Legislative Summit held to discuss Dental and Dental Hygienist Compact

Legislation already enacted in three states

The Council of State Governments, in partnership with the ADA and the Department of Defense, hosted a summit on Capitol Hill Sept. 12 to discuss the Dental and Dental Hygienist Compact.

The 2023 DDH Legislative Summit was held to provide information and answer questions regarding the implementation of an interstate compact that “will create reciprocity among participant states, and reduce the barriers to license portability,” according to the CSG National Center for Interstate Compacts website.

Specifically, the DDH Compact is an agreement between two or more states that provides a legal pathway through which dental practitioners can practice in states where they are not licensed.

The compact, which was finalized in January, will offer many benefits for dentists and dental hygienists, including facilitating multistate practice; enhancing license portability when changing state of residence; expanding employment opportunities in new markets; improving continuity of care when patients or providers relocate; supporting relocating military spouses; and reducing the burden of maintaining multiple licenses.

More than 80 attendees were present at the summit, including legislators, dentists, dental hygienists and dental board staff from various states. Representatives from the DOD, which supports the implementation of the DDH compact and others around the country, opened the meeting. The summit also included a panel of experts: former ADA President Joseph Crowley, D.D.S.; Rep. Michelle Caldier, D.D.S., R-Wash.; Tennessee Hygienists’ Association Member Susan Melton; and Minnesota Board of Dentistry Executive Director Bridgett Anderson.

Dr. Caldier, who sponsored the successful bill in Washington state, highlighted the importance of educating legislators on the definition of a compact since many do not have health care backgrounds, emphasizing that “the more states we can get signed on, the more effective the compact is.”

The summit featured a discussion about the compact’s implementation, including requirements for licensure, the development process and common misconceptions.

“Part of the problem is I think a lot of people don’t know what a compact is, and for the dentists and hygienists, a lot of the concerns they have [are about] someone coming into [their state] and all of a sudden doing fillings if they’re not trained. So, we were able to address those concerns and explain that that’s all done during rulemaking,” Dr. Caldier said, affirming that a process exists to address bad actors and that adequate training is required. “It was helpful for leaders in the profession in each of those states to understand, so when it comes up in those states there’s not a whole lot of pushback.”

Ms. Anderson offered a regulator’s perspective, stating that while her state board has been supportive of the compact, it’s just as important to acknowledge the upcoming obstacles.

“One of the challenges for us is going to be sheer logistics – getting the database set up, getting the commission established, but it’s not like we’re reinventing the wheel. It’s been done with many other health care professions, so it’s just getting things moving in that direction because that’s going to take some time,” she said. “The legislation alone is going to take some time because it has to be adopted in seven states. It’s a process, but once it is established it will streamline things.”

She also highlighted the importance of creating comprehensive legislation early on so as not to require the compact commission – which will consist of state board representatives – to make amendments years down the road.

“You don’t want to change legislation in five years, or even 10 years. You want it to be broad enough where it ultimately allows the compact commission to establish some of these things in further depth. It’s very similar to that process of administrative rulemaking,” Ms. Anderson said.

The DDH Compact process will consist, in part, of a practitioner applying for a compact privilege; undergoing an FBI background check; having their eligibility verified and completing jurisprudence requirements; then receiving a compact privilege, allowing the practitioner to practice in the remote state. Further, practitioners using the compact need to have an unencumbered license, and must have graduated from a CODA-accredited program.

One group that will greatly benefit from the compact is military families, who are only located in any given state for two to three years. Because of these families’ high mobility, licensed military spouses are presented with a significant barrier to career development and employment.

“It’s hard enough to support your spouse when they’re serving, but if you travel with them and you can’t practice, or you can only practice as a dental assistant and not a hygienist, and you have this lower paying contribution to your household, that is very stressful on the marriage,” Dr. Caldier said.

The compact will also work to address staffing shortages in the dental sector. The number of general practitioner dentists who indicated they are “too busy” or “overworked” is currently at an all-time high. According to a survey conducted by the ADA Health Policy Institute, 38% of respondents reported being too busy in 2021, compared to 29% in 2019 and 23% in 2018.

But with implementation of the compact, dental hygienists will be licensed to work across state borders. According to Dr. Caldier, allowing practitioners flexibility in traveling back and forth between states would help alleviate staffing issues.

“The most important thing to me is addressing the workforce issue,” Dr. Caldier said. “[Washington state] has two major cities that border Idaho and Oregon. If we were able to get Idaho and Oregon to join, then they could come up and work a couple days a week in Washington or work a couple days in Oregon.” 

To date, the compact has been enacted in Iowa, Tennessee and Washington. It has been introduced in Kansas and Minnesota, secured sponsors in Michigan and Wisconsin, passed the Assembly in New Jersey, passed the Senate in Ohio, and is pending in committee in Pennsylvania. Nearly a dozen other states have indicated their intent to introduce the compact in 2024.

The compact will become active once it has been enacted in seven states.

Overall, Ms. Anderson said the summit was successful and generated a great deal of enthusiasm about what comes next.

“I think there was a lot of excitement about it. A lot of questions got answered. There was a lot of interest in next steps,” she said.