Proposed Rule Making:
Amendment of Section 94.2(e)(6) of Title 10 NYCRR
(Physician’s Assistants and Specialist’s Assistants - Inpatient Medical Orders)
CONSENSUS RULEMAKING
Publication Date: 08/09/2006
Comment Period Expiration: 09/25/2006
Proposed Text and Statements:
Pursuant to the authority vested in the Commissioner of Health by Sections 3308, 3701 and 3703 of the Public Health Law, Section 94.2 (e)(6) of Part 94 (Physician’s Assistants and Specialist’s Assistants) of Title 10 (Health) of the Official Compilation of Codes, Rules and Regulations of the State of New York is hereby amended, to be effective upon publication of a Notice of Adoption in the New York State Register, to read as follows:
Paragraph (6) of subdivision (e) of section 94.2 is amended to read as follows:
(e) Prescriptions and medical orders may be written by a registered physician’s assistant as provided in this subdivision when assigned by the supervising physician.
(6) A registered physician’s assistant employed or extended privileges by a hospital may, if permissible under the bylaws, rules and regulations of the hospital, write medical orders, including those for controlled substances, for inpatients under the care of the physician responsible for his supervision. [In every case, medical orders so written shall be countersigned by the supervising physician within 24 hours, but such countersignature shall not be required prior to the execution of any such order.] Countersignature of such orders may be required if deemed necessary and appropriate by the supervising physician or the hospital, but in no event shall countersignature be required prior to execution.
NOTICE OF CONSENSUS RULEMAKING
Statutory Authority:
This proposal is authorized by Sections 3308 and 3701 of the Public Health Law (PHL). Section 3308 authorizes the Commissioner of Health to adopt rules and regulations as necessary to implement PHL Article 33 (Controlled Substances). Section 3701 authorizes the Commissioner of Health to adopt rules and regulations as necessary to implement PHL Article 37 (Physician’s Assistants and Specialist’s Assistants). Chapter 351 of the Laws of 2005 created a new section 3703 in PHL Article 37 entitled Inpatient Medical Orders. This new law authorizes physician assistants working or extended privileges in a hospital to issue inpatient medical orders without countersignature if deemed appropriate by the supervising physician or the hospital.
Basis:
Compliance with the mandatory requirement that a supervising physician countersign RPAs in-hospital orders within 24 hours can be difficult for such supervising physician. Furthermore, inpatient medical orders written by RPAs are executed prior to the supervising physician’s co-signature. It is believed that the meaningful supervision comes from the relationship from the supervising physician and the RPA, the credentialing process, the documentation of ongoing competency, and other internal review mechanisms. The Legislature determined that a decision to require countersignature should be determined by the supervising physician or the hospital. The current regulation is out of compliance with this new law. Section 94.2 (e) (6) needs to be amended to be in compliance.
A consensus regulation is warranted since this regulation is merely updating the current provisions in order to comply with Chapter 351 of the Laws of 2005.
JOB IMPACT STATEMENT
Registered physician assistants (RPAs) have become an integral part of the health caregiver team in New York State since they were authorized to practice in 1971. Under Public Health Law (PHL) Article 37, the Commissioner of Health was given the authority to promulgate rules and regulations defining the duties which may be assigned to RPAs by their supervising physician and the degree of supervision required. Section 94.2 (e) (6) as currently written, requiring a mandatory 24-hour co-signature of inpatient orders, has unintentionally become a significant barrier to employment for RPAs who are losing jobs to other mid-level practitioners who are not subject to this requirement. This proposal will remove that barrier to employment for RPAs.
Some nursing homes are reluctant to hire RPAs due to the current requirement because their nursing home physicians may not do rounds every 24 hours. In the rural health care setting, it is not an efficient use of time for a physician, who may live far way from work, to have to return to the workplace to countersign inpatient medical orders written by an RPA.
Chapter 351 of the Laws of 2005 authorizes RPAs working or extended privileges in a hospital to issue inpatient medical orders without a countersignature if deemed appropriate by the supervising physician or the hospital. Section 94.2 of 10 NYCRR is currently not in compliance with this new statute. This proposal is a necessary revision to Part 94 of 10 NYCRR to be in compliance with Chapter 351 of the Laws of 2005.