al-al-6a61130e988b42122efeb80e: 540-X-7-.26 — Limitations Upon Utilization Of Physician Assistants (P.A.)

APA-1 TRANSMITTAL SHEET FOR NOTICE OF INTENDED ACTION Control: 540 Department or Agency: Alabama Board of Medical Examiners Rule No.: 540-X-7-.26 Rule Title: Limitations Upon Utilization Of Physician Assistants (P.A.) Intended Action Amend Would the absence of the proposed rule significantly harm or endanger the public health, welfare, or safety? Yes Is there a reasonable relationship between the state’s police Yes power and the protection of the public health, safety, or welfare? Is there another, less restrictive method of regulation available that could adequately protect the public? No increasing the costs of any goods or services involved?ndirectly No To what degree?: N/A that might result from the absence of the proposed rule?the harm NA Are all facets of the rule-making process designed solely for the protection of the public?ave, as their primary effect, the Yes Does the proposed action relate to or affect in any manner any litigation which the agency is a party to concerning the subject No matter of the proposed rule? Does the proposed rule have an economic impact? No accompanied by a fiscal note prepared in accordance with subsection (f) of Section 41-22-23, Code of Alabama 1975. Certification of Authorized Official I certify that the attached proposed rule has been proposed in full compliance conforms to all applicable filing requirements of the Administrative Procedureit Division of the Legislative Services Agency. Signature of certifying officer Wi iam M. Perkins L E D William M PerkinsR E C ’ D & F I Date Thursday, August 20, 2026 20, 202 6 A UG E S VC A G EN C Y LE G ISL A TIV APA-2 ALABAMA BOARD OF MEDICAL EXAMINERS NOTICE OF INTENDED ACTION AGENCY NAME: Alabama Board of Medical Examiners 540-X-7-.26 Limitations Upon Utilization Of RULE NO. & TITLE: Physician Assistants (P.A.) INTENDED ACTION: Amend SUBSTANCE OF PROPOSED ACTION: The Board removed the requirement for physicians to perform six (6) consecutive months of Quality Assurance review for all Advanced Practice Providers (APP) with whom they collaborate/supervise when adding a new registration if the collaborations/registrations extend past four (4) FTE collaborations (equivalent to 160 hours). TIME, PLACE AND MANNER OF PRESENTING VIEWS: All interested persons may submit data, views, or arguments concerning the proposed new rule(s) and regulation(s) in writing to: Effie Hawthorne, Office of the General Counsel, Alabama State Board of Medical Examiners, Post Office Box 946, Montgomery, Alabama 36101-0946, by mail or email (publiccomment@albme.gov), until and including Monday, October 5, 2026. Persons wishing to submit data, views, or comments in person should contact Effie Hawthorne by telephone (334-242-4116) during the comment period. Copies of proposed rules may be obtained at the Board’s website: www.albme.gov. FINAL DATE FOR COMMENT AND COMPLETION OF NOTICE: Monday, October 5, 2026 CONTACT PERSON AT AGENCY: Effie Hawthorne Phone: 334-833-0171 Email: ehawthorne@albme.gov Wi iam M. Perkins William M Perkins (Signature of officer authorized to promulgate and adopt rules or his or her deputy) 540-X-7-.26 Limitations Upon Utilization Of Physician Assistants (P.A.). (1) A supervising physician must be present in the operating room or be immediately available to that operating room whenever a physician assistant is involved in the care of a patient in the operating room. Whenever a physician assistant performs or assists in performing invasive procedures with involvement deeper than the complete dermis, the supervising physician must be present in the operating room, unless otherwise specifically approved by the Board. (2) The cumulative work time for all physician assistants being supervised by an individual primary supervising physician shall not exceed three hundred and sixty (360) hours (nine FTEs) per week. The physician shall not supervise or collaborate with any combination of assistants to physicians, certified registered nurse practitioners, and/or certified nurse midwives exceeding three hundred and sixty (360) hours per week (nine full-time equivalent positions). “One full-time equivalent” (FTE) is herein described as a person/persons collectively working forty hours a week, excluding time on call. (3) A physician collaborating with or supervising more than four FTEs per week shall engage in documented quality assurance review with each physician assistant every month for six (6) months following registration with a new physician assistant. (4) A physician shall disclose to the Board of Medical Examiners the existence of all collaborative and supervisory agreements to which the physician is party, including collaborative and supervisory agreements in other states, and shall not be eligible to collaborate with or supervise any combination of certified registered nurse practitioners, certified nurse midwives and/or assistants to physicians exceeding three hundred and sixty (360) hours per week (nine full-time equivalent positions), inclusive of collaborative and supervisory agreements existing in other states. Agreements with an individual certified registered nurse practitioner, certified nurse midwife, and/or assistant to physician in multiple states shall only be counted once for purposes of calculating the total number of full-time equivalent positions. (5)(4) A physician assistant may be registered to more than one supervising physician at any one time. The number of supervising physicians to whom a physician assistant may be registered shall be restricted by the Board if the Board, in its discretion, determines that such restriction is appropriate to maintain the 7-.26-1 quality of medical services being provided or to otherwise protect the public health, safety and welfare. (6)(5) A physician in a registration agreement/ collaboration with a Physician Assistant, Certified Registered Nurse Practitioner or Certified Nurse Midwife totaling three hundred and sixty (360) hours per week (nine (9) full-time equivalents (FTEs)) may request a transitional allowance increasing the total weekly hours for the purpose of orientation of the incoming Physician Assistant. The transitional allowance shall not exceed forty-five (45) days. The physician shall request the transitional allowance in writing and specify the starting date of this FTE allowance. (7)(6) Employees of the State Health Department or of a county board of health are specifically exempt from the requirements of paragraph (2) of this rule. The Board of Medical Examiners, in its discretion, may determine how many physician assistants may be registered to and/or supervised by a physician employed by the State Health Department or by a county board of health. Author: Alabama Board of Medical Examiners Statutory Authority: Code of Ala. 1975, §§34-24-290, et. seq. History: Repealed and Replaced: Filed September 21, 1998; effective October 26, 1998. Repealed and New Rule: Filed August 22, 2002; effective September 26, 2002. Repealed and New Rule: Filed September 19, 2002; effective October 24, 2002. Amended: Filed July 22, 2005; effective August 26, 2005. Amended: Filed March 20, 2008; effective April 24, 2008. Amended: Filed October 22, 2015; effective November 26, 2015. Amended: Published August 31, 2021; effective October 15, 2021. Amended: Published ______; effective ______. 7-.26-2