Ala. Admin. Code r. 540-X-7-.23

Current through Register Vol. 42, No. 6, March 29, 2024

Section 540-X-7-.23 - Requirements For Supervised Practice - Physician Assistants (P.A.)

(1) Physician supervision requires, at all times, a direct, continuing and close supervisory relationship between a physician assistant and the physician to whom the assistant is registered.

(2) There shall be no independent, unsupervised practice by physician assistants.

(3) The supervising physician shall be readily available for direct communication or by telephone or telecommunication.

(4) The supervising physician shall be available for consultation or referrals of patients from the physician assistant.

(5) In the event the physician to whom the physician assistant is registered is not readily available, provisions must be made for professional medical oversight and direction by a covering physician who is readily available, who is preapproved by the Board of Medical Examiners, and who is familiar with these rules.

(6) In the event of an unanticipated, permanent absence of a supervising physician, a previously approved covering physician may be designated as a temporary supervising physician for a period of up to sixty (60) days. During the sixty (60) day time period, a new registration agreement designating a new supervising physician should be submitted for approval.

(7) If the physician assistant is to perform duties at a remote site, the application for registration must clearly specify the circumstances and provide written verification of physician availability for consultation and/or referral, and direct medical intervention in emergencies and after hours, if indicated. The Board, at its discretion, may waive the requirement of written verification upon documentation of exceptional circumstances. Employees of state and county health departments and facilities certified by the Alabama Department of Mental Health are exempt from the requirement of written verification of physician availability.

(8) The supervising physician and the physician assistant shall adhere to any written guidelines established by the Board to govern the prescription practices of physician assistants.

(9) If the physician assistant is to perform duties at a remote site physician supervision requires the following:

(a) The supervising physician receives a daily status report to be made in person, by telephone, or by telecommunications from the assistant on any complications or unusual problems encountered;

(b) The supervising physician will be present ten percent (10%) of the P. A.'s scheduled work hours in an approved remote practice site if:

1. The P.A. has less than two (2) years (4,000 hours) in a registration agreement.

2. The P.A. has entered into a new registration agreement and the new supervising physician has a dissimilar primary specialty than the previous supervising physician.

(c) If the P.A. has at least two (2) years (4,000 hours) in a registration agreement, the supervising physician shall:

1. Visit the remote site no less than twice a year.

2. Meet with the P.A. no less than quarterly.

(d) A pre-approved covering physician is allowed to be present in lieu of the supervising physician.

(e) The supervising physician, during office visits, if applicable, reviews with the assistant case histories of patients with unusual problems or complications.

(f) An appropriate physician personally diagnoses or treats patients requiring physician follow-up.

(10) The supervising physician must complete quarterly quality assurance with each physician assistant. Documentation of any quality assurance review required by this chapter shall be maintained by the supervising physician for the duration of the registration agreement and for three years following the termination of the supervised practice agreement.

(a) The mechanism for quarterly quality assurance shall be as follows:

1. Specify a plan for quarterly quality assurance management with defined quality outcome measures for evaluation of the clinical practice of the physician assistant and include review of a meaningful sample of medical records plus all adverse outcomes. The term "medical records" includes, but is not limited to, electronic medical records. Documentation of quality assurance review shall be readily retrievable, identify records that were selected for review, include a summary of findings conclusions, and, if indicated, recommendations for change.

2. Countersignature by supervising physician must be pursuant to established policy and/or applicable legal regulations and accreditation standards.

(11) The supervising physician must maintain documentation of the physician assistant's two (2) years (4,000 hours) of supervised practice experience for the duration of the supervised practice and for three (3) years following the termination of the registration agreement.

(12) The physician shall at all times maintain independent medical judgment related to the practice of medicine, irrespective of employment structure or business model.

(13) Irrespective of the location of the principal practice site and any remote site(s) of the supervised practice, all services provided to patients and actions incident to services provided to patients of the supervised practice shall be deemed to have occurred in the state where the patient is located at the time of service or action incident to the service. The supervising physician, covering physician, and physician assistant shall comply with all applicable Alabama laws, rules, and regulations pertaining to services and actions incident to services provided to Alabama patients of the supervised practice. Actions incident to services include, but are not limited to, professional medical oversight and direction to the physician assistant regarding Alabama patients, consultation, or referral of Alabama patients from the physician assistant, quality assurance review of the medical records of Alabama patients, and maintenance of documentation pursuant to this chapter. The supervising physician shall maintain all documentation required pursuant to this chapter for the duration of the supervised practice and for three years following the termination of the supervised practice agreement.

Ala. Admin. Code r. 540-X-7-.23

Repealed and Replaced: Filed September 21, 1998; effective October 26, 1998. Repealed and New Rule: Filed August 22, 2002; effective September 26, 2002. Repealed and New Rule: Filed September 19, 2002; effective October 24, 2002. Amended: Filed October 21, 2010; effective November 25, 2010.

Amended by Alabama Administrative Monthly Volume XXXIII, Issue No. 03, December 31, 2014, eff. 1/15/2015.

Amended by Alabama Administrative Monthly Volume XXXIV, Issue No. 03, December 31, 2015, eff. 1/30/2016.

Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 01, October 31, 2017, eff. 12/3/2017.

Amended by Alabama Administrative Monthly Volume XXXIX, Issue No. 02, November 30, 2020, eff. 1/14/2021.

Amended by Alabama Administrative Monthly Volume XL, Issue No. 01, October 29, 2021, eff. 12/13/2021.

Author: Alabama Board of Medical Examiners

Statutory Authority:Code of Ala. 1975, §§ 34-24-290, et. seq.