The OT Licensure Compact Is Launching: What Occupational Therapists Should Know Before Applying

On March 9, 2026, Indiana became the latest state to begin accepting applications for the  Occupational Therapy Licensure Compact –– a signal that the interstate compact is moving from legislation to implementation. 

With the OT Compact, occupational therapists across the United States join colleagues in other clinical professions who practice in multiple participating states without needing additional state-specific licenses. The move makes it easier to relocate, travel as a per diem clinician or work remotely via telehealth. Importantly, it expands patient access and addresses clinical shortages, especially in rural areas.

In January 2026, Minnesota, Ohio and West Virginia began accepting applications from OTs seeking to practice in other participating states. This is the first step in expanding practice privileges and marks a significant milestone for those seeking to work across state lines. Indiana followed suit in March. The more states that approve the interstate compact for OTs, the more states where accepted OTs will be eligible to practice.

With the ability to practice in multiple states comes the responsibility to understand each state’s regulations, scope-of-practice rules and liability risks. When rules differ in another state from where you’re licensed, you’re still required to follow those specific regulations.

That means understanding how the compact works and its limits is essential for OTs considering multi-state practice.

What the Occupational Therapy Licensure Compact Is and Why It Matters for OTs

Similar to interstate compacts in other clinical professions, the Occupational Therapy Licensure Compact is an agreement among states that allows licensed OTs and occupational therapy assistants (OTAs) to obtain compact privileges to practice in other participating states without obtaining full licensure in each one.

The compact model requires you to maintain one home-state license. From there, you can apply for privileges to practice in other member states that are actively granting privileges.

Why Interstate Licensure Compacts Are Expanding Across Healthcare

Healthcare workforce shortages and the expansion of telehealth have accelerated interest in licensure compacts across the field. Several clinical professions, including physical therapy and speech therapy, now use compact agreements that allow practitioners to work more easily across state lines.

In every case, compacts simplify the process of obtaining permission to practice in multiple states, but they don’t create a single national license. Each state still regulates clinicians’ practice within its own jurisdiction.

How Occupational Therapy Licensure Compact Privileges Work

To apply for practice privileges in participating states, OTs must do the following: 

• Have an active license in good standing in a Compact member state to be eligible. This state is considered your designated “home state.” 
• Meet any background check and disciplinary requirements outlined by the compact.
• Apply for compact privileges in additional states: Privileges are granted state by state, meaning clinicians must select the states where they plan to practice.
• Follow the laws of the state where the patient is located: Even with a compact privilege, practitioners must comply with the regulations of the state in which care is delivered.

OT Compact Application Requirements, Fees, and Eligibility

Compact privileges are issued separately for each state, and each state may charge its own application or privilege fees. Processing timelines may also vary depending on the state and its regulatory infrastructure.

Note that the compact includes sharing information between state licensing boards, including disciplinary actions. This allows member states to maintain oversight while supporting practitioner mobility.

Practicing Occupational Therapy Across State Lines: Rules OTs Must Follow

One of the most important points for occupational therapists to understand is that compact privileges don’t replace state practice laws. In fact, it complicates them. Each state continues to regulate OT practice within its jurisdiction. That means you must know and follow the rules of the state where your patient receives care.

Differences can include:

• Scope-of-practice definitions
• Supervision requirements for OTAs
• Documentation standards
• Telehealth regulations
• Continuing education requirements
• Mandatory reporting obligations

Practicing across multiple states requires careful attention to these variations. Not knowing the differences between practice requirements can put you at risk if something goes wrong.

Professional Liability Risks When Practicing Occupational Therapy in Multiple States

Professional liability claims are generally evaluated according to the laws and standards of care in the state where treatment occurred. When you practice in multiple jurisdictions, you’re subject to multiple regulatory environments and legal standards.

It’s important to speak with your insurance agent to review your professional liability coverage before expanding into other states in order to ensure you’re covered everywhere you plan to practice.

Next Steps for Occupational Therapists Interested in the OT Licensure Compact

• Confirm whether your home state is taking steps to join the OT Licensure Compact. While only a few states are currently actively issuing privileges, the majority of states have enacted or filed legislation. You can click here to track the progress on the U.S. Compact map.
• If you’re in a state that allows you to apply for privileges, research the practice laws and scope-of-practice rules in the applicable states before ever providing care outside your home state.
• Review your professional liability coverage before expanding into multi-state practice.