Interstate Licensure Compacts Explained

Interstate licensure compacts allow professionals to practice in multiple states with a single license or streamlined process. The Nurse Licensure Compact covers 43 states, while physicians can use the Interstate Medical Licensure Compact (also 43 states) for expedited licensing, according to NCSBN and FSMB data.

What is an interstate licensure compact?

Interstate compacts are legal agreements between states, authorized under the U.S. Constitution’s Compact Clause. When states join a compact, they agree to recognize each other’s licenses under specific conditions, creating a form of managed reciprocity.

Why Compacts Exist

The traditional licensing model creates friction:

• Professionals must apply separately in each state
• Requirements vary, creating administrative burden
• Delays in licensing restrict workforce mobility
• Consumers in underserved areas have limited access to professionals

Compacts address these issues by:

• Streamlining interstate practice
• Maintaining state regulatory authority
• Establishing uniform standards
• Increasing access to services

Which professions have interstate licensure compacts?

Nurse Licensure Compact (NLC)

Status: 43 participating states (as of 2026)

The NLC is the most established healthcare compact, allowing RNs and LPNs to practice in any member state with a single multistate license.

Key features:

• Single license for practice in all member states
• Must be licensed in state of primary residence
• Uniform licensure requirements
• Allows both in-person and telehealth practice

Who benefits:

• Travel nurses
• Telehealth providers
• Military families
• Border community nurses

Interstate Medical Licensure Compact (IMLC)

Status: 43 participating states

The IMLC expedites licensing for physicians who want to practice in multiple states.

Key features:

• Expedited process (not automatic reciprocity)
• Must hold full, unrestricted license in home state
• Separate license issued by each state
• Background check required

How it works:

1. Apply through IMLC portal
2. Pay fees for each state license desired
3. States process applications within 7-10 days
4. Receive individual state licenses

Important distinction: Unlike the NLC, the IMLC results in separate state licenses, not a single multistate license.

Physical Therapy Compact

Status: 35+ participating states

Physical therapists and physical therapist assistants can practice across member states.

Key features:

• Compact privilege allows practice in member states
• Must hold license in home state
• Purchase privilege for each state where you’ll practice
• Annual renewal of compact privileges

Psychology Interjurisdictional Compact (PSYPACT)

Status: 40+ participating states

Psychologists can practice telepsychology and conduct temporary in-person practice in member states.

Key features:

• Authority to Practice Interjurisdictional Telepsychology (APIT)
• Temporary In-Person, Face-to-Face Practice (Temporary Authorization)
• Must meet home state requirements
• Facilitates telehealth psychology services

EMS Compact (REPLICA)

Status: 25+ participating states

Paramedics and EMTs can practice across state lines.

Key features:

• Privilege to practice in member states
• Particularly useful for emergency response
• Supports mutual aid during disasters
• Covers all EMS levels (EMT, AEMT, Paramedic)

Other Notable Compacts

Compact	Profession	States
Counseling Compact	Licensed Counselors	30+
Audiology & Speech Compact	Audiologists, SLPs	30+
Occupational Therapy Compact	OTs, OTAs	25+
Advanced Practice Nurse Compact	APRNs	Emerging (7 states needed)

How are compacts different from traditional license reciprocity?

Traditional Endorsement

Without compacts, professionals must:

1. Apply to each state individually
2. Pay full application fees
3. Submit transcripts, verification, background checks
4. Wait weeks to months for processing
5. Maintain separate license renewals

Compact Practice

With a compact:

Aspect	Compact Advantage
Application	Single or streamlined process
Timeline	Days instead of weeks
Cost	Reduced fees in most cases
Maintenance	Simplified renewal
Scope	Immediate multistate practice

Joining a Compact: State Perspective

States must pass legislation to join a compact. The process typically involves:

Legislative Process

1. Introduction: Legislator introduces compact bill
2. Committee review: Healthcare or licensing committee hearings
3. Floor votes: Both chambers must pass
4. Governor signature: Executive approval required
5. Implementation: Board of nursing/medicine adapts systems

State Considerations

States evaluate compacts based on:

• Consumer protection: Will standards be maintained?
• Revenue impact: How will fee structures change?
• Administrative capacity: Can the board implement it?
• Workforce needs: Will it help address shortages?

Why Some States Haven’t Joined

Major holdout states often cite:

• Different educational or examination standards
• Concerns about disciplinary coordination
• Revenue loss from fewer full-license applications
• Political or administrative resistance

Discipline Under Compacts

Compacts maintain robust disciplinary systems:

Home State Authority

• The state where you’re licensed handles primary discipline
• Disciplinary actions affect compact privileges in all states
• States share discipline information through coordinated databases

Practice State Authority

• Each state retains authority over practice within its borders
• Can investigate complaints about practitioners
• Can limit or revoke practice privileges

Interstate Coordination

• Compact commissions facilitate information sharing
• Discipline in one state triggers review in others
• Uniform discipline reporting requirements

How do compacts affect telehealth practice?

Compacts have become essential for telehealth practice:

Before Compacts

Telehealth providers needed licenses in:

• Their home state
• Every state where patients were located
• Resulting in dozens of license applications

With Compacts

Providers can serve patients in all member states with:

• Nursing: Multistate license covers telehealth
• Medicine: IMLC expedites additional state licenses
• Psychology: PSYPACT specifically designed for telepsychology

Remaining Challenges

• Not all states participate in relevant compacts
• Some compacts require separate “privileges” to be purchased
• Scope of practice variations still apply

Employer Implications

Organizations employing licensed professionals benefit from compact understanding:

Workforce Flexibility

• Hire professionals who can serve multiple states
• Deploy staff across state lines more easily
• Respond to demand fluctuations

Compliance Considerations

• Verify compact eligibility of employees
• Understand which states are covered
• Track compact privilege status and renewals

Strategic Hiring

• Prioritize candidates with multistate licenses
• Consider compact membership in expansion decisions
• Factor in compact trends for long-term planning

The Future of Licensure Compacts

Emerging Trends

Expansion of existing compacts: Most compacts continue adding states

New profession compacts: Teacher, dental, and other profession compacts are developing

Federal interest: Congress has shown interest in supporting compact adoption

Technology integration: Digital credentials and verification systems improving

Potential Developments

• Universal recognition legislation at federal level
• More professions developing compact frameworks
• Enhanced interstate discipline coordination
• Integration with continuing education tracking

Key Takeaways

• Compacts enable multistate practice without individual state applications
• Different professions have different compacts with varying rules
• State authority is preserved while mobility is improved
• Discipline remains coordinated across member states
• Telehealth has accelerated compact adoption and importance

For profession-specific licensing information, explore our professional guides covering healthcare, trades, and financial services.