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    PREVAILED      Roll Call No. _______
    FAILED        Ayes _______
    WITHDRAWN        Noes _______
    RULED OUT OF ORDER


[

HOUSE MOTION ____

]

MR. SPEAKER:

    I move that Engrossed Senate Bill 363 be amended to read as follows:

SOURCE: Page 10, line 15; (11)MO036311.10. -->     Page 10, between lines 15 and 16, begin a new paragraph and insert:
SOURCE: IC 25-27.5-2-13; (11)MO036311.10. -->     "SECTION 10. IC 25-27.5-2-13 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 13. "Supervising physician" means a physician registered with licensed by the board who supervises and is responsible for a physician assistant.
SOURCE: IC 25-27.5-2-14; (11)MO036311.1. -->     SECTION 1. IC 25-27.5-2-14, AS AMENDED BY P.L.3-2008, SECTION 190, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 14. (a) "Supervision" means overseeing the activities of, and accepting responsibility for, the medical services rendered by a physician assistant and that the conditions set forth in subdivision (1) or (2) are met at all times that services are rendered or tasks are performed by the physician assistant:
        (1) The supervising physician or the physician designee is physically present at the location at which services are rendered or tasks are performed by the physician assistant.
        (2) Both of the following apply:
            (A) The supervising physician or the physician designee is immediately available:
                 (i) through the use of telecommunications or other electronic means; and
                (ii)
for consultation , including being able to see the patient in person within twenty-four (24) hours if requested by the patient or the physician assistant.
            (B) Either:
                (i) the supervising physician or the physician designee is in the county of, or a contiguous county to, the onsite location in which services are rendered or tasks are performed by the physician assistant; or
                (ii) the physician or physician assistant is practicing at a hospital or health facility, or traveling to or from the hospital or health facility.
             (B) The supervising physician or the physician designee is in:
                (i) the county of the physician assistant's practice; or
                (ii) a contiguous county, including a county of a neighboring state, of the county containing the onsite location in which services are rendered or tasks are performed by the physician assistant.
        The medical licensing board may permit an exception to the requirements of this clause after receiving an exceptional circumstance waiver request with the filed supervising agreement for each individual physician assistant and practice location. An exception must be approved by the board before the commencement of the physician assistant's practice in the county that requires the exceptional circumstance waiver request.

    (b) The term includes the use of protocols, guidelines, and standing orders developed or approved by the supervising physician.
SOURCE: IC 25-27.5-3-5; (11)MO036311.11. -->     SECTION 11. IC 25-27.5-3-5, AS AMENDED BY P.L.177-2009, SECTION 51, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 5. (a) The committee shall have regular meetings, called upon the request of the president or by a majority of the members appointed to the committee, and upon the advice and consent of the executive director of the Indiana professional licensing agency, for the transaction of business that comes before the committee under this article. At the first committee meeting of each calendar year, the committee shall elect a president and any other officer considered necessary by the committee by an affirmative vote of a majority of the members appointed to the committee.
    (b) Three (3) members of the committee constitute a quorum. An affirmative vote of a majority of the members appointed to the committee is required for the committee to take action on any business.
    (c) The committee shall do the following:
        (1) Consider the qualifications of individuals who apply for an initial license under this article.
        (2) Approve or reject license applications.
        (3) Approve or reject renewal applications.
        (4) Approve or reject applications for a change or addition of a supervising physician.
        (5) (4) Propose rules to the board concerning the competent

practice of physician assistants and the administration of this article.
        (6) (5) Recommend to the board the amounts of fees required under this article.

SOURCE: IC 25-27.5-5-2; (11)MO036311.12. -->     SECTION 12. IC 25-27.5-5-2, AS AMENDED BY P.L.177-2009, SECTION 55, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 2. (a) A physician assistant must engage in a dependent practice with physician supervision. A physician assistant may perform, under the supervision of the supervising physician, the duties and responsibilities that are delegated by the supervising physician and that are within the supervising physician's scope of practice, including prescribing and dispensing drugs and medical devices. A patient may elect to be seen, examined, and treated by the supervising physician.
    (b) If a physician assistant determines that a patient needs to be examined by a physician, the physician assistant shall immediately notify the supervising physician or physician designee.
    (c) If a physician assistant notifies the supervising physician that the physician should examine a patient, the supervising physician shall:
        (1) schedule an examination of the patient in a timely manner unless the patient declines; or
        (2) arrange for another physician to examine the patient.
    (d) If a patient is subsequently examined by the supervising physician or another physician because of circumstances described in subsection (b) or (c), the visit must be considered as part of the same encounter except for in the instance of a medically appropriate referral.
    (e) A supervising physician or physician assistant who does not comply with subsections (b) through (d) is subject to discipline under IC 25-1-9.
    (f) A physician assistant's supervisory agreement with a supervising physician must:
        (1) be in writing;
        (2) include all the tasks delegated to the physician assistant by the supervising physician;
        (3) set forth the supervisory plans for the physician assistant, including the emergency procedures that the physician assistant must follow; and
        (4) specify the name of the drug or drug classification being delegated to the physician assistant and the protocol the physician assistant shall follow in prescribing a drug.
    (g) The physician shall submit the supervisory agreement to the board. for approval. The physician assistant may not prescribe a drug under the supervisory agreement until unless the board approves denies the supervisory agreement. Any amendment to the supervisory agreement must be resubmitted to the board, for approval, and the physician assistant may not operate under any new prescriptive

authority under the amended supervisory agreement until unless the agreement has been approved denied by the board.
    (h) A physician or a physician assistant who violates the supervisory agreement described in this section may be disciplined under IC 25-1-9.

SOURCE: IC 25-27.5-5-4; (11)MO036311.13. -->     SECTION 13. IC 25-27.5-5-4, AS AMENDED BY P.L.90-2007, SECTION 25, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 4. (a) Except as provided in this section, a physician assistant may prescribe, dispense, and administer drugs and medical devices or services to the extent delegated by the supervising physician.
    (b) A physician assistant may not prescribe, dispense, or administer ophthalmic devices, including glasses, contact lenses, and low vision devices.
    (c) As permitted by the board, A physician assistant may use or dispense only drugs prescribed or approved by the supervising physician. A physician assistant may not prescribe or dispense the following drugs:
        (1) a schedule I substance listed in IC 35-48-2-4.
        (2) A schedule II substance listed in IC 35-48-2-6.
        (3) A schedule III, schedule IV, or schedule V drug if the drug contains oxycodone.
However, a physician assistant may prescribe one (1) dose of a drug listed in subdivision (2) or (3) for immediate administration if the patient is in an inpatient hospital post-operative setting and the physician is unavailable to make the prescription.
    (d) A physician assistant may request, receive, and sign for professional samples and may distribute professional samples to patients if the samples are within the scope of the physician assistant's prescribing privileges delegated by the supervising physician.
    (e) A physician assistant may not prescribe drugs unless the physician assistant has successfully completed at least thirty (30) contact hours in pharmacology from an educational program that is approved by the committee.
    (f) A physician assistant may not prescribe, administer, or monitor general anesthesia, regional anesthesia, or deep sedation as defined by the board. A physician assistant may not administer moderate sedation:
        (1) if the moderate sedation contains agents in which the manufacturer's general warning advises that the drug should be administered and monitored by an individual who is:
            (A) experienced in the use of general anesthesia; and
            (B) not involved in the conduct of the surgical or diagnostic procedure; and
        (2) during diagnostic tests, surgical procedures, or obstetric procedures unless the following conditions are met:
            (A) A physician is physically present in the area, is

immediately available to assist in the management of the patient, and is qualified to rescue patients from deep sedation.
            (B) The physician assistant is qualified to rescue patients from deep sedation and is competent to manage a compromised airway and provide adequate oxygenation and ventilation by reason of meeting the following conditions:
                (i) The physician assistant is certified in advanced cardiopulmonary life support.
                (ii) The physician assistant has knowledge of and training in the medications used in moderate sedation, including recommended doses, contraindications, and adverse reactions.
    (g) Before a physician assistant may prescribe drugs, the physician assistant must have been continuously employed practiced as a physician assistant:
         (1) for not less than at least one (1) year after graduating from a physician assistant program approved by the committee; To be considered to have been continuously employed as a physician assistant for a year for purposes of this subsection, a person must have worked as a physician assistant more than and
         (2) at least one thousand eight hundred (1,800) hours. during the year.

SOURCE: IC 25-27.5-5-6; (11)MO036311.14. -->     SECTION 14. IC 25-27.5-5-6, AS ADDED BY P.L.90-2007, SECTION 27, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 6. (a) Except as provided in section 4(d) of this chapter, a supervising physician may delegate authority to a physician assistant to prescribe:
        (1) legend drugs except as provided in section 4(c) of this chapter; and
        (2) medical devices (except ophthalmic devices, including glasses, contact lenses, and low vision devices).
    (b) Any prescribing authority delegated to a physician assistant must be expressly delegated in writing by the physician assistant's supervising physician, including:
        (1) the name of the drug or drug classification being delegated by the supervising physician; and
        (2) the protocols the physician assistant shall use when prescribing the drug.
    (c) A physician assistant who is delegated the authority to prescribe legend drugs or medical devices must do the following:
        (1) Enter the following on each prescription form that the physician assistant uses to prescribe a legend drug or medical device:
            (A) The signature of the physician assistant.
            (B) The initials indicating the credentials awarded to the physician assistant by the NCCPA.
            (C) The physician assistant's state license number.
        (2) Comply with all applicable state and federal laws concerning prescriptions for legend drugs and medical devices.
    (d) A supervising physician may delegate to a physician assistant the authority to prescribe only legend drugs and medical devices that are within the scope of practice of the licensed supervising physician or the physician designee.
    (e) A physician assistant who is delegated the authority to prescribe controlled substances under subsection (a) and in accordance with the limitations specified in section 4(c) of this chapter, must do the following:
        (1) Obtain an Indiana controlled substance registration and a federal Drug Enforcement Administration registration.
        (2) Enter the following on each prescription form that the physician assistant uses to prescribe a controlled substance:
            (A) The signature of the physician assistant.
            (B) The initials indicating the credentials awarded to the physician assistant by the NCCPA.
            (C) The physician assistant's state license number.
            (D) The physician assistant's federal Drug Enforcement Administration (DEA) number.
        (3) Comply with all applicable state and federal laws concerning prescriptions for controlled substances.
    (f) A supervising physician may only delegate to a physician assistant the authority to prescribe controlled substances:
        (1) that may be prescribed within the scope of practice of the licensed supervising physician or the physician designee;
        (2) in an amount that does not exceed
            (A) a seven (7) thirty (30) day supply; for treatment of a single acute episode of a condition or injury; or
            (B) if a controlled substance cannot be dispensed in an amount that is small enough to meet the requirement of clause (A), the smallest dispensable amount; and
        (3) in accordance with the limitations set forth in section 4(c) of this chapter.
SOURCE: IC 25-27.5-6-1; (11)MO036311.15. -->     SECTION 15. IC 25-27.5-6-1 IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 1. (a) Supervision by the supervising physician or the physician designee must be continuous but does not require the physical presence of the supervising physician at the time and the place that the services are rendered.
    (b) A supervising physician or physician designee shall review all patient encounters not later than twenty-four (24) seventy-two (72) hours after the physician assistant has seen the patient.
     (c) The supervising physician or physician designee shall review within seventy-two (72) hours after a patient encounter at least the following percentages of the patient charts:
        (1) For the first year of employment of the physician assistant, one hundred percent (100%).
        (2) For the second year of employment of the physician assistant, fifty percent (50%).
        (3) For the third year of employment of the physician assistant, twenty-five percent (25%).
However, if the physician assistant has had less than one thousand eight hundred (1,800) hours of practice, the supervising physician or physician designee shall review one hundred percent (100%) of the charts within seventy-two (72) hours of the patient encounter.

SOURCE: IC 25-27.5-6-4; (11)MO036311.16. -->     SECTION 16. IC 25-27.5-6-4, AS AMENDED BY P.L.177-2009, SECTION 56, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 4. (a) A physician supervising a physician assistant must do the following:
        (1) Be licensed under IC 25-22.5.
        (2) Register with the board the physician's intent to supervise a physician assistant.
        (3) Submit a statement to the board that the physician will exercise supervision over the physician assistant in accordance with rules adopted by the board and retain professional and legal responsibility for the care rendered by the physician assistant.
        (4) Not have a disciplinary action restriction that limits the physician's ability to supervise a physician assistant.
         (5) Maintain a written agreement with the physician assistant that states the physician will:
            (A) exercise supervision over the physician assistant in accordance with any rules adopted by the board; and
            (B) retain responsibility for the care rendered by the physician assistant.
        The agreement must be signed by the physician and physician assistant, updated annually, and made available to the board upon request.

    (b) Except as provided in this section, this chapter may not be construed to limit the employment arrangement with a supervising physician under this chapter.".
SOURCE: Page 11, line 8; (11)MO036311.11. -->     Page 11, after line 8, begin a new paragraph and insert:
SOURCE: IC 35-48-3-9; (11)MO036311.18. -->     "SECTION 18. IC 35-48-3-9, AS AMENDED BY P.L.204-2005, SECTION 21, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2011]: Sec. 9. (a) Except for dosages medically required for a period of not more than forty-eight (48) hours that are dispensed by or on the direction of a practitioner or medication dispensed directly by a practitioner, other than a pharmacy, to an ultimate user, no controlled substance in schedule II may be dispensed without the written or electronic prescription of a practitioner.
    (b) In emergency situations, as defined by rule of the board, schedule II drugs may be dispensed upon oral prescription of a

practitioner, reduced promptly to writing and filed by the pharmacy. Prescriptions shall be retained in conformity with the requirements of section 7 of this chapter. No prescription for a schedule II substance may be refilled.
    (c) Except for dosages medically required for a period of not more than forty-eight (48) hours that are dispensed by or on the direction of a practitioner, or medication dispensed directly by a practitioner, other than a pharmacy, to an ultimate user, a controlled substance included in schedule III or IV, which is a prescription drug as determined under IC 16-42-19, shall not be dispensed without a written, electronic, or oral prescription of a practitioner. The prescription shall not be filled or refilled more than six (6) months after the date thereof or be refilled more than five (5) times, unless renewed by the practitioner. Prescriptions for schedule III, IV, and V controlled substances may be transmitted by facsimile from the practitioner or the agent of the practitioner to a pharmacy. The facsimile prescription is equivalent to an original prescription to the extent permitted under federal law.
    (d) A controlled substance included in schedule V shall not be distributed or dispensed other than for a medical purpose.".
    Renumber all SECTIONS consecutively.
    (Reference is to ESB 363 printed April 12, 2011.)

________________________________________

Representative Davisson


MO036311/DI 14     2011