The physician associate profession is having a breakout year in state legislatures. In the span of a few months in early 2026, Virginia removed the practice agreement requirement for experienced PAs, Maine did the same at a higher hour threshold, Kentucky expanded prescribing authority, Iowa and Kansas advanced the physician associate title, and Delaware pushed a modernization bill tied to a major rural health program. The PA Licensure Compact, meanwhile, has been enacted in nearly two dozen states.
This is the fastest stretch of PA practice modernization the profession has seen. For PAs, it changes what’s possible: more autonomy, easier multi-state practice, and in a growing number of states, the ability to practice without a formal physician agreement. It also changes the liability picture, because more independence means more of the responsibility for each clinical decision rests directly on you.
This roundup covers the states that moved in 2026, what each change means for PAs practicing there, and how expanded autonomy affects your insurance. If your state isn’t here, the AAPA’s state advocacy resources track the current status everywhere.
Virginia: Practice Agreement Requirement Removed for Experienced PAs
On April 8, 2026, Governor Abigail Spanberger signed House Bill 746 into law. The legislation removes the requirement that PAs with more than three years (roughly 3,000 hours) of clinical practice maintain a written practice agreement with a physician.
What changed: Experienced PAs in Virginia can transition away from the mandatory on-paper agreement once they meet the clinical threshold and regulatory benchmarks the Board of Medicine is finalizing. The change is aimed squarely at Virginia’s 70-plus federally designated health professional shortage areas, where physician oversight isn’t always locally available.
What it means for your coverage: A PA moving from agreement-based practice to independent practice carries a different liability profile. When there’s no supervising physician formally attached to your care, more of the exposure rests with you directly. CM&F PA policies conform automatically to your state’s scope of practice, so as your authority expands, your coverage follows. But this is the moment to confirm your policy reflects independent practice and to review whether your limits match your new level of autonomy.
Maine: Independence at 4,000 Hours
Governor Janet Mills signed LD 2800 into law, removing the practice agreement requirement for PAs with more than 4,000 clinical hours.
What changed: Maine joins the group of states allowing experienced PAs to practice without a formal written physician agreement, at a somewhat higher hour threshold than Virginia. The structure is similar: demonstrate the clinical experience, meet the regulatory requirements, and practice without the mandatory agreement.
What it means for your coverage: The same principle applies as in Virginia. PAs crossing the 4,000-hour threshold and moving to independent practice should confirm their coverage reflects the change and consider whether their limits are appropriate for practicing without formal physician oversight.
Kentucky: Schedule II Prescribing, Supervision Retained
Kentucky’s 2026 legislation took a different shape. Rather than removing supervision, the state retained the physician supervision framework but expanded PA prescribing authority to include Schedule II medications.
What changed: PAs in Kentucky now have Schedule II prescribing authority, a meaningful expansion of clinical scope, while the supervisory relationship with a physician remains in place. The change is aimed at improving primary care access in Kentucky’s 40 health professional shortage area counties.
What it means for your coverage: Expanded prescribing authority, particularly for Schedule II controlled substances, raises the stakes of prescribing decisions. Schedule II prescribing is among the highest-scrutiny clinical activities, and prescribing-related liability often turns on documentation of medical necessity and monitoring. PAs in Kentucky taking on Schedule II prescribing should ensure their coverage reflects their full prescribing scope and document rigorously.
Iowa and Kansas: The Physician Associate Title Advances
Two states moved on the title change in 2026. Iowa passed legislation permitting use of the term “physician associate,” and Kansas enacted a law that retains physician supervision and collaboration but allows the physician associate title.
What changed: These are title-focused changes rather than scope expansions. They reflect the profession’s broader transition from “physician assistant” to “physician associate,” a shift recognizing the clinical role PAs actually play. Iowa, which enacted its first PA practice modernization law in 2023, continues to build on that foundation.
What it means for your coverage: A title change doesn’t alter your liability profile by itself, but it’s a reminder to keep your professional records, credentials, and insurance documentation consistent with the title your state uses. If your state adopts the physician associate title, confirm your policy and certificates reflect it accurately.
Delaware: Modernization Tied to Rural Health Funding
Delaware House Bill 325 would allow clinically experienced PAs to practice without being tied to a single physician through a mandatory collaborative agreement. The bill is notable for its connection to Delaware’s $157 million Rural Health Transformation Program.
What’s happening: The bill advanced to the state Senate and has drawn organized opposition from the Medical Society of Delaware, which argues the current version provides fewer patient-safety safeguards than similar laws elsewhere and wants additional physician representation on the regulatory council for PAs. The legislation is part of a broader federal Rural Health Transformation Program that provides funding to states for modernizing rural healthcare through workforce development.
What it means for your coverage: This one is still in motion, so PAs in Delaware should watch how the final version lands. If it passes and you move to independent practice, the coverage considerations mirror Virginia and Maine: confirm your policy reflects your practice model and review your limits.
The PA Licensure Compact Keeps Growing
Beyond individual state scope changes, the PA Licensure Compact continues to expand. As of 2025 it had been enacted in 19 states, and additional states have moved since, with South Dakota becoming the 23rd state to enter as part of its rural health workforce focus.
What it does: The compact, modeled on the established Nurse Licensure Compact, will allow PAs to practice across member states under a privilege rather than obtaining a separate full license in each one. It takes time to operationalize after enactment (the AAPA has estimated 18 to 24 months), so the practical multi-state benefit is still rolling out.
What it means for your coverage: Multi-state practice, whether through the compact or individual state licenses, requires coverage that follows you across every state where you practice. CM&F PA policies are portable and cover you in every state where you’re licensed or hold a practice privilege, with telehealth included at no additional cost. As the compact operationalizes, confirm your coverage reflects each state where you’ll be seeing patients.
What Expanded PA Autonomy Means for Your Insurance
Every one of these changes points in the same direction: more PA autonomy, and with it, more individual responsibility for clinical decisions. Here’s what to review when your state’s laws change.
Confirm your policy reflects your current practice model. CM&F PA policies conform automatically to your state’s scope of practice, so coverage expands as your authority does. But if you’re moving from agreement-based to independent practice, confirm it with your carrier.
Review your coverage limits. Practicing without a formal physician agreement means you may be the primary or sole defendant in a claim, rather than sharing exposure with a supervising physician. That can warrant a look at whether your limits are appropriate.
Licensing board defense matters more in independent practice. When you practice autonomously, a complaint lands on you directly. License protection as a separate benefit ensures defending your license doesn’t compete with defending a malpractice claim.
If you’re moving toward practice ownership, layer your coverage. Independent practice authority is often the first step toward owning a practice. When that happens, individual professional liability, group coverage for the entity, general liability, and cyber coverage all come into play. Our PA private practice resources walk through the full picture.
Key Takeaways
PA practice modernization accelerated sharply in 2026. Virginia (HB 746) and Maine (LD 2800) removed practice agreement requirements for experienced PAs. Kentucky expanded prescribing to Schedule II while keeping supervision. Iowa and Kansas advanced the physician associate title. Delaware’s modernization bill, tied to a $157 million rural health program, is still moving.
The PA Licensure Compact has been enacted in more than 20 states and continues to grow, though it takes 18 to 24 months to operationalize after enactment.
Every expansion of autonomy shifts more clinical responsibility onto the individual PA. Confirm your coverage reflects your current practice model, review your limits if you’re moving to independent practice, and make sure licensing board defense is a separate benefit.
This roundup will be updated as additional states act. For the current status in your state, check the AAPA’s state advocacy resources.
Frequently Asked Questions
- Which states removed the PA practice agreement requirement in 2026?In 2026, Virginia (HB 746) removed the practice agreement requirement for PAs with more than three years of clinical practice, and Maine (LD 2800) did the same for PAs with more than 4,000 clinical hours. These join a growing group of states allowing experienced PAs to practice without a formal written physician agreement. Kentucky expanded PA prescribing to Schedule II while retaining supervision, and Iowa and Kansas advanced use of the physician associate title.
- Does expanded PA practice authority change my insurance needs?Yes. Practicing without a formal physician agreement means more clinical responsibility rests directly on you, and you may be the primary or sole defendant in a claim rather than sharing exposure with a supervising physician. CM&F PA policies conform automatically to your state’s scope of practice, so coverage expands as your authority does. When moving to independent practice, confirm your policy reflects it and review whether your limits match your new level of autonomy.
- What is the PA Licensure Compact?The PA Licensure Compact, modeled on the Nurse Licensure Compact, allows PAs to practice across member states under a privilege rather than obtaining a separate full license in each state. It has been enacted in more than 20 states and continues to grow. After a state enacts it, the AAPA estimates it takes 18 to 24 months to operationalize, so the practical multi-state benefit is still rolling out. Multi-state practice requires coverage that follows you across every state where you practice.
