Click here for a printer-friendly version of this issue of Legislative Watch.
It's Finally Final!
In mid-August the Pennsylvania attorney general signed regulations authorizing prescriptive authority for physician assistants supervised by osteopathic physicians. Until that moment, PAs in group practices had been in the through-the-looking-glass state of being authorized prescribers when supervised by an MD in the group, but not when supervised by one of the group's DOs. Pennsylvania is one of seven states that licenses PAs separately under allopathic and osteopathic medical boards. The new prescriptive authority represents an amendment in osteopathic board rules and includes Schedules II-V and non-controlled drugs.
In the Wings and Off the Shore
Five U.S. territories regulate health professionals: American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, Puerto Rico, and the U.S. Virgin Islands. Three of these (CNMI, Guam, and the USVI) license PAs.
Which jurisdiction licenses PAs but does not yet authorize them to prescribe? The USVI. And is there an effort to authorize PA practice in Puerto Rico and American Samoa? Absolutely.
A core group of those interested in authorizing PA practice in Puerto Rico continues to network, advocate, and activate. Read more about it in the most recent edition of the PAs for Puerto Rico newsletter, PA Pronto.
Efforts in American Samoa are less formalized; however PAs working in American Samoa are making early overtures and inroads with the licensing agency. If you are interested in the effort to authorize PA practice in American Samoa, contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
Not Everybody Is Waiting on the Feds
While health care reform at the federal level is front and center, most states are awaiting action from the feds rather than tackling reform at the state level. That's most states - but not all...
In Massachusetts, two groups are considering reform - one with a focus on cost and the other focusing on access and quality. Both have hired consulting groups and both consultants concur that more effective utilization of PAs and NPs is required. Both groups are looking at global or bundled payments and at patient-centered medical home models. New Mexico PAs will testify at a legislative hearing mid-month on utilization of PAs in the patient-centered medical home. In Oregon, the PA state society is preparing for end-of-month legislative hearings on HB 2009, legislation that establishes the Oregon Health Authority and charges the Authority with streamlining the application process for medical assistance and premium assistance, increasing reimbursement rates for health services providers participating in medical assistance programs, and conducting outreach for medical assistance and premium assistance. The legislation taxes cigarettes, health insurance, and managed care plans to help fund the Authority's initiatives. Proposed rules in Maine establish a patient-centered medical home program that includes PAs as providers.
A Minnesota report describing the patient-centered health care home calls for changes in laws and systems to allow "all qualified primary care professionals to practice at the top of their education and capacity, use each profession for the tasks which they are uniquely qualified to perform and reduce tasks that do not make the best use of each professional on the team."
And Speaking of the "Patient-Centered Medical Home" (PCMH) Model
The Academy wants to highlight PAs who are involved in this growing clinical movement that emphasizes the use of information technology to manage and streamline each patient's care. Some current high-profile programs are sponsored by the American Academy of Family Physicians (TransforMed), Medicaid programs for chronic care management, and the National Committee on Quality Assurance recognition program, to mention just a few. If you are involved in a PCMH project, the AAPA's professional affairs staff would welcome your input and expertise on this important issue. Please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it by e-mail, or 703-836-2272, ext. 3210.
Eleventh Hour Victory — Maybe
California HB 356, legislation that authorized PAs who complete a 40-hour course in radiation safety to utilize fluoroscopy, was passed by the state legislature in the final hours of the 2009 legislative session. It joins a bucket of bills en route to Governor Schwarzenegger (R) who has threatened to veto them all unless the Assembly deals with legislation on prisons, water, and renewable energy.
Warning: the 2010 Session is Closer than it Appears
States from Vermont (changing to a streamlined licensure process and authorizing PAs to provide care in disasters) to California (removing the physician's name from the prescription) are evaluating priorities for the 2010 session. Along with those previously noted are Ohio (Schedule II prescriptive authority), Colorado (using the state's Sunset process to make a wide variety of improvements), Idaho (clarifying the ability of PAs to participate in practice ownership), Kentucky (controlled medication prescriptive authority), Maryland (changing to a streamlined licensure process and allowing scope of practice to be determined by the physician-PA team), Massachusetts (clarifying PA ability to utilize fluoroscopy and requiring third party payers to cover physician services provided by PAs) and Utah (increasing the proportion of PAs on the physician assistant licensing board and doubling the number of PAs a physician may supervise).
If you are wondering what you might want to consider for the upcoming session, take this quiz to assess key areas of your state law.
Legislative Watch is a monthly state government newsletter written for physician assistant national leaders, PA program directors, PAs who serve as members of state regulatory agencies, and AAPA constituent organization leaders. Newsletter editors may reprint non-sensitive items if you credit the source using its full name: The American Academy of Physician Assistants' Legislative Watch. Please feel free to contact us with news from your state, or to request assistance with any and all state government issues.
