Check filing requirements when retaining PAs, NPs

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Many physicians employing mid-level health care professionals, such as nurse practitioners and physician assistants, are unaware that their state might have mandatory filing requirements for the supervising physician or the mid-levels.

Failure to comply with those requirements could result in monetary fines, license revocation and suspension, and/or criminal charges, depending on the state in which you practice.

Here are examples of the reporting requirements for supervising physicians and mid-level providers in Illinois, Ohio and Wisconsin. They are indicative of the rules you will have to follow in your own state. While many of the rules are similar, it is easy to get tripped up in the subtleties and paperwork.

In Illinois, physician assistants may not perform any medical procedure or other task delegated by a supervising physician until notice of supervision is received and acknowledged by the state's Dept. of Professional Regulation. The state provides a form that must be completed by the supervising physician and signed by both the physician and the physician assistant.

If a PA practices without providing a written notice of supervision to the department, there may be consequences for both the physician and the PA. The department "may refuse to issue or renew, or may revoke, suspend, place on probation, censure or reprimand, or take other disciplinary or non-disciplinary action ... including the issuance of fines not to exceed $10,000 for each violation."

The filing requirements under Illinois law for nurse practitioners vary depending on the nurse's designation.

For advanced-practice nurses, a written collaborative agreement is not required to be submitted to the department. However, it must nevertheless be available upon the department's request. Moreover, a written collaborative agreement is mandatory for advanced-practice nurses engaged in clinical practice, but it is not necessary for those authorized to practice in a hospital or ambulatory surgical treatment center.

Illinois law specifies provisions that must be included in the collaborative agreement.

If a party fails to produce a written collaborative agreement within 60 days of the department's request or has exceeded the agreement's terms, "[t]he Department may refuse to issue or to renew, or may revoke, suspend, place on probation, reprimand, or take other disciplinary or non-disciplinary action ... including fines not to exceed $10,000 per violation."

For licensed practical nurses and registered nurses, Illinois does not require any notice supervision filings with the state, nor a written collaborative agreement.

In Ohio, supervising physicians and physician assistants must have a supervision agreement approved by the state's medical board. The board requires that every physician who wishes to supervise a physician assistant submit a "Physician Assistant Supervision Agreement Application," regardless of whether the physician assistant will be utilized in an office setting or a health care facility. The board provides a form that must be signed by both the supervising physician and the physician assistant.

Failure to have an approved supervision agreement on file with the board may result in undesirable consequences for both the physician and the physician assistant.

If a PA does not have an approved supervision agreement on file with the board, the penalties are similar to those in Illinois: the possibility of limiting, revoking or suspending a physician's license to practice. Ohio law spells out that on the first failure, a physician "is guilty of a misdemeanor of the first degree ... on each subsequent offense, [the physician] is guilty of a felony of the fourth degree."

Although Ohio does not require submission of a supervision agreement, it does require that a written standard care arrangement be retained on file at each site where the nurse practitioner practices.

A certified nurse practitioner in Ohio may only practice in accordance with a standard care arrangement entered into with each physician with whom the nurse collaborates. There is no state-provided form to complete, but the written arrangement must include specific criteria described in the statute.

The written arrangement does not need to be approved by the Ohio Board of Nursing, but the board reserves the right to review it periodically for compliance.

Wisconsin does not require that a written notice of supervision be submitted to the state, but it does require that notice of any change in the supervising physician be filed with the Wisconsin Dept. of Regulation & Licensing.

In Wisconsin, a physician assistant's initial supervising physician is stated on his or her license, and only when there has been a change in the supervising physician is a submission to the state required.

Failure to comply with this requirement may result in the revocation or suspension of the physician assistant's license.

The filing requirements under Wisconsin law for nurse practitioners vary depending on the nurse's designation. According to Wisconsin law, an advanced-practice nurse prescriber is an advanced-practice nurse who has been granted a certificate to issue prescription orders. These nurses shall work in collaboration with a supervising physician and this relationship must be documented.

For licensed practical nurses and registered nurses, Wisconsin does not require notice of supervision reporting to the state.

If you employ or are seeking to hire mid-level health care professionals, you are encouraged to consult with legal counsel to determine whether you are in compliance with your state's filing requirements.

Harris, a partner at McDonald Hopkins, formerly Harris Kessler & Goldstein, in Chicago, concentrates on health care law and has counseled physicians, physician networks and health care groups nationally. The author and publisher are not rendering professional advice and assume no liability in connection with its use. He can be reached at 312-280-0111, or by e-mail (sharris@mcdonaldhopkins.com).

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