Code of Massachusetts Regulations
243 CMR - BOARD OF REGISTRATION IN MEDICINE
Title 243 CMR 2.00 - Licensing and the practice of medicine
Part 1 - LICENSING
Section 2.06 - License Renewals

Universal Citation: 243 CMR 2.00 MA Code of Regs 2.06

Current through Register 1531, September 27, 2024

(1) Two-year Licensing Period for Full, Administrative or Volunteer Licenses. Pursuant to M.G.L. c. 112, § 2, a licensee must renew his full, administrative or volunteer license every two years. Time shall be calculated according to the two year licensing period for the licensee, beginning on the date the license was issued or renewed by the Board and ending on the following renewal date.

(2) Requirements for Renewing a Full, Administrative or Volunteer License. In order to renew a full, administrative or volunteer license, a licensee must meet the prerequisite requirements in 243 CMR 2.02(1), except as otherwise provided, and the following renewal requirements:

(a) Timely Submission. A licensee must submit to the Board a completed renewal application form and the proper fee prior to the renewal date. A license that has not been renewed expires at 11:59 P.M. on the renewal date.

(b) Completed Continuing Medical Education Requirements. A licensee must fulfill his or her continuing medical education requirement as defined in 243 CMR 2.06(5) or obtain a waiver from the Board pursuant to 243 CMR 2.06(5)(e).

(c) Effect of Suspension. A licensee may not renew a license during a period of suspension.

(d) Proficiency in EHR. A renewing full licensee shall establish competency in the use of electronic health records (EHR). Electronic health record systems include computerized physician order entry, e-prescribing and other health information systems.
1. Demonstrating EHR Proficiency. A renewing full licensee must demonstrate proficiency in the use of electronic health records (EHR), as required by M.G.L. c. 112, § 2. A renewing full licensee shall demonstrate proficiency in the use of EHR once, and in one of the following ways:
a. Participation in a Meaningful Use program as an eligible professional;

b. Employment with, credentialed to provide patient care at, or in a contractual agreement with an eligible hospital or critical access hospital that has implemented an electronic health records program;

c. Participation, as either a Participant or Authorized User, in the Massachusetts Health Information Highway; or

d. Completion of three hours of a Category 1 EHR-related CME course that discusses, at a minimum, the core and menu objectives and the CQMs for Meaningful Use. These three EHR credits may be used toward the required ten risk management CME credits.

2. Waiver of the EHR Proficiency Requirement. For purposes of 243 CMR 2.06, a waiver means an extension of time with which to demonstrate EHR Proficiency. A licensee may apply to the Board for a waiver of the EHR Proficiency requirement.
a. The Board may, in its discretion, grant a 90-day waiver of the EHR Proficiency requirement due to undue hardship in meeting the requirement.

b. The licensee must submit the waiver request to the Board no later than 30 days prior to the license renewal date. Only in exceptional circumstances shall the Board permit a licensee to file a waiver request less than 30 days prior to the licensee's renewal date.

c. The Board may extend the validity of the applicant's license through the period of the waiver.

3. Exemptions. Exemptions must be claimed each licensing cycle, if applicable. The following are exempt from the requirement to demonstrate EHR Proficiency:
a. A licensee who is not engaged in the practice of medicine as defined in 243 CMR 2.01(4);

b. An Administrative licensee;

c. A Volunteer licensee;

d. An Inactive licensee;

e. An applicant for any license who is on active duty as a member of the National Guard or of a uniformed service called into service during a national emergency or crisis;

f. An Emergency Restricted licensee; or

g. An applicant who has already demonstrated proficiency under 243 CMR 2.02(2)(f) or 2.06(2)(d).

(e) Domestic Violence and Sexual Violence Training. Pursuant to M.G.L. c. 112, § 264, applicants and licensees shall participate in Domestic Violence and Sexual Violence Training once as a condition for licensure, renewal, revival or reinstatement of licensure. The Board, in consultation with the Department of Public Health, will identify programs or courses of study that meet the standards required by this provision and provide its licensees with a list of such programs or courses. This is a one-time training requirement.

(f) MassHealth Requirement. Pursuant to M.G.L. c. 112, §§ 2 and 9, applicants and licensees shall apply to participate in MassHealth, either as a provider of services or as a non-billing provider for the limited purpose of ordering and referring services in the MassHealth program, as a condition of licensure, renewal, revival or reinstatement of licensure.

(g) Child Abuse and Neglect Training. Pursuant to M.G.L. c. 119, § 51A(k), applicants and licensees shall complete training in recognizing and reporting suspected child abuse and neglect. Physicians may comply with the training requirement by: completing a hospital-sponsored training program in recognizing the signs of child abuse and neglect; completing CME in identifying and reporting child abuse and neglect; completing a Board-approved online training program or completing a specialized certification. This is a one-time training requirement.

(3) Inactive Status.

(a) Exempt from Certain Requirements. A licensee may request to change his or her license status from a full active license to an inactive status. A request to change license status may be made at any time during the license term or at the time of renewal. A licensee shall certify that he or she will not practice medicine in Massachusetts while in inactive status. A licensee who is inactive is exempt from the continuing medical education requirements set forth in 243 CMR 2.06(2) and (6), the domestic violence and sexual violence training, the MassHealth application requirement, the child abuse and neglect training and professional malpractice liability insurance as set forth in 243 CMR 2.07(16), but is subject to all other provisions of 243 CMR 2.00.

(b) Return to Active Status. An inactive licensee may request at any time a change of license status to return to active status. The Board shall require the licensee to satisfy the domestic violence and sexual violence training, the MassHealth application requirement, the child abuse and neglect training, if these requirements have not been previously satisfied, and such continuing medical education requirements as have accumulated during the period of time the licensee was on inactive status, including the EHR Proficiency requirement, or such CME requirements as the Board requires. The Board shall require that the licensee reinstate appropriate professional malpractice liability insurance requirements.

(4) Retiring from the Practice of Medicine. When resignation, as set forth in 243 CMR 1.05(5): Resignation, does not apply, a licensee may retire from the practice of medicine in accordance with the following procedure:

(a) From Active to Retired Status. A licensee who no longer wishes to practice medicine may request, in writing, that the Board change his or her license status from Active to Retired status. A Retired license is an inactive status. The licensee must submit a written statement, signed under the penalties of perjury, detailing the licensee's knowledge of any open or reasonably anticipated complaints before the Board, and agreeing to make patient records accessible in accordance with 243 CMR 2.07(13).

(b) Eligibility for Retired Status. A physician is not eligible to retire if he or she is the subject of an open complaint or reasonably anticipates a complaint will be filed with the Board.

(c) Effective Date of Retirement. If the physician is not the subject of an open complaint, and there are no reasonably anticipated complaints against the licensee, he or she may retire. The physician's retirement status becomes effective on the date set by the Board in its written Notice of a Change in License Status.

(d) Retiree's Duty to Maintain Patient Records. The retired physician shall comply with the requirements of 243 CMR 2.07(13). With respect to patient records existing on or after January 1, 1990, a retiring licensee, a successor physician or the licensee's estate must retain patient records in a manner which permits former patients and their successor physicians to access to them for a minimum period of seven years from the date of the last patient encounter. When the patient is a minor on the date of the last patient encounter, the physician must retain the patient's records for a minimum period of seven years from the date of the last patient encounter or until the date that the minor patient reaches 18 years of age, whichever is the longer retention period.

(e) From Retired Status to Active Status. A physician in Retired status may wish to return to active practice. The physician must complete the Reactivation from Retirement Application and demonstrate EHR Proficiency as set forth in 243 CMR 2.06(2)(d). If the physician has been out of practice for less than two years, he or she may change his or her license status. The Board shall approve such a request provided that the physician has no outstanding complaints or unpaid fines. If the physician in retired status has not engaged in a clinical practice of medicine for two years or more, and the physician intends to return to a practice of medicine that will include direct or indirect patient care, the Board may require that the physician demonstrate current clinical competency prior to reviving the license.

(5) Request for Extension to Complete Certain 243 CMR 2.06 Renewal Requirements. In the circumstances listed in 243 CMR 2.06(5), the Board or its designee may grant a licensee an extension of time in which to file a completed renewal application and may extend the validity of his or her current license through the period of the extension. The Board or its designee may deem that a licensee has requested an extension under 243 CMR 2.06 in the following circumstances:

(a) The Board fails to provide the licensee with a renewal application 60 days prior to the renewal date due to the Board's computer, administrative, or clerical difficulties or other compelling circumstances. Such an extension shall not exceed 60 days.

(b) The licensee fails to receive his or her renewal application in a timely manner because of computer, administrative, or clerical difficulties or other compelling circumstances on the part of the licensee. A licensee's failure to receive his or her renewal application due to his own failure to change his or her address with the Board within 30 days as required by 243 CMR 2.07(8) is not a compelling circumstance.

(6) Continuing Medical Education.

(a) Basic Biennial Requirement. Subject to the exemptions set forth in 243 CMR 2.05(6), each licensee shall obtain no fewer than 100 continuing medical education (CME) credits during each two year period that begins on the date that his or her license is issued or renewed by the Board and ends on the following renewal date. Credits shall be earned as follows:
1. Category 1. Not less than 40 CME credits (example: AMA PRA Category 1 CreditTM; AAFP Prescribed credit or AOA Category 1-A) from an organization accredited by the Accreditation Council for Continuing Medical Education (ACCME), the American Osteopathic Association (AOA), the American Academy of Family Physicians (AAFP) or a state medical society recognized by the ACCME. The entire 100-credit requirement may be completed by earning Category 1, Prescribed or 1-A credits.

2. Category 2. Not more than 60 credits of Category 2 activities, as defined and adopted by the American Medical Association or AOA.

3. Risk Management Continuing Medical Education Courses. Ten credits studying risk management, as defined in 243 CMR 2.01(3), at least four of which shall be in Category 1.

4. Review of Board Regulations. Two credits in either Category 1 or 2 studying 243 CMR 1.00 through 3.00.

(b) End-of-life Care Studies. Pursuant to M.G.L. c. 13, § 10 and M.G.L. c. 112, § 2, the Board shall require that a licensee participate once in at least two credits of either Category 1 or 2 continuing medical education studying end-of-life care issues as a condition for renewal, revival or reinstatement of licensure. End-of-life care studies may be used to satisfy the risk management requirement in 243 CMR 2.06(6)(a)3. The Board will assist licensees in obtaining end-of-life care education and training by providing an online list of resources.

(c) Clinical Assessment. The Board may require a licensee to participate in a clinical skills or competency assessment, if any such programs exist, as a condition for renewing, reinstating, reviving a license or for changing a license category. An applicant for renewal, revival, reinstatement or change of status may also be required to appear for a personal interview with the Board and its committees. This interview may include, but not be limited to, an inquiry regarding the applicant's reason(s) for renewal, revival, reinstating or change of status and the applicant's plan for practicing medicine in Massachusetts.
1. In determining whether to require a clinical skills assessment or a clinical competency assessment, the Board may consider the length of time that the licensee has been clinically inactive, the licensee's specialty; the cost of the program; the location of the program, and other relevant factors that the Board may by policy develop.

2. The Board may accept the successful completion of an Ongoing Physician Performance Evaluation (OPPE) by a licensee as establishing clinical competency, provided the OPPE is completed within the past year.

3. The Board may accept the successful completion of a Focused Physician Performance Evaluation (FPPE) by a licensee as establishing clinical competency, provided the FPPE is completed within the past year.

(d) Opioid Education and Pain Management Training. Renewing licensees who prescribe controlled substances, as defined in M.G.L. c. 94C, § 1, shall, as a prerequisite to renewing a medical license, complete three credits in pain management training, pursuant to St. 2010, c. 283. Pain management training shall include, but not be limited to, training in how to identify patients at high risk for substance abuse and training in how to counsel patients on the side effects, addictive nature and proper storage and disposal of prescription medicines. Three credits of opioid education and pain management training shall be required of licensees when they biennially renew their licenses. Opioid education and pain management training may be used toward a licensee's required risk management credits of continuing professional education.

(e) CME for Temporary Licensee. A temporary licensee with an academic appointment shall have fulfilled 50% of the CME requirement in order to obtain a renewal of the temporary license.

(f) Exemptions. The following licenses are not required to fulfill the basic biennial CME requirement set forth in 243 CMR 2.06(5)(a):
1. Limited licensees.

2. Licensees on inactive status, except as specified in 243 CMR 2.06(3)(b).

3. Licensees enrolled in any of the following programs:
a. A post graduate medical education program (e.g., a residency or fellowship) approved by the ACGME or AOA.

b. The first or second year of a fellowship (including consecutive fellowships) not approved by the ACGME OR AOA (e.g., a pure research fellowship).

4. National Emergency or National Crisis Exemption. The Board shall grant an exemption of the CME requirement to those licensees serving in active military duty as members of the National Guard or of a uniformed service who are called into service during a national emergency or crisis.
a. An exemption of the CME requirement may be granted on a pro rated basis.

b. The exemption shall constitute a permanent waiver, and the licensee shall not be required to complete the excused credits at a future time.

c. A licensee may apply to the Board for a waiver of the CME requirements pursuant to the national emergency or crisis exemption by submitting the waiver request in writing to the Board, together with proof of service, no later than 30 days prior to the license renewal date.

(g) Calculating Credits. Newly licensed or newly active physicians, or licensees initially subject to the exemptions set forth in 243 CMR 2.06(5) shall begin to earn CME credits as follows:
1. A newly licensed physician not otherwise subject to the exemptions set forth in 243 CMR 2.06(5), shall fulfill the basic biennial CME requirement during the two year period that begins on the date his or her license is issued by the Board. If that license will be renewed in less than two years, the licensee shall obtain credits as follows:
a. If the license renewal period is one year or shorter, the licensee need not obtain any CME credits during that renewal period.

b. If the license renewal period is longer than one year but shorter than two years, the licensee shall fulfill one half of the basic biennial CME requirement during that renewal period.

2. A licensee seeking to return to active status from lapsed license status shall first have fulfilled the basic biennial CME requirement during the two year period ending on the date he or she returns to active status.

3. A licensee completing or leaving a program described in 243 CMR 2.06(5)(b)3.a., shall fulfill the basic biennial CME requirement during the two year period that begins on the first license renewal date after the program or the second fellowship year has ended, or (if earlier) that begins on the first license renewal date after the licensee leaves the program or fellowship.

(h) Miscellaneous Provisions.
1. A majority of the total CME credits required for each renewal cycle shall be directly related to the licensee's primary area(s) of practice.

2. Licensees shall document Category 1 CME credits by maintaining a written record that lists the date and type of activity, the program sponsor (if applicable) and the number of credits earned, and shall retain each certificate of attendance or letter of attestation issued by a program sponsor. Licensees shall document Category 2 CME credits and credits certified pursuant to 243 CMR 2.06(5)(d)4. by maintaining a written record that lists the approximate number of hours spent on each type of CME activity. Such records shall be maintained for no less than one full license renewal cycle after the credits have been earned and must be available for Board inspection upon request.

3. The Board, by majority vote, may certify that any activity, course or training deemed appropriate shall be eligible for the equivalent of Category 1 or Category 2 credit for purposes of license renewal in Massachusetts.

(i) Waiver of a CME Requirement.
1. A licensee may apply to the Board for a waiver of the portion of the CME requirements that he or she cannot meet. The licensee must submit the waiver request to the Board no later than 30 days prior to the license renewal date.

2. A waiver request must include the following written information:
a. An explanation of the licensee's failure to complete the CME requirements;

b. A listing of the CME credit hours that the licensee believes that he or she has earned; and

c. The licensee's plan for completing the CME requirements.

3. The Board in its discretion will grant a waiver of the CME requirement. The grounds for waiver include, but are not limited to:
a. Prolonged illness of the licensee; and

b. Inaccessibility or unavailability of CME programs.

4. Licensees granted a waiver by the Board will be given additional time to complete the Board's CME requirement. Licensees required (by the terms of a waiver or otherwise) to make up a deficiency in CME credits may apply those credits only to the period in which the deficiency arose.

(7) Lapsed License Status.

(a) Effect of a Lapsed License. A license not renewed shall lapse at 11:59 P.M. on the license renewal date. A licensee whose license has lapsed shall not practice medicine. Continued practice of medicine following the lapse of the license is the unauthorized practice of medicine, and shall be referred to the Enforcement Division of the Board and to law enforcement.

(b) Reviving a Lapsed License. A licensee whose license has lapsed may petition the Board, upon submission of a lapsed license application and payment of the required fee, to revive his or her license.
1. The Board shall require the licensee to satisfy such continuing medical education requirements as have accumulated during the period of the lapse, including the EHR Proficiency requirement, or such CME requirements as determined by the Board. The Board shall require that the licensee reinstate appropriate professional malpractice liability requirements.

2. If the Board has reason to believe the lapsed licensee has committed a violation of law or regulation, or has deviated from good and acceptable standards of medical practice, the matter will be forwarded to the Enforcement Division. The Enforcement Division will review the lapsed license application and if necessary, investigate the matter as an open complaint. The Board may defer action on the lapsed licensee renewal pending completion of the investigation or 180 days after the Board's receipt of a complete lapsed license application, whichever is shorter, or, should the Board issue a Statement of Allegations against the lapsed licensee, pending completion of the adjudicatory process by the Board. The 180-day period allowed for investigation shall be extended by any period of time during which the licensee is unavailable or fails to cooperate with the Board.

3. Where a license has lapsed during the pendency of a temporary suspension or final order of suspension, and the temporary or final order of suspension has been vacated, the lapsed licensee may renew his or her license under the renewal processes set forth in 243 CMR 2.06. The renewal application must be completed and filed with the Board within 60 days of the temporary suspension having been vacated. All information and responses in the application must cover the time period commencing on the date the licensee signed his or her last license application that was granted by the Board. Such license renewal shall not constitute a waiver of the Board's authority to issue a restricted license or otherwise take disciplinary action against the license or physician. Any action taken by the Board on the license renewal application or against the physician shall be subject to and in accordance with 801 CMR 1.00: Standard Adjudicatory Rules of Practice and Procedure, and M.G.L. c. 30A. After the 60-day period, the physician must seek to revive his or her license under 243 CMR 2.06(7)(b)1. and 2.

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