SB718 The 2017 Assistant Physician Modified Provisions. (Full Text that applies to APs)

ASSISTANT PHYSICIANS:

This act changes the examination requirement for an assistant physician to require that an assistant physician complete Step 2 instead of Step 1 and Step 2, of the United States Medical Licensing Examination within a three-year period before applying for licensure but in no event more than three years after graduation from a medical college.

An assistant physician licensure fee cannot be more than the licensure fee for a physician assistant. Additionally, no rules can require an assistant physician to complete more hours of continuing medical education than a licensed physician.

The act repeals the requirement that an assistant physician has to enter into a collaborative practice agreement within six months of initial licensure.

A health carrier shall reimburse an assistant physician on the same basis that it covers a service when it is provided by another comparable mid-level provider.

No rule or regulation shall require the collaborating physician to review more than ten percent of the assistant physician's patient charts or records during the one-month period that the physician is continuously present while the assistant physician is practicing medicine.

An assistant physician may prescribe buprenorphine for up to a 30-day supply without refill in certain circumstances.

An assistant physician who is providing opioid addiction treatment can receive a certificate of prescriptive authority without having completed 120 hours of practice in a four month period with a collaborating physician.

(Sections 334.036 & 334.037)

These provisions are substantially similar to provisions contained in the truly agreed CCS/HCS/SB 951 (2018), and similar to provisions contained in SCS/HCS/HB 2127 (2018) and SCS/HCS/HB 1574 (2018).

COLLABORATIVE PRACTICE AND SUPERVISORY AGREEMENTS: Current law authorizes physicians to enter into a collaborative practice agreement with 3 advanced practice registered nurses (APRN) and 3 assistant physicians, and a supervising agreement with 3 licensed physician assistants. This act authorizes physicians to enter into a collaborative practice agreement or a supervising agreement with 6 APRNs, assistant physicians, licensed physician assistants, or any combination thereof.

Health Care Provider Taxonomy Paperwork in the Works.

The paper work for AP’s in Missouri is moving forward. Below is the Rational for Request for the Health Care Provider Taxonomy Code Request Form. This is to add a new classification into the NPI numbers for Assistant Physicians.

This will reduce confusion on applying and to make paperwork easier for the insurance companies and the pharmacists.

The request will be sent in soon.

If you click here, it shows the health code taxonomy. As you can see, we are absent. I am suggesting to the NUCC that we be added. The proposed change is to change the name of the category of “Physician Assistants & Advanced Practice Nursing Providers”   to include “Assistant Physicians”. After this, Assistant Physicians can have a sub category and the different specialties can be categorized below that.

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Rationale for Request

Enter a description of the business need for the request. Please include specific examples of

how the provider is impacted by not having a code.

A new taxonomy is needed to identify Assistant/Associate Physicians.

In the last few years, states have been issuing new medical licenses in an effort to deal with the

shortage of healthcare providers. For example, in the state of Missouri, senate bills 716 and 754

contain language calling on the Missouri Board of Healing Arts to license “assistant physicians”,

medical school graduates who have not yet completed a residency. Similar legislation is or has

been occurring in GA, VA, AR, UT, KS, OK, WA, and NH, as well. However, what we have not seen

to date is a new taxonomy for these prescribers and, as a result, we’re seeing many of these

prescribers’ NPIs being enumerated with taxonomies such as Family Medicine, Internal

Medicine, Physician Assistant, and General Practice, which are not accurate. They should have

their own taxonomy to properly identify them, similar to the taxonomy for residents/interns

(Student in an Organized Health Care Education/Training Program).

With these inaccurate taxonomies, industry stakeholders are not able to appropriately perform

prescriptive authority validations. A proper taxonomy for this new provider type is needed to

allow pharmacies, PBMs, and payers (e.g., State Medicaid agencies) to determine if the

prescriber should be practicing under a supervising physician, can prescribe controlled

substances, or are eligible to enroll with Medicare and/or Medicaid programs in order to comply

with state and federal regulatory requirements.

Additional Information for the Request

Enter any additional information to support the request.

Version 5

12/2016

7

The DEA has also recognized the categorization of assistant physicians and has created a new

business activity subcode (BASC = J) to identify these prescribers. It should be noted that the DEA

is categorizing these prescribers as mid-level practitioners with a business activity code of ‘M’.

For additional information, please refer to page 3 of the “DEA REGISTRATION RECORD LAYOUT”

(https://dea.ntis.gov/recordlayout.pdf).

Proposed Definition

Enter the proposed definition for the code. New code requests must include a definition.

An individual who has completed medical school, is nationally ECFMG/ACGME Certified, and

provides patient care services under the supervision of a physician as part of a collaborative

practice agreement. The methods of treatment and the authority to administer, dispense, or

prescribe drugs delegated in a collaborative practice arrangement between a collaborating

physician and collaborating assistant physician shall be within the scope of practice of each

professional and shall be consistent with each professional’s skill, training, education,

competence, licensure, and/or certification. This taxonomy is not to be confused with “Physician

Assistant.”

Definition source

Enter the source for the proposed definition for the code.

Assistantphysicianassociation.com

Proposed Placement in the Code Set

Enter the proposed placement in the code set, e.g., Level III under Allopathic and Osteopathic

Physicians - Internal Medicine.

Level II under Other Service Providers or Level II under Student, Health Care or Level II under

Physician Assistants and Advanced Practice Nursing Providers

Georgia Starts Preliminary Steps for Drafting Assistant Physician Legislation

The preliminary steps for pro AP legislation is underway in Georgia.  This undertaking is being spearheaded by Curt Thompson, State Senator, District 5.   Senator Thomson is acutely aware of the state of Georgia's high amount of medically under served areas as he has been involved in many of the states medical legislation efforts.  The Senator stated to AMDAP, "I have our Senate Research Office determining what would be needed under Georgia law to do this."
 

If you would like to help with the process please send a testimony to Dr. Trevor Cook via the AP Network or send a message via the Contact Us Page. 

 

Message From Missouri State Rep About future AP Legislation Efforts

On January 11th State Representative Keith Frederick wrote: 

"I am drafting a bill that will include not only the revisions I previously referred to but to re-write much of the rules and regulations which in my opinion are not supported by the original legislation I drafted and that was passed. 

I will seek to reduce CME requirement to 25 hours per year ( like other docs) and define collaborative practice arrangements to be the same as for Nurse Practitioners and to allow the same geographic proximity rules as for NPs.

I spoke with a potential Senate sponsor this am so that we will have my bill working it’s way thru the house and a corresponding Senate bill working it’s way through the Senate. The drafting service could not complete it in time for the bill to be filed today but I plan to file it upon return to the Capitol on Tuesday as Monday is MLK Day. Also, reducing the application fee.

Again disclaimer: these changes are proposed and to become law the bill will have to be passed in House and Senate and be singed by the Governor. There will be around 2,000 bills filed this year and less than 100 are likely to get to the Governor’s desk. However, the odds were these same in 2014 and we prevailed and I believe we can do this.

Testimony from you APs who are in the trenches and from your collaborating Physicians and potential collaborating Physicians will be critical. I will have some bullet point suggestions for thoughts and statistics to cover in testimony but all of this will be well familiar to all of you who have come this far in your medical training.

More to come, but it’s progress. I also filed a bill today, The Increased Access to Opioid Addiction Treatment Act that provides a critical role in MAT for Opioid Addiction tx for Assistant Physicians."

 

Keith Frederick

Orthopedic Surgeon/State Representative

Orthopedic Surgeon & State Rep in 121st Dist.

Virginia Associate Physician Bill To Be Continued in 2017

Virginia is continuing the efforts to bring APs to their communities by introducing HB 900.  The bill's tracking website states that it is to be "Continued to 2017 in Education and Health"

The bill is sponsored by Del. Christopher Stolle [R] and Del. Matthew James [D]. This is showing bipartisan support by having a sponsor from both Republican and Democratic parties. 

The state given summary for the bill is well done and is as follows "Licensure and practice of associate physicians. Authorizes the Board of Medicine to issue a two-year license to practice as an associate physician to an applicant who is 18 years of age or older, is of good moral character, has successfully graduated from an accredited medical school, has successfully completed Step 1 and Step 2 of the United States Medical Licensing Examination, and has not been engaged in a postgraduate medical internship or residency training program. The bill requires all associate physicians to practice in accordance with a practice agreement entered into between the associate physician and a physician licensed by the Board and provides for prescriptive authority of associate physicians in accordance with regulations of the Board. The bill requires the Board to promulgate such regulations to be effective no later than July 1, 2018."

I encourage you to contact the delegates who are sponsoring the bill to show your support for the 2017 season.

To see the full text of the bill and track the progress moving forward click here. 

To show your support for Del. Christopher Stolle click here.

To show your support for Del. Matthew James click here.

To see the full list of Virginia's General Assembly's Delegates (The people voting) click here.   

 

The Arkansas Graduate Registered Physician Act (An Equivalent to the Assistant Physician ) and Application.

In 2015, Arkansas passed the Arkansas Graduate Registered Physician Act.  This act created an Assistant Physician equivalent.  The highlights of the act include: 

  • The use of ECFMG and ACGME is not used but the phrasing "accredited allopathic medical school or osteopathic medical school" is used which is to be assumed is to be the simiar. 
  • Although the term Collaborative Physician Agreement is not specifically used the act states "Works under a physician-drafted protocol approved by the Arkansas State Medical Board"
  • shall be licensed by the Arkansas State Medical Board
  • Has successfully completed Step 1 and Step 2 of the USMLE, COMPLEX-USA, or the equivalent of both steps...within the two-year 2 period immediately preceding application for licensure... but not more than two (2) years after graduation from a medical school (DO or MD).
  • Has not completed an approved postgraduate residency.
  • Has no revocation, suspension, or probation for cause resulting from the applicant's medical practice, unless the board considers the conditions and agrees to licensure
  • Enters into a physician-drafted protocol within six months of initial licensure
  • to include prescribing, ordering, and administering Schedules III-V controlled substances." 

House of Representatives Amendment No. 1 to House Bill No. 1162 introduced the additional statement: 

  • "A license issued under this subchapter shall only be renewed for a maximum of two years." This was changed once more because the the regulations application says 3 years.

 

This is only a summary with highlights.  This is far from a complete list.  Before applying or hiring it is suggested that to read the act and the amendments in their entirety. 

 

The Arkansas State Medical Board gives most of the information for license The Graduate Registered Physician Licensure Pack given via their web site.  It is a "how to" for applying to be a GRP in the state. 

Click here for GRP Licensure Pack

Click here for the Regulations PDF

 

Utah Bill for Graduates Associate Physician (An Equivalent to the AP) Passed and are Developing Rules For Possible Future Residency Credit For AP's

"HB 396 requires the Allopathic and Osteopathic Boards, the Division and Deans of educational institutions to develop rules to administer the educational methods and programs that an associate physician shall complete throughout the collaborative practice arrangement, facilitate the advancement of the associate physicians medical knowledge and capabilities such that it may lead to credit toward a future residency program."

- Larry Marx, Bureau Manager State of Utah Department of Commerce
Division of Occupational and Professional Licensing

It seems that Utah is really pushing for the AP licencing to be a stepping stone not a life profession.  The bill also states that there is a four year cap for the licence.  No official statement on what the "rules to administer the educational methods and programs that an associate physician shall complete" are  however AMDAP will closly monitor the situation for details. 

See the contents of the bill by clicking here. 

 

New Hampshire Opens AP legislation via Representative Dr. William Marsh.

New Hampshire Representative William Marsh (of district 8) has formally introduced AP legislation.  The legislation has a lot of commonalities between the Missouri legislation.  Current, rough estimates, if enacted, will put the time-frame in about July, 2018.  Excitement along with bicameral and bipartisan acceptance is building in New Hampshire to bring medicine to those who need it the most.  For more information please see the links down below:

To see proposed HOUSE BILL 1506-FN click here.

To show your support for William Marsh click here.