No. 42807 (Amendment): Rule R156-70a. Physician Assistant Practice Act Rule

(Amendment)

DAR File No.: 42807
Filed: 04/17/2018 10:08:19 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division of Occupational and Professional Licensing (Division) and the Physician Assistant Licensing Board are proposing amendments to conform this rule to new Sections 58-70a-102 and 58-70a-501, as enacted by S.B. 162 during the 2017 General Session.

Summary of the rule or change:

In Section R156-70a-102, the unnecessary definitions of "locum tenens" and "on-site supervision" are removed. In R156-70a-501, the physician/physician assistant working relationship and delegation of duties are changed to comply with S.B. 162 (2017), by: 1) removing the requirement for physicians to cosign all medical chart records for patients; and 2) including the requirement of quality review in place of chart review.

Statutory or constitutional authorization for this rule:

Subsection 58-1-106(1)(a)
Section 58-70a-101
Subsection 58-1-202(1)(a)

Anticipated cost or savings to:

the state budget:

For Section R156-70a-102, these proposed changes remove unnecessary definitions to ensure that the rule only encompasses current practice in the profession. Accordingly, these amendments are not expected to impact state government revenues or expenditures. For Section R156-70a-501, these proposed amendments apply to persons required to be licensed as a physician assistant in Utah, and will also indirectly affect those who employ licensed physician assistants. This will include certain state government entities acting as businesses. However, because these proposed amendments only conform this rule to practices already required by S.B. 162 (2017), the Division estimates that there will be no impact on state agencies over and above that included in the fiscal note for S.B. 162 (2017), available online at https://le.utah.gov/lfa/fnotes/2017/SB0162.fn.pdf. No other fiscal impact to the state is expected beyond a minimal cost to the Division of approximately $75 to print and distribute the rule once the proposed amendments are made effective.

local governments:

For Section R156-70a-102, these proposed changes remove unnecessary definitions to ensure that this rule only encompasses current practice in the profession. Accordingly, these amendments are not expected to impact local government's revenues or expenditures. For Section R156-70a-501, these proposed amendments apply to persons required to be licensed as a physician assistant in Utah, and will also indirectly affect those who employ licensed physician assistants. This will include certain local government entities acting as businesses. However, because these proposed amendments only conform this rule to practices already required by S.B. 162 (2017), the Division estimates that there will be no impact on local governments over and above that included in the fiscal note for S.B. 162 (2017), available online at https://le.utah.gov/lfa/fnotes/2017/SB0162.fn.pdf.

small businesses:

For Section R156-70a-102, these proposed changes remove unnecessary definitions to ensure that this rule only encompasses current practice in the profession. Accordingly, these amendments are not expected to impact small businesses' revenues or expenditures. For Section R156-70a-501, these proposed amendments apply to persons required to be licensed as a physician assistant in Utah, and will also indirectly affect those who employ licensed physician assistants. There are currently 1,589 physician assistant licensees in Utah; it is estimated that approximately two-thirds of these are employed by small business facilities such as private or group physician practices or medical centers (NAICS 621399). However, because these proposed amendments only conform this rule to practices already required by S.B. 162 (2017), the Division estimates that there will be no impact on any of these small businesses who employ physician assistants, over and above that included in the fiscal note for S.B. 162 (2017), available online at https://le.utah.gov/lfa/fnotes/2017/SB0162.fn.pdf.

persons other than small businesses, businesses, or local governmental entities:

For Section R156-70a-102, these proposed changes remove unnecessary definitions to ensure that this rule only encompasses current practice in the profession. Accordingly, these amendments are not expected to impact other persons. For Section R156-70a-501, these proposed amendments apply to persons required to be licensed as a physician assistant in Utah, and will also indirectly affect those who employ licensed physician assistants. However, because these proposed amendments only conform this rule to practices already required by S.B. 162 (2017), the Division estimates that there will be no impact on physician assistants or any persons who may employ them over and above that included in the fiscal note for S.B. 162 (2017), available online at https://le.utah.gov/lfa/fnotes/2017/SB0162.fn.pdf.

Compliance costs for affected persons:

For Section R156-70a-102, these proposed changes remove unnecessary definitions to ensure that this rule only encompasses current practice in the profession. Accordingly, these amendments are not expected to impact affected persons. For Section R156-70a-501, these proposed amendments apply to persons required to be licensed as a physician assistant in Utah, and will also indirectly affect those who employ licensed physician assistants. However, because these proposed amendments only conform this rule to practices already required by S.B. 162 (2017), the Division estimates that there will be no compliance costs for affected persons over and above that included in the fiscal note for S.B. 162 (2017), available online at https://le.utah.gov/lfa/fnotes/2017/SB0162.fn.pdf.

Comments by the department head on the fiscal impact the rule may have on businesses:

I have reviewed the proposed filing for the above-referenced rule and considered the fiscal impact that thid rule may have on businesses. I direct that my comments about the rule's fiscal impact on businesses be inserted at the appropriate place on the notice form to be filed with the Office of Administrative Rules for publication of this rulemaking action. Amendments to Section R156-70a-102 remove unnecessary definitions in the rule. Amendments to Section R156-70a-501 change the physician/physician assistant working relationship and delegation of duties to comply with S.B. 162 (2017) by: 1) removing the requirement for physicians to cosign all medical chart records for patients; and 2) including the requirement of quality review in place of chart review. The deletion of certain definitions from Section R156-70a-102 has no fiscal impact or benefit. The Section R156-70a-502 amendments apply to persons required to be licensed as a physician assistant in Utah, and will also indirectly affect those who employ licensed physician assistants. There are currently 1,589 physician assistant licensees in Utah. It is estimated that approximately two-thirds of these are employed by small business facilities, such as private or group physician practices or medical centers (NAICS 621399). However, because these proposed amendments only conform this rule to practices already required by S.B. 162 (2017), the Division estimates that there will be no impact on or benefit to small businesses who employ physician assistants, and no impact on physician assistants who own or operate their own offices, over and above that included in the fiscal note for S.B. 162 (2017), available online at https://le.utah.gov/lfa/fnotes/2017/SB0162.fn.pdf.

Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY, UT 84111-2316

Direct questions regarding this rule to:

Larry Marx at the above address, by phone at 801-530-6254, by FAX at 801-530-6511, or by Internet E-mail at lmarx@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2018

This rule may become effective on:

06/21/2018

Authorized by:

Mark Steinagel, Director

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2018

FY 2019

FY 2020

State Government

Local Government

Small Businesses

Non-Small Businesses

Other Person

Total Fiscal Costs:

Fiscal Benefits

State Government

Local Government

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Benefits:

Net Fiscal Benefits:

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

Appendix 2: Regulatory Impact to Non - Small Businesses:

Section R156-70a-102: These proposed changes remove unnecessary definitions, to ensure that the rule only encompasses current practice in the profession. Accordingly, these amendments are not expected to impact non-small business revenues or expenditures.

Section R156-70a-501: These proposed amendments apply to persons required to be licensed as a physician assistant in Utah, and will also indirectly affect those who employ licensed physician assistants. There are currently 1,589 physician assistant licensees in Utah; it is estimated that approximately one-third of these may be employed by Utah's 91 non-small business facility hospitals or HMO (health maintenance organization) medical centers (NAICS 622110). However, because these proposed amendments only conform the rule to practices already required by S.B. 162 (2017), the Division estimates that there will be no impact on non-small businesses who employ physician assistants, over and above that included in the Fiscal Note for S.B. 162 (2017), available online at https://le.utah.gov/lfa/fnotes/2017/SB0162.fn.pdf.

The head of the Department of Commerce, Francine A. Giani, has reviewed and approved this fiscal analysis.

R156. Commerce, Occupational and Professional Licensing.

R156-70a. Physician Assistant Practice Act Rule.

R156-70a-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 70a, as used in this rule:

(1) "Full time equivalent" or "FTE" means the equivalent of 2,080 hours of staff time for a one-year period.[

(2) "Locum tenens" means a medical practice situation in which one physician assistant acts as a temporary substitute for the physician assistant who regularly will or does practice in that particular setting.

~~(3) "On-site supervision", as used in Section R156-70a-501, means the physician assistant will be working in the same location as the supervising physician.~~]

R156-70a-501. Working Relationship and Delegation of Duties.

In accordance with Section 58-70a-501, the working relationship and delegation of duties between the supervising physician and the physician assistant are specified as follows:

(1) The supervising physician shall provide supervision to the physician assistant to adequately serve the health care needs of the practice population and ensure that the patient's health, safety and welfare will not be adversely compromised. [~~The degree of on-site supervision shall be outlined in the Delegation of Services Agreement maintained at the site of practice.~~ ]Physician assistants may authenticate with their signature any form that may be authenticated by a physician's signature.

(2) There shall be a method of immediate consultation by electronic means whenever the physician assistant is not under the direct supervision of the supervising physician.

(3) The [~~supervising~~ ]physician and physician assistant shall review [~~and co-sign~~ ]sufficient [~~numbers of~~]practice information which may include patient charts and medical records to ensure that the patient's health, safety, and welfare will not be adversely compromised. The Delegation of Services Agreement, maintained at the site of practice, shall outline specific parameters for quality review that are appropriate for the working relationship.

(4) A supervising physician may not supervise more than four full time equivalent (FTE) physician assistants without the prior approval of the division in collaboration with the board, and only for extenuating circumstances with a written request with justification. The supervising physician shall ensure that patient health, safety, and welfare is not adversely compromised by supervising more physician assistants than the physician can competently supervise.

KEY: licensing, physician assistants

Date of Enactment or Last Substantive Amendment: [~~December 22, 2016~~]2018

Notice of Continuation: November 3, 2016

Authorizing, and Implemented or Interpreted Law: 58-70a-101; 58-1-106(1)(a); 58-1-202(1)(a)