November 2003 Bulletin

• Licensure, Registration and Certification
• A Revolution is Coming!
• Facts You May Need To Know About Your Employment
• Disciplinary Action
• NCLEX "First Time" Test Takers Pass Rates
• Attention: Nurse Practitioners and Nurse Midwives

Licensure, Registration and Certification

Commonly held misconceptions exist regarding credentials in nursing. Some of the misconceptions lie in the incorrect application of the terms: licensure, registration, certification, and accreditation.
Licensure is authorization granted by a government to perform a function or service, e.g. a driver's license, a nursing license, etc. Licensing is founded on the police powers of the state to protect the health, safety, and welfare of the public. To be authorized to practice as a nurse (to be licensed) requires the demonstration of the minimum degree of competence to perform the authorized function.
Registration is listing with and by some entity. It can be a governmental or non-governmental entity that does the registration. Registration grants no authority, nor does it address an individual's qualifications.

Certification is a voluntary act which, according to some organized procedure, measures an individual's qualification to perform a particular function. Because it is voluntary, certification conveys no authority or privilege, in other words, one need not possess the certificate to legally perform a function or service, although custom and/or market forces may require it. Certification exists in many professions and trades. The term "specialty certification" is properly applied to programs which identify a special capability where a primary general credential exists. For example, licensed nurses may be specialty certified when they demonstrate a particular expertise, e.g., critical care.

Accreditation is like certification in that it is voluntary and measures capability to perform. It differs in that accreditation applies to institutions and programs, not individuals. A familiar example is the accreditation of education programs.

A Revolution is Coming!

As most of you know, the status of any Maine licensed nurse may be viewed on the Internet. Simply go to the web site at: http://www.maine.gov/boardofnursing. Click on Licensing and then click on Check Maine License Status Online. The web site is maintained by the Board of Nursing and the licensure information is updated daily. The Board no longer issues "status reports" since the information is readily available on the web. The information provided by the Board on the web site is evidence that the individual is licensed (authorized) to practice nursing (professional or practical) in Maine. As our new licensure system is implemented and enhanced, it is the goal of the Board to go "paperless" - whereby any evidence of licensure may be obtained online. Please watch future Bulletins for further and fascinating discussion on this topic.

Facts You May Need To Know About Your Employment

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services has the authority to exclude from participation in the Federal health care programs any individuals and entities who have been convicted of certain offenses, sanctioned by other governmental agencies, or who have participated in inappropriate activities related to the provision of health care items and services as detailed below. Federal health care programs include Medicare, Medicaid, Tricare, Veterans Affairs, and all other programs that provide health benefits and are funded directly, in whole or in part, by the United States government (except the Federal Employees Health Benefits Program).

The Social Security Act (Act) authorizes the OIG to exclude individuals and entities based on particular circumstances. The Act specifies when the OIG must exclude and when the OIG may exclude. The OIG must exclude an individual or entity who has been convicted of:
1. Medicare- or Medicaid-related crimes (misdemeanor or felony)
2. Patient abuse or neglect (misdemeanor or felony)
3. Felony health care fraud (not related to Medicare or Medicaid)
4. Felony controlled substance violations

The OIG may exclude in several other instances. For example, the OIG may impose exclusions based on:
1. Convictions for misdemeanor health care fraud (not related to Medicare or Medicaid)
2. Convictions for misdemeanor controlled substance violations
3. Disciplinary actions taken by licensing boards or other Federal or State health care programs
4. Quality of care issues related to denial of services, excessive/unnecessary services, or substandard care
5. Prohibited activities such as false claims, fraud, kickbacks (with or without a conviction)
6. Defaults on health education assistance loans

Once a person is excluded, Federal health care programs will not pay for anything that the person furnishes, orders, or prescribes, regardless of what that person's job is. The exclusion affects, among others, the excluded person, anyone who employs or contracts with the excluded person, or any hospital or other provider where the excluded person provides services. The exclusion applies regardless of who submits the claims or requests for reimbursement and applies to all items or services, including administrative and management services, furnished by the excluded person. An excluded person may not be employed by a provider to perform functions for which the provider is paid, in whole or in part, by any Federal health care program. As a result, an excluded person generally may not be employed by a hospital, nursing home, or other institutional provider which participates in Federal health care programs. The exclusion is nationwide in scope and applies to all health care professions and occupations.

For example, if a nurse is excluded, he or she will be precluded from many types of employment in the health care field. Items or services furnished by the excluded nurse cannot be reimbursed, either directly or indirectly, by a Federal health care program. A nurse cannot work at a hospital, nursing home, or other institutional provider if the nurse's salary or fringe benefits are paid directly to the nurse or indirectly through the employer on a Federal health care program's cost report. These prohibitions apply regardless of whether the person excluded as a nurse now has a different license within the nursing field (e.g., LPN instead of RN), or changes fields and is now employed as a physician, secretary, administrator, information clerk, cafeteria worker, or any other position where the salary is reimbursed by Federal health care programs directly or on a cost report.

Once excluded, an individual or entity is not able to participate in Federal procurement and non-procurement programs and activities. For example, an excluded person cannot be granted Federal student loans or housing loans, nor will any excluded party be able to enter into any contract with the Federal government.

An exclusion does not affect an excluded individual's, or his/her family's, rights to receive personal benefits as a beneficiary of Medicare, Medicaid, or any other Federal health care program.

More information about exclusions, Frequently Asked Questions, and a Special Advisory Bulletin about the Effect of Exclusions, may be found on the OIG's Website at http://oig.hhs.gov. Then click on EXCLUSIONS DATABASE, and choose the information you wish to access. If you desire you may also call (617) 565-1567 and speak with Richard DeRoberto, Sanctions Officer.

DISCIPLINARY ACTION

Licensees fined from 07/01/03 - 10/31/03 for practicing during lapsed license status: 35

Complaints Dismissed from 07/01/03 - 10/31/03: 62

NCLEX "FIRST TIME" TEST TAKERS PASS RATES

Practical Nurses For the year October 1, 2002 through September 30, 2003, 16 first time candidates educated in Maine wrote the NCLEX® examination for practical nurses and 16 passed, a 100% pass rate! The national pass rate for U.S. educated, first time test takers (43,138) for the same time period was 88.3%.

Registered Nurses For the year October 1, 2002 through September 30, 2003, 476 first time candidates educated in Maine wrote the NCLEX® examination for registered nurses and 412 passed, a 86.55% pass rate. The national pass rate for U.S. educated, first time test takers (75,678) for the same time period was 87.2%.

NCLEX-RN "FIRST TIME" TEST TAKERS PASS RATES
For the year October 1, 2002 through September 30, 2003

When reviewing statistics, keep in mind absolute numbers as well as percentages.
(Percentages for smaller absolute numbers can vary widely.)

Attention: Nurse Practitioners and Nurse Midwives

The 121st Legislature passed the following two laws that may directly concern your practice.

1. Chapter 1603 Controlled Substances Prescription Monitoring.

The intent of the Legislature is that a prescription monitoring program is established to detect and prevent substance abuse; it is not intended to interfere with the legitimate medical use of controlled substances. The program will be maintained within the Department of Behavioral and Developmental Services.

You may access the law in its entirety at: http://janus.state.me.us/legis/ros/lom/LOM121st/10Pub451-500/Pub451-500-134.htm

For further information, please contact:
Kim Johnson
Director of Office of Substance Abuse
Department of Behavioral and Developmental Services
(207) 287-6344

2. Chapter 418 An Act to Ensure Patient Access to Medical Records

The change for copies of records may not exceed $10.00 for the first page and .35¢ for
each additional page.

You may access the law in its entirety at:
http://janus.state.me.us/legis/ros/lom/LOM121st/9Pub401-450/Pub401-450-21.htm