3 CCR 713-30.2 - MEDICAL SERVICES THAT MAY BE DELEGATED UNDER THESE RULES

A. Medical Services

1. "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.

2. "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.

3. "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.

B. Medical-Aesthetic Services

1. "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.

2. 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.

3. Off-label use of medications or devices when performing delegated Medical-Aesthetic Services is generally prohibited unless:

a. The delegating physician has specifically authorized and delegated the off-label use, and,

b. The off-label use is within generally accepted standards of medical practice.

4. 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 A.

C. Use of Lasers

1. 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.

2. Use of Class IIIb or higher lasers or pulse light devices as constitutes the practice of medicine.

D. Acts That Do Not Constitute Medical Services

1. 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.

2. 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.

3. 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.

4. The use of Class I, II, and IIIa medical devices, including Class I,II, and IIIa lasers, does not constitute a medical service.

5. Monitoring of medication compliance is not a medical service.

6. 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.

E. Delegated Medical Services Should Not Require Exercise of Medical Judgment

1. A physician should not delegate a medical service requiring the exercise of medical judgment by the delegatee.

2. Delegated medical services should be limited to routine, technical services that do not require the special skills of a licensed physician.

F. Medical Services that May Not Be Delegated

1. Prescription Medications

a. Prescribing of drugs may not be delegated under section 12-240-107(3)(l), C.R.S., and these Rules.

b. The ordering of a prescription refill by a delegatee does not constitute "the prescribing of drugs" provided that:

1. The prescription refill is ordered at the same dose and for the same medication as the original prescription for that patient; and

2. The prescription refill is ordered pursuant to a written refill protocol developed and authorized by one or more delegating physicians.

2. Non-Prescription Medications

a. 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.

Notes

3 CCR 713-30.2

40 CR 10, May 25, 2017, effective 6/14/2017