SENATE BILL REPORT

HB 1337

As Passed Senate - Amended, April 5, 2017

Title: An act relating to the interstate medical licensure compact.

Brief Description: Creating the interstate medical licensure compact.

Sponsors: Representatives Riccelli, Harris, Cody, Jinkins, Tharinger, Robinson, Goodman, Ormsby and Ortiz-Self; by request of Washington State Medical Commission.

Brief History: Passed House: 2/15/17, 94-3.

Committee Activity: Health Care: 3/09/17, 3/09/17 [DP].

Floor Activity:

Passed Senate - Amended: 4/05/17, 40-7.

Majority Report: Do pass.

Signed by Senators Rivers, Chair; Becker, Vice Chair; Cleveland, Ranking Minority Member; Kuderer, Assistant Ranking Minority Member; Bailey, Conway, Keiser, Miloscia, Mullet and O'Ban.

Staff: Evan Klein (786-7483)

Background: Physician Licensure. The Medical Quality Assurance Commission (MQAC) is responsible for the licensure and discipline of physicians. To receive a Washington license to practice medicine, a physician must:

• graduate from a medical school within the United States or Canada;

• pass the United States Medication Licensing Examination (USMLE);

• complete two years of postgraduate medical training;

• have good moral character; and

• prove they maintain the ability to safely practice medicine.

Any applicant for licensure who meets the qualifications for licensure and has been licensed under the laws of another state, territory, or province of Canada may be granted a license without examination. In certain circumstances, MQAC may also issue limited licenses.

The Uniform Disciplinary Act governs the following:

• the unlicensed practice of medicine;

• the issuance and denial of licenses; and

• the discipline of licensees.

Osteopathic Physician Licensure. The Board of Osteopathic Medicine and Surgery (BOMS) is responsible for the licensure and discipline of physicians. To receive a Washington license to practice osteopathic medicine, an osteopathic physician must:

• graduate from an accredited school of osteopathic medicine;

• complete at least one year in a postgraduate training program;

• prove they maintain the ability to safely practice medicine;

• pass the Comprehensive Osteopathic Medical Licensing Examination (COMLEX); and

• prove they have not been guilty of any conduct that would constitute grounds for denial or revocation of a license.

The Uniform Disciplinary Act governs the following:

• the unlicensed practice of osteopathic medicine;

• the issuance and denial of licenses; and

• the discipline of licensees.

Interstate Medical Licensure Compact. The Compact is a proposal to create a system for expediting the licensure of physicians already licensed by another state. States must enact model legislation in order to adopt the Compact and become a member to the licensure agreement. As of December 2016, the Interstate Medical Licensure Compact Commission (Interstate Commission) has adopted final rules. As of January 2016, 18 states have enacted the Compact and become party to the agreement.

Summary of Bill: The Compact is adopted by Washington State.

Interstate Medical Licensure Compact Commission. An Interstate Commission is created to administer the Compact. The Interstate Commission consists of two voting members from each member state, one allopathic physician and one osteopathic physician. The Interstate Commission is given general powers and duties, finance powers, authority to elect officers, rule-making functions, enforcement powers, and dispute resolution authorities.

MQAC is required to adopt rules of the Interstate Commission before Washington becomes subject to the rule. Rules must not violate any right guaranteed by the state or United States Constitution.

Physician Eligibility. To be eligible to receive an expedited license under the Compact, a physician must:

• possess a full and unrestricted license to practice medicine in a Compact state;

• possess specialty certification or be in possession of a time unlimited specialty certificate;

• have no discipline on any state medical license;

• have no discipline related to controlled substances;

• not be under investigation by any licensing or law enforcement agency;

• have passed the USMLE or COMLEX within three attempts; and

• have successfully completed a graduate medical education (GME) program.

Physician Licensure. A physician must designate a state that is party to the Compact as the physician's principal state of licensure. A physician seeking licensure through the Compact must file an application for an expedited license with the medical board of the state selected by the physician as the state of principle licensure. The principal state's medical board, in the process of verifying eligibility, shall perform a criminal background check. The principal state, after determining eligibility, shall report a physician's eligibility status to the Interstate Commission. Physicians may then register for expedited licensure in any member state. After receiving verification of eligibility from the Interstate Commission and any applicable fees, a member state must then issue an expedited license to the physician. The license remains valid for a period consistent with the licensure period for the member state. If a physician fails to maintain a license in the state of principal licensure, then all of their expedited licenses are terminated. The Interstate Commission may impose a fee for a license issued or renewed through the Compact.

Licensure Renewal. A physician seeking to renew an expedited license must:

• maintain a full and unrestricted license in the state of principal licensure;

• have not been convicted of any offense by a court of appropriate jurisdiction;

• have not had a license to practice medicine subjected to discipline; and

• have not had a controlled substances license suspended or revoked.

Physicians must comply with the continuing education requirements for renewal of their license in that member state.

Physician Discipline. The Interstate Commission must establish a database of all physicians licensed under the Compact. Member medical boards must report disciplinary and investigatory complaints to the Interstate Commission. Member boards may jointly investigate physician records as part of disciplinary proceedings under the Compact. Disciplinary action taken by any member board against a physician under the Compact may subject the physician to discipline by other member boards in states for which they are licensed. If a license granted to a physician by a member board is revoked or suspended, any licenses issued to the physician by any other member boards shall be suspended for 90 days to permit the member board time to investigate. If the member board for the physician's principal state of licensure revokes or suspends the physician's license, the licenses issued to the physician by other member boards shall automatically be placed on the same status.

Costs. The costs of the operations and activities of health professions licensure compacts must be borne by those who hold licenses issued under the compacts, rather than the state or the licensing authorities.

Effective Date. The Compact takes effect and becomes binding upon legislative enactment of the compact into law by no less than seven states.

Appropriation: None.

Fiscal Note: Available.

Creates Committee/Commission/Task Force that includes Legislative members: No.

Effective Date: Ninety days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony: PRO: This bill would make it easier for physicians to practice in Washington and to use telemedicine. The participation in the Compact is voluntary. Telemedicine will allow Washington to bring more doctors online faster, and the Compact assists with that. The consultant required to facilitate the Compact would be borne by the cost of the Compact, and would be an employee of the Department of Health. There has been a 30 percent increase in medical licensure applications, and this bill would help streamline the process of processing applications. The Compact does not alter the Medical Practice Act. Physicians are already applying for licensure across state lines, and this just expedites licensure. This bill will help encourage more physicians to participate in telemedicine. Many physicians at Harborview treat patients from other states. However, once those patients leave to go home, the physicians at Harborview have to work with physicians from other states to continue treatment of their patients.

Persons Testifying: PRO: Representative Marcus Riccelli, Prime Sponsor; Kathryn Kolan, Washington State Medical Association; Ian Goodhew, UW Medicine; Micah Matthews, WA State Medical Commission.

Persons Signed In To Testify But Not Testifying: No one.