California Temporarily Waives Certain Supervision Requirements for PAs, NPs, and CNMs
Since March 31, under the authority granted by California Governor Newsom’s March 30 Executive Order, DCA has been issuing waivers for certain healthcare professional licensing requirements. On April 14, DCA issued three additional waivers, this time adjusting supervision requirements for Physician Assistants (PAs), Nurse Practitioners (NPs), and Certified Nurse-Midwives (CNMs), enabling them to step in when they are needed most urgently, while still operating within their scope of practice. California PAs, NPs, and CNMs, as well as their supervising physicians and the healthcare facilities where they practice, should review the waivers to understand the flexibility in supervision they offer, as COVID-19 rapidly changes the situation on the ground.
Waiver of PA Supervision Requirements & Guidance
DCA’s Order Waiving Physician Assistant Supervision Requirements does the following:
- Provides that Business and Professions Code (B&P Code) Sections 3502(a)(1), (3), and (4) requirements that PAs be supervised, competent, and have the necessary education, training and experience in order to provide medical services are still in place and not affected by the order.
- Waives the limitation, under B&P Code Section 3516(b), that a supervising physician may supervise only up to four PAs at one time.
- Waives the requirement that a practice agreement or delegation of services agreement be in place, but only when the COVID-19 response leads to either of the following circumstances: (1) the PA “moves to another practice site or organized health care system” and does not have a practice agreement in place there; or (2) there is no supervising physician who has a practice agreement with the PA available to supervise. However, with regard to ordering or furnishing schedule II and III controlled substances, this waiver applies only when the PA orders or furnishes schedule II and III controlled substances in accordance with a patient-specific order approved by the treating or supervising physician.
DCA issued a guidance memorandum alongside the waiver, which clarifies that for PAs who do not change practice sites or supervisors, the existing statutory requirements for practice agreements and ordering and dispensing drugs remain unchanged. The guidance memorandum also suggests that the limitation on how many PAs a physician can supervise is likewise dependent on the PA changing practice sites or there being no supervising physician with a practice agreement with the PA available to supervise; however, the waiver itself does not include such a limitation. Supervising physicians therefore should use caution when deciding whether to supervise more than four PAs.
Waiver of NP and CNM Supervision Requirements
In the Order Waiving Nurse Practitioner Supervision Requirements, the DCA waives the limitation under B&P Code Section 2836.1(e) that a supervising physician may supervise, at any one time, only up to four NPs who are furnishing or ordering drugs or devices. Similarly, the Order Waiving Nurse-Midwife Supervision Requirements also waives the limitation under B&P Code Section 2746.51(a)(4) that a supervising physician may supervise, at any one time, only up to four CNMs who are furnishing or ordering drugs or devices.
The Waivers Do Not Change Scopes of Practice
Healthcare facilities and professionals should keep in mind that the waivers do not change the scopes of practice for PAs, NPs, or CNMs, and are only temporary adjustments to their supervision requirements. For the time being, the waivers are only effective for 60 days, unless they are extended further.