DEPARTMENT OF REGULATORY AGENCIES RULE 160 – EMERGENCY RULES AND REGULATIONS REGARDING EXPANDED DELEGATION FOR PHYSICIANS AND PHYSICIAN ASSISTANTS AND EXPANDED SCOPE OF PRACTICE FOR PHYSICIANS, PHYSICIAN ASSISTANTS AND ANESTHESIOLOGIST ASSISTANT 3 CCR 713-46 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] _________________________________________________________________________

46.1 INTRODUCTION

A. Basis: Through Executive Order D 2022 045, amending and extending Executive Orders D 2021 122, D 2021 124, D 2021 125, D 2021 129, D 2021 132, D 2021 136, D 2021 139, D 2021 141, D 2022 003, D 2022 010, D 2022 013, D 2022 017, D 2022 020, D 2022 028, D 2022 035, D 2022 037, D 2022 038, D 2022 040, D 2022 043, and D 2022 044, Governor Jared Polis temporarily suspended the emergency rulemaking authorities for the Colorado Medical Board (“Board”) set forth in section 24-1-122(3)(m)(I), C.R.S,, and directed the Executive Director of DORA, through the Director of the Division of Professions and Occupations (Division Director), to promulgate and issue temporary emergency rules consistent with the Executive Order. The basis for these emergency rules is Executive Order D 2022 44 issued by Governor Jared Polis pursuant to the Colorado COVID-19 Disaster Recovery Order and Article IV, Section 2 of the Colorado Constitution, and the Colorado Disaster Emergency Act, sections 24-33.5-701, et. seq., C.R.S.

B. These Emergency Rules are adopted by the Executive Director of the Department of Regulatory Agencies, through the Division Director, to effectuate Executive Order D 2022 045, amending and extending Executive Orders D 2021 122, D 2021 124, D 2021 125, D 2021 129, D 2021 132, D 2021 136, D 2021 139, D 2021 141, D 2022 003, D 2022 010, D 2022 013, D 2022 017, D 2022 020, D 2022 028, D 2022 035, D 2022 037, D 2022 040, D 2022 043 and 2022 044 and directing the immediate expansion of the workforce of trained medical personnel available to provide healthcare services within inpatient facilities due to the coronavirus disease 2019 (COVID-19) pandemic, Respiratory Syncytial Virus (RSV), influenza and other respiratory illnesses in Colorado.

46.2 EXPANDED DELEGATION

A. In addition to any delegation authorized by the Medical Practice Act including, but not limited to, section 12-240-107(3)(l), C.R.S., or Colorado Medical Board Rule 800 3 CCR 713-30, physicians are authorized to delegate services in hospitals and inpatient settings as follows:

1. Physicians may delegate medical services within their scope of practice to the following Colorado Licensed Professionals working in a hospital or inpatient facility:

a. Podiatrists b. Optometrists c. Chiropractors d. Veterinarians e. Dentists f. Physical Therapists g. Physical Therapy Assistants h. Occupational Therapists i. Occupational Therapy Assistants j. Speech-Language Pathologists k. Surgical Assistants l. Surgical Technologists m. Volunteer Retired Nurses n. Nurse Aides o. Temporary IMG Licensees 2. Physicians may delegate services within their scope of practice to the following unlicensed persons working in a hospital or inpatient facility:

a. Volunteer Nursing Students b. Medical Assistants 3. Physicians are authorized to provide training to the Colorado licensed professionals and unlicensed persons set forth in this Rule, section 46.2(A)(1) and (2).

4. In order to delegate services pursuant to this Rule, section 46.2(A)(1) and (2), the physician shall ensure, prior to the delegation, that the delegated service is within the knowledge, skill and training of the delegatee.

5. The physician shall ensure on-premises availability to provide direction and supervision of the delegatee.

6. The delegated services shall be routine, technical services, the performance of which do not require the special skill or decision making ability of a physician.

7. The prescription or selection of medications, performance of surgical or other invasive procedures and anesthesia services may not be delegated pursuant to this Rule 160.

B. In addition to any delegation authorized by the Medical Practice Act and section 25-3.5-207, C.R.S., and notwithstanding any limitations set forth in Colorado Medical Board Rules 400 3 CCR 713-7 or 800 3 CCR 713-30, physician assistants are authorized to delegate services in hospitals and inpatient settings as follows:

1. Physician assistants may delegate services within their scope of practice to the following Colorado Licensed Professionals working in a hospital or inpatient facility:

a. Podiatrists b. Optometrists c. Chiropractors d. Veterinarians e. Dentists f. Physical Therapists g. Physical Therapy Assistants h. Occupational Therapists i. Occupational Therapy Assistants j. Speech-Language Pathologists k. Surgical Assistants l. Surgical Technologists m. Volunteer Retired Nurses n. Nurse Aides 2. Physician assistants may delegate services within their scope of practice to the following unlicensed persons working in a hospital or inpatient facility:

a. Volunteer Nursing Students b. Medical Assistants 3. Physician assistants are authorized to provide training to the Colorado licensed professionals and unlicensed persons set forth in Rule 1.27(C)(1) and (2).

4. In order to delegate services pursuant to this Rule, section 46.2(B)(1) and (2), the physician assistant shall ensure, prior to the delegation, that the delegated service is within the knowledge, skill and training of the delegatee.

5. The physician assistant shall ensure on-premises availability to provide direction and supervision of the delegatee.

6. The delegated services shall be routine, technical services, the performance of which do not require the special skill or decision-making ability of a physician assistant.

7. The prescription or selection of medications, performance of surgical or other invasive procedures and anesthesia services may not be delegated pursuant to this Rule 160.

46.3 EXPANDED SCOPE OF PRACTICE

A. Physicians are authorized to engage in inpatient care to evaluate and treat patients regardless of American Board of Medical Specialties (ABMS) Board certifications, national certifications, national specialty certificates of added qualifications, or current scope of specialty or subspecialty practice, if appropriate based on the physicians’ education, training, and experience.

B. Physician assistants are authorized to engage in inpatient care to evaluate and treat patients regardless of National Commission on Certification for Physician Assistants (NCCPA), national certifications, national specialty certificates of added qualifications, or current scope of specialty or subspecialty practice, if appropriate based on the physician assistants’ education, training, and experience.

C. Anesthesiologist Assistants may expand their scope of practice while working in a hospital or inpatient facility as needed to perform airway management outside of the operative setting. _________________________________________________________________________ Editor’s Notes History New rule emer. rule eff. 05/11/2020; expired 09/08/2020. Entire rule emer. rule eff. 09/09/2020.

Entire rule emer. rule eff. 12/28/2020.

Entire rule emer. rule eff. 04/27/2021.

Entire rule emer. rule eff. 07/12/2021.

Entire rule emer. rule eff. 11/02/2021.

Entire rule emer. rule eff. 03/02/2022; expired 06/29/2022. Entire rule emer. rule eff. 07/22/2022.

Entire rule emer. rule eff. 09/22/2022.

Entire rule emer. rule eff. 11/11/2022.

Entire rule emer. rule eff. 12/10/2022.