Certification, Licensure, and Accreditation

Three separate mechanisms regulate genetic counseling in the United States, and they are routinely confused because their acronyms are similar and their functions overlap in ordinary speech. Certification is about the individual, licensure is about the legal right to practice in a state, and accreditation is about the training program. They are granted by different bodies and lost in different ways.

• ABGC, the American Board of Genetic Counseling, certifies individuals. It administers the certification examination, confers the CGC credential, and publishes a Code of Conduct governing certificants. Certification is national and voluntary in the sense that no state requires it directly, though licensure typically does.
• State licensure confers the legal right to practice and to use the title in a given state. It is granted by a state board, not by ABGC, and it is the mechanism that most affects payer credentialing and independent billing. Licensure requirements vary and typically build on ABGC certification.
• ACGC, the Accreditation Council for Genetic Counseling, accredits training programs. Graduation from an ACGC-accredited program is the usual prerequisite for certification eligibility. It does not certify individuals or license anyone.
• NSGC, the National Society of Genetic Counselors, is the professional society. It publishes the Code of Ethics, produces practice guidelines, advocates on policy, and runs the annual conference. Membership is voluntary and is not a credential.
• Two codes, two bodies. NSGC publishes a Code of Ethics for its members; ABGC publishes a Code of Conduct for its certificants. They cover overlapping ground and are not the same document. Confusing them is a classic error, and the distinction between the four organizations is the thing to hold onto.
• Recertification requires ongoing activity rather than a one-time examination. ABGC maintains a certification maintenance program, and certificants must meet its continuing education and activity requirements within each cycle.
• Continuing education units are earned through conferences, journal-based activities, and approved programs, and are required for both recertification and, separately, for state license renewal, whose requirements may differ.
• Scope of practice is defined by state law where licensure exists and by professional standards otherwise. Practicing outside the scope defined by a state's licensure act is a legal matter, not only a professional one.
• Reciprocity is limited. A license in one state does not confer the right to practice in another, which matters directly for telehealth: the governing rule is generally the state where the patient is located at the time of the encounter.

• A counselor certified by ABGC moves to a state with licensure and assumes her national certification permits practice. It does not. She must obtain a state license before seeing patients there, and practicing in the interval would be unlicensed practice.
• A counselor licensed in one state provides telehealth to a patient who has travelled to another state. The relevant jurisdiction is generally the patient's location at the time of the visit, so the encounter may require licensure in that second state.
• A student asks which organization will let her sit the certification examination. The answer involves two: she must graduate from an ACGC-accredited program in order to be eligible for the ABGC examination.
• A counselor faces a complaint alleging a boundary violation. The NSGC Code of Ethics articulates the professional expectation, the ABGC Code of Conduct governs her certification, and the state board governs her license. Three separate processes can follow from one set of facts.