To participate, a state must opt in through the state legislative process, with lawmakers drafting and the governor approving model compact legislation. To be eligible for participation, states must require that licensure applicants pass a national exam and undergo an FBI background check. States also must require licensees to complete continuing competence/education for licensure renewal and must provide licensee data to the Physical Therapy Compact Commission.

Individual PTs and PTAs who reside and hold a license in a participating state can obtain a "compact privilege" to practice or work in other participating states as long as they meet these criteria:

• They hold a license in their state of primary residence and that state is an active member of the PT Compact. The compact calls this the "home state." The rules of the PTCC — which were established to implement and oversee the compact — define the home state as "a person's true, fixed, and permanent home." It's the place where the PT or PTA "intends to remain indefinitely, and to which the person expects to return if absent without intending to establish a new domicile elsewhere."

The compact affords active-duty members of the military and their spouses flexibility in determining their home state. They can cite their home state as their home of record, permanent change of station, or state of current residence.

• They have no encumbrances on any license and no disciplinary actions taken within the previous two years.
• They pass a test on their knowledge of the laws and regulations of the state or states in which they're seeking compact privileges (known as "remote states"), if the remote state or states require it.
• They pay $45 to the PTCC for each state compact privilege, plus any fee charged by the state(s), which may vary.

Licensees meeting these criteria can seek compact privileges through the PTCC website at ptcompact.org. The PTCC, in addition to establishing the rules of the compact, issues compact privileges on behalf of participating states. Each member state is represented by a delegate on the PTCC. Both APTA and the Federation of State Boards of Physical Therapy have nonvoting representation.

Initial Licensure Doesn't Change

The compact doesn't change the process for obtaining an initial license after graduation from an entry-level PT or PTA education program, or for foreign-educated PTs and PTA to seek their initial state license in the United States.

New graduates still must submit an application and evidence of having completed an accredited entry-level DPT or PTA education program, must pass the applicable National Physical Therapy Exam, and must meet all other state-specific requirements in their home state.

Individuals seeking their initial license in a compact-participating state must undergo a background check whether or not they are seeking compact privileges. (Nonparticipating states may or may not require background checks.)

Foreign-educated PTs and PTAs seeking their first U.S. state license still must complete the licensure process required by that state. Once they hold a license in their home state, they can apply for compact privileges in participating states.

The compact also does not change scope of practice in any state. PTs and PTAs delivering physical therapist services in remote states under a compact privilege must function within the laws and rules of the remote state in which the patient is located.

Advantages

While PTs and PTAs in compact-participating states retain the option of going through the traditional licensure process to practice beyond their home state, obtaining a compact privilege holds some advantages over traditional licensure in two or more states.

• Getting a compact privilege is much faster and easier than is going through a state's traditional licensure process. Under the current state licensure system, applying for a license in another state involves many steps and lots of documentation, which can take considerable time to compile and submit. Test scores, transcripts, and validation of holding a current state license all must be submitted, along with a separate application to each state in which the individual wants to become licensed. It can take weeks or months for all of this to be processed and a license to be issued.

In contrast, a licensee in a compact-participating state can simply visit ptcompact.org, complete the online application process for compact privileges in any or all other compact-participating states, and pay the required fees. The system uses licensee data submitted to the PTCC by member states to determine a licensee's eligibility for compact privileges. Once that online process has been completed, the individual is immediately issued compact privileges in the selected state or states.

• Compact privileges require only one set of continuing education requirements. Whether a licensee holds compact privileges in a single state or 20, the only set of continuing education requirements he or she must meet for renewal are those required for the home state license.
• Compact privilege renewal is tied to the home state license. Compact privileges expire along with expiration of the home state license, so licensees need not keep track of different renewal dates for different states. There's only one renewal date to remember.
• Gaining compact privileges typically is cheaper than is going through a state's traditional licensure process. While compact privilege fees vary by state, on average the fees are much lower than are the license fees for the same state.

Compact Privilege Versus License

While obtaining a compact privilege has its pluses, if you live in a compact-participating state and are planning to move and change your primary state of residence to another compact state in the near future, you might consider going through the licensure process in the state to which you are moving rather than seeking a compact privilege. Again, eligibility for a compact privilege is tied to your state of primary residence. This means that when you move to another compact state, you will retain eligibility for a compact privilege, but if you make that state your new primary residence you must get a regular license from that state in order to practice or work, and get compact privileges in other remote states in which you choose to practice.

Let's look at a few different scenarios involving these types of decisions.

• Mary is a PT who resides in Memphis and holds a Tennessee license. She works for a home health agency that operates in both that state and Mississippi. Due to a staffing shortage, her employer wants her to start seeing patients across the state line as soon as possible. Mary does not hold a Mississippi license. Since both states have begun issuing or accepting compact privileges, assuming that Mary meets Mississippi's requirements (including passing that state's jurisprudence exam) she can complete the application process at ptcompact.org, pay the $45 fee and the fee charged by Mississippi, and receive a Mississippi compact privilege in minutes. She then can treat patients in the Magnolia State.
• Sarah is a PTA who is working and living in St. Louis. She just received a job offer in Portland, Oregon, and is pleased to discover that both her home state of Missouri and Oregon are compact members that are issuing and accepting compact privileges. If Sarah will only be living and working in Oregon temporarily and intends to maintain Missouri as her home state, she can work under an Oregon compact privilege. If, however, Sarah will be moving to Oregon long-term and no longer intends to keep her primary residence in Missouri, she needs to seek a PTA license in her new home state through the Oregon Physical Therapist Licensing Board. If Sarah doesn't yet know if she'll change her primary residence to Oregon, she can work using an Oregon compact privilege, but she must report a change of primary residence to the PTCC within 30 days of the move.
• Bob is a PT who lives in Fargo, North Dakota. Many of Bob's patients reside across the border in Minnesota. He's been exploring telehealth options to better serve Minnesotans who cannot frequently come to his clinic because it's a long drive. Bob learns that his home state is issuing and accepting compact privileges. He goes to ptcompact.org to see if Minnesota, too, is a PT Compact state. Unfortunately, however, Minnesota has not yet joined the compact, so obtaining a compact privilege is not an option. Bob instead must apply for a Minnesota license through the Minnesota State Board of Physical Therapy.

Spanning the Nation

The PT Compact already has revolutionized how PTs and PTAs obtain authorization to provide services in more than one state. You can't take advantage of it, however, unless it's been adopted by law in your home state and in the other state or states in which you'd like compact privileges.

If your state isn't yet a PT Compact participant, consider contacting your state chapter of APTA. Let officials there know that you'd like to see the state added to the growing list of compact states — and ask them what you can do to help make that happen.

Coast to Coast

As of March 18, the following 27 states had enacted legislation to join the Physical Therapy Compact. Compact privileges were being offered in 20 of those states (bolded in list) and were pending in the others. (Go to ptcompact.org for up-to-the-minute information.)

• Arizona
• Arkansas
• Colorado
• Delaware
• Georgia
• Iowa
• Kentucky
• Louisiana
• Maryland
• Mississippi
• Missouri
• Montana
• Nebraska
• New Hampshire
• New Jersey
• North Carolina
• North Dakota
• Oklahoma
• Oregon
• South Carolina
• Tennessee
• Texas
• Utah
• Virginia
• Washington
• West Virginia
• Wisconsin

Note

The COVID-19 pandemic highlights the vital importance of being able to quickly mobilize health care services where they are most needed. For the latest on the changing situation and its effects on the physical therapy profession and the patients and clients it serves, go to apta.org/Coronavirus.