GEORGIA DEPARTMENT OF AUDITS & ACCOUNTS PerformGarnecgeGAriuffdinit, DStiavtiesiAounditor PerfoPremrfaonrmceanAcuedAit uDdivitisDioivnision Leslie McGuire, Director 404.656.2180 www.audits.ga.gov Comparative Review Report No. 21-04 November 2021 Regulatory Requirements of Selected Health-Related Professions Georgia's requirements are largely the same as other states About this Report Using data collected by the National Conference of State Legislatures (NCSL), we compared Georgia's regulatory requirements for 14 health-related professions to requirements in all other states and the District of Columbia. Overall, we found that Georgia's requirements are similar to those of other states. NCSL staff collected data on 48 regulated professions--licensed, regulated, or certified--with a projected employment growth rate above zero and for which regulation could pose unnecessary barriers to employment. Additionally, to be selected, the profession had to be regulated in at least 30 states. We reviewed 14 health-related professions from this group because they represent some of the fastest growing professions nationwide and a significant portion of the licenses and renewals handled in Georgia. To ensure the data's reliability, we reviewed the information for Georgia's professions and corrected identified inaccuracies. Additional information on methodology is included in Appendix A. REVIEWED PROFESSIONS Athletic Trainers Certified Nursing Assistant Dental Hygienist Dieticians Emergency Medical Technicians Licensed Practical Nurses Massage Therapists Occupational Therapy Assistants Pharmacy Technicians Physical Therapy Assistants Radiological Technologists Registered Nurses Respiratory Therapists Skin Care Specialists (Estheticians) Georgia's requirements are similar to other states OVERVIEW Overall, we found that Georgia's requirements are similar to those of other states. Of the 14 professions reviewed, Georgia regulates 11 at the highest level as licensed professions. Practitioners of these professions must meet established educational, training, and/or testing requirements to obtain a license. Georgia's regulatory requirements are largely the same--or very similar to--those in other states for most professions reviewed (see highlights in box to the left). However, Georgia applicants for Skin Care Specialists (known as Estheticians in Georgia) and Pharmacy Technicians face requirements that differ the most from other states. In particular: Type of Regulation Most Restrictive Licensure Certification Registration Georgia's Skin Care Specialists pay higher Least Restrictive licensing and renewal fees than most other states. Additionally, Georgia's training and minimum age requirements are significantly more restrictive than other states. Georgia requires Pharmacy Technicians to register with the state, which is more lenient than most other states' licensure requirement. However, Georgia's initial and renewal fees are higher than those in other states--even those that require a license. When reviewing specific data points within all 14 professions, we found that for 9 professions Georgia's initial and renewal fees are lower than most other states. We also found Georgia was the same as other states on the following points: Licensure, certification, or registration requirement (11 professions); License, certification, or registration renewal periods and the time allowed to complete any continuing education requirements (10 professions); Requirements for education, training, experience, and professional exams (11 professions); Restrictions on applicants with prior criminal history (9 professions); and Reciprocity allowances (11 professions). Finally, Georgia differs from other states in several ways. For EMTs, it is less restrictive than most states in that it does not set a minimum age requirement (46 states do) or a training requirement (49 states do). Georgia is more restrictive than other states in that it requires: A minimum age of 18 for Dieticians (34 states have no requirement or a lower one) and 2,000 hours of experience for Skin Care Specialists (46 states require fewer hours). 270 Washington Street, SW, Suite 1-156 Atlanta, Georgia 30334 Phone: (404)656-2180 www.audits.ga.gov Comparison of Georgia's Regulation of Selected Health-Related Professions i Table of Contents Purpose of the Review 1 Background 1 Overview of Methodology 1 Professions and Points of Comparison 1 Comparisons by Profession 4 Athletic Trainers 5 Certified Nursing Assistants 7 Dental Hygienists 9 Dieticians 11 Emergency Medical Technicians 13 Licensed Practical Nurses 15 Massage Therapists 17 Occupational Therapy Assistants 19 Pharmacy Technicians 21 Physical Therapy Assistants 23 Radiological Technologists 25 Registered Nurses 27 Respiratory Therapists 29 Skin Care Specialists 31 Appendix A: Objectives, Scope and Methodology 33 Appendix B: Data Points Collected by NCSL on Each Profession 36 Appendix C: Reviewed Professions and Oversight Body 38 Comparison of Georgia's Regulation of Selected Health-Related Professions ii Comparison of Georgia's Regulation of Selected Health-Related Professions 1 Purpose of the Review The purpose of this review is to provide information on how Georgia's regulatory practices for 14 selected health-related professions are similar to or different from those in other states. Generally, Georgia was compared to 49 states and the District of Columbia. A description of the scope and methodology used in this review is included in Appendix A. Background To protect the public, state governments often regulate certain professions by limiting the practice to individuals who meet certain requirements. States may require licensure, certification, or registration. Georgia currently regulates more than 100 professions through a state board or agency. These include health-related professions such as Nursing and Physical Therapy, as well as trades such as Architecture and Plumbing. The legislature is often faced with requests to establish new boards or make changes to existing regulatory requirements. For example, during the 2021 legislative session, the General Assembly considered 15 bills that included proposals that would require new professions to be regulated, create interstate compact agreements for several existing professions, and attempt to ease licensure requirements for veterans. Overview of Methodology Type of Regulation Most Restrictive Licensure Certification Registration Between 2017 and 2019, National Conference of State Legislatures (NCSL) staff reviewed the occupational licensing laws and regulations of 50 states and the District of Columbia to create an Occupational Licensing Database.1 It should be noted that, for purposes of comparison, any discussion of "states" includes the District of Columbia, for a total of 51. The focus was on professions for which laws and regulations could pose unnecessary barriers to employment. NCSL selected 48 professions that were regulated2 in more than 30 Least Restrictive states and/or had a projected employment growth rate above zero. It collected data on a variety of categories such as minimum age requirements, associated fees, and continuing education requirements (see Appendix B for descriptions of all data points). Staff researched state laws and then state regulations and/or board rules; they also interviewed board staff as necessary. The project was completed in 2019, and compiled data was published on NCSL's website. Professions and Points of Comparison According to the U.S. Bureau of Labor Statistics (BLS), 8 of the 20 occupations with the fastest projected growth rate over the next 10 years are in health-related fields. As of January 2021, health-related professions accounted for approximately half of the 488,710 professional and business licenses managed by the Georgia Secretary of State Office's Professional Licensing Board Division (PLB). We restricted our comparison to 14 health-related professions. 1 The National Occupational Licensing Database was produced by NCSL, The National Governors Association Center for Best Practices, and the Council of State Governments. The groups received grant support from the U.S. Department of Labor, Employment, and Training Administration. 2 Requiring either licensure, certification, or registration. Comparison of Georgia's Regulation of Selected Health-Related Professions 2 The 14 professions analyzed in this review are: Athletic Trainers Certified Nursing Assistants Dental Hygienists Dieticians Emergency Medical Technicians Licensed Practical Nurses Massage Therapists Occupational Therapy Assistants Pharmacy Technicians Physical Therapy Assistants Radiological Technologists3 Registered Nurses Respiratory Therapists Skin Care Specialists (Estheticians) We used NCSL's data to identify comparison points to identify whether Georgia's regulations were similar to other states. (See Appendix B for detail on each of the data fields). Below are descriptions of the comparisons presented in each profession's table (pages 5 to 32). Descriptions of the individual data points used are included in Appendix B. Regulatory Status Depending on the associated requirements, a profession's regulatory status can be a barrier to employment. Professions can be regulated in three ways: licensure (the most restrictive), certification, and registration. Most states require the same regulatory status for a profession.4 Licensure Professionals must meet educational, training, and/or testing requirements before practicing and are subject to board discipline (e.g., Dental Hygienists). Certification After meeting specified requirements, professionals can use a designated title that carries value in the labor market; however, the title is not legally necessary to practice (e.g., Certified Nurse Aide). Registration Professionals must register with a state entity by providing specified personal information before practicing (e.g., Pharmacy Technician working under the direction of a Pharmacist). Not all states regulate every profession reviewed. Additionally, some require a license while others require a certificate or registration. Generally, we compared Georgia to all states that regulate a profession, regardless of the regulation type. Initial Costs and Renewal Frequency and Cost Regulatory fees (for licensure, registration, or certification) include application and initial fees. The renewal fee is a single amount charged once per renewal period. We included all fees and charges incurred by applicants, excluding examination fees and those identified as "other".5 These initial and renewal costs related to practicing in a state can present a barrier for some individuals if they are unnecessarily high. Additionally, the renewal period may present a barrier if it is frequent. Continuing Education Continuing Education (CE) hours may be required, at a designated interval, to renew a license, certificate, or registration. The number of hours and the interval can present a cost barrier for applicants. We reviewed the following: CE term (i.e., the frequency with which the requirement must be met; Georgia has a two-year term for all professions, meaning a prescribed number of CE hours must be completed every two years); 3 This profession is not currently licensed in Georgia. Our review identified common practices nationally. 4 In cases where multiple statuses were present, all were retained for comparisons. 5 Our review found examination fees are usually increased annually; therefore, they were excluded from the analysis because they were outdated. "Other" fees were excluded because we determined they were outdated and inconsistently collected. Comparison of Georgia's Regulation of Selected Health-Related Professions 3 Total hours required by states with a two-year CE term; Average annual hours required by states with CE requirements; and Median annual hours required by states with CE requirements. Restrictions Based on Prior Criminal History States may prevent individuals with certain criminal histories from practicing a profession. These restrictions may specify a particular conviction or a type of conviction (e.g., felony) or a combination of these. For example, Georgia prohibits individuals convicted of violating a controlled substance law from becoming Registered Nurses. A potentially more restrictive approach is to allow the oversight body to determine whether an applicant is of "good moral character."6 The determination of good moral character can vary by state; it is based on the judgement and interpretation of the board in accordance with applicable laws and rules. It should be noted that, for this category, we identified inconsistencies in the way NCSL data was collected. As a result, we compared Georgia to the other seven southeastern states (Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) for 11 professions. For the remaining three professions, we determined the data to be reliable for comparison to all states. Basic Requirements Regardless of the regulatory status, applicants generally must meet basic requirements to serve in the respective profession. The requirements reviewed include: Reciprocity Allows licenses, certifications, or registrations earned in another state to be recognized as a means for meeting a state's regulatory requirements Education Degree requirements for licensure, certification, or registration Professional Examinations Whether applicants must pass a professional examination prior to licensure, certification, or registration Additional Examinations Whether applicants must pass additional examinations such as English language proficiency or state jurisprudence examinations prior to licensure, certification, or registration Training Whether and how much training applicants must obtain prior to licensure, certification, or registration Experience Whether and how much experience applicants must obtain prior to licensure, certification, or registration Minimum Age Whether applicants must be a certain age to be licensed, certified, or registered 6 Based on the methodology used by NCSL, we did not consider overarching laws such as O.C.G.A. 43-1-19(q), which requires boards to consider the relationship of the crime to the profession. It should be noted that this statute applies only to boards housed under the Secretary of State's Division of Professional Licensing. Comparison of Georgia's Regulation of Specific Health-Related Professions 4 Comparisons by Profession The comparisons presented in the following tables are based on data collected by the National Conference of State Legislatures (NCSL). Please note the following points of clarification: NCSL collected data from all 50 states and the District of Columbia. It should be noted that, for purposes of comparison, any discussion of "states" includes the District of Columbia, for a potential total of 51. Unless otherwise noted, comparisons related to restrictions based on prior criminal history are limited to the other seven southeastern states (Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee). This decision was made because we identified inconsistencies in data collection. Additional discussion of methodology is located in Appendix A. Comparison of Georgia's Regulation of Specific Health-Related Professions 5 Athletic Trainers Athletic Trainers evaluate and advise individuals to maintain peak physical fitness, as well as avoid, or assist in recovery from, athletic-related injuries. Practices may include providing first aid or emergency care. In Georgia, Athletic Trainers may also use techniques that involve heat, light, sound, cold, electricity, or mechanical devices. As of January 2021, the Georgia Board of Athletic Trainers licensed approximately 1,600 Athletic Trainers. Georgia is 1 of 45 states that require licensure 12 3 45 None Registration Certification Licensure Costs Like Georgia, most states require a license and renewal (of licensure, certificate, or registration) every one to two years. Georgia's licensure fee of $50 and renewal fee of $100 are lower than the national fee averages. Georgia's licensure fee is lower than the national fee average, similar to 25 other states GA Average $0 $20 $50 $157 $700 1 state 26 states 23 states 43 states require renewal every one or two years 1 21 22 6 None 1 2 3+ Georgia's renewal fee is lower than the national fee average GA Average $0 $25 $100 $112 1 state 28 states 19 states * Colorado and Delaware omitted from analysis because of variable fee amount. N=48 $500 Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. However, its requirement of 40 hours is slightly less than most with a two-year term. 32 states require CE to be completed every two years 44 32 46 23 states with a two-year CE term require 50 hours Not Required 1 2 3+ Multiple Options 22 annual CE hours required on average by the 4510 states Of the 4510 states that require CE, most require the median annual of 25 hours 15 27 3 Below At Median Above 10While South Carolina requires CE to be completed every two years, it is not included in the additional analyses in this section because it requires specific coursework as opposed to a certain number of hours. Comparison of Georgia's Regulation of Specific Health-Related Professions 6 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may restrict licensure based on any criminal conviction. The board may also reject applicants when it determines they do not possess good moral character. Georgia is one of: 49 states that may restrict licensure based on a prior conviction 18 states that have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. As shown below, Georgia is one of: 26 states that allow reciprocity 26 24 50 states that require a bachelor's degree Yes No 40 states that do not specify a minimum age 49 states that require applicants to pass a professional examination 43 states that do not require examinations in addition to a professional examination 48 states that do not require training 50 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 7 Certified Nursing Assistants Certified Nursing Assistants (CNAs), sometimes referred to as Nursing Aides, help provide basic care for patients in hospitals and residents of long-term care facilities (e.g., nursing homes). CNAs may also be orderlies who transport patients and clean treatment areas. As of June 2021, the Department of Community Health certified approximately 64,600 CNAs.11 Georgia is one of 50 states that require certification 1 50 Licensure Certification Costs Like Georgia, almost all states require a certification and renewal every two years. However, Georgia does not charge a fee for either certification or renewal. As shown below, other states charge certification (or licensure) fees ranging from $10-$150. The renewal fees range from $20 to $100. Georgia is 1 of 39 states that do not charge a certification or licensure fee GA Average $0 $10 $44 $150 39 states 7 states 5 states 49 states require renewal every two years 2 49 12 Georgia is 1 of 35 states that do not charge a renewal fee GA $0 35 states Average $20 $43 9 states 7 states $100 Continuing Education Like most states, Georgia does not require continuing education (CE). All of the 13 states that require CE have a two-year renewal period with a CE requirement that ranges from 8 to 48 hours. 38 states do not require CE 38 13 Not Required 2 years 10 annual CE hours required on average by the 13 states 11 states require either 12 or 24 hours of CE Of the 13 states that require CE, most are below or at the median annual of 12 hours 6 6 1 Below At Median Above 11Georgia refers to the profession as registered; however, its requirements are consistent with NCSL's definition for certified. Therefore, we used NCSL's terminology for consistency. Comparison of Georgia's Regulation of Specific Health-Related Professions 8 Licensure Restrictions Based on Prior Criminal History Like all other southeastern states, Georgia's licensing board does not restrict licensure based on prior criminal history, nor are applicants subject to a good moral character requirement. Georgia is one of: 8 southeastern states that do not restrict certification or licensure based on a prior criminal history 8 southeastern states that do not have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. As shown below, Georgia is one of: 50 states that allow reciprocity 50 1 Yes No 51 states that require training instead of a specific degree 49 states that require applicants to pass a professional examination 41 states that do not specify a minimum age 49 states that require an examination in addition to the professional examination 51 states that require at least 75 hours of training (Georgia requires 85 hours) 51 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 9 Dental Hygienists In Georgia, Dental Hygienists practice may perform sealant application, oral procedures and assessment, fluoride treatment, oral hygiene instruction and education, and exposures of radiographs. Some practices require direct supervision by a dentist, while others require only general supervision (present in the office). As of January 2021, the Georgia Board of Dentistry licensed approximately 7,800 Dental Hygienists. Georgia is 1 of 50 states and the District of Columbia that require licensure 51 Licensure Costs Like Georgia, most states require a license that is renewed every two years. Georgia's licensure fee of $75 and renewal fee of $85 are lower than the respective national averages. Georgia's licensure fee is lower than the national average, similar to 32 other states GA Average $60 $75 $177 $1,000 33 states 18 states 38 states require license renewal every two years 7 38 6 1 2 3+ Georgia's renewal fee is lower than the national average GA Average $37 $85 $122 $325 29 states 22 states Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. While its requirement of 22 hours is unique, most states require between 20 and 40 hours every two years. 39 states require CE to be renewed every two years 13 39 8 Not Required 1 2 3+ 12 annual CE hours required by the 50 states 30 states with a 2-year CE term require between 20 and 40 hours Of the 50 states that require CE, most require below the median annual of 12 hours 23 10 17 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 10 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may restrict licensure based on a felony conviction. The board may also reject applicants when it determines they do not possess good moral character. Georgia is one of: 6 southeastern states that may restrict licensure based on prior criminal history 6 southeastern states that have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. As shown below, Georgia is one of: 33 states that allow reciprocity 33 18 Yes No 51 states that require an associate's degree Minimum age requirements unavailable due to invalid data 51 states that require a professional examination 32 states that require two examinations in addition to the professional examination 51 states that have a training requirement in addition to an education requirement (Like 19 other states, Georgia requires two years of training) 50 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 11 Dieticians Dieticians plan and conduct food service or nutritional programs to assist in promoting health and disease control. They may also supervise a department that provides quantity food services, counsel individuals, or conduct nutritional research. As of January 2021, the Georgia Board of Examiners of Licensed Dieticians licensed approximately 2,700 Dieticians. Georgia is one of 36 states that require licensure 8 7 36 None Registration Licensure Costs Like Georgia, most states require a license and renewal (of licensure or registration) every two years. Georgia's licensure fee of $75 and renewal fee of $50 are lower than the respective national averages. Georgia's licensure fee is lower than the national fee average, similar to 24 other states GA Average $20 $75 $146 $390 25 states 18 states 26 states require license renewal ever two years 15 26 2 1 2 3+ Georgia's renewal fee is lower than the national average GA Average $20 $50 $101 27 states 16 states $250 Continuing Education Like 19 states, Georgia requires continuing education (CE) hours to be completed every two years. Its requirement of 30 hours is similar to most other states. 19 states require CE to be completed every two years 7 19 17 1 2 3+ 14 States with a two-year CE term require 30 hours 14 annual CE hours required on average by the 43 states Of the 43 states that require CE, most require the median annual of 15 hours 6 37 Below At Median Comparison of Georgia's Regulation of Specific Health-Related Professions 12 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may restrict licensure based on any criminal conviction. However, applicants are not subject to a "good moral character" requirement. Georgia is one of: 40 states that may restrict licensure based on a prior criminal history 31 states that do not have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. However, while Georgia sets a minimum age at 18, most states set no minimum age. As shown below, Georgia is one of: 35 states that allow reciprocity 35 8 Yes No 43 states that require a Post-Graduate degree 9 states that set a minimum age 43 states that require applicants to pass a professional examination 42 states that do not require examinations in addition to the professional examination 43 states that do not require training 43 states that require 1,200 hours of experience Comparison of Georgia's Regulation of Specific Health-Related Professions 13 Emergency Medical Technicians Emergency Medical Technicians (EMTs) and paramedics care for the sick or injured in emergency medical settings. EMTs and paramedics respond to emergency calls, perform medical services, and transport patients to medical facilities. The Georgia Department of Public Health licenses EMTs and paramedics separately and specifies practices each can perform. As of June 2021, Georgia licensed 14,500 EMTs and approximately 8,300 paramedics. Georgia is one of 24 states that require licensure 24 27 Licensure Certification Costs While all states require licensure or certification, as shown below, Georgia is 1 of 33 states that charge an application and initial fee (e.g., licensure fee). All states require renewal every two years, and most charge a single fee once every two years. Georgia's licensure fee of $75, and renewal of $90, are both above the national fee average. Georgia's licensure fee is higher than the national fee average Average GA $0 $10 $39 $75 18 states 11 states 22 states $150 All states require license renewal every two years 51 2 Georgia's renewal fee is higher than the national fee average $0 2 states Average $15 $21 39 states GA $90 10 states $115 Continuing Education Like all states, Georgia requires continuing education (CE) hours to be completed every two years. It requires 40 hours of continuing education every two years, which is comparable to many other states. 51 states require CE to be completed every two years 46 states with a two-year CE term require 40 hours 20 annual CE hours required on average by the 51 states 46 states require the median annual of 20 hours Comparison of Georgia's Regulation of Specific Health-Related Professions 14 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may restrict licensure based on a felony or other specified conviction. However, applicants are not subject to a good moral character clause. Georgia is one of: 4 southeastern states that may restrict licensure based on prior criminal history 7 southeastern states that have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are not always similar to those in other states. Most states set a minimum age of 18 or older and require training (defined as an approved EMT or a specified number of hours); however, Georgia does not. As shown below, Georgia is one of: 40 states that do not allow reciprocity12 11 40 Yes No 51 states that do not require an educational degree 5 states that do not set a minimum age 51 states that require a professional examination 48 States that require an exam in addition to the professional exam 2 51 states that do not have a training requirement states that do not have an experience requirement 12 Many of these states require EMTs to be part of the National Registry of EMTs (NREMT). This organization oversees the testing and continuing education of EMTs, and participation allows for easy transfer of credentials between states. In Georgia, this is not defined as reciprocity, but it is an avenue for portability. Comparison of Georgia's Regulation of Specific Health-Related Professions 15 Licensed Practical Nurses Licensed Practical Nurses (LPNs) provide basic nursing care under the direction of registered nurses and doctors. As of January 2021, the Georgia Board of Nursing licensed approximately 31,200 LPNs. Georgia is 1 of 51 states that require licensure 51 Licensure Costs Like Georgia, most states require a license and renewal every one to two years. Georgia's licensure fee of $40 is lower than the national average. Unlike 48 other states, Georgia does not charge a renewal fee. Georgia's licensure fee is lower than the national average, similar to 30 states GA Average $0 $30 $40 $102 $250 1 state 31 states 19 states 43 states require licensure renewal every two years 5 43 3 Georgia does not charge a renewal fee GA $0 3 states Average $15 $83 26 states 22 states $165 1 2 3+ Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. The 30hour CE requirement every two years is also comparable to many other states. 28 states require CE to be completed every two years 20 2 28 1 Not Required 1 2 3 24 States with a two-year CE term require between 20 and 30 hours 12 annual CE hours required on average by the 31 states Of the 31 states that require CE, most require at or above the median of 12 hours 11 7 13 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 16 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may restrict licensure based on a felony or other specified conviction. However, applicants are not subject to a good moral character requirement. Georgia is one of: 4 southeastern states that may restrict licensure based on prior criminal history 6 southeastern states that do not have a Good Moral Character clause in statute Basic Requirements Most of Georgia's basic licensure requirements are similar to those in other states. As shown below, Georgia is one of: 51 states that allow reciprocity 51 Yes 51 states that require an associate's degree Minimum age requirements unavailable due to invalid data 51 states that require applicants to pass a national examination 3 states that require examinations in addition to the national professional examination 51 states that do not require training 51 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 17 Massage Therapists Massage Therapists perform therapeutic massage of soft tissues and joints. They may assist in assessing range of motion and muscle strength or propose client therapy plans. Georgia specifically includes cupping therapy, superficial heat/cold, and topical preparations, while it excludes deep thermal ultrasounds and lasers from permitted practices. As of January 2021, the Georgia Board of Massage Therapy licensed approximately 5,800 Massage Therapists. Georgia is one of 46 states that require licensure 5 46 None Licensure Costs Like Georgia, most states require a license and renewal every two years. Georgia's licensure fee of $125 and renewal fee of $75 are lower than the respective national averages. Georgia's licensure fee is lower than the national average, similar to 27 other states GA Average $50 $125 $169 $375 28 states 18 states 34 states require renewal every two years 9 34 1 2 3+ Georgia's renewal fee is lower than the national average GA Average 3 $30 $75 $115 $410 30 states 16 states Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. However, its requirement of 50 hours is more than most with a two-year term. 30 states require CE to be completed every two years 7 7 30 2 Not Required 1 2 3 18 states with a two-year CE term require at least 40 hours 18 annual CE hours required on average by the 39 states 39 states' requirements are fairly evenly divided above and below the median of 18 hours 18 2 19 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 18 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may not restrict licensure of individuals based on prior criminal history. However, the board may reject applicants when it determines they do not possess good moral character. Georgia is one of: 3 southeastern states that do not restrict licensure based on prior convictions 3 southeastern states that have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. As shown below, Georgia is one of: 45 states that allow reciprocity 45 1 44 states that require training instead of a specific degree Yes No 30 states that specify a minimum age of 18 46 states that require applicants to pass a professional examination 38 states that do not require examinations in addition to the professional examination 33 states that require 500 hours of training 43 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 19 Occupational Therapy Assistants Occupational Therapy Assistants help patients develop, recover, and improve the skills needed for daily living and working. Occupational Therapy Assistants are directly involved in providing therapy to patients under the direction of occupational therapists. As of January 2021, the Georgia Board of Occupational Therapy had approximately 1,500 licensed Occupational Therapy Assistants. Georgia is 1 of 50 states that require licensure 1 50 None Licensure Costs Like Georgia, most states require a license and renewal every two years. Georgia's licensure fee of $50 and renewal fee of $55 are lower than the respective national averages. Georgia's licensure fee is lower than the national average, similar to 27 other states GA Average $0 $50 $119 $325 2 states 28 states 20 states 39 states require license renewal every two years Georgia's renewal fee is lower than the national average 10 39 1 2 3+ 1 $0 4 states GA Average $10 $55 $93 24 states 22 states $351 Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. Its 24- hour CE requirement is similar to other two-year term states; requirements range from 12 to 40 hours. 35 states require CE to be completed every two years 59 35 1 12 states with a two-year CE term require 24 hours Not Required 1 2 3+ 11 annual CE hours required on average by the 45 states Of the 45 states that require CE, Georgia is 1 of 9 that require the median annual of 12 hours 20 9 16 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 20 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may not restrict licensure of individuals based on prior criminal history. However, the board may reject applicants when it determines they do not possess good moral character. Georgia is one of: 3 southeastern states that do not restrict licensure based on prior convictions 7 southeastern states that have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. Georgia requires eight weeks of experience, similar to 20 other states. Ten states require fieldwork as prescribed by the respective accrediting institutions; the remaining 13 states require between 12 and 24 weeks of experience. As shown below, Georgia is one of: 41 states that allow reciprocity 41 9 Yes No 50 states that require an associate's degree Minimum age requirements unavailable due to invalid data 50 states that require applicants to pass a professional examination 43 states that do not require examinations in addition to a professional examination 50 states that do not require training 43 states that have an experience requirement Comparison of Georgia's Regulation of Specific Health-Related Professions 21 Pharmacy Technicians In Georgia, Pharmacy Technicians may provide nonjudgmental technical services related to preparing for dispensing prescriptions under the direct supervision of a Pharmacist. As of June 2021, the Georgia Board of Pharmacy had approximately 27,900 registered Pharmacy Technicians. Georgia is one of nine states that require registration 6 9 36 None Registration Licensure Costs Most states require licensure; however, Georgia requires registration. Most states also require the license or registration to be renewed every two years. Georgia's registration fee of $70 and renewal fee of $60 are higher than the respective national averages. Georgia's registration fee is higher than the national fee average and similar to 18 other states Average GA $0 $25 $70 $100 $167 1 state 25 states 19 states 26 states require registration or license renewal every two years 18 26 12 Georgia's renewal fee is higher than the national fee average Average GA $0 $15 $49 $60 1 state 21 states 23 states $140 Continuing Education Like 16 other states, Georgia does not require continuing education (CE). Therefore, the charts below do not include Georgia; however, they are included to show the average and median hours for states that require CE. Georgia is one of 17 states that do not require CE to be completed Of the 17 states with a two-year CE term, most require 40 hours 17 11 17 1 111 14 Not Requred 1 year 2 years 12 20 24 40 15 annual CE hours required on average by the 28 states Of the 28 states, 14 require more and 14 require less than the median annual of 16 hours 14 14 Below Above Comparison of Georgia's Regulation of Specific Health-Related Professions 22 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may not restrict licensure based on prior criminal history. Additionally, applicants are not subject to a good moral character requirement. Georgia is one of: 5 southeastern states that do not restrict licensure based on prior convictions 6 southeastern states that do not have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are not always similar to those in other states. Most states allow reciprocity and require a professional examination (or allow the employer to require one); however, Georgia does not. As shown below, Georgia is one of: Six states that do not allow reciprocity 39 6 Yes No 39 states that do not require an educational degree 27 states that require a minimum age of 17 or higher 15 35 22 None 16 17 18 Five states that do not require passage of a professional examination 19 5 21 Yes No Employer Decision 44 states that do not require examinations in addition to a professional examination 40 states that do not require training 36 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 23 Physical Therapy Assistants Physical Therapy Assistants work under the direction and supervision of physical therapists. They help patients who are recovering from injuries and illness, primarily by assisting with movement and managing pain. As of January 2021, the Georgia Board of Physical Therapy had approximately 2,700 licensed Physical Therapy Assistants. All states require licensure 51 Licensure Costs Like Georgia, most states require a license and renewal every two years. Georgia's licensure fee of $75 and renewal fee of $90 are lower than the respective national averages. Georgia's licensure fee is lower than the national average, similar to 28 other states GA Average $0 $25 $75 $143 $390 1 state 29 states 21 states 37 states require license renewal every two years 12 37 1 2 3+ Georgia's renewal fee is lower than the national average $0 3 states GA $30 $45 28 states Average $90 20 states $300 Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. Georgia's requirement of 30 hours every two years is similar to other states and at the annual median requirement of 15 hours. (Note: Colorado requires licensure renewal, and CE is required every 1-3 years as determined by the board. Due to the unique nature of this provision, Colorado was not included in the comparisons below.) 36 states require license renewal every two years 4 10 36 1 Not Required (or other) 1 2 3+ 14 annual CE hours required on average by the 47 states 32 states with a two-year term require between 20 and 30 hours of CE Of the 47 states that require CE, most require more than the median of 15 hours 13 9 25 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 24 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may restrict licensure based on a felony conviction. However, applicants are not subject to a good moral character requirement. Georgia is one of: 6 southeastern states that may restrict licensure based on prior criminal history 5 southeastern states that do not have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. Most states--like Georgia--require passage of one or more examinations in addition to a professional examination. As shown below, Georgia is one of: 49 states that allow reciprocity 49 2 51 States that require an associate's degree Yes No Minimum age requirements unavailable due to invalid data 51 states that require passage of a professional examination 51 states that do not require training 24 states that require an examination in addition to a professional examination 24 24 3 None 1 2 50 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 25 Radiological Technologists Radiological Technologists take X-rays and CAT (computed tomography) scans or administer nonradioactive materials into patient's blood stream for diagnostic purposes. The profession also includes technologists who specialize in other scanning modalities. Georgia does not regulate Radiological Technologists, but information on other states is included below for comparison purposes. As of June 2021, the Georgia Society of Radiological Technologists reported 12,000 technologists in the state. Georgia is one of nine states that do not require licensure 9 42 None Licensure Costs Most states--unlike Georgia--require a license and renewal every two years. Georgia does not regulate Radiological Technologists, but information on other states is included below for comparison purposes. $200 42 states charge a licensing fee Average $259 20 states 22 states $425 41 states require license renewal every two years 1 41 12 24 states have a renewal fee that is lower than the national average Average $50 $88 $200 24 states 18 states Continuing Education Most states that regulate the profession require 24 continuing education (CE) hours to be completed every two years. 41 states require CE renewal every two years (one state requires annual renewal) 39 states with a two-year CE term require 24 hours 12 annual CE hours required on average by the 42 states 40 states require the median annual of 12 hours Comparison of Georgia's Regulation of Specific Health-Related Professions 26 Licensure Restrictions Based on Prior Criminal History Of the five southeastern states that regulate Radiological Technologists--Florida, Kentucky, Mississippi, South Carolina, and Tennessee--most do not restrict licensure based on prior criminal history. Additionally, most do not allow the board to reject applicants when it determines they do not possess good moral character. 3 southeastern states do not restrict licensure based on prior criminal history 4 southeastern states do not have a Good Moral Character clause in statute Basic Requirements: Of the 42 states that license Radiological Technologists: 41 states allow reciprocity 41 1 41 states require training Yes No 35 states do not have a minimum age 42 states require applicants to pass a professional examination 41 states do not require examinations in addition to a professional examination 41 states require two years of training 42 states do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 27 Registered Nurses Registered Nurses assess patient health problems and needs, develop and implement nursing care plans, maintain medical records, and administer nursing care to ill, injured, convalescent, or disabled patients. In Georgia, they may also manage, supervise, and teach nurses; administer, order, and dispense medication, diagnostics, and other treatment; and collaborate with other healthcare providers. As of January 2021, the Georgia Board of Nursing had approximately 134,000 licensed Registered Nurses. All states require licensure 51 Licensure Costs Like Georgia, most states require a license and renewal every two years. Georgia's licensure fee of $40 and renewal fee of $65 are lower than the national averages. Georgia's licensure fee is lower than the national average, similar to 31 other states GA Average $0 $25 $40 $126 $350 1 state 32 states 18 states 42 states require license renewal every two years 4 42 5 1 2 3+ Georgia's renewal fee is lower than the national average GA $40 $65 29 states Average $103 * Delaware omitted from analysis because of data entry error. N=50 21 states $200 Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. However, its requirement of 30 hours is slightly more than most with a two-year term. 30 states require CE to be completed every two years Of the 30 states with a two-year CE term, Georgia is 1 of 13 that require 30 hours 14 3 30 4 15 13 11 Not Required 1 2 3+ 26 annual CE hours required on average by the 37 states 10-25 30 50 75 Of the 37 states that require CE, Georgia is 1 of 18 that require more than the median annual of 12 hours 10 9 18 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 28 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may restrict licensure based on any prior conviction. The board may also reject applicants when it determines they do not possess good moral character. Georgia is one of: 42 states that may restrict licensure based on a prior conviction 18 states that have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. As shown below, Georgia is one of: 51 states that allow reciprocity 51 47 states that require a bachelor's degree Yes 47 states that do not specify a minimum age 51 states that require applicants to pass a national examination 39 states that require examinations in addition to a professional examination 47 states that require two years of training 51 states that do not require experience Comparison of Georgia's Regulation of Specific Health-Related Professions 29 Respiratory Therapists Respiratory Therapists assess, treat, and care for patients with breathing disorders. They assume primary responsibility for all respiratory care modalities, which includes supervising respiratory therapy technicians; initiating and conducting therapeutic procedures; maintaining patient records; and selecting, assembling, checking, and operating equipment. As of February 2021, the Georgia Composite Medical Board had approximately 5,700 licensed Respiratory Therapists. 50 states require licensure 1 50 None Licensure Costs Like Georgia, most states require a license and renewal every two years. Georgia's licensure fee of $340 and renewal fee of $105 are higher than the national averages. Georgia's licensure fee is higher than the national average, similar to 19 other states Average GA $190 $326 $340 $530 30 states 20 states 35 states require license renewal every two years 13 35 2 Georgia's renewal fee is higher than the national average Average GA $0 $25 $102 $105 $250 1 state 31 states 18 states 1 2 3+ Continuing Education Like most states, Georgia requires continuing education (CE) hours to be completed every two years. However, its requirement of 30 hours is more than most states with a two-year term. 34 states require CE to be completed every two years Of the 34 states with a 2-year CE term, Georgia is 1 of 7 that requires 30 hours 5 10 34 1 3 22 10 10 7 Not Required 1 2 3+ 11 annual CE hours required on average by the 45 states 12 15 16 20 24 30 Of the 45 states that require CE, Georgia is 1 of 22 that require more than the median annual of 10 hours 10 13 22 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 30 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may not restrict licensure based on prior criminal history. However, the board may reject applicants when it determines they do not possess good moral character. Georgia is one of: 6 southeastern states that do not restrict licensure based on prior criminal history 3 southeastern states that have a Good Moral Character clause in statute Basic Requirements Georgia's basic licensure requirements are similar to those in other states. As shown below, Georgia is one of: 43 states that allow reciprocity 43 7 Yes No 50 states that require an associate's degree 10 states that require a minimum age of 18 40 10 None 18 50 states that require applicants to pass a national examination 50 states that require examinations additional to a professional examination 50 states that do not require training Experience requirements unavailable due to invalid data13 13 Georgia's Composite Medical Board requires three months of experience, per rule. Comparison of Georgia's Regulation of Specific Health-Related Professions 31 Skin Care Specialists Skin Care Specialists (referred to as Estheticians in Georgia) "cleanse and beautify the face and body to enhance a person's appearance." In Georgia, these practices can include cosmetic skin care such as waxing, eyebrow threading, and eyelash dyeing. As of January 2021, the Georgia Board of Cosmetology and Barbers had approximately 6,300 licensed Estheticians. Georgia is one of 50 states that require licensure 1 50 None Licensure Costs Like Georgia, most states require a license and renewal every two years. Georgia's licensure fee of $90 and renewal fee of $90 are higher than the respective national averages. Georgia's licensure fee is higher than the national average, similar to 16 other states Average GA $0 $10 $57 $90 $330 4 states 29 states 17 states 37 states require license renewal every two years 10 37 3 1 2 3+ Georgia's renewal fee is higher than the national average Average GA $0 $15 $56 $90 1 state 32 states 18 states $180 Continuing Education Unlike most states, Georgia requires continuing education (CE) hours to be completed every two years. Its requirement of five hours is less than most with a two-year term. 10 states require CE to be completed every two years 37 1 10 2 Not Required 1 2 3+ 13 states with a 2-year term require between 4 and16 hours of CE 4 annual CE hours required on average by the 13 states Of the 13 states that require CE, most require at or less than the median annual of 4 hours 3 4 6 Below At Median Above Comparison of Georgia's Regulation of Specific Health-Related Professions 32 Licensure Restrictions Based on Prior Criminal History In Georgia, the licensing board may not restrict licensure based on prior criminal history. Additionally, applicants are not subject to a good moral character requirement. Georgia is one of: 5 southeastern states that do not restrict licensure based on prior convictions 6 southeastern states that do not have a Good Moral Character clause in statute Basic Requirements Some of Georgia's basic licensure requirements are different from those in other states. For example, its requirement for 1,000 training hours is significantly higher than most states. Unlike 35 states, Georgia requires experience, and its requirement of 2,000 hours is higher than all but 4 other states. Finally, Georgia does not require an additional examination, while the majority of states require at least one. As shown below, Georgia is one of: 48 states that allow reciprocity 48 2 Yes No 50 states that require training or allow training to reduce another requirement 23 states that require a minimum age of 17 or higher 12 15 14 9 None 16 17 18 50 states require passage of a professional examination 11 states that do not require examinations in addition to a professional examination 11 32 7 13 states that require more than 600 hours of training 9 28 13 Less than 600 600 More than 600 None 1 2 4 states that require 2,000 hours or more of experience (remaining 11 states require between 350 hours and 1,600 hours) Comparison of Georgia's Regulation of Specific Health-Related Professions 33 Appendix A: Objectives, Scope and Methodology Objectives This review builds upon data form the National Conference of State Legislatures' (NCSL) Occupational Licensing Database to compare certain data points of Georgia professional regulatory requirements to those in other states. Specifically, our review set out to determine the following: 1. Review NCSL data to ensure the data is reliable and standardize data formats; and 2. Using the NCSL data, compare the licensing characteristics for the 14 selected professions. Scope This review uses a subset of the data pre-compiled by NCSL between 2017 and 2019 for their Occupational Licensing Database. Out of the 48 professions in NCSL's data, the audit team selected 14 health-related professions to perform a detailed analysis and comparison of Georgia to other states (see Appendix C for a list of these professions). According to the U.S. Bureau of Labor Statistics (BLS), 8 of the 20 occupations with the fastest projected growth rate over the next 10 years are in health-related fields. Additionally, as of January 2021, healthrelated professions accounted for approximately half of the 488,710 professional and business licenses managed by the Georgia Secretary of State Office's Professional Licensing Board Division (PLB). It should be noted that we did not include Nursing Home Administrators in the review because of concerns with data reliability for that profession. NCSL's data contained 19 numerical and categorical data points associated with professional licensing, certifying, or registering requirements in 50 states and the District of Columbia. The 19 data points focused on categories prone to variation between states (e.g., education and training) or potential barriers to employment (e.g., prior criminal history and minimum age requirements) and were common across all professions.9 We used 15 of the 19 data points for analysis after determining that none of the 14 healthcare professions we selected used the "Experience with Education" data point and that the "Examination Fee" and "Other Fee" categories were out of date or inconsistently collected. As a result, we also eliminated the "Initial Fees," which was calculated using these two fields (see Appendix B for descriptions of the data points). To collect the data, NCSL analysts took a tiered approach by first reviewing each respective state's enabling legislation and then rules and regulations related to the profession. As necessary, NCSL analysts interviewed staff of state licensing, certifying, or registering entities. Initially, in 2017-2018, NCSL staff collected data on 34 professions that were licensed, certified, or registered in more than 30 states, had a projected employment growth rate above zero, and did not require more than a four-year degree. In 2018-2019, a separate set of NCSL analysts collected data on an additional 14 professions that had a growth rate above 0%. Interviews with NCSL staff indicated that they periodically identified issues with consistency and accuracy due to individual analysts' interpretations, different collection periods, and potential for human error when collecting such a large amount of data based on reviews of laws, rules, and regulations. When these issues were identified, staff reported making the required changes. Our analyses used 11 professions collected in 2017-2018, and three professions collected in 2018-2019 (see Appendix C for details). Methodology The audit team performed multiple checks for data reliability, which are discussed in detail below. Any errors identified by the audit team have been communicated to NCSL staff, who 9 Some, but not all, professions had three additional data points related to criminal history restrictions. However, NCSL staff could not verify reliable collection of these data points. Comparison of Georgia's Regulation of Specific Health-Related Professions 34 continuously update the data feeding its website based on the unsolicited feedback of state officials and ongoing legislative changes. To determine the reliability and useability of NCSL's data, we performed a detailed review of all data fields in the NCSL source data for two professions. For one healthcare profession, Physical Therapy Assistants, we reviewed state law of Georgia, Arizona, Massachusetts, and South Carolina to determine whether the audit team agreed with NCSL's interpretation and categorization of statute into the respective data points. To follow NCSL's tiered review methodology, we then reviewed rules and regulations of the respective state regulatory entity, and, as necessary, websites of the respective regulatory entities. We repeated this process for one profession not related to healthcare (Auctioneers) and reviewed Georgia, North Carolina, West Virginia, and Wisconsin to test the likelihood that we would be able to reproduce the results and draw the same conclusions. The audit team generally found that the data for these two professions were reliable and that most changes noted by the audit team had already been made to NCSL's website. As a result, the audit team compared NCSL's 2017-2019 data to information available on its website for a sample of eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) across all healthcare professions. This comparison verified that NCSL's 2017-2019 data were generally reliable, and NCSL staff could easily explain any errors or inconsistencies. Through these data reliability tests, the audit team also determined we would need to reformat selected fields, which either utilized open text or had inconsistent base units from one state to another, such as using number of weeks of training required in one state and number of months required in another. The audit team corresponded with NCSL staff throughout this process to ensure a complete understanding of their methodology. As discussed above, multiple methodological nuances created limitations to NCSL's data. Some additional methodology limitations that were not altered by the audit team include: Criminal history data points Blanket Bans and Good Moral Character were identified utilizing a keyword search of statutes. As a result, NCSL staff may have missed or overgeneralized information specific to a state or profession. Review of statute, rules, and regulations of specific professions did not consider broad overarching laws. As a result, laws such O.C.G.A. 43-1-19(q), which requires licensing boards10 to consider the relationship of the crime to the profession, are not applied to the data. States with outlier data points--although typically noted by NCSL--were categorized by NCSL staff into entries consistent with all other states, such as a simple "Yes/No" or the educational requirement of a five-year bachelor's degree into "postgraduate degree." To compare the regulatory characteristics for the 14 selected professions, we verified the accuracy of all data points entered for Georgia through a review of Georgia's statutes, rules, and regulations. As necessary, we adjusted how Georgia's data points were categorized to match our interpretation. For some professions, we reformatted certain data points to consistently show units of measure (weeks versus months) or alter open text entries (e.g., convert "30hrs x 2 years" to "30"). Based on conversations with NCSL staff and our preliminary analyses, we determined that the Cost of Initial Licensure data point was a calculation combining four other data points (Initial Fee, Application Fee, Exam Fee, and Other Fee) and that two of those data points were dated. 10 Applies only to boards under the Secretary of State's Professional Licensing Board Division. Comparison of Georgia's Regulation of Specific Health-Related Professions 35 Fees for national examinations, for example, have not remained static since 2017. The audit team eliminated the Exam Fee and Other Fee data points and created our own calculation of Cost of Initial Licensure using only Initial Fee and Application Fee. The audit team analyzed each of the 15 data points independently to determine how Georgia compared to other states. In reviewing each analysis, the audit team decided to remove the occasional outliers when one state's requirements would skew a calculation of national averages or medians. Due to data reliability concerns identified with the data points Blanket Ban and Good Moral Character, the audit team determined we could not use NCSL data for the 11 professions NCSL collected data for in 2017-2018. Instead, we used NCSL's methodology to produce our own data for these two data points by reviewing the laws, rules, and regulations of eight Southeastern states. Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee are defined as the southeast region by the U.S. Bureau of Labor Statistics, a nationally accepted source of employment information. Unlike other reports published by the Performance Audit Division, this report is not a performance audit. As such, adherence to generally accepted government standards were not relevant to this review. However, the work was conducted according to division policies and procedures for non-GAGAS engagements. These policies and procedures require that we plan and perform the engagement to obtain sufficient, appropriate evidence to provide a reasonable basis for the information reported and that data limitations be identified for the reader. Comparison of Georgia's Regulation of Specific Health-Related Professions 36 Appendix B: Data Points Collected by NCSL on Each Profession 1. Licensed (referred to as Regulatory Type for the purposes of this report) States may require a profession to be licensed, certified, or registered. 2. Education Requirement Level of education necessary to obtain licensure, certification, or registration. 3. Hours of Training Required Number of hours/units of training needed to fulfill the requirements for licensure, certification, or registration. 4. Amount of Experience Number of weeks of job experience required for licensure, certification, or registration. 5. Professional Exam Required Whether or not a professional examination is required for licensure, certification, or registration. 6. License Renewal Time (for the purposes of this report referred to as Frequency of Renewal) Number of years before renewal is required for a licensure, certification, or registration. 7. Continuing Education Requirement (for the purposes of this report referred to as CE) Hours of continuing education required to maintain licensure, certification, or registration for the state's renewal period. 8. Additional Required Exams Number of additional exams required for licensure, certification, or registration (e.g., English proficiency, local jurisprudence, etc.). 9. Cost of Initial Licensure (for the purposes of this report referred to as Cost of Initial) The maximum dollar amount that can be charged for initial licensure, certification, or registration. These fees can include the following: 10. Application Fee Fee amount for the application of initial licensure, certification, or registration. 11. Initial Fee Fee amount for the initial licensure, certification, or registration. 12. Exam Fee Fee amount for the professional examination. 13. Other Fee Additional fees required for initial licensure, certification, or registration (background checks, fingerprinting, jurisprudence exam, etc.). 14. Cost of Licensure Renewal (for the purposes of this report referred to as Cost of Renewal) The maximum dollar amount that can be charged to renew a license, certification, or registration. 15. Reciprocity or Endorsement (for the purposes of this report referred to as Reciprocity) Whether or not the state has a process for accepting individuals already licensed, certified, or registered by another state. 16. Good Moral Character Requirement (for the purposes of this report referred to as Good Moral Character) Whether or not state statute has a clause related to good moral character, crimes of moral turpitude, or similar language that could be used by boards to prevent certain individuals from becoming licensed, certified, or registered. Comparison of Georgia's Regulation of Specific Health-Related Professions 37 Appendix B: Data Points Collected by NCSL on Each Profession cont'd 17. Blanket Ban for Ex-Offenders (for the purposes of this report referred to as Restrictions) The extent to which a state has laws in place that prevent individuals with previous offenses from becoming licensed, certified, or registered. 18. Minimum Age Whether or not there a minimum age requirement for this profession, and what is that age. 19. Experience with Education The number of weeks of experience required for licensure as a result of completing an education program. The audit team did not analyze this field because it was not frequently used by professions in our sample. Comparison of Georgia's Regulation of Specific Health-Related Professions 38 Appendix C: Reviewed Professions and Oversight Body Profession Name Oversight Body Data Collected by NCSL in 2017-2018 Certified Nursing Assistants1 Department of Community Health Dental Hygienists Board of Dentistry Emergency Medical Technicians Department of Public Health Licensed Practical Nurses Board of Nursing Massage Therapists Board of Massage Therapy Occupational Therapy Assistants Board of Occupational Therapy Pharmacy Technicians2 Board of Pharmacy Physical Therapy Assistants Board of Physical Therapy Radiological Technologists3 Respiratory Therapists Composite Medical Board Skin Care Specialists (Estheticians) Board of Cosmetology and Barbers Data Collected by NCSL in 2018-2019 Athletic Trainers Board of Athletic Trainers Dieticians Board of Examiners of Licensed Dietitians Registered Nurses Board of Nursing 1 Georgia Nursing Assistants must be certified. Generally, certification requirements are less onerous than licensure requirements. 2 Georgia Pharmacy Technicians must register with the state. 3 Radiological Technologists are not currently regulated in Georgia. Our review identified common practices nationally. Source: NCSL Occupational Licensing Database and DOAA Analysis The Performance Audit Division was established in 1971 to conduct in-depth reviews of state-funded programs. Our reviews determine if programs are meeting goals and objectives; measure program results and effectiveness; identify alternate methods to meet goals; evaluate efficiency of resource allocation; assess compliance with laws and regulations; and provide credible management information to decision makers. For more information, contact us at (404)656-2180 or visit our website at www.audits.ga.gov.