A recent paper from the Healthcare Leadership Council (HLC) and Duke University’s Margolis Center for Health Policy identifies the need for regulatory reforms championed by The Council of State Governments
The Disaster Preparedness and Response Initiative, a project that convened leaders from the Healthcare Leadership Council (HLC) and Duke University’s Margolis Center for Health Policy, recently published National Dialogue for Healthcare Innovation: Framework for Private-Public Collaboration on Disaster Preparedness.
Around 1 in 3 American adults have been arrested before they reach 23 years of age and between 70 and 100 million Americans have a criminal record. Because a criminal record can include speeding tickets, it is no wonder this number is so high. However, a criminal record can still inhibit individuals from finding employment or being licensed in particular occupations. Occupational licensing regulations sometimes have a blanket prohibition on individuals with any criminal convictions, or “good moral character” clauses that allow a licensing board to deny a license for an arrest without conviction. This contributes to a large segment of the population being unable to work, even if their arrest or conviction occurred years prior to their application.
In recent years, states have worked to reduce barriers to interstate mobility for licensed professionals through interstate licensure compacts—statutorily enacted agreements among states allowing licensees to practice across state lines—and universal license recognition laws, in which a single state determines its unique process to grant a license by endorsement to a license holder from another state or territory. These policies help to solve similar problems, but there are several major differences. Notably, compacts are tailored to a particular profession and allow licensees to engage in interstate practice in all compact member states, whereas universal recognition laws attempt to account for most or all professions a state regulates, but only with regard to practice within that state’s borders. The following resource provides a summary comparison of some of the benefits states may realize from each policy.
“The Effect of Occupational Licensing Stringency on the Teacher Quality Distribution,” a recent study sponsored by the National Bureau of Economic Research, finds stricter licensing laws diminish teacher mobility but does not meaningfully affect the quality of teachers coming from other states. The study’s findings may be particularly illuminating for states with teacher shortages, where improving pathways for out-of-state teacher licensure recognition can be useful strategy to increase teacher mobility without harming public welfare.
As states seek ways to improve occupational licensure portability for out-of-state workers, “universal licensure recognition” laws have gained popularity. Since 2019, eight states have either implemented new or reworked existing license portability policies that may be defined under the universal licensure recognition model. The model generally sets less restrictive and more uniform licensure portability standards across most or all licensed occupations within the state.
As the COVID-19 pandemic began to spread quickly throughout the United States, it became readily apparent to state leaders that health care workforce capacities might be overwhelmed. Many states provisionally amended occupational licensure policies to reduce regulatory burdens and increase the capacity of hospitals. Non-health care occupations also were temporarily relieved of certain licensing requirements, especially those reliant on in-person services such as continuing education. All 50 states and Washington D.C. passed some licensure streamlining actions in 2020, typically through executive orders and administrative rule changes. These changes are analyzed in a recent policy report by The Council of State Governments (CSG) researchers: “Assessing COVID-19 Occupational Licensing Policy Actions”.
As states assess ways to improve the occupational licensure policy process, the use of “sunrise reviews” has garnered renewed interest. A sunrise review is a specific, data-informed analysis completed before proposed regulations are considered by a state legislature. The result is better information about the proposed benefits, and potential drawbacks, of the considered regulation. For occupational licensing policy, this review allows states to consider the economic and public safety effects that licensure affords. The Council of State Governments (CSG) has identified 14 states that maintain a process for occupational licensure sunrise reviews: Arizona, Colorado, Florida, Georgia, Hawaii, Idaho, Maine, Minnesota, Nebraska, Ohio, Vermont, Virginia, Washington and West Virginia.
Comparing Military Fee Waivers for Licensed Occupations
Military service members, their spouses, and veterans, are among those disproportionately impacted by occupational licensure policy. With frequent interstate relocations and a propensity for employment in licensed occupations, this population is particularly affected by licensure fees, which must be paid to keep a license active or upon each relocation to a new state.
In February, the United States Air Force released new criteria-based framework for its basing decision evaluation process that assesses state occupational licensing policies for supporting military families. The initiative by the Air Force is part of a larger trend by state policy makers and the departments of the military to facilitate interstate migration by military families and lower barriers to employment caused by occupational licensing.
The COVID-19 crisis has resulted in shortages of qualified, licensed health care and other related professions that are needed to support state and local responses.
States have been enacting measures to modify existing licensing regulations that remove barriers that may prevent an individual to assist in response efforts.
Many states have been granting temporary licensure for out-of-state professionals or those that are otherwise retired, still in training, or have lapsed licenses.
Certain health care practitioners in some states are being granted expanded scopes of practice.
Other states are removing barriers to allow for greater use of telemedicine services.
States are also waiving or suspending certain requirements related to the maintenance or attainment of licenses where they might require physical travel, interactions or might otherwise be difficult to achieve during the crisis.