Missouri academy of physician assistants

President's Corner

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  • November 01, 2011 2:10 PM | Deleted user

    The St. Louis Beacon online news posted this article featuring some of our very own MOAPA members - including President Paul Winter - on how PAs are set to help cure the doctor shortage.  Click the link to read more.


  • October 27, 2011 2:27 PM | Deleted user

    From: Paul Winter

    Update on PA Controlled Prescribing Authority

    October 26, 2011
    Dear Missouri PA,

    After waiting nearly 3 years, Physician Assistants in Missouri will be able to
    prescribe certain controlled substances. As promised, the Missouri Academy of
    Physician Assistants is here to guide PAs through the process to obtain the
    necessary credentials for prescribing certain controlled substances.

    As you remember, the Missouri Academy of Physician Assistants worked with
    lawmakers in 2009 to pass legislation allowing physicians to delegate Schedule
    III-V controlled substance prescriptive authority.  While the bill has been in
    effect for nearly 3 years, PAs haven’t been able to prescribe these medications
    due to “implementation lag.”  That is soon coming to an end.

    MOAPA leaders have been in contact with the Missouri Board of Healing Arts and
    the Bureau of Narcotics and Dangerous Drugs, the two agencies responsible for
    implementing the new law.  We have received the following timeline:

    •         November 1, 2011: The MO Board of Healing Arts will open its
    registration system for PAs who wish to obtain a Certificate to Prescribe.
    •         December 1, 2011: PAs who have obtained a Certificate to Prescribe may
    apply to the BNDD for a state controlled substance registration.

    Keep in mind that there is one final step before PAs may prescribe controlled
    substances, and that is to obtain a Mid-Level Practitioner Registration from the
    Federal Drug Enforcement Registration.  However, the first two steps must be
    completed before a PA can take this last step.

    The Board of Healing Arts will send out an application for PA’s to obtain a
    certificate to prescribe.  While you are not required to file this information
    with the board, make sure that you’ve modified your supervision agreement to
    note your supervising physician’s permission to prescribe Schedules III-V
    controlled medications, and any restrictions the physician places on you
    prescribing such scheduled drugs.

    MOAPA will send out another alert before December 1 with more information.  In
    the meantime, if you have additional questions, please contact me at
    paultwin@aol.com<mailto:paultwin@aol.com> for more information.

    Thanks again for your continued patience during this long implementation stage. 
    We are almost there!

    Paul Winter, PA-C
    MOAPA President

  • August 25, 2011 1:00 PM | Deleted user

    Dear PA Colleague:

    The Missouri Academy of Physician Assistants is the only organization representing all physician assistants in Missouri.  One of MOAPA’s top priorities is to advocate for improvements in state laws and regulations so that PAs can maximally provide, quality, accessible patient care in physician-directed teams.

    Being heard above the noise in Jeff City isn’t easy, and MOAPA needs your help.  As President of MOAPA I’d like to invite you to raise your voice and join MOAPA. If you are already a member, we’d like to thank you for your membership, and ask for your help in recruiting your PA colleagues who aren’t members to join MOAPA.

    If you aren’t yet a member, please join us.  Becoming an MOAPA member is easy.   Click here to join online, or call MOAPA at 800-863-1207 for more information.

    MOAPA members already know that MOAPA is constantly at work, vigorously advocating on behalf of the PA profession.  In the last six years, MOAPA’s leaders and lobbying team worked with state lawmakers to:

    ·        Pass legislation  to decrease onsight supervision from 100% to 66%, as well as put in place a waiver system to apply for supervision less than 66% in select practice settings

    ·        Clarified the supervision requirement to assure that the on-site supervision requirement was measured quarterly and not weekly

    ·        Pass legislation to allow PAs to order physical therapy

    ·        Pass legislation to allow Pas to order handicapped license placards

    ·        Pass legislation eliminating the need for physician-PA teams practicing in federally qualified health clinics to renew a waiver from on-site requirements, and amended the law to prohibit the Board of Healing Arts from imposing an on-site requirement for FQHCs that is higher than the federal supervision requirements.

    ·        Pass legislation to allow physicians to delegate to PAs the prescribing of Schedule III-V controlled substances.

    During the same timeframe, MOAPA and its lobbying team worked with state regulators to make the following positive changes to regulations affecting PA practice.  These include:

    ·         Changing Missouri Medicaid Policy to allow reimbursement for inpatient services PAs provide 

    ·         Amending Missouri Board of Healing Arts regulations to allow PAs to obtain a state license prior to securing a supervising physician.

    ·         Working with the Board of Healing Arts and the Bureau of Narcotics and Dangerous Drugs to implement the law to allow PAs to prescribe controlled medications. 

    MOAPA is also hard at work to be more responsive to its members.  Over time, it has changed membership procedures to allow “rolling membership”, which gives members a full year of membership regardless of what month they join/renew.  MOAPA has also changed its management organization, choosing an organization experienced in managing PA chapters, with a focus on excellent customer service.  Our new and improved and improved website is more user friendly, allowing frequent updates.  Plans also include adding a “members only” section.  If there is something you think MOAPA should be doing and we are not, please send me a message and let me know.

    But we’re not done yet, and that’s where we need your help.  There are still barriers in state laws that prevent physician-PA teams from providing a full range of patient care.  MOAPA’s long-term advocacy goals include:

    ·         Modernizing the PA practice laws, with an emphasis on removing on-site and distance requirements

    ·         Removing regulations which require physicians to sign off on a percentage of PA charts

    ·         Allowing PAs to enroll as Medicaid providers

    ·         Educating physician organizations and other key groups on how modern physician-PA teams practice.

    We cannot get this done without your help.  If you are already a member, please be prepared to respond to requests for assistance in the coming year.  If you are not yet a member, don’t forget to join today.  Remember, if we are not at the table, we are on the menu!

    Join me in being an advocate for your patients and for your profession.  Get involved today!


    Paul Winter, PA-C

    MOAPA President

    This alert is being sent to you via the AAPA Legislative Action Center at the request of your state chapter.

    MOAPA and AAPA: Partners in Advocacy



  • January 28, 2011 2:53 PM | Deleted user

    Below you will find an article that was sent to all of us in the AAPA  PA Advocate email newsletter. One of the articles included in this issue was regarding the ability for PAs to provide hospice services. Currently, PAs are barred from providing these services even if state law allows it. This is a federal issue that the AAPA is working to change. I was also contacted by one of our Missouri PA colleagues who informed me that her job has been directly impacted by this issue.

    I am urging all PAs from Missouri to contact their United States Representative and Senators and urge them to support changing this law. Below is the actual article from the PA Advocate.  At the bottom is a link that will have a sample letter attached and all you have to do is include your contact information, click send, and it is directly sent to your Representative and Senators. Please act on this today as we are singled out on the current law but other midlevels are able to provide these services so we need to continue to work to "level the playing field".

    As always, I thank you for your action with this important issue and ask that you please pass this information along to your colleagues, friends, families and practices to help promote and progress our profession.

    Paul Winter
    MOAPA President

    January 28, 2011

    Take Action 


    Action Alert: Allowing PAs to Provide Hospice Care for Medicare Patients
    Contact Legislators Today

    The 112th Congress is now well underway.  Hopefully you’ve had the opportunity to reach out and connect with your new and returning Members.  It is now time to begin laying the foundation for action on our priority issues.  

    All PAs are urged to contact Senators and Representatives and urge them to make changes to Medicare to allow PAs to provide hospice services to Medicare patients.  Currently, PAs are barred from providing hospice care to beneficiaries, even though it is allowed by state law.  Language to correct this was included in early committee-passed versions of health care reform last year, but was removed prior to final passage by Congress.  The inability of PAs to provide hospice care for their terminally ill Medicare patients places an unconscionable burden on the patient to find alternative care and denies patients access to their "medical home" at a time when they are the most vulnerable.
    Please contact your legislators and tell them of the critical need for PAs in hospice medicine.  Ask them to make this technical correction to Medicare this year.


    In 1997, the 105th Congress passed the Balanced Budget Act (BBA). The BBA made it clear that medical services provided by PAs, as allowed by state law, are covered by Medicare in all settings at one uniform rate.

    Unfortunately, the former Health Care Financing Administration (now the Centers for Medicare and Medicaid Services) decided that the BBA’s Medicare provisions regarding coverage of services provided by PAs did not apply to hospice care. As a result, PAs are not permitted to provide hospice care to beneficiaries who elect the hospice benefit. It makes no sense that Medicare beneficiaries who routinely receive full-spectrum medical care from a PA and who elect to receive the hospice benefit are not able to receive hospice care provided by their PA.  

    Allowing PAs to provide hospice care does not change the PA/physician relationship, nor does it increase cost (as PAs are reimbursed at 85% under Medicare).  What it does do is increase patients' access to care, and improve continuity of care, especially in medically underserved areas.

    Without this technical fix, beneficiaries will continue to face delays and denial of medically necessary care covered by Medicare.  Please contact your legislators today and urge them to take action this year.  (THIS LINK WILL TAKE YOU TO THE AAPA WEBSITE FOR AN EASY-TO-USE EMAIL LETTER)

    Thank you for your advocacy in action!

  • January 17, 2011 2:46 PM | Deleted user

    Dear fellow physician assistants:

    As most of you know, we were successful in passing controlled substance legislation over a year ago.  Following the passage of the legislation, we navigated through the process of promulgating Administrative Rules and Regulations to implement the law. The final component needed for this to become a reality was financing for a new computer system for the Board of Narcotics and Dangerous Drugs to allow them to process our prescriptions.

    I am happy to announce that just today I learned that funding has been allocated to complete the system project!  We have cleared the final hurdle, and in the near future PAs will be able to prescribe controlled substances, per the law that was passed.  I do not have a specific date yet, but was told this should be operational by September  2011.  We will send out additional information as it becomes available. 

    This is an exciting time for the PAs of Missouri as we close in on this goal. Thank you for your patience and support. 

    Paul Winter
    MOAPA President

  • July 14, 2010 2:44 PM | Deleted user

    Both of the bills that contained PA language were signed into law by Governor Jay Nixon. These included HB 2226 which changed our prescriptive language to provide better clarity to our prescribing laws which should help clear the path for our controlled substance law to navigate through the rules and regulations process. 

    The other bill was SB 754 which will give PAs the authority to authorize handicapped license plates and placards. The details of when this will actually take affect with be communicated as the information becomes available.

    This is great news and shows continued progress for the PA profession in Missouri and our ability to deliver care to the citizens that we serve. Thanks for all of your help with this organization and with the legislative process.

    Paul Winter
    MOAPA President

  • June 09, 2010 7:47 PM | Deleted user

    June 2, 2010

    Another Successful Legislative Session!!

    Great news from the legislative front. Both pieces of legislation introduced by MOAPA successfully passed through the Missouri Legislature and are now onto Gov. Nixon for his signature.

    HB2226 was a bill that included language that changed our original prescriptive language to say that "PAs shall not prescribe, nor dispense any drug, medicine or therapy unless pursuant to a physician supervision agreement in accordance to the law". This replaced the original language that stated basically that PAs shall not prescribe without independent consultation with the supervising physician. The latter language was being questioned to say that we should be directly consulting with your supervising physician before you write any prescription even non controlled. Therefore, this new language helps clarify this point and this was also a request from the state BNDD in order to help facilitate the process of enacting our controlled substance law which was passed last session.

    Another part of this bill also dealt with the waiver process as well as off site supervision for rural health clinics. This new bill states that renewal waivers that have been granted on or after August 28,2009 for PAs working in a rural health clinic under the Federal Rural Health Services Act, P.L. 95-210 will not be needed as long as the clinic maintains its designation as a rural health clinic and all other rules have been followed. Also, it is spelled out in the bill that the supervision requirements will follow the minimum federal law regarding physician onsite supervision. This is a physician has to be present no less than 10 percent of the clinic working hours.

    The other bill that successfully passed was SB754. This bill designates PAs as having the authority to authorize handicapped license plates and placards which was previously prohibited.

    Again please know that these bills are now off to Gov Nixon for signature so they are not laws yet. After his signature, they will go into effect August 28,2010. As mentioned earlier this will hopefully help facilitate the process of getting our controlled substance legislation in action. I do not have a time frame on exactly how long this process will take but I will certainly pass along information as it is available. I encourage you to use the legislative links to read the full texts of these bills for your own information and education.

    The legislative success this year was just another example of the outstanding work that is done for us from Jorgen Schleimeier, our lobbyist. He really went to the mat for us this year and got both of our bills passed on the last day of session as it looked like other political issues were going to close us out but he was able to work his magic. If any of you get a chance to meet Jorgen in Branson, please take a moment to thank him personally for the work he has done for us. We have been making steady progress in this state and a lot of that is due to his work.

    Thanks for reading!
    Paul Winter
    MOAPA President

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