Titles of Regulations: 18VAC85-20. Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic (amending 18VAC85-20-141).

18VAC85-50. Regulations Governing the Practice of Physician Assistants (amending 18VAC85-50-50).

18VAC85-101. Regulations Governing the Practice of Radiologic Technology (amending 18VAC85-101-28).

Statutory Authority: § 54.1-2400 of the Code of Virginia.

Public Hearing Information: No public hearing is currently scheduled.

Public Comment Deadline: March 16, 2022.

Effective Date: April 1, 2022.

Agency Contact: William L. Harp, M.D., Executive Director, Board of Medicine, 9960 Mayland Drive, Suite 300, Richmond, VA 23233-1463, telephone (804) 367-4621, FAX (804) 527-4429, or email william.harp@dhp.virginia.gov.

Basis: Regulations are promulgated under the general authority of § 54.1-2400 of the Code of Virginia, which provides the Board of Medicine the authority to promulgate regulations to administer the regulatory system.

Purpose: Amendments will make licensing more efficient, enabling applicants to obtain licensure and begin practice more expeditiously. Public health and safety are still protected, as verification is still required showing that no disciplinary action has been taken or is pending in another jurisdiction.

Rationale for Using Fast-Track Rulemaking Process: This action is appropriate for the fast-track rulemaking process because the amendments will make licensing more efficient, enabling applicants to obtain licensure and begin practice more expeditiously. Public protection and minimal competency are not being compromised, so there should be no objection to these changes.

Substance: Requirements for licensure are amended for applicants in medicine, osteopathic medicine, podiatry, or as a physician assistant or radiologist assistant. The revised regulation will require verification that the most recent license held in another jurisdiction or Canada is in good standing or that there has been no disciplinary action taken or pending.

Issues: The primary advantage to the public is expedited licensure for medical professionals to increase access to vital services. There are no disadvantages; public protection is maintained through a state verification and a report from the National Practitioner Data Bank. There are no advantages or disadvantages to the Commonwealth.

Department of Planning and Budget's Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia (Code) and Executive Order 14 (as amended, July 16, 2018). The analysis presented represents DPB's best estimate of these economic impacts.¹

Summary of the Proposed Amendments to Regulation. The Board of Medicine (Board) proposes to amend 18VAC85-20 Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic to indicate that applicants for licensure by endorsement must provide verification that the most recently acquired license held in another United States jurisdiction or in Canada is in good standing, defined as current and unrestricted, or if lapsed, eligible for renewal or reinstatement. The current regulation requires that such verification be provided for all licenses held in other United States jurisdictions or in Canada.

Similarly, the Board also proposes to amend 18VAC85-50 Regulations Governing the Practice of Physician Assistants and 18VAC85-101 Regulations Governing the Practice of Radiologic Technology to indicate that verification would only be required for the most recently acquired license held in another jurisdiction.

Background. Under the current 18VAC85-20 Regulations Governing the Practice of Medicine, Osteopathic Medicine, Podiatry, and Chiropractic, physicians and podiatrists who are applying for Virginia licensure by endorsement must provide verification that all licenses held in another United States jurisdiction or in Canada are in good standing, defined as current and unrestricted, or if lapsed, eligible for renewal or reinstatement. The Board proposes to only require that the most recently acquired license be so verified.

The current 18VAC85-50 Regulations Governing the Practice of Physician Assistants and 18VAC85-101 Regulations Governing the Practice of Radiologic Technology require that all applicants for Virginia licensure as a physician assistant or radiologist assistant respectively, provide verification of their licensure status in all other jurisdictions where they are licensed. The Board proposes to only require that the most recently acquired license be so verified.

Estimated Benefits and Costs. According to the Department of Health Professions (DHP), many applicants for licensure by endorsement in medicine, osteopathic medicine, and podiatry are licensed in multiple jurisdictions, so verification of every license can significantly delay the licensing process. Licensure would not be granted until all such jurisdictions respond. Thus, the proposal to only require verification for the most recently acquired license would reduce the time it takes to become licensed by endorsement as a physician or podiatrist for many applicants. Similarly, many of the applicants for licensure as a physician assistant or radiologist assistant who are licensed in multiple other jurisdictions would also benefit from reduced time to gain licensure in the Commonwealth.

Applicants for licensure by endorsement in medicine, osteopathic medicine, and podiatry, and applicants for licensure as a physician assistant or radiologist assistant, who are licensed in multiple other jurisdictions would also benefit from the proposed amendments by paying fewer fees. Licensing agencies typically charge fees to verify licensure. For example, DHP charges $10 for verification to other jurisdictions on Virginia licensure of physicians, podiatrists, physician assistants and radiologist assistants. Thus, under the proposal, applicants would only pay the verification fee from the licensing agency in the jurisdiction of the most recently acquired license. Under the current regulations, applicants pay fees to the licensing agencies in all other jurisdictions where they are licensed.

According to DHP, all applicants must provide a current report from the U.S. Department of Health and Human Services National Practitioner Data Bank (NPDB). The NPDB is a web-based repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers. Established by Congress in 1986, the U.S. Department of Health and Human Services describes it as a workforce tool that prevents practitioners from moving state to state without disclosure or discovery of previous damaging performance.² Thus, the proposals to only require verifications of the most recently acquired license would not likely substantively add to the risk of licensing a practitioner in the Commonwealth who unbeknownst to DHP previously practiced in an incompetent or unethical manner in another jurisdiction.

Businesses and Other Entities Affected. The proposed amendments potentially affect applicants for licensure by endorsement as physicians or podiatrists, and applicants for licensure as physician assistants or radiologist assistants, who are licensed in multiple other jurisdictions. According to DHP, in 2020 there were 596 MD and DO licenses issued by endorsement (none for podiatrists). The agency does not have data on how many of those held licenses in multiple jurisdictions, but DHP believes that the vast majority did. DHP issued 150 physician assistant licenses and zero radiologist assistant licenses in the fourth quarter 2021. The agency does not have data on how many of those held licenses in multiple jurisdictions.

The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.³ An adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined. No adverse impact is indicated for this proposal.

Small Businesses⁴ Affected.⁵ The proposed amendments do not appear to adversely affect small businesses.

Localities⁶ Affected.⁷ It may be the case that practitioners who live near jurisdictional borders would be more likely to seek licensure in multiple jurisdictions. To the extent that this occurs, localities adjacent to or otherwise near other jurisdictions may be particularly affected. The proposed amendments do not introduce costs for local governments.

Projected Impact on Employment. For some applicants, the proposed amendments reduce the time it takes to become licensed as a physician, podiatrist, physician assistant or radiologist assistant in Virginia and modestly reduces fees paid to other jurisdictions. However, these benefits would not likely substantively affect total employment.

Effects on the Use and Value of Private Property. By enabling some practitioners to start working in the Commonwealth sooner, the proposed amendments may raise the earnings and value of private entities that employ them during the first year of their employment. The proposed amendments do not affect real estate development costs.

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¹Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

²See https://www.npdb.hrsa.gov/topNavigation/aboutUs.jsp

³Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

⁴Pursuant to § 2.2-4007.04, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁵If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to Code § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

⁶"Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

⁷§ 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency's Response to Economic Impact Analysis: The Board of Medicine concurs with the economic impact analysis of the Department of Planning and Budget.

Summary:

The amendments (i) change licensure by endorsement requirements in medicine, osteopathic medicine, and podiatry to only require verification of the most recent license status in another United States jurisdiction and (ii) change licensure requirements for physician assistants and radiologist assistants to verification of only one jurisdiction, which is consistent with current language for all other allied professions licensed by the Board of Medicine.

18VAC85-20-141. Licensure by endorsement.

To be licensed by endorsement, an applicant shall:

1. Hold at least one current, unrestricted license in a United States jurisdiction or Canada for the five years immediately preceding application to the board;

2. Have been engaged in active practice, defined as an average of 20 hours per week or 640 hours per year, for five years after postgraduate training and immediately preceding application;

3. Verify that all licenses the most recent license held in another United States jurisdiction or in Canada are is in good standing, defined as current and unrestricted, or if lapsed, eligible for renewal or reinstatement;

4. Hold current certification by one of the following:

a. American Board of Medical Specialties;

b. Bureau of Osteopathic Specialists;

c. American Board of Foot and Ankle Surgery;

d. American Board of Podiatric Medicine;

e. Fellowship of Royal College of Physicians of Canada;

f. Fellowship of the Royal College of Surgeons of Canada; or

g. College of Family Physicians of Canada;

5. Submit a current report from the U.S. Department of Health and Human Services National Practitioner Data Bank; and

6. Have no grounds for denial based on provisions of § 54.1-2915 of the Code of Virginia or regulations of the board.

18VAC85-50-50. Licensure: entry requirements and application.

A. The applicant seeking licensure as a physician assistant shall submit:

1. A completed application and fee as prescribed by the board.

2. Documentation of successful completion of an educational program as prescribed in § 54.1-2951.1 of the Code of Virginia.

3. Documentation of passage of the certifying examination administered by the National Commission on Certification of Physician Assistants.

4. Documentation that the applicant has not had a license or certification as a physician assistant suspended or revoked and is not the subject of any disciplinary proceedings in another If licensed or certified in any other jurisdiction, verification that there has been no disciplinary action taken or pending in that jurisdiction.

B. The board may issue a license by endorsement to an applicant for licensure if the applicant (i) is the spouse of an active duty member of the Armed Forces of the United States or the Commonwealth, (ii) holds current certification from the National Commission on Certification of Physician Assistants, and (iii) holds a license as a physician assistant that is in good standing, or that is eligible for reinstatement if lapsed, under the laws of another state.

18VAC85-101-28. Licensure requirements.

A. An applicant for licensure as a radiologist assistant shall:

1. Meet the educational requirements specified in 18VAC85-101-27;

2. Submit the required application, fee, and credentials to the board;

3. Hold certification by the ARRT as an R.T.(R) or be licensed in Virginia as a radiologic technologist;

4. Submit evidence of passage of an examination for radiologist assistants resulting in national certification as an Registered Radiologist Assistant by the ARRT; and

5. Hold current certification in Advanced Cardiac Life Support (ACLS).

B. If an applicant has been licensed or certified in another jurisdiction as a radiologist assistant or a radiologic technologist, he shall provide information on the status of each license or certificate held the application shall include verification that there has been no disciplinary action taken or pending in that jurisdiction.

C. An applicant who fails the ARRT examination for radiologist assistants shall follow the policies and procedures of the ARRT for successive attempts.