Q: What is the practice agreement?

The practice agreement can be thought of as a comprehensive job description. The practice agreement should outline the intended practice of the PA in that specific clinical setting. There must be documentation kept at the practice of the completed agreement. The agreement must be reviewed annually by a physician associated with the practice who has knowledge of the PA's practice, and evidence of that review should be maintained at the practice level.  Nothing needs to be submitted to the Board of Medical Practice unless requested. 

There is no specific example of a practice agreement, as the law was written to allow for flexibility and customization of practice agreements to benefit PA employment.

The specific language from the MN Statutes regarding the practice agreement reads as follows: 

Practice agreement review. A physician assistant shall have a practice agreement at the practice level that describes the practice of the physician assistant. The practice agreement must be reviewed on an annual basis by a licensed physician within the same clinic, hospital, health system, or other facility as the physician assistant and has knowledge of the physician assistant's practice to ensure that the physician assistant's medical practice is consistent with the practice agreement. A document stating that the review occurred must be maintained at the practice level and made available to the board, upon request.

Q: What are the requirements of the new-to-practice collaborative agreement?

A: New graduates with less than 2,080 hours of practice need to have a collaborative agreement in place with an MN-licensed physician(s) that describes the “overall working relationship and collaborative arrangement” for the first 2,080 hours of practice. The amount, frequency, and manner of physician oversight are determined at the practice level.

There is no formal paperwork or board-approved form that needs to be filed with the Board of Medical Practice regarding this collaborative arrangement. It is created and maintained at the practice level and must be made available to the Board upon request.

Upon completion of the 2,080 hours, the PA must sign section C of the Affidavit of Collaborative Practice and submit it to the Board.

Q: What is the Affidavit of Collaborative Practice?

A: MN Statutes, section 147A.02(c) requires PAs in Minnesota to practice for at least 2,080 hours within the context of a collaborative agreement. The affidavit form is available on the MN Board of Medical Practice (BMP) website.

Q: Does Medicare/CMS require a physician to co-sign for PAs?

A: In general, Medicare rules do not require physician co-signature of medical records or orders when patients are treated by a PA unless state law, a specific Medicare rule (i.e., for a particular service), or the hospital/facility policy explicitly requires one. As of August 2020, Minnesota no longer requires a PA to identify a supervising physician; therefore, this should not hinder a PA from employment regarding Medicare rules.

Effective January 1, 2022, medical and surgical services performed by PAs can be submitted to Medicare, identifying the PA as the “billing provider,” the individual to whom payment should be made directly. PAs were already authorized to be listed as rendering providers, identifying them as the health professional who rendered a service. Medicare’s new policy makes PAs eligible to receive payment for the service, as opposed to payment going to a PA’s employer.

Q: Can a PA own their own practice in MN?

A: PAs in Minnesota have always been able to own a practice and employ or otherwise contract a physician for the legal practice requirements. Under current Minnesota law, a PA must have a practice agreement that is reviewed annually by a Minnesota licensed physician. Because PAs practice as members of a team, it is expected that there will be access to physician support when needed for patient care.

Q: Can a PA practice telehealth in Minnesota?

Yes, if you are a licensed PA in Minnesota. Under current national and state regulations, a provider rendering patient care via telehealth must be licensed in the statein which the patient is physically located at the time of the visit.

Minnesota became a member of the PA Licensure Compact in 2024. Once operational, this will enhance access to telehealth services for residents in participating states.

Q: Are there any unique requirements beyond the new graduate clause and annually reviewed practice agreement?

A: Please review MN Statutes Chapter 147A for requirements in MN.

Notably, there is one specific clause that warrants special attention in the practice agreement. This is specific to spinal injections for pain. Please see the following excerpt from the statute:

“For purposes of performing spinal injections for acute or chronic pain symptoms, the physician assistant and one or more physicians licensed under chapter 147 must have a mutually agreed upon plan that designates the scope of collaboration necessary for treating patients with acute and chronic pain.”

Q: I am interested in starting my own practice and have many questions on how to get started. What resources does MAPA have for this?

PAs who desire to be practice owners should consult with a Minnesota-licensed attorney specializing in medical practice law to ensure compliance with all applicable laws and business practices. MAPA is not a legal authority and cannot provide advice on such matters.

AAPA members also have access to various resources related to PA practice ownership.

Q: Where can I find more information about PA practice laws in MN?

A: Please review the MN Statutes, chapter 147A. Any other questions can be directed to mapa.advocate@gmail.com