1. Legislation/Regulatory Updates National Credentialing Forum February 20 – 21, 2004 Tim Knettler, MBA Vice President, Member Support Services Federation of State Medical Boards Tknettler@fsmb.org 817- 868- 4006

2. Legislation/Regulatory Updates State Licensure – How it Relates to Telemedicine Licensure by Endorsement/Reciprocity – Portability (Does Physician mobility create a national adverse action verification problem?) State Medical Board Criminal Background Checks State Medical Board Methods of Medical School and PGT Verification Other National Updates

3. JCAHO 2004 Standards Telemedicine “Like all other standards, these standards assume that the organization is following applicable law and regulation such as appropriate licensure to practice medicine or telemedicine in the state where the Originating Sites and Distant Sites are located.”

4. Main Points to Remember The practice of medicine (includes telemedicine) is deemed to occur in the state where the patient is located Importance of personal exam (H&P)– physician/patient relationship Physicians must hold a valid license in all states where he/she provides professional services

5. Special Purpose License – 9 States Not limited to telemedicine Any medical act occurring when the patient is located in one state and the physician is located outside the state Includes transmission of vital individual patient data across state lines by any means Does not allow opening an office in the state Preceded advent of Internet Prescribing

6. State Licensure Requirements Nine states have authorized an expedited process for telemedicine licensure similar to FSMB’s recommendations (CA has authorized, but not implemented) Thirty-seven (37) states and D.C. have statutes or rules requiring full and unrestricted licensure

7. FL_M GA AL MS SC NC TN-M KY IN IL LA AR TX OH MI-MWI VA WV-M PA-M NY VT- M ME_M RI MA CT NJ DE MD OK-M KSMO IA MN ND SD *** NE WY CO NM-M HI AK AZ-M UT-MNV-M CA-M * OR ** ID MT WA-M WA-O = Full and unrestricted medical licensure STATE KEY FEDERATION OF STATE MEDICAL BOARDS Telemedicine Licensure By Jurisdiction NH *Not currently implemented **Requirements similar to full and unrestricted license ***Statute provides for an expedited process = Telemedicine license = No requirement known AZ-O CA-O FL-O ME-O MI-O NV-O NM-O OK-O PA-O TN-O UT-O VT-O WV-O

8. License Portability Development steps Special Committee Policy Report Common License Application Forms State Medical Board Initiatives Regional Pilots Standardized System of Credentials Verification FCVS or an approved process

9. Does physician mobility create a national adverse action verification problem?

10. Disciplined Physicians in 2002 with One or Multiple Licenses number of physicians = 4074 42% 58%

11. Physician with Multiple Licenses and Sanctions in 2002

12. = State Criminal Background Checks on New License Applicants = Optional Federal &/or State Criminal Background Checks on New License Applicants

13. State Medical Board Methods of Medical School and PGT Verification

14. Other National Updates Emergency Preparedness Patient Safety/Medical Errors Scope of Practice Maintenance of Licensure Clinical Skills Examination as a Requirement for Licensure