Top 5 Issues for 2015: Interstate Compacts

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.  

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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, 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. Each state belongs to an average of 25 compacts; more than 215 interstate compacts operate today. Legislatures will have the opportunity in the coming months to consider several projects facilitated by The Council of State Governments’ National Center for Interstate Compacts.

Compacts Ready for Legislative Consideration

Medical Licensing Compact
CSG has been working for approximately two years with the Federation of State Medical Boards to develop 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 Patient Protection and Affordable Care Act and the rise of telemedicine—have created unprecedented demand for health care services. The finalized compact language creates a process for expedited licensing for doctors wishing to practice in multiple states. 

EMS Licensing Compact
It is becoming more common for emergency services personnel to cross state lines to provide services in non-declared states of emergency, which is making interstate cooperation for EMS licensing more urgent. For that reason, CSG and the National Association of State EMS Officials have developed an EMS Licensing Compact. Under the terms of the new agreement, member states would agree to honor other jurisdictions’ licenses as long as the license is issued in another member state in a manner consistent with the new compact. 

Compacts in Development

Physical Therapy and Telepsychology Licensing Compacts
The Federation of State Boards of Physical Therapy and the Association of State and Provincial Psychology Boards are continuing efforts to draft license portability compacts for their respective professions. Both groups began exploring compacts in 2014 and are expected to finish drafting in 2015. Staff from CSG’s National Center for Interstate Compacts will participate with both projects.

Each effort is being driven by a desire to make affordable health care 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. Access to health care in hard-to-serve locations is one factor contributing significantly to these 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. In addition, these agreements would allow practitioners to more easily move to, and practice in, multiple states in an increasingly mobile society.

Additional CSG-supported Agreements

State Authorization Reciprocity Agreement
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 support from a newly established national office and the existing regional compacts, about 20 states have already joined and that number is expected to continue growing in 2015. To learn more about the State Authorization Reciprocity Agreement, please visit

To review final compact language and 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