Title of Regulation: 18VAC85-50. Regulations Governing the Practice of Physician Assistants (amending 18VAC85-50-10, 18VAC85-50-57, 18VAC85-50-115).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearings are scheduled.

Public Comment Deadline: September 11, 2013.

Effective Date: September 26, 2013.

Agency Contact: William L. Harp, M.D., Executive Director, Board of Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233, telephone (804) 367-4558, FAX (804) 527-4429, or email william.harp@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia provides general powers and duties of health regulatory boards, including the Board of Medicine; § 54.1-2952 of the Code of Virginia provides specific authority to the board to regulate physician assistants; and § 54.1-2952.1 of the Code of Virginia provides that the board promulgate regulations governing the prescriptive authority of physician assistants of certain controlled substances and devices.

Purpose: The purpose of the amendments is to update terminology and reduce the burden of notifying the board when there are changes in the employment or supervision of physician assistants. The amendments will not reduce the responsibility of assistants or physicians to their patients and will continue to protect the health and safety of the public.

Rationale for Using Fast-Track Process: The action results in a less restrictive regulation, has been approved by the Advisory Board on Physician Assistants, has unanimous approval of the Board of Medicine, and will not be controversial.

Substance: The only substantive changes are relating to notification requirements for discontinuation of employment or absences of the supervising physician to make them more reasonable and less burdensome.

Issues: There are no advantages or disadvantages to the public. There are no advantages or disadvantages to the agency or the Commonwealth.

Small Business Impact Report of Findings: This regulatory action serves as the report of findings of the regulatory review pursuant to § 2.2-4007.1 of the Code of Virginia.

Department of Planning and Budget's Economic Impact Analysis:

Summary of the Proposed Amendments to Regulation. The Board of Medicine (the Board) proposes 1) to no longer require that a physician supervising a physician assistant notify the Board when he or she must be absent from the practice provided there is an alternate supervisor present at the practice, and 2) to allow either the supervising physician or the assistant to inform the Board if the physician assistant will discontinue working under the physician with whom he has a practice agreement on file.

Result of Analysis. The benefits likely exceed the costs for all proposed changes.

Estimated Economic Impact. The proposed changes will no longer require that a physician supervising a physician assistant notify the Board when he or she must be absent from the practice provided there is an alternate supervisor present at the practice. Currently, the regulations require the supervisor to notify the Board if he or she is unable to supervise due to illness, vacation, unexpected absence, or planned absence and must temporarily delegate supervision to another physician. The amended regulation will require a report only in the absence of both the supervisor and the alternate supervising physician. This change is expected to reduce the supervising physicians time and postage costs associated with such notifications since a reduction in the number of required notifications will result from this change.

In addition, the proposed changes will amend the regulatory language to allow either the supervising physician or the assistant to inform the Board if the physician assistant will discontinue working under the physician with whom he has a practice agreement on file. Current language requires both the supervising physician and the assistant to inform the Board. However, in practice, the Department of Health Professions (DHP) accepts this notification from both the supervising physician and the assistant. Even though there will be no change in the current practice followed by DHP, a reduction in the number of duplicate notifications may be expected due to the misleading nature of the current regulatory language.

Businesses and Entities Affected. There are currently 2,622 licensed physician assistants. The number of supervising physicians is not known.

Localities Particularly Affected. The proposed regulations apply throughout the Commonwealth.

Projected Impact on Employment. No significant impact on employment is expected.

Effects on the Use and Value of Private Property. A small reduction in time and postage costs may be expected from reduced reporting requirements. If the business entity for which the supervising physician or physician assistant is working for is responsible for handling such notifications, the expected reduction in costs should have a positive impact on the asset value of the business. However, the magnitude of such impact is likely to be very small.

Small Businesses: Costs and Other Effects. If the supervising physician or physician assistant is working for a small business, the small business may benefit from reduced reporting requirements depending on whether the business entity is responsible for handling such notifications.

Small Businesses: Alternative Method that Minimizes Adverse Impact. The proposed regulations are not anticipated to have an adverse impact on small businesses.

Real Estate Development Costs. No significant impact on real estate development costs is expected.

Legal Mandate. The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Administrative Process Act and Executive Order Number 14 (10). Section 2.2-4007.04 requires that such economic impact analyses include, but need not be limited to, a determination of the public benefit, the projected number of businesses or other entities to whom the regulation would apply, the identity of any localities and types of businesses or other entities particularly affected, the projected number of persons and employment positions to be affected, the projected costs to affected businesses or entities to implement or comply with the regulation, and the impact on the use and value of private property. Further, if the proposed regulation has an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include (i) an identification and estimate of the number of small businesses subject to the regulation; (ii) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the regulation, including the type of professional skills necessary for preparing required reports and other documents; (iii) a statement of the probable effect of the regulation on affected small businesses; and (iv) a description of any less intrusive or less costly alternative methods of achieving the purpose of the regulation. The analysis presented above represents DPBs best estimate of these economic impacts.

Agency's Response to Economic Impact Analysis: The Board of Medicine concurs with the analysis of the Department of Planning and Budget for 18VAC85-50, Regulations Governing the Practice of Physician Assistants, relating to regulatory reform changes.

Summary:

Amendments (i) add requirements for the practice agreement to include those relating to prescriptive authority; (ii) revise the notification requirements to make them less burdensome; and (iii) adjust some terminology to conform to current Virginia Administrative Code language.

Part I
General Provisions

18VAC85-50-10. Definitions.

A. The following words and terms shall have the meanings ascribed to them in § 54.1-2900 of the Code of Virginia:

"Board."

"Physician assistant."

B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:

"Committee" means the Advisory Committee on Physician Assistants as specified in § 54.1-2950.1of the Code of Virginia.

"Group practice" means the practice of a group of two or more doctors of medicine, osteopathy, or podiatry licensed by the board who practice as a partnership or professional corporation.

"Institution" means a hospital, nursing home or other health care facility, community health center, public health center, industrial medicine or corporation clinic, a medical service facility, student health center, or other setting approved by the board.

"NCCPA" means the National Commission on Certification of Physician Assistants.

"Practice agreement" means a written agreement developed by the supervising physician and the physician assistant that defines the supervisory relationship between the physician assistant and the physician, the prescriptive authority of the physician assistant, and the circumstances under which the physician will see and evaluate the patient.

"Supervision" means:

1. "Alternate supervising physician" means a member of the same group or professional corporation or partnership of any licensee, any hospital or any commercial enterprise with the supervising physician. Such alternating supervising physician shall be a physician licensed in the Commonwealth who has registered with the board and who has accepted responsibility for the supervision of the service that a physician assistant renders.

2. "Direct supervision" means the physician is in the room in which a procedure is being performed.

3. "General supervision" means the supervising physician is easily available and can be physically present or accessible for consultation with the physician assistant within one hour.

4. "Personal supervision" means the supervising physician is within the facility in which the physician's assistant is functioning.

5. "Supervising physician" means the doctor of medicine, osteopathy, or podiatry licensed in the Commonwealth who has accepted responsibility for the supervision of the service that a physician assistant renders.

6. "Continuous supervision" means the supervising physician has on-going, regular communication with the physician assistant on the care and treatment of patients.

18VAC85-50-57. Discontinuation of employment.

If for any reason the assistant discontinues working in the employment and under the supervision of a licensed practitioner, such assistant and or the employing practitioner shall so inform the board. A new protocol practice agreement shall be submitted to the board and approved by the board in order for the assistant either to be reemployed by the same practitioner or to accept new employment with another supervising physician.

18VAC85-50-115. Responsibilities of the physician assistant.

A. The physician assistant shall not render independent health care and shall:

1. Perform only those medical care services that are within the scope of the practice and proficiency of the supervising physician as prescribed in the physician assistant's practice agreement. When a physician assistant is to be supervised by an alternate supervising physician outside the scope of specialty of the supervising physician, then the physician assistant's functions shall be limited to those areas not requiring specialized clinical judgment, unless a separate practice agreement for that alternate supervising physician is approved and on file with the board.

2. Prescribe only those drugs and devices as allowed in Part V (18VAC85-50-130 et seq.) of this chapter.

3. Wear during the course of performing his duties identification showing clearly that he is a physician assistant.

B. If, due to illness, vacation, or unexpected absence, the supervising physician or alternate supervising physician is unable to supervise the activities of his assistant, such supervising physician may temporarily delegate the responsibility to another doctor of medicine, osteopathic medicine, or podiatry. The supervising physician so delegating his responsibility shall report such arrangement for coverage, with the reason therefor, to the board office in writing, subject to the following provisions:

1. For planned absence, such notification shall be received at the board office at least one month prior to the supervising physician's absence of both the supervising and alternate supervising physicians;

2. For sudden illness or other unexpected absence that necessitates temporary coverage, the board office shall be notified as promptly as possible, but in no event later than one week; and

3. Temporary coverage may not exceed four weeks unless special permission is granted by the board.

C. With respect to assistants employed by institutions, the following additional regulations shall apply:

1. No assistant may render care to a patient unless the physician responsible for that patient has signed the practice agreement to act as supervising physician for that assistant. The board shall make available appropriate forms for physicians to join the practice agreement for an assistant employed by an institution.

2. Any such practice agreement as described in subdivision 1 of this subsection shall delineate the duties which said physician authorizes the assistant to perform.

3. The assistant shall, as soon as circumstances may dictate, report an acute or significant finding or change in clinical status to the supervising physician concerning the examination of the patient. The assistant shall also record his findings in appropriate institutional records.

D. Practice by a physician assistant in a hospital, including an emergency department, shall be in accordance with § 54.1-2952 of the Code of Virginia.