Navigating state regulations and licensing for APPs
CRC Daily kicks off this week’s exploration of vetting and governance approaches for advanced practice providers (APP) with an overview of the applicable regulatory landscape, which is sprawling to say the least.
State licensure for physicians is fairly uniform across the 50 states. Regulatory agencies and the National Committee for Quality Assurance clearly identify the responsibilities of healthcare entities to credential and privilege physicians. Likewise, physicians’ scopes of practice are usually well defined. However, licensing and scope of practice for APP disciplines are anything but consistent.
The trend is that more states are enabling APPs to practice with greater independence, but this varies widely. A nurse practitioner (NP) may be considered an independent practitioner with the authority to prescribe medications in one state. In a neighboring state, however, the NP may neither be licensed to practice independently nor have prescriptive authority. Likewise, one state may require massage therapists or acupuncturists to be licensed or registered, while another state may not. MSPs therefore might have to rely on certification as a possible source of credentials and must pay close attention to state law with regard to provision of independent care.
The lack of uniformity among states and the continuously evolving licensing statutes that apply to APPs will continue to be problems for healthcare organizations for the foreseeable future. Further, as more professional associations champion the advancement of APP professions, licensing bodies will be under increasing pressure to recognize and authorize the services they provide.
State statutes regarding individual eligibility for membership to hospital medical staffs create additional confusion. One statute might stipulate that “physicians, dentists, and podiatrists are eligible for membership to the hospital medical staff.” Another state may leave medical staff membership eligibility up to the hospital.
Certain state statutes also affect the practice of nonphysicians. Some states have regulations that do not allow organizations to discriminate against the practice of APPs. For example, chiropractors in certain states can order and receive the results of diagnostic radiology testing. Other statutes authorize the use of radiological techniques by chiropractors but restrict such use to specified parts of the body. In the latter case, the hospital must consider this state-imposed limitation when reviewing any chiropractic request. Other states may require organizations that provide psychology or podiatry services to make these practitioners eligible for membership on the medical staff or for professional privileges. The medical staff bylaws must also provide the individual access to medical staff membership or clinical privileges in these states.
In addition to state boards of nursing and boards of medicine, the American Academy of Nurse Practitioners (www.aanpcert.org) and the American Association of Physician Assistants (www.aapa.org) provide up-to-date state news and source verification information for NPs and PAs, respectively.
Source: The Medical Staff Office Manual