Source: https://www.mbp.state.md.us/licensure_ahapp_pa.aspx
Timestamp: 2017-11-18 17:44:43
Document Index: 2316376

Matched Legal Cases: ['§ 15', '§15', '§15', '§15', '§12', '§14', '§15', '§ 14']

Click to view the latest approved Delegation Agreement List:
Approved Delegation Agreement List
Graduation from a physician assistant educational program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) or its successor.
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.
Current certification by the National Commission on Licensure of Physician Assistants (NCCPA).
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/.
What is a delegation agreement?
A delegation agreement is a document that is executed by a primary supervising physician (PSP) and a PA (PA) containing the requirements of Health Occupations Article, § 15-302, Annotated Code of Maryland.
What are core duties?
Core duties are medical acts that are included in the standard curricula of accredited PA education programs.
LICENSURE IS ONLY ONE PART OF THE PROCESS. ALL PHYSICIAN ASSISTANTS MUST FILE A DELEGATION AGREEMENT WITH THE BOARD. THE PA MAY BEGIN WORKING ONCE THE BOARD HAS RECEIVED THE COMPLETED DELEGATION AGREEMENT AND ACKNOWLEDGES RECEIPT IN WRITING. BOARD STAFF WILL EMAIL ACKNOWLEDGEMENT LETTERS TO THE PA AND THE PSP.
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
The Board may request a PA to submit evidence of having met the continuing education requirements specified in this regulation. If a PA 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.
What is the delegation agreement process for core duties?
PAs and PSPs must file the completed delegation agreement and appropriate fee with the Board. The Board will not accept faxed delegation agreements or walk-ins.
The Board is no longer required to approve a delegation agreement before the PA begins working if the delegation agreement does not include advanced duties.
The PA may begin working once the Board has received the delegation agreement and acknowledges receipt in writing. Board staff will email acknowledgment letters to the PA and the PSP.
The process may take up to seven weeks.
What are advanced duties?
Advanced duties are medical acts that require additional training beyond the basic PA education program required for licensure. Click here for a listing of Advanced Procedures by Specialty .
What is the delegation agreement addendum process for advanced duties in accredited healthcare facilities?
PAs and PSPs must file the completed delegation agreement with the Board. Delegation agreements with advanced duties will not require prior Board approval if the advanced duty listed in the delegation agreement will be performed in a hospital or an ambulatory surgical facility that:
Is accredited by an accrediting agency recognized by the Board.
Credentials supervising physician as a condition of employment, as an independent contractor or as a member of the medical staff before the supervising physician begins practicing in the facility;
Credentials PA as a condition of employment, as an independent contractor or as a member of the medical staff before the PA begins practicing in the facility; and
Through its governing body has already reviewed and approved the PA to perform each requested advanced duty before the delegation agreement with advanced duties is filed with the Board.
A PA may begin working after the Board receives the delegation agreement for advanced duties and acknowledges receipt in writing. Board staff will email acknowledgment letters to the PA and the PSP.
Note: Pursuant to §15-302.1(e), the Board is authorized to disapprove any delegation agreement not meeting the requirements of the law or if the Board believes that a PA is unable to perform the delegated duties safely.
What does the Board consider an accredited facility?
An accredited facility is a hospital or ambulatory surgical facility accredited by The Joint Commission, the American Association for Accreditation of Ambulatory Surgical Facilities, the Accreditation Association for Ambulatory Health Care, is certified to participate in the Medicare program, as enacted by Title XVIII of the Social Security Act or meets the criteria in Health Occupations Article, §15-302(c)(1).
What does the Board consider a non-accredited facility?
Non-accredited facilities are facilities that do not meet the criteria in Health Occupations Article, §15-302(c)(1). For example:
Non-accredited hospitals;
Non-accredited ambulatory surgical centers;
Hospitals or ambulatory surgical facilities whose governing body has not approved the PA to perform the requested procedure prior to submitting the advanced duties request to the Board.
What is the delegation agreement process for advanced duties in non-accredited facilities?
PAs and PSPs must obtain prior Board approval before the PA may begin practicing any advanced duty. PAs in these practice settings are required to submit training and education documentation. The criteria for Board approval is as follows:
Completion of the Delegation Agreement Addendum for Advanced Duties .
Documentation, including but not limited to:
Procedure logs showing at least 10 – 25 successful procedures (200 for stress testing);
Advanced education/training, including training certificates indicating training completion or a delineation of hospital privileges for the PA;
(Please note that the PAAC or the Board may require a PA or SP to meet additional requirements before approving a request to perform advanced duties. The requirements will depend upon the type of advanced duty.)
Note:A PSP is required to obtain the Board’s approval of a delegation agreement before the PA may administer, monitor or maintain general anesthesia or neuroaxial anesthesia, including spinal and epidural techniques.
Yes. For delegation agreements with advanced duties that require prior Board approval, the PA and PSP may apply for a temporary practice letter. The Board may approve a temporary practice letter if:
The Board previously approved the PSP to supervise one or more PAs in the performance of the requested advanced duty; AND
The Board previously approved the PA to perform the advanced duty.
The temporary practice letter will allow a PA to practice while the delegation agreement is pending Board approval. The temporary practice letter request must be submitted with the delegation agreement.
A PA and PSP will not qualify for a temporary practice letter if:
The PSP has never been approved by the Board to supervise a PA in the performance of the requested advanced duty; OR
The Board never approved the PA to perform the requested advanced duty.
What is an alternate supervising physician?
An alternate supervising physician (ASP) is a physician designated by a PSP to supervise a PA in accordance with the delegation agreement on file with the Board.
Except in a hospital, correctional facility, detention center, or public health facility, the PSP must submit the names of the ASP, PA, the ASPs scope of practice and a statement from that the ASP will accept the responsibility of supervising the PA. This may be done by completing a designated alternate supervising physician form or in a letter.
In a hospital, correctional facility, detention center, or public facility, primary supervising physicians must keep an ongoing list of all approved ASPs with the ASP's scope of practice, signed and dated by each ASP.
When may a PA practice under the supervision of an ASP?
PAs may practice under an ASP if the:
ASP supervises in accordance with the delegation agreement on file with the Board;
ASP supervises no more than four PAs at any one time, except in a hospital, correctional facility, detention center or public health facility;
Period of supervision does not exceed the time specified in the delegation agreement;
ASP’s period of supervision does not exceed 45 days at any one time; and
PAs perform only those medical acts that have been delegated under the delegation agreement filed with the Board and are within the scope of practice of the alternate supervising physician.
When should a PA notify the Board that he/she will no longer be working under the supervision of the PSP whose name appears on the approved delegation agreement on file with the Board?
PAs should notify the Board as soon as they know that their PSP will no longer be with the practice by filing a new delegation agreement.
May a PA practice under an ASP if the PSP supervising physician is no longer with the practice?
In the event of a sudden departure, incapacity, or death of PSP, a designated ASP may assume the role of the PSP by submitting a new delegation agreement to the Board within 15 days.
What are the requirements for prescriptive authority?
Before PSPs delegate prescriptive authority to PAs, the PSP must attest that the PA has:
Passage of the NCCPA Exam within the previous 2 years of submitting the delegation agreement; OR
Provide documentation of successful completion of 8 Category I hours of pharmacology education within the previous 2 years of submitting the delegation agreement; AND
A Bachelor’s degree or its equivalent (120 credit hours); OR
Two years of work experience as a physician assistant.
PSPs may delegate the authority to prescribe prescription drugs, controlled dangerous substances and/or medical devices. PAs who have been delegated the authority to prescribe controlled dangerous substances must have a valid:
Maryland Controlled Dangerous Substance (MCDS) license from the Office of Controlled Substances Administration (OCSA); and
Federal Drug Enforcement Agency (DEA) registration.
For more information about Maryland controlled dangerous substance registration, contact the Office of Controlled Substances Administration.
For more information about DEA registration, contact the Drug Enforcement Agency.
May a PA dispense prescription drugs?
PAs who are delegated the authority to prescribe may dispense a starter dosage or dispense drug samples of any drug the PA is authorized to prescribe to a patient of the PA if:
The starter dosage or drug sample complies with the labeling requirements of Health Occupations Article §12-505;
No charge is made for either samples or starter dosages;
The starter dosage does not exceed a 72 hour supply;
The PA enters an appropriate record in the patient’s medical record; and
The PA complies with the requirements under Title 12 and 14 of Health Occupations and applicable Federal law and regulations.
Is there a scope of practice that a PA may not practice?
A PA may not practice within the scope of practice of any of the following health occupations:
Radiation Therapy; or
Under certain circumstances, a PA 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.
Hospitals, related institutions, alternative health care systems, or employers are required to report to the Board any termination of employment of the PA for any reason, including quality of care issues, within 5 days of the termination.
Hospitals, related institutions, alternative health care systems, or employers are also required to report to the Board within 5 days any limitation, reductions or other changes of employment of the change of employment that might be grounds for disciplinary actions under Health Occupations Article, §15-314.
May a PA take x-rays or inject radiopharmaceuticals?
No. A PA must be a licensed radiographer to take x-rays and a licensed nuclear medicine technologist to inject radiopharmaceuticals. (Maryland Health Occupations Code Annotated, § 14-306e).
May a PA pronounce a patient dead?
There is no statute that specifically prohibits a PA from pronouncing death. However, hospitals may have their own policy on who may pronounce death and under what circumstances. Please check your hospital's policy.
May a PA sign an emergency medical services (EMS) do not resuscitate (DNR) orders form?
Yes, a PA may sign EMS/DNR orders in accordance with Health General Article, Section 5-601(i).
May a PA sign a "regular" DNR in an inpatient facility or hospital?
A PA may sign a non-emergency DNR based on the patient's treatment preferences if this duty is delegated to the PA by the supervising physician.
May a PA sign a death certificate?
Yes, a PA may sign a death certificate.
May a PA write orders for restraints?
Yes, a PA may write orders for restraints.
"HCFA Restraint Rules Allow Delegation to Physician Assistants – MBP Agrees"
In August 1999 the Health Care Financing Administration (HCFA) implemented Medicare rules designed to protect all patients from improper use of restraint and seclusion. The regulations limit the ordering of patient restraint or seclusion to “a physician or other licensed independent practitioner,” which would seem to exclude physician assistants. However, in May 2000, HCFA issued “Interpretive Guidelines” clarifying that physicians may delegate those responsibilities in some instances.
The Interpretive Guidelines state, “For the purpose of this rule, a LIP is any practitioner permitted by both law and the hospital to independently order restraints, seclusion, or medications for patients. This is not to be construed to limit the authority of a doctor of medicine or osteopathy to delegate tasks to other qualified healthcare personnel (i.e., Physician Assistants and Nurse Practitioners) to the extent recognized under State law or a State’s regulatory mechanism.”
In short, physicians are able to delegate to PA's the ordering of restraints and seclusion and the required face-to-face assessment of the patient within one hour, as long as it is within the PA’s state authorized scope of practice and allowed under hospital policy.
The MBP confirms that Physicians may delegate to Maryland PA's the ordering and assessment required for restraints in medical facilities. MBP, however, requests that this duty be included in the PA's delegation agreement. An addendum, in the form of a letter from your supervising physician to MBP, may be sent to add this duty to an already approved delegation agreement. Please note that such delegation is prohibited by state law in any mental health setting, which falls under the purview of the Department of Health and Mental
The HCFA regulations, entitled, “Medicare and Medicaid Programs; Hospital conditions of Participation: “Patients’ Rights,” were published in the July 2, 1999, Federal Register. They can be found through the Federal Register. They can be found through the Federal Register Web site at http://www.access.gpo.gov/su_docs/fedreg/a990702c.html. The interpretive guidelines, dated June 2000, are on the Internet at Section 482.13 Condition of Participation: Patient's Rights The reference to PAs is on page A-182. Approved by MBP, December 2001.
HCFA Restraint Rules
Are supervising physicians required to co-sign medical charts?
On October 1, 2006, the law repealed the requirement for supervising physicians to co-sign medical charts. In place of the co-signature, the supervising physician will be required to describe a process, on the delegation agreement, by which the physician assistant’s practice is reviewed appropriate to the practice setting and consistent with current standards of acceptable medical practice.
The supervising physician will be required to provide a description by which the physician assistant’s practice is reviewed on delegation agreements filed October 1, 2006 and later.
For existing delegation agreements, supervising physicians may wish to keep a written description by which the physician assistant’s practice is reviewed on file at the healthcare facility.
May a physician assistant practice psychotherapy?
A physician assistant (PA) may practice psychotherapy if the PA has the required additional education, training and experience to practice psychotherapy. Performing psychotherapy would be considered an advanced duty and therefore would require documentation of additional education, training and experience. When the Board licensed psychiatrist assistants, the minimum requirements were:
Master’s degree from an accredited college or university; AND
Completion of a graduate program accepted by the Board in a behavioral science that included 1, 000 hours of supervised clinical psychotherapy; OR
4,000 hours of supervised clinical experience that is approved by the Board.
A PA should have similar education, training and experience before seeking Board approval to practice psychotherapy.
If a PA does not have the required education, training and experience to practice psychotherapy, what type of treatment may a PA provide for a psychiatric patient?
A PA may provide treatment for a psychiatric patient’s physical problems.
Advanced Procedures List
Initial Licenses $225.00
Reinstatements $225.00
Renewals* $186.00
Delegation Agreements $200.00
Maryland Academy of Physician Assistants (MAPA)
Federation Credential Verification Service (FCVS)