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HF 1036

2nd Engrossment - 89th Legislature (2015 - 2016) Posted on 06/21/2017 11:01am

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Current Version - 2nd Engrossment

A bill for an act
relating to health care; modifying provisions related to physician assistants,
midwives, and nurses; modifying provisions related to license suspension and
contested case hearings; amending Minnesota Statutes 2014, sections 147A.01,
subdivisions 17a, 23; 147A.20, subdivisions 1, 2; 147D.05, subdivision 1;
147D.09; 147D.25, subdivision 1; 148.271; 214.077; 214.10, subdivisions 2,
2a, by adding a subdivision; 214.32, subdivision 6; Minnesota Statutes 2015
Supplement, section 147D.13, subdivision 2; repealing Minnesota Statutes 2014,
sections 147A.01, subdivision 5; 147D.17, subdivision 4.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 147A.01, subdivision 17a, is amended to
read:


Subd. 17a.

Physician-physician assistant delegation agreement.

"Physician-physician assistant delegation agreement" means the document prepared and
signed by the physician and physician assistant affirming the supervisory relationship and
defining the physician assistant scope of practice. Alternate supervising physicians must be
identified on the delegation agreement or a supplemental listing with signed attestation that
each shall accept full medical responsibility for the performance, practice, and activities of
the physician assistant while under the supervision of the alternate supervising physician.
The physician-physician assistant delegation agreement outlines the role of the physician
assistant in the practice, describes the means of supervision, and specifies the categories of
drugs, controlled substances, and medical devices that the supervising physician delegates
to the physician assistant to prescribe. The physician-physician assistant delegation
agreement must comply with the requirements of section 147A.20, be kept on file at the
address of record, and be made available to the board or its representative upon request.

Sec. 2.

Minnesota Statutes 2014, section 147A.01, subdivision 23, is amended to read:


Subd. 23.

Supervising physician.

"Supervising physician" means a Minnesota
licensed physician who accepts full medical responsibility for the performance, practice,
and activities of a physician assistant under an agreement as described in section 147A.20.
The supervising physician who completes and signs the delegation agreement may be
referred to as the primary supervising physician. A supervising physician shall not
supervise more than five full-time equivalent physician assistants simultaneously. With
the approval of the board, or in a disaster or emergency situation pursuant to section
147A.23, a supervising physician may supervise more than five full-time equivalent
physician assistants simultaneously.

Sec. 3.

Minnesota Statutes 2014, section 147A.20, subdivision 1, is amended to read:


Subdivision 1.

Physician-physician assistant delegation agreement.

(a) A
physician assistant and supervising physician must sign a physician-physician assistant
delegation agreement which specifies scope of practice and manner of supervision as
required by the board. The agreement must contain:

(1) a description of the practice setting;

(2) a listing of categories of delegated duties;

(3) a description of supervision type; and

(4) a description of the process and schedule for review of prescribing, dispensing,
and administering legend and controlled drugs and medical devices by the physician
assistant authorized to prescribe.

(b) The agreement must be maintained by the supervising physician and physician
assistant and made available to the board upon request. If there is a delegation of
prescribing, administering, and dispensing of legend drugs, controlled substances, and
medical devices, the agreement shall include a description of the prescriptive authority
delegated to the physician assistant. Physician assistants shall have a separate agreement
for each place of employment. Agreements must be reviewed and updated on an
annual basis. The supervising physician and physician assistant must maintain the
physician-physician assistant delegation agreement at the address of record.

(c) Physician assistants must provide written notification to the board within 30
days of the following:

(1) name change;

(2) address of record change; and

(3) telephone number of record change.

(d) Any alternate supervising physicians must be identified in the physician-physician
assistant delegation agreement, or a supplemental listing, and must sign the agreement
attesting that they shall provide the physician assistant with supervision in compliance
with this chapter, the delegation agreement, and board rules.

Sec. 4.

Minnesota Statutes 2014, section 147A.20, subdivision 2, is amended to read:


Subd. 2.

Notification of intent to Practice location notification.

A licensed
physician assistant shall submit a notification of intent to practice location notification
to the board prior to beginning within 30 business days of starting practice, changing
practice location, or changing supervising physician
. The notification shall include the
name, business address, and telephone number of the supervising physician and the
physician assistant. Individuals who practice without submitting a notification of intent to
practice location notification shall be subject to disciplinary action under section 147A.13
for practicing without a license, unless the care is provided in response to a disaster or
emergency situation pursuant to section 147A.23.

Sec. 5.

Minnesota Statutes 2014, section 147D.05, subdivision 1, is amended to read:


Subdivision 1.

Practice standards.

(a) A licensed traditional midwife shall provide
an initial and ongoing screening to ensure that each client receives safe and appropriate
care. A licensed traditional midwife shall only accept and provide care to those women
who are expected to have a normal pregnancy, labor, and delivery. As part of the initial
screening to determine whether any contraindications are present, the licensed traditional
midwife must take a detailed health history that includes the woman's social, medical,
surgical, menstrual, gynecological, contraceptive, obstetrical, family, nutritional, and
drug/chemical use histories. If a licensed traditional midwife determines at any time
during the course of the pregnancy that a woman's condition may preclude attendance by a
traditional midwife, the licensed traditional midwife must refer the client to a licensed
health care provider. As part of the initial and ongoing screening, a licensed traditional
midwife must provide or recommend that the client receive the following services, if
indicated, from an appropriate health care provider:

(1) initial laboratory pregnancy screening, including blood group and type, antibody
screen, Indirect Coombs, rubella titer, CBC with differential and syphilis serology;

(2) gonorrhea and chlamydia cultures;

(3) screening for sickle cell;

(4) screening for hepatitis B and human immunodeficiency virus (HIV);

(5) maternal serum alpha-fetoprotein test and ultrasound;

(6) Rh antibody and glucose screening at 28 weeks gestation;

(7) mandated newborn screening;

(8) Rh screening of the infant for maternal RhoGAM treatment; and

(9) screening for premature labor.

(b) A client must make arrangements to have the results of any of the tests described
in paragraph (a) sent to the licensed traditional midwife providing services to the client.
The licensed traditional midwife must include these results in the client's record.

Sec. 6.

Minnesota Statutes 2014, section 147D.09, is amended to read:


147D.09 LIMITATIONS OF PRACTICE.

(a) A licensed traditional midwife shall not prescribe, dispense, or administer
prescription drugs, except as permitted under paragraph (b).

(b) A licensed traditional midwife may administer vitamin K either orally or through
intramuscular injection, maternal RhoGAM treatment, postpartum antihemorrhagic drugs
under emergency situations, local anesthetic, oxygen, and a prophylactic eye agent to
the newborn infant.

(c) A licensed traditional midwife shall not perform any operative or surgical
procedures except for suture repair of first- or second-degree perineal lacerations.

Sec. 7.

Minnesota Statutes 2015 Supplement, section 147D.13, subdivision 2, is
amended to read:


Subd. 2.

Practice report.

(a) A licensed traditional midwife must compile a
summary report on each client. The report must include the following:

(1) vital records;

(2) scope of care administered;

(3) whether the medical consultation plan was implemented; and

(4) any physician or other health care provider referrals made.

(b) The board or advisory council may review these reports at any time upon request.

Sec. 8.

Minnesota Statutes 2014, section 147D.25, subdivision 1, is amended to read:


Subdivision 1.

Membership.

The board shall appoint a five-member Advisory
Council on Licensed Traditional Midwifery. One member shall be a licensed physician
who has been or is currently consulting with licensed traditional midwives, appointed from
a list of names submitted to the board by the Minnesota Medical Association.
One member
shall be a licensed physician who has been or is currently consulting or collaborating with
licensed traditional midwives appointed from a list of names submitted to the board by the
Minnesota Council of Certified Professional Midwives or its successors.
Three members
shall be licensed traditional midwives appointed from a list of names submitted to the
board by Midwifery Now and the Minnesota Council of Certified Professional Midwives
or their successors
. One member shall be a home birth parent of a child born under the
care of a licensed traditional midwife
appointed from a list of names submitted to the
board by Minnesota Families for Midwifery, or its successor.

Sec. 9.

Minnesota Statutes 2014, section 148.271, is amended to read:


148.271 EXEMPTIONS.

The provisions of sections 148.171 to 148.285 shall not prohibit:

(1) The furnishing of nursing assistance in an emergency.

(2) The practice of advanced practice, professional, or practical nursing by any
legally qualified advanced practice, registered, or licensed practical nurse of another state
who is employed by the United States government or any bureau, division, or agency
thereof while in the discharge of official duties.

(3) The practice of any profession or occupation licensed by the state, other than
advanced practice, professional, or practical nursing, by any person duly licensed to
practice the profession or occupation, or the performance by a person of any acts properly
coming within the scope of the profession, occupation, or license.

(4) The provision of a nursing or nursing-related service by an unlicensed assistive
person who has been delegated or assigned the specific function and is supervised by a
registered nurse or monitored by a licensed practical nurse.

(5) The care of the sick with or without compensation when done in a nursing home
covered by the provisions of section 144A.09, subdivision 1.

(6) Professional nursing practice or advanced practice registered nursing practice by
a registered nurse or practical nursing practice by a licensed practical nurse licensed in
another state or territory who is in Minnesota as a student enrolled in a formal, structured
course of study, such as a course leading to a higher degree, certification in a nursing
specialty, or to enhance skills in a clinical field, while the student is practicing in the course.

(7) Professional or practical nursing practice by a student practicing under the
supervision of an instructor while the student is enrolled in a nursing program approved by
the board under section 148.251.

(8) Advanced practice registered nursing as defined in section 148.171, subdivisions
5, 10, 11, 13, and 21
, by a registered nurse who is licensed and currently registered in
Minnesota or another United States jurisdiction and who is enrolled as a student in a
formal graduate education program leading to eligibility for certification and licensure
as an advanced practice registered nurse.

(9) Professional nursing practice or advanced practice registered nursing practice by
a registered nurse or advanced practice registered nurse licensed in another state, territory,
or jurisdiction who is in Minnesota temporarily:

(i) providing continuing or in-service education;

(ii) serving as a guest lecturer;

(iii) presenting at a conference; or

(iv) teaching didactic content via distance education to a student located in
Minnesota who is enrolled in a formal, structured course of study, such as a course leading
to a higher degree or certification in a nursing specialty.

Sec. 10.

Minnesota Statutes 2014, section 214.077, is amended to read:


214.077 TEMPORARY LICENSE SUSPENSION; IMMINENT RISK OF
SERIOUS HARM.

(a) Notwithstanding any provision of a health-related professional practice act,
when a health-related licensing board receives a complaint regarding a regulated person
and has probable cause to believe that the regulated person has violated a statute or rule
that the health-related licensing board is empowered to enforce, and
continued practice
by the regulated person presents an imminent risk of serious harm, the health-related
licensing board shall issue an order temporarily suspend suspending the regulated person's
professional license authority to practice. The temporary suspension order shall take
effect upon written notice to the regulated person and shall
specify the reason for the
suspension. , including the statute or rule alleged to have been violated. The temporary
suspension order shall take effect upon personal service on the regulated person or the
regulated person's attorney, or upon the third calendar day after the order is served by first
class mail to the most recent address provided to the health-related licensing board for the
regulated person or the regulated person's attorney.

(b) The temporary suspension shall remain in effect until the appropriate
health-related licensing board or the commissioner completes an investigation, holds a
contested case hearing pursuant to the Administrative Procedure Act,
and issues a final
order in the matter after a hearing as provided for in this section.

(c) At the time it issues the temporary suspension notice order, the appropriate
health-related licensing board shall schedule a disciplinary contested case hearing, on the
merits of whether discipline is warranted,
to be held before the licensing board or pursuant
to the Administrative Procedure Act. The regulated person shall be provided with at least
ten days' notice of any contested case hearing held pursuant to this section. The contested
case
hearing shall be scheduled to begin no later than 30 days after issuance the effective
service
of the temporary suspension order.

(d) The administrative law judge presiding over the contested case hearing shall
issue a report and recommendation to the health-related licensing board no later than 30
days after the final day of the contested case hearing. The health-related licensing board
shall issue a final order pursuant to sections 14.61 and 14.62 within 30 days of receipt
of the administrative law judge's report and recommendations. Except as provided in
paragraph (e), if the health-related licensing board has not issued a final order pursuant to
sections 14.61 and 14.62 within 30 days of receipt of the administrative law judge's report
and recommendations, the temporary suspension shall be lifted.

(d) (e) If the board has not completed its investigation and issued a final order within
30 days, the temporary suspension shall be lifted, unless the regulated person requests a
delay in the disciplinary proceedings for any reason, upon which the temporary suspension
shall remain in place until the completion of the investigation.
the regulated person
requests a delay in the contested case proceedings provided for in paragraphs (c) and (d)
for any reason, the temporary suspension shall remain in effect until the health-related
licensing board issues a final order pursuant to sections 14.61 and 14.62.

(f) This section shall not apply to the Office of Unlicensed Complementary and
Alternative Health Practice established under section 146A.02. The commissioner of
health shall conduct temporary suspensions for complementary and alternative health care
practitioners in accordance with section 146A.09.

Sec. 11.

Minnesota Statutes 2014, section 214.10, subdivision 2, is amended to read:


Subd. 2.

Investigation and hearing.

The designee of the attorney general providing
legal services to a board shall evaluate the communications forwarded by the board or its
members or staff. If the communication alleges a violation of statute or rule which the
board is to enforce, the designee is empowered to investigate the facts alleged in the
communication. In the process of evaluation and investigation, the designee shall consult
with or seek the assistance of the executive director, executive secretary, or, if the board
determines, a member of the board who has been appointed by the board to assist the
designee. The designee may also consult with or seek the assistance of any other qualified
persons who are not members of the board who the designee believes will materially aid
in the process of evaluation or investigation. The executive director, executive secretary,
or the consulted board member may attempt to correct improper activities and redress
grievances through education, conference, conciliation and persuasion, and in these
attempts may be assisted by the designee of the attorney general. If the attempts at
correction or redress do not produce satisfactory results in the opinion of the executive
director, executive secretary, or the consulted board member, or if after investigation the
designee providing legal services to the board, the executive director, executive secretary,
or the consulted board member believes that the communication and the investigation
suggest illegal or unauthorized activities warranting board action, the person having the
belief shall inform the executive director or executive secretary of the board who shall
schedule a disciplinary contested case hearing in accordance with chapter 14. Before
directing the holding of a disciplinary contested case hearing, the executive director,
executive secretary, or the designee of the attorney general shall have considered the
recommendations of the consulted board member. Before scheduling a disciplinary
contested case hearing, the executive director or executive secretary must have received
a verified written complaint from the complaining party. A board member who was
consulted during the course of an investigation may participate at the hearing but may not
vote on any matter pertaining to the case. The executive director or executive secretary
of the board shall promptly inform the complaining party of the final disposition of the
complaint. Nothing in this section shall preclude the board from scheduling, on its own
motion, a disciplinary contested case hearing based upon the findings or report of the
board's executive director or executive secretary, a board member or the designee of the
attorney general assigned to the board. Nothing in this section shall preclude a member of
the board, executive director, or executive secretary from initiating a complaint.

Sec. 12.

Minnesota Statutes 2014, section 214.10, subdivision 2a, is amended to read:


Subd. 2a.

Proceedings.

A board shall initiate proceedings to suspend or revoke
a license or shall refuse to renew a license of a person licensed by the board who is
convicted in a court of competent jurisdiction of violating section 609.224, subdivision 2
609.2231, subdivision 8
, paragraph (c), 609.23, 609.231, 609.2325, 609.233, 609.2335,
609.234, 609.465, 609.466, 609.52, or 609.72, subdivision 3.

Sec. 13.

Minnesota Statutes 2014, section 214.10, is amended by adding a subdivision
to read:


Subd. 14.

Complementary and alternative health care practitioners.

This section
shall not apply to complementary and alternative health care practitioners practicing under
chapter 146A. Complaints and disciplinary actions against complementary and alternative
health care practitioners shall be conducted in accordance with chapter 146A.

Sec. 14.

Minnesota Statutes 2014, section 214.32, subdivision 6, is amended to read:


Subd. 6.

Duties of a participating board.

Upon receiving a report from the
program manager in accordance with section 214.33, subdivision 3, that a regulated
person has been discharged from the program due to noncompliance based on allegations
that the regulated person has engaged in conduct that might cause risk to the public,
when
and if the participating health-related licensing board has probable cause to believe
continued practice by the regulated person presents an imminent risk of serious harm, the
health-related licensing board shall temporarily suspend the regulated person's professional
license until the completion of a disciplinary investigation. The board must complete the
disciplinary investigation within 30 days of receipt of the report from the program. If the
investigation is not completed by the board within 30 days, the temporary suspension shall
be lifted, unless the regulated person requests a delay in the disciplinary proceedings
for any reason, upon which the temporary suspension shall remain in place until the
completion of the investigation
proceed pursuant to the requirements in section 214.077.

Sec. 15. REVISOR'S INSTRUCTION.

(a) The revisor of statutes shall change the term "physician's assistant" to "physician
assistant" wherever that term is found in Minnesota Statutes and Minnesota Rules.

(b) The revisor of statutes shall change the term "physician ancillary" to "physician
assistant" wherever that term is found in Minnesota Statutes and Minnesota Rules.

Sec. 16. REPEALER.

Minnesota Statutes 2014, sections 147A.01, subdivision 5; and 147D.17, subdivision
4,
are repealed.

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