HB 746 Virginia House of Delegates · 2026 Regular Session

Physician assistants; authorization to practice without a practice agreement.

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.
Bill status signed all 5 stages cleared
Introduction
Jan 2026
Committee Review
Mar 2026
House of Delegates Passage
Mar 2026
Senate Passage
Mar 2026
Signed into Law
Apr 2026
Introduced Jan 13, 2026 Signed Apr 8, 2026
Maddy AI version diff · 4 comparisons

What changed between versions

Health Professions Subcommittee Substitute Chaptered · 5 edits
MODERATE
This bill converts a House substitute draft into a final chaptered act, officially enacting new laws for Virginia physician assistants. The primary substantive change is the formal adoption of regulations allowing experienced physician assistants to practice without a formal practice agreement, provided they have three years of full-time clinical experience and receive an attestation from a supervising physician. The bill also clarifies that these independent practitioners must still collaborate with other providers and establish referral plans for complex cases.
Scope change
The bill's scope remains focused on physician assistant licensure and practice standards, but the applicability of the new 'independent practice' authority is now formally established through this chaptered act.
TIMELINE

Changed the document header from a 'House Substitute' draft to a 'Chaptered' Act, indicating the bill has been approved by the General Assembly and signed into law on April 8, 2026.

Established a condition precedent where the new independent practice rules will not become effective until the Board of Medicine formally adopts the required regulations.

TECHNICAL

Corrected minor formatting inconsistencies, such as spacing around section numbers and punctuation, to match the official style of the Code of Virginia.

REQUIREMENT

Added a new provision requiring the Board of Medicine to adopt specific regulations implementing the new independent practice authority, which exempts this rulemaking from standard administrative process delays.

DEFINITION

Formalized the definition of 'Attestation' and 'Clinical experience' to ensure consistent application of the new independent practice authorization.

Floor votes · Senate Feb 27, 2026 · House of Delegates Feb 17, 2026

How they voted

360
Passed · 3 other
Total votes 39
Feb 27, 2026
D Democratic20
18 Yea 2
90% Yea
R Republican19
18 Yea 1
94% Yea
Vote distribution
All Yea All Nay Mixed No data
Full legislative history

Actions timeline

Total actions
41
Key actions
16
Committee
9
Amendments
3
Apr 8, 2026
Signed into law
Approved by Governor-Chapter 418 (effective 7/1/2026)
executive
Mar 31, 2026
Lower · Passed
Signed by Speaker
lower
Mar 30, 2026
Upper · Passed
Signed by President
upper
Mar 30, 2026
Lower · Passed
Bill text as passed House and Senate (HB746ER)
lower
Mar 10, 2026
Lower · Passed
Senate amendment agreed to by House (99-Y 0-N 0-A)
lower
Mar 9, 2026
Upper · Passed
Passed Senate with amendment (38-Y 2-N 0-A)
upper
Mar 9, 2026
Introduced
Engrossed by Senate as amended
upper
Mar 9, 2026
Upper · Passed
Education and Health Amendment agreed to
upper
Mar 6, 2026
Upper · Passed
Passed by for the day Block Vote (Voice Vote)
upper
Mar 5, 2026
Upper · Passed
Reported from Education and Health with amendment (14-Y 0-N 1-A)
upper
Mar 5, 2026
Upper · Passed
Senate committee offered
upper
Mar 3, 2026
Committee
Recommitted to Education and Health
upper
Mar 2, 2026
Upper · Passed
Passed by for the day
upper
Feb 27, 2026
Upper · Passed
Passed by for the day Block Vote (Voice Vote)
upper
Feb 26, 2026
Upper · Passed
Reported from Education and Health (13-Y 1-N 1-A)
upper
Feb 18, 2026
Committee
Referred to Committee on Education and Health
upper
Feb 17, 2026
Lower · Passed
Read third time and passed House (97-Y 0-N 0-A)
lower
Feb 12, 2026
Lower · Passed
Reported from Health and Human Services with substitute (21-Y 0-N)
lower
Feb 10, 2026
Lower · Passed
House subcommittee offered
lower
Jan 21, 2026
Committee
Assigned sub: Health Professions
lower
Jan 13, 2026
Committee
Referred to Committee on Health and Human Services
lower
1 primary · 1 co-sponsor

Sponsors