Board of Medical Practice releases proposed rule changes

The Board of Medical Practice has released draft rules that update all of the rules for licensing physicians, physician assistants, podiatrists, anesthesiologist assistants and radiologist assistants, and address the discipline procedures for those professions.  

Over the past several months, VMS has had a number of discussions with Board staff regarding the draft rules.  Many are “clean up” changes that update the rules to meet current Board policy or practice, improve organization or eliminate text in the rule that repeated state statute.  Some of the more substantive changes are summarized below.  

VMS is interested in receiving feedback from members regarding these changes, particularly the changes to PA supervision requirements.   The full rules can be found here.  Please send comments, questions or concerns to Jessa Barnard at jbarnard@vtmd.org by Friday, March 3.  

The Department of Health will be holding a public hearing regarding the rule changes on March 14, and will be accepting public comment through March 21. 

VMS summary of proposed substantive changes to the Board of Medical Practice rules

  • New section 13.2.2: discourages licensees from prescribing or dispensing non-controlled prescription substances for his or her own use or immediate family (new to Vermont rule but parallels AMA Code of Medical Ethics Section 1.2.1, Treating Self or Family)
  • New section 13.3: states that a prescription for methadone prescribed outside of an opioid treatment program as an analgesic must state “for pain”
  • New section 21.2: creates professional standards that apply to physicians supervising PAs, including stating that physicians at a work site may be held accountable as a supervising physician if a PA at that work site is practicing without a license or without proper Delegation Agreement documents having been filed with the Board
  • New section 21.4 & 21.5: prohibits a physician from requesting or receiving a prescription for a schedule II, III or IV controlled substance from a physician assistant supervised by the physician or an advanced practice registered nurse with whom the physician has agreed to act as the collaborating provider
  • New section 22.2.3: allows participation in a graduate medical education program to qualify for CME credit (Note that the remainder of Section 22 regarding continuing medical education appears as new text only because it is integrating the existing CME rule into the larger set of Board rules.)
  • Changes and clarifies physician assistant supervision responsibilities and content of the delegation agreement, including:
    • New section 27.1: defining “supervision” as including “regular and effective access to the supervising physician for consultation regarding on-going patient care while they are being treated by the PA; regular, retrospective review of selected PA-generated charts by the supervising physician, with the documentation of such review; regularly scheduled and documented discussions of cases selected by the supervising physician and may also include additional cases chosen by the PA; review of PA referrals outside the normal practice referral pattern as defined in the Delegation Agreement; and methods for in-practice consultation for patients not improving in a reasonable manner or time frame.”
    • Updates to section 27.3 regarding required elements in a PA Delegation Agreement.
    • New section 27.6: clarifying that if a Delegation Agreement is filed with the Board this does not mean that the Board is approving the substance of the plan or finding the plan for supervision adequate – only that the Board has received the documentation
    • New section 27.7: defining the factors the Board will consider in determining “adequacy of supervision,” including whether the documented plan for supervision was followed; the PA’s experience level; the physician’s familiarity with the PA’s capabilities; the complexity of the medical procedures the PA is undertaking; and the degree to which the supervisor or other physicians are available to consult.

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