Senator Lyle W. Hillyard proposes the following substitute bill:


1     
PHYSICIAN TESTING AMENDMENTS

2     
2018 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Lyle W. Hillyard

5     
House Sponsor: Keven J. Stratton

6     

7     LONG TITLE
8     General Description:
9           This bill enacts language related to certain age-based physician testing.
10     Highlighted Provisions:
11          This bill:
12          ▸      unless the test reflects certain nationally recognized standards, prohibits the
13     following from requiring that a physician take a cognitive exam at a certain age:
14               •     a health care facility for purposes of employment, privileges, or reimbursement;
15               •     a managed care organization or other third party for purposes of reimbursement;
16     and
17               •     the Division of Occupational and Professional Licensing for purposes of
18     licensing; and
19          ▸     makes technical and conforming changes.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          This bill provides a special effective date.
24     Utah Code Sections Affected:
25     AMENDS:

26          58-67-302, as last amended by Laws of Utah 2012, Chapters 162 and 225
27          58-67-302.5, as last amended by Laws of Utah 2011, Chapter 214
28          58-68-302, as last amended by Laws of Utah 2012, Chapters 162 and 225
29     ENACTS:
30          26-21-30, Utah Code Annotated 1953
31          31A-45-305, Utah Code Annotated 1953
32     

33     Be it enacted by the Legislature of the state of Utah:
34          Section 1. Section 26-21-30 is enacted to read:
35          26-21-30. Prohibition on certain age-based physician testing.
36          A health care facility may not require for purposes of employment, privileges, or
37     reimbursement, that a physician, as defined in Section 58-67-102, take a cognitive test when
38     the physician reaches a specified age, unless the test reflects nationally recognized standards
39     adopted by the American Medical Association for testing whether an older physician remains
40     able to provide safe and effective care for patients.
41          Section 2. Section 31A-45-305 is enacted to read:
42          31A-45-305. Prohibition on certain age-based physician testing.
43          A managed care organization or other third party may not require for purposes of
44     reimbursement that a physician, as defined in Section 58-67-102, take a cognitive test when the
45     physician reaches a specified age, unless the test reflects nationally recognized standards
46     adopted by the American Medical Association for testing whether an older physician remains
47     able to provide safe and effective care for patients.
48          Section 3. Section 58-67-302 is amended to read:
49          58-67-302. Qualifications for licensure.
50          (1) An applicant for licensure as a physician and surgeon, except as set forth in
51     Subsection (2), shall:
52          (a) submit an application in a form prescribed by the division, which may include:
53          (i) submissions by the applicant of information maintained by practitioner data banks,
54     as designated by division rule, with respect to the applicant;
55          (ii) a record of professional liability claims made against the applicant and settlements
56     paid by or on behalf of the applicant; and

57          (iii) authorization to use a record coordination and verification service approved by the
58     division in collaboration with the board;
59          (b) pay a fee determined by the department under Section 63J-1-504;
60          (c) be of good moral character;
61          (d) provide satisfactory documentation of having successfully completed a program of
62     professional education preparing an individual as a physician and surgeon, as evidenced by:
63          (i) having received an earned degree of doctor of medicine from an LCME accredited
64     medical school or college; or
65          (ii) if the applicant graduated from a medical school or college located outside the
66     United States or its territories, submitting a current certification by the Educational
67     Commission for Foreign Medical Graduates or any successor organization approved by the
68     division in collaboration with the board;
69          (e) satisfy the division and board that the applicant:
70          (i) has successfully completed 24 months of progressive resident training in a program
71     approved by the ACGME, the Royal College of Physicians and Surgeons, the College of
72     Family Physicians of Canada, or any similar body in the United States or Canada approved by
73     the division in collaboration with the board; or
74          (ii) (A) has successfully completed 12 months of resident training in an ACGME
75     approved program after receiving a degree of doctor of medicine as required under Subsection
76     (1)(d);
77          (B) has been accepted in and is successfully participating in progressive resident
78     training in an ACGME approved program within Utah, in the applicant's second or third year
79     of postgraduate training; and
80          (C) has agreed to surrender to the division the applicant's license as a physician and
81     surgeon without any proceedings under Title 63G, Chapter 4, Administrative Procedures Act,
82     and has agreed the applicant's license as a physician and surgeon will be automatically revoked
83     by the division if the applicant fails to continue in good standing in an ACGME approved
84     progressive resident training program within the state;
85          (f) pass the licensing examination sequence required by division rule made in
86     collaboration with the board;
87          (g) be able to read, write, speak, understand, and be understood in the English language

88     and demonstrate proficiency to the satisfaction of the board if requested by the board;
89          (h) meet with the board and representatives of the division, if requested, for the
90     purpose of evaluating the applicant's qualifications for licensure;
91          (i) designate:
92          (i) a contact person for access to medical records in accordance with the federal Health
93     Insurance Portability and Accountability Act; and
94          (ii) an alternate contact person for access to medical records, in the event the original
95     contact person is unable or unwilling to serve as the contact person for access to medical
96     records; and
97          (j) establish a method for notifying patients of the identity and location of the contact
98     person and alternate contact person, if the applicant will practice in a location with no other
99     persons licensed under this chapter.
100          (2) An applicant for licensure as a physician and surgeon by endorsement who is
101     currently licensed to practice medicine in any state other than Utah, a district or territory of the
102     United States, or Canada shall:
103          (a) be currently licensed with a full unrestricted license in good standing in any state,
104     district, or territory of the United States, or Canada;
105          (b) have been actively engaged in the legal practice of medicine in any state, district, or
106     territory of the United States, or Canada for not less than 6,000 hours during the five years
107     immediately preceding the date of application for licensure in Utah;
108          (c) comply with the requirements for licensure under Subsections (1)(a) through (d),
109     (1)(e)(i), and (1)(g) through (j);
110          (d) have passed the licensing examination sequence required in Subsection (1)(f) or
111     another medical licensing examination sequence in another state, district or territory of the
112     United States, or Canada that the division in collaboration with the board by rulemaking
113     determines is equivalent to its own required examination;
114          (e) not have any investigation or action pending against any health care license of the
115     applicant, not have a health care license that was suspended or revoked in any state, district or
116     territory of the United States, or Canada, and not have surrendered a health care license in lieu
117     of a disciplinary action, unless:
118          (i) the license was subsequently reinstated as a full unrestricted license in good

119     standing; or
120          (ii) the division in collaboration with the board determines to its satisfaction, after full
121     disclosure by the applicant, that:
122          (A) the conduct has been corrected, monitored, and resolved; or
123          (B) a mitigating circumstance exists that prevents its resolution, and the division in
124     collaboration with the board is satisfied that, but for the mitigating circumstance, the license
125     would be reinstated;
126          (f) submit to a records review, a practice history review, and comprehensive
127     assessments, if requested by the division in collaboration with the board; and
128          (g) produce satisfactory evidence that the applicant meets the requirements of this
129     Subsection (2) to the satisfaction of the division in collaboration with the board.
130          (3) An applicant for licensure by endorsement may engage in the practice of medicine
131     under a temporary license while the applicant's application for licensure is being processed by
132     the division, provided:
133          (a) the applicant submits a complete application required for temporary licensure to the
134     division;
135          (b) the applicant submits a written document to the division from:
136          (i) a health care facility licensed under Title 26, Chapter 21, Health Care Facility
137     Licensing and Inspection Act, stating that the applicant is practicing under the:
138          (A) invitation of the health care facility; and
139          (B) the general supervision of a physician practicing at the facility; or
140          (ii) two individuals licensed under this chapter, whose license is in good standing and
141     who practice in the same clinical location, both stating that:
142          (A) the applicant is practicing under the invitation and general supervision of the
143     individual; and
144          (B) the applicant will practice at the same clinical location as the individual;
145          (c) the applicant submits a signed certification to the division that the applicant meets
146     the requirements of Subsection (2);
147          (d) the applicant does not engage in the practice of medicine until the division has
148     issued a temporary license;
149          (e) the temporary license is only issued for and may not be extended or renewed

150     beyond the duration of one year from issuance; and
151          (f) the temporary license expires immediately and prior to the expiration of one year
152     from issuance, upon notification from the division that the applicant's application for licensure
153     by endorsement is denied.
154          (4) The division shall issue a temporary license under Subsection (3) within 15
155     business days after the applicant satisfies the requirements of Subsection (3).
156          (5) The division may not require the following requirements for licensure:
157          (a) a post-residency board certification [as a requirement for licensure.]; or
158          (b) a cognitive test when the physician reaches a specified age, unless the test reflects
159     nationally recognized standards adopted by the American Medical Association for testing
160     whether an older physician remains able to provide safe and effective care for patients.
161          Section 4. Section 58-67-302.5 is amended to read:
162          58-67-302.5. Licensing of graduates of foreign medical schools.
163          (1) Notwithstanding any other provision of law to the contrary, an individual enrolled
164     in a medical school outside the United States, its territories, the District of Columbia, or
165     Canada is eligible for licensure as a physician and surgeon in this state if the individual has
166     satisfied the following requirements:
167          (a) meets all the requirements of Subsection 58-67-302(1), except for Subsection
168     58-67-302(1)(d);
169          (b) has studied medicine in a medical school located outside the United States which is
170     recognized by an organization approved by the division;
171          (c) has completed all of the formal requirements of the foreign medical school except
172     internship or social service;
173          (d) has attained a passing score on the educational commission for foreign medical
174     graduates examination or other qualifying examinations such as the United States Medical
175     Licensing Exam parts I and II, which are approved by the division or a medical school
176     approved by the division;
177          (e) has satisfactorily completed one calendar year of supervised clinical training under
178     the direction of a United States medical education setting accredited by the liaison committee
179     for graduate medical education and approved by the division;
180          (f) has completed the postgraduate hospital training required by Subsection

181     58-67-302(1)(e)(i); and
182          (g) has passed the examination required by the division of all applicants for licensure.
183          (2) Satisfaction of the requirements of Subsection (1) is in lieu of:
184          (a) the completion of any foreign internship or social service requirements; and
185          (b) the certification required by Subsection 58-67-302(1)(d).
186          (3) Individuals who satisfy the requirements of Subsections (1)(a) through (f) shall be
187     eligible for admission to graduate medical education programs within the state, including
188     internships and residencies, which are accredited by the liaison committee for graduate medical
189     education.
190          (4) A document issued by a medical school located outside the United States shall be
191     considered the equivalent of a degree of doctor of medicine for the purpose of licensure as a
192     physician and surgeon in this state if:
193          (a) the foreign medical school is recognized by an organization approved by the
194     division;
195          (b) the document granted by the foreign medical school is issued after the completion
196     of all formal requirements of the medical school except internship or social service; and
197          (c) the foreign medical school certifies that the person to whom the document was
198     issued has satisfactorily completed the requirements of Subsection (1)(c).
199          (5) The division may not require as a requirement for licensure a cognitive test when
200     the physician reaches a specified age, unless the test reflects nationally recognized standards
201     adopted by the American Medical Association for testing whether an older physician remains
202     able to provide safe and effective care for patients.
203          [(5)] (6) The provisions for licensure under this section shall be known as the "fifth
204     pathway program."
205          Section 5. Section 58-68-302 is amended to read:
206          58-68-302. Qualifications for licensure.
207          (1) An applicant for licensure as an osteopathic physician and surgeon, except as set
208     forth in Subsection (2), shall:
209          (a) submit an application in a form prescribed by the division, which may include:
210          (i) submissions by the applicant of information maintained by practitioner data banks,
211     as designated by division rule, with respect to the applicant;

212          (ii) a record of professional liability claims made against the applicant and settlements
213     paid by or on behalf of the applicant; and
214          (iii) authorization to use a record coordination and verification service approved by the
215     division in collaboration with the board;
216          (b) pay a fee determined by the department under Section 63J-1-504;
217          (c) be of good moral character;
218          (d) provide satisfactory documentation of having successfully completed a program of
219     professional education preparing an individual as an osteopathic physician and surgeon, as
220     evidenced by:
221          (i) having received an earned degree of doctor of osteopathic medicine from an AOA
222     approved medical school or college; or
223          (ii) submitting a current certification by the Educational Commission for Foreign
224     Medical Graduates or any successor organization approved by the division in collaboration
225     with the board, if the applicant is graduated from an osteopathic medical school or college
226     located outside of the United States or its territories which at the time of the applicant's
227     graduation, met criteria for accreditation by the AOA;
228          (e) satisfy the division and board that the applicant:
229          (i) has successfully completed 24 months of progressive resident training in an
230     ACGME or AOA approved program after receiving a degree of doctor of osteopathic medicine
231     required under Subsection (1)(d); or
232          (ii) (A) has successfully completed 12 months of resident training in an ACGME or
233     AOA approved program after receiving a degree of doctor of osteopathic medicine as required
234     under Subsection (1)(d);
235          (B) has been accepted in and is successfully participating in progressive resident
236     training in an ACGME or AOA approved program within Utah, in the applicant's second or
237     third year of postgraduate training; and
238          (C) has agreed to surrender to the division the applicant's license as an osteopathic
239     physician and surgeon without any proceedings under Title 63G, Chapter 4, Administrative
240     Procedures Act, and has agreed the applicant's license as an osteopathic physician and surgeon
241     will be automatically revoked by the division if the applicant fails to continue in good standing
242     in an ACGME or AOA approved progressive resident training program within the state;

243          (f) pass the licensing examination sequence required by division rule, as made in
244     collaboration with the board;
245          (g) be able to read, write, speak, understand, and be understood in the English language
246     and demonstrate proficiency to the satisfaction of the board, if requested by the board;
247          (h) meet with the board and representatives of the division, if requested for the purpose
248     of evaluating the applicant's qualifications for licensure;
249          (i) designate:
250          (i) a contact person for access to medical records in accordance with the federal Health
251     Insurance Portability and Accountability Act; and
252          (ii) an alternate contact person for access to medical records, in the event the original
253     contact person is unable or unwilling to serve as the contact person for access to medical
254     records; and
255          (j) establish a method for notifying patients of the identity and location of the contact
256     person and alternate contact person, if the applicant will practice in a location with no other
257     persons licensed under this chapter.
258          (2) An applicant for licensure as an osteopathic physician and surgeon by endorsement
259     who is currently licensed to practice osteopathic medicine in any state other than Utah, a
260     district or territory of the United States, or Canada shall:
261          (a) be currently licensed with a full unrestricted license in good standing in any state,
262     district or territory of the United States, or Canada;
263          (b) have been actively engaged in the legal practice of osteopathic medicine in any
264     state, district or territory of the United States, or Canada for not less than 6,000 hours during
265     the five years immediately preceding the day on which the applicant applied for licensure in
266     Utah;
267          (c) comply with the requirements for licensure under Subsections (1)(a) through (d),
268     (1)(e)(i), and (1)(g) through (j);
269          (d) have passed the licensing examination sequence required in Subsection (1)(f) or
270     another medical licensing examination sequence in another state, district or territory of the
271     United States, or Canada that the division in collaboration with the board by rulemaking
272     determines is equivalent to its own required examination;
273          (e) not have any investigation or action pending against any health care license of the

274     applicant, not have a health care license that was suspended or revoked in any state, district or
275     territory of the United States, or Canada, and not have surrendered a health care license in lieu
276     of a disciplinary action, unless:
277          (i) the license was subsequently reinstated as a full unrestricted license in good
278     standing; or
279          (ii) the division in collaboration with the board determines, after full disclosure by the
280     applicant, that:
281          (A) the conduct has been corrected, monitored, and resolved; or
282          (B) a mitigating circumstance exists that prevents its resolution, and the division in
283     collaboration with the board is satisfied that, but for the mitigating circumstance, the license
284     would be reinstated;
285          (f) submit to a records review, a practice review history, and physical and
286     psychological assessments, if requested by the division in collaboration with the board; and
287          (g) produce evidence that the applicant meets the requirements of this Subsection (2) to
288     the satisfaction of the division in collaboration with the board.
289          (3) An applicant for licensure by endorsement may engage in the practice of medicine
290     under a temporary license while the applicant's application for licensure is being processed by
291     the division, provided:
292          (a) the applicant submits a complete application required for temporary licensure to the
293     division;
294          (b) the applicant submits a written document to the division from:
295          (i) a health care facility licensed under Title 26, Chapter 21, Health Care Facility
296     Licensing and Inspection Act, stating that the applicant is practicing under the:
297          (A) invitation of the health care facility; and
298          (B) the general supervision of a physician practicing at the health care facility; or
299          (ii) two individuals licensed under this chapter, whose license is in good standing and
300     who practice in the same clinical location, both stating that:
301          (A) the applicant is practicing under the invitation and general supervision of the
302     individual; and
303          (B) the applicant will practice at the same clinical location as the individual;
304          (c) the applicant submits a signed certification to the division that the applicant meets

305     the requirements of Subsection (2);
306          (d) the applicant does not engage in the practice of medicine until the division has
307     issued a temporary license;
308          (e) the temporary license is only issued for and may not be extended or renewed
309     beyond the duration of one year from issuance; and
310          (f) the temporary license expires immediately and prior to the expiration of one year
311     from issuance, upon notification from the division that the applicant's application for licensure
312     by endorsement is denied.
313          (4) The division shall issue a temporary license under Subsection (3) within 15
314     business days after the applicant satisfies the requirements of Subsection (3).
315          (5) The division may not require the following as a requirement for licensure:
316          (a) a post-residency board certification [as a requirement for licensure.]; or
317          (b) a cognitive test when the physician reaches a specified age, unless the test reflects
318     nationally recognized standards adopted by the American Medical Association for testing
319     whether an older physician remains able to provide safe and effective care for patients.
320          Section 6. Contingent effective date.
321          (1) Except as provided in Subsection (2), this bill takes effect when the Division of
322     Occupational and Professional Licensing certifies to the Health and Human Services Interim
323     Committee that the American Medical Association has adopted standards for testing whether
324     an older physician remains able to provide safe and effective care for patients.
325          (2) If the certification described in Subsection (1) does not occur before July 1, 2019,
326     this bill takes effect on July 1, 2019.