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.
2.4 State licensure/certification
in response to the Coronavirus 2019 (COVID-19) pandemic. See
Chapter 1, Section 15.1.