Archives - October 2016

House Bill 2232 Passes the House 188-0

House Bill 2232 sponsored by Representative Kerry Benninghoff, passed the House of Representatives 188-0. The Bill amends the Vital Statistics Act allowing Physician Assistants to sign death certificates, certifying the cause of death. The Bill now moves on to the Senate for consideration. Call your House of representative and thank them for their support of our legislation. It’s now time to call your Senator and ask them for their support of this important piece of legislation!

Legislative Activity Annual Report

Yearly Committee Report 2016

Our last major rewrite of the Medical Practice Act and Regulations was in 2014. We were able to ease some of the regulatory burden of Physician/PA practice including lessening countersignature requirements, eliminating the filing of the written agreement change form and developing a temporary authorization to practice to allow PAs to begin working within 10 days of submitting a written agreement.

We were not able to achieve all that we wanted but as the political process goes, there is always compromise. We are gearing up for another legislative session to try to achieve our past goals. We will once again try to eliminate countersignature altogether, remove supervising physician ratio restrictions and have our work agreements filed instead of the current approval process. The temporary authorization to practice worked initially, but with the ever increasing volume of applications and work agreements, the process is once again bogged down taking several weeks to months to get approval.

We have been reviewing the Medical Practice for the needed language changes and updates to practice to the full extent of our license. We are also reviewing the regulations. Changes made to the regulations will encompass a whole different process and time frame.
Medical Assistance:

We have been working on getting physician assistants enrolled as providers under Medicaid for many years. It is a frustrating process. It stems around the fact that we are already paid for our services under Medicaid at 100% of the physician fee with the payment going to the supervising physician or organization. Our participation in Medicaid is buried under our supervising physician’s name/organization. The Pennsylvania Department of Human Services does not see the need to bring us out from underneath the supervising physician/organization. Therefore, we cannot independently bill or receive direct payment. We continue to present the argument of being able to recognize physician assistant contributions to the medical care of Pennsylvania Medicaid recipients. With the recent enrollment requirement of all providers, including physician assistants, (listed as Mid-Level Providers) to enroll with Medicaid in order to prescribe, order and refer patients, the process may take care of itself at some point in the future. However, we plan on working with the AAPA in trying to push the issue further over the next year so our numbers and medical contributions can be quantified.

The Boards of Medicine and the legislature continue to develop legislation regarding telemedicine. We are continue to work with the Department of Health and Human Services as the process moves forward ensuring that physician assistants are eligible providers and may be reimbursed for telemedicine services. Senator Vogel recently introduced the following legislation regarding telemedicine:
SB 1342:

The bill was referred to the Senate Banking and Insurance Committee.


Death Certificates:
House Bill 2232 amends the Vital Statistics Law to allow Physician Assistants to sign death certificates, was introduced in June and voted out of committee on September 21, 2016. The bill is now referred to the House for its consideration.
House Bill 2232:

Opioid Addiction:
The legislature has spent the past year trying to develop legislation to deal with the increase in opioid addiction, deaths and prescribing of narcotic/addictive medications. Several bills are in development which we are monitoring. They focus on education requirements of providers in proper opioid prescribing and querying the recently implemented opioid drug database when writing a narcotic prescription. In sponsoring the legislation, Senator Gene Yaw issued the following email in August:

From: Senator Gene Yaw
To: All Senate members
Subject: Opioid Prescribing Guidelines

In the near future, I plan to introduce legislation requiring mandatory implementation of opioid prescribing guidelines developed by the Safe and Effective Prescribing Practices Task Force.

Convened by the Department of Health and the Department of Drug and Alcohol Programs, the task force developed and approved guidelines, which have been all or in part independently adopted by the state Board of Medicine, the Board of Pharmacy and Board of Dentistry. The guidelines include:

• Emergency Department Pain Treatment Guidelines: To appropriately relieve pain and attempt to identify those who may be abusing or addicted to opioid analgesics and refer them for special assistance.
• Opioid Use and Safe Prescribing for Geriatric Pain: This guideline will highlight special problems concerning using opioids when treating older adults for chronic non-cancer pain.
• Guidelines on the Use of Opioids to Treat Chronic Non-cancer Pain: These guidelines address the use of opioids for the treatment of chronic non-cancer pain. These guidelines do not address the use of opioids for acute pain, nor do they address the use of opioids for the treatment of pain at the end-of-life.
• Guidelines on the Use of Opioids in a Dental Practice: These guidelines address the use of opioids for the treatment of acute dental pain.
• Obstetrics and Gynecology Pain Treatment: This guideline addresses the use of opioids for the treatment of pain in pregnant patients, during and immediately following delivery, and during breastfeeding.
• Opioid Dispensing Guidelines: These guidelines are focused on several key areas that can impact pharmacists of any practice setting. Focal points include assessing the appropriateness of opioid pain medication at the point of dispensing, recognition of “red flags” on prescriptions as well as high risk medication combinations, available resources for those with a substance use disorder, and methods to prevent diversion from the emergency department.
 This legislation is part of a comprehensive approach to fighting the ongoing heroin and opioid addiction crisis in Pennsylvania.

I hope you will join me in co-sponsoring this important legislation.

Senate Bill 1346:
(PN 2033) Amends the Medical Practice Act requiring the State Board of Medicine to implement a safe opioid prescribing curriculum in medical colleges and other medical training facilities offering or desiring to offer medical training. The curriculum shall be offered in medical colleges and medical training facilities at least every three years. The bill provides for content of the curriculum and stipulates that state funding of medical colleges and medical training facilities shall be contingent on implementation of the safe opioid prescribing curriculum in conjunction with regulations adopted by the board.

Senate Bill 1347:
(PN 2034) Amends the Medical Practice Act establishing restrictions on prescribing opioids to minors. A physician may not prescribe to a minor more than a seven-day supply of any controlled substance containing an opioid and the physician must take a number of steps before issuing the first prescription in a single course of treatment for a controlled substance containing an opioid.

Senate Bill 1348:
(PN 2035) Amends the Pharmacy Act prohibition a pharmacist from dispensing an opioid unless the container used to dispense the opioid includes a visible label that states: “Warning. This drug is highly addictive.”

On September 28th:
The Pennsylvania Senate unanimously approved opioid-related bills that were referenced during Governor Wolf’s joint address on combatting the heroin and opioid epidemic.
SB 1367: This bill would limit the prescription for a controlled substance containing an opioid to a seven-day duration unless there is a medical emergency that puts the child’s health or safety at risk.  The bill also includes exceptions for cases involving chronic pain, cancer treatment or for palliative care or hospice care.

Senate Bill 1367:

SB 1368: Under this bill, licensing boards must require that an applicant submit proof that they have completed approved safe opioid prescription education prior to granting of a license or certificate that would allow them to prescribe opioids.
Senate Bill 1368:

SB 1212: This bill would require schools to teach students about opioid misuse in existing drug and alcohol abuse curricula.

The state House Health Committee also passed legislation that would clarify that a parent or legal guardian can provide consent over the objection of a minor with respect to furnishing medical care or counseling related to diagnosis or treatment of substance abuse.
HB 2359:

The bills are now referred to the House for its consideration.

Liaison Reports: Our liaisons continue to do wonderful a job representing PAs to various key groups that currently utilize physician assistants. The following is a synopsis of some their excellent representation:

Pennsylvania Health Emergency Services Council: Sarah Lewis, PA-C
The PEHSC continues to have discussion regarding the training and utilization of pre-hospital providers. Medical directives were approved this year dealing with Narcan and glucose administration in the field as well as increasing trauma centers across Pennsylvania. One important note was the increased incidence of suicide risk among EMS providers.
Amanda Lee, PA-C will be serving as the voice for PAs at the PEHSC council. She will also be serving on the Medical Advisory Committee. 

Physicians Health Program: Laura A Delliquadri, PA-C
Physician Assistants established a regular presence at the Physicians Health Program. She has been a valuable resource to the committee on all PA practice and supervision issues. There are several PAs currently enrolled and monitored by the program.

Pennsylvania Rural Health: Jamie Hammond, PA-C, Ron Mezick, PA-C
Physician Assistants have had a long-time presence and have even served as president of this association in the past. Over the past 2 years, the organization has been somewhat dormant, undergoing restructuring and revitalization. Their plan is in place and implementation is underway. Physician Assistants will continue to be an integral part of this association as it moves forward dealing with rural health issues.

Department of Health and Human Services: Gerard Grega, PA-C
The Physician Prescription Drug Monitoring Program website is now active. All prescribers must register and query the site when writing for a controlled substance for a patient to identify possible drug abuse problems.
As of January 1, 2015, all providers, new license and renewing licensees must document that they have completed the Mandatory Child Abuse Education Program before a new license or renewal license will be issued.

Medical Assistance: As stated earlier, you are required to enroll in Medicaid under your NPI number in order to be able to prescribe, refer and order durable medical goods. Do this ASAP since the deadline was September 1, 2106.
Pennsylvania Medical Society is offering free Opioid CME programs until December 31, 2016. With the upcoming legislation, it would be a good time to take advantage of this eventual mandatory program for free.

Pennsylvania Academy of Family Physicians: Pamela Minard, PA-C
Our two organizations have supported one another over the years on several different fronts. We have supported scholarships and they provide us with CME and PAC silent auction donations. They have supported our legislative and regulatory efforts in the past and we will continue to work together to promote the Physician/PA team.

State Board of Osteopathic Medicine: Pamela Minardi, PA-C
We continue to attend all Board meetings promoting the Physician/PA team approach to medicine. It has been frustrating over the years as they ignore changes to both the law and regulations in regards to PA practice. We continue to seek avenues to force them to adhere to the changes made in both law and regulations.

Pennsylvania Medical Society: Karen Sweeney, PA-C, MHS
We continue to attend Medical Society meetings on a regular basis. The Medical Society has undergone several leadership changes over the past year. The current chair has worked with PAs extensively in the past through the Geisinger Health System. We hope to be able to work with them in achieving our legislative and regulatory goals.