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Scope of Practice Determination for Health Care Professions

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Scope of Practice Determination for Health Care Professions Scope of Practice Determination for Health Care Professions DECEMBER 2009 CONNECTICUT GENERAL ASSEMBLY LEGISLATIVE PROGRAM REVIEW AND INVESTIGATIONS COMMITTEE The Legislative Program Review and Investigations Committee is a bipartisan, statutory committee of the Connecticut General Assembly. It was established in 1972 to evaluate the efficiency, effectiveness, and statutory compliance of selected state agencies and programs, recommending remedies where needed. In 1975, the General Assembly expanded the committee's function to include investigations, and during the 1977 session added responsibility for "sunset" (automatic program termination) performance reviews. The committee was given authority to raise and report bills in 1985. The program review committee is composed of 12 members. The president pro tempore of the Senate, the Senate minority leader, the speaker of the house, and the House minority leader each appoint three members. 2008-2009 Committee Members Senate House John A. Kissel Mary M. Mushinsky Co-Chair Co-Chair Donald J. DeFronzo Vincent J. Candelora John W. Fonfara Mary Ann Carson Scott L. Frantz Marilyn Giuliano Anthony Guglielmo Brendan Sharkey Andrew M. Maynard Diana S. Urban Committee Staff Carrie Vibert, Director Catherine M. Conlin, Chief Analyst Jill Jensen, Chief Analyst Brian R. Beisel, Principal Analyst Michelle Castillo, Principal Analyst Maryellen Duffy, Principal Analyst Miriam P. Kluger, Principal Analyst Scott M. Simoneau, Principal Analyst Janelle Stevens, Associate Analyst Michelle Riordan-Nold, Associate Analyst Eric Michael Gray, Legislative Analyst II Bonnine T. Labbadia, Executive Secretary Project Staff Brian Beisel STATE CAPITOL ROOM 506 HARTFORD, CT 06106 (860) 240-0300 Email: [email protected] www.cga.ct.gov/pri/index.asp LEGISLATIVE PROGRAM REVIEW & INVESTIGATIONS COMMITTEE Scope of Practice Determination for Health Care Professions DECEMBER 2009 [Blank Page] Table of Contents SCOPE OF PRACTICE DETERMINATION FOR HEALTH CARE PROFESSIONS EXECUTIVE SUMMARY ....................................................................................................... i INTRODUCTION...................................................................................................................... 1 Study Focus......................................................................................................................... 1 Methodology ...................................................................................................................... 1 Report Organization............................................................................................................ 2 I. BACKGROUND .............................................................................................................. 5 History of Scopes of Practice in Connecticut ..................................................................... 5 Health Care Professions Regulated by Scope of Practice Laws......................................... 6 II. SCOPE OF PRACTICE DETERMINATION PROCESS .......................................... 9 Stakeholders........................................................................................................................ 9 Process Changes ................................................................................................................. 11 State Oversight of Scopes of Practice ................................................................................ 15 Department of Public Health .............................................................................................. 15 Professional Boards and Commissions .............................................................................. 17 III. OTHER STATES ............................................................................................................. 21 Arizona ................................................................................................................................ 21 Hawaii.................................................................................................................................. 23 Iowa ..................................................................................................................................... 23 Minnesota ............................................................................................................................ 25 New Mexico ........................................................................................................................ 25 Oregon ................................................................................................................................. 26 Texas.................................................................................................................................... 27 Virginia................................................................................................................................ 28 New England States............................................................................................................. 29 National Model Practice Acts.............................................................................................. 32 Nurse Licensure Compact ................................................................................................... 32 Table of Contents IV. FINDINGS and RECOMMENDATIONS...................................................................... 33 Guideline Questions............................................................................................................ 33 Scope of Practice Legislation ............................................................................................. 35 Selected Professions............................................................................................................ 36 Outputs and Outcomes........................................................................................................ 49 Stakeholders........................................................................................................................ 52 Department of Public Health .............................................................................................. 57 Best Practices...................................................................................................................... 57 Recommendations............................................................................................................... 61 Scope of Practice and Current Health Care Reform ........................................................... 66 APPENDICES A Licensed Health Professions Scope of Practice Profiles B. DPH Quality Factors for Practitioner Groups Regarding Scopes of Practice C. Declaratory Rulings for Health Care Professions D. Connecticut Nursing Board: Scope of Practice Decision Model E. Program Review Committee Staff Data Base: Data Elements F. Sample Collaborative Practice Agreements G. Overview of Nurse Practitioner Scopes of Practice in United States H. Program Review Committee: Public Health Committee Survey I. Program Review Committee Proposed Scope of Practice Process: Timeline J. Agency Response Executive Summary Scope of Practice Determination for Health Care Professions Health care providers in Connecticut must be licensed by the state to practice their professions. Licensing requirements generally include meeting certain education, experience, and competency standards. “Scope of practice” is the term for the procedures, actions, and processes that a health care practitioner, once licensed, is permitted to perform.1 In Connecticut, scopes of practice for licensed health care professions are established in state statute, as are the underlying licensing requirements. Defining scopes of practice for health care professions in statute provides the state with public policy control over the range of services licensed health care professions may provide. Legislative interest, however, has been raised about whether the state’s process for creating and modifying scopes of practice for health care professions via the legislative process is the most useful and effective process or, if not, whether the scope of practice development process should be revised in any way. Moreover, often scope of practice issues before the legislature are technical in nature and require considerable background knowledge before lawmakers can make truly informed policy decisions. Even with such information, legislators may not feel adequately prepared to make fully informed decisions involving complex scope of practice issues based on their experiences. The program review committee initiated this study in May 2009. The study focused on the state’s process to determine scopes of practice for health care professions and how the state reconciles differences among professions if they arise. The study specifically examined whether changes to the scope of practice process are necessary to make it more useful to legislators and other stakeholders. The committee was principally interested in knowing whether a different model for determining scopes of practice, or changes to the current model, would enhance the overall scope of practice determination process, particularly in terms of outcomes for the public. As the education, training, and technology within health care professions advance and become more sophisticated, and practitioners become more competent as a result, scopes of practice may need to be amended to reflect those changes (along with the corresponding
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