State Laws Restricting Maintenance of Certification

Three decisions, three decision-makers

The phrase “MOC requirement” conceals the fact that at least three unrelated bodies can impose one, for unrelated reasons, under unrelated law.

The licensing board decides whether a physician may practise at all. In California that is the Medical Board, and its continuing-competence mechanism is continuing medical education under Business and Professions Code section 2190 — not certification. This is the decision most MOC statutes address, and in most states it was never the source of the problem.

The hospital decides who holds privileges and medical staff membership. Those criteria come from medical staff bylaws, which are private instruments developed by the medical staff and approved by the governing body. A bylaw requiring current certification is a private eligibility rule.

The payer decides who participates in a network. Credentialing criteria are contractual terms set by health plans and insurers, constrained by insurance regulation rather than by the Medical Practice Act.

A physician who loses certification does not lose a licence. They may lose privileges, and they may lose panel participation, and either can end a practice. That is why a statute directed only at the licensing board can be entirely accurate as drafted and almost entirely beside the point in operation.

Washington’s statute, read closely

RCW 18.71.083 is short enough to read whole and repays it. Subsection (1) provides that, except as provided in subsection (2), the commission may not require a physician to participate in a maintenance of certification requirement as a condition of licensure or license renewal. It then provides that the commission may allow a physician to fulfil licence renewal requirements through satisfactory participation in a recognised maintenance of certification programme.

Three drafting choices carry the weight.

The addressee is the commission. The prohibition binds the licensing body and nobody else. No hospital, no health plan and no employer is restrained by it. A physician in Washington who is told by a hospital that privileges require current certification has not encountered anything the statute prohibits.

The verb is “require.” Read with the second sentence, the section draws a line between compulsion and credit. The commission may not compel participation; it may accept participation as satisfying renewal. That asymmetry is deliberate and it is the model most of these statutes follow. A physician who maintains certification loses nothing; a physician who declines cannot be forced.

The object is licensure and licence renewal. Not privileges, not reimbursement, not employment. The statute’s own subject matter is the narrowest of the three decisions.

Where the protection stops

Subsection (2) is the part least often quoted and the most consequential. The section does not apply to board certification requirements or maintenance of certification requirements included in any of four instruments: a stipulation to informal disposition under RCW 18.130.172; an order issued to resolve a statement of charges under RCW 18.130.090; an order issued under RCW 18.130.160; or a reinstatement order issued under RCW 18.130.150.

Every one of those is a disciplinary instrument. Read together they mean the protection is available to a physician in good standing and withdrawn from a physician who is not. A certification requirement may lawfully be written into a stipulated disposition, into an order resolving charges, into a disciplinary order, and into the terms on which a licence is reinstated.

That is a coherent policy: the Legislature removed certification as a general condition of practising while preserving it as a remedial tool where a specific physician’s competence is in question. It is also a significant limit, because the moment a licence is genuinely at risk is the moment the statute stops helping.

Why the crediting sentence matters more than it looks

The second sentence of RCW 18.71.083(1) — permitting the commission to accept satisfactory participation in a recognised maintenance of certification programme as fulfilling renewal requirements — is easy to read as a minor administrative allowance. It does more than that.

It means the statute does not take a position on whether certification programmes measure anything worthwhile. A legislature that thought they did not would have no reason to let them satisfy a renewal obligation. What the statute objects to is compulsion by the state, not the content of the programmes. That framing is why these provisions attract support from legislators who hold quite different views about certification itself, and it is why they tend to pass in the permissive form rather than as prohibitions on private use.

It also creates a practical route that physicians frequently overlook. Where a jurisdiction credits certification activity toward continuing education, a physician who maintains certification for hospital or payer reasons may find that the same activity discharges part of the licensure obligation. The two systems remain legally distinct while overlapping in what they will accept as evidence.

California has not legislated here

California has no analogue to RCW 18.71.083. No California statute prohibits the Medical Board, a hospital or a health plan from conditioning anything on board certification or its maintenance. The Board’s continuing-competence requirement runs on continuing medical education under section 2190, and nothing in that article makes certification relevant to licensure in either direction — it is neither required nor prohibited as a condition.

The absence is worth stating positively rather than as a gap, because it determines where a California physician’s argument has to be made. A certification requirement imposed by a hospital or a payer in California is challenged, if at all, on the terms of the instrument that imposes it — bylaws, a participation agreement, an employment contract — and through whatever process that instrument provides. There is no statutory prohibition to invoke.

The bill that came closest, and did not pass

Assembly Bill 815 of the 2023–2024 regular session would have added Chapter 7 (commencing with section 1700) to Division 2 of the Health and Safety Code, together with Health and Safety Code section 1374.198 and Insurance Code section 10144.58. It proposed a provider credentialing board within the California Health and Human Services Agency to certify public and private entities for credentialing physicians in lieu of a plan’s or insurer’s own process, a standardised credentialing form that plans and insurers could not supplement with additional requests, and a 90-day verification timeline for provider contracts issued, amended or renewed on and after 1 January 2026.

AB 815 did not become law. Its recorded status is engrossed and dead; it was held under submission in committee on 15 August 2024. Anything describing a California provider credentialing board, a mandatory standardised credentialing form, or a statutory 90-day credentialing timeline arising from AB 815 is describing a bill that failed. That is worth stating plainly, because proposals in this area are frequently written about in the present tense during the session and the corrections rarely travel as far.

A separate and existing requirement should not be confused with it. California law already imposes a 60-day verification timeline on plans and insurers that credential providers of mental health and substance use disorder services, for provider contracts issued, amended or renewed on and after 1 January 2023. That provision was identified in the legislative analysis of AB 815 and was not read at source for this page; it is mentioned only to mark that the existing law and the failed bill are different things.

Reading a restriction in any state

Because these provisions are drafted to a common pattern, four questions dispose of most of them, and they can be answered from the text alone.

Who is the addressee? The board or commission, a hospital, a health carrier, or several. This single question determines whether the statute reaches the pressure a given physician is actually facing.

What is the prohibited act? Requiring participation, denying something on the basis of non-participation, or discriminating in some defined way. “May not require as a condition of X” is narrower than “may not discriminate on the basis of.”

What is the protected object? Licensure and renewal, medical staff membership and privileges, network participation, or reimbursement. A statute can name more than one, and most name only the first.

What are the exceptions? Disciplinary carve-outs of the Washington kind are common, and they remove the protection precisely where a licence is under threat. Others preserve requirements in existing contracts or apply only prospectively.

A statute that binds only the licensing board, prohibits only compulsion, protects only licensure, and lapses under discipline is a narrow instrument. It may still be the right instrument — state compulsion is a distinct objection from private preference — but a physician reading a headline about their state banning maintenance of certification should expect something considerably smaller than the headline.

What a restriction would have to reach to matter

Working backwards from where the pressure actually falls produces a short list of what an effective statute would have to address, and it explains why so few exist.

Medical staff bylaws. Legislating the content of bylaws means legislating the composition of a self-governing medical staff’s own eligibility rules, which runs into the structure of hospital governance rather than into credentialing policy.

Payer participation criteria. These are contract terms between private parties, and a state restricting them is regulating insurance rather than the practice of medicine. Where a plan is a self-funded employer plan, federal preemption raises a further question this page does not address.

Employment terms. A certification condition in an employment agreement is a bargained term, and the state instruments that reach employment terms in California — section 16600 on restraints, for instance — are aimed at different mischief.

The licensing board is, in other words, the easiest of the three to legislate about and the least important in practice. That is not an accident of drafting; it reflects which of the three a legislature can straightforwardly regulate.

Hospitals requiring more than licensure

A hospital that conditions privileges on current certification is doing something the law generally permits and that no California statute restrains. Two features of that arrangement are worth separating.

The first is that the requirement is an eligibility rule rather than a judgment about an individual. A bylaw provision requiring certification in the relevant specialty operates categorically: it does not assert that a particular uncertified physician is unsafe, and it is not a finding about anyone. That is what distinguishes it from peer review, which is individualised and carries procedural protections precisely because it is.

The second is that because it is a bylaw provision rather than a statute, it is amendable by the process the bylaws themselves provide. Where a medical staff wishes to accept alternative evidence of continuing competence, the route is amendment rather than litigation, and the decision sits with the medical staff and the governing body rather than with the Legislature or the Board.

What a hospital may not do is use a credentialing process as cover for retaliation against a physician who has raised a patient-safety concern. That is a different question, governed by Health and Safety Code section 1278.5, which expressly treats unfavourable changes in the terms or conditions of privileges as discriminatory treatment; it is treated on whistleblowing and retaliation.

Insurers using certification

Payer credentialing raises the same structural point in a commercial setting. A health plan setting participation criteria is exercising contractual freedom, and a physician excluded for lapsed certification has lost network access rather than any legal entitlement.

The regulatory constraints that do exist in California operate on process rather than on criteria — timelines for verifying a completed application, notification obligations, and the like. They govern how quickly and how transparently a plan must decide, not what it may decide. AB 815 would have gone further by standardising the form and prohibiting plans from requesting information beyond it, and it did not pass.

The exceptions are where these statutes are actually tested

Subsection (2) of the Washington provision repays a second look, because the four instruments it names are not an arbitrary list and the pattern generalises.

A stipulation to informal disposition is an agreed resolution reached without a full adjudication. A physician negotiating one may be offered terms that include obtaining or maintaining certification, and the statute expressly permits that. Because it is agreed rather than imposed, the physician is in the position of consenting to a condition the Legislature has otherwise forbidden the commission to require — which is coherent only if one reads the prohibition as directed at unilateral imposition rather than at the condition itself.

An order resolving a statement of charges and a disciplinary order are both adjudicated outcomes. Here the rationale is remedial: where a specific competence concern has been established, the board may require the specific remediation it thinks fit, and certification is available as one of the tools.

A reinstatement order is the most demanding context of the four, because a physician seeking reinstatement is asking to resume practice after it has been interrupted. A requirement to obtain certification as a condition of reinstatement is, in substance, a requirement to demonstrate current specialty competence through an external assessment before returning.

Taken together, the four exceptions mark the boundary of the policy. The state will not make a private credential a general condition of practising. It will use that credential as a remedy for an individual whose competence is genuinely in issue. A physician assessing what a restriction is worth to them should therefore ask not only what it prohibits but where it stops applying — and the answer, in the statute read at source for this page, is that it stops at exactly the point where the licence is at risk.

Journalists and the verification problem

The same three-decision structure creates a recurring reporting error, and it is worth setting out because the correction is not obvious from outside medicine.

A reporter checking a physician has ready access to exactly one authoritative public record: the licence. It is held by the state, its status is definitive, and disciplinary history attaches to it. Everything else that sounds like a credential — certification, privileges, network participation, fellowship in a professional society — is held by a private body and is not a public record in the same sense.

Two errors follow predictably. The first is treating a certification lapse as a regulatory finding. It is not: no public body has assessed anything, no process has occurred, and a physician whose certificate has expired remains fully licensed. Reporting a lapse as though it were a sanction misstates what happened by a considerable distance.

The second runs the other way — treating a clean licence as a complete answer. A licence in good standing establishes that the state has not acted. It does not establish that a hospital has granted privileges, that a specialty board has certified, or that any private body has assessed specialty competence at all.

The reliable questions are therefore narrow and separable. Is the licence current, and what does the Board’s record show? Which certifying organisation is being claimed, and does that organisation confirm the certificate is current? Is the claim being made in public material compliant with section 651(h)(5)(C) — that is, does the organisation satisfy one of the three tests, and does the full board name appear with comparable prominence?

The third question is the one most often skipped and the one most likely to be answerable from the material already in front of the reporter. A physician’s own website is evidence of what they claim, and California regulates that claim directly.

Verifying a physician’s credentials

One practical consequence of the three-decision structure is that the credentials a member of the public can verify and the credentials that actually gate a physician’s practice are not the same set.

Licensure is public and authoritative. A physician and surgeon’s certificate, its status, and any disciplinary history are held by the Medical Board of California and are the state’s own record. This is the only credential whose absence means the person may not lawfully practise.

Certification is private. Its status is held by the certifying organisation, and verification means asking that organisation. Because certification has no licensure effect, a lapse tells you about a private credential and not about a legal entitlement to practise.

Privileges and network participation are contractual. Neither is a public record in the way a licence is, and both can change without any regulatory event.

For anyone checking a physician’s standing — a patient, a journalist, a hospital — the ordering matters. The licence answers whether they may practise. Certification answers whether a private body has assessed their specialty competence and, under California’s section 651 rules, constrains what they may claim about it. Privileges and panels answer where they may work, and are the least visible of the three.

The common error runs in one direction: treating a certification lapse as though it were a licensure problem. It is not, and a physician in good standing with the Board who has allowed a certificate to expire has done nothing that affects their right to practise medicine in California.

Why this became a legislative subject at all

The structure described above raises an obvious question. If certification is private and licensure is public, and the two have always been distinct, why did legislatures start writing statutes about it?

The answer visible in the drafting is that the distinction had begun to erode from the licensure side. A licensing board that accepts participation in a private programme as evidence of continuing competence is doing something unremarkable. A board that requires it has effectively delegated a condition of practising to a private organisation — one that sets its own fees, its own assessment intervals and its own terms, and that answers to no public process.

That is a constitutional and administrative objection rather than an objection to assessment. It explains the shape of statutes like Washington’s with some precision: the prohibition attaches to compulsion by a public body, the permission to credit remains, and the exceptions preserve the board’s own remedial authority in individual cases. The Legislature removed the delegation without expressing a view on the programmes.

It also explains why so few of these statutes reach hospitals and payers. When a hospital requires certification it is not delegating public authority to a private body; it is a private body making its own eligibility decision. The objection that motivates the licensure provisions simply does not transfer, and a legislature that wanted to reach private credentialing would need a different justification and would be regulating a different thing.

What this means for a physician deciding whether to maintain certification

The legal position can be stated compactly, and it is more stable than the volume of commentary suggests.

Lapsing does not affect a California licence. It is not reportable as a disciplinary event, because it is not one. It does not restrict scope of practice, and it does not prevent a physician from describing the field they limit their practice to — a permission expressly preserved by section 651(h)(5)(C).

What it does affect is every private arrangement written to depend on it, and those consequences arrive on the private instrument’s own timetable rather than on any regulatory schedule. A bylaw may allow a grace period; a payer contract may not. The operative documents are the medical staff bylaws, the participation agreements and the employment agreement, and the answer for any individual physician is in those three places rather than in the Business and Professions Code.

And a physician who does lapse should audit their public material the same week. A website, directory entry or letterhead asserting a certification that has expired is a misrepresentation under section 651 from the moment the certificate lapses, regardless of how accurate it was when written — and that exposure is criminal, disciplinary and financial at once.

The three targets, side by side

Who can condition what on certification, and what constrains them

Decision	Governing instrument	Restricted anywhere?
Licensure and renewal	State medical practice act; in California, continuing education under Bus. & Prof. Code § 2190	Yes, in some states. Washington bars the commission from requiring it, subject to four disciplinary exceptions. California has no such provision and does not require certification either.
Medical staff privileges	Medical staff bylaws, approved by the governing body	Not by any California statute. Amendable through the bylaws’ own process.
Network participation	Participation agreements; insurance regulation constrains process, not criteria	Not by any California statute. AB 815 would have standardised the form and failed.
Public claim of certification	Cal. Bus. & Prof. Code § 651(h)(5)(C)	Regulated closely, and criminally. This is the one place California legislates directly.

Read down the last column, the pattern is the same one that runs through this whole subject. The state has said almost nothing about who may demand certification, and a great deal about who may claim it.

Enacted, proposed, failed: reading status before relying on anything

This is an area where the gap between what has been proposed and what is in force is unusually wide, and the commentary rarely marks the difference. AB 815 is the local example: a substantial, detailed bill with specific dates and mechanisms, written about while live, and dead since 15 August 2024.

Three status distinctions decide whether a provision matters. Whether a bill was chaptered settles whether it is law at all. Whether an enacted provision has reached its operative date settles whether it binds yet — a statute effective on a future date is law and does not yet apply. And whether implementing regulations have issued settles whether an agency-dependent scheme is workable, since a statute directing an agency to establish requirements does little until the agency does.

The practical rule for anything read about this subject is to check the chaptering before the content. A bill number without a chapter number is a proposal, however precisely it is described.

What this page does not decide

First, it does not survey the fifty states. It uses one statute, read at source, to show what these provisions typically do and do not reach. Other states have enacted provisions with different addressees — some reaching hospitals or insurers — and none of those was verified here. A physician relying on a restriction in another state needs that state’s current text.

Second, it does not address federal preemption of state regulation of self-funded employer health plans, which bears directly on any attempt to legislate payer credentialing criteria.

Third, the California 60-day mental health and substance use disorder credentialing timeline is identified from the legislative analysis of AB 815 and was not read at source.

Fourth, medical staff bylaws, the peer review process and the procedural rights attaching to privilege decisions are a separate body of law not stated here.

Fifth, no judicial construction of RCW 18.71.083 is cited, because none was verified in writing this page.

Sources

1. Rev. Code Wash. § 18.71.083 — official text: the commission may not require maintenance of certification as a condition of licensure or license renewal; may allow renewal requirements to be fulfilled through satisfactory participation; four disciplinary exceptions at subsection (2) referring to RCW 18.130.172, 18.130.090, 18.130.160 and 18.130.150. Enacted 2018 c 211 s 2.
2. California Assembly Bill 815 (2023–2024 Reg. Sess.) — bill text and status: would have added Health & Saf. Code Chapter 7 (commencing with § 1700), Health & Saf. Code § 1374.198 and Ins. Code § 10144.58. Engrossed — dead; held under submission in committee 15 August 2024. Cited to record that it is not law.
3. Cal. Bus. & Prof. Code § 2190 — continuing education as the licensure mechanism; certification is not mentioned.
4. Cal. Bus. & Prof. Code § 651(h)(5)(C) — what a physician may claim about certification; treated on certification: initial, continuing and maintenance.
5. Rev. Code Wash. §§ 18.130.090, 18.130.150, 18.130.160, 18.130.172 — the disciplinary instruments cross-referenced in RCW 18.71.083(2). Not read at source for this page.
6. Cal. Health & Safety Code § 1278.5 — discriminatory treatment includes unfavourable changes in the terms or conditions of privileges; referenced for contrast only and treated on whistleblowing and retaliation. Cal. Bus. & Prof. Code § 16600 — restraints on practice; referenced for contrast only and treated on restrictive covenants.
7. California 60-day credentialing timeline for mental health and substance use disorder providers, for contracts issued, amended or renewed on and after 1 January 2023 — identified in the legislative analysis of AB 815. Not read at source for this page.

Related analysis

• Certification: initial, continuing and maintenance
• Who controls clinical judgment
• Whistleblowing and retaliation
• Restrictive covenants in California physician employment