Optimal Team Practice Updates: On the Path to Full Practice Authority

State by State

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

California

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
Hawaii

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

Idaho

HB 9

  • 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
Indiana

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
Iowa

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.
Maine

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
Minnesota

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
New York

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 new term: “attending practitioner” 
North Dakota

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
Oklahoma

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.
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

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
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
Vermont

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
Virginia

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
Washington

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
West Virginia

SB 668

  • 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

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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