EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0167*
SENATE BILL 167
J2 4lr1212
SB 673/23 – FIN (PRE–FILED)
By: Senator Carozza
Requested: October 27, 2023
Introduced and read first time: January 10, 2024
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Physician Assistants – Revisions 2
(Physician Assistant Modernization Act of 2024) 3
FOR the purpose of requiring that a physician assistant have a collaboration agreement, 4
rather than a delegation agreement, in order to practice as a physician assistant; 5
altering the scope of practice of a physician assistant; altering the education required 6
for licensure as a physician assistant; authorizing physician assistants who are 7
employees of the federal government to perform acts, tasks, or functions as a 8
physician assistant during a certain disaster; and generally relating to physician 9
assistants. 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) and 18–802(a)(8) 23
Annotated Code of Maryland 24
(2022 Replacement Volume and 2023 Supplement) 25
BY repealing and reenacting, without amendments, 26 2 SENATE BILL 167
Article – Education 1
Section 18–802(a)(1) 2
Annotated Code of Maryland 3
(2022 Replacement Volume and 2023 Supplement) 4
BY repealing and reenacting, without amendments, 5
Article – Health – General 6
Section 4–201(a) and 5–601(a) 7
Annotated Code of Maryland 8
(2023 Replacement Volume) 9
BY repealing and reenacting, with amendments, 10
Article – Health – General 11
Section 4–201(s) and 5–601(v) 12
Annotated Code of Maryland 13
(2023 Replacement Volume) 14
BY repealing and reenacting, with amendments, 15
Article – Health Occupations 16
Section 12–102(c)(2)(iv), (v), and (vi), 15–101, 15–103, 15–202(b), 15–205(a), 15–301, 17
15–302, 15–302.2, 15–303, 15–306, 15–309(a), 15–310, 15–314(a)(41), 15–317, 18
15–401, and 15–402.1(a) 19
Annotated Code of Maryland 20
(2021 Replacement Volume and 2023 Supplement) 21
BY adding to 22
Article – Health Occupations 23
Section 12–102(c)(2)(vii) and 15–314(a)(42) 24
Annotated Code of Maryland 25
(2021 Replacement Volume and 2023 Supplement) 26
BY repealing and reenacting, without amendments, 27
Article – Health Occupations 28
Section 15–202(a)(1) and (2) 29
Annotated Code of Maryland 30
(2021 Replacement Volume and 2023 Supplement) 31
BY repealing 32
Article – Health Occupations 33
Section 15–302.1, 15–302.3, 15–313, and 15–314(a)(42) 34
Annotated Code of Maryland 35
(2021 Replacement Volume and 2023 Supplement) 36
BY repealing and reenacting, without amendments, 37
Article – Transportation 38
Section 13–616(a)(1) 39
Annotated Code of Maryland 40 SENATE BILL 167 3
(2020 Replacement Volume and 2023 Supplement) 1
BY repealing and reenacting, with amendments, 2
Article – Transportation 3
Section 13–616(a)(7) 4
Annotated Code of Maryland 5
(2020 Replacement Volume and 2023 Supplement) 6
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 7
That the Laws of Maryland read as follows: 8
Article – Alcoholic Beverages and Cannabis 9
36–101. 10
(a) In this title the following words have the meanings indicated. 11
(m) “Certifying provider” means an individual who: 12
(1) (v) 1. has an active, unrestricted license to practice as a 13
physician assistant issued by the State Board of Physicians under Title 15 of the Health 14
Occupations Article; AND 15
2. [has an active delegation agreement with a primary 16
supervising physician who is a certifying provider; 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 agreement approved 24
by the State Board of Physicians]; or 25
(3) A certified nurse practitioner. 26
18–802. 27
(a) (1) In this section the following words have the meanings indicated. 28
4 SENATE BILL 167
(8) “Physician assistant” means an individual [to whom duties are 1
delegated by a licensed physician under the rules and regulations of the State Board of 2
Physicians] LICENSED UNDER TITLE 15 OF THE HEALTH OCCUPATIONS ARTICLE TO 3
PRACTICE AS A PHYSIC IAN ASSISTANT. 4
Article – Health – General 5
4–201. 6
(a) In this subtitle the following words have the meanings indicated. 7
(s) “Physician assistant” means an individual who is licensed under Title 15 of 8
the Health Occupations Article to practice [medicine with physician supervision] AS A 9
PHYSICIAN ASSISTANT . 10
5–601. 11
(a) In this subtitle the following words have the meanings indicated. 12
(v) “Physician assistant” means an individual who is licensed under Title 15 of 13
the Health Occupations Article to practice [medicine with physician supervision] AS A 14
PHYSICIAN ASSISTANT . 15
Article – Health Occupations 16
12–102. 17
(c) (2) This title does not prohibit: 18
(iv) A licensed physician who complies with the requirements of item 19
(ii) of this paragraph from personally preparing and dispensing a prescription written by: 20
1. A physician assistant [in accordance with a delegation 21
agreement that] WHO complies with Title 15, Subtitle 3 of this article; or 22
2. An advanced practice registered nurse with prescriptive 23
authority under Title 8 of this article and is working with the physician in the same office 24
setting; 25
(v) A hospital–based clinic from dispensing prescriptions to its 26
patients; [or] 27
(vi) An individual licensed or certified under Title 8 of this article 28
from personally preparing and dispensing a drug or device as authorized under Title 8 of 29
this article; OR 30
SENATE BILL 167 5
(VII) A PHYSICIAN ASSISTANT FROM PERSONALL Y PREPARING 1
AND DISPENSING A PRE SCRIPTION IN ACCORDA NCE WITH § 15–302.1 OF THIS 2
ARTICLE. 3
15–101. 4
(a) In this title the following words have the meanings indicated. 5
[(b) “Alternate supervising physician” means one or more physicians designated 6
by the primary supervising physician to provide supervision of a physician assistant in 7
accordance with the delegation agreement on file with the Board.] 8
[(c)] (B) “Ambulatory surgical facility” means a facility: 9
(1) Accredited by: 10
(i) The American Association for Accreditation of Ambulatory 11
Surgical Facilities; 12
(ii) The Accreditation Association for Ambulatory Health Care; or 13
(iii) The Joint Commission on Accreditation of Healthcare 14
Organizations; or 15
(2) Certified to participate in the Medicare program, as enacted by Title 16
XVIII of the Social Security Act. 17
[(d)] (C) “Board” means the State Board of Physicians, established under § 18
14–201 of this article. 19
(D) (1) “COLLABORATION ” MEANS THE COMMUNICAT ION AND 20
DECISION–MAKING PROCESS AMO NG HEALTH CARE PROVI DERS WHO ARE MEMBERS 21
OF A PATIENT CARE TE AM RELATED TO THE TR EATMENT OF A PATIENT THAT 22
INCLUDES THE DEGREE OF COOPERATIO N NECESSARY TO PROVI DE TREATMENT 23
AND CARE TO THE PATI ENT AND INCLUDES : 24
(I) COMMUNICATION OF DATA AND INFORMATION ABOUT THE 25
TREATMENT AND CARE O F A PATIENT, INCLUDING THE EXCHAN GE OF CLINICAL 26
OBSERVATIONS AND ASSESSMENTS ; AND 27
(II) DEVELOPMENT OF AN APP ROPRIATE PLAN OF CAR E, 28
INCLUDING: 29
1. DECISIONS REGARDING T HE HEALTH CARE 30
PROVIDED; 31 6 SENATE BILL 167
2. ACCESSING AND ASSESSMENT OF APPROP RIATE 1
ADDITIONAL RESOURCES OR EXPERTI SE; AND 2
3. ARRANGEMENT OF APPROP RIATE REFERRALS , 3
TESTING, OR STUDIES. 4
(2) “COLLABORATION ” DOES NOT REQUIRE THE CONSTANT, 5
PHYSICAL PRESENCE OF A COLLAB ORATING PHYSICIAN ON –SITE IN THE PRACTICE 6
SETTING, IF THE COLLABORATING PH YSICIAN IS ACCESSIBL E BY ELECTRONIC 7
MEANS. 8
(E) “COLLABORATION AGREEMENT ” MEANS A DOCUMENT THA T: 9
(1) OUTLINES THE COLLABORATION BETWEEN A PHYSICIAN 10
ASSISTANT AND: 11
(I) AN INDIVIDUAL PHYSICI AN; OR 12
(II) A GROUP OF PHYSICIANS ; 13
(2) IS DEVELOPED BY A PHY SICIAN ASSISTANT AND THE PHYSICIAN 14
OR GROUP OF PHYSICIA NS; AND 15
(3) IS SUBMITTED TO THE BOARD. 16
[(e)] (F) “Committee” means the Physician Assistant Advisory Committee. 17
[(f)] (G) “Controlled dangerous substances” has the meaning stated in § 5–101 18
of the Criminal Law Article. 19
[(g)] (H) “Correctional facility” includes a State or local correctional facility. 20
[(h) “Delegated medical acts” means activities that constitute the practice of 21
medicine delegated by a physician under Title 14 of this article. 22
(i) “Delegation agreement” means a document that is executed by a primary 23
supervising physician and a physician assistant containing the requirements of § 15–302 24
of this title. 25
(i–1)] (I) “Disciplinary panel” means a disciplinary panel of the Board 26
established under § 14–401 of this article. 27
(j) “Dispense” or “dispensing” has the meaning stated in § 12–101 of this article. 28 SENATE BILL 167 7
(k) “Drug sample” means a unit of a prescription drug that is intended to promote 1
the sale of the drug and is not intended for sale. 2
(l) “Hospital” means: 3
(1) A hospital as defined under § 19–301 of the Health – General Article; 4
(2) A comprehensive care facility that: 5
(i) Meets the requirements of a hospital–based skilled nursing 6
facility under federal law; and 7
(ii) Offers acute care in the same building; and 8
(3) An emergency room that is physically connected to a hospital or a 9
freestanding medical facility that is licensed under Title 19, Subtitle 3A of the Health – 10
General Article. 11
(m) “License” means a license issued by the Board to a physician assistant under 12
this title. 13
(n) “National certifying examination” means the Physician Assistant National 14
Certifying Examination administered by the National Commission on Certification of 15
Physician Assistants or its successor. 16
(O) “PATIENT CARE TEAM ” MEANS A MULTIDISCIPL INARY TEAM OF HEALTH 17
CARE PROVIDERS ACTIV ELY FUNCTIONING AS A UNIT IN CONSULTATION WITH ONE 18
OR MORE PATIENT CARE TE AM PHYSICIANS FOR TH E PURPOSE OF PROVIDING AND 19
DELIVERING HEALTH CARE TO A PAT IENT OR GROUP OF PAT IENTS. 20
(P) “PATIENT CARE TEAM PHY SICIAN” MEANS A LICENSED PHY SICIAN WHO 21
REGULARLY PRACTICES IN THE STATE AND WHO PROVIDE S CONSULTATION IN THE 22
CARE OF PATIENTS AS PART OF A PATIENT CARE TEAM. 23
[(o)] (Q) “Physician assistant” means an individual who is licensed under this 24
title to practice [medicine with physician supervision] AS A PHYSICIAN ASSIS TANT. 25
[(p)] (R) “Practice as a physician assistant” means the performance of medical 26
acts that are: 27
[(1) Delegated by a supervising physician to a physician assistant; 28
(2) Within the supervising physician’s scope of practice; and 29
(3) Appropriate to the physician assistant’s education, training, and 30 8 SENATE BILL 167
experience] 1
(1) AUTHORIZED UNDER A LI CENSE ISSUED BY THE BOARD; AND 2
(2) AUTHORIZED UNDER THE PHYSICIAN ASSISTANT ’S 3
COLLABORATION AGREEM ENT. 4
[(q)] (S) “Prescriptive authority” means the authority [delegated by a primary 5
or alternate supervising physician to] OF a physician assistant to: 6
(1) Prescribe and administer controlled dangerous substances, prescription 7
drugs, medical devices, and the oral, written, or electronic ordering of medications; and 8
(2) Dispense as provided under [§ 15–302.2(b), (c), and (d)] § 15–302.1 of 9
this title. 10
[(r) “Primary supervising physician” means a physician who: 11
(1) Completes a delegation agreement that meets the requirements under 12
§§ 15–301(d) and (e) and 15–302 of this title and files a copy with the Board; 13
(2) Acts as the physician responsible to ensure that a physician assistant 14
practices medicine in accordance with this title and the regulations adopted under this title; 15
(3) Ensures that a physician assistant practices within the scope of practice 16
of the primary supervising physician or any designated alternate supervising physician; 17
and 18
(4) Ensures that a list of alternate supervising physicians is maintained at 19
the practice setting.] 20
[(s)] (T) “Public health facility” means a site where clinical public health 21
services are rendered under the auspices of the Department, a local health department in 22
a county, or the Baltimore City Health Department. 23
[(t)] (U) “Starter dosage” means an amount of a drug sufficient to begin therapy: 24
(1) Of short duration of 72 hours or less; or 25
(2) Prior to obtaining a larger quantity of the drug to complete therapy. 26
[(u) (1) “Supervision” means the responsibility of a physician to exercise 27
on–site supervision or immediately available direction for physician assistants performing 28
delegated medical acts. 29
(2) “Supervision” includes physician oversight of and acceptance of direct 30 SENATE BILL 167 9
responsibility for the patient services and care rendered by a physician assistant, including 1
continuous availability to the physician assistant in person, through written instructions, 2
or by electronic means and by designation of one or more alternate supervising physicians.] 3
15–103. 4
(a) In this section, “alternative health care system” has the meaning stated in § 5
1–401 of this article. 6
(b) (1) Subject to paragraph (2) of this subsection, an employer of a physician 7
assistant shall report to the Board, on the form prescribed by the Board, any termination 8
of employment of the physician assistant if the cause of termination is related to a quality 9
of care issue. 10
(2) Subject to subsection (d) of this section, a [supervising physician] 11
PHYSICIAN OR GROUP O F PHYSICIANS THAT DEVELOPS A COLL ABORATION 12
AGREEMENT WITH A PHYSICIAN ASS ISTANT or an employer of a physician assistant shall 13
notify the Board within 10 days of the termination of employment of the physician assistant 14
for reasons that would be grounds for discipline under this title. 15
(3) A [supervising physician and a] PHYSICIAN O R GROUP OF 16
PHYSICIANS THAT DEVELOPS A COLL ABORATION AGREEMENT WITH A PHYSICIAN 17
ASSISTANT OR THE physician assistant shall notify the Board within 10 days of the 18
termination of the relationship under a [delegation agreement for any reason] 19
COLLABORATION AGREEMENT. 20
(c) Except as otherwise provided under subsections (b) and (d) of this section, a 21
hospital, a related institution, an alternative health care system, or an employer of a 22
physician assistant shall report to the Board any limitation, reduction, or other change of 23
the terms of employment of the physician assistant or any termination of employment of 24
the physician assistant for any reason that might be grounds for disciplinary action under 25
§ 15–314 of this title. 26
(d) A hospital, related institution, alternative health care system, or employer 27
that has reason to know that a physician assistant has committed an action or has a 28
condition that might be grounds for reprimand or probation of the physician assistant or 29
suspension or revocation of the license of the physician assistant under § 15–314 of this 30
title because the physician assistant is alcohol– or drug–impaired is not required to report 31
to the Board if: 32
(1) The hospital, related institution, alternative health care system, or 33
employer knows that the physician assistant is: 34
(i) In an alcohol or drug treatment program that is accredited by the 35
Joint Commission on the Accreditation of Healthcare Organizations or is certified by the 36
Department; or 37 10 SENATE BILL 167
(ii) Under the care of a health care practitioner who is competent 1
and capable of dealing with alcoholism and drug abuse; 2
(2) The hospital, related institution, alternative health care system, or 3
employer is able to verify that the physician assistant remains in the treatment program 4
until discharge; and 5
(3) The action or condition of the physician assistant has not caused injury 6
to any person while the physician assistant is practicing as a licensed physician assistant. 7
(e) (1) If the physician assistant enters, or is considering entering, an alcohol 8
or drug treatment program that is accredited by the Joint Commission on Accreditation of 9
Healthcare Organizations or that is certified by the Department, the physician assistant 10
shall notify the hospital, related institution, alternative health care system, or employer of 11
the physician assistant’s decision to enter the treatment program. 12
(2) If the physician assistant fails to provide the notice required under 13
paragraph (1) of this subsection, and the hospital, related institution, alternative health 14
care system, or employer learns that the physician assistant has entered a treatment 15
program, the hospital, related institution, alternative health care system, or employer shall 16
report to the Board that the physician assistant has entered a treatment program and has 17
failed to provide the required notice. 18
(3) If the physician assistant is found to be noncompliant with the 19
treatment program’s policies and procedures while in the treatment program, the 20
treatment program shall notify the hospital, related institution, alternative health care 21
system, or employer of the physician assistant’s noncompliance. 22
(4) On receipt of the notification required under paragraph (3) of this 23
subsection, the hospital, related institution, alternative health care system, or employer of 24
the physician assistant shall report the physician assistant’s noncompliance to the Board. 25
(f) A person is not required under this section to make any report that would be 26
in violation of any federal or State law, rule, or regulation concerning the confidentiality of 27
alcohol– and drug–abuse patient records. 28
(g) The hospital, related institution, alternative health care system, or employer 29
shall submit the report within 10 days of any action described in this section. 30
(h) A report under this section is not subject to subpoena or discovery in any civil 31
action other than a proceeding arising out of a hearing and decision of the Board or a 32
disciplinary panel under this title. 33
(i) (1) A disciplinary panel may impose a civil penalty of up to $1,000 for 34
failure to report under this section. 35
SENATE BILL 167 11
(2) The Board shall pay any fees collected under this subsection into the 1
General Fund of the State. 2
(j) An employer shall make the report required under this section to the Board 3
within 5 days after the date of termination of employment. 4
(k) The Board shall adopt regulations to implement the provisions of this section. 5
15–202. 6
(a) (1) The Committee shall consist of 7 members appointed by the Board. 7
(2) Of the 7 Committee members: 8
(i) 3 shall be licensed physicians; 9
(ii) 3 shall be licensed physician assistants; and 10
(iii) 1 shall be a consumer. 11
(b) Of the three physician members of the Committee, two shall [be previously or 12
currently serving as supervising physicians of a phys ician assistant under a 13
Board–approved delegation agreement] HAVE DEVELOPED A COL LABORATION 14
AGREEMENT WITH A PHYSICIAN ASS ISTANT. 15
15–205. 16
(a) In addition to the powers set forth elsewhere in this title, the Committee, on 17
its initiative or on the Board’s request, may: 18
(1) Recommend to the Board regulations for carrying out the provisions of 19
this title; 20
(2) Recommend to the Board approval, modification, or disapproval of an 21
application for licensure [or a delegation agreement]; 22
(3) Report to the Board any conduct of a [supervising physician] 23
PHYSICIAN OR GROUP O F PHYSICIANS WHO DEVELOPS A COLLA BORATION 24
AGREEMENT WITH A PHYSICIAN ASS ISTANT or a physician assistant that may be cause 25
for disciplinary action under this title or under § 14–404 of this article; and 26
(4) Report to the Board any alleged unauthorized practice of a physician 27
assistant. 28
15–301. 29
12 SENATE BILL 167
(a) [Nothing in this] THIS title may NOT be construed to authorize a physician 1
assistant to practice [independent of a primary or alternate supervising physician] 2
INDEPENDENTLY . 3
(b) A license issued to a physician assistant shall limit the physician assistant’s 4
scope of practice to medical acts: 5
[(1) Delegated by the primary or alternate supervising physician;] 6
[(2)] (1) Appropriate to the education, training, and experience of the 7
physician assistant; 8
[(3)] (2) Customary to the practice of the [primary or alternate 9
supervising] physician; and 10
[(4)] (3) Consistent with the [delegation] COLLABORATION agreement 11
filed with the Board. 12
(c) Patient services that may be provided by a physician assistant UNDER A 13
COLLABORATION AGREEM ENT include: 14
[(1) (i) Taking complete, detailed, and accurate patient histories; and 15
(ii) Reviewing patient records to develop comprehensive medical 16
status reports; 17
(2) Performing physical examinations and recording all pertinent patient 18
data; 19
(3) Interpreting and evaluating patient data as authorized by the primary 20
or alternate supervising physician for the purpose of determining management and 21
treatment of patients; 22
(4) Initiating requests for or performing diagnostic procedures as indicated 23
by pertinent data and as authorized by the supervising physician; 24
(5) Providing instructions and guidance regarding medical care matters to 25
patients; 26
(6) Assisting the primary or alternate supervising physician in the delivery 27
of services to patients who require medical care in the home and in health care institutions, 28
including: 29
(i) Recording patient progress notes; 30
(ii) Issuing diagnostic orders; and 31 SENATE BILL 167 13
(iii) Transcribing or executing specific orders at the direction of the 1
primary or alternate supervising physician; and 2
(7) Exercising prescriptive authority under a delegation agreement and in 3
accordance with § 15–302.2 of this subtitle.] 4
(1) OBTAINING COMPREHENSI VE HEALTH HISTORIES ; 5
(2) PERFORMING PHYSICAL E XAMINATIONS ; 6
(3) EVALUATING, DIAGNOSING, MANAGING, AND PROVIDING 7
MEDICAL TREATMENT ; 8
(4) ORDERING, PERFORMING , AND INTERPRETING DIA GNOSTIC 9
STUDIES, THERAPEUTIC PROCEDUR ES, AND LABORATORY TESTS ; 10
(5) ORDERING DIAGNOSTIC T ESTS AND USING THE FINDINGS OR 11
RESULTS IN THE CARE OF PATIENTS; 12
(6) EXERCISING PRESCRIPTI VE AUTHORITY IN ACCO RDANCE WITH § 13
15–302.1 OF THIS SUBTITLE; 14
(7) INFORMING PATIENTS AB OUT HEALTH PROMOTION AND DISEASE 15
PREVENTION ; 16
(8) PROVIDING CONSULTATIO NS; 17
(9) WRITING MEDICAL ORDER S; 18
(10) PROVIDING SERVICES IN HEALTH CARE FACILITI ES, INCLUDING 19
HOSPITALS, NURSING FACILITIES , ASSISTED LIVING FACI LITIES, AND HOSPICE 20
FACILITIES; 21
(11) OBTAINING INFORMED CO NSENT; 22
(12) DELEGATING OR ASSIGNI NG THERAPEUTIC AND D IAGNOSTIC 23
MEASURES TO BE PERFO RMED BY LICENSED OR UNLICENSED PERSONNEL AND 24
SUPERVISING LICENSED OR UNLICENSED PERSON NEL PERFORMING THERA PEUTIC 25
AND DIAGNOSTIC MEASU RES; 26
(13) CERTIFYING A PATIENT ’S HEALTH OR DISABILI TY AS REQUIRED 27
BY A FEDERAL, STATE, OR LOCAL PROGRAM ; AND 28
14 SENATE BILL 167
(14) AUTHENTICATING ANY DO CUMENT THAT A PHYSIC IAN MAY 1
AUTHENTICATE THROUGH SIGNATURE, CERTIFICATION , STAMP VERIFICATION , 2
AFFIDAVIT, OR ENDORSEMENT . 3
(d) (1) Except as otherwise provided in this title, an individual shall be 4
licensed by the Board before the individual may practice as a physician assistant. 5
(2) Except as otherwise provided in this title, a physician may not 6
[supervise] ENTER INTO A C OLLABORATION WITH a physician assistant in the 7
performance of [delegated] medical acts without filing a completed [delegation] 8
COLLABORATION agreement with the Board. 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 physician] THE INDIVIDUAL HAS NO T RECEIVED APPROPRIA TE 14
EDUCATION, TRAINING, AND EXPERIENCE . 15
[(e) A physician assistant is the agent of the primary or alternate supervising 16
physician in the performance of all practice–related activities, including the oral, written, 17
or electronic ordering of diagnostic, therapeutic, and other medical services.] 18
(E) A PHYSICIAN ASSISTANT SHALL CONSULT AND COLLABORATE WITH OR 19
REFER AN INDIVIDUAL TO AN APPROPRIATE LI CENSED PHYSICIAN OR ANY OTHER 20
HEALTH CARE PROVIDER AS APPROPRIATE . 21
(F) A PHYSICIAN ASSISTANT WHO HAS NOT BEEN PRE VIOUSLY LICENSED BY 22
THE BOARD TO PRACTICE AS A PHYSICIAN ASSISTAN T OR LICENSED, CERTIFIED, OR 23
REGISTERED AS A PHYS ICIAN ASSISTANT BY A NOTHER STATE REGULATORY 24
AUTHORITY SHALL BE M ENTORED BY A LICENSE D PHYSICIAN OR PHYSI CIANS WHO 25
ARE IDENTIFIED IN AN INITIAL COLLABORATION AGREEMENT TO CONSULT AND 26
COLLABORATE WITH THE PHYSICIAN ASSISTANT FOR AT LEAST 18 MONTHS AFTER 27
THE DATE AN INITIAL COLLABORATION AGREEMENT IS SUBMITTED TO THE BOARD. 28
[(f)] (G) Except as OTHERWISE provided in [subsection (g) of this section] THIS 29
TITLE, the following individuals may practice as a physician assistant without a license: 30
(1) A physician assistant student enrolled in a physician assistant 31
educational program that is accredited by the Accreditation Review Commission on 32
Education for the Physician Assistant or its successor and approved by the Board; or 33
(2) A physician assistant employed in the service of the federal government 34 SENATE BILL 167 15
while performing duties incident to that employment. 1
[(g) A physician may not delegate prescriptive authority to a physician assistant 2
student in a training program that is accredited by the Accreditation Review Commission 3
on Education for the Physician Assistant or its successor.] 4
(h) (1) If a medical act that is to be [delegated] PERFORM ED BY A PHYSICIAN 5
ASSISTANT under this section is a part of the practice of a health occupation that is 6
regulated under this article by another board, any rule or regulation concerning that 7
medical act shall be adopted jointly by the State Board of Physicians and the board that 8
regulates the other health occupation. 9
(2) If the two boards cannot agree on a proposed rule or regulation, the 10
proposal shall be submitted to the Secretary for a final decision. 11
15–302. 12
(a) A physician [may delegate medical acts to a physician assistant only after: 13
(1) A delegation agreement has been executed and filed with the Board; 14
and 15
(2) Any advanced duties have been authorized as required under 16
subsection (c) of this section] ASSISTANT MAY PRACTI CE AS A PHYSICIAN AS SISTANT 17
ONLY AFTER SUBMITTIN G A COLLABORATION AGREEMENT TO THE BOARD. 18
(b) (1) [The delegation agreement] SUBJECT TO PARAGRAPH (2) OF THIS 19
SUBSECTION, A COLLABORATION AGREEMENT shall contain: 20
[(1)] (I) A description of the qualifications of the [primary supervising 21
physician and] PHYSICIAN OR GROUP O F PHYSICIANS WHO DEVELOPED THE 22
COLLABORATION AGREEMENT WITH THE physician assistant; 23
(II) ANY PRACTICE SPECIALT Y OF THE PHYSICIAN O R GROUP OF 24
PHYSICIANS; AND 25
[(2)] (III) A description of the settings in which the physician assistant will 26
practice[; 27
(3) A description of the continuous physician supervision mechanisms that 28
are reasonable and appropriate to the practice setting; 29
(4) A description of the delegated medical acts that are within the primary 30
or alternate supervising physician’s scope of practice and require specialized education or 31
training that is consistent with accepted medical practice; 32
16 SENATE BILL 167
(5) An attestation that all medical acts to be delegated to the physician 1
assistant are within the scope of practice of the primary or alternate supervising physician 2
and appropriate to the physician assistant’s education, training, and level of competence; 3
(6) An attestation of continuous supervision of the physician assistant by 4
the primary supervising physician through the mechanisms described in the delegation 5
agreement; 6
(7) An attestation by the primary supervising physician of the physician’s 7
acceptance of responsibility for any care given by the physician assistant; 8
(8) A description prepared by the primary supervising physician of the 9
process by which the physician assistant’s practice is reviewed appropriate to the practice 10
setting and consistent with current standards of acceptable medical practice; 11
(9) An attestation by the primary supervising physician that the physician 12
will respond in a timely manner when contacted by the physician assistant; 13
(10) The following statement: “The primary supervising physician and the 14
physician assistant attest that: 15
(i) They will establish a plan for the types of cases that require a 16
physician plan of care or require that the patient initially or periodically be seen by the 17
supervising physician; and 18
(ii) The patient will be provided access to the supervising physician 19
on request”; and 20
(11) Any other information deemed necessary by the Board to carry out the 21
provisions of this subtitle]. 22
(2) IF A PHYSICIAN ASSIST ANT WHO SUBMITS AN I NITIAL 23
COLLABORATION AGREEMENT TO THE BOARD HAS NOT BEEN PR EVIOUSLY 24
LICENSED BY THE BOARD TO PRACTICE AS A PHYSICIAN ASSIS TANT OR LICENSED , 25
CERTIFIED, OR REGISTERED AS A P HYSICIAN ASSISTANT B Y ANOTHER STATE 26
REGULATORY AUTHORITY , THE INITIAL COLLABOR ATION AGREEMENT SHALL 27
IDENTIFY A LICENSED PHYSICIAN OR PHYSICI ANS WHO WILL CONSULT AND 28
COLLABORATE WITH THE PHYSICIAN ASSISTANT FOR AT LEAST 18 MONTHS AFTER 29
THE DATE THE INITIAL COLLABORATION AGREEMENT IS SUBMITTED TO THE BOARD. 30
(3) A COLLABORATION AGREEM ENT MAY INCLU DE PROVISIONS 31
LIMITING THE PHYSICI AN ASSISTANT’S SCOPE OF PRACTICE , SPECIFYING OFFICE 32
PROCEDURES , OR OTHERWISE DETAILING THE PRACTI CE OF THE PHYSICIAN 33
ASSISTANT AS AGREED BY THE PHYSICIAN OR GROUP OF PHYSICIANS AND THE 34
PHYSICIAN ASSISTANT . 35
SENATE BILL 167 17
(c) (1) The Board may not require [prior] approval of a [delegation agreement 1
that includes advanced duties, if an advanced duty will be performed in a hospital or 2
ambulatory surgical facility, provided that: 3
(i) A physician, with credentials that have been reviewed by the 4
hospital or ambulatory surgical facility as a condition of employment, as an independent 5
contractor, or as a member of the medical staff, supervises the physician assistant; 6
(ii) The physician assistant has credentials that have been reviewed 7
by the hospital or ambulatory surgical facility as a condition of employment, as an 8
independent contractor, or as a member of the medical staff; and 9
(iii) Each advanced duty to be delegated to the physician assistant is 10
reviewed and approved within a process approved by the governing body of the health care 11
facility before the physician assistant performs the advanced duties] COLLABORATION 12
AGREEMENT . 13
[(2) (i) In any setting that does not meet the requirements of paragraph 14
(1) of this subsection, a primary supervising physician shall obtain the Board’s approval of 15
a delegation agreement that includes advanced duties, before the physician assistant 16
performs the advanced duties. 17
(ii) 1. Before a physician assistant may perform X–ray duties 18
authorized under § 14–306(e) of this article in the medical office of the physician delegating 19
the duties, a primary supervising physician shall obtain the Board’s approval of a 20
delegation agreement that includes advanced duties in accordance with subsubparagraph 21
2 of this subparagraph. 22
2. The advanced duties set forth in a delegation agreement 23
under this subparagraph shall be limited to nonfluoroscopic X–ray procedures of the 24
extremities, anterior–posterior and lateral, not including the head.] 25
[(3)] (2) [Notwithstanding paragraph (1) of this subsection, a primary 26
supervising physician shall obtain the Board’s approval of a delegation agreement before] 27
A PHYSICIAN ASSISTANT SHALL SUBMIT TO THE BOARD A COLLABORATION 28
AGREEMENT THAT CONTA INS ANESTHESIA DUTIE S BEFORE the physician assistant 29
may administer, monitor, or maintain general anesthesia or neuroaxial anesthesia, 30
including spinal and epidural techniques, under the agreement. 31
[(d) For a delegation agreement containing advanced duties that require Board 32
approval, the Committee shall review the delegation agreement and recommend to the 33
Board that the delegation agreement be approved, rejected, or modified to ensure 34
conformance with the requirements of this title. 35
(e) The Committee may conduct a personal interview of the primary supervising 36
physician and the physician assistant. 37 18 SENATE BILL 167
(f) (1) On review of the Committee’s recommendation regarding a primary 1
supervising physician’s request to delegate advanced duties as described in a delegation 2
agreement, the Board: 3
(i) May approve the delegation agreement; or 4
(ii) 1. If the physician assistant does not meet the applicable 5
education, training, and experience requirements to perform the specified delegated acts, 6
may modify or disapprove the delegation agreement; and 7
2. If the Board takes an action under item 1 of this item: 8
A. Shall notify the primary supervising physician and the 9
physician assistant in writing of the particular elements of the proposed delegation 10
agreement that were the cause for the modification or disapproval; and 11
B. May not restrict the submission of an amendment to the 12
delegation agreement. 13
(2) To the extent practicable, the Board shall approve a delegation 14
agreement or take other action authorized under this subsection within 90 days after 15
receiving a completed delegation agreement including any information from the physician 16
assistant and primary supervising physician necessary to approve or take action.] 17
[(g)] (D) If the Board determines that a [primary or alternate supervising 18
physician] PHYSICIAN OR GROUP O F PHYSICIANS THAT DEVELOPS A 19
COLLABORATION AGREEMENT WITH A PHYSICIAN ASS ISTANT or A physician assistant 20
is practicing in a manner inconsistent with the requirements of this title or Title 14 of this 21
article, the Board on its own initiative or on the recommendation of the Committee may 22
demand modification of the practice[, withdraw the approval of the delegation agreement,] 23
or refer the matter to a disciplinary panel for the purpose of taking other disciplinary action 24
under § 14–404 OF THIS ARTICLE or § 15–314 of this [article] SUBTITLE. 25
[(h)] (E) [A primary supervising physician may not delegate medical acts under 26
a delegation agreement to more than four physician assistants at any one time, except in 27
a] A PHYSICIAN OR GROUP OF PHYSICIANS MAY NOT ENTER INTO A COLLABO RATION 28
AGREEMENT THAT ALLOWS FOR COLLABORA TION OF MORE THA N EIGHT PHYSICIAN 29
ASSISTANTS FOR EACH PHYSICIAN IN THE AGR EEMENT AT ONE TIME , EXCEPT IN A 30
hospital or in the following nonhospital settings: 31
(1) A correctional facility; 32
(2) A detention center; or 33
(3) A public health facility. 34 SENATE BILL 167 19
[(i)] (F) A person may not coerce another person to enter into a [delegation] 1
COLLABORATION agreement under this subtitle. 2
[(j) A physician may supervise a physician assistant: 3
(1) As a primary supervising physician in accordance with a delegation 4
agreement approved by the Board under this subtitle; or 5
(2) As an alternate supervising physician if: 6
(i) The alternate supervising physician supervises in accordance 7
with a delegation agreement filed with the Board; 8
(ii) The alternate supervising physician supervises no more than 9
four physician assistants at any one time, except in a hospital, correctional facility, 10
detention center, or public health facility; 11
(iii) The alternate supervising physician’s period of supervision, in 12
the temporary absence of the primary supervising physician, does not exceed: 13
1. The period of time specified in the delegation agreement; 14
and 15
2. A period of 45 consecutive days at any one time; and 16
(iv) The physician assistant performs only those medical acts that: 17
1. Have been delegated under the delegation agreement filed 18
with the Board; and 19
2. Are within the scope of practice of the primary supervising 20
physician and alternate supervising physician.] 21
[(k)] (G) Subject to the notice required under § 15–103 of this title, a physician 22
assistant may terminate a [delegation agreement filed with the Board under] 23
COLLABORATION AGREEMENT DEVELOPED IN ACCORDANCE WITH this subtitle at any 24
time. 25
[(l)] (H) (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 physician] 28
A PATIENT CARE TEAM PHYSICIAN being unable to legally practice medicine, [an 29
alternate supervising physician designated under subsection (b) of this section may 30
supervise the physician assistant for not longer than 15 days following the event] THE 31
COLLABORATION AGREEM ENT SHALL REMAIN ACTIVE AND VA LID UNDER THE 32 20 SENATE BILL 167
SUPERVISION OF THE REMAINING LISTED PATIENT CARE TEAM PHYSICIANS . 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 CA RE 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
COLLABORATION agreement under [§ 15–302.1 of] this subtitle. 7
[(3) An alternate supervising physician or other licensed physician may 8
assume the role of primary supervising physician by submitting a new delegation 9
agreement to the Board for approval under subsection (b) of this section. 10
(4) The Board may terminate a delegation agreement if: 11
(i) The physician assistant has a change in license status that 12
results in the physician assistant being unable to legally practice as a physician assistant; 13
(ii) At least 15 days have elapsed since an event listed under 14
paragraph (1) of this subsection if there is an alternate supervising physician designated 15
under subsection (b) of this section; or 16
(iii) Immediately after an event listed under paragraph (1) of this 17
subsection if there is no alternate supervising physician designated under subsection (b) of 18
this section.] 19
(I) THE BOARD SHALL NOTIFY TH E PHYSICIAN ASSISTAN T AND PHYSICIAN 20
OR GROUP OF PHYSICIA NS WHO HAVE ENTERED INTO A COLLABORATION 21
AGREEMENT WITH A PHY SICIAN ASSISTANT IMM EDIATELY IF: 22
(1) THE PHYSICIAN ASSISTA NT HAS A CHANGE IN L ICENSE 23
STATUS THAT RESULTS IN THE PHYSICIAN ASS ISTANT BEING UNABLE TO LEGALLY 24
PRACTICE AS A PHYSICIAN ASSIS TANT; OR 25
(2) AN EVENT DESCRIBED IN SUBSECTION (H) OF THIS SECTION 26
OCCURS. 27
[(m)] (J) A physician assistant whose [delegation] COLLABORATION agreement 28
is terminated may not practice as a physician assistant until the physician assistant 29
[receives preliminary approval of a new delegation agreement under § 15–302.1 of this 30
subtitle] SUBMITS A NEW COLLAB ORATION AGREEMENT TO THE BOARD. 31
[(n) Individual members of the Board are not civilly liable for actions regarding 32
the approval, modification, or disapproval of a delegation agreement described in this 33
section. 34 SENATE BILL 167 21
(o) A physician assistant may practice in accordance with a delegation agreement 1
filed with the Board under this subtitle.] 2
[15–302.1. 3
(a) If a delegation agreement does not include advanced duties or the advanced 4
duties have been approved under § 15–302(c)(1) of this subtitle, a physician assistant may 5
assume the duties under a delegation agreement on the date that the Board acknowledges 6
receipt of the completed delegation agreement. 7
(b) In this section, “pending” means that a delegation agreement that includes 8
delegation of advanced duties in a setting that does not meet the requirements under § 9
15–302(c)(1) of this subtitle has been executed and submitted to the Board for its approval, 10
but: 11
(1) The Committee has not made a recommendation to the Board; or 12
(2) The Board has not made a final decision regarding the delegation 13
agreement. 14
(c) Subject to subsection (d) of this section, if a delegation agreement is pending, 15
on receipt of a temporary practice letter from the staff of the Board, a physician assistant 16
may perform the advanced duty if: 17
(1) The primary supervising physician has been previously approved to 18
supervise one or more physician assistants in the performance of the advanced duty; and 19
(2) The physician assistant has been previously approved by the Board to 20
perform the advanced duty. 21
(d) If the Committee recommends a denial of the pending delegation agreement 22
or the Board denies the pending delegation agreement, on notice to the primary supervising 23
physician and the physician assistant, the physician assistant may no longer perform the 24
advanced duty that has not received the approval of the Board. 25
(e) The Board may disapprove any delegation agreement if it believes that: 26
(1) The agreement does not meet the requirements of this subtitle; or 27
(2) The physician assistant is unable to perform safely the delegated 28
duties. 29
(f) If the Board disapproves a delegation agreement or the delegation of any 30
function under an agreement, the Board shall provide the primary supervising physician 31
and the physician assistant with written notice of the disapproval. 32
22 SENATE BILL 167
(g) A physician assistant who receives notice that the Board has disapproved a 1
delegation agreement or an advanced function under the delegation agreement shall 2
immediately cease to practice under the agreement or to perform the disapproved function.] 3
[15–302.2.] 15–302.1. 4
[(a) A primary supervising physician may not delegate prescribing, dispensing, 5
and administering of controlled dangerous substances, prescription drugs, or medical 6
devices unless the primary supervising physician and physician assistant include in the 7
delegation agreement: 8
(1) A notice of intent to delegate prescribing and, if applicable, dispensing 9
of controlled dangerous substances, prescription drugs, or medical devices; 10
(2) An attestation that all prescribing and, if applicable, dispensing 11
activities of the physician assistant will comply with applicable federal and State 12
regulations; 13
(3) An attestation that all medical charts or records will contain a notation 14
of any prescriptions written or dispensed by a physician assistant in accordance with this 15
section; 16
(4) An attestation that all prescriptions written or dispensed under this 17
section will include the physician assistant’s name and the supervising physician’s name, 18
business address, and business telephone number legibly written or printed; 19
(5) An attestation that the physician assistant has: 20
(i) Passed the physician assistant national certification exam 21
administered by the National Commission on the Certification of Physician Assistants 22
within the previous 2 years; or 23
(ii) Successfully completed 8 category 1 hours of pharmacology 24
education within the previous 2 years; and 25
(6) An attestation that the physician assistant has: 26
(i) A bachelor’s degree or its equivalent; or 27
(ii) Successfully completed 2 years of work experience as a physician 28
assistant. 29
(b) (1) A primary supervising physician may not delegate the prescribing or 30
dispensing of substances that are identified as Schedule I controlled dangerous substances 31
under § 5–402 of the Criminal Law Article. 32
(2) A primary supervising physician may delegate the prescribing or 33 SENATE BILL 167 23
dispensing of substances that are identified as Schedules II through V controlled dangerous 1
substances under § 5–402 of the Criminal Law Article, including legend drugs as defined 2
under § 503(b) of the Federal Food, Drug, and Cosmetic Act. 3
(3) A primary supervising physician may not delegate the prescribing or 4
dispensing of controlled dangerous substances to a physician assistant unless the physician 5
assistant has a valid: 6
(i) State controlled dangerous substance registration; and 7
(ii) Federal Drug Enforcement Agency (DEA) registration.] 8
(A) IN THIS SECTION, “PERSONALLY PREPARE A ND DISPENSE” MEANS THAT 9
A PHYSICIAN ASSISTAN T: 10
(1) IS PHYSICALLY PRESENT ON THE PREMISES WHER E A 11
PRESCRIPTION IS FILLE D; AND 12
(2) PERFORMS A FINAL CHEC K OF THE PRESCRIPTIO N BEFORE IT IS 13
PROVIDED TO THE PATI ENT. 14
(B) SUBJECT TO THE COLLAB ORATION AGREEMENT SU BMITTED UNDER § 15
15–302 OF THIS SUBTITLE , A PHYSICIAN ASSISTANT MAY PRESCRIBE , PROCURE, 16
DISPENSE, ORDER, OR ADMINISTER : 17
(1) SUBJECT TO SUBSECTION (C)(2) OF THIS SECTION , DRUGS AND 18
SUBSTANCES THAT ARE IDENTIFIED AS SCHEDULES II THROUGH V CONTROLLED 19
DANGEROUS SUBSTANCES UNDER §§ 5–403 THROUGH 5–406 OF THE CRIMINAL LAW 20
ARTICLE, INCLUDING LEGE ND DRUGS AS DEFINED UNDER § 503(B) OF THE 21
FEDERAL FOOD, DRUG, AND COSMETIC ACT; 22
(2) MEDICAL DEVICES ; AND 23
(3) DURABLE MEDICAL EQUIP MENT. 24
(C) (1) A PHYSICIAN ASSISTANT MAY NOT PRESCRIBE OR DISPENSE 25
SUBSTANCES THAT ARE IDENTIFIED AS SCHEDULE I CONTROLLED DANGEROUS 26
SUBSTANCES UNDER § 5–402 OF THE CRIMINAL LAW ARTICLE. 27
(2) A PHYSICIAN ASSISTANT MAY NOT PRESCRIBE OR DISPENSE 28
CONTROLLED DANGEROUS SUBSTANCES UNLESS TH E PHYSICIAN ASSISTAN T HAS A 29
VALID: 30
(I) STATE CONTROLLED DANG EROUS SUBSTANCE 31 24 SENATE BILL 167
REGISTRATION; AND 1
(II) FEDERAL DRUG ENFORCEMENT AGENCY (DEA) 2
REGISTRATION . 3
[(c)] (D) (1) A physician assistant personally may prepare and dispense [a 4
drug that the physician assistant is authorized to prescribe under a delegation agreement 5
if]: 6
[(1) Except as otherwise provided under § 12–102(g) of this article, the 7
supervising physician possesses a dispensing permit; and 8
(2) The physician assistant dispenses drugs only within: 9
(i) The supervising physician’s scope of practice; and 10
(ii) The scope of the delegation agreement.] 11
(I) A STARTER DOSAGE OF AN Y DRUG THAT THE PHYS ICIAN 12
ASSISTANT IS AUTHORI ZED TO PRESCRIBE TO A PATIENT OF THE PHY SICIAN 13
ASSISTANT IF: 14
1. THE STARTER DOSAGE CO MPLIES WITH THE 15
LABELING REQUIREMENT S OF § 12–505 OF THIS ARTICLE; 16
2. NO CHARGE IS MADE FOR THE STARTER DOSAGE ; AND 17
3. THE PHYSICIAN ASSISTA NT ENTERS AN APPROPR IATE 18
RECORD IN THE PATIEN T’S MEDICAL RECORD ; OR 19
(II) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , ANY 20
DRUG THAT A PHYSICIA N ASSISTANT MAY PRESCR IBE TO THE EXTENT AU THORIZED 21
BY LAW IN THE COURSE OF TREATING A PATIEN T AT: 22
1. A MEDICAL FACILITY OR CLINIC THAT SPECIALI ZES IN 23
THE TREATMENT OF MED ICAL CASES REIMBURSA BLE THROUGH WORKERS ’ 24
COMPENSATION INSURAN CE; 25
2. A MEDICAL FACILITY OR CLINIC T HAT IS OPERATED 26
ON A NONPROFIT BASIS ; 27
3. A HEALTH CENTER THAT O PERATES ON A CAMPUS OF 28
AN INSTITUTION OF HI GHER EDUCATION ; 29
SENATE BILL 167 25
4. A PUBLIC HEALTH FACILI TY, A MEDICAL FACILITY 1
UNDER CONTRACT WITH A STATE OR LOCAL HEALTH DEPARTMENT , OR A FACILITY 2
FUNDED WITH PUBLIC F UNDS; OR 3
5. A NONPROFIT HOSPITAL O R A NONPROFIT HOSPIT AL 4
OUTPATIENT FACILITY AS AUTHORIZED UNDER THE POLICIES ESTABLI SHED BY THE 5
HOSPITAL. 6
(2) A PHYSICIAN ASSISTANT WHO PERSONALLY PREPA RES AND 7
DISPENSES A DRUG IN THE COURSE OF TREATIN G A PATIENT AS AUTHO RIZED UNDER 8
THIS SUBSECTION SHAL L: 9
(I) COMPLY WITH THE LABEL ING REQUIREMENTS OF § 12–505 10
OF THIS ARTICLE; 11
(II) RECORD THE DISPENSING OF THE PRESCRIPTION DRUG ON 12
THE PATIENT’S CHART; 13
(III) ALLOW THE OFFICE OF CONTROLLED SUBSTANCES 14
ADMINISTRATION TO ENT ER AND INSPECT THE O FFICE IN WHICH THE PHYSICI AN 15
ASSISTANT PRACTICES AT ALL REASONABLE HO URS; AND 16
(IV) EXCEPT FOR STARTER DO SAGES OR SAMPLES DIS PENSED 17
WITHOUT CHARGE , PROVIDE THE PATIENT WITH A WRITTEN PR ESCRIPTION, 18
MAINTAIN PRESCRIPTIO N FILES, AND MAINTAIN A SEPAR ATE FILE FOR SCHEDULE 19
II PRESCRIPTIONS FOR A PERIOD OF AT LEAST 5 YEARS. 20
[(d)] (E) A physician assistant who personally dispenses a drug in the course of 21
treating a patient as authorized under subsections (b) and [(c)] (D) of this section shall 22
comply with the requirements under Titles 12 and 14 of this article and applicable federal 23
law and regulations. 24
[(e) Before a physician assistant may renew a license for an additional 2–year 25
term under § 15–307 of this subtitle, the physician assistant shall submit evidence to the 26
Board of successful completion of 8 category 1 hours of pharmacology education within the 27
previous 2 years.] 28
(F) A PRESCRIPTION DISPENS ED UNDER THIS SECTIO N SHALL INCLUDE 29
THE PHYSICIAN ASSISTANT ’S: 30
(1) NAME; 31
(2) BUSINESS ADDRESS ; AND 32
26 SENATE BILL 167
(3) BUSINESS TELEPHONE NU MBER. 1
(G) A PHYSICIAN ASSISTANT STUDENT IN A TRAININ G PROGRAM THAT IS 2
ACCREDITED BY THE ACCREDITATION REVIEW COMMISSION ON EDUCATION FOR 3
THE PHYSICIAN ASSISTANT MAY NOT EXERCISE PRE SCRIPTIVE AUTHORITY . 4
[15–302.3. 5
(a) On a quarterly basis, the Board shall provide to the Board of Pharmacy a list 6
of physician assistants whose delegation agreements include the delegation of prescriptive 7
authority. 8
(b) The list required under subsection (a) of this section shall specify whether 9
each physician assistant has been delegated the authority to prescribe controlled dangerous 10
substances, prescription drugs, or medical devices. 11
(c) If a primary supervising physician who has delegated authority to exercise 12
prescriptive authority to a physician assistant subsequently restricts or removes the 13
delegation, the primary supervising physician shall notify the Board of the restriction or 14
removal within 5 business days.] 15
15–303. 16
(a) To qualify for a license, an applicant shall: 17
(1) Complete a criminal history records check in accordance with § 18
14–308.1 of this article; 19
(2) Be of good moral character; 20
(3) Demonstrate oral and written competency in the English language as 21
required by the Board; 22
(4) Be at least 18 years old; [and] 23
(5) [(i) Be a graduate of a physician assistant training program 24
approved by the Board; or 25
(ii) Have passed the physician assistant national certifying 26
examination administered by the National Commission on Certification of Physician 27
Assistants prior to 1986, maintained all continuing education and recertification 28
requirements, and been in continuous practice since passage of the examination] EXCEPT 29
AS PROVIDED IN SUBSE CTION (B) OF THIS S ECTION, HAVE SUCCESSFULLY 30
COMPLETED AN EDUCATI ONAL PROGRAM FOR PHY SICIAN ASSISTANTS AC CREDITED 31
BY: 32
SENATE BILL 167 27
(I) THE ACCREDITATION REVIEW COMMISSION ON 1
EDUCATION FOR THE PHYSICIAN ASSISTANT; OR 2
(II) IF COMPLETED BEFORE 2001: 3
1. THE COMMITTEE ON ALLIED HEALTH EDUCATION 4
AND ACCREDITATION ; OR 5
2. THE COMMISSION ON ACCREDITATION OF ALLIED 6
HEALTH EDUCATION PROGRAMS; AND 7
(6) HAVE PASSED THE PHYSICIAN ASSISTANT NATIONAL 8
CERTIFYING EXAMINATION ADMINISTE RED BY THE NATIONAL COMMISSION ON 9
CERTIFICATION OF PHYSICIAN ASSISTANTS. 10
[(b) Except as otherwise provided in this title, the applicant shall pass a national 11
certifying examination approved by the Board.] 12
[(c)] (B) An applicant who graduates from [a physician assistant training 13
program] AN ACCREDITED ED UCATIONAL PROGRAM FO R PHYSICIAN ASSISTAN TS 14
UNDER THIS SECTION after October 1, 2003, shall have a bachelor’s degree or its 15
equivalent. 16
15–306. 17
A license authorizes the licensee to practice as a physician assistant [under a 18
delegation agreement] while the license is effective. 19
15–309. 20
(a) Each licensee shall keep a license and [delegation] COLLABORATION 21
agreement for inspection at the primary place of business of the licensee. 22
15–310. 23
(a) In reviewing an application for licensure or in investigating an allegation 24
brought under § 15–314 of this subtitle, the Committee may request the Board to direct, or 25
the Board on its own initiative may direct, the physician assistant to submit to an 26
appropriate examination. 27
(b) In return for the privilege given to the physician assistant to [perform 28
delegated medical acts] PRACTICE AS A PHYSIC IAN ASSISTANT in the State, the 29
physician assistant is deemed to have: 30
(1) Consented to submit to an examination under this section, if requested 31 28 SENATE BILL 167
by the Board in writing; and 1
(2) Waived any claim of privilege as to the testimony or examination 2
reports. 3
(c) The unreasonable failure or refusal of the licensed physician assistant or 4
applicant to submit to an examination is prima facie evidence of the licensed physician 5
assistant’s inability to [perform delegated medical acts] PRACTICE AS A PHYSIC IAN 6
ASSISTANT and is cause for denial of the application or immediate suspension of the 7
license. 8
(d) The Board shall pay the costs of any examination made under this section. 9
[15–313. 10
(a) (1) Except as otherwise provided under § 10–226 of the State Government 11
Article, before the Board takes any action to reject or modify a delegation agreement or 12
advanced duty, the Board shall give the licensee the opportunity for a hearing before the 13
Board. 14
(2) The Board shall give notice and hold the hearing under Title 10, 15
Subtitle 2 of the State Government Article. 16
(3) The Board may administer oaths in connection with any proceeding 17
under this section. 18
(4) At least 14 days before the hearing, the hearing notice shall be sent to 19
the last known address of the applicant or licensee. 20
(b) Any licensee aggrieved under this subtitle by a final decision of the Board 21
rejecting or modifying a delegation agreement or advanced duty may petition for judicial 22
review as allowed by the Administrative Procedure Act.] 23
15–314. 24
(a) Subject to the hearing provisions of § 15–315 of this subtitle, a disciplinary 25
panel, on the affirmative vote of a majority of the quorum, may reprimand any physician 26
assistant, place any physician assistant on probation, or suspend or revoke a license if the 27
physician assistant: 28
(41) Performs [delegated] medical acts beyond the scope of the [delegation] 29
COLLABORATION agreement filed with the Board [or after notification from the Board 30
that an advanced duty has been disapproved]; 31
[(42) Performs delegated medical acts without the supervision of a 32
physician;] 33 SENATE BILL 167 29
(42) PRACTICES AS A PHYSIC IAN ASSISTANT WITHOU T FIRST 1
SUBMITTING A COLLABO RATION AGREEMENT TO THE BOARD; 2
15–317. 3
(a) A physician assistant WHO IS LICENSED in this State or in any other state 4
OR WHO IS AN EMPLOYE E OF THE FEDERAL GOV ERNMENT is authorized to perform 5
acts, tasks, or functions as a physician assistant [under the supervision of a physician 6
licensed to practice medicine in the State] during a disaster as defined by the Governor, 7
within a county in which a state of disaster has been declared, or counties contiguous to a 8
county in which a state of disaster has been declared. 9
(b) The physician assistant shall notify the Board in writing of the names, 10
practice locations, and telephone numbers for the physician assistant [and each primary 11
supervising physician] within 30 days [of] AFTER the first performance of medical acts, 12
tasks, or functions as a physician assistant during the disaster. 13
(c) A team of physicians and physician assistants or physician assistants 14
practicing under this section may not be required to maintain on–site documentation 15
describing [supervisory arrangements] COLLABORATION AGREEMENTS as otherwise 16
required under this title. 17
15–401. 18
[(a)] Except as otherwise provided in this title, a person may not practice, attempt 19
to practice, or offer to practice as a physician assistant in the State unless the person has 20
[a]: 21
(1) A license issued by the Board TO PRACTICE AS A PHY SICIAN 22
ASSISTANT; AND 23
(2) SUBMITTED A COLLABORA TION AGREEMENT TO THE BOARD. 24
[(b) Except as otherwise provided in this title, a person may not perform, attempt 25
to perform, or offer to perform any delegated medical act beyond the scope of the license 26
and which is consistent with a delegation agreement filed with the Board.] 27
15–402.1. 28
(a) Except as otherwise provided in this subtitle, a licensed physician may not 29
employ [or supervise] an individual practicing as a physician assistant who does not have 30
a license OR WHO HAS NOT SUBMI TTED A COLLABORATION AGREEMENT TO THE 31
BOARD. 32
30 SENATE BILL 167
Article – Transportation 1
13–616. 2
(a) (1) In this subtitle the following words have the meanings indicated. 3
(7) “Licensed physician assistant” means an individual who is licensed 4
under Title 15 of the Health Occupations Article to practice [medicine with physician 5
supervision] AS A PHYSICIAN ASSIS TANT. 6
SECTION 2. AND BE IT FURTHER ENACTED, That: 7
(a) A physician assistant authorized to practice under a delegation agreement on 8
October 1, 2024, may continue to practice as a physician assistant under the delegation 9
agreement. 10
(b) The delegation agreement in effect on October 1, 2024, shall be treated the 11
same as the collaboration agreement required under § 15–302 of the Health Occupations 12
Article, as enacted by Section 1 of this Act, until an initial collaboration agreement is 13
submitted to the State Board of Physicians by the physician assistant. 14
SECTION 3. AND BE IT FU RTHER ENACTED, That this Act shall take effect 15
October 1, 2024. 16