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

2. 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

3. 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

4. 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

5. Change in License Type There will now be two types of licensesPA
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

6. 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

7. 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

8. 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)

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

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

11. 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.

12. 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.

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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.

19. 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.

20. 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.

21. 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

22. 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.

23. 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.

24. 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.

25. 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

26. 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)

27. 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

28. 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.

29. 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

30. 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.

31. 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.

32. 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

33. 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

34. 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.

35. 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 or (207)
Thank you