Original Notice.

     Preproposal statement of inquiry was filed as WSR 03-17-056.

     Title of Rule and Other Identifying Information: New sections WAC 246-854-010 Approved training and additional skills and procedures, 246-854-015 Utilization and supervision of an osteopathic physician assistant, 246-854-025 Remote practice site -- Utilization, 246-854-035 Osteopathic physician assistant -- Scope of practice and 246-854-085 Interim permit -- Qualifications and interim permit requirements; amended section WAC 246-854-080 Osteopathic physician assistant application for licensure -- Qualifications and requirements; and repealed sections WAC 246-854-020 and 246-854-090.

     Hearing Location(s): St. Francis Hospital, 34515 9th Avenue South, Federal Way, WA 98003, on January 26, 2007, at 9:30 a.m.

     Date of Intended Adoption: January 26, 2007.

     Submit Written Comments to: Arlene Robertson, P.O. Box 47866, Olympia, WA 98504-7866, web site http://www3.doh.wa.gov/policyreview/, fax (360) 236-2406, by January 19, 2007.

     Assistance for Persons with Disabilities: Contact Arlene Robertson by January 19, 2007, TTY (800) 833-6388 or 711.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: WAC 246-854-020, the proposal specifies the level of education and training needed for osteopathic physician assistants (PA) by identifying approved programs. Accredited programs will provide consistent training standards for licensure eligibility. Proposed language also provides for training and approval of new skills.

     WAC 246-854-080, the proposal identifies the National Commission on Certification of Physician Assistants examination as being approved by the board of osteopathic medicine and surgery (board) to meet the minimal qualifications for licensure. The examination implements legislative changes made by SB 5702 in 1999.

     New section WAC 246-854-085, the proposal provides for an interim permit for one-year until the licensee can pass the examination. Since the interim permit is a new license category, a new section has been established which defines permitted practice. The interim permit implements legislative changes made by SB 5702.

     WAC 246-854-090, the proposed modifications will permit an osteopathic physician to supervise multiple PAs without special board approval; address required chart reviews for licensed PAs; clarify that PAs may sign birth and death certificates; require notification of termination of the osteopathic physician/osteopathic physician assistant relationship to the board from both parties. These proposed changes are needed so that practice standards will be similar to allopathic physician assistants. The proposals will reduce the supervisory burden on osteopathic physicians while maintaining oversight of the PAs' practice.

     Reasons Supporting Proposal: The proposed rules will allow more flexibility in most practices, especially rural areas and remote practices, by allowing 10% of the charts to be reviewed after the first thirty days of practice. These and the other proposed changes provide more consistency with the practice and supervision standards established for allopathic physician assistants.

     Statutory Authority for Adoption: RCW 18.57.005, 18.57A.020.

     Statute Being Implemented: Chapter 18.57A RCW.

     Rule is not necessitated by federal law, federal or state court decision.

     Name of Proponent: Department of health, board of osteopathic medicine and surgery, governmental.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Arlene Robertson, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4945.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The department did not complete a small business economic impact statement under RCW 19.85.030(1) because the rule does not impose costs to businesses within an industry.

     A copy of the statement may be obtained by contacting Arlene Robertson, P.O. Box 47866, Olympia, WA 98504-7866, phone (360) 236-4945, fax (360) 236-2406, e-mail arlene.robertson@doh.wa.gov.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Arlene Robertson, P.O. Box 47866, Olympia, WA 98504-7866, phone (360) 236-4945, fax (360) 236-2406, e-mail arlene.robertson@doh.wa.gov.

October 16, 2006

Blake T. Maresh

Executive Director

OTS-7260.4

NEW SECTION
WAC 246-854-010   Approved training and additional skills or procedures.   (1) "Board approved program" means a physician assistant program accredited by:

     (a) The committee on allied health education and accreditation (CAHEA);

     (b) The commission on accreditation of allied health education programs (CAAHEP);

     (c) The accreditation review committee on education for the physician assistant (ARC-PA); or

     (d) Any successor accrediting organization utilizing the same standards.

     (2) An individual enrolled in an accredited board approved program for physician assistants may function only in direct association with his or her preceptorship physician or a delegated alternate physician in the immediate clinical setting. A trainee may not function in a remote location or in the absence of the preceptor.

     (3) If an osteopathic physician assistant is being trained to perform additional skills or procedures beyond those established by the board, the training must be carried out under the direct, personal supervision of the supervising osteopathic physician or other qualified physician familiar with the practice plan of the osteopathic physician assistant. The training arrangement must be mutually agreed upon by the supervising osteopathic physician and the osteopathic physician assistant.

     (4) Requests for approval of newly acquired skills or procedures shall be submitted in writing to the board, including a certificate by the program director or other acceptable evidence showing that he or she was trained in the additional skill or procedure for which authorization is requested. The board will review the evidence to determine whether the applicant has adequate knowledge to perform the additional skill or procedure.

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     (2) A credentialed osteopathic physician assistant may not practice until the board approves a practice plan jointly submitted by the osteopathic physician assistant and osteopathic physician or physician group under whose supervision the osteopathic physician assistant will practice. The osteopathic physician assistant must submit the fee under WAC 246-853-990(5) with the practice plan.

     (3) An osteopathic physician may supervise three osteopathic physician assistants. The board may consider requests to supervise more than three osteopathic physician assistants based on the individual qualifications and experience of the osteopathic physician and osteopathic physician assistant, community need, and review mechanisms identified in the approved practice plan.

     (4) The osteopathic physician assistant shall practice only in the locations designated in the practice plan.

     (5) The osteopathic physician assistant and supervising osteopathic physician shall ensure that:

     (a) The supervising osteopathic physician timely reviews all reports of abnormalities and significant deviations, including the patient's chart;

     (b) The charts of all patients seen by the osteopathic physician assistant are immediately and properly documented to include the activities, functions, services and treatment measures performed by the osteopathic physician assistant;

     (c) All telephone advice given through the osteopathic physician assistant by the supervising osteopathic physician, alternate supervising physician, or member of a supervising physician group are documented in the patient's record;

     (d) The supervising osteopathic physician provides adequate supervision and review of the osteopathic physician assistant's practice. The supervising osteopathic physician or designated alternate physician shall review and countersign:

     (i) All charts of the licensed osteopathic physician assistant within seven working days for the first thirty days of practice and thereafter ten percent of their charts, including clinic, emergency room, and hospital patients within seven working days.

     (ii) Every chart entry of an interim permit holder within two working days;

     (e) The osteopathic physician assistant, at all times when meeting or treating patients, wears identification or a badge identifying him or her as an osteopathic physician assistant;

     (f) The osteopathic physician assistant is represented in a manner which would not be misleading to the public as to his or her title.

     (6) The osteopathic physician assistant shall notify the supervisor within twenty-four hours of any significant deviation in a patient's ongoing condition as identified by EKGs, laboratory tests, or X rays not read by a radiologist.

     (7) In the temporary absence of the supervising osteopathic physician, the osteopathic physician assistant may carry out those tasks for which he or she is credentialed, if the supervisory and review mechanisms are provided by a designated alternate supervisor. If an alternate osteopathic physician is not available in the community or practice, the board may authorize a physician licensed under chapter 18.71 RCW or physician group to act as the alternate physician supervisor. If a physician group is proposed as a designated alternate supervisor, the practice plan must specify how supervising responsibility is to be assigned among the members of the group.

     (8) The supervising osteopathic physician and the osteopathic physician assistant shall advise the board of the termination date of the working relationship. The notification must be submitted in writing within thirty days of termination and include a written report indicating the reasons for termination.

     (9) In the event that an osteopathic physician assistant who is currently credentialed desires to become associated with another osteopathic physician or physician group, he or she must submit a new practice plan and submit the fee under WAC 246-853-990(5). Board approval of the new relationship is required before the osteopathic physician assistant may begin practice under the new supervising physician. A physician assistant being supervised by an allopathic physician (MD) must be licensed and have an approved practice plan as provided in chapter 18.71A RCW.

     (10) An osteopathic physician assistant working in or for a hospital, clinic or other health organization must be credentialed. His or her responsibilities to any other physicians must be defined in the board approved practice plan.

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     (2) The board may approve a practice plan proposing utilization of an osteopathic physician assistant at a remote practice site if:

     (a) There is a demonstrated need for this utilization;

     (b) There is adequate means for immediate communication between the primary osteopathic physician or alternate physician and the osteopathic physician assistant;

     (c) The supervising osteopathic physician spends at least ten percent of the documented and scheduled practice time of the osteopathic physician assistant in the remote office site. In the case of part time or unique practice settings, the osteopathic physician may petition the board to modify the on-site requirement provided adequate supervision is maintained by an alternate method. The board will consider each request on an individual basis;

     (d) The names of the supervising osteopathic physician and osteopathic physician assistant must be prominently displayed at the entrance to the clinic or in the reception area.

     (3) No osteopathic physician assistant holding an interim permit shall be utilized in a remote practice site.

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     (2) The osteopathic physician assistant may perform services for which they have been trained and approved in a practice plan by the board. Those services summarized in the standardized procedures reference and guidelines established by the board may be performed by the osteopathic physician assistant unless limited in the approved practice plan.

     (3) An osteopathic physician assistant may sign and attest to any document that might ordinarily be signed by a licensed osteopathic physician, to include, but not be limited to, such things as birth and death certificates.

     (4) An osteopathic physician assistant may prescribe legend drugs and controlled substances as permitted in WAC 246-854-030.

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     (3) That the applicant is physically and mentally capable of practicing as an osteopathic physician assistant with reasonable skill and safety.)) (1) Individuals applying to the board under chapter 18.57A RCW after July 1, 1999, must have graduated from an accredited board approved physician assistant program and successfully passed the National Commission on Certification of Physician Assistants examination;

     (2) Subsection (1) of this section does not apply to an osteopathic physician assistant licensed prior to July 1, 1999.

     (3) An applicant applying for licensure as an osteopathic physician assistant must submit an application on forms supplied by the board. The application must detail the education, training, and experience of the osteopathic physician assistant and provide other information as may be required. The application must be accompanied by a fee determined by the secretary under RCW 43.70.250 as specified in WAC 246-853-990(5).

     (4) Each applicant shall furnish proof of the following, which must be approved by the board:

     (a) The applicant has completed an accredited board approved physician assistant program;

     (b) The applicant has successfully passed the National Commission on Certification of Physician Assistants examination;

     (c) The applicant has not committed unprofessional conduct as defined in RCW 18.130.180; and

     (d) The applicant is physically and mentally capable of practicing as an osteopathic physician assistant with reasonable skill and safety.

     (5) The board will only consider complete applications with all supporting documents for licensure.

     (6) An osteopathic physician assistant may not begin practice without written board approval of the practice plan for each working relationship.

[Statutory Authority: RCW 43.70.280. 98-05-060, § 246-854-080, filed 2/13/98, effective 3/16/98. Statutory Authority: RCW 18.57.005 and 18.130.050. 94-15-068, § 246-854-080, filed 7/19/94, effective 8/19/94. Statutory Authority: RCW 18.57.005. 93-24-028, § 246-854-080, filed 11/22/93, effective 12/23/93; 90-24-055 (Order 100B), recodified as § 246-854-080, filed 12/3/90, effective 1/31/91. Statutory Authority: RCW 18.57.005(2). 89-22-065 (Order PM 863), § 308-138A-070, filed 10/31/89, effective 12/1/89.]

     (2) Interim permit holders will have one year from issuance of the interim permit to successfully pass the National Commission on Certification of Physician Assistants examination.

     (3) An applicant applying for an osteopathic physician assistant interim permit must submit an application on forms supplied by the board. The application must detail the education, training, and experience of the osteopathic physician assistant and provide other information as may be required. The application must be accompanied by a fee determined by the secretary under RCW 43.70.250 as specified in WAC 246-853-990(5).

     (4) Each applicant shall furnish proof of the following, which must be approved by the board:

     (a) The applicant has completed an accredited physician assistant program approved by the board;

     (b) The applicant is eligible to take the National Commission on Certification of Physician Assistants examination;

     (c) The applicant has not committed unprofessional conduct as defined in RCW 18.130.180; and

     (d) The applicant is physically and mentally capable of practicing as an osteopathic physician assistant with reasonable skill and safety.

     (5) The board will only consider complete applications with all supporting documents for the interim permit.

     (6) An osteopathic physician assistant may not begin practice without written board approval of the practice plan for each working relationship.

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     The following sections of the Washington Administrative Code are repealed:

WAC 246-854-020	Osteopathic physician assistant program.
WAC 246-854-090	Osteopathic physician assistant practice plan.

© Washington State Code Reviser's Office