Changes in healthcare that affect AHP credentialing, Part 2: State statutes
Note: In the last issue, we began a multi-part series focusing on changes in healthcare that are affecting the way non-physician practitioners are credentialed and monitored. This week focuses on individual state statutes.
As states develop their own statutes (licensures) related to AHPs, they have created a varied and uneven landscape regarding whether the advanced practice allied health disciplines (i.e., physician assistants [PA], advanced practice registered nurses) may practice independently. In one state, a nurse practitioner (NP) may be considered an independent practitioner with the authority to practice completely independently of a physician-he or she could have an independent office practice and have full authority to prescribe medication by state licensure. In another state, the same NP may be required to have a collaborating or supervisory agreement with a physician and may or may not have prescriptive authority.
In the case of a massage therapist or an acupuncturist, one state may license or register either individual, while another state may not, thus leaving healthcare organizations to rely on certification as a possible criterion for credentialing. And as with the NP, the scope of services that states may authorize for a particular individual is not consistent across the nation-for example, the acupuncturist may be allowed greater latitude in providing patient care independently in one state than in another.
Lack of uniformity among state licensure and the continuously evolving licensing statutes that apply to the allied health disciplines pose problems for healthcare entities as well as AHPs. For example, a PA who has been licensed (authorized) in state A to prescribe medications, including controlled substances, may move to state B, which does not permit PAs to prescribe a narcotic medication. If the PA orders a controlled substance for a hospitalized patient in state B, the PA is functioning beyond the scope of his or her license. Further, the PA's physician supervisor, medical staff, and governing body in state B are also at risk for allowing this practice to occur.
Although the licensure laws of each state generally are clear, this circumstance happens easily and often as practitioners move from state to state. As more professional organizations seek recognition of AHP professions, licensing bodies will be under increasing pressure to recognize and authorize the services that these individuals provide.
Additional confusion is created by varied wording within state statutes regarding AHPs' eligibility for membership on hospital medical staffs. Hospital licensing regulations in some states clearly define which medical disciplines are eligible to be members of the medical staff. For example, state A's statute may provide that "physicians, dentists, and podiatrists are eligible for membership to the hospital medical staff," whereas state B's statute leaves the option to the hospital by stating that "the healthcare organization will determine the healthcare disciplines that are eligible for membership." Still other states, such as Ohio, may require that if an organization chooses to provide services from a particular discipline-such as psychology or podiatry-then an individual practicing in that discipline must be eligible for membership on the medical staff or for professional privileges. In this instance, if an organization is contemplating offering podiatric or psychological services, the medical staff bylaws must also provide the individual access to medical staff membership or clinical privileges. Ohio regulations also stipulate that if the organization provides maternity services, in considering and acting on requests, it shall not discriminate against a qualified person solely on the basis that the individual is authorized to practice nurse midwifery and not obstetrics.
The importance of identifying applicable state statutes for all AHPs cannot be overemphasized. It is paramount that organizations understand the difference between what scope of practice is permitted by the state licensing organization and what scope of practice will be permitted by the healthcare facility.
Editor's note: In the next issue of CVU, we look at AHPs' scopes of practice.
