EDUCATION Starting as early as winter 2025, the Dentist and Dental Hygienist (DDH) Compact will begin accepting applications for interstate practice privileges. Georgia is not a member of the newly operationalizing compact, and DDH’s formation provides an opportunity to reflect on the potential value and drawbacks of licensure portability. Without tightening certain provisions, DDH falls short of Georgia’s existing licensure standard, and its benefits are likely to be limited at best. What is the DDH Compact? The DDH Compact is an agreement that creates a way for dentists and dental hygienists to practice across state lines. It is an interstate compact, essentially a contract between states.1 Compacts are enacted when a group of states enact identical legislation, and since they cannot be unilaterally amended, compacts offer a stable solution to long-term problems.1 The oldest interstate compacts have historically been related to issues like boundary disputes and water rights.1 Agreements related to licensure portability are relatively new.1 DDH currently has 10 participating states (Figure 1): Washington, Colorado, Kansas, Minnesota, Iowa, Wisconsin, Ohio, Tennessee, Virginia, and Maine. Pennsylvania and New Jersey have pending legislation.2 Figure 1 DDH’s agreement lays out a framework for developing an infrastructure to facilitate interstate licensing.2–4 It creates a Compact Commission, composed of 1 delegate from each state, which administers all aspects of the program. The compact’s primary function is to allow providers to obtain compact privileges which authorize them to practice in other participating states. To obtain and exercise a compact privilege, providers must have a license in good standing and meet other qualifying criteria shared by member states. At their first meeting in August of 2024, the Compact Commission began the work of operationalizing DDH. That work includes developing by-laws, deploying necessary data infrastructure, rulemaking, laying the organization’s financial groundwork, and other fundamental tasks necessary to launching a functional organization. If done well, DDH’s early work will address and assuage critics’ concerns. Critics of DDH raise questions related to cost, differences in clinical exam requirements, and surrendering some regulatory authority to an interstate organization with limited accountability. 6 Notably, DDH does not require a hand skills test to access compact privileges, but it does require a clinical exam. The result is that its standard is currently lower than Georgia’s. Rulemaking by the Compact Commission could account for this, and defining the term “clinical assessment” was listed as an initial rulemaking priority at the Commission’s meeting.4 However, critics argue that a standard without a required hand skills test could put dentists in states with higher thresholds at an unfair disadvantage on the path to practicing in their state.6 The Commission also heard a presentation on other compacts’ financial arrangements at their first meeting. Tools for financing a compact include compact privilege fees, state assessments, and grants. Typically, grants fund startup costs. Privilege fees cover much of the budget once a compact is up and running, but some compacts do require states to supplement their income. Compacts referenced in the financial presentation included occupational therapy, physical therapy, psychology, counseling, speech pathology, and EMS. Their annual budgets run from $140,000 to $460,000.4 The Compact Commission’s initial meeting did pay special attention to concerns about regulatory authority. Representatives from the Council of State Governments, a group providing administrative support as DDH operationalizes, emphasized statutory limitations on the Compact Commission’s rulemaking authority. Legislation required for a state to join DDH reserves the right of states to take adverse action against a person’s compact privilege, but only a state that licensed a licensee may take adverse action against a license. States retain the right to enforce their own laws related to the practice of dentistry, and they retain the right to determine limits on the scope of practice. DDH’s rulemaking authority is limited to the promulgation of, “reasonable Rules in order to effectively and efficiently implement the purposes and provisions of the Compact.”7 In sum, states surrender a degree of authority related to who may be authorized to work in the state, allowing the Compact to make initial determinations Compact Map No Active Legislation Legislation Pending Legislation Enacted GEORGIA, Licensure Portability, and the DDH Compact Jon Hoin, GDA Health Policy Specialist 12 | Jan 2025
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