North Dakota Enacts PA Compact in First Rural Health Transformation Program Inspired Win of 2026
February 4, 2026
North Dakota has joined the growing list of states enacting the Physician Assistant Licensure Compact. With the signing of House Bill 1622, the state is now the 21st state to join an interstate licensure compact that will streamline multistate practice for physician associates (PAs) and expand access to care across state lines.
The legislation, enacted during a special session to implement a series of bills tied to North Dakota’s Rural Health Transformation Program (RHTP), will position the state to ease workforce barriers and supports federal funding priorities tied to improving care delivery in rural and underserved communities.
“The North Dakota Academy of Physician Assistants (NDAPA) commends the North Dakota Legislature and Governor Kelly Armstrong for advancing legislation to join the interstate PA Licensure Compact, brought forward by the ND Legislative Management Joint Policy Committee as part of the Rural Health Transformation Program,” said NDAPA President Travis Booke, MPAS, PA-C.
“Participation in the compact is a meaningful step toward strengthening North Dakota’s healthcare workforce and improving access to care, particularly in rural and underserved communities. By streamlining licensure across participating states, the compact allows qualified PAs to practice more efficiently while helping our healthcare system respond to workforce needs. NDAPA appreciates Governor Armstrong’s leadership and commitment to improving healthcare access, as well as the collaboration of the Joint Policy Committee and all those involved in moving this important initiative forward.”
Rural Health Transformation Program is Inspiring Action
The enactment of the PA Licensure Compact in North Dakota marks the first legislative victory tied to PA practice and AAPA’s policy agenda since RHTP grants were announced and awarded at the end of 2025. The milestone demonstrates how RHTP incentives are driving policy action to modernize PA practice and expand access to care.
The RHTP is a $50 billion federal initiative established under H.R. 1 to strengthen rural healthcare systems by addressing workforce shortages, modernizing care delivery, and improving access to essential services in underserved communities. All 50 states applied for and received funding through the program and are now required to implement comprehensive plans, with progress assessed over the next five years and tied to continued federal investment.
Thanks to sustained engagement with the Centers for Medicare & Medicaid Services (CMS), AAPA’s PA practice modernization framework — which categorizes states based on their PA practice laws — was incorporated into the program’s scoring criteria, along with state action on PA Licensure Compact legislation. As a result, states are formally evaluated on whether their PA practice environments support workforce mobility, team-based care, and PAs practicing at the top of their education and training.
As states move from planning to implementation of their RHTP strategies, PA priorities are emerging as clear drivers of change.
“AAPA expects the Rural Health Transformation Program to be a major driving force for policy progress this legislative season,” said Chantell Taylor, Chief of Public Affairs and Advocacy. “North Dakota’s early success is a sign of things to come, and we anticipate more states will follow this path in 2026.”
What the PA Compact Means for PAs and Patients
The Physician Assistant Licensure Compact will provide a streamlined path for qualified PAs to obtain authorization to practice in other compact member states via a single compact privilege. This system eliminates the need for separate state-by-state licensure applications for each state where a PA intends to practice, potentially reducing administrative burdens and improving mobility for providers, especially those serving rural areas or delivering care through telehealth.
Under the compact framework, eligible PAs must hold an unrestricted license in a compact state, maintain current certification, and meet other professional standards. While compact privileges will not be active until the compact commission has operationalized rules and systems nationwide, North Dakota’s law ensures the state is positioned as a partner in multistate licensure collaboration.
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