S&H has recently become aware (at the time we have hired RNs from other case management companies) that many RNs are not licensed in the states for which they practice case management.
When asked why the RN is not licensed (and many of these RNs were most recently employed by national or large regional case management companies) they have uniformly responded, our most recent company told us they are “covering our licenses” in our other states. Every one of these RNs told us their company did research and found they did not need to be licensed except for their “home state”.
In the past (over 15 – 20 years ago), some states did not specifically address case managment when discussing the need for out of state licensure. Many companies gambled on this technicality when deciding to or not to license their RN staff. Later, many states tightened up the in-person case management, but left the telephonic requirements vague. All of this has changed.
I have looked at the state board of nursing for each state in which S&H practices, and there are no remaining “loopholes”. In addition, when I attended the National Case Management Society Conference (CMSA) in Phoenix, AZ, in 2009, I attended a seminar on legal issues in nursing. I specifically addressed this with the RN, JD that taught the seminar.
This is how it was explained to me: If the RN Case Manager is providing field-based (in person) case management, there is NO EXCEPTION! All RNs are to be licensed in the state (and all states) in which they practice.
Further, If the RN is performing telephonic case management and is only contacting the physician or physical therapist, or other treatment provider and is basing her recommendations on analysis of this information, then (s)he does not require a nursing license in that state. HOWEVER, if the RN is also speaking with the injured worker or recipient of health care, then she does require a nursing license to make this assessment.
Why would a company not get the proper licensures for their staff? Because it is expensive and time consuming! There are also continuing education requirements in some states. S&H has always insisted upon proper state licensure for all RNs providing field and telephonic case management.
So what does this mean to you, the adjuster or plan administrator? Would you use a physician that is not licensed in the state in which your plan recipient or injured worker is receiving treatment? Would you use an attorney that is not licensed in the state in which they are practicing? Why not? The same reasons apply for the RN.
If the RN is practicing outside of the scope of the Nurse Practice Act (and she is, if she is not licensed) then her company’s liability insurance does not cover her. If there is any type of untoward result as a consequence of recommendations made by the RN and it comes to light that you hired this consultant but did not make sure they were properly licensed, do you think your company will share in the liability?
So how do you safeguard against this? You can ask to see copies of all licenses for all states in which the RN practices. Another safeguard: Use a URAC accredited company. As part of the accreditation, URAC does spot checks for licensure. However, in some of our most recent hires from national companies that are URAC accredited, we found the RN did not have the proper licensure.
S&H was also informed at this recent conference many states are now making it their business to aggessively seek out and prosecute any company and/or RN working in their state, but working without a license in their state.
One solution that is helping with some of the licensure issues is a concept called State Licensure Compact. S&H communicated with the Missouri State Legislature as this issue was being considered in 2009. We are happy to report that as of this date, Missouri is in process to consider joining the compact!
More information on RN Multi-State Licensure Compact: https://www.ncsbn.org/158.htm
