Healt hcare Advisory
Published by Howard & Howard Attorneys PLLC
October 2017  
The Healthcare Law Group at Howard & Howard is dedicated to assisting all types of healthcare entities, including medical providers and suppliers, in a full range of legal services ranging from business formation, to credentialing, to negotiating insurance contracts and other third party payment agreements, to Medicare and other payor appeals, to complex regulatory compliance issues, such as compliance with the federal Anti-Kickback Statute, Stark Law, and HIPAA.  We are happy to provide legal counsel to meet all your healthcare and overall business needs.  
The members of the Healthcare Law Group include: Rick Miettinen, Brandon Booth, Tom O'Neal, and Andre Perrotta. Please contact any of them for any of your healthcare business needs. We are pleased to provide our clients and friends with periodic updates on issues, industry developments, and changes in the law to help you address the challenges facing business owners. As always, if you have any questions, please feel free to contact any of the Healthcare attorneys.

Authored by Andre Perrotta, Esq.

Earlier this year, Michigan Public Act 379 established new requirements regarding the working relationship between a physician and a physician assistant ("PA").  Under the new law, PAs are no longer allowed to merely work under the supervision or direction of a physician without a formalized agreement. Instead, PAs must now execute a written Practice Agreement with a "participating physician" in order to render services. A "participating physician" means an individual physician, a physician designated by a group practice to represent the group, or a physician designated by a health facility to represent the facility. 
The new law mandates the inclusion of several express provisions in the Practice Agreement.  Specifically, the Practice Agreement must define the communication and decision making processes under which the physician and PA provide medical services to their patients.  The Practice Agreement is also required to contain a protocol for designating an alternative physician for consultation in situations where the participating physician is unavailable for consultation. The Practice Agreement must further include a termination provision allowing the PA or participating physician to terminate the agreement upon thirty (30) days advance written notice to the other party.  The Practice Agreement must be signed by both the PA and participating physician.
In addition to the required provisions listed above, the Practice Agreement may also contain a provision allowing the PA to prescribe medication.  This is because Public Act 379 now defines PAs as independent "Prescribers" within the context of a Practice Agreement.  As such, if the Practice Agreement establishes that the PA may prescribe medication as an independent Prescriber without delegation from a physician, then the PA must apply for and obtain a State of Michigan Controlled Substance License ("CSL") in order to prescribe controlled substances pursuant to their Practice Agreement.  In these circumstances, the PA is also required to maintain their own DEA license. 
It is important to note that PAs in the State of Michigan are prohibited from practicing independently without a physician, and nothing contained in Public Act 379 alters such prohibition.  In other words, PAs must still practice with a physician, physician group, or health facility, but they now must do so pursuant to a written Practice Agreement.  While the new law does not remove the prohibition of PAs practicing independently of physicians, it also does not place any additional limitations on the scope of practice of PAs. 
Public Act 379 does not contain a grandfather clause.  Therefore, all PAs are now required to execute a written Practice Agreement with a participating physician in order to legally practice in Michigan. 
The laws, rules, and regulations governing the delivery of healthcare services are constantly changing. Physicians and other healthcare providers need to be keenly aware of the ever-changing regulatory environment in which they operate. Public Act 379 is yet another example of the constant stream of change.  Please contact Howard & Howard healthcare attorneys if you have any questions regarding the requirements of Public Act 379 or its application to your practice.  

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This Advisory is intended for informational purposes only, and is not offered as legal advice.  Please call a qualified attorney for counsel related to your particular situation.