PENNSYLVANIA ~ STATUTE

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1 PENNSYLVANIA ~ STATUTE STATUTE Medical Practice Act, 63 P.S et seq DATE Enacted 1978 REGULATORY BODY Pennsylvania State Board of Medicine PA DEFINED Individual who is licensed as a PA by the board. 2 SCOPE OF PRACTICE PRESCRIBING/DISPENSING SUPERVISION DEFINED PAs PER PHYSICIAN PA may perform a medical service delegated by an approved physician and as approved by the board. A PA shall not perform a medical service without the supervision and personal direction of an approved physician. PA may not provide medical service without a written agreement with one or more physicians which describes how PA will assist, the nature of supervision, designates a primary supervisor, and which has been approved by the board. PA may be employed by medical care facility if under the supervision and direction of physician(s), except a PA shall not be responsible to more than 3 physicians. PA may not measure range or powers of human vision, determine refractive status of human eye. Routine vision or refractive screenings permitted. PA not allowed to practice chiropractic. 13 PA not permitted to independently prescribe or dispense drugs. Medical board directed to develop regulations which permit PAs to prescribe and dispense drugs at direction of a physician. Board shall request comments and recommendations from the pharmacy board. 13 PA may not perform medical services without the supervision and personal direction of a licensed physician approved by the board. Board shall promulgate regulations which define the supervision and personal direction required by the standards of acceptable medical practice in the community. 13 Supervising physician shall not have primary responsibility for more than 4 PAs at any time. A physician may apply to the board for a waiver to supervise more than 4 PAs. PA employed by a medical care facility may not be responsible to more than 3 physicians. 13 APPLICATION QUALIFICATIONS TEMPORARY PERMIT TERMINATION CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION PHYSICIAN LIABILITY By PA for license. Application must include written request from supervising physician who files with the board a description of the manner in which PA will assist physician. Subject to board approval. 36 Board grants PA license to applicants who meet following criteria: satisfactory performance on proficiency exam satisfactory completion of certified PA education and training program Those licensed after January 1, 2004, must have baccalaureate degree and must have completed no less than 60 clock hours of didactic instruction in pharmacology or other related courses approved by the board 36 Graduates of PA programs recognized by the board may register with the board and practice only under direct supervision of a physician until certified by a process recognized by the board. Practice limited to the period between graduation and receipt of results of the first examination offered after graduation. If exam failed, authority to practice expires. Must use title of graduate physician assistant. May not prescribe PA may use the title physician assistant or appropriate abbreviation, such as PA-C. 13 It is unlawful for person to practice profession without a license. 38

2 PENNSYLVANIA ~ STATUTE FEE/RENEWAL SCHEDULE Board may charge a reasonable fee. 6 License subject to biennial renewal. 36 PROGRAM APPROVAL BOARD REPRESENTATION/ ADVISORY COMMITTEE Requirements for certification of training and educational programs for PAs shall be set by the board and any accrediting body which may be recognized by the board. 23 Medical board seats for commissioner of professional occupational affairs, secretary of health, 2 public members, 6 medical doctors and 1 certified nurse midwife, PA, NP, respiratory care practitioner, or athletic trainer. Governor assures that CNMs, PAs, NPs, RCPs and athletic trainers are appointed to 4-year terms on a rotating basis. 3 BOARD POWERS Establish rules and regulations to implement the act. 8 DISCIPLINARY POWERS VIOLATIONS/PENALTY PAYMENT FOR SERVICES GRANDFATHER CLAUSE STUDENTS LOCUM TENENS Board may: refuse to grant license administer a public reprimand, with or without probation impose a fine suspend, revoke or restrict license impose corrective measures 42 Board has authority to refuse, revoke, suspend PA license or impose for any or all of following reasons: failure to demonstrate qualifications fraud or deceit in practice or in obtaining license or renewal conviction of felony or misdemeanor related to health profession disciplinary action taken or application refused, revoked or suspended by proper certifying body in another state inability to practice due to illness or addiction to drugs or alcohol violation of board regulation or order knowingly maintaining professional connection with person in violation of act or regulations or assisting in unlicensed practice being guilty of immoral or unprofessional conduct acting in a manner presenting immediate clear danger to public health or safety practicing outside scope of license 41 For reimbursement purposes, a PA shall be an employee subject to the normal employeremployee reimbursement procedures. 13 OTHER

3 PENNSYLVANIA ~ REGULATIONS REGULATIONS DATE REGULATORY BODY Chapter 18 State Board of Medicine Subchapter D. Physician Assistants Revised 11/06; regulations to implement 2007 statutory changes not yet adopted. Pennsylvania State Board of Medicine PA DEFINED An individual who is licensed by the board as a physician assistant SCOPE OF PRACTICE PRESCRIBING/DISPENSING PA practices medicine with physician supervision. PA may perform those duties and responsibilities, including ordering, prescribing, dispensing, and administering drugs and medical devices, as well as the ordering, prescribing, and executing of diagnostic and therapeutic medical regimens, as directed by the supervising physician. PA may provide any medical service as directed by the supervising physician, when the service is within the physician assistant s skills, training and experience, forms a component of the physician s scope of practice, is included in the written agreement, and is provided with supervision in keeping with the accepted standards of medical practice. PAs may pronounce death, but not the cause of death, and may authenticate with their signature any form related to pronouncing death. PAs may authenticate with their signature any form that may otherwise be authenticated by a physician s signature, if permitted to do so by the supervising physician, state and federal law, and facility protocol. PA is considered the agent of the supervising physician in the performance of all practicerelated activities including the ordering of diagnostic, therapeutic, and other medical services PA may not provide medical services including prescribing and dispensing medication except as described in a written agreement, maintain or manage a satellite office unless registered with the board, independently delegate to another health care provider a task specifically assigned to the PA, or perform acupuncture PA may only provide medical services in an emergency care setting if he has training in emergency medicine, functions within the purview of his written agreement, and is under the supervision of a supervising physician PA may provide medical services at a satellite location in an area of medical need with board approval. Direct communication must be available; physician must review directly with the patient the progress of the patient s care, as needed or at the request of the patient; and must visit the location every 10 days to provide supervision and personally review and sign the records of selected patients seen by the PA PA may order and/or administer controlled substances and whole blood and blood components if authority expressly set forth in written agreement If permitted by the supervising physician through written agreement, PA may execute a written or oral order for a medical regimen, or may relay a written or oral order for a medical regimen to be executed by another health care practitioner Supervising physician may delegate to the PA the prescribing, dispensing, and administering of drugs and therapeutic devices, including Schedule II-V controlled substances. PA must register with DEA if prescribing or dispensing controlled medications. PA may prescribe a Schedule II medication for initial therapy, up to a 72-hour dose. PA shall notify the supervising physician of the prescription as soon as possible, but no later than 24 hours after the prescription was written. PA may write a prescription for a Schedule II medication for up to a 30-day supply if it has been approved by the supervising physician for an ongoing therapy. Written prescription must indicate that it is for initial or ongoing therapy. PA may only prescribe or dispense medication for a patient who is under the care of the supervising physician, and only in accordance with the supervising physician s instructions and written agreement. Prescription blanks must include the license number, name, and DEA registration number (if applicable) of the PA in a printed format on the heading of the blank. Supervising physician must also be identified. PA must sign the prescription, and include the initials PA-C to identify the prescriber as a PA. Supervising physician may not pre-sign prescription blanks. Hospital-generated prescription blanks are appropriate, if the above information is included PA shall keep a copy of the prescription in a ready reference file, or in the patient s medical record. A record of dispensed medications, the dose, and the date dispensed, must be included in the patient s medical record. PA must report to the supervising physician within 36 hours, either orally or in writing, any medication prescribed, ordered or dispensed while the supervising physician was not physically present, and the basis for the decision to prescribe. Supervising physician shall countersign the patient record within 10 days.

4 PENNSYLVANIA REGULATIONS SUPERVISION DEFINED PAs PER PHYSICIAN Written agreement specifying PA prescribing and dispensing privileges, including the categories of drugs which the PA is not permitted to prescribe, must be kept on file and available for review , The oversight and personal direction, and responsibility for, the medical services rendered by a PA. The constant physical presence of the physician is not required so long as physician and PA are or can easily be in contact via radio, telephone or telecommunications. Appropriate degree of supervision includes immediate availability of physician for necessary consultations; personal and regular (within 10 days) review of patient records; a written agreement that lists delegated functions, practice sites, supervisors and the manner in which PA will assist each one, and other information Responsibilities of primary supervising physician include: Monitor PA s compliance of written agreement, and report any failure to comply with the written agreement to the appropriate parties Arrange for substitute supervising physician Review directly with the patient the progress of the patient s care, as needed or at the request of the patient See hospitalized patients at least once during each admission Provide access to written agreement upon request and provide clarification of orders and prescriptions written by the PA that are relayed to other health care practitioners Supervising physician must review and sign medical record of orders for medical regimens within 10 days, unless more immediate co-signature required by facility policy. Supervising physician shall provide immediate access to the written agreement authorizing PA s authority to relay or execute a medical order upon request Supervising physician must review the medical records of patients cared for by the PA within 10 days If PA practices in satellite location supervising physician must visit location at least once every 10 days to provide supervision Physician assistant supervisor may not have primary responsibility for more than 2 PAs PA employed by a medical care facility may not be responsible to more than 3 physicians APPLICATION PA applies for license on board forms Physician applies for registration as a PA supervisor. In cases where a group of physicians will supervise a physician assistant, the names of all supervisory physicians shall be included on the application QUALIFICATIONS TEMPORARY PERMIT TERMINATION CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION Graduation from CAHEA-accredited PA program Passage of NCCPA exam (and current NCCPA certification) PA and supervisor must notify the board in writing of a change in or termination of employment within 15 days To be eligible for renewal of license, PA must maintain national certification by completing current recertification mechanisms available to the profession and recognized by the board PA may not render medical services to any patient until patient has been informed of following: PA is not physician PA may perform service as an agent of the physician and only as directed by supervising physician Patient has right to be treated by physician. In physician s office and any satellite locations, a notice plainly visible to all patients shall be posted explaining that a physician assistant is authorized to assist physician in the provision of medical care and services. Physician and PA must display registration to supervise and state license. PA must conspicuously wear identification tag which uses term physician assistant in easily readable type

5 PENNSYLVANIA REGULATIONS PHYSICIAN LIABILITY Physician assistant supervisor retains full professional and legal responsibility for the performance of his PA and the care and treatment of his patients FEE/RENEWAL SCHEDULE Biennial renewal PROGRAM APPROVAL Board recognizes and approves CAHEA-accredited PA programs BOARD REPRESENTATION/ ADVISORY COMMITTEE BOARD POWERS DISCIPLINARY POWERS VIOLATIONS/PENALTY Designated board representatives authorized to make scheduled and unscheduled on-site inspections Disciplinary action may be imposed for: misrepresentation or concealment of facts in obtaining certificate violation of PA statute or regulations commission of act involving moral turpitude, dishonesty or corruption conviction of felony or misdemeanor relating to health profession misconduct in practice, fraud, practicing beyond authorized scope or with incompetence or negligence practicing while impaired by alcohol, drugs, physical disability or mental instability impersonating physician or another certified PA violations of standards of professional conduct practicing under a suspended, expired, or revoked license offering to treat or cure disease by secret method; use of methods or treatment outside of those accepted by reasonable segment of medical profession delegating to unqualified individual failure to notify supervising physician that PA has withdrawn care from patient PAYMENT FOR SERVICES PA may not independently bill patients for services provided GRANDFATHER CLAUSE STUDENTS LOCUM TENENS OTHER PA may not list name independently in any phone directory or other directory for public use, in a manner which indicates that he functions as an independent practitioner

6 PENNSYLVANIA ~ STATUTE OSTEOPATHIC STATUTE Osteopathic Medical Practice Act, 63 P.S. 271 et seq DATE Enacted 1978 REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/DISPENSING SUPERVISION DEFINED PAs PER PHYSICIAN APPLICATION QUALIFICATIONS TEMPORARY PERMIT TERMINATION CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION PHYSICIAN LIABILITY Pennsylvania State Board of Osteopathic Medicine A person certified by the board to assist a physician or group of physicians in the provision of medical care and services under physician direction and supervision. 2 PA may perform any service within his skills which is delegated by the supervising physician and which forms a usual component of the physician s scope of practice. No medical services may be performed by a PA which include measurement of the range of powers of human vision or determination of the refractive status of the human eye. This does not prohibit routine vision screenings or the performance of refractive screenings in the physician s office. PAs not allowed to practice chiropractic. 10 Nothing in this act permits PA to independently prescribe or dispense drugs. The board and the state board of pharmacy will jointly develop regulations to permit a PA to prescribe and dispense drugs at the direction of a licensed physician. 10 (Note: Board has not developed regulations to permit physician-delegated PA prescribing.) Supervision and direction shall not be construed to necessarily require the personal presence of the supervising physician at the place where services are rendered. 10 Supervising physician shall not have primary responsibility for more than 4 PAs at any time. Physician may apply to the board for a waiver to supervise more than 4 PAs. 10 PA applies for certification on board forms. Supervising physician applies for approval to utilize a PA. 10 Graduation from board-approved program Passage of board-approved proficiency exam (NCCPA) 10 If graduation from PA program is a prerequisite to taking the proficiency exam, the board shall have the power to waive the education requirement. 10 It shall be unlawful for any person to practice as a PA unless certified and approved by the board. 3 The board shall establish rules and regulations including but not limited to reasonable procedures for identification of PAs and for informing patients and the public of the use of PAs. 10 FEE/RENEWAL SCHEDULE Biennial renewal 10 All fees shall be fixed by the board by regulation PROGRAM APPROVAL BOARD REPRESENTATION/ ADVISORY COMMITTEE Board to adopt criteria for program approval in accordance with national criteria. 5 State Board of Osteopathic Medicine consists of Commissioner of Professional and Occupational Affairs or their designee, Secretary of Health or their designee, 2 public members, 1 member who is either a PA or respiratory therapist and 6 osteopathic physicians. Public members, physicians, PA and respiratory therapist are governor appointees. Governor shall assure that respiratory care practitioners and PAs are appointed to rotating terms. 2.1

7 PENNSYLVANIA ~ STATUTE OSTEOPATHIC BOARD POWERS DISCIPLINARY POWERS VIOLATIONS/PENALTY PAYMENT FOR SERVICES GRANDFATHER CLAUSE STUDENTS LOCUM TENENS Formulate requirements for certification of PA educational programs in accordance with national criteria 5 Establish rules and regulations to protect the public and to implement the provisions of this act 10, 16 The board shall have the authority to refuse, revoke or suspend PA certification; may deny application, administer a public or private reprimand, place on probation, or require PA to submit to care, counseling or treatment. 15 Failure to demonstrate qualifications Fraud or deceit in obtaining or renewing certification Conviction of a felony Disciplinary action by another jurisdiction Inability to practice with reasonable skill and safety due to illness, drunkenness, excessive use of drugs, any mental or physical condition Violation of the law or board regulations Practicing without physician supervision Immoral or unprofessional conduct; failure to conform to acceptable standards 15 The PA defines his status as an employee and is subject to normal employer/employee reimbursement procedures. 10 OTHER

8 PENNSYLVANIA ~ OSTEOPATHIC REGULATIONS REGULATIONS Chapter 25, State Board of Osteopathic Medicine, Subchapter C: Physician Assistant Provisions Subchapter D: Minimum Standards of Practice DATE REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/DISPENSING Revised 1/04; regulations to implement 2007 statutory changes not yet adopted. Pennsylvania Board of Osteopathic Medicine Physician may delegate medical procedures and other tasks, subject to prior approval by the board, which are within the normal scope of his practice and within the PA s training and expertise. PA shall augment the physician s data gathering abilities to assist in reaching decisions and instituting patient care plans. PAs may perform following functions (list not intended to be allinclusive): screen patients, review records, take history, record data perform physical and developmental screening exams make decisions regarding data gathering and appropriate management and treatment of patients initiate appropriate evaluation and management for emergency situations request lab studies, collect specimens, perform analyses perform clinical procedures, such as venipuncture, minor suturing, casting and splinting counsel and instruct patients PA may not: manage or maintain a separate office unless approved by the board independently delegate an assigned task perform acupuncture pronounce a patient dead in any setting Written protocols must be provided by the supervising physician for the PA s use One satellite operation per physician allowed upon board approval, provided: PA utilized in area of medical need adequate provision exists for direct communication and the distance between the main and satellite office does not prohibit or impede appropriate support services physician sees patients regularly (i.e., every fifth visit), with some exceptions physician sees every pediatric patient (infants every third visit, children 2-18 every other visit) PA has been employed by a Pennsylvania-approved supervising physician in primary office for at least 1 year PA may provide care in emergency department if trained in emergency medicine, functions under protocols and under direct supervision. PA may not substitute for a physician on call in the emergency department In medical care facilities where PAs diagnose, prescribe therapeutic or corrective measures, there must be committee to set standard policies and procedures. Committee to have representatives from medical, nursing, PA staffs and administration. Policies to be reviewed annually ;.184 SUPERVISION DEFINED The opportunity or ability of the physician or a substitute supervisor to provide control and direction over the PA s services. The constant physical presence of the physician on the premises is not required, so long as the PA and physician are or can easily be in contact with each other by radio, telephone or telecommunication. Appropriate degree of supervision includes an overview of PA s activities to determine that directions are being followed; immediate availability for necessary consultations; personal and regular (at least weekly) review of patient records; periodic (at least monthly) discussion of conditions, protocols, procedures and patients Supervising physician must get board approval of at least 2 designated substitute physicians who will supervise PA in his absence. An allopathic physician may serve as a substitute but when doing so he is subject to the standards of this law Supervising physician must visit remote site at least weekly PAs PER PHYSICIAN Physician may not supervise more than 2 PAs at one time

9 PENNSYLVANIA OSTEOPATHIC REGULATIONS APPLICATION QUALIFICATIONS TEMPORARY PERMIT TERMINATION CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION PHYSICIAN LIABILITY FEE/RENEWAL SCHEDULE PROGRAM APPROVAL BOARD REPRESENTATION/ ADVISORY COMMITTEE BOARD POWERS DISCIPLINARY POWERS PA applies for certification on board forms. A PA who has been certified by Pennsylvania State Board of Medicine must make separate application if he intends to work for osteopath Physician applies for registration as a supervising physician; provides: information on professional background, specialties, education, internship, residency, continuing education, specialty board memberships, hospital staff privileges, etc. statement of responsibility for PA performance detailed description of proposed PA utilization Good moral character and reputation Graduation from board-approved PA program Passage of NCCPA exam (current NCCPA certification required) PA and supervising physician must notify the board of employment termination within 15 days. Failure to do so is basis for disciplinary action Informed consent required. Sign must be posted in any office where PA works, explaining the term physician assistant. Physician must display his registration to supervise; PA must display certificate of registration. PA must wear identification tag which uses term physician assistant in 16 point type or larger Supervising physician retains full professional and legal responsibility for the performance of the PA and the care and treatment of his patients $30 application for PA certificate $10 biennial renewal of PA certificate $95 application fee for registration as supervising physician Board uses criteria identical to criteria developed by CAHEA. Other PA programs seeking board certification may apply to the board for approval Designated board representatives are authorized to make on-site visits to review supervision, compliance with protocols, records, compliance with other requirements in the regulations VIOLATIONS/PENALTY Sexual misconduct Unprofessional conduct includes, but not limited to: misrepresentation in obtaining or renewing certificate crime involving moral turpitude, dishonesty or corruption conviction of felony misconduct in practice, fraudulent performance, incompetence or negligence performing as PA while impaired by alcohol, drugs, physical disability or mental instability impersonation of licensed physician or another certified PA offering to cure of treat disease by secret method violation of PA statute or rules PAYMENT FOR SERVICES PA may not independently bill patients for services GRANDFATHER CLAUSE STUDENTS LOCUM TENENS OTHER