Collaborative Practice Agreement · PA
Maryland Collaboration Agreement for Physician Assistants
Required. The Collaboration Agreement is the written instrument Maryland law names for a Physician Assistant working with a physician. Below: the board that governs it, what it must contain, and the terms it has to carry.
No independent-practice or experience-based autonomy pathway exists for PAs in Maryland — a delegation agreement with a supervising physician and 'continuous supervision' are required for as long as the PA practices (Health Occ. § 15-302; COMAR 10.32.03).
What a Maryland Collaboration Agreement must contain
Governed by the Maryland Board of Physicians and the Maryland Board of Pharmacy. Each numbered item is a statutory requirement the agreement must satisfy.
The Physician Assistant ("PA") shall practice pursuant to a written Collaboration Agreement with the Physician, acting as patient care team physician, as required by Health Occupations Article § 15-302 and COMAR 10.32.03. The Collaboration Agreement shall limit the Physician Assistant's scope of practice to the practice specialties of the listed patient care team physician(s), and the Parties shall give the Maryland Board of Physicians notice of the executed agreement before the Physician Assistant begins practicing under it.
A patient care team physician may not be the patient care team physician for more than eight (8) Physician Assistants at one time, except as Maryland law otherwise permits for hospitals, correctional facilities, or public health facilities. The Physician Assistant may have one or more patient care team physicians at the same facility.
- The Collaboration Agreement on file also carries 1 scope, 1 education, 1 registration clauses, generated in the document itself.
Statutes and rules cited
- COMAR 10.34.29 (Drug Therapy Management)regulation
Maryland Board of Pharmacy regulation implementing Health Occupations Article §§ 12-6A-01 to 12-6A-10, governing prescriber-pharmacist agreements, protocols, and therapy management contracts.
Terms it has to carry
Ratio, proximity, chart review, meeting and prescribing terms the agreement has to carry, from the state's supervision rules.
Proximity
Available remotely (no on-site requirement)
COMAR 10.32.03.05 requires the delegation agreement to describe 'continuous physician supervision mechanisms reasonable and appropriate to the practice setting' and the physician to attest to responding to the PA 'in a timely manner' — no on-site or mile/minute radius standard was confirmed in this pass.
Supervision ratio
Up to 4 at a time
A primary (or alternate) supervising physician may not supervise more than 4 PAs at any one time, except in hospitals, correctional/detention facilities, or public health facilities, where this cap does not apply (COMAR 10.32.03.07).
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Schedule II-III: 30-day supply max per single filling (7-day max for institutionalized patients' Schedule II). A patient-care-team physician may delegate prescribing/dispensing of Schedules II-V, provided the PA holds both a Maryland CDS registration and a federal DEA registration; the delegation agreement must attest to compliance with applicable state/federal law. PAs may not delegate dispensing of drug samples/starter dosages.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation (PC) — Maryland does not recognize PLLCs as a business entity, and secondary-sourced guidance describes medical-services PCs as issuing stock only to licensed physicians, with regulatory interpretation blocking a combined physician+PA/NP PC structure. Whether a PA-only practice entity has any independent-ownership pathway under a different structure was not confirmed in this pass — treat as an open item.
This ownership question is legally distinct from the clinical delegation agreement above.
Legal sources for these rules (4)
About Maryland's rules
Maryland's APRN categories are NOT uniform: CRNPs/CNMs gained full practice authority in 2015 (after an 18-month new-graduate mentorship), but CRNAs remain fully supervised with NO prescriptive authority at all (Maryland is one of ~11 states granting CRNAs none), and only the psychiatric-mental-health population focus of CNS practice is independent. Maryland does not recognize PLLCs — professional entities use physician-only Professional Corporations, so multi-disciplinary PC ownership questions are open items below.
Other clinicians in Maryland: see the state overview.