A long sought-after pathway for medical doctors to treat patients across state lines moved one step closer to reality with the inaugural meeting of the Interstate Medical Licensure Compact Commission—or IMLC—held Oct. 27-28 in Chicago.

The proposed creation of an interstate compact that would allow psychologists to practice over the phone and across state lines has been introduced by the Association of State and Provincial Psychology Boards. While still in its draft stage, the association, which has partnered with The Council of State Governments’ National Center for Interstate Compacts to develop model language, hopes to have legislation introduced in the coming 2016 legislative session.

Telehealth is one of the fastest growing sectors within the health care industry. Nurses are increasingly being asked to deliver care through electronic means, offering opportunities for better patient care regardless of geographic boundaries. The NLC is a state-based licensure model that facilitates innovative care models by allowing nurses to legally deliver that care to patients through a multistate license. The NLC also has economic benefits, as it facilitates and expedites the hiring process for employers in their state, by enabling them to verify licenses online and to recruit from other states without having to go through the entire endorsement process. The NLC reduces licensure fees for nurses who practice in more than one state, eliminates unnecessary duplicative license procedures, reduces a nurse’s ability to move to another state to avoid a disciplinary action, and provides more expedient access to nurses in times of national crises. In the face of calls for the federal government to address health care licensing nationally, the NLC also offers a state-based solution to the claims that licensure is a barrier to interstate practice.

In 2002, the NCSBN Delegate Assembly approved the adoption of model language for a licensure compact for APRNs that would facilitate interstate practice for all four APRN roles: nurse practitioners, nurse midwives, clinical nurse specialists, and nurse anesthetists. Under the APRN Compact, only states that adopted the RN and LPN/VN NLC would be eligible to implement the compact for APRNs. Utah was the first state to pass APRN Compact legislation in 2004 (Senate Bill 107) with Iowa following shortly thereafter that same year (House File 784). Texas passed the law in June 2007 (House Bill 2426). Implementation of the APRN Compact was halted due to issues surrounding lack of uniformity of APRN titles and practice from state to state. In response, NCSBN, along with other nursing organizations, developed and began implementing the APRN Consensus Model, which addressed these problems.

This Act enacts the Interstate Medical Licensure Compact. The compact: Becomes effective when adopted by seven states; Creates an interstate commission comprised of two representatives from each member state to oversee operation of the compact; Provides for physicians licensed in one compact state to obtain an expedited license in another compact state; Directs the commission to maintain a database of licensed physicians, and disciplinary records involving licensed physicians, from compact states; Provides for joint investigations and disciplinary actions; Authorizes the commission to levy and collect an assessment on member states to cover the cost of commission operations, and provides civil immunity for commission representatives and employees; Reserves member states’ rights to determine eligibility for physician licensure, license fees, grounds for discipline and continuing education requirements.

In Kansas v. Nebraska and Colorado the Supreme Court agreed with a Special Master in a dispute about water rights involving an interstate compact, that Kansas would receive partial disgorgement (a fine) but not an injunction against Nebraska and accounting procedures would be changed so that Nebraska’s use of imported water would not be count against its compact allocation. Through an interstate compact ratified in 1943, Colorado, Nebraska, and Kansas share the virgin water supply originating in the Republican River Basin. The Court adopted the Master’s recommendation of $1.8 million in disgorgement because Nebraska knowingly failed to comply with the compact by knowingly exposing Kansas to a substantial risk that it would breach the contract and because water is more valuable to farmland in Nebraska than Kansas.

Crady deGolian, Director of CSG's National Center for Interstate Compacts, outlines the top 5 compacts to watch in 2015, including those dealing with medical, EMS, physical therapy, and telepsychology licensing, and the State Authorization Reciprocity Agreement, which seeks to achieve interstate reciprocity in the regulation of distance regulation.  

When it comes to solving problems, states increasingly are turning to a mechanism that dates back to America’s colonial past—the interstate compact. Compacts are one of the few tools specifically granted to states by the U.S. Constitution. They provide states a sophisticated administrative mechanism, allowing interstate collaboration to resolve complex policy challenges.

Compacts, which are governed by the tenets of contract law, provide states an enforceable, sustainable and durable tool capable of ensuring permanent change...

With state legislative sessions getting ready to gear back up in the New Year, the newly drafted Interstate Medical Licensure Compact continues to receive wide spread endorsement from both state boards and key stakeholder groups.  To date, 17 state medical and osteopathic boards have formally endorsed the Compact, including:

Multi-State Internet Gaming Agreement (Statement)

Existing law authorizes certain gaming establishments to obtain a license to operate interactive gaming. Sections 2-5 of this bill define certain terms for the purposes of determining whether a person may be found suitable for a license to operate interactive gaming. Section 6 of this bill requires the Nevada Gaming Commission to adopt regulations authorizing the...