STATE BOARD OF MEDICINE [49 PA. CODE CH. 16] Licensure, Certification, Examination and Registration Fees [28 Pa.B. 814] The State Board of Medicine (Board) proposes to amend § 16.13 (relating to licensure, certification, examination and registration fees) by raising the renewal fees to read as set forth in Annex A. The following indicates the change in fees for Board regulated practitioners:
License Class Current Fee Proposed Fee Medical Doctor $80 $125 Graduate Trainee $10 $ 15 Midwife $25 $ 40 Physician Assistant $25 $ 40 Acupuncturist $25 $ 40 Drugless Therapist $25 $ 35 Since 1975, the Board's revenue and expenses have been reserved in a restricted receipts account in the General Fund for exclusive use of the Board in implementing its licensure and enforcement activities. See section 907(b) of the Health Care Services Malpractice Act (40 P. S. § 1301.907(b)). Additionally, the sole purpose of the fund is to provide for the operations of the Board. Further, the Board derives all of its revenue from licensees.
The increase is proposed to take effect for the next biennial renewal, due by December 31, 1998. From 1976 through 1980, the renewal fees for physicians was $75. This fee was reduced to $50 from 1980 to 1982, and was further reduced to $25 from 1982 through 1990. During this period of time, the renewal fee was waived three times in 1982, 1984 and 1986. These reductions and waivers were taken to reduce the size of the Board's account balance at a time when revenues exceeded expenditures. The fee has been $80 since 1990.
Section 6 of the Medical Practice Act of 1985 (act) (63 P. S. § 422.6) requires the Board to fix fees by regulation to meet expenditures over a 2-year period so that projected revenues would meet or exceed projected expenditures.
The beginning balance in the Board's restricted account for FY 1994-95 was $1,265,234.53. Because FY 1994-95 was a biennial renewal year, revenues increased the beginning balance in the Board's restricted account for FY 1995-96 to $2,859,334.71. The beginning balance was reduced to $1,002,720.52 for FY 1996-97. FY 1996-97 was a biennial renewal year, thus, the balance in the restricted account rose to $2,220,647.33 for the beginning of FY 1997-98. This figure, however, represents a $638,687.38 decrease from the previous renewal cycle.
Projected expenditures will further reduce the account balance to $431,432.14 by the end of FY 1997-98. If revenues are not increased for the renewal period FY 1998-99, the projected beginning balance for FY 1999-00 will be $1,251,377.14. Because FY 1999-00 is a nonrenewal year, revenues will be significantly overtaken by expenditures, thus leaving a $1,324,202.86 deficit by the end of FY 1999-00. Even in FY 2000-01, a biennial renewal year, the deficit will remain at $386,105.26, and is projected to worsen from there.
It should be noted that account balance figures for FY 1997-98 and FY 1998-99 include a $300,000 loan and repayment from the Professional Licensure Augmentation Account, a pooled account for 22 licensing boards situated within the Bureau of Professional and Occupational Affairs. This loan was authorized by the General Assembly by Act 2-A of 1997, act of April 25, 1997, to forestall a potential shortfall in the Board's account.
Biennial revenues for the Board have remained relatively constant. In contrast, expenditures over the past 3 fiscal years have increased by an average of 7% per year and are projected to increase by 3% per year through FY 2000-01: (FY 1994-95: $2,191,515; FY 1995-96: $2,334,722; FY 1996-97: $2,494,215; Projected FY 1997-98: $2,851,000; Projected FY 1998-99: $2,986,000; Projected FY 1999-00: $3,075,580; Projected FY 2000-01: $3,167,847).
Because the Board's operations are funded almost entirely by licensee fees, the Board is in need of an increase in revenue in order to meet its statutory obligations in a timely and responsive manner. These obligations include issuing licenses, hearing and adjudicating complaints and assisting licensees and the public with legal-medical issues which come before the Board.
The proposed fee increase will generate approximately $6,526,250 in the biennium as indicated:
Licensee No. Fee Revenue Acupuncturists 240 $ 40 $ 9,600 Physician Assistants 1,504 $ 40 $ 60,160 Physician 43,532 $125 $5,441,500 Trainee 8,000 $ 15 $ 120,000 Midwife 265 $ 40 $ 10,600 Respiratory Care Practitioner 5,356 $ 25 $ 133,900 Non-renewal Revenue $ 750,000 Total $6,526,250 The current medical doctor renewal fee is the second lowest in the nation, behind only Arkansas. With the increase, it will be the ninth lowest. The current fee is the lowest of the Medical Board fees for the surrounding states and will remain the lowest of these states even with the increase. A review of the medical doctor renewal fees indicates a National average of $108.50. Twenty-eight state medical boards renew biennially, like the Commonwealth. Twenty-two states renew annually, and two renew every 3 years. Calculated annually, the Commonwealth currently charges medical doctors $40. That figure will rise to $62.50 with the increase.
Maryland $400 West Virginia $200 New Jersey $345 Delaware $160 New York $330 Pennsylvania $ 80 Ohio $250 The proposed fee is also reasonable relative to other Commonwealth health care professionals:
Chiropractor $210 Pharmacist $120 Dentist $100 Podiatrist $175 Nursing Home Admin. $108 Psychologist $120 Osteopathic Phys. $140 Registered Nurse $ 21 Optometrist $135 Veterinarian $105 If the proposed fee increase is implemented, the Board's financial status is projected to remain stable through FY 1998-2001.
Statutory Authority
Section 6 of the act requires the Board to establish fees by regulation. The same provision requires the Board to increase fees to meet or exceed projected expenditures if the revenues raised by fees, fines and civil penalties are not sufficient to meet expenditures.
Fiscal Impact
The proposed amendment will increase the biennial renewal fees for licensees of the Board, but should have no other fiscal impact on the private sector, the general public or political subdivisions.
Paperwork Requirements
The proposed amendment will require the Board to alter some of its forms to reflect the new biennial renewal fees; however, the proposed amendment should not create additional paperwork for the private sector.
Regulatory Review
Under section 5(a) of the Regulatory Review Act (71 P. S. § 745.5(a)), the Board submitted a copy of the proposed amendment on February 4, 1998, to the Independent Regulatory Review Commission (IRRC) and the Chairpersons of the House Committee on Professional Licensure and the Senate Committee on Consumer Protection and Professional Licensure. In addition to submitting the proposed amendment, the Board has provided IRRC and the Committees with a copy of a detailed regulatory analysis form prepared by the Board in compliance with Executive Order 1996-1. A copy of the material is available to the public upon request. If IRRC has objections to any portion of the proposed amendments, it will notify the Board by within 10 days of the close of the Committees' comment period. The notification shall specify the regulatory review criteria which have not been met by that portion. The Regulatory Review Act specifies detailed procedures for review of objections prior to final publication of the regulation by the Board, the General Assembly and the Governor.
Public Comment
Interested persons are invited to submit written comments, suggestions or objections regarding this proposed rulemaking to Cindy L. Warner, Board Administrator, State Board of Medicine, Post Office Box 2649, Harrisburg, PA 17105-2649, within 30 days following publication of this proposed rulemaking in the Pennsylvania Bulletin.
DANIEL B. KIMBALL, Jr., M.D.
ChairpersonFiscal Note: 16A-498. No fiscal impact; (8) recommends adoption.
Annex A TITLE 49. PROFESSIONAL AND VOCATIONAL STANDARDS PART I. DEPARTMENT OF STATE Subpart A. PROFESSIONAL AND OCCUPATIONAL AFFAIRS CHAPTER 16. STATE BOARD OF MEDICINE--GENERAL PROVISIONS SUBCHAPTER B. GENERAL LICENSE, CERTIFICATION AND REGISTRATION PROVISIONS § 16.13. Licensure, certification, examination and registration fees.
* * * * * (b) The fee for a license without restriction for a graduate of an accredited medical college is $20. The fee for a license without restriction for a graduate of an unaccredited medical college is $80. The biennial registration fee for a license without restriction is $[ 80 ] 125.
* * * * * (e) The fee for a graduate license for a graduate of an accredited medical college is $15. The fee for a graduate license for a graduate of an unaccredited medical college is $80. The fee to renew a graduate license is $[ 10 ] 15.
* * * * * (h) The fee for a midwife license is $20. The biennial registration fee for a midwife license is $[ 25 ] 40.
(i) The fee for a physician assistant certificate is $15. The biennial registration fee for a physician assistant certificate is $[ 25 ] 40.
* * * * * (m) The fee for an acupuncturist registration is $15. The biennial registration fee for an acupuncturist registration is $[ 25 ] 40.
* * * * * (o) The biennial registration fee for a drugless therapist license is $[ 25 ] 40.
* * * * * [Pa.B. Doc. No. 98-255. Filed for public inspection February 13, 1998, 9:00 a.m.]
