HF 1036

Conference Committee Report - 89th Legislature (2015 - 2016) Posted on 05/10/2016 02:05pm

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
2.11147A.23, 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 Practice location notification. A licensed
3.9physician assistant shall submit a notification of intent to practice location notification
3.10to the board prior to beginning within 30 business days of starting practice, changing
3.11practice location, or changing supervising physician. 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 location notification 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 provide or 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, maternal RhoGAM treatment, 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 or advisory council 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. One member
5.1shall be a licensed physician who has been or is currently consulting or collaborating with
5.2licensed traditional midwives appointed from a list of names submitted to the board by the
5.3Minnesota Council of Certified Professional Midwives or its successors. Three members
5.4shall be licensed traditional midwives appointed from a list of names submitted to the
5.5board by Midwifery Now and the Minnesota Council of Certified Professional Midwives
5.6or their successors. One member shall be a home birth parent of a child born under the
5.7care of a licensed traditional midwife appointed from a list of names submitted to the
5.8board by Minnesota Families for Midwifery, or its successor.

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.
6.4(9) Professional nursing practice or advanced practice registered nursing practice by
6.5a registered nurse or advanced practice registered nurse licensed in another state, territory,
6.6or jurisdiction who is in Minnesota temporarily:
6.7(i) providing continuing or in-service education;
6.8(ii) serving as a guest lecturer;
6.9(iii) presenting at a conference; or
6.10(iv) teaching didactic content via distance education to a student located in
6.11Minnesota who is enrolled in a formal, structured course of study, such as a course leading
6.12to a higher degree or certification in a nursing specialty.

6.13    Sec. 10. Minnesota Statutes 2014, section 214.077, is amended to read:
6.14214.077 TEMPORARY LICENSE SUSPENSION; IMMINENT RISK OF
6.15SERIOUS 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 that the regulated person has violated a statute or rule
6.19that the health-related licensing board is empowered to enforce, and continued practice
6.20by the regulated person presents an imminent risk of serious harm, the health-related
6.21licensing board shall issue an order temporarily suspend suspending the regulated person's
6.22professional license authority to practice. The temporary suspension order shall take
6.23effect upon written notice to the regulated person and shall specify the reason for the
6.24suspension., including the statute or rule alleged to have been violated. The temporary
6.25suspension order shall take effect upon personal service on the regulated person or the
6.26regulated person's attorney, or upon the third calendar day after the order is served by first
6.27class mail to the most recent address provided to the health-related licensing board for the
6.28regulated person or the regulated person's attorney.
6.29(b) The temporary suspension shall remain in effect until the appropriate
6.30health-related licensing board or the commissioner completes an investigation, holds a
6.31contested case hearing pursuant to the Administrative Procedure Act, and issues a final
6.32order in the matter after a hearing as provided for in this section.
6.33(c) At the time it issues the temporary suspension notice order, the appropriate
6.34health-related licensing board shall schedule a disciplinary contested case hearing, on the
6.35merits of whether discipline is warranted, 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 contested case hearing held pursuant to this section. The contested
7.3case hearing shall be scheduled to begin no later than 30 days after issuance the effective
7.4service of the temporary suspension order.
7.5(d) The administrative law judge presiding over the contested case hearing shall
7.6issue a report and recommendation to the health-related licensing board no later than 30
7.7days after the final day of the contested case hearing. The health-related licensing board
7.8shall issue a final order pursuant to sections 14.61 and 14.62 within 30 days of receipt
7.9of the administrative law judge's report and recommendations. Except as provided in
7.10paragraph (e), if the health-related licensing board has not issued a final order pursuant to
7.11sections 14.61 and 14.62 within 30 days of receipt of the administrative law judge's report
7.12and recommendations, the temporary suspension shall be lifted.
7.13(d) (e) 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. the regulated person
7.17requests a delay in the contested case proceedings provided for in paragraphs (c) and (d)
7.18for any reason, the temporary suspension shall remain in effect until the health-related
7.19licensing board issues a final order pursuant to sections 14.61 and 14.62.
7.20(f) This section shall not apply to the Office of Unlicensed Complementary and
7.21Alternative Health Practice established under section 146A.02. The commissioner of
7.22health shall conduct temporary suspensions for complementary and alternative health care
7.23practitioners in accordance with section 146A.09.

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 disciplinary contested case hearing in accordance with chapter 14. Before
8.10directing the holding of a disciplinary contested case 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
8.13contested case 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 disciplinary contested case 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
8.27609.2231, subdivision 8 , 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    Subd. 14. Complementary and alternative health care practitioners. This section
8.32shall not apply to complementary and alternative health care practitioners practicing under
8.33chapter 146A. Complaints and disciplinary actions against complementary and alternative
8.34health care practitioners shall be conducted in accordance with chapter 146A.

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,
9.6when and if the participating health-related licensing board has probable cause to believe
9.7continued practice by the regulated person presents an imminent risk of serious harm, the
9.8health-related licensing 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 investigation proceed pursuant to the requirements in section 214.077.

9.15    Sec. 15. REVISOR'S INSTRUCTION.
9.16(a) The revisor of statutes shall change the term "physician's assistant" to "physician
9.17assistant" wherever that term is found in Minnesota Statutes and Minnesota Rules.
9.18(b) The revisor of statutes shall change the term "physician ancillary" to "physician
9.19assistant" wherever that term is found in Minnesota Statutes and Minnesota Rules.

9.20    Sec. 16. REPEALER.
9.21Minnesota Statutes 2014, sections 147A.01, subdivision 5; and 147D.17, subdivision
9.224, are repealed.
"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