Background:

The Board of Osteopathic Medicine and Surgery (BOMS) regulates the practice of osteopathic medicine by osteopathic physicians and physician assistants. An osteopathic physician assistant (OPA) is a person who has satisfactorily completed a BOMS-approved training program designed to prepare him or her to practice osteopathic medicine to a limited extent. An OPA may not practice osteopathic medicine until a practice arrangement plan is approved. A practice arrangement plan delineates the manner and extent to which the OPA will practice and be supervised, and must jointly be submitted by the osteopathic physician or physician group and the OPA. An OPA also may not be employed or supervised by an osteopathic physician without approval of the BOMS. An OPA is permitted to practice medicine only to the extent permitted by the BOMS and in a manner consistent with the approved practice arrangement plan.

The Medical Quality Assurance Commission (MQAC) regulates the quality of healthcare provided by physicians and physician assistants. A physician assistant (PA) is a person who is licensed by the MQAC to practice medicine to a limited extent and who is academically and clinically prepared to provide health care services and perform diagnostic, therapeutic, preventative, and health maintenance services. A PA practices medicine under the supervision of a physician, but a PA cannot be employed or supervised by a physician or physician group without the approval of the MQAC. Prior to practicing, a PA has to apply to the MQAC for permission to be employed or supervised by a physician or physician group. A practice arrangement plan must be jointly submitted by the physician or physician group and the PA. A PA is permitted to practice medicine only to the extent permitted by the MQAC and in a manner consistent with the approved practice arrangement plan.

Rules adopted by the BOMS provide that an osteopathic physician may supervise three OPAs, and the BOMS may consider requests to supervise more than three OPAs, based on the individual's qualification and experience among other factors. Similarly, MQAC rules prohibit a physician from serving as primary supervisor or sponsor for more than three PAs without authorization by the MQAC. The rules also provide that OPAs and PAs may be used at remote practice sites if approved by the relevant governing authority based upon need; adequate means for immediate communication between the osteopathic physician or physician and the OPA or PA; supervision; and the names of the supervising osteopathic physician or physician and OPA or PA being prominently displayed at the entrance of the site or reception area.

Summary:

The OPAs and PAs may not be used at a remote site without the approval of their respective regulating bodies. A "remote site" is defined as a setting physically separate from the sponsoring or supervising physician's primary place for meeting patients or a setting where the physician is present less than 25 percent of the practice time of the OPA or the PA. Approval may be granted for the use of an OPA or a PA at a remote site if there is a demonstrated need; there is adequate ability to timely communicate between the physician and the OPA or the PA; the responsible sponsoring or supervising physician spends at least 10 percent of the practice time of the OPA or the PA in the remote site, unless the sponsoring physician can demonstrate that adequate supervision is being maintained by an alternate method; and the names of the sponsoring or supervising physician and the OPA or the PA are prominently displayed at the entrance to the remote site. No OPA or PA with an interim permit may be utilized at a remote site.

An osteopathic physician or a physician may enter into a delegation agreement with up to five PAs, but no more than three of the PAs may work at a remote site. An osteopathic physician or a physician may petition their respective regulating bodies for a waiver of the five PA limit, however an osteopathic physician or physician may not supervise more physician assistants than he or she can adequately supervise.

The MQAC and the BOMS must work in collaboration with a statewide organization that represents the interests of PAs to modernize the current rules regulating PAs and report to the Legislature by December 31, 2014.

The practice arrangement plan required for approval before an assistant can practice is renamed delegation agreement.

Votes on Final Passage:

House	97
Senate	48	(Senate amended)
House	95	(House concurred)