Revision: Feb. 23, 2022, 3:51 p.m.
Senate Executive Departments and Administration
February 23, 2022
2022-0821s
12/04
Amendment to SB 228
Amend the title of the bill by replacing it with the following:
AN ACT relative to the regulation and practice of physician assistants.
Amend RSA 328-D:1, III as inserted by section 1 of the bill by replacing it with the following:
III. "Physician assistant" or "P.A." means a person qualified both by academic and practical training [in a program approved by the board] to provide patient services [under the supervision and direction of a licensed physician in a variety of medical care settings] in collaboration with one or more physicians pursuant to the requirements of this chapter.
Amend RSA 328-D:3-b, I-II as inserted by section 5 of the bill by replacing them with the following:
I. Except as provided in RSA 328-D:15, III and RSA 328-D:16, III, a physician assistant shall engage in practice as a physician assistant in this state only if the physician assistant has entered into a written collaboration agreement with a sole practice physician or a physician representing a group or health system so long as the sole practitioner or at least one physician in the group or health system practices in a similar area of medicine as the physician assistant, and is a licensed New Hampshire physician.
II. A collaboration agreement shall include all of the following:
(a) Processes for collaboration and consultation with the appropriate physician and other health care professional as indicated based on the patient’s condition; the physician assistant’s education, training, and experience, and the applicable standards of care.
(b) An acknowledgment that the physician assistant's scope of practice shall be limited to medical care that is within the physician assistant's education, training, and experience as outlined in VII-XVIII below.
(c) A statement that although collaboration occurs between the physician assistant and physicians and other health care professionals, a physician shall be accessible for consultation in person, by telephone, or electronic means at all times when a physician assistant is practicing.
(d) The signatures of the physician assistant and the participating physician. No other signatures shall be required.
Amend the bill by inserting after section 7 the following new sections and renumbering the original sections 8-12 to read as 10-14, respectively:
8 Physician Assistants; Physician Liability. RSA 328-D:12 is repealed and reenacted to read as follows:
328-D:12 Physician Liability. A physician assistant is responsible for his or her own medical decision making. A participating physician included in a collaboration agreement with a physician assistant shall not, by the existence of the collaboration agreement alone, be legally liable for the actions or inactions of the physician assistant; provided, however, that this shall not otherwise limit the liability of the participating physician.
9 New Subparagraph; Rulemaking; Liability Insurance Coverage. Amend RSA 328-D:10, I by inserting after subparagraph (k) the following new subparagraph:
(l) The definition of adequate liability insurance coverage under RSA 328-D:18.
Amend the bill by replacing section 10 with the following:
10 New Sections; Physician Assistants; Disaster Care, Emergency Care, and Coverage of Services. Amend RSA 328-D by inserting after section 14 the following new sections:
328-D:15 Participation in Disaster and Emergency Care.
I. A physician assistant licensed in this state or licensed or authorized to practice in any other U.S. jurisdiction or who is credentialed as a physician assistant by a federal employer who is responding to a need for medical care created by an emergency or a state or local disaster may render such care that they are able to provide, provided that a state or local disaster shall not include an emergency situation that occurs in the place of the physician assistant's employment.
II. A physician assistant so responding who voluntarily and gratuitously, and other than in the ordinary course of employment or practice, renders emergency medical assistance shall not be liable for civil damages for any personal injuries that result from acts or omissions which may constitute ordinary negligence. The immunity granted by this section shall not apply to acts or omissions constituting gross, willful or wanton negligence.
III. A physician assistant licensed in this state or licensed or authorized to practice in any other U.S. jurisdiction or credentialed as a physician assistant by a federal employer shall not be required to have a collaboration agreement when responding to a need for medical care created by a disaster or emergency.
328-D:16 Participation in Volunteer Care.
I. A physician assistant licensed in this state, or licensed or authorized to practice in any other U.S. jurisdiction, or who is credentialed by a federal employer or meets the licensure requirements of his or her requisite federal agency as a physician assistant may volunteer to render such care that he or she is able to provide at a children's summer camp or for a public or community event or in a licensed ambulatory health center providing free care. Such care must be rendered without compensation or remuneration.
II. A physician assistant licensed in this state, or licensed or authorized to practice in any other U.S. jurisdiction, or credentialed as a physician assistant by a federal employer shall not be required to have a collaboration agreement when participating in volunteer care.
328-D:17 Coverage of Services.
I. Health insurers and, to the extent permitted under federal law, Medicaid and Medicare shall reimburse a participating provider who is a physician assistant for any medical and surgical service delivered by the physician assistant if the same service would be covered if delivered by a physician. Physician assistants are authorized to bill for and receive direct payment for the medically necessary services they deliver.
II. To provide accountability and transparency for patients, payers, and health care systems, the physician assistant, when appropriate, shall be identified as the treating provider in the billing and claims processes when the physician assistant delivered the medical services to the patient.
III. A health insurer shall not impose any practice, education, or collaboration requirement for a physician assistant that is inconsistent with or more restrictive than the provisions of this chapter.
IV. Nothing in this chapter shall be construed to preclude a health carrier from exercising its rights and responsibilities set forth in RSA 420-J:4.
328-D:18 Professional Liability Insurance Coverage. Physician assistants actively engaged in providing medical care shall have adequate, current, and valid professional liability insurance coverage.
Amend section 13 of the bill by deleting paragraph VI.