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Legislation & Collaboration

The SDPA has been an integral part of legislation that affects our profession, patients and society as a whole. We have worked at the federal, state and grassroots levels to help protect our patients and protect and expand PA practice laws. We quickly challenge any legislation that seeks to limit PA practice or patient access to care. We have advocated for tanning bed legislation beginning with California the first state to pass a total ban for minors. We continue to advocate for all states to pass similar bans. We have worked with the FDA and were successful in getting tanning beds reclassified from a class I to a class II medical device. We have partnered with the American Cancer Society, AIM at Melanoma, The Melanoma Research Foundation, American Academy of Physician Assistants (AAPA), SPEAKE oral parity coalition and The World Skin Cancer Foundation to help support important legislation that not only protects our patients, but helps reduce skin cancer rates in the future.

Current Legislation

PAs in Puerto Rico

The AAPA has teamed up with the SDPA to target legislation for PAs to serve patients in the Commonwealth of Puerto Rico. The 2017 SDPA CME conference is scheduled to be held November 4-12, 2017 in San Juan, Puerto Rico at the Caribe Hilton hotel. SDPA hopes to use the conference as an opportunity to reach out to the medical community and demonstrate how PAs learn and practice. SDPA is also looking to do a “goodwill service project” in conjunction with the event.

SDPA and AAPA held a conference call to inform SDPA about PAs in Puerto Rico, efforts to pass a PA practice act in the Commonwealth and to discuss PA advocacy opportunities surrounding the SDPA conference.

Legislative  Bill 37 - Nebraska Dispensing License

LB37 was introduced in January 2015 and became effective September 2015. It prohibits PAs, nurse practitioners, and physicians from legally dispensing medications without a pharmacy license. Nebraska Legislature has restricted our role as health care providers, thus directly reflecting upon the patient. LB37 can be a direct obstacle to many patients that may not otherwise receive care.

According to the American Academy of Physician Assistants, “The purpose of limited dispensing is not to replace pharmacy services, but rather to increase patient ability to receive needed medication when access to pharmacy services is limited.” Removal of such privileges removes an elemental purpose of a physician assistant: extending access to healthcare. Expanding access to healthcare is not only our career but our desire.

https://www.nebraskapa.org/news/141-notifcation-from-nebraska-dhhs-physician-assistant-committee-pac

SDPA Partnerships

Previous Legislation

Tanning Bed Legislation

At least 42 states and D.C. regulate indoor tanning for minors. Thirteen states (California, Delaware, Hawaii, Illinois, Louisiana, Minnesota, Nevada, New Hampshire, North Carolina, Oregon, Texas, Vermont and Washington) ban the use of ultraviolet tanning devices by anyone under age 18. Other state laws combine various restrictions.

For example, Delaware, New Hampshire and North Dakota ban the use of indoor tanning by anyone under age 14 unless medically necessary—subsequently requiring parental accompaniment and parental consent for those between 14 and 18 years of age. At least 23 states require operators to limit exposure time to manufacturers’ recommendations and provide eye protection. Along with requiring parental permission for minors, Arizona also requires public schools to provide education about risks to developing skin cancer. The SDPA has been advocating for total tanning bed bans for minors since 2010. We have partnered with AIM at Melanoma and have worked on countless state led initiatives. We have also partnered with the American Cancer Society in several states including Maryland to try to pass tanning bed legislation.

Tanning Legislation in 2015 – State by State Comparison – Updated October 2015

Modern PA Practice Act

SDPA has teamed up with AAPA to help promote The Modern PA Practice Act which encourages states to meet six key elements to ensure effective and efficient patient care. In 2014 after hearing about practice issues from Dermatology PAs in Ohio the SDPA worked with AAPA to help practice reform in the state.

Click here for more Information on the Modern PA Practice Act.

HB 412 - Practice reform for PAs in the state of Ohio. The bill removes the approval process by the Ohio State Medical Board of physicians’ supervision agreements, which will allow PAs to begin practicing immediately; in the past, the approval process could take up to 3 months. The bill creates one process for applications for licensure to practice and prescribe instead of the current three application processes. The Bill removes the travel time requirement for the doctor and allows PAs to delegate to MAs. Most importantly, the bill removes the restrictive list of procedures a PA may perform and allows the supervising physician to delegate duties within his or her scope of practice. The bill increases the number of PAs a doctor may supervise at one time from two to five.

SB110Passed June 25th, 2015. Update PA practice laws in Ohio.

HB 1183Passed July 1st, 2015 in Indiana. Allows a physician assistant who is delegated authority to prescribe a controlled substance after practicing for at least 1,800 hours.

Bill (92-8) HR 2 - bill to repeal Medicare's SGR formula. HR 2 will also extend the Children's Health Insurance Program (CHIP) and finding for National Health Service Corps and Community Health Centers programs.  President Obama signed into law on April 16th, 2015 contains the following PA-friendly provisions:

  • Treats PAs in the same fashion as physicians and nurse practitioners in the value-based performance payment program.
  • Recognizes the role of PAs in providing complex chronic care to patients.
  • Allows PAs to perform the face-to-face encounters in documenting the need for durable medical equipment (DME) for Medicare beneficiaries.

HR 1202 - the Medicare Patient Access to Hospice Act of 2015, which would authorize PAs to provide hospice care.

Oral Parity Legislation

Oral chemotherapy medications are not covered by insurance compared to IV medications.  New York, Colorado, Hawaii, Indiana, Iowa, Kansas, Minnesota, Oregon, Texas, Vermont, Nebraska, and the District of Columbia have passed oral parity reform.

Oral cancer therapies are less invasive, require fewer trips to the doctor’s office or hospital, and can be taken at home. Without this legislation, out of pocket costs to patients will only continue to increase as more oral cancer therapies become available.

What is the difference in coverage between oral and intravenous/injected cancer drugs?
Intravenous or injected drugs are typically covered under medical benefit plans because of way they are administered.

Intravenous and injectable drugs are typically administered in a physician's office or hospital outpatient center.  This treatment is generally covered as a physician service or hospital outpatient service and therefore covered as a medical benefit. Oral medications are self-administered and obtained through a pharmacy, so they are typically covered as a pharmacy benefit.

Why are oral cancer drugs more expensive for cancer patients than intravenous or injected anticancer medications?

A patient's cost burden for cancer treatments is determined by the copayment, coinsurance, deductible, maximum out of pocket, and annual/lifetime maximum benefit provisions of the patient's medical benefit plan, while the patient's cost burden for oral medications is determined by the same features of the patient's prescription drug plan.  Prescription drug plans commonly include unlimited coinsurance provisions that lead to higher cost sharing requirements for patients who obtain oral medications than medical benefit plans would require for intravenous or injected drugs.

SDPA has joined two coalitions to support oral parity legislation. SPEAKE at the State level and PEAC at the federal level.

Disease Research

Modern PA Practice Act

SDPA has teamed up with AAPA to help promote The Modern PA Practice Act which encourages states to meet six key elements to ensure effective and efficient patient care. In 2014 after hearing about practice issues from Dermatology PAs in Ohio the SDPA worked with AAPA to help practice reform in the state.

Click here for more Information on the Modern PA Practice Act.

According to the American Academy of Physician Assistants the Modern PA Practice Act includes:

  1. "Licensure" as the regulatory term – The goal is for uniformity from state to state to facilitate the process in which physician assistants become licensed. The broad term “licensed health care providers” enables specific rights that can only occur under universal language.   
  2. Full prescriptive authority – Physicians should collaborate with physician assistants regarding prescriptive authority. The physician – physician assistant team can prevent interruption of care to patients and should be determined at the practice level.
  3. Scope of practice determined at the practice level – Privileges ought to be based according to the supervising physician or facility not by the state which can become restrictive.
  4. Adaptable supervision requirements – Official policy states that “the circumstance of each practice determines the exact means by which responsible supervision is accomplished.” State laws and regulations may limit the ability of physician assistants to practice most efficiently and effectively.
  5. Chart co-signature requirements determined at the practice – The AAPA’s view on co-signature states it should only be utilized when the supervising physician, physician assistant or the facility determines that it is necessary.
  6. Number of PAs a physician may supervise determined at the practice level – Each situation should dictate the ratio of each physician to physician assistants. Several organizations agree that physicians at the practice level should the ultimate decision maker on this issue.
Calendar

SDPA 15th Annual Fall Dermatology Conference 2017 - REGISTER NOW!
November 8-11, 2017 – Caribe Hilton – San Juan, Puerto Rico

SDPA Annual Summer Dermatology Conference 2018
June 28-July 1, 2018 – Westin Hotel – Seattle, WA

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