Proposed Amendments: N.J.A.C. 13:35-2B.4 and 2B.10

Physician Assistant Advisory Committee

Scope of Practice; Supervision

Authorized By: State Board of Medical Examiners, William Roeder, Executive Director.

Authority: N.J.S.A. 45:9-27.10 et seq., specifically 45:9-27.23(b) and 27.24.

Calendar Reference: See Summary below for explanation of exception to calendar requirement.

Proposal Number: PRN 2010-184 .

Submit comments by November 6, 2010 to:

Dorcas O'Neal, Executive Director

Physician Assistant Advisory Committee

124 Halsey Street

P.O. Box 45035

Newark , New Jersey 07101

The agency proposal follows:

Summary

The State Board of Medical Examiners (the Board), in consultation with the Physician Assistant Advisory Committee, is proposing to amend N.J.A.C. 13:35-2B.4, which concerns the scope of practice for licensed physician assistants. N.J.A.C. 13:35-2B.4(a)6 currently provides that a physician assistant who is working under the direct supervision of a licensed physician, and who complies with all practice requirements set forth in N.J.A.C. 13:35-2B.3, may facilitate the referral of patients to health care facilities and other agencies and resources in the community. [page=2002] The Board believes that permitting a physician assistant to make the actual referral of patients to such services on behalf of the supervising physician, rather than just facilitating the referral, is reasonable and will lead to greater efficiency in the rendering of patient care. Therefore, the Board is proposing to amend N.J.A.C. 13:35-2B.4(a)6 to clarify that the referral of patients falls within a licensed physician assistant's scope of practice. In addition, the Board is proposing to further amend N.J.A.C. 13:35-2B.4(a)6 to clarify that such referrals may be made to health care practitioners, in addition to the currently permitted health care facilities and community agencies and resources.

The Board is also proposing an amendment to the supervision requirements for physician assistants set forth at N.J.A.C. 13:35-2B.10. Paragraph (b)5 establishes the supervisory ratios with which physician assistants must comply in order to render care. Specifically, existing paragraph (b)5 provides that in a private practice setting that is not hospital based or institutionally affiliated, the supervisory ratio must be no more than two physician assistants to one physician at any one time. In all other practice settings, the rule provides that the supervisory ratio must be no more than four physician assistants to one physician at any one time. The Board does not believe that the differences in these practice settings with respect to the care provided by physician assistants are sufficient enough to warrant different supervisory ratios. Therefore, the Board is proposing to amend N.J.A.C. 13:35-2B.10(b)5 to eliminate all references to particular practice settings as they relate to supervisory ratios. As amended, paragraph (b)5 would provide that in order for a physician assistant to render care, the supervisory relationship must be no more than four physician assistants to one physician at any one time.

The Board has provided a 60-day comment period for this notice of proposal. Therefore, this notice is excepted from the rulemaking calendar requirement pursuant to N.J.A.C. 1:30-3.3(a)5.

Social Impact

The Board believes that the proposed amendments will have a positive impact upon patients. The proposed amendment to N.J.A.C. 13:35-2B.4, which will expressly authorize physician assistants to refer patients to health care practitioners and facilities and other community agencies, will help to expedite patient referrals for such services. In addition, the proposed amendment to N.J.A.C. 13:35-2B.10, which will increase the number of physician assistants who may work under the supervision of a single physician in private practice settings, will increase patient access to the care rendered by physician assistants in such settings.

Economic Impact

The Board believes that the proposed amendment to N.J.A.C. 13:35-2B.10 may have an economic impact upon private health care practices that employ physician assistants. These private practices may now augment their work force with additional physician assistants, which may lead to an overall increase in the number of patients that may receive care in these practice settings. The Board does not anticipate that the proposed amendment to N.J.A.C. 13:35:2B-4, which will permit physician assistants to refer patients for services on behalf of supervising physicians, will have any economic impact upon physician assistants or upon their supervising physicians.

Federal Standards Statement

A Federal standards analysis is not required because the proposed amendments are governed by N.J.S.A. 45:9-27.10 et seq., and are not subject to any Federal requirements or standards.

Jobs Impact

The proposed amendment to N.J.A.C. 13:35-2B.10 may result in an increase in the number of jobs available for physician assistants in private health care practice settings, to the extent that the proposed amendment will authorize physician assistants employed in such settings to work in a ratio greater than the current ratio of two physician assistant to one physician. The Board does not anticipate that the proposed amendment to N.J.A.C. 13:35-2B.4 will have any impact on the number of jobs available to physician assistants in the State.

Agriculture Industry Impact

The proposed amendments will have no impact on the agriculture industry in the State.

Regulatory Flexibility Statement

Currently, the Board licenses approximately 1,600 physician assistants. If these Board licensees are considered "small businesses" within the meaning of the Regulatory Flexibility Act, N.J.S.A. 52:14B-16 et seq., then the following analysis applies.

The proposed amendments to N.J.A.C. 13:35-2B.4 and 2B.10 will not impose any reporting, recordkeeping or compliance requirements upon licensed physician assistants. No additional professional services will be needed to comply with the proposed amendments. The costs of compliance with the proposed amendments are discussed in the Economic Impact statement above. The Board believes that the proposed amendments should be uniformly applied to all licensed physician assistants in order to ensure the health, safety and welfare of the general public in the rendering of care by these heath care practitioners. Therefore, no differing compliance requirements for any licensed physician assistants are provided.

Smart Growth Impact

The Board does not believe that the proposed amendments will have any impact upon the achievement of smart growth or upon the implementation of the State Development and Redevelopment Plan.

Housing Affordability Impact

The proposed amendments will have an insignificant impact on affordable housing in New Jersey and there is an extreme unlikelihood that the rules would evoke a change in the average costs associated with housing because the proposed amendments concern the rendering of services by physician assistants.

Smart Growth Development Impact

The proposed amendments will have an insignificant impact on smart growth and there is an extreme unlikelihood that the rules would evoke a change in housing production in Planning Areas 1 or 2 or within designated centers under the State Development and Redevelopment Plan in New Jersey because the proposed amendments concern the rendering of services by physician assistants.

Full text of the proposal follows (additions indicated in boldface thus ; deletions indicated in brackets [thus]):

SUBCHAPTER 2B. LIMITED LICENSES: PHYSICIAN ASSISTANTS

13:35-2B.4 Scope of practice

(a) A licensee who has complied with the provisions of N.J.A.C. 13:35-2B.3 may perform the following procedures on a discretionary and routine basis:

1.-5. (No change.)

6. [Facilitating the referral of] Referring patients to, and promoting their awareness of, health care practitioners, facilities and /or other appropriate agencies and resources in the community;

7.-13. (No change.)

(b) (No change.)

13:35-2B.10 Supervision

(a) (No change.)

(b) The physician assistant shall not render care unless the following conditions are met:

1.-4. (No change.)

[5. The following supervisory ratios are met:

i. In a private practice which is not hospital based or institutionally affiliated, no more than two physician assistants to one physician at any one time;

ii. In all other settings, no more than four physician assistants to one physician at any one time.]

5. The supervisory ratio shall be no more than four physician assistants to one physician at any one time.

(c)-(d) (No change.)