1. Mann, Chikita MSN, RN, CCM

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"Bob," who lived in Louisiana but worked on a large construction project in Texas, suffered a shoulder injury on the job, which required him to undergo surgery and receive physical therapy. During Bob's 8 weeks of treatment and recovery at home in Louisiana, the care and services he received were coordinated by a nurse case manager specializing in workers' compensation. The circumstances of where Bob lived and worked created some challenges. First, because the injury occurred in Texas, that state's workers' compensation laws applied to the case, including which treatments were covered. Second, because Louisiana, where Bob received treatment, is not among the 25 states covered by the multistate Nurse Licensure Compact (NLC), a nurse case manager licensed in Texas could not legally handle his case. The third-party provider of workers' compensation case management services had to locate a case manager licensed in Louisiana who specialized in workers' compensation in order to manage Bob's case.


State licensure laws impact both in-person and telephonic case management provided by nurse case managers; 89% of professional case managers are registered nurses, according to the most recent Role and Function Study conducted by the Commission for Case Manager Certification (Tahan, Watson, & Sminkey, 2016). Such practice limitations are removed among states that are part of the NLC; nurses have one multistate license that allows them to practice both in their home state and in other compact states.


Multistate licensure is an issue that affects all case managers to some degree. The most obvious direct impact is on nurse case managers whose cases may have a multistate component. But even professional case managers who practice only in one geographic location or who come from other professional disciplines should be aware of the NLC because it speaks to the importance of facilitating case management services easily and consistently for individuals who would best benefit from it, regardless of where they live or work. The Case Management Society of America (CMSA), for example, encourages individuals and organizations to urge states to adopt the NLC and to enable nurse case managers to provide case management services on site or telephonically across state lines, without concern of potential violation of the law. The CMSA states,


The practice of case management is often conducted telephonically in multiple work settings. Often telephonic management was considered solely an issue for nurse case managers working in the insurance or disability industries. The changing health care landscape with a rise in Accountable Care Organizations, Patient Centered Medical Homes, and integrated delivery models has placed greater demand for nurse case managers to provide patient-centered care within the continuum of care and across state lines to promote quality, efficient care. (2016, p. 3)


The National Council of State Boards of Nursing also observed, "Primary care nurses, case managers, transport nurses, school and hospice nurses, among many others, ... routinely cross state boundaries to provide the public with access to nursing services, and a multistate license facilitates this process" (2017, p. 1). Even if nurse case managers never cross a state line in the course of fulfilling their duties, knowing that others must do so to deliver evidence-based, patient-centered case management service should be enough cause to advocate for the expansion of the NLC. It is in the best interest of case management practice to ensure that both in-person and telehealth case management services are more available, particularly to underserved populations.


Telehealth services, such as telephonic case management, are frequently used to help manage workers' compensation cases, particularly after the first few weeks of in-person visits when follow-up by phone can be time-efficient and cost-effective. Such services are part of a growing overall trend in telemedicine, which is defined as the remote delivery of health care services and clinical information using telecommunications technology. This includes delivering clinical services using the Internet, wireless, satellite, and telephone (American Telemedicine Association, 2016). Telemedicine has enabled more health care services to be delivered to patients in rural areas. For example, rural primary care physicians and clinics can be connected to academic centers or larger health centers for consultation, while urban-based specialists can help care for patients in rural or underserved areas (Darves, 2013). In the same way, telephonic case management provides the expertise of a board-certified case manager, along with a friendly voice. Given the spread of mobile communication-an estimated 95% of Americans own a cell phone of some kind (Pew Research Center, 2017)-telephonic communication is a comfortable mode of communication. As experienced telephonic case managers can attest, such services are typically welcomed by individuals and their support systems.


With the aging of the population and more complex cases being managed by case managers, telephonic case management can be used to perform regular check-ins to promote compliance with physicians' orders and address issues that may have arisen since the last doctor's appointment. Individuals receiving case management services can also reach out to their telephonic case manager by phone or e-mail at any time.


In workers' compensation, telephonic services allow case managers to handle cases for hundreds of individuals for whom follow-up by phone is most appropriate. Immediately after an incident or a surgery, the individual can receive in-person visits; as the person's recovery progresses according to plan, case management follow-up can be done remotely by phone.


Telehealth and telephonic case management are effective tools that can be used across case management practice to pursue the "triple aims" of improving the experience of care, achieving better health of individuals and populations, and reducing the per capita cost of care (Berwick, Nolan, & Whittington, 2008). As more states join the NLC, multistate licensure will allow nurse case managers to practice across state lines with greater ease and consistency. Given demands for more nursing professionals and the need for more case managers, the NLC will allow these professionals to utilize their expertise across a broad population, regardless of where individuals live or work.




American Telemedicine Association. (2016). About telemedicine. Retrieved from http:// [Context Link]


Berwick D., Noland T., Whittington J. (2008). The triple aim: Care, health, and cost. Health Affairs, 27(3), 759-769. Retrieved from [Context Link]


Case Management Society of America. (2016). Position statement: Multistate nursing licensure in case management. Retrieved from http://


Darves B. (2013, May). Telemedicine: Changing the landscape of the rural physician practice. New England Journal of Medicine, Career Center. Retrieved from http:// [Context Link]


National Council of State Boards of Nursing. (2017, May). News release: South Carolina enacts enhanced nurse licensure compact (eNLC). Retrieved from https://


Pew Research Center. (2017). Mobile fact sheet. Retrieved from http:// [Context Link]


Tahan H., Watson A., Sminkey P. (2016, January-February). Informing the content and composition of the CCM(R) certification examination: A national study from the Commission for Case Manager Certification-part II. Professional Case Management, 21(1), 3-21. [Context Link]