LEGISLATIVE SERVICES AGENCY OFFICE OF FISCAL AND MANAGEMENT ANALYSIS FISCAL IMPACT STATEMENT LS 6409 NOTE PREPARED: Jan 21, 2025 BILL NUMBER: HB 1031 BILL AMENDED: Jan 21, 2025 SUBJECT: Dental Matters. FIRST AUTHOR: Rep. Goss-Reaves BILL STATUS: CR Adopted - 1 st House FIRST SPONSOR: FUNDS AFFECTED:XGENERAL IMPACT: State DEDICATED FEDERAL Summary of Legislation: Dental Compact– The bill establishes the Dentist and Dental Hygienist Compact (DDH Compact). The bill provides the requirements states must follow in order to participate in the DDH Compact. The bill provides that dentists and dental hygienists may practice in participating states so long as the dentists and dental hygienists meet certain criteria. The bill provides that active military members and their spouses should pay reduced or no fees in order to practice in participating states. The bill establishes a governing commission and sets out its powers, duties, financing, and liability. The bill provides various mechanisms for the participating states and the governing commission to regulate the interstate practice of dentists and dental hygienists. The bill also provides for various contingencies, including the process to effect, amend, enforce, withdraw from, or terminate the DDH Compact. Other Miscellaneous Provisions– The bill makes technical corrections. The bill also removes certain language regarding the regulation of dentists. Effective Date: July 1, 2025. Explanation of State Expenditures: Dental Compact– Joining the DDH Compact would increase the workload of the Professional Licensing Agency (PLA) and the State Board of Dentistry beyond routine administrative functions. Implementation of the DDH Compact is expected to require between $170 and $41,600 in IT staff time and implementation costs in FY 2026. After implementation, the PLA would incur between $0 and $7,000 in ongoing annual operating expenses related to administering the DDH Compact. (There are currently enough states within the DDH Compact for Indiana to join immediately after the bill’s effective date.) PLA operating expenses are paid from state General Fund appropriations. The following table provides a breakdown of estimated initial and ongoing expenditures required for the State to join the DDH Compact. HB 1031 1 Table. Estimated PLA Expenditures for the Dentist & Dental Hygienist Licensure Compact Expense FY 2026^ FY 2027 & Subsequent Years Low Estimate High Estimate Low Estimate High Estimate PLA IT Staff Costs to Implement * $170 $34,000 - - PLA IT Database Implementation/Start-Up Costs** $0 $7,600 - - Delegate Travel*** - - $0 $1,000 Annual Assessment Fee**** - - $0 $6,000 TOTAL $170 $41,600 $0 $7,000 ^Assumes Indiana would join Compact in FY 2026. *Estimated salary cost of existing staff to complete the bill’s requirements. **Estimate is based on PLA provided estimates for IT implementation costs for currently operational compacts the State has joined. The estimate has been modified by OFMA by the amount licenses currently active in the proposed compact profession. ***Includes average costs for domestic airfare, lodging, meals, and ground transportation. ****Possible assessment fee range based on assessments of similar license compacts. Attorney General and Board of Dentistry– The Attorney General’s Office and the Board of Dentistry would experience an increase in workload for investigatory and disciplinary procedures to the extent that complaints are made against out-of-state practitioners practicing in Indiana under the DDH Compact or Indiana licensees practicing in other states. The Board of Dentistry would also be required to pay any witness fees and travel expenses necessary to summon witnesses from other compact states for hearings held by the Board of Dentistry. The volume of such complaints and disciplinary actions is expected to be minimal. Additional Information– Commissioner Travel– It is assumed that any business travel required of Indiana’s appointed delegate for the DDH Compact Commission would be at the expense of the PLA. However, the bill provides that the Commission must meet at least once per year and may meet by telecommunication, video conference, or other similar electronic means. Costs for Indiana’s delegate to attend annual meetings are estimated between $0 (if electronic meetings are held) and $1,000 per year, based on recent domestic airfare and lodging costs. Uniform Data Set– Upon joining the DDH Compact, the bill would require the PLA to submit a uniform database containing certain identifying, licensure, and disciplinary information to the Commission’s coordinated database on all participating practitioners. Each member state is required to monitor the database to determine whether adverse action has been taken against any licensee or license applicant. Similar requirements were included in the authorization of the Nurse Licensure Compact, which was recently implemented by the PLA. The PLA estimated costs of IT implementation/start-up costs for harmonizing its licensure database with the Nurse Licensure Compact’s national database, at $165,250, which was funded through a grant awarded by the National Council of State Boards of Nursing. Also, the PLA has estimated the cost at $60,000 in implementation/start-up costs of harmonizing their database with the Physical Therapist Compact’s database. The cost of implementation was also covered with a grant from the Federation of State Boards of Physical Therapy. HB 1031 2 Adverse Action– The bill grants Indiana the authority to investigate and take adverse action against a dentist or dental hygienist’s compact privileges in Indiana. It is likely the Attorney General’s Office and the Board of Dentistry would be the state’s advocates for investigating and taking adverse action. It is likely the Attorney General and the Board of Dentistry would conduct any investigations and take action within their existing staff and resource levels. Annual Compact Membership Fee– A state membership fee has not yet been established. According to the DDH Compact website, “[t]he first seven states to pass the compact will make up the initial Commission. They will set up the fee structure. Only two active licensure compacts assess the state with a participation fee. Whether or not the Dentist and Dental Hygienist Compact will charge a fee will be up to the Commission which is made up of member states.” Currently, the Interstate Medical Licensure Compact Commission charges a service fee to each interstate license applicant. However, the Nursing Compact charges member states an annual fee of $6,000. Therefore, the fiscal impact estimate assumes a minimum fee of $0 to a maximum fee of $6,000 that would be assessed, depending on what the DDH Compact Commission decides. Other Miscellaneous Provisions– The PLA may have an additional workload to update their website and practitioners of the changes under this provision. It is likely the PLA would be able to make any necessary changes as a routine administrative action. Explanation of State Revenues: Summary– If a significant number of out-of-state dentists and dental hygienists holding Indiana licenses choose to forego Indiana license renewal for compact authorization to practice in Indiana, the bill could potentially result in a reduction in state General Fund revenue from license fees estimated between $31,000 and $93,000 per biennium. However, the bill provides that member states may charge a fee for granting compact privileges. Therefore, Indiana could potentially recoup some or all of this lost revenue through compact privilege fees, depending on rules adopted by the Commission relating to member state fees. Any revenue impact would not be expected until the fiscal year that compact privileges begin to be granted in Indiana (FY 2026 at the earliest). Additional Information– The Board of Dentistry currently collects a biennial license renewal fee of $100 for dentists and $50 for dental hygienists. In FY 2023 and FY 2024, the Board of Dentistry collected approximately $1.03 M from license fees, with a significant majority of that amount [$0.907 M] collected in FY 2024. As of November 2024, there were 9,788 dentists and dental hygienists with an active Indiana license, and 8,286 licensed dentists and dental hygienists with an in-state address. Estimates of possible revenue reduction assume between 25% and 75% of the out-of-state licensees would choose not to renew their Indiana licenses upon receiving compact privileges. Explanation of Local Expenditures: Explanation of Local Revenues: State Agencies Affected: Professional Licensing Agency; State Board of Dentistry; Attorney General. Local Agencies Affected: Information Sources: https://ddhcompact.org; https://ddhcompact.org/compact-map; https://ddhcompact.org/faq; https://www.ncsbn.org/public-files/FY21-NLCAnnualReport.pdf; https://www.imlcc.org/wp-content/uploads/2020/02/IMLCC-Rule-Chapter-3-Administrative-Rule-on-Fee s-Amended-May-22-2017.pdf; HB 1031 3 Indiana Handbook of Taxes, Revenues and Appropriations, Fiscal Year 2023; PLA license search and verify tool, November 2024. Fiscal Analyst: Chris Baker, 317-232-9851. HB 1031 4