PSPA ALERT – Supervising Physician Written Agreements Soon On-line

A delegation from PSPA and representatives from the Hospital Association of Pennsylvania Bureau of Professional Affairs commissioner Ian Harlow and the legal and administrative staff for the Pennsylvania State Board of Medicine and State Board of Osteopathic Medicine met on Monday, January 30th.  The focus of the meeting was the supervising physician written agreement approval process. The PSPA met with this group in December to discuss the delays in approval of temporary authorization to practice privilege. We also discussed the lack of communication from the board to PAs and physicians if an application did not pass the initial “first pass for completeness” and assigning of discrepancies.

As a result of that meeting, new written agreement forms were developed that added more specific instructions on requirements to assure “completeness of the application.”

Key elements outlined in the instructions included the following:

  1. Use of the correct form
  2. Payment in the correct amount
  3. A current certificate of malpractice in the name of the PA with $1M in coverage
  4. Signatures of all parties
  5. Include a list of PA functions, drugs the PA will not prescribe, location the PA will work in, countersignature protocol and description for supervision

In addition, the State Board of Osteopathic Medicine modified their application to only require the listing of one alternate supervisor. They joined the SBM in making the primary physician / practice responsible for keeping track of the additional alternate supervising physician. The need to use a written agreement change form to add or delete alternates is no longer required for both the SBOM and SBM.

On Monday, the discussion focused on the crippling effect the shortage of application reviewers has had on PAs, physician supervisors and health systems. The commissioner announced that the BPOA is preparing to have the supervising physician written agreement applications be done through an online process in the next 30-60 days. They have guaranteed that a PA and the supervising physician will be notified by email within 7-10 business days with a temporary authorization to practice or a notification that the application is not complete. They will accept missing documents by email.

An online process will eliminate the possibility of an incomplete application submission; the main reason for delay in issuing a temporary authorization to practice. The goal is to be able to issue a permanent approval as soon as possible. Access to the system will be provided to both the PA and physician to monitor how the application is moving through the process and any outstanding action that may be needed.

The feature of this new on-line system will include:

  1. Online chat for customer service
  2. Ability for email and text correspondence
  3. Auto-population of license verification database
  4. Smart phone app availability
  5. Bar code scanning ability to access the application and renew licenses
  6. Account access utilizing security questions

Listing of 2 email addresses will be required to assure communication if first email address is invalid.

The BPOA is planning to prepare an instructional video on how to use the online application system. They plan to offer a twitter town hall format as well. HAP and PSPA have offered to distribute information through newsletters, websites, email blasts as well as webinars once the program is live.

The PSPA has been invited to participate in testing of the new system. The BPOA plans to have ongoing meetings with the PSPA and HAP to get feedback on the process and make any modifications.

We are optimistic that these changes will occur in a timely fashion as promised. In the meantime, it is critical that all applications be submitted using the key elements listed above. Otherwise, the application approval will be delayed. Please do your part to make sure that you may begin to practice in a timely fashion.

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.

Pennsylvania Prescription Drug Monitoring Program

The Pennsylvania Department of Health (DOH) launched user registration for the new Pennsylvania Prescription Drug Monitoring Program (PA PDMP) on Aug. 8, 2016. The DOH has been conducting extensive outreach to educate Pennsylvania health care providers about this valuable tool and to encourage registration. The PA PDMP system will be available for patient query on Aug. 25, 2016, giving prescribers and pharmacists an additional resource for making informed clinical decisions by providing them access to their patients’ controlled substance prescription history (Schedules II – V). Prescribers (or their delegates) are required to check the PDMP system for each patient the first time the patient is prescribed a controlled substance by the prescriber, or if the prescriber believes or has reason to believe, using sound clinical judgment, that a patient may be abusing or diverting drugs. However, as a best clinical practice, the DOH recommends prescribers and pharmacists check the system every time before prescribing or dispensing. For more information including tutorials, FAQs and registration instructions, please visit​ Click here to open a document with useful links and more information.

Enrollment of Physician Assistants in the Pennsylvania Medical Assistance Program

Physician Assistants (PAs) who order, refer, or prescribe items or services to Pennsylvania Medical Assistance (MA) beneficiaries need to enroll as participating providers in the MA program. Historically PAs have not enrolled as MA program providers. However as required by the Affordable Care Act (ACA) and implementing regulation all providers including those who order, refer, or prescribe items or services for MA beneficiaries must enroll in the MA program. Beginning September 25, 2016, claims will deny if the ordering, referring or prescribing provider is not enrolled in the MA program. PAs who order, refer, or prescribe items or services to MA should access the Department of Human Service Enrollment Information website at the following link:

PAs should complete and submit a provider type 10 – Mid Level Practitioner. Please review the “Requirements/Additional Information” instructions on what to include when submitting the application. PAs are not currently able to use the online application and must submit a paper application.

Opioid Crisis Webinars

The PSPA and the Pennsylvania Medical Society have collaborated on the development of 4 webinars to educate providers on the Pennsylvania opioid crisis. PAs can earn 1 hour of AMA CME for each webinar.  The webinars are still under development, and links will be provided as soon as each one is completed. These webinars are free to PSPA members or $39.00 each for non-members. Members click here to view instructions and links for the webinars. Non-members click here to go to the Pennsylvania Medical Society’s store to purchase the webinars.

2013-2014 Legislative Session Proves to be Successful!

The 2013-2014 Pennsylvania legislative session was a success for the physician assistant profession.  With the support of our membership, we were able to attain the passage of 6 bills that will enhance the PA practice in our Commonwealth.  Thank you to everyone who participated in contacting their legislators asking for support of our measures.  Particular thanks goes out to our lobbyist and legislative affairs group, Milliron & Goodman, LLC.  Without their hard work, none of this would have been possible.  Here is recap of this past legislative session:

House Bill: 939: Amended the Public Utilities Act for new rules to authorize physician assistants to sign health forms to delay utility shut off for health reasons.  We have tried for many years to open a public utility bill that we could amend to allow PAs to certify the health status of individuals and prevent utility shut off.  There are very few times that bills like this will move during any given legislative session. The Society and our lobbyists monitored several public utility bills for movement over the past two years and HB 939 became the vehicle.  We were able to amend the language to allow PAs to finally sign health certifications and prevent utility shut off. 

Senate Bill 1180:  Establishes the Pharmaceutical Accountability Monitoring System.  This bill creates a database of patients and practitioners who have been prescribed controlled substances allowing providers and law enforcement agencies to cross reference all controlled substance prescriptions given to a patient in an attempt to control diversion and addiction.  Physician assistants are included among the providers who may access the system.  Regulations will need to be promulgated to enforce the new law.  That process will begin next year and is slated to be completed in 2015.  We will keep you updated as those regulations move forward.

House Bill 1655:  Establishes the Patient-Centered Medical Home Advisory Council with the charge of developing a statewide medical home model.  Physician Assistants are included as members of the council and permitted to lead a Patient Centered Medical Home (PCMH).  Many practices in the state already have a PCMH in place. These systems promote wellness, prevention, chronic care management, immunizations, health care management and the use of electronic medical records in providing patient care.  Reimbursement incentives are in place as part of the Patient Access and Portability Health Care Act for establishing a PCMH.  The council will be established over the next several months with recommendations to the Governor, Senate and House of Representatives due by December 31, 2015.

Senate Bill 379:  An Act which provides for a benevolent gesture relating to medical liability insurance.  This new law prevents most physician/provider apologies from being used against admissible in a medical liability lawsuit.  It does not include admissions of negligence, which remain admissible. You are permitted to say you are sorry for their injury or loss and that cannot be held against you in a court of law.

House Bill 1348 & 1351:  These bills that amended countersignature regulations for both the Allopathic and Osteopathic Medical Boards.  Special thanks goes to Representative Curt Sonney (Erie) for sponsoring this legislation.  The Medical Board has implemented the internal process of approving amended work agreements.  The Osteopathic Board has been slower to adapt and approve the written agreement change forms.  The Society continues to educate the board along with legal counsel in complying with the new law.

The Society along with Milliron & Goodman will continue to work toward additional improvements in legislation and regulations over the next 2 year legislative cycle to improve PA practice in our Commonwealth.  We also be focusing on reimbursement issues and participation in all commercial and state funded programs.  If you have any questions or see areas that need attention to improve our PA practice enviroment, please contact the Society.

Mark DeSantis, PAC

Chairman, Governmental Affairs

Implementing Act 101 and 101 Countersignatures

The State Board of Medicine / State Board of Osteopathic Medicine are implementing changes to effectuate Act 100 /101 of 2013 (related to physician requirements for countersigning patient records completed by a physician assistant). Physicians who currently have a written agreement with a physician assistant, and who wish to change their current countersigning practice, must submit a written agreement change form and have the change approved by the Board. Physicians who are entering into a new written agreement will see the statutory amendment reflected in the new application form.

Prior to the enactment of Act 100/101 of 2013, a supervising physician was required to countersign 100% of the patient records completed by the physician assistant within a reasonable time, not to exceed ten days. Under the new rules, 100% countersignature within 10 days will be required only during each of the following time periods:

  • The first 12 months of the physician assistant’s practice post-graduation and after obtaining licensure.
  • The first 12 months of the physician assistant’s practice in a new specialty.
  • The first 6 months of the physician assistant’s practice in the same specialty under a new primary supervisor (unless, the new primary supervisor was registered as a substitute supervisor for at least six months under another written agreement).

If after the required time frames listed above, the supervising physician wishes to deviate from the 100% chart review, the supervising physician must complete and submit a written agreement change form, including specific details regarding how patient records will be selected for review and how often patient records will be reviewed.

This information should include specifics such as type or percentage of patient charts that will be reviewed, specific types or categories of patient cases that will be reviewed, and the review schedule, etc. In addition, the supervising physician must affirm that the review plan is sufficient to assure adequate review of the physician assistant’s practice.

Deviation from 100% review of patient records within 10 days will require Board approval.

The supervising physician will need to continue to perform 100% review of patient records within 10 days until the Board approves the amended written agreement.

Countersignature requirements in a facility are under the jurisdiction of the facility bylaws, the Pennsylvania Department of Health’s Health Care Facility Act, and The Joint Commission. Maintenance of 100% countersignature may still be required in your setting. The medical staff office, facility compliance office or the lead PA would be your resource for those details. A facility’s bylaws can be more restrictive than the state regulations for PA practice.

The written agreement change form can be found on the Medical Board’s website at or the Osteopathic Board’s website at within the list of Board applications.

Acts 100 / 101 formalize the temporary authorization practice provision process as well.

The Acts approved a temporary authorization for Physician Assistants to practice pending formal approval of the “Application for Registration as a Supervising Physician.”

Upon submission of the application, Board staff will review the application only for completeness and issue a letter to the supervising physician providing the temporary authorization for the physician assistant to begin practice. If the application is not “complete” (i.e., required signatures are not provided, information is missing, fee is not included, etc.), a temporary authorization for the physician assistant to begin practicing will not be issued.

The temporary authorization, when issued, will provide a period of 120 days during which the physician assistant may practice, under the terms set forth in the written agreement as submitted to the Board. While practicing under the temporary authorization, the supervising physician shall countersign 100% of the patient records completed by the physician assistant within a reasonable time, which shall not exceed ten days. Within 120 days, the Board will notify the supervising physician of the final approval or disapproval of the application. If approved, a final approval of the written agreement will be issued to the Supervising Physician. If there are discrepancies that have not been corrected within the 120 day period, the temporary authorization to practice will expire.

Please note: The primary supervisor’s responsibilities also include:

• Providing a copy of the final Board approved written agreement to all substitute


  • Maintaining a current list of all locations where the physician assistant will perform duties.
  • Maintaining a current list of all substitute supervisors under which the physician assistant will work.
  • Notifying the Board of changes to the primary practice location utilizing a written agreement change form.
  • Ensuring that the physician assistant will not practice without supervision by either the primary supervisor or an authorized substitute supervisor.

The complete language for Act 100 / 101 can be found on the PSPA website, under the Governmental Affairs tab legislative section. A reference table describing the implementation of Act 100 and 101 can also be found in the same section of the PSPA website. It is highly recommended that all PA’s confirm receipt of the temporary and final approvals from the Board(s) and retain a copy for your own file.


Mark DeSantis, PA-C Gerry Grega, PA-C

PSPA Governmental Affairs Committee Chair PSPA President

House Bills Become Law

The PSPA is proud to announce that the House & Senate voted in favor of House Bills 1348 and 1351 giving supervising physicians the option to eliminate countersignature! The bills were signed by the Governor on November 26th and will become effective 60 days from the time of signature.  As you may remember, the PSPA negotiated a deal with the Pennsylvania Medical Society to amend countersignature as follows:

The supervising physician must countersign 100% of patient records completed by the PA within 10 days:

1) For the first 12 months post-graduation and until initial licensure

2) For the first 12 months in a new specialty

3) For the first 6 months in the same specialty but new practice

The supervising physician written agreement needs to contain a statement that indicates the number, (if any), frequency and criteria for chart selection for physician review after the 100% requirement timeframe has passed.

The bills also delineate the time frame for the Boards to review applications and work agreements. The language reads as follows:

“Upon submission of the application, board staff shall review the application only for completeness and shall issue a letter to the supervising physician providing the temporary authorization for the physician assistant to begin practice. If the application is not complete, including, but not limited to, required information or signatures not being provided or the fee not being submitted, a temporary authorization for the physician assistant to begin practicing shall not be issued. The temporary authorization, when issued, shall provide a period of 120 days during which the physician assistant may practice under the terms set forth in the written agreement as submitted to the board. Within 120 days the board shall notify the supervising physician of the final approval or disapproval of the application. If approved, a final approval of the written agreement shall be issued to the supervising physician. If there are discrepancies that have not been corrected within the 120- day period, the temporary authorization to practice shall expire.”

It will be extremely important that particular attention is paid to completing the application correctly so that the temporary authorization may be granted.  The process since its inception last spring is taking anywhere from 3-10 days on average as long as the applications have been completed correctly.  We suggest that you review the application yourself before it is submitted by the office manager, facility administrator or supervising physician.  The more eyes that see it, the less chance of the application being rejected for incompleteness.

The Boards are currently working on the implementation process.  Until that process is in place, countersignature of PA charts must continue as usual.  Stay tuned for further information.