HF 2445

2nd Engrossment - 89th Legislature (2015 - 2016) Posted on 06/02/2016 09:37am

A bill for an act
relating to health; modifying licensure requirement for osteopathic physicians;
making technical changes to the composition of the Board of Medical Practice;
amending Minnesota Statutes 2014, sections 147.01, subdivisions 1, 2; 147.02,
subdivision 1; 147.03, subdivision 1; 147.037, subdivision 1; 147.091,
subdivision 1.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2014, section 147.01, subdivision 1, is amended to read:

Subdivision 1.

Creation; terms.

The Board of Medical Practice consists of 16
residents of the state of Minnesota appointed by the governor. deleted text begin Ten deleted text end new text begin Eleven new text end board members
must deleted text begin hold a degree of doctor of medicine and deleted text end be licensed to practice medicine under
this chapter. deleted text begin Not less than deleted text end new text begin At least new text end one board member must hold a degree of doctor of
deleted text begin osteopathy and either be licensed to practice osteopathy under Minnesota Statutes 1961,
sections 148.11 to 148.16; prior to May 1, 1963, or be licensed to practice medicine under
this chapter deleted text end new text begin medicine, and at least one board member must hold a degree of doctor of
osteopathic medicine new text end . Five board members must be public members as defined by section
214.02. The governor shall make appointments to the board which reflect the geography of
the state. In making these appointments, the governor shall ensure that no more than one
public member resides in each United States congressional district, and that at least one
member who is not a public member resides in each United States congressional district.
The board members holding the degree of doctor of medicine new text begin or doctor of osteopathic
medicine new text end must, as a whole, reflect the broad mix of expertise of physicians practicing in
Minnesota. A member may be reappointed but shall not serve more than eight years
consecutively. Membership terms, compensation of members, removal of members,
the filling of membership vacancies, and fiscal year and reporting requirements are as
provided in sections 214.07 to 214.09. The provision of staff, administrative services and
office space; the review and processing of complaints; the setting of board fees; and other
provisions relating to board operations are as provided in chapter 214.

Sec. 2.

Minnesota Statutes 2014, section 147.01, subdivision 2, is amended to read:

Subd. 2.

Recommendations for appointment.

Prior to the end of the term of a
doctor of medicine or public member on the board, or within 60 days after a doctor of
medicine or public member position on the board becomes vacant, the State Medical
Association, the Mental Health Association of Minnesota, and other interested persons and
organizations may recommend to the governor doctors of medicine and public members
qualified to serve on the board. Prior to the end of the term of deleted text begin a doctor of osteopathy
deleted text end new text begin an osteopathic physician new text end , or within 60 days after deleted text begin a doctor of osteopathy deleted text end new text begin an osteopathic
physician new text end membership becomes vacant, the Minnesota Osteopathic Medical Society may
recommend to the governor three deleted text begin doctors of osteopathy deleted text end new text begin osteopathic physicians new text end qualified
to serve on the board. The governor may appoint members to the board from the list of
persons recommended or from among other qualified candidates.

Sec. 3.

Minnesota Statutes 2014, section 147.02, subdivision 1, is amended to read:

Subdivision 1.

United States or Canadian medical school graduates.

The board
shall issue a license to practice medicine to a person not currently licensed in another state
or Canada and who meets the requirements in paragraphs (a) to (i).

(a) An applicant for a license shall file a written application on forms provided by
the board, showing to the board's satisfaction that the applicant is of good moral character
and satisfies the requirements of this section.

(b) The applicant shall present evidence satisfactory to the board of being a graduate
of a medical or osteopathic new text begin medical new text end school located in the United States, its territories
or Canada, and approved by the board based upon its faculty, curriculum, facilities,
accreditation by a recognized national accrediting organization approved by the board,
and other relevant data, or is currently enrolled in the final year of study at the school.

(c) The applicant must have passed an examination as described in clause (1) or (2).

(1) The applicant must have passed a comprehensive examination for initial licensure
prepared and graded by the National Board of Medical Examiners, the Federation of State
Medical Boards, the Medical Council of Canada, the National Board of Osteopathic
Examiners, or the appropriate state board that the board determines acceptable. The board
shall by rule determine what constitutes a passing score in the examination.

(2) The applicant taking the United States Medical Licensing Examination (USMLE)
new text begin or Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) new text end must
have passed steps new text begin or levels new text end one, two, and three. Step new text begin or level new text end three must be passed
within five years of passing step new text begin or level new text end two, or before the end of residency training.
The applicant must pass each of steps new text begin or levels new text end one, two, and three with passing scores
as recommended by the USMLE program new text begin or National Board of Osteopathic Medical
Examiners new text end within three attempts. The applicant taking combinations of Federation of State
Medical Boards, National Board of Medical Examiners, and USMLE may be accepted
only if the combination is approved by the board as comparable to existing comparable
examination sequences and all examinations are completed prior to the year 2000. deleted text begin The deleted text end
deleted text begin applicant taking the deleted text end deleted text begin College of Osteopathic Medical Licensure Examination (COMLEX) deleted text end deleted text begin
must deleted text end deleted text begin pass all three steps within deleted text end deleted text begin six deleted text end deleted text begin attempts.
deleted text end

(d) The applicant shall present evidence satisfactory to the board of the completion
of one year of graduate, clinical medical training in a program accredited by a national
accrediting organization approved by the board or other graduate training approved
in advance by the board as meeting standards similar to those of a national accrediting
organization.

(e) The applicant may make arrangements with the executive director to appear in
person before the board or its designated representative to show that the applicant satisfies
the requirements of this section. The board may establish as internal operating procedures
the procedures or requirements for the applicant's personal presentation.

(f) The applicant shall pay a fee established by the board by rule. The fee may not be
refunded. Upon application or notice of license renewal, the board must provide notice
to the applicant and to the person whose license is scheduled to be issued or renewed of
any additional fees, surcharges, or other costs which the person is obligated to pay as a
condition of licensure. The notice must:

(1) state the dollar amount of the additional costs; and

(2) clearly identify to the applicant the payment schedule of additional costs.

(g) The applicant must not be under license suspension or revocation by the
licensing board of the state or jurisdiction in which the conduct that caused the suspension
or revocation occurred.

(h) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee, or have been subject to disciplinary action other than as specified in
paragraph (g). If the applicant does not satisfy the requirements stated in this paragraph,
the board may issue a license only on the applicant's showing that the public will be
protected through issuance of a license with conditions and limitations the board considers
appropriate.

(i) If the examination in paragraph (c) was passed more than ten years ago, the
applicant must either:

(1) pass the special purpose examination of the Federation of State Medical Boards
with a score of 75 or better within three attempts; or

(2) have a current certification by a specialty board of the American Board of
Medical Specialties, of the American Osteopathic Association deleted text begin Bureau of Professional
deleted text end deleted text begin Education deleted text end , the Royal College of Physicians and Surgeons of Canada, or of the College
of Family Physicians of Canada.

Sec. 4.

Minnesota Statutes 2014, section 147.03, subdivision 1, is amended to read:

Subdivision 1.

Endorsement; reciprocity.

(a) The board may issue a license to
practice medicine to any person who satisfies the requirements in paragraphs (b) to (f).

(b) The applicant shall satisfy all the requirements established in section 147.02,
subdivision 1, paragraphs (a), (b), (d), (e), and (f).

(c) The applicant shall:

(1) have passed an examination prepared and graded by the Federation of State
Medical Boards, the National Board of Medical Examiners, or the United States Medical
Licensing Examination (USMLE) program in accordance with section 147.02, subdivision
1, paragraph (c), clause (2); the National Board of Osteopathic new text begin Medical new text end Examiners; or the
Medical Council of Canada; and

(2) have a current license from the equivalent licensing agency in another state or
Canada and, if the examination in clause (1) was passed more than ten years ago, either:

(i) pass the Special Purpose Examination of the Federation of State Medical Boards
with a score of 75 or better within three attempts; or

(ii) have a current certification by a specialty board of the American Board of
Medical Specialties, of the American Osteopathic Association deleted text begin Bureau of Professional
Education deleted text end , the Royal College of Physicians and Surgeons of Canada, or of the College of
Family Physicians of Canada; or

(3) if the applicant fails to meet the requirement established in section 147.02,
subdivision 1, paragraph (c), clause (2), because the applicant failed to pass each of steps
one, two, and three of the USMLE within the required three attempts, the applicant may
be granted a license provided the applicant:

(i) has passed each of steps one, two, and three with passing scores as recommended
by the USMLE program within no more than four attempts for any of the three steps;

(ii) is currently licensed in another state; and

(iii) has current certification by a specialty board of the American Board of Medical
Specialties, the American Osteopathic Association Bureau of Professional Education, the
Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians
of Canada.

(d) The applicant shall pay a fee established by the board by rule. The fee may
not be refunded.

(e) The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or
revocation occurred.

(f) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee, or have been subject to disciplinary action other than as specified in
paragraph (e). If an applicant does not satisfy the requirements stated in this paragraph, the
board may issue a license only on the applicant's showing that the public will be protected
through issuance of a license with conditions or limitations the board considers appropriate.

(g) Upon the request of an applicant, the board may conduct the final interview of
the applicant by teleconference.

Sec. 5.

Minnesota Statutes 2014, section 147.037, subdivision 1, is amended to read:

Subdivision 1.

Requirements.

The board shall issue a license to practice medicine
to any person who satisfies the requirements in paragraphs (a) to (g).

(a) The applicant shall satisfy all the requirements established in section 147.02,
subdivision 1, paragraphs (a), (e), (f), (g), and (h).

(b) The applicant shall present evidence satisfactory to the board that the applicant
is a graduate of a medical or osteopathic school approved by the board as equivalent
to accredited United States or Canadian schools based upon its faculty, curriculum,
facilities, accreditation, or other relevant data. If the applicant is a graduate of a medical or
osteopathic program that is not accredited by the Liaison Committee for Medical Education
or the American Osteopathic Association, the applicant may use the Federation of State
Medical Boards' Federation Credentials Verification Service (FCVS) or its successor. If
the applicant uses this service as allowed under this paragraph, the physician application
fee may be less than $200 but must not exceed the cost of administering this paragraph.

(c) The applicant shall present evidence satisfactory to the board that the applicant
has been awarded a certificate by the Educational Council for Foreign Medical Graduates,
and the applicant has a working ability in the English language sufficient to communicate
with patients and physicians and to engage in the practice of medicine.

(d) The applicant shall present evidence satisfactory to the board of the completion
of two years of graduate, clinical medical training in a program located in the United
States, its territories, or Canada and accredited by a national accrediting organization
approved by the board. This requirement does not apply:

(1) to an applicant who is admitted as a permanent immigrant to the United States on
or before October 1, 1991, as a person of exceptional ability in the sciences according to
Code of Federal Regulations, title 20, section 656.22(d);

(2) to an applicant holding a valid license to practice medicine in another country
and issued a permanent immigrant visa after October 1, 1991, as a person of extraordinary
ability in the field of science or as an outstanding professor or researcher according to
Code of Federal Regulations, title 8, section 204.5(h) and (i), or a temporary nonimmigrant
visa as a person of extraordinary ability in the field of science according to Code of
Federal Regulations, title 8, section 214.2(o),

provided that a person under clause (1) or (2) is admitted pursuant to rules of the United
States Department of Labor; or

(3) to an applicant who is licensed in another state, has practiced five years without
disciplinary action in the United States, its territories, or Canada, has completed one year
of the graduate, clinical medical training required by this paragraph, and has passed the
Special Purpose Examination of the Federation of State Medical Boards within three
attempts in the 24 months before licensing.

(e) The applicant must:

(1) have passed an examination prepared and graded by the Federation of State
Medical Boards, the United States Medical Licensing Examination program in accordance
with section 147.02, subdivision 1, paragraph (c), clause (2), or the Medical Council
of Canada; and

(2) have a current license from the equivalent licensing agency in another state or
country and, if the examination in clause (1) was passed more than ten years ago, either:

(i) pass the Special Purpose Examination of the Federation of State Medical Boards
with a score of 75 or better within three attempts; or

(ii) have a current certification by a specialty board of the American Board of
Medical Specialties, of the American Osteopathic Association deleted text begin Bureau of Professional
Education deleted text end , of the Royal College of Physicians and Surgeons of Canada, or of the College
of Family Physicians of Canada; or

(3) if the applicant fails to meet the requirement established in section 147.02,
subdivision 1, paragraph (c), clause (2), because the applicant failed to pass each of steps
one, two, and three of the USMLE within the required three attempts, the applicant may
be granted a license provided the applicant:

(i) has passed each of steps one, two, and three with passing scores as recommended
by the USMLE program within no more than four attempts for any of the three steps;

(ii) is currently licensed in another state; and

(iii) has current certification by a specialty board of the American Board of Medical
Specialties, the American Osteopathic Association deleted text begin Bureau of Professional Education deleted text end , the
Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians
of Canada.

(f) The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or
revocation occurred.

(g) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee, or have been subject to disciplinary action other than as specified in
paragraph (f). If an applicant does not satisfy the requirements stated in this paragraph, the
board may issue a license only on the applicant's showing that the public will be protected
through issuance of a license with conditions or limitations the board considers appropriate.

Sec. 6.

Minnesota Statutes 2014, section 147.091, subdivision 1, is amended to read:

Subdivision 1.

Grounds listed.

The board may refuse to grant a license, may
refuse to grant registration to perform interstate telemedicine services, or may impose
disciplinary action as described in section 147.141 against any physician. The following
conduct is prohibited and is grounds for disciplinary action:

(a) Failure to demonstrate the qualifications or satisfy the requirements for a license
contained in this chapter or rules of the board. The burden of proof shall be upon the
applicant to demonstrate such qualifications or satisfaction of such requirements.

(b) Obtaining a license by fraud or cheating, or attempting to subvert the licensing
examination process. Conduct which subverts or attempts to subvert the licensing
examination process includes, but is not limited to: (1) conduct which violates the
security of the examination materials, such as removing examination materials from the
examination room or having unauthorized possession of any portion of a future, current, or
previously administered licensing examination; (2) conduct which violates the standard of
test administration, such as communicating with another examinee during administration
of the examination, copying another examinee's answers, permitting another examinee
to copy one's answers, or possessing unauthorized materials; or (3) impersonating an
examinee or permitting an impersonator to take the examination on one's own behalf.

(c) Conviction, during the previous five years, of a felony reasonably related to the
practice of medicine or osteopathy. Conviction as used in this subdivision shall include
a conviction of an offense which if committed in this state would be deemed a felony
without regard to its designation elsewhere, or a criminal proceeding where a finding or
verdict of guilt is made or returned but the adjudication of guilt is either withheld or
not entered thereon.

(d) Revocation, suspension, restriction, limitation, or other disciplinary action
against the person's medical license in another state or jurisdiction, failure to report to the
board that charges regarding the person's license have been brought in another state or
jurisdiction, or having been refused a license by any other state or jurisdiction.

(e) Advertising which is false or misleading, which violates any rule of the board,
or which claims without substantiation the positive cure of any disease, or professional
superiority to or greater skill than that possessed by another physician.

(f) Violating a rule promulgated by the board or an order of the board, a state, or
federal law which relates to the practice of medicine, or in part regulates the practice of
medicine including without limitation sections 604.201, 609.344, and 609.345, or a state
or federal narcotics or controlled substance law.

(g) Engaging in any unethical conduct; conduct likely to deceive, defraud, or harm
the public, or demonstrating a willful or careless disregard for the health, welfare or safety
of a patient; or medical practice which is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof
of actual injury need not be established.

(h) Failure to supervise a physician assistant or failure to supervise a physician
under any agreement with the board.

(i) Aiding or abetting an unlicensed person in the practice of medicine, except that
it is not a violation of this paragraph for a physician to employ, supervise, or delegate
functions to a qualified person who may or may not be required to obtain a license or
registration to provide health services if that person is practicing within the scope of that
person's license or registration or delegated authority.

(j) Adjudication as mentally incompetent, mentally ill or developmentally disabled,
or as a chemically dependent person, a person dangerous to the public, a sexually
dangerous person, or a person who has a sexual psychopathic personality by a court of
competent jurisdiction, within or without this state. Such adjudication shall automatically
suspend a license for the duration thereof unless the board orders otherwise.

(k) Engaging in unprofessional conduct. Unprofessional conduct shall include
any departure from or the failure to conform to the minimal standards of acceptable
and prevailing medical practice in which proceeding actual injury to a patient need not
be established.

(l) Inability to practice medicine with reasonable skill and safety to patients by
reason of illness, drunkenness, use of drugs, narcotics, chemicals or any other type of
material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills.

(m) Revealing a privileged communication from or relating to a patient except when
otherwise required or permitted by law.

(n) Failure by a doctor of deleted text begin osteopathy deleted text end new text begin osteopathic medicine new text end to identify the school
of healing in the professional use of the doctor's name by one of the following terms:
osteopathic physician and surgeon, doctor of osteopathy, or D.O.

(o) Improper management of medical records, including failure to maintain adequate
medical records, to comply with a patient's request made pursuant to sections 144.291 to
144.298 or to furnish a medical record or report required by law.

(p) Fee splitting, including without limitation:

(1) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
or remuneration, directly or indirectly, primarily for the referral of patients or the
prescription of drugs or devices;

(2) dividing fees with another physician or a professional corporation, unless the
division is in proportion to the services provided and the responsibility assumed by each
professional and the physician has disclosed the terms of the division;

(3) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the referring physician has a "financial or economic interest," as defined
in section 144.6521, subdivision 3, unless the physician has disclosed the physician's
financial or economic interest in accordance with section 144.6521; and

(4) dispensing for profit any drug or device, unless the physician has disclosed the
physician's own profit interest.

The physician must make the disclosures required in this clause in advance and in writing
to the patient and must include in the disclosure a statement that the patient is free to
choose a different health care provider. This clause does not apply to the distribution
of revenues from a partnership, group practice, nonprofit corporation, or professional
corporation to its partners, shareholders, members, or employees if the revenues consist
only of fees for services performed by the physician or under a physician's direct
supervision, or to the division or distribution of prepaid or capitated health care premiums,
or fee-for-service withhold amounts paid under contracts established under other state law.

(q) Engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws.

(r) Becoming addicted or habituated to a drug or intoxicant.

(s) Prescribing a drug or device for other than medically accepted therapeutic or
experimental or investigative purposes authorized by a state or federal agency or referring
a patient to any health care provider as defined in sections 144.291 to 144.298 for services
or tests not medically indicated at the time of referral.

(t) Engaging in conduct with a patient which is sexual or may reasonably be
interpreted by the patient as sexual, or in any verbal behavior which is seductive or
sexually demeaning to a patient.

(u) Failure to make reports as required by section 147.111 or to cooperate with an
investigation of the board as required by section 147.131.

(v) Knowingly providing false or misleading information that is directly related
to the care of that patient unless done for an accepted therapeutic purpose such as the
administration of a placebo.

(w) Aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:

(1) a copy of the record of criminal conviction or plea of guilty for a felony in
violation of section 609.215, subdivision 1 or 2;

(2) a copy of the record of a judgment of contempt of court for violating an
injunction issued under section 609.215, subdivision 4;

(3) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or

(4) a finding by the board that the person violated section 609.215, subdivision
1 or 2. The board shall investigate any complaint of a violation of section 609.215,
subdivision 1 or 2.

(x) Practice of a board-regulated profession under lapsed or nonrenewed credentials.

(y) Failure to repay a state or federally secured student loan in accordance with
the provisions of the loan.

(z) Providing interstate telemedicine services other than according to section 147.032.

Sec. 7. new text begin REVISOR'S INSTRUCTION.
new text end

new text begin The revisor of statutes shall change the terms "osteopath" to "osteopathic physician"
and "osteopathy" to "osteopathic medicine" whenever they appear in Minnesota Statutes
and Minnesota Rules. The revisor of statutes shall also make grammatical changes
related to these changes.
new text end