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Legislative Initiative to Modernize PA Practice Introduced

State Sen. John C. Rafferty, Jr., (REPUBLICAN; parts of Berks, Chester and Montgomery Counties) recently introduced PSPA’s PA modernization legislation, Senate Bill 895 (allopathic) and Senate Bill 896 (osteopathic), which would remove significant barriers to PA practice in the commonwealth and provide for better PA representation with the Board of Medicine and Osteopathic Medicine.

The bills are currently in the Senate Consumer Protection & Professional Licensure Committee, and would make the following PA-positive changes:

  • Add a permanent PA seat to each board;
  • Allow for co-signature to be determined by the physician and PA at the practice level;
  • Remove the requirement that practice written agreements need to be submitted to and approved by the board.
  • Remove the requirement for physicians to be on-site at satellite locations.

The procedure we’d encourage you to take to make sure this legislation is successful is as follows:

  1. Reach out to your local state senator by phone or email. You can find your senator here: Find Your Legislator.
  2. When you call or write:
    a.  Identify yourself as a constituent and a community member
    b.  If calling, ask for the Senator. If he or she is not available (often they are busy), you should definitely leave a message with the Secretary or Aide who answers the phone.
    c.  If writing, be polite, and incorporate the talking points below.
    d.  Introduce yourself
    e.  Express your support for these bills to modernize PA practice. Explain why you support the bills and offer any personal stories related to the issues – like whether you’ve had issues with written agreement approvals with the boards, etc.
    Below are some talking points.

    • PAs conduct physical exams, diagnose and treat illnesses, manage their own patient panels, write prescriptions and often serve as the principal healthcare professional for patients.  PAs are in every medical specialty and every medical setting.  PAs often serve as primary care providers.
    • Current law calls for the Medical and Osteopathic Boards to approve each individual PA’s written agreement and scope. This restricts the ability of healthcare teams to customize practice, leading to inefficiencies and limiting access to care.
    • Current regulations require physicians to be on-site at satellite locations a certain amount of time. However, this is cumbersome and inefficient. For example, in rural primary care settings, this is an inefficient use of the physician’s time and it limits the team’s ability to expand access to care.
    • Current law mandates that physicians co-sign 100% of PA charts, which is incredibly inefficient. Chart review is only one method of communication between providers, and it is by definition retrospective. Ongoing communication between providers caring for a group of patients enhances coordination of care and patient outcomes. Reviewing medical record entries may be part of this communication, but it should be at the discretion of the providers and not required in law.
    • Currently, there is no full-time representation on either the Osteopathic or Medical Board for PAs, even though there are approximately 7,600 active allopathic licenses and 1,700 active osteopathic licenses.

    f.  Ask the Senator to support the bills
    g.  Offer your expertise, if needed, in future policy decisions impacting PAs

  3. Follow up by letting Susan DeSantis (pspa@pspa.net) know of your contact and its outcome.

If we are successful with this legislation in the senate, we will be asking you to do the same on the House of Representative side, so be on the lookout for future correspondence on this important issue.

Finally, we’d like to take this opportunity to remind you that there are new CME requirements in place for licensure. You can read more about these new requirements here.

PSPA is offering a 2-hour presentation as part of the 42nd Annual PSPA Fall CME Conference in King of Prussia. The presentation, “Opioid Prescribing: Safe Practice, Changing Lives,” is Wednesday, Oct. 17, 2017, from 1:45pm to 3:45pm.

Thank you.

Mark DeSantis, PA-C
PSPA Governmental Affairs Chairman

ANNOUNCEMENT FOR THE PENNSYLVANIA MEDICAL AND OSTEOPATHIC BOARDS REGARDING ADDITIONAL CME REQUIREMENTS FOR LICENSURE

VERIFICATION OF OPIOID EDUCATION FOR
MEDICAL PHYSICIAN ASSISTANT APPLICATIONS AND RENEWALS
SUBMITTED AFTER JULY 1, 2017

Section 9.1(a) of ABC-MAP* requires that all prescribers or dispensers, as defined in Section 3 of ABC-MAP, applying for licensure/certification complete at least 4 hours of Board-approved education consisting of 2 hours in pain management or the identification of addiction and 2 hours in the practices of prescribing or dispensing of opioids. Medical physician assistants, who hold prescriptive authority approval fall within ABC-MAP’s definition of prescribers or dispensers.

Requirements for initial applicants

Medical physician assistants seeking prescriptive authority approval on or after July 1, 2017, must document, within one (1) year from issuance of the license or prescriptive authority approval, that they completed this education either as part of their professional degree education program, or through a stand-alone course. The four (4) hours of Board-approved education needs to be completed only once.

Where this education is part of the professional degree educational program, verification of completion from the Program may be included within the Verification of Graduation from a Physician Assistant Program for medical physician assistants.

New initial PA license forms were published August of 2017 on the State Board of Medicine website http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Pages/default.aspxunder general board information.

Renewals

In order for medical physician assistants to renew their license or prescriptive authority approval for the next renewal period, section 9.1(a)(2) of ABC-MAP requires that they complete at least two (2) hours of continuing education in pain management, the identification of addiction or the practices of prescribing or dispensing of opioids. The continuing education requirements of ABC-MAP will count towards the total number of continuing education credits required for renewal.  For medical physician assistants, this continuing education must be acceptable for credit by the National Commission on Certification of Physician Assistants (NCCPA).

Allopathic physician assistant licenses expire December 31 of every even-numbered year. The Board mails renewal notices two to three months prior to the license expiration date. Notices are mailed to the most recent address that was reported to the Board.  The Postal Service does not forward licenses.

 

*The Achieving Better Care by Monitoring All Prescriptions Program Act (ABC-MAP) (also known as Act 124 of 2016), 35 P.S. § 872.3, is available on the Legislature’s website at:http://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2016&sessInd=0&act=124

 

      VERIFICATION OF OPIOID EDUCATION FOR OSTEOPATHIC
PHYSICIAN ASSISTANT APPLICATIONS AND RENEWALS
SUBMITTED AFTER JULY 1, 2017

Section 9.1(a) of ABC-MAP* requires that all prescribers or dispensers, as defined in Section 3 of ABC-MAP, applying for licensure/certification complete at least 4 hours of Board-approved education consisting of 2 hours in pain management or the identification of addiction and 2 hours in the practices of prescribing or dispensing of opioids. Osteopathic physician assistants fall within ABC-MAP’s definition of prescribers or dispensers.

Requirements for initial applicants

Osteopathic physician assistants must document within one (1) year from issuance of the license that they completed this education either as part of their professional degree education program and its completion attested to when applying for renewal. The four (4) hours of Board-approved education needs to be completed only once.

Where this education is part of the professional degree educational program, verification of completion from the Program may be included within the Verification of Graduation from a Physician Assistant Program for osteopathic physician assistants. The Verification forms will be available on the website at http://www.dos.pa.gov/ost.

New initial PA license forms were published August 2017 on the State Board of Osteopathic Board website http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/OsteopathicMedicine/Pages/default.aspx under general board information.

Renewals

In order for osteopathic physician assistants to renew their license for the next renewal period, section 9.1(a)(2) of ABC-MAP requires that they complete at least two (2) hours of continuing education in pain management, the identification of addiction, or the practices of prescribing or dispensing of opioids. The continuing education requirements of ABC-MAP will count towards the total number of continuing education credits required for renewal. For osteopathic physician assistants, this continuing education must be acceptable for credit by the National Commission on Certification of Physician Assistants (NCCPA).

The board mails renewal notices 2 to 3 months prior to the license expiration date. Notices are mailed to the most recent address the licensee has reported to the Board. The Postal Service does not forward licenses.  The Osteopathic Physician Assistant renewal cycle is October 31st even-numbered years at a cost of $10.00

 

*The Achieving Better Care by Monitoring All Prescriptions Program Act (ABC-MAP) (also known as Act 124 of 2016), 35 P.S. § 872.3, is available on the Legislature’s website at:  http://www.legis.state.pa.us/cfdocs/legis/li/uconsCheck.cfm?yr=2016&sessInd=0&act=124

 

The PSPA is offering a 2-hour presentation as part of the 42nd Annual PSPA Fall CME Conference in King of Prussia. The presentation entitled “Opioid Prescribing: Safe Practice, Changing Lives is Wednesday, October 17, 2017 at 1:45pm to 3:45pm. Conference registration is available at the following link: http://pspa.net/App/PSPA/Conference/Conf_1_All_Main.aspx

This course is acceptable for credit by the NCCPA.

Update on Pennsylvania Informed Consent Issue

TO:              Chief Executive Officers, Chief Medical Officers, Chief Nursing Officers, Compliance Officers, and Governmental Relations Officers of HAP Member Hospitals and Health Systems

FROM:         Jennifer Jordan, Vice President, Regulatory Advocacy Hospital and Healthsystem Association of Pennsylvania

SUBJECT:    Pennsylvania Department of Health Rescinds Past Guidance regarding Obtaining Informed Consent

Issue:  On July 31, 2017, the Pennsylvania Department of Health (DOH) rescinded its November 6, 2012, guidance related to obtaining consent for Peripherally Inserted Central Catheter (PICC) Line insertion and blood transfusions.

Member Action:  HAP recommends that members take note of this development and evaluate their informed consent processes. We recommend that members take the following actions:

  • Review your current policies, procedures, medical staff bylaws and privileges related to obtaining informed consent
  • Consult your legal counsel to ensure that your practices align with your organization’s assessment of the current common law and statutory requirements
  • Alert HAP if DOH surveyors or accreditation organizations surveying to DOH standards flag or cite “informed consent” issues during the course of a licensure survey or complaint investigation

DOH Message Board Post:  On July 31, 2017, DOH posted the following message on its facility message board:

“The Pennsylvania Department of Health is rescinding in its entirety the guidance dated November 6, 2012 regarding PICC Lines, and on administering and obtaining consent for blood transfusions. To the extent the guidance conflicts with the June 20, 2017 ruling of the Pennsylvania Supreme Court in Shinal v. Toms, it is no longer valid.”

Upon reading the message board post, HAP reached out to DOH staff to learn whether or not the message board post indicates a change in DOH’s enforcement related to informed consent. In a verbal conversation on August 1, 2017, DOH staff took the position that the July 31 post does not mark a change in the department’s enforcement approach related to informed consent. DOH stated that surveyors will continue to look for signed consent forms and confirm that hospitals have (and follow) policies for obtaining informed consent consistent with MCARE Act.

DOH staff indicated that, at this time, DOH does not intend to provide formal guidance related to the Shinal v Toms decision.

Shinal v. TomsIn its June 20 ruling regarding Shinal v. Toms, the Pennsylvania Supreme Court held that a physician may not delegate to others his or her obligation to provide sufficient information in order to obtain a patient’s informed consent. The Court stated that informed consent requires direct communication between the physician and patient and contemplates a back-and-forth, face-to-face exchange, which might include questions that the patient feels the physician must answer personally before the patient feels informed and becomes willing to consent.

Please see HAP’s June 30 Bulletin for more information about the ruling.

HAP Next Steps:  HAP will continue to monitor for any emerging developments related to the Shinal v Toms and advocate on behalf of our members.

  • HAP will continue to monitor Professional Licensure Boards to alert members about any potential practice impact. We meet regularly with DOH’s Division of Acute and Ambulatory Care (DAAC) leadership and will keep you informed if DAAC plans to adjust their enforcement approach.
  • HAP is actively investigating legislative options to remedy the resulting operational burden. We are engaging members to shape our legislative advocacy strategy. HAP is convening a joint meeting of its Physician Leadership Advisory Group and Committee on Quality and Care Management members, today, August 3 at 12 p.m. to discuss the practical implication of the decision and solicit input necessary to shape our legislative strategy. We will alert members to future opportunities to provide feedback and input.
  • HAP is engaging other provider stakeholders including The Pennsylvania Medical Society, Pennsylvania Society of Physician Assistants, and Pennsylvania Coalition of Nurse Practitioners to identify ways that we can coordinate our efforts to clarify and modernize the statutory landscape.

 

Passage of House Bill 424 Allows PAs to Certify Cause of Death and Sign Death Certificates

On June 30th, the Pennsylvania State Legislature passed House Bill 424, allowing for Physician Assistants to certify cause of death and sign death certificates of patients who were under their care. Representative Kerry Benninghoff, (Centre and Mifflin Counties) was the prime sponsor of the legislation. The bill passed unanimously in both chambers. The bill moves on to the Governors desk for signature and will become effective in 60 days from signing. This timing will allow for the vital statistics forms to be updated to include Physician Assistants.

The PSPA would like to thank Representative Benninghoff for his tireless efforts over the past 2 sessions to get the bill introduced and passed. We would also like to thank those of you who contacted your legislator asking for support of the bill. Those efforts are fundamentally key in getting legislation passed.

Follow the link below to read the bill in its entirety:

http://www.legis.state.pa.us/cfdocs/legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2017&sessInd=0&billBody=H&billTyp=B&billNbr=0424&pn=0440

Learn more about completing a death certificate here.

 

 

 

PSPA ALERT: PA Supreme Court Rules on Informed Consent

Supreme Court of Pennsylvania Renders Decision on Informed Consent

On June 20, the Supreme Court of Pennsylvania ruled in Shinal vs. Toms that only a physician can obtain informed consent based on the Medical Care Availability and Reduction of Error (MCARE) Act of 2002. The ruling also outlines that a physician cannot rely upon staff to disclose sufficient information required to obtain a patient’s informed consent.

The duty to obtain a patient’s informed consent is a non-delegable duty, the Court ruled, belonging solely to the physician conducting the surgery or treatment. The Court found no provisions in the MCARE Act allowing for information given by a physician’s staff to satisfy the physician’s burden to obtain informed consent.

Section 504 of the Medical Care Availability and Reduction of Error Act, 40 P.S. § 1303.504(a), specifically states:

“A physician owes a duty to a patient to obtain Informed Consent of the patient or the patient’s authorized representative prior to the conducting the following procedures:

  1. Surgery, including the related administration of anesthesia;
  2. Administering radiation or chemotherapy;
  3. Administering a blood transfusion and all blood products;
  4. Inserting a surgical device or appliance; and
  5. Administering an experimental medication, using an experimental device or using an approved medication or device in an experimental manner.”

Be advised that with this ruling, the ability for PAs, NPs, mid wives and other practitioners to obtain informed consent is in serious question. We recommend that you discuss this situation with your organization’s legal affairs and medical staff departments, as well as your supervising physician. The Hospital & Healthsystem Association of Pennsylvania (HAP) and the Pennsylvania Medical Society (PA Med. Soc.) have notified their constituents of the Supreme Court of Pennsylvania’s decision. Hospitals will in all likelihood be revising their informed consent policies to reflect this ruling.

PSPA, AAPA, PA Med. Soc. and HAP are analyzing the impact of this ruling on the Pennsylvania health care environment and are exploring opportunities for legislative relief.

**Disclaimer:  The PSPA is not a legal entity and any information given is not meant to construe a legal opinion or recommendation. Your situation may be unique and different than others, therefore, we recommend you consult formal legal counsel for any legal advice.

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.

Telemedicine:
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:  http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=S&billTyp=B&billNbr=1342&pn=2032

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

Legislation:

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: http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=H&billTyp=B&billNbr=2232&pn=3679

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:

MEMORANDUM
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: http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=S&billTyp=B&billNbr=1367&pn=2093

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: http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=S&billTyp=B&billNbr=1368&pn=2094

SB 1212: This bill would require schools to teach students about opioid misuse in existing drug and alcohol abuse curricula.
http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=S&billTyp=B&billNbr=1212&pn=2058

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: http://www.legis.state.pa.us/CFDOCS/Legis/PN/Public/btCheck.cfm?txtType=PDF&sessYr=2015&sessInd=0&billBody=H&billTyp=B&billNbr=2359&pn=3901

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 www.doh.pa.gov/PDMP.​ 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:
http://www.dhs.pa.gov/provider/healthcaremedicalassistance/enrollmentinformation/index.htm

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.