Lifelong Learning- Practicing in Missouri Jennifer Allen, M.D. - PowerPoint PPT Presentation

Lifelong Learning- Practicing in Missouri Jennifer Allen, M.D.

Objectives  1. Understand requirements for initial licensing in Missouri  2. Understand requirements for initial credentialing in Missouri  3. Understand MOC requirements for ongoing licensure/credentialing  4. Understand how to gain prescriptive license  5. Review credentialing for health insurance for reimbursement  6. Review current status of Collaborative or supervisory practice agreements in Missouri

Basic Requirements Good character  Graduate from accredited high school  Have at least 60 hours of pre-professional college credit  Must list all medical and non-medical activities since entrance into med school  Graduate from approved medical school  Graduate from approved training program  US Graduate- minimum 1 year  IM Graduate- must complete 3 years training  Pass examination-   All 3 USMLE (Comlex) steps- no more than 3 attempts, within 7 years Must pass jurisprudence exam (initial only)  Pay the licensure fee ($75) 

Initial Licensure  4 Routes to licensure in Missouri  1. Board endorsement  2. Reciprocity  3. Endorsement by Flex, USMLE or LMCC  4. Passing the USMLE Step 3 in Missouri

Board Endorsement: ABFM Eligibility  1. Complete 50 MC-FP points  2. Pay the fee: $1300-$1400  3. License- must be able to get one  4. Complete training  5. Pass the exam

Reciprocity  If successfully licensed in another state then may receive licensure in Missouri  Must pay the fee equivalent to the test fee  List in chronological order all places of previous practice and licensure

Endorsement by examination  Must have passed all prior Steps (total 3 attempts at all Steps)  Must complete training within 60 days of Step 3 in Missouri

Renewal  Complete the renewal application by January 31 each year  Pay the fee ($100)  Complete and report 50 hours of CME every 2 years  CME is not required in the 2 years post residency completion/initial licensure period

ABFM- MOC  Maintain a full unrestricted license  Complete 50 points of self-assessment/quality improvement  Complete 150 hours of CME in 3 year stages  Take the exam every 10 years  Pay an annual fee ($200)

Prescriptive licensing BNDD and DEA

BNDD- state level  Bureau of Narcotics and Dangerous Drugs  Any person who prescribes, stocks, dispenses, orders, manufactures….controlled substances  Apply online- print certificate online also (nothing will be mailed, only on computer not smart phone for example)  Pay Fee $30/year  Keep address updated (within 30 days of moving)  Most common violation is record keeping

DEA- Federal registration

DEA  6 sections to complete  Personal info  Activity- practitioner, pharmacy, teacher, researcher, manufacturer, etc  State license- need BNDD and valid state license  Background- any issues, experience etc. with controlled subs in past  Pay the fee- $731/3 years  Confirmation- all info correct and print certificate.

Credentialing for insurance reimbursement $$$  Credentialing is a process used to evaluate the qualifications and practice history of a doctor. This process includes a review of a doctor's completed education, training, residency and licenses. It also includes any certifications issued by a board in the doctor's area of specialty.May 22, 2013 www.aetna.com accessed on April 24, 2017 Need an NPI number- national provider identifier, unique to the individual or entity that allows all data to be collected and shared through one number Came out of HIPAA legislation of 1996, implemented in 2005.

NPI  https://nppes.cms.hhs.gov/NPPES/Welcome.do

NCQA and CAQH  National Committee for Quality Assurance: www.NCQA.org  Non-profit that certifies the verification organizations and accredits managed care organizations  The Seal is supposed to inform consumers and providers that an organization is well managed and provides quality care  Informative blog about rules and regs/ quality measures/MACRA  Everything you want to know about health plans, clinicians, organizations

CAQH  Council for Affordable Quality Healthcare  Credentialing database, non-profit alliance of health plans  Goal is to streamline the business of healthcare  Free  Fill out info once and they provide it to all the health plans you want to work with  Enables electronic payments  Follows sanctions/discipline actions/

Collaborative Practice  NPs- advanced practice registered nurses  PAs- physician assistants  APs- assistant physicians (medical school graduates who have not completed residency)  Each group has its own section in the statutes  Very similar practice acts

Key points for collaboration/supervision  Information found in Mo Revised Statutes Chapter 334, current August 28, 2016  Regardless of the agreement the PHYSICIAN accepts responsibility for oversight and all treatment given.  Medical acts: all treatments, prescribing, dispensing, advice etc are considered delegated medical acts.  PA’s and AP’s are governed by the BOHA, NP’s are governed by the SBON  SCOPE of practice is a defining factor

References: MO Division of Professional Registration: www.pr.mo.gov http://www.moga.mo.gov/mostatutes/chapters/chapText334.html https://www.theabfm.org Health.mo.gov/safety/bndd https://www.deadiversion.usdoj.gov/drugreg/ http://www.medscape.org/viewarticle/506277_10 US Nurse Practitioner Prescribing Law: A State-by-State Summary http://www.medscape.com/viewarticle/440315 Boards of Nursing in the United States: State-by-State Web Links http://www.medscape.com/viewarticle/482270

References continued  http://www.ncqa.org/  https://www.caqh.org/