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.

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

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.