An Act To Improve Access to Physician Assistant Care
Maine Legislature, Session 129, LD 1660
Committee Amendment CA_A_S432 (Senate)
Amends: 24-A MRSA §4306, 24-A MRSA §4320, 6 MRSA §205, 12 MRSA §10703, 18-C MRSA §5, 22 MRSA §1241, 22 MRSA §1597-A, 26 MRSA §683, 29-A MRSA §2524, 32 MRSA §86, 32 MRSA §2561, 32 MRSA §2594-F, 32 MRSA §3263, 32 MRSA §3270-A, 32 MRSA §3270-E, 32 MRSA §3270-G, 32 MRSA §3300-C, 32 MRSA §13786, 34-B MRSA §3801, 37-B MRSA §185

COMMITTEE AMENDMENT "A," to S.P. 537, L.D. 1660, Bill, "An Act To 
Improve Access to Physician Assistant Care" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'PART A 
Sec. A-1. 24-A MRSA §4306, as amended by PL 2011, c. 364, §28, is further 
amended to read: 
§4306. Enrollee choice of primary care provider 
A carrier offering or renewing a managed care plan shall allow enrollees to choose 
their own primary care providers, as allowed under the managed care plan's rules, from 
among the panel of participating providers made available to enrollees under the managed 
care plan's rules. 
A carrier shall allow physicians, including, but not limited to, 
pediatricians and physicians who specialize in obstetrics and gynecology, and physician 
assistants licensed pursuant to Title 32, section 2594-E or section 3270-E and certified 
nurse practitioners who have been approved by the State Board of Nursing to practice 
advanced practice registered nursing without the supervision of a physician pursuant to 
Title 32, section 2102, subsection 2-A to serve as primary care providers for managed 
care plans. 
A carrier is not required to contract with certified nurse practitioners .. 
physician assistants or physicians as primary care providers in any manner that exceeds 
the access and provider network standards required in this chapter or chapter 56, or any 
rules adopted pursuant to those chapters. A carrier shall allow enrollees in a managed 
care plan to change primary care providers without good cause at least once annually and 
to change with good cause as necessary. When an enrollee fails to choose a primary care 
provider, the carrier may assign the enrollee a primary care provider located in the same 
geographic area in which the enrollee resides. 
Sec. A-2. 24-A MRSA §4320-0 is enacted to read: 
COMMITTEE AMENDMENT 
COMMITTEEAMENDMENT"f1 "to S.P. 537, L.D, 1660 ( 
§4320-0. Coverage for services provided by a physician assistant 
1. Services provided by a physician assistant. A carrier offering a health plan in 
this State shall provide coverage for health care services performed by a physician 
assistant licensed under Title 32, section 2594-E or 3270-E when those services are 
covered services under the health plan when performed by any other health care provider 
and when those services are within the lawful scope of practice of the physician assistant. 
2. Limits; deductible; copayment; coinsurance. A carrier may offer a health plan 
containing a provision for a deductible, copayment or coinsurance requirement for a 
health care service provided by a physician assistant as long as the deductible, copayment 
or coinsurance does not exceed the deductible, copayment or coinsurance applicable to 
the same service provided by other health care providers. 
3. Network participation. A carrier shall demonstrate that the carrier's provider 
network includes reasonable access. in accordance with section 4303. to all covered 
services that are within the lawful scope of practice of a physician assistant. A carrier 
may not exclude a provider from participation in the carrier's provider network solely 
because the provider is a physician assistant as long as the provider is willing to meet the 
same terms and conditions as other participating providers. This subsection does not 
require a carrier to contract with all physician assistants or require a carrier to provide 
coverage under a health plan for any service provided by a participating physician 
assistant that is not within the health plan's scope of coverage. 
4. Billing. A carrier shall authorize a physician assistant to bill the carrier and 
receive direct payment for a medically necessary service the physician assistant provides 
to an enrollee and identify the physician assistant as provider in the billing and claims 
process for payment of the service. A carrier may not impose on a physician assistant a 
practice, education or collaboration requirement that is inconsistent with or more 
restrictive than a requirement of state law or board or agency rules. 
Sec. A-3. Application. 
The requirements of this Part apply to all policies, 
contracts and certificates executed, delivered, issued for delivery, continued or renewed 
in this State on or after January 1, 2021. For purposes of this Act, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
Sec. A-4. 
Exemption from review. 
Notwithstanding the Maine Revised 
Statutes, Title 24-A, section 2752, section 2 of this Part is enacted without review and 
evaluation by the Department of Professional and Financial Regulation, Bureau of 
Insurance. 
PARTB 
Sec. B-1. 6 MRSA §205, sub-§5, as amended by PL 2009, c. 447, §4, is further 
7 
amended to read: 
5. Administration of tests. Persons conducting analyses of blood, breath or urine 
for the purpose of determining the alcohol level or drug concentration must be certified 
for this purpose by the Department of Health and Human Services under certification 
standards set by that department. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT"{\ "to S.P. 537, L.D. 1660 [ ~, · q 
Only a duly licensed physician, registered physician's licensed physician assistant, 
registered nurse or a person certified by the Department of Health and Human Services 
under certification standards set by that department, acting at the request of a law 
enforcement officer, may draw a specimen of blood to determine the alcohol level or drug 
concentration of a person who is complying with the duty to submit to a chemical test. 
This limitation does not apply to the taking of breath specimens. When a person draws a 
specimen of blood at the request of a law enforcement officer, that person may issue a 
certificate that states that the person is in fact a duly licensed or certified person as 
required by this subsection and that the person followed the proper procedure for drawing 
a specimen of blood to determine the alcohol level or drug concentration. 
That 
certificate, when duly signed and sworn to by the person, is admissible as evidence in any 
court of the State. It is prima facie evidence that the person was duly licensed or certified 
and that the person followed the proper procedure for drawing a specimen for chemical 
testing, unless, with 10 days' written notice to the prosecution, the defendant requests that 
the person testify as to licensure or certification, or the procedure for drawing the 
specimen of blood. 
A law enforcement officer may take a sample specimen of the breath or urine of any 
person whom the officer has probable cause to believe operated or attempted to operate 
an aircraft while under the influence of intoxicating liquor or drugs and who is complying 
with the duty to submit to and complete a chemical test. The sample specimen must be 
submitted to the Department of Health and Human Services or a person certified by the 
Department of Health and Human Services for the purpose of conducting chemical tests 
of the sample specimen to determine the alcohol level or drug concentration of that 
sample. 
Only equipment approved by the Department of Health and Human Services may be used 
by a law enforcement officer to take a sample specimen of the defendant's breath or urine 
for submission to the Department of Health and Human Services or a person certified by 
the Department of Health and Human Services for the purpose of conducting tests of the 
sample specimen to determine the alcohol level or drug concentration of that sample. 
Approved equipment must have a stamp of approval affixed by the Department of Health 
and Human Services. Evidence that the equipment was in a sealed carton bearing the 
stamp of approval must be accepted in court as prima facie evidence that the equipment 
was approved by the Department of Health and Human Services for use by the law 
enforcement officer to take the sample specimen of the defendant's breath or urine. 
As an alternative to the method of breath testing described in this subsection, a law 
enforcement officer may test the breath of any person whom the officer has probable 
cause to believe operated or attempted to operate an aircraft while under the influence of 
intoxicating liquor or drugs, by use of a self-contained, breath-alcohol testing apparatus to 
determine the person's alcohol level, as long as the testing apparatus is reasonably 
available. The procedures for the operation and testing of self-contained, breath-alcohol 
testing apparatuses must be as provided by rule adopted by the Department of Health and 
Human Services. The result of any such test must be accepted as prima facie evidence of 
the alcohol level of a person in any court. 
Approved self-contained, breath-alcohol testing apparatuses must have a stamp of 
approval affixed by the Department of Health and Human Services after periodic testing. 
That stamp of approval is valid for a limited period of no more than one year. Testimony 
COMMITTEE AMENDMENT 
j .~ 
COMMITTEE AMENDMENT " A, " to S.P. 53 7, L.D. 1660 \ '::, • 
'l 
or other evidence that the equipment was bearing the stamp of approval must be accepted 
in court as prima facie evidence that the equipment was approved by the J)epartment of 
Health and Human Services for use by the law enforcement officer to collect and analyze 
a sample specimen of the defendant's breath. 
Failure to comply with any provision of this subsection or with any rule adopted under 
this subsection does not, by itself, result in the exclusion of evidence of alcohol level or 
drug concentration, unless the evidence is determined to be not sufficiently reliable. 
Testimony or other evidence that any materials used in operating or checking the 
operation of the equipment were bearing a statement of the manufacturer or of the 
Department of Health and Human Services must be accepted in court as prima facie 
evidence that the materials were of a composition and quality as stated. 
A person certified by the Maine Criminal Justice Academy, under certification standards 
set by the academy, as qualified to operate approved self-contained, breath-alcohol 
testing apparatuses may operate those apparatuses to collect and analyze a sample 
specimen of a defendant's breath. 
Sec. B-2. 12 MRSA §10703, sub-§5, 1A, as amended by PL 2019, c. 452, §5, is 
further amended to read: 
A. Only a physician, registered physioian's licensed physician assistant, registered 
nurse or person whose occupational license or training allows that person to draw 
blood samples may draw a specimen of blood for the purpose of determining the 
blood-alcohol level or the presence of a drug or drug metabolite. This limitation does 
not apply to the taking of breath or urine specimens. 
When a person draws a 
specimen of blood at the request of a law enforcement officer, that person may issue 
a certificate that states that the person is in fact a duly licensed or certified person as 
required by this subsection and that the person followed the proper procedure for 
drawing a specimen of blood to determine an alcohol level or drug concentration. 
That certificate, when duly signed and sworn to by the person, is admissible as 
evidence in any court of the State. It is prima facie evidence that the person was duly 
licensed or certified and that the person followed the proper procedure for drawing a 
specimen of blood for chemical testing, unless, with 10 days' written notice to the 
prosecution, the defendant requests that the person testify as to licensure or 
certification, or the procedure for drawing the specimen of blood. 
Sec. B-3. 12 MRSA §10703, sub-§6, as amended by PL 2019, c. 452, §6, is 
further amended to read: 
6. Liability. Only a physician, registered physioian's licensed physician assistant, 
registered nurse or person whose occupational license or training allows that person to 
draw blood samples or other health care provider in the exercise of due care is not liable 
in damages or otherwise for any act done or omitted in performing the act of collecting or 
withdrawing specimens of blood at the request of a law enforcement officer pursuant to 
this section. 
Sec. B-4. 18-C MRSA §5-306, sub-§1, as amended by PL 2019, c. 276, §1, is 
further amended to read: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" H "to S.P. 537, L.D. 1660 
1. Evaluation; report. In every adult guardianship matter, the respondent must be 
examined by a medical practitioner who is acceptable to the court and who is qualified to 
evaluate the respondent1s alleged cognitive and functional abilities. 
The individual 
conducting the evaluation shall file a report in a record with the court at least 10 days 
before any hearing on the petition. Unless otherwise directed by the court, the report 
must contain: 
A. A description of the nature, type and extent of the respondent
1s cognitive and 
functional abilities and limitations; 
B. 
An evaluation of the respondent1s mental and physical condition and, if 
appropriate, educational potential, adaptive behavior and social skills; 
C. A prognosis for improvement and recommendation for the appropriate treatment, 
support or habilitation plan; and 
D. The date of the examination on which the report is based. 
As used in this subsection, 
11medical practitioner
means a licensed physician, a registered 
licensed physician assistant, a certified psychiatric clinical nurse specialist, a certified 
nurse practitioner or a licensed clinical psychologist. 
Sec. B-5. 22 MRSA §1241, sub-§3, as enacted by PL 2009, c. 533, §1, is 
amended to read: 
3. 
Health care professional. 
11Health care professional
means an allopathic 
physician licensed pursuant to Title 32, chapter 48, an osteopathic physician licensed 
pursuant to Title 32, chapter 36, a physician assistant who has been delegated the 
provision of sexually transmitted disease therapy or expedited partner therapy by that 
physician assista-et1s supervising physioian licensed pursuant to Title 32. chapter 36 or 48, 
an advanced practice registered nurse who has a written collaborative agreement with a 
collaborating physician that authorizes the provision of sexually transmitted disease 
therapy or expedited partner therapy or an advanced practice registered nurse who 
possesses appropriate clinical privileges in accordance with Title 32, chapter 31. 
Sec. B-6. 22 MRSA §1597-A, sub-§1, ,r:B, as amended by PL 1993, c. 600, Pt. 
B, §21, is further amended by amending subparagraph (5) to read: 
(5) 
A physioian1s physician assistant registered licensed by the Board of 
Licensure in Medicine, Title 32, chapter 48; 
Sec. B-7. 26 MRSA §683, sub-§5, ,r:B, as amended by PL 2017, c. 407, Pt. A, 
§107, is further amended to read: 
B. In the case of an employee, have a blood sample taken from the employee by a 
licensed physician, registered physioian
1s licensed physician assistant, registered 
nurse or a person certified by the Department of Health and Human Services to draw 
blood samples. The employer shall have this sample tested for the presence of 
alcohol or marijuana metabolites, if those substances are to be tested for under the 
employer
1s written policy. If the employee requests that a blood sample be taken as 
provided in this paragraph, the employer may not test any other sample from the 
employee for the presence of these substances. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" (1-" to S.P. 537, L.D. 1660 ( 
(1) 
The Department of Health and Human Services may identify, by rules 
adopted under section 687, other substances for which an employee may request 
a blood sample be tested instead of a urine sample if the department determines 
that a sufficient correlation exists between the presence of the substance in an 
individual's blood and its effect upon the individual's performance. 
(2) An employer may not require, request or suggest that any employee or 
applicant provide a blood sample for substance use testing purposes nor may any 
employer conduct a substance use test upon a blood sample except as provided in 
this paragraph. 
(3) Applicants do not have the right to require the employer to test a blood 
sample as provided in this paragraph. 
Sec. B-8. 29-A MRSA §2524, sub-§1, as amended by PL 2013, c. 459, §11, is 
further amended to read: 
1. Persons qualified to draw blood for blood tests. Only a physician, registered 
physician's licensed physician assistant, registered nurse or person whose occupational 
license or training allows that person to draw blood samples may draw a specimen of 
blood for the purpose of determining the blood-alcohol level or the presence of a drug or 
drug metabolite. 
Sec. B-9. 32 MRSA §86, sub-§2-A, ,rA, as amended by PL 1993, c. 152, §3, is 
further amended to read: 
A. When a patient is already under the supervision of a personal physician or a 
physician's physician assistant or~ nurse practitioner supervised by that the physician 
and the physician, physieian's physician assistant or nurse practitioner assumes the 
care of the patient, then for as long as the physician, physieian's physician assistant or 
nurse practitioner remains with the patient, the patient must be cared for as the 
physician, physieian's physician assistant or nurse practitioner directs. 
The 
emergency medical services persons shall assist to the extent that their licenses and 
protocol allow; and 
Sec. B-10. 32 MRSA §2561, as amended by PL 2013, c. 101, §1, is further 
amended to read: 
§2561. Membership; qualifications; tenure; vacancies 
The Board of Osteopathic Licensure, as established by Title 5, section 12004-A, 
subsection 29, and in this chapter called the "board," consists of -1-0 11 members 
appointed by the Governor. Members must be residents of this State. Six members must 
be graduates of a school or college of osteopathic medicine approved by the American 
Osteopathic Association and must be have been, at the time of appointment, actively 
engaged in the practice of the profession of osteopathic medicine in the State for a 
continuous period of at least 5 years preceding their appointment to the board. Goo 
member Two members must be a physician assistant assistants licensed under this chapter 
who has have been actively engaged in that member's the profession of physician 
assistant in this State for at least 5 years preceding appointment to the board. Three 
members must be public members. . Consumer groups may submit nominations to the 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" fi "to S.P. 537, L.D. 1660 
Governor for the members to be appointed to represent the interest of consumers. A full 
term of appointment is for 5 years. Appointment of members must comply with section 
60. A member of the board may be removed from office for cause by the Governor. 
Sec. B-11. 32 MR.SA §2594-A, as amended by PL 2013, c. 33, §1, is further 
amended to read: 
§2594-A. Assistants; delegating authority 
Nothing contained in tlris chapter may be construed to prohibit an individual from 
rendering medical services if these services are rendered under the supervision and 
control of a physician and if the individual has satisfactorily completed a training 
program approved by the Board of Osteopathic Licensure. Supervision and control may 
not be construed as requiring the personal presence of the superYising and controlling 
physician at the place where these services are rendered, unless a physical presence is 
necessary to provide patient care of the same quality as provided by the physician. 
Nothing in tlris This chapter may not be construed as prohibiting a physician from 
delegating to the physician's employees or support staff certain activities relating to 
medical care and treatment carried out by custom and usage when these activities are 
under the direct control of the physician. The physician delegating these activities to 
employees or support staff, to program graduates or to participants in an approved 
training program is legally liable for the activities of those individuals, and any individual 
in this relationship is considered the physician's agent. Nothing contained in this section 
may be construed to apply to registered nurses acting pursuant to chapter 31 and licensed 
physician assistants acting pursuant to this chapter or chapter 48. 
When the delegated activities are part of the practice of optometty as defined in 
chapter 34-A, then the individual to whom these activities are delegated must possess a 
valid license to practice optometry in Maine or otherwise may perform only as a 
technician within the established office of a physician and may act solely on the order of 
and under the responsibility of a physician skilled in the treatment of eyes as designated 
by the proper professional board and without assuming evaluation or interpretation of 
examination findings by prescribing corrective procedures to preserve, restore or improve 
vision. 
Sec. B-12. 32 MR.SA §2594-E, as amended by PL 2017, c. 288, Pt. A, §33, is 
further amended to read: 
§2594-E. License and registration Licensure of physician assistants 
1. 
License and registration required. 
A physician assistant may not render 
medical services under the supervision of an osteopathic physician or an allopathic 
physician pursuant to a plan of supervision until the physician assistant has applied for 
and obtained from either the Board of Osteopathic Licensure or the Board of Licensure in 
Medicine: 
A. A license, which must be renewed biennially with the board that issued the initial 
licens~~ 
B. A certificate of registration. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" f) "to S.P. 537, L.D. 1660 
Applications An application for licensure and certificate of registration as a physician 
assistant must be made to the board that licenses the physician assistant's primary 
supervising physician at the time the applications for initial lic@nSure and certificate of 
registration are filed. 
A physician assistant who applies for licsnsure without a 
designated primary supervising physician may submit the application submitted to either 
the Board of Osteopathic Licensure or the Board of Licensure in Medicine. A license 
granted by either the Board of Osteopathic Licensure or the Board of Licensure in 
Medicine authorizes the physician assistant to render medical services under the 
supervision of an osteopathic or allopatbic physician regardless of which board issued the 
licsnse to the physician assistant. 
2. Qualification for Iicensure. The board may issue to an individual a license to 
practice as a physician assistant under the following conditions: 
A. A license may be issued to an individual who: 
(1) Graduated from a physician assistant program approved by the board; 
(2) Passed a physician assistant national certifying examination administered by 
the National Commission on Certification of Physician Assistants or its successor 
organization; 
(3) Demonstrates current clinical competency; 
(4) Does not have a license or certificate of registration that is the subject of 
disciplinary action such as probation, restriction, suspension, revocation or 
surrender; 
(5) Completes an application approved by the board; 
(6) Pays an application fee ofup to~ $300; and 
(7) Passes an examination approved by the board7; and 
B. No grounds exist as set forth in section 2591-A to deny the application. 
3. 
Certificate ef registratien. 
A physician assistant may not render medical 
services until issued a certificate of registration by the board. The board may issue a 
certificate of registration to a physieian assistant under the following requirements: 
A. The physician assistant shall: 
(1) Submit an applieation on forms approved by the board. The application must 
include: 
(a) 
A written statement by the proposed supervising physician talcing 
responsibility for all medical activities of the physician assistant; and 
(b) A vtritten statement by the physician assistant and proposed supervising 
physician that a written plan of supervision has been established; and 
(2) Pays an applicatioa fue ofup to $50. 
B. 
A proposed supervising physioian must hold an active license to praotice 
medicine in the State and be in good standiag. 
COMMITTEE AMENDMENT 
f 
COMMITTEE AMENDMENT" A "to S.P. 537, L.D. 1660 ( 
4. Delegation by physician assistant. A physician assistant may delegate medioal 
acts to a medical assistant employed by the physician assistant or by an employer of the 
physician assistant as long as that delegation is permitted in the plan of sl;lf)srvision 
established by the physioian assistant and the supervising physioian to the physician 
assistant's employees or support staff or members of a health care team, including 
medical assistants. certain activities relating to medical care and treatment carried out by 
custom and usage when the activities are under the control of the physician assistant The 
physician assistant who delegates an activity permitted under this subsection is legally 
liable for the activity performed by an employee, a medical assistant, support staff or a 
member of a health care team. 
5. Rules. The Board of Osteopathic Licensure is authorized to adopt rules regarding 
the training and licensure and practice of physician assistants and the agenoy relationship 
between the physician assistant and the Sl;lflerYising physician. These rules, which must be 
adopted jointly with the Board of Licensure in Medicine, may pertain to, but are not 
limited to, the following matters: 
A. Information to be contained in the application for a license and certificate of 
registration; 
B. Information that is required on the application for a certificate of registration filed 
by the proposed supervising physician; 
C. Training and education Education requirements and seope of permissible clinical 
medical proeedures of for the physician assistant and the maHner and methods by 
which the supervising physioian must Sl;lf)eryise the physioian assistant's modioal 
seryices; 
D. Scope of practice for physician assistants, including prescribing of eontrolled 
~ 
E. 
Requirements for written plans of supervision collaborative agreements and 
practice agreements under section 2594-F, including uniform standards and forms; 
F. 
Requirements for a physician assistant to notify the board regarding certain 
circumstances, including but not limited to any change in address, any change in the 
identity or address of the physician assistant's employer or in the physiciaa assistant's 
employment statas, any change in. the identity or address of the supervising 
physician, the permanent departure of the physician assistant from the State, any 
criminal convictions of the physician assistant and any discipline by other 
jurisdictions of the physician assistant; 
G. Issuance of temporary physician assistant licenses aad temporary registration of 
physician assistants; 
H. Appointment of an advisory committee for continuing review of the physician 
assistant program and rules. The physician assistant member members of the board 
pursuant to section 2561 must be a member members of the advisory committee; 
I. Continuing education requirements as a precondition to continued licensure or 
licensure renewal; 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" 11 "to S.P. 537, L.D. 1660 ( ';;, 
H' 
-
) 
J. Fees for the application for an initial physician assistant license, which may not 
exceed~ $300; and 
K. Fees for an initial certificate of registration, 1.vhich may not ~ceed $100; 
L. Pees for transfer of the certificate of registration by a physician assistant from one 
supervising physician to another, vm.ich may not exceed $50; and 
M. Fees for the biennial renewal of a physician assistant license in an amount not to 
exceed $250. 
Sec. B-13. 32 MRSA §2594-F is enacted to read: 
§2594-F. Physician assistants; scope of practice and agreement requirements 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Collaborative agreement" means a document agreed to by a physician assistant 
and a physician that describes the scope of practice for the physician assistant as 
determined by practice setting and describes the decision-making process for a health 
care team. including communication and consultation among health care team 
members. 
B. "Consultation" means engagment in a process in which members of a health care 
team use their complementary training, skill. knowledge and experience to provide 
the best care for a patient. 
C. "Health care team" means 2 or more health care professionals working in a 
coordinated. complementary and agreed-upon manner to provide quality, cost-
effective. evidence-based care to a patient and may include a physician, physician 
assistant, advanced practice nurse. nurse, physical therapist. occupational therapist, 
speech therapist, social worker. nutritionist. psychotherapist, counselor or other 
licensed professional. 
D. "Physician" means a person licensed as a physician under this chapter or chapter 
48. 
E. "Physician assistant" means a person licensed under section 2594-E or 3270-E. 
F. "Practice agreement" means a document agreed to by a physician assistant who is 
the principal clinical provider in a practice and a physician that states the physician 
will be available to the physician assistant for collaboration gr consultation. 
G. "Prescription or legend drug" has the same meaning as "prescription drug" in 
section 13702-A. subsection 30 and includes schedule II to schedule V drugs or other 
substances under the federal Controlled Substances Act, 21 United States Code, 
Section 812. 
2. Scope of practice. A physician assistant may provide any medical service for 
which the physician assistant has been prepared by education, training and experience 
8 
and is competent to perform. The scope of practice of a physician assistant is determined 
by practice setting. including. but not limited to. a physician employer setting, physician 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" /i "to S.P. 537, L.D. 1660 
group practice setting or independent private practice setting, or, in a health care facility 
setting. by a system of credentialing and granting of privileges. 
3. Dispensing drugs. Except for distributing a professional sample of a prescription 
or legend drug, a physician assistant who dispenses a prescription or legend drug: 
A. Shall comply with all relevant federal and state laws and federal regulations and 
state rules: and 
B. May dispense the prescription or legend drug only when: 
(1) A pharmacy service is not reasonably available: 
(2) Dispensing the drug is in the best interests of the patient: or 
(3) An emergency exists. 
4. Consultation. A physician assistant shall. as indicated by a patient's condition, 
the education. competencies and experience of the physician assistant and the standards 
of care, consult with, collaborate with or refer the patient to an appropriate physician or 
other health care professional. The level of consultation required under this subsection is 
determined by the practice setting, including a physician employer. physician group 
practice or private practice. or by the system of credentialing and granting of privileges of 
a health care facility. A physician must be accessible to the physician assistant at all times 
for consultation. Consultation may occur electronically or through telecommunication 
and includes communication. task sharing and education among all members of a health 
care team. 
5. Collaborative agreement requirements. A physician assistant with less than 
4,000 hours of clinical practice documented to the board shall work in accordance with a 
collaborative agreement with an active physician that describes the physician assistant's 
scope of practice. except that a physician assistant working in a physician group practice 
setting or a health care facility setting under a system of credentialing and granting of 
privileges and scope of practice agreement may use that system of credentialing and 
granting of privileges and scope of practice agreement in lieu of a collaborative 
agreement. A physician assistant is legally responsible and assumes legal liability for any 
medical service provided by the physician assistant in accordance with the physician 
assistant's scope of practice under subsection 2 and a collaborative agreement under this 
subsection. Under a collaborative agreement. collaboration may occur through electronic 
means and does not require the physical presence of the physician at the time or place that 
the medical services are provided. A physician assistant shall submit the collaborative 
agreement. or. if appropriate. the scope of practice agreement, to the board for approval 
and the agreement must be kept on file at the main location of the place of practice and be 
made available to the board or the board's representative upon request. Upon submission 
to the board of documentation of 4.000 hours of clinical practice. a physician assistant is 
no longer subject to the requirements of this subsection. 
6. Practice agreement requirements. A physician assistant who has more than 
4,000 hours of clinical practice may be the principal clinical provider in a practice that 
does not include a physician partner as long as the physician assistant has a practice 
agreement with an active physician, and other health care professionals as necessary. that 
describes the physician assistant's scope of practice. A physician assistant is legally 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "Pt" to S.P. 537, L.D. 1660 ( 
responsible anq assumes legal liability for any medical service provided by the physician 
assistant in accordance with the physician assistant's scope of practice under subsection 2 
and a practice l!,greement under this subsection. A physician assistant shall submit the 
practice agreement to the board for approval and the agreement must be kept on file at the 
main location of the physician assistant's practice and be made available to the board or 
the board's representative upon request. Upon any change in the parties to the practice 
agreement or other substantive change in the practice agreement, the physician assistant 
shall submit the revised practice agreement to the board for approval. Under a practice 
agreement, consultation may occur through electronic means and does not require the 
physical presence of the physician or other health care providers who are parties to the 
agreement at the time or place that the medical services are provided. 
7. 
Construction. 
To address the need for affordable. high-quality health care 
services throughout the State and to expand, in a safe and responsible ·manner, access to 
health care providers such as physician assistants. this section must be liberally construed 
to authorize physician assistants to provide health care services to the full extent of their 
education, training and experience in accordance with their scopes of practice as 
determined by their practice settings. 
Sec. B-14. 32 MRSA §3263, first ,, as amended by PL 2013, c. 101, §5, is 
further amended to read: 
The Board of Licensure in Medicine, as established by Title 5, section 12004-A, 
subsection 24, and in this chapter called the "board," consists of -1-0 11 individuals who 
are residents of this State, appointed by the Governor. 
Three individuals must be 
representatives of the public. Six individuals must be graduates of a legally chartered 
medical college or university having authority to confer degrees in medicine and must 
have been actively engaged in the practice of their profession in this State for a 
continuous period of 5 years preceding their appointments to the board. One individual 
Two individuals must be a physician assistant assistants licensed under this chapter who 
has have been actively engaged in the practice of that indhzidual's the profession of 
physician assistant in this State for a continuous period of 5 years preceding appointment 
to the board. A full-term appointment is for 6 years. Appointment of members must 
comply with Title 10, section 8009. A member of the board may be removed from office 
for cause by the Governor. 
Sec. B-15. 32 MRSA §3270-A, as amended by PL 2013, c. 33, §2, is further 
amended to read: 
§3270-A. Assistants; delegating authority 
This chapter may not be construed to prohibit an individual from rendering medical 
senzices if these services are rendered under the supervision and control of a physician or 
surgeon and if that individual has satisfactorily completed a training program approved 
by the Board of Licensure in Medicine and a competency e*amination determined by this 
board. Supervision and eontrol may not be construed as req-iriring the personal presence 
of the supervising and controlling physician at the place v,1here these services are 
rendered, unless a physical presence is necessary to prO't'ide patient care of the same 
quality as provided by the physician. This chapter may not be construed as prohibiting a 
physician or surgeon from delegating to the physician's or surgeon's employees or support 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT "f) "to S.P. 537, L.D. 1660 ( 
staff certain activities relating to medical care and treatment carried out by custom and 
usage when the activities are under the control of the physician or surgeon. The physician 
delegating these activities to employees or support staff, to program graduates or to 
participants in an approved training program is legally liable for the activities of those 
individuals, and any individual in this relationship is considered the physician's agent. 
This section may not be construed to apply to registered nurses acting pursuant to chapter 
and licensed physician assistants acting pursuant to this chapter and chapter 36. 
When the delegated activities are part of the practice of optometry as defmed in 
chapter 34-A, then the individual to whom these activities are delegated must possess a 
valid license to practice optometry in Maine, or otherwise may perform only as a 
technician within the established office of a physician, and otherwise acting solely on the 
order of and under the responsibility of a physician skilled in the treatment of eyes as 
designated by the proper professional board, and without assuming evaluation or 
interpretation of examination fmdings by prescribing corrective procedures to preserve, 
restore or improve vision. 
Sec. B-16. 32 MRSA §3270-E, as amended by PL 2017, c. 288, Pt. A, §34, is 
further amended to read: 
§3270-E. License and registration Licensure of physician assistants 
1. 
License and registration required. 
A physician assistant may not render 
medical services under the supervision of an osteopathic physician or an allopathic 
physician pursuant to a plan of supervision until the physician assistant has applied for 
and obtained from either the Board of Li censure in Medicine or the Board of Osteopathic 
Licensure: 
A. A license, which must be renewed biennially with the board that issued the initial 
licenset-afl4~ 
B. A. certificate of registration. 
Applications An application for licensure and certificate of registration as a physician 
assistant must be made to the board that licenses the physician assistant's primary 
supervising physician at the time the applicatioas for initial lioensure and certificate of 
registration are filed. 
l'.. physician assistant who applies for Hcensur6 without a 
designated primary supervising physician may submit the application submitted to either 
the Board of Osteopathic Licensure or the Board of Licensure in Medicine. A license 
granted by either the Board of Osteopathic Licensure or the Board of Licensure in 
Medicine authorizes the physician assistant to render medical services under the 
supervision of an allopathio or osteopathic physician regardless of which board issued the 
license to the physician assistant, 
2. Qualification for Iicensure. The board may issue to an individual a license to 
practice as a physician assistant under the following conditions: 
A. A license may be issued to an individual who: 
(1) Graduated from a physician assistant program approved by the board; 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" f+ "to S.P. 537, L.D. 1660 ( 
(2) Passed a physician assistant national certifying examination administered by 
the National Commission on Certification of Physician Assistants or its successor 
organization; 
(3) Demonstrates current clinical competency; 
(4) Does not have a license or certificate of registration that is the subject of 
disciplinary action such as probation, restriction, suspension, revocation or 
surrender; 
(5) Completes an application approved by the board; 
(6) Pays an application fee ofup to $UG $300; and 
(7) Passes an examination approved by the board; and 
B. No grounds exist as set forth in section 3282-A to deny the application. 
3. 
Certifieate af registration. 
A physician assistant may not render medical 
services until issued a certificate of registration by the board. The board may issue a 
certificate of registration to a physician assistant under the following requirements: 
A. The physician assistant shall: 
(I) Submit an application on forms approved by the board. The application must 
include: 
(a) 
f~ written statement by the proposed supervising physician taking 
responsibility for all medical activities of the physician assistant; and 
(b) A ,,mitten statement by the physician assistant and proposed supervising 
physician that a \vritten plan of supervision has been established; and 
(2) Pays an application fee ofup to $50. 
B. 
A proposed supervising physician must hold an acti¥e license to practice 
medicine in the State and be in good standing. 
4. Delegation by physician assistant. A physician assistant may delegate medical 
acts to a medical assistant employed by the physician assistant or by an employer of the 
physician assistant as long as that delegation is permitted in the plan of supervision 
established by the physician assistant and the supervising physician to the physician 
assistant's employees or support staff or members of a health care team. including 
medical assistants. certain activities relating to medical care and treatment carried out by 
custom and usage when the activities are under the control of the physician assistant. The 
physician assistant who delegates an activity permitted under this subsection is legally 
liable for the activity performed by an employee. a medical assistant. support staff or a 
member of a health care team. 
5. Rules. The Board of Licensure in Medicine is authorized to adopt rules regarding 
the training ood licensure and practice of physician assistants and the agency relationship 
benvoen tho physician assistant and tho supervising physician. These rules, which must be 
adopted jointly with the Board of Osteopathic Licensure, may pertain to, but are not 
limited to, the following matters: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" ft" to S.P. 537, L.D. 1660 
A. Information to be contained in the application for a license and oertifioate of 
registration; 
B. Infonnation that is required on the applioation for a oertifioate of registration filed 
by the proposed supervising physieian; 
C. Training and eduoation Education requirements and soope of permissible olinioal 
medieal prooedures of for the physician assistant and the manner and methods by 
whioh the supervising physieian must supervise the physician assistant's medioal 
servioes; 
D. 
Scope of praotice for physician assistants, inoludiag prescribing of controlled 
drugst 
E. 
Requirements for vmtten plans of supervision collaborative agreements and 
practice agreements under section 3270-G, including uniform standards and forms; 
F. 
Requirements for a physician assistant to notify the board regarding certain 
circumstances, including but not limited to any change in address, any ohaage in the 
identity or address of the physieian assistant's employer or in the physician assistant's 
employment status, any ohange in the identity or address of the supervising 
physieian, the permanent departure of the physician assistant from the State, any 
criminal convictions of the physician assistant and any discipline by other 
jurisdictions of the physician assistant; 
G. Issuance of temporary physician assistant licenses and temporary registration of 
physieian assistants; 
H. Appointment of an advisory committee for continuing review of the physician 
assistant program and rules. The physician assistant member members of the board 
pursuant to section ~ 
3263 must be a member members of the advisory 
committee; 
I. Continuing education requirements as a precondition to continued licensure or 
Iicensure renewal; 
J. Fees for the application for an initial physician assistant license, which may not 
exceed~ $300; and 
K. Fees for an initial eertifieate of registration, w-hioh may not exceed $100; 
L. Fees for transfer of the certificate of registration by a physician assistant from one 
supervisiag physician to another, •.vhioh may :not e1weed $50; and 
M. Fees for the biennial renewal of a physician assistant license in an amount not to 
exceed $250. 
Sec. B-17. 32 MRSA §3270-G is enacted to read: 
§3270-G. Physician assistants; scope of practice and agreement requirements 
1. Definitions. As used in this section. unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Collaborative agreement" means a document agreed to by a physician assistant 
and a physician that describes the scope of practice for the physician assistant as 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" J'.1 "to S.P. 537, L.D. 1660 ( ••-.,, . .,.,_1·."'·'·~ 
•1 
-
determined by practice setting and describes the decision-making process for a health 
care team, including communication and consultation among health care team 
members. 
B. "Consultation" means engagement in a process in which members of a health care 
team use their complementary training, skill, knowledge and experience to provide 
the best care for a patient. 
C. 
"Health care team" means 2 or more health care professionals working in a 
coordinated. complementary and agreed-upon manner to provide quality. cost-
effective, evidence-based care to a patient and may include a physician. physician 
assistant. advanced practice nurse. nurse. physical therapist, occupational therapist. 
speech therapist. social worker, nutritionist. psychotherapist, counselor or other 
licensed professional. 
D. "Physician" means a person licensed as a physician under this chapter or chapter 
36. 
E. "Physician assistant" means a person licensed under section 2594-E or 3270-E. 
F. "Practice agreement" means a document agreed to by a physician assistant who is 
the principal clinical provider in a practice and a physician that states the physician 
will be available to the physician assistant for collaboration or consultation. 
G. "Prescription or legend drug" has the same meaning as "prescription drug" in 
section 13702-A. subsection 30 and includes schedule II to schedule V drugs or other 
substances under the federal Controlled Substances Act, 21 United States Code, 
Section 812. 
2. Scope of practice. A physician assistant may provide any medical service for 
which the physician assistant has been prepared by education, training and experience 
and is competent to perform. The scope of practice of a physician assistant is determined 
by practice setting, including, but not limited to. a physician employer setting, physician 
group practice setting or independent private practice setting. or, in a health care facility 
setting. by a system of credentialing and granting of privileges. 
3. Dispensing drugs. Except for distributing a professional sample of a prescription 
or legend drug. a physician assistant who dispenses a prescription or legend drug: 
A. Shall comply with all relevant federal and state laws and federal regulations and 
state rules: and 
B. May dispense the prescription or legend drug only when: 
(1) A pharmacy service is not reasonably available: 
(2) Dispensing the drug is in the best interests of the patient: or 
(3) An emergency exists. 
4. Consultation. A physician assistant shall, as indicated by a patient's condition. 
the education. competencies and experience of the physician assistant and the standards 
of care, consult with. collaborate with or refer the patient to an appropriate physician or 
other health care professional. The level of consultation required under this subsection is 
COMMITTEE AMENDMENT 
COMMITTEEAMENDMENT"f+ "to S.P. 537, L.D. 1660 (_ 
\ ) 
determined by the practice setting. including a physician employer, physician group 
practice. or private practice. or by the system of credentialing and granting of privileges 
of a health care facility. A physician must be accessible to the physician assistant at all 
times 
for 
consultation. 
Consultation 
may 
occur 
electronically 
or 
through 
telecommunication and includes communication, task sharing and education among all 
members of a health care team. 
5. Collaborative agreement requirements. A physician assistant with less than 
4,000 hours of clinical practice documented to the board shall work in accordance with a 
collaborative agreement with an active physician that describes the physician assistant's 
scope of practice, except that a physician assistant working in a physician group practice 
setting or a health care facility setting under a system of credentialing and granting of 
privileges and scope of practice agreement may use that system of credentialing and 
granting of privileges and scope of practice agreement in lieu of a collaborative 
agreement. A physician assistant is legally responsible and assumes legal liability for any 
medical service provided by the physician assistant in accordance with the physician 
assistant's scope of practice under subsection 2 and a collaborative agreement under this 
subsection. Under a collaborative agreement. collaboration may occur through electronic 
means and does not require the physical presence of the physician at the time or place that 
the medical services are provided. A physician assistant shaU submit the collaborative 
agreement. or, if appropriate, the scope of practice agreement, to the board for approval 
and the agreement must be kept on file at the main location of the place of practice and be 
made available to the board or the board's representative upon request. Upon submission 
to the board of documentation of 4,000 hours of clinical practice, a physician assistant is 
no longer subject to the requirements of this subsection. 
6. Practice agreement requirements. A physician assistant who has more than 
4,000 hours of clinical practice may be the principal clinical provider in a practice that 
does not include a physician partner as long as the physician assistant has a practice 
agreement with an active physician, and other health care professionals as necessary, that 
describes the physician assistant's scope of practice. A physician assistant is legally 
responsible and assumes legal liability for any medical service provided by the physician 
assistant in accordance with the physician assistant's scope of practice under subsection 2 
and a practice agreement under this subsection. A physician assistant shall submit the 
practice agreement to the board for approval and the agreement must be kept on file at the 
main location of the physician assistant's practice and be made available to the board or 
the board's representative upon request. Upon any change in the parties to the practice 
agreement or other substantive change in the practice agreement, the physician assistant 
7 
shall submit the revised practice agreement to the board for approval. Under a practice 
agreement, consultation may occur through electronic means and does not require the 
physical presence of the physician or other health care providers who are parties to the 
agreement at the time or place that the medical services are provided. 
7. 
Construction. To address the need for affordable, high-quality health care 
services throughout the State and to expand, in a safe and responsible manner. access to 
health care providers such as physician assistants, this section must be liberally construed 
to authorize physician assistants to provide health care services to the full extent of their 
education, training and experience in accordance with their scopes of practice as 
determined by their practice settings. 
COMMITTEE AMENDMENT 
I 
COMMITTEE AMENDMENT" f:J,, "to S.P. 537, L.D. 1660 ( 
t; 
.. 
Sec. B-18. 32 MRSA §3300-C, as enacted by PL 2011, c. 477, Pt. J, §1, is 
repealed. 
Sec. B-19. 32 MRSA §13786, last ,r, as enacted by PL 1987, c. 710, §5, is 
amended to read: 
This section applies to any physician's assistant or registered nurse who writes a 
prescription while working under the control or supervision of a physician. lR ease of the 
physioian's assistant or registered nurse, the The name of the physician under whom the 
assistant or nurse works shall must be printed, stamped or typed on the blank. 
Sec. B-20. 34-B MRSA §3801, sub-§4-B, as enacted by PL 2009, c. 651, §5, is 
amended to read: 
4-B. 
Medical practitioner. 
"Medical practitioner" or "practitioner" means a 
licensed physician, registered licensed physician assistant, certified psychiatric clinical 
nurse specialist, certified nurse practitioner or licensed clinical psychologist. 
Sec. B-21. 37-B MRSA §185, sub-§1-A, as amended by PL 2015, c. 242, §6, is 
further amended to read: 
1-A. Immunity from civil and criminal liability for sapervising collaborating or 
consulting physician. 
Subsection 1 applies to the supervising a collaborating or 
consulting physician of a physician assistant under Title 32, section 2594 B 2594-F or 
3270 E 3270-G: 
A. 
With regard to any act of the physician assistant in providing services to 
individuals not on active state service; 
B. When the physician assistant is on active state service in the performance of the 
physician assistant's duty; and 
C. When the supervising collaborating or consulting physician is not on active state 
service. 
Sec. B-22. Transition. The license of a physician assistant under the Maine 
Revised Statutes, Title 32, section 2594-B or section 3270-B that is current, active and not 
under investigation on the effective date of this Act remains valid. A physician assistant 
holding an active, nonclinical license that is not under investigation on the effective date 
of this Act and who has not been out of clinical practice for more than 2 years as of the 
effective date of this Act is deemed to have a valid license. A physician assistant holding 
an active, nonclinical license who has been out of clinical practice for more than 2 years 
as of the effective date of this Act is required to meet any requirements established by the 
board before being issued a license. 
PARTC 
Sec. C-1. Appropriations and allocations. The following appropriations and 
allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Office ofMaineCare Services 0129 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT"(} "to S.P. 537, L.D.1660 (_ 
Initiative: Provides one-time appropriation and allocation for technology changes 
required to allow physician assistants to be reimbursed directly for services. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
FEDERAL EXPENDITURES FUND 
All Other 
FEDERAL EXPENDITURES FUND TOTAL 
2019-20 
$26,139 
$26,139 
2019-20 
$78,418 
$78,418 
2020-21 
$0 
$0 
2020-21 
$0 
$0 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment replaces the bill and does the following. 
In Part A, the amendment requires health insurance carriers to allow physician 
assistants to serve as primary care providers under managed care plans. It also specifies 
that carriers are required to provide coverage for services provided by physician assistants 
if those services are within a physician assistant's scope of practice and are covered 
services under a health plan and makes that provision applicable to contracts issued or 
renewed on or after January 1, 2021. 
In Part B, the amendment makes the following changes to the laws governing the 
licensing and scope of practice of physician assistants. 
1. It increases the membership of the Board of Osteopathic Licensure and the Board 
of Licensure in Medicine from 10 to 11 members by changing the number of members on 
each board who are physician assistants from one member to 2 members. 
2. It establishes provisions for the scope of practice of physician assistants based on 
practice setting. 
3. It removes registration and physician supervisory requirements and establishes 
requirements for physician assistants to have collaborative agreements and practice 
agreements with physicians and other health care professionals. 
4. 
It clarifies that physician assistants are legally responsible for any medical 
services provided in accordance with collaborative and practice agreements and 
authorizes the licensing boards to adopt rules related to requirements for collaborative 
and practice agreements. 
5. It changes the fee for an application for initial licensure from up to $250 to up to 
$300. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" f)-" to S.P. 537, L.D. 1660 
6. It provides a transition provision for physician assistant licenses that are cunent 
and not under investigation. 
In Part C, the amendment adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/10/20 .:wac 
LD 1660 
LR 1174(02) 
An Act To Improve Access to Physician Assistant Care 
Fiscal Note for Bill as Amended by Committee Amendment 'ft"(S-,1~;9-
Committee: Health Coverage, Insurance and Financial Services 
Net Cost (Savings) 
General Fund 
Appropriations/ Allocations 
General Fund 
Federal Expenditures Fund 
Revenue 
Federal Expenditures Fund 
Other Special Revenue Funds 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2019-20 
$26,139 
$26,139 
$78,418 
$78,418 
$0 
FY 2020-21 
$0 
$0 
$0 
$0 
($51,000) 
Projections 
FY 2021-22 
$0 
$0 
$0 
$0 
($51,000) 
Projections 
FY 2022-23 
$0 
$0 
$0 
$0 
($51,000) 
The bill includes a one-time General Fund appropriation to the Department of Health and Human Services of $26,139 
in fiscal year 2019-20 for technology changes required to allow physician assistants to be reimbursed directly for 
services. A one-time Federal Expenditures Fund allocation is also included for the FMAP match. 
The impact of the change in certain application and registration fees is a net reduction in dedicated revenue of 
$35,000 annually to the Board of Licensure in Medicine and $16,000 annually to the Board of Osteopathic Li censure, 
both affiliated boards of the Department of Professional and Financial Regulation. 
LRl 174(02) - Fiscal Note - Page l of 1