MEDICAL RULES AND REGULATIONS

1

Department of Regulatory Agencies

Colorado Medical Board

MEDICAL RULES AND REGULATIONS

3 CCR 713-1

[Editor’s Notes follow the text of the rules at the end of this CCR Document.]

1.1

AUTHORITY

These rules and regulations are adopted pursuant to the authority in sections 12-20-204

and 12-240-106(1)(a), C.R.S., and are intended to be consistent with the requirements

of the State Administrative Procedures Act, sections 24-4-101, et seq. (the “APA”),

C.R.S., and the Medical Practice Act, sections 12-240-101, et seq. (the “Practice Act”),

C.R.S.

1.2

SCOPE AND PURPOSE

These regulations shall govern the process to become licensed as a physician,

physician assistant, and anesthesiologist assistant in Colorado.

1.3

APPLICABILITY

The provisions of these regulations shall be applicable to the practice of medicine in

Colorado.

1.4

DEFINITIONS [RESERVED]

1.5

RULES AND REGULATIONS RELATING TO THE UNITED STATES MEDICAL

LICENSING EXAMINATION, THE COMPREHENSIVE OSTEOPATHIC MEDICAL

LICENSING EXAMINATION-USA, AND THE FEDERAL LICENSURE EXAMINATION

A.

Basis: The authority for the promulgation of these rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 12-20-204(1) and 12-

240-106(1)(a), 12-240-115, and 12240-110(1)(a), (b) and (c), C.R.S.

B.

Purpose: The purpose of the rules and regulations is to set forth administrative

guidelines for eligibility and acceptance of examinations as required by section

12-240-110(1), C.R.S. These Rules are not meant to preclude acceptance of any

licensing exam previously approved by the board.

C.

The Board authorizes the following examinations as satisfying the required

examinations identified in section 12-240-110(1)(b), C.R.S.

Code of Colorado Regulations

Secretary of State

State of Colorado

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tion

12-240-110(1), C.R.S. These Rules are not meant to preclude acceptance of any

licensing exam previously approved by the board.

C.

The Board authorizes the following examinations as satisfying the required

examinations identified in section 12-240-110(1)(b), C.R.S.

Code of Colorado Regulations

Secretary of State

State of Colorado

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1.

The United States Medical Licensing Examination (“USMLE”),

administered by the National Board of Medical Examiners;

2

The Comprehensive Osteopathic Medical Licensing Examination-USA

(“COMLEX-USA”), administered by the National Board of Osteopathic

Medical Examiners;

3.

The Federal Licensure Examination (“FLEX”), administered by the

Federation of State Medical Boards.

D.

Additional examinations approved by the Board, for the purpose of satisfying the

required examinations identified in Section 12-240-110(1)(a), C.R.S. include:

1.

Medical Council of Canada Qualifying Examination (“MCCQE”), Part I,

along with conferral of the Licentiate of the Medical Council of Canada

(“LMCC”).

To be eligible for USMLE Step 3 or COMLEX-USA Level 3, applicant must have:

1.

Obtained the degree of Medical Doctor (“M.D.”) or Doctor of Osteopathic

Medicine (“D.O.); and,

2.

Successfully completed both USMLE Steps 1 and 2 or COMLEX-USA

Level 1 and 2.

E.

To be eligible to sit for the USMLE Step 3 or COMLEX-USA Level 3, an applicant

must be serving in, or have completed, one year of postgraduate training in a

program of graduate medical education accredited by the Accreditation Council

for Graduate Medical Education (“ACGME”) of the American Medical Association

(“AMA”) or the American Osteopathic Association (“AOA”).

F.

An examinee who fails USMLE Step 3 or COMLEX-USA Level 3 may be

reexamined at any subsequent examination upon payment of the required fee.

G

eted, one year of postgraduate training in a

program of graduate medical education accredited by the Accreditation Council

for Graduate Medical Education (“ACGME”) of the American Medical Association

(“AMA”) or the American Osteopathic Association (“AOA”).

F.

An examinee who fails USMLE Step 3 or COMLEX-USA Level 3 may be

reexamined at any subsequent examination upon payment of the required fee.

G.

In order to be eligible for licensure, an applicant must successfully complete

USMLE Steps 1, 2, and 3 or COMLEX-USA Levels 1, 2, 3, within ten years of the

date the applicant first sat for any step of the USMLE or any level of the

COMLEX, irrespective of whether the applicant passed said step or level. .

1.

Upon applicant’s showing of good cause, the Board may waive the time

requirements set forth in this paragraph (G). Any such waiver shall be

based upon the circumstances relating to the particular individual’s

application. The decision to grant or deny such a waiver shall be in the

sole discretion of the board.

H.

A failure of any USMLE step or COMLEX-USA level, regardless of the jurisdiction

in which the examination was administered, shall be considered a failure of that

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step for purposes of Colorado licensure and shall be considered for purposes of

determining compliance with the requirements of paragraph (D) above.

I.

The USMLE examination is designed to supersede and replace the FLEX over

time.

1.

For those medical students and physicians who may have already

successfully completed part of the FLEX or National Board Examination

sequence, the Board designates the following combinations of

examinations, and passing score for each, which shall be considered

comparable to the existing examinations. In order to meet the examination

requirement for licensure, the examination sequence combinations

illustrated above must be successfully completed no later than January 1,

2000

pleted part of the FLEX or National Board Examination

sequence, the Board designates the following combinations of

examinations, and passing score for each, which shall be considered

comparable to the existing examinations. In order to meet the examination

requirement for licensure, the examination sequence combinations

illustrated above must be successfully completed no later than January 1,

2000.

NBME Part I (passing score = 75) or USMLE Step 1 (passing score = 75)

NBME Part II (passing score = 75) or USMLE Step 2 (passing score = 75)

NBME Part III (passing score = 75) or USMLE Step 3 (passing score = 75)

Or

FLEX Component 1(passing score = 75)

plus

USMLE Step 3 (passing score = 75)

Or

NBME Part I (passing score = 75) or USMLE Step 1 (passing score = 75)

plus

NBME Part II (passing score = 75) or USMLE Step 2 (passing score = 75)

plus

FLEX Component 2 (passing score = 75)

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2.

For those applicants who successfully completed the FLEX, the Board

finds the following minimum scores required to meet the requirements of

section 12-240-110(1), C.R.S.:

DATE OF EXAM

ACCEPTED

SCORES

Before June 1985

75% weighted

average; passed in

one sitting; no

scrambling or

replacement of

scores.

Between June 1985

and December

1993

75 each component;

both components

must be passed

within 7 years

Effective: 5/30/93; Revised:1/30/95; Revised: 5/30/95; Revised: 12/1/95; Revised:

9/30/98; Revised 6/30/00; Revised 12/30/00; Revised 11/15/02, Effective 1/30/03;

Revised 8/19/10, Effective 10/15/10; Revised 5/22/14, Effective 7/15/14; Revised

8/20/15, Effective 10/15/15; Effective 04/30/26

1.6

LICENSURE AND SUPERVISION OF DISTINGUISHED FOREIGN TEACHING

PHYSICIANS

A.

Basis: The authority for promulgation of these rules by the Colorado Medical

Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1), 12-240-106(1)(a),

and 12-240-111, C.R.S.

B

1/30/03;

Revised 8/19/10, Effective 10/15/10; Revised 5/22/14, Effective 7/15/14; Revised

8/20/15, Effective 10/15/15; Effective 04/30/26

1.6

LICENSURE AND SUPERVISION OF DISTINGUISHED FOREIGN TEACHING

PHYSICIANS

A.

Basis: The authority for promulgation of these rules by the Colorado Medical

Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1), 12-240-106(1)(a),

and 12-240-111, C.R.S.

B.

Purpose: These rules have been adopted by the Board to specify standards

related to the qualification and supervision of distinguished foreign teaching

physicians and to clarify application requirements for this license type.

C.

A physician who meets the conditions set forth in section 12-240-111, C.R.S., of

the Medical Practice Act and the qualification standards and application

requirements set forth in this Rule may be granted a distinguished foreign

teaching physician license to practice medicine in this state at the discretion of

the Board. When determining whether an applicant is eligible for this license

type, the Board shall in the exercise of its discretion, consider the following

Qualification Standards.

1.

QUALIFICATION STANDARDS: For licensure as a distinguished foreign

teaching physician that demonstrate noteworthy and recognized

professional attainment.

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a.

The applicant holds a current medical license in good standing in

his/her home country or in any other country.

b.

The applicant's foreign medical education and training meets or

exceeds the minimum educational requirements for medical

licensure in Colorado.

c.

The applicant holds Board certification conferred by a regular

member board of the American Board of Medical Specialties or the

American Osteopathic Association in the applicant's area of

medical specialty OR holds Board certification outside of the United

States.

d.

The applicant has undergone extensive clinical post-graduate

medical training in the applicant's area of medical specialty.

e

do.

c.

The applicant holds Board certification conferred by a regular

member board of the American Board of Medical Specialties or the

American Osteopathic Association in the applicant's area of

medical specialty OR holds Board certification outside of the United

States.

d.

The applicant has undergone extensive clinical post-graduate

medical training in the applicant's area of medical specialty.

e.

The applicant has demonstrated recent clinical experience by being

actively and continuously involved in the practice of medicine for at

least a two year period immediately preceding the filing of the

application and has demonstrated expertise that meets or exceeds

the clinical skills required by the faculty position.

f.

The applicant has demonstrated teaching ability to include prior

experience in an academic position, including other visiting

professorships or professorships.

g.

The applicant has published a significant number of peer-reviewed

articles or noteworthy research in respected medical publications.

h.

The applicant's training, skills or talents will contribute uniquely to

clinical medicine and medical education in Colorado.

i.

The applicant demonstrates that s/he will continue to contribute

uniquely to clinical medicine and medical education in Colorado

during the ensuing period of licensure.

j.

The applicant's other medical license(s) and health care privileges

are unrestricted and have not been subject to discipline by any

licensing body or health care entity.

k.

The applicant is free from prior medical malpractice judgments,

settlements, or their equivalent.

2.

APPLICATION REQUIREMENTS: An applicant for licensure as a

distinguished foreign teaching physician shall:

a.

Fully and accurately complete the Board’s distinguished foreign

teaching physician application, initial or renewal, as applicable;

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pplicant is free from prior medical malpractice judgments,

settlements, or their equivalent.

2.

APPLICATION REQUIREMENTS: An applicant for licensure as a

distinguished foreign teaching physician shall:

a.

Fully and accurately complete the Board’s distinguished foreign

teaching physician application, initial or renewal, as applicable;

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b.

Pay the Board a licensing fee to be determined and collected

pursuant to section 12-20-105, C.R.S.;

c.

Submit a letter from the Dean's Office of the medical school on

whose academic faculty the applicant will serve identifying:

(1)

The applicant's proposed faculty position, title, and term of

appointment;

(2)

Whether the applicant will serve in the role of professor,

associate professor, or assistant professor;

(a)

If assistant professor, provide the following

information:

(i)

An explanation as to why the applicant does

not qualify or satisfy the University guidelines

for the rank of associate professor or higher;

and

(ii)

Identification of a supervising physician who

shall have a rank of associate professor or

above and have a current Colorado medical

license in good standing, which is not a

distinguished foreign teaching license nor

reentry license; and

(b)

For renewal applicants not designated as associate

professor or higher, provide detailed information for

the applicant's plans to obtain Colorado medical

licensure pursuant to sections 12-240-110 or 12-240-

114, C.R.S.;

(3)

The reasons international recruitment for this academic

faculty position was or continues to be necessary, to include

if salary was a motivating factor;

(4)

How the applicant will uniquely enhance or has uniquely

enhanced clinical medicine and medical education in this

state;

(5)

How the applicant meets or continues to meet the

Qualification Standards defined in this Rule to be eligible for

this license type;

international recruitment for this academic

faculty position was or continues to be necessary, to include

if salary was a motivating factor;

(4)

How the applicant will uniquely enhance or has uniquely

enhanced clinical medicine and medical education in this

state;

(5)

How the applicant meets or continues to meet the

Qualification Standards defined in this Rule to be eligible for

this license type;

(6)

Additional information which would assist the Board in

understanding the reason for this appointment; and

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(7)

For a renewal applicant continued satisfaction of the

Qualification Standards defined in this Rule shall be

demonstrated by:

(a)

An updated curriculum vita;

(b)

An updated list of publications and teaching

experience;

(c)

Continued post-graduate education; and

(d)

Copies of the applicant's teaching evaluations since

the last renewal application.

3.

DEFINITIONS: A “medical school in this state” pursuant to section 12-240-

111, C.R.S., must be an approved medical college as defined by section

12-240-104(3)(a), C.R.S., located in the state of Colorado.

Adopted: August 17, 2006, Effective: October 30, 2006; Revised: 08/19/10; Effective:

10/15/2010; Revised: 08/16/2012; Effective: 10/15/2012; Repealed by Act of Colorado

Legislature: 05/15/2013; Readopted by Emergency Rulemaking on: 05/16/2013;

Effective: 05/16/2013; Readopted by Emergency Rulemaking on 08/15/2013; Effective:

08/15/2013; Revised 11/14/2013; Effective: 01/14/2014

1.7

EDUCATION, TRAINING, OR SERVICE GAINED DURING MILITARY

SERVICE

A.

Basis: The authority for promulgation of these rules and regulation by the

Colorado Medical Board (“Board”) is set forth in sections 12-20-202(4), 12-240-

106(1)(a), 12-240-110(1)(d)(I)(C), 12-240-119, 12-240-120(1)(d), 12-240-141,

12-20-202(2), and 24-4-201 et seq., C.R.S.

B

08/15/2013; Revised 11/14/2013; Effective: 01/14/2014

1.7

EDUCATION, TRAINING, OR SERVICE GAINED DURING MILITARY

SERVICE

A.

Basis: The authority for promulgation of these rules and regulation by the

Colorado Medical Board (“Board”) is set forth in sections 12-20-202(4), 12-240-

106(1)(a), 12-240-110(1)(d)(I)(C), 12-240-119, 12-240-120(1)(d), 12-240-141,

12-20-202(2), and 24-4-201 et seq., C.R.S.

B.

Purpose: The following rules and regulations have been adopted by the Board to

implement the requirements set forth in section 12-20-202(4), C.R.S., and to

otherwise streamline licensure for applicants with relevant military education,

training, or experience, pursuant to Colorado House Bill 16-1197.

C.

Credit for Military Education, Training, or Experience

1.

An applicant for licensure may submit information about the applicant’s

education, training, or experience acquired during military service. It is the

applicant’s responsibility to provide timely and complete information for the

Board’s review.

2.

In order to meet the requirements for licensure, such education, training,

or experience must be substantially equivalent to the required

qualifications that are otherwise applicable at the time the application is

received by the Board.

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3.

The Board will determine, on a case-by-case basis, whether the

applicant’s military education, training, or experience meet the

requirements for licensure.

4.

Documentation of military experience, education, or training may include,

but is not limited to, the applicant’s Certificate of Release or Discharge

from Active Duty (DD-214), Verification of Military Experience and Training

(DD-2586), military transcript, training records, evaluation reports, or

letters from commanding officers describing the applicant’s practice.

D.

Military Experience as Demonstration of Continued Competency for Physician

Licensure

1

ing may include,

but is not limited to, the applicant’s Certificate of Release or Discharge

from Active Duty (DD-214), Verification of Military Experience and Training

(DD-2586), military transcript, training records, evaluation reports, or

letters from commanding officers describing the applicant’s practice.

D.

Military Experience as Demonstration of Continued Competency for Physician

Licensure

1.

The practice of medicine while an applicant is on active military duty shall

be credited towards the requirements for demonstrating continued

competency for physician licensure, reinstatement, or reactivation of a

license.

2.

Applicants with relevant military experience must otherwise comply with

statutory requirements and the processes and requirements of Rule 1.8.

E.

Military Experience as Demonstration of Continued Competency for Physician

Assistant Licensure

1.

Practice as a physician assistant while an applicant is on active military

duty shall be credited towards the requirements for demonstrating

continued competency for physician assistant licensure, reinstatement, or

reactivation of a license.

2.

Applicants with relevant military experience must otherwise comply with

statutory requirements and the processes and requirements of Rule 1.9.

1.8

LICENSE RENEWAL AND REINSTATEMENT PROCEDURES,

DEMONSTRATION OF CONTINUED COMPETENCY BY PHYSICIAN APPLICANTS

FOR LICENSURE PURSUANT TO THE OCCUPATIONAL CREDENTIAL

PORTABILITY PROGRAM, REINSTATEMENT OF AN EXPIRED LICENSE, OR

REACTIVATION OF A LICENSE

A.

Basis: The general authority for promulgation of these rules and regulations by

the Colorado Medical Board (“Board”) is set forth in sections 12-20-202, 12-20-

204(1), 12-240-106(1)(a), 12-240-110, 12-240-120(1)(d), 12-240-130, and 12-

240-141(5), C.R.S.

B.

Purpose: The following rules and regulations have been adopted by the Board to

clarify the requirements set forth in sections 12-240-130 and 12-20-202(1) and

ral authority for promulgation of these rules and regulations by

the Colorado Medical Board (“Board”) is set forth in sections 12-20-202, 12-20-

204(1), 12-240-106(1)(a), 12-240-110, 12-240-120(1)(d), 12-240-130, and 12-

240-141(5), C.R.S.

B.

Purpose: The following rules and regulations have been adopted by the Board to

clarify the requirements set forth in sections 12-240-130 and 12-20-202(1) and

(2), C.R.S., for the renewal and reinstatement of licenses issued by the Board,

and to set forth the process by which a physician may demonstrate qualifications

substantially equivalent for licensure by endorsement in this state pursuant to the

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Occupational Credential Portability Program as set forth in section 12-20-202,

C.R.S., reinstatement of an expired license, or reactivation of an existing license.

These rules apply to physicians who are applying for licensure by endorsement

through the Occupational Credential Portability Program, physicians seeking

reactivation of an inactive Colorado license, physicians seeking a reentry license,

or physicians seeking the reinstatement of an expired Colorado license who have

not established that they have actively practiced medicine for the two year period

immediately preceding the filing of the application (hereinafter: “applicant(s)”).

This Rule does not apply to physicians applying for licensure in Colorado via the

Interstate Medical Licensure Compact.

C.

Renewal

1.

Pursuant to the requirements of sections 12-240-130 and 12-20-202(1),

C.R.S., the Board will not renew a licensee's license until the individual

has complied with the following requirements:

a.

The licensee shall pay the Board a registration fee to be

determined and collected pursuant to section 12-20-105, C.R.S.;

b.

The licensee shall fully and accurately complete the Board's

renewal questionnaire, which was developed pursuant to section

12-240-130(2), C.R.S.; and

c

.R.S., the Board will not renew a licensee's license until the individual

has complied with the following requirements:

a.

The licensee shall pay the Board a registration fee to be

determined and collected pursuant to section 12-20-105, C.R.S.;

b.

The licensee shall fully and accurately complete the Board's

renewal questionnaire, which was developed pursuant to section

12-240-130(2), C.R.S.; and

c.

The licensee shall provide proof that the individual has complied

with the financial responsibility requirements set forth in Part 3 of

Article 64, Title 13, C.R.S., and Board Rule 1.14.

2.

If a licensee fails to comply with the requirements listed above prior to the

date on which the licensee is required to complete the renewal process,

the license of such licensee shall expire.

3.

At any point before, during or after the renewal process, a licensee's

license may be subject to disciplinary action pursuant to sections 12-240-

121 and 12-240-125, C.R.S., or as otherwise provided by Article 240 of

Title 12, C.R.S. (“the Medical Practice Act”) or other applicable Colorado

law.

D.

Reinstatement

1.

Pursuant to the requirements of sections 12-240-130 and 12-20-202(2),

C.R.S., the Board will not reinstate an individual’s expired license until the

individual submits a Board approved application for reinstatement. The

expired license may be reinstated only upon compliance with the following

conditions:

a.

The individual shall pay a reinstatement fee determined by the

Board pursuant to section 12-20-105, C.R.S., and

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rd will not reinstate an individual’s expired license until the

individual submits a Board approved application for reinstatement. The

expired license may be reinstated only upon compliance with the following

conditions:

a.

The individual shall pay a reinstatement fee determined by the

Board pursuant to section 12-20-105, C.R.S., and

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b.

The individual shall fully and accurately complete all portions of the

Board's application for reinstatement, including but not limited to the

Board’s renewal questionnaire, and

c.

The individual shall provide proof that they have complied with the

financial responsibility requirements set forth in Part 3 of Article 64,

Title 13, C.R.S., and Board Rule 1.14.

d.

If the individual has a matter pending before an Inquiry or Hearings

Panel, the Board may defer action on the pending application for

reinstatement and proceed with disciplinary action as provided by

section 12-240-125, C.R.S. Pursuant to any such disciplinary

action, the Board may determine whether to deny or reinstate with

or without probationary terms or impose other sanctions as

authorized by the Medical Practice Act.

e.

If the individual has not practiced medicine during the two years

preceding the Board's consideration of the licensee's application for

reinstatement, and the individual cannot otherwise demonstrate

continued competency, the Board’s Licensing Panel may exercise

discretion to require the individual to undertake a competency

assessment or evaluation conducted by a Board-approved

program, undertake a period of supervised practice, or complete an

educational program, consistent with the requirements of the

Medical Practice Act, including but not limited to sections 12-240-

119 and 12-20-202(3), C.R.S., and the Board’s supporting rules

and policies.

f.

The Board may approve the reinstatement application or may deny

the application as set forth in section 12-240-120, C.R.S

ed

program, undertake a period of supervised practice, or complete an

educational program, consistent with the requirements of the

Medical Practice Act, including but not limited to sections 12-240-

119 and 12-20-202(3), C.R.S., and the Board’s supporting rules

and policies.

f.

The Board may approve the reinstatement application or may deny

the application as set forth in section 12-240-120, C.R.S.

Effective: 06/30/2001, Revised: 02/09/2006; Effective: 03/31/2006; Revised:

08/19/2010; Effective: 10/15/2010; Revised: 08/16/2012; Effective: 10/15/2012

E.

LICENSURE BY ENDORSEMENT PURSUANT TO THE OCCUPATIONAL

CREDENTIAL PORTABILITY PROGRAM PURSUANT TO SECTION 12-20-

202(3), C.R.S.

1.

Definitions:

a.

For the purpose of licensure by endorsement through the occupational

credential portability program, “substantially equivalent experience or

credentials” means the applicant holds a current, valid, and unrestricted

license in another U.S. jurisdiction that requires qualifications substantially

equivalent to the qualifications for licensure in this state; the applicant

submits written verification they have actively practiced medicine in

another jurisdiction for the last year or has otherwise maintained continued

competency as determined by the Board; and submits proof satisfactory to

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the board and attests that they have not been and are not subject to final

or pending disciplinary or other action by any state or jurisdiction in which

the applicant is or has been previously licensed except that, if the

applicant is or has been subject to action, the board may review the action

to determine whether the underlying conduct warrants refusal of a license

pursuant to section 12-240-120, C.R.S.

b

d attests that they have not been and are not subject to final

or pending disciplinary or other action by any state or jurisdiction in which

the applicant is or has been previously licensed except that, if the

applicant is or has been subject to action, the board may review the action

to determine whether the underlying conduct warrants refusal of a license

pursuant to section 12-240-120, C.R.S.

b.

For the purpose of licensure by endorsement through the occupational

credential portability program, an applicant may demonstrate “continued

competency” by establishing that they have maintained an active,

continuous, and unrestricted license in another state, have actively

practiced medicine for the last year in a jurisdiction with a scope of

practice that is substantially similar to the scope of practice for physicians

in Colorado, and have not been subject to any disciplinary action during

that time period. The active practice of medicine includes the practice of

administrative medicine, so long as such practice is not the result of a

limitation or restriction by another state licensing board or credentialing

entity.

Alternatively, an applicant may demonstrate “continued competency”

through participation in numerous professional activities, including but not

limited to: maintenance of certification (MOC) activities; successful

completion and maintenance of board certification exams for ABME or

AOA member boards; category 1 approved CME educational courses with

relevance to practice; teaching/lecturing/mentoring activities; non-patient

care hospital or organization committee participation, including quality,

safety, pharmacy and therapeutics, peer review, tumor board or other

clinically relevant activities; clinically applicable research; surveying on

behalf of accreditation organizations; reentry to practice programs, or

volunteer medical care provided overseas or in other jurisdictions

cturing/mentoring activities; non-patient

care hospital or organization committee participation, including quality,

safety, pharmacy and therapeutics, peer review, tumor board or other

clinically relevant activities; clinically applicable research; surveying on

behalf of accreditation organizations; reentry to practice programs, or

volunteer medical care provided overseas or in other jurisdictions. The

Board’s Licensing Panel shall have discretion to consider an applicant’s

activities on a case-by-case basis and may determine an applicant has

met continued competency through a combination of any of the above

activities or other relevant professional activities.

c.

For the purpose of licensure by endorsement through the

occupational credential portability program, “substantially similar

scope of practice” means the scope of practice for physicians in

another state that is substantially similar to the practice of medicine

as defined in section 12-240-107, C.R.S.

2.

If the Board determines that the applicant has not established continued

competency for purposes of complying with section 12-20-202(3), 12-240-

110, 12-240-120(1)(d), 12-240-119, or 12-240-141(5), C.R.S., the Board

may require an applicant to submit to any competency assessment(s) or

evaluation(s) conducted by a program approved by the Board. Although

the Board retains the discretion as to the method of determining continued

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es of complying with section 12-20-202(3), 12-240-

110, 12-240-120(1)(d), 12-240-119, or 12-240-141(5), C.R.S., the Board

may require an applicant to submit to any competency assessment(s) or

evaluation(s) conducted by a program approved by the Board. Although

the Board retains the discretion as to the method of determining continued

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12

competency based on the applicant’s specific circumstances, a

competency assessment or evaluation conducted by a Board-approved

program is the Board’s standard operating procedure. The Board also

retains discretion as to whether the Applicant has demonstrated

his/her/their qualifications are substantially equivalent to the active

practice of medicine.

Nothing in this Rule is intended to limit the Board’s Licensing Panel from

discretion to deny a license or to otherwise offer a restricted license

consistent with the authority in the Medical Practice Act, including those

circumstances in which an Applicant holds a restricted license in another

jurisdiction or has been subject to disciplinary action.

3.

If the Board determines that the applicant requires a period of supervised

practice and/or the completion of an educational program (hereinafter

“training requirements”), the Board at its discretion may either issue the

applicant a license subject to probationary terms or a reentry license.

F.

REENTRY LICENSE

The Board will consider an applicant to be ineligible for a reentry license if their

period of inactive practice resulted from disciplinary action or unprofessional

conduct. If a reentry license is issued, such a license is valid only for three years

from the date of issue and is not renewable. Failure to complete the training

requirements before the end of the three-year period will result in the reentry

license being administratively inactivated.

In the discretion of the Board, the physician may be issued a re-entry license for

the specific purpose of completing the education and/or training requirements

license is valid only for three years

from the date of issue and is not renewable. Failure to complete the training

requirements before the end of the three-year period will result in the reentry

license being administratively inactivated.

In the discretion of the Board, the physician may be issued a re-entry license for

the specific purpose of completing the education and/or training requirements.

The re-entry license is valid for a single period of time not greater than three (3)

years from the date of issue. Failure to complete the education and/or training

requirements before the end of the three-year (3) period for the re-entry license

will result in the re-entry license being administratively inactivated.

G.

CONVERSION OF REENTRY LICENSE

When an applicant has timely and successfully completed the training

requirements, the applicant shall apply to the Licensing Panel of the Board to

convert the reentry license to full licensure by submitting a letter to the Licensing

Panel with documents that clearly establish timely and successful completion of

the training requirements. If the Board determines that the applicant is competent

and qualified to practice medicine without supervision, the Board will convert the

reentry license to a full license to practice medicine. If the Board determines that

the applicant is not competent nor qualified to practice medicine without

supervision, the Board may require further assessment, training, or period of

supervised practice in its discretion.

H.

EXPENSES

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without supervision, the Board will convert the

reentry license to a full license to practice medicine. If the Board determines that

the applicant is not competent nor qualified to practice medicine without

supervision, the Board may require further assessment, training, or period of

supervised practice in its discretion.

H.

EXPENSES

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13

All expenses resulting from the assessment and/or any training requirements are

the responsibility of the applicant and not of the Board.

I.

ADMINISTRATIVE PRACTICE OF MEDICINE

“Administrative medicine” carries the definition set forth in Board Policy 20-06.

Administrative medicine shall constitute the active practice of medicine.

When an applicant who practices administrative medicine seeks licensure, the

Board shall evaluate the applicant’s application to determine whether they meet

the criteria for active and unrestricted licensure in Colorado. If the applicant is not

subject to a restricted license because of disciplinary action in another

jurisdiction, and otherwise meets the criteria for a full, active, and unrestricted

license in Colorado, the Licensing Panel may grant the application for a full,

active, and unrestricted license.

If the applicant is subject to a restricted license or credentialing because of

disciplinary action in another jurisdiction, the Licensing Panel may consider

whether to enter into an agreement with the applicant to limit their practice to

administrative medicine in the form of a stipulation and final agency order.

J.

REINSTATEMENT OR REACTIVATION OF A LICENSE

In support of any application for reinstatement or reactivation of a license to

practice medicine, for the purpose of complying with sections 12-20-202(2)(c)(II),

12-240-120(1)(d), or 12-240-141(5), C.R.S., a physician may demonstrate

continued competency in accordance with the methods identified in Rule 22.2(A),

identified above

nd final agency order.

J.

REINSTATEMENT OR REACTIVATION OF A LICENSE

In support of any application for reinstatement or reactivation of a license to

practice medicine, for the purpose of complying with sections 12-20-202(2)(c)(II),

12-240-120(1)(d), or 12-240-141(5), C.R.S., a physician may demonstrate

continued competency in accordance with the methods identified in Rule 22.2(A),

identified above.

Effective 12/1/95, Revised 8/15/02, Effective 10/30/02, Revised 2/13/03, Effective

4/30/03, Revised 4/14/05, Effective 6/30/05; Revised 2/9/06; Effective 3/31/06; Revised

8/19/10; Effective 10/15/10; Revised 11/17/2011; Effective 1/14/2012

1.9

DEMONSTRATION OF CONTINUED COMPETENCY BY PHYSICIAN

ASSISTANT APPLICANTS FOR LICENSURE, LICENSURE PURSUANT TO THE

OCCUPATIONAL CREDENTIAL PORTABILITY PROGRAM, REINSTATEMENT OF

AN EXPIRED LICENSE, OR REACTIVATION OF A LICENSE

A.

Basis: The authority for promulgation of these rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1),

12-240-119, 12-240-106(1)(a), 12-240-120(1)(d), 12-20-202(2)(c)(II), and 12-

240-141(5), C.R.S.

B.

Purpose: The purpose of these rules and regulations is to set forth the process

by which a physician assistant may demonstrate continued competency for the

purpose of complying with the statutory sections referenced above to obtain a

Colorado physician assistant license; demonstrate qualifications substantially

equivalent for licensure by endorsement in this state pursuant to the

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ions is to set forth the process

by which a physician assistant may demonstrate continued competency for the

purpose of complying with the statutory sections referenced above to obtain a

Colorado physician assistant license; demonstrate qualifications substantially

equivalent for licensure by endorsement in this state pursuant to the

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14

Occupational Credential Portability Program as set forth in section 12-20-202,

C.R.S.; demonstrate at least one year of having practiced as a physician

assistant in another jurisdiction with a scope of practice substantially similar to

the scope of practice in this state for licensure by endorsement pursuant to the

Occupational Credential Portability Program as set forth in section 12-20-202,

C.R.S.; reinstate an expired license; or reactivate an existing Colorado physician

assistant license. The Board finds that if a physician assistant has ceased clinical

practice for two or more years, the nature of the physician assistant/physician or

physician group collaborating relationship in and of itself cannot compensate for

potential knowledge and clinical deficiencies, which may exist due to the lack of

practice experience for an extended period of time.

1.

On and after August 7, 2023, Colorado requires a collaborative agreement

between physicians or physician groups and physician assistants. Some

collaborative agreement may include supervisory oversight. In addition,

there are specific circumstances requiring collaborative agreements to

take the form of supervisory agreements. See rule 1.15(C)(E)(F).

C.

LICENSURE BY ENDORSEMENT PURSUANT TO THE OCCUPATIONAL

CREDENTIAL PORTABILITY PROGRAM PURSUANT TO SECTION 12-20-

202(3), C.R.S.

1.

For the purpose of licensure by endorsement through the occupational

credential portability program, “substantially equivalent experience or

credentials” means the applicant holds a current, valid, and unrestricted

license in another U.S

ents. See rule 1.15(C)(E)(F).

C.

LICENSURE BY ENDORSEMENT PURSUANT TO THE OCCUPATIONAL

CREDENTIAL PORTABILITY PROGRAM PURSUANT TO SECTION 12-20-

202(3), C.R.S.

1.

For the purpose of licensure by endorsement through the occupational

credential portability program, “substantially equivalent experience or

credentials” means the applicant holds a current, valid, and unrestricted

license in another U.S. jurisdiction that requires qualifications substantially

equivalent to the qualifications for licensure in this state; the applicant

submits written verification they have actively practiced as a physician

assistant in another jurisdiction for the last two years or has otherwise

maintained continued competency as determined by the Board; and

submits proof satisfactory to the Board and attests that they have not been

and are not subject to final or pending disciplinary or other action by any

state or jurisdiction in which the applicant is or has been previously

licensed except that, if the applicant is or has been subject to action, the

Board may review the action to determine whether the underlying conduct

warrants refusal of a license pursuant to section 12-240-120, C.R.S.

2.

To demonstrate continued competency for purposes of complying with

section 12-20-202(3), C.R.S., a physician assistant may:

a.

Submit proof satisfactory to the Board of active practice as a

physician assistant in another jurisdiction for the one-year period

immediately preceding the filing of the application. If the physician

assistant has practiced as a physician assistant only for a portion of

the one-year period immediately preceding the filing of the

application, the Board may determine on a case by case basis in its

discretion whether the physician assistant has adequately

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r period

immediately preceding the filing of the application. If the physician

assistant has practiced as a physician assistant only for a portion of

the one-year period immediately preceding the filing of the

application, the Board may determine on a case by case basis in its

discretion whether the physician assistant has adequately

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15

demonstrated continued competency to practice as a physician

assistant;

a.

Submit proof satisfactory to the Board of having held for at least

one year a current and valid physician assistant license in another

jurisdiction with a scope of practice that is substantially similar to

the scope of practice for physician assistants as specified in section

12-240-107, C.R.S.

c.

Submit to the Board the following: (a) proof satisfactory to the

Board that the physician assistant has been out of practice as a

physician assistant for less than two years; (b) proof of current

certification by the National Commission on Certification of

Physician Assistants, Inc. (“NCCPA” ); (c) proof of 100 hours of

continuing medical education within the past two years, including

twenty-five hours of category I continuing medical education in the

past twelve months; and (d) a written plan satisfactory to the Board,

documenting the nature, extent, and duration of collaboration that

will be undertaken by the physician assistant with a collaborating

physician or physician group as the physician assistant makes the

transition back into clinical practice; or

d

years, including

twenty-five hours of category I continuing medical education in the

past twelve months; and (d) a written plan satisfactory to the Board,

documenting the nature, extent, and duration of collaboration that

will be undertaken by the physician assistant with a collaborating

physician or physician group as the physician assistant makes the

transition back into clinical practice; or

d.

Submit to the Board proof of participation in numerous professional

activities, including but not limited to: maintenance of certification

(MOC) activities; successful completion of the National Commission

on Certification of Physician Assistants (NCCPA); category 1

approved CME educational courses with relevance to practice;

teaching/lecturing/mentoring activities; non-patient care hospital or

organization committee participation, including quality, safety,

pharmacy and therapeutics, peer review, tumor board or other

clinically relevant activities; clinically applicable research; surveying

on behalf of accreditation organizations; or volunteer medical care

provided overseas or in other jurisdictions. The Board’s Licensing

Panel shall have discretion to consider an applicant’s activities on a

case-by-case basis and may determine an applicant has met

continued competency through a combination of any of the above

activities or other relevant professional activities.

D.

REENTRY LICENSE

For those physician assistants who have been out of practice as a physician

assistant for two or more years, (a) submit to the Board a personalized

competency evaluation report prepared by a program approved by the Board,

and (b) complete any education and/or training recommended by the program as

a result of the evaluation prior to obtaining a license. In the discretion of the

Board, the physician assistant may be able to receive a re-entry license prior to

completing the education and/or training recommended by the program for the

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oved by the Board,

and (b) complete any education and/or training recommended by the program as

a result of the evaluation prior to obtaining a license. In the discretion of the

Board, the physician assistant may be able to receive a re-entry license prior to

completing the education and/or training recommended by the program for the

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16

purpose of facilitating the completion of such education and/or training. All

expenses resulting from the evaluation and/or any recommended education

and/or training are the responsibility of the physician assistant and not of the

Board.

The Board will consider an applicant to be ineligible for a reentry license if their

period of inactive practice resulted from disciplinary action or unprofessional

conduct. If a reentry license is issued, such a license is valid only for three years

from the date of issue and is not renewable. Failure to complete the training

requirements before the end of the three-year period will result in the reentry

license being administratively inactivated.

In the discretion of the Board, the physician assistant may be issued a re-entry

license for the specific purpose of completing the education and/or training

requirements. The re-entry license is valid for a single period of time not greater

than three (3) years from the date of issue. Failure to complete the education

and/or training requirements before the end of the three (3) year period for the re-

entry license will result in the re-entry license being administratively inactivated.

E.

CONVERSION OF REENTRY LICENSE

When an applicant has timely and successfully completed the training

requirements, the applicant shall apply to the Licensing Panel of the Board to

convert the reentry license to full licensure by submitting a letter to the Licensing

Panel with documents that clearly establish timely and successful completion of

the training requirements

ministratively inactivated.

E.

CONVERSION OF REENTRY LICENSE

When an applicant has timely and successfully completed the training

requirements, the applicant shall apply to the Licensing Panel of the Board to

convert the reentry license to full licensure by submitting a letter to the Licensing

Panel with documents that clearly establish timely and successful completion of

the training requirements. If the Board determines that the applicant is competent

and qualified to practice as a physician assistant, the Board will convert the

reentry license to a full license to practice as a physician assistant. If the Board

determines that the applicant is not competent nor qualified to practice as a

physician assistant, the Board may require further assessment, training, or period

of supervised practice in its discretion.

F.

EXPENSES

All expenses resulting from the assessment and/or any training requirements are

the responsibility of the applicant and not of the Board.

G.

REINSTATEMENT OR REACTIVATION OF A LICENSE

1.

In support of any application for reinstatement or reactivation of a license

to practice as a physician assistant, for the purpose of complying with

sections 12-20-202(2)(c)(II), 12-240-120(1)(d), or 12-240-141(5), C.R.S., a

physician assistant may demonstrate continued competency in

accordance with the methods identified in Rule 1.9(C)(2), identified above.

2.

Where appropriate, the Board may determine that demonstration of

continued competency requires an additional or different approach. For

example, due to the length of time the physician assistant has been out of

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stant may demonstrate continued competency in

accordance with the methods identified in Rule 1.9(C)(2), identified above.

2.

Where appropriate, the Board may determine that demonstration of

continued competency requires an additional or different approach. For

example, due to the length of time the physician assistant has been out of

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17

practice, the Board may require a written plan documenting the nature,

extent, and duration of supervision that will be provided by the

collaborating physician or physician group to the physician assistant as

the physician assistant makes the transition back into clinical practice.

This written plan may be in addition to the personalized competency

evaluation and/or recommended education and/or training. The decision

as to the method of determining continued competency shall be at the

discretion of the Board.

Adopted 8/15/02, Effective 10/30/02, Revised 2/13/03, Effective 4/30/03, Revised

4/14/05, Effective 6/30/05, Revised 5/17/07, Effective July 30, 2007; Revised

08/19/10; Effective 10/15/10.

1.10 DEMONSTRATION OF CONTINUED COMPETENCY BY

ANESTHESIOLOGIST ASSISTANT APPLICANTS FOR LICENSURE, LICENSURE

PURSUANT TO THE OCCUPATIONAL CREDENTIAL PORTABILITY PROGRAM,

REINSTATEMENT OF AN EXPIRED LICENSE, OR REACTIVATION OF A LICENSE

A.

Basis: The authority for promulgation of these rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-240-119,

12-20-204(1), 12-240-106(1)(a), 12-240-120(1)(d), 12-20-202(2)(c)(II), and 12-

240-141(5), C.R.S.

B

URE, LICENSURE

PURSUANT TO THE OCCUPATIONAL CREDENTIAL PORTABILITY PROGRAM,

REINSTATEMENT OF AN EXPIRED LICENSE, OR REACTIVATION OF A LICENSE

A.

Basis: The authority for promulgation of these rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-240-119,

12-20-204(1), 12-240-106(1)(a), 12-240-120(1)(d), 12-20-202(2)(c)(II), and 12-

240-141(5), C.R.S.

B.

Purpose: The purpose of these rules and regulations is to set forth the process

by which an anesthesiologist assistant may demonstrate continued competency

for the purpose of complying with the statutory sections referenced above to

obtain a Colorado anesthesiologist assistant license; demonstrate qualifications

substantially equivalent for licensure by endorsement in this state pursuant to the

Occupational Credential Portability Program as set forth in section 12-20-202,

C.R.S.; demonstrate at least one year of having practiced as an anesthesiology

assistant in another jurisdiction with a scope of practice substantially similar to

the scope of practice in this state for licensure by endorsement pursuant to the

Occupational Credential Portability Program as set forth in section 12-20-202,

C.R.S.; reinstate an expired license; or reactivate an existing Colorado

anesthesiologist assistant license. The Board finds that due to the significant

differences between the nature of anesthesiologist assistant practice and the

nature of physician practice, it is necessary and appropriate to delineate different

methods by which anesthesiologist assistants and physicians shall demonstrate

continued competency as required by the Medical Practice Act. The significant

differences between the two types of practice include the requirements that

anesthesiologist assistants must be supervised by a licensed physician in

accordance with existing Board rules and regulations

ry and appropriate to delineate different

methods by which anesthesiologist assistants and physicians shall demonstrate

continued competency as required by the Medical Practice Act. The significant

differences between the two types of practice include the requirements that

anesthesiologist assistants must be supervised by a licensed physician in

accordance with existing Board rules and regulations. The Board finds, however,

that if an anesthesiologist assistant has ceased clinical practice for two or more

years, the nature of the anesthesiologist assistant/physician supervisory

relationship in and of itself cannot compensate for potential knowledge and

clinical deficiencies, which may exist due to the lack of practice experience for

such an extended period of time.

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18

C.

LICENSURE BY ENDORSEMENT PURSUANT TO THE OCCUPATIONAL

CREDENTIAL PORTABILITY PROGRAM PURSUANT TO SECTION 12-20-

202(3), C.R.S.

1.

For the purpose of licensure by endorsement through the occupational

credential portability program, “substantially equivalent experience or

credentials” means the applicant holds a current, valid, and unrestricted

license in another U.S. jurisdiction that requires qualifications substantially

equivalent to the qualifications for licensure in this state; the applicant

submits written verification they have actively practiced as an

anesthesiologist assistant in another jurisdiction for the last two years or

has otherwise maintained continued competency as determined by the

Board; and submits proof satisfactory to the Board and attests that they

have not been and are not subject to final or pending disciplinary or other

action by any state or jurisdiction in which the applicant is or has been

previously licensed except that, if the applicant is or has been subject to

action, the Board may review the action to determine whether the

underlying conduct warrants refusal of a license pursuant to section 12-

240-120, C.R.S.

2

attests that they

have not been and are not subject to final or pending disciplinary or other

action by any state or jurisdiction in which the applicant is or has been

previously licensed except that, if the applicant is or has been subject to

action, the Board may review the action to determine whether the

underlying conduct warrants refusal of a license pursuant to section 12-

240-120, C.R.S.

2.

To demonstrate continued competency for purposes of complying with

section 12-20-202(3), C.R.S., an anesthesiologist assistant may:

a.

Submit proof satisfactory to the Board of active practice as an

anesthesiologist assistant in another jurisdiction for the one-year

period immediately preceding the filing of the application. If the

anesthesiologist assistant has practiced as an anesthesiologist

assistant for only a portion of the one-year period immediately

preceding the filing of the application, the Board may determine on

a case-by-case basis in its discretion whether the anesthesiologist

assistant has adequately demonstrated continued competency to

practice as an anesthesiologist assistant;

b.

Submit proof satisfactory to the Board of having held for at least

one year a current and valid anesthesiologist assistant license in

another jurisdiction with a scope of practice that is substantially

similar to the scope of practice for anesthesiologist assistants as

specified in section 12-240-107, C.R.S.

c.

Submit to the Board the following: (a) proof satisfactory to the

Board that the anesthesiologist assistant has been out of practice

as an anesthesiologist assistant for less than two years; (b) proof of

current certification by the National Commission on Certification of

Anesthesiologist Assistants (“NCCAA”); (c) CME hours as required

by the certifying body; and (d) a written plan satisfactory to the

Board, documenting the nature, extent, and duration of supervision

that will be provided by the supervising physician to the

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proof of

current certification by the National Commission on Certification of

Anesthesiologist Assistants (“NCCAA”); (c) CME hours as required

by the certifying body; and (d) a written plan satisfactory to the

Board, documenting the nature, extent, and duration of supervision

that will be provided by the supervising physician to the

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19

anesthesiologist assistant as the anesthesiologist assistant makes

the transition back into clinical practice; or

.d.

Submit to the Board proof of participation in numerous professional

activities, including but not limited to: maintenance of certification

(MOC) activities; successful completion of National Commission on

Certification of Anesthesiologist Assistants (NCCAA); category 1

approved CME educational courses with relevance to practice;

teaching/lecturing/mentoring activities; non-patient care hospital or

organization committee participation, including quality, safety,

pharmacy and therapeutics, peer review, tumor board or other

clinically relevant activities; clinically applicable research; surveying

on behalf of accreditation organizations; or volunteer medical care

provided overseas or in other jurisdictions. The Board’s Licensing

Panel shall have discretion to consider an applicant’s activities on a

case-by-case basis and may determine an applicant has met

continued competency through a combination of any of the above

activities or other relevant professional activities.

D.

REENTRY LICENSE

For those anesthesiologist assistants who have been out of practice as an

anesthesiologist assistant for two or more years, (a) submit to the Board a

personalized competency evaluation report prepared by a program approved by

the Board, and (b) complete any education and/or training recommended by the

program as a result of the evaluation prior to obtaining a license

activities.

D.

REENTRY LICENSE

For those anesthesiologist assistants who have been out of practice as an

anesthesiologist assistant for two or more years, (a) submit to the Board a

personalized competency evaluation report prepared by a program approved by

the Board, and (b) complete any education and/or training recommended by the

program as a result of the evaluation prior to obtaining a license. In the discretion

of the Board, the anesthesiologist assistant may be able to receive a re-entry

license prior to completing the education and/or training recommended by the

program for the purpose of facilitating the completion of such education and/or

training. All expenses resulting from the evaluation and/or any recommended

education and/or training are the responsibility of the anesthesiologist assistant

and not of the Board.

The Board will consider an applicant to be ineligible for a reentry license if their

period of inactive practice resulted from disciplinary action or unprofessional

conduct. If a reentry license is issued, such a license is valid only for three years

from the date of issue and is not renewable. Failure to complete the training

requirements before the end of the three-year period will result in the reentry

license being administratively inactivated.

In the discretion of the Board, the anesthesiologist assistant may be issued a re-

entry license for the specific purpose of completing the education and/or training

requirements. The re-entry license is valid for a single period of time not greater

than three (3) years from the date of issue. Failure to complete the education

and/or training requirements before the end of the three (3) year period for the re-

entry license will result in the re-entry license being administratively inactivated.

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g

requirements. The re-entry license is valid for a single period of time not greater

than three (3) years from the date of issue. Failure to complete the education

and/or training requirements before the end of the three (3) year period for the re-

entry license will result in the re-entry license being administratively inactivated.

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20

E.

CONVERSION OF REENTRY LICENSE

When an applicant has timely and successfully completed the training

requirements, the applicant shall apply to the Licensing Panel of the Board to

convert the reentry license to full licensure by submitting a letter to the Licensing

Panel with documents that clearly establish timely and successful completion of

the training requirements. If the Board determines that the applicant is competent

and qualified to practice as an anesthesiologist assistant, the Board will convert

the reentry license to a full license to practice as an anesthesiologist assistant. If

the Board determines that the applicant is not competent nor qualified to practice

as an anesthesiologist assistant, the Board may require further assessment,

training, or period of supervised practice in its discretion.

F.

EXPENSES

All expenses resulting from the assessment and/or any training requirements are

the responsibility of the applicant and not of the Board.

G.

REINSTATEMENT OR REACTIVATION OF A LICENSE

In support of any application for reinstatement or reactivation of a license to

practice as an anesthesiologist assistant, for the purpose of complying with

sections 12-20-202(2)(c)(II), 12-240-120(1)(d), or 12-240-141(5), C.R.S., an

anesthesiologist assistant may demonstrate continued competency in

accordance with the methods identified in Rule 29.2(A)(2), identified above.

H.

Where appropriate, the Board may determine that demonstration of continued

competency requires an additional or different approach

assistant, for the purpose of complying with

sections 12-20-202(2)(c)(II), 12-240-120(1)(d), or 12-240-141(5), C.R.S., an

anesthesiologist assistant may demonstrate continued competency in

accordance with the methods identified in Rule 29.2(A)(2), identified above.

H.

Where appropriate, the Board may determine that demonstration of continued

competency requires an additional or different approach. For example, due to the

length of time the anesthesiologist assistant has been out of practice, the Board

may require a written plan documenting the nature, extent, and duration of

supervision that will be provided by the supervising physician to the

anesthesiologist assistant as the anesthesiologist assistant makes the transition

back into clinical practice. This written plan may be in addition to the

personalized competency evaluation and/or recommended education and/or

training. The decision as to the method of determining continued competency

shall be at the discretion of the Board.

Adopted 5/22/14: Effective 7/15/14.

1.11 MAINTENANCE OF CURRENT ADDRESS

A.

Basis: The authority for the promulgation of rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1),

12-240-106(1)(a), C.R.S.

B.

Purpose: The purpose of this Rule is to provide licensees and staff with clear

guidance regarding a licensee’s address of record for Board purposes.

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A.

Basis: The authority for the promulgation of rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1),

12-240-106(1)(a), C.R.S.

B.

Purpose: The purpose of this Rule is to provide licensees and staff with clear

guidance regarding a licensee’s address of record for Board purposes.

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C.

A licensee’s address for purposes of sending a “30-Day Letter” pursuant to

section 12-240-125(4), C.R.S., for purposes of issuing a formal complaint

pursuant to section 12-240-125(5), C.R.S., and for all other Board purposes,

shall be the mailing address as indicated by the licensee on the application for

initial licensure. Licensees shall inform the Board in a clear, explicit, and

unambiguous written statement of any name, address, telephone or email

change within thirty days of the change. Such information may also be updated

by the licensee via electronic means made available by the Board or by any other

manner approved by the Board. The mere receipt of correspondence from a

licensee showing a new address shall not be sufficient to change an address.

D.

Thereafter, the licensee’s last address of record with the Board shall be the

address as indicated in the request for the change. In the event that a licensee

submits a request for a change of address, but does not indicate between the

business and home address where Board correspondence should be sent, the

business address shall constitute the address for purposes of this Rule.

E.

In no event will the Board accept a change of address request which requests

the address be changed for some, but not all, communications. Also, in no event

shall the Board change the address if a licensee indicates that Board

correspondence shall be marked “confidential”

ress where Board correspondence should be sent, the

business address shall constitute the address for purposes of this Rule.

E.

In no event will the Board accept a change of address request which requests

the address be changed for some, but not all, communications. Also, in no event

shall the Board change the address if a licensee indicates that Board

correspondence shall be marked “confidential”.

Effective: 9/30/98 Revised 4/14/05, Effective 6/30/05; Revised 08/19/10; Effective

10/15/10

1.12 REPORTING REQUIREMENTS OF SECTIONS 12-30-204(8)(f) AND 12-30-

206(2)(b)(I), C.R.S., AND OF THE FEDERAL HEALTH CARE QUALITY

IMPROVEMENT ACT OF 1986, AS AMENDED

A.

Basis: The authority for promulgation of rules and regulations by the Colorado

Medical Board (“Board”) is set forth in sections 24-4-103, 12-30-201(1)(a), 12-30-

203(1)(b), 12-30-203(3)(a), and 12-30-208(2), C.R.S.

B.

Purpose: These rules have been adopted by the Board to clarify reporting

requirements so that the Board is able to effectively and efficiently utilize and

allow professional review committees and governing boards, in order to meet the

Board’s responsibilities under Colorado Revised Statutes, Title 12, Article 240.

These Rules will enable the Board to more effectively regulate the conduct of the

practice of medicine by encouraging prompt, accurate, and complete reporting by

governing boards of authorized entities and their professional review committees.

C.

Reporting to the Board is required:

1.

As obligated under:

a.

The federal “Health Care Quality Improvement Act of 1986”, as

amended as required by section 12-30-208(2), C.R.S.; and

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f medicine by encouraging prompt, accurate, and complete reporting by

governing boards of authorized entities and their professional review committees.

C.

Reporting to the Board is required:

1.

As obligated under:

a.

The federal “Health Care Quality Improvement Act of 1986”, as

amended as required by section 12-30-208(2), C.R.S.; and

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b.

The Professional Review of Health Care Providers as required by

sections 12-30-204(7)(f) and 12-30-204(10), C.R.S.; and

c.

The Professional Review of Health Care Providers Act as required

by section 12-30-206(2)(b)(I), C.R.S.

2.

In response to a subpoena issued by the Board in accordance to section

12-30-204(11), C.R.S.

D.

Reporting: In order to be considered in compliance with the reporting

requirements of this Rule:

1.

Reports required under part (A)(1)(a) and (b) of this Rule, must be

submitted to the Board within thirty calendar days of the reportable

recommendation, finding, or adverse action.

2.

Reports required under part (A)(1)(c) of this Rule, the report must be

submitted to the Board no later than the first day of March of each year for

the information from the preceding calendar year.

3.

Paper copies of reports must be sent to the Board’s office by U.S. mail or

via electronic mail to the Program Director of the Colorado Medical Board.

4.

The Board delegates authority to the Program Director of the Colorado

Medical Board to receive the reporting information on its behalf and to

resolve reporting discrepancies and irregularities directly with the reporting

entity.

Adopted: 05/16/2013, Effective: 07/15/2013

1.13 REPORTING REQUIREMENTS FOR CRIMINAL CONVICTIONS

A.

Basis: The authority for the promulgation of these rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1),

and 12-240-106(1)(a), C.R.S.

B

on its behalf and to

resolve reporting discrepancies and irregularities directly with the reporting

entity.

Adopted: 05/16/2013, Effective: 07/15/2013

1.13 REPORTING REQUIREMENTS FOR CRIMINAL CONVICTIONS

A.

Basis: The authority for the promulgation of these rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1),

and 12-240-106(1)(a), C.R.S.

B.

Purpose: The purpose of these rules and regulations is to establish and clarify

requirements surrounding the reporting of criminal convictions that constitute

unprofessional conduct pursuant to section 12-240-121, C.R.S., including but not

limited to sections 12-240-121(1)(b), (1)(d), (1)(r) and (1)(s), C.R.S.

C.

A licensee, as defined in section 12-20-102(10), C.R.S., means any physician,

physician assistant, or anesthesiologist assistant who is licensed by the Board

(hereinafter known as “licensee”). Each licensee shall inform the Board, in the

manner set forth by the Board, within thirty days of the conviction of the licensee

of any of the following:

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1.

An offense of moral turpitude under the laws of any state or of the United

States;

2.

A felony under the laws of any state or of the United States;

3.

A crime that may constitute a violation of the Medical Practice Act, section

12-240-101 et seq., C.R.S.; or

4.

A violation of any federal or state law regulating the possession,

distribution, or use of any controlled substance, as defined in section 12-

22-303(7), C.R.S. [repealed].

D.

For purposes of this Rule, a “conviction” includes:

1.

A guilty verdict;

2.

A plea of guilty accepted by the court or the entry of a guilty plea;

3.

A plea of nolo contendere (no contest) accepted by the court; or

4.

The imposition of a deferred sentence accepted by the court.

E.

For the purposes of this Rule, “crimes of moral turpitude” include the following

felony, misdemeanors, or municipal offenses:

1

oses of this Rule, a “conviction” includes:

1.

A guilty verdict;

2.

A plea of guilty accepted by the court or the entry of a guilty plea;

3.

A plea of nolo contendere (no contest) accepted by the court; or

4.

The imposition of a deferred sentence accepted by the court.

E.

For the purposes of this Rule, “crimes of moral turpitude” include the following

felony, misdemeanors, or municipal offenses:

1.

Any of the offenses against the person set forth in Title 18, Article 3 of the

Colorado Revised Statutes. Examples of such offenses include, but are

not limited to, any assault, menacing, or unlawful sexual behavior;

2.

Any of the offenses against property set forth in Title 18, Article 4 of the

Colorado Revised Statutes. Examples of such offenses include, but are

not limited to, any arson, theft, trespass, or criminal mischief;

3.

Any of the offenses involving fraud set forth in Title 18, Article 5 of the

Colorado Revised Statutes;

4.

Computer crime as set forth in Title 18, Article 5.5 of the Colorado Revised

Statutes;

5.

Any of the offenses involving the family relations set forth in Title 18,

Article 6, Part 4 (wrongs to children), when committed intentionally and

knowingly or recklessly; Part 6 (harboring a minor); or Part 8 (domestic

violence), of the Colorado Revised Statutes;

6.

Any of the offenses constituting wrongs to at-risk adults set forth in Title

18, Article 6.5 of the Colorado Revised Statutes;

7.

Any of the offenses relating to morals set forth in Title 18, Article 7 of the

Colorado Revised Statutes. Examples of such offenses include, but are

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domestic

violence), of the Colorado Revised Statutes;

6.

Any of the offenses constituting wrongs to at-risk adults set forth in Title

18, Article 6.5 of the Colorado Revised Statutes;

7.

Any of the offenses relating to morals set forth in Title 18, Article 7 of the

Colorado Revised Statutes. Examples of such offenses include, but are

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not limited to, prostitution, indecent exposure, and criminal invasion of

privacy;

8.

Any other offense in any jurisdiction whatsoever that is committed

intentionally, knowingly, or recklessly, and involves violence, coercion,

threats, cruelty, fraud, deception, or deprivation of legally recognized

rights; and

9.

Any conspiracy, solicitation, or criminal attempt to commit any of the

above offenses, or participation as an accessory to any of the above

offenses.

F.

The conviction of the licensee of any of the above, under the laws of any state or

of the United States, is unprofessional conduct and may be grounds for discipline

pursuant to section 12-240-121(1)(b), (d) or (r), C.R.S.

G.

The notice to the Board shall include the following information:

1.

The court;

2.

The jurisdiction;

3.

The case name;

4.

The case number; and

5.

A description of the matter or a copy of the indictment or charges.

H.

Even after making the initial report described above, the licensee shall inform the

Board of the following information within thirty days of each such occurrence:

1.

The imposition of sentence for the conviction.

2.

The completion of all terms of the sentence for the conviction.

I.

The licensee notifying the Board may submit a written statement with any notice

under this Rule to be included in the licensee records.

J.

A licensee’s compliance with this Rule does not excuse compliance with any

other applicable statute or rule, including those relating to reporting requirements

of sentence for the conviction.

2.

The completion of all terms of the sentence for the conviction.

I.

The licensee notifying the Board may submit a written statement with any notice

under this Rule to be included in the licensee records.

J.

A licensee’s compliance with this Rule does not excuse compliance with any

other applicable statute or rule, including those relating to reporting requirements.

A licensee’s reporting of information pertaining to criminal convictions on an

application for initial licensure, renewal or reinstatement, or pursuant to section

12-30-102, C.R.S. (The Michael Skolnik Medical Transparency Act of 2010),

does not excuse the licensee from compliance with this Rule.

K.

Failure to comply with this Rule may constitute grounds for disciplinary action.

L.

This Rule shall apply to any conviction or plea as described in Section (A) of this

Rule occurring on or after October 1, 2009.

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Effective 09/30/2009; Revised 08/19/2010, Effective: 10/15/2010; Revised 5/22/14,

Effective 7/15/14

1.14 FINANCIAL RESPONSIBILITY STANDARDS

A.

Basis: The general authority for the promulgation of rules and regulations by the

Colorado Medical Board (“Board”) is set forth in sections 12-20-204(1) and 12-

240-106(1)(a), C.R.S., as amended. Specific authority for the promulgation of

rules regarding financial liability requirements is set forth in section 13-64-

301(1)(a.5), C.R.S.

B.

Purpose: Part 3 of Article 64, Title 13, sets forth financial responsibility

requirements to be met by all Colorado licensed physicians and physician

assistants. However, the Board may, by rule, exempt or establish lesser

standards for certain classes of license holders. These Rules have been adopted

by the Board in order to exempt from the requirements certain categories of

licensees for whom the financial responsibility standards do not serve to enhance

the public interest.

C

rements to be met by all Colorado licensed physicians and physician

assistants. However, the Board may, by rule, exempt or establish lesser

standards for certain classes of license holders. These Rules have been adopted

by the Board in order to exempt from the requirements certain categories of

licensees for whom the financial responsibility standards do not serve to enhance

the public interest.

C.

Pursuant to the requirements of section 13-64-301(1)(a.5), C.R.S., every

physician and physician assistant who holds or desires to obtain a Colorado

medical license must maintain commercial professional liability insurance

coverage with an insurance company authorized to do business in this state in a

minimum indemnity amount of one million dollars per incident and three million

dollars annual aggregate per year (or meet alternative responsibility standards

which comply with the provisions of sections 13-64-301(1)(c), (d), or (e), C.R.S.);

except that this requirement is not applicable to a health care professional who is

a public employee under the “Colorado Governmental Immunity Act”.

D.

Pursuant to these Rules, a physician or a physician assistant whose medical

practice falls entirely within one or more of the following categories is exempt

from the requirements set forth in paragraph (A), above:

1.

Physicians or physician assistants who solely perform medical services as

employees of the United States government.

2.

A physician or physician assistant who is not engaged in the practice of

medicine.

3.

A physician or a physician assistant who is covered by individual

professional liability coverage (or an alternative which complies with

sections 13-64-301(1)(c), (d) or (e), C.R.S.), maintained by an

employer/contracting agency in the amounts set forth in paragraph (A),

above.

4.

A physician or a physician assistant who provides uncompensated health

care to patients, or who does not otherwise engage in any compensated

patient care in Colorado.

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ive which complies with

sections 13-64-301(1)(c), (d) or (e), C.R.S.), maintained by an

employer/contracting agency in the amounts set forth in paragraph (A),

above.

4.

A physician or a physician assistant who provides uncompensated health

care to patients, or who does not otherwise engage in any compensated

patient care in Colorado.

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E.

Any physician or physician assistant who claims exemption from the financial

responsibility requirements must provide such information, as may be requested

by the Board in order to establish eligibility for any such exemption.

Effective 8/30/90; Revised 9/30/99; Revised 08/19/10; Effective 10/15/10

1.15 RULES AND REGULATIONS REGARDING THE LICENSURE OF AND

PRACTICE BY PHYSICIAN ASSISTANTS

A.

Basis: The authority for promulgation of Rule 1.15 (“these Rules”) by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-240-

106(1)(a),12-240-107(6) and 12-240-113, C.R.S.

B.

Purpose: The purpose of these rules and regulations is to implement the

requirements of sections 12-240-113, 12-240-114.5 and 12-240-107(6), C.R.S.,

and provide clarification regarding the application of these Rules to various

practice settings.

C.

EXTENT AND MANNER IN WHICH A PHYSICIAN ASSISTANT MAY

PERFORM ACTS CONSTITUTING THE PRACTICE OF MEDICINE WITH A

COLLABORATIVE AGREEMENT IN PLACE

1.

The requirements for a Collaborative Agreement applies to all

collaborating physicians and physician assistants as of August 7, 2023.

2.

Responsibilities of the Physician Assistant

a.

Compliance with these Rules. A physician assistant is responsible

for implementing and complying with statutory requirements and

the provisions of these Rules.

b.

License. A physician assistant shall ensure that the individual’s

license to practice as a physician assistant is active and current

prior to performing any acts requiring a license.

c.

Collaborative Agreement

the Physician Assistant

a.

Compliance with these Rules. A physician assistant is responsible

for implementing and complying with statutory requirements and

the provisions of these Rules.

b.

License. A physician assistant shall ensure that the individual’s

license to practice as a physician assistant is active and current

prior to performing any acts requiring a license.

c.

Collaborative Agreement. A physician assistant must keep on file

their Collaborative Agreement at their primary location of practice

and make it available to the Board upon request.

d.

Identification As A Physician Assistant. While performing acts

defined as the practice of medicine, a physician assistant shall

clearly identify both visually (e.g. by nameplate or embroidery on a

lab coat) and verbally as a physician assistant.

e.

Chart Note. A physician assistant shall make a chart note for every

patient for whom the physician assistant performs any act defined

as the practice of medicine in section 12-240-107(1), C.R.S. When

a physician assistant consults with any physician about a patient,

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27

the physician assistant shall document in the chart note the names

of any physician consulted and the date of the consultation.

f.

Documentation. A physician assistant shall keep such

documentation as necessary to assist a collaborating or other

physician in performing an adequate performance assessment as

set forth below in Section (C)(3)(b) of this Rule.

g.

Emergency Department Settings

(1)

Collaborative Agreements entered into by physician

assistants in emergency departments in hospitals with Level

I or II trauma center settings shall take the form of a

supervisory agreement as identified in section 12-240-

114.5(2)(b)(IV)(A), C.R.S.

r

physician in performing an adequate performance assessment as

set forth below in Section (C)(3)(b) of this Rule.

g.

Emergency Department Settings

(1)

Collaborative Agreements entered into by physician

assistants in emergency departments in hospitals with Level

I or II trauma center settings shall take the form of a

supervisory agreement as identified in section 12-240-

114.5(2)(b)(IV)(A), C.R.S.

(2)

For Collaborative Agreements entered into by physician

assistants in emergency departments in hospitals other than

with Level I or II trauma center settings, a supervising

physician or physician group may increase the number of

hours for which the Collaborative Agreement is a supervisory

agreement, pursuant to section 12-240-114.5(2)(b)(IV)(B),

C.R.S.

3.

Requirements for Physicians and Physician Groups Entering into

Collaborating Agreements

a.

Physicians must be actively practicing medicine in Colorado by

means of a regular and reliable physical presence in Colorado. For

purposes of this Rule, to practice medicine based primarily on

telecommunication devices or other telehealth technologies does

not constitute “actively practicing medicine in Colorado.”

b.

Performance Evaluation

(1)

A physician or physician group who has entered into a

Collaborating Agreement with a physician assistant shall

develop and carry out a periodic Performance Evaluation as

required by these Rules and section 12-240-114.5(1)(c),

C.R.S. The Performance Evaluation should include domains

of competency relevant to the particular practice and utilize

more than one modality of assessment to evaluate those

domains of competency. The Performance Evaluation

should take into account the education, training, experience,

competency, and knowledge of the individual physician

assistant for whatever practice area in which the physician

assistant is engaged.

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ticular practice and utilize

more than one modality of assessment to evaluate those

domains of competency. The Performance Evaluation

should take into account the education, training, experience,

competency, and knowledge of the individual physician

assistant for whatever practice area in which the physician

assistant is engaged.

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(2)

The relationship between the physician or physician group

and physician assistant is by its nature a team relationship.

The purpose of the Performance Evaluation is to enhance

the collaborative nature of the team relationship, promote

public safety, clarify expectations, and facilitate the

professional development of an individual physician

assistant.

(3)

The domains of competency may be dependent upon the

type of practice the physician assistant is engaged in and

may include but are not limited to:

(a)

Medical knowledge;

(b)

Ability to perform an appropriate history and physical

examination;

(c)

Ability to manage, integrate and understand objective

data, such as laboratory studies, radiographic studies,

and consultations;

(d)

Clinical judgment, decision-making and assessment

of patients;

(e)

Accurate and appropriate patient management;

(f)

Communication skills (patient communication and

communication with other care providers);

(g)

Documentation and record keeping;

(h)

Collaborative practice and professionalism;

(i)

Procedural and technical skills appropriate to the

practice.

(4)

The modalities of assessment to evaluate domains of

competency may include but are not limited to:

(a)

Co-management of patients;

(b)

Direct observation;

(c)

Chart review with identification of charts reviewed;

cation with other care providers);

(g)

Documentation and record keeping;

(h)

Collaborative practice and professionalism;

(i)

Procedural and technical skills appropriate to the

practice.

(4)

The modalities of assessment to evaluate domains of

competency may include but are not limited to:

(a)

Co-management of patients;

(b)

Direct observation;

(c)

Chart review with identification of charts reviewed;

(d)

Feedback from patients and other identified providers.

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(5)

Performance evaluations must occur with at least the

minimum frequency required in section 12-240-

114.5(2)(b)(I)(C), C.R.S.

(6)

A physician or physician group must maintain accurate

records and documentation of the Performance Evaluations,

including the initial Performance Evaluation and periodic

Performance Evaluations for each physician assistant with

whom they have entered into a Collaborative Agreement.

(7)

The Board may audit a physician’s or physician group’s

performance assessment records. Upon request, the

physician or physician group shall produce records of the

performance assessments as required by the Board.

D.

PRESCRIPTION AND DISPENSING OF DRUGS.

1.

Prescribing Provisions:

a.

A physician assistant may issue a prescription order for any drug or

controlled substance provided that:

(1)

Each prescription and refill order is entered on the patient’s

chart.

(2)

For each written prescription issued by a physician assistant,

the prescription shall contain, in legible form imprinted on the

prescription, the physician assistant’s name and the address

of the health facility where the physician assistant is

practicing.

ription order for any drug or

controlled substance provided that:

(1)

Each prescription and refill order is entered on the patient’s

chart.

(2)

For each written prescription issued by a physician assistant,

the prescription shall contain, in legible form imprinted on the

prescription, the physician assistant’s name and the address

of the health facility where the physician assistant is

practicing.

(a)

If the health facility is a multi-specialty organization,

the name and address of the specialty clinic within the

health facility where the physician assistant is

practicing must be imprinted on the prescription.

(3)

A physician assistant may not issue a prescription order for

any controlled substance unless the physician assistant has

received a registration from the United States Drug

Enforcement Administration.

(4)

For the purpose of this Rule electronic prescriptions are

considered written prescription orders.

(5)

The dispensing of prescription medication by a physician

assistant is subject to section 12-280-120(6)(a), C.R.S.

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2.

Obtaining Prescription Drugs or Devices to Prescribe, Dispense,

Administer or Deliver

a.

No drug that a physician assistant is authorized to prescribe,

dispense, administer, or deliver shall be obtained by said physician

assistant from a source other than a collaborating physician,

pharmacist, or pharmaceutical representative.

b.

No device that a physician assistant is authorized to prescribe,

dispense, administer, or deliver shall be obtained by said physician

assistant from a source other than a collaborating physician,

pharmacist, or pharmaceutical representative.

E.

REPORTING REQUIREMENTS

1.

Collaborative Agreements.

a.

A Collaborative Agreement must be in writing and maintained at the

main practice location for the physician assistant.

b.

The Collaborative Agreement must include the requirements set

forth in section 12-240-114.5(2)(a), C.R.S.

c

cian

assistant from a source other than a collaborating physician,

pharmacist, or pharmaceutical representative.

E.

REPORTING REQUIREMENTS

1.

Collaborative Agreements.

a.

A Collaborative Agreement must be in writing and maintained at the

main practice location for the physician assistant.

b.

The Collaborative Agreement must include the requirements set

forth in section 12-240-114.5(2)(a), C.R.S.

c.

The form shall be signed by the physician and the physician

assistant.

d.

Collaborative Agreements for physician assistants with fewer than

five thousand practice hours, or for physician assistants changing

practice areas with fewer than three thousand hours in the new

practice area shall be a supervisory agreement and include the

additional requirements set forth in section 12-240-114.5(2)(b),

C.R.S.

F.

EXTENT AND MANNER IN WHICH A PHYSICIAN ASSISTANT MAY

PERFORM ACTS CONSTITUTING THE PRACTICE OF MEDICINE WITH A

COLLABORATING AGREEMENT THAT TAKES THE FORM OF A

SUPERVISORY AGREEMENT IN PLACE

1.

In addition to all other requirements in this Section, the following rules

apply to the manner and extent of acts constituting the practice of

medicine practice by physician assistants subject to supervisory

agreements under sections C(2)(g)(1) and (2) and E(1)(d):

2.

A physician or physician member of a physician group in a collaborating

agreement that takes the form of a supervisory agreement must perform

personal and responsible direction and supervision, which may not be

rendered through intermediaries.

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istants subject to supervisory

agreements under sections C(2)(g)(1) and (2) and E(1)(d):

2.

A physician or physician member of a physician group in a collaborating

agreement that takes the form of a supervisory agreement must perform

personal and responsible direction and supervision, which may not be

rendered through intermediaries.

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3.

No physician shall enter a collaborating agreement that takes the form of a

supervisory agreement for more than eight (8) specific, individual

physician assistants.

4.

If not physically on site with the physician assistant, the collaborating

physician or physician member of a physician group must be readily

available by telephone, radio, pager, or other telecommunication device.

5.

Certain physician assistants are subject to collaborating agreements

which take the form of supervisory agreements. The following physician

assistants are subject to supervisory agreements:

a.

Physician assistants with fewer than five thousand (5000) practice

hours;

b.

Physician assistants changing practice areas with fewer than three

thousand (3000) practice hours in the new practice area;

(1)

For a physician assistant changing practice areas to practice

in an emergency department of a hospital that is not a level I

or level II trauma center, the supervising physician or

physician group may increase the number of hours for which

the collaborative agreement is a supervisory agreement.

c.

Physician assistants entering into a collaborative agreement with a

physician or physician group in the emergency department of a

hospital with a level I or level II trauma center (whose agreements

will remain supervisory agreements indefinitely).

6.

Collaborative agreements which take the form of supervisory agreements

must include the following:

a.

The physician assistant’s name, license number, and primary

location of practice;

b

collaborative agreement with a

physician or physician group in the emergency department of a

hospital with a level I or level II trauma center (whose agreements

will remain supervisory agreements indefinitely).

6.

Collaborative agreements which take the form of supervisory agreements

must include the following:

a.

The physician assistant’s name, license number, and primary

location of practice;

b.

The signature of the physician assistant and the physician or

physician group with whom the physician assistant has entered into

the collaborative agreement.

c.

A description of the physician assistant’s process for collaboration,

the degree of which must be based on the physician assistant’s

primary location and area of practice and may include:

(1)

Decisions made by the physician or physician group with

whom the physician assistant has entered into a

collaborative agreement; and

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(2)

The credentialing or privileging requirements of the physician

assistant’s primary location of practice.

d.

A description of the performance evaluation process, which may be

completed by the physician assistant’s employer in accordance with

a performance evaluation and review process established by the

employer;

e.

Any additional requirements specific to the physician assistant’s

practice required by the physician or physician group entering into

the collaborative agreement, including additional levels of oversight,

limitations on autonomous judgment, and the designation of a

primary contact for collaboration;

f.

Require that collaboration during the first one hundred sixty (160)

practice hours be completed in person or through technology, as

permitted by the physician or physician group with whom the

physician assistant has entered into the collaborative agreement;

g

including additional levels of oversight,

limitations on autonomous judgment, and the designation of a

primary contact for collaboration;

f.

Require that collaboration during the first one hundred sixty (160)

practice hours be completed in person or through technology, as

permitted by the physician or physician group with whom the

physician assistant has entered into the collaborative agreement;

g.

Incorporate elements defining the expected nature of collaboration,

including: The physician assistant’s expected area of practice;

expectations regarding support and consultation from the physician

or physician group with whom the physician assistant has entered

into a collaborative agreement; methods and modes of

communication and collaboration; and any other pertinent elements

of collaborative, team-based practice applicable to the physician

assistant’s practice or establishment by the employer; and

h.

Require a performance evaluation and discussion of the

performance evaluation with the physician assistant after the

physician assistant has worked with the employer for six (6)

months, again after the physician assistant has worked with the

employer for twelve (12) months, and additional evaluation

thereafter as determined by the physician or physician group with

whom the physician assistant has entered into the collaborative

agreement.

1.16 LICENSURE OF AND PRACTICE BY ANESTHESIOLOGIST ASSISTANTS

A.

Basis: The authority for promulgation of Rule 1.16 (“these Rules”) by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1),

12-240-106(1)(a), and 12-240-112, C.R.S.

B.

Purpose: The purpose of these rules and regulations is to implement the

requirements of sections 12-240-107(7) and 12-240-112, C.R.S.

C.

QUALIFICATIONS FOR LICENSURE APPLICATION

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ule 1.16 (“these Rules”) by the

Colorado Medical Board (“Board”) is set forth in sections 24-4-103, 12-20-204(1),

12-240-106(1)(a), and 12-240-112, C.R.S.

B.

Purpose: The purpose of these rules and regulations is to implement the

requirements of sections 12-240-107(7) and 12-240-112, C.R.S.

C.

QUALIFICATIONS FOR LICENSURE APPLICATION

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To apply for a license, an applicant must meet the requirements for licensure as

outlined in section 12-240-112(1), C.R.S.

D.

EXTENT AND MANNER IN WHICH AN ANESTHESIOLOGIST ASSISTANT

MAY PERFORM DELEGATED TASKS CONSTITUTING THE PRACTICE OF

MEDICINE UNDER PERSONAL AND RESPONSIBLE DIRECTION AND

SUPERVISION

1.

Responsibilities of the Anesthesiologist Assistant

a.

Compliance with these Rules

(1)

An anesthesiologist assistant and the anesthesiologist

assistant’s supervising physician are responsible for

implementing and complying with statutory requirements and

the provisions of these Rules.

b.

License

(1)

An anesthesiologist assistant shall ensure that his or her

license to practice as an anesthesiologist assistant is active

and current prior to performing any acts requiring a license.

c.

Registration

(1)

An anesthesiologist assistant shall ensure that a form in

compliance with Section (D) of these Rules is on record with

the Board.

d.

Nameplate

(1)

In addition to the requirements regarding patient disclosure

in the Statute, and while performing acts defined as the

practice of medicine, an anesthesiologist assistant shall

wear a nameplate or photo identification badge with the non-

abbreviated title “Anesthesiologist Assistant” clearly visible.

e.

Chart Note

(1)

An anesthesiologist assistant shall make a chart note for

every patient for whom the anesthesiologist assistant

performs any act defined as the practice of medicine in

section 12-240-107(1), C.R.S.

e

practice of medicine, an anesthesiologist assistant shall

wear a nameplate or photo identification badge with the non-

abbreviated title “Anesthesiologist Assistant” clearly visible.

e.

Chart Note

(1)

An anesthesiologist assistant shall make a chart note for

every patient for whom the anesthesiologist assistant

performs any act defined as the practice of medicine in

section 12-240-107(1), C.R.S.

(2)

The chart note at a minimum must include documentation

that clearly indicates the times that the anesthesiologist

assistant was responsible for the care of a patient (i.e. start

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of service, end of service, on/off breaks, assuming care to

cover a scheduled break, etc.).

(3)

The Anesthesiologist Assistant shall document in the chart

note the name of the supervising Anesthesiologist and the

date of the anesthesia service.

f.

Documentation

(1)

An anesthesiologist assistant shall keep such documentation

as necessary to assist the supervising physician in

performing an adequate performance assessment as set

forth below in Section (B)(3)(d) of these Rules.

2.

Physician Supervisors and Scope and Authority to Delegate

a.

Four Anesthesiologist Assistant Limit

(1)

No physician shall concurrently supervise more than four

specific, individual anesthesiologist assistants at any one

time.

(2)

The names of the supervising physician and the

anesthesiologist assistant shall appear within the anesthesia

or other medical records for each patient when care is

provided by the anesthesiologist assistant.

(3)

To help ensure compliance with the four anesthesiologist

assistant rule, anesthesia records must be maintained in

such a way as to clearly show the beginning and end of each

anesthesiologist assistant involvement in an anesthetic

service.

b.

Physician Supervisor

shall appear within the anesthesia

or other medical records for each patient when care is

provided by the anesthesiologist assistant.

(3)

To help ensure compliance with the four anesthesiologist

assistant rule, anesthesia records must be maintained in

such a way as to clearly show the beginning and end of each

anesthesiologist assistant involvement in an anesthetic

service.

b.

Physician Supervisor

(1)

A physician licensed to practice medicine by the Board and

who practices as an anesthesiologist may delegate to an

anesthesiologist assistant licensed by the Board the ability to

perform acts that constitute the practice of medicine,

however, the authority for those acts remains with the

supervising physician.

(2)

The physician whose name appears on the form in

compliance with Section (D) of these Rules shall be deemed

the “physician supervisor”.

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(3)

The supervisory relationship shall be deemed to be effective

for all time periods in which a form in compliance with

Section (D) of these Rules is on file.

(4)

An incorporated group practice may meet the requirements

of this Section by submitting to the Board a listing of all its

employed anesthesiologist assistants and all of its employed

physicians who may act as supervising physicians.

(5)

During an anesthesia service where a transfer of authority

may take place, the transfer from one physician supervisor

to another must be clearly indicated in the anesthesia or

other medical record.

c.

Delegation of Medical Services

(1)

Delegated services must be consistent with the delegating

physician’s education, training, experience and active

practice. Delegated services must be of the type that a

reasonable and prudent physician would find within the

scope of sound medical judgment to delegate.

(2)

A physician may only delegate services that the physician is

qualified and insured to perform and services that the

physician has not been legally restricted from performing.

delegating

physician’s education, training, experience and active

practice. Delegated services must be of the type that a

reasonable and prudent physician would find within the

scope of sound medical judgment to delegate.

(2)

A physician may only delegate services that the physician is

qualified and insured to perform and services that the

physician has not been legally restricted from performing.

(3)

Any services rendered by the anesthesiologist assistant will

be held to the same standard that is applied to the

delegating physician, as defined in section 12-240-107(7),

C.R.S.

3.

Responsibilities of and Supervision by the Physician Supervisor

a.

Compliance with these Rules

(1)

Both the supervising physician and the anesthesiologist

assistant are responsible for implementing and complying

with the statutory requirements and the provisions of these

Rules.

b.

Liability for Actions of an Anesthesiologist Assistant

(1)

A physician supervisor may supervise and delegate tasks to

an anesthesiologist assistant in a manner consistent with the

requirements of these Rules.

(2)

The physician supervisor may be deemed to have violated

these Rules if a supervised anesthesiologist assistant

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commits unprofessional conduct as defined in section 12-

240-121(1)(j), C.R.S., or if such anesthesiologist assistant

otherwise violates these Rules.

c.

Evaluation

(1)

Prior to engaging the services of an anesthesiologist

assistant, the hospital, facility, ambulatory surgery center, or

office must ascertain that a mechanism exists for obtaining

an annual performance review that contains, at a minimum,

the requirements outlined in Section (B)(3)(d) of this Rule.

1)(j), C.R.S., or if such anesthesiologist assistant

otherwise violates these Rules.

c.

Evaluation

(1)

Prior to engaging the services of an anesthesiologist

assistant, the hospital, facility, ambulatory surgery center, or

office must ascertain that a mechanism exists for obtaining

an annual performance review that contains, at a minimum,

the requirements outlined in Section (B)(3)(d) of this Rule.

(2)

The performance assessment must be performed by a

physician licensed to practice medicine in this State who

practices as an anesthesiologist. Whenever possible the

evaluation and performance assessment should be

conducted by the physician with the most knowledge of the

anesthesiologist assistant’s performance throughout the

year.

(3)

Performance evaluation information may be gathered

through direct observation, review of available information,

including a review of reports which evidence performance, or

a combination of both.

(4)

Facilities required by local, state or federal statute and

regulations to have reviews performed by a director of

anesthesia services are deemed to have satisfied the

evaluation requirements.

d.

Performance Assessment

(1)

An anesthesiologist assistant shall have a periodic

performance assessment as required by these Rules to

assist in evaluating and maintaining the quality of care

provided by an anesthesiologist assistant that include, at a

minimum:

(a)

An assessment of the medical competency of the

anesthesiologist assistant;

(b)

A review of selected charts;

(c)

An assessment of the ability of the anesthesiologist

assistant to take a medical history from, and perform

an examination of, patients representative of those

cared for by the anesthesiologist assistant; and,

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nimum:

(a)

An assessment of the medical competency of the

anesthesiologist assistant;

(b)

A review of selected charts;

(c)

An assessment of the ability of the anesthesiologist

assistant to take a medical history from, and perform

an examination of, patients representative of those

cared for by the anesthesiologist assistant; and,

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(d)

Maintenance by the facility or employer of accurate

records and documentation of the performance

assessments for each anesthesiologist assistant

supervised.

(2)

The Board may audit an anesthesiologist assistant’s

performance assessment records.

e.

Availability of the physician supervisor.

The supervising physician must provide adequate means for

communication with the anesthesiologist assistant and remain

immediately available throughout the anesthesia service.

(1)

The Board considers a supervising physician to be

immediately available if s/he is in physical proximity that

allows the physician to return to re-establish direct contact

with the patient in order to meet medical needs and address

any urgent or emergent clinical problems.

(2)

These responsibilities may also be met through the

coordination among physicians of the same incorporated

group practice.

E.

ADMINISTRATION OF DRUGS AND CONTROLLED SUBSTANCES

1.

An anesthesiologist assistant may not independently write or issue a

prescription order for any drug or controlled substance.

a.

An anesthesiologist assistant may communicate an order from the

supervising physician to another licensed practitioner.

b.

Such communication may be verbal, written or electronic.

2.

Once a physician order is entered into the medical record by an

anesthesiologist assistant; the supervising physician must review and, if

required by the facility or institutional policy, cosign those orders in a

timely manner.

3.

An anesthesiologist assistant may administer drugs and controlled

substances under the supervision of a physician provided that:

a

y be verbal, written or electronic.

2.

Once a physician order is entered into the medical record by an

anesthesiologist assistant; the supervising physician must review and, if

required by the facility or institutional policy, cosign those orders in a

timely manner.

3.

An anesthesiologist assistant may administer drugs and controlled

substances under the supervision of a physician provided that:

a.

Each administration is entered in the patient’s anesthesia or other

medical record.

b.

Nothing in this Section (C) of these Rules shall prohibit a physician

supervisor from restricting the ability of a supervised

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anesthesiologist assistant to administer drugs or controlled

substances.

c.

An anesthesiologist assistant may not issue or communicate an

order for any drug or controlled substance outside of the hospital,

facility, ambulatory surgery center, or office setting reported

pursuant to Section (D) of these Rules.

d.

Anesthesiologist assistants shall not write or issue prescriptions or

perform any services that the supervising physician for that

particular patient is not qualified or authorized to prescribe or

perform.

F.

REPORTING REQUIREMENTS

1.

The application for licensure shall include a requirement that

anesthesiologist assistants provide the Board with a list of hospitals,

facilities, ambulatory surgery centers, and physician offices where they

intend to practice medicine under the supervision of a physician.

2.

The reporting must be provided in a form established by the Board and

completed in conformance with these Rules.

Adopted 02/14/2013, Effective 04/30/2013; Revised 5/22/14, Effective 7/15/14; Revised

5/17/18, Effective

1.17 DELEGATION AND SUPERVISION OF MEDICAL SERVICES TO

UNLICENSED PERSONS PURSUANT TO SECTION 12-240-107(3)(l), C.R.S.

A.

Basis: The general authority for promulgation of these Rules by the Colorado

Medical Board (“Board”) is set forth in sections 12-20-204(1), 12-240-106(1)(a),

and 24-4-103, C.R.S.

B

02/14/2013, Effective 04/30/2013; Revised 5/22/14, Effective 7/15/14; Revised

5/17/18, Effective

1.17 DELEGATION AND SUPERVISION OF MEDICAL SERVICES TO

UNLICENSED PERSONS PURSUANT TO SECTION 12-240-107(3)(l), C.R.S.

A.

Basis: The general authority for promulgation of these Rules by the Colorado

Medical Board (“Board”) is set forth in sections 12-20-204(1), 12-240-106(1)(a),

and 24-4-103, C.R.S.

B.

Purpose: The following Rules have been adopted by the Board to clarify the

requirements of section 12-240-107(3)(l), C.R.S. (the “Delegation Statute”). The

Delegation Statute governs the delegation of medical services to, and personal

and responsible direction and supervision over, a person who is not licensed to

practice medicine or otherwise licensed to perform the delegated medical

services. This Rule does not govern delegation of medical services to physician

assistants, anesthesiologist assistants or those individuals regulated by the

Board of Nursing. Such delegation is governed by Rules 1.15 and 1.16, and the

Nurse Practice Act, section 12-255-101 et seq., C.R.S., respectively.

C.

Scope of Rules: These Rules apply to the delegation of services constituting the

practice of medicine to a person who is not licensed to practice medicine, is not

qualified for licensure as a physician, physician assistant or anesthesiologist

assistant, and is not otherwise exempt pursuant to section 12-240-107, C.R.S.,

from holding a license to practice medicine.

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ly to the delegation of services constituting the

practice of medicine to a person who is not licensed to practice medicine, is not

qualified for licensure as a physician, physician assistant or anesthesiologist

assistant, and is not otherwise exempt pursuant to section 12-240-107, C.R.S.,

from holding a license to practice medicine.

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D.

MEDICAL SERVICES THAT MAY BE DELEGATED UNDER THESE RULES

1.

Medical Services

a.

“Medical services” are defined by the Medical Practice Act, section

12-240-107, C.R.S., to include suggesting, recommending,

prescribing, or administering any form of treatment, operation, or

healing for the intended palliation, relief, or cure of any physical or

mental disease, ailment, injury, condition or defect of any person.

b.

“Medical services” also include holding oneself out to the public as

being able to diagnose, treat, prescribe for, palliate or prevent any

human disease, ailment, pain, injury, deformity, or physical or

mental condition. “Medical services” are further defined by section

12-240-107(1), C.R.S.

c.

“Medical Services” includes those acts, other than those acts

excluded by subsection (D) of this Section, performed pursuant to

physician delegation by unlicensed persons or licensed healthcare

professionals.

2.

Medical-Aesthetic Services

a.

“Medical-Aesthetic Services” are medical services in the cosmetic

or aesthetic field that constitute the practice of medicine. Such

Medical-Aesthetic Services include, but are not limited to: (a) the

use of a Class IIIb or higher laser, radio-frequency device, intense

pulsed light, or other technique that results in the revision,

destruction, incision or other structural alteration of human tissue

and/or for hair removal; and (b) the performance of injection(s) of

any substance into the human body except as may be permitted

pursuant to subsection (D) of this Section.

b

not limited to: (a) the

use of a Class IIIb or higher laser, radio-frequency device, intense

pulsed light, or other technique that results in the revision,

destruction, incision or other structural alteration of human tissue

and/or for hair removal; and (b) the performance of injection(s) of

any substance into the human body except as may be permitted

pursuant to subsection (D) of this Section.

b.

As with all delegated medical services, delegated Medical-

Aesthetic Services must be of the type that a reasonable and

prudent physician would find within the scope of sound medical

judgment to delegate. Consequently, delegated Medical-Aesthetic

Services should be routine, technical services, the performance of

which do not require the special skills of a licensed physician.

c.

Off-label use of medications or devices when performing delegated

Medical-Aesthetic Services is generally prohibited unless:

(1)

The delegating physician has specifically authorized and

delegated the off-label use, and,

(2)

The off-label use is within generally accepted standards of

medical practice.

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d.

Medical-Aesthetic Services must be delivered within a facility

appropriate to the delegated service provided and listed on the

written agreement as set forth in Appendix D.

3.

Use of Lasers

a.

The revision, destruction, incision, or other structural alteration of

human tissue using laser technology is a medical service and

constitutes the practice of medicine, as defined in section 12-240-

107, C.R.S.

b.

Use of Class IIIb or higher lasers or pulse light devices as

constitutes the practice of medicine.

4.

Acts That Do Not Constitute Medical Services

a.

The definition of medical services under the Medical Practice Act

does not include acting as an intermediary by communicating a

physician’s message or order to another person, or otherwise

carrying out education activities as directed by the physician

se of Class IIIb or higher lasers or pulse light devices as

constitutes the practice of medicine.

4.

Acts That Do Not Constitute Medical Services

a.

The definition of medical services under the Medical Practice Act

does not include acting as an intermediary by communicating a

physician’s message or order to another person, or otherwise

carrying out education activities as directed by the physician.

Therefore a person who merely acts as an intermediary to

communicate a physician’s message or order to another person is

not subject to these Rules.

b.

The definition of medical services under the Medical Practice Act

does not include gathering data. A person who merely gathers data

is not subject to these Rules. For example, performing phlebotomy,

measuring vital signs, and gathering historical patient information is

not subject to these Rules.

c.

Tattooing, application of permanent makeup, superficial exfoliative

therapies, such as microdermabrasion, other superficial skin

treatments, and those services regulated by the Barber and

Cosmetologist Practice Act, section 12-105-101, et seq., C.R.S.,

are not medical services.

d.

The use of Class I, II, and IIIa medical devices, including Class I, II,

and IIIa lasers, does not constitute a medical service.

e.

Monitoring of medication compliance is not a medical service.

f.

Medication administration by Qualified Medication Administration

Personnel (QMAP) who are regulated by the Colorado Department

of Public Health and Environment is not included within the

definition of medical services for purposes of this Rule.

5.

Delegated Medical Services Should Not Require Exercise of Medical

Judgment

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service.

f.

Medication administration by Qualified Medication Administration

Personnel (QMAP) who are regulated by the Colorado Department

of Public Health and Environment is not included within the

definition of medical services for purposes of this Rule.

5.

Delegated Medical Services Should Not Require Exercise of Medical

Judgment

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a.

A physician should not delegate a medical service requiring the

exercise of medical judgment by the delegatee.

b.

Delegated medical services should be limited to routine, technical

services that do not require the special skills of a licensed

physician.

6.

Medical Services that May Not Be Delegated

a.

Prescription Medications

(1)

Prescribing of drugs may not be delegated under section 12-

240-107(3)(l), C.R.S., and these Rules.

(2)

The ordering of a prescription refill by a delegatee does not

constitute “the prescribing of drugs” provided that:

(a)

The prescription refill is ordered at the same dose and

for the same medication as the original prescription

for that patient; and

(b)

The prescription refill is ordered pursuant to a written

refill protocol developed and authorized by one or

more delegating physicians.

b.

Non-Prescription Medications

(1)

The recommendation of marijuana as a therapeutic option

may not be delegated under section 12-240-107(3)(l),

C.R.S., and these Rules.

E.

RULES GOVERNING INDIVIDUALS WHO CHOOSE TO DELEGATE MEDICAL

SERVICES

1.

Who May Delegate

a.

Licensed physicians may delegate the performance of medical

services to delegatees, in conformance with these Rules.

b.

To delegate a medical service, an eligible delegating physician

must be:

(1)

Qualified by education, training and experience to perform

the medical service;

(2)

Actively performing the medical service as part of his or her

medical practice and not exclusively by delegating the

service to a delegatee;

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(3)

Insured to perform the medical service; and

cal service, an eligible delegating physician

must be:

(1)

Qualified by education, training and experience to perform

the medical service;

(2)

Actively performing the medical service as part of his or her

medical practice and not exclusively by delegating the

service to a delegatee;

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(3)

Insured to perform the medical service; and

(4)

Actively practicing medicine and available in the community

where the delegated medical services occur.

(a)

To be “available in the community,” a physician must

be physically present in the State and able to

promptly, personally consult with or otherwise provide

follow up care to the patient.

(b)

A delegating physician may utilize telehealth

technologies, where appropriate, to satisfy the

requirements for prompt personal consultation or

follow-up care, but should not rely exclusively on such

telehealth technologies to perform those services.

(c)

Physician assistants or anesthesiologist assistants

may delegate medical services to unlicensed

healthcare providers who are acting under the direct

supervision of the licensed physician assistant or

anesthesiologist assistant, where appropriate, within

the scope of the physician assistant's or

anesthesiologist assistant's delegated medical

services.

2.

Who May Not Delegate

a.

Delegated services cannot be re-delegated to another party by the

delegatee.

b.

A person who holds a physician training license pursuant to section

12-240-128, C.R.S., is not authorized to delegate medical services

pursuant to section 12-240-107(3)(l), C.R.S., and these Rules.

c.

Persons with a limited medical license may not delegate pursuant

to these Rules any medical services for which the licensee is

prohibited from performing.

F.

RULES GOVERNING INDIVIDUALS TO WHOM MEDICAL SERVICES ARE

DELEGATED (“DELEGATEES”)

1.

Persons Who May Serve as Delegatees

a.

Qualified by Education, Training or Experience

vices

pursuant to section 12-240-107(3)(l), C.R.S., and these Rules.

c.

Persons with a limited medical license may not delegate pursuant

to these Rules any medical services for which the licensee is

prohibited from performing.

F.

RULES GOVERNING INDIVIDUALS TO WHOM MEDICAL SERVICES ARE

DELEGATED (“DELEGATEES”)

1.

Persons Who May Serve as Delegatees

a.

Qualified by Education, Training or Experience

(1)

The delegating physician must evaluate and determine that

the delegatee has the necessary education, training or

experience to perform each delegated medical service.

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(2)

As part of his or her evaluation, the delegating physician

shall personally assess and review:

(a)

Copies of diplomas, certificates or professional

degrees from bona fide training program(s)

appropriate to the specific services delegated; and,

(b)

Appropriate credentialing by a bona fide agency,

Board or institution, if applicable.

(c)

In any practice which utilizes a credentialing

committee or a human resources department for

verification of credentials, a delegating physician may

rely on a credentialing committee or a human

resources department for verification of Section

30.4(A)(1)(b)(1) and (2).

(3)

The delegating physician shall perform over-the-shoulder

direct observation of the delegatee’s performance of any

medical service prior to authorizing the delegatee to perform

the medical service outside of the delegating physician’s

physical presence. A delegating physician may rely on

another Colorado Medical Board licensee’s evaluation of the

delegatee’s skill to perform medical services.

b

(3)

The delegating physician shall perform over-the-shoulder

direct observation of the delegatee’s performance of any

medical service prior to authorizing the delegatee to perform

the medical service outside of the delegating physician’s

physical presence. A delegating physician may rely on

another Colorado Medical Board licensee’s evaluation of the

delegatee’s skill to perform medical services.

b.

In the event that a delegating physician chooses to delegate

medical services to a person holding a license, certificate or

registration, and the delegated services are beyond the scope of

that person’s license, certificate or registration, the delegating

physician must ensure that the delegatee is qualified by additional

education, training or experience beyond that required for the

delegatee’s license, certificate or registration. Any delegation

described in this paragraph must comply with the requirements of

this Rule 800.

c.

These Rules apply to individuals who are certified by a national or

private body but who do not have Colorado state licensure,

registration or certification.

d.

Graduates of physician assistant and anesthesiologist assistant

programs who have not yet taken the certification examination, and

thus, are not qualified for licensure, may perform delegated medical

services pursuant to section 12-240-107(3)(l), C.R.S., until such

time as they have been notified that they have passed the

certification exam and are eligible for a Colorado license. The

delegating physician and the unlicensed physician assistant

graduate or unlicensed anesthesiologist assistant graduate shall

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form delegated medical

services pursuant to section 12-240-107(3)(l), C.R.S., until such

time as they have been notified that they have passed the

certification exam and are eligible for a Colorado license. The

delegating physician and the unlicensed physician assistant

graduate or unlicensed anesthesiologist assistant graduate shall

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44

comply with the requirements of these Rules until the physician

assistant or anesthesiologist assistant is licensed and subject to

Board Rule 1.15 or 1.16.

e.

Medical aesthetic service instructors at institutions

accredited/certified by the Department of Higher Education may

serve as delegatees provided the instructor possesses the

necessary education, training or experience to perform each

delegated medical service.

(1)

The physician may delegate the medical service to such

Instructor and students at the aforementioned institution to

be performed by the student under the direct supervision of

the instructor.

2.

The delegating physician and the delegatee shall take appropriate

measures to ensure that delegatees are identified in a manner that

prevents confusion as to the delegatees’ qualifications and legal authority

to provide medical services. Following are examples of situations in which

confusion as to the delegatees’ qualifications and legal authority to provide

medical services is likely and in which the physician and the delegatee

shall be responsible for taking effective measures to prevent such

confusion. This list is illustrative and not exhaustive.

a.

A delegatee who is a “radiology practitioner assistant” uses the

acronym “RPA”, which is easily confused with the title of a licensed

physician assistant or PA;

b.

A delegatee uses the word “licensed” as part of a title when the

delegatee is not licensed, registered, or certified by the state of

Colorado to perform the medical services at issue;

c.

A delegatee uses the word “doctor” or the abbreviation “Dr.” when

acting as a delegatee; or

d

assistant” uses the

acronym “RPA”, which is easily confused with the title of a licensed

physician assistant or PA;

b.

A delegatee uses the word “licensed” as part of a title when the

delegatee is not licensed, registered, or certified by the state of

Colorado to perform the medical services at issue;

c.

A delegatee uses the word “doctor” or the abbreviation “Dr.” when

acting as a delegatee; or

d.

A delegatee who is an “aesthetician” uses the word “medical” as

part of a title, such as “medical aesthetician”, when the delegatee is

not licensed, registered or certified by the state of Colorado to

perform medical services.

3.

Persons Not Eligible to Serve as Delegatees

a.

A physician shall not delegate medical services to any person who

is otherwise qualified to be licensed by the Board as a physician,

physician assistant or anesthesiologist assistant but who is not so

licensed, including, but not limited to:

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45

(1)

Any physician, physician assistant or anesthesiologist

assistant with an inactive, expired, revoked, restricted,

limited, suspended or surrendered license;

(2)

Any physician, physician assistant or anesthesiologist

assistant (other than those physician assistants or

anesthesiologist assistants authorized pursuant to Rule

1.17(F)(1)(d)) who meets all qualifications for licensure but

who is not licensed in Colorado; and

(3)

Any physician, physician assistant or anesthesiologist

assistant whose application for licensure in the State of

Colorado has been denied unless the denial is pursuant to

section 12-240-120(1)(a), C.R.S.

b.

Medical services shall not be delegated to any person who holds a

physician training license pursuant to section 12-240-128, C.R.S.

4.

Exceptions

a.

These Rules do not apply to a person performing acts that do not

constitute the practice of medicine as defined by section 12-240-

107(1), C.R.S.

b

State of

Colorado has been denied unless the denial is pursuant to

section 12-240-120(1)(a), C.R.S.

b.

Medical services shall not be delegated to any person who holds a

physician training license pursuant to section 12-240-128, C.R.S.

4.

Exceptions

a.

These Rules do not apply to a person performing acts that do not

constitute the practice of medicine as defined by section 12-240-

107(1), C.R.S.

b.

These Rules do not apply to health care providers who are

licensed, registered or certified by the state of Colorado and who

are acting within their scope of practice.

c.

These Rules do not apply to a registered nurse (also known as a

professional nurse or an RN). Services provided by a registered

nurse, either as an independent nursing function or a delegated

medical function, are governed by the Nurse Practice Act.

d.

These Rules do not apply to any person who is otherwise exempt

pursuant to section 12-240-107, C.R.S. from holding a license to

practice medicine and who is acting within the scope of the specific

statutory exemption.

G.

RULES GOVERNING THE DELEGATING PHYSICIAN’S DELEGATION OF

AUTHORITY TO PROVIDE MEDICAL SERVICES.

1.

Any medical service rendered by the delegatee must conform to the same

standard applicable if the delegating physician performed the service

personally.

H.

RULES GOVERNING THE DELEGATING PHYSICIAN’S REQUIREMENTS

FOR SUPERVISION OF DELEGATEES

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GOVERNING THE DELEGATING PHYSICIAN’S DELEGATION OF

AUTHORITY TO PROVIDE MEDICAL SERVICES.

1.

Any medical service rendered by the delegatee must conform to the same

standard applicable if the delegating physician performed the service

personally.

H.

RULES GOVERNING THE DELEGATING PHYSICIAN’S REQUIREMENTS

FOR SUPERVISION OF DELEGATEES

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1.

The delegating physician must:

a.

Provide ongoing inspection, evaluation, advice and control;

b.

Make decisions as to the necessity, type, effectiveness and method

of treatment;

c.

Provide sufficient on-the-spot inspection to determine that the

physician’s directions are regularly being followed;

d.

Monitor the quality of the services provided by the delegatee; and,

e.

Provide personal and responsible direction and supervision that is

consistent with generally accepted standards of medical practice.

2.

The physician’s direction and supervision of the delegatee shall be

sufficient to limit the need for a delegatee to exercise the judgment

required of a physician.

3.

Delegated services must be provided in the context of an appropriate

physician/patient relationship.

4.

Ongoing care of a particular patient without direct physician involvement is

inappropriate and demonstrates insufficient personal and responsible

direction and supervision of a delegatee.

a.

Factors establishing the presence of an appropriate

physician/patient relationship include, but are not limited to, some

or all of the following: physician performance of an initial

consultation with the patient, direct observation by the physician of

delegated services rendered by the delegatee, physician review of

care rendered to the patient by the delegatee, physician review of

outcomes following the performance of delegated services, and

other active physician involvement in the provision, review and

documentation of services provided by the delegatee.

5

ce of an initial

consultation with the patient, direct observation by the physician of

delegated services rendered by the delegatee, physician review of

care rendered to the patient by the delegatee, physician review of

outcomes following the performance of delegated services, and

other active physician involvement in the provision, review and

documentation of services provided by the delegatee.

5.

Except as otherwise provided in these Rules, a physician must be on the

premises and readily available to provide adequate personal and

responsible direction and supervision.

6.

Where a delegatee is acting pursuant to specific and detailed written

protocols and where adequate written emergency protocols are in place,

the presence of the delegating physician on the premises may not be

necessary. However, a delegating physician must be physically present in

the State and available to promptly, personally attend to the patient. At

any time when a delegating physician is not physically present within the

State, the delegating physician must identify and provide the contact

information to delegatees of a covering physician who is physically

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47

present in the State and available to promptly, personally attend to the

patient.

7.

At least every two weeks, the delegating physician must monitor the

quality of the services provided by the delegatee through such means as

direct observation, review of care, review of outcomes, review of

equipment, review of protocols and procedures and review of charts. The

monitoring must occur at the site where the delegated services are

performed.

8.

On at least an annual basis, the delegating physician must personally

reassess the qualifications and competence of the delegatee to perform

the medical services. This reassessment must include, but must not be

limited to, over-the-shoulder monitoring of the delegatee’s performance of

each delegated medical service.

9

monitoring must occur at the site where the delegated services are

performed.

8.

On at least an annual basis, the delegating physician must personally

reassess the qualifications and competence of the delegatee to perform

the medical services. This reassessment must include, but must not be

limited to, over-the-shoulder monitoring of the delegatee’s performance of

each delegated medical service.

9.

The delegating physician must document the initial assessment and

follow-up reassessments of the delegatee’s performance of the delegated

medical services. Upon request, the delegating physician must provide

such documentation to the Board.

a.

In a hospital or medical practice, a delegating physician may rely on

a credentialing committee, human resources, or other documented

institutional process/es for verification of this Rule 1.17(H)(6)-(9).

I.

DOCUMENTATION REQUIREMENTS

1.

Written Procedure Protocols

a.

Written procedure protocols are required to be in place at any time

that a delegating physician will not be physically located on the

premises where medical services are provided by a delegatee.

b.

The delegating physician shall create a comprehensive written

protocol for use by the delegatee for each procedure that the

physician delegates to the delegatee. The delegating physician

may not rely upon a written protocol created by the delegatee to

satisfy this requirement.

2.

Written Emergency Protocols

a.

Written emergency protocols are required to be in place at any time

that a delegating physician will not be physically located on the

premises where medical services are provided by a delegatee.

b.

The delegating physician shall create a comprehensive written

emergency protocol for use by the delegatee when medical

services result in adverse events. The delegating physician may not

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place at any time

that a delegating physician will not be physically located on the

premises where medical services are provided by a delegatee.

b.

The delegating physician shall create a comprehensive written

emergency protocol for use by the delegatee when medical

services result in adverse events. The delegating physician may not

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48

rely upon a written protocol created by the delegatee to satisfy this

requirement.

c.

As part of a written emergency protocol, the delegatee shall be

required to notify the delegating physician of all adverse events.

3.

Medical Records

a.

A delegating physician shall assure that there is a timely medical

record for all patient contacts with either the delegatee or with the

delegating physician. The medical record prepared by a delegatee

shall conform to generally accepted standards of medical practice

for recordkeeping.

b.

A delegating physician shall review the care provided to every

patient who is treated by the delegatee. The delegating physician

shall demonstrate that he or she has reviewed the care provided to

the patient by reviewing each entry in the patient’s medical record.

The delegating physician shall initial and date the medical record at

the time he or she reviews the record.

c.

A delegating physician shall review the care provided to patients

pursuant to his or her delegated authority within fourteen days of

the date that the care was provided.

d.

When the delegated medical services by delegatees occur in the

context of a same-day encounter with the delegating physician and

the delegating physician has been personally involved in the care of

the patient, the delegating physician’s own documentation of the

encounter shall be adequate to meet the requirements for chart

review, and the delegating physician need not co-sign any entries

made by the delegatee.

4.

Written Agreement between Delegating Physician and Delegatee

a

-day encounter with the delegating physician and

the delegating physician has been personally involved in the care of

the patient, the delegating physician’s own documentation of the

encounter shall be adequate to meet the requirements for chart

review, and the delegating physician need not co-sign any entries

made by the delegatee.

4.

Written Agreement between Delegating Physician and Delegatee

a.

The delegating physician and the delegatee must have a written

agreement documenting and detailing the relationship. This written

agreement is attached in Appendix D of these Rules. The written

agreement as set forth in Appendix D must be available to the

public at the site where the delegated medical services are

performed.

b.

The delegating physician must maintain a list of all delegatees to

whom the physician has delegated medical services. The list must

include a comprehensive and specific list of the delegated medical

services that the physician has authorized the delegatee to

perform.

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49

c.

Where the delegating physician is on-site and able to personally

direct the delegatee at least 60% of the time, the requirement for a

written agreement may be satisfied through job descriptions,

personnel records or other documents that identify the relationship

between the delegating physician and delegatee.

5.

Documentation that the Delegating Physician or Healthcare Facility Must

Maintain

a.

The delegating physician or healthcare facility shall maintain a copy

of all documentation required by these Rules, including but not

limited to:

(1)

Appendix D written agreement;

job descriptions,

personnel records or other documents that identify the relationship

between the delegating physician and delegatee.

5.

Documentation that the Delegating Physician or Healthcare Facility Must

Maintain

a.

The delegating physician or healthcare facility shall maintain a copy

of all documentation required by these Rules, including but not

limited to:

(1)

Appendix D written agreement;

(2)

Any agreement that the delegating physician enters into, in

order to serve as a medical director.

b.

The delegating physician or healthcare facility is required to

maintain all documentation required by these Rules.

c.

Upon request, the delegating physician is responsible to provide all

documentation maintained by the physician or healthcare facility in

accordance with these Rules to the Board. The delegating

physician may not rely solely on a medical office or other entity to

provide the requested documents.

6.

Disclosure Requirements to Patients

a.

Delegating physicians shall ensure that delegatees adequately

disclose that a medical service will be performed by a delegatee,

rather than by the delegating physician. When the delegating

physician is not actively involved in the patient encounter, the

disclosure shall include: the service the patient is receiving is a

medical service; the delegatee of the service is not licensed by the

state of Colorado or is acting beyond the scope of his or her

Colorado license, certification or registration; the delegatee is

providing the service pursuant to the delegated authority of a

physician; and, the delegating physician is available personally to

consult with them or provide appropriate evaluation or treatment in

relation to the delegated medical services. Upon request, the

delegating physician must timely and personally provide such

consultation, evaluation or treatment, or provide appropriate follow-

up care and/or referrals.

vice pursuant to the delegated authority of a

physician; and, the delegating physician is available personally to

consult with them or provide appropriate evaluation or treatment in

relation to the delegated medical services. Upon request, the

delegating physician must timely and personally provide such

consultation, evaluation or treatment, or provide appropriate follow-

up care and/or referrals.

(1)

The disclosure requirements may be made in writing as part

of a signed disclosure agreement, an Informed Consent

agreement, or a Consent or Agreement to Treat form.

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50

b.

For all delegated medical services occurring in the context of a

bona fide physician-patient relationship, the delegating physician

and the delegatee shall document the disclosure made to the

patient, at the time each medical service is performed.

c.

For all offices at which delegated medical-aesthetic services are

provided, the delegating physician shall ensure that each office

conspicuously posts, in the office’s reception area, a notice with the

name and contact information for each delegating physician.

d.

For all offices at which delegated medical-aesthetic services are

provided, the delegating physician shall create a written disclosure,

identifying the service to be performed, that the performance of the

medical service is delegated to an unlicensed person, the name of

the unlicensed person/delegatee, and the name and contact

information for the delegating physician. The written disclosure

shall be signed by the patient prior to receiving the medical service.

The patient shall be given a copy of each disclosure and a copy

shall be retained within the patient’s medical record.

e.

The delegating physician must ensure that each patient receives all

information necessary to give appropriate informed consent or

consent or agreement for treatment for any medical service and

that such informed consent or consent or agreement for treatment

is timely documented in the patient’s chart

ven a copy of each disclosure and a copy

shall be retained within the patient’s medical record.

e.

The delegating physician must ensure that each patient receives all

information necessary to give appropriate informed consent or

consent or agreement for treatment for any medical service and

that such informed consent or consent or agreement for treatment

is timely documented in the patient’s chart.

J.

UNPROFESSIONAL CONDUCT

1.

It is a violation of these Rules for any physician to have delegated medical

services without complying with the provisions of these Rules.

2.

It is a violation of these Rules for a licensee to perform delegated medical

services pursuant to these Rules, when such licensee is otherwise

restricted from performing such acts.

3.

It is a violation of these Rules for any person qualified for licensure by this

Board and who later applies for licensure by this Board, to have performed

delegated medical services or to have delegated medical services

pursuant to section 12-240-107(3)(l), C.R.S., prior to licensure in

Colorado.

4.

Any violation of these Rules may be determined to be unprofessional

conduct pursuant to section 12-240-121(1)(n), C.R.S.

5.

To the extent that delegatees do not provide delegated medical services

within generally accepted standards of medical practice, the delegating

physician may be determined to have committed unprofessional conduct

pursuant to section 12-240-121(1)(j), C.R.S.

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to be unprofessional

conduct pursuant to section 12-240-121(1)(n), C.R.S.

5.

To the extent that delegatees do not provide delegated medical services

within generally accepted standards of medical practice, the delegating

physician may be determined to have committed unprofessional conduct

pursuant to section 12-240-121(1)(j), C.R.S.

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6.

To the extent that delegatees falsify or repeatedly make incorrect essential

entries on patient records, or repeatedly fail to make essential entries on

patient records, the delegating physician may be determined to have

committed unprofessional conduct pursuant to section 12-240-121(1)(v),

C.R.S.

7.

In the event that a delegating physician fails to produce to the Board, upon

its request through a 30-day letter, a copy of any document required to be

maintained by these Rules, the Board may determine that the delegating

physician has committed unprofessional conduct pursuant to section 12-

240-121(1)(y), C.R.S.

K.

UNLICENSED PRACTICE OF MEDICINE

1.

Pursuant to section 12-240-107(2), C.R.S., any person who performs any

of the acts constituting the practice of medicine as defined by section 12-

240-107(1), C.R.S., and who is not licensed by the Board to practice

medicine or exempt from licensure requirements by some provision of

section 12-240-107, C.R.S., shall be deemed to be practicing medicine

without a license. No person shall be exempt from medical licensure

requirements pursuant to section 12-240-107(3)(l), C.R.S., unless such

person is acting in conformance with these Rules.

2.

A person who practices medicine without a license may be the subject of a

cease and desist order pursuant to section 12-240-125, C.R.S. Such

person may also be the subject of injunctive proceedings by the Board in

the name of the People of the State of Colorado pursuant to section 12-

20-406, C.R.S. Such person may also be held criminally liable pursuant to

section 12-240-135(1), C.R.S

e Rules.

2.

A person who practices medicine without a license may be the subject of a

cease and desist order pursuant to section 12-240-125, C.R.S. Such

person may also be the subject of injunctive proceedings by the Board in

the name of the People of the State of Colorado pursuant to section 12-

20-406, C.R.S. Such person may also be held criminally liable pursuant to

section 12-240-135(1), C.R.S. Finally, such person may be subject to any

other enforcement allowed under the law.

Adopted 11/15/02, Effective 1/30/03; Revised 04/14/05, Effective 06/30/05; Revised

10/13/05, Effective 11/30/05, Revised 5/11/06, Effective 7/2/06; Repealed and

Readopted 5/22/08, Effective 6/30/08; Revised 08/19/10; Effective 10/15/10; Revised

11/18/2010; Effective 01/14/2011; Emergency-Revised 4/20/17, Effective 4/20/17;

Permanent-Revised 4/20/17, Effective 6/14/17

1.18 RESPONSIBILITIES OF A PHYSICIAN WHO ENGAGES IN DRUG THERAPY

MANAGEMENT WITH A COLORADO LICENSED PHARMACIST

A.

Basis: The general authority for promulgation of these Rules by the Colorado

Medical Board(“Board”) is set forth in sections 12-20-204(1), 12-240-106(1)(a),

and 24-4-103, C.R.S.

B.

Purpose: The Board has adopted these Rules to delineate the requirements and

responsibilities applicable to a licensed physician who enters into an agreement

with a Colorado licensed pharmacist to provide “drug therapy management” by

protocol as defined in these Rules. Colorado State Board of Pharmacy Rule

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a),

and 24-4-103, C.R.S.

B.

Purpose: The Board has adopted these Rules to delineate the requirements and

responsibilities applicable to a licensed physician who enters into an agreement

with a Colorado licensed pharmacist to provide “drug therapy management” by

protocol as defined in these Rules. Colorado State Board of Pharmacy Rule

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52

17.00.00 (“Pharmaceutical Care, Drug Therapy Management and Practice by

Protocol”) defines the requirements and responsibilities applicable to a Colorado

licensed pharmacist who enters into an agreement with a Colorado licensed

physician to provide “drug therapy management” by protocol.

C.

Definitions

1.

“Active, unrestricted license” means a license that is not currently subject

to any practice restrictions, terms, or conditions, including but not limited

to terms of probation.

2.

“Board” means the Colorado Medical Board unless otherwise specified in

these Rules.

3.

“Drug therapy management” means the review and evaluation of drug

therapy regimens for patients undertaken by a pharmacist in order to

provide drug therapy, monitor progress and modify drug therapy. Drug

therapy management may only be undertaken pursuant to an initial

diagnosis made by a licensed physician, a valid order for the therapy, and

a written agreement, which delineates proper protocols to be used, and

the type of interaction that must occur between the pharmacist and the

physician. Therapeutic interchange programs in inpatient and group model

integrated closed HMO settings that are approved by medical staff

committees are not considered drug therapy management for purposes of

these Rules. Drug therapy management may include:

a.

Collecting and reviewing patient drug histories;

b.

Obtaining and checking vital signs;

c.

Ordering and evaluating the results of laboratory tests directly

related to management of the drug therapy when performed in

compliance with the protocol ordered by the physician;

d

taff

committees are not considered drug therapy management for purposes of

these Rules. Drug therapy management may include:

a.

Collecting and reviewing patient drug histories;

b.

Obtaining and checking vital signs;

c.

Ordering and evaluating the results of laboratory tests directly

related to management of the drug therapy when performed in

compliance with the protocol ordered by the physician;

d.

Modifying drug therapy when appropriate, in compliance with the

protocol ordered by the physician; and

e.

Implementing the drug therapy plan agreed upon between the

physician and the pharmacist, using a protocol and managing the

therapy according to the protocol.

4.

“Protocol” means a specific written plan for a course of medical treatment

for a certain disease state containing a written set of specific directions

created by the physician, groups of physicians, hospital medical

committee, or pharmacy and therapeutics committee.

D.

Eligibility to Enter into a Drug Therapy Management Agreement:

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1.

A physician may engage in drug therapy management by protocol with a

Colorado licensed pharmacist only when the protocol used is within the

scope of the physician’s current practice and are consistent with the

physician’s education, training and experience.

2.

Only a physician with an active, unrestricted Colorado license may engage

in a drug therapy management agreement with a Colorado licensed

pharmacist. Upon a showing of good cause and written request, the Board

may allow a physician with a restricted license to engage in drug therapy

management with a Colorado licensed pharmacist. Consideration shall be

given on a case by case basis. It is anticipated that such waivers would be

rare. The decision to grant such a waiver shall be in the sole discretion of

the Board.

3

Colorado licensed

pharmacist. Upon a showing of good cause and written request, the Board

may allow a physician with a restricted license to engage in drug therapy

management with a Colorado licensed pharmacist. Consideration shall be

given on a case by case basis. It is anticipated that such waivers would be

rare. The decision to grant such a waiver shall be in the sole discretion of

the Board.

3.

A physician may engage in a drug therapy management agreement only

with a Colorado licensed pharmacist who has an active, unrestricted

license to practice pharmacy and who meets the qualifications to provide

drug therapy management as determined by the Colorado State Board of

Pharmacy and set forth in Pharmacy Board Rule 17.00.30.

E.

Protocol Requirements:

1.

The protocol used by a physician and pharmacist engaging in drug

therapy management must follow the format of and contain the elements

required in Exhibit A, which is attached to these Rules.

2.

The protocol used by a physician and pharmacist engaging in drug

therapy management must demonstrate a plan of treatment that

constitutes evidence-based medicine. This means that the plan of

treatment must be guided by or based on current, objective, and

supported scientific evidence as published in scientific literature, rather

than anecdotal observations.

3.

The protocol shall be signed and dated by the authorizing physician or

chairperson of the authorizing group or committee. Upon request, the

physician shall submit the written protocols for drug therapy management

to the Board for review.

4.

The protocol shall be reviewed and revised as necessary by the physician,

at least annually. The protocol must also be revised in a timely fashion to

reflect any changes in the accepted standard of medical care. The

protocol developed must allow for the provision of patient care that meets

generally accepted standards of medical practice.

F.

Requirements for Written Agreements or General Authorization Plans:

1

shall be reviewed and revised as necessary by the physician,

at least annually. The protocol must also be revised in a timely fashion to

reflect any changes in the accepted standard of medical care. The

protocol developed must allow for the provision of patient care that meets

generally accepted standards of medical practice.

F.

Requirements for Written Agreements or General Authorization Plans:

1.

Physicians who wish to engage in drug therapy management with

Colorado licensed pharmacists in an inpatient setting or in a group model

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54

integrated closed HMO setting must first execute a general authorization

plan. The general authorization plan must identify those physicians and

pharmacists who are authorized and who have agreed to participate in

drug therapy management in the specified practice setting. The general

authorization plans must define the responsibilities of physicians and

pharmacists engaging in drug therapy management in order to assure

compliance with generally accepted standards of medical practice and

with those items set forth in paragraph (D)(2) of these Rules.

2.

A physician who wishes to engage in drug therapy management by

protocol with a Colorado licensed pharmacist in any other setting must first

execute a written agreement containing the following information:

a.

Pharmacist’s name;

b.

Physician’s name;

c.

Diagnoses relevant to the drug therapy to be managed and other

patient conditions relevant to maintenance of the patient’s health

during drug therapy management;

d.

Protocol to be employed;

e.

Functions and activities the pharmacist will perform, and restrictions

or limitations on the pharmacist’s management;

f.

Method, content and frequency of reports to the physician;

g.

Manner in which pharmacist’s drug therapy management will be

monitored by the physician, including method and frequency;

h

tenance of the patient’s health

during drug therapy management;

d.

Protocol to be employed;

e.

Functions and activities the pharmacist will perform, and restrictions

or limitations on the pharmacist’s management;

f.

Method, content and frequency of reports to the physician;

g.

Manner in which pharmacist’s drug therapy management will be

monitored by the physician, including method and frequency;

h.

A specified time, not to exceed twenty-four hours (excluding

Saturdays, Sundays and State holidays), within which the

pharmacist must notify the physician or when applicable, the

covering physician, of any modifications of drug therapy;

i.

A provision that allows the physician to override any action taken by

the pharmacist when the physician deems it to be necessary;

j.

An effective date of the agreement and signatures of both parties;

k.

A provision addressing how drug therapy management will be

handled when the patient has more than one physician involved in

evaluating or treating the medical condition which is the subject of

the agreement. All physicians who are actively involved in the

management of the relevant conditions shall be parties to the

agreement.

CODE OF COLORADO REGULATIONS

3 CCR 713-1

Colorado Medical Board

55

l.

A provision that the pharmacist agrees to maintain liability

insurance in the amount of at least $1,000,000 per occurrence.

3.

Any general authorization plan or written agreement executed in

accordance with these Rules must allow any physician or pharmacist to

withdraw from the general authorization plan or written agreement within a

period of time specified in the agreement.

G.

Record Keeping and Retention of Records

1.

A physician who engages in drug therapy management by protocol with a

Colorado licensed pharmacist must obtain copies of the pharmacist’s

records for each patient in a timely manner and must review such records.

2.

The physician’s receipt and review of the records are important for the

following reasons:

a

n a

period of time specified in the agreement.

G.

Record Keeping and Retention of Records

1.

A physician who engages in drug therapy management by protocol with a

Colorado licensed pharmacist must obtain copies of the pharmacist’s

records for each patient in a timely manner and must review such records.

2.

The physician’s receipt and review of the records are important for the

following reasons:

a.

To assure that the drug therapy management is in compliance with

the protocol and with these Rules;

b.

To assure that the physician’s decision to participate in drug

therapy management is consistent with generally accepted

standards of medical practice;

c.

To assure that the patient’s drug therapy management records are

complete; and

d.

To assure that the physician is providing overall care to the patient

that meets generally accepted standards of medical practice.

Adopted 10/13/05, Effective 11/30/05; Revised 08/19/10, Effective 10/15/10; Revised

11/19/15, Effective 1/14/16

1.19 REQUIREMENTS TO BECOME A RECOGNIZED AND ESTABLISHED

ACCREDITATION OR REVIEW ORGANIZATION FOR THE PURPOSES OF § 12-

240-121(1)(U)(II), C.R.S.

A.

Basis: The general authority for the promulgation of rules and regulations by the

Colorado Medical Board is set forth in sections 12-20-204(1) and 12-240-

106(1)(a), C.R.S. The specific authority to promulgate this rule appears at section

12-240-121(1)(u)(II), C.R.S.

B.

Purpose: The following Rule is promulgated by the Board to comply with the

mandate of section 12-240-121(1)(u)(II), C.R.S., that the Board utilize, in addition

to its own expertise, the standards developed by recognized and established

accreditation or review organizations which organizations meet requirements

established by the Board by rule and regulation.

CODE OF COLORADO REGULATIONS

3 CCR 713-1

Colorado Medical Board

le is promulgated by the Board to comply with the

mandate of section 12-240-121(1)(u)(II), C.R.S., that the Board utilize, in addition

to its own expertise, the standards developed by recognized and established

accreditation or review organizations which organizations meet requirements

established by the Board by rule and regulation.

CODE OF COLORADO REGULATIONS

3 CCR 713-1

Colorado Medical Board

56

C.

The Board hereby adopts the criteria set out in section 12-30-204(4), (5) and (6)

as the requirements for qualifying as an established accreditation or review

organization for the purposes of section 12-240-121(1)(u)(II), C.R.S.

Effective 08/14/95; Revised 08/19/10; Effective 10/15/10

1.20 DESIGNATION OF AUTHORIZED ENTITIES TO CONDUCT PROFESSIONAL

REVIEW

A.

Basis: The authority for promulgation of rules and regulations by the Colorado

Medical Board (“Board”) is set forth in sections 24-4-103, 12-30-201(1)(a), 12-30-

204(5), and 12-30-204(6), C.R.S.

B.

Purpose: These Rules have been adopted by the Board to:

1.

Establish procedures necessary

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