HRSA and licensure portability

The topic of licensure portability has particular importance in telehealth, where the entire premise is to deliver services across distances from pockets of providers to underserved regions. Urban centers often contain an abundance of providers, especially those connected to universities and teaching hospitals. Surrounding rural areas often do not have ready access to specialists (my interest is in behavioral health, and not just psychiatry but psychology, addictions, and talk therapies as well).

[may be that there is a map showing urban centers and the rural area they serve...probably yes, I just don't have one yet.]

While looking through some emails and chasing a few links today I ran across this discussion on the Telehealth Resource Center site on the Legal & Regulatory page:

Under Licensure and Scope of Practice, several models for cross state licensure agreements are presented. They include:

• Licensure by endorsement;
• Mutual recognition;
• Reciprocity;
• Special purpose or limited licenses.

The Health Resources and Service Administration (HRSA) reported to Congress about the issues. HRSA has an online resource center under their rural health section specifically related to telehealth. The page includes a broken link to the The Licensure Portability Grant Program (LPGP).

"The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is the primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable."

The emerging role of telehealth/telemedicine/mHealth in bridging the gaps to universal access to physiological and psychological healthcare continues to present opportunities for research and advocacy. One that I'll keep following with expectation for the next part of my career.

National Licensure

FixLicensure.org is a website promoting national licensure for medical professionals (I hope that independent mental health providers would also be included).

These folks are working with Senator Tom Udall (D-NM) and have briefed congress on issues related to telehealth and provider mobility.

Sign their petition to show support for this important issue.

The argument is being framed around the lack of access for military personnel (active and veteran) to mental health care and the promise of telehealth as a solution. Since military providers are licensed in their home state and able to practice across the nation, and, can help soldiers remotely when both are in a military facility there does seem to be some opportunity for change.

Other folks argue that the licensure process goes beyond insuring all practitioners meet minimum quality standards and is more properly a gate-keeping function that discourages people from entering the field. Clearly, with licensed providers being disciplined for ethics and fraud the quality standards can not be insured through verification alone. With the workforce issues in behavioral health this function is questionable.

To even cross the bar to be licensed an applicant must have educational experience from an accredited university. Well, let me re-phrase that, "to get a job in North Carolina you must have graduated from an accredited university." And, to get a license you must have completed coursework equal to the CACREP standards.

I think that I would support national reciprocity. That would allow states to set home rules while allowing licensed professionals mobility. For instance, if your get licensed in NC in 2002 and apply for licensure in TN in 2012 you will have to meet the 2012 rules. The bar has been raised in the intervening 10 years.

to review my earlier notes on this topc.

The TAF crisis assessment instrument

James and Gilliland (2013) discuss their Triage Assessment Form for Crisis Intervention (TAF).

In class tonight we are being trained in the use of this evidence supported instrument. Its a little different from most of the tools I've used in the past. More like using the GAF in that we are trying to score with guidelines related to the score.

The TAF also breaks out various domains to guide the assessor. Looking at the affective, behavioral, and cognitive domains helps describe the situation.