State licensure and interstate compacts standardize provider qualifications while enabling the sharing of disciplinary records.
MO uses compacts and universal license recognition (ULR) to manage healthcare licensure and professional mobility.
Healthcare compacts allow provider mobility while preserving the state’s power to regulate practitioners.
Healthcare professionals use nationally standardized training and examinations to qualify for state-issued credentials (Department of Health and Human Services (DHHS) 2025, George 2021). Licensing requirements exist to ensure public health and safety by confirming that practitioners meet qualifications and standards of care (National Conference of State Legislatures (NCSL) 2024, Feldman & Goot 2021). State licensing boards within the Division of Professional Registration grant these credentials, determine eligibility, and review disciplinary actions (Nguyen & Schaler-Haynes 2023, National Governors Association (NGA) n.d.). These rules require a professional to hold a license in the state where their patient receives care (DHHS 2024).
Interstate compacts are outlined in the constitution as legally binding contracts allowing two-way commerce between states (Mulligan 2023, Bruenger et al. 2016, U.S. Constitution art 1 § 10, cl 3). In healthcare compacts a compact commission administers the agreement and shares background and discipline records of healthcare professionals between member states (NGA n.d., Fitzhugh 2024). Member states maintain their authority to determine licensure requirements and take disciplinary action against healthcare professionals healthcare professionals (Fitzhugh 2024, NCSL 2024).
Compacts are profession-specific, and each uses a different mechanism to enable crossstate practice for healthcare professionals. The Nurse Licensure Compact uses a single multistate license (DHHS 2025). The Physical Therapy Compact grants a privilege to practice in designated states (Assistant Secretary for Planning and Evaluation (ASPE) 2024, Feldman & Goot 2021). The Medical Licensure Compact provides an expedited process for obtaining multiple state licenses for physicians. For more information, see the Interstate Medical Licensure Compact Science Note.
MO issues licenses to a wide range of healthcare providers through the MO Division of Professional Registration (Missouri Division of Professional Registration n.d.). MO participates in interstate compacts for physicians and surgeons, registered and licensed practical nurses, physical therapists (PTs) and PT assistants, occupational therapists (OTs) and OT assistants, psychologists, professional counselors, social workers, speech-language pathologists and audiologists, and emergency medical technicians (EMTs) (RSMo 334.1605, RSMo 335.360, RSMo 334.1206, RSMo 324.087, RSMo 337.115, RSMo 337.550, RSMo 337.1010, RSMo 345.085, RSMo 190.900). The remaining MO-licensed healthcare professions do not currently have an active interstate compact (Missouri Division of Professional Registration n.d.).
Professions in MO without an active interstate compact use a Universal License Recognition (ULR) (RSMo 324.009, Feldman & Goot 2021). ULR grants MO licenses to qualified out-of-state practitioners with at least one year of licensure in good standing (RSMo 324.009, Feldman & Goot 2021, Council of State Governments (CSG) 2021). ULR does not grant MO licensed professionals the ability to practice in other states. While compacts use shared data systems to give state boards information about practitioners’ disciplinary history across all participating states, URL involves manual verification processes for each individual applicant (CSG 2021, Feldman & Goot 2021).
Interstate compacts impact healthcare access, professional oversight, and state authority (ASPE 2024, Table 1). State legislatures determine the specific requirements professionals must meet to practice within their jurisdiction (NCSL 2024, CSG 2021). Interstate compacts allow providers to give continuous care to patients who move across state lines, such as university students and military families, and residents in border regions (DHHS 2024, Brannon et al. 2012).
Compacts increase professional oversight by providing state licensing boards with access to a centralized database containing the disciplinary records of all licensees (Feldman & Goot 2021). This system notifies participating state boards of active investigations and disciplinary actions, which prevents clinicians from obtaining new licenses in different states before a previous review is concluded or misconduct is reported (Fitzhugh 2024). This real-time data sharing reduces regulatory lag and assists state regulators in their mission of public protection.
While compact commissions manage these multistate agreements, individual state licensing boards remain separate entities. States retain the legal authority to set their own licensure requirements, determine who is eligible to practice, and punish practitioners for misconduct through disciplinary action (NCSL 2024, Nguyen & Schaler-Haynes 2023).
Table 1. Primary Impacts of Interstate Healthcare Compacts. Interstate compacts allow cross state clinical practice through standardized legal frameworks, while creating fiscal and administrative tradeoffs for state boards. This table outlines the opportunities and challenges across access, oversight, and authority.
References
Assistant Secretary for Planning and Evaluation (ASPE), Office of Behavioral Health, Disability and Aging Policy (2024) Barriers and Opportunities for Improving Interstate Licensure Reciprocity and Portability for Behavioral Health Practitioners: Technical Expert Panel Findings. Department of Health and Human Services. URL
Brannon JA, Cohn ER, Cason J (2012) Making the Case for Uniformity in Professional State Licensure Requirements. International Journal of Telerehabilitation, 4(1):41–46. https://doi.org/10.5195/IJT.2012.6091
Buenger ML, Masters RL, Litwak J, Markham J, Jeremy M, et al. (2024) General Law of Interstate Compacts In: ICAOS Bench Book for Judges and Court Personnel, version 15.0: 8 – 19. https://interstatecompact.org/bench-book
Buenger ML, Litwak JB, McCabe MH, Masters RL (2016) The Evolving Law and Use of Interstate Compacts (2nd edition). American Bar Association. https://www.americanbar.org/products/inv/book/417971987/
Cornell Law (n.d.) ART I. S10.C3.31 Overview of the Compacts Clause. https://www.law.cornell.edu/constitution-conan/article-1/section-10/clause-3/overview-of-the-compact-clause
Council of State Governments (CSG) (2021) 2021 Survey of Universal License Recognition Laws. National Center for Interstate Compacts Occupational Licensure Project. https://compacts.csg.org/wp-content/uploads/2022/06/2021_ULR_Report.pdf
Department of Health and Human Services (2025). Licensure Compacts. https://telehealth.hhs.gov/licensure/licensure-compacts
Department of Health and Human Services (2024). Getting Started with Licensure. https://telehealth.hhs.gov/licensure/getting-started-licensure
Feldman SD, Goot ME (2021) Porting Professional Privileges Across State Lines. Robinson Bradshaw Publication. https://www.robinsonbradshaw.com/newsroom/publications/Porting-Professional-Privileges-Across-State-Lines
Fitzhugh A (2024) Interstate Licensing Compacts and Universal License Recognition for NC Healthcare Professionals. Ward and Smith, PA. https://www.wardandsmith.com/article/interstate-licensing-compacts-and-universal-license-recognition-for-nc-healthcare-professionals
George K (2021) Licensure and Interstate Compacts. National Conference of State Legislatures. https://documents.ncsl.org/wwwncsl/Health/Licensure-and-interstate-compacts_36242.pdf
Missouri Division of Professional Registration (n.d.) Listing of Professions. https://pr.mo.gov/professions.asp
Mulligan SP (2023) Interstate Compacts: An Overview. Congressional Research Service, LSB10807. https://www.congress.gov/crs-product/LSB10807
National Conference of State Legislatures (NCSL) (2024) Telehealth: Licensure and Interstate Compacts. Telehealth Explainer Series. https://www.ncsl.org/health/the-telehealth-explainer-series/licensure-and-interstate-compacts
National Governors Association (NGA) (n.d.) State Health Workforce Toolkit: Licensing and Regulation. https://www.nga.org/state-health-workforce-toolkit/licensing-and-regulation/
Nguyen AM, Schaler-Haynes M (2023) Can Interstate Licensure Compacts Enhance the Health Care Workforce? The Milbank Quarterly Opinion. https://www.milbank.org/2023/04/can-interstate-licensure-compacts-enhance-the-health-care-workforce/
Nguyen AM, Shaler-Haynes M, Chou J, Wetzel M, Koller M, et al. (2022) Impact of the New Jersey COVID-19 Temporary Emergency Reciprocity Licensure Program on Health Care Workforce Supply. Health Affairs 41(8): 1125–1132. https://doi.org/10.1377/hlthaff.2022.00249
Peterson E (2023) Are Interstate Compacts the Answer to Health Workforce Shortages. National Conference on State Legislatures. https://www.ncsl.org/state-legislatures-news/details/are-interstate-compacts-an-answer-to-health-workforce-shortages
Revised Statutes of Missouri, § 324.1605 (2023). https://revisor.mo.gov/main/OneSection.aspx?section=334.1605&bid=54190&hl=
Revised Statutes of Missouri, § 335.360 (2016). https://revisor.mo.gov/main/OneSection.aspx?section=335.360&bid=33783&hl=
Revised Statutes of Missouri, § 334.1206 (2016). https://revisor.mo.gov/main/OneSection.aspx?section=334.1206&bid=33773&hl=
Revised Statutes of Missouri, § 324.087 (2021). https://revisor.mo.gov/main/OneSection.aspx?section=324.087&bid=49648&hl=
Revised Statutes of Missouri, § 337.115 (2020). https://revisor.mo.gov/main/OneSection.aspx?section=337.115&bid=35895&hl=
Revised Statutes of Missouri, § 337.550 (2023). https://revisor.mo.gov/main/OneSection.aspx?section=337.550&bid=54215&hl=
Revised Statutes of Missouri, § 337.1010 (2023). https://revisor.mo.gov/main/OneSection.aspx?section=337.1010&bid=54221&hl=
Revised Statutes of Missouri, § 345.085 (2022). https://revisor.mo.gov/main/OneSection.aspx?section=345.085&bid=51035&hl=
Revised Statutes of Missouri, § 190.900 (2018). https://revisor.mo.gov/main/OneSection.aspx?section=190.900&bid=35941&hl=
Revised Statutes of Missouri, § 324.009 (2025). https://revisor.mo.gov/main/OneSection.aspx?section=324.009&bid=57647&hl=
U.S. Constitution, Article I § 10, cl 3. (1778) https://constitution.congress.gov/browse/article-1/section-10/clause-3/
