Respiratory Care Interstate Compact
About
The Council of State Governments (CSG) is partnering with the Department of Defense (DoD) and The American Association for Respiratory Care (AARC) to support the mobility of licensed respiratory therapists through the development of a new interstate compact. This additional licensing pathway will facilitate multistate practice among member states and reduce the barriers to license portability.
The Respiratory Care Interstate Compact (RCIC) is an interstate occupational licensure compact for respiratory therapists. There are approximately 130,000 licensed respiratory therapists in the United States. Licensees currently face significant barriers to providing services across state borders, even when they meet the qualifications to practice in another state. The Respiratory Care Interstate Compact will facilitate multistate practice by reducing unnecessary licensure burdens and improve public safety by enhancing state information sharing.
Current Status
The model legislation of the Respiratory Care Interstate Compact has been finalized and is now available for state enactment. View the finalized language below:
Click here to view the model lesgislation
Project History and Timeline
The Department of Defense has sought to support the development of interstate compacts as a mechanism for ensuring the professional licenses of military spouses are easily portable. In September 2020, the Department of Defense entered into a cooperative agreement with The Council of State Governments (CSG) to fund the creation of new interstate compacts designed to strengthen occupational licensing portability. In collaboration with the Department of Defense, CSG developed and administered a competitive application process to select the professions for initial compact development. Eligible applicants included associations of professionals, associations or federations of state licensing boards, coalitions of state licensing boards and national credentialing bodies for professions licensed in at least 30 states. In 2023, the Department of Defense and CSG announced that the American Association for Respiratory Care (AARC) was a successful applicant for compact technical assistance.
To develop recommendations guiding the drafting of the Respiratory Care Interstate Compact, CSG and AARC brought together a Technical Assistance Group made up of representatives from the National Board for Respiratory Care and the Commission on Accreditation for Respiratory Care, state board members, board administrators, members of professional associations, licensed respiratory therapists and other stakeholders. The group met over the course of several months to determine the needs of the profession and the compact model, respiratory therapy mobility patterns, and current licensure systems.
A separate, smaller drafting team transitioned the recommendations and model from the Technical Assistance Group into a full draft of the Respiratory Care Interstate Compact model legislation.
Working Group Members*
Vanessa Beauchamp, Executive Director, Missouri Board for Respiratory Care
Lexie Caraway, MBA, RRT, RRT-ACCS, RRT-NPS, AE-C
Kellie Carroll, MPA, RRT, RRT-NPS, AE-C, C-ELBW, Representative of the National Board for Respiratory Care
Vincent A. Culotta Jr. M.D., Executive Director, Louisiana State Board of Medical Examiners
Daniel Garrett, CAE, Representative of the American Association for Respiratory Care
Carl Hinkson, MSc, RRT, RRT-ACCS, RRT-NPS, FAARC, Representative of the American Association for Respiratory Care
Kiley Hodge, RCP, RRT, RRT-ACCS
Stephanie Lotridge, Executive Officer, Respiratory Therapy Licensure Board, Idaho Division of Occupational and Professional Licenses
Tamara McDaniel, Executive Director, Kentucky Board of Respiratory Care
Miriam O’Day, Representative of the American Association for Respiratory Care
Ron Pasewald BS, RRT-ACCS, AACVPR
Nicholas Prush, Ph.D., MHA, RRT, RRT-ACCS, University of Michigan
Franz Schuttenhelm, MS, RRT, RRT-NPS, RRT-ACCS, Wisconsin Society for Respiratory Care
Lori Tinkler, CEO, National Board for Respiratory Care
Sarah Varekojis, Ph.D., RRT, RRT-ACCS, FAARC, Representative of the Commission on Accreditation for Respiratory Care
*This list is not inclusive of the entire Document Team and Technical Assistance Group, just those individuals who agreed to be listed
The model legislation of the compact was finalized in October 2024. States can now begin enacting the language through their legislative process. On average, compacts may take 1-2 years after the model legislation is finalized to reach its activation threshold. The Respiratory Care Interstate Compact has an activation threshold of seven states. Once the compact the activation threshold is reached, a commission will be formed of the states who have enacted the language at that time. This commission will oversee the operations of the compact and work to set up the data system so states may begin issuing compact privileges. Operationalization of the compact typically takes between 2-3 years after the activation threshold has been met.
Frequently Asked Questions
What is the the Respiratory Care Interstate Compact?
The Respiratory Care Interstate Compact is a legally binding agreement among states that provides a pathway through which respiratory therapists can obtain compact privileges which authorize practice in states where they are not licensed. A state must enact the compact model legislation via a state’s legislative process to join.
What are some benefits of the compact?
Some benefits of the Respiratory Care Interstate Compact include:
– Facilitating multistate practice through enhanced licensure portability.
– Expanding employment opportunities into new markets.
– Improving continuity of care when patients or providers relocate.
– Expanding patient access to highly qualified practitioners.
– Supporting relocating military spouses.
– Reducing the burden of maintaining multiple licenses.
How does the Respiratory Care Interstate Compact work?
The Respiratory Care Interstate Compact is a mutual recognition model compact similar in form and function to professional licensure compacts for nurses, physical therapists and psychologists. Respiratory therapists who are licensed in one compact member state can practice in another participating state by obtaining a compact privilege.
A compact privilege is the legal authorization for a respiratory therapist to practice in a compact member state where they are not licensed. A respiratory therapist must hold an active and unencumbered license in a compact participating state in which they reside and meet additional eligibility criteria to be eligible for a compact privilege. A respiratory therapist applies for a compact privilege and may begin legally working in the new state when eligibility is verified, jurisprudence requirements are met and all fees are paid.
How do practitioners qualify for a compact privilege?
To hold and maintain a compact privilege an individual must:
– Hold and maintain an active license as a respiratory therapist in a compact member state of primary residence
– Hold and maintain an active credential from the National Board for Respiratory Care that would otherwise qualify them for licensure in the compact member state in which they are seeking a compact privilege
– Have not had any adverse actions against a license within the previous two years
– Notify the compact commission about seeking the compact privilege
– Pay any applicable fees, including any state and commission fees
– Meet any jurisprudence requirements established by the compact member state in which the licensee is seeking a compact privilege
What is the compact commission?
The commission is a government agency established by the compact. The commission will be comprised of one delegate from each participating state. The commission writes rules and bylaws to administer and implement the compact. As stated in section 7 of the compact, commissioners will be the executive director, or their designee, from each participating state’s licensing authority. The commission is not a licensing board. It cannot affect state licensing requirements or take action against a licensee.
Will respiratory therapists need to complete jurisprudence requirements for each state?
Practitioners will only need to complete a jurisprudence assessment if it is required by the compact member state where they are seeking a compact privilege.
Do I have to be licensed in my home state to join the compact?
To participate in the compact, a RT must hold a license issued by their home state. The compact defines home state as the licensee’s primary domicile. A license from a state other than the home state does not qualify one to participate in the compact.
How will state regulators know who is practicing in their state?
Because respiratory therapists need to obtain individual compact privileges in each state where they want to practice, regulators will know who has compact privileges in their state. They will see this information via the commission’s data system that the participating states have access to. Just as a regulator can currently see who has a license in their state, regulators will also be able to know who has compact privileges to practice in their state.
Will the compact be inclusive of both CRT and RRT credentials?
To obtain a compact privilege, an individual must hold a credential from the National Board for Respiratory Care that would otherwise qualify them for single state licensure in the state they are seeking the compact privilege. If a state requires the CRT credential as the minimum standard for a single state license, an individual with either a CRT or RRT credential may obtain a compact privilege in that state. If a state requires an RRT as the minimum standard for single state licensure, then only an individual with an RRT may obtain a compact privilege in that state.
How can interested parties get involved?
The compact model legislation has been finalized. Each state must enact the compact model legislation via a state’s legislative process to join.
The Respiratory Care Interstate Compact is the result of a partnership between The Council of State Governments, the American Association for Respiratory Care, and Department of Defense. To get involved, reach out to your local respiratory care state society.
Where can I find frequently asked questions about interstate compacts generally?
Visit our general compacts FAQ page here.
Compact Stakeholder Review Meeting
Additional Questions
If you have any additional questions, reach out to [email protected]