|
|
To amend sections 2105.35, 2108.40, 4730.06, 4730.09, | 1 |
4730.38, 4730.39, 4730.40, 4730.42, 4730.44, | 2 |
4730.45, 4755.48, and 4755.481, to enact sections | 3 |
2305.2310, 4730.04, 4730.53, and 5111.0212, and to | 4 |
repeal section 4730.401 of the Revised Code | 5 |
regarding Medicaid reimbursement for physician | 6 |
assistants, immunity from civil liability for | 7 |
physicians and physician assistants providing | 8 |
certain emergency medical services, the | 9 |
determination and pronouncement of death by | 10 |
physician assistants, and the scope of practice | 11 |
and prescriptive authority of physician | 12 |
assistants. | 13 |
Section 1. That sections 2105.35, 2108.40, 4730.06, 4730.09, | 14 |
4730.38, 4730.39, 4730.40, 4730.42, 4730.44, 4730.45, 4755.48, and | 15 |
4755.481 be amended and sections 2305.2310, 4730.04, 4730.53, and | 16 |
5111.0212 of the Revised Code be enacted to read as follows: | 17 |
Sec. 2105.35. (A)(1) A person is dead if the person has been | 18 |
determined to be and pronounced dead pursuant to standards | 19 |
established under section 2108.40 of the Revised Code. | 20 |
(2) A physician or physician assistant who makes a | 21 |
determination and pronouncement of death in accordance with | 22 |
section 2108.40 of the Revised Code and any person who acts in | 23 |
good faith in reliance on a determination and pronouncement of | 24 |
death made | 25 |
2108.40 of the Revised Code by a physician or physician assistant | 26 |
are each entitled to the immunity conveyed by
| 27 |
2108.40 of the Revised Code. | 28 |
(B) A certified or authenticated copy of a death certificate | 29 |
purporting to be issued by an official or agency of the place | 30 |
where the death of a person purportedly occurred is prima-facie | 31 |
evidence of the fact, place, date, and time of the person's death | 32 |
and the identity of the decedent. | 33 |
(C) A certified or authenticated copy of any record or report | 34 |
of a domestic or foreign governmental agency that a person is | 35 |
missing, detained, dead, or alive is prima-facie evidence of the | 36 |
status and of the dates, circumstances, and places disclosed by | 37 |
the record or report. | 38 |
(D) In the absence of prima-facie evidence of death under | 39 |
division (B) or (C) of this section, the fact of death may be | 40 |
established by clear and convincing evidence, including | 41 |
circumstantial evidence. | 42 |
(E) Except as provided in division (F) of this section, a | 43 |
presumption of the death of a person arises: | 44 |
(1) When the person has disappeared and been continuously | 45 |
absent from the person's place of last domicile for a five-year | 46 |
period without being heard from during the period; | 47 |
(2) When the person has disappeared and been continuously | 48 |
absent from the person's place of last domicile without being | 49 |
heard from and was at the beginning of the person's absence | 50 |
exposed to a specific peril of death, even though the absence has | 51 |
continued for less than a five-year period. | 52 |
(F) When a person who is on active duty in the armed services | 53 |
of the United States has been officially determined to be absent | 54 |
in a status of "missing" or "missing in action," a presumption of | 55 |
death arises when the head of the federal department concerned has | 56 |
made a finding of death pursuant to the "Federal Missing Persons | 57 |
Act," 80 Stat. 625 (1966), 37 U.S.C.A. 551, as amended. | 58 |
(G) In the absence of evidence disputing the time of death | 59 |
stipulated on a document described in division (B) or (C) of this | 60 |
section, a document described in either of those divisions that | 61 |
stipulates a time of death one hundred twenty hours or more after | 62 |
the time of death of another person, however the time of death of | 63 |
the other person is determined, establishes by clear and | 64 |
convincing evidence that the person survived the other person by | 65 |
one hundred twenty hours. | 66 |
(H) The provisions of divisions (A) to (G) of this section | 67 |
are in addition to any other provisions of the Revised Code, the | 68 |
Rules of Criminal Procedure, or the Rules of Evidence that pertain | 69 |
to the determination of death and status of a person. | 70 |
Sec. 2108.40. (A) An individual is dead if the individual has | 71 |
sustained either irreversible cessation of circulatory and | 72 |
respiratory functions or irreversible cessation of all functions | 73 |
of the brain, including the brain stem, as determined in | 74 |
accordance with accepted medical standards. If the respiratory and | 75 |
circulatory functions of a person are being artificially | 76 |
sustained, under accepted medical standards a determination that | 77 |
death has occurred is made by a physician by observing and | 78 |
conducting a test to determine that the irreversible cessation of | 79 |
all functions of the brain has occurred. | 80 |
(B) The determination and pronouncement of an individual's | 81 |
death may be made by a physician or, subject to divisions (C) and | 82 |
(D) of this section, a physician assistant. | 83 |
(C) A physician assistant may determine and pronounce an | 84 |
individual's death only if the individual's respiratory and | 85 |
circulatory functions are not being artificially sustained and, at | 86 |
the time the determination and pronouncement of death is made, | 87 |
either or both of the following conditions are met: | 88 |
(1) The individual was receiving care in one of the | 89 |
following: | 90 |
(a) A nursing home, residential care facility, or home for | 91 |
the aging licensed under Chapter 3721. of the Revised Code; | 92 |
(b) A county home or district home operated pursuant to | 93 |
Chapter 5155. of the Revised Code; | 94 |
(c) A residential facility licensed under section 5123.19 of | 95 |
the Revised Code. | 96 |
(2) The physician assistant is providing or supervising the | 97 |
individual's care through a hospice care program licensed under | 98 |
Chapter 3712. of the Revised Code or any other entity that | 99 |
provides palliative care. | 100 |
(D) If a physician assistant determines and pronounces an | 101 |
individual's death, both of the following conditions apply: | 102 |
(1) The physician assistant shall not complete any portion of | 103 |
the individual's death certificate. | 104 |
(2) The physician assistant shall notify the individual's | 105 |
attending physician of the determination and pronouncement in | 106 |
order for the physician to fulfill the physician's duties under | 107 |
section 3705.16 of the Revised Code. The physician assistant shall | 108 |
provide the notification within a reasonable period of time | 109 |
following the determination and pronouncement of the individual's | 110 |
death. | 111 |
(E)(1) A physician who makes a determination and | 112 |
pronouncement of death in accordance with this section and | 113 |
accepted medical standards is not liable for | 114 |
to, any of the following for the physician's acts, the acts of a | 115 |
physician assistant who makes a determination and pronouncement of | 116 |
death in accordance with this section and accepted medical | 117 |
standards, or the acts of others based on a determination and | 118 |
pronouncement of death in accordance with this section and | 119 |
accepted medical standards: | 120 |
(a) Damages in any civil action | 121 |
(b) Prosecution in any criminal proceeding | 122 |
123 | |
124 |
(c) Professional disciplinary action pursuant to Chapter | 125 |
4731. of the Revised Code. | 126 |
(2) A physician assistant who makes a determination and | 127 |
pronouncement of death in accordance with this section and | 128 |
accepted medical standards is not liable for, or subject to, any | 129 |
of the following for the physician assistant's acts or the acts of | 130 |
others based on that determination and pronouncement: | 131 |
(a) Damages in any civil action; | 132 |
(b) Prosecution in any criminal proceeding; | 133 |
(c) Professional disciplinary action pursuant to Chapter | 134 |
4730. of the Revised Code. | 135 |
(3) Any person who acts in good faith in reliance on a | 136 |
determination and pronouncement of death made by a physician or | 137 |
physician assistant in accordance with this section and accepted | 138 |
medical standards is not liable for damages in any civil action or | 139 |
subject to prosecution in any criminal proceeding for the person's | 140 |
actions. | 141 |
Sec. 2305.2310. (A) As used in this section: | 142 |
(1) "Disaster" means any imminent threat or actual occurrence | 143 |
of widespread or severe damage to or loss of property, personal | 144 |
hardship or injury, or loss of life that results from any natural | 145 |
phenomenon or act of a human. | 146 |
(2) "Medical claim" has the same meaning as in section | 147 |
2305.113 of the Revised Code. | 148 |
(3) "Physician" means an individual authorized under Chapter | 149 |
4731. of the Revised Code to practice medicine and surgery, | 150 |
osteopathic medicine and surgery, or podiatric medicine and | 151 |
surgery. | 152 |
(4) "Reckless disregard" as it applies to a given physician | 153 |
or physician assistant rendering emergency medical services means | 154 |
conduct that a physician or physician assistant knew or should | 155 |
have known, at the time those services were rendered, created an | 156 |
unreasonable risk of injury, death, or loss to person or property | 157 |
so as to affect the life or health of another and that risk was | 158 |
substantially greater than that which is necessary to make the | 159 |
conduct negligent. | 160 |
(5) "Tort action" means a civil action for damages for | 161 |
injury, death, or loss to person or property other than a civil | 162 |
action for damages for a breach of contract or another agreement | 163 |
between persons or governmental entities. "Tort action" includes | 164 |
an action on a medical claim. | 165 |
(B)(1) Subject to division (C)(3) of this section, a | 166 |
physician or physician assistant who provides emergency medical | 167 |
services, first-aid treatment, or other emergency professional | 168 |
care, including the provision of any medication or other medical | 169 |
product, in compliance with the "Emergency Medical Treatment and | 170 |
Active Labor Act," 100 Stat. 164 (1986), 42 U.S.C. 1395dd, as | 171 |
amended, is not liable in damages to any person in a tort action | 172 |
for injury, death, or loss to person or property that allegedly | 173 |
arises from an act or omission of the physician or physician | 174 |
assistant in the physician's or physician assistant's provision of | 175 |
those services or that treatment or care if that act or omission | 176 |
does not constitute a reckless disregard for the consequences so | 177 |
as to affect the life or health of the patient. | 178 |
(2) Subject to division (C)(3) of this section, a physician | 179 |
or physician assistant who provides emergency medical services, | 180 |
first-aid treatment, or other emergency professional care, | 181 |
including the provision of any medication or other medical | 182 |
product, as a result of a disaster is not liable in damages to any | 183 |
person in a tort action for injury, death, or loss to person or | 184 |
property that allegedly arises from an act or omission of the | 185 |
physician or physician assistant in the physician's or physician | 186 |
assistant's provision of those services or that treatment or care | 187 |
if that act or omission does not constitute willful or wanton | 188 |
misconduct. | 189 |
(C)(1) This section does not create a new cause of action or | 190 |
substantive legal right against a physician or physician | 191 |
assistant. | 192 |
(2) This section does not affect any immunities from civil | 193 |
liability or defenses established by another section of the | 194 |
Revised Code or available at common law to which a physician or | 195 |
physician assistant may be entitled in connection with the | 196 |
provision of emergency medical services, first-aid treatment, or | 197 |
other emergency professional care. | 198 |
(3) This section does not grant an immunity from tort or | 199 |
other civil liability to a physician or physician assistant for | 200 |
actions that are outside the scope of authority of the physician | 201 |
or physician assistant. | 202 |
(4) This section does not affect any legal responsibility of | 203 |
a physician or physician assistant to comply with any applicable | 204 |
law of this state or rule of an agency of this state. | 205 |
(D) This section does not apply to a tort action alleging | 206 |
wrongful death against a physician or physician assistant who | 207 |
provides emergency medical services, first-aid treatment, or other | 208 |
emergency medical care, including the provision of any medication | 209 |
or other medical product that allegedly arises from an act or | 210 |
omission of the physician or physician assistant in the | 211 |
physician's or physician assistant's provision of those services | 212 |
or that treatment or care or as a result of a disaster. | 213 |
Sec. 4730.04. (A) As used in this section: | 214 |
(1) "Disaster" means any imminent threat or actual occurrence | 215 |
of widespread or severe damage to or loss of property, personal | 216 |
hardship or injury, or loss of life that results from any natural | 217 |
phenomenon or act of a human. | 218 |
(2) "Emergency" means an occurrence or event that poses an | 219 |
imminent threat to the health or life of a human. | 220 |
(B) Nothing in this chapter prohibits any of the following | 221 |
individuals from providing medical care, to the extent the | 222 |
individual is able, in response to a need for such care | 223 |
precipitated by a disaster or emergency: | 224 |
(1) An individual who holds a certificate to practice as a | 225 |
physician assistant issued under this chapter; | 226 |
(2) An individual licensed or authorized to practice as a | 227 |
physician assistant in another state; | 228 |
(3) An individual credentialed or employed as a physician | 229 |
assistant by an agency, office, or other instrumentality of the | 230 |
United States government. | 231 |
(C) Only for purposes of medical care provided by an | 232 |
individual described in division (B)(1) of this section in | 233 |
response to a need for such care precipitated by a disaster or | 234 |
emergency, nothing in this chapter does either of the following: | 235 |
(1) Requires the physician who supervises the physician | 236 |
assistant pursuant to a physician supervisory plan approved by the | 237 |
state medical board under section 4730.17 of the Revised Code to | 238 |
meet the supervision requirements in this chapter; | 239 |
(2) Prohibits the physician designated as the medical | 240 |
director of the disaster or emergency from supervising the medical | 241 |
care provided by the physician assistant. | 242 |
(D)(1)(a) Except as provided in division (D)(1)(b) of this | 243 |
section, an individual described in division (B) of this section | 244 |
who voluntarily and without remuneration of any kind or the | 245 |
expectation of remuneration provides medical care to the extent | 246 |
the individual is able in response to a need for such care | 247 |
precipitated by a disaster or an emergency shall not be liable in | 248 |
damages to any person in a tort or other civil action for injury, | 249 |
death, or loss to person or property that results from an act or | 250 |
omission by the individual providing medical care. | 251 |
(b) The immunity described in division (D)(1)(a) of this | 252 |
section shall not apply to an act or omission that constitutes | 253 |
willful or wanton misconduct or to medical care provided in a | 254 |
hospital, physician office, or other facility where medical | 255 |
services are provided on a routine or regular basis. | 256 |
(2) Only for purposes of medical care provided by an | 257 |
individual described in division (B) of this section in response | 258 |
to a need for such care precipitated by a disaster or emergency, | 259 |
the physician who supervises such individual pursuant to a | 260 |
physician supervisory plan approved by the state medical board | 261 |
under section 4730.17 of the Revised Code or pursuant to a similar | 262 |
plan required by a law of another state or the United States shall | 263 |
not be liable in damages to any person in a tort or other civil | 264 |
action for injury, death, or loss to person or property that | 265 |
results from an act or omission of the individual who provided the | 266 |
medical care. | 267 |
Sec. 4730.06. (A) The physician assistant policy committee | 268 |
of the state medical board shall review, and shall submit to the | 269 |
board recommendations concerning, all of the following: | 270 |
(1) Requirements for issuance of certificates to practice as | 271 |
a physician assistant, including the educational requirements that | 272 |
must be met to receive a certificate to practice; | 273 |
(2) Existing and proposed rules pertaining to the practice of | 274 |
physician assistants, the supervisory relationship between | 275 |
physician assistants and supervising physicians, and the | 276 |
administration and enforcement of this chapter; | 277 |
(3) | 278 |
the Revised Code, physician-delegated prescriptive authority for | 279 |
physician assistants | 280 |
the physician assistant formulary the board adopts pursuant to | 281 |
division (A)(1) of section | 282 |
(4) Application procedures and forms for certificates to | 283 |
practice as a physician assistant, physician supervisory plans, | 284 |
and supervision agreements; | 285 |
(5) Fees required by this chapter for issuance and renewal of | 286 |
certificates to practice as a physician assistant; | 287 |
(6) Criteria to be included in applications submitted to the | 288 |
board for approval of physician supervisory plans, including | 289 |
criteria to be included in applications for approval to delegate | 290 |
to physician assistants the performance of special services; | 291 |
(7) Criteria to be included in supervision agreements | 292 |
submitted to the board for approval and renewal of the board's | 293 |
approval; | 294 |
(8) Any issue the board asks the committee to consider. | 295 |
(B) In addition to the matters that are required to be | 296 |
reviewed under division (A) of this section, the committee may | 297 |
review, and may submit to the board recommendations concerning, | 298 |
either or both of the following: | 299 |
(1) Quality assurance activities to be performed by a | 300 |
supervising physician and physician assistant under a quality | 301 |
assurance system established pursuant to division (F) of section | 302 |
4730.21 of the Revised Code; | 303 |
(2) The development and approval of one or more model | 304 |
physician supervisory plans and one or more models for a special | 305 |
services portion of the one or more model physician supervisory | 306 |
plans. The committee may submit recommendations for model plans | 307 |
that reflect various medical specialties. | 308 |
(C) The board shall take into consideration all | 309 |
recommendations submitted by the committee. Not later than ninety | 310 |
days after receiving a recommendation from the committee, the | 311 |
board shall approve or disapprove the recommendation and notify | 312 |
the committee of its decision. If a recommendation is disapproved, | 313 |
the board shall inform the committee of its reasons for making | 314 |
that decision. The committee may resubmit the recommendation after | 315 |
addressing the concerns expressed by the board and modifying the | 316 |
disapproved recommendation accordingly. Not later than ninety days | 317 |
after receiving a resubmitted recommendation, the board shall | 318 |
approve or disapprove the recommendation. There is no limit on the | 319 |
number of times the committee may resubmit a recommendation for | 320 |
consideration by the board. | 321 |
(D)(1) Except as provided in division (D)(2) of this section, | 322 |
the board may not take action regarding a matter that is subject | 323 |
to the committee's review under division (A) or (B) of this | 324 |
section unless the committee has made a recommendation to the | 325 |
board concerning the matter. | 326 |
(2) If the board submits to the committee a request for a | 327 |
recommendation regarding a matter that is subject to the | 328 |
committee's review under division (A) or (B) of this section, and | 329 |
the committee does not provide a recommendation before the | 330 |
sixty-first day after the request is submitted, the board may take | 331 |
action regarding the matter without a recommendation. | 332 |
Sec. 4730.09. (A) Under a physician supervisory plan approved | 333 |
under section 4730.17 of the Revised Code, a physician assistant | 334 |
may provide any or all of the following services without approval | 335 |
by the state medical board as special services: | 336 |
(1) Obtaining comprehensive patient histories; | 337 |
(2) Performing physical examinations, including audiometry | 338 |
screening, routine visual screening, and pelvic, rectal, and | 339 |
genital-urinary examinations, when indicated; | 340 |
(3) Ordering, performing, or ordering and performing routine | 341 |
diagnostic procedures, as indicated; | 342 |
(4) Identifying normal and abnormal findings on histories, | 343 |
physical examinations, and commonly performed diagnostic studies; | 344 |
(5) Assessing patients and developing and implementing | 345 |
treatment plans for patients; | 346 |
(6) Monitoring the effectiveness of therapeutic | 347 |
interventions; | 348 |
(7) Exercising physician-delegated prescriptive authority | 349 |
pursuant to a certificate to prescribe issued under this chapter; | 350 |
(8) Carrying out or relaying the supervising physician's | 351 |
orders for the administration of medication, to the extent | 352 |
permitted by law; | 353 |
(9) Providing patient education; | 354 |
(10) Instituting and changing orders on patient charts; | 355 |
(11) Performing developmental screening examinations on | 356 |
children with regard to neurological, motor, and mental functions; | 357 |
(12) Performing wound care management, suturing minor | 358 |
lacerations and removing the sutures, and incision and drainage of | 359 |
uncomplicated superficial abscesses; | 360 |
(13) Removing superficial foreign bodies; | 361 |
(14) Administering intravenous fluids; | 362 |
(15) Inserting a foley or cudae catheter into the urinary | 363 |
bladder and removing the catheter; | 364 |
(16) | 365 |
| 366 |
| 367 |
supervising physician; | 368 |
| 369 |
(18) Removing birth control devices; | 370 |
| 371 |
| 372 |
| 373 |
posterior iliac crest; | 374 |
| 375 |
iliac crest; | 376 |
| 377 |
| 378 |
of nephrostomy tubes; | 379 |
| 380 |
including intrauterine devices, diaphragms, and cervical caps; | 381 |
| 382 |
| 383 |
| 384 |
| 385 |
| 386 |
| 387 |
| 388 |
completion of an advanced cardiac life support course; | 389 |
| 390 |
| 391 |
light-based medical devices for the purpose of hair removal; | 392 |
| 393 |
anesthesia, as defined in section 4730.091 of the Revised Code; | 394 |
| 395 |
| 396 |
(38) Prescribing or referring a patient to a physical | 397 |
therapist for the purpose of receiving physical therapy, as | 398 |
defined in section 4755.40 of the Revised Code; | 399 |
(39) Performing other services that are within the | 400 |
supervising physician's normal course of practice and expertise, | 401 |
if the services are included in any model physician supervisory | 402 |
plan approved under section 4730.06 of the Revised Code or the | 403 |
services are designated by the board by rule or other means as | 404 |
services that are not subject to approval as special services. | 405 |
(B) Under the policies of a health care facility, the | 406 |
services a physician assistant may provide are limited to the | 407 |
services the facility has authorized the physician assistant to | 408 |
provide for the facility. The services a health care facility may | 409 |
authorize a physician assistant to provide for the facility | 410 |
include the following: | 411 |
(1) Any or all of the services specified in division (A) of | 412 |
this section; | 413 |
(2) Assisting in surgery in the health care facility; | 414 |
(3) Any other services permitted by the policies of the | 415 |
health care facility, except that the facility may not authorize a | 416 |
physician assistant to perform a service that is prohibited by | 417 |
this chapter. | 418 |
Sec. 4730.38. (A) | 419 |
420 | |
the physician assistant policy committee of the state medical | 421 |
board shall, at such times the committee determines to be | 422 |
necessary, submit to the board | 423 |
regarding physician-delegated prescriptive authority for physician | 424 |
assistants. The committee's recommendations shall address | 425 |
of the following: | 426 |
(1) Policy and procedures regarding physician-delegated | 427 |
prescriptive authority, including the issuance of certificates to | 428 |
prescribe under this chapter; | 429 |
(2) | 430 |
431 | |
432 | |
433 | |
434 | |
435 |
| 436 |
board in fulfilling its duty to adopt rules governing | 437 |
physician-delegated prescriptive authority, including the issuance | 438 |
of certificates to prescribe. | 439 |
(B) | 440 |
441 | |
442 | |
443 | |
444 | |
445 | |
day of June following the effective date of this amendment, the | 446 |
committee shall review the physician assistant formulary the board | 447 |
adopts pursuant to division (A)(1) of section 4730.39 of the | 448 |
Revised Code and, to the extent it determines to be necessary, | 449 |
submit recommendations proposing changes to the formulary. | 450 |
(C) Recommendations submitted under this section are subject | 451 |
to the procedures and time frames specified in division (C) of | 452 |
section 4730.06 of the Revised Code. | 453 |
Sec. 4730.39. (A) | 454 |
455 | |
456 | |
457 | |
of the following: | 458 |
(1) Adopt a formulary listing the drugs and therapeutic | 459 |
devices by class and specific generic nomenclature that a | 460 |
physician may include in the physician-delegated prescriptive | 461 |
authority granted to a physician assistant who holds a certificate | 462 |
to prescribe under this chapter; | 463 |
(2) Adopt rules governing physician-delegated prescriptive | 464 |
authority for physician assistants, including the issuance of | 465 |
certificates to prescribe under this chapter. | 466 |
(B) The board's rules governing physician-delegated | 467 |
prescriptive authority adopted pursuant to division (A)(2) of this | 468 |
section shall be adopted in accordance with Chapter 119. of the | 469 |
Revised Code and shall establish all of the following: | 470 |
(1) | 471 |
472 | |
473 | |
474 | |
475 | |
476 |
| 477 |
physician assistant is required to complete to receive a | 478 |
certificate to prescribe; | 479 |
| 480 |
of certificates to prescribe to physician assistants; | 481 |
| 482 |
of the provisional period that a physician assistant is required | 483 |
to complete pursuant to section 4730.45 of the Revised Code and | 484 |
for determining whether a physician assistant has successfully | 485 |
completed the provisional period; | 486 |
| 487 |
device to perform or induce an abortion; | 488 |
| 489 |
assistant in personally furnishing samples of drugs or complete or | 490 |
partial supplies of drugs to patients under section 4730.43 of the | 491 |
Revised Code; | 492 |
| 493 |
to implement the provisions of this chapter regarding | 494 |
physician-delegated prescriptive authority and the issuance of | 495 |
certificates to prescribe. | 496 |
| 497 |
recommendations submitted by the physician assistant policy | 498 |
committee pursuant to sections 4730.06 and 4730.38 of the Revised | 499 |
Code, the board shall | 500 |
the | 501 |
submitted recommendations: | 502 |
(a) The formulary the board adopts under division (A)(1) of | 503 |
this section; | 504 |
(b) The rules the board adopts under division (A)(2) of this | 505 |
section regarding physician-delegated prescriptive authority. | 506 |
(2) Based on its review, the board shall make any necessary | 507 |
modifications to the formulary or rules. | 508 |
| 509 |
510 | |
511 | |
512 | |
513 | |
514 | |
515 | |
516 | |
517 |
Sec. 4730.40. (A) Subject to | 518 |
of this section, the physician assistant formulary | 519 |
adopted by the state medical board | 520 |
4730.39 of the Revised Code
| 521 |
522 | |
523 | |
524 | |
525 | |
the following drugs: | 526 |
(1) Schedule II, III, IV, and V controlled substances; | 527 |
(2) Drugs that under state or federal law may be dispensed | 528 |
only pursuant to a prescription by a licensed health professional | 529 |
authorized to prescribe drugs, as defined in section 4729.01 of | 530 |
the Revised Code; | 531 |
(3) Any drug that is not a dangerous drug, as defined in | 532 |
section 4729.01 of the Revised Code. | 533 |
(B) The formulary | 534 |
the board shall not include, and shall specify that it does not | 535 |
include, | 536 |
| 537 |
| 538 |
abortion. | 539 |
| 540 |
541 | |
542 | |
543 | |
544 | |
545 | |
546 | |
547 | |
548 | |
549 | |
550 |
Sec. 4730.42. (A) In granting physician-delegated | 551 |
prescriptive authority to a particular physician assistant who | 552 |
holds a certificate to prescribe issued under this chapter, the | 553 |
supervising physician is subject to all of the following: | 554 |
(1) The supervising physician shall not grant | 555 |
physician-delegated prescriptive authority for any drug or | 556 |
therapeutic device that is not listed on the physician assistant | 557 |
formulary | 558 |
the Revised Code as a drug or therapeutic device that may be | 559 |
included in the physician-delegated prescriptive authority granted | 560 |
to a physician assistant. | 561 |
(2) The supervising physician shall not grant | 562 |
physician-delegated prescriptive authority for any drug or device | 563 |
that may be used to perform or induce an abortion. | 564 |
(3) The supervising physician shall not grant | 565 |
physician-delegated prescriptive authority in a manner that | 566 |
exceeds the supervising physician's prescriptive authority. | 567 |
(4) The supervising physician shall supervise the physician | 568 |
assistant in accordance with all of the following: | 569 |
(a) The supervision requirements specified in section 4730.21 | 570 |
of the Revised Code and, in the case of supervision provided | 571 |
during a provisional period of physician-delegated prescriptive | 572 |
authority, the supervision requirements specified in section | 573 |
4730.45 of the Revised Code; | 574 |
(b) The physician supervisory plan approved for the | 575 |
supervising physician or the policies of the health care facility | 576 |
in which the physician and physician assistant are practicing; | 577 |
(c) The supervision agreement approved under section 4730.19 | 578 |
of the Revised Code that applies to the supervising physician and | 579 |
the physician assistant. | 580 |
(B)(1) The supervising physician of a physician assistant may | 581 |
place conditions on the physician-delegated prescriptive authority | 582 |
granted to the physician assistant. If conditions are placed on | 583 |
that authority, the supervising physician shall maintain a written | 584 |
record of the conditions and make the record available to the | 585 |
state medical board on request. | 586 |
(2) The conditions that a supervising physician may place on | 587 |
the physician-delegated prescriptive authority granted to a | 588 |
physician assistant include the following: | 589 |
(a) Identification by class and specific generic nomenclature | 590 |
of drugs and therapeutic devices that the physician chooses not to | 591 |
permit the physician assistant to prescribe; | 592 |
(b) Limitations on the dosage units or refills that the | 593 |
physician assistant is authorized to prescribe; | 594 |
(c) Specification of circumstances under which the physician | 595 |
assistant is required to refer patients to the supervising | 596 |
physician or another physician when exercising physician-delegated | 597 |
prescriptive authority; | 598 |
(d) Responsibilities to be fulfilled by the physician in | 599 |
supervising the physician assistant that are not otherwise | 600 |
specified in the physician supervisory plan or otherwise required | 601 |
by this chapter. | 602 |
Sec. 4730.44. (A) A physician assistant seeking a certificate | 603 |
to prescribe shall submit to the state medical board a written | 604 |
application on a form prescribed and supplied by the board. The | 605 |
application shall include all of the following information: | 606 |
(1) The applicant's name, residential address, business | 607 |
address, if any, and social security number; | 608 |
(2) Evidence of holding a valid certificate to practice as a | 609 |
physician assistant issued under this chapter; | 610 |
(3) Either of the following: | 611 |
(a) Satisfactory proof that the applicant meets the | 612 |
requirements specified in section 4730.46 of the Revised Code to | 613 |
participate in a provisional period of physician-delegated | 614 |
prescriptive authority or satisfactory proof of successful | 615 |
completion of the provisional period, evidenced by a letter or | 616 |
copy of a letter attesting to the successful completion written by | 617 |
a supervising physician of the physician assistant at the time of | 618 |
completion; | 619 |
(b) Satisfactory proof that the applicant has practiced as a | 620 |
physician assistant in another state or was credentialed or | 621 |
employed as a physician assistant by the United States government, | 622 |
holds a master's or higher degree that was obtained from a program | 623 |
accredited by the accreditation review commission on education for | 624 |
the physician assistant or a predecessor or successor organization | 625 |
recognized by the board, and held valid authority issued by the | 626 |
other state or the United States government to prescribe | 627 |
therapeutic devices and drugs, including at least some controlled | 628 |
substances, evidenced by an affidavit issued by an appropriate | 629 |
agency or office of the other state or the United States | 630 |
government attesting to the prescriptive authority described in | 631 |
division (A)(3)(b) of this section. | 632 |
(4) Any other information the board requires. | 633 |
(B) At the time of making application for a certificate to | 634 |
prescribe, the applicant shall pay the board a fee of one hundred | 635 |
dollars, no part of which shall be returned. The fees shall be | 636 |
deposited in accordance with section 4731.24 of the Revised Code. | 637 |
(C)(1) The board shall review all applications received. If | 638 |
an application is complete and the board determines that the | 639 |
applicant meets the requirements for a certificate to prescribe, | 640 |
the board shall, subject to division (C)(2) of this section, issue | 641 |
the certificate to the applicant. | 642 |
(2) The initial certificate to prescribe issued to an | 643 |
applicant who meets the requirements of division (A)(3)(a) of this | 644 |
section shall be issued as a provisional certificate to prescribe. | 645 |
Sec. 4730.45. (A) A provisional certificate to prescribe | 646 |
issued under division (C)(2) of section 4730.44 of the Revised | 647 |
Code authorizes the physician assistant holding the certificate to | 648 |
participate in a provisional period of physician-delegated | 649 |
prescriptive authority. The physician assistant shall successfully | 650 |
complete the provisional period as a condition of receiving a new | 651 |
certificate to prescribe. | 652 |
(B) The provisional period shall be conducted by one or more | 653 |
supervising physicians in accordance with rules adopted under | 654 |
section 4730.39 of the Revised Code. When supervising a physician | 655 |
assistant who is completing the first five hundred hours of a | 656 |
provisional period, the supervising physician shall provide | 657 |
on-site supervision of the physician assistant's exercise of | 658 |
physician-delegated prescriptive authority. | 659 |
The provisional period shall last not longer than one year, | 660 |
unless it is extended for not longer than one additional year at | 661 |
the direction of a supervising physician. The physician assistant | 662 |
shall not be required to participate in the provisional period for | 663 |
more than | 664 |
hours, except when a supervising physician has extended the | 665 |
physician assistant's provisional period. | 666 |
(C) If a physician assistant does not successfully complete | 667 |
the provisional period, each supervising physician shall cease | 668 |
granting physician-delegated prescriptive authority to the | 669 |
physician assistant. The supervising physician with primary | 670 |
responsibility for conducting the provisional period shall | 671 |
promptly notify the state medical board that the physician | 672 |
assistant did not successfully complete the provisional period and | 673 |
the board shall revoke the certificate. | 674 |
(D) A physician assistant who successfully completes a | 675 |
provisional period shall not be required to complete another | 676 |
provisional period as a condition of being eligible to be granted | 677 |
physician-delegated prescriptive authority by a supervising | 678 |
physician who was not involved in the conduct of the provisional | 679 |
period. | 680 |
Sec. 4730.53. A physician assistant who provides services | 681 |
under the medicaid program established under Chapter 5111. of the | 682 |
Revised Code shall enter into a medicaid provider agreement with | 683 |
the department of job and family services. When submitting a claim | 684 |
for reimbursement from the medicaid program, the physician | 685 |
assistant shall use only the medicaid provider number the | 686 |
department assigns to the physician assistant. | 687 |
Sec. 4755.48. (A) No person shall employ fraud or deception | 688 |
in applying for or securing a license to practice physical therapy | 689 |
or to be a physical therapist assistant. | 690 |
(B) No person shall practice or in any way imply or claim to | 691 |
the public by words, actions, or the use of letters as described | 692 |
in division (C) of this section to be able to practice physical | 693 |
therapy or to provide physical therapy services, including | 694 |
practice as a physical therapist assistant, unless the person | 695 |
holds a valid license under sections 4755.40 to 4755.56 of the | 696 |
Revised Code or except for submission of claims as provided in | 697 |
section 4755.56 of the Revised Code. | 698 |
(C) No person shall use the words or letters, physical | 699 |
therapist, physical therapy, physical therapy services, | 700 |
physiotherapist, physiotherapy, physiotherapy services, licensed | 701 |
physical therapist, P.T., Ph.T., P.T.T., R.P.T., L.P.T., M.P.T., | 702 |
D.P.T., M.S.P.T., P.T.A., physical therapy assistant, physical | 703 |
therapist assistant, physical therapy technician, licensed | 704 |
physical therapist assistant, L.P.T.A., R.P.T.A., or any other | 705 |
letters, words, abbreviations, or insignia, indicating or implying | 706 |
that the person is a physical therapist or physical therapist | 707 |
assistant without a valid license under sections 4755.40 to | 708 |
4755.56 of the Revised Code. | 709 |
(D) No person who practices physical therapy or assists in | 710 |
the provision of physical therapy treatments under the supervision | 711 |
of a physical therapist shall fail to display the person's current | 712 |
license granted under sections 4755.40 to 4755.56 of the Revised | 713 |
Code in a conspicuous location in the place where the person | 714 |
spends the major part of the person's time so engaged. | 715 |
(E) Nothing in sections 4755.40 to 4755.56 of the Revised | 716 |
Code shall affect or interfere with the performance of the duties | 717 |
of any physical therapist or physical therapist assistant in | 718 |
active service in the army, navy, coast guard, marine corps, air | 719 |
force, public health service, or marine hospital service of the | 720 |
United States, while so serving. | 721 |
(F) Nothing in sections 4755.40 to 4755.56 of the Revised | 722 |
Code shall prevent or restrict the activities or services of a | 723 |
person | 724 |
physical therapy in an accredited or approved educational program | 725 |
if the activities or services constitute a part of a supervised | 726 |
course of study and the person is designated by a title that | 727 |
clearly indicates the person's status as a student. | 728 |
(G) | 729 |
section and subject to division (H) of this section, no person | 730 |
shall practice physical therapy other than on the prescription of, | 731 |
or the referral of a patient by, a person who is licensed in this | 732 |
or another state to | 733 |
(a) Practice medicine and surgery, chiropractic, dentistry, | 734 |
osteopathic medicine and surgery, podiatric medicine and surgery | 735 |
736 |
(b) Practice as a physician assistant; | 737 |
(c) Practice nursing as a certified registered nurse | 738 |
anesthetist, clinical nurse specialist, certified nurse-midwife, | 739 |
or certified nurse practitioner | 740 |
741 | |
742 |
| 743 |
practicing physical therapy other than on the prescription of, or | 744 |
the referral of a patient by, any of the persons described in that | 745 |
division does not apply if either of the following applies to the | 746 |
person: | 747 |
(a) The person holds a master's or doctorate degree from a | 748 |
professional physical therapy program that is accredited by a | 749 |
national physical therapy accreditation agency recognized by the | 750 |
United States department of education. | 751 |
| 752 |
completed at least two years of practical experience as a licensed | 753 |
physical therapist. | 754 |
(H) To be authorized to prescribe physical therapy or refer | 755 |
a patient to a physical therapist for physical therapy, a person | 756 |
described in division (G)(1) of this section must be in good | 757 |
standing with the relevant licensing board in this state or the | 758 |
state in which the person is licensed and must act only within the | 759 |
person's scope of practice. | 760 |
(I) In the prosecution of any person for violation of | 761 |
division (B) or (C) of this section, it is not necessary to allege | 762 |
or prove want of a valid license to practice physical therapy or | 763 |
to practice as a physical therapist assistant, but such matters | 764 |
shall be a matter of defense to be established by the accused. | 765 |
Sec. 4755.481. (A) If a physical therapist evaluates and | 766 |
treats a patient without the prescription of, or the referral of | 767 |
the patient by, a person | 768 |
769 | |
770 | |
771 | |
772 | |
division (G)(1) of section 4755.48 of the Revised Code, all of the | 773 |
following apply: | 774 |
(1) The physical therapist shall, upon consent of the | 775 |
patient, inform the | 776 |
777 | |
778 | |
779 | |
section 4755.48 of the Revised Code of the evaluation not later | 780 |
than five business days after the evaluation is made. | 781 |
(2) If the physical therapist determines, based on reasonable | 782 |
evidence, that no substantial progress has been made with respect | 783 |
to that patient during the thirty-day period immediately following | 784 |
the date of the patient's initial visit with the physical | 785 |
therapist, the physical therapist shall consult with or refer the | 786 |
patient to a | 787 |
788 | |
789 | |
790 | |
4755.48 of the Revised Code, unless either of the following | 791 |
applies: | 792 |
(a) The evaluation, treatment, or services are being provided | 793 |
for fitness, wellness, or prevention purposes. | 794 |
(b) The patient previously was diagnosed with chronic, | 795 |
neuromuscular, or developmental conditions and the evaluation, | 796 |
treatment, or services are being provided for problems or symptoms | 797 |
associated with one or more of those previously diagnosed | 798 |
conditions. | 799 |
(3) If the physical therapist determines that orthotic | 800 |
devices are necessary to treat the patient, the physical therapist | 801 |
shall be limited to the application of the following orthotic | 802 |
devices: | 803 |
(a) Upper extremity adaptive equipment used to facilitate the | 804 |
activities of daily living; | 805 |
(b) Finger splints; | 806 |
(c) Wrist splints; | 807 |
(d) Prefabricated elastic or fabric abdominal supports with | 808 |
or without metal or plastic reinforcing stays and other | 809 |
prefabricated soft goods requiring minimal fitting; | 810 |
(e) Nontherapeutic accommodative inlays; | 811 |
(f) Shoes that are not manufactured or modified for a | 812 |
particular individual; | 813 |
(g) Prefabricated foot care products; | 814 |
(h) Custom foot orthotics; | 815 |
(i) Durable medical equipment. | 816 |
(4) If, at any time, the physical therapist has reason to | 817 |
believe that the patient has symptoms or conditions that require | 818 |
treatment or services beyond the scope of practice of a physical | 819 |
therapist, the physical therapist shall refer the patient to a | 820 |
licensed health care practitioner acting within the practitioner's | 821 |
scope of practice. | 822 |
(B) Nothing in sections 4755.40 to 4755.56 of the Revised | 823 |
Code shall be construed to require reimbursement under any health | 824 |
insuring corporation policy, contract, or agreement, any sickness | 825 |
and accident insurance policy, the medical assistance program as | 826 |
defined in section 5111.01 of the Revised Code, or the health | 827 |
partnership program or qualified health plans established pursuant | 828 |
to sections 4121.44 to 4121.442 of the Revised Code, for any | 829 |
physical therapy service rendered without the prescription of, or | 830 |
the referral of the patient by, a | 831 |
832 | |
833 | |
834 | |
(G)(1) of section 4755.48 of the Revised Code. | 835 |
(C) For purposes of this section, "business day" means any | 836 |
calendar day that is not a Saturday, Sunday, or legal holiday. | 837 |
"Legal holiday" has the same meaning as in section 1.14 of the | 838 |
Revised Code. | 839 |
Sec. 5111.0212. For any service a physician assistant | 840 |
provides to a medicaid recipient in accordance with Chapter 4730. | 841 |
of the Revised Code, the medicaid program shall reimburse the | 842 |
physician assistant an amount that is one hundred per cent of the | 843 |
amount, as contained in the medicaid fee schedule determined | 844 |
pursuant to rules adopted under section 5111.02 of the Revised | 845 |
Code, established as the medicaid maximum for the service. | 846 |
Section 2. That existing sections 2105.35, 2108.40, 4730.06, | 847 |
4730.09, 4730.38, 4730.39, 4730.40, 4730.42, 4730.44, 4730.45, | 848 |
4755.48, and 4755.481 and section 4730.401 of the Revised Code | 849 |
are hereby repealed. | 850 |