Bill Summary – FastDemocracy

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68th Legislature 2023                                                                                           HB 313.1
                                                HOUSE BILL NO. 313
     INTRODUCED BY J. ETCHART, S. GUNDERSON, M. MALONE, M. WEATHERWAX, J. WINDY BOY, T.
      RUNNING WOLF, C. KNUDSEN, S. GIST, K. ZOLNIKOV, S. ESSMANN, B. MITCHELL, P. FIELDER, S.
   VINTON, L. SHELDON-GALLOWAY, T. MOORE, B. MERCER, J. HINKLE, N. NICOL, B. LER, A. REGIER, K.
   SEEKINS-CROWE, S. GALLOWAY, F. NAVE, R. MARSHALL, B. KEENAN, G. OBLANDER, T. BROCKMAN,
   G. PARRY, M. YAKAWICH, S. HINEBAUCH, T. MCGILLVRAY, B. USHER, D. LENZ, C. FRIEDEL, P. GREEN,
                   G. KMETZ, B. BARKER, P. TUSS, W. RUSK, B. PHALEN, L. DEMING, N. DURAM
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  A BILL FOR AN ACT ENTITLED: “AN ACT PROVIDING FOR INDEPENDENT PRACTICE OF PHYSICIAN
  ASSISTANTS; CLARIFYING COVERAGE OF PHYSICIAN ASSISTANTS UNDER HEALTHY MONTANA
  KIDS, HEALTH MAINTENANCE ORGANIZATIONS, AND MULTIPLE WELFARE EMPLOYER
  ARRANGEMENTS; AMENDING SECTIONS 33-22-114, 33-31-111, 33-35-306, 37-20-101, 37-20-104, 37-20-
  301, 37-20-401, 37-20-403, 37-20-404, 37-20-405, 37-20-410, 37-20-411, 50-5-1301, 50-12-102, 50-19-403,
  50-20-109, AND 53-4-1005, MCA; AND PROVIDING AN IMMEDIATE EFFECTIVE DATE.”
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  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
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          Section 1. Section 33-22-114, MCA, is amended to read:
          "33-22-114. Coverage required for services provided by physician assistants, advanced
  practice registered nurses, and registered nurse first assistants. An insurer, a health service corporation,
  or any employee health and welfare fund that provides accident or health insurance benefits to residents of this
  state shall provide, in group and individual insurance contracts, coverage as well as payment or reimbursement
  for health services provided by:
          (1)       a physician assistant as normally covered by contracts for services supplied by a physician if
  health care services that the physician assistant is approved to perform performs are covered by the contract;
          (2)       an advanced practice registered nurse, defined in 37-8-102, as normally covered by contracts
  for services supplied by a physician or a physician assistant if health care services that the advanced practice
  registered nurse is approved to perform are covered by the contract; and
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68th Legislature 2023                                                                                               HB 313.1
          (3)         a registered nurse first assistant, licensed under Title 37, chapter 8, as normally covered by
  contracts for surgical services supplied by a physician, a physician assistant, or an advanced practice
  registered nurse if surgical services that the registered nurse first assistant is approved to perform are covered
  by the contract."
  5
          Section 2. Section 33-31-111, MCA, is amended to read:
          "33-31-111.       Statutory construction and relationship to other laws. (1) Except as otherwise
  provided in this chapter, the insurance or health service corporation laws do not apply to a health maintenance
  organization authorized to transact business under this chapter. This provision does not apply to an insurer or
  health service corporation licensed and regulated pursuant to the insurance or health service corporation laws
  of this state except with respect to its health maintenance organization activities authorized and regulated
  pursuant to this chapter.
          (2)         Solicitation of enrollees by a health maintenance organization granted a certificate of authority
  or its representatives is not a violation of any law relating to solicitation or advertising by health professionals.
          (3)         A health maintenance organization authorized under this chapter is not practicing medicine and
  is exempt from Title 37, chapter 3, relating to the practice of medicine.
          (4)         This chapter does not exempt a health maintenance organization from the applicable certificate
  of need requirements under Title 50, chapter 5, parts 1 and 3.
          (5)         This section does not exempt a health maintenance organization from the prohibition of
  pecuniary interest under 33-3-308 or the material transaction disclosure requirements under 33-3-701 through
  33-3-704. A health maintenance organization must be considered an insurer for the purposes of 33-3-308 and
  33-3-701 through 33-3-704.
          (6)         This section does not exempt a health maintenance organization from:
          (a)         prohibitions against interference with certain communications as provided under Title 33,
  chapter 1, part 8;
          (b)         the provisions of Title 33, chapter 22, parts 7 and 19;
          (c)         the requirements of 33-22-134 and 33-22-135;
          (d)         network adequacy and quality assurance requirements provided under chapter 36; or
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68th Legislature 2023                                                                                            HB 313.1
          (e)      the requirements of Title 33, chapter 18, part 9.
          (7)      Other chapters and provisions of this title apply to health maintenance organizations as follows:
  Title 33, chapter 1, parts 6, 12, and 13; 33-2-1114; 33-2-1211 and 33-2-1212; Title 33, chapter 2, parts 13, 19,
  23, and 24; 33-3-401; 33-3-422; 33-3-431; Title 33, chapter 3, part 6; Title 33, chapter 10; Title 33, chapter 12;
  33-15-308; Title 33, chapter 17; Title 33, chapter 19; 33-22-107; 33-22-114; 33-22-128; 33-22-129; 33-22-131;
  33-22-136 through 33-22-139; 33-22-141 and 33-22-142; 33-22-152 and 33-22-153; 33-22-156 through 33-22-
  159; 33-22-180; 33-22-244; 33-22-246 and 33-22-247; 33-22-514 and 33-22-515; 33-22-521; 33-22-523 and
  33-22-524; 33-22-526; and Title 33, chapter 32."
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          Section 3. Section 33-35-306, MCA, is amended to read:
          "33-35-306. Application of insurance code to arrangements. (1) In addition to this chapter, self-
  funded multiple employer welfare arrangements are subject to the following provisions:
          (a)      33-1-111;
          (b)      Title 33, chapter 1, part 4, but the examination of a self-funded multiple employer welfare
  arrangement is limited to those matters to which the arrangement is subject to regulation under this chapter;
          (c)      Title 33, chapter 1, part 7;
          (d)      Title 33, chapter 2, parts 23 and 24;
          (e)      33-3-308;
          (f)      Title 33, chapter 7;
          (g)      Title 33, chapter 18, except 33-18-242;
          (h)      Title 33, chapter 19;
          (i)      33-22-107, 33-22-114, 33-22-128, 33-22-131, 33-22-134, 33-22-135, 33-22-138, 33-22-139,
  33-22-141, 33-22-142, 33-22-152, and 33-22-153;
          (j)      33-22-512, 33-22-515, 33-22-525, and 33-22-526;
          (k)      Title 33, chapter 22, part 7; and
          (l)      33-22-707.
          (2)      Except as provided in this chapter, other provisions of Title 33 do not apply to a self-funded
  multiple employer welfare arrangement that has been issued a certificate of authority that has not been
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68th Legislature 2023                                                                                           HB 313.1
  revoked."
  2
          Section 4. Section 37-20-101, MCA, is amended to read:
          "37-20-101. Qualifications of supervising physician and physician assistant. (1) The supervising
  physician named in the supervision agreement required by 37-20-301 shall:
          (a)   possess a current, active license to practice medicine in this state; and
          (b)   exercise supervision over the physician assistant in accordance with the rules adopted by the
  board and retain professional and legal responsibility for the care and treatment of patients by the physician
  assistant.
          (2)   A physician assistant named in the supervision agreement required by 37-20-301 must have a
  current, active Montana physician assistant license."
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          Section 5. Section 37-20-104, MCA, is amended to read:
          "37-20-104. Unlicensed practice -- penalties. (1) A person who employs a physician assistant or
  holds out to the public that the person is a physician assistant without having been issued a Montana physician
  assistant license is guilty of a misdemeanor and is punishable as provided in 46-18-212.
          (2)      Prior to being issued a license and submitting a supervision agreement to the board, a
  physician assistant may not practice as a physician assistant in this state, even under the supervision of a
  licensed physician.
          (3)      The board may enforce the provisions of this section by the remedy of injunction and the
  application of other penalties as provided by law."
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          Section 6. Section 37-20-301, MCA, is amended to read:
          "37-20-301. Requirements for use of physician assistant practice-- supervision agreement --
  duties and delegation agreement -- content -- approval -- filing. (1) A physician, office, firm, state institution,
  or professional service corporation may not employ or make use of the services of a physician assistant in the
  practice of medicine, as defined in 37-3-102, and as provided in this chapter and a physician assistant may not
  be employed or practice as a physician assistant unless the physician assistant:
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68th Legislature 2023                                                                                            HB 313.1
          (a)   is supervised by a physician licensed in this state;
          (b)(1)   is licensed by the board; and
          (c)   has submitted a physician assistant supervision agreement to the board on a form prescribed by
  the department; and
          (d)(2)   has paid to the board the applicable fees required by the board.
          (2)   A supervising physician and the supervised physician assistant shall execute a duties and
  delegation agreement constituting a contract that defines the physician assistant's professional relationship with
  the supervising physician and the limitations on the physician assistant's practice under the supervision of the
  supervising physician. The agreement must be kept current, by amendment or substitution, to reflect changes
  in the duties of each party occurring over time. The board may by rule specify other requirements for the
  agreement. A physician assistant licensed by the board before October 1, 2005, shall execute a duties and
  delegation agreement with a supervising physician by October 1, 2006.
          (3)   A physician assistant and the physician assistant's supervising physician shall keep the
  supervision agreement and the duties and delegation agreement at their place of work and provide a copy upon
  request to a health care provider, a health care facility, a state or federal agency, the board, and any other
  individual who requests one."
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          Section 7. Section 37-20-401, MCA, is amended to read:
          "37-20-401. Definitions. As used in this chapter, the following definitions apply:
          (1)      "Board" means the Montana state board of medical examiners established in 2-15-1731.
          (2)   "Duties and delegation agreement" means a written contract between the supervising physician
  and the physician assistant that meets the requirements of 37-20-301.
          (3)(2)   "Physician assistant" means a member of a health care team, licensed by the board, an
  individual licensed pursuant to this chapter who provides medical services that may include but are not limited
  to examination, diagnosis, prescription of medications, and treatment under the supervision of a physician
  licensed by the board.
          (4)   "Supervising physician" means a medical doctor or doctor of osteopathy licensed by the board
  who agrees to a supervision agreement and a duties and delegation agreement.
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68th Legislature 2023                                                                                               HB 313.1
          (5)   "Supervision agreement" means a written agreement between a supervising physician and a
  physician assistant providing for the supervision of the physician assistant."
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          Section 8. Section 37-20-403, MCA, is amended to read:
          "37-20-403.    Physician assistant as agent of supervising physician -- degree of supervision
  required -- scope of practice. (1) A physician assistant is considered the agent of the supervising physician
  with regard to all duties delegated to the physician assistant and is professionally and legally responsible for the
  care and treatment of a patient by a physician assistant licensed in accordance with this chapter. A health care
  provider shall consider the instructions of a physician assistant as being the instructions of the supervising
  physician as long as the instructions concern the duties delegated to the physician assistant.
          (2)   Onsite or direct supervision of a physician assistant by a supervising physician is not required if
  the supervising physician has provided a means of communication between the supervising physician and the
  physician assistant or an alternate means of supervision in the event of the supervising physician's absence.
          (3)(2)   A physician assistant may A physician assistant may:
          (a)      diagnose, examine, and treat human conditions, ailments, diseases, injuries, or infirmities,
  either physical or mental, by any means, method, device, or instrumentality authorized by the supervising
  physician;
          (b)      obtain informed consent;
          (c)      supervise, delegate, and assign therapeutic and diagnostic measures;
          (d)      certify the health or disability of a patient as required by any local, state, or federal program;
  and
          (e)      authenticate any document that a physician may authenticate."
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          Section 9. Section 37-20-404, MCA, is amended to read:
          "37-20-404.    Prescribing and dispensing authority -- discretion of supervising physician on
  limitation of authority. (1) A physician assistant may prescribe, dispense, and administer drugs to the extent
  authorized by the supervising physician.
          (2)      All dispensing activities allowed by this section must comply with 37-2-104 and with packaging
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68th Legislature 2023                                                                                              HB 313.1
  and labeling guidelines developed by the board of pharmacy under Title 37, chapter 7.
          (3)      The prescribing and dispensing authority granted for a physician assistant may include the
  following:
          (a)      Prescribing, dispensing, and administration of Schedule III drugs listed in 50-32-226, Schedule
  IV drugs listed in 50-32-229, and Schedule V drugs listed in 50-32-232 is authorized.
          (b)      Prescribing, dispensing, and administration of Schedule II drugs listed in 50-32-224 may be
  authorized for limited periods not to exceed 34 days.
          (c)      Records on the dispensing and administration of scheduled drugs must be kept.
          (d)      A physician assistant shall maintain registration with the federal drug enforcement
  administration if the physician assistant is authorized by the supervising physician to prescribe controlled
  substances.
          (e)      A prescription written by a physician assistant must comply with regulations relating to
  prescription requirements adopted by the board of pharmacy."
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          Section 10. Section 37-20-405, MCA, is amended to read:
          "37-20-405. Billing. A supervising physician physician assistant, medical office, firm, institution, or
  other entity may bill for a service provided by a supervised physician assistant."
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          Section 11. Section 37-20-410, MCA, is amended to read:
          "37-20-410.    Participation in disaster and emergency care -- liability of physician assistant and
  supervising physician. (1) A physician assistant licensed in this state, licensed or authorized to practice in
  another state, territory, or possession of the United States, or credentialed as a physician assistant by a federal
  employer who provides medical care in response to an emergency or a federal, state, or local disaster may
  provide that care either without supervision as required by this chapter or with whatever supervision is
  available. The provision of care allowed by this subsection is limited to for the duration of the emergency or
  disaster.
          (2)   A physician who supervises a physician assistant providing medical care in response to an
  emergency or disaster as described in subsection (1) need not comply with the requirements of this chapter
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