Maryland 2023 Regular Session

Maryland House Bill HB727 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	hb0727
6	6
7	7	HOUSE BILL 727
8	8	J2 3lr1582
9	9	CF SB 673
10	10	By: Delegate Kerr
11	11	Introduced and read first time: February 8, 2023
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	Physician Assistants – Revisions 2
19	19	(Physician Assistant Modernization Act of 2023) 3
20	20
21	21	FOR the purpose of requiring that a physician assistant have a collaboration registration, 4
22	22	rather than a delegation agreement, in order to practice as a physician assistant; 5
23	23	altering the scope of practice of a physician assistant; altering the education required 6
24	24	for licensure as a physician assistant; authorizing physician assistants who are 7
25	25	employees of the federal government to perform acts, tasks, or functions as a 8
26	26	physician assistant during a certain disaster; providing certain immunity to certain 9
27	27	physician assistants; and generally relating to physician assistants. 10
28	28
29	29	BY repealing and reenacting, with amendments, 11
30	30	Article – Education 12
31	31	Section 7–402(c) and 18–802(a)(8) 13
32	32	Annotated Code of Maryland 14
33	33	(2022 Replacement Volume) 15
34	34
35	35	BY repealing and reenacting, without amendments, 16
36	36	Article – Education 17
37	37	Section 18–802(a)(1) 18
38	38	Annotated Code of Maryland 19
39	39	(2022 Replacement Volume) 20
40	40
41	41	BY repealing and reenacting, without amendments, 21
42	42	Article – Health – General 22
43	43	Section 4–201(a), 5–601(a), and 13–3301(a) 23
44	44	Annotated Code of Maryland 24
45	45	(2019 Replacement Volume and 2022 Supplement) 25
46	46
47	47	BY repealing and reenacting, with amendments, 26
48	48	Article – Health – General 27 2 HOUSE BILL 727
49	49
50	50
51	51	Section 4–201(s), 5–601(v), and 13–3301(d)(1)(v) 1
52	52	Annotated Code of Maryland 2
53	53	(2019 Replacement Volume and 2022 Supplement) 3
54	54
55	55	BY repealing and reenacting, with amendments, 4
56	56	Article – Health Occupations 5
57	57	Section 12–102(c)(2)(iv) and (v), 14–306(a) and (e)(3), 15–101, 15–102, 15–103, 6
58	58	15–202(b), 15–205(a), 15–301, 15–302, 15–302.2, 15–303, 15–306, 7
59	59	15–309(a), 15–310, 15–314(a)(43) through (45), 15–317, 15–401, and 8
60	60	15–402.1(a) 9
61	61	Annotated Code of Maryland 10
62	62	(2021 Replacement Volume and 2022 Supplement) 11
63	63
64	64	BY adding to 12
65	65	Article – Health Occupations 13
66	66	Section 12–102(c)(2)(vi) and 15–314(a)(41) 14
67	67	Annotated Code of Maryland 15
68	68	(2021 Replacement Volume and 2022 Supplement) 16
69	69
70	70	BY repealing and reenacting, without amendments, 17
71	71	Article – Health Occupations 18
72	72	Section 15–202(a)(1) and (2) 19
73	73	Annotated Code of Maryland 20
74	74	(2021 Replacement Volume and 2022 Supplement) 21
75	75
76	76	BY repealing 22
77	77	Article – Health Occupations 23
78	78	Section 15–302.1, 15–302.3, 15–313, and 15–314(a)(41) and (42) 24
79	79	Annotated Code of Maryland 25
80	80	(2021 Replacement Volume and 2022 Supplement) 26
81	81
82	82	BY repealing and reenacting, without amendments, 27
83	83	Article – Transportation 28
84	84	Section 13–616(a)(1) 29
85	85	Annotated Code of Maryland 30
86	86	(2020 Replacement Volume and 2022 Supplement) 31
87	87
88	88	BY repealing and reenacting, with amendments, 32
89	89	Article – Transportation 33
90	90	Section 13–616(a)(7) 34
91	91	Annotated Code of Maryland 35
92	92	(2020 Replacement Volume and 2022 Supplement) 36
93	93
94	94	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 37
95	95	That the Laws of Maryland read as follows: 38
96	96
97	97	Article – Education 39 HOUSE BILL 727 3
98	98
99	99
100	100
101	101	7–402. 1
102	102
103	103	(c) The physical examination required under subsection (b) of this section shall 2
104	104	be completed by: 3
105	105
106	106	(1) A licensed physician; 4
107	107
108	108	(2) A licensed physician assistant [with a delegation agreement approved 5
109	109	by the State Board of Physicians]; or 6
110	110
111	111	(3) A certified nurse practitioner. 7
112	112
113	113	18–802. 8
114	114
115	115	(a) (1) In this section the following words have the meanings indicated. 9
116	116
117	117	(8) “Physician assistant” means an individual [to whom duties are 10
118	118	delegated by a licensed physician under the rules and regulations of the State Board of 11
119	119	Physicians] LICENSED UNDER TITLE 15 OF THE HEALTH OCCUPATIONS ARTICLE TO 12
120	120	PRACTICE AS A PHYSIC IAN ASSISTANT. 13
121	121
122	122	Article – Health – General 14
123	123
124	124	4–201. 15
125	125
126	126	(a) In this subtitle the following words have the meanings indicated. 16
127	127
128	128	(s) “Physician assistant” means an individual who is licensed under Title 15 of 17
129	129	the Health Occupations Article to practice [medicine with physician supervision] AS A 18
130	130	PHYSICIAN ASSISTANT . 19
131	131
132	132	5–601. 20
133	133
134	134	(a) In this subtitle the following words have the meanings indicated. 21
135	135
136	136	(v) “Physician assistant” means an individual who is licensed under Title 15 of 22
137	137	the Health Occupations Article to practice [medicine with physician supervision] AS A 23
138	138	PHYSICIAN ASSISTANT . 24
139	139
140	140	13–3301. 25
141	141
142	142	(a) In this subtitle the following words have the meanings indicated. 26
143	143
144	144	(d) “Certifying provider” means an individual who: 27
145	145	4 HOUSE BILL 727
146	146
147	147
148	148	(1) (v) 1. Has an active, unrestricted license to practice as a 1
149	149	physician assistant issued by the State Board of Physicians under Title 15 of the Health 2
150	150	Occupations Article; AND 3
151	151
152	152	2. [Has an active delegation agreement with a primary 4
153	153	supervising physician who is a certifying provider; and 5
154	154
155	155	3.] Is in good standing with the State Board of Physicians; 6
156	156
157	157	Article – Health Occupations 7
158	158
159	159	12–102. 8
160	160
161	161	(c) (2) This title does not prohibit: 9
162	162
163	163	(iv) A licensed physician who complies with the requirements of item 10
164	164	(ii) of this paragraph from personally preparing and dispensing a prescription written by: 11
165	165
166	166	1. A physician assistant [in accordance with a delegation 12
167	167	agreement that] WHO complies with Title 15, Subtitle 3 of this article; or 13
168	168
169	169	2. A nurse practitioner who is authorized to practice under 14
170	170	Title 8, Subtitle 3 of this article and is working with the physician in the same office setting; 15
171	171	[or] 16
172	172
173	173	(v) A hospital–based clinic from dispensing prescriptions to its 17
174	174	patients; OR 18
175	175
176	176	(VI) A PHYSICIAN ASSISTANT FROM PERSONALLY PREPARING 19
177	177	AND DISPENSING A PRE SCRIPTION IN ACCORDA NCE WITH § 15–302.1 OF THIS 20
178	178	ARTICLE. 21
179	179
180	180	14–306. 22
181	181
182	182	(a) To the extent permitted by the rules, regulations, and orders of the Board, an 23
183	183	individual to whom duties are delegated by a licensed physician OR A PHYSI CIAN 24
184	184	ASSISTANT WHO HAS TH E APPROPRIATE EDUCAT ION, TRAINING, AND EXPERIENCE 25
185	185	TO PERFORM X–RAY DUTIES may perform those duties without a license as provided in 26
186	186	this section. 27
187	187
188	188	(e) Except as otherwise provided in this section, an individual may perform 28
189	189	X–ray duties without a license only if the duties: 29
190	190
191	191	(3) Are performed: 30
192	192	HOUSE BILL 727 5
193	193
194	194
195	195	(i) By an individual who is not employed primarily to perform 1
196	196	X–ray duties; 2
197	197
198	198	(ii) 1. In the medical office of the physician who delegates the 3
199	199	duties; [and] OR 4
200	200
201	201	2. IN THE SETTING IN WHICH THE PHYSICIAN ASSISTANT 5
202	202	PRACTICES AS A PHYSI CIAN ASSISTANT; AND 6
203	203
204	204	(iii) 1. By an individual who, before October 1, 2002, has: 7
205	205
206	206	A. Taken a course consisting of at least 30 hours of training 8
207	207	in performing X–ray procedures approved by the Maryland Radiological Society in 9
208	208	consultation with the Maryland Society of Radiologic Technologists; and 10
209	209
210	210	B. Successfully passed an examination based on that course 11
211	211	that has been approved by the Maryland Radiological Society in consultation with the 12
212	212	Maryland Society of Radiologic Technologists; or 13
213	213
214	214	2. By a licensed physician assistant [who has completed a 14
215	215	course that includes anterior–posterior and lateral radiographic studies of extremities on 15
216	216	at least 20 separate patients under the direct supervision of the delegating physician or 16
217	217	radiologist using a mini C–arm or similar low–level radiation machine to perform 17
218	218	nonfluoroscopic X–ray procedures, if the duties: 18
219	219
220	220	A. Include only the X–ray procedures described in paragraph 19
221	221	(2)(iii) of this subsection; and 20
222	222
223	223	B. Are performed pursuant to a Board–approved delegation 21
224	224	agreement that includes a request to perform advanced duties under § 15–302(c)(2) of this 22
225	225	article] WHO HAS THE APPROPRI ATE EDUCATION , TRAINING, AND EXPERIENCE TO 23
226	226	PERFORM X–RAY DUTIES. 24
227	227
228	228	15–101. 25
229	229
230	230	(a) In this title the following words have the meanings indicated. 26
231	231
232	232	[(b) “Alternate supervising physician” means one or more physicians designated 27
233	233	by the primary supervising physician to provide supervision of a physician assistant in 28
234	234	accordance with the delegation agreement on file with the Board.] 29
235	235
236	236	[(c)] (B) “Ambulatory surgical facility” means a facility: 30
237	237
238	238	(1) Accredited by: 31
239	239	6 HOUSE BILL 727
240	240
241	241
242	242	(i) The American Association for Accreditation of Ambulatory 1
243	243	Surgical Facilities; 2
244	244
245	245	(ii) The Accreditation Association for Ambulatory Health Care; or 3
246	246
247	247	(iii) The Joint Commission on Accreditation of Healthcare 4
248	248	Organizations; or 5
249	249
250	250	(2) Certified to participate in the Medicare program, as enacted by Title 6
251	251	XVIII of the Social Security Act. 7
252	252
253	253	[(d)] (C) “Board” means the State Board of Physicians, established under § 8
254	254	14–201 of this article. 9
255	255
256	256	(D) “COLLABORATION REGISTR ATION” MEANS A DOCUMENT THA T: 10
257	257
258	258	(1) OUTLINES A COLLABORAT IVE RELATIONSHIP BET WEEN A 11
259	259	PHYSICIAN ASSISTANT AND: 12
260	260
261	261	(I) AN INDIVIDUAL PHYSICI AN; 13
262	262
263	263	(II) A GROUP OF PHYSICIANS ; OR 14
264	264
265	265	(III) A HEALTH CARE FACILITY OR ORGANIZATION THAT 15
266	266	EMPLOYS, CONTRACTS WITH , OR CREDENTIALS PHYSI CIANS; 16
267	267
268	268	(2) IS DEVELOPED BY A PHY SICIAN ASSISTANT AND A PERSON LISTED 17
269	269	IN ITEM (1) OF THIS SUBSECTION ; AND 18
270	270
271	271	(3) IS SUBMITTED TO THE BOARD. 19
272	272
273	273	(e) “Committee” means the Physician Assistant Advisory Committee. 20
274	274
275	275	(f) “Controlled dangerous substances” has the meaning stated in § 5–101 of the 21
276	276	Criminal Law Article. 22
277	277
278	278	(g) “Correctional facility” includes a State or local correctional facility. 23
279	279
280	280	[(h) “Delegated medical acts” means activities that constitute the practice of 24
281	281	medicine delegated by a physician under Title 14 of this article. 25
282	282
283	283	(i) “Delegation agreement” means a document that is executed by a primary 26
284	284	supervising physician and a physician assistant containing the requirements of § 15–302 27
285	285	of this title. 28
286	286	HOUSE BILL 727 7
287	287
288	288
289	289	(i–1)] (H) “Disciplinary panel” means a disciplinary panel of the Board 1
290	290	established under § 14–401 of this article. 2
291	291
292	292	[(j)] (I) “Dispense” or “dispensing” has the meaning stated in § 12–101 of this 3
293	293	article. 4
294	294
295	295	[(k)] (J) “Drug sample” means a unit of a prescription drug that is intended to 5
296	296	promote the sale of the drug and is not intended for sale. 6
297	297
298	298	[(l)] (K) “Hospital” means: 7
299	299
300	300	(1) A hospital as defined under § 19–301 of the Health – General Article; 8
301	301
302	302	(2) A comprehensive care facility that: 9
303	303
304	304	(i) Meets the requirements of a hospital–based skilled nursing 10
305	305	facility under federal law; and 11
306	306
307	307	(ii) Offers acute care in the same building; and 12
308	308
309	309	(3) An emergency room that is physically connected to a hospital or a 13
310	310	freestanding medical facility that is licensed under Title 19, Subtitle 3A of the Health – 14
311	311	General Article. 15
312	312
313	313	[(m)] (L) “License” means a license issued by the Board to a physician assistant 16
314	314	under this title. 17
315	315
316	316	[(n)] (M) “National certifying examination” means the Physician Assistant 18
317	317	National Certifying Examination administered by the National Commission on 19
318	318	Certification of Physician Assistants or its successor. 20
319	319
320	320	[(o)] (N) “Physician assistant” means an individual who is licensed under this 21
321	321	title to practice [medicine with physician supervision] AS A PHYSICIAN ASSIS TANT. 22
322	322
323	323	[(p)] (O) “Practice as a physician assistant” means the performance of medical 23
324	324	acts that are: 24
325	325
326	326	(1) [Delegated by a supervising physician to a physician assistant; 25
327	327
328	328	(2) Within the supervising physician’s scope of practice; and 26
329	329
330	330	(3)] Appropriate to the physician assistant’s education, training, and 27
331	331	experience; AND 28
332	332
333	333	(2) PERFORMED BY A PHYSIC IAN ASSISTANT WHO HA S SUBMITTED A 29
334	334	COLLABORATION REGISTRATION WITH TH E BOARD. 30 8 HOUSE BILL 727
335	335
336	336
337	337
338	338	[(q)] (P) “Prescriptive authority” means the authority [delegated by a primary 1
339	339	or alternate supervising physician to] OF a physician assistant to: 2
340	340
341	341	(1) Prescribe and administer controlled dangerous substances, prescription 3
342	342	drugs, medical devices, and the oral, written, or electronic ordering of medications; and 4
343	343
344	344	(2) Dispense as provided under [§ 15–302.2(b), (c), and (d)] § 15–302.1 of 5
345	345	this title. 6
346	346
347	347	[(r) “Primary supervising physician” means a physician who: 7
348	348
349	349	(1) Completes a delegation agreement that meets the requirements under 8
350	350	§§ 15–301(d) and (e) and 15–302 of this title and files a copy with the Board; 9
351	351
352	352	(2) Acts as the physician responsible to ensure that a physician assistant 10
353	353	practices medicine in accordance with this title and the regulations adopted under this title; 11
354	354
355	355	(3) Ensures that a physician assistant practices within the scope of practice 12
356	356	of the primary supervising physician or any designated alternate supervising physician; 13
357	357	and 14
358	358
359	359	(4) Ensures that a list of alternate supervising physicians is maintained at 15
360	360	the practice setting.] 16
361	361
362	362	[(s)] (Q) “Public health facility” means a site where clinical public health 17
363	363	services are rendered under the auspices of the Department, a local health department in 18
364	364	a county, or the Baltimore City Health Department. 19
365	365
366	366	[(t)] (R) “Starter dosage” means an amount of a drug sufficient to begin therapy: 20
367	367
368	368	(1) Of short duration of 72 hours or less; or 21
369	369
370	370	(2) Prior to obtaining a larger quantity of the drug to complete therapy. 22
371	371
372	372	[(u) (1) “Supervision” means the responsibility of a physician to exercise 23
373	373	on–site supervision or immediately available direction for physician assistants performing 24
374	374	delegated medical acts. 25
375	375
376	376	(2) “Supervision” includes physician oversight of and acceptance of direct 26
377	377	responsibility for the patient services and care rendered by a physician assistant, including 27
378	378	continuous availability to the physician assistant in person, through written instructions, 28
379	379	or by electronic means and by designation of one or more alternate supervising physicians.] 29
380	380
381	381	15–102. 30
382	382	HOUSE BILL 727 9
383	383
384	384
385	385	(a) A physician assistant may not practice within the scope of practice of any of 1
386	386	the following health occupations authorized under this article: 2
387	387
388	388	(1) Nursing; 3
389	389
390	390	(2) Optometry; OR 4
391	391
392	392	(3) Physical therapy[; or 5
393	393
394	394	(4) Psychology]. 6
395	395
396	396	(b) This title does not limit the right of an individual to practice a health 7
397	397	occupation that the individual is authorized to practice under this article. 8
398	398
399	399	15–103. 9
400	400
401	401	(a) In this section, “alternative health care system” has the meaning stated in § 10
402	402	1–401 of this article. 11
403	403
404	404	(b) (1) Subject to paragraph (2) of this subsection, an employer of a physician 12
405	405	assistant shall report to the Board, on the form prescribed by the Board, any termination 13
406	406	of employment of the physician assistant if the cause of termination is related to a quality 14
407	407	of care issue. 15
408	408
409	409	(2) Subject to subsection (d) of this section, a [supervising physician] 16
410	410	PERSON THAT DEVELOPS A COLLABORATION REGI STRATION WITH A PHYS ICIAN 17
411	411	ASSISTANT or an employer of a physician assistant shall notify the Board within 10 days 18
412	412	of the termination of employment of the physician assistant for reasons that would be 19
413	413	grounds for discipline under this title. 20
414	414
415	415	(3) A [supervising physician and a] PERSON THAT DEVELOPS A 21
416	416	COLLABORATION REGIST RATION WITH A PHYSICIAN ASS ISTANT OR THE physician 22
417	417	assistant shall notify the Board within [10] 30 days of the termination of the relationship 23
418	418	under a [delegation agreement for any reason] COLLABORATION REGIST RATION. 24
419	419
420	420	(c) Except as otherwise provided under subsections (b) and (d) of this section, a 25
421	421	hospital, a related institution, an alternative health care system, or an employer of a 26
422	422	physician assistant shall report to the Board any limitation, reduction, or other change of 27
423	423	the terms of employment of the physician assistant or any termination of employment of 28
424	424	the physician assistant for any reason that might be grounds for disciplinary action under 29
425	425	§ 15–314 of this title. 30
426	426
427	427	(d) A hospital, related institution, alternative health care system, or employer 31
428	428	that has [reason to know] ACTUAL KNOWLEDGE that a physician assistant has committed 32
429	429	an action or has a condition that might be grounds for reprimand or probation of the 33
430	430	physician assistant or suspension or revocation of the license of the physician assistant 34 10 HOUSE BILL 727
431	431
432	432
433	433	under § 15–314 of this title because the physician assistant is alcohol– or drug–impaired is 1
434	434	not required to report to the Board if: 2
435	435
436	436	(1) The hospital, related institution, alternative health care system, or 3
437	437	employer knows that the physician assistant is: 4
438	438
439	439	(i) In an alcohol or drug treatment program that is accredited by the 5
440	440	Joint Commission on the Accreditation of Healthcare Organizations or is certified by the 6
441	441	Department; or 7
442	442
443	443	(ii) Under the care of a health care practitioner who is competent 8
444	444	and capable of dealing with alcoholism and drug abuse; 9
445	445
446	446	(2) The hospital, related institution, alternative health care system, or 10
447	447	employer is able to verify that the physician assistant remains in the treatment program 11
448	448	until discharge; and 12
449	449
450	450	(3) The action or condition of the physician assistant has not caused injury 13
451	451	to any person while the physician assistant is practicing as a licensed physician assistant. 14
452	452
453	453	(e) (1) If the physician assistant enters, or is considering entering, an alcohol 15
454	454	or drug treatment program that is accredited by the Joint Commission on Accreditation of 16
455	455	Healthcare Organizations or that is certified by the Department, the physician assistant 17
456	456	shall notify the hospital, related institution, alternative health care system, or employer of 18
457	457	the physician assistant’s decision to enter the treatment program. 19
458	458
459	459	(2) If the physician assistant fails to provide the notice required under 20
460	460	paragraph (1) of this subsection, and the hospital, related institution, alternative health 21
461	461	care system, or employer learns that the physician assistant has entered a treatment 22
462	462	program, the hospital, related institution, alternative health care system, or employer shall 23
463	463	report to the Board that the physician assistant has entered a treatment program and has 24
464	464	failed to provide the required notice. 25
465	465
466	466	(3) If the physician assistant is found to be noncompliant with the 26
467	467	treatment program’s policies and procedures while in the treatment program, the 27
468	468	treatment program shall notify the hospital, related institution, alternative health care 28
469	469	system, or employer of the physician assistant’s noncompliance. 29
470	470
471	471	(4) On receipt of the notification required under paragraph (3) of this 30
472	472	subsection, the hospital, related institution, alternative health care system, or employer of 31
473	473	the physician assistant shall report the physician assistant’s noncompliance to the Board. 32
474	474
475	475	(f) A person is not required under this section to make any report that would be 33
476	476	in violation of any federal or State law, rule, or regulation concerning the confidentiality of 34
477	477	alcohol– and drug–abuse patient records. 35
478	478	HOUSE BILL 727 11
479	479
480	480
481	481	(g) The hospital, related institution, alternative health care system, or employer 1
482	482	shall submit the report within [10] 30 days of any action described in this section. 2
483	483
484	484	(h) A report under this section is not subject to subpoena or discovery in any civil 3
485	485	action other than a proceeding arising out of a hearing and decision of the Board or a 4
486	486	disciplinary panel under this title. 5
487	487
488	488	(i) (1) A disciplinary panel may impose a civil penalty of up to $1,000 for 6
489	489	failure to report under this section. 7
490	490
491	491	(2) The Board shall pay any fees collected under this subsection into the 8
492	492	General Fund of the State. 9
493	493
494	494	(j) An employer shall make the report required under this section to the Board 10
495	495	within [5] 14 days after the date of termination of employment. 11
496	496
497	497	(k) The Board shall adopt regulations to implement the provisions of this section. 12
498	498
499	499	15–202. 13
500	500
501	501	(a) (1) The Committee shall consist of 7 members appointed by the Board. 14
502	502
503	503	(2) Of the 7 Committee members: 15
504	504
505	505	(i) 3 shall be licensed physicians; 16
506	506
507	507	(ii) 3 shall be licensed physician assistants; and 17
508	508
509	509	(iii) 1 shall be a consumer. 18
510	510
511	511	(b) Of the three physician members of the Committee, two shall [be previously or 19
512	512	currently serving as supervising physicians of a physician assistant unde r a 20
513	513	Board–approved delegation agreement] HAVE DEVELOPED A COL LABORATION 21
514	514	REGISTRATION WITH A PHYSICIAN ASSISTANT . 22
515	515
516	516	15–205. 23
517	517
518	518	(a) In addition to the powers set forth elsewhere in this title, the Committee, on 24
519	519	its initiative or on the Board’s request, may: 25
520	520
521	521	(1) Recommend to the Board regulations for carrying out the provisions of 26
522	522	this title; 27
523	523
524	524	(2) Recommend to the Board approval, modification, or disapproval of an 28
525	525	application for licensure [or a delegation agreement]; 29
526	526	12 HOUSE BILL 727
527	527
528	528
529	529	(3) Report to the Board any conduct of a [supervising physician] PERSON 1
530	530	WHO DEVELOPS A COLLA BORATION REGISTRATIO N WITH A PHYSICIAN A SSISTANT or 2
531	531	a physician assistant that may be cause for disciplinary action under this title or under § 3
532	532	14–404 of this article; and 4
533	533
534	534	(4) Report to the Board any alleged unauthorized practice of a physician 5
535	535	assistant. 6
536	536
537	537	15–301. 7
538	538
539	539	(a) [Nothing in this] THIS title may NOT be construed to authorize a physician 8
540	540	assistant to practice [independent of a primary or alternate supervising physician] 9
541	541	INDEPENDENTLY . 10
542	542
543	543	(b) A license issued to a physician assistant shall limit the physician assistant’s 11
544	544	scope of practice to medical acts[: 12
545	545
546	546	(1) Delegated by the primary or alternate supervising physician; 13
547	547
548	548	(2) Appropriate] APPROPRIATE to the education, training, and experience 14
549	549	of the physician assistant[; 15
550	550
551	551	(3) Customary to the practice of the primary or alternate supervising 16
552	552	physician; and 17
553	553
554	554	(4) Consistent with the delegation agreement filed with the Board]. 18
555	555
556	556	(c) Patient services that may be provided by a physician assistant include: 19
557	557
558	558	[(1) (i) Taking complete, detailed, and accurate patient histories; and 20
559	559
560	560	(ii) Reviewing patient records to develop comprehensive medical 21
561	561	status reports; 22
562	562
563	563	(2) Performing physical examinations and recording all pertinent patient 23
564	564	data; 24
565	565
566	566	(3) Interpreting and evaluating patient data as authorized by the primary 25
567	567	or alternate supervising physician for the purpose of determining management and 26
568	568	treatment of patients; 27
569	569
570	570	(4) Initiating requests for or performing diagnostic procedures as indicated 28
571	571	by pertinent data and as authorized by the supervising physician; 29
572	572
573	573	(5) Providing instructions and guidance regarding medical care matters to 30
574	574	patients; 31 HOUSE BILL 727 13
575	575
576	576
577	577
578	578	(6) Assisting the primary or alternate supervising physician in the delivery 1
579	579	of services to patients who require medical care in the home and in health care institutions, 2
580	580	including: 3
581	581
582	582	(i) Recording patient progress notes; 4
583	583
584	584	(ii) Issuing diagnostic orders; and 5
585	585
586	586	(iii) Transcribing or executing specific orders at the direction of the 6
587	587	primary or alternate supervising physician; and 7
588	588
589	589	(7) Exercising prescriptive authority under a delegation agreement and in 8
590	590	accordance with § 15–302.2 of this subtitle] 9
591	591
592	592	(1) OBTAINING COMPREHENSI VE HEALTH HISTORIES ; 10
593	593
594	594	(2) PERFORMING PHYSICAL E XAMINATIONS ; 11
595	595
596	596	(3) EVALUATING, DIAGNOSING, MANAGING, AND PROVIDING 12
597	597	MEDICAL TREATMENT ; 13
598	598
599	599	(4) ORDERING, PERFORMING , AND INTERPRETING DIA GNOSTIC 14
600	600	STUDIES AND THERAPEU TIC PROCEDURES ; 15
601	601
602	602	(5) EXERCISING PRESCRIPTI VE AUTHORITY IN ACCO RDANCE WITH § 16
603	603	15–302.1 OF THIS SUBTITLE; 17
604	604
605	605	(6) INFORMING PATIENTS AB OUT HEALTH PROMOTION AND DISEASE 18
606	606	PREVENTION ; 19
607	607
608	608	(7) PROVIDING CONSULTATIO NS; 20
609	609
610	610	(8) WRITING MEDICAL ORDER S; 21
611	611
612	612	(9) PROVIDING SERVICES IN HEALTH CARE FACILITI ES, INCLUDING 22
613	613	HOSPITALS, NURSING FACILITIES , ASSISTED LIVING FACI LITIES, AND HOSPICE 23
614	614	FACILITIES; 24
615	615
616	616	(10) OBTAINING INFORMED CO NSENT; 25
617	617
618	618	(11) DELEGATING OR ASSIGNI NG THERAPEUTIC AND D IAGNOSTIC 26
619	619	MEASURES TO BE PERFO RMED BY LICENSED OR UNLICENSED PERSONNEL AND 27 14 HOUSE BILL 727
620	620
621	621
622	622	SUPERVISING LICENSED OR UNLICENSED PERSON NEL PERFORMING THERA PEUTIC 1
623	623	AND DIAGNOSTIC MEASURES ; 2
624	624
625	625	(12) CERTIFYING A PATIENT ’S HEALTH OR DISABILI TY AS REQUIRED 3
626	626	BY A FEDERAL, STATE, OR LOCAL PROGRAM ; AND 4
627	627
628	628	(13) AUTHENTICATING ANY DO CUMENT THAT A PHYSIC IAN MAY 5
629	629	AUTHENTICATE THROUGH SIGNATURE, CERTIFICATION , STAMP VERIFICATION , 6
630	630	AFFIDAVIT, OR ENDORSEMENT . 7
631	631
632	632	(d) (1) Except as otherwise provided in this title, an individual shall be 8
633	633	licensed by the Board before the individual may practice as a physician assistant. 9
634	634
635	635	(2) [Except as otherwise provided in this title, a physician may not 10
636	636	supervise a physician assistant in the performance of delegated medical acts without filing 11
637	637	a completed delegation agreement with the Board. 12
638	638
639	639	(3)] Except as otherwise provided in this title or in a medical emergency, a 13
640	640	physician assistant may not perform any medical act for which: 14
641	641
642	642	(i) The individual has not been licensed; and 15
643	643
644	644	(ii) [The medical acts have not been delegated by a primary or 16
645	645	alternate supervising physician] THE INDIVIDUAL HAS NO T RECEIVED APPROPRIA TE 17
646	646	EDUCATION, TRAINING, AND EXPERIENCE . 18
647	647
648	648	[(e) A physician assistant is the agent of the primary or alternate supervising 19
649	649	physician in the performance of all practice–related activities, including the oral, written, 20
650	650	or electronic ordering of diagnostic, therapeutic, and other medical services.] 21
651	651
652	652	(E) A PHYSICIAN ASSISTANT SHALL CONSULT AND COLLABORATE WITH OR 22
653	653	REFER AN INDIVIDUAL TO AN APPROPRIATE LI CENSED PHYSICIAN OR ANY OTHER 23
654	654	HEALTH CARE PROVIDER AS APPROPRIATE . 24
655	655
656	656	(F) A PHYSICIAN ASSISTANT WHO HAS NOT BEEN PRE VIOUSLY LICENSED BY 25
657	657	THE BOARD TO PRACTICE AS A PHYS ICIAN ASSISTANT OR L ICENSED, CERTIFIED, OR 26
658	658	REGISTERED AS A PHYS ICIAN ASSISTANT BY A NOTHER STATE REGULAT ORY 27
659	659	AUTHORITY SHALL BE M ENTORED BY A LICENSE D PHYSICIAN OR PHYSI CIANS WHO 28
660	660	ARE IDENTIFIED IN AN INITIAL COLLABORATIO N REGISTRATION TO CONSULT AND 29
661	661	COLLABORATE WITH THE PHYSICIAN ASSISTANT FOR AT LEAST 18 MONTHS AFTER 30
662	662	THE DATE AN INITIAL COLLABORATION REGIST RATION IS SUBMITTED TO THE 31
663	663	BOARD. 32
664	664	HOUSE BILL 727 15
665	665
666	666
667	667	[(f)] (G) Except as OTHERWISE provided in [subsection (g) of this section] THIS 1
668	668	TITLE, the following individuals may practice as a physician assistant without a license: 2
669	669
670	670	(1) A physician assistant student enrolled in a physician assistant 3
671	671	educational program that is accredited by the Accreditation Review Commission on 4
672	672	Education for the Physician Assistant or its successor and approved by the Board; or 5
673	673
674	674	(2) A physician assistant employed in the service of the federal government 6
675	675	while performing duties incident to that employment. 7
676	676
677	677	[(g) A physician may not delegate prescriptive authority to a physician assistant 8
678	678	student in a training program that is accredited by the Accreditation Review Commission 9
679	679	on Education for the Physician Assistant or its successor.] 10
680	680
681	681	(h) (1) If a medical act that is to be [delegated] PERFORMED BY A PHYSI CIAN 11
682	682	ASSISTANT under this section is a part of the practice of a health occupation that is 12
683	683	regulated under this article by another board, any rule or regulation concerning that 13
684	684	medical act shall be adopted jointly by the State Board of Physicians and the board that 14
685	685	regulates the other health occupation. 15
686	686
687	687	(2) If the two boards cannot agree on a proposed rule or regulation, the 16
688	688	proposal shall be submitted to the Secretary for a final decision. 17
689	689
690	690	15–302. 18
691	691
692	692	(a) A physician [may delegate medical acts to a physician assistant only after: 19
693	693
694	694	(1) A delegation agreement has been executed and filed with the Board; 20
695	695	and 21
696	696
697	697	(2) Any advanced duties have been authorized as required under 22
698	698	subsection (c) of this section] ASSISTANT MAY PRACTI CE AS A PHYSICIAN AS SISTANT 23
699	699	ONLY AFTER SUBMITTIN G A COLLABORATION RE GISTRATION TO THE BOARD. 24
700	700
701	701	(b) (1) [The delegation agreement] SUBJECT TO PARAGRAPH (2) OF THIS 25
702	702	SUBSECTION, A COLLABORATION REGI STRATION shall contain: 26
703	703
704	704	[(1)] (I) A description of the qualifications of the [primary supervising 27
705	705	physician] PERSON WHO DEVELOPED THE COLLABORATION RE GISTRATION WITH 28
706	706	THE PHYSICIAN ASSIST ANT and THE physician assistant; 29
707	707
708	708	[(2)] (II) A description of the settings in which the physician assistant will 30
709	709	practice; 31
710	710
711	711	[(3) A description of the continuous physician supervision mechanisms that 32
712	712	are reasonable and appropriate to the practice setting; 33 16 HOUSE BILL 727
713	713
714	714
715	715
716	716	(4) A description of the delegated medical acts that are within the primary 1
717	717	or alternate supervising physician’s scope of practice and require specialized education or 2
718	718	training that is consistent with accepted medical practice; 3
719	719
720	720	(5) An attestation that all medical acts to be delegated to the physician 4
721	721	assistant are within the scope of practice of the primary or alternate supervising physician 5
722	722	and appropriate to the physician assistant’s education, training, and level of competence; 6
723	723
724	724	(6) An attestation of continuous supervision of the physician assistant by 7
725	725	the primary supervising physician through the mechanisms described in the delegation 8
726	726	agreement; 9
727	727
728	728	(7) An attestation by the primary supervising physician of the physician’s 10
729	729	acceptance of responsibility for any care given by the physician assistant; 11
730	730
731	731	(8) A description prepared by the primary supervising physician of the 12
732	732	process by which the physician assistant’s practice is reviewed appropriate to the practice 13
733	733	setting and consistent with current standards of acceptable medical practice; 14
734	734
735	735	(9) An attestation by the primary supervising physician that the physician 15
736	736	will respond in a timely manner when contacted by the physician assistant; 16
737	737
738	738	(10) The following statement: “The primary supervising physician and the 17
739	739	physician assistant attest that: 18
740	740
741	741	(i) They will establish a plan for the types of cases that require a 19
742	742	physician plan of care or require that the patient initially or periodically be seen by the 20
743	743	supervising physician; and 21
744	744
745	745	(ii) The patient will be provided access to the supervising physician 22
746	746	on request”; and 23
747	747
748	748	(11) Any other information deemed necessary by the Board to carry out the 24
749	749	provisions of this subtitle] 25
750	750
751	751	(III) AN ATTESTATION BY THE PHYSICIAN ASSISTANT THAT THE 26
752	752	PHYSICIAN ASSISTANT WILL CONSULT AND COLLABORATE WITH OR REFER AN 27
753	753	INDIVIDUAL TO AN APP ROPRIATE LICENSED PH YSICIAN OR ANY OTHER HEALTH 28
754	754	CARE PROVIDER , AS APPROPRIATE ; AND 29
755	755
756	756	(IV) AN ATTESTATION BY THE PERS ON THAT DEVELOPED TH E 30
757	757	COLLABORATION REGIST RATION WITH THE PHYS ICIAN ASSISTANT THAT THE 31
758	758	PERSON WILL ENSURE T HAT A PHYSICIAN WILL RESPOND IN A TIMELY MANNER 32
759	759	WHEN CONTACTED BY TH E PHYSICIAN ASSISTAN T. 33
760	760	HOUSE BILL 727 17
761	761
762	762
763	763	(2) IF A PHYSICIAN ASSIST ANT WHO SU BMITS AN INITIAL 1
764	764	COLLABORATION REGIST RATION TO THE BOARD HAS NOT BEEN PR EVIOUSLY 2
765	765	LICENSED BY THE BOARD TO PRACTICE AS A PHYSICIAN ASSISTAN T OR LICENSED, 3
766	766	CERTIFIED, OR REGISTERED AS A P HYSICIAN ASSISTANT B Y ANOTHER STATE 4
767	767	REGULATORY AUTHORITY , THE INITIAL CO LLABORATION REGISTRA TION SHALL 5
768	768	IDENTIFY A LICENSED PHYSICIAN OR PHYSICI ANS WHO WILL CONSULT AND 6
769	769	COLLABORATE WITH THE PHYSICIAN ASSISTANT FOR AT LEAST 18 MONTHS AFTER 7
770	770	THE DATE THE INITIAL COLLABORATION REGIST RATION IS SUBMITTED TO THE 8
771	771	BOARD. 9
772	772
773	773	(c) [(1)] The Board may not require [prior] approval of a [delegation agreement 10
774	774	that includes advanced duties, if an advanced duty will be performed in a hospital or 11
775	775	ambulatory surgical facility, provided that: 12
776	776
777	777	(i) A physician, with credentials that have been reviewed by the 13
778	778	hospital or ambulatory surgical facility as a condition of employment, as an independent 14
779	779	contractor, or as a member of the medical staff, supervises the physician assistant; 15
780	780
781	781	(ii) The physician assistant has credentials that have been reviewed 16
782	782	by the hospital or ambulatory surgical facility as a condition of employment, as an 17
783	783	independent contractor, or as a member of the medical staff; and 18
784	784
785	785	(iii) Each advanced duty to be delegated to the physician assistant is 19
786	786	reviewed and approved within a process approved by the governing body of the health care 20
787	787	facility before the physician assistant performs the advanced duties] COLLABORATION 21
788	788	REGISTRATION . 22
789	789
790	790	[(2) (i) In any setting that does not meet the requirements of paragraph 23
791	791	(1) of this subsection, a primary supervising physician shall obtain the Board’s approval of 24
792	792	a delegation agreement that includes advanced duties, before the physician assistant 25
793	793	performs the advanced duties. 26
794	794
795	795	(ii) 1. Before a physician assistant may perform X–ray duties 27
796	796	authorized under § 14–306(e) of this article in the medical office of the physician delegating 28
797	797	the duties, a primary supervising physician shall obtain the Board’s approval of a 29
798	798	delegation agreement that includes advanced duties in accordance with subsubparagraph 30
799	799	2 of this subparagraph. 31
800	800
801	801	2. The advanced duties set forth in a delegation agreement 32
802	802	under this subparagraph shall be limited to nonfluoroscopic X–ray procedures of the 33
803	803	extremities, anterior–posterior and lateral, not including the head. 34
804	804
805	805	(3) Notwithstanding paragraph (1) of this subsection, a primary 35
806	806	supervising physician shall obtain the Board’s approval of a delegation agreement before 36
807	807	the physician assistant may administer, monitor, or maintain general anesthesia or 37
808	808	neuroaxial anesthesia, including spinal and epidural techniques, under the agreement. 38 18 HOUSE BILL 727
809	809
810	810
811	811
812	812	(d) For a delegation agreement containing advanced duties that require Board 1
813	813	approval, the Committee shall review the delegation agreement and recommend to the 2
814	814	Board that the delegation agreement be approved, rejected, or modified to ensure 3
815	815	conformance with the requirements of this title. 4
816	816
817	817	(e) The Committee may conduct a personal interview of the primary supervising 5
818	818	physician and the physician assistant. 6
819	819
820	820	(f) (1) On review of the Committee’s recommendation regarding a primary 7
821	821	supervising physician’s request to delegate advanced duties as described in a delegation 8
822	822	agreement, the Board: 9
823	823
824	824	(i) May approve the delegation agreement; or 10
825	825
826	826	(ii) 1. If the physician assistant does not meet the applicable 11
827	827	education, training, and experience requirements to perform the specified delegated acts, 12
828	828	may modify or disapprove the delegation agreement; and 13
829	829
830	830	2. If the Board takes an action under item 1 of this item: 14
831	831
832	832	A. Shall notify the primary supervising physician and the 15
833	833	physician assistant in writing of the particular elements of the proposed delegation 16
834	834	agreement that were the cause for the modification or disapproval; and 17
835	835
836	836	B. May not restrict the submission of an amendment to the 18
837	837	delegation agreement. 19
838	838
839	839	(2) To the extent practicable, the Board shall approve a delegation 20
840	840	agreement or take other action authorized under this subsection within 90 days after 21
841	841	receiving a completed delegation agreement including any information from the physician 22
842	842	assistant and primary supervising physician necessary to approve or take action.] 23
843	843
844	844	[(g)] (D) If the Board determines that a [primary or alternate supervising 24
845	845	physician] PERSON THAT DEVELOPS A COLLABORATION REGI STRATION WITH A 25
846	846	PHYSICIAN ASSISTANT or A physician assistant is practicing in a manner inconsistent 26
847	847	with the requirements of this title or Title 14 of this article, the Board on its own initiative 27
848	848	or on the recommendation of the Committee may demand modification of the practice[, 28
849	849	withdraw the approval of the delegation agreement,] or refer the matter to a disciplinary 29
850	850	panel for the purpose of taking other disciplinary action under § 14–404 or § 15–314 of this 30
851	851	article. 31
852	852
853	853	[(h) A primary supervising physician may not delegate medical acts under a 32
854	854	delegation agreement to more than four physician assistants at any one time, except in a 33
855	855	hospital or in the following nonhospital settings: 34
856	856	HOUSE BILL 727 19
857	857
858	858
859	859	(1) A correctional facility; 1
860	860
861	861	(2) A detention center; or 2
862	862
863	863	(3) A public health facility. 3
864	864
865	865	(i) A person may not coerce another person to enter into a delegation agreement 4
866	866	under this subtitle. 5
867	867
868	868	(j) A physician may supervise a physician assistant: 6
869	869
870	870	(1) As a primary supervising physician in accordance with a delegation 7
871	871	agreement approved by the Board under this subtitle; or 8
872	872
873	873	(2) As an alternate supervising physician if: 9
874	874
875	875	(i) The alternate supervising physician supervises in accordance 10
876	876	with a delegation agreement filed with the Board; 11
877	877
878	878	(ii) The alternate supervising physician supervises no more than 12
879	879	four physician assistants at any one time, except in a hospital, correctional facility, 13
880	880	detention center, or public health facility; 14
881	881
882	882	(iii) The alternate supervising physician’s period of supervision, in 15
883	883	the temporary absence of the primary supervising physician, does not exceed: 16
884	884
885	885	1. The period of time specified in the delegation agreement; 17
886	886	and 18
887	887
888	888	2. A period of 45 consecutive days at any one time; and 19
889	889
890	890	(iv) The physician assistant performs only those medical acts that: 20
891	891
892	892	1. Have been delegated under the delegation agreement filed 21
893	893	with the Board; and 22
894	894
895	895	2. Are within the scope of practice of the primary supervising 23
896	896	physician and alternate supervising physician.] 24
897	897
898	898	[(k)] (E) Subject to the notice required under § 15–103 of this title, a physician 25
899	899	assistant may terminate a [delegation agreement filed with the Board under] 26
900	900	COLLABORATION REGIST RATION DEVELOPED IN ACCORDANCE WITH this subtitle at 27
901	901	any time. 28
902	902
903	903	[(l) (1) In the event of the sudden departure, incapacity, or death of the 29
904	904	primary supervising physician of a physician assistant, or change in license status that 30
905	905	results in the primary supervising physician being unable to legally practice medicine, an 31 20 HOUSE BILL 727
906	906
907	907
908	908	alternate supervising physician designated under subsection (b) of this section may 1
909	909	supervise the physician assistant for not longer than 15 days following the event. 2
910	910
911	911	(2) If there is no designated alternate supervising physician or the 3
912	912	designated alternate supervising physician does not agree to supervise the physician 4
913	913	assistant, the physician assistant may not practice until the physician assistant receives 5
914	914	approval of a new delegation agreement under § 15–302.1 of this subtitle. 6
915	915
916	916	(3) An alternate supervising physician or other licensed physician may 7
917	917	assume the role of primary supervising physician by submitting a new delegation 8
918	918	agreement to the Board for approval under subsection (b) of this section. 9
919	919
920	920	(4) The Board may terminate a delegation agreement if: 10
921	921
922	922	(i) The physician assistant has a change in license status that 11
923	923	results in the physician assistant being unable to legally practice as a physician assistant; 12
924	924
925	925	(ii) At least 15 days have elapsed since an event listed under 13
926	926	paragraph (1) of this subsection if there is an alternate supervising physician designated 14
927	927	under subsection (b) of this section; or 15
928	928
929	929	(iii) Immediately after an event listed under paragraph (1) of this 16
930	930	subsection if there is no alternate supervising physician designated under subsection (b) of 17
931	931	this section.] 18
932	932
933	933	[(m)] (F) A physician assistant whose [delegation agreement] COLLABORATION 19
934	934	REGISTRATION is terminated may not practice as a physician assistant until the physician 20
935	935	assistant [receives preliminary approval of a new delegation agreement under § 15–302.1 21
936	936	of this subtitle] SUBMITS A NEW COLLAB ORATION REGISTRATION TO THE BOARD. 22
937	937
938	938	[(n) Individual members of the Board are not civilly liable for actions regarding 23
939	939	the approval, modification, or disapproval of a delegation agreement described in this 24
940	940	section. 25
941	941
942	942	(o) A physician assistant may practice in accordance with a delegation agreement 26
943	943	filed with the Board under this subtitle.] 27
944	944
945	945	[15–302.1. 28
946	946
947	947	(a) If a delegation agreement does not include advanced duties or the advanced 29
948	948	duties have been approved under § 15–302(c)(1) of this subtitle, a physician assistant may 30
949	949	assume the duties under a delegation agreement on the date that the Board acknowledges 31
950	950	receipt of the completed delegation agreement. 32
951	951
952	952	(b) In this section, “pending” means that a delegation agreement that includes 33
953	953	delegation of advanced duties in a setting that does not meet the requirements under § 34 HOUSE BILL 727 21
954	954
955	955
956	956	15–302(c)(1) of this subtitle has been executed and submitted to the Board for its approval, 1
957	957	but: 2
958	958
959	959	(1) The Committee has not made a recommendation to the Board; or 3
960	960
961	961	(2) The Board has not made a final decision regarding the delegation 4
962	962	agreement. 5
963	963
964	964	(c) Subject to subsection (d) of this section, if a delegation agreement is pending, 6
965	965	on receipt of a temporary practice letter from the staff of the Board, a physician assistant 7
966	966	may perform the advanced duty if: 8
967	967
968	968	(1) The primary supervising physician has been previously approved to 9
969	969	supervise one or more physician assistants in the performance of the advanced duty; and 10
970	970
971	971	(2) The physician assistant has been previously approved by the Board to 11
972	972	perform the advanced duty. 12
973	973
974	974	(d) If the Committee recommends a denial of the pending delegation agreement 13
975	975	or the Board denies the pending delegation agreement, on notice to the primary supervising 14
976	976	physician and the physician assistant, the physician assistant may no longer perform the 15
977	977	advanced duty that has not received the approval of the Board. 16
978	978
979	979	(e) The Board may disapprove any delegation agreement if it believes that: 17
980	980
981	981	(1) The agreement does not meet the requirements of this subtitle; or 18
982	982
983	983	(2) The physician assistant is unable to perform safely the delegated 19
984	984	duties. 20
985	985
986	986	(f) If the Board disapproves a delegation agreement or the delegation of any 21
987	987	function under an agreement, the Board shall provide the primary supervising physician 22
988	988	and the physician assistant with written notice of the disapproval. 23
989	989
990	990	(g) A physician assistant who receives notice that the Board has disapproved a 24
991	991	delegation agreement or an advanced function under the delegation agreement shall 25
992	992	immediately cease to practice under the agreement or to perform the disapproved function.] 26
993	993
994	994	[15–302.2.] 15–302.1. 27
995	995
996	996	[(a) A primary supervising physician may not delegate prescribing, dispensing, 28
997	997	and administering of controlled dangerous substances, prescription drugs, or medical 29
998	998	devices unless the primary supervising physician and physician assistant include in the 30
999	999	delegation agreement: 31
1000	1000
1001	1001	(1) A notice of intent to delegate prescribing and, if applicable, dispensing 32
1002	1002	of controlled dangerous substances, prescription drugs, or medical devices; 33 22 HOUSE BILL 727
1003	1003
1004	1004
1005	1005
1006	1006	(2) An attestation that all prescribing and, if applicable, dispensing 1
1007	1007	activities of the physician assistant will comply with applicable federal and State 2
1008	1008	regulations; 3
1009	1009
1010	1010	(3) An attestation that all medical charts or records will contain a notation 4
1011	1011	of any prescriptions written or dispensed by a physician assistant in accordance with this 5
1012	1012	section; 6
1013	1013
1014	1014	(4) An attestation that all prescriptions written or dispensed under this 7
1015	1015	section will include the physician assistant’s name and the supervising physician’s name, 8
1016	1016	business address, and business telephone number legibly written or printed; 9
1017	1017
1018	1018	(5) An attestation that the physician assistant has: 10
1019	1019
1020	1020	(i) Passed the physician assistant national certification exam 11
1021	1021	administered by the National Commission on the Certification of Physician Assistants 12
1022	1022	within the previous 2 years; or 13
1023	1023
1024	1024	(ii) Successfully completed 8 category 1 hours of pharmacology 14
1025	1025	education within the previous 2 years; and 15
1026	1026
1027	1027	(6) An attestation that the physician assistant has: 16
1028	1028
1029	1029	(i) A bachelor’s degree or its equivalent; or 17
1030	1030
1031	1031	(ii) Successfully completed 2 years of work experience as a physician 18
1032	1032	assistant. 19
1033	1033
1034	1034	(b) (1) A primary supervising physician may not delegate the prescribing or 20
1035	1035	dispensing of substances that are identified as Schedule I controlled dangerous substances 21
1036	1036	under § 5–402 of the Criminal Law Article. 22
1037	1037
1038	1038	(2) A primary supervising physician may delegate the prescribing or 23
1039	1039	dispensing of substances that are identified as Schedules II through V controlled dangerous 24
1040	1040	substances under § 5–402 of the Criminal Law Article, including legend drugs as defined 25
1041	1041	under § 503(b) of the Federal Food, Drug, and Cosmetic Act. 26
1042	1042
1043	1043	(3) A primary supervising physician may not delegate the prescribing or 27
1044	1044	dispensing of controlled dangerous substances to a physician assistant unless the physician 28
1045	1045	assistant has a valid: 29
1046	1046
1047	1047	(i) State controlled dangerous substance registration; and 30
1048	1048
1049	1049	(ii) Federal Drug Enforcement Agency (DEA) registration.] 31
1050	1050	HOUSE BILL 727 23
1051	1051
1052	1052
1053	1053	(A) IN THIS SECTION, “PERSONALLY PREPARE A ND DISPENSE” MEANS THAT 1
1054	1054	A PHYSICIAN ASSISTAN T: 2
1055	1055
1056	1056	(1) IS PHYSICALL Y PRESENT ON THE PRE MISES WHERE A 3
1057	1057	PRESCRIPTION IS FILL ED; AND 4
1058	1058
1059	1059	(2) PERFORMS A FINAL CHEC K OF THE PRESCRIPTIO N BEFORE IT IS 5
1060	1060	PROVIDED TO THE PATI ENT. 6
1061	1061
1062	1062	(B) A PHYSICIAN ASSISTANT MAY PRESCRIBE , DISPENSE, ORDER, OR 7
1063	1063	ADMINISTER: 8
1064	1064
1065	1065	(1) SUBJECT TO SUBSECTION (C)(2) OF THIS SECTION , DRUGS AND 9
1066	1066	SUBSTANCES THAT ARE IDENTIFIED AS SCHEDULES II THROUGH V CONTROLLED 10
1067	1067	DANGEROUS SUBSTANCES UNDER §§ 5–403 THROUGH 5–406 OF THE CRIMINAL LAW 11
1068	1068	ARTICLE, INCLUDING LEGEND DRU GS AS DEFINED UNDER § 503(B) OF THE 12
1069	1069	FEDERAL FOOD, DRUG, AND COSMETIC ACT; 13
1070	1070
1071	1071	(2) MEDICAL DEVICES ; AND 14
1072	1072
1073	1073	(3) DURABLE MEDICAL EQUIP MENT. 15
1074	1074
1075	1075	(C) (1) A PHYSICIAN ASSISTANT MAY NOT PRESCRIBE OR DISPENSE 16
1076	1076	SUBSTANCES THAT ARE IDENTIFIED AS SCHEDULE I CONTROLLED DANGEROUS 17
1077	1077	SUBSTANCES UNDER § 5–402 OF THE CRIMINAL LAW ARTICLE. 18
1078	1078
1079	1079	(2) A PHYSICIAN ASSISTANT MAY NOT PRESCRIBE OR DISPENSE 19
1080	1080	CONTROLLED DANGEROUS SUBSTANCES UNLESS TH E PHYSICIAN ASSISTAN T HAS A 20
1081	1081	VALID: 21
1082	1082
1083	1083	(I) STATE CONTROLLED DANG EROUS SUBSTANCE 22
1084	1084	REGISTRATION ; AND 23
1085	1085
1086	1086	(II) FEDERAL DRUG ENFORCEMENT AGENCY (DEA) 24
1087	1087	REGISTRATION. 25
1088	1088
1089	1089	[(c)] (D) (1) A physician assistant personally may prepare and dispense [a 26
1090	1090	drug that the physician assistant is authorized to prescribe under a delegation agreement 27
1091	1091	if]: 28
1092	1092
1093	1093	[(1) Except as otherwise provided under § 12–102(g) of this article, the 29
1094	1094	supervising physician possesses a dispensing permit; and 30
1095	1095
1096	1096	(2) The physician assistant dispenses drugs only within: 31 24 HOUSE BILL 727
1097	1097
1098	1098
1099	1099
1100	1100	(i) The supervising physician’s scope of practice; and 1
1101	1101
1102	1102	(ii) The scope of the delegation agreement] 2
1103	1103
1104	1104	(I) A STARTER DOSAGE OF ANY DRUG THAT THE PH YSICIAN 3
1105	1105	ASSISTANT IS AUTHORI ZED TO PRESCRIBE TO A PATIENT OF THE PHY SICIAN 4
1106	1106	ASSISTANT IF: 5
1107	1107
1108	1108	1. THE STARTER DOSAGE CO MPLIES WITH THE 6
1109	1109	LABELING REQUIREMENT S OF § 12–505 OF THIS ARTICLE; 7
1110	1110
1111	1111	2. NO CHARGE IS MADE FOR THE STARTER DOSAGE ; AND 8
1112	1112
1113	1113	3. THE PHYSICIAN ASSISTA NT ENTERS AN APPROPR IATE 9
1114	1114	RECORD IN THE PATIEN T’S MEDICAL RECORD ; OR 10
1115	1115
1116	1116	(II) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , ANY 11
1117	1117	DRUG THAT A PHYSICIA N ASSISTANT MAY PRES CRIBE TO THE EXTENT AUTHORIZED 12
1118	1118	BY LAW IN THE COURSE OF TREATING A PATIENT A T: 13
1119	1119
1120	1120	1. A MEDICAL FACILITY OR CLINIC THAT SPECIALI ZES IN 14
1121	1121	THE TREATMENT OF MED ICAL CASES REIMBURSA BLE THROUGH WORKERS ’ 15
1122	1122	COMPENSATION INSURAN CE; 16
1123	1123
1124	1124	2. A MEDICAL FACILITY OR CLINIC THAT IS OPERA TED 17
1125	1125	ON A NONPROFIT BASIS ; 18
1126	1126
1127	1127	3. A HEALTH CENTER THAT OPERAT ES ON A CAMPUS OF 19
1128	1128	AN INSTITUTION OF HI GHER EDUCATION ; 20
1129	1129
1130	1130	4. A PUBLIC HEALTH FACILI TY, A MEDICAL FACILITY 21
1131	1131	UNDER CONTRACT WITH A STATE OR LOCAL HEALTH DEPARTMENT , OR A FACILITY 22
1132	1132	FUNDED WITH PUBLIC F UNDS; OR 23
1133	1133
1134	1134	5. A NONPROFIT HOSPITAL O R A NONPROFIT HOSPIT AL 24
1135	1135	OUTPATIENT FACILITY AS AUTHORIZED UNDER THE POLICIES ESTABLI SHED BY THE 25
1136	1136	HOSPITAL. 26
1137	1137
1138	1138	(2) A PHYSICIAN ASSISTANT WHO PERSONALLY PREPA RES AND 27
1139	1139	DISPENSES A DRUG IN THE COURSE OF TREATI NG A PATIENT AS AUTH ORIZED UNDER 28
1140	1140	THIS SUBSECTION SHAL L: 29
1141	1141	HOUSE BILL 727 25
1142	1142
1143	1143
1144	1144	(I) COMPLY WITH THE LABEL ING REQUIREMENTS OF § 12–505 1
1145	1145	OF THIS ARTICLE; 2
1146	1146
1147	1147	(II) RECORD THE DISPENSING OF THE PRESCRIPTION DRUG ON 3
1148	1148	THE PATIENT’S CHART; 4
1149	1149
1150	1150	(III) ALLOW THE OFFICE OF CONTROLLED SUBSTANCES 5
1151	1151	ADMINISTRATION TO ENT ER AND INSPECT THE P HYSICIAN ASSISTANT’S OFFICE AT 6
1152	1152	ALL REASONABLE HOURS ; AND 7
1153	1153
1154	1154	(IV) EXCEPT FOR STARTER DO SAGES OR SAMPLES DIS PENSED 8
1155	1155	WITHOUT CHARGE , PROVIDE THE PATIENT WITH A WRITTEN PRESC RIPTION, 9
1156	1156	MAINTAIN PRESCRIPTIO N FILES, AND MAINTAIN A SEPAR ATE FILE FOR SCHEDULE 10
1157	1157	II PRESCRIPTIONS FOR A PERIOD O F AT LEAST 5 YEARS. 11
1158	1158
1159	1159	[(d)] (E) A physician assistant who personally dispenses a drug in the course of 12
1160	1160	treating a patient as authorized under subsections (b) and [(c)] (D) of this section shall 13
1161	1161	comply with the requirements under Titles 12 and 14 of this article and applicable federal 14
1162	1162	law and regulations. 15
1163	1163
1164	1164	[(e) Before a physician assistant may renew a license for an additional 2–year 16
1165	1165	term under § 15–307 of this subtitle, the physician assistant shall submit evidence to the 17
1166	1166	Board of successful completion of 8 category 1 hours of pharmacology education within the 18
1167	1167	previous 2 years.] 19
1168	1168
1169	1169	(F) A PRESCRIPTION DISPENS ED UNDER THIS SECTIO N SHALL INCLUDE 20
1170	1170	THE PHYSICIAN ASSIST ANT’S: 21
1171	1171
1172	1172	(1) NAME; 22
1173	1173
1174	1174	(2) BUSINESS ADDRESS ; AND 23
1175	1175
1176	1176	(3) BUSINESS TELEPHONE NUMBER. 24
1177	1177
1178	1178	(G) A PHYSICIAN ASSISTANT STUDENT IN A TRAININ G PROGRAM THAT IS 25
1179	1179	ACCREDITED BY THE ACCREDITATION REVIEW COMMISSION ON EDUCATION FOR 26
1180	1180	THE PHYSICIAN ASSISTANT MAY NOT EXE RCISE PRESCRIPTIVE A UTHORITY. 27
1181	1181
1182	1182	[15–302.3. 28
1183	1183
1184	1184	(a) On a quarterly basis, the Board shall provide to the Board of Pharmacy a list 29
1185	1185	of physician assistants whose delegation agreements include the delegation of prescriptive 30
1186	1186	authority. 31
1187	1187	26 HOUSE BILL 727
1188	1188
1189	1189
1190	1190	(b) The list required under subsection (a) of this section shall specify whether 1
1191	1191	each physician assistant has been delegated the authority to prescribe controlled dangerous 2
1192	1192	substances, prescription drugs, or medical devices. 3
1193	1193
1194	1194	(c) If a primary supervising physician who has delegated authority to exercise 4
1195	1195	prescriptive authority to a physician assistant subsequently restricts or removes the 5
1196	1196	delegation, the primary supervising physician shall notify the Board of the restriction or 6
1197	1197	removal within 5 business days.] 7
1198	1198
1199	1199	15–303. 8
1200	1200
1201	1201	(a) To qualify for a license, an applicant shall: 9
1202	1202
1203	1203	(1) Complete a criminal history records check in accordance with § 10
1204	1204	14–308.1 of this article; 11
1205	1205
1206	1206	(2) Be of good moral character; 12
1207	1207
1208	1208	(3) Demonstrate oral and written competency in the English language as 13
1209	1209	required by the Board; 14
1210	1210
1211	1211	(4) Be at least 18 years old; [and] 15
1212	1212
1213	1213	(5) [(i) Be a graduate of a physician assistant training program 16
1214	1214	approved by the Board; or 17
1215	1215
1216	1216	(ii) Have passed the physician assistant national certifying 18
1217	1217	examination administered by the National Commission on Certification of Physician 19
1218	1218	Assistants prior to 1986, maintained all continuing education and recertification 20
1219	1219	requirements, and been in continuous practice since passage of the examination] EXCEPT 21
1220	1220	AS PROVIDED IN SUBSE CTION (B) OF THIS SECTION , HAVE SUCCESSFULLY 22
1221	1221	COMPLETED AN EDUCATI ONAL PROGRAM FOR PHY SICIAN ASSISTANTS AC CREDITED 23
1222	1222	BY: 24
1223	1223
1224	1224	(I) THE ACCREDITATION REVIEW COMMISSION ON 25
1225	1225	EDUCATION FOR THE PHYSICIAN ASSISTANT; OR 26
1226	1226
1227	1227	(II) IF COMPLETED BEFORE 2001: 27
1228	1228
1229	1229	1. THE COMMITTEE ON ALLIED HEALTH EDUCATION 28
1230	1230	AND ACCREDITATION ; OR 29
1231	1231
1232	1232	2. THE COMMISSION ON ACCREDITATION OF ALLIED 30
1233	1233	HEALTH EDUCATION PROGRAMS; AND 31
1234	1234	HOUSE BILL 727 27
1235	1235
1236	1236
1237	1237	(6) HAVE PASSED THE PHYSICIAN ASSISTANT NATIONAL 1
1238	1238	CERTIFYING EXAMINATION ADMINISTE RED BY THE NATIONAL COMMISSION ON 2
1239	1239	CERTIFICATION OF PHYSICIAN ASSISTANTS. 3
1240	1240
1241	1241	[(b) Except as otherwise provided in this title, the applicant shall pass a national 4
1242	1242	certifying examination approved by the Board.] 5
1243	1243
1244	1244	(B) THE BOARD MAY GRANT A LIC ENSE TO AN APPLICANT WHO DOES NOT 6
1245	1245	MEET THE EDUCATIONAL REQUIREMENTS UNDER S UBSECTION (A) OF THIS SECTION 7
1246	1246	IF THE APPLICANT HAS PASSED THE PHYSICIAN ASSISTANT NATIONAL CERTIFYING 8
1247	1247	EXAMINATION ADMINISTE RED BY THE NATIONAL COMMISSION ON CERTIFICATION 9
1248	1248	OF PHYSICIAN ASSISTANTS. 10
1249	1249
1250	1250	(c) An applicant who graduates from [a physician assistant training program] AN 11
1251	1251	ACCREDITED EDUCATION AL PROGRAM FOR PHYSI CIAN ASSISTANTS UNDE R THIS 12
1252	1252	SECTION after October 1, 2003 shall have a bachelor’s degree or its equivalent. 13
1253	1253
1254	1254	15–306. 14
1255	1255
1256	1256	A license authorizes the licensee to practice as a physician assistant [under a 15
1257	1257	delegation agreement] while the license is effective. 16
1258	1258
1259	1259	15–309. 17
1260	1260
1261	1261	(a) Each licensee shall keep a license and [delegation agreement] 18
1262	1262	COLLABORATION REGIST RATION for inspection at the primary place of business of the 19
1263	1263	licensee. 20
1264	1264
1265	1265	15–310. 21
1266	1266
1267	1267	(a) In reviewing an application for licensure or in investigating an allegation 22
1268	1268	brought under § 15–314 of this subtitle, the Committee may request the Board to direct, or 23
1269	1269	the Board on its own initiative may direct, the physician assistant to submit to an 24
1270	1270	appropriate examination. 25
1271	1271
1272	1272	(b) In return for the privilege given to the physician assistant to [perform 26
1273	1273	delegated medical acts] PRACTICE AS A PHYSIC IAN ASSISTANT in the State, the 27
1274	1274	physician assistant is deemed to have: 28
1275	1275
1276	1276	(1) Consented to submit to an examination under this section, if requested 29
1277	1277	by the Board in writing; and 30
1278	1278
1279	1279	(2) Waived any claim of privilege as to the testimony or examination 31
1280	1280	reports. 32
1281	1281	28 HOUSE BILL 727
1282	1282
1283	1283
1284	1284	(c) The unreasonable failure or refusal of the licensed physician assistant or 1
1285	1285	applicant to submit to an examination is prima facie evidence of the licensed physician 2
1286	1286	assistant’s inability to [perform delegated medical acts] PRACTICE AS A PHYSIC IAN 3
1287	1287	ASSISTANT and is cause for denial of the application or immediate suspension of the 4
1288	1288	license. 5
1289	1289
1290	1290	(d) The Board shall pay the costs of any examination made under this section. 6
1291	1291
1292	1292	[15–313. 7
1293	1293
1294	1294	(a) (1) Except as otherwise provided under § 10–226 of the State Government 8
1295	1295	Article, before the Board takes any action to reject or modify a delegation agreement or 9
1296	1296	advanced duty, the Board shall give the licensee the opportunity for a hearing before the 10
1297	1297	Board. 11
1298	1298
1299	1299	(2) The Board shall give notice and hold the hearing under Title 10, 12
1300	1300	Subtitle 2 of the State Government Article. 13
1301	1301
1302	1302	(3) The Board may administer oaths in connection with any proceeding 14
1303	1303	under this section. 15
1304	1304
1305	1305	(4) At least 14 days before the hearing, the hearing notice shall be sent to 16
1306	1306	the last known address of the applicant or licensee. 17
1307	1307
1308	1308	(b) Any licensee aggrieved under this subtitle by a final decision of the Board 18
1309	1309	rejecting or modifying a delegation agreement or advanced duty may petition for judicial 19
1310	1310	review as allowed by the Administrative Procedure Act.] 20
1311	1311
1312	1312	15–314. 21
1313	1313
1314	1314	(a) Subject to the hearing provisions of § 15–315 of this subtitle, a disciplinary 22
1315	1315	panel, on the affirmative vote of a majority of the quorum, may reprimand any physician 23
1316	1316	assistant, place any physician assistant on probation, or suspend or revoke a license if the 24
1317	1317	physician assistant: 25
1318	1318
1319	1319	[(41) Performs delegated medical acts beyond the scope of the delegation 26
1320	1320	agreement filed with the Board or after notification from the Board that an advanced duty 27
1321	1321	has been disapproved; 28
1322	1322
1323	1323	(42) Performs delegated medical acts without the supervision of a 29
1324	1324	physician;] 30
1325	1325
1326	1326	(41) PRACTICES AS A PHYSIC IAN ASSISTANT WITHOU T FIRST 31
1327	1327	SUBMITTING A COLLABO RATION REGISTRATION TO THE BOARD; 32
1328	1328	HOUSE BILL 727 29
1329	1329
1330	1330
1331	1331	[(43)] (42) Fails to complete a criminal history records check under § 1
1332	1332	14–308.1 of this article; 2
1333	1333
1334	1334	[(44)] (43) Fails to comply with the requirements of the Prescription Drug 3
1335	1335	Monitoring Program in Title 21, Subtitle 2A of the Health – General Article; or 4
1336	1336
1337	1337	[(45)] (44) Fails to comply with any State or federal law pertaining to the 5
1338	1338	practice as a physician assistant. 6
1339	1339
1340	1340	15–317. 7
1341	1341
1342	1342	(a) A physician assistant WHO IS LICENSED in this State or in any other state 8
1343	1343	OR WHO IS AN EMPLOYE E OF THE FEDERAL GOV ERNMENT is authorized to perform 9
1344	1344	acts, tasks, or functions as a physician assistant [under the supervision of a physician 10
1345	1345	licensed to practice medicine in the State] during a disaster as defined by the Governor, 11
1346	1346	within a county in which a state of disaster has been declared, or counties contiguous to a 12
1347	1347	county in which a state of disaster has been declared. 13
1348	1348
1349	1349	(b) The physician assistant shall notify the Board in writing of the names, 14
1350	1350	practice locations, and telephone numbers for the physician assistant [and each primary 15
1351	1351	supervising physician] within 30 days [of] AFTER the first performance of medical acts, 16
1352	1352	tasks, or functions as a physician assistant during the disaster. 17
1353	1353
1354	1354	(c) A team of physicians and physician assistants or physician assistants 18
1355	1355	practicing under this section may not be required to maintain on–site documentation 19
1356	1356	describing [supervisory arrangements] COLLABORATION REGIST RATIONS as otherwise 20
1357	1357	required under this title. 21
1358	1358
1359	1359	(D) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION , A 22
1360	1360	PHYSICIAN ASSISTANT WHO RESPONDS DURING A DISASTER MAY NOT B E LIABLE 23
1361	1361	FOR CIVIL DAMAGES FO R INJURIES THAT RESU LT FROM ACTS OR OMIS SIONS WITHIN 24
1362	1362	AN ACT, A TASK, OR A FUNCTION. 25
1363	1363
1364	1364	(2) THE IMMUNITY GRANTED UNDER PARAGRAPH (1) OF THIS 26
1365	1365	SUBSECTION DOES NOT APPLY TO ANY ACT THA T IS COMMITTED NEGLI GENTLY. 27
1366	1366
1367	1367	15–401. 28
1368	1368
1369	1369	[(a)] Except as otherwise provided in this title, a person may not practice, attempt 29
1370	1370	to practice, or offer to practice as a physician assistant in the State unless the person has 30
1371	1371	[a]: 31
1372	1372
1373	1373	(1) A license issued by the Board TO PRACTICE AS A PHY SICIAN 32
1374	1374	ASSISTANT; AND 33
1375	1375	30 HOUSE BILL 727
1376	1376
1377	1377
1378	1378	(2) SUBMITTED A COLLABORA TION REGISTRATION TO THE BOARD. 1
1379	1379
1380	1380	[(b) Except as otherwise provided in this title, a person may not perform, attempt 2
1381	1381	to perform, or offer to perform any delegated medical act beyond the scope of the license 3
1382	1382	and which is consistent with a delegation agreement filed with the Board.] 4
1383	1383
1384	1384	15–402.1. 5
1385	1385
1386	1386	(a) Except as otherwise provided in this subtitle, a licensed physician may not 6
1387	1387	employ [or supervise] an individual practicing as a physician assistant who does not have 7
1388	1388	a license OR WHO HAS N OT SUBMITTED A COLLA BORATION REGISTRATIO N TO THE 8
1389	1389	BOARD. 9
1390	1390
1391	1391	Article – Transportation 10
1392	1392
1393	1393	13–616. 11
1394	1394
1395	1395	(a) (1) In this subtitle the following words have the meanings indicated. 12
1396	1396
1397	1397	(7) “Licensed physician assistant” means an individual who is licensed 13
1398	1398	under Title 15 of the Health Occupations Article to practice [medicine with physician 14
1399	1399	supervision] AS A PHYSICIAN ASSIS TANT. 15
1400	1400
1401	1401	SECTION 2. AND BE IT FURTHER ENACTED, That: 16
1402	1402
1403	1403	(a) A physician assistant authorized to practice under a delegation agreement on 17
1404	1404	October 1, 2023, may continue to practice as a physician assistant under the delegation 18
1405	1405	agreement. 19
1406	1406
1407	1407	(b) The delegation agreement in effect on October 1, 2023, shall be treated the 20
1408	1408	same as collaboration registration required under § 15–302 of the Health Occupations 21
1409	1409	Article, as enacted by Section 1 of this Act, until an initial collaboration registration is 22
1410	1410	submitted to the State Board of Physicians by the physician assistant. 23
1411	1411
1412	1412	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 24
1413	1413	October 1, 2023. 25
1414	1414