03/25/2020

Pennsylvania to Allow Retired Health Care Professionals to Bolster COVID-19 Response

March 22, 2020

Some License Requirements for Qualified Physicians Assistants Are Suspended During Coronavirus Emergency

In order to allow physician assistants practicing under the state Board of Osteopathic Medicine to more easily and effectively assist with emergency response efforts to COVID-19, Governor Wolf granted the Department of State’s request to suspend requirements pertaining to written agreements and several other items. The following requirements are suspended:

• The Osteopathic Medical Practice Act restricts physicians to the supervision of four physician assistants, but they can apply for a waiver from the state board of Osteopathic Medicine to supervise more. Governor Wolf has suspended both the ratio and waiver requirements.
• The requirement is suspended that all physicians with whom a physician assistant is assisting be named on the written agreement. Only one primary and one substitute physician will need to be named.
• The board regulations that require contact information for at least two substitute supervising physicians are suspended because if a primary physician and substitute physician are named, their contact information will be in the Department of State’s PALS system.
• The requirement that written agreements receive board approval is suspended. Written agreements will be effective upon submission to the board.
• The requirement is suspended that temporary authorization to practice be issued for up to 120 days upon board receipt of a complete written agreement. o Countersignature requirements outlined in the Osteopathic Medical Practice Act will be suspended, provided that the number of patient records reviewed is sufficient to assure adequate review of the physician assistant’s scope of practice.
• Board regulations that require countersignature from a physician within 10 days and at least weekly review by a physician of medical records prepared by a physician assistant are suspended.
• The requirement that the board must approve use of a physician assistant at “satellite operations” is suspended. This will allow more physician assistants to practice wherever they are needed during the disaster declaration.

In addition, after review, the department determined that no suspensions pertaining to written agreements are required for physician assistants practicing under the Pennsylvania Board of Medicine.

This allowance is due to an emergency medical services clause in their regulations that permits licensed physician assistants to respond to a need for medical care created by a declared state of emergency by rendering care consistent with relevant standards of care. It applies to physician assistants licensed in Pennsylvania and physician assistants licensed or authorized to practice in any other state.

Pennsylvania State of Emergency Declaration

Preliminary Announcement Regarding PA Regulatory Relief

After thorough review, the Pennsylvania Department of State determined that Physician Assistants that practice under the Pennsylvania Board of Medicine do not require a waiver pertaining to written agreements and may render care consistent with relevant standards. This allowance is due to an emergency medical services clause in the Board of Medicine regulations. The emergency service clause permits licensed physician assistants to respond to a need for medical care created by a declared state of emergency by rendering care consistent with relevant standards of care. The clause is under section 18.162 of the Board of Medicine regulations and specifically states as follows:

“A physician assistant licensed in this Commonwealth or licensed or authorized to practice in any other state who is responding to a need for medical care created by a declared state of emergency or a state or local disaster (not to be defined as an emergency situation which occurs in the place of one’s employment) may render care consistent with relevant standards of care.”

Physician Assistants practicing under the State Board of Osteopathic Medicine require a suspension of the requirements pertaining to written agreements, which must be issued by the Governor. The Department crafted this request and submitted it for approval to the Governor’s Office on 3/20/20. That approval is pending. We hope to hear something in the next few days.

A formal announcement will be posted on the Department of State website under the newly created section regarding regulatory relief. It can be found at  https://www.dos.pa.gov/Pages/default.aspx

Stay tuned for further information as it becomes available. Thanks to all PAs for their patience in this complicated emergency regulatory process. Also, thanks to you and all health care providers for your tireless efforts and dedication to the citizens of Pennsylvania.

Effective March 15, 2020 – New Joint Commission Elements of Performance Removes the term Licensed dependent Practitioner from restraint and seclusion standards

The new Elements of Performance:

PC.03.05.05
The hospital initiates restraint or seclusion based on an individual order.

Elements of Performance for PC.03.05.05
1. A physician, clinical psychologist, or other authorized licensed independent practitioner primarily responsible for the patient’s ongoing care orders the use of restraint or seclusion in accordance with hospital policy and law and regulation.

www.jointcommission.org/-/media/tjc/documents/standards/…

This is in response to A Centers for Medicare and Medicaid Services (CMS) final rule, Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction, published 9/30/19 that removed the modifying word “Independent”, changing the term “Licensed Independent Practitioner” to “Licensed Practitioner” in Federal regulations to clearly demonstrate that PAs are authorized to order restraint and seclusion.

Hospital bylaws and policies, state laws and regulations, and PA practice agreements and granted privileges may need to be updated to authorize PAs to order restraint and seclusion.

Per AAPA Advocacy