SPEAKERS Claudia Bray, RN, BS, CCM Marilyn Edwards, RN, CCM

 Describe the history of multi state nurse licensure  Define the Nurse Licensure Compact (NLC)  Identify the adopted amendments to the NLC  Define obstacles to adoption of the compact by California  Describe the future strategies and timing for implementation

Compacts are contracts between states creating an agreement that carries the force of statutory law.

1994 – National Council State Boards of Nursing initiated task force to study regulation around multi state licensure 1995 – Regulation task force charged to consider “compact models” Telecommunication task force authorized 1996 – Studied issues: magnitude of need, impact on state regulatory processes 1997 – Endorsed “mutual recognition” model Special Delegate Assembly Meeting approved NLC

Nurse Licensure Compact (NLC) An interstate compact permitting practice across state lines A statuary contract between all member states The Model Legislation adopted by the NLC member boards, passed by the individual state legislative bodies, then signed into law by the states governor Nurse Licensure Compact Administrators (NLCA) The governing body of the NLC A quasi-governmental agency with characteristics of being a subfederal and suprastate entity. Comprised of the executive directors of boards of nursing in the NLC states Affiliated with and supported in part by NCSBN, although a distinct, non- incorporated entity and not a 501©3 organization

 The Nurse Licensure Compact was originally developed based on the Drivers License Compact (DLC)  Mutual recognition contract  The concept of one multistate license issued in the primary state of residence (PSOR) and accepted in all member states  You drive across state lines with one license because other states are members of the DLC. They accept the license of your PSOR

Allows RN’s and LPN/LVN’s, to have one multistate license in a compact primary (home) state of residence and practice in other compact (remote) states, while subject to each state’s practice laws and discipline

 Compact initially adopted by NCSBN in 2002  Adopted by 3 states in 2002  Revisions adopted by NCSBN on May 4, 2015

 Pass NCLEX  Declare (with proof) a compact state as primary state of residence  Meet all requirements for licensure in that state  Residents of non-compact states not eligible

 Practice takes place in the state where the patient is located at the time practice occurs  Practice requires licensure

 1997 – NLC initially adopted by NCSBN in 1997  Maryland was first compact state  2010 – Five states with active NLC legislation  Enacted by 24 states as of March 2015  2015 – 25 th state, Montana, passed legislation in October

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 Traditional face to face plus  Telecommunication - Mobile apps – EMR  Telehealth Video Software  Telemedicine – Virtual MD  Telehealth Portals The promise of this innovation has yielded a new generation of ethical dilemmas as nurses and nurse case managers find themselves practicing across cyberspace and state lines ◦

American Telemedicine Association: established launched a public service campaign “FIXLicensure”, to generate public awareness and lobby federal regulators, state medical boards and congress about need to eliminate state licensure barriers. The Center for Connected Health Policy (CCHP) Public interest nonprofit organization that develops and advances telehealth policy solutions to promote improvements in health and health care systems. Acts as the federally designated National Telehealth Policy Resource Center (NTRC-P), providing technical policy advice to the twelve regional telehealth resource centers, as well as state and federal policymakers.

 The Center for Telehealth and e-Health Law CTeLhas established itself as the “go-to” legal and regulatory telehealth organization – providing vital support to the community on topics such as: physician and nurse licensure; credentialing and privileging; Medicare and Medicaid reimbursement; and private insurance payment policies.  HHS’s Health Licensing Board’s report to Congress. The Executive Summary in 2011makes the commanding connection between the resolution of licensure portability as a means to assure quality health care access. CMSA Today Issue 2, 2012

 Licensing requirements varied state to state  Misconceptions about the compact (costs, information exchange, board authority)  Differing view points among nurse groups  Nurse union opposition

 2014 – 2015, Executive Directors of Boards of Nursing met to reconsider regulation that best supports cross-border practice  Commissioned three working groups: compact revision, Legislative strategy, Fiscal Impact  Convened a Special Delegate Assembly on May 4, 2015

 Members agreed to revise the compact language to address concerns about public protection  Decided to align the provisions of the NLC and the APRN Compacts  Determine implementation strategies

 Criminal background checks are now required for all compact states  Felony convictions are a bar to a compact license  Various provisions to improve the operations of the Compact  NCSBN commits to fund ongoing operations of the compacts and assist states with grants for implementation expenses.

 Removed the primary barriers for most states to adopt the compacts  Legislative strategies and tactics to assist states in adoption  Progress toward goal: adoption by all states

 Coordinate grassroots advocacy; get nurses and nurse leaders working together  Be active in nursing organizations, state and national and ask that they pass a resolution in support of the NLC  Ask your Employer to endorse both compacts (Nurse and APPN)

 Organize a coalition of nurses and other professional healthcare providers  Voice your support to your board of nursing  Work with the coalition and nursing organizations to identify a legislator to introduce legislation  Testify at legislative hearings and contact more legislators.

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National State Boards of Nursing Contact: Jim Puente Multi State Licensure for Ca Nurses Taskforce Contact: Claudia Bray, RN, BS, CCM Acknowledgements: Jim Puente and Sandra Evans, Chair NLCA