Maryland 2022 Regular Session

Maryland House Bill HB961 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	hb0961
6	6
7	7	HOUSE BILL 961
8	8	J2 2lr2170
9	9	CF SB 808
10	10	By: Delegates Kerr and Krebs
11	11	Introduced and read first time: February 10, 2022
12	12	Assigned to: Health and Government Operations
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Health Occupations – Physician Assistants – Revisions 2
19	19
20	20	FOR the purpose of requiring a physician assistant to practice under a collaboration 3
21	21	agreement with a signing physician rather than under a delegation agreement with 4
22	22	a primary supervising physician; requiring a physician assistant to submit a 5
23	23	collaboration agreement to the State Board of Physicians before a certain date; 6
24	24	altering the scope of practice for a licensed physician assistant; repealing the 7
25	25	provisions of law governing the delegation of prescribing, dispensing, and 8
26	26	administering controlled dangerous substances, prescription drugs, and medical 9
27	27	devices and delegation agreements; and generally relating to physician assistants. 10
28	28
29	29	BY repealing 11
30	30	Article – Health Occupations 12
31	31	Section 15–302.1 and 15–302.2 13
32	32	Annotated Code of Maryland 14
33	33	(2021 Replacement Volume) 15
34	34
35	35	BY repealing and reenacting, without amendments, 16
36	36	Article – Health – General 17
37	37	Section 13–3301(a) 18
38	38	Annotated Code of Maryland 19
39	39	(2019 Replacement Volume and 2021 Supplement) 20
40	40
41	41	BY repealing and reenacting, with amendments, 21
42	42	Article – Health – General 22
43	43	Section 13–3301(d)(1)(v)2. 23
44	44	Annotated Code of Maryland 24
45	45	(2019 Replacement Volume and 2021 Supplement) 25
46	46
47	47	BY repealing and reenacting, without amendments, 26
48	48	Article – Health Occupations 27 2 HOUSE BILL 961
49	49
50	50
51	51	Section 12–101(a) 1
52	52	Annotated Code of Maryland 2
53	53	(2021 Replacement Volume) 3
54	54
55	55	BY repealing and reenacting, with amendments, 4
56	56	Article – Health Occupations 5
57	57	Section 12–101(b), 12–102(c)(2)(iv), 14–306(e)(3)(iii)2., 15–101, 15–103(b), 15–202(b), 6
58	58	15–205(a), 15–301, 15–302, 15–302.3, 15–306, 15–309(a), 15–310(b) and (c), 7
59	59	15–313(a)(1) and (b), 15–314(a)(41), 15–317, 15–401(b), and 15–402.1(a) 8
60	60	Annotated Code of Maryland 9
61	61	(2021 Replacement Volume) 10
62	62
63	63	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
64	64	That Section(s) 15–302.1 and 15–302.2 of Article – Health Occupations of the Annotated 12
65	65	Code of Maryland be repealed. 13
66	66
67	67	SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 14
68	68	as follows: 15
69	69
70	70	Article – Health – General 16
71	71
72	72	13–3301. 17
73	73
74	74	(a) In this subtitle the following words have the meanings indicated. 18
75	75
76	76	(d) “Certifying provider” means an individual who: 19
77	77
78	78	(1) (v) 2. Has an active [delegation] COLLABORATION agreement 20
79	79	with a [primary supervising] SIGNING physician UNDER TITLE 15 OF THE HEALTH 21
80	80	OCCUPATIONS ARTICLE AND who is a certifying provider; and 22
81	81
82	82	Article – Health Occupations 23
83	83
84	84	12–101. 24
85	85
86	86	(a) In this title the following words have the meanings indicated. 25
87	87
88	88	(b) “Authorized prescriber” means any licensed dentist, licensed dental hygienist 26
89	89	with prescriptive authority under § 4–206.4 of this article, licensed physician, LICENSED 27
90	90	PHYSICIAN ASSISTANT , licensed podiatrist, licensed veterinarian, advanced practice 28
91	91	nurse with prescriptive authority under § 8–508 of this article, or other individual 29
92	92	authorized by law to prescribe prescription or nonprescription drugs or devices. 30
93	93
94	94	12–102. 31
95	95
96	96	(c) (2) This title does not prohibit: 32
97	97	HOUSE BILL 961 3
98	98
99	99
100	100	(iv) A licensed physician who complies with the requirements of item 1
101	101	(ii) of this paragraph from personally preparing and dispensing a prescription written by: 2
102	102
103	103	1. A physician assistant PRACTICING in accordance with a 3
104	104	[delegation] COLLABORATION agreement that complies with Title 15, Subtitle 3 of this 4
105	105	article; or 5
106	106
107	107	2. A nurse practitioner who is authorized to practice under 6
108	108	Title 8, Subtitle 3 of this article and is working with the physician in the same office setting; 7
109	109	or 8
110	110
111	111	14–306. 9
112	112
113	113	(e) Except as otherwise provided in this section, an individual may perform 10
114	114	X–ray duties without a license only if the duties: 11
115	115
116	116	(3) Are performed: 12
117	117
118	118	(iii) 2. By a licensed physician assistant who has completed a 13
119	119	course that includes anterior–posterior and lateral radiographic studies of extremities on 14
120	120	at least 20 separate patients [under the direct supervision of the delegating physician or 15
121	121	radiologist] using a mini C–arm or similar low–level radiation machine to perform 16
122	122	nonfluoroscopic X–ray procedures, if the duties: 17
123	123
124	124	A. Include only the X–ray procedures described in paragraph 18
125	125	(2)(iii) of this subsection; and 19
126	126
127	127	B. Are performed [pursuant to a Board–approved delegation 20
128	128	agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this 21
129	129	article] IN COLLABORATION WIT H A PHYSICIAN IN ACC ORDANCE WITH A 22
130	130	COLLABORATION AGREEM ENT THAT MEETS THE R EQUIREMENTS ESTABLIS HED 23
131	131	UNDER TITLE 15 OF THIS ARTICLE . 24
132	132
133	133	15–101. 25
134	134
135	135	(a) In this title the following words have the meanings indicated. 26
136	136
137	137	[(b) “Alternate supervising physician” means one or more physicians designated 27
138	138	by the primary supervising physician to provide supervision of a physician assistant in 28
139	139	accordance with the delegation agreement on file with the Board. 29
140	140
141	141	(c) “Ambulatory surgical facility” means a facility: 30
142	142
143	143	(1) Accredited by: 31
144	144	4 HOUSE BILL 961
145	145
146	146
147	147	(i) The American Association for Accreditation of Ambulatory 1
148	148	Surgical Facilities; 2
149	149
150	150	(ii) The Accreditation Association for Ambulatory Health Care; or 3
151	151
152	152	(iii) The Joint Commission on Accreditation of Healthcare 4
153	153	Organizations; or 5
154	154
155	155	(2) Certified to participate in the Medicare program, as enacted by Title 6
156	156	XVIII of the Social Security Act. 7
157	157
158	158	(d)] (B) “Board” means the State Board of Physicians, established under § 8
159	159	14–201 of this article. 9
160	160
161	161	(C) “COLLABORATION ” MEANS A COOPERATIVE RELATIONSH IP BETWEEN A 10
162	162	PHYSICIAN ASSISTANT AND ONE OR MORE PHYS ICIANS. 11
163	163
164	164	(D) “COLLABORATION AGREEME NT” MEANS A WRITTEN OR E LECTRONIC 12
165	165	DOCUMENT THAT : 13
166	166
167	167	(1) CONFIRMS THAT A PHYSI CIAN ASSISTANT WILL PERFORM 14
168	168	MEDICAL ACTS APPROPR IATE TO THE EDUCATIO N, TRAINING, AND EXPERIENCE OF 15
169	169	THE PHYSICIAN ASSIST ANT; 16
170	170
171	171	(2) IS SUBMITTED TO THE BOARD; AND 17
172	172
173	173	(3) IS MUTUALLY AGREED TO AND SIGNED BY THE PH YSICIAN 18
174	174	ASSISTANT AND: 19
175	175
176	176	(I) A PHYSICIAN, ACTING ON BEHALF OF THE PHYSICIAN; 20
177	177
178	178	(II) AN AUTHORIZED PHYSICI AN THAT REPRESENTS A GR OUP 21
179	179	OF PHYSICIANS; OR 22
180	180
181	181	(III) AN AUTHORIZED PHYSICI AN WHO REPRESENTS A HEALTH 23
182	182	CARE FACILITY THAT E MPLOYS, CONTRACTS, OR CREDENTIALS PHYSI CIANS. 24
183	183
184	184	(e) “Committee” means the Physician Assistant Advisory Committee. 25
185	185
186	186	(f) “Controlled dangerous substances” has the meaning stated in § 5–101 of the 26
187	187	Criminal Law Article. 27
188	188
189	189	(g) “Correctional facility” includes a State or local correctional facility. 28
190	190	HOUSE BILL 961 5
191	191
192	192
193	193	[(h) “Delegated medical acts” means activities that constitute the practice of 1
194	194	medicine delegated by a physician under Title 14 of this article. 2
195	195
196	196	(i) “Delegation agreement” means a document that is executed by a primary 3
197	197	supervising physician and a physician assistant containing the requirements of § 15–302 4
198	198	of this title.] 5
199	199
200	200	[(i–1)] (H) “Disciplinary panel” means a disciplinary panel of the Board 6
201	201	established under § 14–401 of this article. 7
202	202
203	203	[(j)] (I) “Dispense” or “dispensing” has the meaning stated in § 12–101 of this 8
204	204	article. 9
205	205
206	206	[(k)] (J) “Drug sample” means a unit of a prescription drug that is intended to 10
207	207	promote the sale of the drug and is not intended for sale. 11
208	208
209	209	[(l)] (K) “Hospital” means: 12
210	210
211	211	(1) A hospital as defined under § 19–301 of the Health – General Article; 13
212	212
213	213	(2) A comprehensive care facility that: 14
214	214
215	215	(i) Meets the requirements of a hospital–based skilled nursing 15
216	216	facility under federal law; and 16
217	217
218	218	(ii) Offers acute care in the same building; and 17
219	219
220	220	(3) An emergency room that is physically connected to a hospital or a 18
221	221	freestanding medical facility that is licensed under Title 19, Subtitle 3A of the Health – 19
222	222	General Article. 20
223	223
224	224	[(m)] (L) “License” means a license issued by the Board to a physician assistant 21
225	225	under this title. 22
226	226
227	227	[(n)] (M) “National certifying examination” means the Physician Assistant 23
228	228	National Certifying Examination administered by the National Commission on 24
229	229	Certification of Physician Assistants or its successor. 25
230	230
231	231	[(o)] (N) “Physician assistant” means an individual who is licensed under this 26
232	232	title to practice medicine [with physician supervision] UNDER A COLLABORATIO N 27
233	233	AGREEMENT . 28
234	234
235	235	[(p)] (O) “Practice as a physician assistant” means the performance of medical 29
236	236	acts that are: 30
237	237	6 HOUSE BILL 961
238	238
239	239
240	240	(1) [Delegated by a supervising physician to a physician assistant] 1
241	241	CONSISTENT WITH A COL LABORATION AGREEMENT ; 2
242	242
243	243	(2) Within the [supervising] SIGNING physician’s scope of practice; and 3
244	244
245	245	(3) Appropriate to the physician assistant’s education, training, and 4
246	246	experience. 5
247	247
248	248	[(q)] (P) “Prescriptive authority” means the authority [delegated by a primary 6
249	249	or alternate supervising physician to] PROVIDED TO a physician assistant [to: 7
250	250
251	251	(1) Prescribe and administer controlled dangerous substances, prescription 8
252	252	drugs, medical devices, and the oral, written, or electronic ordering of medications; and 9
253	253
254	254	(2) Dispense as provided under § 15–302.2(b), (c), and (d) of this title] 10
255	255	UNDER A COLLABORATIO N AGREEMENT TO PRESC RIBE DRUGS AND DEVIC ES THAT 11
256	256	IS CONSISTENT WITH T HE PHYSICIAN ASSISTA NT’S EDUCATION , TRAINING, AND 12
257	257	EXPERIENCE . 13
258	258
259	259	[(r) “Primary supervising physician” means a physician who: 14
260	260
261	261	(1) Completes a delegation agreement that meets the requirements under 15
262	262	§§ 15–301(d) and (e) and 15–302 of this title and files a copy with the Board; 16
263	263
264	264	(2) Acts as the physician responsible to ensure that a physician assistant 17
265	265	practices medicine in accordance with this title and the regulations adopted under this title; 18
266	266
267	267	(3) Ensures that a physician assistant practices within the scope of practice 19
268	268	of the primary supervising physician or any designated alternate supervising physician; 20
269	269	and 21
270	270
271	271	(4) Ensures that a list of alternate supervising physicians is maintained at 22
272	272	the practice setting.] 23
273	273
274	274	[(s)] (Q) “Public health facility” means a site where clinical public health 24
275	275	services are rendered under the auspices of the Department, a local health department in 25
276	276	a county, or the Baltimore City Health Department. 26
277	277
278	278	(R) “SIGNING PHYSICIAN ” MEANS A PHYSICIAN WH O SIGNS A 27
279	279	COLLABORATION AGREEM ENT. 28
280	280
281	281	[(t) “Starter dosage” means an amount of a drug sufficient to begin therapy: 29
282	282
283	283	(1) Of short duration of 72 hours or less; or 30
284	284
285	285	(2) Prior to obtaining a larger quantity of the drug to complete therapy. 31 HOUSE BILL 961 7
286	286
287	287
288	288
289	289	(u) (1) “Supervision” means the responsibility of a physician to exercise 1
290	290	on–site supervision or immediately available direction for physician assistants performing 2
291	291	delegated medical acts. 3
292	292
293	293	(2) “Supervision” includes physician oversight of and acceptance of direct 4
294	294	responsibility for the patient services and care rendered by a physician assistant, including 5
295	295	continuous availability to the physician assistant in person, through written instructions, 6
296	296	or by electronic means and by designation of one or more alternate supervising physicians.] 7
297	297
298	298	15–103. 8
299	299
300	300	(b) (1) Subject to paragraph (2) of this subsection, an employer of a physician 9
301	301	assistant shall report to the Board, on the form prescribed by the Board, any termination 10
302	302	of employment of the physician assistant if the cause of termination is related to a quality 11
303	303	of care issue. 12
304	304
305	305	(2) Subject to subsection (d) of this section, a [supervising] SIGNING 13
306	306	physician or an employer of a physician assistant shall notify the Board within 10 days of 14
307	307	the termination of employment of the physician assistant for reasons that would be grounds 15
308	308	for discipline under this title. 16
309	309
310	310	(3) A [supervising] SIGNING physician and a physician assistant shall 17
311	311	notify the Board within 10 days of the termination of the relationship under a [delegation] 18
312	312	COLLABORATION agreement for any reason. 19
313	313
314	314	15–202. 20
315	315
316	316	(b) Of the three physician members of the Committee, two shall [be] HAVE 21
317	317	previously [or currently serving] SERVED as supervising physicians of a physician 22
318	318	assistant under a Board–approved delegation agreement ENTERED INTO ON OR B EFORE 23
319	319	SEPTEMBER 30, 2022, OR BE CURRENTLY SERV ING AS A SIGNING PHY SICIAN UNDER 24
320	320	A COLLABORATION AGREEMENT . 25
321	321
322	322	15–205. 26
323	323
324	324	(a) In addition to the powers set forth elsewhere in this title, the Committee, on 27
325	325	its initiative or on the Board’s request, may: 28
326	326
327	327	(1) Recommend to the Board regulations for carrying out the provisions of 29
328	328	this title; 30
329	329
330	330	(2) Recommend to the Board approval, modification, or disapproval of an 31
331	331	application for licensure [or a delegation agreement]; 32
332	332	8 HOUSE BILL 961
333	333
334	334
335	335	(3) Report to the Board any conduct of a [supervising] physician or a 1
336	336	physician assistant that may be cause for disciplinary action under this title or under § 2
337	337	14–404 of this article; and 3
338	338
339	339	(4) Report to the Board any alleged unauthorized practice of a physician 4
340	340	assistant. 5
341	341
342	342	15–301. 6
343	343
344	344	(a) [Nothing in this] THIS title may NOT be construed to authorize a physician 7
345	345	assistant to practice independent of a [primary or alternate supervising physician] 8
346	346	COLLABORATION AGREEM ENT. 9
347	347
348	348	(b) A license issued to a physician assistant shall limit the physician assistant’s 10
349	349	scope of practice to medical acts: 11
350	350
351	351	(1) [Delegated by the primary or alternate supervis ing physician] 12
352	352	AUTHORIZED BY A COLLA BORATION AGREEMENT ; 13
353	353
354	354	(2) Appropriate to the education, training, and experience of the physician 14
355	355	assistant; AND 15
356	356
357	357	(3) Customary to the practice of the [primary or alternate supervising] 16
358	358	SIGNING physician[; and 17
359	359
360	360	(4) Consistent with the delegation agreement filed with the Board]. 18
361	361
362	362	(c) Patient services that may be provided by a physician assistant include: 19
363	363
364	364	[(1) (i) Taking complete, detailed, and accurate patient histories; and 20
365	365
366	366	(ii) Reviewing patient records to develop comprehensive medical 21
367	367	status reports; 22
368	368
369	369	(2) Performing physical examinations and recording all pertinent patient 23
370	370	data; 24
371	371
372	372	(3) Interpreting and evaluating patient data as authorized by the primary 25
373	373	or alternate supervising physician for the purpose of determining management and 26
374	374	treatment of patients; 27
375	375
376	376	(4) Initiating requests for or performing diagnostic procedures as indicated 28
377	377	by pertinent data and as authorized by the supervising physician; 29
378	378
379	379	(5) Providing instructions and guidance regarding medical care matters to 30
380	380	patients; 31 HOUSE BILL 961 9
381	381
382	382
383	383
384	384	(6) Assisting the primary or alternate supervising physician in the delivery 1
385	385	of services to patients who require medical care in the home and in health care institutions, 2
386	386	including: 3
387	387
388	388	(i) Recording patient progress notes; 4
389	389
390	390	(ii) Issuing diagnostic orders; and 5
391	391
392	392	(iii) Transcribing or executing specific orders at the direction of the 6
393	393	primary or alternate supervising physician; and 7
394	394
395	395	(7) Exercising prescriptive authority under a delegation agreement and in 8
396	396	accordance with § 15–302.2 of this subtitle] 9
397	397
398	398	(1) TAKING COMPREHENSIVE PATIENT HISTORIES AN D PERFORMING 10
399	399	COMPREHENSIVE PHYSIC AL EXAMINATIONS ; 11
400	400
401	401	(2) EVALUATING, DIAGNOSING, AND MANAGING PATIENT S; 12
402	402
403	403	(3) PROVIDING MEDICAL TRE ATMENT TO PATIENTS ; 13
404	404
405	405	(4) ORDERING, INTERPRET ING, AND PERFORMING DIAGN OSTIC AND 14
406	406	THERAPEUTIC MEDICAL SERVICES; 15
407	407
408	408	(5) PROVIDING CONSULTATIO N ON MEDICAL MATTERS ON REQUEST; 16
409	409
410	410	(6) EXERCISING PRESCRIPTI VE AUTHORITY IN ACCO RDANCE WITH 17
411	411	THE EDUCATION , TRAINING, AND EXPERIENCE OF TH E PHYSICIAN ASSISTAN T; 18
412	412
413	413	(7) EDUCATING PATIENTS ON HEALTH PROMOTION AND DISEASE 19
414	414	PREVENTION ; 20
415	415
416	416	(8) WRITING, TRANSCRIBING , OR EXECUTING MEDICAL ORDERS; 21
417	417
418	418	(9) PERFORMING MEDICAL AC TS IN PUBLIC HEALTH FACILITIES, 22
419	419	NURSING HOMES , HOSPITALS, HOME HEALTH AGENCIES , ASSISTED LIVING 23
420	420	FACILITIES, AND HOSPICES; 24
421	421
422	422	(10) OBTAINING INFORMED CO NSENT; 25
423	423
424	424	(11) SUPERVISING, DELEGATING , AND ASSIGNING DIAGNO STIC AND 26
425	425	THERAPEUTIC MEDICAL SERVICES TO LICENSED AND UNLICENSED PERSO NNEL; 27
426	426	10 HOUSE BILL 961
427	427
428	428
429	429	(12) CERTIFYING THE HEALT H OR DISABILITY OF A PATIENT AS 1
430	430	REQUIRED BY ANY FEDE RAL, STATE, OR LOCAL PROGRAM ; AND 2
431	431
432	432	(13) AUTHENTICATING ANY DO CUMENT, CERTIFICATION , 3
433	433	VERIFICATION, OR AFFIDAVIT AS A PH YSICIAN. 4
434	434
435	435	(d) (1) Except as otherwise provided in this title, an individual shall be 5
436	436	licensed by the Board before the individual may practice as a physician assistant. 6
437	437
438	438	(2) Except as otherwise provided in this title, a physician may not 7
439	439	[supervise] COLLABORATE WITH a physician assistant in the performance of [delegated] 8
440	440	medical acts without [filing a completed delegation agreement with] SUBMITTING A 9
441	441	COLLABORATION AGREEM ENT TO the Board. 10
442	442
443	443	(3) Except as otherwise provided in this title or in a medical emergency, a 11
444	444	physician assistant may not perform any medical act for which: 12
445	445
446	446	(i) The individual has not been licensed; and 13
447	447
448	448	(ii) The [medical acts have not been delegated by a primary or 14
449	449	alternate supervising physician] INDIVIDUAL HAS NOT B EEN PREPARED THROUGH 15
450	450	EDUCATION, TRAINING, OR EXPERIENCE . 16
451	451
452	452	(e) [A] WHILE PRACTICING UNDER A COL LABORATION AGREEMENT , A 17
453	453	physician assistant [is the agent of the primary or alternate supervising physician in the 18
454	454	performance of all practice–related activities, including the oral, written, or electronic 19
455	455	ordering of diagnostic, therapeutic, and other medical services] SHALL COLLABORATE 20
456	456	AND CONSULT WITH THE SIGNING PHYSICIAN OR ANOTHER PHYSICIAN AS 21
457	457	AUTHORIZED UNDER THE COLLABORATION AGREEM ENT. 22
458	458
459	459	(f) Except as [provided in subsection (g) of this section] OTHERWISE PROVIDED 23
460	460	IN THIS TITLE, the following individuals may practice as a physician assistant without a 24
461	461	license: 25
462	462
463	463	(1) A physician assistant student enrolled in a physician assistant 26
464	464	educational program that is accredited by the Accreditation Review Commission on 27
465	465	Education for the Physician Assistant or its successor and approved by the Board; or 28
466	466
467	467	(2) A physician assistant employed in the service of the federal government 29
468	468	while performing duties incident to that employment. 30
469	469
470	470	[(g) A physician may not delegate prescriptive authority to a physician assistant 31
471	471	student in a training program that is accredited by the Accreditation Review Commission 32
472	472	on Education for the Physician Assistant or its successor.] 33
473	473	HOUSE BILL 961 11
474	474
475	475
476	476	[(h)] (G) (1) If a medical act that is to be [delegated] PERFORMED under this 1
477	477	section is a part of the practice of a health occupation that is regulated under this article 2
478	478	by another board, any rule or regulation concerning that medical act shall be adopted 3
479	479	jointly by the State Board of Physicians and the board that regulates the other health 4
480	480	occupation. 5
481	481
482	482	(2) If the two boards cannot agree on a proposed rule or regulation, 6
483	483	the proposal shall be submitted to the Secretary for a final decision. 7
484	484
485	485	15–302. 8
486	486
487	487	(a) A [physician may delegate medical acts to a] physician assistant MAY 9
488	488	PERFORM MEDICAL ACTS only after[: 10
489	489
490	490	(1) A delegation agreement has been executed and filed with the Board; 11
491	491	and 12
492	492
493	493	(2) Any advanced duties have been authorized as required under 13
494	494	subsection (c) of this section] A COLLABORATION AGRE EMENT HAS BEEN SUBMI TTED 14
495	495	TO THE BOARD. 15
496	496
497	497	(b) The [delegation] COLLABORATION agreement shall contain: 16
498	498
499	499	(1) A description of the qualifications of the [primary supervising] 17
500	500	SIGNING physician and physician assistant; 18
501	501
502	502	(2) A description of the settings in which the physician assistant will 19
503	503	practice; 20
504	504
505	505	[(3) A description of the continuous physician supervision mechanisms that 21
506	506	are reasonable and appropriate to the practice setting; 22
507	507
508	508	(4) A description of the delegated medical acts that are within the primary 23
509	509	or alternate supervising physician’s scope of practice and require specialized education or 24
510	510	training that is consistent with accepted medical practice; 25
511	511
512	512	(5) An attestation that all medical acts to be delegated to the physician 26
513	513	assistant are within the scope of practice of the primary or alternate supervising physician 27
514	514	and appropriate to the physician assistant’s education, training, and level of competence; 28
515	515
516	516	(6) An attestation of continuous supervision of the physician assistant by 29
517	517	the primary supervising physician through the mechanisms described in the delegation 30
518	518	agreement; 31
519	519
520	520	(7) An attestation by the primary supervising physician of the physician’s 32
521	521	acceptance of responsibility for any care given by the physician assistant;] 33 12 HOUSE BILL 961
522	522
523	523
524	524
525	525	(3) AN ATTESTATION THAT T HE PHYSICIAN AS SISTANT WILL 1
526	526	COLLABORATE AND CONS ULT WITH APPROPRIATE MEMBERS OF A HEALTH CARE 2
527	527	TEAM, WHILE CONSIDERING A PATIENT’S CONDITION AND THE PHYSICIAN 3
528	528	ASSISTANT’S EDUCATION, TRAINING, AND EXPERIENCE ; 4
529	529
530	530	[(8)] (4) A description prepared by the [primary supervising] SIGNING 5
531	531	physician of the process by which the physician [assistant’s practice is reviewed 6
532	532	appropriate to the practice setting and consistent with current standards of acceptable 7
533	533	medical practice] ASSISTANT WILL COLLA BORATE WITH A PHYSIC IAN; 8
534	534
535	535	[(9)] (5) An attestation by the [primary supervising] physician [that the 9
536	536	physician will respond in a timely manner when contacted by the physician assistant] 10
537	537	ASSISTANT AND THE SI GNING PHYSICIAN THAT THE PHYSICIAN A SSISTANT WILL 11
538	538	SEEK A TIMELY RESPON SE FROM THE SIGNI NG PHYSICIAN; AND 12
539	539
540	540	[(10)] (6) The following statement: “The [primary supervising] SIGNING 13
541	541	physician and the physician assistant attest that: 14
542	542
543	543	(i) [They] THE PHYSICIAN ASSISTA NT will establish a plan for the 15
544	544	types of cases that require a physician plan of care or require that the patient initially or 16
545	545	periodically be seen by [the supervising] A physician; and 17
546	546
547	547	(ii) The patient will be provided access to [the supervising] A 18
548	548	physician on request”[; and 19
549	549
550	550	(11) Any other information deemed necessary by the Board to carry out the 20
551	551	provisions of this subtitle]. 21
552	552
553	553	[(c) (1) The Board may not require prior approval of a delegation agreement 22
554	554	that includes advanced duties, if an advanced duty will be performed in a hospital or 23
555	555	ambulatory surgical facility, provided that: 24
556	556
557	557	(i) A physician, with credentials that have been reviewed by the 25
558	558	hospital or ambulatory surgical facility as a condition of employment, as an independent 26
559	559	contractor, or as a member of the medical staff, supervises the physician assistant; 27
560	560
561	561	(ii) The physician assistant has credentials that have been reviewed 28
562	562	by the hospital or ambulatory surgical facility as a condition of employment, as an 29
563	563	independent contractor, or as a member of the medical staff; and 30
564	564
565	565	(iii) Each advanced duty to be delegated to the physician assistant is 31
566	566	reviewed and approved within a process approved by the governing body of the health care 32
567	567	facility before the physician assistant performs the advanced duties. 33
568	568	HOUSE BILL 961 13
569	569
570	570
571	571	(2) (i) In any setting that does not meet the requirements of paragraph 1
572	572	(1) of this subsection, a primary supervising physician shall obtain the Board’s approval of 2
573	573	a delegation agreement that includes advanced duties, before the physician assistant 3
574	574	performs the advanced duties. 4
575	575
576	576	(ii) 1. Before a physician assistant may perform X–ray duties 5
577	577	authorized under § 14–306(e) of this article in the medical office of the physician delegating 6
578	578	the duties, a primary supervising physician shall obtain the Board’s approval of a 7
579	579	delegation agreement that includes advanced duties in accordance with subsubparagraph 8
580	580	2 of this subparagraph. 9
581	581
582	582	2. The advanced duties set forth in a delegation agreement 10
583	583	under this subparagraph shall be limited to nonfluoroscopic X–ray procedures of the 11
584	584	extremities, anterior–posterior and lateral, not including the head. 12
585	585
586	586	(3) Notwithstanding paragraph (1) of this subsection, a primary 13
587	587	supervising physician shall obtain the Board’s approval of a delegation agreement before 14
588	588	the physician assistant may administer, monitor, or maintain general anesthesia or 15
589	589	neuroaxial anesthesia, including spinal and epidural techniques, under the agreement. 16
590	590
591	591	(d) For a delegation agreement containing advanced duties that require Board 17
592	592	approval, the Committee shall review the delegation agreement and recommend to the 18
593	593	Board that the delegation agreement be approved, rejected, or modified to ensure 19
594	594	conformance with the requirements of this title. 20
595	595
596	596	(e) The Committee may conduct a personal interview of the primary supervising 21
597	597	physician and the physician assistant. 22
598	598
599	599	(f) (1) On review of the Committee’s recommendation regarding a primary 23
600	600	supervising physician’s request to delegate advanced duties as described in a delegation 24
601	601	agreement, the Board: 25
602	602
603	603	(i) May approve the delegation agreement; or 26
604	604
605	605	(ii) 1. If the physician assistant does not meet the applicable 27
606	606	education, training, and experience requirements to perform the specified delegated acts, 28
607	607	may modify or disapprove the delegation agreement; and 29
608	608
609	609	2. If the Board takes an action under item 1 of this item: 30
610	610
611	611	A. Shall notify the primary supervising physician and the 31
612	612	physician assistant in writing of the particular elements of the proposed delegation 32
613	613	agreement that were the cause for the modification or disapproval; and 33
614	614
615	615	B. May not restrict the submission of an amendment to the 34
616	616	delegation agreement. 35
617	617	14 HOUSE BILL 961
618	618
619	619
620	620	(2) To the extent practicable, the Board shall approve a delegation 1
621	621	agreement or take other action authorized under this subsection within 90 days after 2
622	622	receiving a completed delegation agreement including any information from the physician 3
623	623	assistant and primary supervising physician necessary to approve or take action.] 4
624	624
625	625	[(g)] (C) If the Board determines that UNDER A COLLABORATIO N 5
626	626	AGREEMENT , a [primary or alternate supervising physician or] physician assistant, A 6
627	627	SIGNING PHYSICIAN , OR ANOTHER PHYSICIAN AUTHORIZED TO COLLAB ORATE WITH 7
628	628	THE PHYSICIAN ASSIST ANT UNDER THE COLLAB ORATION AGREEMENT is practicing 8
629	629	in a manner inconsistent with the requirements of this title or Title 14 of this article, the 9
630	630	Board on its own initiative or on the recommendation of the Committee may [demand 10
631	631	modification of the practice, withdraw the approval of the delegation agreement,] MODIFY 11
632	632	THE COLLABORATION AG REEMENT or refer the matter to a disciplinary panel for the 12
633	633	purpose of taking other disciplinary action under § 14–404 or § 15–314 of this article. 13
634	634
635	635	[(h) A primary supervising physician may not delegate medical acts under a 14
636	636	delegation agreement to more than four physician assistants at any one time, except in a 15
637	637	hospital or in the following nonhospital settings: 16
638	638
639	639	(1) A correctional facility; 17
640	640
641	641	(2) A detention center; or 18
642	642
643	643	(3) A public health facility. 19
644	644
645	645	(i) A person may not coerce another person to enter into a delegation agreement 20
646	646	under this subtitle. 21
647	647
648	648	(j) A physician may supervise a physician assistant: 22
649	649
650	650	(1) As a primary supervising physician in accordance with a delegation 23
651	651	agreement approved by the Board under this subtitle; or 24
652	652
653	653	(2) As an alternate supervising physician if: 25
654	654
655	655	(i) The alternate supervising physician supervises in accordance 26
656	656	with a delegation agreement filed with the Board; 27
657	657
658	658	(ii) The alternate supervising physician supervises no more than 28
659	659	four physician assistants at any one time, except in a hospital, correctional facility, 29
660	660	detention center, or public health facility; 30
661	661
662	662	(iii) The alternate supervising physician’s period of supervision, in 31
663	663	the temporary absence of the primary supervising physician, does not exceed: 32
664	664	HOUSE BILL 961 15
665	665
666	666
667	667	1. The period of time specified in the delegation agreement; 1
668	668	and 2
669	669
670	670	2. A period of 45 consecutive days at any one time; and 3
671	671
672	672	(iv) The physician assistant performs only those medical acts that: 4
673	673
674	674	1. Have been delegated under the delegation agreement filed 5
675	675	with the Board; and 6
676	676
677	677	2. Are within the scope of practice of the primary supervising 7
678	678	physician and alternate supervising physician.] 8
679	679
680	680	[(k)] (D) Subject to the notice required under § 15–103 of this title, a physician 9
681	681	assistant may terminate a [delegation agreement filed with] COLLABORATION 10
682	682	AGREEMENT SUBMITTED TO the Board under this subtitle at any time. 11
683	683
684	684	[(l) (1) In the event of the sudden departure, incapacity, or death of the 12
685	685	primary supervising physician of a physician assistant, or change in license status that 13
686	686	results in the primary supervising physician being unable to legally practice medicine, an 14
687	687	alternate supervising physician designated under subsection (b) of this section may 15
688	688	supervise the physician assistant for not longer than 15 days following the event. 16
689	689
690	690	(2) If there is no designated alternate supervising physician or the 17
691	691	designated alternate supervising physician does not agree to supervise the physician 18
692	692	assistant, the physician assistant may not practice until the physician assistant receives 19
693	693	approval of a new delegation agreement under § 15–302.1 of this subtitle. 20
694	694
695	695	(3) An alternate supervising physician or other licensed physician may 21
696	696	assume the role of primary supervising physician by submitting a new delegation 22
697	697	agreement to the Board for approval under subsection (b) of this section. 23
698	698
699	699	(4) The Board may terminate a delegation agreement if: 24
700	700
701	701	(i) The physician assistant has a change in license status that 25
702	702	results in the physician assistant being unable to legally practice as a physician assistant; 26
703	703
704	704	(ii) At least 15 days have elapsed since an event listed under 27
705	705	paragraph (1) of this subsection if there is an alternate supervising physician designated 28
706	706	under subsection (b) of this section; or 29
707	707
708	708	(iii) Immediately after an event listed under paragraph (1) of this 30
709	709	subsection if there is no alternate supervising physician designated under subsection (b) of 31
710	710	this section.] 32
711	711	16 HOUSE BILL 961
712	712
713	713
714	714	[(m)] (E) A physician assistant whose [delegation] COLLABORATION agreement 1
715	715	is terminated may not practice as a physician assistant until the physician assistant 2
716	716	[receives preliminary approval of a new delegation agreement under § 15–302.1 of this 3
717	717	subtitle] HAS SUBMITTED A NEW COLLABORATION AGREEM ENT TO THE BOARD. 4
718	718
719	719	[(n)] (F) Individual members of the Board are not civilly liable for actions 5
720	720	regarding the [approval, modification, or disapproval of a delegation agreement described 6
721	721	in this section] SUBMISSION OF A COLL ABORATION AGREEMENT . 7
722	722
723	723	[(o) A physician assistant may practice in accordance with a delegation agreement 8
724	724	filed with the Board under this subtitle.] 9
725	725
726	726	[15–302.3.] 15–302.1. 10
727	727
728	728	[(a)] On a quarterly basis, the Board shall provide to the STATE Board of Pharmacy 11
729	729	a list of physician assistants [whose delegation agreements include the delegation of 12
730	730	prescriptive authority]. 13
731	731
732	732	[(b) The list required under subsection (a) of this section shall specify whether 14
733	733	each physician assistant has been delegated the authority to prescribe controlled dangerous 15
734	734	substances, prescription drugs, or medical devices. 16
735	735
736	736	(c) If a primary supervising physician who has delegated authority to exercise 17
737	737	prescriptive authority to a physician assistant subsequently restricts or removes the 18
738	738	delegation, the primary supervising physician shall notify the Board of the restriction or 19
739	739	removal within 5 business days.] 20
740	740
741	741	15–306. 21
742	742
743	743	A license authorizes the licensee to practice as a physician assistant [under a 22
744	744	delegation agreement] AS AUTHORIZED BY A C OLLABORATION AGREEME NT while the 23
745	745	license is effective. 24
746	746
747	747	15–309. 25
748	748
749	749	(a) Each licensee shall keep a license and [delegation agreement] 26
750	750	COLLABORATION AGREEMEN T for inspection at the primary place of business of the 27
751	751	licensee. 28
752	752
753	753	15–310. 29
754	754
755	755	(b) In return for the privilege given to the physician assistant to perform 30
756	756	[delegated] medical acts in the State, the physician assistant is deemed to have: 31
757	757	HOUSE BILL 961 17
758	758
759	759
760	760	(1) Consented to submit to an examination under this section, if requested 1
761	761	by the Board in writing; and 2
762	762
763	763	(2) Waived any claim of privilege as to the testimony or examination 3
764	764	reports. 4
765	765
766	766	(c) The unreasonable failure or refusal of the licensed physician assistant or 5
767	767	applicant to submit to an examination is prima facie evidence of the licensed physician 6
768	768	assistant’s inability to perform [delegated] medical acts and is cause for denial of the 7
769	769	application or immediate suspension of the license. 8
770	770
771	771	15–313. 9
772	772
773	773	(a) (1) Except as otherwise provided under § 10–226 of the State Government 10
774	774	Article, before the Board takes any action to [reject or] modify a [delegation agreement or 11
775	775	advanced duty,] COLLABORATION AGREEM ENT, the Board shall give the licensee the 12
776	776	opportunity for a hearing before the Board. 13
777	777
778	778	(b) Any licensee aggrieved under this subtitle by a final decision of the Board 14
779	779	[rejecting or] modifying a [delegation agreement or advanced duty] COLLABORATION 15
780	780	AGREEMENT may petition for judicial review as allowed by the Administrative Procedure 16
781	781	Act. 17
782	782
783	783	15–314. 18
784	784
785	785	(a) Subject to the hearing provisions of § 15–315 of this subtitle, a disciplinary 19
786	786	panel, on the affirmative vote of a majority of the quorum, may reprimand any physician 20
787	787	assistant, place any physician assistant on probation, or suspend or revoke a license if the 21
788	788	physician assistant: 22
789	789
790	790	(41) Performs [delegated] medical acts beyond the scope of the [delegation] 23
791	791	COLLABORATION agreement filed with the Board or after notification from the Board that 24
792	792	an advanced duty has been disapproved; 25
793	793
794	794	15–317. 26
795	795
796	796	(a) A physician assistant in this State or in any other [state] JURISDICTION 27
797	797	WITHIN THE UNITED STATES is authorized to perform acts, tasks, or functions [as a 28
798	798	physician assistant under the supervision of a physician licensed to practice medicine] in 29
799	799	the State during a STATE OF EMERGENCY O R DURING A STATE OR LOCAL disaster as 30
800	800	defined by the Governor, within a county in which a state of disaster has been declared, or 31
801	801	counties contiguous to a county in which a state of disaster has been declared. 32
802	802
803	803	(b) The physician assistant shall notify the Board in writing of the [names,] 33
804	804	practice locations[,] and telephone numbers for the physician assistant [and each primary 34 18 HOUSE BILL 961
805	805
806	806
807	807	supervising physician] within 30 days of the first performance of medical acts, tasks, or 1
808	808	functions as a physician assistant during the disaster. 2
809	809
810	810	(c) A team of physicians and physician assistants or physician assistants 3
811	811	practicing under this section may not be required to maintain on–site documentation 4
812	812	describing [supervisory] arrangements UNDER A COLLABORATIO N AGREEMENT as 5
813	813	otherwise required under this title. 6
814	814
815	815	15–401. 7
816	816
817	817	(b) Except as otherwise provided in this title, a person may not perform, attempt 8
818	818	to perform, or offer to perform any [delegated] medical act beyond the scope of the license 9
819	819	and which is consistent with a [delegation agreement filed with the Board ] 10
820	820	COLLABORATION AGREEM ENT SUBMITTED TO THE BOARD. 11
821	821
822	822	15–402.1. 12
823	823
824	824	(a) Except as otherwise provided in this subtitle, a licensed physician may not 13
825	825	employ [or supervise] an individual practicing as a physician assistant who does not have 14
826	826	a license. 15
827	827
828	828	SECTION 3. AND BE IT FURTHER ENACTED, That a physician assistant who 16
829	829	entered into a delegation agreement with a supervising physician on or before September 17
830	830	30, 2022: 18
831	831
832	832	(1) may continue to practice under the delegation agreement until the end 19
833	833	of September 30, 2023; and 20
834	834
835	835	(2) must submit to the State Board of Physicians a signed collaboration 21
836	836	agreement before October 1, 2023, to continue to practice in the State after September 30, 22
837	837	2023. 23
838	838
839	839	SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 24
840	840	October 1, 2022. 25
841	841