Strength in Numbers

As states faced the spreading COVID-19 pandemic in early 2020, they were met with strains on health care systems that threatened their ability to take care of communities impacted by the virus. Mobilizing health care workers was an important aspect in addressing these problems and getting help to those who needed it most. To facilitate health care worker mobility, 42 states implemented some form of temporary licensure or license waiver for out-of-state workers. The majority of these measures relate to physicians, nurses and other professions engaged in virus treatment. Many states also have implemented emergency licensure policies for equally important mental health professions and for specialties like audiology and speech-language pathology that face care delivery challenges. Since the pandemic began, The Council of State Governments has identified more than 400 occupational licensing and telehealth actions by state legislatures, governors and regulatory bodies. The CSG report, “Assessing COVID-19 Occupational Licensing Policy Actions,” reveals the significant strain on state health care workforces and highlights the inadequacy of traditional systems of licensure in confronting a national crisis. To read the report, visit: licensing.csg.org/wp-content/ uploads/2020/12/Assessing-COVID-19-Occupational-Licensing-Policy-Actions-20202.pdf Interstate occupational licensure compacts preclude this complicated patchwork of emergency orders and waivers. Compacts allow professionals who meet a uniform set of licensure requirements to practice in any member state, including via telehealth. A licensee’s good stand“[The compact] has enabled nurses to respond at short notice and avoid any delays due to licensing,” he said. “Hospitals throughout the 34 compact states have appreciated the NLC [...] because the multistate license significantly decreased the onboarding time of nurses needed to supplement nurse staffing.” “States in the compact were easier to work with,” said Dr. Henry ‘Hank’ Drummond, a senior vice president and chief clinical officer for the staffing firm Cross Country Healthcare, in a National Council of State Boards of Nursing interview. “[The executive orders] were very confusing. We would read them and say, ‘What does this really mean?’ We would get on the phone with the governor’s office and ask very pointed questions, and they would still not be able to answer them. We called the boards of nursing and asked them, and they said they were trying to get clarity too. We would reach out to the client and get the same response.” Drummond sees the pandemic as a potential motivator for the nursing profession to standardize its licensure system, creating greater resilience for the next crisis.

“If the pandemic has shown us anything, it has revealed the need for standardization across the board. [The compact] allows us to be agile, it allows us to be fluid and it allows us to be quick. If you think of it from the health care professional’s point of view, do we really need to put them through all of these steps every time they go to a new assignment?” States are getting the message. Puente said the pandemic has played a “huge role” in the introduction of NLC legislation in 13 states and territories.

ing is verified instantly through a shared licensure database. During a public health crisis, licensure compact states have a distinct advantage in confronting health care workforce challenges. Nurse Licensure Compact (NLC) administrator Jim Puente said his compact’s multistate license has supported professional mobility for thousands of nurses during the pandemic. “That this is the highest number of states to introduce an NLC bill in one legislative session in the 21-year history of the NLC is no coincidence,” he said.

Dan Logsdon, director of the CSG National Center for Interstate Compacts (NCIC), notes the NLC is not the only licensure compact attracting attention from states due to COVID-19.

“In our recent conversations with state legislators and regulators, NCIC is hearing a lot of concerns about barriers to interstate practice. The pandemic has certainly highlighted licensure compacts in general as powerful, state-driven solutions to these barriers.” In addition to the five compacts operating at the start of the pandemic (for nurses, physicians, EMS personnel, physical therapists and psychologists), new compacts for occupational therapists, professional counselors, and audiologists and speech language pathologists are under legislative consideration. Under an agreement with the Department of Defense, CSG will facilitate the development of additional licensure compacts for professions to be determined. The Pentagon identifies compacts as the most effective solution to interstate licensure challenges facing military spouses. Compacts maximize their value through maximum state participation. Until a compact has representation from all states, additional licensure recognition policies may be needed, including bilateral reciprocity agreements and universal licensure recognition laws.

Nonetheless, compacts are the most powerful tool available to states to bolster the resilience of essential workforces by removing barriers to interstate practice.

[The compact] has enabled nurses to respond at short notice and avoid any delays due to licensing. Hospitals throughout the 34 compact states have appreciated the Nurse Licensure Compact [...] because the multistate license significantly decreased the onboarding time of nurses needed to supplement nurse staffing.”

— JIM PUENTE Nurse Licensure Compact administrator

Since the pandemic began, The Council of State Governments has identified more than 400 occupational licensing and telehealth actions by state legislatures, governors and regulatory bodies.

WHAT IS AN INTERSTATE COMPACT?

Interstate compacts are agreements between states. Often, these compacts create reciprocal professional licensing practices between states while ensuring the quality and safety of services and safeguarding state sovereignty. The benefits of interstate compacts include:

Streamlined relicensing process between member States of the compact for all practitioners in the occupation

Support for military spouses of relocating active duty military personnel through provisions recognizing unique requirements of military life

Creation of streamlined pathways for interstate practice

Increased public access to care or services

Enhanced ability for member states to protect the public’s health and safety

Increased cooperation of compact member states in regulating multistate practice

LEARN MORE ABOUT OCCUPATIONAL LICENSURE:

Occupational licensure compacts create reciprocity between states while maintaining the quality and safety of services and protecting state sovereignty. Compacts result in a more efficient distribution of licensed workers by supporting practitioner mobility. The CSG National Center for Interstate Compacts leads the development of interstate compacts for physicians, nurses, emergency medical services personnel, physical therapists, psychologists, occupational therapists, licensed professional counselors and audiologists/speech-language pathologists. More than 40 states and territories have adopted at least one of the compacts and over half have adopted three or more.

The CSG report, “Assessing COVID-19 Occupational Licensing Policy Actions,” reveals the significant strain on state health care workforces and highlights the inadequacy of traditional systems of licensure in confronting a national crisis.

To read the report, visit:

licensing.csg.org/wp-content/ uploads/2020/12/Assessing-COVID-19-Occupational-Licensing-Policy-Actions-20202.pdf