Allied Health Professions Allied Health Professions and Licensure Effortsand Licensure Efforts

Can We Go for One National Can We Go for One National License?License?

NONO

Why Not?Why Not?

Feds don’t want itFeds don’t want it States want to keep itStates want to keep it *Decades of precedent*Decades of precedent

Licensure is to Protect the Health Licensure is to Protect the Health and Safety of the Citizensand Safety of the Citizens

of the Stateof the State Licensure regulates both the Practice of Licensure regulates both the Practice of

the Profession and those who render those the Profession and those who render those defined servicesdefined services

Must Define Parameters within the Scope Must Define Parameters within the Scope of Practice sectionof Practice section

Then must set standards/requirements for Then must set standards/requirements for those who will provide that scope of those who will provide that scope of practicepractice

Regulating the PracticeRegulating the Practice

Professions scope of practice can Professions scope of practice can vary state to state. vary state to state.

Meet the needs of the citizens: what Meet the needs of the citizens: what you can’t do in CA you could do in you can’t do in CA you could do in AlaskaAlaska

States, not the feds, set the States, not the feds, set the parameters what can and cannot be parameters what can and cannot be donedone

Regulating the PractitionersRegulating the Practitioners

Process applications -is it filled out right?Process applications -is it filled out right? Issue and renew licenses – have they Issue and renew licenses – have they

met the CEs requirements, etc? Is that met the CEs requirements, etc? Is that course really acceptable for a CE credit?course really acceptable for a CE credit?

Disciplinary complaints: must Disciplinary complaints: must investigateinvestigate

Provide procedural rights for practitioner Provide procedural rights for practitioner with disciplinary action takenwith disciplinary action taken

Collect the fees (States want the $$$)Collect the fees (States want the $$$)

Nurse CompactNurse Compact

Comes close to national license for Comes close to national license for nurses-sort of…….nurses-sort of…….

License issued in nurses resident License issued in nurses resident state; can work “off” of license state; can work “off” of license issued in one state in those states issued in one state in those states participating in Nurse Compactparticipating in Nurse Compact

Advocated by National Council of Advocated by National Council of State Boards of Nursing State Boards of Nursing

Nurses Participating in NC Nurses Participating in NC MustMust

Adhere to all state laws where practicingAdhere to all state laws where practicing

between states in relation to licensure /between states in relation to licensure /

re-registration requirements, such re-registration requirements, such

as mandatory continuing education,as mandatory continuing education,

criminal background checks, disciplinary criminal background checks, disciplinary

causes of action, and evidentiary causes of action, and evidentiary

standardsstandards

Since 1997 -21 states participate in Since 1997 -21 states participate in Nurse CompactNurse Compact

Requires each state legislature to Requires each state legislature to enact and change current laws- Not enact and change current laws- Not very eager very eager

American Nurses Association: American Nurses Association: “agrees to disagree” with details of “agrees to disagree” with details of the complicated NC processthe complicated NC process

State by State EffortState by State EffortWhat Do You Need to Have in What Do You Need to Have in

Place?Place? Professional InfrastructureProfessional Infrastructure

Strong State AssociationStrong State Association

Strong (Central) National AssociationStrong (Central) National Association

Professional InfrastructureProfessional Infrastructure

Are there enough practitioners to Are there enough practitioners to make a state by state case?make a state by state case?

Is there a rationale for patient safetyIs there a rationale for patient safety Licensure is NOT for professional Licensure is NOT for professional

enhancement or job securityenhancement or job security States want to license “professions” States want to license “professions”

not occupations or disciplinesnot occupations or disciplines

Profession= nationwide accredited Profession= nationwide accredited education/training programseducation/training programs

Are they educated the same; Are they educated the same; curricula the same?curricula the same?

Are there enough schools across the Are there enough schools across the country?country?

Consistent and valid competency testConsistent and valid competency test Are they all tested on the same Are they all tested on the same

content?content? States will use the professional States will use the professional

competency test as state licensure competency test as state licensure examexam

Cost of developing a state based test Cost of developing a state based test is $50Kis $50K

Strong State SocietyStrong State Society

Will lead the legislative effortWill lead the legislative effort Accept the fact it may take several Accept the fact it may take several

yearsyears Does the state society have the people, Does the state society have the people,

time, and money?time, and money? Leaders in the state will be the “face” Leaders in the state will be the “face”

of the profession to the legislatorsof the profession to the legislators Will have to convince rank and file to Will have to convince rank and file to

support licensure effortssupport licensure efforts

Need to have the support from other Need to have the support from other key licensed professions key licensed professions

Physicians are crucial, so are nursesPhysicians are crucial, so are nurses Already a powerful, influential factor Already a powerful, influential factor

in state health policy in state health policy Have legislators/policy makers earsHave legislators/policy makers ears

State hospital associations State hospital associations traditionally oppose licensing traditionally oppose licensing professionsprofessions

Argument: it will cost more moneyArgument: it will cost more money No proven evidence to that, but has No proven evidence to that, but has

impact anywayimpact anyway Therefore need other professions Therefore need other professions

(docs) support to offset(docs) support to offset

Most state societies are volunteer Most state societies are volunteer Lobbying is Lobbying is notnot their profession their profession Licensure effort takes timeLicensure effort takes time Many states if the can afford it hire state a Many states if the can afford it hire state a

lobbyist to spearhead effortlobbyist to spearhead effort Still need cohort of state leaders to carry it Still need cohort of state leaders to carry it

through- Gov’t/Leg Affairs Cmte.through- Gov’t/Leg Affairs Cmte. What are the financial resources of the What are the financial resources of the

state society? state society?

Communication SystemCommunication System

Must have a good communication Must have a good communication system in place system in place

Need to let members and supporters Need to let members and supporters know what is happening and when to know what is happening and when to make contact with their legislatorsmake contact with their legislators

Need to communicate with legislatorsNeed to communicate with legislators Internet vastly makes this easierInternet vastly makes this easier

Strong National AssociationStrong National Association

Act as ringmaster/cheerleaderAct as ringmaster/cheerleader May act as financierMay act as financier Develop a Model Practice Act, should Develop a Model Practice Act, should

use as a template in every stateuse as a template in every state Key to that: consistent scope of Key to that: consistent scope of

practicepractice Clearinghouse for support documentsClearinghouse for support documents Advice on what worked elsewhereAdvice on what worked elsewhere

Model Licensure Language will Model Licensure Language will change over timechange over time

Each state is uniqueEach state is unique Services provided may differ to some Services provided may differ to some

extent in different statesextent in different states Interested parties are different with Interested parties are different with

different agendasdifferent agendas Compromises will be madeCompromises will be made

State By State Licensure Takes State By State Licensure Takes TimeTime

Scope of Practice will evolveScope of Practice will evolve RTs licensed in the 1980’s no smoking RTs licensed in the 1980’s no smoking

cessation, telecommunications, Dx. cessation, telecommunications, Dx. Mgt.Mgt.

More focus on alternate site careMore focus on alternate site care patients leave hospital “sicker and patients leave hospital “sicker and

quicker”quicker” New disciplines emerge, overlap of New disciplines emerge, overlap of

practicepractice

Respiratory Therapy Respiratory Therapy ExperienceExperience

Model Practice Act developed as Model Practice Act developed as templatetemplate

Licensure first began in early ’80s Licensure first began in early ’80s Currently there are 48 states, DC and Currently there are 48 states, DC and

PR that are licensed. PR that are licensed. Hawaii and Alaska not yet licensedHawaii and Alaska not yet licensed Last state to gain licensure was Last state to gain licensure was

Alabama-2004Alabama-2004

Similarities among states:Similarities among states: Licensure requirements: graduates of Licensure requirements: graduates of

accredited schools of RTaccredited schools of RT Take the national credentialing exam Take the national credentialing exam

used as state licensure examused as state licensure exam Majority (but not all) of scope of Majority (but not all) of scope of

practice is the samepractice is the same

Examples of Political Examples of Political CompromiseCompromise

Under Medical DirectionUnder Medical Direction Supervision: only by a DocSupervision: only by a Doc Supervision: Doc, Nurse Practitioner, Supervision: Doc, Nurse Practitioner,

Physician Assistant (LA revised 2007)Physician Assistant (LA revised 2007)

Continuing ed: Continuing ed: 3 states none required (UT, CO, WI)3 states none required (UT, CO, WI) 24 biennially in Al, 12 biennially in RI24 biennially in Al, 12 biennially in RI

CompromiseCompromise

Scope of practice issuesScope of practice issues

ECMO: No way in NJ, absolutely in TXECMO: No way in NJ, absolutely in TX

Protocols: Can do in most states, only Protocols: Can do in most states, only in an emergency in OHin an emergency in OH

CompromiseCompromise

18 RC “Boards” are under Board of 18 RC “Boards” are under Board of MedicineMedicine

Most fully independent RC Licensure Most fully independent RC Licensure Bds.Bds.

Some are Advisory Councils rarely Some are Advisory Councils rarely meet, paid state staff administers and meet, paid state staff administers and addresses issues (WA)addresses issues (WA)

Regulatory AgenciesRegulatory Agencies

Depending on the state, some state Depending on the state, some state licensure boards have sweeping authority licensure boards have sweeping authority to “creatively” interpret the lawto “creatively” interpret the law

Others extremely restrained in what they Others extremely restrained in what they can docan do

Just the nature of the state government Just the nature of the state government psyche psyche

The way a state licensesThe way a state licenses

States like to follow similar formulaStates like to follow similar formula What did they do for other allied What did they do for other allied

health professions in the state?health professions in the state? License renewal: annual/biennial?License renewal: annual/biennial? Most now all follow same disciplinary Most now all follow same disciplinary

criteria (liability reasons) criteria (liability reasons) States make revisions that affect all States make revisions that affect all

licensure boardslicensure boards

Once licensure is gained must be Once licensure is gained must be tended to: new/revised regulationstended to: new/revised regulations

Advise state societies to fight the Advise state societies to fight the urge to tweak the law, can be a urge to tweak the law, can be a Pandora’s boxPandora’s box

Licensure Like a Chess Licensure Like a Chess GameGame

Get all the pieces on the board Get all the pieces on the board before you make your first movebefore you make your first move

And have patienceAnd have patience