Senate Bill No. 1083

Introduced by Senator Pavley

February 19, 2014

An act to amend Section 3502.3 of the Business and Professions Code, and to amend Section 2708 of the Unemployment Insurance Code, relating to physician assistants.

LEGISLATIVE COUNSEL’S DIGEST

SB 1083, as introduced, Pavley. Physician assistants: disability certifications.

The Physician Assistant Practice Act authorizes a delegation of services agreement to authorize a physician assistant to engage in specified activities.

Existing law requires a claimant for unemployment compensation disability benefits to establish medical eligibility for each uninterrupted period of disability by filing a first claim for disability benefits supported by the certificate of a treating physician or practitioner that establishes the sickness, injury, or pregnancy of the employee, or the condition of the family member that warrants the care of the employee. Existing law defines the term “practitioner” to mean a person duly licensed or certified in California acting within the scope of his or her license or certification who is a dentist, podiatrist, or a nurse practitioner, as prescribed.

This bill would amend the Physician Assistant Practice Act to authorize a physician assistant to certify disability, after performance of a physical examination by the physician assistant under the supervision of a physician and surgeon consistent with the act. The bill would correspondingly expand the definition of practitioner to include a physician assistant.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 3502.3 of the Business and Professions
Code is amended to read:

3502.3.  

(a) Notwithstanding any other provision of law, in
addition to any other practices that meet the general criteria set
forth in this chapter or the Medical Board of California’s
regulations for inclusion in a delegation of services agreement, a
delegation of services agreement may authorize a physician
assistant to do any of the following:

(1) Order durable medical equipment, subject to any limitations
set forth in Section 3502 or the delegation of services agreement.
Notwithstanding that authority, nothing in this paragraph shall
operate to limit the ability of a third-party payer to require prior
approval.

(2) For individuals receiving home health services or personal
care services, after consultation with the supervising physician,
approve, sign, modify, or add to a plan of treatment or plan of care.

begin insert

(3) After performance of a physical examination by the physician
assistant under the supervision of a physician and surgeon
consistent with this chapter, certify disability pursuant to Section
2708 of the Unemployment Insurance Code.

end insert

(b) Nothing in this section shall be construed to affect the
validity of any delegation of services agreement in effect prior to
the enactment of this section or those adopted subsequent to
enactment.

SEC. 2.  

Section 2708 of the Unemployment Insurance Code,
as added by Section 2 of Chapter 350 of the Statutes of 2013, is
amended to read:

2708.  

(a) (1) In accordance with the director’s authorized
regulations, and except as provided in subdivision (c) and Sections
2708.1 and 2709, a claimant shall establish medical eligibility for
each uninterrupted period of disability by filing a first claim for
disability benefits supported by the certificate of a treating
physician or practitioner that establishes the sickness, injury, or
pregnancy of the employee, or the condition of the family member
that warrants the care of the employee. For subsequent periods of
uninterrupted disability after the period covered by the initial
certificate or any preceding continued claim, a claimant shall file
a continued claim for those benefits supported by the certificate
of a treating physician or practitioner. A certificate filed to establish
medical eligibility for the employee’s own sickness, injury, or
pregnancy shall contain a diagnosis and diagnostic code prescribed
in the International Classification of Diseases, or, if no diagnosis
has yet been obtained, a detailed statement of symptoms.

(2) A certificate filed to establish medical eligibility of the
employee’s own sickness, injury, or pregnancy shall also contain
a statement of medical facts, including secondary diagnoses when
applicable, within the physician’s or practitioner’s knowledge,
based on a physical examination and a documented medical history
of the claimant by the physician or practitioner, indicating the
physician’s or practitioner’s conclusion as to the claimant’s
disability, and a statement of the physician’s or practitioner’s
opinion as to the expected duration of the disability.

(b) An employee shall be required to file a certificate to establish
eligibility when taking leave to care for a family member with a
serious health condition. The certificate shall be developed by the
department. In order to establish medical eligibility of the serious
health condition of the family member that warrants the care of
the employee, the information shall be within the physician’s or
practitioner’s knowledge and shall be based on a physical
examination and documented medical history of the family member
and shall contain all of the following:

(1) A diagnosis and diagnostic code prescribed in the
International Classification of Diseases, or, if no diagnosis has yet
been obtained, a detailed statement of symptoms.

(2) The date, if known, on which the condition commenced.

(3) The probable duration of the condition.

(4) An estimate of the amount of time that the physician or
practitioner believes the employee needs to care for the child,
parent, grandparent, grandchild, sibling, spouse, or domestic
partner.

(5) (A) A statement that the serious health condition warrants
the participation of the employee to provide care for his or her
child, parent, grandparent, grandchild, sibling, spouse, or domestic
partner.

(B) “Warrants the participation of the employee” includes, but
is not limited to, providing psychological comfort, and arranging
“third party” care for the child, parent, grandparent, grandchild,
sibling, spouse, or domestic partner, as well as directly providing,
or participating in, the medical care.

(c) The department shall develop a certification form for bonding
that is separate and distinct from the certificate required in
subdivision (a) for an employee taking leave to bond with a minor
child within the first year of the child’s birth or placement in
connection with foster care or adoption.

(d) The first and any continuing claim of an individual who
obtains care and treatment outside this state shall be supported by
a certificate of a treating physician or practitioner duly licensed
or certified by the state or foreign country in which the claimant
is receiving the care and treatment. If a physician or practitioner
licensed by and practicing in a foreign country is under
investigation by the department for filing false claims and the
department does not have legal remedies to conduct a criminal
investigation or prosecution in that country, the department may
suspend the processing of all further certifications until the
physician or practitioner fully cooperates, and continues to
cooperate, with the investigation. A physician or practitioner
licensed by, and practicing in, a foreign country who has been
convicted of filing false claims with the department may not file
a certificate in support of a claim for disability benefits for a period
of five years.

(e) For purposes of this part:

(1) “Physician” has the same meaning as defined in Section
3209.3 of the Labor Code.

(2) “Practitioner” means a person duly licensed or certified in
California acting within the scope of his or her license or
certification who is a dentist, podiatrist, begin insert physician assistant who
has performed a physical examination under the supervision of a
physician and surgeon, end insert or a nurse practitioner, and in the case of
a nurse practitioner, after performance of a physical examination
by a nurse practitioner and collaboration with a physician and
surgeon, or as to normal pregnancy or childbirth, a midwife or
nurse midwife, or nurse practitioner.

(f) For a claimant who is hospitalized in or under the authority
of a county hospital in this state, a certificate of initial and
continuing medical disability, if any, shall satisfy the requirements
of this section if the disability is shown by the claimant’s hospital
chart, and the certificate is signed by the hospital’s registrar. For
a claimant hospitalized in or under the care of a medical facility
of the United States government, a certificate of initial and
continuing medical disability, if any, shall satisfy the requirements
of this section if the disability is shown by the claimant’s hospital
chart, and the certificate is signed by a medical officer of the
facility duly authorized to do so.

(g) Nothing in this section shall be construed to preclude the
department from requesting additional medical evidence to
supplement the first or any continued claim if the additional
evidence can be procured without additional cost to the claimant.
The department may require that the additional evidence include
any or all of the following:

(1) Identification of diagnoses.

(2) Identification of symptoms.

(3) A statement setting forth the facts of the claimant’s disability.
The statement shall be completed by any of the following
individuals:

(A) The physician or practitioner treating the claimant.

(B) The registrar, authorized medical officer, or other duly
authorized official of the hospital or health facility treating the
claimant.

(C) An examining physician or other representative of the
department.

(h) This section shall become operative on July 1, 2014.