Rhode Island Removes Supervision Requirements for PAs in Favor of Expanded “Collaboration” Standard for PA Practice
On July 15, 2019, Rhode Island Governor Gina Raimondo signed into law “An Act Relating To Businesses and Professions – Physician Assistants” (H5572/S0443), which significantly revises the supervision requirements and expands certain aspects of the scope of practice for physician assistants (PAs) in Rhode Island effective immediately. Among other things, the Act removes the current supervision requirements for PAs, changes the nature of the relationship between PAs and physicians to a “collaborative” arrangement, and removes the requirement that hospitals and other health care practices have written PA supervision agreements on file for PAs.
Currently, PAs in Rhode Island can only provide medical services under the supervision of a physician in accordance with a written agreement setting forth the level of supervision to be provided, as well as the patient care responsibilities of the PA. The Act removes this supervision requirement, and PAs will now be allowed to practice “in collaboration with physicians” and to “provide any medical or surgical services that are within the physician assistant’s skills, education and training.” Notably, the Act also removes current statutory provisions stating (i) that PAs “shall be considered the agents of their supervising physicians” when performing practice-related services, which could scale back the potential liability of physicians for a PA’s actions, and (ii) that a PA may only prescribe controlled substances, medical therapies, and medical devices and diagnostics, according to guidelines established by the PA’s employer or other health care delivery organization.
The Act defines collaboration between a PA and a physician in part as requiring the PA to “consult with or refer to an appropriate physician or health care professional” as necessary based upon a “patient’s condition, the education, competencies and experience of the physician assistant and the standards of care.” Under this law, a “physician must be accessible at all times for consultation by” a PA. The Act further directs that the degree of collaboration should “be determined by the practice and includes decisions made by” a physician employer or practice, or the credentialing and privileging systems of hospitals, health centers, or ambulatory care centers.
As noted above, the Act as written would allow PAs to provide medical and surgical services with greater autonomy, and without the current requirement of a supervisory arrangement or written supervisory agreement. In connection with these changes, the law also expressly states that a PA may be “considered to be a primary care provider when the physician assistant is practicing in the medical specialties required for a physician to be a primary care provider,” a change that is consistent with laws in other states and under payor policies that allow PAs to be independently credentialed as primary care providers. Finally, as a check, the Act does set forth a new limitation prohibiting PAs from undertaking or representing that “he or she is qualified to provide a medical or surgical care service that he or she knows or reasonably should know to be outside his or her competence or is prohibited by law.” Additionally, the Act increases the annual continuing medical education requirement for PAs to 25 hours (from 10).
The Act takes effect upon passage, and therefore these changes are now set to take effect throughout Rhode Island. Hospitals and physician groups would therefore be well-advised to review their practices and policies relating to PAs to determine how to most efficiently meet the needs of patients and their communities in the state.
This post was co-authored by Michael Lisitano, legal intern at Robinson+Cole. Michael is not yet admitted to practice law.