PURPOSE: This rule establishes procedures for individual physician-physician assistant FINANCIAL INSTITUTIONS AND PROFESSIONAL REGISTRATION

teams to renew waiver for alternate minimum amounts of on-site supervision and maximum distance between the supervising physician and physician assistant. (1) A physician-physician assistant team may make application for renewal of a waiver upon forms obtained from the board for a waiver from the minimum on-site 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) A request for renewal of waiver must be submitted to the board office at least sixty (60) days prior to its expiration.

1. (3) Renewal applications must state if any of the following has changed since the initial application for waiver:

   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 the 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.
2. (4) Applications for renewal 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 a renewal application.
3. (5) When the advisory commission receives a renewal application, it will publish notice of the application on the board’s web site 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.
4. (6) The advisory commission and the board will determine whether an individual physician-physician assistant team meets the criteria for a waiver outlined in section 334.735.1(2), RSMo, using the information provided in the renewal 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.
5. (7) The physician must be on-site a minimum of once every two (2) weeks. If the advisory commission and the board approve a request for renewal, the advisory commission and board may establish an alternate minimum amount of time the supervising physician must be on-site while the physician assistant is practicing. The alternate minimum amount of time may be no less than ten percent (10%) of the time that 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 (50) miles.
6. (8) Once the advisory commission and the board approve a request for renewal 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.
7. (9) 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.

8. (10) The Board of Healing Arts may refuse to renew a waiver for the following reasons:

   1. (A) The applicants fail to continue to meet the eligibility requirements pursuant to section 334.735.2, RSMo;
   2. (B) The applicants have previously failed to comply with the requirements of the prior waiver; and/or
   3. (C) A member of the physician-physician assistant team has violated Chapter 334, RSMo.
9. (11) Within thirty (30) days of the board’s refusal to renew a waiver, the physicianphysician assistant team may request a hearing before the board to contest the refusal to renew. After conducting this hearing, the board shall make a finding of fact to either uphold its prior refusal or to issue the waiver.

AUTHORITY: section 334.125, RSMo 2000 and section 334.735, RSMo Supp. 2010.* Original rule filed Oct. 19, 2007, effective May 30, 2008. Amended: Filed May 9, 2008, effective Dec. 30, 2008. 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.