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 Updated: 12/8/2004 |
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Final Draft Highlights
The Texas Sunset Commission staff recently released their recommendations for the Texas State Board of Physician Assistant Examiners/Texas State Board of Medical Examiners as well as their recommendations on the Licensing Reorganization Project. The Sunset Commission staff report is a compilation of recommendations for the TSBPAE, TSBME, and the Acupuncturists board. We are pleased that the essence of the staff's recommendations is consistent with what TAPA has advocated as important to our profession and to the safety of the public. The staff recognized the uniqueness of our profession and our sustained growth and prominently noted that in their recommendation the TSBPAE not be consolidated with any other board or umbrella agency.
We encourage all Texas PAs to take a few minutes and review these documents. They can be accessed on line at the Texas Sunset Commission web site at http://www.sunset.state.tx.us/, then click on Publications, and then click on All Sunset Reports 2004-2005. Scroll down and click on the staff report for the Texas State Board of Physician Assistant Examiners and the Licensing Reorganization Project. If you would like to provide us input or have questions on this process or the highlights below please feel free to contact Linda Contreras -TAPA President or Michael Clark - TAPA LAC chair and President Elect.
Even these recommendations are not a done deal but the legislative members of the Sunset Commission traditionally follow very closely the recommendations of the staff. The recommendations usually involve the creation or amendment of statute and/or rule and/or policy of the licensing board. The staff recommendations will play an important role in TAPAs representation of you during public testimony at the sunset commission hearing in November. These recommendations will also provide additional support to our lobbying efforts in the legislative session.
For your information we have put together the following highlights of the commission staff recommendations that most closely affect the PA. We have included commentary and thoughts from TAPAs prospective. Issues that were under consideration by TAPA in the first edition of these highlights have now been discussed and the new TAPA comment has been italicized and underlined.
The highlights of the Sunset Commission staff recommendations are:
1. ISSUE 1: The staff recommends increased access and discussion with stakeholders in the board's decision-making process. This is a significant recommendation to the board for including the input of professional organizations such as TAPA. TAPA has consistently been proactive in providing the board our input but the board at times has been slow in seeking our opinions.
The recommendation requires the TSBME and the TSBPAE to include input from those stakeholders that a proposed rule may affect such as the recent rule on medical devices that would have negatively impacted PA practice. We also recognize explicitly that stakeholder involvement should be expanded to other boards that consider matters involving the Physician-PA team such the Texas State Board of Pharmacy. TAPA will support this staff recommendation and advocate for expanded consideration of the stakeholder ideology to other boards.
In addition, this recommendation highlights the need of team stakeholders being involved in decisions that affect the Physician-PA team. We feel it is very important to have individuals intimate to the Physician-PA team concept be involved in the TSBME's decision-making on rules involving PA practice. TAPA believes the most accessible and knowledgeable individuals are those currently involved in the rule-making process. We feel those individuals most accessible to the board are the physician and PA members sitting on the TSBPAE. TAPA will recommend to the commission to support that one physician member and one PA member of the TSBPAE be assigned to the TSBME when it considering rules, prescription delegation waiver requests, or any issue affecting the Physician-PA team. Additionally, because of the growth of the Physician-PA team in Texas we also feel it is important the TSBME reflect this growth and relationship. TAPA will recommend the commission support that at least two physician members of the TSBME be physicians that supervise Physician Assistants.
2. ISSUE 2: The staff recommends more appropriate and efficient guidelines in evaluating mental and physical health disorders of physicians, PAs, and acupuncturists. The current case-by-case process the board uses to address concerns on an individual PAs mental and/or physical health allows much latitude in the decision-making without a clear definition of equity, law, and science. We support the staff's recommendations for clear and effective guidelines in the board's decision-making in these matters. But because of the potential stigma that could be placed on a good provider, it is not only important that the decision of the board protects the public but that it is also fair and just to the provider. The delicate and specialized nature of these disorders should include input from those knowledgeable about the treatment and outcomes of these disorders. We will recommend to the commission to support the inclusion of experts in mental and physical medical disorders in assisting the board in development of their guidelines as well as make their input more prominent when considering each case.
3. ISSUE 3: The staff recommends stricter adherence to standard-of-care investigation timelines as well as be more inclusive of expert panel review in its decision-making. Currently investigations are taking up to one year and sometimes longer to provide resolution. This is not fair to the PA or the public. The staff recommends a strict adherence to 180-day review process. TAPA supports this recommendation and will also advocate for PA inclusion on expert panels reviewing standard of care issues involving a PA.
4. ISSUE 6: The staff recommends a better definition and improved guidelines of professional organizations providing resources for substance abuse rehabilitation of a provider. This is a house-cleaning recommendation that requires the board to provide a clearer understanding of the relationship of professional organizations as utilized by the board in the rehabilitation of a provider. These same rehabilitation resources are available to Texas PAs. TAPA supports this recommendation.
5. ISSUE 9: The staff recommends continuation of the prescriptive delegation waiver process by the board. TAPA advocated to the commission staff the importance of the prescription delegation waiver. The staff feels this process is still an essential option in prescription delegation and its impact on access to health care. The waiver now only allows consideration of waving the statutory on-site supervision requirements and chart review when considering a waiver request. The staff recommends that the distance of the practice site be included as an option in the waiver process.
The staff also recommends abolishment of the waiver advisory committee and relegates the waiver consideration responsibility to an existing TSBME committee. The waiver advisory committee has been difficult to administer and the staff believes this should be a TSBME duty. Even though we don't disagree with the staff's recommendations we feel this is one of those areas stakeholder considerations are important and it is important to include TSBPAE members and TAPA to assist in the process. As noted in Issue #1, TAPA will request the commission support of one PA and one physician TSBPAE member be assigned to the TSBME when deliberating on prescription delegation waiver applications and advocate for continued stakeholder involvement by TAPA.
6. ISSUE 9: The staff recommends the board not require prescription delegation registration to the board. This is a positive step in that it articulates a higher recognition from a governmental body of the professional relationship of the Physician-PA team. To practice a PA must submit an intent to practice form that documents the establishment of the individual physician-PA team relationship. This staff recommendation if approved would do away with another administrative step, the prescription delegation registration, in the licensure and practice process. The staff recommends the board develop rules on how physicians must document delegation of prescriptive authority at the practice site. One concern that TAPA will monitor is how the pharmacy board may view and act on this. TAPA will support this recommendation but of course will participate as a stakeholder in the rule-making process.
One last thought, even though it is implied in the recommendations, this was one area we were hoping the staff would comment on the frustrations, which TAPA shares, of the current site-based practice language. We hope it will be better articulated in the legislative session when legislation is introduced to support the commission's recommendations.
7. ISSUE 10: The staff recommends abolishment of the surgical assistant license. Years ago TAPA, TMA, nursing organizations, and even the TSBME expressed their concern on the necessity of a licensure process for surgical assistants. The role and definition was vague and the size of the group was not seen as large enough to support a licensing board. TAPA will support the staff's recommendation.
8. ISSUE 11: The staff recommends that all new licensure applicants for a PA license take a jurisprudence examination. The staff recommends that all new licensees after 1 September 2006 be required to take this examination. All current licensees would be exempt. The concept of a jurisprudence examination for Physician Assistants was proposed by the TSBPAE several years ago. TAPA worked with the TSBPAE to improve professional CME access for Texas PAs on our practice laws in an attempt to delay this testing requirement. But with the TSBME persistently wanting it, the sunset commission staff now recommending it, and with the greatly increased recognition of PAs as integral health care professionals, the recommended standards by the commission staff were expected. As you know, physicians are required to demonstrate they understand the law for medical practice in Texas and it really is not unreasonable to expect that PAs demonstrate a more comprehensive knowledge of the laws governing medical practice. After all, PAs do practice medicine under the supervision of a physician! The jurisprudence exam is viewed by the state as a mechanism for protecting the welfare and safety of the state. One thought about this recommendation that has not been discussed is its fiscal impact to the board or practicing PAs. TAPA will support this recommendation.
9. ISSUE 11: The staff recommends the board staff be allowed to grant a full license until the full board can meet. This administrative action would simply do away with the temporary license (as you know temporary licenses do not have permit numbers). Since the board now requires the PA graduate to have passed the NCCPA exam before being granting a license, the temporary title essentially becomes moot. If a PA administratively meets all the requirements without outstanding concerns then granting of a full license by the staff would be a logical process and shorten the time for the PA to receive a full permit. The board must still review the licensee at their established board meetings and can withdraw a license and/or require a response from the PA if so needed. The commission staff believes this recommendation will allow for improved efficiency by the board and more fairness for the applying PA. TAPA will support this recommendation.
10. ISSUE 11: The commission staff recommends statutory requirements for the TSBPAE to adopt, monitor, and enforce a reporting program of continuing medical education of PAs licensed in Texas. The commission staff also recommends that the number of CME hours required for license renewal also be placed in statute. Currently the board only requires PAs to sign a statement on their permit renewal form that affirms the PA has obtained the required 40 hours of CME. The board does do random auditing of CME hours. The commission staff recommends the board be more aggressive in documenting the PA has received the CME hours required to renew one's license.
TAPA supports the recommendation of the commission staff for statute that reflects clearly the continuing medical education requirements for relicensure of PAs in Texas. We also support sound and fair reporting requirements for ascertaining the PA having successfully met these requirements. Currently the board utilizes a random auditing system to determine the effectiveness of CME reporting for PAs as well as physicians. This system works well for the protection of the public and is fair. TAPA does not agree a more comprehensive reporting requirement is needed at this time and any change would certainly have a fiscal impact to the board.
11. ISSUE 11: The commission staff recommends a late-renewal fee be applied to PAs as appropriate, the board obtain the power to deliver a cease-and-desist order to a PA, create staggered license renewal dates, and incorporate a statutory requirement for voluntary surrender of a PA license. This is another administrative house-cleaning recommendation by the commission staff to emulate the physician statutory/regulatory laws for licensure. These recommendations are not unreasonable and appropriate for a board regulating providers in the practice of medicine. The late-renewal fee would mandate the board apply a penalty fee for late registration. The cease-and-desist order would provide the board the ability to take an immediate action on a provider whose actions are deemed a risk to the public or to themselves. The creation of different renewal dates throughout the year will encourage efficiency for the board staff. The voluntary surrender of a PA license recommendation would allow a PA an option to take a responsible action before the board makes a possible deleterious judgment. TAPA will support these recommendations.
12. ISSUE 11: The staff recommends medical faculty be allowed to serve on the boards. This actually only effects the physicians serving on the TSBME but was being considered to be extended to the TSBPAE. The experiences of medical educators can be a valuable resource for the board. All board appointees must take and honor an oath of office no matter their private, civilian commitments. TAPA will support this recommendation.
13. ISSUE 12: The staff recommends several options for the organizational structure of the boards. The staff provided several options for the commission to consider in the organization of the boards. Consolidation is one of the options but we lobbied the commission staff against consideration of consolidation of the TSBME. We are pleased the commission staff recommended against consolidation of the TSBPAE as noted in the Licensing Reorganization Project recommendations.
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First Draft Highlights
First Draft Highlights of the Texas Sunset Commission Staff Report
The Texas Sunset Commission staff recently released their recommendations for the Texas State Board of Physician Assistant Examiners/Texas State Board of Medical Examiners as well as their recommendations on the Licensing Reorganization Project. The Sunset Commission staff report is a compilation of recommendations for the TSBPAE, TSBME, and the Acupuncturists board. We are pleased that the essence of the staff's recommendations is consistent with what TAPA has advocated as important to our profession and to the safety of the public. The staff recognized the uniqueness of our profession and our sustained growth and prominently noted that in their recommendation the TSBPAE not be consolidated with any other board or umbrella agency.
We encourage all Texas PA's to take a few minutes and review these documents. They can be accessed on line at the Texas Sunset Commission web site at http://www.sunset.state.tx.us/,
then click on Publications, and then click on All Sunset Reports 2004-2005. Scroll down and click on the staff report for the Texas State Board of Physician Assistant Examiners and the Licensing Reorganization Project. If you would like to provide us input or have questions on this process or the highlights below please feel free to contact Linda Contreras -TAPA President or Michael Clark - TAPA LAC chair and President Elect.
Even these recommendations are not a done deal but the legislative members of the Sunset Commission traditionally follow very closely the recommendations of the staff. The recommendations usually involve the creation or amendment of statute and/or rule and/or policy of the licensing board. The staff recommendations will play an important role in TAPA's representation of you during public testimony at the sunset commission hearing in November. These recommendations will also provide additional support to our lobbying efforts in the legislative session.
For your information we have put together the following highlights of the commission staff recommendations that most closely affect the PA. We have included some commentary and thoughts from TAPA's prospective. Though we have established support for some issues, there are a few issues we are still discussing our position. A follow-up final version of these highlights with TAPA position responses will be posted on the TAPA web site in about two weeks.
The highlights of the Sunset Commission staff recommendations are:
1. ISSUE 1: The staff recommends increased access and discussion with stakeholders in the board's decision-making process. This is a significant recommendation to the board for including the input of professional organizations such as TAPA. TAPA has consistently been proactive in providing the board our input but the board at times has been slow in seeking our opinions.
The recommendation requires the TSBME and the TSBPAE to include input from those stakeholders that a proposed rule may affect such as the recent rule on medical devices that would have negatively impacted PA practice. We also recognize explicitly that stakeholder involvement should be expanded to other boards that consider matters involving the Physician-PA team such the Texas State Board of Pharmacy. TAPA will support this staff recommendation and advocate for expanded consideration of the stakeholder ideology to other boards.
In addition, this recommendation highlights the need of team stakeholders being involved in decisions that affect the Physician-PA team. We feel it is very important to have individuals intimate to the Physician-PA team concept be involved in the TSBME's decision-making on rules involving PA practice. Options we will recommend to the commission are that either a current TSBPAE member be appointed to the rule-making committee of the TSBME and/or require that at least two physicians that supervise PA's be appointed to the TSBME for the purpose of being involved in the rule-making and decision-making process.
2. ISSUE 2: The staff recommends more appropriate and efficient guidelines in evaluating mental and physical health disorders of physicians, PAs, and acupuncturists. The current case-by-case process the board uses to address concerns on an individual PA's mental and/or physical health allows much latitude in the decision-making without a clear definition of equity, law, and science. TAPA supports clear and effective guidelines to identify those that may pose a risk to the public and themselves but have some concerns on the appropriateness of this board making decisions on the mental health of PA's. At this writing the TAPA continues discussion on our stance on this recommendation.
3. ISSUE 3: The staff recommends stricter adherence to standard-of-care investigation timelines as well as be more inclusive of expert panel review in its decision-making. Currently investigations are taking up to one year and sometimes longer to provide resolution. This is not fair to the PA or the public. The staff recommends a strict adherence to 180-day review process. TAPA supports this recommendation and will also advocate for PA inclusion on expert panels reviewing standard of care issues involving a PA.
4. ISSUE 6: The staff recommends a better definition and improved guidelines of professional organizations providing resources for substance abuse rehabilitation of a provider. This is a house-cleaning recommendation that requires the board to provide a clearer understanding of the relationship of professional organizations as utilized by the board in the rehabilitation of a provider. These same rehabilitation resources are available to Texas PA's. TAPA supports this recommendation.
5. ISSUE 9: The staff recommends continuation of the prescriptive delegation waiver process by the board. TAPA advocated to the commission staff the importance of the prescription delegation waiver. The staff feels this process is still an essential option in prescription delegation and its impact on access to health care. The waiver now only allows consideration of waving the statutory on-site supervision requirements and chart review when considering a waiver request. The staff recommends that the distance of the practice site be included as an option in the waiver process.
The staff also recommends abolishment of the waiver advisory committee and relegates the waiver consideration responsibility to an existing TSBME committee. The waiver advisory committee has been difficult to administer and the staff believes this should be a TSBME duty. Even though we don't disagree with the staff's recommendations we feel this is one of those areas stakeholder considerations are important and it is important to include TSBPAE members and TAPA to assist in the process. TAPA will support this recommendation but will advocate for continued stakeholder involvement.
6. ISSUE 9: The staff recommends the board not require prescription delegation registration to the board. This is a positive step in that it articulates a higher recognition from a governmental body of the professional relationship of the Physician-PA team. To practice a PA must submit an intent to practice form that documents the establishment of the individual physician-PA team relationship. This staff recommendation if approved would do away with another administrative step, the prescription delegation registration, in the licensure and practice process. The staff recommends the board develop rules on how physicians must document delegation of prescriptive authority at the practice site. One concern that TAPA will monitor is how the pharmacy board may view and act on this. TAPA will support this recommendation but of course will participate as a stakeholder in the rule-making process.
One last thought, even though it is implied in the recommendations, this was one area we were hoping the staff would comment on the frustrations, which TAPA shares, of the current site-based practice language. We hope it will be better articulated in the legislative session when legislation is introduced to support the commission's recommendations.
7. ISSUE 10: The staff recommends abolishment of the surgical assistant license. Years ago TAPA, TMA, nursing organizations, and even the TSBME expressed their concern on the necessity of a licensure process for surgical assistants. The role and definition was vague and the size of the group was not seen as large enough to support a licensing board. TAPA will support the staff's recommendation.
8. ISSUE 11: The staff recommends that all new licensure applicants for a PA license take a jurisprudence examination. The staff recommends that all new licensees after 1 September 2006 be required to take this examination. All current licensees would be exempt. The concept of a jurisprudence examination for Physician Assistants was proposed by the TSBPAE several years ago. TAPA worked with the TSBPAE to improve professional CME access for Texas PA's on our practice laws in an attempt to delay this testing requirement. But with the TSBME persistently wanting it, the sunset commission staff now recommending it, and with the greatly increased recognition of PA's as integral health care professionals, the recommended standards by the commission staff were expected. As you know, physicians are required to demonstrate they understand the law for medical practice in Texas and it really is not unreasonable to expect that PA's demonstrate a more comprehensive knowledge of the laws governing medical practice. After all, PA's do practice medicine under the supervision of a physician!! One thought about this recommendation that has not been discussed is its fiscal impact to the board or practicing PAs. At this writing, TAPA is still discussing this recommendation for comment.
9. ISSUE 11: The staff recommends the board staff be allowed to grant a full license until the full board can meet. This administrative action would simply do away with the temporary license (as you know temporary licenses do not have permit numbers). Since the board now requires the PA graduate to have passed the NCCPA exam before being granting a license, the temporary title essentially becomes moot. If a PA administratively meets all the requirements without outstanding concerns then granting of a full license by the staff would be a logical process and shorten the time for the PA to receive a full permit. The board must still review the licensee at their established board meetings and can withdraw a license and/or require a response from the PA if so needed. The commission staff believes this recommendation will allow for improved efficiency by the board and more fairness for the applying PA. TAPA will support this recommendation.
10. ISSUE 11: The commission staff recommends statutory requirements for the TSBPAE to adopt, monitor, and enforce a reporting program of continuing medical education of PA's licensed in Texas. The commission staff also recommends that the number of CME hours required for license renewal also be placed in statute. Currently the board only requires PA's to sign a statement on their permit renewal form that affirms the PA has obtained the required 40 hours of CME. The board does do random auditing of CME hours. The commission staff recommends the board be more aggressive in documenting the PA has received the CME hours required to renew one's license.
TAPA does not disagree with our CME requirement for renewal of licensure being established in statute but we will advocate the current number and distribution of continuing medical education hours remain unchanged. TAPA does not disagree with a fair reporting system for CME hours but will not support a process that is overly burdensome to the PA. This recommendation is currently under discussion by the TAPA BOD and LAC.
11. ISSUE 11: The commission staff recommends a late-renewal fee be applied to PAs as appropriate, the board obtain the power to deliver a cease-and-desist order to a PA, create staggered license renewal dates, and incorporate a statutory requirement for voluntary surrender of a PA license. This is another administrative house-cleaning recommendation by the commission staff to emulate the physician statutory/regulatory laws for licensure. These recommendations are not unreasonable and appropriate for a board regulating providers in the practice of medicine. The late-renewal fee would mandate the board apply a penalty fee for late registration. The cease-and-desist order would provide the board the ability to take an immediate action on a provider whose actions are deemed a risk to the public or to themselves. The creation of different renewal dates throughout the year will encourage efficiency for the board staff. The voluntary surrender of a PA license recommendation would allow a PA an option to take a responsible action before the board makes a possible deleterious judgment. TAPA will support these recommendations.
12. ISSUE 11: The staff recommends medical faculty be allowed to serve on the boards. This actually only effects the physicians serving on the TSBME but was being considered to be extended to the TSBPAE. The experiences of medical educators can be a valuable resource for the board. All board appointees must take and honor an oath of office no matter their private, civilian commitments. TAPA will support this recommendation.
13. ISSUE 12: The staff recommends several options for the organizational structure of the boards. The staff provided several options for the commission to consider in the organization of the boards. Consolidation is one of the options but we lobbied the commission staff against consideration of consolidation of the TSBME. We are pleased the commission staff recommended against consolidation of the TSBPAE as noted in the Licensing Reorganization Project recommendations.
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Sunset Commission Staff Highlghts 