PA State Chapters Persevere in 2020 to Achieve Improvements for Profession

Profession Makes Progress on OTP, Collaboration, COVID-19

January 29, 2021

In a year that saw unprecedented disruption, PA state chapters persevered in 2020 to achieve great improvements for the PA profession. Due to the COVID-19 pandemic, PAs around the country had to adapt their advocacy plans to pursue both temporary and permanent change to allow for the maximum PA response to COVID-19.

The pandemic disrupted many functions of every-day life, and state legislatures were no exception. Legislatures across the country were left to piece together whether and how to continue their 2020 sessions safely and govern effectively. Through it all, AAPA worked with its state chapters to develop and execute ever-evolving advocacy plans and strategies, draft legislation and regulations, submit testimony and written comments, and assist with media outreach.

Optimal Team Practice
Multiple states achieved elements of AAPA’s Optimal Team Practice (OTP) policy. Many legislatures recognized that bills already active in their chambers could be fast-tracked to respond directly to COVID-19. In Maine, the Maine Association of PAs and AAPA worked closely on legislation that would allow PAs to practice to the full extent of their education and training. In March, Maine’s Governor signed legislation into law that makes PAs eligible for direct pay, replaces supervision with collaboration in Maine law, allows a majority of PAs to practice without an agreement, streamlines licensure, and adds a second PA to each medical board.

Vermont also enacted legislation that makes PAs eligible for direct pay, as well as shifts the PA-physician relationship from supervision to collaboration, defines PA scope of practice based on the PA’s education, training and experience, and makes PAs responsible for the care they provide. Florida also achieved a component of OTP through legislation that changed the composition of the state’s PA Council, giving PAs a majority of seats. Oklahoma enacted legislation allowing for direct pay.

Executive Orders
Given the pandemic, many states were able to temporarily remove the mandated physician-PA relationship through executive orders (EOs). Often this was done to maximize the providers states could deploy to care for patients, whereas others eased licensure requirements, and/or allowed for greater telehealth delivery. Eight states – Maine, Michigan, New Jersey, New York, Louisiana, South Dakota, Tennessee, and Virginia – waived the requirement for PAs to have a relationship with a physician or other provider to practice.

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Many of these states are already hard at work trying to make these changes permanent to maximize patients’ access to PAs.

Collaboration, Removal of Physician Responsibility, and Key Elements
In 2020, states also made significant strides to modernize PA practice.

Minnesota made the shift from using the term supervision to collaboration to describe PA practice. Minnesota’s landmark law eliminates agreements with physicians for PAs with more than 2,080 practice hours, removes references to delegation and responsibility for care, as well as removes delegated prescriptive authority, authorizing PAs to prescribe based on their own qualifications.

Iowa gained four of the  Six Key Elements of a Modern PA Practice Act (Key Elements) in 2020 through legislation. The new law allows PAs to prescribe all Schedule II controlled medications, consistent with their education and experience; removes chart co-signature requirements; eliminates the requirement that a physician visit remote locations staffed by a PA at least once every six months; allows a PA’s scope of practice to be determined at the practice site; authorizes PAs to be rendering providers under Medicaid; and updates language regarding dispensing and damages for medical liability.

Georgia gained an additional Key Element with a law that allows chart review to be determined at the practice site. The law also increased the PA to physician ratio in the state to 4:1, to match the current nurse practitioner (NP) to physician ratio.

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Additional Advocacy Victories
The year also saw many states achieve other important victories. After years of collaborative advocacy efforts by the Kentucky Academy of PAs and AAPA, Kentucky now allows PAs to prescribe controlled substances. This means PAs finally can prescribe controlled substances in all 50 states and the District of Columbia.

Washington modernized PA practice with a new law that removes the requirement for practice agreements to be approved by the Washington Medical Commission; removes the requirement for Commission approval to employ or work with a PA; removes the requirement for Commission approval for PAs to practice in remote sites; increases the physician to PA ratio from 1:5 to 1:10 with the option to request a higher ratio; moves all licensing and regulation of PAs under the state’s allopathic board and removes this responsibility from the osteopathic board.

Nebraska passed legislation that greatly improved PA practice through a host of changes, most notably by removing references in statute to physician direction and control of PAs and making practice agreements more flexible by giving the PA-physician team more say over what goes in the agreement.

In 2020, the Academy also continued to engage the Federal Trade Commission (FTC) on state laws and regulations with potentially anti-competitive effects on PA practice in states. Nowhere was this more evident, than in Maine, where the FTC wrote to the boards of medicine during rulemaking efforts to emphasize the FTC’s previous guidance on anti-competitive regulation of PAs and NPs.

2021 is off to a busy start for the Academy and state chapters; we are already hard at work to achieve OTP and other improvements for PAs.

For more information on improvements to PA practice, please contact the appropriate member of the State Advocacy and Outreach team.

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