Licensure portability and grandfathering concerns for case managers

The ease of practitioners to transfer active professional licenses to others states is a longstanding issue across the industry. Known as licensure portability, this issue tests the patience and fortitude of every case manager. Licensure portability would be less of a problem if state boards developed their regulations simultaneously. Unfortunately, these entities developed their rules and regulations independently of each other.

The inequity of regulations from state to state caused further problems over time, when local priorities mandated shifts in licensure requirements to meet population needs for communities. For example, a drought of mental health professionals in one state might have led to grandfathering in of other diverse professionals to fill the void. As a result, anyone with a baccalaureate degree in a health and human services field (e.g., majors in psychology, counseling, sociology) could have been granted licensure without fulfilling the current requirements (e.g., educational or professional qualifications, licensure exam) simply because a statute allowed it, and for a specified time only. The public protection concern is evident when individuals are not educated or licensed as a particular type of professional but still allowed to hold the credential of that profession. Would you want a physician without the requisite didactic knowledge, training, and expertise to be caring for you or a family member? This becomes confusing for clients and other industry stakeholders.

The disciplines comprising case management (e.g., nursing, medicine, counseling, social work) experience countless licensure scope variations across the states. The licensure levels available (e.g., baccalaureate, masters) vary, as do the individual credentials assigned to each level. For example, social work is notoriously the most complex discipline for the case management workforce to understand. Of the four levels of licensure available to social workers, not all are offered in every state or country (e.g., in Canada), with the decision about which are offered left up to each region to decide.

Discrepancies may also be present for required work hours, supervised clinical hours (e.g., clinical social work, licensed professional counselors), continuing education (CE), and other renewal requirements.

In our mobile society, a licensure structure with so many intricacies poses undue hardship for licensed professionals, as well as the consumers who rely on their interventions. Now add the vast numbers of healthcare professionals who are spouses of military members. These individuals are subject to frequent moves, as often as annually. Each move brings the need to jump through countless hoops to apply for licensure in the new state. Each hoop serves as an impediment to employment and earning potential, which put professionals and their dependents at unnecessary financial risk.

For more, see The Essential Guide to Interprofessional Ethics in Healthcare Case Management.