State Seal2 copy           Bill Number: S.B. 1271

            Barto Floor Amendment

            Reference to: HEALTH AND HUMAN SERVICES

Committee amendment

            Amendment drafted by: Leg Council

 

 

FLOOR AMENDMENT EXPLANATION

 

1.   Requires permittees to function only under the supervision of a qualified physician and deems the physician responsible for permittee performance and task delegation.

2.   Limits qualified physicians to only supervise one permittee at a time and establishes supervising physician notification requirements.

3.   Modifies entities eligible to employ or contract a permittee and expands entity requirements related to supervision, liability coverage, evaluations and information reporting. 

4.   Establishes permittee notification requirements and modifies drug dispensing permits. 

5.   Establishes reporting and rulemaking requirements and defines relevant terms.


 

Fifty-fifth Legislature                                                     Barto

First Regular Session                                                   S.B. 1271

 

BARTO FLOOR AMENDMENT

SENATE AMENDMENTS TO S.B. 1271

(Reference to HEALTH AND HUMAN SERVICES Committee amendment)

 


Page 1, line 5, after "requirements" insert "; definitions"

Strike line 12

Line 13, strike "(a)" insert "1."

Line 14, after "was" insert "either:

(a)"

Line 17, strike "was"

Page 2, line 3, after "submits" strike remainder of line insert "complete and valid applications to at least three accredited primary care"

Line 4, strike "program" insert "programs"; strike the first "a" insert "An internship or residency"; after the period insert "The permittee shall provide the board with written documentation of the internship or residency program applications and the nonselections."

Line 7, after the first "the" insert "transitional"; after "only" insert "under the supervision of a qualified physician"

Line 8, strike "supervised"; strike "entity that is either" insert "eligible entity, which includes the following if located in this state"

Line 9, after "1." insert "A hospital or behavioral health facility that is"; after "4" insert a period strike remainder of line

Strike lines 10 through 13

Line 14, after "A" insert "patient care"

Line 16, strike the second comma insert "or"; strike the third comma insert ".

3."

Strike line 18, insert:

"4. A private office or clinic where a supervising qualified physician practices and that is not a pain management clinic as defined in section 36-448.01.

D. An eligible entity contracting with or employing a permittee shall:"

Page 2, line 19, after "permittee" insert ", in collaboration with the supervising qualified physician,"

Line 20, after "permittee" insert "by the supervising qualified physician"

Strike lines 21 through 23

Renumber to conform

Line 24, after "responsible" insert ", along with the supervising qualified physician,"; strike "person"

Strike line 25, insert "permittee."

Line 26, strike "person issued a"

Line 27, strike "permit pursuant to this section" insert "permittee"; after "of" insert "medical"

Line 28, strike "by the"

Line 29, strike "supervising entity" insert "and supervised by a qualified physician"

Page 3, strike lines 1 and 2, insert:

"4. Ensure that during the permittee's first six months of full-time practice, all clinical encounters performed by the permittee are under the direct supervision of the supervising qualified physician. Subsequent encounters performed by the permittee after the initial six-month period may be under indirect supervision with direct supervision immediately available from the supervising qualified physician.

5. Ensure that all qualified physician supervision is documented."

Line 3, after "in" insert "all"

Line 7, after "and" insert "general and professional"

Line 9, after "performance" insert "That includes a review by the supervising qualified physician of all medical records related to the clinical encounters performed by the permittee"

Line 10, strike the first "A" insert "The"; strike "entity" insert "qualified physician"

Page 3, line 11, strike "medical" insert "health care"

Strike lines 15 through 19, insert:

"F. Before employing or contracting with a permittee, an eligible entity shall notify the department of health services on a form prescribed by the department, or on an equivalent form from the entity, of all the following information:

1. The types and extent of medical training the entity plans to provide to the permittee.

2. The names of the qualified physicians who will supervise the permittee and the types of health care tasks that may be delegated to the permittee by those supervising qualified physicians.

G. An eligible entity shall post on its public website and submit to the department an annual report that includes all of the following:

1. The number of permittees and supervising qualified physicians employed by or contracted with the entity.

2. The length of time each permittee and supervising qualified physician has been employed by or contracted with the entity.

3. The total number of hours of medical education provided to each permittee.

4. The total number of hours of clinical care provided by each permittee.

5. The number of permittees who obtained a match with an accredited internship or residency program.

H. Before supervising a permittee, a qualified physician shall notify the board in writing of the qualified physician's agreement to serve as a supervising qualified physician.  The notification shall include the name of the permittee and the name and location of the eligible entity at which the supervision will occur."

Reletter to conform

Page 3, strike lines 25 through 31

Reletter to conform

Page 4, line 1, strike "entity" insert "eligible entity or qualified physician"; strike "create" insert "establish"; after "program" insert "to employ or contract with permittees as"

Line 2, after "section" insert "or require any qualified physician to assume supervision responsibilities for a permittee"

Line 3, after "section" insert ":

1."

Between lines 4 and 5, insert:

"2. Per one-year period, shall participate in at least sixty hours of continuing medical education programs approved by the board.

3. Shall notify the board on the permittee's acceptance to an accredited internship or residency program.

L. A supervising qualified physician under this section:

1. Is responsible for all aspects of a permittee's performance whether or not the supervising qualified physician employs the permittee.

2. Is responsible for supervising the permittee and ensuring that the health care tasks performed by the permittee are within the permittee's scope of medical training and experience, are appropriate to the permittee's level of competence and are properly delegated by the supervising qualified physician.

3. May allow a permittee to administer or dispense drugs under the conditions of section 32-1491 if the controlled substance permit under which the drugs are dispensed is either the supervising qualified physician's or the eligible entity's permit.

4. May serve as a supervising qualified physician for only one permittee at any one time.

5. Shall notify the board, the eligible entity and the permittee in writing if the permittee exceeds the scope of the delegated health care tasks to allow the board to investigate.

M. For the purposes of this section:

1. "Direct supervision" means the supervising qualified physician is physically present with the permittee and patient.

2. "Indirect supervision with direct supervision immediately available" means the supervising qualified physician is physically present within the hospital or other eligible entity site of patient care and is immediately available to provide direct supervision of the permittee.

3. "Permittee" means a person who holds a transitional training permit issued pursuant to this section.

4. "Qualified physician" means a physician who possesses a full and unrestricted license issued pursuant to this chapter to engage in the practice of medicine in this state and who is not currently under board discipline."

Page 4, line 8, after "requirements" insert "; definitions"

Strike line 15

Line 16, strike "(a)" insert "1."

Line 17, after "was" insert "either:

(a)"

Line 20, strike "was"

Line 29, after "submits" strike remainder of line insert "complete and valid applications to at least three accredited primary care"

Line 30, strike "program" insert "programs"; strike the first "a" insert "An internship or residency"; after the period insert "The permittee shall provide the board with written documentation of the internship or residency program applications and the nonselections."

Page 5, line 1, after the first "the" insert "transitional"; after "only" insert "under the supervision of a qualified physician"

Line 2, strike "supervised"; strike "entity that is either" insert "eligible entity, which includes the following if located in this state"

Line 3, after "1." insert "A hospital or behavioral health facility that is"; after "4" insert a period strike remainder of line

Page 5, strike lines 4 through 7

Line 8, after "A" insert "patient care"

Line 10, strike the second comma insert "or"; strike the third comma insert ".

3."

Strike line 12, insert:

"4. A private office or clinic where a supervising qualified physician practices and that is not a pain management clinic as defined in section 36-448.01.

D. An eligible entity contracting with or employing a permittee shall:"

Line 13, after "permittee" insert ", in collaboration with the supervising qualified physician,"

Line 14, after "permittee" insert "by the supervising qualified physician"

Strike lines 15 through 17

Renumber to conform

Line 18, after "responsible" insert ", along with the supervising qualified physician,"; strike "person"

Strike line 19, insert "permittee."

Line 20, strike "person issued a"

Line 21, strike "permit pursuant to this section" insert "permittee"; after "of" insert "medical"

Line 22, strike "by the"

Line 23, strike "supervising entity" insert "and supervised by a qualified physician"

Strike lines 24 and 25, insert:

"4. Ensure that during the permittee's first six months of full-time practice, all clinical encounters performed by the permittee are under the direct supervision of the supervising qualified physician. Subsequent encounters performed by the permittee after the initial six-month period may be under indirect supervision with direct supervision immediately available from the supervising qualified physician.

5. Ensure that all qualified physician supervision is documented."

Page 5, line 26, after "in" insert "all"

Line 30, after "and" insert "general and professional"

Page 6, line 2, after "performance" insert "that includes a review by the supervising qualified physician of all medical records related to the clinical encounters performed by the permittee"

Line 3, strike the first "A" insert "The"; strike "entity" insert "qualified physician"

Line 4, strike "medical" insert "health care"

Strike lines 8 through 12, insert:

"F. Before employing or contracting with a permittee, an eligible entity shall notify the department of health services on a form prescribed by the department, or on an equivalent form from the entity, of all the following information:

1. the types and extent of medical training the entity plans to provide to the permittee.

2. The names of the qualified physicians who will supervise the permittee and the types of health care tasks that may be delegated to the permittee by those supervising qualified physicians.

G. An eligible entity shall post on its public website and submit to the department an annual report that includes all of the following:

1. The number of permittees and supervising qualified physicians employed by or contracted with the entity.

2. The length of time each permittee and supervising qualified physician has been employed by or contracted with the entity.

3. The total number of hours of medical education provided to each permittee.

4. The total number of hours of clinical care provided by each permittee.

5. The number of permittees who obtained a match with an accredited internship or residency program.

H. Before supervising a permittee, a qualified physician shall notify the board in writing of the qualified physician's agreement to serve as a supervising qualified physician.  The notification shall include the name of the permittee and the name and location of the eligible entity at which the supervision will occur."

Reletter to conform

Page 6, strike lines 18 through 24

Reletter to conform

Line 25, strike "entity" insert "eligible entity or qualified physician"; strike "create" insert "establish"; after "program" insert "to employ or contract with permittees as"

Line 26, after "section" insert "or require any qualified physician to assume supervision responsibilities for a permittee"

Line 27, after "section" insert ":

1."

After line 28, insert:

"2. Per one-year period, shall participate in at least sixty hours of continuing medical education programs approved by the board.

3. Shall notify the board on the permittee's acceptance to an accredited internship or residency program.

L. A supervising qualified physician under this section:

1. Is responsible for all aspects of a permittee's performance, whether or not the supervising qualified physician employs the permittee.

2. Is responsible for supervising the permittee and ensuring that the health care tasks performed by the permittee are within the permittee's scope of medical training and experience, are appropriate to the permittee's level of competence and are properly delegated by the supervising qualified physician.

3. May allow a permittee to administer or dispense drugs under the conditions of section 32-1871 if the controlled substance permit under which the drugs are dispensed is either the supervising qualified physician's or the eligible entity's permit.

4. May serve as a supervising qualified physician for only one permittee at any one time.

5. Shall notify the board, the eligible entity and the permittee in writing if the permittee exceeds the scope of the delegated health care tasks to allow the board to investigate.

M. For the purposes of this section:

1. "Direct supervision" means the supervising qualified physician is physically present with the permittee and patient.

2. "Indirect supervision with direct supervision immediately available" means the supervising qualified physician is physically present within the hospital or other eligible entity site of patient care and is immediately available to provide direct supervision of the permittee.

3. "Permittee" means a person who holds a transitional training permit issued pursuant to this section.

4. "Qualified physician" means a physician who possesses a full and unrestricted license issued pursuant to this chapter to engage in the practice of medicine in this state and who is not currently under board discipline.

Sec. 3. Department of health services; medical boards report; delayed repeal

A. On or before January 1, 2024, and on or before January 1, 2025, the department of health services, in conjunction with the Arizona medical board and the Arizona board of osteopathic examiners in medicine and surgery, shall report to the president of the senate and the speaker of the house of representatives the number of medical graduate transitional training permits that are issued and in force under sections 32-1432.04 and 32-1829.01, Arizona Revised Statutes, as added by this act, the number of permittees who are placed with each type of eligible entity, the number of permittees who are successfully accepted into accredited internship or residency programs, the type and location of internship or residency programs in which the permittees are accepted or declined and the number and type of disciplinary actions taken against permittees and supervising qualified physicians.

B. This section is repealed from and after December 31, 2025.

Sec. 4. Medical boards; rulemaking exemption

A. Notwithstanding any other law, for the purposes of this act, the Arizona medical board and the Arizona board of osteopathic examiners in medicine and surgery are exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, for eighteen months after the effective date of this act.

B. The Arizona medical board and the Arizona board of osteopathic examiners in medicine and surgery shall adopt any rules necessary to implement sections 32-1432.04 and 32-1829.01, Arizona Revised Statutes, as added by this act, not later than six months after the effective date of this act."

Renumber to conform

Amend title to conform


 

 

NANCY BARTO

 

1271FloorBARTO

02/24/2021

1:20 PM

C: mh