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PA Bulletin, Doc. No. 02-1170




[49 PA. CODE CH. 16]

Biennial Renewal Fees

[32 Pa.B. 3217]

   The State Board of Medicine (Board) amends § 16.13 (relating to licensure, certification, examination and registration fees) by increasing the biennial renewal fee for physicians to read as set forth in Annex A.

A.  Effective Date

   This final-omitted rulemaking is effective upon publication in the Pennsylvania Bulletin. The new fee will take effect for the biennial renewal period January 2003--December 2004.

B.  Statutory Authority

   This final-omitted rulemaking is authorized under section 6 of the Medical Practice Act (act) (63 P. S. § 422.6).

C.  Background and Purpose

   Section 6(a) of the act requires the Board to increase fees by regulation if the revenues raised by fees, fines and civil penalties are not sufficient to meet expenditures over a 2-year period. The Board raises virtually all its revenue through fees. The biennial license renewal fee is the most substantial revenue-generating fee of the fees charged by the Board. If the Board anticipates that its revenue will not meet its expenditures, the Board must increase its revenue. The Board last increased its biennial renewal fees on September 18, 1998.

   The act mandates that the Board protect the public by adopting rules and regulations that govern the practice of medicine. In addition, the Board is mandated to promote public health, safety and welfare through Board initiatives and coordination with other agencies and departments in this Commonwealth.

   The Medical Care Availability and Reduction of Error Act (Mcare Act) (40 P. S. §§ 1303.101--1303.910), amended the act in several significant ways that will increase the operational costs of the Board. The additional duties assigned to the Board include the obligation to commence investigations within 4 years of receipt of notice of a complaint with regard to a medical professional liability action that is filed against the physician; information regarding disciplinary action taken against the physician by a health care licensing authority of another state; information regarding sentencing of the physician for an offense as provided in section 41 of the act (63 P. S. § 422.41); or information regarding an arrest of the physician for any of the following offenses in this Commonwealth or another state: 18 Pa.C.S. Chapter 25 (relating to criminal homicide); 18 Pa.C.S. § 2702 (relating to aggravated assault); 18 Pa.C.S. Chapter 31 (relating to sexual offenses); or a violation of The Controlled Substance, Drug, Device and Cosmetic Act (35 P. S. §§ 780-101--780-144).

   Importantly, the Board will have authority to initiate disciplinary action against a physician for a single act of negligence. Currently the Board's authority is limited to multiple acts of negligence or a single act of gross negligence. Additionally the Board is charged with regulating physicians with regard to the completion of mandatory continuing medical education.

   During 2000, the Bureau of Professional and Occupational Affairs (BPOA) received 1,046 complaints against physicians. During the consideration of the Mcare Act, the Insurance Federation of Pennsylvania estimated that approximately 7,000 medical malpractice civil complaints were filed in 2001. Enforcement of the notification and continuing medical education requirements is expected to generate an additional 1,000 cases. Accordingly, the Board anticipates a substantial increase in complaints filed against physicians under the Mcare Act provisions.

   Consequently the Board will require additional resources to fulfill its additional obligations under the act. During the development of the Mcare Act, the General Assembly was aware additional Board resources would be necessary to implement the requirements under the act. These resources include staff, equipment, space, supplies, furniture and support resources such as contracts for expert witnesses. These additional resources will be needed in the Board's Administrative Office, the Bureau of Enforcement and Investigations, the Complaints Office, the Legal Office and the Office of Hearing Examiner. It is estimated that the additional operational resources and complement necessary to implement the Mcare Act will result in $5,379,031 in increased costs per year between the Board and the State Board of Osteopathic Medicine.

   At its April 23, 2002, Board meeting, the Board reviewed a summary of its revenues and expenses. The summary, prepared by the BPOA Revenue Office and the Bureau of Finance and Operations and presented in the format as follows, shows that for the Board to support its pro rata portion of the increase, the Board must raise the biennial renewal fee to meet or exceed projected expenditures and thereby comply with section 6 of the act.

STATUS FY 00-01 FY 01-02 FY 02-03 FY 03-04 FY 04-05 FY 05-06
Beginning Balance: $1,222,431.15 $4,151,604.96 $1,625,719.95 $990,175.95 ($6,690,824.05) ($9,072,973.05)
Revenue: 6,110,851.25 525,000.00 6,110,851.00 525,000.00 6,110,851.25 525,000.00
Prior Yr. Returned Funds: 0.00 472,114.99 0.00 0.00 0.00 0.00
Total Revenue: 7,333,282.40 5,148,719.95 7,736,570.95 1,515,175.95 (579,973.05) (8,547,973.05)
Expenses: 3,181,677.44 3,523,000.00 6,746,395.00 8,206,000.00 8,493,000.00 8,790,000.00
Remaining Balance: 4,151,604.96 1,625,719.95 990,175.95 (6,690,824.05) (9,072,973.05) (17,337,973.05)

   As the foregoing indicates, a deficit of $6,690,824.05 is projected by the end of Fiscal Year 2003-2004. Without the fee increase the deficit grows to over $9 million by the end of Fiscal Year 2004-2005, and over $17.3 million by the end of Fiscal Year 2005-2006. This deficit is compounded and more critical since this Board fiscally stands on its own and is not contained within the Professional Licensure Augmentation Account (PLAA). Since this Board is not a part of the PLAA, it cannot utilize any fiscal backing to carry it through budget shortfalls. The Board anticipates that the new fee would enable it to meet its estimated expenditures.

   The biennial renewal period for the Board begins January 2003. To meet the requirements of the act and the Mcare Act, fees must be raised for this period. Accordingly, the Board finds that under section 204(3) of the act of July 31, 1968 (P. L. 769, No. 240) (45 P. S. § 1204(3)) (CDL), good cause exists to adopt the new fee and that publication as proposed rulemaking in this circumstance is impractical and contrary to the public interest as identified by the General Assembly in the Mcare Act.

D.  Description of Amendments

   The following table outlines the affected fee and change:

Current Fee New Fee
Biennial renewal fee $125 $360

E.  Compliance with Executive Order 1996-1

   In compliance with Executive Order 1996-1, ''Regulatory Review and Promulgation,'' the Board considered this final-omitted rulemaking as both required by law and the least restrictive means of covering the costs of services required to be performed by the Board.

F.  Fiscal Impact and Paperwork Requirements

   This final-omitted rulemaking increases the biennial renewal fee for physicians in this Commonwealth, but, otherwise, should have no fiscal impact on the private sector, the general public or political subdivisions.

   This final-omitted rulemaking requires the Board to alter some of its forms to reflect the new biennial renewal fees; however, it should create no additional paperwork for the private sector.

G.  Sunset Date

   The Board continuously monitors the cost effectiveness of its regulations. Therefore, no sunset date has been assigned.

H.  Regulatory Review

   Under section 5.1(c) of the Regulatory Review Act (71 P. S. § 745.5a(c)), on May 22, 2002, the Board submitted a copy of this amendment with proposed rulemaking omitted to the Independent Regulatory Review Commission (IRRC), the Senate Consumer Protection and Professional Licensure Committee (SCP/PLC) and the House Professional Licensure Committee (HPLC). On the same date, the final-omitted rulemaking was submitted to the Office of Attorney General for review and approval under the Commonwealth Attorneys Act (71 P. S. §§ 732-101--732-506).

   Under section 5.1(d) of the Regulatory Review Act, on June 11, 2002, the HPLC and SCP/PLC deemed approved the final-omitted rulemaking. Under sectin 5.1(e) of the Regulatory Review Act, IRRC met on June 13, 2002, and the final-omitted rulemaking was approved.

I.  Additional Information

   Interested persons are invited to submit inquiries regarding this rulemaking to Joanne Troutman, Board Administrator, State Board of Medicine, Post Office Box 2649, Harrisburg, PA 17105-2649, us.

J.  Findings

   The Board finds that:

   (1)  Public notice of its intention to amend its regulation as adopted in this order under sections 201 and 202 of the CDL (45 P. S. §§ 1201 and 1202) has been omitted under section 204(3) of the CDL, because the Board has, for good cause, found that the procedures specified in sections 201 and 202 of the CDL are, in this circumstance, impractical and contrary to the public interest as identified by the General Assembly in the Mcare Act because the Board must increase revenues immediately to meet the obligations imposed on it by the Mcare Act.

   (2)  The adoption of the amendment in the manner provided in this order is necessary and appropriate for the administration of its authorizing statute.

K.  Order

   The Boad, acting under its authorizing satutes, orders that:

   (a)  The regulations of the Board, 49 Pa. Code Chapter 16, are amended by amending § 16.13 to read as set forth in Annex A.

   (b)  The Chairperson of the Board shall submit this order and Annex A to the Office of General Counsel and the Office of Attorney General for approval as to form and legality as required by law.

   (c)  The Chairperson of the Board shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.

   (d)  This order shall become effective immediately upon publication in the Pennsylvania Bulletin.


   (Editor's Note:  For the text of the order of the Independent Regulatory Review Commission, relating to this document, see 32 Pa.B. 3183 (June 29, 2002).)

   Fiscal Note:  16A-4913. No fiscal impact; (8) recommends adoption.

Annex A






§ 16.13.  Licensure, certification, examination and registration fees.

(a)  Medical Doctor License:

License Without Restriction:
Application, graduate of accredited medical college $35
Application, graduate of unaccredited medical college $85
Biennial renewal $360
Extraterritorial License:
Application $30
Biennial renewal $80
Graduate License:
Application, graduate of accredited medical college $30
Application, graduate of unaccredited medical college $85
Annual renewal $15
Interim Limited License:
Application $30
Biennial renewal $10
Application, institutional license $35
Application, temporary license $45
Biennial renewal, limited license (permanent) $25
(b)  Midwife License:
Application $30
Biennial renewal $40
(c)  Physician Assistant Certificate:
Application $30
Biennial renewal $40
Registration, physician assistant supervisor $35
Registration of additional supervisors $ 5
Satellite location approval $25
(d)  Acupuncturist Registration:
Application $30
Biennial renewal $40
Registration, acupuncture supervisor $30
(e)  Drugless Therapist License:
Biennial renewal $35
(f)  Radiology Technician:
Application for examination $25
(g)  Respiratory Care Practitioner Certificate:
Application, temporary permit $30
Application, initial certification $30
Biennial renewal $25
(h)  Verification or Certification:
Verification of status $15
Certification of records $25
(i)  Examination Fees:

   The State Board of Medicine has adopted Nationally recognized examinations in each licensing class. Fees are established by the National owners/providers of the examinations and are indicated in the examination applications.

[Pa.B. Doc. No. 02-1170. Filed for public inspection July 5, 2002, 9:00 a.m.]

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