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Legislative Information


New Virginia PA Laws

VAPA would like to call your attention to two significant changes to the PA laws that took effect on July 1st, 2016:

  1. Practice Agreements between a PA and supervising physician are no longer subject to approval by the Board of Medicine. PAs are required to maintain evidence of an agreement, however, and to submit it to the Board upon request.
  2. PAs employed by a hospital or emergency department are no longer required to discuss cases with an attending physician prior to patient discharge. Specialty consulting PAs would still need to discuss the patient with the attending physician.

We also wanted to mention some additional changes to Virginia law as of July 1, 2016:

  • Active duty health care providers in active service at any public or private health care facility are now required to provide services in accordance with official military duties instead of official military orders.
  • PAs may administer vaccinations to children, and provide a certificate stating that an immunization has been administered.
  • Authorizes PAs to provide training programs on the administration of drugs to students of accredited private schools.

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Update on Virginia Prescription Regulations

Over a year ago, the Virginia Academy of Physician Assistants became aware that not all Electronic Medical Records reflected the supervising physician's name on prescriptions when sent electronically. This is largely due to a fault of the written code of some programs, and placed PAs at risk of violating Virginia code.

VAPA sought and has received regulatory change. As of 15 January 2016, the supervising physician's name is no longer required on Schedule VI (non-controlled) prescriptions (see below reference). This change does not necessarily mean one needs to change their prescription pad or software, should their physician be currently listed. However, if ones EMR was previously not in compliance, there is now relief.

Note that regulations continue to require that the supervising physician be reflected on all Schedule II-V (controlled) prescriptions. Should your EMR remain out of compliance, VAPA's recommendation is to check with your IT department for help in developing a solution to insure regulatory compliance. Identifying ones physician in a comment block might be an option.

The Virginia Academy of Physician Assistants continues to monitor the climate for the opportunity to remove the need for the physician name to be included on any prescription. Please contact us at vapa@vapa.org with any question or concern.

18VAC85-50-160. Disclosure.

  1. Each prescription for a Schedule II through V drug shall bear the name of the supervising physician and of the physician assistant.
  2. The physician assistant shall disclose to the patient that he is a licensed physician assistant, and also the name, address and telephone number of the supervising physician. Such disclosure shall either be included on the prescription pad or may be given in writing to the patient.

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New CPT Code for Fluoride Varnish Application for Medical Providers

Please be aware of an important code change that will affect medical providers who bill Medicaid for fluoride varnish application.

Medical Providers Only:
  • Beginning March 1, 2015, physicians and other qualified health professionals who bill Medicaid for application of topical fluoride varnish will only be able to bill using CPT code 99188.
  • Medical providers currently using the code D1206 should immediately begin using 99188 to avoid claim denials.
  • The rate of payment, age limitations and frequency of treatment will remain the same.
There is no change for dental providers. Dental providers using an ADA claim form should continue to bill using the code D1206.

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2015 White Coats on Call

White Coats on Call

VAPA will advocate for the PA profession with our physician partners at MSV at the General Assembly in Richmond on February 4, 2015. Register here: http://msv.org/MainMenuCategories/Advocacy/WCOC.aspx

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Hydrocodone Prescription Changes Effective October 6th

The Drug Enforcement Administration (DEA) issued a final rule rescheduling hydrocodone combination products (HCPs) into controlled substance schedule II, effective Oct. 6. Click here to view detailed information on the final rule, which states that prescriptions for HCPs issued before Oct. 6 that have authorized refills may be dispensed in accordance with DEA rules for refilling, partial filling, transferring and central filling Schedule III-V controlled substances until April 8, 2015. Some health insurers and pharmacies may not honor refills on or after Oct. 6, 2014 due to state laws, insurance limitations or pharmacy processes so prescribers should be prepared to provide new hard copy or electronic prescriptions for patients beginning on Oct. 6, 2014 rather than have patients use what would have been existing refills.

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Interactive Physician Assistant Scope of Practice Law Guide

The duties and responsibilities PAs are able to perform are determined by the state in which they practice. All PAs must practice under physician supervision; however, state laws dictate the extent of that relationship. This interactive guide provides a general overview of the physician assistant scope of practice laws per state with regard to the American Association for Physician Assistant’s (AAPA) Six Key Elements.

bartonassociates.com/nurse-practitioners/physician-assistant-scope-of-practice-laws/

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+HVaW
A Healthy Virginia Works is a coalition of business and community leaders and citizens seeking to reform and replace traditional Medicaid in Virginia in order to improve access to quality healthcare in the Commonwealth through a new initiative. For more information, visit ahealthyvirginiaworks.com/.

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Prescription Monitoring Program (PMP) Update

Virginia and West Virginia now work together across state lines in the fight against prescription drug abuse as part of the National Association of Boards of Pharmacy Prescription Monitoring Program InterConnect (PMPi). The online system allows physicians and prescribers in both states, as well as several other states, to mutually review a patient’s use of controlled substances, reduce drug diversion and make doctor shopping more difficult. As of early March 2014, practitioners in Virginia have access to prescription data in West Virginia’s PMP. West Virginia has also implemented reciprocal capabilities with Virginia’s PMP.

Other PMPi states as of 2014 include: Arizona, Connecticut, Delaware, Illinois, Indiana, Kansas, Louisiana, Michigan, New Mexico, North Dakota, Ohio, South Carolina, South Dakota and Tennessee.

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2014 VAPA Legislation

HB 191 Expert witness testimony; chiropractor; physician assistant. (Delegate Minchew)
Allows a properly qualified physician assistant to testify as an expert witness in a court of law on certain matters within the scope of his activities as authorized under Virginia law, except in any medical malpractice action for or against (i) a defendant doctor of medicine or osteopathic medicine regarding standard of care or (ii) a defendant health care provider regarding causation. The bill also adds "treatment" and "treatment plan" to those matters about which a chiropractor may testify as an expert witness.
03/03/14 House: Signed by Speaker
03/06/14 Senate: Signed by President

HB 1129 Physician assistants; possession and administration of topical fluoride varnish. (Delegate Garrett)
Allows physician assistants to possess and administer topical fluoride varnish to the teeth of children aged six months to three years pursuant to an oral or written order or a standing protocol issued by a doctor of medicine, osteopathic medicine or dentistry that conforms to standards adopted by the Department of Health.
03/03/14 Approved by Governor (effective 7/1/14)

HB 1134 Practice of physician assistants. (Delegate O’Bannon)
Updates terminology related to practice agreements for physician assistants and adds physician assistants to the definition of "health care provider" for the purposes of medical malpractice.
03/03/14 Approved by Governor (effective 7/1/14)

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PHYSICIAN ASSISTANT FLUOROSCOPY REGULATIONS


UPDATE (3/13/14)
The application for the ARRT Fluoroscopy Exam is available at: www.dhp.virginia.gov/Forms/medicine/PA/ARRT_Fluoroscopy_Exam_App.doc

Once the AART receives the application from the Virginia Board of Medicine, they will contact the candidate with information about the how to register for the exam.

18 VAC 85-50-117. Authorization to use fluoroscopy.
A physician assistant working under the supervision of a licensed doctor of medicine or osteopathy specializing in the field of radiology is authorized to use fluoroscopy for guidance of diagnostic and therapeutic procedures provided such activity is specified in his protocol and he has met the following qualifications:
  1. Completion of at least 40 hours of structured didactic educational instruction and at least 40 hours of supervised clinical experience as set forth in the Fluoroscopy Educational Framework for the Physician Assistant created by the American Academy of Physician Assistants (AAPA) and the American Society of Radiologic Technologists (ASRT); and
  2. Successful passage of the American Registry of Radiologic Technologists (ARRT) Fluoroscopy Examination.

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PHYSICIAN ASSISTANT FCVS PACKETS NOW ACCEPTED IN VIRGINIA

The Virginia Board of Medicine will now accept FEDERATION CREDENTIALS VERIFICATION SERVICE (FCVS) packets for physician assistants. Application for FCVS can be found: http://www.fsmb.org/fcvs_paapp.html

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Updated PA Practice Regulations

Click here for the updated Regulations Governing the Practice of Physician Assistants as of Sept. 26, 2013

Click here for the new regulations as published in the Virginia Register of Regulations on August 12, 2013


Click Here to View Archived Information

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>> Health Care Reform Testimony by Fitzhugh Mullan, MD

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Prescriptive Privileges

Do you have a question about prescriptive privileges in the state of Virginia? You may find your answer on the prescriptive privileges page. If not, e-mail us with your question at vapa@vapa.org .

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Chart Signing

This is a summary of the most current chart signing information for licensed PAs in Virginia. The section of regulation is also listed in this summary.

The Virginia Board of Medicine approved the removal of the need to sign charts within 72 hrs via an emergency regulation in 2002. This regulation was made permanent in June 2003. The timing of signature was left up to the supervising physician based on the acuity of care and practice setting. Also, there is no specific requirement as to the number of charts that need signature. The regulation also requires that a practice agreement be developed giving the details of the chart signing procedure in your practice. The practice agreement needs to be kept in your office should the Board of Medicine request to view it. It was recommended by Dr. William Harp, the Executive Director of the Board of Medicine, that the content of the practice agreement be "defensible to a panel of your peers." It is also suggested that your group's legal council be involved in development of the practice agreement. Below is the section of the regulation that involves the above.

18VAC85-50-101. Requirements for a practice agreement. A. Prior to initiation of practice, a physician assistant and his supervising physician shall submit a written practice agreement which spells out the roles and functions of the assistant. Any such practice agreement shall take into account such factors as the physician assistant's level of competence, the number of patients, the types of illness treated by the physician, the nature of the treatment, special procedures, and the nature of the physician availability in ensuring direct physician involvement at an early stage and regularly thereafter. The practice agreement shall also provide an evaluation process for the physician assistant's performance, including a requirement specifying the time period, proportionate to the acuity of care and practice setting, within which the supervising physician shall review the record of services rendered by the physician assistant.

 

Legislative Update

This link provides information on our latest legislative victory concerning pronouncement of death by PAs in Virginia. The section of the law (effective July 1) is also available. More...

 

 

Updated: July 12, 2016