VirginiaHB7462026 Regular SessionHouseWALLET

Physician assistants; authorization to practice without a practice agreement.

Sponsored By: Jen Kiggans - to resign 12/31 (Republican)

Became Law

Summary

Physician assistants; authorization to practice without a practice agreement. Authorizes a physician assistant with at least three years of full-time clinical experience to practice without a practice agreement upon receipt of an attestation from a patient care team physician or patient care team podiatrist who provided collaboration and consultation to such physician assistant verifying the length and nature of the physician assistant's practice. The bill establishes methods for a physician assistant who is unable to obtain the required attestation to submit other evidence that the physician assistant meets the requirements to practice without a practice agreement and establishes a method for physician assistants who obtain licensure by endorsement to practice without a practice agreement if they meet the applicable requirements. The bill also establishes a scope of practice for physician assistants who practice without a practice agreement. The bill specifies that the effective date of the foregoing provisions are contingent upon the Board of Medicine adopting regulations to implement the bill's provisions and to establish processes for granting authorization to physician assistants to practice without a practice agreement.

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 2 benefits, 1 costs, 4 mixed.

Trained PAs may use fluoroscopy

PAs who work in radiology or orthopedics, meet Board training rules, and pass the ARRT exam for PAs may use fluoroscopy to guide care.

Where PAs can skip a separate agreement

Hospitals, state behavioral health facilities, and federally qualified health centers can use their credentialing and privileging in place of a separate practice agreement. That setup must name a team physician or podiatrist and include the required elements. PAs appointed as medical examiners may perform those duties without a practice agreement.

Team-based practice rules for PAs

Most PAs must work on a patient care team under a written or electronic practice agreement. The agreement sets allowed tasks, chart review, and how to consult in complex cases and emergencies. A supervising physician or podiatrist must be available to consult. One supervisor may work with no more than six PAs at a time. PAs may only do what the agreement or team allows, and in hospitals the responsible physician must be available.

Changes start after Board sets rules

These changes take effect only after the Board of Medicine adopts rules and certifies the date to the Code Commission. The first set of rules is exempt from the usual rulemaking process.

PA licensing rules and spouse endorsement

To get a Virginia PA license, you must finish an accredited PA program, pass the national PA exam, and have no active discipline. Military spouses with current national PA certification and a valid out‑of‑state PA license in good standing can get a Virginia license by endorsement.

PA prescribing rules and patient notice

PAs may prescribe controlled substances only if allowed by a practice agreement, a facility’s credentialing setup, or an independent‑practice authorization. Agreements must state which drugs the PA can or cannot prescribe. Prescribing outside those limits is illegal. The Board of Medicine, with the Board of Pharmacy, sets safety and competency rules and addresses new drugs. PAs must tell patients their name, contact info, and that they are a PA, and help reach the team physician on request unless they are independently authorized.

Path to PA independent practice

A PA may practice in a specialty without a practice agreement after three years of full‑time clinical work in that specialty. Full‑time means 1,800 hours a year for at least three years, verified by an attestation (or other Board‑accepted evidence). The Board issues a new license once it verifies the proof and fee. Endorsement or compact licensees must submit the same proof to practice without an agreement. Independent PAs must stay within their training, consult other providers as needed, and have a plan to refer complex or emergency cases.

Sponsors & Cosponsors

Sponsor

  • Jen Kiggans - to resign 12/31

    Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 329 • No: 3

House vote 3/10/2026

Senate amendment agreed to by House

Yes: 99 • No: 0

Senate vote 3/9/2026

Passed Senate with amendment

Yes: 38 • No: 2

Senate vote 3/9/2026

Education and Health Amendment agreed to

Yes: 0 • No: 0

Senate vote 3/5/2026

Reported from Education and Health with amendment

Yes: 14 • No: 0 • Other: 1

Senate vote 3/3/2026

Motion to recommit to Education and Health agreed to

Yes: 0 • No: 0

Senate vote 2/27/2026

Passed by for the day Block Vote (Voice Vote)

Yes: 0 • No: 0

Senate vote 2/27/2026

Constitutional reading dispensed Block Vote (on 2nd reading)

Yes: 37 • No: 0

Senate vote 2/26/2026

Reported from Education and Health

Yes: 13 • No: 1 • Other: 1

House vote 2/17/2026

Read third time and passed House Block Vote

Yes: 97 • No: 0

House vote 2/12/2026

Reported from Health and Human Services with substitute

Yes: 21 • No: 0

House vote 2/10/2026

Subcommittee recommends reporting with substitute

Yes: 10 • No: 0

Actions Timeline

  1. Acts of Assembly Chapter text (CHAP0418)

    4/8/2026Governor
  2. Approved by Governor-Chapter 418 (effective 7/1/2026)

    4/8/2026Governor
  3. Fiscal Impact Statement from Department of Planning and Budget (HB746)

    3/31/2026House
  4. Governor's Action Deadline 11:59 p.m., April 13, 2026

    3/31/2026Governor
  5. Enrolled Bill communicated to Governor on March 31, 2026

    3/31/2026House
  6. Signed by Speaker

    3/31/2026House
  7. Bill text as passed House and Senate (HB746ER)

    3/30/2026House
  8. Enrolled

    3/30/2026House
  9. Signed by President

    3/30/2026Senate
  10. Senate amendment agreed to by House (99-Y 0-N 0-A)

    3/10/2026House
  11. Passed Senate with amendment (38-Y 2-N 0-A)

    3/9/2026Senate
  12. Education and Health Amendment agreed to

    3/9/2026Senate
  13. Engrossed by Senate as amended

    3/9/2026Senate
  14. Read third time

    3/9/2026Senate
  15. Passed by for the day Block Vote (Voice Vote)

    3/6/2026Senate
  16. Senate committee offered

    3/5/2026Senate
  17. Reported from Education and Health with amendment (14-Y 0-N 1-A)

    3/5/2026Senate
  18. Recommitted to Education and Health

    3/3/2026Senate
  19. Motion to recommit to Education and Health agreed to

    3/3/2026Senate
  20. Passed by for the day

    3/2/2026Senate
  21. Read third time

    3/2/2026Senate
  22. Passed by for the day Block Vote (Voice Vote)

    2/27/2026Senate
  23. Constitutional reading dispensed Block Vote (on 2nd reading) (37-Y 0-N 0-A)

    2/27/2026Senate
  24. Rules suspended

    2/27/2026Senate
  25. Reported from Education and Health (13-Y 1-N 1-A)

    2/26/2026Senate

Bill Text

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