Summary of the Ten Recommendations

Policy options for state consideration:

• Use the term "licensure" for public or state regulation of health professions title protection and practice acts.
• Use standard language in health professional licensing statutes including reference to:
  • title protection;
  • practice acts;
  • regulatory terms such as "supervision" and "delegation;" and
  • enforcement and discipline processes and outcomes, including uniform definitions of classes of alleged offenses, and phases in and outcomes of the adjudication process.
• Reserve the term "certification" for voluntary private sector programs that attest to the competency of individual health professionals.
• Identify and convene a body to codify regulatory terms and language. States should consider models for standardizing and adopting terms such as those employed by the National Conference of State Legislatures, the National Governors' Association, or the Council on Licensure, Enforcement and Regulation. This body should include representation from the regulated health professions, consumers, providers, and payers of health care.

Policy options for state consideration:

• Adopt entry-to-practice standards which are uniform throughout the fifty states for each profession.
• Adopt mutual recognition of licensure by endorsement legislation, even without uniform entry-to-practice standards.
• Cooperate with the relevant private sector organizations and with other states to develop and use standard competency examinations to test minimum competence for entry-to-practice. In developing these standards, states should resist reliance on accreditation or examination standards which do not directly and demonstrably relate to the minimum knowledge and skills necessary for safe and contemporary practice.
• Recognize alternative pathways in education, previous experience, and combinations of these, to satisfy some entry-to-practice requirements for licensure.
• Eliminate entry-to-practice standards which are not based on the competence, skills, training or knowledge of the professional.

Policy options for state consideration:

• Eliminate exclusive scopes of practice which unnecessarily restrict other professions from providing competent, effective and accessible care. States should ensure that the training, testing and regulating of health professionals allow different professions to provide the same services when competence -- based on knowledge, training, experience and skills -- has been demonstrated.
• Grant title protection without accompanying scope of practice acts to some professions. This would be appropriate for professions (e.g., massage therapy) which provide services which are not especially risky to consumers. Consumers will benefit from the assurance that the titled professional has met the state's minimum standards for initial and continuing competence.
• Allow individual professionals from one profession to expand their scopes of practice with an additional service or level of service found in one or more other professional practice acts through a combination of training, experience and successful demonstration of competency in that skill or service level.

Policy options for state consideration:

• Establish an interdisciplinary oversight board which has a majority of public members. The mission of this board should be to coordinate health professions regulation to meet an explicit state health policy agenda and provide oversight to ensure that the public's best interests are served. This board should have the authority to approve, amend or reject decisions made by individual boards.
• Consolidate the structure and function of boards around related health professional or health service areas. These consolidated boards should be dedicated to consumer protection and quality assurance. Such consolidated boards, for example, might be medical/nursing care, vision health care, oral health care, rehabilitation, mental health care or health technologies.
• Develop board membership profiles that include significant, meaningful and effective public representation to improve board credibility and accountability. States should evaluate the board member appointment process to ensure that all appointments are fair and accountable to the public. All board members should be carefully recruited, well-trained and supported.
• Staff and finance all boards and regulatory committees so that they can perform their missions effectively and efficiently. Support should include funding for appropriate technological needs.
• Compose boards with representatives of the state's urban, rural, ethnic and cultural communities. Boards should also include representatives from the health care delivery system.

Policy options for state consideration:

• Collect information about health professionals and make that information accessible and understandable to the public unless the law forbids disclosure or there is a compelling public policy reason that mandates confidentiality. The burden in disclosure decisions rests with those seeking to restrict access to information. The "compelling" criteria which prevents disclosure should be publicly available and specifically explained when an individual request is denied.
• Develop individual profiles for regulated health care professionals who deal directly with consumers. These profiles should include legally disclosable information about demographics, education, practice, employment, disciplinary actions, criminal convictions, and malpractice judgments.

Policy options for state consideration:

• Use regulatory mechanisms to collect a workforce data set to facilitate timely and informed workforce policy development. Regulatory agencies would not have the responsibility to analyze the data that they collect but, respecting disclosure and confidentiality laws, would share it with other public and private agencies.
• Work collaboratively with other public and private agencies that use such data for health policy planning to identify a standard health personnel data set which is comparable, compatible and accessible.

Policy options for state consideration:

• Require the regulated health professionals to periodically demonstrate competence through appropriate testing mechanisms. Competence assessment testing could be:
  • "triggered" by a variety of markers, including for example, the number of disciplinary actions, lack of specialty or private certification, length of time in solo practice, number of procedures performed, or other state-determined indicators; and
  • random or targeted peer reviews for practitioners.
• Cooperate with the relevant private sector organizations and with other states to develop and use standard continuing competency examinations to test minimum competence for continuing practice.
• Support the expanded use of modern technological tools to enhance traditional competencies and their assessment.

Policy options for state consideration:
Detection

• Establish an authoritative body, or assign such responsibility to an existing body, which would oversee the complaints, resolution and discipline processes for all professions to ensure that boards are acting uniformly, equitably and in the interest of public protection.
• Establish uniform complaints and discipline processes for all regulated health professions to ensure that all investigations of complaints are handled in an objective, prioritized, and timely manner. The concerned parties should be informed of the progress of the complaint and investigation on a regular basis.
• Make public access to the complaints and discipline process simple and clear. Information about filing a complaint, the standards by which complaints are judged, investigation procedures, discipline, and appeals should be explained in a manner that is simple and clear.

• Employ resolution processes that are best suited to the parties and dispute, including alternative dispute resolution methods.
• Discipline practitioners using the best available tools including rehabilitation, targeted education, settlement, and punitive actions.

• Ensure that the outcomes of complaints and resolution of investigations are available and understandable to the parties involved, and to the public where appropriate, unless the law forbids disclosure or there is a compelling public policy reason that mandates confidentiality. The burden in disclosure decisions rests with those seeking to restrict access to information. The "compelling" criteria which prevents disclosure should be publicly available and specifically explained when an individual request is denied.

Policy option for state consideration:

• Regulatory bodies and processes should be subject to periodic external (e.g., sunset type according to agreed upon objective standards) and internal (e.g., self-evaluation assessment based on set criteria) evaluation. Criteria for evaluation might include:
  • timeliness of adjudication process;
  • public perception of and satisfaction with regulatory processes and accountability; and
  • effectiveness of boards at meeting their mission and objectives.

Policy option for state consideration:

• Study the interplay between state health professions regulatory systems and the systems listed below in order to evaluate where links should be forged or broken, where redundancies could be streamlined or removed, where conflicts exist and can be resolved and where gaps demand attention:
  • testing
  • facility regulation
  • accreditation
  • federal government
  • reimbursement
  • professional associations
  • legal system (civil & criminal)