8.3 The Dentist and Dental Hygienist Compact & Multistate Practice

8.3 The Dentist and Dental Hygienist Compact & Multistate Practice

MN Stat. § 150A.051 enacts the Dentist and Dental Hygienist Compact "into law and entered into with all other jurisdictions legally joining in the compact." It is the newest structural addition to Minnesota dental jurisprudence and the one most likely to be missed by candidates studying from older material — the section runs many pages, and none of it existed in the Practice Act a few years ago.

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1. What a Compact Privilege Is — and Is Not

The compact's own definitions in Article II settle most of the confusion:

The single most important distinction. A compact privilege is granted by the remote state, not carried from home like a driver's license. The definition of "license" expressly excludes compact privileges. A dentist licensed in Minnesota who wants to practice in another participating state applies for, and is granted, a privilege by that state.

Note the alternative-program carve-out. An "encumbered license" is one limited other than through an alternative program — so participation in a nondisciplinary monitoring program such as Minnesota's Health Professional Services Program does not, by itself, encumber the license or forfeit the compact privilege.

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2. What Minnesota Had to Agree To — Article III

To join and remain a participating state, a state must satisfy twelve conditions. They are worth reading because they describe the regulatory floor the compact imposes on Minnesota itself:

1. enact a compact that is not materially different from the model compact as determined by commission rules;
2. participate fully in the commission's data system;
3. have a mechanism for receiving and investigating complaints about its licensees and applicants;
4. notify the commission of any adverse action or the availability of significant investigative information regarding a licensee or applicant;
5. fully implement a criminal background check requirement within a commission-set time frame;
6. comply with commission rules applicable to a participating state;
7. accept the national board examinations of the Joint Commission on National Dental Examinations, or another examination accepted by commission rule;
8. accept for a dentist license graduation from a CODA-accredited predoctoral dental education program (or another U.S. Department of Education–recognized accreditor) leading to the D.D.S. or D.M.D.;
9. accept for a dental hygienist license graduation from a CODA-accredited dental hygiene education program (or another recognized accreditor);
10. require a clinical assessment for licensure;
11. have continuing professional development requirements as a condition of license renewal; and
12. pay a participation fee to the commission.

Paragraph (B) preserves state flexibility: "Providing alternative pathways for an individual to obtain an unrestricted license does not disqualify a state from participating." Minnesota's licensure-by-credentials route under MN Stat. § 150A.06, subd. 4 and MN Rules 3100.1400 therefore coexists with the compact.

Paragraph (C) tells the state licensing authority what to do with a background check: consider that information in making a licensure decision; maintain documentation of completion and the background information to the extent state and federal law allow; and report to the commission whether the check was completed and whether the individual was granted or denied a license.

The jurisprudence carve-out — the point that matters most for this examination

Article III, paragraph (D) provides that a licensee with a qualifying license who is not encumbered in any participating state "shall be issued a compact privilege in a remote state in accordance with the terms of the compact and commission rules. If a remote state has a jurisprudence requirement a compact privilege will not be issued to the licensee unless the licensee has satisfied the jurisprudence requirement."

Minnesota has a jurisprudence requirement — every licensure rule from MN Rules 3100.1100 through 3100.1400 demands "evidence of passing the board's jurisprudence examination within the past five years." The compact does not eliminate it. A dentist or hygienist entering Minnesota on a compact privilege still meets Minnesota's jurisprudence requirement, and a Minnesota licensee seeking a privilege in another participating state must satisfy that state's jurisprudence requirement.

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3. What the Licensee Must Do — Article IV

To obtain and exercise a compact privilege, paragraph (A) requires the licensee to:

Paragraph (B) makes these ongoing: the licensee "must comply with the requirements of (A) ... to maintain the compact privilege," and the privilege "will continue as long as the licensee maintains a qualifying license in the state through which the licensee applied for the compact privilege and pays any applicable compact privilege renewal fees."

Compare items 11 and 12 with MN Stat. § 150A.09, subd. 3. Minnesota requires a licensee to keep a current mailing and email address with the Board and to report changes within 30 days. The compact requires the licensee to report a change in primary residence to the commission immediately, and attaches consent to service of process and subpoenas at that address. Two address duties, two different addressees, two different clocks.

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4. Scope of Practice and Enforcement in the Remote State

Paragraph (C) — whose scope governs: "A licensee providing dentistry or dental hygiene in a remote state under the compact privilege shall function within the scope of practice authorized by the remote state for a dentist or dental hygienist licensed in that state."

This is the practical heart of the compact for a Minnesota candidate. A hygienist arriving in Minnesota under a compact privilege practices under Minnesota's scope rules — MN Rules 3100.8700, the supervision definitions in 3100.0100, subp. 21, the nitrous oxide rules in 3100.3600, subp. 14, and the collaborative practice conditions in MN Stat. § 150A.10, subd. 1a — regardless of what the home state permits. The compact moves the person, not the scope.

Paragraph (D) — whose regulator governs, and the cross-state effect: a licensee practicing under a compact privilege "is subject to that state's regulatory authority." A remote state may, consistent with due process and its own laws, "revoke or remove a licensee's compact privilege in the remote state for a specific period of time and impose fines or take any other necessary actions to protect the health and safety of its citizens." Then the sentence that gives the compact its teeth: "If a remote state imposes an adverse action against a compact privilege that limits the compact privilege, that adverse action applies to all compact privileges in all remote states." A licensee whose privilege is removed in one remote state "is not eligible for a compact privilege in any other remote state" until the removal period passes and all encumbrance requirements are satisfied.

Paragraphs (E) through (H) — the encumbrance cascade:

• "If a license in a participating state is an encumbered license, the licensee shall lose the compact privilege in a remote state and shall not be eligible for a compact privilege in any remote state until the license is no longer encumbered."
• Once the encumbered license "is restored to good standing, the licensee must meet the requirements of (A) ... to obtain a compact privilege" — restoration does not revive the old privilege automatically; the licensee reapplies.
• The same reapplication rule follows removal of a privilege by a remote state, once the removal period has ended and all conditions for removal have been satisfied.

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5. Implementation Status — What Is True Right Now

The compact is enacted in Minnesota and the commission has reached activation status, but the compact is not yet operational for practitioners. The Dentist and Dental Hygienist Compact Commission has stated that compact privileges are not yet being issued, with implementation — principally the build-out of the interstate data system that Article III, condition 2 requires — expected to take 18 to 24 months from activation. Adoption has continued to grow, passing a dozen states.

How to answer an exam question about the compact. Two things are simultaneously true and a well-drafted item will test both: Minnesota has enacted the compact (MN Stat. § 150A.051 is real, current law), and compact privileges are not yet being issued, so today a dentist or hygienist coming to Minnesota still obtains a Minnesota license — by examination under MN Rules 3100.1100 or 3100.1200, or by credentials under MN Rules 3100.1400 — and still passes the Minnesota jurisprudence examination. And when privileges do begin issuing, that last requirement does not go away: Article III(D) preserves every participating state's jurisprudence requirement by name.