AAPA 2021 Grant Proposal for Legislation Assistance

1. Description of barriers to PA practice in our state and how this initiative seeks to address in OTP aspects Delaware has over 700 licensed PAs and PA regulations fall under the Board of Medical Licensure and Division (BOMLD) who currently does not have any PA representation, despite being our regulatory board. There is a PA Council that can make recommendation to the BOLMD but it does not have any voting or legislation power- its advisory only. Delaware PAs also still practice under a supervisory agreement, have a 1:40 ratio in all areas of clinical practice and are not able to volunteer medical care without a supervisory physician (except in a state of emergency) . These aspects are inconsistent with todays modern medical practice for both national and state medical needs and do not allow for PAs to practice to the full extent of our training and scope of practice. This bill, HB 169, changes the relationship between physicians and Physician Assistants (PAs) from supervisory to collaborative in recognition of the evolving role of PAs and reflecting the education, training, and experience required for licensing, which emphasizes the team-based practice model. This bill retains a 1:4 ration of physicians to PAs unless a regulation of the Board increases or decreases the number. However, this limit of 1:4 does not apply to physicians and PAs who practice in the same physical office or facility building, such as an emergency department. This bill increases the number of Board of Medical Licensure and Discipline members from 16 to 18, to include 2 PA members appointed by the Regulatory Council for Physician Assistants. The bill authorizes PAs to participate as uncompensated volunteers in public and community events independent of a state of emergency. Please see attached bill for full details.

2. Likelihood of success and how will funding help. In January 2020, DAPA took the bill to the Sunset Committee of the House ,and it passed through. DAPA was there to present the bill along with our lobbyist, Hamilton Goodman Partners, as well as numerous practicing Delaware PAs who came to speak on behalf of the bill and PA support, as well as submitting over 200 letters of support for the bill from practicing Delaware PAs and practicing Delaware physicians. DAPA worked with our members and lobbying team to educate our members and our local physicians about the bill and how to support it through letters, personal testimony at the Sunset Committee. We also worked closely by educating stakeholders who also came to the committee and submitted letters of support. We also worked very closely with the The Medical Society of Delaware and they stated a position of neutrality. Unfortunately, the Board of Medical and Licensure Division did oppose the bill, but this was expected- they are not PA friendly. The bill was expected to progress through the House and Senate and the overall expectation was that it would pass. However, COVID occurred and the Delaware Assembly ceased all bills and meetings, and would only allow bills that directly related to the budget. Our lobbying team met with legislators, bill sponsors and unfortunately, nothing could be done to allow the bill to be addressed during the covid crisis and before the legislation session ended June 30th. Also due to the COVID crisis, we were unable to hold our workshops and annual conference we looked into virtual platforms but they were out of budget and the overall attendance interest was not there. This was our main financial income source outside of membership, so we were unable to gain income this year other than membership dues. We still have a lobbyist cost of $2,000 per month which we have been paying and will still continue to have to pay in 2021 for their services. Therefore, with the challenge of COVID and not having our income sources, we were unable to have our bill passed in 2020 as was originally expected and our financial income had a big loss. We would appreciate the assistance of the AAPA in helping DAPA, especially since we are a very small and completely volunteer constituent organization. The grant would be to pay for our lobbyist to not only complete the intended bill process but also aid in protecting PA interests going forward in our state.

3. Identification of champions in Legislation and Community. DAPA worked with our members and local physicians to educate them on the bill, providing in person and virtual meetings to educate PAs on the bill and also ways for them to educate their practicing physicians and their administrative teams. Our lobbyists helped us significantly with these educational opportunities, providing physical presence at our meetings, providing talking points for PAs to use and information on letter submission to our state legislators. Our lobbyists also work closely with other healthcare organizations, such as Christiana Care and Nemours, our 2 biggest hospital systems, and have many healthcare connections in the state of Delaware. They are able to have constructive conversations with stakeholders about the bill and about the importance and contribution to care PAs make to Delaware. We felt they greatly supported the DAPA legislative committee and the board and were able to have the necessary productive conversations. For over 4 years, Daniella Benson, PA-C and Ed Woodford, PA-C (DAPA legislation Co-chairs) have worked closely with the Medical Society of Delaware. The MSD usually opposed the PA changes but we were able to improve our relationship with them and gain mutual understanding of each others goals. The MSD does support PAs in healthcare, and their past president, Dr Richard Henderson, and their attorney, Drew Wilson, were great champions for HB 169 and for ensuring MSD and DAPA worked together for common goals. Daniella and Ed spent years working with the MSD on various healthcare projects, and the MSD leaders also worked with many excellent PAs and got to know Daniella and Ed on a more professional and personal level. These recent years allowed these two organizations to come together and discuss this bill that will benefit Delaware’s healthcare and access to care. They gave some input on the bill to meet mutual needs as well as arranged meetings with their specialty physician groups with DAPA. These meetings allowed physicians to meet with DAPA and educate them about the bill- its intent and its changes. The meetings were very well received and allowed the physicians to understand the PA perspective and we were able to answer their questions and alleviate concerns. Our relationship with them become a positive one and they were able to submit a letter of neutrality at the Sunset Committee with many complimentary words about PAs and the DAPA organization. In the past, they typically oppose, so we were pleased with the neutrality outcome. Rep. David Benz, Chair of the Sunset House Committee, is also a champion of the bill and improving Delaware healthcare, as well as its 2 bill sponsors Rep. Johnson and Sen. Lockman. Through our lobbyist connections, DAPA and Daniella Benson and DAPA president Torianne Davies, were also able to establish a relationship with the Delaware Medical Reserve Corp, and since our existing Delaware law allowed PAs to step in and serve the states medical needs during a state of emergency, PAs were able to shift to where help was needed. PAs were deployed to COVID testing sites to supervise testing and serve as leaders as well as be able to be re-deployed within hospital systems to serve where care and needs were. This was a great testimony to our PA training, but also demonstrated to the Delaware governor, healthcare systems, and the Legislation just how versatile and highly competent PAs are and were ready to stand and serve their community during this COVID crisis. DAPA corresponded with the Governors office, reminding them of the care PAs could readily provide, and it was extremely well received.

4. Right now, we are meeting with our lobbyist this week to review a game plan for HB 169. This will receive a new bill number for January 2021, which is when the Assembly reconvenes, and the bill is expected to be on the agenda for the the January House Sunset Committee- it passed there easily in Jan 2020, so we are expecting to run this bill quickly, and all signs are pointing in the right direction. The Delaware Legislative session runs from Jan - June 30th 2021. DAPA and its members, its legislative team, and its lobbying team, bill sponsors and supportive stakeholders are anxiously waiting to have this bill passed and achieve the necessary changes to modernize Delaware PA law. We are looking forward to the positive changes it will achieve for PAs and Delaware healthcare, and we will continue to work on improving the PA laws for the future to ensure PAs practice to the full extent of their training and scope of practice