1. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. National Credentialing Forum 2016 San Diego, CA AAPA/NCCPA Update

2. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. Speaker Disclosure Tricia Marriott, PA-C, MPAS, DFAAPA MJ Health Law, CHC® AAPA Senior Director, Regulatory & Professional Advocacy and Principal Advisor, CHLM tmarriott@aapa.org @TriciaPAC I am a full-time employee of the AAPA. I am a licensed and certified practicing PA, currently employed part- time by Yale Medical Group, Department of Orthopaedics. I have no financial/industry disclosures to report.

3. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM.

4. Source: NCCPA 2014 Statistical Profile of Certified Physician Assistants.Used with permission. © NCCPA. 2015. All rights reserved.

5. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. Source: NCCPA 2014 Statistical Profile of Certified Physician Assistants. Used with permission. © NCCPA. 2015. All rights reserved.

6. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM.

7. https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment Nurse Practitioners

8. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. 2015-2016 201 New PA-Positive Changes in 49 States 8 40 states have made 119 legislative improvements 31 states have made 82 regulatory improvements

9. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. 2015-2016 Highlights January 2016, Gov. Christie signed S1184 into law. 1. Removed co-signature requirements 2. Allows option for Scope of Practice to be determined at the practice site, rather than “laundry list”. 3. Eliminates need for physician to maintain a “continuing or intermittent presence,” in an inpatient setting - July 17, 2015 − On Thursday, July 16, Gov. John Kasich signed Senate Bill 110 into law. 1. Eliminated the requirement that a physician not be more than 60 minutes away 2. scope to be determined at the practice level 3. Changed the “Certificate of Registration” to a “License” 4. Allows physicians to supervise up to three PAs at any given time; 5. Eliminated the certificate to prescribe requirement; 6. Eliminating medical board approval of supervision agreements; Combining the supervision agreement with the supervisory plan; 7. Allowing a PA to delegate certain tasks related to implementation of patient care to MAs, RTs, RNs and others.

10. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. 2015 10 Federal PA-Positive Laws and Regulations Allow PAs to order portable X-rays and fecal occult blood tests for Medicare patients Clarify that PAs can write hospital admission orders and conduct H&Ps Eliminate on-site supervision requirements for PAs working in RHCs Allow RHCs to contract directly with PAs Allow PAs to order DME under TRICARE Avoid a 21% immediate decrease in Medicare payments for PA and physician services; establish.5% increase for 5 years Include PAs in new value-based incentive program (MIPS) under Medicare Allow PAs to care for Medicare patients with complex, chronic conditions Allow PAs to document face-to- face encounters for DME under Medicare

11. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. CMS Continued Challenges Conditions of Payment Hospice Home Health DME Diabetic Shoes Medical Nutrition Therapy Supervision of Diagnostic Tests Supervision of Intensive Cardiac Rehab and Pulmonary Rehab Conditions of Participation Restraints Standard -use of “LIP”. Used in Interpretive Guidelines only. Definition does not align with the Joint Commission glossary definition which allows for delegation. Licensed Independent Practitioner (LIP) For the purpose of ordering restraint or seclusion, an LIP is any practitioner permitted by State law and hospital policy as having the authority to independently order restraints or seclusion for patients.

12. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. Licensed Independent Practition er Not a term defined in federal statute, but has crept into everyday lexicon. Term continues to create barriers, despite the Joint Commission glossary disclaimer. In areas of the country where facilities have not yet utilized PAs, the “LIP” terminology leads them to believe PAs cannot provide care without physician present. The Joint Commission glossary disclaimer has not changed this. “Licensed Practitioner, as allowed by state law and facility policy” would be an appropriate substitute.

13. NCCPA Certification/Maintenance

14. 108,500 PA S NCCPA CERTIFIED DECEMBER 31. 2015

15. Verification of NCCPA Certification NCCPA is the primary source www.nccpa.net www.nccpa.net Verification is FREE Immediate verification with email confirmation Note: Verification is also available through the AMA Masterfile Service which is an “equivalent” source.

16. Changes to the Certification Maintenance Process

17. New Process 100 CME credits every two years – Still 50 Category 1 credits – 20 of the Category 1 credits must be designated as self-assessment and/or performance improvement PANRE every 6 years 10

18. Specialty Certificate of Added Qualifications (CAQ) Program

19. Key Principles of the Specialty CAQ Program NCCPA (and many stakeholders) agree that the PA-C must maintain its position as the primary credential for all PAs. The Specialty CAQ program is not available to new graduates: PA must have 1-2 years experience in the specialty in order to sit for the exam. NCCPA has remained committed to developing a voluntary specialty program. ─ A CAQ is not required to maintain NCCPA certification, and we require licensure as a condition of earning a CAQ so that table can’t be turned.

20. Specialty CAQ Process CME Experience Cases and/or Procedures After completing requirements above: Pass Specialty Exam Prerequisite: License PA-C Maintenance Process (10-yr CAQ cycle): 125 credits specialty CME Specialty exam 6 years to finish Details by specialty available at www.nccpa.net/SpecialtyCAQs.aspx.

21. CAQ 2016=986* # of PAs in CAQ SpecialtiesCAQs Awarded CVTS40 Emergency Medicine538 Hospital Medicine79 Nephrology17 Orthopaedic Surgery104 Pediatrics37 Psychiatry171 *Fewer than 1% of all PAs have obtained a CAQ.

22. Greater than 70 percent of certified PAs practice in specialties other than primary care Plan to continue generalist/medical core knowledge testing Considering options for specialty assessment that would be optional STAY TUNED! – Comment period opened Feb 1 st ; Survey distributed to Certified PAs Feb 10th NCCPA Announces Proposed Changes to PANRE and CAQs

23. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. http://news-center.aapa.org/?utm_source=aapa.org&utm_medium=hero_story&utm_campaign=recert

24. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. HOT TOPICS

25. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM.

27. But the most serious charges outlined in the indictment involve Uwaydah and his staff deceiving nearly two dozen patients into having surgeries thinking they would be done by Uwaydah. In fact, the surgical procedures were performed by a physician’s assistant who never attended medical school, prosecutors said. The physician’s assistant operated on patients while they were under general anesthesia and without Uwaydah present in the operating room, the indictment alleges. Prosecutors said in addition all 21 patients sustained lasting scars and many required additional surgeries and suffered physical and psychological trauma as a result of their experience in Uwaydah’s clinics.

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29. Sacred Heart Hospital Chicago: Jury To Weigh Kickback Charges Against Ill. Hospital Execs

30. © Copyright 2015 CHLM. All rights reserved. These materials may not be duplicated without the express written permission of CHLM. Questions?