> Minutes of AILA-CGFNS Liaison Meeting (4/14/06)

MINUTES OF APRIL 14, 2006 AILA/CGFNS LIAISON MEETING

Persons in attendance: AILA: Frank Novak, Sherry Neal, Matthew Dunn, Mercedes Badia-Tavas, Bob Deasy, Joanna Hedvall; CGFNS: Donna Richardson, Sylvia Pompony

1. Are there any new CGFNS initiatives of which CGFNS would like the AILA membership to be aware?

CGFNS raised prices as of May 1, 2006, as noted on the website. The prices are being raised for all of the programs except for the New York Credential Verifications Service, on because of the increased costs of doing business. Anyone who was in process before then is covered by the current fee scale.

CGFNS is in the process of extending the electronic transmission system that it uses with the CES programs to other CGFNS programs. Under the CES transmission system, credentials evaluation reports go directly to the state board of nursing electronically. The report stays on-line for a year. The applicant receives a hard copy. It allows the state board of nursing to go in and look at a monthly report with regard to the applications and their status. This system may be in place for other programs by this summer. The two first programs will probably be the NY CVS and CGFNS certificate and VisaScreen verifications. (Note CGFNS certificate verification is already provided to NYS as part of the CVS program, unless the nurse does not yet have the CGFNS certificate, and then CGFNS will send it as an addendum to the CVS report once it is received.

CGFNS will begin charging for verification of CGFNS certificates.

2. If a case seems to be taking too long for CGFNS to process whether it is the VisaScreen, the certification program, or some other program, how can an applicant resolve the matter? Is there an ombudsman position or something similar at CGFNS? How long is too long? What are the internal timeline performance metrics for processing a case? If a case is designated as ready for review, how long should it be before it is reviewed? If a CVS case is designated as ready for submission, how long should it be before the report is issued?

CGNFS has an Ombudsman unit. The Ombudsman unit handles cases with numerous problems, not status inquiries. It receives complaints from the public and responds within twenty-four hours by e-mail or phone. A person cannot call and speak to an Ombudsman directly. There is a triage system set up for the Ombudsman based upon the program and also based upon the nature of the complaint.

Separate from the Ombudsman, if a person calls with an unresolved issue that has been previously raised by the person, the issue will be bumped up to a back-up person, which is a credentialer or a manager. If a person has called and they believe that the information that they have been given is wrong, then they are asked to document that information.

All documents are now scanned. The entry and scanning process can take up to fourteen days - depending upon the volume of the mail that has come in. Once those documents are scanned, then they are available for staff to see on-line. VisaScreen and Certification Program files are normally reviewed within four to six weeks of the document receipt.

"Ready for review" does not necessarily mean that the documents will be approved and accepted.

The Credentials Evaluation Service is a much more detailed process and it may take eight weeks to do the review of those documents and to get the correspondence out.

CGFNS encourages people to inform CGFNS of deadlines; specifically, deadlines for Visa appointments; deadlines for their VISA exit; and deadlines if they have applications for licensure in states where they only have a year or two years before their application is considered abandoned. In those cases, CGFNS can pull their application out of queue and expedite them so that they can meet their deadline.

Under the NY Credentials Verification Service, a case should not register as "ready for submission" for more than a couple weeks. The NY CVS "ready for review" time-line should be about four to six weeks.

If an applicant has a complaint that applicant can send a letter to the Director of AQA (Advocacy and Quality Assurance) and that is Brittany Zaehringer.

3. Is CGFNS aware of any plans to amend the language exam score standards, add additional language exams as meeting VisaScreen requirements, or amend the format of any language exams. With respect to the last possibility, the TSE is difficult, so that even those that communicate fully in English seem to fail.

CGFNS worked with HHS to adopt the IELTS given the reported scheduling and scoring TSE difficulties. There is a rumor that IELTS is not going to be accepted anymore, but there is no truth to that rumor. There is also the rumor that Indian nurses cannot take the IELTS. That also is not true. The Department of Health and Human Services is in the process of studying and recommending the scores for the IBT exams.

4. Why does the CGFNS Qualifying Exam score become invalid when the English exam scores are two or more years old? It is our understanding that holding English scores that are two years old invalidates both the English score and the CGFNS exam score. What is the rational for invalidating the CGFNS exam scores? Are there any other circumstances under which the CGFNS exam score expires?

The English testing community has established the two-year validity rule for the English test. CGFNS has followed that rule for the last twenty-five years. CGFNS set the two-year rule with regard to the CGFNS exam to ensure that nursing knowledge would be current. So if the CGFNS exam scores are more than two years old and an applicant now submits English scores, those English scores would not be valid for the purposes of issuing the CGFNS certificate. The English scores would be good for another two years. The ability to pass the NCLEX exam is higher when the CGFNS exam is taken in close proximity of the NCLEX examination. The purpose of the CGFNS exam is to predict how the nurse will do on the NCLEX examination.

The exam dates and not the dates the exams are graded control the date of expiration. If you were to take the CGFNS exam on March 4, 2004 and then were to take a language exam on March 3, 2006, and if you were to pass, irrespective of when the exam was graded, you would still get your certificate.

5. Does the VisaScreen, CGFNS certification or any other CGFNS program require that initial licensure be in the country of first level, professional education?

CGFNS requires that the initial licensure be in the country of professional education for the CGFNS certification program. Only one license in that instance is required and that is the licensure from the country of education. If, however, the country does not issue a license or registration, then CGFNS recognizes that there is no such procedure. In those instances where a person cannot take the licensing exam because of a citizenship requirement, e.g., Chinese nurses who graduated from Philippine schools are not allowed to take the licensing exam, CGFNS waives that requirement. Assumption University in Thailand is considered an international university and teaches in English. However the licensing exam is only given in Thai. Therefore non-Thai graduates cannot take the exam so the validation of licensure is waived for them. The license would also be waived if the person had to leave the country before they could take the licensing exam.

The certification program exists to demonstrate baseline competency and comparability of education. And thus this policy is required as a test of competency since the nurse is thus required to demonstrate competency by obtaining licensure in the country of education.

Many U.S. states have the same rule. New York does not require it for registered nurses, but it does for LPNs. If an RN educated in the Phillipines obtained initial licensure in NY, CGFNS would review the matter on a case-by-base basis. CGFNS would, e.g., consider if that person couldn't take the licensing exam because he or she was not a Philippine citizen or if he or she had to leave the country for some reason and was unable to take the licensing exam.

For the purposes of the VisaScreen, if the applicant was not licensed in their country of education, then it is not required because the VisaScreen regulations say "all licenses ever held, past or present". So if an applicant never held a license, CGFNS does not hold them to producing one.

6. Have the standards for issuing VisaScreens or CGFNS certifications changed in the last year. For example, CGFNS previously stated that a 212(r) certificate required licensure by exam, but that is no longer the case. Have there been any other changes in eligibility standards?

An RN is eligible for 212(r) if licensed by exam in any state and then endorsed into one of the five covered states, or if the nurse is licensed by exam in one of the five covered states. Licensure in one of the five states must be current. The rationale for the change is that the state endorsement processes are as stringent as licensure by exam.

Another change has been to add Barbados and Jamaica to the English exemption list.

7. Will CGFNS issue a VisaScreen to a PT who does not have a PT license but who shows eligibility to take the PT Board examination based on the new requirements found in the eligibility criteria for Schedule A Physical Therapists in 20§CFR656.5(a)(1) (considering PTs are only required to be eligible to take the board exam)?

CGFNS does not require a VisaScreen applicant for physical therapy to hold a license in their country. But if he or she was ever licensed, CGFNS must receive a validation of that license.

8. Under what conditions would a licensed vocational nurse be exempt from the English testing requirements when he or she is educated in the US? More broadly, can CGFNS please clarify when the English language proficiency testing is required for VisaScreen applicants who have received their allied healthcare degree from within the United States.

An LVN educated in the U.S would not be required to take the English exams because, if they have graduated from an approved school of nursing in the U.S., they are not held to that requirement. The regulations also provide a streamlined process for graduates of U.S. approved schools in nursing, physical therapy, occupational therapy, speech pathology, and audiology. These persons are not required to take the English proficiency exams and they only need to have their graduation from an approved U.S. school verified. CGFNS does not review their transcript for comparability.

9. What is the policy for waiving document requirements from less-than-cooperative foreign governments? If this is considered on a case-by-case situation, please outline what type of evidence/efforts you will consider concerning efforts to obtain documents (e.g. numerous attempts in writing or by telephone, Int'l courier w/ a pre-paid return envelope, etc.). How should an attorney go about making a formal request for a waiver of requirements?

CGFNS requires a showing of good faith by the applicant to obtain the document from less than cooperative governments. CGFNS has a database of over 500 thousand individuals and is familiar with the countries where there are problems. CGFNS has a process for cases where a document has been unobtainable. CGFNS asks the applicant for proof of good faith efforts like copies of letters that they have written. CGFNS will run a query to determine if it had any graduates of programs from the same time frame as the applicant and then to look at that information to help make a determination as to whether or not their education was comparable. If the person is a refugee or has asylum status then CGFNS asks for documentation of that. Special accommodations have been made for applicants from Tsunami affected countries and victims of Katrina where documents are just not available. Where there are not any original documents, CGFNS will accept copies and then those copies are reviewed against documents that CGFNS would have on-hand.

However, it is also the case that in some countries where the applicant has been requesting documents and they have not been forthcoming, often times it is because there is a problem. The applicant may not have finished government service, military service, or there might be outstanding fees. The Philippine PRC will not issue validations for anyone who has not renewed their licenses, notwithstanding the fact that the person hasn't been in the Philippines in ten years.

Eastern Europe has been difficult to get some documents. There have been improvements in the Ukraine and India. CGFNS is still working with Mexico to address the problems with getting documents out of Mexico.

Applicants need to be realistic about time-lines in obtaining documents internationally. It is not uncommon to wait six or more months to obtain documents from many countries - like the former Soviet Union eastern block. Fraudulent documentation is not uncommon and this requires CGFNS to obtain documents from the primary source.

If you have Nigerian applicants who say that they are licensed practical nurses, there is no such program in Nigeria. There has been a recent spat of bogus Caribbean schools issuing licensed practical nurse documents. St. Regis University and Concordia College & University have been linked to a diploma mill. Note that there is a real Regis University and there is a real Concordia College.

Maine previously has accepted the Canadian license for endorsement. As of December, 2006 they will no longer accept the Canadian license. As of January 1, 2006 North Carolina stopped accepting the Canadian license.

The CGFNS website provides a grid with average timelines for document retrieval by country.