BILL ANALYSIS �
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|Hearing Date:April 21, 2014 |Bill No:SB |
| |1083 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Ted W. Lieu, Chair
Bill No: SB 1083Author:Pavley
As Introduced: February 19, 2014 Fiscal: No
SUBJECT: Physicians assistants: disability certifications
SUMMARY: Amends the Physician Assistant Practice Act to authorize a
physician assistant to certify claims for disability insurance, after
performance of a physical examination by the physician assistant and
under the supervision of a physician and surgeon. The bill also
expands the definition of "practitioner" to include physician
assistants.
Existing law:
1) Authorizes the Physician Assistant Board to license and regulate
the practice of physician assistants (PAs). (BPC � 3504 et seq.)
2) Specifies the delegation of services agreement for a physician
assistant (PA) including ordering durable medical equipment,
approving, signing, modifying or, after consultation with a
supervising physician, adding to a plan of treatment or care. (BPC
� 3502.3 et seq.)
3) Allows a physician assistant or nurse practitioner, under the
supervision of a physician, to carry out the initial report for and
authorize temporary disability for no more than three calendar
days. (Labor Code � 3209.10)
4) Prohibits a physician assistant or nurse practitioner from
prescribing permanent disability insurance. (Labor Code � 3209.10)
5) Allows the claimant to apply for disability insurance (DI) by
having a doctor's note that certifies the claimant's illness,
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injury, or pregnancy, or that of a family member that is under the
claimant's care. If the claimant requires more DI after the first
period of DI is over, they can continue to file for DI using the
original doctor's note. (Unemployment Insurance Code � 2708 (a)
(1))
6) Defines a "doctor's note" as a medical document that certifies the
claimant's illness, injury, or pregnancy based on the physician or
practitioner's medical knowledge, a physical examination, and the
claimant's medical history. The note must also include the
physician or practitioner's recommendation for the claimant's leave
from work and their reception of disability insurance.
(Unemployment Insurance Code � 2708 (a) (2))
7) Defines "Practitioner" as 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, 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. (Unemployment Insurance Code � 2708 (e) (2))
This bill:
1) Permits physician assistants to certify disability under the
supervision of a physician and surgeon.
2) Expands the definition of practitioner to include physician
assistants for the purpose of conducting a physical examination
required for disability certification.
FISCAL EFFECT: Unknown. This bill has been keyed "non-fiscal" by
Legislative Counsel.
COMMENTS:
1. Purpose. This bill is sponsored by the California Academy of
Physician Assistants . According to the Author, "Physician
assistants are licensed health care professionals who practice
medicine as members of a physician-led team, delivering a broad
range of medical and surgical services to diverse populations in
rural, urban and suburban settings?SB 1083 would include physician
assistants as recognized practitioners who may certify disability
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insurance with the State Employment Development Department (EDD)."
The Author believes ,"?this bill closes a loophole in the law that
currently allows PAs to certify some claims of temporary
disability, such as Paid Family Leave, but not others such as
claims for disability insurance with the EDD."
2. Background.
a) Physician Assistant Roles and Training .
A physician assistant, or PA, is a licensed and highly skilled
health care professional trained to provide patient evaluation,
education, and health care services. A PA works with a physician
to provide medical care and guidance needed by a patient.
A PA must attend a specialized medical training program
associated with a medical school that includes classroom studies
and clinical experience. An Academic degree and/or certificate
is awarded upon graduation. Most PA training programs require
prior health care experience. Many PAs have two or four-year
academic degrees before entering a PA training program.
b) Authorization to Sign Forms .
Current law permits PAs to sign corresponding certificates or
forms for the purpose of issuing disabled person placards,
certify licensees to drive standard commercial vehicles, school
buses, general public transportation vehicles, and farm labor
vehicles. PAs are also authorized to conduct physical
examinations and sign corresponding forms or certificates for
those seeking employment in school districts or with the county
superintendent of schools.
Under current law, PAs can certify some claims of temporary
disability including Paid Family Leave (PFL). The PFL insurance
provides up to six weeks of benefits for individuals who must
take time off to care for a seriously ill child, spouse, parent,
or registered domestic partner, or to bond with a new child.
c) State Disability Insurance (SDI) programs .
According to information obtained from the California Employment
Development Department, SDI programs offer affordable, short-term
benefits to eligible workers who suffer a loss of wages when they
are unable to work due to a non-work-related injury or due to
pregnancy or childbirth. SDI eligible workers must not have been
able to perform their daily work tasks for at least eight
consecutive days.
Anyone who is considered under California law as a "practitioner"
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can sign SDI forms via EDD's online system. A "practitioner" is
defined as any person who has been licensed or certified in
California as a dentist, podiatrist, or nurse practitioner who
collaborates with a physician and surgeon. In the case of
signing forms for an individual who is determined to have a
normal pregnancy or childbirth; a midwife, nurse midwife, or
nurse practitioner can perform a physical examination to
determine whether or not the patient is eligible for SDI.
Additionally, a medical officer of a U.S. Government facility,
chiropractor, or psychologist is also authorized to certify
claims for SDI. However, because PAs are not recognized as a
practitioner, they are not permitted to certify claims for SDI.
3. Arguments in Support. The California Academy of Physician
Assistants is the sponsor of this measure and notes in their
letter, "The restrictions related to EDD forms are inconsistent
with the scope of practice of a physician assistant, which allows
them to act as an agent of their supervising physician in
performing medical examinations as well as most other medical
services. The law pertaining to DI is also inconsistent with a
physician assistants' ability to certify other claims of temporary
disability, such as Paid Family Leave under the Family Medical
Leave Act and the California Family Rights Act, but not claims for
Disability Insurance."
Kaiser Permanente also supports the bill and writes, "This bill
would align PA's scope of practice with authority nurse
practitioners gained under SB 819 (Yee) in 2009. Kaiser Permanente
supports this bill as it would reduce confusion, expand the pool of
medical professionals who can certify disability, and ensure
appropriate physician supervision."
4. Policy Issue. According to the Author, EDD has recently created an
online version of the SDI application. If PAs are added to the
list of authorized providers who can sign off on SDI claims, it
will be necessary for PAs to be added to the newly automated EDD
SDI form.
SUPPORT AND OPPOSITION:
Support: California Academy of Physician Assistants (Sponsor)
Opposition : None received as of April 15, 2014
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Consultants: Zach Shpak and Le Ondra Clark