On August 15, 2020 Governor Pete Ricketts signed L.B. 755, which streamlines statutory language relating to PA practice and made several changes enhancing care provided by PAs. L.B. 755, which will be effective on November 14, 2020, is the product of collaboration amongst NAPA, the Nebraska Medical Association, Nebraska Department of Health and Human Services and the American Academy of PAs. Among other provisions, L.B. 755:
- Improves the flexibility of PAs to provide care in group practices by allowing a PA’s scope to be determined by the PA’s education, training and experience as long as a physician in the group has a similar scope;
- What does this mean: Previously your scope of practice was defined by only your supervising physician’s scope of practice. Now your scope of practice can also be supported by others in the group setting, if mutually agreed upon. Example: My supervising physician doesn’t place IUDs, but I have this knowledge/skill and would like to be able to do this procedure. Placing an IUD falls into the “usual scope of practice” in the area in which I practice, such as family medicine or OB/GYN. I obtained this skill either through a training program, previous work experience or with a different physician within the same group. I am able to demonstrate competency of this procedure in a way that is mutually agreed upon. I can, therefore, provide this service to patients. The scope of practice agreement should specify which physician will be supporting the additional services, and the supporting physician should be a party to the collaborative agreement.
- Removes language stating that a PA is the agent of the PA’s supervising physician;
- What does this mean: The removal of this statute applies more to the institution interpreting the language, i.e. hospitals, diagnostic centers, and perhaps pharmacies. When ordering a diagnostic test or lab PAs had previously been required to sign both their name and also put the MDs name on the chart, with or without the language “as an agent of”, depending on the facility acting upon those orders. The removal of this language allows the institution to more clearly interpret orders, prescription and other documentation of services performed by the PA.
- Removes practice restrictions for PAs who practice in hospital settings;
- What does this mean: PAs employed by a hospital no longer have to have a supervising agreement with one specific doctor. It was realized PAs employed by hospitals often work with multiple providers in teams, not just one specific doctor. Hospitals have their own by-laws that can address how a PA will be used in their institution.
- Removes practice restrictions for PAs who have less than two years’ experience;
- Specific time together requirements for PAs with less than 2 years of experience and their supervising doctor were removed, as well as specific percentage of chart review requirements. Implementation of a new PA to a practice will be determined at the practice setting.
- Clarifies that PAs may practice in remote settings and removes restrictions on PAs practicing in remote settings with less than two years of experience;
- What does this mean: Specific time together requirements for PAs with less than 2 years of experience and their supervising doctor were removed, as well as specific percentage of chart review requirements. Implementation of a new PA to a practice will be determined at the practice setting.
- Removing this requirement allows for emphasis to be placed on the professional relationship among the PA and MD and advocates for an environment that supports team-based care.
- Removes provisions outlining the information required in a PA-physician agreement, allowing these decisions to be made by the PA-physician team;
- Removes the requirement that a physician’s name be on the label of a prescription issued by a PA;
- Specifically authorizes PAs to dispense, request, receive, or sign for drug samples;
- Authorizes PAs to order/prescribe durable medical equipment, nutrition, blood and blood products, home health, hospice, physical therapy, and occupational therapy;
- Limitations may still exist related to reimbursement subject to CMS guidelines.
- Allows PAs to pronounce death and sign death certificates and other forms within the PA’s scope of practice without physician co-signature;
- Changes the PA Committee voting status of the Board of Medicine physician member to “nonvoting”;
- Requires one of the physician members of the Board of Medicine to have experience practicing with PAs; and
- Allows PAs to collaborate with a podiatrist.
- This portion of the bill was introduced by Senator Hilkemann (a podiatrist) separate from the 407 process NAPA had been working on for over 18 months. We are open to communication with the state podiatry association on this matter and we are confident PAs will continue to use their skills to provide high quality health care to Nebraskans.
We are excited for this update to PA practice to prevent unnecessary administrative burden. Most importantly, we are excited for PAs in the state of Nebraska to be able to serve their patients and communities more effectively.
Sincerely,
Nebraska Academy of Physician Assistant Board of Directors