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Maryland Anesthesiologist Assistants Act

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  Quote JCole Quote  Post ReplyReply Direct Link To This Post Topic: Maryland Anesthesiologist Assistants Act
    Posted: 20 Sep 2009 at 2:45pm
SB 798
Department of Legislative Services
Maryland General Assembly
2009 Session
Re: Anesthesiologist Assistants


Senate Bill 798                                 (Senator Conway)
Education, Health, and Environmental Affairs 

Maryland Anesthesiologist Assistants Act

This bill requires the Board of Physicians to license and regulate the practice of
anesthesia care and establishes an Anesthesiologist Assistants Advisory Committee
within the board.

Fiscal Summary

State Effect: No effect on revenues in FY 2010 as the board develops regulations.
Special fund revenues increase beginning in FY 2011 to the extent that the board issues
licenses to anesthesiologist assistants and approves delegation agreements for a fee, and
collects any civil penalties. Special fund expenditures for the Department of Health and
Mental Hygiene increase by $46,400 in FY 2010 to develop regulations and handle
inquiries regarding the licensure of anesthesiologist assistants and the process for
delegation agreements. Future years reflect annualization and inflation. Potential
minimal increase in general fund revenues and expenditures beginning in FY 2011 due to
the bill’s criminal penalty provisions.

(in dollars)                    FY 2010           FY 2011           FY 2012           FY 2013           FY 2014
GF Revenue                     $0                     -                      -                       -                      -
SF Revenue                     $0                     -                      -                       -                      -
GF Expenditure               $0                     -                       -                       -                      -
SF Expenditure             $46,400         $57,100           $59,900           $62,900          $66,000
Net Effect                    ($46,400)       ($57,100)        ($59,900)         ($62,900)       ($66,000)

Note:() = decrease; GF = general funds; FF = federal funds; SF = special funds; - = indeterminate  effect

Local Effect: Potential minimal increase in revenues and expenditures due to the bill’s
criminal penalty provisions.

Small Business Effect: None.



Bill Summary: With certain exceptions, an “anesthesiologist assistant” means an
individual who is licensed to perform delegated medical acts under the supervision of an
anesthesiologist. The bill specifies age, education, and other requirements that an
applicant has to meet to be licensed. The bill also authorizes the board to issue temporary
licenses – valid for 90 days – to applicants who meet specific qualifications and inactive
licenses under certain circumstances; it also specifies a process and requirements for
license renewal and reinstatement.

An anesthesiologist assistant may only practice under a delegation agreement executed
by a supervising anesthesiologist and the anesthesiologist assistant that limits the scope of practice to specific medical acts outlined in the bill. Delegation agreements, which have
to include information specified in the bill, must be approved by the board, and are valid
for two years. The supervising anesthesiologist is responsible for overseeing medical
acts performed by the anesthesiologist assistant, and is liable for any of the
anesthesiologist assistant’s acts or omissions under his or her supervision and control. A
supervising anesthesiologist may not delegate medical acts under a delegation agreement
to more than four anesthesiologist assistants at one time.

The bill also specifies that an alternate supervising anesthesiologist, designated by the
supervising anesthesiologist, may provide direct supervision of an anesthesiologist
assistant, in accordance with the board approved delegation agreement, in the supervising
anesthesiologist’s absence.

An anesthesiologist assistant who holds a temporary license may practice under a
delegation agreement pending board approval if (1) the supervising anesthesiologist who
executed the pending agreement has been previously approved by the board to supervise
one or more anesthesiologist assistants in the practice setting for the same scope of
practice in the pending agreement; and (2) the anesthesiologist assistant has been
previously approved for the same scope of practice in the pending delegation agreement
in a different practice setting. If the board modifies or denies the pending agreement, the
board must notify the supervising anesthesiologist and anesthesiologist assistant of the
cause for modification or disapproval. Upon receipt of notice of a denial, the
anesthesiologist assistant must stop practicing immediately.

The board must set license and delegation agreement application fees so that funds
generated approximate the cost of maintaining the program.

The committee, consisting of seven members appointed by the board, is charged with
recommending regulations relating to the practice of anesthesia care, continuing
education requirements, and whether to approve applications for licensure or delegation
agreements. Additionally the committee is charged with reporting any conduct of a
supervising anesthesiologist or anesthesiologist assistant that warrants disciplinary action.
The committee has to submit annual reports to the board, keep a record of its
proceedings, and perform duties delegated to it by the board. If the board rejects or
modifies any committee recommendations, it has to provide a written explanation of its
reasons. Committee members serve staggered three-year terms.

The bill sets specific grounds and procedures for disciplinary action against a licensee or
applicant, which include an opportunity for a hearing. Within five days of the
termination of an anesthesiologist assistant related to a quality of care issue, the
supervising anesthesiologist and the anesthesiologist assistant must report the termination to the board.

The bill also requires hospitals, related institutions, alternative health systems, and other
employers to report to the board if an anesthesiologist assistant is limited, reduced,
otherwise changed, or terminated for reasons that might be grounds for disciplinary
action. The bill also describes circumstances under which a report does not have to be
made. The board may impose a civil penalty of up to $1,000 for failure to report; any
such penalty is deposited in the general fund.

An individual who attempts, offers, or performs a medical act beyond his or her scope of
practice and inconsistent with his or her delegation will have the license revoked.

A person who violates any provision of the bill is guilty of a misdemeanor and on
conviction is subject to a fine of up to $5,000 and/or imprisonment for up to five years.
In addition, a person who violates the scope of practice parameters of the bill is subject to
a civil fine of up to $5,000, imposed by the board, payable to the Board of Physicians

The bill subjects the new licensure program to periodic review under the Maryland
Program Evaluation Act, consistent with other health occupations boards. An evaluation
is required by July 1, 2015. If not reauthorized, the new license program terminates on
July 1, 2015.

Current Law: The board, which operates through special funds, is responsible for the
licensure and discipline of physicians and allied health professionals. Committees play a
large role in the oversight of allied health professionals under the board’s jurisdiction.
For instance, the Physician Assistant Advisory Committee makes recommendations to
the board concerning the approval, modification, or disapproval of an application for
certification as a physician assistant and delegation agreements as well as regulations
governing physician assistants.

The Maryland Program Evaluation Act requires the Department of Legislative Services
to periodically evaluate certain State agencies according to a statutory schedule. The
agencies subject to review are usually subject to termination; typically, the General
Assembly must reauthorize them. The board is one of about 70 entities currently subject
to evaluation.

An anesthesiologist is a licensed physician who has had specialized training in the field
of anesthesiology, administers anesthesia on a regular basis, and devotes a substantial
portion of the medical practice to the practice of anesthesiology.

Anesthetics have to be administered only by a qualified anesthesiologist, physician, or
dentist qualified to administer anesthesia, certified or registered nurse anesthetist, or a
licensed podiatrist.

A certified nurse anesthetist works with a collaborating physician, anesthesiologist, or
dentist in delivering anesthesia care services to patients. Specifically, a nurse anesthetist
may perform the following functions: perioperative assessment and management of
patients requiring anesthesia services; administrating anesthetics; management of fluids
in intravenous therapy; and respiratory care.

Background: An anesthesiologist assistant works as a specialty physician assistant
under the direction of a licensed anesthesiologist, and assists the anesthesiologist in
developing and implementing the anesthesia care plan. The National Commission for
Certification of Anesthesiologist Assistants certifies anesthesiologist assistants.


Anesthesiologist assistant education programs are post baccalaureate programs that
typically range from 24 to 29 months. The Commission on Accreditation of Allied
Health Education Programs (CAAHEP) accredits anesthesiologist assistant programs in
the United States. To date, CAAHEP has accredited just five programs; none is located
in Maryland. However, the board advises that the Johns Hopkins University may be
developing a program.

While a few other States license anesthesiologist assistants, in Maryland, certified nurse
anesthetists perform functions similar to those that would be performed by
anesthesiologist assistants under the bill. However, the Board of Nursing, which
regulates certified nurse anesthetists, advises that nurse anesthetists in the State are
required to meet more stringent training and education requirements than those required
for anesthesiologist assistants under the bill.

State Revenues: As the bill does not include a date by which anesthesiologist assistants
have to be licensed in order to practice in the State, it is assumed that licensure must
occur as soon after the bill’s effective date of October 1, 2009 as possible. However,
given the level of detail necessary to set up a licensure system for anesthesiologist
assistants, which includes delegation agreements as part of practice regulation, it is
unlikely that the board can develop and approve regulations in time to accept licensure
applications in fiscal 2010. In addition, the board advises that it does not know how
many applicants will apply for licensure under the bill, and therefore cannot estimate the
fee levels it must set to meet the bill’s requirement to set fees that approximate program
maintenance costs. Indeed, any applicants in the near-term will likely be from
out-of-state since there are no anesthesiologist assistant education programs in Maryland.

Therefore, special fund revenues increase beginning in fiscal 2011 to the extent that the
board issues licenses and approves delegation agreements for a fee. The board may have
to adjust the fees depending on how many applications it receives. For instance, if
the Johns Hopkins University develops a program that produces a large number of
anesthesiologist assistant licensure applicants, the board will likely have to reduce its fees
since a larger number of licensure applicants will generate greater fee revenue, possibly
exceeding the board’s program expenditures.

Special fund revenues may also increase beginning in fiscal 2011 to the extent that
anesthesiologist assistants pay civil fines to the Board of Physicians Fund.

General fund revenues may increase minimally due to the payment of criminal penalties
for violations of the bill’s provisions as well as civil penalties for failure to report.

State Expenditures: Special fund expenditures increase by $46,364 in fiscal 2010 for
the board to hire one administrative officer to develop regulations and handle inquiries
regarding the licensure of anesthesiologist assistants and the process for delegation
agreements. The estimate includes a salary, fringe benefits, one-time start-up costs, and
ongoing operating expenses.

Position                                                    1
Salary                                            $40,786
Operating Expenses                         1,283
Start-up Costs                                 4,295
Total FY 2010 Expenditures         $46,364

Future year expenditures reflect a full salary with 4.4% annual increases, 3% employee
turnover, and 1% increases in ongoing operating expenses.

Legislative Services advises that program staff may have to be adjusted to meet the
volume of applications received by the board under the bill. If few applications are
received under the bill, a full-time administrative officer may not be necessary to
maintain the program once regulations are in place. Thus, the officer may have to work
half or even quarter time. However, if a large number of applications are received under
the bill, as might be the case in future years if the Johns Hopkins University develops an
anesthesiologist assistant education program and graduates a large number of qualified
applicants, an office assistant may have to be hired to help the administrative officer
process licensure applications and delegation agreements.

Additional Comments: Typically, programs subject to review under the Maryland
Program Evaluation Act must have an evaluation completed the year before expiration.
However, the bill requires review of the new licensure program to be completed the same
year (2015) that it is scheduled to terminate.


Additional Information

Prior Introductions: None.

Cross File:
HB 1161 (Delegate Donoghue) - Health and Government Operations.

Information Source(s):
Department of Health and Mental Hygiene, Office of
Administrative Hearings, Department of Legislative Services

Fiscal Note History:  First Reader - March 10, 2009

Analysis by: Sarah K. Volker                                                                  Direct Inquiries to:
      (410) 946-5510
(301) 970-5510


Who are DNAP's? = Doctorate Of Nurse Anesthesia Practice


Anesthesiologist Assistant Resource Websites:

Edited by admin - 05 Feb 2011 at 7:44pm
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