NOTICES
DEPARTMENT OF PUBLIC WELFARE
Revision to Physician Assistant and Midwife Supervision Requirements; Notice of Rule Change
[27 Pa.B. 4045] The Department of Public Welfare (Department) announces that it is revising its regulations on supervision requirements for payment for medical services provided by physician assistants and midwives to Medical Assistance recipients to accurately reflect current State law requirements as set by the Board of Medicine. These changes benefit recipients and providers and are needed to clarify that these are compensable services when provided as allowed by applicable State law and regulations. This Rule Change will be adopted by final rulemaking to 55 Pa. Code Chapter 1141, sections 1141.53(f) and 1141.54(f).
This Rule Change is needed for consistency between Medical Assistance payment regulations and the regulations of the State Board of Medicine which sets the practice standards and licensure requirements for physician assistants and midwives. (49 Pa. Code §§ 18.1--18.6, 18.121 and 18.122). Failure to remove obsolete payment standards will continue inconsistency in the Medical Assistance regulations with current practice standards and licensure requirements.
This Rule Change amends and updates the Notice of Rule Change published on November 30, 1996, at 26 Pa.B. 5847, effective September 1, 1996. That Notice announced the Department's policy revision to permit payment for services of physician assistants and midwives when those services are provided and allowed by State law.
This Rule Change has been reviewed by the Office of General Counsel and the Office of Attorney General.
This Rule Change is made under the Joint Committee on Documents Resolution 1996-1(3) 26 Pa.B. 2374 (May 18, 1996) and will be in effect for 365 days pending adoption of final rulemaking by the Department.
Public comments to this Rule Change can be made by contacting: Department of Public Welfare, Office of Medical Assistance Programs, c/o Deputy Secretary's Office, Attention: Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120.
Persons with a disability may use the AT&T Relay Service by calling (800) 654-5984 (TDD users) or (800) 654-5988 (voice users). If you require another alternative is required, contact Thomas Vracarich at (717) 772-2286.
FEATHER O. HOUSTOUN,
SecretaryPurpose
The purpose of this notice is to inform providers of the following updates in the Medical Assistance (MA) Program regulations regarding physician assistant and midwife supervision requirements:
1. Revise supervision requirements for Physician Assistants for inpatient services, as well as outpatient services.
2. Delete obsolete physician supervision requirements for Midwife services.
This notice amends and updates MA bulletin 1141-96-01 issued on November 22, 1996.
Scope
This notice is applicable to all physicians and midwives enrolled in the MA Program.
Background
MA Bulletin 1141-96-01 issued on November 22, 1996, effective September 1, 1996, was intended to contain revisions to Medical Assistance regulations on Physician Assistant and Midwife supervision requirements based on the current practice standards and licensure requirements established by the State Board of Medicine. After the release of the Bulletin, the Department identified that it inadvertently omitted payment conditions for inpatient services, and inaccurately included supervision requirements for midwife services.
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Discussion
MA regulations at 55 Pa. Code § 1141.54(f) relating to payment for inpatient physician services currently state that a physician assistant and midwife must be under the direct supervision of a physician when providing medical services to a MA recipient.
Since the MA Program's regulation is not consistent with current Board of Medicine practice standards and license provisions for physician assistants and midwives in the Commonwealth, the regulations on this requirement are revised to reflect current practice standards and licensure requirements.
PHYSICIAN ASSISTANT: Current practice standards and licensure requirements of physician assistants now permit them to provide medical services to patients on behalf of a physician without the direct supervision of that physician as long as the physician is accessible by telephone or some other means of communication. This extends to inpatient as well as outpatient services.
MIDWIFE: Current practice standards and licensure requirements of midwives permit them to provide medical services to patients in accordance with midwife protocol and a collaborative agreement with physicians. Physician supervision has been removed as a requirement by the Board of Medicine. Accordingly, this is no longer required by the Department, and is being deleted from the regulations.
Policy
Payment conditions in 55 Pa. Code Chapter 1141, consistent with Board of Medicine requirements, are as follows:
§ 1141.53. Payment conditions for outpatient services.
* * * * * (f) All covered outpatient physicians' services billed to the Department shall be performed by one of the following:
(i) The physician personally.
(ii) A registered nurse under the physician's direct supervision.
(iii) A physician assistant provided that a physician is accessible at all times by telephone or some other means of communication as permitted under current Pennsylvania practice standards and licensure.
* * * * * § 1141.54. Payment conditions for inpatient services.
* * * * * (f) All covered inpatient physicians' services billed to the Department shall be performed by one of the following:
(i) The physician personally.
(ii) A registered nurse under the physician's direct supervision.
(iii) A physician assistant provided that a physician is accessible at all times by telephone or some other means of communication as permitted under current Pennsylvania practice standards and licensure.
* * * * * Next Step
The Department will amend the MA regulations through the regulatory process.
Fiscal Note: 14-NRC-071. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 97-1262. Filed for public inspection August 8, 1997, 9:00 a.m.]
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