DEA Notice of Proposed Rule on Locum Tenens Registration Requirements for Individual Practitioners

Washington, D.C. November 11 2009 —The Drug Enforcement Administration (DEA) has released an advance notice of proposed rule making on registration requirements for individual practitioners operating in a locum tenens capacity. Locum tenens is a procedure in which one practitioner temporarily substitutes for another. DEA is seeking information in advance of issuing a proposed rule. The deadline for comments is December 28, 2009.

DEA implements and enforces the Controlled Substances Act (CSA) and the Controlled Substances Import and Export Act. CSA requires that any person who dispenses controlled substances register with DEA.. DEA individual practitioner registrations are based on state authority to practice and prescribe controlled substances. A practitioner is authorized to dispense controlled substances only in the state(s) in which he or she is licensed and registered.

In December 2004, DEA published a proposed rule clarifying registration requirements for individual practitioners. The final rule was published in December 2006. This rule stated that when a practitioner practices in more than one state, the individual must obtain a separate DEA registration for each state. This rule also noted that policy regarding locum tenens would be addressed in a separate document at a future date. This forthcoming rule will address locum tenens requirements.

The CSA does not specifically reference the practice of locum tenens However, DEA regulations do state that ``A separate registration is required for each principal place of business or professional practice at one general physical location where controlled substances are manufactured, distributed, imported, or dispensed by a person.'' When a locum tenens practitioner substitutes for another practitioner on a temporary or sporadic basis at that other practitioner's [DEA registered] place of business, that place of business is considered by DEA to be a ``principal place of business or professional practice'' for purposes of the locum tenens practitioner's DEA registration.

Locum tenens practitioners typically contract with a staffing company to perform medical services for a health care corporation for a specific length of time. DEA is seeking information on the locum tenens industry and specifically on how it functions. DEA is particularly interested in comments and has developed a specific list of questions for the following groups:

Locum Tenens Practitioners

• In your experience, what types of practitioners participate in locum tenens activities (e.g., physicians, dentists, nurse practitioners)? Please specify your type of licensure.
• How long is the typical locum tenens assignment?
• Do locum tenens practitioners seek State/Federal licensure or registration prior to accepting a position as a locum tenens practitioner?
• What is the length of time between hiring for the position and reporting to duty?
• Do practitioners secure locum tenens positions independently or through an agency?
• As locum tenens practitioners, do you administer, dispense and prescribe controlled substances? Does your authority to do so vary in the States in which you practice?
• Can you have more than one locum tenens job at a time?

Those that Employ and Place Locum Practitioners

• What role do you have in the locum tenens process?
• Do you assist with State and Federal licensure/registration? If so, how?
• What types of practitioners do you employ or place (e.g., physicians, dentists, nurse practitioners)?
• How do you verify the locum tenens practitioner's credentials?
• Are criminal background checks performed on locum tenens practitioners?
• What is the geographical coverage for locum tenens (e.g. local, statewide, multi-state, national)?
• How much time is there between assignments for one practitioner?

Institutions that Retain Services of Locum Tenens Practitioners

• How many locum tenens placement agencies do you contract with?
• How frequently do you secure locum tenens services?
• What credentialing checks do you perform on the locum tenens practitioners working for you? Do you perform fewer checks for practitioners supplied by agencies than you do for practitioners you contract with individually?
• For how long do you secure locum tenens services (i.e., duration)?
• For what specialties do you use locum tenens practitioners?
• What authority do you grant locum tenens practitioners? (For example, can they administer, dispense, or prescribe controlled substances? Under whose DEA registration would such an activity occur?)
• Do you grant locum tenens practitioners the same controlled substance authority that other practitioners using the institution's DEA registration to dispense controlled substances? If not, why not?

State Regulatory Authorities

• What are the State requirements for locum tenens practice for practitioners (e.g., physicians, dentists)?
• Does the State waive State medical licensure (or automatically grant temporary courtesy licensure) for locum tenens practitioners if they are properly licensed in another State? If so, what checks are performed to confirm State licensure in the other State?
• If granted, for how long is the waiver or courtesy licensure?
• What are the State requirements for locum tenens practice for mid-level practitioners (e.g., physician assistants, nurse practitioners)?
• Does the State waive State licensure (or automatically grant temporary courtesy licensure) for locum tenens practitioners who are mid-level practitioners if they are properly licensed in another State? If so, what checks are performed to confirm State licensure in the other state?
• If granted, for how long is the waiver or courtesy licensure?
• If the State requires State licensure with the medical or other professional board, how long is it good for?
• Does the State grant locum tenens practitioners the same controlled substance authority that it grants to practitioners that are fully licensed by the State professional board? If not, why not?
• To dispense controlled substances, must a locum tenens practitioner obtain a State controlled substance registration?
• Does the State medical or other professional board report board actions against locum tenens practitioners to the National Practitioner database and to States in which the locum tenens practitioner holds a license?

In comments received on the December 2004 proposed rule, groups that were supportive of locum tenens noted that it is beneficial as it provides flexibility for both practitioners and health care organizations. For complete information on the proposed rule go to: http://www.access.gpo.gov/su_docs/fedreg/a091028c.html