CERTIFICATION OF ENROLLMENT
ENGROSSED SUBSTITUTE HOUSE BILL 2041
Chapter 62, Laws of 2024
68th Legislature
2024 Regular Session
PHYSICIAN ASSISTANT COLLABORATIVE PRACTICE
EFFECTIVE DATE: January 1, 2025—Except for section 9, which takes
effect June 6, 2024; sections 19 and 27, which are contingent; and
section 29, which takes effect July 1, 2026.
Passed by the House February 9, 2024 CERTIFICATE
Yeas 91 Nays 6
I, Bernard Dean, Chief Clerk of the
House of Representatives of the
LAURIE JINKINS State of Washington, do hereby
Speaker of the House of certify that the attached is
Representatives ENGROSSED SUBSTITUTE HOUSE BILL
2041 as passed by the House of
Representatives and the Senate on
the dates hereon set forth.
Passed by the Senate February 27,
2024
Yeas 49 Nays 0 BERNARD DEAN
Chief Clerk
DENNY HECK
President of the Senate
Approved March 13, 2024 2:04 PM FILED
March 14, 2024
Secretary of State
JAY INSLEE State of Washington
Governor of the State of Washington
 ENGROSSED SUBSTITUTE HOUSE BILL 2041
Passed Legislature - 2024 Regular Session
State of Washington 68th Legislature 2024 Regular Session
By House Health Care & Wellness (originally sponsored by
Representatives Riccelli, Schmick, Simmons, Reed, Schmidt, Macri, and
Lekanoff)
READ FIRST TIME 01/23/24.
1 AN ACT Relating to physician assistant collaborative practice;
2 amending RCW 18.71A.020, 18.71A.025, 18.71A.030, 18.71A.050,
3 18.71A.090, 18.71A.120, 18.71A.150, 51.28.100, 10.77.175, 18.71.030,
4 7.68.030, 51.04.030, 71.05.215, 71.05.217, 71.05.585, 71.32.110,
5 71.32.140, 71.32.250, 71.34.020, 71.34.020, 71.34.755, and 74.09.497;
6 reenacting and amending RCW 18.71A.010, 69.50.101, 71.05.020,
7 71.05.020, 71.34.750, 71.34.750, and 9.41.010; adding a new section
8 to chapter 18.71A RCW; adding a new section to chapter 48.43 RCW;
9 creating a new section; providing effective dates; providing
10 contingent effective dates; providing an expiration date; and
11 providing contingent expiration dates.
12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
13 NEW SECTION. Sec. 1. From March 2020 through October 2022,
14 physician assistants were permitted under the governor's proclamation
15 20-32 to work without a delegation agreement signed by a supervising
16 physician. During the public health emergency, physician assistants
17 provided safe and efficient care, expanding access to necessary
18 services and procedures statewide. There continues to be a great need
19 for additional providers in primary care and specialty areas,
20 especially in medically underserved and rural communities. Therefore,
21 the legislature intends to authorize physician assistants to enter
p. 1 ESHB 2041.SL
1 into collaborative practice with physicians to provide team-based
2 care and enhance access to health care for the people of the state.
3 Sec. 2. RCW 18.71A.010 and 2020 c 80 s 2 are each reenacted and
4 amended to read as follows:
5 The definitions ((set forth)) in this section apply throughout
6 this chapter unless the context clearly requires otherwise.
7 (1) "Collaboration" means how physician assistants shall interact
8 with, consult with, or refer to a physician or other appropriate
9 member or members of the health care team as indicated by the
10 patient's condition, the education, experience, and competencies of
11 the physician assistant, and the standard of care. The degree of
12 collaboration must be determined by the practice, which may include
13 decisions made by the physician assistant's employer, group, hospital
14 service, and credentialing and privileging systems of licensed
15 facilities.
16 (2) "Collaboration agreement" means a written agreement that
17 describes the manner in which the physician assistant is supervised
18 by or collaborates with at least one physician and that is signed by
19 the physician assistant and one or more physicians or the physician
20 assistant's employer.
21 (3) "Commission" means the Washington medical commission.
22 (((2))) (4) "Department" means the department of health.
23 (((3))) (5) "Employer" means the scope appropriate clinician,
24 such as a medical director, who is authorized to enter into the
25 collaboration agreement with a physician assistant on behalf of the
26 facility, group, clinic, or other organization that employs the
27 physician assistant.
28 (6) "Participating physician" means a physician that supervises
29 or collaborates with a physician assistant pursuant to a
30 collaboration agreement.
31 (7) "Physician" means a physician licensed under chapter 18.57 or
32 18.71 RCW.
33 (((4))) (8) "Physician assistant" means a person who is licensed
34 by the commission to practice medicine according to a ((practice))
35 collaboration agreement with one or more participating physicians((,
36 with at least one of the physicians working in a supervisory
37 capacity,)) and who is academically and clinically prepared to
38 provide health care services and perform diagnostic, therapeutic,
39 preventative, and health maintenance services.
p. 2 ESHB 2041.SL
 1 (((5) "Practice agreement" means an agreement entered under RCW
2 18.71A.120.
3 (6))) (9) "Practice medicine" has the meaning defined in RCW
4 18.71.011 and also includes the practice of osteopathic medicine and
5 surgery as defined in RCW 18.57.001.
6 (((7))) (10) "Secretary" means the secretary of health or the
7 secretary's designee.
8 Sec. 3. RCW 18.71A.020 and 2020 c 80 s 3 are each amended to
9 read as follows:
10 (1) The commission shall adopt rules fixing the qualifications
11 and the educational and training requirements for licensure as a
12 physician assistant or for those enrolled in any physician assistant
13 training program. The requirements shall include completion of an
14 accredited physician assistant training program approved by the
15 commission and within one year successfully take and pass an
16 examination approved by the commission, if the examination tests
17 subjects substantially equivalent to the curriculum of an accredited
18 physician assistant training program. An interim permit may be
19 granted by the department of health for one year provided the
20 applicant meets all other requirements. Physician assistants licensed
21 by the board of medical examiners, or the commission as of July 1,
22 1999, shall continue to be licensed.
23 (2)(a) The commission shall adopt rules governing the extent to
24 which:
25 (i) Physician assistant students may practice medicine during
26 training; and
27 (ii) Physician assistants may practice after successful
28 completion of a physician assistant training course.
29 (b) Such rules shall provide:
30 (i) That the practice of a physician assistant shall be limited
31 to the performance of those services for which he or she is trained;
32 and
33 (ii) That each physician assistant shall practice medicine only
34 under the terms of one or more ((practice)) collaboration agreements,
35 each signed by ((one or more supervising physicians licensed in this
36 state)) the physician assistant and one or more physicians licensed
37 in this state or the physician assistant's employer. A ((practice))
38 collaboration agreement may be signed electronically using a method
39 for electronic signatures approved by the commission. ((Supervision
p. 3 ESHB 2041.SL
 1 shall not be construed to necessarily require the personal presence
2 of the supervising physician or physicians at the place where
3 services are rendered.))
4 (3) Applicants for licensure shall file an application with the
5 commission on a form prepared by the secretary with the approval of
6 the commission, detailing the education, training, and experience of
7 the physician assistant and such other information as the commission
8 may require. The application shall be accompanied by a fee determined
9 by the secretary as provided in RCW 43.70.250 and 43.70.280. A
10 surcharge of fifty dollars per year shall be charged on each license
11 renewal or issuance of a new license to be collected by the
12 department and deposited into the impaired physician account for
13 physician assistant participation in the ((impaired)) physician
14 health program. Each applicant shall furnish proof satisfactory to
15 the commission of the following:
16 (a) That the applicant has completed an accredited physician
17 assistant program approved by the commission and is eligible to take
18 the examination approved by the commission;
19 (b) That the applicant is of good moral character; and
20 (c) That the applicant is physically and mentally capable of
21 practicing medicine as a physician assistant with reasonable skill
22 and safety. The commission may require an applicant to submit to such
23 examination or examinations as it deems necessary to determine an
24 applicant's physical or mental capability, or both, to safely
25 practice as a physician assistant.
26 (4)(a) The commission may approve, deny, or take other
27 disciplinary action upon the application for license as provided in
28 the Uniform Disciplinary Act, chapter 18.130 RCW.
29 (b) The license shall be renewed as determined under RCW
30 43.70.250 and 43.70.280. The commission shall request licensees to
31 submit information about their current professional practice at the
32 time of license renewal and licensees must provide the information
33 requested. This information may include practice setting, medical
34 specialty, or other relevant data determined by the commission.
35 (5) All funds in the impaired physician account shall be paid to
36 the contract entity within sixty days of deposit.
37 Sec. 4. RCW 18.71A.025 and 2020 c 80 s 4 are each amended to
38 read as follows:
p. 4 ESHB 2041.SL
1 (1) The uniform disciplinary act, chapter 18.130 RCW, governs the
2 issuance and denial of licenses and the discipline of licensees under
3 this chapter.
4 (2) The commission shall consult with the board of osteopathic
5 medicine and surgery when investigating allegations of unprofessional
6 conduct against a licensee who ((has a supervising)) is supervised by
7 or is collaborating with a physician licensed under chapter 18.57
8 RCW.
9 Sec. 5. RCW 18.71A.030 and 2020 c 80 s 5 are each amended to
10 read as follows:
11 (1) A physician assistant may practice medicine in this state to
12 the extent permitted by the ((practice)) collaboration agreement. A
13 physician assistant shall be subject to discipline under chapter
14 18.130 RCW.
15 (2)(a) A physician assistant who has completed fewer than 4,000
16 hours of postgraduate clinical practice must work under the
17 supervision of a participating physician, as described in the
18 collaboration agreement and determined at the practice site. A
19 physician assistant with 4,000 or more hours of postgraduate clinical
20 practice may work in collaboration with a participating physician, if
21 the physician assistant has completed 2,000 or more supervised hours
22 in the physician assistant's chosen specialty.
23 (b) If a physician assistant chooses to change specialties after
24 the completion of 4,000 hours of postgraduate clinical practice, the
25 first 2,000 hours of postgraduate clinical practice in the new
26 specialty must be completed under the supervision of a participating
27 physician, as described in the collaboration agreement and determined
28 at the practice site.
29 (c) Supervision shall not be construed to necessarily require the
30 personal presence of the participating physician or physicians at the
31 place where services are rendered.
32 (3)(a) Physician assistants may provide services that they are
33 competent to perform based on their education, training, and
34 experience and that are consistent with their ((practice))
35 collaboration agreement. The ((supervising physician)) participating
36 physician or physicians, or the physician assistant's employer, and
37 the physician assistant shall determine which procedures may be
38 performed and the ((supervision)) degree of autonomy under which the
39 procedure is performed.
p. 5 ESHB 2041.SL
 1 (b) Physician assistants may practice in any area of medicine or
2 surgery as long as the practice is not beyond the ((supervising
3 physician's own scope of expertise and clinical practice and the
4 practice agreement.
5 (3) A physician assistant delivering)) scope of expertise and
6 clinical practice of the participating physician or physicians or the
7 group of physicians within the department or specialty areas in which
8 the physician assistant practices.
9 (c) A physician assistant who has at least 10 years or 20,000
10 hours of postgraduate clinical experience in a specialty may continue
11 to provide those specialty services if the physician assistant is
12 employed in a practice setting where those services are outside the
13 specialty of the physician assistant's participating physician or
14 physicians, as outlined in the collaboration agreement, if the
15 practice is located in a rural area as identified by the department
16 under RCW 70.180.011 or in an underserved area as designated by the
17 health resources and services administration as a medically
18 underserved area or having a medically underserved population. The
19 physician assistant must complete continuing education related to
20 that specialty while performing services outside the specialty of the
21 physician assistant's participating physician or physicians.
22 (4) A physician assistant working with an anesthesiologist who is
23 acting as a participating physician as defined in RCW 18.71A.010 to
24 deliver general anesthesia or intrathecal anesthesia pursuant to a
25 ((practice)) collaboration agreement ((with a physician)) shall show
26 evidence of adequate education and training in the delivery of the
27 type of anesthesia being delivered on ((his or her practice
28 agreement)) the physician assistant's collaboration agreement as
29 stipulated by the commission.
30 Sec. 6. RCW 18.71A.050 and 2020 c 80 s 7 are each amended to
31 read as follows:
32 No physician or employer who enters into a ((practice))
33 collaboration agreement with a licensed physician assistant in
34 accordance with and within the terms of any permission granted by the
35 commission is considered as aiding and abetting an unlicensed person
36 to practice medicine. The ((supervising physician and)) physician
37 assistant shall ((each)) retain ((professional and personal))
38 responsibility for any act which constitutes the practice of medicine
39 as defined in RCW 18.71.011 or the practice of osteopathic medicine
p. 6 ESHB 2041.SL
 1 and surgery as defined in RCW 18.57.001 when performed by the
2 physician assistant.
3 Sec. 7. RCW 18.71A.090 and 2020 c 80 s 8 are each amended to
4 read as follows:
5 (1) A physician assistant may sign and attest to any
6 certificates, cards, forms, or other required documentation that the
7 physician assistant's ((supervising)) participating physician or
8 physician group may sign, provided that it is within the physician
9 assistant's scope of practice and is consistent with the terms of the
10 physician assistant's ((practice)) collaboration agreement as
11 required by this chapter.
12 (2) Notwithstanding any federal law, rule, or medical staff bylaw
13 provision to the contrary, a physician is not required to countersign
14 orders written in a patient's clinical record or an official form by
15 a physician assistant with whom the physician has a ((practice))
16 collaboration agreement.
17 Sec. 8. RCW 18.71A.120 and 2020 c 80 s 6 are each amended to
18 read as follows:
19 (1)(a) Prior to commencing practice, a physician assistant
20 licensed in Washington state must enter into a ((practice))
21 collaboration agreement ((with a physician or group of physicians, at
22 least one of whom must be working in a supervisory capacity.
23 (a))) that identifies at least one participating physician and
24 that is signed by one or more participating physicians or the
25 physician assistant's employer.
26 (b) A collaboration agreement must be signed by a physician if
27 the physician assistant's employer is not a physician.
28 (c) If a participating physician is not a signatory to the
29 collaboration agreement, the participating physician must be provided