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Practice Agreement

 

As a benefit of CAPA membership, CAPA has prepared sample Practice Agreements. There are different sample agreements for those PAs holding a certificate of completion of an approved Controlled Substances Education Course and those who don't. Holding a certificate of completion of an approved Controlled Substances Education Course enables the Practice Agreement to authorize furnishing and ordering of schedule II medications. Further options exist for those who provide only outpatient care and those who at times provide care within a general acute care hospital. As of January 1, 2020, California law requires every practicing PA to enter into a Practice Agreement. A Practice Agreement is a written document, developed through collaboration among one or more physicians and surgeons at the practice and one or more PAs, that defines the medical services the PAs are authorized to perform in that particular practice. The Practice Agreement must be signed by the PA and one or more physicians, or a physician who is authorized to approve the Practice Agreement on behalf of the staff of the physicians of an organized health care system. *

 

A Practice Agreement is not simply a renamed version of the former Delegation of Services Agreement (DSA). The documents are quite different.  New to California as of January 1, 2020, the medical services that a PA may provide will be determined at the practice level with physician supervision, based on a Practice Agreement and an individual PA’s competency, education, training, and experience. Factors at the practice level, such as facility credentialing/privileging, malpractice coverage, the standard of care, etc. may further define those medical services a PA may provide. No longer is the section of regulations entitled: Medical Services Performable limiting, and no longer are the medical services you provide “delegated.”** It is no longer necessary to couple the services you are competent and capable to provide with one particular supervising physician. Your Practice Agreement is literally an agreement “with the practice.”

A single Practice Agreement can cover each and every PA providing professional medical services in the practice who signs the Practice Agreement. Alternatively, the practice may choose to have separate and unique Practice Agreements for different PAs or segments of PAs within the practice based on their education, training, experience, and competency.

The components of the Practice Agreement are defined in the PA Practice Act (Business and Professions Code § 3500).

Important note: The Practice Agreement may be signed by a physician who is authorized on behalf of the physicians on the staff of the organized health care system. The signing physician may or may not also be a supervising physician. Unless a physician signing the Practice Agreement is also a supervising physician, they would not be responsible for the medical services provided by the PA. A supervising physician is responsible for the medical services provided by a PA only during the time when actually serving in their role as a supervising physician.  

Important note: If a practice is not administratively prepared for a Practice Agreement on January 1, 2020, a DSA established and signed by the PA and physician supervisor prior to December 31, 2019, will satisfy the requirement. New hires to practice after January 1, 2020, must have a Practice Agreement in place.

 

*“Organized health care system” includes a licensed clinic as described in Chapter 1 (commencing with Section 1200) of Division 2 of the Health and Safety Code, an outpatient setting as described in Chapter 1.3 (commencing with Section 1248) of Division 2 of the Health and Safety Code, a health facility as described in Chapter 2 (commencing with Section 1250) of Division 2 of the Health and Safety Code, a county medical facility as described in Chapter 2.5 (commencing with Section 1440) of Division 2 of the Health and Safety Code, an accountable care organization, a home health agency, a physician’s office, a professional medical corporation, a medical partnership, a medical foundation, and any other entity that lawfully provides medical services and is in compliance with Article 18 (commencing with Section 2400) of Chapter 5. (Business and Professions Code §3501(j).

**Although not required, a Practice Agreement may designate a PA as an agent of the supervising physician and the PA would be limited to delegated medical services.

***The information and sample documents on this website are being provided for general informational purposes only and is not legal advice or a substitute for legal counsel. Given that the medical services performed by PAs can vary greatly from practice to practice, the reader should contact their attorney to obtain legal advice tailored to their specific circumstances.