PURPOSE: This rule establishes procedures for individual physician-physician assistant teams to apply for alternate minimum amounts of on-site supervision and maximum distance between the supervising physician and physician assistant.

1. (1) A physician-physician assistant team may make application upon forms obtained from the board for a waiver from the minimum onsite supervision and maximum distance requirements specified in section 334.735.1(8), RSMo. No application will be considered unless fully and completely made out on the specified form and properly attested to by both members of the physician-physician assistant team.

2. (2) Applications must state:

   1. (A) The names, license numbers and telephone numbers of the physician assistant and the supervising physician(s) who make up the physician-physician assistant team;
   2. (B) The specialty of physician assistant and supervising physician(s) who make up the physician-physician assistant team;
   3. (C) The location(s) where the physician assistants will practice and the location(s) of the supervising physician when the physician assistants will be practicing;
   4. (D) How the community or communities served by the supervising physician-physician assistant team would experience reduced access to health care services in the absence of a waiver;
   5. (E) If the practice location is a health professional shortage area;
   6. (F) Whether the clinic is designated as a Federally Qualified Health Center or Rural Health Clinic; and
   7. (G) The amount and type of supervision that will be provided to the physician assistant.
3. (3) Applications for a waiver will be first considered by the advisory commission for physician assistants. The advisory commission will make a recommendation to the board and will receive the board’s advice and consent before approval or denial of an application.
4. (4) When the advisory commission receives a waiver application, it will publish notice of the application on the board’s website and invite public comments. The advisory commission will consider any comments received from members of the public up to fifteen (15) days from the notice in determining whether to recommend approval or denial of the application.
5. (5) The advisory commission and the board will determine whether an individual physician-physician assistant team meets the criteria for a waiver outlined in section 334.735.2, RSMo, using the information provided in the waiver application and the best information available to the board on the availability of health care services in the community or communities served by the physician-physician assistant team. The advisory commission and the board will utilize the most recently available information from the United States Department of Health and Human Services, Health Resources and Services Administration on the extent of health professional shortage areas.
6. (6) If the advisory commission and the board approve a waiver, the advisory commission and board may establish an alternate minimum amount of time the supervising physician must be on-site while the physician assistant practices. The physician must be onsite a minimum of once every two (2) weeks and no less than ten percent (10%) of the time the physician assistant is practicing each calendar quarter. The advisory commission and board may also establish an alternate maximum distance between the supervising physician and physician assistant. The alternate maximum distance may not exceed fifty
7. (50) miles.
8. (7) Once the advisory commission and the board approve a waiver for a physician-physician assistant team, the physician-physician assistant team shall only be required to seek a renewal of the waiver every five (5) years or when they move their primary location more than ten (10) miles from the location shown on the waiver application. If a waiver has been granted by the Board of Healing Arts to 20 CSR 2150-7

a physician-physician assistant team working in a rural health clinic under the federal Rural Health Clinic Services Act, P.L. 95-210, as amended, no additional waiver shall be required, so long as the rural health clinic maintains its status as a rural health clinic under such federal act, and such physician assistant and supervising physician comply with federal supervision requirements.

1. (8) The physician-physician assistant team will notify the advisory commission and board of any changes to the waiver application data within fifteen (15) days of the change.
2. (9) If a member of the physician-physician assistant team changes or if any of the eligibility requirements as stated in section 334.735.2, RSMo, change, then the physician-physician assistant team must request a new waiver.
3. (10) The board may refuse to issue a waiver to a physician-physician assistant team if either applicant has previously violated the terms of a prior waiver granted pursuant to section 334.735.2, RSMo, or violated any section of Chapter 334, RSMo.
4. (11) Within thirty (30) days of the board’s refusal to issue a waiver, the physician-physician assistant team may request a hearing before the board to contest the refusal to issue the waiver. After conducting this hearing, the board shall make a finding of fact to either uphold its prior refusal or to issue the waiver.
5. (12) The Board of Healing Arts may void a current waiver after conducting a hearing and upon a finding of fact that the physicianphysician assistant team has failed to comply with the requirements of the waiver.

AUTHORITY: section 334.125, RSMo 2000 and section 334.735, RSMo Supp. 2010.* Emergency rule filed Oct. 19, 2007, effective Oct. 29, 2007, expired April 25, 2008. Original rule filed Oct. 19, 2007, effective May 30, 2008. Amended: Filed April 3, 2009, effective Sept. 30, 2009. Amended: Filed Nov. 1, 2010, effective June 30, 2011.

*Original authority: 334.125, RSMo 1959, amended 1993, 1995 and 334.735, RSMo 1989, amended 1996, 1997, 1998, 2005, 2007, 2008, 2009, 2010.