(a) The Council must adopt rules and regulations which address the following: (1) The licensing of physician associates to allow the following: a. The practice of medicine within the education, training, and experience of physician associates. b. The performance of medical services within the education, training, and experience of physician associates. (2) Medical acts provided by physician associates to include all of the following: a. The performance of complete patient histories and physical examinations. b. The recording of patient progress notes in an in-patient or out-patient setting. c. The ordering, relaying, transcribing, or executing of specific diagnostic or therapeutic orders or procedures. d. Medical acts of diagnosis and prescription of therapeutic drugs and treatments; and referral of patients to specialists as needed. e. Prescriptive authority for therapeutic drugs and treatments within the scope of physician associate practice. The physician associate's prescriptive authority and authority to practice as a physician associate are subject to biennial renewal upon application to the Physician Associate Regulatory Council. f. The use of telemedicine as defined in this chapter and, as further described in regulation, the use of and participation in telehealth. g. Pronouncing death and completing and signing a medical certification of death. (3) The verification of postgraduate clinical practice hours for physician associates with more than 6,000 postgraduate clinical practice hours. (4) Independent practice within a setting with at least 1 licensed Delaware physician. — Creating an application form for physician associates with more than 6,000 postgraduate clinical practice hours to request independent practice authority for physician associates who intend to practice in a setting with at least 1 licensed Delaware physician in the group, practice, or health system. The application form must require a physician associate to provide at least the physician associate's name, license number, physical location of practice, mailing address, phone number, primary area of medical practice, and proof of required postgraduate clinical practice hours. (5) Independent practice within a setting without at least 1 licensed Delaware physician. — Creating an application form for physician associates with more than 6,000 postgraduate clinical practice hours to request independent practice authority for physician associates who intend to practice in a setting without at least 1 licensed Delaware physician in the group, practice, or health system. The application form must require a physician associate to provide at least the physician associate's name, license number, physical location of the practice, mailing address, phone number, primary area of medical practice, proof of required postgraduate clinical practice hours, and proof that the physician associate has had training which aligns to the physician associate's practice areas. (6) Changes to practice area for independent practice within a setting without at least 1 licensed Delaware physician. — Creating an application form and process for physician associates in the group, practice, or health system, that have been granted independent practice authority, to notify the Physician Associates Regulatory Council prior to a change of the physician associate's practice area and provide proof the physician associate has had training that aligns to the new practice area. (7) The conditions under which a physician associate who is denied a waiver of the collaborative agreement requirement may reapply. (b) (1) The Board, in conjunction with the Regulatory Council for Physician Associates, must suspend, revoke, or restrict the license of a physician associate or take disciplinary action or other action against a physician associate for engaging in unprofessional conduct as defined in § § 1731(b) of this title; or for the inability to render medical acts with reasonable skill or safety to patients because of the physician associate's physical, mental, or emotional illness or incompetence, including but not limited to: deterioration through the aging process, or loss of motor skills, or excessive use of drugs, including alcohol; or for representing oneself as a physician, or for knowingly allowing oneself to be represented as a physician; for failing to report in writing to the Board within 30 days of becoming aware of any physician, physician associate, or healthcare provider who the licensee reasonably believes has engaged in unprofessional conduct as defined in § § 1731(b) of this title or is unable to act with reasonable skill or safety to patients because of the physician's, physician associate's, or other healthcare provider's physical, mental, or emotional illness or incompetence, including but not limited to deterioration through the aging process, or loss of motor skills, or excessive use of drugs, including alcohol, or for failing to report child abuse and neglect as required by § § 903 of Title 16. The license of any physician associate who is convicted of a felony sexual offense must be revoked. Disciplinary action or other action undertaken against a physician associate must be in accordance with the procedures, including appeal procedures, applicable to disciplinary actions against physicians pursuant to subchapter IV of this chapter, except that a hearing panel for a complaint against a physician associate consists of 3 unbiased members of the Regulatory Council, the 3 members being 2 physician associate members and 1 physician or pharmacist member if practicable. A person reporting or testifying in any proceeding as a result of making a report pursuant to this section is immune from claim, suit, liability, damages, or any other recourse, civil or criminal, so long as the person acted in good faith and without gross or wanton negligence; good faith being presumed until proven otherwise, and gross or wanton negligence required to be shown by the complainant. (2) a. If the Board or the Regulatory Council for Physician Associates receives a formal or informal complaint concerning the activity of a physician associate and the Regulatory Council members reasonably believe that the activity presents a clear and immediate danger to the public health, the Regulatory Council may issue an order temporarily suspending the physician associate's license to practice pending a hearing upon the written order of the Secretary of State or the Secretary's designee, with the concurrence of the Council Chair or the Chair's designee. An order temporarily suspending a license to practice may not be issued by the Council unless the physician associate or the physician associate's attorney received at least 24 hours' written or oral notice prior to the temporary suspension so that the physician associate or the physician associate's attorney can be heard in opposition to the proposed suspension. An order of temporary suspension pending a hearing may remain in effect for no longer than 60 days from the date of the issuance of the order unless the temporarily suspended physician associate requests a continuance of the hearing date. If the physician associate requests a continuance, the order of temporary suspension remains in effect until the hearing panel convenes and a decision is rendered. b. A physician associate whose license to practice has been temporarily suspended pursuant to this section must be notified of the temporary suspension immediately and in writing. Notification consists of a copy of the complaint and the order of temporary suspension pending a hearing personally served upon the physician associate or sent by certified mail, return receipt requested, to the physician associate's last known address. c. A physician associate whose license to practice has been temporarily suspended pursuant to this section may request an expedited hearing. The Council shall schedule the hearing on an expedited basis, provided that the Council receives the request within 5 calendar days from the date on which the physician associate received notification of the decision of the Council, with the approval of the Board, to temporarily suspend the physician associate's license to practice. d. As soon as possible after the issuance of an order temporarily suspending a physician associate's license to practice pending a hearing, the Executive Director must appoint a 3-member hearing panel. After notice to the physician associate pursuant to paragraph (b)(2)b. of this section, the hearing panel shall convene within 60 days of the date of the issuance of the order of temporary suspension to consider the evidence regarding the matters alleged in the complaint. If the physician associate requests in a timely manner an expedited hearing, the hearing panel shall convene within 15 days of the receipt of the request by the Council. The 3- member panel must proceed to a hearing and shall render a decision within 30 days of the hearing. e. In addition to making findings of fact, the hearing panel shall also determine whether the facts found by it constitute a clear and immediate danger to public health. If the hearing panel determines that the facts found constitute a clear and immediate danger to public health, the order of temporary suspension must remain in effect until the Board deliberates and reaches conclusions of law based upon the findings of fact made by the hearing panel. An order of temporary suspension may not remain in effect for longer than 60 days from the date of the decision rendered by the hearing panel unless the suspended physician associate requests an extension of the order pending a final decision of the Board. Upon the final decision of the Board, an order of temporary suspension is vacated as a matter of law and is replaced by the disciplinary action, if any, ordered by the Board. (c) The Board or the Regulatory Council for Physician Associates may not impose any sanction under subsection (b) of this section for the performance, recommendation, or provision of any healthcare service that is lawful in this State even if such performance, recommendation, or provision is for a person who resides in a state where such performance, recommendation, or provision is illegal or considered to be unprofessional conduct or the unauthorized practice of a physician associate. (d) A nonhuman entity, including an agent powered by artificial intelligence, may not be licensed as a physician associate in this State. A nonhuman entity, including an agent powered by artificial intelligence, may not use the title physician associate or the abbreviation "PA." (e) A physician associate may be designated as the primary care provider by an insurer or healthcare services corporation. (f) A physician associate must collaborate with, consult with, and refer to the appropriate member of the healthcare team as indicated by the patient's condition, and the education, experience, and competencies of the physician associate. (g) Physician associates must be authorized to bill for and receive direct payment for the medically-necessary services they deliver. (1) To ensure accountability and transparency for patients, payers, and the healthcare system, when appropriate, a physician associate must also be identified as the rendering professional in the billing and claims process when the physician associate delivers medical or surgical services to patients. (2) No insurance company or third-party payer may impose a practice, education, or collaboration requirement that is inconsistent with or more restrictive than physician associate state law or regulation.
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