Optimal Team Practice Updates: A State-by-State Breakdown of PA Full Practice Authority

HB 2043

• No supervision requirement for PAs with >8,000 practice hours
• Allows for direct payment to PAs
• PAs are responsible for the care they provide
• Arizona Board of Physician Assistants to determine appropriate regulations for changes in specialty

SB 152

• New PA seat on the medical board
• “Delegation” replaces “protocol”
• PAs can prescribe schedule II medications without physician sign-off
• PAs can pronounce death
• Allows PAs to volunteer

SB 697

• Repeals state law requirements for chart review or counter signature for PAs allowing these determinations to be made at the practice level
• “PAs do not practice under delegation”, allows for collaborative agreements
• Repeals requirement for physician contact info on PA prescriptions
• Repeals requirement for the medical record for each episode of care to identify the physician responsible for supervising the PA

SB 083

• PAs now in a collaborative agreement with an employer, physician, podiatrist, or physician group
• PAs with <5,000 practice hours, or PAs changing practice areas with <3,000 practice hours in the new practice area, the collaborative agreement is a supervisory agreement

SB24018

• Establishes participation in the PA Licensure Compact

Public Act No. 21-196, Public Act No. 21-121

• PAs able to order home health and hospice
• PAs added to many other passages previously referring only to NPs and physicians

HB 33

• Two new PA seats on the Delaware Board of Medical Licensure and Discipline
• Collaboration replaces supervision
• PAs responsible for their own care
• No supervision ratios in hospitals and large group practices
• PAs able to participate in volunteer work

SB 116

• Joins Utah in adopting the PA licensure compact 

HB 431

• Authorizes PAs to receive direct payment
• Removes requirement for Supervision Data Forms
• Increased physician to PA ratio of 1:10
• No separate prescriber license required
• Removed “right to see a physician” requirement
• PAs can procure medical devices and drugs per state formula
• Now able to prescribe for a 14-day supply of stimulants for children younger than 18 years of age
• PAs can authenticate various medicolegal documents
• PAs can supervise medical assistants

HB 1133

• Authorization for PAs to receive direct payment
• Revised language regarding educational requirements for PAs

SB 1406

• Repeals the 100% chart review requirement
• Allows chart review to be determined at the practice for PAs with more than one year of experience
• PAs with less than one year of experience require 50% chart review for the first six months and 25% chart review for the second six months
• Includes a “group of physicians” among those who may establish a work relationship with a PA

HB 9 (2019)

• PA added to Idaho Board of Medicine 
• Added fourth PA to the Board’s PA Advisory Committee 
• Physician to PA ratio increased to 1:4
• Repeal requirements for physician’s contact info on PA prescription forms

SB 1093 (2021)

• Removes references to supervising physicians and physician delegation
• Collaboration to be determined by the facility or practice
• Hospitals and other facilities with credentialing systems do not require any specific PA-physician relationship
• PAs otherwise employed and PA-owned clinics must identify a collaborating physician
• No more mandated chart reviews, site visits, and registration of the associated physician

HB 1248

• Replaces references to PA “supervision” with “collaboration”
• Removing the requirement that PAs complete at least 30 contact hours in pharmacology if they have graduated from an accredited PA program
• Eliminating the requirement that PAs complete at least 1,800 practice hours prior to prescribing controlled medications
• Removing the requirement that the collaborating physician expressly delegate and issue written protocols to the PA regarding prescriptive authority
• Eliminating the prohibition on PAs prescribing more than 30 days’ worth of controlled medications
• Reducing the required chart review for prescribing PAs in their first year of practice from 25% (50% for Schedule II) to 10%
• Eliminating the requirement that PAs changing specialties undergo the same review as a new PA for the first year in their new specialty

SF 2357

• Allows PAs to prescribe all Schedule II controlled medications
• Removes chart co-signature requirements
• Removes the requirement that a physician visit remote locations staffed by a PA at least once every six months
• Allows a PA’s scope of practice to be determined at the practice site
• Authorizes PAs to be rendering providers under Medicaid
• Updates language regarding dispensing and damages for medical liability.

HF 424

•  No requirement for a PA to be supervised by a physician

LD 1660

• Removes the term “supervision” from Maine law
• Requires PAs with less than 4,000 hours of practice to practice in a collaborative agreement with a physician
• Allows a majority of PAs with more than 4,000 hours to practice without a written agreement. A physician must simply be available for consultation (PAs who are the principal provider in a practice that does not include a physician partner must have a practice agreement with a physician)
• Adds a second PA to the Maine Board of Licensure in Medicine (allopathic) and the Maine Board of Osteopathic Licensure
• Authorizes PAs to be eligible for direct payment.
• Eliminates the requirement that a PA receive a certificate of registration (in addition to a license) prior to practicing

LD 2043

• Establishes participation in the PA Licensure Compact

HF 1036

• Removal of the supervisory agreement – PAs will no longer be required to be attached to a specific physician in order to practice
• Removes the delegation of scope of practice – Scope of practice is now established based on the PAs individual education, experience and training, and determined at the practice level
• Prescriptive authority is now established in statute and no longer needs to be delegated
• Removes the burden on physicians that practice with PAs, by eliminating the supervisory liability – which will save healthcare costs
• Provides parity of practice for PAs in the healthcare marketplace by making us more employable and removes burdensome paperwork currently associated with PA practice

HF 5247

• Establishes participation in the PA Licensure Compact

HB 313

• PAs with 8,000 practice hours are exempt from the collaboration agreements
• PAs with fewer than 8,000 practice hours require collaboration with a physician or a PA with >8,000

Med 600

• No more ratios
• No further requirement for PAs to have a supervising physician
• No further requirement for PAs to have an alternate supervising physician

HB0806/SB0167

• Established collaboration agreements

LB1215

• Establishes participation in the PA Licensure Compact

SO4841

• Permits PAs to execute orders not to resuscitate and orders pertaining to life-sustaining treatments (MOLST).
• Adds PAs to various statutory provisions by using a new term: “attending practitioner” 

HB1175

• Removes the requirement that PAs have a written agreement with a physician if they practice at licensed facilities (e.g., hospitals and nursing homes), facilities or clinics with a credentialing and privileging process, or physician-owned facilities or practices
• Removes references to “supervision” and allows PAs to collaborate with members of the healthcare team as determined at the practice level
• Allows PAs to own their own practice with approval of the North Dakota Board of Medicine (PA practice owners with less than 4,000 hours of experience must have a collaborating physician)
• Removes references to physician responsibility for care provided by PAs
• Makes PAs responsible for the care they provide to patients
• Defines PA scope of practice to align with AAPA’s Model State Legislation for PAs

AB364

• The Nevada State Board of Medical Examiners will now be comprised of a PA, six physicians; one practitioner of respiratory care, and three Nevada residents.

HB 1915

• Allows PAs to receive direct pay
• PAs to be designated as Primary Care Providers
• Enables PAs to volunteer in the case of a disaster or emergency
• Changes references of “supervising” to “delegating”
• Scope of practice to be determined at the practice level and filed with the medical board within 10 days of employment.

H.B. 3781/S.B. 1654

• Establishes participation in the PA Licensure Compact

HB 3036

• Allows for Collaborative Practice Agreements
• PAs to register with the Oregon Medical Board to dispense drugs and agreements are kept at the practice location
• PAs with less than 2,000 hours of experience are required to collaborate with a physician in person and electronically for a minimum number of hours monthly
• Permanent changes to PA use of telehealth
• No more ratio restrictions
• No requirements for board approval of supervising physicians
• No submission of practice agreements to the board
• No requirement for physician names on PA prescriptions
• No requirement for physicians to apply for PA dispensing authority
• No requirement to submit annual reports on PA dispensing
• No requirement to submit a list of drugs the PA is authorized to dispense

HB 2627

• Adds another PA to the Oregon Medical Board (2 total).

Senate Bills 397, 398

• Permanent PA seat on the Pennsylvania State Board of Medicine and the Pennsylvania Board of Osteopathic Medicine
• Countersignature only for the first year PAs and/or the first year in a new specialty
• No onsite requirement for physicians
• New 6:1 physician to PA ratio
• Written agreements do not need Board approval

H-7002 Sub A

• Mandate insurance coverage for specified treatments associated with mastectomies, including those which are ordered by PAs
• PAs added to the definition of “practitioner” as it relates to the use of medical marijuana

H5572/S0443

• Move from “supervisory” to a “collaborative” PA-Physician relationship (no practice agreement or delegation agreement required)
• Increase in the Category I CME requirements for PA license renewal from 10 to 25 hours annually
• Addition of a third PA to the RI Board of Licensure for PAs

S. 132

• Removes the requirement to pass a jurisprudence exam as part of the licensure process
• Removes mileage restrictions that required PAs to practice within a certain distance from their physician partners (unless the PA has less than two years’ experience or is changing specialties)
• Allows PAs to prescribe up to a five-day supply of Schedule II narcotic medications for the initial prescription
• PAs can now sign specified clinical patient-related documents that their supervising physician can sign to expedite patient care

HB 1080
HB 0671

• New Board of PAs

SB 1727

• Establishes participation in the PA Licensure Compact

SB 2136

• PA Practice Moderniztion

SB 27

• PAs may independently bill a patient 
• PAs with greater than 10,000 hours of experience may practice independently
• New PAs must collaborate with a physician up until 2,000 hours of experience, then with an experienced PA until 10,000 hours

SB 35

• Adoption of the PA Licensure Compact

S.128

• Supervision becomes collaboration. Delegation agreements with one physician become collaboration agreements with an entire practice or group.
• Removes physician liability for PA practice.
• No need to submit physician paperwork when reapplying for licensure.
• Direct reimbursement
• Can function as primary care providers

HB 1952/SB 1209

• Removes all references to “supervision”
• Authorizes PAs to practice “in collaboration and consultation” with patient care team physicians (or podiatrists) 
• Removes references to a “delegated scope of practice”
• Permits PA scope of practice to be determined at the practice level

HB 324

• Establishes participation in the PA Licensure Compact

HB 2378

• Removes requirement that practice agreements be approved by the Washington Medical Commission
• Removes requirement for Commission approval to employ or work with a PA
• Removes requirement for Commission approval for PAs to practice in remote sites
• Increases the physician/PA ratio from 1:5 to 1:10 with the option to request a higher ratio
• Moves all licensing and regulation of PAs under the state’s allopathic board and removes this responsibility from the osteopathic board

HB 1917

• Establishes participation in the PA Licensure Compact

SB 668 (2019)

• Eliminates the requirement for PAs who work in hospitals to have practice agreements with specific physicians in order to practice
• Scope of practice for PAs who provide care in hospitals will be determined at the practice level
• Current ratio restrictions in state law (5 full-time PAs:1 physician) will no longer apply to PA-physician teams in hospitals; determinations will be made at the practice level in accordance with facility policy
• Removes physician responsibility for PA-provided care to patients with whom physicians had no involvement

SB 714 (2021)

• PAs and collaborating physician file a “practice notification “with the medical board–no board approval required
• No more “alternate collaborating physician” which will streamline PA practice
• No more delegated scope of practice
• New ability to prescribe a non-refillable three-day supply of Schedule II medications
• PAs must be reimbursed the same as other providers who render similar services

SB 667

• Establishes participation in the PA Licensure Compact

Assembly Bill 125

• Create a PA Affiliated Credentialing Board
• Replace references to “supervision” with “collaboration”
• Allow PAs to either enter into a written collaboration agreement with a physician
• Remove references to physician responsibility for care provided by a PA
• Removes PA-physician ratio limit
• Scope of practice to be determined at the practice site

SB 400

• Establishes participation in the PA Licensure Compact

Senate File 0033

Repeals requirement for PAs to have a specific relationship with a physician. 

Updated IHS Manual

• PAs exercise autonomous medical decision-making and take full responsibility for the patient care they provide
• PA scope of practice now determined at the practice level
• PAs are now eligible to serve in administrative and supervisory positions
• IHS facilities to provide time and funding for CME