The federal government approved a change to the United States Code Annotated Title 25. Indians Chapter 18. Indian Health Care Subchapter II. Health Services effective March 23, 2010

“Licensed health professionals employed by a tribal health program shall be exempt, if licensed in any State, from the licensing requirements of the State in which the tribal health program performs the services described in the contract or compact of the tribal health program under the Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.).”

Alaska law sections and provides that all physicians must have a license to practice in Alaska except in 5 circumstances one of which is where "a physician or osteopath, who is not a resident of [Alaska], who is asked by a physician or osteopath licensed in the state to help in the diagnosis or treatment of a case." Alaska Statute also allows consultants to be licensed in another state:

What does this mean for your facility? Direct hire employees of tribal health programs do not need to be licensed by the State of Alaska Medical, Dental and Nursing Boards Locum Tenens are traditionally hired by a locum company and are not employed by the tribal health program. The federal exception does not apply to them.

In many states physician assistants work under a collaborative plan The licensing states Practice Act must be consulted to see if State Laws preclude the physician assistant from using their license in another state The Alaska Medical Board requires all physician assistants practicing in Alaska to have a collaborative plan on file with them

In many states Advance Nurse Practitioners work under collaborative agreements and are not licensed independent practitioners Alaska’s Nursing Board allows Advance Nurse Practitioners to function as licensed independent practitioners An Advance Nurse Practitioner cannot use a license from a state that requires a collaborative agreement in Alaska

What you should be aware of when processing a provider who is not licensed by the State of Alaska The state laws in which the provider holds a license are the laws you must follow States may have special requirements for controlled substances Many states require a second license for controlled substances

These states do not require a controlled substance license in addition to the DEA: AlaskaMaineOregon ArizonaMinnesotaPennsylvania ArkansasMontanaTennessee CaliforniaNebraskaVermont ColoradoNew HampshireVirginia FloridaNew YorkWashington GeorgiaNorth CarolinaWest Virginia KansasNorth DakotaWisconsin KentuckyOhio

These states do require a 2nd controlled substance license in addition to the DEA: AlabamaIowaNew Mexico ConnecticutLouisianaOklahoma DelawareMarylandPuerto Rico* DCMassachusettsRhode Island GuamMichiganSouth Carolina HawaiiMissouriTexas IllinoisNevadaUtah IndianaNew JerseyWyoming *Puerto Rico requires 3 licenses

Many State Dental Boards require additional permits and licenses for analgesia & sedation. Some even require inspections before granting sedation permits: “It is extremely important that sedation facility inspection appointments are NOT CANCELLED or rescheduled!” “Please insure you have EVERY item on the checklist at your office BEFORE you schedule an appointment and check your calendar carefully before you confirm the date and time with the inspector.”

Nitrous Oxide/Oxygen Inhalation Conscious Sedation Level 1: Minimal Sedation = Nitrous Plus One Enteral Drug Level 2: Moderate Enteral =Multiple Enteral Drug Level 3: Moderate Parenteral = Limited to Parenteral Routes of Administration Level 4: Deep Sedation/General Anesthesia Texas Dental Anesthesia Permits

Oregon Dental Anesthesia Rules and Educational Requirements Anesthesia Rules Anesthesia Rules Educational Requirements for Anesthesia Permits Anesthesia Permit Applications Nitrous Oxide Permit Application Nitrous Oxide Permit Application Minimal Sedation Permit Application Moderate Sedation Permit Application General Anesthesia Permit Application

Idaho Dentists General Dentist Application and Instructions Specialist Application and Instructions Volunteer License Application and Instructions Application to convert Inactive License to Active Status Idaho Controlled Substance and DEA Registration Anesthesia Permits Application for Anesthesia Permit Policy For Moderate Enteral Sedation Evaluations Policy For Moderate Parenteral Sedation Evaluations Policy For General Anesthesia/Deep Sedation Evaluations Use of Other Anesthesia Personnel – Rule 62 Notification Process

Illinois Applications for Physicians Physician, Licensed Physician Limited Temporary License Physician Temporary License Visiting Professor Visiting Physician Physician Controlled Substance

It is not as easy as just ensuring a provider is license in another state and has their own DEA. It takes a lot of time, work and research to ensure your facility is in compliance with another states laws. There are no shortcuts Questions