 16 | 16 | | Introduced By: Senators Valverde, and Lauria |
|---|
| 17 | 17 | | Date Introduced: March 07, 2025 |
|---|
| 18 | 18 | | Referred To: Senate Health & Human Services |
|---|
| 19 | 19 | | |
|---|
| 20 | 20 | | |
|---|
| 21 | 21 | | It is enacted by the General Assembly as follows: |
|---|
| 22 | 22 | | SECTION 1. Sections 5-54-2, 5-54-22 and 5-54-28 of the General Laws in Chapter 5-54 1 |
|---|
| 23 | 23 | | entitled "Physician Assistants" are hereby amended to read as follows: 2 |
|---|
| 24 | 24 | | 5-54-2. Definitions. 3 |
|---|
| 25 | 25 | | As used in this chapter, the following words have the following meanings: 4 |
|---|
| 26 | 26 | | (1) “Administrator” means the administrator, division of professional regulation. 5 |
|---|
| 27 | 27 | | (2) “Approved program” means a program for the education and training of physician 6 |
|---|
| 28 | 28 | | assistants formally approved by the American Medical Association’s (A.M.A.’s) Committee on 7 |
|---|
| 29 | 29 | | Allied Health, Education and Accreditation, its successor, the Commission on Accreditation of 8 |
|---|
| 30 | 30 | | Allied Health Education Programs (CAAHEP) or its successor. 9 |
|---|
| 31 | 31 | | (3) “Approved program for continuing medical education” means a program for continuing 10 |
|---|
| 32 | 32 | | education approved by the American Academy of Physician Assistants (AAPA) or the 11 |
|---|
| 33 | 33 | | Accreditation Council for Continuing Medical Education of the American Medical Association 12 |
|---|
| 34 | 34 | | (AMA), or the American Academy of Family Physicians (AAPFP) or the American Osteopathic 13 |
|---|
| 35 | 35 | | Association Committee on Continuing Medical Education (AOACCME) or any other board-14 |
|---|
| 36 | 36 | | approved program. 15 |
|---|
| 37 | 37 | | (4) “Board” means the board of licensure of physician assistants. 16 |
|---|
| 38 | 38 | | (5) “Collaboration” means the physician assistant shall, as indicated by the patient’s 17 |
|---|
| 39 | 39 | | condition, the education, competencies, and experience of the physician assistant, and the standards 18 |
|---|
| 40 | 40 | | of care, consult with or refer to an appropriate physician or other healthcare professional. The 19 |
|---|
| 41 | 41 | | |
|---|
| 42 | 42 | | |
|---|
| 43 | 43 | | LC001802 - Page 2 of 8 |
|---|
| 44 | 44 | | degree of collaboration shall be determined by the practice and includes decisions made by a 1 |
|---|
| 45 | 45 | | physician employer, physician group affiliated with the practice, and or the credentialing and 2 |
|---|
| 46 | 46 | | privileging systems of a licensed hospital, health center, or ambulatory care center healthcare 3 |
|---|
| 47 | 47 | | facility licensed pursuant to chapter 17 of title 23 or a health maintenance organization licensed 4 |
|---|
| 48 | 48 | | pursuant to chapter 17 of title 23 or chapter 41 of title 27. A physician must be accessible at all 5 |
|---|
| 49 | 49 | | times for consultation by the physician assistant. 6 |
|---|
| 50 | 50 | | (6) “Director” means the director of the department of health. 7 |
|---|
| 51 | 51 | | (7) “Division” means the division of professional regulation, department of health. 8 |
|---|
| 52 | 52 | | (8) [Deleted by P.L. 2013, ch. 320, § 1 and P.L. 2013, ch. 420, § 1.] 9 |
|---|
| 53 | 53 | | (9) “Physician” means a person licensed under the provisions of chapter 29 or 37 of this 10 |
|---|
| 54 | 54 | | title. 11 |
|---|
| 55 | 55 | | (10) “Physician assistant” or “PA” means a person who is qualified by academic and 12 |
|---|
| 56 | 56 | | practical training to provide medical and surgical services in collaboration with physicians. 13 |
|---|
| 57 | 57 | | (11) “Unprofessional conduct” includes, but is not limited to, the following items or any 14 |
|---|
| 58 | 58 | | combination and may be defined by regulations established by the board with prior approval of the 15 |
|---|
| 59 | 59 | | director: 16 |
|---|
| 60 | 60 | | (i) Fraudulent or deceptive procuring or use of a license; 17 |
|---|
| 61 | 61 | | (ii) Representation of himself or herself as a physician; 18 |
|---|
| 62 | 62 | | (iii) Conviction of a felony; conviction of a crime arising out of the practice of medicine. 19 |
|---|
| 63 | 63 | | All advertising of medical business that is intended or has a tendency to deceive the public; 20 |
|---|
| 64 | 64 | | (iv) Abandonment of a patient; 21 |
|---|
| 65 | 65 | | (v) Dependence upon a controlled substance, habitual drunkenness, or rendering 22 |
|---|
| 66 | 66 | | professional services to a patient while intoxicated or incapacitated by the use of drugs; 23 |
|---|
| 67 | 67 | | (vi) Promotion of the sale of drugs, devices, appliances, or goods or services provided for 24 |
|---|
| 68 | 68 | | a patient in a manner that exploits the patient for the financial gain of the physician assistant; 25 |
|---|
| 69 | 69 | | (vii) Immoral conduct of a physician assistant in the practice of medicine; 26 |
|---|
| 70 | 70 | | (viii) Willfully making and filing false reports or records; 27 |
|---|
| 71 | 71 | | (ix) Willful omission to file or record or willfully impeding or obstructing a filing or 28 |
|---|
| 72 | 72 | | recording, or inducing another person to omit to file or record medical or other reports as required 29 |
|---|
| 73 | 73 | | by law; 30 |
|---|
| 74 | 74 | | (x) Agreeing with clinical or bioanalytical laboratories to accept payments from these 31 |
|---|
| 75 | 75 | | laboratories for individual tests or test series for patients; 32 |
|---|
| 76 | 76 | | (xi) Practicing with an unlicensed physician or physician assistant or aiding or abetting 33 |
|---|
| 77 | 77 | | these unlicensed persons in the practice of medicine; 34 |
|---|
| 78 | 78 | | |
|---|
| 79 | 79 | | |
|---|
| 80 | 80 | | LC001802 - Page 3 of 8 |
|---|
| 81 | 81 | | (xii) Offering, undertaking, or agreeing to cure or treat a disease by a secret method, 1 |
|---|
| 82 | 82 | | procedure, treatment, or medicine; 2 |
|---|
| 83 | 83 | | (xiii) Professional or mental incompetence; 3 |
|---|
| 84 | 84 | | (xiv) Surrender, revocation, suspension, limitation of privilege based on quality of care 4 |
|---|
| 85 | 85 | | provided, or any other disciplinary action against a license or authorization to practice in another 5 |
|---|
| 86 | 86 | | state or jurisdiction; or surrender, revocation, suspension, or any other disciplinary action relating 6 |
|---|
| 87 | 87 | | to membership on any medical staff or in any medical professional association, or society while 7 |
|---|
| 88 | 88 | | under disciplinary investigation by any of those authorities or bodies for acts or conduct similar to 8 |
|---|
| 89 | 89 | | acts or conduct that would constitute grounds for action as stated in this chapter; 9 |
|---|
| 90 | 90 | | (xv) Any adverse judgment, settlement, or award arising from a medical liability claim 10 |
|---|
| 91 | 91 | | related to acts or conduct that would constitute grounds for action as stated in this chapter; 11 |
|---|
| 92 | 92 | | (xvi) Failure to furnish the board, the administrator, investigator, or representatives, 12 |
|---|
| 93 | 93 | | information legally requested by the board; 13 |
|---|
| 94 | 94 | | (xvii) Violation of any provisions of this chapter or the rules and regulations promulgated 14 |
|---|
| 95 | 95 | | by the director or an action, stipulation, or agreement of the board; 15 |
|---|
| 96 | 96 | | (xviii) Cheating or attempting to subvert the certifying examination; 16 |
|---|
| 97 | 97 | | (xix) Violating any state or federal law or regulation relating to controlled substances; 17 |
|---|
| 98 | 98 | | (xx) Medical malpractice; 18 |
|---|
| 99 | 99 | | (xxi) Sexual contact between a physician assistant and patient during the existence of the 19 |
|---|
| 100 | 100 | | physician assistant/patient relationship; 20 |
|---|
| 101 | 101 | | (xxii) Providing services to a person who is making a claim as a result of a personal injury, 21 |
|---|
| 102 | 102 | | who charges or collects from the person any amount in excess of the reimbursement to the physician 22 |
|---|
| 103 | 103 | | assistant by the insurer as a condition of providing or continuing to provide services or treatment. 23 |
|---|
| 104 | 104 | | 5-54-22. Continuing medical education. 24 |
|---|
| 105 | 105 | | Every physician assistant licensed to practice within the state shall be required to have 25 |
|---|
| 106 | 106 | | satisfactorily completed twenty-five (25) fifty (50) hours of approved continuing medical education 26 |
|---|
| 107 | 107 | | annually biannually. The annual biannual period for accumulation of continuing-education hours 27 |
|---|
| 108 | 108 | | commences on the first day of October June and runs through the last day of September beginning 28 |
|---|
| 109 | 109 | | in 1996 May. Beginning with the annual biannual renewal period commencing the first day of 29 |
|---|
| 110 | 110 | | October 1997 June 2025, the administrator shall not renew the certificate of licensure until 30 |
|---|
| 111 | 111 | | satisfactory evidence of the completion of the required continuing medical education is provided 31 |
|---|
| 112 | 112 | | to the division. The board may extend for only one six (6) month period these educational 32 |
|---|
| 113 | 113 | | requirements if the board is satisfied that the applicant has suffered hardship that prevented the 33 |
|---|
| 114 | 114 | | applicant from meeting the educational requirement. No recertification to practice medicine in this 34 |
|---|
| 115 | 115 | | |
|---|
| 116 | 116 | | |
|---|
| 117 | 117 | | LC001802 - Page 4 of 8 |
|---|
| 118 | 118 | | state shall be refused, nor shall any certificate be suspended or revoked, except: 1 |
|---|
| 119 | 119 | | (1) As provided for in this chapter; and 2 |
|---|
| 120 | 120 | | (2) For failure to provide satisfactory evidence of continuing medical education as provided 3 |
|---|
| 121 | 121 | | for in this section. 4 |
|---|
| 122 | 122 | | 5-54-28. Participation in charitable and voluntary care. 5 |
|---|
| 123 | 123 | | A physician assistant licensed in this state, or licensed or authorized to practice in any other 6 |
|---|
| 124 | 124 | | U.S. jurisdiction, or who is credentialed by a federal employer or meets the licensure requirements 7 |
|---|
| 125 | 125 | | of his or her requisite federal agency as a physician assistant may volunteer to render such care that 8 |
|---|
| 126 | 126 | | he or she is able to provide at a children’s summer camp or for a public or community event or in 9 |
|---|
| 127 | 127 | | a licensed ambulatory health center providing free care without a collaborating physician as it is 10 |
|---|
| 128 | 128 | | defined in this chapter or with such collaborating physicians as may be available. Such care must 11 |
|---|
| 129 | 129 | | be rendered without compensation or remuneration. It is the obligation of the physician assistant to 12 |
|---|
| 130 | 130 | | assure adequate and appropriate professional liability coverage. 13 |
|---|
| 131 | 131 | | SECTION 2. Chapter 5-54 of the General Laws entitled "Physician Assistants" is hereby 14 |
|---|
| 132 | 132 | | amended by adding thereto the following section: 15 |
|---|
| 133 | 133 | | 5-54-29. Restrictive covenants. 16 |
|---|
| 134 | 134 | | (a) Any contract or agreement that creates or establishes the terms of a partnership, 17 |
|---|
| 135 | 135 | | employment, or any other form of professional relationship with a physician assistant licensed to 18 |
|---|
| 136 | 136 | | practice pursuant to this chapter that includes any restriction of the right of such physician assistant 19 |
|---|
| 137 | 137 | | to practice shall be void and unenforceable with respect to said restriction; provided, however, that 20 |
|---|
| 138 | 138 | | nothing herein shall render void or unenforceable the remaining provisions of any such contract or 21 |
|---|
| 139 | 139 | | agreement. 22 |
|---|
| 140 | 140 | | (b) Restrictions rendered void under subsection (a) of this section shall include, but shall 23 |
|---|
| 141 | 141 | | not be limited to, the following: 24 |
|---|
| 142 | 142 | | (1) The right to practice in any geographic area for any period of time after the termination 25 |
|---|
| 143 | 143 | | of such partnership, employment, or professional relationship; 26 |
|---|
| 144 | 144 | | (2) The right of such physician assistant to provide treatment, advise, consult with or 27 |
|---|
| 145 | 145 | | establish a professional relationship with any current patient of the employer; and 28 |
|---|
| 146 | 146 | | (3) The right of such physician assistant to solicit or seek to establish a professional 29 |
|---|
| 147 | 147 | | relationship with any current patient of the employer. 30 |
|---|
| 148 | 148 | | (c) Notwithstanding the foregoing, the prohibition on physician assistant covenants shall 31 |
|---|
| 149 | 149 | | not apply in connection with the purchase and sale of a practice; provided that, the restrictive 32 |
|---|
| 150 | 150 | | covenant and/or non-compete covenant is for a period not more than five (5) years. 33 |
|---|
| 151 | 151 | | SECTION 3. Section 16-91-3 of the General Laws in Chapter 16-91 entitled "School and 34 |
|---|
| 152 | 152 | | |
|---|
| 153 | 153 | | |
|---|
| 154 | 154 | | LC001802 - Page 5 of 8 |
|---|
| 155 | 155 | | Youth Programs Concussion Act" is hereby amended to read as follows: 1 |
|---|
| 156 | 156 | | 16-91-3. School district’s guidelines to be developed and implemented. 2 |
|---|
| 157 | 157 | | (a) The department of education and the department of health shall work in concert with 3 |
|---|
| 158 | 158 | | the Rhode Island Interscholastic League to develop and promulgate guidelines to inform and 4 |
|---|
| 159 | 159 | | educate coaches, teachers, school nurses, youth athletes, and their parents and/or guardians of the 5 |
|---|
| 160 | 160 | | nature and risk of concussion and head injury, including continuing to play after concussion or head 6 |
|---|
| 161 | 161 | | injury. A concussion and head injury information sheet shall be signed and returned by the youth 7 |
|---|
| 162 | 162 | | athlete and the athlete’s parent and/or guardian prior to the youth athlete’s return to practice or 8 |
|---|
| 163 | 163 | | competition. 9 |
|---|
| 164 | 164 | | (b) School districts are required to use training materials made available by the United 10 |
|---|
| 165 | 165 | | States Center for Disease Control and Prevention entitled “Heads Up: Concussion in the High 11 |
|---|
| 166 | 166 | | School Sports/Concussion in Youth Sports” and any updates or amendments thereto, or training 12 |
|---|
| 167 | 167 | | materials substantively and substantially similar thereto. The department of education shall post 13 |
|---|
| 168 | 168 | | training materials made available by the Center for Disease Control and Prevention and the Rhode 14 |
|---|
| 169 | 169 | | Island Interscholastic League on its website. All coaches and volunteers involved in a youth sport 15 |
|---|
| 170 | 170 | | or activity covered by this chapter must complete a training course and a refresher course annually 16 |
|---|
| 171 | 171 | | thereafter in concussions and traumatic brain injuries. All school nurses must complete a training 17 |
|---|
| 172 | 172 | | course and an annual refresher course in concussions and traumatic brain injuries. Teachers and 18 |
|---|
| 173 | 173 | | teachers’ aides are strongly encouraged to complete the training course in concussions and 19 |
|---|
| 174 | 174 | | traumatic brain injuries. Training may consist of videos, classes, and any other generally accepted 20 |
|---|
| 175 | 175 | | mode and medium of providing information. 21 |
|---|
| 176 | 176 | | (c) School districts are encouraged to have all student athletes perform baseline 22 |
|---|
| 177 | 177 | | neuropsychological testing, computerized or otherwise. Parents and/or guardians shall be provided 23 |
|---|
| 178 | 178 | | with information as to the risk of concussion and/or traumatic brain injuries prior to the start of 24 |
|---|
| 179 | 179 | | every sport season and they shall sign an acknowledgement as to their receipt of such information. 25 |
|---|
| 180 | 180 | | (d) A youth athlete, who is suspected of sustaining a concussion or head injury in a practice 26 |
|---|
| 181 | 181 | | or game, shall be removed from competition at that time. 27 |
|---|
| 182 | 182 | | (e) A youth athlete, who has been removed from play, may not return to play until the 28 |
|---|
| 183 | 183 | | athlete is evaluated by a licensed physician, physician assistant, or certified nurse practitioner who 29 |
|---|
| 184 | 184 | | may consult with an athletic trainer, all of whom shall be trained in the evaluation and management 30 |
|---|
| 185 | 185 | | of concussions. The athlete must receive written clearance to return to play from that licensed 31 |
|---|
| 186 | 186 | | physician, physician assistant, or certified nurse practitioner. 32 |
|---|
| 187 | 187 | | (f) All school districts are encouraged to have an athletic trainer, or similarly trained 33 |
|---|
| 188 | 188 | | person, at all recreational and athletic events addressed by this statute. 34 |
|---|
| 189 | 189 | | |
|---|
| 190 | 190 | | |
|---|
| 191 | 191 | | LC001802 - Page 6 of 8 |
|---|
| 192 | 192 | | SECTION 4. Section 16-91.1-3 of the General Laws in Chapter 16-91.1 entitled "The 1 |
|---|
| 193 | 193 | | Sudden Cardiac Arrest Prevention Act" is hereby amended to read as follows: 2 |
|---|
| 194 | 194 | | 16-91.1-3. School districts’ guidelines to be developed and implemented. 3 |
|---|
| 195 | 195 | | (a) The department of education and the department of health shall promulgate guidelines 4 |
|---|
| 196 | 196 | | to inform and educate coaches, teachers, school nurses, youth athletes, and their parents and/or 5 |
|---|
| 197 | 197 | | guardians about the nature and warning signs of sudden cardiac arrest, including the risks associated 6 |
|---|
| 198 | 198 | | with continuing to play or practice after experiencing the following symptoms: fainting or seizures 7 |
|---|
| 199 | 199 | | during exercise, unexplained shortness of breath, chest pains, dizziness, racing heart rate and 8 |
|---|
| 200 | 200 | | extreme fatigue. 9 |
|---|
| 201 | 201 | | (b) School districts may use training materials made available at no cost to the school 10 |
|---|
| 202 | 202 | | district by organizations such as Simon’s Fund, Parent Heart Watch, Sudden Arrhythmia Death 11 |
|---|
| 203 | 203 | | Syndromes Foundation, or training materials substantively and substantially similar thereto. The 12 |
|---|
| 204 | 204 | | department of education shall post links to training materials on its website. All coaches and 13 |
|---|
| 205 | 205 | | volunteers involved in a youth sport program or activity covered by this chapter must complete a 14 |
|---|
| 206 | 206 | | training course that may be completed online about the nature and warning signs of sudden cardiac 15 |
|---|
| 207 | 207 | | arrest, including the risks associated with continuing to play or practice after experiencing 16 |
|---|
| 208 | 208 | | symptoms including: fainting or seizures during exercise, unexplained shortness of breath, chest 17 |
|---|
| 209 | 209 | | pains, dizziness, racing heart rate and extreme fatigue. Training may consist of videos, classes, and 18 |
|---|
| 210 | 210 | | any other generally accepted mode and medium of providing information. 19 |
|---|
| 211 | 211 | | (c) Parents and/or guardians shall be provided with information as to the nature and 20 |
|---|
| 212 | 212 | | warning signs of sudden cardiac arrest prior to the start of every sport season. 21 |
|---|
| 213 | 213 | | (d)(1) A student who, as determined by a game official, coach from the student’s team, 22 |
|---|
| 214 | 214 | | certified athletic trainer, licensed physician, or other official designated by the student’s school 23 |
|---|
| 215 | 215 | | entity, exhibits signs or symptoms of sudden cardiac arrest while participating in an athletic activity 24 |
|---|
| 216 | 216 | | shall be removed by the coach from participation at that time, subject to subsection (d)(3) of this 25 |
|---|
| 217 | 217 | | section. 26 |
|---|
| 218 | 218 | | (2) If a student is known to have exhibited signs or symptoms of sudden cardiac arrest at 27 |
|---|
| 219 | 219 | | any time prior to or following an athletic activity, the student shall be prevented from participating 28 |
|---|
| 220 | 220 | | in an athletic activity, subject to subsection (d)(3) of this section. 29 |
|---|
| 221 | 221 | | (3) A student removed or prevented from participating in an athletic activity under 30 |
|---|
| 222 | 222 | | subsections (d)(1) or (d)(2) of this section shall not return to participation until the student is 31 |
|---|
| 223 | 223 | | evaluated and cleared for return to participation in writing by a licensed physician, physician 32 |
|---|
| 224 | 224 | | assistant, or certified registered nurse practitioner, or cardiologist. 33 |
|---|
| 225 | 225 | | (e) All school districts are encouraged to have an athletic trainer, or similarly trained 34 |
|---|
| 226 | 226 | | |
|---|
| 227 | 227 | | |
|---|
| 228 | 228 | | LC001802 - Page 7 of 8 |
|---|
| 229 | 229 | | person, at all recreational and athletic events addressed by this statute. 1 |
|---|
| 230 | 230 | | SECTION 5. This act shall take effect upon passage. 2 |
|---|
| 231 | 231 | | ======== |
|---|
| 232 | 232 | | LC001802 |
|---|
| 233 | 233 | | ======== |
|---|
| 234 | 234 | | |
|---|
| 235 | 235 | | |
|---|
| 236 | 236 | | LC001802 - Page 8 of 8 |
|---|
| 237 | 237 | | EXPLANATION |
|---|
| 238 | 238 | | BY THE LEGISLATIVE COUNCIL |
|---|
| 239 | 239 | | OF |
|---|
| 240 | 240 | | A N A C T |
|---|
| 241 | 241 | | RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANTS |
|---|
| 242 | 242 | | *** |
|---|
| 243 | 243 | | This act would alter the continuing medical education requirements of physician assistants 1 |
|---|
| 244 | 244 | | to fifty (50) credits submitted biannually. This act would also allow physician assistants to render 2 |
|---|
| 245 | 245 | | charitable care without a collaborating physician when the physician assistant has appropriate 3 |
|---|
| 246 | 246 | | professional liability insurance coverage. This act would alter “The School and Youth Programs 4 |
|---|
| 247 | 247 | | Concussion Act” and “The Sudden Cardiac Arrest Prevention Act” to permit physician assistants 5 |
|---|
| 248 | 248 | | to clear student athletes to return to athletic activities after being removed from such activities for 6 |
|---|
| 249 | 249 | | evoking symptoms of a concussive or cardiac origin. This act would further prohibit restrictive 7 |
|---|
| 250 | 250 | | covenants and non-compete agreements that would prohibit physician assistants from practicing in 8 |
|---|
| 251 | 251 | | a certain geographic area, advising or treating a patient with whom a relationship was established 9 |
|---|
| 252 | 252 | | while the physician assistant was employed by the party to the agreement, or establishing a 10 |
|---|
| 253 | 253 | | relationship with another employer. The prohibition of the foregoing would not apply to 11 |
|---|
| 254 | 254 | | agreements involving the purchase and sale of a practice. 12 |
|---|
| 255 | 255 | | This act would take effect upon passage. 13 |
|---|
| 256 | 256 | | ======== |
|---|
| 257 | 257 | | LC001802 |
|---|
| 258 | 258 | | ======== |
|---|
| 259 | 259 | | |
|---|