WSR 04-05-044



(Medical Quality Assurance Commission)

[ Filed February 12, 2004, 2:18 p.m. ]

     Original Notice.

     Preproposal statement of inquiry was filed as WSR 01-15-089.

     Title of Rule: WAC 246-918-120 Physician assistant remote site criteria.

     Purpose: The rule amendment is being proposed to ensure public safety by requiring demonstration of minimal competency before practicing without direct supervision from the supervising physician.

     Other Identifying Information: During the 1999 legislative session, the legislature required physician assistants demonstrate minimum competency by taking an exam (RCW 18.71A.020).

     Statutory Authority for Adoption: RCW 18.71A.020.

     Statute Being Implemented: Chapter 18.71A RCW.

     Summary: This proposal will limit practice in remote sites to only those individuals who have demonstrated minimum competency by successfully passing the examination or by having had significant oversight by the supervising physician.

     Reasons Supporting Proposal: To ensure public safety by requiring the physician assistant new graduates to take and successfully pass the examination that will demonstrate minimum competency.

     Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Beverly A. Thomas, 310 Israel Road S.E., Tumwater, WA 98501, (360) 236-4788.

     Name of Proponent: Department of Health and the Medical Quality Assurance Commission.

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

     Explanation of Rule, its Purpose, and Anticipated Effects: This rule will increase the minimum requirements for physician assistants working in a remote site setting. During the 1999 legislative session, the legislature increased the requirements for physician assistant licensure by requiring physician assistants to demonstrate minimum competency by taking and passing an examination (RCW 18.71A.020). This proposal will limit practice in remote sites to only those individuals who have demonstrated minimum competency by successfully passing the examination or by having had significant oversight by the supervising physician. This will also ensure public safety by the requirement to show proof of minimal competency to practice in a remote site.

     Proposal Changes the Following Existing Rules: The proposal amends WAC 246-918-120 by updating the minimal criteria physician assistants must meet to practice in a remote site. Under the amendment, only licensed physician assistants may practice in a remote site, those working under an interim permit may not.

     A small business economic impact statement has been prepared under chapter 19.85 RCW.

Small Business Economic Impact Statement

     Background: Rules promulgated must promote the delivery of quality health care to the residents of Washington state. The intentions of physician assistant (PA) regulation are to protect the public from being misled by incompetent, unethical and/or unauthorized persons; to assure the availability of physician assistant services of a level of minimal competency correlating to a high level of patient care; and to assure the professional conduct and competency in the delivery of counseling services.

     The Washington State Medical Quality Assurance Commission (MQAC) defines and establishes qualifications and requirements for education, training, supervision, and examination for the licensure of PAs under RCW 18.71A.020. Ultimately, the MQAC establishes rules that it considers are appropriate for the protection of consumers and patients of PAs, the people of the state of Washington.

     WAC 246-918-120 allows PAs to be utilized in a remote site. After graduating from a licensed physician assistant program, an interim permit for up to one year can be acquired. As the rules currently allow, such an individual can become employed in a remote site as a PA for one year without taking the National Commission on Certification of Physician Assistants (NCCPA). The NCCPA ensures each certified PA has passed the level of minimal competency, correlating to a high level of patient care to the people of Washington state. A public meeting, in which the MQAC was present, all agreed an amendment was in order to ensure no interim permit PA can be utilized in a remote site because of the lack of physician supervision.

     Rule-making Requirements of the Regulatory Fairness Act (Chapter 19.85 RCW): The Regulatory Fairness Act, RCW 19.85.030 requires the department to conduct a small business economic impact statement (SBEIS) for proposed rules that have more than minor impact on small businesses. As defined in RCW 19.85.020 a small business is "any business entity, including a sole proprietorship, corporation, partnership, or other legal entity, that is owned and operated independently from all other businesses, that has the purpose of making a profit, and that has fifty or fewer employees."

     I. What does the rule or rule amendment require? The proposed rule amendment prevents any PA holding an interim permit from being employed and utilized at a remote site. Such rule will cause all PAs in remote sites to be certified. The proposed amendment directly affects PAs in the following ways:

Make certain that only certified PAs, who have passed the NCCPA, are utilized in remote sites.
Compel those PAs with interim permits to be employed at the same site as the physician to ensure adequate physician supervision and oversight.

     II. Which industries are affected by this rule? In preparing this small business economic impact statement (SBEIS), the Department of Health used the following codes:

SIC Description Minor Impact Threshold ($)
8049 Office of Health Practitioners 66.10

     III. What are the costs of complying with this rule for small businesses (those with fifty or fewer employees) and for the largest 10% of businesses affected? The most current data indicate there are currently no PAs with an interim permit working in a remote site in Washington state. Therefore, the cost to both small businesses and the largest 10% is zero.

     IV. Does the rule impose a disproportionate impact on small businesses? Since the rule change imposes zero costs to both small and large businesses, there is no disproportionate impact on small businesses. On the contrary, small businesses that utilize PAs in remote sites will only accrue benefits. The proposed rule amendment demands a higher minimal level of competency, translating into a diminished level of risk to the small business.

     V. How will you involve small business in the rule making? The Department of Health advertised the proposed rule by sending to the "interested parties listing" that included the MEDEX Physician Assistant Program, Washington Academy of Physician Assistants and the Washington State Medical Association. Also, the rule change was publicized in the MQAC's newsletter in the summer of 2001 that was sent to all active licensed physicians and PAs in and out of the state of Washington.

     A copy of the statement may be obtained by writing to Beverly A. Thomas, Medical Quality Assurance Commission, P.O. Box 47866, Olympia, WA 98504, phone (360) 236-4788, fax (360) 236-4768.

     RCW 34.05.328 applies to this rule adoption. This rule places an additional qualification on a license, rules that amend licensure requirements are legislatively significant under RCW 34.05.328 (5)(c)(iii)(B).

     Hearing Location: Holiday Inn Select, One Grady Way South, Renton, WA 98055, on April 16, 2004, at 1:30 p.m.

     Assistance for Persons with Disabilities: Contact Beverly A. Thomas by April 1, 2004, TDD (800) 833-6388 or (360) 236-4788.

     Submit Written Comments to: Beverly A. Thomas, P.O. Box 47866, Olympia, WA 98504, fax (360) 586-4573, by April 1, 2004.

     Date of Intended Adoption: April 16, 2004.

January 15, 2004

Doron N. Maniece

Executive Director


AMENDATORY SECTION(Amending WSR 96-03-073, filed 1/17/96, effective 2/17/96)

WAC 246-918-120   Remote site -- Utilization -- Limitations, geographic.   (1) No licensee shall be utilized in a remote site without approval by the commission or its designee. 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 twenty-five percent of the practice time of the licensee.

     (2) Approval by the commission or its designee may be granted to utilize a licensee in a remote site if:

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

     (b) Adequate provision for timely communication between the primary or alternate physician and the licensee exists;

     (c) The responsible sponsoring or supervising physician spends at least ten percent of the practice time of the licensee in the remote site. In the case of part time or unique practice settings, the physician may petition the commission to modify the on-site requirement providing the sponsoring physician demonstrates that adequate supervision is being maintained by an alternate method. The commission will consider each request on an individual basis;

     (d) The names of the sponsoring or supervising physician and the licensee shall be prominently displayed at the entrance to the clinic or in the reception area.

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

[Statutory Authority: RCW 18.71.017 and 18.71A.020. 96-03-073, § 246-918-120, filed 1/17/96, effective 2/17/96. Statutory Authority: RCW 18.71.017. 92-12-089 (Order 278B), § 246-918-120, filed 6/3/92, effective 7/4/92; 91-06-030 (Order 147B), recodified as § 246-918-120, filed 2/26/91, effective 3/29/91. Statutory Authority: RCW 18.71A.020. 88-06-008 (Order PM 706), § 308-52-147, filed 2/23/88.]

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