Number of bills moving in state legislatures on Dentist and Dental Hygienist Compact

Compacts create standardized credentials among participant states, reduce the barriers to portability

Over two decades ago, the ADA approved policy supporting license portability.

Fast forward to today, and with legislative activity on licensure in nearly a dozen states across the nation, license portability is making significant headway, as states consider joining the Dentist and Dental Hygienist Compact, with three already passing the compact.

The Council of State Governments, a nonpartisan, nonprofit organization that serves all three branches of state government, has been collaborating with the ADA, the American Dental Hygienists’ Association, the Association of Dental Support Organizations and the Department of Defense to support the mobility of licensed dentists and dental hygienists through the development of an interstate licensure compact. States interested in joining the compact must enact mirroring legislation.

The Dentist and Dental Hygienist Compact would create standardized credentials among participant states and reduce the barriers to license portability, said Joseph P. Crowley, D.D. S., past ADA president and chair of the Coalition for Modernizing Dental Licensure.

A licensure compact would benefit the public by increasing access to care for patients; the professions of dentistry and dental hygiene by enhancing mobility for all professionals including military personnel and spouses; and the licensure boards by preserving and strengthening the current system of licensure, Dr. Crowley said.

“License portability has long been a challenge for the professions of dental hygiene and dentistry,” said Ann Lynch, director of advocacy for the American Dental Hygienists’ Association. “The compact will offer a clear pathway for those licensed dentists and dental hygienists who wish to move across state lines or practice in multiple states. This will reduce the burden of obtaining multiple licenses which is often expensive, cumbersome, and results in loss of income and delays in contributing to the workforce.”

Interest from states

The compact, which sets up a legal agreement among states, establishes pathways for dentists and dental hygienists licensed in a participating state to practice in another participating state in which they are not licensed. States retain the authority to regulate the practice of dentistry and dental hygiene in the state.

A state must enact the Dentist and Dental Hygienist Compact model legislation to join. The model legislative language became available in January and was written by a team made up of experts, stakeholders and state officials. The compact will go into effect once enacted into law by seven states.

“Compacts are an effective solution which allows states to craft their own solution to these problems rather than a one-size fits all dictate,” said Matt Shafer, deputy policy director of the National Center for Interstate Compacts with the Council of State Governments. “In recent years, states have been examining the way they regulate and license professions with a view towards eliminating unnecessary barriers to labor market entry.”

Ms. Lynch said response from state lawmakers has been positive, with more than a dozen states already interested in the legislation, according to tracking by the ADA Department of State Government Affairs.

“There is seemingly an appetite for workforce solutions across the country and the compact can be part of that conversation,” she said.

“The compact language was only finalized in January, so we are very pleased with the number of states who are already showing interest,” Mr. Shafer said. “The Council of State Governments is committed to providing education and technical assistance to stakeholders from states who are interested in learning more about the compact.”

Dr. Crowley also said he was appreciative of some of the dialogues he’s had with states and legislators.

“We are encouraged by conversations we’re having with coalition partners who intend to move forward and introduce bills in the near future,” Dr. Crowley said. “The compact is a great opportunity for the professions of dentistry and dental hygiene.”

Washington became the first state to pass the compact, with its governor expected to sign it into law in the near future after both houses unanimously voted to approve the legislation.

“Given the severe shortage of hygienists we are seeing at both the state and national level, we are taking a multifaceted approach to address this shortage, and we believe the compact is an important part of that effort,” said Emily Lovell, director of government affairs for the Washington State Dental Association.

Washington’s compact legislation, House Bill 1576, benefits providers by making it easier to practice in the state by reducing the burden of applying for and maintaining multiple licenses, while also benefiting the state’s patients by expanding access to qualified dental professionals, Ms. Lovell said.

Iowa and Tennessee have also completed final passage, with Iowa Governor Kim Reynolds signing the bill into law April 27.

Recent history

In 2018, the ADA, American Dental Education Association and American Student Dental Association formed the Taskforce on Assessment of Readiness to Practice to address issues related to dental licensure and competency assessment.

TARP released the Report of the Task Force on Assessment of Readiness for Practice, which provided a description of the recent history and current issues related to dental licensure, and focused on addressing the key challenges of eliminating the use of single encounter, procedure-based examinations on patients as part of the licensure examination.

The report was reviewed and approved by the ADA Board of Trustees and the ADA Council on Dental Education and Licensure, the latter which called for state dental boards to enact changes that allow for increased licensure portability and to critically evaluate their licensure-by-credentials regulations and statutes, with the goal of accepting a common core of credentials that can serve as a basis for licensure compacts.

Later that year, the ADA, American Dental Education Association and American Student Dental Association co-founded the Coalition for Modernizing Dental Licensure to continue the work of Task Force on Assessment of Readiness for Practice and encouraged states to consider its Policy Statement on Initial Licensure and Licensure Portability. The Association of Dental Support Organizations joined the coalition in 2023.

The Coalition for Modernizing Dental Licensure is a coalition of more than 120 national and state organizations, institutions and programs representing dentistry, dental education, dental specialties, dental hygiene and nonprofit groups working to improve public access to oral health care by seeking to increase licensure portability and eliminate single-encounter, procedure-based patient examinations, replacing them with clinical assessments that have stronger validity and reliability evidence.

The 2018 ADA House of Delegates approved a comprehensive policy on dental licensure that stated, “Provisions for freedom of movement across state lines for all dental professionals should exist to facilitate the provision of quality oral health care to the public.” 

Future steps

State advocacy efforts spearheaded by the American Dental Hygienists' Association, ADA, Association of Dental Support Organizations, and Council of State Governments will continue through the 2023 legislative sessions, with plans already underway for 2024.

The American Dental Hygienists’ Association, ADA, Association of Dental Support Organizations, and Council of State Governments are working together on identifying interested states and educating stakeholders within those states on the provisions of the compact. They are encouraging dentists and hygienists to advocate for the compact in their respective states by contacting state dental associations or representatives in the legislature.

“Next steps involve educating and engaging with those who have questions and concerns,” Dr. Crowley said. “An obstacle could be the misunderstanding that compacts will impact a state’s current licensure pathways, whereas a compact protects state sovereignty and offers an additional, optional pathway to licensure for those professionals who meet all the requirements. There have been significant positive changes to dental and dental hygiene licensure over the last few years and the coalition wants to engage in conversations and assist our partners in their advocacy efforts to continue this forward progress for the professions of dentistry and dental hygiene.”

“Truly the compact is a win for public safety,” said Ms. Lynch. “A win for dentists and dental hygienists who face the need to have multiple licenses or move across state lines. A win for dentist and dental hygienists who are military spouses and their families. A win to expand workforce opportunities in new markets.”