EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0961*
HOUSE BILL 961
J2 2lr2170
CF SB 808
By: Delegates Kerr and Krebs
Introduced and read first time: February 10, 2022
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Health Occupations – Physician Assistants – Revisions 2
FOR the purpose of requiring a physician assistant to practice under a collaboration 3
agreement with a signing physician rather than under a delegation agreement with 4
a primary supervising physician; requiring a physician assistant to submit a 5
collaboration agreement to the State Board of Physicians before a certain date; 6
altering the scope of practice for a licensed physician assistant; repealing the 7
provisions of law governing the delegation of prescribing, dispensing, and 8
administering controlled dangerous substances, prescription drugs, and medical 9
devices and delegation agreements; and generally relating to physician assistants. 10
BY repealing 11
Article – Health Occupations 12
Section 15–302.1 and 15–302.2 13
Annotated Code of Maryland 14
(2021 Replacement Volume) 15
BY repealing and reenacting, without amendments, 16
Article – Health – General 17
Section 13–3301(a) 18
Annotated Code of Maryland 19
(2019 Replacement Volume and 2021 Supplement) 20
BY repealing and reenacting, with amendments, 21
Article – Health – General 22
Section 13–3301(d)(1)(v)2. 23
Annotated Code of Maryland 24
(2019 Replacement Volume and 2021 Supplement) 25
BY repealing and reenacting, without amendments, 26
Article – Health Occupations 27 2 HOUSE BILL 961
Section 12–101(a) 1
Annotated Code of Maryland 2
(2021 Replacement Volume) 3
BY repealing and reenacting, with amendments, 4
Article – Health Occupations 5
Section 12–101(b), 12–102(c)(2)(iv), 14–306(e)(3)(iii)2., 15–101, 15–103(b), 15–202(b), 6
15–205(a), 15–301, 15–302, 15–302.3, 15–306, 15–309(a), 15–310(b) and (c), 7
15–313(a)(1) and (b), 15–314(a)(41), 15–317, 15–401(b), and 15–402.1(a) 8
Annotated Code of Maryland 9
(2021 Replacement Volume) 10
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 11
That Section(s) 15–302.1 and 15–302.2 of Article – Health Occupations of the Annotated 12
Code of Maryland be repealed. 13
SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 14
as follows: 15
Article – Health – General 16
13–3301. 17
(a) In this subtitle the following words have the meanings indicated. 18
(d) “Certifying provider” means an individual who: 19
(1) (v) 2. Has an active [delegation] COLLABORATION agreement 20
with a [primary supervising] SIGNING physician UNDER TITLE 15 OF THE HEALTH 21
OCCUPATIONS ARTICLE AND who is a certifying provider; and 22
Article – Health Occupations 23
12–101. 24
(a) In this title the following words have the meanings indicated. 25
(b) “Authorized prescriber” means any licensed dentist, licensed dental hygienist 26
with prescriptive authority under § 4–206.4 of this article, licensed physician, LICENSED 27
PHYSICIAN ASSISTANT , licensed podiatrist, licensed veterinarian, advanced practice 28
nurse with prescriptive authority under § 8–508 of this article, or other individual 29
authorized by law to prescribe prescription or nonprescription drugs or devices. 30
12–102. 31
(c) (2) This title does not prohibit: 32
HOUSE BILL 961 3
(iv) A licensed physician who complies with the requirements of item 1
(ii) of this paragraph from personally preparing and dispensing a prescription written by: 2
1. A physician assistant PRACTICING in accordance with a 3
[delegation] COLLABORATION agreement that complies with Title 15, Subtitle 3 of this 4
article; or 5
2. A nurse practitioner who is authorized to practice under 6
Title 8, Subtitle 3 of this article and is working with the physician in the same office setting; 7
or 8
14–306. 9
(e) Except as otherwise provided in this section, an individual may perform 10
X–ray duties without a license only if the duties: 11
(3) Are performed: 12
(iii) 2. By a licensed physician assistant who has completed a 13
course that includes anterior–posterior and lateral radiographic studies of extremities on 14
at least 20 separate patients [under the direct supervision of the delegating physician or 15
radiologist] using a mini C–arm or similar low–level radiation machine to perform 16
nonfluoroscopic X–ray procedures, if the duties: 17
A. Include only the X–ray procedures described in paragraph 18
(2)(iii) of this subsection; and 19
B. Are performed [pursuant to a Board–approved delegation 20
agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this 21
article] IN COLLABORATION WIT H A PHYSICIAN IN ACC ORDANCE WITH A 22
COLLABORATION AGREEM ENT THAT MEETS THE R EQUIREMENTS ESTABLIS HED 23
UNDER TITLE 15 OF THIS ARTICLE . 24
15–101. 25
(a) In this title the following words have the meanings indicated. 26
[(b) “Alternate supervising physician” means one or more physicians designated 27
by the primary supervising physician to provide supervision of a physician assistant in 28
accordance with the delegation agreement on file with the Board. 29
(c) “Ambulatory surgical facility” means a facility: 30
(1) Accredited by: 31
4 HOUSE BILL 961
(i) The American Association for Accreditation of Ambulatory 1
Surgical Facilities; 2
(ii) The Accreditation Association for Ambulatory Health Care; or 3
(iii) The Joint Commission on Accreditation of Healthcare 4
Organizations; or 5
(2) Certified to participate in the Medicare program, as enacted by Title 6
XVIII of the Social Security Act. 7
(d)] (B) “Board” means the State Board of Physicians, established under § 8
14–201 of this article. 9
(C) “COLLABORATION ” MEANS A COOPERATIVE RELATIONSH IP BETWEEN A 10
PHYSICIAN ASSISTANT AND ONE OR MORE PHYS ICIANS. 11
(D) “COLLABORATION AGREEME NT” MEANS A WRITTEN OR E LECTRONIC 12
DOCUMENT THAT : 13
(1) CONFIRMS THAT A PHYSI CIAN ASSISTANT WILL PERFORM 14
MEDICAL ACTS APPROPR IATE TO THE EDUCATIO N, TRAINING, AND EXPERIENCE OF 15
THE PHYSICIAN ASSIST ANT; 16
(2) IS SUBMITTED TO THE BOARD; AND 17
(3) IS MUTUALLY AGREED TO AND SIGNED BY THE PH YSICIAN 18
ASSISTANT AND: 19
(I) A PHYSICIAN, ACTING ON BEHALF OF THE PHYSICIAN; 20
(II) AN AUTHORIZED PHYSICI AN THAT REPRESENTS A GR OUP 21
OF PHYSICIANS; OR 22
(III) AN AUTHORIZED PHYSICI AN WHO REPRESENTS A HEALTH 23
CARE FACILITY THAT E MPLOYS, CONTRACTS, OR CREDENTIALS PHYSI CIANS. 24
(e) “Committee” means the Physician Assistant Advisory Committee. 25
(f) “Controlled dangerous substances” has the meaning stated in § 5–101 of the 26
Criminal Law Article. 27
(g) “Correctional facility” includes a State or local correctional facility. 28
HOUSE BILL 961 5
[(h) “Delegated medical acts” means activities that constitute the practice of 1
medicine delegated by a physician under Title 14 of this article. 2
(i) “Delegation agreement” means a document that is executed by a primary 3
supervising physician and a physician assistant containing the requirements of § 15–302 4
of this title.] 5
[(i–1)] (H) “Disciplinary panel” means a disciplinary panel of the Board 6
established under § 14–401 of this article. 7
[(j)] (I) “Dispense” or “dispensing” has the meaning stated in § 12–101 of this 8
article. 9
[(k)] (J) “Drug sample” means a unit of a prescription drug that is intended to 10
promote the sale of the drug and is not intended for sale. 11
[(l)] (K) “Hospital” means: 12
(1) A hospital as defined under § 19–301 of the Health – General Article; 13
(2) A comprehensive care facility that: 14
(i) Meets the requirements of a hospital–based skilled nursing 15
facility under federal law; and 16
(ii) Offers acute care in the same building; and 17
(3) An emergency room that is physically connected to a hospital or a 18
freestanding medical facility that is licensed under Title 19, Subtitle 3A of the Health – 19
General Article. 20
[(m)] (L) “License” means a license issued by the Board to a physician assistant 21
under this title. 22
[(n)] (M) “National certifying examination” means the Physician Assistant 23
National Certifying Examination administered by the National Commission on 24
Certification of Physician Assistants or its successor. 25
[(o)] (N) “Physician assistant” means an individual who is licensed under this 26
title to practice medicine [with physician supervision] UNDER A COLLABORATIO N 27
AGREEMENT . 28
[(p)] (O) “Practice as a physician assistant” means the performance of medical 29
acts that are: 30
6 HOUSE BILL 961
(1) [Delegated by a supervising physician to a physician assistant] 1
CONSISTENT WITH A COL LABORATION AGREEMENT ; 2
(2) Within the [supervising] SIGNING physician’s scope of practice; and 3
(3) Appropriate to the physician assistant’s education, training, and 4
experience. 5
[(q)] (P) “Prescriptive authority” means the authority [delegated by a primary 6
or alternate supervising physician to] PROVIDED TO a physician assistant [to: 7
(1) Prescribe and administer controlled dangerous substances, prescription 8
drugs, medical devices, and the oral, written, or electronic ordering of medications; and 9
(2) Dispense as provided under § 15–302.2(b), (c), and (d) of this title] 10
UNDER A COLLABORATIO N AGREEMENT TO PRESC RIBE DRUGS AND DEVIC ES THAT 11
IS CONSISTENT WITH T HE PHYSICIAN ASSISTA NT’S EDUCATION , TRAINING, AND 12
EXPERIENCE . 13
[(r) “Primary supervising physician” means a physician who: 14
(1) Completes a delegation agreement that meets the requirements under 15
§§ 15–301(d) and (e) and 15–302 of this title and files a copy with the Board; 16
(2) Acts as the physician responsible to ensure that a physician assistant 17
practices medicine in accordance with this title and the regulations adopted under this title; 18
(3) Ensures that a physician assistant practices within the scope of practice 19
of the primary supervising physician or any designated alternate supervising physician; 20
and 21
(4) Ensures that a list of alternate supervising physicians is maintained at 22
the practice setting.] 23
[(s)] (Q) “Public health facility” means a site where clinical public health 24
services are rendered under the auspices of the Department, a local health department in 25
a county, or the Baltimore City Health Department. 26
(R) “SIGNING PHYSICIAN ” MEANS A PHYSICIAN WH O SIGNS A 27
COLLABORATION AGREEM ENT. 28
[(t) “Starter dosage” means an amount of a drug sufficient to begin therapy: 29
(1) Of short duration of 72 hours or less; or 30
(2) Prior to obtaining a larger quantity of the drug to complete therapy. 31 HOUSE BILL 961 7
(u) (1) “Supervision” means the responsibility of a physician to exercise 1
on–site supervision or immediately available direction for physician assistants performing 2
delegated medical acts. 3
(2) “Supervision” includes physician oversight of and acceptance of direct 4
responsibility for the patient services and care rendered by a physician assistant, including 5
continuous availability to the physician assistant in person, through written instructions, 6
or by electronic means and by designation of one or more alternate supervising physicians.] 7
15–103. 8
(b) (1) Subject to paragraph (2) of this subsection, an employer of a physician 9
assistant shall report to the Board, on the form prescribed by the Board, any termination 10
of employment of the physician assistant if the cause of termination is related to a quality 11
of care issue. 12
(2) Subject to subsection (d) of this section, a [supervising] SIGNING 13
physician or an employer of a physician assistant shall notify the Board within 10 days of 14
the termination of employment of the physician assistant for reasons that would be grounds 15
for discipline under this title. 16
(3) A [supervising] SIGNING physician and a physician assistant shall 17
notify the Board within 10 days of the termination of the relationship under a [delegation] 18
COLLABORATION agreement for any reason. 19
15–202. 20
(b) Of the three physician members of the Committee, two shall [be] HAVE 21
previously [or currently serving] SERVED as supervising physicians of a physician 22
assistant under a Board–approved delegation agreement ENTERED INTO ON OR B EFORE 23
SEPTEMBER 30, 2022, OR BE CURRENTLY SERV ING AS A SIGNING PHY SICIAN UNDER 24
A COLLABORATION AGREEMENT . 25
15–205. 26
(a) In addition to the powers set forth elsewhere in this title, the Committee, on 27
its initiative or on the Board’s request, may: 28
(1) Recommend to the Board regulations for carrying out the provisions of 29
this title; 30
(2) Recommend to the Board approval, modification, or disapproval of an 31
application for licensure [or a delegation agreement]; 32
8 HOUSE BILL 961
(3) Report to the Board any conduct of a [supervising] physician or a 1
physician assistant that may be cause for disciplinary action under this title or under § 2
14–404 of this article; and 3
(4) Report to the Board any alleged unauthorized practice of a physician 4
assistant. 5
15–301. 6
(a) [Nothing in this] THIS title may NOT be construed to authorize a physician 7
assistant to practice independent of a [primary or alternate supervising physician] 8
COLLABORATION AGREEM ENT. 9
(b) A license issued to a physician assistant shall limit the physician assistant’s 10
scope of practice to medical acts: 11
(1) [Delegated by the primary or alternate supervis ing physician] 12
AUTHORIZED BY A COLLA BORATION AGREEMENT ; 13
(2) Appropriate to the education, training, and experience of the physician 14
assistant; AND 15
(3) Customary to the practice of the [primary or alternate supervising] 16
SIGNING physician[; and 17
(4) Consistent with the delegation agreement filed with the Board]. 18
(c) Patient services that may be provided by a physician assistant include: 19
[(1) (i) Taking complete, detailed, and accurate patient histories; and 20
(ii) Reviewing patient records to develop comprehensive medical 21
status reports; 22
(2) Performing physical examinations and recording all pertinent patient 23
data; 24
(3) Interpreting and evaluating patient data as authorized by the primary 25
or alternate supervising physician for the purpose of determining management and 26
treatment of patients; 27
(4) Initiating requests for or performing diagnostic procedures as indicated 28
by pertinent data and as authorized by the supervising physician; 29
(5) Providing instructions and guidance regarding medical care matters to 30
patients; 31 HOUSE BILL 961 9
(6) Assisting the primary or alternate supervising physician in the delivery 1
of services to patients who require medical care in the home and in health care institutions, 2
including: 3
(i) Recording patient progress notes; 4
(ii) Issuing diagnostic orders; and 5
(iii) Transcribing or executing specific orders at the direction of the 6
primary or alternate supervising physician; and 7
(7) Exercising prescriptive authority under a delegation agreement and in 8
accordance with § 15–302.2 of this subtitle] 9
(1) TAKING COMPREHENSIVE PATIENT HISTORIES AN D PERFORMING 10
COMPREHENSIVE PHYSIC AL EXAMINATIONS ; 11
(2) EVALUATING, DIAGNOSING, AND MANAGING PATIENT S; 12
(3) PROVIDING MEDICAL TRE ATMENT TO PATIENTS ; 13
(4) ORDERING, INTERPRET ING, AND PERFORMING DIAGN OSTIC AND 14
THERAPEUTIC MEDICAL SERVICES; 15
(5) PROVIDING CONSULTATIO N ON MEDICAL MATTERS ON REQUEST; 16
(6) EXERCISING PRESCRIPTI VE AUTHORITY IN ACCO RDANCE WITH 17
THE EDUCATION , TRAINING, AND EXPERIENCE OF TH E PHYSICIAN ASSISTAN T; 18
(7) EDUCATING PATIENTS ON HEALTH PROMOTION AND DISEASE 19
PREVENTION ; 20
(8) WRITING, TRANSCRIBING , OR EXECUTING MEDICAL ORDERS; 21
(9) PERFORMING MEDICAL AC TS IN PUBLIC HEALTH FACILITIES, 22
NURSING HOMES , HOSPITALS, HOME HEALTH AGENCIES , ASSISTED LIVING 23
FACILITIES, AND HOSPICES; 24
(10) OBTAINING INFORMED CO NSENT; 25
(11) SUPERVISING, DELEGATING , AND ASSIGNING DIAGNO STIC AND 26
THERAPEUTIC MEDICAL SERVICES TO LICENSED AND UNLICENSED PERSO NNEL; 27
10 HOUSE BILL 961
(12) CERTIFYING THE HEALT H OR DISABILITY OF A PATIENT AS 1
REQUIRED BY ANY FEDE RAL, STATE, OR LOCAL PROGRAM ; AND 2
(13) AUTHENTICATING ANY DO CUMENT, CERTIFICATION , 3
VERIFICATION, OR AFFIDAVIT AS A PH YSICIAN. 4
(d) (1) Except as otherwise provided in this title, an individual shall be 5
licensed by the Board before the individual may practice as a physician assistant. 6
(2) Except as otherwise provided in this title, a physician may not 7
[supervise] COLLABORATE WITH a physician assistant in the performance of [delegated] 8
medical acts without [filing a completed delegation agreement with] SUBMITTING A 9
COLLABORATION AGREEM ENT TO the Board. 10
(3) Except as otherwise provided in this title or in a medical emergency, a 11
physician assistant may not perform any medical act for which: 12
(i) The individual has not been licensed; and 13
(ii) The [medical acts have not been delegated by a primary or 14
alternate supervising physician] INDIVIDUAL HAS NOT B EEN PREPARED THROUGH 15
EDUCATION, TRAINING, OR EXPERIENCE . 16
(e) [A] WHILE PRACTICING UNDER A COL LABORATION AGREEMENT , A 17
physician assistant [is the agent of the primary or alternate supervising physician in the 18
performance of all practice–related activities, including the oral, written, or electronic 19
ordering of diagnostic, therapeutic, and other medical services] SHALL COLLABORATE 20
AND CONSULT WITH THE SIGNING PHYSICIAN OR ANOTHER PHYSICIAN AS 21
AUTHORIZED UNDER THE COLLABORATION AGREEM ENT. 22
(f) Except as [provided in subsection (g) of this section] OTHERWISE PROVIDED 23
IN THIS TITLE, the following individuals may practice as a physician assistant without a 24
license: 25
(1) A physician assistant student enrolled in a physician assistant 26
educational program that is accredited by the Accreditation Review Commission on 27
Education for the Physician Assistant or its successor and approved by the Board; or 28
(2) A physician assistant employed in the service of the federal government 29
while performing duties incident to that employment. 30
[(g) A physician may not delegate prescriptive authority to a physician assistant 31
student in a training program that is accredited by the Accreditation Review Commission 32
on Education for the Physician Assistant or its successor.] 33
HOUSE BILL 961 11
[(h)] (G) (1) If a medical act that is to be [delegated] PERFORMED under this 1
section is a part of the practice of a health occupation that is regulated under this article 2
by another board, any rule or regulation concerning that medical act shall be adopted 3
jointly by the State Board of Physicians and the board that regulates the other health 4
occupation. 5
(2) If the two boards cannot agree on a proposed rule or regulation, 6
the proposal shall be submitted to the Secretary for a final decision. 7
15–302. 8
(a) A [physician may delegate medical acts to a] physician assistant MAY 9
PERFORM MEDICAL ACTS only after[: 10
(1) A delegation agreement has been executed and filed with the Board; 11
and 12
(2) Any advanced duties have been authorized as required under 13
subsection (c) of this section] A COLLABORATION AGRE EMENT HAS BEEN SUBMI TTED 14
TO THE BOARD. 15
(b) The [delegation] COLLABORATION agreement shall contain: 16
(1) A description of the qualifications of the [primary supervising] 17
SIGNING physician and physician assistant; 18
(2) A description of the settings in which the physician assistant will 19
practice; 20
[(3) A description of the continuous physician supervision mechanisms that 21
are reasonable and appropriate to the practice setting; 22
(4) A description of the delegated medical acts that are within the primary 23
or alternate supervising physician’s scope of practice and require specialized education or 24
training that is consistent with accepted medical practice; 25
(5) An attestation that all medical acts to be delegated to the physician 26
assistant are within the scope of practice of the primary or alternate supervising physician 27
and appropriate to the physician assistant’s education, training, and level of competence; 28
(6) An attestation of continuous supervision of the physician assistant by 29
the primary supervising physician through the mechanisms described in the delegation 30
agreement; 31
(7) An attestation by the primary supervising physician of the physician’s 32
acceptance of responsibility for any care given by the physician assistant;] 33 12 HOUSE BILL 961
(3) AN ATTESTATION THAT T HE PHYSICIAN AS SISTANT WILL 1
COLLABORATE AND CONS ULT WITH APPROPRIATE MEMBERS OF A HEALTH CARE 2
TEAM, WHILE CONSIDERING A PATIENT’S CONDITION AND THE PHYSICIAN 3
ASSISTANT’S EDUCATION, TRAINING, AND EXPERIENCE ; 4
[(8)] (4) A description prepared by the [primary supervising] SIGNING 5
physician of the process by which the physician [assistant’s practice is reviewed 6
appropriate to the practice setting and consistent with current standards of acceptable 7
medical practice] ASSISTANT WILL COLLA BORATE WITH A PHYSIC IAN; 8
[(9)] (5) An attestation by the [primary supervising] physician [that the 9
physician will respond in a timely manner when contacted by the physician assistant] 10
ASSISTANT AND THE SI GNING PHYSICIAN THAT THE PHYSICIAN A SSISTANT WILL 11
SEEK A TIMELY RESPON SE FROM THE SIGNI NG PHYSICIAN; AND 12
[(10)] (6) The following statement: “The [primary supervising] SIGNING 13
physician and the physician assistant attest that: 14
(i) [They] THE PHYSICIAN ASSISTA NT will establish a plan for the 15
types of cases that require a physician plan of care or require that the patient initially or 16
periodically be seen by [the supervising] A physician; and 17
(ii) The patient will be provided access to [the supervising] A 18
physician on request”[; and 19
(11) Any other information deemed necessary by the Board to carry out the 20
provisions of this subtitle]. 21
[(c) (1) The Board may not require prior approval of a delegation agreement 22
that includes advanced duties, if an advanced duty will be performed in a hospital or 23
ambulatory surgical facility, provided that: 24
(i) A physician, with credentials that have been reviewed by the 25
hospital or ambulatory surgical facility as a condition of employment, as an independent 26
contractor, or as a member of the medical staff, supervises the physician assistant; 27
(ii) The physician assistant has credentials that have been reviewed 28
by the hospital or ambulatory surgical facility as a condition of employment, as an 29
independent contractor, or as a member of the medical staff; and 30
(iii) Each advanced duty to be delegated to the physician assistant is 31
reviewed and approved within a process approved by the governing body of the health care 32
facility before the physician assistant performs the advanced duties. 33
HOUSE BILL 961 13
(2) (i) In any setting that does not meet the requirements of paragraph 1
(1) of this subsection, a primary supervising physician shall obtain the Board’s approval of 2
a delegation agreement that includes advanced duties, before the physician assistant 3
performs the advanced duties. 4
(ii) 1. Before a physician assistant may perform X–ray duties 5
authorized under § 14–306(e) of this article in the medical office of the physician delegating 6
the duties, a primary supervising physician shall obtain the Board’s approval of a 7
delegation agreement that includes advanced duties in accordance with subsubparagraph 8
2 of this subparagraph. 9
2. The advanced duties set forth in a delegation agreement 10
under this subparagraph shall be limited to nonfluoroscopic X–ray procedures of the 11
extremities, anterior–posterior and lateral, not including the head. 12
(3) Notwithstanding paragraph (1) of this subsection, a primary 13
supervising physician shall obtain the Board’s approval of a delegation agreement before 14
the physician assistant may administer, monitor, or maintain general anesthesia or 15
neuroaxial anesthesia, including spinal and epidural techniques, under the agreement. 16
(d) For a delegation agreement containing advanced duties that require Board 17
approval, the Committee shall review the delegation agreement and recommend to the 18
Board that the delegation agreement be approved, rejected, or modified to ensure 19
conformance with the requirements of this title. 20
(e) The Committee may conduct a personal interview of the primary supervising 21
physician and the physician assistant. 22
(f) (1) On review of the Committee’s recommendation regarding a primary 23
supervising physician’s request to delegate advanced duties as described in a delegation 24
agreement, the Board: 25
(i) May approve the delegation agreement; or 26
(ii) 1. If the physician assistant does not meet the applicable 27
education, training, and experience requirements to perform the specified delegated acts, 28
may modify or disapprove the delegation agreement; and 29
2. If the Board takes an action under item 1 of this item: 30
A. Shall notify the primary supervising physician and the 31
physician assistant in writing of the particular elements of the proposed delegation 32
agreement that were the cause for the modification or disapproval; and 33
B. May not restrict the submission of an amendment to the 34
delegation agreement. 35
14 HOUSE BILL 961
(2) To the extent practicable, the Board shall approve a delegation 1
agreement or take other action authorized under this subsection within 90 days after 2
receiving a completed delegation agreement including any information from the physician 3
assistant and primary supervising physician necessary to approve or take action.] 4
[(g)] (C) If the Board determines that UNDER A COLLABORATIO N 5
AGREEMENT , a [primary or alternate supervising physician or] physician assistant, A 6
SIGNING PHYSICIAN , OR ANOTHER PHYSICIAN AUTHORIZED TO COLLAB ORATE WITH 7
THE PHYSICIAN ASSIST ANT UNDER THE COLLAB ORATION AGREEMENT is practicing 8
in a manner inconsistent with the requirements of this title or Title 14 of this article, the 9
Board on its own initiative or on the recommendation of the Committee may [demand 10
modification of the practice, withdraw the approval of the delegation agreement,] MODIFY 11
THE COLLABORATION AG REEMENT or refer the matter to a disciplinary panel for the 12
purpose of taking other disciplinary action under § 14–404 or § 15–314 of this article. 13
[(h) A primary supervising physician may not delegate medical acts under a 14
delegation agreement to more than four physician assistants at any one time, except in a 15
hospital or in the following nonhospital settings: 16
(1) A correctional facility; 17
(2) A detention center; or 18
(3) A public health facility. 19
(i) A person may not coerce another person to enter into a delegation agreement 20
under this subtitle. 21
(j) A physician may supervise a physician assistant: 22
(1) As a primary supervising physician in accordance with a delegation 23
agreement approved by the Board under this subtitle; or 24
(2) As an alternate supervising physician if: 25
(i) The alternate supervising physician supervises in accordance 26
with a delegation agreement filed with the Board; 27
(ii) The alternate supervising physician supervises no more than 28
four physician assistants at any one time, except in a hospital, correctional facility, 29
detention center, or public health facility; 30
(iii) The alternate supervising physician’s period of supervision, in 31
the temporary absence of the primary supervising physician, does not exceed: 32
HOUSE BILL 961 15
1. The period of time specified in the delegation agreement; 1
and 2
2. A period of 45 consecutive days at any one time; and 3
(iv) The physician assistant performs only those medical acts that: 4
1. Have been delegated under the delegation agreement filed 5
with the Board; and 6
2. Are within the scope of practice of the primary supervising 7
physician and alternate supervising physician.] 8
[(k)] (D) Subject to the notice required under § 15–103 of this title, a physician 9
assistant may terminate a [delegation agreement filed with] COLLABORATION 10
AGREEMENT SUBMITTED TO the Board under this subtitle at any time. 11
[(l) (1) In the event of the sudden departure, incapacity, or death of the 12
primary supervising physician of a physician assistant, or change in license status that 13
results in the primary supervising physician being unable to legally practice medicine, an 14
alternate supervising physician designated under subsection (b) of this section may 15
supervise the physician assistant for not longer than 15 days following the event. 16
(2) If there is no designated alternate supervising physician or the 17
designated alternate supervising physician does not agree to supervise the physician 18
assistant, the physician assistant may not practice until the physician assistant receives 19
approval of a new delegation agreement under § 15–302.1 of this subtitle. 20
(3) An alternate supervising physician or other licensed physician may 21
assume the role of primary supervising physician by submitting a new delegation 22
agreement to the Board for approval under subsection (b) of this section. 23
(4) The Board may terminate a delegation agreement if: 24
(i) The physician assistant has a change in license status that 25
results in the physician assistant being unable to legally practice as a physician assistant; 26
(ii) At least 15 days have elapsed since an event listed under 27
paragraph (1) of this subsection if there is an alternate supervising physician designated 28
under subsection (b) of this section; or 29
(iii) Immediately after an event listed under paragraph (1) of this 30
subsection if there is no alternate supervising physician designated under subsection (b) of 31
this section.] 32
16 HOUSE BILL 961
[(m)] (E) A physician assistant whose [delegation] COLLABORATION agreement 1
is terminated may not practice as a physician assistant until the physician assistant 2
[receives preliminary approval of a new delegation agreement under § 15–302.1 of this 3
subtitle] HAS SUBMITTED A NEW COLLABORATION AGREEM ENT TO THE BOARD. 4
[(n)] (F) Individual members of the Board are not civilly liable for actions 5
regarding the [approval, modification, or disapproval of a delegation agreement described 6
in this section] SUBMISSION OF A COLL ABORATION AGREEMENT . 7
[(o) A physician assistant may practice in accordance with a delegation agreement 8
filed with the Board under this subtitle.] 9
[15–302.3.] 15–302.1. 10
[(a)] On a quarterly basis, the Board shall provide to the STATE Board of Pharmacy 11
a list of physician assistants [whose delegation agreements include the delegation of 12
prescriptive authority]. 13
[(b) The list required under subsection (a) of this section shall specify whether 14
each physician assistant has been delegated the authority to prescribe controlled dangerous 15
substances, prescription drugs, or medical devices. 16
(c) If a primary supervising physician who has delegated authority to exercise 17
prescriptive authority to a physician assistant subsequently restricts or removes the 18
delegation, the primary supervising physician shall notify the Board of the restriction or 19
removal within 5 business days.] 20
15–306. 21
A license authorizes the licensee to practice as a physician assistant [under a 22
delegation agreement] AS AUTHORIZED BY A C OLLABORATION AGREEME NT while the 23
license is effective. 24
15–309. 25
(a) Each licensee shall keep a license and [delegation agreement] 26
COLLABORATION AGREEMEN T for inspection at the primary place of business of the 27
licensee. 28
15–310. 29
(b) In return for the privilege given to the physician assistant to perform 30
[delegated] medical acts in the State, the physician assistant is deemed to have: 31
HOUSE BILL 961 17
(1) Consented to submit to an examination under this section, if requested 1
by the Board in writing; and 2
(2) Waived any claim of privilege as to the testimony or examination 3
reports. 4
(c) The unreasonable failure or refusal of the licensed physician assistant or 5
applicant to submit to an examination is prima facie evidence of the licensed physician 6
assistant’s inability to perform [delegated] medical acts and is cause for denial of the 7
application or immediate suspension of the license. 8
15–313. 9
(a) (1) Except as otherwise provided under § 10–226 of the State Government 10
Article, before the Board takes any action to [reject or] modify a [delegation agreement or 11
advanced duty,] COLLABORATION AGREEM ENT, the Board shall give the licensee the 12
opportunity for a hearing before the Board. 13
(b) Any licensee aggrieved under this subtitle by a final decision of the Board 14
[rejecting or] modifying a [delegation agreement or advanced duty] COLLABORATION 15
AGREEMENT may petition for judicial review as allowed by the Administrative Procedure 16
Act. 17
15–314. 18
(a) Subject to the hearing provisions of § 15–315 of this subtitle, a disciplinary 19
panel, on the affirmative vote of a majority of the quorum, may reprimand any physician 20
assistant, place any physician assistant on probation, or suspend or revoke a license if the 21
physician assistant: 22
(41) Performs [delegated] medical acts beyond the scope of the [delegation] 23
COLLABORATION agreement filed with the Board or after notification from the Board that 24
an advanced duty has been disapproved; 25
15–317. 26
(a) A physician assistant in this State or in any other [state] JURISDICTION 27
WITHIN THE UNITED STATES is authorized to perform acts, tasks, or functions [as a 28
physician assistant under the supervision of a physician licensed to practice medicine] in 29
the State during a STATE OF EMERGENCY O R DURING A STATE OR LOCAL disaster as 30
defined by the Governor, within a county in which a state of disaster has been declared, or 31
counties contiguous to a county in which a state of disaster has been declared. 32
(b) The physician assistant shall notify the Board in writing of the [names,] 33
practice locations[,] and telephone numbers for the physician assistant [and each primary 34 18 HOUSE BILL 961
supervising physician] within 30 days of the first performance of medical acts, tasks, or 1
functions as a physician assistant during the disaster. 2
(c) A team of physicians and physician assistants or physician assistants 3
practicing under this section may not be required to maintain on–site documentation 4
describing [supervisory] arrangements UNDER A COLLABORATIO N AGREEMENT as 5
otherwise required under this title. 6
15–401. 7
(b) Except as otherwise provided in this title, a person may not perform, attempt 8
to perform, or offer to perform any [delegated] medical act beyond the scope of the license 9
and which is consistent with a [delegation agreement filed with the Board ] 10
COLLABORATION AGREEM ENT SUBMITTED TO THE BOARD. 11
15–402.1. 12
(a) Except as otherwise provided in this subtitle, a licensed physician may not 13
employ [or supervise] an individual practicing as a physician assistant who does not have 14
a license. 15
SECTION 3. AND BE IT FURTHER ENACTED, That a physician assistant who 16
entered into a delegation agreement with a supervising physician on or before September 17
30, 2022: 18
(1) may continue to practice under the delegation agreement until the end 19
of September 30, 2023; and 20
(2) must submit to the State Board of Physicians a signed collaboration 21
agreement before October 1, 2023, to continue to practice in the State after September 30, 22
2023. 23
SECTION 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 24
October 1, 2022. 25