PROPOSED RULEMAKING
STATE BOARD OF MEDICINE
[49 PA. CODE CH. 16]
Licensure by Endorsement
[52 Pa.B. 4923]
[Saturday, August 13, 2022]The State Board of Medicine (Board) proposes to add §§ 16.12a, 16.12b and 16.12c (relating to definitions for license by endorsement under 63 Pa.C.S. § 3111; licensure by endorsement under 63 Pa.C.S. § 3111; and provisional endorsement license under 63 Pa.C.S. § 3111) and amend § 16.13(a) (relating to licensure, certification, examination and registration fees) to read as set forth in Annex A.
Effective Date
This proposed rulemaking will be effective upon publication of the final-form rulemaking in the Pennsylvania Bulletin.
Statutory Authority
The provisions of 63 Pa.C.S. § 3111 (relating to licensure by endorsement) require licensing boards and commissions to issue a license, certificate, registration or permit to an applicant to allow practice in this Commonwealth provided the applicant meets the following criteria: holds a current license, certificate, registration or permit from another state, territory or country whose licensing requirements are substantially equivalent to or exceed the requirements in this Commonwealth; demonstrates competency; has not committed any act that constitutes grounds for refusal, suspension or revocation of a license, certificate, registration or permit to practice that profession or occupation in this Commonwealth, unless the board or commission determines such conduct is not an impediment to granting the license, certificate, registration or permit; is in good standing and has not been disciplined by the jurisdiction that issued the license, certificate, registration or permit, unless the board or commission determines the conduct is not an impediment to granting the license, certificate, registration or permit; and the applicant pays fees, as established by regulation. Section 3111(b) of 63 Pa.C.S. authorizes boards and commissions to issue a provisional license, certificate, registration or permit while an applicant is satisfying remaining requirements for licensure by endorsement, for which the Board must set by regulation the terms of expiration. Additionally, section 8 of the Medical Practice Act of 1985 (act) (63 P.S. § 422.8), section 207 of the Naturopathic Doctor Registration Act (NDRA) (63 P.S. § 272.207), and section 3 of the Acupuncture Licensure Act (ALA) (63 P.S. § 1803) provides the Board with broad authority to adopt regulations as are reasonably necessary to carry out the purposes of the act, the NDRA and the ALA.
The act of July 1, 2020 (P.L. 575, No. 53) added 63 Pa.C.S. § 3111 as part of the consolidation of the act of July 2, 1993 (P.L. 345, No. 48) (Act 48) (repealed) into 63 Pa.C.S. Chapter 31 (relating to powers and duties). The text of 63 Pa.C.S. § 3111 was originally added to Act 48 by the act of July 1, 2019 (P.L. 292, No. 41).
Background and Need for the Amendments
This proposed rulemaking is needed to effectuate 63 Pa.C.S. § 3111, which requires the Board to issue a license to applicants who meet the requirements for licensure by endorsement. Under 63 Pa.C.S. § 3111, the Board must determine whether the jurisdiction's standards for licensure are substantially equivalent to or exceed those established by the Board. Additionally, 63 Pa.C.S. § 3111(a)(2) requires the Board to determine the methods of competency, including completion of continuing education or experience in the profession or occupation for at least 2 of the 5 years immediately preceding the filing of the application. Under 63 Pa.C.S. § 3111(b)(2), the Board must establish, by regulation, the expiration of the provisional endorsement license. This proposed rulemaking sets forth the criteria for eligibility for licensure by endorsement, including the specific methods required for an applicant to demonstrate competency as well as requirements for granting a provisional endorsement license.
Description of the Proposed Amendments
The Board proposes to add § 16.12a to include a definition of the term ''jurisdiction'' consistent with 63 Pa.C.S. § 3111. Proposed § 16.12b requires an applicant to satisfy nine criteria required for licensure by endorsement. The first criterion, as set forth in proposed § 16.12b(a)(1), requires an applicant to have a current license, certificate, registration or permit in good standing to practice as a medical physician and surgeon, nurse-midwife, acupuncturist, practitioner of Oriental medicine, physician assistant, respiratory therapist, athletic trainer, behavior specialist, perfusionist, genetic counselor, prosthetist, orthotist, pedorthist, orthotic fitter or naturopathic doctor in another jurisdiction whose standards for licensure are substantially equivalent to or exceed those under the act, the NDRA (63 P.S. §§ 272.101—272.301) or the ALA (63 P.S. §§ 1801—1806.1).
Section 16.12b(a)(1) also requires the standards for licensure to be substantially equivalent to standards set forth in the Board's regulations, to include § 16.12 (relating to general qualifications for licenses and certificates), which outlines the general qualifications for licensure for all licenses issued under the Board. Section 16.12 includes licensure standards for legal age, good moral character, intemperate use of alcohol or drugs, and felony convictions. In addition to meeting the requirements of § 16.12, an applicant must also meet the applicable regulatory requirements under §§ 17.1 regarding medicine and surgery, 18.2, 18.13, 18.13a, 18.141, 18.307, 18.504 regarding athletic trainers, 18.524, 18.603, 18.703, 18.814, 18.824, 18.833 and 18.843.
Under § 16.12b(a)(2), an applicant from another country or territory must submit a copy of the current applicable law, regulation or other rule governing licensure and scope of practice in the jurisdiction that issued the license. Section 16.12b(a)(2)(i) is applicable to countries that use languages other than English. Where the applicable law, regulation or other rule is in a language other than English, the Board would require, at the applicant's expense, translation of the applicable law, regulation or other rule by a professional translation service. Section 16.12b(a)(2)(ii) would also require that the copy of the applicable law, regulation or other rule include the enactment date. The purpose of this section is to allow the Board to evaluate the licensure requirements of the other country or territory to make a determination as to whether their licensure standards are substantially equivalent to those of this Commonwealth.
Proposed § 16.12b(a)(3) requires demonstration of competency. Under subsection (a)(3)(i), an applicant for a license to practice as a medical physician and surgeon, nurse-midwife, acupuncturist, practitioner of Oriental medicine, physician assistant, respiratory therapist, athletic trainer, behavior specialist, perfusionist, genetic counselor, prosthetist, orthotist, pedorthist, orthotic fitter or naturopathic doctor must provide proof of competency by demonstrating experience in the practice of the profession. To demonstrate competency by experience, an applicant must demonstrate the licensed practice of the profession for at least 2 of the 5 years immediately preceding the filing of the application in the jurisdiction that issued the license, certificate, registration or permit. This means that the individual must establish to the Board that they practiced for any 2 of the preceding 5 years while holding the license, certificate, registration or permit in the profession for which the applicant is applying.
Additionally, to show competence, applicants must demonstrate English proficiency under subsection (a)(3)(ii). Under section 24 of the act (63 P.S. § 422.24) the Board has authority to require applicants whose principal language is other than English to demonstrate English proficiency by examination. Under the act, English proficiency is necessary because of the crucial nature of the services provided by physicians and other allied health professionals. Physicians and allied health professionals licensed under the Board must be able to communicate with medical staff, patients and family members on a daily basis. To demonstrate English proficiency under subsection (a)(3)(ii), an applicant may take an English proficiency examination, including the Test of English as a Foreign Language (TOEFL), the Occupational English Test or another substantially equivalent English proficiency examination as approved by the Board. In following the spirit of 63 Pa.C.S. § 3111, which encourages elimination of unnecessary barriers to licensure, the Board also offers other options that allow an applicant to demonstrate English proficiency including the following: professional education program was in English; the professional training was in an English-speaking facility; entry examination to practice in the profession was in English; or certification by the Educational Commission for Foreign Medical Graduates.
Proposed subsection (a)(4) and (5) incorporate the statutory prohibitions in 63 Pa.C.S. § 3111 pertaining to conduct that would constitute grounds for refusal, suspension or revocation of a license, certificate, registration or permit to practice the profession or occupation, and prior discipline by the jurisdiction that issued the license.
Proposed subsection (a)(6) provides for payment of an application fee, as required by 63 Pa.C.S. § 3111(a)(5). The applicable fee for licensure by endorsement under 63 Pa.C.S. § 3111(a)(5) is the application fee in § 16.13 of the Board's current fee schedule for all professionals licensed under the Board.
Proposed subsection (a)(7) requires that applicants meet the malpractice insurance requirements under the act, section 3.2 of the ALA (63 P.S. § 1803.2), this chapter and Chapter 18 (relating to State Board of Medicine—practitioners other than medical doctors). Proposed subsection (a)(8) requires applicants to satisfy application requirements, as set forth in the act and Chapters 16 and 17 (relating to State Board of Medicine—general provisions; and State Board of Medicine—medical doctors) and Chapter 18. Finally, proposed subsection (a)(9) requires completion of 3 hours of training in child abuse recognition and reporting, which is mandated continuing education under 23 Pa.C.S. § 6383(b)(3)(i) (relating to education and training).
In proposed § 16.12b(b), the Board may require a personal interview or additional information to assist the Board in determining eligibility and competency. When a personal interview is necessary, the applicant may request the interview to be conducted by video teleconference for good cause shown. Consistent with 63 Pa.C.S. § 3111(a)(4) and (5), proposed § 16.12b(c) authorizes the Board, in its discretion, to determine that an act prohibited under section 41 of the act (63 P.S. § 422.41), section 204 of the NDRA (63 P.S. § 272.204) or disciplinary action by a jurisdiction are not impediments to the granting of a license, certification, registration or a permit by endorsement under 63 Pa.C.S. § 3111.
Consistent with 63 Pa.C.S. § 3111(b), proposed § 16.12c(a) (relating to provisional endorsement license under 63 Pa.C.S. § 3111) provides that the Board, in its discretion, may issue a provisional endorsement license while an applicant is satisfying remaining requirements under 63 Pa.C.S. § 3111 and proposed § 16.12b. Proposed § 16.12c(b) sets the expiration of a provisional endorsement license at 1 year, unless the Board determines that an expiration date of less than 1 year is appropriate. Additionally, upon a written request, the Board may extend the term of the license upon a showing of good cause. Proposed § 16.12c(c) sets forth reasons for which a provisional endorsement license will be terminated by the Board, including when the Board denies or grants a license, or the provisional endorsement licensee fails to comply with the terms of a provisional endorsement license. Finally, proposed § 16.12c(d) clarifies that while an individual may reapply for a license by endorsement under proposed § 16.12b, the Board will not issue a subsequent provisional endorsement license to an applicant who previously held a provisional endorsement license that expired or was terminated.
In proposed § 16.13(a), the Board proposes to amend the names of the application fees for the medical doctor license without restriction. This proposed rulemaking removes the terms ''accredited'' and ''unaccredited.'' Instead, the Board distinguishes the applications based upon whether the medical college was within or outside the United States and Canada. The Board has determined that the standards for licensure in the United States and Canada are substantially equivalent to those of this Commonwealth; therefore, those applications are not as time-consuming as applications where the medical college is located outside the United States and Canada. The amendment to this section is consistent with § 16.12b(a)(1) in that the review process for individuals who attended a medical college outside of the United States or Canada will be more in-depth and necessitates a higher fee. For these applications, the Board must review the laws and regulations of other countries or territories to determine whether the licensure requirements are substantially equivalent or exceed those of this Commonwealth as outlined in § 16.12b(a)(1)(i)—(iii). Thus, the review process for individuals who attended a medical college within the United States or Canada will require less Board time and should require a lower fee. In the application for licensure by endorsement, the Board will include a question in its online platform as to whether the applicant is a graduate of a medical college within the United States or Canada to determine the appropriate fee.
Fiscal Impact and Paperwork Requirements
This proposed rulemaking will have no adverse fiscal impact on the Commonwealth or its political subdivisions. The costs to the Board related to processing applications for licensure by endorsement will be recouped through fees paid by applicants. Applicants who apply for licensure by endorsement will be impacted by the initial application fees in § 16.13. Applicants will have to pay the initial application fee (medical doctor $35 graduate of medical college within the United States or Canada and $85 for graduate of medical college outside of the United States or Canada; $75 behavioral specialist; $50 nurse midwives, perfusionist, genetic counselor, prosthetists, orthotist; $30 physician assistant, acupuncturist, practitioner of Oriental medicine, respiratory therapist, $25 pedorthist, orthotic fitter; $20 athletic trainer). The Board has published a proposed rulemaking that would impose a $100 fee for naturopathic doctors at 51 Pa.B. 7877 (December 18, 2021). Applicants must complete child abuse recognition and reporting training, as required by 23 Pa.C.S. § 6383(b)(3)(i). There are free in-person and online child abuse recognition and reporting training options available; therefore, the Board does not anticipate a negative fiscal impact for this statutorily mandated training. If an applicant is unable to establish English proficiency by demonstrating that their education, training or examination was in English and they must take the TOEFL examination or another examination, the cost to the applicant is approximately $200.
Sunset Date
The Board continuously monitors the cost effectiveness of the Board's 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 August 1, 2022, the Board submitted a copy of this proposed rulemaking and a copy of a Regulatory Analysis Form to the Independent Regulatory Review Commission (IRRC) and to the Chairpersons of the Senate Consumer Protection and Professional Licensure Committee and the House Professional Licensure Committee. A copy of this material is available to the public upon request.
Under section 5(g) of the Regulatory Review Act, IRRC may convey comments, recommendations or objections to the proposed rulemaking within 30 days from the close of the public comment period. The comments, recommendations or objections shall specify the regulatory review criteria in section 5.2 of the Regulatory Review Act (71 P.S. § 745.5b) that have not been met. The Regulatory Review Act specifies detailed procedures for review, prior to final publication of the rulemaking, by the Board, the General Assembly and the Governor.
Public Comment
Interested persons are invited to submit written comments, recommendations or objections regarding this proposed rulemaking to Board Counsel, Department of State, State Board of Medicine, P.O. Box 69523, Harrisburg, PA 17106-9523 or RA-STRegulatoryCounsel@pa.gov within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin. Reference 16A-4958 (Licensure by endorsement), when submitting comments.
MARK B. WOODLAND, MPH, MD,
ChairpersonFiscal Note: 16A-4958. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 49. PROFESSIONAL AND
VOCATIONAL STANDARDS
PART I. DEPARTMENT OF STATE
Subpart A. PROFESSIONAL AND
OCCUPATIONAL AFFAIRS
CHAPTER 16. STATE BOARD OF MEDICINE—GENERAL PROVISIONS
Subchapter B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION PROVISIONS (Editor's Note: The following sections are proposed to be added and are printed in regular type to enhance readability.)
§ 16.12a. Definitions for license by endorsement under 63 Pa.C.S. § 3111.
The following term, when used in §§ 16.12b and 16.12c (relating to license by endorsement under 63 Pa.C.S. § 3111; and provisional endorsement license under 63 Pa.C.S. § 3111), has the following meaning, unless the context clearly indicates otherwise:
Jurisdiction—A state, territory or country.
§ 16.12b. Licensure by endorsement under 63 Pa.C.S. § 3111.
(a) Requirements for issuance. To be issued a license by endorsement under 63 Pa.C.S. § 3111 (relating to licensure by endorsement), an applicant must satisfy all of the following conditions:
(1) Have a current license, certification, registration or permit in good standing in another jurisdiction whose standards for licensure are substantially equivalent to or exceed those under the following:
(i) The act, the Naturopathic Doctor Registration Act (NDRA) (63 P.S. §§ 272.101—272.301) or the Acupuncture Licensure Act (ALA) (63 P.S. §§ 1801—1806.1).
(ii) Section 16.12 (relating to general qualifications for licenses and certificates).
(iii) Sections 17.1 regarding medicine and surgery, 18.2, 18.13, 18.13a, 18.141, 18.307, 18.504 regarding athletic trainers, 18.524, 18.603, 18.703, 18.814, 18.824, 18.833 and 18.843, as applicable.
(2) An applicant who holds a license, certificate, registration or permit in another country or territory must submit a copy of the current applicable law, regulation or other rule governing licensure, certification, registration or permit requirements and scope of practice in the jurisdiction that issued the license, certificate, registration or permit. The following apply:
(i) If the applicable law, regulation or other rule is in a language other than English, at the applicant's expense, the applicable law, regulation or other rule shall be translated by a professional translation service and verified to be complete and accurate.
(ii) The copy of the applicable law, regulation or other rule must include the enactment date.
(3) Demonstrates competency by establishing the following:
(i) Experience in the practice of the profession by demonstrating, at a minimum, that the applicant has actively engaged in the licensed practice of the profession under a license, certificate, registration or permit in a substantially equivalent jurisdiction or jurisdictions, for at least 2 of the 5 years immediately preceding the filing of the application with the Board.
(ii) English language proficiency by demonstrating one of the following:
(A) The applicant's educational program was in English.
(B) The applicant's training was at an English-speaking facility.
(C) The applicant's entry examination was taken in English.
(D) The applicant is certified by the Educational Commission for Foreign Medical Graduates.
(E) The applicant has achieved a score of at least 83, or similar score acceptable to the Board, on the Test of English as a Foreign Language examination.
(F) The applicant has achieved a score of 350 in each of the four subtests of the Occupational English Test.
(G) The applicant has achieved a passing score on a substantially equivalent English proficiency examination as approved by the Board.
(4) Have not committed any act that constitutes grounds for refusal, suspension or revocation of a license, certification, registration or permit to practice prohibited by section 41 of the act (63 P.S. § 422.41) or section 204 of the NDRA (63 P.S. § 272.204).
(5) Have not been disciplined by the jurisdiction that issued the license, certification, registration or permit.
(6) Have paid the applicable application fee as required by § 16.13 (relating to licensure, certification, examination and registration fees).
(7) Satisfies the professional liability insurance requirements as required under the act, section 3.2 of the ALA (63 P.S. § 1803.2), this chapter and Chapter 18 (relating to State Board of Medicine—practitioners other than medical doctors).
(8) Have applied for a license, certification, registration or permit in accordance with this chapter in the manner and format prescribed by the Board.
(9) Completes 3 hours of training in child abuse recognition and reporting from a provider approved by the Department of Human Services as required under 23 Pa.C.S. § 6383(b)(3)(i) (relating to education and training).
(b) Interview and additional information. An applicant may be required to appear before the Board for a personal interview and may be required to submit additional information, including supporting documentation relating to competency, experience or English proficiency. The applicant may request the interview to be conducted by video teleconference for good cause shown.
(c) Prohibited acts. Notwithstanding subsection (a)(4) and (5), the Board may, in its discretion, determine that an act prohibited under section 41 of the act (63 P.S. § 422.41), section 204 of the NDRA (63 P.S. § 272.204) or a disciplinary action taken by another jurisdiction is not an impediment to licensure under 63 Pa.C.S. § 3111.
§ 16.12c. Provisional endorsement license under 63 Pa.C.S. § 3111.
(a) Provisional endorsement license. The Board may, in its discretion, issue a provisional endorsement license to an applicant while the applicant is satisfying remaining requirements for licensure by endorsement under 63 Pa.C.S. § 3111 (relating to licensure by endorsement) and § 16.12b (relating to licensure by endorsement under 63 Pa.C.S. § 3111).
(b) Expiration of a provisional endorsement license
(1) An individual holding a provisional endorsement license may practice for up to 1 year after issuance of the provisional endorsement license. The Board, in its discretion, may determine that an expiration date of less than 1 year is appropriate.
(2) Upon written request and showing of good cause, the Board may grant an extension of no longer than 1 year from the expiration date of the provisional endorsement license.
(c) Termination of a provisional endorsement license. A provisional endorsement license terminates if any of the following occurs:
(1) When the Board completes its assessment of the applicant and denies or grants the license.
(2) When the holder of the provisional endorsement license fails to comply with the terms of the provisional endorsement license.
(d) Reapplication. An individual may reapply for licensure by endorsement under § 16.12b after expiration or termination of a provisional endorsement license; however, the individual may not be issued a subsequent provisional endorsement license.
§ 16.13. Licensure, certification, examination and registration fees.
(a) Medical Doctor License:
License Without Restriction:
Application, graduate of [accredited] a medical college within the United States or Canada . . . $35
Application, graduate of [unaccredited] a medical college outside of the United States or Canada . . . $85
Biennial renewal . . . $360
* * * * *
[Pa.B. Doc. No. 22-1210. Filed for public inspection August 12, 2022, 9:00 a.m.]
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