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Proposed Rule Change 2015
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Draft Revisions to Montana Administrative Code

Sections 24.156.1622 and 24.156.1623


June 29, 2015

24.156.1622    SUPERVISION OF PHYSICIAN ASSISTANT

(1) A supervising physician may provide the following types of supervision to a physician assistant:

(a) direct supervision;

(b) onsite supervision; or

(c) general supervision.

(2) The supervising physician shall consider the location, nature, and setting of the practice and the experience of the physician assistant when entering into a new supervision agreement and a duties and delegation agreement to assure the safety and quality of physician assistant services.

(3) The supervising physician shall meet face-to-face with each physician assistant supervised a minimum of once a month for the purposes of discussion, education, and training, to include but not be limited to practice issues, and patient care. , and chart reviews in accordance with ARM 24.156.1623.

(4) A supervising physician may supervise more than one physician assistant if the supervising physician:

(a) agrees to supervise more than one physician assistant by signing and filing multiple supervision agreements with the board;

(b) provides appropriate and real time means of communication or back up supervision for the physician assistants;

(c) determines the appropriate level supervision (direct, on-site, or general), based on the physician assistant's education, training, and experience; and

(d) assumes professional and legal responsibility for all physician assistants under the supervising physician's supervision regardless of the varying types of supervision.

(5) The supervision agreement and duties and delegation agreement for nonroutine applicants must assure the safety and quality of physician assistant services, considering the location, nature, and setting of the practice and the experience of the physician assistant, and shall provide for:

(a) an appropriate type or combination of types of supervision identified in (1), including specific supervising physician response and availability times;

(b) an appropriate scope of delegation of practice authority and appropriate limitations upon the practice authority of the physician assistant;

(c) appropriate frequency and duration of face-to-face meetings; and

(d) an appropriate percentage of physician assistant charts that must be reviewed by the supervising physician in accordance with ARM 24.156.1623.

(6) The supervision agreement and duties and delegation agreement for nonroutine applicants may provide for periodic changes in the type of supervision, scope of delegation, practice limitations, frequency, and duration of face-to-face meetings, and percentage of charts reviewed, based upon the duration and nature of experience gained by the physician assistant, the supervising physician's written assessment and evaluation of the physician assistant's experience and judgment, and other factors relevant to the nature and degree of supervision appropriate to assure the safety and quality of physician assistant services.

(7) The duties and delegation agreement must be submitted, if requested, to the board or its designee during the interview required pursuant to ARM 24.156.1601(3).

 

24.156.1623    CHART REVIEW

(1) The supervising physician shall review a minimum of 10 percent of the physician assistant charts on at least a monthly basis.

(2) Chart review for a physician assistant having less than one year of full time practice experience from the date of initial licensure must be 100 20 percent for the first three six months of practice, and then may be reduced to not less than 25 10 percent for the next three six months, on a monthly basis, for each supervision agreement. After 12 months, any further chart review is at the discretion of the physician assistant and their supervising physician to determine in a collaborative agreement.

(3) Chart review for a physician assistant who has been issued a probationary license must be 100 percent on a monthly basis, unless the board terminates the probationary period.

(4) The supervising physician shall countersign and date all written entries that have been chart reviewed and shall document any amendments, modifications, or guidance provided.

(5) A supervising physician shall not be deemed out of compliance with the chart review percentage requirements of this section if the supervising physician demonstrates review of at least 95 percent of the required number of chart reviews.

 

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