Bill Name: House Bill 2041 (HB 2041)

Primary Sponsor: Representatives Marcus Riccelli and Joe Schmick

Status: 3/13/2024 Signed by Governor into law, becomes effective 1/1/2025

AmSpa’s Take: Reducing the amount of regulation and paperwork with which advanced practitioners such as physician assistants (PAs) and nurse practitioners (NPs) need to comply to practice frees up time and resources that can be better spent seeing patients, improving their skills and developing their practices.

Outlook: This bill is in the first steps of the process. However, a similar bill was introduced last session and failed to advance out of committee.

Analysis: Currently, Washington physician assistants (PAs) practice under the supervision of a physician who delegates the health care tasks that the PA may perform. The relationship is formalized using a supervision agreement, which lays out what is authorized. Under HB 2041, PAs would instead work under collaboration with a physician. Representative Riccelli introduced a similar bill last session known as HB 1310, which we discussed here.

This new collaborative relationship, like the supervisory one, requires a written agreement between the physician and PA. In fact, the provisions of these agreements are largely similar to the current requirements, with some changes. The physician must:

1. List the duties and responsibilities of the PA and physician;
2. Create a process for communication and decision-making;
3. Designate an alternate physician if there is only one participating physician;
4. Retain the signatures of both the PA and physician;
5. Create a termination provision;
6. Obtain an attestation of the number of clinical hours the PA has completed; and
7. Determine if the PA requires supervision.

HB 2041 adds a requirement that PAs with fewer than 4,000 hours of clinical experiences or fewer than 2,000 hours in their chosen specialty would need to practice in supervision with a physician. Changing specialties would require the PA to perform another period of 2,000 supervised hours in the new specialty. This supervision—the same as the current situation—would not require the physical presence of the physician. The PA must practice within the scope of expertise of the collaborating or supervising physician. However, when the PA is practicing in a rural or underserved area, they may continue to practice in the specialty, even if it exceeds the scope of practice of the collaborating physician, once they achieve 10 years or 20,000 hours of experience in a specialty.

The greatest change that HB 2041 makes is in the definition of “collaboration,” which is characterized as involving interaction, consultation or referral to a physician or other appropriate health care member as indicated by the patient’s condition. Collaboration does not assign supervisory or legal responsibility to the PA. Additionally, PAs would be specifically permitted to own their own practice. The provisions of HB 2041, if passed, would become effective on July 1, 2025. However, PAs could continue to practice under their existing agreements up until the date of their next license renewal.

The majority of states allow NPs to practice independently. More recently, many states have given more freedom and autonomy to PAs, as well. HB 2041 is squarely within this trend. If you would like additional information, to read the language of the bill or to contact the sponsors or committee, you can find the information you need through this link.