The Colorado Medical Board recently finalized an updated version of Rule 800 concerning the delegation and supervision of medical services to unlicensed persons. Highlights of these rule changes, which are of particular interest to physicians who delegate services and health care providers who work with delegating physicians, include:
- A delegating physician must ensure there is, on-site and available to the public, a list of all of the individuals to whom the physician is delegating services (the “delegatees”), a written agreement detailing the arrangement between the physician and the delegatee(s), and a comprehensive list of all services delegated by the physician.
- Delegating physicians are responsible for ensuring delegatees adequately disclose to patients when a delegating physician will not be actively involved in the delivery of care.
- Delegating physicians must review, initial, and date at time of review every entry by the delegatee on a patient’s medical records. The delegating physician must assess all care delivered to a patient by a delegatee within 14 days of its delivery.
- Delegating physicians are responsible for new vetting and supervision requirements such as personal assessment of a delegatee’s certifications and abilities, and documenting such vetting and supervision.
- When the delegating physician will not be physically on the premises, he or she must develop comprehensive written protocols for each delegated procedure, as well as written protocols for emergency situations that could arise. Written emergency protocols must include notification to the delegating physician when an adverse event occurs.
- Delegating physicians are not required to be present where delegated services are being performed, but they must be in the State of Colorado and available to promptly and personally attend to the patient. If a delegating physician is not in Colorado, he or she must provide the delegatee with the name of a covering physician who is in the state and available to promptly and personally attend to the patient.
- Delegating physicians are allowed to utilize telehealth technology to satisfy the prompt, personal consultation requirement in appropriate circumstances but may not rely exclusively on such technology to meet that requirement.
Although it is not a change to Rule 800, it is important to remember that Rule 800 does not apply to situations in which a licensed practitioner, such as a registered nurse or physician assistant, is providing services within the scope of his or her licensure.