.06 Delegation Agreements — Approval.

A. Review by the Board.

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

(2) The Board may disapprove a delegation agreement or delegation of an advanced duty based upon:

(a) Licensure or compliance issues with the primary supervising physician or the physician assistant;

(b) Failure of the delegation agreement to meet the requirements of:

(i) Health Occupations Article, Title 15, Subtitle 3, Annotated Code of Maryland; or

(ii) Regulation .05 of this chapter; or

(c) Belief that the physician assistant cannot safely perform the delegated duty.

(3) 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.

(4) 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.

(1) 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.

(2) 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.

(1) Regardless of setting or other factors, a supervising physician may not delegate and a physician assistant may not perform general anesthesia or neuroaxial anesthesia before the Board has approved the delegation.

(2) The Board shall provide written notification of approval or disapproval of the delegation under §C(1) of this regulation.

(3) If the Board disapproves the delegation under §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.

D. Advanced Duties in a Special Facility.

(1) 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 special facility’s privileging process.

(2) The Board shall notify the physician assistant and the primary supervising physician that the Board received the delegation agreement.

(3) If the Board disapproves a delegation agreement under §D(1) of this regulation, the primary supervising physician and physician assistant:

(a) Shall immediately cease to perform the advanced duty; and

(b) May appeal the decision using the procedure described in Regulation .12 of this chapter.

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

(1) 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 Committee and request that the Committee make a recommendation to the Board.

(2) The Committee shall present its recommendation to the Board for consideration.

(3) If the Board disapproves the delegation under §E(1) of this regulation, the primary supervising physician and physician assistant:

(a) Shall immediately cease to perform the advanced duty; and

(b) May appeal the decision using the procedure described in Regulation .12 of this chapter.

F. Temporary Practice Letter.

(1) 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:

(a) The Board previously approved the physician assistant to perform the advanced duty; and

(b) The Board previously approved the primary supervising physician to supervise a physician assistant in the performance of the advanced duty.

(2) Process. An applicant who is requesting a temporary practice letter shall:

(a) Indicate on the delegation agreement that a temporary practice letter is requested;

(b) 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; and

(c) 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.

(3) Approval. Issuance of a temporary practice letter by Board staff entitles the physician assistant to work in accordance with the proposed delegation agreement until:

(a) Notification that the proposed delegation agreement has been denied by the Committee or the Board; or

(b) 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.