1. WELCOME OCTOBER 30, 2013 Professional Leadership Forum

2. NEW LAWS IMPACTING THE OFFICE OF THE PROFESSIONS An Overview from 2010 to Present Sarah Benson

3. NEW PROFESSIONS & OFFICE OF THE PROFESSIONS RESPONSIBILITIES Polysomnographic Technologist Authorization – Ch.262/2011 Perfusionist Licensure – Ch. 479/2012; Ch.409/2013 Clinical Nurse Specialist (CNS) Certification – Ch.364/2013 Social Work, Mental Health, Psychology Corporate Practice Waiver – Ch.130,132/2010; Ch.187/2011 4410/Early Intervention Corporate Practice Waiver – Ch.581/2011 Required Reporting of Sexual Offenses to Law Enforcement – Ch.365/2012 New Laws

4. CHANGES TO SCOPE OF PRACTICE Eliminated Midwifery Collaborative Practice requirement – Ch. 238/2010 Pharmacists permitted to engage in CDTM (Collaborative Drug Therapy Management) – Ch.21/2011 Expand podiatry to below the knee – Ch.438/2012; Ch.23/2013 Qualified Pharmacists authorized to administer immunizations – Ch.316/2011; Ch.116/2012; Ch. 274/2013 Allows Dental Hygienists to work with a Collaborative Practice Agreement in an Article 28 facility – Ch.239/2013 New Laws

5. CHANGES TO EXISTING LAWS Requires Masters Degree for Physical Therapy licensure – Ch.410/2011 Defines and sets requirements for Occupational Therapy Assistants – Ch.460/2011 Authorizes Design Professional Corporations – Ch. 550/2011 Ch.467/2012; Ch.9/2013 Permits Accountancy mobility – Ch. 456/2011 Requires Pharmacy interpretation services – Ch.56/2012 Extends Clinical Laboratory Technology Limited License to 2016 – Ch. 336/2013 Includes optometrists within provisions relating to clinical laboratories – Ch.444/2013 New Laws

6. NEW CONTINUING EDUCATION REQUIREMENTS Veterinary Medicine/Vet Med Tech – Ch.328/2010 Massage Therapy – Ch. 463/2010 Occupational Therapy/OTA – Ch.444/2012; Ch.18/2013 Social Work (LMSW/LCSW) – Ch.443/2013 New Laws

7. GROWTH AND CHANGE Statistical Highlights in Professional Licensing Susan Naccarato

8. NEW LICENSES ISSUED Steady Increase in Licensed Professionals in NYS

9. OPERATIONAL RESPONSIBILITY - 2012 New licenses issued45,804 Registrations processed278,511 New filing processed for professional corporations3,480 Candidates took OP-developed licensing exams2,744 Email/telephone inquiries answered1,000,000 NYSED and its Partners support the important role of Licensed Professionals in New York State

10. OPERATIONAL RESPONSIBILITY - 2012 Serve the Public

11. NUMBER OF LICENSED PROFESSIONALS THAT ARE REGISTERED TO PRACTICE IN NYS, BY YEAR Serve the Public

12. GROWTH AND CHANGE Technology Updates e-Licensing Mary Beth Nelligan Web Site Re-Design David Hamilton

13. Agriculture and Markets (AGM) Dept. of State (DOS) – individual licenses only Dept. of Environmental Conservation (DEC) GROWTH AND CHANGE Dept. of Tax & Finance (DTF) State Education Dept. (SED) State Liquor Authority (SLA) 6 State Agencies are part of the e-Licensing Project e-Licensing

14. TODAYS NYSED WEBSITE IS TEXT-HEAVY AND CUMBERSOME Web Site Re-Design

15. Commissioner King has set goals for improving NYSED.GOV High-Demand Information & Services o User-Friendly Platform (Desk, Tablet, Mobile) o Enhanced Customer Service Communication o Useful, Timely, Accurate, Appropriate Technology Platform o Effective, Streamlined, Robust Targeted Implementation on 1/4/2014 Web Site Re-Design

16. A CLEANER PRESENCE WITH ENHANCED FEATURES USING NEW TECHNOLOGY Web Site Re-Design

17. MAKING THE OFFICE FOR THE PROFESSIONS WEBSITE MORE RESPONSIVE TO OUR CUSTOMERS Protect the public –Up-to-date information about disciplinary actions –Integrate e-Licensing and other SED databases Maintain a responsive website –Provide customers access to laws, rules, regulations that define professional practice –Organize information so customers can quickly find answers to more than 1,000,000 inquiries each year Transfer current information and test new website format in December 2013 for a go-live in January 2014 Web Site Re-Design

18. HORIZON ISSUES Then and Now Doug Lentivech

19. Continuing Competence Technology and Tele-practice Cross-jurisdictional Practice Effective Professional Regulation Rising Consumer Demands Managed Care Corporate Practice Unlicensed Practice Expansion of the Licensed Professions Expanding Scopes of Practice HORIZON ISSUES

20. Technology and Telepractice Kathleen Doyle

21. AN ELUSIVE GOAL – EVER CHANGING 1950 – Challenge of telephone, facsimile, research re: speech & hearing, NASA studies of vital signs and physiological parameters transmitted from space with primates; videoconferencing 1970 – Transmission of medical records and images and hotlines, e.g. ask-a-nurse 1990 – Explosion of telepractice. Major advances and cost savings for technology and health care; means to provide care over wide geographic areas and to many without other access to health care Telepractice

22. AN ELUSIVE GOAL – EVER CHANGING 2000 – Focus on all professions, creation of a multitude of organizations, committees, laws and regulations and associations of state licensing boards, including the Council of Licensure, Enforcement and Regulation. Geographical distance was discarded as a core purpose. 2013 – Historical issues remain – licensure requirements for health, design and accountancy professions; competence; confidentiality; medical records; safety, appropriateness and accuracy of technology; changes in social communication Telepractice

23. THE DEFINITION HAS EVOLVED 1950 – 2000: Telepractice is the provision of professional service over geographical distances by means of modern telecommunications technology. 2013: Telepractice includes the use of telecommunication and web based applications to provide education, information, and services, as part of the practice of health care and the design professions Telepractice

24. AN SED HISTORY 1995 – A Regents presentation addressing telemedicine and a demonstration of diagnosing a tumor during surgery by a pathologist at a distant hospital 1997 – A Regents presentation on telemedicine and NYS requirements, including licensure for providers of NY residents Telepractice

25. REQUIREMENTS FOR TELEPRACTICE SERVICES TO NEW YORK STATE RESIDENTS - 1999 In accordance with Education Law, anyone practicing in NYS must be fully licensed and registered, or otherwise authorized. All professionals must adhere to the same laws, rules & regulations and uphold the same standards of practice that they must follow without the use of technology over a distance to ensure the highest degree of public protection. Each profession has its unique provisions for practice, so exemptions would also apply to telepractice. Telepractice

26. RECENT SED ACTIVITIES Practice Alerts and Guidelines posted on the webpages for several professions Participation in many workshops, conferences on telepractice Technical assistance to the Legislature Telepractice

27. PRACTICE ALERTS EVOLVE The Boards for Psychology, Social Work and the Mental Health Practitioners develop joint guidance as the explosion of technology coupled with social changes evolve in the 2000s Guidance expands from issues of privacy and confidentiality, access, provisions for emergencies, and technology proficiency to a universe of technology and communication changes Telepractice

28. SPECIFIC ADDITIONS ARE MADE TO THE PRACTICE ALERT TO MEET CURRENT NEEDS - 2013 Becoming familiar with legal requirements across state lines Understanding technology, encryption and limits of software and hardware Expansion of concern to digital storage devices, copiers that retain images, disposal of equipment Videoconferencing, security, and assuring identity of participants Ability of patients and clients to adequately participate and understand the risks and benefits Telepractice

29. SEEING THE NEXT HORIZON Awareness that social media has significantly affected concepts of appropriate communication Social media opens vast opportunities and challenging interactions by professionals, including setting boundaries Avatars and Virtual Environments are creating new opportunities and challenges and the need for much more research to support initial positive findings Telepractice

30. HORIZON ISSUES Continuing Competency James Hinds

31. Continuing Competency

32. HORIZON ISSUES Cross-jurisdictional Practice Lawrence Mokhiber

33. Pharmacy Oversight Individuals and Entities Such As: Pharmacists Pharmacies Manufacturers Cross-jurisdictional Practice

34. Dispensing/Manufacturing/Compounding Cross-jurisdictional Practice Pharmacies dispense pharmaceuticals upon the authority of a patient specific prescription. Manufacturers distribute bulk, non-patient specific pharmaceuticals. Compounders are a hybrid that currently has no specific authority under either NY or federal law. Pharmaceuticals, by their very nature, may be distributed across state borders, and may even be distributed internationally.

35. COMPOUNDING OF STERILE PRODUCTS Cross-jurisdictional Practice Over the past year, the United States has dealt with the latest – but not the first series of infections and fatalities related to contaminated products The NECC contamination has been the worst: 751 Infected 64 Deaths

36. Cross-jurisdictional Practice

37. COMPOUNDING OF STERILE PRODUCTS Cross-jurisdictional Practice New York Law clearly distinguishes between manufacturing and compounding for prescriptions New York Law makes no provision for COMPOUNDING FOR OFFICE USE

38. COMPOUNDING OF STERILE PRODUCTS Cross-jurisdictional Practice NYSED collaborated with many states and the Federal government to review legislation. Some amendment of NYS laws may be needed. The Board of Pharmacy has developed draft regulations regarding the training & procedures ALL personnel engaged in preparing Compounded Sterile Products (CSPs) must follow.

39. LETS TAKE A 15 MINUTE BREAK

40. PROFESSIONAL OVERSIGHT AND DISCIPLINE The Disciplinary Process Louis Catone

41. PROFESSIONAL OVERSIGHT AND DISCIPLINE Hundreds of practice interpretations and clarifications Investigations and prosecutions across the state Implementation of Illegal Practice enforcement: 2012 Illegal Practice Cases Opened: 226 2012 Compliance Agreements: 55 2012 Cease & Desist Orders: 15 Pending Criminal Cases: 99 Public Protection through Professional Oversight and Discipline

42. SOURCE OF CASE REFERRALS Total Number of Cases TAKEN in 2012 REFERENTNO. OF CASESPERCENTAGE INDIVIDUAL COMPLAINTS178037.32% INSURERS1052.20% LAW ENFORCEMENT1292.70% NYS DEPT OF HEALTH32.67% NYSED AGENCIES194540.87% OTHER65613.76% OTHER GOV'T AGENCIES941.97% PROFESSIONAL SOCIETIES240.5% Protect the Public

43. 2012 HIGHLIGHTS 4,514 Investigations Completed 1,032 Pharmacy inspections conducted 47 Moral Character Final Actions 18 License Restoration Final Actions Protect and Serve the Public

44. 2012 HIGHLIGHTS Disciplinary Actions: 412 Regents Actions o 377 Suspensions/Revocations o $420,750 in Regents fines 474 Corrective Actions Required letters 15 Cease and Desist Orders Issued 34 Administrative Warnings Issued 224 Violations Committee Resolutions 110 Illegal Practice Referrals to AG and Compliance Agreements Protect and Serve the Public

45. PROFESSIONAL CORPORATIONS AND CORPORATE PRACTICE Recent Changes Doug Lentivech

46. OVERVIEW Authority to regulate professional business organizations is generally found in Title VIII of the Education Law Other authority exists in other areas of NY law including the Business Corporation Law, Partnership Law, Limited Liability Company Law in addition to Public Health Law, Insurance Law and Labor Law. Corporations and Corporate Practice

47. WHO CAN OFFER AND PROVIDE PROFESSIONAL SERVICES? Corporations and Corporate Practice Individuals/sole proprietorships---simple but with minimal statutory guidance Professional partnerships---simple and with only minimal statutory guidance Professional Corporations---formally established and authorized within the Business Corporation Law

48. WHO CAN OFFER AND PROVIDE PROFESSIONAL SERVICES? Registered Limited Liability Partnerships---formally established and authorized within the Partnership Law Professional Limited Liability Companies---formally established and authorized within the Limited Liability Company Law Anyone else who is exempted or otherwise authorized by law Corporations and Corporate Practice

49. THE INTERFACE OF PROFESSIONAL AND NON- PROFESSIONAL BUSINESS STRUCTURES Management companies - non-professional business enterprises that have a formal or informal relationship to a professional business enterprise Management companies cannot practice or hold out to practice any restricted professional practice Management companies cannot share profits or split fees with professional business enterprises (8 NYCRR 29.1 (b) (3) and (4)) Corporations and Corporate Practice

50. TITLE PROTECTION VS SCOPE PROTECTION All Title VIII professions restrict the title of their profession to only those individuals licensed by NYSED Most, but not all, Title VIII professions also restrict the provision of services defined within their practice to only those licensed by NYSED and other individuals authorized or exempted by law Corporations and Corporate Practice

51. WHATS IN A NAME? Standard set forth in NYCRR 59.10 requires that name specify the profession to be practiced and the services to be provided Regents Rule 29.1(b)(12) restricts any holding out that is false, fraudulent, deceptive or misleading Specialty advertising Corporations and Corporate Practice

52. Historical Developments Adoption of mental health practitioners licensing article Creation of restricted scope of practice for psychology and social work 4410 schools and early intervention providers Health care services in correctional institutions Retail health Corporate mergers and consolidations involving grandparent corporations Office based surgeries Design Professional Service Corporations Backroom services in authorized institutions Corporations and Corporate Practice

53. PRIORITIES OF THE PROFESSIONS Communicate with Our Important Partners Board of Regents Office of Professions Professional Associations Legislators Public

54. PROFESSIONAL PRIORITIES A Moderated Discussion of Priority Issues in a Variety of Professions Robert Lopez - Moderator Participant Priorities

55. ISSUES FACED IN YOUR PROFESSION TODAY Professional Practice Issues Overlaps in Scope of Practice Legislative Issues Communication to Licensees regarding Licensure and Practice Ownership of practice/firms Corporate Practice/Exemptions from Licensure Changes in Professional Education Continuing Education/Competence

56. THANK YOU FOR YOUR PARTICIPATION!