MAPA Legislative Alert
To advance the PA practice to its fullest potential in Michigan, MAPA has created a bill that has been voted on, passed and signed into law by Governor Snyder in December 2016 called Public Act 379. The initial bill was introduced by our physician friend Representative Ned Canfield, DO. As it is now called, Public Act 379 delineates points and clarifies items of a practice agreement between PAs and a participating physician.
The ‘Good News’ from this bill is that the terms “Supervision” and “Delegation” are removed from the statute when referring to PA-physician teams and PAs are no longer delegated prescribers, but “independent prescribers within a practice agreement.”
Summary Points of the Signed PA Law PA 379:
PAs will continue to practice medicine and remain a sub-field of Medicine, Osteopathic Medicine and Podiatry boards and continue to be subject to the rules promulgated by these boards.
PAs will continue to practice with a physician as a member of a practice team.
PAs will work with a participating physician and within a practice agreement that defines an inter-professional process for communication, availability and decision-making which enables the shared knowledge and skills of health care providers to deliver medical treatment to patients based upon each provider’s education, training and experience and specifies the following:
- includes the signature of each party to the agreement
- includes a termination provision
- defines the methods of communication between, and periods of availability of, each of the parties in the agreemement
- stipulates that a party to the agreement cannot practice outside their scope and training
Continue to be held to the standards of competency and training: “A physician’s assistant shall not undertake or represent that he or she is qualified to undertake provision of a medical care service that he or she knows or reasonably should know to be outside of his or her competence or is prohibited by law.”
The practice agreement removes supervision and delegation provisions in the statute, in favor of physician oversight within the practice agreement.
Mandate that the “Boards” consider rules to be developed that may further define a practice agreement.
Removes arbitrary PA/physician ratios in statute and allows the “Boards” to deliberate on a more comprehensive approach through the rules process.
PAs will be included in the definition of “prescribers,” but prescribe only as a party to a practice agreement with a participating physician.
PAs have always promoted the benefit of practicing with physicians and these same physicians have embraced the team concept with PAs. In summary, PA 379 modernizes the language in the Public Health Code of Michigan and mirrors how PAs practice, while adhering to our team practice concept with physicians.
Chris Noth, PA-C Ron X. Stavale, PA-C
MAPA President 2015-2016 MAPA Legislative Committee Chair
Michigan’s Mental Health Code – Time for PA Inclusion!
Over the years, MAPA has fielded many requests from employed PAs in mental health, regarding the various barriers they face in practice. These issues ranged from prescribing to reimbursement, but also other problems limiting PAs in providing care for patients with mental health issues. Some of these limitations have been based on the fact that the PA profession was just emerging in the early 70’s, and despite being well defined in the Public Health Code, unfortunately PAs were not included in the Mental Health Code, when it was written in 1974. While our Michigan State Law allows for physicians and psychiatrists to delegate the practice of medicine to PAs, this is not the case in the mental health arena, because PAs were not listed as providers in the Mental Health Code back then. Therefore, PAs have become limited to practice in the mental health arena because of this glitch and that some office or hospital administrators interpret this glitch as a reason for not allowing PAs to perform a specific aspect of a practice.
Early in 2016, MAPA approached Thadd Gormas, who is the Chief of Staff for Senator James Marleau, about including PAs in the Mental Health Code. Initial work was started and a Psychiatric PA facilitated connecting MAPA with a psychiatrist, Michelle Reid, MD who has already been actively working to include PAs in the Mental Health Code and in the Medicaid Manual. During the past several months, a group of providers have been meeting weekly to address this issue. The group consists of me, Dr. Reid, and another psychiatrist colleague from their department, along with a doctoral NP student, Thadd Gormas and MAPA’s Executive Director- Mike DeGrow. We have been going through the Mental Health Code- adding the title PA to the list of providers in each section, so that PAs will be specifically mentioned throughout the code instead of leaving the possibility that someone could interpret the lack of mentioning ‘PAs’ as reason to deny a PA the ability to care for patients with mental health issues.
This synergy of forces has allowed us to project the ability and send a draft of a bill to our Legislative Service Bureau by the end of August; hopefully, having a draft of a bill that can be fine tuned and submitted for consideration in the fall’s legislative session. We are limiting the focus of this bill to including PAs as providers; knowing that the more issues that are addressed in a specific bill, the better chance other professions will comment or amend the bill. We don’t expect this to be a slam dunk; so therefore, MAPA would like to make a list of all of the Michigan PAs working in psychiatry so that we can contact PAs and physicians who would be supportive of this effort. We will need the support of physicians, administrators and PAs working in the mental health community to allow this process to become successful. Hence, we are asking all Michigan PAs working in psychiatry to contact the MAPA office or myself to be included in this process. The MAPA office phone is: 877-YES- MAPA (877-937-6272) or email our Academy Administrator Sara Surprenant at: firstname.lastname@example.org
By Ron X. Stavale, PA-C
MAPA Legislative Committee Chair