(1) The Board of Medical Examiners adopts and incorporates the public participation rules of the Department of Labor and Industry as listed in chapter 2 of this title.

This rule has been repealed.

(1) A health care provider authorized by 37-3-104, MCA, may delegate administrative and clinical tasks which are within the delegating health care provider's scope of practice to medical assistants who:

(a) work in the delegating health care provider's office under the general supervision of the delegating health care provider; and

(b) are known by the delegating health care provider to possess the education, training, knowledge, and skill to perform the delegated tasks in keeping with the standard of medical care owed by the delegating health care provider to the patient.

(2) A health care provider's knowledge of a medical assistant's education, training, knowledge, and skill to perform delegated tasks may be evidenced by:

(a) documentation of the medical assistant's graduation from an accredited medical assistant program;

(b) completion of education and training courses which are substantially equivalent to curriculum taught by accredited medical assistant programs;

(c) the delegating health care provider's personal knowledge of instruction, training, and experience provided directly to the medical assistant by the delegating health care provider; or

(d) other objective evidence known to the health care provider.

(3) A health care provider delegating administrative and/or clinical tasks to a medical assistant shall:

(a) require that the medical assistant record in the patient's medical records:

(i) the identity of the medical assistant to whom the health care provider has delegated tasks included in the patient's care; and

(ii) the clinical tasks delegated to the medical assistant;

(b) ensure through oversight and supervision that the medical assistant's performance of the delegated tasks meets the standard of medical care owed by the delegating health care provider to the patient;

(c) personally provide onsite or direct supervision as defined by ARM 24.156.403 to a medical assistant to whom the health care provider has delegated:

(i) injections other than immunizations;

(ii) invasive procedures;

(iii) conscious sedation monitoring;

(iv) allergy testing;

(v) intravenous administration of blood products; or

(vi) intravenous administration of medication; and

(d) require medical assistants to wear a name badge which includes the title: "Medical Assistant".

(4) Health care providers shall not delegate to medical assistants:

(a) medical tasks which are outside the delegating health care provider's scope of practice;

(b) medical tasks which the delegating health care provider is not authorized to perform;

(c) surgery as defined in ARM 24.156.403;

(d) medical tasks which the medical assistant is not qualified by education, training, knowledge, and skill to perform in keeping with the standard of medical care owed by the delegating health care provider to the patient; or

(e) who previously held a health care provider license of any kind in any jurisdiction which was restricted, suspended, revoked, or voluntarily relinquished in lieu of discipline for unprofessional conduct in a health care profession.

(1) As used in this chapter, the following terms are defined: 

(a) "Act" means the statutory provisions governing the licensee's scope of practice. 

(b) "Applicant" means a person who has applied to take a licensing examination in Montana or who has applied for licensure in Montana.

(c) "Board" means the Board of Medical Examiners created by 2-15-1731, MCA.

(d) "Foreign medical graduate" means a graduate of a medical school that is listed in the World Health Directory of Medical Schools but is not located in a state or territory of the United States or the District of Columbia.

(e) "Health corps physician" means a physician who has applied to participate in the health corps and completed the registration requirements set by the board.

(f) "Intern," "in post-graduate year 1" or "PGY-1" means a person who:

(i) has graduated from an approved medical school;

(ii) is enrolled in a training program approved for first year post-graduates;

(iii) has passed USMLE Steps 1 and 2 or the AOA equivalent or holds a certificate from the ECFMG; and

(iv) is preparing for or awaiting the results of USMLE Step 3 or the AOA equivalent.

(g) "Licensee" means the current holder of an active license issued by the board.

(h) "Medical student" means a person currently enrolled in or who has graduated from an approved medical school who has not yet entered PGY-1.

(i) "Paramedic" means a level of emergency care provider as established in 50-6-202, MCA.

(j) "Postgraduate clinical experience" means the delivery of health care directly to patients, after licensure as a physician assistant, pursuant to a collaborative agreement with a physician or physician assistant.

(k) "Resident" means a person who:

(i) has the degree of medical doctor or doctor of osteopathy from an approved medical school;

(ii) is in post-graduate year 2 (PGY-2) or above;

(iii) has either completed the USMLE Steps 1 and 2 or the AOA equivalent or holds a certificate from the ECFMG; and

(iv) is enrolled in an approved residency program.

(l) "Retired," applicable to the Montana Health Corps Act, means no longer maintaining a private, institutional, or governmental practice for the purposes of monetary remuneration within the United States.  Occasional locum tenens work for monetary remuneration will not disqualify a physician from retired status.

(m) "Standards of dietetic practice" means Academy of Nutrition and Dietetics Standards of Practice in Nutrition Care and Standards of Professional Performance for Registered Dietitian Nutritionists and the Academy of Nutrition and Dietetics/Commission on Dietetic Registration Code of Ethics for the Nutrition and Dietetics Profession.

(n) "Supervision" may be of the following types:

(i) "Direct supervision" means the supervisor is physically present with the person being supervised;

(ii) "On-site supervision" means the supervisor must be in the facility and quickly available to the person being supervised.

(o) "Surgery" means any procedure in which human tissue is cut or altered by mechanical or energy forms, including electrical or laser energy or ionizing radiation.

(2) As used in this chapter, the following abbreviations are identified:

(a) "AEMT" means a licensed advanced emergency medical technician.

(b) "ABMS" means the American Board of Medical Specialties.

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

(d) "AOA" means the American Osteopathic Association.

(e) "CIHC" means community-integrated health care, as defined under 37-3-102, MCA.

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

(g) "ECP" means a licensed emergency care provider.

(h) "EMR" means a licensed emergency medical responder.

(i) "EMS" means a licensed emergency medical service.

(j) "EMT" means a licensed emergency medical technician.

(k) "NPDB" means the National Practitioner Databank established by Public Law 99-660 (42 U.S.C. 11101, et seq.).

(l) "NREMT" means the National Registry of Emergency Medical Technicians.

(m) "USDOT" means the United States Department of Transportation.

(n) "USMLE" means the United States Medical Licensing Examination or its successor.

(1) It is unprofessional conduct for a licensee or applicant to violate any statute, rule, or standard of care governing their scope of practice. 

(2) In addition, the following is unprofessional conduct: 

(a) failure to cooperate in any investigation of the board or to provide any information requested by the board or its agents;

(b) failure to report to the board within thirty days from the date of a final judgment, order, or agency action, all information related to malpractice, misconduct, criminal, or disciplinary action in which the licensee or applicant is a party;

(c) abusive billing practices;

(d) testifying in court on a contingency basis;

(e) administering, dispensing, prescribing, ordering, or otherwise diverting a controlled substance as defined by the federal Food and Drug Administration or its successors, otherwise than in the course of legitimate or reputable professional practice;

(f) regarding patient records, to fail to:

(i) appropriately secure records;

(ii) appropriately document patient care; or

(iii) transfer records to another licensed health care provider, the patient, or the patient's representative when requested to do so by the patient or the patient's legally designated representative;

(g) termination of an existing relationship with a patient for whatever reason without verifiable written notice prior to terminating the relationship, and sufficiently far in advance to allow other medical care to be secured;

(h) sexual abuse, sexual misconduct, or sexual exploitation by the licensee, whether or not related to the licensee's practice;

(i) failure to supervise, appropriately direct, or train individuals under the licensee's supervision according to applicable law, rule, or standards;

(j) failure to comply with an agreement entered into by the licensee with the medical assistance program;

(k) for physician assistants with fewer than 8,000 hours of postgraduate clinical experience, practicing without a collaborative agreement meeting the requirements of 37-20-203, MCA;

(l) while under investigation or during a pending complaint, in Montana or elsewhere, but prior to a determination:

(i) withdrawing an application for licensure, certification, or registration; or

(ii) voluntarily relinquishing or surrendering of professional or occupational license, certification, registration, or privileges;

(m) engaging in practice under a license issued by the board as the partner, agent, or employee of, or in joint venture with, a person who does not hold an equivalent license for practice.  However, this rule does not prohibit:

(i) the incorporation of an individual licensee or group of licensees as a professional service corporation under Title 35, chapter 4, MCA, a professional limited liability company under Title 35, chapter 8, MCA, or a professional limited liability partnership under Title 35, chapter 10; or

(ii) practicing medicine as the partner, agent, or employee of, or in joint venture with, a licensed health care facility or other licensed health care provider; however:

(A) there must be a written agreement that the relationship may not affect the independent judgment of the licensee;

(B) the independent judgment of the licensee must, in fact, not be affected by the relationship; and

(C) the licensee may not be required to refer any patient to a particular provider or supplier or take any other action that the physician or physician assistant determines not to be in the patient's best interest;

(n)  for physicians and physician assistants, involuntary loss of or failure to report to the board any involuntary loss of privileges, which exceeds 30 days, within 30 days;

(o) when used, failure to maintain a collaborative practice agreement meeting the requirements of 37-20-203, MCA;

(p) for emergency care providers, violation of facility patient care policy or procedure while providing services in a health care facility. 

(1) The board authorizes the department to: 

(a) administratively suspend licenses for deficiencies set forth in 37-1-321(1)(a) though (e), MCA; or

(b) file a complaint pertaining to the deficiencies in (1) that are based on repeated or egregious conduct, or that have co-occurring misconduct allegations that directly implicate public safety and may warrant formal disciplinary action.

(2) An administrative suspension is not a negative, adverse, or disciplinary action under Title 37, MCA, and is not reportable under federal law and regulations implementing the Healthcare Practitioner Databank or the department's licensee lookup and license verification databank.

(1) Each application for licensure from the board must include: 

(a) a completed application form; 

(b) the initial license fee; and

(c) verification of applicable educational requirements.

(2) The board's designee will obtain a query from the National Practitioner Data Bank.  Applicants for podiatric licensure shall cause a disciplinary report from the Federation of Podiatric Medical Boards to be transmitted directly to the board.

(3) An applicant licensed in any other jurisdiction at any time shall cause the other jurisdictions to submit a current verification of licensure directly to the board.

(4) An applicant may voluntarily withdraw their application by written request if the application has not appeared on a board agenda.  Application fees are not refundable.

(1) Initial and active license renewal application fees:

(a) Physician license application fee                                                          $375

(b) Physician letter of qualification for interstate compact                           300

(c) Resident                                                                                                         75

(d) Podiatrist                                                                                                      375

(e) Podiatrist ankle surgery certification                                                         75

(f) Nutritionist                                                                                                       75

(h) Physician assistant                                                                                    375

(i) Emergency medical responder                                                                   20

(j) Emergency medical technician                                                                   35

(k) Advanced emergency medical technician                                                55

(l) Paramedic                                                                                                       75

(m) Emergency care provider endorsement–per submission                     10

      (A single submission may include multiple endorsement applications from a single applicant.)

(2) Inactive status license renewal application fees:

(a) Physician                                                                                                   190

(b) Podiatrist                                                                                                   190

(c) Physician assistant                                                                                   115

(3) Inactive to active status conversion fees:

(a) Physician                                                                                                     185

(b) Podiatrist                                                                                                      185

(c) Physician assistant                                                                                       75

(4) Montana Health Corps Registration                                                          25

(5) Additional standardized fees to be charged are specified in ARM 24.101.403.

(6) All fees are nonrefundable.

This rule has been repealed.

(1)  For the purpose of processing nonroutine applications, the board incorporates the definitions of routine and nonroutine at ARM 24.101.402 by reference.   

(2)  Nonroutine applications must be reviewed and approved by the board before a license may be issued.

(1)  The board incorporates ARM 24.101.406 by reference with the following modification: 

(a)  Nonviolent misdemeanor convictions involving driving under the influence (DUI) in (5)(a) are routine if the conviction date is more than five years before the application date, unless the applicant is still in custody due to the conviction.

(2) To be qualified, an evaluation program must meet the following criteria:

(a) possess the knowledge, experience, staff, and referral resources necessary to fully evaluate the forensic and clinical condition(s) of impairment in question;

(b) adhere to all applicable federal and state confidentiality statutes and regulations;

(c) have no actual or perceived conflicts of interest between the evaluator and the referent or patient which includes:

(i) no secondary gain may accrue to the evaluator dependent on evaluation findings/outcome;

(ii) there can be no current treatment relationship with the professional being evaluated; and

(iii) the evaluator cannot be affiliated with the entity requiring the evaluation;

(d) keep the physician assistance program fully advised throughout the evaluation process;

(e) have resources available to conduct a secondary intervention as indicated/needed at the time diagnoses and recommendations are discussed;

(f) have immediate access to medical and psychiatric hospitalization if needed;

(g) be able to arrange for timely intake and admission;

(h) fully disclose costs prior to admission;

(i) evaluate all causes of impairment, including:

(i) mental illness;

(ii) chemical dependency and other addictions;

(iii) dual diagnosis;

(iv) behavioral problems including: sexual harassment, disruptive behaviors, abusive behaviors, criminal conduct; and

(v) physical illness including: neurological disorders and geriatric decline;

(j) employ standardized psychological tests and questionnaires during the evaluation process;

(k) conduct comprehensive and discrete collateral interviews of colleagues and significant others to develop an unbiased picture of all circumstances, behavior, and functioning;

(l) make rehabilitation/treatment recommendations; and

(m) have resources and qualified staff to complete a multidisciplinary assessment if recommended.

(3) To be qualified, a treatment program must meet the following criteria:

(a) meet criteria as listed in (2);

(b) allow physician assistance program staff to visit the treatment site and the referred patients;

(c) maintain a business office capable of and willing to work with insurance providers and assist indigent physicians with payment plans;

(d) have a peer professional patient population and a staff accustomed to treating this population;

(e) make appropriate referrals when faced with a patient who has an illness/issue that is outside of the program's area of expertise;

(f) maintain a staff-to-patient ratio conducive to each patient receiving individualized attention;

(g) inform the physician assistance program throughout the treatment process through calls from the therapists involved, as well as written reports. Type and frequency of contact may be arranged with the physician assistance program, but in all cases should occur no less than monthly;

(h) include a strong family program;

(i) report immediately to the physician assistance program, a patient's threat to leave against medical advice, any discharges against medical advice, therapeutic discharges, any other irregular discharge or transfer, hospitalization, positive urine drug screen, noncompliance, significant change in treatment protocol, significant family or workplace issues, or other unusual occurrences;

(j) specifically, the staff must be vigilant in screening for, identifying, and diagnosing covert co-occurring addictions and comorbid psychiatric illnesses and address these concurrently with the presenting illness. This includes appropriately assessing and managing concurrent chronic pain diagnoses (in house, consultative, and/or referral capacity);

(k) use a multidisciplinary team approach and include psychological, psychiatric, and medical stabilization;

(l) provide disclosure of full fees upfront;

(m) offer a flexible payment plan for the varied income levels of participants, but the patient should make some financial investment into the treatment process;

(n) determine clinically justified length of residential stay;

(o) maintain complete and appropriate records to fully defend diagnoses, treatment, and recommendations; and

(p) provide discharge planning and coordination, including documentation of final diagnoses, recommendations for return to work, and aftercare recommendations.

(4) A treatment program that offers substance use disorder treatment must also meet the following:

(a) use an abstinence-based model with provision for appropriate psychoactive medication as prescribed. In rare cases that are refractory to abstinence-based treatment, alternative evidence-based approaches should be considered;

(b) make available, when a 12-step model is utilized for substance use disorders, appropriate therapeutic alternatives (acceptable to the physician assistance program) to participants with religious or philosophical objections;

(c) provide a strong family program. The family program component should focus on disease education, family dynamics, and supportive communities for family members. Family/significant other needs must be accessed early in the process and participation with family/significant other programs and family and individual therapy and treatment encouraged;

(d) offer treatment services that include:

(i) intervention and denial reduction;

(ii) detoxification; and

(iii) ongoing assessment and treatment of patient needs throughout treatment, with referral for additional specialty evaluation and treatment as appropriate;

(e) offer family treatment;

(f) offer group and individual therapy;

(g) offer educational programs;

(h) offer mutual support experience (e.g. AA/NA/etc.) and appropriate alternatives when indicated;

(i) develop a continuing care plan and sobriety support system for each participant;

(j) offer relapse prevention training;

(k) assess return to work/fitness to practice prior to discharge; and

(l) extend treatment options when indicated.

(5) The physician assistance program will maintain a current list of qualified programs available to accept referrals for evaluation and treatment.

(1) The Montana Board of Medical Examiners has established a program which provides assistance, rehabilitation, and after-care monitoring to all licensed health care providers under the jurisdiction of the board who are suspected and/or found to be physically or mentally impaired by habitual intemperance or the excessive use of addictive drugs, alcohol, or any other drug or substance, or by mental or chronic physical illness.

(2) The board encourages and shall permit the rehabilitation of licensees, if in the board's opinion, public health, safety, and welfare can be assured. Early intervention and referral are paramount to promoting public health, safety, and welfare.

(2) Individuals, entities, or associations may report information of suspected impairment of a licensee or new license applicant to the appropriate personnel of the professional assistance program established by the board in lieu of reporting to the board, as provided in 37-3-203 and 37-3-401 , MCA.

(3) Reports received by the board of suspected impaired licensees or license applicants may be referred to the professional assistance program at the board's discretion through the nondisciplinary track without formal disciplinary action against the licensee or license applicant.

(a) enter into a contractual agreement with the professional assistance program for the specified length of time determined by the professional assistance program; and

(b) abide by all the requirements set forth by the professional assistance program.

(2) Self-reporting by a licensee or license applicant may still result in disciplinary action by the board, if:

(a) the professional assistance program determines that the self-reporting licensee or the license applicant poses a danger to themselves or to the public;

(b) the licensee or license applicant is noncompliant with a contractual agreement with the professional assistance program;

(c) the licensee or license applicant has not completed evaluation, treatment, or after-care monitoring as recommended by the professional assistance program; or

(d) the screening panel otherwise determines that disciplinary action is warranted.

(3) The professional assistance program shall notify the board, disclose the identity of the licensee or license applicant involved, and provide all facts and documentation to the board whenever:

(a) the licensee or license applicant:

(i) has committed an act described in 37-3-323 or 37-3-401 , MCA;

(ii) is noncompliant with a recommendation of the professional assistance program for evaluation, treatment, or after-care monitoring contract; or

(iii) is the subject of credible allegations that the licensee or license applicant has put a patient or the public at risk or harm; or

(b) the screening panel otherwise determines disciplinary action is warranted.

(a) providing two tracks for assistance of licensees and license applicants under the board's jurisdiction:

(i) a disciplinary track; and

(ii) a nondisciplinary track;

(b) providing recommendations to licensees and license applicants for appropriate evaluation and treatment facilities;

(c) recommending to the board terms and conditions of treatment, rehabilitation, and monitoring of licensees or license applicants known to the board; and

(d) monitoring all aftercare of participants under contract, to ensure public safety and compliance with agreed treatment recommendations propounded by one or more of the following:

(i) the board, through stipulations and/or final orders;

(ii) treatment centers; and

(iii) the professional assistance program established by the board.

(2) The professional assistance program shall consult with the board regarding professional assistance program processes and procedures to ensure program responsibilities are met, consistent with board orders, requests and contract terms.

(3) The professional assistance program shall provide information to and consult with the board upon the board's request.

(2) A licensee or license applicant is placed in the disciplinary track by one or more of the following:

(a) as a condition of licensure imposed by a board final order;

(b) as a result of a sanction imposed by a board final order;

(c) as a result of noncompliance with the licensee's or license applicant's contractual agreement with the program;

(d) pursuant to an agreement between the licensee and the screening panel; or

(e) pursuant to an agreement between the license applicant and the full board.

(2) The identity of the participant who is noncompliant or refuses a reasonable request by the professional assistance program shall be reported to the board.

(3) If the board determined that a participant does not abide by all terms and conditions of the professional assistance program, the participant will be referred to the screening panel of the board for appropriate action under the disciplinary track.

(a) under a monitoring agreement;

(b) referred to the program; or

(c) in the process of evaluation or treatment.

(2) The full board shall receive a written compliance status report from the professional assistance program, at intervals established by contract between the program and the board, regarding each participant:

(a) under a monitoring agreement;

(b) referred to the program; or

(c) in the process of evaluation or treatment.

(3) The identity of a participant in the nondisciplinary track must be reported to the full board by participant number except as required by ARM 24.156.438.

(4) The identity of a participant in the disciplinary track must be reported to the full board by name.

(2) The discharge criteria must be determined by the board in conjunction with the recommendations of the professional assistance program.

(3) The following are required upon discharge of a participant from the endorsed professional assistance program:

(a) report of the discharge of the participant to the board; and

(i) verification of satisfactory completion of monitoring, program requirements, and appropriate assurance of public safety;

(ii) completion of board final order terms and conditions with professional assistance recommendation for discharge and release;

(iii) request by a participant to transfer assistance into an appropriate endorsed professional assistance program in another jurisdiction, such transfer to be confirmed by the program.

(a) A participant who has a single episode of relapse and/or early detection of relapse with nominal substance abuse may be reported to the board by the professional assistance program.

(b) A participant who has a second or severe relapse must be reported by the professional assistance program to the board screening panel for review.

(2) Any of the following may be required by the board, upon the recommendation of the professional assistance program, when a participant suffers relapse:

(a) the participant may be required to withdraw from practice;

(b) the participant may undergo further recommended evaluation and/or treatment as determined by the professional assistance program;

(c) the participant's monitoring agreement required by the professional assistance program must be reassessed and may be modified;

(d) the participant may be required to comply with other recommendations of the professional assistance program; or

(e) the participant may be subject to discipline as imposed by a board final order.

(1) Each person licensed by the board shall store, transport off premises, and dispose of infectious wastes, as defined in 75-10-1003, MCA, in accordance with the requirements set forth in 75-10-1005, MCA.             

(2) Used sharps are properly packaged and labeled within the meaning of 75-10-1005, MCA, when this is done as required by the Occupational Safety and Health Administration (OSHA).

This rule has been repealed.

This rule has been repealed.

(1) All medical student practice shall be under the direct supervision of a Montana-licensed physician except patient care in an emergency room shall occur only in the physical presence of the supervising physician.

(2) A medical student may:

(a) assist the licensed physician in medical procedures in an office or hospital;

(b) assist the licensed physician in surgery;

(c) participate in patient conferences;

(d) participate in medical research;

(e) prescribe medications with the supervising physician's co-signature;

(f) write or issue orders with the supervising physician's co-signature; and

(g) sign hospital records or patient charts with the supervising physician's co-signature.

(3) Either the medical school or the supervising physician shall carry malpractice insurance covering the medical student's practice during training.

(1) An internship which is not an "approved internship" as defined by 37-3-102, MCA, may be approved upon investigation by the board at the expense of the applicant. 

(2) The board may extend the time of internship beyond one year.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) A residency is approved for purposes of 37-3-102(3), MCA, if the training program meets the following criteria:

(a) is in a hospital or clinic located in the United States; and

(b) has been approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association.

(2) Alternatively, a residency is approved if, upon investigation, the board finds that the residency:

(a) is approved by, or affiliated with, the World Health Organization;

(b) carries malpractice insurance; and

(c) requires residents to have sufficient fluency in spoken and written English to practice medicine with reasonable skill and safety.

(1) Physician supervision requirements and limitations on patient care by interns and residents shall adhere to the requirements set by the internship or residency program in which the post-graduate is enrolled.

(2) A resident who holds a Montana physician or resident license may practice outside of the residency program without the supervision of a Montana-licensed physician (i.e., "moonlight") with the permission of the residency program director.
 

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) Eligibility requirements for USMLE Step III are:

(a) an M.D. or D.O. degree;

(b) completion or near completion of one year of postgraduate training in a program of graduate medical education accredited by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association;

(c) a passing score on one of the following:

(i) National Board of Medical Examiners examination (NBME) Parts I and II, taken before January 1, 2000; or

(ii) Federation Licensing Examination (FLEX) Component I, taken before January 1, 2000; or

(iii) USMLE Steps I and II; and

(d) for foreign medical graduates not eligible for the fifth pathway, a passing score on ECFMG.

(2) USMLE Step III must be taken within seven years of the applicant's first examinations under (1)(c), unless the applicant is or has been a student in a recognized M.D./Ph.D. program in a field of biological sciences tested in the Step I content. Applicants seeking an exception to the seven-year rule shall present a verifiable and rational explanation for being unable to meet the seven-year limit.

(3) If an applicant fails to pass the first attempt at USMLE Step III, the applicant may be reexamined no more than five additional times.

(4) For exams taken prior to January 1, 2000, the board will accept the following combination of examinations, with passing scores on each:

(a) NBME Parts I, II, and III; or

(b) NBME Part I or USMLE Step 1, plus NBME Part II or USMLE Step 2, plus NBME Part III or USMLE Step 3; or

(c) FLEX Components 1 and 2; or

(d) FLEX Component 1 plus USMLE Step 3; or

(e) NBME Part I or USMLE Step 1, plus NBME Part II or USMLE Step 2, plus FLEX Component 2.

(5) For exams taken after January 1, 2000, the board will accept only USMLE Steps 1, 2, and 3.

(6) The board will accept an examination by the National Board of Examiners for Osteopathic Physicians and Surgeons, or its successor, with a passing score, regardless of date of examination.

(1) A license will not be granted to a foreign medical graduate unless:

(a) the graduate has had three years of post-graduate training education in a post-graduate institution that has been approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association or successors; or

(b) the graduate has had three years of postgraduate training education in a program approved by or affiliated with the World Health Organization and has sufficient fluency in spoken and written English to practice medicine with reasonable skill and safety; or

(c) the graduate has been granted board certification by a specialty board which is approved by and a member of the American Board of Medical Specialties or the American Osteopathic Association, or provides verification of being a certificant of the College of Family Physicians of Canada, a fellow of the Royal College of Physicians, or a fellow of the Royal College of Surgeons.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The board may, in its discretion, grant an exemption to a physician who renders medical services in this state, provided that the physician:

(a) submits an application to the board describing the date, place, and the scope of practice and/or the procedure to be performed, and a statement detailing the need for the physician's expertise in Montana, prior to such service;

(b) submits proof of medical licensure (active and in good standing) and practice in another state or territory of the United States;

(c) submits the name of a physician licensed in this state who will be in attendance and will assume continuing care for the patient; and

(d) limits the service to an occasional case.

(2) An occasional case is defined as not more than two cases per year. A single case may include rendering medical services to multiple patients on no more than five consecutive or nonconsecutive days.

(3) An occasional case exemption is valid for two months from the date of issuance.

(1) A medical resident within six months of completing an approved residency program may apply for a physician license and must:

(a) submit a completed application on a form approved by the board;

(b) provide verification from an approved residency program that the applicant is in good standing and expected to complete the residency program within six months of the date of application;

(c) pay the physician license application fee as prescribed in ARM 24.156.409; and

(d) provide to the board any additional information the board or the board's designee deems necessary to evaluate the applicant's eligibility for licensure.
 

(1) A Montana-licensed physician who wishes to apply for expedited licensure in another state that is a member of the Interstate Medical Licensure Compact shall:

(a) submit a completed application on a form approved by the board;

(b) pay an application fee for licensure in another state via interstate compact per ARM 24.156.409; and

(c) designate Montana as the state of principal license in compliance with 37-3-356, MCA.

(2) Upon receiving an application for expedited licensure via the Interstate Medical Licensure Compact, the department shall:

(a) conduct a review of qualifications and a criminal background check as required by 37-3-356, MCA; and

(b) inform the Interstate Medical Licensure Compact Commission whether or not the applicant meets the qualifications of 37-3-356, MCA.

(1) All licensees will renew for a period of two years.

(2) A physician actively engaged in the practice of medicine with an active license shall pay a license renewal fee. If the physician does not pay the license renewal fee and return the required renewal before the date set by ARM 24.101.413, the physician must pay the late penalty fee specified in ARM 24.101.403 in order to renew the physician's license.

(3) A physician with an active license who is not actively engaged in the clinical practice of medicine in this state, or who is absent from this state for a period of one or more years, may renew as an inactive licensee and pay the inactive fee listed in ARM 24.156.409.

(a) A physician seeking to renew an inactive Montana license as an active license (reactivate), and who has ceased the clinical practice of medicine in all jurisdictions for the two or more years during which the license has been inactive preceding the request for reactivation, must seek reactivation pursuant to ARM 24.156.618.

(4) The provisions of ARM 24.101.408 apply.

This rule has been repealed.

(1) If the board determines that an applicant or licensee possesses the qualifications for licensure required under Title 37, chapter 3, MCA, the board may instruct the department to issue licenses in the following categories:

(a) active license;

(b) inactive license; or

(c) limited temporary (resident).

(2) An active license is required for a physician actively practicing medicine in this state at any time during the renewal period.

(a) The term "actively practicing medicine" means the exercise of any activity or process identified in 37-3-102, MCA.

(3) An active license is required for a physician participating in the Montana health corps.

(4) An inactive license may be obtained by a physician who is not actively practicing medicine in this state, and does not intend to actively practice medicine in this state at any time during the current renewal period, but may wish to reactivate in the next renewal period.

(a) To renew a license on inactive status, a physician must pay a fee prescribed by the board, and complete the renewal prior to the date set by ARM 24.101.413.

(b) If both the renewal fee and completed renewal are not returned prior to the date specified in ARM 24.101.413, the physician must pay the late penalty fee specified in ARM 24.101.403 in order to renew the license.

(5) An inactive-retired license may be renewed by the renewal date set in ARM 24.101.413 through March 31, 2016, after which date the inactive-retired status no longer will be granted.

(1) A physician seeking to reactivate a Montana license, which has been inactive for the two or more years preceding the request for reactivation, and who has ceased the clinical practice of medicine in all jurisdictions for the entire time during which the license has been inactive, may be required to do one or more of the following:

(a) practice for a specified period of time under a mentor/supervising physician who will provide periodic reports to the board;

(b) obtain certification or recertification by a specialty board recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association's Bureau of Osteopathic Specialists (AOA-BOS);

(c) complete one year of accredited postgraduate or clinical fellowship training, which must be preapproved by the board;

(d) pass the Special Purpose Examination (SPEX) or the Comprehensive Osteopathic Medical Variable Purpose Examination (COMVEX). The applicant who fails the SPEX or COMVEX examination three times, whether in Montana or other states, must successfully complete one year of an accredited residency or an accredited or board-approved clinical training before retaking the SPEX or COMVEX examination;

(e) undergo a competency evaluation by an entity approved by the board;

(i) if deemed necessary, complete a reentry plan that has been approved by the board prior to the applicant beginning the plan, to the satisfaction of the board;

(f) complete any other requirements as determined by the board; and

(g) pay the difference between the fee for an inactive and active license.

(2) A physician seeking to reactivate a Montana license, which has been inactive for the two or more years preceding the request for activation, and who has practiced medicine on an active license in another state or jurisdiction for the five years preceding the request to reactivate, may be required to appear before the board, and must:

(a) provide verification of one or more active licenses maintained during the time period the physician has held an inactive Montana license;

(b) identify all locations and dates of practice during the five years preceding the request for reactivation; and

(c) pay the difference between the fee for an inactive and active license.

(3) A physician seeking to participate in the Montana health corps and holding an active license, who has ceased the clinical practice of medicine for two or more years preceding the health corps application date, is required to comply with the requirements set forth in (1).

This rule has been repealed.

This rule has been repealed.

(1) In those cases brought pursuant to the provisions of 37-3-323, MCA, such proceedings may be initiated by any person or a member of the board by the filing of a written, signed complaint in which the charge or charges against the licensee are stated separately and with particularity. Such a complaint may be delivered to and filed with the board by any person of legal age or may be delivered to and filed with the board by the executive officer of the board or by the attorney for the board.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) An applicant who holds an active license to practice medicine in the State of Montana and who wants to participate in the health corps program shall:

(a) complete and return a registration form approved by the board, together with accompanying documentation; and

(b) submit a registration fee.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) A physician who holds an active license to practice medicine in Montana, as a health corps volunteer, may practice medicine within the scope of their training and experience by providing outpatient care to eligible individuals. 

(2) Health corps physicians shall provide a written disclosure on the limitation on legal liability to patients of the health corps program.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) Treatment of a patient who is physically located in Montana by a licensee using telemedicine occurs where the patient is physically located.

(2) The licensee using telemedicine in the treatment and care of patients in Montana shall adhere to the same standards of care required for in-person medical care settings.

(3) A provider-patient relationship may be established for purposes of telemedicine:

(a) by an in-person medical interview and physical examination when the standard of care requires an in-person encounter;

(b) by consultation with another licensee or health care provider who has a documented relationship with the patient and who agrees to participate in, or supervise, the patient's care; or

(c) through telemedicine if the standard of care does not require an in-person encounter.

(4) The licensee using telemedicine in patient care may prescribe Schedule II drugs in compliance with Drug Enforcement Agency requirements and 37-20-404, MCA.

(5) The licensee using telemedicine in patient care shall:

(a) make available to the patient verification of the licensee's identity and credentials;

(b) verify the identity of the patient;

(c) establish a provider-patient relationship prior to initiating care;

(d) obtain a medical history sufficient for diagnosis and treatment in keeping with the applicable standard of care prior to providing treatment or issuing prescriptions, or delegating the patient's medical services to other health care providers;

(e) delegate the patient's medical care only to health care providers:

(i) who are known by the licensee to be qualified and competent to perform the delegated services;

(ii) with whom the patient has an established provider-patient relationship; or

(iii) who have physical or electronic access to the licensee for consultation and follow-up while the patient is under the licensee's or the delegee's care;

(f) securely maintain and make timely available:

(i) to the patient or the patient's representative all relevant medical and billing records received or produced in connection with the patient's care; and

(ii) to other health care providers all medical records received or produced in connection with the patient's care.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) Ankle surgery certification will be granted to a doctor of podiatric medicine licensed to practice in Montana, or to an otherwise qualified applicant for a license to practice podiatric medicine in Montana, who makes application on forms provided by the board, and who:

(a) submits proof of certification by the American Board of Foot and Ankle Surgery or its successor(s) in foot and ankle surgery or reconstructive rearfoot/ankle surgery; or

(b) submits proof of current licensure or certification to perform ankle surgery in another state whose licensing standards at the time the license or certificate was issued were essentially equivalent, in the judgment of the board, to those of this state; or

(c) submits proof of completion of a podiatric surgical residency approved in the year of the candidate's residency by the Council on Podiatric Medical Education or the American Board of Foot and Ankle Surgery or its successor(s), and submits evidence satisfactory to the board of not fewer than 25 ankle surgeries performed by the applicant and proctored by a primary surgeon of record who is an orthopedic surgeon with foot and ankle experience or a doctor of podiatric medicine with ankle surgery certification within the five years immediately preceding the application.

(2) The applicant shall submit a nonrefundable fee of $100 with the application for certification in ankle surgery.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) "Equivalent experience or training" per 37-6-302(2)(c), MCA, means:

(a) successful completion of a 12-month preceptorship in a jurisdiction that statutorily authorizes preceptorships and sets standards in rule for preceptor clinical affiliation, scope of preceptor practice, and standards for review and completion of the program;

(b) a minimum of three years of active clinical practice in another jurisdiction or in the armed forces with licensing standards substantially equivalent to or greater than the standards in this state;

(c) completion of at least one year of postdoctoral fellowship training;

(d) a minimum of two years of full-time teaching in a college of podiatric medicine subsequent to receipt of the degree of doctor of podiatric medicine; or

(e) successful evaluation of clinical competency in a program approved by the board prior to initiation of evaluation.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) A licensee shall conform to generally accepted principles and the standards of dietetic practice which are those generally recognized by the profession as appropriate for the situation presented, including those promulgated or interpreted by or under the Academy of Nutrition and Dietetics or Commission on Dietetic Registration, and other professional or governmental bodies.

(2) A licensee who demonstrates appropriate education and experience may engage in the practice of diabetes education as defined and credentialed by the Academy of Nutrition and Dietetics and the American Association of Diabetes Educators.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been transferred.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been transferred.

This rule has been transferred.

This rule has been transferred.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been transferred.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) A physician assistant student training in Montana is not required to apply for licensure under these rules.

(2) A physician assistant student must train under the supervision of a physician or a physician assistant who is licensed in Montana.

(3) A physician assistant student training in Montana must:

(a) be currently enrolled in a physician assistant training program accredited by the Accreditation Review Commission on Education for the Physician Assistant or, if accreditation was granted before 2001, accredited by the American Medical Association's Committee on Allied Health Education and Accreditation or the Commission on Accreditation of Allied Health Education Programs; and

(b) conspicuously wear an identification badge indicating that he or she is a "physician assistant student" whenever engaged in patient care activities.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) Chart review for a physician assistant shall occur, with frequency and amount to be determined at the practice level and as described in the collaboration agreement.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) For purposes of the rules set forth in this subchapter, the following definitions apply:

(a) "Clinical experience" means supervised instruction, observation, or practice in a patient care setting as part of a course curriculum.

(b) "Clinical preceptor" means an individual licensed to a licensure level greater than the student, who is responsible for supervising and teaching the student in a clinical setting, under the supervision of the medical director or lead instructor.

(c) "Curriculum" means the combination of the National EMS Educational Standards and Instructional Guidelines prepared by the USDOT, and the Montana ECP Practice Guidelines.

(d) "Endorsement" means a supplement within a level of licensure issued in conjunction with the appropriate standard license type (EMR, EMT, AEMT, or Paramedic). Each endorsement acquired by a licensee indicates the licensee has obtained a defined set of skills and knowledge, determined and approved by the board or its designee, that expands the scope of practice of the ECP.

(e) "Lead instructor" is an endorsement which indicates the endorsed licensee has attended a board-approved instructor training program and is authorized to offer and conduct ECP courses.

(f) "Medical director" means a physician or physician assistant who holds a current unrestricted Montana license and is professionally and legally responsible for training, providing medical direction, and oversight of licensed ECPs under the medical director's supervision.

(g) "Montana ECP Practice Guidelines" means the written guidelines developed, approved, and distributed by the board, that provide guidance to medical directors and ECPs licensed to practice at all levels.

(h) "Offline medical direction" means general medical oversight and supervision for an emergency medical service or an ECP, including, but not limited to, review of patient care techniques, emergency medical service procedures, and quality of care.

(i) "Online medical control" means real-time interactive medical advice or orders to ECPs.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The board shall license an applicant as an ECP at the appropriate licensure level if the applicant:

(a) has successfully completed an ECP course of instruction at or above the level of requested licensure; and

(b) possesses a current active or inactive NREMT certification equal to or greater than the level applied for, or provides a current unrestricted substantially equivalent ECP license or certification in another state which has a complaint process.

(2) If an applicant is not eligible for certification by NREMT, the board or its designee may approve the applicant to undergo an assessment exam administered by NREMT and provide proof of passage of the assessment exam to the department in lieu of a NREMTcertification card.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) All licensed ECPs are required to complete continued competency requirements prior to their license expiration date.

(2) Proof of completion shall be retained by the ECP and submitted to the department upon request in one of the following forms:

(a) a current active or inactive NREMT certification card; or

(b) a certificate of completion, issued and signed by the lead instructor and/or medical director, of the NREMT continued competency training requirements.

(3) The lead instructor is responsible for the quality, consistency, and management of the continued competency training at the EMR and EMT levels and shall maintain records of all courses conducted including an agenda and detailed student performances that document the licensee's ability demonstrated during the training.

(4) The medical director is responsible for the quality, consistency, and management of the continued competency training at the EMT with endorsement(s), AEMT, and paramedic levels. The medical director may assign duties as appropriate, but retains the overall responsibility for the training.

(5) All ECPs shall affirm understanding of their recurring duty to comply with continued competency requirements as part of license renewal.

(a) The ECP is responsible for maintaining documentation of completed continued competency training and their medical director's authorization/attestation of continued competence (including endorsement skills) on a board-approved form which shall be made available to the board upon request.

(b) The medical director may require the ECP to complete training to ensure competency of endorsement skills.

(1) An expired ECP license may be reactivated upon completion of an expired license renewal application. To reactivate an expired license an ECP shall:

(a) meet department requirements under ARM 24.101.403 and 24.101.408; and

(b) provide documentation of completion of all renewal requirements required under ARM 24.156.2718.

(1) An individual, corporation, partnership, or any other organization may conduct ECP training courses. All ECP training courses or programs must include the following:

(a) current USDOT curriculum;

(b) Montana ECP Practice Guidelines;

(c) statutes and rules governing ECPs in Montana;

(d) a final competency evaluation including a practical skill evaluation; and

(e) certificate of successful completion which states:

(i) full name of student;

(ii) start and end dates of the course;

(iii) course level; and

(iv) names of designated lead instructor and/or medical director.

(2) A clinical component must be included and documented in the following levels of ECP courses:

(a) EMT course participants must complete a minimum of ten hours of clinical experience during which the student shall:

(i) observe patient care on at least 5 patients; and

(ii) perform a patient assessment on at least 5 adult patients.

(b) AEMT course participants shall:

(i) properly administer medications at least 10 times to live patients;

(ii) successfully access the venous circulation at least 15 times on live patients of various age groups;

(iii) ventilate at least 15 live patients of various age groups;

(iv) perform an advanced patient assessment on at least 15 adult patients, 5 pediatric patients, and 10 trauma patients;

(v) perform an advanced patient assessment, formulate and implement a treatment plan on at least 10 patients with chest pain;

(vi) perform an advanced patient assessment, formulate and implement a treatment plan on at least 10 adult patients and 3 pediatric patients with dyspnea/respiratory distress;

(vii) perform an advanced patient assessment, formulate and implement a treatment plan on at least 10 patients with altered mental status; and

(viii) serve as the team leader for at least 20 prehospital emergency responses.

(c) Paramedic course participants shall:

(i) properly administer medications at least 15 times to live patients;

(ii) successfully intubate at least 5 live patients;

(iii) successfully access the venous circulation at least 25 times on live patients of various age groups;

(iv) ventilate at least 20 live patients of various age groups;

(v) perform a comprehensive patient assessment on at least 50 adult patients, 30 pediatric patients (including newborns, infants, toddlers, and school age), 40 trauma patients, 30 geriatric patients, 10 obstetric patients, and 20 psychiatric patients;

(vi) perform a comprehensive patient assessment, formulate and implement a treatment plan on at least 30 patients with chest pain;

(vii) perform a comprehensive patient assessment, formulate and implement a treatment plan on at least 20 adult patients and 8 pediatric patients (including infants, toddlers, and school age) with dyspnea/respiratory distress;

(viii) perform a comprehensive patient assessment, formulate and implement a treatment plan on at least 10 patients with syncope;

(ix) perform a comprehensive patient assessment, formulate and implement a treatment plan on at least 20 patients with abdominal complaints;

(x) perform a comprehensive patient assessment, formulate and implement a treatment plan on at least 20 patients with altered mental status; and

(xi) serve as the team leader for at least 50 prehospital emergency responses.

(3) Upon written request from the medical director of an AEMT or paramedic course, the board or its designee may approve substitution of patient simulators for up to 50 percent of the live patient requirements specified under (2)(b) and (c).

(4) All levels of ECP courses must designate a lead instructor and a medical director. The lead instructor is under the supervision of the board and medical director for these courses.

(5) The medical director of an ECP course shall be responsible for the overall quality, consistency, and management of the ECP course in which they agree to provide medical oversight. The medical director may delegate duties where appropriate.

(a) Medical direction of an EMR or EMT level course consists of review of agenda, selection of instructors, review of evaluation tools, and review of clinical offerings and objectives.

(b) Medical direction of an AEMT or paramedic level course consists of approval of agenda, approval and selection of instructors, involvement in the development and implementation of evaluation tools, participation as an instructor, approval of clinical offerings and objectives to be met by clinical components, and verification of successful course completion for each student.

(6) The lead instructor of an EMR course shall:

(a) issue a certificate as provided under (1)(e);

(b) complete the course within six months of the date the course commences; and

(c) provide at least one instructor per six students when practical skills are taught or evaluated.

(7) The lead instructor of an EMT course shall:

(a) issue a certificate as provided under (1)(e);

(b) complete the course within 12 months of the date the course commences;

(c) provide at least one instructor per six students when practical skills are taught or evaluated; and

(d) provide the clinical experience as specified under (2)(a).

(8) The lead instructor and medical director of an AEMT or paramedic course shall:

(a) issue a certificate as provided under (1)(e);

(b) provide clinical experience as specified under (2)(b) and (c);

(c) complete the course in the following time frames:

(i) AEMT course within 18 months from the starting date of the course; and

(ii) paramedic course within 24 months from the starting date of the course;

(d) provide clinical experiences with no fewer than one clinical preceptor for every two students; and

(e) provide sufficient patient accessibility to allow students to complete all clinical experiences within the course dates.

(9) Requests for extension of required course completion times stated in (8)(c) must be submitted in writing and may be granted by the board or its designee.

This rule has been repealed.

This rule has been repealed.

(1) Within 60 days of taking on the responsibilities of providing medical oversight as a medical director to an individual or group of ECPs, a physician or physician assistant shall:

(a) notify the board they are providing medical direction to ECPs on a form provided by the board; and

(b) provide proof of completion of a board-approved medical director training program or a board-approved exemption from the training on a form provided by the board.

(2) The medical director shall be responsible for the overall medical care provided by the ECPs for whom the director agrees to provide medical oversight.

(3) The medical director overseeing an ECP may grant or restrict the ECP's practice or utilization of any endorsement.

(4) The medical director must maintain and have access to records of all ECPs for whom the director provides medical oversight. These records must document:

(a) the name, address, and current Montana licensure of the ECP, including any endorsements;

(b) date when medical oversight began and at what level the ECP is authorized to practice; and

(c) any changes to limit or approve the ECP's authorization to function at the ECP's current licensure level including endorsement(s).

(5) The medical director must develop a process to continuously meet the applicable standard of medical practice and patient care. This process may include regular review of patient care reports (PCR), direct observation of care, skills demonstrations, and ongoing involvement in ECP education. Documentation of these activities must be maintained by the medical director.

(6) The medical director is responsible for assessing competency of skills required for endorsements held by ECPs under the medical director's supervision and shall sign an affidavit stating such competence as required under ARM 24.156.2718.

(7) A medical director may assign duties where appropriate, but retains the responsibility for all assigned duties. This includes delegation of:

(a) local offline medical direction responsibilities to another unrestricted Montana licensed physician or physician assistant; and

(b) maintenance of records required under (4).

(8) The medical director will approve and review the offering of online medical control which must be provided by any unrestricted Montana licensed physician or physician assistant who has been contacted for this purpose.

(9) A medical director shall provide written notice to the ECP and the board upon discontinuing medical oversight.

(10) The medical director shall be responsible for and approve a system to assure the inventory, storage, and security of all the medications utilized by the ECPs to whom the medical director provides medical oversight. The medical director may delegate the day-to-day duties where appropriate but retains overall responsibility.

(11) A medical director may not unilaterally alter a patient care plan developed by a physician, PA, or APRN for care provided by an ECP with a CIHC endorsement.

This rule has been repealed.

This rule has been repealed.

(1) The board issues four levels of licenses for ECPs. Each level has endorsements that may be added to an ECP license. Endorsements do not have to be acquired in the order listed below and may consist of one or more combinations within each ECP level. The levels of licensure and endorsements are as follows:

(a) EMR licenses:

(i) EMR monitoring;

(ii) lead instructor; and

(iii) CIHC.

(b) EMT licenses:

(i) medication;

(ii) IV and IO (intravenous infusion and intraosseous infusion) initiation;

(iii) IV and IO (intravenous infusion and intraosseous infusion) maintenance;

(iv) airway;

(v) lead instructor; and

(vi) CIHC.

(c) AEMT licenses:

(i) AEMT medication;

(ii) AEMT-99;

(iii) lead instructor; and

(iv) CIHC.

(d) Paramedic licenses:

(i) critical care paramedic;

(ii) lead instructor; and

(iii) CIHC.

(1) An applicant for an ECP endorsement, at any level, shall submit an application on a form prescribed by the board, the appropriate fee, and:

(a) the applicant's verification of knowledge and skills as identified on a form provided by the board for each endorsement level for which the applicant is applying; and

(b) attestation of current Montana ECP license at the appropriate level to qualify for the endorsement.

(2) The applicant may voluntarily withdraw the application by submitting a written request to the board. All application fees submitted will be forfeited.

(1) An applicant for CIHC endorsement shall submit an application, the appropriate fees, and:

(a) verification of completion of a board-approved curriculum in community-integrated health care provided by an accredited institution of higher learning, which must include 48 hours of clinical experience; and

(b) attestation of a minimum of one year of experience at the applicant's current level of licensure.

(2) An ECP acting under a current CIHC endorsement shall:

(a) act within their scope of practice according to the Montana ECP Practice Guidelines;

(b) follow the patient care plan developed by the physician, PA, or APRN directing the CIHC to their patient, which may not be unilaterally altered by the ECP's medical director; and

(c) consult their medical director regarding scope of practice.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) A medical director may submit a petition for revisions to the Montana ECP Practice Guidelines.

(2) The petition must be submitted on a board-approved form with the following supporting documentation:

(a) a written recommendation and/or position statement for the revision; and

(b) literature supporting the recommendations and/or position.

(3) Upon receiving the petition, the board shall proceed as follows:

(a) the board's medical direction committee (committee) shall review an initial petition to determine whether to place the petition as an action item on the agenda for the next regularly scheduled board meeting;

(b) the committee may accept public comment regarding the petition;

(c) the committee shall present the board with a written recommendation; and

(d) the board shall consider the committee's recommendation and take action on the petition no sooner than the next regularly scheduled board meeting.

(4) The board shall approve the proposed revision when:

(a) it is demonstrated to the satisfaction of the board that granting the petitioner's request is necessary to provide appropriate standards of medical care;

(b) the board finds that the public's interest in granting the revision clearly outweighs the interest of maintaining uniform Montana ECP Practice Guidelines; and

(c) the board concludes the revisions will protect public health, safety, and welfare.

(1) An ECP licensed at an EMR or EMT level may perform any acts allowed within the ECP's licensure or endorsement level when:

(a) operating independently within the most current version of the Montana ECP Practice Guidelines;

(b) under the medical oversight of a medical director who is taking responsibility for the ECP; or

(c) participating in a continuing education program.

(2) An ECP licensed at an EMT with endorsement(s), AEMT, or paramedic level may perform any acts allowed within the ECP's licensure level or endorsement level when:

(a) under medical oversight of a medical director who is taking responsibility for the ECP; or

(b) participating in a continuing education program.

(3) An ECP legally licensed in good standing in the state from which they are responding may perform within their scope of practice at the level licensed, when functioning as a member of a licensed ambulance service that finds itself within the boundaries of Montana, while:

(a) responding to an emergency where the border is not clearly known;

(b) responding to an emergency in accordance to a mutual aid agreement with a Montana licensed EMS service; or

(c) conducting a routine transfer to or from a Montana medical facility.

(4) A student may perform beyond the level of his or her individual licensure when functioning as a student in an ECP training course conducted in accordance with board rules including participating in a clinical component of a course or program of instruction originating in another state that has a clinical contract with a Montana healthcare facility or a Montana licensed EMS agency and functions under the direct supervision of a clinical preceptor licensed in Montana. The student must perform within the Montana scope of practice at the level for which the student is a student candidate.

(5) Except as provided in (4), an ECP may not perform any acts that are beyond the ECP's level of licensure or endorsement.

(6) The medical director may limit the functioning scope of an ECP due to community needs and/or issues with maintaining competency. If, after remediation and review of an individual ECP's performance, the medical director has continuing concerns as to the ECP's ability to perform to the ECP's scope of practice, this shall be reported to the board.

(7) An ECP currently licensed and in good standing in another state may function during a state or federally managed incident in compliance with the Montana ECP Practice Guidelines, but shall comply with all of the following:

(a) the ECP's practice shall be limited to the duration of the state or federally managed incident;

(b) practice shall be conducted within the geographic area, whether on federal, state, or private land, designated as being within the state or federally managed incident;

(c) the ECP practices only at the level licensed in another state; however, if the ECP is licensed above the basic EMT level, the practice above a basic EMT level may only occur if the ECP has medical direction oversight provided by a Montana licensed physician or physician assistant approved by the board as a medical director, and the medical director authorizes the ECP to function beyond the basic EMT level;

(d) provide proof of current licensure and good standing in another state; and

(e) submit the appropriate form to the board.

(8) The board or their designee may conduct onsite visits of state or federally managed incidents to assure compliance.

This rule has been repealed.