2023 Maryland Statutes › Health Occupations › Title 15 - Physician Assistants › Subtitle 3 - Certification › Section 15-302 - Delegation Agreements

(a)    A physician may delegate medical acts to a physician assistant only after:
(1)    A delegation agreement has been executed and filed with the Board; and
(2)    Any advanced duties have been authorized as required under subsection (c) of this section.
(b)    The delegation agreement shall contain:
(1)    A description of the qualifications of the primary supervising physician and physician assistant;
(2)    A description of the settings in which the physician assistant will practice;
(3)    A description of the continuous physician supervision mechanisms that are reasonable and appropriate to the practice setting;
(4)    A description of the delegated medical acts that are within the primary or alternate supervising physician’s scope of practice and require specialized education or training that is consistent with accepted medical practice;
(5)    An attestation that all medical acts to be delegated to the physician assistant are within the scope of practice of the primary or alternate supervising physician and appropriate to the physician assistant’s education, training, and level of competence;
(6)    An attestation of continuous supervision of the physician assistant by the primary supervising physician through the mechanisms described in the delegation agreement;
(7)    An attestation by the primary supervising physician of the physician’s acceptance of responsibility for any care given by the physician assistant;
(8)    A description prepared by the primary supervising physician of the process by which the physician assistant’s practice is reviewed appropriate to the practice setting and consistent with current standards of acceptable medical practice;
(9)    An attestation by the primary supervising physician that the physician will respond in a timely manner when contacted by the physician assistant;
(10)    The following statement: “The primary supervising physician and the physician assistant attest that:
(i)    They will establish a plan for the types of cases that require a physician plan of care or require that the patient initially or periodically be seen by the supervising physician; and
(ii)    The patient will be provided access to the supervising physician on request”; and
(11)    Any other information deemed necessary by the Board to carry out the provisions of this subtitle.
(c)    (1)    The Board may not require prior approval of a delegation agreement that includes advanced duties, if an advanced duty will be performed in a hospital or ambulatory surgical facility, provided that:
(i)    A physician, with credentials that have been reviewed by the hospital or ambulatory surgical facility as a condition of employment, as an independent contractor, or as a member of the medical staff, supervises the physician assistant;
(ii)    The physician assistant has credentials that have been reviewed by the hospital or ambulatory surgical facility as a condition of employment, as an independent contractor, or as a member of the medical staff; and
(iii)    Each advanced duty to be delegated to the physician assistant is reviewed and approved within a process approved by the governing body of the health care facility before the physician assistant performs the advanced duties.
(2)    (i)    In any setting that does not meet the requirements of paragraph (1) of this subsection, a primary supervising physician shall obtain the Board’s approval of a delegation agreement that includes advanced duties, before the physician assistant performs the advanced duties.
(ii)    1.    Before a physician assistant may perform X–ray duties authorized under § 14–306(e) of this article in the medical office of the physician delegating the duties, a primary supervising physician shall obtain the Board’s approval of a delegation agreement that includes advanced duties in accordance with subsubparagraph 2 of this subparagraph.
2.    The advanced duties set forth in a delegation agreement under this subparagraph shall be limited to nonfluoroscopic X–ray procedures of the extremities, anterior–posterior and lateral, not including the head.
(3)    Notwithstanding paragraph (1) of this subsection, a primary supervising physician shall obtain the Board’s approval of a delegation agreement before the physician assistant may administer, monitor, or maintain general anesthesia or neuroaxial anesthesia, including spinal and epidural techniques, under the agreement.
(d)    For a delegation agreement containing advanced duties that require Board approval, the Committee shall review the delegation agreement and recommend to the Board that the delegation agreement be approved, rejected, or modified to ensure conformance with the requirements of this title.
(e)    The Committee may conduct a personal interview of the primary supervising physician and the physician assistant.
(f)    (1)    On review of the Committee’s recommendation regarding a primary supervising physician’s request to delegate advanced duties as described in a delegation agreement, the Board:
(i)    May approve the delegation agreement; or
(ii)    1.    If the physician assistant does not meet the applicable education, training, and experience requirements to perform the specified delegated acts, may modify or disapprove the delegation agreement; and
2.    If the Board takes an action under item 1 of this item:
A.    Shall notify the primary supervising physician and the physician assistant in writing of the particular elements of the proposed delegation agreement that were the cause for the modification or disapproval; and
B.    May not restrict the submission of an amendment to the delegation agreement.
(2)    To the extent practicable, the Board shall approve a delegation agreement or take other action authorized under this subsection within 90 days after receiving a completed delegation agreement including any information from the physician assistant and primary supervising physician necessary to approve or take action.
(g)    If the Board determines that a primary or alternate supervising physician or physician assistant is practicing in a manner inconsistent with the requirements of this title or Title 14 of this article, the Board on its own initiative or on the recommendation of the Committee may demand modification of the practice, withdraw the approval of the delegation agreement, or refer the matter to a disciplinary panel for the purpose of taking other disciplinary action under § 14–404 or § 15–314 of this article.
(h)    A primary supervising physician may not delegate medical acts under a delegation agreement to more than four physician assistants at any one time, except in a hospital or in the following nonhospital settings:
(1)    A correctional facility;
(2)    A detention center; or
(3)    A public health facility.
(i)    A person may not coerce another person to enter into a delegation agreement under this subtitle.
(j)    A physician may supervise a physician assistant:
(1)    As a primary supervising physician in accordance with a delegation agreement approved by the Board under this subtitle; or
(2)    As an alternate supervising physician if:
(i)    The alternate supervising physician supervises in accordance with a delegation agreement filed with the Board;
(ii)    The alternate supervising physician supervises no more than four physician assistants at any one time, except in a hospital, correctional facility, detention center, or public health facility;
(iii)    The alternate supervising physician’s period of supervision, in the temporary absence of the primary supervising physician, does not exceed:
1.    The period of time specified in the delegation agreement; and
2.    A period of 45 consecutive days at any one time; and
(iv)    The physician assistant performs only those medical acts that:
1.    Have been delegated under the delegation agreement filed with the Board; and
2.    Are within the scope of practice of the primary supervising physician and alternate supervising physician.
(k)    Subject to the notice required under § 15–103 of this title, a physician assistant may terminate a delegation agreement filed with the Board under this subtitle at any time.
(l)    (1)    In the event of the sudden departure, incapacity, or death of the primary supervising physician of a physician assistant, or change in license status that results in the primary supervising physician being unable to legally practice medicine, an alternate supervising physician designated under subsection (b) of this section may supervise the physician assistant for not longer than 15 days following the event.
(2)    If there is no designated alternate supervising physician or the designated alternate supervising physician does not agree to supervise the physician assistant, the physician assistant may not practice until the physician assistant receives approval of a new delegation agreement under § 15–302.1 of this subtitle.
(3)    An alternate supervising physician or other licensed physician may assume the role of primary supervising physician by submitting a new delegation agreement to the Board for approval under subsection (b) of this section.
(4)    The Board may terminate a delegation agreement if:
(i)    The physician assistant has a change in license status that results in the physician assistant being unable to legally practice as a physician assistant;
(ii)    At least 15 days have elapsed since an event listed under paragraph (1) of this subsection if there is an alternate supervising physician designated under subsection (b) of this section; or
(iii)    Immediately after an event listed under paragraph (1) of this subsection if there is no alternate supervising physician designated under subsection (b) of this section.
(m)    A physician assistant whose delegation agreement is terminated may not practice as a physician assistant until the physician assistant receives preliminary approval of a new delegation agreement under § 15–302.1 of this subtitle.
(n)    Individual members of the Board are not civilly liable for actions regarding the approval, modification, or disapproval of a delegation agreement described in this section.
(o)    A physician assistant may practice in accordance with a delegation agreement filed with the Board under this subtitle.