On September 30, 2021, the Pennsylvania legislature passed Act 73 of 2021. Act 73 extended the remaining Bureau of Professional and Occupation Affairs emergency declaration waivers until March 31, 2022. PAs may continue to function under these waivers until that time. As you recall the waivers that impacted PAs included the following:
Written agreements were considered active upon submission
Countersignature requirements were lifted
Ratio restrictions were lifted
A direct link to those waivers is available here:
https://www.dos.pa.gov/Documents/2020-03-22-Physcian-Assistant-Waiver.pdf
In addition, on September 29, 2021, the Pennsylvania legislature passed Senate Bill 397 and 398. The bills impact multiple levels of PA regulations for both the Medical and Osteopathic Boards. A summary table is included below. The boards will begin to work on regulations to implement these changes to operationalize them at the board level. The PSPA and their legal counsel will be working with the board legal counsel to optimize these changes. Because the waivers are still in place, this gives facilities and practices time to plan on how to implement any changes in bylaws or system changes that may be needed to reflect this modernization in state law.
The PSPA will continue to provide updates on the regulatory process via our social media, member email blasts, website and newsletter.
Summary of changes in Medical and Osteopathic Practice Acts after passage of SB 397 and 398
| TOPIC | Medical Board | Osteopathic Board |
|---|---|---|
| BOARD MAKEUP | - A permanent Physician Assistant board seat was added. - The PA applicant will be appointed by the Governor and confirmed with a Senate majority vote. | - A permanent Physician Assistant board seat was added. - The PA applicant will be appointed by the Governor and confirmed with a Senate majority vote. |
| CLARIFICATION IN SUPERVISION DEFINITION | Supervision shall not require the onsite presence or personal direction of the supervising physician. | Supervision shall not be construed to require the personal presence of the supervising physician at the place where the services are rendered. |
| COUNTERSIGNATURE | - The primary supervising physician shall determine countersignature requirements (if any) of patient records completed by the physician assistant as outlined in the written agreement. - Exceptions include the continued requirement of 100% countersignature of charts for new graduates for 12 months or PAs entering a new specialty for 12 months. Note - Language has been added to prevent the board from changing the new law: "The board may not require, by order, regulation or any other method, countersignature requirements of patient records completed by a physician assistant that exceed the requirements specified under this subsection." | - The primary supervising physician shall determine countersignature requirements of patient records completed by the physician assistant in a written agreement with the exception of continued requirement of 100% of charts for new graduates for 12 months or PAs entering a new specialty for 12 months. Note - Language added to prevent board from changing the new law: "The board may not require, by order, regulation or any other method, countersignature requirements of patient records completed by a physician assistant that exceed the requirements specified under this subsection." |
| WRITTEN AGREEMENTS | Required Components: - Identify primary supervising physician - Describes physician assistant's scope of practice - Describes the nature and degree of supervision - Permits written agreement to be prepared and submitted by the primary supervising physician, the physician assistant or a delegate of the primary supervising physician and the physician assistant. - The agreement is effective upon submission. Review: The board shall review 10% of written agreements going forward. If deficiencies are noted, a revised written agreement will need to be resubmitted within 2 weeks of notification that written agreement came under review. No work stoppage is required due to the revised written agreement being effective upon submission. - Clarification language was added stating that all written agreements submitted during the emergency declaration are deemed approved. - Board has 120 days to publish written agreement review process in the PA Bulletin | Required Components: - Identify primary supervising physician - Describes physician assistant's scope of practice. - Describes the nature and degree of supervision - Permits written agreement to be prepared and submitted by the primary supervising physician, the physician assistant or a delegate of the primary supervising physician and the physician assistant. - The agreement is effective upon submission Review: The board shall review 10% of written agreements going forward. If deficiencies are noted, a revised written agreement will need to be resubmitted within 2 weeks of notification that the written agreement came under review. No work stoppage is required due to the revised written agreement being effective upon submission. - Clarification language added that stating all written agreements submitted during emergency declaration are deemed approved. Board has 120 days to publish written agreement review process in the PA Bulletin |
| RATIOS | - Increases the ratio of one supervising physician to 6 PAs in both the inpatient and outpatient settings - An appeal can be submitted to add additional PAs - Clarification language added that states the following: "Nothing in this act shall be construed to authorize an employer or other entity to require a physician to supervise more physician assistants when the physician, in his or her clinical judgment, determines that supervising more physician assistants will compromise patient care or otherwise affect the physician's ability to properly supervise another physician assistant in accordance with the requirements of this act or regulations promulgated by the board." | - Increases the ratio of one supervising physician to 6 PAs in both the inpatient and outpatient settings - An appeal can be submitted to add additional PAs - Clarification language added that states the following: "Nothing in this act shall be construed to authorize an employer or other entity to require a physician to supervise more physician assistants when the physician, in his or her clinical judgment, determines that supervising more physician assistants will compromise patient care or otherwise affect the physician's ability to properly supervise another physician assistant in accordance with the requirements of this act or regulations promulgated by the board." |
| Regulations | The Board is to promulgate regulations within 180 days. | The Board is to promulgate regulations within 180 days. |
| Effective date | Immediate | Immediate |