This is one long title for a blog post. However, I wanted the intent of this blog post clear, as this question crosses my ethical lens on a regular basis!
The short answer is YES! The industry standard for professional case managers is that they should be licensed in every state that their patients are in. However, case managers across healthcare organizations, health plans and other practice settings are chronically put in that ethical and legal “hot seat” and asked to juggle employer mandates with professional requirements. The workforce is chronically set up for sanction by being told things like, “case management is coaching and does not involve assessment”. The inaccuracies of this statement couldn’t be farther from the truth!
The Answer Is: YES
Let’s face it, our case management workforce does it all, from providing resource information and arranging provider appointments to assessing for clinical intervention and treatment planning. CMSA’s Standards of Practice and ACMA’s Standard of Practice and Scope of Services are robust for a reason. Much is at stake for our patients and their families, and thus the role should not be taken lightly, especially for our employers.
One would think that in response to the scope of case management practice, the professionals involved would have the ability to legally engage, assess, facilitate care plans for, and support treatment planning for their patients, independent of their location. Yet, despite interstate practice being more norm than exception, significant obstacles exist for the workforce.
Uninformed organizations too often claim case management roles involve patient or caregiver coaching or education rather than assessment. Case managers might hear, “You don’t need to be licensed to call and check in on patients” or “Why would you need a licensure to make sure the patient has access to their meds”. However, as legal colleagues remind me, the majority of licensed professional transcend this reality once they engage with a patient, whether virtually, telephonically, or in-person. Independent of discipline, case managers are polite, take a minute to engage each person, then ask that question: “How are you today?”
There are times when a case manager calls to provide only basic resource information to patients. Those moments may not involve, or perhaps start with assessment, care coordination, facilitation, monitoring, or other identified elements of case management, but they can get there quickly. Unfortunately, this view is short-sighted and flawed thinking at best. This mindset limits a case manager’s role and impedes their success in ensuring a positive patient outcome.
Remember
- Be familiar with the scope of practice for each state where you hold licensure: It is the responsibility of each licensed professional to make sure they are working within the scope of their license. Every licensed discipline involved in case management has a practice act for their licensure level, which can be found on each state board’s website. Remember, license is issued by the individual state regulatory board versus an employer. The licensure board and scope of practice for that profession supersedes organizational policy.
- Some entities identify a mandate for case management certification with licensure, which is buried in each state’s regulations: Keep in mind case management credentialing (e.g., ACM, CCM, CMGT-RN) and licensure scope of practice are different. An increasing number of states require case management certification (e.g., Texas) and you should verify this reality with your state board. My nursing colleagues often query the National Council of State Boards of Nursing (NCSBN) who administers the NCLEX exam, about these state requirements. Traditionally, they will refer you to your primary state licensure nursing board and that state’s scope of practice regulations. The same will happen for my social work colleagues if they reach out to the Association of Social Work Boards (ASWB) who administer each level of each state’s social work licensure exam across the US and US territories, and Canada.
- If your employer can’t provide you documentation to validate your actions, it doesn’t exist: What do we always say about documentation? If it doesn’t exist, it didn’t happen. Well, the same mantra applies here. Every case manager should ask their employing organizations to provide documentation from each state board (and for all disciplines of case managers for their workforce) stating case management employees are able to practice without a license in that state. If they cannot produce that validation, then they are not doing their job.
- When in doubt, check your other Established Resources of Guidance: State practice acts are among several of the Established Resources of Guidance for case management. Also included are specific standards of practice, code of professional conduct, and ethical codes. CMSA’s standards A: Qualifications and C: Legal are clear about heeding requirements defined by respective licensure boards and scope of practice. The Principles and Rules defined by CCMC for Board-certified Case Managers are as clear in their guidance.
- If your clinical gut screams NO, LISTEN: Our case management workforce has clinical intuition that informs our practice. Most often case managers say, “I had a feeling this wasn’t right, but felt that my job was on the line”. I also get, “who is going to know if I cross the line?”; actually, the better question is, why would you want to take that risk? If you are unsure about whether you need to be licensed in a state or jurisdiction, reach out to that state board for your primary licensure. You can also reach out to your case management credential for an advisory opinion, seek guidance from your malpractice provider, as well as thought leaders, such as those in The Case Managers Community on Facebook.
Licensure Compacts on the Move
Licensure compacts are a viable solution for professionals seeking to be licensed in multiple jurisdictions and the that hire them. Through the compact structure, members of the workforce who are licensed in one state can actively practice at that same level in other states which are part of that compact. The presence of a compact also reduces the economic burden faced by licensed individuals in dealing with multiple state licensure applications.
The only exception to this quandary is for those individuals who are employed by or contracted with the DOD, VA, and several other governmental entities and covered by the National Defense Authorization Act. The current roster of happenings with the licensure compacts of interest for case managers.
Nursing
Nurses are required to be licensed in any state where they practice and where the recipient of nursing practice is located at the time service is provided. This fact is a common point of confusion for most licensed professionals—and especially tricky for those my case management colleagues. As was posted in the Case Managers Community by industry thought leader, Deanna Cooper, “When your case management position requires that the person be an RN, and you state you are functioning as an RN, then you must meet the license requirements in the states where your patients are located”; yup, that means licensure. Most employers will pay the cost of you obtaining and maintaining a license in those other states. The Licensure Compact is actively on the move, and now covers 41 states. Current info appears on the NCSBN website.
Social Work
The formal language for the Social Work Licensure Compact was released in February 2023, with legislation actively being introduced across state legislatures; 24 states have done so at the time of blog post with a current map viewable on the compact website. 12 states have approved the legislation at the time of this writing: Georgia, Iowa, Kansas, Kentucky, Maine, Missouri, Nebraska, S. Dakota, Utah, Vermont, Virginia, and Washington State, with more states having the legislation pass both houses and only awaiting signature by their governors. The Model Compact Bill has now been approved by the minimum 7 states required. The necessary infrastructure will now be implemented, in the coming months.
After verifying eligibility, individual social workers will then be granted a multistate license, which authorizes their ability to practice in all other compact member states, and removes those longstanding barriers to interstate practice.
Counseling
The American Counseling Association Counseling Compact calls for counselors licensed in one state who have no disciplinary record, to be eligible for licensure in any state or U.S. jurisdiction where they seek residence. Like other disciplines, laws that impact counselors (e.g., mandated reporting statutes) vary from state to state, so the compact recognizes how jurisdictions may require a state jurisprudence exam. At the time of this writing more than 32 states have approved the Counseling Compact with the interactive map viewable on the compact site.
Other Compacts on the Move
In addition to the compacts listed, information is available for those covering:
- The Audiology and Speech Language Pathology Compact (ASLPC)
- The Interstate Medical Licensure Compact (IMLC)
- The Occupational Therapy Compact (OTC)
- The Physical Therapy Compact (PTC)
- The Psychology Interjurisdictional Compact (PsyPact)
Individual practitioners must advocate to advance licensure through their respective professional associations. These entities have fierce public policy committees actively working toward interstate practice.
In addition, contact your local legislators to provide individual support for those licensure compacts of interest to you. Access your elected legislators through USA.gov. Remember, support for one interstate compact, leverages them all!
More information on Interstate Compacts and the Do’s and Don’ts of practice across state lines appears in Chapters 2 and 8 of The Ethical Case Manager: Tools and Tactics, available on Amazon.
Ellen's Interprofessional Insights 