Virginia has officially joined the ranks of states modernizing their approach to healthcare delivery by expanding the professional autonomy of Physician Assistants (PAs). On April 8, 2026, Virginia Governor Abigail Spanberger signed House Bill 746 (HB 746) into law, marking a significant milestone in the state’s efforts to improve healthcare access and efficiency.
The legislation introduces a pathway for experienced PAs to practice without a formal practice agreement, a move that mirrors the legislative trends seen in other states and reflects the evolving role of PAs in the modern healthcare landscape.
A New Regulatory Framework for Virginia PAs
Historically, PAs in Virginia were required to maintain a written or electronic practice agreement with a patient care team physician or podiatrist. HB 746 establishes a new framework that allows qualified PAs to transition away from this requirement, provided they meet specific clinical and regulatory benchmarks.
Key Provisions of HB 746
Authorization to Practice Without a Practice Agreement
The cornerstone of the bill is the authorization for a PA with at least three years of full-time clinical experience to practice without a practice agreement. Full-time clinical experience is defined as 1,800 hours per year of clinical experience. Therefore, to qualify for autonomous practice, a PA must accrue at least 3,600 hours of clinical experience. The transition to autonomy is not automatic; it requires an attestation from a patient care team physician or podiatrist who has collaborated with the PA, verifying their clinical competence and experience.
Alternative Pathways for Verification
The law also accounts for PAs who may be unable to obtain a direct attestation. According to the new law, the Board may accept other evidence demonstrating that the PA satisfies the clinical experience requirements needed to secure autonomy.
Defining Scope of Practice
PAs practicing without an agreement are not operating in a vacuum. The bill explicitly provides that PAs with free autonomy shall practice within the scope of the PAs clinical and professional training, within the limits of the PAs knowledge and experience, and in a manner consistent with the applicable standards of care.
The bill also requires that PAs with autonomy collaborate and consult with other healthcare providers based on patient needs and establish a plan for referral of complex medical cases and emergencies to physicians or other appropriate health care providers. This ensures that while autonomy is increased, patient safety remains the paramount priority.
Contingent Implementation
It is important to note that while the law has been signed, the door to independent practice isn’t open just yet. The effective date for these changes depends on the Virginia Board of Medicine. The Board is responsible for drafting the regulations required to implement the bill’s provisions and establishing the formal processes for granting autonomous practice. Until these regulations are finalized and officially published, PAs must continue to operate under their existing practice agreements.
Why This Matters Beyond Virginia
While HB 746 is specific to Virginia, it reflects a broader national movement toward “Optimal Team Practice” (OTP). Across the country, states are re-evaluating the rigid supervision models of the past in favor of more flexible, collaborative structures that reflect the reality of modern clinical teams.
What Virginia PAs and Practices Should Do Now
As the Board of Medicine finalizes the necessary regulations, PAs and their healthcare employers should begin preparing for this transition:
- Review Clinical Experience: PAs nearing or exceeding the three-year full-time clinical threshold should begin documenting their experience and identifying physicians who can provide the required attestation.
- Audit Practice Agreements: Practices should review current practice agreements to identify which PAs may soon qualify for independent practice and how this will shift internal workflows.
The Bottom Line
Virginia’s HB 746 represents a meaningful evolution in the regulation of healthcare professionals. By granting experienced PAs greater autonomy, the state is acknowledging their vital role in the patient care team and taking a proactive step toward a more efficient healthcare system. For PAs and practices that invest in understanding and preparing for these changes today, the transition will offer a pathway to more streamlined and effective patient care tomorrow.