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We had an ICPC for an out-of-state kinship placement. In our case it was definitely more of a formality (though obviously if we hadn't passed drug test/bg screen, I assume we would have been rejected), however I have heard of others on here whose states couldn't work out an agreement, like the receiving state would request tuition reimbursement from the sending state, or refused to pay the medical care (provide state medicaid) or supervise the placement (like CW visits)... We were not informed of the details of our arrangement, but the sending state pays the stipend/daily rate in our case, but our state provides medicaid and is not reimbursed for public school tuition (as far as I know)...
No personal experience, but I have heard the states can be nitpicky and disagreeable. Perhaps that is more likely to happen in a non-kinship situation.