2016 was another banner year for PAs at the state level

By Carson Walker, director of Constituent Organization Outreach and Advocacy

The end of the year is always a time to reflect on our accomplishments, and also prepare for the year ahead. For the PA profession, 2016 was another year of significant legislative and regulatory victories. It was also a year many states laid the foundation for future initiatives. From Maine to Washington, states made huge leaps forward and brought down practice barriers that revised legislation, regulations and even medical board FAQs. Some states added PAs to various parts of statutes through harmonization acts, other states were able to gain anywhere from one to three of AAPA’s Six Key Elements of Modern PA Practice Act through modernizing PA practice acts and regulatory amendments.

In 2016:

■ Florida and Maine gained full-prescriptive authority for PAs. Florida was one of only two states to not have controlled prescribing authority for PAs. Maine previously had Schedules III-V for all PAs, and allowed for PAs in allopathic medicine to apply separately for limited Schedule II authority. With the addition of these two states, PAs in 43 states and the District of Columbia have full prescriptive authority. Kentucky is the only state that does not allow controlled prescribing by PAs.

■ Illinois and Washington had major legislation adding PAs to various sections of state statutes through harmonization acts. The first phase of Illinois legislation amended 60 chapters of Illinois statute to explicitly include PAs. The Washington legislation added PAs to 22 sections of the state’s mental health code. This was in addition to regulations enacted in January clarifying that PAs in Washington may exercise the same authority as physicians regarding restraint and seclusion.

■ Minnesota and North Carolina became the fifth and sixth states to achieve all six of AAPA’s Key Elements of a Modern PA Practice Act. Minnesota achieved this feat through legislation that removed the state’s ratio requirement, while North Carolina’s last key element (adaptable supervision) came through minutes of the Medical Board. The minutes revealed the board’s decision that electronic communication between a PA and physician is acceptable for purposes of quality improvement meetings required by state regulations. This action removed the necessity for PA-physician teams to meet face-to-face.

■ The Indiana High School Athletic Association recognized PA-conducted sports physicals and PA-signed forms for the first time. This marked the first victory in AAPA’s new competition advocacy efforts, which revolve around using the U.S. Supreme Court’s decision in North Carolina Board of Dental Examiners v. Federal Trade Commission.

■ New Jersey modernized PA practice, and made the leap from having only two of AAPA’s Six Key Elements, to five. The legislation, signed in January and effective in August, did away with on-site and co-signature requirements and allows for scope of practice to be determined at the practice level.

■ South Dakota also successfully amended regulations to eliminate on-site requirements. AAPA submitted comments to the South Dakota Board of Medical and Osteopathic Examiners explaining that repealing this requirement allows better use of clinician time, and would thus improve access to care. This gives South Dakota five of the Key Elements.

■ In addition to gaining full-prescriptive authority, PAs in Florida also saw legislation and regulations enacted to allow PA scope of practice to be determined at the practice level. Florida now has four of the Key Elements.

These are just the major accomplishments. Numerous smaller victories came in 2016. While 2016 saw multiple gains for PAs, we believe 2017 promises to be a groundbreaking year for the profession.

As December 2016, more than 20 states plan to go to their legislatures with major bills in 2017 that include elements of our Model State legislation, ranging from replacing “supervision” with “collaboration,” to removing physician responsibility language, to gaining remaining Key Elements. In addition to these efforts, AAPA looks to build on the momentous achievements in 2016 in Florida, and work with the Kentucky Academy of PAs in 2017 to allow PAs to prescribe controlled substances. AAPA is also ramping up its efforts to address anti-competitive actions against PAs by medical boards across the country.

Finally, 2017 will be a big year in AAPA’s efforts to improve PA license portability by encouraging greater PA participation in the Federation of State Medical Boards’ Federation Credentials Verification Service, assisting the federation in launching a uniform application for PAs, and continuing to make progress in establishing an interstate compact for PAs.

AAPA will be sure to keep you updated of the latest developments in your states. For questions about a specific state or specialty, be sure to contact the appropriate member of AAPA’s constituent organization and advocacy department.