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ARIZONA STATE SENATE
Fifty-Sixth Legislature, First Regular Session
physician assistants; supervision; collaboration
Purpose
Effective January 1, 2024, allows a physician assistant (PA) who has at least 8,000 hours of clinical practice certified by the Arizona Regulatory Board of Physician Assistants (AZPA) to practice without a supervision agreement in collaboration with appropriate health care professionals. Requires a PA who has less than 8,000 hours of AZPA-certified clinical practice to work under a supervision agreement.
Background
PAs in Arizona are licensed and regulated by the AZPA. PAs may work under
the supervision of a licensed physician in physician offices, clinics,
hospitals, surgical centers, patient homes, nursing homes or other health care
institutions. The duties of a PA include: 1) ordering, prescribing, dispensing
or administering drugs and medical devices; 2) pronouncing and authenticating
deaths; 3) obtaining patient histories; 4) performing physical examinations;
5) ordering and performing diagnostic and therapeutic procedures; 6)
formulating diagnostic impressions; 7) developing and implementing treatment
plans; 8) monitoring the effectiveness of therapeutic interventions; 9)
assisting in surgery; 10) offering counseling and education;
11) making appropriate referrals; 12) prescribing schedule II, III, IV or V
controlled substances; 13) performing minor surgery; and 14) performing other
delegated nonsurgical health care tasks.
A physician supervising a PA must: 1) meet AZPA supervision requirements; 2) accept responsibility for all tasks and duties delegated to a PA; 3) notify the AZPA and the PA in writing if the PA exceeds the scope of the delegated health care tasks; and 4) maintain a written agreement with the PA that describes the PA's scope of practice (A.R.S. § 32-2531).
The AZPA certifies PAs for 30-day prescription privileges for schedule II, III, IV and V controlled substances that are opioids or benzodiazepine and 90-day prescription privileges for schedule II, III, IV and V controlled substances that are not opioids or benzodiazepine if the physician assistant meets outlined requirements (A.R.S. §. 32-2504).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
PA Scope of Practice
1. Expands a PA's scope of practice from health care tasks delegated by a supervising physician to any legal medical service for which the PA has been prepared by education, training and experience and that the PA is competent to perform and adds, to the medical services that a PA may provide:
a) interpreting diagnostic studies and therapeutic procedures;
b) providing, rather than offering, counseling and education to meet patient needs;
c) providing consultation on request;
d) writing medical orders;
e) obtaining informed consent;
f) delegating and assigning therapeutic and diagnostic measures to and supervising licensed or unlicensed personnel; and
g) prescribing prescription-only medications for up to one year for each patient.
Collaborative PAs
2. Exempts a PA who has at least 8,000 hours of AZPA-certified clinical practice from the requirement to practice pursuant to a supervision agreement and requires the PA to continue to collaborate with, consult with or refer to the appropriate health care professional as indicated by the patient's condition and by the PA's education, experience and competencies.
3. Deems a PA who does not practice pursuant to a supervision agreement as legally responsible for the health care services performed by the PA.
4. Specifies that the level of collaboration required of a PA is determined by the policies of the practice setting at which the PA is employed, including a physician employer, physician group practice or health care institution.
5. Allows a PA's collaboration, consultation or referral to an appropriate health care professional to occur through electronic means and specifies that the collaboration, consultation or referral does not require the physical presence of the appropriate health care professional at the time or place the PA provides medical services.
6. Specifies that the authority for a PA who has 8,000 hours of AZPA-certified clinical practice to practice without a supervision agreement does not prohibit the PA from practicing pursuant to a supervision agreement.
7. Requires a licensed PA who is in good standing, who has graduated from an accredited U.S. PA program and who has at least 8,000 hours of clinical practice within the previous five years in Arizona or another jurisdiction to provide the AZPA with documentation of having completed at least 8,000 hours of clinical practice.
8. Allows a PA to bill and receive direct payment for the professional services provide by the PA.
PAs Working Under a Supervision Agreement
9. Requires a PA who has less than 8,000 hours of AZPA-certified clinical practice to work in accordance with a supervision agreement that describes the PA's scope of practice and prohibits the PA from performing health care tasks until the PA has completed and signed a supervision agreement.
10. Requires the supervision agreement to specify the PA's ability to prescribe, dispense or administer prescription-only medication or schedule II, III, IV or V controlled substances.
11. Allows, under a supervision agreement, supervision to occur through electronic means and specifies that the physical presence of the supervising physician is not required at the time or place the PA provides medical services.
12. Exempts a PA from the supervision agreement requirements on receipt of AZPA-certification of the PA's completion of at least 8,000 hours of clinical practice.
AZPA
13. Allows the AZPA to count practice hours earned in another jurisdiction toward the hours of required clinical practice.
14. Requires the AZPA to develop:
a) a policy that sets forth the process of attestation or documentation required as proof of completion of at least 8,000 hours of clinical practice and issuance of certification of completion of the 8,000 hours of clinical practice; and
b) an alternative comparable standard for certification of 8,000 hours of clinical practice for PAs who have been actively practicing for more than five years.
15. Requires the AZPA to adopt rules establishing additional certification standards or requirements for PAs who previously completed 8,000 hours of AZPA-certified clinical practice and who are seeking employment with a collaborating physician or entity for a position that is not substantially similar to the practice setting or specialty in which the PA was previously certified.
16. Modifies AZPA membership by allowing collaborating physicians to fulfil the physician member positions.
17. Removes the requirement for the AZPA to randomly audit at least five percent of supervision agreements each year.
18. Exempts the AZPA from rulemaking requirements for one year.
Supervising Physicians
19. Removes requirements for a supervising physician to:
a) meet AZPA-established supervisory requirements;
b) notify the AZPA and PA in writing if the PA exceeds the scope of the delegated health care tasks.
20. Removes the requirement, if a PA practices in a location where a supervising physician is not routinely present, for the PA to meet with the supervising physician at least once each week to ensure ongoing direction and oversight of the PAs work.
Miscellaneous
21. Applies requirements for supervising physicians in disciplinary action investigations to collaborating physicians.
22. Specifies that a PA is not required to have completed 8,000 hours of clinical practice to provide medical care in response to a natural disaster, accident or other emergency.
23. Adds, to the methods of pronouncing death or authenticating a form, a PA's certification, stamp, verification, affidavit or endorsement.
24. Removes the requirement for a PA to wear a name tag with the designation physician assistant while on duty.
25. Defines collaborating physician or entity and supervision agreement.
26. Modifies the definition of unprofessional conduct to include the PA performing a health care task that does not meet the applicable supervision or collaboration requirements.
27. Makes technical and conforming changes.
28. Becomes effective on January 1, 2024.
House Action
HHS 2/13/23 DPA 6-3-0-0
3rd Read 3/7/23 42-18-0
Prepared by Senate Research
March 24, 2023
MG/slp