Missouri academy of physician assistants
(MOAPA)

Update from the MOAPA President

September 09, 2013 1:30 PM | Deleted user

As the Labor Day holiday is now behind us, this signals the end of the summer 2013. This seemed like an appropriate time to send out from MOAPA. This is a bit overdue, and I apologize, as the rigors of the summer piled up on me a bit so therefore this update is getting to you a little later than I had planned. Never the less, I will try and bring everyone up to speed on the most current information that impacts the PAs of Missouri.

  1. As of Aug. 28, 2013, our new onsite supervision laws went into effect. The new requirements state that the physician must be present no less than 4 hours for every 14 day that a PA provides patient services. This will basically null and void the previous waivers that some of you may have had on file with the Missouri Board of Healing Arts.
  2. The law that now identifies PAs as Missouri Medicaid providers has in theory gone into effect but the process has hit some bumps in the road. These bumps in the road are part of the reason for the delay in this update as I was hoping to have more information. Here is the latest: The Missouri Medicaid Audit and Compliance (MMAC) department is the department that will be instrumental in setting up the enrollment process. After this law passed, they identified a line in the current PA statute that states “No PA shall bill a patient independently or directly for any services or procedures”, MO.REV 334.735. This was interpreted by MMAC in a way that called into question whether or not legally they could enroll PAs as Medicaid providers. MOAPA has engaged legal counsel who has drafted an opinion that states that there would not be direct billing by a PA to a patient but rather to a third party payer just like what is done with any other insurance claims process. I have spoken directly with the director of MO Medicaid about this and they have been very cooperative but both MO Medicaid and MMAC, two different departments, just want to be absolutely sure that enrolling PAs as providers will not be a violation of the current statute. I have been told they are scheduled to meet within the next few weeks and will review the legal opinion that MOAPA had prepared and review it with their legal counsel and then make a decision. Worst case scenario would be that they hold their ground on this issue which would force MOAPA next legislative session, to have this section of our current PA law removed through new legislation which would kick us back one year. We did not anticipate this as we never interpreted that section of the law like this so it was basically impossible to foresee this. Never a dull moment is there?
  3. Along the same lines as this, many of you have run into difficulties with having prescriptions written by Pas, and NPs too, for Medicaid patients being refused by several pharmacies especially the Walmart pharmacies. I brought this to the attention of the Medicaid director on a conference call several weeks ago and she was unaware of this. This apparently occurred due to the fact that MO Medicaid identifies providers by DEA numbers and when a mid-level writes a prescription and then places their supervising/collaborating physician’s DEA number on the prescription, as previously done, these were being refused for payment reimbursement because the person writing the prescription and the DEA number needed to match. This was supposed to be clarified with the pharmacies but I am not sure that has occurred or been effective. I have recently been notified by some PAs that Walmart pharmacies are still refusing these prescriptions. I have notified the Medicaid director about this and she has asked that I send her names and addresses of pharmacies that are still refusing PA prescriptions. If any of you have names and addresses of pharmacies that are refusing your prescriptions for Medicaid patients, please email the information to paultwin@aol.com and I will forward it to her. Also, I have asked Jorgen Schlemeier, MOAPA's lobbyist, to reach out again to Walmart corporate in Arkansas to try and deal with this at the corporate level since he represents Walmart as well. We will continue to work to clear this up.
  4. On a much more positive note, our Summer CME Conference in Branson went very well this year. We had a brand new group of PAs organizing the event this year and they hit a home run! Great job to Meredith Cunningham, Melanie Chism, Ashley Schnell and Jeff LeClaire! The event was well-attended, there were great topics and speakers, and the display area was just about full. The group was able to identify ways to decrease some of the costs through educational grants and sponsors which helped defray some of the costs and resulted in a more profitable event. This will directly benefit MOAPA and help us continue to do the work that is needed for the PAs of Missouri.
  5. The MOAPA Board is trying to determine the most efficient and cost-effective way to market the PA profession and the new law changes to prospective employers. I think we have all seen the jobs for mid-levels being opened or at least talked about but PAs are not always included in the hiring plans. Is that due to ignorance about the profession? If so, it is our job to take the information to them and push to get our name into those hiring discussions. This will be high on the priority list.

All in all, we have a lot to celebrate as we near the last quarter of 2013. Our ship is on a good course from a legislative and organizational standpoint. As discussed above, we still have some hurdles to jump and places where we can improve and progress. Be sure to still take time to celebrate the accomplishments of not only 2013 but the progress that we have made as a profession over the past 5-6 years. For myself and the rest of the board, complacency is not on our agenda and we will continue to move things forward and address the needed issues that impact the PAs of Missouri. We cannot know all of the challenges that you may face so please be a part of the progress of our profession and organization and help the board identify things that need to be addressed, clarified or changed. I guarantee your ideas or questions will be considered, addressed and followed up on but we need to know what they are. Please do not sit on the side lines or your questions to go unanswered. We are available to you, the membership, so reach out.

Our requests of you from the board are consistent. One, we MUST improve our membership numbers. That is how we survive as an organization as well as how we most effectively get information to the PAs in Missouri. Being a member is not enough; you must address this directly with your colleagues, friends and classmates and start the dialogue about where we have been and where we are and how that happened. It happened by having a living, breathing active state chapter. That chapter needs resources to survive and that is where membership is vital to the survival of MOAPA. If there is ever a question of where your membership dollars go, please contact me directly and I will be glad to review what it takes to keep MOAPA running financially. 

In addition to membership, stay alert to what is happening in the Missouri PA world. We will always try to keep everyone up to date on the latest developments that affect PAs and will specifically inform you of direct actions we may need from you so be sure to read the information we send out. We try to not flood your world with “soft” information and instead spread information out so that you know the message we send will have direct and timely information. 

We always need to keep our PAC account funded for assistance with our ongoing legislative goals, so again, we ask every PA to donate $100 per year to the PAC fund. This can be done directly on the website. Please carefully consider donating whatever you are able. 

Lastly, please take an interest in your work place. Get involved in committees at your job and help with ideas that may not be PA related but just global hospital/clinic initiatives. We as PAs need to be part of those processes to make sure that we are part of the decision making processes in our institutions. Tat takes some sacrifice or time and energy but if we don’t, other professional groups will, and that will continue to keep us on the outside looking it. So, take time to represent your profession to the best of YOUR ability.

Sorry for the lengthiness of this update but I just felt this was important information that needed to be shared. As always, if you have any questions or comments about the above information do not hesitate to contact me directly either by email or phone at 314-374-8033. Remember to send me any contact information of pharmacies that are refusing your prescriptions and I will forward that information. Lastly, our next Board of Directors meeting is scheduled for Saturday, Nov. 9, 2013 at 10 a.m. The meeting will be held at Missouri Baptist Medical Center in St Louis. Everyone is welcome to attend. Thanks for reading and for your hard work in the name of the profession.

Paul Winter
MOAPA President
paultwin@aol.com
314-374-8033

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