Utilization of advanced practice nurses and physician assistants has been increasing over the past several years. Laws with respect to these health care providers have also changed – on both federal and state levels.
On May 4, Gov. Pence signed into Indiana law HB 1183 that included changes for both advanced practice nurses (APN’s) and physician assistants (PA’s), effective July 1, 2015. Further, on April 16, Pres. Obama signed into federal law HR 2 that impacted nurse practitioners.
Weight Reduction Treatment
Historically, only physicians have been permitted to prescribe and treat patients with schedule III and IV controlled substances for weight reduction or obesity control under special protocols. HB 1183 expands that authority to APN’s and PA’s. Prescribing schedule II’s for weight loss remains prohibited for all licensees.
PA’s engage in dependent practices with physicians in which the physicians delegate authority to the PA’s. Nevertheless, HB 1183 substantially changes many requirements related to physician supervision.
- A supervising physician no longer is required to name each drug or drug classification the PA has been delegated authority to prescribe.
- A supervising physician does not need to co-sign any prescriptions ordered by a PA.
- A supervising physician must now review the PA’s patient encounters within 10 days – formerly 72 hours.
- The supervising physician’s chart reviews must include at least 25 percent of the PA’s encounters in the first year of practice. Thereafter, the physician can determine what amount is reasonable for the practice setting and PA’s experience level, and what is appropriate to maintain quality medical care. Requirements were previously higher and discretion did not exist.
- PA’s are now eligible to prescribe controlled substances after 1,800 PA work hours, even if those hours are met before the prior one year waiting period. For the first year a PA obtains authority to prescribe a schedule II controlled substance, 50 percent of the schedule II patient records must be reviewed. This was previously 100 percent.
- PA’s can now also issue controlled substance refills consistent with their delegated authority.
Finally, a supervising physician can now supervise a maximum of four PA’s at any time – expanded from two.
Advanced practice nurses/nurse practitioners
APN’s include nurse practitioners, certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists. APN’s are independent members of the health care team who can make independent decisions related to the health care of patients. For APN’s seeking prescriptive authority, a collaborative agreement with a physician is required. The new federal law passed in HR 2 authorizes nurse practitioners to document face-to-face encounters required for durable medical equipment orders. Previously, a physician needed to document such an order. These changes may have a significant impact on how you utilize these health care professionals after the state law becomes effective July 1, 2015.
For questions, contact the ISMA legal department. The author, Alex T. Krouse, attorney with Krieg DeVault, can be reached at (574) 485-2003.
This article is provided for educational purposes and should not be construed as legal advice.