AB170 - Providing for the licensure of associate physicians and associate osteopathic physicians. (BDR 54-840)

REQUIRES TWO-THIRDS MAJORITY VOTE (§§ 9, 21, 26 & NRS 453.221, 453.226, 639.170) A.B. 170 - *AB170* ASSEMBLY BILL NO. 170–ASSEMBLYMEMBER NADEEM PREFILED JANUARY 31, 2025 ____________ Referred to Committee on Commerce and Labor SUMMARY—Providing for the licensure of associate physicians and associate osteopathic physicians. (BDR 54-840) FISCAL NOTE: Effect on Local Government: No. Effect on the State: Yes. ~ EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. AN ACT relating to health care; providing for the licensure of associate physicians and associate osteopathic physicians; prescribing the conditions under which an associate physician or associate osteopathic physician is authorized to practice medicine or osteopathic medicine; authorizing an associate physician or associate osteopathic physician to register to possess, administer, prescribe or dispense controlled substances; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law provides for the licensing of physicians and physician assistants 1 by the Board of Medical Examiners and for the licensing of osteopathic physicians 2 and physician assistants by the State Board of Osteopathic Medicine. (NRS 3 630.160-630.1607, 630.258-630.2665, 630.271-630.2755, 633.305-633.420, 4 633.432-633.4336) Sections 2-9 and 14-21 of this bill create limited licenses that 5 authorize certain medical school graduates to engage in the supervised practice of 6 medicine as an associate physician or associate osteopathic physician. Sections 2 7 and 14 authorize the Board of Medical Examiners and State Board of Osteopathic 8 Medicine, respectively, to issue a limited license as an associate physician or 9 associate osteopathic physician to an applicant who: (1) has graduated from certain 10 medical schools; (2) has completed at least 1 year of postgraduate medical 11 education as a resident or intern as a part of certain programs; and (3) possesses 12 certain other qualifications. Sections 3 and 15 limit an associate physician or 13 associate osteopathic physician to practicing medicine under the supervision and 14 control of a supervising physician or supervising osteopathic physician. Sections 5 15 and 17 prescribe the required qualifications of a supervising physician or 16 supervising osteopathic physician. Sections 3 and 15 require an associate physician 17 or associate osteopathic physician to enter into a collaborative practice agreement 18 with his or her supervising physician or supervising osteopathic physician. 19 – 2 – - *AB170* Sections 6 and 18 prescribe the provisions that are required to be included in the 20 collaborative practice agreement. 21 Sections 3 and 15 require a supervising physician or supervising osteopathic 22 physician to be on the same premises and available to assist an associate physician 23 or associate osteopathic physician for the first 30 days of supervision. Sections 3 24 and 15 require a supervising physician or supervising osteopathic physician, or 25 designee thereof, to be on the same premises and available to assist at all times an 26 associate physician or associate osteopathic physician, as applicable, who is 27 practicing in a county whose population is less than 100,000 (currently all counties 28 other than Clark and Washoe Counties). Sections 3 and 15 also require the 29 employer of an associate physician or associate osteopathic physician to credential 30 and bill for services rendered by an associate physician or associate osteopathic 31 physician in the same manner as a physician assistant. Sections 4 and 16 require a 32 supervising physician and associate physician or supervising osteopathic physician 33 and associate osteopathic physician to take certain measures to notify the public of 34 their respective statuses and their relationship. Sections 5 and 17: (1) provide that a 35 supervising physician or supervising osteopathic physician is responsible for the 36 practice of medicine or osteopathic medicine by the associate physician or associate 37 osteopathic physician, as applicable, that he or she is supervising; and (2) require a 38 supervising physician or supervising osteopathic physician to maintain insurance 39 that covers malpractice by an associate physician or associate osteopathic 40 physician, as applicable. Sections 5 and 17 prohibit a supervising physician or 41 supervising osteopathic physician from entering into a collaborative practice 42 agreement with more than three associate physicians or associate osteopathic 43 physicians, as applicable. Sections 5 and 17 additionally prohibit the Board of 44 Medical Examiners and the State Board of Osteopathic Medicine, respectively, 45 from disciplining a supervising physician or supervising osteopathic physician for 46 legal activity of an associate physician or associate osteopathic physician that is 47 within the scope of the relevant collaborative practice agreement. 48 Sections 7 and 19 authorize an associate physician or associate osteopathic 49 physician, respectively, to prescribe or dispense certain controlled substances and 50 establish the conditions under which an associate physician or associate osteopathic 51 physician may prescribe or dispense such controlled substances. Existing law: (1) 52 authorizes the State Board of Pharmacy to issue a registration certificate to 53 authorize a physician assistant to possess, administer, prescribe or dispense 54 controlled substances, poisons, dangerous drugs or devices in or out of the presence 55 of his or her supervising physician; and (2) requires the Board to adopt regulations 56 governing the storage, security, recordkeeping and transportation of controlled 57 substances, poisons, dangerous drugs or devices by a physician assistant. (NRS 58 639.1373) Section 26 of this bill authorizes the State Board of Pharmacy to 59 additionally issue such a registration certificate to associate physicians and 60 associate osteopathic physicians and to regulate associate physicians and associate 61 osteopathic physicians who hold such a certificate in the same manner as physician 62 assistants. 63 Sections 8 and 20 provide for the expiration and renewal of the limited licenses 64 issued to associate physicians and associate osteopathic physicians, respectively. 65 Sections 11 and 25 of this bill require a physician or osteopathic physician to 66 biennially submit to the Board of Medical Examiners or the State Board of 67 Osteopathic Medicine, as applicable, a list of the names of each associate physician 68 or associate osteopathic physician who is supervised by the physician or 69 osteopathic physician. Sections 9 and 21 of this bill require those Boards to adopt 70 regulations to implement sections 2-9 and 19-21. 71 Sections 10, 22 and 27 of this bill make conforming changes to clarify the 72 meaning of the terms “supervising physician,” “associate physician,” “supervising 73 osteopathic physician” and “associate osteopathic physician.” Sections 11 and 23 74 – 3 – - *AB170* of this bill make conforming changes to clarify that an applicant for a license as an 75 associate physician or an associate osteopathic physician does not hold the same 76 qualifications for licensure as an applicant for a standard license as a physician or 77 an osteopathic physician. Section 24 of this bill makes a conforming change to 78 clarify the applicability of a provision relating to the supervising osteopathic 79 physician of a physician assistant. 80 THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 630 of NRS is hereby amended by adding 1 thereto the provisions set forth as sections 2 to 9, inclusive, of this 2 act. 3 Sec. 2. Except as otherwise provided in NRS 630.161, the 4 Board may issue a limited license for a person to practice 5 medicine as an associate physician if the applicant: 6 1. Has received the degree of doctor of medicine from a 7 medical school in the United States or Canada: 8 (a) Approved by the Liaison Committee on Medical Education 9 of the American Medical Association and Association of American 10 Medical Colleges; or 11 (b) Which provides a course of professional instruction 12 equivalent to that provided in medical schools in the United States 13 approved by the Liaison Committee on Medical Education; 14 2. Has passed the Step 1 Exam and Step 2 CK Exam of the 15 United States Medical Licensing Examination or an examination 16 deemed equivalent by the Board; 17 3. Has not completed a residency in a program described in 18 sub-subparagraph (I) of subparagraph (1) of paragraph (c) of 19 subsection 2 of NRS 630.160; 20 4. Has completed at least his or her first year of postgraduate 21 medical education as a resident or intern as part of a program 22 that: 23 (a) Has been approved by the Accreditation Council for 24 Graduate Medical Education; 25 (b) Conforms to the minimum standards for intern training 26 established by the American Osteopathic Association; or 27 (c) Is approved by the Board in accordance with the 28 regulations adopted pursuant to section 9 of this act; and 29 5. Has basic fluency in the English language. 30 Sec. 3. 1. An associate physician shall only practice 31 medicine under the supervision and control of a physician: 32 (a) Who meets the requirements of section 5 of this act; and 33 – 4 – - *AB170* (b) With whom the associate physician has entered into a 1 collaborative practice agreement that meets the requirements of 2 section 6 of this act. 3 2. An associate physician shall not practice medicine in a 4 manner that exceeds the skill, training and competence of the 5 associate physician or his or her supervising physician. 6 3. For the first 30 days during which an associate physician 7 practices medicine under the supervision of a new supervising 8 physician, the supervising physician must be physically present on 9 the same premises and available to assist the associate physician. 10 4. An associate physician shall not practice medicine in a 11 county whose population is less than 100,000 unless the 12 supervising physician or another physician designated by the 13 supervising physician is physically present on the same premises 14 and is available to assist the associate physician. 15 5. An associate physician working in a rural health clinic, as 16 defined in 42 U.S.C. § 1395x(aa)(2), shall be considered to be a 17 physician assistant for the purposes of the regulations of the 18 Centers for Medicare and Medicaid Services of the United States 19 Department of Health and Human Services. Such an associate 20 physician and his or her supervising physician are not required to 21 comply with the requirements of any regulations adopted pursuant 22 to section 9 of this act governing the supervision of an associate 23 physician that are more stringent than the requirements of federal 24 law and regulations. 25 6. A person or entity that employs an associate physician 26 shall credential the associate physician and bill for services 27 rendered by the associate physician in the same manner as the 28 person or entity credentials and bills for the services of a physician 29 assistant. 30 Sec. 4. 1. The supervising physician of an associate 31 physician shall prominently display a disclosure at every office 32 where the associate physician practices medicine explaining to 33 patients that the patient may be seen by an associate physician and 34 the patient may instead request to be seen by the supervising 35 physician. 36 2. An associate physician shall clearly identify himself or 37 herself as an associate physician, including, without limitation, by 38 wearing an identification badge that clearly identifies the person 39 as an associate physician. An associate physician may identify 40 himself or herself as a doctor. 41 3. While acting as the supervising physician of an associate 42 physician, a physician shall wear an identification badge that 43 clearly identifies the person as a supervising physician of an 44 associate physician. 45 – 5 – - *AB170* Sec. 5. 1. A physician shall not serve as the supervising 1 physician of an associate physician pursuant to subsection 1 of 2 section 3 of this act or the designee of a supervising physician 3 pursuant to subsection 4 of section 3 of this act unless the 4 physician: 5 (a) Holds an active unrestricted license to practice medicine in 6 this State; and 7 (b) Practices in the same specialty area as the associate 8 physician or a substantially similar specialty area as the associate 9 physician. 10 2. The supervising physician of an associate physician: 11 (a) Is responsible for any act that constitutes the practice of 12 medicine by the associate physician; 13 (b) Must have insurance that includes coverage for any claim 14 of malpractice against the associate physician; and 15 (c) May not enter into a collaborative practice agreement with 16 more than three associate physicians. 17 3. The Board may not deny, revoke or suspend the license of 18 or take any other disciplinary action against the supervising 19 physician of an associate physician for any act performed by the 20 associate physician that: 21 (a) Is performed in accordance with the collaborative practice 22 agreement entered into pursuant to section 3 of this act; and 23 (b) Does not violate applicable federal, state or local laws or 24 the regulations of the Board. 25 Sec. 6. 1. A collaborative practice agreement entered into 26 pursuant to section 3 of this act must be in writing and must 27 include, without limitation: 28 (a) The names, home and business addresses and telephone 29 numbers of the supervising physician and associate physician; 30 (b) A list of each location where the associate physician may 31 practice medicine, including, without limitation, the prescribing 32 and dispensing of controlled substances; 33 (c) Any specialty or board certification held by the supervising 34 physician; 35 (d) Any certification held by the associate physician; 36 (e) Requirements governing collaboration between the 37 supervising physician and the associate physician, including, 38 without limitation: 39 (1) The geographic proximity which must exist between the 40 supervising physician and the associate physician whil [Text truncated for display. Full text available on LegiScan.]