Q&A: Licensure variations between states

April 10, 2019
Medicare Web

Q: How do licensures for case managers vary across state lines?

A: 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.

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.

A broad sweep of licensure variations to consider include:

  • Professional titles
  • Practice scopes for the same level
  • Licensure levels available
  • Credentials for each licensure level offered
  • Qualifications for each title and level of practice
  • Number of required graduate credits to achieve certain licensure levels
  • Number of required postgraduate supervision hours (e.g., none to 500 hours)
  • Number of continuing education requirements to achieve, maintain, and renew licensure
  • Type of specialty continuing education requirements (e.g., ethics, medication errors, human trafficking)

For more information, see The Essential Guide to Interprofessional Ethics in Healthcare Case Management . Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.