Establishes "Graduate Physician Licensing Act."

A2114

ASSEMBLY, No. 2114

STATE OF NEW JERSEY

222nd LEGISLATURE

�

PRE-FILED FOR INTRODUCTION IN THE 2026 SESSION

Sponsored by:

Assemblywoman LINDA S. CARTER

District 22 (Somerset and Union)

Assemblywoman VERLINA REYNOLDS-JACKSON

District 15 (Hunterdon and Mercer)

Co-Sponsored by:

Assemblyman Sampson, Assemblywomen Speight and Haider

SYNOPSIS

���� Establishes "Graduate Physician Licensing
Act."

CURRENT VERSION OF TEXT

���� Introduced Pending Technical Review by Legislative
Counsel.

��

An Act
concerning graduate physicians, supplementing Title 45
of the Revised Statutes, P.L.1997, c.192 (C.26:2S-1 et seq.), and Title 30 and
Title 52 of the Revised Statutes, and amending P.L.2009, c.307 and P.L.2017,
c.28.

����
Be It
Enacted
by the Senate and General Assembly of
the State of New Jersey:

���� 1.��� (New section) This act
shall be known and may be cited as the �Graduate Physician Licensing Act.�

���� 2.��� (New section) As used in
this act:

���� "Board" means the
State Board of Medical Examiners created pursuant to R.S.45:9-1.

���� "Collaborating
physician" means a physician who enters a collaborative practice
arrangement with a graduate physician and who assumes responsibility for the
oversight of the activities and the primary care services rendered by a
graduate physician.

���� �Collaborative practice
arrangement� means an agreement between a physician and a graduate physician
established pursuant to the requirements of section 6 of this act.

���� �Graduate physician� means a
health professional who meets the qualifications under this act and holds a
current, valid license pursuant to this act.

���� �Medically underserved area�
means an area in this State with a medically underserved population; an area in
this State designated by the United States Secretary of Health and Human
Services as an area with a shortage of personal health services; a population
group designated by the United States Secretary of Health and Human Services as
having a shortage of personal health services; an area designated under State
or federal law as a medically underserved community; or an area that the
Department of Health considers to be medically underserved based on relevant
demographic, geographic, and environmental factors.

���� �Physician� means a person
fully licensed to practice medicine and surgery pursuant to chapter 9 of Title
45 of the Revised Statutes.

���� �Primary care� means physician
services in family practice, internal medicine, or pediatrics.

���� 3.��� (New section) a.� The
State Board of Medical Examiners shall issue a license as a graduate physician
to an applicant who has fulfilled the following requirements:

���� (1)�� is at least 18 years of
age;

���� (2)�� is a graduate of a
medical school accredited by the Liaison Committee on Medical Education, the
Commission on Osteopathic College Accreditation, or a medical school listed in
the International Medical Education Directory or its equivalent;

���� (3) has completed one year of
clinical practice hours;

���� (4)

has
successfully completed Step 2 of the United States Medical Licensing
Examination, Level 2 of the Comprehensive Osteopathic Medical Licensing
Examination, or the equivalent of such step of any other board-approved medical
licensing examination;

���� (5)�� has not completed an
approved postgraduate residency;

���� (6)�� has never been
convicted, received adjudication, deferred adjudication, community supervision,
or deferred disposition for any criminal offense by a court of appropriate
jurisdiction;

���� (7)�� has never held a license
authorizing the practice of medicine that was subjected to discipline by a
licensing agency in any state, federal, or foreign jurisdiction, excluding any
action related to non-payment of fees related to a license;

���� (8)�� has never had a
controlled dangerous substance license or permit suspended or revoked by a
state or the United States Drug Enforcement Administration; and

���� (9)�� is not under active
investigation for wrongdoing by a licensing agency or law enforcement authority
in any state, federal, or foreign jurisdiction.

���� b.��� In addition to the
requirements of subsection a. of this section, an applicant for renewal of a
license as a graduate physician shall:

���� (1)�� execute and submit a
sworn statement made on a form provided by the board that neither the license
for which renewal is sought nor any similar license or other authority issued
by another jurisdiction has been revoked or suspended; and

���� (2)�� present satisfactory
evidence that any continuing education requirements have been completed as
required by this act.

���� c.���� A graduate physician
shall not be required to complete more hours of continuing education than are
required of a physician.

���� d.��� The board may accept, in
lieu of the requirements of subsection a. of this section, proof that an
applicant for licensure holds a current graduate physician license in a state
which has standards substantially equivalent to those of this State.

���� e.���� The board may deny an
application for issuance or renewal of a graduate physician license and the
licensure of a graduate physician may be revoked in the same manner as is
provided for denial or revocation of a physician license based on a violation
of any standards prescribed by State law or by the board for physicians for
which the violation merits denial or revocation of a physician license.

���� 4.��� (New section) a. �(1)�
No person shall practice as a graduate physician or present, call, or represent
himself as a graduate physician unless that person is licensed pursuant to
section 3 of this act.

���� (2)�� Nothing in this act
shall be construed to limit, preclude, or otherwise interfere with the practice
of any person licensed by an appropriate agency of the State of New Jersey,
provided that such duties are consistent with the accepted standards of the person�s
profession and the person does not present himself a graduate physician.

���� b.��� No person shall assume,
represent himself as, or use the title or designation "graduate physician�
or any other title or designation which indicates or implies that he is a
graduate physician unless that person is licensed pursuant to this act.

���� c.���� A graduate physician
shall clearly identify himself as a graduate physician. �A graduate physician
may represent himself as or use the titles or designations of �doctor�, �Dr.�,
or �doc.�

���� 5.��� (New section) a.� A graduate
physician may practice as a graduate physician provided that:

���� (1)�� the practice of the graduate
physician is limited to the provision of primary care services in medically
underserved areas of the State, and to procedures that are delegated to the graduate
physician by a collaborating physician, as authorized under the terms of the
collaborative practice arrangement;

���� (2)�� the graduate physician
conspicuously wears an identification tag using the term "graduate physician"
whenever acting in that capacity; and

���� (3)�� any entry by a graduate physician
in a clinical record is appropriately signed and followed by the designation,
"GP".

���� b.��� A graduate physician
shall not practice or attempt to practice without a collaborative practice
arrangement, except in an emergency situation.

���� c.���� Any graduate physician
who practices in violation of any of the conditions specified in this section
shall be deemed to have engaged in professional misconduct.

���� 6.��� (New section) a.� A
physician who supervises a graduate physician may maintain a written
collaborative practice arrangement with the graduate physician. A graduate physician
shall sign a separate written agreement with each physician who delegates the
authority to administer or prescribe medications and controlled dangerous
substances and provide treatment.� The delivery of health care services by a
graduate physician shall not exceed the scope of practice of the graduate physician
and shall be consistent with that graduate physician's skill, training, and
competence and the skill and training of the collaborating physician.� Each
collaborative practice arrangement shall:

���� (1)�� state that the
collaborating physician will exercise supervision over the graduate physician
in accordance with the provisions of this act and any rules adopted by the
board;

���� (2)�� contain complete names,
home and business addresses, zip codes, and telephone numbers of the
collaborating physician and the graduate physician;

���� (3)�� list all other offices
or locations besides those listed in paragraph (2) of this subsection where the
collaborating physician authorizes the graduate physician to practice;

���� (4)�� contain a requirement
that a prominently displayed disclosure statement, informing patients that they
may be seen by a graduate physician and have the right to see the collaborating
physician, be posted at every office where the graduate physician is authorized
to practice in collaboration with a physician;

���� (5)�� list all specialty or
board certifications of the collaborating physician and all certifications of
the graduate physician;

���� (6)�� state the manner of
collaboration between the collaborating physician and the graduate physician,
including the manner in which the collaborating physician and the graduate physician
shall engage in collaborative practice consistent with each professional�s
skill, training, education, and competence; and

���� (b)�� provide for alternative
coverage during absence, incapacity, or infirmity or an emergency;

���� (7)�� provide a description of
the graduate physician�s prescriptive authority in collaboration with the
collaborating physician, including a list of the controlled dangerous
substances the collaborating physician authorizes the graduate physician to
prescribe, whether the graduate physician will be authorized to authorize
qualifying patients for the medical use of cannabis and issue written
instructions for medical cannabis pursuant to P.L.2009, c.307 (C.24:6I-1 et
al.), and documentation that the graduate physician�s prescriptive authority is
consistent with each professional�s education, knowledge, skill, and
competence;

���� (8)�� contain a list of all
other written practice agreements of the collaborating physician and the graduate
physician;

���� (9)�� provide a description of
the time and manner of the collaborating physician�s review of the graduate physician�s
delivery of health care services, including requiring the graduate physician to
submit a minimum of 10 percent of the charts documenting the graduate physician�s
delivery of health care services to the collaborating physician for review by
the collaborating physician or any other physician designated in the
collaborative practice arrangement, every 14 days;

���� (10)� require that the
collaborating physician, or any other physician designated in the collaborative
practice arrangement, review every 14 days a minimum of 20 percent of the
charts in which the graduate physician prescribes controlled dangerous
substances, which charts reviewed under this paragraph may be counted in the
number of charts required to be reviewed under paragraph (9) of this
subsection;

���� (11)� state the duration of
the written practice agreement between the collaborating physician and the graduate
physician;

���� (12)� be signed and dated
annually by the physician and the graduate physician, and updated as necessary
to reflect any changes in the practice or the graduate physician�s role in the
practice; and

���� (13)� be kept on file at the
practice site.

���� b.��� The collaborating
physician shall be responsible at all times for the oversight of the activities
of, and shall accept responsibility for primary care services rendered by, the graduate
physician.

���� c.���� The collaborating
physician shall determine and document the completion of at least a one-month
period of time during which the graduate physician practices in a setting in
which the collaborating physician is continuously present before practicing
when the collaborating physician is not continuously present.

���� d.��� A collaborating
physician shall not enter into a collaborative practice arrangement with more
than six full-time equivalent graduate physicians, full-time equivalent
physician assistants, or full-time equivalent advanced practice nurses, or any
combination thereof.

���� e.���� A collaborating
physician and the graduate physician in a collaborative practice arrangement
shall wear identification badges while acting within the scope of their
collaborative practice arrangement.� The identification badges shall
prominently display the licensure status of the collaborating physician and graduate
physician.

���� f.���� No agreement made under
this section shall supersede current hospital licensing regulations governing
hospital medication orders under protocols or standing orders for the purpose
of delivering inpatient or emergency care within a hospital if such protocols
or standing orders have been approved by the hospital�s medical staff and
pharmaceutical therapeutics committee.

���� 7.��� (New section) a.� The
State Board of Medical Examiners shall promulgate rules and regulations,
pursuant to the �Administrative Procedure Act,� P.L.1968, c.410 (C.52:14B-1 et
seq.), concerning the following:

���� (1)�� licensure and license
renewal procedures for graduate physicians;

���� (2)�� collaborating physician
supervision and collaborative practice arrangements;

���� (3)�� the establishment of
licensing fees; and

���� (4)�� any other matter that
may be necessary to protect the public and discipline the profession.

���� b.��� The board shall
promulgate rules concerning the use of collaborative practice arrangements
established pursuant to this act.� Such rules shall specify:

���� (1)�� geographic areas to be
covered;

���� (2)�� the methods of treatment
that may be covered by a graduate physician collaborative practice arrangement;

���� (3)�� in conjunction with
deans of medical schools and primary care residency program directors in the
State, the development and implementation of educational methods and programs
undertaken during the collaborative practice service which shall facilitate the
advancement of the graduate physician's medical knowledge and capabilities, and
which may lead to credit toward a future residency program for programs that
deem such documented educational achievements acceptable; and

���� (4)�� the requirements for
review of services provided under a collaborative practice arrangement,
including delegating authority to prescribe medications and controlled dangerous
substances.

���� b.��� Any rules relating to the
dispensing or distribution of medications or devices by prescription or
prescription drug orders under this section shall be subject to the approval of
the New Jersey State Board of Pharmacy.� Any rules relating to the dispensing
or distribution of controlled dangerous substances by prescription or
prescription drug orders under this section shall be subject to the approval of
the Department of Health and the New Jersey State Board of Pharmacy.� The board
shall promulgate rules applicable to graduate physicians that shall be
consistent with guidelines for federally funded clinics.

���� c.���� The board shall not
promulgate rules that require the collaborating physician to review more than
10 percent of the graduate physician�s patient charts or records during the
one-month period provided by subsection c. of section 6 of this act.

���� d.��� The board shall not
deny, revoke, suspend, or otherwise take disciplinary action against a
collaborating physician for health care services delegated to a graduate physician
pursuant to the provisions of this section, provided that the rules promulgated
pursuant to this section are satisfied.

���� e.���� Within 30 days of any
change to, and upon each renewal of, a collaborative practice arrangement and
upon licensure renewal, the board shall require each physician to identify
whether the physician is engaged in any collaborative practice arrangement, including
collaborative practice arrangements delegating the authority to prescribe
controlled dangerous substances, and also report to the board the name of each graduate
physician with whom the physician has entered into such arrangement.� The board
may make such information available to the public.� The board shall track the
reported information and may routinely conduct random reviews of such
arrangements to ensure that arrangements are carried out for compliance under
this act.

���� 8.��� (New section) a.� A graduate
physician with a certificate of controlled dangerous substance prescriptive
authority as provided pursuant to this act may prescribe any controlled dangerous
substance listed in Schedule III, IV, or V, may have restricted authority to
prescribe controlled dangerous substances listed in Schedule II, and may
authorize qualifying patients for medical cannabis and issue written
instructions for medical cannabis to registered qualifying patients pursuant to
P.L.2009, c.307 (C.24:6I-1 et al.). Prescriptions for Schedule II controlled dangerous
substances prescribed by a graduate physician who has a certificate of
controlled dangerous substance prescriptive authority shall be restricted to
only those medications containing hydrocodone.� A graduate physician may
prescribe and dispense narcotic drugs for maintenance treatment or
detoxification treatment if the graduate physician has met the training and
registration requirements set forth in subsection (g) of 21 U.S.C. s.823 and
the collaborative practice arrangement expressly authorizes the graduate
physician to prescribe and dispense narcotic drugs for maintenance treatment or
detoxification treatment.� Authorizations to prescribe controlled dangerous
substances under this subsection, authorize qualifying patients for medical
cannabis, and issue written instructions for medical cannabis shall be filed
with the State Board of Medical Examiners.�

���� b.��� The collaborating
physician shall maintain the right to limit a specific scheduled drug or
scheduled drug category that the graduate physician may be permitted to
prescribe or otherwise authorize.� Any limitations shall be listed in the
collaborative practice arrangement.�

���� c.���� A graduate physician
shall not prescribe controlled dangerous substances for himself or members of
the graduate physician�s family.�

���� d.��� Prescriptions for Schedule
III controlled dangerous substances and Schedule II medications containing hydrocodone
shall be limited to a five-day supply without refill, except that buprenorphine
may be prescribed for up to a 30-day supply without refill for patients
receiving medication-assisted treatment for substance use disorders under the
direction of the collaborating physician.�

���� e.���� A graduate physician
may authorize qualifying patients for the medical use of cannabis and issue
written instructions for medical cannabis to registered qualifying patients,
subject to the following conditions:

���� (1)�� the collaborating
physician has authorized the graduate physician to authorize qualifying
patients for the medical use of cannabis and issue written instructions for
medical cannabis;

���� (2)�� the graduate physician
signs the graduate physician�s own name to the authorization or written
instruction and prints the graduate physician�s name and certification number;

���� (3)�� the authorization or
written instruction is dated and includes the name of the qualifying patient
and the name, address, and telephone number of the collaborating physician;

���� (4)�� prior to issuing written
instructions for medical cannabis, the graduate physician verifies the patient
is a registered qualifying patient; and

���� (5)�� the graduate physician
complies with the requirements for authorizing qualifying patients for the
medical use of cannabis and for issuing written instructions for medical
cannabis established pursuant to P.L.2009, c.307 (C.24:6I-1 et al.).

���� f.���� A graduate physician
who is authorized to prescribe controlled dangerous substances or issue written
instructions for medical cannabis under this section shall register with the
federal Drug Enforcement Administration and any other appropriate State and
federal agencies, and shall include the graduate physician�s Drug Enforcement
Administration registration number on prescriptions for controlled dangerous
substances and on written instructions for medical cannabis.

���� g.��� A collaborating
physician shall determine and document the completion of at least 120 hours in
a four-month period by the graduate physician during which the graduate physician
shall practice with the collaborating physician on-site prior to prescribing
controlled dangerous substances, authorizing qualifying patients for medical
cannabis, and issuing written instructions for medical cannabis when the
collaborating physician is not on-site.�

���� 9.��� (New section) a.� No
contract or other agreement shall require a physician to act as a collaborating
physician for a graduate physician against the physician's will.� A physician
shall have the right to refuse to act as a collaborating physician, without
penalty, for a particular graduate physician.� No contract or other agreement
shall limit the collaborating physician's ultimate authority over any protocols
or standing orders or in the delegation of the physician's authority to any graduate
physician, but such requirement shall not authorize a physician in implementing
such protocols, standing orders, or delegation to violate applicable standards
for safe medical practice.

���� b.��� No contract or other
agreement shall require any graduate physician to serve as a collaborating graduate
physician for any collaborating physician against the graduate physician's
will.� A graduate physician shall have the right to refuse to collaborate,
without penalty, with a particular physician.

���� c.���� Nothing contained in
this act shall be construed to limit the authority of hospitals or hospital
medical staff to make employment, credentialing, or privileging decisions.

���� 10.� (New section) Each
carrier that offers a health benefits plan in this State shall reimburse a graduate
physician for the diagnosis, consultation, or treatment of a patient enrolled
in the plan on the same basis that the carrier reimburses the service when it
is delivered by another comparable mid-level health care provider, including,
but not limited to, a physician assistant.

���� 11.� (New section) Subject to
the receipt of any necessary federal approvals or waivers, the Division of
Medical Assistance and Health Services in the Department of Human Services
shall ensure that the State Medicaid and NJ FamilyCare programs reimburse a graduate
physician for the diagnosis, consultation, or treatment of a Medicaid or NJ
FamilyCare enrollee on the same basis that the programs reimburse the service
when it is delivered by another comparable mid-level health care provider,
including, but not limited to, a physician assistant.

���� 12.� (New section) The State
Health Benefits Commission and the School Employees' Health Benefits Commission
shall ensure that a graduate physician is reimbursed for the diagnosis,
consultation, or treatment of a program enrollee on the same basis that the State
Health Benefits Program and the School Employees' Health Benefits Program
reimburse the service when it is delivered by another comparable mid-level
health care provider, including, but not limited to, a physician assistant.

���� 13.� Section 3 of P.L.2009,
c.307 (C.24:6I-3) is amended to read as follows:

���� 3.��� As used in P.L.2009,
c.307 (C.24:6I-1 et al.) and P.L.2015, c.158 (C.18A:40-12.22 et al.):

���� "Academic medical
center" means (1) an entity located in New Jersey that, on the effective
date of P.L.2019, c.153 (C.24:6I-5.1 et al.), has an addiction medicine faculty
practice or is in the same health care system as another facility located in
New Jersey that offers outpatient medical detoxification services or inpatient
treatment services for substance use disorder; has a pain management faculty
practice or a facility-based pain management service located in New Jersey; has
graduate medical training programs accredited, or pending accreditation, by the
Accreditation Council for Graduate Medical Education or the American
Osteopathic Association in primary care and medical specialties; is the
principal teaching affiliate of a medical school based in the State; and has
the ability to conduct research related to medical cannabis.� If the entity is
part of a system of health care facilities, the entity shall not qualify as an
academic medical center unless the health care system is principally located within
the State; or

���� (2)�� an accredited school of
osteopathic medicine that: is located in a state that shares a common border
with this State; has an articulation agreement or similar memorandum of
understanding, plus an agreement to establish and maintain an apprenticeship
program in this State to train workers in the cannabis industry, which training
would earn college credit, with any State college or university located in a
county of the first class with a college of nursing or nursing degree program
accredited by the Commission on Collegiate Nursing Education on the effective
date of P.L.2021, c.16 (C.24:6I-31 et al.); and has an institutional review
board that has, on the effective date of P.L.2021, c.16 (C.24:6I-31 et al.),
previously approved a clinical research study in this State involving medical
cannabis; and has the ability and will conduct all research and development in
the county in which the partner State college or university is located.

���� "Adverse employment
action" means refusing to hire or employ an individual, barring or
discharging an individual from employment, requiring an individual to retire
from employment, or discriminating against an individual in compensation or in
any terms, conditions, or privileges of employment.

���� "Cannabis" has the
meaning given to "marihuana" in section 2 of the "New Jersey
Controlled Dangerous Substances Act," P.L.1970, c.226 (C.24:21-2).

���� "Clinical
registrant" means an entity that has a written contractual relationship
with an academic medical center in the region in which it has its principal
place of business, which includes provisions whereby the parties will engage in
clinical research related to the use of medical cannabis and the academic
medical center or its affiliate will provide advice to the entity regarding
patient health and safety, medical applications, and dispensing and managing
controlled dangerous substances, among other areas.

���� "Commission" means
the Cannabis Regulatory Commission established pursuant to section 31 of
P.L.2019, c.153 (C.24:6I-24).

���� "Commissioner" means
the Commissioner of Health.

���� "Common ownership or
control" means:

���� (1)�� between two for-profit
entities, the same individuals or entities own and control more than 50 percent
of both entities;

���� (2)�� between a nonprofit
entity and a for-profit entity, a majority of the directors, trustees, or
members of the governing body of the nonprofit entity directly or indirectly
own and control more than 50 percent of the for-profit entity; and

���� (3)�� between two nonprofit
entities, the same directors, trustees, or governing body members comprise a
majority of the voting directors, trustees, or governing body members of both
nonprofits.

���� "Department" means
the Department of Health.

���� "Designated
caregiver" means a resident of the State who:

���� (1)�� is at least 18 years
old;

���� (2)�� has agreed to assist
with a registered qualifying patient's medical use of cannabis, is not
currently serving as a designated caregiver for more than one other qualifying
patient, and is not the qualifying patient's health care practitioner;

���� (3)�� subject to the
provisions of paragraph (2) of subsection c. of section 4 of P.L.2009, c.307
(C.24:6I-4), has never been convicted of possession or sale of a controlled
dangerous substance, unless such conviction occurred after the effective date
of P.L.2009, c.307 (C.24:6I-1 et al.) and was for a violation of federal law
related to possession or sale of cannabis that is authorized under P.L.2009,
c.307 (C.24:6I-1 et al.) or P.L.2015, c.158 (C.18A:40-12.22 et al.);

���� (4)�� has registered with the
commission pursuant to section 4 of P.L.2009, c.307 (C.24:6I-4), and, except in
the case of a designated caregiver who is an immediate family member of the
patient, has satisfied the criminal history record background check requirement
of section 4 of P.L.2009, c.307 (C.24:6I-4); and

���� (5)�� has been designated as a
designated caregiver by the patient when registering or renewing a registration
with the commission or in other written notification to the commission.

���� "Dispense" means the
furnishing of medical cannabis to a registered qualifying patient, designated
caregiver, or institutional caregiver by a medical cannabis dispensary or
clinical registrant pursuant to written instructions issued by a health care
practitioner pursuant to the requirements of P.L.2009, c.307 (C.24:6I-1 et
al.).� The term shall include the act of furnishing medical cannabis to a
medical cannabis handler for delivery to a registered qualifying patient,
designated caregiver, or institutional caregiver, consistent with the
requirements of subsection i. of section 27 of P.L.2019, c.153 (C.24:6I-20).

���� "Health care
facility" means a general acute care hospital, nursing home, long term
care facility, hospice care facility, group home, facility that provides
services to persons with developmental disabilities, behavioral health care
facility, or rehabilitation center.

���� "Health care
practitioner" means a physician,
graduate physician,
advanced
practice nurse, or physician assistant licensed or certified pursuant to Title
45 of the Revised Statutes who:

���� (1)�� possesses active
registrations to prescribe controlled dangerous substances issued by the United
States Drug Enforcement Administration and the Division of Consumer Affairs in
the Department of Law and Public Safety;

���� (2)�� is the health care
practitioner responsible for the ongoing treatment of a patient's qualifying
medical condition, the symptoms of that condition, or the symptoms associated
with the treatment of that condition, provided, however, that the ongoing
treatment shall not be limited to the provision of authorization for a patient
to use medical cannabis or consultation solely for that purpose; and

���� (3)�� if the patient is a
minor, is a pediatric specialist.

���� "Immediate family"
means the spouse, domestic partner, civil union partner, child, sibling, or
parent of an individual, and shall include the siblings, parents, and children
of the individual's spouse, domestic partner, or civil union partner, and the
parents, spouses, domestic partners, or civil union partners of the
individual's parents, siblings, and children.

���� "Institutional
caregiver" means a resident of the State who:

���� (1)�� is at least 18 years
old;

���� (2)�� is an employee of a
health care facility;

���� (3)�� is authorized, within
the scope of the individual's professional duties, to possess and administer
controlled dangerous substances in connection with the care and treatment of
patients and residents pursuant to applicable State and federal laws;

���� (4)�� is authorized by the
health care facility employing the person to assist registered qualifying
patients who are patients or residents of the facility with the medical use of
cannabis, including, but not limited to, obtaining medical cannabis for
registered qualifying patients and assisting registered qualifying patients
with the administration of medical cannabis;

���� (5)�� subject to the
provisions of paragraph (2) of subsection c. of section 4 of P.L.2009, c.307
(C.24:6I-4), has never been convicted of possession or sale of a controlled
dangerous substance, unless such conviction occurred after the effective date
of P.L.2009, c.307 (C.24:6I-1 et al.) and was for a violation of federal law
related to possession or sale of cannabis that is authorized under P.L.2009,
c.307 (C.24:6I-1 et al.) or P.L.2015, c.158 (C.18A:40-12.22 et al.); and

���� (6)�� has registered with the
commission pursuant to section 4 of P.L.2009, c.307 (C.24:6I-4).

���� "Integrated
curriculum" means an academic, clinical, or research program at an
institution of higher education that is coordinated with a medical cannabis
cultivator, medical cannabis manufacturer, or medical cannabis dispensary to
apply theoretical principles, practical experience, or both involving the
cultivation, manufacturing, dispensing, delivery, or medical use of cannabis to
a specific area of study, including, but not limited to, agriculture, biology,
business, chemistry, culinary studies, ecology, environmental studies, health
care, horticulture, technology, or any other appropriate area of study or
combined areas of study.� Integrated curricula shall be subject to approval by
the commission and the Office of the Secretary of Higher Education.

���� "Integrated curriculum
permit" or "IC permit" means a permit issued to a medical
cannabis cultivator, medical cannabis manufacturer, or medical cannabis
dispensary that includes an integrated curriculum approved by the commission
and the Office of the Secretary of Higher Education.

���� "Medical cannabis
alternative treatment center" or "alternative treatment center"
means an organization issued a permit, including a conditional permit, by the
commission to operate as a medical cannabis cultivator, medical cannabis manufacturer,
medical cannabis dispensary, or clinical registrant. This term shall include
the organization's officers, directors, board members, and employees.

���� "Medical cannabis
cultivator" means an organization holding a permit issued by the
commission that authorizes the organization to: possess and cultivate cannabis
and deliver, transfer, transport, distribute, supply, and sell medical cannabis
and related supplies to other medical cannabis cultivators and to medical
cannabis manufacturers, clinical registrants, and medical cannabis
dispensaries, as well as to plant, cultivate, grow, and harvest medical
cannabis for research purposes. A medical cannabis cultivator permit shall not
authorize the permit holder to manufacture, produce, or otherwise create
medical cannabis products, or to deliver, transfer, transport, distribute,
supply, sell, or dispense medical cannabis, medical cannabis products,
paraphernalia, or related supplies to qualifying patients, designated
caregivers, or institutional caregivers.

���� "Medical cannabis
dispensary" means an organization issued a permit by the commission that
authorizes the organization to: purchase or obtain medical cannabis and related
supplies from medical cannabis cultivators; purchase or obtain medical cannabis
products and related supplies from medical cannabis manufacturers; purchase or
obtain medical cannabis, medical cannabis products, and related supplies and
paraphernalia from other medical cannabis dispensaries and from clinical
registrants; deliver, transfer, transport, distribute, supply, and sell medical
cannabis and medical cannabis products to other medical cannabis dispensaries;
furnish medical cannabis, including medical cannabis products, to a medical
cannabis handler for delivery to a registered qualifying patient, designated
caregiver, or institutional caregiver consistent with the requirements of
subsection i. of section 27 of P.L.2019, c.153 (C.24:6I-20); and possess,
display, deliver, transfer, transport, distribute, supply, sell, and dispense medical
cannabis, medical cannabis products, paraphernalia, and related supplies to
qualifying patients, designated caregivers, and institutional caregivers.� A
medical cannabis dispensary permit shall not authorize the permit holder to
cultivate medical cannabis, to produce, manufacture, or otherwise create
medical cannabis products.

���� "Medical cannabis
manufacturer" means an organization issued a permit by the commission that
authorizes the organization to: purchase or obtain medical cannabis and related
supplies from a medical cannabis cultivator or a clinical registrant; purchase
or obtain medical cannabis products from another medical cannabis manufacturer
or a clinical registrant; produce, manufacture, or otherwise create medical
cannabis products; and possess, deliver, transfer, transport, distribute,
supply, and sell medical cannabis products and related supplies to other
medical cannabis manufacturers and to medical cannabis dispensaries and
clinical registrants.� A medical cannabis manufacturer permit shall not
authorize the permit holder to cultivate medical cannabis or to deliver,
transfer, transport, distribute, supply, sell, or dispense medical cannabis,
medical cannabis products, paraphernalia, or related supplies to registered
qualifying patients, designated caregivers, or institutional caregivers.

���� "Medical use of
cannabis" means the acquisition, possession, transport, or use of cannabis
or paraphernalia by a registered qualifying patient as authorized by P.L.2009,
c.307 (C.24:6I-1 et al.) and P.L.2015, c.158 (C.18A:40-12.22 et al.).

���� "Minor" means a
person who is under 18 years of age and who has not been married or previously
declared by a court or an administrative agency to be emancipated.

���� "Paraphernalia" has
the meaning given in N.J.S.2C:36-1.

���� "Pediatric
specialist" means a physician who is a board-certified pediatrician or
pediatric specialist, or an advanced practice nurse
, graduate physician,

or physician assistant who is certified as a pediatric specialist by an
appropriate professional certification or licensing entity.

���� "Primary care" means
the practice of family medicine, general internal medicine, general pediatrics,
general obstetrics, or gynecology.

���� "Qualifying medical
condition" means seizure disorder, including epilepsy; intractable
skeletal muscular spasticity; post-traumatic stress disorder; glaucoma;
positive status for human immunodeficiency virus; acquired immune deficiency
syndrome; cancer; amyotrophic lateral sclerosis; multiple sclerosis; muscular
dystrophy; inflammatory bowel disease, including Crohn's disease; terminal
illness, if the patient has a prognosis of less than 12 months of life;
anxiety; migraine; Tourette's syndrome; dysmenorrhea; chronic pain; opioid use
disorder; or any other medical condition or its treatment that is approved by
the commission.

���� "Qualifying patient"
or "patient" means a resident of the State who has been authorized
for the medical use of cannabis by a health care practitioner.

���� "Registration with the
commission" means a person has met the qualification requirements for, and
has been registered by the commission as, a registered qualifying patient,
designated caregiver, or institutional caregiver.� The commission shall
establish appropriate means for health care practitioners, health care
facilities, medical cannabis dispensaries, law enforcement, schools, facilities
providing behavioral health services or services for persons with developmental
disabilities, and other appropriate entities to verify an individual's status
as a registrant with the commission.

���� "Significantly involved
person" means a person or entity who holds at least a five percent
investment interest in an entity issued, or applying for a permit to operate
as, a medical cannabis cultivator, medical cannabis manufacturer, medical cannabis
dispensary, or clinical registrant, or who is a decision making member of a
group that holds at least a 20 percent investment interest in an entity issued,
or applying for a permit to operate as, a medical cannabis cultivator, medical
cannabis manufacturer, medical cannabis dispensary, or clinical registrant, in
which no member of that group holds more than a five percent interest in the
total group investment interest, and the person or entity makes controlling
decisions regarding the operations of the entity issued, or applying for a
permit to operate as, a medical cannabis cultivator, medical cannabis
manufacturer, medical cannabis dispensary, or clinical registrant.

���� "Terminally ill"
means having an illness or condition with a prognosis of less than 12 months of
life.

���� "Usable cannabis"
means the dried leaves and flowers of cannabis, and any mixture or preparation
thereof, and does not include the seeds, stems, stalks, or roots of the plant.

(cf: P.L.2021, c.16, s.4)

���� 14.� Section 11 of P.L.2017,
c.28 (C.24:21-15.2) is amended to read as follows:

���� 11.� a.� A practitioner shall
not issue an initial prescription for an opioid drug which is a prescription
drug as defined in section 2 of P.L.2003, c.280 (C.45:14-41) in a quantity
exceeding a five-day supply for treatment of acute pain.� Any prescription for
acute pain pursuant to this subsection shall be for the lowest effective dose
of immediate-release opioid drug.�

���� b.��� Prior to issuing an
initial prescription of a Schedule II controlled dangerous substance or any
opioid drug which is a prescription drug as defined in section 2 of P.L.2003,
c.280 (C.45:14-41) in a course of treatment for acute or chronic pain, a
practitioner shall:

���� (1)�� take and document the
results of a thorough medical history, including the patient's experience with
non-opioid medication and non-pharmacological pain management approaches and
substance use disorder history;

���� (2)�� conduct, as appropriate,
and document the results of a physical examination;

���� (3)�� develop a treatment
plan, with particular attention focused on determining the cause of the
patient's pain;

���� (4)�� access relevant
prescription monitoring information under the Prescription Monitoring Program
pursuant to section 8 of P.L.2015, c.74 (C. 45:1-46.1); and

���� (5)�� limit the supply of any
opioid drug prescribed for acute pain to a duration of no more than five days
as determined by the directed dosage and frequency of dosage.

���� c.���� No less than four days
after issuing the initial prescription pursuant to subsection a. of this
subsection, the practitioner, after consultation with the patient, may issue a
subsequent prescription for the drug to the patient in any quantity that complies
with applicable State and federal laws, provided that:

���� (1)�� the subsequent
prescription would not be deemed an initial prescription under this section;

���� (2)�� the practitioner
determines the prescription is necessary and appropriate to the patient's
treatment needs and documents the rationale for the issuance of the subsequent
prescription; and

���� (3)�� the practitioner
determines that issuance of the subsequent prescription does not present an
undue risk of abuse, addiction, or diversion and documents that determination.

���� d.��� Prior to issuing the
initial prescription of a Schedule II controlled dangerous substance or any
opioid drug which is a prescription drug as defined in section 2 of P.L.2003,
c.280 (C.45:14-41) in a course of treatment for acute pain and prior to issuing
a prescription at the outset of a course of treatment for chronic pain, a
practitioner shall discuss with the patient, or the patient's parent or
guardian if the patient is under 18 years of age and is not an emancipated
minor, the risks associated with the drugs being prescribed, including but not
limited to:

���� (1)�� the risks of addiction
and overdose associated with opioid drugs and the dangers of taking opioid
drugs with alcohol, benzodiazepines and other central nervous system
depressants;

���� (2)�� the reasons why the
prescription is necessary;

���� (3)�� alternative treatments
that may be available; and

���� (4)�� risks associated with
the use of the drugs being prescribed, specifically that opioids are highly
addictive, even when taken as prescribed, that there is a risk of developing a
physical or psychological dependence on the controlled dangerous substance, and
that the risks of taking more opioids than prescribed, or mixing sedatives,
benzodiazepines or alcohol with opioids, can result in fatal respiratory
depression.

���� The practitioner shall include
a note in the patient's medical record that the patient or the patient's parent
or guardian, as applicable, has discussed with the practitioner the risks of
developing a physical or psychological dependence on the controlled dangerous
substance and alternative treatments that may be available.� The Division of
Consumer Affairs shall develop and make available to practitioners guidelines
for the discussion required pursuant to this subsection.

���� e.���� Prior to the
commencement of an ongoing course of treatment for chronic pain with a Schedule
II controlled dangerous substance or any opioid, the practitioner shall enter
into a pain management agreement with the patient.

���� f.���� When a Schedule II
controlled dangerous substance or any prescription opioid drug is continuously
prescribed for three months or more for chronic pain, the practitioner shall:

���� (1)�� review, at a minimum of
every three months, the course of treatment, any new information about the
etiology of the pain, and the patient's progress toward treatment objectives
and document the results of that review;

���� (2)�� assess the patient
prior to every renewal to determine whether the patient is experiencing
problems associated with physical and psychological dependence and document the
results of that assessment;

���� (3)�� periodically make
reasonable efforts, unless clinically contraindicated, to either stop the use
of the controlled substance, decrease the dosage, try other drugs or treatment
modalities in an effort to reduce the potential for abuse or the development of
physical or psychological dependence and document with specificity the efforts
undertaken;

���� (4)�� review the Prescription
Drug Monitoring information in accordance with section 8 of P.L.2015, c.74 (C.
45:1-46.1); and

���� (5)�� monitor compliance with
the pain management agreement and any recommendations that the patient seek a
referral.

���� g.��� As used in this section:

���� "Acute pain" means
pain, whether resulting from disease, accidental or intentional trauma, or
other cause, that the practitioner reasonably expects to last only a short
period of time.� "Acute pain" does not include chronic pain, pain
being treated as part of cancer care, hospice or other end of life care, or
pain being treated as part of palliative care.

���� "Chronic pain" means
pain that persists or recurs for more than three months.�

���� "Initial
prescription" means a prescription issued to a patient who:

���� (1)�� has never previously
been issued a prescription for the drug or its pharmaceutical equivalent; or

���� (2)�� was previously issued a
prescription for, or used or was administered the drug or its pharmaceutical
equivalent, but the date on which the current prescription is being issued is
more than one year after the date the patient last used or was administered the
drug or its equivalent.

���� When determining whether a
patient was previously issued a prescription for, or used or was administered a
drug or its pharmaceutical equivalent, the practitioner shall consult with the
patient and review the patient's medical record and prescription monitoring
information.

���� "Opioid antidote"
means any drug, regardless of dosage amount or method of administration, which
has been approved by the United States Food and Drug Administration (FDA) for
the treatment of an opioid overdose.� "Opioid antidote" includes, but
is not limited to, naloxone hydrochloride, in any dosage amount, which is
administered through nasal spray or any other FDA-approved means or methods.

���� "Pain management
agreement" means a written contract or agreement that is executed between
a practitioner and a patient, prior to the commencement of treatment for
chronic pain using a Schedule II controlled dangerous substance or any opioid
drug which is a prescription drug as defined in section 2 of P.L.2003, c.280
(C.45:14-41), as a means to:

���� (1)�� prevent the possible
development of physical or psychological dependence in the patient;

���� (2)�� document the
understanding of both the practitioner and the patient regarding the patient's
pain management plan;

���� (3)�� establish the patient's
rights in association with treatment, and the patient's obligations in relation
to the responsible use, discontinuation of use, and storage of Schedule II
controlled dangerous substances, including any restrictions on the refill of
prescriptions or the acceptance of Schedule II prescriptions from
practitioners;

���� (4)�� identify the specific
medications and other modes of treatment, including physical therapy or
exercise, relaxation, or psychological counseling, that are included as a part
of the pain management plan;

���� (5)�� specify the measures
the practitioner may employ to monitor the patient's compliance, including but
not limited to random specimen screens and pill counts; and

���� (6)�� delineate the process
for terminating the agreement, including the consequences if the practitioner
has reason to believe that the patient is not complying with the terms of the
agreement.

���� "Practitioner" means
a medical doctor, doctor of osteopathy, dentist, optometrist, podiatrist,
graduate
physician,
physician assistant, certified nurse midwife, or advanced
practice nurse, acting within the scope of practice of their professional
license pursuant to Title 45 of the Revised Statutes.

���� h.��� This section shall not
apply to a prescription for a patient who is currently in active treatment for
cancer, receiving hospice care from a licensed hospice or palliative care, or
is a resident of a long term care facility, or to any medications that are
being prescribed for use in the treatment of substance use disorder.

���� i.���� Every policy, contract
or plan delivered, issued, executed or renewed in this State, or approved for
issuance or renewal in this State by the Commissioner of Banking and Insurance,
and every contract purchased by the School Employees' Health Benefits Commission
or State Health Benefits Commission, on or after the effective date of this
act, that provides coverage for prescription drugs subject to a co-payment,
coinsurance or deductible shall charge a co-payment, coinsurance or deductible
for an initial prescription of an opioid drug prescribed pursuant to this
section that is either:

���� (1)�� proportional between the
cost sharing for a 30-day supply and the amount of drugs the patient was
prescribed; or

���� (2)�� equivalent to the cost
sharing for a full 30-day supply of the opioid drug, provided that no
additional cost sharing may be charged for any additional prescriptions for the
remainder of the 30-day supply.

���� j. (1) Subject to paragraph
(2) of this subsection, if a health care practitioner issues a prescription for
an opioid drug which is a controlled dangerous substance to a patient, the
prescriber shall additionally issue the patient a prescription for an opioid
antidote if any of the following conditions is present:

���� (a)�� the patient has a
history of substance use disorder;

���� (b)�� the prescription for the
opioid drug is for a daily dose of more than 90 morphine milligram equivalents;
or

���� (c)�� the patient holds a
current, valid prescription for a benzodiazepine drug that is a Schedule III or
Schedule IV controlled dangerous substance.

���� (2)�� A practitioner shall
not be required to issue more than one prescription for an opioid antidote to a
patient under paragraph (1) of this subsection per year.

���� (3)�� Nothing in paragraph
(2) of this subsection shall be construed to prohibit a practitioner from
issuing additional prescriptions for an opioid antidote to a patient upon the
patient's request or when the practitioner determines there is a clinical or
practical need for the additional prescription.

(cf: P.L.2023, c.177, s.57)

���� 15.� (New section) The
Commissioner of Human Services shall apply for such State plan amendments or
waivers as may be necessary to implement the provisions of section 11 of this
act and to secure federal financial participation for State Medicaid
expenditures under the federal Medicaid program.

���� 16.� This act shall take
effect immediately.

STATEMENT

���� This bill establishes the
�Graduate Physician Licensing Act.�

���� Under the bill, the State
Board of Medical Examiners (board) will issue a license as a graduate physician
to an applicant who:� 1) is at least 18 years of age; 2) is a medical school
graduate; 3) has completed one year of clinical practice hours; 4) has successfully
completed Step 2 of the physician licensing examination; 5) has not completed
an approved postgraduate residency; and 6) has no criminal history.�
Alternatively, the board may accept proof that an applicant holds a current
graduate physician license in a state which has standards substantially
equivalent to those of New Jersey.

���� Graduate physicians will be
authorized to provide primary care services in medically underserved areas of
the State, subject to any restrictions set forth in a collaborative practice
arrangement with a collaborating physician, who is responsible for supervising
the graduate physician at all times.� The delivery of health care services is
to be within the scope of practice of the graduate physician and consistent
with that graduate physician's skill, training, and competence and the skill
and training of the collaborating physician.� Graduate physicians may be
delegated the authority to prescribe controlled dangerous substances and
authorize patients for medical cannabis, subject to certain restrictions.

���� The bill further requires
health benefits plans, the Medicaid and NJ FamilyCare programs, the State
Health Benefits Program, and the School Employees� Health Benefits Program, to
reimburse a graduate physician for the diagnosis, consultation, or treatment of
patients on the same basis that reimbursement is provided for the service when
it is delivered by another comparable mid-level health provider including, but
not limited to, a physician assistant.