Beginning September 1, 2016, Physician Assistants in Pennsylvania were enrolled as participating providers who could order, refer or prescribe items for Medical Assistance beneficiaries. The PSPA has been trying to change our status from participating providers to enrolled rendering providers since that time. On January 7th, 2022, The Pennsylvania Department of Human Services published in the Pennsylvania Bulletin that this monumental change has occurred. The language and the steps that need to be taken by PAs and their employers can be found at this link: https://www.dhs.pa.gov/docs/Publications/Documents/FORMS%20AND%20PUBS%20OMAP/MAB2022010701.pdf

History:
Pennsylvania PAs were hidden providers under the state’s Medicaid program as claims for PA services were attributed to their supervising physician. This system prevented patients, regulators, employers, and legislators from knowing which healthcare professional was accountable for a patient’s care.  The issue of appropriate enrollment of PAs was about accountability and transparency.  Because Pennsylvania PAs are hidden providers, inaccurate data was delivered to policymakers on workforce and network adequacy considerations. This has lead to an inefficient allocation of taxpayer resources.

Impact of this change
There are now 48 states across the country that enroll physician assistants in Medicaid programs as rendering providers, authorizing them to use their own provider number when claims are submitted to Medicaid to identify who rendered the service.  PAs will be recognized as enrolled rendering providers under Pennsylvania’s Medicaid program, allowing services provided by PAs to be submitted with the PA’s name and NPI included on the claim form indicating that he or she rendered the service. Enrollment of PAs as rendering providers under Medicaid will lead to the identification of PAs in provider directories. This clear identification of health professionals locally delivering care will make it easier for patients, especially those in underserved communities, to find care options, particularly in a time of physician shortage.

The enrollment of PAs as rendering providers does not increase costs for the state Medicaid program or duplicate services. PAs are currently providing said services but submitting claims under the physician’s provider number. Payment would continue to go to the employer.

This status change is a huge win for PSPA and PAs of Pennsylvania. Much thanks goes to the PSPA Board of Directors and the Governmental Affairs team.

Gov. Wolf Signs Executive Order to Provide Civil Immunity for Health Care Providers

https://www.governor.pa.gov/newsroom/gov-wolf-signs-executive-order-to-provide-civil-immunity-for-health-care-providers/

Today, Governor Tom Wolf signed an executive order to afford health care practitioners protection against liability for good faith actions taken in response to the call to supplement the health care provider workforce during the COVID-19 pandemic.

During the course of the pandemic and the disaster declaration associated with it, the Wolf Administration has used its authority under the declaration to suspend a significant number of regulations and regulatory statutes to supplement the health care workforce, including facilitating the deployment of retirees and out-of-state health care professionals, expanding scope of practices and relaxing supervision requirements for numerous health care licensees, bringing in health care professionals who have not previously maintained liability coverage, and calling upon health care providers to perform acts they would not perform in the ordinary course of business.

“As the COVID-19 pandemic has required the Wolf Administration to take broad action to respond to and prepare for Pennsylvanians’ critical health care needs, so too has it required our health care providers to broaden their professional responsibilities and experiences like never before,” Gov. Wolf said. “This Executive Order to Enhance Protections for Health Care Professionals serves to protect the individuals serving on the front lines of the disaster response.”

The executive order:

• Grants immunity to any individual who holds a license, certificate, registration or certification to practice a health care profession or occupation in Pennsylvania and who is engaged in providing COVID-19 medical and health treatment or services during the COVID- 19 disaster emergency response. Immunity does not extend to acts or omissions that constitute a crime, gross negligence, or fraud, malice, or other willful misconduct;
• Extends immunity to those medical professionals in Pennsylvania that provide services in any health care facility as defined by the Health Care Facilities Act, as well as any nursing facility, personal care home, assisted living facility or any alternate care site, community-based testing site or non-congregate care facility used for the purpose of conducting emergency services activities or the provision of disaster services activities related to the Commonwealth’s COVID- 19 disaster emergency response;
• Affirms immunity for any person, organization or authority allowing real estate or other premises used for emergency services without compensation in the case of death, injury, or loss or damage to the property of any person who is on the premises for the purpose of those emergency services; and
• Suspends or removes a host of regulatory barriers that would otherwise impede or prevent out-of-state, retired or other qualified practitioners from providing services where needed in the Commonwealth.

The order was written in response to stakeholders requesting civil immunity for health care practitioners practicing with good judgment under very challenging circumstances during the COVID-19 pandemic. The executive order also is in line with actions neighboring states have taken and is responsive to the needs and requests of the health care community.

This order is effective immediately and shall remain in effect for the duration of the disaster emergency.

Opioid prescribing CME courses: https://cme.aapa.org/opioidrems.aspx
                                                             https://www.medscape.org/sites/advances/long-acting-opioids

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

HAP’s Advanced Practice Professionals Advisory Group has develped a guidebook entitled “Use of Physician Assistants, Certified Registered Nurse Practitioners, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists in the Hospital Setting in Pennsylvania.”  We are confident that this resource tool will provide guidance in understanding allowable practices in the hospital setting. Please distribute to your supervising physicians, PA co-workers and hospital administration.

Board Approves Temporary Authorization for Physician Assistants to Practice Pending Board Approval of the “Application for Registration as a Supervising Physician”

At its meeting on March 21, 2013, the State Board of Medicine 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 of set forth in the written agreement as submitted to the Board. 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.

Board Approves Reduction in Paperwork and Reporting Requirements
for Substitute Supervising Physicians of the Physician Assistants
The Board also approved a reduction in paperwork and reporting requirements for substitute supervising physicians. Effective immediately, the “Written Agreement Change Form” for Adding/Deleting a Substitute Supervisor will no longer be required to be filed with the Board office.
However, the “Written Agreement Change Form” is required and must be submitted to:

• Delete a Physician Assistant;
• Dissolve a Written Agreement;
• Make Changes in Protocol, including: changing the job duties of the Physician Assistant;
• Changing the Physician Assistant’s prescribing or dispensing privileges;
• Changing the practice address (only if changing a hospital practice location)

Additional Amendments to Requirements for the Supervision of Physician Assistants
The Board will issue a Statement of Policy to make additional amendments to the “Application for Registration as a Supervising Physician” which will reduce the paperwork and reporting requirements. When the Statement of Policy has been published in the Pennsylvania Bulletin, additional amendments will be made to the application form(s).

Link to special notice on State Board of Medicine website:
Special Notice: 572039

Link to new forms:
State Board of Medicine Forms