Interstate medical compacts let providers practice across state lines—but they don't work the way most people think. Here's what IMLC, PSYPACT, and other compacts actually cover, which states are members, and where the gaps are.
Interstate compacts are legal agreements between states that allow licensed professionals to practice across state lines without obtaining a separate license in each state. They're one of the most important developments in telehealth—and one of the most misunderstood.
Many providers assume that having a compact privilege means they can practice anywhere in the country. Others assume that if a state joined a compact last year, it's still a member this year. And some believe that being compact-authorized eliminates all compliance risk. All of these assumptions can be dangerously wrong.
This post covers what the major compacts are, how they work, which states participate, and the critical gaps that trip up providers. It's a reference you'll want to bookmark—because compact membership changes, and the rules are more complex than they initially appear.
A compact is a legal agreement between member states. When a state joins a compact, it agrees to recognize licenses issued by other member states under specific conditions. A provider applies once through the compact commission, and if approved, receives a "compact privilege" that allows practice in all member states.
This is not the same as having a license in each state. A compact privilege is exactly what it sounds like—a privilege granted through the compact agreement, revocable if the provider's home state license is affected. If your home state license is disciplined, your compact privileges in all member states can be suspended simultaneously.
Critical point: Compacts only work in member states. If a patient is in a non-member state, the compact provides no coverage. The provider needs a separate license in that state, or compliance fails.
IMLC is the largest and most relevant for telehealth physicians.
A physician applies through the IMLC commission and designates a state of principal licensure (SPL)—typically their home state. Once approved, they can apply for expedited licenses in any IMLC member states they select. The process is significantly faster than traditional individual state licensing, but it's not instant. Providers still need to meet each state's specific requirements and pay state licensing fees.
Important caveat: Not every IMLC member state can be an SPL. Hawaii and Vermont, for example, are IMLC members and can issue licenses through the compact when a provider qualifies from another SPL, but neither state qualifies as an SPL itself. Connecticut, Pennsylvania, and Vermont also have restrictions on serving as an SPL.
Recent development: As of January 1, 2026, North Carolina's Medical Board began processing IMLC applications, expanding compact access further.
PSYPACT is critical for telepsychology. While IMLC focuses on physicians, PSYPACT is the compact for psychologists and licensed professional counselors.
Unlike IMLC, which issues actual state licenses, PSYPACT issues an Authority to Practice Interjurisdictional Telepsychology (APIT). This means your home state license remains the legal foundation of your practice. You're not getting 43 separate psychology licenses; you're getting a multi-state practice authority that works in conjunction with your primary state license.
This distinction matters when states audit or discipline. If your home state license is affected, your PSYPACT authorization is at risk across all member states—just like with IMLC.
PSYPACT also includes the Temporary Authorization to Practice (TAP), which allows licensed psychologists to practice in-person in other member states for short periods, making it valuable for providers who travel or see patients in person during telehealth relationships.
IMLC and PSYPACT are the largest, but they're not the only compacts. Here are others that may affect your practice:
Nurse Licensure Compact (NLC): One of the oldest and most widely adopted. Currently 41+ member states. Covers RNs and LPNs and issues a "multistate license" that allows nurses to practice across member states without additional state licenses. Like other compacts, multistate license status is contingent on home state licensure.
ASWB Mobility Compact (Social Work): Newer than the physician and psychology compacts, but growing. Covers licensed social workers and allows practice across member states through an interjurisdictional authorization. Member count continues to expand as more states join.
Physical Therapy Compact (PT Compact): Covers physical therapists (PTs) and physical therapist assistants (PTAs). Growing adoption, though not yet as widespread as IMLC or NLC. Member states vary, so verification is essential for multi-state PT practices.
Counseling Compact: Covers licensed professional counselors. Similar structure to psychology and social work compacts, providing interjurisdictional practice authority.
This section covers the most common misconceptions. These gaps are where compliance risk actually lives.
A compact privilege is only valid if the patient is located in a member state. You still need to know which state the patient is in—every session. The compact determines whether you're covered in that state, but only if you check. If you assume a patient is in a compact member state without verifying, and they're actually in a non-member state, you're practicing without proper authorization, even if you have active compact privileges elsewhere.
No single compact covers all 50 states. If even one of your patients' states isn't in your relevant compact, you need a separate license in that state. Many providers discover this the hard way—they have IMLC or PSYPACT coverage for 90% of their patient population, but that remaining 10% requires separate licensing in 2–3 non-member states.
States can join or leave compacts. More commonly, a state's implementation status can shift—a state might have passed legislation but not yet implemented the compact, or its regulations might change to restrict certain types of providers. A state that was covered last year might not be this year. Relying on a list you checked months ago is a dangerous compliance practice. You need to verify current membership status regularly, and that verification needs to be documented.
Being compact-authorized doesn't override federal exclusion from healthcare programs. If a provider is on the Office of Inspector General (OIG) exclusion list, they cannot bill Medicare or Medicaid, regardless of their compact status or state licenses. Compact privilege is state-level; exclusion is federal. The compact cannot help you.
If your home state license is disciplined, suspended, or revoked, your compact privileges in all member states can be suspended simultaneously. Disciplinary action is reciprocal—one state action triggers action across the entire compact network. This is a feature, not a bug; it's designed to protect patients across state lines. But many providers don't realize how fast and how broadly a home state discipline can propagate through the compact system.
For a telehealth provider seeing patients in two or three states with mixed compact coverage, manual compliance might be manageable. But at scale, it breaks down fast.
Imagine an organization with 150 providers spread across 20 states, with a mix of IMLC members, PSYPACT members, non-member states, and providers with direct licenses in some states and compact coverage in others. Determining the correct compliance pathway for each session—checking the patient's state, cross-referencing the provider's licensure, confirming current compact membership, verifying no OIG exclusion, and documenting the result—becomes a full-time compliance operation. And if a state's compact status changes, you're now retroactively checking past encounters.
This is where many organizations hit the wall. They've set up compacts correctly, but they lack visibility into whether they're being used correctly in practice.
TeleVerify solves this problem by automating the entire compact verification workflow.
For every telehealth encounter, TeleVerify:
The result is automatic compliance documentation that survives an audit. If regulators ask, "How did you verify this provider was authorized to see this patient in this state on this date?", you have an answer that's timestamped, evidence-based, and repeatable.
This is especially valuable when compact membership changes. If a state's IMLC status changes mid-year, TeleVerify's data updates automatically. You don't need to manually recalculate compliance for past encounters; the system maintains historical accuracy.
Interstate compacts have made multi-state telehealth dramatically more accessible. A physician who might have needed 10 separate state licenses a decade ago can now get IMLC coverage in 43 states. A psychologist can practice telepsychology across 43 PSYPACT member states through a single authorization.
But compacts haven't made compliance simple. They've just moved the complexity. Instead of managing dozens of individual state license renewals, providers now manage compact membership, multi-state license status, location verification, OIG exclusion checks, and the reciprocal discipline risk that comes with putting all your eggs in one compact basket.
The providers who get the most value from compacts are the ones who pair them with automated verification. They use compacts to expand access, and they use automation to ensure every session is checked against current compact membership, current licensure status, current OIG exclusion data, and documented in a way that survives an audit.