Legislative Summit 2020 3 - PowerPoint Presentation

1. Legislative Summit 2020

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3. 3WHAT IS AN INTERSTATE COMPACT?Speaker: Dan LogsdonDirector, National Center for Interstate CompactsThe Council of State Governments

4. WHAT IS AN INTERSTATE COMPACT?4Simple, versatile and proven toolEffective means of cooperatively addressing common problemsAllows states to respond to national priorities with one voiceRetains collective state sovereignty over issues belonging to the states

5. Used to resolve boundary disputes.Used to manage shared natural resources.Used to create administrative agencies which have jurisdiction over a wide variety of state concerns: State transportationTaxationEnvironmental mattersRegulationEducationCorrectionsPublic safetyOccupational Licensure5Three Primary Uses

6. Constitutional Authorization/Congressional ConsentCompacts between States are authorized under Art. I, Sec. 10, Cl. 3 of the U. S. Constitution: No State shall, without the Consent of Congress . . . enter into any Agreement or Compact with another State . . .” U.S. Supreme Court holds, in effect, that “any” doesn’t mean “all” and consent isn’t required unless the compact infringes on the federal supremacy. [See U.S. Steel Corp. v. Multi-State Tax Commission, 434 U.S. 452 (1978)]6

7. Compacts Today Approximately 215 active compactsPrecedent for international participationOn average states are members of about 25 compactsPort Authority of NY & NJ (1922) signaled a new era in regulatory compacts7

8. 8COMPACTS TODAYState-by-State Interstate Compact Membership> 21 (Includes the District of Columbia)21–3031-40

9. What Is Driving Interest in Occupational Licensure Interstate Compacts?Threat of a federally mandated solution Advances in technologyIncreasingly mobile worldDistrust of federal governmentProven track record9

10. Benefits of the Interstate Compact10

11. Interstate Compacts – Key Benefits1. Effectiveness and efficiency Economies of scale2. Flexibility and autonomy compared to national policy “One size does not fit all”Dispute resolution among the statesState and federal partnership Cooperative behaviors leading to “win-win” situations11

12. Benefits of Occupational Licensure CompactsAgreement on Uniform Licensure RequirementsA data system adequate to allow electronic processing of interstate licensureDisciplinary issues related to interstate licensureFBI Fingerprint Based Criminal Background ChecksCompact governance issues:Legal status of interstate compact governing agencyRulemaking and other authority12

13. Why Health Care License Reciprocity?Mobile society (patients and practitioners)Technological advancementsDeficit/Availability of health care professionalsPractical advancement for current and future generations of practitioners Increase public access to health care servicesSupport of spouses of relocating military members13

14. Notable Medical and Licensure CompactsNurse Licensure Compact – 25 states (expired)Enhanced Nurse Licensure Compact – 34 states (25)EMS Licensure Compact – 20 states (10)Medical Licensure Compact – 29 states & 2 territories (7)Physical Therapy Compact – 28 states (10)PsyPact – 15 states (7)ASLP-IC – 5 states (10 state threshold)APRN Compact – 3 statesOT Compact – January 2021Counseling Compact – January 202114

15. STATE PARTICIPATION IN OCCUPATIONAL LICENSURE COMPACTSSince January 2016 – 142 separate pieces of legislation has been enacted42 states have joined at least 1 occupational licensure compact27 states have enacted at least 3 occupational licensure compacts 15

16. Developing An Interstate Compact 16

17. Phase IDevelopmentPhase IIEducation and EnactmentPhase IIITransition and OperationADVISORY GROUPComposed of approx. 20 state officials, stakeholders and issue expertsExamines issues, current policy, best practices and alternative structuresEstablishes recommendations as to the content of an interstate compactDRAFTING TEAMComposed of 5 to 8 state officials, stakeholders, and issue expertsCrafts compact based on recommendationsCirculates draft compact to states and stakeholder groups for commentFINAL PRODUCTDrafting team considers comments and incorporates into compactFinal product sent to advisory groupReleased to states for consideration EDUCATIONDevelop comprehensive legislative resource kitDevelop informational website with state-by-state tracking and support documentsConvene “National Briefing” to educate legislators and key state officialsSTATE SUPPORTDevelop network of “champions” Provide on-site technical support and assistanceProvide informational testimony to legislative committees STATE ENACTMENTSTrack and support state enactmentsPrepare for transition and implementation of compactProvide requested support as neededTRANSITIONEnactment threshold metState notificationInterim Executive Board appointedInterim Committee’s establishedConvene first Compact meetingInformation system development (standards, security, vendors)OPERATIONOngoing state control and governanceStaff supportAnnual assessment, if necessaryAnnual business meetingInformation system oversight (maintenance, security, training, etc.)Long-term enhancements / up-grades17INTERSTATE COMPACTS—DEVELOPMENT

18. Interstate Compact Governance 18

19. Compact CommissionForms when the threshold of jurisdictions pass compact legislationQuasi-governmental entityInstrumentality of the member statesSupra-state, sub-federal nature19

20. Interstate Compacts Typical Governance StructureThe commission is comprised of voting representatives from each member state and is responsible for key decisions with respect to the compact.The commission can form committees, including an executive committee that is responsible for making day-to-day decisions. Compact commissions are frequently granted the authority to hire staff, which is responsible for implementing the policies and procedures established by the commissionCommissions serve agencies of the member states and are tasked with acting on their behalf and not on the behalf of particular groups or organizations. 20

21. Healthcare Licensure Compacts: Common Misconceptions21

22. HealthCare Licensure Compacts: Common MisconceptionsMyth 1: Interstate compacts are a takeover of state licensing22

23. Health Care Licensure Compacts: Common MisconceptionsMyth 2: Interstate compacts are owned or controlled by an outside organization23

24. Health Care Licensure Compacts: Common MisconceptionsMyth 3: Commission rules and bylaws thwart state sovereignty24

25. Contact InformationASLP-IC website:aslpcompact.comNational Center for Interstate Compacts website:csg.org/ncicDan LogsdonDirector,CSG’s National Center for Interstate Compactsdlogsdon@csg.org25

26. Next Up: A Review of ASLP-IC’s Key ProvisionsNahale Freeland KalfasLegal Consultant, NCICGeneral Counsel, Psychology Interjurisdictional Compact (PSYPACT)26

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28. Developing the ASLP-IC?October 2017: Advisory group initial meeting November 2017 – March 2018: Advisory group work sessions April 2018: Advisory group presented a set of recommendations to the drafting team May 2018: Drafting team met for the first time June 2018 – September 2018: Drafting team work sessions October 2018: Drafting team presented a draft compact for stakeholder review October 2018 – January 2019: The project team conducted over 60 interactions with state regulatory boards, practitioners, specialty groups, and membership associations February 2019: Drafting team reconvened to review stakeholder feedback and incorporate changes into draft compact March 2019: The Audiology & Speech-Language Pathology Interstate Compact (ASLP-IC) was approved by the advisory group

29. What is the ASLP-IC?ASLP-IC is an occupational licensure compact that: Allows licensed audiologists and speech-language pathologists to practice face to face or through telehealth across state lines without having to become licensed in additional ASLP-IC states – licensees receive a privilege to practice which is equivalent to a license.Increases access to audiology and SLP services for populations currently underserved or geographically isolated.Increases continuity of care for clients who relocate or travel.Allows military personnel and spouses to more easily maintain their profession when relocating.

30. How Does the ASLP-IC Work?ASLP-IC becomes operational when 10 states enact the legislation for the compact.It is similar in form and function to occupational licensure compacts for nursing, psychology, medicine, physical therapy and emergency medical services.ASLP-IC states communicate and exchange information including verification of licensure and disciplinary sanctions – promoting cooperation and a higher degree of consumer protection between states.States still retain the ability to regulate practice in their states.The rules of the ASLP-IC are only applicable to states that enact ASLP-IC.A state can withdraw from ASLP-IC by repealing the ASLP-IC Legislation.

31. What Must States do? States must meet the same requirements for licensure to join the compact. Audiologists – Doctoral degree (Masters before 12/31/07); supervised clinical practicum; passage of national examSLPs – Masters degree; supervised clinical practicum; passage of national exam; clinical fellowshipStates must have or adopt an FBI finger-print based criminal background check system.States must allow for the practice of telehealth for privilege holders* Missouri, Nevada & North Dakota are currently ineligible as they do not require a clinical fellowship for licensure.

32. How Does a Compact Privilege Work?Audiologists and SLPs must be licensed in their home state apply to apply for a privilege to practice in another ASLP-IC. No forum shopping.Applicants must have an active unencumbered license; have not been convicted or found guilty of felony related to practice within 2 years; have a valid Social Security number or NPI numberThe privilege to practice is equivalent to a license issued by the remote state.The privilege to practice renews at the same time as the home state license.Continuing education is based on your home state license, unless it relates to scope of practice.Active duty military personnel, or their spouse, may designate a home state where the individual has a current license in good standing. The individual may retain the home state designation during the period the service member is on active duty.

33. How Will it Affect School Based Members?If an ASLP-IC participating state does not require a separate license or certification to work in a school, an individual who works in a school may obtain a privilege to practice under the ASLP-IC. That individual may work in a school in another participating state only if that state does not require a separate license or certification to do so. Home State RequirementRemote State RequirementPrivilege to Practice?One LicenseOne LicensePrivilege to PracticeOne LicenseDOE License/CertificationDOE License/CertificationDOE License/CertificationDOE License/CertificationDOE License/CertificationDOE License/CertificationOne LicensePrivilege to Practice

34. How Will it Affect Dispensing Audiologists?If an ASLP-IC participating state does not require a separate license or certification to dispense hearing aids, a dispensing audiologist may obtain a privilege to practice under the ASLP-IC. That individual may dispense hearing aids in another participating state only if that state does not require a separate license to do so. Home State RequirementRemote State RequirementPrivilege to Practice?One LicenseOne LicensePrivilege to PracticeOne LicenseHAD LicenseHAD LicenseHAD LicenseHAD LicenseHAD LicenseHAD LicenseOne LicensePrivilege to Practice

35. How are Adverse Actions Handled?ASLP-IC states communicate and exchange information including verification of licensure and disciplinary sanctions.The home state may take adverse actions against an audiologist or SLP license. A remote state may take adverse action on an audiologist or SLP privilege to practice within that remote state. If the home state does take adverse action and audiologist SLP license is terminated and the privilege to practice in all remote states is revoked. If a privilege to practice is revoked because of an adverse action, every other state where a privilege to practice is held and where the home state license is held will determine if the privilege or license in that state is also revoked.

36. How is it Administered?A Compact Commission is created once the 10th state enacts the compact legislation. It is the governing body of ASLP-IC and is responsible for its oversight and the creation of its Rules and Bylaws.Consists of two voting delegates (one audiologist and one speech-language pathologist) appointed by each compact state who shall serve as that state’s commissioner. The delegates are appointed by each states regulatory Board or agency. An additional five (5) delegates, who are either a public member or board administrator from a state licensing board, shall be chosen by the Executive Committee from a pool of nominees provided by the Commission at Large. Each commissioner is granted (1) vote Executive Committee is made up of seven voting members and 3 non-voting ex-officios.

37. ASLP-IC: A Summary of Key ProvisionsNahale will now lead a review of a summary of the key provisions of each section of ASLP-IC.

38. Questions?

39. The Military Spouse PerspectiveSpeaker:Lesley Edwards-Gaither, PhD, CCP-SLP Practitioner & Military Spouse

40. Lesley Edwards-Gaither, PhD, CCC-SLPLegaitherSLP@gmail.com

41. Location. Location. Location.Lesley Edwards-Gaither, PhD, CCC-SLPLegaitherSLP@gmail.com

42. AssignmentState LicenseRenewal CycleContinuing EdDate$$$$$$$$$$$Wright Patterson, OHOhioIndiana2 years2 years20 hours36 hoursDecember 31 even yearDecember 31$120$150Ellsworth AFB, SDSouth Dakota Ohio3 years2 years30 hours20 hoursOriginal licensure dateDecember 31 even year$250$120Wilford Hall Med Center, TXTexasOhio2 years2 years20 hours20 hoursBirth monthDecember 31 even year$150$120Ramstein AFB, GermanyTexas2 years20 hoursBirth month$150Wright Patterson, OHOhio2 years20 hoursDecember 31 even year$120Nellis AFB, NVNevada TexasCalifornia1 year2 years2 years15 hours20 hours24 hoursDecember 31Birth monthLast day of birthday month$250$150$110Maxwell AFB, ALAlabamaFlorida1 year2 years12 hours30 hoursDecember 31December 31 of odd year$100$200National Capital RegionDC/MD/VAVirginia California Florida2 years2 years2 years30 hours24 hours30 hoursDecember 31Last day of birthday monthDecember 31 of odd year $135$110$200Air Force Academy, COColoradoCalifornia1 year2 years10 hours30 hoursNovember 30Last day of birthday month$145$110Lesley Edwards-Gaither, PhD, CCC-SLPLegaitherSLP@gmail.com

43. Multi-State Practitioners and ASLP-ICSpeaker:Dr. Tracey Ambrose, AuD, CCC-ALead Clinical AudiologistChildren’s National Hospital

44. Benefits of Licensure Compacts for Practitioners and Military FamiliesSpeaker:Marcus J. BeauregardDirector, Defense-State Liaison OfficeU.S. Dept. of Defense

45. Enacting ASLP-IC:WyomingSpeaker:Sen. Stephan PappasWyoming State Senate

46. Enacting ASLP-IC:West VirginiaSpeaker:Vickie Pullins, MA, CCC-SLPSecretary, WV Board of Speech-Language Pathology and Audiology

47. Enacting ASLP-IC: NebraskaSpeaker:Sen. Carol BloodNebraska Legislature

48. QUESTIONS?Contact Info:ASLP-IC website:aslpcompact.comNational Center for Interstate Compacts website:csg.org/ncicDan LogsdonDirector, National Center for Interstate Compactsdlogsdon@csg.org