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Once the pandemic revealed the state’s dire shortage of health care and other workers, state officials moved quickly to ease or quicken the licensing process. Gov. Chris Sununu signed the most sweeping change into law in June, allowing any licensed professional to practice here if their home state’s licensing requirements are “substantially similar” to New Hampshire’s.
But Sununu’s recent letter to the Board of Mental Health Practice, blasting it for failing to move forward on a 2021 significant licensing change, illustrates how slow progress can be.
Sununu accused the board of “dereliction of duty” for failing to pave the way for conditional licenses for social workers, mental health workers, and marriage and family therapists, as required by the law he signed two years ago.
The licenses would be especially significant for new practitioners and their employers. For the first time, they would be able to bill private insurance companies for their services during their two years of supervision. Currently, they can bill only Medicaid.
“That’s the harm here,” said Lindsey Courtney, executive director of the Office of Professional Licensure and Certification, which works with licensing boards. “You don’t have parity between individuals with Medicaid and those who pay with private insurance.”
The change was also seen as a way to attract more practitioners to the state.
Sununu has given the board until Sept. 1 to file proposed rules for implementing the conditional license. Sununu warned board Chairman Samuel Rosario that he’d replace board members if they are “unwilling or incapable of fulfilling their responsibilities.”
The board can’t look to a new law making it easier for out-of-state professionals to practice here for a solution. It doesn’t create the conditional licenses needed for insurance billing. Even if it did, Courtney has warned that implementing those changes will take time too, because boards must decide which out-of-state licensing requirements satisfy New Hampshire’s requirements.
Any licensing changes would then have to be approved by the Joint Legislative Committee on Administrative Rules, a panel of House and Senate lawmakers. Courtney told the Bulletin in June they will likely prioritize certain licenses that have the highest demand or need, such as physicians and cosmetologists.
It’s unclear why the Board of Mental Health Practice has not moved forward on writing the rules creating conditional licenses.
Rosario, a social worker who became board chairman this year, did not return messages. A letter to lawmakers from the prior chairman, Gary Goodnow, suggested it was not the board’s unwillingness to comply with the law but rather a technicality.
In written testimony to the House Committee on Health, Human Services, and Elderly Affairs, Goodnow said the wording of the 2021 law was problematic because it put the new conditional licenses for mental health workers and marriage and family therapists within the section of the law pertaining to social workers.
Goodnow urged lawmakers to remedy that this year by passing House Bill 428, which would have moved those license requirements to the right section. “This legislation, if passed, will smooth the ability of the Board of Mental Health Practice to write logical administrative rules,” Goodnow wrote. The bill was retained in the House.
But the board had another option, according to Courtney. She said her office encourages boards to write interim rules while they pursue the lengthy process of adopting final rules. “I think that could have been an avenue that they didn’t express interest in exploring,” she said.
Sununu referred questions about the board’s inaction on the 2021 law to Courtney.
Courtney said she understood the governor’s frustration, saying two years is a reasonable amount of time to have adopted the conditional licensure rules. But she also acknowledged the workload challenges facing volunteer boards, which must follow an involved rulemaking process.
She pointed to the Board of Psychology as an example. It only recently got final approval for rules allowing schools to bill Medicaid for some services as permitted in a 2022 law.
Sununu has championed easing, even eliminating professional licensing requirements, saying it would make it easier to recruit workers from other states. Lawmakers rejected his proposal this year to eliminate more than 30 professional licenses.
They have agreed to other licensing measures.
Last year, New Hampshire was the 15th state to join a mental health counseling compact that allows licensed professional counselors from outside the state to practice here without an additional license. It did the same for nurses several years ago.
But they said no this year to allowing New Hampshire to join a new compact for social workers. Rep. Joe Schapiro, a Keene Democrat and retired social worker who sponsored the compact legislation this year, said he or another lawmaker will bring a similar bill back next year. Once seven states join, social workers in those states will be able to easily practice in the other states without a separate license.
“The issue is portability of licensure,” Schapiro said. “For a long time, there have been complaints from employers and clinicians.” A social worker with 20 years of experience in Vermont, for example, can’t take a job in New Hampshire without going through the lengthy licensing process, which can require tracking down old transcripts, he said.
“We have a shortage of people, so anything that makes it easier for people to practice in New Hampshire is good,” Schapiro said.
This story was republished with permission under NH Bulletin’s Creative Commons license.