Healthcare License Compacts in Illinois: Where We Are, Where We’re Going

Can you cross state lines with your Illinois license? We examine the medical, nursing, dental, and physical therapy compacts. Read on to learn about who supports them, who opposes them, and how they impact you.

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Over the past few years, many states have become more flexible on geographic licensing requirements for medical professionals, in part to increase the delivery of telehealth services and expand patient access to care. This flexibility has taken the form of agreements between multiple states, agreements known as “interstate compacts.” With a number of such interstate medical compacts in effect in parts of the United States, and more compacts currently being explored, interstate agreements will be a growing area of attention, especially for those who are looking to expand their practice beyond their original licensing state.

This post discusses the status of four of these compacts: the Physical Therapy Interstate Licensure Compact, Interstate Medical Licensure Compact, Nurse Licensure Compact, and Interstate Dental Licensure Compact. One, the Interstate Medical Licensure Compact is in effect in Illinois. The Physical Therapy Interstate Licensure Compact and Nurse Licensure Compact are in effect, but Illinois has not yet joined. The Dental Licensure Compact is not in effect and is only in an initial stage of development. Each of these compacts have been met with support and opposition, and this post will describe the nature of these conflicts.

The Physical Therapy Interstate Licensure Compact in Illinois

The Physical Therapy Interstate Licensure Compact (PT Compact) came into effect in the middle of 2018, after the last of 10 required states joined the compact to initiate its provisions. The PT Compact covers physical therapists and physical therapist assistants. To join the PT Compact, like with other compacts, a state is required to pass legislation adopting the PT Compact language. This language requires the state to take actions like participate in the Compact’s data system, maintain a mechanism for receiving and investigating complaints, comply with rules issued by the Compact’s governing body, and have continuing education requirements.

While there was proposed legislation last session to adopt the PT Compact, the Illinois General Assembly did not pass the bill, and in the current legislative session no legislation has been introduced to adopt the Compact. There is no publicly available opposition to joining the PT Compact in Illinois, but an analysis of opposition in other states shows that some state governmental stakeholders are concerned that it will add administrative burdens, increase regulatory costs, and limit the ability of states to regulate their licensees. Additionally, policy groups like ALEC, the American Legislative Exchange Council, oppose the PT Compact because they believe it nationalizes licensure requirements. Support for the PT Compact comes from practitioners and professional associations, who argue it reduces costs and increases consumer access to physical therapy services, especially in underserved areas.

Learn more about Jackson LLP’s physical therapy legal services here.

The Interstate Medical Licensure Compact in Illinois

The Interstate Medical Licensure Compact (IMLC) covers physicians who have unrestricted licenses and current specialty certification or time-unlimited certification by an American Board of Medical Specialties (ABMS) or American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS) board. Physicians who meet these and other requirements are eligible to apply for an expedited license in the other compact states.

The IMLC was developed in 2012 and 2013, and came into effect in 2015, after seven states ratified it. Illinois is a member state, and one that ratified the compact in 2015. Currently, 25 states, D.C., and Guam are members of the IMLC. As of the end of last year, more than 4,500 licenses have been issued and 2,400 processed through the IMLC.

Despite the IMLC’s operation in half of the country, it has received strident criticism. Some state agencies oppose it for similar reasons as the PT Compact, concerned about the administrative cost and loss of sovereignty. Groups such as ALEC and the Association of American Physicians and Surgeons (AAPS) also oppose the IMLC on sovereignty grounds. Additionally, the AAPS opposes the requirement that licensees must be certified by the ABMS or AOABOS, which they argue puts non-certified physicians at a competitive disadvantage, and the definition of “location of medical care” as the patient’s location. The American Board of Physician Specialties also opposes the IMLC, primarily on ABMS or AOABOS certification requirement and state sovereignty grounds. Some medical societies have also opposed the IMLC as creating additional and redundant licensing requirements.

The IMLC is supported by the Federation of State Medical Boards, the American Medical Association, and several health systems and state medical associations. Supporters point to the IMLC’s facilitation of expanded delivery of telemedicine services, allowing the needs of rural and underserved areas to be better met. Additionally, they argue that, instead of reducing state sovereignty, the IMLC keeps licensing with the states by preventing any push for a federal licensing program.

Learn more about Jackson LLP’s legal services for physicians here.

The Nurse Licensure Compact in Illinois

The Nurse Licensure Compact (NLC) covers registered nurse and licensed practical/vocational nurses. The National Council of State Boards of Nursing, which houses the NLC, has also developed an Advanced Practice Registered Nurse Compact, which has not yet reached the required 10 state members to come into effect. The NLC was first developed and implemented in 2000, with updated compact language developed in 2015, also known as the Enhanced Nurse Licensure Compact (eNLC). This updated language came into effect in 2017 after 26 states ratified it. This updated language was written to facilitate interstate mobility for nurses and clarified their authority to practice telenursing.

Illinois was not a party to the original NLC, and while legislation passed the state senate in 2017 for the state to adopt the updated compact, this bill died in the state house after failing a vote to move out of the Health Care Licenses Committee. No legislation has been introduced this legislative session to ratify the NLC.

Like the other compacts, the NLC has entrenched opposition. Some nurses’ unions—including the Illinois Nurses Association (INA)—oppose the NLC because they see the NLC as taking jobs away from local nurses. The INA also opposes the NLC because it believes the compact will allow companies to move large number of out-of-state nurses “under-the-radar” to circumvent the state’s regulations. This is especially their concern in instances when labor negotiations turn sour. In these situations, the INA views the NLC as enabling employers to more easily replace their nurses, undercutting collective bargaining on pay and workplace safety issues.

Other professional associations, such as the American Nursing Association-Illinois and the Illinois Society for Advanced Nursing, support the NLC. They argue the NLC allows nurses to serve more patients without having to obtain additional licenses, makes practice across state borders more affordable, and allows nurses to provide critical services to patients in other states in emergency situations. The Nurse Advocacy Council of Advocate Health Care also supports the NLC.

The Interstate Dental Licensure Compact in Illinois

The Interstate Dental Licensure Compact (IDLC) is currently not in effect, and no draft language has been developed, though the American Association of Dental Boards (AADB) is considering whether to do so. From the information publicly available about the compact, it appears that the AADB is patterning the IDLC off of the IMLC, and views it as a way to expand the delivery of teledentistry services.

Despite an indication that the IDLC would borrow heavily from the IMLC, it is unclear which dental practitioners would be covered by the IDLC. Additionally, it is unclear how stakeholders will react to the compact once it is finalized and who will fall on each side of the question. However, considering that much of the opposition about the other compacts were based on the use of the compact mechanism itself, it is likely that the same concerns raised about the other compacts will be raised for the IDLC.

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Despite opposition in some corners to the compacts already in effect, reliance on these interstate mechanisms is likely to grow. Beyond nascent compacts like the APRN Compact and IDLC, psychologist, speech pathologist, and occupational therapist associations are all exploring the possibility of creating interstate agreements of their own. Additionally, like with the NLC, there is the potential that existing compacts will be updated as the need arises.

These changes promise to impact providers’ practices in Illinois but also their ability to practice in-person or via telehealth into compact states. Jackson LLP’s dedicated healthcare attorneys work closely with healthcare providers and clinics to understand the impact of legislative changes on their day-to-day practice. To schedule a complimentary consultation with one of our attorneys, click the button below.

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