As noted above, considerable progress has been made in promoting licensure portability for both nurses and physicians, but much remains to be done if the U.S. is to achieve true licensure portability for health professionals. This report focused on licensure portability for physicians and nurses. However, great variation exists in the licensure laws for many other healthcare practitioners. Given the challenges of ensuring an adequate workforce, licensure
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National Governors Association, ACCELERATING PROGRESS: Using Health Information Technology and Electronic Health Information Exchange to Improve Care, page 33, 2008.
32 issues for these health professionals will need to be addressed, including related issues that go beyond cross-state practice to issues of scope of practice and harmonization of standards. With regard to nurses and physicians, a number of different strategies/activities are underway to advance licensure portability, some of which have been described above.
1. Criminal Background Checks: Not every state requires a CBC and thus some states that do may be reluctant to acknowledge the license of a state that does not require a CBC for either physicians or nurses. CBCs are requested by the state and performed by the Federal Bureau of Investigation (FBI). The applying nurse or physician is responsible for covering the fee for the CBC. The applicant must pay a fee for each separate state they intend to be licensed. The FBI can only share the results of the CBC with another investigative authority. The information may not be shared between state licensing boards. The CBC process is a significant barrier to obtaining multiple state licenses. As noted previously, the NCSBN is working with the FBI and the Department of Justice to explore more effective sharing of criminal background information through state adoption of the National Crime Prevention and Privacy Compact (NCPPC).
2. Independent Evaluations: Independent outside evaluations need to be performed of both the NLC states and the states that have adopted expedited endorsement. These evaluations would provide objective assessments of the impact of these licensure portability initiatives.
3. Implementation Toolkits: There is a need to develop better “tools” to assist states in the adoption of the NLC and expedited licenses. These toolkits should be web-based, interactive “manuals” that are based on the experience of successful states in adopting streamlined approaches to licensure. Ideally, they would also reflect the findings from the independent evaluations suggested above.
4. Harmonization of Standards and Reporting: Ultimately, the NCSBN and its member boards know that adoption of uniform core requirements will diminish concerns over disparate qualifications for licensure and promote adoption of the Compact. And even in single licensure states, adoption of the uniform requirements should contribute to improved quality of the nursing workforce. To this end, the NCSBN formed a committee to revisit its current uniform core licensure requirements and make recommendations for improving harmonization of these standards across states. The committee’s report is due to be released by August, 2010. The NCSBN is also working to expand state reporting to Nursys® to all licensure jurisdictions. This expansion should facilitate timely nurse and state board access to credential and disciplinary information, which are critical enablers to licensure portability.
As noted above, the FSMB is pursuing a variety of strategies to enhance deployment of expedited licenses and adoption of the Uniform Licensure Application. One of the issues being pursued by the State Alliance for e-Health is harmonizing the attestation clauses in the Uniform Licensure Application and expedited licensure criteria. The State Alliance for e-Health is trying to simplify the licensure process even further by coming up with uniform language for attestation clauses. Currently, states use
33 different attestation clauses in their applications. The goal is to bring together state board attorneys in certain states to develop consensus on uniform language for a core set of attestation clauses.
Licensure Portability Grants:
6. State Health Care Workforce Development Grants: The Affordable Care Act (PL111-148) authorizes a program of grants to states to engage in planning and implementation activities that are designed to address health care workforce issues within that state. The program is overseen by the National Health Care Workforce Commission (also established by the Affordable Care Act) and administered by HRSA. One of the issues that states may choose to address through this grant program is the potential that licensure portability has for addressing shortages of particular types of health professionals without needing to permanently recruit and retain individuals in those professions.
The American Recovery and Reinvestment Act of 2009 (ARRA), P. L. 111-5, provided additional funding to support licensure
portability initiatives. These grants will continue to focus on licensure issues for physicians. The FSMB and the Department of Regulation and Licensing, State of Wisconsin were awarded grants beginning in March 2010, for projects to be
completed by February 2012. The FSMB also had been awarded a 3-yr LPGP grant in September 2009. Both the LPGP and the ARRA Licensure Portability Initiative grantees will be monitored carefully to glean lessons learned. Future LPGP competitions will build on these lessons to revise and update the LPGP to better address barriers that have been identified above and those that are likely emerge. Licensure boards overseeing other health professions will be encouraged to apply for the program.
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