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A Comparison of Changes in the Professional Practice of Nurse Practitioners, Physician Assistants, and Certified Nurse Midwives:  1992 and 2000

This page: Appendix D.  Professional Practice Index Calculations for PAs

Appendix D.  Professional Practice Index Calculations for PAs

This appendix contains a table that documents the detailed calculations used to compute the new professional practice index for PAs for each of the 50 States plus the District of Columbia. The criteria used in the new index include:

Legal Authority (Maximum = 35)

Title protection prevents those not qualified or certified by the State from practicing as a professional. Title protection provides safeguards to the public and to the professional.

Licensure implies approval of credentials and granting of professional status. Licensing of PAs occurs in many States, but certification and registration is used in other States. States vary on the qualifications for licensure which may include the passing of a national certification examination and in some States, an employment agreement with a physician.

Although having a supervising physician is fundamental to PA practice, the professional association for PAs suggests that employment agreements should be independent of licensure. PAs should not be required to have an employment contract to remain licensed [PAs 8th edition, p. v].

Professional Practice should be “dependent on what the supervising Physician wishes to delegate” [PAs 8th edition, p. xi] and not be finely detailed in law.

Supervision should be the least restrictive mode that permits appropriately supervised practice. “Continuous” [PAs, 8th edition, p. xvi] supervision which may be indirect, but which permits contact with the supervising physician as needed is most desirable.

Regulation by a PA Committee of the Board of Medicine is the optimal regulatory mechanism. Input by PAs is important to the profession.

Fees for supervisory agreements can create disincentives for association with a professional. High costs may limit the number of agreements between a physician and PAs.

The conditions and timing of review of records, although an implicit part of practice between a physician and a PA, is best determined by the agreement between the two professionals rather than by specific delineation in legislation.

Limiting the number of PAs with whom a physician may associate through legislated ratios may be unduly restrictive. Leaving that number to the discretion of the physician and PAs suggests confidence in the abilities of both professions to adequately provide care within the skill and competencies of each and “according to the tenets of good patient care, adequate supervision, and legal responsibility.” [PAs, 8th edition, p. vi]

Locum Tenens means “the temporary provision of services by a substitute provider.” [PAs, 8th edition, p xx]. Allowance for substitution in law provides legal means for a physician or a PA to continue to practice in the temporary absence or inaccessibility of the other.

Temporary License permits a PA to practice prior to taking the certification examination.

Supervising Physician Liability in law reinforces the legal relationship that exists between a physician and PA.

The ability to act independently in a declared emergency allows a PA to respond appropriately to emergency needs in a disaster. It provides legal protection for services provided by the PA in those circumstances.

Reimbursement (Maximum = 25)

Any mandated payment reflects the evolution of payment over the decade. Payment to PAs was changed after passage of the Balanced Budget Act in 1997 which extended payment for services rendered by PAs to all locations where they are employed.

Medicaid payment percentage varies by State and this category reflects that fluctuation.

Any language that permits reimbursement to “any qualified provider” is intended to describe the legal obligation to pay for services supplied by a PA. PAs are generally in employment situations in which the physician or the facility is billing for and receiving reimbursement for health services. Legislation that protects the right to payment is enabling to care.

Prescriptive Authority (Maximum = 40)

Prescriptive authority as delegated to PAs “can improve patient access to comprehensive care and provide for increased efficiency and cost effectiveness.” [PAs, 8th edition, p. vii]. It may be defined in law or by the supervisory agreement. The more extensive privilege allows the PA more latitude in patient care. DEA numbers are required when prescribing scheduled drugs. Points are allotted for a DEA number to emphasize the importance of the prescriptive privilege.

Accepting and distributing samples, having the PA name on the prescription pad and signing prescriptions are indicative of latitude in practice provided to the PA in law.

The actual point allocations for PAs for the 50 States are presented below.

Table D-1 Professional Practice Index Scoring Criteria For Physician Assistants in 2000 New Index for AL, AK, AZ, AR, CA, and CO
Scoring Category
Points
Optimal Score
fn
State
AL
AK
AZ
AR
CA
CO
Legal authority
Title protection
3
3
a
3
3
3
3
3
How Licensed
b

Licensure language only
5
5
5
b
5
5

Licensure w/Registration ( i.e. reg. w/employment papers)
3
3
3

Certification or Registration language only
1
1
Agreement
c

No notification required, agreement exists btw phys & PA
3
3

Notification only of employment/agreement btw phys & PA
2

Written agreement available
2

File practice agreement w/board
1
1

File for approval of board
0
0
0
c
0
0
0
Definition of Scope
d

Scope defined by supervising physician & PA

5
5
5
5

Scope loosely defined in law (may include but not limited to…)
3
3
3
3
3

Scope clearly delineated in law (list of permissible tasks)
1
National certification required for initial licensing
1
1
e
1
1
1
1
1
Supervision:
f

Indirect-physical presence not required
5
5
5
5
5
5
5
5

Limited Indirect (limit on distance, time, travel, etc)
3

Direct-physical presence required (on site)
0
Regulated by:
g
PA Board or committee appt by ext agency resp to med bd
5
5
5
5
Medical Board with PA representation
5
PA Committee appt by medical board
5
5
Medical Board with no PA representation
0
0
0
g
0
No fees for supervisory agreements
1
1
h
1
Review of Records by Physician:
I
> 7 days/not described/determined by phys-PA team
1
1
1
I
1
1
I
1
< 7 days
0
I
0
Ratios > 2 in outpatient settings, or not legislated
2
2
j
2
2
j
Locum Tenens
k
Legislated
1
1
1
When no practice agreement, locum tenens inherent
1
Temporary License
1
1
l
1
1
1
1
Supervising physician liability
1
1
m
1
1
1
1
1
1
Disaster relief legislation
1
1
n
1
1
1
Subtotals Legal
35
25
25
25
18
25
15
Reimbursement
o
Any mandated payment- Medicare, Champus, et al.
10
10
10
10
10
10
10
10
Medicaid % x 10
10
10
10
8.5
10
10
10
10
Any legislated mandate for coverage of PA services
5
5
5
0
0
0
0
0
Subtotals Reimbursement
25
25
18.5
20
20
20
20
Prescriptive Authority
How defined
p
Defined by Supervisory Agreement
30
30
30
p
30
30
p
30
Defined in Law--allows controlled substances--II-V
30
III-V
25
25
p
IV-V
20
V only
15
no controlled
10
10
Defined in Law--formulary, no controlled substances
0
No Rx Authority
0
Sign for samples
1
1
q
1
1
Dispense/distribute samples--implies prepackaged w/ inst
1
1
r
1
1
1
PA's name on pad
1
1
s
1
1
1
1
1
1
PA's signature only
2
2
t
2
t
2
Own DEA number
5
5
u
5
5
5
5
5
Subtotals Rx Authority
40
11
38
37
31
38
40
TOTAL
100
61
81.5
82
69
83
75

FOOT NOTES

Alabama
h) Physician must review PA prescribing practices weekly by a review of 10% of patient charts
Alaska b) Lose authority to practice if lose collaborative agreement
c) Board approves "method for periodic assessment" and plan for delegation of prescriptive authority
p) Schedule ll allowed with approval of physician
Arizona
 I) PA must meet with physician once a week but review of records is not defined
Arkansas
g) Board "may" appoint an Advisory Committee
j) No more than 2 PA's at onetime
p) Statute says pharmacists authorized to fill scripts from PA's but rules say physician must sign all scripts . 1999 statutory change not yet reflected in rules
California
 I) Countersignature and dating of 10% of medical records within 30 days but review of records of patients receiving prescription within 7 days
p) Practice specific formulary and protocols that list specific criteria for prescribing. Controlled substance prescriptive authority is patient specific
Colorado
I) In statute, review of records every 2 days in HPSA. In regulations, chart notes of PA's reviewed and signed by physician within 7 days
j) No more than 2 "specific individual" PA's
f) PA practices "under personal and responsible direction and supervision of licensed physician"

REFERENCES
Main Resources
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Sixth Edition, Alexandria, Virginia 1992.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Seventh Edition, Alexandria, Virginia 1998.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Eighth Edition, Alexandria, Virginia 2000.
American Academy of Physician Assistants, http://www.aapa.org
Henderson T and Norris S, National Conference of State Legislatures, Health Policy Tracking Service.
U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Program, Mid-Level Practitioners
Authorization by State, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
Washburn Law School, www.washlaw.edu Alabama State of Alabama Medicaid, http://www.medicaid.state.al.us
Alabama
Society of Physician Assistants, http://www.alabamapasociety.org
Alaska
Alaska Academy of Physician Assistants, http://www.akapa.org
Arizona
The Arizona State Association of Physician Assistants, http://www.asapa.org
Arkansas
Arkansas General Assembly, http://www.arkleg.state.ar.us
Arkansas Academy of Physician Assistants, http://www.aapa.org/states/arapa
California
Physician Assistant Committee, Medical Board of California, http://www.physicianassistant.ca.gov
Colorado
Colorado State Board of Medical Examiners, http://www.dora.state.co.us
Colorado Academy of Physician Assistants, http://www.corloradopas.org

Table D-1, continued Professional Practice Index Scoring Criteria For Physician Assistants in 2000 New Index for CT, DE, DC, FL, GA, and HI
Scoring Category
Points
Optimal Score
fn
State
CT
DE
DC
FL
GA
HI
Legal authority
Title protection
3
3
a
3
3
3
3
How Licensed
b

Licensure language only
5
5
5
5
5
5
5

Licensure w/Registration ( i.e. reg. w/employment papers)
3
3

Certification or Registration language only
1
Agreement
c

No notification required, agreement exists btw phys & PA
3
3
3
3

Notification only of employment/agreement btw phys & PA
2
2

Written agreement available
2

File practice agreement w/board
1
1

File for approval of board
0
0
0
Definition of Scope
d

Scope defined by supervising physician & PA

5
5
5
5
d

Scope loosely defined in law (may include but not limited to…)
3
3
3
3
3

Scope clearly delineated in law (list of permissible tasks)
1
National certification required for initial licensing
1
1
e
1
1
1
1
1
Supervision:
f

Indirect-physical presence not required
5
5
5
5

Limited Indirect (limit on distance, time, travel, etc)
3
3
f
3
f
3
f
3
f

Direct-physical presence required (on site)
0
Regulated by:
g

PA Board or committee appt by ext agency resp to med bd
5
5
5

Medical Board with PA representation
5
5

PA Committee appt by medical board
5
5
5
5
5

Medical Board with no PA representation
0
No fees for supervisory agreements
1
1
h
1
1
1
1
1
h
Review of Records by Physician:
I

> 7 days/not described/determined by phys-PA team

1
1
1
I
1
I

< 7 days
0
0
I
0
I
0
I
0
I
Ratios > 2 in outpatient settings, or not legislated
2
2
j
2
2
j
j
j
Locum Tenens
k
k
k

Legislated
1
1

When no practice agreement, locum tenens inherent

1
Temporary License
1
1
l
1
1
1
1
1
Supervising physician liability
1
1
m
1
1
1
1
1
1
Disaster relief legislation
1
1
n
1
Subtotals Legal
35
29
24
23
27
25
23
Reimbursement
o

Any mandated payment- Medicare, Champus, et al.

10
10
10
10
10
10
10
10

Medicaid % x 10
10
10
10
10
0
8
9
10

Any legislated mandate for coverage of PA services
5
5
5
0
0
5
o
0
0
Subtotals Reimbursement
25
25
20
10
23
19
20
Prescriptive Authority
How defined
p

Defined by Supervisory Agreement
30
30
30

Defined in Law--allows controlled substances--II-V
30

III-V
25
25
p
25
p

IV-V
20
20
p

V only
15

no controlled
10
10
10

Defined in Law--formulary, no controlled substances
0

No Rx Authority
0
Sign for samples
1
1
q
1
q
Dispense/distribute samples--implies prepackaged w/ inst
1
1
r
1
1
1
1
1
r
PA's name on pad
1
1
s
1
1
1
1
PA's signature only
2
2
t
2
2
2
2
Own DEA number
5
5
u
5
5
5
5
Subtotals Rx Authority
40
29
38
12
11
33
35
TOTAL
75
83
82
45
61
77
78

FOOT NOTES

Connecticut
I) Regular review of records
p)Schedule II, III inpatients only, co-signature by physician within 24 hours
Delaware
f) Not more than 30 minutes distant
I) In regulation every 3 months (not merely up to physician and physician assistant team)
k) Maximum number of PA's is 2
DC
f) Present within a 15 mile radius of District
I) Countersign all medical orders and progress notes within 48 hours
k) No more than 2 PA's at one time
Florida
f) Reasonable physical proximity
I) Review and sign records within 7 days
j) No more than 4 at anyone time
o) Insurance must provide payment for PA first assist if coverage would have been provided to physician first assist
Georgia
d) But board must approve scope job description
f) Physician readily available for personal supervision
I) Physician to sign medical record entry for script within 7 days, review patient records daily in remote site
j) No more than 2 PA's at any onetime
p) Schedule II in emergency only
Hawaii
h) No agreement
I) Review of charts within 7 days
j) No more than 2 at one time
p) Administer, Prescribe, Dispense Schedule ll inpatient only
q,r) May request, receive or sign for professional samples, not controlled substances

REFERENCES
Main Resources

American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Sixth Edition, Alexandria, Virginia 1992.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Seventh Edition, Alexandria, Virginia 1998.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Eighth Edition, Alexandria, Virginia 2000.
American Academy of Physician Assistants, http://www.aapa.org
Henderson T and Norris S, National Conference of State Legislatures, Health Policy Tracking Service.
U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Program, Mid-Level Practitioners
Authorization by State, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
Washburn Law School, www.washlaw.edu
Connecticut
Connecticut Academy of Physician Assistants, http://www.connapa.org
Delaware
Delaware Academy of Physician Assistants, http://www.delawarepas.org
DC
District of Columbia Code, dccode.westgroup.com
Office of Documents and Administrative Issuances, os.doc.gov/info
Florida
Nova Southeastern University, http://www.nova.edu/pa
Florida Academy of Physician Assistants, http://www.fapaonline.org
Georgia
Georgia Association of Physician Assistants, http://www.gapaonline.org
Hawaii
State of Hawaii, Office of the Auditor, http://www.state.hi.us/auditor
Hawaii Academy of Physician Assistants, http://www.aapa.org/states/hapa.htm.

Table D-1, continued Professional Practice Index Scoring Criteria For Physician Assistants in 2000 New Index for ID, IL, IN, IA, KS, and KY
Scoring Category
Points
Optimal Score
fn
State
ID
IL
IN
IA
KS
KY
Legal authority
                              
Title protection
3
3
a
3
3
3
3
a
How Licensed
b

Licensure language only
5
5
5
5

Licensure w/Registration ( i.e. reg. w/employment papers)
3
3
b

Certification or Registration language only
1
1
b
1
b
1
b
Agreement
c

No notification required, agreement exists btw phys & PA
3
3
3

Notification only of employment/agreement btw phys & PA
2
2
c

Written agreement available
2
2

File practice agreement w/board
1
1
c
1

File for approval of board
0
0
Definition of Scope
d

Scope defined by supervising physician & PA

5
5
5
5
5
5

Scope loosely defined in law (may include but not limited to…)
3
3
3

Scope clearly delineated in law (list of permissible tasks)
1
National certification required for initial licensing
1
1
e
1
e
1
1
1
1
1
Supervision:
f

Indirect-physical presence not required
5
5
5
5
f
5
f
5
f
5
f

Limited Indirect (limit on distance, time, travel, etc)
3
3
f

Direct-physical presence required (on site)
0
Regulated by:
g

PA Board or committee appt by ext agency resp to med bd
5
5
5
g
5
g
5
g
5
g

Medical Board with PA representation
5

PA Committee appt by medical board
5
5
g

Medical Board with no PA representation
0
0
No fees for supervisory agreements
1
1
h
1
h
1
h
h
1
1
h
Review of Records by Physician:
I

> 7 days/not described/determined by phys-PA team

1
1
1
i
1
I
0
I
1
I

< 7 days
0
0
I
0
I
Ratios > 2 in outpatient settings, or not legislated
2
2
j
j
j
j
j
j
j
Locum Tenens
k

Legislated
1
1
1

When no practice agreement, locum tenens inherent

1
Temporary License
1
1
l
1
1
1
1
Supervising physician liability
1
1
m
1
1
1
1
1
1
Disaster relief legislation
1
1
n
1
1
Subtotals Legal 
35
20
29
20
27
24
22
Reimbursement
o

Any mandated payment- Medicare, Champus, et al.

10
10
10
10
10
10
10
10

Medicaid % x 10
10
10
8.5
10
10
10
7.5
10

Any legislated mandate for coverage of PA services
5
5
5
o
5
o
o
Subtotals Reimbursement
25
18.5
25
20
25
17.5
20
Prescriptive Authority
How defined

Defined by Supervisory Agreement
30
30

Defined in Law--allows controlled substances--II-V
30

III-V
25
25
p
25
p
25
p
25
p

IV-V
20

V only
15

no controlled
10
10
p
10

Defined in Law--formulary, no controlled substances
0
q

No Rx Authority
0
r
Sign for samples
1
1
s
1
1
q
1
q
Dispense/distribute samples--implies prepackaged w/ inst
1
1
t
1
1
1
1
PA's name on pad
1
1
u
1
1
PA's signature only
2
2
2
2
2
2
Own DEA number
5
5
5
5
5
5
Subtotals Rx Authority
40
34
32
10
35
34
12
TOTAL
100
72.5
86
50
87
75.5
54

FOOT NOTES
Idaho
e) National certification and baccalaureate degree required
h) Agreement not filed with the board
I) Periodic review of representative sample
j) No more than 2
p) Prescribe only
Illinois
c) Required to file notice of delegation of prescriptive authority and notice of supervisory control
f) Physician within reasonable distance
g) PA Advisory Committee - 7 members
h) No agreement filed
I) Review on a timely basis
j) No more than 2
o) PA not allowed to bill patients for services but employer can bill. Payment must be made if services rendered would have been paid if rendered by a physician
p) Prescribe, Dispense and Administer if delegated by supervising physician
Indiana
b) Certificate
f) Physically present or immediately available
g) 5 member PA committee appointed by governor
h) $ 20 fee for changing physician
I) Within 24 hours
j) No more than 2 in statute, 1 in regulations
p) Use or dispense drugsif approved by supervising physician
Iowa
b) Licensure and registration
f) PA may function in remote medical clinic if approved by board
g) 7 member PA committee appointed by governor
I) Charts signed at least once per week in remote clinic
j) No more than 2 at one time
o) 3rd party payer to pay for PA care if same care provided by MD would be paid
p) Schedule ll depressants and stimulants excluded
Kansas
b) Registered
f) PA may work at a different practice location under certain conditions
g) PA council, 5 members appointed by governor
I) Review and sign patient records biweekly
j) No more than 2
p) Schedule ll in emergency situation only
q) Request, receive, sign for and distribute samples
Kentucky
a) No protection
b) Certification
c) Physician applies for approval to supervise PA
f) May practice in separate clinic or office with board approval
g) member of PA Advisory Committee
h) $ 100 fee
I) Sign all records in timely manner
j) No more than 2 at any time
o) Prohibited from directly billing any patient or payer
q) Request, receive, sign for, and distribute samples

REFERENCES
Main Resources
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Sixth Edition, Alexandria, Virginia 1992.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Seventh Edition, Alexandria, Virginia 1998.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Eighth Edition, Alexandria, Virginia 2000.
American Academy of Physician Assistants, http://www.aapa.org
Henderson T and Norris S, National Conference of State Legislatures, Health Policy Tracking Service.
U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Program, Mid-Level Practitioners
Authorization by State, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
Washburn Law School, www.washlaw.edu
Idaho
Idaho Statutes and Constitution Internet Home Page, http://www3.state.id.us
Illinois
Association Management Partners, http://ampka.com/iapa
Illinois General Assembly, http://www.legis.state.il.us/legisnet
Illinois Academy of PAs, http://www.ampka.com/iapa
Indiana
Indiana Academy of Physician Assistants, www.aapa.org/iapa.htm
Iowa
Iowa Physician Assistant Society, http://showcase.netins.net/web/ipas
Kansas
Kansas Academy of Physician Assistants, http://www.kansaspa.com
Kentucky
Kentucky Academy of Physician Assistants, http://www.kyapa.org

Table D-1, continued Professional Practice Index Scoring Criteria For Physician Assistants in 2000 New Index for LA, ME, MD, MA, MI, and MN
Scoring Category
Points
Optimal Score
fn
State
LA
ME
MD
MA
MI
MN
Legal authority
Title protection
3
3
a
3
3
3
3
3
3
How Licensed
b

Licensure language only
5
5
5
5

Licensure w/Registration ( i.e. reg. w/employment papers)
3
3
b

Certification or Registration language only
1
1
1
b
1
b
Agreement
c

No notification required, agreement exists btw phys & PA
3
3
3
c

Notification only of employment/agreement btw phys & PA
2
2
2
c

Written agreement available
2
2
c
2
c

File practice agreement w/board
1

File for approval of board
0
0
c
Definition of Scope
d

Scope defined by supervising physician & PA

5
5
5
5
d

Scope loosely defined in law (may include but not limited to…)
3
3
d
3
3

Scope clearly delineated in law (list of permissible tasks)
1
1
National certification required for initial licensing
1
1
e
1
1
1
1
1
1
Supervision:
f

Indirect-physical presence not required
5
5
5
5
5
5
5
5
f

Limited Indirect (limit on distance, time, travel, etc)
3

Direct-physical presence required (on site)
0
Regulated by:
g

PA Board or committee appt by ext agency resp to med bd
5
5
5
5
5
5
g

Medical Board with PA representation
5

PA Committee appt by medical board
5
5
5
g

Medical Board with no PA representation
0
No fees for supervisory agreements
1
1
h
h
h
h
1
1
1
Review of Records by Physician:
I

> 7 days/not described/determined by phys-PA team

1
1
1
1
I

< 7 days
0
0
I
0
I
0
I
0
I
Ratios > 2 in outpatient settings, or not legislated
2
2
j
j
2
j
j
j
j
j
Locum Tenens
k

Legislated
1
1
1
k
k
1

When no practice agreement, locum tenens inherent

1
Temporary License
1
1
l
1
1
1
1
1
1
Supervising physician liability
1
1
m
1
1
1
1
1
1
Disaster relief legislation
1
1
n
1
n
1
1
1
n
Subtotals Legal
35
28
29
18
25
31
25
Reimbursement
o

Any mandated payment- Medicare, Champus, et al.

10
10
10
10
10
10
10
10

Medicaid % x 10
10
10
10
10
10
10
10
9

Any legislated mandate for coverage of PA services
5
5
5
o
o
5
o
Subtotals Reimbursement
25
25
20
20
20
25
19
Prescriptive Authority
How defined
p

Defined by Supervisory Agreement
30
30
30
p
30
30

Defined in Law--allows controlled substances--II-V
30

III-V
25
25
25
p

IV-V
20

V only
15

no controlled
10

Defined in Law--formulary, no controlled substances
0

No Rx Authority
0
0
p
Sign for samples
1
1
q
Dispense/distribute samples--implies prepackaged w/ inst
1
1
r
1
1
PA's name on pad
1
1
s
1
1
1
PA's signature only
2
2
t
2
2
2
2
2
Own DEA number
5
5
u
5
5
5
5
5
Subtotals Rx Authority
40
1
34
38
37
33
37
TOTAL
100
54
83
76
82
89
81

FOOT NOTES

Louisiana
d) Legislation states list is "intended to be illustrative not limiting"
h) $ 75 fee
I) Inpatient records 24 hours, Nursing Home 48 hrs, all others 72 hrs
j) Not more than 2
k) Physician may supervise up to 4 PA's on a locum tenens basis
n) Under supervision of physician who is present (not supervising physician)
o) "Nothing shall prohibit" charges from being submitted to any government or private payer for services rendered by PA
p) May orally transmit physician prescription, may administer, may transmit physician order into medical record
Maine
 b) Certificate of registration and license
c) Physician notifies board
h) $ 100 Fee
j) No limitation
Maryland
b) Delegation agreement
h) $ 200 Fee
I) Certificate of registration and license
j) No more than 2 in a hospital setting
p) PA may not dispense
Massachusetts
b) Registration
c) Written guidelines
i) Prescriptive orders for Schedule ll must be reviewed within 96 hours. Physician reviews diagnosis and treatment information in a timely manner
j) No more than 2
o) PA's may not bill separately for services rendered -services are considered those of supervising physician
Michigan
c) Written authorization for prescriptive authority maintained in each practice location
d) Separate statute and rules for osteopathic PA's
g) Joint Task Force for PA's and Osteopathic PA's - 9 members, PA member of Medical Board as well
I) Regular review of records
j) No more than 2 at one practice site
o) 3rd party payer may not deny payment for services by PA, under special conditions of practice
p) Schedule ll only in facility where PA and supervising physician practice and only for patient being discharged
Minnesota
b) Registered
c) Physician PA agreement details practice arrangement and delegated prescriptive authority
f) PA may provide services in geographically remote location
g) PA Advisory Council (7 members) to Board
I) Daily reviews of prescriptions
j) Not more than 2 simultaneously
n) May provide care during an emergency under direction of Emergency Medical Director

REFERENCES
Main Resources

American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Sixth Edition, Alexandria, Virginia 1992.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Seventh Edition, Alexandria, Virginia 1998.
American Academy of Physician Assistants, Physician Assistants, State Laws and Regulations, Eighth Edition, Alexandria, Virginia 2000.
American Academy of Physician Assistants, http://www.aapa.org
Henderson T and Norris S, National Conference of State Legislatures, Health Policy Tracking Service.
U.S. Department of Justice, Drug Enforcement Administration, Diversion Control Program, Mid-Level Practitioners
Authorization by State, http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html
Washburn Law School, www.washlaw.edu
Louisiana
Louisiana Board of Medical Examiners, http://www.lsbme.org
Louisiana State Legislature, http://www.legis.state.la.us
Maine
 State of Maine, Bill Status, 120th Legislature, http://janus.state.me.us
Maryland
Maryland General Assembly, http://mlis.state.md.us
Massachusetts
Massachusetts Association of Physician Assistants, http://www.mass-pa.com
Michigan
The Michigan Academy of Physician Assistants, http://www.michiganpa.org
Minnesota
Minnesota Statutes, http://www.revisor.leg.state.mn.us
Minnesota Medical Association, http://www.mnmed.org/mapa
Minnesota Academy of Physician Assistants, http://www.mnmed.org/mapa

Table D-1, continued Professional Practice Index Scoring Criteria For Physician Assistants in 2000 New Index for MS, MO, MT, NE, NV, and NH
Scoring Category
Points
Optimal Score
fn
State
MS
MO
MT
NE
NV
NH
Legal authority
Title protection
3
3
a
3
3
3
3
3
3
How Licensed
b

Licensure language only
5
5
5
5
5
b
5

Licensure w/Registration ( i.e. reg. w/employment papers)
3
3
3
b

Certification or Registration language only
1
Agreement
c

No notification required, agreement exists btw phys & PA
3
3

Notification only of employment/agreement btw phys & PA
2

Written agreement available
2
2
2

File practice agreement w/board
1

File for approval of board
0
0
c
0
0
0
Definition of Scope
d

Scope defined by supervising physician & PA

5
5
5
5
d
5
5
d
5
d

Scope loosely defined in law (may include but not limited to…)
3
3

Scope clearly delineated in law (list of permissible tasks)
1
National certification required for initial licensing
1
1
e
1
e
1
1
1
1
1
Supervision:
f

Indirect-physical presence not required
5
5
5
5
f
5
5

Limited Indirect (limit on distance, time, travel, etc)
3
3
f
3
f

Direct-physical presence required (on site)
0
Regulated by:
g

PA Board or committee appt by ext agency rasp to med bd
5
5
5
5
5

Medical Board with PA representation
5
5
5
g

PA Committee appt by medical board
5
5
5

Medical Board with no PA representation
0
No fees for supervisory agreements
1
1
h
1
h
1
h
1
Review of Records by Physician:
I

> 7 days/not described/determined by phys-PA team

1
1
1
I
1
I
1
I
1