Understanding State-by-State Licensure Challenges
Before interstate licensing compacts, healthcare professionals in the U.S. faced significant barriers to practicing across state lines. Each state required a separate professional license, and providers handling controlled substances needed individual Drug Enforcement Administration (DEA) registrations.
This process was time-consuming, costly, and involved navigating varied state requirements, often taking months to complete. Despite the effort, additional licensing did not improve care quality, as education and training standards are already consistent nationwide.
How Interstate Compacts Transform Healthcare
Interstate licensing compacts have revolutionized healthcare by allowing professionals to practice in multiple states with a single license or privilege, streamlining licensure and DEA registration processes. These agreements tackle workforce shortages, particularly in psychiatry and psychology, where over 60% of U.S. counties lack a psychiatrist and nearly half of adults with mental health needs cannot access care.
By enabling cross-state practice, compacts enhance access to telehealth services, especially in underserved and rural areas, reducing treatment delays and addressing critical mental health provider shortages.
Revolutionizing Telemedicine and Mental Health Access
Compacts have transformed telemedicine, enabling providers to deliver virtual mental health care across state lines without redundant licensing barriers. This is vital for telepsychiatry, where a national shortage of psychiatrists—approximately 28,000 for a population exceeding 330 million—leaves facilities understaffed. Compacts like the Interstate Medical Licensure Compact (IMLC) and Counseling Compact provide expedited licensing pathways, ensuring timely access to psychiatric evaluations, medication management, and therapy in areas with limited providers.
Nurse Licensure Compact (NLC)
Origin (1996-2000)
The Nurse Licensure Compact (NLC), launched in 1996 by the National Council of State Boards of Nursing (NCSBN), aimed to simplify cross-state nursing practice. It was enacted in 2000, with Utah, Texas, Wisconsin, and North Carolina as the first participating states.
Development
The original NLC allowed registered nurses (RNs) and licensed practical/vocational nurses (LPNs/VNs) to practice in member states using a multistate license. In 2015, the Enhanced NLC (eNLC) introduced stricter standards, including federal background checks, and by 2018, states fully transitioned to the eNLC.
Growth and Advocacy
As of 2025, over 40 states and territories participate in the eNLC, driven by demand for telenursing and nurse mobility, especially post-COVID-19. The compact supports psychiatric nurse practitioners in addressing mental health shortages, reducing wait times for virtual mental health care, with streamlined DEA registration for prescribing. Lobbying by groups like the American Nurses Association and state hospital associations has spurred expansion, with Michigan advancing legislation in 2025 and New York proposing bills despite nursing union opposition. This growth enhances telemedicine for mental health, enabling nurses to provide cross-state virtual care.
Interstate Medical Licensure Compact (IMLC)
Origin (2013-2017)
Proposed in 2013 by the Federation of State Medical Boards (FSMB), the Interstate Medical Licensure Compact (IMLC) aimed to streamline physician licensure for telemedicine and cross-state practice. Drafted in 2014, it launched in 2017 after 11 states passed enabling legislation.
Development
The IMLC offers an expedited licensure process, allowing physicians to apply through their principal state license to practice in other member states, often simplifying DEA registration. It upholds strict standards, such as a clean disciplinary record.
Growth and Advocacy
By 2025, 39 states, the District of Columbia, and Guam participate, fueled by the rise of telepsychiatry during the pandemic. The IMLC alleviates psychiatrist shortages by enabling providers to deliver virtual psychiatric care, including medication management and evaluations, without delays. Advocacy from organizations like Weill Cornell Medicine supports New York’s proposed legislation, while Michigan’s bills aim to make the IMLC permanent, ensuring ongoing access for telemedicine physicians. The IMLC has driven investments in telehealth platforms and interstate health data exchange, normalizing virtual mental health care.
Counseling Compact
Origin (2018-2022)
The Counseling Compact, conceptualized in 2018 by the American Counseling Association (ACA), sought to remove barriers for licensed professional counselors, particularly in telehealth. Model legislation was finalized in 2020.
Development
Georgia enacted the compact in 2021, and it became operational in 2022 after reaching the 10-state threshold, allowing counselors to apply for cross-state practice privileges.
Growth and Advocacy
By 2025, over 20 states have joined, driven by demand for mental health services amid a shortage of psychology providers, with only about 100,000 licensed counselors nationwide. The compact enhances access to teletherapy, addressing behavioral health shortages worsened by resource strains. With 39 states passing legislation and privileges set to be granted by fall 2025, ACA’s advocacy investment has accelerated adoption, with Texas’ legislation authorizing implementation fees to support cross-state telebehavioral health. This expansion boosts telemedicine, enabling counselors to conduct virtual therapy sessions across states for timely mental health support.
Meeting Post-COVID Expectations and Enhancing Care
Interstate licensing compacts have revolutionized healthcare by promoting professional mobility, standardizing licensure, and easing DEA registration hurdles. By eliminating redundant barriers that don’t enhance care quality, they ensure better access to mental health services, particularly in psychiatry and psychology.
Post-COVID, patients expect seamless access to all healthcare providers, including psychiatrists and counselors, regardless of location, a demand driven by the widespread adoption of telehealth during the pandemic. Companies like FasPsych, with providers licensed within the NLC, IMLC, and Counseling Compact, are ideally positioned to meet telepsychiatry needs for medical facilities nationwide.
FasPsych’s large, diverse provider pool—including psychiatric nurse practitioners, psychiatrists, and counselors—enhances affordability by optimizing resource allocation and reducing overhead costs compared to hiring local providers. This larger pool improves care quality by matching patients with specialists suited to their needs, such as those with expertise in specific mental health conditions or cultural competencies. FasPsych’s inclusion of Spanish-speaking providers and diverse professionals ensures equitable access, addressing linguistic and cultural barriers in underserved communities. By offering specialized mental health services and diverse provider expertise, FasPsych meets the growing demand for accessible, high-quality virtual mental health care across the nation, with compacts enabling continued expansion as telehealth evolves.
Frequently Asked Questions (FAQ)
What are interstate licensing compacts?
Interstate licensing compacts are agreements among U.S. states allowing healthcare professionals to practice across state lines with a single license or privilege, streamlining licensure and DEA registration.
How do compacts benefit telemedicine?
Compacts enable providers to offer virtual mental health care across states without multiple licenses, expanding access to telepsychiatry and teletherapy, reducing delays, and addressing psychiatry and psychology shortages.
Why were compacts created?
Compacts address workforce shortages, particularly in mental health, enhance professional mobility, and improve access to telehealth services by removing time-consuming licensing barriers that don’t improve care quality.
Which states participate in these compacts?
As of 2025, the NLC includes over 40 states and territories, the IMLC covers 39 states, the District of Columbia, and Guam, and the Counseling Compact includes over 20 states, with more joining through legislation.
Are there efforts to expand these compacts?
Yes, advocacy from groups like the American Nurses Association, Weill Cornell Medicine, and the American Counseling Association drives legislation, such as in Michigan and New York for the NLC and IMLC, and Texas for the Counseling Compact.
Do compacts compromise care quality?
No, compacts maintain high standards, including clean disciplinary records and background checks, ensuring care quality while eliminating redundant processes.
How do compacts address psychiatry and psychology shortages?
Compacts like the IMLC and Counseling Compact enable psychiatrists and counselors to practice across states via telemedicine, reducing wait times and providing on-demand mental health services in areas with severe provider shortages.
How does FasPsych leverage compacts for telepsychiatry?
FasPsych’s providers, licensed within the NLC, IMLC, and Counseling Compact, offer affordable, high-quality telepsychiatry with specialized and diverse expertise, including Spanish-language support, meeting the needs of medical facilities nationwide.