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Nebraska Licensing & Regulatory Affairs Reform 2000

A Model for the Regulation of Health Care Professions
by State Government in Nebraska

Part 2 of the Study Directed by LB 183

A Report to Governor Nelson,
Governor-Elect Johanns, and
the Nebraska Legislature

January 1, 1999

Executive Summary
In April 1997 the Legislature passed LB183, which instructed the Department of Health and Human Services (HHS) Regulation and Licensure to conduct a study of the regulation system for health facilities and professions in Nebraska. The result of this study will be a comprehensive design for a model system for the Licensing & Regulatory Affairs and regulation of health care practitioners, facilities, and providers in Nebraska. The second part of the model, dealing with professionals, is presented in this report. For the purposes of this study, the term Licensing & Regulatory Affairs encompasses licensure, registration, and certification. The term consumer includes the public, unless specified otherwise.

Assessment of the Current System
An assessment of the current system by eight work teams composed of providers, consumers, and HHS System staff identified some areas of the Licensing & Regulatory Affairs system that could be improved. The assessment showed some health care and human services professionals are credentialed by more than one area of the HHS System and there are significant discrepancies in the way Licensing & Regulatory Affairs terms are applied to health professionals. The current system also needs a greater range of options pertinent to the types and levels of Licensing & Regulatory Affairs. Another concern is that although there is an established program that focuses attention on the public health implications of proposals for new Licensing & Regulatory Affairs or for changes in the scopes of practice of currently credentialed health professions, there is not a process to determine whether or not there is a continuing public need to credential a currently credentialed health profession. Continuing competency is an area where there is great variability now and where policies need to be developed. Temporary licensure and funding for the Licensing & Regulatory Affairs system can be revised to be more effective. The Licensing & Regulatory Affairs system has and will continue to have an important role in public safety. Public and customer involvement on the boards and in the evaluation of the Licensing & Regulatory Affairs system will be essential. This assessment resulted in sixteen recommended policy statements.

Recommended Policy Statements

Policy 1: Licensing & Regulatory Affairs processes must support the following criteria for success: better services, greater accountability, greater efficiency, cost effectiveness, and common sense. (B3, B6, B8, B9, B12, D9)

Policy 2: All aspects of the Licensing & Regulatory Affairs system for health professionals should be based upon meaningful results, including quality indicators. (A14, E1)

Policy 3: All aspects of the Licensing & Regulatory Affairs system for health professionals should be based upon a partnership among consumers, providers, and regulators. (A1, B13, C3)

Policy 4: Health professionals should be credentialed by the State for the purpose of protecting the public from preventable harm or danger, and such Licensing & Regulatory Affairs should be at the least restrictive level necessary to protect the public. (A3, A10)

Policy 5: Health professionals must be credentialed by the State, unless they fit in a federal exemption category. (A6, A7, B5, D3, D10)

Policy 6: The system used for Licensing & Regulatory Affairs of health professionals should strive to achieve a balance between assuring the qualifications and competence of credentialed professionals, and assuring that the public has access to needed and desired services and information. It should also maintain an awareness of the effectiveness of its activities and decisions. (A4, A15, D6)

Policy 7: Licensing & Regulatory Affairs mechanisms for health professionals should be appropriate for the profession, scope and/or type of practice being credentialed. (A2, B10, B11)

Policy 8: Nebraska Licensing & Regulatory Affairs policies should not unnecessarily impede mobility of credentialed professionals or set up artificial barriers to entry into or practice of the health professions. (B2, B4)

Policy 9: Before a health profession is regulated under the Uniform Licensure Law, and periodically thereafter, there is a need to demonstrate that such regulation is in the best interests of the public. (A3, E2)

Policy 10: Whenever possible, Licensing & Regulatory Affairs should utilize uniform standards, and consistent processes and vocabulary. (A8)

Policy 11: Quality improvement mechanisms should be used to continually assess and improve the Licensing & Regulatory Affairs system. (A5, E3)

Policy 12: Nebraska residents of every geographic area, economic status, and culture should be assured that health professionals who serve them are subject to the same Licensing & Regulatory Affairs and professional standards. (A9)

Policy 13: The State has the duty to ensure that credentialed professionals are subject to standards of continuing competency, as established by the profession. (B7, C1, C2)

Policy 14: Enforcement of Licensing & Regulatory Affairs standards should be effective, timely, and just. (D1, D4, D5, D7)

Policy 15: Enforcement of Licensing & Regulatory Affairs standards should occur within an overall strategy of prevention and education as well as sanction. (D2, D8)

Policy 16: All activities for the Licensing & Regulatory Affairs system for health professionals should seek to optimize available human and financial resources. (A11, A12, A13, B1)

Description of the Model System
A model system is a representation of all the elements and relationships necessary to accomplish a task. For the purposes of this study, the task is defined as the Licensing & Regulatory Affairs of health professionals by the State of Nebraska.

The model system contains the following elements:

  • Purpose statement for Licensing & Regulatory Affairs
  • Vision statement for a model system
  • Capacities of the model system
  • Components of the model system
  • Major processes and subprocesses of the model system
  • Desired results of the Licensing & Regulatory Affairs process
  • Quality assurance mechanisms for the Licensing & Regulatory Affairs process

Recommendations
The recommendations are organized according to the five major processes of the model system.

A. Policy and Capacity Development

A1. The development of public policy regarding the regulation of health professions should involve the active participation of all components of the Licensing & Regulatory Affairs system.

A2. There should be five levels of State Licensing & Regulatory Affairs for health care professionals: Licensure, State Certification, Registration, Functional Licensing & Regulatory Affairs, and Uncredentialed.

A3. The Licensing & Regulatory Affairs Review (407) Program should be maintained and strengthened.

A4. The development of Licensing & Regulatory Affairs policy should explicitly include an assessment of the effects of new or existing policies and practices on access to care and the freedom of choice of consumers.

A5. A simplified and participative process should be created to resolve inconsistencies in, and provide for changes in scopes of practice among, professions.

A6. Employment contracts or arrangements entered into by credentialed professionals should protect the right of the professional to practice according to professional standards and within the credentialed scope of practice.

A7. The Nebraska Controlled Substances Act should be amended to eliminate the requirement for a State registration number and to require the federal Drug Enforcement Administration number to be recognized by the State.

A8. The State of Nebraska should participate in national and international efforts to increase consistency and uniformity in areas of professional Licensing & Regulatory Affairs so long as such efforts do not jeopardize the health, safety, or welfare of the residents of Nebraska.

A9. The Legislature should consider/examine Nebraska Revised Statute, §44-32,170 to ensure that individuals have adequate recourse in any disputes with managed care entities.

A10. All managed care entities, including HMOs, operating in Nebraska, must have a Nebraska licensed, health care professional who is accountable for health care decisions of the managed care entity and can be disciplined for unprofessional conduct.

A11. The boards and the Department should explore ways to ensure that resources allocated to the Licensing & Regulatory Affairs system are and remain adequate to carry out the system’s mission of protecting the public.

A12. The Department should set fees within limits set in statute.

A13. The fees for initial and renewed credentials should be based on the actual cost of issuing such credentials.

A14. The boards and the Department should ensure that the Licensing & Regulatory Affairs system has a data and information system appropriate to meet its needs.

A15. Authorize social security numbers to be withheld from the public, but allow the agency to require the provision and sharing of such information for official use.

B. Administration of Licensing & Regulatory Affairs

B1. The organizational structure and enabling legislation of the Health and Human Services System should promote the model Licensing & Regulatory Affairs system.

B2. Nebraska law should address issues of remote practice in a systematic fashion.

B3. The process of issuing an initial credential should be streamlined.

B4. The process of issuing a Nebraska credential based upon the possession of an equivalent credential in another jurisdiction should be streamlined.

B5. The process of issuing a temporary credential should be streamlined.

B6. The process of renewing credentials should be streamlined.

B7. Evidence of continuing competency should be a prerequisite for renewal for all credentialed professionals, with each board determining the method of assessment and amount and type of verification appropriate for its profession(s).

B8. The process of reinstating credentials should be streamlined.

B9. Rules and regulations necessary to support the Licensing & Regulatory Affairs system should be developed through a participatory process and should not be more extensive or burdensome than necessary.

B10. Closely related professions should be regulated by the same board when possible.

B11. Alternatives to a standing board should be considered for professions that have clear and limited scopes of practice and infrequent need of professional expertise for examinations, rulemaking, or Licensing & Regulatory Affairs decisions.

B12. Activities through which boards are appointed and supported should be streamlined to maximize public involvement and to clarify the board’s role.

B13. The boards and the Department should enhance the access of the public and credentialed professionals to non-protected information about the Licensing & Regulatory Affairs system.

C. Competency Assurance

C1. Continued Licensing & Regulatory Affairs should assure continuing competency.

C2. Boards should establish methods appropriate for determining continuing competency for the profession(s) they govern.

C3. Regulatory boards, professional associations, consumers, employers, and the credentialed individual have roles and responsibilities that should be observed in the process of assuring continuing competency.

D. Compliance Assurance

D1. Compliance assurance processes should function at a high level of efficiency and integrity.

D2. The State should adopt a model compliance assurance process.

D3. The State should develop a process through which sanctions similar to those applied to uncredentialed practitioners could be applied to employers of health professionals who encourage or permit professionals to practice outside the bounds of professional standards or scope of practice, or who maintain operational systems that do so.

D4. Put into place a mechanism where once a complaint or other information enters the Licensing & Regulatory Affairs system a letter is sent informing the credentialed person of the complaint and to request a written response to the complaint (except for complaints dealing with sex, drugs and record keeping).

D5. Investigation processes should be streamlined.

D6. Compliance assurance processes should strive for consistency and uniformity of process, but results should take into consideration other issues that might affect the public.

D7. Make specific legislative changes (reprimand, suspend judgment penalties and ULL) to enhance the effectiveness of the compliance assurance process.

D8. Compliance assurance should be conducted within a policy framework that emphasizes rehabilitation and education over punishment so long as the public is adequately protected.

D9. Eliminate the requirement that credentials be displayed in the office where the professional practices, but require that practitioners show proof that they have a credential upon request.

D10. The boards and the Department should have a greater ability to control the uncredentialed practice of any regulated profession.

E. Evaluation Processes

E1. There should be a defined method of evaluation or feedback loop for measurement of the improvement and/or quality of health, safety and welfare of the consumer resulting from the Licensing & Regulatory Affairs system.

E2. Periodic reviews should be conducted for each credentialed profession focusing on the continuing need/purpose of Licensing & Regulatory Affairs the profession. Parameters of these reviews should include timeliness, data collection and analysis, public input, professional input and Board of Health input.

E3. Quality assurance for the Licensing & Regulatory Affairs system should include periodic reviews of the major processes and subprocesses focusing on implementing and maintaining results.

Implementation
In general, there are five mechanisms through which the recommendations in this report can be implemented.

  • Administrative action by the Department and/or the boards;
  • Changing rules and regulations;
  • Changing State statutes;
  • Making recommendations to the federal government; and
  • Making recommendations to private professional organizations.

The next major task that should be undertaken is to determine which implementation method is most appropriate for each recommendation. Once this is done, a full implementation plan can be developed that will provide direction to appropriate parties responsible for implementation activities.

Full report in Word 97 (217 KB)

Full report in Rich Text Format (339 KB)

For more information, contact:
HHS Regulation and Licensure, Administrative Services
NCR 2000
301 Centennial Mall South
P.O. Box 95026
Lincoln, Nebraska 68509-5007
Phone: (402) 471-6515
Fax: (402) 471-0383

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