Senator Lyle W. Hillyard proposes the following substitute bill:


1     
PROFESSIONAL COMPETENCY STANDARDS AMENDMENTS

2     
2019 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Jennifer Dailey-Provost

5     
Senate Sponsor: Daniel Hemmert

6     

7     LONG TITLE
8     General Description:
9          This bill amends certain restrictions on age-based physician testing.
10     Highlighted Provisions:
11          This bill:
12          ▸     amends a restriction on certain age-based testing for physician licensing,
13     employment, privileges, or reimbursement.
14     Money Appropriated in this Bill:
15          None
16     Other Special Clauses:
17          None
18     Utah Code Sections Affected:
19     AMENDS:
20          26-21-31, as enacted by Laws of Utah 2018, Chapter 438
21          31A-45-305, as enacted by Laws of Utah 2018, Chapter 438
22          58-67-302, as last amended by Laws of Utah 2018, Chapters 318 and 438
23          58-67-302.5, as last amended by Laws of Utah 2018, Chapters 318 and 438
24          58-68-302, as last amended by Laws of Utah 2018, Chapters 318 and 438
25     


26     Be it enacted by the Legislature of the state of Utah:
27          Section 1. Section 26-21-31 is amended to read:
28          26-21-31. Prohibition on certain age-based physician testing.
29          A health care facility may not require for purposes of employment, privileges, or
30     reimbursement, that a physician, as defined in Section 58-67-102, take a cognitive test when
31     the physician reaches a specified age, unless the test reflects [nationally recognized] the
32     standards [adopted by the American Medical Association for testing whether an older physician
33     remains able to provide safe and effective care for patients] described in Subsections
34     58-67-302(5)(b)(i) through (x).
35          Section 2. Section 31A-45-305 is amended to read:
36          31A-45-305. Prohibition on certain age-based physician testing.
37          A managed care organization or other third party may not require for purposes of
38     reimbursement that a physician, as defined in Section 58-67-102, take a cognitive test when the
39     physician reaches a specified age, unless the test reflects [nationally recognized] the standards
40     [adopted by the American Medical Association for testing whether an older physician remains
41     able to provide safe and effective care for patients] described in Subsections 58-67-302(5)(b)(i)
42     through (x).
43          Section 3. Section 58-67-302 is amended to read:
44          58-67-302. Qualifications for licensure.
45          (1) An applicant for licensure as a physician and surgeon, except as set forth in
46     Subsection (2), shall:
47          (a) submit an application in a form prescribed by the division, which may include:
48          (i) submissions by the applicant of information maintained by practitioner data banks,
49     as designated by division rule, with respect to the applicant;
50          (ii) a record of professional liability claims made against the applicant and settlements
51     paid by or on behalf of the applicant; and
52          (iii) authorization to use a record coordination and verification service approved by the
53     division in collaboration with the board;
54          (b) pay a fee determined by the department under Section 63J-1-504;
55          (c) be of good moral character;
56          (d) if the applicant is applying to participate in the Interstate Medical Licensure

57     Compact under Chapter 67b, Interstate Medical Licensure Compact, consent to a criminal
58     background check in accordance with Section 58-67-302.1 and any requirements established by
59     rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act;
60          (e) provide satisfactory documentation of having successfully completed a program of
61     professional education preparing an individual as a physician and surgeon, as evidenced by:
62          (i) having received an earned degree of doctor of medicine from an LCME accredited
63     medical school or college; or
64          (ii) if the applicant graduated from a medical school or college located outside the
65     United States or its territories, submitting a current certification by the Educational
66     Commission for Foreign Medical Graduates or any successor organization approved by the
67     division in collaboration with the board;
68          (f) satisfy the division and board that the applicant:
69          (i) has successfully completed 24 months of progressive resident training in a program
70     approved by the ACGME, the Royal College of Physicians and Surgeons, the College of
71     Family Physicians of Canada, or any similar body in the United States or Canada approved by
72     the division in collaboration with the board; or
73          (ii) (A) has successfully completed 12 months of resident training in an ACGME
74     approved program after receiving a degree of doctor of medicine as required under Subsection
75     (1)(e);
76          (B) has been accepted in and is successfully participating in progressive resident
77     training in an ACGME approved program within Utah, in the applicant's second or third year
78     of postgraduate training; and
79          (C) has agreed to surrender to the division the applicant's license as a physician and
80     surgeon without any proceedings under Title 63G, Chapter 4, Administrative Procedures Act,
81     and has agreed the applicant's license as a physician and surgeon will be automatically revoked
82     by the division if the applicant fails to continue in good standing in an ACGME approved
83     progressive resident training program within the state;
84          (g) pass the licensing examination sequence required by division rule made in
85     collaboration with the board;
86          (h) be able to read, write, speak, understand, and be understood in the English language
87     and demonstrate proficiency to the satisfaction of the board if requested by the board;

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

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

150          (f) the temporary license expires immediately and prior to the expiration of one year
151     from issuance, upon notification from the division that the applicant's application for licensure
152     by endorsement is denied.
153          (4) The division shall issue a temporary license under Subsection (3) within 15
154     business days after the applicant satisfies the requirements of Subsection (3).
155          (5) The division may not require the following requirements for licensure:
156           (a) a post-residency board certification; or
157          (b) a cognitive test when the physician reaches a specified age, unless[ the test reflects
158     nationally recognized standards adopted by the American Medical Association for testing
159     whether an older physician remains able to provide safe and effective care for patients.]:
160          (i) the screening is based on evidence of cognitive changes associated with aging that
161     are relevant to physician performance;
162          (ii) the screening is based on principles of medical ethics;
163          (iii) physicians are involved in the development of standards for assessing competency;
164          (iv) guidelines, procedures, and methods of assessment, which may include cognitive
165     screening, are relevant to physician practice and to the physician's ability to perform the tasks
166     specifically required in the physician's practice environment;
167          (v) the primary driver for establishing assessment results is the ethical obligation of the
168     profession to the health of the public and patient safety;
169          (vi) the goal of the assessment is to optimize physician competency and performance
170     through education, remediation, and modifications to a physician's practice environment or
171     scope;
172          (vii) a credentialing committee determines that public health or patient safety is
173     directly threatened, the screening permits a physician to retain the right to modify the
174     physician's practice environment to allow the physician to continue to provide safe and
175     effective care;
176          (viii) guidelines, procedures, and methods of assessment are transparent to physicians
177     and physicians' representative, if requested by a physician or a physician's representative, and
178     physicians are made aware of the specific methods used, performance expectations and
179     standards against which performance will be judged, and the possible outcomes of the
180     screening or assessment;

181          (ix) education or remediation practices that result from screening or assessment
182     procedures are:
183          (A) supportive of physician wellness;
184          (B) ongoing; and
185          (C) proactive; and
186          (x) procedures and screening mechanisms that are distinctly different from for cause
187     assessments do not result in undue cost or burden to senior physicians providing patient care.
188          Section 4. Section 58-67-302.5 is amended to read:
189          58-67-302.5. Licensing of graduates of foreign medical schools.
190          (1) Notwithstanding any other provision of law to the contrary, an individual enrolled
191     in a medical school outside the United States, its territories, the District of Columbia, or
192     Canada is eligible for licensure as a physician and surgeon in this state if the individual has
193     satisfied the following requirements:
194          (a) meets all the requirements of Subsection 58-67-302(1), except for Subsection
195     58-67-302(1)(e);
196          (b) has studied medicine in a medical school located outside the United States which is
197     recognized by an organization approved by the division;
198          (c) has completed all of the formal requirements of the foreign medical school except
199     internship or social service;
200          (d) has attained a passing score on the educational commission for foreign medical
201     graduates examination or other qualifying examinations such as the United States Medical
202     Licensing Exam parts I and II, which are approved by the division or a medical school
203     approved by the division;
204          (e) has satisfactorily completed one calendar year of supervised clinical training under
205     the direction of a United States medical education setting accredited by the liaison committee
206     for graduate medical education and approved by the division;
207          (f) has completed the postgraduate hospital training required by Subsection
208     58-67-302(1)(f)(i); and
209          (g) has passed the examination required by the division of all applicants for licensure.
210          (2) Satisfaction of the requirements of Subsection (1) is in lieu of:
211          (a) the completion of any foreign internship or social service requirements; and

212          (b) the certification required by Subsection 58-67-302(1)(e).
213          (3) Individuals who satisfy the requirements of Subsections (1)(a) through (g) shall be
214     eligible for admission to graduate medical education programs within the state, including
215     internships and residencies, which are accredited by the liaison committee for graduate medical
216     education.
217          (4) A document issued by a medical school located outside the United States shall be
218     considered the equivalent of a degree of doctor of medicine for the purpose of licensure as a
219     physician and surgeon in this state if:
220          (a) the foreign medical school is recognized by an organization approved by the
221     division;
222          (b) the document granted by the foreign medical school is issued after the completion
223     of all formal requirements of the medical school except internship or social service; and
224          (c) the foreign medical school certifies that the person to whom the document was
225     issued has satisfactorily completed the requirements of Subsection (1)(c).
226          (5) The division may not require as a requirement for licensure a cognitive test when
227     the physician reaches a specified age, unless the test reflects [nationally recognized] the
228     standards [adopted by the American Medical Association for testing whether an older physician
229     remains able to provide safe and effective care for patients] described in Subsections
230     58-67-302(5)(b)(i) through (x).
231          [(6)] (5) The provisions for licensure under this section shall be known as the "fifth
232     pathway program."
233          Section 5. Section 58-68-302 is amended to read:
234          58-68-302. Qualifications for licensure.
235          (1) An applicant for licensure as an osteopathic physician and surgeon, except as set
236     forth in Subsection (2), shall:
237          (a) submit an application in a form prescribed by the division, which may include:
238          (i) submissions by the applicant of information maintained by practitioner data banks,
239     as designated by division rule, with respect to the applicant;
240          (ii) a record of professional liability claims made against the applicant and settlements
241     paid by or on behalf of the applicant; and
242          (iii) authorization to use a record coordination and verification service approved by the

243     division in collaboration with the board;
244          (b) pay a fee determined by the department under Section 63J-1-504;
245          (c) be of good moral character;
246          (d) if the applicant is applying to participate in the Interstate Medical Licensure
247     Compact under Chapter 67b, Interstate Medical Licensure Compact, consent to a criminal
248     background check in accordance with Section 58-68-302.1 and any requirements established by
249     rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act;
250          (e) provide satisfactory documentation of having successfully completed a program of
251     professional education preparing an individual as an osteopathic physician and surgeon, as
252     evidenced by:
253          (i) having received an earned degree of doctor of osteopathic medicine from an AOA
254     approved medical school or college; or
255          (ii) submitting a current certification by the Educational Commission for Foreign
256     Medical Graduates or any successor organization approved by the division in collaboration
257     with the board, if the applicant is graduated from an osteopathic medical school or college
258     located outside of the United States or its territories which at the time of the applicant's
259     graduation, met criteria for accreditation by the AOA;
260          (f) satisfy the division and board that the applicant:
261          (i) has successfully completed 24 months of progressive resident training in an
262     ACGME or AOA approved program after receiving a degree of doctor of osteopathic medicine
263     required under Subsection (1)(e); or
264          (ii) (A) has successfully completed 12 months of resident training in an ACGME or
265     AOA approved program after receiving a degree of doctor of osteopathic medicine as required
266     under Subsection (1)(e);
267          (B) has been accepted in and is successfully participating in progressive resident
268     training in an ACGME or AOA approved program within Utah, in the applicant's second or
269     third year of postgraduate training; and
270          (C) has agreed to surrender to the division the applicant's license as an osteopathic
271     physician and surgeon without any proceedings under Title 63G, Chapter 4, Administrative
272     Procedures Act, and has agreed the applicant's license as an osteopathic physician and surgeon
273     will be automatically revoked by the division if the applicant fails to continue in good standing

274     in an ACGME or AOA approved progressive resident training program within the state;
275          (g) pass the licensing examination sequence required by division rule, as made in
276     collaboration with the board;
277          (h) be able to read, write, speak, understand, and be understood in the English language
278     and demonstrate proficiency to the satisfaction of the board, if requested by the board;
279          (i) meet with the board and representatives of the division, if requested for the purpose
280     of evaluating the applicant's qualifications for licensure;
281          (j) designate:
282          (i) a contact person for access to medical records in accordance with the federal Health
283     Insurance Portability and Accountability Act; and
284          (ii) an alternate contact person for access to medical records, in the event the original
285     contact person is unable or unwilling to serve as the contact person for access to medical
286     records; and
287          (k) establish a method for notifying patients of the identity and location of the contact
288     person and alternate contact person, if the applicant will practice in a location with no other
289     persons licensed under this chapter.
290          (2) An applicant for licensure as an osteopathic physician and surgeon by endorsement
291     who is currently licensed to practice osteopathic medicine in any state other than Utah, a
292     district or territory of the United States, or Canada shall:
293          (a) be currently licensed with a full unrestricted license in good standing in any state,
294     district or territory of the United States, or Canada;
295          (b) have been actively engaged in the legal practice of osteopathic medicine in any
296     state, district or territory of the United States, or Canada for not less than 6,000 hours during
297     the five years immediately preceding the day on which the applicant applied for licensure in
298     Utah;
299          (c) comply with the requirements for licensure under Subsections (1)(a) through (e),
300     (1)(f)(i), and (1)(h) through (k);
301          (d) have passed the licensing examination sequence required in Subsection (1)(g) or
302     another medical licensing examination sequence in another state, district or territory of the
303     United States, or Canada that the division in collaboration with the board by rulemaking
304     determines is equivalent to its own required examination;

305          (e) not have any investigation or action pending against any health care license of the
306     applicant, not have a health care license that was suspended or revoked in any state, district or
307     territory of the United States, or Canada, and not have surrendered a health care license in lieu
308     of a disciplinary action, unless:
309          (i) the license was subsequently reinstated as a full unrestricted license in good
310     standing; or
311          (ii) the division in collaboration with the board determines, after full disclosure by the
312     applicant, that:
313          (A) the conduct has been corrected, monitored, and resolved; or
314          (B) a mitigating circumstance exists that prevents its resolution, and the division in
315     collaboration with the board is satisfied that, but for the mitigating circumstance, the license
316     would be reinstated;
317          (f) submit to a records review, a practice review history, and physical and
318     psychological assessments, if requested by the division in collaboration with the board; and
319          (g) produce evidence that the applicant meets the requirements of this Subsection (2) to
320     the satisfaction of the division in collaboration with the board.
321          (3) An applicant for licensure by endorsement may engage in the practice of medicine
322     under a temporary license while the applicant's application for licensure is being processed by
323     the division, provided:
324          (a) the applicant submits a complete application required for temporary licensure to the
325     division;
326          (b) the applicant submits a written document to the division from:
327          (i) a health care facility licensed under Title 26, Chapter 21, Health Care Facility
328     Licensing and Inspection Act, stating that the applicant is practicing under the:
329          (A) invitation of the health care facility; and
330          (B) the general supervision of a physician practicing at the health care facility; or
331          (ii) two individuals licensed under this chapter, whose license is in good standing and
332     who practice in the same clinical location, both stating that:
333          (A) the applicant is practicing under the invitation and general supervision of the
334     individual; and
335          (B) the applicant will practice at the same clinical location as the individual;

336          (c) the applicant submits a signed certification to the division that the applicant meets
337     the requirements of Subsection (2);
338          (d) the applicant does not engage in the practice of medicine until the division has
339     issued a temporary license;
340          (e) the temporary license is only issued for and may not be extended or renewed
341     beyond the duration of one year from issuance; and
342          (f) the temporary license expires immediately and prior to the expiration of one year
343     from issuance, upon notification from the division that the applicant's application for licensure
344     by endorsement is denied.
345          (4) The division shall issue a temporary license under Subsection (3) within 15
346     business days after the applicant satisfies the requirements of Subsection (3).
347          (5) The division may not require [the following as a requirement for licensure: (a)] a
348     post-residency board certification[; or].
349          (b) a cognitive test when the physician reaches a specified age, unless the test reflects
350     [nationally recognized] the standards [adopted by the American Medical Association for testing
351     whether an older physician remains able to provide safe and effective care for patients]
352     described in Subsections 58-67-302(5)(b)(i) through (x).