December 2022

From the President

Donald A. Balasa, JD, MBA

2022-2023 CAAHEP President

In this article President Balasa provides information about potential changes proposed by the Department of Education that may alter or tighten requirements for health professions educational programs. It is recommended that CAAHEP program sponsors, educators, and professional organizations maintain awareness about these proposed changes and consider their potential impact on institutions of higher education and health science professions.) 

As discussed in the last “From the President,” the United States Department of Education (USDE) intends to propose the following amendments to its regulations: 

In the current version of the USDE regulations, schools are required to publicize for each of their programs in licensed professions:  

• the states for which their program meets the licensing requirements for the profession; 
• the states for which their program does not meet the licensing requirements for the profession; 
• the states for which the school has not made a determination of whether their program meets the licensing requirements for the profession. 

In contrast, the anticipated proposed revisions to 668.14 and 668.43 would impose a legal duty on each school to ensure/guarantee that programs in the licensed professions (in the state in which the school is located and in the states in which enrolled students are located) meet the state educational requirements and therefore permit graduates of each program to take the state licensing examination. Although the anticipated changes in the USDE rules would provide more information and transparency for prospective students, there has been concern about whether imposing such a significant legal obligation on each school is sound education policy. Colleges and their accreditors have pointed out that placing an affirmative duty on schools to make accurate legal analyses of whether their programs meet the educational requirements of state licensing laws would require a significant expenditure of resources on an ongoing basis. This additional expense would not be welcomed by public and private postsecondary institutions, many of which are facing increasing financial challenges. 

In theory, these expected changes in the Department of Education rules would eliminate (or at least reduce) the horror stories of students who have completed a pre-professional program only to discover that the program does not meet the requirements of a state’s licensing laws. But who should bear the cost of this compliance system? As noted above, schools would be hard-pressed to analyze and monitor the licensing requirements for each profession in each American jurisdiction. Many state licensing boards already list academic programs in their state that meet the educational requirements for licensing. However, this does not help prospective students who intend to become licensed in a state other than the one in which their school is located. 

The best solution may be for an association of licensing boards or academic programs to assume this compliance responsibility. Having staff (or independent contractors) of a national association of licensing bodies monitor state licensing laws would seem to be the least costly way of accomplishing this noble policy objective. For example, the National Council of State Boards of Nursing has started to compile and post this information for the various levels of the nursing profession.   

Questions may be directed to Mr. Balasa at dbalasa@aama-ntl.org

by Elise Scanlon, JD, Elise Scanlon Law Group

Recent years have been transformative for higher education as institutions have explored ways to expand access to a rapidly changing demographic of students and grapple with the effects of COVID. We have seen new structures emerge, including outsourcing arrangements and partnerships with education providers that are neither accredited nor participants in Title-IV federal aid programs. Department of Education (ED) regulations permit such arrangements under 34 C.F.R. § 668.5 et seq. https://www.law.cornell.edu/cfr/text/34/668.5,¹ and CAAHEP has a number of accredited programs offered through written arrangements. For example, a college or university sponsor (Standard 1.A.1.) may outsource a portion of a program to an ineligible provider such as an unaccredited school, training facility, medical care facility or hospital.² A consortium sponsor (Standard 1.B.) may be created through an agreement between a college or university and an ineligible provider. This article is intended to raise awareness of guidance recently issued by ED on 34 C.F.R § 668.5 that may be important to 1.A.1. and 1.B. sponsors of CAAHEP-accredited programs.

Under 34 CFR § 668.5, up to 50% of a program may be offered by an institution through a written arrangement with an ineligible provider.³ The institution where the student is enrolled is responsible for determining the student’s eligibility and calculating and disbursing Title-IV funds to the student. In doing so, the institution must accurately determine the percentage of the program that is provided by the ineligible entity, attributing all credit or clock hours that comprise the academic program to one of the partners in the arrangement, and ensuring that the portion of the program that is provided by the ineligible entity does not exceed the regulatory maximum (generally 50%). If the ineligible entity has authority over the design, administration, or instruction of the course, the credit or clock hours for the course must be attributed to the ineligible entity.

In a July 6, 2022, Dear Colleague Letter,⁴ ED issued guidance on 34 C.F.R. § 668.5 providing the following examples of when an ineligible entity would be considered to have authority over the design, administration or instruction of a course:

• Establishing the requirements for completion of the course;
• Delivering instruction or mandatory tutoring;
• Assessing student learning, including through electronic means; or
• Developing curricula or course materials, where the institution and its instructors cannot make changes to the materials.

ED’s guidance also illustrates where credit or clock hours have been improperly attributed to the eligible institution instead of the ineligible entity through the following scenarios:

The ineligible entity:

• offered a program in its entirety, but the program is inaccurately represented as being offered by the eligible institution:
• provided the instructors for the program and directly or indirectly compensates them, but the eligible institution treats those instructors as employees of the eligible institution, in some instances, classifying them as “adjunct faculty;” or

The eligible institution:

• designated one of its employees as the “instructor of record,” or a similar designation, while the actual instruction is performed by staff employed by the ineligible entity, referring to these staff members as “teaching assistants,” “tutors,” “coaches,” or similar titles;
• agreed to serve as the “institution of record” for the purpose of transcribing hours for an ineligible entity’s program; or
• agreed that curriculum or curricular materials purchased from an ineligible entity cannot be modified by the institution or its instructors.

Accreditors have responded to ED’s guidance by strengthening standards and policies intended to assure quality in programs offered through written arrangements. CAAHEP’s Sponsorship Standards provide a framework for engaging programs that have written arrangements to better understand: how they assure the recognized program sponsor (I.A.1 or I.B sponsor) is exercising proper authority and control over the program; how they maintain sound governance structures that are transparent to students and the public; and how they maintain compliance with applicable Title-IV regulations and institutional accreditation standards? The answers to these questions are likely to add important insight and perspective to ongoing discussions of emerging structures within the CAAHEP portfolio that build on CAAHEP’s commitment to quality.

¹ Programs offered through written arrangements must meet accreditation requirements, some of which are mandated by 34 C.F.R. § 602.22 et seq.

² Clinical affiliation agreements are not written arrangements under 668.5.

³ The % is capped at 25% where parties to a written arrangement operate under the same ownership or control.

⁴ https://fsapartners.ed.gov/knowledge-center/library/dear-colleague-letters/2022-06-16/written-arrangements-between-title-iv-eligible-institutions-and-ineligible-third-party-entities-providing-portion-academic-program

Don't miss the debut of the CAAHEP Symposium, January 20-21, 2023, at Renaissance Tampa International Plaza Hotel, in Tampa, Florida.

The CAAHEP Symposium is a forum for accreditation leaders to discuss issues related to health professions accreditation focusing on quality improvement, education outcomes, and societal impact.

The agenda includes a keynote address from two representatives from the American Hospital Association, a plenary session on Exploring and Communicating the Value of Accreditation, and other general sessions on important topics, such as:

• Balancing Innovation with Regulation in Health Professions Education and Accreditation
• Distance Education is Here to Stay in Health Professions: Where do we go from here?
• Working Across Organizational Silos: Lessons Learned from the Paramedic Profession

There are breakout sessions for leadership development and general accreditation topics. See the full agenda and list of speakers on the CAAHEP website and register today.

Thank you to the Symposium sponsoring organizations:

GOLD LEVEL SPONSOR

SILVER LEVEL SPONSOR

SILVER LEVEL SPONSOR

Sponsorship opportunities are also available for this inaugural event. Please contact the CAAHEP office for more information on the Symposium and sponsorships.

Commission on Accreditation of Allied Health Education Programs

9355 - 113th St. N, #7709, Seminole, FL 33775-7709

W: www.caahep.org  P: 727-210-2350 E: mail@caahep.org