What times we are in! Providing clinical intervention and treatment can happen anywhere courtesy of telephonic platforms, plus virtual, remote, and digital products galore. Rural populations rely on these technologies to engage with their practitioners and even health plan case managers, whether for assessment or monitoring of the care process and resource linkage. Patient with disabilities can now access care with greater ease. Yet, there’s a BIG CATCH! Despite interstate practice being more norm than exception, significant obstacles exist for those persons rendering and accessing care.
The health and behavioral health workforce continues to be held hostage by lack of an inappropriate licensure portability structure. Care for consumers is obstructed amid a regulatory system that fails to account for the reality of our professional practice landscape.
Regulatory Realities Reduce Access to Care and Employment
Technology is only one driver of the need for professionals to practice across state lines. Society is more mobile than ever, both for clients and clinicians alike. Traveling practitioners (e.g., case managers, nurses, social workers) are commonly hired to fill employment gaps for staff on medical or family leave, and to mitigate workforce shortages. Yet, this sector of the workforce and their employers face chronic challenges with licensure delays, which only perpetuate barriers and limits to care for the public.
Throngs of licensed mental health providers are at the ready to provide sorely needed telehealth intervention across the states. However, care is often delayed and waiting lists for treatment grow from an antiquated licensure structure that limits one’s inability to practice across state lines. Military families move their state residence every few years and in doing so deal with financial difficulties imposed by licensure delays, and thus, employment. First responders may find their interventions are limited when disasters occur across state lines.
There are an endless list of challenges for the workforce and the public they serve. With minimal exceptions (e.g., licensed professionals who are military members, employed for military contractors), licensed professionals may only practice in the state(s) where they are licensed in good standing. How can licensed practitioners engage with their ethical and legal due diligence when their practice regulations interfere with their ability to do so?
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, such as behavioral health providers, case managers, and others who are licensed in one state can actively practice at that same level in other states which are part of the compact. The presence of a compact also reduces the economic burden faced by licensed individuals in dealing with multiple state licensure applications.
The practice of all licensed professionals is controlled by the law in the state(s) where each individual is licensed, typically by the practice act of each state. Scope of practice even supersedes academic degrees. For example, one might presume that as a Doctor of Behavioral Health, I am licensed to prescribe psychopharmacological agents to patients. However, prescribing medications is not included under the scope of practice for my licensure as an LCSW in the Commonwealth of Virginia. The scope of practice for any practitioner extends only to those activities that a person who is licensed to practice as a health professional is permitted to perform.
A change in the traditional licensure structure is mandated: one that allows health and behavioral health professionals to intervene across state and jurisdictional lines. Several professions have engaged in rigorous efforts to advocate for licensure portability through formal regulation.
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. In contrast, many employers believe licensure must be held in the professional’s state of residence only, instead of where a patient may reside or is receiving care. The Nurse Licensure Compact is actively on the move, and now covers 41 states. More information is accessible on the NCSBN website.
Social Work
The lack of licensure portability has been identified as a public
safety, workforce, and technology issue. The mandate is clear that the workforce responsible for providing the bulk of mental health services to society must be able to practice across geographic state borders. 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 official compact website. 4 states have fully approved the legislation: Missouri, S. Dakota, Utah, and Washington State. The Model Compact Bill must be approved by 7 states to be enacted in its entirety before its necessary infrastructure can be implemented, which is expected to happen 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, over 32 states have approved the Counseling Compact with the interactive map viewable on the compact site.
Compacts on the Move
In addition to the compacts listed, further 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 engage in advocacy efforts through their respective professional associations. Many of these entities have fierce public policy committees that work diligently to support interstate practice. In addition, contact 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!
What to find out more on Interstate Compacts, and the Do’s and Don’ts of practice across state lines?? Read Chapter 8 in The Ethical Case Manager: Tools and Tactics, available on Amazon.
Ellen's Interprofessional Insights 