Change of Law: Hospital Action Required
To: Chief Medical Officers, Human Resources Leaders, Legal Counsel and Government
From: David Streeter | Policy Director- Clinical and Data
DavidS@wsha.org | (206) 216-2508
Subject: Changes to Physician Assistant Practice Laws Passed Effective 2021 and 2022
This bulletin’s purpose is to notify hospitals about the changes contained in Substitute House Bill 2378 that impact physician assistants, osteopathic physician assistants, and supervising physicians. The new laws are intended to remove administrative burdens and allow for more efficient use of physician assistants. This bulletin covers three key changes:
- A new practice agreement process will replace the current delegation agreement process between physicians and physician assistants, effective July 1, 2021.
- Physician assistants will be permitted to practice at remote sites without requiring approval from the Washington Medical Commission, effective July 1, 2021.
- The laws and licensure governing physician assistants in chapter 18.71A RCW will replace the osteopathic physician assistant license found in chapter 18.57A RCW, effective July 1, 2022.
These changes apply to physician assistants, supervising physicians, and their employers. The new laws will require action by physician assistants and their supervising physicians in preparation for the July 1, 2021, effective date. No action is required for the July 1, 2022, effective date.
- Review this bulletin for a summary of the major changes made to PA practice in Washington State.
- Understand the changes of this new law and how it will impact your medical staff by reviewing sections 1-10 in SHB 2378. Section 6 contains specific information regarding practice agreements, including the agreement criteria, process, and record-keeping requirements.
The Washington Medical Commission is required to educate stakeholders about these changes. Physician assistants, supervising physicians, and hospital human resources staff should watch for updates and guidance from the Washington Medical Commission.
- Practice Agreements Replace Delegation Agreements
Currently, physician assistants and physicians work together under delegation agreements approved by the Washington Medical Commission. Beginning July 1, 2021, the delegation agreement process will be replaced with the new practice agreement system. Current delegation agreements will still be valid after July 1, 2021, unless the contents of the delegation agreement change, or the physician assistant changes jobs.
Under the new law, physician assistants are required to enter into a practice agreement with a supervising physician or group of physicians before treating patients. The practice agreement is a contract between the physician assistant and their supervisory physician that determines the scope of practice for the physician assistant and duties for all parties, including supervision required for various tasks or procedures outlined in the agreement. Regarding the scope of practice, Section 5 (2) clarifies current RCW 18.71A.030 to state, “Physician assistants may practice in any area of medicine or surgery as long as the practice is not beyond the supervising physician’s own scope of expertise and clinical practice and the practice agreement.” At the suggestion of stakeholders, section 5 (3) adds a new subsection to the same RCW specifying requirements for physician assistants who administer anesthesia.
In a major change from current law, practice agreements will be valid as soon as all parties sign them and will no longer require approval from the Washington Medical Commission. Instead, practice agreements are filed with the Washington Medical Commission by the physician assistant once they are signed. Practice agreements can also be amended at any time to reflect new duties or responsibilities. The physician assistant will be responsible for filing any amendments or changes with the Washington Medical Commission.
In another change from current law, the Washington Medical Commission will no longer determine if practice agreements reflect the physician assistant’s qualifications. Instead, it will be the physician’s responsibility to determine the scope of the physician assistant’s duties and the supervision required for specific procedures or areas of practice. It is also the responsibility of the physician, or their designee, to verify a physician assistant’s credentials.
Section 6 contains specific information regarding practice agreements, including the requirements, process, and recordkeeping requirements. Importantly, section 6 (2) states that practice agreements must include all these items:
- The duties and responsibilities of the physician assistant, the supervising physician, and alternate physicians. The practice agreement must describe the supervision requirements for specified procedures or areas of practice. The practice agreement may only include acts, tasks, or functions that the physician assistant and supervising physician or alternate physicians are qualified to perform by education, training, or experience and that are within the scope of expertise and clinical practice of both the physician assistant and the supervising physician or alternate physicians, unless otherwise authorized by law, rule, or the commission;
- A process between the physician assistant and supervising physician or alternate physicians for communication, availability, and decision making when providing medical treatment to a patient or in the event of an acute health care crisis not previously covered by the practice agreement, such as a flu pandemic or other unforeseen emergency. Communications may occur in person, electronically, by telephone, or by an alternate method;
- If there is only one physician party to the practice agreement, a protocol for designating an alternate physician for consultation in situations in which the physician is not available;
- The signature of the physician assistant and the signature or signatures of the supervising physician. A practice agreement may be signed electronically using a method for electronic signatures approved by the commission; and
- A termination provision. A physician assistant or physician may terminate the practice agreement as it applies to a single supervising physician without terminating the agreement with respect to the remaining participating physicians. If the termination results in no supervising physician being designated on the agreement, a new supervising physician must be designated for the agreement to be valid.
Please refer to section 6 (2)(e)(i) and (ii) for specific termination criteria.
- New Filing and Record-Keeping Requirements
The physician assistant will be responsible for filing the agreement, any amendments to the agreement, and notice if the agreement is terminated with the Washington Medical Commission. Employers will be responsible for retaining a copy of the practice agreement that is available to the Washington Medical Commission upon request.
- Supervision Limitations Expanded
Physician assistants and physicians may enter into multiple practice agreements. Under current law, supervising physicians may only supervise up to 5 physician assistants. The new law increases the number to 10 physician assistants. Physicians who want to supervise more than 10 physician assistants will need to seek a waiver from the Washington Medical Commission to do so. The new law states that it is voluntary for physicians to serve as supervisors and that employers cannot condition a physician’s employment on providing supervision to a physician assistant.
- Practice at Remote Sites – Restriction Removed
Under current law, physician assistants are required to receive approval from the Washington Medical Commission in order to practice at remote sites. Effective July 1, 2021, physician assistants may practice at remote sites if it is within the scope of their practice agreement.
- Expansion of PA Power to Sign Documents
Under current law, physician assistants may sign any documents that their supervising physician may sign as long as the documents are within the scope of the delegation agreement. HB 2378 adds a subsection to RCW 18.71A.090 that states, “a physician is not required to countersign orders written in a patient’s clinical record or an official form by a physician assistant with whom the physician has a practice agreement.”
- Elimination of Osteopathic Physician Assistant Licenses and Transition to One Unified License
Effective July 1, 2021, the osteopathic physician assistant license contained in chapter 18.57A RCW will be superseded by the physician assistant license contained in 18.71A RCW. Current osteopathic physician assistant licensees will be issued new physician assistant licenses under chapter 18.71A RCW when they apply for license renewal. On July 1, 2022, chapter 18.57A RCW will be repealed and references to the chapter throughout state statutes will be replaced with references to chapter 18.71A RCW.
The Washington Medical Commission and the Board of Osteopathic Medicine and Surgery are mandated to engage in rulemaking. Physician assistants, supervising physicians and hospital human resources staff should subscribe to regulatory updates from the Washington State Department of Health using this link.
The new laws are the result of a multiyear collaborative effort between the Washington Academy of Physician Assistants, Washington Medical Commission, Washington State Medical Association, Washington Association of Nurse Anesthetists and other stakeholders.
House Bill 2378– An Act Concerning Physician Assistants
Explanatory Video on SHB 2378 from the Washington Academy of Physician Assistants
Chapter 18.71A RCW– Physician Assistants
Chapter 18.57A RCW– Osteopathic Physician Assistants
WSHA’s 2020 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online, where you will find a list of the high priority laws that WSHA is preparing resources and information on to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.