As a Case Manager, Must I be Licensed in Every State that My Patients Are? My boss says NO, BUT….

RN compact licensure

compact licensure

This article was originally posted in Ellen’s Interprofessional Insights by Dr. Ellen Fink-Samnick DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCM

The short answer is YES! The industry standard for professional case managers is that they should be licensed in every state where their patients are. However, case managers and other practitioners are chronically put in that ethical and legal “hot seat”, and asked to juggle employer mandates with professional requirements. The workforce is constantly set up for sanction by being told things like, “Case management is coaching” and does not involve assessment. The inaccuracies of this statement couldn’t be farther from the truth!

Let’s face it, our case management workforce does it all, from providing resource information and arranging provider appointments to assessing for clinical intervention and treatment planning. CMSA’s Standards of Practice and ACMA’s Standards of Practice and Scope of Services are robust. One would think that in response to the scope of case management practice, the professionals involved would have the ability to legally engage, assess, facilitate care plans for, and support treatment planning for their patients, independent of their location. Yet, despite interstate practice being more the norm than the exception, significant obstacles exist for the workforce.

Uninformed organizations too often claim case management roles involve patient or caregiver coaching or education rather than assessment. Case managers might hear, “You don’t need to be licensed to call and check in on patients” or “Why would you need a licensure to make sure the patient has access to their meds”. However, as legal colleagues remind me, the majority of licensed professionals transcend this reality once they engage with a patient, whether virtually, telephonically, or in person. Independent of discipline, case managers are polite, take a minute to engage each person, then ask the question: “How are you today?” 

I know there are times when a case manager calls to provide basic resource information to patients. Those moments may not involve or, perhaps, start with assessment, care coordination, facilitation, monitoring, or other identified elements of case management that fall within a licensed professional’s scope of practice. Unfortunately, this view is short-sighted and flawed thinking at best. This mindset limits a case manager’s role and impedes their success in ensuring a positive patient outcome.

Remember

  1. Be familiar with the scope of practice for each state where you hold licensure: It is the responsibility of each licensed professional to make sure they are working within the scope of their license. Every licensed discipline involved in case management has a practice act for their licensure level, which can be found on each state board’s website. Remember, the license is issued by the individual state regulatory board versus an employer. The licensure board and scope of practice for that professional supersedes organizational policy.
  2. Some entities identify a mandate for case management certification with licensure, which is buried in each state’s regulations: Keep in mind Case Management credentialing (e.g., ACM, CCM, CMGT-RN) and licensure scope of practice are different. An increasing number of states require case management certification (e.g., Texas) and you should verify this reality with your state board. My nursing colleagues often query the National Council of State Boards of Nursing (NCSBN) who administers the NCLEX exam, about these state requirements. Traditionally, they will refer you to your primary state licensure nursing board and that state’s scope of practice regulations. The same will happen for my social work colleagues if they reach out to the Association of Social Work Boards (ASWB) who administer each level of each state’s social work licensure exam across the US and US territories, and Canada.
  3. If your employer can’t provide documentation to validate your actions, it doesn’t exist:  What do we always say about documentation? If it doesn’t exist, it didn’t happen. Well, the same mantra applies here. Every case manager should ask their employing organizations to provide documentation from each state board (and for all disciplines of case managers for their workforce) stating case management employees can practice without a license in that state. If they cannot produce that validation, then they are not doing their job. 
  4. If your clinical gut screams NO, LISTEN: Our case management workforce has clinical intuition that informs our practice. Most often case managers say, “I had a feeling this wasn’t right, but felt that my job was on the line”. I also get, “Who is going to know if I cross the line?”; actually, the better question is, why would you want to take that risk? If you are unsure about whether or not you need to be licensed in a state or jurisdiction, reach out to that state board for your primary licensure. You can also reach out to your case management credential for an advisory opinion, and seek guidance from your malpractice provider, as well as thought leaders, such as those in The Case Managers Community on Facebook. 

Licensure Compacts on the Move

Licensure compacts are a viable solution for professionals seeking to be licensed in multiple jurisdictions and those who hire them. Through the compact structure, members of the workforce who are licensed in one state can actively practice at that same level in other states that are part of that compact. The presence of a compact also reduces the economic burden faced by licensed individuals in dealing with multiple state licensure applications. Here’s the current roster of happenings with the licensure compacts of interest for case managers.

Nursing

Nurses are required to be licensed in any state where they practice and where the recipient of nursing practice is located at the time service is provided. This fact is a common point of confusion for most licensed professionals—and especially tricky for those my case management colleagues. As was posted in the Case Managers Community by industry thought leader, Deanna Cooper, “When your case management position requires that the person be an RN, and you state you are functioning as an RN, then you must meet the license requirements in the states where your patients are located”; yup, that means licensure. Most employers will pay the cost of you obtaining and maintaining a license in those other states. The Licensure Compact is actively on the move, and now covers 41 states. Current info appears on the NCSBN website.

Social Work

Formal language for the Social Work Licensure Compact was released in February 2023, with legislation actively being introduced across state legislatures; 24 states have done so at the time of blog post with a current map viewable on the compact website. 4 states have fully approved the legislation at the time of this writing: Missouri, S. Dakota, Utah, and Washington State. The Model Compact Bill must be approved by 7 states to be enacted in its entirety before its necessary infrastructure can be implemented, which is expected to occur in the coming months. After verifying eligibility, individual social workers will then be granted a multistate license, which authorizes their ability to practice in all other compact member states, and removes those longstanding barriers to interstate practice.

Counseling

The American Counseling Association Counseling Compact calls for counselors licensed in one state who have no disciplinary record, to be eligible for licensure in any state or U.S. jurisdiction where they seek residence. Like other disciplines, laws that impact counselors (e.g., mandated reporting statutes) vary from state to state, so the compact recognizes how jurisdictions may require a state jurisprudence exam. At the time of this writing over 32 states have approved the Counseling Compact with the interactive map viewable on the compact site.

Other Compacts on the Move

In addition to the compacts listed, information is available for those covering:

Individual practitioners must advocate to advance licensure through their respective professional associations. These entities have fierce public policy committees actively working toward interstate practice. In addition, contact your local legislators to provide individual support for those licensure compacts of interest to you. Access your elected legislators through USA.gov. Remember, support for one interstate compact, leverages them all!

More information on Interstate Compacts and the Do’s and Don’ts of practice across state lines appears in Chapters 2 and 8 of The Ethical Case Manager: Tools and Tactics, available on Amazon.

Dr. Ellen Fink-Samnick DBH, MSW, LCSW, ACSW, CCM, CCTP, CRP, FCMBio: Dr. Ellen Fink-Samnick is an award-winning industry entrepreneur who is known as “The Ethical Compass of Case Management”. Her focus is on competency-based case management, interprofessional ethics, holistic health equity, quality, and trauma-informed leadership.

Dr. Fink-Samnick is a content-developer professional speaker, author, and educator with academic appointments at Cummings Graduate Institute of Behavioral Health Studies and George Mason University. She has served in national leadership and consultant roles across the industry. Further information is available on her LinkedIn Bio or her website