Amendment 9

Amendment ID: S2856-9

Amendment 9

Improving Healthcare delivery for underserved residents of the Commonwealth

Messrs. Tarr and O'Connor move that the proposed new text be amended by adding at the end thereof the following section:-

"SECTION XX. Chapter 112 of the General Laws, as appearing in the 2022 Official Edition, is hereby amended by striking out section 9, and inserting in place thereof the following section:-

Section 9. (a) An applicant for limited registration under this section may, upon payment of a fee to be determined annually by the secretary of administration and finance under section 3B of chapter 7, be registered by the board as an intern, fellow or medical officer for such time as it may subscribe if the applicant furnishes the board with satisfactory proof of the following:

(i) The applicant is at least 18 years of age and of good moral character.

(ii) (1) The applicant has creditably completed 2 years of a premedical course of study at an accredited college or university and not less than 3 ½ years of study in a legally chartered medical school having the power to grant degrees in medicine; or (2) if not enrolled in or a graduate of a legally chartered medical school in the United States or Canada, the applicant is the holder of a standard certificate granted after an examination by the Education Council for Foreign Medical Graduates, unless granted an exemption by the board; or (3) the applicant has completed a minimum of 2 years of premedical education at an accredited college or university of the United States, Canada or Puerto Rico and if the applican131t has studied medicine in a medical school outside the United States, Canada or Puerto Rico that is recognized by the World Health Organization, has completed all the formal requirements for the degree corresponding to doctor of medicine, except internship and social service and has completed 1 year of clinical clerkship approved by the liaison committee on medical education of the American Medical Association.

(iii) The applicant has been appointed as an intern, fellow or medical officer in a hospital or other institution of the commonwealth, or of a county or municipality thereof; or in a hospital or clinic which is incorporated under the laws of the commonwealth or in a clinic which is affiliated with a hospital licensed by the department of public health under authority of section 71 of chapter 111; or in an outpatient clinic operated by the department of mental health; or in the department of public health for duty in clinics or in programs operated or approved by the department of public health; or in programs approved by the board of registration in medicine in the commonwealth and leading toward certification by specialty boards recognized by the American Medical Association.

(iv) The applicant has applied to participate in the medical assistance program administered by the secretary of health and human services in accordance with chapter 118E and Title XIX of the Social Security Act and any federal demonstration or waiver relating to the medical assistance program for the limited purpose of ordering and referring services covered under the program if regulations governing such limited participation are promulgated under section 37 of chapter 118E.

Such limited registration shall entitle the applicant to practice medicine only in the hospital, institution, clinic or program designated on the applicant’s certificate of limited registration, or outside such hospital, institution, clinic or program for the treatment, under the supervision of one of its medical officers who is a duly registered physician, of persons accepted by such hospital, institution, clinic or program as patients, or in any hospital, institution, clinic or program affiliated for training purposes with the hospital, institution, clinic or program designated on such certificate, which affiliation is approved by the board and in any case under regulations established by such hospital, institution, clinic or program. The name of any hospital, institution, clinic or program so affiliated and so approved shall also be indicated on such certificate. Limited registration under this section may be revoked at any time by the board.

(b) Notwithstanding the other provisions of this section, an internationally-trained physician who has been licensed or is otherwise authorized to practice medicine in a country other than the United States shall be eligible to apply for a limited license to practice medicine for a renewable 1-year term after satisfying the criteria in below paragraph (iii), provided, however, that such limited registration shall provide a pathway for the issuance of a full unrestricted license to practice medicine in accordance with, and upon satisfaction of, the criteria in below paragraph (v).

(i) Definitions. For the purposes of this subsection, the following terms shall have the following meanings, unless the context clearly requires otherwise:-

“Commission”, the Educational Commission for Foreign Medical Graduates.

“Internationally-trained physician”, a physician who has received a degree of doctor of medicine or its equivalent from a legally chartered medical school outside the United States recognized by the World Health Organization, who has been licensed or otherwise authorized to practice medicine in a country other than the United States, and who has practiced medicine for at least one year.

“Licensing Exam”, the United States Medical Licensing Examination.

“Massachusetts physician shortage area”, a geographic region or population in the commonwealth experiencing a shortage of physicians, especially primary care physicians or psychiatrists, relative to population and need.

“Participating healthcare facility”, a federally-qualified health center, community health center, hospital or other healthcare facility approved by the board that provides an assessment and evaluation program designed to develop, assess and evaluate an internationally-trained physician’s non-clinical skills , according to criteria developed or approved by the board; provided, however, that the participating healthcare facility provides medical care in a Massachusetts physician shortage area.

(ii) For the purposes of this subsection, the Massachusetts health care workforce center or its equivalent in the department of public health shall assist the board in determining the regions or populations comprising a Massachusetts physician shortage area.

(iii) The board shall issue a limited license to an applicant if the participating facility and the applicant submit evidence acceptable to the board that the applicant:

(A) is an internationally trained physician;

(B) has a valid certificate issued by the commission or other credential evaluation service approved by the board, provided, however, that the board may waive such certification at its discretion where the applicant is unable to obtain the required documentation from a non-cooperating country;

(D) has entered into an agreement with the participating facility providing that the facility shall develop, assess and evaluate the applicant’s familiarity with non-clinical skills and standards appropriate for medical practice in the commonwealth, according to assessment and evaluation criteria developed or approved by the board;

(E) shall enter a full-time full employment relationship with the participating facility after the board issues a limited license to practice medicine to the applicant; and

(F) has satisfied other criteria that may be developed by the board in fulfillment of this subsection.

(iv) The 1-year limited license may not be renewed more than once.

(v) An internationally-trained physician who provides the board with proof of (A) successful completion of the participating facility’s assessment and evaluation program, (B) a passing score on Step 3 of the Licensing Exam and (C) any additional prerequisites that the board may require, shall be eligible to apply for a renewable 2-year restricted license to practice medicine only in a Massachusetts physician shortage area designated by the board; provided, however, that any additional prerequisites for eligibility shall not include post-graduate clinical training, and that the restricted license shall authorize the holder to practice independently in a primary care specialty, psychiatry or other specialty approved by the board. After 2 years of restricted practice, the internationally-trained physician shall be eligible to apply for a full, unrestricted license to practice medicine. The 2-year restricted license may not be renewed more than once."