TITLE XXX
OCCUPATIONS AND PROFESSIONS

Chapter 328-D
PHYSICIAN ASSISTANTS

Section 328-D:1

    328-D:1 Definitions. –
In this chapter:
I. "Applicant" means a physician assistant who has submitted an application for licensure.
I-a. "Approved continuing medical education activity" means a continuing education activity certified for American Academy of Physician Assistants (AAPA) Category 1 credit, American Medical Association (AMA) Category 1 PRA credit, American Osteopathic Association (AOA) Category 1-A credit, American Academy of Family Physicians (AAFP) Prescribed credit, or any other board-approved activity.
II. "Board" means the board of medicine.
II-a. "Collaboration" means a physician assistant's consultation with or referral to an appropriate physician or other health care professional as indicated based on the patient's condition, the physician assistant's education, training, and experience, and the applicable standards of care.
II-b. "Collaboration agreement" means an agreement that meets the requirements of RSA 328-D:3-b.
II-c. "Participating physician" means a physician practicing as a sole practitioner, a physician designated by a group of physicians to represent their physician group, or a physician designated by a health care facility to represent that facility, who enters into a collaboration agreement with a physician assistant in accordance with this chapter.
III. "Physician assistant" or "P.A." means a person qualified both by academic and practical training to provide patient services in collaboration with one or more physicians pursuant to the requirements of this chapter.

Source. 1989, 290:1. 1995, 286:26, eff. Jan. 1, 1996. 2022, 148:1, eff. Aug. 6, 2022.

Section 328-D:2

    328-D:2 License Required. –
I. No person shall practice as a physician assistant in the state of New Hampshire unless he or she is licensed by the board of medicine in accordance with this chapter.
II. This section shall not be construed to prohibit students enrolled in physician assistant training programs, from performing work incidental to their respective courses of study or supervised clinical work while under the supervision of a designated preceptor.
III. The board shall license each applicant who satisfies the requirements under RSA 328-D:3. Upon payment of a license fee, the board shall issue to such person a license, which shall be prima facie evidence of the right to practice as a physician assistant.

Source. 1989, 290:1, eff. Jan. 1, 1990. 2020, 39:48, eff. July 29, 2020. 2022, 148:2, eff. Aug. 6, 2022.

Section 328-D:2-a

    328-D:2-a Licensure Requirements Suspended; Manchester Veterans Administration Medical Center. –
I. New Hampshire state licensure laws, rules, and regulations for physician assistants are hereby suspended for those physician assistants licensed by another state or territory of the United States or another country who are employed by the United States Department of Veterans Affairs and who are offering medical services to patients offered through the Veterans Administration Medical Center (VAMC), provided that such physician assistants are acting within the scope of their employment at the VAMC and possess a current license in good standing in their respective state, territory, or country of licensure. Physician assistants who are employed by the United States Department of Veterans Affairs and who are offering medical services to patients of the Veterans Administration Medical Center (VAMC) and requesting licensure in New Hampshire may collaborate with physicians licensed in any state or territory of the United States provided the participating physician possesses a current license in good standing in their respective state or territory of the United States.
II. The acting director of the Manchester VAMC shall submit to the executive director of the New Hampshire office of professional licensure and certification, or designee, a list of all out-of-state or out-of-country licensed physician assistants offering services in the state of New Hampshire and out-of-state licensed physicians collaborating with physician assistants.
III. Nothing in this section shall be construed to preempt or supplant an individual licensed medical facility's policies regarding the emergency credentialing of physician assistants or any other medical personnel.

Source. 2018, 266:2, eff. June 14, 2018. 2021, 151:1, eff. Sept. 21, 2021. 2022, 148:3, eff. Aug. 6, 2022.

Section 328-D:3

    328-D:3 Conditions for Licensure. –
I. To apply for licensure by the board as a physician assistant, an applicant shall file a written application on forms provided by the office of professional licensure and certification and pay an application fee. The applicant to be licensed shall:
(a) Have successfully completed an educational program for physician assistants accredited by the Accreditation Review Commission on Education for the Physician Assistant, or prior to 2001, either by the Committee on Allied Health Education and Accreditation, or the Commission on Accreditation of Allied Health Education Programs.
(b) Have passed a national proficiency examination, as designated by the board.
(c) Demonstrate that the applicant has good character.
(d) Submit a complete set of fingerprints and a criminal history record release form pursuant to RSA 328-D:3-a.
II. The application shall include a statement of good standing from the licensing authority of all states in which the applicant currently holds a license.
III. Circumstances that exist which would be grounds for disciplinary action under RSA 328-D:6 may be grounds for denial of a license.

Source. 1989, 290:1. 2004, 198:1, 2. 2007, 303:5, eff. Sept. 11, 2007. 2018, 318:18, eff. Aug. 24, 2018. 2021, 197:67, eff. July 1, 2021. 2022, 148:4, eff. Aug. 6, 2022.

Section 328-D:3-a

    328-D:3-a Criminal History Record Checks. –
I. Every applicant for initial permanent licensure or reinstatement shall submit to the board a criminal history record release form, as provided by the New Hampshire division of state police, which authorizes the release of his or her criminal history record, if any, to the board.
II. The applicant shall submit with the release form a complete set of fingerprints taken by a qualified law enforcement agency or an authorized employee of the department of safety. In the event that the first set of fingerprints is invalid due to insufficient pattern, a second set of fingerprints shall be necessary in order to complete the criminal history records check. If, after 2 attempts, a set of fingerprints is invalid due to insufficient pattern, the board may, in lieu of the criminal history records check, accept police clearances from every city, town, or county where the person has lived during the past 5 years.
III. The board shall submit the criminal history records release form and fingerprint form to the division of state police which shall conduct a criminal history records check through its records and through the Federal Bureau of Investigation. Upon completion of the records check, the division of state police shall release copies of the criminal history records to the board.
IV. The board shall review the criminal record information prior to making a licensing decision and shall maintain the confidentiality of all criminal history records received pursuant to this section.
V. The applicant shall bear the cost of a criminal history record check.

Source. 2007, 303:4, eff. Sept. 11, 2007. 2018, 318:19, eff. Aug. 24, 2018.

Section 328-D:3-b

    328-D:3-b Physician Assistant Scope of Practice. –
I. Except as provided in RSA 328-D:15, III and RSA 328-D:16, II, a physician assistant shall engage in practice as a physician assistant in this state only if the physician assistant has entered into a written collaboration agreement with a sole practice physician or a physician representing a group or health system so long as the sole practitioner or at least one physician in the group or health system practices in a similar area of medicine as the physician assistant, and is a licensed New Hampshire physician.
II. A collaboration agreement shall include all of the following:
(a) Processes for collaboration and consultation with the appropriate physician and other health care professional as indicated based on the patient's condition; the physician assistant's education, training, and experience, and the applicable standards of care.
(b) An acknowledgment that the physician assistant's scope of practice shall be limited to medical care that is within the physician assistant's education, training, and experience as outlined in paragraphs VII-XVIII.
(c) A statement that although collaboration occurs between the physician assistant and physicians and other health care professionals, a physician shall be accessible for consultation in person, by telephone, or electronic means at all times when a physician assistant is practicing.
(d) The signatures of the physician assistant and the participating physician. No other signatures shall be required.
III. The collaboration agreement shall be updated as necessary.
IV. In the event of the unanticipated unavailability of a participating physician practicing as a sole practitioner due to serious illness or death, a physician assistant may continue to practice for not more than a 30-day period without entering into a new collaboration agreement with another participating physician.
V. The collaboration agreement shall be kept on file at the practice and made available to the board upon request. The board shall not request or require any modifications to the collaboration agreement.
VI. A participating physician shall not be required to submit a written acceptance of collaboration to the board.
VII. Physician assistants may provide any legal medical service for which they have been prepared by their education, training, and experience and are competent to perform. Medical and surgical services provided by physician assistants include, but are not limited to:
(a) Obtaining and performing comprehensive health histories and physical examinations;
(b) Evaluating, diagnosing, managing, and providing medical treatment;
(c) Ordering, performing, and interpreting diagnostic studies and therapeutic procedures;
(d) Educating patients on health promotion and disease prevention;
(e) Providing consultation upon request;
(f) Writing medical orders;
VIII. Physician assistants may provide services in healthcare facilities or programs including but not limited to hospitals, nursing facilities, assisted living facilities, and hospices.
IX. Physician assistants may obtain informed consent.
X. Physician assistants may supervise, delegate, and assign therapeutic and diagnostic measures to licensed or unlicensed personnel.
XI. Consistent with the scope of practice, physician assistants may certify the health or disability of a patient as required by any local, state, or federal program.
XII. Physician assistants may authenticate any document with their signature, certification, stamp, verification, affidavit, or endorsement if it may be so authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of a physician.
XIII. A physician assistant may prescribe, dispense, order, administer, and procure drugs and medical devices. Physician assistants may plan and initiate a therapeutic regimen that includes ordering and prescribing non pharmacological interventions, including but not limited to durable medical equipment, nutrition, blood and blood products, and diagnostic support services including but not limited to home healthcare, hospice, and physical and occupational therapy.
XIV. The prescribing and dispensing of drugs shall:
(a) Comply with the requirements of RSA 318, and federal and state regulations;
(b) Occur when pharmacy services are not reasonably available, or when it is in the best interests of the patient, or when it is an emergency; and
(c) Include any medications that may be dispensed by a physician.
XV. Physician assistants may request, receive, and sign for professional samples, and may distribute professional samples to patients.
XVI. Physician assistants who prescribe and/or dispense controlled substances shall register with the United States Drug Enforcement Administration and any applicable state controlled substance regulatory authority.
XVII. Physician assistants shall collaborate with, consult with, and/or refer to the appropriate member(s) of the healthcare team as indicated by the patient's condition, the education, experience, and competencies of the physician assistant, and the standard of care. The degree of collaboration should be outlined in the collaboration agreement. Physician assistants are solely responsible for the care they provide.
XVIII. The scope of practice of a physician assistant shall be determined at the practice level based on the education, training, and experience of the physician assistant. Practice settings may include, but are not limited to, a physician employer setting, group practice setting, independent private practice setting, or in a health care facility setting governed by a system of credentialing and/or granting of privileges.

Source. 2022, 148:5, eff. Aug. 6, 2022.

Section 328-D:4

    328-D:4 Repealed by 2004, 198:11, I, eff. Dec. 31, 2004. –

Section 328-D:5

    328-D:5 Renewal of Licenses. – Every person licensed to practice under this chapter shall apply to the board for biennial renewal of license on forms provided by the office of professional licensure and certification and shall pay a renewal fee as established by the office of professional licensure and certification. Applications for renewal shall be filed no later than December 31 of every other year. A license issued under this chapter shall not expire until the board has taken final action upon the application for renewal.

Source. 1989, 290:1. 2004, 198:3, eff. Dec. 31, 2004. 2020, 39:49, eff. Jan. 1, 2021. 2022, 148:6, eff. Aug. 6, 2022.

Section 328-D:5-a

    328-D:5-a Failure to Renew; Lapse. –
I. Any licensee who fails to apply for renewal under RSA 328-D:5 shall pay double the renewal fee, provided the licensee applies and pays the renewal fee no later than 90 days after the expiration date. Any licensee who fails to apply for renewal of his or her license within the 90-day period after expiration, shall have his or her license lapse. A lapsed license shall be reinstated only upon payment of a reinstatement fee as established by the board, and upon showing evidence of professional competence as the board may reasonably require.
II. If a license expires or lapses as a result of a licensee being ordered to active duty with the armed services, the licensee shall have 90 days from the date of discharge or release from the armed service to apply for renewal and all late fees shall be waived.

Source. 2004, 198:4, eff. Dec. 31, 2004.

Section 328-D:6

    328-D:6 Grounds for Discipline. –
The board, after hearing, may take action against any person licensed under this chapter upon finding that the licensee:
I. Has knowingly provided false information on any application for professional licensure, whether by making any affirmative statement which was false at the time it was made or by failing to disclose any fact material to the application.
II. Is a habitual user of drugs or intoxicants or is afflicted with a physical disability, insanity, psychiatric disorders, or other disease deemed dangerous to the public health.
III. Has displayed a pattern of behavior which is incompatible with the basic knowledge and competence expected of persons in the practice of his or her profession.
IV. Has engaged in dishonest or unprofessional conduct or has been grossly or repeatedly negligent in practicing his or her profession or in performing activities ancillary to the practice of his or her profession or any particular aspect or specialty thereof, or has intentionally injured a patient while practicing his or her profession or performing such ancillary activities.
V. Has undertaken to practice outside of the collaboration agreement required pursuant to RSA 328-D:3-b.
VI. Has failed to provide adequate safeguards with regard to aseptic techniques or radiation techniques.
VII. Has included in advertising any statement of a character tending to deceive or mislead the public or any statement claiming professional superiority.
VIII. Has advertised the use of any drug or medicine of an unknown formula or any system of anesthetic that is unnamed, misnamed, misrepresented, or not in reality used.
IX. Has willfully or repeatedly violated any provision of this chapter or any substantive rule of the board.
X. Has been convicted of a felony under the laws of the United States or any state.
XI. Has failed to maintain adequate medical record documentation on diagnostic and therapeutic treatment provided or has unreasonably delayed medical record transfer, or violated RSA 332-I.

Source. 1989, 290:1. 2004, 198:5, eff. Dec. 31, 2004. 2022, 148:7, eff. Aug. 6, 2022.

Section 328-D:6-a

    328-D:6-a Off-label Use of Prescription Drugs; When Permitted. –
The state of New Hampshire confirms its strong support for shared decision making between healthcare professionals and their patients. A licensee may lawfully prescribe an FDA approved drug product for an off-label indication and be held to the same standard of care as when prescribing for on-label indication when:
I. Off-label use of the drug product for this indication has longstanding common use;
II. There is medical evidence to support this use and no known evidence contraindicating such use, including but not limited to peer reviewed studies and practice guidelines from relevant medical societies; or
III. The licensee has provided and the patient, or if the patient is a minor, the patient's parent or guardian, has signed an informed consent form that includes the known potential benefits, known potential risks, alternative treatment options, expected prognosis without treatment, and a disclosure that a prescription is for an off-label indication. The signed informed consent form shall remain part of the patient's medical record.

Source. 2022, 306:3, eff. July 1, 2022.

Section 328-D:7

    328-D:7 Repealed by 2023, 212:19, I, eff. Oct. 3, 2023. –

Section 328-D:8

    328-D:8 Appeals. – Disciplinary action taken by the board under RSA 328-D:7 may be appealed to the supreme court under RSA 541.

Source. 1989, 290:1. 2004, 198:7, eff. Dec. 31, 2004.

Section 328-D:9

    328-D:9 Repealed by 2008, 21:6, II, eff. July 11, 2008. –

Section 328-D:10

    328-D:10 Rulemaking. –
I. The board shall adopt rules under RSA 541-A relative to:
(a) [Repealed.]
(b) Content of the application for licensure.
(c) [Repealed.]
(d) [Repealed.]
(e) [Repealed.]
(f) [Repealed.]
(g) Notification of changes in employment.
(h) [Repealed.]
(i) Manner of recordkeeping under RSA 328-D:11.
(j) The implementation of strategies and procedures necessary to increase the acceptance of military training and experience towards licensure for military veterans seeking to be licensed as a physician assistant. For the purposes of this subparagraph, "veterans" means veterans as defined in 38 U.S.C. section 101(2).
(k) Except as provided in paragraph II, any other matter which is consistent with the legislative intent of this chapter and which is necessary to the administration of this chapter.
(l) The definition of adequate liability insurance coverage under RSA 328-D:18.
II. [Repealed.]

Source. 1989, 290:1. 2008, 21:1, eff. July 11, 2008. 2020, 34:13, eff. Sept. 26, 2020. 2021, 197:68, 70, eff. July 1, 2021. 2022, 148:9, 13, I-V, eff. Aug. 6, 2022. 2023, 212:19, III, eff. Oct. 3, 2023.

Section 328-D:10-a

    328-D:10-a Completion of Survey; Rulemaking. – The board shall adopt rules, pursuant to RSA 541-A, requiring, as part of the license renewal process, completion by licensees of a survey or opt-out form provided by the office of rural health, department of health and human services, for the purpose of collecting data regarding the New Hampshire primary care workforce, pursuant to the commission established in RSA 126-T. Any rules adopted under this section shall provide the licensee with written notice of his or her opportunity to opt-out from participation in the survey.

Source. 2017, 131:6, eff. June 16, 2017. 2019, 254:8, eff. July 1, 2019.

Section 328-D:11

    328-D:11 Recordkeeping. – The board shall keep a record of its proceedings under this chapter in accordance with the retention policy established by the office of professional licensure and certification.

Source. 1989, 290:1, eff. Jan. 1, 1990. 2021, 197:69, eff. July 1, 2021.

Section 328-D:12

    328-D:12 Physician Liability. – A physician assistant is responsible for his or her own medical decision making. A participating physician included in a collaboration agreement with a physician assistant shall not, by the existence of the collaboration agreement alone, be legally liable for the actions or inactions of the physician assistant; provided, however, that this shall not otherwise limit the liability of the participating physician.

Source. 1989, 290:1, eff. Jan. 1, 1990. 2022, 148:8, eff. Aug. 6, 2022.

Section 328-D:13

    328-D:13 Penalty. –
I. Any person who, not being licensed or otherwise authorized according to the law of this state, shall advertise oneself or hold oneself out as a physician assistant, or any person who does such act after receiving notice that such person's license has been revoked, shall be guilty of a misdemeanor.
II. Any person who shall practice or attempt to practice as a physician assistant in this state without a license shall be guilty of a class A misdemeanor if a natural person or guilty of a felony if any other person.

Source. 1989, 290:1. 2004, 198:9. 2006, 76:14, eff. July 1, 2006.

Section 328-D:14

    328-D:14 Limitation on Action. – A person, licensed or authorized to practice as a physician assistant under this chapter or under the laws of any other state, who, in good faith, renders emergency care at the scene of an emergency, shall not be liable for any civil damages as a result of acts or omissions by such person in rendering such emergency care, or as a result of any act or failure to act to provide or arrange for further medical treatment or care, as long as such person receives no direct compensation for the care from or on behalf of the person cared for.

Source. 2004, 198:10, eff. Dec. 31, 2004.

Section 328-D:15

    328-D:15 Participation in Disaster and Emergency Care. –
I. A physician assistant licensed in this state or licensed or authorized to practice in any other U.S. jurisdiction or who is credentialed as a physician assistant by a federal employer who is responding to a need for medical care created by an emergency or a state or local disaster may render such care that they are able to provide, provided that a state or local disaster shall not include an emergency situation that occurs in the place of the physician assistant's employment.
II. A physician assistant so responding who voluntarily and gratuitously, and other than in the ordinary course of employment or practice, renders emergency medical assistance shall not be liable for civil damages for any personal injuries that result from acts or omissions which may constitute ordinary negligence. The immunity granted by this section shall not apply to acts or omissions constituting gross, willful or wanton negligence.
III. A physician assistant licensed in this state or licensed or authorized to practice in any other U.S. jurisdiction or credentialed as a physician assistant by a federal employer shall not be required to have a collaboration agreement when responding to a need for medical care created by a disaster or emergency.

Source. 2022, 148:10, eff. Aug. 6, 2022.

Section 328-D:16

    328-D:16 Participation in Volunteer Care. –
I. A physician assistant licensed in this state, or licensed or authorized to practice in any other U.S. jurisdiction, or who is credentialed by a federal employer or meets the licensure requirements of his or her requisite federal agency as a physician assistant may volunteer to render such care that he or she is able to provide at a children's summer camp or for a public or community event or in a licensed ambulatory health center providing free care. Such care must be rendered without compensation or remuneration.
II. A physician assistant licensed in this state, or licensed or authorized to practice in any other U.S. jurisdiction, or credentialed as a physician assistant by a federal employer shall not be required to have a collaboration agreement when participating in volunteer care.

Source. 2022, 148:10, eff. Aug. 6, 2022.

Section 328-D:17

    328-D:17 Coverage of Services. –
I. Health insurers and, to the extent permitted under federal law, Medicaid and Medicare shall reimburse a participating provider who is a physician assistant for any medical and surgical service delivered by the physician assistant if the same service would be covered if delivered by a physician. Physician assistants are authorized to bill for and receive direct payment for the medically necessary services they deliver.
II. To provide accountability and transparency for patients, payers, and health care systems, the physician assistant, when appropriate, shall be identified as the treating provider in the billing and claims processes when the physician assistant delivered the medical services to the patient.
III. A health insurer shall not impose any practice, education, or collaboration requirement for a physician assistant that is inconsistent with or more restrictive than the provisions of this chapter.
IV. Nothing in this chapter shall be construed to preclude a health carrier from exercising its rights and responsibilities set forth in RSA 420-J:4.

Source. 2022, 148:10, eff. Aug. 6, 2022.

Section 328-D:18

    328-D:18 Professional Liability Insurance Coverage. – Physician assistants actively engaged in providing medical care shall have adequate, current, and valid professional liability insurance coverage.

Source. 2022, 148:10, eff. Aug. 6, 2022.