PA Laws and Regulations by State

8/10/2019 PA Laws and Regulations by State

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SIX KEY ELEMENTS

1) Licensure as the regulatory term for PAs: included as licensed health

professionals (vs. certified, registered)2) Physician authorized to delegate prescriptive authority to include all

Schedules of drugs

3) Scope of practice determined by the supervising physician, the PA, and

any relevant facility

4) Adaptable supervision requirements (no mile limit, on site requirement)

5) Chart co-signature requirements determined by the practice

6) No ratio limitation (physician:PA)

Regulations are meant to establish a legal framework under which:

The public is protected from dangerous practices

Physician-PA teams are able to provide care to patients in the mostefficient and effective manner possible


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Number of Key Elements Included inState PA Law

June 2013

DC

DE

One Key Element

Two Key Elements

Three Key Elements

Four Key Elements

Five Key Elements

Six Key Elements

RI


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NEW YORK

-8,662 PracticingPAs as of 2011

-21 PA schools


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5/6 KEY ELEMENTS

1) Licensure as the regulatory term for PAs

2) Physician authorized to delegate prescriptiveauthority to include all Schedules of drugs

3) Scope of practice is determined by thesupervising physician, the PA, and any relevant

facility 4) Adaptable supervision requirements

5) Chart co-signature requirements determined bythe practice

6) Ratio Limitation


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RATIO LIMITATION

Ratio of Physicians to PAs is on a sliding scale.

Private Practice1:2

Correctional Facility1:4

Facility Licensed Pursuant

to PHL Article 28

(Hospitals and Nursing Homes)

1:6


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OREGON

1) Licensure as the regulatory term

Yes: Physician Assistants practicing in OR must be licensed by the

state. License must be renewed every 24 months.

2) Physician may delegate prescriptive authority to include all

Schedules of drugs

Yes: Physician Assistants can prescribe schedule IIV drugs.

However, prescribing rights for schedule II drugs (opioids, etc) requires

medical board approval per the individual practice agreement.

3) Scope of practice is determined by the supervising physician, the PA,

and any relevant facility

Yes: Determined by the practice agreement.


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4) Adaptable supervision requirements

Yes: Physician supervision can be adapted to the practice. 3 typesavailable.

DirectPhysician and PA are in the same facility

Example: Working in the same the clinic at the same time, but seeing separatepatients

GeneralPhysician is NOT on site, but is available via telecommunication

Example: Working in a clinic remote from the physician, but quick contact isavailable via phone.

Physician must be on-site for at least 8 hours per month.

PersonalPhysician and PA work side-by-side. Example: Surgeon and PA perform surgeries together, or Physician and PA seeall patients in clinic together.

5) Chart co-signature requirements determined by the practice

Yes and No!

Charts must be reviewed, but there is not a defined minimum number Allows the Physician to decide how many charts need to be reviewed per

month.

Depends on the type and needs of the practice


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6) No ratio limitation

No: Maximums set by the state board

4 PAs per physician

A single PA can have up to 4 Supervising Physicians

A Supervising Physician Organization can oversee any number of PAs


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CALIFORNIA

1) Person who meets requirements is licensedby the PAB

2) Physician authorized to delegate prescriptive authority to include all

Schedules of drugs:Yes

3) Scope of practice determined by the supervising physician, the PA, and

any relevant facility:Yes

4) Adaptable supervision requirements:Yes

5) Chart co-signature requirements: The supervising physician and surgeon

shall review, countersign, and date a sample consisting of, at a minimum, 5

percent of the medical records of patients treated by the physician assistant

functioning under the protocols within 30 days of thedate of treatment by the

physician assistant

6) Ratio limitation (physician:PA): No physician shall supervise more than 4

PAs at any one time.


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COLORADO

1) Licensure as the regulatory term for PAs

2) Physician authorized to delegate prescriptive authority to include allSchedules of drugs

3) Scope of practice is determined by the supervising physician, the PA,

and any relevant facility

4) Different: Supervision requirements

5) Different: Chart co-signature requirements

6) Different: Ratio limitation


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SUPERVISION REQUIREMENTS

New graduate PAs require on-site presence of supervising physician for

1000 working hours.

For experienced PAs new to a practice setting, supervising physician

must complete performance review by the end of the first 6 months and

twice yearly thereafter.

Supervising physician must either be on site with PA or be readily

available by telecommunication.


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CHART CO SIGNATURE REQUIREMENTS

Based on the years of active practice by PA as listed in the table, the following

minimum activities must be performed for PAs that are New to a PracticeSetting.

The physician supervisor shall review the chart for every patient seen by a PA

no later than 14 days after the physician assistant has performed an act

defined as the practice of medicine. The physician supervisor shall document

the performance of such review by signing the chart in a legible manner.

Electronically-generated signatures accepted.

Meet with supervising physician twice yearly and physician must conduct

performance assessment.Experience Oversight

Duration

Patient

Encounters

6 mo up to 5 yrs First 3 months Minimum of 500

pt.5 yrs up to 10

yrs

First 2 months Minimum of 250

pt.

More than 10 yrs ----------------------- Minimum of 100

pt.


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RATIO LIMITATION

A primary physician supervisor shall be the primary physician supervisor

for no more than 4 specific individual PAs, or their full-time equivalent.

Board may grant a waiver to this restriction for good cause.

A physician may not supervise more than 4 PAs at any one particular

moment in time.


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ALABAMA

1) licensed HP by the state

2) Prescription limitations: Board may establish guidelines governingdelegated prescribing; after 12 months of active clinical employmentfollowing certification, PA may apply for a DEA number in order toprescribe Schedule III-V controlled substances

3) Scope of practice: The PA is prohibited from performing any medicalservice, procedure, function or activity which is not specifically listed, indetail, in the job description approved by the board

4) Supervision:Professional oversight and direction as may be requiredby the regulations and guidelines of the medical board

5) Chart co-signature: Countersignature by supervising physician mustconform to established policy and/or applicable legal regulations

6) PAs per physician: Cumulative work time for all PAs supervised by anindividual primary supervising physician may not exceed 120 hours per

week. Board may determine number of PAs physician may supervise atits discretion


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Documents

PA Laws and Regulations by State