2016 -- H 7357

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LC004166

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS - TRAINING ON DRUG ADDICTION

RISK

     Introduced By: Representatives McNamara, Bennett, and Lancia

     Date Introduced: January 28, 2016

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

     SECTION 1. Section 5-37-2 of the General Laws in Chapter 5-37 entitled "Board of

Medical Licensure and Discipline" is hereby amended to read as follows:

     5-37-2. License to practice – Qualifications of applicants – Fee – Reexamination. –

(a)(1) Authority to practice allopathic or osteopathic medicine under this chapter shall be by a

license issued by the director of the department of health to any reputable physician who intends

to practice allopathic or osteopathic medicine in this state, and who meets the requirements for

licensure established in this chapter and regulations established by the board or by the director.

Applicants for licensure shall present satisfactory evidence of graduation from a medical school

or school of osteopathic medicine approved by the board and in good standing, shall meet post

graduate training requirements and any other requirements that the board or director establishes

by regulation, and shall pass in a satisfactory manner any examination that the board may require.

Any physician applying for licensure shall pay a non refundable application fee and when

applicable a reexamination fee for each reexamination, in a total amount as set forth in § 23-1-54.

     (2) A license to practice allopathic medicine shall be issued to persons who have

graduated from a school of medicine, possess a degree of doctor of medicine (or meet the

requirements of subsection (b) of this section), and meet the requirements for licensure.

     (3) A license to practice osteopathic medicine shall be issued to persons who have

graduated from a school of osteopathic medicine and possess a degree of doctor of osteopathy

and otherwise meet the requirements for licensure. A license to practice osteopathic medicine

shall confer upon the holder the right to practice osteopathic medicine in all its branches as taught

and practiced in accredited colleges of osteopathic medicine. The holder of that license shall be

subject to the same duties and liabilities and entitled to the same rights and privileges, which may

be imposed by law or governmental regulation, upon physicians of any school of medicine.

     (b)(1) Qualification of Certain Other Applicants for License. Notwithstanding any other

provisions of this section an individual, who at the time of his or her enrollment in a medical

school outside the United States is a citizen of the United States, shall be eligible to apply for a

certificate pursuant to this section if he or she has satisfied the following requirements:

     (i) Has studied medicine in a medical school located outside the United States, which is

recognized by the World Health Organization;

     (ii) Has completed all of the formal requirements of the foreign medical school except

internship and/or social service;

     (iii) Has attained a score satisfactory to a medical school approved by the liaison

committee on medical education on a qualifying examination acceptable to the state board for

medicine, and has satisfactorily completed one academic year of supervised clinical training

under the direction of any United States medical school;

     (iv) Has completed the post-graduate hospital training required by the board of applicants

for licensure; and

     (v) Has passed the examination required by the board of all applicants for licensure.; and

     (2) Satisfaction of the requirements of subdivision (1) of this subsection is in lieu of the

completion of any foreign internship and/or social service requirements, and no such

requirements are a condition of licensure as a physician in this state.

     (3) Satisfaction of the requirements of subdivision (1) of this subsection is in lieu of

certification by the educational council for foreign medical graduates, and this certification is not

a condition of licensure as a physician in this state.

     (4) No hospital licensed by this state, or operated by the state or a political subdivision of

the state, or which receives state financial assistance, directly or indirectly, requires an individual,

who at the time of his or her enrollment in a medical school outside the United States is a citizen

of the United States, to satisfy any requirements other than those contained in paragraphs (1)(i),

(ii), and (iii) of this subsection prior to commencing an internship or residency.

     (5) A document granted by a medical school located outside the United States which is

recognized by the World Health Organization issued after the completion of all the formal

requirements of that foreign medical school except internship and/or social service, upon

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certification by the medical school in which this training was received of satisfactory completion

by the person to whom this document was issued of the requirements in paragraph (1)(iii) of this

subsection, shall be deemed the equivalent of a degree of doctor of medicine for purposes of

licensure and practice as a physician in this state.

     (6) No funds appropriated by the general assembly to any school or college of medicine

shall be disbursed until the director of the department of health has certified that this school or

college has established, and will maintain until December 31, 1989, a clinical training program as

contemplated by paragraph (1)(iii) of this subsection, to accommodate residents of this state

deemed qualified by that school or college of medicine consistent with that school's or college's

educational resources.

     (c) Any individual licensed under subsections (a) or (b) of this section shall be required to

complete and provide evidence of completion of at least five (5) hours of training every two (2)

years on the risks of addiction associated with medications prescribed for pain management as a

condition of the renewal of any license.

     (d) Any individual licensed under subsections (a) or (b) of this section, who prescribes

controlled substances, shall complete eight (8) hours of training to qualify for a waiver to

prescribe and dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA

2000), Title XXXV, Section 3502 of the Children's Health Act of 2000, within four (4) years of

the physician's licensure under this chapter, or within four (4) years of the passage of this act,

whichever event occurs later in time. Completion of training to qualify for a waiver to prescribe

and dispense buprenorphine under DATA 2000 shall be in lieu of the training required by §5-37-

2(c) for the concurrent two (2) year period when the physician is undertaking the DATA 2000

training. Provided, a person who has already successfully completed the DATA 2000 training

shall not be required to repeat such training.

     SECTION 2. Section 5-35.1-2 in Chapter 5-35.1 entitled "Optometrists" is hereby

amended to read as follows:

     5-35.1-2. Qualifications to practice optometry. – (a) Every applicant for licensure shall

present satisfactory evidence in the form of affidavits properly sworn to that he or she;

     (1) is of good moral character; and

     (2) has graduated from a school or college or optometry which maintains a course in

optometry of not less than four (4) years and is approved by the accreditation council on

optometric education (ACOE) or other accrediting body as approved by the board; and

     (3) has successfully passed a national examination or other examinations approved by the

department and the board; and

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     (4) any other qualifications as may be established in rules and regulations promulgated by

the department.

      (b) Any individual licensed under subsection (a) of this section shall be required to

complete and provide evidence of completion of at least five (5) hours of training every two (2)

years on the risks of addiction associated with medications prescribed for pain management as a

condition of the renewal of any license.

     SECTION 3. Section 5-31.1-6 of the General Laws in Chapter 5-35.1 entitled "Dentists

and Dental Hygienists" is hereby amended to read as follows:

     5-31.1-6. License to practice – Qualifications of applicants – Fee – Reexamination. –

(a) Authority to practice dentistry or dental hygiene under this chapter is by a license, issued by

the director of the department of health, to any reputable dentist, dental hygienist or DAANCE-

certified maxillofacial surgery assistant who intends to practice dentistry, dental hygiene or

DAANCE-certified maxillofacial surgery assisting in this state, and who meets the requirements

for licensure prescribed in this chapter and regulations established by the board or the director.

     (b) Applicants for licensure as dentists shall:

     (1) Present satisfactory evidence of graduation from a school of dentistry accredited by

the American Dental Association Commission on Dental Accreditation, or its designated agency,

and approved by the board;

     (2) Meet any other requirements that the board or director by regulation establishes; and

     (3) Pass in a satisfactory manner any examinations that the board requires.; and

      (c) Applicants for licensure as dental hygienists shall:

     (1) Present satisfactory evidence of graduation from a school for dental hygiene

accredited by the American Dental Association Commission on Dental Auxiliary Accreditation or

its designated agency and approved by the board;

     (2) Meet any other requirements that the board or director by regulation establishes; and

     (3) Pass in a satisfactory manner any examination that the board requires.

     (d) Any dentist and any dental hygienist or DAANCE-certified maxillofacial surgery

assistant applying for licensure shall pay an application fee as set forth in § 23-1-54. Application

fees shall in no case be returned. Applicants requiring reexamination for dentistry, for dental

hygiene or for DAANCE-certified maxillofacial surgery assisting shall submit fees as set forth in

§ 23-1-54 for each reexamination.

     (e)(1) Notwithstanding any other provision of law, the board of dental examiners may

issue a special license to qualifying dentists and dental hygienists under the terms and conditions

set forth in this section and pursuant to requirements that may be set forth in the rules and

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regulations of the board. The special license may only be issued to a person who is retired from

the practice of dentistry or dental hygiene and not currently engaged in such practice either full-

time or part-time and has, prior to retirement, maintained full licensure in good standing in

dentistry or dental hygiene in any state.

     (2) The special licensee shall be permitted to practice dentistry or dental hygiene only in

the non-compensated employ of public agencies or institutions, not-for-profit agencies, not-for-

profit institutions, nonprofit corporations, or not-for-profit associations that provide dentistry or

dental hygiene services only to indigent patients in areas underserved by dentists or dental

hygienists or critical need population areas of the state.

     (3) The person applying for the special license under this section shall submit to the

board a notarized statement from the employing agency, institution, corporation, association, or

health care program, on a form prescribed by the board, whereby he or she agrees unequivocally

not to receive compensation for any dentistry or dental hygiene services he or she may render

while in possession of the special license.

     (4) Any application fees and all licensure and renewal fees shall be waived for the holder

of the special license under this section.

     (5) A dentist or dental hygienist licensed pursuant to this section shall comply with the

continuing education requirements established by the board of dental examiners in this state.

     (f) Applicants for licensure as certified maxillofacial surgical assistants shall:

     (1) Present satisfactory evidence of completion of the DAANCE oral surgery assistant

training course prepared and administered by the American Association of Oral and Maxillofacial

Surgeons or its designated agency and approved by the board;

     (2) Meet any other requirements that the board or director by regulation establishes;

     (3) Pass, in a satisfactory manner, any examination that the board requires; and

     (4) Complete a board of examiners in dentistry-approved advanced cardiac life support

course and current certification.

     (g) Any individual licensed under this section shall be required to complete and provide

evidence of completion of at least five (5) hours of training every two (2) years on the risks of

addiction associated with medications prescribed for pain management as a condition of the

renewal of any license.

     SECTION 4. Section 5-54-9 of the General Laws in Chapter 5-54 entitled "Physician

Assistants" is hereby amended to read as follows:

     5-54-9. Criteria for licensure as a physician assistant. – (a) The board shall

recommend to the director for licensure as a physician assistant an applicant who:

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     (1) Is of good character and reputation;

     (2) Graduated from a physician assistant training program certified by the AMA's

Committee on Allied Health, Education, and Accreditation, its successor, the Commission on

Accreditation of Allied Health Education Programs (CAAHEP), its successor or the Accreditation

Review Commission on Education for the Physician Assistant (ARC-PA) or its successor.;

     (3) Passed a certifying examination approved by the National Commission on

Certification of Physician Assistants or any other national certifying exam approved by the

board.;

     (4) Submitted a completed application together with the required fee as set forth in § 23-

1-54.

     (b) Any individual licensed under subsection (a) of this section shall be required to

complete and provide evidence of completion of at least five (5) hours of training every two (2)

years on the risks of addiction associated with medications prescribed for pain management as a

condition of the renewal of any license.

     SECTION 5. Section 5-29-6 of the General Laws in Chapter 5-29 entitled "Podiatrists" is

hereby amended to read as follows:

     5-29-6. Qualifications of applicants. -- (a) All persons subsequently desiring to

commence the practice of podiatry in this state shall apply to the division of professional

regulation for a license. Applicants for examination shall present to the division, at least thirty

(30) days before the commencement of the examination at which he or she is to be examined, a

written application on a form or forms provided by the division, together with satisfactory proof

that the applicant is more than eighteen (18) years of age, is of good moral character, has obtained

a certificate showing that the applicant before entering a school or college of podiatric medicine

and surgery had obtained an academic education consisting of at least three (3) years of study at a

duly recognized college or university. The applicant shall provide evidence of satisfactory

completion of a course of study in podiatric medicine approved and accredited by the council on

podiatric medical education of the American podiatric medical association.

      (b) The applicant shall provide evidence that the degree doctor of podiatric medicine was

conferred upon the applicant from the same college as was his or her course of study.

      (c) In addition to the above requirements the applicant shall provide evidence of

satisfactory completion of a minimum one year residency program as defined, recognized, and

accredited by the Council on podiatric medical education of the American Podiatric Medical

Association, and the program must have also been accredited by that body at the time of

residency participation.

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     (d) Any individual licensed under this section shall be required to complete and provide

evidence of completion of at least five (5) hours of training every two (2) years on the risks of

addiction associated with medications prescribed for pain management as a condition of the

renewal of any license.

     SECTION 6. Section 5-34-45 of the General Laws in Chapter 5-34 entitled "Nurses" is

hereby amended to read as follows:

     5-34-45. Licensure of APRNs. -- (a) An applicant for initial licensure to practice as an

APRN shall:

      (1) Submit a completed, written application and appropriate fees as established by the

board of nursing;

      (2) Hold a current RN license or privilege to practice and shall not hold an encumbered

license or privilege to practice as an RN in any state or territory;

      (3) Have completed an accredited graduate or post-graduate level APRN program in one

of the three roles (RNP, CRNA, or CNS) and at least one population focus;

      (4) Be currently certified by a national certifying body recognized by the board of

nursing in the APRN role and population foci appropriate to educational preparation;

      (5) Report any criminal conviction, nolo contendere plea, Alford plea, or other plea

arrangement in lieu of conviction;

      (6) Have committed no acts or omissions that are grounds for disciplinary action as set

forth in this chapter; and

      (7) Provide other evidence as required by regulation.

     (b) The board of nursing may issue an initial APRN license to clinical nurse specialists

without a certification exam when:

      (1) A national certification exam does not exist for the current population foci; and

      (2) The applicant has submitted a portfolio to the board of nursing that includes proof of

graduation; course descriptions; official transcript that includes courses in pharmacology,

pathophysiology and physical assessment; and letters of recommendation from his/her employer

attesting to the CNS's practice at the advanced-practice level.

      (c) After January 1, 2015, all clinical nurse specialists seeking initial licensure as an

APRN must meet all the criteria as stated in this chapter, including national certification in a role

and population foci recognized by the board of nursing.

      (d) The board of nursing may issue a license by endorsement to an APRN licensed under

the laws of another state if, in the opinion of the board of nursing, the applicant meets the

qualifications for licensure in this jurisdiction. An applicant for APRN licensure by endorsement

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shall:

      (1) Submit a completed, written application and appropriate fees as established by the

board of nursing;

      (2) Hold a current license or privilege to practice as an RN and APRN in a state or

territory;

      (3) Have an unencumbered license or privilege to practice in any state or territory;

      (4) Have completed an accredited graduate or post-graduate level APRN program in one

of the three roles (CNP, CRNA or CNS) and at least one population focus or meets the standards

for grandfathering as described in this chapter;

      (5) Be currently certified by a national certifying body recognized by the board of

nursing in the APRN role and at least one population focus appropriate to educational

preparation;

      (6) Meet continued competency requirements as set forth in board of nursing regulations;

      (7) Report any conviction, nolo contendere plea, Alford plea, or other plea arrangement

in lieu of conviction;

      (8) Have committed no acts or omissions that are grounds for disciplinary action in

another jurisdiction; and

      (9) Provide other evidence as required by the board of nursing in its regulations.

     (e) APRN licenses issued under this chapter shall be renewed every two (2) years

according to a schedule established by the board of nursing. An applicant for APRN license

renewal shall:

      (1) Submit a renewal application as directed by the board of nursing and remit the

required fee as set forth in regulation;

      (2) Maintain national certification in the appropriate APRN role and at least one

population focus, authorized by licensure, through an ongoing recertification maintenance

program of a nationally recognized certifying body recognized by the board of nursing; and

      (3) Meet other requirements set forth in regulations.

      (f) The board of nursing may reactivate or reinstate an APRN license as set forth in

board of nursing regulation.

     (g) Any individual licensed under this section shall be required to complete and provide

evidence of completion of at least five (5) hours of training every two (2) years on the risks of

addiction associated with medications prescribed for pain management as a condition of the

renewal of any license.

     SECTION 7. Section 23-13-9 of the General Laws in Chapter 23-13 entitled "Maternal

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and Child Health Services for Children with Special Health Care Needs" is hereby amended to

read as follows:

     23-13-9. Licensing and regulation of midwives -- Penalty for violations. – (a) The

state director of health is authorized and directed to make rules for the regulation of the practice

of midwifery and for the licensing of midwives, including regulations that require the payment of

an initial application fee equal to that fee that is imposed upon applicants for licensure as nurse

practitioners and a renewal fee also equivalent to that for nurse practitioners. The rules regarding

the regulation of the practice of midwifery shall authorize a licensed, certified nurse-midwife

(CNM) or a licensed, certified midwife (CM) to prescribe medications that might be reasonably

required by his or her patients; provided however, that a licensed, certified nurse-midwife (CNM)

or a licensed, certified midwife (CM) shall prescribe any of those medications as authorized by

the director of health. The provisions of this section relating to prescription authority by certified

nurse-midwives and certified midwives shall be overseen by the department of health as defined

in the department's rules and regulations for licensing of midwives (R23-13MID). No person not

a licensed midwife or a physician, registered under the provisions of chapter 37 of title 5, shall

practice midwifery, or shall make a practice of attending women in childbirth for hire, or use the

name or title of midwife. Any person who violates the provisions of this section, or who violates

any of the rules of the department of health made in pursuance of this section, shall be fined not

more than one hundred dollars ($100), or imprisoned not more than six (6) months, or both, and

the director of health may revoke the license issued to any person when, in the opinion of the

director of health, that person is guilty of unprofessional conduct.

     (b) Any individual licensed under subsection (a) of this section shall be required to

complete and provide evidence of completion of at least five (5) hours of training every two (2)

years on the risks of addiction associated with medications prescribed for pain management as a

condition of the renewal of any license.

     SECTION 8. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS - TRAINING ON DRUG ADDICTION

RISK

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     This act would require that physicians, dentists, and other healthcare professionals who

treat patients complete at least five (5) hours of training every two (2) years on the risks of

addiction associated with medications prescribed for pain management.

     This act would also require physicians to complete training necessary to obtain a DATA

2000 waiver to prescribe buprenorphine.

     This act would take effect upon passage.

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