2.0 POLICY
2.1 State Licensure/Certification.
Otherwise covered services shall be cost-shared only if the individual
professional provider holds a current, valid license or certification
to practice his or her profession in the state where the service
is rendered. Licensure/certification in a profession other than that
for which the provider is seeking authorization is not acceptable.
The licensure/certification must be at the full clinical level of
practice. Full clinical practice level is defined as an unrestricted
license that is not subject to limitations on the scope of practice
ordinarily granted all other applicants for similar specialty in
the granting jurisdiction. The services provided must be within
the scope of the license, certification, or other legal authorization.
Licensure or certification is required to be an authorized provider
when offered in the state where the service is rendered, even if
such licensure or certification is not required by the state where
the service is rendered. Providers who practice in a state where licensure
or certification is optional are required to obtain that licensure
or certification to become an authorized provider. A temporary professional
state license which allows full and unrestricted scope of practice
fully satisfies any Individual Professional Provider certification
requirement for the period during which the temporary license is
valid. The authorized status of the provider expires when the temporary
license expires unless the temporary license is renewed or a regular
license is issued to the provider.
2.2 Certified Membership in National
or Professional Association that Sets Standards for the Profession.
If the state does not offer licensure or certification, the provider
must have membership in or certification by (or be eligible to have
membership in or certification by) the appropriate national or professional
association that sets standards for the specific profession. Associate,
provisional, or student membership is not acceptable. Membership
or certification must be at the full clinical level. If the provider
does not have membership in or certification by the standard setting
national or professional association, acceptable proof of eligibility
is a letter or other written documentation from the appropriate
association stating that the provider meets the requirements to
be a member of or certified by the association.
2.3 Time Period
for Obtaining Licensure or Certification. When a new State law is
enacted that requires or provides for a certain category of provider
to be in possession of licensure or certification, authorized providers
must obtain the license as soon as the State begins issuance. A
period of time, not to exceed a maximum of six months, will be authorized
to obtain the license. This six month time frame may
be changed if the State provides a specific grace period (a longer
or shorter time period) for obtaining licensure.