N.J. Admin. Code § 13:35-6.19

Current through Register Vol. 56, No. 21, November 4, 2024

Section 13:35-6.19 - Duty to report changes in status

(a) The following words and terms, when used in this section, shall have the following meanings unless the context clearly indicates otherwise.

"Ability to practice" means and is construed to include all of the following:

1. The cognitive capacity to make appropriate clinical diagnoses and exercise reasoned medical judgments and to learn and keep abreast of medical developments;

2. The ability to communicate those judgments and medical information to patients and other health care providers, with or without the use of aids or devices, such as voice amplifiers; and

3. The physical capability to perform medical tasks such as physical examination and surgical procedures, with or without the use of aids or devices, such as corrective lenses or hearing aids.

"Affiliation" means a professional relationship, including an employment relationship, a position as an independent contractor or the grant of privileges by a health care facility or health maintenance organization in this State or any other jurisdiction.

"Alternative Resolution Program" refers to the program established pursuant to N.J.A.C. 13:35-11 by which licensees suffering from medical conditions or chemical dependency may confidentially enter into a rehabilitation and monitoring program, under the sponsorship of an approved professional assistance program, subject to the periodic submission of coded status reports and continuing confidential review by the Board's Impairment Review Committee. To be deemed a participant in the Alternative Resolution Program, the licensee must be accepted by the Impairment Review Committee and assigned a code number.

"Biennial renewal form" means the form provided to a licensee by the Board, which must be completed in order to renew and keep current a license to practice in this State.

"Chemical substances" is to be construed to include alcohol, drugs or medications, including those taken pursuant to a valid prescription for legitimate medical purposes and in accordance with the prescriber's direction, as well as those used illegally.

"Conviction" means a judgment of conviction entered following plea agreement or trial on an arrest, indictment, accusation or bill of particulars in a state or Federal criminal proceeding, or the resolution of such charges, whether by a plea of no contest or nolo contendere or by pre-trial diversion program.

"Directly associated" means a professional relationship including an employment relationship, partnership arrangement or a shareholder status in a professional service corporation or general business corporation. "Directly associated" does not include any relationship established pursuant to preferred provider agreements, IPA's or other provider panels.

"Disciplinary order" means a disposition suspending or revoking licensure privileges or imposing civil penalties or ordering the restoration of money or ordering corrective action or medical or other professional treatment or monitoring, or censuring or reprimanding a licensee.

"Financial interest" means a monetary interest of any amount held by a practitioner personally or through immediate family, as defined at 45:9-22.4 et seq.

"Health care facility" means a facility or institution, whether public or private, engaged in providing medical services, including diagnosis or treatment of human disease, pain, injury, deformity or physical condition, including, but not limited to, a general hospital, special hospital, mental hospital, health maintenance organizations, public health center, diagnostic center, treatment center, rehabilitation center, extended care facility, skilled nursing home, nursing home, intermediate care facility, tuberculosis hospital, chronic disease hospital, maternity hospital, outpatient clinic, dispensary, home health care agency, boarding home for the sheltered care of adult persons, and bio-analytical laboratory or central services facilities serving one or more such institutions but excluding institutions that provide healing solely by prayer.

"Health care service entity" means a business entity which provides on an inpatient or outpatient basis: testing for a diagnosis or treatment of human disease or dysfunction; or dispensing of drugs or medical devices for the treatment of human disease or dysfunction. Health care service entity includes, but is not limited to, a bio-analytical laboratory, pharmacy, home health care agency, rehabilitation facility, nursing home, hospital, home infusion company, or facility which provides radiological or other diagnostic imagery services, physical therapy, ambulatory surgery, or ophthalmic services.

"Health maintenance organization" means any entity licensed by the State Department of Health and Senior Services, which directly or through contracts with providers furnishes health care services on a prepaid basis to enrollees.

"Illegal use of controlled dangerous substances" means the use of controlled dangerous substances obtained illegally (for example, heroin or cocaine) as well as the use of controlled dangerous substances which are not obtained pursuant to a valid prescription or not taken in accordance with the directions of a licensed health care practitioner.

"Licensee" means any person licensed or authorized to engage in the health care profession regulated by the Board of Medical Examiners.

"Licensing authority" means any professional or occupational licensing board charged with granting, suspending or revoking licensure or certification privileges.

"Medical condition" includes physiological, mental or psychological conditions or disorders, such as, but not limited to, orthopedic, visual, speech, or hearing impairments, cerebral palsy, epilepsy, muscular dystrophy, multiple sclerosis, cancer, heart disease, diabetes, mental retardation, emotional or mental illness, specific learning disabilities, HIV disease, tuberculosis, drug addiction and alcoholism.

"Practice location" means the actual physical site of the office and business address from which the licensee provides professional services and where relevant books and records are or should be maintained.

"Practice name" means the title under which a group practice of five or more practitioners is conducted.

"Practitioner" means physician or podiatrist licensed by the Board.

(b) A licensee shall provide notice to the Board in writing, on such forms as the Board may require and within 21 days, of any changes, additions or deletions pertaining to the following information last provided by the licensee on the biennial license renewal form:

1. The name and address of all practice locations;

2. The name of all practitioners directly associated with the practice, or the practice name if five or more practitioners are offering professional services through the same practice entity;

3. The name and address of each licensed health care facility and health maintenance organization with which the licensee has an affiliation, except that with respect to health maintenance organization affiliations, the licensee shall be relieved of this reporting obligation if the entities with which the licensees has an affiliation have agreed to provide the Board with a list of participating providers on a quarterly basis;

4. The name and address of the licensee's medical malpractice insurer, if any; and

5. The name and address of any health care service entity in which the licensee or any member of his or her immediate family has acquired a financial interest, the date on which that interest was acquired and whether the licensee refers patients to that service.

(c) A licensee shall provide notice to the Board in writing within 10 days of any changes in circumstances that would alter the response last provided by the licensee to questions on the biennial renewal form eliciting information pertaining to pending or finalized actions, including those predicated on a no contest or nolo contendere plea or other consensual or voluntary agreement, or a surrender or resignation of license or of privileges or a consent to limitations on practice, which occurred in the face of an investigation or of pending action. Reporting of the following actions is required:

1. Pending or final actions by criminal authorities for violations of law or regulation, or any arrest or conviction for any criminal or quasi-criminal offense pursuant to the laws of the United States, this State or another state, including, but not limited to:

i. Criminal homicide pursuant to 2C:11-2;

ii. Aggravated assault pursuant to 2C:12-1;

iii. Sexual assault, criminal sexual contact or lewdness pursuant to 2C:14-2 through 2C:14-4; or

iv. An offense involving any controlled dangerous substance or controlled substance analog as set forth in 2C:35-1 et seq.;

2. Actions by a health care facility or health maintenance organization grounded, in whole or in part, upon patient care concerns which actions condition, curtail, limit, suspend or revoke privileges;

3. Disciplinary actions by state licensing authorities;

4. Actions by the Department of Health and Senior Services;

5. Actions by the Drug Enforcement Administration or any state drug enforcement agency;

6. Actions by Medicaid, Medicare, CHAMPUS, or other governmental insurance program;

7. Actions by professional review organizations or utilization review organizations; or

8. Actions by a medical malpractice insurance carrier declining coverage or a continuation of coverage, assessing a surcharge based on claims experience, imposing new limitations or restrictions on practice, or requiring remedial education or office monitoring.

(d) A licensee, who is not already known to the Board's Impairment Review Committee through participation in the Alternative Resolution Program, shall provide notice to the Board in writing within 21 days of any changes in circumstances that would alter the response last provided by the licensee to questions on the biennial renewal form pertaining to medical conditions and use of chemical substances, which in any way impair or limit the licensee's ability to practice with reasonable skill and safety. Licensees shall provide notice to the Board of any hospitalization, in-patient treatment or participation in supervised rehabilitation programs relating to these medical conditions. Licensees shall notify the Board of any leave of absence taken from a health care facility or health maintenance organization for reasons related to these medical conditions. (Parental leaves need not be reported.) Any notices received by the Board pursuant to this subsection shall be retained by the Board in a confidential manner and shall not be deemed to be government records within the meaning of 47:1A-1 et seq.

(e) To the extent that a required disclosure may relate to the illegal use of controlled dangerous substances or other criminal activity which may give a licensee reasonable cause to believe he or she is exposed to the possibility of criminal prosecution, the licensee may assert, on the form provided by the Board, the Fifth Amendment privilege against self-incrimination. Any claim of Fifth Amendment privilege must be made in good faith, and does not relieve the licensee from making disclosures not implicating criminal liability. The Board may make follow-up inquiries and the licensee may later be directed by the Attorney General to make a disclosure of information previously withheld on the basis of the Fifth Amendment, provided that the Attorney General first grants immunity afforded by statutory law. 45:1-20.

(f) For each change, addition or deletion in the foregoing information, the licensee shall further indicate the effective date of the change, addition or deletion and provide an explanation therefor.

(g) Failure by a licensee to provide the Board with notice of any information required pursuant to this section within the required time period of the change or the event necessitating the filing of the notice may be deemed professional misconduct within the meaning of 45:1-21(e).

N.J. Admin. Code § 13:35-6.19

New Rule, R.1996 d.243, effective 5/20/1996.
See: 27 N.J.R. 1746(b), 28 N.J.R. 2563(a).
Amended by R.2005 d.120, effective 4/18/2005.
See: 36 N.J.R. 4633(a), 37 N.J.R. 1203(a).
In (c), inserted "within 10 days" preceding "of any changes" in the introductory paragraph and rewrote 1; in (d), inserted "within 21 days" preceding "of any changes"; in (g), substituted "the required time period" for "21 days" preceding "of the change".
Amended by R.2011 d.155, effective 6/6/2011.
See: 42 N.J.R. 1310(a), 43 N.J.R. 1359(b).
In definition "Health maintenance organization" in (a) and in (c)4, inserted "and Senior Services"; in the introductory paragraph of (c), substituted "that" for the first occurrence of "which" and inserted a comma following "practice"; and in (d), substituted "that" for the first occurrence of "which" and "government" for "public".