No. 43142 (Amendment): Rule R156-68. Utah Osteopathic Medical Practice Act Rule

(Amendment)

DAR File No.: 43142
Filed: 08/09/2018 09:57:00 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 396, passed during the 2017 General Session, amended the Osteopathic Medical Practice Act to establish the Associate Physician License classification effective 07/01/2018. This rule filing provides necessary definitions and establishes the requirements of the "collaborative practice arrangement contract" for an associate physician and a collaborative physician. Second, these amendments also clarify certain licensure requirements for all applicants applying for licensure as an osteopathic physician and surgeon by defining the practitioner data banks used for verification.

Summary of the rule or change:

In Section R156-68-102, these amendments provide definitions relative to the collaborative practice arrangement contract, terms, and approval requirement. In Section R156-68-302a, these amendments clarify the qualifications for licensure for all applicants applying for licensure as an osteopathic physician and surgeon under the Utah Osteopathic Medical Practice Act, by defining the practitioner data banks used for verification and required for submission of an application. Section R156-68-807 is a new section to this rule to establish and clarify the criteria for the collaborative practice arrangement contract between an associate physician and a collaborative physician.

Statutory or constitutional authorization for this rule:

• Section 58-68-101
• Subsection 58-1-106(1)(a)
• Subsection 58-1-202(1)(a)

Anticipated cost or savings to:

the state budget:

In Sections R156-68-102 and R156-68-807, because these proposed amendments only ensure that this rule implements the mandates of H.B. 396 (2017), the Division of Occupational and Professional Licensing (Division) estimates that there will be no impact on the state budget over and above that included in the fiscal note for H.B. 396 (2017), available online at https://le.utah.gov/~2017/bills/static/HB0396.html. In Section R156-68-302a, the Division estimates that there will be no impact on the state budget from these amendments that define the practitioner data banks used for verification, because these amendments only conform this rule to existing practice. The Division will incur minimal costs of approximately $75 to disseminate this rule once these proposed amendments are made effective.

local governments:

In Sections R156-68-102 and R156-68-807, because these proposed amendments only ensure that this rule implements the mandates of H.B. 396 (2017), the Division estimates that there will be no impact on local governments over and above that included in the fiscal note for H.B. 396 (2017), available online at https://le.utah.gov/~2017/bills/static/HB0396.html. In Section R156-68-302a, the Division estimates that there will be no impact on local governments from these amendments that define the practitioner data banks used for verification, because these amendments only conform this rule to existing practice.

small businesses:

In Sections R156-68-102 and R156-68-807, these proposed amendments, which establish and clarify the criteria for the collaborative practice arrangement contract between an associate physician and the collaborative physician, will apply to any small business that chooses to hire an associate physician. There are currently 1,808 potential small-business employers in Utah in the health industry field (NAICS 621111, Offices of Physicians) who might hire an associate physician under the criteria clarified by this rule. In turn, it is estimated that approximately two medical school graduates per year may apply for an associate physician position. In 2017, there were 92 graduates from the University of Utah Medical School (an increase of 12 from 2016). In Utah, there are currently 6 residency sponsoring programs which include 34 specialties and 52 subspecialties for postgraduate training. There is an Osteopathic Medical School in Ivins, Utah, which opened in 2018, and an Osteopathic Medical School scheduled to open in Provo, Utah, in 2021, which may increase the number of graduates applying for residency programs in Utah. For 2018, 197 postgraduate education positions for first-year residents were available in Utah. Graduates from medical schools in the United States and foreign programs may also apply for these available positions. In 2016, 94.3% of graduating medical students were matched to a residency program. An additional 3% of graduates are matched to residency programs after the initial match period, leaving only 3% of medical school graduates without a residency program. Statistically, this could leave 2 - 3 of the Utah graduates without a match. In short, the Division's analysis supports the estimate of the fiscal note for H.B. 396 (2017) that two graduates per year may apply for an associate physician position. Finally, however, regardless of the number of applicants for an associate physician position and the number of associate physician licensees in subsequent years, the Division estimates that these amendments will have no impact on any of these businesses over and above that already included in the fiscal note for H.B. 396 (2017), available online at: https://le.utah.gov/~2017/bills/static/HB0396.html, because these proposed amendments only implement the mandates of H.B. 396 (2017). In Section R156-68-302a, the Division estimates that there will be no impact on small business from these amendments that define the practitioner data banks used for verification, because these amendments only conform this rule to existing practice.

persons other than small businesses, businesses, or local governmental entities:

In Sections R156-68-102 and R156-68-807, the Division estimates that these proposed amendments establishing and clarifying the criteria for the collaborative practice arrangement between an associate physician and the collaborative physician, will have no impact on other persons over and above that already included in the fiscal note for H.B. 396 (2017), available online at: https://le.utah.gov/~2017/bills/static/HB0396.html, because these proposed amendments only implement the mandates of H.B. 396 (2017). In Section R156-68-302a, the Division estimates that there will be no impact on other persons from these amendments that define the practitioner data banks used for verification, because these amendments only conform this rule to existing practice.

Compliance costs for affected persons:

In Sections R156-68-102 and R156-68-807, the fiscal note for H.B. 396 (2017) estimated that there would be a $150 annual compliance cost (licensing fees) for each individual who qualifies for and elects to obtain an associate physician license. The Division estimates that these amendments will have no additional impact on these affected persons over and above this cost already included in the fiscal note, available online at: https://le.utah.gov/~2017/bills/static/HB0396.html, because these amendments only implement the mandates of H.B. 396 (2017). In Section R156-68-302a, the Division estimates that there will be no compliance costs to any affected persons from these amendments that define the practitioner data banks used for verification, because these amendments only conform this rule to existing practice.

Comments by the department head on the fiscal impact the rule may have on businesses:

The new Section R156-68-807 and the amendments to Sections R156-68-102 and R156-68-302a implement H.B. 396 (2017). H.B. 396 amended the Osteopathic Medical Practice Act to establish the Associate Physician License classification effective 07/01/2018. This rule and these amendments provide necessary definitions and establish and clarify the requirements of the collaborative practice arrangement between an associate physician and the collaborative physician. Second, these amendments also clarify certain licensure requirements for all applicants applying for licensure as an osteopathic physician and surgeon by defining the practitioner data banks used for verification. In Section R156-68-102, these amendments to this rule provide definitions relative to the collaborative practice arrangement contract, terms, and approval requirement. In Section R156-68-302a, these amendments to this rule clarify the qualifications for licensure for all applicants applying for licensure as an osteopathic physician and surgeon under the Utah Osteopathic Medical Practice Act, by defining the practitioner data banks used for verification and required for submission of an application. These amendments have no fiscal impact, as they merely conform this rule to existing practice. The new Section R156-68-807 is added to establish and clarify the criteria for the collaborative practice arrangement contract between an associate physician and a collaborative physician. Because Section R156-68-807 and these amendments to Section R156-68-102 only implement the mandates of H.B. 396 (2017), the Division estimates that there will be no impact on businesses over and above that included in the fiscal note for H.B. 396 (2017), available online at https://le.utah.gov/~2017/bills/static/HB0396.html. Although there are currently 1,808 potential small-business employers in Utah in the health industry field (NAICS 621111, Offices of Physicians) who might hire an associate physician under the criteria clarified by these amendments, the Division estimates that annually only two or three medical school graduates will apply for associate physician positions.

Francine A. Giani, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Commerce
Occupational and Professional Licensing
HEBER M WELLS BLDG
160 E 300 S
SALT LAKE CITY, UT 84111-2316

Direct questions regarding this rule to:

• Larry Marx at the above address, by phone at 801-530-6254, by FAX at 801-530-6511, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

10/01/2018

Interested persons may attend a public hearing regarding this rule:

• 09/20/2018 09:15 AM, Heber Wells Bldg, 160 E 300 S, North Conference Room (first floor), Salt Lake City, UT

This rule may become effective on:

10/08/2018

Authorized by:

Mark Steinagel, Director

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2019

FY 2020

FY 2021

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Person

$0

$0

$0

Total Fiscal Costs:

$0

$0

$0

Fiscal Benefits

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Persons

$0

$0

$0

Total Fiscal Benefits:

$0

$0

$0

Net Fiscal Benefits:

$0

$0

$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

For Sections R156-68-102 and R156-68-807, there are currently 96 potential non-small business employers in Utah in the health industry field (NAICS 621111, Offices of Physicians) who might hire an associate physician under the criteria established and clarified for a collaborative practice arrangement pursuant to these proposed amendments, although again, it is estimated that only two medical school graduates per year may actually apply for an associate physician position. However, similar to small businesses, the Division estimates that these proposed amendments will have no impact on non-small businesses over and above that already included in the fiscal note for H.B. 396 (2017), available online at:https://le.utah.gov/~2017/bills/static/HB0396.html, because these proposed amendments only implement the mandates of H.B. 396 (2017).

 

For Section R156-68-302a, the Division estimates that there will be no impact on non-small businesses from these amendments that define the practitioner data banks used for verification, because these amendments only conform this rule to existing practice.

 

The head of the Department of Commerce, Francine Giani, has reviewed and approved this fiscal analysis.

 

 

R156. Commerce, Occupational and Professional Licensing.

R156-68. Utah Osteopathic Medical Practice Act Rule.

R156-68-102. Definitions.

In addition to the definitions in Title 58, Chapters 1 and 68, as used in Title 58, Chapters 1 and 68 or this rule:

(1) "AAPS" means American Association of Physician Specialists.

(2) "ABMS" means American Board of Medical Specialties.

(3) "ACCME" means Accreditation Council for Continuing Medical Education.

(4) "Alternate medical practices" as used in Section R156-68-603, means treatment or therapy which is determined in an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative Procedures Act, to be:

(a) not generally recognized as standard in the practice of medicine;

(b) not shown by current generally accepted medical evidence to present a greater risk to the health, safety or welfare of the patient than does prevailing treatment considered to be the standard in the profession of medicine; and

(c) supported by a body of current generally accepted written documentation demonstrating the treatment or therapy has reasonable potential to be of benefit to the patient to whom the therapy or treatment is to be given.

(5) "AMA" means the American Medical Association.

(6) "AOA" means American Osteopathic Association.

(7) "Collaborative practice arrangement contract" means a written, signed contract between a collaborating physician licensed and in good standing under Section 58-68-302, and an associate physician holding a restricted license in accordance with Section 58-68-302.5, that:

(a) includes the terms and conditions required by Section 58-68-807 and Section R156-68-807; and

(b) is approved by the Division in accordance with Section 58-68-807 and Section R156-68-807.

([7]8) "COMLEX" means the Comprehensive Osteopathic Medical Licensing Examination.

([8]9) "FLEX" means the Federation of State Medical Boards Licensure Examination.

([9]10) "FMGEMS" means the Foreign Medical Graduate Examination in Medical Science.

([10]11) "FSMB" means the Federation of State Medical Boards.

([11]12) "Homeopathic medicine" means a system of medicine employing and limited to substances prepared and prescribed in accordance with the principles of homeopathic pharmacology as described in the Homeopathic Pharmacopoeia of the United States, its compendia, addenda, and supplements, as officially recognized by the federal Food, Drug and Cosmetic Act, Public Law 717.21 U.S. Code Sec. 331 et seq., as well as the state of Utah's food and drug laws and Controlled Substances Act.

([12]13) "LMCC" means the Licentiate of the Medical Council of Canada.

([13]14) "NBME" means the National Board of Medical Examiners.

([14]15) "NBOME" means the National Board of Osteopathic Medical Examiners.

([15]16) "NPDB" means the National Practitioner Data Bank.

(17) "Supervision form" means the form provided by the Division to document completion of the "continuously present" or "on-site" supervision required by Subsection 58-68-807(1)(d) for an associate physician practicing in a medically underserved area.

([16]18) "Unprofessional conduct" as defined in Title 58, Chapters 1 and 68, is further defined, in accordance with Subsection 58-1-203(1)(e), in Section R156-68-502.

([17]19) "USMLE" means the United States Medical Licensing Examination.

 

R156-68-302a. Qualifications for Licensure - Application Requirements.

In accordance with Subsections 58-68-301(1)(a)(i), submissions by the applicant of information maintained by practitioner data banks shall include the following:

(1) American Osteopathic Association Profile or American Medical Association Profile;

(2) Federation of State Medical Boards Disciplinary Inquiry form;[and]

(3) Federation Credentials Verification (FCVS) report; and

([3]4) National Practitioner Data Bank Report of Action.

 

R156-68-807. Collaborative Practice Arrangement Contract - Duties and Responsibilities of Collaborating Physician and Associate Physician.

In accordance with Section 58-68-807, the Division's approval of a collaborative practice arrangement, and the educational methods and programs required of an associate physician throughout the duration of a collaborative practice arrangement, are established as follows:

(1) Collaborative practice arrangement contract.

(a) Before beginning a collaborative practice arrangement, the prospective collaborating physician and associate physician shall sign a written collaborative practice arrangement contract, which the associate physician shall submit to the Division for approval.

(b) A collaborative practice arrangement contract shall include at least the following:

(i) all of the terms and conditions required by Section 58-68-807, including:

(A) a description of how the health care services to be rendered by the associate physician under the collaborative practice arrangement will be consistent with the associate physician's skill, training, and competence;

(B) a description of the medically underserved population or medically underserved area within the state where the associate physician will provide primary care services;

(C) if the associate physician will practice in a medically underserved area, a plan for documenting completion of the "continuously present" or"on-site" supervision required by Subsection 58-68-807(1)(d), using the Division-provided supervision forms;

(D) if the associate physician will prescribe Schedule III through V controlled substances, documentation of the associate physician's mid-level practitioner Federal Drug Administration (DEA) registration; and

(E) a provision requiring the associate physician to notify the Division in writing within 10 days of any modifications to the collaborative practice arrangement contract, and providing that any changes shall become effective only upon receipt of written notice from the Division approving the changes;

(ii) in accordance with Subsection 58-68-807(4), a plan establishing educational methods and programs that the associate physician shall complete throughout the duration of the collaborative practice arrangement contract, which:

(A) will facilitate the advancement of the associate physician's medical knowledge and abilities; and

(iii) remedies in the event of breach of contract by either the collaborating physician or associate physician, including procedures for contract termination and written notification to the Division.

(c) Before an associate physician may render any health care services under a collaborative practice arrangement, the parties must have obtained the Division's written approval of the collaborative practice arrangement contract.

(d) In evaluating a collaborative practice arrangement contract, the Division shall consider whether it sufficiently complies with all of the terms and conditions required by Section 58-68-807 and this section to adequately protect the public health, safety, and welfare.

(2) Collaborating physician duties and responsibilities.

A collaborating physician overseeing an associate physician shall have the following duties and responsibilities:

(a) ensure that the collaborating physician and associate physician:

(i) are both appropriately licensed; and

(ii) are practicing pursuant to a Division-approved collaborative practice arrangement contract in accordance with Subsection (1);

(b) ensure that during the term of the collaborative practice arrangement contract the collaborating physician does not enter into a collaborative practice arrangement with more than three full-time equivalent associate physicians as required by Subsection 58-68-807(3)(b);

(c) maintain a relationship with the associate physician in which the collaborating physician is independent from control by the associate physician, and in which the ability of the collaborating physician to supervise and direct the health care services rendered by the associate physician is not compromised;

(d) be available to the associate physician for advice, consultation, and direction consistent with the standards and ethics of the profession and the requirements suggested by the total of the profession and the requirements suggested by the total circumstances, including consideration of the associate physician's level of skill, training, and competence and other factors known to the associate physician and collaborating physician;

(e) ensure periodic review of the charts documenting the associate physician's delivery of health care services, in compliance with Subsection 58-68-807(1)(b)(xii);

(f) monitor the associate physician's performance for compliance with the laws, rules, standards, and ethics of the profession, and report violations to the Division; and

(g) upon request, submit appropriate documentation to the Division with respect to practice hours completed by the associate physician evidencing the "continuously present" or "on-site" supervision required by Subsection 58-68-807(1)(d).

(3) Associate physician duties and responsibilities.

An associate physician shall have the following duties and responsibilities:

(a) prior to beginning a collaborative practice arrangement and rendering any health care services, enter into a Division-approved collaborative practice arrangement contract with a collaborating physician in accordance with Subsection (1);

(b) maintain required licensure and any DEA registration;

(c) be professionally responsible for the acts and practices of the associate physician; and

(d) comply with all applicable laws, rules, standards, and ethics of the profession.

(4)(a) A collaborating physician shall submit to the Division a written explanation outlining the collaborating physician's concerns if the collaborating physician:

(i) terminates a collaborative practice arrangement contract for cause;

(ii) does not support continuance of a license for an associate physician to practice; or

(iii) has other concerns regarding the associate physician that the collaborating physician believes requires input from the Division and Board.

(b) Upon receipt of written concerns from a collaborating physician with respect to an associate physician, the Division shall:

(i) provide the associate physician an opportunity to respond in writing to the Division regarding the collaborating physician's concerns;

(ii) review the written statements from the collaborating physician and associate physician with the Board; and

(iii) in consultation with the Board, take any appropriate licensure action.

 

KEY: osteopaths, licensing, osteopathic physician

Date of Enactment or Last Substantive Amendment: [December 11, 2017]2018

Notice of Continuation: January 8, 2018

Authorizing, and Implemented or Interpreted Law: 58-1-106(1)(a); 58-1-202(1)(a); 58-68-101

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