Health Care Without Borders
Data from the 2010 Census indicates that roughly 17 percent of Americans live in rural communities, but according to the American Academy of Family Physicians, only 11 percent of medical specialists practice in those areas.
The lack of access to quality and affordable health care in rural areas coupled with disparities in access to newer technologies, medicines and treatment options, also contribute to rural communities being perilously underserved.
Adding to the crisis of care, the Annals of Family Medicine estimates that by 2025 the United States will need an additional 52,000 primary care physicians to keep up with the demands of providing health care throughout the United States.
The Council of State Governments’ National Center for Interstate Compacts, or NCIC, has participated in conversations across the nation with various health care professional organizations, state governments and advocates on how best to meet the challenges of improving access to health care to the American people. One solution that has emerged through those conversations and that many believe will reduce barriers to patient access is license portability, or the ability to obtain a license to practice in multiple states, and utilizing the interstate compact model to reduce the often painstaking and expensive barriers to multi-state licensure. Health Care Licensing Compacts, which encompass a variety of services, have the ability to allow for the practice of health care services across state lines in border communities, the near seamless licensure of military spouses who move due to relocation orders and even have the potential to utilize telemedicine as a means to deliver health care services across long distances.
Interstate compacts are not new. In fact, the utilization of compacts in the United States predates the formation of the nation. Approximately 215 compacts are currently in use, with most states belonging to between 20–25 compacts.
Interstate compacts, which are governed by the tenets of contract law, give states an enforceable, sustainable and durable tool capable of ensuring permanent change without federal intervention.
Several existing compacts deal specifically with licensing issues. Compacts such as the Driver’s License Compact and the Nurse Licensure Compact provide precedence for member states to honor licenses issued in another member state.
Licensing compacts also provide a mechanism to ensure state regulatory agencies maintain their licensing and disciplinary authority, while simultaneously providing a framework to share information and processes essential to licensing and regulation across a variety of medical professions.
The success of the aforementioned compacts and the crisis of health care delivery have led many health care professions to consider interstate compacts as a tool to break down existing barriers to multi-state practice and increase patient access to providers.
EMS Licensure Compact
CSG, through its National Center for Interstate Compacts, or NCIC, has partnered with the National Association of State EMS Officials on the Recognition of EMS Personnel Licensure compact, also known as REPLICA. As more EMS personnel cross state lines to provide critical care and services in times of crisis, the necessity to ensure those personnel are legally covered to provide care has been the driving force behind this compact as it has been introduced in legislatures throughout the nation.
Medical Licensure Compact
CSG-NCIC has partnered with The Federation of State Medical Boards to create the Interstate Medical Licensure Compact. The compact, which would allow for licensure in a home state and practice states was introduced in January 2015 and to date 11 states have passed the compact legislation. The first meeting of the Interstate Medical Licensure Commission will be held in Chicago in October 2015.
Nurse and APRN Licensure Compacts
The Nurse Licensure Compact was first introduced in 2000 and to date has been ratified by 25 states. Updates to the compact have led to the reintroduction of model language to state legislatures, however, which will take place during the 2016 legislation sessions. CSG-NCIC has partnered with the National Council of State Boards of Nursing to assist with education and outreach to state policymakers regarding passage of the new model compact language. The Advanced Practice Registered Nurse Compact, or APRN, and the Nurse Licensure Compact, or NLC, allow nurses to practice in other compact states with a single multistate license. The NLC gives multistate rights to registered nurses and licensed practical/vocational nurses residing in a member state. The APRN Compact gives the same rights to advanced practice registered nurses.
Physical Therapy Compact
The Interstate Licensure Compact for Physical Therapy model compact language will be introduced for the first time in state legislatures in 2016. The compact would allow not only for portability of licensure, but also address the utilization of telehealth treatment as a means of patient care. CSG-NCIC is pleased to have partnered with the American Physical Therapy Association and the Federation of State Boards of Physical Therapy on this effort.
- The National Center for Interstate Compacts—www.csg.org/ncic
- The American Academy of Family Physicians—www.aafp.org
- The White House Council of Economic Advisors—www.whitehouse.gov
- The Federation of State Medical Boards—www.fsmb.org
- The National Association of State EMS Officials—www.nasemso.org
- The American Physical Therapy Association—www.apta.org
- The Federation of State Boards of Physical Therapy—www.fsbpt.org
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