The Overview
Pennsylvania's new Interstate Occupational Therapy Licensure Act lets the governor join a compact that allows occupational therapists and assistants to practice in other member states. [](#ngr-1537bea8-4c5b-490b-9d0e-f5556e6ddc5c)
To get a "Compact Privilege," a practitioner needs a valid, unencumbered license in their home state, must complete a criminal background check, meet jurisprudence requirements and pay fees, and can have no adverse actions in the prior two years. The compact creates an Occupational Therapy Compact Commission, with one delegate from each member state, that can make binding rules, run a shared database of licensing and disciplinary information, and enforce compliance.
According to the bill's summary, an adverse action against a practitioner's home-state license deactivates their Compact Privilege in all other member states. The *Erie Times-News* reported that Pennsylvania's health-care workforce has faced persistent shortages: hospitals report vacancy rates above 10 percent for several critical positions, and more than half of nursing homes have more than 10 open slots. In-state licensing processes could take months, compounding those shortages, *The Philadelphia Inquirer* reported.
The bill also adds provisions for active-duty military members and their spouses.
Lead sponsor Rep. Brandon Markosek, a Democrat from House District 25, introduced the bill Feb. 4, 2025, and the governor approved it July 20, 2026. The act stands on its own and doesn't name any existing Pennsylvania statute it amends or repeals, though the compact overrides conflicting state laws where they clash.
The Demo
Pennsylvania has about 13 million residents in more than 5.2 million households, according to 2024 American Community Survey five-year estimates. About 5.6 percent of residents have no health insurance, and 14.4 percent report a disability. About 11.7 percent of residents live below the poverty line.
The Debate
The House passed the bill 199 to 3 on July 1, 2025, with one other vote recorded. The Senate followed with a 50-to-0 vote on July 11, 2026, after an amendment.
In a January 9, 2025 co-sponsorship memo, Markosek said he planned to introduce legislation to bring Pennsylvania into the National Occupational Therapy Licensure Compact. Pennsylvania Senate Republicans described the bill as a way to make interstate practice easier and improve access to services.
What's Next
The act takes effect about 60 days after the July 20, 2026 signing, which puts it in September 2026. Pennsylvania's participation starts once the governor executes the compact, files a verified copy with the Secretary of the Commonwealth, and at least one other state ratifies it; the Secretary then notifies the Legislative Reference Bureau for publication in the *Pennsylvania Bulletin*. The compact itself takes effect once at least 10 member states enact it, but the bill materials don't say how many had ratified it at launch or when practitioners can apply for a Compact Privilege.
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