Alaska: Advanced Practice Provider Laws and Regulations

Published on: March 13, 2020

Physician Assistants

Qualifications [12 AAC 40.400]: Graduate accredited PA program; current NCCPA certificate.

MD Supervision of Physician Assistant:

Collaborative Plan as defined in 12 AAC 40.410(a)-(j), in part:

• PA may not practice without at least one collaborative relationship that is documented by a plan on a form provided by the medical board. Must include: Name, license number and specialty of primary supervising physician, at least one alternate collaborative physician, beginning date of employment, physical location of practice, compliance with 12 AAC 40.415 as it pertains to a remote location, and prescriptive authority granted by collaborating physician under the collaborative plan.
• Collaborative plan must be filed with the medical board within 14 days after the effective date of the plan or within 14 days after the effective date of any change in the plain.
• Any change to the plan automatically suspends a licensed PA’s authority to practice under the plan, unless the change is to replace the primary collaborating physician with an existing alternate collaborating physician. Changes must be reported to the board.
• Copy of the plan must be kept in the place of employment and must be available for inspection by the public.
• The physician who wishes to establish a collaborative relationship with a PA must hold a current, active and unrestricted license to practice medicine in AK and must be in an “active” (at least 200 hours each year of direct patient contact) practice.
• The primary collaborating physician is responsible for ensuring that the PA complies with state and federal inventory and record keeping requirements. The collaborating physician shall maintain in his/her records a copy of each DEA Form 222 from each PA with whom the physician has a collaborative relationship.

Remote practice location [ 12 AAC 40.415]:

• To qualify to practice in a remote practice location, a physician assistant with less than two years of full-time clinical experience must work 160 hours in direct patient care under the direct and immediate supervision of the collaborating physician or alternate collaborating physician. The first 40 hours must be completed before the physician assistant begins practice in the remote practice location, and the remaining 120 hours must be completed within 90 days after the date the physician assistant starts practice in the remote practice location.
• A PA with less than two years of full-time clinical experience who practices in a remote practice location and who has a change of collaborating physician must work 40 hours under the direct and immediate supervision of the new collaborating physician within 60 days after the effective date of the new collaborative plan unless the change is only to replace the primary collaborating physician with an existing alternate collabo- rating physician.
• A PA with two or more years of full-time clinical experience who applies for authorization to practice in a remote practice location shall submit with the collaborative plan: (a) a detailed curriculum vitae documenting that the physician assistant’s previous experience as a PA is sufficient to meet the requirements of the location assignment; and (b) a written recommendation and approval from the collaborating physician.
• In this section, “remote practice location” means a location in which a physician assistant practices that is 30 or more miles by road from the collaborating physician’s primary office

Performance and Assessment of Practice [12 AAC 40.430(a)-(n)]:

• PA may perform medical diagnosis and treatment only if licensed by the board and only within the scope of practice of the collaborating physician.
• Collaborating physician must establish a periodic quality of practice assessment of the PA’s medical care and clinic management. Plans in effect less than 2 years must include at least one direct personal visit from the supervising physician per quarter for at least four hours. Plans in effect 2 years or more must include at least two direct personal contact visits with primary or alternate collaborating physician per year lasting at least four hours and must be four months apart. A PA who practices under a plan for a continuous period of less than 3 months per year must have at least one direct personal contact visit with the collaborating physician annually.
• Plans must include at least monthly telephone, radio, electronic or direct personal contact between the PA and collaborating physician. Contact must be documented.
• Contacts, whether direct personal contact or contact by telephone, radio, or other electronic means, must include reviews of patient care and the medical records.
• Collaborating MD shall maintain records of performance assessments for at least seven years after the date of the evaluation.
• If an alternate collaborating physician performs the evaluation, copies of the records assessment must be given to the primary collaborating physician for retention in his/her records.
• The board’s executive secretary may initiate audits of performance assessment records. In any one calendar year, the performance assessment records of not more than 10% of the actively licensed PAs, selected randomly by computer, will be audited. Auditing requirements are outlined in the code.

Physician Assistant prescribing medications [12 AAC 40.450(a)-(i)]:

(a) A PA who prescribes, orders, administers, or dispenses controlled substances must have a current Drug Enforcement Administration (DEA) registration number, valid for that handling of that controlled substance on file with the department. . . (b) repealed.

(c) A PA with a valid DEA registration number may order, administer, dispense, and write a prescription for a Schedule II, III, IV, or V controlled substance only with the authorization of the PA’s primary collaborating physician. The authorization must be documented in the PA’s current collaborative plan on file with the division.

(d) The PA’s authority to prescribe may not exceed that of the primary collaborating physician as documented in the collaborative plan on file with the division.

(e) A PA with a valid DEA registration number may request, receive, order, or procure Schedule II, III, IV, or V controlled substance supplies from a pharmaceutical distributor, warehouse, or other entity only with the authorization of the PA’s primary collaborating physician. If granted this authority, the PA is responsible for complying with all state and federal inventory and record keeping requirements. The authorization must be documented in the PA’s current collaborative plan on file with the division. Within 10 days after the date of issue on the form, the PA shall provide to the primary collaborating physician a copy of each DEA Form 222 official order form used to obtain controlled substances.

(f) A PA may prescribe, order, administer, or dispense a medication that is not a controlled substance only with the authorization of the PA’s primary collaborating physician. The authorization must be documented in the PA’s current collaborative plan on file with the division.

(g) A graduate PA licensed under this chapter may not prescribe, order, administer, or dispense a controlled substance.

(h) Termination of a collaborative plan terminates a PA’s authority to prescribe, order, administer, and dispense medication under that plan.

(i) A prescription written under this section by a PA must include the: primary collaborating physician’s name and DEA registration number; PA’s name and DEA registration number.

Alaska – Advanced Practice Registered Nurses (Nurse Practitioner, Certified Nurse Midwife, Certified Nurse Specialist and Certified Registered Nurse Anesthetist)

Qualifications of Advanced Practice Registered Nurse [AS §08.68.850(1)]: A registered nurse authorized to practice in the state who, because of specialized education and experience, is certified to perform acts of medical diagnosis and the prescription and dispensing of medical, therapeutic, or corrective measures under regulations adopted by the AK Board of Nursing.

APRNs may practice independently in the role for which the individual has received specialized education. Populations include: (1) family/individual across the lifespan; (2) adult/gerontology; (3) neonatal; (4) pediatric; (5) women’s health/gender related; (6) psychiatric/mental health. An advanced practice registered nurse licensed or certified in the following population foci by January 1, 2024 may continue to practice as long as that certification is maintained: (1) acute care/emergency; (2) adult health; (3) adult psychiatric/mental health; (4) family health; (5) family psychiatric/mental health; (6) geriatric nursing; (7) women’s health. [12 AAC 44.380]

APRN educational requirements are outlined in 12 AAC 44.400.

APRN prescribing medications [12 AAC 44.440]:

Alaska’s Board of Nursing will, in its discretion, authorize an APRN to prescribe/dispense legend drugs in accordance with applicable state and federal laws. A nurse who applies for authorization to prescribe and dispense must: (1) be an APRN in Alaska; (2) have completed 15 hours of pharmacology education and clinical management of drug therapy within a 2-yr period immediately before date of application; and, (3) submit a completed notarized application. Prescriptions must contain the prescriber’s ID number assigned by the Board of Nursing, and signature followed by the letters “APRN.”

APRN controlled substance prescriptive and dispensing authority [12 AAC 44,445 (a)-(i)]:

In addition to legend drug prescriptive and dispensing authority under 12 AAC 44.440, the board may authorize an APRN to prescribe and dispense Schedule II – V controlled substances in accordance with applicable state and federal laws if an applicant:

(1) Submits a completed application on a form provided by the department. The completed application must include the applicant’s: name, address, and phone number; license number as an APRN; date of birth; notarized signature certifying that the information in the application is correct to the best of the applicant’s knowledge; and payment of the application free.

(b) All the provisions of 12 AAC 44.440 apply to an APRN with controlled substance prescriptive authority under this section.

(c) Written, verbal, or electronic controlled substance prescriptions and orders must comply with all applicable state and federal laws.

An APRN with controlled substance prescriptive and dispensing authority must register with the controlled substance prescription database.

(e) An APRN with authority to prescribe controlled substances may only delegate to a registered nurse or licensed practical nurse to access the database on the practitioner’s behalf.

(f) When prescribing a drug that is a controlled substance, the APRN shall create and maintain a complete, clear, and legible written record of care that includes:

(1) a patient history and evaluation sufficient to support a diagnosis;

(2) a diagnosis and treatment plan for the diagnosis;

(3) a plan for monitoring the patient for side effects of the drug and results of the drug;

(4) a record of each drug prescribed, administered, or dispensed, including the type of drug, dose, and any authorized refills.

(g) The APRN shall check the controlled substance prescription database before a Schedule II or III controlled substance is initially dispensed, prescribed, or administered to a patient, at least once every 30 days for up to 90 days, and at least once every three months if a course of treatment continues for more than 90 days. This subsection does not apply if:

(1) the patient is currently receiving treatment in a licensed health care facility and that prescription is nonrefillable;

(2) the patient is currently receiving treatment in the emergency room in a licensed health care facility and that prescription is non-refillable;

(3) the controlled substance is dispensed or prescribed to a patient immediately before, during, or within the first 48 hours of undergoing a medical or surgical procedure in a licensed health care facility, and that prescription is non-refillable;

(4) the controlled substance is dispensed or prescribed to a patient currently receiving care in hospice;

(5) the quantity of the controlled substance prescribed does not exceed an amount that is adequate for a single three-day treatment period, the prescription does not allow a refill, and no subsequent prescriptions are written for or dispensed for the next 15 days; or,

(6) the controlled substance prescription database is not operational due to a temporary technological or electrical failure or natural disaster.

(h) A licensee treating a patient with a prescription for a controlled substance that was initially written at least 90 days before May 16, 2018 shall check the controlled substance prescription database at least once every three months for the duration of the prescription.

(i) An applicant who holds a valid federal DEA registration number, shall provide verification that he/she has (1) completed no less than two hours of education in pain management and opioid use and addiction within the two-year period immediately before the date of application; and (2) registered with the prescription drug monitoring program (PDMP) controlled substance prescription database.

APRN maximum dosage for opioid prescriptions [Sec. 08.68.705 (a)-(c)]:

(a) An APRN may not issue:

(1) an initial prescription for an opioid that exceeds a seven-day supply to an adult patient for outpatient use;

(2) a prescription for an opioid that exceeds a seven-day supply to a minor. At the time an APRN writes a prescription for an opioid for a minor, the APRN shall discuss with the minor’s parent or guardian why the prescription is necessary and the risks associated with opioid use.

(b) Notwithstanding (a) of this section, an APRN may issue a prescription for an opioid that exceeds a seven-day supply to an adult or minor patient if, in the professional judgment of the APRN, more than a seven-day supply of an opioid is necessary for:

(1) the patient’s acute medical condition, chronic pain management, pain associated with cancer, or pain experienced while the patient is in palliative care. The APRN may write a prescription for an opioid for the quantity needed to treat the above. The APRN shall document in the patient’s medical record the condition triggering the prescription of an opioid in a quantity that exceeds a seven day supply and indicate that a non-opioid alternative was not appropriate to address the medical condition; or,

(2) a patient who is unable to access a practitioner within the time necessary for a refill of the seven-day supply because of a logistical or travel barrier. The APRN may write a prescription for an opioid for the quantity needed to treat the patient for the time that the patient is unable to access a practitioner. The APRN shall document in the patient’s medical record the reason for the prescription of an opioid in a quantity that exceeds a seven-day supply and indicate that a non-opioid alternative was not appropriate to address the medical condition.

(c ) This section does not authorize an APRN to prescribe a controlled substance if the APRN is not otherwise authorized to prescribe a controlled substance under policies, procedures, or regulations issued or adopted by the board.

For APRN dispensing standards, see 12 AAC 44.447.

Certified Nurse Midwife (CNM) Qualifications: Under AK’s nursing regulations, CNMs are Advanced Nurse Practitioners. See Advanced Practice Registered Nurse description above. Alaska has a well-defined Certified Direct-Entry Midwife program. AS 08.65 and 12 AAC 14 are the defining statutes and regulations.

Certified Registered Nurse Anesthetist (CRNA) Qualifications: Under AK’s nursing regulations, CRNAs are Advanced Nurse Practitioners. See Advanced Practice Registered Nurse description above.