Emergency Text
Part I
General Provisions
18VAC85-50-10. Definitions.
A. The following words and terms shall have the meanings ascribed to them in § 54.1-2900 of the Code of Virginia:
"Board."
"Collaboration"
"Consultation"
"Patient care team physician"
"Patient care team podiatrist"
"Physician assistant."
B. The following words and terms when used in this chapter shall have the following meanings unless the context clearly indicates otherwise:
"Group practice" means the practice of a group of two or more doctors of medicine, osteopathy, or podiatry licensed by the board who practice as a partnership or professional corporation.
"Institution" means a hospital, nursing home or other health care facility, community health center, public health center, industrial medicine or corporation clinic, a medical service facility, student health center, or other setting approved by the board.
"NCCPA" means the National Commission on Certification of Physician Assistants.
"Practice agreement" means a written or
electronic agreement developed by the supervising patient care team
physician or podiatrist and the physician assistant that defines the supervisory
relationship between the physician assistant and the physician or podiatrist,
the prescriptive authority of the physician assistant, and the circumstances
under which the physician or podiatrist will see and evaluate the
patient.
"Supervision" means the supervising physician has
on-going, regular communication with the physician assistant on the care and
treatment of patients, is easily available, and can be physically present or
accessible for consultation with the physician assistant within one hour.
18VAC85-50-35. Fees.
Unless otherwise provided, the following fees shall not be refundable:
1. The initial application fee for a license, payable at the time application is filed, shall be $130.
2. The biennial fee for renewal of an active license shall be $135 and for renewal of an inactive license shall be $70, payable in each odd-numbered year in the birth month of the licensee. For 2019, the fee for renewal of an active license shall be $108, and the fee for renewal of an inactive license shall be $54.
3. The additional fee for late renewal of licensure within one renewal cycle shall be $50.
4. A restricted volunteer license shall expire 12 months from the date of issuance and may be renewed without charge by receipt of a renewal application that verifies that the physician assistant continues to comply with provisions of § 54.1-2951.3 of the Code of Virginia.
5. The fee for review and approval of a new protocol
submitted following initial licensure shall be $15.
6. The fee for reinstatement of a license pursuant to §
54.1-2408.2 of the Code of Virginia shall be $2,000.
7. 6. The fee for a duplicate license shall be
$5.00, and the fee for a duplicate wall certificate shall be $15.
8. 7. The fee for a returned check shall be $35.
9. 8. The fee for a letter of good standing or
verification to another jurisdiction shall be $10.
10. 9. The fee for an application or for the
biennial renewal of a restricted volunteer license shall be $35, due in the
licensee's birth month. An additional fee for late renewal of licensure shall
be $15 for each renewal cycle.
Part II
Requirements for Practice as a Physician's Assistant
18VAC85-50-40. General requirements.
A. No person shall practice as a physician assistant in the Commonwealth of Virginia except as provided in this chapter.
B. All services rendered by a physician assistant shall be performed only under the continuous supervision of a doctor of medicine, osteopathy, or podiatry licensed by this board to practice in the Commonwealth.
18VAC85-50-57. Discontinuation of employment.
If for any reason the assistant discontinues working in the
employment and under the supervision of a licensed practitioner with a
patient care team physician or podiatrist, a new practice agreement shall
be entered into in order for the assistant either to be reemployed by the same
practitioner or to accept new employment with another supervising physician
patient care team physician or podiatrist.
Part IV
Practice Requirements
18VAC85-50-101. Requirements for a practice agreement.
A. Prior to initiation of practice, a physician assistant and
his supervising patient care team physician or podiatrist
shall enter into a written or electronic practice agreement that spells out the
roles and functions of the assistant and is consistent with provisions of §
54.1-2952 of the Code of Virginia.
1. The supervising patient care team physician or
podiatrist shall be a doctor of medicine, osteopathy, or podiatry licensed
in the Commonwealth who has accepted responsibility for the supervision of
the service that a physician assistant renders.
2. Any such practice agreement shall take into account such factors as the physician assistant's level of competence, the number of patients, the types of illness treated by the physician, the nature of the treatment, special procedures, and the nature of the physician availability in ensuring direct physician involvement at an early stage and regularly thereafter.
3. The practice agreement shall also provide an evaluation
process for the physician assistant's performance, including a requirement
specifying the time period, proportionate to the acuity of care and practice
setting, within which the supervising physician or podiatrist
shall review the record of services rendered by the physician assistant.
4. The practice agreement may include requirements for periodic
site visits by supervising licensees who supervise and direct patient
care team physician or podiatrist to collaborate and consult with physician
assistants who provide services at a location other than where the licensee
physician or podiatrist regularly practices.
B. The board may require information regarding the level
degree of supervision collaboration and consultation with
which the supervising by the patient care team physician or
podiatrist plans to supervise the physician assistant for selected tasks.
The board may also require the supervising patient care team
physician or podiatrist to document the assistant's competence in
performing such tasks.
C. If the role of the assistant includes prescribing drugs and
devices, the written practice agreement shall include those schedules and
categories of drugs and devices that are within the scope of practice and
proficiency of the supervising patient care team physician or
podiatrist.
D. If the initial practice agreement did not include prescriptive authority, there shall be an addendum to the practice agreement for prescriptive authority.
E. If there are any changes in supervision consultation
and collaboration, authorization, or scope of practice, a revised practice
agreement shall be entered into at the time of the change.
18VAC85-50-110. Responsibilities of the supervisor patient
care team physician or podiatrist.
The supervising physician patient care team
physician or podiatrist shall:
1. Review the clinical course and treatment plan for any patient
who presents for the same acute complaint twice in a single episode of care and
has failed to improve as expected. The supervising physician or
podiatrist shall be involved with any patient with a continuing illness as
noted in the written or electronic practice agreement for the evaluation
process.
2. Be responsible for all invasive procedures.
a. Under supervision, a physician assistant may insert a nasogastric tube, bladder catheter, needle, or peripheral intravenous catheter, but not a flow-directed catheter, and may perform minor suturing, venipuncture, and subcutaneous intramuscular or intravenous injection.
b. All other invasive procedures not listed in subdivision 2 a
of this section must be performed under supervision with the physician in the
room unless, after directly observing the performance of a specific invasive
procedure three times or more, the supervising patient care team
physician or podiatrist attests on the practice agreement to the
competence of the physician assistant to perform the specific procedure without
direct observation and supervision.
3. Be responsible for all prescriptions issued by the physician assistant and attest to the competence of the assistant to prescribe drugs and devices.
4. Be available at all times to collaborate and consult with the physician assistant.
18VAC85-50-115. Responsibilities of the physician assistant.
A. The physician assistant shall not render independent health care and shall:
1. Perform only those medical care services that are within the
scope of the practice and proficiency of the supervising patient care
team physician or podiatrist as prescribed in the physician
assistant's practice agreement. When a physician assistant is to be
supervised by an alternate supervising physician working outside the
scope of specialty of the supervising patient care team physician
or podiatrist, then the physician assistant's functions shall be limited
to those areas not requiring specialized clinical judgment, unless a separate
practice agreement has been executed for that alternate supervising
patient care team physician or podiatrist is approved and on
file with the board.
2. Prescribe only those drugs and devices as allowed in Part V (18VAC85-50-130 et seq.) of this chapter.
3. Wear during the course of performing his duties identification showing clearly that he is a physician assistant.
B. An alternate supervising patient care team
physician or podiatrist shall be a member of the same group or
professional corporation or partnership of any licensee who supervises is
the patient care team physician for a physician assistant or shall be a
member of the same hospital or commercial enterprise with the supervising
patient care team physician. Such alternating supervising
physician shall be a physician licensed in the Commonwealth who has
registered with the board and who has accepted responsibility for the supervision
of the service that a physician assistant renders.
C. If, due to illness, vacation, or unexpected absence, the supervising
patient care team physician or alternate supervising physician is
unable to supervise the activities of his physician assistant, such supervising
patient care team physician may temporarily delegate the responsibility
to another doctor of medicine, osteopathic medicine, or podiatry.
Temporary coverage may not exceed four weeks unless special permission is granted by the board.
D. With respect to physican assistants employed by institutions, the following additional regulations shall apply:
1. No physician assistant may render care to a patient
unless the physician responsible for that patient has signed the practice
agreement to act as supervising patient care team physician or
podiatrist for that assistant. The board shall make available appropriate
forms for physicians or podiatrists to join the practice agreement for
an assistant employed by an institution.
2. Any such practice agreement as described in subdivision 1 of this subsection shall delineate the duties which said patient care team physician or podiatrist authorizes the physician assistant to perform.
3. The assistant shall, as soon as circumstances may
dictate, report an acute or significant finding or change in clinical status to
the supervising physician concerning the examination of the patient. The assistant
shall also record his findings in appropriate institutional records.
E. Practice by a physician assistant in a hospital, including an emergency department, shall be in accordance with § 54.1-2952 of the Code of Virginia.
18VAC85-50-117. Authorization to use fluoroscopy.
A physician assistant working under the supervision of a
practice agreement with a licensed doctor of medicine or osteopathy
specializing in the field of radiology is authorized to use fluoroscopy for
guidance of diagnostic and therapeutic procedures provided such activity is
specified in his protocol and he has met the following qualifications:
1. Completion of at least 40 hours of structured didactic educational instruction and at least 40 hours of supervised clinical experience as set forth in the Fluoroscopy Educational Framework for the Physician Assistant created by the American Academy of Physician Assistants (AAPA) and the American Society of Radiologic Technologists (ASRT); and
2. Successful passage of the American Registry of Radiologic Technologists (ARRT) Fluoroscopy Examination.
Part V
Prescriptive Authority
18VAC85-50-130. Qualifications for approval of prescriptive authority.
An applicant for prescriptive authority shall meet the following requirements:
1. Hold a current, unrestricted license as a physician assistant in the Commonwealth;
2. Submit a practice agreement acceptable to the board as
prescribed in 18VAC85-50-101. This practice agreement must be approved by
the board prior to issuance of prescriptive authority and § 54.1-2952.1
of the Code of Virginia; and
3. Submit evidence of successful passing of the NCCPA exam;
and
4. Submit evidence of successful completion of a minimum
of 35 hours of acceptable training to the board in pharmacology.
18VAC85-50-140. Approved drugs and devices.
A. The approved drugs and devices which the physician assistant with prescriptive authority may prescribe, administer, or dispense manufacturer's professional samples shall be in accordance with provisions of § 54.1-2952.1 of the Code of Virginia:
B. The physician assistant may prescribe only those categories
of drugs and devices included in the practice agreement as submitted for
authorization. The supervising patient care team physician or
podiatrist retains the authority to restrict certain drugs within these
approved categories.
C. The physician assistant, pursuant to § 54.1-2952.1 of the Code of Virginia, shall only dispense manufacturer's professional samples or administer controlled substances in good faith for medical or therapeutic purposes within the course of his professional practice.
18VAC85-50-160. Disclosure.
A. Each prescription for a Schedule II through V drug shall
bear the name of the supervising patient care team physician or
podiatrist and of the physician assistant.
B. The physician assistant shall disclose to the patient that he
is a licensed physician assistant, and also the name, address and telephone
number of the supervising patient care team physician or
podiatrist. Such disclosure shall either be included on the prescription or
be given in writing to the patient.
18VAC85-50-181. Pharmacotherapy for weight loss.
A. A practitioner shall not prescribe amphetamine, Schedule II, for the purpose of weight reduction or control.
B. A practitioner shall not prescribe controlled substances, Schedules III through VI, for the purpose of weight reduction or control in the treatment of obesity, unless the following conditions are met:
1. An appropriate history and physical examination are performed and recorded at the time of initiation of pharmacotherapy for obesity by the prescribing physician, and the physician reviews the results of laboratory work, as indicated, including testing for thyroid function;
2. If the drug to be prescribed could adversely affect cardiac function, the physician shall review the results of an electrocardiogram performed and interpreted within 90 days of initial prescribing for treatment of obesity;
3. A diet and exercise program for weight loss is prescribed and recorded;
4. The patient is seen within the first 30 days following initiation of pharmacotherapy for weight loss, by the prescribing physician or a licensed practitioner with prescriptive authority working under the supervision of the prescribing physician, at which time a recording shall be made of blood pressure, pulse, and any other tests as may be necessary for monitoring potential adverse effects of drug therapy; and
5. The treating physician shall direct the follow-up care, including the intervals for patient visits and the continuation of or any subsequent changes in pharmacotherapy. Continuation of prescribing for treatment of obesity shall occur only if the patient has continued progress toward achieving or maintaining a target weight and has no significant adverse effects from the prescribed program.
C. If specifically authorized in his practice agreement with a
supervising patient care team physician, a physician assistant
may perform the physical examination, review tests, and prescribe Schedules III
through VI controlled substances for treatment of obesity as specified in subsection
B of this section.