License Portability Research Articles

Examining State Licensing Requirements for Select Master's-Level Behavioral Health Providers for Children.

The authors examined licensing requirements for select children's behavioral health care providers. Statutes and regulations as of October 2021 were reviewed for licensed clinical social workers, licensed professional counselors, and licensed marriage and family therapists for all 50 U.S. states and the District of Columbia. All jurisdictions had laws regarding postgraduate training and license portability. No jurisdiction included language about specialized postgraduate training related to serving children and families or cultural competence. Other policies that related to the structure, composition, and authority of licensing boards varied across states and licensure types. In their efforts to address barriers to licensure, expand the workforce, and ensure that children have access to high-quality and culturally responsive care, states could consider their statutes and regulations.

LACE and the APRN Consensus Model: Implications for Advancing Nursing Practice.

Understanding the historical context and contemporary trends in advanced practice registered nurse (APRN) education and regulation is pivotal for effective professional advocacy. Until the release of the APRN Consensus Model in 2008, a uniform model for APRN regulation was lacking. Adopting the model's recommendations has implications for APRNs beyond licensure and regulation, including full practice authority, license portability, and patient access to APRN-led care. A comprehensive understanding of APRN education and regulation empowers nurses, APRNs, and stakeholders to drive the profession forward through informed advocacy.

Poster 396: Barriers and facilitators to national licensure for US medical professionals: what Covid has taught us and using sports medicine as a launch pad

Objectives: GLOBAL AIM: Increase license portability across state lines for all US medical professionals. SPECIFIC AIM: Increase the ability to provide medical care nationwide for all US sports medicine physicians (who have a CAQ for their specialty) across state lines and set a precedent for other licensed healthcare professionals by 2026. The aim is to extend the portability of medical licensure across state lines to all sports medicine professionals (not just those who care for professional teams) and use this as a precedent eventually for all types of healthcare workers. Currently sports medicine physicians for professional teams are allowed to provide care across state lines which is legislated by “The Sports Medicine Licensure Clarity Act” (SMLCA) in 2018. As July 22, 2022, licensure is allowed for at least telemedicine across state lines for 23 states and has been extended by the HHS as part of Covid healthcare measures that were implemented in 2020. Methods: Review of current policies, barriers and facilitators has been performed using various search strategies and qualitative techniques. Current state and national laws were reviewed and will be presented. California has a large population where there is no reciprocity for other medical professionals, therefore meetings have been set with the Business Professions Committee with a plan to submit a bill sponsored by a state assemblyman to expand access to licensure across state lines in 2023. Results: One barrier is the loss of states’ autonomy as well as the individual authority and stature a medical professional may gain from being on a licensing board. Most US states have no reciprocity and not all have the licensure process standardized. Some states have a non-transparent process and others do not wish to participate in regional compacts such as California. Even more concerning, some states are found to more-likely censure doctors of color and perform sham peer review. This is an example of bias in medical credentialing that can impede diversity and inclusion efforts. The European Union allows medical licensure across national borders. Doctors need to pass a language proficiency test for the country they wish to practice in, regardless of which European country they received their medical training. Given that English is the only language of instruction in the US, proficiency can be easily evaluated. Language should not be a barrier to license portability, especially if one is already licensed in one US state even for foreign medical graduates. The Covid pandemic showed licensure is obtainable in a relatively rapid fashion across state lines. In addition, federal health care facilities such as the VA system already allow practitioners licensed in one state to practice in another without a license to that specific state. Portability across state-lines aids practitioners who practice on state borders in both rural and urban areas, such as the NH and VT border(rural), and NY and DC metro areas (urban) as well as telehealth for both an immobile and mobile populations, enhancing equitable healthcare access. This also removes financial barriers of cost for licensing fees for practitioners and staff resources to process licenses. Conclusions: The US has one of the most restrictive medical licensures of all developed countries, making mobilization of healthcare workers extremely difficult. Removing this barrier will be beneficial when medical staff is needed across state lines for pandemics, natural disasters, intake of refugees/immigrants, and global sporting events held in the US such as the World Cup in 2026, and Olympics in 2028. This could also extend access for the general US population to healthcare providers via “tele-medicine” (virtual/video visits), to essentially all populations (socio-economically disadvantaged, immigrants, those with mobility and transportation barriers, rural locations etc). This will ensure higher quality care, better follow-up along with more timely and equitable healthcare, which are all currently limited by restricting portability and requiring licenses for each individual state.

Use of Communication Technology to Improve Clinical Trial Participation in Adolescents and Young Adults With Cancer: Consensus Statement From the Children's Oncology Group Adolescent and Young Adult Responsible Investigator Network.

Adolescents and young adults (AYAs; age 15-39 years) with cancer are under-represented in cancer clinical trials because of patient, provider, and institutional barriers. Health care technology is increasingly available to and highly used among AYAs and has the potential to improve cancer care delivery. The COVID-19 pandemic forced institutions to rapidly adopt novel approaches for enrollment and monitoring of patients on cancer clinical trials, many of which have the potential for improving AYA trial participation overall. This consensus statement from the Children's Oncology Group AYA Oncology Discipline Committee reviews opportunities to use technology to optimize AYA trial enrollment and study conduct, as well as considerations for widespread implementation of these practices. The use of remote patient eligibility screening, electronic informed consent, virtual tumor boards, remote study visits, and remote patient monitoring are recommended to increase AYA access to trials and decrease the burden of participation. Widespread adoption of these strategies will require new policies focusing on reimbursement for telehealth, license portability, facile communication between electronic health record systems and advanced safeguards to maintain patient privacy and security. Studies are needed to determine optimal approaches to further incorporate technology at every stage of the clinical trial process, from enrollment through study completion.

Toward Multistate Pharmacy Practice: Enhancing Mobility and Portability of Pharmacist Licensure.

Pharmacists are licensed in all 50 states. As society becomes increasingly mobile and interconnected, several models of cross-state pharmacy practice have emerged, straining the current state-based system of licensure. The nursing profession has provided a model for license portability that offers 3 primary advantages over the current pharmacist licensure model while still protecting safety: (1) faster speed, (2) lower cost, and (3) reduced administrative burden. A hybrid approach for the pharmacy profession that builds off of the expedited license transfer model and adds a mutual recognition model is ideal.

An Emerging Theory to Guide Clinical Social Workers Seeking Change in Regulation of Clinical Social Work

U.S. regulation of social work began in the 1940s. By the mid-1990s, all jurisdictions within the United States regulated the profession through licensure. One purpose of licensure is to protect the public and the profession; however, legislation defining social work varies vastly among jurisdictions. The variation exists not only between jurisdictions, but also within licensure categories. The disparity within clinical social work continues without resolve. This qualitative study explored the barriers encountered and solutions used in three states as they secured laws allowing licensed clinical social workers to independently provide mental health services. Grounded theory research, based on information from 12 historians, is used to develop a theory to aid advocates in jurisdictions not yet achieving fully independent practice of clinical social work. The emerging theory offers a complex-systems approach to using a strategic framework to overcome barriers when attempting policy change. The primary purpose of the research is to develop strategies that aid in securing changes in clinical social work regulation. The emerging theory may serve a broader purpose by supporting the Association of Social Work Board’s (ASWB) goal of practice mobility and license portability. As advocates in various jurisdictions attempt to align regulations with the Model Social Work Practice Act from ASWB, they may experience barriers. This emerging theory could guide efforts to change clinical social work regulation.

Legal Perspectives on Telemedicine Part 2: Telemedicine in the Intensive Care Unit and Medicolegal Risk.

Tele-intensive care unit (tele-ICU) implementation has been shown to improve clinical and financial outcomes. The expansion of this new care delivery model has outpaced the development of its accompanying regulatory framework. In the first part of this commentary we discussed legal and regulatory issues of telemedicine in general and expanded on tele-ICU implementation in particular. Major legal and regulatory barriers to expansion remain, including uncertainty regarding license portability and reimbursement. In this second part we discuss the effects of telemedicine implementation on the various aspects of medicolegal risk and risk mitigation, with a particular focus on tele-ICU. There is a paucity of legal data regarding the effect of tele-ICU implementation on medicolegal risk. We will therefore systematically discuss the effects of tele-ICU on the various root causes of medical error. Given the substantial capital and operational investment that must be undertaken to build and run a tele-ICU, any reduction in risk adds to the financial return on investment and further decreases barriers to implementation.

Licensure Portability Through an Ethical Lens: Considering Multiple Stakeholders

Counselors have been licensed to practice in all 50 U.S. states and the District of Columbia since 2009, but licensure portability (the ability to transfer a license from one state to another) remains elusive, due in large part to variations in educational and training requirements between states. In this article, we extend the American Counseling Association and American Mental Health Counselors Association counseling codes of ethics beyond the counseling relationship to consider license portability along ethical dimensions at the macro level. We apply an ethical decision-making model to demonstrate how lack of portability may have ethical implications related to both counselors and clients. We submit several considerations for how the profession can conceptualize and address these issues through an ethical lens.

Letter to the Editor: Licensure Portability for Occupational Audiologists is Essential.

Occupational audiologists have a crisis in their profession and need advocates. These audiologists are primarily responsible for industrial hearing conservation programs and their compliance with multiple regulations, such as Occupational Safety and Health Administration (OSHA), Mine Safety and Health Administration (MSHA) and the Federal Railroad Administration. Occupational hearing programs, for the most part, are multi-state programs as companies and corporations are national organizations. Also, companies may contract services across state lines as local services may not be desired or available. Individual state telepractice regulations require audiologists who are professionally supervising these programs via the internet and phone, to secure licensure in each state. For this licensure redundancy, the cost in time and tracking are enormous. It is imperative that the American Speech-Language-Hearing Association (ASHA), secure multistate licensure for speech-language pathologists and audiologists. For the profession of occupational audiology, it is essential.

2015 Representative Assembly Summary of Minutes.

Official Document| Online December 22 2015 2015 Representative Assembly Summary of Minutes Author & Article Information Online Issn: 1943-7676 Print Issn: 0272-9490 Copyright © 2015 by the American Occupational Therapy Association, Inc.2015 The American Journal of Occupational Therapy, 2015, Vol. 69(Supplement_3), 6913420020p1. https://doi.org/10.5014/ajot.2015.696S10 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation 2015 Representative Assembly Summary of Minutes. Am J Occup Ther November/December 2015, Vol. 69(Supplement_3), 6913420020p1. doi: https://doi.org/10.5014/ajot.2015.696S10 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentThe American Journal of Occupational Therapy Search Advanced Search Keywords: agenda, case managers, certified occupational therapy assistant, clients, ethics, military personnel, occupational therapists, reentry, rehabilitation, self-help devices The business of the 38th spring meeting of the Representative Assembly is presented here in summary. A complete copy of the official minutes can be obtained from the American Occupational Therapy Association (AOTA) website at http://www.aota.org/AboutAOTA/Get-Involved/RA.aspx or from the AOTA National Office. The Representative Assembly met on Thursday, April 16, 2015, in Nashville, Tennessee. The Assembly passed motions to establish two ad hoc groups: one to investigate the merits of establishing a professional license portability for the occupational therapy profession, and a second one to explore opportunities and challenges related to occupational therapy practitioners as case managers in existing and emerging practice areas with recommendations for strategies to support practitioners who perform case management functions as a major component of their work. In addition, the Assembly passed a motion to adopt a resolution that AOTA support access to and... Copyright © 2015 by the American Occupational Therapy Association, Inc.2015 You do not currently have access to this content.

The Case for License Portability.

All RNs sit for the same exam, so why not agree on licensure requirements?

A Survey and Review of Telemedicine License Portability

One of the major barriers to the practice of telemedicine is the state-to-state inconsistency and variability of requirements for physicians to obtain a medical license. Invitations were extended to 61 individuals, representing 21 companies and healthcare systems. The participants had to meet strict inclusion criteria. Health professionals who process well over 1,000 applicants a year were provided a 30-question survey asking about state medical boards and their assessment, including ease of obtaining a license as well as difficulties. Responses were received from 40 of 61 (66%) individuals. Responders ranked their expectations of state medical boards for the following qualities: responsiveness to questions, cooperation, willingness to expedite the application, and knowledge. Although 46% of respondents perceived the state medical board licensing to be reasonable, 54% reported a prolonged application process owing to variable requirements and a deficiency of board office assistance. When respondents were asked about difficulty in dealing with the state medical boards, the reasons listed included the following: failure to respond to e-mails or calls, failure to provide updates on missing content, lack of cooperation, lack of uniform process/consistency, provision of erroneous information, and failure to use the Federation Credentials Verification Service. Lost documents was a problem in that 79% had to resubmit documents that were lost. The rapid growth of telemedicine is consistently meeting resistance because of the timely, costly, and variable process of medical license portability. A survey of professionals who, combined, annually process over 1,000 applications revealed major disparities among states. The survey demonstrated delayed responsiveness by the medical board, lost documents, and lack of access online as to the current applicant's status. Many of the respondents felt a standardized process or even a national license was a viable solution. Several models for a solution are presented.

CACREP Accreditation: A Solution to License Portability and Counselor Identity Problems

A confluence of forces addressing counselor identity occurred with the 20/20: A Vision for the Future of Counseling initiative, the 2009 Standards of the Council for Accreditation of Counseling and Related Education Programs (CACREP), and the quest by the American Association of State Counseling Boards to establish license portability. This article provides a historical context for the profession's struggles with these issues, 1 state's experience, TRICARE's impact, and the role CACREP standards can play in their resolution.

Making the case for uniformity in professional state licensure requirements.

Telehealth, the use of communication and information technologies to deliver health services, was initially envisioned as a way for persons in rural or remote settings to receive otherwise unavailable healthcare services. Now, in addition to overcoming personnel shortages for underserved populations, telehealth shows promise in meeting the needs of a constantly mobile U.S. society and workforce. Fortunately, telerehabilitation can meet the needs of a mobile society and workforce by enabling continuity of care for individuals who are out-of-town, on vacation, in temporary residence as a university student, or on business travel. Unfortunately, outdated legislative and regulatory policies and inhospitable infrastructures currently stand in the way of a seamless continuum of care.In 2010, the American Telemedicine Association’s Telerehabilitation Special Interest Group (TR SIG) convened a License Portability Sub-Committee to explore ways to diminish barriers for state licensure portability with a particular focus on physical therapy, occupational therapy, speech therapy, and audiology. In 2011, the Subcommittee published a factsheet (1) that detailed the challenges and potential solutions that surround the difficult issue of licensure portability. Concurrently, the American Telemedicine Association is advocating for national reform of professional licensure. (2)At the heart of all licensure requirements is the ability to determine who should be granted the authority to practice in a particular profession. This is done by focusing on educational, examination and behavioral requirements that are deemed the minimum necessary to protect the public from harm. States, however, with whom authority for licensure of health professionals rests, have independently defined those minimum requirements. This approach has led to a myriad of requirements that vary from state to state.Licensure portability will best succeed when variability between licensure requirements is minimized and an efficient licensure process exists. In this paper, these two critical factors for licensure portability are referred to as “licensure requirements” and “the credentialing process.” Currently the variability between both of these factors is different between professions as well as between jurisdictions. To find the best solution to licensure portability, it is critical to determine which of these two elements create significant barriers for licensure mobility. This document outlines a method for the professions to begin collecting data to pinpoint the areas where agreement and variations exist in licensure requirements and processes between states. Such information will inform efforts towards uniformity.

The time has come for speech-language pathology license portability!

Melissa Jakubowitz, M.A., CCC-SLP is Vice President of SLP Services at PresenceLearning. A speech-language pathologist with over 20 years of clinical and managerial experience, Ms. Jakubowitz is a Board Recognized Specialist in Child Language. With a diverse clinical background, Ms. Jakubowitz began her career working in the public schools and has also operated a successful, multi-office private practice. She is a past Director of the Scottish Rite Institute for Childhood Language Disorders in Stockton, CA. She is also a past-president of the California Speech-Language-Hearing Association, which, with over 5, 000 SLP members, is one of the largest speech-language pathologist state associations in the country. Active in the American Speech-Language-Hearing Association (ASHA), Ms. Jakubowitz served as a Legislative Counselor for 12 years.

The Legal Framework for Meeting Surge Capacity Through the Use of Volunteer Health Professionals During Public Health Emergencies and Other Disasters

Recent events such as Hurricane Katrina and the global SARS outbreak underscore the importance of having public health and medical systems that are prepared to increase surge capacity in a variety of emergency scenarios. A core component to increasing surge capacity is the availability of skilled health professionals to supplement the existing health workforce. This article examines the legal context volunteer health professionals find themselves in during public health emergencies and disasters. In addition, the article makes several recommendations about how to refine the law to increase the availability of volunteer health professionals during public health emergencies and disasters. First, states should incorporate advance registration systems and protections for volunteers into laws that authorize emergency preparedness and response efforts. These laws should explicitly define the powers of state government during emergencies and clarify the legal provisions applicable to VHPs and the entities or organizations that may rely on them. Second, a floor of legal protections for volunteers is essential to achieve a minimum level of uniformity among the states and facilitate multi-jurisdictional cooperation in emergency response. Third, the scope and breadth of state based volunteer registries must be expanded to ensure comprehensive and coordinated emergency response efforts among states. Fourth, laws must ensure balanced civil liability protections for VHPs and their host entities by creating responsible immunity protections and alternative mechanisms to compensate injured patients. Fifth, states are encouraged to enact laws and regulations providing for license portability during emergencies. Sixth, VHPs should be vested with workers' compensation protections for injuries, disabilities, or deaths experienced while carrying out their duties. Finally, state and federal laws should confer robust privacy protections on volunteer registries, implement fair information practices to allow VHPs and patients to access and verify registry data, and simultaneously ensure responsible access to and use of registry information to mount an effective response.

License portability: Do we want it?

License portability: Do we want it?

The Future of Medical Licensure in the United States

Medical licensure in the United States is undergoing significant change. With calls for greater accountability and transparency, state medical boards and their membership association, the Federation of State Medical Boards (FSMB), are seeking ways to assure the public that physicians are maintaining their competence throughout the lifetime of their practice of medicine. At present, competence in cognitive, clinical, and communicative skills is regularly measured only at initial licensure. Yet, the public and policy-related organizations are demanding ongoing assessment of physicians' ability to safely and competently practice medicine. The author reports on activities that involve the FSMB and other national organizations, including the Educational Commission for Foreign Medical Graduates, in planning for a future of increased accountability and transparency of the licensing and regulatory communities that oversee the practice of medicine. He notes that topics of discussion include possible nationalization of what has been traditionally state-based licensure. He raises questions about a future that may include specialty-based licensure and greater national and even international license portability.

Medical Licensure and the Federation of State Medical Boards

The Federation of State Medical Boards (FSMB) is the membership association of the nation’s licensing regulatory authorities. The 70 member boards consist of representatives from each of the 50 states, 14 of the states having a separate board for osteopathic physicians. The 4 territories of Puerto Rico, Guam, the Virgin Islands, and the Northern Mariana Islands are also members. The final 2 members are Washington, DC, and a second board from New York. The state of New York is unique in that it has 2 seats in the House of Delegates of the FSMB because it has a board of discipline that reports to the Department of Health and a board of licensure that reports to the Department of Education. All other jurisdictions have a single reporting authority for licensing and regulation. The FSMB was formed in 1912 for the purpose of providing information to the various licensing authorities regarding disciplinary actions. The mission of the FSMB is to ensure continual improvement in the quality, safety, and integrity of health care through the development and promotion of high standards for physician licensure and practice. The FSMB is organized with a house of delegates that meets annually and establishes policy. The House of Delegates elects a 13-member board of directors from the membership, who have the responsibility of overseeing the work of the FSMB, including hiring the CEO who manages the organization and its 145 employees out of the offices in Dallas, Tex. The FSMB offers a number of services to the state medical boards and helps draft policy to improve the licensure and regulatory process in this country. Among those services is maintaining the nation’s largest database on disciplinary actions by physicians. In addition, the FSMB operates a disciplinary alert service in which state medical boards are notified any time a disciplinary action is taken against a licensee in that state. Approximately 80% of physicians who have disciplinary actions against them have licensure in multiple states. The disciplinary alert service provides notification to all the states in which a physician is licensed at the time of the disciplinary action. A data-sharing relationship with the American Board of Medical Specialties (ABMS) provides for notification also to the ABMS any time a diplomate of one of the specialty boards has a medical board disciplinary action taken against him or her.