Physician Assistants

Q1: What is the Physician Assistant Modernization Act of 2024?

A: See link a to the new law.

Q2: When does the Physician Assistant Modernization Act take effect?

A: October 1st, 2024.

Q3: What happens to my active delegation agreement with my supervising physician on October 1st, 2024?

A: All active delegation agreements will remain active and be treated the same as a collaboration agreement on October 1st, 2024, until the agreement is terminated.

Q4: What happens to my alternate supervising physicians (ASPs) on October 1st, 2024?

A: All ASPs listed on an active delegation agreement will become patient care team physicians on October 1st, 2024.

Q5: What happens to my active delegation agreement addendum for advanced duties on October 1st, 2024?

A: All board-approved advanced duties will remain valid, and the approval will be valid across additional collaboration agreements that list the physician assistant as authorized by Section 15-302.1 of the Health Occupations Article.

Q6: Will existing delegation agreements ever have to transition to Collaboration Agreements?

A: On October 1st, 2024, all delegation agreements will be treated the same as a collaboration agreement and remain active until the agreement is terminated.

Q7: Do I have to replace my active delegation agreement with a collaboration agreement by October 1st, 2024?

A: No. Physician assistants are not required to change/update their current active delegation agreements to collaboration agreements.

Q8: Is there a sample (template/format) that will be shared of the new collaboration agreement?

A: Yes, the Board has created a sample collaboration agreement for use by a Physician Assistant, which is available here.

Q9: Can I create a new delegation agreement after October 1st, 2024?

A: No. After October 1st, 2024, delegation agreements will no longer be available for submission to the Board

Q10: When will COMAR 10.32.03 (Physician Assistant Regulations) be promulgated?

A: Click here for a Non-approved draft of COMAR 10.32.03

Q11: When will MBP update its website with this information?

A: Please recheck the Board's website periodically as we will be adding additional information and answers to questions that arise on a rolling basis.

Q11: How is the transition being communicated to the Physician Assistants licensed in Maryland?

A: The Board has provided relevant information on its website and hosted a joint live recorded webinar.

Q12: How will this change the length of time it takes to get licensed?

A: The changes do not impact the initial licensure process.

Q13: Will there be a delay in the approval process of this new system that could affect our ability to practice?

A: The Physician Assistant must notify the Board of the executed collaboration agreement. No approval from the Board is required.

Q14: How will these changes impact Physician Assistants working in the federal government with MD licenses?

A: There will be no change.

Q15: Can you please explain it when you say "transitioning from a supervising physician to a patient care team physician?"

A: On October 1st, 2024, all Primary Supervising Physicians (PSPs) and Alternate Supervising Physicians (ASPs) part of an active Delegation Agreement will be treated as and called Patient Care Team Physicians.

Q1: When will COMAR 10.32.03 (Physician Assistant Regulations) be promulgated?

A: Click here for a Non-approved draft of COMAR 10.32.03.

Q2: How does the Physician Assistant Modernization Act of 2024 impact cosmetic practice under COMAR 10.32.09?

A: The Modernization Act has not changed COMAR 10.32.09.

Q1: What is a collaboration agreement?

A: A collaboration agreement is a document that is executed by one or more patient care team physicians and a physician assistant containing the requirements of Health Occupations Article, § 15-302, Annotated Code of Maryland.

Q2: What is a "patient care team"?

A: A multidisciplinary team of health care providers actively functioning as a unit with the leadership of one or more patient care team physicians for the purpose of providing and delivering health care to a patient or group of patients.

Q3: What is a "patient care team physician"?

A: A licensed physician who regularly practices in the State and who provides leadership in the care of patients as a part of a patient care team.

Q4: What are core duties?

A: Core duties are medical acts included in the standard curricula of accredited Physician Assistant education programs.

Q5: What are advanced duties?

A: Advanced duties are medical acts that require additional training beyond the basic Physician Assistant education program required for licensure. Click here for a listing of Advanced Procedures by Specialty.

Q1: Do Physician Assistants have to demonstrate competence if they change fields of practice?

A: A physician assistant may not perform any medical act for which:

1. the individual has not been licensed;
2. that has not been delegated in a manner consistent with the collaboration agreement;
3. that is not appropriate to the education, training, and experience of the physician assistant; and
4. that is not customary to the practice of a Patient Care Team Physician listed on the collaboration agreement.

Q2: Is there a scope of practice that a Physician Assistant may not practice?

A: A Physician Assistant may not practice within the scope of practice of any of the following health occupations:

1. Radiography
2. Nuclear Medicine Technology
3. Nursing
4. Optometry
5. Physical Therapy
6. Psychology
7. Radiation Therapy; or
8. Psychotherapy

Under certain circumstances, a Physician Assistant may operate a mini C-arm or similar low-level radiation machine to perform non-fluoroscopic procedures. See Health Occupations Article, §14-306e(3)(iii)B for more information.

Q1: What are the requirements for licensure?

A: The applicant shall complete an online application:

1. Be of good moral character.
2. Be at least 18 years old.
3. Pay the application fee.
4. Graduation from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or its successor.
5. Applicants who graduate from an accredited physician assistant educational program after October 1, 2003, must have a baccalaureate degree or the equivalent education to a baccalaureate degree.
6. Current certification by the National Commission on Licensure of Physician Assistants (NCCPA).
7. Demonstrate oral and written competency in English as required by the Board.
8. Meet any other requirements established by the Board.
9. Submit to a criminal history records check.

The Board may accept the Federation Credential Verification Service (FCVS) for primary source verification of a physician assistant's core credentials. For more information about the FCVS, contact them at 817-868-4000; fcvs@fsmb.org or go to their website at https://www.fsmb.org/licensure/fcvs/.

Q2: How long does it take to be licensed?

A: If a completed application is submitted, a license can take between 2 business days to 20 business days. However, it may take longer depending on the applicant's circumstances or if the individual does not provide the required documentation on a timely basis.

Processing an application for licensure is only one part of the process. In addition, all Physician Assistants and their patient care team physicians must complete and notify the Board of an executed collaboration agreement kept at the practice setting. The Physician Assistant may begin working once the Board has been notified of the executed Collaboration Agreement in a manner approved by the Board.

Q3: Do you require evidence of English proficiency as a condition for licensure?

A: An applicant may not be required to provide additional evidence of english proficiency if the applicant holds a valid, unrestricted license, certification, or registration from another state that requires evidence of english proficiency for licensure, certification, or registration.

Q4: What are the requirements for reinstatement?

1. Completion of an online reinstatement application approved by the Board.
2. Payment of a reinstatement fee.
3. Satisfactory evidence of compliance with the continuing education requirements.
4. Verification from the Maryland Office of the Comptroller that the applicant has paid all undisputed taxes and unemployment insurance contributions payable to the Comptroller or the Secretary of Labor, Licensing, and Regulation or that the applicant has provided for payment in a manner satisfactory to the unit responsible for collection. (Maryland Health Occupations Code Annotated, § 1-213).

The continuing education requirement does not apply to the first renewal after initial certification or reinstatement of certification.

Q5: What are the requirements for renewal?

1. Fifty hours (50) of Category I continuing education earned within the 2 years preceding the date of the application for renewal or reinstatement. A minimum of eight (8) must relate to pharmacology topics; OR
2. Current certification by the National Commission on Certification of Physician Assistants (NCCPA).

The Board may request a Physician Assistant to submit evidence of having met the continuing education requirements specified in this regulation. If a Physician Assistant cannot demonstrate completion of the required continuing education credit hours, the Board may impose a civil penalty of up to $100 per missing continuing education credit hour.

Q1: Can we work in multiple service lines (moonlighting in lung and renal transplant, cardiology) with only one Patient Care Team Physician or do we need additional Patient Care Team Physicians listed on the Collaboration Agreement (currently would need a delegation agreement with each physician group)?

A: A collaboration agreement must include a Physician Assistant and one or more Patient Care Team physicians. The Physician Assistants scope of practice is limited to the:

1. Appropriate education, training, and experience of the physician assistant;
2. Customary practice speciality of a patient care team physician listed on the collaboration agreement; and
3. Manner that is consistent with the collaboration agreement.

Q2: Does the collaborating physician need to be working within the organization where the Physician Assistant is employed?

A: A physician assistant shall have a separate collaboration agreement for each of the physician assistant's employers.

Q3: Does the patient care team physician need to be physically available at the practice location?

A: "Collaboration" does not require the constant, physical presence of a collaborating physician on-site in the practice setting, if the Patient Care Team Physician is accessible by electronic means.

Q4: How many Physician Assistants can a patient care team physician collaborate with at a single time (during a single shift)?

A: A patient care team physician may not delegate medical acts under a collaboration agreement to more than eight physician assistants at any one time unless in a:

1. a hospital;
2. a correctional facility;
3. a detention center; or
4. a public health facility

Q5: How many collaboration agreements can a Physician Assistant have?

A: There is no limit on the number of collaboration agreements that a Physician Assistant can have.

Q6: How many collaboration agreements can a Patient Care Team Physician have?

A: There is no limit on the number of collaboration agreements that a Patient Care Team Physician can have.

Q7: Does the Physician need to be licensed in Maryland to be listed as a Patient Care Team Physician on the collaboration agreement?

A: Yes, a collaboration agreement may only list a Maryland-licensed physician assistant and one or more Maryland-licensed physicians.

Q1: What is an Executed Collaboration Agreement?

A: An executed collaboration agreement is a completed and signed document developed by the physician assistant and one or more patient care team physicians that outlines the collaboration between the two parties as required by Health Occupations Article §15‐302. A physician assistant may practice only after executing a collaboration agreement (sample) with one or more patient care team physicians AND submitting a Notice of a Collaboration Agreement to the Board by accessing the PA's Practitioner Profile on the Board's website.

Q2: I am a new Physician Assistant ‐‐ do I need a Collaboration Agreement to practice?

A: Yes. All physician assistants, regardless of the practice setting, are required to have an executed collaboration agreement with one or more patient care team physicians to practice as a Physician Assistant. The Board must be notified of the executed Collaboration Agreement prior to a Physician Assistant practicing.

Q3: Do I need to submit my collaboration agreement to the Board?

A: No. Collaboration agreements do not need to be submitted to the Board. Collaboration Agreements shall be kept on file at the practice setting and made immediately available to the Board upon request.

Q4: Does my collaboration agreement need to be Board-Approved?

A: No. Collaboration agreements do not require board approval. However, the physician assistant is required to notify the Board of an executed Collaboration Agreement prior to practicing.

Q5: How do I notify the Board of an executed collaboration agreement?

A: A physician assistant may notify the Board of an executed collaboration agreement via the Practitioner Profile on the Board's website.

Q6: How many physicians can be on a collaboration agreement?

A: A collaboration agreement may list one or more patient care team physicians.

Q7: How many Physician Assistants can be on a collaboration agreement?

A: A collaboration agreement may only list one Physician Assistant.

Q8: Who is responsible for the development and documentation of collaborative agreements?

A: The Physician Assistant and patient care team physician(s) are responsible for the development and documentation of the collaboration agreement.

Q9: Who is responsible for creating a collaboration agreement?

A: A physician assistant should develop a collaboration agreement with their collaborating physician or group of physicians.

Q10: If I work with different physicians at two different jobs, will we need multiple collaborating agreements?

A: Yes. A collaboration agreement may only consist of one physician assistant and one or more patient care team physicians practicing at the same employer/facility.

Q11: Do we need to have a list with the signatures of all physicians working with the PA?

A: A collaboration agreement between the Physician Assistant and all listed Patient Care Team Physicians must be signed by both physicians and PAs and kept at the primary place of practice.

12: Where should the collaboration agreement between the physician assistant and patient care team physician(s) be kept?

A: The collaboration agreement should be kept at the primary place of business.

Q13: Can I keep an electronic version of the collaboration agreement between the physician assistant and patient care team physician or does it need to be a physical document kept on paper?

A: The collaboration agreement may be kept electronically and a physical document need not be kept. However, the electronic copy must be available to download and print at the primary place of business.

Q14: Are we able to write a general collaboration agreement to cover all Physician Assistant-led service lines in the hospital? For example, a Physician Assistant who covers trauma, orthopedics, and critical care needs to submit three separate agreements or can all services be covered in one agreement with appropriate signatures?

A: A Collaboration Agreement must include and list one Physician Assistant and one or more Patient Care Team Physicians. If multiple Patient Care Team Physicians are listed, the Patient Care Team Physicians may be of different practice specialties. A physician assistant may only practice within the practice specialties of the patient care team physician (s) listed in the collaboration agreement.

Q15: How long is the collaboration agreement valid?

A: A collaboration agreement becomes valid after the Physician Assistant notifies the Board of the executed collaborative agreement and remains valid until the agreement is terminated.

Q16: If a Patient Care Team Physician leaves, does the collaborative agreement stay in place?

A: The statute states that in the event of a sudden departure, incapacity, or death of a patient care team physician, or change in license status that results in a patient care team physician being unable to legally practice medicine, the collaboration agreement will remain active and valid under the supervision of any remaining listed patient care team physicians.

If there is no remaining patient care team physician listed on the collaboration agreement, the physician assistant may not practice until the physician assistant has executed a new collaboration agreement and, if applicable, has board approval to perform any advanced duties delegated to the physician assistant under the new collaboration agreement.

Q17: How soon can a Physician Assistant begin work once a collaborative agreement is completed?

A: A Physician Assistant may begin practicing as a Physician Assistant only after the Board has been notified of an executed collaboration agreement.

Q18: How should a collaboration agreement be maintained in an office or hospital (paper, digital, renewal term)?

A: The Collaboration Agreement can be paper or electronic as long as it contains the required information. The Collaboration Agreement is valid until such time as it is terminated.

Q19: My current MD is retiring, what paperwork should be done to be covered with another physician in same practice?

A: First, a physician cannot sign on behalf of other physicians. Each patient care team physician must sign the collaboration agreement.

The statute states that in the event of a sudden departure, incapacity, or death of a patient care team physician, or change in license status that results in a patient care team physician being unable to legally practice medicine, the collaboration agreement will remain active and valid under the supervision of any remaining listed patient care team physicians.

If there is no remaining patient care team physician listed on the collaboration agreement, the physician assistant may not practice until the physician assistant has executed a new collaboration agreement and, if applicable, has board approval to perform any advanced duties delegated to the physician assistant under the new collaboration agreement.

Q20: Does the organization keep the collaboration agreements or send them to the Board?

A: Collaboration agreements do not have to be submitted to the Board, but the Board must be notified of the executed collaboration agreement by the Physician Assistant.

Q21: What are the fees for the collaborative agreement?

A: There are no fees for a Collaboration Agreement.

Q22: Do collaboration agreements need to list all locations where the Physician Assistant practices?

A: Collaboration Agreements does not require all locations where the Physician Assistant practices to be listed. However, a collaboration agreement must list the primary place of business.

Q23: Am I required to use the Board-provided collaboration agreement sample?

A: No, you are not required to use the collaboration agreement sample form provided by the Board. However, any form used must contain information required by sections 15-302, 15-302.1, and 15-302.2 of the Health Occupation Article.

Q1: What are advanced duties?

A: Advanced duties are medical acts that require additional training beyond the basic Physician Assistant education program required for licensure. Click here for a listing of previously approved Advanced Procedures by Specialty.

Q2: Do I need Board approval before performing advanced duties under my collaboration agreement?

A: Generally, a physician assistant must demonstrate to the Board their competence in providing such duties in many cases. However, under the new law, a physician assistant can keep the practice logs and coursework that demonstrate competence at the practice and available for audit rather than obtaining prior Board approval in the following circumstances:

1. The Physician Assistant is performing the advanced duty at an exempt facility;
2. The Board has previously approved the Physician Assistant to perform the advanced duty; or
3. The Physician Assistant has at least 7,000 hours of clinical practice experience.

Q3: Is a Physician Assistant required to obtain Board approval to perform an advanced duty in an exempt facility?

A: No. A physician assistant does not require Board-approval to perform an advanced duty in an exempt facility.

However, the advanced duty must be part of the practice specialty of a patient care team physician listed on the collaboration agreement and the Physician Assistant must keep documentation of their education, training, and experience related to the advanced duty, within their Collaboration Agreement at the practice setting.

Q4: What is an exempt facility?

A: An exempt facility is defined in Health Occupations Article, § 15-302, Annotated Code of Maryland as a:

1. Hospital;
2. Ambulatory surgical facility;
3. Federally qualified health center (FQHC); or
4. Another practice setting listed on a hospital delineation of privileges.

Q5: What does the Board consider a non-exempt facility?

A: Non-accredited facilities are facilities that do not meet the criteria in Health Occupations Article, §15-302(c)(1). For example:

1. Non-accredited hospitals;
2. Non-accredited ambulatory surgical centers;
3. Private practices; or
4. Detention centers;
5. Public health facilities;
6. Correctional facilities;
7. Hospitals or ambulatory surgical facilities whose governing body has not approved the Physician Assistant to perform the requested procedure prior to submitting the advanced duties request to the Board.

Q6: Does a Physician Assistant require board approval to perform an advanced duty if they have previously received Board approval for that same advanced duty?

A: No, a physician assistant does not need additional Board approval to perform an advanced duty if they have previously received Board approval for that duty.

However, the advanced duty must be part of the practice specialty of a patient care team physician listed on the collaboration agreement and the Physician Assistant must keep documentation of their past Board approval, as well as records of their education, training, and experience related to the advanced duty, within their collaboration agreement at the practice setting.

Q7: Does a Physician Assistant require Board approval to perform an advanced duty if the Physician Assistant has more than 7,000 hours of clinical practice experience?

A: No, a physician assistant does not require Board-approval to perform an advanced duty if the Physician Assistant has more than 7,000 hours of clinical practice experience.

However, the advanced duty must be a part of the practice specialty of a patient care team physician listed on the collaboration agreement and the Physician Assistant must keep documentation of their education, training, and experience related to the advanced duty, within their Collaboration Agreement at the practice setting.

Q8: How many years of work is 7,000 hours?

A: 7,000 hours is about 3½ years of full-time work. If a physician assistant works more than full-time, it could be less than 3½ years, and if the physician assistant works part-time, it could be more than 3½ years.

Q9: In terms of the 7,000 hours, how is that metric tracked? Is there documentation needed? Are these clinical hours actual hours worked?

A: The Physician Assistant shall attest that they have at least 7,000 hours of clinical practice experience as a part of the collaboration agreement. The Board may audit this, so the Physician Assistant should ensure that they have documentation of at least 7,000 hours of clinical practice.

Q10: May a Physician Assistant or Nurse Practitioner sign off on another Physician Assistant's advanced duty practice logs?

A: No. Only a patient care team physician may observe and sign off on a physician assistant's advance duties.

Q11: May a physician assistant delegate medical acts to another physician assistant or to a medical assistant?

A: A physician assistant who has notified the Board, in a manner approved by the Board, of an executed collaboration agreement may delegate medical acts authorized under Health Occupations § 14‐306 if the physician assistant has at least 7,000 hours of clinical practice experience.

Q12: Are there any updates on advanced duties for Physician Assistants in psychiatry?

A: The Modernization Act does not change what is considered an advanced duty.

Q13: Can a Physician Assistant working in multiple practice settings for different employers perform the advanced duties in both locations?

A: A physician assistant may only perform an advanced duty at the employer or practice where the supervisor whose practice specialty includes the advanced duty. For example, a physician assistant who performs Botox at a cosmetic practice may not perform the Botox advanced duty at another employer if the other location does not have physicians in that speciality.

Q14: If a Physician Assistant is exempt from Board approval to perform an Advanced Duty, what documentation must be maintained with the Collaboration Agreement?

A: The Board cannot provide advice regarding the documentation for Advanced Duties. The Physician Assistant and Patient Care Team Physician(s) should work together to determine the appropriate documentation that demonstrates that the Physician Assistant has the education, training, and experience to perform the Advanced Duty.

The agreed-upon documentation demonstrating the Physician Assistant's education, training, and experience to perform the Advanced Duty will then be kept within the collaboration agreement on file at the location where the advanced duty is performed.

Q15: Can a Physician Assistant perform X-ray duties?

A: A physician assistant may perform X-ray duties only after the Physician Assistant has completed a course that includes anterior-posterior and lateral radiographic studies of extremities on at least 20 separate patients under the direct supervision of a collaborating physician or radiologist using a mini C-arm or similar low-level radiation machine to perform nonfluoroscopic X-ray procedures of the extremities, anterior-posterior and lateral, not including the head.

Q16: What X-ray duties can a Physician Assistant perform?

A: A physician assistant is limited to performing nonfluoroscopic X-ray procedures of the extremities, anterior-posterior and lateral, not including the head.

Q17: Can a Physician Assistant perform fluoroscopic X-rays?

A: No. A physician assistant is limited to performing nonfluoroscopic X-ray procedures of the extremities, anterior-posterior and lateral, not including the head.

Q18: Can a Physician Assistant delegate X-ray duties?

A: No. A physician assistant is not authorized to delegate X-ray duties.

Q1: What is the prescribing policy with the new law? Does a Physician Assistant need to collaborate with a Maryland-licensed Physician to prescribe in Maryland?

A: A Physician Assistant is required to be delegated prescriptive authority by a Patient Care Team Physician in the collaboration agreement.

Q2: Will Physician Assistants still need a supervising physician's name attached to prescriptions?

A: For written prescriptions, the physician's name is no longer required on the prescription.

Q3: Will the collaborating physician's name, DEA number, and dispensing permit number need to be listed when dispensing controlled substances?

A: For prescriptions dispensed, the physician's information still must be included because the Physician Assistant will still be dispensing under the physician's dispensing permit.

Q4: Can a Physician Assistant prescribe medications, including controlled substances, without physician approval?

A: A Physician Assistant is required to be delegated prescriptive authority by a Patient Care Team Physician in a collaboration agreement.

Q5: Does this law change any charting requirements?

A: Check with your employer.

Q1: If there is a change in staffing for collaborating physicians, do we need to update the Board or just our records as a hospital organization?

A: There is no need to update the Board for a change such as an addition or removal of a single or multiple physicians, but the hospital organization should update the collaboration agreement that is kept on file at the practice. However, the Hospital should inform the Board within 10 days upon the complete termination of a delegation agreement.

Q2: Are we able to write a general collaboration agreement to cover all Physician Assistant-led service lines in the hospital? For example Physician Assistant who covers trauma, ortho, and critical care needs to submit three separate agreements or can all services be covered in one agreement with appropriate signatures?

A: A Collaboration Agreement must include and list one Physician Assistant and one or more Patient Care Team Physicians. If multiple Patient Care Team Physicians are listed, the Patient Care Team Physicians may be of different practice specialties. A Physician Assistant may only practice within the practice specialty of the Patient Care Team physician(s) listed on the collaboration agreement.

Q3: How should a collaboration agreement be maintained in an office or hospital (paper, digital, renewal term)?

A: The Collaboration Agreement can be paper or electronic as long as it contains the required information and a copy is available upon request. The Collaboration Agreement is valid until such time as it is terminated.