Overview: Interstate Licensure Compacts and Universal License Recognition Laws

By Andrew Bates, CSG Research Associate

One state policy area that has surged in importance during the COVID-19 pandemic is occupational licensing. As the virus has strained many states’ healthcare workforces, governors and legislatures have rushed to reduce barriers to license portability and interstate practice, so that qualified professionals are better able to practice where they are needed most.

Two key mechanisms for reducing barriers to interstate practice are interstate licensure compacts and universal licensure recognition laws (sometimes referred to as “universal reciprocity,” “universal licensure by endorsement,” or simply “universal licensure”).

These two policy tools share a similar aim: allowing for expeditious interstate practice by qualified professionals, including military spouses. However, they differ in several important ways.

Interstate compacts are statutorily enacted contracts in which states agree upon a set of uniform licensure requirements for a given profession. Any professional in good standing who meets these requirements is eligible to practice in any state that is a member of the compact, including through telehealth. Eligibility can be verified almost instantly via a licensure data system through which all member states share investigative and disciplinary information. A key advantage of interstate compacts is that they facilitate continuity of practice when a client or provider relocates to another compact member state. However, development and enactment of compacts can take two or three years.

Whereas compacts are tailored to a given profession, universal recognition laws attempt to account for all professions regulated by a state. These laws allow licensed out-of-state professionals to practice within a given state, but they do not affect in-state professionals’ ability to practice in person or via telehealth in other states and thus do not enable continuity of care in most client-provider relationships. An advantage of recognition laws is that they can be enacted in a single legislative session. However, they do not provide for the same near-instant licensure verification as interstate compacts, and they lack the enhanced public protection capability of a compact’s data system. 

These two mechanisms need not be mutually exclusive – interstate licensure compacts can coexist with universal recognition laws as part of a states’ broader occupational licensing strategy, as long as the universal laws include an exception for compacts.

CSG has compiled this report to highlight the similarities and differences between these two policy tools, and to show how they can work together to reduce barriers to practice and improve the resiliency of state workforces.

Download the full report: https://licensing.csg.org/wp-content/uploads/2021/02/Compacts_vs_UniversalRec_Final.pdf

The report cover of Interstate Licensure Compacts and Universal License Recognition Laws Fact Sheet from The Council of State Governments National Center for Interstate Compacts.