Allied Health Services Avoiding Crises (1989) / Chapter Skim
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7 Licensure and Other Mechanisms for Regulating Allied Health Personnel
7 Licensure and Other Mechanisms for Regulating Allied Health Personnel
Pages 235-258
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From page 235... ...
Certification, if it is accepted as a valid distinction by employers or if it is required by accrediting bodies such as the Joint Commission on Accreditation of Healthcare Organizations, also affects employers' decisions to employ allied health personnel; certified and noncertified members of the same allied health field are then treated as separate labor pools. Regulatory mechanisms also influence supply by defining who may enter and remain in certain allied health fields.
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From page 236... ...
In addition, the committee reviewed the research literature on occupational regulation. METHODS OF CONTROL State Regulation Society applies many quality control methods to health care personnel, including allied health personnel.
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From page 237... ...
Carpenter (1987) defines licensure as "a process by which a governmental agency restricts entry into an occupation by defining a set of functions and activities constituting a 'scope of practice,' grants permission to engage in that practice only to persons meeting predetermined qualifications, and establishes structures and procedures for screening applicants and granting licenses to practice." These and other definitions share certain common elements, including: · licensure is intended to protect the public; · licensure is exclusionary; · licensure prescribes the characteristics and qualifications of persons who may be licensed; · licensure defines a scope of practice for licensees (and therefore licensure laws are often referred to as "practice acts"~; and · licensure prohibits nonlicensed persons from engaging in the defined scope of practice.
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From page 238... ...
This regulatory mechanism is also applied in other fields such as accountancy, in which anyone can practice but only those who have met state standards can use the title "certified public accountant." In one form or another, about 800 occupations are regulated by the states, including architects, real estate brokers, barbers and cosmetologists, electricians, and engineers. Besides occupational regulation, states also oversee allied health personnel through the regulation of institutions and settings in which they work.
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From page 239... ...
3. STATUTORY CERTIFICATION With state standards and state enforcement Through regulation, occupational members can be required to meet certain state standards; only those who meet these predetermined qualifications may legally use the designated title of the occupation.
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From page 240... ...
Department of Health, Education, and Welfare's Office of the Assistant Secretary for Health and Scientific Affairs investigated problems in health care personnel licensure and certification. The department's 1971 Report on Licensure and Related Health Personnel Credentialing contained far-reaching recommendations, including a recommendation to the states for "a two-year moratorium on the enactment of legislation that would establish new categories of health personnel with statutorily-defined scopes of functions." The moratorium was to allow time for further consideration of the tasks and functions of new health care occupations.
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From page 241... ...
scopes ot practice. Above all, state regulation is viewed as a means of improving the quality of health care by restricting entry into health care occupations to persons who have proper credentials and by disciplining persons who do not meet standards of professional behavior.
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From page 242... ...
Yet this is not the only theater of conflict; insurance coverage and reimbursement constitute another. Yet the regulatory arena is where the identity and power of allied health personnel are largely determined.
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From page 243... ...
In the course of testimony by representatives of the American Dental Hygienists' Association (1987a,b) and the American Dental Association (1987)
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From page 244... ...
In Washington State, dental hygienists have practiced unsupervised in long-term care facilities since 1984. The American Dental Association is seeking to tighten supervisory requirements for hygienists.
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From page 245... ...
According to the California Office of Statewide Health Planning and Development (1987) , the agency responsible for the program, it "is authorized to approve locally conceived and implemented demonstration projects to prepare and utilize health personnel for new or expanded roles." To qualify for the program, hygienists needed at least 4 years of clinical experience, certification in cardiopulmonary resuscitation, and special training in instrumentation.
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From page 246... ...
Criticisms as to Outcome In addition to criticisms of the structures and processes of state regulation, there have been substantial criticisms of the outcomes of regulation in terms of health care cost, quality, and accessibility. A body of research literature generally calls into question whether state regulation as we know it is serving the public.
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From page 247... ...
Reforms of State Regulation Twenty years of criticism have led to a number of recommendations for the reform of state regulation of health occupations, some of which have been implemented. Criteria for Regulation: "Sunrise" Procedures In the face of a growing number of occupations seeking licensure and a growing concern about the cost-effectiveness of licensure, 13 states have sought to bring a greater degree of reason and due process to what had been largely an ad hoc and political procedure.
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From page 248... ...
Accountants are certified by the states after meeting certain eligibility criteria. These criteria vary among the states, but all states require passing grades in each of four parts of the uniform national examination given by the American Institute of Certified Public Accountants (CPAs)
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From page 249... ...
This broader statement would encourage allied health occupations seeking state regulation, other parties at interest, and the states themselves to make as explicit as possible the nature of the trade-offs under consideration. Reforms of the Regulatory Structure and Process The criticisms enumerated above have led to calls that date back to the late 1960s for structural and procedural changes.
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From page 250... ...
A third approach is to link related health occupations through joint boards. Rather than the single board envisioned by Selden, there would
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From page 251... ...
~~$ ,,,~,,,,~,,$ be.. ~~_.~_v ,,^ ~ The Federal Role The federal government plays a very important role in regulating allied health personnel.
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From page 252... ...
NCHCA sets standards that are designed to ensure that certifying agencies are accountable to individuals seeking certification, to their employers, to health care payers, and to the public. (A copy of their standards is attached as Appendix G.i The federal Medicare program has a significant impact on allied health personnel through the way it defines covered services.
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From page 253... ...
The second form of accreditation that is a quality control mechanism for allied health personnel is the accreditation of hospitals and nursing homes by the joint Commission on the Accreditation of Health Care Organizations. The joint commission promulgates standards that include qualifications of key hospital personnel.
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From page 254... ...
Separate services are defined, including occupational therapy, physical therapy, prosthetic and orthotic services, psychological services, recreation therapy, social work services, speech-language pathology or audiology services, and vocational rehabilitation services. No specific staffing standards are given beyond the general one.
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From page 255... ...
These decisions should follow three basic principles: 1. the protection of the public is the sole reason for states to regulate health occupations; 2.
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From page 256... ...
The Bureau of Health Professions (or another future focal point for allied health personnel in the Depa~-l'''ent of Health and Human Services) should sponsor a body with members drawn from allied health and other health professions and from the health and social science research communities to assess objectively the evidence bearing on jurisdictional issues.
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From page 257... ...
1987. State regulation of allied health personnel trends and emerging issues.
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From page 258... ...
1971. Report on Licensure and Related Health Personnel Credentialing.
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