The NCSL Blog


By Iris Hentze

What kind of medical licensing compact would fit your state’s workforce?

Health workersLast week, NCSL joined the National Governor’s Association Center for Best Practices, The Council of State Governments and the Bowen Center for Health Workforce Research & Policy from Indiana University’s School of Medicine in hosting a Compact Licensure Learning Lab in Indianapolis.

The meeting, part of Indiana’s participation in the National Occupational Licensing Learning Consortium, brought together four national experts to discuss broadly how interstate compacts operate and to provide specific details on three medical compacts: Recognition of EMS Personnel Licensure (REPLICA), the Enhanced Nurse Licensure Compacts (eNLC) and the Interstate Medical Licensure Compact (IMLC).

Stakeholders in attendance included Legislators, legislative staff, members of the Governor’s Health Workforce Council and a variety of representatives from healthcare and workforce development sectors in the state.

Fred Payne, commissioner for Indiana’s Department of Workforce Development, kicked the meeting off with a few words about the importance of, and his appreciation for, the work the council is doing to advance the state’s health workforce.

Dan Logsdon from CSG’s National Center for Interstate Compacts provided an ‘Interstate Licensure Compacts 101” that discussed how compacts derive their authority, what they are primarily used to accomplish, how they are developed and what some common misconceptions surrounding them are.

One such misconception is that compacts are owned or controlled by an outside organization. In his presentation, Dan dispelled this misconception and attendees learned that compacts are not owned or controlled by any organization and are instead governed by statutorily created governing “infrastructure” as determined by the member states through terms in the compact.

Representatives from the three compacts provided attendees with in-depth information on each compact and participated in extensive Q&A.

Dan Manz presented on behalf of REPLICA, the compact for EMS (emergency medical services) personnel. REPLICA covers EMTs, advanced EMTs and paramedics and utilizes a privilege-to-practice model, meaning that as long as an individual is licensed and in good standing in their home state, they can enjoy immediate legal recognition of their license in other compact states, no additional fees or applications necessary.

Rebecca Fotsch presented on behalf of the eNLC, the most recent iteration of the compact for registered nurses (RNs) and licensed practical nurses (LPNs). In contrast to REPLICA, the eNLC works by utilizing the multistate licensure model, meaning that if a nurse is licensed and in good-standing in their home state and has passed the appropriate national accreditation exam, they can receive a multi-state license allowing them to practice in any state that is part of the compact.

Finally, Marschall Smith presented on behalf of the Interstate Medical Licensure Compact, available for both osteopaths and medical doctors. Differing from both REPLICA and eNLC, the IMLC operates by providing an expedited process for physicians to obtain a full, unrestricted license from a member state. Individual providers opt-in to this compact, which helps them both obtain new licensure in other states and renew current licensure in however many states they are licensed, quickly and efficiently. 

By all accounts, attendees found the meeting to be extremely helpful and informative as the state considers which occupational licensing compacts may be beneficial to their healthcare workforce.

Iris Hentze is a policy associate in NCSL’s  Employment, Labor and Retirement program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.