HF 1036
CCR--HF1036 - 89th Legislature (2015 - 2016)
Posted on 05/10/2016 02:05 p.m.
KEY: stricken = removed, old language.
underscored = added, new language.
Line numbers
1.1CONFERENCE COMMITTEE REPORT ON H. F. No. 1036
1.2A bill for an act
1.3relating to health care; modifying provisions related to physician assistants;
1.4amending Minnesota Statutes 2014, sections 147A.01, subdivisions 17a, 23;
1.5147A.20, subdivisions 1, 2; repealing Minnesota Statutes 2014, section 147A.01,
1.6subdivision 5.
1.7May 5, 2016
1.8The Honorable Kurt L. Daudt
1.9Speaker of the House of Representatives
1.10The Honorable Sandra L. Pappas
1.11President of the Senate
1.12We, the undersigned conferees for H. F. No. 1036 report that we have agreed upon
1.13the items in dispute and recommend as follows:
1.14That the Senate recede from its amendments and that H. F. No. 1036 be further
1.15amended as follows:
1.16Delete everything after the enacting clause and insert:
1.17 "Section 1. Minnesota Statutes 2014, section 147A.01, subdivision 17a, is amended to
1.18read:
1.19 Subd. 17a. Physician-physician assistant delegation agreement.
1.20"Physician-physician assistant delegation agreement" means the document prepared and
1.21signed by the physician and physician assistant affirming the supervisory relationship and
1.22defining the physician assistant scope of practice. Alternate supervising physicians must be
1.23identified on the delegation agreement or a supplemental listing with signed attestation that
1.24each shall accept full medical responsibility for the performance, practice, and activities of
1.25the physician assistant while under the supervision of the alternate supervising physician.
1.26The physician-physician assistant delegation agreement outlines the role of the physician
1.27assistant in the practice, describes the means of supervision, and specifies the categories of
1.28drugs, controlled substances, and medical devices that the supervising physician delegates
1.29to the physician assistant to prescribe. The physician-physician assistant delegation
2.1agreement must comply with the requirements of section
147A.20, be kept on file at the
2.2address of record, and be made available to the board or its representative upon request.
2.3 Sec. 2. Minnesota Statutes 2014, section 147A.01, subdivision 23, is amended to read:
2.4 Subd. 23. Supervising physician. "Supervising physician" means a Minnesota
2.5licensed physician who accepts full medical responsibility for the performance, practice,
2.6and activities of a physician assistant under an agreement as described in section
147A.20.
2.7The supervising physician who completes and signs the delegation agreement may be
2.8referred to as the primary supervising physician. A supervising physician shall not
2.9supervise more than five full-time equivalent physician assistants simultaneously. With
2.10the approval of the board, or in a disaster or emergency situation pursuant to section
2.11, a supervising physician may supervise more than five full-time equivalent
2.12physician assistants simultaneously.
2.13 Sec. 3. Minnesota Statutes 2014, section 147A.20, subdivision 1, is amended to read:
2.14 Subdivision 1. Physician-physician assistant delegation agreement. (a) A
2.15physician assistant and supervising physician must sign a physician-physician assistant
2.16delegation agreement which specifies scope of practice and manner of supervision as
2.17required by the board. The agreement must contain:
2.18(1) a description of the practice setting;
2.19(2) a listing of categories of delegated duties;
2.20(3) a description of supervision type; and
2.21(4) a description of the process and schedule for review of prescribing, dispensing,
2.22and administering legend and controlled drugs and medical devices by the physician
2.23assistant authorized to prescribe.
2.24(b) The agreement must be maintained by the supervising physician and physician
2.25assistant and made available to the board upon request. If there is a delegation of
2.26prescribing, administering, and dispensing of legend drugs, controlled substances, and
2.27medical devices, the agreement shall include a description of the prescriptive authority
2.28delegated to the physician assistant. Physician assistants shall have a separate agreement
2.29for each place of employment. Agreements must be reviewed and updated on an
2.30annual basis. The supervising physician and physician assistant must maintain the
2.31physician-physician assistant delegation agreement at the address of record.
2.32(c) Physician assistants must provide written notification to the board within 30
2.33days of the following:
2.34(1) name change;
3.1(2) address of record change; and
3.2(3) telephone number of record change.
3.3(d) Any alternate supervising physicians must be identified in the physician-physician
3.4assistant delegation agreement, or a supplemental listing, and must sign the agreement
3.5attesting that they shall provide the physician assistant with supervision in compliance
3.6with this chapter, the delegation agreement, and board rules.
3.7 Sec. 4. Minnesota Statutes 2014, section 147A.20, subdivision 2, is amended to read:
3.8 Subd. 2. Notification of intent to Practicenew text begin location notificationnew text end . A licensed
3.9physician assistant shall submit a notification of intent to practice new text begin location notification new text end
3.10to the board prior to beginningnew text begin within 30 business days of startingnew text end practicenew text begin , changing new text end
3.11new text begin practice location, or changing supervising physiciannew text end . The notification shall include the
3.12name, business address, and telephone number of the supervising physician and the
3.13physician assistant. Individuals who practice without submitting a notification of intent to
3.14practice new text begin location notification new text end shall be subject to disciplinary action under section
147A.13
3.15for practicing without a license, unless the care is provided in response to a disaster or
3.16emergency situation pursuant to section
147A.23.
3.17 Sec. 5. Minnesota Statutes 2014, section 147D.05, subdivision 1, is amended to read:
3.18 Subdivision 1. Practice standards. (a) A licensed traditional midwife shall provide
3.19an initial and ongoing screening to ensure that each client receives safe and appropriate
3.20care. A licensed traditional midwife shall only accept and provide care to those women
3.21who are expected to have a normal pregnancy, labor, and delivery. As part of the initial
3.22screening to determine whether any contraindications are present, the licensed traditional
3.23midwife must take a detailed health history that includes the woman's social, medical,
3.24surgical, menstrual, gynecological, contraceptive, obstetrical, family, nutritional, and
3.25drug/chemical use histories. If a licensed traditional midwife determines at any time
3.26during the course of the pregnancy that a woman's condition may preclude attendance by a
3.27traditional midwife, the licensed traditional midwife must refer the client to a licensed
3.28health care provider. As part of the initial and ongoing screening, a licensed traditional
3.29midwife must new text begin provide or new text end recommend that the client receive the following services, if
3.30indicated, from an appropriate health care provider:
3.31(1) initial laboratory pregnancy screening, including blood group and type, antibody
3.32screen, Indirect Coombs, rubella titer, CBC with differential and syphilis serology;
3.33(2) gonorrhea and chlamydia cultures;
3.34(3) screening for sickle cell;
4.1(4) screening for hepatitis B and human immunodeficiency virus (HIV);
4.2(5) maternal serum alpha-fetoprotein test and ultrasound;
4.3(6) Rh antibody and glucose screening at 28 weeks gestation;
4.4(7) mandated newborn screening;
4.5(8) Rh screening of the infant for maternal RhoGAM treatment; and
4.6(9) screening for premature labor.
4.7(b) A client must make arrangements to have the results of any of the tests described
4.8in paragraph (a) sent to the licensed traditional midwife providing services to the client.
4.9The licensed traditional midwife must include these results in the client's record.
4.10 Sec. 6. Minnesota Statutes 2014, section 147D.09, is amended to read:
4.11147D.09 LIMITATIONS OF PRACTICE.
4.12(a) A licensed traditional midwife shall not prescribe, dispense, or administer
4.13prescription drugs, except as permitted under paragraph (b).
4.14(b) A licensed traditional midwife may administer vitamin K either orally or through
4.15intramuscular injection, new text begin maternal RhoGAM treatment, new text end postpartum antihemorrhagic drugs
4.16under emergency situations, local anesthetic, oxygen, and a prophylactic eye agent to
4.17the newborn infant.
4.18(c) A licensed traditional midwife shall not perform any operative or surgical
4.19procedures except for suture repair of first- or second-degree perineal lacerations.
4.20 Sec. 7. Minnesota Statutes 2015 Supplement, section 147D.13, subdivision 2, is
4.21amended to read:
4.22 Subd. 2. Practice report. (a) A licensed traditional midwife must compile a
4.23summary report on each client. The report must include the following:
4.24(1) vital records;
4.25(2) scope of care administered;
4.26(3) whether the medical consultation plan was implemented; and
4.27(4) any physician or other health care provider referrals made.
4.28(b) The board new text begin or advisory council new text end may review these reports at any time upon request.
4.29 Sec. 8. Minnesota Statutes 2014, section 147D.25, subdivision 1, is amended to read:
4.30 Subdivision 1. Membership. The board shall appoint a five-member Advisory
4.31Council on Licensed Traditional Midwifery. One member shall be a licensed physician
4.32who has been or is currently consulting with licensed traditional midwives, appointed from
4.33a list of names submitted to the board by the Minnesota Medical Association. new text begin One member new text end
5.1new text begin shall be a licensed physician who has been or is currently consulting or collaborating with new text end
5.2new text begin licensed traditional midwives appointed from a list of names submitted to the board by the new text end
5.3new text begin Minnesota Council of Certified Professional Midwives or its successors.new text end Three members
5.4shall be licensed traditional midwives appointed from a list of names submitted to the
5.5board by Midwifery Nownew text begin and the Minnesota Council of Certified Professional Midwives new text end
5.6new text begin or their successorsnew text end . One member shall be a home birth parent new text begin of a child born under the new text end
5.7new text begin care of a licensed traditional midwife new text end appointed from a list of names submitted to the
5.8board by Minnesota Families for Midwiferynew text begin , or its successornew text end .
5.9 Sec. 9. Minnesota Statutes 2014, section 148.271, is amended to read:
5.10148.271 EXEMPTIONS.
5.11The provisions of sections
148.171 to
148.285 shall not prohibit:
5.12(1) The furnishing of nursing assistance in an emergency.
5.13(2) The practice of advanced practice, professional, or practical nursing by any
5.14legally qualified advanced practice, registered, or licensed practical nurse of another state
5.15who is employed by the United States government or any bureau, division, or agency
5.16thereof while in the discharge of official duties.
5.17(3) The practice of any profession or occupation licensed by the state, other than
5.18advanced practice, professional, or practical nursing, by any person duly licensed to
5.19practice the profession or occupation, or the performance by a person of any acts properly
5.20coming within the scope of the profession, occupation, or license.
5.21(4) The provision of a nursing or nursing-related service by an unlicensed assistive
5.22person who has been delegated or assigned the specific function and is supervised by a
5.23registered nurse or monitored by a licensed practical nurse.
5.24(5) The care of the sick with or without compensation when done in a nursing home
5.25covered by the provisions of section
144A.09, subdivision 1.
5.26(6) Professional nursing practice or advanced practice registered nursing practice by
5.27a registered nurse or practical nursing practice by a licensed practical nurse licensed in
5.28another state or territory who is in Minnesota as a student enrolled in a formal, structured
5.29course of study, such as a course leading to a higher degree, certification in a nursing
5.30specialty, or to enhance skills in a clinical field, while the student is practicing in the course.
5.31(7) Professional or practical nursing practice by a student practicing under the
5.32supervision of an instructor while the student is enrolled in a nursing program approved by
5.33the board under section
148.251.
5.34(8) Advanced practice registered nursing as defined in section
148.171, subdivisions
5.355, 10, 11, 13, and 21
, by a registered nurse who is licensed and currently registered in
6.1Minnesota or another United States jurisdiction and who is enrolled as a student in a
6.2formal graduate education program leading to eligibility for certification and licensure
6.3as an advanced practice registered nurse.
6.4new text begin (9) Professional nursing practice or advanced practice registered nursing practice by new text end
6.5new text begin a registered nurse or advanced practice registered nurse licensed in another state, territory, new text end
6.6new text begin or jurisdiction who is in Minnesota temporarily:new text end
6.7new text begin (i) providing continuing or in-service education;new text end
6.8new text begin (ii) serving as a guest lecturer;new text end
6.9new text begin (iii) presenting at a conference; ornew text end
6.10new text begin (iv) teaching didactic content via distance education to a student located in new text end
6.11new text begin Minnesota who is enrolled in a formal, structured course of study, such as a course leading new text end
6.12new text begin to a higher degree or certification in a nursing specialty.new text end
6.13 Sec. 10. Minnesota Statutes 2014, section 214.077, is amended to read:
6.14214.077 TEMPORARY LICENSE SUSPENSION; IMMINENT RISK OF
6.15new text begin SERIOUS new text end HARM.
6.16(a) Notwithstanding any provision of a health-related professional practice act,
6.17when a health-related licensing board receives a complaint regarding a regulated person
6.18and has probable cause to believe new text begin that the regulated person has violated a statute or rule new text end
6.19new text begin that the health-related licensing board is empowered to enforce, and new text end continued practice
6.20by the regulated person presents an imminent risk of new text begin serious new text end harm, the new text begin health-related new text end
6.21licensing board shall new text begin issue an order new text end temporarily suspendnew text begin suspendingnew text end the regulated person's
6.22professional licensenew text begin authority to practicenew text end . The new text begin temporary new text end suspension new text begin order new text end shall take
6.23effect upon written notice to the regulated person and shall specify the reason for the
6.24suspension.new text begin , including the statute or rule alleged to have been violated. The temporary new text end
6.25new text begin suspension order shall take effect upon personal service on the regulated person or the new text end
6.26new text begin regulated person's attorney, or upon the third calendar day after the order is served by first new text end
6.27new text begin class mail to the most recent address provided to the health-related licensing board for the new text end
6.28new text begin regulated person or the regulated person's attorney.new text end
6.29(b) The new text begin temporary new text end suspension shall remain in effect until the appropriate
6.30new text begin health-relatednew text end licensing board or the commissioner completes an investigationnew text begin , holds a new text end
6.31new text begin contested case hearing pursuant to the Administrative Procedure Act,new text end and issues a final
6.32order in the matter after a hearingnew text begin as provided for in this sectionnew text end .
6.33(c) At the time it issues the new text begin temporary new text end suspension noticenew text begin ordernew text end , the appropriate
6.34new text begin health-relatednew text end licensing board shall schedule a disciplinarynew text begin contested casenew text end hearingnew text begin , on the new text end
6.35new text begin merits of whether discipline is warranted,new text end to be held before the licensing board or pursuant
7.1to the Administrative Procedure Act. The regulated person shall be provided with at least
7.2ten days' notice of any new text begin contested case new text end hearing held pursuant to this section. The new text begin contested new text end
7.3new text begin case new text end hearing shall be scheduled to begin no later than 30 days after issuancenew text begin the effective new text end
7.4new text begin servicenew text end of the new text begin temporary new text end suspension order.
7.5new text begin (d) The administrative law judge presiding over the contested case hearing shall new text end
7.6new text begin issue a report and recommendation to the health-related licensing board no later than 30 new text end
7.7new text begin days after the final day of the contested case hearing. The health-related licensing board new text end
7.8new text begin shall issue a final order pursuant to sections 14.61 and 14.62 within 30 days of receipt new text end
7.9new text begin of the administrative law judge's report and recommendations. Except as provided in new text end
7.10new text begin paragraph (e), if the health-related licensing board has not issued a final order pursuant to new text end
7.11new text begin sections 14.61 and 14.62 within 30 days of receipt of the administrative law judge's report new text end
7.12new text begin and recommendations, the temporary suspension shall be lifted.new text end
7.13(d)new text begin (e)new text end If the board has not completed its investigation and issued a final order within
7.1430 days, the temporary suspension shall be lifted, unless the regulated person requests a
7.15delay in the disciplinary proceedings for any reason, upon which the temporary suspension
7.16shall remain in place until the completion of the investigation.new text begin the regulated person new text end
7.17new text begin requests a delay in the contested case proceedings provided for in paragraphs (c) and (d) new text end
7.18new text begin for any reason, the temporary suspension shall remain in effect until the health-related new text end
7.19new text begin licensing board issues a final order pursuant to sections 14.61 and 14.62.new text end
7.20new text begin (f) This section shall not apply to the Office of Unlicensed Complementary and new text end
7.21new text begin Alternative Health Practice established under section 146A.02. The commissioner of new text end
7.22new text begin health shall conduct temporary suspensions for complementary and alternative health care new text end
7.23new text begin practitioners in accordance with section 146A.09.new text end
7.24 Sec. 11. Minnesota Statutes 2014, section 214.10, subdivision 2, is amended to read:
7.25 Subd. 2. Investigation and hearing. The designee of the attorney general providing
7.26legal services to a board shall evaluate the communications forwarded by the board or its
7.27members or staff. If the communication alleges a violation of statute or rule which the
7.28board is to enforce, the designee is empowered to investigate the facts alleged in the
7.29communication. In the process of evaluation and investigation, the designee shall consult
7.30with or seek the assistance of the executive director, executive secretary, or, if the board
7.31determines, a member of the board who has been appointed by the board to assist the
7.32designee. The designee may also consult with or seek the assistance of any other qualified
7.33persons who are not members of the board who the designee believes will materially aid
7.34in the process of evaluation or investigation. The executive director, executive secretary,
7.35or the consulted board member may attempt to correct improper activities and redress
8.1grievances through education, conference, conciliation and persuasion, and in these
8.2attempts may be assisted by the designee of the attorney general. If the attempts at
8.3correction or redress do not produce satisfactory results in the opinion of the executive
8.4director, executive secretary, or the consulted board member, or if after investigation the
8.5designee providing legal services to the board, the executive director, executive secretary,
8.6or the consulted board member believes that the communication and the investigation
8.7suggest illegal or unauthorized activities warranting board action, the person having the
8.8belief shall inform the executive director or executive secretary of the board who shall
8.9schedule a disciplinarynew text begin contested casenew text end hearing in accordance with chapter 14. Before
8.10directing the holding of a disciplinarynew text begin contested casenew text end hearing, the executive director,
8.11executive secretary, or the designee of the attorney general shall have considered the
8.12recommendations of the consulted board member. Before scheduling a disciplinary
8.13new text begin contested casenew text end hearing, the executive director or executive secretary must have received
8.14a verified written complaint from the complaining party. A board member who was
8.15consulted during the course of an investigation may participate at the hearing but may not
8.16vote on any matter pertaining to the case. The executive director or executive secretary
8.17of the board shall promptly inform the complaining party of the final disposition of the
8.18complaint. Nothing in this section shall preclude the board from scheduling, on its own
8.19motion, a disciplinarynew text begin contested casenew text end hearing based upon the findings or report of the
8.20board's executive director or executive secretary, a board member or the designee of the
8.21attorney general assigned to the board. Nothing in this section shall preclude a member of
8.22the board, executive director, or executive secretary from initiating a complaint.
8.23 Sec. 12. Minnesota Statutes 2014, section 214.10, subdivision 2a, is amended to read:
8.24 Subd. 2a. Proceedings. A board shall initiate proceedings to suspend or revoke
8.25a license or shall refuse to renew a license of a person licensed by the board who is
8.26convicted in a court of competent jurisdiction of violating section
609.224, subdivision 2
8.27new text begin 609.2231, subdivision 8new text end
, paragraph (c),
609.23,
609.231,
609.2325,
609.233,
609.2335,
8.28609.234
,
609.465,
609.466,
609.52, or
609.72, subdivision 3.
8.29 Sec. 13. Minnesota Statutes 2014, section 214.10, is amended by adding a subdivision
8.30to read:
8.31 new text begin Subd. 14.new text end new text begin Complementary and alternative health care practitioners.new text end new text begin This section new text end
8.32new text begin shall not apply to complementary and alternative health care practitioners practicing under new text end
8.33new text begin chapter 146A. Complaints and disciplinary actions against complementary and alternative new text end
8.34new text begin health care practitioners shall be conducted in accordance with chapter 146A.new text end
9.1 Sec. 14. Minnesota Statutes 2014, section 214.32, subdivision 6, is amended to read:
9.2 Subd. 6. Duties of a participating board. Upon receiving a report from the
9.3program manager in accordance with section
214.33, subdivision 3, that a regulated
9.4person has been discharged from the program due to noncompliance based on allegations
9.5that the regulated person has engaged in conduct that might cause risk to the public,
9.6whennew text begin and ifnew text end the participating new text begin health-related licensing new text end board has probable cause to believe
9.7continued practice by the regulated person presents an imminent risk of new text begin serious new text end harm, the
9.8new text begin health-related licensing new text end board shall temporarily suspend the regulated person's professional
9.9license until the completion of a disciplinary investigation. The board must complete the
9.10disciplinary investigation within 30 days of receipt of the report from the program. If the
9.11investigation is not completed by the board within 30 days, the temporary suspension shall
9.12be lifted, unless the regulated person requests a delay in the disciplinary proceedings
9.13for any reason, upon which the temporary suspension shall remain in place until the
9.14completion of the investigationnew text begin proceed pursuant to the requirements in section 214.077new text end .
9.15 Sec. 15. new text begin REVISOR'S INSTRUCTION.new text end
9.16new text begin (a) The revisor of statutes shall change the term "physician's assistant" to "physician new text end
9.17new text begin assistant" wherever that term is found in Minnesota Statutes and Minnesota Rules.new text end
9.18new text begin (b) The revisor of statutes shall change the term "physician ancillary" to "physician new text end
9.19new text begin assistant" wherever that term is found in Minnesota Statutes and Minnesota Rules.new text end
9.20 Sec. 16. new text begin REPEALER.new text end
9.21new text begin Minnesota Statutes 2014, sections 147A.01, subdivision 5; and 147D.17, subdivision new text end
9.22new text begin 4,new text end new text begin are repealed.new text end
"9.23Delete the title and insert:
9.24"A bill for an act
9.25relating to health care; modifying provisions related to physician assistants,
9.26midwives, and nurses; modifying provisions related to license suspension and
9.27contested case hearings;amending Minnesota Statutes 2014, sections 147A.01,
9.28subdivisions 17a, 23; 147A.20, subdivisions 1, 2; 147D.05, subdivision 1;
9.29147D.09; 147D.25, subdivision 1; 148.271; 214.077; 214.10, subdivisions 2,
9.302a, by adding a subdivision; 214.32, subdivision 6; Minnesota Statutes 2015
9.31Supplement, section 147D.13, subdivision 2; repealing Minnesota Statutes 2014,
9.32sections 147A.01, subdivision 5; 147D.17, subdivision 4."
We request the adoption of this report and repassage of the bill.
House Conferees:
.....
.....
Dave Baker
Tara Mack
.....
Debra Hilstrom
Senate Conferees:
.....
.....
Chris A. Eaton
Mary Kiffmeyer
.....
Melissa H. Wiklund