1. MEAPA CONFERENCE FEBRUARY 2016 STATUTE AND RULE UPDATES FOR PHYSICIAN ASSISTANTS Dennis E. Smith, Esq. Executive Director Maine Board of Licensure in Medicine

2. Caveats and Disclaimers Nothing in this presentation constitutes legal advice or is intended to be legal advice Nothing in this presentation represents the opinion of the Maine Board of Licensure in Medicine or the Board of Osteopathic Licensure

3. A Little Background Professional Licensing Maine’s Medical Boards A Little History Where We Are Now

4. Professional Licensing States license and regulate professions – Department of Health – Commissions – Boards Medical Commissions/Boards – Licensing/Re-licensing Standards – Complaint Investigation/Discipline – Education – Rules/Policies

5. STATE REGULATION OF MEDICINE Dent v. State of West Virginia 1889 – U.S. Supreme Court: The power of the State to provide for the general welfare of its people authorizes it to prescribe all such regulations as in its judgment will secure or tend to secure them against the consequences of ignorance and incapacity, as well as of deception and fraud. As one means to this end, it has been the practice of different States, from time immemorial, to exact in many pursuits a certain degree of skill and learning upon which the community may confidently rely…The nature and extent of the qualifications required must depend primarily upon the judgment of the State as to their necessity.

6. Purpose of occupational and professional regulatory boards in Maine as defined by the Legislature The sole purpose of an occupational and professional regulatory board is to protect the public health and welfare. A board carries out this purpose by ensuring that the public is served by competent and honest practitioners and by establishing minimum standards of proficiency in the regulated professions by examining, licensing, regulating and disciplining practitioners of those regulated professions. Other goals or objectives may not supersede this purpose. 32 M.R.S. § 8008.

7. Protecting the Public Competent Honest Minimum standards of proficiency BY doing these things: Examining Licensing Implementing Rules Discipline

8. Maine has 2 Medical Licensing Boards Board of Licensure in Medicine Board of Osteopathic Licensure Allopathic PhysiciansOsteopathic PhysiciansPhysician Assistants

9. Maine has 2 Medical Licensing Boards – with both separate and joint rules Board of Licensure in Medicine Board of Osteopathic Licensure Chapter 2 PA RuleChapter 2 PA Rule Chapter 16 Self Rx (Joint) Chapter 10 - Sexual Misconduct Chapter 17 Gifts (Joint) Chapter 21 – Treatment of Pain

10. Composition of Maine’s 2 Medical Licensing Boards Board of Licensure in Medicine Board of Osteopathic Licensure 6 Physicians6 Physicians3 Public Members1 Physician Assistant

11. A Little History In the beginning… - Physicians were mostly in private practices -Physicians employed their staff (medical assistants, physician assistants) -There was more separation between allopathic physicians and osteopathic physicians

12. A Little History In the beginning… Board of Licensure in Medicine Board of Osteopathic Licensure Own PA Statutory Language Own PA Statutory Language Own Chapter 2 PA RuleOwn Chapter 2 PA Rule

13. A Little History In the beginning… Different Laws: - License Fees - License Expiration Dates - PA Advisory Committee vs. none Different Rules: - License Expiration/Renewal - Schedule II Prescribing Privileges - Plans of Supervision - Continuing Medical Education

14. A Little History And then things began to change… - More physicians leaving private practice and working as employees of healthcare entities - Physician assistants employed by healthcare entities rather than physicians - Less separation between allopathic and osteopathic physicians - especially where employed by healthcare entities - Physician assistants being supervised by both allopathic and osteopathic physicians employed by the same healthcare entity

15. A Little History And with the changes came questions… - Why do PAs need two licenses? - Why can a PA licensed by the Medical Board prescribe Schedule II drugs but a PA licensed by the Osteopathic Board cannot? - Why is the license renewal date for PAs different for each medical board? -Why are the CMEs required for PAs different for each medical board?

16. A Little History And with the questions came legislation… LD 830 “An Act to Eliminate the Dual Licensing of Physician Assistants” Be it enacted by the People of the State of Maine as follows: CONCEPT DRAFT SUMMARY This bill is a concept draft pursuant to Joint Rule 208. This bill proposes to reduce the regulatory burden on a physician assistant who is currently required to be licensed by both the Board of Licensure in Medicine and the Board of Osteopathic Licensure if that physician assistant is supervised by both allopathic and osteopathic physicians. The bill proposes to require one of the physician licensing boards to issue all the licenses needed by a physician assistant, regardless of which board licenses the supervising physician.

17. A Little History And with the legislation came a stakeholder group led by PFR Commissioner Anne Head… - Medical Board Staff - Osteopathic Board Staff - MEAPA Representatives - Interested Physician Assistants - MMA Representatives - MOA Representatives - Assistant Attorney General TASK: Find a solution for a single PA license in Maine.

18. A Little History The solution… An amendment to LD 830 that did the following: 1. Eliminated the requirement of dual licensure with the Board of Licensure in Medicine and the Board of Osteopathic Licensure: A physician assistant may apply for licensure to EITHER board - If the primary supervising physician is known at the time of application – then the application will be made to the board that licenses the supervising physician - If the primary supervising physician is NOT known at the time of application, then the physician assistant may apply to the board of his/her choice Licensure by EITHER board allows a physician assistant to render medical services under the supervision of EITHER an allopathic physician or an osteopathic physician

19. A Little History The solution… An amendment to LD 830 that did the following: 2. Synchronized the Medical Board and Osteo Board statutes regarding physician assistants: - The TWO boards’ statutes regarding PAs are made identical - Qualifications for licensure made identical - Registration requirements made identical - Fees made identical

20. A Little History The solution… An amendment to LD 830 that did the following: 3. Clarified that a physician assistant may not render medical services until issued a certificate of registration (regarding his/her supervising physician). 4. Retained the requirement that the Medical Board and Osteo Board adopt JOINT rules pertaining to physician assistants: -Uniform license application -Uniform license procedures -Uniform license/registration fees -Uniform Scope of Practice (Schedule II) -Uniform Requirements for Plans of Supervision -Uniform Requirements for Continuing Education

21. A Little History The solution… The stakeholders also had some discussion with regard to the JOINT Chapter 2 rules: -Getting the process back on track -Transparency and input -Timely enactment of a JOINT rule -Elimination of the “inactive” license status for physician assistants who do not have a registered supervising physician -Schedule II prescribing privileges -Continuing Education Requirements

22. A Little History The solution… MEAPA President Steve Blessington and I presented the stakeholders report to LCRED Committee – which unanimously voted it out of committee “Ought to Pass” LD 830 as amended was enacted into law and became effective October 15, 2016 In the meantime, Board staff and assistant attorney general developed draft Chapter 2 rules Draft chapter 2 rules were sent to stakeholders for review and comment – before both Boards formally proposed them

23. Where we are today The Joint Chapter 2 Rule (Finally!)… Both Boards formally proposed a joint rule that do the following: -Uniform license application -Uniform license/registration procedures -Uniform license/registration fees -Eliminate “inactive” license status (“clinical or non- clinical”) – ALMS -Uniform Scope of Practice (Schedule II) -Uniform Requirements for Plans of Supervision -Uniform Requirements for Continuing Education

24. Where we are today The Joint Chapter 2 Rule (Finally!)… Proposed Chapter 2 Rule – posted on Boards’ websites: http://www.maine.gov/md/ http://www.maine.gov/osteo/ Comment period ended January 22, 2016 5 M.R.S. § 8052(1) – “Prior to the adoption of any rule… a public hearing must be held if… requested by any 5 interested persons…” The Boards received requests from at least 5 persons for a public hearing – which now must be scheduled 5 M.R.S. § 8052(2)(A) requires at least 1/3 of the agency members to be present at the public hearing (in this case that would be 4 members from EACH Board)

25. Where we are today The Joint Chapter 2 Rule (Finally!)… 5 M.R.S. § 8052(3) requires the agency to allow written comments to be filed with the agency within the ten (10) days after the close of the public hearing [Note: The agency may provide for a greater period of time] 5 M.R.S. § 8053(5) requires the agency to publish the rule 17- 24 days prior to the public hearing or at least 30 days prior to the close of the comment period after the hearing Why this is important: To understand that the Boards cannot simply schedule a hearing tomorrow. But they are in the process of scheduling it.

26. Where we are today The Joint Chapter 2 Rule (Finally!)… What the rule making hearing will look like: Will occur at the Boards’ meeting room in Augusta Will begin at a time certain Will be open to the public Is opened by an acting chair Persons giving verbal comments will sign-in, state their names and identify any organization whom they may represent, provide verbal comments on the rule (and may also submit a transcript of testimony or summary of testimony) The Boards members do not respond to comments at the hearing nor have a dialogue or answer any questions at the hearing The hearing will be closed, and written comments can still be submitted for a period of at least 10 days

27. Where we are today The Joint Chapter 2 Rule (Finally!)… After the hearing: Boards review comments – accept/reject and provide an explanation of their decision Basis Statement – Boards review and adopt If there is a substantive change to the proposed rule – then it must go back out for public comment for 20 days Once adopted – rule must be approved for form and legality by the Office of Attorney General

28. QUESTIONS AND DISCUSSION MEAPA CONFERENCE FEBRUARY 2016 STATUTE AND RULE UPDATES FOR PHYSICIAN ASSISTANTS Dennis E. Smith, Esq. Executive Director Maine Board of Licensure in Medicine