Chapter 4730-1 Regulation of Physician Assistants

4730-1-01 Definitions.

(A) For purposes of agency-level 4730 of the Administrative Code:

(1) "Direct supervision" means that the supervising physician is physically present in the same room as the physician assistant, with the physician assistant in the actual sight of the supervising physician, when the physician assistant is performing the medical function, task, or service requiring direct supervision.

(2) "On-site supervision" means the supervising physician is required to be physically present in the same location as the physician assistant, but does not require the supervising physician's physical presence in the same room.

(3) "Off-site supervision" means the supervising physician must be continually available for direct communication with the physician assistant by such means as telephone or other real-time electronic, active communication, and must be in a location that under normal conditions is not more than sixty minutes travel time from the physician assistant's practice location.

(4) "Health care facility" means either of the following:

(a) A hospital registered with the department of health under section 3701.07 of the Revised Code;

(b) A health care facility licensed by the department of health under section 3702.30 of the Revised Code.

(5) "Office-based practice" means medical practice in a location other than a health care facility.

(6) "Service" means a medical function, task, or activity which requires training in the diagnosis, treatment and prevention of disease, including the use and administration of drugs.

(7) "Board" means the state medical board of Ohio.

(8) "Local anesthesia" means the injection of a drug or combination of drugs to stop or prevent a painful sensation in a circumscribed area of the body where a painful procedure is to be performed, and is limited to local infiltration anesthesia, digital blocks, and pudendal blocks. Local anesthesia does not include regional anesthesia or any systemic sedation.

(9) "Medical order" means one or more diagnostic or treatment directives generated by a physician or physician assistant that commands the execution of specific activities to be performed or delivered as part of a diagnostic or therapeutic regimen of a patient.

(10) "CME" means continuing medical education.

(11) "Licensure registration period" means the period between granting of the initial or renewed certificate to practice and the next scheduled renewal date for the certificate to practice.

(12) "Special services plan" means the portion of a supervisory plan that lists services not specified in division (A) of section 4730.09 of the Revised Code, that is either submitted for board approval as a portion of a supervisory plan or as an addendum to a supervisory plan that was previously approved.

(B) For purposes of Chapter 4730. of the Revised Code:

(1) "Setting in which the supervising physician routinely practices" means a practice environment in which the supervising physician ordinarily provides medical services.

(2) "Routine diagnostic procedure" means a diagnostic or therapeutic evaluation that is commonly performed, as indicated, within the scope of practice of the supervising physician.

R.C. 119.032 review dates: 03/19/2014 and 03/19/2019
Promulgated Under: 119.03
Statutory Authority: 4730.07
Rule Amplifies: 4730.01 , 4730.091 , 4730.21
Prior Effective Dates: 10/31/2007

4730-1-02 Physician assistant practice.

(A) A physician assistant shall practice under the supervision, control, and direction of a supervising physician with whom the physician assistant has a supervision agreement approved by the board.

(1) The physician assistant may enter into supervision agreements with any number of supervising physicians.

(2) The physician assistant's practice shall be in a practice setting in which the supervising physician routinely practices.

(3) In a health care facility that includes an emergency department, the physician assistant who does not routinely practice in the emergency department, may, on occasion, be sent to the emergency department by a supervising physician who does not routinely practice in the emergency department for the purpose of assessing and managing a patient, provided the supervising physician is available to come to the emergency department upon request.

(4) The services a physician assistant is authorized to perform shall be services within the supervising physician's normal course of practice and expertise, and which are consistent with the board-approved physician supervisory plan or the policies of the health care facility in which the physician and physician assistant are practicing.

(B) The scope of practice of the physician assistant is determined as follows:

(1) In a health care facility:

(a) The policies of the health care facility, as may be limited by the particular supervising physician who is providing the supervision, may authorize the physician assistant to provide any or all of the services listed in division (A) of section 4730.09 of the Revised Code;

(b) The policies of the health care facility, as may be limited by the particular supervising physician who is providing supervision, may authorize the physician assistant to assist in surgery in the health care facility;

(c) The policies of the health care facility, as may be limited by the particular supervising physician who is providing supervision, may authorize the physician assistant to provide any other services permitted by the policies of the health care facility, except where performance of a service is prohibited by any provision of Chapter 4730. of the Revised Code;

(d) The policies of the health care facility, as may be limited by the particular supervising physician who is providing supervision, may authorize the physician assistant to order or direct the execution of procedures or techniques by a registered nurse or licensed practical nurse without the need for co-signature by the supervising physician;

(e) The policies of the health care facility, as may be limited by the particular supervising physician who is providing supervision, may authorize the physician assistant to administer, monitor, or maintain local anesthesia as a component of a procedure the physician assistant is performing or as a separate service when the procedure requiring local anesthesia is to be performed by the physician assistant's supervising physician or another person; and

(f) The policies of the health care facility, as may be limited by the particular supervising physician who is providing supervision, may authorize the physician assistant to perform routine visual screening, provide medical care prior to or following eye surgery, or assist in the care of diseases of the eye.

(2) In an office-based practice:

(a) The board approved physician supervisory plan or the board approved special services plan for the particular supervising physician may authorize the physician assistant to provide any or all of the services listed in division (A) of section 4730.09 of the Revised Code;

(b) The board approved physician supervisory plan or the board approved special services plan for the particular supervising physician may authorize the physician assistant to administer, monitor, or maintain local anesthesia as a component of a procedure the physician assistant is performing or as a separate service when the procedure requiring local anesthesia is to be performed by the physician assistant's supervising physician or another person;

(c) The board approved physician supervisory plan or the board approved special services plan for the particular supervising physician may authorize the physician assistant to order or direct the execution of procedures or techniques by a registered nurse or licensed practice nurse without the need for co-signature by the supervising physician;

(d) The board approved physician supervisory plan or the board approved special services plan for the particular supervising physician may authorize the physician assistant to perform routine visual screening, provide medical care prior to or following eye surgery, or assist in the care of diseases of the eye; and

(e) The board approved physician supervisory plan or the board approved special services plan for the particular supervising physician may authorize the physician assistant to provide any service approved by the board as a special service in the physician supervisory plan, pursuant to section 4730.17 of the Revised Code.

(3) A physician assistant shall not perform any of the following activities regardless of the practice setting:

(a) Prescribe any drug or device to perform or induce an abortion, or otherwise perform or induce an abortion;

(b) Administer, monitor, or maintain any form of anesthesia except for local anesthesia; or

(c) Engage in the practice of optometry, except to the extent of authorization to perform routine visual screening, provide medical care prior to or following eye surgery, or assist in the care of diseases of the eye.

(C) The physician assistant shall include the following information with each medical order written:

(1) The physician assistant shall sign the form on which the order or order set is written, and record the time and date that the order is written; and

(2) The physician assistant shall include the name of the physician under whose supervision the physician assistant was practicing at the time the order was written.

R.C. 119.032 review dates: 03/19/2014 and 03/19/2019
Promulgated Under: 119.03
Statutory Authority: 4730.07
Rule Amplifies: 4730.02 , 4730.03 , 4730.08 , 4730.09 , 4730.091 , 4730.21
Prior Effective Dates: 10/31/2007

4730-1-03 Duties of a supervising physician.

(A) The physician supervising a physician assistant assumes legal liability for the services provided by the physician assistant under a board-approved supervision agreement. A supervision agreement shall be terminated by one of the following means:

(1) The supervising physician fails to renew the supervision agreement;

(2) The physician notifies the board, in writing, that the supervision agreement has been terminated; or

(3) The certificate to practice held by either the physician or the physician assistant is inactive due to failure to renew or for any other reason.

(B) The supervising physician may enter into supervision agreements with any number of physician assistants, but shall not supervise more than two physician assistants at any one time.

(C) A supervising physician may authorize the physician assistant to perform a service only if all the following criteria are met:

(1) The supervising physician has a board-approved supervision agreement with the physician assistant;

(2) The service is listed on the board-approved physician supervisory plan or special services plan, if the practice is an office-based practice, or is in accordance with the policies of the health care facility in which the physician and physician assistant are practicing;

(3) The service is within the supervising physician's normal course of practice;

(4) The supervising physician is satisfied that the physician assistant is capable of competently performing the service; and

(5) The supervising physician is authorized to perform the service.

(D) When on-site supervision or direct supervision of the physician assistant is not required under rule 4730-1-04 of the Administrative Code, the supervisory plan or special services plan approved by the board, or the policies of the health care facility in which the supervising physician and physician assistant are practicing, the supervising physician shall be continuously available for direct communication with the physician assistant by either of the following means:

(1) Being physically present at the location where the physician assistant is practicing; or

(2) Being in a location that under normal conditions is not more than sixty minutes travel time away from the practice location of the physician assistant and being readily available to the physician assistant through some means of telecommunication.

(E) The supervising physician shall perform all of the following supervisory activities:

(1) Personally and actively review the physician assistant's professional activities;

(2) Regularly review the condition of the patients treated by the physician assistant;

(3) Regularly perform any other reviews of the physician assistant that the supervising physician considers necessary;

(4) Establish, in consultation with each physician assistant supervised by the physician, implement, and maintain a quality assurance system, in accordance with the requirements of rule 4730-1-05 of the Administrative Code;

(5) Only grant prescriptive authority to a physician assistant in compliance with the formulary adopted in rule by the board;

(6) Supervise the physician assistant's provisional period of prescriptive authority in accordance with rule 4730-2-04 of the Administrative Code; and

(7) Maintain a written record of the following:

(a) Any conditions placed upon a specific physician assistant's practice in an office-based practice.

(b) Any limitations imposed in addition to any limitations applicable under the policies of a health care facility.

(8) Make the written record of conditions and/or limitations required in paragraph (E)(7) of this rule available upon request of the board or any health care professional working with the supervising physician and physician assistant.

Effective: 10/31/2007
R.C. 119.032 review dates: 10/31/2012
Promulgated Under: 119.03
Statutory Authority: 4730.07
Rule Amplifies: 4730.21 , 4730.22

4730-1-04 Supervision.

(A) A physician assistant's practice shall be under the on-site supervision of the supervising physician in the following instances:

(1) For practice in a health care facility's emergency department when that is a routine practice location for the supervising physician and physician assistant;

(2) During the first five hundred hours of a physician assistant's provisional period of physician delegated prescriptive authority;

(3) When on-site supervision is specified as the supervision level in a special services plan or the policies of a health care facility; and

(4) When a supervising physician specifies that on-site supervision is required as a condition for the physician assistant's performance of one or more identified services in the supervisory plan, special services plan, or policies of a health care facility.

(B) A physician assistant's practice shall be under the direct supervision of the supervising physician in the following instances:

(1) When direct supervision is specified in a special services plan approved by the board; or

(2) When the supervising physician specifies that direct supervision is required as a condition for the physician assistant's performance of one or more identified services in a supervisory plan, special services plan, or the policies of a health care facility.

(C) Where paragraphs (A) and (B) of this rule do not apply, a physician assistant may practice under the off-site supervision of the supervising physician.

R.C. 119.032 review dates: 03/19/2014 and 03/19/2019
Promulgated Under: 119.03
Statutory Authority: 4730.07 , 4730.39
Rule Amplifies: 4730.21 , 4730.45
Prior Effective Dates: 10/31/2007

4730-1-05 Quality assurance system.

(A) A quality assurance system shall be developed to assess the physician assistant's performance.

(B) The quality assurance system shall describe the process to be used for all of the following:

(1) Review by the physician of selected patient record entries made by the physician assistant and selected medical orders issued by the physician assistant, to include, at a minimum, all of the following:

(a) Assessment of the medical history and physical examination documented in the record;

(b) Assessment of the appropriateness of the diagnosis and treatment plan based on the medical history and physical examination documented in the record;

(c) Feedback to the physician assistant concerning appropriateness of the physician assistant's prescriptive decisions; and

(d) Assessment of whether the physician assistant is practicing according to the supervisory plan or the policies of the health care facility, as applicable.

(2) Discussion of complex cases;

(3) Discussion of new medical developments relevant to the practice of the physician and physician assistant, including new pharmaceuticals;

(4) Performance of any other quality assurance activities that the supervising physician considers to be appropriate.

(C) The quality assurance assessment shall be conducted at least twice per year during the first year of a physician assistant's practice and at least once per year thereafter.

(D) Each supervising physician and physician assistant shall keep records of their quality assurance activities for at least seven years, and shall make the records available to the board and any health care professional working with the supervising physician and physician assistant.

(E) The quality assurance system developed pursuant to this rule shall not preclude a health care facility or other entity in which physician assistants practice from conducting quality assurance activities involving the assessment of physician assistant performance.

(F) This provision allows, and does not preclude, multiple supervising physicians to assign the quality assurance process to one supervising physician.

R.C. 119.032 review dates: 03/19/2014 and 03/19/2019
Promulgated Under: 119.03
Statutory Authority: 4730.07
Rule Amplifies: 4730.21
Prior Effective Dates: 10/31/2007

4730-1-06 Certificate to practice as a physician assistant.

(A) All applicants for a certificate to practice as a physician assistant shall file a written application under oath on the forms prescribed by the board, and provide such other facts and materials as the board requires.

(B) No application shall be considered filed, and shall not be reviewed, until the fee required by section 4730.10 of the Revised Code has been received by the board.

(C) An application shall be considered complete when all of the following requirements are met:

(1) The fee required pursuant to section 4730.10 of the Revised Code has been received by the board;

(2) Verification of the applicant's current certification has been received by the board directly from the "National Commission on Certification of Physician Assistants";

(3) All information required by section 4730.10 of the Revised Code, including such other facts and materials as the board requires, has been received by the board; and

(4) The applicant has complied with the requirements of paragraph (A) of rule 4730-3-02 of the Administrative Code and the board has received the results of the criminal records checks and any other forms required to be submitted pursuant to paragraph (A) of rule 4730-3-02 of the Administrative Code.

(5) The board is not conducting an investigation, pursuant to section 4730.26 of the Revised Code, of evidence appearing to show that the applicant has violated section 4730.25 of the Revised Code or applicable rules adopted by the board.

(D) All application materials submitted to the board will be thoroughly investigated. The board will contact individuals, agencies, or organizations for information about applicants as the board deems necessary. As part of the application process, an applicant may be requested to appear before the board or a representative thereof to answer questions or provide additional information.

(E) Any applicant to whom the board proposes to deny certificate issuance pursuant to Chapter 4730. of the Revised Code or because of failure to meet any of the requirements of the rules of the board shall be entitled to a hearing on the issue of such proposed denial. Notice and hearing requirements incident to such proposed denial will be in compliance with the provisions of Chapter 119. of the Revised Code and any rules adopted by the board.

(F) No application for a certificate to practice as a physician assistant may be withdrawn without the approval of the board.

(G) The following processes apply when an application is not complete within six months of the date the application is filed with the board:

(1) If the application is not complete because required information, facts, or other materials have not been received by the board, the board may notify the applicant by certified mail that it intends to consider the application abandoned if the application is not completed.

(a) The written notice shall:

(i) Specifically identify the information, facts, or other materials required to complete the application; and

(ii) Inform the applicant that the information, facts, or other materials must be received by the deadline date specified; that if the application remains incomplete at the close of business on the deadline date the application may be deemed to be abandoned and no further review of the application will occur; and that if the application is abandoned the submitted fees shall neither be refundable nor transferable to a subsequent application.

(b) If all of the information, facts, or other materials are received by the board by the deadline date and the application is determined to be complete, the board shall process the application and may require updated information as it deems necessary.

(2) If the application is not complete because the board is investigating, pursuant to section 4730.26 of the Revised Code, evidence appearing to show that the applicant has violated Chapter 4730. of the Revised Code or applicable rules adopted by the board, the board shall do both of the following:

(a) Notify the applicant that although otherwise complete, the application will not be processed pending completion of the investigation; and

(b) Upon completion of the investigation and the determination that the applicant is not in violation of statute or rule, process the application, including requiring updated information as it deems necessary.

(H) A certificate to practice as a physician assistant must be renewed in the manner and according to the requirements of section 4730.14 of the Revised Code.

(I) The CME requirement for renewal of the certificate to practice is as follows:

(1) Each applicant for renewal shall certify that the applicant has completed the requisite hours of CME since the start of the licensure registration period.

(2) Except as provided in paragraph (I)(3) of this rule, a physician assistant shall have completed one hundred hours of CME during the licensure registration period.

(3) If the certificate to practice is initially issued prior to the first day of the second year of a licensure registration period, an individual shall be required to earn fifty total hours; if the license is issued on or after the first day of the second year of a licensure registration period and prior to the first day of the eighteenth month of that licensure registration period, the licensee shall be required to earn twenty-five total hours; if the certificate to practice is issued on or after the first day of the eighteenth month of a licensure registration period, the licensee shall not be required to earn any hours of CME credits for that licensure registration period.

(4) Only those hours earned from the date of initial licensure to the end of the licensure registration period shall be used towards the total hour requirement as contained in this rule.

(5) Completion of the CME requirement may be satisfied by courses acceptable for the individual to maintain NCCPA certification.

Effective: 09/30/2008
R.C. 119.032 review dates: 10/31/2012
Promulgated Under: 119.03
Statutory Authority: 4730.07 , 4776.03
Rule Amplifies: 4730.101 , 4730.11 , 4730.12 , 4730.13 , 4730.14 , 4730.28 , 4776.01 , 4776.02 , 4776.03 , 4776.04
Prior Effective Dates: 10/31/07

4730-1-07 Miscellaneous provisions.

For purposes of Chapter 4730. of the Revised Code and Chapters 4730-1 and 4730-2 of the Administrative Code:

(A) An adjudication hearing held pursuant to the provisions of Chapter 119. of the Revised Code shall be conducted in conformance with the provisions of Chapter 4731-13 of the Administrative Code.

(B) The provisions of Chapters 4731-13, 4731-14, 4731-15, 4731-16, 4731-17, 4731-18, 4731-19, 4731-21, 4731-26, and 4731-28 of the Administrative Code are applicable to the holder of a certificate to practice as a physician assistant issued pursuant to section 4730.12 of the Revised Code, as though fully set forth in Chapter 4730-1 or 4730-2 of the Administrative Code.

(C) A holder of a certificate to practice as a physician assistant issued pursuant to section 4730.12 of the Revised Code shall not assist in surgery in an office setting, except where such authority is specified in a special services plan approved by the board pursuant to section 4730.17 of the Revised Code. Where a board-approved special services plan specifically authorizes the physician assistant to assist in office-based surgery, the requirements of paragraph (B) of this rule and the provisions of Chapter 4731-25 of the Administrative Code apply, as though fully set forth in Chapter 4730-1 or 4730-2 of the Administrative Code.

Effective: 10/31/2007
R.C. 119.032 review dates: 10/31/2012
Promulgated Under: 119.03
Statutory Authority: 4730.07
Rule Amplifies: 4730.09 , 4730.25 , 4730.26

4730-1-08 Special services plan.

(A) For a physician assistant who practices in an office-based setting, a special services plan approved by the board is required for all services beyond the scope of the services authorized under paragraph (A) of section 4730.09 of the Revised Code.

(B) An application for approval of a service under a special services plan shall be made on a form prescribed by the board and include such facts and materials as the board requires, including, but not limited to, all of the following information:

(1) Documentation of the supervising physician's normal course of practice, experience and training to perform the requested service, and any board certification;

(2) The minimum education, training, and experience required for any physician assistant providing service under the plan, including the following:

(a) Any formal postgraduate physician assistant training that will be provided to the physician assistant;

(b) The minimum number of procedures the physician assistant will observe the supervising physician in performing; and

(c) The minimum number of procedures performed by the physician assistant under the direct observation of the supervising physician in order to be certified by that physician as competent.

(3) The location or locations in which the service will be performed;

(4) The criteria that will be used in granting authority for the specific service to be performed by the physician assistant and the quality assurance process that will be utilized to review the performance of that service;

(5) Whether the service will be performed under direct supervision, on-site supervision, or off-site supervision, as those terms are defined in rule 4730-1-01 of the Administrative Code;

(6) The quality assurance process that will apply to the physician assistant in the performance of the special service;

(7) The minimum number of procedures per year the physician assistant will be required to perform in order to maintain authority to perform the service;

(8) If the service is a diagnostic procedure, whether a permanent visual record is maintained for the supervising physician's review and interpretation;

(9) A listing of all significant complications associated with the requested procedure and the processes in place to document and respond to those complications, should they occur;

(10) Any peer-reviewed articles on physician assistant or other ancillary personnel performance of the requested service and rate of complications, as applicable; and

(11) Any other information required by the board.

(C) The board may approve or deny a special services plan upon consideration of factors including, but not limited to, the following:

(1) Whether performance of the service will likely require complex observations or critical decision making during the performance of the service;

(2) Whether the potential complications that may occur if the service is not performed properly will likely include life threatening consequences or the danger of immediate and serious harm to the patient;

(3) Whether medical judgment requiring the exclusive expertise and training of a physician must ordinarily be exercised during the performance of the service;

(4) Whether the performance of the service is otherwise prohibited by statute or rule;

(5) Whether the supervision proposed is appropriate for the level of service to be performed;

(6) Whether the education and/or training proposed for the physician assistant will adequately and appropriately prepare the physician assistant to perform the service;

(7) Whether the service to be performed is within the routine scope of practice of the supervising physician;

(8) Whether, as proposed, performance of the service will not conform to the minimal standard of care of similar practitioners under the same or similar circumstances; and

(9) Whether the quality assurance system proposed presents sufficient opportunities for feedback to the physician assistant concerning the quality of the physician assistant's practice under the special services plan, including the frequency of performance of the special service to ensure competency.

(D) The approval of a special services plan may require the supervising physician to submit quarterly reports for one year following the date the service was approved by the board, including that the reports list the number of times each procedure was performed by the physician assistant and any complications that occurred

Effective: 10/31/2007
R.C. 119.032 review dates: 10/31/2012
Promulgated Under: 119.03
Statutory Authority: 4730.07
Rule Amplifies: 4730.06 , 4730.09 , 4730.15 , 4730.16 , 4730.17