PROPOSAL
Maryland Register
Issue Date: October 28, 2016
Volume 43 • Issue 22 • Pages 1239—1244
Title 10
DEPARTMENT OF HEALTH AND MENTAL HYGIENE
Subtitle 32 BOARD OF PHYSICIANS
Notice of Proposed Action
[16-275-P]
The Secretary of Health and Mental Hygiene proposes to amend:
(1) Regulations .08, .10, and .11 under COMAR 10.32.01 General Licensure Regulations;
(2) Regulation .09 under COMAR 10.32.03 Delegation of Duties by a Licensed Physician ― Physician Assistant;
(3) Regulations .07 and .08 under COMAR 10.32.06 Licensure of Polysomnographic Technologists;
(4) Regulation .07 under COMAR 10.32.08 Licensure of Athletic Trainers;
(5) Regulation .13 under COMAR 10.32.10 Licensure of Radiation Therapists, Radiographers, Nuclear Medicine Technologists, and Radiologist Assistants; and
(6) Regulations .09 and .11 under COMAR 10.32.11 Licensing of Respiratory Care Practitioners.
This action was considered at a public meeting held on July 13, 2016, notice of which was given by publication on the Board’s Website at http://www.mbp.state.md.us/forms/jul16Aagenda.pdf from July 1 through July 13, 2016 pursuant to General Provisions Article, §3-302(c), Annotated Code of Maryland.
Statement of Purpose
The purpose of this action is to revise the time frame for physicians and allied health professionals to earn continuing medical education (CME) credits. For renewals, the proposed changes would allow licensees to earn CME credits during the 2-year period preceding the date of license expiration. Currently, for renewals, CME credits must be earned prior to the date the renewal application is submitted.
This proposal to change the time frame to earn CME credits is being made, in part, due to concerns expressed by the legislature during the 2016 Maryland General Assembly session.
The proposed regulations also include the following changes, which have been made for clarity or consistency purposes:
(1) Updating the taglines for COMAR 10.32.03.09, 10.32.08.07, and 10.32.11.09;
(2) Adding language regarding satisfying tax liabilities to COMAR 10.32.01.08, 10.32.03.09, 10.32.10.13, and 10.32.11.11;
(3) Adding language regarding compliance with renewal requirements to COMAR 10.32.01.08;
(4) Updating language regarding practicing without a license in COMAR 10.32.01.08;
(5) Adding two definitions and correcting citations in COMAR 10.32.01.10;
(6) Deleting duplicative language in COMAR 10.32.01.11; and
(7) Other technical and stylistic changes where appropriate.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
The proposed action has no economic impact.
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Department of Health and Mental Hygiene, 201 West Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6483 (TTY 800-735-2258), or email to dhmh.regs@maryland.gov, or fax to 410-767-6483. Comments will be accepted through November 28, 2016. A public hearing has not been scheduled.
10.32.01 General Licensure Regulations
Authority: Health Occupations Article, §§1-213, 14-205(a), 14-316, 14-317, and 14-320, Annotated Code of Maryland
.08 Renewals.
A. The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02.
[A.] B.—[C.] D. (text unchanged)
E. The failure to receive a renewal notice does not excuse a licensee from complying with §B of this regulation.
[D.] F. [A] Before the expiration date of the license, a licensee applying for renewal shall complete the application for renewal on a form supplied by the Board.
[E. During the application process, a licensee applying for renewal shall have the duty to inform the Board by electronic or first-class mail of any of the circumstances listed in Regulation .03H(1) and (2) of this chapter within 30 days of the occurrence of or notification about these circumstances.]
[F.] G. [During the entire 2-year renewal cycle, a] A licensee shall [have the duty to] inform the Board by electronic or first-class mail of any of the circumstances listed in Regulation .03H(1) and (2) of this chapter within 30 days of the occurrence of or notification about these circumstances.
[G.] H. A licensee applying for renewal shall complete the [continuing medical education] CME requirements [for each renewal period] as defined in Regulation .10 of this chapter.
[H.] I. (text unchanged)
[I.] J. [Before the expiration date of the license, a licensee shall complete and return to the Board the renewal form and renewal fee according to instructions.] After the expiration date of the license, the physician is no longer licensed to practice medicine [and shall submit an application for reinstatement and documentation of continuing medical education credits].
[J.] K. — [L.] M. (text unchanged)
.10 Continuing Medical Education.
A. Definitions.
(1) In this regulation, the following terms have the meanings indicated.
(2) Terms Defined.
(a) “2-year period” means:
(i) For license renewal, the 2 years preceding the expiration of the physician license; or
(ii) For license reinstatement, the 2 years preceding the date of the submission of the application for reinstatement of the physician license.
(b) “Applicant” means:
(i) A licensed physician applying for renewal of the physician license; or
(ii) A physician applying for reinstatement of the physician license.
[A.] B. The Board recognizes and accepts [continuing medical education] CME activities which serve to maintain, develop, or increase knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession, and are within the basic medical sciences, the disciplines of clinical medicine, and the provision of health care to the public.
[B.] C. Requirements.
(1) [A physician applying for renewal or reinstatement] In accordance with the requirements specified in §C(2) of this regulation, an applicant shall earn at least 50 credit hours of Category I CME during [the] a 2-year period [immediately preceding the licensee’s submission of the renewal or reinstatement application].
(2) The Board shall recognize for Category I CME credit those activities which meet at least one of the following additional requirements for the activity:
(a)—(b) (text unchanged)
(c) Be an accredited training program and have been attended by the applicant within [the] a 2-year period [immediately preceding the date of submission of the application], on the basis of either of the following:
(i)—(ii) (text unchanged)
(d) Is a program of self-instruction to prepare for an approved specialty board certification or recertification examination under the [American Board of Medical Specialties (ABMS)] ABMS which occurs solely within [the 2 years preceding the application for renewal or reinstatement] a 2-year period, on the basis of 5 hours of study equals 1 hour of CME Category I credit up to a maximum of 10 credit hours;
(e) Is a service performed under the auspices of a peer review, focused professional education, or physician rehabilitation committee of the Faculty or a Faculty-approved committee of one of its component societies or a specialty society and involves evaluation of medical care or fitness to provide medical care, and the service is performed without compensation and is credited up to a maximum of 10 credit hours for a 2-year period as follows:
(i) (text unchanged)
(ii) If the service consists of [the review by the applicant of] reviewing medical records, the applicant shall be credited with 1 hour per patient record reviewed;
(iii) If the service consists of service as chair of a peer review, focused professional education, or physician rehabilitation committee and the service lasted the entire length of a [renewal] 2-year period, the applicant shall be credited with 10 hours of CME Category I credit, but if the service did not cover the entire length of a [renewal] 2-year period, the applicant shall be credited with CME Category I credit proportionately; and
(iv) If the service consists of service as an intervenor or assessor or as a monitor of ongoing treatment of a physician participant under the auspices of a physician rehabilitation committee, or as a preceptor under the auspices of a focused professional education committee of the Faculty, and the service lasted the entire length of a [renewal] 2-year period, the applicant shall be credited with 10 hours of CME Category I credit, but if the service did not cover the entire length of a [renewal] 2-year period, the applicant shall be credited with CME Category I credit proportionately;
(f)—(g) (text unchanged)
(h) Is a service performed voluntarily and without compensation and is credited up to a maximum of 5 CME credits in a [renewal] 2-year period as follows:
(i) (text unchanged)
(ii) The applicant shall demonstrate, by submitting documentation consistent with [§D] §E of this regulation, the total number of voluntary, uncompensated hours provided, and the dates, times, and locations of the medical services provided.
(3) Nothing in [§B(2)(e)] §C(2)(e) or (f) of this regulation shall limit or impair the ability of a licensee to earn CME Category I credits for participation in any other approved program.
(4) For the purposes of [§B(2)(g)] §C(2)(g) and (h) of this regulation, 5 hours of voluntary, uncompensated services are equal to 1 hour of CME Category 1 credit.
[C.] D. On the application form for renewal or reinstatement, [a physician] the applicant shall attest to the fact that the [physician] applicant has completed the [continuing medical education] CME requirement.
[D.] E. Documentation of CME Credits.
(1) The [physician] applicant has the affirmative obligation to obtain the requisite documentation of CME attendance and retain this documentation for the succeeding 6 years for possible inspection by the Board.
(2) The required documentation of attendance at a CME program as described in [§B(2)(a)] §C(2)(a) and (b) of this regulation shall be a certificate or other documentation of attendance which shall:
(a) (text unchanged)
(b) Demonstrate that the CME activity fell within [the] a 2-year period [immediately preceding submission of the renewal or reinstatement application by the licensee].
(3) The required documentation of attendance at an accredited residency or fellowship as described in [§B(2)(c)] §C(2)(c) of this regulation shall be a certificate or other form of documentation which shall contain at the minimum the:
(a)—(f) (text unchanged)
(4) The required documentation for completion of a program of self-instruction as described in [§B(2)(d)] §C(2)(d) of this regulation shall be a specialty certificate issued by an ABMS-approved specialty board within [the] a 2-year period [immediately preceding the submission of a renewal or reinstatement application].
(5) (text unchanged)
(6) The required documentation of service as described in [§B(2)(g)] §C(2)(g) of this regulation shall be a certificate or other form of documentation acknowledging the applicant as a specialist reviewer on a medical record review, and stating the number of hours the applicant expended on the completion of the review.
E. The Board shall apply the [continuing medical education] CME requirement to all renewal and reinstatement applications after the first renewal, or, in the case of an applicant who has never renewed, after initial licensure.
.11 Reinstatement of Expired or Inactive Licenses.
A.—F. (text unchanged)
G. A physician applying for reinstatement may be required to pass the SPEX or COMVEX-USA examination if the physician:
(1) (text unchanged)
(2) Has never had specialty board certification or last passed a specialty board certification examination given by a member board of the [American Board of Medical Specialties] ABMS or the [American Osteopathic Board] AOA Bureau of Osteopathic Specialists more than 10 years before this application;
(3)—(4) (text unchanged)
H. (text unchanged)
[I. A physician with an expired or inactive license may be denied restoration of active status subject to any of the grounds listed in Health Occupations Article, §14-404, Annotated Code of Maryland, the hearing for which would be conducted subject to the hearing provisions of Health Occupations Article, §14-405, Annotated Code of Maryland.]
10.32.03 Delegation of Duties by a Licensed Physician ― Physician Assistant
Authority: Health Occupations Article, §§1-213, 14-205(a), 15-307, and 15-308, Annotated Code of Maryland
.09 Renewal, Reinstatement, Change in Name or Address, and Continuing Education.
A. Renewal. [To renew a physician assistant's license, the applicant shall:]
(1) The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02.
(2) An individual who has been licensed by the Board as a physician assistant may renew the license every 2 years on the date specified by the Board by:
[(1)] (a) [Complete] Completing an application on a form approved by the Board;
[(2)] (b) [Pay an application] Paying the required renewal fee as defined in Regulation .16 of this chapter;
[(3)] (c) [Attest] Attesting to completion of continuing education activities as specified in §D of this regulation; and
[(4)] (d) [Meet] Meeting any additional requirements set by the Board for renewal of a license.
B. Reinstatement. [To be reinstated, the applicant shall:] The Board shall reinstate the license of a physician assistant if the physician assistant:
(1) [Complete] Completes an application on a form approved by the Board;
(2) [Pay an application] Pays the required reinstatement fee as defined in Regulation .16 of this chapter;
(3) [Submit] Submits evidence of completion of continuing education activities as specified in §D of this regulation; and
(4) [Meet] Meets any additional requirements set by the Board for reinstatement of a license.
C. Change [of] in Name or Address.
(1)—(2) (text unchanged)
D. Continuing Education.
(1) Except as specified in §D(2) of this regulation, in order to renew or reinstate a license under §A or B of this regulation, a physician assistant shall complete at least 50 hours of continuing education consisting of:
(a) [A minimum] At least 8 hours of Category 1 education on pharmacology topics earned [within: the 2 years preceding the date of the application for renewal or reinstatement; and] during the 2-year period preceding:
(i) For license renewal, the expiration of the physician assistant license; or
(ii) For license reinstatement, the date of the submission of the application for reinstatement; and
(b) In addition to the continuing education hours specified in §D(1)(a) of this regulation, [a minimum of] at least 42 hours of Category I continuing education [activities within: the 2 years preceding the date of the application for renewal or reinstatement.] earned during the 2-year period preceding:
(i) For license renewal, the expiration of the physician assistant license; or
(ii) For license reinstatement, the date of the submission of the application for reinstatement.
(2) A physician assistant who is renewing a license as a physician assistant for the first time since either initial licensure or reinstatement of a license:
(a) Shall [meet the requirement of §D(1)(a)(i) of this regulation] earn at least 8 hours of Category 1 education on pharmacology topics prior to the expiration of the physician assistant license; and
(b) Is not required to [meet the requirement specified in §D(1)(b)(i) of this regulation] complete any other hours of Category I continuing education prior to the expiration of the physician assistant license.
(3)—(5) (text unchanged)
10.32.06 Licensure of Polysomnographic Technologists
Authority: Health Occupations Article, §§14-205(a), 14-5C-03, and 14-5C-14, Annotated Code of Maryland
.07 Renewal and Reinstatement.
A. Renewal.
(1) (text unchanged)
(2) An individual who has been licensed by the Board as a polysomnographic technologist may renew the license on or before the date specified by the Board by:
(a)—(b) (text unchanged)
(c) [Certifying] Attesting to the completion of at least 20 hours of continuing education, earned during the 2-year period preceding the expiration of the license, [and meeting the requirements stated] as specified in Regulation .08 of this chapter; and
(d) (text unchanged)
B. Reinstatement. The Board [may] shall reinstate the license of a polysomnographic technologist [who has failed to renew the license for any reason] if the polysomnographic technologist:
(1) [Applies for reinstatement after the date the license expires] Completes a reinstatement application on a form supplied by the Board;
(2) Pays the required reinstatement fee and any other fees specified in Regulation .09 of this chapter;
(3) Documents evidence of completion of at least 20 hours of approved continuing education in the 2-year period preceding the date of the submission of the application for reinstatement, as specified in Regulation .08 of this chapter; and
[(2)] (4) Meets [the renewal requirements of §A of this regulation;] any additional requirements set by the Board for reinstatement of a license.
[(3) Submits evidence of completion of 20 hours of approved continuing education in the 2 years preceding the application for reinstatement, which meet the requirements stated in Regulation .08 of this chapter; and
(4) Pays to the Board the reinstatement fee set by the Board in Regulation .09 of this chapter.]
.08 Continuing Education.
A. (text unchanged)
B. Requirements.
(1) A polysomnographic technologist shall earn at least 20 continuing education hours as described in §B(2) of this regulation during the 2-year period [immediately] preceding: [the licensee's submission of the renewal or reinstatement application.]
(a) For license renewal, the expiration of the license for polysomnographic technologist; or
(b) For license reinstatement, the date of the submission of the application for reinstatement.
(2) (text unchanged)
C. (text unchanged)
10.32.08 Licensure of Athletic Trainers
Authority: Health Occupations Article, §§1-213, 14-205(a), and 14-5D-12, Annotated Code of Maryland
.07 Renewal, Reinstatement, [Change in Name or Address, and Continuing Education] Continuing Education, and Change in Name or Address.
A. Renewal.
(1) The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02.
[(1)] (2) An individual who has been licensed by the Board as an athletic trainer may renew the license every 2 years on the date specified by the Board by:
(a)—(b) (text unchanged)
(c) Attesting to the completion of at least 50 hours of approved continuing education credits, earned during the 2-year period preceding the expiration of the license for athletic training, in accordance with the requirements specified in §C of this regulation; and
[(d) Paying or reaching an agreement with the Office of the Comptroller to pay unpaid unemployment insurance or taxes; and]
[(e)] (d) (text unchanged)
[(2)] (3) (text unchanged)
B. Reinstatement. The Board shall reinstate the license of an athletic trainer if the athletic trainer:
(1)—(2) (text unchanged)
(3) Documents evidence of at least 50 hours of approved continuing education credits during the 2-year period [immediately] preceding the date of the submission of the application for reinstatement;
(4) Meets [the renewal requirements in §A of this regulation] any additional requirements set by the Board for reinstatement of a license; and
(5) (text unchanged)
C.—D. (text unchanged)
10.32.10 Licensure of Radiation Therapists, Radiographers, Nuclear Medicine Technologists, and Radiologist Assistants
Authority: Health Occupations Article, §§1-213, 14-205(a), 14-5B-03, and 14-5B-12, Annotated Code of Maryland
.13 Renewal and Reinstatement.
A. Renewal.
(1) The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02.
[(1)] (2) An individual who has been licensed by the Board as a radiation therapist, radiographer, or nuclear medicine technologist shall renew the license every 2 years on the date specified by the Board by:
(a)—(b) (text unchanged)
(c) Attesting to one of the following:
(i) Completion of at least 24 hours of approved continuing education earned during the 2-year period preceding the [date of the renewal application] expiration of the license for radiation therapist, radiographer, or nuclear medicine technologist, in accordance with the requirements specified in §A(5) of this regulation;
(ii)—(iii) (text unchanged)
[(2)] (3) An individual who has been licensed by the Board as a radiologist assistant shall renew the license every 2 years on the date specified by the Board by:
(a)—(b) (text unchanged)
(c) Attesting to one of the following:
(i) Completion of at least 50 hours of approved continuing education earned during the 2-year period preceding the [date of the renewal application] expiration of the license for radiologist assistant, in accordance with the requirements specified in §A(5)of this regulation; or
(ii) (text unchanged)
[(3)] (4)—[(4)] (5) (text unchanged)
[(5)] (6) (text unchanged)
B. Reinstatement. [A person who has been licensed by the Board as] The Board shall reinstate the license of a radiation therapist, radiographer, nuclear medicine technologist, or radiologist assistant [and who has allowed the license to lapse shall apply for reinstatement by] if the individual:
(1) [Completing] Completes a reinstatement application on a form approved by the Board;
(2) [Paying] Pays a reinstatement fee as defined in Regulation .18 of this chapter; and
(3) [Documenting] Documents evidence of:
(a) For a radiographer, radiation therapist, or nuclear medicine technologist, [meeting] at least one of the following requirements: [specified in §A(1)(c) of this regulation; or]
(i) Completion of at least 24 hours of approved continuing education earned during the 2-year period preceding the date of the submission of the application for reinstatement of the license for radiation therapist, radiographer, or nuclear medicine technologist;
(ii) Current ARRT registration; or
(iii) Active certification by the NMTCB; or
(b) For a radiologist assistant, [meeting] at least one of the following requirements: [specified in §A(2)(c) of this regulation.]
(i) Completion of at least 50 hours of approved continuing education earned during the 2-year period preceding the date of the submission of the application for reinstatement of the license for radiologist assistant; or
(ii) Current ARRT registration as a radiologist assistant.
10.32.11 Licensing of Respiratory Care Practitioners
Authority: Health Occupations Article, §§1-213, 14-205(a), 14-5A-03, 14-5A-13, and 14-5A-14, Annotated Code of Maryland
.09 Scope of [Practice.] Practice, Identification, and Change in Name or Address.
A.—C. (text unchanged)
D. [A respiratory care practitioner shall advise the Board in writing of any change in name or mailing address within 60 days or be subject to a penalty of $100.] Change in Name or Address.
(1) Within 60 days after the change, a licensee shall notify the Board in writing of a change in name or address.
(2) Licensees who fail to notify the Board of name or address changes as required by §D(1) of this regulation are subject to an administrative penalty of $100.
.11 Renewal, Reinstatement, and Continuing Education.
A. Renewal.
(1) The Board may not renew a license until the Comptroller of Maryland has verified that the individual has paid all undisputed taxes and unemployment insurance contributions, or arranged for repayment, as required by COMAR 10.31.02.
[(1)] (2) An individual who has been licensed by the Board as a respiratory care practitioner may renew the license every 2 years on the date specified by the Board by:
(a)—(b) (text unchanged)
(c) Attesting to the completion of at least 16 [contact] hours of [approvedcontinuing] approved continuing respiratory care education, earned during the 2-year period preceding the expiration of the license for respiratory care, as described in §C of this regulation; and
(d) (text unchanged)
[(2)] (3) The continuing education requirement applies to all renewal applications after the first renewal.
B. Reinstatement.
(1) Except as provided in §B(2) of this regulation, the Board shall reinstate the license of a respiratory care practitioner if the respiratory care practitioner:
(a)—(b) (text unchanged)
(c) Documents evidence of at least 16 hours of approved continuing education in the [2 years] 2-year period preceding the date of the submission of the application for reinstatement, as described in §C of this regulation; and
(d) Meets [the renewal requirements in §A of this regulation] any additional requirements set by the Board for reinstatement of a license.
(2) (text unchanged)
C. Continuing Education.
(1) (text unchanged)
(2) [An] Instead of completing the required continuing education, an applicant for renewal or reinstatement may substitute passing the examination for either certified respiratory therapist or registered respiratory therapist conducted by the National Board for Respiratory Care during the 2-year period [preceding the application for renewal or reinstatement for the required continuing education.] preceding:
(a) For license renewal, the expiration of the license for respiratory care; or
(b) For license reinstatement, the date of the submission of the application for reinstatement.
(3) The Board may impose a civil penalty of up to $100 per continuing respiratory care education [contact] hour in lieu of a sanction under Health Occupations Article, §14–5A–17, Annotated Code of Maryland, for a first offense, for the failure of a licensee to obtain continuing education [contact] hours required by the Board.
VAN T. MITCHELL
Secretary of Health and Mental Hygiene
