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Chapter 18.71A RCW

PHYSICIAN ASSISTANTS

RCW Sections

18.71A.010Definitions.
18.71A.020Rules fixing qualifications and restricting practice -- Applications -- Discipline -- Payment of funds.
18.71A.023Practice requirements -- Military training or experience.
18.71A.025Application of uniform disciplinary act.
18.71A.030Limitations on practice.
18.71A.035Limitation on practice -- Remote sites.
18.71A.040Commission approval required -- Application -- Fee -- Discipline.
18.71A.045Eligibility of foreign medical school graduates.
18.71A.050Physician's liability, responsibility.
18.71A.060Limitations on health care services.
18.71A.085Acupuncture.
18.71A.090Signing and attesting to required documentation.
18.71A.100Pain management rules -- Criteria for new rules.

Notes:

     Reviser's note: Certain powers and duties of the department of licensing and the director of licensing transferred to the department of health and the secretary of health. See RCW 43.70.220.

Health professions account -- Fees credited -- Requirements for biennial budget request -- Unappropriated funds: RCW 43.70.320.



18.71A.010
Definitions.

The definitions set forth in this section apply throughout this chapter.

     (1) "Physician assistant" means a person who is licensed by the commission to practice medicine to a limited extent only under the supervision of a physician as defined in chapter
18.71 RCW and who is academically and clinically prepared to provide health care services and perform diagnostic, therapeutic, preventative, and health maintenance services.

     (2) "Commission" means the medical quality assurance commission.

     (3) "Practice medicine" has the meaning defined in RCW 18.71.011.

     (4) "Secretary" means the secretary of health or the secretary's designee.

     (5) "Department" means the department of health.

[1994 sp.s. c 9 § 318; 1990 c 196 § 1; 1988 c 113 § 1; 1975 1st ex.s. c 190 § 1; 1971 ex.s. c 30 § 1.]

Notes:

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

     Severability -- 1971 ex.s. c 30: "If any provision of this 1971 act, or its application to any person or circumstance is held invalid, the remainder of the act, or the application of the provision to other persons or circumstances is not affected." [1971 ex.s. c 30 § 13.]

Medical quality assurance commission: Chapter 18.71 RCW.




18.71A.020
Rules fixing qualifications and restricting practice — Applications — Discipline — Payment of funds.

(1) The commission shall adopt rules fixing the qualifications and the educational and training requirements for licensure as a physician assistant or for those enrolled in any physician assistant training program. The requirements shall include completion of an accredited physician assistant training program approved by the commission and within one year successfully take and pass an examination approved by the commission, if the examination tests subjects substantially equivalent to the curriculum of an accredited physician assistant training program. An interim permit may be granted by the department of health for one year provided the applicant meets all other requirements. Physician assistants licensed by the board of medical examiners, or the medical quality assurance commission as of July 1, 1999, shall continue to be licensed.

     (2)(a) The commission shall adopt rules governing the extent to which:

     (i) Physician assistant students may practice medicine during training; and

     (ii) Physician assistants may practice after successful completion of a physician assistant training course.

     (b) Such rules shall provide:

     (i) That the practice of a physician assistant shall be limited to the performance of those services for which he or she is trained; and

     (ii) That each physician assistant shall practice medicine only under the supervision and control of a physician licensed in this state, but such supervision and control shall not be construed to necessarily require the personal presence of the supervising physician or physicians at the place where services are rendered.

     (3) Applicants for licensure shall file an application with the commission on a form prepared by the secretary with the approval of the commission, detailing the education, training, and experience of the physician assistant and such other information as the commission may require. The application shall be accompanied by a fee determined by the secretary as provided in RCW
43.70.250 and 43.70.280. A surcharge of fifty dollars per year shall be charged on each license renewal or issuance of a new license to be collected by the department and deposited into the impaired physician account for physician assistant participation in the impaired physician program. Each applicant shall furnish proof satisfactory to the commission of the following:

     (a) That the applicant has completed an accredited physician assistant program approved by the commission and is eligible to take the examination approved by the commission;

     (b) That the applicant is of good moral character; and

     (c) That the applicant is physically and mentally capable of practicing medicine as a physician assistant with reasonable skill and safety. The commission may require an applicant to submit to such examination or examinations as it deems necessary to determine an applicant's physical or mental capability, or both, to safely practice as a physician assistant.

     (4)(a) The commission may approve, deny, or take other disciplinary action upon the application for license as provided in the Uniform Disciplinary Act, chapter 18.130 RCW.

     (b) The license shall be renewed as determined under RCW 43.70.250 and 43.70.280. The commission shall request licensees to submit information about their current professional practice at the time of license renewal. This information may include practice setting, medical specialty, or other relevant data determined by the commission.

     (c) The commission may authorize the use of alternative supervisors who are licensed either under chapter 18.57 or 18.71 RCW.

     (5) All funds in the impaired physician account shall be paid to the contract entity within sixty days of deposit.

[2011 c 178 § 2; 2009 c 98 § 2; 1999 c 127 § 1; 1998 c 132 § 14; 1996 c 191 § 57; 1994 sp.s. c 9 § 319; 1993 c 28 § 5; 1992 c 28 § 2; 1990 c 196 § 2; 1971 ex.s. c 30 § 2.]

Notes:

     Finding -- Intent -- Severability -- 1998 c 132: See notes following RCW 18.71.0195.

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.




18.71A.023
Practice requirements — Military training or experience.

An applicant with military training or experience satisfies the training or experience requirements of this chapter unless the commission determines that the military training or experience is not substantially equivalent to the standards of this state.

[2011 c 32 § 6.]




18.71A.025
Application of uniform disciplinary act.

The uniform disciplinary act, chapter 18.130 RCW, governs the issuance and denial of licenses and the discipline of licensees under this chapter.

[1986 c 259 § 106.]

Notes:

     Severability -- 1986 c 259: See note following RCW 18.130.010.




18.71A.030
Limitations on practice.

A physician assistant may practice medicine in this state only with the approval of the delegation agreement by the commission and only to the extent permitted by the commission. A physician assistant who has received a license but who has not received commission approval of the delegation agreement under RCW 18.71A.040 may not practice. A physician assistant shall be subject to discipline under chapter 18.130 RCW.

[2013 c 203 § 6; 1994 sp.s. c 9 § 320; 1993 c 28 § 6; 1990 c 196 § 3; 1971 ex.s. c 30 § 3.]

Notes:

     Rules -- 2013 c 203: See note following RCW 18.57A.035.

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.




18.71A.035
Limitation on practice — Remote sites.

(1) No licensee may be utilized in a remote site without approval by the commission or its designee. A "remote site" is defined as a setting physically separate from the sponsoring or supervising physician's primary place for meeting patients or a setting where the physician is present less than twenty-five percent of the practice time of the licensee.

     (2)(a) Approval by the commission or its designee may be granted to utilize a licensee in a remote site if:

     (i) There is a demonstrated need for the utilization;

     (ii) Adequate provision for timely communication between the primary or alternate physician and the licensee exists;

     (iii) The responsible sponsoring or supervising physician spends at least ten percent of the practice time of the licensee in the remote site unless the sponsoring physician demonstrates that adequate supervision is being maintained by an alternate method such as telecommunication.

     (b) The names of the sponsoring or supervising physician and the licensee must be prominently displayed at the entrance to the clinic or in the reception area.

     (3) No physician assistant holding an interim permit may be utilized in a remote site setting.

[2013 c 203 § 2.]

Notes:

     Rules -- 2013 c 203: See note following RCW 18.57A.035.




18.71A.040
Commission approval required — Application — Fee — Discipline.

(1) No physician assistant practicing in this state shall be employed or supervised by a physician or physician group without the approval of the commission.

     (2) Prior to commencing practice, a physician assistant licensed in this state shall apply to the commission for permission to be employed or supervised by a physician or physician group. The delegation agreement shall be jointly submitted by the physician or physician group and physician assistant. Administrative procedures, administrative requirements, and fees shall be established as provided in RCW
43.70.250 and 43.70.280. The delegation agreement shall delineate the manner and extent to which the physician assistant would practice and be supervised. Whenever a physician assistant is practicing in a manner inconsistent with the approved delegation agreement, the commission may take disciplinary action under chapter 18.130 RCW.

     (3) A physician may enter into delegation agreements with five physician assistants, but may petition the commission for a waiver of this limit. However, no physician may have under his or her supervision: (a) More than three physician assistants who are working in remote sites; or (b) more physician assistants than the physician can adequately supervise.

[2013 c 203 § 7. Prior: 1996 c 191 § 58; 1996 c 191 § 40; 1994 sp.s. c 9 § 321; 1993 c 28 § 7; 1990 c 196 § 4; prior: 1986 c 259 § 113; 1985 c 7 § 61; 1975 1st ex.s. c 30 § 64; 1975 1st ex.s. c 190 § 2; 1971 ex.s. c 30 § 4.]

Notes:

     Rules -- 2013 c 203: See note following RCW 18.57A.035.

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

     Severability -- 1986 c 259: See note following RCW 18.130.010.




18.71A.045
Eligibility of foreign medical school graduates.

Foreign medical school graduates shall not be eligible for licensing as physician assistants after July 1, 1989.

[1994 sp.s. c 9 § 322; 1988 c 113 § 2.]

Notes:

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.




18.71A.050
Physician's liability, responsibility.

No physician who supervises a licensed physician assistant in accordance with and within the terms of any permission granted by the commission is considered as aiding and abetting an unlicensed person to practice medicine. The supervising physician and physician assistant shall retain professional and personal responsibility for any act which constitutes the practice of medicine as defined in RCW 18.71.011 when performed by the physician assistant.

[1994 sp.s. c 9 § 323; 1993 c 28 § 8; 1990 c 196 § 5; 1986 c 259 § 114; 1971 ex.s. c 30 § 5.]

Notes:

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.

     Severability -- 1986 c 259: See note following RCW 18.130.010.




18.71A.060
Limitations on health care services.

No health care services may be performed under this chapter in any of the following areas:

     (1) The measurement of the powers or range of human vision, or the determination of the accommodation and refractive state of the human eye or the scope of its functions in general, or the fitting or adaptation of lenses or frames for the aid thereof.

     (2) The prescribing or directing the use of, or using, any optical device in connection with ocular exercises, visual training, vision training, or orthoptics.

     (3) The prescribing of contact lenses for, or the fitting or adaptation of contact lenses to, the human eye.

     (4) Nothing in this section shall preclude the performance of routine visual screening.

     (5) The practice of dentistry or dental hygiene as defined in chapters
18.32 and 18.29 RCW respectively. The exemptions set forth in RCW 18.32.030 (1) and (8), shall not apply to a physician assistant.

     (6) The practice of chiropractic as defined in chapter 18.25 RCW including the adjustment or manipulation of the articulations of the spine.

     (7) The practice of podiatric medicine and surgery as defined in chapter 18.22 RCW.

[1994 sp.s. c 9 § 324; 1990 c 196 § 6; 1973 c 77 § 21; 1971 ex.s. c 30 § 6.]

Notes:

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.




18.71A.085
Acupuncture.

Any physician assistant acupuncturist currently licensed by the commission may continue to perform acupuncture under the physician assistant license as long as he or she maintains licensure as a physician assistant.

[1994 sp.s. c 9 § 325; 1990 c 196 § 10.]

Notes:

     Severability -- Headings and captions not law -- Effective date -- 1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.




18.71A.090
Signing and attesting to required documentation.

A physician assistant may sign and attest to any certificates, cards, forms, or other required documentation that the physician assistant's supervising physician or physician group may sign, provided that it is within the physician assistant's scope of practice and is consistent with the terms of the physician assistant's practice arrangement plan as required by this chapter.

[2007 c 264 § 3.]

Notes:

     Finding -- Intent -- 2007 c 264: "The legislature finds that some state agencies and departments do not accept the signature of physician assistants on certain certificates, reports, and other documents that their supervising physician is permitted to sign, notwithstanding the fact that the signing of such documents is within the physician assistant's scope of practice, covered under their practice arrangement plan, and permitted pursuant to WAC 246-918-140.

     It is therefore the intent of the legislature to clarify in statute what was adopted by rule in WAC 246-918-140, that a physician assistant may sign and attest to any document that might ordinarily be signed by the supervising physician and that is consistent with the terms of the practice arrangement plan." [2007 c 264 § 1.]




18.71A.100
Pain management rules — Criteria for new rules.

(1) By June 30, 2011, the commission shall adopt new rules on chronic, noncancer pain management that contain the following elements:

     (a)(i) Dosing criteria, including:

     (A) A dosage amount that must not be exceeded unless a physician assistant first consults with a practitioner specializing in pain management; and

     (B) Exigent or special circumstances under which the dosage amount may be exceeded without consultation with a practitioner specializing in pain management.

     (ii) The rules regarding consultation with a practitioner specializing in pain management must, to the extent practicable, take into account:

     (A) Circumstances under which repeated consultations would not be necessary or appropriate for a patient undergoing a stable, ongoing course of treatment for pain management;

     (B) Minimum training and experience that is sufficient to exempt a physician assistant from the specialty consultation requirement;

     (C) Methods for enhancing the availability of consultations;

     (D) Allowing the efficient use of resources; and

     (E) Minimizing the burden on practitioners and patients;

     (b) Guidance on when to seek specialty consultation and ways in which electronic specialty consultations may be sought;

     (c) Guidance on tracking clinical progress by using assessment tools focusing on pain interference, physical function, and overall risk for poor outcome; and

     (d) Guidance on tracking the use of opioids, particularly in the emergency department.

     (2) The commission shall consult with the agency medical directors' group, the department of health, the University of Washington, and the largest professional association of physician assistants in the state.

     (3) The rules adopted under this section do not apply:

     (a) To the provision of palliative, hospice, or other end-of-life care; or

     (b) To the management of acute pain caused by an injury or a surgical procedure.

[2010 c 209 § 6.]