Updates Regarding New Physician Assistant Rules Timothy Terranova Assistant Executive Director Board of Licensure in Medicine

Abbreviations PA – Physician Assistant PSP – Primary Supervising Physician SSP – Secondary Supervising Physician CSP – Covering Supervising Physician POS – Plan of Supervision CME – Continuing Medical Education PMP – Prescription Monitoring Program

One License Physician Assistants need one license to practice in Maine. The license can come from: The Board of Osteopathic Licensure The Board of Licensure in Medicine The licensure of the PSP does not dictate the license of the PA PA’s with two licenses have had one license terminated

One License How does this work? PA chooses which Board to obtain a license from That Board will issue all registrations regardless of PSP licensure All forms and renewals need to be filed with the Board where the PA is licensed How do I know where the PA is licensed? Ask the PA for a copy of their license or check the Board websites

Change in License Type There will now be two types of licenses PA PAN PA (Clinical) means the PA has an active license and a current registration PAN (Non Clinical) means the PA has an active license, but no current registration and may not practice

License Status PA (Clinical) may only have an active status PAN (Non Clinical) may have an active or inactive status Inactive means the PA has not remained current with CME and is unable to practice even if they find a supervising physician

Changing License Status Changing from: Clinical to Non Clinical Automatic when last active supervisory relationship is terminated Inactive to Active Proof of CME Proof of clinical practice in 12 of the last 18 months Non-Clinical to Clinical Supervisory Relationship

Items needed for Initial Licensure Completed Application Application Fee Notarized Copy of Diploma NCCPA Certification (we obtain) Original Transcript CV State License Verifications (we obtain) Employment Verifications (we obtain) NPDB Self Query Written Exam Plan of Supervision (optional)

Renewal Changes POS does not need to be provided. Schedule II Applications no longer exist Random Audits of: POS CME

Supervisory Changes There are now three categories of PA Supervisors Primary Supervising Physician Secondary Supervising Physician Covering Supervising Physician

Primary Supervising Physician “Primary Supervising Physician” (PSP) means a physician who has agreed in writing to provide supervision of a PA and to be legally liable and responsible for all delegated medical services rendered by the PA pursuant to a written POS that meets the requirements of this rule. A PSP must hold an active, unrestricted permanent, temporary, or emergency license, unless the Board has waived the requirement that the PSP license be unrestricted.

Secondary Supervising Physician “Secondary Supervising Physician” (SSP) means a physician who has agreed in writing to provide supervision of a PA and, when actively engaged as a supervisor, to be legally liable and responsible for all delegated medical services rendered by the PA pursuant to a written POS that meets the requirements of this rule. A SSP must hold an active, unrestricted permanent, temporary, or emergency license, unless the Board has waived the requirement that the SSP license be unrestricted.

Secondary Supervising Physicians If the PA is routinely working under the supervision of a SSP who is a medical specialist (i.e. cardiologist, neurologist, etc.) outside of the PSP’s field of practice, then the SSP shall also perform semi-annual evaluations

Covering Supervising Physician “Covering Supervising Physician” (CSP) means a physician who has agreed in writing to provide supervision of the PA when PSP is not available, and when actively engaged as a supervisor, to be legally liable and responsible for all delegated medical services rendered by the PA pursuant to a written POS that meets the requirements of this rule. A CSP must hold an active, unrestricted permanent, temporary, or emergency license unless the Board has waived the requirement that the CSP license be unrestricted. A CSP shall accept supervisory responsibility for periods of time not to exceed the time period specified in the written PSO, which time period may not exceed forty-five (45) consecutive calendar days.

Registration of Supervisory Relationship Registration Application must be completely filled out Fee must be paid Unless the application form is designated as the POS, a copy of the POS must accompany the application

Plans of Supervision Plans of Supervision must include: Scope of practice PAs render medical services under physician supervision. Physician assistants may render only those medical services that have been delegated to the PA by a supervising physician pursuant to a written plan of supervision Practice Setting A PA may render medical services only in a practice setting in which the supervising physician agrees to provide supervision as documented in the written POS

Plans of Supervision Type and Level of Supervision Whether delegation is appropriate to level of competence Medical services are to be rendered outside the normal practice of the PSP Appropriately trained supervision Ability to access PSP Coverage

Plans of Supervision Evaluation by PSP and SSP At least two documented meetings each licensure year between each PSP and the PA to evaluate the PA’s performance (semi-annual evaluations). All four semi-annual evaluations shall be documented on a form attached to the most current POS. If the PSP supervises the PA for less than six months of a licensure year, only one evaluation need be completed. Semi-annual evaluations must be signed by the PSP and the PA and the information must be kept by the PA.

Plans of Supervision Evaluation by PSP and SSP Each semi-annual meeting evaluation shall address the following areas: clinical and procedural care delivery, PA supervision of medical assistants patient relations and professionalism documentation review. It is recommended that a representative sample of patient charts be reviewed on a routine basis prescriptive practices. Special attention shall be devoted to the prescribing of controlled substances, if such prescribing is authorized.

Plans of Supervision Patient Chart Reviews: No specific amount of chart reviews is required BUT the amount reviewed must be sufficient in number to assure adequate review of the PA’s scope of practice.

Plans of Supervision Maintenance and Production of the POS PAs and PSPs must prepare and have on file in the main administrative office of the practice or practice location a written, dated POS that is signed by both the supervising physician(s) and the PA. The POS shall specify at which location the POS will be maintained. The POS must be reviewed and updated as necessary but at least every two years at license/registration

Plans of Supervision Maintenance and Production of the POS If a PA is to be supervised by (a) SSP(s), the SSP(s) must accept delegation of supervision in writing as part of POS Failure to have a current written POS on file at the location specified in the POS and/or failure to produce a current written POS upon request of the Board or Board staff shall result in a citation and/or possible disciplinary action.

Schedule II Prescribing If authorized and delegated by the PSP, the delegation of the authority to prescribe, administer, or dispense scheduled drugs must be specifically included in the written POS and must identify which scheduled drugs (e.g. schedule II, schedule III, etc.) the PA is authorized to prescribe, administer or dispense.

Schedule II Prescribing The PSP shall perform a review of the PA’s scheduled drug prescribing practices every three months during the first year of the PA’s delegation of scheduled drug prescribing authority in the plan of supervision. Thereafter, the PSP shall conduct such a review every six months. All reviews shall include a review of patient charts and a review of the PMP. The PSP shall take corrective action regarding any deficiencies noted regarding the PA’s scheduled drug prescribing practices.

Schedule II Prescribing PAs may not prescribe Methadone, Suboxone (Buprenorphine), or Subutex unless allowed under state and federal laws. If permitted under state and federal laws, and if delegated by the PSP, the authority to prescribe Methadone, Suboxone (Buprenorphine), or Subutex must be specifically included in the written POS

Schedule II Prescribing Physicians are ultimately responsible for the prescribing practices of the PAs working under their delegation, and should closely monitor the prescribing of all scheduled drugs and controlled substances. Inappropriate prescribing practices by a PA shall constitute grounds to discipline the PA and supervising physicians(s)

Supervising Physician Requirements A supervising physician is responsible for observing, directing and evaluating the work, records and practices performed by the PA pursuant to a written POS and is legally responsible for the practice of the PA at all times A supervising physician may not permit a PA to practice independently

Supervising Physician Requirements A supervising physician is responsible for providing continuous supervision of the PA. It is the responsibility of the PSP to ensure that supervision is maintained in his or her absence.

Supervising Physician Requirements Appropriate supervision shall include: Active and continuing overview of the PA’s activities Immediate availability either in-person or by electronic communication, for all necessary consultations Personal and regular review, at least quarterly, by the supervising physician of selected patient records upon which entries are made by the PA. The chart review will be sufficient in number to assure adequate review of the Pa’s scope of practice

Supervising Physician Requirements Periodic, in person, education and review sessions discussing specific conditions, protocols, procedures and specific patients shall be held by the supervising physician for the PA in accordance with the terms of the written POS. These sessions must occur at least twice each calendar year, and must be documented by the supervising physician and the PA.

Identification Requirements PAs licensed under these rules shall keep their license and certificate of registration available for inspection at the location where they render medical services and shall, when rendering medical services, wear a name tag identifying themselves as a PA.

10 Day Notification Requirements Change of PSP or SSP Termination of POS Change of Contact Information Death/Departure of PSP or SSP Failure to pass NCCPA exam Criminal Arrest/Summons/Indictment/Conviction

10 Day Notification Requirements Change of status of employment or hospital privileges Disciplinary action Material change A PA shall notify the Board of any material change in qualifications or the information and responses provided to the Board in connection with the PA’s most recent application

Uniform Citation The board, may issue citations in lieu of taking disciplinary action for: The failure to have a current POS that conforms to the requirements of this rule and performance review documentation on file at the location specified in the POS. The administrative fine for each violation is $200; or The failure to file a written notification form with the relevant Board as required by this rule. The administrative fine for each violation is $100.

Chapter 2 Rule This presentation has attempted to hit the highlights of the new rule. Please refer to the rule for complete information. For questions, please contact me at tim.e.terranova@maine.gov or (207)287-6930 Thank you