An Act concerning the optometry law; concerning the practice of optometry; creating an interprofessional advisory committee; amending K.S.A. 65-1501, 65-1501a, 65-1505, 65- 1522 and 74-1501 and repealing the existing sections.

Be it enacted by the Legislature of the State of Kansas:

Section 1. K.S.A. 65-1501 is hereby amended to read as follows: 65- 1501. (a) The practice of optometry means:

(1) The examination of the human eye and its adnexae and the em- ployment of objective or subjective means or methods (including the ad- ministering, prescribing or dispensing, of topical pharmaceutical drugs) for the purpose of diagnosing the refractive, muscular, or pathological condition thereof;

(2) the prescribing or adapting of lenses (including any ophthalmic lenses which are classified as drugs by any law of the United States or of this state), prisms, orthoptic exercises and visual training therapy for the relief of any insufficiencies or abnormal conditions of the human eye and its adnexae; and

(3) except as otherwise limited by this section, the prescribing, ad- ministering or dispensing of topical pharmaceutical drugs for the treat- ment of any insufficiencies or abnormal conditions of the human eye and its adnexae.

(b) The practice of optometry shall not include: (1) The management and treatment of glaucoma, except as provided in subsection (d); (2) the performance of surgery, including the use of lasers for surgical purposes, except that therapeutic licensees may remove superficial foreign bodies from the cornea and the conjunctiva; and (3) the use of topical pharma- ceutical drugs for diagnostic or therapeutic purposes by a person licensed to practice optometry unless such person successfully meets and com- pletes the requirements of K.S.A. 65-1505 and amendments thereto.

(c) An optometrist certified to use topical pharmaceutical drugs and an optometrist certified to treat adult open-angle glaucoma as provided herein shall be held to a standard of care in the use of such agents in diagnosis and treatment commensurate to that of a person licensed to practice medicine and surgery, who exercises that degree of skill and proficiency commonly exercised by an ordinary, skillful, careful and pru- dent person licensed to practice medicine and surgery.

(d) An optometrist may prescribe, administer and dispense topical pharmaceutical drugs for the treatment of adult open-angle glaucoma only following glaucoma licensure as provided in subsection (l) of K.S.A. 65- 1501a and amendments thereto. After the initial diagnosis of adult open- angle glaucoma, by an optometrist during the co-management period de- scribed in subsection (s) of K.S.A. 65-1501a and amendments thereto, the patient shall be notified that the diagnosis must be confirmed by an oph- thalmologist and that any subsequent treatment requires a written co- management plan with an ophthalmologist of the patient's choice.

Sec. 2. K.S.A. 65-1501a is hereby amended to read as follows: 65- 1501a. For the purposes of this act the following terms shall have the meanings respectively ascribed to them unless the context requires oth- erwise:

(a) ``Board'' means the board of examiners in optometry established under K.S.A. 74-1501 and amendments thereto.

(b) ``License'' means a license to practice optometry granted under the optometry law.

(c) ``Licensee'' means a person licensed under the optometry law to practice optometry.

(d) ``Adapt'' means the determination, selection, fitting or use of lenses, prisms, orthoptic exercises or visual training therapy for the aid of any insufficiencies or abnormal conditions of the eyes after or by exami- nation or testing.

(e) ``Lenses'' means any type of ophthalmic lenses, which are lenses prescribed or used for the aid of any insufficiencies or abnormal condi- tions of the eyes.

(f) ``Prescription'' means a verbal or written order directly from a licensee giving or containing the name and address of the prescriber, the license registration number of the licensee, the name and address of the patient, the specifications and directions for lenses, prisms, orthoptic ex- ercises or visual training therapy to be used for the aid of any insufficien- cies or abnormal conditions of the eyes, including instructions necessary for the fabrication or use thereof and the date of issue.

(g) ``Prescription for topical pharmaceutical drugs'' means a verbal or written order directly from a licensee expressly certified to prescribe drugs under the optometry law and giving or containing the name and address of the prescriber, the license registration number of the licensee, the name and address of the patient, the name and quantity of the drug prescribed, directions for use, the number of refills permitted, the date of issue and expiration date.

(h) ``Topical pharmaceutical drugs'' means drugs known generically as anesthetics, mydriatics, cycloplegics, anti-infectives and anti-inflam- matory agents, which anti-inflammatory agents shall be limited to a four- teen-day supply, administered topically and not by other means for the examination, diagnosis and treatment of the human eye and its adnexae.

(i) ``Dispense'' means to deliver prescription-only medication or oph- thalmic lenses to the ultimate user pursuant to the lawful prescription of a licensee and dispensing of prescription-only medication by a licensee shall be limited to a twenty-four-hour supply or minimal quantity nec- essary until a prescription can be filled by a licensed pharmacist.

(j) ``Diagnostic licensee'' means a person licensed under the optom- etry law and certified by the board to administer or dispense topical phar- maceutical drugs for diagnostic purposes.

(k) ``Therapeutic licensee'' means a person licensed under the optom- etry law and certified by the board to prescribe, administer or dispense topical pharmaceutical drugs for therapeutic purposes.

(l) ``Glaucoma licensee'' means a person described in subsections (j) and (k) of this section who is also licensed under the optometry law to manage and treat adult open-angle glaucoma by nonsurgical means, in- cluding the prescribing, administering and dispensing of topical phar- maceutical drugs, but not other pharmaceutical drugs.

(l) (m) ``False advertisement'' means any advertisement which is false, misleading or deceptive in a material respect. In determining whether any advertisement is misleading, there shall be taken into account not only representations made or suggested by statement, word, design, de- vice, sound or any combination thereof, but also the extent to which the advertisement fails to reveal facts material in the light of such represen- tations made.

(m) (n) ``Advertisement'' means all representations disseminated in any manner or by any means, for the purpose of inducing, or which are likely to induce, directly or indirectly, the purchase of professional serv- ices or ophthalmic goods.

(n) (o) ``Health care provider'' shall have the meaning ascribed to that term in subsection (f) of K.S.A. 40-3401 and amendments thereto.

(o) (p) ``Medical facility'' shall have the meaning ascribed to that term in subsection (c) of K.S.A. 65-411 and amendments thereto.

(p) (q) ``Medical care facility'' shall have the meaning ascribed to that term in K.S.A. 65-425 and amendments thereto.

(r) ``Co-management'' means confirmation by an ophthalmologist of a licensee's diagnosis of adult open-angle glaucoma together with a written treatment plan which includes (1) all tests and examinations supporting the diagnosis, (2) a schedule of tests and examinations necessary to treat the patient's condition, (3) a medication plan, (4) a target intraocular pressure, (5) periodic review of the patient's progress and (6) criteria for referral of the patient to an ophthalmologist for additional treatment or surgical intervention, except that any co-management plan may be mod- ified only with the consent of both the ophthalmologist and the optometrist and the modification noted in writing on the patient's record.

(s) ``Co-management period'' means that period of time during which an optometrist co-manages patients either suspected of having or diag- nosed as having adult open-angle glaucoma with an ophthalmologist.

(t) ``Ophthalmologist'' means a person licensed to practice medicine and surgery by the state board of healing arts who specializes in the diagnosis and medical and surgical treatment of diseases and defects of the human eye and related structures.

Sec. 3. K.S.A. 65-1505 is hereby amended to read as follows: 65- 1505. (a) Persons entitled to practice optometry in Kansas shall be those persons licensed in accordance with the provisions of the optometry law. A person shall be qualified to be licensed and to receive a license as an optometrist: (1) Who is of good moral character; and in determining the moral character of any such person, the board may take into consideration any felony conviction of such person, but such conviction shall not auto- matically operate as a bar to licensure; (2) who has graduated from a school or college of optometry approved by the board; and (3) who suc- cessfully meets and completes the requirements set by the board and passes an examination given by the board. All licenses issued on and after the effective date of this act, to persons not licensed in this state or in another state prior to July 1, 1987 1996, shall be diagnostic and, thera- peutic and glaucoma licenses.

(b) All applicants for licensure or reciprocal licensure and all licensed optometrists at the time this act takes effect, except as provided in sub- section (a) and (e) (f), in addition to successfully completing all other requirements for licensure, shall take and successfully pass an examina- tion required by the board before being certified by the board as a di- agnostic and therapeutic licensee.

(c) All persons before taking the examination required by the board to be certified as a diagnostic and therapeutic licensee shall submit evi- dence satisfactory to the board of having successfully completed a course approved by the board in didactic education and clinical training in the examination, diagnosis and treatment of conditions of the human eye and its adnexae, totaling at least 100 hours.

(d) All applicants for glaucoma licensure, in addition to successfully completing all other requirements for licensure, shall submit evidence sat- isfactory to the board of: (1) Professional liability insurance in an amount acceptable to the board, (2) completion of a course of instruction approved by the board after consultation with the interprofessional advisory com- mittee which includes at least 24 hours of training in the treatment and co-management of adult open-angle glaucoma and (3) co-management for a period of at least 24 months and not less than 20 diagnoses of suspected or confirmed glaucoma, except that the board may eliminate or shorten the co-management period, and eliminate or reduce the number of diag- noses of suspected or confirmed glaucoma for applicants for glaucoma licensure who graduate from approved optometric schools or colleges after July 1, 1998.

(d) (e) Any person applying for examination by the board shall fill out and swear to an application furnished by the board, accompanied by a fee fixed by the board by rules and regulations in an amount of not to exceed $150, and file the same with the secretary of the board at least 30 days prior to the holding of the examination. At such examinations the board shall examine each applicant in subjects taught in schools or col- leges of optometry approved by the board, as may be required by the board. If such person complies with the other qualifications for licensing and passes such examination, such person shall receive from the board, upon the payment of a fee fixed by the board by rules and regulations in an amount of not to exceed $30, a license entitling such person to practice optometry. In the event of the failure on the part of the applicant to pass the first examination, such person may, with the consent of the board, within 18 months, by filing an application accompanied by a fee fixed by the board by rules and regulations in an amount of not to exceed $75, take a second examination; for the third and each subsequent examination a fee fixed by the board by rules and regulations in an amount of not to exceed $45. Any examination fee and license fee fixed by the board under this subsection which is in effect on the day preceding the effective date of this act shall continue in effect until the board adopts rules and regu- lations under this subsection fixing a different fee therefor.

(e) (f) Any applicant for reciprocal licensure may in the board's dis- cretion be licensed and issued a license without examination in the cat- egory of licensure under the optometry law for which application is made if the applicant has been in the active practice of optometry in another state and the applicant:

(1) Presents a certified copy of a certificate of registration or license which has been issued to the applicant by another state where the require- ments for licensure are deemed by the board to be equivalent to the requirements for licensure in the category of licensure under this act for which application is made, if such state accords a like privilege to holders of a license issued by the board;

(2) submits a sworn statement of the licensing authority of such other state that the applicant's license has never been limited, suspended or revoked and that the applicant has never been censured or had other disciplinary action taken; and

(3) successfully passes an examination of Kansas law administered by the board and such clinical practice examination as the board deems nec- essary.

Such applicant shall be required to satisfy only the requirements of the category of licensure under the optometry law for which application is made and which existed in this state at the time of the applicant's licen- sure in such other state; or, if such requirements did not exist in this state at the time of the applicant's licensure in such other state, the applicant shall be required to satisfy only the requirements of the category of li- censure under the optometry law for which application is made which originally were required for that category of licensure. The fee for li- censing such applicants shall be fixed by the board by rules and regula- tions in an amount of not to exceed $150. The reciprocal license fee fixed by the board under this subsection which is in effect on the day preceding the effective date of this act shall continue in effect until the board adopts rules and regulations under this subsection fixing a different fee therefor.

(f) (g) The board shall adopt rules and regulations establishing the criteria which a school or college of optometry shall satisfy in meeting the requirement of approval by the board established under subsection (a). The board may send a questionnaire developed by the board to any school or college of optometry for which the board does not have suffi- cient information to determine whether the school or college meets the requirements for approval and rules and regulations adopted under this act. The questionnaire providing the necessary information shall be com- pleted and returned to the board in order for the school or college to be considered for approval. The board may contract with investigative agen- cies, commissions or consultants to assist the board in obtaining infor- mation about schools or colleges. In entering such contracts the authority to approve schools or colleges shall remain solely with the board.

Sec. 4. K.S.A. 74-1501 is hereby amended to read as follows: 74- 1501. The governor shall appoint a board of examiners in optometry for the state of Kansas, consisting of four five members. Three Four members shall be selected after consideration of a list of four or more names for each appointment, submitted by the Kansas optometric association, or its successor. One member shall be a representative of the general public. No person other than the member representing the general public shall be eligible for appointment as a member of the board unless such person has been engaged in the actual practice of optometry in the state of Kan- sas continuously for five years and is a resident thereof. All members shall serve for a term of three years, but in no case shall any member be appointed for more than three successive three-year terms. In the case of a vacancy in the membership of the board for any reason, the governor shall appoint a successor of like qualifications to fill the unexpired term, and in making such appointment the governor shall give consideration to the list of persons last submitted. Each member of the board shall hold office until a successor is duly appointed and qualified. The governor shall have the power to remove from office any member of the board for neglect of duty, incompetency, improper or unprofessional conduct.

New Sec. 5. (a) No later than 30 days following the effective date of this act, the board shall appoint a seven-member committee to be known as the interprofessional advisory committee which, subject to approval of the board, shall have general responsibility for the establishment, review and monitoring of the procedures for co-management by optometrists and ophthalmologists of adult open-angle glaucoma.

(b) The interprofessional advisory committee shall consist of one member of the board appointed by the board who shall serve as a non- voting chair, together with three optometrists licensed to practice optom- etry in this state chosen by the board from those nominated by the Kansas optometric association and three ophthalmologists licensed to practice in this state chosen by the board from those nominated by the Kansas med- ical society and the Kansas association of osteopathic medicine. The Kan- sas optometric association and Kansas medical society shall submit six nominees to the board. The Kansas association of osteopathic medicine shall submit two nominees to the board. Persons appointed to the com- mittee shall serve terms of three years and without compensation. All expenses of the committee shall be paid by the board.

(c) The committee shall submit recommendations to the board on the following:

(1) An ongoing quality assessment program including the monitoring and review of co-management of patients pursuant to subsection (d) of K.S.A. 65-1505 and amendments thereto;

(2) requirements for the education and clinical training necessary for glaucoma licensure, which shall be submitted to the board within 90 days following appointment;

(3) criteria for evaluating the training or experience acquired in other states by applicants for glaucoma licensure;

(4) requirements for annual reporting during a glaucoma licensee's co-management period to the committee and the board which shall be submitted to the board within 90 days following appointment;

(5) the classes and mix of patients either suspected of having or di- agnosed as having adult open-angle glaucoma who may be included in the number of co-management cases required by subsection (d) of K.S.A. 65-1505 and amendments thereto, which shall be submitted to the board within 90 days following appointment; and

(6) requirements for annual continuing education by glaucoma li- censees.

(d) After considering the recommendations of the committee pur- suant to subparagraph (c), the board shall proceed to adopt procedures to confirm that each applicant has completed the requirements for glau- coma licensure.

(e) The interprofessional advisory committee shall also review the educational and clinical prerequisites of optometrists to use oral phar- maceutical drugs and identify those classes of oral pharmaceutical drugs which are effective treatments for ocular diseases and conditions. The interprofessional advisory committee and the board shall prepare a report of the results of co-management pursuant to subsection (r) of K.S.A. 65- 1501a and amendments thereto and findings on the subject of the advis- ability of expanding the scope of practice of optometrists to prescribe, administer and dispense oral pharmaceutical drugs, which report shall be submitted to the legislature not later than January 1, 1999.

(f) The interprofessional advisory committee may continue after Jan- uary 1, 2001, if authorized by the board.

(g) This section shall be part of and supplemental to the optometry law.

Sec. 6. K.S.A. 65-1522 is hereby amended to read as follows: 65- 1522. (a) A licensee may practice optometry under the name of a profes- sional corporation, authorized by K.S.A. 17-2706 and amendments thereto. Such professional corporate name may contain a trade name or assumed name approved by the board.

(b) A licensee may practice as a sole practitioner or may associate with other licensees or health care providers licensed under the laws of the state of Kansas and may practice optometry as a sole practitioner or in such associations under a trade or assumed name approved by the board.

(c) A licensee may practice in a medical facility, medical care facility or a governmental institution or agency.

(d) A licensee shall not derive any economic benefit from nor have or maintain more than three practice locations be limited in the number of locations from which the licensee may engage in the practice of optom- etry pursuant to subsections (a), (b) and (c) except when practicing in governmental institutions.

(e) In all office locations a licensee shall:

(1) Provide adequate staff during the hours of its operation and shall provide the necessary optometric equipment to enable a licensee to pro- vide adequate optometric care on the premises; and

(2) provide that there shall be present at the office location a person licensed by optometry law when optometric practice acts requiring a li- cense are performed at the office location.

(f) Nothing herein contained shall be construed to permit the fran- chised practice of optometry except that a licensee may purchase a fran- chise to engage in the business of optical dispensing separate and apart from any of the licensee's offices for the practice of optometry so long as the terms of the franchise agreement do not violate the optometry law.

Sec. 7. K.S.A. 65-1501, 65-1501a, 65-1505, 65-1522 and 74-1501 are hereby repealed.

Sec. 8. This act shall take effect and be in force from and after its publication in the Kansas register.

Approved April 1, 1996.

Published in the Kansas Register: April 4, 1996.