Changes to Physician Assistant Requirements Under SB 110
Overview
On July 16, 2015 Governor Kasich signed Senate Bill 110 into law, which will become effective October 15, 2015. This bill seeks to modernize physician assistant practices. The bill provides for several changes that affect certification, the types of services that may be provided, supervision, and prescriptive practices. The bill also allows for a physician assistant to delegate certain tasks related to implementing patient care to RNs, RTs, and MAs.
Licensure
Physician Assistants currently obtain a certificate to practice. The bill changes the name of certificate to a “license” and eliminates a provision of the law that treats a certificate to practice as a license. The State of Ohio Medical Board may continue to issue certificates to practice for up to ninety days after the bill takes place, but then must begin to issue licenses. Existing certificates to practice and certificates to prescribe will be honored until January 31, 2016.
Services Performed By a Physician Assistant
Under the bill a physician assistant is allowed to provide any service that the supervising physician authorizes, as long as those practices are part of the physician’s normal course of practice and expertise. Effective as of October 15, 2015, the physician assistant may:
- Order diagnostic, therapeutic, and other medical services;
- Prescribe physical therapy or refer a patient to a physical therapist for physical therapy;
- Order occupational therapy or refer a patient to an occupational therapist for occupational therapy
- Identify and comply with a patient’s DNR
- Determine and pronounce death
- Assist in surgery
- Order, prescribe, personally furnish, and administer drugs and medical devices (as long as the physician assistant has been granted physician-delegated prescriptive authority)
- Perform any other service that the supervising physician provides in his or her normal course of practice and expertise.[1]
Supervision
Under SB 110, a physician assistant may practice in any setting within which the supervision physician has supervision, control, and direction of the physician assistant.[2] Further, the bill allows the physician assistant to practice as long as the supervising physician is “in a location that is a distance from the location where the physician assistant is practicing that reasonably allows the physician to assure proper care of patients.”[3] Thus, the requirement that a supervising physician be within sixty minutes travel time to the physician assistant’s location is removed. In addition, a physician may now supervise up to three physician assistants at any one time.
For physician assistants who practice outside of a health care facility, the bill removes the requirement for a Board-approved physician supervisory plan. Physician assistants and supervising physicians are still required to have a supervision agreement, and the bill provides for some additional requirements for supervision agreements. For example, each supervision agreement must clearly state that the supervising physician is legally responsible and assumes legal liability for services the physician assistant provides. If the physician assistant practices in a health care facility, the agreement must include a term requiring the physician assistant to practice pursuant to the facility’s policies. If the physician assistant practices outside a health care facility the following terms must be included in the physician supervision agreement:
- The responsibilities to be fulfilled by the supervising physician;
- The responsibilities to be fulfilled by the physician assistant when performing services under the supervising physician;
- Any limitations on the responsibilities under which the physician assistant is required to refer a patient to the supervising physician; and
- If the supervising physician chooses to designate physicians to act as alternate supervising physicians, the names, business addresses, and business telephone numbers of the physicians who have agreed to act in that capacity.[4]
Once submitted, a supervision agreement becomes effective by the end of the fifth business day, unless the Board notifies the supervising physician otherwise. If an agreement doesn’t comply with the law, the supervising physician may revise and resubmit the agreement. The supervision agreement is then effective for a period of two years, upon which it may be renewed. During that two year period, a supervising physician may amend the agreement and resubmit it to the board to add additional physician assistants. The supervising physician is required by law to keep the supervision agreement in his or her records. At any time, the Board may review a submitted supervision agreement to ensure compliance and verify the licensure of the physician assistant and the supervising physician.
Prescriptive Authority
Ohio SB 110 eliminates the certificate to prescribe and the provisional certificate. Instead, a physician assistant holding a valid prescriber number issued by the State of Ohio Medical Board is allowed to prescribe and personally furnish drugs and therapeutic devices under physician-delegated prescriptive authority. It is worth mentioning that the bill is silent regarding the procedure for obtaining a prescriber number. For the first five hundred hours of physician delegated prescriptive authority, the physician assistant must work under an on-site physician’s supervision. The supervising physician must keep a record of the completion of the five hundred supervised hours or the issuance of prescriptive authority that has been given through another state. This record must be available and may be inspected by the board.
Delegation
Physician assistants may now delegate the administration of drugs and the performance of tasks to implement a patient’s plan of care. The physician assistant must first determine that the drug administration or task is appropriate and can be done safely. In addition, the following requirements must be met:
- The physician assistant has physician–delegated prescriptive authority;
- The drug is included in the formulary established under current law;
- The drug is not a controlled substance;
- The drug will not be administered intravenously; (the drug may be administered via any other route, which could be orally, topically, or into a patient’s bone marrow); and
- The drug will not be administered in a hospital inpatient care unit, a hospital emergency department, a freestanding emergency department, or an ambulatory surgical facility.[5]
Next Steps
Physician assistants and supervising physicians should take steps to ensure they will be working under a valid and complete Supervision Agreement. Furthermore, physician assistants should obtain prescriber numbers. Supervising physicians must make sure they have all necessary documents in their records, and that their records are in compliance with the new requirements.
Brennan, Manna & Diamond, LLC’s Health Law Department advises its clients on various healthcare issues, including compliance with physician assistant regulations. If you have any questions regarding this Client Alert or need assistance in developing policies and procedures for compliance with Ohio S.B. 110, please contact John N. Childs, Esq. at (330) 730-0861.