Opioid Treatment Agreements (Act 112 of 2019)

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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:

For Patients:

Telemedicine Update

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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.

PAs in Pennsylvania Urge Legislature to Modernize PA Practice Laws

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PA Advocates Throughout the State Geared Up for Legislative Day

GREENSBURG, Pa. (September 24, 2019) – The Pennsylvania Society of Physician Assistants (PSPA) today commends Senator Tom Killion and Representative Curt Sonney for introducing legislation to modernize state PA (physician assistant) practice laws. This package of legislation would make changes to current law that will ensure PAs in Pennsylvania can provide patient care in the most efficient and effective way possible.

“As the need for more healthcare providers continues to be a concern across the country, Pennsylvanians are very fortunate to have access to the second highest concentration of PAs in the country. Unfortunately, current laws and regulations are placing unnecessary burdens on the physician/PA team,” PSPA President Jackie Borst, PA-C, said.

“PSPA urges the legislature to pass this legislation and place decision-making back in the hands of PAs and the physicians they practice with. Physicians and PAs need more flexibility to quickly adapt to a changing practice environment while ensuring patient safety.”

PAs are medical providers who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a principal healthcare provider. With thousands of hours of medical training, PAs are versatile and collaborative. PAs practice in every medical setting and specialty, improving healthcare access and quality.

The PA profession is one of the fastest growing in the country. The U.S. Bureau of Labor Statistics projects that the profession will increase 37 percent from 2016 to 2026, significantly faster than the average for all occupations. Today, there are more than 8,818 practicing PAs in Pennsylvania.

Borst said PSPA’s Physician Assistant Modernization Act Legislative Day on September 24 was an opportunity to educate members of the legislature about the PA profession and to seek support for the legislation.

The legislation will:

  • Place a physician assistant on the Medical Board and Osteopathic Board with a permanent seat,
  • Remove the requirement of a physician countersignature on 100% of patient files,
  • Allow a written agreement to be “filed” instead of “approved” by the Medical and Osteopathic Boards (to allow physician assistants to immediately begin working instead of waiting 120 days or longer for the medical boards.)
  • Outline what supervision means to ensure laws and regulations do not hinder the physician, physician assistant, patient relationship.

Advocates can learn more about the legislation and contact their representatives through PSPA’s Action Center.

About the Pennsylvania Society of Physician Assistants (PSPA)
The Pennsylvania Society of Physician Assistants (PSPA) was established in 1976. As a nonprofit organization, the PSPA strives to be representative of all physician assistants within the Commonwealth of Pennsylvania. Engage with us on Facebook and LinkedIn.

Legislation Update

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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!

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

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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.

 

 

 

Implementing Act 101 and 101 Countersignatures

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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 www.dos.state.pa.us/med or the Osteopathic Board’s website at www.dos.state.pa.us/ost 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

supervisors.

  • 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, www.pspa.net 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.

Sincerely,

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

PSPA Governmental Affairs Committee Chair PSPA President

House Bills Become Law

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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.

Legislative Action Center

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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