Optimal Team Practice (OTP)

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

Updated August 26, 2023

State by State

The following changes have been signed into law since January 2019.


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


  • 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


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
New Hampshire

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


  • Established collaboration agreements


  • Establishes participation in the PA Licensure Compact
New York


  • 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” 
North Dakota


  • 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


  • 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
Rhode Island

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


  • 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
South Carolina

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



  • 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
West Virginia

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. 

At the Federal Level

Indian Health System

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

Is your state on this list? Support your state organization! Advocacy isn’t free.

Whether you believe in FPA or OTP, please join and support AAPA as they are our voice with Medicare and the VA in addition to supporting efforts of individual states.

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