ACN 063/19 - JUN 2019 ADVANCED PRACTICE PROVIDER POLICY UPDATE

ALCOAST COMMANDANT NOTICE                                  CANCEL DATE  17 JUN 2020

R 181003 JUN 19
FM COMDT COGARD WASHINGTON DC//CG-11//
TO ALCOAST
UNCLAS//N06000//
ACN 063/19
SUBJ:  ADVANCED PRACTICE PROVIDER POLICY UPDATE
A. Coast Guard Medical Manual, COMDTINST M6000.1 (series)
B. Health Services Quality Improvement Implementation Guide Eight
C. Health, Safety and Work-Life Technical Directive 2016-005 Provider Peer Review.
D. HSWL-SC Technical Directive, Tactics, Techniques and Procedures for Advanced Practice
Provider (APP) Practice
1. This ACN establishes updated policy regarding utilization and scope of practice of
advanced practice providers (APPs), which include Physician Assistants (PAs) and Nurse
Practitioners (NPs). This ACN applies to active duty and reserve Coast Guard (CG) providers,
other Uniformed Services providers detailed to the Coast Guard, CG civilian providers, and
contract providers to the maximum extent practicable so long as it does not conflict with
their contract.
2. REFs (A) and (C) will reflect these updates in the next revisions within one year.
    a. Paragraph 1.B.10 will now include: “APPs will have written collaborative or supervisory
practice agreements on record with a physician assigned by the Senior Medical Executive.
All APPs in their first year of CG practice until the end of their initial privileging period,
and non-designated aeromedical PAs, must have a supervisory practice agreement. In general,
other APPs will have a collaborative practice agreement. Specific parameters are outlined in
REF (D). APPs will inform their respective supervisors of any specific state license
requirements. APPs shall abide by the laws and regulations of the jurisdiction that issued
their credentials or license to the greatest extent practicable. However, compliance with
state requirements shall not interfere with the individual’s performance of assigned
duties/responsibilities in the specified discipline within the Coast Guard.”
    b. Paragraph 1.B.17, pertaining to Physician Assistants (PAs) and Nurse Practitioners (NPs),
will be amended as follows:
        (1) Paragraph B. will be deleted. Refer to REF (D) for guidance regarding APP
responsibilities.
        (2) New paragraph, add: “Junior APP assignment and TDY restrictions.”
    c. New IPAP graduates will be assigned to a clinic with a physician, and preferably also
a senior APP, for the first two years to ensure proper clinical mentorship, development and
oversight.
    d. APPs in the first year of practice will not deploy on solo TDY medical support missions
unless approved by HSWL SC OPMED.
    e. Paragraph 10.A.3.a. delete last sentence.
    f. Paragraph 10.B.6.b.(2): replace with “APPs are licensed and privileged practitioners,
and as such, co-signature by a physician or other privileged provider of APP entries in the
patient’s medical record, prescriptions, and so forth, is not required, except where noted in
their privileging document or as otherwise required by policy.”
3. REF (B) is hereby cancelled and will be replaced with REF (D).
4. The POC for this ACN is: CDR Charlene Criss, Advanced Practice Provider Force Manager,
COMDT (CG-1121), 202-475-5183, Charlene.R.Criss@uscg.mil.
5. Released by RADM Dana L. Thomas, Director of Health, Safety and Work-Life.
6. Internet release is authorized.