334.735. Definitions--rules--scope of practice--prohibited activities--board of healing arts to administer licensing program--supervision agreements--duties and liability of physicians.
Definitions--rules--scope of practice--prohibited activities--board ofhealing arts to administer licensing program--supervisionagreements--duties and liability of physicians.
334.735. 1. As used in sections 334.735 to 334.749, the followingterms mean:
(1) "Applicant", any individual who seeks to become licensed as aphysician assistant;
(2) "Certification" or "registration", a process by a certifyingentity that grants recognition to applicants meeting predeterminedqualifications specified by such certifying entity;
(3) "Certifying entity", the nongovernmental agency or associationwhich certifies or registers individuals who have completed academic andtraining requirements;
(4) "Department", the department of insurance, financial institutionsand professional registration or a designated agency thereof;
(5) "License", a document issued to an applicant by the boardacknowledging that the applicant is entitled to practice as a physicianassistant;
(6) "Physician assistant", a person who has graduated from aphysician assistant program accredited by the American MedicalAssociation's Committee on Allied Health Education and Accreditation or byits successor agency, who has passed the certifying examinationadministered by the National Commission on Certification of PhysicianAssistants and has active certification by the National Commission onCertification of Physician Assistants who provides health care servicesdelegated by a licensed physician. A person who has been employed as aphysician assistant for three years prior to August 28, 1989, who haspassed the National Commission on Certification of Physician Assistantsexamination, and has active certification of the National Commission onCertification of Physician Assistants;
(7) "Recognition", the formal process of becoming a certifying entityas required by the provisions of sections 334.735 to 334.749;
(8) "Supervision", control exercised over a physician assistantworking within the same facility as the supervising physician sixty-sixpercent of the time a physician assistant provides patient care, except aphysician assistant may make follow-up patient examinations in hospitals,nursing homes, patient homes, and correctional facilities, each suchexamination being reviewed, approved and signed by the supervisingphysician, except as provided by subsection 2 of this section. For thepurposes of this section, the percentage of time a physician assistantprovides patient care with the supervising physician on-site shall bemeasured each calendar quarter. The supervising physician must be readilyavailable in person or via telecommunication during the time the physicianassistant is providing patient care. The board shall promulgate rulespursuant to chapter 536, RSMo, for documentation of joint review of thephysician assistant activity by the supervising physician and the physicianassistant. The physician assistant shall be limited to practice atlocations where the supervising physician is no further than thirty milesby road using the most direct route available, or in any other fashion sodistanced as to create an impediment to effective intervention andsupervision of patient care or adequate review of services. Any otherprovisions of this chapter notwithstanding, for up to ninety days followingthe effective date of rules promulgated by the board to establish thewaiver process under subsection 2 of this section, any physician assistantpracticing in a health professional shortage area as of April 1, 2007,shall be allowed to practice under the on-site requirements stipulated bythe supervising physician on the supervising physician form that was ineffect on April 1, 2007.
2. The board shall promulgate rules under chapter 536, RSMo, todirect the advisory commission on physician assistants to establish aformal waiver mechanism by which an individual physician-physicianassistant team may apply for alternate minimum amounts of on-sitesupervision and maximum distance from the supervising physician. Afterreview of an application for a waiver, the advisory commission on physicianassistants shall present its recommendation to the board for its advice andconsent on the approval or denial of the application. The rule shallestablish a process by which the public is invited to comment on theapplication for a waiver, and shall specify that a waiver may only begranted if a supervising physician and physician assistant demonstrate tothe board's satisfaction in accordance with its uniformly applied criteriathat:
(1) Adequate supervision will be provided by the physician for thephysician assistant, given the physician assistant's training andexperience and the acuity of patient conditions normally treated in theclinical setting;
(2) The physician assistant shall be limited to practice at locationswhere the supervising physician is no further than fifty miles by roadusing the most direct route available, or in any other fashion so distancedas to create an impediment to effective intervention and supervision ofpatient care or adequate review of services;
(3) The community or communities served by the supervising physicianand physician assistant would experience reduced access to health careservices in the absence of a waiver;
(4) The applicant will practice in an area designated at the time ofapplication as a health professional shortage area;
(5) Nothing in this section shall be construed to require aphysician-physician assistant team to increase their on-site requirementallowed in their initial waiver in order to qualify for renewal of suchwaiver;
(6) If a waiver has been granted by the board of healing arts to aphysician assistant working in a rural health clinic under the federalRural Health Clinic Services Act, P.L. 95-210, as amended, no additionalwaiver shall be required, so long as the rural health clinic maintains itsstatus as a rural health clinic under such federal act, and such physicianassistant and supervising physician comply with federal supervisionrequirements;
(7) A physician assistant shall only be required to seek a renewal ofa waiver every five years or when his or her supervising physician is adifferent physician than the physician shown on the waiver application orthey move their primary practice location more than ten miles from thelocation shown on the waiver application.
3. The scope of practice of a physician assistant shall consist onlyof the following services and procedures:
(1) Taking patient histories;
(2) Performing physical examinations of a patient;
(3) Performing or assisting in the performance of routine officelaboratory and patient screening procedures;
(4) Performing routine therapeutic procedures;
(5) Recording diagnostic impressions and evaluating situationscalling for attention of a physician to institute treatment procedures;
(6) Instructing and counseling patients regarding mental and physicalhealth using procedures reviewed and approved by a licensed physician;
(7) Assisting the supervising physician in institutional settings,including reviewing of treatment plans, ordering of tests and diagnosticlaboratory and radiological services, and ordering of therapies, usingprocedures reviewed and approved by a licensed physician;
(8) Assisting in surgery;
(9) Performing such other tasks not prohibited by law under thesupervision of a licensed physician as the physician's assistant has beentrained and is proficient to perform;
(10) Physician assistants shall not perform abortions.
4. Physician assistants shall not prescribe nor dispense any drug,medicine, device or therapy independent of consultation with thesupervising physician, nor prescribe lenses, prisms or contact lenses forthe aid, relief or correction of vision or the measurement of visual poweror visual efficiency of the human eye, nor administer or monitor general orregional block anesthesia during diagnostic tests, surgery or obstetricprocedures. Prescribing and dispensing of drugs, medications, devices ortherapies by a physician assistant shall be pursuant to a physicianassistant supervision agreement which is specific to the clinicalconditions treated by the supervising physician and the physician assistantshall be subject to the following:
(1) A physician assistant shall only prescribe controlled substancesin accordance with section 334.747;
(2) The types of drugs, medications, devices or therapies prescribedor dispensed by a physician assistant shall be consistent with the scopesof practice of the physician assistant and the supervising physician;
(3) All prescriptions shall conform with state and federal laws andregulations and shall include the name, address and telephone number of thephysician assistant and the supervising physician;
(4) A physician assistant or advanced practice nurse as defined insection 335.016, RSMo, may request, receive and sign for noncontrolledprofessional samples and may distribute professional samples to patients;
(5) A physician assistant shall not prescribe any drugs, medicines,devices or therapies the supervising physician is not qualified orauthorized to prescribe; and
(6) A physician assistant may only dispense starter doses ofmedication to cover a period of time for seventy-two hours or less.
5. A physician assistant shall clearly identify himself or herself asa physician assistant and shall not use or permit to be used in thephysician assistant's behalf the terms "doctor", "Dr." or "doc" nor holdhimself or herself out in any way to be a physician or surgeon. Nophysician assistant shall practice or attempt to practice without physiciansupervision or in any location where the supervising physician is notimmediately available for consultation, assistance and intervention, exceptas otherwise provided in this section, and in an emergency situation, norshall any physician assistant bill a patient independently or directly forany services or procedure by the physician assistant.
6. For purposes of this section, the licensing of physicianassistants shall take place within processes established by the state boardof registration for the healing arts through rule and regulation. Theboard of healing arts is authorized to establish rules pursuant to chapter536, RSMo, establishing licensing and renewal procedures, supervision,supervision agreements, fees, and addressing such other matters as arenecessary to protect the public and discipline the profession. Anapplication for licensing may be denied or the license of a physicianassistant may be suspended or revoked by the board in the same manner andfor violation of the standards as set forth by section 334.100, or suchother standards of conduct set by the board by rule or regulation. Personslicensed pursuant to the provisions of chapter 335, RSMo, shall not berequired to be licensed as physician assistants. All applicants forphysician assistant licensure who complete a physician assistant trainingprogram after January 1, 2008, shall have a master's degree from aphysician assistant program.
7. "Physician assistant supervision agreement" means a writtenagreement, jointly agreed-upon protocols or standing order between asupervising physician and a physician assistant, which provides for thedelegation of health care services from a supervising physician to aphysician assistant and the review of such services.
8. When a physician assistant supervision agreement is utilized toprovide health care services for conditions other than acute self-limitedor well-defined problems, the supervising physician or other physiciandesignated in the supervision agreement shall see the patient forevaluation and approve or formulate the plan of treatment for new orsignificantly changed conditions as soon as practical, but in no case morethan two weeks after the patient has been seen by the physician assistant.
9. At all times the physician is responsible for the oversight of theactivities of, and accepts responsibility for, health care servicesrendered by the physician assistant.
10. It is the responsibility of the supervising physician todetermine and document the completion of at least a one-month period oftime during which the licensed physician assistant shall practice with asupervising physician continuously present before practicing in a settingwhere a supervising physician is not continuously present.
11. No contract or other agreement shall require a physician to actas a supervising physician for a physician assistant against thephysician's will. A physician shall have the right to refuse to act as asupervising physician, without penalty, for a particular physicianassistant. No contract or other agreement shall limit the supervisingphysician's ultimate authority over any protocols or standing orders or inthe delegation of the physician's authority to any physician assistant, butthis requirement shall not authorize a physician in implementing suchprotocols, standing orders, or delegation to violate applicable standardsfor safe medical practice established by hospital's medical staff.
12. Physician assistants shall file with the board a copy of theirsupervising physician form.
13. No physician shall be designated to serve as supervisingphysician for more than three full-time equivalent licensed physicianassistants. This limitation shall not apply to physician assistantagreements of hospital employees providing inpatient care service inhospitals as defined in chapter 197, RSMo.
(L. 1989 S.B. 217 § 1, A.L. 1996 H.B. 999, A.L. 1997 S.B. 141, A.L. 1998 H.B. 1601, et al., A.L. 2005 S.B. 177, A.L. 2007 H.B. 497, A.L. 2008 S.B. 788, A.L. 2009 S.B. 296)