Top 5 Issues for 2016: Interstate Compacts

Colmon Elridge, Director of CSG's National Center for Interstate Compacts, outlines compacts to watch in 2016, including those dealing with health care licensing and the State Authorization Reciprocity Agreement, which seeks to achieve interstate reciprocity in the regulation of distance education.  He also discusses non-congressionally consented compacts and international interstate compacts.  

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From transportation, to health care, to education, there is no shortage of issues confronting state governments across the nation. As states continue to shape priorities while rebounding from the worst economic recession since the Great Depression, they increasingly are working collaboratively, using interstate compacts and erasing the silos of state lines, to meet the needs of the American people. Governed by the tenets of contract law, interstate compacts provide states an enforceable, sustainable and durable tool capable of ensuring permanent change without federal intervention. There are currently more than 215 interstate compacts and on average each state is a member of 25 compacts. The Council of State Governments National Center for Interstate Compacts (CSG-NCIC) has worked hand-in-hand with professional organizations, state governments, and advocates to creatively find solutions to a variety of issues. Below are a few pieces of legislation that state legislatures may consider in 2016.

Medical Licensing Compact
CSG-NCIC has worked with state medical boards, state legislatures, the Federation of State Medical Boards, and subject matter experts to develop the Interstate Medical Licensure Compact (IMLC) and the accompanying legislation. The compact, created in part to expand patient access to care, creates a process for expedited licensing for doctors who qualify to practice in multiple states. Eleven states passed the IMLC legislation, creating the Interstate Medical Licensure Commission. The commission’s inaugural meeting was held in October 2015. To read the final compact language, learn more about license portability, or the work of the commission, please click here.

Health Care Licensure Compacts
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. Several challenges contributing significantly to these costs are access to health care in hard-to-serve locations and problems accessing care, which 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. CSG-NCIC is working on securing that passage of licensure compact legislation with the Federation of State Boards of Physical Therapy (FSBPT), the National Council of State Boards of Nursing (NCSBN), and the National Association of State EMS Officials.

To read the final compact language for each initiative, please follow the links below:

State Authorization Reciprocity Agreement

  • CSG-NCIC, 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.To date nearly 20 states have already joined and that number is expected to continue growing in 2015. To learn more about SARA, please click here.

Non-Congressionally Consented Compacts
While interstate compacts are not new, new issues surrounding the implementation, enforcement, and amending of compacts are readjusting the landscape. Questions surrounding the issue of Multistate Tax Compact election are in
courts not only in California but also in Michigan, Minnesota and Oregon. While the California case is widely watched for precedence, the Michigan Supreme Court has already ruled in favor of the taxpayer in a similar case, IBM vs. the Michigan Department of Treasury. Eighteen states, including the District of Columbia, are members of the Multistate Tax Compact.

For more information on the above cases, please click the following:

International Interstate Compacts 
On average, most states are members of about 25 compacts. However, many states, including but not limited to states that include international borders, are increasingly entering into compacts that include in their membership foreign nations. As states continue to assess how best to confront a range of issues from the environment, to economic development, to immigration, working collaboratively with one another and like-minded nations on the sharing of resources and information serves as a reminder that the power of states to meet the needs of their people does not necessarily stop at the borders' edge.

For more information on the compacts listed above, please click the following:

To track the progress of these and other compacts, commissions, or cases, please visit the CSG National Center for Interstate Compacts—the only organization of its kind—at or contact center director, Colmon Elridge at

Top 5 Issues for 2016: Interstate Compacts