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ARIZONA STATE SENATE
Fifty-Fifth Legislature, First Regular Session
AMENDED
associate physicians; licensure; collaborative practice
(NOW: medical graduate transitional training permits)
Purpose
An emergency measure that directs the Arizona Medical Board (AMB) and the Arizona Board of Osteopathic Examiners in Medicine and Surgery (ABOE) to grant a one-year transitional training permit (transitional training permit) to qualified applicants. Establishes training permittee eligibility, qualifications, permitted duties and supervision requirements.
Background
The AMB is tasked with protecting the public from unlawful, incompetent, unqualified, impaired or unprofessional practitioners of allopathic medicine through licensure, regulation and rehabilitation. The AMB's responsibilities include: 1) issuing licenses, permits and registrations; 2) investigating and resolving conflicts; 3) providing information to the public; and 4) administering the Physician Health Program (A.R.S. § 32-1403).
The ABOE licenses and regulates medical physicians who practice osteopathic medicine, a system of medical treatment that emphasizes the inter-relationship of the body’s muscles, bones and joints with other body systems as an adjunct to invasive or chemically-based treatment. The ABOE's responsibilities include: 1) issuing licenses; 2) conducting hearings; 3) placing physicians on probation; 4) entering stipulated orders; and 5) issuing letters of concern and decrees of censure (A.R.S. §§ 32-1801 and 32-1803).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Transitional Training Permits
1. Requires the AMB and the ABOE, or the delegated Executive Directors, to grant a transitional training permit to a graduate of an allopathic school of medicine or an osteopathic school of medicine who is not otherwise eligible to apply for a license to practice or a specified training permit but who:
a) has successfully completed steps one and two of the U.S. Medical Licensing Examination or equivalent exams; and
b) within two years immediately preceding application for a training permit, either:
i. has qualified for and submitted a valid application to an accredited internship or residency program, but denied a position; or
ii. has been selected for an internship or residency position but ended participation before completion for a reason not considered grounds for disciplinary action.
2. Allows the transitional training permit to be renewed for two additional one-year periods if the permittee submits at least three valid applications to and is not selected for an accredited internship or residency program in the year preceding an application for renewal.
Permittee Requirements
3. Requires a permittee to participate in at least 60 hours of continuing medical education as approved by the AMB or the ABOE.
4. Requires a permittee to provide the AMB or ABOE with written documentation of the internship or residency applications and non-selections and notification of acceptance to a program.
5. Prohibits a permittee from holding a permit for an aggregate time period of more than 36 months.
6. Requires a permittee to function only under the supervision of a qualified physician within the setting of an eligible entity in Arizona that is:
a) a
licensed hospital or behavioral health facility;
b) a patient care facility operated by or for any federally recognized American Indian tribe, the Indian Health Service, the U.S. Veterans Administration, a prison or a school or university;
c) a community health center or a federally qualified health center; or
d) a private office or clinic where a supervising qualified physician practices, that is not a pain management clinic.
7. Subjects a permittee to applicable disciplinary regulations.
8. Requires an applicant for an initial or renewed transitional training permit to comply with applicable registration requirements and pay a fee that is the same as the fee prescribed for an approved internship program prior to the issuance of a permit.
Eligible Entity Requirements
9. Requires an eligible entity contracting with or employing a permittee to:
a) provide the permittee ongoing clinical training, in collaboration with the supervising physician, related to the services that may be delegated to the permittee;
b) be responsible, along with the supervising physician, for all aspects of the performance of the permittee;
c) ensure that the health care tasks performed by a permittee have been properly delegated and supervised and are within the scope of their medical training, experience and competence;
d) ensure that during the permittee's first six months of full-time practice all clinical encounters are directly supervised and all subsequent encounters are in-directly supervised by a qualified physician;
e) ensure that all 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 terms of compensation, benefits, billing, 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.
10. Requires an eligible entity, prior to employing or contracting with a permittee, to notify the Department of Health Services (DHS), on a prescribed form, of:
a) the types and extent of medical training the entity plans to provide; and
b) the names of the supervising physicians and the types of health care tasks that may be delegated.
11. Requires an eligible entity to post on its public website, and submit to DHS in an annual report, the following information:
a) the number of permittees and supervising physicians employed or contracted;
b) the length of time each permittee and supervising physician has been employed or contracted;
c) the total hours of medical education and clinical care provided to each permittee; and
d) the number of permittees who obtained a match with an accredited internship or residency program.
Supervising Physician Requirements
12. Deems a supervising physician responsible for:
a) all aspects of permittee performance, regardless of if the physician employs the permittee; and
b) supervising and ensuring that tasks performed by the permittee are within their scope training, experience and competency and are properly delegated.
13. Allows a supervising physician to grant a permittee the ability to dispense drugs if the controlled substance permit under which the drugs are dispensed belongs to either the supervising physician or the eligible entity.
14. Limits supervising physicians to supervise one permittee at a time.
15. Allows a supervising physician to delegate to a permittee health care tasks that are of a nature typically delegated in an accredited internship or residency program, including telehealth services, if all other prescribed conditions are met.
16. Requires 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.
17. Requires supervising physicians to notify the AMB or the ABOE, the eligible entity and the permittee if the permittee exceeds the scope of delegated tasks and to allow the applicable board to investigate.
Miscellaneous
18. Specifies that a supervising physician or eligible entity is not required to:
a) establish a transitional training permit program;
b) employ or contract with permittees; or
c) require any qualified physician to assume supervision responsibility.
19. Directs 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 transitional training permits issued and in force;
b) permittees placed with each type of eligible entity;
c) permittees 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.
20. Repeals reporting requirements on January 1, 2025.
21. Defines relevant terms.
22. Exempts the AMB and the ABOE from rulemaking requirements for 18 months after the effective date of this legislation.
23. Requires the AMB and the ABOE to adopt rules, as necessary, to implement prescribed transitional training permit requirements no later than six months after the effective date of this legislation.
24. Becomes effective on signature of the Governor, if the emergency clause is enacted.
Amendments Adopted by Committee
1. Adopted the strike-everything amendment.
2. Makes a technical correction.
Amendments Adopted by Committee of the Whole
1. Requires permittees to apply to three internship or residency programs and submit documentation of non-selection and notification of program acceptance.
2. Requires permittees to function only under the supervision of a qualified physician and deems the physician responsible for permittee performance and task delegation.
3. Limits qualified physicians to only supervise one permittee at a time and establishes supervising physician notification requirements.
4. Modifies entities eligible to employ or contract with a permittee and expands entity requirements related to supervision, liability coverage, evaluations and information reporting.
5. Establishes permittee notification requirements and modifies drug dispensing permits.
6. Establishes reporting and rulemaking requirements and defines relevant terms.
Senate Action
HHS 2/10/21 DPA/SE 6-2-0
Prepared by Senate Research
March 2, 2021
CRS/JP/kja