Why Reciprocity Provisions in State O&P
Licensure Bills Are Important

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Andy Helms, BOCO, CP, LP, LPO

State licensure laws are an important priority for O&P providers. Licensure laws offer extra protection to our patients and help reduce the potential for fraud and abuse by preventing those who may be unscrupulous or underqualified from interfering with high-quality care. In addition to creating rules for who can secure an O&P license, a good state licensure law should address reciprocity. Consider this fictitious conversation between two friends, whom I’ll call Sam and Charlie:

The phone rings in Charlie’s office, and he glances at the caller ID. “Hmm, Sam Miller. Haven’t heard from him for a long time.” Charlie answers the phone.

“Charlie? Sam Miller here.”

After some small talk, Sam moves on to the reason for his call. “I’m hoping you could give me some advice,” he begins. “I’m not sure if you know how I got into O&P in the first place, but when I finished college, I didn’t really know what I wanted to do. I started helping out in the O&P facility where my dad worked. Next thing I knew, I was hooked. I came up the old way, learning from older, experienced practitioners, and now I’ve been certified by BOC [Board of Certification/Accreditation, International] for over 20 years, dual certified for the past five, and I received my state license under the state’s grandfathering clause. I’ve been doing really well. Until now, anyway.”

“Why?” Charlie asks tentatively.

“Well, a few years back my parents moved out of state. Not long after that my dad passed away.”

“Sorry to hear that,” Charlie offers.

“Thanks. Anyway, I’ve tried to encourage my mom to come back this way, but she won’t, so I thought I’d move closer to her.

“I connected with a buddy of mine who is a prosthetist near my mom, and he said they could use someone like me. But then I found out I can’t get licensed in that state because I don’t meet the state’s new requirements! Who should I call to get this straightened out?”

While this account is fictional, it represents the hard truth about an issue that could be left behind by many states as they implement O&P licensure legislation.

Although licensure establishes minimum standards of education and experience for practitioners, when licensure becomes required in a state, those practitioners who already live and work in the state are typically grandfathered in and can continue to practice, even if they do not fully meet the licensure standards. If Sam already lived in his mother’s state, he wouldn’t have a licensure-related issue. But as a new practitioner in that state, he must meet the state’s current licensure standards.

In states where reciprocity is not addressed, I wonder if the state licensure law that protects the patient will also inadvertently prevent qualified practitioners from practicing?

There are other unintended consequences. Physicians, physical and occupational therapists, and other professionals—and even manufacturers’ representatives—are exempted from O&P licensure in most of the states that have enacted it. If a facility can’t recruit a competent O&P practitioner, it may very well hire one of these exempted professionals instead. Failure to address reciprocity appropriately seems short-sighted.

It is possible to enact licensure that protects patients and ensures quality care but does not lead to the undesirable outcome I’ve described here. In 2010, BOC developed a model state licensure act that accomplishes this. The model act, which can be downloaded from the BOC website’s External Relations page ( www.bocusa.org/external-relations), states the following:

Section 13: License without Examination; Reciprocity; Endorsement

(1) The Department/Board may, at its discretion, license as an Orthotist, Prosthetist, Pedorthist, or Orthotic Fitter without examination and on payment of the required fee, an applicant who is an Orthotist, Prosthetist, Pedorthist, or Orthotic Fitter and is:

  1. Licensed under the laws of another state, territory, or country, if the requirements for licensure in that state, territory, or country in which the applicant is licensed were, at the date of his or her licensure, equal to or more stringent than the requirements in force in this state on that date; or
  2. Resides in a state without licensure of orthotics, prosthetics, or pedorthics and has been certified as an Orthotist, Prosthetist, Pedorthist, or Orthotic Fitter by a national Certifying Agency that is accredited by the National Commission for Certifying Agencies.

I cite this only as an example, as there are other ways to address reciprocity and other places where the line might be drawn.

Ultimately, it is the actions of the practitioners “on the ground” that will affect the decisions of each state’s representatives. We need to think about reciprocity when we consider licensure legislation so that qualified practitioners—like Sam, you, and me—can practice and meet patient demands wherever we are needed.

Andy Helms, BOCO, CP, LP, LPO, practices at Grand Prosthetics & Orthotics, Grove, Oklahoma. He has 20 years of experience as an O&P professional in private and corporate practice.

Helms is a Texas-licensed prosthetist and an Oklahoma-licensed prosthetist-orthotist.

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