Initial Licensure for Graduates of Medical Schools in the US, Canada, and Puerto Rico

(1) Prerequisites to Initial Licensure. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold a full active license to practice medicine. In order to qualify for a full medical license, an applicant shall meet all of the following minimum requirements for licensure: (a) Be 18 years of age or older; (b) Possess Good Moral Character; (c) Have Premedical Education as described in 243 CMR 2.02(2)(a); (d) Have a Medical School Education as described in either 243 CMR 2.02 or 2.03; (e) Have Postgraduate Medical Training as described in either 243 CMR 2.02 or 2.03; (f) Pass a Professional Examination as described in 243 CMR 2.02(3) or (4); (g) Complete Pain Management Training, as described in M.G.L. c. 94C, § 18; (h) Participate in a Risk Management Program as described in M.G.L. c. 112, § 5; (i) Agree to refrain from balance billing Medicare recipients, if the applicant has agreed to treat Medicare recipients, as provided in M.G.L. c. 112, § 2; (j) Sign and swear to the contents of his or her Licensing Application; (k) Pay a registration fee, as described in 243 CMR 2.05(1) and 801 CMR 4.02 (243); (l) Demonstrate Proficiency in Electronic Health Records, as required by M.G.L. c. 112, § 2; (m) Obtain professional liability malpractice insurance of at least $100,000/$300,000 coverage amounts, as provided in 243 CMR 2.07(16), if providing patient care in the Commonwealth; (n) Certify that he or she is in compliance with the laws of the Commonwealth relating to taxes, the reporting of employees and independent contractors, and the withholding and remitting of child support, pursuant to M.G.L. c. 62C, § 49A; (o) Complete Domestic Violence and Sexual Violence Training; (p) Applyfor or participate in MassHealth, either as a provider of services or as a nonbilling provider for the limited purpose of ordering and referring services covered under MassHealth, and provided that regulations governing such limited participation are promulgated under M.G.L. c. 118E; and (q) Complete Child Abuse and Neglect Training. (2) Procedure for Obtaining an Initial Full License for Graduates of Medical Schools in the United States, Canada and the Commonwealth of Puerto Rico. In order to qualify for a full medical license, an applicant shall meet the prerequisites to licensure in 243 CMR 2.02(1) and the following requirements, in addition to other requirements for licensure as set forth in 243 CMR 2.00 and M.G.L. c. 112. (a) Premedical Education. An applicant shall have completed a minimum of two or more academic years at a legally chartered college or university. Such premedical training shall include courses in biology, inorganic chemistry, organic chemistry and physics, or their equivalent as determined by the Board. (b) Medical Education. An applicant for an initial full license shall have completed and attended for four academic years of instruction, of not less than 32 weeks in each academic year, or courses which in the opinion of the Board are equivalent thereto, in one or more legally chartered medical schools, and have received the degree of doctor of medicine from a medical school accredited by the LCME, or a doctor of osteopathy degree from an osteopathic school accredited by the AOA. (c) Postgraduate Medical Training. Each applicant for a full license, whose application is received by the Board on or after February 1, 2012, must have completed two years of postgraduate medical training in an ACGME or AOA approved, or accredited Canadian program. In the case of sub-specialty clinical fellowship programs, however, the Board may accept postgraduate training in a hospital that has an ACGME or AOA approved, or accredited Canadian, postgraduate medical training program in the primary specialty. In its discretion, the Board may consider an applicant who has completed one year of ACGME or AOA approved, or accredited Canadian, postgraduate training and who: 1. Holds a current, active, unrestricted full medical license in another state; 2. Demonstrates continuous clinical activity; and 3. Is board certified by either ABMS or AOA. (d) Examination. An applicant for full licensure shall fulfill the examination requirements for licensure as set forth in 243 CMR 2.02(3) or (4), whichever applies; and (e) Pain Management Training. Applicants who prescribe controlled substances shall, as a prerequisite to obtaining or renewing a medical license, complete appropriate Pain Management Training and opioid education, accordingto M.G.L. c. 94C, § 18 and 243 CMR 2.00. Pain Management Training shall consist of at least three credits of Board-approved continuing medical education and may be used toward the required ten credits of risk management training. (f) EHR Proficiency Requirement. 1. Demonstrating EHR Proficiency. An applicant for an initial full license must demonstrate proficiency in the use of electronic health records (EHR), as required by M.G.L. c. 112, § 2. An applicant shall demonstrate proficiency in the use of EHR once, and in one of the following ways: a. Participation in a Meaningful Use program as an eligible professional; b. Employment with, credentialed to provide patient care at, or in a contractual agreement with an eligible hospital or critical access hospital with a CMS Meaningful Use program; c. Participation as either a Participant or an Authorized User in the Massachusetts Health Information Highway; d. Completion of three hours of a Category 1 EHR-related CME course that discusses, at a minimum, the core and menu objectives and the CQMs for Meaningful Use. These three EHR credits may be used toward the required ten risk management CME credits. 2. Exemptions. Exemptions must be claimed each licensing cycle if applicable. The following are exempt from the requirement to demonstrate EHR Proficiency: a. An applicant who will not be engaged in the practice of medicine as defined in 243 CMR 2.01(4); b. An applicant for an Administrative License; c. An applicant for a Volunteer License; d. An applicant on active duty as a member of the National Guard or of a uniformed service called into service during a national emergency or crisis; or e. An applicant for an Emergency Restricted License. (g) Participating in a Risk Management Program. The applicant shall agree to participate in a risk management program as a condition of licensure, as required by M.G.L. c. 112, § 5 and 243 CMR 3.00: The Establishment of and Participation in Qualified Patient Care Assessment Programs, Pursuant to M.G.L. c. 112, § 5, and M.G.L. c. 111, § 203. The applicant must agree to participate in a risk management program that meets or exceeds the rules, procedures and standards set forth in 243 CMR 3.00. (h) Prohibition on Balance Billing of Medicare Beneficiaries. The applicant shall agree, if he or she agrees to treat Medicare beneficiaries, that he or she shall accept as payment in full the Medicare fee schedule amount for the services performed, and shall not balance bill a Medicare beneficiary as provided in M.G.L. c. 112, § 2, and 243 CMR 2.07(15). (i) Mandatory Medical Malpractice Insurance. Whenever an applicant renders direct or indirect patient care in Massachusetts, he or she shall maintain professional liability insurance in an amount of at least $100,000 per claim, $300,000 minimum annual aggregate, pursuant to 243 CMR 2.07(16). 1. Pursuant to 243 CMR 2.07(16), coverage may be on an individual or shared limit basis. Coverage shall be continued until the expiration of any relevant statutes of limitations relevant to the events or occurrences covered. 2. The following licensees are not subject to the medical malpractice insurance requirement: a. Licensees with no direct or indirect responsibility for patient care in the Commonwealth; or b. Licensees whose patient care in the Commonwealth is limited to professional services rendered at or on behalf of federal, state, county or municipal health care facilities; or c. Limited licensees pursuant to M.G.L. c. 112, § 9. (j) Domestic Violence and Sexual Violence Training. Pursuant to M.G.L. c. 112, § 264, applicants and licensees shall participate in Domestic Violence and Sexual Violence Training once as a condition for licensure, renewal, revival or reinstatement of licensure. The Board, in consultation with the Department of Public Health, will identify programs or courses of study that meet the standards required by this provision and provide its licensees with a list of such programs or courses. This is a one-time training requirement. (k) MassHealth Requirement. Pursuant to M.G.L. c. 112, §§ 2 and 9, applicants and licensees shall apply to participate in MassHealth, either as a provider of services or as a non billing provider for the limited purpose of ordering and referring services in the MassHealth program, as a condition for licensure, renewal, revival or reinstatement of licensure. A physician who is not engaged in the practice of medicine is exempt from the MassHealth requirement. This is a one-time licensing requirement. (l) Child Abuse and Neglect Training. Pursuant to M.G.L. c. 119, § 51A(k), applicants and licensees shall complete training in recognizing and reporting suspected child abuse and neglect. Physicians may comply with the training requirement by: receiving training in child abuse and neglect assessment in medical school education or postgraduate training; completing a hospital-sponsored training program in recognizing the signs of child abuse and neglect; completing CME in identifying and reporting child abuse and neglect; completing a Board-approved online training program or completing a specialized certification. This is a one-time training requirement. (m) Compliance with Tax Laws. Pursuant to M.G.L. c. 62C, § 49A, the applicant for a license to practice medicine shall certify, upon penalties of perjury, that he or she has complied with all the laws of the Commonwealth relating to taxes, the reporting of employees and contractors, and the withholding and remitting of child support. The commissioner of the department of revenue shall notify the board of any returns due or any taxes payable for an applicant. 1. Upon reasonable cause, the commissioner of the department of revenue may issue a waiver of the certification requirement in M.G.L. c. 62C, § 49A. 2. The existence of a non-frivolous appeal of an unfiled tax return or a tax due or an overdue child support assessment, or the existence of a payment agreement with the department of revenue with which the applicant is fully compliant, shall not prevent the issuance of the full license. 3. The commissioner of the department of revenue shall confirm for the Board when the applicant is in good standing with respect to returns due or taxes payable. (n) Certificate of Registration. If the Board determines that an applicant is qualified, competent and of good moral character, such applicant will be registered as a licensed physician and entitled to a certificate in testimony thereof signed by the chair and secretary. (3) Examination Requirements. (a) Conduct Prior to and During an Examination. Applicants who engage in the conduct described in 243 CMR 2.02(3)(a)1. through 3. shall have their test materials confiscated, shall be denied permission to complete the examination and shall be required to leave the examination room: 1. Removing test materials from the examination room; reproducing in any manner or aiding in the reproduction of test materials; selling, distributing, buying or having unauthorized possession of test materials; or 2. Communicating with any other examinee during the exam; copying answers or permitting answers to be copied; having in one's possession, during the examination, any material other than the examination materials; failure to obey instructions to stop working or starting an examination prior to being authorized to do so; or 3. Falsifying or misrepresenting educational credentials or other information required for admission to the exam; having another person take the exam on one's behalf. (b) Examinations Completed January 1, 2000 or Later. An applicant for an initial full license, except those who satisfy the requirements of 243 CMR 2.02(3)(c), must submit evidence, including certification by the examining body, of having achieved a passing score on each of Steps 1, 2, and 3 of the USMLE, or received a passing score on each of the three levels of NBME's COMLEX exam, within a seven-year time period, beginning with the examination date when the examinee first passes a step of either exam. An applicant for an initial full license must submit evidence of having successfully completed all parts of the MCCQE. (c) The Seven-year Rule An applicant who fails to pass Step 3 of the USMLE, or level 3 of the COMLEX, within three attempts, shall be required to take one additional year of ACGME or AOA approved postgraduate training between the third and fourth attempt. If the applicant did not complete an additional year of ACGME or AOA approved postgraduate training between the third and fourth attempt at Step 3 or level 3, the applicant is not eligible for Massachusetts licensure. If an applicant for licensure fails to pass Step 1 of the USMLE or Level 1 of the COMLEX after four attempts, the applicant is not eligible for Massachusetts licensure. No waiver is available to any candidate that did not pass Step 1 of the USMLE or Level 1 of the COMLEX on the fourth attempt. If an applicant for licensure fails to pass Step 2 of the USMLE or Level 2 of the COMLEX after four attempts, the applicant is not eligible for Massachusetts licensure. No waiver is available to any applicant that did not pass Step 2 of the USMLE or Level 2 of the COMLEX on the fourth attempt. If an applicant for licensure fails to pass Step 3 of the USMLE or Level 3 of the COMLEX after four attempts, the applicant is not eligible for Massachusetts licensure. No waiver is available to any candidate that did not pass Step 3 of the USMLE or Level 3 of the COMLEX on the fourth attempt. 1. Joint Degree Waiver of Seven-year Rule. The Board may grant a waiver of the seven-year examination completion requirement in the case of an applicant who is actively pursuing another advanced doctoral study, provided: a. The applicant requesting a waiver of the seven-year rule must be enrolled in a LCME accredited program and be a student in good standing. b. The Board shall consider the length of time the applicant is beyond the seven years; a candidate requesting a waiver of the seven-year rule will be required to present a verifiable and rational explanation for his or her inability to meet the seven-year requirement. In no case will a waiver be granted beyond a total period of ten years for completion of all three steps of the USMLE. 2. Other Reasons for Requesting a Waiver of the Seven-year Rule. In very limited and extraordinarycircumstances, the Board, subject to anypolicies or guidelines that may be adopted and in effect on the date of the waiver petition, may grant a case-by-case exception to the seven-year period upon petition by an applicant for licensure and demonstration by the applicant of: a. A verifiable and rational explanation for the failure to satisfy the regulation; b. Strong academic and post-graduate record; and c. A compelling totality of circumstances. (4) Examinations Completed before January 1, 2000. Applicants may submit evidence, including certification bythe examining body, of havingachieved scores acceptable to the Board on the following combinations of exams, if satisfactorily completed before January 1, 2000, in lieu of passing scores on the USMLE or COMLEX: (a) Part I of the examination of the NBME or Step 1 of the USMLE, and Part II of examination of the NBME or Step 2 of the USMLE, and Part III of the examination of the NBME or Step 3 of the USMLE; or (b) Both Component 1 and Component 2 of the FLEX; or (c) All parts of the MCCQE; or (d) Individual state examinations given prior to June 19, 1970, which are satisfactoryto the Board; or (e) Component 1 of the FLEX and Step 3 of the USMLE; or (f) Component 2 of the FLEX and: 1. Part I and Part II of the examination of the NBME; or 2. Step 1 and Step 2 of the USMLE; or 3. Part I of the examination of the NBME and Step 2 of the USMLE; or 4. Step 1 of the USMLE and Part II of the examination of the NBME. (5) FLEX Requirements. (a) Beginning with the June 1985 examination, an applicant who has received the passing score of 75 or higher on Component 1 and 2 has passed the licensing examination. Prior to the June 1985 examination, an applicant who completed the FLEX in one sitting and has received a passing grade of a FLEX weighted average of 75% or higher has passed the licensing examination. (b) An applicant who applies on the basis of an examination taken in June 1985 or later must have received a passing score of 75 or higher on each of the two components and be otherwise qualified. An applicant who applies on the basis of an examination taken prior to June 1985 must have taken the FLEX in one sitting, must have received a grade of a FLEX weighted average of 75% or higher and be otherwise qualified. (6) Restricted Licenses. (a) Nature of Restrictions. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold a restricted license to practice medicine. An applicant for a license issued under M.G.L. c. 112, § 5A shall first satisfy all the applicable prerequisites to licensure outlined in 243 CMR 2.02(1), except the electronic health records requirement in 243 CMR 2.02(1)(l) shall not be required. If the Board determines that an applicant's qualifications and professional training indicate that the Board should restrict his or her practice of medicine, the Board may issue a license restricted to any of the following: 1. A specialty or specified procedures within the specialty in which the applicant is a diplomate; or 2. A specified health care facility in which the applicant will practice under the supervision of a fully licensed specified physician; or 3. Prohibitions on performing certain procedures or operations, or prohibitions on performing procedures or operations under certain circumstances; or 4. In any other manner deemed appropriate by the Board based on the Board's assessment of the applicant's qualifications and professional training. (b) Emergency Restricted License for a Displaced Physician. The Board may issue an emergencyrestricted license to practice to a physician licensed in another state, who has been displaced from his or her medical practice by reason of a federally-declared disaster, provided the physician applies for the emergency restricted license under the sponsorship of a licensed Massachusetts physician. An emergencyrestricted license issued for this purpose shall expire no later than three months after the date of issuance, or upon issuance of a full, unrestricted license, if sooner. If the Board approves a restricted licensee's application for a full, unrestricted license, the issue date of the full unrestricted license shall be the issue date of the emergency restricted license. An emergency restricted license may be restricted by location, specialty or any other manner as described in 243 CMR 2.02(6)(a). For purposes of 243 CMR 2.02(6)(a), a sponsoring physician must have a full, active, unrestricted Massachusetts license, and must be readily available on a continuing basis to provide guidance to the applicant regarding his or her responsibilities under 243 CMR and the statutes of the Commonwealth. Each restricted licensee shall provide the Board with proof of appropriate insurance coverage for malpractice claims. (7) Limited Licenses. (a) Purpose. Under M.G.L. c. 112, § 9, the Board issues a limited license to a person who has received an appointment as an intern, resident or fellow at a health care facility or in a training program approved by the Board. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold a limited license to practice medicine. A limited license enables a person to complete his or her medical training. (b) Prerequisites and Exceptions. Applicants for a Limited License shall satisfy the requirements of 243 CMR 2.02(1), except the following: 1. 243 CMR 2.02(1)(e): Post-graduate Training; 2. 243 CMR 2.02(1)(f): Professional Examination; 3. 243 CMR 2.02(1)(g): Pain Management Training; 4. 243 CMR 2.02(1)(h): Participating in a Risk Management Program; 5. 243 CMR 2.02(1)(i): Agreement to not Balance Bill Medicare Patients; 6. 243 CMR 2.02(1)(l): Demonstration of Proficiency in Electronic Health Records; 7. 243 CMR 2.02(1)(q): Child Abuse and Neglect Training.. (c) Emergency Restricted Limited License. The Board may issue an emergency restricted limited license to practice to a person who has been displaced from his or her medical training by reason of a federally-declared disaster, provided the person has received an appointment as an intern, resident or fellow at a health care facility or in a training program approved by the Board, and such program sponsors the person for the emergency restricted limited license. Applicants for an Emergency Restricted Limited License shall satisfy the requirements of 243 CMR 2.02(7)(b). An emergency restricted license issued for this purpose shall expire no later than three months after the date of issuance, or upon issuance of a limited license, if sooner. If the Board approves a restricted licensee's application for a limited license, the issue date of the limited license shall be the issue date of the emergency restricted limited license. An emergency restricted limited license may be restricted by location, specialty or any other manner as described in 243 CMR 2.00. For purposes of 243 CMR 2.02(7), a sponsoring training program or health care facility must designate a physician who is readily available on a continuing basis to provide guidance to the applicant regarding his or her responsibilities under 243 CMR and the laws of the Commonwealth. (d) Requirements for a Limited Medical License. In order to qualify for a limited medical license, an applicant shall meet the following requirements, in addition to other applicable requirements for licensure as set forth in 243 CMR 2.00 and relevant sections of M.G.L. c. 112: 1. Medical Education. Each applicant for a limited license must satisfy the degree requirements of 243 CMR 2.02(1)(a) through (d) or be a graduate of a Fifth Pathway program. 2. Examination Requirements. Each applicant for a limited license must submit evidence of having achieved a passing score on Steps 1 and 2 of the USMLE, or the first two Levels of the COMLEX exam, or having received a certificate from the MCCQE. 3. ECFMG Certification. International medical graduates, other than graduates of a Fifth Pathway program, shall submit ECFMG certification valid as of the date of issuance. 4. ACGME or AOA Approved Position. Each applicant for a limited license must submit proof of an appointment to an ACGME or AOA approved postgraduate training program in Massachusetts, or a fellowship in a Massachusetts health care facility, which conducts on its premises ACGME or AOA approved programs. (8) Procedure for Issuing a Limited License. Any applicant who meets all of the requirements of 243 CMR 2.02(8) to the satisfaction of the Board will be granted a limited license and is entitled to a certificate of registration signed by the chair and the secretary of the Board. (a) Limited License Is Specific to Training Program. A limited license authorizes a limited licensee to practice medicine only in the specified training program. The licensee may only practice at the training program or at the health care facility designated on the limited license or at the facility's approved affiliates. Limited licensees may, however, practice for up to eight weeks in any single year of residency at a non-designated facility, if that facility is a teaching hospital with three or more ACGME or AOA accredited programs. A limited licensee may practice medicine only under the supervision of a full licensee who has been credentialed by the facility where the limited licensee is practicing pursuant to 243 CMR 2.02(8). The Board will not issue more than one limited license to a person at a time. (b) Report of Disciplinary Actions to the Board. A health care facility that takes a disciplinary action against a limited licensee in a training program must report this action to the Board. In the event that a limited licensee terminates his or her appointment at a health care facility or his or her participation in a training program prior to the limited license's expiration date, or has his or her appointment or participation terminated, the health care facilitydesignated on the license shall submit to the Board, pursuant to M.G.L. c. 111, § 53B, a written notice of termination which sets forth the reasons for the termination and is signed by the director or the administrator of the health care facility or training program. (9) Duration of a Limited License. (a) The Duration of a Limited License Shall Be One Academic Year. The Board may, subject to anyguidelines that have been adopted by the Licensing Committee and the Board, issue a limited license for the duration of a trainee's enrollment in an ACGME or AOA training program. The issuance of a limited license beyond a total of seven years of practice pursuant to a limited license may be granted only by a majority vote of the Board. (b) Nothing in 243 CMR 2.02(9) shall limit the Board's authorityto revoke a limited license at any time in accordance with M.G.L. c. 112, § 9. (10) Restrictions on Billing by Limited Licensees. In a training program, a full licensee may bill for the services of a limited licensee, but only if such services are rendered as part of the training program under the direct supervision of a full licensee. Except as provided in the preceding sentence, no one may bill for the services of a limited licensee, but the salary of a limited licensee may constitute part of a health care facility's service charges. (11) Volunteer License. (a) Purpose. In order to encourage physician volunteerism and to serve the public health, the Board establishes a Volunteer License category. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold a volunteer license to practice medicine. To qualify for a volunteer license, an applicant shall satisfy the prerequisites for a full initial license as set forth in 243 CMR 2.02(1), except for 243 CMR 2.02(1)(l). In satisfaction of 243 CMR 2.02(1)(k), the candidate shall pay a Volunteer License application fee, if one is established by the secretary of administration and finance pursuant to M.G.L. c. 7, § 3B. The Board may require that the applicant successfully pass a clinical skills assessment or other professional evaluation of clinical competency. The Volunteer License is chosen voluntarily by the applicant, and the Board shall not involuntarily impose this license status on an applicant or licensee. 1. Serving the Public Health. As part of the application for a volunteer license, a candidate shall submit the following information: a. A written statement from the applicant outlining the scope and duration of services to be provided by him or her; b. A written statement from the director of the applicant's proposed work site outlining the scope and duration of the applicant's responsibilities; and c. Evidence satisfactory to the Board that the volunteer physician's proposed work will serve the public interest. An example of work that serves the public interest is treating a medical population in need that may not otherwise have access to medical care. (b) Issuance of Volunteer License. An applicant who meets all of the requirements of 243 CMR 2.02(11) to the satisfaction of the Board will be granted a volunteer license and is entitled to a certificate of registration signed by the chair and the secretary of the Board. (c) Scope of Practice for Volunteer Status. A licensee engaged in volunteer practice shall be subject to the same conditions and responsibilities as a full licensee, and may not accept compensation in any form for his or her practice of medicine. (d) Termination. A volunteer license issued in accordance with 243 CMR 2.02(11) may be renewed biennially. A volunteer license shall terminate automatically when it expires upon its expiration date or upon Board approval of a full license application. A volunteer licensee engaged in patient care is required to have professional malpractice liability insurance as in 243 CMR 2.02(1)(m). (e) Change in License Status. 1. From Retired to Volunteer License. A licensee holding a Retired inactive license may apply to the Board for a change of license status from Retired inactive status to a Volunteer active license. The licensee shall complete an application for a Volunteer license. If the licensee has been away from the clinical practice of medicine for two or more years, the Board may require the completion of a Board-approved clinical skills assessment program, physician supervision or monitoring, CMEs, medical education or other such requirements to assist the licensee in reentering the clinical practice of medicine. 2. From Full to Volunteer License. If a physician with a full license wishes to change his or her license category to a volunteer license, he or she may file a Request for a Change of License Category with the Board. Such a request may be made at the time of license renewal or anytime during the license term. 3. From Volunteer to Full License. A licensee holding a volunteer license may apply to the Board for a change of license status from a Volunteer license to a full license. The licensee shall complete an application for a full license and pay the difference between the volunteer license application fee and the full license application fee. (12) Administrative License. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold an administrative license to practice medicine. In order to qualify for an administrative license, an applicant shall satisfy the educational and postgraduate training requirements for a full license as set forth in at 243 CMR 2.02(1), except for 243 CMR 2.02(1)(g), (l) and (m) and the following requirements: (a) General. The Board may issue an administrative license to an applicant whose primary responsibilities are those of an administrative or academic nature; such as professional managerial, administrative, or supervisoryactivities related to the practice of medicine or the delivery of health care services or medical research, the practice of investigative medicine or the administration of health insurance organizations. The Administrative License status is chosen voluntarily by the applicant, and the Board shall not involuntarily impose this license status on an applicant or licensee. An administrative license does not include the authority to diagnose or treat patients, issue prescriptions for drugs or controlled substances, delegate medical acts or prescriptive authority, or issue opinions regarding medical necessity. (b) Malpractice Insurance Requirements. A physician with an administrative license is not required to have professional malpractice liability insurance. (c) Issuance of License. An applicant who meets all of the requirements of 243 CMR 2.02(1), except for 243 CMR 2.02(1)(g) and (m), to the satisfaction of the Board will be granted an administrative license and is entitled to a certificate of registration signed by the chair and the secretary of the Board. (d) Biennial. An administrative license issued in accordance with 243 CMR 2.02(12) may be renewed biennially. An administrative license shall terminate automatically upon Board approval of a full license application. (e) Change in License Status. 1. From Full to Administrative License. If a physician with a Full license wishes to change his or her license category to an Administrative license, he or she may file a request for a Change of License status with the Board. 2. From Administrative to Full License. A licensee with an Administrative license may apply to the Board to change his or her license status to a Full license upon filing a Request for a Change in License status. The licensee shall submit a proposed reentryinto clinical practice plan, if applicable, and pay the full license application fee. A reentry into clinical practice plan will describe the applicant's proposal to resume clinical practice, his or her continuing professional development, clinical training and other relevant experience during the time period in which the applicant held an administrative license. The Board may require that a licensee with an Administrative license status, who wishes to return to clinical practice, successfully pass a Board-approved clinical skills assessment or other Board-approved professional determination of clinical competency. (13) Temporary License. The Board shall determine whether an applicant is qualified, competent and of good moral character to hold a temporary license to practice medicine. In order to qualify for an initial temporary license, an applicant must meet the requirements of 243 CMR 2.02(1), except 243 CMR 2.02(1)(l) and except as otherwise provided in 243 CMR 2.00, in addition to the requirements of 243 CMR 2.02(13). (a) Academic Faculty Appointment. Pursuant to M.G.L. c. 112, § 9B, the Board may issue an Academic Faculty Appointment license. This is a temporary license that the Board may issue to a visiting physician who is licensed to practice in another jurisdiction, and who has a temporary faculty appointment certified by the dean of a medical school in Massachusetts for purposes of medical education in an accredited hospital associated with the medical school; and a scope of practice plan certified by the Chair of the Department, approved by the Board and subject to audit thereof. 1. A temporary license issued under 243 CMR 2.02(13) shall be valid for a period set by the Board, not exceeding 12 months, may be renewed up to two times, and shall terminate automatically upon termination of the faculty appointment. A temporary license under 243 CMR 2.02(13) and any renewals thereof shall not exceed three years. 2. In order to renew a temporary license under 243 CMR 2.02(13), the licensee shall complete the following requirements: a. The opioid education and pain management training requirement, as described in 243 CMR 2.02(2)(e); b. The end-of-life care education requirement, as described in 243 CMR 2.06(6)(b); and c. 50% of the continuing professional development requirement for full licensees, as described in 243 CMR 2.06(6). 3. All practice of medicine by a licensee under 243 CMR 2.02(13)(a) must be essential to his or her teaching and shall be restricted to the specified institution or any of that facility's approved affiliates. 4. A temporary licensee may not practice outside the scope of practice that is directly related to his or her educational and training responsibilities. (b) Substitute Physician. 1. Holds an Out-of-state License. Pursuant to M.G.L. c. 112, § 9B, the Board may issue a temporary license to a physician who is licensed to practice medicine in another U.S. jurisdiction to permit him or her to act as a substitute physician for a physician licensed in Massachusetts. A temporary license issued in accordance with 243 CMR 2.02(13)(b) may be granted only upon written request of the physician licensed in Massachusetts and shall be limited to a period of three months or less. A locum tenens physician may be a substitute physician. 2. Diplomate of Specialty Board. The Board may issue a temporary license to a physician eligible for examination or registration in the Commonwealth who is a diplomate of a specialty board approved by the American Medical Association or the American Osteopathic Association to permit him or her to act as a substitute physician for a registered physician in the commonwealth. This temporary license is granted only upon written request of the licensed physician, is limited to the specialty in which the applicant is certified and limited to three months or less. (c) Participating in a CME Course. Pursuant to M.G.L. c. 112, § 9B, the Board may issue a temporarylicense to a physician who is licensed to practice in another jurisdiction, and who is enrolled in a course of continuing medical education in Massachusetts. A temporary license issued in accordance with 243 CMR 2.02(13)(c) is limited to continuing medical education activities conducted under the supervision of a physician licensed in Massachusetts and shall terminate automatically upon termination of the course and, in any event, at the end of three months. (d) Issuance of License. An applicant who meets all of the requirements of 243 CMR 2.02(13) to the satisfaction of the Board will be granted a temporary license and is entitled to a certificate of registration signed by the chair and the secretary of the Board.