Interstate Professional Licensing Compact for Occupational Therapists


Overview and Timeline

The American Occupational Therapy Association (AOTA), in partnership with the National Board for Certification in Occupational Therapy (NBCOT) and the Council of State Governments (CSG), has created an interstate professional licensing compact for occupational therapy to address licensure portability.  The purpose of the Compact is to facilitate interstate practice of occupational therapy (OT) with the goal of improving public access to OT services.  An interstate licensing compact would not change state occupational therapy practice acts or the scope of practice.

In order to enter into the Occupational Therapy Licensure Compact, each participating state must pass identical legislation.  The Compact will go into effect once 10 states enact legislation.  Once enacted, a newly created Occupational Therapy Compact Commission would administer the Compact, including developing bylaws and a code of ethics; and overseeing administrative tasks, including hiring staff and managing the Compact’s data system.

How Does Licensure Portability Work Under A Compact

A compact is a legal agreement between states, which will allow licensed OTs and occupational therapy assistants (OTAs) in Maryland to practice in other states that join the compact.  Currently, OTs and OTAs must obtain licensure in each state in which they want to practice. 

OTs licensed in Maryland would still be required to meet all licensure requirements set out by the Maryland Board of Occupational Therapy Practice.  In addition, OTs licensed in other states would be subject to Maryland’s laws and regulations when providing services in Maryland through the compact. 

Improving Consumer Access While Addressing Workforce Shortages

Among the many benefits of enacting an interstate compact, the primary benefits to consumers and health care providers are to: 

  1. Improve access to OT services through facilitating the use of telehealth across state lines.  The increase of telehealth over the past several years has led to a myriad of differing state laws.  Even where workforce shortages exist, this patchwork means many consumers are unable to access services via telehealth from an OT if they are not located in the same state.  This is due to the confusion among OTs on when and how they can provide telehealth services across state lines.  Compacts provide guidance on how health care professionals can provide services through telehealth, while allowing states to retain their own rules.    
  2. Improve continuity of care, including for specialty services.  One of the major benefits of establishing a compact in Maryland is to allow consumers to access their provider, whether through telehealth or in-person, when they reside or relocate to a border state.  There are several examples of how this benefits consumers:
    1. A child with a disability or complex medical need can continue to see their regular OT that they have a treatment relationship with if they are temporarily sent to an out-out-state care facility for treatment.
    1. Medical systems that cover multiple border states can more readily recruit OTs to see patients in their homes or other community settings without the burden of obtaining and retaining multiple state licenses.
    1. An older adult who moves to another state to live with relatives can continue to access OT services via telehealth, including consulting with family members on environmental adaptations to the home.
    1. A consumer who requires a specialist out-of-state can readily receive pre- and post- treatment and consultation via telehealth, reducing the burden to travel to every appointment.
  3. Support the relocation of OT professionals, particularly military spouses.  As each state has its own unique rules regarding reciprocity, delays in obtaining licensure are commonplace when moving from one state to another.  Compacts have the benefit of ensuring that OTs will be able to more readily begin providing services when relocating, while still meeting an agreed upon set of education and training standards. 
  4. Assist in the recruitment of OTs.  Building on #3 above, having an expedited process for OTs to work in multiple states allows health facilities and other employers to more readily recruit OTs from out-of-state.  OTs will no longer be required to reapply for licensure when relocating, which is often a barrier for health employers trying to recruit. 

See the Council of State Governments for more information about licensure compacts.