TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF MEDICINE

Fast-Track Regulation

Title of Regulation: 18VAC85-50. Regulations Governing the Practice of Physician Assistants (amending 18VAC85-50-35, 18VAC85-50-56; adding 18VAC85-50-62).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: March 25, 2026.

Effective Date: April 9, 2026.

Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Department of Health Professions, Perimeter Center, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, fax (804) 915-0382, or email erin.barrett@dhp.virginia.gov.

Basis: Section 54.1-2400 of the Code of Virginia authorizes the Board of Medicine to promulgate regulations to effectively administer the regulatory system.

Purpose: This action is essential to protect the health, safety, and welfare of citizens because it allows physician assistants to reinstate a lapsed license in a more efficient manner, theoretically leading to more physician assistants available to treat patients.

Rationale for Using Fast-Track Rulemaking Process: This action is expected to be noncontroversial and therefore appropriate for the fast-track rulemaking process because it reduces reinstatement requirements and creates a reinstatement process consistent with other license types of the agency.

Substance: The amendments (i) provide a fee for reinstatement of a physician assistant license; (ii) remove the requirement that a physician assistant with a lapsed license make a new application for licensure; (iii) require physician assistants with licenses lapsed for two years or less to pay a reinstatement fee and apply for renewal; and (iv) require physician assistants with licenses lapsed for more than two years to pay a reinstatement fee and provide evidence of current certification by the National Commission of Certification of Physician Assistants (NCCPA), which is currently required for initial licensure and renewal of a physician assistant license.

Issues: There are no primary advantages or disadvantages to the public. There are no primary advantages or disadvantages to the agency or the Commonwealth.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

Summary of the Proposed Amendments to Regulation. The Board of Medicine (board) proposes to create late renewal and reinstatement processes for physician assistants with lapsed licenses.

Background. Currently, a physician assistant whose license has lapsed is required to reapply for licensure as if they have never been licensed by the board. This reapplication process for a lapsed license is the same as the initial application process, wherein the applicant must complete an application for initial licensure, pay the initial application fee ($130), document successful completion of a qualifying educational program and the passage of the certifying examination by the National Commission on Certification of Physician Assistants (NCCPA). This process contrasts with other professions for which there is a simpler process for addressing late renewals and the reinstatement of lapsed licenses. In this action, the board proposes to create two processes: (i) a late renewal process for physician assistant licenses that have not been lapsed for more than one renewal cycle (i.e., two years), and (ii) a reinstatement process for licenses that have been lapsed for more than two years.

Estimated Benefits and Costs. Both of the proposed processes would be administratively less burdensome for the applicant and the board. The applicant would not have to document completion of a qualifying educational program, as the board would already have that information from the initial licensure application. Furthermore, the late renewal and reinstatement application forms are expected to be simpler than the form for initial application. Finally, late renewal applicants would not be required to provide evidence of current certification by NCCPA. The reinstatement applicants, however, would be required to provide evidence of this certification, just as they are required to under the current rules. The Department of Health Professions (DHP) does not have an estimate of the magnitude of the expected administrative cost savings. A late renewal fee of $50 or a reinstatement fee of $180 would also be assessed. Both late renewal and reinstatement applicants would have to pay an additional $50 compared to having to pay the $130 initial application fee under the current regulation. The board reports that the higher fees are intended to incentivize individuals to renew their licenses within the renewal period. DHP also does not have an estimate on how many late renewal and reinstatement applications may be received.

Businesses and Other Entities Affected. According to DHP, there are currently 7,196 physician assistants licensed in the Commonwealth. However, the proposed amendments would only affect those physician assistants whose license has lapsed. There is no estimate on the number of late renewal and reinstatement applications that may be received under the proposed new pathways. No regulant appears to be disproportionately affected. The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.² An adverse impact is indicated if there is any increase in net cost or reduction in net benefit for any entity, even if the benefits exceed the costs for all entities combined.³ Whether an adverse impact on the physician assistants who use these new processes is indicated is unknown but appears unlikely.

Small Businesses⁴ Affected.⁵ The proposed amendments do not appear to adversely affect small businesses.

Localities⁶ Affected.⁷ The proposed amendments do not introduce costs for localities.

Projected Impact on Employment. The proposed amendments would make it easier for physician assistants with lapsed licenses to regain licensure for a small cost (i.e., $50 in additional fees). This should have a positive impact on the supply of physician assistants but whether the expected impact is significant and whether it would affect total employment are not known.

Effects on the Use and Value of Private Property. The proposed pathways to regain licensure should not have a direct impact on the use and value of private property unless the applicant owns a medical practice. No impact on real estate development costs is expected.

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¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

³ Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation. As a result, DPB has adopted a definition of adverse impact that assesses changes in net costs and benefits for each affected Virginia entity that directly results from discretionary changes to the regulation.

⁴ Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁵ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

⁶ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁷ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Board of Medicine concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

The amendments provide a reinstatement pathway for physician assistants who allow a license to lapse. Specifically, the action (i) adds a fee for reinstatement of a physician assistant license, (ii) removes the requirement that a physician assistant with a lapsed license make a new application for licensure, and (iii) sets out a reinstatement process for physician assistants with lapsed licenses.

18VAC85-50-35. Fees.

Unless otherwise provided, the following fees shall not be refundable:

1. The initial application fee for a license, payable at the time application is filed, shall be $130.

2. The biennial fee for renewal of an active license shall be $135 and for renewal of an inactive license shall be $70, payable in each odd-numbered year in the birth month of the licensee.

3. The additional fee for late renewal of licensure within one renewal cycle shall be $50.

4. A restricted volunteer license issued pursuant to § 54.1-2951.3 of the Code of Virginia shall expire 12 months from the date of issuance and may be renewed without charge by receipt of a renewal application that verifies that the physician assistant continues to comply with provisions of § 54.1-2951.3 of the Code of Virginia.

5. The fee for reinstatement of a license pursuant to § 54.1-2408.2 of the Code of Virginia shall be $2,000.

6. The fee for reinstatement of a license that has been expired for a period of two years or more shall be $180.

7. The fee for a duplicate license shall be $5.00, and the fee for a duplicate wall certificate shall be $15.

7. 8. The handling fee for a returned check or a dishonored credit card or debit card shall be $50.

8. 9. The fee for a letter of good standing or verification to another jurisdiction shall be $10.

9. 10. The fee for an application or for the biennial renewal of a restricted volunteer license pursuant to 18VAC85-50-61 shall be $35, due in the licensee's birth month. An additional fee for late renewal of licensure shall be $15 for each renewal cycle.

18VAC85-50-56. Renewal of license.

A. Every licensed physician assistant intending to continue to practice shall biennially renew the license in each odd numbered year in the licensee's birth month by:

1. Returning the renewal form and fee as prescribed by the board; and

2. Verifying compliance with continuing medical education standards established by the NCCPA.

B. No physician assistant who allows a an NCCPA certification to lapse shall be considered licensed by the board. Any such physician assistant who proposes to resume practice shall make a new application for licensure within two years or fewer shall apply for renewal and pay the late fee specified in 18VAC85-50-35. A physician assistant shall apply for reinstatement and pay the associated fee specified in 18VAC85-50-35 if the license has lapsed for more than two years.

18VAC85-50-62. Reinstatement.

A. A physician assistant whose license is lapsed for a period of two years or less may reinstate the license by payment of the renewal and late fees as set forth in 18VAC85-50-35.

B. A physician assistant whose license is lapsed for a period of more than two years may apply for reinstatement and shall submit:

1. A completed application package;

2. The fee specified in 18VAC85-50-35; and

3. Evidence of current certification by NCCPA.