Qualifications for Licensure As a PA

A.  Application

  • Applicants shall:
    • Complete an application on a form approved by the Board
    • Pay an application fee as defined in Regulation
    • Be at least 18 years old
    • Be of good moral character and
    • Demonstrate oral and written competency in English by one or more of the following
      • Graduation from a recognized English-speaking high school or undergraduate school after at least 3 years of enrollment
      • Graduation from a recognized English-speaking professional school or
      • Receiving a grade of
      • At least 26 on the Speaking Section of the Internet-based Test of English as a Foreign Language; and
      • At least 79 on the Internet-based Test of English as a Foreign   Language

B.  Education

An applicant who passed the physician assistant certifying examination administered by the National Commission on Certification of Physician Assistants before 1986 is not required to meet the education requirements of this Regulation if both of the following are true:

  • The applicant has met the continuing education requirements and recertification requirements of the NCCPA on a continuous basis since passing the examination; and
  • The applicant has been employed and practicing as a physician assistant on a continuous basis since passing the examination.
  •  Except as specified, an applicant shall graduate from a physician assistant educational program that was accredited at the time of graduation by the Commission on Accreditation of Allied Health Education Programs, the Accreditation Review Commission on the Education for the Physician Assistant or their successors.

In addition to the requirement specified in the Regulation, an applicant who graduates from a physician assistant training program after October 1, 2003, shall have one of the following:

  • Bachelor’s degree or
  • At least 120 credits hours of education at the college or university level
  • Examination.  An applicant shall pass the national certifying examination for physician assistants given by the NCCPA or its successor
  • Primary Source Verification.  The Board may accept the Federation Credential Verification Service for primary source verification of a physician assistant’s education and examination


Delegation Agreements: Contents

A. Before a physician may delegate medical acts and before a physician assistant (PA) may perform medical acts, the PA and primary supervising  shall file with the Board:

  • A delegation agreement on the Board approved form; and
  • The required fee as specified in Regulation

B. The delegation agreement shall include the following information:

  • The primary supervising physician’s Maryland license number;
  • A description of the supervising physician’s qualifications to supervise a PA;
  • The PA’s Maryland license number;
  • The location and settings where the PA will practice;
  • The scope of the primary and alternate physicians’ practices;
  • The delegated medical acts which the PA will perform, including
    • Core duties; and
    •  Any advanced duties;
  • A description of the continuous supervision mechanisms that the primary supervising physician will useA description of how the PA’s performance will be evaluated; and
  • Any other information deemed necessary by the Board to carry out the provisions of Health Occupations Article, Title 15, Annotated Code of Maryland.

C. The primary supervising physician shall make the following attestations as a part of the delegation agreement:

  • All medical acts to be delegated to the PA are within the scope of practice of the primary or alternate supervising physician and appropriate to the PA’s education, training, and level of competence;
  • The primary supervising physician will utilize the mechanisms of continuous supervision as described in the delegation agreement;
  • The primary supervising physician will accept responsibility for any care given by the PA;
  • The primary supervising physician will respond in a timely manner when contacted by the PA; and
  • The primary supervising physician may not supervise more than 4 Pas at any one time, except as permitted in a:
    •  Hospital;
    • Correctional facility;
    • Detention center; or
    • Public health facility

D. Except as provided in this Regulation, if a delegation agreement includes delegation of one or more advanced duties, the delegation agreement shall include the following additional information and documentation:

  • In a special facility:
    •  A description of the advanced duty and the education, training and experience that qualifies the PA to perform the advanced duty; and
    • A copy of the approved delineation of duties from the governing board of the health care facility stating that the PA has been approved by the facility to perform the advanced duty; or
  • In a setting other than a special facility:
    • A description of the advanced duties to be delegated;
    • Documentation of the advanced duty and the education, training and experience that qualifies the PA to perform the advanced duty;
    • The level of supervision that the primary supervising physician will use when the PA is performing the advanced duty; and
    • Documentation described in Regulations, if the delegation agreement includes a request for a temporary practice letter allowing the PA to perform an advanced duty before approval by the Board.

E. If a delegation agreement includes the delegation of general anesthesia or neuroaxial anesthesia, the delegation agreement shall include all of the information specified in regulation.

Delegation Agreements: Approval

A.  Review by the Board

The Board may review a delegation agreement filed under Regulation .05 of this chapter

The board may disapprove a delegation agreement or delegation of an advanced duty base upon:

  •  Licensure compliance issues with the primary supervising physician or the physician assistant
  • Failure of the delegation agreement to meet the requirements of:
  1. Health Occupation Article, Title 15, Subtitle 3, Annotated Code of Maryland or Regulation .05 of this chapter
  2. Belief that the physician assistant cannot safely perform the delegated duty

If the Board disapproves the delegation under A(2) or C(1) of this regulation,the primary supervising physician and physician assistant may appeal the decision using the procedure described in Regulation .12 of this chapter. Upon notification by the Board that a delegation agreement or an advanced  duty has been denied, the physician assistant shall immediately cease to practice under the agreement or  perform the advanced duty

B.  Core Duties

Upon receipt of a delegation agreement at the Board of Physicians, a physician may delegate and a physician assistant may perform delegated core medical acts. The Board shall notify the primary supervising physician and the physician assistant of the Board’s receipt of the delegation agreement

C.  General Anesthesia and Neuroaxial Anesthesia

Regardless of setting or other factors, a supervising physician may not delegate anesthesia before the Board has approved the delegation and a physician assistant may not perform general or neuroaxial anesthesia. The Board shall provide written notification of approval or disapproval of the delegation under C (1). If the Board disapproves the delegation under C (1) of this regulation, the using the procedure described in Regulation .12 of this chapter the primary supervising physician and physician assistant may appeal the decision

D.  Advanced Duties in a Special Facility

Upon receipt of a delegation agreement at the Board of Physicians, a physician may delegate and a physician assistant may perform delegated core medical acts and advanced duties that have been approved through the specialty facility’s privileging process. The Board shall notify the physician assistant and the primary supervising physician that the Board received the delegation agreement. If the Board disapproves a delegation agreement under D (1) of this regulation, the primary supervising physician and the physician assistant:

  •  Shall immediately cease to perform the advanced duty; and
  •  May appeal the decision using the procedure described in Regulation .123 of this chapter

E.  Advanced Duties in Settings or Facilities Other than Special Facilities

Upon receipt of a delegation agreement under which a physician assistant will perform one or more advanced duties in a location other than a  special facility, the Board shall forward the agreement to the PAAC and request that the PAAC make a recommendation to the board. The committee shall present its recommendation to the Board for consideration. If the Board disapproves the delegation under E (1) of this regulation, the primary supervising physician and physician assistant:

  •  Shall immediately cease to perform the advanced duty; and
  •  May appeal the decision using the procedure described in Regulation .12 of this chapter

F.  Temporary Practice Letter

Eligibility 

A primary supervising physician who has filed a delegation agreement under E (1) of this regulation for approval to perform one or more advanced duties in a setting other than a special facility is eligible for a temporary practice  letter if the primary supervising physician and the physician assistant meet the  following criteria:

  •  The Board previously approved the physician assistant to perform the advanced duty; and
  •  The Board previously approved the primary supervising physician to supervise a physician assistant in the performance of the advanced duty Process.

An applicant who is requesting a temporary practice letter shall:

  •  Indicate on the delegation that a temporary practice letter is requested;
  •  Include the name of the physician, the name of the physician assistant, and the date of the delegation agreement which satisfies the requirements of F (1) (a) of this regulation
  • Include the name of the physician, the name of the physician assistant, and the date of the delegation agreement which satisfies the requirements of F (1) (b) of this regulation

Approval

Issuance of a temporary practice letter by Board staff entitles the physician assistant to work in accordance with the proposed delegation agreement until;

  •  Notification that the proposed delegation agreement has been denied by the Committee or the Board; or
  •  Notification that the proposed delegation agreement has been approved by the Board

G.  To the extent practicable

The Board shall approve a delegation agreement or take other action with respect to a delegation agreement within 90 days after receiving a completed delegation agreement including any information from the physician assistant and primary supervising physician.


Fee Schedule


Initial Licensure $225.00
Reinstatements $225.00
Renewals $196.00*
Delegation Agreements $200.00
Name Changes $25.00
Replacement License $25.00
Written Verifications $25.00
Replacement Wall Certificate $75.00

*Includes a $36.00 assessment fee to fund the Maryland Health Care Commission (MHCC) as required by law (MD Code Annotated Health Occupations 1-209) and a $25.00 fee for the Physician Assistant Rehabilitation Program as required by law (MD Code Annotated Health Occupation 15-310 (e)


Prescribing and Dispensing Medications

A Physician may delegate prescribing of Schedule II-V and non-controlled medications to PA if:

  • Intent to delegate prescriptive authority is included in the delegation agreement
  • The PA shows evidence of certification by NCCPA within previous 2 years or completion of 8 hours of pharmacology CME within previous 2 years and
    • Has a Bachelor’s degree or equivalent, or
    • Has 2 years of work experience as PA
  • The PA attests to a willingness to comply with applicable state and federal law
  • Prescriptions written by PA are noted in the medical record
  • Prescriptions written by the PA contains the  PA’s name and supervising Physician’s name, address and phone number
  • PAs who are delegated prescribers of controlled medications have a valid DEA registration and state controlled substance registration

 

MD. HEALTH OCC. ยง 15-302.2


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