2025 -- S 0347 SUBSTITUTE A AS AMENDED

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- BOARD OF MEDICAL LICENSURE

AND DISCIPLINE

     Introduced By: Senators Urso, Murray, Lauria, Thompson, LaMountain, Appollonio,

     Date Introduced: February 21, 2025

     Referred To: Senate Health & Human Services

     (General Treasurer)

It is enacted by the General Assembly as follows:

     SECTION 1. Sections 5-37-1 and 5-37-16 of the General Laws in Chapter 5-37 entitled

"Board of Medical Licensure and Discipline" are hereby amended to read as follows:

     5-37-1. Definitions.

     As used in this chapter:

     (1) "ACGME" means the Accreditation Council for Graduate Medical Education.

     (2) "ACGME-I" means the Accreditation Council for Graduate Medical Education-

International.

     (1)(3) "Board" means the Rhode Island board of medical licensure and discipline or any

committee or subcommittee thereof.

     (2)(4) "Chief administrative officer" means the administrator of the Rhode Island board of

medical licensure and discipline.

     (3)(5) "Department" means the Rhode Island department of health.

     (4)(6) "Director" means the director of the Rhode Island department of health.

     (7) "ECFMG" means the Educational Commission for Foreign Medical Graduates.

     (8) "GME" means graduate medical education, which is specialty-specific clinical training

that commences after graduation from medical school and provides physicians with the knowledge

and clinical skills necessary to practice their specialty independently. GME curricula and clinical

experience vary widely across countries and do not have uniform standards.

     (5)(9) "Healthcare facility" means any institutional health-service provider licensed

pursuant to the provisions of chapter 17 of title 23.

     (6)(10) "Health-maintenance organization" means a public or private organization licensed

pursuant to the provisions of chapter 17 of title 23 or chapter 41 of title 27.

     (11) "Internationally-trained physician" means a physician who has received a degree of

doctor of medicine or its equivalent from a medical school located outside the United States with

recognized accreditation status from ECFMG; has completed the required years of training in a

residency program accredited by ACGME-I or in a residency program in a country whose GME

accrediting agency has been recognized by the WFME, or programs accredited by another

accreditation authority approved by the board; and who has been licensed or otherwise authorized

to practice medicine in a country other than the United States for at least three (3) years with an

unrestricted medical license. Physicians who have completed ACGME-accredited residency

training in the United States or Royal College of Physicians and Surgeons-accredited residency

training in Canada are not internationally-trained physicians.

     (12) "Limited international physician registrant" means an internationally-trained

physician granted a limited license pursuant to the provisions of this chapter.

     (7)(13) "Limited registrant" means a person holding a limited-registration certificate

pursuant to the provisions of this chapter.

     (8)(14) "Medical malpractice" or "malpractice" means any tort, or breach of contract, based

on health care or professional services rendered or that should have been rendered, by a physician,

dentist, hospital, clinic, health-maintenance organization, or professional service corporation

providing healthcare services and organized under chapter 5.1 of title 7, to a patient or the rendering

of medically unnecessary services except at the informed request of the patient.

     (9)(15) "Medical-practice group" means a single legal entity formed primarily for the

purpose of being a physician group practice in any organizational form recognized by the state in

which the group practice achieves its legal status, including, but not limited to, a partnership,

professional corporation, limited-liability company, limited-liability partnership, foundation, not-

for-profit corporation, faculty practice plan, or similar association.

     (10)(16) "Medical record" means a record of a patient's medical information and treatment

history maintained by physicians and other medical personnel, which includes, but is not limited

to, information related to medical diagnosis, immunizations, allergies, x-rays, copies of laboratory

reports, records of prescriptions, and other technical information used in assessing the patient's

health condition, whether such information is maintained in a paper or electronic format.

     (11)(17) "Nonprofit medical-services corporation" or "nonprofit hospital-service

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corporation" means any corporation organized pursuant to chapter 19 or chapter 20 of title 27 for

the purpose of establishing, maintaining, and operating a nonprofit medical-service plan.

     (18) "Participating healthcare facility" means a federally-qualified health center,

community health center, hospital, or other healthcare facility that provides a board-approved

assessment, training and evaluation program designed to develop, assess, train and evaluate an

internationally-trained physician's clinical and non-clinical skills, including training in identified

clinical and non-clinical gaps identified by the physician(s) in the facility.

     (12)(19)(i) "Peer-review board" means any committee of a state or local professional

association or society including a hospital association, or a committee of any licensed healthcare

facility, or the medical staff thereof, or any committee of a medical-care foundation or health-

maintenance organization, or any committee of a professional-service corporation or nonprofit

corporation employing twenty (20) or more practicing professionals, organized for the purpose of

furnishing medical service, or any staff committee or consultant of a hospital-service or medical-

service corporation, the function of which, or one of the functions of which, is to evaluate and

improve the quality of health care rendered by providers of healthcare services or to determine that

healthcare services rendered were professionally indicated or were performed in compliance with

the applicable standard of care or that the cost of health care rendered was considered reasonable

by the providers of professional healthcare services in the area and shall include a committee

functioning as a utilization-review committee under the provisions of 42 U.S.C. § 1395 et seq.

(Medicare law) or as a professional-standards review organization or statewide professional-

standards review council under the provisions of 42 U.S.C. § 1301 et seq. (professional-standards

review organizations) or a similar committee or a committee of similar purpose, to evaluate or

review the diagnosis or treatment of the performance or rendition of medical or hospital services

that are performed under public medical programs of either state or federal design.

     (ii) "Peer-review board" also means the board of trustees or board of directors of a state or

local professional association or society, a licensed healthcare facility, a medical-care foundation,

a health-maintenance organization, and a hospital-service or medical-service corporation only

when such board of trustees or board of directors is reviewing the proceedings, records, or

recommendations of a peer-review board of the above enumerated organizations.

     (13)(20) "Person" means any individual, partnership, firm, corporation, association, trust

or estate, state or political subdivision, or instrumentality of a state.

     (14)(21) "Physician" means a person with a license to practice allopathic or osteopathic

medicine in this state under the provisions of this chapter.

     (15)(22) "Practice of medicine" includes the practice of allopathic and osteopathic

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medicine. Any person is regarded as practicing medicine within the meaning of this chapter who

holds himself or herself out as being able to diagnose, treat, operate, or prescribe for any person ill

or alleged to be ill with disease, pain, injury, deformity, or abnormal physical or mental condition,

or who either professes to heal, offer, or undertake, by any means or method, to diagnose, treat,

operate, or prescribe for any person for disease, pain, injury, deformity, or physical or mental

condition. In addition, one who attaches the title, M.D., physician, surgeon, D.O., osteopathic

physician, and surgeon, or any other similar word or words or abbreviation to his or her name

indicating that he or she is engaged in the treatment or diagnosis of the diseases, injuries, or

conditions of persons, shall be held to be engaged in the practice of medicine.

     (23) "USMLE" means United States Medical Licensing Examination which consists of

three (3) steps:

     (i) Step 1 of the USMLE requires an assessment of the examinee's understanding of and

ability to apply important concepts of the basic sciences to the practice of medicine, with special

emphasis on principles and mechanisms underlying health disease, and modes of therapy;

     (ii) Step 2 of the USMLE requires an assessment of the examinee's ability to apply

knowledge, skills, and understanding of clinical science essentials for the provision of patient care

under supervision, with an emphasis on health promotion and disease prevention;

     (iii) Step 3 of the USMLE requires an assessment of the examinee's ability to apply medical

knowledge and understanding of biomedical and clinical science essential for the unsupervised

practice of medicine, with the emphasis on patient management in ambulatory settings.

     (24) "WFME" means the World Federation for Medical Education.

     (25) Notwithstanding any foreign medical graduate post graduate training requirements to

the contrary, such requirements shall be deemed satisfied and the board shall issue a full,

unrestricted license to practice medicine in Rhode Island if the following criteria are met:

     (i) Ten (10) years' experience as a fully licensed physician in good standing in another

state;

     (ii) Board certification in the physician's area of specialty; and

     (iii) Membership in a recognized professional organization specific to the physician's area

of specialty.

     5-37-16. Limited registrations.

     (a) An applicant for limited registration under this chapter who furnishes the board with

satisfactory proof that the applicant is eighteen (18) years of age or older and of good moral

character; that the applicant has graduated from a legally chartered medical school or school of

osteopathic medicine having power to grant degrees in allopathic or osteopathic medicine; and that

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the applicant has been appointed an intern, resident, fellow, or medical officer in a hospital or other

institution maintained by the state, or by a city or town, or in a hospital or clinic that is incorporated

under the laws of this state, or in a clinic that is affiliated with a hospital licensed by the department

of health, or in an outpatient clinic operated by the state, may, upon the payment as set forth in §

23-1-54, be registered by the board as a hospital medical officer for any time that the board may

prescribe. This limited registration shall entitle the applicant to practice medicine in the hospital or

other institution designated on his or her certificate of limited registration, or outside this hospital

or other institution for the treatment, under the supervision of one of its medical officers who is a

licensed physician, of persons accepted by it as patients, or in any hospital, institution, clinic, or

program affiliated for training purposes with the hospital, institution, or clinic designated on this

certificate, which affiliation is approved by the board, and in any case under regulations established

by the hospital, institution, or clinic; provided, that each hospital, institution, or clinic annually

submits to the board a list of affiliated hospitals, institutions, clinics, or programs providing training

programs that comply with the terms of this section. Limited registration under this section may be

revoked at any time by the board.

     (b) Notwithstanding the other provisions of subsection (a) of this section, an

internationally-trained physician who has been licensed or otherwise authorized to practice

medicine in a country other than the United States shall be eligible to apply for a limited

international physician registration (license) to practice medicine for a renewable one-year term

after satisfying the criteria in subsection (c) of this section; provided, however, that such limited

registration shall provide a pathway to apply for the issuance of a full unrestricted license to practice

medicine in accordance with, and upon satisfaction of, the criteria in subsection (f) of this section.

     (c) The board shall issue a limited license international physician license to an applicant if

the participating healthcare facility and the applicant submit evidence acceptable to the board that

the applicant:

     (1) Is an internationally-trained physician;

     (2) Has a valid certificate issued by the Educational Commission for Foreign Medical

Graduates; 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;

     (3) Has achieved a passing score on both of Steps 1 and 2 (clinical knowledge) of the

United States Medical Licensing Examination within three (3) attempts for each step;

     (4) Has entered into an agreement with the participating healthcare facility providing that

the facility shall assess, train and evaluate the applicant's clinical and nonclinical skills to ensure

standards appropriate for medical practice in Rhode Island, according to the assessment and

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evaluation criteria developed or approved by the board;

     (5) Will enter a full-time employment relationship with that participating healthcare facility

after the board issues a limited international physician license pursuant to this subsection; and

     (6) Has satisfied other criteria that the board may require for issuance of a limited

international physician license pursuant to this section.

     (d) The one-year limited international physician license may be renewed twice, for a total

three (3) year term of limited international physician registration for physicians in primary care

specialties and may be renewed for the total number of years required for ACGME-accredited

residency training in other specialties, at the discretion of the board.

     (e) To be eligible to apply for a full medical license to practice medicine in Rhode Island,

an internationally-trained physician shall provide the board with proof of the following:

     (1) Successful completion of the participating healthcare facility's assessment, training and

evaluation program, with an attestation from the facility that the physician is competent to practice

their specialty independently;

     (2) A passing score on Step 3 of the USMLE within three (3) attempts; and

     (3) The license shall authorize the holder to practice independently in a primary care

specialty, psychiatry, or other specialty approved by the board.

     (b)(f) The director may promulgate any rules and regulations that he or she the director

deems necessary to carry out the provisions of this chapter.

     SECTION 2. 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 -- BOARD OF MEDICAL LICENSURE

AND DISCIPLINE

***

     This act would allow internationally-trained physicians to practice at healthcare facilities

in Rhode Island under the guidance, assessment and evaluation of licensed physicians in the state,

offering a pathway to full licensure outside of the current requirements to train in ACGME-

accredited United States residency training programs.

     This act would take effect upon passage.

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