PA Compact Development History


The PA Compact was developed to enhance licensure portability for physician assistants through the collaborative effort of the Federation of State Medical Boards (FSMB), the American Academy of Physician Associates (AAPA), the National Commission on Certification of Physicians Assistants (NCCPA) and The Council of State Governments (CSG). The project began in 2019 with grant support from the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of funding for the Licensure Portability Grant Program (H1MRH24097). To develop the compact legislation, the organizations used a multitier, stakeholder-informed process that prioritized transparency, collaboration, and consensus. 

1. Conduct Project Research

With support from CSG, FSMB researched and analyzed the scope of the proposed interstate compact, including a detailed examination of strengths, barriers, benefits, impacts, historical data, timelines and other extraordinary or specialized data.

2. Develop and Convene Technical Assistance Group

The four collaborating organizations formed a technical assistance group to review research, examine issues and the current policy spectrum, explore best practices and alternative structures, and develop recommendations for the draft interstate compact.

The group planned a two-day meeting in Washington, D.C., bringing together subject matter experts, partner and project organizations, policymakers, elected officials and other stakeholders to identify the elements of a potential compact to facilitate PA license portability. The COVID-19 pandemic forced the cancellation of a planned in-person stakeholder meeting in spring 2020, but an additional technical assistance group meeting was successfully held one year later.

3. Develop and Convene Document Team

In consultation with project stakeholders, CSG, FSMB, AAPA and NCCPA formed a document team to draft the interstate compact. CSG attorneys and staff supported the work of the document team by providing legal and policy technical assistance. The team produced a draft interstate compact in spring 2021, conforming to standard and accepted language and structure based on the policy provisions recommended by the technical assistance group.

4. Conduct Stakeholder Review

A draft of proposed model legislation was distributed in April 2021 to state medical boards and key stakeholders. CSG conducted a transparent and extensive stakeholder draft review process that was open to the public. Each of the four organizations also solicited feedback on the proposed draft compact from identified stakeholders, including state medical boards and other interested parties. CSG organized comments and reconvened the document team to analyze the feedback and decide if the issues raised warranted changes to the draft document. The draft was then updated based on any feedback received beginning in August 2021. The model language has been revised multiple times to accommodate concerns and to address questions raised. The “privilege to practice” model remains the consensus of the PA community.

5. Finalize Document

Upon completing its analysis of stakeholder comments from the review process, the document team delivered a final draft of the interstate compact to the technical assistance group. CSG reconvened the technical assistance group to review the proposed final draft, stakeholder feedback, technical assistance group recommendations, project scope materials and research to finalize the compact. It was finalized in November 2022, with informational webinars hosted by FSMB and AAPA occurring in December 2022 and January 2023. The model PA Compact legislation authorizes physician assistants to practice in a remote state based on a participating state’s full and unrestricted license. To qualify, PAs are required to meet certain criteria, including, but not limited to, graduation from an accredited PA program, current NCCPA certification, and no felony or misdemeanor convictions or controlled substance restrictions.