EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0312*
HOUSE BILL 312
J2 4lr2034
By: Delegate Bagnall
Introduced and read first time: January 15, 2024
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Physician Assistants – Collaboration Agreements 2
FOR the purpose of requiring a physician assistant to have a collaboration agreement with 3
a patient care team physician, rather than a delegation agreement with a primary 4
supervising physician, in order to practice as a physician assistant; increasing the 5
number of physician assistants to whom a patient care team physician may delegate 6
medical acts under a collaboration agreement; altering the circumstances under 7
which and settings at which a physician assistant is authorized to perform advanced 8
duties without the approval of the State Board of Physicians; and generally relating 9
to physician assistant collaboration agreements. 10
BY repealing and reenacting, without amendments, 11
Article – Alcoholic Beverages and Cannabis 12
Section 36–101(a) 13
Annotated Code of Maryland 14
(2016 Volume and 2023 Supplement) 15
BY repealing and reenacting, with amendments, 16
Article – Alcoholic Beverages and Cannabis 17
Section 36–101(m)(1)(v) 18
Annotated Code of Maryland 19
(2016 Volume and 2023 Supplement) 20
BY repealing and reenacting, with amendments, 21
Article – Education 22
Section 7–402(c) 23
Annotated Code of Maryland 24
(2022 Replacement Volume and 2023 Supplement) 25
BY repealing and reenacting, with amendments, 26
Article – Health Occupations 27 2 HOUSE BILL 312
Section 12–102(c)(2)(iv), 14–306(e)(3)(iii)2.B., 15–101, 15–103(b), 15–202(b), 1
15–205(a), 15–301, 15–302, 15–302.1, 15–302.2, 15–302.3, 15–306, 15–309(a), 2
15–313, 15–314(a)(41), 15–317(b), and 15–401(b) 3
Annotated Code of Maryland 4
(2021 Replacement Volume and 2023 Supplement) 5
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
That the Laws of Maryland read as follows: 7
Article – Alcoholic Beverages and Cannabis 8
36–101. 9
(a) In this title the following words have the meanings indicated. 10
(m) “Certifying provider” means an individual who: 11
(1) (v) 1. has an active, unrestricted license to practice as a 12
physician assistant issued by the State Board of Physicians under Title 15 of the Health 13
Occupations Article; 14
2. has an active [delegation] COLLABORATION agreement 15
with a [primary supervising] PATIENT CARE TEAM physician who is a certifying provider; 16
and 17
3. is in good standing with the State Board of Physicians; 18
Article – Education 19
7–402. 20
(c) The physical examination required under subsection (b) of this section shall 21
be completed by: 22
(1) A licensed physician; 23
(2) A licensed physician assistant with a [delegation] COLLABORATION 24
agreement [approved by the State Board of Physicians] THAT MEETS THE 25
REQUIREMENTS OF § 15–302 OF THE HEALTH OCCUPATIONS ARTICLE; or 26
(3) A certified nurse practitioner. 27
Article – Health Occupations 28
12–102. 29
(c) (2) This title does not prohibit: 30 HOUSE BILL 312 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 in accordance with a [delegation] 3
COLLABORATION agreement that complies with Title 15, Subtitle 3 of this article; or 4
2. An advanced practice registered nurse with prescriptive 5
authority under Title 8 of this article and is working with the physician in the same office 6
setting; 7
14–306. 8
(e) Except as otherwise provided in this section, an individual may perform 9
X–ray duties without a license only if the duties: 10
(3) Are performed: 11
(iii) 2. By a licensed physician assistant who has completed a 12
course that includes anterior–posterior and lateral radiographic studies of extremities on 13
at least 20 separate patients under the direct supervision of the delegating physician or 14
radiologist using a mini C–arm or similar low–level radiation machine to perform 15
nonfluoroscopic X–ray procedures, if the duties: 16
B. Are performed pursuant to a [Board–approved delegation] 17
COLLABORATION agreement that includes a request to perform advanced duties under § 18
15–302(c)(2) of this article. 19
15–101. 20
(a) In this title the following words have the meanings indicated. 21
(b) [“Alternate supervising physician” means one or more physicians designated 22
by the primary supervising physician to provide supervision of a physician assistant in 23
accordance with the delegation agreement on file with the Board. 24
(c)] “Ambulatory surgical facility” means a facility: 25
(1) Accredited by: 26
(i) The American Association for Accreditation of Ambulatory 27
Surgical Facilities; 28
(ii) The Accreditation Association for Ambulatory Health Care; or 29
(iii) The Joint Commission on Accreditation of Healthcare 30 4 HOUSE BILL 312
Organizations; or 1
(2) Certified to participate in the Medicare program, as enacted by Title 2
XVIII of the Social Security Act. 3
[(d)] (C) “Board” means the State Board of Physicians, established under § 4
14–201 of this article. 5
(D) “COLLABORATION AGREEME NT” MEANS A DOCUMENT THAT: 6
(1) IS EXECUTED BY ONE OR MORE PATIENT CARE TE AM PHYSICIANS 7
AND ONE OR MORE PHYS ICIAN ASSISTANTS; AND 8
(2) MEETS THE REQUIREMENT S OF § 15–302 OF THIS TITLE. 9
(e) “Committee” means the Physician Assistant Advisory Committee. 10
(f) “Controlled dangerous substances” has the meaning stated in § 5–101 of the 11
Criminal Law Article. 12
(g) “Correctional facility” includes a State or local correctional facility. 13
(h) “Delegated medical acts” means activities that constitute the practice of 14
medicine delegated by a physician under Title 14 of this article. 15
(i) [“Delegation agreement” means a document that is executed by a primary 16
supervising physician and a physician assistant containing the requirements of § 15–302 17
of this title. 18
(i–1)] “Disciplinary panel” means a disciplinary panel of the Board established 19
under § 14–401 of this article. 20
(j) “Dispense” or “dispensing” has the meaning stated in § 12–101 of this article. 21
(k) “Drug sample” means a unit of a prescription drug that is intended to promote 22
the sale of the drug and is not intended for sale. 23
(l) “Hospital” means: 24
(1) A hospital as defined under § 19–301 of the Health – General Article; 25
(2) A comprehensive care facility that: 26
(i) Meets the requirements of a hospital–based skilled nursing 27
facility under federal law; and 28
HOUSE BILL 312 5
(ii) Offers acute care in the same building; [and] OR 1
(3) An emergency room that is physically connected to a hospital or a 2
freestanding medical facility that is licensed under Title 19, Subtitle 3A of the Health – 3
General Article. 4
(m) “License” means a license issued by the Board to a physician assistant under 5
this title. 6
(n) “National certifying examination” means the Physician Assistant National 7
Certifying Examination administered by the National Commission on Certification of 8
Physician Assistants or its successor. 9
(O) “PATIENT CARE TEAM PHY SICIAN” MEANS A PHYSICIAN WH O: 10
(1) COMPLETES A COLLABORA TION AGREEMENT THAT MEETS THE 11
REQUIREMENTS UNDER §§ 15–301(D) AND (E) AND 15–302 OF THIS TITLE; 12
(2) ACTS AS AN AGENT OF O R IS EMPLOYED BY THE EMPLOYER OF 13
THE PHYSICIAN ASSIST ANTS LISTED IN THE C OLLABORATION AGREEME NT; 14
(3) IS RESPONSIBLE FOR EN SURING THAT THE PHYS ICIAN 15
ASSISTANTS LISTED IN THE COLLABORATION AG REEMENT PRACTICE MED ICINE IN 16
ACCORDANCE WITH THIS TITLE AND THE REGULATIONS ADOP TED UNDER THIS 17
TITLE; AND 18
(4) ENSURES THAT THE PHYS ICIAN ASSISTANTS PRA CTICE WITHIN 19
THE SCOPE OF PRACTIC E OF THE PHYSICIAN . 20
[(o)] (P) “Physician assistant” means an individual who is licensed under this 21
title to practice medicine with physician supervision. 22
[(p)] (Q) “Practice as a physician assistant” means the performance of medical 23
acts that are: 24
(1) Delegated by a [supervising] PATIENT CARE TEAM physician to a 25
physician assistant; 26
(2) Within the [supervising physician’s] scope of practice OF THE PATIENT 27
CARE TEAM PHYSICIAN ; and 28
(3) Appropriate to the physician assistant’s education, training, and 29
experience. 30
[(q)] (R) “Prescriptive authority” means the authority delegated by a [primary 31 6 HOUSE BILL 312
or alternate supervising] PATIENT CARE TEAM physician to a physician assistant to: 1
(1) Prescribe and administer controlled dangerous substances, prescription 2
drugs, medical devices, and the oral, written, or electronic ordering of medications; and 3
(2) Dispense as provided under § 15–302.2(b), (c), and (d) of this title. 4
[(r) “Primary supervising physician” means a physician who: 5
(1) Completes a delegation agreement that meets the requirements under 6
§§ 15–301(d) and (e) and 15–302 of this title and files a copy with the Board; 7
(2) Acts as the physician responsible to ensure that a physician assistant 8
practices medicine in accordance with this title and the regulations adopted under this title; 9
(3) Ensures that a physician assistant practices within the scope of practice 10
of the primary supervising physician or any designated alternate supervising physician; 11
and 12
(4) Ensures that a list of alternate supervising physicians is maintained at 13
the practice setting.] 14
(s) “Public health facility” means a site where clinical public health services are 15
rendered under the auspices of the Department, a local health department in a county, or 16
the Baltimore City Health Department. 17
(t) “Starter dosage” means an amount of a drug sufficient to begin therapy: 18
(1) Of short duration of 72 hours or less; or 19
(2) Prior to obtaining a larger quantity of the drug to complete therapy. 20
(u) (1) “Supervision” means the responsibility of a PATIENT CARE TEAM 21
physician to exercise on–site supervision or immediately available direction for physician 22
assistants performing delegated medical acts. 23
(2) “Supervision” includes [physician] THE oversight of and acceptance of 24
direct responsibility BY A PATIENT CARE TEAM PHYSICIAN for the patient services and 25
care rendered by a physician assistant, including continuous availability to the physician 26
assistant in person, through written instructions, or by electronic means [and by 27
designation of one or more alternate supervising physicians]. 28
15–103. 29
(b) (1) Subject to paragraph (2) of this subsection, an employer of a physician 30
assistant shall report to the Board, on the form prescribed by the Board, any termination 31 HOUSE BILL 312 7
of employment of the physician assistant if the cause of termination is related to a quality 1
of care issue. 2
(2) Subject to subsection (d) of this section, a [supervising] PATIENT CARE 3
TEAM physician or an employer of a physician assistant shall notify the Board within 10 4
days of the termination of employment of the physician assistant for reasons that would be 5
grounds for discipline under this title. 6
(3) A [supervising] PATIENT CARE TEAM physician and a physician 7
assistant shall notify the Board within 10 days of the termination of the relationship under 8
a [delegation] COLLABORATION agreement for any reason. 9
15–202. 10
(b) Of the three physician members of the Committee, two shall be previously or 11
currently serving as [supervising] PATIENT CARE TEAM physicians of a physician 12
assistant under a [Board–approved delegation] COLLABORATION agreement. 13
15–205. 14
(a) In addition to the powers set forth elsewhere in this title, the Committee, on 15
its initiative or on the Board’s request, may: 16
(1) Recommend to the Board regulations for carrying out the provisions of 17
this title; 18
(2) Recommend to the Board approval, modification, or disapproval of an 19
application for licensure or a [delegation] COLLABORATION agreement; 20
(3) Report to the Board any conduct of a [supervising] PATIENT CARE 21
TEAM physician or a physician assistant that may be cause for disciplinary action under 22
this title or under § 14–404 of this article; and 23
(4) Report to the Board any alleged unauthorized practice of a physician 24
assistant. 25
15–301. 26
(a) Nothing in this title may be construed to authorize a physician assistant to 27
practice independent of a [primary or alternate supervising] PATIENT CARE TEAM 28
physician. 29
(b) A license issued to a physician assistant shall limit the physician assistant’s 30
scope of practice to medical acts: 31
(1) Delegated by [the primary or alternate supervising] A PATIENT CARE 32 8 HOUSE BILL 312
TEAM physician; 1
(2) Appropriate to the education, training, and experience of the physician 2
assistant; 3
(3) Customary to the practice of the [primary or alternate supervising] 4
PATIENT CARE TEAM physician; and 5
(4) Consistent with the [delegation] COLLABORATION agreement [filed 6
with the Board]. 7
(c) Patient services that may be provided by a physician assistant include: 8
(1) (i) Taking complete, detailed, and accurate patient histories; and 9
(ii) Reviewing patient records to develop comprehensive medical 10
status reports; 11
(2) Performing physical examinations and recording all pertinent patient 12
data; 13
(3) Interpreting and evaluating patient data as authorized by [the primary 14
or alternate supervising] A PATIENT CARE TEAM physician for the purpose of determining 15
management and treatment of patients; 16
(4) Initiating requests for or performing diagnostic procedures as indicated 17
by pertinent data and as authorized by [the supervising] A PATIENT CARE TEAM 18
physician; 19
(5) Providing instructions and guidance regarding medical care matters to 20
patients; 21
(6) Assisting [the primary or alternate supervising] A PATIENT CARE 22
TEAM physician in the delivery of services to patients who require medical care in the home 23
and in health care institutions, including: 24
(i) Recording patient progress notes; 25
(ii) Issuing diagnostic orders; and 26
(iii) Transcribing or executing specific orders at the direction of [the 27
primary or alternate supervising] A PATIENT CARE TEAM physician; and 28
(7) Exercising prescriptive authority under a [delegation] 29
COLLABORATION agreement and in accordance with § 15–302.2 of this subtitle. 30
HOUSE BILL 312 9
(d) (1) Except as otherwise provided in this title, an individual shall be 1
licensed by the Board before the individual may practice as a physician assistant. 2
(2) (I) Except as otherwise provided in this title, a physician may not 3
supervise a physician assistant in the performance of delegated medical acts [without filing 4
a completed delegation agreement with the Board] UNLESS THE PHYSICIAN IS LISTED 5
AS A PATIENT CARE TE AM PHYSICIAN ON A CO LLABORATION AGREEMEN T WITH THE 6
PHYSICIAN ASSISTANT . 7
(II) A COLLABORATION AGREEM ENT MAY LIST ONE OR MORE 8
PHYSICIANS AS PATIENT CARE TEAM PH YSICIANS FOR A PHYSI CIAN ASSISTANT. 9
(3) Except as otherwise provided in this title or in a medical emergency, a 10
physician assistant may not perform any medical act for which: 11
(i) The individual has not been licensed; and 12
(ii) The medical acts have not been delegated by a [primary or 13
alternate supervising] PATIENT CARE TEAM physician. 14
(e) A physician assistant is the agent of the [primary or alternate supervising] 15
PATIENT CARE TEAM physician in the performance of all practice–related activities, 16
including the oral, written, or electronic ordering of diagnostic, therapeutic, and other 17
medical services. 18
(f) Except as provided in subsection (g) of this section, the following individuals 19
may practice as a physician assistant without a license: 20
(1) A physician assistant student enrolled in a physician assistant 21
educational program that is accredited by the Accreditation Review Commission on 22
Education for the Physician Assistant or its successor and approved by the Board; or 23
(2) A physician assistant employed in the service of the federal government 24
while performing duties incident to that employment. 25
(g) A PATIENT CARE TEAM physician may not delegate prescriptive authority to 26
a physician assistant student in a training program that is accredited by the Accreditation 27
Review Commission on Education for the Physician Assistant or its successor. 28
(h) (1) If a medical act that is to be delegated under this section is a part of the 29
practice of a health occupation that is regulated under this article by another board, any 30
rule or regulation concerning that medical act shall be adopted jointly by the State Board 31
of Physicians and the board that regulates the other health occupation. 32
(2) If the two boards cannot agree on a proposed rule or regulation, the 33
proposal shall be submitted to the Secretary for a final decision. 34 10 HOUSE BILL 312
15–302. 1
(a) A PATIENT CARE TEAM physician may delegate medical acts to a physician 2
assistant only after: 3
(1) A [delegation] COLLABORATION agreement has been executed [and 4
filed with the Board]; [and] 5
(2) Any advanced duties have been authorized as required under 6
subsection (c) of this section; AND 7
(3) THE BOARD HAS BEEN NOTIFI ED OF THE EXECUTED 8
COLLABORATION AGREEM ENT AND OF EACH PATI ENT CARE TEAM PHYSICIAN 9
LISTED ON THE AGREEM ENT. 10
(b) The [delegation] COLLABORATION agreement shall contain: 11
(1) A description of the qualifications of the [primary supervising physician 12
and] physician assistant AND EACH PATIENT CAR E TEAM PHYSICIAN LIS TED ON THE 13
COLLABORATION AGREEM ENT; 14
(2) A description of the settings in which the physician assistant will 15
practice; 16
(3) A description of the continuous physician supervision mechanisms that 17
are reasonable and appropriate to the practice setting; 18
(4) [A] FOR EACH PATIENT CARE TEAM PHYSICIAN LISTE D ON THE 19
COLLABORATION AGREEM ENT, A description of the delegated medical acts that are 20
within the [primary or alternate supervising] PATIENT CARE TEAM physician’s scope of 21
practice and require specialized education or training that is consistent with accepted 22
medical practice; 23
(5) An attestation that all medical acts to be delegated to the physician 24
assistant are within the scope of practice of the [primary or alternate supervising] 25
DELEGATING PATIENT C ARE TEAM physician and appropriate to the physician 26
assistant’s education, training, and level of competence; 27
(6) An attestation of continuous supervision of the physician assistant by 28
[the primary supervising] EACH PATIENT CARE TEAM physician through the mechanisms 29
described in the [delegation] COLLABORATION agreement; 30
(7) An attestation by [the primary supervising] EACH PATIENT CARE 31
TEAM physician of the physician’s acceptance of responsibility for any care given by the 32 HOUSE BILL 312 11
physician assistant; 1
(8) A description prepared by [the primary supervising] EACH PATIENT 2
CARE TEAM physician of the process by which the physician assistant’s practice is reviewed 3
appropriate to the practice setting and consistent with current standards of acceptable 4
medical practice; 5
(9) An attestation by [the primary supervising] EACH PATIENT CARE 6
TEAM physician that the physician will respond in a timely manner when contacted by the 7
physician assistant; 8
(10) The following statement: 9
“The [primary supervising physician and the] physician assistant AND EACH 10
PATIENT CARE TEAM PH YSICIAN attest that: 11
(i) They will establish a plan for the types of cases that require a 12
physician plan of care or require that the patient initially or periodically be seen by [the 13
supervising physician] A PATIENT CARE TEAM PHYSICIAN; and 14
(ii) The patient will be provided access to [the supervising physician] 15
A PATIENT CARE TEAM PHYSICIAN on request”; and 16
(11) Any other information deemed necessary by the Board to carry out the 17
provisions of this subtitle. 18
(c) (1) [The Board may not require prior approval of a delegation agreement 19
that includes] A PHYSICIAN ASSISTANT MAY PERFORM advanced duties WITHOUT 20
BOARD APPROVAL , if an advanced duty will be performed in a hospital, [or] ambulatory 21
surgical facility, [provided that] OR ANOTHER PRACTICE SETTING LISTED ON A 22
DELINEATION OF PRIVI LEGES DOCUMENT AND : 23
(i) A physician, with credentials that have been reviewed by the 24
hospital or ambulatory surgical facility as a condition of employment, as an independent 25
contractor, or as a member of the medical staff, supervises the physician assistant; 26
(ii) The physician assistant has credentials that have been reviewed 27
by the hospital or ambulatory surgical facility as a condition of employment, as an 28
independent contractor, or as a member of the medical staff; [and] 29
(iii) Each advanced duty to be delegated to the physician assistant is 30
reviewed and approved within a process approved by the governing body of the health care 31
facility before the physician assistant performs the advanced duties; AND 32
(IV) THE PHYSICIAN ASSISTA NT KEEPS THE DOCUMEN TS 33 12 HOUSE BILL 312
DEMONSTRATING COMPLI ANCE WITH ITEMS (I) THROUGH (III) OF THIS PARAGRAPH 1
ON FILE AT THE HOSPI TAL, AMBULATORY SURGICAL FACILITY, OR OTHER PRACTICE 2
SETTING. 3
(2) (i) In any setting that does not meet the requirements of paragraph 4
(1) of this subsection, a [primary supervising] PATIENT CARE TEAM physician shall obtain 5
the Board’s approval of a [delegation] COLLABORATION agreement that includes 6
advanced duties, before the physician assistant performs the advanced duties. 7
(ii) 1. Before a physician assistant may perform X–ray duties 8
authorized under § 14–306(e) of this article in the medical office of the physician delegating 9
the duties, a [primary supervising] PATIENT CARE TEAM physician shall obtain the 10
Board’s approval of a [delegation] COLLABORATION agreement that includes advanced 11
duties in accordance with subsubparagraph 2 of this subparagraph. 12
2. The advanced duties set forth in a [delegation] 13
COLLABORATION agreement under this subparagraph shall be limited to nonfluoroscopic 14
X–ray procedures of the extremities, anterior–posterior and lateral, not including the head. 15
(3) Notwithstanding paragraph (1) of this subsection, a [primary 16
supervising] PATIENT CARE TEAM physician shall obtain the Board’s approval of a 17
[delegation] COLLABORATION agreement before the physician assistant may administer, 18
monitor, or maintain general anesthesia or neuroaxial anesthesia, including spinal and 19
epidural techniques, under the COLLABORATION agreement. 20
(4) A PHYSICIAN ASSISTANT DOES NOT NEED PRIOR APPROVAL TO 21
PERFORM AN ADVANCED DUTY IN COLLABORATIO N WITH A PATIENT CAR E TEAM 22
PHYSICIAN IF: 23
(I) THE PHYSICIAN ASSISTA NT HAS PREVIOUSLY OB TAINED 24
BOARD APPROVAL TO PERFORM THE ADVANCED DUTY IN COLLABORATION WITH A 25
PATIENT CARE TEAM PH YSICIAN; AND 26
(II) THE ADVANCED DUTY IS WITHIN THE SCOPE OF PRACTICE 27
OF A PATIENT CARE TE AM PHYSICIAN LISTED IN THE COLLABORATION AGREEMENT . 28
(d) For a [delegation] COLLABORATION agreement containing advanced duties 29
that require Board approval, the Committee shall review the [delegation] 30
COLLABORATION agreement and recommend to the Board that the [delegation] 31
COLLABORATION agreement be approved, rejected, or modified to ensure conformance 32
with the requirements of this title. 33
(e) The Committee may conduct a personal interview of the [primary supervising 34
physician] PATIENT CARE TEAM PH YSICIANS and the physician assistant. 35 HOUSE BILL 312 13
(f) (1) On review of the Committee’s recommendation regarding [a primary 1
supervising physician’s] THE request OF ONE OR MORE PATIE NT CARE TEAM 2
PHYSICIANS to delegate advanced duties as described in a [delegation] COLLABORATION 3
agreement, the Board: 4
(i) May approve the [delegation] COLLABORATION agreement; or 5
(ii) 1. If the physician assistant does not meet the applicable 6
education, training, and experience requirements to perform the specified delegated acts, 7
may modify or disapprove the [delegation] COLLABORATION agreement; and 8
2. If the Board takes an action under item 1 of this item: 9
A. Shall notify the [primary supervising] DELEGATING 10
PATIENT CARE TEAM physician and the physician assistant in writing of the particular 11
elements of the proposed [delegation] COLLABORATION agreement that were the cause 12
for the modification or disapproval; and 13
B. May not restrict the submission of an amendment to the 14
[delegation] COLLABORATION agreement. 15
(2) To the extent practicable, the Board shall approve a [delegation] 16
COLLABORATION agreement or take other action authorized under this subsection within 17
90 days after receiving a completed [delegation] COLLABORATION agreement including 18
any information from the physician assistant and [primary supervising physician] THE 19
PATIENT CARE TEAM PHYSICIANS necessary to approve or take action. 20
(g) If the Board determines that a [primary or alternate supervising physician] 21
PATIENT CARE TEAM PH YSICIAN or physician assistant is practicing in a manner 22
inconsistent with the requirements of this title or Title 14 of this article, the Board on its 23
own initiative or on the recommendation of the Committee may demand modification of the 24
practice, withdraw the approval of [the delegation agreement] ADVANCED DUTIES , or 25
refer the matter to a disciplinary panel for the purpose of taking other disciplinary action 26
under § 14–404 or § 15–314 of this article. 27
(h) A [primary supervising] PATIENT CARE TEAM physician may not delegate 28
medical acts under a [delegation] COLLABORATION agreement to more than [four] EIGHT 29
physician assistants at any one time, except in a hospital or in the following nonhospital 30
settings: 31
(1) A correctional facility; 32
(2) A detention center; or 33
14 HOUSE BILL 312
(3) A public health facility. 1
(i) A person may not coerce another person to enter into a [delegation] 2
COLLABORATION agreement under this subtitle. 3
(j) [A physician may supervise a physician assistant: 4
(1) As a primary supervising physician in accordance with a delegation 5
agreement approved by the Board under this subtitle; or 6
(2) As an alternate supervising physician if: 7
(i) The alternate supervising physician supervises in accordance 8
with a delegation agreement filed with the Board; 9
(ii) The alternate supervising physician supervises no more than 10
four physician assistants at any one time, except in a hospital, correctional facility, 11
detention center, or public health facility; 12
(iii) The alternate supervising physician’s period of supervision, in 13
the temporary absence of the primary supervising physician, does not exceed: 14
1. The period of time specified in the delegation agreement; 15
and 16
2. A period of 45 consecutive days at any one time; and 17
(iv) The physician assistant performs only those medical acts that: 18
1. Have been delegated under the delegation agreement filed 19
with the Board; and 20
2. Are within the scope of practice of the primary supervising 21
physician and alternate supervising physician. 22
(k)] Subject to the notice required under § 15–103 of this title, a physician 23
assistant may terminate a [delegation] COLLABORATION agreement [filed with the 24
Board] under this subtitle at any time. 25
[(l)] (K) (1) In the event of the sudden departure, incapacity, or death of [the 26
primary supervising physician of a physician assistant] A PATIENT CARE TEAM 27
PHYSICIAN, or change in license status that results in [the primary supervising] A 28
PATIENT CARE TEAM physician being unable to legally practice medicine, [an alternate 29
supervising physician designated under subsection (b) of this section may supervise the 30
physician assistant for not longer than 15 days following the event] THE COLLABORATION 31
AGREEMENT WILL REMAI N ACTIVE AND VALID U NDER THE SUPERVISION OF ANY 32 HOUSE BILL 312 15
REMAINING LISTED PATIEN T CARE TEAM PHYSICIA NS. 1
(2) If there is no [designated alternate supervising physician] REMAINING 2
PATIENT CARE TEAM PH YSICIAN LISTED ON TH E COLLABORATION AGRE EMENT or 3
the [designated alternate supervising physician] REMAINING PATIENT CARE TEAM 4
PHYSICIAN does not agree to supervise the physician assistant, the physician assistant 5
may not practice until the physician assistant [receives approval of a new delegation 6
agreement under § 15–302.1 of this subtitle] HAS EXECUTED A NEW COLLABOR ATION 7
AGREEMENT AND, IF APPLICABLE , HAS BOARD APPROVAL TO PER FORM ANY 8
ADVANCED DUTIES DELE GATED TO THE PHYSICI AN ASSISTANT UNDER T HE NEW 9
COLLABORATION AGREEM ENT. 10
(3) [An alternate supervising physician or other licensed physician may 11
assume the role of primary supervising physician by submitting a new delegation 12
agreement to the Board for approval under subsection (b) of this section. 13
(4)] The Board may terminate a [delegation] COLLABORATION agreement 14
if: 15
(i) The physician assistant has a change in license status that 16
results in the physician assistant being unable to legally practice as a physician assistant; 17
OR 18
(ii) [At least 15 days have elapsed since an event listed under 19
paragraph (1) of this subsection if there is an alternate supervising physician designated 20
under subsection (b) of this section; or 21
(iii)] Immediately after an event listed under paragraph (1) of this 22
subsection if there is no [alternate supervising] REMAINING PATIENT CARE TEAM 23
physician [designated under subsection (b) of this section] LISTED ON THE 24
COLLABORATION AGREEM ENT. 25
[(m)] (L) A physician assistant whose [delegation] COLLABORATION agreement 26
is terminated may not practice as a physician assistant until the physician assistant 27
[receives preliminary approval of] EXECUTES a new [delegation] COLLABORATION 28
agreement under [§ 15–302.1 of this subtitle] THIS SECTION. 29
[(n)] (M) Individual members of the Board are not civilly liable for actions 30
regarding the approval, modification, or disapproval of a [delegation] COLLABORATION 31
agreement described in this section. 32
[(o)] (N) A physician assistant may practice in accordance with a [delegation] 33
COLLABORATION agreement [filed with the Board] under this subtitle. 34
(O) A PATIENT CARE TEAM PH YSICIAN MAY BE ADDED TO OR REMOVED 35 16 HOUSE BILL 312
FROM A COLLABORATION AGREEMENT BY PROVIDI NG NOTIFICATION TO T HE 1
BOARD. 2
(P) A COLLABORATION AGREEM ENT SHALL BE MAINTAI NED AT THE 3
PRACTICE SETTING AND MADE AVAILABLE TO TH E BOARD ON REQUEST . 4
15–302.1. 5
(a) If a [delegation] COLLABORATION agreement does not include advanced 6
duties or the advanced duties have been approved under § 15–302(c)(1) of this subtitle, a 7
physician assistant may assume the duties under a [delegation] COLLABORATION 8
agreement on the date that the [Board acknowledges receipt of the completed delegation] 9
PHYSICIAN ASSISTANT PROVIDES NOTIFICATIO N TO THE BOARD OF AN EXECUTED 10
COLLABORATION agreement AS REQUIRED UNDER § 15–302(A)(3) OF THIS SUBTITLE. 11
(b) In this section, “pending” means that a [delegation] COLLABORATION 12
agreement that includes delegation of advanced duties in a setting that does not meet the 13
requirements under § 15–302(c)(1) of this subtitle has been executed and submitted to the 14
Board for its approval, but: 15
(1) The Committee has not made a recommendation to the Board; or 16
(2) The Board has not made a final decision regarding the [delegation] 17
COLLABORATION agreement. 18
(c) [Subject to subsection (d) of this section, if a delegation agreement is pending, 19
on receipt of a temporary practice letter from the staff of the Board, a physician assistant 20
may perform the advanced duty if: 21
(1) The primary supervising physician has been previously approved to 22
supervise one or more physician assistants in the performance of the advanced duty; and 23
(2) The physician assistant has been previously approved by the Board to 24
perform the advanced duty. 25
(d)] If the Committee recommends a denial of the pending [delegation] 26
COLLABORATION agreement or the Board denies the pending [delegation] 27
COLLABORATION agreement, on notice to [the primary supervising] EACH PATIENT 28
CARE TEAM physician and the physician assistant, the physician assistant may no longer 29
perform the advanced duty that has not received the approval of the Board. 30
[(e)] (D) The Board may disapprove any [delegation] COLLABORATION 31
agreement if it believes that: 32
(1) The agreement does not meet the requirements of this subtitle; or 33 HOUSE BILL 312 17
(2) The physician assistant is unable to perform safely the delegated 1
duties. 2
[(f)] (E) If the Board disapproves a [delegation] COLLABORATION agreement 3
or the delegation of any function under [an] A COLLABORATION agreement, the Board 4
shall provide [the primary supervising] EACH PATIENT CARE TE AM physician and the 5
physician assistant with written notice of the disapproval. 6
[(g)] (F) A physician assistant who receives notice that the Board has 7
disapproved a [delegation] COLLABORATION agreement or an advanced function under 8
the [delegation] COLLABORATION agreement shall immediately cease to practice under 9
the COLLABORATION agreement or to perform the disapproved function. 10
15–302.2. 11
(a) A [primary supervising] PATIENT CARE TEAM physician may not delegate 12
prescribing, dispensing, and administering of controlled dangerous substances, 13
prescription drugs, or medical devices unless the [primary supervising] PATIENT CARE 14
TEAM physician and physician assistant include in the [delegation] COLLABORATION 15
agreement: 16
(1) A notice of intent to delegate prescribing and, if applicable, dispensing 17
of controlled dangerous substances, prescription drugs, or medical devices; 18
(2) An attestation that all prescribing and, if applicable, dispensing 19
activities of the physician assistant will comply with applicable federal and State 20
regulations; 21
(3) An attestation that all medical charts or records will contain a notation 22
of any prescriptions written or dispensed by a physician assistant in accordance with this 23
section; 24
(4) An attestation that all prescriptions written or dispensed under this 25
section will include the physician assistant’s name and the [supervising] PATIENT CARE 26
TEAM physician’s name, business address, and business telephone number legibly written 27
or printed; 28
(5) An attestation that the physician assistant has: 29
(i) Passed the physician assistant national certification exam 30
administered by the National Commission on the Certification of Physician Assistants 31
within the previous 2 years; or 32
(ii) Successfully completed 8 category 1 hours of pharmacology 33
education within the previous 2 years; and 34 18 HOUSE BILL 312
(6) An attestation that the physician assistant has: 1
(i) A bachelor’s degree or its equivalent; or 2
(ii) Successfully completed 2 years of work experience as a physician 3
assistant. 4
(b) (1) A [primary supervising] PATIENT CARE TEAM physician may not 5
delegate the prescribing or dispensing of substances that are identified as Schedule I 6
controlled dangerous substances under § 5–402 of the Criminal Law Article. 7
(2) A [primary supervising] PATIENT CARE TEAM physician may delegate 8
the prescribing or dispensing of substances that are identified as Schedules II through V 9
controlled dangerous substances under § 5–402 of the Criminal Law Article, including 10
legend drugs as defined under § 503(b) of the Federal Food, Drug, and Cosmetic Act. 11
(3) A [primary supervising] PATIENT CARE T EAM physician may not 12
delegate the prescribing or dispensing of controlled dangerous substances to a physician 13
assistant unless the physician assistant has a valid: 14
(i) State controlled dangerous substance registration; and 15
(ii) Federal Drug Enforcement Agency (DEA) registration. 16
(c) A physician assistant personally may prepare and dispense a drug that the 17
physician assistant is authorized to prescribe under a [delegation] COLLABORATION 18
agreement if: 19
(1) Except as otherwise provided under § 12–102(g) of this article, [the 20
supervising] A PATIENT CARE TEAM physician possesses a dispensing permit; and 21
(2) The physician assistant dispenses drugs only within: 22
(i) The [supervising] PATIENT CARE TEAM physician’s scope of 23
practice; and 24
(ii) The scope of the [delegation] COLLABORATION agreement. 25
(d) A physician assistant who personally dispenses a drug in the course of 26
treating a patient as authorized under subsections (b) and (c) of this section shall comply 27
with the requirements under Titles 12 and 14 of this article and applicable federal law and 28
regulations. 29
(e) Before a physician assistant may renew a license for an additional 2–year 30
term under § 15–307 of this subtitle, the physician assistant shall submit evidence to the 31 HOUSE BILL 312 19
Board of successful completion of 8 category 1 hours of pharmacology education within the 1
previous 2 years. 2
15–302.3. 3
(a) On a quarterly basis, the Board shall provide to the Board of Pharmacy a list 4
of physician assistants whose [delegation] COLLABORATION agreements include the 5
delegation of prescriptive authority. 6
(b) The list required under subsection (a) of this section shall specify whether 7
each physician assistant has been delegated the authority to prescribe controlled dangerous 8
substances, prescription drugs, or medical devices. 9
(c) If a [primary supervising] PATIENT CARE TEAM physician who has delegated 10
authority to exercise prescriptive authority to a physician assistant subsequently restricts 11
or removes the delegation, the [primary supervising] PATIENT CARE TEAM physician shall 12
notify the Board of the restriction or removal within 5 business days. 13
15–306. 14
A license authorizes the licensee to practice as a physician assistant under a 15
[delegation] COLLABORATION agreement while the license is effective. 16
15–309. 17
(a) Each licensee shall keep a license [and delegation agreement] for inspection 18
at the primary place of business of the licensee. 19
15–313. 20
(a) (1) Except as otherwise provided under § 10–226 of the State Government 21
Article, before the Board takes any action to reject or modify a [delegation] 22
COLLABORATION agreement or advanced duty, the Board shall give the licensee the 23
opportunity for a hearing before the Board. 24
(2) The Board shall give notice and hold the hearing under Title 10, 25
Subtitle 2 of the State Government Article. 26
(3) The Board may administer oaths in connection with any proceeding 27
under this section. 28
(4) At least 14 days before the hearing, the hearing notice shall be sent to 29
the last known address of the applicant or licensee. 30
(b) Any licensee aggrieved under this subtitle by a final decision of the Board 31
rejecting or modifying a [delegation] COLLABORATION agreement or advanced duty may 32 20 HOUSE BILL 312
petition for judicial review as allowed by the Administrative Procedure Act. 1
15–314. 2
(a) Subject to the hearing provisions of § 15–315 of this subtitle, a disciplinary 3
panel, on the affirmative vote of a majority of the quorum, may reprimand any physician 4
assistant, place any physician assistant on probation, or suspend or revoke a license if the 5
physician assistant: 6
(41) Performs delegated medical acts beyond the scope of the [delegation] 7
COLLABORATION agreement filed with the Board or after notification from the Board that 8
an advanced duty has been disapproved; 9
15–317. 10
(b) The physician assistant shall notify the Board in writing of the names, 11
practice locations, and telephone numbers for the physician assistant and each [primary 12
supervising] PATIENT CARE TEAM physician within 30 days of the first performance of 13
medical acts, tasks, or functions as a physician assistant during the disaster. 14
15–401. 15
(b) Except as otherwise provided in this title, a person may not perform, attempt 16
to perform, or offer to perform any delegated medical act beyond the scope of the license 17
and which is consistent with a [delegation] COLLABORATION agreement filed with the 18
Board. 19
SECTION 2. AND BE IT FURTHER ENACTED, That: 20
(a) A delegation agreement in effect on October 1, 2024, shall be treated the same 21
as a collaboration agreement required under § 15–302 of the Health Occupations Article, 22
as enacted by Section 1 of this Act. 23
(b) A physician assistant authorized to practice under a delegation agreement on 24
October 1, 2024, may continue to practice as a physician assistant under the delegation 25
agreement. 26
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 27
October 1, 2024. 28