Amends TCA Title 4; Title 33; Title 38; Title 48; Title 49; Title 53; Title 55; Title 56; Title 63; Title 68 and Title 71.

This bill revises various provisions governing physician assistants, including the following: (1) Transfers oversight of physician's assistants (including orthopedic physician assistants) from the committee of physician assistants, which is part of the board of medical examiners, to a newly created board of physician assistants (discussed below) and makes corresponding changes in various statutes. This bill also restricts the licensure/renewal of licensure of orthopedic physician assistants to those persons who were performing services as an orthopedic physician assistant in this state on January 1, 2021; (2) Removes the requirement that a written protocol, jointly developed by a collaborating physician and a physician assistant, be in place prior to a physician performing certain services (however, the present law collaboration agreement requirement for orthopedic physician assistants is retained). Generally under present law, a physician assistant is authorized to perform selected medical services only in collaboration with a licensed physician. This bill rewrites the collaboration requirement to instead provide that a physician assistant must collaborate with, consult with, or refer to the appropriate member of the healthcare team as indicated by the patient's condition, the education, experience, and competencies of the physician assistant and the standard of care. This bill provides that the degree of collaboration should be determined by the practice, which may include decisions made by the employer, group, hospital services, and the credentialing and privileging systems of licensed facilities. This bill further provides that: a physician assistant is fully responsible for the care the physician assistant provides; and that a physician assistant is authorized to perform medical services for which the physician assistant has been prepared by the physician assistant's education, training, and experience and is competent to perform; (3) Specifies the scope of practice of a physician assistant. As noted above, under present law, services that a physician assistant may provide are in collaboration with a physician; such services include that the collaborating physician may delegate to a physician assistant the authority to prescribed Schedule II-V controlled substances and legend drugs. In conjunction with removing the collaboration requirement, this bill sets out specific authorized medical and surgical services that are included in the practice of a physician assistant, which include: evaluating, diagnosing, managing, and providing medical treatment; and prescribing, dispensing, ordering, administering, and procuring drugs (including Schedule II-V controlled substances and all legend drugs) and medical devices; (4) Retains the present law requirement that the performance of invasive procedures involving any portion of the spine, spinal cord, sympathetic nerves of the spine, or block of major peripheral nerves of the spine be performed under the direct supervision of a qualified physician, if such a service is performed in a setting other than a licensed healthcare facility; (5) Authorizes physician assistants to work in the following business organization settings with certain other healthcare providers (these are in addition to any such arrangements authorized pursuant to present law, such as physician assistants and physicians are authorized under present law to form and own shares in the same professional corporation): (A) Professional corporation, professional limited liability company, with a podiatrist; and (B) Professional limited liability company with a physician and advance practice registered nurse (all three jointly or with just the physician assistant and physician (authorized by present law) or just the physician assistant and advance practice registered nurse); (6) Establishes the board of physician assistants. This bill abolishes the existing committee on physician assistants and creates the board of physician assistants to regulate the practice of physician assistants. The board will consist of the following nine members appointed by the governor: seven physician assistants, one physician, one public member who is not a licensed healthcare provider. This bill sets out in detail provisions governing the board, including the terms of members, and the various powers and duties of the board. Like the committee members under present law, board members under this bill will receive a per diem of $100 and expenses while engaged in the business of the board; (7) Clarifies the accrediting entities for physician assistant training programs and examination and specifies in detail the process for application, payment of fees (which will set by the board), and clarifies other qualifications and processes for licensure (most of which are the same as under present law); (8) Reduces from 15 months to 12 months after graduation the period of validity of a temporary license granted to a new graduate to provide the graduate time to take the required examination; and (9) Schedules the board of physician assistants to sunset June 30, 2025. For purposes of establishing the board and promulgating rules, this bill will take effect upon becoming a law. For all other purposes, this bill will take effect January 1, 2022. ON MAY 4, 2021, THE HOUSE ADOPTED AMENDMENTS #1 AND #2 AND PASSED HOUSE BILL 1080, AS AMENDED. AMENDMENT #1 revises the bill as follows: (1) Changes the termination date for the new board of physician assistants from June 30, 2025, to June 30, 2024; (2) Deletes the provisions described (2) of the Bill Summary and retains the present law provisions authorizing a physician assistant to perform selected medical services only in collaboration with a licensed physician; (3) Replaces references to the committee on physicians assistants with references to the board of physician assistants and specifies that, until the board of physician assistants and the board of medical examiners jointly adopt new regulations governing the collaborating physician's personal review of data contained in the charts of patients examined by the physician assistant, the rules jointly adopted by the committee on physician assistants and the board of medical examiners in effect as of December 31, 2020, remain in effect; (4) Specifies that, on the date this bill becomes law for the purposes of the board being established, the current members of the board of medical examiners' committee on physician assistants will become members of the board of physician assistants, except that any current member who is an orthopedic physician assistant will not become a member of the board of physician assistants. The terms of the committee members who are held over as board members will be four years from the date the members were appointed to service as members of the committee. The former committee members will be term-limited to not more than two consecutive four-year terms, including the time served on the committee; (5) Adds procedural requirements for the establishment of the board, such as staggering of initial terms of appointees to the board, carrying forward the committee's rule so that such rules may be enforced by the board, establishment of quorum requirements, and transfer of the committee's fiscal balance or deficit to the board; (6) Deletes the provisions described (3) of the Bill Summary and retains present law governing practices for collaboration with physician assistants; (7) Deletes the provision of this bill and present law providing that a physician assistant rendering professional services inconsistent with the laws applicable to the practice of a physician assistant is considered to be practicing medicine without a license and is subject to appropriate legal action by the board. This amendment instead authorizes the board to deny a license or otherwise discipline a license holder upon certain proof as detailed by this amendment. This amendment also adds that upon taking a disciplinary action against a licensee, the board must notify the board of medical examiners, board of osteopathic examination, or board of podiatry, as appropriate, of the disciplinary action and the licensee's primary collaborating physician of record. Under this amendment, a disciplinary action issued by the board for a violation involving the prescribing, dispensing, or otherwise issuing of controlled substances by a physician assistant must also be approved by the board of medical examiners, and the board will give notice to the appropriate licensing board of the primary collaborating physician of record; (8) Retains the present law provision, which this bill would delete, regarding unprofessional conduct by a physician supervising a physician assistance; (9) Retains present law giving physician assistants the exclusive right to use the abbreviation "PA-C"; (10) Retains present law concerning the standard of care for orthopedic physician assistants; (11) Adds authorization for the board to renew the license of an orthopedic physician who was performing services as an orthopedic physician assistant in this state on or after January 1, 2021, and has been continuously licensed as an orthopedic physician assistant in this state since 1995; (12) Authorizes a person serving as a consultant solely for the board of medical examiners' committee on physician assistants, and not for any other board or committee, as of January 1, 2021, to continue to serve as a consultant for the board of physician assistants until such time that the board of physician assistants decides otherwise; and (13) Makes this bill effective upon becoming a law for all purposes. AMENDMENT #2 further specifies that the board of physician assistants will terminate July 1, 2024.