The OT Compact for Occupational Therapy Assistants

Yes, occupational therapy assistants can use the OT Compact. The compact model law covers "Occupational Therapists and Occupational Therapy Assistants" throughout, and the eligibility rules are the same: a home state license where you live, in a state that is issuing privileges, with a clean record and a background check through your home board. The one rule specific to OTAs is supervision. On a privilege, you must be supervised by an OT who is licensed in, or holds a privilege in, the state where you are working.

Which rule applies only to OTAs?

Section 4D of the model law: "Occupational Therapy Assistants practicing in a Remote State shall be supervised by an Occupational Therapist licensed or holding a Compact Privilege in that Remote State." Your supervising OT back home does not count for work in another state unless that OT is also authorized there.

Section 4C adds that anyone practicing on a privilege "shall function within the laws and regulations of the Remote State." For OTAs that means the remote state's supervision rules, which differ more than most people expect. A few examples from the regulations:

• Kentucky requires at least four hours a month of general supervision for each OTA, including at least two hours face-to-face, and countersignature of OTA notes on evaluations, plans of care and discharge summaries within 14 days (201 KAR 28:130). Kentucky has enacted the compact but is not issuing yet.
• Pennsylvania requires supervisory contact for at least 10 percent of the OTA's direct patient care time, with face-to-face contact on site at least once a month (49 Pa. Code § 42.22). Also enacted, not issuing.
• Oregon, not a compact member, requires the OTA to record a supervising OT in the board's license portal and the OT to approve it before work starts (OAR 339-010-0035).

More states, and the traps they set, are in OTA supervision rules that trip up a move. Before you apply for any privilege, read that state's supervision rule; the application asks you to attest that you have read its laws and rules.

What do OTAs pay for a privilege?

The Commission's $75 fee is the same for OTs and OTAs. Several states charge OTAs a lower state fee, per the Commission's Before You Apply page in October 2026:

• Virginia: $40 for OTAs, $75 for OTs
• Tennessee: $100 for OTAs, $125 for OTs
• Mississippi: $150 for OTAs, $200 for OTs
• Arkansas: $3 for OTAs, $4 for OTs
• Minnesota, Ohio, West Virginia, Indiana, Maryland and Wisconsin charge the same for both

Full totals are in what an OT Compact privilege costs.

Is the rest of the process the same as for OTs?

Yes. As an OTA you need:

1. A home state license in the state where you live, which must be issuing privileges. See your home state.
2. No encumbrance on any license you hold.
3. An FBI background check through your home board. See the FBI background check.
4. Any jurisprudence exam the remote state requires. Ohio, Maryland and Wisconsin among the issuing states. See jurisprudence requirements.
5. Your own CompactConnect application and payment. The Commission bars employers and agencies from completing it for you. See can someone else apply?

Privileges expire with your home license, and continuing education is due only in your home state.

Where does the compact not help OTAs?

• Non-member states. California, Texas, Florida, New Jersey and Oregon, among others, are not in the compact. You need a license there.
• Enacted states not yet issuing. Including Kentucky, Pennsylvania and North Carolina, as of October 2026.
• Supervision gaps. If no OT at the job holds a license or privilege in that state, the privilege does not let you work there.
• School credentials. Some states require a school credential on top of the license. Wisconsin's school occupational therapist assistant license, for example, requires certification as an OTA by Wisconsin's occupational therapists affiliated credentialing board (Wis. Admin. Code PI 34.092). See school-based OT credentials.

Does a privilege change how Medicare treats OTA services?

No. CMS treats a license through a compact pathway as a valid license (MLN Matters SE20008), but the Medicare rules for OTA services do not change. Under 42 CFR 410.59, Medicare Part B pays for outpatient OT services furnished by an OT or "an appropriately supervised occupational therapy assistant." In an OT private practice, an OTA may work under the OT's general supervision. Claims for services furnished in whole or in part by an OTA carry a modifier and, since 2022, are paid at 85 percent of the otherwise applicable amount. The Medicare enrollment form for individual practitioners, the CMS-855I, lists "Occupational Therapist in Private Practice" as a supplier type and has no category for OTAs; OTA services are billed through the supervising OT or the provider. See Medicare enrollment for OTs.

How do we help OTAs?

The same way we help OTs, at the same compact prices: an OT Compact Readiness Review ($149) to confirm the compact works for you, and the Compact Privilege Concierge ($299 for the first privilege, $149 for each additional) to coordinate your home-board background check, prepare you for jurisprudence and the remote state's supervision rules, and guide you while you complete and submit your own application. For states outside the compact, our OTA license by endorsement is $499 per state and includes the supervision paperwork some states require before you start work. See also licensing as an OTA in another state.