Allied Health Professions and Licensure Efforts

1. Allied Health Professions and Licensure Efforts

2. Can We Go for One National License? • NO • Why Not? • Feds don’t want it • States want to keep it • *Decades of precedent

3. Licensure is to Protect the Health and Safety of the Citizensof the State • Licensure regulates both the Practice of the Profession and those who render those defined services • Must Define Parameters within the Scope of Practice section • Then must set standards/requirements for those who will provide that scope of practice

4. Regulating the Practice • Professions scope of practice can vary state to state. • Meet the needs of the citizens: what you can’t do in CA you could do in Alaska • States, not the feds, set the parameters what can and cannot be done

5. Regulating the Practitioners • Process applications -is it filled out right? • Issue and renew licenses – have they met the CEs requirements, etc? Is that course really acceptable for a CE credit? • Disciplinary complaints: must investigate • Provide procedural rights for practitioner with disciplinary action taken • Collect the fees (States want the $$$)

6. Nurse Compact • Comes close to national license for nurses-sort of……. • License issued in nurses resident state; can work “off” of license issued in one state in those states participating in Nurse Compact • Advocated by National Council of State Boards of Nursing

7. Nurses Participating in NC Must Adhere to all state laws where practicing between states in relation to licensure / re-registration requirements, such as mandatory continuing education, criminal background checks, disciplinary causes of action, and evidentiary standards

8. Since 1997 -21 states participate in Nurse Compact • Requires each state legislature to enact and change current laws- Not very eager • American Nurses Association: “agrees to disagree” with details of the complicated NC process

9. State by State EffortWhat Do You Need to Have in Place? • Professional Infrastructure • Strong State Association • Strong (Central) National Association

10. Professional Infrastructure • Are there enough practitioners to make a state by state case? • Is there a rationale for patient safety • Licensure is NOT for professional enhancement or job security • States want to license “professions” not occupations or disciplines

11. Profession= nationwide accredited education/training programs • Are they educated the same; curricula the same? • Are there enough schools across the country?

12. Consistent and valid competency test • Are they all tested on the same content? • States will use the professional competency test as state licensure exam • Cost of developing a state based test is $50K

13. Strong State Society • Will lead the legislative effort • Accept the fact it may take several years • Does the state society have the people, time, and money? • Leaders in the state will be the “face” of the profession to the legislators • Will have to convince rank and file to support licensure efforts

14. Need to have the support from other key licensed professions • Physicians are crucial, so are nurses • Already a powerful, influential factor in state health policy • Have legislators/policy makers ears

15. State hospital associations traditionally oppose licensing professions • Argument: it will cost more money • No proven evidence to that, but has impact anyway • Therefore need other professions (docs) support to offset

16. Most state societies are volunteer • Lobbying is not their profession • Licensure effort takes time • Many states if the can afford it hire state a lobbyist to spearhead effort • Still need cohort of state leaders to carry it through- Gov’t/Leg Affairs Cmte. • What are the financial resources of the state society?

17. Communication System • Must have a good communication system in place • Need to let members and supporters know what is happening and when to make contact with their legislators • Need to communicate with legislators • Internet vastly makes this easier

18. Strong National Association • Act as ringmaster/cheerleader • May act as financier • Develop a Model Practice Act, should use as a template in every state • Key to that: consistent scope of practice • Clearinghouse for support documents • Advice on what worked elsewhere

19. Model Licensure Language will change over time • Each state is unique • Services provided may differ to some extent in different states • Interested parties are different with different agendas • Compromises will be made

20. State By State Licensure Takes Time • Scope of Practice will evolve • RTs licensed in the 1980’s no smoking cessation, telecommunications, Dx. Mgt. • More focus on alternate site care patients leave hospital “sicker and quicker” • New disciplines emerge, overlap of practice

21. Respiratory Therapy Experience • Model Practice Act developed as template • Licensure first began in early ’80s • Currently there are 48 states, DC and PR that are licensed. • Hawaii and Alaska not yet licensed • Last state to gain licensure was Alabama-2004

22. Similarities among states: • Licensure requirements: graduates of accredited schools of RT • Take the national credentialing exam used as state licensure exam • Majority (but not all) of scope of practice is the same

23. Examples of Political Compromise • Under Medical Direction • Supervision: only by a Doc • Supervision: Doc, Nurse Practitioner, Physician Assistant (LA revised 2007) • Continuing ed: • 3 states none required (UT, CO, WI) • 24 biennially in Al, 12 biennially in RI

24. Compromise • Scope of practice issues • ECMO: No way in NJ, absolutely in TX • Protocols: Can do in most states, only in an emergency in OH

25. Compromise • 18 RC “Boards” are under Board of Medicine • Most fully independent RC Licensure Bds. • Some are Advisory Councils rarely meet, paid state staff administers and addresses issues (WA)

26. Regulatory Agencies • Depending on the state, some state licensure boards have sweeping authority to “creatively” interpret the law • Others extremely restrained in what they can do • Just the nature of the state government psyche

27. The way a state licenses • States like to follow similar formula • What did they do for other allied health professions in the state? • License renewal: annual/biennial? • Most now all follow same disciplinary criteria (liability reasons) • States make revisions that affect all licensure boards

28. Once licensure is gained must be tended to: new/revised regulations • Advise state societies to fight the urge to tweak the law, can be a Pandora’s box

29. Licensure Like a Chess Game • Get all the pieces on the board before you make your first move • And have patience