Changes to NJ Physician Assistant Licensing Act:
New Professional Liability Insurance Requirements and Changes to Scope of Practice and Supervision Requirements
On August 1, 2016, changes to New Jersey’s “Physician Assistant Licensing Act,” N.J.S.A. 45:9-27.10 et seq., will become effective, adding requirements for professional liability insurance and amending the scope of practice and supervision requirements for New Jersey licensed physician assistants (PAs). Some highlights are below.
Malpractice Coverage
Beginning August 1, 2016, PAs engaging in clinical practice in New Jersey will be required to be covered by medical malpractice insurance policies or, if unavailable, a letter of credit. The statutory amendments do not dictate the specific amounts or requirements for coverage. Rather, the statute provides that the specific requirements will be established by regulations adopted by the New Jersey State Board of Medical Examiners (BME). Because of the impending effective date and the fact that the BME has not yet proposed or adopted regulations under the statute, the BME issued a letter to the medical community on June 30, 2016.
In the letter, the BME advised the medical community that the board intends to promulgate regulations requiring PAs to maintain malpractice coverage in the amounts of $1 million per occurrence and $3 million per policy year. Letter of credit amounts and requirements will be consistent with those forth in existing N.J.A.C. 13:35-6.18. Pursuant to that regulation, letters of credit must be non-assignable, non-transferable, unexpired, continuous irrevocable obligations issued by a bank or saving association authorized to do business in New Jersey, payable to the medical beneficiary (in this case physician assistants) within 30 days after a demand for payment and the presentation of a final judgment or settlement in a medical malpractice action. The letter of credit must be secured and issued in the minimum sum of $500,000.
Broadened Prescribing Powers
Prescribing authority for PAs has been broadened. Under the statutory amendments, beginning August 1st, PAs may (with certain limitations concerning controlled dangerous substances) order, prescribe, dispense and administer medications and medical devices to the extent delegated by a supervising physician. (Added language is in bold print.) The dispensing of medication or a medical device by a PA must comply with relevant federal and state regulations and may occur only if: (i) pharmacy services are not reasonably available; (ii) it is in the best interests of the patient; or (iii) the PA is rendering emergency medical assistance.
“Direct” Supervision No Longer Required
The “direct” supervision requirement has been replaced with a requirement for “continuous” supervision by the supervising physician at all times when the PA is working in an official capacity. Continuous supervision does not necessarily require physical presence by the supervising physician. Rather, supervision must be continuous and the physician and PA must maintain contact through electronic, or other means of, communication.
Scope of Practice
The statutory amendments change the scope of practice for PAs. While certain procedures may be performed by the PA simply under the “continuous supervision” of the supervising physician, certain procedures may be performed only when directed, ordered or prescribed by the supervising physician or when the performance of the procedure is delegated to the PA by the supervising physician under a written delegation agreement. The concept of such an agreement is new.
Delegation Agreements
The amendments provide that a physician who supervises a PA may maintain a written “delegation agreement.” The statute provides the specific requirements for such an agreement, including agreements that may be entered into for a single- or multi-specialty physician practice. A PA must sign a separate written agreement with each physician who delegates medical services as briefly described above. The agreement must, among other things, state that the physician will exercise supervision over the PA in accordance with applicable law and BME rules. It also must be signed and dated annually by the physician and PA.
Action May Be Required
Health care employers should review the scope of practice of the PAs providing services to them to make sure services remain consistent with the statutory amendments. Services and arrangements will need to be reviewed to determine whether or not a delegation agreement will be required. Training may be needed to ensure physicians, PAs and the rest of the medical team understand the permissible scope of practice as well as legal and administrative requirements.
Should you need assistance in understanding and applying the new requirements, reviewing your relationships or preparing delegation agreements, please contact one of the Members of our health law team below.
Health Law Practice Group
Members
John D. Fanburg, Chair
973.403.3156 • jfanburg@bracheichler.com
Riza I. Dagli
973.403.3103 • rdagli@bracheichler.com
Lani M. Dornfeld
973.403.3136 • ldornfeld@bracheichler.com
Joseph M. Gorrell
973.403.3112 • jgorrell@bracheichler.com
Carol Grelecki
973.403.3140 • cgrelecki@bracheichler.com
Debra Lienhardt
973.364.5203 • dlienhardt@bracheichler.com
Mark Manigan
973.403.3132 • mmanigan@bracheichler.com
Keith J. Roberts
973.364.5201 • kroberts@bracheichler.com
