Administrative Code

Virginia Administrative Code
6/13/2024

Part IV. Practice Requirements

18VAC85-50-101. Requirements for a practice agreement.

A. Prior to initiation of practice, a physician assistant and one or more patient care team physicians or podiatrists shall enter into a written or electronic practice agreement that spells out the roles and functions of the assistant and is consistent with provisions of § 54.1-2952 of the Code of Virginia.

1. Any such practice agreement shall take into account such factors as the physician assistant's level of competence, the number of patients, the types of illness treated by the physicians or podiatrists, the nature of the treatment, special procedures, and the nature of the physicians' or podiatrists' availability in ensuring direct physician or podiatrist involvement at an early stage and regularly thereafter.

2. The practice agreement shall also provide an evaluation process for the physician assistant's performance, including a requirement specifying the time period, proportionate to the acuity of care and practice setting, within which the physicians or podiatrists shall review the record of services rendered by the physician assistant.

3. The practice agreement may include requirements for periodic site visits by licensees who supervise and direct the patient care team physicians or podiatrists to collaborate and consult with physician assistants who provide services at a location other than where the physicians or podiatrists regularly practice.

B. The board may require information regarding the degree of collaboration and consultation by the patient care team physicians or podiatrists. The board may also require a patient care team physician or podiatrist to document the physician assistant's competence in performing such tasks.

C. If the role of the physician assistant includes prescribing drugs and devices, the written practice agreement shall include those schedules and categories of drugs and devices that are within the scope of practice and proficiency of the patient care team physicians or podiatrists.

D. If the initial practice agreement did not include prescriptive authority, there shall be an addendum to the practice agreement for prescriptive authority.

E. If there are any changes in consultation and collaboration, authorization, or scope of practice, a revised practice agreement shall be entered into at the time of the change.

F. Physician assistants appointed as medical examiners pursuant to § 32.1-282 of the Code of Virginia may practice without a written or electronic practice agreement.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 14, Issue 21, eff. August 5, 1998; amended, Virginia Register Volume 17, Issue 21, eff. August 1, 2001; Volume 19, Issue 18, eff. June 18, 2003; Volume 29, Issue 20, eff. July 3, 2013; Volume 33, Issue 1, eff. October 5, 2016; Volume 34, Issue 25, eff. September 20, 2018; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021; Volume 39, Issue 4, eff. November 9, 2022.

18VAC85-50-110. Responsibilities of the patient care team physician or podiatrist.

A patient care team physician or podiatrist shall:

1. Review the clinical course and treatment plan for any patient who presents for the same acute complaint twice in a single episode of care and has failed to improve as expected. A physician or podiatrist shall be involved with any patient with a continuing illness as noted in the written or electronic practice agreement for the evaluation process.

2. Be available at all times to collaborate and consult with the physician assistant.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from VR465-05-1 § 4.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; Volume 13, Issue 21, eff. August 6, 1997; Volume 19, Issue 18, eff. June 18, 2003; Volume 29, Issue 20, eff. July 3, 2013; Volume 33, Issue 1, eff. October 5, 2016; Volume 33, Issue 19, eff. June 29, 2017; Volume 34, Issue 25, eff. September 20, 2018; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021.

18VAC85-50-115. Responsibilities of the physician assistant.

A. The physician assistant shall not render independent health care and shall:

1. Perform only those medical care services that are within the scope of the practice and proficiency of the patient care team physicians or podiatrists as prescribed in the physician assistant's practice agreement. When a physician assistant is working outside the scope of specialty of the patient care team physicians or podiatrists, then the physician assistant's functions shall be limited to those areas not requiring specialized clinical judgment, unless a separate practice agreement has been executed for an alternate patient care team physician or podiatrist.

2. Prescribe only those drugs and devices as allowed in Part V (18VAC85-50-130 et seq.) of this chapter.

3. Wear during the course of performing his duties identification showing clearly that he is a physician assistant.

B. If, due to illness, vacation, or unexpected absence, a patient care team physician or podiatrist or alternate physician or podiatrist is unable to supervise the activities of his physician assistant, such patient care team physician or podiatrist may temporarily delegate the responsibility to another doctor of medicine, osteopathic medicine, or podiatry.

Temporary coverage may not exceed four weeks unless special permission is granted by the board.

C. With respect to physician assistants employed by institutions, the following additional regulations shall apply:

1. No physician assistant may render care to a patient unless the physician or podiatrist responsible for that patient is available for collaboration and consultation with that physician assistant.

2. Any such practice agreement as described in subdivision 1 of this subsection shall delineate the duties which said patient care team physician or podiatrist authorizes the physician assistant to perform.

D. Practice by a physician assistant in a hospital, including an emergency department, shall be in accordance with § 54.1-2952 of the Code of Virginia.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 13, Issue 21, eff. August 6, 1997; amended, Virginia Register Volume 14, Issue 21, eff. August 5, 1998; Volume 16, Issue 21, eff. August 2, 2000; Volume 18, Issue 21, eff. July 31, 2002; Volume 19, Issue 18, eff. June 18, 2003; Volume 29, Issue 20, eff. July 3, 2013; Volume 29, Issue 25, eff. September 26, 2013; Volume 33, Issue 1, eff. October 5, 2016; Volume 34, Issue 25, eff. September 20, 2018; Volume 35, Issue 23, eff. August 22, 2019; Volume 37, Issue 13, eff. March 16, 2021; Volume 37, Issue 26, eff. September 15, 2021.

18VAC85-50-116. Volunteer restricted license for certain physician assistants.

The issuance of a volunteer restricted license and the practice of a physician assistant under such a license shall be in accordance with the provisions of § 54.1-2951.3 of the Code of Virginia.

Statutory Authority

§§ 54.1-2400 and 54.1-2949 through 54.1-2953 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 14, Issue 21, eff. August 5, 1998.

18VAC85-50-117. Authorization to use fluoroscopy.

A physician assistant working under a practice agreement with a licensed doctor of medicine or osteopathy specializing in the field of radiology or orthopedics is authorized to use fluoroscopy for guidance of diagnostic and therapeutic procedures provided such activity is specified in his protocol and he has met the following qualifications:

1. Completion of at least 40 hours of structured didactic educational instruction and at least 40 hours of supervised clinical experience as set forth in the Fluoroscopy Educational Framework for the Physician Assistant created by the American Academy of Physician Assistants (AAPA) and the American Society of Radiologic Technologists (ASRT); and

2. Successful passage of the American Registry of Radiologic Technologists (ARRT) Fluoroscopy Examination.

Statutory Authority

§ 54.1-2400 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 31, Issue 9, eff. February 13, 2015; amended, Virginia Register Volume 37, Issue 13, eff. March 16, 2021; Volume 39, Issue 4, eff. November 9, 2022.

18VAC85-50-120. (Repealed.)

Historical Notes

Derived from VR465-05-1 § 5.1, eff. February 1, 1989; amended, Virginia Register Volume 6, Issue 20, eff. August 1, 1990; Volume 8, Issue 12, eff. April 8, 1992; Volume 8, Issue 25, eff. October 8, 1992; Volume 10, Issue 9, eff. February 23, 1994; repealed, Virginia Register Volume 13, Issue 21, eff. August 6, 1997.

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