Please amend 18VAC85-50-110(1) to not have specific verbiage requiring a physician be involved in patient care after presenting twice in a single episode of care. I work in psychiatry and patients frequently don't improve after 2 visits, especially when finding the medication that works for them.  It does not benefit my patient to have them involved at this point in their care and would waste the valuable time of my collaborating psychiatrist. We are severely short-staffed in mental health and removing these barriers is essential to getting more patients seen. PAs are trained to ask our collaborator for assistance when needed and PAs work as a part of a healthcare team. Please know that we will do as we are trained and remove these unnecessary barriers to patient care.