EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*sb0167*
SENATE BILL 167
J2 4lr1212
SB 673/23 – FIN (PRE–FILED) CF HB 806
By: Senator Carozza
Requested: October 27, 2023
Introduced and read first time: January 10, 2024
Assigned to: Finance
Committee Report: Favorable with amendments
Senate action: Adopted
Read second time: March 16, 2024
CHAPTER ______
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; requiring the State Board of 9
Physicians to review and update the list of advanced duties for physician assistants; 10
and generally relating to physician assistants. 11
BY repealing and reenacting, without amendments, 12
Article – Alcoholic Beverages and Cannabis 13
Section 36–101(a) 14
Annotated Code of Maryland 15
(2016 Volume and 2023 Supplement) 16
BY repealing and reenacting, with amendments, 17
Article – Alcoholic Beverages and Cannabis 18
Section 36–101(m)(1)(v) 19
Annotated Code of Maryland 20
(2016 Volume and 2023 Supplement) 21
2 SENATE BILL 167
BY repealing and reenacting, without amendments, 1
Article – Courts and Judicial Proceedings 2
Section 3–2A–01(a) 3
Annotated Code of Maryland 4
(2020 Replacement Volume and 2023 Supplement) 5
BY repealing and reenacting, with amendments, 6
Article – Courts and Judicial Proceedings 7
Section 3–2A–01(f) 8
Annotated Code of Maryland 9
(2020 Replacement Volume and 2023 Supplement) 10
BY repealing and reenacting, with amendments, 11
Article – Education 12
Section 7–402(c) and 18–802(a)(8) 13
Annotated Code of Maryland 14
(2022 Replacement Volume and 2023 Supplement) 15
BY repealing and reenacting, without amendments, 16
Article – Education 17
Section 18–802(a)(1) 18
Annotated Code of Maryland 19
(2022 Replacement Volume and 2023 Supplement) 20
BY repealing and reenacting, without amendments, 21
Article – Health – General 22
Section 4–201(a) and 5–601(a) 23
Annotated Code of Maryland 24
(2023 Replacement Volume) 25
BY repealing and reenacting, with amendments, 26
Article – Health – General 27
Section 4–201(s) and 5–601(v) 28
Annotated Code of Maryland 29
(2023 Replacement Volume) 30
BY repealing and reenacting, with amendments, 31
Article – Health Occupations 32
Section 12–102(c)(2)(iv), (v), and (vi) 12–102(a) and (c)(2)(iv), 14–306(a), 15–101, 33
15–103, 15–202(b), 15–205(a), 15–301, 15–302, 15–302.2, 15–303, 15–306, 34
15–309(a), 15–310, 15–314(a)(41), (43), (44), and (45), 15–317, 15–401, and 35
15–402.1(a) 36
Annotated Code of Maryland 37
(2021 Replacement Volume and 2023 Supplement) 38
BY adding to 39
Article – Health Occupations 40 SENATE BILL 167 3
Section 12–102(c)(2)(vii) and 15–314(a)(42) 1
Annotated Code of Maryland 2
(2021 Replacement Volume and 2023 Supplement) 3
BY repealing and reenacting, without amendments, 4
Article – Health Occupations 5
Section 15–202(a)(1) and (2) 6
Annotated Code of Maryland 7
(2021 Replacement Volume and 2023 Supplement) 8
BY repealing 9
Article – Health Occupations 10
Section 15–302.1, 15–302.3, 15–313, and 15–314(a)(42) 11
Annotated Code of Maryland 12
(2021 Replacement Volume and 2023 Supplement) 13
BY adding to 14
Article – Health Occupations 15
Section 15–302.1, 15–309(c) and (d), and 15–314(a)(42), (43), and (44) 16
Annotated Code of Maryland 17
(2021 Replacement Volume and 2023 Supplement) 18
BY repealing and reenacting, without amendments, 19
Article – Transportation 20
Section 13–616(a)(1) 21
Annotated Code of Maryland 22
(2020 Replacement Volume and 2023 Supplement) 23
BY repealing and reenacting, with amendments, 24
Article – Transportation 25
Section 13–616(a)(7) 26
Annotated Code of Maryland 27
(2020 Replacement Volume and 2023 Supplement) 28
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 29
That the Laws of Maryland read as follows: 30
Article – Alcoholic Beverages and Cannabis 31
36–101. 32
(a) In this title the following words have the meanings indicated. 33
(m) “Certifying provider” means an individual who: 34
4 SENATE BILL 167
(1) (v) 1. has an active, unrestricted license to practice as a 1
physician assistant issued by the State Board of Physicians under Title 15 of the Health 2
Occupations Article; AND 3
2. [has an active delegation agreement with a primary 4
supervising physician COLLABORATION AGREEM ENT WITH A PATIENT C ARE TEAM 5
PHYSICIAN who is a certifying provider; and 6
3.] is in good standing with the State Board of Physicians; 7
Article – Courts and Judicial Proceedings 8
3–2A–01. 9
(a) In this subtitle the following terms have the meanings indicated unless the 10
context of their use requires otherwise. 11
(f) (1) “Health care provider” means a hospital, a related institution as defined 12
in § 19–301 of the Health – General Article, a medical day care center, a hospice care 13
program, an assisted living program, a freestanding ambulatory care facility as defined in 14
§ 19–3B–01 of the Health – General Article, a physician, A PHYSICIAN ASSISTAN T, an 15
osteopath, an optometrist, a chiropractor, a registered or licensed practical nurse, a dentist, 16
a podiatrist, a psychologist, a licensed certified social worker–clinical, and a physical 17
therapist, licensed or authorized to provide one or more health care services in Maryland. 18
(2) “Health care provider” does not include any nursing institution 19
conducted by and for those who rely upon treatment by spiritual means through prayer 20
alone in accordance with the tenets and practices of a recognized church or religious 21
denomination. 22
Article – Education 23
7–402. 24
(c) The physical examination required under subsection (b) of this section shall 25
be completed by: 26
(1) A licensed physician; 27
(2) A licensed physician assistant [with a delegation agreement approved 28
by the State Board of Physicians WHO HAS AN ACTIVE CO LLABORATION AGREEMEN T]; 29
or 30
(3) A certified nurse practitioner. 31
18–802. 32 SENATE BILL 167 5
(a) (1) In this section the following words have the meanings indicated. 1
(8) “Physician assistant” means an individual [to whom duties are 2
delegated by a licensed physician under the rules and regulations of the State Board of 3
Physicians] LICENSED UNDER TITLE 15 OF THE HEALTH OCCUPATIONS ARTICLE TO 4
PRACTICE AS A PHYSIC IAN ASSISTANT. 5
Article – Health – General 6
4–201. 7
(a) In this subtitle the following words have the meanings indicated. 8
(s) “Physician assistant” means an individual who is licensed under Title 15 of 9
the Health Occupations Article to practice [medicine with physician supervision] AS A 10
PHYSICIAN ASSISTANT . 11
5–601. 12
(a) In this subtitle the following words have the meanings indicated. 13
(v) “Physician assistant” means an individual who is licensed under Title 15 of 14
the Health Occupations Article to practice [medicine with physician supervision] AS A 15
PHYSICIAN ASSISTANT . 16
Article – Health Occupations 17
12–102. 18
(a) (1) In this section the following terms have the meanings indicated. 19
(2) “In the public interest” means the dispensing of drugs or devices by a 20
licensed dentist, physician, nurse or midwife, or podiatrist to a patient when a pharmacy 21
is not conveniently available to the patient. 22
(3) “Nurse or midwife” means an individual licensed or certified by the 23
Board of Nursing under Title 8 of this article. 24
(4) [“Personally] EXCEPT AS PROVIDED IN § 15–302.2 OF THIS 25
ARTICLE, “PERSONALLY preparing and dispensing” means that the licensed dentist, 26
physician, nurse or midwife, or podiatrist: 27
(i) Is physically present on the premises where the prescription is 28
filled; and 29
6 SENATE BILL 167
(ii) Performs a final check of the prescription before it is provided to 1
the patient. 2
(c) (2) This title does not prohibit: 3
(iv) A licensed physician who complies with the requirements of item 4
(ii) of this paragraph from personally preparing and dispensing a prescription written by: 5
1. A physician assistant [in accordance with a delegation 6
agreement that] WHO complies with Title 15, Subtitle 3 of this article; or 7
2. An advanced practice registered nurse with prescriptive 8
authority under Title 8 of this article and is working with the physician in the same office 9
setting; 10
(v) A hospital–based clinic from dispensing prescriptions to its 11
patients; [or] 12
(vi) An individual licensed or certified under Title 8 of this article 13
from personally preparing and dispensing a drug or device as authorized under Title 8 of 14
this article; OR 15
(VII) A PHYSICIAN ASSISTANT FROM PERSONALLY PREP ARING 16
AND DISPENSING A PRE SCRIPTION IN ACCORDANCE WITH § 15–302.1 OF THIS 17
ARTICLE. 18
14–306. 19
(a) [To] EXCEPT AS PROVIDED IN SUBSECTIONS (E) AND (F) OF THIS 20
SECTION, TO the extent permitted by the rules, regulations, and orders of the Board, an 21
individual to whom duties are delegated by a licensed physician OR PHYSICIAN 22
ASSISTANT may perform those duties without a license as provided in this section. 23
15–101. 24
(a) In this title the following words have the meanings indicated. 25
[(b) “Alternate supervising physician” means one or more physicians designated 26
by the primary supervising physician to provide supervision of a physician assistant in 27
accordance with the delegation agreement on file with the Board.] 28
[(c)] (B) “Ambulatory surgical facility” means a facility: 29
(1) Accredited by: 30
SENATE BILL 167 7
(i) The American Association for Accreditation of Ambulatory 1
Surgical Facilities; 2
(ii) The Accreditation Association for Ambulatory Health Care; or 3
(iii) The Joint Commission on Accreditation of Healthcare 4
Organizations; or 5
(2) Certified to participate in the Medicare program, as enacted by Title 6
XVIII of the Social Security Act. 7
[(d)] (C) “Board” means the State Board of Physicians, established under § 8
14–201 of this article. 9
(D) (1) “COLLABORATION ” MEANS THE COMMUNICAT ION AND 10
DECISION–MAKING PROCESS AMONG HEALTH CARE PROVIDER S WHO ARE MEMBERS 11
OF A PATIENT CARE TE AM RELATED TO THE TR EATMENT OF A PATIENT THAT 12
INCLUDES THE DEGREE OF COOPERATION NECESSAR Y TO PROVIDE TREATME NT 13
AND CARE TO THE PATI ENT AND INCLUDES : 14
(I) COMMUNICATION OF DATA AND INFORMATION ABOU T THE 15
TREATMENT AND CARE O F A PATIENT, INCLUDING THE EXCHAN GE OF CLINICAL 16
OBSERVATIONS AND ASS ESSMENTS; AND 17
(II) DEVELOPMENT OF AN APP ROPRIATE PLAN OF CAR E, 18
INCLUDING: 19
1. DECISIONS REGARDING T HE HEALTH CARE 20
PROVIDED; 21
2. ACCESSING AND ASSESSM ENT OF APPROPRIATE 22
ADDITIONAL RESOURCES OR EXPERTISE; AND 23
3. ARRANGEMENT OF APPROP RIATE REFERRALS , 24
TESTING, OR STUDIES. 25
(2) “COLLABORATION ” DOES NOT REQUIRE THE CONSTANT, 26
PHYSICAL PRESENCE OF A COLLABORATING PHYS ICIAN ON–SITE IN THE PRACTICE 27
SETTING, IF THE COLLABORATING PHYSICIAN IS ACCESSI BLE BY ELECTRONIC 28
MEANS. 29
(E) “COLLABORATION AGREEME NT” MEANS A DOCUMENT THA T: 30
(1) OUTLINES THE COLLABOR ATION BETWEEN A PHYS ICIAN 31
ASSISTANT AND: 32 8 SENATE BILL 167
(I) AN INDIVIDUAL PHYSICI AN; OR 1
(II) A GROUP OF PHYSICIANS ; AND 2
(2) IS DEVELOPED BY A PHY SICIAN ASSISTANT AND THE PHYSICIAN 3
OR GROUP OF PHYSICIA NS; AND 4
(3) IS SUBMITTED TO THE BOARD. 5
[(e)] (F) “Committee” means the Physician Assistant Advisory Committee. 6
[(f)] (G) “Controlled dangerous substances” has the meaning stated in § 5–101 7
of the Criminal Law Article. 8
[(g)] (H) “Correctional facility” includes a State or local correctional facility. 9
[(h) “Delegated medical acts” means activities that constitute the practice of 10
medicine delegated by a physician under Title 14 of this article. 11
(i) “Delegation agreement” means a document that is executed by a primary 12
supervising physician and a physician assistant containing the requirements of § 15–302 13
of this title. 14
(i–1)] (I) “Disciplinary panel” means a disciplinary panel of the Board 15
established under § 14–401 of this article. 16
(j) “Dispense” or “dispensing” has the meaning stated in § 12–101 of this article. 17
(k) “Drug sample” means a unit of a prescription drug that is intended to promote 18
the sale of the drug and is not intended for sale. 19
(l) “Hospital” means: 20
(1) A hospital as defined under § 19–301 of the Health – General Article; 21
(2) A comprehensive care facility that: 22
(i) Meets the requirements of a hospital–based skilled nursing 23
facility under federal law; and 24
(ii) Offers acute care in the same building; and 25
(3) An emergency room that is physically connected to a hospital or a 26
freestanding medical facility that is licensed under Title 19, Subtitle 3A of the Health – 27
General Article. 28 SENATE BILL 167 9
(m) “License” means a license issued by the Board to a physician assistant under 1
this title. 2
(n) “National certifying examination” means the Physician Assistant National 3
Certifying Examination administered by the National Commission on Certification of 4
Physician Assistants or its successor. 5
(O) “PATIENT CARE TEAM ” MEANS A MULTIDISCIPL INARY TEAM OF HEALTH 6
CARE PROVIDERS ACTIV ELY FUNCTIONING AS A UNIT IN CONSULTATION WITH THE 7
LEADERSHIP OF ONE OR MORE PATIENT CARE TEAM PHYSICIANS FOR THE PURPOSE 8
OF PROVIDING AND DEL IVERING HEALTH CARE TO A PATIENT OR GROU P OF 9
PATIENTS. 10
(P) “PATIENT CARE TEAM PHY SICIAN” MEANS A LICENSED PHY SICIAN WHO 11
REGULARLY PRACTICES IN THE STATE AND WHO PROVIDE S CONSULTATION 12
LEADERSHIP IN THE CARE OF PATIE NTS AS PART OF A PAT IENT CARE TEAM . 13
[(o)] (Q) “Physician assistant” means an individual who is licensed under this 14
title to practice [medicine with physician supervision] AS A PHYSICIAN ASSIS TANT. 15
[(p)] (R) “Practice as a physician assistant” means the performance of medical 16
acts that are: 17
[(1) Delegated by a supervising physician to a physician assistant; 18
(2) Within the supervising physician’s scope of practice; and 19
(3) Appropriate to the physician assistant’s education, training, and 20
experience] 21
(1) AUTHORIZED UNDER A LI CENSE ISSUED BY THE BOARD; AND 22
(2) AUTHORIZED UNDER THE PHYSICIAN ASSISTANT’S 23
COLLABORATION AGREEM ENT. 24
[(q)] (S) “Prescriptive authority” means the authority [delegated by a primary 25
or alternate supervising physician to] OF a physician assistant to: 26
(1) Prescribe and administer controlled dangerous substances, prescription 27
drugs, medical devices, and the oral, written, or electronic ordering of medications; and 28
(2) Dispense as provided under [§ 15–302.2(b), (c), and (d)] § 15–302.1 of 29
this title. 30
10 SENATE BILL 167
[(r) “Primary supervising physician” means a physician who: 1
(1) Completes a delegation agreement that meets the requirements under 2
§§ 15–301(d) and (e) and 15–302 of this title and files a copy with the Board; 3
(2) Acts as the physician responsible to ensure that a physician assistant 4
practices medicine in accordance with this title and the regulations adopted under this title; 5
(3) Ensures that a physician assistant practices within the scope of practice 6
of the primary supervising physician or any designated alternate supervising physician; 7
and 8
(4) Ensures that a list of alternate supervising physicians is maintained at 9
the practice setting.] 10
[(s)] (T) “Public health facility” means a site where clinical public health 11
services are rendered under the auspices of the Department, a local health department in 12
a county, or the Baltimore City Health Department. 13
[(t)] (U) “Starter dosage” means an amount of a drug sufficient to begin therapy: 14
(1) Of short duration of 72 hours or less; or 15
(2) Prior to obtaining a larger quantity of the drug to complete therapy. 16
[(u) (1) “Supervision” means the responsibility of a physician to exercise 17
on–site supervision or immediately available direction for physician assistants performing 18
delegated medical acts. 19
(2) “Supervision” includes physician oversight of and acceptance of direct 20
responsibility for the patient services and care rendered by a physician assistant, including 21
continuous availability to the physician assistant in person, through written instructions, 22
or by electronic means and by designation of one or more alternate supervising physicians.] 23
15–103. 24
(a) In this section, “alternative health care system” has the meaning stated in § 25
1–401 of this article. 26
(b) (1) Subject to paragraph (2) of this subsection, an employer of a physician 27
assistant shall report to the Board, on the form prescribed by the Board, any termination 28
of employment of the physician assistant if the cause of termination is related to a quality 29
of care issue. 30
(2) Subject to subsection (d) of this section, a [supervising physician] 31
PHYSICIAN OR GROUP O F PHYSICIANS THAT DE VELOPS A COLLABORATI ON 32 SENATE BILL 167 11
AGREEMENT WITH A PHY SICIAN ASSISTANT or an employer of a physician assistant shall 1
notify the Board within 10 days of the termination of employment of the physician assistant 2
for reasons that would be grounds for discipline under this title. 3
(3) A [supervising physician and a] PHYSICIAN OR GROUP O F 4
PHYSICIANS THAT DEVE LOPS A COLLABORATION AGREEMENT WITH A PHY SICIAN 5
ASSISTANT OR THE physician assistant shall notify the Board within 10 days of the 6
termination of the relationship under a [delegation agreement for any reason] 7
COLLABORATION AGREEM ENT. 8
(c) Except as otherwise provided under subsections (b) and (d) of this section, a 9
hospital, a related institution, an alternative health care system, or an employer of a 10
physician assistant shall report to the Board any limitation, reduction, or other change of 11
the terms of employment of the physician assistant or any termination of employment of 12
the physician assistant for any reason that might be grounds for disciplinary action under 13
§ 15–314 of this title. 14
(d) A hospital, related institution, alternative health care system, or employer 15
that has reason to know that a physician assistant has committed an action or has a 16
condition that might be grounds for reprimand or probation of the physician assistant or 17
suspension or revocation of the license of the physician assistant under § 15–314 of this 18
title because the physician assistant is alcohol– or drug–impaired is not required to report 19
to the Board if: 20
(1) The hospital, related institution, alternative health care system, or 21
employer knows that the physician assistant is: 22
(i) In an alcohol or drug treatment program that is accredited by the 23
Joint Commission on the Accreditation of Healthcare Organizations or is certified by the 24
Department; or 25
(ii) Under the care of a health care practitioner who is competent 26
and capable of dealing with alcoholism and drug abuse; 27
(2) The hospital, related institution, alternative health care system, or 28
employer is able to verify that the physician assistant remains in the treatment program 29
until discharge; and 30
(3) The action or condition of the physician assistant has not caused injury 31
to any person while the physician assistant is practicing as a licensed physician assistant. 32
(e) (1) If the physician assistant enters, or is considering entering, an alcohol 33
or drug treatment program that is accredited by the Joint Commission on Accreditation of 34
Healthcare Organizations or that is certified by the Department, the physician assistant 35
shall notify the hospital, related institution, alternative health care system, or employer of 36
the physician assistant’s decision to enter the treatment program. 37 12 SENATE BILL 167
(2) If the physician assistant fails to provide the notice required under 1
paragraph (1) of this subsection, and the hospital, related institution, alternative health 2
care system, or employer learns that the physician assistant has entered a treatment 3
program, the hospital, related institution, alternative health care system, or employer shall 4
report to the Board that the physician assistant has entered a treatment program and has 5
failed to provide the required notice. 6
(3) If the physician assistant is found to be noncompliant with the 7
treatment program’s policies and procedures while in the treatment program, the 8
treatment program shall notify the hospital, related institution, alternative health care 9
system, or employer of the physician assistant’s noncompliance. 10
(4) On receipt of the notification required under paragraph (3) of this 11
subsection, the hospital, related institution, alternative health care system, or employer of 12
the physician assistant shall report the physician assistant’s noncompliance to the Board. 13
(f) A person is not required under this section to make any report that would be 14
in violation of any federal or State law, rule, or regulation concerning the confidentiality of 15
alcohol– and drug–abuse patient records. 16
(g) The hospital, related institution, alternative health care system, or employer 17
shall submit the report within 10 days of any action described in this section. 18
(h) A report under this section is not subject to subpoena or discovery in any civil 19
action other than a proceeding arising out of a hearing and decision of the Board or a 20
disciplinary panel under this title. 21
(i) (1) A disciplinary panel may impose a civil penalty of up to $1,000 for 22
failure to report under this section. 23
(2) The Board shall pay any fees collected under this subsection into the 24
General Fund of the State. 25
(j) An employer shall make the report required under this section to the Board 26
within 5 days after the date of termination of employment. 27
(k) The Board shall adopt regulations to implement the provisions of this section. 28
15–202. 29
(a) (1) The Committee shall consist of 7 members appointed by the Board. 30
(2) Of the 7 Committee members: 31
(i) 3 shall be licensed physicians; 32
SENATE BILL 167 13
(ii) 3 shall be licensed physician assistants; and 1
(iii) 1 shall be a consumer. 2
(b) Of the three physician members of the Committee, two shall [be previously or 3
currently serving as supervising physicians of a physician assistant under a 4
Board–approved delegation agreement] HAVE DEVELOPED A COL LABORATION 5
CURRENTLY SERVING AS A PATIENT CA RE TEAM PHYSICIAN UN DER A 6
COLLABORATION AGREEMENT WITH A PHY SICIAN ASSISTANT . 7
15–205. 8
(a) In addition to the powers set forth elsewhere in this title, the Committee, on 9
its initiative or on the Board’s request, may: 10
(1) Recommend to the Board regulations for carrying out the provisions of 11
this title; 12
(2) Recommend to the Board approval, modification, or disapproval of an 13
application for licensure [or a delegation agreement]; 14
(3) Report to the Board any conduct of a [supervising physician] 15
PHYSICIAN OR GROUP OF PHY SICIANS WHO DEVELOPS A COLLA BORATION 16
AGREEMENT WITH A PHY SICIAN ASSISTANT or a physician assistant that may be cause 17
for disciplinary action under this title or under § 14–404 of this article; and 18
(4) Report to the Board any alleged unauthorized practice of a physician 19
assistant. 20
15–301. 21
(a) [Nothing in this] THIS title may NOT be construed to authorize a physician 22
assistant to practice [independent of a primary or alternate supervising physician] 23
INDEPENDENTLY . 24
(b) A license issued to a physician assistant shall limit the physician assistant’s 25
scope of practice to medical acts: 26
[(1) Delegated by the primary or alternate supervising physician;] 27
[(2)] (1) Appropriate to the education, training, and experience of the 28
physician assistant; 29
[(3)] (2) Customary to the practice of the [primary or alternate 30
supervising] physician; and 31
14 SENATE BILL 167
(2) CUSTOMARY TO THE PRAC TICE OF A PATIENT CA RE TEAM 1
PHYSICIAN; AND 2
[(4)] (3) Consistent with the [delegation] COLLABORATION agreement 3
filed with the Board. 4
(3) IN A MANNER CONSISTEN T WITH THE COLLABORA TION 5
AGREEMENT . 6
(c) Patient services that may be provided by a physician assistant UNDER A 7
COLLABORATION AGREEM ENT include: 8
[(1) (i) Taking complete, detailed, and accurate patient histories; and 9
(ii) Reviewing patient records to develop comprehensive medical 10
status reports; 11
(2) Performing physical examinations and recording all pertinent patient 12
data; 13
(3) Interpreting and evaluating patient data as authorized by the primary 14
or alternate supervising physician for the purpose of determining management and 15
treatment of patients; 16
(4) Initiating requests for or performing diagnostic procedures as indicated 17
by pertinent data and as authorized by the supervising physician; 18
(5) Providing instructions and guidance regarding medical care matters to 19
patients; 20
(6) Assisting the primary or alternate supervising physician in the delivery 21
of services to patients who require medical care in the home and in health care institutions, 22
including: 23
(i) Recording patient progress notes; 24
(ii) Issuing diagnostic orders; and 25
(iii) Transcribing or executing specific orders at the direction of the 26
primary or alternate supervising physician; and 27
(7) Exercising prescriptive authority under a delegation agreement and in 28
accordance with § 15–302.2 of this subtitle.] 29
(1) OBTAINING COMPREHENSI VE HEALTH HISTORIES ; 30
SENATE BILL 167 15
(2) PERFORMING PHYSICAL E XAMINATIONS ; 1
(3) EVALUATING, DIAGNOSING, MANAGING, AND PROVIDING 2
MEDICAL TREAT MENT; 3
(4) ORDERING, PERFORMING , AND INTERPRETING DIA GNOSTIC 4
STUDIES, THERAPEUTIC PROCEDUR ES, AND LABORATORY TESTS ; 5
(5) ORDERING DIAGNOSTIC T ESTS AND USING THE F INDINGS OR 6
RESULTS IN THE CARE OF PATIENTS; 7
(4) INTERPRETING AND EVAL UATING PATIENT DATA AS AUTHORIZED 8
BY A PATIENT CARE TE AM PHYSICIAN FOR THE PURPOSE OF DETERMINI NG 9
MANAGEMENT AND TREAT MENT OF PATIENTS ; 10
(5) INITIATING REQUESTS F OR OR PERFORMING DIA GNOSTIC 11
PROCEDURES AS INDICA TED BY PERTINENT DAT A AND AS AUTHORIZED BY A 12
PATIENT CARE TEAM PH YSICIAN; 13
(6) EXERCISING PRESCRIPTI VE AUTHORITY IN ACCO RDANCE WITH § 14
15–302.1 15–302.2 OF THIS SUBTITLE; 15
(7) INFORMING PATIENTS ABOUT HE ALTH PROMOTION AND D ISEASE 16
PREVENTION ; 17
(8) PROVIDING CONSULTATIO NS; 18
(9) WRITING MEDICAL ORDER S; 19
(10) PROVIDING SERVICES IN HEALTH CARE FACILITI ES, INCLUDING 20
HOSPITALS, NURSING FACILITIES , ASSISTED LIVING FACI LITIES, AND HOSPICE 21
FACILITIES; 22
(11) (10) OBTAINING INFORMED CO NSENT; 23
(12) DELEGATING OR ASSIGNI NG THERAPEUTIC AND D IAGNOSTIC 24
MEASURES TO BE PERFO RMED BY LICENSED OR UNLICENSED PERSONNEL AND 25
SUPERVISING LICENSED OR UNLICENSED PERSON NEL PERFORMING THERA PEUTIC 26
AND DIAGNO STIC MEASURES ; 27
(11) DELEGATING MEDICAL AC TS TO LICENSED OR UN LICENSED 28
PERSONNEL AS AUTHORI ZED UNDER § 14–306 OF THIS ARTICLE IF T HE PHYSICIAN 29
ASSISTANT HAS AT LEA ST 7,000 HOURS OF CLINICAL PR ACTICE EXPERIENCE ; AND 30
16 SENATE BILL 167
(13) (12) CERTIFYING A PATIENT ’S HEALTH OR DISABILITY AS 1
REQUIRED BY A FEDERA L, STATE, OR LOCAL PROGRAM ; AND 2
(14) AUTHENTICATING ANY DO CUMENT THAT A PHYSIC IAN MAY 3
AUTHENTICATE THROUGH SIGNATURE, CERTIFICATION , STAMP VERIFICATION , 4
AFFIDAVIT, OR ENDORSEMENT . 5
(d) (1) Except as otherwise provided in this title, an individual shall be 6
licensed by the Board before the individual may practice as a physician assistant. 7
(2) Except as otherwise provided in this title, a physician may not 8
[supervise] ENTER INTO A COLLABO RATION COLLABORATE WITH a physician assistant 9
in the performance of [delegated] medical acts without filing NOTIFYING THE BOARD OF 10
a completed [delegation] COLLABORATION agreement with the Board. 11
(3) Except as otherwise provided in this title or in a medical emergency, a 12
physician assistant may not perform any medical act for which: 13
(i) The FOR WHICH THE individual has not been licensed; and 14
(ii) [The medical acts have not been delegated by a primary or 15
alternate supervising physician] THE INDIVIDUAL HAS NO T RECEIVED APPROPRIA TE 16
EDUCATION, TRAINING, AND EXPERIENCE 17
(II) THAT HAS NOT BEEN DEL EGATED IN A MANNER 18
CONSISTENT WITH THE COLLABORATION AGREEM ENT; 19
(III) THAT IS NOT APPROPRIA TE TO THE EDUCATION , TRAINING, 20
AND EXPERIENCE OF TH E PHYSICIAN ASSISTAN T; AND 21
(IV) THAT IS NOT CUSTOMARY TO THE PRACTICE OF A PATIENT 22
CARE TEAM PHYSICIAN LISTED ON THE COLLAB ORATION AGREEMENT . 23
[(e) A physician assistant is the agent of the primary or alternate supervising 24
physician in the performance of all practice–related activities, including the oral, written, 25
or electronic ordering of diagnostic, therapeutic, and other medical services.] 26
(E) A PHYSICIAN ASSISTANT SHALL CONSULT AND CO LLABORATE WITH O R 27
REFER AN INDIVIDUAL TO AN APPROPRIATE LI CENSED PHYSICIAN OR ANY OTHER 28
HEALTH CARE PROVIDER AS APPROPRIATE . 29
(F) A PHYSICIAN ASSISTANT WHO HAS NOT BEEN PRE VIOUSLY LICENSED BY 30
THE BOARD TO PRACTICE AS A PHYSICIAN ASSISTAN T OR LICENSED, CERTIFIED, OR 31
REGISTERED AS A PHYS ICIAN ASSISTANT BY A NOTHER STATE REGULAT ORY 32
AUTHORITY SHALL BE M ENTORED BY A LICENSE D PHYSICIAN OR PHYSI CIANS WHO 33 SENATE BILL 167 17
ARE IDENTIFIED IN AN INITIAL COLLABORATIO N AGREEMENT TO CONSU LT AND 1
COLLABORATE WITH THE PHYSICIAN ASSISTANT FOR AT LEAST 18 MONTHS AFTER 2
THE DATE AN INITIAL COLLABORATION AGREEM ENT IS SUBMITTED TO THE BOARD. 3
[(f)] (G) Except as OTHERWISE provided in [subsection (g) of this section] THIS 4
TITLE, the following individuals may practice as a physician assistant without a license: 5
(1) A physician assistant student enrolled in a physician assistant 6
educational program that is accredited by the Accreditation Review Commission on 7
Education for the Physician Assistant or its successor and approved by the Board; or 8
(2) A physician assistant employed in the service of the federal government 9
while performing duties incident to that employment. 10
[(g) A physician may not delegate prescriptive authority to a physician assistant 11
student in a training program that is accredited by the Accreditation Review Commission 12
on Education for the Physician Assistant or its successor.] 13
(h) (G) (1) If a medical act that is to be [delegated] PERFORMED BY A 14
PHYSICIAN ASSISTANT under this section is a part of the practice of a health occupation 15
that is regulated under this article by another board, any rule or regulation concerning that 16
medical act shall be adopted jointly by the State Board of Physicians and the board that 17
regulates the other health occupation. 18
(2) If the two boards cannot agree on a proposed rule or regulation, the 19
proposal shall be submitted to the Secretary for a final decision. 20
15–302. 21
(a) A physician [may delegate medical acts to a physician assistant only after: 22
(1) A delegation agreement has been executed and filed with the Board; 23
and 24
(2) Any advanced duties have been authorized as required under 25
subsection (c) of this section] ASSISTANT MAY PRACTI CE AS A PHYSICIAN AS SISTANT 26
ONLY AFTER SUBMITTING A COLLABO RATION AGREEMENT TO THE BOARD 27
PROVIDING NOTICE TO THE BOARD, IN A MANNER APPROVED BY THE BOARD, OF: 28
(1) THE EXECUTED COLLABOR ATION AGREEMENT ; AND 29
(2) EACH PATIENT CARE TEA M PHYSICIAN LISTED O N THE 30
COLLABORATION AGREEM ENT. 31
18 SENATE BILL 167
(b) (1) [The delegation agreement] SUBJECT TO PARAGRAPH (2) OF THIS 1
SUBSECTION, A A COLLABORATION AGREEM ENT shall contain: 2
[(1)] (I) A description of the qualifications of the [primary supervising 3
physician and] PHYSICIAN ASSISTANT AND THE PHYSICIAN OR GROUP O F PHYSICIANS 4
WHO DEVELOPED THE CO LLABORATION AGREEMEN T WITH THE physician assistant; 5
(II) ANY PRACTICE SPECIALT Y OF THE PHYSICIAN O R GROUP OF 6
PHYSICIANS; AND 7
[(2)] (III) A description of the settings in which the physician assistant will 8
practice[; 9
(3) A description of the continuous physician supervision mechanisms that 10
are reasonable and appropriate to the practice setting; 11
(4) A description of the delegated medical acts that are within the primary 12
or alternate supervising physician’s scope of practice and require specialized education or 13
training that is consistent with accepted medical practice; 14
(5) An attestation that all medical acts to be delegated to the physician 15
assistant are within the scope of practice of the primary or alternate supervising physician 16
and appropriate to the physician assistant’s education, training, and level of competence; 17
(6) An attestation of continuous supervision of the physician assistant by 18
the primary supervising physician through the mechanisms described in the delegation 19
agreement; 20
(7) An attestation by the primary supervising physician of the physician’s 21
acceptance of responsibility for any care given by the physician assistant; 22
(8) A description prepared by the primary supervising physician of the 23
process by which the physician assistant’s practice is reviewed appropriate to the practice 24
setting and consistent with current standards of acceptable medical practice; 25
(9) An attestation by the primary supervising physician that the physician 26
will respond in a timely manner when contacted by the physician assistant; 27
(10) The following statement: “The primary supervising physician and the 28
physician assistant attest that: 29
(i) They will establish a plan for the types of cases that require a 30
physician plan of care or require that the patient initially or periodically be seen by the 31
supervising physician; and 32
SENATE BILL 167 19
(ii) The patient will be provided access to the supervising physician 1
on request”; and 2
(11) Any other information deemed necessary by the Board to carry out the 3
provisions of this subtitle]. 4
(2) IF A PHYSICIAN ASSISTANT WHO SUBMITS AN INITI AL 5
COLLABORATION AGREEM ENT TO THE BOARD HAS NOT BEEN PR EVIOUSLY 6
LICENSED BY THE BOARD TO PRACTICE AS A PHYSICIAN ASSISTAN T OR LICENSED, 7
CERTIFIED, OR REGISTERED AS A P HYSICIAN ASSISTANT B Y ANOTHER STATE 8
REGULATORY AU THORITY, THE INITIAL COLLABOR ATION AGREEMENT SHAL L 9
IDENTIFY A LICENSED PHYSICIAN OR PHYSICI ANS WHO WILL CONSULT AND 10
COLLABORATE WITH THE PHYSICIAN ASSISTANT FOR AT LEAST 18 MONTHS AFTER 11
THE DATE THE INITIAL COLLABORATION AGREEM ENT IS SUBMITTED TO THE BOARD. 12
(3) (2) A COLLABORATION AGREEM ENT MAY INCLUDE PROV ISIONS 13
LIMITING THE PHYSICI AN ASSISTANT’S SCOPE OF PRACTICE , SPECIFYING OFFICE 14
PROCEDURES , OR OTHERWISE DETAILI NG THE PRACTICE OF T HE PHYSICIAN 15
ASSISTANT AS AGREED BY THE PHYSICIAN OR GROUP OF PHYSICI ANS AND THE 16
PHYSICIAN ASSISTANT . 17
(c) (1) The Board may not require [prior] approval of a [delegation agreement 18
that includes advanced duties, if an advanced duty will be performed in a hospital or 19
ambulatory surgical facility, provided that: 20
(i) A physician, with credentials that have been reviewed by the 21
hospital or ambulatory surgical facility as a condition of employment, as an independent 22
contractor, or as a member of the medical staff, supervises the physician assistant; 23
(ii) The physician assistant has credentials that have been reviewed 24
by the hospital or ambulatory surgical facility as a condition of employment, as an 25
independent contractor, or as a member of the medical staff; and 26
(iii) Each advanced duty to be delegated to the physician assistant is 27
reviewed and approved within a process approved by the governing body of the health care 28
facility before the physician assistant performs the advanced duties] COLLABORATION 29
AGREEMENT . 30
[(2) (i) In any setting that does not meet the requirements of paragraph 31
(1) of this subsection, a primary supervising physician shall obtain the Board’s approval of 32
a delegation agreement that includes advanced duties, before the physician assistant 33
performs the advanced duties. 34
(ii) 1. Before a physician assistant may perform X–ray duties 35
authorized under § 14–306(e) of this article in the medical office of the physician delegating 36 20 SENATE BILL 167
the duties, a primary supervising physician shall obtain the Board’s approval of a 1
delegation agreement that includes advanced duties in accordance with subsubparagraph 2
2 of this subparagraph. 3
2. The advanced duties set forth in a delegation agreement 4
under this subparagraph shall be limited to nonfluoroscopic X–ray procedures of the 5
extremities, anterior–posterior and lateral, not including the head.] 6
[(3)] (2) [Notwithstanding paragraph (1) of this subsection, a primary 7
supervising physician shall obtain the Board’s approval of a delegation agreement before] 8
A PHYSICIAN ASSISTANT SHALL SUBMIT TO THE BOARD A COLLABORATION 9
AGREEMENT THAT CONTA INS ANESTHESIA DUTIE S BEFORE the physician assistant 10
may administer, monitor, or maintain general anesthesia or neuroaxial anesthesia, 11
including spinal and epidural techniques, under the agreement. 12
[(d) For a delegation agreement containing advanced duties that require Board 13
approval, the Committee shall review the delegation agreement and recommend to the 14
Board that the delegation agreement be approved, rejected, or modified to ensure 15
conformance with the requirements of this title. 16
(e) The Committee may conduct a personal interview of the primary supervising 17
physician and the physician assistant. 18
(f) (1) On review of the Committee’s recommendation regarding a primary 19
supervising physician’s request to delegate advanced duties as described in a delegation 20
agreement, the Board: 21
(i) May approve the delegation agreement; or 22
(ii) 1. If the physician assistant does not meet the applicable 23
education, training, and experience requirements to perform the specified delegated acts, 24
may modify or disapprove the delegation agreement; and 25
2. If the Board takes an action under item 1 of this item: 26
A. Shall notify the primary supervising physician and the 27
physician assistant in writing of the particular elements of the proposed delegation 28
agreement that were the cause for the modification or disapproval; and 29
B. May not restrict the submission of an amendment to the 30
delegation agreement. 31
(2) To the extent practicable, the Board shall approve a delegation 32
agreement or take other action authorized under this subsection within 90 days after 33
receiving a completed delegation agreement including any information from the physician 34
assistant and primary supervising physician necessary to approve or take action.] 35 SENATE BILL 167 21
[(g)] (D) If the Board determines that a [primary or alternate supervising 1
physician] PHYSICIAN OR GROUP O F PHYSICIANS THAT DE VELOPS A 2
COLLABORATION AGREEM ENT WITH A PHYSICIAN ASSISTANT or A physician assistant 3
is practicing in a manner inconsistent with the requirements of this title or Title 14 of this 4
article, the Board on its own initiative or on the recommendation of the Committee may 5
demand modification of the practice[, withdraw the approval of the delegation agreement,] 6
or refer the matter to a disciplinary panel for the purpose of taking other disciplinary action 7
under § 14–404 OF THIS ARTICLE or § 15–314 of this [article] SUBTITLE. 8
[(h)] (E) [A primary supervising physician may not delegate medical acts under 9
a delegation agreement to more than four physician assistants at any one time, except in 10
a] A PHYSICIAN OR GROUP O F PHYSICIANS MAY NOT ENTER INTO A COLLABO RATION 11
AGREEMENT THAT ALLOW S FOR COLLABORATION OF MORE THAN EIGHT P HYSICIAN 12
ASSISTANTS FOR EACH PHYSICIAN IN THE AGR EEMENT AT ONE TIME , EXCEPT IN A 13
hospital or in the following nonhospital settings: 14
(1) A correctional facility; 15
(2) A detention center; or 16
(3) A public health facility. 17
[(i)] (F) A person may not coerce another person to enter into a [delegation] 18
COLLABORATION agreement under this subtitle. 19
[(j) A physician may supervise a physician assistant: 20
(1) As a primary supervising physician in accordance with a delegation 21
agreement approved by the Board under this subtitle; or 22
(2) As an alternate supervising physician if: 23
(i) The alternate supervising physician supervises in accordance 24
with a delegation agreement filed with the Board; 25
(ii) The alternate supervising physician supervises no more than 26
four physician assistants at any one time, except in a hospital, correctional facility, 27
detention center, or public health facility; 28
(iii) The alternate supervising physician’s period of supervision, in 29
the temporary absence of the primary supervising physician, does not exceed: 30
1. The period of time specified in the delegation agreement; 31
and 32
22 SENATE BILL 167
2. A period of 45 consecutive days at any one time; and 1
(iv) The physician assistant performs only those medical acts that: 2
1. Have been delegated under the delegation agreement filed 3
with the Board; and 4
2. Are within the scope of practice of the primary supervising 5
physician and alternate supervising physician.] 6
[(k)] (G) Subject to the notice required under § 15–103 of this title, a physician 7
assistant may terminate a [delegation agreement filed with the Board under] 8
COLLABORATION AGREEM ENT DEVELOPED IN ACC ORDANCE WITH this subtitle at any 9
time. 10
[(l)] (H) (1) In the event of the sudden departure, incapacity, or death of [the 11
primary supervising physician of a physician assistant] A PATIENT CARE TEAM 12
PHYSICIAN, or change in license status that results in [the primary supervising physician] 13
A PATIENT CARE TEAM PHYSICIAN being unable to legally practice medicine, [an 14
alternate supervising physician designated under subsection (b) of this section may 15
supervise the physician assistant for not longer than 15 days following the event] THE 16
COLLABORATION AGREEM ENT SHALL REMAIN ACT IVE AND VALID UNDER THE 17
SUPERVISION OF THE R EMAINING LISTED PATI ENT CARE TEAM PHYSIC IANS. 18
(2) If there is no [designated alternate supervising physician] REMAINING 19
PATIENT CARE TEAM PH YSICIAN LISTED ON TH E COLLABORATION AGRE EMENT or 20
the [designated alternate supervising physician] REMAINING PATIENT CA RE TEAM 21
PHYSICIAN does not agree to supervise the physician assistant, the physician assistant 22
may not practice until the physician assistant receives approval of a new [delegation] 23
COLLABORATION agreement under [§ 15–302.1 of] this subtitle. 24
[(3) An alternate supervising physician or other licensed physician may 25
assume the role of primary supervising physician by submitting a new delegation 26
agreement to the Board for approval under subsection (b) of this section. 27
(4) The Board may terminate a delegation agreement if: 28
(i) The physician assistant has a change in license status that 29
results in the physician assistant being unable to legally practice as a physician assistant; 30
(ii) At least 15 days have elapsed since an event listed under 31
paragraph (1) of this subsection if there is an alternate supervising physician designated 32
under subsection (b) of this section; or 33
SENATE BILL 167 23
(iii) Immediately after an event listed under paragraph (1) of this 1
subsection if there is no alternate supervising physician designated under subsection (b) of 2
this section.] 3
(I) THE BOARD SHALL NOTIFY TH E PHYSICIAN ASSISTAN T AND PHYSICIAN 4
OR GROUP OF PHYSICIA NS WHO HAVE ENTERED INTO A COLLABORATION 5
AGREEMENT WITH A PHY SICIAN ASSISTANT IMM EDIATELY IF: 6
(1) THE PHYSICIAN ASSISTA NT HAS A CHANGE IN LICENSE 7
STATUS THAT RESULTS IN THE PHYSICIAN ASS ISTANT BEING UNABLE TO LEGALLY 8
PRACTICE AS A PHYSIC IAN ASSISTANT; OR 9
(2) AN EVENT DESCRIBED IN SUBSECTION (H) OF THIS SECTION 10
OCCURS. 11
[(m)] (J) A physician assistant whose [delegation] COLLABORATION agreement 12
is terminated may not practice as a physician assistant until the physician assistant 13
[receives preliminary approval of a new delegation agreement under § 15–302.1 of this 14
subtitle] SUBMITS A NEW COLLAB ORATION AGREEMENT TO THE BOARD. 15
[(n) Individual members of the Board are not civilly liable for actions regarding 16
the approval, modification, or disapproval of a delegation agreement described in this 17
section. 18
(o) A physician assistant may practice in accordance with a delegation agreement 19
filed with the Board under this subtitle.] 20
(C) IF THE BOARD DETERMINES THAT A PATIENT CARE TEAM PHYSICIAN OR 21
PHYSICIAN ASSISTANT IS PRACTICING IN A M ANNER INCONSISTENT W ITH THE 22
REQUIREMENTS OF THIS TITLE OR TITLE 14 OF THIS ARTICLE, THE BOARD ON ITS 23
OWN INITIATIVE OR ON THE RECO MMENDATION OF THE COMMITTEE MAY DEMAND 24
MODIFICATION OF THE PRACTICE, WITHDRAW THE APPROVA L OF AN ADVANCED 25
DUTY REGARDLESS OF W HETHER THE ADVANCED DUTY REQUIRES PRIOR APPROVAL 26
UNDER THIS SECTION , OR REFER THE MATTER TO A DISCIPLINARY PA NEL FOR THE 27
PURPOSE OF TAKING OT HER DISCIPLINARY ACT ION UNDER § 14–404 OF THIS 28
ARTICLE OR § 15–314 OF THIS SUBTITLE. 29
(D) (1) EXCEPT AS PROVIDED UN DER PARAGRAPH (2) OF THIS 30
SUBSECTION, A PATIENT CARE TEAM PHYSICIAN MAY NOT DE LEGATE MEDICAL ACTS 31
UNDER A CO LLABORATION AGREEMEN T TO MORE THAN EIGHT PHYSICIAN 32
ASSISTANTS AT ANY ON E TIME. 33
24 SENATE BILL 167
(2) A PATIENT CARE TEAM PH YSICIAN MAY DELEGATE MEDICAL ACTS 1
UNDER A COLLABORATIO N AGREEMENT TO MORE THAN EIGHT PHYSICIAN 2
ASSISTANTS IN: 3
(I) A HOSPITAL; 4
(II) A CORRECTIONAL FACILITY ; 5
(III) A DETENTION CENTER ; OR 6
(IV) A PUBLIC HEALTH FACILI TY. 7
(E) A PERSON MAY NOT COERC E ANOTHER PERSON TO ENTER INTO A 8
COLLABORATION AGREEM ENT UNDER THIS SUBTI TLE. 9
(F) SUBJECT TO THE NOTICE REQUIRED UNDER § 15–103 OF THIS TITLE, A 10
PHYSICIAN ASSISTANT MAY TERMINATE A COLL ABORATION AGREEMENT UNDER 11
THIS SUBTITLE AT ANY TIME. 12
(G) (1) IN THE EVENT OF A SUD DEN DEPARTURE , INCAPACITY, OR DEATH 13
OF A PATIENT CARE TE AM PHYSICIAN, OR CHANGE IN LICENSE STATUS THAT 14
RESULTS IN A PATIENT CARE TEAM PHYSICIAN BEING UNABLE TO LEGA LLY 15
PRACTICE MEDICINE , THE COLLABORATION AG REEMENT WILL REMAIN ACTIVE AND 16
VALID UNDER THE SUPE RVISION OF ANY REMAI NING LISTED PATIENT CARE TEAM 17
PHYSICIANS. 18
(2) IF THERE IS NO REMAIN ING PATIENT CARE TEA M PHYSICIAN 19
LISTED ON THE COLLAB ORATION AGREEMENT , THE PHYSICIAN ASSIST ANT MAY NOT 20
PRACTICE UNTIL THE P HYSICIAN ASSISTANT H AS EXECUTED A NEW 21
COLLABORATION AGREEM ENT AND, IF APPLICABLE , HAS BOARD APPROVAL TO 22
PERFORM ANY ADVANCED DUTIES DELEGATED TO THE PHYSICIAN ASSIST ANT 23
UNDER THE NEW COLLAB ORATION AGREEMENT . 24
(3) THE BOARD MAY TERMINATE A COLLABORATION AGREEM ENT IF: 25
(I) THE PHYSICIAN ASSISTA NT HAS A CHANGE IN L ICENSE 26
STATUS THAT RESULTS IN THE PHYSICIAN ASSISTANT BE ING UNABLE TO LEGALL Y 27
PRACTICE AS A PHYSIC IAN ASSISTANT; OR 28
(II) IMMEDIATELY AFTER AN EVENT LISTED UNDER 29
PARAGRAPH (1) OF THIS SUBSECTION I F THERE IS NO REMAIN ING PATIENT CARE 30
TEAM PHYSICIAN LISTE D IN THE COLLABORATI ON AGREEMENT . 31
SENATE BILL 167 25
(H) A PHYSICIAN ASSISTANT WHOSE COLLABORATION AGREEMENT IS 1
TERMINATED MAY NOT P RACTICE AS A PHYSICI AN ASSISTANT UNTIL T HE PHYSICIAN 2
ASSISTANT EXECUTES A NEW COLLABORATION AG REEMENT UNDER THIS S ECTION. 3
(I) A PHYSICIAN ASSISTANT MAY PRACTICE IN ACCO RDANCE WITH A 4
COLLABORATION AGREEM ENT UNDER THIS SUBTI TLE. 5
(J) A PATIENT CARE TEAM PH YSICIAN MAY BE ADDED OR REMOVED FROM 6
A COLLABORATION AGRE EMENT BY PROVIDING N OTIFICATION TO THE BOARD. 7
(K) THE BOARD MAY MODIFY A CO LLABORATION AGREEMEN T IF IT FINDS 8
THAT: 9
(1) THE COLLABORATION AGR EEMENT DOES NOT MEET THE 10
REQUIREMENTS OF THIS SUBTITLE; OR 11
(2) THE PHYSICIAN ASSISTA NT IS UNABLE TO PERF ORM THE 12
DELEGATED DUTIES SAF ELY. 13
(L) A COLLABORATION AGREEM ENT SHALL BE MAINTAI NED AT THE 14
PRACTICE SETTING AND MADE AVAILABLE TO TH E BOARD ON REQUEST . 15
(M) A LICENSED PHYSICIAN A SSISTANT WHO FAILS T O COMPLY WITH THE 16
COLLABORATION AGREEM ENT REQUIREMENTS IS SUBJECT TO AN ADMINI STRATIVE 17
PENALTY AS ESTABLISHED IN REGULATIONS . 18
[15–302.1. 19
(a) If a delegation agreement does not include advanced duties or the advanced 20
duties have been approved under § 15–302(c)(1) of this subtitle, a physician assistant may 21
assume the duties under a delegation agreement on the date that the Board acknowledges 22
receipt of the completed delegation agreement. 23
(b) In this section, “pending” means that a delegation agreement that includes 24
delegation of advanced duties in a setting that does not meet the requirements under § 25
15–302(c)(1) of this subtitle has been executed and submitted to the Board for its approval, 26
but: 27
(1) The Committee has not made a recommendation to the Board; or 28
(2) The Board has not made a final decision regarding the delegation 29
agreement. 30
26 SENATE BILL 167
(c) Subject to subsection (d) of this section, if a delegation agreement is pending, 1
on receipt of a temporary practice letter from the staff of the Board, a physician assistant 2
may perform the advanced duty if: 3
(1) The primary supervising physician has been previously approved to 4
supervise one or more physician assistants in the performance of the advanced duty; and 5
(2) The physician assistant has been previously approved by the Board to 6
perform the advanced duty. 7
(d) If the Committee recommends a denial of the pending delegation agreement 8
or the Board denies the pending delegation agreement, on notice to the primary supervising 9
physician and the physician assistant, the physician assistant may no longer perform the 10
advanced duty that has not received the approval of the Board. 11
(e) The Board may disapprove any delegation agreement if it believes that: 12
(1) The agreement does not meet the requirements of this subtitle; or 13
(2) The physician assistant is unable to perform safely the delegated 14
duties. 15
(f) If the Board disapproves a delegation agreement or the delegation of any 16
function under an agreement, the Board shall provide the primary supervising physician 17
and the physician assistant with written notice of the disapproval. 18
(g) A physician assistant who receives notice that the Board has disapproved a 19
delegation agreement or an advanced function under the delegation agreement shall 20
immediately cease to practice under the agreement or to perform the disapproved function.] 21
15–302.1. 22
(A) IN THIS SECTION, “EXEMPT FACILITY ” MEANS: 23
(1) A HOSPITAL; 24
(2) AN AMBULATORY SURGICA L FACILITY; 25
(3) A FEDERALLY QUALIFIED HEALTH CENTER ; OR 26
(4) ANOTHER PRACTICE SETT ING LISTED ON A HOSP ITAL 27
DELINEATION OF PRIVI LEGES DOCUMENT . 28
(B) EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS SECTION , A 29
PHYSICIAN ASSISTANT MAY PERFORM ADVANCED DUTIES WITHOUT BOARD 30 SENATE BILL 167 27
APPROVAL IF THE ADVA NCED DUTY WILL BE PE RFORMED IN AN EXEMPT FACILITY 1
AND: 2
(1) THE PHYSICIAN ASSISTA NT IS SUPERVISED BY A PHYSICIAN WI TH 3
CREDENTIALS THAT HAV E BEEN REVIEWED BY T HE EXEMPT FACILITY A S A 4
CONDITION OF EMPLOYM ENT AS AN INDEPENDEN T CONTRACTOR OR AS A MEMBER 5
OF THE MEDICAL STAFF ; 6
(2) THE PHYSICIAN ASSISTA NT HAS CREDENTIALS T HAT HAVE BEEN 7
REVIEWED BY THE EXEM PT FACILITY AS A CONDITION OF EMPLOYM ENT AS AN 8
INDEPENDENT CONTRACT OR OR AS A MEMBER OF THE MEDICAL STAFF ; AND 9
(3) THE ADVANCED DUTY TO BE DELEGATED TO THE PHYSICIAN 10
ASSISTANT IS REVIEWE D AND APPROVED IN A PROCESS APPROVED BY THE EXEMPT 11
FACILITY BEFORE THE PHYSICIAN ASSISTANT PERFORMS THE ADVANCED DUTY . 12
(C) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION A ND 13
SUBSECTION (D) OF THIS SECTION AND EXCEPT AS PROVIDED I N SUBSECTION (E) OF 14
THIS SECTION, A PHYSICIAN ASSISTAN T MAY PERFORM ADVANC ED DUTIES IN A 15
PRACTICE SETTING THAT IS NOT AN EXEMP T FACILITY ONLY AFTE R THE PHYSICIAN 16
ASSISTANT OBTAINS BOARD APPROVAL OF THE ADVANCED DUTY UNDER THE 17
COLLABORATION AGREEM ENT. 18
(2) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH , A 19
PHYSICIAN ASSISTANT MAY PERFORM X–RAY DUTIES AUTH ORIZED UNDER § 20
14–306(E) OF THIS ARTICLE IN T HE MEDICAL OFFICE OF A PATIENT CARE TEAM 21
PHYSICIAN ONLY AFTER THE PHYSICIAN ASSIST ANT OBTAINS BOARD APPROVAL OF 22
THE X–RAY DUTY UNDER THE C OLLABORATION AGREEME NT. 23
(II) A COLLABORATION AGREEM ENT MAY AUTHORIZE THE 24
DELEGATION OF X–RAY DUTIES LIMITED T O NONFLUOROSCOPIC X–RAY 25
PROCEDURES OF THE EX TREMITIES, ANTERIOR–POSTERIOR AND LATERA L, NOT 26
INCLUDING THE HEAD . 27
(D) A PHYSICIAN ASSISTANT MAY NOT PERFORM THE MEDICAL ACTS OF 28
ADMINISTERING GENERA L ANESTHESIA OR NEUR OAXIAL ANESTHESIA , INCLUDING 29
SPINAL, EPIDURAL, AND IMAGE GUIDED INT ERVENTIONAL SPINE PR OCEDURES. 30
(E) A PHYSICIAN ASSISTANT MAY PERFORM AN ADVAN CED DUTY IN 31
COLLABORATION WITH A PATIENT CARE TEAM PH YSICIAN WITHOUT PRIO R 32
APPROVAL OF THE BOARD IF: 33
28 SENATE BILL 167
(1) THE BOARD HAS PREVIOUSLY APPROVED THE PHYSICI AN 1
ASSISTANT TO PERFORM THE ADVANCED DUTY IN COLLABORATION WITH A PATIENT 2
CARE TEAM PHYSICIAN ; OR 3
(2) THE PHYSICIAN ASSISTANT HAS AT LEAST 7,000 HOURS OF 4
CLINICAL PRACTICE EX PERIENCE. 5
(F) IF AN ADVANCED DUTY R EQUIRES BOARD APPROVAL , THE COMMITTEE: 6
(1) SHALL REVIEW THE COLL ABORATION AGREEMENT ; 7
(2) MAY CONDUCT A PERSONA L INTERVIEW OF THE P HYSICIAN 8
ASSISTANT AND PATIENT CAR E TEAM PHYSICIANS ; AND 9
(3) MAY RECOMMEND TO THE BOARD THAT THE COLLAB ORATION 10
AGREEMENT BE MODIFIE D TO ENSURE CONFORMA NCE WITH THE REQUIRE MENTS 11
OF THIS TITLE. 12
(G) (1) ON REVIEW OF THE COMMITTEE’S RECOMMENDATIONS 13
REGARDING THE REQUE ST OF A PATIENT CARE TEAM PHYSICIAN TO DE LEGATE 14
ADVANCED DUTIES AS D ESCRIBED IN A COLLAB ORATION AGREEMENT , THE BOARD 15
MAY MODIFY THE PERFO RMANCE OF ADVANCED D UTIES UNDER A COLLAB ORATION 16
AGREEMENT IF THE PHY SICIAN ASSISTANT DOE S NOT MEET THE APPLI CABLE 17
EDUCATION, TRAINING, AND EXPERIENCE REQUI REMENTS TO PERFORM T HE 18
SPECIFIED ADVANCED D UTIES. 19
(2) IF THE BOARD MAKES A MODIFIC ATION UNDER PARAGRAP H (1) 20
OF THIS SUBSECTION , THE BOARD: 21
(I) SHALL NOTIFY EACH PAT IENT CARE TEAM PHYSI CIAN 22
LISTED IN THE COLLAB ORATION AGREEMENT AND THE PHYSICIAN ASSIST ANT IN 23
WRITING OF THE PARTI CULAR ELEMENTS OF TH E ADVANCED DUTY APPR OVAL 24
REQUEST THAT WERE TH E CAUSE FOR THE MODI FICATION; AND 25
(II) MAY NOT RESTRICT THE SUBMISSION OF AN AME NDMENT 26
TO THE ADVANCED DUTY . 27
(H) DOCUMENTATION DEMONSTRATI NG A PHYSICIAN ASSIS TANT’S 28
AUTHORITY TO PERFORM AN ADVANCED DUTY UND ER THIS SECTION SHAL L BE 29
MAINTAINED AT THE FA CILITY IN WHICH THE PHYSICIAN ASSISTANT IS PERFORMING 30
THE ADVANCED DUTY . 31
(I) INDIVIDUAL MEMBERS OF THE BOARD ARE NOT CIVI LLY LIABLE FOR 32
ACTIONS REGARDING TH E APPROVAL , MODIFICATION , OR DISAPPROVAL OF AN 33 SENATE BILL 167 29
ADVANCED DUTY UNDER THE COLLABORATION AG REEMENT DESCRIBED IN THIS 1
SECTION. 2
[15–302.2.] 15–302.1. 3
[(a) A primary supervising PATIENT CARE TEAM physician may not delegate 4
prescribing, dispensing, and administering of controlled dangerous substances, 5
prescription drugs, or medical devices unless the primary supervising physician and 6
physician assistant include in the delegation COLLABORATION agreement: 7
(1) A notice of intent to delegate prescribing and, if applicable, dispensing 8
(1) THE AUTHORITY OF THE PHYSICIAN ASSISTANT TO PRESCRIBE 9
AND, IF APPLICABLE, DISPENSE of controlled dangerous substances, prescription drugs, 10
or medical devices; 11
(2) An attestation that all prescribing and, if applicable, dispensing 12
activities of the physician assistant will comply with applicable federal and State LAW AND 13
regulations; 14
(3) An attestation that all medical charts or records will contain a notation 15
of any prescriptions written or dispensed by a physician assistant in accordance with this 16
section; 17
(4) An attestation that all prescriptions written or dispensed under this 18
section will include the physician assistant’s name and the supervising PATIENT CARE 19
TEAM physician’s name, business address, and business telephone number legibly written 20
or printed; 21
(5) AN ATTESTATION THAT A LL PRESCRIPTIONS WRI TTEN UNDER 22
THIS SECTION WILL IN CLUDE THE PHYSICIAN ASSISTANT’S NAME, BUSINESS 23
ADDRESS, AND BUSINESS TELEPHONE NUMBER LEGIBLY WRITTEN OR P RINTED; 24
(5) (6) An attestation that the physician assistant has: 25
(i) Passed the physician assistant national certification exam 26
administered by the National Commission on the Certification of Physician Assistants 27
within the previous 2 years; or 28
(ii) Successfully completed 8 category 1 hours of pharmacology 29
education within the previous 2 years; and 30
(6) (7) An attestation that the physician assistant has: 31
(i) A bachelor’s degree or its equivalent; or 32
30 SENATE BILL 167
(ii) Successfully completed 2 years of work experience as a physician 1
assistant. 2
(b) (1) A primary supervising PATIENT CARE TEAM physician may not 3
delegate the prescribing or dispensing of substances that are identified as Schedule I 4
controlled dangerous substances under § 5–402 of the Criminal Law Article. 5
(2) A primary supervising PATIENT CARE TEAM physician may delegate 6
the prescribing or dispensing of substances that are identified as Schedules II through V 7
controlled dangerous substances under § 5–402 of the Criminal Law Article, including 8
legend drugs as defined under § 503(b) of the Federal Food, Drug, and Cosmetic Act. 9
(3) A primary supervising PATIENT CARE TEAM physician may not 10
delegate the prescribing or dispensing of controlled dangerous substances to a physician 11
assistant unless the physician assistant has a valid: 12
(i) State controlled dangerous substance registration; and 13
(ii) Federal Drug Enforcement Agency (DEA) registration.] 14
(A) IN THIS SECTION, “PERSONALLY PREPARE A ND DISPENSE” MEANS THAT 15
A PHYSICIAN ASSISTAN T: 16
(1) IS PHYSICALLY PRESENT ON THE PREMISES WHER E A 17
PRESCRIPTION IS FILL ED; AND 18
(2) PERFORMS A FINAL CHEC K OF THE PRESCRIPTIO N BEFORE IT IS 19
PROVIDED TO THE PATI ENT. 20
(B) SUBJECT TO THE COLLAB ORATION AGREEMENT SU BMITTED UNDER § 21
15–302 OF THIS SUBTITLE , A PHYSICIAN ASSISTAN T MAY PRESCRIBE , PROCURE, 22
DISPENSE, ORDER, OR ADMINISTER : 23
(1) SUBJECT TO SUBSECTION (C)(2) OF THIS SECTION , DRUGS AND 24
SUBSTANCES THAT ARE IDENTIFIED AS SCHEDULES II THROUGH V CONTROLLED 25
DANGEROUS SUBSTANCES UNDER §§ 5–403 THROUGH 5–406 OF THE CRIMINAL LAW 26
ARTICLE, INCLUDING LEGEND DRU GS AS DEFINED UNDER § 503(B) OF THE 27
FEDERAL FOOD, DRUG, AND COSMETIC ACT; 28
(2) MEDICAL DEVICES ; AND 29
(3) DURABLE MEDICAL EQUIP MENT. 30
SENATE BILL 167 31
(C) (1) A PHYSICIAN ASSISTANT MAY NOT PRESCRIBE OR DISPENSE 1
SUBSTANCES THAT ARE IDENTIFIED AS SCHEDULE I CONTROLLED DANGEROUS 2
SUBSTANCES UNDER § 5–402 OF THE CRIMINAL LAW ARTICLE. 3
(2) A PHYSICIAN ASSISTANT MAY NOT PRESCRIBE OR DISPENSE 4
CONTROLLED DANGEROUS SUBSTANCES UNLESS TH E PHYSICIAN ASSISTAN T HAS A 5
VALID: 6
(I) STATE CONTROLLED DANG EROUS SUBSTANCE 7
REGISTRATION ; AND 8
(II) FEDERAL DRUG ENFORCEMENT AGENCY (DEA) 9
REGISTRATION . 10
[(c)] (D) (C) (1) A PATIENT CARE TEAM PH YSICIAN MAY AUTHORIZ E A 11
physician assistant TO personally may prepare and dispense [a drug that the physician 12
assistant is authorized to prescribe under a delegation COLLABORATION agreement if]: 13
[(1) (I) Except as otherwise provided under § 12–102(g) of this article, 14
the supervising PATIENT CARE TEAM physician possesses a dispensing permit; and 15
(2) (II) The physician assistant dispenses drugs only within: 16
(i) 1. The supervising PATIENT CARE TEAM physician’s scope 17
of practice; and 18
(ii) 2. The scope of the delegation COLLABORATION 19
agreement.] 20
(2) A PATIENT CARE TEAM PH YSICIAN MAY DELEGATE ANY 21
DISPENSING DUTIES , INCLUDING THE PERFOR MANCE OF THE FINAL CHECK OF 22
PRESCRIPTIONS AS REQ UIRED UNDER § 12–102(A)(4)(II) OF THIS ARTICLE. 23
(D) IF A PATIENT CARE TEA M PHYSICIAN WHO HAS DELEGATED AUTHORITY 24
TO EXERCISE PRESCRIP TIVE AUTHORITY TO A PHYSICIAN ASSISTANT 25
SUBSEQUENTLY RESTRIC TS OR REMOVES THE DE LEGATION, THE PATIENT CARE 26
TEAM PHYSICIAN SHALL NOTIFY THE BOARD OF THE RESTRICT ION OR REMOVAL 27
WITHIN 5 BUSINESS DAYS. 28
(I) A STARTER DOSAGE OF AN Y DRUG THAT THE PHYS ICIAN 29
ASSISTANT IS AUTHORI ZED TO PRESCRIBE TO A PATIENT OF THE PHY SICIAN 30
ASSISTANT IF: 31
32 SENATE BILL 167
1. THE STARTER DOSAGE COMPL IES WITH THE 1
LABELING REQUIREMENT S OF § 12–505 OF THIS ARTICLE; 2
2. NO CHARGE IS MADE FOR THE STARTER DOSAGE ; AND 3
3. THE PHYSICIAN ASSISTA NT ENTERS AN APPROPR IATE 4
RECORD IN THE PATIEN T’S MEDICAL RECORD ; OR 5
(II) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , ANY 6
DRUG THAT A PHYSICIA N ASSISTANT MAY PRES CRIBE TO THE EXTENT AUTHORIZED 7
BY LAW IN THE COURSE OF TREATING A PATIEN T AT: 8
1. A MEDICAL FACILITY OR CLINIC THAT SPECIALI ZES IN 9
THE TREATMENT OF MED ICAL CASES REIMBURSA BLE THROUGH WORKERS ’ 10
COMPENSATION INSURAN CE; 11
2. A MEDICAL FACILITY OR CLINIC THAT IS OPERA TED 12
ON A NONPROFIT BASIS ; 13
3. A HEALTH CENTER THAT O PERATES ON A CAMPUS OF 14
AN INSTITUTION OF HI GHER EDUCATION ; 15
4. A PUBLIC HEALTH FACILI TY, A MEDICAL FACIL ITY 16
UNDER CONTRACT WITH A STATE OR LOCAL HEALTH DEPARTMENT , OR A FACILITY 17
FUNDED WITH PUBLIC F UNDS; OR 18
5. A NONPROFIT HOSPITAL O R A NONPROFIT HOSPIT AL 19
OUTPATIENT FACILITY AS AUTHORIZED UNDER THE POLICIES ESTABLI SHED BY THE 20
HOSPITAL. 21
(2) A PHYSICIAN ASSISTANT WHO PERSON ALLY PREPARES AND 22
DISPENSES A DRUG IN THE COURSE OF TREATI NG A PATIENT AS AUTH ORIZED UNDER 23
THIS SUBSECTION SHAL L: 24
(I) COMPLY WITH THE LABEL ING REQUIREMENTS OF § 12–505 25
OF THIS ARTICLE; 26
(II) RECORD THE DISPENSING OF THE PRESCRIP TION DRUG ON 27
THE PATIENT’S CHART; 28
(III) ALLOW THE OFFICE OF CONTROLLED SUBSTANCES 29
ADMINISTRATION TO ENT ER AND INSPECT THE O FFICE IN WHICH THE P HYSICIAN 30
ASSISTANT PRACTICES AT ALL REASONABLE HO URS; AND 31
SENATE BILL 167 33
(IV) EXCEPT FOR STARTER DO SAGES OR SAMPLES DIS PENSED 1
WITHOUT CHARGE , PROVIDE THE PATIENT WITH A WRITTEN PRESC RIPTION, 2
MAINTAIN PRESCRIPTIO N FILES, AND MAINTAIN A SEPAR ATE FILE FOR SCHEDULE 3
II PRESCRIPTIONS FOR A PERIOD OF AT LEAST 5 YEARS. 4
[(d)] (E) A physician assistant who personally dispenses a drug in the course of 5
treating a patient as authorized under subsections (b) and [(c)] (D) of this section shall 6
comply with the requirements under Titles 12 and 14 of this article and applicable federal 7
law and regulations. 8
[(e) Before a physician assistant may renew a license for an additional 2–year 9
term under § 15–307 of this subtitle, the physician assistant shall submit evidence to the 10
Board of successful completion of 8 category 1 hours of pharmacology education within the 11
previous 2 years.] 12
(F) A PRESCRIPTION DISPENS ED UNDER THIS SECTIO N SHALL INCLUDE 13
THE PHYSICIAN ASSIST ANT’S: 14
(1) NAME; 15
(2) BUSINESS ADDRESS ; AND 16
(3) BUSINESS TELEPHONE NU MBER. 17
(G) A PHYSICIAN ASSISTANT STUDENT IN A TRAINING PROGRAM THA T IS 18
ACCREDITED BY THE ACCREDITATION REVIEW COMMISSION ON EDUCATION FOR 19
THE PHYSICIAN ASSISTANT MAY NOT EXE RCISE PRESCRIPTIVE A UTHORITY. 20
[15–302.3. 21
(a) On a quarterly basis, the Board shall provide to the Board of Pharmacy a list 22
of physician assistants whose delegation agreements include the delegation of prescriptive 23
authority. 24
(b) The list required under subsection (a) of this section shall specify whether 25
each physician assistant has been delegated the authority to prescribe controlled dangerous 26
substances, prescription drugs, or medical devices. 27
(c) If a primary supervising physician who has delegated authority to exercise 28
prescriptive authority to a physician assistant subsequently restricts or removes the 29
delegation, the primary supervising physician shall notify the Board of the restriction or 30
removal within 5 business days.] 31
15–303. 32
34 SENATE BILL 167
(a) To qualify for a license, an applicant shall: 1
(1) Complete a criminal history records check in accordance with § 2
14–308.1 of this article; 3
(2) Be of good moral character; 4
(3) Demonstrate oral and written competency in the English language as 5
required by the Board; 6
(4) Be at least 18 years old; [and] 7
(5) [(i) Be a graduate of a physician assistant training program 8
approved by the Board; or 9
(ii) Have passed the physician assistant national certifying 10
examination administered by the National Commission on Certification of Physician 11
Assistants prior to 1986, maintained all continuing education and recertification 12
requirements, and been in continuous practice since passage of the examination] EXCEPT 13
AS PROVIDED IN SUBSE CTION (B) OF THIS SECTION , HAVE SUCCESSFULLY 14
COMPLETED AN EDUCATI ONAL PROGRAM FOR PHY SICIAN ASSISTANTS AC CREDITED 15
BY: 16
(I) THE ACCREDITATION REVIEW COMMISSION ON 17
EDUCATION FOR THE PHYSICIAN ASSISTANT; OR 18
(II) IF COMPLETED BEFORE 2001: 19
1. THE COMMITTEE ON ALLIED HEALTH EDUCATION 20
AND ACCREDITATION ; OR 21
2. THE COMMISSION ON ACCREDITATION OF ALLIED 22
HEALTH EDUCATION PROGRAMS; AND 23
(6) HAVE PASSED TH E PHYSICIAN ASSISTANT NATIONAL 24
CERTIFYING EXAMINATION ADMINISTE RED BY THE NATIONAL COMMISSION ON 25
CERTIFICATION OF PHYSICIAN ASSISTANTS. 26
[(b) Except as otherwise provided in this title, the applicant shall pass a national 27
certifying examination approved by the Board.] 28
[(c)] (B) An applicant who graduates from [a physician assistant training 29
program] AN ACCREDITED EDUCAT IONAL PROGRAM FOR PH YSICIAN ASSISTANTS 30
UNDER THIS SECTION after October 1, 2003, shall have a bachelor’s degree or its 31
equivalent. 32 SENATE BILL 167 35
15–306. 1
A license authorizes the licensee to practice as a physician assistant [under a 2
delegation agreement] while the license is effective. 3
15–309. 4
(a) Each licensee shall keep a license and [delegation] COLLABORATION 5
agreement for inspection at the primary place of business of the licensee. 6
(C) THE BOARD MAY AUDIT AND R EVIEW COLLABORATION AGREEMENTS 7
KEPT BY THE LICENSEE AT THE PRIMARY PLACE OF BUSINESS OF THE L ICENSEE AT 8
ANY TIME. 9
(D) A PHYSICIAN ASSISTANT WHO FAILS TO PRODUCE A COLL ABORATION 10
AGREEMENT TO THE BOARD ON REQUEST IS S UBJECT TO AN ADMINIS TRATIVE 11
PENALTY AS ESTABLISH ED IN REGULATIONS . 12
15–310. 13
(a) In reviewing an application for licensure or in investigating an allegation 14
brought under § 15–314 of this subtitle, the Committee may request the Board to direct, or 15
the Board on its own initiative may direct, the physician assistant to submit to an 16
appropriate examination. 17
(b) In return for the privilege given to the physician assistant to [perform 18
delegated medical acts] PRACTICE AS A PHYSIC IAN ASSISTANT in the State, the 19
physician assistant is deemed to have: 20
(1) Consented to submit to an examination under this section, if requested 21
by the Board in writing; and 22
(2) Waived any claim of privilege as to the testimony or examination 23
reports. 24
(c) The unreasonable failure or refusal of the licensed physician assistant or 25
applicant to submit to an examination is prima facie evidence of the licensed physician 26
assistant’s inability to [perform delegated medical acts] PRACTICE AS A PHYSIC IAN 27
ASSISTANT and is cause for denial of the application or immediate suspension of the 28
license. 29
(d) The Board shall pay the costs of any examination made under this section. 30
[15–313. 31
36 SENATE BILL 167
(a) (1) Except as otherwise provided under § 10–226 of the State Government 1
Article, before the Board takes any action to reject or modify a delegation agreement or 2
advanced duty, the Board shall give the licensee the opportunity for a hearing before the 3
Board. 4
(2) The Board shall give notice and hold the hearing under Title 10, 5
Subtitle 2 of the State Government Article. 6
(3) The Board may administer oaths in connection with any proceeding 7
under this section. 8
(4) At least 14 days before the hearing, the hearing notice shall be sent to 9
the last known address of the applicant or licensee. 10
(b) Any licensee aggrieved under this subtitle by a final decision of the Board 11
rejecting or modifying a delegation agreement or advanced duty may petition for judicial 12
review as allowed by the Administrative Procedure Act.] 13
15–314. 14
(a) Subject to the hearing provisions of § 15–315 of this subtitle, a disciplinary 15
panel, on the affirmative vote of a majority of the quorum, may reprimand any physician 16
assistant, place any physician assistant on probation, or suspend or revoke a license if the 17
physician assistant: 18
(41) Performs [delegated] medical acts beyond the scope of the [delegation] 19
COLLABORATION agreement filed with the Board [or after notification from the Board 20
that an advanced duty has been disapproved] IN A MANNER THAT IS NOT CONSISTENT 21
WITH THE COLLABORATI ON AGREEMENT ; 22
[(42) Performs delegated medical acts without the supervision of a 23
physician;] 24
(42) PERFORMS MEDICAL ACTS WHICH ARE OUTSIDE TH E EDUCATION, 25
TRAINING, AND EXPERIENCE OF TH E PHYSICIAN ASSISTAN T; 26
(43) PERFORMS MEDICAL ACTS THAT ARE NOT CUSTOMA RY TO THE 27
PRACTICE OF THE PATI ENT CARE TEAM PHYSIC IANS LISTED ON THE 28
COLLABORATION AGREEM ENT; 29
(42) (44) PRACTICES AS A PHYSIC IAN ASSISTANT WITHOU T FIRST 30
SUBMITTING A COLLABO RATION AGREEMENT TO THE BOARD; PROVIDING NOTICE 31
TO THE BOARD AS REQUIRED UND ER § 15–302(A) OF THIS SUBTITLE; 32
[(43)] (45) Fails to complete a criminal history records check under § 33
14–308.1 of this article; 34 SENATE BILL 167 37
[(44)] (46) Fails to comply with the requirements of the Prescription Drug 1
Monitoring Program under Title 21, Subtitle 2A of the Health – General Article; or 2
[(45)] (47) Fails to comply with any State or federal law pertaining to the 3
practice as a physician assistant. 4
15–317. 5
(a) A physician assistant WHO IS LICENSED in this State or in any other state 6
OR WHO IS AN EMPLOYE E OF THE FEDERAL GOV ERNMENT is authorized to perform 7
acts, tasks, or functions as a physician assistant [under the supervision of a physician 8
licensed to practice medicine in the State] during a disaster as defined by the Governor, 9
within a county in which a state of disaster has been declared, or counties contiguous to a 10
county in which a state of disaster has been declared. 11
(b) The physician assistant shall notify the Board in writing of the names, 12
practice locations, and telephone numbers for the physician assistant [and each primary 13
supervising physician] within 30 days [of] AFTER the first performance of medical acts, 14
tasks, or functions as a physician assistant during the disaster. 15
(c) A team of physicians and physician assistants or physician assistants 16
practicing under this section may not be required to maintain on–site documentation 17
describing [supervisory arrangements] COLLABORATION AGREEM ENTS as otherwise 18
required under this title. 19
15–401. 20
[(a)] Except as otherwise provided in this title, a person may not practice, attempt 21
to practice, or offer to practice as a physician assistant in the State unless the person has 22
[a]: 23
(1) A license issued by the Board TO PRACTICE AS A PHY SICIAN 24
ASSISTANT; AND 25
(2) SUBMITTED A COLLABORA TION AGREEMENT TO TH E BOARD. 26
(2) PROVIDED NOTICE TO TH E BOARD AS REQUIRED UND ER § 27
15–302(A) OF THIS TITLE. 28
[(b) Except as otherwise provided in this title, a person may not perform, attempt 29
to perform, or offer to perform any delegated medical act beyond the scope of the license 30
and which is consistent with a delegation agreement filed with the Board.] 31
15–402.1. 32 38 SENATE BILL 167
(a) Except as otherwise provided in this subtitle, a licensed physician may not 1
employ [or supervise] an individual practicing as a physician assistant who does not have 2
a license OR WHO HAS NOT SUBMITTED A COLLABOR ATION AGREEMENT TO T HE 3
BOARD PROVIDED NOTICE TO T HE BOARD AS REQUIRED UND ER § 15–302(A) OF 4
THIS TITLE. 5
Article – Transportation 6
13–616. 7
(a) (1) In this subtitle the following words have the meanings indicated. 8
(7) “Licensed physician assistant” means an individual who is licensed 9
under Title 15 of the Health Occupations Article to practice [medicine with physician 10
supervision] AS A PHYSICIAN ASSISTANT. 11
SECTION 2. AND BE IT FURTHER ENACTED, That: 12
(a) A physician assistant authorized to practice under a delegation agreement on 13
October 1, 2024, may continue to practice as a physician assistant under the delegation 14
agreement. 15
(b) The delegation agreement in effect on October 1, 2024, shall be treated the 16
same as the collaboration agreement required under § 15–302 of the Health Occupations 17
Article, as enacted by Section 1 of this Act, until an initial collaboration agreement is 18
submitted to the State Board of Physicians by the physician assistant the physician 19
assistant has provided notice to the State Board of Physicians as required under § 20
15–302(a) of the Health Occupations Article, as enacted under Section 1 of this Act. 21
SECTION 3. AND BE IT FURTHER ENACTED, That, on or before January 1, 2025, 22
the State Board of Physicians, with representatives from the Maryland Academy of 23
Physician Assistants, the Physician Assistant Education Association, and physician 24
assistant education programs in the State, shall review and update the list of advanced 25
duties for physician assistants. 26
SECTION 3. 4. AND BE IT FURTHER ENACTED, That this Act shall take effect 27
October 1, 2024. 28