Practice: Potential Impact of Licensure for CDEs on Advanced Practice Nurses in Diabetes and Chronic Disease Carol Manchester, MSN, ACNS- BC, BC-

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1 Practice: Potential Impact of Licensure for CDEs on Advanced Practice Nurses in Diabetes and Chronic Disease Carol Manchester, MSN, ACNS- BC, BC- ADM, CDE Past President, NACNS

2 American Associa,on of Diabetes Educators State Licensure Ini,a,ve Credentialed diabetes educators are not recognized as DSME/T (diabetes self management education/ training) providers by Medicare. There is not a legal definition or standardized scope of practice for diabetes education. Consumer safety and protection is enhanced with licensure. This would establish minimum standards and guidelines for recognition of the profession.

3 Current Voluntary Cer,fica,ons CDE (certified diabetes educator) Administered by National Certification Board for Diabetes Educators BC- ADM (board certified in advanced diabetes management) Administered by AADE; originally by ANCC The above certifications and credentials do not give the practitioner the ability to provide care beyond that for which they are legally licensed or registered.

4 AADE s recommenda,ons Discipline Include, but are not limited to : registered nurses, registered dietitians, registered pharmacists, licensed mental health professionals, and exercise physiologists Education A bachelor s degree or education that meets the state s healthcare professional licensure requirements for the primary discipline. Completion of AADE s Core Concepts Course or a diabetes education program sponsored by any advanced academic or continuing education organization that meets state- determined standards and provides a minimum of 15 hours of learning in the biological and social sciences, communication, counseling, and education. 15 hours of continuing education related to DSME/T each year. Professional Practice Experience 250 hours within a two- year time frame, specific to DSME/T; evidence of experience caring for people with diabetes.

5 To date Kentucky first state to pass legislation in 2010 requiring the licensure of diabetes educators who provide DSME/T Indiana- Governor Pence signed bill to license diabetes educators in April, 2014, regulated under the Board of Medicine Florida is in the early stages of exploring licensure for diabetes educators. Pennsylvania- advocacy efforts are currently taking place.

6 Na,onal Cer,fica,on Board for Diabetes Educators The NCBDE believes that the provision of DSME/T should be vested in health professionals who have fulfilled requirements for NCBDE certification as CDE s. Furthermore, NCBDE believes that a state which, in its wisdom, has determined a diabetes educator licensure is necessary to protect the health and welfare of its citizens, should also embody similar requirements.

7 NCBDE will advocate that the law include: A licensed health professional, providing DSME/T within his/her scope of practice, may optionally obtain licensure but would not be required to do so. An applicant that holds a CDE certification, in good standing, would automatically qualify for licensure. Educational requirements for non- licensed or non- certified applicants should include completion of diabetes education program(s) sponsored by any advanced academic or continuing education organization that meets state determined standards.

8 (con,nued) All non- licensed or non- certified applicants should be required to successfully pass a psychometrically valid competency assessment examination. States should consider using existing voluntary certification processes, including administration of eligibility and psychometrically valid examination requirements, as the basis for issuing licenses. Grandfathering of current diabetes educators, may be necessary. However, such provisions should be time- limited.

9 Advanced Prac,ce Specialty Prac,ce Group Strong opposition voiced regarding the initiative Concerns for yet another license Licensed in one s professional discipline, not a role or competency within Concern that there is on- going misunderstanding of scope of practice The complexity and needs of individuals with diabetes demands education and management There is a limited number of educators and access is already restricted

10 Implica,ons and Poten,al Impact for APNs There are Adult Health/Pediatric NPs and CNSs with specialty in Diabetes who do not hold the CDE, but are certified and are prepared to provide DSME/T in addition to management of the diabetes and other chronic co- morbid conditions. Would they possibly be required to have the additional CDE certification or similar credential to provide and bill for education? Diabetes education is provided by multiple disciplines. By allowing this to be regulated by the Board of Medicine, there is a potential for negative impact on advanced practice.

11 Implica,ons and Poten,al Impact for APNs Would states who adopt this model for state licensure for education pursue licensure for heart failure, or any other chronic disease education that specifically demands behavioral change? Where does this end? How many licenses and certifications will one need to demonstrate competence? Financially, this becomes a burden. There is a potential for endorsement concerns. This has the potential to actually decrease advanced practice nurses clientele.

12 Other thoughts?

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