Maryland 2024 Regular Session

Maryland House Bill HB312 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	hb0312
6	6
7	7	HOUSE BILL 312
8	8	J2 4lr2034
9	9
10	10	By: Delegate Bagnall
11	11	Introduced and read first time: January 15, 2024
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 – Collaboration Agreements 2
19	19
20	20	FOR the purpose of requiring a physician assistant to have a collaboration agreement with 3
21	21	a patient care team physician, rather than a delegation agreement with a primary 4
22	22	supervising physician, in order to practice as a physician assistant; increasing the 5
23	23	number of physician assistants to whom a patient care team physician may delegate 6
24	24	medical acts under a collaboration agreement; altering the circumstances under 7
25	25	which and settings at which a physician assistant is authorized to perform advanced 8
26	26	duties without the approval of the State Board of Physicians; and generally relating 9
27	27	to physician assistant collaboration agreements. 10
28	28
29	29	BY repealing and reenacting, without amendments, 11
30	30	Article – Alcoholic Beverages and Cannabis 12
31	31	Section 36–101(a) 13
32	32	Annotated Code of Maryland 14
33	33	(2016 Volume and 2023 Supplement) 15
34	34
35	35	BY repealing and reenacting, with amendments, 16
36	36	Article – Alcoholic Beverages and Cannabis 17
37	37	Section 36–101(m)(1)(v) 18
38	38	Annotated Code of Maryland 19
39	39	(2016 Volume and 2023 Supplement) 20
40	40
41	41	BY repealing and reenacting, with amendments, 21
42	42	Article – Education 22
43	43	Section 7–402(c) 23
44	44	Annotated Code of Maryland 24
45	45	(2022 Replacement Volume and 2023 Supplement) 25
46	46
47	47	BY repealing and reenacting, with amendments, 26
48	48	Article – Health Occupations 27 2 HOUSE BILL 312
49	49
50	50
51	51	Section 12–102(c)(2)(iv), 14–306(e)(3)(iii)2.B., 15–101, 15–103(b), 15–202(b), 1
52	52	15–205(a), 15–301, 15–302, 15–302.1, 15–302.2, 15–302.3, 15–306, 15–309(a), 2
53	53	15–313, 15–314(a)(41), 15–317(b), and 15–401(b) 3
54	54	Annotated Code of Maryland 4
55	55	(2021 Replacement Volume and 2023 Supplement) 5
56	56
57	57	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
58	58	That the Laws of Maryland read as follows: 7
59	59
60	60	Article – Alcoholic Beverages and Cannabis 8
61	61
62	62	36–101. 9
63	63
64	64	(a) In this title the following words have the meanings indicated. 10
65	65
66	66	(m) “Certifying provider” means an individual who: 11
67	67
68	68	(1) (v) 1. has an active, unrestricted license to practice as a 12
69	69	physician assistant issued by the State Board of Physicians under Title 15 of the Health 13
70	70	Occupations Article; 14
71	71
72	72	2. has an active [delegation] COLLABORATION agreement 15
73	73	with a [primary supervising] PATIENT CARE TEAM physician who is a certifying provider; 16
74	74	and 17
75	75
76	76	3. is in good standing with the State Board of Physicians; 18
77	77
78	78	Article – Education 19
79	79
80	80	7–402. 20
81	81
82	82	(c) The physical examination required under subsection (b) of this section shall 21
83	83	be completed by: 22
84	84
85	85	(1) A licensed physician; 23
86	86
87	87	(2) A licensed physician assistant with a [delegation] COLLABORATION 24
88	88	agreement [approved by the State Board of Physicians] THAT MEETS THE 25
89	89	REQUIREMENTS OF § 15–302 OF THE HEALTH OCCUPATIONS ARTICLE; or 26
90	90
91	91	(3) A certified nurse practitioner. 27
92	92
93	93	Article – Health Occupations 28
94	94
95	95	12–102. 29
96	96
97	97	(c) (2) This title does not prohibit: 30 HOUSE BILL 312 3
98	98
99	99
100	100
101	101	(iv) A licensed physician who complies with the requirements of item 1
102	102	(ii) of this paragraph from personally preparing and dispensing a prescription written by: 2
103	103
104	104	1. A physician assistant in accordance with a [delegation] 3
105	105	COLLABORATION agreement that complies with Title 15, Subtitle 3 of this article; or 4
106	106
107	107	2. An advanced practice registered nurse with prescriptive 5
108	108	authority under Title 8 of this article and is working with the physician in the same office 6
109	109	setting; 7
110	110
111	111	14–306. 8
112	112
113	113	(e) Except as otherwise provided in this section, an individual may perform 9
114	114	X–ray duties without a license only if the duties: 10
115	115
116	116	(3) Are performed: 11
117	117
118	118	(iii) 2. By a licensed physician assistant who has completed a 12
119	119	course that includes anterior–posterior and lateral radiographic studies of extremities on 13
120	120	at least 20 separate patients under the direct supervision of the delegating physician or 14
121	121	radiologist using a mini C–arm or similar low–level radiation machine to perform 15
122	122	nonfluoroscopic X–ray procedures, if the duties: 16
123	123
124	124	B. Are performed pursuant to a [Board–approved delegation] 17
125	125	COLLABORATION agreement that includes a request to perform advanced duties under § 18
126	126	15–302(c)(2) of this article. 19
127	127
128	128	15–101. 20
129	129
130	130	(a) In this title the following words have the meanings indicated. 21
131	131
132	132	(b) [“Alternate supervising physician” means one or more physicians designated 22
133	133	by the primary supervising physician to provide supervision of a physician assistant in 23
134	134	accordance with the delegation agreement on file with the Board. 24
135	135
136	136	(c)] “Ambulatory surgical facility” means a facility: 25
137	137
138	138	(1) Accredited by: 26
139	139
140	140	(i) The American Association for Accreditation of Ambulatory 27
141	141	Surgical Facilities; 28
142	142
143	143	(ii) The Accreditation Association for Ambulatory Health Care; or 29
144	144
145	145	(iii) The Joint Commission on Accreditation of Healthcare 30 4 HOUSE BILL 312
146	146
147	147
148	148	Organizations; or 1
149	149
150	150	(2) Certified to participate in the Medicare program, as enacted by Title 2
151	151	XVIII of the Social Security Act. 3
152	152
153	153	[(d)] (C) “Board” means the State Board of Physicians, established under § 4
154	154	14–201 of this article. 5
155	155
156	156	(D) “COLLABORATION AGREEME NT” MEANS A DOCUMENT THAT: 6
157	157
158	158	(1) IS EXECUTED BY ONE OR MORE PATIENT CARE TE AM PHYSICIANS 7
159	159	AND ONE OR MORE PHYS ICIAN ASSISTANTS; AND 8
160	160
161	161	(2) MEETS THE REQUIREMENT S OF § 15–302 OF THIS TITLE. 9
162	162
163	163	(e) “Committee” means the Physician Assistant Advisory Committee. 10
164	164
165	165	(f) “Controlled dangerous substances” has the meaning stated in § 5–101 of the 11
166	166	Criminal Law Article. 12
167	167
168	168	(g) “Correctional facility” includes a State or local correctional facility. 13
169	169
170	170	(h) “Delegated medical acts” means activities that constitute the practice of 14
171	171	medicine delegated by a physician under Title 14 of this article. 15
172	172
173	173	(i) [“Delegation agreement” means a document that is executed by a primary 16
174	174	supervising physician and a physician assistant containing the requirements of § 15–302 17
175	175	of this title. 18
176	176
177	177	(i–1)] “Disciplinary panel” means a disciplinary panel of the Board established 19
178	178	under § 14–401 of this article. 20
179	179
180	180	(j) “Dispense” or “dispensing” has the meaning stated in § 12–101 of this article. 21
181	181
182	182	(k) “Drug sample” means a unit of a prescription drug that is intended to promote 22
183	183	the sale of the drug and is not intended for sale. 23
184	184
185	185	(l) “Hospital” means: 24
186	186
187	187	(1) A hospital as defined under § 19–301 of the Health – General Article; 25
188	188
189	189	(2) A comprehensive care facility that: 26
190	190
191	191	(i) Meets the requirements of a hospital–based skilled nursing 27
192	192	facility under federal law; and 28
193	193	HOUSE BILL 312 5
194	194
195	195
196	196	(ii) Offers acute care in the same building; [and] OR 1
197	197
198	198	(3) An emergency room that is physically connected to a hospital or a 2
199	199	freestanding medical facility that is licensed under Title 19, Subtitle 3A of the Health – 3
200	200	General Article. 4
201	201
202	202	(m) “License” means a license issued by the Board to a physician assistant under 5
203	203	this title. 6
204	204
205	205	(n) “National certifying examination” means the Physician Assistant National 7
206	206	Certifying Examination administered by the National Commission on Certification of 8
207	207	Physician Assistants or its successor. 9
208	208
209	209	(O) “PATIENT CARE TEAM PHY SICIAN” MEANS A PHYSICIAN WH O: 10
210	210
211	211	(1) COMPLETES A COLLABORA TION AGREEMENT THAT MEETS THE 11
212	212	REQUIREMENTS UNDER §§ 15–301(D) AND (E) AND 15–302 OF THIS TITLE; 12
213	213
214	214	(2) ACTS AS AN AGENT OF O R IS EMPLOYED BY THE EMPLOYER OF 13
215	215	THE PHYSICIAN ASSIST ANTS LISTED IN THE C OLLABORATION AGREEME NT; 14
216	216
217	217	(3) IS RESPONSIBLE FOR EN SURING THAT THE PHYS ICIAN 15
218	218	ASSISTANTS LISTED IN THE COLLABORATION AG REEMENT PRACTICE MED ICINE IN 16
219	219	ACCORDANCE WITH THIS TITLE AND THE REGULATIONS ADOP TED UNDER THIS 17
220	220	TITLE; AND 18
221	221
222	222	(4) ENSURES THAT THE PHYS ICIAN ASSISTANTS PRA CTICE WITHIN 19
223	223	THE SCOPE OF PRACTIC E OF THE PHYSICIAN . 20
224	224
225	225	[(o)] (P) “Physician assistant” means an individual who is licensed under this 21
226	226	title to practice medicine with physician supervision. 22
227	227
228	228	[(p)] (Q) “Practice as a physician assistant” means the performance of medical 23
229	229	acts that are: 24
230	230
231	231	(1) Delegated by a [supervising] PATIENT CARE TEAM physician to a 25
232	232	physician assistant; 26
233	233
234	234	(2) Within the [supervising physician’s] scope of practice OF THE PATIENT 27
235	235	CARE TEAM PHYSICIAN ; and 28
236	236
237	237	(3) Appropriate to the physician assistant’s education, training, and 29
238	238	experience. 30
239	239
240	240	[(q)] (R) “Prescriptive authority” means the authority delegated by a [primary 31 6 HOUSE BILL 312
241	241
242	242
243	243	or alternate supervising] PATIENT CARE TEAM physician to a physician assistant to: 1
244	244
245	245	(1) Prescribe and administer controlled dangerous substances, prescription 2
246	246	drugs, medical devices, and the oral, written, or electronic ordering of medications; and 3
247	247
248	248	(2) Dispense as provided under § 15–302.2(b), (c), and (d) of this title. 4
249	249
250	250	[(r) “Primary supervising physician” means a physician who: 5
251	251
252	252	(1) Completes a delegation agreement that meets the requirements under 6
253	253	§§ 15–301(d) and (e) and 15–302 of this title and files a copy with the Board; 7
254	254
255	255	(2) Acts as the physician responsible to ensure that a physician assistant 8
256	256	practices medicine in accordance with this title and the regulations adopted under this title; 9
257	257
258	258	(3) Ensures that a physician assistant practices within the scope of practice 10
259	259	of the primary supervising physician or any designated alternate supervising physician; 11
260	260	and 12
261	261
262	262	(4) Ensures that a list of alternate supervising physicians is maintained at 13
263	263	the practice setting.] 14
264	264
265	265	(s) “Public health facility” means a site where clinical public health services are 15
266	266	rendered under the auspices of the Department, a local health department in a county, or 16
267	267	the Baltimore City Health Department. 17
268	268
269	269	(t) “Starter dosage” means an amount of a drug sufficient to begin therapy: 18
270	270
271	271	(1) Of short duration of 72 hours or less; or 19
272	272
273	273	(2) Prior to obtaining a larger quantity of the drug to complete therapy. 20
274	274
275	275	(u) (1) “Supervision” means the responsibility of a PATIENT CARE TEAM 21
276	276	physician to exercise on–site supervision or immediately available direction for physician 22
277	277	assistants performing delegated medical acts. 23
278	278
279	279	(2) “Supervision” includes [physician] THE oversight of and acceptance of 24
280	280	direct responsibility BY A PATIENT CARE TEAM PHYSICIAN for the patient services and 25
281	281	care rendered by a physician assistant, including continuous availability to the physician 26
282	282	assistant in person, through written instructions, or by electronic means [and by 27
283	283	designation of one or more alternate supervising physicians]. 28
284	284
285	285	15–103. 29
286	286
287	287	(b) (1) Subject to paragraph (2) of this subsection, an employer of a physician 30
288	288	assistant shall report to the Board, on the form prescribed by the Board, any termination 31 HOUSE BILL 312 7
289	289
290	290
291	291	of employment of the physician assistant if the cause of termination is related to a quality 1
292	292	of care issue. 2
293	293
294	294	(2) Subject to subsection (d) of this section, a [supervising] PATIENT CARE 3
295	295	TEAM physician or an employer of a physician assistant shall notify the Board within 10 4
296	296	days of the termination of employment of the physician assistant for reasons that would be 5
297	297	grounds for discipline under this title. 6
298	298
299	299	(3) A [supervising] PATIENT CARE TEAM physician and a physician 7
300	300	assistant shall notify the Board within 10 days of the termination of the relationship under 8
301	301	a [delegation] COLLABORATION agreement for any reason. 9
302	302
303	303	15–202. 10
304	304
305	305	(b) Of the three physician members of the Committee, two shall be previously or 11
306	306	currently serving as [supervising] PATIENT CARE TEAM physicians of a physician 12
307	307	assistant under a [Board–approved delegation] COLLABORATION agreement. 13
308	308
309	309	15–205. 14
310	310
311	311	(a) In addition to the powers set forth elsewhere in this title, the Committee, on 15
312	312	its initiative or on the Board’s request, may: 16
313	313
314	314	(1) Recommend to the Board regulations for carrying out the provisions of 17
315	315	this title; 18
316	316
317	317	(2) Recommend to the Board approval, modification, or disapproval of an 19
318	318	application for licensure or a [delegation] COLLABORATION agreement; 20
319	319
320	320	(3) Report to the Board any conduct of a [supervising] PATIENT CARE 21
321	321	TEAM physician or a physician assistant that may be cause for disciplinary action under 22
322	322	this title or under § 14–404 of this article; and 23
323	323
324	324	(4) Report to the Board any alleged unauthorized practice of a physician 24
325	325	assistant. 25
326	326
327	327	15–301. 26
328	328
329	329	(a) Nothing in this title may be construed to authorize a physician assistant to 27
330	330	practice independent of a [primary or alternate supervising] PATIENT CARE TEAM 28
331	331	physician. 29
332	332
333	333	(b) A license issued to a physician assistant shall limit the physician assistant’s 30
334	334	scope of practice to medical acts: 31
335	335
336	336	(1) Delegated by [the primary or alternate supervising] A PATIENT CARE 32 8 HOUSE BILL 312
337	337
338	338
339	339	TEAM physician; 1
340	340
341	341	(2) Appropriate to the education, training, and experience of the physician 2
342	342	assistant; 3
343	343
344	344	(3) Customary to the practice of the [primary or alternate supervising] 4
345	345	PATIENT CARE TEAM physician; and 5
346	346
347	347	(4) Consistent with the [delegation] COLLABORATION agreement [filed 6
348	348	with the Board]. 7
349	349
350	350	(c) Patient services that may be provided by a physician assistant include: 8
351	351
352	352	(1) (i) Taking complete, detailed, and accurate patient histories; and 9
353	353
354	354	(ii) Reviewing patient records to develop comprehensive medical 10
355	355	status reports; 11
356	356
357	357	(2) Performing physical examinations and recording all pertinent patient 12
358	358	data; 13
359	359
360	360	(3) Interpreting and evaluating patient data as authorized by [the primary 14
361	361	or alternate supervising] A PATIENT CARE TEAM physician for the purpose of determining 15
362	362	management and treatment of patients; 16
363	363
364	364	(4) Initiating requests for or performing diagnostic procedures as indicated 17
365	365	by pertinent data and as authorized by [the supervising] A PATIENT CARE TEAM 18
366	366	physician; 19
367	367
368	368	(5) Providing instructions and guidance regarding medical care matters to 20
369	369	patients; 21
370	370
371	371	(6) Assisting [the primary or alternate supervising] A PATIENT CARE 22
372	372	TEAM physician in the delivery of services to patients who require medical care in the home 23
373	373	and in health care institutions, including: 24
374	374
375	375	(i) Recording patient progress notes; 25
376	376
377	377	(ii) Issuing diagnostic orders; and 26
378	378
379	379	(iii) Transcribing or executing specific orders at the direction of [the 27
380	380	primary or alternate supervising] A PATIENT CARE TEAM physician; and 28
381	381
382	382	(7) Exercising prescriptive authority under a [delegation] 29
383	383	COLLABORATION agreement and in accordance with § 15–302.2 of this subtitle. 30
384	384	HOUSE BILL 312 9
385	385
386	386
387	387	(d) (1) Except as otherwise provided in this title, an individual shall be 1
388	388	licensed by the Board before the individual may practice as a physician assistant. 2
389	389
390	390	(2) (I) Except as otherwise provided in this title, a physician may not 3
391	391	supervise a physician assistant in the performance of delegated medical acts [without filing 4
392	392	a completed delegation agreement with the Board] UNLESS THE PHYSICIAN IS LISTED 5
393	393	AS A PATIENT CARE TE AM PHYSICIAN ON A CO LLABORATION AGREEMEN T WITH THE 6
394	394	PHYSICIAN ASSISTANT . 7
395	395
396	396	(II) A COLLABORATION AGREEM ENT MAY LIST ONE OR MORE 8
397	397	PHYSICIANS AS PATIENT CARE TEAM PH YSICIANS FOR A PHYSI CIAN ASSISTANT. 9
398	398
399	399	(3) Except as otherwise provided in this title or in a medical emergency, a 10
400	400	physician assistant may not perform any medical act for which: 11
401	401
402	402	(i) The individual has not been licensed; and 12
403	403
404	404	(ii) The medical acts have not been delegated by a [primary or 13
405	405	alternate supervising] PATIENT CARE TEAM physician. 14
406	406
407	407	(e) A physician assistant is the agent of the [primary or alternate supervising] 15
408	408	PATIENT CARE TEAM physician in the performance of all practice–related activities, 16
409	409	including the oral, written, or electronic ordering of diagnostic, therapeutic, and other 17
410	410	medical services. 18
411	411
412	412	(f) Except as provided in subsection (g) of this section, the following individuals 19
413	413	may practice as a physician assistant without a license: 20
414	414
415	415	(1) A physician assistant student enrolled in a physician assistant 21
416	416	educational program that is accredited by the Accreditation Review Commission on 22
417	417	Education for the Physician Assistant or its successor and approved by the Board; or 23
418	418
419	419	(2) A physician assistant employed in the service of the federal government 24
420	420	while performing duties incident to that employment. 25
421	421
422	422	(g) A PATIENT CARE TEAM physician may not delegate prescriptive authority to 26
423	423	a physician assistant student in a training program that is accredited by the Accreditation 27
424	424	Review Commission on Education for the Physician Assistant or its successor. 28
425	425
426	426	(h) (1) If a medical act that is to be delegated under this section is a part of the 29
427	427	practice of a health occupation that is regulated under this article by another board, any 30
428	428	rule or regulation concerning that medical act shall be adopted jointly by the State Board 31
429	429	of Physicians and the board that regulates the other health occupation. 32
430	430
431	431	(2) If the two boards cannot agree on a proposed rule or regulation, the 33
432	432	proposal shall be submitted to the Secretary for a final decision. 34 10 HOUSE BILL 312
433	433
434	434
435	435
436	436	15–302. 1
437	437
438	438	(a) A PATIENT CARE TEAM physician may delegate medical acts to a physician 2
439	439	assistant only after: 3
440	440
441	441	(1) A [delegation] COLLABORATION agreement has been executed [and 4
442	442	filed with the Board]; [and] 5
443	443
444	444	(2) Any advanced duties have been authorized as required under 6
445	445	subsection (c) of this section; AND 7
446	446
447	447	(3) THE BOARD HAS BEEN NOTIFI ED OF THE EXECUTED 8
448	448	COLLABORATION AGREEM ENT AND OF EACH PATI ENT CARE TEAM PHYSICIAN 9
449	449	LISTED ON THE AGREEM ENT. 10
450	450
451	451	(b) The [delegation] COLLABORATION agreement shall contain: 11
452	452
453	453	(1) A description of the qualifications of the [primary supervising physician 12
454	454	and] physician assistant AND EACH PATIENT CAR E TEAM PHYSICIAN LIS TED ON THE 13
455	455	COLLABORATION AGREEM ENT; 14
456	456
457	457	(2) A description of the settings in which the physician assistant will 15
458	458	practice; 16
459	459
460	460	(3) A description of the continuous physician supervision mechanisms that 17
461	461	are reasonable and appropriate to the practice setting; 18
462	462
463	463	(4) [A] FOR EACH PATIENT CARE TEAM PHYSICIAN LISTE D ON THE 19
464	464	COLLABORATION AGREEM ENT, A description of the delegated medical acts that are 20
465	465	within the [primary or alternate supervising] PATIENT CARE TEAM physician’s scope of 21
466	466	practice and require specialized education or training that is consistent with accepted 22
467	467	medical practice; 23
468	468
469	469	(5) An attestation that all medical acts to be delegated to the physician 24
470	470	assistant are within the scope of practice of the [primary or alternate supervising] 25
471	471	DELEGATING PATIENT C ARE TEAM physician and appropriate to the physician 26
472	472	assistant’s education, training, and level of competence; 27
473	473
474	474	(6) An attestation of continuous supervision of the physician assistant by 28
475	475	[the primary supervising] EACH PATIENT CARE TEAM physician through the mechanisms 29
476	476	described in the [delegation] COLLABORATION agreement; 30
477	477
478	478	(7) An attestation by [the primary supervising] EACH PATIENT CARE 31
479	479	TEAM physician of the physician’s acceptance of responsibility for any care given by the 32 HOUSE BILL 312 11
480	480
481	481
482	482	physician assistant; 1
483	483
484	484	(8) A description prepared by [the primary supervising] EACH PATIENT 2
485	485	CARE TEAM physician of the process by which the physician assistant’s practice is reviewed 3
486	486	appropriate to the practice setting and consistent with current standards of acceptable 4
487	487	medical practice; 5
488	488
489	489	(9) An attestation by [the primary supervising] EACH PATIENT CARE 6
490	490	TEAM physician that the physician will respond in a timely manner when contacted by the 7
491	491	physician assistant; 8
492	492
493	493	(10) The following statement: 9
494	494
495	495	“The [primary supervising physician and the] physician assistant AND EACH 10
496	496	PATIENT CARE TEAM PH YSICIAN attest that: 11
497	497
498	498	(i) They will establish a plan for the types of cases that require a 12
499	499	physician plan of care or require that the patient initially or periodically be seen by [the 13
500	500	supervising physician] A PATIENT CARE TEAM PHYSICIAN; and 14
501	501
502	502	(ii) The patient will be provided access to [the supervising physician] 15
503	503	A PATIENT CARE TEAM PHYSICIAN on request”; and 16
504	504
505	505	(11) Any other information deemed necessary by the Board to carry out the 17
506	506	provisions of this subtitle. 18
507	507
508	508	(c) (1) [The Board may not require prior approval of a delegation agreement 19
509	509	that includes] A PHYSICIAN ASSISTANT MAY PERFORM advanced duties WITHOUT 20
510	510	BOARD APPROVAL , if an advanced duty will be performed in a hospital, [or] ambulatory 21
511	511	surgical facility, [provided that] OR ANOTHER PRACTICE SETTING LISTED ON A 22
512	512	DELINEATION OF PRIVI LEGES DOCUMENT AND : 23
513	513
514	514	(i) A physician, with credentials that have been reviewed by the 24
515	515	hospital or ambulatory surgical facility as a condition of employment, as an independent 25
516	516	contractor, or as a member of the medical staff, supervises the physician assistant; 26
517	517
518	518	(ii) The physician assistant has credentials that have been reviewed 27
519	519	by the hospital or ambulatory surgical facility as a condition of employment, as an 28
520	520	independent contractor, or as a member of the medical staff; [and] 29
521	521
522	522	(iii) Each advanced duty to be delegated to the physician assistant is 30
523	523	reviewed and approved within a process approved by the governing body of the health care 31
524	524	facility before the physician assistant performs the advanced duties; AND 32
525	525
526	526	(IV) THE PHYSICIAN ASSISTA NT KEEPS THE DOCUMEN TS 33 12 HOUSE BILL 312
527	527
528	528
529	529	DEMONSTRATING COMPLI ANCE WITH ITEMS (I) THROUGH (III) OF THIS PARAGRAPH 1
530	530	ON FILE AT THE HOSPI TAL, AMBULATORY SURGICAL FACILITY, OR OTHER PRACTICE 2
531	531	SETTING. 3
532	532
533	533	(2) (i) In any setting that does not meet the requirements of paragraph 4
534	534	(1) of this subsection, a [primary supervising] PATIENT CARE TEAM physician shall obtain 5
535	535	the Board’s approval of a [delegation] COLLABORATION agreement that includes 6
536	536	advanced duties, before the physician assistant performs the advanced duties. 7
537	537
538	538	(ii) 1. Before a physician assistant may perform X–ray duties 8
539	539	authorized under § 14–306(e) of this article in the medical office of the physician delegating 9
540	540	the duties, a [primary supervising] PATIENT CARE TEAM physician shall obtain the 10
541	541	Board’s approval of a [delegation] COLLABORATION agreement that includes advanced 11
542	542	duties in accordance with subsubparagraph 2 of this subparagraph. 12
543	543
544	544	2. The advanced duties set forth in a [delegation] 13
545	545	COLLABORATION agreement under this subparagraph shall be limited to nonfluoroscopic 14
546	546	X–ray procedures of the extremities, anterior–posterior and lateral, not including the head. 15
547	547
548	548	(3) Notwithstanding paragraph (1) of this subsection, a [primary 16
549	549	supervising] PATIENT CARE TEAM physician shall obtain the Board’s approval of a 17
550	550	[delegation] COLLABORATION agreement before the physician assistant may administer, 18
551	551	monitor, or maintain general anesthesia or neuroaxial anesthesia, including spinal and 19
552	552	epidural techniques, under the COLLABORATION agreement. 20
553	553
554	554	(4) A PHYSICIAN ASSISTANT DOES NOT NEED PRIOR APPROVAL TO 21
555	555	PERFORM AN ADVANCED DUTY IN COLLABORATIO N WITH A PATIENT CAR E TEAM 22
556	556	PHYSICIAN IF: 23
557	557
558	558	(I) THE PHYSICIAN ASSISTA NT HAS PREVIOUSLY OB TAINED 24
559	559	BOARD APPROVAL TO PERFORM THE ADVANCED DUTY IN COLLABORATION WITH A 25
560	560	PATIENT CARE TEAM PH YSICIAN; AND 26
561	561
562	562	(II) THE ADVANCED DUTY IS WITHIN THE SCOPE OF PRACTICE 27
563	563	OF A PATIENT CARE TE AM PHYSICIAN LISTED IN THE COLLABORATION AGREEMENT . 28
564	564
565	565	(d) For a [delegation] COLLABORATION agreement containing advanced duties 29
566	566	that require Board approval, the Committee shall review the [delegation] 30
567	567	COLLABORATION agreement and recommend to the Board that the [delegation] 31
568	568	COLLABORATION agreement be approved, rejected, or modified to ensure conformance 32
569	569	with the requirements of this title. 33
570	570
571	571	(e) The Committee may conduct a personal interview of the [primary supervising 34
572	572	physician] PATIENT CARE TEAM PH YSICIANS and the physician assistant. 35 HOUSE BILL 312 13
573	573
574	574
575	575
576	576	(f) (1) On review of the Committee’s recommendation regarding [a primary 1
577	577	supervising physician’s] THE request OF ONE OR MORE PATIE NT CARE TEAM 2
578	578	PHYSICIANS to delegate advanced duties as described in a [delegation] COLLABORATION 3
579	579	agreement, the Board: 4
580	580
581	581	(i) May approve the [delegation] COLLABORATION agreement; or 5
582	582
583	583	(ii) 1. If the physician assistant does not meet the applicable 6
584	584	education, training, and experience requirements to perform the specified delegated acts, 7
585	585	may modify or disapprove the [delegation] COLLABORATION agreement; and 8
586	586
587	587	2. If the Board takes an action under item 1 of this item: 9
588	588
589	589	A. Shall notify the [primary supervising] DELEGATING 10
590	590	PATIENT CARE TEAM physician and the physician assistant in writing of the particular 11
591	591	elements of the proposed [delegation] COLLABORATION agreement that were the cause 12
592	592	for the modification or disapproval; and 13
593	593
594	594	B. May not restrict the submission of an amendment to the 14
595	595	[delegation] COLLABORATION agreement. 15
596	596
597	597	(2) To the extent practicable, the Board shall approve a [delegation] 16
598	598	COLLABORATION agreement or take other action authorized under this subsection within 17
599	599	90 days after receiving a completed [delegation] COLLABORATION agreement including 18
600	600	any information from the physician assistant and [primary supervising physician] THE 19
601	601	PATIENT CARE TEAM PHYSICIANS necessary to approve or take action. 20
602	602
603	603	(g) If the Board determines that a [primary or alternate supervising physician] 21
604	604	PATIENT CARE TEAM PH YSICIAN or physician assistant is practicing in a manner 22
605	605	inconsistent with the requirements of this title or Title 14 of this article, the Board on its 23
606	606	own initiative or on the recommendation of the Committee may demand modification of the 24
607	607	practice, withdraw the approval of [the delegation agreement] ADVANCED DUTIES , or 25
608	608	refer the matter to a disciplinary panel for the purpose of taking other disciplinary action 26
609	609	under § 14–404 or § 15–314 of this article. 27
610	610
611	611	(h) A [primary supervising] PATIENT CARE TEAM physician may not delegate 28
612	612	medical acts under a [delegation] COLLABORATION agreement to more than [four] EIGHT 29
613	613	physician assistants at any one time, except in a hospital or in the following nonhospital 30
614	614	settings: 31
615	615
616	616	(1) A correctional facility; 32
617	617
618	618	(2) A detention center; or 33
619	619	14 HOUSE BILL 312
620	620
621	621
622	622	(3) A public health facility. 1
623	623
624	624	(i) A person may not coerce another person to enter into a [delegation] 2
625	625	COLLABORATION agreement under this subtitle. 3
626	626
627	627	(j) [A physician may supervise a physician assistant: 4
628	628
629	629	(1) As a primary supervising physician in accordance with a delegation 5
630	630	agreement approved by the Board under this subtitle; or 6
631	631
632	632	(2) As an alternate supervising physician if: 7
633	633
634	634	(i) The alternate supervising physician supervises in accordance 8
635	635	with a delegation agreement filed with the Board; 9
636	636
637	637	(ii) The alternate supervising physician supervises no more than 10
638	638	four physician assistants at any one time, except in a hospital, correctional facility, 11
639	639	detention center, or public health facility; 12
640	640
641	641	(iii) The alternate supervising physician’s period of supervision, in 13
642	642	the temporary absence of the primary supervising physician, does not exceed: 14
643	643
644	644	1. The period of time specified in the delegation agreement; 15
645	645	and 16
646	646
647	647	2. A period of 45 consecutive days at any one time; and 17
648	648
649	649	(iv) The physician assistant performs only those medical acts that: 18
650	650
651	651	1. Have been delegated under the delegation agreement filed 19
652	652	with the Board; and 20
653	653
654	654	2. Are within the scope of practice of the primary supervising 21
655	655	physician and alternate supervising physician. 22
656	656
657	657	(k)] Subject to the notice required under § 15–103 of this title, a physician 23
658	658	assistant may terminate a [delegation] COLLABORATION agreement [filed with the 24
659	659	Board] under this subtitle at any time. 25
660	660
661	661	[(l)] (K) (1) In the event of the sudden departure, incapacity, or death of [the 26
662	662	primary supervising physician of a physician assistant] A PATIENT CARE TEAM 27
663	663	PHYSICIAN, or change in license status that results in [the primary supervising] A 28
664	664	PATIENT CARE TEAM physician being unable to legally practice medicine, [an alternate 29
665	665	supervising physician designated under subsection (b) of this section may supervise the 30
666	666	physician assistant for not longer than 15 days following the event] THE COLLABORATION 31
667	667	AGREEMENT WILL REMAI N ACTIVE AND VALID U NDER THE SUPERVISION OF ANY 32 HOUSE BILL 312 15
668	668
669	669
670	670	REMAINING LISTED PATIEN T CARE TEAM PHYSICIA NS. 1
671	671
672	672	(2) If there is no [designated alternate supervising physician] REMAINING 2
673	673	PATIENT CARE TEAM PH YSICIAN LISTED ON TH E COLLABORATION AGRE EMENT or 3
674	674	the [designated alternate supervising physician] REMAINING PATIENT CARE TEAM 4
675	675	PHYSICIAN does not agree to supervise the physician assistant, the physician assistant 5
676	676	may not practice until the physician assistant [receives approval of a new delegation 6
677	677	agreement under § 15–302.1 of this subtitle] HAS EXECUTED A NEW COLLABOR ATION 7
678	678	AGREEMENT AND, IF APPLICABLE , HAS BOARD APPROVAL TO PER FORM ANY 8
679	679	ADVANCED DUTIES DELE GATED TO THE PHYSICI AN ASSISTANT UNDER T HE NEW 9
680	680	COLLABORATION AGREEM ENT. 10
681	681
682	682	(3) [An alternate supervising physician or other licensed physician may 11
683	683	assume the role of primary supervising physician by submitting a new delegation 12
684	684	agreement to the Board for approval under subsection (b) of this section. 13
685	685
686	686	(4)] The Board may terminate a [delegation] COLLABORATION agreement 14
687	687	if: 15
688	688
689	689	(i) The physician assistant has a change in license status that 16
690	690	results in the physician assistant being unable to legally practice as a physician assistant; 17
691	691	OR 18
692	692
693	693	(ii) [At least 15 days have elapsed since an event listed under 19
694	694	paragraph (1) of this subsection if there is an alternate supervising physician designated 20
695	695	under subsection (b) of this section; or 21
696	696
697	697	(iii)] Immediately after an event listed under paragraph (1) of this 22
698	698	subsection if there is no [alternate supervising] REMAINING PATIENT CARE TEAM 23
699	699	physician [designated under subsection (b) of this section] LISTED ON THE 24
700	700	COLLABORATION AGREEM ENT. 25
701	701
702	702	[(m)] (L) A physician assistant whose [delegation] COLLABORATION agreement 26
703	703	is terminated may not practice as a physician assistant until the physician assistant 27
704	704	[receives preliminary approval of] EXECUTES a new [delegation] COLLABORATION 28
705	705	agreement under [§ 15–302.1 of this subtitle] THIS SECTION. 29
706	706
707	707	[(n)] (M) Individual members of the Board are not civilly liable for actions 30
708	708	regarding the approval, modification, or disapproval of a [delegation] COLLABORATION 31
709	709	agreement described in this section. 32
710	710
711	711	[(o)] (N) A physician assistant may practice in accordance with a [delegation] 33
712	712	COLLABORATION agreement [filed with the Board] under this subtitle. 34
713	713
714	714	(O) A PATIENT CARE TEAM PH YSICIAN MAY BE ADDED TO OR REMOVED 35 16 HOUSE BILL 312
715	715
716	716
717	717	FROM A COLLABORATION AGREEMENT BY PROVIDI NG NOTIFICATION TO T HE 1
718	718	BOARD. 2
719	719
720	720	(P) A COLLABORATION AGREEM ENT SHALL BE MAINTAI NED AT THE 3
721	721	PRACTICE SETTING AND MADE AVAILABLE TO TH E BOARD ON REQUEST . 4
722	722
723	723	15–302.1. 5
724	724
725	725	(a) If a [delegation] COLLABORATION agreement does not include advanced 6
726	726	duties or the advanced duties have been approved under § 15–302(c)(1) of this subtitle, a 7
727	727	physician assistant may assume the duties under a [delegation] COLLABORATION 8
728	728	agreement on the date that the [Board acknowledges receipt of the completed delegation] 9
729	729	PHYSICIAN ASSISTANT PROVIDES NOTIFICATIO N TO THE BOARD OF AN EXECUTED 10
730	730	COLLABORATION agreement AS REQUIRED UNDER § 15–302(A)(3) OF THIS SUBTITLE. 11
731	731
732	732	(b) In this section, “pending” means that a [delegation] COLLABORATION 12
733	733	agreement that includes delegation of advanced duties in a setting that does not meet the 13
734	734	requirements under § 15–302(c)(1) of this subtitle has been executed and submitted to the 14
735	735	Board for its approval, but: 15
736	736
737	737	(1) The Committee has not made a recommendation to the Board; or 16
738	738
739	739	(2) The Board has not made a final decision regarding the [delegation] 17
740	740	COLLABORATION agreement. 18
741	741
742	742	(c) [Subject to subsection (d) of this section, if a delegation agreement is pending, 19
743	743	on receipt of a temporary practice letter from the staff of the Board, a physician assistant 20
744	744	may perform the advanced duty if: 21
745	745
746	746	(1) The primary supervising physician has been previously approved to 22
747	747	supervise one or more physician assistants in the performance of the advanced duty; and 23
748	748
749	749	(2) The physician assistant has been previously approved by the Board to 24
750	750	perform the advanced duty. 25
751	751
752	752	(d)] If the Committee recommends a denial of the pending [delegation] 26
753	753	COLLABORATION agreement or the Board denies the pending [delegation] 27
754	754	COLLABORATION agreement, on notice to [the primary supervising] EACH PATIENT 28
755	755	CARE TEAM physician and the physician assistant, the physician assistant may no longer 29
756	756	perform the advanced duty that has not received the approval of the Board. 30
757	757
758	758	[(e)] (D) The Board may disapprove any [delegation] COLLABORATION 31
759	759	agreement if it believes that: 32
760	760
761	761	(1) The agreement does not meet the requirements of this subtitle; or 33 HOUSE BILL 312 17
762	762
763	763
764	764
765	765	(2) The physician assistant is unable to perform safely the delegated 1
766	766	duties. 2
767	767
768	768	[(f)] (E) If the Board disapproves a [delegation] COLLABORATION agreement 3
769	769	or the delegation of any function under [an] A COLLABORATION agreement, the Board 4
770	770	shall provide [the primary supervising] EACH PATIENT CARE TE AM physician and the 5
771	771	physician assistant with written notice of the disapproval. 6
772	772
773	773	[(g)] (F) A physician assistant who receives notice that the Board has 7
774	774	disapproved a [delegation] COLLABORATION agreement or an advanced function under 8
775	775	the [delegation] COLLABORATION agreement shall immediately cease to practice under 9
776	776	the COLLABORATION agreement or to perform the disapproved function. 10
777	777
778	778	15–302.2. 11
779	779
780	780	(a) A [primary supervising] PATIENT CARE TEAM physician may not delegate 12
781	781	prescribing, dispensing, and administering of controlled dangerous substances, 13
782	782	prescription drugs, or medical devices unless the [primary supervising] PATIENT CARE 14
783	783	TEAM physician and physician assistant include in the [delegation] COLLABORATION 15
784	784	agreement: 16
785	785
786	786	(1) A notice of intent to delegate prescribing and, if applicable, dispensing 17
787	787	of controlled dangerous substances, prescription drugs, or medical devices; 18
788	788
789	789	(2) An attestation that all prescribing and, if applicable, dispensing 19
790	790	activities of the physician assistant will comply with applicable federal and State 20
791	791	regulations; 21
792	792
793	793	(3) An attestation that all medical charts or records will contain a notation 22
794	794	of any prescriptions written or dispensed by a physician assistant in accordance with this 23
795	795	section; 24
796	796
797	797	(4) An attestation that all prescriptions written or dispensed under this 25
798	798	section will include the physician assistant’s name and the [supervising] PATIENT CARE 26
799	799	TEAM physician’s name, business address, and business telephone number legibly written 27
800	800	or printed; 28
801	801
802	802	(5) An attestation that the physician assistant has: 29
803	803
804	804	(i) Passed the physician assistant national certification exam 30
805	805	administered by the National Commission on the Certification of Physician Assistants 31
806	806	within the previous 2 years; or 32
807	807
808	808	(ii) Successfully completed 8 category 1 hours of pharmacology 33
809	809	education within the previous 2 years; and 34 18 HOUSE BILL 312
810	810
811	811
812	812
813	813	(6) An attestation that the physician assistant has: 1
814	814
815	815	(i) A bachelor’s degree or its equivalent; or 2
816	816
817	817	(ii) Successfully completed 2 years of work experience as a physician 3
818	818	assistant. 4
819	819
820	820	(b) (1) A [primary supervising] PATIENT CARE TEAM physician may not 5
821	821	delegate the prescribing or dispensing of substances that are identified as Schedule I 6
822	822	controlled dangerous substances under § 5–402 of the Criminal Law Article. 7
823	823
824	824	(2) A [primary supervising] PATIENT CARE TEAM physician may delegate 8
825	825	the prescribing or dispensing of substances that are identified as Schedules II through V 9
826	826	controlled dangerous substances under § 5–402 of the Criminal Law Article, including 10
827	827	legend drugs as defined under § 503(b) of the Federal Food, Drug, and Cosmetic Act. 11
828	828
829	829	(3) A [primary supervising] PATIENT CARE T EAM physician may not 12
830	830	delegate the prescribing or dispensing of controlled dangerous substances to a physician 13
831	831	assistant unless the physician assistant has a valid: 14
832	832
833	833	(i) State controlled dangerous substance registration; and 15
834	834
835	835	(ii) Federal Drug Enforcement Agency (DEA) registration. 16
836	836
837	837	(c) A physician assistant personally may prepare and dispense a drug that the 17
838	838	physician assistant is authorized to prescribe under a [delegation] COLLABORATION 18
839	839	agreement if: 19
840	840
841	841	(1) Except as otherwise provided under § 12–102(g) of this article, [the 20
842	842	supervising] A PATIENT CARE TEAM physician possesses a dispensing permit; and 21
843	843
844	844	(2) The physician assistant dispenses drugs only within: 22
845	845
846	846	(i) The [supervising] PATIENT CARE TEAM physician’s scope of 23
847	847	practice; and 24
848	848
849	849	(ii) The scope of the [delegation] COLLABORATION agreement. 25
850	850
851	851	(d) A physician assistant who personally dispenses a drug in the course of 26
852	852	treating a patient as authorized under subsections (b) and (c) of this section shall comply 27
853	853	with the requirements under Titles 12 and 14 of this article and applicable federal law and 28
854	854	regulations. 29
855	855
856	856	(e) Before a physician assistant may renew a license for an additional 2–year 30
857	857	term under § 15–307 of this subtitle, the physician assistant shall submit evidence to the 31 HOUSE BILL 312 19
858	858
859	859
860	860	Board of successful completion of 8 category 1 hours of pharmacology education within the 1
861	861	previous 2 years. 2
862	862
863	863	15–302.3. 3
864	864
865	865	(a) On a quarterly basis, the Board shall provide to the Board of Pharmacy a list 4
866	866	of physician assistants whose [delegation] COLLABORATION agreements include the 5
867	867	delegation of prescriptive authority. 6
868	868
869	869	(b) The list required under subsection (a) of this section shall specify whether 7
870	870	each physician assistant has been delegated the authority to prescribe controlled dangerous 8
871	871	substances, prescription drugs, or medical devices. 9
872	872
873	873	(c) If a [primary supervising] PATIENT CARE TEAM physician who has delegated 10
874	874	authority to exercise prescriptive authority to a physician assistant subsequently restricts 11
875	875	or removes the delegation, the [primary supervising] PATIENT CARE TEAM physician shall 12
876	876	notify the Board of the restriction or removal within 5 business days. 13
877	877
878	878	15–306. 14
879	879
880	880	A license authorizes the licensee to practice as a physician assistant under a 15
881	881	[delegation] COLLABORATION agreement while the license is effective. 16
882	882
883	883	15–309. 17
884	884
885	885	(a) Each licensee shall keep a license [and delegation agreement] for inspection 18
886	886	at the primary place of business of the licensee. 19
887	887
888	888	15–313. 20
889	889
890	890	(a) (1) Except as otherwise provided under § 10–226 of the State Government 21
891	891	Article, before the Board takes any action to reject or modify a [delegation] 22
892	892	COLLABORATION agreement or advanced duty, the Board shall give the licensee the 23
893	893	opportunity for a hearing before the Board. 24
894	894
895	895	(2) The Board shall give notice and hold the hearing under Title 10, 25
896	896	Subtitle 2 of the State Government Article. 26
897	897
898	898	(3) The Board may administer oaths in connection with any proceeding 27
899	899	under this section. 28
900	900
901	901	(4) At least 14 days before the hearing, the hearing notice shall be sent to 29
902	902	the last known address of the applicant or licensee. 30
903	903
904	904	(b) Any licensee aggrieved under this subtitle by a final decision of the Board 31
905	905	rejecting or modifying a [delegation] COLLABORATION agreement or advanced duty may 32 20 HOUSE BILL 312
906	906
907	907
908	908	petition for judicial review as allowed by the Administrative Procedure Act. 1
909	909
910	910	15–314. 2
911	911
912	912	(a) Subject to the hearing provisions of § 15–315 of this subtitle, a disciplinary 3
913	913	panel, on the affirmative vote of a majority of the quorum, may reprimand any physician 4
914	914	assistant, place any physician assistant on probation, or suspend or revoke a license if the 5
915	915	physician assistant: 6
916	916
917	917	(41) Performs delegated medical acts beyond the scope of the [delegation] 7
918	918	COLLABORATION agreement filed with the Board or after notification from the Board that 8
919	919	an advanced duty has been disapproved; 9
920	920
921	921	15–317. 10
922	922
923	923	(b) The physician assistant shall notify the Board in writing of the names, 11
924	924	practice locations, and telephone numbers for the physician assistant and each [primary 12
925	925	supervising] PATIENT CARE TEAM physician within 30 days of the first performance of 13
926	926	medical acts, tasks, or functions as a physician assistant during the disaster. 14
927	927
928	928	15–401. 15
929	929
930	930	(b) Except as otherwise provided in this title, a person may not perform, attempt 16
931	931	to perform, or offer to perform any delegated medical act beyond the scope of the license 17
932	932	and which is consistent with a [delegation] COLLABORATION agreement filed with the 18
933	933	Board. 19
934	934
935	935	SECTION 2. AND BE IT FURTHER ENACTED, That: 20
936	936
937	937	(a) A delegation agreement in effect on October 1, 2024, shall be treated the same 21
938	938	as a collaboration agreement required under § 15–302 of the Health Occupations Article, 22
939	939	as enacted by Section 1 of this Act. 23
940	940
941	941	(b) A physician assistant authorized to practice under a delegation agreement on 24
942	942	October 1, 2024, may continue to practice as a physician assistant under the delegation 25
943	943	agreement. 26
944	944
945	945	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 27
946	946	October 1, 2024. 28