The Ohio State Medical Board finalized the physician assistant rules, which are codified at Ohio Administrative Code Chapter 4730-1 and Chapter 4730-2. The rules supplement the physician assistant law enacted in 2006.
Most significantly, the new rules establish the process for a physician assistant ("PA") to apply for a certificate to prescribe ("CTP"). While prescriptive authority for PAs was established in the PA law, PAs could not obtain a CTP until issuance of the rules. Accordingly, as of October 31, 2007, a PA can apply for a CTP. To apply for a CTP or provisional CTP, a PA must use the Medical Board forms which are also now available.
The rules do not yet finalize a PA Formulary. However, the PA law and rules allow PAs granted a CTP to prescribe under the APN Formulary immediately and until the PA Formulary is finalized (with the exception of schedule II controlled substances). Separate proposed rules containing a PA Formulary are currently pending (because PAs can use the APN Formulary on an interim basis, the fact that the PA Formulary is still pending does not mean that PAs must wait to apply for a CTP).
Hospitals should be prepared to evaluate PAs requesting to exercise prescriptive authority in the hospitals. Under the PA law, hospitals should have policies defining the ability of a PA to practice in the hospital and should have developed privilege sets to grant PAs under such policies. The inclusion of prescriptive authority in these policies and privilege sets should be relatively straightforward. Hospitals, however, will need to determine the parameters of prescriptive authority for all PAs and individual PAs.
Further, a mandatory part of the process for a PA to get a CTP is to complete an initial provisional CTP period. Obviously, these will be the initial issues hospitals will encounter with the first PAs seeking CTPs. Under the new rules, the provisional period must last between 1,000 and 1,800 hours and between six and twelve months. During the first 500 hours of this period, the PA with a provisional CTP must be under on-site supervision by the PA's supervising physician. Additionally, during the first 500 hours of this period, the supervising physician must sign-off on all patient charts of the PA to evaluate the PA's competence, skill and knowledge in pharmacokinetic principles. This physician sign-off must occur "within a reasonable period of time," which is not defined in the new rules. During the rest of the provisional period after the first 500 hours, the supervising physician must sign-off on at least 50% of patient charts of the PA for this purpose. This is the PA's requirement in order to complete successfully the provisional CTP period. This physician sign-off is not a hospital obligation. Nevertheless, failure by a supervising physician to supervise the PA in accordance with these rules may have clinical quality effects and should be of concern to hospitals.
Additionally, the rules contain new provisions for levels of physician supervision required for PA practice, which correspond to the supervision levels previously found in the former PA law. The supervision levels and requirements are:
- Direct supervision. Supervising physician in the same room as and in actual sight of the PA. The rules provide that direct supervision is required: (1) when required by a supervisory plan or special services plan (for PAs practicing outside of a health care facility), or (2) when required by the health care facility (for PAs practicing in a health care facility).
- On-site supervision. Supervising physician in the same location, but not necessarily the same room as the PA. The rules provide that on-site supervision is required: (1) for PAs practicing in a hospital emergency room when that is the routine practice location of the supervising physician and PA; (2) as noted above, during the first 500 hours of a provisional CTP period; (3) when required by a supervisory plan or special services plan (for PAs practicing outside of a health care facility), or (4) when required by the health care facility (for PAs practicing in a health care facility).
- Off-site supervision. Supervising physician continually available for direct communication with the PA (such as via telephone) and must be within sixty minute travel time of the PA. The rules provide that off-site supervision is required in all other instances when direct or on-site supervision are not required.
Thus, the new PA rules expressly recognize that hospitals may impose direct or on-site supervision requirements as deemed appropriate by the hospital. Hospitals should ensure such requirements are described in their PA policies (if applicable to all PAs) or in PA privilege sets (if applicable to individual PAs).