Policies and Procedures of the American Osteopathic Board of Family Physicians

Policies and Procedures of the American Osteopathic Board of Family Physicians Adopted in its Entirety November 2010 Amended April 2013

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 CONTENTS Article I Procedures... 3 II Committees... 3 III Board Eligibility... 3 IV Primary Certification Eligibility Requirements... 5 V Requirements for CAQ in Osteopathic Geriatrics in Family Medicine... 7 VI Requirements for CAQ in Sports Medicine...7 VII Requirements for CAQ in Addiction Medicine... 8 VIII Requirements for CAQ in Undersea and Hyperbaric Medicine... 9 IX Requirements for CAQ in Hospice and Palliative Medicine... 10 X Requirements for CAQ in Sleep Medicine... 11 XI Examination... 12 XII Rules for the Conduct of Examinations... 13 XIII Reexamination... 14 XIV Certificates... 14 XV Osteopathic Continuous Certification... 15 XVI Appeals... 22 XVII Compliance with Federal Regulations... 23 XVIII Inquiries Regarding Status of a Physician... 23 XIX Amendments... 23 Page 2

POLICIES AND PROCEDURES OF THE AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS Article I. Procedures To expedite and direct its activities, the American Osteopathic Board of Family Physicians (hereinafter also referred to as the Board or AOBFP) shall place into effect this set of Policies and Procedures. This document is in addition to, and based upon, the American Osteopathic Association (AOA) Procedures of the Bureau of Osteopathic Specialists and AOA Specialty Certifying Boards ( Policies and Procedures of the BOS ) and the Bylaws of the Board. Article II. Committees Board committees will be established and administered as denoted in the Bylaws of the Board. Article III. Board Eligibility Section 1. Board Eligibility Process The AOBFP will follow the board eligibility and reentry petition process and procedure as outlined in Article VIII of the Policies and Procedures of the BOS. Section 2. Eligibility Period Board eligibility for candidates qualifying under the residency requirement is effective for six years from the date of completion of the residency. Eligibility for residents in ACGME programs completed prior to July 1, 1989 is three (3) years from the date of approval of the program by the AOA. In both cases, the candidate must successfully complete the examination for certification within that period. (7/95) Section 3. Letter of Board Eligibility Upon the payment of the application and examination fee and the submission of the application and required documents (3/01), a letter of board eligibility may be sent to an applicant who meets the eligibility requirements. Board eligibility for candidates who qualified under the clinical practice pathway expired December 31, 2001. Section 4. Termination Of Board Eligible Status (2/96) A. If a candidate does not initiate examination within the period of board eligibility, board eligibility status will be automatically lost and so recorded by the AOA and this Board. B. The Board will notify the registered candidate in writing by certified, return receipt mail, a minimum of one year prior to termination of board eligible status. The notice shall include a statement that the candidate has the right to appeal to the bureau or that they may reenter the examination process, if eligible. Page 3

Section 5. Mechanism For Reentry Into The Certification Process For Candidates Whose Board Eligibility Expired On or Before December 31, 2010 A. Reentry into the certification process allows a candidate who has successfully completed a one-year AOA-approved internship and a two year AOA-approved residency, and has verification of residency complete and approved status by the AOA, to pursue certification in family medicine. The candidate may petition up to two times to reenter the certification process. Each petition can be for up to one year, with two examination attempts. The candidate is not considered board eligible during this time and verification of such status will not be provided to the candidate. After exhausting the above process, the candidate is not eligible to continue the certification process. B. The applicant s petition for reentry must contain evidence of meeting the following requirements in addition to the required application and supporting documents for certification. 1. Valid and unrestricted license to practice medicine in a state or territory of the united states; 2. Continuous membership in good standing in the AOA or Canadian Osteopathic Association during the immediate preceding two years prior to petition and maintenance of AOA membership in good standing for the three year period of extension; 3. Documentation per AOA activity reports of 150 applicable CME hours for the previous three years; 4. The required petition application fee. Section 6. Mechanism For Reentry Into The Certification Process For Candidates Entering The Certification Process (Meeting Eligibility Requirements And Filing An Application) On Or After July 1, 2009 A. Effective July 1, 2009, any candidate entering the certification process (meeting the eligibility requirements and filing an application) may petition the board at the end of their six years of board eligibility up to two times to reenter the certification process. Each petition can be for no more than one year. The candidate s residency training must have AOA complete and approved status. If the candidate fails to pass the examination after two petitions, there will be no further opportunity to become certified. B. Each petition for reentry into the certification process must be submitted within six months prior to expiration of the initial six year period of board eligibility or upon expiration of the first reentry petition. A petition allows a candidate with approved residency training to pursue certification in family medicine for an extended period of up to one year from the date of acceptance of the candidate s petition. The candidate is not considered board eligible during this time and verification of such status will not be provided to the candidate. C. The applicant s petition for reentry must contain evidence of meeting the following requirements in addition to the required application and supporting documents for certification. 1. Valid and unrestricted license to practice medicine in a state or territory of the United States; Page 4

2. Continuous membership in good standing in the AOA or Canadian Osteopathic Association during the immediate preceding two years prior to petition and maintenance of AOA membership in good standing for the period of extension; 3. Documentation per AOA activity reports of 150 applicable CME hours for the previous three years; 4. The required examination fee. Article IV. Primary Certification Eligibility Requirements Section 1. Eligibility Criteria Primary Certification To be eligible to receive certification from the AOA through the AOBFP, applicants for examination for certification are required to file an application, which shall set forth their qualifications for examination. Applicants must demonstrate: A. The minimum requirements for AOA board certification outlined in Article IX of the Policies and Procedures of the BOS. B. Beginning July 1, 2008, the applicant must have completed an AOA-approved family medicine residency training program of at least three years. 1. Prior to July 1, 2008, the program length was two years (2/09), after the required one year of AOA-approved internship. 2. Prior to July 1, 1989, the program length was one year in addition to the internship; that option has terminated, as the period of board eligibility was six years from the completion date of the program (3/01). C. The period of board eligibility for residents completing an ACGME program prior to July 1, 1989 will be three (3) years from the date of approval of that program by the AOA. D. Beginning in 2010, the candidate must show evidence of participation in the AOA Clinical Assessment Program (CAP). (2/09) Section 2. Training Program Requirement This board shall recognize only those training programs that have been approved by the AOA Council on Postdoctoral Training (COPT). Section 3. Additional Certification Requirements Subject to the recommendation of the BOS and to the approval of the AOA Board of Trustees, the AOBFP may require such further training and/or practice in each of the specialties or subspecialties coming under its jurisdiction as, in its judgment, such subspecialty may require, provided that the additional requirement for each specialty or subspecialty is clearly set forth in the Policies and Procedures of the Board. Additions to training and/or practice requirements shall go into effect one (1) year subsequent to the announcement of such change. Section 4. Licensure Requirement An applicant for certification that has a restricted license may petition the Board for the ability to enter the certification process based upon review of the reason for licensure restriction. Page 5

Section 5. ACGME Training Approval A. Residents in ACGME programs must have their program approved by the AOA prior to applying for examination. After successful completion of all examinations, completion of the residency program and approval of the residency scientific paper and documents required by the AOA and the American College of Osteopathic Family Physicians ACOFP), the candidate will be recommended for certification. B. The AOA Postgraduate Education Department or the AOA Department of Certification may offer other routes to eligibility concerning either the individual approval of ACGME training programs or acceptance of ABMS certification. Section 6. Application A. Applicants desiring examination for any certification offered by the Board shall be required to file an application, which shall set forth the applicant's qualifications for examination. The application will include an applicant release statement as required by the AOA. The procedure for filing applications and the release statement language is set forth in the applications of this Board (3/01). B. The candidate may apply for examination during the spring of the final year of training if training is anticipated to be completed by August 1 st of that final year. C. For all certifications offered by the Board, candidates must submit the required application, fees and supporting documents within the established deadlines as determined by the Board. Section 7 Eligibility Period The period of board eligibility is six (6) years after completion of the residency program. The examination must be successfully completed, the paperwork approved and the candidate presented for certification within that period. Section 8. Lapse in AOA Membership Physicians reinstating their membership with the AOA must do so in ample time to meet the two-year consecutive AOA membership requirement prior to application and to allow time for the processing of their CME hours for the present cycle by the AOA Department of CME. Hours for previous cycles will not be reviewed by the AOA; those certificates of attendance must be arranged in chronological order and submitted to AOBFP with the application materials. An additional fee may be assessed by AOBFP based on the volume of certificates or letters requiring review. Those applications submitted at the deadline may require a longer period of processing than the usual three weeks. Documents submitted two months or more prior to the deadline will be processed more quickly. Section 9. Special Accommodations (ADA) The Board supports the intent of the Americans with Disabilities Act (ADA) for candidates who meet ADA eligibility. The board will make a reasonable effort to provide qualified board candidates who have documented disabilities the necessary auxiliary aids and services that do not fundamentally alter the measurement of the skills or knowledge the board assessment process is intended to test or result in an undue burden. Candidates seeking special accommodations must submit in writing a request for information on the specific documentation to be supplied in support of their request. This must be Page 6

submitted with the completed application and supporting documents and posted by the published deadline. (7/04) Article V. Requirements for Certification of Added Qualifications (CAQ) in Osteopathic Geriatrics in Family Medicine Section 1. Definition The osteopathic geriatrics in family medicine examination program for certification of added qualifications is designed to recognize excellence among those who provide care to the elderly. Section 2. Qualifications of Candidates Candidates seeking a certification of added qualifications in osteopathic geriatrics in family medicine shall demonstrate: A. Certification in family medicine by the AOA, upon the recommendation of the AOBFP through the BOS, active and in good standing. B. The minimum requirements for AOA board certification outlined in Article IX of the Policies and Procedures of the BOS. C. Satisfactorily completion of training in geriatric medicine in the care of the elderly. The training requirement consists of two (2) years of AOA-approved training in osteopathic geriatrics in family medicine or, if training was completed prior to 1996, two (2) years of AOA-approved training in geriatric medicine. Eligibility for examination for candidates who have completed the training requirement will be six (6) years from the date of completion of the residency training program. Article VI. Requirements for Certification of Added Qualifications (CAQ) in Sports Medicine Section 1. Definition The sports medicine examination program for certification of added qualifications (CAQ) is conjointly developed by interested osteopathic specialty boards and the American Osteopathic Academy of Sports Medicine. A sports medicine conjoint examination committee has representation from each participating specialty board and academy. This CAQ is designed to recognize excellence among those who provide care to persons who participate in athletics or exercise programs. (7/95) Section 2. Qualifications of Candidates Candidates seeking certification of added qualifications in sports medicine shall demonstrate: A. Certification in family medicine by the AOA, upon the recommendation of the AOBFP through the BOS, active and in good standing. B. The minimum requirements for AOA board certification outlined in Article IX of the Policies and Procedures of the BOS. Page 7

C. Satisfactorily complete training in sports medicine or practice requirements in the care of the athlete. 1. Satisfactorily complete one year of an AOA-approved residency training program in sports medicine as defined by the American College of Osteopathic Family Physicians. The candidate may apply for examination during the Spring of the final year of training and must successfully complete a written examination. After successful completion of the examination, completion of the residency program and approval of the residency scientific paper and documents required by the AOA and the American College of Osteopathic Family Physicians, the candidate will be recommended for certification of added qualifications. (7/95) Eligibility for examination for candidates who have completed the training requirement will be within six years from the date of completion of the residency training program. 2. The practice requirements consist of: a. Demonstration of interest and training in sports medicine with four (4) years of practice experience with at least 20% of the total practice devoted to sports medicine with the documentation of at least 400 CME hours per the AOA individual activity report within the four year period and with at least 100 hours in sports medicine. (7/95) This pathway expired with the 2001 examination. b. Substantiation by local authorities that the diplomate has recognized competence in sports medicine with verification provided by appropriate bodies, i.e., hospital, family medicine department. Article VII. Requirements for Certification of Added Qualifications (CAQ) in Addiction Medicine NOTE The AOBFP was a participating member of the Addiction Medicine Conjoint Examination Committee through the October 2002 examination. The AOBFP petitioned the AOA BOS in January 2004 and was granted approval for withdrawal from that conjoint process. (7/04) In November 2004, the AOBFP agreed to rejoin the Committee to assist with the recertification CAQ process. (2/09) Section 1. Definition The examination program for certification of added qualifications in addiction medicine is designed to recognize excellence among those with advanced or concentrated training in addiction medicine. Section 2. Qualifications of Candidates Candidates seeking certification of added qualifications in addiction medicine shall demonstrate: A. Certification in family medicine by the AOA, upon the recommendation of the AOBFP through the BOS, active and in good standing. B. The minimum requirements for AOA board certification outlined in Article IX of the Policies and Procedures of the BOS. Page 8

C. Satisfactorily complete training or practice requirements in Addiction Medicine. 1. Satisfactorily complete one year of an AOA-approved training program in addiction medicine as defined by the American College of Osteopathic Family Physicians. Eligibility for examination for candidates who have completed the training requirement will be within six years from the date of completion of the training program. 2. The practice requirements consist of: a. Completion of at least four (4) years of practice experience with at least 25% of the total practice devoted to addiction medicine with the documentation of at least 200 CME hours per the AOA Individual Activity Report within the four-year period and with at least 100 hours in addiction medicine. Eligibility for examination for candidates who have completed the clinical practice pathway will be six years from the date of the first offering of the exam, until the end of year 2002. (2/96) b. Substantiation by local authorities that the diplomate has recognized competence in addiction medicine with verification provided by appropriate bodies, i.e., hospital, community practitioners. Article VIII. Requirements For Certification Of Added Qualifications (CAQ) In Undersea And Hyperbaric Medicine Section 1. Definition The examination program for certification of added qualifications in undersea and hyperbaric medicine is designed to recognize excellence among those with advanced or concentrated training in undersea and hyperbaric medicine. Section 2. Qualifications of candidates Candidates seeking certification of added qualifications in undersea and hyperbaric medicine shall demonstrate: A. Certification in family medicine by the AOA, active and in good standing. B. The minimum requirements for AOA board certification outlined in article IX of the Policies and Procedures of the BOS. C. Satisfactorily complete training or practice requirements in undersea and hyperbaric medicine. 1. Satisfactorily complete training shall consist of one year of an aoa-approved training program in undersea and hyperbaric medicine. Eligibility for examination for candidates who have completed the training requirement will be within six years from the date of completion of the training program. Page 9

2. The practice requirements consist of: a. Documentation of successful completion of a basic course in undersea and hyperbaric medicine approved by either the American College of Hyperbaric Medicine, the Undersea and Hyperbaric Medical Society, or the US Department of Defense. The length of the course must have been at least 40 hours followed by formal assessment. b. Documentation of a two-year period of time in which a minimum of 25% of practice time was in the practice of undersea and hyperbaric medicine. Documentation of undersea and hyperbaric medicine research and teaching activities may also be submitted for review. During this two-year period, the practice must be devoted to one or more of the 13 treatment indications of undersea and hyperbaric medicine. c. Documentation of supervision of at least 500 treatments (with a distribution across the 13 treatment indications in proportion to the frequency with which they are encountered at the institution). d. Eligibility for examination for candidates who have completed the clinical practice pathway will begin five years from the date of the first offering of the exam, and expire at the end of year 2013. Article IX. Certification Of Added Qualifications (CAQ) In Hospice And Palliative Medicine Section 1. Definition The examination program for Certification of Added Qualifications in Hospice and Palliative Medicine is designed to recognize excellence among those with advanced or concentrated training in hospice and palliative medicine. Section 2. Qualifications of Candidates Candidates seeking Certification of Added Qualifications in Undersea and Hyperbaric Medicine shall demonstrate: A. Certification in family medicine by the AOA, active and in good standing. B. The minimum requirements for AOA board certification outlined in Article IX of the Policies and Procedures of the BOS. C. Satisfactorily complete training or practice requirement in hospice and palliative medicine. 1. Satisfactorily complete training shall consist of one year of an AOA-approved training program in hospice and palliative medicine. Eligibility for examination for candidates who have completed the training requirement will expire six years from the date of completion of the training program. Page 10

2. The practice requirements consist of: a. Documentation of 30 hours of CME in hospice and palliative medicine over the preceding 24 months prior to application for examination. b. Clinical practice for a minimum of two years and be able to demonstrate that a minimum of 25% of practice is in the care of the terminally ill. c. Having directly participated in the active care of at least 50 terminally ill patients in the preceding three years for whom palliative medicine was the predominant goal of care. d. Having worked as a physician member of an interdisciplinary clinical care team for at least two years, which included a minimum of 100 hours of active participation in team meetings that complied with the clinical practice guidelines for quality palliative care. e. Verification of two palliative care medicine authorities that the applicant is an established palliative care provider physician and meets the criteria above (one of the authorities must be the CEO or director of the hospice unit were the physician has privileges); and f. In lieu of (e), the applicant must have served as a hospice medical director in a palliative care practice for one or more years. g. Eligibility for examination for candidates who have completed the clinical practice pathway will begin six years from the date of the first offering of the exam, and expire at the end of year 2015. Article X. Certification of Added Qualifications (CAQ) in Sleep Medicine Section 1. Definition The examination program for Certification of Added Qualifications in Sleep Medicine is designed to recognize excellence among those with advanced or concentrated training in sleep medicine. Section 2. Qualifications of Candidates Candidates seeking Certification of Added Qualifications in Sleep Medicine shall demonstrate: A. Certification in family medicine by the AOA, active and in good standing. B. The minimum requirements for AOA board certification outlined in Article IX of the Policies and Procedures of the BOS. C. Satisfactorily complete training or practice requirement in sleep medicine. Page 11

1. Satisfactorily complete training shall consist of one year of an AOA-approved training program in sleep medicine. Eligibility for examination for candidates who have completed the training requirement will expire six years from the date of completion of the training program. 2. The practice requirements consist of: a. Documentation of 30 hours of CME in sleep medicine over the preceding 24 months prior to application for examination. b. Possess privileges in a certified sleep medicine laboratory and be able to verify: 1. Interpretation of a minimum of 200 overnight polysomnographic (PSG) tests and 25 multiple sleep latency (MSLTS) and/or maintenance of wakefulness tests (MWTS) in the period of 2 years prior to application and verify that at least 30% of the applicant s clinical activity over the preceding 2 years has been dedicated to the practice of sleep medicine; or 2. Interpretation of a minimum of 500 overnight PSGS and 50 MSLTS and/or MWTS during the candidate s career and verify that a portion of the applicant s clinical activity has been dedicated to the practice of sleep medicine with an accumulation of one year of full-time activity achieved over the preceding 5 years. c. Eligibility for examination for candidates who have completed the clinical practice pathway will begin six years from the date of the first offering of the exam, and expire at the end of year 2015. Article XI. Examination Section 1. General Examination Information Following satisfactory compliance with the prescribed eligibility requirements in the field in which the applicant is pursuing certification, the applicant shall be required to pass appropriate examinations planned to evaluate an understanding and application of the osteopathic principles and techniques involved in the practice of the field, of the scientific basis of the problems involved in the field, a familiarity with the current advances in the field and the possession of sound judgment and a high degree of skill in the diagnostic and therapeutic procedures involved in the practice of the field. Section 2. Examination Content The completion of a proctored cognitive assessment examination consisting of multiple-choice items is required in each field. Additional exam formats, such as an oral exam, practical exam, etc., may also be required. Exam requirements and content are specified within the application appropriate to that area of certification. Section 3. Application For Exam Applicants must submit the required application, fees and supporting documents within the established deadlines as determined by the board or the appropriate conjoint examination committee. Page 12

Section 4. Examination Fees A. The appropriate fee must accompany the application and supporting documents. A fee schedule will be provided with the application. Late fees will be imposed on applications accepted at the prerogative of the Board after the deadline. Nonrefundable fees will be retained from refund requests. B. A processing fee shall be retained by the Board and is non-refundable if the applicant is denied examination or withdraws. C. If an applicant fails any part of the examination for certification, the fee for reexamination shall be determined by the Board. D. A rescheduling fee will be assessed to a candidate canceling a scheduled administration. Section 5. Applicant Approval Candidates will be notified by US mail of the approval and acceptance of their application and scheduling for examination. A final examination schedule, summary of the examination components and process, and other information pertinent to evaluation and certification will be sent 6-8 weeks prior to the exam date. Section 6. Examination Opportunities The AOBFP Policy and Procedure for re-examination is found in Article XIII of this document. Section 7. Unprofessional Conduct Any irregular behavior that constitutes unprofessional conduct in regards to the application or registration for, the taking of, or the conduct after taking any examinations subject to AOBFP policies could result in invalidation of an examination or disqualification. This includes copying, fraud, or sharing of any examination content or material, use of prohibited reference materials during the examination, and verbally or physically harassing any AOBFP board member, examiner or staff at any time. Article XII. Rules for the Conduct of Examinations Section 1. Examiners The Board will serve as examiners or observers and appoint associate examiners as necessary, who shall be diplomates of this Board. Section 2. Examination Evaluation Passing standards are established by psychometric evaluation after each examination administration and are approved by the AOBFP. Section 3. Notification To Applicants A. The AOBFP will follow the procedures outlined in Article VIII of the Policies and Procedures of the BOS. Page 13

B. Candidates fulfilling all requirements and passing the examination will be recommended to the BOS of the AOA for certification, recertification, or certification of added qualifications status. The AOA is the certifying body and will inform recipients by letter of certification status. C. Past or current residents completing the initial certification exam, whose training has not yet been approved by the American College of Osteopathic Family Physicians (ACOFP) by approval of residency paperwork, will not receive a final score nor be presented for certification until that approval is granted. Pass/fail information, however, will be provided. Article XIII. Reexamination Section 1. Reexamination An applicant who has failed may apply for reexamination at the next scheduled exam. Retake examinations of the written and/or practical sections (7/01) are limited to two administrations prior to further board review (2/94) with a recommendation for further educational requirements (3/01). Section 2. Cancellation And Rescheduling Failure to appear for a scheduled examination will be regarded as a cancellation. A rescheduling fee will be charged for any cancellation. Failure to cancel from a scheduled electronic examination by the published deadline will result in charges for the testing center seat fee as well as a rescheduling fee. These fees represent administrative costs to the Board. Section 3. Withdrawal Withdrawal is defined as withdrawing from the examination process. A new application, fee and appropriate documentation in effect at that time must be filed for future examination. In the event of withdrawal of an application, an administrative fee will be charged and the balance of the examination fee will be refunded. Article XIV. Certificates Section 1. Process The AOBFP will issue and maintain certificates of certification and recertification in accordance with the Policies and Procedures of the BOS. Section 2. Certificate Dates Primary Certification The date carried by primary certification certificates shall correspond with the date on which successful completion of all Board requirements is confirmed by the Board. All primary certifications issued after March 1997 shall be time-limited to eight (8) years. The certificate will expire on December 31 of the eighth year following issuance of the certificate. Lifetime primary certifications issued prior to this date without a time limit, will remain in effect. Section 3. Certificate Dates Certification of Added Qualifications The date carried by certification of added qualifications (CAQ) certificates shall correspond with the date on which successful completion of all Board requirements is confirmed by the Board. All certification of added qualifications certificates are time-limited to 10 years. The certificate will expire on December 31 of the tenth year following issuance of the certificate. Lifetime certificates which were issued prior to this date without a time limit will remain in effect. Page 14

Section 4. Certificate Dates Recertification Certificates Recertification certificates in family medicine/omt will be awarded to successful candidates upon the expiration of their original certificate with an expiration date eight (8) years thereafter. Section 5. Inactivation, Revocation, Reinstatement, and Reactivation The AOBFP will follow the procedures regarding certificate inactivation, revocation, reinstatement and reactivation in accordance with Article XI of the Policies and Procedures of the BOS. Section 6. Verbiage The certificate language shall reflect certification in family medicine and osteopathic manipulative treatment, as approved by the AOA Board of Trustees in July 1999. Reissued certificates with this language are offered at a fee to those physicians certified prior to the approved change. (6/00) Section 7. Maintaining Certification A. In order to maintain his/her certificate, a diplomate must: 1. Be a member in good standing of the American Osteopathic Association or the Canadian Osteopathic Association, and 2. Pay the annual certification registration fee, unless classified as inactive, and 3. Maintain a minimum of 150 hours of approved and documented AOA continuing medical education credits within a three-year period, at least one-third of which shall be in their general specialty (category I or II). B. Specialty Practice Requirement (2/09). A diplomate is not eligible for annual certification registration of his/her certificate if it is determined by the AOBFP that the diplomate does not qualify within reason as a practicing physician in the particular specialty, subspecialty and/or areas of added qualifications under the regulations and requirements of the AOBFP. The AOBFP shall notify the secretary of the BOS of any such disqualified diplomate so that appropriate action may be taken by the BOS and the Board of Trustees. C. Recertification in areas of added qualifications requires maintenance of valid primary certification in family medicine from which the added qualification was modified. (2/96) Article XV. Osteopathic Continuous Certification Section 1. In order to enter the OCC process, the applicant must meet the following minimum eligibility requirements for recertification in family medicine and osteopathic manipulative treatment and the caq field if applicable. A. Hold a valid AOA certification, recertification, or a CAQ certificate. B. Currently practice as a family physician or as a family physician with emphasis in an emphasis in an applicable CAQ field. Page 15

C. Conform to ethical and moral standards as set forth in the AOA Code of Ethics. Section 2. Osteopathic Continuous Certification (OCC) is the process by which the American Osteopathic Board of Family Physicians (AOBFP) will assess its diplomats on an ongoing basis to ensure that family physicians remain current within their specialty. The Bureau of Osteopathic Specialists of the American Osteopathic Association has determined that by year-end 2012 its eighteen specialty boards must develop and implement an OCC process, which will provide certified physicians with the opportunity to evaluate and improve their knowledge base, facilitating the incorporation of evidence-based medicine into their practices. The goal of the process is to provide enhanced patient care and a consistent method for the evaluation of osteopathic care. A transition schedule for moving those already certified/recertified by the current process into the OCC process to be initiated in 2013 is addressed later in this document. The OCC process will be mandatory for those holding time-dated certificates. The process will be strongly encouraged for those with non-time dated certification (certificates dated prior to march 1997). Consideration will be given to an alternate process for those physicians in an academic setting. The components of the OCC process include: Component 1 Unrestricted Licensure A candidate must hold an unrestricted license to practice medicine in a state or territory of the United States. An applicant that has a restricted license may petition the board for the ability to enter the OCC process based upon review of the reason for licensure restriction. The status of a diplomate s licensure will be verified throughout the cycle by requesting a copy of the license with each completion of a OCCAP measure set and prior to the completion of the cognitive portion of the exam. Component 2 Lifelong Learning/Continuing Medical Education A candidate will maintain ongoing CME requirements validated by the AOA. In addition to the basic requirements established by the AOA for membership (120 credits with 30 in 1-A), the AOBFP requires an additional 30 family medicine credits, which may be acquired in any category, for a total of 150 credits per three-year CME cycle. A minimum of 50 credits per three-year cycle must be in the primary specialty area. The category and number of credits applicable to the primary specialty is determined by the AOBFP. Component 3 Cognitive Assessment - (Years 7-8 of 8-Year Certificate Term) Part 1: A candidate must successfully complete a proctored, computerized examination every eight years, which will be offered twice yearly at regional test sites located throughout the united states. The exam may be completed up to two years prior to the expiration of the certificate (in the seventh or eighth year of the candidate s certificate cycle). Recertification will be awarded upon the expiration of the current certificate held by the physician. The examination is based on the results of a work force task analysis Page 16

conducted as a portion of the standards review process required by the bureau of osteopathic specialists and tests knowledge and problem-solving ability relevant to family medicine. Part 2: The osteopathic manipulative treatment (OMT) performance examination is required of every certification and recertification candidate. This is a standardized assessment of a candidate s competence in performing OMT. This will be offered twice yearly at the spring and fall convention sites. The candidate must complete this OMT performance examination once in the eight year certification cycle, and it may be taken up to two years prior to the completion of the cycle. Failure to pass both parts of the cognitive examination by the end of the OCC cycle results in the loss of certification. Unsuccessful candidates are allowed two retake examinations thereafter, and the board will further review the candidate file if the candidate is unsuccessful after those retake examinations. If the failure/s is/are at the end of the 8-year recertification period, the candidate s certification will be inactivated. The OCC cycle will not begin again until the candidate successfully completes the cognitive examination and is awarded recertification. The candidate would then be required to complete measure sets and educational modules within the specified timeframe, as will be required of all physicians in the OCC process. Component 4 Practice Performance Assessment and Improvement The candidate will demonstrate performance improvement in knowledge and skills; scores may be compared to national benchmarks and standards of care based on documented evidence. This component, Osteopathic Continuous Certification Assessment Program (OCCAP), is a disease state management practice specific evaluation. This will be based on data abstraction of specific disease state management parameters such as is done in the traditional CAP submission. The difference between OCCAP and CAP is that the OCCAP data will be the sole property of the AOBFP and will not be used for reporting to other agencies. Acceptable standards will be determined by the AOBFP. Those who fall below those standards will need to remediate by completing an educational process and resubmit data after this remediation that demonstrates performance improvement. Module Completion Components and Timeline 1. Each certification cycle (years 1 thru 6 of 8-year certificate term) a. Each diplomat must complete a total of four OCC modules in six years. Two modules must be from the currently listed OCCAP subject areas and require the completion of OCCAP measure sets (chart abstraction) or the use of another assessment tool that provides performance data demonstrating practice performance improvement. The professional activity pathway chosen will determine how the remaining two required modules are fulfilled. b. Examples of current CAP modules include: Diabetes Mellitus Page 17

Coronary Artery Disease Women s Health Hypertension and Metabolic Syndrome Chronic Obstructive Pulmonary Disease Asthma Low Back Pain Explanatory note- only two modules will be offered initially (diabetes mellitus and low back pain). Others will be offered in future cycles as they are developed. 2. Each three-year cycle requirement All candidates are required to complete two (2) three-year cycles (years 1-3 and 4-6 of 8-year certificate term) a. There are three (3) pathways in which a diplomat may meet this requirement based on their professional activity. i. Full Scope Clinical Practice 1. Family physicians not meeting the requirements in ii and iii below. 2. Protocol for each three-year cycle a. Completion of two OCC modules. b. One module will be an OCCAP module (information regarding the OCCAP process can be found under a separate OCCAP portal on the AOA web site). i. An OCCAP measure set will be completed (data from 20 charts is entered for the measure set) for each OCCAP module; ii. Candidate will receive performance analysis report from the AOA; iii. Completion of one attended or web-based AOBFP approved educational unit referable to this module (to be completed between 1st and final chart data entry); iv. Completion of an AOBFP web-based exam for each module based on the educational unit; v. Results will be reported to candidate from AOBFP; vi. Failure will require remediation per AOBFP vii. Candidate enters final chart data from an additional 20 charts for measure set; viii. Candidate will receive a comparison report from the AOA. This data will be trended by the AOBFP. c. Completion of one designated AOBFP OCC module covering either communication or cultural competency. One to be done in one 3 year cycle and the other to be done in the other 3 year cycle. Page 18

i. Completion of one attended or web-based AOBFP approved educational unit referable to this module. ii. Completion of an AOBFP web-based exam for each module based on the educational unit. iii. Results will be reported to candidate from AOBFP. iv. Failure will require remediation per AOBFP. ii. Limited Scope Family Medicine Practice (must provide documentation to AOBFP verifying limited practice) 1. Family physicians devoting 90% or greater of time in clinical practice of non OCCAP areas (i.e. Occupational medicine, sports medicine, wound care, etc.), will be allowed to submit practice performance data specific to their area of clinical practice. The format of the data for the module relative to clinical practice must be submitted for AOBFP approval at the time of application. 2. Protocol for each three-year cycle requirement a. Completion of one educational module in topic area relative to their clinical practice i. At the time of application, the candidate will complete and forward to the AOBFP for approval an assessment tool that provides performance data demonstrating practice performance improvement in the specific content are of the module (see 4- family physicians wishing to complete component 4 of OCC). b. Completion of one designated AOBFP OCC module covering either communication or cultural competency. One to be done in one 3-year cycle and the other to be done in the other 3-year cycle. i. Completion of one attended or web-based AOBFP approved educational unit referable to this module; ii. Completion of an AOBFP web-based exam for each module based on the educational unit; iii. Results will be reported to candidate from AOBFP; iv. Failure will require remediation per AOBFP. iii. Non Clinical Practice 1. Family physicians who may qualify for this process include, but are not limited to: a. Family physicians in academic positions such as directors of medical education, academic deans, associate deans and assistant deans; b. Family physicians who are health care executives or medical directors; Page 19

c. Family physicians who are federal employees (i.e. physicians employed by the veterans administration) and may be restricted by law from abstracting practice data; d. Family physicians who serve as faculty in MBA or other administrative educational programs. 2. Protocol for each three-year cycle requirement: a. Diplomats wishing to be considered under the Non-Clinical Practice Category must petition the board for consideration. b. Completion of one OCC module in topic areas relative to their activities. i. At the time of application, the candidate will complete and forward to the AOBFP for approval an assessment tool that provides performance data that demonstrates practice performance improvement in the specific content area of the module. (see 4-- Family Physicians Wishing To Complete Component 4 of OCC). c. Completion of one designated AOBFP OCC module covering either communication or cultural competency. One to be done in one 3-year cycle and the other to be done in the other 3-year cycle. i. Completion of one attended or web-based AOBFP approved educational unit referable to this module; ii. Completion of an AOBFP web-based exam for each module based on the educational unit; iii. Results will be reported to candidate from AOBFP; iv. Failure will require remediation per AOBFP. 3. Phase-In Requirements Starting With Initiation of OCC Process Jan. 1, 2013 thru Dec. 31, 2020. (as of Jan. 1, 2021, this phase in requirement will sunset.) a. For those diplomats with certificate expiration dates in 2019 or 2020 - completion of four OCC modules will be required prior to their next recertification. b. For those diplomats with certificate expiration dates in 2016, 2017, or 2018 - completion of two OCC modules will be required prior to their next recertification. c. For those diplomats with certificate expiration dates in 2013, 2014, or 2015 - no modules will be required until next recertification cycle 4. Family physicians wishing to complete component 4 of OCC under ii or iii above (limited scope family medicine practice and non-clinical practice pathways) must apply in writing to the AOBFP during the first year of their recertification cycle for approval of their pathway status and approval of the format of performance data. Clear documentation of the inability to extract practice data is the responsibility of the candidate for recertification and must accompany the written application. AOBFP will charge an additional fee for non-occap modules. Page 20

5. If a candidate fails to meet the first 3 year cycle requirement, their certificate will lapse after the 4th year of their OCC process. If a candidate fails to meet the second 3-year cycle requirement, their certificate will lapse after the 7th year of their OCC process. 6. For candidates whose certificates have lapsed, in order to be reinstated in the OCC process, the candidate must complete two OCC modules in 1 year. After completion of two modules they will be eligible to apply to take the cognitive and performance examination. This must be done within one year of completion of the modules. Successful completion (including passage of both exams) will allow the candidate to be reenrolled in the OCC cycle as outlined in the AOBFP Website. Acceptance of Non-OCCAP Assessments A process for accepting pertinent non-occap participation in practice performance assessment will be developed for physicians seeking recognition of these activities for OCC. Other activities including NCQA, Patient 360, and similar programs offered by the AAFP or the ABIM will be vetted by the board relative to content deemed appropriate for inclusion in the continuous osteopathic certification process. The conversion of data necessary to be compatible with OCCAP data is at the cost of the candidate. The OCCAP alternative activities must be statistically sound, reproducible and psychometrically valid; OCCAP measure sets, and performance levels, will be available to vendors to allow construction of similar metrics within their product. Duplication of Osteopathic Continuous Certification Assessment Program (OCCAP) The candidate may duplicate the OCCAP information (chart abstractions) for submission to the AOA CAP (CAP for PQRS) to be used for pay for performance criteria. Currently the AOA CAP supports physician quality reporting system (PQRS) reporting for payment from CMS and will make reasonable efforts to accommodate other payment programs as identified. If and only if the candidate wishes his entered data to be shared with another vendor (so as not to duplicate work) will that be possible. The information may also be duplicated for submission to the AOA CAP (CAP for physicians), resulting in 20 1-B CME hours awarded by the AOA for each measure set completed. It is the candidate s responsibility to consult with the AOA, prepare and submit the data, and pay their fees (CAP participation) for the duplication of information for other programs. OCC Reentry Process For physicians whose time-limited certification has been deemed inactive for any reason may petition the Certification Compliance Review Committee to reactivate the certification. This process also applies to non-clinical and academic physicians reentering clinical practice and to former non-time-limited certificate holders who did not maintain their board certification as required. A. Physicians reentering the certification process within three (3) years of the expiration or inactivation of their certification may reenter the process by sufficing any outstanding OCC requirements not fulfilled when the certification became inactive. The date of certification will be effective on the date that all requirements have been satisfied. B. Physicians wishing to reenter the certification process three (3) or more years following the expiration or inactivation of their certification must take the AOBFP component 3 cognitive Page 21

assessment at the next available administration and immediately begin the OCC process through participation in a Component 4 activity. Additional remedial activities such as training or CME may be required by the AOBFP. Component 5 Continuous AOA Membership A candidate must have been a member in good standing of the American Osteopathic Association or the Canadian Osteopathic Association for a continuous period of at least two years immediately prior to the date of initial certification application and examination and continuously thereafter. The status of a diplomate s AOA membership will be verified throughout the cycle by requesting verification of membership with each completion of an OCCAP measure set and prior to the completion of the cognitive portion of the exam. Section 3. Recertification History The American Osteopathic Board of Family Physicians began a voluntary recertification process in November 1994. Unsuccessful completion of OCC will not result in the revocation of original certification in family medicine and osteopathic manipulative treatment for diplomates holding a nontime-limited certificate. (2/09). Recertification in family medicine and osteopathic manipulative treatment is required every eight years for those with certificates dated March 1997 and later. Recertification every ten years in certification of added qualifications (CAQ) fields is mandatory. Section 4. Notification of Recertification Deadline The AOBFP will, as its work schedule allows, notify diplomates with expiring certificates at least one year in advance of that expiration. The diplomate, however, is responsible for maintaining a schedule of exams. Exam dates and applications are available on the board website. Article XVI. Appeals Section 1. Right of Appeal In the event a candidate feels that the actions of this Specialty Certifying Board, with regard to the examination s administration, constitute unequal application of the regulations and requirements or standards, unwarranted discrimination, prejudice, unfairness or improper conduct of the examination, he/she has the right to appeal to this Specialty Certifying Board. Section 2. Non-Appealable Issues The AOBFP will not consider appeals addressing examination content, exam evaluation, or the determination of the minimum passing score. Section 3. Submission of Appeal A candidate must submit in writing a signed statement addressing the basis for the appeal. This must be submitted to the board in writing and postmarked no later than thirty days (30) after the date of the exam result letter from the AOBFP. Section 4. Levels of Appeal If the candidate is not satisfied with the results of an appeal before this Specialty Certifying Board, he/she has the right to further appeal to the BOS and the AOA Board of Trustees. Page 22