The answer to the question depends on the practice setting.  In facility-based hospital practices and in practices that serve medically underserved populations, there are no limitations.  In all other practice settings, one physician may delegate to no more than seven full time equivalent APRNs and PAs (1:7 FTEs).  

No, the waiver process no longer exists.  A physician may only delegate prescriptive authority to more than seven full time equivalent APRNs and PAs in facility based hospital practices and in practices that serve medically underserved populations.  In all other settings and practice scenarios, the 1:7 FTE ratios applies.  

No.  The old site-based prescriptive authority system is no longer in effect.  

Yes.  SB 406 clarified that it is necessary to have prescriptive authority to order these devices.  In the past, it was not clear to DME suppliers that APRNs and PAs had this authority.  The changes to the law as a result of the passage of SB 406 clearly indicate that APRNs and PAs may order or prescribe this equipment provided all requirements for delegation of prescriptive authority are met.  

SB 406 eliminated site based prescriptive authority.  The law is silent regarding the practice location of the physician and its proximity to the practice site of the APRN or PA. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the distance between a physician’s primary practice and the practice site at which the physician’s delegates provide medical services may be an important factor in determining the quality of the physician’s supervision. 

All prescriptive delegation requires adequate supervision under the Medical Practice Act.  As such, a physician delegating to an APRN or PA must adequately supervise those individuals.  An individual physician may serve in both the supervising and delegating role and does not need to be physically present at all times to be considered to have adequate supervision.

APRNs and PAs are required to have delegated authority from a licensed physician in order to provide medical aspects of patient care. Historically, this delegation has occurred through a protocol or other written authorization. Rather than requiring multiple documents, delegation protocols can now be included in one document the prescriptive authority agreement. The prescriptive authority agreement need not describe the exact steps that an advanced practice registered nurse or physician assistant must take with respect to each specific condition, disease, or symptom, however.

A physician, advanced practice registered nurse, or physician assistant must have an active license to practice that is not suspended, delinquent, or otherwise subject to a disciplinary order that specifically prohibits the licensee from entering into a prescriptive authority agreement.    

Note that if a licensee’s authority to supervise, delegate, or prescribe devices is limited under a board order, the licensee may enter into a prescriptive authority agreement and practice under the agreement only to the extent permitted by the board order.

It depends upon when the agreement was executed.  Note that there have been several changes to the law affecting this area in recent legislative sessions.  To understand how the law might apply to your situation, you may want to seek the advice of private legal counsel.

For a prescriptive authority agreement executed on or after September 1, 2019, the agreement must, at a minimum:

(1)  be in writing and reviewed, signed and dated by the parties to the agreement on an annual basis;

(2)  state the name, address, and all professional license numbers of the parties to the agreement;

(3)  state the nature of the practice, practice locations, or practice settings;

(4)  identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;

(5)  provide a general plan for addressing consultation and referral;

(6)  provide a plan for addressing patient emergencies;

(7)  state the general process for communication and the sharing of information related to the care and treatment of patients;

(8)  if alternate physician supervision is to be utilized, designate one or more alternate physicians; and

(9)  describe a prescriptive authority quality assurance and improvement plan and how it will be implemented. The plan must require chart reviews and periodic meetings.

The law does not provide a specific number or percentage of charts that must be reviewed.  Rather, the law provides that the number of charts to be reviewed is determined by the parties to the prescriptive authority agreement.  The number may vary from one practice setting to another.  Factors such as the length of time the APRN or PA has been in practice, the length of time the physician and APRN or PA have practiced together, whether the parties to the prescriptive authority agreement practice together in the same practice setting, and the complexity of patient care needs should be given consideration when making this determination. That said, there has been no change in the law that requires that a physician must provide adequate supervision of delegates. In any given case, the number or percentage of charts reviewed may be an important factor in determining the quality of the physician’s supervision. 

No. Periodic meetings are required, regardless of the distance between or locations at which the physician and delegate(s) practice.

No.  Free standing clinics, centers or other medical practices that are owned or operated by or associated with a hospital or long term care facility that are not physically located within the hospital or long term care facility are not considered facility based practices.  Prescriptive authority agreements are required in these settings.

Although it is possible to use a prescriptive authority agreement in a hospital or long term care facility based practice, it is not required.  You may continue to practice under protocols in these settings.  APRNs and PAs must exercise prescriptive authority under one of these delegation mechanisms.

In a hospital facility based practice, the delegating physician may be the medical director, the chief of medical staff, the chair of the credentialing committee, a department chair, or a physician who consents to the request of the medical director or chief of the medical staff to delegate.  

In a long term care facility based practice, delegation is by the medical director.