The Senate Consumer Protection and Professional Licensure Committee has voted to move Senate Bills 870 and 871 out of their committee. The next step is for the bills to be voted on by the full Senate later in the month of October. The PSPA and the PA profession needs to continue the momentum of showing the state senators that these bills are critical to moving our profession forward and to ease the risk of being put at a disadvantage in the competitive healthcare employment market. These bills offer flexibility to the Physician / PA team and allow for an increase access to health care.

Simply go to the PSPA Legislative action center and send a letter to your Senator. There are links for PAs, PA students, physicians and the general public to raise their voices up in support of these bills.

Go to https://pspa.net/advocacy/governmental-affairs/action-center/ to learn more and speak up for future of PAs in Pennsylvania.

Last night, the legislature passed HR 836, a resolution that directs the Governor to terminate his disaster declaration. The legislature is now saying to people that the declaration has ended. This is not true. This needs to be signed by the Governor to take effect, and the Governor will obviously not sign this. Below is additional background as I am sure you may receive questions as to how this may impact your members and all professional licensees operating under one of the emergency waivers put into place by the Department of State under the authority of the Governor’s 3/6 Disaster Proclamation.

When the concurrent resolution is presented to him, as the Constitution requires, he will disapprove it. Until then, no action will be taken. The disaster proclamation has not been terminated by the House or Senate’s actions. Only the governor can terminate the disaster emergency.

That said, this resolution would not affect the Secretary of Health’s order including business closure orders, building safety orders, and business safety orders, and therefore the Administration’s phased reopening plan and associated orders would remain in place even if it passes.

Practically speaking, if the resolution becomes effective, the Governor must end the March 6, 2020 disaster proclamation, meaning that certain powers  granted to him by law to effectively deal with the state’s response to the pandemic will end.

Legislative enactments tied specifically to the March 6, 2020 disaster proclamation, which were passed specifically to help Pennsylvanians and Pennsylvania businesses during the pandemic, may expire upon the termination of the COVID-19 disaster declaration.  These include, among others:

1. All Waived & Suspended licensing regulations across all 29 State Licensing Boards & Commissions housed within the Bureau of Professional and Occupational Affairs (a list of which can be found by following this link). The professional licensing regulatory structure would revert to a Pre-Covid-19 state.
2. Unemployment Compensation eligibility requirements and employer relief from charges.
3. Property tax relief.
4. Educational tax credit waivers.
5. Certification requirements under the public-school code and child protective services law.

Ending the declaration removes many practical aspects of the state’s response to this disaster, including the authority to activate the National Guard to help with nursing homes; deploying commonwealth personnel, services and distributing supplies and equipment; implementing emergency funding; suspending rules and regulations that would hinder or delay necessary action in coping with the emergency; and using all available resources of the commonwealth government and its political subdivisions to deal with the emergency.

The state may also lose federal public and individual disaster assistance, and any additional state funding sources available through transfer of unused General Fund dollars.

During a state of emergency declared by the governor, commonwealth agencies and departments may implement their emergency assignments without regard to procedures required by other laws pertaining to performing their work, entering into contracts, purchasing supplies and equipment, and employing temporary workers.

For additional background purposes here’s the references in PA Constitution:

Pa. Const. Art. III, § 9. Action on concurrent orders and resolutions.

Every order, resolution or vote, to which the concurrence of both Houses may be necessary, except on the question of adjournment, shall be presented to the Governor and before it shall take effect be approved by him, or being disapproved, shall be repassed by two-thirds of both Houses according to the rules and limitations prescribed in case of a bill.

What is Act 112?

Act 112 of 2019 requires prescribers in Pennsylvania to educate their patients and establish treatment agreements with their patients before issuing the first prescription in a single course of treatment for chronic pain with a controlled substance containing an opioid.

Act 112 of 2019 requires prescribers to:

• Assess whether the patient has taken or is currently taking a prescription drug for treatment of a substance use disorder.
• Counsel the patient on treatment goals, expectations, benefits, and risks.
• Obtain the consent of the patient for targeted urine testing.
• Include the brand name or generic name, quantity and initial dose of the controlled substance medication containing an opioid being prescribed.
• Ensure the patient understands the prescriber and patient treatment responsibilities and the prescribing policies of the practice.
• Ensure the patient understands that a controlled substance medication containing an opioid has a potential for abuse, the associated risks of addiction and overdose, increased risk factors of addiction, the dangers of taking a controlled substance medication containing an opioid with benzodiazepines, alcohol or other central nervous system depressants, and other information deemed appropriate by the prescriber under 21 CFR 201.57(c)(18).
• Discuss the efficacy, risks, and benefits of other treatment options; if applicable.

View the Temporary Regulations for Act 112 of 2019 (submitted for publication in the PA Bulletin on March 7, 2020, subject to change).

Resources

For Prescribers:

• Sample Treatment Agreement
• Requirements of Act 112 and Considerations for Prescribers
• Act 112 Questions and Answers
• Act 112 of 2019 Treatment Agreement Checklist

For Patients:

• Opioid Use and Safety
• What is Act 112 and Questions to Ask Your Provider

Senate Bill 857 sponsored by Senator Vogel, has passed the Senate by a vote of 47-1. The bill now moves on to the Insurance Committee in the state House of Representatives.

The Telemedicine Act authorizes the practice of telemedicine by health care providers. It requires that each licensing board promulgate regulations within 24 months of the effective date of passage and provides for the publishing of temporary regulations within 60 days of passage. It also provides for evaluation and treatment, insurance coverage and Medicaid program reimbursement. The provisions regarding insurance coverage and medicaid program reimbursement shall take effect 90 days. The remainder take effect immediately.

Last session the telemedicine bill failed to advance getting caught up in the politics of abortion. State Representative Kathy Rapp added an amendment to ban telemedicine services from prescribing abortion medications.

The present version of the bill includes language changes to satisfy insurers and health care providers. They bills don’t address the issue of abortion.  Representative Rapp said that she will push to have the bills amended again so that telemedicine cannot be used to prescribe abortion drugs.

Representative Rapp chairs the House Insurance Committee where the bills currently reside. The House is expected to consider the legislation in November along with a range of other health-related bills.

Telemedicine has been touted as a way to improve patient care in rural and underserved areas. It is also expected to save the health care industry up to $6 billion annually “by reducing readmission, improving staff utilization and preventing hospitalizations,” according to a Towers Watson study. PAs are expected to play a significant role in Telemedicine services.

We are pleased to announce an important legislative victory with Senate Bills 688 and 689 which allow for a delegate to participate and complete the physician/PA application and work agreement forms.

This legislation became necessary as the Pennsylvania Licensing  System (PALS) comes online over the next several months. If you are not familiar with PALS, it is an online system created by the Department of State, that will replace the paper applications for licenses and work agreements. The state has been working on this process for several years and it will come to fruition within the next year.  The Medical and Osteopathic boards will continue to accept paper applications in the meantime.

PALS will help to streamline and speed up the application and approval process, something that has been sorely needed for the past several decades. It will be particularly helpful for institutions where credentialing and administration staff are the primary individuals who fill out the applications and have the physician and PA sign. However, the system was not developed with a third party use in mind. It would have forced the physician and PA to complete the entire application process online themselves, something that is not feasible in most facilities. Test demonstrations of the system will be conducted over the next 1-2 months to work out any technical issues. Instructional webinars are planned as well.  We will keep you informed as the process moves along. For now, you may continue using the current paper system.

PA Modernization Act Legislation

The House and Senate have recessed for the summer. But, that doesn’t mean we take a break. We are still seeking to add more co-sponsors to our legislation. We encourage all of you to contact your state senators over the summer asking for their support and co-sponsorship of Senator’s Killion and Yudichak’s memorandum on Physician Assistant Modernization of Practice.   They will be the prime sponsors for our upcoming bills. The language has not yet been introduced, therefore there are no bill numbers. We hope to garner as many supporters of the legislation as possible this summer and introduce the bills in September.

We will be holding a “capitol hill” day in September as well. We recently sent out a save the date announcement through Voter Voice. Information is also posted on the PSPA web site. I have included the announcement here as well. We hope to have as many of you as possible for a day to educate the legislators on the PA profession and ask for their support in modernizing our practice acts. Don’t forget to contact your Senators, introduce yourself as a PA in their district and ask them to support Senator Killion’s and Senator Yudichak’s memorandum on Physician Assistant Modernization!

Save the Date!

What: Physician Assistant Modernization Act Legislative Day
When: Tuesday, September 24th, 2019
Where: Capitol Hill, Harrisburg, Pa

The PSPA invites you to join your colleagues for a day on Capitol Hill in Harrisburg. The purpose of this event is to educate legislators on the physician assistant profession and to ask for support for our legislation.  Our goal is to have a PA visit every house of representative and senator in the Capitol.

The day will begin with an introduction/breakfast meeting where we will discuss the legislation talking points, handouts on the PA profession, and tips on how to talk with your legislator.

Appointments with the legislators will be arranged for you to attend during the day followed by a post visit wrap up.

All you need to bring is your lab coat and smiling personality!  We will provide the rest.

Coming Soon: Further details and information regarding local hotel options. 

Please plan on attending! We hope to see you there!

Visit the AAPA Legislative Action Center to find out who your state and federal legislators are and what important legislation is pending.

Legislative Alert Letter February 15, 2014

Implementation of Act 100 and Act 101 Countersignature modification and temporary authorization to practice table

Act 100 / House Bill 1348: Countersignature modification and temporary authorization to practice under the State Board of Medicine
Act 101 / House Bill 1351: Countersignature modification and temporary authorization to practice under the State Board of Osteopathic Medicine

Bill summary
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 now move on to the Governor’s office for signature. They 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 timef rame has passed. The legal Counsel for both boards have been modified the written agreement change forms at this time. In order to modify your present requirement for 100% countersignature within 10 days, the new written agreement change form will need to be approved by the board.

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.

House Bill 1251: Expansion of ratios under State Board of Medicine
House Bill 1252: Expansion of ratios under State Board of Osteopathic Medicine
House 1804: Expansion of scope and Malpractice limits under State Board of Medicine
House 2088: Expansion of scope and Malpractice limits under State Board of Osteopathic Medicine