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Title 26: Professions and Occupations

Chapter 031: PHYSICIAN ASSISTANTS

  • §§ 1725-1729. Repealed. 1981, No. 100 § 13.

  • § 1730. [Reserved.].

  • § 1731. Policy and purpose

    The General Assembly recognizes the need to provide means by which physician assistants may practice medicine in collaboration with physicians and other health care professionals to provide increased efficiency and to ensure that high-quality medical services are available to all Vermonters at reasonable cost. The General Assembly recognizes that physician assistants, with their education, training, and experience in the field of medicine, are well suited to provide these services to Vermonters. (Added 1981, No. 100, § 1; amended 1985, No. 208 (Adj. Sess.), § 1, eff. June 30, 1986; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1732. Definitions

    As used in this chapter:

    (1) "Accredited physician assistant program" means a physician assistant educational program that has been accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), or, prior to 2001, by either the Committee on Allied Health Education and Accreditation (CAHEA) or the Commission on Accreditation of Allied Health Education Programs (CAAHEP).

    (2) "Board" means the State Board of Medical Practice established by chapter 23 of this title.

    (3) "Collaboration" means a physician assistant's consultation with or referral to an appropriate physician or other health care professional as indicated based on the patient's condition; the physician assistant's education, training, and experience; and the applicable standards of care.

    (4) "Disciplinary action" means any action taken by the Board against a physician assistant or an applicant, or an appeal of that action, when the action suspends, revokes, limits, or conditions licensure in any way. The term includes reprimands and administrative penalties.

    (5) "Health care facility" has the same meaning as in 18 V.S.A. § 9402.

    (6) "Participating physician" means a physician practicing as a sole practitioner, a physician designated by a group of physicians to represent their physician group, or a physician designated by a health care facility to represent that facility, who enters into a practice agreement with a physician assistant in accordance with this chapter.

    (7) "Physician" means an individual licensed to practice medicine pursuant to chapter 23 or 33 of this title.

    (8) "Physician assistant" or "PA" means an individual licensed by the State of Vermont to practice medicine in collaboration with one or more physicians pursuant to this chapter.

    (9) "Physician group" means a medical practice involving two or more physicians.

    (10) "Practice agreement" means an agreement that meets the requirements of section 1735a of this chapter.

    (11) "Practice as a physician assistant" means the practice of medicine by a PA pursuant to a practice agreement signed by a participating physician. (Added 1981, No. 100, § 2; amended 1985, No. 208 (Adj. Sess.), § 2, eff. June 30, 1986; 1989, No. 250 (Adj. Sess.), § 4(a); 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1733. Licensure

    The State Board of Medical Practice is responsible for the licensure of physician assistants, and the Commissioner of Health shall adopt, amend, or repeal rules regarding the training, practice, qualification, and discipline of physician assistants. (Added 1981, No. 100, § 3; amended 1985, No. 208 (Adj. Sess.), § 3, eff. June 30, 1986; 2003, No. 34, § 10, eff. May 23, 2003; 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1734. Eligibility

    (a) The Board may grant a license to practice as a physician assistant to an applicant who meets all of the following requirements:

    (1) Submits a completed application form provided by the Board.

    (2) Pays the required application fee.

    (3) Has graduated from an accredited physician assistant program or has passed and maintained the certification examination by the National Commission on the Certification of Physician Assistants (NCCPA) prior to 1988.

    (4) Has passed the Physician Assistant National Certifying Examination administered by the NCCPA.

    (5) Is mentally and physically able to engage safely in practice as a physician assistant.

    (6) Does not hold any license, certification, or registration as a physician assistant in another state or jurisdiction that is under current disciplinary action, or has been revoked, suspended, or placed on probation for cause resulting from the applicant's practice as a physician assistant, unless the Board has considered the applicant's circumstances and determines that licensure is appropriate.

    (7) Is of good moral character.

    (8) Submits to the Board any other information that the Board deems necessary to evaluate the applicant's qualifications.

    (9) Has engaged in practice as a physician assistant within the last three years or has complied with the requirements for updating knowledge and skills as defined by Board rules. This requirement shall not apply to applicants who have graduated from an accredited physician assistant program within the last three years.

    (b), (c) [Repealed.]

    (d) When the Board intends to deny an application for licensure, it shall send the applicant written notice of its decision by certified mail. The notice shall include a statement of the reasons for the action. Within 30 days of the date that an applicant receives such notice, the applicant may file a petition with the Board for review of its preliminary decision. At the hearing, the burden shall be on the applicant to show that licensure should be granted. After the hearing, the Board shall affirm or reverse its preliminary denial.

    (e) Failure to maintain competence in the knowledge and skills of a physician assistant, as determined by the Board, shall be cause for revocation of licensure. (Added 1981, No. 100, § 4; amended 1985, No. 208 (Adj. Sess.), § 4, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1734a. Repealed. 2011, No. 61, § 9, eff. June 2, 2011.

  • § 1734b. Renewal of license

    (a) Licenses shall be renewed every two years on payment of the required fee. At least one month prior to the date on which renewal is required, the Board shall send to each licensee a license renewal application form and notice of the date on which the existing license will expire. On or before the renewal date, the licensee shall file an application for license renewal and pay the required fee. The Board shall register the applicant and issue the renewal license. Within one month following the date renewal is required, the Board shall pay the license renewal fees into the Medical Practice Board Special Fund. Any physician assistant while on extended active duty as a member of the U.S. Armed Forces, a reserve component of the U.S. Armed Forces, the National Guard, or the State Guard who is licensed as a physician assistant at the time of an activation or deployment shall receive an extension of licensure up to 90 days following the physician assistant's return from activation or deployment, provided the physician assistant notifies the Board of the activation or deployment prior to the expiration of the current license, and certifies that the circumstances of the activation or deployment impede good faith efforts to make timely application for renewal of the license.

    (b) A licensee shall demonstrate that the requirements for licensure are met.

     [Subsection (c) effective 60 days after the adoption of the maintenance of licensure for physician assistants.]

    (c) A licensee for renewal of an active license to practice shall have practiced as a physician assistant within the last three years or have complied with the requirements for updating knowledge and skills as defined by Board rules.

    (d) A licensee shall promptly provide the Board with new or changed information pertinent to the information in the physician assistant's license and license renewal applications at the time the licensee becomes aware of the new or changed information.

    (e) A license that has lapsed may be reinstated on payment of a renewal fee and a late renewal fee. The applicant shall not be required to pay renewal fees during periods when the license was lapsed. However, if a license remains lapsed for a period of three years, the Board may require the licensee to update the licensee's knowledge and skills as defined by Board rules. (Added 1985, No. 208 (Adj. Sess.), § 6, eff. June 30, 1986; amended 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1734c. Exemptions

    (a) Nothing in this chapter shall be construed to require licensure under this chapter of any of the following:

    (1) Physician assistant students enrolled in a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant.

    (2) Physician assistants employed in the service of the U.S. Armed Forces or National Guard, including National Guard in state status, while performing duties incident to that employment.

    (3) Technicians or other assistants or employees of a physician who perform physician-delegated tasks but who are not rendering services as physician assistants or identifying themselves as physician assistants.

    (4) Physician assistants who are duly licensed and in good standing in another state, territory, or jurisdiction of the United States or in Canada if the physician assistants are employed as or formally designated as team physician assistants by an athletic team visiting Vermont for a specific sporting event and the physician assistants limit their practice in this State to the treatment of the members, coaches, and staff of the sports team employing or designating the physician assistants.

    (b) Physician assistants licensed in this State or credentialed as physician assistants by a federal employer shall not be required to have a practice agreement when responding to a need for medical care created by a disaster or emergency, as that term is defined in 20 V.S.A. § 102(c). (Added 2011, No. 61, § 4, eff. June 2, 2011; amended 2015, No. 94 (Adj. Sess.), § 3, eff. May 10, 2016; 2017, No. 113 (Adj. Sess.), § 166; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1735. Repealed. 2011, No. 61, § 9, eff. June 2, 2011.

  • § 1735a. Practice agreement and scope of practice

    (a) Except as provided in subsection 1734c(b) of this chapter and subsection (e) of this section, a physician assistant shall engage in practice as a physician assistant in this State only if the physician assistant has entered into a written practice agreement as set forth in subsection (b) of this section.

    (1) A physician assistant shall enter into a practice agreement with a physician who practices as a sole practitioner only if the participating physician's area of specialty is similar to or related to the physician assistant's area of specialty.

    (2) A physician assistant shall enter into a practice agreement with a participating physician who represents a physician group or health care facility only if one or more of the physicians practicing in the physician group or at the health care facility has an area of specialty similar to or related to the physician assistant's area of specialty.

    (b) A practice agreement shall include all of the following:

    (1) Processes for physician communication, availability, decision making, and periodic joint evaluation of services delivered when providing medical care to a patient.

    (2) An agreement that the physician assistant's scope of practice shall be limited to medical care that is within the physician assistant's education, training, and experience. Specific restrictions, if any, on the physician assistant's practice shall be listed.

    (3) A plan to have a physician available for consultation at all times when the physician assistant is practicing medicine.

    (4) The signatures of the physician assistant and the participating physician; no other signatures shall be required.

    (c) A practice agreement may specify the extent of the collaboration required between the PA and physicians and other health care professionals; provided, however, that a physician shall be accessible for consultation by telephone or electronic means at all times when a PA is practicing.

    (d) The practice agreement shall be reviewed by the physician assistant and either the participating physician or a representative of the practice, physician group, or health care facility, at a minimum, at the time of the physician assistant's license renewal.

    (e) In the event of the unanticipated unavailability of a participating physician practicing as a sole practitioner due to serious illness or death, a physician assistant may continue to practice for not more than a 30-day period without entering into a new practice agreement with another participating physician.

    (f) The practice agreement shall be filed with the Board. The Board shall not request or require any modifications to the practice agreement. The practice agreement may be filed with the Board electronically at the option of the physician assistant; no original documents shall be required.

    (g) Nothing in this section shall be construed to require the physical presence of a physician at the time and place at which a physician assistant renders a medical service.

    (h) A physician assistant may prescribe, dispense, administer, and procure drugs and medical devices to the same extent as may a physician. A physician assistant who prescribes controlled substances shall be registered with the federal Drug Enforcement Administration. (Added 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1735b. Physician assistant as primary care provider

    Notwithstanding any provision of law to the contrary, a physician assistant shall be considered a primary care provider when the physician assistant practices in one or more of the medical specialties for which a physician would be considered to be a primary care provider. (Added 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1736. Unprofessional conduct

    (a) The following conduct and the conduct described in section 1354 of this title by a licensed physician assistant shall constitute unprofessional conduct; when that conduct is by an applicant or person who later becomes an applicant, it may constitute grounds for denial of licensure:

    (1) fraud or misrepresentation in applying for or procuring a license or in applying for or procuring a periodic renewal of a license;

    (2) occupational advertising that is intended or has a tendency to deceive the public;

    (3) exercising undue influence on or taking improper advantage of a person using the individual's services, or promoting the sale of professional goods or services in a manner that exploits a person for the financial gain of the practitioner or of a third party;

    (4) failing to comply with provisions of federal or state statutes or rules governing the profession;

    (5) conviction of a crime related to the profession; and

    (6) conduct that evidences unfitness to practice in the profession.

    (b) Unprofessional conduct includes the following actions by a licensed physician assistant:

    (1) Making or filing false professional reports or records, impeding or obstructing the proper making or filing of professional reports or records, or failing to file a proper professional report or record.

    (2) Practicing the profession when mentally or physically unfit to do so.

    (3) Practicing as a physician assistant without a practice agreement meeting the requirements of section 1735a of this chapter, except under the circumstances described in subsections 1734c(b) and 1735a(e) of this chapter. The Board's receipt of a practice agreement filed in accordance with subsection 1735a(f) of this chapter shall not be construed to constitute Board approval of the practice agreement or of its contents.

    (4) Accepting and performing responsibilities that the individual knows or has reason to know the individual is not competent to perform.

    (5) Making any material misrepresentation in the practice of the profession, whether by commission or omission.

    (6) The act of holding oneself out as, or permitting oneself to be represented as, a licensed physician.

    (7) [Repealed.]

    (8) Performing or offering to perform a task or tasks beyond the individual's scope of practice.

    (9) Administering, dispensing, procuring, or prescribing any controlled substance otherwise than as authorized by law.

    (10) Habitual or excessive use or abuse of drugs, alcohol, or other substances that impair the ability to provide medical services.

    (11) Failure to practice competently by reason of any cause on a single occasion or on multiple occasions. Failure to practice competently includes, as determined by the Board:

    (A) performance of unsafe or unacceptable patient care; or

    (B) failure to conform to the essential standards of acceptable and prevailing practice.

    (c) A person aggrieved by a determination of the Board may, within 30 days of the order, appeal that order to the Vermont Supreme Court on the basis of the record created before the Board. (Added 1981, No. 100, § 6; amended 1985, No. 208 (Adj. Sess.), § 8, eff. June 30, 1986; 1989, No. 250 (Adj. Sess.), § 47; 2003, No. 34, § 13, eff. May 23, 2003; 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1737. Disposition of complaints

    (a) Complaints and allegations of unprofessional conduct shall be processed in accordance with the rules of procedure of the Board of Medical Practice.

    (b) Any person, firm, corporation, or public officer may submit a written complaint to the Board alleging a physician assistant practicing in the State committed unprofessional conduct, specifying the grounds. The Board may initiate disciplinary action in any complaint against a physician assistant and may act without having received a complaint.

    (c) After giving opportunity for hearing, the Board shall take disciplinary action described in subsection 1361(b) of this title against a physician assistant or applicant found guilty of unprofessional conduct.

    (d) The Board may approve a negotiated agreement between the parties when it is in the best interests of the public health, safety, or welfare to do so. Such an agreement may include any of the following conditions or restrictions, which may be in addition to, or in lieu of, suspension:

    (1) A requirement that the individual submit to care or counseling.

    (2) A restriction that the individual practice only under supervision of a named person or a person with specified credentials.

    (3) A requirement that the individual participate in continuing education in order to overcome specified practical deficiencies.

    (4) A requirement that the scope of practice permitted be restricted to a specified extent.

    (5) An administrative penalty not to exceed $1,000.00 for each act that constitutes an unprofessional conduct violation. Any money received from the imposition of an administrative penalty imposed under this subdivision shall be deposited into the Board of Medical Practice Regulatory Fee Fund for the purpose of providing education and training for Board members and the professions regulated by the Board. The Commissioner shall detail in the annual report receipts and expenses from money received under this subsection.

    (e) Upon application, the Board may modify the terms of an order under this section and, if licensure has been revoked or suspended, order reinstatement on terms and conditions it deems proper. (Added 1981, No. 100, § 7; amended 1985, No. 208 (Adj. Sess.), § 9, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

  • § 1737a. Repealed. 1989, No. 250 (Adj. Sess.), § 92.

  • § 1738. Use of title

    Any person who is licensed to practice as a physician assistant in this State shall have the right to use the title "physician assistant" and the abbreviations "PA" and "PA-C." No other person shall assume that title, use those abbreviations, or use any other words, letters, signs, or devices to indicate that the person using them is a physician assistant. (Added 1981, No. 100, § 8; amended 1985, No. 208 (Adj. Sess.), § 11, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1739. Legal liability

    Physician assistants are responsible for their own medical decision making. A participating physician in a practice agreement with a physician assistant shall not, by the existence of the practice agreement alone, be legally liable for the actions or inactions of the physician assistant; provided, however, that this does not otherwise limit the liability of the participating physician. (Added 1981, No. 100, § 9; amended 1985, No. 208 (Adj. Sess.), § 12, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1739a. Repealed. 2019, No. 123 (Adj. Sess.), § 1.

  • § 1740. Fees

    Applicants and persons regulated under this chapter shall pay the following fees:

    (1) Original application for licensure, $225.00; the Board shall use at least $10.00 of this fee to support the cost of maintaining the Vermont Practitioner Recovery Network, which, for the protection of the public, monitors and evaluates, coordinates services for, and promotes rehabilitation of licensees who have or potentially have an impaired ability to practice medicine with reasonable skill and safety.

    (2) Biennial renewal, $215.00; the Board shall use at least $10.00 of this fee to support the cost of maintaining the Vermont Practitioner Recovery Network described in subdivision (1) of this section. (Added 1981, No. 100, § 10; amended 1985, No. 208 (Adj. Sess.), § 14, eff. June 30, 1986; 1989, No. 250 (Adj. Sess.), § 48; 1999, No. 49, § 211; 2003, No. 163 (Adj. Sess.), § 6; 2007, No. 76, § 20; 2011, No. 61, § 4, eff. June 2, 2011; 2015, No. 57, § 15; 2017, No. 39, § 5; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1741. Repealed. 2019, No. 123 (Adj. Sess.), § 1.

  • § 1742. Penalty

    (a) Any person who not being licensed holds himself or herself out to the public as being licensed under this chapter shall be liable for a fine of not more than $10,000.00.

    (b) In addition to the penalty provided in subsection (a) of this section, the Attorney General or a State's Attorney may bring a civil action to restrain continuing violations of this section. (Added 1981, No. 100, § 15; amended 1985, No. 208 (Adj. Sess.), § 16, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011.)

  • § 1743. Medicaid reimbursement

    The Secretary of Human Services shall provide reimbursement under Title XIX (Medicaid) of the Social Security Act and 33 V.S.A. chapter 19 that recognizes reasonable cost differences between services provided by physicians and those provided by physician assistants under this chapter. (Added 1981, No. 100, § 16; amended 1985, No. 208 (Adj. Sess.), § 17, eff. June 30, 1986; 2011, No. 61, § 4, eff. June 2, 2011; 2015, No. 23, § 129; 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1743a. Payment for medical services

    (a) As used in this section:

    (1) "Health insurer" has the same meaning as in 18 V.S.A. § 9402.

    (2) "Participating provider" has the same meaning as in 18 V.S.A. § 9418 and includes providers participating in the Vermont Medicaid program.

    (b) Health insurers and, to the extent permitted under federal law, Medicaid shall reimburse a participating provider who is a physician assistant for any medical service delivered by the physician assistant if the same service would be covered if delivered by a physician. Physician assistants are authorized to bill for and receive direct payment for the medically necessary services they deliver.

    (c) To provide accountability and transparency for patients, payers, and the health care system, the physician assistant shall be identified as the treating provider in the billing and claims processes when the physician assistant delivered the medical services to the patient.

    (d) A health insurer shall not impose any practice, education, or collaboration requirement for a physician assistant that is inconsistent with or more restrictive than the provisions of this chapter. (Added 2019, No. 123 (Adj. Sess.), § 1.)

  • § 1744. Repealed. 2019, No. 123 (Adj. Sess.), § 1.