RULES AND REGULATIONS
Title 49—PROFESSIONAL AND VOCATIONAL STANDARDS
STATE BOARD OF PODIATRY
[49 PA. CODE CH. 29]
Continuing Education
[52 Pa.B. 4401]
[Saturday, August 6, 2022]The State Board of Podiatry (Board) amends §§ 29.60, 29.61 and 29.68 (relating to definitions; requirements for biennial renewal and eligibility to conduct educational conferences; and continuing education exemptions).
Effective Date
This final-form rulemaking will be effective upon publication in the Pennsylvania Bulletin.
Statutory Authority
Section 15 of the Podiatry Practice Act (act) (63 P.S. § 42.15) authorizes the Board to promulgate and enforce such rules and regulations to carry out the intent and purposes of the act. Section 9 of the act (63 P.S. § 42.9) requires licensees to apply for biennial renewal and submit evidence that the licensee completed ''such hours of approved educational conferences as determined by the board by regulation.'' Thus, the Board has the authority to determine the number of hours of continuing education required for biennial renewal, and to set those hours by regulation. Additionally, section 9.1 of the act (63 P.S. § 42.9a) requires licensees to furnish evidence satisfactory to the Board that the licensee has completed mandated continuing education and authorizes the Board to determine whether or not to approve proposed continuing education courses.
The act of December 22, 2021 (P.L. 488, No. 100) (Act 100) was added to 63 Pa.C.S. § 3107.1 (relating to virtual operation). Section 3107.1 of 63 Pa.C.S. requires licensing boards and commissions to establish rules and regulations for continuing education that provide for distance education if continuing education is required for license, certificate, registration or permit in a practice act. Additionally, 63 Pa.C.S. § 3102 (relating to definitions) defines distance education as instruction offered by any means where the licensee is in a separate physical location from the instructor and communication is accomplished through one or more technological media. The term includes real-time or delayed interaction using voice, video, data or text, including instruction provided online, by means of correspondence or interactive video.
Background and Purpose
The Board last updated its regulations related to continuing education at 40 Pa.B. 5805 (October 9, 2010). Now, this final-form rulemaking seeks to eliminate unnecessary burdens on licensees, while continuing to protect the public's health, safety and welfare through the continuing education requirements. Inspired by Governor Tom Wolf's initiative to reduce barriers to licensure and unnecessary burdens on licensees, the Board initially proposed to reduce the number of required continuing education credits from 50 hours per biennial renewal to 45 hours. However, in consideration of comments received, the Board decided not to reduce those hours.
This final-form rulemaking also eliminates the current restriction on the number of hours (currently limited to 10 hours) that may be completed through distance education courses and programs. This final-form rulemaking allows for an unlimited amount of continuing education credits through distance education, consistent with trends in licensure requirements in other states. Notably, through 63 Pa.C.S. § 3107.1, the legislature expressed its intent to modernize the approach to continuing education by requiring that boards under the Bureau of Professional and Occupational Affairs (Bureau) offer licensees the opportunity to receive distance education. As a safeguard to ensure appropriate education is received, the Board's regulations require a skills or knowledge assessment component for credit hours obtained through asynchronous distance education.
This final-form rulemaking also adds a continuing education exemption for newly licensed podiatrists and clarifies that individuals with a serious illness or demonstrated hardship may request an extension for all or a portion of their continuing education for a biennial renewal.
Summary of Comments to the Proposed Rulemaking; the Board's Response and Description of Amendments to the Final-form Rulemaking
Notice of proposed rulemaking was published at 50 Pa.B. 2743 (May 30, 2020). Publication was followed by a 30-day public comment period. The Board received comments and objections from National and State organizations and individual licensees throughout this Commonwealth. The National and State organizations and nine individual licensees expressed opposition to three provisions of the proposed rulemaking. In addition, the Independent Regulatory Review Commission (IRRC) reviewed the proposed rulemaking and provided comments and recommendations. The Board did not receive any comments from the House Professional Licensure Committee (HPLC) or the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC).
Public Comments
The Pennsylvania Podiatric Medical Association (PPMA) has over 850 members who are doctors of podiatric medicine. PPMA expressed opposition regarding three issues: 1) the reduction of the number of continuing education hours from 50 to 45; 2) the expansion of distance education; and 3) providing credit hours for reading of professional journals. Nine podiatrists, including the current President of the Podiatric Medical Assurance of Pennsylvania, a past president of the Pennsylvania Podiatric Medical Association, and a clinical professor from Temple University and current PPMA board member submitted comments supporting PPMA comments and objections. One of these commentors noted that it is not the time to reduce the time or quality of continuing education given the expanded scope of practice granted by the Governor to podiatrists during the novel coronavirus (COVID-19) crisis. Additionally, the American Podiatric Medical Association (APMA) submitted a comment supporting the PPMA comments regarding the reduction of continuing education hours and also citing the profession's proud history of obtaining parity with its allopathic and osteopathic colleagues, which APMA asserts is due to the profession being successful in demonstrating that education, training and experience of podiatrists is similar to that of allopathic and osteopathic physicians. APMA also recommended that the Board's regulations more closely align with the Counsel of Podiatric Medical Education (CPME) guidance on the issue of journal reading.
Regarding the comments opposing the reduction in continuing education credit hours, PPMA asserts that it runs afoul of the agreement established by the stakeholders involved in the creation of the act of March 20, 2002 (P.L. 154, No. 13), the Medical Care Availability and Reduction of Error (MCARE) Act (40 P.S. §§ 1303.101—1303.910). PPMA explained that podiatrists participate in the MCARE Fund, which means that each year the amount of each judgment and settlement reached in all claims against doctors of podiatric medicine, medical doctors, osteopathic medical doctors and hospitals are aggregated and assessed to each licensee in the form of the MCARE Assessment. As a result, PPMA asserted that podiatry has an inherent interest in patient safety and risk management practiced by medical doctors and osteopathic doctors and by the same token they have an inherent interest in podiatric patient safety practices and risk management; therefore, reducing the number of continuing education hours runs contrary to their established relationship with other MCARE Fund participants. Additionally, PPMA asserts that it does not see the current 50-hour continuing education requirement as a barrier or burden, that there is no factual basis upon which to reduce the required continuing education hours and that the current requirement is actually below the relevant surrounding states. In response, the Board carefully considered the comments regarding the required number of credits and as a result will not be reducing the continuing education credits to 45 hours. Instead, the Board amends this final-form rulemaking to return to the 50-hour biennial credit requirement.
PPMA and nine individual podiatrists oppose the elimination of the 10-hour limitation on continuing education hours provided through distance education. PPMA bases its objection on several factors, including the value of face-to-face interaction and concerns about the quality and breadth of distance education. Notably, APMA does not oppose the Board's decision to allow for unlimited distance education continuing education hours.
This final-form rulemaking gives the licensee the option to obtain the continuing education requirements in person or through distance education. With the National and world trend moving rapidly toward advancing health information technology and remote monitoring and education, the Board anticipates that the quality of education will be enhanced as organizations will be keeping the bar high with a wide variety of topics for in person and distance education. Moreover, in enacting Act 100, the General Assembly provided boards with the flexibility to determine the appropriate amount of distance education. Additionally, providing licensees with the option of completing all continuing education credits through distance education is consistent with the State Board of Medicine (Medical Board) and the State Board of Osteopathic Medicine (Osteopathic Board) continuing education requirements. The Medical Board requires 100 credit hours of continuing medical education under § 16.19 (relating to continuing medical education). The Medical Board relies upon the American Medical Association (AMA) Physician's Recognition Award and its related credit system for continuing medical education credit, which provides for live in person, live Internet webinars, Internet point of care learning by means of a database of accredited courses, and unstructured online searching and learning. The Osteopathic Board also requires 100 credit hours of continuing medical education under § 25.271(c) (relating to requirements for renewal). The Osteopathic Board relies upon the American Osteopathic Association (AOA) and its related credit system for continuing medical education credit, which provides both Internet based interactive and non-interactive continuing education.
The Board submits that this final-form rulemaking provides sufficient safeguards with regard to the quality of continuing education in that the regulations require at least 30 clock hours in courses and programs in podiatry approved by the Board or approved by the Council on Podiatric Medical Education. The remaining clock hours must be in courses and programs in medical subjects pertinent to the practice of podiatry, approved by the AMA, AOA, the Board or CPME, or offered by an accredited school or college of podiatric medicine. Therefore, the Board is ensuring that licensees maintain competencies specific to podiatry to protect public health, safety and welfare. To address the concern that licensees may not engage or pay attention during asynchronous distance education, this final-form rulemaking requires a skills or knowledge assessment component to verify licensees receive and understand the appropriate level of education through asynchronous distance education programs. Synchronous distance learning is real-time interaction and is comparable to in person learning; therefore, a skills or knowledge assessment component is not necessary.
To clarify the definition of ''distance learning,'' the Board adds and amends definitions in § 29.60. To provide consistency between the Board's regulations and 63 Pa.C.S. § 3102, the Board replaced the term ''distance learning'' with ''distance education.'' Additionally, the Board adopted the definition of ''distance education'' set forth in 63 Pa.C.S. § 3102. These amendments do not have a substantive impact, but rather, merely provide consistency in the terms and definitions. The Board adds a definition of ''asynchronous distance education'' and ''synchronous distance education'' to clarify that only ''asynchronous distance education'' requires a skills or knowledge assessment component.
Regarding journal reading, PPMA and other commentors oppose the proposed amendment that would allow up to 10 clock hours for the reading of professional journals. The Board considered the comments of PPMA and APMA. In doing so, the Board considered CPME Standards and Requirements for Approval of Providers of Continuing Education in Podiatric Medicine, which does not permit granting of CE for unsupervised study or assigned reading but allows for continuing education to utilize instructional materials including, but not limited to journals. Given the concerns raised by the commentors, the Board decided to amend this final-form rulemaking in § 29.61(a)(3) to stay consistent with CMPE's Standards and Requirements for Approval of Providers of Continuing Education in Podiatric Medicine. Accordingly, the Board revised this provision to allow for a maximum of 10 clock hours in approved courses and programs that involve the use of reading professional journals, which is consistent with CMPE standards. In its comment, PPMA recommended adding a definition of ''professional journal;'' however, because the Board has reverted to its existing standard on the reading of professional journals, a definition for the term ''professional journal'' is unnecessary.
Comments from IRRC
IRRC asked that the Board explain how the total number of required continuing education hours and the maximum number of hours permitted to be obtained through distance education protects the public health, safety and welfare. The Board has addressed this previously in responding to PPMA's comments. As previously noted, the Board amends this final-form rulemaking to return to the 50-hour biennial credit requirement. Regarding the number of hours permitted to be obtained through distance education, as previously explained in detail, the Board believes that allowing licensees the option to use distance education is a step towards modernizing the Board's approach to continuing education and puts the Commonwealth on par with other states and other boards within the Bureau.
With respect to the Board's proposed restructuring of § 29.61(a)(3) regarding professional journals, IRRC reiterated PPMA's concern that the Board's proposed amendments to this section may diminish the quality of continuing education. As previously discussed under Public Comments, given the concerns regarding the proposed amendments from PPMA, APMA and IRRC, the Board made revisions in this final-form rulemaking to revert to the original, existing regulatory language that is consistent with CMPE standards and requirements.
IRRC also asked the Board to address the statutory authority for exempting an individual for the first renewal period, which could exceed a calendar year. Section 42.9a of the act exempts an individual for an initial registration during the calendar year in which the application for license is made, provided the applicant graduates from an accredited school of podiatric medicine and surgery during the calendar year. Section 42.9 of the act requires licensees to apply for biennial renewal and submit evidence that the licensee completed ''such hours of approved educational conferences as determined by the board by regulation.'' Exempting individuals for the first renewal period meets the requirements of section 42.9a, but the Board has chosen to also use its authority to determine the number of hours of continuing education required for biennial renewal and to set those hours by regulation. Under this broad authority, the Board in § 29.68 has set the number of credit hours for the first biennial registration at zero. The Board recognizes that under the current regulations most, but not all, podiatrists are exempt from continuing education in the first biennial period in which they are licensed because most podiatrists enter a residency program. Section 29.68(e) merely provides for a similar exemption for those podiatrists in this Commonwealth who do not enter residency programs. Furthermore, this regulation aligns with both the Medical and Osteopathic Boards which both provide that a physician applying for licensure in this Commonwealth for the first time shall be exempt from the continuing medical education requirement for the biennial renewal period following initial licensure. Accordingly, consistent with the statutory authority in section 42.9 of the act, all podiatrists will be exempt for the first calendar year and the remainder of the biennial renewal period.
Miscellaneous Clarity
Lastly, IRRC asks the Board to amend the name of the body which approves the podiatric residency program. That entity is CPME, not the American Podiatry Association. For clarity, the Board adds this acronym to the definitions in § 29.60. Additionally, the American Podiatry Association is now the American Podiatric Medical Association. The Board made corrections to this final-from rulemaking consistent with IRRC's comment.
Fiscal Impact
There is no fiscal impact on the Commonwealth or its political subdivisions associated with this final-form rulemaking. There is a positive fiscal impact on licensees due to the elimination of the restriction in the amount of distance education courses and programs that can be completed. Licensees will have the option of choosing whichever type of continuing education is preferable and if the cost of distance education is higher, the licensee has the option of choosing in person learning if that is less expensive.
Paperwork Requirements
This final-form rulemaking does not necessitate any legal, accounting, reporting or other additional paperwork requirements. Licensees are already required to retain certificates of attendance documenting completion of continuing education.
Sunset Date
The Board continuously monitors the cost effectiveness of its regulations. Therefore, no sunset date has been assigned.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P.S. § 745.5(a)), on May 18, 2020, the Board submitted a copy of the proposed rulemaking, published at 50 Pa.B. 2743, and a copy of a Regulatory Analysis Form to IRRC and to the Chairpersons of the HPLC and the SCP/PLC for review and comment. A copy of this material is available to the public upon request.
Under section 5(c) of the Regulatory Review Act, IRRC, the HPLC and the SCP/PLC were provided copies of the comments received during the public comment period, as well as other documents when requested. In preparing this final-form rulemaking, the Board has considered all comments from IRRC and the public. The Board received no comments from the HPLC or the SCP/PLC.
Under section 5.1(a) of the Regulatory Review Act (71 P.S. § 745.5a(a)), on April 27, 2022, the Board delivered this final-form rulemaking to IRRC, the HPLC and the SCP/PLC. Under section 5.1(g)(3) and (j.2) of the Regulatory Review Act, on June 15, 2022, the final-form rulemaking was deemed approved by the HPLC and the SCP/PLC. Under section 5.1(e) of the Regulatory Review Act, IRRC met on June 16, 2022, and approved the final-form rulemaking.
Additional Information
Additional information may be obtained by contacting Nichole Wray, Administrator, State Board of Podiatry, P.O. Box 69523, Harrisburg, PA 17106-9523, ST-PODIATRY@ pa.gov.
Findings
The Board finds that:
(1) Public notice of proposed rulemaking was given under sections 201 and 202 of the act of July 31, 1968 (P.L. 769, No. 240) (45 P.S. §§ 1201 and 1202), referred to as the Commonwealth Documents Law and the regulations promulgated thereunder, 1 Pa. Code §§ 7.1 and 7.2 (relating to notice of proposed rulemaking required; and adoption of regulations).
(2) A public comment period was provided as required by law and all comments were considered in drafting this final-form rulemaking.
(3) This final-form rulemaking does not include any amendments that would enlarge the scope of the proposed rulemaking published at 50 Pa.B. 2743.
(4) This final-form rulemaking is necessary and appropriate for administration and enforcement of the act.
Order
The Board orders that:
(a) The regulations of the Board at 49 Pa. Code Chapter 29, are amended by amending §§ 29.60, 29.61 and 29.68 to read as set forth in Annex A.
(b) The Board shall submit this final-form rulemaking to the Office of General Counsel and to the Office of Attorney General as required by law.
(c) The Board shall submit this final-form rulemaking to IRRC, the HPLC and the SCP/PLC for approval as required by law.
(d) The Board shall certify this final-form rulemaking and deposit it with the Legislative Reference Bureau as required by law.
(e) This final-form rulemaking shall take effect immediately upon publication in the Pennsylvania Bulletin.
DR. MICHAEL L. PARIS, DPM,
Chairperson(Editor's Note: See 52 Pa.B. 3740 (July 2, 2022) for IRRC's approval order.)
Fiscal Note: Fiscal Note 16A-4417 remains valid for the final adoption of the subject regulations.
Annex A
TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS
CHAPTER 29. STATE BOARD OF PODIATRY
CONTINUING EDUCATION § 29.60. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
Asynchronous distance education—A form of distance education that does not provide for real-time interaction between the learner and instructor.
Biennium—The period from January 1 of an odd-numbered year to December 31 of the next even-numbered year.
CPME—Council on Podiatric Medical Education.
Certification—A statement signed by the licensee certifying that continuing education requirements have been met.
Clock hour—Sixty minutes of instruction, exclusive of coffee breaks, lunches, visits to exhibits and the like.
Distance education—Instruction offered by any means where the licensee is in a separate physical location from the instructor and communication is accomplished through one or more technological media. The term includes real-time or delayed interaction using voice, video, data or text, including instruction provided online, by means of correspondence or interactive video.
Provider—An agency, organization, institution, association or center approved by the Board to offer an organized course or program.
Synchronous distance education—A form of distance education that provides for real-time interaction between the learner and instructor.
§ 29.61. Requirements for biennial renewal and eligibility to conduct educational conferences.
(a) A licensee applying for biennial renewal of a license shall have completed 50 clock hours of continuing education in approved courses and programs during the preceding biennium, in accordance with the following:
(1) At least 30 clock hours must be in courses and programs in podiatry approved by the Board under § 29.64 (relating to applications for approval of educational conferences) or approved by the CPME.
(2) The remaining clock hours must be in courses and programs in medical subjects pertinent to the practice of podiatry approved by the American Medical Association, the American Osteopathic Association, the Board or the CPME, or offered by an accredited school or college of podiatric medicine.
(3) A maximum of 10 clock hours may be in approved courses and programs that involve the use of reading professional journals.
(4) Clock hours may be obtained by completing approved synchronous distance education or asynchronous distance education courses and programs. Approved asynchronous distance education courses or programs must include a skill or knowledge assessment component in addition to all other requirements.
(5) Continuing education credit will not be awarded for courses or programs in office management or marketing the practice.
(6) Excess clock hours may not be carried over to the next biennium.
(7) Continuing education courses completed in accordance with a disciplinary order of the Board may not be used to meet the biennial continuing education requirement.
(8) A licensee who wishes to use a course or program for continuing education credit toward licensure renewal is responsible for ensuring that a particular course or program is approved for continuing education credit prior to participating in the course or program.
(b) Providers approved by the Board are eligible to conduct educational conferences.
(c) Applicants for license renewal shall provide, on the renewal application, a certification and shall electroni-cally submit the certificates of attendance provided by the course provider, as applicable. The certificates of attendance must include the following:
(1) The date attended.
(2) The clock hours claimed.
(3) The title of the course or program and description of content.
(4) The provider which sponsored the course or program.
(5) The location of the course or program.
(d) The licensee shall retain attendance certificates to document completion of the prescribed number of clock hours for 5 years following the completion of each course, which shall be produced upon demand by the Board or its authorized representatives or agents.
§ 29.68. Continuing education exemptions.
(a) Continuing education credits are not required for the years in which a licensed and currently registered podiatrist is in active military service. A podiatrist exempt from continuing education under this subsection must submit verification of active military service.
(b) The Board may waive or grant an extension for all or a portion of the continuing education requirement for biennial renewal upon request of a licensee for serious illness or other demonstrated hardship. The request shall be made in writing, contain supporting documentation and shall include a description of circumstances sufficient to show why compliance is impossible. A waiver or extension will be evaluated by the Board on a case-by-case basis. The Board will send written notification of its approval or denial of a waiver or extension request.
(c) A fee shall be assessed for review of waiver or extension requests in accordance with § 29.13 (relating to fees).
(d) A podiatrist is exempt from the continuing education requirements set forth in § 29.61(a) (relating to requirements for biennial renewal and eligibility to conduct educational conferences) in a renewal cycle in which the podiatrist is engaged in a CPME approved podiatric residency program.
(e) A podiatrist who has never been previously licensed in any jurisdiction is exempt from the continuing education requirements set forth in § 29.61(a) for the first renewal period immediately following licensure in this Commonwealth.
[Pa.B. Doc. No. 22-1175. Filed for public inspection August 5, 2022, 9:00 a.m.]
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