Chapter 582 Oregon Laws 1999

Session Law

AN ACT

HB 2267

Relating to physician assistants; creating new provisions; and amending ORS 316.144, 442.550, 656.245, 677.495, 677.500, 677.505, 677.510, 677.515, 677.520, 677.535, 677.540, 677.545, 688.130, 811.604 and 811.611.

Be It Enacted by the People of the State of Oregon:

SECTION 1. ORS 677.495 is amended to read:

677.495. As used in ORS 677.495 to 677.545, unless the context requires otherwise:

(1) "Committee" means the Physician Assistant Committee created in ORS 677.540.

(2) "Medically disadvantaged area" means an area of the state designated by the Director of Human Resources to be in need of primary health care providers.

(3) "Physician assistant" means a person who is [registered as a physician assistant] licensed in accordance with ORS 677.505 to 677.525.

(4) "Supervision" means the routine direction and regular review by the supervising physician, as determined to be appropriate by the Board of Medical Examiners for the State of Oregon, of the medical services provided by the physician assistant. The practice description shall provide for the maintenance of direct, verbal communication either in person or by means described in ORS 677.515 (4)(b) but the description shall not require the physical presence at all times of the supervising physician.

SECTION 2. ORS 677.500 is amended to read:

677.500. It is the intent of the Legislative Assembly in requiring the [certification] licensure of physician assistants that there be reasonable utilization of the physician assistant by the supervising physician.

SECTION 3. ORS 677.505 is amended to read:

677.505. (1) ORS 677.495 and 677.505 to 677.525 are not intended to alter or affect ORS chapter 678, regarding the practice of nursing; ORS chapter 679, regarding the practice of dentistry; ORS 680.010 to 680.205, regarding the practice of dental hygienists and auxiliaries; or ORS 683.010 to 683.335, regarding the practice of optometry.

(2) ORS 677.495 and 677.505 to 677.530 do not require an employee of a person licensed to practice medicine under this chapter, or of a medical clinic or hospital to be [registered] licensed under ORS 677.495 and 677.505 to 677.525, unless the employee is [employed] practicing as a physician assistant in which case the [employee] individual shall be [registered] licensed under ORS 677.495 and 677.505 to 677.525.

SECTION 4. ORS 677.510 is amended to read:

677.510. (1) A person licensed to practice medicine under this chapter shall not use the services of a physician assistant without the prior approval of the Board of Medical Examiners. The application shall state the name of the physician assistant, describe the manner and extent to which the physician assistant's services would be used and supervised, state the education, training and experience of the physician assistant and provide such other information in such a form as the board may require.

(2) The board may approve or reject an application, or it may modify the proposed use of the services of the physician assistant and approve the application as modified. Approval shall be valid for no more than one year but may be renewed annually. When it appears to the board that the services of a physician assistant are being used in a manner inconsistent with the approval granted, the board may withdraw its approval. If a hearing is requested by the physician or the physician assistant upon the rejection of an application, or upon the withdrawal of an approval, a hearing shall be conducted in accordance with ORS 677.200.

(3) The supervising physician may have a different specialty from the physician assistant. A physician assistant may be supervised by no more than four physicians. A physician may supervise two physician assistants. However, in population groups that are in geographic areas that are federally designated health professional shortage areas, federally designated medically underserved areas or areas designated as medically underserved by the Office of Rural Health, a physician may supervise four physician assistants. The board may review and approve applications from physicians in federally designated health professional shortage areas, federally designated medically underserved areas or areas designated as medically underserved by the Office of Rural Health to supervise more than four physician assistants, and applications from physician assistants to be supervised by more than four physicians. A physician assistant may render services in an emergency room and other hospital settings, a nursing home, a corrections institution and any site included in the practice description.

(4) A [certified] licensed physician assistant may make application to the board for emergency drug dispensing authority. The board shall consider the criteria adopted by the Physician Assistant Committee under ORS 677.545 (4) in reviewing the application. Such emergency dispensing shall be of drugs prepared by a licensed pharmacist.

SECTION 5. ORS 677.515 is amended to read:

677.515. (1) This chapter does not prohibit a person from rendering medical services:

(a) If the person has satisfactorily completed [a training] an educational program for physician assistants, approved by the Board of Medical Examiners for the State of Oregon, for physician assistants;

(b) If the services are rendered under the supervision and control of a person licensed under this chapter to practice medicine and the use of the physician assistant's services has been approved by the board as provided by ORS 677.510; and

(c) If the person is [registered] licensed as a physician assistant as provided by ORS 677.495 and 677.505 to 677.525.

(2) This chapter does not prohibit a student enrolled in an approved program for [training] educating physician assistants from rendering medical services if the services are rendered in the course of the program.

(3) Notwithstanding subsections (1) and (2) of this section, the degree of independent judgment that [the] a physician assistant may exercise shall be determined by the supervising physician and the physician assistant in accordance with a practice description approved by the board.

(4) A physician assistant may provide medical services to ambulatory patients in a medical care setting where [the] a supervising physician does not regularly practice only if the following conditions exist:

(a) The medical care setting is located in a medically disadvantaged area;

(b) Direct communication either in person or by telephone, radio, radiotelephone, television or similar means is maintained; and

(c) The medical services provided by the physician assistant are reviewed by [the] a supervising physician on a regularly scheduled basis as determined by the board.

(5) A supervising physician, upon the approval of the board and in accordance with the rules established by the board, may delegate to the physician assistant the authority to administer and dispense limited emergency medications and to prescribe medications pursuant to this section and ORS 677.535 to 677.545. Neither the board nor the Physician Assistant Committee shall limit the privilege of administering, dispensing and prescribing to medically disadvantaged areas. All prescriptions written pursuant to this subsection shall bear the name, office address and telephone number of the supervising physician.

(6) Nothing in this chapter is intended to require or prohibit a physician assistant from practicing in a hospital licensed pursuant to ORS 441.015 to 441.097.

(7) Prescriptions for medications prescribed by a physician assistant in accordance with this section and ORS 475.005, 677.010, 677.500, 677.510 and 677.535 to 677.545 and dispensed by a licensed pharmacist may be filled by the pharmacist according to the terms of the prescription, and the filling of such a prescription shall not constitute evidence of negligence on the part of the pharmacist if the prescription was dispensed within the reasonable and prudent practice of pharmacy.

SECTION 6. ORS 677.520 is amended to read:

677.520. Performance of any medical services by a physician assistant after the [termination of registration] revocation or suspension of the license by the Board of Medical Examiners for the State of Oregon, after expiration of a temporary [registration] license or in the absence of renewal of [registration] a license constitutes the unauthorized practice of medicine and subjects the physician assistant to the penalties provided in ORS 677.990.

SECTION 7. ORS 677.535 is amended to read:

677.535. The Board of Medical Examiners for the State of Oregon may grant a limited [certification] license to a physician assistant if:

(1) The applicant meets the qualifications of the board, the application file is complete and no derogatory information has been submitted but board approval is pending; or

(2) The physician assistant is changing employment or supervising physicians.

SECTION 8. ORS 677.540 is amended to read:

677.540. (1) There is created a Physician Assistant Committee which shall consist of five members. Members of the committee shall be appointed as follows:

(a) The Board of Medical Examiners for the State of Oregon shall appoint one of its members and one physician. One of the two must supervise a physician assistant.

(b) The Oregon Society of Physician Assistants shall appoint two physician assistants.

(2) The term of each member of the committee shall be for three years. A member shall serve until a successor is appointed. If a vacancy occurs, it shall be filled for the unexpired term by a person with the same qualifications as the retiring member.

(3) If any vacancy under subsection (1) of this section is not filled within 45 days, the Governor shall make the necessary appointment from the category which is vacant.

(4) The committee shall elect its own chairperson with such powers and duties as the committee shall fix.

(5) A quorum of the committee shall be three members. The committee shall hold a meeting at least once quarterly and at such other times the committee considers advisable to review requests for prescription and dispensing privileges and to review applications for [certification] licensure or renewal.

(6) The chairperson may call a special meeting of the Physician Assistant Committee upon at least 10 days' notice in writing to each member, to be held at any place designated by the chairperson.

(7) The committee members are entitled to compensation and expenses as provided in ORS 292.495.

SECTION 9. ORS 677.545 is amended to read:

677.545. The Physician Assistant Committee shall:

(1) Review all applications for physician assistants' [certification] licensure and for renewal thereof.

(2) Review applications of physician assistants for dispensing privileges.

(3) Recommend approval or disapproval of applications submitted under subsection (1) or (2) of this section to the Board of Medical Examiners for the State of Oregon.

(4) Recommend criteria to be used in granting dispensing privileges under ORS 677.515.

(5) Recommend the formulary for prescriptive privileges which may include all or parts of Schedules III, IV and V controlled substances and the procedures for physician assistants and supervising physicians to follow in exercising the prescriptive privileges.

(6) Recommend the approval, disapproval or modification of the application for prescriptive privileges for any physician assistant.

SECTION 10. ORS 316.144 is amended to read:

316.144. A resident or nonresident individual who is certified as eligible under ORS 442.561, 442.562, 442.563 or 442.564, and is licensed as a physician or podiatric physician and surgeon under ORS chapter 677, [registered] licensed as a physician assistant under ORS chapter 677, licensed as a nurse practitioner under ORS chapter 678, licensed as a certified registered nurse anesthetist under ORS chapter 678, licensed as a dentist under ORS chapter 679 or licensed as an optometrist under ORS 683.010 to 683.335 is entitled to the tax credit described in ORS 316.143 even if not a member of the hospital medical staff if the Office of Rural Health certifies that the individual:

(1) Has a rural practice that amounts to 60 percent of the individual's practice; and

(2) If a physician or a physician assistant, can cause a patient to be admitted to the hospital; and

(3) If a certified registered nurse anesthetist, is employed by or has a contractual relationship with one of the hospitals described in ORS 316.143 (1)(a) to (c); and

(4) If an optometrist, has consulting privileges with a hospital listed in ORS 316.143 (1)(a) to (c). This subsection does not apply to an optometrist who qualifies as a "frontier rural practitioner," as defined by the Office of Rural Health.

SECTION 11. ORS 442.550 is amended to read:

442.550. As used in ORS 442.550 to 442.570:

(1) "Commission" means the State Scholarship Commission.

(2) "Nurse practitioner" means any person who is licensed under ORS 678.375.

(3) "Physician" means any person licensed to practice medicine under ORS chapter 677.

(4) "Physician assistant" means any such person [registered] licensed under ORS 677.495 and 677.505 to 677.525.

(5) "Qualifying loan" means any loan made to a medical student, physician assistant student or nursing student under:

(a) Common School Fund loan program under ORS 348.040 to 348.090;

(b) Programs under Title IV parts B, D and E, of the Higher Education Act of 1965, as amended; and

(c) The Health Professions Student Loan, Nursing Student Loan and Health Education Assistance Loan programs administered by the United States Department of Health and Human Services.

SECTION 12. ORS 656.245 is amended to read:

656.245. (1)(a) For every compensable injury, the insurer or the self-insured employer shall cause to be provided medical services for conditions caused in material part by the injury for such period as the nature of the injury or the process of the recovery requires, subject to the limitations in ORS 656.225, including such medical services as may be required after a determination of permanent disability. In addition, for consequential and combined conditions described in ORS 656.005 (7), the insurer or the self-insured employer shall cause to be provided only those medical services directed to medical conditions caused in major part by the injury.

(b) Compensable medical services shall include medical, surgical, hospital, nursing, ambulances and other related services, and drugs, medicine, crutches and prosthetic appliances, braces and supports and where necessary, physical restorative services. A pharmacist or dispensing physician shall dispense generic drugs to the worker in accordance with ORS 689.515. The duty to provide such medical services continues for the life of the worker.

(c) Notwithstanding any other provision of this chapter, medical services after the worker's condition is medically stationary are not compensable except for the following:

(A) Services provided to a worker who has been determined to be permanently and totally disabled.

(B) Prescription medications.

(D) Prosthetic devices, braces and supports.

(E) Services necessary to monitor the status, replacement or repair of prosthetic devices, braces and supports.

(F) Services provided pursuant to an accepted claim for aggravation under ORS 656.273.

(G) Services provided pursuant to an order issued under ORS 656.278.

(H) Services that are necessary to diagnose the worker's condition.

(I) Life-preserving modalities similar to insulin therapy, dialysis and transfusions.

(J) With the approval of the insurer or self-insured employer, palliative care that the worker's attending physician referred to in ORS 656.005 (12)(b)(A) prescribes and that is necessary to enable the worker to continue current employment or a vocational training program. If the insurer or self-insured employer does not approve, the attending physician or the worker may request approval from the Director of the Department of Consumer and Business Services for such treatment. The director may order a medical review by a physician or panel of physicians pursuant to ORS 656.327 (3) to aid in the review of such treatment. The decision of the director is subject to the contested case and review provisions of ORS 183.310 to 183.550.

(K) With the approval of the director, curative care arising from a generally recognized, nonexperimental advance in medical science since the worker's claim was closed that is highly likely to improve the worker's condition and that is otherwise justified by the circumstances of the claim. The decision of the director is subject to the contested case and review provisions of ORS 183.310 to 183.550.

(L) Curative care provided to a worker to stabilize a temporary and acute waxing and waning of symptoms of the worker's condition.

(d) Except for services provided under a managed care contract, out-of-pocket expense reimbursement to receive care from the attending physician shall not exceed the amount required to seek care from an appropriate attending physician of the same specialty who is in a medical community geographically closer to the worker's home. For the purposes of this paragraph, all physicians within a metropolitan area are considered to be part of the same medical community.

(2)(a) The worker may choose an attending doctor or physician within the State of Oregon. The worker may choose the initial attending physician and may subsequently change attending physician two times without approval from the director. If the worker thereafter selects another attending physician, the insurer or self-insured employer may require the director's approval of the selection and, if requested, the director shall determine with the advice of one or more physicians, whether the selection by the worker shall be approved. The decision of the director is subject to a contested case review under ORS 183.310 to 183.550. The worker also may choose an attending doctor or physician in another country or in any state or territory or possession of the United States with the prior approval of the insurer or self-insured employer.

(b) A medical service provider who is not a member of a managed care organization is subject to the following provisions:

(A) A medical service provider who is not qualified to be an attending physician may provide compensable medical service to an injured worker for a period of 30 days from the date of injury or occupational disease or for 12 visits, whichever first occurs, without the authorization of an attending physician. Thereafter, medical service provided to an injured worker without the written authorization of an attending physician is not compensable.

(B) A medical service provider who is not an attending physician cannot authorize the payment of temporary disability compensation. Except as otherwise provided in this chapter, only the attending physician at the time of claim closure may make findings regarding the worker's impairment for the purpose of evaluating the worker's disability.

(3) Notwithstanding any other provision of this chapter, the director, by rule, upon the advice of the committee created by ORS 656.794 and upon the advice of the professional licensing boards of practitioners affected by the rule, may exclude from compensability any medical treatment the director finds to be unscientific, unproven, outmoded or experimental. The decision of the director is subject to a contested case review under ORS 183.310 to 183.550.

(a) Those workers who are subject to the contract shall receive medical services in the manner prescribed in the contract. Workers subject to the contract include those who are receiving medical treatment for an accepted compensable injury or occupational disease, regardless of the date of injury or medically stationary status, on or after the effective date of the contract. If the managed care organization determines that the change in provider would be medically detrimental to the worker, the worker shall not become subject to the contract until the worker is found to be medically stationary, the worker changes physicians or the managed care organization determines that the change in provider is no longer medically detrimental, whichever event first occurs. A worker becomes subject to the contract upon the worker's receipt of actual notice of the worker's enrollment in the managed care organization, or upon the third day after the notice was sent by regular mail by the insurer or self-insured employer, whichever event first occurs. A worker shall not be subject to a contract after it expires or terminates without renewal, except that workers with open claims at the time of such expiration or termination shall remain subject to the contract for that claim until closure. A worker shall not be subject to a contract if the worker's primary residence is more than 100 miles outside the managed care organization's certified geographical area. Each such contract must comply with the certification standards provided in ORS 656.260. However, a worker may receive immediate emergency medical treatment that is compensable from a medical service provider who is not a member of the managed care organization. Insurers or self-insured employers who contract with a managed care organization for medical services shall give notice to the workers of eligible medical service providers and such other information regarding the contract and manner of receiving medical services as the director may prescribe. Notwithstanding any provision of law or rule to the contrary, a worker of a noncomplying employer is considered to be subject to a contract between the State Accident Insurance Fund Corporation as a processing agent or the assigned claims agent and a managed care organization.

(b)(A) For initial or aggravation claims filed after June 7, 1995, the insurer or self-insured employer may require an injured worker, on a case-by-case basis, immediately to receive medical services from the managed care organization.

(B) If the insurer or self-insured employer gives notice that the worker is required to receive treatment from the managed care organization, the insurer or self-insured employer must guarantee that any reasonable and necessary services so received, that are not otherwise covered by health insurance, will be paid as provided in ORS 656.248, even if the claim is denied, until the worker receives actual notice of the denial or until three days after the denial is mailed, whichever event first occurs. The worker may elect to receive care from a primary care physician who agrees to the conditions of ORS 656.260 (4)(g). However, guarantee of payment is not required by the insurer or self-insured employer if this election is made.

(C) If the insurer or self-insured employer does not give notice that the worker is required to receive treatment from the managed care organization, the insurer or self-insured employer is under no obligation to pay for services received by the worker unless the claim is later accepted.

(D) If the claim is denied, the worker may receive medical services after the date of denial from sources other than the managed care organization until the denial is reversed. Reasonable and necessary medical services received from sources other than the managed care organization after the date of claim denial must be paid as provided in ORS 656.248 by the insurer or self-insured employer if the claim is finally determined to be compensable.

(5) Notwithstanding any other provision of this chapter, the director, by rule, shall authorize nurse practitioners certified by the Oregon State Board of Nursing and physician assistants [registered] licensed by the Board of Medical Examiners for the State of Oregon who practice in areas served by Type A or Type B rural hospitals described in ORS 442.470 to authorize the payment of temporary disability compensation for injured workers for a period not to exceed 30 days from the date of the first visit on the claim. In addition, the director, by rule, may authorize such practitioners and assistants who practice in areas served by a Type C rural hospital described in ORS 442.470 to authorize such payment.

(6) If a claim for medical services is disapproved for any reason other than the formal denial of the compensability of the underlying claim and this disapproval is disputed, the injured worker, the insurer or self-insured employer shall request administrative review by the director pursuant to this section, ORS 656.260 or 656.327. The decision of the director is subject to the contested case review provisions of ORS 183.310 to 183.550.

SECTION 13. ORS 656.245, as amended by section 25a, chapter 332, Oregon Laws 1995, is amended to read:

(c) Notwithstanding any other provision of this chapter, medical services after the worker's condition is medically stationary are not compensable except for the following:

(A) Services provided to a worker who has been determined to be permanently and totally disabled.

(B) Prescription medications.

(D) Prosthetic devices, braces and supports.

(E) Services necessary to monitor the status, replacement or repair of prosthetic devices, braces and supports.

(F) Services provided pursuant to an accepted claim for aggravation under ORS 656.273.

(G) Services provided pursuant to an order issued under ORS 656.278.

(H) Services that are necessary to diagnose the worker's condition.

(I) Life-preserving modalities similar to insulin therapy, dialysis and transfusions.

(L) Curative care provided to a worker to stabilize a temporary and acute waxing and waning of symptoms of the worker's condition.

(b) A medical service provider who is not a member of a managed care organization is subject to the following provisions:

(4) Notwithstanding subsection (2)(a) of this section, when a self-insured employer or the insurer of an employer contracts with a managed care organization certified pursuant to ORS 656.260 for medical services required by this chapter to be provided to injured workers, those workers who are subject to the contract shall receive medical services in the manner prescribed in the contract. Each such contract must comply with the certification standards provided in ORS 656.260. However, a worker may receive immediate emergency medical treatment that is compensable from a medical service provider who is not a member of the managed care organization. Insurers or self-insured employers who contract with a managed care organization for medical services shall give notice to the workers of eligible medical service providers and such other information regarding the contract and manner of receiving medical services as the director may prescribe.

SECTION 14. Nothing in the amendments to ORS 656.245 by section 12 or 13 of this 1999 Act affects the operative or applicability date provisions of sections 25a and 66, chapter 332, Oregon Laws 1995.

SECTION 14a. Sections 13 (amending ORS 656.245) and 14 of this 1999 Act are repealed.

SECTION 15. ORS 688.130 is amended to read:

688.130. (1) Unless the education and training requirements described in ORS 688.134 have been met, no licensed physical therapist or person who holds a temporary permit issued under ORS 688.110 shall use physical therapy upon any person except where there has been:

(a) Prior evaluation of dysfunction of the person by the physical therapist by the use of recognized evaluative physical therapy tests and procedures; and either

(b) Diagnosis or referral by a physician or a podiatric physician and surgeon licensed under ORS chapter 677 by the Board of Medical Examiners for the State of Oregon, a dentist licensed by the Oregon Board of Dentistry, a physician assistant [registered] licensed under ORS chapter 677, a chiropractic physician licensed under ORS chapter 684 by the State Board of Chiropractic Examiners or a nurse practitioner certified under ORS 678.375; or

(c) Diagnosis or referral made in another state by a medical doctor, osteopathic physician or podiatric physician and surgeon licensed by an authority of that state similar to the Board of Medical Examiners for the State of Oregon or by a dentist licensed by an authority of that state similar to the Oregon Board of Dentistry.

(2) No person shall practice as a physical therapist assistant unless the person is licensed under ORS 688.090 and such practice is solely under the supervision and direction of a physical therapist.

SECTION 16. ORS 811.604 is amended to read:

811.604. (1) Application for issuance of a disabled person parking permit in the form of an individual placard or decal issued under ORS 811.602 shall include:

(a) A certificate by a licensed physician, a certified nurse practitioner or a [certified] licensed physician assistant to the Department of Transportation that the applicant is a disabled person or a certificate by a licensed optometrist that the applicant is a disabled person because of loss of vision or substantial loss of visual acuity or visual field beyond correction;

(b) The number of a current, valid driver license, golf cart driver permit or identification card issued to the applicant by the department; and

(2) Application for renewal of a disabled person parking permit shall be a signed statement from the holder of the permit saying that the person is still qualified to hold the permit.

SECTION 17. ORS 811.611 is amended to read:

811.611. (1) The Department of Transportation may issue a disabled person parking permit in the form of a placard to a person who is visiting from a foreign country if the person presents to the department either a valid driver license or other grant of driving privileges from the foreign country or a passport or visa showing that the person is a visitor to the United States and presents one of the following:

(a) A valid disabled person parking permit issued by the country that issued the visitor's passport or visa;

(b) A certificate from an official of the agency that issues disabled person parking permits in the country that issued the visitor's passport or visa certifying that the person holds a valid disabled person parking permit; or

(c) A certificate from a licensed physician, a certified nurse practitioner or a [certified] licensed physician assistant addressed to the Department of Transportation certifying that the applicant is a disabled person, or a certificate from a licensed optometrist certifying that the applicant is a disabled person because of loss of vision or substantial loss of visual acuity or visual field beyond correction.

(2) A disabled person parking permit issued under this section is valid for 30 days.

(3) Fees for issuance or replacement of a disabled person parking permit under this section shall be as provided in ORS 811.640.

Approved by the Governor July 12, 1999

Filed in the office of Secretary of State July 12, 1999

Effective date October 23, 1999

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