Existing law provides for the licensing of physicians and physician assistants by the Board of Medical Examiners and for the licensing of osteopathic physicians by the State Board of Osteopathic Medicine. (NRS 630.160-630.1607, 630.258-630.2665, 630.271-630.2755, 633.305-633.469) Existing law also authorizes a graduate of a foreign medical school to obtain a restricted license to teach, research or practice medicine at a medical facility, medical research facility or medical school by completing certain requirements that are less stringent than the requirements to obtain an unrestricted license. (NRS 630.2645) If the holder of such a restricted license wishes to obtain an unrestricted license, existing law requires the holder to meet all of the qualifications ordinarily required to obtain an unrestricted license. (NRS 630.160, 630.2645) Sections 3-13 and 23-30 of this bill create special license types that authorize certain medical school graduates to engage in the supervised practice of medicine in a medically underserved area of this State. Sections 2 and 22 of this bill define the term “medically underserved area” for those purposes. Sections 14 and 31 of this bill make conforming changes to indicate the appropriate placement of sections 2 and 22, respectively, in the Nevada Revised Statutes. Section 3 authorizes the Board of Medical Examiners to issue a limited license to practice medicine to a graduate of a foreign medical school who agrees to practice in a medically underserved area and possesses certain other qualifications related to the practice of medicine. Section 4 of this bill requires the holder of a limited license to practice medicine only under the supervision of a physician who holds an unrestricted license and with whom the holder of the limited license has entered into a practice agreement. Section 5 of this bill: (1) provides for the expiration and renewal of a limited license; and (2) requires the Board of Medical Examiners to adopt regulations governing the limited license. Sections 16, 17, 19 and 20 of this bill update references to certification by the Educational Commission for Foreign Medical Graduates in existing law to reflect the current practices of the Commission. Sections 32 and 33 of this bill make revisions to reflect that internships for osteopathic physicians are currently approved by the Accreditation Council for Graduate Medical Education. Sections 6 and 23 of this bill authorize the Board of Medical Examiners and State Board of Osteopathic Medicine, respectively, to issue a limited license as an associate physician or associate osteopathic physician to an applicant who: (1) has graduated from certain medical schools in the United States or Canada; (2) agrees to perform medical services in a medically underserved area in this State; and (3) possesses certain other qualifications. Sections 7 and 24 of this bill limit the practice of an associate physician or associate osteopathic physician to: (1) certain primary care services that are within the skill, training and competence of the associate physician or associate osteopathic physician; and (2) practicing under the supervision and control of a supervising physician or supervising osteopathic physician and in a medically underserved area. Sections 7 and 24: (1) deem an associate physician or associate osteopathic physician working in a rural health clinic to be a physician assistant for certain purposes under federal law; and (2) exempt such an associate physician or associate osteopathic physician and his or her supervising physician or supervising osteopathic physician from state requirements governing supervision that are more stringent than federal law and regulations. Sections 7 and 24 require an associate physician or associate osteopathic physician to enter into a collaborative practice agreement with his or her supervising physician or supervising osteopathic physician. Sections 7 and 24 require a supervising physician or supervising osteopathic physician to be on the same premises and available to assist an associate physician or associate osteopathic physician who is practicing in a medically underserved urban area for the first 30 days of supervision. Sections 7 and 24 require a supervising physician or supervising osteopathic physician, or a designee thereof, to be on the same premises and available to assist an associate physician or associate osteopathic physician, as applicable, who is practicing in a medically underserved rural area at all times. Sections 7 and 24 also require the employer of an associate physician or associate osteopathic physician to credential and bill for services rendered by an associate physician or associate osteopathic physician in the same manner as a physician assistant. Sections 8 and 25 of this bill require a supervising physician and associate physician or supervising osteopathic physician and associate osteopathic physician to take certain measures to notify the public of their respective statuses and their relationship. Sections 9 and 26 of this bill prescribe the required qualifications of a supervising physician or supervising osteopathic physician. Sections 9 and 26 also: (1) provide that a supervising physician or supervising osteopathic physician is responsible for the practice of medicine or osteopathic medicine by the associate physician or associate osteopathic physician that he or she is supervising; and (2) require a supervising physician or supervising osteopathic physician to maintain liability insurance that covers malpractice by an associate physician or associate osteopathic physician. Sections 9 and 26 prohibit a supervising physician or supervising osteopathic physician from entering into a collaborative practice agreement with more than three associate physicians or associate osteopathic physicians. Sections 9 and 26 additionally prohibit the Board of Medical Examiners and the State Board of Osteopathic Medicine from disciplining a supervising physician or supervising osteopathic physician for legal activity of an associate physician or associate osteopathic physician that is within the scope of the relevant collaborative practice agreement. Sections 10 and 27 of this bill prescribe the required provisions of a collaborative practice agreement. Sections 18 and 34 of this bill require a physician or osteopathic physician to biennially submit to the Board of Medical Examiners or the State Board of Osteopathic Medicine, as applicable, a list of the names of each associate physician or associate osteopathic physician supervised by the physician or osteopathic physician. Sections 11 and 28 of this bill authorize an associate physician or associate osteopathic physician to prescribe or dispense certain controlled substances and establish the conditions under which an associate physician or associate osteopathic physician may prescribe or dispense such controlled substances. Existing law: (1) authorizes the State Board of Pharmacy to issue a registration certificate to authorize a physician assistant to possess, administer, prescribe or dispense controlled substances, poisons, dangerous drugs or devices in or out of the presence of his or her supervising physician; and (2) requires the Board to adopt regulations governing the storage, security, recordkeeping and transportation of controlled substances, poisons, dangerous drugs or devices by a physician assistant. (NRS 639.1373) Section 34.5 of this bill authorizes the State Board of Pharmacy to additionally issue such a registration certificate to associate physicians and associate osteopathic physicians and to regulate associate physicians and associate osteopathic physicians with such a certificate in the same manner as physician assistants. Sections 12 and 29 of this bill provide for the expiration and renewal of the licenses. Sections 13 and 30 of this bill require the Board of Medical Examiners and the State Board of Osteopathic Medicine to: (1) adopt regulations to carry out the provisions of law governing associate physicians and associate osteopathic physicians; and (2) work with medical schools in this State to develop and implement a program for associate physicians and associate osteopathic physicians to gain knowledge and experience that may count as credit towards a residency program in this State. Sections 15 and 33 of this bill make conforming changes to ensure that the limited licenses created by this bill are treated the same as other special licenses for physicians or osteopathic physicians, as applicable. Section 35 of this bill makes a conforming change to clarify the meaning of the terms “associate physician” and “associate osteopathic physician.” Existing law requires public and private policies of insurance regulated under Nevada law to include certain coverage. (NRS 287.010, 287.04335, 422.2712-422.27241, 689A.04033-689A.0465, 689B.0303-689B.0379, 689C.1655-689C.169, 689C.194-689C.195, 695A.184-689A.1875, 695B.1901-695B.1949, 695C.1691-695C.176, 695G.162-695G.177) Existing law also requires employers to provide certain benefits to employees, including the coverage required of health insurers, if the employer provides health benefits for its employees. (NRS 608.1555) Sections 37-40, 42, 43, 45-48 and 50 of this bill require public and private health plans, including Medicaid, to provide coverage for medical services provided by an associate physician or associate osteopathic physician, if the health plan covers the same medical services when performed by a different provider of health care. Sections 36, 41 and 44 of this bill make conforming changes to indicate the proper placement of sections 39, 40 and 43 in the Nevada Revised Statutes. Section 49 of this bill authorizes the Commissioner of Insurance to suspend or revoke the certificate of a health maintenance organization that fails to comply with the requirement of section 47 of this bill to cover medical services provided by an associate physician or associate osteopathic physician. The Commissioner would also be authorized to take such actions against other health insurers who fail to comply with the requirements of sections 40, 42, 43, 45, 46 and 50.

Statutes affected:
As Introduced: 630.005, 630.160, 630.195, 630.265, 630.267, 630A.270, 630A.320, 633.011, 633.061, 633.311, 633.471, 0.040, 232.320, 287.010, 287.04335, 689A.330, 689C.425, 695C.050, 695C.330
Reprint 1: 630.005, 630.160, 630.195, 630.265, 630.267, 630A.270, 630A.320, 633.011, 633.061, 633.311, 633.471, 639.1373, 0.040, 232.320, 287.010, 287.04335, 689A.330, 689C.425, 695C.050, 695C.330
BDR: 630.005, 630.160, 630.195, 630.265, 630.267, 630A.270, 630A.320, 633.011, 633.061, 633.311, 633.471, 0.040, 232.320, 287.010, 287.04335, 689A.330, 689C.425, 695C.050, 695C.330