compact licensure

The short answer is: NO! The industry standard for professional case managers is that they should be licensed in every state that their patients are in. However, case managers across practice settings are put in an ethical and legal “hot seat” with respect to this issue. Employer mandates don’t sync with professional requirements. This leaves case managers set up for sanction by being told that, “case management is coaching and doesn’t involve assessment” or bluntly informed “Don’t worry….You practice virtually, so who’s going to know that you’re not licensed in that state.“. The inaccuracies of these statements couldn’t be farther from the truth! Interstate licensure may incur greater fiscal costs for employers. However, case managers face greater legal and ethical costs when they’re not appropriately licensed for their roles!

Case Management Is More Than “Coaching”

Case management has a large lens of practice, from assessing patient needs and providing resource information, to arranging provider appointments, monitoring clinical intervention, treatment planning, outcomes, and other domains. CMSA’s Standards of Practice, assorted Board-certification and renewal requirements, and professional codes of conduct–such as those through ANCC and CCMC—are robust for a reason. With so much is at stake for patients and their families, the case manager role should not be taken lightly, and especially by employers.

One would think that in response to this vast scope of practice, case managers could legally engage, assess, facilitate care plans for, and support treatment planning for their patients, and independent of their physical location. Yet, significant obstacles exist for the workforce, despite the interstate practice being more norm than the exception,

Uninformed organizations come up with a litany of excuses to not provide multi-state licensure for employees. Case managers might hear, “Why do you need to be licensed to call and check in on patients?”, or “The role involves only coaching”, or even “Why would you need a licensure to make sure a patient has access to their meds”. Yet, as legal colleagues caution, licensed professionals step into a cautionary zone once they engage with a patient or their caregiver, whether virtually, telephonically, or in person. Independent of discipline, case managers take a minute to engage each person, then ask the question: “How are you today?” It’s a dangerous and slippery legal and ethical slope to maneuver from that point onward! 

And About Those Interstate Licensure Compacts

Licensure compacts are a viable solution for professionals needing licensure in multiple states. Through the compact structure, members of the workforce licensed in one state can actively practice at that same level in other states that are part of a compact. The presence of a compact also reduces the economic burden faced by licensed individuals when dealing with multiple state licensure applications. The only exception to this challenge is when individuals are employed by, or contracted with the DOD, VA, and several other governmental entities under the National Defense Authorization Act. Here is a current roster of licensure compact happenings for professional 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 tricky for case managers. Most employers will pay the cost to obtain and maintain a license in those other states. The NLC is on the move and now covers 42 states. Current info appears on the NCSBN website.

Social Work

The Social Work Licensure Compact is on the move with an interactive map on the compact website. 22 states have enacted the legislation: Alabama, Arizona, Colorado, Connecticut, Georgia, Iowa, Kansas, Kentucky, Louisiana, Maine, Minnesota, Missouri, New Hampshire, Ohio, Nebraska, Rhode Island, S. Dakota, Tennessee, Utah, Vermont, Virginia, and Washington State. Implementation of multi-state licensure will take 18-24 months.

Counseling

The American Counseling Association Counseling Compact calls for counselors licensed in one state with 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. Over 32 states have approved the Counseling Compact with an interactive map on the compact site.

Other Compacts of Interest for Case Management

• The Interstate Medical Licensure Compact (IMLCC)
• The Occupational Therapy Compact (OTC)
• The Physical Therapy Compact (PTC)
• The Psychology Interjurisdictional Compact (PsyPact)

Passage of one compact leverage all. Individual practitioners must advocate to advance licensure through their respective professional associations. All associations are engaged in fierce public policy initiatives to attain interstate practice. Contact local legislators for individual support with licensure compacts of interest to you. Access elected legislators through USA.gov.

Professional Case Management Credos for Interstate Licensure

Don’t Google and guess what to do! Follow our industry guidance!

1. Be familiar with the scope of practice for each state where you hold licensure:  Licensed professionals are responsible for working within the scope of their license. Every discipline involved in case management has a practice act for their licensure level that can be found on the website of each state licensure board. Remember, licensure scope of practice for a profession supersedes organizational policy.
2. Mandates for case management certification with licensure may be buried in state regulations: Case management credentialing (e.g., CCM, CMGT-RN) and licensure scope of practice are different. Increasingly states require case management certification (e.g., Texas); this fact should be verified with your state board. My nursing colleagues may query the National Council of State Boards of Nursing which administers the NCLEX exam, about these state requirements. Expect to be referred to your primary state licensure nursing board for a review of 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, the entity that administers social work licensure exams across the US, 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 employer to provide documentation from each state board (and for all disciplines of case managers for their workforce) stating case management employees are able to practice without a license in that state. If they cannot produce that validation, they are not doing their job. 
4. When in doubt, check your other Established Resources of Guidance: State practice acts are only one of several Established Resources of Guidance for case management. Also included are dedicated standards of practice, codes of professional conduct, and ethical codes. CMSA’s standards A: Qualifications and C: Legal are clear about heeding requirements defined by licensure boards and scope of practice. CCMC’s Principles and Rules for Board-certified Case Managers also provide guidance.
5. If your clinical gut screams NO, THEN 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 will know if I cross the line?”; the better question is, why would you take that risk? If you are unsure whether licensure is required in a state or jurisdiction, contact that state board for your primary licensure. You can also request an advisory opinion from a case management credential, seek guidance from your malpractice provider, or ask industry thought leaders, such as those in The Case Managers Community on Facebook.

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, FCM is an award-winning industry entrepreneur known as “The Ethical Compass of Case Management”. She focuses 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