Licensing with Laura: Seeking Legitimacy Through Licensing

Licensing with Laura: Seeking Legitimacy Through Licensing

Several occupations are currently exploring possibilities here in Nebraska to require licensing for their professions. Two examples are Art Therapists and Music Therapists.

These professions undoubtedly contribute value to our health care system. Art Therapists and Music Therapists can use their training in mental health, social work, and in some cases physical rehabilitation by incorporating the use of the arts. They typically have masters-level college degrees in Art or Music Therapy and can take national exams for professional certification.

About one-third of the states have some regulatory framework for Art Therapists and/or Music Therapists. Some license them as a special category of mental health professional or social worker, under existing licensing boards, while a few created new state licenses and boards.

Other states recognize these professions generally, but don’t regulate them, allowing independent practice, or practice with other licensed professionals or health care institutions. This leaves it up to the individual patient or client, licensed professional, or institution to determine whether the therapist’s credentials are adequate for their needs.

I attended a hearing in which local Art Therapists were testifying for more regulation of their profession. I wondered why, since many of us would prefer to be left alone and to avoid red tape in our work.

One possibility was for reimbursement purposes. Perhaps insurance, Medicare, and Medicaid don’t recognize Art Therapy as a unique billing code, and it was thought licensing would address this issue. However, one of the senators on the committee noted that “just because you have a code, doesn’t mean insurance will pay.”

I listened carefully for examples of patients or the public being harmed by unregulated Art Therapists in Nebraska. But I heard none. No one from the public was asking for licensing to keep them safe.

What’s going on here?

No matter how counterintuitive it may seem to many of us, more and more, it appears that seeking licensing—ASKING to be regulated (and in most cases, asking for a monopoly on the use of a title)—is a way for new professions to obtain a sense of legitimacy in the public eye.  In other words, practitioners who are licensed by the state are “the real deal.”

From a regulatory and economic point of view, granting “Legitimacy Through Licensing” is dangerous.

Who would have ever thought 70 years ago that there would be advanced degrees and professional certification in Art or Music Therapy? But as new fields are developed, the move to licensure increases bureaucracy; and increases costs of entry into occupations. That, in turn, limits who can enter, and raises prices for consumers, as fewer people can meet the demand.

Art Therapists are currently undergoing a “407 Review” within the Department of Health and Human Services. This is an independent review which will provide advice to the Legislature concerning the need for any new licensing or changes in the level of regulation or scope of practice. Ultimately, both the 407 review, and the licensing review covered by the Occupational Board Reform Act of 2018, establish the policy of regulating “only when necessary to protect the public” and using the “least restrictive means of regulation” possible.

The Legislature should look carefully at all new license proposals, and ask the questions: Why is this necessary to protect the public?  Are there alternate ways to approach needs like recognition for insurance payment purposes that doesn’t require full licensing? If active practitioners of the occupation are asking for the license, why? Do they have evidence of harm having been done by someone who was unqualified, or are they trying to protect their credential?

In my next article, I want to talk about another danger attached to licensing—the possibility that innovation and initiative will be stifled.

Read the entire "Licensing with Laura" series at

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