SB427: SB427 Physicians; limited provisional licenses and a pathway to licensure for certain internationally trained physicians; provide

26 LC 46 1510S Senate Bill 427 By: Senators Watson of the 1st, Kirkpatrick of the 32nd, Hufstetler of the 52nd, Jackson of the 41st, Anavitarte of the 31st and others AS PASSED A BILL TO BE ENTITLED AN ACT To amend Article 2 of Chapter 34 of Title 43 of the Official Co de of Georgia Annotated,1 relating to medical practice relative to physicians, so as to p rovide for limited provisional2 licenses and a pathway to licensure for certain internationally trained physicians; to provide3 for definitions; to provide for qualifications and conditions; to provide for penalties, license4 sanctions, and enforcement; to provide for one or more medical directors; to provide for5 annual reports; to provide for rules, regulations and procedures; to provide for conditional6 automatic repeal; to provide for related matters; to provide for a contingent effective date;7 to repeal conflicting laws; and for other purposes.8 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9 SECTION 1.10 Article 2 of Chapter 34 of Title 43 of the Official Code of Geo rgia Annotated, relating to11 medical practice relative to physicians, is amended by adding a new Code section to read as12 follows:13 "43-34-34.1.14 (a) As used in this Code section, the term:15 (1) 'Foreign jurisdiction' means any jurisdiction other than a state of the United States.16 S. B. 427 - 1 - 26 LC 46 1510S (2) 'Internationally trained physician' means an individual wh o received a degree of17 doctor of medicine or its equivalent, as approved by the board or provided by rule, from18 a medical school in a foreign jurisdiction.19 (3) 'Limited provisional license' means a license to practice medicine issued to an20 internationally trained physician and permitting supervised medical practice as provided21 in this Code section.22 (4) 'Medical director' means a physician with a full, unrestricted license in this state who23 oversees the development, establishment, and implementation of the limited provisional24 license and pathway to licensure, as provided for in this Code section.25 (5) 'Pathway to licensure' means the requirements an internati onally trained physician26 holding a current, valid limited provisional license shall complete in order to obtain a full27 license to practice medicine in this state.28 (6) 'Rural county' means a county in this state having a popul ation of less than 50,00029 according to the United States decennial census of 2020 or any future such census;30 provided, however, that, for counties which contain a military base or installation, the31 military personnel and their dependents living in such county shall be excluded from the32 total population of such county for purposes of this definition.33 (7) 'Supervising physician' means a physician with a full, unrestricted license in this state34 who physically practices at a medical practice located in a rur al county, a licensed35 hospital, a federally qualified health center, or an accredited medical school where an36 internationally trained physician is employed, provides on-site clinical supervision of a37 limited provisional licensee, and attests to the competence of such licensee in accordance38 with board rules. Such physician's specialty shall be comparab le to that of the39 internationally trained physician applying for a limited provisional license as determined40 by a medical director.41 S. B. 427 - 2 - 26 LC 46 1510S (b) The board may issue a limited provisional license to practice medicine in this state to42 an internationally trained physician when the board receives satisfactory verification that43 the applicant:44 (1) Has been offered full-time employment under a supervising physician either at a45 medical practice located in a rural county, a hospital licensed pursuant to Chapter 7 of46 Title 31, a federally qualified health center, or an accredited medical school;47 (2) Has a current and active license in good standing to pract ice medicine in a foreign48 jurisdiction or had such a license that expired no more than th ree years prior to the49 submission of an application for a limited provisional license to the board;50 (3) Has not had a license to practice medicine revoked, suspended, restricted, denied, or51 otherwise acted against in any state, federal, or foreign juris diction, including, but not52 limited to, the voluntary relinquishment of a license or relinq uishment of a license by53 stipulation, consent order, or other settlement in response to or in anticipation of the filing54 of administrative charges or disciplinary action against a license, and is not the subject55 of any pending investigations by a licensing authority;56 (4) Completed 130 weeks of medical education at a medical school listed in the World57 Directory of Medical Schools or its successor organization; is certified or eligible for58 certification by the Educational Commission for Foreign Medical Graduates or other59 credential evaluation service approved by the board; and active ly practiced medicine60 either:61 (A) For at least five years after completing two years of post graduate training in a62 graduate medical education program approved by the applicant's foreign jurisdiction63 of licensure; provided that such practice is in the same specialty as such training; or64 (B) For at least ten years after graduating from medical school in a foreign jurisdiction;65 (5) Demonstrated competency to practice medicine by:66 (A) Successfully passing each part of an examination approved by the board;67 S. B. 427 - 3 - 26 LC 46 1510S (B) Successfully passing each part of a nationally recognized standard medical68 licensing examination from a foreign jurisdiction that is a member of the International69 Association of Medical Regulatory Authorities that includes an interactive testing70 component and tests for the ability to practice medicine; medical knowledge, skills and71 understanding of clinical science essential for providing patient care, as prescribed by72 the board in rules; and communication and interpersonal skills; provided, however, that73 the examining body shall provide verification in English directly to the board that the74 applicant has successfully passed an examination that satisfies each of the requirements75 of this subparagraph;76 (C) Receiving specialty board certification approved by the Am erican Board of77 Medical Specialties, the Bureau of Osteopathic Specialist of the American Osteopathic78 Association, the Royal College of Physicians and Surgeons of Ca nada, or any other79 specialty board prescribed by board rules; or80 (D) Submitting to a comprehensive assessment demonstrating clinical competence by81 a program prescribed by board rules;82 (6) Has not been convicted in any state, federal, or foreign jurisdiction of any felony, any83 criminal offense involving moral turpitude, or a violation of law relative to the practice84 of medicine; provided, however, that the applicant shall submit to the board a background85 screening in English from the foreign jurisdiction in which such applicant is licensed;86 (7) Has successfully passed an English proficiency examination that includes the87 components of reading, speaking, writing, and listening, as prescribed by board rules;88 (8) Is legally authorized to work in the United States; provid ed, however, that an89 applicant may apply for a limited proficiency license prior to receiving federal work90 authorization but shall not begin employment in a medical pract ice located in a rural91 county, a licensed hospital, a federally qualified health center, or an accredited medical92 school as provided for in paragraph (1) of this subsection until the applicant receives legal93 S. B. 427 - 4 - 26 LC 46 1510S work authorization from the relevant federal agency and an appr oved license from the94 board;95 (9) Submits an application and pays any application fees to the board; and96 (10) Participates in an interview at the discretion of the board prior to consideration of97 the application.98 (c) Any documents required in subsection (b) of this Code sect ion shall be submitted in99 English or translated by a certified professional translation service, provided that any such100 translation includes a certification statement and notarized signature.101 (d) The holder of a limited provisional license issued under t his Code section shall not102 practice medicine outside of a medical practice located in a ru ral county, a licensed103 hospital, a federally qualified health center, or an accredited medical school as provided104 for in paragraph (1) of subsection (b) of this Code section. A person who violates this105 subsection shall be subject to disciplinary action by the board and shall be guilty of a106 misdemeanor, and, upon conviction, shall be fined not more than $500.00 for each offense.107 (e) A limited provisional licensee shall be subject to the provisions of this article and the108 rules of the board in the same manner as a person holding full licensure under this article.109 Such licensee shall update and maintain a complete public physician profile in compliance110 with the provisions of Code Section 43-34A-3. The board shall have the authority to issue,111 deny, renew, revoke, suspend, issue terms and conditions, place on probation, limit, fine,112 or otherwise sanction the limited provisional licensee for any violation of the provisions113 of this Code section, this article, or board rules after notice and opportunity for a hearing.114 (f)(1) A limited provisional license shall become inactive whe n the holder of such115 license:116 (A) Ceases to be employed in a full-time capacity at a medical practice located in a117 rural county, a licensed hospital, a federally qualified health center, or an accredited118 medical school as provided for in paragraph (1) of subsection (b) of this Code section;119 S. B. 427 - 5 - 26 LC 46 1510S (B) Ceases to be employed under a supervising physician who is physically practicing120 onsite at a medical practice located in a rural county, a licen sed hospital, a federally121 qualified health center, or an accredited medical school as provided for in paragraph (1)122 of subsection (b) of this Code section; provided, however, that any supervising123 physician shall immediately notify the board in writing of any change to the124 employment status or hours of such physician or the limited provisional licensee at such125 medical practice, licensed hospital, or accredited medical school; or126 (C) Obtains any other license to practice medicine issued by the board.127 (2) The board shall retain jurisdiction over the holder of an inactive license for128 disciplinary purposes.129 (g) An internationally trained physician who holds a current, valid limited provisional130 license pursuant to this Code section shall be eligible to apply for a full license to practice131 medicine after four years of active practice at a medical practice located in a rural county,132 a licensed hospital, a federally qualified health center, or an accredited medical school in133 this state. The board may grant a full license to practice med icine in this state if such134 applicant has no disciplinary actions or pending investigations by any state, federal, or135 foreign regulatory agency against a license held by the applica nt; no misdemeanor136 convictions, excluding minor traffic violations, in any state, federal, or foreign jurisdiction137 in the two years preceding the application for a full license; no felony convictions or138 convictions for criminal offenses involving moral turpitude in any state, federal, or foreign139 jurisdiction; and no adverse actions affecting the applicant's privileges or ability to practice140 medicine. As a condition of license issuance, the board shall require the licensee to provide141 two additional years of medical practice is an underserved area as defined by board rules.142 (h) The board shall employ additional administrative, professional, investigative, and legal143 staff necessary to implement the provisions of this Code section. The board shall employ144 one or more medical directors who shall oversee the development , establishment, and145 implementation of the limited provisional license and the pathway to licensure, as provided146 S. B. 427 - 6 - 26 LC 46 1510S for in this Code section. Such medical director or directors shall evaluate medical practice,147 hospital, or medical school site readiness, audit supervision, review performance, analyze148 data, recommend disciplinary actions, advise on rule-making, and coordinate with public149 health partners and other state agencies.150 (i) No later than December 1, 2027, and annually thereafter, the board shall submit a report151 on the implementation of this Code section to the chairpersons of the House Committee on152 Health and the Senate Health and Human Services Committee. Such report shall include,153 but shall not be limited to:154 (A) The number of applicants for a limited provisional license;155 (B) The applicant's licensing foreign jurisdiction and the foreign jurisdiction where the156 applicant attained his or her education and training;157 (C) The number of limited provisional licenses granted and denied and the reasons for158 such denials;159 (D) The counties where limited provisional licensees practice and whether the practice160 is in a medical practice located in a rural county, a licensed hospital, a federally qualified161 health center, or an accredited medical school;162 (E) The number of limited provisional licensees applying for a full license through the163 pathway to licensure; 164 (F) The number of full licenses granted to limited provisional licensees applying through165 the pathway to licensure, the number of denials to such license es, and the reasons for166 such denials;167 (G) The number and nature of complaints received by the board or the employing168 medical practice, hospital, or medical school regarding a limited provisional licensee and169 any disciplinary actions taken; and170 (H) The practice setting and specialty of applicants:171 (i) In their licensing foreign jurisdiction;172 (ii) When they were employed under their limited provisional license; and173 S. B. 427 - 7 - 26 LC 46 1510S (iii) During the first two years under their full license to p ractice medicine in an174 underserved area as provided under subsection (g) of this Code section.175 (j) The board shall promulgate rules and regulations necessary to implement and176 administer the provisions of this Code section.177 (k) The board shall implement this Code section upon the effec tive date of a specific178 appropriation of funds for purposes of this Code section as expressed in a line item making179 specific reference to the full funding of this Code section in an appropriations Act enacted180 by the General Assembly. This Code section shall stand repealed on the effective date of181 the appropriations Act for the fiscal year that fails to make s pecific reference to the full182 funding of this Code section. The House Budget and Research Of fice and the Senate183 Budget and Evaluation Office shall certify any such lack of app ropriation to the Code184 Revision Commission for purposes of updating the Code in accord ance with this185 subsection."186 SECTION 2.187 This Act shall become effective only if the Code section provided for in this Act is funded188 in an appropriations Act making specific reference to such Code section.189 SECTION 3.190 All laws and parts of laws in conflict with this Act are repealed.191 S. B. 427 - 8 -