Full Text: SB 27 & SB 28 FAQs (Frequently Asked Questions) and Answers
Posted about 2 years ago by Amy Baird
SB 27 & SB 28 Frequently Asked Questions
What are SB 27 and SB 28 and What is Their Impact on Utah Physician Assistants?
On March 17, 2021, Senator Spencer Cox signed Senate Bill 27 and Senate Bill 28 into law. These bills make significant changes to the requirements for physician supervision to physician assistant practice. Once a physician assistant has 10,000 hours in their specialty, they are able to practice without a collaborating physician.
Why SB 27 & SB 28?
These acts were created in response to the difficulties created by the requirement of a supervising physician, particularly for physician assistants who have extended experience and years of experience. During the pandemic, there were rural physician assistants who struggled to practice due to lack of a supervising physician. The act aims to ensure that physician assistants are able to alleviate the strain of a limited medical workforce to provide care by allowing qualified, trained, experienced physician assistants to practice without direct oversight of a physician.
What do SB 27 & SB 28 Do?
Senate Bill 27 creates clear requirements for new graduates. Once a physician assistant has reached 10,000 hours of practice, it allows them more autonomy in their practice. Physician assistants are allowed to bill public and private insurance companies and have responsibility for the care they provide.
Senate Bill 28 specifically addresses mental health services provided by physician assistants. The act allows physician assistants to work in a more collaborative role after 2 years (4,000 hours)of working with a psychiatrist rather than as a supervisory relationship. The act also clarifies requirements for what they need to qualify as independent mental health providers.
Executive Summary SB 27: Physician Assistant Practice Act Amendments
• Allow PA scope of practice to be determined at the practice-level by:
o Clinical leadership
o Credentialing & privileging process
o Commensurate with experience, competency, knowledge & skill of the PA
o Patient’s condition & the applicable standard of care reflected by evidence-based medicine
- Remove legal requirements for a specific relationship between a PA, a physician, or any other specific healthcare provider
- Establish PA responsibility for the care they provide
- Maintains the composition of the PA regulatory board of three physicians, three PAs, & one lay member
- Allow PAs & their employers to bill public & private insurers for services provided by the PA employee
o Medicaid billing finalized in November 2021
o Medicare billing effective Jan. 1, 2022
• Create requirements for newly graduated PAs
o A PA with < 10,000 hours of post-graduate clinical practice experience practice underwritten policies & procedures established at a practice level
o Describe how collaboration will occur
o Describe methods for evaluating PA competency, knowledge, & skills;
o Collaborate with a physician for the first 4,000 hours of post-graduate clinical practice
o A PA with > 4,000 hours of practice experience & < 10,000 hours of practice experience shall enter into a written collaborative agreement with
■ A physician; or
■ Licensed PA with > 10,000 hours of practice experience in the same specialty as the PA
• Create requirements for PAs switching specialties
o A PA changing to another specialty in which the PA has < 4,000 hours of experience shall collaborate for a minimum of 4,000 hours with a physician trained & experienced in the specialty to which the PA is transitioning
• Define the scope of practice of a PA who volunteers their services
o A PA may provide health care services as a volunteer for a charitable organization or at a public or private event, including a religious event, youth camp, community event, or health fair if the PA
■ Receives no compensation for such services &
■ Provides the health care services in a manner that is consistent with the PA’s education, experience & scope of practice
■ A PA who is providing volunteer health services under this section may not issue a prescription to a patient for a controlled substance
Executive Summary Utah S.B. 28 — Mental Health Practice Act Amendments
• Recognize PAs as Mental Health Care Providers:
o After working with a psychiatrist for 2 years, PAs would be in a collaborative rather than a supervisory relationship
o PAs would be responsible for the care they provide
o PAs will be recognized as mental healthcare providers in the Utah Mental Health Practice Act
o Employers can bill under the PA’s license, but they can also bill under the psychiatrist’s license
o PAs can choose to qualify to be recognized as independent mental healthcare providers by:
■ Completing the before mentioned 4000 hours (two full time years) of practice under the supervision of a psychiatrist
■ Obtaining the NCCPA PSYCH CAQ
■ Completing one of the following division approved postgraduate academic programs
- A psychiatric/mental health residency
- A doctoral level certificate awarding program
- A doctorate degree
- Provide psychotherapeutic services under the supervision of a psychiatrist or other qualified psychotherapist for 2000 hours (one full time year)
- Work an additional 4000 hours in collaboration with a psychiatrist
■ Qualifying post graduate academic programs must include 1,600 of accredited instructional hours that provide graduate level instruction including a list of specific coursework identified in the bill.
DOPL Information on Licensing:
Learn more about DOPL and licensing here: https://dopl.utah.gov/physician-assistant/
FAQ: Frequently Asked Questions
- Why 10,000 hours?
5 years of clinical practice in the same discipline gets you the 10,000 hours
As a 1099 employee, I pay my supervising Dr a percentage of my receivables each month. Am I able to stop this now?
If you have over 10,000 hours you no longer need a supervising physician.
Billing:
Incident to and shared billing:
Does this also mean that PAs can bill 100% with incident-to and shared billing?
AAAP discourages this form of billing because of high incidents of fraud if you don’t meet all the criteria.
If you are looking at billing you need to credential directly with the insurance company and then the insurance companies will determine your rate of pay. If you’re in a practice by yourself then there is no incident to billing.
Also, CMS and medicare are going to split billing for hospital services and shared billing so you need to consider it. Incident to billing you have to meet all of the criteria and that means if the patient has seen a physician for hypertension and you see them in follow up but they also have a cough that day that is unrelated oryou want to treat an unrelated issue, that is not qualified as an incident to visit and cannot be billed at 100%.
PAs can be listed in the Utah Medicaid directory.
You are fully liable for your practice as a PA! .
Mental Health Physician Assistant
Question: Hi! I am looking for some clarification. I work as a 1099 in psychiatry (3yrs) outpatient and inpatient. At my outpatient job I pay my supervising physician a percentage of my billables monthly. With the passage of OTP in Utah am I still required to keep this doctor as a supervising physician that I have to pay?
Response: I have attached a summary of the changes for SB28 with references for the Mental Health practice act https://le.utah.gov/xcode/Title58/Chapter60/58-60-P1.html and the section of the PA practice act that is relevant https://le.utah.gov/xcode/Title58/Chapter70A/58-70a-S501.1.html?v=C58-70a-S501.1_2021050520210505
With 3 yrs of supervised experience you would need 2 more years of collaboration by a psychiatrist. You also need to make sure you have met the educational and supervised psychotherapy requirements as well.
Aesthetic Business/IV Infusion Business
I am possibly relocating to Utah and I’m trying to find out what the parameters are for a PA to own their own aesthetic business/IV infusion business. Can you please send me links to the wording that would cover that or help me out. I would greatly appreciate it. Thank you and God bless.
You can familiarize yourself with PA statute and rules on the DOPL website; DOPL - PA
We are aware of a restriction where PA's are not named on legislation for aesthetic clinics/Spas and thus prevent sole practice in that speciality.
We have other PA's interested in changing that legislation if you want to join the legislative committee and work on changing that.
Telemedicine:
Question: Hello - It appears that for PAs with 10k hours of practice, there is no supervision/collab or delegation agreement requirements. Is this correct? I have tried contacting the board but they stated they will not give advice on this matter.
I work for a nationwide telemedicine company with patients in Utah. We are wanting to cross license some of our staff in Utah right now. They do have SP/CP's and a medical director as a resource. But am I correct in understanding that they don't need a specific physician agreement if they have the 10K hours of practice?
Would appreciate any direction you can point me in on this. It seems to be really challenging to get information.
Thank you so much!
Response:
Telemedicine you must be licensed in the state of the patients you are seeing. And follow the rules outlined on the DOPL website: https://dopl.utah.gov/physician-assistant/
Sleep Medicine/ Speciality Fields
I am a Physician Assistant licensed to practice in the state of Utah. I graduated from PA school in 2012 and have nearly 15,000 hours working under physician supervision in multiple fields, 6,000 of which have been completed in the field of sleep medicine. I would like to go into independent practice for sleep medicine at some point but have been having trouble finding straightforward information about what would be required for me to be able to practice independently. I was wondering if you have any resources you can send me about how many hours would be required for me to practice sleep medicine independently and what the process of setting myself up for independence might look like or involve? I really appreciate any help you can offer.
DOPL - PA is an excellent resource to review. The language in the practice act and rules is very clear. You need to have 10,000 hours experience in the specialitythat you want to practice in. If you have the hours of experience and expertise then you should be good in that speciality. https://dopl.utah.gov/physician-assistant/
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