Legislative Watch for June 16, 2009

16 June 2009

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If you like to read success stories...

...then start right here. 2009 has been almost beyond belief. Maybe you should sit down.

Alabama passed legislation authorizing PAs to prescribe controlled substances (Schedules III-V).
The Alaska state legislature appropriated $922,000 to fund a physician assistant program.
Bills to specifically authorize PAs to participate in neonatal transport and to authorize PAs to use fluoroscopy have passed in Connecticut.
Legislation to remove a chart co-signature requirement has been signed by the governor in Florida.
The professional title has been corrected and the licensure process streamlined through legislation passed in Georgia.
An omnibus bill that added PAs to the definition of "health care provider" in key sections of Hawaii code has been passed by the state legislature.
Illinois hit a triple play (see related story below).
A new law in Indiana removes a requirement that a PA have a supervising physician as a condition of licensure.
Kentucky's legislature has mandated that its Legislative Research Commission study PAs as prescribers of controlled medications.
Minnesota has passed legislation changing PAs from "registered" to "licensed," increasing the number of PAs a physician may supervise from two to five, and making additional improvements to the law.
Missouri has passed legislation authorizing PAs to prescribe controlled medications (bringing the number of states authorizing PAs to prescribe controlled Rx to 48) and improving supervision language.
Nebraska's unicameral legislature has passed a bill to remove a requirement that supervising physicians register with the state, increase the number of PAs a physician may supervise from two to four, and improve supervision requirements.
Legislation passed in North Dakota authorizes PAs to prescribe Schedule II medications.
Bills to authorize PAs to perform police officer physical exams and sign for handicapped placards have been passed in Tennessee.
Legislation to decrease on-site requirements, expand distance limitations, and increase the number of PAs to which a physician may delegate prescribing authority is awaiting Governor Perry's signature in Texas.
Lawmakers are poised to approve a regulation change eliminating the requirement that physicians must countersign all prescriptions written by PAs in Wisconsin.
Legislation that authorizes the board to approve a physician to supervise more than three PAs has become law in Wyoming.

This doesn't include states like Virginia, where the PA state society joined a coalition to successfully support legislation to curb tobacco use. And 12 state legislatures are still in session. And then there's also big regulatory news.

Every PA benefits when one state law is improved. Hats off to savvy and hard working state legislative leaders!

Case Study: Working the Program in IlLinois

As reported, the Illinois Academy of PAs (IAPA) worked with state legislators to introduce four bills during the 2009 session of the Illinois General Assembly. We're pleased to report that three of these bills have passed the legislature and are sitting on Governor Pat Quinn's desk as we type. The three bills allow PAs to practice during a disaster with or without supervision, strengthen the role of the state's PA Advisory Committee, and authorize physician-delegated Schedule II prescribing authority.

This level of success was no accident, but rather a result of IAPA leaders plotting a course that started in December 2007, when AAPA state government staff first reviewed the Illinois law and helped chapter leaders map a strategy. Following directions outlined in Taking Charge, IAPA hired a lobbyist with good connections and a sterling reputation. Working with Academy model language, they presented their draft bill to potential sponsors in both the state House and the Senate. IAPA leaders and their lobbying team also visited with key organizations including the state medical society and the state organization of family physicians, and were willing to negotiate with these groups so that there was no opposition during the legislative process. IAPA also assembled a group of PAs ready to testify in Springfield on behalf of every bill at every hearing. IAPA combined all of these efforts with calls to action to all PAs in the state via the AAPA Legislative Action Center at critical moments during the process.

We're eager to help you duplicate this kind of success in your state.

Quick Notes from the Annual Conference

Dr. Martin Crane, Chairman-Elect of the Federation of State Medical Boards (FSMB), was a distinguished guest at the Annual Conference. During his brief visit, he met with Academy Leadership and observed the proceedings in the House of Delegates. In follow up letters to Cindy Lord and Steve Hanson, Dr. Crane indicated that he found his time spent with PAs to be "informative and inspiring" and observed that "there is much that we can do to collaborate." Academy leaders and staff will follow up with Dr. Crane and FSMB staff to make sure that happens.

California Assemblyman Nathan Fletcher (R-San Diego), guest speaker at the state legislative coordinators meeting and author of CAPA's fluoroscopy legislation, encouraged all PAs to serve as resources and advocates for health and health care with their individual state legislators. Said Fletcher, "I'm going to vote on 2,000 bills this session. I'm going to need some input."

The House of Delegates passed changes to the Academy's Guidelines for State Regulation of Physician Assistants. The new language includes:

a description of regulatory options for dealing with physician assistants who reenter clinical practice after a time away
an affirmative statement that the state regulatory agency should not require licensed physicians and PAs to submit paperwork to the state when establishing a supervising physician-PA relationship
an expanded section on the separation of employment and supervision, including affirmation that a variety of practice ownership arrangements and employer-employee relationships should be available to physicians and to PAs
a new section describing parameters for regulatory agency disclosure of malpractice claim information.

We'll Be Calling

In the last edition of the 2008 volume of LW, we outlined the Six Key Elements (6 KEs) of excellent PA laws. You know what they are - because you work with them every day. By way of quick review, the six KEs include:

Scope of practice determined at the practice site
The PA, supervising physician, and any relevant licensed facility should decide what the PA can do, not the regulatory agency, which has no ability to assess the patients in the practice nor the skills and preferences of the providers.

No ratio restriction in the law
In some settings a PA and physician should work one on one. In others a physician may safely supervise multiple PAs. So any number in law will pose an arbitrary restriction for some teams. This too should be decided at the practice level.

Appropriate supervision language
PAs practice with physician supervision. But language that mandates specific requirements for personal meetings or a distance limit will impose restrictions that have no added value for many teams. Supervision is great; let the team decide how to make it work.

No chart co-signature requirement
In many settings and circumstances PAs will want their chart entries co-signed, or physicians will want to co-sign chart entries. But this should be determined by the team. The quality of chart review diminishes in direct proportion to the number of chart reviews required. The physician-PA team should be empowered to customize a plan to assure excellent patient care.

Full prescriptive authority
Sometimes only a Schedule II will do. Physicians should be authorized to delegate prescriptive authority for all legal medications to PAs.

Licensure as the regulatory term
Many sections of law are written to apply to "licensed health professions." PAs need to be readily identifiable as "among the licensed."

Does any state law include all six Key Elements? Rhode Island does. (Hats off to Jim Carney, PA-C, long time chair of the Rhode Island Academy of PAs' legislative committee and Chair of the AAPA Government Affairs and Reimbursement Committee.)

We'll soon be in touch with suggestions for improving your state's Six Key Elements and resources to help you do so.

Kay Bills-Kazimi, PA-C, legislative chair of the Montana Academy of PAs, was invited to present at the Montana Medical Board's planning meeting. She gave a presentation ( view presentation here ) on the Six Key Elements, and the Montana law (prepared by Academy staff) which laid the groundwork for changes in Big Sky regulation of PAs. Staff is happy to customize this presentation for your state.

Legislative Watch is a monthly state government newsletter written by Ann Davis, PA-C, AAPA director of state government advocacy and outreach. Constituent organization newsletter editors are welcome to reprint articles if you credit the source using its full name, "The American Academy of Physician Assistants' Legislative Watch." News, suggestions, ideas for sharing, and pleas for help encouraged ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; extension 3201).