In an age of telehealth, interjurisdictional care, and mobile workforces, the concept of a licence tied to a single jurisdiction is increasingly a barrier. For occupational therapists (OTs) and occupational therapy assistants (OTAs), navigating multiple state licensure requirements when working across state lines or providing telepractice can be time-consuming, costly, and administratively burdensome. To address these challenges, the Occupational Therapy Licensure Compact (OT Compact) was introduced to streamline licensure and make it easier for professionals to practise across state borders.
In this post, we'll explore why the OT Compact matters, how it works, its current status and challenges, and what it means for OTs and patients.
What Is the Occupational Therapy Compact?
An interstate professional licensure compact is essentially an agreement between states that lets them recognize each other’s licenses under certain conditions. For occupational therapists (OTs) and occupational therapy assistants (OTAs), this means you can practise in other compact states without having to go through the full licensing process again. The Occupational Therapy Licensure Compact (OT Compact), launched in 2019 by the American Occupational Therapy Association (AOTA) and the National Board for Certification in Occupational Therapy (NBCOT), was created to make licensure simpler and give professionals more freedom to work across state lines. It’s modelled on similar compacts in nursing, physical therapy, and other healthcare professions, providing a proven way to improve access to care while keeping state-level standards in place.
Why the OT Compact Matters
The Compact brings tremendous benefits to both practitioners and the public:
1. Enhances professional mobility – Enables occupational therapists (OTs) and occupational therapy assistants (OTAs) to practise across multiple member states under one primary licence, reducing the need for separate applications and renewals.
2. Supports telehealth expansion – Allows OTs to deliver virtual services to clients in other compact states, improving access to care for rural and underserved communities.
3. Ensures continuity of care – Clients who move or travel across state lines can continue working with the same therapist without service disruption.
4. Maintains public protection – States retain full regulatory authority and share data on licensure and disciplinary actions, ensuring consistent professional standards.
5. Reduces administrative and financial burdens – Streamlines licensure processes, saving practitioners time and money while simplifying compliance.
6. Addresses workforce shortages – Makes it easier for therapists to relocate or fill roles in high-demand areas, strengthening the national OT workforce.
7. Aligns with other healthcare professions – Brings occupational therapy in line with fields such as nursing and physical therapy that already use interstate licensure compacts.
What are the specific requirements for an OT Compact privilege?
To obtain a compact privilege, a practitioner must:
- Hold a valid, unrestricted OT or OTA licence in good standing in a compact member state.
- Have a Social Security Number or National Provider Identifier (NPI).
- Meet jurisprudence (law/ethics) exam requirements of the remote state, if applicable.
- Pass an FBI fingerprint-based criminal background check.
- Have had no recent disciplinary or adverse actions.
- Pay the required fees for each compact privilege.
- Comply with compact rules and obligations.
Note: The home state must be a compact member and issue a full licence - non-resident state licences do not qualify as a home licence.
Current Status and Timeline
The Occupational Therapy Compact (OT Compact) is gaining serious momentum, with 31 states already having enacted the legislation. Currently, the OT Compact Commission is busy finalizing the necessary rules and policies for operation. The system is projected to go live and begin granting practice privileges in late 2025 for participating states.
Until the official "go-live" date, therapists must continue to apply for and maintain separate state licenses to legally practice across state borders. Stay tuned for the official launch announcement!
How OT and OTAs Can Prepare
- Stay Informed – Follow updates from otcompact.gov and your state OT board.
- Support Legislation – Advocate for compact adoption in your state if it hasn’t yet joined.
- Maintain Licence Good Standing – Keep your credentials current and free from disciplinary actions.
- Prepare for Application – Gather background checks and any jurisprudence exam materials early.
- Understand Remote State Rules – Be aware of local telehealth or practice laws, even under the compact.
- Engage with Employers – Clarify your compact privilege status with HR, insurers, and credentialing teams.
Conclusion
The Occupational Therapy Licensure Compact represents a significant advancement for occupational therapy in the United States. By allowing qualified professionals to practise across member states more easily, it enhances access to care while maintaining robust public protection.
For practitioners, now is the time to prepare – stay informed, advocate for adoption in your state, and position yourself for a more flexible and connected future in occupational therapy.
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