Is Your Nursing Home Administrators' License "Portable"?

You re an administrator of a successful skilled nursing facility. Because of your success, you receive a job offer that is too good to refuse, but the new facility is located in another state. Your new employer wants you to start immediately. After a little research, you find out that there's a six-month wait until your application for a new license is reviewed and approved. Meanwhile, you jump through hoops to obtain a temporary license and get a headache in the process.

Or, you are a regional vice-president for a multifacility corporation that has just purchased several new facilities in another region of the country. The last survey team to visit these facilities found some serious deficiencies. Your plan of correction starts with relocating three of your most successful administrators to fix the problems. You find out that each state in this region has different requirements for administrator-in-training (AIT) programs and continuing education, and that a temporary license will take several weeks to obtain. How are you supposed to turn these facilities around in record time?

Sound familiar? If you hold multiple licenses as an administrator or a consultant, you probably know the scenario. Licensure reciprocity, or the ability to move fluidly from one state to another and practice immediately, has been an ongoing problem for mobile administrators for years. Some states will grant reciprocity if the state in which you already practice has similar licensure requirements. However, no two states are alike, and those that are similar are few.

The social security amendments of the late 1960s mandated licensure for nursing home administrators as a way to establish a minimum level of competency necessary to operate a facility. However, each state or jurisdiction's legislative body created individual legislation that ultimately slowed down the process for administrators to move from one jurisdiction to another.

For example, regulations in some states called for baccalaureate degrees; in others, a high school education was sufficient. Furthermore, some regulations required internships through AIT programs; others did not. Even today, some jurisdictions require a state-specific examination above and beyond the federal licensure administered by the National Association of Boards of Examiners of Long Term Care Administrators (NAB).

In an effort to address this problem, a proposal was made in the late 1980s, with the coming of the Omnibus Budget Reconciliation Act (OBRA) that would implement national standards for nursing home administrators. The federal government chose, however, to pass over any substantial action on the proposal. Ever since then, administrators have looked for ways to transfer their license from one jurisdiction to another.

In 1996, NAB decided to do what the federal government had been unable to do through OBRA--find a credible way to meet the challenge of reciprocity and make portability of licensure a reality for nursing home administrators. In 1997, and following thorough review, the NAB Board of Governors unanimously approved the concept of professional certification through the American College of Health Care Administrators (ACHCA). In other words, a certified nursing home administrator (CNHA) could be granted licensure reciprocity from state to state. Although provisions allow individual states to exercise their right to require administrators to pass a state exam or similar state-specific criteria, the length of time from applying for reciprocity to licensure should be less.

The ACHCA Certification Program is a voluntary program designed to measure advanced-level skill, knowledge and abilities--a step above licensure. In fact, a 1996 survey by Brown University and LTCQ, Inc., revealed that facilities operated by CNHAs had fewer survey deficiencies than those under noncertified administrators.

Since that action in 1997, 13 states have officially recognized ACHCA certification as an option for reciprocity: Arkansas, Georgia, Iowa, Kentucky, Louisiana, Maine, New Jersey, North Dakota, Ohio, Oregon, Tennessee, Washington and West Virginia. Also, the following boards have approved the concept and are moving forward with public hearings and/or legislative reviews with the intent of incorporating the option into their rules: Arizona, District of Columbia, Minnesota, New Hampshire, Nevada, Rhode Island and Wisconsin.

Twenty licensing boards have made or are working toward making it possible for CNHAs to be licensed more rapidly without sacrificing the integrity of individual state regulations. All boards want to safeguard their gubernatorial charge to protect the public good by having the best possible people credentialed to guide America's nursing homes.

If you are a CNHA and wish to obtain a license in another state, call the relevant state officials and ask if you can be licensed by reciprocity via the ACHCA certification option. Even if the state does not recognize the program as an option for reciprocity, ask if the board will consider exceptions. If enough administrators petition the board or state legislature, eventually more states will officially endorse the option.

If you are a corporate leader, profit or not-for-profit, one of the wisest business decisions you can make will be to explore professional certification and include it in the corporation's business plan. Certification in any profession raises the bar on professional standards and sends a strong message to your employees about your corporate culture. Executives who can enhance the portability of the best and brightest administrators in their systems will be better prepared to maximize the talents of those who will address the ever-increasing frontline issues surfacing in today's professionally managed nursing home. Therefore, corporate leaders, too, should consider joining the effort. NH

Daniel W. Farley, PhD, CNHA, is a Fellow of the American College of Health Care Administrators and serves as president/CEO of GlenWood Park Retirement Village, Princeton, WV. Dr. Farley is also serving a second term as Chair of NAB's State Government and Regulatory Issues Committee (formerly the Endorsement Committee). From 1994-1995, he served as president of ACHCA.