Top Five Issues in 2014: Interstate Compacts

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 without federal intervention.  Each state belongs to an average of 25 compacts, of the more than 215 interstate compacts in existence.

Legislatures will have the opportunity to consider several CSG-facilitated projects in the coming months.

Interstate Compact for the Siting of Electricity Transmission Lines

The Energy Policy Act of 2005 granted states advance congressional consent to create regional interstate compacts governing the siting of interstate transmission lines. At the request of its membership, CSG began exploring—and ultimately developing—an electric transmission line siting compact to help move energy from where it is produced to where it is needed. Compact drafting is finalized and the language is now ready for legislative consideration.

Work began in 2011 with two Advisory Team meetings.  During the initial meetings the advisory team explored the use of an interstate compact to facilitate transmission line siting and eventually endorsed the creation of a transmission line siting compact. A drafting team met five times total, both in person and electronically, beginning in late 2011. The drafting team finished their work in October of 2012.  CSG is also working closely with federal officials to ensure they are aware of the compact and gauge their willingness to participate. To learn more about the Electric Transmission Line Siting Compact please click here

State Authorization Reciprocity Agreement

Many of today’s colleges and universities employ online learning with varied degrees of onsite support for students on a national, and even international, scale. Regulatory requirements and evaluative measures, however, vary considerably from state to state, making interstate reciprocity difficult to achieve. This problem is costing states and institutions significant amounts of money.

CSG, The Presidents’ Forum, the existing regional higher education compacts and The Commission on the Regulation of Postsecondary Distance Education have collaborated to advance an effective, practical framework to achieve interstate reciprocity in the regulation of distance education. This voluntary State Authorization Reciprocity Agreement is intended to broaden the availability of and access to accredited online degree programs by reducing state regulatory barriers, while also ensuring strong consumer safeguards.

The agreement allows states and institutions to work together to address an existing patchwork of regulation across states while strengthening the states' roles in protecting students from unfair or illegal practices..  With funding from the Lumina Foundation a national office has already been formed and the agreement is ready for state and institutional participation. To learn more about SARA please click here

In addition, CSG’s National Center for Interstate Compacts is working with stakeholders on the development of other compacts, including the following:

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 telemedicine—have created unprecedented demand for health care services. Former Wyoming Gov. Jim Geringer proposed the concept, which memberships of CSG and the Federation of State Medical Boards have supported through resolutions. Compact drafting is underway.

EMS Licensing Compact

States have had the authority to license emergency medical services personnel since the 1970s. States issue licenses based on individual state practices procedures. While there is overlap between the licensing requirements, there is also considerable variation among the states. It is becoming more common for EMS emergency services personnel to cross state lines to provide services in non-declared states of emergency, which is making interstate cooperation for EMS licensing all the more urgent.

One possible way to solve this problem is the formation of an interstate compact, which would allow member states to work cooperatively to address interstate licensing challenges. CSG and the National Association of State EMS Officials have been working with a group of subject matter experts to develop an EMS Licensing Compact. Drafting is well underway and compact language should be ready for legislative consideration by 2015.

Physical Therapy and Telepsychology Licensing Compacts

The Federation of State Boards of Physical Therapy and the Association of State and Provincial Psychology Boards will begin exploring license portability compacts for their respective organizations in 2014. Both groups will convene initial advisory committee meetings in early 2014. Staff from CSG’s National Center for Interstate Compacts will participate and assist with both projects.

Each one of the efforts is being driven by a desire to make affordable healthcare across a variety of medical professions more accessible.  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 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.

To track the progress of these and other compacts, visit CSG’s National Center for Interstate Compacts—the only organization of its kind—at or contact Crady deGolian at

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