First Regular Session Sixty-eighth General Assembly STATE OF COLORADO INTRODUCED LLS NO. 11-0167.02 Bart Miller HOUSE BILL 11-1175 HOUSE SPONSORSHIP Balmer, SENATE SPONSORSHIP Morse, House Committees Senate Committees Health and Environment Economic and Business Development A BILL FOR AN ACT Concerning requirements for health care practitioners to identify to patients the type of professional license held by the practitioner, and, in connection therewith, enacting the "Health Care Professional Transparency Act". Bill Summary (Note: This summary applies to this bill as introduced and does not reflect any amendments that may be subsequently adopted. If this bill passes third reading in the house of introduction, a bill summary that applies to the reengrossed version of this bill will be available at http://www.leg.state.co.us/billsummaries.) The bill enacts the "Health Care Professional Transparency Act". The bill requires health care practitioners to identify the type of professional license they hold in an advertisement for health care services. Advertisements for health care services must be free from deceptive or misleading information. Health care practitioners working in patient care settings must post and communicate the practitioner's specific licensure by: Wearing a photo identification name tag during all patient encounters. The name tag must contain a recent photo, the practitioner's name, the type of license the practitioner holds, and the expiration date of the license. Displaying in the practitioner's office a written notice clearly identifying the type of license held by the practitioner; Complying with these requirements at all office locations where the practitioner sees patients; Posting a schedule of regular hours when a medical doctor or osteopathic doctor is present in offices where the practitioner practices in collaborative settings with other non-M.D. or non-D.O. practitioners; and Informing a patient or the patient's family, or both, when a portion of patient care is performed by a qualified provider other than a medical doctor or doctor of osteopathic medicine. Violations of the bill are punished as acts of unprofessional conduct under the appropriate licensure laws governing the respective health care practitioner. The bill specifies that in the event of violations any fees or charges paid by a patient must be refunded to the patient. Be it enacted by the General Assembly of the State of Colorado: SECTION 1. Title 12, Colorado Revised Statutes, is amended BY THE ADDITION OF A NEW ARTICLE to read: ARTICLE 28.5 Health Care Professional Transparency Act 12-28.5-101. Short title. This article shall be known and may be cited as the "Health Care Professional Transparency Act". 12-28.5-102. Legislative declaration. (1) The general assembly hereby finds, determines, and declares that: (a) There are a multitude of professional degrees using the term "doctor", including medical doctor (M.D.); doctor of osteopathic medicine (D.O.); doctor of dental surgery (D.D.S.); doctor of podiatric medicine (D.P.M.); doctor of optometry (O.D.); doctor of chiropractic (D.C.); and other designations that may be used by health care practitioners; (b) An August 2008 study by the American medical association found that thirty-eight percent of patients believe that a chiropractor is a medical doctor; thirty-eight percent of patients believe that a doctor of nursing practice is a medical doctor; forty-nine percent of patients believe that a psychologist is a medical doctor; fifty-four percent of patients believe that an optometrist is a medical doctor; and sixty-seven percent of patients believe a podiatrist is a medical doctor; (c) There are widespread differences regarding the training and qualifications required to earn the professional degrees described in and subject to this article. These differences often concern the training and skills necessary to correctly detect, diagnose, prevent, and treat serious health care conditions. (d) There is a compelling state interest in patients being promptly and clearly informed of the training and qualifications of the health care practitioners who provide health care services; and (e) There is a compelling state interest in the public being protected from potentially misleading and deceptive health care advertising that might cause patients to have undue expectations regarding their treatment and outcome. 12-28.5-103. Definitions. As used in this article, unless the context otherwise requires: (1) "Advertisement" means any communication or statement, whether printed, electronic, or oral, that names the health care practitioner in relation to his or her practice, profession, or institution in which the individual is employed, volunteers, or otherwise provides health care services. This includes business cards, letterhead, patient brochures, e-mail, internet, audio and video, and any other communication or statement used in the course of business. (2) "Deceptive" or "misleading" includes any advertisement or affirmative communication or representation that misstates, falsely describes, holds out, or falsely details the health care practitioner's profession, skills, training, expertise, education, board certification, licensure, or registration. (3) "Health care practitioner" means any person who engages in the following acts that are the subject of licensure or registration: (a) Practitioners of allopathic medicine, signified by the letters "M.D." or the terms "surgeon", "medical doctor", or "doctor of medicine" by a person licensed to practice medicine and surgery; (b) Practitioners of osteopathic medicine, signified by the letters "D.O." or the terms "surgeon", "osteopathic surgeon", "osteopath", "doctor of osteopathy", or "doctor of osteopathic medicine"; (c) Practitioners of nursing, signified by the letters "D.N.P.", "N.P.", "R.N.", "L.P.N.", "C.R.N.A.", or "C.N.A." or any other commonly used signifier to denote a doctorate of nursing practice, nurse practitioner, registered nurse, licensed practical nurse, certified registered nurse anesthetist, or certified nurse assistant, respectively, as appropriate to signify the type of licensure and degree earned from a regionally accredited institution of higher education in the appropriate field of learning; (d) Practitioners of podiatry, signified by the letters "D.P.M." or the terms "podiatrist", "doctor of podiatry", "podiatric surgeon", or "doctor of podiatric medicine"; (e) Practitioners of chiropractic, signified by the letters "D.C." or the terms "chiropractor" or "doctor of chiropractic"; (f) Practitioners of dentistry, signified by the letters "D.D.S." or "D.M.D.", as appropriate, or the terms "dentist", "doctor of dental surgery", or "doctor of dental medicine", as appropriate; (g) Practitioners of optometry, signified by the letters "O.D." or the terms "optometrist" or "doctor of optometry"; (h) Practitioners of naturopathy, signified by the letters "N.D." or the terms "naturopathic doctor" or "doctor of naturopathy"; (i) Physician and medical assistants, signified by the letters "P.A." or "M.A." or the terms "physician assistant" or "medical assistant", respectively; (j) Practitioners of audiology, signified by the letters "Au.D.", "Sc.D.", or "Ph.D." or the terms "audiologist" or "doctor of audiology"; (k) Psychologists, therapists, speech-language pathologists, counselors, or any other health care practitioner not covered under this subsection (3), including those signified by the letters "Ph.D.", "Ed.D.", "P.T.", "M.P.T.", "Psy.D.", or "Sc.D." as appropriate to signify the type of licensure and degree earned from a regionally accredited institution of higher education in the appropriate field of learning. (4) "Licensee" means a health care practitioner who holds an active license with the licensing board governing his or her practice in this state. 12-28.5-104. Requirements. (1) An advertisement for health care services that names a health care practitioner must identify the type of license held pursuant to the definitions in section 12-28.5-103. The advertisement must be free from any and all deceptive or misleading information. (2) A health care practitioner providing health care services in this state shall conspicuously post and affirmatively communicate the practitioner's specific licensure as defined in section 12-28.5-103. The health care practitioner shall: (a) (I) Wear a photo identification name tag during all patient encounters that includes: (A) A recent photograph of the health care practitioner; (B) The health care practitioner's name; (C) The type of license the health care practitioner holds; and (D) The expiration date of the license. (II) The name tag must be of sufficient size and be worn in a conspicuous manner so as to be visible and apparent. (b) Display in his or her office a written notice that clearly identifies the type of license held by the health care practitioner. The notice must be of sufficient size so as to be visible and apparent to all current and prospective patients. (3) A health care practitioner who practices in more than one office shall comply with the requirements of this section in each practice setting. (4) A medical doctor or doctor of osteopathic medicine who supervises or participates in collaborative practice agreements with non-M.D. or non-D.O. health care practitioners shall conspicuously post in each office a schedule of the regular hours when he or she will be present in that office. (5) A health care practitioner who is part of a patient care team that includes medical doctors, doctors of osteopathic medicine, and other types of health care practitioners shall identify himself or herself clearly to the patient and members of the patient's family as to the type of license held by the health care practitioner. A health care practitioner shall not permit the misrepresentation of nonphysician personnel as resident physicians or practicing physicians. When any portion of a patient's care is performed by a qualified health care practitioner who is not a medical doctor or doctor of osteopathic medicine, a medical doctor or doctor of osteopathic medicine shall inform the patient or the patient's family, or both, that delegation of duties is included in care provided by the patient care team. (6) Health care practitioners working in nonpatient care settings, and who do not have any direct patient care interactions, are not subject to this section. 12-28.5-105. Violations and enforcement. (1) Failure to comply with this article constitutes a violation of this article. (2) Knowingly aiding, assisting, procuring, employing, or advising any unlicensed person or entity to practice or engage in acts contrary to the health care practitioner's type of licensure constitutes a violation of this article. (3) Delegating or contracting for the performance of health care services by a health care practitioner when the licensee delegating or contracting for performance knows, or has reason to know, that the person does not have the required authority pursuant to the person's licensure, constitutes a violation of this article. (4) Each day this article is violated constitutes a separate offense and is punishable as such. (5) A health care practitioner who violates this article is guilty of unprofessional conduct and subject to disciplinary action under the appropriate licensure provisions governing the respective health care practitioner. (6) In the event of a violation of this article, any fees or other amounts billed to and paid by the patient shall be refunded to the patient. This includes third parties contracted to collect fees on behalf of the health care practitioner, the health care practitioner's employer, or other entities contracting with the health care practitioner. (7) The imposition of professional sanctions, administrative fines, or other disciplinary actions shall be publicly reported in a journal of official record. (8) Notwithstanding the imposition of any penalty under this article, a professional licensing board or other administrative agency with jurisdiction may seek an injunction or other legal means, as appropriate, against a person or entity violating this article. SECTION 2. Act subject to petition - effective date - applicability. (1) This act shall take effect at 12:01 a.m. on the day following the expiration of the ninety-day period after final adjournment of the general assembly (August 10, 2011, if adjournment sine die is on May 11, 2011); except that, if a referendum petition is filed pursuant to section 1 (3) of article V of the state constitution against this act or an item, section, or part of this act within such period, then the act, item, section, or part shall not take effect unless approved by the people at the general election to be held in November 2012 and shall take effect on the date of the official declaration of the vote thereon by the governor. (2) The provisions of this act shall apply to health care practitioners on or after the applicable effective date of this act.