Medical Licensing Compacts Backgrounder

The cost of health care in the United States has grown an average of 2.4 percent faster than the gross domestic product since 1970 and now represents 18 percent of the total GDP, according to the Kaiser Family Foundation. One challenge contributing significantly to these costs is access to health care in hard-to-serve locations.  A possible solution to the challenge of providing medical services in hard-to-serve locations is a series of medical licensing compacts intended to reduce existing barriers to the process of gaining licensure in multiple states. 

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The cost of health care in the United States has grown an average of 2.4 percent faster than the gross domestic product since 1970 and now represents 18 percent of the total GDP, according to the Kaiser Family Foundation. One challenge contributing significantly to these costs is access to health care in hard-to-serve locations.

Problems accessing care is especially common in rural areas. According to the American Academy of Family Physicians, 21 percent of the U.S. population lives in rural areas, but only 11 percent of medical specialists practice in those areas. The group notes that because of this disparity, patients in these areas are frequently dramatically undeserved. These patients often do not have access to the latest research, scientific breakthroughs and medicine because of where they live. Missed appointments and incomplete care can contribute to escalating health care costs.
 
Experts expect this problem to worsen as the population grows and ages and the number of insured Americans seeking health services increases as a result of the Patient Protection and Affordable Care Act. Research published by the Annals of Family Medicine estimate the United States will need an additional 52,000 primary care physicians by 2025 to keep up with growing demands on the health care system.
 
One possible solution is a series of medical licensing compacts intended to reduce existing barriers to the process of gaining licensure in multiple states. This has the potential to help facilitate telemedicine—the use of technology to aid in the delivery of medical services across long distances—and widen access to a variety of medical services in underserved areas of the nation as the Affordable Care Act is implemented. Licensing compacts also provide a mechanism to ensure state regulatory agencies maintain their licensing and disciplinary authority, while simultaneously providing a framework to share information and processes essential to licensing and regulation across a variety of medical professions. 
 
Interstate Compacts as a Solution
Interstate compacts offer one approach to achieve these goals, and in turn, improve access to health care through telehealth. Compacts are unique tools reserved for states that encourage multistate cooperation and innovative policy solutions while asserting and preserving state sovereignty.
 
Compacts, which are governed by the tenets of contract law, give states an enforceable, sustainable and durable tool capable of ensuring permanent change without federal intervention. With more than 215 interstate compacts in existence today and each state belonging to an average of 25 compacts, there is considerable legal and historical precedence for the development and use of the tool.
 
Several existing compacts deal specifically with licensing issues. Compacts such as the Driver’s License Compact and the Nurse Licensure Compact provide precedence for member states to honor licenses issued in another member state. For these reasons, a variety of medical professions are considering interstate compacts as a tool to break down existing barriers to multi-state practice.
 
Ongoing Medical Licensing Compact Work
 
EMS Licensure Compact
CSG, through its National Center for Interstate Compacts, has been working with the National Association of State EMS Officials to explore a multi-state EMS licensure compact. It is becoming more common for EMS personnel to cross state lines to provide services in a state in which they are not technically licensed and do not enjoy legal recognition. Drafting for this is well underway. Compact language should be ready for legislative consideration by 2015.
 
Medical Licensing Compact
CSG is working with The Federation of State Medical Boards to assess the feasibility of a medical licensing compact. Several factors, including changing demographics, the need for better and faster access to medical care in rural and underserved areas, the passage of the Affordable Care Act and the rise of telehealth have created unprecedented demand for health care services. Former Wyoming Gov. Jim Geringer initially proposed the concept, which memberships of CSG and The Federation of State Medical Boards’ have supported through resolutions. Compact drafting is set to begin in November.
 
Federation of the State Boards of Physical Therapists
Building on the EMS and medical licensure projects, the Federation of State Boards of Physical Therapy also has begun exploring a license portability compact for physical therapists. The physical therapy board’s membership recently passed a resolution endorsing the exploration of a compact. 
 
National Board for Certification in Occupational Therapy
The National Board for Certification in Occupational Therapy is planning a session at its annual meeting in November of this year to explore the need for license portability across state lines. The session will include presentations on the broad need for reciprocal licensing agreements and how interstate compacts can address that need. While it is too early to speculate how these various efforts will turn out, it is clear that compacts are viewed as a viable mechanism to increase access to high quality health care across state lines.
 
ADDITIONAL RESOURCES
 
For more information, contact Crady deGolian, director of CSG’s National Center for Interstate Compacts, at 859-244-8068 or cdegolian@csg.org.

Medical Licensing Compacts Backgrounder