UPDATED 09/30/2021 (ORIGINALLY POSTED: 05/17/2021) – With the Governor’s signing of HB 1861 (now Act 73 of 2021), licensing waivers that had been set to expire September 30 will remain active until March 31, 2022, unless action is taken to end them sooner. We will provide additional updates as needed.

https://www.dos.pa.gov/…/Medicine/Pages/default.aspx

By Charles Thompson | cthompson@pennlive.com

Using the powers voters awarded them last month, the state Legislature’s Republican majorities brought a sudden end Thursday to Gov. Tom Wolf’s pandemic disaster declarations.

Resolutions to formally close the 16-month state of emergency passed on mostly party line votes first by a 30-20 margin in the Senate, and later in the House, 121-81.

The actions are effective with Thursday’s votes, since the Constitutional amendments passed by statewide ballot referendums on May 18 now give the General Assembly the authority to end a governor’s emergency declaration with a simple majority vote.

For many Pennsylvanians, the legislative votes simply put a political stamp on an unusual era that – for all intents and purposes – ended with one or two vaccination shots earlier this year. Even Gov. Tom Wolf, the architect of the prolonged disaster regimen, stood down all the broad public health restrictions but for certain masking mandates effective with Memorial Day.

The final language did contain some compromises.

While ending the disaster declaration, the measures passed Thursday do leave most of the nearly 500 regulatory changes taken under Wolf’s original and renewed disaster declarations intact through September.

These changes, effected through the administration’s emergency powers s the pandemic played out, did things like suspending certification and licensure renewals for doctors and other direct care workers, which allowed recent retirees to supplement hospital and other medical staffs as demand soared.

Other emergency changes loosened rules governing on-line provision of medical services during the pandemic, while still more allowed the state to maximize the number of vaccine providers and improve vaccine distribution.

Keeping the regulatory changes in place for the short term was the result of a compromise between legislative leaders and Wolf’s team that gives all sides three months to determine what COVID-19 rules they need to keep, which they want to keep to prevent federal funds from being blocked, which they want to keep for policy reasons, and which should be sunsetted.

Republicans applauded today’s actions, which put a period on furious efforts to end pandemic restrictions that gained steam with some business owners last May and have led to various legislative, court and political battles.

They achieved their goal with the passage of the amendments last month. For many in the majority, Thursday’s vote was matter of honoring that result.

“My constituents have spoken loudly, they want this over,” said Sen. Cris Dush, R-Jefferson County.

Still, most Democrats in the legislature voted against the disaster-ending resolution.

Some said they believe it’s too early from a public health standpoint, even though nearly 60 percent of Pennsylvania’s adult population is now fully vaccinated.

“There is no guarantee that the vaccines are going to be effective against new mutations,” warned Sen. Amanda Cappelletti, D-Montgomery County. “What happens when the virus rears its ugly head again and we’re caught flat-footed? It’ll be worse than 2020.

“This is a move to gain political points for the next election cycle. It’s not legislating with the health and safety of Pennsylvanians as the priority, which is what we should be doing,” she continued. “Passing this resolution could cost us lives, and I hope that the deaths of those Pennsylvanians will haunt those who vote yes for this resolution for the rest of their lives.”

Others expressed concern that the Republican majorities were rushing to the end before getting absolute certainty that ending the emergency won’t staunch the flow of hundreds of millions of pandemic-related federal funding that has helped to protect the state’s neediest residents.

They were particularly worried about closing the door to emergency Supplemental Nutrition Assistance Program funding, that has provided extra monthly benefits to several hundred thousand households in Pennsylvania through the pandemic.

During Thursday’s debate, Senate Majority Leader Kim Ward, R-Westmoreland County, was unable to definitively guarantee that the extra SNAP benefits won’t be affected, saying her understanding is that in the worst case scenario the extra funding would at least run through the summer months.

But Ward also promised she and her colleagues will bend every effort to make sure they are protected, and said the temporary extension of the regulatory suspensions and waivers is proof of their good faith on that point, even as Wolf’s ability to order unilateral business closures or limit public gatherings has ended.

“We were able to protect those waivers until the end of September, while we try to back out of this situation we’re in. We did not get in it all in one day, and we’re not going to get out of it all in one day,” Ward said. “… But the people of Pennsylvania wanted the emergency to be over. It’s over. It was going to be over at some point, and that over is today.”

AAPA sent a letter to several national medical organizations this week underscoring how the PA title change to physician associate affirms our commitment to team-based care and our shared goal to serve the needs of patients. https://bit.ly/3pkOxwl

June 4, 2021

We are writing to inform you that AAPA’s House of Delegates recently passed a policy affirming physician associate as the official title for the PA profession. We believe that this title more distinctly articulates the role and responsibilities of PAs in continuing to deliver quality healthcare, while reaffirming our commitment to team-based patient care. We kept “physician” in our title to demonstrate the value we place on our longstanding relationship with our physician colleagues and our historic roots within the physician community. As you know, the PA profession was created in response to the primary care physician shortage of the mid-1960s. It was Dr. Eugene A. Stead of the Duke University Medical Center who established the first PA program and recruited the first class of PAs from the Navy Hospital Corpsmen who had received considerable training during their military service.

We respect our relationship with your organization and the healthcare team members you represent, and we believe that our common interest – to best serve the needs of patients – unites us and presents collaborative opportunities to strengthen the fabric of America’s healthcare system. There has never been a greater need for access to quality healthcare for all Americans, and it is up to us – together – to heed the call to service.

While our title has changed, our mission has not — to transform health through patient-centered, team-based medical practice. We look forward to our continued work together.

Sincerely,

Beth R. Smolko, DMSc, MMS, PA-C, DFAAPA
President and Chair, Board of Directors

William T. Reynolds, Jr., MPAS, PA-C, DFAAPA
Vice President and Speaker of the House

Lisa M. Gables, CPA
Chief Executive Officer

Title Change Investigation

Why is AAPA undertaking a Title Change Investigation (TCI)?

At the May 2018 AAPA House of Delegates (HOD) meeting, a resolution passed requesting that the AAPA Board of Directors (BOD), “contract with an appropriate independent consulting/research firm(s) to investigate state/federal, financial, political, branding aspects, and alternatives to the creation of a new professional title for physician assistants that accurately reflects AAPA professional practice policies…”

What was the goal of the TCI?

The overarching goal of this project was to position PAs to successfully compete in the ever-changing healthcare marketplace by boosting the profession’s relevance and impact among stakeholder groups, especially patients, now and in the future.

What was the process and conclusion of the TCI?

Please refer to the November 2020 Final Report to the AAPA House of Delegates, which includes input from WPP, the firm hired to conduct the investigation (to include Kantar, Kantar Research, and Landor); AAPA, the national professional organization; and Foley & Lardner LLP, AAPA’s external legal counsel.

Title Change Vote: 2021 AAPA House of Delegates Meeting

What is the AAPA House of Delegates and why did they discuss the title change at their meeting?

The House of Delegates (HOD) is the policy-making body of AAPA, responsible for enacting policies establishing the collective values, philosophies, and principals of the PA profession. This authority is delegated to them under AAPA’s Articles of Incorporation. The HOD is comprised of elected representatives from 57 state and federal service chapters, 26 specialty organizations, 10 caucuses, and the Student Academy.

The formal title of the profession is acknowledged in an AAPA policy. Therefore, it was the responsibility of the HOD to consider any changes to this policy.

It was the 2018 HOD that passed a resolution requesting that the Board of Directors “contract with an appropriate independent consulting/research firm(s) to investigate state/federal, financial, political, branding aspects and alternatives to the creation of a new professional title for physician assistants that accurately reflects AAPA professional practice policies.”  This policy resolution initiated the Title Change Investigation, which concluded with an extensive report to the 2020 House of Delegates. At that meeting, delegates were charged with returning to their respective constituencies to begin the next phase of this process – discussing the current policy that titles the profession “physician assistant” and returning to the May 2021 HOD Meeting with any proposed changes to that policy.

What was the resolution the HOD voted on?

HOD delegates, board members, representatives of PAEA, ARC-PA & NCCPA and AAPA members met in a reference committee hearing on May 21, 2021 to debate and discuss proposed resolutions. On May 24, the AAPA House of Delegates (HOD) passed a resolution affirming “physician associate” as the official title of the PA profession by a majority vote of 198 to 68.

Next Steps for the Profession

What happens next?

The AAPA Board of Directors will deliberate next steps relating to implementation of HOD policy on title change. AAPA members and nonmembers will be updated as this process unfolds.

Can the AAPA Board of Directors overturn the decision of the HOD regarding the title change?

No. Per AAPA Bylaws, Article VII, Section 1(j), the role of the Board of Directors is: “To review and determine, on no less than an annual basis, how to implement those policies enacted by the House of Delegates on behalf of the Academy that establish the collective values, philosophies, and principles of the PA profession. If it determines that implementation of one or more such policies will require an inadvisable expenditure of Academy resources, or is otherwise not presently prudent or feasible, the Board shall, at its earliest convenience, report to the House the reasons for its decision.”

What is the timeline for changing the title?

A great deal of planning is now required in order to implement the decision to change the title as implementation requires a significant commitment from the profession and its associated entities in terms of financial obligations, resource allocations, and legislative and regulatory efforts. More research and conversations need to occur before a timeline can be finalized. For more details on a potential 5-year implementation timeline and estimated costs, please refer to the November 2020 Final Report to the AAPA House of Delegates.

What will the estimated cost be?

The estimated cost in the final Title Change Investigation report is $21.6 million. This estimate was based on discovery, research, and environment at the time of publication. For details, please refer to the Financial Impact Analysis section of the November 2020 Final Report to the AAPA House of Delegates, pg. 81-85.

Can PAs start calling themselves “physician associates” now?

AAPA’s legal counsel, Foley & Lardner LLP recommends that PAs refrain from representing themselves as “physician associates” at this time. Our view is based on the following:

• Implementing the new HOD policy is going to be complex, challenging, and take many years to complete. There are many intertwined considerations that require thoughtful due diligence to ensure we do not jeopardize any aspect of implementation. It would be unwise for the profession to appear to be out in front of state and federal legislatures and regulators. The next few years of work will be critical and must be strategically undertaken. Winning and keeping allies will be essential. The profession should not do anything to make this already-challenging process harder.
• Prematurely using the term “physician associate” may be viewed as confusing to patients and could be interpreted as the PA stepping beyond the scope of their current license. This could subject the PA to a regulatory challenge or discipline from their state licensing board or an attorney general’s office action. Other professions looking to hold back the PA profession may seize upon such premature usage to file complaints with the regulators.
• Employers or healthcare facilities where the PA has privileges could view the action as a violation of policy, procedure, or professional staff bylaws.
• There may be professional malpractice issues if adverse outcomes are linked to perceived “informed consent” violations from patients who claim they believed they were being treated by a physician. A malpractice insurer could use this as an excuse not to cover the claim.

How will AAPA educate the public about the title change?

AAPA will create a branding campaign to educate all stakeholders on the new title. This campaign will demonstrate the vital role that PAs play across the healthcare landscape. It will likely include media relations, advertising, communications toolkits for our key audiences, and more – with the goal of facilitating brand awareness around the PA role in healthcare.

It’s also vitally important that all PAs take part in showcasing the PA brand. Brand can be reflected in those very personal and caring conversations you have with a patient, and then that patient shares with their friends, family, and colleagues. Here are some more examples of how a brand might be showcased:

• Brand is the stories shared via earned media or paid media focusing on medical interactions a patient has had with a PA that has resulted in successful treatments in conjunction with real compassion.
• Brand is showcasing a PA on a panel of experts at a hospital conference where s/he is providing perspective, learnings, and education on how the healthcare system can deliver high-quality care to patients.
• Brand is a media story featuring a PA working with an indigenous population in Alaska, bringing preventive care to a place in the U.S. that has been ignored – providing these patients with the hope that they too can lead healthy lives.
• Brand is a social influencer or entertainer who is your patient – and they tell the story of how the best value in healthcare needs some attention. The PA, who has been part of their healthcare team, is the one who made the biggest difference in their care. Their true partner in wellness.
• Brand is a major network interview with a PA astronaut and her thoughts around the future of healthcare.
• Brand is partnering with corporations or medical celebrities who can amplify PA voices and tell your stories to bigger audiences.
• Brand is sitting on an esteemed National Panel at a revered medical organization to represent the profession on a body of work that will impact the way primary care is delivered.
• Brand is research (AAPA or PA) that provides insights into how mental health can best be addressed with patients during well visits.
• The PA brand is who you are and what you do each day to deliver on your purpose. Those interactions, stories, and your devotion to your patients will serve to educate and elevate the PA role in healthcare.

How will this affect the pursuit of other AAPA priorities like Optimal Team Practice (OTP)?

Pursuit of legislative initiatives such as OTP will continue to be determined by PA state chapters. Each state chapter will make its own determination about pursuing the title change and elements of OTP. OTP remains a top priority of AAPA and funding for state chapter grants will be evaluated in this process.

How does the title change affect AAPA’s 2021-2025 Strategic Plan?

In developing the plan, AAPA made sure the strategy was flexible enough to enable us to pivot as necessary to account for the variety of possible outcomes with both the Title Change Investigation and Optimal Team Practice.

Do PAEA, NCCPA and ARC-PA agree with this change?

Each organization prepared a report for the HOD on the impact of a potential title change on their respective organization. Each organization will make its own decision about implementation. AAPA is committed to working with all PA organizations to ensure ease and accuracy of adoption.

Do AAPA’s Constituent Organizations have the choice not to pursue the title change?

It is ultimately up to the constituent organizations to decide to adopt or not. AAPA does not have the authority to force a title change on any individual or organization.

The AAPA House of Delegates (HOD) today passed a resolution affirming “physician associate” as the official title for the PA profession by a majority vote of 198 to 68. The vote followed several hours of deliberation by HOD members and several years of study by an international marketing and communications firm.

The AAPA Board of Directors will now begin discussions to implement the HOD policy. As the Board moves forward with implementation, each constituent organization will conduct its own deliberations about a title change to physician associate. It is inappropriate for PAs to hold themselves out as “physician associates” at this time until legislative and regulatory changes are made to incorporate the new title. — AAPA

The PSPA will keep Pennsylvanians updated on how this will affect our state and practice moving forward. Always remember #PAsAreEssential #YourPACan #PAsDoThat

On December 21, 2020, the Department of State requested, and Governor Wolf granted, an extension for 90 days of certain license renewal deadlines for licensees under the State Board of Medicine. This moved the deadline from December 31, 2020, to March 31, 2021.

Due to licensees having difficulty meeting the March 31 deadline, the Department requested, and Governor Wolf granted, an additional 30 days to renew for all licensees under the Board of Medicine with a license that was set to expire on December 31, 2020, and who have not yet renewed. Any licensee who has not yet renewed must do so on or before April 30, 2021.

Renewal fees were waived by the Board of Medicine due to a funding surplus, but all licensees are required to complete their renewal to retain their license.

This will be the final extension for these licensees under the State Board of Medicine. 

Visit – pals.pa.gov for license renewals

March 22, 2021

Various measures have been taken to boost the number of health care professionals available to administer COVID-19 vaccines. This includes a Declaration made by the former U.S. Acting Secretary of HHS on March 10, 2020, under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19 (PREP Act). That Declaration has since been amended several times.

The current Acting HHS Secretary anticipates that significantly more vaccines will be available to the public in spring and summer 2021 and wants to ensure that states have the greatest flexibility in mobilizing the workforce necessary to engage in what he describes as “the largest vaccination effort in our nation’s history.” As a result, an Amendment to the PREP Act Declaration was issued on March 12, 2021.

The primary purpose of this Amendment was to add additional categories of “qualified persons” covered under the PREP Act to expand the pool of trained professionals available to administer vaccines.

The Amendment identifies several types of actively licensed practitioners, recently retired professionals, and students in health care training programs, who − subject to appropriate training, supervision and certain other specified requirements − may participate in COVID-19 vaccination programs.

In Pennsylvania, this adds a number of professions that would not otherwise be able to administer COVID vaccines, including the following under the State Board of Medicine, the State Board of Osteopathic Medicine, the State Board of Dentistry, the State Board of Podiatry, and the State Board of Veterinary Medicine:

• Certified Nurse Midwives
• Dentists
• Dental students
• Optometrists
• Optometry students
• Physician Assistants
• Physician Assistant students
• Podiatrists
• Podiatry students
• Respiratory Therapists
• Respiratory Therapy students
• Veterinarians
• Veterinary students

To administer COVID-19 vaccines and be covered as “qualified persons” under the COVID-19 PREP Act Declaration, those listed above must meet the following training, supervision, and other requirements:

• The vaccine must be authorized, approved, or licensed by the Food and Drug Administration (FDA).
• Vaccination must be ordered and administered according to the COVID-19 vaccine recommendation(s) of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP).
• Professionals must have documentation showing that the CDC COVID−19 Vaccine Training ModulesOpens In A New Window were completed, as well as any other training required that may be required by the State Local Tribal Territory (SLTT) where the vaccine is being administered. (https://www.cdc.gov/vaccines/COVID−19/training.htmlOpens In A New Window)
• Professionals must have documentation of an observation period by a currently practicing healthcare professional experienced in administering intramuscular injections, and for whom administering intramuscular injections is in their ordinary scope of practice. The observer practitioner must confirm competency of the provider in preparation and administration of the COVID-19 vaccine(s) to be administered.
• Professionals must hold current certification in basic cardiopulmonary resuscitation (CPR). For those who are seeking their first CPR certificate, such certification cannot come entirely from an online course; there must be at least some element of hands-on training.
• Professionals must comply with recordkeeping and reporting requirements of the jurisdiction in which the vaccine is to be administered, including (a) informing the patient’s primary-care provider when available, (b) submitting the required immunization information to the state or local immunization information system (vaccine registry), (c) complying with requirements with respect to reporting adverse events, and (d) complying with requirements whereby the person administering a vaccine must review the vaccine registry or other vaccination records prior to administering a vaccine.
• Professionals must comply with any applicable requirements (or conditions of use) as set forth in the CDC’s COVID-19 vaccination provider agreement and any other federal requirements that apply to the administration of COVID-19 vaccine(s).

For healthcare professionals and students in healthcare professions who do not traditionally find themselves in the role of administering vaccines, additional training is vital. For example, the PREP Act Declaration/Amendments imposes additional training requirements on pharmacy interns and licensed pharmacists who either have not already completed the immunization training that their licensing state requires for pharmacists to order and administer vaccines, or whose licensing state does not specify training requirements for the licensed pharmacist to order and administer vaccines.

In Pennsylvania, the following training requirements apply:

• Certified Nurse Midwives, Dentists, Physician Assistants, and Podiatrists do not need to take a 20-hour ACPE-approved vaccination training program which some licensed pharmacists are required to take.
• Dental students, Physician Assistant students, Podiatry students, Respiratory Therapists, and Respiratory Therapy students who have not yet had training in the administration of injectables, must complete the 20-hour ACPE-approved vaccination training program.
• In addition to requirements under the PREP Act, Optometrists, Veterinarians, and Veterinary students must take and complete a 20-hour ACPE-approved vaccination training program that includes hands-on injection technique and the recognition and treatment of emergency reactions to vaccines.

Any authorized individual looking to enroll as a COVID-19 provider in Pennsylvania needs to complete a provider agreement form. All information for providers, including a copy of this form, can be found on the provider section of the DOH website: https://www.health.pa.gov/topics/programs/immunizations/Pages/COVID-19-Vaccine-Providers.aspx

Important Announcement regarding Written Agreements

At today’s State Board of Medicine, the BPOA Commissioner Kalonji Johnson announced the written agreement applications are now available online for the State Board of Medicine and State Board of Osteopathic on the PALS website https://www.pals.pa.gov/#/page/default

Paper written agreements will only be accepted until April 30^, 2021.

On the main Medical and Osteopathic Medicine website, instructional packets have been posted. The applications can either be started by the PA or the primary supervising physician. Here are the links for both for each board:

State Board of Medicine Instructions for written agreement initiated by a PA
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20Online%20Written%20Agreement%20User%20Guide%20-%20initiated%20by%20Physician%20Assistant.pdf

State Board of Medicine Instructions for written agreement initiated by a Primary supervising physician
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20Online%20Written%20Agreement%20User%20Guide%20-%20initiated%20by%20Physician%20and%20Surgeon.pdf

State Board of Osteopathic Medicine Instructions for written agreement initiated by a PA
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20Online%20Written%20Agreement%20User%20Guide%20-%20initiated%20by%20Physician%20Assistant.pdf

State Board of Osteopathic Medicine Instructions for written agreement initiated by a PA
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20Online%20Written%20Agreement%20User%20Guide%20-%20initiated%20by%20Physician%20and%20Surgeon.pdf

Overall instructions as posted on the Board website:

If you have submitted a paper application and fee to the Board, do not submit the application electronically. This will create a discrepancy and the application fees are non-refundable.

The written agreement application involves a workflow between the supervising physician and physician assistant. When it is time for each party to complete their portion of the application, emails will be sent to the email address on the licensee’s PALS profile. Applications will not be submitted until the final step of making payment. The individual that submits the application will be able to view the application status and respond to discrepancies online. Discrepancies and approvals will be emailed to both the supervising physician and physician assistant. Responses to discrepancies must be uploaded to the application.

Items you will need prior to starting the application: Valid license numbers of the physician assistant, primary supervisor, and substitute supervisor. The primary supervising physician and physician assistant must be under the same Board (Example: Primary supervisor license number starts with MD; physician assistant license number starts with MA). You will need to enter the details describing the functions/tasks to be delegated to the physician assistant, details describing the time, place, and manner of supervision, practice location information, chart review deviation (if applicable), and drug prescribing/dispensing information. This information can be cut and pasted into the fields from templates. The physician assistant will need to upload proof of insurance. Applications can only be submitted with a valid credit card payment. The application initiator will be required to submit the payment.

Written agreements can also be terminated online. Instruction links as follow:
State Board of Medicine:
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20Terminating%20a%20Written%20Agreement%20Online.pdf

State Board of Osteopathic Medicine:
https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20Terminating%20a%20Written%20Agreement%20Online.pdf

The PSPA has already sought further clarification from the Commissioner regarding the online process. If you have questions that you would like PSPA to submit, please send them to pspa@pspa.net by March 19, 2021.

AAPA’s Top Federal Priority Secured in Bipartisan Agreement

December 22, 2020

AAPA commends Congress for passing legislation authorizing PAs to receive direct payment under Medicare as part of the Coronavirus Relief & Omnibus Agreement, which is expected to be signed into law by the president soon.

The PA Direct Payment Act (S.596/H.R. 1052) was included in the omnibus, along with a number of additional changes related to the Medicare program, and will take effect January 1, 2022.

Enactment of the PA Direct Payment Act will place PAs on equal footing with other Medicare providers who can be directly paid for services provided to Medicare patients. Current Medicare policy requires that the employer of a PA be paid for services provided to Medicare patients. However, other health professionals – physicians, advanced practice registered nurses (APRNs), physical therapists, psychologists, podiatrists, social workers, and others – are permitted to receive direct payment under their own name and National Provider Identifier number.

“The difficulties PAs face as a result of this outdated policy have never been more evident than during the COVID-19 pandemic,” said AAPA President and Chair of the Board Beth R. Smolko, DMSc, MMS, PA-C, DFAAPA. “AAPA leadership and advocacy staff have worked tirelessly to make the case to Congress that it was necessary to pass this legislation in order to modernize Medicare and fully utilize the PA workforce when our nation is confronting the pandemic. By including this bill in the omnibus, Congress has demonstrated its commitment to improving access to quality healthcare services provided by PAs. AAPA extends our gratitude to Congress for working to get a bipartisan agreement across the finish line that includes many updates to Medicare policy as well as providing much-needed support to American families and businesses.”

Advocating for passage of the PA Direct Payment Act has been a top priority for AAPA and PA advocates this Congress. Direct payment for PAs is one of the three important legislative pillars of Optimal Team Practice and has been a legislative goal for the organization since 2017. AAPA applauds the primary sponsors of the bill, Senators John Barrasso (R-WY) and Tom Carper (D-DE) in the Senate and U.S. Reps. Terri Sewell (D-AL) and Adrian Smith (R-NE) in the House of Representatives, for shepherding this bill through Congress.

Authorizing PAs to be paid directly by Medicare will ensure they can reassign their payments in a manner similar to physicians and APRNs. It will also ensure PAs who own their own practice in accordance with state law will be able to receive direct pay from the Medicare program. The inability to be paid directly hinders PAs from fully participating in the increasing number of emerging models of healthcare delivery. For example, the restriction often impedes PAs from obtaining employment with healthcare staffing companies or group practices used by hospitals to deliver care because PAs cannot reassign their Medicare payments to the hospital.

The COVID-19 pandemic reinforced the urgent need for the PA Direct Payment Act to become law by bringing to light many of the obstacles faced by PAs as a result of this outdated policy. This is especially the case in rural areas, where Medicare allows PA-owned rural health clinics (RHCs) to receive Medicare payments in some instances. These PA-owned RHCs are only permitted to receive Medicare payment for bundled RHC primary care services. PA-owned RHCs are required to bear the costs of services not included in the bundled payment. For instance, COVID-19 and flu testing, as well as other laboratory services, are not included in the payment bundle for RHC primary care services.

Another key update to Medicare policy included in the omnibus authorizes PAs in RHCs and Federally Qualified Health Centers (FQHCs) to furnish and bill for hospice “attending physician” services when RHC and FQHC patients become terminally ill and elect the hospice benefit.