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Allied Health Professions and Licensure Efforts

Allied Health Professions and Licensure Efforts. Can We Go for One National License?. NO Why Not? Feds don’t want it States want to keep it *Decades of precedent. Licensure is to Protect the Health and Safety of the Citizens of the State.

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Allied Health Professions and Licensure Efforts

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  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

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