1     
PHYSICIAN CERTIFICATION AMENDMENTS

2     
2019 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Michael K. McKell

5     
Senate Sponsor: Curtis S. Bramble

6     

7     LONG TITLE
8     General Description:
9          This bill amends provisions related to physician licensing and certification.
10     Highlighted Provisions:
11          This bill:
12          ▸     prohibits the following persons from requiring that a physician maintain certain
13     certifications:
14               •     a health care facility, for purposes of employment, privileges, or reimbursement;
15               •     a managed care organization or other third party for purposes or reimbursement;
16     or
17               •     the Division of Occupational and Professional Licensing, for purposes of
18     licensing; and
19          ▸     makes technical changes.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          None
24     Utah Code Sections Affected:
25     AMENDS:
26          26-21-31, as enacted by Laws of Utah 2018, Chapter 438
27          31A-45-305, as enacted by Laws of Utah 2018, Chapter 438

28          58-67-302, as last amended by Laws of Utah 2018, Chapters 318 and 438
29          58-67-302.5, as last amended by Laws of Utah 2018, Chapters 318 and 438
30          58-68-302, as last amended by Laws of Utah 2018, Chapters 318 and 438
31     

32     Be it enacted by the Legislature of the state of Utah:
33          Section 1. Section 26-21-31 is amended to read:
34          26-21-31. Prohibition on certain physician testing.
35          A health care facility may not require for purposes of employment, privileges, or
36     reimbursement, that a physician, as defined in Section 58-67-102[,]:
37          (1) take a cognitive test when the physician reaches a specified age, unless the test
38     reflects nationally recognized standards adopted by the American Medical Association for
39     testing whether an older physician remains able to provide safe and effective care for
40     patients[.]; or
41          (2) secure maintenance of certification by a nationally recognized accrediting
42     organization that includes continuous reexamination to measure core competencies in practice
43     of medicine, as defined in Section 58-67-102, as a requirement for maintaining certification.
44          Section 2. Section 31A-45-305 is amended to read:
45          31A-45-305. Prohibition on certain physician testing.
46          A managed care organization or other third party may not require for purposes of
47     reimbursement that a physician, as defined in Section 58-67-102[,]:
48          (1) take a cognitive test when the physician reaches a specified age, unless the test
49     reflects nationally recognized standards adopted by the American Medical Association for
50     testing whether an older physician remains able to provide safe and effective care for
51     patients[.]; or
52          (2) secure maintenance of certification by a nationally recognized accrediting
53     organization that includes continuous reexamination to measure core competencies in practice
54     of medicine, as defined in Section 58-67-102, as a requirement of maintaining certification.
55          Section 3. Section 58-67-302 is amended to read:
56          58-67-302. Qualifications for licensure.
57          (1) An applicant for licensure as a physician and surgeon, except as set forth in
58     Subsection (2), shall:

59          (a) submit an application in a form prescribed by the division, which may include:
60          (i) submissions by the applicant of information maintained by practitioner data banks,
61     as designated by division rule, with respect to the applicant;
62          (ii) a record of professional liability claims made against the applicant and settlements
63     paid by or on behalf of the applicant; and
64          (iii) authorization to use a record coordination and verification service approved by the
65     division in collaboration with the board;
66          (b) pay a fee determined by the department under Section 63J-1-504;
67          (c) be of good moral character;
68          (d) if the applicant is applying to participate in the Interstate Medical Licensure
69     Compact under Chapter 67b, Interstate Medical Licensure Compact, consent to a criminal
70     background check in accordance with Section 58-67-302.1 and any requirements established by
71     rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act;
72          (e) provide satisfactory documentation of having successfully completed a program of
73     professional education preparing an individual as a physician and surgeon, as evidenced by:
74          (i) having received an earned degree of doctor of medicine from an LCME accredited
75     medical school or college; or
76          (ii) if the applicant graduated from a medical school or college located outside the
77     United States or its territories, submitting a current certification by the Educational
78     Commission for Foreign Medical Graduates or any successor organization approved by the
79     division in collaboration with the board;
80          (f) satisfy the division and board that the applicant:
81          (i) has successfully completed 24 months of progressive resident training in a program
82     approved by the ACGME, the Royal College of Physicians and Surgeons, the College of
83     Family Physicians of Canada, or any similar body in the United States or Canada approved by
84     the division in collaboration with the board; or
85          (ii) (A) has successfully completed 12 months of resident training in an ACGME
86     approved program after receiving a degree of doctor of medicine as required under Subsection
87     (1)(e);
88          (B) has been accepted in and is successfully participating in progressive resident
89     training in an ACGME approved program within Utah, in the applicant's second or third year

90     of postgraduate training; and
91          (C) has agreed to surrender to the division the applicant's license as a physician and
92     surgeon without any proceedings under Title 63G, Chapter 4, Administrative Procedures Act,
93     and has agreed the applicant's license as a physician and surgeon will be automatically revoked
94     by the division if the applicant fails to continue in good standing in an ACGME approved
95     progressive resident training program within the state;
96          (g) pass the licensing examination sequence required by division rule made in
97     collaboration with the board;
98          (h) be able to read, write, speak, understand, and be understood in the English language
99     and demonstrate proficiency to the satisfaction of the board if requested by the board;
100          (i) meet with the board and representatives of the division, if requested, for the purpose
101     of evaluating the applicant's qualifications for licensure;
102          (j) designate:
103          (i) a contact person for access to medical records in accordance with the federal Health
104     Insurance Portability and Accountability Act; and
105          (ii) an alternate contact person for access to medical records, in the event the original
106     contact person is unable or unwilling to serve as the contact person for access to medical
107     records; and
108          (k) establish a method for notifying patients of the identity and location of the contact
109     person and alternate contact person, if the applicant will practice in a location with no other
110     persons licensed under this chapter.
111          (2) An applicant for licensure as a physician and surgeon by endorsement who is
112     currently licensed to practice medicine in any state other than Utah, a district or territory of the
113     United States, or Canada shall:
114          (a) be currently licensed with a full unrestricted license in good standing in any state,
115     district, or territory of the United States, or Canada;
116          (b) have been actively engaged in the legal practice of medicine in any state, district, or
117     territory of the United States, or Canada for not less than 6,000 hours during the five years
118     immediately preceding the date of application for licensure in Utah;
119          (c) comply with the requirements for licensure under Subsections (1)(a) through (e),
120     (1)(f)(i), and (1)(h) through (k);

121          (d) have passed the licensing examination sequence required in Subsection (1)(f) or
122     another medical licensing examination sequence in another state, district or territory of the
123     United States, or Canada that the division in collaboration with the board by rulemaking
124     determines is equivalent to its own required examination;
125          (e) not have any investigation or action pending against any health care license of the
126     applicant, not have a health care license that was suspended or revoked in any state, district or
127     territory of the United States, or Canada, and not have surrendered a health care license in lieu
128     of a disciplinary action, unless:
129          (i) the license was subsequently reinstated as a full unrestricted license in good
130     standing; or
131          (ii) the division in collaboration with the board determines to its satisfaction, after full
132     disclosure by the applicant, that:
133          (A) the conduct has been corrected, monitored, and resolved; or
134          (B) a mitigating circumstance exists that prevents its resolution, and the division in
135     collaboration with the board is satisfied that, but for the mitigating circumstance, the license
136     would be reinstated;
137          (f) submit to a records review, a practice history review, and comprehensive
138     assessments, if requested by the division in collaboration with the board; and
139          (g) produce satisfactory evidence that the applicant meets the requirements of this
140     Subsection (2) to the satisfaction of the division in collaboration with the board.
141          (3) An applicant for licensure by endorsement may engage in the practice of medicine
142     under a temporary license while the applicant's application for licensure is being processed by
143     the division, provided:
144          (a) the applicant submits a complete application required for temporary licensure to the
145     division;
146          (b) the applicant submits a written document to the division from:
147          (i) a health care facility licensed under Title 26, Chapter 21, Health Care Facility
148     Licensing and Inspection Act, stating that the applicant is practicing under the:
149          (A) invitation of the health care facility; and
150          (B) the general supervision of a physician practicing at the facility; or
151          (ii) two individuals licensed under this chapter, whose license is in good standing and

152     who practice in the same clinical location, both stating that:
153          (A) the applicant is practicing under the invitation and general supervision of the
154     individual; and
155          (B) the applicant will practice at the same clinical location as the individual;
156          (c) the applicant submits a signed certification to the division that the applicant meets
157     the requirements of Subsection (2);
158          (d) the applicant does not engage in the practice of medicine until the division has
159     issued a temporary license;
160          (e) the temporary license is only issued for and may not be extended or renewed
161     beyond the duration of one year from issuance; and
162          (f) the temporary license expires immediately and prior to the expiration of one year
163     from issuance, upon notification from the division that the applicant's application for licensure
164     by endorsement is denied.
165          (4) The division shall issue a temporary license under Subsection (3) within 15
166     business days after the applicant satisfies the requirements of Subsection (3).
167          (5) The division may not require the following requirements for licensure:
168          (a) a post-residency board certification; [or]
169          (b) a cognitive test when the physician reaches a specified age, unless the test reflects
170     nationally recognized standards adopted by the American Medical Association for testing
171     whether an older physician remains able to provide safe and effective care for patients[.]; or
172          (c) maintenance of certification by a nationally recognized accrediting organization that
173     includes continuous reexamination to measure core competencies in practice of medicine as a
174     requirement for maintaining certification.
175          Section 4. Section 58-67-302.5 is amended to read:
176          58-67-302.5. Licensing of graduates of foreign medical schools.
177          (1) Notwithstanding any other provision of law to the contrary, an individual enrolled
178     in a medical school outside the United States, its territories, the District of Columbia, or
179     Canada is eligible for licensure as a physician and surgeon in this state if the individual has
180     satisfied the following requirements:
181          (a) meets all the requirements of Subsection 58-67-302(1), except for Subsection
182     58-67-302(1)(e);

183          (b) has studied medicine in a medical school located outside the United States which is
184     recognized by an organization approved by the division;
185          (c) has completed all of the formal requirements of the foreign medical school except
186     internship or social service;
187          (d) has attained a passing score on the educational commission for foreign medical
188     graduates examination or other qualifying examinations such as the United States Medical
189     Licensing Exam parts I and II, which are approved by the division or a medical school
190     approved by the division;
191          (e) has satisfactorily completed one calendar year of supervised clinical training under
192     the direction of a United States medical education setting accredited by the liaison committee
193     for graduate medical education and approved by the division;
194          (f) has completed the postgraduate hospital training required by Subsection
195     58-67-302(1)(f)(i); and
196          (g) has passed the examination required by the division of all applicants for licensure.
197          (2) Satisfaction of the requirements of Subsection (1) is in lieu of:
198          (a) the completion of any foreign internship or social service requirements; and
199          (b) the certification required by Subsection 58-67-302(1)(e).
200          (3) Individuals who satisfy the requirements of Subsections (1)(a) through (g) shall be
201     eligible for admission to graduate medical education programs within the state, including
202     internships and residencies, which are accredited by the liaison committee for graduate medical
203     education.
204          (4) A document issued by a medical school located outside the United States shall be
205     considered the equivalent of a degree of doctor of medicine for the purpose of licensure as a
206     physician and surgeon in this state if:
207          (a) the foreign medical school is recognized by an organization approved by the
208     division;
209          (b) the document granted by the foreign medical school is issued after the completion
210     of all formal requirements of the medical school except internship or social service; and
211          (c) the foreign medical school certifies that the person to whom the document was
212     issued has satisfactorily completed the requirements of Subsection (1)(c).
213          (5) The division may not require as a requirement for licensure:

214          (a) a cognitive test when the physician reaches a specified age, unless the test reflects
215     nationally recognized standards adopted by the American Medical Association for testing
216     whether an older physician remains able to provide safe and effective care for patients[.]; or
217          (b) maintenance of certification by a nationally recognized accrediting organization
218     that includes continuous reexamination to measure core competencies in practice of medicine
219     as a requirement for maintaining certification.
220          (6) The provisions for licensure under this section shall be known as the "fifth pathway
221     program."
222          Section 5. Section 58-68-302 is amended to read:
223          58-68-302. Qualifications for licensure.
224          (1) An applicant for licensure as an osteopathic physician and surgeon, except as set
225     forth in Subsection (2), shall:
226          (a) submit an application in a form prescribed by the division, which may include:
227          (i) submissions by the applicant of information maintained by practitioner data banks,
228     as designated by division rule, with respect to the applicant;
229          (ii) a record of professional liability claims made against the applicant and settlements
230     paid by or on behalf of the applicant; and
231          (iii) authorization to use a record coordination and verification service approved by the
232     division in collaboration with the board;
233          (b) pay a fee determined by the department under Section 63J-1-504;
234          (c) be of good moral character;
235          (d) if the applicant is applying to participate in the Interstate Medical Licensure
236     Compact under Chapter 67b, Interstate Medical Licensure Compact, consent to a criminal
237     background check in accordance with Section 58-68-302.1 and any requirements established by
238     rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act;
239          (e) provide satisfactory documentation of having successfully completed a program of
240     professional education preparing an individual as an osteopathic physician and surgeon, as
241     evidenced by:
242          (i) having received an earned degree of doctor of osteopathic medicine from an AOA
243     approved medical school or college; or
244          (ii) submitting a current certification by the Educational Commission for Foreign

245     Medical Graduates or any successor organization approved by the division in collaboration
246     with the board, if the applicant is graduated from an osteopathic medical school or college
247     located outside of the United States or its territories which at the time of the applicant's
248     graduation, met criteria for accreditation by the AOA;
249          (f) satisfy the division and board that the applicant:
250          (i) has successfully completed 24 months of progressive resident training in an
251     ACGME or AOA approved program after receiving a degree of doctor of osteopathic medicine
252     required under Subsection (1)(e); or
253          (ii) (A) has successfully completed 12 months of resident training in an ACGME or
254     AOA approved program after receiving a degree of doctor of osteopathic medicine as required
255     under Subsection (1)(e);
256          (B) has been accepted in and is successfully participating in progressive resident
257     training in an ACGME or AOA approved program within Utah, in the applicant's second or
258     third year of postgraduate training; and
259          (C) has agreed to surrender to the division the applicant's license as an osteopathic
260     physician and surgeon without any proceedings under Title 63G, Chapter 4, Administrative
261     Procedures Act, and has agreed the applicant's license as an osteopathic physician and surgeon
262     will be automatically revoked by the division if the applicant fails to continue in good standing
263     in an ACGME or AOA approved progressive resident training program within the state;
264          (g) pass the licensing examination sequence required by division rule, as made in
265     collaboration with the board;
266          (h) be able to read, write, speak, understand, and be understood in the English language
267     and demonstrate proficiency to the satisfaction of the board, if requested by the board;
268          (i) meet with the board and representatives of the division, if requested for the purpose
269     of evaluating the applicant's qualifications for licensure;
270          (j) designate:
271          (i) a contact person for access to medical records in accordance with the federal Health
272     Insurance Portability and Accountability Act; and
273          (ii) an alternate contact person for access to medical records, in the event the original
274     contact person is unable or unwilling to serve as the contact person for access to medical
275     records; and

276          (k) establish a method for notifying patients of the identity and location of the contact
277     person and alternate contact person, if the applicant will practice in a location with no other
278     persons licensed under this chapter.
279          (2) An applicant for licensure as an osteopathic physician and surgeon by endorsement
280     who is currently licensed to practice osteopathic medicine in any state other than Utah, a
281     district or territory of the United States, or Canada shall:
282          (a) be currently licensed with a full unrestricted license in good standing in any state,
283     district or territory of the United States, or Canada;
284          (b) have been actively engaged in the legal practice of osteopathic medicine in any
285     state, district or territory of the United States, or Canada for not less than 6,000 hours during
286     the five years immediately preceding the day on which the applicant applied for licensure in
287     Utah;
288          (c) comply with the requirements for licensure under Subsections (1)(a) through (e),
289     (1)(f)(i), and (1)(h) through (k);
290          (d) have passed the licensing examination sequence required in Subsection (1)(g) or
291     another medical licensing examination sequence in another state, district or territory of the
292     United States, or Canada that the division in collaboration with the board by rulemaking
293     determines is equivalent to its own required examination;
294          (e) not have any investigation or action pending against any health care license of the
295     applicant, not have a health care license that was suspended or revoked in any state, district or
296     territory of the United States, or Canada, and not have surrendered a health care license in lieu
297     of a disciplinary action, unless:
298          (i) the license was subsequently reinstated as a full unrestricted license in good
299     standing; or
300          (ii) the division in collaboration with the board determines, after full disclosure by the
301     applicant, that:
302          (A) the conduct has been corrected, monitored, and resolved; or
303          (B) a mitigating circumstance exists that prevents its resolution, and the division in
304     collaboration with the board is satisfied that, but for the mitigating circumstance, the license
305     would be reinstated;
306          (f) submit to a records review, a practice review history, and physical and

307     psychological assessments, if requested by the division in collaboration with the board; and
308          (g) produce evidence that the applicant meets the requirements of this Subsection (2) to
309     the satisfaction of the division in collaboration with the board.
310          (3) An applicant for licensure by endorsement may engage in the practice of medicine
311     under a temporary license while the applicant's application for licensure is being processed by
312     the division, provided:
313          (a) the applicant submits a complete application required for temporary licensure to the
314     division;
315          (b) the applicant submits a written document to the division from:
316          (i) a health care facility licensed under Title 26, Chapter 21, Health Care Facility
317     Licensing and Inspection Act, stating that the applicant is practicing under the:
318          (A) invitation of the health care facility; and
319          (B) the general supervision of a physician practicing at the health care facility; or
320          (ii) two individuals licensed under this chapter, whose license is in good standing and
321     who practice in the same clinical location, both stating that:
322          (A) the applicant is practicing under the invitation and general supervision of the
323     individual; and
324          (B) the applicant will practice at the same clinical location as the individual;
325          (c) the applicant submits a signed certification to the division that the applicant meets
326     the requirements of Subsection (2);
327          (d) the applicant does not engage in the practice of medicine until the division has
328     issued a temporary license;
329          (e) the temporary license is only issued for and may not be extended or renewed
330     beyond the duration of one year from issuance; and
331          (f) the temporary license expires immediately and prior to the expiration of one year
332     from issuance, upon notification from the division that the applicant's application for licensure
333     by endorsement is denied.
334          (4) The division shall issue a temporary license under Subsection (3) within 15
335     business days after the applicant satisfies the requirements of Subsection (3).
336          (5) The division may not require the following as a requirement for licensure:
337          (a) a post-residency board certification; [or]

338          (b) a cognitive test when the physician reaches a specified age, unless the test reflects
339     nationally recognized standards adopted by the American Medical Association for testing
340     whether an older physician remains able to provide safe and effective care for patients[.]; or
341          (c) maintenance of certification by a nationally recognized accrediting organization that
342     includes continuous reexamination to measure core competencies in the practice of medicine as
343     a requirement for maintaining certification.