Minnesota lawmakers push to streamline health licensing across state lines

ROCHESTER — From the MinnesotaCare Public Option proposal and medical debt relief to a hospital CEO pay cap and the End-of-Life Option Act, health legislation remains at the forefront in the Minnesota Legislature's 2024 regular session.

Among these potential laws are several bills that would have Minnesota join interstate licensure compacts for certain health professions. In the Minnesota Senate, these bills have the support of at least one of Rochester's senators.

"If you move to another state, even if you have been working in your profession for 30 years ... you have to go through the process of getting a license in that state," said Sen. Liz Boldon, DFL-Rochester. "The benefit of the compact is that there's reciprocity; there's recognition of a license from another state."

Both Sen. Carla Nelson, R-Rochester, and Boldon are co-authors of SF 2990, which would have Minnesota join the emerging Dentist and Dental Hygienist Compact.

"Local dentists reached out to me about this," Nelson said. "We have some dentists who are not able to practice to their full ability because they don't have enough dental assistants and dental hygienists."

Nelson is also the chief author for SF 3281, which would have Minnesota join the Nurse Licensure Compact. Additionally, Boldon is chief author for the audiology and speech-language pathology compact bill (SF 2656) and co-authors bills for compacts for physician assistants, professional counselors, physical therapists and social workers. Another bill, SF 1572, would affect occupational therapists.

The spate of licensure compact bills comes as these agreements between states and their health care workforces become more common.

Traditionally, when a medical provider wants to work in a different state, they have to apply for a license in that state. A dentist, for example, who is licensed in Minnesota would need to seek licensure in Wisconsin in order to practice there.

This is what Dr. Isaac Perry did when his family's Minnesota-based dental practice, Perry Dental, expanded into Pepin, Wisconsin a few years ago. Perry, his sister and fellow dentist Dr. Ava Perry Line and two of their dental hygienists now hold licenses in both states.

"Some states require different board exams," Perry said. "But Minnesota and Wisconsin require the same board exam, so I didn't need to take anything extra; I just needed to gather all of my previous parperwork, all my certificates and send that to the Wisconsin Board of Dentistry."

In addition to maintaining his Minnesota dental license, Perry has to renew his Wisconsin license every three years.

The administrative process of attaining a new license can take several months, which can delay how soon that person can start their new job or expand their practice across state lines.

"If you think about a military family, they're moving, on average, every one to two years, which comes with a lot of challenges, particularly if there's a spouse that's in a licensed profession," said Matt Schafer, deputy program director in the Council of State Governments' National Center for Interstate Compacts. "When that individual is having to get relicensed every one to two years in a new state, that's extremely burdensome on the military spouse."

Licensure compacts were created to expedite this process. In 1999, the Nurse Licensure Compact became the first compact of its kind in the country, and 39 states participate in the NLC today.

"The idea was to have a seamless nursing practice and safe nursing practice happen across state lines, whether that be in person or electronically," said Nicole Livanos, director of state affairs at the National Council of State Boards of Nursing.

Now, several compacts exist between states for licensed workers such as nurses, physical therapists, physician assistants, speech-language pathologists and more. Each compact has its nuances but, in general, they fast-track licensure by sharing the professional's credentials between participating states instead of having the professional submit those credentials to each state every time they apply for a license.

A registered nurse in Wisconsin, for example, already holds a multistate license because Wisconsin is an NLC member. This means that this nurse can also work in Iowa or another NLC state without having to go through each state's separate licensure process.

That process is slightly different for the Interstate Medical Licensure Compact Commission, which is the licensure compact used by 41 states for physicians. Each state still issues its own medical license, but if a physician applies for a license in an IMLCC state and qualifies, their credentials (such as their medical school transcripts) are sent between those states' medical boards.

As of March 2023, 455 Minnesota doctors have used the physicians' compact to get licensed in another state, said Marshall Smith, executive director of the IMLCC.

"It's set up to, basically, collect the data once and then share it among the different states that are in the compact," said Dr. Michael Dolan, the chief clinical officer for Gundersen Health System's hospitals and clinics in Minnesota, Iowa and western Wisconsin.

Dolan said that about 35% to 40% of Gundersen's 600 physicians and 400 advanced practice providers, including himself, hold multiple state licenses. Because Minnesota is an IMLCC member, "I think I was licensed within less than 60 days," Dolan said.

The DDH compact will work in a similar way, once it's up and running. Schafer, who helps oversee that compact's development, said the brand-new compact is backed by the American Dental Association and the American Dental Hygienists’ Association and currently has five members: Washington, Iowa, Virginia, Wisconsin and Tennessee. Once a total of seven states join the compact, it will go into effect.

Right now, Minnesota is only part of two interstate licensure compacts: the IMLCC and the Psychology Interjurisdictional Compact. Minnesota did temporarily allow out-of-state nurses to practice in the state without a Minnesota license during the COVID-19 pandemic.

But Minnesota could soon be part of the NLC, the DDH compact and others.

"You're moving from a scenario where it might take months to be able to get a license in another state to, with the compact, you could gain access to work in another state in a matter of minutes," Schafer said.

The workforce shortage affecting Minnesota's health care sector is one of the main drivers behind Boldon's and Nelson's compact bills, they said. By trimming down the time a nurse or a dentist needs to become licensed in Minnesota, they can start working here sooner.

"If we can make Minnesota a state which is more open to having those qualified, highly trained people (who) have passed those national boards be able to practice in our state without needing to go through all the individual hoops of each and every state," Nelson said, "I think it can help with the workforce shortage."

Having more staff who can practice in multiple states can help health systems fill gaps in staffing, Dolan said. If a doctor at a Minnesota clinic is out sick for a day, Gundersen can have a Wisconsin-based one fill in at the Minnesota clinic instead of making those patients travel to a Wisconsin location for their appointment.

"We may have a surplus of individuals in one place and then develop an acute need elsewhere," Dolan said. "The ability to move (staff) around easily, because they're all licensed in all of those locations, makes fulfilling our mission of providing the right care close to home much more achievable."

If Minnesota enters the DDH compact, it likely won't have an immediate effect on Perry and his colleagues since they have already gone through the Wisconsin licensure process.

"It would probably only affect us if we had a new provider that was only licensed in one (state), and then it would just be easier to get dual licensure," Perry said. "Overall, I think it's a reasonable idea."

On top of the health care staff shortages, the rise in telemedicine usage and the increased mobility of the American workforce came into play during the COVID-19 pandemic, Nelson said. A health care provider can only provide care via telemedicine if they are licensed in the state where the patient lives.

"Patients and their doctors, their dentists, their dental assistants, their hygienists, they are all mobile," Nelson said. "We all are in different places at many times, and yet we all need that expert care."

Another reason is the fact that the Minnesota Legislature hasn't touched these proposals much in the past few years, Boldon said.

"There's been a bit of a backlog of different professions wanting these to be heard," Boldon said. "There's a good list of them at this point."

Adopting licensure compacts has become increasingly more common for states since the NLC's founding, but interstate compacts themselves aren't a new concept, Smith said.

"The most common example of a compact that impats people almost every day is the Drivers License Compact," Smith said. "It allows states to control and regulate the use of automobiles and how people drive ... but yet still allows people to drive into other states and obey and practice and follow those laws."

"Compacts, I think, really are the next natural progression in the licensure process," Smith added.

Nelson said she has high hopes that her nursing and dental compact bills will advance this year.

"There's no opposition at all on the dental (compact)," Nelson said. "The Nurse Licensure Compact, in the last few years, we've had phenomenal hearings — Department of Defense, the nurses, the nurse educators, the physicians, the insurers, the hospitals, all of those associations support (it)."

The Minnesota Nurses Association has, in previous years, been against Minnesota joining the NLC. A representative for MNA did not respond to the Post Bulletin's request for comment by deadline.

"In terms of the licensure compacts, I think, as of right now, they're on a pretty good track," Boldon said. "We've heard many of them in committee, and many of them don't really have any controversy."

The group of licensure compact bills — except for the NLC proposal — advanced through the Senate's Health and Human Services Committee in early March.