Legislative Information

House Approves Bill to Improve Federal Workers' Access to Care Provided by PAs

Exciting news! The House approved H.R. 2465, the Federal Workers' Compensation Modernization and Improvement Act. The bill, which was introduced on July 8, 2011, amends the Federal Employees Compensation Act (FECA) to allow PAs to diagnose and treat federal employees with job-related traumatic injuries, 85% of all federal workers' compensation cases. It was approved by the House Committee on Education and the Workforce in July and passed without objection by the House of Representatives on November 29, 2011. HR 2465 is the first significant reform of FECA in over 40 years.

Many thanks to all the PAs who have worked in support of this legislation for decades. Your advocacy efforts contributed significantly to its passage by the House. However, there is still work to be done. Before it can become law, the Senate must approve the House-passed legislation. All PAs are asked to contact their Senators and ask them to take action on the Federal Workers' Compensation Modernization and Improvement Act this Congress.

Background: This legislation would make a technical fix to a law that pre-dates the PA profession. The Federal Employees' Compensation Act (FECA) was enacted before the PA profession was created and desperately needs to be updated to recognize the role of PAs in a modern health care system. Although the overwhelming majority of state workers' compensation programs recognize PAs, the federal program does not. Consequently, unless a physician is on site to sign a federal workers' compensation claim form for care provided by a PA, the PA must either send the injured worker to a local emergency room for treatment, or provide care that will not be compensated by the US Department of Labor.The inability of PAs to provide medical care to federal employees who are injured on the job limits federal employees' access to medical care, disrupts continuity of care, and creates unnecessary costs to the program.Please contact your Senators TODAY – urge them to pass the Federal Workers' Compensation Modernization and Improvement Act this Congress. Please also thank your Representative for House passage of HR 2465.Thank you for your advocacy in action!

Changes to Malpractice Insurance in VA

Virginia lawmakers overrode Governor McDonnell's veto of HB 1459 / SB 771 which allows for annual increases in the maximum amount that a plaintiff can recover from any one medical incident. The new law provides for annual increases of $50,000 over the course of the next 20 years, which will incrementally increase the cap from $2,000,000 to $3,000,000.

Of significance to you, your company policy should allow for an increase in coverage of an additional $50,000 per year. Please check with your employer to make sure they are adequately covering you. This should include an annual increase in coverage by $50,000 for the next 20 years.

New Laws for July 1, 2011

The signature of a physician assistant will be accepted in those circumstances that the signature, certification, stamp, verification, affidavit or endorsement of a physician is required.
Nurse practitioners and physician assistants can now determine the cause of death and sign the death certificate provided they have access to the decedent’s medical history and the death is due to natural causes.
Emergency department physician assistants are added to the list of those that can sign death certificates, and immunity is granted for a good faith completion of the death certificate. See below:
- In the absence of the physician or with his approval, the certificate may be completed and signed by an associate another physician employed or engaged by the same professional practice, a nurse practitioner or physician assistant supervised by such physician, the chief medical officer of the institution in which death occurred, a physician specializing in the delivery of health care to hospitalized or emergency department patients who is employed by or engaged by the facility where the death occurred, or the physician who performed an autopsy upon the decedent, if such individual has access to the medical history of the case and death is due to natural causes.
- A physician, nurse practitioner or physician assistant who, in good faith, signs a certificate of death or determines the cause of death shall be immune from civil liability, only for such signature and determination of causes of death on such certificate, absent gross negligence or willful misconduct.

Physician Assistant Proposed Regulations re: 4th visit and supervision

The Board of Medicine approved proposed regulations that will replace the term “protocol” in the regulations with “practice agreement” to reflect the language in the law. Also, the requirement for a visit with the supervising physician every 4th visit has been replaced with “the supervising physician shall be involved with any patient with a continuing illness as noted in the written practice agreement for the evaluation process.” These changes are not yet in place; they are under Executive Branch review.

Hospice Bill Introduced in the Senate - Contact Senators TODAY!

An exciting development: A bill has been introduced in the Senate to allow PAs to provide hospice services to Medicare beneficiaries. Sens. Chuck Grassley (R-IA) and Kent Conrad (D-ND) introduced S. 891, the Medicare Hospice Care Access Act, on May 5, 2011. Please contact your Senators TODAY and ask them to cosponsor this important legislation.

Currently, PAs are barred from providing hospice care to beneficiaries, even though it is allowed by state law. The inability of PAs to provide hospice care for their terminally ill Medicare patients places an unconscionable burden on the patient to find alternative care and denies patients access to their "medical home" at a time when they are the most vulnerable.
Please contact your Senators and tell them of the critical need for PAs in hospice medicine. Ask them to cosponsor S. 891 today.

Background
In 1997, the 105th Congress passed the Balanced Budget Act (BBA). The BBA made it clear that medical services provided by PAs, as allowed by state law, are covered by Medicare in all settings at one uniform rate.
Unfortunately, the former Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) decided that the BBA’s Medicare provisions regarding coverage of services provided by PAs did not apply to hospice care. As a result, PAs are not permitted to provide hospice care to beneficiaries who elect the hospice benefit. It makes no sense that Medicare beneficiaries who routinely receive full-spectrum medical care from a PA and who elect to receive the hospice benefit are not able to receive hospice care provided by their PA.
Allowing PAs to provide hospice care does not change the PA/physician relationship, nor does it increase cost (as PAs are reimbursed at 85% under Medicare). What it does do is increase patients' access to care, and improve continuity of care, especially in medically underserved areas.
Without this technical fix, beneficiaries will continue to face delays and denial of medically necessary care covered by Medicare. Please contact your legislators today and urge them to cosponsor S. 891.
Thank you for your advocacy in action!

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Dear Virginia Physician Assistants,

I am happy to report that our 2011 PA Advocacy Day at the State Capitol culminated in much success for our profession and patients. Both of the bills we lobbied for were signed by Governor McDonnell and will allow for the continued efficiency and effectiveness of Physician-PA teams in our great state. Here are brief descriptions of the enacted legislation which become effective July 1, 2011.

Senate Bill 1144 will now allow PA s to perform DMV-required competency examinations. Prior to the bill’s enactment, these examinations could only be performed by licensed physicians and nurse practitioners.

Under House Bill 1968, whenever any law or regulation requires a signature, certification, stamp, verification, affidavit or endorsement by a physician, it shall be deemed to include a signature, certification, stamp, verification, affidavit or endorsement by a physician assistant.

In addition to the above legislation, we have also been working with the Medical Society of Virginia on the medical malpractice cap which was recently vetoed by the Governor. This will be an ongoing project for us as we continue to collaborate with the MSV.

I would like to thank the VAPA Legislative Committee members- Dave Falkenstein, Zane Reasoner and Robert Glasglow for all of their hard work and dedication as well as all the PA professionals and students who actively participated in Lobby Day 2011.

Physician Assistants are a valuable part of the health care reform in Virginia and we must continue to contribute to this endeavor in order to increase access to care for all patients in Virginia.

Finally, I ask you to remember that we are only as strong as our membership base and your involvement within our organization. Join VAPA today and be a part of our continued advocacy efforts. We have many issues to pursue, including the elimination of the 4th visit rule and the use of fluoroscopy, which can only be achieved by our help.

Thank you for your support.

Polly A. Porter, MPAS, PA-C, ATC
President
Virginia Academy of Physician Assistants
www.vapa.org

Use the feature below to write to your legislators.

>> Health Care Reform Testimony by Fitzhugh Mullan, MD

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 .

Chart Signing

This is a summary of the most current chart signing information for licensed PAs in Virginia. The section of regulation i 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 protocol be developed giving the details of the chart signing procedure in your practice. The protocols need 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 protocol be "defensible to a panel of your peers." It is also suggested that your group's legal council be involved in development of the protocols. Below is the section of the regulation that involves the above.

18VAC85-50-101. Requirements for a protocol. A. Prior to initiation of practice, a physician assistant and his supervising physician shall submit a written protocol which spells out the roles and functions of the assistant. Any such protocol 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 protocol 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...