ALABAMA~STATUTE STATUTE Code of Alabama 34-24-290 et seq DATE Enacted 1971 REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/DISPENSING SUPERVISION DEFINED PAs PER PHYSICIAN APPLICATION QUALIFICATIONS TEMPORARY PERMIT TERMINATION CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION PHYSICIAN LIABILITY Alabama Board of Medical Examiners A graduate of an approved program, licensed and registered by the board to perform medical services under supervision of approved physician. 34-24-290 Medical service under supervision of licensed physician(s) approved by board, except that certain eye care services may be performed only in the office of an ophthalmologist in which such ophthalmologist normally actually practices. 34-24-292 A licensed assistant to a physician registered to a licensed physician practicing under a job description approved by the board may prescribe legend drugs if the type, dosage, quantity prescribed and number of refills are authorized in approved job description and the drug is included on the board s formulary (controlled medications not included). 34-24-292 The board may establish guidelines governing prescribing by assistants to physicians. Guidelines not considered a rule or regulation requiring publication under the Alabama Administrative Procedures Act. Guidelines establish formulary of legend drugs that may be prescribed by PAs and establish minimum requirements for physician review of PA prescribing. 34-24-293 A formal relationship between a licensed assistant to a physician and a licensed physician with whom an approved job description is established. Supervision requires a direct continuing and close relationship. Supervision does not require direct on-site supervision; however, it does require professional oversight and direction as may be required by the regulations and guidelines of the medical board. 34-24-290 By PA for license. By licensed physician for approval to supervise. Physician application must include qualifications of PA, professional background and specialty of physician, and description of the practice and the way PA will be utilized. 34-24-293 Prior to practicing as PA, licensed PA shall be registered by board to perform medical services under supervision of supervising physician approved by the board. 34-24-303 Graduation from PA program accredited by CAHEA, CAAHEP, or successor Successful completion of PANCE exam administered by the NCCPA 34-24-297 Board may deny a license to applicant with felony conviction, conviction of crime reflecting on the ability of the individual to render safe patient care, conviction of violation relating to controlled substance, action against PA license in another jurisdiction, inability to provide safe patient care due to addiction or mental or physical condition or disability, falsification of licensure information, history of representing oneself as a physician, history of practicing without supervision, history of performing functions beyond his or her competence, permitting another to practice as a PA without board approval, prescribing outside of board guidelines, falsification of CME documentation. 34-24-302 Board may grant a temporary license to applicant who meets qualifications for licensure except that the applicant has not taken the PANCE exam for the first time or the applicant has taken the exam for the first time and is awaiting the results. Temporary license valid for 1 year from date issued or until results of exam are available or until board makes a final decision on applicant s request for licensure, whichever comes first. Temporary licensees may not prescribe nor be allowed to practice without direct, on-site physician supervision (these restrictions may be waived by the board). 34-24-301 Any person who practices or offers to practice as an assistant to physician without a license and registration issued by the board is guilty of a misdemeanor. 34-24-296 PA conclusively presumed to be agent of physician; no other person, firm, corporation or other organization shall be held liable or responsible. 34-24-292
ALABAMA~STATUTE FEE/RENEWAL SCHEDULE PROGRAM APPROVAL BOARD REPRESENTATION/ ADVISORY COMMITTEE BOARD POWERS DISCIPLINARY POWERS Annual renewal on or before January 1 each year. Board shall establish reasonable fee schedule. 34-24-299 Board shall adopt and publish standards, issue certificates of approval to PA education and training programs. 34-24-293 Adopt rules and regulations pertaining to approval and regulation of PAs; approval, disapproval and withdrawal of approval from physicians to utilize PAs Recognize, approve and disapprove new categories and specialties of PAs as they develop Formulate guidelines for the consideration of applications by physicians who supervise physician assistants Formulate guidelines for prescriptive practice Adopt rules and regulations necessary to carry out law 34-24-293 Seek injunctions through Attorney General 34-24-294 Refuse to issue license Suspend or revoke PA license Suspend or revoke approval of physicians to supervise PAs 34-24-293 Board may deny license or may suspend, revoke or otherwise discipline licensee. 34-24-302 VIOLATIONS/PENALTY PAYMENT FOR SERVICES GRANDFATHER CLAUSE Felony conviction Conviction of crime reflecting on ability to render safe patient care Conviction of violation relating to controlled substances Action against PA license or denial of license in another jurisdiction Being unable to render safe patient care by reason of addiction to alcohol or drugs or by reason of a mental or physical condition or disability Revocation, termination, suspension or restriction of hospital privileges Submitting false information to the board Representing oneself as a physician or permitting another to do so Practicing without supervision Performing tasks or functions beyond competence or outside of approved job description Practicing as a PA without a license Violation of board rules and regulations Violation of statute or board guidelines governing prescribing Falsification of CME documentation 34-24-302 Third party payers shall reimburse a supervising physician for necessary medical or surgical services provided by a physician assistant practicing under the supervision of the physician if the policy or contract would have paid for the same care provided by a physician. No additional practice or supervision restrictions may be imposed. Coverage under Title XVIII of the federal Social Security Act (Medicare) or any similar coverage under a state or federal government plan is exempted. Group health maintenance organizations or organized delivery systems are not required to provide payment for services provided by a PA unless the supervising physician has entered into a contract with the plan. 27-51-1 Person certified by the board as PA or surgeon assistant (SA) on December 21, 1994, shall be eligible for the issuance of a license to practice as an assistant to physician. 34-24-300 STUDENTS Person currently enrolled in approved program in state. 34-24-290 LOCUM TENENS
ALABAMA ~ REGULATIONS REGULATIONS Assistants to Physicians (Physician Assistants) 540-X-7-.01 et seq DATE Revised 4/06 REGULATORY BODY PA DEFINED SCOPE OF PRACTICE PRESCRIBING/ DISPENSING SUPERVISION DEFINED Alabama Board of Medical Examiners Person who is a graduate of an approved program, is licensed by the board and is registered by the board to perform medical services under supervision of approved physician. 540-X-7-.01 PA shall provide medical services within the education, training, and experience of the PA that are delegated by the supervising physician. These services include, but are not limited to: histories and physical examinations, ordering and/or performing diagnostic and therapeutic procedures, formulating a working diagnosis, developing and implementing a treatment plan, monitoring the effectiveness of therapeutic interventions, assisting at surgery, offering counseling and education to meet patient needs, and making appropriate referrals. The PA is prohibited from performing any medical service, procedure, function or activity which is not specifically listed, in detail, in the job description approved by the board. 540-X-7-.25 Unless prohibited by federal or state statutes or regulations or by agency governing a specific form, PA may sign any form which can be authenticated by supervising physician s signature, if signing by the PA is authorized by the supervising physician. 540-X-7.31 PAs may prescribe a legend drug when the drug type, dosage, quantity prescribed, and number of refills are authorized in the job description which is signed by the supervising physician and the drug is included in the formulary approved under the guidelines established by the board. PAs shall not prescribe any drug, substance or compound which is listed in schedules I through V of the state controlled substances act. A PA may not call in a prescription in the name of the supervising physician for any drug which the PA is not authorized to prescribe unless the drug is specifically ordered by the supervising physician. Prescriptions must include the name, address and telephone number of the supervising physician and PA and the PA s license number assigned by the board. Medication orders for hospitalized patients must be validated by the ordering physician within 24 hours or within the time period specified in the hospital bylaws or policies. (Board Guidelines specify that the supervising physician shall review PA prescribing practice weekly by reviewing a minimum of 10% of patient charts for which prescriptions are written. However, every patient who has not responded to treatment or who has unusual problems shall be reviewed. A log of this review shall be maintained at the practice location.) 540-X-7-.28 There shall be at all times a direct, continuing and close supervisory relationship between PA and physician to whom registered. The supervising physician shall be available for direct communication or by radio, telephone or telecommunication for consultation or referrals of patients from the PA. If the PA is to perform duties at a site away from the supervising physician, the application must specify the circumstances and verification of physician availability. This requirement may be waived by the board for exceptional circumstances. Employees of state and county health departments are exempt from the requirement of written verification. If the PA performs duties at a site away from the supervising physician, the supervising physician must receive a daily status report in person, by telephone or by telecommunication, and the supervising physician must visit the clinic at least once a week during regular business hours to observe and provide direction and consultation and at such visits must review case histories of patients with unusual or complicated problems. An appropriate physician must personally diagnose or treat patients requiring physician follow-up. A written plan for review of medical records and patient outcomes shall be submitted with the application for registration, with documentation of the reviews maintained. Countersignature by supervising physician must conform to established policy and/or applicable legal regulations and accreditation standards. 540-X-7-.23 When the primary supervising physician is off duty, out of town, or not on call and not immediately available, the PA is not authorized to perform any act or render any treatments unless another qualified physician in the same partnership, group, medical professional corporation or physician practice foundation with whom the primary supervising physician shares call is on call and is immediately available to supervise the PA and has previously filed with the board a letter stating that he or she assumes all responsibility for the actions of the PA during the temporary absence of the primary supervising physician. The covering physician must also affirm that he is familiar with current PA rules, the job description, and the prescribing authorization of the PA. 540-X-7-.24
ALABAMA REGULATIONS When a PA is involved in the care of a patient in the operating room, a supervising physician must be present in the operating room or be immediately available to the operating room. When a PA performs or assists in invasive procedures with involvement deeper than the complete dermis, the supervising physician must be present in the operating room unless specifically approved by the board. 540-X-.26 PAs PER PHYSICIAN Except for surgical specialty, cumulative work time for all PAs supervised by an individual primary supervising physician may not exceed 120 hours per week. Employees of state health department or county board of health exempted from this requirement; board may determine number of registered or supervised PAs physician may supervise in public health settings at its discretion. 540-X-7-.26 A physician who practices in a surgical specialty may have registered to him not more than 2 PAs. 540-X-7-.26 APPLICATION PA applies for license on board forms. 540-X-.04 Hearing may be held before application for licensure denied. 540-X-7-.11 PA and supervising physician apply for PA registration on board forms. Includes detailed job description. Personal interviews of physician and PA required at board s discretion. 540-X-7-.15 Hearing may be held before application for registration denied. 540-X-7-.19 In order to be registered PA must be employed by physician group, medical partnership, or physician practice foundation that also employs qualified supervising physician. 540-X-7-.17 Physician required to have practiced medicine for at least 1 year if board certified or board eligible; or have practiced medicine for at least 3 years. These requirements may be waived by the board at its discretion. 540-X-7-.17 If the PA is seeking registration to a physician not regularly engaged in the full-time practice of medicine and/or if the physician and the PA are both employees of a legal entity other than a professional partnership, the applicant must satisfy the board that there exists a supervisory relationship between the physician and the PA. Board may consider the physician s authority to terminate PA employment, recommend levels of compensation, enforce compliance with orders, extent to which direction and control may be executed in patient care, and the extent to which the PA is subject to the supervisory authority of a non-physician. 540-X-7-.22 QUALIFICATIONS TEMPORARY PERMIT TERMINATION To practice or to offer to practice as a PA, each person shall be licensed by and registered by the board. 540-X-7-.03 To qualify for licensure, PA must: be a graduate of program accredited by CAHEA or CAAHEP or its successor agency provide evidence satisfactory to the board of successful completion of the NCCPA PANCE exam pay appropriate fee 540-X-7-.04 To qualify for registration, PA must be employed by physician or by partnership, corporation or foundation that employs the supervising physician, or employed by board-approved entity of good moral character 540-X-7-.16 The board may grant a temporary license to applicant who meets qualifications for licensure except that the applicant has not yet taken the PANCE for the first time or the applicant has taken the PANCE for the first time and is awaiting the results. Temporary license valid: for 1 year, or until the results of applicant s examination are available, or until the board makes a final decision on application for certification, whichever comes first. PAs practicing with temporary licenses may not prescribe and must have direct on-site supervision. These restrictions may be waived by the board. PA with temporary license shall not practice or offer to practice unless registered by the board. 540-X-7-.09 PA and physician must both inform board of termination of PA employment. PA registration automatically terminated. 540-X-7-.20
ALABAMA REGULATIONS PAs previously approved to practice who have been terminated may continue supervised practice with an interim supervising physician after board receives reapplication for approval and may continue until the new application is approved or denied, provided the interim supervising physician meets all qualifications for a supervising physician. 540-X-7-.21 CONTINUING EDUCATION TITLE/PRACTICE PROTECTION IDENTIFICATION PA must receive not less than 12 hours of Category 1 CME each year. Documentation of such attendance must be maintained for 3 years. 540-X-7-.29 PHYSICIAN LIABILITY Supervising physician at all times responsible for the PA s activities. 540-X-7-.25 FEE/RENEWAL SCHEDULE $200 PA license fee 540-X-7-.06 $100 annual license renewal fee on or before December 31st 540-X-7-.07 $100 registration fee 540-X-7.15 PROGRAM APPROVAL Board approves those programs accredited by CAHEA, CAAHEP, or their successors. 540-X-7-.04 BOARD REPRESENTATION/ PA Advisory Committee is established for enabling the exchange of information between ADVISORY COMMITTEE the medical board and the PAs through their representative organization. PAAC consists of 4 members of the board appointed by the chairman of the board and 4 PAs appointed by the Alabama Society of PAs. Terms are 2 years; reappointments may be made. The PAAC may review and recommend changes to the rules for PAs, make recommendations regarding changes to the scope of PA practice, advise the board on issues related to applications, practice agreements, disciplinary proceedings, and renewal, and discuss ideas of mutual concern regarding education, utilization and scope of practice of PAs. Committee meets quarterly upon call of board chairman, or upon petition of 3 board members to the chairman. 540-X-7-.30 BOARD POWERS DISCIPLINARY POWERS Approve or deny applications 540-X-7-.11 Suspend, revoke, place on probation or otherwise discipline the license of the PA. 540-X-7-.12 Assess fines 540-X-7-.13 VIOLATIONS/PENALTY PAYMENT FOR SERVICES GRANDFATHER CLAUSE STUDENTS LOCUM TENENS Board may revoke, suspend, place on probation, or otherwise discipline license of a PA found guilty of: conviction of a felony or other criminal offense reflecting on the ability of PA to render safe patient care violation of state or federal drug laws discipline or denial of licensure by another jurisdiction curtailment of hospital privileges drug or alcohol addiction or other mental or physical condition or disability that renders PA unable to render safe patient care fraudulent application holding oneself out as a physician performing tasks beyond one s competence or without physician direction and supervision performing tasks not authorized in the job description prescribing in violation of board rules or guidelines practicing without board approval falsification of documents certifying compliance with CME requirement; failing to maintain CME records or provide CME records to board 540-X-7-.12 Except for unlicensed physicians, those certified by the board as PAs or surgeon assistants on December 21, 1994, are eligible for licensure and registration as PAs if application for licensure submitted on or before May 7, 1999. 540-X-7-.08
ALABAMA REGULATIONS OTHER A person who holds an MD degree but is not licensed to practice medicine in Alabama shall not be eligible for a license and registration as a PA. Anyone with these qualifications certified as a physician assistant or surgeon assistant on December 21, 1994 is eligible for issuance of license and registration if application received by May 7, 1999. 540-X-7-.08 In emergency or disaster declared by the Governor or a federal official a PA may provide emergency medical treatment without immediate physician supervision in affected areas of the state provided treatment is within PA s education, training and approved job description. PA to make reasonable efforts to inform supervising physician of location and type of services being provided and shall take direction from local medical supervisors. This provision in effect only for duration of declared emergency or disaster. 540-x-7-.25