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The goal of this report is to document the growth of the central panel movement that has now emerged in a majority of states. This research is designed to provide data-informed recommendations to states and municipalities considering the adoption of a central panel system or the enlargement of the jurisdiction encompassed by an existing central panel as well as to states considering the adoption of a more final decision-making authority for their central panel ALJs. The work is also intended to inform the debate over whether the central panel approach is something that the federal government should consider. This research looks at such issues as the cost efficiency of central panels as well as the effect that central panels have on fairness. We also look at what characteristics are most likely to increase efficiency while maintaining the benefits of expertise and specialization, including finality of decision-making, whether jurisdiction is mandatory or optional, and how judges are assigned to cases.