VaAGC

Virginia Association of Genetic Counselors

Licensure

On March 20, 2014 Governor McAuliffe signed SB330 (The Regulation and Licensure of Genetic Counselors) into law.  This law will go into effect July 1, 2014.  Now that a licensure bill has been passed the next step will be writing rules and regulations.  Once this process is finished the Commonwealth of Virginia will begin to issue licenses.

T
he regulation of certain health care professionals is necessary to legally protect the public from harm caused by inadequately trained practitioners. Health care professionals, such as physicians, nurses, physician assistants and midwives, are licensed by the Commonwealth of Virginia. The following information is intended to help educate the public about genetic counselors and why state regulation of genetic counselors is needed.

If you are looking for general information about genetic counselors, we recommend that you click here. This link will provide you with basic information about who genetic counselors are, what they do, where they are employed in Virginia, and how they are trained.

Why hasn't licensure for genetic counselors been a concern before now? 

The genetic counseling profession is relatively new compared to other health professions. The first training program for genetic counselors began in 1969. With the completion of the Human Genome Project, there has been a significant increase in the use of genetic testing in various medical specialties. With this increase in genetic testing, there has been an increase in demand for genetic counselors and regulation of this growing profession is increasingly important. 

While the total number of genetic counselors practicing in any given state is relatively low compared to other medical professions, it has grown exponentially in the last few decades, with ~90 genetic counselors currently living and working in the Commonwealth of Virginia. Despite these low numbers, the highly specialized nature of work performed by genetic counselors means that certain training and certification standards should be met in order to prevent harm to the public. A person who does not meet these standards can put patients at risk for serious medical mismanagement.

How will Virginians benefit from licensing genetic counselors? 

The primary benefit to the public is PROTECTION from harm by unqualified providers. Inadequate genetic counseling can cause significant irreversible harm to consumers.

Virginians will be protected from harm through genetic counselor licensure because licensure will:  
  1. Define the qualifications needed to be a genetic counselor
  2. Give the state the ability to take action against negligent genetic counselors
  3. Increase the public's awareness of and access to health care providers who have been fully trained to provide genetic counseling services.
Licensure ensures that individuals who call themselves genetic counselors are truly qualified to provide that service.
  • A licensure bill will define the minimum training and certification process a genetic counselor must satisfactorily complete prior to providing genetic counseling services to the public. With licensure, individuals will be qualified to use the title of Genetic Counselor only after they have demonstrated that they have the necessary skills and knowledge to provide genetic counseling services. A licensure bill also generally includes a requirement that the licensee obtain continuing education to stay current in their field. Those who do not obtain continuing education cannot renew their licenses when they expire. Currently, there is no legal requirement that Virginia genetic counselors undergo specific training, certification or receive continuing education to perform their jobs. Many institutions in Virginia do not even require that their genetic counseling employees undergo a credentialing process because without licensing they are not required to do so.
Licensure holds genetic counselors accountable for their actions and allows the state to take action against negligent genetic counselors.
  • With licensure, the Commonwealth of Virginia will legally recognize a genetic counselor's specific scope of practice and the standards for professional conduct. If a licensed genetic counselor violates the laws or rules defined by the legislation, then Virginia has the authority to take disciplinary action. Currently, there are no existing laws in Virginia or at the federal level that provide the public with a mechanism to report incompetent, unethical, unlawful behavior of a genetic counselor or to sanction a genetic counselor for proven offenses of these claims and/or for operating outside of their scope of practice. Currently, there is no way for Virginians and employers in Virginia to determine if a genetic counselor has engaged in such behavior.
  • Licensure will ultimately increase the public's awareness of and access to health care providers who have been fully trained to provide genetic counseling services.
  • Licensure will not only improve the recognition of genetic counselors as health care providers by the state, but it will also allow for hospitals and health insurers to formally recognize genetic counselors as part of the patient's care team, alongside other recognized health care providers, including physicians, nurses, physician assistants, midwives, etc. Many health systems have policies that require that a provider be licensed in order to go through a credentialing process. Credentialing is important for verifying that employees are truly performing their jobs appropriately and is closely linked to an institutions billing and reimbursement system. Lack of formal recognition by a health system can even extend to difficulties in giving non-licensed providers the ability to document their patient interactions in electronic medical records.
Licensure will allow genetic counselors to become fully integrated into our existing health system. This in turn will allow health systems to recruit more genetic counselors to fulfill the growing demand for quality genetic services.

Additionally, the regulation of genetic counselors will assure patients and health care institutions appropriate genetic test utilization which will result in an overall decrease of health care dollars.
  • Genetic Counselors save healthcare dollars by ensuring genetic tests are ordered in the most appropriate manner. 
  • ARUP Laboratory estimated that the licensed genetic counselors at their laboratory cancelled or changed inappropriately ordered genetic tests for an average cost savings of $36,500 per month (ARUP, 2011).
  • Priority Health estimated that if genetic counseling had been required prior to BRCA1/2 testing in 10,000 cases, it would have prevented over $10 million worth of inappropriate tests.
  • Over a three month periood, a genetic counselor at Seattle Children's Hospital reviewed genetic test requests, cancelling or modifying inappropriate orders for a cost savings of $36,530. (Conta, 2012)
Will licensure restrict who may provide genetic counseling services? 

Licensure is intended to protect the public from harm by unqualified providers, NOT to restrict the practice of medicine. Licensure will restrict who can use the title Genetic Counselor. However, other licensed health care professionals may continue to practice the profession for which they are trained, including providing genetic information to patients.

Are there other states that have passed genetic counselor licensure legislation? 

Yes. Currently 18 states have legislation requiring licensing of genetic counselors. Utah was the first state to license genetic counselors. In addition to Utah, there are 13 other states currently issuing licenses for genetic counselors including: Tennessee, South Dakota, Oklahoma, Nebraska, Indiana, Pennsylvania, Washington, California, Massachusetts, Illinois, Delaware, New Mexico, and Ohio.

Four additional states have passed licensure regulation and are in the rule-making process.  This group includes North Dakota, New Jersey, Hawaii and New Hampshire.  For more information about the current status of genetic counselor licensure please visit here.

What should be included in a bill for licensing genetic counselors? 

  • A minimum level of continuing education in order to maintain a license
  • Exemption from licensure for other licensed healthcare providers whose scope of practice overlaps that of genetic counselors (e.g. physicians, masters trained nurses and physician assistants).
  • Adherence to a professional code of ethics (e.g. National Society of Genetic Counselors Code of Ethics).

How much will it cost Virginia to license genetic counselors? 

Licensure of Genetic Counselors is budget neutral for Virginia.

The administrative costs of regulating genetic counselors would be absorbed by the genetic counselors (licensees) through licensure fees. The existing Board of Medicine with the assistance of a Genetic Counseling Advisory Board will supervise the regulation of genetic counselors, minimizing the overall costs to licensees. Since the number of licensed genetic counselors would be relatively small, the Board of Medicine’s workload would be only minimally increased.

Also, the state would not have to create or administer a certification exam specifically for genetic counselors. Licensure can require national certification through the American Board of Genetic Counseling (ABGC). To learn more about the existing certification process, click here.

What if I have additional questions about the Virginia Licensure Effort? 

If you have additional questions, please contact the VaAGC at info@vaagc.org.