Title 11 W. Va. C.S.R.

Medicine Medicine

Series 01B Licensure, Practice Requirements, Disciplinary and Complaint Procedures, Continuing Education, Physician Assistants

W. Va. Code R. § 11-1B-1 General

1.1. Scope. -- This rule relates to physician assistants and to their licensing, practice, complaint procedures and professional discipline, and continuing education.

1.2. Authority. -- W. Va. Code § 30-1-7a, § 30-3E-3(a)(1)-(9), and W. Va. Code § 30-1D-1(d).

1.3. Filing Date. -- April 27, 2026.

1.4. Effective Date. -- July 1, 2026.

1.5. Sunset Provision -- This rule shall terminate and have no further force or effect upon August 1, 2031.

W. Va. Code R. § 11-1B-2 Definitions

2.1. “Active practice notification” means a practice notification which is currently in effect.

2.2. “Authorization to practice” means written notification from the Board that a physician assistant may commence practice in collaboration with physicians pursuant to an active practice notification.

2.3. “Board” means the West Virginia Board of Medicine.

2.4. “Collaborating Physician” means a doctor of medicine, osteopathic medicine, or podiatric medicine fully authorized to practice clinical medicine or podiatric medicine in West Virginia by the appropriate board in this state without restriction or limitation, who collaborates with physician assistants.

2.5. “Collaboration” means overseeing the activities of the medical services rendered by a physician assistant. Constant physical presence of the collaborating physician is not required as long as the collaborating physician and physician assistant are, or can be, easily in contact with one another by telecommunication. Collaboration does not require the personal presence of the collaborating physician at the place or places where services are rendered.

2.6. “Controlled substances” means drugs that are classified by federal or state law in Schedules I, II, III, IV or V, as defined in W. Va. Code Chapter 60A, Article 2.

2.7. “Core duties” means medical acts that are included in the standard curricula of accredited physician assistant education programs.

2.8. “Endorsement” means a summer camp or volunteer endorsement to practice as a physician assistant as set forth in W. Va. Code §30-3E-1 et seq.

2.9. “Health care facility” means any licensed hospital, nursing home, extended care facility, state health or mental institution, clinic or physician’s office.

2.10. “Hospital” means a facility licensed pursuant to W. Va. Code §16-5B-1 et seq.

2.11. “License” means a license issued by the Board to a physician assistant applicant pursuant to the provisions of W. Va. Code § 30-3E-1 et seq.

2.12. “Licensee” means a physician assistant licensed pursuant to the provisions of W. Va. Code § 30-3E-1 et seq. and the provisions of this legislative rule.

2.13. “Licensure” means the process of application to the Board, and the Board’s consideration and approval of individuals to practice as physician assistants in collaboration with physicians.

2.14. “Narcotic drug” and “opioid” mean controlled substance medications which are natural and semi-synthetic derivatives of the opium poppy, as well as similar synthetic compounds that have analgesic or pain relieving properties because of their effects in the central nervous system. Narcotics and opioids include, but are not limited to, codeine, morphine, hydromorphone, hydrocodone, oxycodone, methadone, and fentanyl.

2.15. “NCCPA” means The National Commission on the Certification of Physician Assistants.

2.16. “Osteopathic Board” means the West Virginia Board of Osteopathic Medicine.

2.17. “Physician” means a doctor of allopathic or osteopathic medicine who is fully licensed by the Board or the Osteopathic Board to practice medicine or surgery in this state.

2.18. “Physician Assistant” means a person who meets the qualifications set forth in the Physician Assistants Practice Act, W. Va. Code §30-3E-1 et seq., and is licensed to practice medicine with a collaborating physician or podiatric physician. Physician assistant also means an individual who holds a physician assistant license in another state and an interstate telehealth registration issued by this Board.

2.19. “Podiatric physician” means a physician of podiatric medicine who is fully licensed by the Board to practice podiatric medicine in this state.

2.20. “Practice notification” means a written notice to the Board that a physician assistant will practice in collaboration with one or more physicians in the state of West Virginia.

2.21. “Practice setting” means the type of practice environment, and includes hospitals, ambulatory surgical facilities, clinics, private medical offices, and long term care facilities.

2.22. “Prescription drug” means a drug that may be dispensed under federal or state law only pursuant to the prescription of an authorized prescriber.

2.23. “Prescriptive authority” means the authority of a physician assistant to prescribe, order, administer or dispense prescription drugs.

2.24. “Registrant” means a physician assistant issued an interstate telehealth registration by the Board pursuant to W. Va. Code § 30-1-26.

2.25. “Registration” means an authorization to practice in collaboration with physicians issued by the Board pursuant to W. Va. Code § 30-1-26 for the limited purpose of providing interstate telehealth services.

2.26. “Reporting period” means the two-year period preceding the renewal deadline for a license issued by the Board. Continuing education satisfactory to the Board must be obtained in each reporting period.

2.27. “Risk Assessment and Responsible Prescribing of Controlled Substances” means drug diversion training, best-practice prescribing of controlled substances training, and training on prescribing and administering an opioid antagonist which includes all of the following components:

2.27.1. Risk Assessment and responding to drug diversion and drug seeking behavior including:

2.27.1.a. Tools for conducting routine patient assessments for risk factors associated with drug diversion, misuse or abuse and identification of substance use disorder treatment referral resources;

2.27.1.b. West Virginia statistics on prescription drug abuse and resulting deaths;

2.27.1.c. Identification of diversion and drug seeking tactics and behaviors;

2.27.1.d. Best practices for assessing, treating and referring patients suspected of drug seeking behavior, diversion or substance use disorder;

2.27.1.e. Introduction to Medication for Opioid Use Disorder (MOUD) and training on the effectiveness of MOUD treatment including the use of full opioid agonist, partial opioid agonist, and opioid antagonists; and

2.27.1.f. Training on the impacts of stigma on treatment effectiveness including the concept of addiction as a chronic disease.

2.27.2. Responsible prescribing of controlled substances, including:

2.27.2.a. Compliance with state and federal controlled substances laws and rules, including the Opioid Reduction Act;

2.27.2.b. Registering with and utilization of the West Virginia Controlled Substances Monitoring Program established in West Virginia Code Chapter 60A, Article 9;

2.27.2.c. Epidemiology of chronic pain in West Virginia and misuse of opioids;

2.27.2.d. Indication for opioids in chronic pain treatment including general characteristics, toxicities and drug interactions;

2.27.2.e. Examination of patient evaluation and risk assessment and tools to assess risk and monitor benefits;

2.27.2.f. Initiation and ongoing management of chronic pain patients treated with opioid based therapies, including treatment objectives; monitoring and periodic review; referrals and consultations; informed consent; prescription of controlled substance agreements, urine screens and pill counts; patient education on safe use, storage and disposal of opioids; discontinuation of opioids for pain due to lack of benefits or increased risks; documentation and medical records;

2.27.2.g. Presentation of a case study of a patient with chronic pain; and

2.27.2.h. Best practices for managing patients with active prescriptions for more than one controlled substance.

2.27.3. Training on prescribing and administering an opioid antagonist.

2.28. “Website” or “Board’s website” means the set of related web pages operated by or on behalf of the West Virginia Board of Medicine located at the domain name wvbom.wv.gov, or at any successor domain name published by the Board.

W. Va. Code R. § 11-1B-3 Qualification and Application for Licensure to Practice as a Physician Assistant

3.1. Minimum qualifications for licensure as a physician assistant are set forth in W. Va. Code §30-3E-4.

3.2. An application for a license to practice as a physician assistant shall be completed on a form provided by the Board, which is available on the Board’s website. The Board shall not consider an application or decide upon the issuance of a license to an applicant until the complete application, including all third-party documentation or verification, is on file with the Board and the Board has had at least 15 days to review the application. An application for licensure must be accompanied by payment of a nonrefundable application fee in an amount established by 11 CSR 4 unless the applicant has applied for and been granted an initial licensing fee waiver as set forth in 11 CSR 13.

3.3. Applicants must provide the following information:

3.3.1. The applicant's name, email address, home address, preferred mailing address and primary practice location address(es) and telephone numbers;

3.3.2. Demographic information of the applicant, such as date of birth, sex, etc.;

3.3.3. A photograph taken within the previous 12 months which substantially resembles the applicant;

3.3.4. A copy of the individual’s birth certificate, certificate of naturalization, or passport to be used in identifying the applicant, and verifying his or her date of birth and the appropriate spelling of his or her name;

3.3.5. Documentation establishing that the applicant:

3.3.5.a. Obtained a baccalaureate or master’s degree from an accredited program of instruction for physician assistants; or

3.3.5.b. Graduated from an approved program of instruction in primary health care or surgery prior to July 1, 1994; or

3.3.5.c. Was certified by the Board as a “Type B” physician assistant prior to July 1, 1983;

3.3.6. Documentation that the applicant has passed the Physician Assistant National Certifying Examination administered by the NCCPA and documentation establishing that the applicant:

3.3.6.a. Has a current certification from the NCCPA; or

3.3.6.b. Has a current license in good standing from a state that does not require a physician assistant to maintain national certification;

3.3.7. A report from the National Practitioner Data Bank and documentation and/or certification which establishes that the applicant does not hold a physician assistant license, certification or registration in any jurisdiction which is currently suspended or revoked;

3.3.8. Information with respect to the applicant’s professional practice, character and fitness to practice as a physician assistant;

3.3.9. Other information as determined by the Board which relates to whether the applicant is mentally and physically able to engage safely in practice as a physician assistant; and

3.3.10. Additional information identified by the Board for licensure.

3.4. In addition to the requirements for licensure set forth elsewhere in this legislative rule, all applicants for an initial license to practice as a physician assistant in West Virginia shall request and submit to the Board the results of a state and a national criminal history record check.

3.5. The purpose of the criminal history record check is to assist the Board in obtaining information that may relate to the applicant’s fitness for licensure.

3.6. In addition to the State Police, the Board may contract with and designate a company specializing in the services required by this section instead of requiring the applicant to apply directly to the West Virginia State Police or similar out-of-state agency for the criminal history records checks. Provided, that any such company must utilize protocols consistent with standards established by the Federal Bureau of Investigation and the National Crime Prevention and Privacy Compact.

3.7. The applicant shall furnish to the State Police, or other organization duly designated by the Board, a full set of fingerprints and any additional information required to complete the criminal history record check.

3.8. The applicant is responsible for any fees required by the State Police, or other organization duly designated by the Board, for the actual costs of the fingerprinting and the actual costs of conducting a complete criminal history record check.

3.9. The Board may require the applicant to obtain a criminal history records check from a similar Board approved agency or organization in the state of the applicant’s residence, if outside of West Virginia.

3.10. The applicant shall authorize the release of all records obtained by the criminal history record check to the Board.

3.11. A criminal history record check submitted in support of an application for licensure must have been requested by the applicant no earlier than 12 months immediately prior to the Board’s receipt of the applicant’s electronic application for licensure.

3.12. An initial licensure application is not complete until the Board receives the results of a state and a national criminal history record check conducted by the State Police or another entity duly authorized by the Board. The Board shall not grant an application for licensure submitted by any applicant who fails or refuses to submit the criminal history record check required by this section.

3.13. Should criminal offenses be reported on an applicant’s criminal history record check, the Board shall consider the nature, severity, and recency of offenses, as well as rehabilitation and other factors on a case by case basis for licensure.

3.14. The results of the state and national criminal history record check may not be released to or by a private entity except:

3.14.1. To the individual who is the subject of the criminal history record check;

3.14.2. With the written authorization of the individual who is the subject of the criminal history record check; or

3.14.3. Pursuant to a court order.

3.15. Criminal history record checks and related records are not public records for the purposes of W. Va. Code §29B-1-1 et. seq.

3.16. The Board may require an applicant to provide original documents and/or certified documents in support of an application for licensure. The application, together with all documents submitted, becomes the property of the Board and shall not be returned.

3.17. An applicant may be required to appear before Board members at the meeting at which his or her application is to be considered.

3.18. The burden of satisfying the Board of the applicant's qualifications for licensure is upon the applicant. The Board may deny an application for a physician assistant license to any applicant determined to be unqualified for licensure by the Board.

W. Va. Code R. § 11-1B-4 Temporary License; Special Licenses and/or Endorsements

4.1. If an applicant for licensure meets the qualifications for a license but is awaiting the next scheduled meeting of the Board for action upon his or her application, the applicant may request a temporary license. The Board may authorize its staff to issue temporary licenses to applicants who provide:

4.1.1. A written request that the applicant be issued a temporary license; and

4.1.2. A nonrefundable temporary license fee in an amount established by 11 CSR 4.

4.2. A temporary license expires six months after issuance or after the Board acts, whichever is earlier.

4.3. To the extent authorized by W. Va. Code §30-3E-15, a physician assistant licensed by this Board may apply for an endorsement to practice at a summer camp or as a volunteer at a community event by completing the application form prepared by the Board. No application fee shall be assessed. The Board may authorize its staff to issue summer camp and community event endorsements to an applicant who holds an unrestricted license issued by the Board and has submitted a complete and timely application.

4.4. To the extent authorized by W. Va. Code §30-3E-16, a physician assistant currently holding a license, registration or certification to practice in another jurisdiction may apply for an endorsement to practice at a summer camp or as a volunteer at a community event by completing the application form and submitting a fee equal to the fee set by the Board for a temporary license.

4.5. The Board shall not consider an application for a summer camp or a community event volunteer license or endorsement made pursuant to W. Va. Code §30-3E-16 until the complete application is on file with the Board, the appropriate fee has been submitted, and the Board has had at least 15 days to review the application.

4.6. To the extent authorized by W. Va. Code §30-1-21, a physician assistant currently holding a license, registration or certification to practice in another jurisdiction may apply for an authorization to serve as a volunteer without compensation for a charitable function for a period not to exceed 10 days by submitting a Board approved authorization form at least 10 days in advance of the charitable function. No fee shall be charged in association with requests made pursuant to this subsection. The Board may authorize its staff to approve the charitable practice if the physician assistant meets the eligibility criteria set forth in W. Va. Code §30-1-21.

W. Va. Code R. § 11-1B-5 License Renewal

5.1. With the exception of an initial license, a license to practice as a physician assistant is issued for a term of two years. An initial license expires on the 31st day of March in the next year established by the Board for physician assistant license renewal. Provided, that if an original license is issued within 30 days of an established renewal deadline, the initial license shall expire on the 31st day of March in the subsequent renewal year.

5.2. License renewal for all licensed physician assistants, regardless of the date the license was first issued, shall occur prior to April 1 of every odd year. A license shall expire, if not renewed by the renewal deadline, which shall be set by the Board and published on the Board’s website.

5.3. A physician assistant license shall be renewed upon timely submission of a fully completed renewal application form and payment of a nonrefundable renewal fee in an amount established by 11 CSR 4.

5.4. An online application is available through the Board’s website. A licensee shall maintain current contact information on file with the Board including: a preferred mailing address; a home address; current practice locations; telephone number; and a current email address. A licensee shall notify the Board of any changes to such contact information within 15 days of the change.

5.5. It is the responsibility of the licensee to submit a renewal application before the renewal deadline set by the Board. Failure of the licensee to receive a renewal application or a renewal notice does not constitute justification for any physician assistant to practice on an expired license, even if the physician assistant is otherwise authorized to practice as a physician assistant under an active practice notification.

5.6. The Board's physician assistant renewal application form shall include, and applicants must provide, the following information:

5.6.1. The applicant's name, email address, home address, preferred mailing address and primary practice location address(es) and telephone numbers;

5.6.2. Demographic information of the applicant, such as date of birth, sex, etc.;

5.6.3. A statement concerning any disciplinary action taken against the applicant in the last two years in any jurisdiction;

5.6.4. Information with respect to the applicant’s professional practice, character and fitness to practice as a physician assistant;

5.6.5. A statement of all other jurisdictions in which the applicant is licensed to practice as a physician assistant;

5.6.6. The renewal applicant’s NCCPA certification status;

5.6.7. Certification of successful completion of all continuing education requirements;

5.6.8. An attestation by the physician assistant that, to the extent he or she has been authorized to practice during the last two years, the physician assistant has practiced within the delegation of duties set forth in the licensee’s authorized practice agreement(s) and/or pursuant to an active practice notification; and

5.6.9. Other information required by the Board for renewal of a license.

5.7. The license of a physician assistant who fails to certify his or her successful completion of all continuing education requirements by the renewal deadline established by the Board shall automatically expire.

W. Va. Code R. § 11-1B-6 Reporting of NCCPA Certification Status and Professional Designation

6.1. A physician assistant shall accurately report his or her NCCPA certification status on applications and forms of the Board.

6.2. A physician assistant who has a current certification from the NCCPA may use the professional designation of PA-C. A physician assistant who is not certified by the NCCPA shall use the professional designation of PA.

W. Va. Code R. § 11-1B-7 Reinstatement and Reactivation of License

7.1. A physician assistant may seek reinstatement of an expired license within one year of the expiration by submitting:

7.1.1. A complete reinstatement application, which is available on the Board’s website, with all required supporting documentation;

7.1.2. Certification that the renewal applicant has completed all required continuing education for the previous reporting period, and documentation satisfactory to the Board corroborating the applicant’s certification of continuing education compliance;

7.1.3. A renewal fee; and

7.1.4. A reinstatement fee equal to 50 percent of the renewal fee.

7.2. If more than one year has passed since a physician assistant’s license automatically expired, the former licensee shall apply anew for licensure pursuant to section 3 of this rule. A license granted pursuant to this subsection does not constitute an initial license. If licensure is granted, the Board shall reactivate the license and reissue the individual’s original license number.

W. Va. Code R. § 11-1B-8 Collaborative Practice

8.1. A physician assistant may not practice independently.

8.2. Physician assistants who are authorized to practice in West Virginia shall practice in collaboration with physicians.

8.3. Physician assistants who are authorized to practice in West Virginia may also collaborate and consult with other providers, in addition to collaborating physicians, to facilitate a team-based patient-centered practice.

8.4. Physicians and physician assistants who collaborate shall not allow an employment arrangement to:

8.4.1. Interfere with sound clinical judgment;

8.4.2. Diminish or influence the practitioner’s ethical obligation to patients; or

8.4.3. Exert undue influence on, or interfere with the robustness of, the collaborative relationship.

W. Va. Code R. § 11-1B-9 Scope of Practice

9.1. A physician assistant shall have, as a minimum, the knowledge and competency to perform the following core duties with appropriate physician collaboration:

9.1.1. Screen patients to determine the need for medical attention;

9.1.2. Review patient records to determine health status;

9.1.3. Take a patient history;

9.1.4. Perform a physical examination;

9.1.5. Perform development screening examinations on children;

9.1.6. Record pertinent patient data;

9.1.7. Make decisions regarding data gathering and appropriate management and treatment of patients being seen for the initial evaluation of a problem or the follow-up evaluation of a previously diagnosed and stabilized condition;

9.1.8. Prepare patient summaries;

9.1.9. Initiate requests for commonly performed initial laboratory studies;

9.1.10. Collect specimens for and carry out commonly performed blood, urine and stool analyses and cultures;

9.1.11. Identify normal and abnormal findings in patient history and physical examination and in commonly performed laboratory studies;

9.1.12. Initiate appropriate evaluation and emergency management for emergency situations; for example, cardiac arrest, respiratory distress, injuries, burns and hemorrhage;

9.1.13. Provide counseling and instruction regarding common patient problems and/or questions;

9.1.14. Execute documents at the direction of and for the collaborating physician;

9.1.15. Perform clinical procedures such as, but not limited to:

9.1.15.a. Venipuncture;

9.1.15.b. Electrocardiogram;

9.1.15.c. Care and suturing of minor lacerations, which may include injection of local anesthesia;

9.1.15.d. Casting and splinting;

9.1.15.e. Control of external hemorrhage;

9.1.15.f. Application of dressings and bandages;

9.1.15.g. Removal of superficial foreign bodies;

9.1.15.h. Cardiopulmonary resuscitation;

9.1.15.i. Audiometry screening;

9.1.15.j. Visual screening; and

9.1.15.k. Carry out aseptic and isolation techniques;

9.1.16. Assist in surgery;

9.1.17. Prepare patient discharge summaries if the physician assistant has been directly involved in patient care; and

9.1.18. Assist physicians under personal collaboration in a manner by which to learn and become proficient in new procedures.

9.2. In addition to core duties, a physician assistant may perform medical acts commensurate with his or her education, training, and experience, which the physician assistant is competent to perform, and consistent with the rules of the Board. The physician assistant may only perform medical acts consistent with sound medical practice and that will protect the health and safety of the patient.

9.3. A physician assistant may pronounce death provided that:

9.3.1. The physician assistant is in compliance with subsection 9.2 of this rule;

9.3.2. The physician assistant has a need to do so within his or her scope of practice; and

9.3.3. That the pronouncement is in accordance with applicable West Virginia law and rules.

9.4. A physician assistant may augment the physician's data gathering abilities to assist the collaborating physician in reaching decisions and instituting care plans for the physician's patients.

9.5. A physician assistant may provide an authorized signature, certification, stamp, verification, affidavit or endorsement on documents within the scope of his or her practice, including, but not limited to the following:

9.5.1. If permitted by the place of practice, a physician assistant may sign orders within the scope of his or her practice, including admission and/or discharge orders for patients personally treated by the physician assistant;

9.5.2. Medical certifications for death certificates if the physician assistant has received training on the completion thereof;

9.5.3. Instruments related to scope and limitation of treatment, including:

9.5.3.a. Physician orders for life sustaining treatment;

9.5.3.b. Physician orders for scope of treatment; and

9.5.3.c. Do not resuscitate forms and/or orders.

9.5.4. Disability medical evaluations and/or certifications for persons with disabilities in support of a hunting or fishing permit;

9.5.5. Utility company forms or certifications requiring maintenance of utilities regardless of ability to pay;

9.5.6. Governmental forms as permitted by law including, but not limited to parking applications for mobility impaired persons; and

9.5.7. Durable medical equipment.

9.6. A physician assistant may prescribe, order, administer or dispense medications in accordance with the provisions of W. Va. Code § 30-3E-3(c) and this rule.

W. Va. Code R. § 11-1B-10 Requirements for Practice Authorization

10.1. A physician assistant may practice in collaboration with physicians in any practice setting pursuant to a practice notification which has been filed with and activated by the Board in accordance with W. Va. Code § 30-3E-10a and this rule. A physician assistant shall not commence practicing pursuant to a practice notification until he or she has received written authorization from the Board.

W. Va. Code R. § 11-1B-11 Practice Notifications

11.1. Before a physician assistant may practice in collaboration with physicians, the physician assistant and a health care facility shall file a practice notification with the Board.

11.2. A practice notification shall be completed on a form provided by the Board and shall be accompanied by the appropriate fee. The fee for the submission of a practice notification shall be one hundred dollars ($100) until such time as a different fee is established by 11 CSR 4. Practice Notification forms can be found on the Board’s website.

11.3. A physician assistant may not commence practice pursuant to a practice notification until the Board provides written notification to the physician assistant and health care facility that a complete practice notification has been filed with the Board. The Board’s written notification activates the practice notification and provides the physician assistant with authorization to practice in the identified health care facility or facilities.

11.4. A practice notification shall include:

11.4.1. The full name, license number, preferred mailing address, telephone number, and email address of the physician assistant;

11.4.2. The name and address of each health care facility where the physician assistant will practice pursuant to the practice notification including all locations of the health care facility where the physician assistant customarily or routinely practices;

11.4.3. Verification that the physician assistant meets the qualifications for prescriptive authority;

11.4.4. The name, job title, email address and contact information of the health care facility representative who is responsible for executing the practice notification and ensuring compliance with the provisions of the certification; and

11.4.5. Certification by the physician assistant and the health care facility that:

11.4.5.a. The physician assistant shall practice in collaboration with physicians;

11.4.5.b. The physician assistant shall practice in conformity with the physician assistant’s education, training and experience and in accord with the delineation of privileges granted to the physician assistant or other credentialing requirements of the health care facility;

11.4.5.c. The physician assistant holds a license issued by the Board to practice as a physician assistant or an interstate telehealth registration issued by the Board pursuant to W. Va. Code § 30-1-26;

11.4.5.d. The physician assistant meets the requirements for prescriptive authority and shall exercise prescriptive authority in conformity with section 12 of this rule; and

11.4.5.e. The physician assistant shall notify the Board upon the cessation of the physician assistant’s practice pursuant to the practice notification.

11.4.6. If a physician assistant who files a practice notification holds a license which is subject to probation or any practice restriction or limitation, the practice notification shall be accompanied by:

11.4.6.a. A description of the physician assistant’s practice restrictions or limitations;

11.4.6.b. Certification by the health care facility representative completing the practice notification that the health care facility is aware of all such practice restrictions or limitations;

11.4.6.c. Certification by the physician assistant and the health care facility representative that the physician assistant’s practice shall comport with all practice restrictions or limitations.

11.5. A practice notification is complete when it conforms to the requirements of this section and is accompanied by the appropriate fee. The Board may return an incomplete practice notification unprocessed and may request additional information from the health care facility or physician assistant to obtain information necessary to complete the practice notification.

11.6. Upon receipt of a complete practice notification and the appropriate fee, the Board shall provide the physician assistant and health care facility written notice that the physician assistant is authorized to practice in the identified health care facility or facilities.

11.7. A physician assistant with an active practice notification on file with the Board may only practice within the health care facility or facilities identified in the practice notification. If practicing on behalf of the health care facility, a physician assistant may practice at one or more additional locations not included on his or her activated practice notification on an occasional basis not to exceed two days per month per location if the health care facility maintains documentation of the physician assistant’s practice at such occasional practice locations and provides such documentation to the Board upon request.

11.8. A physician assistant may list more than one health care facility on a single practice notification if each of the facilities is operated under the same corporate umbrella and the health care facility representative identified in subdivision 11.4.4 of this rule is authorized and responsible for executing the practice notification and ensuring compliance with the provisions of the practice notification certification at every health care facility listed on the practice notification.

11.9. A new practice notification, with the required fee, must be filed for approval by the Board if the physician assistant seeks to practice at a health care facility not listed in an active practice notification.

11.10. A practice notification automatically terminates if:

11.10.1. The physician assistant’s license or interstate telehealth registration expires;

11.10.2. The physician assistant ceases practice at the health care facility or facilities listed in the practice notification; or

11.10.3. The physician assistant is no longer credentialed to practice at the health care facility or facilities listed in the practice notification.

11.11. A physician assistant with more than one health care facility location on an active practice notification shall notify the Board within ten days if he or she ceases practicing, or is no longer credentialed to practice, at one of the health care facilities included in the practice notification. The practice notification shall not terminate, but shall no longer authorize practice at the location identified by the physician assistant as a former practice location.

11.12. A health care facility or a physician assistant may terminate a practice notification. A physician assistant shall immediately cease practicing upon the termination of a practice notification. The physician assistant must notify the Board, in writing, within 10 days of the termination of any practice notification.

11.13. A physician assistant may simultaneously practice pursuant to one or more active practice notifications.

W. Va. Code R. § 11-1B-12 Prescriptive Authority Pursuant to a Practice Notification

12.1. A physician assistant practicing pursuant to an active practice notification has prescriptive authority to prescribe, order, administer and/or dispense medication in the course of his or her practice subject to the provisions of W. Va. Code § 30-3E-3(c).

12.2. A physician assistant may not prescribe a Schedule I controlled substance.

12.3. A physician assistant may prescribe up to a three-day supply of a Schedule II narcotic medication.

12.4. A physician assistant’s prescribing of narcotic medication shall conform with the quantity and duration limitation set forth in subsection 12.3 and any practice requirements set forth in Opioid Reduction Act, W. Va. Code § 16-54-1 et. seq., which are consistent with the quantity and duration limitations established for physician assistant narcotic prescribing.

12.5. There are no other formulary limitations on a physician assistant’s prescriptive authority.

12.6. When exercising prescriptive authority, a physician assistant shall comply with the requirements of this rule and the requirements of the West Virginia Board of Pharmacy, other applicable state and federal laws, rules and regulations, and all applicable standards of care.

12.7. All prescriptions, including electronic prescriptions, written by the physician assistant must include the physician assistant’s name, professional designation, practice location, telephone number, signature, license number issued by the Board, and any other information required by state and federal law.

W. Va. Code R. § 11-1B-13 Responsibilities of Physicians Collaborating with Physician Assistants Pursuant to Practice Notifications

13.1. Unless otherwise prohibited by a health care facility, a physician who practices at a health care facility may collaborate with any physician assistant who holds an active practice notification with the same facility.

13.2. A physician collaborating with a physician assistant shall observe, direct, and evaluate the physician assistant’s work records and practices, including collaborating with the physician assistant in the care and treatment of patients.

13.3. A collaborating physician shall only delegate those medical acts which are:

13.3.1. Within the physician’s scope of practice;

13.3.2. Consistent with the physician assistant’s education, training, and experience; and

13.3.3. Consistent with any credentialing requirements of the health care facility.

13.4. While collaboration does not require the constant physical presence of the collaborating physician, if the collaborating physician and physician assistant are, or can be, easily in contact with one another by electronic communication, including but not limited to telecommunication, physician collaboration shall not exclusively occur through written communication, electronic communication, telecommunication or any combination thereof.

W. Va. Code R. § 11-1B-14 Continuing Medical Education Requirements

14.1. Successful completion of continuing education satisfactory to the Board during the preceding two-year period is required for the biennial renewal of a physician assistant license.

14.2. Types and categories of continuing medical education satisfactory to the Board for physician assistants are:

14.2.1. Successful completion, during the reporting period, of a minimum of 100 hours of continuing medical education as follows:

14.2.1.a. At least 50 hours of the required 100 hours must be designated as Category I by either the American Medical Association, American Academy of Physician Assistants or the American Academy of Family Physicians.

14.2.1.b. A maximum of 50 hours may be designated as Category II by either the American Medical Association, American Academy of Physician Assistants or the American Academy of Family Physicians.

14.2.2. Obtaining a master’s degree from an accredited program of instruction for physician assistants within one year of the expiration of an initial license.

14.2.3. Passing the Physician Assistant National Recertifying Examination or successfully recertifying with the NCCPA through completion of the Physician Assistant National Recertifying Examination – Longitudinal Assessment during the reporting period.

There are no other types or categories of continuing education activity for physician assistants satisfactory to the Board.

14.3. Mandatory Continuing Education Activity Upon Initial Licensure -- Within one year of receiving an initial physician assistant license by the Board, a licensee shall complete three hours of training in a Board-approved course on Risk Assessment and Responsible Prescribing of Controlled Substances. This requirement is waived for licensees who do not prescribe, administer, or dispense any controlled substances whatsoever pursuant to a West Virginia license. Completion of a Board-approved course on Risk Assessment and Responsible Prescribing of Controlled Substances during the initial year of licensure may be allocated towards a licensee’s biennial continuing education obligation for the renewal period during which the course was completed.

14.4. The Board-approved Risk Assessment and Responsible Prescribing of Controlled Substances shall satisfy three of the 100 required hours of continuing education for the reporting period.

14.5. The Board shall maintain and publish on its website a current list of all educational activities which have been approved by the Board to satisfy the Risk Assessment and Responsible Prescribing of Controlled Substances continuing education requirement.

14.6. The Board shall include a certification of successful completion of required continuing education on its biennial renewal application. The certification shall require the renewal applicant to:

14.6.1. Certify successful completion of all required continuing education;

14.6.2. Attest to the truthfulness and accuracy of the renewal applicant’s statements regarding continuing education activities;

14.6.3. Acknowledge that any license issued based upon the renewal application is based upon the truth and accuracy of the applicant’s statements and that if false information is submitted in the application, such act constitutes good cause for the revocation of the renewal applicant’s license to practice in the State of West Virginia; and

14.6.4. Sign and date the certification.

14.7. A license shall automatically expire if the certification required by subsection 14.6 is not submitted to the Board by the renewal deadline. An automatically expired license shall remain expired until a licensee successfully seeks reinstatement or reactivation of licensure.

14.8. A licensee shall maintain accurate records of all continuing education he or she has completed. Continuing education records shall be maintained for a period of six years.

14.9. The Board may conduct such audits and investigations as it considers necessary to assure compliance with continuing education requirements and/or to verify the accuracy of a renewal applicant’s certification of continuing education.

14.10. Upon written request of the Board to a licensee’s preferred mailing address or email address of record with the Board, a licensee shall, within 30 days, submit written documentation satisfactory to the Board corroborating the licensee’s renewal application certification of continuing education compliance.

14.11. Failure or refusal of a licensee to provide written documentation requested by the Board as set forth in subsection 14.10 of this rule is prima facie evidence of renewing a license to practice as a physician assistant by fraudulent misrepresentation and the licensee is subject to disciplinary proceedings.

W. Va. Code R. § 11-1B-15 Identification and Compliance Audits

15.1. Except as otherwise provided by law, when practicing as a physician assistant, a physician assistant must wear a name tag in a conspicuous manner which identifies the practitioner as a physician assistant. An individual may not identify himself or herself as a physician assistant unless licensed by this Board or the Osteopathic Board.

15.2. A physician assistant shall keep his or her license and current practice notification available for inspection at each of his or her primary places of practice.

15.3. A physician assistant shall notify the Board in writing of a change in the physician assistant's name or address within 15 days of the change.

15.4. The Board may review physician assistant utilization without prior notice to the physician assistant, the collaborating physician, or the practice setting. An authorized representative or investigator for the Board may, without prior notice, enter at any reasonable hour a place of employment or practice of a physician or physician assistant or into public premises:

15.4.1. For the purpose of an audit to verify general compliance with the Physician Assistants Practice Act and this legislative rule; or

15.4.2. To investigate an allegation or complaint with respect to a collaborating physician or physician assistant.

15.5. A person may not deny or interfere with an entry under this section.

15.6. The Board’s representatives may require a physician, physician assistant, or facility where the physician assistant is employed or practicing to provide access to records relating to the physician assistant’s licensure, employment, credentialing, practice and medical records of patients seen by the physician assistant. It is a violation of this rule for a hospital, practice setting, collaborating physician or a physician assistant to refuse to undergo or cooperate with a review or audit by the Board.

15.7. The Board’s representative shall refer possible compliance issues to the appropriate Committee of the Board and/or to any other agency that has jurisdiction over a facility, place of practice or practitioner.

W. Va. Code R. § 11-1B-16 Mental and Physical Examination

16.1. The Board under any circumstances may require a licensed physician assistant or a person applying for licensure or other authorization to practice as a physician assistant in this state to submit to a physical or mental examination by a physician or physicians approved by the Board. The expense of the examination shall be paid by the Board.

16.2. A physician assistant submitting to an examination has the right, at his or her expense, to designate another physician to be present at the examination and make an independent report to the Board.

16.3. An applicant or licensee is considered to have given his or her consent to submit to all examinations when requested to do so in writing by the Board and to have waived all objections to the admissibility of the testimony or examination report of an examining physician on the ground that the testimony or report is privileged communication.

16.4. If a person fails or refuses to submit to an examination under circumstances which the Board finds are not beyond his or her control, failure or refusal is prima facie evidence of his or her inability to practice as a physician assistant competently and in compliance with the standards of acceptable and prevailing physician assistant practice.

W. Va. Code R. § 11-1B-17 License Denial, Complaint and Disciplinary Procedures

17.1. The licensure denial, complaint and disciplinary process and procedures and appeal rights set forth in the contested case hearing procedure, W. Va. Code §29A-5-1 et seq., W. Va. Code §30-3-14(h) and (i), and in the Board’s procedural rule, 11 CSR 3, Board Organization and Meeting Procedure; Complaint and Contested Case Hearing Procedure, also apply to physician assistants.

17.2. If the Board determines the evidence in its possession indicates that a physician assistant's continuation in practice or unrestricted practice constitutes an immediate danger to the public, the Board may take any of the actions provided in W. Va. Code §30-3-14(j) on a temporary basis and without a hearing if institution of proceedings for a hearing before the Board are initiated simultaneously with the temporary action and begin within 15 days of the action. The Board shall render its decision within five days of the conclusion of a hearing under this subsection.

W. Va. Code R. § 11-1B-18 Denial of Licensure and Discipline

18.1. The Board may deny an application for license, or other authorization to practice as a physician assistant and may discipline a physician assistant licensed or registered by the Board who, after a hearing, has been adjudged by the Board as unqualified due to any of the following reasons:

18.1.1. Conduct by a physician assistant which is equivalent to any of the grounds cited for the discipline of physicians or podiatric physicians in W. Va. Code §30-3-14(c) or section 12 of the Board’s rule 11 CSR 1A;

18.1.2. Failure to comply with any portion of this rule, the provisions of W. Va. Code §30-3E-1 et seq. and any other rule of the Board;

18.1.3. Practicing as a physician assistant:

18.1.3.a. In the absence of an active practice notification;

18.1.3.b. Outside or beyond the scope of an active practice notification; or

18.1.3.c. Beyond his or her level of competence, education, training and/or experience;

18.1.4. Prescribing, ordering, administering or dispensing a prescription drug that the physician assistant is not authorized to prescribe, order, administer or dispense.

18.1.5. Prescribing any controlled substance to or for himself or herself, or to or for any member of his or her immediate family;

18.1.6. Failure of a physician assistant to:

18.1.6.a. Notify the Board that an active practice notification has been terminated in the required time frame; or

18.1.6.b. Maintain a copy of his or her license and active practice notification in each primary place of practice;

18.1.7. Impersonation of a licensed physician, podiatric physician or another licensed physician assistant;

18.1.8. Misrepresentation that the physician assistant is a physician, that the physician assistant is currently certified by the NCCPA, or that the physician assistant holds any position for which he or she is not qualified by license, training, or experience;

18.1.9. Knowingly permitting another person to misrepresent the physician assistant as a physician;

18.1.10. Allowing an employment relationship to exert undue influence on sound clinical judgment or on the physician assistant’s professional role and patient obligations; or

18.1.11. Misrepresentation or concealment of any material fact in obtaining any certification, registration, or license or a reinstatement or reactivation of any certification, registration or license related to his or her practice as a physician assistant.

18.2. If a physician assistant is found guilty of or pleads guilty or nolo contendere to any court of competent jurisdiction of any felony involving prescribing, selling, administering, dispensing, mixing or otherwise preparing any prescription drug, including any controlled substance under state or federal law, for other than generally accepted therapeutic purposes in a state or federal court of competent jurisdiction, the Board shall deny an application for licensure or revoke the physician assistant’s license without resort to the procedures set forth in section 17 of this rule. A certified copy of the guilty verdict or plea rendered is sufficient proof for licensure denial or revocation.

18.3. If the Board determines that a physician assistant is unqualified, the Board may enter an order denying an application or imposing any limitation, restriction or other disciplinary measure set forth in W. Va. Code §30-3-14(j) and/or 11 CSR 1A.

18.4. In their discretion, the Board and the Osteopathic Board may refer and receive information from one another concerning:

18.4.1. Mutual applicants, registrants and/or licensees;

18.4.2. Information developed during the complaint and investigation process of one board which implicates or otherwise relates to applicants, registrants and/or licensees of the other board;

18.4.3. Any Complaints received or discovered by one board which relate to mutual applicants, registrants and/or licensees or applicants, registrants and/or licensees of the other board.

Series 02 Establishment And Regulation Of Restricted License Issued To an Applicant In Extraordinary Circumstances

W. Va. Code R. § 11-2-1 General

1.1. Scope. -- W. Va. Code §30-3-10(e) provides for the issuance of a restricted license by the Board to an applicant in extraordinary circumstances under certain specific conditions and W. Va. Code §30-3-10(f) requires that rules be promulgated that establish and regulate the restricted license issued to an applicant in extraordinary circumstances.

1.2. Authority. -- W. Va. Code §30-3-10(f).

1.3. Filing date. -- May 6, 2009.

1.4. Effective date. -- June 1, 2009. §11.2.2. Definitions.

2.1. As used in this rule, the following words and terms have the following meanings:

2.1.a. “Extraordinary circumstances” means circumstances where the physician has achieved a high level of academic or professional recognition for excellence in research, teaching, specialty or the practice of medicine as evidenced by objective factors.

2.1.b. “Restricted license in extraordinary circumstances” means a license which contains limitations or conditions including but not limited to the following:

2.1.b.1. Practice location;

2.1.b.2. Practice setting;

2.1.b.3. Specialty area of practice;

2.1.b.4. Practice procedures;

2.1.b.5. Hours and length of practice;

2.1.b.6. Type of patients;

2.1.b.7. Sitting for and successful completion of examination(s);

2.1.b.8. Evaluations and treatment;

2.1.b.9. Education; and,

2.1.b.10. Monitoring and supervision.

2.1.c. “Restricted licensee” means a person licensed pursuant to this rule.

W. Va. Code R. § 11-2-3 Issuance of License in Extraordinary Circumstances

3.1. The Board may issue a restricted license in extraordinary circumstances to an applicant who meets the criteria established by this rule.

3.2. After reviewing the application and interviewing the applicant, the Board makes written findings describing:

3.2.a. The applicant’s exceptional education, training and practice credentials, including but not limited to, academic appointments, length of time in a profession, specialty, scholarly publications and presentations, professional accomplishments, and awards;

3.2.b. How the applicant’s practice in the state would be beneficial to the public welfare;

3.2.c. The applicant’s specialty and the need of that specialty;

3.2.d. How the applicant’s education, training and practice credentials are substantially equivalent to the requirements of licensure established in W. Va. Code §30-3-10; and,

3.2.e. That the applicant received his or her post-graduate medical training outside of the United States and its territories.

3.3. The applicant must provide to the board all additional information requests, and an explanation of his or her extraordinary circumstances.

3.4. The board by three-fourths vote shall approve a restricted license issued in extraordinary circumstances.

3.5. An applicant who has been the subject of disciplinary action by any other jurisdiction; the United States Uniformed Services; the applicant’s peers in a professional medical association; or the staff of a hospital is not eligible for a restricted license in extraordinary circumstance.

3.5.a. However, an applicant who was temporarily suspended from a hospital for: failure to maintain records on a timely basis; failure to attend staff or section meetings; or voluntary cessation of hospital privileges for reasons unrelated to professional competence or ethics is not considered to be disciplinary action for purposes of this section.

3.6. An applicant who was convicted, pled guilty, pled no contest, placed on deferred adjudication, community supervision, or deferred disposition for a felony is not eligible for a restricted license in extraordinary circumstances.

3.7. An applicant who was convicted, pled guilty, pled no contest, placed on deferred adjudication, community supervision, or deferred disposition for a misdemeanor connected with the practice of medicine or with moral turpitude is not eligible for a restricted license in extraordinary circumstances.

3.8. An applicant is not eligible for a temporary license pursuant to W. Va. Code §30-3-11.

3.9. Orders denying applications for a restricted license in extraordinary circumstances are not appealable.

3.10. The board shall report to the President of the Senate and the Speaker of the House of Delegates all decisions made regarding requests for a restricted license under extraordinary circumstances.

3.11. The burden of satisfying the board of the applicant qualifications for a restricted license under extraordinary circumstances is upon the applicant.

W. Va. Code R. § 11-2-4 Regulation of Restricted License in Extraordinary Circumstances

4.1. The Restricted licensee is subject to all the provisions of the West Virginia Medical Practice Act, W. Va. Code §30-3-1 et seq. and all rules.

W. Va. Code R. § 11-2-5 Change in Restricted License

5.1. The board may, upon its own motion or upon the request of a restricted licensee, by a vote of three fourths of its members, authorize changes in restrictions applicable to a restricted license. The board may authorize changes under this subsection only upon a finding that the changes are appropriate, necessary and in the public interest.

W. Va. Code R. § 11-2-6 Conversion of Restricted License to Standard License

6.1. The board may convert the restricted license to a standard license upon application of a restricted licensee who later meets the requirements for a standard license.

11CSR2

11CSR2

Series 03 Board Organization And Meeting Procedure; Complaint And Contested Case Hearing Procedures

W. Va. Code R. § 11-3-1 General

1.1. Scope. -- This procedural rule governs all regularly scheduled meetings and special meetings of the West Virginia Board of Medicine (the "Board") and establishes procedures for Complaints and for the adjudication of formal contested case hearings, except those hearings held under the provisions of W. Va. Code §30- 3-14(k) where action is taken by the Board on a temporary basis prior to a hearing.

1.2. Authority. -- W. Va. Code §§6-9A-3, 29A-5-1 and 30-3-7.

1.3. Filing Date. -- May 10, 2010.

1.4. Effective Date. -- June 10, 2010.

W. Va. Code R. § 11-3-2 Definitions

2.1. Application and enforcement. -- This procedural rule applies to the Board and to any and all individuals desiring to attend Board meetings, to complaints, and to any person involved in a contested case proceeding as defined in W. Va. Code §29a-1-2(b), 1931, as amended. The enforcement of these rules shall be vested in the Board.

W. Va. Code R. § 11-3-3 Regular Meetings Established; Time, Place

3.1. The Board shall meet in regular session on the second Monday of alternate months: Provided, That when such date falls upon a legal holiday, the Board may designate another date by a majority of a quorum of the Board: Provided further, That the Board may change its regular meeting dates by resolution of a majority of its members.

3.2. The Board shall convene all regular meetings at nine a.m., unless otherwise changed by a majority vote of a quorum of the Board.

3.3. The Board shall convene all regular meetings at the Offices of the West Virginia Board of Medicine, Dee Drive, Charleston, West Virginia 25311, unless otherwise changed by a majority vote of a quorum of the Board.

3.4. The Board may, without notice, move the location of the meeting to accommodate members of the public who wish to attend such meeting, in the event the meeting room is too small to accommodate such attendance.

3.5. All regular meetings shall be general meetings for the consideration of any and all matters which may properly come before the Board.

3.6. The date, time, place and agenda of all regularly scheduled meetings shall be made available to the public and news media prior to the meeting.

W. Va. Code R. § 11-3-4 Special Meetings; Notice Required, Time, Place And Purpose

4.1. The Board may convene special meetings in accordance with the procedures established herein.

4.2. Special meetings of the Board may be called by the joint action of the President and Vice-President, or by any three (3) members of the Board, upon seven (7) days' prior written notice by mail postage prepaid, or electronic means, or in case of emergency, on two (2) days' notice by telephone and electronic means.

4.3. The Board shall send to all members in advance of a special meeting a written notice setting forth the time and place of such special meeting and the matters to be considered at such special meeting: Provided, That such written notice is not required if the time, place and matter for consideration have been fixed in a regular meeting or if the emergency nature of a special meeting precludes other than notice by telephone or personal contact.

4.4. The Board shall cause by electronic means notification of the public and the news media by issuing a public notice of such special meeting as expeditiously as possible. The public notice shall contain the date, time, place and purpose of the meeting. A copy of the public notice shall be filed with the office of the Secretary of State.

4.5. The provisions of this section shall not apply in the event of an emergency requiring immediate official action by the Board. An emergency meeting notice may be filed at any time prior to the emergency meeting. The emergency meeting notice shall state the date, time, place and purpose of the meeting and the facts and circumstances of the emergency.

4.6. Meetings may be held by telephone conference or other electronic means.

W. Va. Code R. § 11-3-5 Proceedings To Be Open; Exceptions; Executive Session Permitted; Broadcasting and Recording

All meetings of the Board shall be open to the public, except as otherwise provided in W. Va. Code §§6-9A-4 and 30-3-6. Except as otherwise provided in W. Va. Code §6-9A-9, the Board shall permit any radio or television station to broadcast all or any part of a meeting required to be open.

W. Va. Code R. § 11-3-6 Minutes

6.1. The Board shall provide for the preparation of written minutes of all of its meetings. All minutes of open meetings shall be available to the public within a reasonable time after such meetings and shall include the following information:

6.1.a. The date, time and place of the meeting;

6.1.b. The name of each Board member present or absent;

6.1.c. All motions, proposals, resolutions, orders, ordinances and measures proposed, the name of the persons proposing the same and their disposition;

6.1.d. The results of all votes, and upon the request of a member, the vote of each member, by name; and

6.1.e. Minutes of executive sessions, if any are taken, may be limited to material which is not inconsistent with the provisions of W. Va. Code §6-9A-4.

W. Va. Code R. § 11-3-7 Quorum; Majority Open Vote Required; Vote By Proxy Prohibited

A majority of the members of the Board shall constitute a quorum for the transaction of business, and business shall be transacted by majority of a quorum except that votes on disciplinary actions shall require an affirmative vote of five (5) members or a majority vote, whichever is greater. Proxy voting or voting by secret or written ballot, are prohibited.

W. Va. Code R. § 11-3-8 Records Of The Board -- Public Documents

All records of open proceedings of the Board are public records and shall be available to the public during the usual and customary business hours of the Board.

W. Va. Code R. § 11-3-9 Board Membership and Organization

9.1. Members of the Board shall be appointed and serve as provided by W. Va. Code §30-3-5.

9.2. Every two (2) years, the Board shall elect from its members a President and Vice-President. The State Health Officer or his or her designee shall serve as Secretary of the Board. The Board may elect such other officers as it deems necessary to perform its duties.

9.3. The President shall preserve order and conduct all proceedings according to and by parliamentary rules, and demand conformity thereto on the part of the members. The President shall appoint all committees, unless otherwise ordered by the Board or specifically provided by law, and notify any appointee of his or her appointment and he or she shall sign his or her name as President to the certificates and licenses authorized to be signed by the President.

9.4. The Vice-President shall act as President in the absence of the President.

9.5. The Board shall keep true records of all general and special acts of the Board and all papers of value and shall preserve a record of all individuals licensed or disciplined by the Board. The Secretary shall sign certificates and licenses authorized to be issued by the Board and shall perform all such duties as naturally pertain to his or her office.

9.6. The Board may employ an Executive Director who shall work under the immediate supervision of the President and Secretary in administering the day-to-day activities of the Board.

9.7. The Board may appoint, employ or contract with duly licensed physicians, or podiatrists, or physician assistants, as appropriate, to serve as medical or podiatric consultants to the Board on a part-time basis. A medical or podiatric consultant shall be vested with the following powers and shall perform the following duties:

9.7.a. Review matters requiring medical expertise for decision to come to the attention of the Board;

9.7.b. Provide medical advice to the Executive Director and the investigative staff in all matters requiring pertinent medical knowledge; and

9.7.c. Medically evaluate investigative reports, when necessary, and assist in the preparation of matters to be heard by the Board or any matter in which the Board is involved.

The authority so delegated is not intended to divest the Board of the power to elect to perform any such function at any regular or special meeting of the Board, but is a delegation to enable the performance of these Board functions at such times as the Board is not in session, and to assist the Board in the more efficient and lawful handling of its affairs.

9.8. The order of business during any regular or special meeting of the Board shall be governed by the Sturgis Rules of Order.

9.9. Permanent committees are as follows:

9.9.a. The executive/management committee shall consist of the officers of the Board plus one (1) other member of the Board, as appointed by the President. The President shall serve as chair of the committee. The committee shall oversee the day-to-day operation of the Board and shall be responsible for all financial matters with the exception of the setting of fees which, where discretionary under the law, shall be the responsibility of the entire Board.

9.9.b. The licensure committee shall consist of three (3) or more members appointed by the President. The President shall designate one (1) member to be chair of the committee. The committee shall consider all matters relating to applicants for, and renewal of, physician and podiatric licensure. The licensure committee may request the Board to issue subpoenas and subpoenas duces tecum as required to carry out its purposes and responsibilities.

9.9.c. The legislative committee shall consist of three (3) or more members appointed by the President. The President shall designate one (1) member to be chair of the committee. The committee shall consider all questions bearing upon state and national legislation and shall recommend from time to time such changes in the law as it may deem advisable and, at the direction of the Board, shall take such steps as may further the desire of the Board in matters of legislation. Proposed changes in the rules shall be presented by the legislative committee, in writing, to all Board members.

9.9.d. The complaint committee shall consist of three (3) or more members of the Board appointed by the President. The President shall designate one (1) member to be chair of the committee. Upon receipt of a complaint submitted to the Board, the matter shall be referred to the complaint committee for further disposition.

9.9.e. The Board may create such additional permanent committees as it deems necessary to carry out its purposes and duties.

9.10. The President may appoint such temporary committees as are necessary to assist the Board in the performance of its duties and responsibilities and shall empower each such committee with a delegation of such Board authority as is necessary to accomplish the purpose of such temporary committees.

W. Va. Code R. § 11-3-10 Reports And Complaints

10.1. Any person, medical peer review committee, firm, corporation, member of the Board or public officer may make a complaint to the Board which charges a physician, podiatrist, or physician assistant with a violation of the West Virginia Medical Practice Act or of the Rules of the Board. The Board shall provide a form for such purpose. In addition to describing the alleged violation which prompted the complaint, the complaint shall contain the following:

10.1.a. The name and address of the individual(s) against whom the complaint is lodged;

10.1.b. The date of care;

10.1.c. The name(s) of individual(s) who may have treated the patient after the alleged incident; and

10.1.d. The name of any health care institution in which the patient was an inpatient or outpatient after or during the alleged incident.

10.2. Reports submitted by a medical or podiatric peer review committee, a physician, a podiatrist, the chief executive officer of a hospital, a professional society, an insurer or any other person, in compliance with the provisions of W. Va. Code §30-3-14(b) may result in the initiation of its own complaint by the Board or its complaint committee.

10.2.a. The Board may prepare forms for filing required reports and make them available upon request.

10.2.b. Any individual or any medical or podiatric entity having reason to believe that the conduct of a physician, podiatrist, or physician assistant amounts to professional malpractice or professional incompetence may report such information to the Board.

10.2.c. Information received by the Board under the provisions of W. Va. Code §§30-3-10, 30-3-14(c) and under 11CSR1A may be used by the Board or its complaint committee in its determination as to whether to deny an application for a license or to initiate disciplinary action against a physician, podiatrist or physician assistant licensed in this State, and such information may be submitted into evidence notwithstanding its prior use in any administrative, civil or criminal hearing involving such applicant physician, podiatrist, or physician assistant.

10.3. All communications with the Board charging a physician, podiatrist, or physician assistant with violations of the Medical Practice Act and/or 11CSR1A or 11CSR1B are conditionally privileged and a person making a communication is privileged from liability based upon the communication unless the person makes the communication in bad faith or for a malicious reason.

10.4. A complaint log shall be maintained which records the receipt of each complaint, its nature and its disposition.

10.5. An individual making a complaint will receive one of the following acknowledgments:

10.5.a. That the matter will be reviewed by Board members;

10.5.b. That the complaint is outside of the jurisdiction of the Board, with suggestions as to how the complainant might best obtain a resolution of his or her problem; or

10.5.c. That more information will be required in order to adequately review the individual complaint.

10.6. A separate investigative or complaint folder shall be maintained on each case reviewed, and each folder shall have a case number assigned to it.

10.7. After receipt and review of a complaint, unless the complaint is determined to fall within the provisions of Subdivision 10.5.b of this rule, the complaint committee of the Board established by the Board under this rule shall cause to be conducted any reasonable inquiry or investigation it considers necessary to determine the truth and validity of the allegations set forth in the complaint. The complaint committee shall provide reports to the Board on the number, nature, procedure and handling of the complaints received.

10.8. A complaint against an individual must allege that in his or her professional capacity he or she is acting in violation of the law, rules or good and accepted medical or podiatric practice and may be founded on any violation enumerated in W. Va. Code §30-3-14(c) or Subsections 12.1 or 12.2 of Board rule 11CSR1A, or Subsection 10 of Board rule 11CSR1B, or any rule hereinafter promulgated by the Board.

10.9. The complaint committee may request the Board to issue subpoenas and subpoenas duces tecum as required to complete its investigation and may utilize the Board investigator to conduct whatever investigations are necessary to determine the truth and validity, or lack thereof, of complaints. In the event the Board or its complaint committee initiates its own complaint, it may utilize subpoenas, subpoenas duces tecum and its investigators as it determines necessary to gather facts and evidence.

10.10. To facilitate disposition of a complaint, the complaint committee may request any person to attend an informal conference, at any time prior to the commencement of an adjudicatory proceeding. The Board or complaint committee shall give fifteen (15) days' notice of the conference, which notice shall include a statement of the issues to be informally discussed. Statements made at a conference may not be introduced at any hearing on the merits without the consent of all parties to the hearing. No prejudice shall attach for failure to attend a conference pursuant to a request.

10.11. If it is determined that a complaint complies substantially with subsection 10.8 of this rule and that it relates to matters set forth in W. Va. Code §30-3-14(c) or subsections 12.1 or 12.2 of 11CSR1A, or subsection 10 of 11CSR1B, the individual complained of (hereinafter referred to as the "Respondent") may respond in writing to the complaint within thirty (30) days. A copy of the complaint shall be attached to the request for response. A respondent may respond either personally or through his or her attorney, but the response must address the substantive allegations set forth in the complaint or request.

10.12. Upon receipt of the respondent's response or at any point in the course of investigation or inquiry into a complaint, the complaint committee may determine that there is not and will not be sufficient evidence to warrant further proceedings or that the complaint fails to allege misconduct for which a licensee may be sanctioned by the Board. In that event, the complaint committee shall dismiss the complaint. It is the complaint committee’s responsibility to retain a file of all complaints and to review this file periodically.

10.13. At any point in its investigation of a complaint, the complaint committee may assign the matter to one of its medical or podiatric consultants for review. The report of the medical or podiatric consultant shall contain a statement of the allegations, the facts, analysis of the complaint and care provided, a brief description of the records reviewed and a recommendation and finding. The medical or podiatric consultant shall, upon request, be afforded an opportunity to have an investigation interview with the physician or podiatrist in question or other involved parties, a report of which shall be placed in the investigative file.

10.14. If the complaint committee determines that there is reason to believe that the acts alleged occurred and constitute a violation for which a licensee may be sanctioned by the Board, the complaint committee shall find probable cause to believe there is a violation of the law.

10.15. A hearing is required if it is determined that there is probable cause to believe that acts alleged occurred and may constitute a violation of any provision of law. The complaint committee may take such action as it determines a complaint warrants.

10.16. The Board may take summary action pending a hearing, if the health, safety or welfare of the public necessitates such summary action. The Board shall provide a hearing on the necessity for the summary action within fifteen (15) days after the summary action. The Board shall render its decision within five (5) days of the conclusion of a hearing under this section.

10.17. W. Va. Code §30-3-9(a) requires the Board to maintain a permanent file on each physician, podiatrist, and physician assistant, licensed or otherwise lawfully practicing in this State and of all persons applying to be licensed. This file shall include an individual historical record of each physician, podiatrist, and physician assistant, which shall include all reports and information furnished to the Board pursuant to applicable law. In the event an investigative or complaint file is opened, a record shall be made of the file. The Board shall provide a licensee written notice of the substance of any record placed in his or her historical file, and the licensee will be permitted thirty (30) days in which to file a written statement regarding the record; the statement shall always accompany that part of the record in contention. A physician, podiatrist, or physician assistant may examine his or her historical file during regular office hours of the Board or may designate his or her attorney to do so. A request for photocopies of his or her historical file may be made by a physician, podiatrist, or physician assistant and it shall be processed by the Board on the basis of staff availability. The cost of the request shall be paid by the requesting physician, podiatrist, or physician assistant. All matters in an historical file are strictly confidential, except as exempted by W. Va. Code §30-3-9. Except for information enumerated in W. Va. Code §30-3-9(f), the Board shall expunge any matter in an historical file which is not involved in a proceeding for a hearing regarding the physician, podiatrist, or physician assistant concerned within two (2) years from its placement into the file. If the investigative or complaint file is closed on the basis that the individual physician, podiatrist, or physician assistant concerned is not guilty of any misconduct or wrongdoing, the Board shall remove all information relating to that investigation from his or her historical file.

10.18. A physician, podiatrist, or physician assistant shall respond within thirty (30) days to a written communication from the Board, the complaint committee or other designee and shall make available to the Board any relevant and authorized records with respect to an inquiry or complaint about his or her professional conduct. The thirty (30) day period commences on the date the communication is sent by registered or certified mail with return receipt requested to his or her last known address.

W. Va. Code R. § 11-3-11 Hearings

11.1. Any party who demands a hearing to have determined any constitutional rights, legal rights, duties, interests or privileges of specific parties as required by law shall specify in writing the grounds relied upon as basis for the relief requested.

11.2. When the President or his or her authorized designee is presented with a demand for a hearing as described in Subsection 11.1 of this section, he or she shall schedule a hearing within forty-five (45) days of receipt by him or her of such written demand, unless postponed to a later date by mutual agreement. However, if the President or his or her designee shall determine that the hearing demanded would either involve an exercise of authority in excess of that available to him or her under law, or would serve no useful purpose, the President shall, within forty-five (45) days of receipt of such demand, enter an order refusing to grant the hearing as requested, incorporating therein the reason(s) for such refusal. Appeal may be taken from such order as provided in W. Va. Code §29A-5-4.

11.3. Charges may be instituted in a complaint against any physician, podiatrist, or physician assistant by the Board and shall be noted in the official minutes of the Board. Charges may be based upon information indicating that there is probable cause for believing that said physician, podiatrist, or physician assistant may have engaged in such conduct or be in such condition that his or her license may be disciplined for one or more grounds set forth in the Medical Practice Act or its implementing rules.

11.4. Upon the receipt of a demand for a hearing as described in Subsection 11.1 of this section, or where a hearing is otherwise required, the President or his or her designee shall as soon thereafter as possible provide the party making such demand and the party charged with a violation of licensing provisions of the law or rules promulgated by the Board, with a notice of hearing (assuming the President has not entered an order denying a hearing as provided in Subsection 11.2 of this section.) Said notice shall be served upon the respondent at least thirty (30) days prior to the hearing date. Said notice shall contain the following information:

11.4.a. The date, time and place of the hearing;

11.4.b. A short plain statement of the matters asserted or charged, as set forth in the complaint; and

11.4.c. A statement of intention to appoint a hearing examiner.

Where charges are instituted, the complaint shall be issued in the name of the Board as an agency of the state and designate the Board as "Petitioner" and shall designate the physician, podiatrist, or physician assistant being proceeded against as "Respondent." The petitioner shall set out the substance of each offense charged with sufficient particularity to reasonably apprise the respondent of the nature, time and place of the conduct or condition complained of therein. The Board may amend the complaint as it deems proper.

Upon proper motion, a more definite statement of the matters asserted or charged shall be provided to the respondent or his or her counsel, at least fifteen (15) days prior to the hearing date.

11.5. Hearings shall be conducted as follows:

11.5.a. Any party to a hearing shall have the right to be represented by an attorney-at-law, duly qualified to practice in the State of West Virginia.

11.5.b. The Board may be represented by the Office of the Attorney General.

11.5.c. The rules of evidence as applied in civil cases in the circuit courts of this State shall be followed.

11.5.d. Hearings conducted by the Board or by a hearing examiner appointed by the Board, upon a complaint issued by the Board, are a continuance of the investigation designed to enable the Board to properly discharge its administrative functions and authority. The purpose of such hearing is to afford the respondent an opportunity, in person or by counsel or other representative, to respond to the complaint, to present his or her position, to present evidence in support of his or her contention, to examine and cross-examine evidence and witnesses produced in support of the complaint and to argue orally at the hearing.

11.5.e. The hearing shall be held at such time and place as is designated by the Board, but no hearing shall be conducted unless and until at least thirty (30) days' written notice thereof has been served upon the respondent in person or by registered or certified mail.

11.5.f. The hearing shall be open to the general public.

11.5.g. The purpose of the hearing shall be to further inquire into the matters set forth in the complaint or any amended complaint, and to record evidence and arguments in support of same and in opposition thereto, so that the Board may determine all issues. Members of the Board and its officers, agents and employees shall be competent to testify at the hearing, as to material and relevant matters: Provided, That no member of the Board who testifies at such hearing shall thereafter participate in the deliberations or decisions of the Board with respect to the case in which he or she so testified.

11.5.h. The hearing may be conducted by a Board member, or by a hearing examiner appointed by the Board.

11.5.i. A record of the hearing (including the complaint and amended complaint, the notice of hearing, all pleadings, motions, rulings, stipulations, exhibits, documentary evidence, evidentiary depositions and the stenographic report of the hearing) shall be prepared under the supervision of the Board, if the hearing is conducted by it, or by a hearing examiner who conducts the hearing on behalf of the Board.

11.5.j. Documentary evidence may be received in the form of copies or excerpts or by incorporation by reference.

11.5.k. Initially, the Board shall be given an opportunity to present evidence, including testimony, papers, electronic and other records, agency staff memoranda and documents in the possession of the Board, in support of its position, except where a hearing has been demanded under the provisions of subsection 11.1 of this section, in which case initially the party demanding the hearing shall present his or her evidence.

11.5.l. Every party shall have the right of cross-examination of witnesses who testify, and following the conclusion of the Board's presentation, shall have the right to submit rebuttal evidence.

11.5.m. The Board shall have the right to cross-examine witnesses providing rebuttal testimony and shall have the right to submit rebuttal evidence.

11.5.n. Following the presentation of all evidence, every party, including the Board, shall have the right to offer argument, not to exceed ten (10) minutes for each presentation.

11.5.o. The state or local organization which represents the profession to which the respondent belongs may seek to intervene in any hearing for the purpose of assisting in the prosecution of the complaint, or may, with the consent of the respondent, seek to intervene for the purpose of assisting the respondent in contesting the complaint.

11.5.p. Hearing examiners are not authorized or empowered to suspend or revoke any license or to place any licensee on probation or to discipline any licensee. The function of a hearing examiner is to preside at the hearing and to cause to be prepared a record of the hearing, as described above, so that the Board is able to discharge its functions. The hearing examiner shall prepare recommended findings of fact and conclusions of law for submission to the Board.

11.5.q. Summons and subpoenas may be issued by the President or Secretary of the Board and by hearing examiners appointed by the Board.

11.5.r. The Board or its hearing examiner may institute proceedings in circuit courts to punish persons for contemptuous or contumacious conduct directed to the Board or to its hearing examiner in the course of hearings.

11.5.s. The respondent shall serve his or her answer within thirty (30) days after service of the complaint upon him or her. Upon failure of the respondent to respond to the complaint as required herein, all of the allegations set out therein as to conduct or conditions of the respondent may be taken by the Board as confessed by the respondent.

11.6. Hearings may be continued from one day to another, or adjourned to a later date or a different place, by announcement thereof or by appropriate notice to all parties.

A continuance may be granted by the President or his or her designee for good cause shown. A written notice of a continuance shall be filed at least five (5) days prior to the hearing date.

W. Va. Code R. § 11-3-12 Transcription Of Reported Testimony And Evidence

12.1. All testimony, evidence, arguments and rulings on the admissibility of testimony and evidence shall be reported by stenographic notes and characters or by mechanical means.

12.2. Upon request to the Board by any party to the hearing, all reported materials shall be transcribed and a copy thereof furnished to such party at his or her expense.

12.3. In all cases where a hearing examiner is appointed, all reported materials shall be transcribed and forwarded to Board members. A party who requests a copy of a transcript prepared pursuant to this subsection shall be furnished a copy at his or her expense.

12.4. The Board shall have the responsibility to make arrangements for the transcription of the reported testimony and evidence. In the event transcription is required pursuant to this section, it shall be accomplished within a reasonable time.

12.5. Upon the motion of the Board or any party assigning error or omission in any part of any transcript, the Board, through the President or its duly appointed hearing examiner, shall settle all differences arising as to whether such transcript truly discloses what occurred at the hearing and shall direct that the transcript be corrected and revised in the respects designated, so as to make it conform to the whole truth.

W. Va. Code R. § 11-3-13 Submission Of Proposed Findings Of Fact And Conclusions of Law

13.1. Any party may submit proposed findings of fact and conclusions of law within thirty (30) days of the conclusion of a hearing, or within twenty (20) days from the date the final transcript is available to all parties and to all members of the Board. Transcripts of the hearing shall be provided to members of the Board for review at least ten (10) days before the vote on the proposed findings of fact and conclusions of law is called.

W. Va. Code R. § 11-3-14 Hearing Examiner

14.1. The President, with the approval of a majority of the Board, may appoint hearing examiners on an annual basis who shall be empowered to subpoena witnesses and documents, administer oaths and affirmations, examine witnesses under oath, rule on evidentiary questions, hold conferences for the settlement or simplification of issues by consent of the parties and otherwise conduct hearings as provided in Section 11.5 herein. If a hearing examiner is appointed under this section, he or she shall make proposed findings of fact and conclusions of law.

14.2. The President, with the approval of a majority of the Board, may appoint one or more members of the Board to serve as hearing examiner(s) for the purpose of conducting any hearing on behalf of the Board.

14.3. The hearing examiner shall submit written findings of fact and conclusions of law to the Board pursuant to W. Va. Code §29A-5-3, and the Board may adopt, modify or reject such findings of fact and conclusions of law.

W. Va. Code R. § 11-3-15 Conferences; Disposition of Cases

15.1. At any time prior to the hearing or thereafter, the President, his or her designee or his or her duly appointed hearing examiner may hold conferences for the following purposes:

15.1.a. To dispose of procedural requests or similar matters;

15.1.b. To simplify or settle issues by consent of the parties; or

15.1.c. To provide for the disposition of cases by stipulation, agreed settlement or consent order.

15.2. The President, his or her designee, or a duly appointed hearing examiner may cause such conferences to be held on his or her own motion or by the request of a party.

W. Va. Code R. § 11-3-16 Depositions

Evidentiary depositions may be taken and read into evidence as in civil actions in the circuit courts of this State.

W. Va. Code R. § 11-3-17 Subpoenas

17.1. The President or his or her designee shall have the power to issue subpoenas or subpoenas duces tecum pursuant to the provisions set forth in W. Va. Code §29A-5-1(b).

17.2. Written requests for the issuance of subpoenas or subpoenas duces tecum as provided in subsection 17.1 of this rule shall be made no later than ten (10) days before a scheduled hearing.

W. Va. Code R. § 11-3-18 Orders

18.1. Any final order entered by the President or his or her designee following a hearing conducted pursuant to these rules, shall be made pursuant to the provisions of W. Va. Code §29A-5-3. Such orders shall be entered within forty-five (45) days following the submission of all documents and materials necessary for the proper disposition of the case, including transcripts, and shall contain findings of fact and conclusions of law.

18.2. The findings of fact and conclusions of law must be approved by a majority of the Board either by a poll or vote at a regular or special meeting, before a final order is entered. A copy of the final order approved by a majority of the Board shall be served upon the respondent within five (5) days after entry by the Board, in person or by means of registered or certified mail sent to the party and his or her counsel.

W. Va. Code R. § 11-3-19 Appeal

An appeal from any final order entered in accordance with this rule shall comply with the provisions of W. Va. Code §29A-5-4.

11CSR3

11CSR3

Series 04 Fees For Services Rendered By The Board Of Medicine Including Assistance To The Board-Designated Physician Health Program

W. Va. Code R. § 11-4-1 General

1.1. Scope. -- This legislative rule establishes the fees to be charged by the Board of Medicine for services rendered including assistance to the board-designated physician health program.

1.2. Authority. -- W. Va. Code §§30-3-7(a)(1) and (5); 30-3-9(h); 30-3D-1 et. seq.

1.3. Filing Date. -- April 6, 2010.

1.4. Effective Date. -- May 1, 2010.

W. Va. Code R. § 11-4-2 Schedule of Fees For Physicians and Podiatrists including Assistance to The Board-Designated Physician Health Program

2.1. Medical Licensure Application Fee -- $400.00, $50.00 of which shall be promptly disbursed by the board to the physician health program.

2.2. Podiatric Licensure Application Fee -- $400.00, $50.00 of which shall be promptly disbursed by the board to the physician health program.

2.3. Temporary Medical or Podiatric License Fee -- $100.00.

2.4. Active Medical and/or Podiatry Biennial Renewal Fee -- $400.00, $50.00 of which shall be promptly disbursed by the board to the physician health program.

2.5. Inactive Medical and/or Podiatry Biennial Renewal Fee -- $150.00, $25.00 of which shall be promptly disbursed by the board to the physician health program.

2.6. Limited Medical School Faculty Initial Licensure Application Fee and Renewal Fee -- $150.00.

2.7. Limited Medical School Faculty Fee for Physician Health Program Assistance -- $50.00 to be paid with initial limited medical school faculty licensure application fee and with limited medical school faculty renewal fee, which $50.00 fee shall be promptly disbursed by the board to the physician health program.

2.8. Medical and Podiatry Examination Score Endorsement or Written Licensure Verification Fee -- $25.00.

W. Va. Code R. § 11-4-3 Schedule of Fees For Physician Assistants, including Assistance to The Board-Designated Physician Health Program

3.1. Physician Assistant Licensure Application Fee -- $200.00.

3.2. Temporary Physician Assistant Licensure Fee -- $50.00.

3.3. Physician Assistant Biennial Renewal Fee -- $100.00.

3.4. Physician Assistant Fee for Physician Health Program Assistance -- $50.00 to be paid with physician assistant licensure application fee and with physician assistant biennial renewal fee, which $50.00 fee shall be promptly disbursed by the board to the physician health program.

3.5. Physician Assistant Examination Score Endorsement or Written Licensure Verification Fee -- $25.00.

3.6. Prescriptive Writing Privileges Fee -- $50.00.

3.7. Change or Addition of Supervising Physician Fee -- $50.00.

3.8. Change or Addition of Job Location Fee -- $50.00.

W. Va. Code R. § 11-4-4 Schedule of Fees For Medical and Podiatric Corporations

4.1. Medical and Podiatry Corporation Application Fee -- $500.00.

4.2. Medical and Podiatry Corporation Biennial Registration Fee -- $250.00.

11CSR4

11CSR4

Series 05 Dispensing of Prescription Drugs by Practitioners

W. Va. Code R. § 11-5-1 General

1.1. Scope. -- West Virginia Code §30-3-7(a)(1) and §30-3E-2(3) authorizes the Board of Medicine to promulgate rules related to the regulation and control of controlled substances by a practitioner.

1.2. Authority. -- W. Va. Code §§ 30-3-7(a)(1), 30-3E-2(3) and 60A-3-301.

1.3. Filing Date. -- May 9, 2022.

1.4. Effective Date. -- June 1, 2022.

1.5. Sunset Provision. -- This rule shall terminate and have no further force or effect upon August 1, 2027.

W. Va. Code R. § 11-5-2 Definitions

2.1. "The Board" means the West Virginia Board of Medicine.

2.2. "Administer" means the direct application of any prescription drug whether by injection, inhalation, ingestion or any other means, to the body of a patient or research subject by:

2.2.a. A physician or podiatric physician, or his or her authorized agent;

2.2.b. A physician assistant practicing in collaboration with physicians; or

2.2.c. The patient or research subject at the direction and in the presence of the practitioner.

2.3. "Controlled substance" means a drug that is classified by federal or state law in Schedules I, II, III, IV or V.

2.4. "Course of treatment" means the period of time necessary to effect a cure for an acute disease, or the period of time from one office visit until the next scheduled or anticipated office visit for a chronic disease.

2.5. “Dispense" means the preparation and delivery of a prescription drug, in an appropriately labeled and suitable container, by a practitioner to a patient under the practitioner’s care. 2.6 "Drug" means: (1) Substances recognized as drugs in the official "United States Pharmacopoeia, official Homeopathic Pharmacopoeia of the United States or official National Formulary", or any supplement to any of them; (2) substances intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or animals; (3) substances (other than food) intended to affect the structure or any function of the body of man or animals; and (4) substances intended for use as a component of any article specified in subdivision (1), (2) or (3) of this subdivision. It does not include devices or their components, parts or accessories.

2.7. “Drug dispensing practitioner” means a practitioner who dispenses or administers prescription drugs to a patient under his or her care within West Virginia in the course of his or her professional practice and consistent with his or her scope of practice and/or authorization. This term includes, but is not limited to, practitioners who are registered with the Board pursuant to section 3 of this rule.

2.8. "Generic drug product" means a drug marketed without a trade name as a substitute for an innovator or previously patented pioneer drug.

2.9. “Label” means a display of written, printed, or graphic matter affixed upon the immediate container of a dispensed drug.

2.10. "Package insert" means the official labeling information sheet that accompanies a prescription drug when it is distributed by the manufacturer.

2.11. "Practitioner" means a physician, podiatric physician, or physician assistant licensed by the Board.

2.12. “Prescription drug” means a drug that may be prescribed, dispensed or administered under federal or state law only pursuant to the prescription of an authorized prescriber. Prescription drugs are also referred to as legend drugs.

2.13. "Professional samples" means complimentary drugs packaged and distributed in accordance with federal and state statutes and regulations and provided to a practitioner free of charge by manufacturers or distributors and distributed free of charge by the practitioner to his or her patients.

2.14. “Registered controlled substance dispensing practitioner” means a practitioner who is registered with the Board to dispense or administer controlled substances to a patient under the practitioner’s care within West Virginia in the course of his or her professional practice and consistent with his or her scope of practice and/or authorization.

2.15. “Returned or surrendered drug” means a prescription drug which has been dispensed to an end user by any entity, and which is subsequently returned or surrendered to a practitioner for any reason.

2.16. "Sale at retail" means dispensing prescription drugs to persons other than current active patients of a dispensing practitioner during the course of treatment of such patients.

2.17. "Free clinic" means a clinic where medical and other health-related services are rendered at no charge to the patient.

W. Va. Code R. § 11-5-3 Registration to Dispense or Administer Controlled Substances Required; Application and Registration Renewal

3.1. A practitioner who dispenses a controlled substance to a patient under his or her care within West Virginia, including free or professional samples of controlled substances, shall first register with the Board as a registered controlled substance dispensing practitioner. A separate registration is required for each practice location where the practitioner dispenses controlled substances.

3.2. A practitioner who administers a controlled substance to a patient under his or her care in an office based setting within West Virginia shall first register with the Board as a registered controlled substance dispensing practitioner. A separate registration is required for each practice location where the practitioner administers controlled substances. This registration requirement does not apply to practitioners who administer controlled substances exclusively to patients who are receiving inpatient health care services at a hospital or other inpatient health care facility, a hospital-based emergency department, or an ambulatory surgical center.

3.3. An application for registration as a registered controlled substance dispensing practitioner at one or more locations shall be completed on a Board-approved application. The Board's controlled substance dispensing application shall include, and applicants must provide, the following information:

3.3.a. The applicant’s full name and West Virginia Board of Medicine license number;

3.3.b. The applicant’s current individual Drug Enforcement Agency (DEA) controlled substance registration number;

3.3.c. Verification by the applicant that he or she is currently registered to access the West Virginia Controlled Substance Monitoring Program (“WVCSMP”), if required to be so registered by law, and that he or she understands his or her obligation to report the dispensing of controlled substances to the WVCSMP; and

3.3.d. The practice name, physical address and telephone number of each practice location where the applicant seeks to be registered to dispense and/or administer controlled substances.

3.4. A physician assistant must have an active practice notification on file with the Board for the proposed controlled substance dispensing location identified on the physician assistant’s registration application.

3.5. The Board shall not grant a registration, and an applicant is ineligible to register or retain registration as a controlled substance dispensing practitioner, if the applicant:

3.5.a. Does not possess a current, valid and unexpired individual DEA controlled substance registration number;

3.5.b. Has been convicted of a felony offense relating to controlled substances in any jurisdiction; or

3.5.c. Is currently subject to any administrative or court order in any jurisdiction which places restrictions or limitations of any kind upon the practitioner’s prescriptive authority in any jurisdiction.

3.6. An initial controlled substance dispensing registration shall expire on the same date as the practitioner’s medical, podiatric or physician assistant license, unless renewed prior to that date. Thereafter, registration shall be valid for a period of two years.

3.7. If the initial registration period is less than one year, an application for registration as a controlled substance dispensing practitioner must be accompanied by payment of a nonrefundable annual registration fee in the amount of fifteen dollars per dispensing location. If the initial registration period is greater than one year, an application for registration as a controlled substance dispensing practitioner must be accompanied by payment of a nonrefundable biennial registration fee in the amount of thirty dollars per dispensing location.

3.8. After the initial registration period, all controlled substance dispensing registrations shall be valid for a period of two years, and the annual registration fee shall be collected biennially at a rate of thirty dollars per dispensing location.

3.9. Controlled substance dispensing registrations issued by the Board to a practitioner are granted for specific practice locations, and are not transferable from one location to another.

3.10. Controlled substance dispensing registrations issued by the Board automatically terminate if a registered controlled substance dispensing practitioner is no longer authorized to prescribe controlled substances in West Virginia.

3.11. The Board shall waive the registration fee and renewal registration fees for a controlled substance dispensing registration which is obtained to dispense and/or administer controlled substances free of charge to patients at a free clinic or summer camp.

3.12. A registered controlled substance dispensing practitioner may engage in office-based dispensing and/or administering of controlled substances to a patient under his or her care at registered controlled substance dispensing locations.

W. Va. Code R. § 11-5-4 Registration not Required for Practitioners Dispensing and Administering Prescription Drugs Which are not Classified as Controlled Substances

4.1. A practitioner may dispense or administer prescription drugs which are not classified as controlled substances to patients under his or her care without registering with the Board. However, he or she may be required to report office-based dispensing activity on his or her biennial license renewal application.

4.2. A drug dispensing practitioner, regardless of registration status, shall comport his or her dispensing practice with the requirements set forth in this rule, and with all applicable state and federal rules and regulations.

W. Va. Code R. § 11-5-5 General Practice Requirements Applicable to All Drug Dispensing Practitioners

5.1. A drug dispensing practitioner may not fill prescriptions written by other practitioners.

5.2. A drug dispensing practitioner may only dispense or administer prescription drugs to a patient under the practitioner’s care in the course of his or her professional practice.

5.3. The sale at retail of prescription drugs by dispensing practitioners is prohibited.

5.4. A legible notice, no smaller than 8 1/2" by 11", shall be posted in a conspicuous place in every office of where a drug dispensing practitioner engages in dispensing. The notice must include: "Every patient has the right to receive a written prescription as an alternative to having prescription medications dispensed to you by your physician, podiatric physician or physician assistant."

5.5. A drug dispensing practitioner may administer those drugs to a patient under his or her care, which are, in the practitioner’s medical judgment, therapeutically beneficial or necessary for the patient's treatment and in keeping with approved use of the medication. 5.6 A drug dispensing practitioner shall comply with all appropriate record keeping requirements applicable to the drugs administered. A practitioner must assure compliance with the record keeping requirements by persons acting under his or her direction and supervision.

5.7. Prior to dispensing a prescription drug to a patient, a drug dispensing practitioner shall offer to provide a written prescription to the patient, which the patient may elect to have filled by the practitioner or by any licensed pharmacy of the patient’s choice.

5.8. The dispensing of prescription drugs shall be the personal act of the drug dispensing practitioner to a patient under his or her care. A drug dispensing practitioner may not delegate any aspect of dispensing prescription drugs which requires the utilization of the knowledge, judgment, ability or skill of a drug dispensing practitioner.

5.9. Drug dispensing practitioners may make reasonable charges for their services, including reasonable charges for any prescription drugs they dispense. If a drug dispensing practitioner charges for dispensing prescription drugs, a charge for prescription drugs shall be separately listed on the patient's bill, and the patient shall be informed of the separate charge for said prescription drug prior to the medication being dispensed by the practitioner.

5.10. When a patient receives a generic drug product from a dispensing practitioner, the patient shall be informed that a generic drug product is being dispensed.

5.11. Except as otherwise limited by state or federal law, a drug dispensing practitioner may dispense amounts of drugs as the provider determines is sufficient to a patient's course of treatment. A drug dispensing practitioner may not dispense a quantity or classification of prescription drugs which exceeds the quantity or classification that the practitioner is authorized by law to prescribe.

5.12. Prior to dispensing a prescription drug, a dispensing practitioner shall discuss with the patient matters pertaining to the drug, why the dispensing practitioner has prescribed the drug, contraindications to the drug’s use, and he or she shall provide the patient with an opportunity to ask questions regarding the drug, any side effects and/or the directions for usage.

5.13. A drug dispensing practitioner must clearly document in the patient’s medical record when a prescription drug is dispensed or administered to a patient. The documentation must include:

5.13.a. The date the prescription drug was dispensed or administered;

5.13.b. The name of the prescription drug which was dispensed or administered;

5.13.c. The quantity and/or dose of prescription drug dispensed or administered; and

5.13.d. The basis or reason the prescription drug was prescribed, dispensed or administered.

5.14. Dispensing practitioners are prohibited from:

5.14.a. Dispensing or administering any unit or quantity of a prescription drug which has exceeded its expiration or beyond use date; and

5.14.b. Dispensing any unit or quantity of a prescription drug which will exceed its expiration or beyond use date prior to the end user’s reasonable use of the dispensed quantity.

5.15. A dispensing practitioner shall ensure that expired prescription drugs are promptly removed from his or her prescription drug office use and dispensing inventory.

5.16. Practitioner disposal of expired or unwanted controlled substances in the practitioner’s office use or dispensing inventory shall comport with the requirements of 21 C.F.R. §1317.05(a), and any other applicable state or federal requirements for the documentation and disposal of controlled substances.

W. Va. Code R. § 11-5-6 Security, Packaging and Labeling

6.1. A dispensing practitioner must have immediate access to reference materials relating to the dispensing of medication, and must also have immediate access to the package insert, or its equivalent, for every prescription drug dispensed to patients.

6.2. A dispensing practitioner shall maintain at all times the minimum professional and technical equipment and sanitary appliances and environmental conditions that are necessary to prepare and dispense prescriptions properly.

6.3. A dispensing practitioner must maintain a dispensing area, where all stock quantities of prescription drugs maintained for dispensing to patients must be stored under conditions that prevent deterioration.

6.4. Prescription drugs must be stored in a locked or otherwise secure area to prevent access when the drug dispensing practitioner is not present in the office. A registered controlled substance dispensing practitioner shall provide effective, enhanced controls and procedures to guard against theft and diversion of controlled substances. Physical security controls shall be commensurate with the schedules and quantity of controlled substances in the possession of the registrant in normal business operations. At a minimum, these security controls shall include the storage of all controlled substances in an environmentally controlled, separately locked safe or cabinet with the access code or key limited to registered controlled substance dispensing practitioners.

6.5. A registered controlled substance dispensing practitioner shall notify the Board, in writing, of any theft or significant loss of any controlled substances upon discovery of the theft.

6.6. A prescription drug dispensed by a dispensing practitioner must be packaged in its own separate container and labeled with its own specific directions.

6.7. A practitioner shall package prescription drugs in appropriate containers, and shall generally utilize child-proof and tamper-resistant packaging. In determining the appropriate packaging container, the practitioner should evaluate whether the dispensed drug is susceptible to damage or deterioration if exposed to light, moisture or other environmental conditions. Paper or plastic bags, boxes or envelopes do not meet packaging requirements for prescription drugs and should not be used.

6.8. Labels for dispensed medications must be legible.

6.9. Prescription drugs that are not classified as controlled substances must be packaged in a container labeled with the following information:

6.9.a. The name, address and telephone number of the dispensing practitioner;

6.9.b. The name of the patient for whom the prescription drug was dispensed;

6.9.c. The date the prescription drug was dispensed;

6.9.d. The name of the actual drug dispensed (if a generic drug product is dispensed, the container shall be labeled with the generic name of the drug and the name of the manufacturer or distributor of the generic drug product. The container may not be labeled with a brand name unless the product dispensed is actually the brand name product);

6.9.e. The strength of the drug dispensed;

6.9.f. The quantity of the drug dispensed;

6.9.g. Full directions for use of the dispensed drug and any special storage requirements;

6.9.h. Any cautions which may be required by federal or state law; and

6.9.i. The expiration or beyond use date of the drug dispensed.

6.10. The directions "Take as directed," or any formulation thereof which does not provide full and specific directions to the patient may cause patient confusion and do not constitute compliance with the labeling requirements of this rule.

6.11. Practitioner dispensed prescriptions for controlled substances must be packaged in a container labeled with all of the information required in subsection 6.9. Labels for dispensed controlled substances must also include:

6.11.1. An identification of the controlled substance classification of the dispensed drug (C-II, C-III, C-IV, etc.); and

6.11.2. The following statement: "Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed."

W. Va. Code R. § 11-5-7 Additional Requirements for the Dispensing of Controlled Substances

7.1. A licensee of this Board who is not a registered controlled substance dispensing practitioner, or who is ineligible to register, shall not dispense or administer any controlled substances at any outpatient or office-based practice location in West Virginia.

7.2. When dispensing a prescription drug that is classified as a controlled substance, a registered controlled substance dispensing practitioner shall make all required reports to the West Virginia Controlled Substance Monitoring Program (“CSMP”). Reports to the CSMP may also be required for certain prescription drugs which are not classified as controlled substances, and as set forth in § 15 CSR 8.

7.3. A practitioner shall not issue a prescription to obtain a controlled substance drug for dispensing to patients or for “office use.” A practitioner may obtain controlled substances from a pharmacy for office use, but must do so by providing appropriate documentation through the use of an invoice or other federally required documentation or forms.

7.4. When dispensing a controlled substance a registered controlled substance dispensing practitioner shall comport his or her dispensing practice with all applicable state and federal laws.

W. Va. Code R. § 11-5-8 Returned or Surrendered Drugs; Authorization and Procedures for Destruction; Prohibition on Reuse

8.1. In accord with current federal DEA regulations, licensees of the Board are prohibited from accepting unused and/or unwanted controlled substances from or on behalf of patients.

8.2. A licensee may refer individuals in lawful possession of unwanted and unused controlled substances and who are seeking disposal assistance to:

8.2.a. Entities which are registered with the DEA as authorized collectors to receive the transfer from ultimate users of any unwanted and unused pharmaceutical controlled substances in their lawful possession for safe, secure, and responsible disposal pursuant to 21 C.F.R. §1317.40;

8.2.b. Local law enforcement operating federally authorized take-back events, mail-back programs, or collection receptacles; and/or

8.2.c. The DEA website for information regarding proper methods of self-disposal by the lawful possessor.

8.3. With the exception of controlled substances, a licensee of the Board may accept unused prescription drugs from or on behalf of patients for the purpose of proper disposal.

8.4. The disposal of returned or surrendered prescription drugs shall occur promptly, and no later than thirty days after receipt.

8.5. Until disposed of, returned or surrendered prescription drugs shall be stored in a locked or otherwise secure area to prevent access by unauthorized individuals.

8.6. Returned or surrendered prescription drugs may not be stored with a practitioner’s office use or dispensing inventory.

8.7. A licensee who accepts returned or surrendered prescription drugs shall maintain a log which lists:

8.7.a. The name of the patient to whom the retuned or surrendered drug was dispensed;

8.7.b. The strength of the returned or surrendered drug;

8.7.c. The quantity returned or surrendered;

8.7.d. The date and manner of disposal; and

8.7.e. The printed name and signature of the individual who actually disposed of the drug.

8.8. Logs required by subsection 8.7 must be maintained for a period of two years after disposal of the returned or surrendered prescription drug.

8.9. A practitioner may not dispense, administer or reuse any returned or surrendered drug unless such dispensing, administering or reuse occurs pursuant to and in accord with the requirements of a prescription drug donation program established by this state.

W. Va. Code R. § 11-5-9 Dispensing Records; Inspection and Audit of Dispensing Locations

9.1. A drug dispensing practitioner must maintain records that are available for inspection by the Board and any other state or federal entity authorized to conduct such an inspection. All dispensing records:

9.1.a. Shall be maintained for a period of at least five years; and

9.1.b. Must be readily retrievable.

9.2. Patient records must facilitate an audit trail for each patient to whom prescription drugs are dispensed. They may be maintained either in a patient's chart or in an equivalent but separate patient medication record.

9.3. Daily records must facilitate an audit trail for each day on which scheduled controlled substances are dispensed. They may be maintained in a daily log or in a file of prescriptions.

9.3.a. Daily records of dispensed Schedule II controlled substances must be maintained in a separate daily log or file of prescriptions, apart from all other records.

9.3.b. Daily records of dispensed Schedule III, IV and V controlled substances may be maintained either in another separate daily log or in a file of prescriptions.

9.4. For each prescription drug dispensed, both patient records and daily records shall include:

9.4.a. The name of the patient to whom the drug was dispensed;

9.4.b. The name of the drug and the strength dispensed;

9.4.c. The quantity of the drug dispensed;

9.4.d. The date that the drug was dispensed; and

9.4.e. The directions for use.

9.5. An authorized representative or investigator for the Board may, without prior notice, enter at any reasonable hour a registered drug dispensing location and/or a location where the Board believes the unregistered dispensing of controlled substances is occurring by a licensee of the Board to conduct an audit:

9.5.a. To verify general compliance with this rule; or

9.5.b. To investigate an allegation or complaint with respect to a practitioner’s dispensing practice.

9.6. A person may not deny or interfere with an entry under this section.

9.7. The Board’s representative may require a practitioner or facility where dispensing occurs by a licensee of this Board to provide access to:

9.7.a. Any records relating to the practitioner’s dispensing practice;

9.7.b. Any records a practitioner is required to maintain pursuant to this rule; and

9.7.c. All inventories of prescription drugs, including controlled substances, maintained at the location subject to audit.

9.8. It is a violation of this rule for a licensee of this Board to refuse to undergo or cooperate with a dispensing review or audit by the Board.

9.9. The Board’s representative shall refer possible compliance issues to the appropriate Committee of the Board and/or to any other agency that has jurisdiction over a facility, place of practice or practitioner.

W. Va. Code R. § 11-5-10 Disciplinary Action

10.1. Any violation of these rules shall constitute unprofessional conduct and shall subject the violator to disciplinary action by the Board under the provisions of West Virginia Code §§ 30-3-14 and 30-3E-17.

11CSR5

Series 07 Formation And Approval Of Professional Limited Liability Companies

W. Va. Code R. § 11-7-1 General

1.1. Scope. -- This legislative rule addresses procedures for the formation and approval of professional limited liability companies for physicians, podiatrists, and others legally authorized to render the same or compatible professional services under W. Va. Code §31B-13-1301 et seq.

1.2. Authority. -- W. Va. Code §31B-13-1304.

1.3. Filing Date. -- April 9, 2012.

1.4. Effective Date. -- May 1, 2012.

W. Va. Code R. § 11-7-2 Definitions

2.1. “Board” means the West Virginia Board of Medicine, as provided for in W. Va. Code §30-3-1 et seq.

2.2. “Professional limited liability company” means a limited liability company organized under the provisions of W. Va. Code 31B, for the purpose of rendering a professional service.

2.3. “Same or compatible professional services” means services rendered by physicians, osteopathic physicians, and podiatrists.

W. Va. Code R. § 11-7-3 Procedures for Formation and Approval of Professional Limited Liability Companies for Physicians and Podiatrists; Fees

3.1. Physicians licensed to practice medicine and surgery in an active status in this State may join together with those rendering the same or compatible services to render professional services as a limited liability company. They shall comply with the provisions of W. Va. Code §31B-13-1301 et seq. A professional limited liability company may not have as a member a person who is not legally authorized to render the professional services for which the professional limited liability company was organized.

3.2. Podiatrists licensed to practice podiatry in an active status in this State who desire to render professional services as a limited liability company shall comply with the provisions of W. Va. Code §31B-13-1301 et seq. Podiatrists may join together with those rendering the same or compatible services to render professional services as a limited liability company. A professional limited liability company may not have as a member a person who is not legally authorized to render the professional services for which the professional limited liability company was organized.

3.3. The name of a professional limited liability company shall contain the words "professional limited liability company" or the abbreviation "P.L.L.C.", “PLLC”, “Professional LLC” or “Professional L.L.C."

3.4. A professional limited liability company shall file with the Board at the time of formation, the names of its one or more member(s), and written documentation that the professional limited liability company carries at least one million dollars of professional liability insurance, together with an initial filing fee of $100. Thereafter, every professional limited liability company on an annual basis on or before the first day of July, shall file with the Board the names of its member(s), and written documentation that the professional limited liability company carries at least one million dollars of professional limited liability insurance, together with an annual renewal fee of $100.

3.4.a. The requirement under W. Va. Code §31B-13-1305 that a professional limited liability company carry one million dollars of professional liability insurance is satisfied if the professional limited liability company provides one million dollars of funds specifically designated and segregated for the satisfaction of judgements against the company members or any of its professional or nonprofessional managers or employees arising out of the performance of professional services to patients or clients of the company, by:

3.4.a.1. Deposit in trust or in bank escrow of cash, bank certificates of deposit or United States treasury obligation; or

3.4.a.2. A bank letter of credit or insurance company bond.

3.5. Every professional limited liability company shall file with the Board a copy of the annual report required to be filed with the secretary of state under W. Va. Code §31B-2-211. The copy of the annual report, and a copy of any corrected annual report filed with the secretary of state, shall be filed with the Board on or before the first day of July on an annual basis.

3.6. The Board shall approve every professional limited liability company in compliance with all the provisions of this rule, and every professional limited liability company remaining in compliance with this rule shall remain approved by the Board.

3.7. If a person ceases to be a member of a professional limited liability company, he or she shall notify the Board in writing within twenty days from that departure. A person ceasing to be a member of a professional limited liability company does not affect the approval of the professional limited liability company by the Board, provided that the Board determines that the professional limited liability company remains in compliance with all the provisions of this rule.

W. Va. Code R. § 11-7-4 Notification of Non-compliance, Cessation of Rendering Professional Services

4.1. If the Board determines that a professional limited liability company is not in compliance with all the provisions of this rule and should cease rendering professional services in the State, the Board shall notify the professional limited liability company in writing of its noncompliance and shall order the professional limited liability company to stop rendering professional services. Upon receipt of the written notice, the professional limited liability company shall cease rendering professional services.

W. Va. Code R. § 11-7-5 Physician-Patient and Podiatrist-Patient Relationship

5.1. The provisions of this rule shall not be construed to alter or affect the physician-patient or podiatrist-patient relationship.

11CSR7

11CSR7

Series 08 Collaborative Pharmacy Practice

W. Va. Code R. § 11-8-1 General

1.1. Scope. -- This rule is jointly agreed upon and proposed by the Boards of Pharmacy, Medicine, and Osteopathic Medicine for legislative approval pertaining to a pharmacist’s scope of practice pursuant to collaborative pharmacy practice and collaborative pharmacy practice agreements, content of collaborative pharmacy agreements, responsibilities of a pharmacist and physician with respect to collaborative pharmacy agreements, the content, process and fee for filing collaborative pharmacy practice notifications, and the termination of collaborative pharmacy practice agreements by the parties or the boards.

1.2. Authority. -- W. Va. Code §30-5-7(c).

1.3. Filing date. -- May 10, 2023

1.4. Effective date. -- June 1, 2023

1.5. Sunset Provision – This rule shall terminate and have no further force or effect upon August 1, 2028.

W. Va. Code R. § 11-8-2 Definitions

For purposes of this rule, the following definitions apply:

2.1. “Boards” means the West Virginia Board of Pharmacy, the West Virginia Board of Medicine, and the West Virginia Board of Osteopathic Medicine.

2.2. “Collaborating pharmacist” means a pharmacist licensed in West Virginia who has been verified by the Board of Pharmacy to engage in collaborative pharmacy practice:

With one or more collaborating physicians:

Pursuant to a collaborative pharmacy practice agreement developed in accord with this rule; and For which a complete and valid practice notification is filed with the boards.

2.3. “Collaborating physician” means a doctor of medicine or osteopathic medicine fully and actively licensed to practice clinical medicine, without restriction, in West Virginia by the Board of Medicine or the Board of Osteopathic Medicine who collaborates with pharmacists:

Pursuant to a collaborative pharmacy practice agreement developed in accord with this rule; and For which a complete and valid practice notification is filed with the boards.

A physician in training may also collaborate with pharmacists pursuant to an active collaborative pharmacy agreement if the trainee’s supervising physician or medical department chair executes the collaborative pharmacy practice agreement and the physician in training collaborates under the supervision of the physician who executed the agreement.

2.4. “Collaborative pharmacy practice” is that practice of pharmacist care where one or more pharmacists have jointly agreed, on a voluntary basis, to work in conjunction with one or more physicians under written protocol where the pharmacist or pharmacists may perform certain patient care functions authorized by the physician or physicians under certain specified conditions and limitations.

2.5. “Collaborative pharmacy practice agreement” is a written and signed agreement, which is a physician directed approach, that is entered into between an individual physician or physician group, or for a medical provider in training where the agreement is signed by the supervising physician or chairperson of the medical department where the medical provider in training is practicing, and an individual pharmacist or pharmacists that provides for collaborative pharmacy practice for the purpose of drug therapy management of a patient.

2.6. “Collaborative pharmacy practice protocol” is the detailed written portion of the collaborative pharmacy practice agreement pursuant to which the authorized pharmacist will base drug therapy management decisions for patients.

2.7. “Controlled substances” means drugs that are classified by federal or state law in Schedules I, II, III, IV or V, as defined in W. Va. Code Chapter 60A, Article 2.

2.8. “Drug therapy management” means the review of drug therapy regimens of patients by a pharmacist for the purpose of evaluating and rendering advice to a physician regarding adjustment of the regimen in accordance with the collaborative pharmacy practice agreement. Decisions involving drug therapy management shall be made in the best interest of the patient. Drug therapy management is limited to:

2.8.1. Implementing, modifying, and managing drug therapy according to the terms of the collaborative pharmacy practice agreement;

2.8.2. Collecting and reviewing patient histories;

2.8.3. Performing patient evaluations that are mutually agreed upon in the collaborative agreement; and

2.8.4. Ordering screening laboratory tests that are dose related and specific to the patient’s medication or are protocol driven and are also specifically set out in the collaborative pharmacy practice agreement between the pharmacist and physician.

2.9. “Pharmacist Care” means the provision by a pharmacist of patient care activities, with or without the dispensing of drugs or devices, intended to achieve outcomes related to the cure or prevention of a disease, elimination, or reduction of a patient’s symptoms, or arresting or slowing of a disease process and as provided for in W. Va. Code § 30-5-10.

2.10. “Pharmacist’s scope of practice pursuant to the collaborative pharmacy practice agreement” means those duties and limitations of duties placed upon the pharmacist by the collaborating physician.

2.11. “Practice notification” means a written notice to the appropriate licensing board that an individual physician or physician group or a medical provider in training where the agreement is signed by the supervising physician or chairperson of the medical department where the medical provider in training is practicing, and an individual pharmacist or pharmacists will practice in collaboration.

2.12. “Website” means the set of related web pages operated by or on behalf of the boards located at the domain names of wvbop.com, wvbom.wv.gov, and wvbdosteo.org or at any successor domain name published by the boards.

W. Va. Code R. § 11-8-3 Requirements for Collaborative Pharmacy Practice

3.1. Pharmacists and physicians may engage in collaborative pharmacy practice in accordance with the provisions of this rule.

3.2. Collaborative pharmacy practice may only occur:

3.2.1. Pursuant to a collaborative pharmacy practice agreement developed in accord with this rule; and

3.2.2. Once a complete and valid practice notification is filed with the boards.

3.3. A physician’s eligibility to serve as a collaborating physician may be verified through information available on the websites of the Board of Medicine and Board of Osteopathic Medicine. Physicians who are eligible to collaborate with pharmacists shall ensure that pharmacy collaboration remains within:

3.3.1. The medical specialty and scope of the physician’s practice; and

3.3.2. The education, training and experience of the collaborating pharmacist.

3.4. The Board of Pharmacy shall verify a pharmacist’s eligibility to enter into collaborative pharmacy practice agreements upon receipt of an eligibility verification request which is accompanied by satisfactory documentation that the pharmacist:

3.4.1. Has an unrestricted and current license to practice as a pharmacist in West Virginia;

3.4.2. Has at least one million dollars of professional liability insurance coverage; and

3.4.3. Meets one of the following eligibility criteria:

3.4.3.a. The pharmacist earned a Certification from the Board of Pharmaceutical Specialties, or has completed an American Society of Health System Pharmacists (ASHP) accredited residency program, and two years of experienced verified by the Board of Pharmacy;

3.4.3.b. The pharmacist successfully completed the course of study and holds an academic degree of Doctor of Pharmacy and has three years of clinical experience verified by the Board of Pharmacy and has completed an Accreditation Council for Pharmacy Education (ACPE) approved certificate program in the area of practice covered by the collaborative pharmacy practice agreement; or

3.4.3.c. The pharmacist successfully completed the course of study and holds the academic degree Bachelor of Science in Pharmacy and has five years clinical experience verified by the Board of Pharmacy and has completed two ACPE approved certificate programs with at least one program in the area of practice covered by the collaborative pharmacy practice agreement.

3.5. Eligible pharmacists and physicians may enter into collaborative pharmacy practice agreements in any practice setting. Collaborative pharmacy practice agreements must contain all required elements set forth in section 4 of this rule.

3.6. Prior to commencing practice pursuant to a collaborative pharmacy practice agreement, the parties shall file a complete practice notification with the Board of Pharmacy.

3.7. A practice notification shall be submitted on a form approved by the boards and shall be accompanied by a $50 fee payable to the Board of Pharmacy. The practice notification form shall be published on the boards’ websites.

3.8. A practice notification shall include:

3.8.1. The full name, license number, licensing board, preferred mailing address, telephone number, and email address of the pharmacist(s) and physician(s) who are entering into a collaborative pharmacy practice agreement;

3.8.2. The name and address of each location where the pharmacist will engage in collaborative pharmacy practice pursuant to the agreement;

3.8.3. The proposed effective date of the collaborative pharmacy practice agreement;

3.8.4. Certification by the collaborating pharmacist and collaborating physician that:

3.8.4.a. The pharmacist has been verified as eligible for collaborative pharmacy practice by the Board of Pharmacy;

3.8.4.b. The physician is eligible to serve as a collaborating physician;

3.8.4.c. A collaborative pharmacy practice agreement has been agreed upon and executed by the pharmacist and physician which is consistent with the physician’s scope of practice, the pharmacist’s education, training and experience, and includes, at a minimum, the protocols required by section 4 of this rule;

3.8.4.d. The collaborating pharmacist will maintain a copy of the collaborative pharmacy practice agreement at his or her place of practice and the parties will provide a copy to any of the boards, upon request;

3.8.4.e. Collaborative pharmacy practice shall only occur after informed consent of the patient, which must be noted in the patient medical record; and

3.8.4.f. The parties acknowledge that the collaborative pharmacy practice agreement does not include the management of controlled substances.

3.9. A complete practice notification is effective upon filing, remains valid until the collaborative pharmacy practice agreement terminates, and is not subject to renewal or renewal fees.

3.10. The boards shall acknowledge receipt of all practice notifications. If a practice notification is incomplete or appears to be invalid, the Board of Pharmacy shall contact the collaborating pharmacist about any issue of validity and any information needed to complete the practice notification. The Board of Pharmacy may request the assistance of the Board of Medicine or the Board of Osteopathic Medicine to evaluate or respond to any issues of practice notification completeness or validity.

3.11. Within five business days of receiving a complete, valid practice notification, the Board of Pharmacy shall confirm receipt to the collaborating pharmacist and provide a copy of the practice notification to the collaborating physician’s licensing board. Within five days of receipt of the practice notification from the Board of Pharmacy, the Board of Medicine or Board of Osteopathic Medicine shall notify the collaborating physician.

3.12. The boards shall maintain a current list of all practice notifications for collaborative pharmacy practice agreements.

W. Va. Code R. § 11-8-4 Collaborative Pharmacy Practice Agreements

4.1. Collaborative pharmacy practice agreements are voluntarily implemented by practitioners who seek to serve patients with active pharmacist participation in drug therapy management and other related protocols.

4.2. Collaborative pharmacy practice is a collaborative, physician-directed approach which may be utilized after informed consent is received from the patient and recorded in the patient medical record.

4.3. A collaborative pharmacy practice agreement shall establish the pharmacist’s scope of practice for purposes of the agreement.

4.4. A pharmacist may not diagnose patients.

4.5. Collaborative pharmacy practice agreements shall be in writing. All pharmacists and physicians who are parties to the agreement shall sign the agreement, and copies of the agreement shall be made available to all individuals collaborating thereunder.

4.6. Collaborating pharmacists shall maintain a copy of the collaborative practice agreement at their place of practice.

4.7. Collaborative practice agreements shall incorporate protocols containing detailed direction concerning the services that collaborating pharmacists may perform for patients and the role of collaborating physicians. The protocols shall, at a minimum, include:

4.7.1. The specific drug or drugs to be managed by the collaborating pharmacist, and the terms and conditions under which drug therapy may be implemented, modified, or discontinued, including:

4.7.1.a. The protocols may authorize implementation or modification of drug dosages based on symptoms or laboratory or patient evaluations defined in the protocol;

4.7.1.b. The protocol shall include information specific to the drugs authorized by the collaborating physician;

4.7.1.c. In instances where drug therapy is discontinued, the pharmacist shall notify the treating physician of the discontinuance within seventy-two hours unless the protocol incorporates a shorter time period for notice;

4.7.1.d. Specific protocols for patients identified by the collaborating physician as having complex medical conditions or comorbidities, one or more of which are under treatment by another medical provider or specialist;

4.7.1.e. The protocol may not authorize the pharmacist to change a controlled substance or to initiate a drug not included in the established protocol.

4.7.2. The conditions and events upon which the pharmacist is required to notify the physician, including but not limited to the need for new prescription orders and reports of the patient’s therapeutic response or adverse reaction. All evaluation notes shall be in the patient’s medical record within one week of the evaluation and/or drug management change. If there are no drug therapy changes the information shall be provided to the physician within 30 days unless the protocol incorporates a shorter time period for such notice;

4.7.3. The laboratory tests that may be ordered in accordance with drug therapy management, including:

4.7.3.a. Authorization of the collaborating pharmacist to obtain or to conduct specific laboratory tests related to the drug therapy management;

4.7.3.b. The collaborating pharmacist may only obtain the laboratory tests specified in the collaborative pharmacy practice agreement;

4.7.3.c. Laboratories utilized by the pharmacist may be in a pharmacy or pharmacy center; and

4.7.3.d. All laboratory results obtained are to be sent to the physician within forty-eight hours, except that any severely abnormal or critical values shall be sent by the pharmacist to the physician immediately;

4.7.4. The mutually agreed upon patient evaluations the pharmacist may conduct;

4.7.5. The protocol may authorize the pharmacist to monitor specific patient activities;

4.7.6. Procedures for documenting patient informed consent in the patient’s medical record;

4.7.7. A provision for the collaborative drug therapy management protocol to be reviewed, updated, and re-executed or discontinued at least every two years;

4.7.8. A description of the method the pharmacist shall use to document the pharmacist’s decisions or recommendations for the physician;

4.7.9. Procedures for record keeping, record sharing, and long-term record storage.

4.7.10. Procedures to follow in emergency situations.

4.7.11. A description of the mechanism for the pharmacist and the physician to communicate with each other and for documentation by the pharmacist of the implementation of collaborative drug therapy. Pharmacist visits may not be substituted for physician visits.

4.8. A copy of the protocols set forth in the collaborative pharmacy practice agreement shall be filed in the patient’s medical record.

4.9. A collaborating pharmacist may not delegate drug therapy management to anyone other than another collaborating pharmacist that has signed the applicable protocol. 4.10 A collaborating physician may not delegate collaborative drug therapy management to any unlicensed person or licensed person other than another physician, a collaborating physician assistant or a collaborating pharmacist.

W. Va. Code R. § 11-8-5 Termination of Collaborative Pharmacy Practice Agreements

5.1. A collaborative pharmacy practice agreement automatically terminates if either the collaborating pharmacist(s) or collaborating physician(s) are no longer eligible to collaborate. If multiple practitioners are parties to the agreement, it shall not automatically terminate as long as there is at least one collaborating pharmacist and physician remaining.

5.2. A collaborative pharmacy practice agreement may be terminated at any time by any of the parties to the agreement.

5.3. A collaborating pharmacist shall notify the Board of Pharmacy in writing within ten days of the termination of an active collaborative pharmacy practice agreement.

5.4. The Board of Pharmacy shall notify the collaborating physician’s licensing board within five days of receiving notice of termination of a collaborative pharmacy practice agreement.

5.5. A patient may, at any time, revoke consent for collaborative pharmacy practice. Immediately upon withdrawal of patient consent, collaborative pharmacy practice with respect to the non-consenting patient shall cease. Collaboration may continue pursuant to the collaborative pharmacy practice agreement with respect to other patients.

W. Va. Code R. § 11-8-6 Ethics

6.1. There shall be no advertising of any collaborative pharmacy practice by either the physician or the pharmacist.

6.2. No physician may be employed by any pharmacist or pharmacy for the purpose of collaborative pharmacy practice.

6.3. No pharmacist or pharmacy shall make any direct or indirect referral to any physician or medical clinic for the purpose of collaborative pharmacy practice.

6.4. Nothing in this rule shall be interpreted to permit a pharmacist to accept delegation of a physician’s authority outside the limits included in the appropriate board’s statute and rules.

6.5. Pharmacists and physicians who collaborate shall not allow an employment arrangement to:

6.5.1. Interfere with sound clinical judgment;

6.5.2. Diminish or influence the practitioners’ ethical obligation to patients; or

6.5.3. Exert undue influence on, or interfere with the robustness of, the collaborative relationship.

W. Va. Code R. § 11-8-7 Reporting and Discipline

7.1. Any or all of the appropriate licensing boards shall have the right to cancel any collaborative pharmacy practice agreement if there is satisfactory evidence that either the physician or pharmacist signatories to the agreement are not acting in accordance with the agreement.

7.2. Each appropriate board with jurisdiction of either of the signatories to the agreement shall report to the other appropriate board any acts which it believes are in violation of any agreement.

7.3. Any physician or pharmacist signatory to a collaborative pharmacy agreement shall be subject to additional monitoring and education or to disciplinary proceedings by the appropriate boards if the subject physician or pharmacist violates the terms of the collaborative pharmacy practice agreement. The licensure denial, complaint and disciplinary process and procedures and appeal rights set forth in each boards’ practice act and rules shall apply to their respective licensees in connection with allegations of professional misconduct in connection with pharmacist-physician collaboration.

7.4. In their discretion, the boards may refer and receive information from one another concerning:

7.4.1. Mutual registrants and/or respective licensees;

7.4.2. Information developed during the complaint and investigation process of one board which implicates or otherwise relates to applicants, registrants and/or licensees of another board;

7.4.3. Any complaints received or discovered by one board which relate to mutual applicants, registrants and/or licensees or applicants, registrants and/or licensees of the other board.

7.5. It is dishonorable, unethical or unprofessional conduct for a pharmacist or a physician to engage in collaborative pharmacy practice without first entering into a written agreement which comports with the requirements of this rule and filing a complete practice notification with the boards through the process described in section 3 of this rule.

11CSR8

11CSR8

Series 09 Certification, Disciplinary And Complaint Procedures, Continuing Education, Radiologist Assistants

W. Va. Code R. § 11-9-1 General

1.1. Scope. -- W. Va. Code §30-3-7a requires the Board of Medicine to regulate the practice of Radiologist Assistants, and with the advice of the West Virginia Medical Imaging and Radiation Therapy Technology Board of Examiners the Board of Medicine is to propose rules to establish the scope of practice of a Radiologist Assistant, develop the education and training requirements for a Radiologist Assistant and regulate Radiologist Assistants.

1.2. Authority. -- W. Va. Code §30-3-7a.

1.3. Filing date. -- April 4, 2008.

1.4. Effective date. -- July 1, 2008.

W. Va. Code R. § 11-9-2 Definitions

2.1. For purposes of this rule, the following definitions apply:

a. “ARRT” means the American Registry of Radiologic Technologists.

b. “Certification” means the approval of individuals by the Board of Medicine to serve as Radiologist Assistants.

c. “Direct Supervision” means the radiologist must be present in the office suite and immediately available to furnish assistance and directions to the radiologist assistant throughout the performance of the procedure.

d. “Personal Supervision” means a physician must be in attendance in the room throughout the performance of the procedure.

e. “Radiologist” means a physician licensed by the West Virginia Board of Medicine (M.D.) specializing in radiology who is Board certified in radiology by a member board of the American Board of Medical Specialties.

f. “Radiologist Assistant” means a person, other than a licensed practitioner, who is qualified by education and certification, as an advanced-level radiologic technologist who works under the supervision of a radiologist to enhance patient care by assisting the radiologist in the medical-imaging environment.

g. “Supervision” means the opportunity and ability of the radiologist to exercise control and direction over the services of radiologist assistants. Constant physical presence of the supervising radiologist of a radiologist assistant certified by the Board of Medicine is not required so long as the supervising radiologist and the radiologist assistant are or may easily be in contact in person by radio, telephone, e-mail, teleradiology or other telecommunications methods. Supervision requires continuous availability of the supervising radiologist. To be eligible as a supervising radiologist, the radiologist must hold a full and unrestricted medical license in West Virginia.

W. Va. Code R. § 11-9-3 Supervision of Radiologist Assistants by Licensed Radiologist

3.1. A radiologist fully licensed under W. Va. Code §30-3-1 et seq. may submit a job description to the Board of Medicine to supervise a radiologist assistant. Upon approval of the submitted job description, the radiologist will be deemed a supervising radiologist.

3.2. The delegation of certain acts to a radiologist assistant shall be stated on the job description in a manner consistent with sound radiological practice and with the protection of the health and safety of the patient in mind.

W. Va. Code R. § 11-9-4 Submission of Application; Job Description

4.1. An application completed by the applicant radiologist assistant and a job description signed by the supervising radiologist listing in numerical order the duties which are requested to be performed by the radiologist assistant must be in the office of the Board of Medicine, 101 Dee Drive, Suite 103, Charleston, West Virginia 25311, thirty (30) days prior to a Board of Medicine meeting. Meetings are held bimonthly or as needed beginning in January. The filing of an application and job description does not entitle a radiologist assistant to certification. The Board of Medicine is the only legal authority for certification.

4.2. An application for certification and the proposed job description shall be accompanied by the following:

a. Documentation that the applicant is currently certified by the American Registry of Radiologic Technologists as a radiologic technologist (RT), and b. Documentation that the applicant is currently certified by the American Registry of Radiologic Technologists as a radiologist assistant, and c. Documentation that the applicant has unencumbered licensure, certification, or registration status in all other jurisdictions where the applicant holds or held licensure, certification or registration.

d. The applicable fee of $100.

4.3. The Board of Medicine at its next regular meeting following receipt of the required items shall make a determination as to certification of the radiologist assistant.

4.4. Application for changes to the standard approved job description as provided for in subdivision 14.2. of this rule, or for a previously approved job description shall be made thirty (30) days prior to the Board of Medicine meeting.

4.5. The proposed job description shall be signed by the supervising radiologist and radiologist assistant.

W. Va. Code R. § 11-9-5 Biennial Report of Radiologist Assistants Performing, Renewal, Annual Report of the Board of Medicine

5.1. Radiologist assistants and their supervising radiologists must submit to the Board of Medicine biennial reports, signed either individually or combined, on the professional conduct, capabilities and performance of the radiologist assistant. The report shall be submitted in conjunction with each completed renewal application and shall be submitted to the Board of Medicine office by April 1.

5.2. The Board of Medicine shall compile and publish in an annual report a list of currently certified radiologist assistants, their supervisors, and their location in the state.

W. Va. Code R. § 11-9-6 Supervision and Control of Radiologist Assistant

6.1. The radiologist assistant, whether employed by a health care facility or the supervising radiologist, shall perform only under the supervision and control of the supervising radiologist. The radiologist assistant may function in any setting within which the supervising radiologist routinely practices, but in no instance may a separate place of work for the radiologist assistant be established. The supervising radiologist shall be a physician permanently licensed in this state by the Board of Medicine, specializing in radiology and Board certified in radiology.

W. Va. Code R. § 11-9-7 Limitations on Supervision

7.1. A supervising radiologist may not supervise more than two (2) radiologist assistants at any one time.

7.2. In the absence of the supervising radiologist, another radiologist may serve as the supervising radiologist, however, the legal responsibility remains at all times with the absent supervising radiologist.

7.3. It is appropriate for a radiologist assistant to provide radiologic services to another supervising radiologist’s patients at his or her direction in settings such as a health care facility, partnerships, group practices and other mutually agreed on patient coverage arrangements where a radiologist assistant is providing radiologic services to another supervising radiologist’s patients at his or her direction in such settings. That supervising radiologist is also legally responsible with the Board of Medicine’s approved supervising radiologist for the radiologist assistant.

7.4. A radiologist assistant may not be supervised by and work for more than three (3) supervising radiologists at one time. Radiologist assistants who are supervised by more than one (1) supervising radiologist shall be those whose scope of professional duties require multiple radiologist supervisors.

7.5. A supervising radiologist may not permit a radiologist assistant to independently practice radiology. The supervising radiologist shall supervise the radiologist assistant at all times.

W. Va. Code R. § 11-9-8 Limitations on Scope of Duties of Radiologist Assistant

8.1. The radiologist assistant may not interpret images, preliminary or final or otherwise make diagnoses, or prescribe medications or therapies.

8.2. A radiologist assistant may not perform any physical examination.

8.3. The radiologist assistant may not perform the following procedures, including contrast media administration and needle or catheter placement for such procedures:

a. Lumbar puncture under fluoroscopic guidance.

b. Lumbar myelogram.

c. Thoracic or cervical myelogram.

d. Conventional arthrogram.

e. Non-tunneled venous central line placement.

f. Paracentesis with appropriate image guidance.

g. Thoracentesis with appropriate image guidance.

h. Venous catheter placement for dialysis.

i. Breast needle localization.

8.4. The radiologist assistant is not authorized to record previously communicated observations of imaging procedures in the chart.

8.5. A radiologist assistant may not independently bill patients for services provided.

8.6. A radiologist assistant may not sign prescriptions.

8.7. A radiologist assistant may not independently delegate a task assigned to him or her by his or her supervising radiologist to another individual.

8.8. A radiologist assistant may not perform any services which his or her supervising radiologist is not qualified to perform.

8.9. A radiologist assistant may not perform any services which are not included in his or her job description and approved by the Board of Medicine.

W. Va. Code R. § 11-9-9 Identification of Radiologist Assistant

9.1. When functioning as a radiologist assistant, the radiologist assistant must wear a nametag which identifies the radiologist assistant as a certified radiologist assistant or the letters “RA-C” after his or her name.

W. Va. Code R. § 11-9-10 Responsibilities of the Supervising Radiologist

10.1. The supervising radiologist is responsible for observing, directing and evaluating the work, records and practices performed by the radiologist assistant.

10.2. The supervising radiologist shall notify the Board of Medicine in writing of any termination of the employment of his or her radiologist assistant within ten (10) days of the termination.

10.3. The legal responsibility for any radiologist assistant remains that of his or her supervising radiologist at all times. Also, in temporary situations not to exceed twenty-one (21) days, when a certified and fully qualified radiologist assistant is substituting for another certified radiologist assistant, the acts and omissions of the substituting radiologist assistant are the legal responsibility of the absent radiologist assistant’s designated supervising radiologist.

10.4. The temporary change in supervisory responsibility shall be provided to the Board of Medicine in writing, or through electronic notification, within ten (10) days of the effective date of the substitution, signed by the affected supervising radiologists and radiologist assistants, and clearly specifying the dates of substitution.

W. Va. Code R. § 11-9-11 Disciplinary Action Against a Radiologist Assistant

11.1. The certification of a radiologist assistant shall be restricted, suspended or revoked by the Board of Medicine in accordance with all the alternatives set out at W. Va. Code §30-3-14(i) when, after due notice and a hearing in accordance with the manner and form prescribed by the contested case hearing procedure, W. Va. Code §29A-5-1 et seq. and rules of the Board of Medicine set out in Procedural Rule 11 CSR 3, if it is found:

a. That the assistant has held himself or herself out or permitted another person to represent him or her as a licensed radiologist.

b. That the assistant has in fact performed other than at the direction and under the supervision of a supervising radiologist licensed by the Board of Medicine.

c. That the assistant has been delegated and performed a task or tasks beyond his or her competence and not in accordance with the job description approved by the Board of Medicine.

d. That the assistant is a habitual user of intoxicants or drugs to such an extent that he or she is unable to safely perform as an assistant to the radiologist.

e. That the assistant has been convicted in any court, state or federal, of any felony or other criminal offense involving moral turpitude.

f. That the assistant has been adjudicated a mental incompetent or his or her mental condition renders him or her unable to safely perform as an assistant to a radiologist.

g. That the assistant has failed to comply with any of the provisions of this rule or the West Virginia Medical Practice Act; W. Va. Code §30-3-1 et seq.; or h. That the assistant is guilty of unprofessional conduct which includes, but is not limited to, the following:

1. Misrepresentation or concealment of any material fact in obtaining any certificate or license or a reinstatement of any certificate or license.

2. The commission of an offense against any provision of state law related to the practice of radiologist assistants, or any rule promulgated under the law.

3. The commission of any act involving moral turpitude, dishonesty or corruption, when the act directly or indirectly affects the health, welfare or safety of citizens of this State. If the act constitutes a crime, conviction of the crime in a criminal proceeding is not a condition precedent to disciplinary action.

4. Conviction of a felony, as defined under the laws of this State or under the laws of any other jurisdiction.

5. Misconduct in his or her practice as a radiologist assistant or performing tasks fraudulently, beyond his or her authorized scope of practice, with incompetence or with negligence on a particular occasion or negligence on repeated occasions.

6. Performing tasks as a radiologist assistant while the ability to do so is impaired by alcohol, drugs, physical disability or mental instability.

7. Impersonation of a licensed radiologist or another certified radiologist assistant.

8. Offering, undertaking or agreeing to cure or treat disease by a secret method, procedure, treatment or medicine; treating or prescribing for any human condition by a method, means or procedure which the radiologist assistant refuses to divulge upon demand of the Board of Medicine; or using methods or treatment processes not accepted by a reasonable segment of licensed radiologists.

9. Prescribing a prescription drug, including any controlled substance under state or federal law.

10. Conviction of a misdemeanor or a felony, as defined under the laws of this State or under the laws of any other jurisdiction, if the offense relates to the practice of medical imaging.

W. Va. Code R. § 11-9-12 Denial of Certification of Radiologist Assistant

12.1. The burden of satisfying the Board of Medicine of his or her qualifications for certification is on the applicant.

12.2. Whenever the Board of Medicine determines that an applicant has failed to satisfy the Board of Medicine that he or she should be certified, the Board of Medicine shall immediately notify the applicant of its decision and indicate in what respect the applicant has failed to satisfy the Board of Medicine. The applicant shall be given a formal hearing before the Board of Medicine upon request of the applicant filed with or mailed by registered or certified mail to the Secretary of the Board, 101 Dee Drive, Suite 103, Charleston, West Virginia 25311. The request must be filed within thirty (30) days after receipt of the Board of Medicine's decision, stating the reasons for the request. The Board of Medicine shall within twenty (20) days of receipt of the request, notify the applicant of the time and place of a public hearing, which shall be held within a reasonable time. Following the hearing, the Board of Medicine shall determine on the basis of this rule whether the applicant is qualified to be certified. The decision of the Board of Medicine is final as to that application.

W. Va. Code R. § 11-9-13 Complaint and Disciplinary Procedures

13.1. The complaint and disciplinary process and procedures set forth in the contested case hearing procedure, W. Va. Code §29A-5-1 et seq., and in the Board of Medicine Procedural Rule 11 CSR 3, also apply to the complaint process for radiologist assistants and to disciplinary actions instituted against radiologist assistants with the same provisions regarding the appeal of decisions made to circuit courts.

W. Va. Code R. § 11-9-14 Radiologist Assistant Utilization

14.1. The tasks a radiologist assistant may perform are those which require technical skill, execution of standing orders, routine radiologic tasks and procedures which the supervising radiologist may wish to delegate to the radiologist assistant after the supervising radiologist has satisfied himself or herself as to the ability and competence of the radiologist assistant. The supervising radiologist may, with due regard for the safety of the patient and in keeping with sound medical practice, delegate to the radiologist assistant those radiologic procedures and tasks that are usually performed within the scope of the practice of radiology, subject to the limitations set forth in this rule at section eight (8) and the West Virginia Medical Practice Act, W. Va. Code §30-3-1 et seq. and the training and expertise of the radiologist assistant.

14.2. The radiologist assistant shall, under the appropriate direction and supervision by a radiologist, augment the radiologist’s data gathering abilities in order to assist the supervising radiologist in reaching decisions and instituting plans of care for the radiologist’s patients. A radiologist assistant shall have, the knowledge and competency to perform the following functions and may under appropriate supervision perform them; the standard job description is not meant to be specific or all-inclusive:

a. Review patient medical record to verify the appropriateness of a specific exam or procedure and report significant findings to radiologist.

b. Interview patient to obtain, verify, and update medical history.

c. Explain procedure to patient or significant others, including a description of risks, benefits, alternatives, and follow-up. Patient must be able to communicate with the radiologist if he/she requests or if any questions arise that cannot be appropriately answered by the radiologist assistant.

d. Obtain informed consent. Patient must be able to communicate with the radiologist if he/she requests or if any questions arise that cannot be appropriately answered by the radiologist assistant.

e. Determine if patient has followed instructions in preparation for the examination (e.g., diet, premedications).

f. Assess and review with the radiologist the risk factors that may contraindicate the procedure (e.g. health history, medications, pregnancy, psychological indicators, alternative medicines).

g. Obtain and evaluate vital signs.

h. Apply ECG leads and be able to recognize life threatening abnormalities.

i. Perform urinary catheterization. Catheterization can be performed by appropriately trained radiologist assistants under general supervision. If a patient is known to have an anatomic anomaly, recent surgery in the area, etc., direct supervision would be needed.

j. Perform venipuncture.

k. Monitor IV for flow rate and complications in compliance with facility and regulatory rules.

l. Position patient to perform required procedure, using immobilization devices and modifying technique as necessary. Application of restraints should be in compliance with departmental rules and regulations.

m. Assess patient’s vital signs and level of anxiety/pain and inform radiologist when appropriate.

n. Recognize and respond to medical emergencies (e.g. drug reactions, cardiac arrest, hypoglycemia) and activate emergency response systems, including notification of the radiologist.

o. Administer oxygen as prescribed.

p. Operate a fixed/mobile fluoroscopic unit.

q. Assure documentation of fluoroscopy time.

r. Explain effects and potential side effects to the patient of the radiopharmaceutical and contrast media required for the examination.

s. Administer medications, including conscious sedation medications, only under the personal supervision of the supervising radiologist.

t. Under direct supervision, meaning the radiologist must be present in the office suite and immediately available to furnish assistance and directions throughout the performance of the procedure, may perform the following fluoroscopic examinations and procedures including contrast media administration and operation of fluoroscopic unit:

1. hysterosalpingogram (imaging only)

2. port injection 3. contrast injection into joint for MR or CT arthrogram 4. PICC line placement u. Under general supervision, may perform the following fluoroscopic examinations and procedures including contrast media administration and operation of fluoroscopic unit:

3. upper GI 2. esophagus 3. small bowel studies 4. barium enema 5. cystogram 6. t-tube cholangiogram 7. retrograde urethrogram 8. nasoentric and oroentric feeding tube placement 9. fistulogram/sonogram 10. loopogram 11. swallowing study 12. lower extremity venography 13. ductogram (galactogram)

v. Evaluate images for completeness and diagnostic quality, and recommend additional images as required in general radiography, CT or MR. (Additional images only in the same modality such as additional CT cuts.)

w. Evaluate images for diagnostic utility and report observations to the radiologist in general radiography, CT, and MR.

x. Review imaging procedures, make initial observations, and communicating observations only to the radiologist.

y. Communicate radiologist’s reports to referring physician consistent with American College of Radiology Communication Guidelines.

z. Provide physician-prescribed post care instructions (no medicines) to patients.

aa. Perform follow-up patient evaluation and communicate findings to the radiologist.

bb. Document procedure in appropriate record and document exceptions from established protocol or procedure.

cc. Write patient discharge summary for review and co-signature by radiologist.

dd. Participate in quality improvement activities within radiology practice (e.g. quality of care, patient flow, reject-repeat analysis, patient satisfaction).

ee. Assist with data collection and review for clinical trials or other research.

ff. Perform specialized CT/MR post processing.

14.3. A radiologist assistant making application to the Board of Medicine for job description changes or additions shall document that his or her training and competency supports the request.

14.4. If the supervising radiologist absents himself or herself in such a manner or to such a manner or to such an extent that he or she is unavailable to aid the radiologist assistant when required, the supervising radiologist shall not delegate tasks to his or her radiologist assistant unless he or she has made arrangements for another supervising radiologist. The legal responsibility for the acts and omissions of the radiologist assistant remains with the supervising radiologist at all times.

14.5. It is the responsibility of the supervising radiologist to ensure that supervision is maintained in his or her absence.

14.6. Designated representatives of the Board of Medicine are authorized to make on-site visits to the offices of supervising radiologists and facilities utilizing radiologist assistants to review the following:

a. The supervision of radiologist assistants.

b. Utilization of radiologist assistants in conformity with the provisions of this section.

c. Identifications of radiologist assistants.

d. Compliance with certification requirements.

14.7. The Board of Medicine reserves the right to review radiologist assistant utilization without prior notice to either the radiologist assistant or the supervising radiologist. It is a violation of this rule for a supervising radiologist or a radiologist assistant to refuse to undergo a review by the Board of Medicine.

14.8. The provisions of this section may not be construed to require medical care facilities or radiologists to accept radiologist assistants or to use them within their premises. It is appropriate for the radiologist assistant to provide services to the hospitalized patients of his or her supervising radiologist under the supervision of the radiologist, if the health care facility permits it.

14.9. Radiologist assistants employed directly by health care facilities shall perform services only under the supervision of a clearly identified supervising radiologist.

14.10. It is the supervising radiologist's responsibility to be alert to patient complaints concerning the type or quality of services provided by the radiologist assistant.

14.11. In the supervising radiologist's office and any office in which the radiologist assistant may function, a notice plainly visible to all patients shall be posted in a prominent place explaining the meaning of the term "Radiologist Assistant". The radiologist assistant's certificate must be prominently displayed in any office in which he or she may function. A radiologist assistant may obtain a duplicate certificate from the Board of Medicine if required.

14.12. The radiologist assistant is required to notify the Board of Medicine of changes in his or her employment within thirty (30) days. The radiologist assistant must provide the Board of Medicine with his or her new address and telephone number of his or her residence, address and telephone number of employment and name of his or her supervising radiologist.

14.13. The supervising radiologist is required to notify the Board of Medicine of any changes in his or her supervision of a radiologist assistant within ten (10) days.

W. Va. Code R. § 11-9-15 Continuing Education

15.1. Beginning the first day of April, 2010, each radiologist assistant, as a condition of his or her biennial renewal of radiologist assistant certification, shall provide to the Board written documentation of participation in and successful completion during the preceding two (2) year period of a minimum of fifty (50) hours of continuing education. A copy of the certificate of registration from the ARRT for both of the applicable years will satisfy the Board of Medicine as written documentation.

W. Va. Code R. § 11-9-16 Fees

16.1. The fee for an initial application is $100.

16.2. The fee for the biennial certification is $100.

16.3. The fee for any change of supervising radiologist is $25.

16.4. The fee for reinstatement of an expired certification is $25.

11CSR9

11CSR9

Series 10 Practitioner Requirements for Accesing the West Virginia Controlled Substances Monitoring Program Database

W. Va. Code R. § 11-10-1 General

1.1. Scope. -- This rule sets forth the requirements for licensees and registrants of the West Virginia Board of Medicine regarding accessing the West Virginia Controlled Substance Monitoring Program database.

1.2. Authority. -- W.Va. Code § 60A-9-5a(c)

1.3. Filing Date. -- May 9, 2022.

1.4. Effective Date. -- June 1, 2022.

1.5. Sunset Provision -- This rule shall terminate and have no further force or effect upon August 1, 2027.

W. Va. Code R. § 11-10-2 Definitions

2.1. As used in this rule, the following words and terms have the following meaning:

2.1.a. “Administering” means the direct application of a drug to the body of a patient by injection, inhalation, ingestion or any other means.

2.1.b. “Benzodiazepine” means a class of controlled substance medications that produce sedation, induce sleep, relieve anxiety and prevent seizures and which are generally approved to treat anxiety disorder, insomnia, seizures, social phobia, and panic disorder.

2.1.c. “Board” means the West Virginia Board of Medicine as described at W. Va. Code §30-3-5.

2.1.d. “Controlled substance” means a drug that is classified by federal or state law in Schedules I, II, III, IV or V, as defined in W. Va. Code Chapter 60A, Article 2.

2.1.e. “CSMP” means the West Virginia Controlled Substances Monitoring Program repository and database.

2.1.f. “DEA registration identification number” means the federal Drug Enforcement Administration registration identification number issued to a practitioner.

2.1.g. “Dispensing” means the preparation and delivery of a drug to an ultimate user by or pursuant to a lawful order of a practitioner, including the prescribing, packaging, labeling, administering or compounding necessary to prepare the drug for that delivery.

2.1.h. “Medical records” means records including the medical history and physical examination; diagnostic, therapeutic and laboratory results; evaluations and consultations; treatment objectives; discussion of risks and benefits; informed consent; treatments; medications (including date, type, dosage and quantity provided); instructions and agreements; and periodic reviews.

2.1.i. “Opioid” means controlled substance medications which are natural and semi-synthetic derivatives of the opium poppy, as well as similar synthetic compounds that have analgesic or pain relieving properties because of their effects in the central nervous system. Opioids include, but are not limited to, codeine, morphine, hydromorphone, hydrocodone, oxycodone, methadone, and fentanyl.

2.1.j. “Patient” means a person presenting himself or herself for treatment who is not considered by the practitioner as suffering from a terminal illness.

2.1.k. “Practitioner” means a physician, podiatric physician or physician assistant who possesses a valid DEA registration identification number and who is licensed by the Board pursuant to Articles 3 or 3E of Chapter 30, or holds an interstate telehealth registration issued by the Board pursuant to W. Va. Code § 30-1-26.

2.1.l. “Providing” means prescribing, dispensing or administering medication.

2.1.m. “Terminal illness” means an incurable or irreversible condition as diagnosed by the attending physician or a qualified physician for which the administration of life-prolonging intervention will serve only to prolong the dying process.

W. Va. Code R. § 11-10-3 Practitioner Requirements for Obtaining and Maintaining Access to the CSMP

3.1. Practitioners who prescribe or dispense Schedule II, III, IV, or V controlled substances shall register with the CSMP and obtain and maintain online or other electronic access to the program database. Compliance with the provisions of this section must be accomplished within 30 days of the practitioner obtaining a new license or registration or within 30 days of re-licensure or re-registration.

3.2. Licensees shall be required to certify compliance with the provisions of this section when renewing a license. The Board may conduct an audit to verify compliance therewith.

W. Va. Code R. § 11-10-4 General Rules for Practitioners for Patients Not Suffering from a Terminal Illness

4.1. The provisions of this section only apply to a practitioner’s prescribing, administering or dispensing of Schedule II controlled substances, opioids, or benzodiazepines to a patient that the practitioner does not consider to be suffering from a terminal illness. 4.2 A practitioner shall apply for and receive capability to access the CSMP providing a patient any Schedule II controlled substance, any opioid, or any benzodiazepine.

4.3. Before initially providing any Schedule II controlled substance, any opioid, or any benzodiazepine to a patient a current practitioner shall access the CSMP to determine whether the patient has obtained any controlled substance reported to the CSMP from any source other than the current practitioner within the twelve month period immediately preceding the current practitioner’s encounter with the patient.

4.4. The practitioner shall promptly document the initial CSMP data review in the patient’s medical record. Documentation must include the date the practitioner accessed the patient’s CSMP record, a dated copy of the CSMP report or a list of all controlled substances reported to the CSMP as dispensed to the patient within the preceding twelve months, and the practitioner’s rationale for providing the patient Schedule II controlled substance(s), opioid(s), and/or benzodiazepine(s).

4.5. If a practitioner-patient relationship continues and the course of treatment includes the continued prescribing, dispensing or administering of any controlled substance, the practitioner shall access the CSMP at least annually to determine whether the patient has obtained any controlled substances reported to the CSMP from any source other than the current practitioner within the twelve month period immediately preceding the date of access. The date of access and any controlled substances from any other source other than the current practitioner reported to the CSMP within such twelve month period immediately preceding the date of access shall be then promptly documented in the patient’s medical record by the current practitioner, with rationale for continuing provision of the controlled substance by the current practitioner.

4.6. A practitioner may review a patient’s CSMP data more frequently than annually. However, a practitioner must document each CSMP data review in the patient medical record. Documentation must include the date the practitioner accessed the patient’s CSMP record, a dated copy of the CSMP report or a list of all controlled substances reported to the CSMP for the patient from any source other than the practitioner, and the practitioner’s rationale for discontinuing or continuing to provide controlled substances to the patient.

4.7. A practitioner who is providing a patient controlled substance medication shall review a patient’s CSMP data whenever the provider has a specific concern regarding controlled substance abuse, misuse, or diversion of controlled substances by the patient. 11-10 5. Discipline and Administrative Penalties.

5.1. Any practitioner who fails to comply with this rule is subject to Board disciplinary proceedings for failing to perform any statutory or legal obligation placed upon the practitioner and unprofessional, unethical, and dishonorable conduct, pursuant to W. Va. Code § 30-3-14, W. Va. Code § 30-3E-17, and/or the rules of the Board.

5.2. Any practitioner who fails to comply with the requirements described in W. Va. Code § 60A-9-7(f) or (g) shall be subject to the respective administrative penalties set forth in those subsections. All fines collected pursuant to those subsections shall be transferred by the Board to the Fight Substance Abuse Fund created under W. Va. Code § 60A-9-8.

Series 11 Establishment and Regulation of Limited License to Practice Medicine and Surgery at Certain State Veterans Nursing Home Facilities

W. Va. Code R. § 11-11-1 General

1.1. Scope. -- W. Va. Code §30-3-11b provides for the issuance of a limited license by the Board to an applicant to practice medicine and surgery at a designated state veterans nursing home facility under certain specific conditions, and W. Va. Code §30-3-11b(d) requires that the Board promulgate emergency rules to implement the provisions of W. Va. Code §30-3-11b.

1.2. Authority. -- W. Va. Code §30-3-11b(d).

1.3. Filing Date. -- May 9, 2022.

1.4. Effective Date. -- June 1, 2022.

1.5. Sunset Provision. -- This rule shall terminate and have no further force or effect upon August 1, 2027.

W. Va. Code R. § 11-11-2 Definitions

2.1. For purposes of this rule, the following words and terms mean:

2.1.a. “Designated state veterans nursing home facility” means a nursing home operated by the West Virginia Department of Veteran’s Assistance.

2.1.b. “Limited license to practice medicine and surgery at a designated state veterans nursing home facility” means a license issued to a physician who meets the criteria established in W. Va. Code §30-3-11b(a) and which contains limitations on practice location, practice setting and type of patients.

2.1.c. “Limited licensee” means a person licensed pursuant to this rule.

2.1.d. “Website” or “Board’s website” means the set of related web pages operated by or on behalf of the West Virginia Board of Medicine located at the domain name wvbom.wv.gov, or at any successor domain name published by the Board.

W. Va. Code R. § 11-11-3 Qualification and Application for a Limited License to Practice at a Designated State Veterans Nursing Home Facility

3.1. An applicant for a limited license to practice medicine and surgery at a designated state veterans nursing home facility shall submit an application in the form designated by the Board which shall include:

3.1.a. Proof that he or she has the requisite qualifications to provide the same standard of care as a physician initially licensed in this State;

3.1.b. A photograph taken within the previous twelve (12) months which substantially resembles the applicant;

3.1.c. Evidence of graduation from a medical school approved by the Liaison Committee on Medical Education or by the Board;

3.1.d. Applicants who graduated from an approved medical school located in United States, Canada, or the Commonwealth of Puerto Rico shall submit proof of successful completion of at least one year of postgraduate clinical training in a program approved by the Accreditation Council for Graduate Medical Education (ACGME)or a graduate medical education residency program outside of the United States and a minimum of one year of fellowship training in the United States in a clinical field related to the applicant’s residency training which was completed:

3.1.d.1. At an institution that sponsors or operates a residency program in the same clinical field or a related clinical field approved by the ACGME; or

3.1.d.2. At a time when accreditation was not available for the fellowship’s clinical field and the board has determined that the training was similar to accredited training due to objective standards, including, but not limited to, the presence of other accredited programs at the sponsoring institution during the applicants’ clinical training at the fellowship location.

3.1.e. Graduates of international medical schools located outside of the United States, Canada, or the Commonwealth of Puerto Rico shall submit proof of:

3.1.e.1. Successful completion of a minimum of two years of graduate clinical training approved by the ACGME;

3.1.e.2. Successful completion of a graduate medical education residency program outside of the United States and a minimum of two years of fellowship training in the United States in a clinical field related to the applicants’ residency training which was completed:

3.1.e.2.1. At an institution that sponsors or operates a residency program in the same clinical field or a related clinical field approved by the ACGME; or

3.1.e.2.2. At a time when accreditation was not available for the fellowship’s clinical field and the board has determined that the training was similar to accredited training due to objective standards, including, but not limited to, the presence of other accredited programs at the sponsoring institution during the applicant’s clinical training at the fellowship location; or

3.1.e.3. Proof of current certification by a member board of the American Board of Medical Specialties and a minimum of one year of graduate clinical training which comports with the accreditation requirements subdivision 3.1.e.1 or 3.1.e.2.

3.1.f. Graduates of international medical schools located outside of the United States, Canada, or the Commonwealth of Puerto Rico shall also submit evidence of a valid certificate issued by the Educational Commission for Foreign Medical Graduates (“ECFMG”) or documentation of a passing score on the examination of the ECFMG. Provided, That an applicant who: (i) is currently fully licensed, excluding any temporary, conditional or restricted license or permit, under the laws of another state, the District of Columbia, Canada or the Commonwealth of Puerto Rico; (ii) has been engaged on a full- time professional basis in the practice of medicine within the state or jurisdiction where the applicant is fully licensed for a period of at least five years; and is not the subject of any pending disciplinary action by a medical licensing board in any jurisdiction, is not required to have a certificate from the educational commission for foreign medical graduates;

3.1.g. Proof satisfactory to the Board that the applicant is currently employed by and authorized to practice medicine at a Federal Veterans Administration Hospital which is located in the same county as the designated state veterans nursing home facility where the applicant seeks to practice;

3.1.h. Evidence that the applicant maintains a valid, unrestricted license to practice medicine in another state within the United States;

3.1.i. An attestation that the applicant is in good standing in each jurisdiction in which he or she is licensed, and that he or she has had no medical disciplinary action taken against him or her within the last five years and has no medical board complaint investigations or medical board disciplinary action pending against him or her;

3.1.j. Verification from each state where the applicant has been licensed which corroborates that the applicant is in good standing in each such jurisdiction;

3.1.k. The nature and number of malpractice settlements made or judgements against the applicant in the last five years;

3.1.l. A criminal history record check in conformity with the procedure set forth in section 8 of W. Va. Code R. § 11-1A-1 et seq.

3.1.m. Any other documents or information as may be required by the Board of all applicants for physician licensure pursuant to section 4.5 of W. Va. Code R. §11-1A-1 et. seq.

3.2. Complete applications are considered by the Board at regular Board meetings. The Board will not consider an application or decide upon the issuance of a license to an applicant until the complete application, including all third-party documentation and/or verifications, is on file with the Board and the Board has had at least ten days to review the application.

3.3. If derogatory or conflicting information regarding an applicant’s qualifications exists within a pending application file, the information shall be presented to the Board’s Licensure Committee for review. Thereafter, the Licensure Committee shall determine whether the applicant should be scheduled to appear before the Committee. The Committee may also direct staff to obtain additional information related to the applicant’s qualifications or make a recommendation upon the application.

3.4. No fee is required for the submission and processing of an application for a limited license to practice medicine and surgery at a designated state veterans nursing home facility.

W. Va. Code R. § 11-11-4 License Renewals

4.1. With the exception of an initial license, a limited license to practice medicine and surgery at a designated state veterans nursing home facility is issued for a term of two years. An initial license is issued with an expiration date consistent with the applicant’s renewal classification as set forth in subsection 4.2.

4.2. License renewal for all physicians issued a limited license pursuant to this rule shall occur on the following schedule:

4.2.a. Physicians whose last names begin with the letters “A” through “L” shall renew prior to July 1 of every even year; and

4.2.b. Physicians whose last names begin with the letters “M” through “Z” shall renew prior to July 1 of every odd year.

4.3. Renewal deadlines shall be published by the Board on its website.

4.4. Renewal applications shall be available on the Board’s website. It is the responsibility of the limited licensee to acquire and submit renewal application forms.

4.5. No fee is required for the submission and processing of a renewal application for a limited license to practice medicine and surgery at a designated state veterans nursing home facility.

4.6. A limited license shall expire if not renewed by the renewal deadline set by the Board. An expired license is not a valid license.

W. Va. Code R. § 11-11-5 Regulation of Limited License to Practice at a Designated State Veterans Nursing Home Facility

5.1. A physician granted a limited license pursuant to W. Va. Code §30-3-11b is subject to all the provisions and protections of the West Virginia Medical Practice Act, W. Va. Code §30-3-1 et seq. and all rules of the Board governing the professional practice of medicine and surgery by allopathic physicians.

5.2. A limited licensee shall report, in writing, to the Board within fifteen days of the occurrence:

5.2.a. Any suspension, revocation, probation, restriction, term, condition or other discipline taken against the limited licensee in any other jurisdiction;

5.2.b. Any adverse employment action, restriction upon practice or limitation upon authorization to practice at the Federal Veterans Administration Hospital where the limited licensee is employed; and/or

5.2.c. Any separation from employment or transfer of employment from the Federal Veterans Administration Hospital where the limited licensee is employed.

5.3. Any failure of a limited licensee to make a required report as set forth in Section 5.2 shall constitute dishonorable, unprofessional or unethical conduct which may result in the imposition of discipline against the licensee.

W. Va. Code R. § 11-11-6 Conversion of Limited License to Standard License

6.1. The board may permit a limited licensee to transfer the authorized practice location associated with his or her limited license if the licensee has transferred to a different Federal Veterans Administration Hospital located in this state, and a designated state veterans nursing home exists in the county where the limited licensee has transferred.

6.2. The board may convert the limited license to practice at a designated state veterans nursing home to a standard license upon submission of a complete application and the appropriate fee by a limited licensee who meets the requirements for a standard license.

W. Va. Code R. § 11-11-7 Termination of Limited License

7.1. A limited license to practice medicine and surgery at a designated state veterans nursing home facility shall automatically terminate if:

7.1.a. The limited licensee is no longer employed at the Federal Veterans Administration Hospital which is located in the same county as the designated state veterans nursing home facility for which the limited license was issued;

7.1.b. The limited licensee is no longer practicing, or no longer authorized to practice, at the Federal Veterans Administration Hospital which is located in the same county as the designated state veterans nursing home facility for which the limited license was issued; or

7.1.c. The limited licensee no longer holds a valid, unrestricted license to practice medicine in another state within the United States.

Series 12 Permitting and Disciplinary Procedures: Educational Permits for Graduate Medical Interns, Residents and Fellows

W. Va. Code R. § 11-12-1 General

1.1. Scope. -- W. Va. Code § 30-3-7(1)(a) authorizes the Board of Medicine to promulgate rules which are necessary to perform the duties and responsibilities of the Board, and W. Va. Code § 30-3-16(f) authorizes the Board to promulgate rules to implement this section of the West Virginia Medical Practice Act.

1.2. Authority. -- W. Va. Code § 30-3-7(a)(1) and §30-3-16(f).

1.3. Filing Date. -- April 30, 2024.

1.4. Effective Date. -- May 1, 2024.

1.5. Sunset Provision. -- This rule shall terminate and have no further force or effect upon August 1, 2028.

W. Va. Code R. § 11-12-2 Definitions

2.1. For purposes of this rule, the following words and terms mean:

2.1.1. "ACGME" means the Accreditation Council for Graduate Medical Education.

2.1.2. "Board" means the West Virginia Board of Medicine, established in W. Va. Code §30-3-5.

2.1.3. "ECFMG" means the Educational Commission for Foreign Medical Graduates.

2.1.4. “Educational permit” means an authorization issued to a physician by the Board to practice medicine and surgery under the auspices of ACGME approved graduate medical training or a fellowship in an approved program of post-graduate clinical training sponsored by an institution that is accredited to provide graduate medical education.

2.1.5. “Fellowship” means a period of additional specialized training for a physician who has completed a specialty training program/residency which is sponsored by an institution that is accredited to provide graduate medical education.

2.1.6. “Good standing” means that a participant in graduate medical training is not under suspension or otherwise prohibited from current participation in his or her training program.

2.1.7. “Graduate medical training” means formal medical training pursued after the receipt of a medical degree and includes internship, residency and fellowship programs.

2.1.8. "LCME" means the Liaison Committee on Medical Education.

2.1.9. “Program Director” means the director of an accredited or approved graduate medical education training program.

2.1.10. “Reciprocal educational permit” means an authorization issued to a physician by the Board to practice medicine and surgery under the auspices of ACGME approved graduate medical training domiciled outside of West Virginia during a temporary residency rotation within West Virginia.

W. Va. Code R. § 11-12-3 Permit Required for Participation in Graduate Medical Training

3.1. Beginning July 1, 2019, no person shall participate in a program of graduate medical education training in West Virginia unless he or she:

3.1.1. Holds a license to practice medicine and surgery in this state issued by the Board pursuant to W. Va. Code § 30-3-10; or

3.1.2. Holds an educational permit or reciprocal educational permit issued by the Board pursuant to W. Va. Code § 30-3-16 and this rule.

3.2. An educational permit authorizes the holder to participate in:

3.2.1. An ACGME approved training program; or

3.2.2. A fellowship in an approved program of post-graduate clinical training sponsored by an institution that is accredited to provide graduate medical education.

3.3. An educational permit holder may only practice medicine and surgery within the auspices of his or her training program. If a permit holder leaves the training program for which an educational permit was issued, the permit becomes invalid.

3.4. An educational permit is not a license to practice medicine and surgery in West Virginia, and an educational permit holder may not practice medicine and surgery outside the scope of his or her training program or fellowship.

3.5. Receipt of an educational permit does not entitle an applicant to receive a license to practice medicine and surgery in West Virginia upon completion of graduate medical training or any portion thereof. An individual who seeks to be licensed to practice medicine and surgery must apply and meet the qualifications and criteria for licensure set forth in W. Va. Code § 30-3-10 and 11 CSR 1A.

3.6. A permit holder may apply for a medical license when he or she becomes eligible. In the event that a West Virginia medical license is granted to the holder of an educational permit, the permit shall expire upon licensure.

3.7. The Board shall begin issuing educational permits to qualified applicants on September 1, 2018.

3.8. Reciprocal educational permits shall be issued beginning July 1, 2019.

W. Va. Code R. § 11-12-4 Educational Permit Eligibility and Application

4.1. Minimum qualifications for receipt of an educational permit are set forth in West Virginia Code §30-3-16.

4.2. An application for an educational permit to participate in graduate medical training shall be completed on a Board-approved application.

4.3. The Board will not consider an application or decide upon the issuance of a permit to an applicant until the complete application, including all third-party documentation and/or verification, is on file with the Board and the Board has had at least fifteen business days to review the application.

4.4. An application for an educational permit must be accompanied by payment of a nonrefundable application fee in an amount established by 11 CSR 4. Until such time as 11 CSR 4 is modified to reflect a fee for permits, the fee shall be $100.

4.5. Applicants must provide the following information in association with an application for an educational permit:

4.5.1. The applicant's legal name, e-mail address, home address, preferred mailing address and telephone numbers;

4.5.2. Demographic information of the applicant, such as date of birth, place of birth, sex, etc.;

4.5.3. Satisfactory proof that prior to commencing graduate medical training pursuant to a permit issued by the Board, the applicant:

4.5.3.a. Is a graduate of an allopathic medical school approved by the LCME;

4.5.3.b. Is a graduate of a medical college that meets the requirements for certification by the ECFMG; or

4.5.3.c. Has completed an alternate pathway for initial entry or transfer requirements by the ACGME.

4.5.4. Primary source verification from the Program Director of the proposed graduate medical training, or his or her designee, that the applicant:

4.5.4.a. Is under contract as a resident in a program of post-graduate clinical training approved by the ACGME; or

4.5.4.b. Has completed an ACGME-approved residency program or a residency program recognized by the ECFMG and is under contract as a fellow in an approved program of post-graduate clinical training sponsored by an institution that is accredited to provide graduate medical education.

4.5.5. Satisfactory proof of legal name, identity and date of birth;

4.5.6. A copy of legal documentation satisfactory to the Board which verifies any name change the applicant has experienced;

4.6. Board staff is authorized to issue permits without presentation to the Board if the application is complete and there is no derogatory or conflicting information regarding an applicant’s qualifications and eligibility for a permit.

4.7. If Board staff receives or discovers derogatory or conflicting information regarding an applicant’s qualifications or eligibility for an educational permit, the information may be presented to the Board for review.

4.8. A complete application, including all associated documentation submitted to the Board, becomes the property of the Board and will not be returned.

4.9. The applicant has the burden of demonstrating that he or she is qualified to receive an educational permit.

W. Va. Code R. § 11-12-5 Permit Renewal

5.1. An educational permit is valid for a period of up to one year and, except as otherwise provided in this rule, expires on the last day of June following the issuance date of the permit.

5.2. An educational permit may be renewed annually during the renewal period established by the Board if the permit holder remains eligible to receive a permit.

5.3. An educational permit holder may renew a permit by:

5.3.1. Completing and submitting the Board’s renewal application;

5.3.2. Having the applicant’s Program Director to submit verification that the applicant remains under contract as set forth in subdivision 4.5.4. of this rule; and

5.3.3. Submitting a nonrefundable renewal fee in the amount of $100.

5.4. Communications and notifications regarding the permit renewal process will be provided to the permit holder via e-mail. Failure of the permit holder to receive a renewal notification does not justify participation in graduate medical training without a valid educational permit.

W. Va. Code R. § 11-12-6 Permit Requirements

6.1. An educational permit holder shall maintain current contact information on file with the Board including: a preferred mailing address; a home address; and a current e-mail address. He or she shall notify the Board of any changes to such contact information, and any legal name change, within fifteen days of the change.

6.2. If an educational permit holder leaves his or her training program at any time other than the end of the training contract, he or she shall notify the Board, in writing, within five business days. Such notice must provide an explanation of the facts and circumstances surrounding the cessation of training.

6.3. Prior to prescribing any controlled substances pursuant to an educational permit issued pursuant to section 4 of this rule, a permit holder shall complete of a minimum of three hours of drug diversion training and best practice prescribing of controlled substances training through a Board approved course. The Board shall maintain a list of approved courses on its website.

W. Va. Code R. § 11-12-7 Permit Denial, Complaint and Disciplinary Procedures

7.1. The application denial, complaint and disciplinary process and procedures and appeal rights set forth in the contested case hearing procedure, W. Va. Code §29A-5-1 et seq., W. Va. Code §30-3-14(h) and (i), and in the Board’s procedural rule, 11 CSR 3, Board Organization and Meeting Procedure; Complaint and Contested Case Hearing Procedure, also apply to educational permit holders.

7.2. If the Board determines the evidence in its possession indicates that an educational permit holder's continuation in practice or unrestricted practice as part of a graduate medical training program constitutes an immediate danger to the public, the Board may take any of the actions provided in W. Va. Code §30-3-14(j) on a temporary basis and without a hearing if institution of proceedings for a hearing before the Board are initiated simultaneously with the temporary action and begin within fifteen days of the action. The Board shall render its decision within five days of the conclusion of a hearing under this subsection.

W. Va. Code R. § 11-12-8 Denial of Permit and Discipline

8.1. If an educational permit applicant or holder is found guilty of, or pleads guilty or nolo contendere to, any felony involving prescribing, selling, administering, dispensing, mixing or otherwise preparing any prescription drug, including any controlled substance for other than generally accepted therapeutic purposes under state or federal law and in a state or federal court of competent jurisdiction, the Board shall deny the permit application or revoke the physician’s permit without resort to the procedures set forth in section 8 of this rule. A certified copy of the guilty verdict or plea rendered is sufficient proof for permit denial or revocation.

8.2. The Board shall deny an application for an educational permit if the applicant:

8.2.1. Is ineligible based upon the criteria set forth in W. Va. Code § 30-3-16 or this rule;

8.2.2. Has ever held a license to practice medicine and surgery in West Virginia; or

8.2.3. Has ever had an educational permit or a license to practice medicine and surgery revoked, suspended or surrendered in any jurisdiction unless such action is no longer in effect and the authorization to practice has been restored.

8.3. The Board may deny an application for an educational permit and/or may discipline a permit holder who, after a hearing, has been adjudged by the Board as unqualified due to any of the following reasons:

8.3.1. Conduct by a permit holder which is equivalent to any of the grounds cited for the discipline in W. Va. Code §30-3-14(c) or section 12 of the Board’s rule 11 CSR 1A;

8.3.2. Failure to comply with any portion of this rule;

8.3.3. Practicing medicine or surgery outside of or beyond the scope of the permit holder’s graduate medical training program; or

8.3.4. Prescribing any controlled substance to or for himself or herself, his or her spouse, or for any other member of his or her immediate family including parents, siblings, children and their spouses.

8.4. If the Board determines that a physician is unqualified to hold an educational permit, the Board may enter an order denying an application or imposing any limitation, restriction or other disciplinary measure set forth in W. Va. Code §30-3-14(j) and/or 11 CSR 1A.

W. Va. Code R. § 11-12-9 Reciprocal Educational Permit Eligibility and Application

9.1. A participant in ACGME-approved medical residency program outside of West Virginia who holds an educational permit, current license or other authorization to practice medicine and surgery in the state where the residency program is domiciled and who seeks to participate in a temporary residency rotation within West Virginia shall, at least thirty days in advance of the rotation, apply for a reciprocal educational permit from the Board.

9.2. Pursuant to a reciprocal educational permit, a physician’s practice is limited to the location and scope of his or her temporary West Virginia residency rotation.

9.3. A reciprocal educational permit shall be limited to a period of sixty concurrent days and is nonrenewable. The Board may issue a reciprocal educational permit to a physician once each academic year.

9.4. Applicants must provide the following information in association with an application for a reciprocal educational permit:

9.4.1. The applicant's legal name, e-mail address, home address, preferred mailing address and telephone numbers;

9.4.2. Demographic information of the applicant, such as date of birth, place of birth, sex, etc.;

9.4.3. Satisfactory proof that the applicant holds the appropriate authorization to practice medicine and surgery in the state where the applicant’s residency program is domiciled;

9.4.4. Primary source verification from the program director of the proposed graduate medical training, or his or her designee, which establishes:

9.4.4.a. The applicant is under contract as a resident in a program of post-graduate clinical training approved by the ACGME;

9.4.4.b. The applicant is in good standing with the residency program; and

9.4.4.c. The dates the applicant is scheduled to participate in a temporary residency rotation in West Virginia and the location of the training; and

9.4.5. An application fee of $50.

W. Va. Code R. § 11-12-10 Required Reports from Graduate Medical Education Programs

10.1. Every graduate medical education program providing graduate medical education to residents or fellows in West Virginia shall notify the Board within five days of the termination of any graduate medical education contract with a physician who holds an educational permit issued by the Board.

11CSR12

Series 13 Waiver of Initial Licensing Fees For Certain Initial Licensure Applicants

W. Va. Code R. § 11-13-1 General

1.1. Scope. -- This rule establishes procedures for waiving the initial licensing fee for low-income individuals and military families.

1.2. Authority. -- W. Va. Code §30-1-23.

1.3. Filing Date. -- May 7, 2025

1.4. Effective Date. – July 1, 2025

1.5. Sunset Provision -- This rule shall terminate and have no further force or effect upon August 1, 2030.

W. Va. Code R. § 11-13-2 Definitions

2.1. For purposes of this rule, the following words and terms mean:

2.1.1. “Below 130 percent of the poverty line” means below 130 percent of the poverty line pursuant to the most recent annual poverty guidelines released by the United States Department of Health and Human Services.

2.1.2. “Board” means the West Virginia Board of Medicine.

2.1.3. “Initial license” means the first license approved by the Board and issued to an applicant:

To practice medicine and surgery;

To practice podiatric medicine and surgery; or To practice as a physician assistant in collaboration with physicians in West Virginia.

Initial license does not include permits to participate in graduate medical training which are issued by the Board.

2.1.4. “Initial licensing fee” only means a fee directly assessed, collected and retained by the Board in connection with:

An application for an initial medical license;

An application for an initial podiatric license; or An application for an initial physician assistant license.

This term does not include fees assessed by third parties which may be necessary to obtain documentation and/or information needed to complete an applicant’s initial application.

2.1.5. “LIW” means the Low-Income Waiver form used to request a waiver of the initial licensing fee for low-income individuals.

2.1.6. "Local labor market" means every county in West Virginia, and any county outside of West Virginia if any portion of that county is within fifty miles of the border of West Virginia, pursuant to W.Va. Code §21-1C-2.

2.1.7. “Low-income individual” means an individual who resides in the local labor market whose household adjusted gross income is below 130 percent of the federal poverty line. This term also includes any person enrolled in the Temporary Assistance for Needy Families Program (TANF), Medicaid, the Supplemental Nutrition Assistance Program (SNAP) or other state or federal public assistance program with substantially equivalent low-income eligibility requirements.

2.1.8. “Military family” means any person who serves as an active member of the armed forces of the United States, the National Guard, or a reserve component as described in 38 U.S.C. §101, honorably discharged veterans of those forces, and their spouses. This term also includes surviving spouses of deceased service members who have not remarried.

2.1.9. “MFW” means the Military Family Waiver form used to request a waiver of the initial licensing fee for military service members and eligible spouses.

W. Va. Code R. § 11-13-3 Request for Waiver of Initial Licensure Fees

3.1. An individual applying for an initial license who seeks a waiver of the initial licensing fee pursuant to the low-income or military family waiver shall make his or her request to the Board on the appropriate fee waiver form and provide all required documentation and information.

3.2. The Board shall provide the LIW and MFW initial licensing fee waiver forms and instructions on what documentation is necessary to submit when an individual is seeking the low-income or military family initial licensing fee waiver.

3.3. The Board shall process the initial licensing fee waiver form and notify the individual whether he or she meets the eligibility requirements for an initial licensing fee waiver within thirty days of receipt of all required information and documentation. The thirty-day processing period shall not commence until the Board has received a completed LIW or MFW form and the individual has provided all required documentation and information needed to process the request.

3.4. Approval of the initial licensing fee waiver for an individual does not entitle the individual to receive a West Virginia license. An individual granted an initial licensing fee waiver must still apply for licensure and meet the qualifications and criteria for licensure as set forth in W. Va. Code §30-3-1, et seq., or W. Va. Code §30-3E-1, et seq., and the Board’s corresponding legislative rules.

3.5. An applicant who receives an initial licensing fee waiver pursuant to this rule must apply for a license no later than sixty days after the initial licensing fee waiver is granted or the waiver shall expire.

3.6. An applicant shall only be eligible for one initial licensing fee waiver from the Board.

3.7. The Board shall deny a request for an initial licensing fee waiver if the applicant:

3.7.1. Has previously held a license in this state for the same occupation;

3.7.2. Does not meet the eligibility criteria for a low-income or military family waiver;

3.7.3. Submits false or fraudulent information in association with the initial licensing fee waiver application; or

3.7.4. Has previously received an initial licensing fee waiver from the Board for the same occupation.

3.8. If a physician who has been granted an initial licensing fee waiver is approved for licensure, any assessment that may be required for the Patient Injury Compensation Fund pursuant to W. Va. Code §29-12D-1a shall also be waived until the physician’s first license renewal.

W. Va. Code R. § 11-13-4 Required Documentation for a Waiver of Initial Licensing Fees for Low-Income Individuals

4.1. An individual requesting a waiver of the initial licensing fee as a low-income individual shall submit a completed LIW form and all appropriate documentation and information specified in this section.

4.2. To establish eligibility for a waiver of an initial licensing fee based upon low-income, the applicant must either:

4.2.1. Be in the local labor market and submit the appropriate Federal Income Tax returns for the preceding year which verifies that the applicant has a household adjusted gross income below 130 percent of the federal poverty line; or

4.2.2. Submit certified documents or other documents satisfactory to the Board which verify that the individual is enrolled in the Temporary Assistance for Needy Families Program (TANF), Medicaid, the Supplemental Nutrition Assistance Program (SNAP) or other state or federal public assistance program with substantially equivalent low-income eligibility requirements.

W. Va. Code R. § 11-13-5 Required Documentation for a Waiver of Initial Licensing Fees for Military Families

5.1. An individual requesting a military family waiver of the initial licensing fee shall submit a completed MFW form and all appropriate documentation and information specified in this section.

5.2. To establish eligibility for a military family waiver of the initial licensing fee, an individual shall submit the following documentation to the Board:

5.2.1. If the applicant is the service member, the applicant’s DD-214 form, NGB-22 form, a copy of the applicant’s current military orders or other official military documentation satisfactory to the Board demonstrating the service member’s qualifying past or current military service;

5.2.2. If the applicant is the spouse of a service member, the applicant must submit:

5.2.2.a. The service member’s DD-214 form, NGB-22 form, a copy of the service member’s current military orders or other official military documentation satisfactory to the Board demonstrating the service member’s qualifying past or current military service; and

5.2.2.b. A copy of the certificate of marriage between the applicant and the service member.

5.2.3. If the applicant is the surviving spouse of a service member and has not remarried, the applicant must submit:

5.2.3.a. The decedent service member’s DD-1300 form or substantially equivalent official military report of casualty form, or a certified copy of the death certificate for the decedent service member plus the decedent service member’s DD-214 form, NGB-22 form or other official military documentation satisfactory to the Board demonstrating the decedent service member’s qualifying past military service;

5.2.3.b. A copy of the certificate of marriage between the applicant and the decedent service member; and

5.2.3.c. A notarized affidavit from the applicant verifying that the applicant has not remarried.

Series 14 Registration to Practice During Declared State of Emergency

W. Va. Code R. § 11-14-1 General

1.1. Scope. -- This rule establishes procedures for authorizing a physicians or physician assistants who does not hold an active status medical license to practice in West Virginia during a declared state of emergency.

1.2. Authority. -- W. Va. Code §§ 30-3-7(a)(1) and 30-3E-3(a).

1.3. Filing Date. -- May 9, 2022.

1.4. Effective Date. -- July 1, 2022.

1.5. Sunset Provision -- This rule shall terminate and have no further force or effect upon August 1, 2027.

W. Va. Code R. § 11-14-2 Registration for Out-Of-State Physicians and Physician Assistants to Practice in West Virginia During Declared State of Emergency

2.1. In the event of an emergency declared by the Governor of West Virginia, the Board shall allow a physician or physician assistant licensed in another state to provide medical care in West Virginia under special provisions during the period of the declared emergency, subject to such limitations and conditions as the Governor may prescribe. To be eligible to practice pursuant to this rule, the physician or physician assistant must register with the Board.

2.2. The out-of-state physician or physician assistant shall submit to the Board the following information on a form provided by the Board to establish eligibility for registration to practice during a declared state of emergency:

2.2.1. Verification of a valid, permanent, current, and unrestricted license to practice in another state;

2.2.2. Verification that the physician or physician assistant is not the subject of a pending or active complaint, investigation, Consent Order, Board Order or pending disciplinary proceeding in any jurisdiction;

2.2.3. Verification that the physician or physician assistant has not surrendered a license while under investigation or had a license revoked in any jurisdiction, unless the revocation was subsequently withdrawn or overturned;

2.2.4. Date of birth and current contact information, including home address and valid email address; and

2.2.5. Current federal or state photo identification, i.e., driver license or passport.

2.3. Registration with the Board as an out-of-state physician and/or physician assistant authorized to practice in West Virginia during a declared state of emergency does not require the payment of any fee.

2.4. An Emergency registration issued pursuant to this section shall expire sixty days after issuance or five business days after a declared state of emergency terminates, whichever is sooner. Thereafter, the emergency registrant must hold an active West Virginia license or interstate telehealth registration to practice medicine and surgery to patients in West Virginia.

W. Va. Code R. § 11-14-3 Registration for Inactive and Retired West Virginia Physicians and Physician Assistants to Practice in West Virginia During Declared State of Emergency

3.1. In the event of an emergency declared by the Governor of West Virginia, the Board shall allow an inactive and/or retired physician or physician assistant who currently holds an inactive or expired status West Virginia medical license or physician assistant license to provide medical care in West Virginia under special provisions during the period of the declared emergency, subject to such limitations and conditions as the Governor may prescribe. To be eligible to practice pursuant to this rule, the physician or physician assistant must register with the Board.

3.2. To be eligible for registration to practice under this section, the physician or physician assistant must:

3.2.1. Have had an active clinical practice within the last five years;

3.2.2. No longer hold an active status medical or physician assistant license in any state;

3.2.3. Not have surrendered a medical license or physician assistant license while under investigation or had a license revoked in any jurisdiction, unless the revocation was subsequently withdrawn or overturned; and

3.2.4. Have been in good standing at the time the physician’s West Virginia medical license or the physician assistant’s West Virginia physician assistant license became inactive or expired.

3.3. The physician or physician assistant shall submit to the Board the following information on a form provided by the Board:

3.3.1. Verification that the inactive or retired West Virginia physician or physician assistant is not the subject of a pending or active complaint, investigation, Consent Order, Board Order or pending disciplinary proceeding in any jurisdiction;

3.3.2. Verification that the physician or physician assistant has not surrendered a license while under investigation or had a license revoked in any jurisdiction, unless the revocation was subsequently withdrawn or overturned;

3.3.3. Date of birth and current contact information, including home address and valid email address; and

3.3.4. Current federal or state photo identification, i.e., driver license or passport.

3.4. Registration with the Board does not require the payment of any fee.

3.5. An Emergency registration issued to a retired or inactive physician or physician assistant shall expire sixty days after issuance or five business days after a declared state of emergency terminates, whichever is sooner. Thereafter, the emergency registrant must hold an active West Virginia license or interstate telehealth registration to practice medicine and surgery to patients in West Virginia.

W. Va. Code R. § 11-14-4 Required Records

4.1. The Board shall provide each physician and physician assistant registered to practice during a declared state of emergency written verification of registration and registration expiration via email.

4.2. The Board shall maintain a list of each physician and physician assistant who is registered to practice in West Virginia during a declared state of emergency pursuant to the provisions of this rule.

W. Va. Code R. § 11-14-5 Professional Conduct, Authorization Denial, Complaint and Disciplinary Procedures

5.1. The Board shall deny a registration to practice during a declared state of emergency to any physician or physician assistant who is ineligible based upon the criteria set forth in this rule or additional criteria established by the Governor during the declared state of emergency.

5.2. A physician or physician assistant who is registered to practice pursuant to this rule is required to meet the professional conduct standards and requirements required of licensed physicians and licensed physician assistants in West Virginia.

5.3. A physician assistant who is registered to practice pursuant to this rule must practice pursuant to an active Practice Notification pursuant to W. Va. Code § 30-3E-1 et seq., and all applicable legislative rules.

5.4. The Board may rescind a registration granted pursuant to this rule for conduct which is equivalent to any of the grounds cited for the discipline in W. Va. Code §30-3-14(c), section 12 of the Board’s rule 11 CSR 1A, and/or section 21 of 11 CSR 1B. In its discretion, the Board may also report or refer any complaint or allegation of professional misconduct to an emergency registrant’s out of state licensing board.

Series 15 Telehealth and Interstate Telehealth Registration for Physicians, Podiatric Physicians and Physician Assistants

W. Va. Code R. § 11-15-1 General

1.1. Scope. -- This rule establishes the scope of practice for the provision of medical services via telehealth technologies and the process for allopathic physicians, podiatric physicians, and physician assistants to obtain an interstate telehealth registration with the Board.

1.2. Authority. -- W. Va. Code § 30-1-26(b).

1.3. Filing Date. -- May 9, 2022.

1.4. Effective Date. -- June 1, 2022.

1.5. Sunset Provision -- This rule shall terminate and have no further force or effect upon August 1, 2027.

W. Va. Code R. § 11-15-2 Definitions

2.1. "Board" means the West Virginia Board of Medicine, established in W. Va. Code §30-3-5.

2.2. “CSMP” means the West Virginia Controlled Substances Monitoring Program repository and database.

2.3. “Distant site” means the telehealth site where the health care practitioner is seeing the patient at a distance or consulting with a patient’s health care practitioner.

2.4. “Established patient” means a patient who has received professional services, face-to-face, from the physician, qualified health care professional, or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.

2.5. “Good standing” means a license that:

2.5.1. Is not currently revoked, suspended, or subject to a probationary period or a practice restriction or limitation;

2.5.2. Was not surrendered while under or to avoid an investigation or disciplinary action; or

2.5.3. Was not revoked, suspended, or subject to a probationary period or a practice restriction or limitation at the time the license expired, lapsed, terminated, or was cancelled.

2.6. “Health care practitioner” or “practitioner” means a physician, podiatric physician or physician assistant.

2.7. “Interstate telehealth registration” or “registration” means an authorization to practice as a physician, podiatric physician or physician assistant for the limited purpose of providing interstate telehealth services within the registrant’s scope of practice.

2.8. “Interstate telehealth registrant” or “Registrant” means a physician, podiatric physician or physician assistant issued an interstate telehealth registration by the Board.

2.9. “Interstate telehealth services” means the provision of telehealth services to a patient located in West Virginia by a health care practitioner located in any other state or commonwealth of the United States.

2.10. “Licensee” means:

2.10.1. A physician who has been granted a license to practice medicine and surgery pursuant to W. Va. Code § 30-3-1 et seq.;

2.10.2. A podiatric physician who has been granted a license to practice podiatric medicine and surgery pursuant to W. Va. Code § 30-3-1 et seq.; or

2.10.3. A physician assistant who has been granted a license by the Board to practice medicine in collaboration with physicians pursuant to W. Va. Code § 30-3E-1 et seq.

2.11. ”Originating site” means the location where the patient is located, whether or not accompanied by a health care practitioner, at the time services are provided by a health care practitioner through telehealth, including, but not limited to, a health care practitioner’s office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient’s home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

2.12. “Professional license” means a license to practice medicine, podiatric medicine or as a physician assistant in any state or commonwealth of the United States.

2.13. “Telehealth services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls by a health care practitioner to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include internet questionnaires, email messages, or facsimile transmissions.

2.14. “Telehealth provider” means a licensee or registrant who provides health care services using telemedicine technologies to patients in West Virginia.

2.15. “Telemedicine technologies” means technologies and devices which enable secure communications and information exchange in the practice of telemedicine, and typically involve the application of secure real-time audio/video conferencing or similar secure video services, remote monitoring or store and forward digital image technology, or audio only telephone calls to provide or support health care delivery by replicating the interaction of a traditional in-person provider and a patient.

2.16. “Website” or “Board’s website” means the set of related web pages operated by or on behalf of the West Virginia Board of Medicine located at the domain name wvbom.wv.gov, or at any successor domain name published by the Board.

W. Va. Code R. § 11-15-3 Telehealth Practice Requirements

3.1. The practice of medicine and podiatric medicine occurs where the patient is located at the time health services, including telehealth services, are provided.

3.2. A health care practitioner may not provide telehealth services to patients in West Virginia unless the practitioner is:

3.2.1. Licensed by the Board; or

3.2.2. Registered with the Board pursuant to this rule or pursuant to 11 CSR 14 during a declared state of emergency.

3.3. A licensees of the Board may, within the practitioner’s scope of practice, provide telehealth services to patients located at an originating site in West Virginia from any distant site, in accord with the provisions of W. Va. Code § 30-3-13a and this rule.

3.4. A health care practitioner who is not licensed in West Virginia may provide interstate telehealth services to patients located at an originating site in West Virginia, within the practitioner’s scope of practice, if the practitioner holds an interstate telehealth registration issued by the Board or pursuant to 11 CSR 14 during a declared state of emergency.

3.5. An interstate telehealth registration does not authorize a health care practitioner:

3.5.1. To practice from a physical location or distant site within this state; or

3.5.2. To provide telehealth services to patients in this state from an international location or distant site.

3.6. A physician assistant telehealth providers may provide telehealth services within the physician assistant scope of practice in collaboration with physicians, in conformity with the practice requirements of W. Va. Code § 30-3E-1 et seq. and 11 CSR 1B.

3.7. Nothing in this section shall prohibit a West Virginia educational permit holder from providing telehealth services in conformity with the guidelines, requirements, and supervision of the physician’s graduate medical education training program.

3.8. The requirement to hold a license or interstate telehealth registration to provide telehealth services does not apply to:

3.8.1. A health care practitioner furnishing medical assistance in case of an emergency or disaster, if no charge is made for the medical assistance; or

3.8.2. An informal consultation or second opinion, at the request of a licensee. Provided, That the physician or podiatric physician requesting the opinion retains authority and responsibility for the patient’s care. § 11-15-4 Interstate Telehealth Registration Eligibility; Invalidation and Reinstatement 4.1 A health care practitioners who is not licensed in West Virginia may only provide telehealth services pursuant to this rule if the practitioner is eligible for an interstate telehealth registration.

4.2. A health care practitioner is eligible for an interstate telehealth registration issued by the Board if all of the following requirements are continuously met: 4.2.1 The practitioner holds a valid, active medical license issued by another state licensing authority or board; 4.2.2 The practitioner is licensed in good standing in all states in which the practitioner is licensed;

4.2.3. The practitioner is not the subject of an administrative complaint which is currently pending before another state licensing authority or board; and

4.2.4. The practitioner is not currently under investigation by another state licensing authority or board.

4.3. A health care practitioner may not apply for an initial registration or renew a registration unless the eligibility requirements set forth in subsection 4.2. are met.

4.4. The Board shall decline to issue or renew an interstate telehealth registration to any applicant who does not meet all eligibility requirements.

4.5. A registrant must continue to maintain eligibility at all times to continue to practice pursuant to an interstate telehealth registration.

4.6. An interstate telehealth registration issued by the Board shall invalidate upon a registrant’s loss of eligibility.

4.7. A registrant whose interstate telehealth registration is invalid due to a loss of eligibility may apply for registration reinstatement upon regaining eligibility.

4.8. A health care practitioner who is ineligible to apply for, receive or maintain an interstate telehealth registration is not automatically disqualified from or ineligible for a professional license issued by the Board.

W. Va. Code R. § 11-15-5 Interstate Telehealth Registration Application, Renewal and Expiration

5.1. An eligible health care practitioner who is not licensed in West Virginia may apply for an interstate telehealth registration with the Board.

5.2. The Board shall issue an interstate telehealth registration to a health care practitioner who:

5.2.1. Meets all eligibility requirements for an interstate telehealth registration set forth above in Section 4 of this rule; and

5.2.2. Submits a complete application for an interstate telehealth registration, including all required documentation and verifications, which is accompanied by the appropriate fee.

5.3. An application for an interstate telehealth registration shall be completed on a form provided by the Board, which is available on the Board’s website. An interstate telehealth registration application must be accompanied by payment of a nonrefundable application fee as set forth herein:

5.3.1. The initial and renewal registration fee for physicians and podiatric physicians is $175; and

5.3.2. The initial fee for physician assistants is $100 and the renewal fee is $50.

5.4. The Board will not consider an application or decide upon the issuance of an interstate telehealth registration until the complete application, including all third-party documentation and/or verification, is on file with the Board and the Board has had at least ten business days to review the application.

5.5. An applicant must provide the following information in association with an application for an interstate telehealth registration:

5.5.1. The applicant's full legal name, email address, home address, preferred mailing address and primary practice location address(es) and telephone numbers;

5.5.2. The applicant’s social security number and demographic information of the applicant, such as date of birth, sex, etc.;

5.5.3. A photograph taken within the previous twelve months which substantially resembles the applicant;

5.5.4. A copy of the applicant’s birth certificate, certificate of naturalization, or passport to be used in identifying the applicant, and verifying his or her date of birth and the appropriate spelling of his or her name;

5.5.5. The applicant’s profession, professional degree earned, date of graduation, professional school and documentation establishing the applicant’s graduation therefrom;

5.5.6. A listing of all current and former professional licenses held by the applicant and primary source verification of license to determine the applicant’s good standing of each professional license; and

5.5.7. Information concerning whether the applicant:

5.5.7.1. Has any limitations, restrictions or conditions placed upon a professional license by any licensing board;

5.5.7.2. Has had a professional license revoked, suspended or placed on probation;

5.5.7.3. Has had disciplinary action taken against a professional license in any jurisdiction; or

5.5.7.4. Is currently under investigation or subject to an administrative complaint in any jurisdiction related to professional conduct or professional licensure.

5.6. An ineligible application shall be declined. A complete application without discrepant information may be approved without presentation to the Board. Any registration application that contains discrepant information concerning the applicant may be presented to the Licensure Committee for review and recommendation to the Board.

5.7. A registrant shall maintain complete and up-to-date contact information, including a current email address, with the Board. Registrants are required to update all categories of contact information collected by the Board within 10 business days of any change to the information previously provided.

5.8. A registrant shall immediately notify the Board, in writing, of any restrictions placed on the registrant’s professional license(s) in any state or jurisdiction.

5.9. An interstate telehealth registration is valid for a period of up to one year, and automatically expires on the 31st day of March unless the applicant renews the registration.

5.10. An interstate telehealth registration may be renewed annually during the renewal period established by the Board if the registrant remains eligible and meets all of the requirements for renewal.

5.11. A registrant may renew an interstate telehealth registration issued by the Board if the registrant:

5.11.1. Meets all eligibility requirements for an interstate telehealth registration as set forth in section 4 of this rule. 5.11.2 Submits a complete application for registration renewal accompanied by the appropriate renewal fee; and

5.11.3. Certifies compliance with all continuing education requirements associated with the registrant’s current professional licenses.

5.12. The Board shall decline to renew a registration if the renewal applicant is ineligible.

5.13. The Board shall publish the renewal period and renewal application on its website and shall provide email notice of the renewal to the registrants’ email address of record with the Board. A registrant is responsible for submitting a timely renewal application.

5.14. Communications and notifications regarding the renewal process will be provided to the registrant via email. Failure of the registrant to receive or review a renewal notification does not justify the provision of interstate telehealth services after registration expiration.

5.15. If a registration automatically expires, the former registrant may apply anew. If registration is granted, the Board shall reactivate the registration and reissue the practitioner’s original registration number.

W. Va. Code R. § 11-15-6 Establishment of the Provider-Patient Relationship

6.1. Among other ways, a provider-patient relationship is formed when a provider serves a patient’s medical needs, examines, diagnoses or treats a patient, or agrees to examine, diagnose or treat a patient.

6.2. A provider-patient relationship may be established through:

6.2.1. An in-person patient encounter; 6.2.2 Store and forward telemedicine or other similar technologies for the practice of pathology and radiology;

6.2.3. Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or

6.2.4. Audio-only calls or conversations that occur in real time.

6.3. While real-time audio-only communications may be utilized to establish the provider-patient relationship, patient communication though audio-visual communication is preferable, if available or possible. Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

6.4. The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

6.5. After a provider-patient relationship has been established, a provider may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

6.6. This rule does not prohibit the use of text-based communications for:

6.6.1. Responding to call for existing patients;

6.6.2. Providing cross coverage for a provider who has established a provider-patient relationship with the patient through an in-person encounter; or

6.6.3. Providing medical assistance in the event of an emergency.

W. Va. Code R. § 11-15-7 Standard of Care, Delivery of Telehealth Services and Medical Records

7.1. A telehealth provider has the duty to practice in a manner consistent with:

7.1.1. The provider’s scope of practice;

7.1.2. The professional conduct standards established in this state for the provider’s profession; and

7.1.3. The standard of care applicable to the provider’s practice.

7.2. The standard of care for the provision of health care services is the same for health care services provided in-person and health care services provided via telemedicine technologies.

7.3. A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation. Treatment, including issuing a prescription, based solely on an online questionnaire, does not conform to the standard of care.

7.4. Nothing in this rule requires a practitioner to use telemedicine technologies to treat a patient if the practitioner, in his or her discretion determines that an in-person encounter is required.

7.5. With the exception of the practice of pathology and radiology, a telehealth provider shall:

7.5.1. Verify the identify and location of the patient;

7.5.2. Provide the patient with confirmation of the identity and professional qualifications of the telehealth provider;

7.5.3. Provide the patient with the physical location and contact information for the telehealth provider;

7.5.4. Establish or maintain a provider-patient relationship that conforms to the scope of practice, professional conduct standards, and standard of care;

7.5.5. Determine whether telemedicine technologies are appropriate for the patient’s presentation of a specific health issue;

7.5.6. Obtain the patient’s consent to receive telehealth services;

7.5.7. Conduct all appropriate evaluations and history of the patient consistent with the standard of care for in-person treatment of the patient’s health condition; and

7.5.8. Create and maintain health care records for the patient which justify the course of treatment, and which verify compliance with the requirements of this section.

7.6. It is the standard of care in this state for health care practitioners to complete an appropriate controlled substance prescribing course prior to prescribing controlled substances to patients located in West Virginia. The Board maintains a list of Board-approved courses in drug diversion training and best practice prescribing controlled substances training on its website. Registrants may comply with the standard of care by completing a Board-approved course or a controlled substance continuing education course required by the registrant’s state of licensure.

7.7. A telehealth provider shall maintain a patient medical record for each patient for whom telehealth services are provided. The patient record shall be accessible to the provider and the patient and maintained consistent with the laws and legislative rules governing patient health care records. All laws governing the confidentiality of health care information and governing patient access to medical records shall apply to records of telehealth encounters.

7.8. A telehealth provider solely providing services using telemedicine technologies shall make a patient’s medical record easily available to the patient, and subject to the patient’s consent, to any identified care provider of the patient.

7.9. Upon request of the Board, a telehealth provider shall provide the Board with the identify of, and address for, the custodian of records of any company, service, platform or entity through which the telehealth provider practices to patients at originating sites in West Virginia.

W. Va. Code R. § 11-15-8 Prescribing Authority and Limitations

8.1. When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in this state.

8.2. A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances, which are authorized by W. Va. Code § 30-3-13a:

8.2.1. The patient is an established patient of the prescribing telehealth provider’s group practice;

8.2.2. The provider submits an order to dispense a Schedule II controlled substance to a hospital patient, other than in the emergency department, for immediate administration in a hospital; or

8.2.3. The telehealth provider is treating patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The provider must maintain records supporting the diagnosis and the continued need of treatment.

8.3. A telehealth provider who prescribes any medication listed in Schedules II though V of the Uniform Controlled Substance Act pursuant to a telehealth encounter with a patient at an originating site in West Virginia shall:

8.3.1. Obtain and maintain online or other electronic access to the CSMP;

8.3.2. Comply with all preconditions to prescribing identified in W. Va. Code § 60A-9-5a and the requirements set forth in 11 CSR 10;

8.3.3. Maintain a record of the controlled substance prescribed and the diagnosis or basis for the prescription in the patient medical record;

8.3.4. Comply with all prescribing protocols and prescribing limitations established in the Opioid Reduction Act, W. Va. Code § 16-54-1 et seq; and

8.3.5. Comply with all state and federal laws which govern the prescribing of controlled substances.

8.4. A telehealth provider may not prescribe any drug with the intent of causing an abortion.

W. Va. Code R. § 11-15-9 Complaint and Disciplinary Procedures for Interstate Telehealth Registrants

9.1. By registering with the Board to provide interstate telehealth services to patients in this state, a health care practitioner is subject to:

9.1.1. All state laws regarding the registrant’s profession in this state;

9.1.2. The state judicial system;

9.1.3. All professional conduct rules and standards incorporated into the West Virginia Medical Practice Act and/or West Virginia Physician Assistants Practice Act and the Board’s legislative rules; and

9.1.4. The jurisdiction of the Board, including the Board’s complaint, investigation, and hearing process.

9.2. In circumstances where a registration is not declined or invalidated due to uncontested ineligibility, the complaint and disciplinary process and procedures, and appeal rights set forth in the contested case hearing procedure, W. Va. Code §29A-5-1 et seq., W. Va. Code §30-3-14(h) and (i), and in the Board’s procedural rule, 11 CSR 3, Board Organization and Meeting Procedure; Complaint and Contested Case Hearing Procedure, also apply to interstate telehealth registrants.

W. Va. Code R. § 11-15-10 Registration Denial, Professional Conduct, and Discipline

10.1. The Board shall deny an application for an interstate telehealth registration, or a registration renewal, to any applicant who is ineligible based upon the criteria set forth in W. Va. Code § 30-1-26 or section 4 of this rule.

10.2. In circumstances where a registration is not declined or invalidated due to ineligibility, the Board may discipline a health care practitioner registered by the Board who, after a hearing, has been adjudged by the Board as unqualified due to any of the following reasons:

10.2.1. Conduct by a registrant which is equivalent to any of the grounds cited for the discipline in W. Va. Code § 30-3-14(c) § 30-3E-17(b), section 12 of 11 CSR 1A, or section 21 of 11 CSR 1B, which apply equally to registrants or applicants as they do to licensees; or

10.2.2. Failure to comply with any provision of this rule, the provisions of W. Va. Code § 30-1-16, or § 30-3-13a; and/or

10.2.3. Failure to immediately notify the Board of any restrictions placed on the registrant’s professional license in any state or jurisdiction.

10.3. If the Board determines that an eligible registrant is otherwise unqualified, the Board may enter an order imposing any limitation, restriction or other disciplinary measure set forth in W. Va. Code § 30-3-14(j) and/or 11 CSR 1A.

10.4. In addition to the complaint, investigation and disciplinary processes available in this state, the Board may elect to report or refer any complaint or allegation of professional misconduct by a registrant to the registrant’s professional licensing boards.

W. Va. Code R. § 11-15-11 Required Records

11.1. The Board shall provide each interstate telehealth practitioner registered written verification of registration and registration expiration via email.

11.2. The Board shall maintain a list of all practitioners who are registered with the Board as interstate telehealth practitioners and shall publish the following information for each registrant on its website:

11.2.1. Full name;

11.2.2. Health profession;

11.2.3. Registration date;

11.2.4. Registration status;

11.2.5. Registrant-reported education;

11.2.6. States of licensure;

11.2.7. Primary practice address or preferred contact address; and

11.2.8. Any disciplinary action taken by the Board.

Series 16 Prohibiting Sexual Misconduct by Health Care Practitioners

W. Va. Code R. § 11-16-1 General

1.1. Scope. -- This rule establishes the definition of sexual misconduct and identifies sexual misconduct, for which an application may be denied and/or a license or other authorization to practice may be subject to disciplinary action.

1.2. Authority. -- W. Va. Code §§ 30-3-7(a)(1) and 30-3-14(u).

1.3. Filing Date. – May 10, 2023.

1.4. Effective Date. – June 1, 2023.

1.5. Sunset Provision -- This rule shall terminate and have no further force or effect upon August 1, 2028.

W. Va. Code R. § 11-16-2 Definitions

2.1. “Chaperone” means a third person who, with the patient’s consent, is present during a medical examination.

2.2. “Health care practitioner” or “practitioner” means:

2.2.1. A physician, podiatric physician or physician assistant who holds any practice credential issued by the Board; or

2.2.2. An applicant for any practice credential issued by the Board.

2.3. “Health care services” means any examination, treatment, evaluation, or other medical care rendered by a practitioner pursuant to a practice credential.

2.4. “Patient” means a person for whom a practitioner is providing, has provided, or is scheduled to provide health care services. The fact that a person is not actively receiving treatment or professional services from a practitioner is not determinative of a person’s status as a patient. Once a practitioner-patient relationship is established, a person is presumed to remain a patient until the practitioner-patient relationship is terminated.

2.5. “Practice credential” means a license, permit, registration, or other authorization to practice a health profession.

2.6. “Sexual contact” includes, but is not limited to:

2.6.1. Performing an examination of the patient’s pelvic area, genitals, breasts, rectum, or prostate without clinical justification;

2.6.2. Touching any body part that has sexual connotation for the practitioner or patient, for any purpose other than appropriate and legitimate health care services, or where the patient has refused or has withdrawn consent; and

2.6.3. Examining or touching a patient’s genitals without the use of gloves.

2.7. “Sexual impropriety” means practitioner conduct that is seductive, sexually suggestive, disrespectful of patient privacy, or sexually harassing or demeaning including but not limited to:

2.7.1. Soliciting or accepting a date or romantic relationship with a patient or surrogate;

2.7.2. Making comments that are not clinically relevant about or to the patient, including but not limited to, making sexual comments about a patient’s body or underclothing, making sexualized or sexually demeaning comments to a patient, or making comments about potential sexual performance; 2.7.3 Requesting details of the patient’s sexual history, sexual problems, sexual preferences, or sexual fantasies when not clinically indicated for the type of health care services;

2.7.4. Participation by the practitioner in conversation regarding the sexual problems, sexual preferences, or sexual fantasies of the practitioner;

2.7.5. Any verbal, written or electronic communication between the practitioner and patient or surrogate which are of a sexual nature, including sexually suggestive or explicit images, messages, or videos;

2.7.6. Sexual harassment, including but not limited to the following practitioner conduct towards patients, surrogates, or other persons the practitioner encounters during the course of the practitioner’s professional practice:

2.7.6.a. Unwelcome sexual advances;

2.7.6.b. Requests for sexual favors; and

2.7.6.c. Other verbal or physical conduct of a sexual nature.

2.7.7. Failing to employ disrobing or draping practices which respect the patient’s privacy;

2.7.8. If a patient requests a chaperone, failing to provide a chaperone in the examining room during an examination of the pelvic area, genitals, breasts, rectum, or prostate; and

2.7.9. Subjecting a patient to an intimate examination in the presence of a third party, other than a chaperone, without the patient’s consent.

2.7.10. Conduct that is sexually demeaning to a patient or which demonstrates a lack of respect for the patient’s privacy.

2.8. “Sexual interaction” means conduct between a practitioner and patient or surrogate, whether or not initiated by, consented to, or participated in by the patient or surrogate, that is sexual or may be reasonably interpreted as sexual, including but not limited to, the following:

2.8.1. Any physical contact intended to provide sexual gratification or sexual stimulation to the practitioner or the patient or surrogate;

2.8.2. Kissing in a romantic or sexual manner; and

2.8.3. Offering to provide any health care services, including but not limited to prescribing medication, in exchange for sexual favors.

2.9. “Sexual misconduct” means:

2.9.1. Conduct that exploits the practitioner-patient relationship in a sexual way, whether verbal or physical, and may include the expression of thoughts, feelings or gestures that are sexual or romantic, or that reasonably may be construed as sexual or romantic;

2.9.2. Sexual contact with a patient;

2.9.3. Sexual interaction with a patient or surrogate; and

2.9.4. Sexual impropriety with a patient, surrogate, or another person the practitioner encounters during the course of the practitioner’s professional practice.

2.10. “Surrogate” means a key third party closely involved in a patient’s medical decision making and care, including but not limited to the patient’s spouse or partner, family member, legal representative, proxy, or guardian.

W. Va. Code R. § 11-16-3 Sexual Misconduct With A Patient

3.1. Practitioners are prohibited from engaging in sexual misconduct with a patient.

3.2. Sexual misconduct with a patient constitutes dishonorable, unethical, and unprofessional conduct.

3.3. Sexual misconduct with a patient involving sexual contact or sexual interaction constitutes gross misconduct.

3.4. Patient consent, participation in, or initiation of sexual contact, sexual interaction or sexual impropriety with a practitioner may not be used by the practitioner as defense to charges of practitioner sexual misconduct or as mitigation of professional misconduct.

W. Va. Code R. § 11-16-4 Sexual Misconduct With A Surrogate

4.1. Practitioners are prohibited from engaging in sexual misconduct with a surrogate.

4.2. It is not sexual misconduct for a practitioner to participate in a romantic or sexual relationship with a surrogate if:

4.2.1. The practitioner-patient relationship has terminated;

4.2.2. The surrogate no longer serves as a surrogate for the patient; or

4.2.3. Objective evidence exists for a reasonable practitioner to conclude that a romantic or sexual relationship between the practitioner and surrogate:

4.2.3.a. Would not exploit trust, knowledge, influence, or emotions derived from a practitioner’s professional relationship with the surrogate;

4.2.3.b. Would not compromise or have an adverse effect on the patient’s care; and

4.2.3.c. The surrogate’s decisions and participation in the patient’s health care do not directly affect the health and welfare of the patient.

4.3. Sexual misconduct with a surrogate constitutes dishonorable, unethical, and unprofessional conduct.

4.4. Surrogate consent, participation or initiation may not be used by a practitioner as defense to charges of practitioner sexual misconduct or as mitigation of professional misconduct.

W. Va. Code R. § 11-16-5 Sexual Misconduct With A Former Patient

5.1. A romantic or sexual relationship between a practitioner and a former patient after termination of the practitioner-patient relationship constitutes sexual misconduct if:

5.1.1. The relationship is, at least in part, a result of the exploitation of trust, knowledge, emotions or influence derived from the previous professional relationship or if the relationship would otherwise foreseeably harm the former patient;

5.1.2. The relationship occurs within 90 days of the termination of the practitioner-patient relationship; or

5.1.3. The practitioner provided psychiatric or mental health services to the patient and the conduct is in violation of the code of ethics of the American Psychiatric Association as set forth in American Psychiatric Association's Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry.

5.2. It is sexual misconduct for a practitioner to engage in sexual contact, sexual interactions, or sexual impropriety with a former patient within 90 days of the termination of the practitioner-patient relationship.

5.3. Sexual misconduct with a former patient as set forth in this section constitutes dishonorable, unethical, and unprofessional conduct.

5.4. Consent, participation, or initiation by a former patient may not be used by a practitioner as defense to charges of practitioner sexual misconduct or as mitigation of professional misconduct.

W. Va. Code R. § 11-16-6 Other Practitioner Sexual Misconduct

6.1. Sexual relationships between practitioners who supervise health care practitioners in training and trainees currently under their supervision are unethical and constitute practitioner sexual misconduct. Trainee consent is not a defense to charges of professional misconduct.

6.2. Engaging in sexual impropriety, including sexual harassment, in the practice of a health profession or in a practitioner’s work environment is unethical, may disrupt patient care, and constitutes sexual misconduct.

6.3. Sexual misconduct with respect to trainees and other individuals a practitioner encounters during the course of the practitioner’s professional practice as set forth in this section constitutes dishonorable, unethical, and unprofessional conduct.

W. Va. Code R. § 11-16-7 Exceptions

7.1. A practitioner’s failure to provide for appropriate draping, include chaperones for certain examinations, exclude third parties from examinations absent patient consent, or to wear required personal protective equipment while conducting intimate examinations shall not constitute sexual misconduct if:

7.1.1. The conduct occurred while the practitioner rendered clinically necessary health care services to the patient in an emergency;

7.1.2. The patient’s clinical condition required immediate action; and

7.1.3. The patient was unconscious or otherwise unable to provide consent for the healthcare services and the practitioner’s conduct conformed to the standard of care for the patient presentation in an emergency setting.

W. Va. Code R. § 11-16-8 Disciplinary Action

8.1. Practitioners who engage in sexual misconduct or other violations of the professional conduct standards set forth in this rule shall be subject to license or other credential denial proceedings or disciplinary action pursuant to the processes, standards and penalties set forth in the West Virginia Medical Practice Act, W. Va. Code § 30-3-1 et seq., the West Virginia Physician Assistants Practice Act, W. Va. Code § 30-3E-1 et seq., and W. Va. Code R. § 11-1A-12.

W. Va. Code R. § 11-16-9 Required Reporting

9.1. Any person who holds a practice credential issued by the Board shall submit a written report to the Board in conformity with the provisions of W. Va. Code § 30-3-14(b)(5) if he or she reasonably believes that a person licensed or otherwise authorized to practice by the Board has:

9.1.1. Exercised influence within a provider-physician relationship for the purpose of engaging a patient in sexual activity; or

9.1.2. Engaged in other sexual misconduct with a patient.

Provided, that a person does not have an individual obligation to submit a report if the person’s knowledge is gained solely through participation on a medical staff committee tasked with investigation and other peer review activities. This exception does not relieve any institutional obligations to comply with the provisions of W. Va. Code §§ 30-3-14(b)(2) or (3).