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ARIZONA HOUSE OF REPRESENTATIVESFifty-fifth Legislature First Regular Session |
Senate: HHS DPA/SE 6-2-0-0 | 3rd Read 17-12-1-0 |
SB 1271: medical graduate transitional training permits
Sponsor: Senator Barto, LD 15
Committee on Health & Human Services
Overview
Requires the Arizona Medical Board (AMB) and the Arizona Board of Osteopathic Examiners in Medicine and Surgery (ABOE) to grant one-year transitional training permits to qualified applicants and establishes eligibility, qualifications and supervision requirements.
History
The AMB protects the public from unlawful, incompetent, unqualified, impaired or unprofessional practitioners of allopathic medicine through licensure, regulation and rehabilitation of the profession in Arizona. The powers an duties of the AMB include: 1) investigating unprofessional conduct and incompetent medical care; 2) reviewing the credentials and abilities of applicants; 3) engaging in exchange of information with the licensing and disciplinary board of other states; 4) adopting rules regarding the regulations and qualifications of doctors of medicine; and 5) delegating licensing and regulatory authority to the executive director (A.R.S. § 32-1403).
The ABOE regulates the practice of osteopathic medicine by: 1) issuing licenses, conducting hearing and administering disciplinary actions; 2) maintaining a record of its acts and proceedings; 3) adopt rules regarding the regulation and qualification of medical assistants (A.R.S. § 32-1803).
The AMB requires an applicant for licensure to successfully complete an approved twelve-month hospital internship, residency or clinical fellowship program. Similarly, the ABOE requires an applicant for licensure to successfully complete an approved internship or the first year of an approved multiple-year residency (A.R.S. §§ 32-1422 and 32-1822).
Both the AMB and the ABOE grant one-year renewable training permits to a person participating in a teaching hospital's accredited internship, residency or clinical fellowship training program to allow that person to function only in the supervised setting of that program (A.R.S. §§ 32-1432.02 and 32-1829).
Provisions
Transitional Training Permits
1. 
Instructs the AMB and the ABOE to grant
a one-year transitional training permit to a graduate of an allopathic school
of medicine or an osteopathic school of medicine who is not eligible to apply
for a license to practice or training permit if the applicant:
a) Within two years immediately preceding application, was either:
i. Qualified to submit, and submitted, a valid application to an accredited internship or residency program but was not selected; or
ii. Was selected but ended participation before completion for a reason that would not be considered grounds for disciplinary action; and
b) Successfully completed steps one and two of the United States Medical Licensing Examination or equivalent exams. (Sec. 1-2)
2. Allows the transitional training permit to be renewed for two additional one-year periods, in the year preceding an application for renewal, if the permittee submits valid applications to at least three accredited internship or residency programs and is not selected for a position. (Sec. 1-2)
Permittee Requirements
3. Requires permittees seeking renewal of a transitional training permit to provide the AMB or ABOE with written documentation of the internship or residency programs application and the nonselections. (Sec. 1-2)
4. Prohibits permittees from holding transitional training permits for a total of more than 36 months. (Sec. 1)
5. Limits the permittee to function only under the supervision of a qualified physician within the setting of an eligible entity, which includes the following if located in Arizona:
a) A licensed hospital or behavioral health facility;
b) A patient care facility operated by any federally recognized American Indian tribe, the Indian Health Service, the United States Veterans Administration, a prison or a school or university;
c) A community or federally qualified health center; and
d) A private office or clinic where a supervising physician practices, excluding a pain management clinic. (Sec. 1-2)
6. Requires, prior to issuing a permit, applicants and renewing permittees to comply with prescribed applicable registration requirements and pay a fee in the same amount as the fee prescribed for an approved internship. (Sec. 1-2)
7. States that a permittee:
a) Is subject to disciplinary regulations;
b) Must annually participate in at least 60 hours of continuing medical education programs approved by the AMB or the ABOE;
c) Must notify the AMB or the ABOE on the permittee's acceptance to an accredited internship or residency program. (Sec. 1-2)
Eligible Entity Requirements
8. Requires an eligible entity contracting with or employing a permittee to:
a) Provide, in collaboration with the supervising physician, ongoing clinical training related to the services that may be delegated to the permittee;
b) Be responsible, along with the supervising physician, for all aspects of the permittee’s performance;
c) Ensure that health care tasks performed by a permittee are within the permittee’s scope of medical training, experience and competence and have been properly delegated and supervised by a qualified physician;
d) Ensure that during the permittee’s first six months of full-time practice all clinical encounters are directly supervised by a qualified physician;
e) Ensure that all qualified physician supervision is documented;
f) Ensure that in all clinical or other patient encounters the permittee is clearly identified as a medical graduate in training;
g) Define the employment or contractual relationship with the permittee, including compensation and benefits, billing and reimbursement and general and professional liability coverage; and
h) Establish and document a process for evaluating the permittee’s performance that includes a review by the supervising physician of all medical records related to the clinical encounters performed by the permittee. (Sec. 1-2)
9. Allows clinical encounters performed by the permittee after the first six months to be under indirect supervision with direct supervision immediately available from the supervising physician. (Sec. 1-2)
10. Directs an eligible entity, prior to employing or contracting with a permittee, to notify the Arizona Department of Health Services (DHS) of:
a) The types and extent of medical training the entity plans to provide to the permittee;
b) The names of the qualified physicians who will supervise the permittee and the types of health care tasks that may be delegated by the supervising physicians. (Sec. 1-2)
11. Requires an eligible entity to post on its public website and submit to DHS an annual report that includes:
a) The number of permittees and supervising physicians employed by or contracted with the entity;
b) The length of time each permittee or supervising physician has been employed or contracted with the entity;
c) The total number of hours of medical education provided to each permittee;
d) The total number of hours of clinical care provided by each permittee; and
e) The number of permittees who obtained a match with an accredited internship or residency program. (Sec. 1-2)
Supervising Physician Requirements
12. Permits a supervising physician to delegate to a permittee health care tasks that are typically delegated in an accredited internship or residency program, including the ability to provide telehealth services, if all prescribed conditions are met. (Sec. 1-2)
13. Instructs a supervising physician to submit a written notification to the AMB or the ABOE stating the physician’s agreement to supervise a permittee, the name of the permittee and the name and location of the eligible entity at which the supervision will occur. (Sec. 1-2)
14. Specifies that a supervising physician:
a) Is responsible for all aspects of a permittee’s performance whether or not the supervising physician employs the permittee;
b) Is responsible for supervising and ensuring that the health care tasks performed by the permittee are within their scope of medical training and experience, are appropriate to the permittee’s level of competence and are properly delegated;
c) May allow a permittee to administer and dispense drugs if the controlled substance permit under which the drugs are dispensed belongs to either the supervising physician or the eligible entity;
d) May serve as a supervising physician for only one employee at any one time; and
e) Must notify the AMB or the ABOE, the eligibly entity and the permittee if the permittee exceeds the scope of the delegated health care tasks to allow the applicable board to investigate. (Sec. 1-2)
Miscellaneous
15. Specifies that an eligible entity or qualified physician is not required to establish a program to employ or contract permittees and that a qualified physician is not required to assume supervision responsibilities for a permittee. (Sec.1-2)
16. Requires DHS, in conjunction with the AMB or the ABOE, to report by January 1, 2024 and January 1, 2025, to the President of the Senate and the Speaker of the House of Representatives the number of:
a) Medical graduate transition training permits issued and in force;
b) Permittees who are placed with each type of eligible entity;
c) Permittees who are successfully accepted into accredited internship or residency programs and the type and location of these programs; and
d) Disciplinary actions taken against permittees and supervising physicians. (Sec. 3)
17. Repeals the reporting requirement on January 1, 2026. (Sec. 3)
18. Exempts the AMB and the ABOE from rulemaking requirements for 18 months after the general effective date of this act. (Sec. 4)
19. Requires the AMB and the ABOE to adopt rules, as necessary, to implement the prescribed transition training permits requirements no later than six months after the effective date of this act. (Sec. 4)
20. Defines direct supervision, indirect supervision with direct supervision immediately available, permittee and qualified physician. (Sec. 1-2)
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24. SB 1271
25. Initials EB/SF Page 0 Health & Human Services
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