Senate Standing Committee on Business, Professions and Economic Development

We're going to go ahead and start the meeting. Let me just first say welcome to my first gavel down for BMP. And I'm happy to be here. And I've had a chance over the last few days to get to know the staff. Really excited to get to work with this team and all of you today and moving forward. So. So be patient with me here. We'll work our way through it all right together.

Today's hearing for the Senate Committee on Business, Professions and economic Development will come to order. And I want to just let everybody know that the issues surrounding our occupational licensing system impact so many hardworking people. That's why Senator Roth, previous chair, decided that this would be an important hearing to have. And I agree with him. Happy to be here today to see it through.

It's critical that we focus on the barriers to employment that may exist today as a result of the steps that we require folks to take just to do their job in the State of California. We want to make sure that we all have the experience, increase opportunities that our connected systems provide for patients and for the public, for all that we serve in every industry.

Today's hearing will look at some of those things where there may be settings and services that licensure, portability helps fill gaps, how we're going to address that, how a compact might address that as we talk today about pathways to employment with a focus on what the interstate license or compact model means from a variety of perspectives, I do want to thank our panelists today.

We'll be quick and try to get through everybody, but we also want to be thorough, want to make sure we have good information and that at the end of this hearing, as we look to the legislation that we'll address later this year, that this hearing helps us to have better foundational information as we look to make decisions in this area of law for the State of California, and better serve as many people as possible.

Before we start with our first panel, because it's so unusual to have a switch like this right before a hearing, I just would like to give Senator Roth the opportunity to make some comments and some introductory comments about how we got here. Senator Roth.

Well, thank you, Madam Chair. I'm just delighted to be allowed to participate. And thank you for giving me the opportunity.

Okay. All right. Well, thank you very much for being here. And I would like to say to you, Senator Roth, that I think that this was a good call. This was a good call because this body is going to be asked to make decisions in this area, and it's good to have the information that helps inform those decisions. And thanks to my colleagues who all made time to come for the hearing today. I appreciate you. All right, ready to start? Yeah. Okay.

All right, we're going to hear from our first speaker, who's going to be with us on Zoom. His name is Dan Logdton. He's the Director of the National Center for Interstate Compacts with the Council of State Government's Center of Innovation, not from California. So appearing electronically with us here. Mr. Logsdon, thank you for being here.

Thank you, chair Ashby. And thanks to the Members of the Committee for having me today. I'm Dan Logsdon. I'm Director of the National Center for Interstate Compacts at the Council of State Governments. CSG is a nonpartisan membership organization of states. We're composed of all 50 states, DC, and the five us territories, and serve all three branches of government. The National Center for Interstate Compacts was founded in 2004. We serve as a technical assistance resource for states as they're considering compacts.

We provide education, development and Administration services. We work with professional membership associations, legislators, regulators, administrators, and then most of our work right now is focused on occupational licensure compacts. We have a cooperative agreement with the Department of Defense to develop licensure compacts, and we've had that since 2020. So just briefly, interstate compacts generally, these are legislatively enacted agreements between or among states. There's bilateral, regional and national compacts. They're a way for states to cooperatively address shared problems. These are very powerful, versatile, proven tools.

Compacts have been around. They predate the founding of the republic. There was compacts clause in the articles of confederation, certainly in the US Constitution, and they're applicable across multiple policy areas. And again, most of the work with Compax right now, although not all of it exclusively, is in the occupational licensure space. And the reason for that is, in recent years, states have wanted to respond to licensure issues and portability issues. They want to reduce the social cost of licensure.

They want to, at the same time, safeguard health and safety, improve portability, and most importantly, preserve state sovereignty, state authority over the practice in their state, and their ability to license professionals to the standards that they set. There's also been a lot of interest in the Federal Government, a lot of scrutiny about how states are licensing. So again, these licensure compacts are an outgrowth of that. The way that we work to facilitate the creation of these licensure compacts is it's a collaborative, transparent process.

They establish uniform standards, but those are based off the standards and uniform standards in the states. I'll talk later about what professions maybe are better suited for interstate compacts. They do create a license system that's used for both discipline and then to get people into the states under certain models to practice in those remote compact Member states. And all modern compacts have an interstate Commission, and these commissions are just there to implement and administer the compacts.

They can't dictate policy to the Member states, they can't prohibit a certain kind of service or procedure. They can't require states to authorize a certain kind of service or procedures. They're really hemmed in by the four corners of the agreement. There are currently 16 occupational licensure compacts out to the states for consideration. The oldest one of them, the most mature, nursing and medicine, the psychology compact, Scipac. Each of those have 40 or more states. I'll spare you the entire list.

We're currently working on a compact for respiratory therapy as part of our DOB cooperative agreement. In form and function, they're all the same, but they're also situated differently and work a little differently. You've got the mutual recognition compacts, which is the vast majority of them, every one of them, besides the nursing compact, that operates off of your home state or qualifying state license being recognized to get you into all the other compact Member states through a mechanism.

So the nursing compact works just like your driver's license, as does cosmetology and the social work compact. You get a multi state license from your home state board, and that allows you to work in the other compact Member states. The PT compact was the first compact to do the same thing. But the boards were very concerned about authority. They were very concerned about, frankly, revenue loss, potentially from the compact mechanism.

Although the nursing compact boards will tell you that the impact of their financial viability has been De minimis. But still, it's one thing to hear that, and it's another thing to potentially live it. So they created a privilege to practice model, so essentially works the same, but you're getting a compact privilege to work in the states that you want to work in, that are compact Member states. So just a little bit of a variation there. Then you've got an expedited licensure model.

That's the interstate medical licensure compact. And then Scipac is also a mutual recognition compact, but it's exclusively for telepsychology. Since 2016, states have responded by enacting a number of these. There's over 300 separate pieces of licensure compact legislation that's been enacted by the states, and 26 states have adopted seven or more of these licensure compacts. These are simply a means to provide another pathway for licensed professional to practice in other compact Member states. They don't eliminate or curtail other portability pathways.

The biggest benefit for practitioners is the amount of time required to be able to work in other compact Member states as opposed to other pathways. Another benefit for practitioners is the regulatory certainty, the uniformity of the process. Whereas other pathways, particularly like a ULR or licensure recognition based on expedited licensure, based on endorsement from another state, all states are going to handle that differently. Even some boards in the same state might handle that differently.

Other benefits for practitioners, it reduces the effort needed to maintain individual licenses. So your one home state or qualifying state license allows you to practice in other compact Member states. So obviously you don't need to retain multiple licenses. It does improve portability and it allows practitioners to leverage telehealth. All these licensure compacts allow for telehealth. The benefits for licensing boards is again, states retain control over their scope.

Compacts facilitate the exchange of licensure data and disciplinary data through the compact data system, and they approve cooperation among state boards, especially with regard to public protection, and then for patients or clients, it increases access to care, especially through telehealth. It improves continuity of care, promotes practitioner diversity, expands the pool of practitioners that are available, and it increases the access to specialists. Now, I mentioned our work with the Department of Defense.

I know that there's been a new federal law that was passed last year around military spouse licensure. We're concerned that it's really not going to alleviate the issues for military spouses. We've communicated that this language appeared in the National Defense Authorization Act a couple of times before it was enacted. It was promoted by Senator Mike Lee of Utah, and we expressed our concerns there. States have done a good job responding to the needs of military spouses in licensed professions.

Every state has something on the books to help military spouses in licensed professions. The issue for military spouses is they're all different, right? Every state's got a little bit different regime on how they approach that. The federal legislation certainly tries to remedy that. But again, we believe that it's going to be implemented inconsistently, and we're already kind of seeing that across the states. And so military spouses are again going to be back to navigating sort of different approaches.

In our experience, military spouses carry multiple state licenses. So to get proof of licensure, and licensure in good standing from all those states could potentially be burdensome. There's the CE requirement. How's that going to be handled? Are some states going to let you go ahead and practice? Are they going to make you fulfill those before you can practice or work in your profession?

The notion around using your license in the previous two years, there's really no way yet on how to, and I think states are going to take it a different approach on how to address that. And then this notion around similar scope that again, is going to have different variations in every state. But again, understand, Congress wanted to take action to try to alleviate this issue with concerns military spouses and issues that they run into.

But again, I think states were doing a good job of approaching that. So all these licensure compacts, again, have robust provisions around protecting the public. So you're really taking what the states do individually and they're sharing their sovereignty over the breadth of the compact. Member states, there's provisions around cooperating on investigations, sharing information on investigations. Through the compact data system, you can more readily track practitioners if you need to.

You can inform Member states about practitioners that may be under investigation or had a case adjudicated against them. So from that standpoint, it really raises the ability of boards to not only communicate, meet out discipline is not impacted at all, and they share information around that so that, again, you don't have rogue practitioners potentially drifting from state to state and trying to evade disciplinary measures. And lastly, just we get this question a lot. It's like, well, there are 17 licensure compacts.

What professions maybe aren't suited for these? And what we see as barriers is if there's no lack of uniformity in licensure requirements from state to state, that makes it virtually impossible to do one of these licensure compacts. There can be variations, but if there's broad differences, that becomes a problem. Same thing with scope. If scope of practice varies widely from state to state, a profession is not a good candidate.

The size of the profession also, and then the ability of the profession to support the compact financially as it gets stood up for its Commission. So again, I'll be available for questions. Thank you for allowing me to testify today, and I'll turn it back over to you. Chair Ashley Great.

Well, first of all, thank you for being here with us. And I know my colleagues probably have some comments. I actually have a couple of questions just to kick us off and get us started, if you don't mind, Mr. Logsdon. So first of all, the first thing that I hear you saying in relation to the compacts is there's no doubt that states, including California, would cede quite a bit of their authority by entering into one of these compacts.

And it doesn't seem like there's a lot of room for negotiation. You sort of take it as is the language that is existing. You accept that when you enter into the contract, as you mentioned, very legal term within the four corners of the document. And so how have other states dealt with compact provisions that are contrary to state priorities? California has quite a few priorities that may not line up with other states.

So what are the suggestions you have for addressing those kinds of policies and procedures, those priorities that are incredibly important to the State of California? I'm not sure I understand the route for implementing the kind of change Californians seek to change absent being a Member of the compact governance table team. Can you address that?

I'll try. So again, all these licensure compacts allow the states to retain the control of the practice within their borders. And certainly the licensure process and disciplinary issues understand that states have varying requirements around licensure. What we've seen in other states is that while, yes, they're invested in these, they believe that the benefits of the compact outweigh those potential roadblocks for joining.

So the access to care issues, diversity of practitioners for their citizens, the portability, the ability to bring practitioner in, but also the ability of their practitioners to practice in other states and maybe enhance their economic prospects. So yes, there is that tension there. But again, we've seen over 300 separate pieces of licensed compact legislation be enacted in the states. We've not seen that to be a barrier that can't be overcome, again, because of the benefits that the compacts provide.

Okay, a couple more for me, these brief ones. So we've heard a lot about interstate licensing compacts allowing certain populations to, as Southwest Airlines would say, move freely about the country without having to be burdened with professional regulation requirements in every state, which I understand is the obvious key here. But are the licenses intended to practice in another Member state temporary, or how long does it make sense for someone to practice in California through a compact?

Well, in terms of a compact privilege or multi state license, they're authorized through the pendency of the licensing period. So if I have a multi state license from here in, know it's good till its expiration period, and then I would obviously have to renew my license. They're not in the same with a compact privilege, it's on either home state license or qualifying state license, you could practice full time in another compact, Member state, based on a compact privilege or a multistate license.

There's not any sort of temporary practice associated with that except for the psychology compact. Again, it's a telehealth compact, but it does have emergency provisions for 30 day practice in a state, in a Member state, if a client's in crisis or they're needed to consult.

Just expanding on that a little bit, you mentioned these working a little bit like a driver's license, which in California we handle quite differently than the rest of the country. So ultimately, someone who lives in California gets their license here and is subject to whatever rules and standards we've put in place. Why would people be allowed to be here, identify and indefinitely on this pathway? And how does that process, the compact, support the existing licensees that we have here in California?

Yeah, we use the driver's license example on a high level. It didn't mean for it to be so. For instance, if I reside in Kentucky and I'm practicing in to, I can't establish residency there. I can't essentially move to California and then practice on the license that I have in Kentucky. All the compacts have provisions that if you have a change of residence, that homestate license is based on your primary State of residence, you're required to change your State of residence.

And that's where the Member boards would work together to ensure that where you're reporting that you reside, you actually reside there. So it's not an instance where you can get a license in one state and say, that's my home state, and then practice in any other state, actually live there full time. The home state requirement is meant to address those types of issues.

Most of the practice is temporary, but again, the compact isn't limited to a certain number of days in the state, know, certain months of the year or anything like that. It's not curtailed in that matter.

Okay. I'd like to open it up to my colleagues here who have questions. Senator Roth?

Well, just to tag on to that, residency is a legal term, and it implicates taxation, authority, and a whole variety of things. So these compacts really operate to deal with folks who move from state to state on a sort of a temporary basis and perform services. Is that not correct, Mr. Roger?

Yes, that's correct.

Okay. Madam Chair, do I have time to ask a few more?

I'll let other people go ahead.

We were provided with a model agreement, one of your model agreements. And the one thing that I was immediately taken by is the phrase on the COVID no substantive changes should be made to the model language. And of course, there's another provision that requires, as you referenced, that the compact be adopted by a state Legislature, in total, all of the terms, presumably without a lot of legal review and certainly without any opportunity to negotiate.

So my initial question is, conceptually, why was a decision made to require the adoption of these actual compacts by the state Legislature, as opposed to allowing the state Legislature to authorize administrations or agencies to enter into and negotiate compacts with the entities that are proposing them? It's sort of a take it or leave it Proposition, as I take it.

Yes, these are contracts, and each state has to agree in the same way that individuals enter into contracts or business enter into contracts. The terms have to be the same. One state can't have a different term than the other state, and that's just the nature of these agreements. I know we say no substantive changes on the COVID but we encourage states to, and they do do legal review, ask us questions, talk with us.

Our expectation isn't that states are going to copy and paste the language into a Bill and move on. We are there to have those types of conversations. In fact, there's language in the compact that since I've been here, we always include in the compact, and these are very powerful tools. They do supersede conflicting state law. Now we're talking about occupational licensure here and promoting portability. So that's a very area where that could happen.

But still, we want to be upfront with states about exactly what they're getting into. I think that it's really just sort of a time and expense issue. We include states. That's why the American Counseling Association or the Federation of State Medical Boards work with us is because we pull in state officials. These things aren't written in a back room somewhere with a membership Association or board federation, and then we take it out to the states.

We have a robust stakeholder review process that's months long to get that feedback that's expected, because, like you said, once you get to the legislative part, they can't be changed substantive.

Well, then that leads to a companion question. When I looked at the model agreement, I think it's on page 23 of this particular one in the section called withdrawal. I note that in order to withdraw from a compact once it's been adopted, the state Legislature of a Member state must introduce and pass a Bill in order to withdraw from the compact.

Now, those of us in this process know how difficult it is to put a Bill forward to get it through committees and get it passed in both houses and get it to the Governor and hopefully get it signed. I'm just wondering what the rationale was for on the back end, requiring the Legislature to propose and pass a Bill in order to withdraw from the compact as opposed to authorizing administrative action at that point.

Yes, Senator, that's the unique nature of interstate compacts. I'm not an attorney. I can get you a memo if you want a more detailed explanation of that. But you have to withdraw from a compact in the same way manner that you have to enter a compact. And the reason for that is, again, these are contracts. They're binding upon the Member states.

And so, yes, those withdrawal provisions are something that, it's not language that we prefer or the groups that we're working with prefer and want to put it in there in an effort to forestall people from even groups or states from even thinking about withdrawing. They'll speak to the unique nature of these constitutional making in terms of the.

Why for the compact. We've spent a lot of time in this Committee and my colleagues particularly talking about occupational licensing as a barrier to employment. So we're well aware of that. And, of course, California, we seem to license everything. But we have over time, been talking about license portability, and I recognize that there are various ways to get there. A license by endorsement reciprocity, which in the law business we sometimes see, but not out here, expedited and temporary licensure.

And, of course, these interstate compacts, we here seem to have been moving, at least in the past few years, toward temporary and expedited licensure, whether it's for nurses or teachers or others.

And so since we have this expedited and temporary licensure movement here to try to encourage folks who move here to become licensed quickly and get to work, and given the fact that the Congress on the federal side has, and I've read the law, I think I disagree a little bit with you, but pretty much eliminated, if not totally eliminated, the issue with military spouses by this amendment to the service Members Civil Relief act.

What is the rationale for the adoption of a compact in California, whether it's cosmetologist or somebody else? If we can license them in two to three days or even a week, and if the license fee is $50 or $100 or $200, so it's quick and it's fairly inexpensive. What is the rationale at this point, not 10 years ago, but at this point, for California to consider the adoption of a compact, for example.

Yeah. Senator, I think I'm not familiar with California's reciprocity statutes or license by endorsement, but what we've seen in other states is, yes, once a practitioner provides everything that the board needs, it moves quickly, but they spend weeks, if not months, pulling that information together. So what we've seen in other states is it's not faster and it's not a lot of times a speedy process. And then I think there's a two way nature of a compact.

With a compact, not only is California able know, pull practitioners in, but Californians have the ability to practice in other states if they, you know, they're able to grow their economic opportunities in the same way that other states. We run into this with ULR laws. We've had states say to us, and look, we're here to talk about the benefits of compacts. Certainly the National Center for Interstate Compacts believe in compacts.

But as our CEO says, our Executive Director, we don't tell states what to do, but we believe in these mechanisms. We've passed the UlR law. We've solved this issue. You've certainly aided portability, you've enhanced portability, but your citizens don't receive those same benefits because we don't see those provisions out in other states. And if they are, they all work differently. They all have different requirements, typically. And so that two way nature of a compact, I think, is important as well.

And then I just disagree about that federal law. I think from a practical standpoint, ultimately it's not going to benefit military spouses.

I hope I'm wrong, but in our correspondence with Senator Lee of Utah, when he tried to insert this into the National Defense Authorization Act a couple of times, it was almost as if they didn't have any idea that states were doing this work, that states were trying to help military spouses, and that this sort of overarching federal know, from a practical standpoint, it's very problematic, I think, for boards to implement. Maybe not in California, but I think other states are going to struggle.

Well, Madam Chair may continue.

Go ahead, General.

No, no. I just pulled the law and it says in any case in which a service Member or spouse of a service Member has a covered license and they relocate residency because of, I'm paraphrasing, military orders for military service outside of the jurisdiction where the license is issued, the covered license shall be considered valid at a similar scope of practice and in the discipline applied for.

So in other words, if they move and they're licensed in one state, they're licensed in that state's good in the next state. Now there are some conditions. Obviously, it has to be in good standing and this and that. Now, in fairness to those of you who do compacts, it does say that if the service Member is licensed in a state that has an interstate licensed compact, of course, this particular amendment to the service Members Civil Relief act doesn't apply.

So if you're in a compact state, you can move from compact to compact state and not be covered. But it seems to me that's pretty definitive. I don't know. May I ask a couple of questions about the compact minimum chair? I'm willing to defer to my colleagues. I just got a question.

Do you want me to let a couple other.

Yes, I certainly do come back to.

You, but please do keep your questions because I think that's really important line Senator Archuleta and then Senator Smallwood.

Quava good, thank you for your information and piggybacking on what the General is talking about. Let's walk me through this, because it sounded like you were not in agreement, obviously, with the federal side. I'm excited because of the fact that you take a military personnel, Fort Bragg, North Carolina, and he gets shipped over here, lockstock and Barrow, to California, and his spouse or her spouse will only be here for a year, maybe three, tops, because that's the duration of a movement.

I'm concerned about the time for the family to start making some money and surviving when they get to the higher cost of living here in California. And it's imperative we get them working quickly. But what roadblocks do you see here in California when that movement is made and when you kind of disagree with the federal movement, what do you see here in California that would hinder a smooth transition into the employment cycle with some of these professionals?

Yes. Well, again, I'm not familiar with how California is going to implement this or has implemented this. What we do see in other states is there, and I think just generally with some of the things that you mentioned, the provisions that the spouse has to provide. So I have to get a letter. Military spouses are typically licensed in multiple states.

So from each of those states, they're going to have to get a letter saying that they're in good standing and how to prove that you've been practicing in the previous two years. Again, California may have a very expedited way, a very good way of doing that. I don't expect every state to. So they're going to run into that challenge like, well, it was different in California than it is here the requirement to complete the continuing ed in the state where you're moving.

Do I have to do that before? Do I have to do it after? And that's in addition to the multiple licenses that I currently hold, because, again, getting an occupational license, it gets played almost impossible. It's not. But once you have it, you don't want to relinquish it. So we see military spouses that carry license, eight to 10 licenses, and now they've got another continuing education requirement on top of that. So again, I don't think that it's going to solve the problems in the way that it's laid out to.

Thank you, Madam Chair.

Thank you, Senator Archuleta. Senator Smallwood-Cuevas.

Thank you, Madam Chair. And I really appreciating the discussion. I guess I am always reminded when our Governor says that California has no peers. And so this conversation is an interesting one, given the scale of our economy and the education and skill set of our amazing and productivity of our amazing California workforce. And I think this Committee has done a lot to ensure that we are doing all that we can to expedite the licensure process and particularly focusing on those industries where we have significant.

Guess you know, you're in Kentucky. So I'm trying to also think about these other states and how you talked, know, how workers from Kentucky living in Kentucky and coming into California to work and taking resources back to Kentucky. I'm curious, how do we ensure that Californians, particularly those that have gone through the process of being licensed, who've gone through the requirements that the state Legislature and the voters of California want to see put forth?

How do we ensure that our workers are not pushed out by these out of state workers who are coming in from places like Kentucky through this interstate compact. And I'm particularly concerned about some of the lower and moderate waged occupations. It seems like you track on these trends. I'm curious what that's showing in terms of the impact of existing workforce who have gone through all of the necessary steps here in the state to do similar work?

Yeah. Thank you. The only study that we have is from the interstate medical licensure compact, and we can certainly share that with the Committee. Anecdotally, we don't see that in other states with other professions. What we see is more of supply side impact. The more counselors, the more social workers, the more psychologists, the more occupational therapists that are available, the more those services are taken up.

I don't think any state can meet the needs of every patient for mental health care and the ability of these practitioners to spread their reach. What we've seen is it's not something that's going to drive residents out of the marketplace. It's actually going to create greater opportunity for people to get care. But again, what we can share, these things are relatively new, but more data is becoming available every year.

And like I said, I think it was San Jose state that did a study for the interstate Medical Licensure compact. We can get that with you, to you and share it with the Committee.

Yeah, I would love to see that. And particularly what the impact is in terms of fiscal impact to the state. As workers who live and buy property pay sales tax, there's a ripple effect in terms of an economy where workers are being trained, certified, licensed, and then working in that state. I'm also curious, just like what the economic impacts are when the workforce obviously does the work, provide the service, but then takes those resources back to their home state from the State of California.

So I'd be curious to know more about that, if there is some data on that. My other question that I had, and I think you mentioned, you talked about the registered nurses and the cost of these compacts to different boards and associations. You mentioned that there was some negative impact. Could you expand on that and say a little more?

Well, what we're seeing right now is that the responsibility for standing up an interstate Commission isn't being borne by the states. It's being borne by the organizations that spearheaded the effort to create the compact. So there's only two compacts that currently assess their Member states. The nursing compact, I think, assesses Member states 6000 a year. SCIPAC has a sliding scale based on the number of privileges they issue per state. That's not to say they won't ever start assessing states.

And I think that if states are seeing benefits from these compacts, and I believe they will, I believe they'd be interested in supporting the compacts in some way. But right now what you're seeing is a coalition of groups in the profession, a credentialing organization, a membership Association, a board Association coming together and helping Fund the operations so that burden isn't falling on the states. And again, I want to be clear. I'm not saying it never will, but currently that's not happening.

Boards in Member states, I'm not going to also say that they're not going to have any cost interfacing with the data system or providing that data. In most states, there's no physical notes.

In some states there are, but we acknowledge that there may be a cost to that, but what we've also seen, again, anecdotally, is that not processing licenses frees up staff to do more sort of public protection type of activities or more activities around what the board's true mission is, which is to protect the public from a financial standpoint. That's what I've got.

All the licensure compacts, again, that are operating seek to keep fees as Low as possible, but again, they have to go away into funding their operations. PT, for example, ask states to keep the fee at $45. Some do, some don't, some don't charge anything. But the benefits of this, I think that practitioners are seeing they're willing to pay that fee in order to have the ability to have multi state practice in a manner that compact provides.

Your response brought one other question to mine. So you're saying the oversight and monitoring and enforcement of, let's say, the malpractice of individuals on an interstate compact, that responsibility falls on the state? Or does that responsibility, should there be any sort of negligence or question of that individual's licensing and the type of care or service that they're providing? Does the compact ensure the safety of the individual that's working in a state, or is that on the state. To Cover those costs as well?

So if I'm a practitioner, regardless of the state I am, I'm responsible for my malpractice insurance or my liability insurance. I mean, it really is akin to the licensure process. If I'm working in California, I'm under the jurisdiction of California. I have to abide by California scope. I'm subject to their disciplinary rules. So from that standpoint, California does have control. But as far as the cost for malpractice or liability insurance, that would be on the practitioner, again, that's the same thing that you get with.

That's the same process you'd have with the license and.

Thank you, Senator Smallwood-Cuevas. I'm just going to make one comment, less of a question, and then I'm going to hand it back to Senator Roth to finish us out with this panel. But I think that Senator Smallwood-Cuevas asked the, I'll say, 40 million person question because that's what we collectively represent.

It doesn't sound like there are a lot of comprehensive studies to address the question that she asked, and legal review and questions which are encouraged upon entering into the compact is very different than being able to effectuate or change the terms. Those are very different legal processes, and California has strong procedures in place, and that may be the understatement of a lifetime, that are intended to impact outcomes.

We start with an outcome in mind, for example, diversity or equity or working conditions, and then we set policies and procedures in place to try to effectuate those outcomes. I worry about a compact with other states that, as Senator Smallwood-Cuevas has very eloquently already stated, potentially don't hold the same value set as the State of California, as our Governor says, has no peers, right?

How we enter into a compact beyond a temporary piece, which, as Senator Archuleta stated, could be really helpful for the stated group of military spouses. However, I think you'll hear in a moment from Senator Roth, it's not really necessary for this compact in order for those military spouses, under the new federal law, to be able to have those same outcomes. So that's my concern. And I just add it on top here and hand this back to Senator Roth to finish us out with this panel.

Well, Chair, can I indulge you to respond to some of that?

Sure you can.

Okay. I hear what you're saying, and we're not trying to dispute that. The compact is merely a means to get access to a state. The way California regulates a profession, its scope of practice, its requirements for different tiers of the profession would all remain in place. So, you know, California not having a peer would apply to me as a practitioner coming into California. I don't get to bring my practice act from another state in there.

We're not creating some sort of special class of practitioners that gets to flaunt the rules in every state because their state allows this or doesn't allow that. So I just wanted to be clear that by joining the compact, you're essentially allowing people to come in your state via the compact instead of through licensure or some other agreement. You're not relinquishing control of the practice within your borders.

In the State of California, we go a lot farther than just the actual practice itself. There is a lot that happens around recruitment, what we do with our community colleges, what we do out in our neighborhoods with our own workforce development partners.

And so I think what we're trying to get you to understand is this would be a shortcut to that step, which gives us pause and concern, because we've spent many years and millions of dollars on trying to create avenues for people across our state to find their way to middle class employment through the types of programs that we license and regulate in the State of California. That's really at the root of my question. Senator Roth?

Oh, thank you, Madam Chair. I'll try to make this quick. In terms of these compacts, generally, in the ones I've looked at, I didn't see any specific requirements, for example, for certain educational or professional requirements or school accreditations or anything like that. Can a member state specify certain accreditation requirements for entry into the state to practice, or is that limited by the terms of the compact? And if the compact is silence?

Yes, Senator, if you're not seeing those in a compact, that's because of the uniformity among the states around those provisions. So there was no need for us to include specific provisions around that for a practitioner in need. That's not true of all of them. But in some of them, there's no need to essentially recreate the will. We want to build these documents broadly enough that they can stay evergreen through Commission rules and not build them so narrow that within five years they're worthless.

You can't build them so broadly, though, that states are going to have discomfort about joining them because of the rules process. So again, you may not see specific requirements on the practitioner side that may be on what a state has to do to qualify to join. But again, that's very likely the result of the uniformity for that profession among the states.

Good. And then I assume that a member state, not the home state, but a member state, some state that is taking licensees in under a compact, that the member state can charge fees to the licensee coming into the state to cover the cost of enforcement.

Okay. That would necessarily depend on the model. So if it's a multistate license model, you can certainly charge a higher fee for the multistate license. But a practitioner coming into your state on a multistate license, you wouldn't have a means to charge them. Again, the boards that operate that way say that it's not impacted them negatively from a financial standpoint, and certainly get you more information on that if you'd like it. But with a compact privilege model? Yes. Those compacts empower the states. They can charge a fee for that compact privilege? Yes.

I'm not sure I understand difference. So, why have a home state- I've got whoever you want to call it, a licensee from the State of Georgia and that's the home state. And they're coming to California and they're going to practice on that multi, and they are part of the multi-state license process and they want to come into California and work with their multi-state license here.

Yes.

I assume California has the right, and in some cases the obligation from a public safety standpoint to enforce practice rules in the state, right?

Yes.

And that the State of California can revoke the multi-state licensees privilege to work in the State of California?

Yes.

And all that carries a cost. So can California assess a fee to the person coming into California under a multi-state compact to cover the costs of monitoring, enforcement and disciplinary action inside the state borders?

Certainly it can be reimbursed for the cost of an investigation from the practitioner if the state currently allows that and most states do. I don't know about California.

But I mean, we have a mechanism here in California to conduct disciplinary proceedings and conduct and impose license revocations and it's a state process and unfortunately for those who are licensed here, it's not cheap.

Right. And if you can recover those costs from a practitioner, you can recover those from someone practicing in California under the compound.

But generally speaking, we would not be able to charge the licensee driving across the border, the state line rather, a fee to practice in the state under a multi-license compact.

No. If you're in that compact, though, you'll have practitioners purchasing or getting multi state licenses, and that would be how you would recover your cost, or go toward recovering your costs.

I'll try to speed it up. So with respect to the Commission and the way the Commission is organized, I've looked at a couple of them and it seems that, for example, California as a member state participating would have one delegate to, out of however many there are, to the Commission's board. Is that typically how it works?

Yes, across compacts. California is a member of many national compacts, the Military Children's Compact Commission, the Interstate Juvenile Compact, the Emergency Management Assistance compact, and they have one representative on all of those. It's the same with the Licensure compact.

And is that regardless of the number of licensees that California is contributing to the process?

Yes. Each state under the Compact Commission model for the licensure compacts and then other compacts. Yes. They get one delegate. Yes.

And then I noticed that in a couple of the model compacts that I looked at, that the Commission has the authority to lease, purchase property, borrow money, and all of the rest as part of its, I guess it's a 501 whatever nonprofit corporation.

It's a government agency.

Oh, it's a government agency. Okay. And then, of course, there's the authority to assess, as you mentioned, annual assessments to the member states, right? Is there any limitation on the amount of money that a member state might be assessed? Because I didn't see it in the compact.

That would be established by Commission rule, if the Commission wanted to establish that. That's why each state has a delegate, is because what other compacts have found is that it would fall to the states, obviously, to pay that assessment. And so that check is, those representatives of the states are going to keep those costs as low as possible. Again, it's not just the licensure compacts that assess.

All the national compacts assess states in some way, and I'm not aware of any states leaving because of assessments from those compacts.

Does the assessment process typically involve a formula that's based on the number of licensees that the member state contributes to the issue or problem?

It can, yes, it can. Like I said, nursing just charges a straight $6,000 to each state. SciPAC does have a sliding scale that's based on a formula. I know the interstate compact for the placement of children has a formula. I'm not sure about the other. I think the Military Children's Compact Commission also has a formula.

So, for example, California would have one vote on the Commission board, but the assessment could be based on the number of licensees that we contribute, which could be huge.

Again, California would be a huge prize for any of these licensure compacts. So I don't think they would price them out of the compact. But, yes, if it was based on the number of privileges or number of licensees, it would very likely flow like SciPAC, that you're going to base it on the number of people that are using it. You're not going to base it on the number of licensee in the state. I think that's inherently unfair, and California wouldn't be alone there.

Other large states would also push back on that. But if a large percentage of California practitioners are utilizing the compact, then, yes, it's very likely they would pay higher fees than others based on the size of their population.

Well, given the fact that licensure in the State of California and the cost of it. Unfortunately, a system set up long before any of us got here is borne by the licensees themselves. So I assume that any, certainly that's an issue that we're going to have to grapple with, any annual assessment to the State of California, the way we've currently scheduled this and set it up, would be passed on to the California licensees and the ones coming in, to the extent that we could charge them a fee.

So we'll have to figure that out. Data breach and cybersecurity, I noticed that there's a data reporting requirement of member states. Data, individualized data with respect to licensees, that's maintained in some central data system, presumably somewhere.

It was not set out in any detail in the compacts that I reviewed. But I'm just wondering, I didn't see any provision or commitments by the Commission regarding a subject that's very sensitive here in the California Legislature, and that's data protection and data breach. Where would I find the obligations and liability of the Commission with respect to that, given the fact that there's a call for data with or without the consent of the licensee?

Yeah. Senator, that's something that would be more appropriate for Commission rule rather than the contract. Again, the terms of the contract, if you want to change the terms of the compact, you would have to change them in every member state. And so to get specific about those types of provisions would be something that could impair the ability of the compact to operate down the road. So that's more appropriate for the Commission rule process.

But I appreciate you raising that issue, and that's something that we can gather information from the current licensure compacts that are operating and see and get you that information that they have on that.

Well, just one final question. I've now exhausted my Chair and my colleagues' patience.

But not mine, you haven't exhausted mine.

Well, you are a good man, sir, but you're from the south, so there you go. One final question on rulemaking. I noticed in a couple of the compacts that I looked at. One of them in particular contained the following: Rules of Commission shall have the force of law in each member state.

Now, does that mean that the Commission can pass a rule by, I assume, a vote of the Commission board, which California would have one delegate on, that would constitute a law in the State of California? And if so, how does that work?

Well, again, I'm not an attorney. Hope this gives you some comfort. Yes, compacts, these are powerful mechanisms for states, and they're binding. What's important to frame here is that, again, as I said a little earlier, that rulemaking process is important to keep the compact operating. You can't get so specific in the language that it's out of date in a few years and its provisions don't work. So that rulemaking power has to be substantial.

There's also language in the compacts that say, I don't know about the ones that you've reviewed, but the ones that we've written under the DoD cooperative agreement, that any rule that is contrary to the scope or intent of the compact or outside the four corners of the agreement is deemed null and void. That wouldn't stand up to judicial review. Again, that's not saying a compact commission couldn't do it, but I don't believe that they would.

The Compact Commission exists only to implement and then administer the compact. It can't dictate policy to the states. It can't take unilateral action against any sort of practitioner. But you are correct, one of the reasons that these work so well is because of their rulemaking authority. But if it gives you any comfort that is hemmed in by judicial review, by precedent and by the language of the compact about it can't get outside the scope or the intent of the compact or the language of the compact.

Well, one thing that, with respect to this, that was a little concerning to me, and I noticed a provision that said that it, under the compact, it takes a majority of the legislatures of the member states taking action by passing a statute or resolution to reject a rule adopted by the Commission. So that's a little cumbersome. Is that a typical provision in compacts that you all put together?

Well, yes, it is. And it's also just a typical provision of the compacts.

Well, listen, I appreciate you being so patient and responding to my questions. I assume that many of these issues are issues that could be resolved by negotiation if the Legislature in the State of California decide to participate in any or all of these. And I look forward to see what happens. Thank you, Madam Chair, for your patience.

Thank you, Senator Roth, for asking a lot of really good questions that needed to be asked. This is the point of the informational hearing, and we just want to thank you, Mr. Logsdon, for joining us from Kentucky today. Thanks for letting us ask you some hard questions. We appreciate your expertise and knowledge on the compacts. We're going to move to our next- Yes, thank you. We're going to move to our next speaker.

Now I want to thank the Members for your round of questions there, too. That was great. Our next speaker is the Director of the Department of Consumer Affairs here in California. So, Kim Kirchmeyer, thanks for being here with us today. We're glad to have you.

Well, good morning, Madam Ashby.

Good morning.

Members of the Committee, thank you for having me here today. As you stated, my name is Kimberly Kirchmeyer, and I do serve as the Director of the Department of Consumer Affairs, or also known as DCA. DCA is the state department that regulates professional licensing through 36 different boards and bureaus and more than 3.4 million licensees throughout the state in 280 different license types. DCA understands the importance of professional licensing and the ability to practice.

And most of all, DCA understands the importance of consumer protection. We appreciate the invitation to be here today to join you on this discussion on interstate compacts. Before I begin, before I begin to speak about compacts, I would like to just make a few comments on something that's of great interest to the Legislature and to the department, and that is creating opportunities and flexibility for service members and their spouses.

A new federal law went into effect, as we've heard quite a bit about today already, that went into effect January 1 of last year, related to licensed portability for service members and their spouses or domestic partners to practice in states where they are relocated to. The license portability allows that individual the ability to practice, addressing the need and concern for service members and their spouses.

In light of this recent change in federal law, interstate compacts really are not needed to accomplish this goal for service members and their spouses. And DCA has fully implemented this federal law and has an easy online registration process. And I just checked, and we have 26 different individuals who've already started that process since we brought it up and running, and there are several other who are pending the process as they go through.

Now, turning to compacts. Interstate compacts are legally binding legislative enacted contracts among states enabling licensed professionals to practice in all states participating in that compact. Compacts can eliminate some barriers to licensure by allowing an avenue for individuals to get licensed in one state and enter the profession in multiple states, sometimes by paying only one state fee. This can be an advantage for states participating in compacts to quickly address issues that may come up during natural disasters, and we realize there is concern regarding these licensing compacts.

This topic is very complex. It's a very complex one, and not all compacts are not identical, and compacts are not a one size fits all situation. Compacts are specifically tailored to each practice area. So a compact governing one practice will usually be different from a compact governing a different practice. And as I mentioned, California currently has 36 different licensing boards and bureaus that govern its various practice areas.

Every compact is also different in what it allows and what it provides for both the member state and the licensees, sometimes in a very significant way. Compacts can differ in terms of whether practitioners need to acquire a separate license in each state or merely obtain a privilege to practice in each state based on the license they acquired in a single state, or what is referred to as the home state. They can also differ in terms of disciplinary authority and how disciplinary actions are reported.

These variables raise major policy questions for each compact and each license type. They also raise consumer protection concerns, especially in a state such as ours, where we put consumer protection above all else and are consumer protection leaders. It's also important to understand the multistate governing body behind compacts. Compacts are often overseen by a commission, as you heard a lot about by the previous speaker, made up of representatives from compact member states.

Usually each state has one vote on the commission, and the commission adopts and amends the rules governing the collective practices of all member states. While presently in California, the Legislature in each licensing board adopts the laws and regulations that govern each profession, under a compact, this function is largely delegated to the commission. This means California may be disproportionately underrepresented in each compact, which can be problematic as California's licensee populations are significantly higher than other states in almost every category.

It's also fair to say that California consumers might also be affected since our state is one of the most populous in the nation. If California only has one vote, there may be consumer protection concerns as the rules and bylaws adopted by the commission could be changed, and California would generally be obligated to abide by the rules unless it withdraws from the compact.

In addition to a commission, some compacts actually have a smaller board of directors, usually made up of commission members who can have decision making delegated to them, thus completely circumventing the member states from being able to be involved in certain provisions of that compact. One other important fact about the commission is that they often do not have requirements about the membership that's made up of that commission. So each member board will delegate a member to the commission.

If all members delegate a licensee board member, the commission will be made up of all licensees who are making decisions for consumer protection boards. In California, our boards are a mix of licensee and public members so all perspectives can be heard and that consumer viewpoint is brought forward. The commission should have requirement that the commission have a balance of both licensee and public members.

Based on California's licensee and consumer protection and consumer population size, California's vote and voice in governing rules of the compact should be reflective of the California's size. And I think that Senator Roth kind of was explaining that. It is also important to note that once a state enters a compact, it usually takes a legislative act to withdraw from it, which may be difficult to do once the state has committed substantial resources to that new compact and that governance structure. Also, it is difficult to remove non-compliant states from compacts.

So even in a situation where another state may be flouting the agreed upon compact rules, California would have limited options to sever those ties with non-compliant states. In California, licensing boards are specially funded, meaning funding comes from the license fees.

While some compacts require applicants to pay fees to practice in each state, others are set up like a driver's license in that the fees are only paid to that home state and sometimes to a fee to the compact's governing body, like that commission, at which point the individual can then practice in California. The California board then has the responsibility to enforce the laws among a larger licensee population, but may not receive the full funding needed to do so.

Licensure and renewal fees should be paid to the board or bureau in California. The fees cannot all go to the commission or only to the home state. Fees need to cover enforcement costs or only California licensees are going to be paying for investigating cases for individuals not licensed in this state. The ability to be a contributor to drafting or changing language in a compact to address licensing standards and consumer protection concerns is an important factor for any compact to be considered here in California.

As I mentioned earlier, California is a consumer protection leader. In some professions, California actually has higher licensing standards than other states, including a requirement for fingerprints amongst numerous of our professions, and it is these standards that should be used for any compact California is considering to join. Also, in order to be eligible to practice under a licensure compact in California, a licensee should have an unrestricted license in good standing in other states. Subsequent arrest records also need to be shared with all states in that compact.

In California, applicants can provide an individual taxpayer identification number to the licensing boards in lieu of a Social Security number and still be eligible for licensure. Some states require Social Security numbers for licensure. This issue would need to be addressed in any compact that California is looking at. For those licensees that do not take national exams, the examination requirements should be equivalent to California's examination requirements, including California specific law and ethics examination requirements.

The California Legislature has adopted several laws that are important for consumer protection and may be more stringent and different from other states, for example, in the architecture, engineering, and pharmacy industries. This is why specific California law examinations are important to ensure those practicing in California are aware of the laws and that they are following them when providing services to California consumers.

For some license types, there are special and specific continuing education that is required here in California, such as implicit bias, discrimination training, et cetera, and it would be important to ensure that these will be required for those licensees coming to practice in California under the compacts. Any compact that California considers should take into account that there are differences in the scope of practice or what services an individual is authorized to provide under a license from state to state.

For some professions, the scope of practice in California may be broader than in other states, and the individuals coming into California do not have the appropriate training to perform those expanded functions. Conversely, for some professions, the scope of practice in California is actually more restrictive than in other states. For example, in other states, some healing arts licensees can prescribe medication, but they cannot prescribe in California. Some licensees in California can perform expanded functions with additional training, but they cannot perform those functions in other states.

The scope of practice needs to be addressed in any compact to ensure that licensees are trained and have knowledge in any services that California allows them to be practiced. Enforcement is a critical component of any compact in order to protect consumers. California boards and bureaus should be able to take disciplinary action against the licensee practicing in California, even if California is not the home state. The inability to take disciplinary action should be considered non-negotiable for our state.

Not only the ability to take action, but take the action that California wants to take and not be required to mirror that of the home state or another state takes. Additionally, with the influx of new practitioners, enforcement responsibilities may increase for boards and bureaus, the Attorney General's Office, and the Office of Administrative Hearings. All of this increases costs to the boards and bureaus, which must be covered by licensing fees. Thus, licensing fees may increase.

Discipline taken by any state in the compact, as well as the complaint and investigation filed, needs to be disclosed with home states and all other states in the compact. Disciplinary actions and when discipline may be taken will differ across states. This needs to be addressed. In addition, something actually could be prohibited in another state, such as reproductive health services, but allowed in California or prohibited in California, such as gender conversion therapy, but allowed for in other states.

These are a few examples of unique and specific issues that need to be addressed in any compact. There are alternatives to compacts that accomplish many of the same goals. For instance, the accountancy profession has what is called practice privilege or mobility. This profession uses substantial equivalency of education, examination, and experience as the foundational elements for cross border practice for regulating bodies across the nation, including California.

Unlike interstate compacts that require approval by multiple state legislatures and once approved, cannot be changed pursuant to the statute, the Board of Accountancy retains their authority and received states. They have the ability to review states disciplinary processes to ensure they are appropriate. The board also maintains the flexibility to vote to remove a state from the practice privilege list. Another viable way for license portability is through reciprocity, which can be done by statute.

This approach maintains the oversight by the California Border Bureau and would allow for a quicker pathway to licensure. Currently, 17 of the 36 boards and bureaus under DCA also already offer some form of reciprocity already. The point that I'd like to drive home with this information that I've already shared today is that compacts are not a one size fits all solution.

There are many factors that come into play, including the priorities of consumer protection and licensing standards that should not be compromised or lowered for Californians, and the Legislature and board should have autonomy. DCA understands that individuals want to be licensed as quickly as possible and has implemented expedited licensure and even temporary licensure to assist with this issue and is always looking at ways to reduce licensing barriers. The Department looks forward to continuing to work with the Legislature on any of these issues, and I'm happy to answer any questions from the Committee Members.

Thank you so much for that thorough overview. I do want to open it up to my colleagues, and I have a couple of quick questions, too. You touched on this a bit, but I think one question that every Legislator asks when presented with something like this is what is the problem we're trying to solve for and whether or not this is a good fit for our state and for the people that we represent. So sort of trying to dig into that.

At the root of this question, we know that California has been asked to enter various compacts. The last speaker, of course, called us a prize, which we know. Right. That's why we're being so defensive. Of course. Right. It's California. We know that we would have a lot to offer, but we want to make sure we offer it to our own folks first and we take care of people here and that they have lots of opportunity.

So I guess my question for you is it just strikes me how the difference in how enforcement would be handled and what power we would be ceding, not just for enforcement, but like you said, not being able to deal with states that aren't being good actors because we don't hold all the cards in a compact. It's unequal. It's not like a contract between two people where one can enforce easily against the other. Compact is different from that. Reciprocity is more like that.

So what provisions do you think these compacts need in order for us to be able to in any way justify entering into them? And do you think there is like one area that maybe we would benefit from compacts and other areas where you think it might not make sense? One thing that was already mentioned earlier, for example, there are some industries that are being discussed as compacts here where really, if you move here, you just pay a pretty nominal licensure fee and you're in.

So I'm not sure why we would create an entire new level of sort of national bureaucracy that it doesn't seem like there's a real problem or solution there. So can you maybe address that piece, tell us how and where is this relevant for us and how do we protect our California standards?

Okay. I think I've kind of gone over in a lot of my talking points of the things that we think are important in any compact that you're looking at and what is important for consumer protection. And obviously, as you stated, enforcement is one of the biggest things. Right. We want to make sure that we are able to take action against an individual who's practicing here in California and potentially could harm either financially or physically, one of our consumers here in California.

So you want to make sure that we are able to take action. I think, how and where it's relevant, I think it's the decision of the licensee. You're looking at the licensee, what's the easiest for them, and that's where a lot of these are relevant. Right. Because an individual can choose that ability to join a compact in another state and then allows them just automatically to come here into California.

One of the other big things that I think the licensee gets a benefit of is they potentially could only pay one license fee. They don't have to pay those here in California. You'd pay that one fee. You'd get to come and practice into California. As Senator Roth so eloquently stated earlier, our fees are set up potentially very differently from other states. Other states sometimes have a different fee structure that they are specially funded by the licensee fees.

So I think that that's something, while it might be a benefit to the licensee, is it a benefit to us here in California? If we're not getting the fees that allow us to do our role of consumer protection and enforcement, then no, obviously that wouldn't be a benefit to us here in California.

I think the scope of practice is usually kind of set already, and a lot of the compacts at the beginning state that it follows the state's compact, follows the state's scope of practice or the rules here. But if you read through a lot of the compacts, a lot of the things are developed by the rule of the commission. So I think it's important that when you look at those compacts, you look at what is the rule of the commission that's being allowed to be changed.

So I think that's another thing you really need to look at when you're entering those compacts. I think that Senator Roth did a great example of looking at a compact and pointing out those areas where there's concern, not only for California but for consumer protection. And I think a lot of those, that's where you have to focus is really pulling apart those individual compacts and looking at the pros and cons of them and seeing if it is the best thing here for the state.

Okay. Colleagues? Senator Dodd.

Yeah. Question first. I mean, what I heard here, I've heard a lot here, and there's 36 different boards in the state. Can we pick and choose, cherry pick, if you use that term, on which compacts we would want to enter into?

You do have that ability as the Legislature because every one of these compacts has to go through the Legislature to choose. The way these compacts are set up, they have to go through the legislative process.

And while I do agree that California is different, I just take exception to the fact that a professional, licensed doctor or nurse or teacher in any other state, they're all out and all in for protecting their patients, for helping them, blah, blah, blah, blah, blah. So I'm not a big believer in that nobody else can do it better than California, while I do believe we're doing a good job.

So I guess for me, if we're going to enter into some of these compacts, it probably should be based on metrics that we have. Where do we have a need? And maybe they're not long term. Do we have a need right now for teachers in the state of California? How many teachers did we have five years ago? How many do we have today post Covid? All these post Covid, nurses, mental health professionals, doctors, other health officials. So to me, that would guide my thinking, and that's about as much as I want to have to do with this because this is something that this guy understands a lot better than I do. Thank you.

Okay. Senator Archuleta.

Thank you for your information. My God, that was quite a bit. But it sounds like you're also concerned about the educational standards of coming in and how we are protecting our consumers, our general public. And, as we just heard, my colleague mention, a series of professionals, but they also practiced over there in whatever state. But should we have some rule that we do a little vetting prior to issuing the license? Is that what your concern is, or is it just the fees? What's your primary concern? It sounds to me like it's more the educational standards.

You're absolutely right, Senator Archuleta, and fees are one piece of it. But you want to make sure that the individuals coming in here is competent to practice and that they meet the competency requirements that you have set in the legislative process for what those requirements are. I think in looking at how the accountancy board was set up with their practice privilege, they looked at, I think they call it the threes. And they have an organization that looks like that. It's education, examination, and experience.

And what requirements have been set up already here in California? That is something you want to look. Because one of the concerns is, and again, all of these compacts are so different in how they have been set up. So that's why you really need to look at how it was set up and what their requirements are. Some of them are actually stronger than California. Not a lot of them, but probably there's a few of them that I know of. But on the flip side, what haven't they said that is in there that we actually, we actually have?

If a person is going to be able to go to the lowest denominator state and be licensed, the state that has the lowest requirements for licensure, and then be able to come in here and practice in California, that would be something you should be concerned about. Because they haven't met the requirements that have already been established here in California, that the legislative body itself has said this is important for Californian consumers to have an individual who's competent to pracrice.

What would be the first step? Obviously, if there's a need for teachers, a need for physicians or whatever it might be, and we're trying to expedite anything, how can we do the vetting to verify the educational standards and open up those doors to fulfill our needs?

So there's a couple of things. First of all, for the entities that have reciprocity. There's really making sure that us, as the Department of Consumer Affairs, we're getting those individuals through the process and licensed as quickly as possible. I think for getting people into California, I think we have a good process that's already here that individuals can follow and get licensed. And now especially for, I know that we're always talking about service members and their spouses. With the new process, it's a lot faster to come in for them and be able just to provide proof that they're licensed in this other state and they have these orders. So that's been a big benefit for them.

I think at the end of the day, it's kind of when you get these compacts that come before you and individuals are saying, we need more licensees, you do have to drill down and look at what are the requirements for that licensure and compare them to what California has already put in place and see are these individuals that you want to have practicing here in California based on their training that they have received.

Because unlike a lot of reciprocity bills that we see or that we have actually laws now, sometimes even in those they require that the individuals not only licensed in the other state, but maybe they're practicing for a certain amount of time as well and they don't have any disciplinary action. That's how a lot of reciprocity is set up. So if you allow an individual to go and get licensed at one of these minimal licensure states, they get licensed there. There's no, potentially, requirement for any time of practice for them to be there and then to come into California.

Thank you for your presentation. Thank you.

Senator Niello.

Thank you, Madam Chair. I didn't know anything about this prior to the hearing, prior to getting this packet, nor did I have a great deal of time to review it ahead of time. So I'm learning all this now currently and trying to process it. But kind of piggybacking on Senator Dodd's comments, it seems to me the reason for compacts, the benefit to California is additional competition and therefore benefits to consumers, as opposed to primarily offering opportunities to practitioners that are licensed here and then could.

And beyond that, it seems that the allowance for practicing in state is very episodic. In other words, transient. People coming in here to provide services temporarily and then leaving. That doesn't do anything to satisfy the demand that we have for professions like medical providers and teachers and the like. To the extent that we are lacking on the supply side there, we need people living here and providing that service. It seems to me compacts aren't designed to do that.

So I'm not terribly enthused, nor do I gather that your testimony is a resounding endorsement of the arrangement. So I could see where there are some benefits in some areas where consumers here would have additional consuming opportunities episodically. But in terms of, it does not appear to me to be in any way a tool to satisfy the shortage that we have of certain professions, of which there are a lot, even auto mechanics, as an example. Thank you.

And I do agree. I think at the end of the day, one side or the other, whether we're support or not supportive compacts is kind of irrelevant. It's consumer protection at the end of the day and making sure if there is a compact that comes in, that it's doing the best for our consumers.

Senator Becker.

Yeah. I just want to add that I appreciate the discussion. I didn't know a lot about this previously. I appreciate the discussion and questions from my colleagues. I think it is a balance at the end of the day. Right. And holding our standards, although at the same time, as per the Little Hoover Commission, making sure that we make them as manageable as possible while still protecting consumers, while making sure that we do have enough roles to fill these positions.

And I think to Senator Niello's point, we don't necessarily want people coming in, the whole sort of travel nurse phenomenon. And hopefully we have enough nurses here, for example, just in a different area to fill those needs. But I don't think we can say for sure that most of these people are just transient. Right. There might be people who are moving here to fill a need and stay here. I don't know if we have the data on that. Right.

There might be some people who say, hey, great, this is an opportunity to come. So I'm just more, just saying I appreciate the discussion and I'm learning more about this and I am appreciating more kind of that balance between protecting our consumers and upholding our standards while making sure we have enough people to fill these key roles. Thank you.

Senator Dodd, did you have a follow up comment? Okay. I just wanted to say, sort of piggybacking on a couple of my colleagues here, that compacts aren't the only strategy forward. You talked a little bit about reciprocity. And I would just, in a temporary need for any group, whatever group that may be, just remember that a compact would be really hard to get out of later.

So if you're using it to address a dip in something, auto mechanics, as you stated, or something else, just remember that we would stay in that compact even after we fill that hole, because these are not easy to get out of, where there's reciprocity or other things that might be a better tool for dealing with a temporary lack of employment in an area. And then just for me, I just want to sort of say this out loud.

I think what I hear from a lot of my colleagues is whatever we do, we probably need to look at them each individually and then think about California's needs and where we are, not just right now, but really where we want to go with it all. Don't just make a decision based on the exact moment that we're in.

And what I'm hearing from you, adding so much depth to this dialogue, is to make sure we put consumers in the equation and that they have a seat at the table, that we don't cede that power and authority to another group of folks not in California that may or may not even have a consumer frame for looking at the problems. And also that we protect the integrity of the professions. Though I'm sure there are many great people working in these licensed areas outside of California.

I don't think that's the argument. I think the argument is once they come here, that we do hold them to a standard. And then sort of that very unique California piece that we figure out how we hold those California values inside of a compact or make sure that we can, before we enter into one, those things that we hold so dear here that we fight so hard for. So thank you for adding much to this dialogue. I don't see any further comments from my colleagues.

Greatly appreciate not just your testimony here today, but the work you do for us and on behalf of all Californians every day when you come to work and your amazing team. Thank you so much for everything that you're doing. Thank you. All right, we're going to move to our next speaker, which I believe is our final speaker. Right? Do we have two more? Sorry, hold on.

Yeah, yeah, yeah. We have one final speaker for our sort of informational piece. And then when we're done with that speaker, we're going to hear from Assembly Member Gipson. Okay. We invited him to come and share some comments with us today. Thanks for being here. If you're okay to hang out, we have one speaker before you. And so our next speaker is Leslie Roste. She's the Vice President of Government Affairs for the Future of the Beauty Industry Coalition.

Thank you very much.

Yeah. So you're going to have to turn your necks a little bit here because she's with us via Zoom. And we thank you for being here, Ms. Roste. Thanks for taking some time. Go ahead.

All right, so good morning, Chair Ashby and Committee Members. Thank you for your interest in better understanding the Cosmetology Interstate Licensure Compact that is currently under consideration in your Committee. I represent the Future of the Beauty Industry Coalition. It's a collective of companies that provide multistate business services. Businesses such as Ulta, JCPenney, Sport Clips, Great Clips. You get the idea.

I was asked by this Committee to address specific aspects of the Cosmetology Compact, which I will try to do, but will also be available for questions, should you have any, at the end. However, from the previous testimony, it sounds as though the Cosmetology Compact may be very different than other compacts, both in implementation, scope, and impact for California. In particular, this is one license where licensing requirements are actually lower in California than in 45 other states.

That's not to say I don't think that they're adequate, they just happen to be lower. As our CSG partner explained, this compact is considered the gold standard of license mobility, allowing licensees to move seamlessly across state lines to other member states and simply continue to work in this industry where jobs are plentiful and daily pay allows for a licensee to be able to immediately do things like pay rent and buy groceries in a community they may be considering moving to.

This type of mobility benefits licensees, including California residents who often need to work across state lines temporarily, such as when a new store is open. There are seasonal needs or other personal reasons that require someone to work somewhere other than where they are licensed for a temporary time. For the industry businesses in your state, a compact allows them to draw from a larger pool of potential employees when opening new stores, filling seasonal needs, and simply putting someone to work immediately in the state of California.

Currently, transfer of a license to California is done through a version of universal licensing reciprocity, basically allowing a type of license for license approach. However, this is not as easy or timely as it might seem. It still requires that an applicant produce certification letters from all other states in which they hold a license before the California application is even considered. California obviously has no control over how long it may take another state to send these, but it generally takes several weeks.

When certifications are received, it still takes time in California to process that license application. The timeframe currently is four to six weeks to receive a California license, during which someone could not work legally in the state and would not be gainfully employed. California does not offer temporary licenses for cosmetology.

However, the compact is intended to provide temporary authorization to practice there and would require a licensee to make California their new home state, should they move their domicile to that state, much like you do with your driver's license when you move. There are many benefits to California of becoming a member state, but likely the most important is the ability to use the required comprehensive database to provide improved enforcement and a reduction in license fraud and potential human trafficking.

For example, there is currently a national multistate review taking place revolving around broad and significant cosmetology licensure fraud across the country. This review has been slowed by the inability to share investigative information between states and the fact that there is no single repository for validated license information. The compact database would change this by allowing for immediate transparency of a particular license history from its inception.

Another benefit to California, should you elect to enact this compact, is having a seat on the Charter Commission that will be seated later this year. Each member state will have a seat on the Commission ongoing, but this initial Commission will be unique in that it will set the rules and bylaws for the implementation of the compact legislation. It will do those things like determine what needs to be in the database, what triggers when you get your license changed for your home state.

Some of the things we have been talking about here in this conversation. That said, if California did not enact this year, they would still have a seat on the Commission when they do enact, but would not have the opportunity to be a part of writing the rules and bylaws that will guide this compact in the future.

Incidentally, Kristy Underwood, the Executive Officer of your Cosmetology Board, was a part of the document writing group for this particular compact to ensure that the language developed would support the requirements of California. As far as cost to the state or the board, California would continue to offer both a single state license and a multi state license.

They would have the option with the opportunity to set an increased cost for the multistate benefit that would offset any cost to the state or to the board. In terms of enforcement, California would have authority over member state licensees while practicing in the state. So if I come to your state, California would not only be able to fully sanction a licensee as they would their own licensees, but also flag them in the database so that other states would be able to have a clear understanding around any specific licensee or license number.

The compact allows for states to conduct joint investigations such that evidence could be shared and acted upon immediately and appropriately. In the current review described previously, the discussion around issues with license fraud, bad actors, and ongoing issues is being done as a phone call or an email chain that only allows for limited disclosure and requires time that state offices often do not have, often bringing these reviews to, actually, a halt or slowing them significantly.

In addition, different from healthcare compacts that have existed for many years, this compact embraces and improves your current oversight efforts. For example, there is no routine oversight for a nurse. No one comes into the hospital to see if a nurse has washed her hands before she touches a patient. However, in cosmetology, both routine and complaint based inspections occur where any potential concerns with licensees would be discovered and authorization to practice could be revoked proactively.

Finally, the compact commission will fill a void in terms of the sharing of information and the absence of a single association representing the industry that so many other occupations benefit from. Member states will meet to discuss compact issues regularly, but also issues they have in common.

And states as diverse and large as California certainly could benefit from the sharing and discussions, as they would almost certainly apply to states with this many licensees. In terms of the military spouse eligibility as written on the state website, does reference the need to prove licensing good standing in all active and valid out of state licenses, as well as use of the active license in the immediately preceding years.

These are both time intensive processes for military family licensees who may hold licenses in many states or may have been unable to utilize their license in the previous two years. I believe that if California is going to enter into any occupational licensing compact, this may be the one that gives them the most control with the lowest risk. We've talked about how they are all individually different, and I believe this one has a significant difference for the state of California. I'm happy to answer any questions.

Great. I'm sure there will be some comments from my colleagues. Let me start by saying that there are absolutely people that go into the hospitals and watch our nurses and make sure that they wash their hands and follow all proper procedures. And as the wife of a clinical manager for our largest ER in Sacramento, I can't go home without saying that publicly. Let me assure you, the hospitals are well regulated by the state of California, so that is an inaccurate statement.

Okay, so thank you so much for being here and for chiming in and particularly on this topic. I know you weren't here to talk about hospitals with us, so not holding that against you. But I do want to ask you if you have a sense of how frequently Californians are leaving the state and then unable to become licensed somewhere else. And really at the root of my question is who in California is this designed to help?

I can kind of hear from your comment how it would help other people coming in. However, in the information we've received, there is a bit of conflict about how long it does take for that process in terms of cosmetology, for somebody coming from, say, Oregon or whatever to come into California and receive a license to go ahead and start making a living. We certainly do want to streamline that. But can you give us an idea? Do you have a thought on the other half of that equation, people leaving California?

Yes. In 19 other of the other states, a California cosmetologist, licensed cosmetologist, would have to either take additional hours or reexamine, so take their board exam all over again, or perhaps both. So in 19 states, it would be a significant challenge right now.

And those 19 states are members of the compact?

The compact isn't standing yet. It's a new compact. We only have three states that have enacted right now. We have legislation pending in 12 other states. So right now I can't tell you who will be in it when it actually is standing.

It's Kentucky and Arizona in right now.

Kentucky, Arizona, and Alabama are in right now.

Okay. Senator Roth.

So just to follow up. Thank you, Madam Chair. Just to follow up on this, the individual doesn't get to pick domicile or residence. So if you come to California and you move here, beacons delivers your stuff, and you rent or buy a home or live with somebody else, and you want to establish your place of your life here and your work here, at some point you become a California resident, and it's usually after six months or 12 months.

And you can't drive on your, I use Georgia because I was originally licensed in Georgia. You can't drive on your Georgia driver's license. You ultimately have to pay California income tax. And so I guess I'm trying to figure out who benefits from the compact.

And if it's employees of larger corporations in the beauty industry that need to move people around temporarily to cover staffing needs or training needs, then wouldn't we be better off just fixing that in our practice act, if we don't already have a provision for it, to allow temporary employment of individuals who are licensed in some other state for that purpose? Because it seems to me it's the temporary employees that we're talking about here, not those who are residents of the state of California. Am I right on that, ma'am?

So two things. One is when you talk about your residency. That would be something that this initial commission would be making rules around. When do you become a resident of the state, much like your motor vehicle department decided when you have to get a new driver's license. This compact, the commission would decide, when does somebody have to get a license? This becomes their home state.

Let me just stop you. You mean the commission, in this case, the commission would adopt a rule, which was my point of my earlier question with one of the other speakers. The commission, where California has one vote, would adopt a rule to establish domicile or residency in the state of California which impacts driver's license...

No, no, no, no. Specific to this license. Specific to this license. So what is the time frame in which they would have to make this their home state for this particular license?

But still it's California with one vote on a commission board, where California has the bulk of the licensees in the United States of America, at least a significant number of them. And the commission is going to make a rule telling California as a matter of law, who is a resident of the state of California for purposes of licensure?

Only specific to this particular license that you've entered into this compact on this cosmetology license.

And if we subsequently don't like that, then it requires a majority of the legislatures of the member states to either revoke the rule or California's Legislature to pass a bill and a statute to extract itself from the compact?

That, I don't know, I'm not an attorney, on how that piece of it would work. That might be a more appropriate question for Dan.

Well, let me go back to my question. If, in fact, the target audience here are, and it could apply to any number of compacts, not just this one. If the target audience is that group of licensees who either want to or their employer wants them to, or we need them to come into the state of California to provide services within the scope of their practice or their occupation, why wouldn't we want to do that, just in terms of a change to our Practice Act to allow individuals to come in temporarily and do that work, as opposed to the broader issue?

That could benefit people coming into your state. If that was a decision that was made. It definitely doesn't benefit the people who live in California who may also have to do those things.

Well, the one thing that strikes me is we've had hearings, as you well know. I spent a fair amount of time dealing with barbers and cosmetologists a year or two ago. I don't remember anybody coming in, and maybe my memory may be faulty. But I don't remember any significant number of individuals coming in to complain about portability going outside the state of California. The complaints were much different. Am I wrong?

In the previous conversations when we talked in terms of barbering and cosmetology, I don't really recall there being any significant conversation around license portability. So it may be my memory in this case, it was not significant about license portability. But arguably, you have said that you have the most number of licensees in the United States. So if it's an issue in other states, it's even a bigger issue in California for people needing to go and do other things. So if it's an issue in a state as small as Delaware, it's multiple times as big in California that people might have to go and do something temporarily in another state.

Well, that's my point. I mean, it's the temporary person we're talking about. And isn't there another way to deal with the temporary work issue outside of a compact so we don't have to get into how we get into the thing, how we get out of the thing? What does qualified immunity mean? How we assess fees, data protection, and all the other issues that were identified with the prior speaker?

I think the problem is there's 49 other states. Right. And getting all the 49 other states to agree makes it... In this industry, you already have a complete, I don't want to say Hodgepodge, but across state lines, it is very different. It is very complicated how license work, how you get license reciprocity, how you transfer a license. And that may not be true in other industries. Other industries may have a more straightforward approach to it.

But in this industry, if you live in the state of California and you want to go to another state, it may be extremely complicated, time consuming, time that you don't have. And so I get what you're saying about making it a temporary thing, but how do we get all the other states to agree that when someone wants to leave California, your constituents want to leave, that they can actually work? There's no mechanism for that. And this is the best mechanism that there is at this moment. Right, for bidirectional mobility?

Well, we're interested in that, of course. But our primary concern is what happens in the state of California and how we protect consumers and how we give employment opportunities to those who wish to continue to live here, those who wish to move here, and provide work here, and also those who are providing a service on behalf of their employers, which was the point of my question.

If this is an employer issue, how can we accommodate employers who do business here to facilitate the temporary movement of employees from one state into the state of California to cover staffing needs, training needs, and all the rest? And I'd be interested in continuing the conversation, but I'm sure my colleague, Senator Dodd, is going to tell me I've exhausted my time. Thank you, Madam Chair.

Can I make one comment on that? When we talk about public safety, the compact requires an educational program, and it also requires licensure exam that the people take. A licensure exam. The licensees complete one. And both national exams are widely based on health and public safety. So that issue of not being safe in California, someone coming from another state, you're getting licensed people that you already said, they just show up and you give them a license. You know, if that license recognition piece. You're already giving someone a license from another state. So I just want to make sure that you understand that people would be safe working in your state.

Thank you. Thank you for your response. I agree.

Yeah.

All right. Thank you for your comments. Senator Becker.

Thanks. I just want to get clear on the timeframe currently that it takes to give someone a license from out of state. I think we had the Executive Officer from the Board maybe could comment quickly.

That's great. Yes, please.

Thank you for being here.

Kristy Underwood, Executive Officer with the Board. We are currently running at three weeks for somebody coming into California to get a license. We've had some vacancy issues in our office, fully staffed, so we'll see where that goes. But about three to four weeks right now.

Got it. Very helpful. Thank you.

Can you walk us through that? Start to finish. So they come in, they let you know they've just moved here?

Yes. So they fill out an application, most commonly online. They have to get a certification letter from the state where they're licensed. That comes in separately. We only accept that from the actual other state. So those come in separately. We mirror those two together, and then we approve that application. And that individual must go pick up their license from one of our testing facilities so that their photograph and identification can be verified.

And you said with vacancies, you're at three weeks. That sounds like maybe it's a little longer than usual. What is it normally?

When we first implemented SB 803 with license, we're basically license for license here in California. We were down to less than a week.

So your range is somewhere under a week to about three weeks. Got it. Thank you very much. Good call, Senator Becker, did you have other questions?

No.

Okay.

Ma'am, let me just ask one quick know if the concern is we have corporate operators in the State of California that employ cosmetologists, and they are in other states, and there are specific, unique issues associated with training, or maybe primarily training of others, setting up offices, or maybe staffing shortages. I suppose we could take a look inside the practice act to see if there could be specific carve outs and provisions or procedures to allow those individuals to come into the state and practice their occupation.

There definitely could be. My board does support the cosmetology compact. I did work on it, as it was mentioned earlier. We do think that- I've been with the Department of Consumer Affairs for close to 30 years, and I do think that this is a compact that is a little more friendly to our licensees. Cosmetology is cosmetology among the states?

I don't know that I would be saying that if I worked for one of our allied health boards, but we do believe that there is a strong line of states that have the same scope of practice. We do have some limitations on some states, but our board does support the cosmetology compact.

And, of course, you heard my comments. I think there's some unintended consequences by most of us wouldn't sign a contract if it was complicated without getting legal review and adjusting the terms and provisions to fit our particular circumstances. Unfortunately, in the compact arena, as it's currently operating, it doesn't seem to work that way. Thank you.

You're welcome. Before you walk away, let me ask you one more question. Just because this came up on some of the others, is this an area where we have a need for additional people in the cosmetology space, or how many licenses do we have across the State of California?

My board licenses 621,000 individuals in the cosmetology area. We are at about 230,000 individuals.

Great. Thank you very much. Thanks for letting us put you on the hot seat. All right. I think that's it from my colleagues. So thank you to everybody who commented there. And we're going to have Assemblymember Gipson come on up and share a few thoughts with us. Obviously, this is a broad informational hearing. You want to sit at the table or you want to stand at, you can do whatever you want.

I'm here.

Most comfortable there. Okay. Welcome, Assemblymember. Thanks for joining us.

Thank you very much, Madam Chair and Vice Chair and Committee Members. And I want to also pause and thank Senator Roth for one. I was in his office, and we had a very robust conversation that has led to us coming together to gather to have this informational hearing. And thank you and congratulations to you and your Chairship and moving this conversation forward. So I'm very excited to be here. I want to thank all those who've spoken thus far.

I appreciate the opportunity to comment on this topic and the work of this Committee. Under the former Chair, as I indicated, to explore California's consideration on the Interstate compact. I currently serve as the Vice Chair of CSG West. I was the immediate past president of CSG West. Now I serve on the National Committee as Vice Chair of CSG, representing California, and California is a member of that organization, which is a national organization.

And because I served as CSG West officer for such a long time, it has led us to having this robust conversation that talks about a compact that's the subject of the topic today. The organization naturally facilitates the exchange of ideals and experiences and best practices on policies that states governs. And you heard from these witnesses on extensive studies and talking about the pros and cons of Interstate compact across many different industries.

Some of you may know that I have a bill, and that bill is being sponsored by the California Board of Barbering Cosmetology to establish a state cosmetology compact for our current cosmetology workforce. Incoming, I'll get there, cosmetologists, excuse me, and military families who have licenses in this space. And I just want to pause for a moment just to note that former speaker Karen Bass, when she was a speaker of the California State Assembly, made it her point to also correct and modify this space.

Because many of you know that those who have been convicted, who serve time in prison, in jail, they get out, learn a trade, come back, and they could not get licensed in this space. And it was her job to making sure that the Board of Cosmetology and Barbering take a case by case basis to ensure that those individuals who have developed this skill have an opportunity to become entrepreneurs in our community. And most of those individuals certainly have been people of color.

And so I thank our now mayor of the City of Los Angeles for this opportunity. In addition to that, in the movie industry, when an individual follows an actor or an actress or a singer, and they do their makeup and things of that nature, that license has to come here so they can perform that kind of service to that individual.

We have heard from many of the benefits this compact will provide for cosmetology workforce, and I am excited to work with you all on hopefully advancing this work in this legislative session. However, I understand that not all compacts are created the same way. And I wanted to underscore that not all compacts are treated the same way. Each industry has its own unique challenges. Ensuring public health and consumer safety and protection should be at the forefront of our minds in considering a compact across various industries.

And it is our job to thoroughly evaluate each compact on its own merits and determine how California can engage. And I want to also underscore that the Chair Member mentioned that a lot of California, a lot of people want to invite California in and be part of these compacts. And I think for a number of reasons, this very specific reason is very unique, is very focused on the barbering cosmetology world. And we also want to underscore those who are military wives.

And I understand that through the previous dialogue, that the Federal Government has made some allowances, but we want to make sure those allowances meet our standard. And I think that that's the reason why this bill that I have is sponsoring, making sure that we allow this to happen, that mirrors certain Federal Government, takes a long time in that particular space, and we hope to create in this space with this particular interstate, it creates equity across the entire board.

I am confident that the testimonies provided today and here helps educate us all a little bit further on the importance of this particular subject matter both positively and negatively. Those particular points have come out, and I want to underscore, it wouldn't have come out if had we not had an opportunity to have this robust conversation. And it's good that we can partner with other states in this particular compact. My hope today is to hear in this hearing will add added value to legislative conversation.

We anticipate this session to help us and to better inform in our decision making process to consider establishing a compact, which is a very inappropriate point to underscore in this conversation. So I want to thank this Committee, thank the Chair, for allowing us a few words to just make comments. Thank you very much.

Thank you very much, Assemblymember. Just to be clear, this hearing is much broader than one bill. His bill will have its day. It'll be appropriately noticed, and people will be able to come and speak and all those things. But because this topic was providing a baseline of discussion for something we know is coming, we wanted to welcome him here. So thank you for that and for being here today.

Thank you.

Okay, that is it for our speakers. We do have a few moments here for public comment. We're going to ask folks to be brief and succinct, but we would like to hear from you. Thanks for being here with us. If there's anyone who has a comment, please line up here at the mic and we'll hear from you quickly. Go right ahead. Just give us the name and your organization and then your very brief comments.

All right, thank you, Chairperson Ashby, Senator Roth and Committee Members. My name is Cathy Kennedy, President of the California Nurses Association, registered nurse of 44 years, and I'm also a Council Member of the California Health Workforce Education Training Council. CNA has long opposed the nurse licensure compact because it would do harm both to our patients and our profession.

Nurses with multi-state license do not have to meet our state's high bar for clinical education and continuing education, including our requirement of 500 hours of direct patient care, clinical hours, implicit bias education, thus lowering the standards for nursing education and practice. This Operation Nightingale scandal underscores the dangers of the nursing compact. For example, over 7600 fraudulent nursing diplomas were issued in Florida, which is a compact state.

If California was a compact state, we would have been required to accept Florida's lower education standards and may have dangerously allowed improperly trained individuals to practice in our state. The nurse compact is a deliberate step to deregulate nursing profession, and it lays the groundwork for virtual nursing across state lines, as you heard when they talked about Telehealth.

Compact would allow employers to race to the bottom, shifting nursing jobs outside of our state, using the cheapest labor with the lowest staffing standards, thus threatening a nurse's ability to advocate for our patients and for better working conditions. So we urge the Committee to reject this idea of a nurse licensure compact and instead focus on creating and preserving the good nursing jobs and supporting the BRN in maintaining California's high standards in nursing education, licensure and practice. Thank you.

Great. Thank you for your comments and thank you for sitting through the whole hearing.

Good afternoon. Thank you, Chair Ashby and welcome. I'm Lead Regulatory Policy Specialist Carmen Comsti with the California Nurses Association. With respect to registered nurses, compact licensure is not only dangerous for patients and the nursing profession, but it has not been an effective tool in retaining and recruiting RNs in our state. The asserted benefits of compact licensure for nurses simply have not materialized in compact states. Many compact states have experienced decreases in nurses since 2020.

During the height of the pandemic, Texas, Louisiana, Nebraska, Tennessee, all compact states reported nurse staffing shortfalls and comparing federal data from compact states with non-compact states. A higher percent of hospitals in compact states report critical staffing shortages on an average annual basis. In contrast, California in 2021, without needing nurse licensure compact issued 29% more licenses to out of state RN applicants and granted over 1100 temporary licenses.

And the diligent work of this Committee and the Board of Registered Nurses is making the RN licensure by endorsement process more efficient while maintaining California's high standards in education, training and licensure to recruit and retain nurses at the bedside, the Legislature can support safe staffing for RNs, strong workplace health and safety protections, and good union jobs. We can share more data with the Committee and thank you for this hearing.

Good stats. Thank you.

Hi, good afternoon. Thank you, Chair Ashby and Senator Roth for the robust discussion today. Jack Yanos with Sloat Higgins Jensen and Associates on behalf of Teladoc Health. Little background, Teladoc Health is the world's largest telehealth provider, delivering health care in 175 countries and more than 40 languages. Just wanted to quickly highlight the importance of licensed portability in the mental health care provider space. Obviously, California is suffering from a shortage of mental health care providers.

One statistic to really underscore this point, from the County Behavioral Health Directors Association, more than 90 counties have reported difficulty in recruiting licensed clinical social workers and licensed marriage and family counselors. This brings us the importance of licensed reportability for out of state professional providers to practice via telehealth. As we talked about today, portability grows the pie providers so we get a more robust network and shorter wait times for patients and those who need care.

And the Little Hoover Commission and then Senator Dodd himself pointed out today that assessing reciprocity in occupations facing a shortage of workforce should be a priority. And obviously, as I just highlighted, mental health workforce, there's a clear shortage there. We have 12 other states that have some level of license for reciprocity outside of compacts. They include Minnesota, Delaware and Connecticut. So again, appreciate the conversation here today and happy to work with the Committee.

Thank you for your comments. Anybody else? All right, looks like we're done with our first hearing, or at least my first hearing as your Chair. Thank you. And Senator Roth, thanks for staying with me. Appreciate you. All right, that's it. We're adjourned. Thanks, you guys.