Below is the report Terry Carlise from a recent meeting he attended on our behalf updating all of us on the the process related to the passage of HB618 authorizing PAs to be able to sign death certificates. Please read this and as always, reach out to us with any questions you might have regarding this. Thank you Terry for representing us on this committee.
An update in regards to HB 618 that was recently in acted which gives PAs the authority to pronounce death and certify a death ( sign a death certificate) from natural cause.
Last week the Department of Health and Senior Services Division of Community and Public Health Bureau of Vital records had a quality improvement work group in Jeff City dealing with in proving the death certificate issue, MOevr- Missouri Electronic vital records. The electronic death certificate has had multiple problems with the states in regards to difficult to use ,not users friendly etc... they are trying to fix that and with the new legislation passed now was a perfect time for them to tackle this. The groups invited were the MDs. DO. APRN, PAs, coroners, medical examiners, funeral directors, and embalmers. I was there as the PA representative and they were very glad to have the PAs at the table in discussing this issue. Currently the electronic medical record does not have a" box" for PA but they are working on to correct this missing information. There are still 3 ways in MO to do a death certificate 1) all electronic 2) started by funeral home electronic then finished as paper document . 3) all paper document. I was told by the Chief of the Bureau of vital records (Michelle Zeilman) that they will recognize a PA signature on the form even though the paper forms and electronic media have not been updated that took effect September 26, 2015. Some PAs will need to make sure that their credentials in certain hospitals or healthcare systems need to reflect this additional authority although some may not require this. This is a work in progress and with the new changes the Vital Records division would like to meet with the PAs at different times and set up a work shop on how to sign in to MOEVR,fill out the forms etc.
I have to say one of the biggest supports the PAs had during this and still is the MO Funeral Home Directors ,they made a point of coming over and talking to me telling me how they want to work with the PAs to make this system work the best we can in getting a death certificate to the families for business, banking etc.
Listed below are the current contacts for this process:
Michelle Zeilman Bureau Chief Michelle.Zeilman@health.mo.gov 573-526-0348
Neelie Churchill Deputy state registrar Neelie.Churchill@health.mo.gov 573-526-1511
As promised, I was able to obtain a bit more information regarding the DEA and the issue with PAs prescribing hydrocodone. This information is coming directly from the Missouri BNDD who has been in contact with the DEA about this issue. Here is what I received:
All the mid-level practitioners in Missouri are having the same issue with this. They are all waiting on the DEA.
I called our Mid-West regional DEA guy and asked him.
Here is what he said:
1. Missouri copied the DEA on all the laws as they passed;
2. Missouri updated their laws and rules and have made the change;
3. The DEA has received our documentation and they are preparing to make the same adjustments….BUT
4. They are waiting on approval from their DEA attorneys. Once the DEA legal department approves everything, then DEA will make the amendments.
The hold up is the DEA registrations department is waiting on the DEA legal department.
So the time frame of when this will be resolved appears to still be unknown but we will continue to monitor this and update all of you when more information becomes available. I know this is frustrating, but we will just have to be patient for a while longer.
Legislative Update: HB 618
September 21, 2015
Click here to access the entire voting record from the recent Veto override session. Please look at both the House Of Rep as well as the Senate and identify your legislators and if they voted in favor of the override, please drop them a brief thank you email for their support. And if they voted against this, consider also emailing them and just reminding them that you are a PA in their district and you are disappointed that they did not support our efforts with this veto override and ask them if they have any questions about your profession that we can answer that would make them feel more comfortable supporting our efforts in the future.
It is important that you inform them that you are an involved, voting member of their district and PA issues are very important to you. This kind of dialogue with your legislators, whether it be a thank you or a note expressing your disappointment, either way it is the on going dialogue that will be vital for future efforts.
Legislative Update: HB 618
August 14, 2015
1) The bill that will grant PAs the authority to prescribe hydrocodone was signed into law and will become effective August 28, 2015. I have reached out to the BNDD regarding what the process will be for us once this law goes into effect and below is the response I received:
Here are the steps we will be going through:
1. Gov signed the bill into law;
2. The law will go into effect on August 28, 2015;
3. At that time, mid-levels will have C2 authority;
4. Those already registered, can fax or email, or mail a request to BNDD to have Schedule 2 added to their existing registrations. BNDD will amend and update a registration for no fee.
5. Those who will be re-applying, will have a Schedule 2 box to check on their applications.
Between now and August……BNDD will be working on two things:
1. Updating our paper application to add the Schedule 2 box; and
2. Working with OA-ITSD to have them update our online application by adding a Schedule 2 box.
Once practitioners have updated their Missouri BNDD registration to show schedule 2…..they can go to the DEA website and make a similar request to update their DEA certificate.
Michael R. Boeger, Administrator
Missouri Bureau of Narcotics and Dangerous Drugs
P.O. Box 570
For any specific question(s) you may have about this process that do not seem clear on what they have provided, I would recommend contacting the MO BNDD directly for any clarification you might require.
2) We have also received an update regarding the MO Medicaid enrollment process for PAs of MO. Here is the language that was most recently sent to me:
The MO HealthNet Division (MHD) is in the process of adding a new Physician Assistant provider type to allow PAs to independently enroll and submit claims for service reimbursement. This change is targeted for implementation in August 2015. A provider information bulletin will be released in advance so providers may begin enrolling.
3) As we reported several weeks ago, Governor Nixon vetoed HB618 which contained language giving PAs authority to declare death and sign death certificates. Jorgen has been discussing this issue with the sponsors of the bill as well as other groups who were supporting this bill in hopes that there would be interest from these people and groups to pursue overriding his veto. Therefore, it is time to call the troops into action. We are asking every PA to contact their state representative and state senator and ask them to support the veto override on HB618. We will place some talking points for you to use in the members only section. Don’t feel the need to be bogged down with too many details as the legislators will not ask you pointed detailed questions if you speak with them or in an email response. If you are asked anything that you are unsure of the answer, just tell them that you are not sure but you will find out and get back in contact with them and provide whatever answers they need. Then contact me or your local DAL and we will help you find the answers they are looking for from you. Feel free to ask your physicians, patients, families or whoever is willing to contact their legislators as well with the same request. If you are unsure who your state legislators currently are, there is a link on our website that will provide that info but have your 9 digit zip code with you as that will be needed. The veto session will be held in September so do not procrastinate with reaching out to these legislators! Remember, we need a 2/3 majority to override a veto so this is by no means a lay-up.