Professional Licensing, Re-Licensing & Accreditation

Health care professionals and organizations depend upon licenses, certifications, registrations, and accreditations to operate legally and participate in the health care system. A delay, denial, suspension, lapse, or other problem involving a professional license or accreditation can disrupt employment, prevent a provider from practicing, interfere with reimbursement, and create significant operational consequences.

Licensing and accreditation requirements are often complex because they involve multiple state and federal agencies, professional boards, accrediting organizations, and health care program requirements. The process can become even more difficult when an applicant has a prior disciplinary action, malpractice history, criminal matter, licensing gap, adverse credentialing event, or other issue requiring disclosure.

G2Z Law Group assists physicians, health care professionals, practices, and health care organizations with professional licensing, license reinstatement, re-licensing, accreditation, regulatory applications, and related compliance matters.

What Is Professional Health Care Licensing?

Professional licenses authorize individuals to practice regulated health care professions within a particular jurisdiction. Licensing requirements are generally established and enforced at the state level through professional licensing boards and regulatory agencies.

Depending upon the profession, licensure may apply to:

• physicians and osteopathic physicians;

• nurses and advanced practice nurses;

• pharmacists;

• dentists;

• psychologists and behavioral health professionals;

• physical and occupational therapists;

• physician assistants;

• other licensed health care professionals; and

• health care facilities and organizations subject to separate operating licenses.

Each jurisdiction establishes its own eligibility, education, examination, training, background, disclosure, and renewal requirements.

For physicians, for example, state medical boards maintain jurisdiction-specific requirements for initial medical licensure, and those requirements can differ significantly from state to state. The Federation of State Medical Boards maintains state-specific licensing information but advises applicants to confirm current requirements directly with the applicable board.

When Can Licensing Problems Arise?

Licensing issues can arise during an initial application, renewal, reinstatement, endorsement, reciprocity, or application for licensure in another jurisdiction.

An applicant may face additional scrutiny when an application requires disclosure of matters such as:

• prior professional discipline;

• malpractice claims or settlements;

• criminal charges or convictions;

• prior license restrictions;

• termination from employment or training;

• hospital privilege actions;

• credentialing or peer-review matters;

• prior adverse actions by another licensing board; or

• gaps in practice, training, or professional activity.

Even when an underlying event occurred years earlier, licensing applications frequently require detailed disclosure and supporting documentation.

A response that is incomplete, inconsistent, or inaccurate can create additional problems beyond the underlying issue. Health care professionals should therefore carefully review both the applicable licensing requirements and the wording of application questions before submitting responses.

What Is Re-Licensing or License Reinstatement?

A professional license may become inactive, expire, lapse, or be suspended or revoked for a variety of reasons.

Re-licensing or license reinstatement generally refers to the process of restoring a health care professional’s legal authority to practice after a license has expired, become inactive, or been subject to disciplinary action.

Depending upon the jurisdiction and circumstances, reinstatement may require:

• submission of a new or supplemental application;

• payment of fees or penalties;

• completion of continuing education;

• proof of recent clinical competence;

• verification of prior licenses;

• explanation of disciplinary or professional history;

• compliance with previous board orders;

• submission of character or fitness information; or

• appearance before a licensing board or committee.

The process is particularly important where the license was previously suspended, revoked, surrendered, or allowed to lapse after an adverse event.

How Can G2Z Law Help With Difficult Licensing Applications?

Some licensing applications are administrative and straightforward. Others require strategic preparation.

Where an applicant must disclose a prior regulatory, disciplinary, employment, malpractice, or criminal matter, the application should accurately explain the event while providing the board with the information necessary to evaluate present eligibility for licensure.

G2Z Law Group can assist with reviewing licensing applications, preparing disclosure statements, gathering supporting documentation, responding to board inquiries, and representing applicants when additional board review is required.

We can also assist when licensing issues overlap with professional discipline, medical staff privileges, peer review, credentialing, controlled-substance matters, or board certification concerns.

What Is Health Care Accreditation?

Accreditation is a separate process from individual professional licensure.

Health care organizations may seek or be required to maintain accreditation from recognized accrediting organizations in order to demonstrate compliance with applicable quality, safety, operational, or program standards.

Accreditation may apply to hospitals, ambulatory surgical centers, home health agencies, hospices, laboratories, behavioral health organizations, outpatient facilities, and other health care providers.

In some cases, accreditation is directly connected to participation in federal health care programs.

CMS permits many health care providers and suppliers to demonstrate compliance with Medicare health and safety requirements through accreditation by a CMS-approved accrediting organization. When the applicable requirements are met, the organization may receive “deemed status,” meaning CMS treats the provider as satisfying applicable Medicare participation requirements.

What Happens During an Accreditation or Re-Accreditation Process?

Accrediting organizations may conduct initial accreditation surveys, re-accreditation surveys, follow-up reviews, and complaint investigations. CMS-approved accrediting organizations must maintain standards and survey processes that satisfy applicable federal requirements when exercising Medicare deeming authority.

Accreditation preparation may therefore require review of an organization’s:

• policies and procedures;

• credentialing files;

• staffing requirements;

• quality assurance systems;

• patient-care standards;

• governing-body responsibilities;

• documentation practices;

• infection-control procedures;

• regulatory compliance systems; and

• corrective-action processes.

When deficiencies are identified, the organization may need to develop corrective-action plans, respond to survey findings, or demonstrate continuing compliance.

What Can G2Z Law Group Do for My Health Care Business or Professional License?

G2Z Law Group assists health care professionals and organizations with licensing, re-licensing, reinstatement, accreditation, and regulatory compliance matters.

Our attorneys can help physicians and other licensed professionals prepare applications, respond to disclosure questions, address prior disciplinary or credentialing issues, communicate with licensing boards, and seek reinstatement or renewal of professional licenses.

We also assist health care organizations with accreditation readiness, responses to survey findings, regulatory compliance, corrective-action planning, and issues involving CMS participation requirements and accrediting organizations.

Whether the matter involves an individual professional license or an organization’s ability to maintain accreditation, licensing and accreditation issues can affect the ability to provide care, participate in health care programs, and continue operations. Early legal review can help identify regulatory concerns and improve the organization or professional’s ability to respond effectively.