NAMSS Interstate Medical Licensure Compact Grassroots Training Webinar

• Foundational Background on the Compact • The Nuts and Bolts of the

The Need for License Portability • Health care rapidly changing – Rise of telemedicine and new technology – Passage of Affordable Care Act and need for greater access to care – Integration of health care delivery systems – Increase in multi-state practice • 16% of physicians are licensed in 2 states • 6% of physicians are licensed in 3 or more • Goal: Facilitate multi-state practice without compromising patient safety or quality 4 © 2014 Federation of State Medical Boards

FSMB’s License Portability Initatives Uniform Application Legislative and Policy Expand UA Utilization FCVS Telemedicine Guidelines Improve FCVS Support Expedited Endorsement of Licensure 5 © 2014 Federation of State Medical Boards

Licensure Developments • Aggressive Push for a ‘National’ License – Legislation in Congress calling for “nationalized” licensure system – Proposals tie licensure to federal health programs (i. e. Medicare) • Need for a Nationwide Solution, Implemented by the States, without Federalizing Licensure – State solution would preserve proven regulatory approach – State solution does not require overhaul or new federal program – Licensing is constitutionally a state power • Options for interstate cooperation – Uniform Law? – Interstate Compact? 6 © 2014 Federation of State Medical Boards

What is an Interstate Compact? • A contract between compact states • Constitutionally authorized • Retains state sovereignty on issues traditionally reserved to state jurisdictions • Commission established to coordinate cooperation 7 © 2014 Federation of State Medical Boards

Interstate Compact HOD Directive in 2013 • FSMB House of Delegates unanimously adopted Resolution 13 -5: Development of an Interstate Compact to Expedite Medical Licensure and Facilitate Multi-State Practice (HOD 2013) • Directed FSMB to study the feasibility of an Interstate Compact model to facilitate license portability 8 © 2014 Federation of State Medical Boards

Interstate Compact Key Principles • Participation voluntary for both physicians and state boards of medicine • Creates another pathway for licensure, but does not otherwise change a state’s existing Medical Practice Act • Regulatory authority remains with the participating state medical boards 9 © 2014 Federation of State Medical Boards

Interstate Compact Key Principles • The practice of medicine occurs where the patient is located • Compliance with the statutes, rules and regulations of state where patient located • State boards aware of physicians practicing in the state 10 © 2014 Federation of State Medical Boards

Interstate Compact Key Principles • Improved sharing of complaint and investigative information between medical boards • The license to practice medicine may be revoked by member state once issued • The ability of boards to assess fees will not be compromised 11 © 2014 Federation of State Medical Boards

Compact Eligibility Requirements • Not all Physicians will be eligible • Must meet the following requirements: – Successfully passed USMLE or COMLEX-USA – Successful completion of a GME program – Specialty certification or a time-unlimited certificate – No discipline on any state medical license – No discipline related to controlled substances – Not under investigation by any agency 13 © 2014 Federation of State Medical Boards

State of Principal License • Serves as the entry point for eligible physician – State must be a Compact State – Physician must obtain a full and unrestricted license • What state can serve as State of Principal License? – – 14 State of physician’s primary residence State where 25% of medical practice occurs Location of physician’s employer State designated for federal income taxes © 2014 Federation of State Medical Boards

Proposed Interstate Compact Pathway Step 1 • Eligible Physician is/becomes licensed in a Compact State (State of Principal License) Step 2 • Eligible Physician applies for expedited licensure in other Compact states via State of Principal License • State of Principal License verifies eligibility Step 3 • State of Principal License sends attestation to an Interstate Commission • Eligible physician transmits fees to Interstate Commission 15 © 2014 Federation of State Medical Boards

Proposed Licensure Pathway Step 4 Step 5 Step 6 16 • Interstate Commission sends fees and physician information to other Compact states selected by Physician • Selected member states issue physician a license • ONGOING: Commission is used as a clearinghouse for shared discipline and investigatory information, renewals © 2014 Federation of State Medical Boards

Impact of Disciplinary Actions 17 © 2014 Federation of State Medical Boards

Impact of Disciplinary Actions 18 © 2014 Federation of State Medical Boards

Joint Investigations • Member Boards may participate with other member boards in joint investigations of physicians licensed by the member boards • Boards may share information and other materials • Subpoenas issued by member states enforceable in other member states 19 © 2014 Federation of State Medical Boards

Coordinated Information System • Commission to establish database of all physicians who apply or are licensed through Compact • Member Boards will report complaint/disciplinary information to the Commission • Increased permissive sharing of complaints and other investigatory information 20 © 2014 Federation of State Medical Boards

Interstate Compact Commission • State Boards retain licensing authority, participate as Commission members • Administrative Role Only – Coordinate education and training – Empowered to determine when a state has breached its obligations under Compact – Can raise own funds to remain budget neutral 21 © 2014 Federation of State Medical Boards

Interstate Compact Commission • Each member state would appoint two representatives to serve • Rulemaking authority crucial to success • Substantive changes to Compact must be unanimous 22 © 2014 Federation of State Medical Boards

Funding and Fees • Budget not envisioned to be substantial • Each member board retains power to set licensing fees • Commission would assess user fee – Similar to a ‘convenience fee’ for online ticketing • Commission can seek grants 23 © 2014 Federation of State Medical Boards

Enactment Activity (as of Feb 23 2015) 25 © 2014 Federation of State Medical

Enactment Activity (as of Feb 23 2015) 26 © 2014 Federation of State Medical

Who Else Is Supporting the Compact? • Practitioners – AMA – State Medical Associations • Provider Groups – – Mayo Clinic Gundersen Health System Ascension Health State Hospital Associations • Patients – AARP South Dakota – Helmsley Charitable Trust – US Senate / Federal Trade Commission 27 © 2014 Federation of State Medical Boards

Common Questions • • • 28 Cost? How long will it take to become licensed? What laws apply to physician? Maintenance of Certification? Creation of Super-Licensing Board? © 2014 Federation of State Medical Boards

Licenseportability. org 29 © 2014 Federation of State Medical Boards

Questions/Discussion/Contact Us Eric Fish Senior Director, Legal Services FEDERATION OF STATE MEDICAL BOARDS 1300 Connecticut Ave NW, Suite 500 Washington, DC 20036 Tel: (202) 463 -4000 efish@fsmb. org 30 © 2014 2012 Federation of State Medical Boards

CALL TO ACTION: We Need Your Voice! Interstate Medical Licensure Compact NAMSS Grassroots Training Webinar Eric Fish, JD FSMB’s Senior Director – Legal Services John Richardson NAMSS, Director of Policy and Government Relations

Why Grassroots? q Legislators are ultimately accountable to the constituents who elected them…that’s you q Grassroots advocacy facilitates direct contact with your legislators

What is Grassroots Advocacy? q. Constituent involvement in the political process q Constituents get to know their elected officials and communicate their views – relationship building is critical in politics q Constituents can use varied means to build this relationship (Letters, email, phone calls, meetings, and facility tours)

Why are Relationships with Legislators so Important? q. Legislators who understand a constituent’s interest can mean the difference between an issue with a face, and one without q “You scratch my back; I’ll scratch yours, ” holds true in politics

Grassroots Advocacy in the Legislative Process

How a Bill becomes Law • School House Rock

Building a Lasting Relationship with Your Legislator q Contact your legislators q Phone calls, e-mails, letters, or in-person meetings q Follow up with your legislators after initial contact q Volunteer for your legislators q Be an advisor on healthcare issues q Volunteer for their campaigns

STAFF CAN BE KEY q. Staff make things happen q Staff are often legislators’ ears and eyes q Discussing NAMSS priorities with staff can be just as important as discussing priorities with legislators q Establish a staff contact q Your chances of influencing your representative are better if you have a staff contact

Responsibilities of an NAMSS Grassroots Advocate q Represent medical service professionals when meeting with your elected officials q Maintain personal relationships with your representatives & staff; they should recognize your name q Follow relevant legislation; use the NAMSS GR team as a reference on important policy issues q Generate community support for NAMSS’ agenda; get your colleagues & friends involved

Build Community Support for NAMMS’ Policy Agenda q. Keep colleagues updated q Enthusiasm is contagious! q There’s power in numbers, so help us build our policy efforts q Attend town halls and public forums q These sessions are good opportunities to bring attention to your interests q Attendance will enhance name recognition within your community

Promoting the Compact q. Stay Engaged q Meet and write letters/emails to legislators and their staff q FSMB has issue briefs and talking points q Stay Informed q NAMSS’ GR team is always ready to provide you with background on all NAMSS-related legislative issues

We Need Your Help q. Strong NAMSS Grassroots Advocacy in your state will greatly improve chances for success q You are the constituents, the experts, and the voice that legislators want to hear q Successful efforts may greatly benefit your work

NAMSS is a Resource • • • www. licenseportability. org National Conference of State Legislatures NCSL. org Draft letters of support Strategic advice