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Overview

In the healthcare context, licensure typically is performed by a government agency, usually the applicable state board. Licensure standards, which typically are based on educational and training requirements, are viewed as necessary to help ensure patient safety and keep healthcare providers accountability for the care they provide.

Licensure generally is required for health professionals (physicians, nurses, dentists, etc.) and for institutional providers (hospitals, nursing homes, clinics, etc.). Licensure may require the paying of a periodic fee and often for health professionals includes continuing education requirements. A state agency can revoke licensure for incompetence or other specified reasons.

Policy

Licensure issues for individual providers include ensuring they provide services in accordance with their training and expertise and the respective scope of practice and supervision permitted by their licensure and modality of clinical practice. Most states have a requirement for a written delineation of the scope of allied health professionals’ (e.g., CRNAs, PAs, ARNPs, NPs) responsibilities. Often supervision of allied health professionals are governed by statute, regulation and a written description of delegated responsibilities and supervision requirements. This may be encompassed in a written protocol or similar document. Organizations, supervising physicians and supervised allied health professionals all bear licensure responsibility and risk and liability exposure for failure to appropriately delegate responsibility, supervise and document those processes.

Excerpt from Peggy Nakamura and Jay Martus, Enterprise Risk Management (ERM) Principles and provider Liability for Physicians and Physician Organizations, Physicians and Physician Organizations (American Health Lawyers Association 2010).

Authority

All states regulate the operation of hospitals because of the understandable perception that the public good demands such oversight. State regulation takes the form of licensure laws and regulations. Obtaining a license typically requires the filing of an application by the proposed operator with the appropriate state authority, typically a Department of Public Health. The application usually will require a description of the intended scope of operations at the hospital. Not all general acute care hospitals provide all medical services to their patients. Many hospitals specialize in particular services, and even more hospitals limit their scope of services because of financial or other practical reasons. In many states, specialty hospitals are licensed separately from the acute care hospitals, and in most states the delivery of inpatient mental healthcare is separately licensed. Specialty hospitals are licensed separately because they must meet more specific state requirements.

Excerpt from Robert G. Hoban and Monte Dube, Regulation of Hospitals, Fundamentals of Health Law (American Health Lawyers Association 2000).

Licensed SNFs [skilled nursing facilities]/NFs [nursing facilities] are subject to certain staffing, provision of services and physical plant requirements, as set forth in the applicable licensure statute and regulations. HHAs [home health agencies] are generally subject to state licensure requirements. In some states, licensure is only required if the entity provides skilled nursing and at least one type of therapy service. In other states, the provision of skilled nursing services alone, through a private duty nursing agency or a home infusion therapy company, or non-medical companion service may trigger licensure.

Excerpt from Todd J. Selby, Introduction to Long Term Care, Home Care and Hospice Law, Fundamentals of Health Law (American Health Lawyers Association 2010).