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AB-359 Physicians and surgeons: licensure: examination.(2021-2022)

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Date Published: 03/22/2021 09:00 PM
AB359:v98#DOCUMENT

Amended  IN  Assembly  March 22, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 359


Introduced by Assembly Member Cooper
(Principal coauthor: Assembly Member Smith)

February 01, 2021


An act to amend Section 2177 Sections 2177 and 2190.1 of the Business and Professions Code, relating to healing arts, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


AB 359, as amended, Cooper. Physicians and surgeons: licensure: examination.
Existing law, the Medical Practice Act, requires the Medical Board of California to issue a physician’s and surgeon’s certificate to a qualified applicant. Under the act, an applicant for a physician’s and surgeon’s certificate is required to include specified information in the application and to obtain a passing score on an entire examination or on each part of an examination. Existing law requires an applicant to obtain a passing score on all parts of Step 3 of the United States Medical Licensing Examination within not more than 4 attempts in order to be eligible for a certificate. Existing law provides an exception to the 4-attempt requirement for an applicant who holds an unlimited and unrestricted license as a physician and surgeon in another state, and has held that license continuously for a minimum of 4 years prior to the date of application, meets certain postgraduate training requirements and is certified by a specialty board, and is not subject to specified licensure denials or disciplinary action.
This bill would eliminate the exception described above and would instead establish an exception for an applicant who holds an unrestricted license as a physician and surgeon in another state, if the board makes prescribed determinations with regard to the applicant.
Existing law requires a physician and surgeon to demonstrate satisfaction of continuing education requirements and requires the board to adopt and administer standards for continuing education for licensees. Under existing law, these continuing medical education (CME) standards may be met by educational activities that meet the standards of the board and that serve to maintain, develop, or increase the knowledge, skills, and professional performance that a physician and surgeon uses to provide care, or to improve the quality of care provided to patients. Existing law specifically authorizes educational activities with specified content or curriculum. Existing law prohibits educational activities that are not directed toward the practice of medicine, or are directed primarily toward the business aspects of medical practice, from being deemed to meet the standards.
This bill would revise these standards provisions to authorize CME standards to be met by educational activities that meet the standards of the board and that serve to maintain, develop, or increase the knowledge, skills, and professional performance via educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician and surgeon uses to provide care, to provide services for patients, the public, or the profession, or to improve the quality of care provided to patients. The bill would authorize educational activities that promote recommendations, treatment, or manners of practicing medicine with specified content or curriculum, and expand that content to include content relating to improved practice management, health care facility management, and medical school teaching, as described. The bill would delete the provision limiting educational activities not directed toward the practice of medicine, or directed primarily toward the business aspects of medicine, and, instead, prohibit deeming educational activities that are not consistent with the revised standards provisions to meet the continuing medical education standards for licensed physicians and surgeons.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 2177 of the Business and Professions Code is amended to read:

2177.
 (a) A passing score is required for an entire examination or for each part of an examination, as established by resolution of the board.
(b) Applicants may elect to take the written examinations conducted or accepted by the board in separate parts.
(c) (1) An applicant shall have obtained a passing score on all parts of Step 3 of the United States Medical Licensing Examination within not more than four attempts in order to be eligible for a physician’s and surgeon’s certificate.
(2) Paragraph (1) shall not apply to an applicant for a physician’s and surgeon’s certificate who holds an unrestricted license as a physician and surgeon in another state, if the board determines that no disciplinary action has been taken against the applicant by any medical licensing authority and that the applicant has not been the subject of adverse judgments or settlements resulting from the practice of medicine that the board determines constitutes evidence of a pattern of negligence or incompetence.

SEC. 2.

 Section 2190.1 of the Business and Professions Code is amended to read:

2190.1.
 (a) The continuing medical education standards of Section 2190 may be met by educational activities that meet the standards of the board and that serve to maintain, develop, or increase the knowledge, skills, and professional performance performance, via educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships, that a physician and surgeon uses to provide care, to provide services for patients, the public, or the profession, or to improve the quality of care provided to patients. These may include, but are not limited to, educational activities that promote recommendations, treatment, or manners of practicing medicine that meet any of the following criteria:
(1) Have a scientific or clinical content with a direct bearing on the quality or cost-effective provision of patient care, community or public health, or preventive medicine.
(2) Concern quality assurance or improvement, risk management, health facility standards, or the legal aspects of clinical medicine.
(3) Concern bioethics or professional ethics.
(4) Are designed to improve the physician-patient relationship.
(5) Have practice management content designed to provide better service to patients, including, but not limited to, the use of technology or clinical office workflow.
(6) Have management content designed to support managing a health care facility, including, but not limited to, coding or reimbursement in a medical practice.
(7) Support educational methodology for physicians and surgeons teaching in a medical school.
(b) (1) On and after July 1, 2006, all continuing medical education courses shall contain curriculum that includes cultural and linguistic competency in the practice of medicine.
(2) Notwithstanding the provisions of paragraph (1), a continuing medical education course dedicated solely to research or other issues that does not include a direct patient care component or a course offered by a continuing medical education provider that is not located in this state is not required to contain curriculum that includes cultural and linguistic competency in the practice of medicine.
(3) Associations that accredit continuing medical education courses shall develop standards before July 1, 2006, for compliance with the requirements of paragraph (1). The associations may update these standards, as needed, in conjunction with an advisory group that has expertise in cultural and linguistic competency issues.
(4) A physician and surgeon who completes a continuing education course meeting the standards developed pursuant to paragraph (3) satisfies the continuing education requirement for cultural and linguistic competency.
(c) In order to satisfy the requirements of subdivision (b), continuing medical education courses shall address at least one or a combination of the following:
(1) Cultural competency. For the purposes of this section, “cultural competency” means a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities. At a minimum, cultural competency is recommended to include the following:
(A) Applying linguistic skills to communicate effectively with the target population.
(B) Utilizing cultural information to establish therapeutic relationships.
(C) Eliciting and incorporating pertinent cultural data in diagnosis and treatment.
(D) Understanding and applying cultural and ethnic data to the process of clinical care, including, as appropriate, information pertinent to the appropriate treatment of, and provision of care to, the lesbian, gay, bisexual, transgender, and intersex communities.
(2) Linguistic competency. For the purposes of this section, “linguistic competency” means the ability of a physician and surgeon to provide patients who do not speak English or who have limited ability to speak English, direct communication in the patient’s primary language.
(3) A review and explanation of relevant federal and state laws and regulations regarding linguistic access, including, but not limited to, the federal Civil Rights Act (42 U.S.C. Sec. 1981 et seq.), Executive Order 13166 of August 11, 2000, of the President of the United States, and the Dymally-Alatorre Bilingual Services Act (Chapter 17.5 (commencing with Section 7290) of Division 7 of Title 1 of the Government Code).
(d) (1) On and after January 1, 2022, all continuing medical education courses shall contain curriculum that includes the understanding of implicit bias.
(2) Notwithstanding the provisions of paragraph (1), a continuing medical education course dedicated solely to research or other issues that does not include a direct patient care component or a course offered by a continuing medical education provider that is not located in this state is not required to contain curriculum that includes implicit bias in the practice of medicine.
(3) Associations that accredit continuing medical education courses shall develop standards before January 1, 2022, for compliance with the requirements of paragraph (1). The associations may update these standards, as needed, in conjunction with an advisory group established by the association that has expertise in the understanding of implicit bias.
(e) In order to satisfy the requirements of subdivision (d), continuing medical education courses shall address at least one or a combination of the following:
(1) Examples of how implicit bias affects perceptions and treatment decisions of physicians and surgeons, leading to disparities in health outcomes.
(2) Strategies to address how unintended biases in decisionmaking may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or other characteristics.
(f) Notwithstanding subdivision (a), educational Educational activities that are not directed toward the practice of medicine, or are directed primarily toward the business aspects of medical practice, including, but not limited to, medical office management, billing and coding, and marketing consistent with subdivision (a) shall not be deemed to meet the continuing medical education standards for licensed physicians and surgeons.
(g) Educational activities that meet the content standards set forth in this section and are accredited by the California Medical Association or the Accreditation Council for Continuing Medical Education may be deemed by the Division of Licensing board to meet its continuing medical education standards.

SEC. 2.SEC. 3.

 This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
California is currently in a declared state of emergency due to the COVID-19 pandemic. This is alarming, as California has a shortage of licensed physicians, as evidenced by the recent passage of AB 890 in 2020, which removes the physician supervision requirement for nurse practitioners, and the publication by the Emergency Medical Services Authority of a memorandum permitting physicians licensed in other states to practice medicine in California.
To immediately increase the number of licensed medical doctors (MDs) practicing in California, by adjusting the reciprocity statutes that govern the entry of out-of-state MDs into our state, making them consistent with the reciprocity statutes that already apply to other independent, out-of-state health care practitioners, like Doctors of Osteopathy, and to expand continuing medical education course offerings for improved practice management, health care facility management, and medical school teaching as soon as possible, it is necessary for this act to take immediate effect.