Multi-state compacts, or agreements between states, make licensing easier to navigate by streamlining the application process.
Overview of multi-state licensing compacts
Licensing compacts are one way that state regulatory oversight of health care can offer a faster pathway to interstate telehealth practice. Compacts are created when a certain number of states agree upon a uniform standard of care and enact a state law to support that standard.
Each state in the compact agrees that a telehealth appointment occurs in the state where the patient is located at the time of the appointment. This approach enables both the home and compact states to maintain their oversight over health care professionals practicing within their borders and ensure patient safety. Provider participation in a compact is voluntary.
Did you know?
Medicare allows billing by health care providers in compacts. This is because compacts meet the federal licensing requirements (PDF) of the Centers for Medicare & Medicaid Services.
Compacts can decrease the time-consuming process for providers seeking to practice telehealth in multiple states. The average wait time for a license for physicians seeking to practice interstate in the medical licensure compact is 19 days compared to 60 days or as long as four months for an individual state license.
The compact for nurses allows for even greater flexibility, as nurses can practice in other compact states without having to obtain an additional state license.
Multi-state licensing compacts continue to gain traction as telehealth practices expand around the country.
Compacts for physicians and nurses
Interstate Medical Licensure Compact (IMLC)
The IMLC coordinates the application process for physicians so they can be licensed to practice medicine in multiple states. For a map of participating states, see the compact state map. Physicians have to pay and satisfy the requirements of each medical board in the states where they wish to practice under the IMLC model.
Tip: Provider Bridge offers a comprehensive directory of resources to help health care providers navigate state licensure requirements.
The NLC authorizes eligible nurses to practice across multiple member states while maintaining a single license. The NCL creates a multi-state license similar to a U.S. driver’s license, where the license is recognized in the home state and other compact member states. For a map of member states and pending NLC states, see NLC member states (PDF). Only nurses who declare a compact state as their primary state of residence may be eligible for a multistate license. If a nurse is a resident of a non-compact state, then the application has an extra step of applying for a license by endorsement in an NCL state.
Allied and auxiliary health care workers
Tip: The Multi-Discipline Licensure Resource Project offers licensing resources on compacts for physical therapists, psychologists, social workers, and occupational therapists, as well as online and phone support to address questions.
Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC)
The ASLP-IC authorizes telehealth and in-person practice across state lines for audiologists and speech-language pathologists. For a map of member states, see the ASLP-IC map. Similar to other compacts, the ASLP-IC facilitates access to services via telehealth, increases choice of providers, and improves continuity of care. The ASLP-IC offers a number of resources, including information for frequently asked questions.
Occupational Therapy Compact (OT compact)
Under the OT compact, occupational therapists and occupational therapy assistants who are licensed in good standing in a compact member state can practice in other compact member states under a single license. The OT compact established a licensure system that allows for instant verification of licensing information. For a map of member states, see OT compact member map.
Physical Therapy Compact (PT compact)
The PT compact authorizes eligible physical therapists to work in multiple member states under a single license. For a map of member states, see compact map. Each state in the PT compact has various fees and state-specific requirements, such as an exam, which are kept up-to-date on this list.
Psychology Interjurisdictional Compact (PSYPACT)
The PSYPACT authorizes eligible psychologists to practice telepsychology across member states. For a map of member states, see PSYPACT member map. The Association of State and Provincial Psychology Boards provides detailed information on PSYPACT and how to practice telepsychology under its authority.
Emergency medical services personnel
Emergency Medical Services Compact (EMS Compact)
Member states in the EMS compact are all represented on the interstate commission for EMS personnel practice. Each member state is represented by one appointed individual who has one seat on the commission and one vote on each issue brought before the commission. The EMS compact authorizes EMS personnel to work in multiple member states under a single license. For a list of member states, see EMS compact member states & commissioners.
The Center for Connected Health Policy (CCHP) uses an interactive map to track which states have joined multi-state licensing compacts.