S 4114

SENATE, No. 4114
STATE OF NEW JERSEY
222nd LEGISLATURE
�
INTRODUCED MAY 11, 2026
Sponsored by:
Senator� JOSEPH A. LAGANA
District 38 (Bergen)
SYNOPSIS
���� Authorizes physician assistants in behavioral health
care to provide procedures and services without supervision.
CURRENT VERSION OF TEXT
���� As introduced.
��
An Act concerning supervision of certain physician
assistants and supplementing P.L.1991, c.378 and amending various parts of the
statutory law.
���� Be It
Enacted by the Senate and General Assembly of
the State of New Jersey:
���� 1.��� Section 2 of P.L.1991,
c.378 (C.45:9-27.11) is amended to read as follows:
���� 2.��� As used in this act:
���� "Accredited program"
means an education program for physician assistants which is accredited by the
Accreditation Review Commission on Education for the Physician Assistant or its
predecessor or successor agency.
���� �Behavioral health care�
means procedures or services rendered by a physician
assistant to a patient for the treatment of a mental illness, emotional
disorder, or drug or alcohol use disorder.
���� "Board" means the
State Board of Medical Examiners created pursuant to R.S.45:9-1.
���� "Committee" means
the Physician Assistant Advisory Committee established pursuant to section 11
of P.L.1991, c.378 (C.45:9-27.20).
���� "Director" means the
Director of the Division of Consumer Affairs.
���� "Health care
facility" means a health care facility as defined in section 2 of
P.L.1971, c.136 (C.26:2H-2).
���� "Institution" means
any of the charitable, hospital, relief and training institutions,
noninstitutional agencies, and correctional institutions enumerated in
R.S.30:1-7.
���� "Physician
assistant" means a health professional who meets the qualifications under
P.L.1991, c.378 (C.45:9-27.10 et seq.) and holds a current, valid license
issued pursuant to section 4 of P.L.1991, c.378 (C.45:9-27.13).
���� "Physician" means a
person licensed to practice medicine and surgery pursuant to chapter 9 of Title
45 of the Revised Statutes.
���� "Veterans' home"
means the New Jersey Veterans' Memorial Home - Menlo Park, the New Jersey
Veterans' Memorial Home - Vineland, and the New Jersey Veterans' Memorial Home
- Paramus.
(cf: P.L.2015, c.224, s.1)
���� 2.��� Section 11 of P.L.2015,
c.224 (C.45:9-27.13a) is amended to read as follows:
���� 11.� a.� A physician assistant
who engages in clinical practice, including providing behavioral
health care pursuant to section 9 of P.L.��� , c.��� (C.������� ) (pending
before the Legislature as this bill), in this State is required to be
covered by medical malpractice liability insurance, or if such liability
coverage is not available, by a letter of credit.� The board shall establish by
regulation the minimum amount for medical malpractice liability insurance
coverage or lines of credit.
���� b.��� The physician assistant
shall include, on the physician assistant's license renewal form, the name and
address of the insurance carrier or the institution issuing the letter of
credit to the physician assistant.
���� c.���� A physician assistant
who is in violation of this section is subject to disciplinary action and civil
penalties pursuant to sections 8, 9, and 12 of P.L.1978, c.73 (C.45:1-21 to 22
and 45:1-25).
���� d.��� The board shall notify
all licensed physician assistants of the requirements of this section within 30
days of the date of enactment of [P.L.2015,
c.224 (C.45:9-27.13a et al.)]
P.L.��� , c.��� (C.������� ) (pending before the Legislature as this bill).
(cf: P.L.2015, c.224, s.11)
���� 3.��� Section 6 of P.L.1991,
c.378 (C.45:9-27.15) is amended to read as follows:
���� 6.��� a. A physician assistant
may practice in all medical care settings, including, but not limited to, a
physician's office, a health care facility, an institution, a veterans' home,
or a private home, provided that:
���� (1)�� the physician assistant
performs medical services within the physician assistant's education, training,
and experience under the supervision of a physician pursuant to section 9 of
P.L.1991, c.378 (C.45:9-27.18).� A physician assistant providing behavioral
health care pursuant to section 9 of P.L.��� , c.��� (C.������� ) (pending
before the Legislature as this bill) shall be exempt from the requirement for supervision
by a physician;
���� (2)�� the practice of the
physician assistant is limited to those procedures enumerated under section 7
of P.L.1991, c.378 (C.45:9-27.16), and any other procedures that are delegated
to the physician assistant by the supervising physician, as authorized under subsection
d. of section 7 of P.L.1991, c.378 (C.45:9-27.16), and to those authorized
in accordance with section 9 of P.L.��� , c.��� (C.������� ) (pending before
the Legislature as this bill);
���� (3)�� (Deleted by amendment,
P.L.2015, c.224)
���� (4)�� the supervising
physician or physician assistant advises the patient at the time that services
are rendered that they are to be performed by the physician assistant;
���� (5)�� the physician assistant
conspicuously wears an identification tag using the term "physician
assistant" or the designation, "PA-C" or "PA" whenever
acting in that capacity; and
���� (6)�� any entry by a physician
assistant in a clinical record is appropriately signed and followed by the
designation, "PA-C" or "PA."
���� b.��� Any physician assistant
who practices in violation of any of the conditions specified in subsection a.
of this section shall be deemed to have engaged in professional misconduct in
violation of subsection e. of section 8 of P.L.1978, c.73 (C.45:1-21).
(cf: P.L.2015, c.224, s.3)
���� 4.��� Section 7 of P.L.1991,
c.378 (C.45:9-27.16) is amended to read as follows:
���� 7.��� a. A physician assistant
may perform the following procedures:
���� (1)�� Approaching a patient to
elicit a detailed and accurate history, perform an appropriate physical
examination, identify problems, record information, and interpret and present
information to the supervising physician;
���� (2)�� Suturing and caring for
wounds including removing sutures and clips and changing dressings, except for
facial wounds, traumatic wounds requiring suturing in layers, and infected
wounds;
���� (3)�� Providing patient
counseling services and patient education consistent with directions of the
supervising physician;
���� (4)�� Assisting a physician in
an inpatient setting by conducting patient rounds, recording patient progress
notes, determining and implementing therapeutic plans jointly with the
supervising physician, and compiling and recording pertinent narrative case
summaries;
���� (5)�� Assisting a physician in
the delivery of services to patients requiring continuing care in a private
home, nursing home, extended care facility, or other setting, including the
review and monitoring of treatment and therapy plans; and�����
���� (6)�� Referring patients to,
and promoting their awareness of, health care facilities and other appropriate
agencies and resources in the community.
���� (7)�� (Deleted by amendment,
P.L.2015, c.224)
���� �b.�� A physician assistant
may perform the following procedures only when directed, ordered, or prescribed
by the supervising physician, or when performance of the procedure is delegated
to the physician assistant by the supervising physician as authorized under
subsection d. of this section:
���� (1)�� Performing non-invasive
laboratory procedures and related studies or assisting duly licensed personnel
in the performance of invasive laboratory procedures and related studies;
���� (2)�� Giving injections,
administering medications, and requesting diagnostic studies;
���� (3)�� Suturing and caring for
facial wounds, traumatic wounds requiring suturing in layers, and infected
wounds;
���� (4)�� Writing prescriptions or
ordering medications in an inpatient or outpatient setting in accordance with
section 10 of P.L.1991, c.378 (C.45:9-27.19);
���� (5)�� Prescribing the use of
patient restraints; and
���� (6)�� Authorizing qualifying
patients for the medical use of cannabis and issuing written instructions for
medical cannabis to registered qualifying patients pursuant to P.L.2009, c.307
(C.24:6I-1 et al.).
���� c.���� A physician assistant
may assist a supervising surgeon in the operating room when a qualified
assistant physician is not required by the board and a second assistant is
deemed necessary by the supervising surgeon.
���� d.��� A physician assistant
may perform medical services beyond those explicitly authorized in this
section, when such services are delegated by a supervising physician with whom
the physician assistant has signed a delegation agreement pursuant to section 8
of P.L.1991, c.378 (C.45:9-27.17).� The procedures delegated to a physician
assistant shall be limited to those customary to the supervising physician's
specialty and within the supervising physician's and the physician assistant's
competence and training.
���� e.���� Notwithstanding
subsection d. of this section, a physician assistant shall not be authorized to
measure the powers or range of human vision, determine the accommodation and
refractive states of the human eye, or fit, prescribe, or adapt lenses, prisms,
or frames for the aid thereof.� Nothing in this subsection shall be construed
to prohibit a physician assistant from performing a routine visual screening.
���� f.���� A physician
assistant shall be able to provide behavioral health care without the
supervision of a physician if the physician assistant qualifies to provide the
behavioral health care pursuant to section 9 of P.L.��� , c.��� (C.������� )
(pending before the Legislature as this bill).
(cf: P.L.2019, c.153, s.45)
���� 5.��� Section 9 of P.L.1991,
c.378 (C.45:9-27.18) is amended to read as follows:
���� 9.��� a. A physician assistant
shall be under the supervision of a physician at all times during which the
physician assistant is working in an official capacity, unless a physician
assistant practices behavioral health care pursuant to section 9 of P.L.��� ,
c.��� (C.������� ) (pending before the Legislature as this bill).
���� b.��� Supervision of a
physician assistant shall be continuous but shall not be construed as
necessarily requiring the physical presence of the supervising physician,
provided that the supervising physician and physician assistant maintain
contact through electronic, or other means of, communication.
���� (1)�� (Deleted by amendment,
P.L.2015, c.224)
���� (2)�� (Deleted by amendment,
P.L.2015, c.224)
���� (3)�� (Deleted by amendment,
P.L.2015, c.224)
���� c.���� (Deleted by amendment,
P.L.2015, c.224)
���� (1)�� (Deleted by amendment,
P.L.2015, c.224)
���� (2)�� (Deleted by amendment,
P.L.2015, c.224)
���� (3)�� (Deleted by amendment,
P.L.2015, c.224)
���� d.��� (Deleted by amendment,
P.L.2015, c.224)
���� (1)�� (Deleted by amendment,
P.L.2015, c.224)
���� (2)�� (Deleted by amendment,
P.L.2015, c.224)
���� (3)�� (Deleted by amendment,
P.L.2015, c.224)
���� e.���� It is the obligation of
each supervising physician and physician assistant to ensure that:� (1) the
physician assistant's scope of practice is identified; (2) delegation of
medical tasks is appropriate to the physician assistant's level of competence;
(3) the relationship of, and access to, the supervising physician is defined;
and (4) a process for evaluation of the physician assistant's performance is
established.
(cf: P.L.2015, c.224, s.6)
���� 6.��� Section 10 of P.L.1991,
c.378 (C.45:9-27.19) is amended to read as follows:
���� 10.� A physician assistant may
order, prescribe, dispense, and administer medications and medical devices and
issue written instructions to registered qualifying patients for medical
cannabis to the extent delegated by a supervising physician, unless a
physician assistant provides behavioral health care in accordance with
section�� 9 of P.L.��� , c.��� (C.������� ) (pending before the Legislature as
this bill).
���� �a.��� Controlled dangerous
substances may only be ordered or prescribed if:
���� (1)�� a supervising physician
has authorized a physician assistant to order or prescribe Schedule II, III,
IV, or V controlled dangerous substances in order to:
���� (a)�� continue or reissue an
order or prescription for a controlled dangerous substance issued by the
supervising physician;
���� (b)�� otherwise adjust the
dosage of an order or prescription for a controlled dangerous substance
originally ordered or prescribed by the supervising physician, provided there
is prior consultation with the supervising physician;
���� (c)�� initiate an order or
prescription for a controlled dangerous substance for a patient, provided there
is prior consultation with the supervising physician if the order or
prescription is not pursuant to subparagraph (d) of this paragraph; or
���� (d)�� initiate an order or
prescription for a controlled dangerous substance as part of a treatment plan
for a patient with a terminal illness, which for the purposes of this
subparagraph means a medical condition that results in a patient's life
expectancy being 12 months or less as determined by the supervising physician;
���� (2)�� the physician assistant
has registered with, and obtained authorization to order or prescribe
controlled dangerous substances from, the federal Drug Enforcement
Administration and any other appropriate State and federal agencies; and
���� (3)�� the physician assistant
complies with all requirements which the board shall establish by regulation
for the ordering, prescription, or administration of controlled dangerous
substances, all applicable educational program requirements, and continuing professional
education programs approved pursuant to section 16 of P.L.1991, c.378
(C.45:9-27.25).
���� �b.�� (Deleted by amendment,
P.L.2015, c.224)
���� �c.��� (Deleted by amendment,
P.L.2015, c.224)
���� �d.�� In the case of an order
or prescription for a controlled dangerous substance or written instructions
for medical cannabis, the physician assistant shall print on the order or
prescription or the written instructions the physician assistant's Drug Enforcement
Administration registration number.
���� �e.��� The dispensing of
medication or a medical device by a physician assistant shall comply with
relevant federal and State regulations, and shall occur only if: (1) pharmacy
services are not reasonably available; (2) it is in the best interest of the
patient; or (3) the physician assistant is rendering emergency medical
assistance.
���� �f.��� A physician assistant
may request, receive, and sign for prescription drug samples and may distribute
those samples to patients.
���� �g.�� A physician assistant
may issue written instructions to a registered qualifying patient for medical
cannabis pursuant to section 10 of P.L.2009, c.307 (C.24:6I-10) only if:
���� (1)�� a supervising physician
has authorized the physician assistant to issue written instructions to
registered qualifying patients;
���� (2)�� the physician assistant
verifies the patient's status as a registered qualifying patient; and
���� (3)�� the physician assistant
complies with the requirements for issuing written instructions for medical
cannabis established pursuant to P.L.2009, c.307 (C.24:6I-1 et al.).
(cf: P.L.2019, c.153, s.46)
���� 7.��� Section 12 of P.L.2017,
c.341 (C.45:9-27.19b) is amended to read as follows:
���� 12.� a.� Notwithstanding any
other provision of law to the contrary, a physician assistant who is otherwise
authorized to order, prescribe, and dispense controlled dangerous substances
pursuant to P.L.1991, c.378 (C.45:9-27.10 et seq.) may dispense narcotic drugs
for maintenance treatment or detoxification treatment if the physician
assistant has met the training and registration requirements set forth in
subsection (g) of 21 U.S.C. s.823.� A physician assistant who is authorized to
dispense such drugs may do so regardless of whether the physician assistant's
supervising physician has met the training and registration requirements set
forth in subsection (g) of 21 U.S.C. s.823, provided that the written
delegation agreement between the supervising physician and the physician
assistant executed pursuant to subsection d. of section 8 of P.L.1991, c.378
(C.45:9-27.17) included the supervising physician's written approval for the
physician assistant to dispense the drugs or the physician assistant
practices behavioral health care in accordance with section 9 of P.L.    , c.    (C.        ) (pending
before the Legislature as this bill).�
���� b.��� Notwithstanding any
other provision of law to the contrary, a physician assistant under the direct
supervision of a licensed physician or practicing behavioral health care
pursuant to section 9 of P.L.��� , c.��� (C.������� ) (pending before the
Legislature as this bill) may make the determination as to the medical
necessity for services for the treatment of substance use disorder, as provided
in P.L.2017, c.28 (C.17:48-6nn et al.), and may prescribe such services.�
(cf: P.L.2017, c.341, s.12)
���� 8.��� Section 17 of P.L.1991,
c.378 (C.45:9-27.26) is amended to read as follows:
���� 17.� In consultation with the
committee, the board shall, in addition to such other powers and duties as it
may possess by law:
���� a.���� Administer and enforce
the provisions of P.L.1991, c.378 (C.45:9-27.10 et seq.) and P.L.��� , c.���
(C.������� ) (pending before the Legislature as this bill);
���� b.��� Adopt and promulgate
rules and regulations, pursuant to the "Administrative Procedure
Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to effectuate the purposes of
P.L.1991, c.378 (C.45:9-27.10 et seq.) and P.L.��� , c.��� (C.������� )
(pending before the Legislature as this bill;
���� c.���� Establish professional
standards for persons licensed under P.L.1991, c.378 (C.45:9-27.10 et seq.) and
providing behavioral health care pursuant to P.L.��� , c.��� (C.������� )
(pending before the Legislature as this bill);
���� d.��� Conduct hearings
pursuant to the "Administrative Procedure Act," P.L.1968, c.410
(C.52:14B-1 et seq.), except that the board shall have the right to administer
oaths to witnesses, and shall have the power to issue subpoenas for the
compulsory attendance of witnesses and the production of pertinent books,
papers, or records;
���� e.���� Conduct proceedings
before any board, agency, or court of competent jurisdiction for the
enforcement of the provisions of P.L.1991, c.378 (C.45:9-27.10 et seq.);
���� f.���� Evaluate and pass upon
the qualifications of candidates for licensure;
���� g.��� (Deleted by amendment,
P.L.2015, c.224)
���� h.��� (Deleted by amendment,
P.L.2015, c.224)
���� i.���� Subject to the
requirements of section 16 of P.L.1991, c.378 (C.45:9-27.25) and section 9 of
P.L.��� , c.��� (C.������� ) (pending before the Legislature as this bill),
establish standards for and approve continuing education programs; and
���� j.���� Have the enforcement
powers provided pursuant to P.L.1978, c.73 (C.45:1-14 et seq.).
(cf: P.L.2015, c.224, s.10)
���� 9.��� (New section) a.� A
physician assistant shall be authorized to provide behavioral health care without
a supervising physician if the physician assistant:
���� (1)�� has completed more than
5,000 hours of licensed, active work as a licensed physician assistant in
behavioral health care; and
���� (2)�� each licensure renewal
period, demonstrates completion of at least 10 contact hours of continuing
education in pharmacology.
���� b.��� A physician assistant
who practices independently shall be held to the same standard of care as other
independent health care practitioners.
���� c.���� A physician assistant shall immediately notify the Physician Assistant
Advisory Committee if the physician assistant:
���� (1)�� is
incapable, for medical or any other good cause, of discharging the functions of
a physician assistant in a manner consistent with the public's health, safety
and welfare;
���� (2)�� is
indicted or convicted of a crime involving moral turpitude or a crime adversely
relating to the physician assistant�s practice;
���� (3)�� is
named as a defendant or respondent in a civil, criminal or administrative
investigation, complaint or judgment involving alleged malpractice, negligence
or misconduct relating to the physician assistant�s practice;
���� (4)�� is
the subject of any voluntary license or certification surrender or any
disciplinary action or order by any state or Federal agency, board or
commission, including any order of limitation or preclusion; or
���� (5)�� fails
to maintain or renew any certification which is required by law as a condition
of practice or as a condition of license renewal.
���� d.��� Any
provision of State law or regulation that requires the signature, stamp,
verification, affidavit, or endorsement of a physician shall be deemed to
require the signature, stamp, verification, affidavit, or endorsement of a
physician or a physician assistant providing behavioral health care, to the
extent consistent with the scope of practice of the physician assistant
providing behavioral health care.
���� e.���� If
the physician assistant does not provide services to beneficiaries of the
Medicare program established pursuant to section 1801 of the Social Security
Act (42 U.S.C. s.1395 et seq.), the physician assistant shall, if applicable,
prominently display in the office of the physician assistant an appropriate
notice, and inform, in writing, the Physician Assistant Advisory Committee.
���� 10.� This act shall take
effect on the first day of the thirteenth month next following the date of
enactment except that the State Board of Medical Examiners may take any
anticipatory action as necessary to implement the provisions of the act.
STATEMENT
���� This bill authorizes physician
assistants to provide behavioral health care without supervision.� �Behavioral
health care� is defined in the bill to mean procedures
or services rendered by a physician assistant to a patient for the treatment of
a mental illness, emotional disorder, or drug or alcohol use disorder.
���� Under the bill, a physician
assistant may provide behavioral health care without supervision if the
physician assistant has completed more than 5,000 hours of licensed, active
work as a licensed physician assistant in behavioral health care and, for each
licensure renewal period, demonstrate completion of at least 10 contact hours
of continuing education in pharmacology.
���� The bill further stipulates
that a physician assistant who practices independently is 1) to be held to the
same standard of care as other independent health care practitioners and 2) is to report on a variety of matters to the Physician
Assistant Advisory Committee if certain circumstances arise, including if
the physician assistant is incapable, for medical or
any other good cause, of discharging the functions of a physician assistant in
a manner consistent with the public's health, safety and welfare.�
Additionally, the bill allows that any provision of State law or regulation
that requires the signature, stamp, verification, affidavit, or endorsement of
a physician is to be deemed to require the signature, stamp, verification,
affidavit, or endorsement of a physician or a physician assistant providing
behavioral health care, to the extent consistent with the scope of practice of the
physician assistant providing behavioral health care.
���� The
bill incorporates physician assistants providing behavioral health care
independently into the statute governing physician assistants, including as
part of the requirement for malpractice insurance or a letter of credit.
���� Lastly,
a physician assistant independently providing behavioral health care is to, if
applicable, prominently display in the office of the physician assistant an
appropriate notice if the physician assistant does not provide services to Medicare
beneficiaries.� The physician assistant is to also inform, in writing, the Physician
Assistant Advisory Committee.