New Law Affects Physician Assistant Supervision Agreements

By Joseph J. Feltes, JD
Thursday, October 25, 2018

More and more physician practices are utilizing physician assistants as valuable extenders for providing care to patients according to a supervision agreement between the supervising physician and physician assistant, who acts within the scope of licensure under that physician’s supervision.

By law, supervision agreements for physician assistants practicing in a physician office must include terms specifying: (a) responsibilities to be fulfilled by the supervising physician, including performance of duties listed in Ohio Revised Code 4730.21 and proper delegation of medical tasks according to Ohio Administrative Code 4731-23-02; (b) responsibilities to be fulfilled by the physician assistant when performing services and delegated tasks under the physician’s supervision; (c) limitations applying to responsibilities by the physician assistant; and (d) circumstances under which the physician assistant must refer the patient to the supervising physician. The supervision agreement also must clearly state that the supervising physician is “legally responsible and assumes legal liability” for the services the physician assistant provides to patients in the practice.

Until recently, the supervising physician was required to submit a copy of the supervision agreement to the State Medical Board of Ohio, which would review it for compliance with Ohio Revised Code 4730.19. If compliant, the supervision agreement would become effective at the end of the fifth business day after the Board received the agreement unless the Board notifies the supervising physician of any non-compliance or deficiencies. Upon notification by the Board, the supervising physician had an opportunity to revise and resubmit the supervision agreement for approval.

The Medical Board has statutory authority to impose a civil monetary penalty of what previously had been no more than $1,000 if it were to find that the supervised physician assistant practiced in a manner that departed from the terms of the supervision agreement, and/or the supervising physician departed from, or failed to comply with, the terms of the supervision agreement, as approved by the Medical Board. In some ways, Board review and approval procedure for supervision agreements acted as a safety net for physician compliance.

Joseph J. Feltes, JD

The Ohio General Assembly, recognizing greater utilization and independence of midlevel providers, enacted Am. Sub. H.B. No. 111, which amended Revised Code 4731.19 (effective September 28, 2018) by eliminating the procedural requirement for physicians to submit supervision agreements of physician assistants to the Medical Board for review and approval. The amended statute also increased the civil monetary penalty from $1,000 to $5,000 if the Board were to determine, at any time, that the supervising physician failed to comply with Section 4731.19. In addition to imposing a civil monetary penalty, the statute authorizes the Board, if warranted, to initiate disciplinary action against the supervising physician and physician assistants.

Given the amended statute, it is incumbent for physicians who supervise physician assistants to assure that their supervision agreement complies with Ohio law and to understand and carry out their supervisory duties and responsibilities.

Joe Feltes is an attorney with Buckingham, Doolittle & Burroughs in Canton OH and a member of its Health & Medicine Practice Group. He is also the managing partner of Buckingham Canton. For more information about the law firm, go to or email Mr. Feltes at