WELCOME OCTOBER 30, 2013 Professional Leadership Forum

WELCOME

OCTOBER 30, 2013

Professional Leadership

Forum

NEW LAWS IMPACTING THE OFFICE OF THE PROFESSIONS

An Overview from 2010 to Present

Sarah Benson

NEW PROFESSIONS & OFFICE OF THE PROFESSIONS RESPONSIBILITIES

• Polysomnographic Technologist Authorization – Ch.262/2011

• Perfusionist Licensure – Ch. 479/2012; Ch.409/2013

• Clinical Nurse Specialist (CNS) Certification – Ch.364/2013

• Social Work, Mental Health, Psychology Corporate Practice Waiver – Ch.130,132/2010; Ch.187/2011

• 4410/Early Intervention Corporate Practice Waiver – Ch.581/2011

• Required Reporting of Sexual Offenses to Law Enforcement – Ch.365/2012

New Laws

CHANGES TO SCOPE OF PRACTICE

• Eliminated Midwifery Collaborative Practice requirement – Ch. 238/2010

• Pharmacists permitted to engage in CDTM (Collaborative Drug Therapy Management) – Ch.21/2011

• Expand podiatry to below the knee – Ch.438/2012; Ch.23/2013

• Qualified Pharmacists authorized to administer immunizations – Ch.316/2011; Ch.116/2012; Ch. 274/2013

• Allows Dental Hygienists to work with a Collaborative Practice Agreement in an Article 28 facility – Ch.239/2013New Laws

CHANGES TO EXISTING LAWS• Requires Masters Degree for Physical Therapy licensure –

Ch.410/2011

• Defines and sets requirements for Occupational Therapy Assistants – Ch.460/2011

• Authorizes Design Professional Corporations – Ch. 550/2011 Ch.467/2012; Ch.9/2013

• Permits Accountancy mobility – Ch. 456/2011

• Requires Pharmacy interpretation services – Ch.56/2012

• Extends Clinical Laboratory Technology Limited License to 2016 – Ch. 336/2013

• Includes optometrists within provisions relating to clinical laboratories – Ch.444/2013

New Laws

NEW CONTINUING EDUCATION REQUIREMENTS

•Veterinary Medicine/Vet Med Tech – Ch.328/2010

•Massage Therapy – Ch. 463/2010

•Occupational Therapy/OTA – Ch.444/2012; Ch.18/2013

•Social Work (LMSW/LCSW) – Ch.443/2013

New Laws

GROWTH AND CHANGE

Statistical Highlights in Professional Licensing

Susan Naccarato

NEW LICENSES ISSUED

Steady Increase in Licensed Professionals in NYS

OPERATIONAL RESPONSIBILITY - 2012

New licenses issued 45,804

Registrations processed 278,511

New filing processed for professional corporations 3,480

Candidates took OP-developed licensing exams 2,744

Email/telephone inquiries answered 1,000,000

NYSED and its Partners

support

the important role of Licensed Professionals in

New York State

OPERATIONAL RESPONSIBILITY - 2012

Serve the Public

NUMBER OF LICENSED PROFESSIONALS THAT ARE REGISTERED TO PRACTICE IN NYS, BY YEAR

Serve the Public

GROWTH AND CHANGE

Technology Updates

e-Licensing Mary Beth

Nelligan Web Site Re-Design David

Hamilton

• Agriculture and Markets (AGM)

• Dept. of State (DOS) – individual licenses only

• Dept. of Environmental Conservation (DEC)

GROWTH AND CHANGE

• Dept. of Tax & Finance

(DTF)• State Education Dept.

(SED)

• State Liquor Authority (SLA)

6 State Agencies are part of thee-Licensing Project

e-Licensing

TODAY’S NYSED WEBSITE IS TEXT-HEAVY AND CUMBERSOME

Web Site Re-Design

Commissioner King has set goals for improving NYSED.GOV

• High-Demand Information & Serviceso User-Friendly Platform (Desk, Tablet,

Mobile)o Enhanced Customer Service

• Communicationo Useful, Timely, Accurate, Appropriate

• Technology Platformo Effective, Streamlined, Robust

• Targeted Implementation on 1/4/2014

Web Site Re-Design

A CLEANER PRESENCE WITH ENHANCED FEATURES USING NEW TECHNOLOGY

Web Site Re-Design

MAKING THE OFFICE FOR THE PROFESSIONS WEBSITE

MORE RESPONSIVE TO OUR CUSTOMERS• Protect the public

– Up-to-date information about disciplinary actions – Integrate e-Licensing and other SED databases

• Maintain a responsive website– Provide customers access to laws, rules, regulations that

define professional practice– Organize information so customers can quickly find

answers to more than 1,000,000 inquiries each year

• Transfer current information and test new website format in December 2013 for a “go-live” in January 2014

Web Site Re-Design

HORIZON ISSUES

Then and NowDoug Lentivech

• Continuing Competence

• Technology and Tele-practice• Cross-jurisdictional

Practice

• Effective Professional Regulation

• Rising Consumer Demands

• Managed Care

• Corporate Practice

• Unlicensed Practice

• Expansion of the Licensed Professions

• Expanding Scopes of Practice

HORIZON ISSUES

HORIZON ISSUES

Technology and Telepractice

Kathleen Doyle

AN ELUSIVE GOAL – EVER CHANGING

1950 – Challenge of telephone, facsimile, research re: speech & hearing, NASA studies of vital signs and physiological parameters transmitted from space with primates; videoconferencing

1970 – Transmission of medical records and images and hotlines, e.g. ask-a-nurse

1990 – Explosion of telepractice. Major advances and cost savings for technology and health care; means to provide care over wide geographic areas and to many without other access to health care

Telepractice

AN ELUSIVE GOAL – EVER CHANGING

2000 – Focus on all professions, creation of a multitude of organizations, committees, laws and regulations and associations of state licensing boards, including the Council of Licensure, Enforcement and Regulation. Geographical distance was discarded as a core purpose.

2013 – Historical issues remain – licensure requirements for health, design and accountancy professions; competence; confidentiality; medical records; safety, appropriateness and accuracy of technology; changes in social communication

Telepractice

THE DEFINITION HAS EVOLVED

1950 – 2000: Telepractice is the provision of professional service over geographical distances by means of modern telecommunications technology.

2013: Telepractice includes the use of telecommunication and web based applications to provide education, information, and services, as part of the practice of health care and the design professions

Telepractice

AN SED HISTORY

• 1995 – A Regents presentation addressing telemedicine and a demonstration of diagnosing a tumor during surgery by a pathologist at a distant hospital

• 1997 – A Regents presentation on telemedicine and NYS requirements, including licensure for providers of NY residents

Telepractice

REQUIREMENTS FOR TELEPRACTICE SERVICES TO NEW YORK STATE RESIDENTS -

1999• In accordance with Education Law, anyone

practicing in NYS must be fully licensed and registered, or otherwise authorized.

• All professionals must adhere to the same laws, rules & regulations and uphold the same standards of practice that they must follow without the use of technology over a distance to ensure the highest degree of public protection.

• Each profession has its unique provisions for practice, so exemptions would also apply to telepractice.

Telepractice

RECENT SED ACTIVITIES

• Practice Alerts and Guidelines posted on the webpages for several professions

• Participation in many workshops,

conferences on telepractice

• Technical assistance to the Legislature

Telepractice

PRACTICE ALERTS EVOLVE

• The Boards for Psychology, Social Work and the Mental Health Practitioners develop joint guidance as the explosion of technology coupled with social changes evolve in the 2000’s

• Guidance expands from issues of privacy and confidentiality, access, provisions for emergencies, and technology proficiency to a universe of technology and communication changes

Telepractice

SPECIFIC ADDITIONS ARE MADE TO THE PRACTICE ALERT TO MEET CURRENT NEEDS -

2013• Becoming familiar with legal requirements across

state lines• Understanding technology, encryption and limits of

software and hardware• Expansion of concern to digital storage devices,

copiers that retain images, disposal of equipment• Videoconferencing, security, and assuring identity of

participants• Ability of patients and clients to adequately

participate and understand the risks and benefits

Telepractice

SEEING THE NEXT HORIZON• Awareness that social media has significantly

affected concepts of appropriate communication

• Social media opens vast opportunities and challenging interactions by professionals, including setting boundaries

• Avatars and Virtual Environments are creating new opportunities and challenges and the need for much more research to support initial positive findings

Telepractice

HORIZON ISSUES

Continuing Competency

James Hinds

Continuing Competency

HORIZON ISSUES

Cross-jurisdictional

PracticeLawrence Mokhiber

Pharmacy Oversight

Individuals and Entities Such As:

PharmacistsPharmacies

Manufacturers

Cross-jurisdictional Practice

Dispensing/Manufacturing/Compounding


• Pharmacies dispense pharmaceuticals upon the authority of a patient specific prescription.

• Manufacturers distribute bulk, non-patient specific pharmaceuticals.

• “Compounders” are a hybrid that currently has no specific authority under either NY or federal law.

• Pharmaceuticals, by their very nature, may be distributed across state borders, and may even be distributed internationally.

COMPOUNDING OF STERILE PRODUCTS


• Over the past year, the United States has dealt with the latest – but not the first—series of infections and fatalities related to contaminated products

• The NECC contamination has been the worst:

751 Infected 64 Deaths




• New York Law clearly distinguishes between

manufacturing and compounding for prescriptions

• New York Law makes no provision for “COMPOUNDING

FOR OFFICE USE”



• NYSED collaborated with many states and the Federal government to review legislation. Some amendment of NYS laws may be needed.

• The Board of Pharmacy has developed draft regulations regarding the training & procedures ALL personnel engaged in preparing Compounded Sterile Products (CSPs) must follow.

LETS TAKE A 15 MINUTE BREAK

PROFESSIONAL OVERSIGHT AND DISCIPLINE

The Disciplinary ProcessLouis Catone

PROFESSIONAL OVERSIGHT AND DISCIPLINE

• Hundreds of practice interpretations and clarifications

• Investigations and prosecutions across the state

• Implementation of Illegal Practice enforcement:

2012 Illegal Practice Cases Opened: 2262012 Compliance Agreements: 552012 Cease & Desist Orders: 15Pending Criminal Cases: 99

Public Protection through Professional

Oversight and Discipline

SOURCE OF CASE REFERRALS

Total Number of Cases TAKEN in 2012

REFERENT NO. OF CASES PERCENTAGE

INDIVIDUAL COMPLAINTS 1780 37.32%

INSURERS 105 2.20%

LAW ENFORCEMENT 129 2.70%

NYS DEPT OF HEALTH 32 .67%

NYSED AGENCIES 1945 40.87%

OTHER 656 13.76%

OTHER GOV'T AGENCIES 94 1.97%

PROFESSIONAL SOCIETIES 24 0.5%

Protect the Public

2012 HIGHLIGHTS

4,514 Investigations Completed

1,032 Pharmacy inspections conducted

47 Moral Character Final Actions

18 License Restoration Final Actions

Protect and Serve the Public

2012 HIGHLIGHTS

Protect and Serve

the Public

PROFESSIONAL CORPORATIONS AND CORPORATE PRACTICE

Recent Changes

Doug Lentivech

OVERVIEW• Authority to regulate professional

business organizations is generally found in Title VIII of the Education Law• Other authority exists in other areas of NY

law including the Business Corporation Law, Partnership Law, Limited Liability Company Law in addition to Public Health Law, Insurance Law and Labor Law.

Corporations and Corporate Practice

WHO CAN OFFER AND PROVIDE PROFESSIONAL SERVICES?


• Individuals/sole proprietorships---simple but with minimal statutory guidance• Professional partnerships---simple

and with only minimal statutory guidance• Professional Corporations---formally

established and authorized within the Business Corporation Law

WHO CAN OFFER AND PROVIDE PROFESSIONAL SERVICES?

• Registered Limited Liability Partnerships---formally established and authorized within the Partnership Law• Professional Limited Liability

Companies---formally established and authorized within the Limited Liability Company Law• Anyone else who is exempted or

otherwise authorized by law


THE INTERFACE OF PROFESSIONAL AND NON-PROFESSIONAL BUSINESS

STRUCTURES• Management companies - non-professional

business enterprises that have a formal or informal relationship to a professional business enterprise

• Management companies cannot practice or hold out to practice any restricted professional practice

• Management companies cannot share profits or split fees with professional business enterprises (8 NYCRR 29.1 (b) (3) and (4))Corporations and Corporate

Practice

TITLE PROTECTION VS SCOPE PROTECTION

• All Title VIII professions restrict the title of their profession to only those individuals licensed by NYSED• Most, but not all, Title VIII professions also

restrict the provision of services defined within their practice to only those licensed by NYSED and other individuals authorized or exempted by law


WHAT’S IN A NAME?

• Standard set forth in NYCRR 59.10 requires that name specify the profession to be practiced and the services to be provided

• Regents Rule 29.1(b)(12) restricts any holding out that is “false, fraudulent, deceptive or misleading”

• Specialty advertising


Historical Developments • Adoption of mental health practitioners licensing article• Creation of restricted scope of practice for psychology

and social work• 4410 schools and early intervention providers• Health care services in correctional institutions• Retail health• Corporate mergers and consolidations involving

grandparent corporations• Office based surgeries• Design Professional Service Corporations• Backroom services in authorized institutions


PRIORITIES OF THE PROFESSIONS

Communicate with Our Important Partners

Board of Regents Office of Professions Professional Associations Legislators

Public

PROFESSIONAL PRIORITIES

A Moderated Discussion of Priority Issues in a Variety of

ProfessionsRobert Lopez - Moderator

Participant Priorities

ISSUES FACED IN YOUR PROFESSION TODAY

• Professional Practice Issues • Overlaps in Scope of Practice • Legislative Issues • Communication to Licensees regarding

Licensure and Practice • Ownership of practice/firms • Corporate Practice/Exemptions from Licensure • Changes in Professional Education • Continuing Education/Competence

THANK YOU FOR YOUR

PARTICIPATION!

Documents

WELCOME OCTOBER 30, 2013 Professional Leadership Forum