© 2014 Federation of State Medical Boards Eric Fish Federation of State Medical Boards (FSMB) NAMSS Interstate Medical Licensure Compact Grassroots Training Webinar

2 © 2014 Federation of State Medical Boards Foundational Background on the Compact The Nuts and Bolts of the Interstate Compact Enactment Activity and Outreach

3 © 2014 Federation of State Medical Boards Foundational Background on the Compact The Nuts and Bolts of the Interstate Compact Enactment Activity and Outreach

4 © 2014 Federation of State Medical Boards The Need for License Portability Health care rapidly changing –Rise of telemedicine and new technology –Passage of Affordable Care Act and need for greater access to care –Integration of health care delivery systems –Increase in multi-state practice 16% of physicians are licensed in 2 states 6% of physicians are licensed in 3 or more Goal: Facilitate multi-state practice without compromising patient safety or quality

5 © 2014 Federation of State Medical Boards FSMB’s License Portability Initatives Expand UA Utilization Improve FCVS Telemedicine Guidelines Support Expedited Endorsement of Licensure Uniform Application FCVS Legislative and Policy

6 © 2014 Federation of State Medical Boards Licensure Developments Aggressive Push for a ‘National’ License –Legislation in Congress calling for “nationalized” licensure system –Proposals tie licensure to federal health programs (i.e. Medicare) Need for a Nationwide Solution, Implemented by the States, without Federalizing Licensure –State solution would preserve proven regulatory approach –State solution does not require overhaul or new federal program –Licensing is constitutionally a state power Options for interstate cooperation –Uniform Law? –Interstate Compact?

7 © 2014 Federation of State Medical Boards What is an Interstate Compact? A contract between compact states Constitutionally authorized Retains state sovereignty on issues traditionally reserved to state jurisdictions Commission established to coordinate cooperation

8 © 2014 Federation of State Medical Boards Interstate Compact HOD Directive in 2013 FSMB House of Delegates unanimously adopted Resolution 13-5: Development of an Interstate Compact to Expedite Medical Licensure and Facilitate Multi-State Practice (HOD 2013) Directed FSMB to study the feasibility of an Interstate Compact model to facilitate license portability

9 © 2014 Federation of State Medical Boards Interstate Compact Key Principles Participation voluntary for both physicians and state boards of medicine Creates another pathway for licensure, but does not otherwise change a state’s existing Medical Practice Act Regulatory authority remains with the participating state medical boards

10 © 2014 Federation of State Medical Boards Interstate Compact Key Principles The practice of medicine occurs where the patient is located Compliance with the statutes, rules and regulations of state where patient located State boards aware of physicians practicing in the state

11 © 2014 Federation of State Medical Boards Interstate Compact Key Principles Improved sharing of complaint and investigative information between medical boards The license to practice medicine may be revoked by member state once issued The ability of boards to assess fees will not be compromised

12 © 2014 Federation of State Medical Boards Foundational Background on the Compact The Nuts and Bolts of the Interstate Compact Enactment Activity and Outreach

13 © 2014 Federation of State Medical Boards Compact Eligibility Requirements Not all Physicians will be eligible Must meet the following requirements: –Successfully passed USMLE or COMLEX-USA –Successful completion of a GME program –Specialty certification or a time-unlimited certificate –No discipline on any state medical license –No discipline related to controlled substances –Not under investigation by any agency

14 © 2014 Federation of State Medical Boards State of Principal License Serves as the entry point for eligible physician –State must be a Compact State –Physician must obtain a full and unrestricted license What state can serve as State of Principal License? –State of physician’s primary residence –State where 25% of medical practice occurs –Location of physician’s employer –State designated for federal income taxes

15 © 2014 Federation of State Medical Boards Proposed Interstate Compact Pathway Step 1 Eligible Physician is/becomes licensed in a Compact State (State of Principal License) Step 2 Eligible Physician applies for expedited licensure in other Compact states via State of Principal License State of Principal License verifies eligibility Step 3 State of Principal License sends attestation to an Interstate Commission Eligible physician transmits fees to Interstate Commission

16 © 2014 Federation of State Medical Boards Proposed Licensure Pathway Step 4 Interstate Commission sends fees and physician information to other Compact states selected by Physician Step 5 Selected member states issue physician a license Step 6 ONGOING: Commission is used as a clearinghouse for shared discipline and investigatory information, renewals

17 © 2014 Federation of State Medical Boards Impact of Disciplinary Actions

18 © 2014 Federation of State Medical Boards Impact of Disciplinary Actions

19 © 2014 Federation of State Medical Boards Joint Investigations Member Boards may participate with other member boards in joint investigations of physicians licensed by the member boards Boards may share information and other materials Subpoenas issued by member states enforceable in other member states

20 © 2014 Federation of State Medical Boards Coordinated Information System Commission to establish database of all physicians who apply or are licensed through Compact Member Boards will report complaint/disciplinary information to the Commission Increased permissive sharing of complaints and other investigatory information

21 © 2014 Federation of State Medical Boards Interstate Compact Commission State Boards retain licensing authority, participate as Commission members Administrative Role Only –Coordinate education and training –Empowered to determine when a state has breached its obligations under Compact –Can raise own funds to remain budget neutral

22 © 2014 Federation of State Medical Boards Interstate Compact Commission Each member state would appoint two representatives to serve Rulemaking authority crucial to success Substantive changes to Compact must be unanimous

23 © 2014 Federation of State Medical Boards Funding and Fees Budget not envisioned to be substantial Each member board retains power to set licensing fees Commission would assess user fee –Similar to a ‘convenience fee’ for online ticketing Commission can seek grants

24 © 2014 Federation of State Medical Boards Foundational Background on the Compact The Nuts and Bolts of the Interstate Compact Enactment Activity and Outreach

25 © 2014 Federation of State Medical Boards Enactment Activity (as of Feb )

26 © 2014 Federation of State Medical Boards Enactment Activity (as of Feb )

27 © 2014 Federation of State Medical Boards Who Else Is Supporting the Compact? Practitioners –AMA –State Medical Associations Provider Groups –Mayo Clinic –Gundersen Health System –Ascension Health –State Hospital Associations Patients –AARP South Dakota –Helmsley Charitable Trust –US Senate / Federal Trade Commission

28 © 2014 Federation of State Medical Boards Common Questions Cost? How long will it take to become licensed? What laws apply to physician? Maintenance of Certification? Creation of Super-Licensing Board?

29 © 2014 Federation of State Medical Boards Licenseportability.org

30 © 2014 Federation of State Medical Boards Questions/Discussion/Contact Us Eric Fish Senior Director, Legal Services FEDERATION OF STATE MEDICAL BOARDS 1300 Connecticut Ave NW, Suite 500 Washington, DC Tel: (202) © 2012 Federation of State Medical Boards

CALL TO ACTION: We Need Your Voice! Interstate Medical Licensure Compact NAMSS Grassroots Training Webinar Eric Fish, JD FSMB’s Senior Director – Legal Services John Richardson NAMSS, Director of Policy and Government Relations

Why Grassroots?  Legislators are ultimately accountable to the constituents who elected them…that’s you  Grassroots advocacy facilitates direct contact with your legislators

What is Grassroots Advocacy?  Constituent involvement in the political process  Constituents get to know their elected officials and communicate their views – relationship building is critical in politics  Constituents can use varied means to build this relationship (Letters, , phone calls, meetings, and facility tours)

Why are Relationships with Legislators so Important?  Legislators who understand a constituent’s interest can mean the difference between an issue with a face, and one without  “You scratch my back; I’ll scratch yours,” holds true in politics

Grassroots Advocacy in the Legislative Process

How a Bill becomes Law School House Rock

Building a Lasting Relationship with Your Legislator  Contact your legislators  Phone calls, s, letters, or in-person meetings  Follow up with your legislators after initial contact  Volunteer for your legislators  Be an advisor on healthcare issues  Volunteer for their campaigns

STAFF CAN BE KEY  Staff make things happen  Staff are often legislators’ ears and eyes  Discussing NAMSS priorities with staff can be just as important as discussing priorities with legislators  Establish a staff contact  Your chances of influencing your representative are better if you have a staff contact

Responsibilities of an NAMSS Grassroots Advocate  Represent medical service professionals when meeting with your elected officials  Maintain personal relationships with your representatives & staff; they should recognize your name  Follow relevant legislation; use the NAMSS GR team as a reference on important policy issues  Generate community support for NAMSS’ agenda; get your colleagues & friends involved

Build Community Support for NAMMS’ Policy Agenda  Keep colleagues updated  Enthusiasm is contagious!  There’s power in numbers, so help us build our policy efforts  Attend town halls and public forums  These sessions are good opportunities to bring attention to your interests  Attendance will enhance name recognition within your community

Promoting the Compact  Stay Engaged  Meet and write letters/ s to legislators and their staff  FSMB has issue briefs and talking points  Stay Informed  NAMSS’ GR team is always ready to provide you with background on all NAMSS-related legislative issues

We Need Your Help  Strong NAMSS Grassroots Advocacy in your state will greatly improve chances for success  You are the constituents, the experts, and the voice that legislators want to hear  Successful efforts may greatly benefit your work

NAMSS is a Resource National Conference of State Legislatures NCSL.org Draft letters of support Strategic advice