CODHA Explorer October 2022
LICENSE PORTABILITY MAY BE CLOSER THAN YOU THINK
ALYSSA ABERLE RDH MBA
What is an Interstate Licensure Compact?
An interstate compact is a contract between two or more states. It carries the force of statutory law and allows states to perform a certain action, observe a certain standard, or cooperate in a critical policy area. Through these compacts states can establish uniform guidelines, standards or procedures for agencies in the compact’s member states. One of the simplest examples of an interstate compact is a driver’s licenset. Individuals that hold a driver’s license in one state can cross the state line and drive in another state as long as they follow that state’s driving laws. In the example of a driver’s license, all 50 states participate in that compact, so drivers can drive in any US state under their original driver’s license. Another example of similar laws would be with concealed carry permit reciprocity. Only some states participate in reciprocity laws for concealed carry permits. If you hold a concealed carry permit in one state (for instance Colorado) and you travel to another state that has reciprocity, you can also carry a firearm in that state. However, every state has very different carry laws, similar to the different scopes of practice for dental hygienists from state to state. When you cross state lines into another state, even if they have reciprocity, it is the permit holder’s responsibility to know and follow that state’s carry laws.
An interstate compact for occupational licensure is an interstate agreement that provides a pathway through which licensed professionals can obtain authorization to practice in states where they are not licensed. A state must enact the compact model legislation via a state’s legislative process in order to join. Compacts are constitutionally authorized and legally binding.
Will this ever happen for dentistry?
The American Dental Association (ADA) and American Dental Hygienists’ Association (ADHA) both applied for a technical assistance grant from the Council on State Governments (CSG) and the National Center for Interstate Compacts to research and develop an interstate compact for dentists and dental hygienists. This summer, they released draft language for the compact and had public stakeholder meetings as well as a public feedback survey so that stakeholders could provide feedback and testimony about the draft language. The final language is planned to be released late fall 2022 and should be ready to be introduced to state legislatures in the 2023 legislative sessions.
The current project is supported financially by the US Department of Defense. The Department of Defense has taken significant interest in occupational licensure compacts due to the obvious impact it would have on military spouses and families. Unlike other legislation, these compacts would include all licensees and not just military families.
Would I still have to retake boards to move to another state?
It depends. In order to participate in the interstate compact, there are minimum requirements. Participating states must require graduation from a CODA accredited dental or dental hygiene program, passing the national written board exam, complete a clinical assessment, and have continuing professional development requirements for licensure or license renewal. The wording for “clinical assessment” is intentionally broad to allow states to participate regardless of the type of clinical assessment they accept. It is likely that if you were to apply for compact privileges to practice in another state you would not have to retake your clinical exam in order to obtain those privileges. You may have to show some form of relevant experience or competency though if you have not practiced in recent years.
What if I already have licenses in multiple states?
The concept of the interstate compact is that you have one “originating license” and then can apply for “compact privileges” in any participating compact state. If the states that you have licenses in are all participating states, you could choose to renew all of those licenses, or you could let all but one expire and keep that one license as your originating license. You’d then have to apply for compact privileges in the other states where you want to practice.
People are often worried about what will happen if they let a license lapse. What if that state then withdraws from the compact and they have to reapply for the license in that state (especially if it’s a state that has a particularly difficult licensure process)? There are currently 9 professions that have active interstate compacts. 44 states participate in at least one interstate compact for occupational licensure. Of all those pieces of legislation, only one state has ever withdrawn from an occupational compact.
What about states that have different licensure requirements?
States will still have the ability to have state specific requirements like jurisprudence and ethics exams. However, in general, you shouldn’t have to retake board exams or obtain your transcripts to get compact privileges in other states.
What about states that have different scopes of practice?
As mentioned earlier, scope of practice in each state will remain the same and determined by the state legislature. When practicing under compact privileges in another state it is up to the licensee to understand and abide by the state’s practice act and rules. Essentially this is how it is now as well. A dental hygienist from Colorado can move to Texas and get a Texas dental hygiene license. Even though they also hold a Colorado dental hygiene license, the dental hygienist must follow Texas laws when practicing in Texas.
What if someone has discipline against their license in one state?
Part of the interstate compact project is a shared database for licensees. This means that the dental board, employer, or member of the public, could look up a licensee from any participating state in the database. State dental boards will have special access to see discipline in other states and can determine at that time if that discipline should limit or revoke the licensee’s compact privileges in their state.
How does this help us if Colorado is already very friendly to license portability?
Colorado is already one of the easiest states to obtain a dental or dental hygiene license. Colorado currently accepts all clinical board exams, has no time limitations on board exams as long as you have been practicing clinically in another state in recent years, and has not state specific exams or requirements. Despite this, the interstate compact could still greatly impact dentists and dental hygienists who are attempting to obtain a license in Colorado, or move out of state. For instance, the physical therapists interstate compact states that they can approve compact privileges in another participating state within 10 minutes. Because of the shared database, licensees do not have to obtain or submit copies of their transcripts, board scores, etc. All of that information is stored and shared through the database with other participating licensing entities and therefore confirmation of compact privileges can be approved very quickly and very cost effectively.
What are the next steps and how can I help?
The workgroup is currently reviewing testimony and feedback from this summer’s stakeholder meetings and the feedback survey. They will be making final edits and releasing the final compact language in late fall 2022. Colorado Dental Hygienists’ Association has already begun stakeholder engagement surrounding this potential legislation and we hope to be able to secure bill sponsors shortly after the November election. We would love for dentists and dental hygienists impacted by the lack of license portability to reach out and participate by contacting legislators and providing testimony at legislative hearings. Please contact us at firstname.lastname@example.org for more information on how to get involved in Colorado. To read more about the interstate compact project for dentists and dental hygienists, visit https://compacts.csg.org/compact-updates/dentistry-and-dental-hygiene.