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     ARTICLE 20

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RELATING TO HEALTHCARE REFORM

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SECTION 1. Title 5 of the General Laws entitled "Businesses and Professions” is hereby

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amended by adding thereto the following chapter:

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CHAPTER 37.8

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THE INTERSTATE MEDICAL LICENSURE COMPACT

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5-37.8-1. Short title. -- This chapter shall be known and may be cited as the "interstate

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medical licensure compact act".

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     5-37.8-2. Purpose. -- In order to strengthen access to health care, and in recognition of the

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advances in the delivery of health care, the member states of the interstate medical licensure

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compact have allied in common purpose to develop a comprehensive process that complements the

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existing licensing and regulatory authority of state medical boards, provides a streamlined process

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that allows physicians to become licensed in multiple states, thereby enhancing the portability of a

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medical license and ensuring the safety of patients. The compact creates another pathway for

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licensure and does not otherwise change a state's existing medical practice act. The compact also

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adopts the prevailing standard for licensure and affirms that the practice of medicine occurs where

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the patient is located at the time of the physician-patient encounter, and therefore, requires the

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physician to be under the jurisdiction of the state medical board where the patient is located. State

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medical boards that participate in the compact retain the jurisdiction to impose an adverse action

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against a license to practice medicine in that state issued to a physician through the procedures in

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the compact.

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5-37.8-3. Definitions. -- As used in this chapter, the following words and terms shall have

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the following meanings:

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(1) "Bylaws" means those bylaws established by the interstate commission pursuant to §5-

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37.8-12 for its governance, or for directing and controlling its actions and conduct.

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(2) "Commissioner" means the voting representative appointed by each member board

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pursuant to § 5-37.8-12.

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(3) "Conviction" means a finding by a court that an individual is guilty of a criminal offense

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through adjudication, or entry of a plea of guilt, nolo contendere, or no contest to the charge by the

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offender. Evidence of an entry of a conviction of a criminal offense by the court shall be considered

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final for purposes of disciplinary action by a member board.

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(4) "Expedited license" means a full and unrestricted medical license granted by a member

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state to an eligible physician through the process set forth in the compact.

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(5) "Interstate commission" means the interstate commission created pursuant to § 5-

 

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37.8-12.

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(6) “Interstate medical licensure compact” or “compact” means the interstate medical

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licensure compact created pursuant to this chapter.

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(7) "License" means authorization by a state for a physician to engage in the practice of

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medicine, which would be unlawful without the authorization.

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(8) "Medical practice act" means laws and regulations governing the practice of allopathic

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and osteopathic medicine within a member state.

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(9) "Member board" means a state agency in a member state that acts in the sovereign

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interests of the state by protecting the public through licensure, regulation, and education of

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physicians as directed by the state government.

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(10) "Member state" means a state that has enacted the compact.

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(11) "Practice of medicine" means the clinical prevention, diagnosis, or treatment of human

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disease, injury, or condition requiring a physician to obtain and maintain a license in compliance

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with the medical practice act of this state.

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(12) "Physician" means any person who:

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(i) Is a graduate of a medical school accredited by the Liaison Committee on Medical

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Education, the Commission on Osteopathic College Accreditation, or a medical school listed in the

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International Medical Education Directory or its equivalent;

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(ii) Passed each component of the United States Medical Licensing Examination (USMLE)

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or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) within three

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(3) attempts, or any of its predecessor examinations accepted by a state medical board as an

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equivalent examination for licensure purposes;

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(iii) Successfully completed graduate medical education approved by the Accreditation

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Council for Graduate Medical Education or the American Osteopathic Association;

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(iv) Holds specialty certification or a time-unlimited specialty certificate recognized by the

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American Board of Medical Specialties or the American Osteopathic Association's Bureau of

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Osteopathic Specialists;

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(v) Possesses a full and unrestricted license to engage in the practice of medicine issued by

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a member board;

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(vi) Has never been convicted, received adjudication, deferred adjudication, community

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supervision, or deferred disposition for any offense by a court of appropriate jurisdiction;

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(vii) Has never held a license authorizing the practice of medicine subjected to discipline

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by a licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to

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non-payment of fees related to a license;

 

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(viii) Has never had a controlled substance license or permit suspended or revoked by a

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state or the United States Drug Enforcement Administration; and

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(ix) Is not under active investigation by a licensing agency or law enforcement authority in

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any state, federal, or foreign jurisdiction.

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(13) "Offense" means a felony, gross misdemeanor, or crime of moral turpitude.

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(14) "Rule" means a written statement by the interstate commission promulgated pursuant

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to § 5-37.8-13 of the compact that is of general applicability, implements, interprets, or prescribes

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a policy or provision of the compact, or an organizational, procedural, or practice requirement of

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the interstate commission, and has the force and effect of statutory law in a member state, and

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includes the amendment, repeal, or suspension of an existing rule.

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(15) "State" means any state, commonwealth, district, or territory of the United States.

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(16) "State of principal license" means a member state where a physician holds a license to

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practice medicine and which has been designated as such by the physician for purposes of

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registration and participation in the compact.

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5-37.8-4. Eligibility.

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(a) A physician must meet the eligibility requirements as defined in § 5-37.8-3(11) to

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receive an expedited license under the terms and provisions of the compact.

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(b) A physician who does not meet the requirements of § 5-37.8-3(11) may obtain a license

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to practice medicine in a member state if the individual complies with all laws and requirements,

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other than the compact, relating to the issuance of a license to practice medicine in that state.

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     5-37.8-5. Designation of state principal license.

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     (a) A physician shall designate a member state as the state of principal license for purposes

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of registration for expedited licensure through the compact if the physician possesses a full and

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unrestricted license to practice medicine in that state, and the state is:

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     (1) The state of primary residence for the physician; or

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     (2) The state where at least twenty-five percent (25%) of the practice of medicine occurs;

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or

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     (3) The location of the physician's employer; or

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(4) If no state qualifies under §§ 5-37.8-5(a)(1), (2), or (3), the state designated as state of

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residence for purpose of federal income tax.

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(b) A physician may redesignate a member state as state of principal license at any time, as

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long as the state meets the requirements in § 5-37.8-5(a).

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(c) The interstate commission is authorized to develop rules to facilitate redesignation of

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another member state as the state of principal license.

 

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5-37.8-6. Application and issuance of expedited licensure.

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(a) A physician seeking licensure through the compact shall file an application for an

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expedited license with the member board of the state selected by the physician as the state of

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principal license.

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(b) Upon receipt of an application for an expedited license, the member board within the

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state selected as the state of principal license shall evaluate whether the physician is eligible for

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expedited licensure and issue a letter of qualification, verifying or denying the physician's

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eligibility, to the interstate commission.

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(1) State qualifications, which include verification of medical education, graduate medical

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education, results of any medical or licensing examination, and other qualifications as determined

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by the interstate commission through rule, shall not be subject to additional primary source

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verification where already primary source verified by the state of principal license.

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(2) The member board within the state selected as the state of principal license shall, in the

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course of verifying eligibility, perform a criminal background check of an applicant, including the

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use of the results of fingerprint or other biometric data checks compliant with the requirements of

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the Federal Bureau of Investigation, with the exception of federal employees who have suitability

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determination in accordance with U.S.C.F.R. § 731.202.

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(3) Appeal on the determination of eligibility shall be made to the member state where the

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application was filed and shall be subject to the laws of that state.

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(c) Upon verification in § 5-37.8-6(b), physicians eligible for an expedited license shall

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complete the registration process established by the interstate commission to receive a license in a

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member state selected pursuant to § 5-37.8-6(a), including the payment of any applicable fees.

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(d) After receiving verification of eligibility under § 5-37.8-6(b) and any fees under § 5-

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37.8-6(c), a member board shall issue an expedited license to the physician. This license shall

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authorize the physician to practice medicine in the issuing state consistent with the medical practice

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act and all applicable laws and regulations of the issuing member board and member state.

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(e) An expedited license shall be valid for a period consistent with the licensure period in

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the member state and in the same manner as required for other physicians holding a full and

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unrestricted license within the member state.

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(f) An expedited license obtained through the compact shall be terminated if a physician

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fails to maintain a license in the state of principal licensure for a non-disciplinary reason, without

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redesignation of a new state of principal licensure.

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(g) The interstate commission is authorized to develop rules regarding the application

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process, including payment of any applicable fees, and the issuance of an expedited license.

 

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5-37.8-7. Fees for expedited licensure.

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(a) A member state issuing an expedited license authorizing the practice of medicine in that

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state may impose a fee for a license issued or renewed through the compact.

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(b) The interstate commission is authorized to develop rules regarding fees for expedited

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licenses.

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5-37.8-8. Renewal and continued participation.

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(a) A physician seeking to renew an expedited license granted in a member state shall

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complete a renewal process with the interstate commission if the physician:

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(1) Maintains a full and unrestricted license in a state of principal license;

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(2) Has not been convicted, received adjudication, deferred adjudication, community

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supervision, or deferred disposition for any offense by a court of appropriate jurisdiction;

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(3) Has not had a license authorizing the practice of medicine subject to discipline by a

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licensing agency in any state, federal, or foreign jurisdiction, excluding any action related to

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nonpayment of fees related to a license; and

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(4) Has not had a controlled substance license or permit suspended or revoked by a state or

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the United States Drug Enforcement Administration.

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(b) Physicians shall comply with all continuing professional development or continuing

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medical education requirements for renewal of a license issued by a member state.

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(c) The interstate commission shall collect any renewal fees charged for the renewal of a

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license and distribute the fees to the applicable member board.

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(d) Upon receipt of any renewal fees collected in § 5-37.8-8(c), a member board shall renew

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the physician's license.

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(e) Physician information collected by the interstate commission during the renewal

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process will be distributed to all member boards.

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(f) The interstate commission is authorized to develop rules to address renewal of licenses

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obtained through the compact.

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5-37.8-9. Coordinated information system.

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(a) The interstate commission shall establish a database of all physicians licensed, or who

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have applied for licensure, under § 5-37.8-6.

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(b) Notwithstanding any other provision of law, member boards shall report to the interstate

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commission any public action or complaints against a licensed physician who has applied or

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received an expedited license through the compact.

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(c) Member boards shall report disciplinary or investigatory information determined as

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necessary and proper by rule of the interstate commission.

 

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(d) Member boards may report any non-public complaint, disciplinary, or investigatory

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information not required by § 5-37.8-6(c) to the interstate commission.

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(e) Member boards shall share complaint or disciplinary information about a physician

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upon request of another member board.

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(f) All information provided to the interstate commission or distributed by member boards

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shall be confidential, filed under seal, and used only for investigatory or disciplinary matters.

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(g) The interstate commission is authorized to develop rules for mandated or discretionary

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sharing of information by member boards.

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5-37.8-10. Joint investigations.

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(a) Licensure and disciplinary records of physicians are deemed investigative.

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(b) In addition to the authority granted to a member board by its respective medical practice

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act or other applicable state law, a member board may participate with other member boards in

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joint investigations of physicians licensed by the member boards.

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(c) A subpoena issued by a member state shall be enforceable in other member states.

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(d) Member boards may share any investigative, litigation, or compliance materials in

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furtherance of any joint or individual investigation initiated under the compact.

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(e) Any member state may investigate actual or alleged violations of the statutes

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authorizing the practice of medicine in any other member state in which a physician holds a license

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to practice medicine.

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5-37.8-11. Disciplinary actions.

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(a) Any disciplinary action taken by any member board against a physician licensed

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through the compact shall be deemed unprofessional conduct which may be subject to discipline

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by other member boards, in addition to any violation of the medical practice act or regulations in

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that state.

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(b) If a license granted to a physician by the member board in the state of principal license

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is revoked, surrendered or relinquished in lieu of discipline, or suspended, then all licenses issued

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to the physician by member boards shall automatically be placed, without further action necessary

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by any member board, on the same status. If the member board in the state of principal license

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subsequently reinstates the physician's license, a license issued to the physician by any other

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member board shall remain encumbered until that respective member board takes action to reinstate

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the license in a manner consistent with the medical practice act of that state.

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(c) If disciplinary action is taken against a physician by a member board not in the state of

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principal license, any other member board may deem the action conclusive as to matter of law and

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fact decided, and:

 

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(1) impose the same or lesser sanction(s) against the physician so long as such sanctions

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are consistent with the medical practice act of that state; or

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(2) Pursue separate disciplinary action against the physician under its respective medical

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practice act, regardless of the action taken in other member states.

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(d) If a license granted to a physician by a member board is revoked, surrendered or

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relinquished in lieu of discipline, or suspended, then any license(s) issued to the physician by any

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other member board(s) shall be suspended, automatically and immediately without further action

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necessary by the other member board(s), for ninety (90) days upon entry of the order by the

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disciplining board, to permit the member board(s) to investigate the basis for the action under the

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medical practice act of that state. A member board may terminate the automatic suspension of the

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license it issued prior to the completion of the ninety (90) day suspension period in a manner

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consistent with the medical practice act of that state.

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5-37.8-12. Interstate medical licensure compact commission.

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(a) The member states hereby create the "Interstate Medical Licensure Compact

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commission".

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(b) The purpose of the interstate commission is the administration of the interstate medical

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licensure compact, which is a discretionary state function.

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(c) The interstate commission shall be a body corporate and joint agency of the member

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states and shall have all the responsibilities, powers, and duties set forth in the compact, and such

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additional powers as may be conferred upon it by a subsequent concurrent action of the respective

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legislatures of the member states in accordance with the terms of the compact.

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(d) The interstate commission shall consist of two (2) voting representatives appointed by

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each member state who shall serve as commissioners. In states where allopathic and osteopathic

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physicians are regulated by separate member boards, or if the licensing and disciplinary authority

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is split between multiple member boards within a member state, the member state shall appoint one

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representative from each member board. A commissioner shall be a(n):

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(1) Allopathic or osteopathic physician appointed to a member board;

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(2) Executive director, executive secretary, or similar executive of a member board; or

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(3) Member of the public appointed to a member board.

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(e) The interstate commission shall meet at least once each calendar year. A portion of this

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meeting shall be a business meeting to address such matters as may properly come before the

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commission, including the election of officers. The chairperson may call additional meetings and

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shall call for a meeting upon the request of a majority of the member states.

 

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(f) The bylaws may provide for meetings of the interstate commission to be conducted by

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telecommunication or electronic communication.

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(g) Each commissioner participating at a meeting of the interstate commission is entitled

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to one vote. A majority of commissioners shall constitute a quorum for the transaction of business,

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unless a larger quorum is required by the bylaws of the interstate commission. A commissioner

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shall not delegate a vote to another commissioner. In the absence of its commissioner, a member

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state may delegate voting authority for a specified meeting to another person from that state who

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shall meet the requirements of § 5-37.8-12(d).

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(h) The interstate commission shall provide public notice of all meetings and all meetings

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shall be open to the public. The interstate commission may close a meeting, in full or in portion,

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where it determines by a two-thirds (2/3) vote of the commissioners present that an open meeting

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would be likely to:

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(1) Relate solely to the internal personnel practices and procedures of the interstate

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commission;

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(2) Discuss matters specifically exempted from disclosure by federal statute;

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(3) Discuss trade secrets, commercial, or financial information that is privileged or

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confidential;

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(4) Involve accusing a person of a crime, or formally censuring a person;

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(5) Discuss information of a personal nature where disclosure would constitute a clearly

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unwarranted invasion of personal privacy;

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(6) Discuss investigative records compiled for law enforcement purposes; or

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(7) Specifically relate to the participation in a civil action or other legal proceeding.

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(i) The interstate commission shall keep minutes which shall fully describe all matters

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discussed in a meeting and shall provide a full and accurate summary of actions taken, including

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record of any roll call votes.

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(j) The interstate commission shall make its information and official records, to the extent

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not otherwise designated in the compact or by its rules, available to the public for inspection.

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(k) The interstate commission shall establish an executive committee, which shall include

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officers, members, and others as determined by the bylaws. The executive committee shall have

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the power to act on behalf of the interstate commission, with the exception of rulemaking, during

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periods when the interstate commission is not in session. When acting on behalf of the interstate

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commission, the executive committee shall oversee the administration of the compact including

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enforcement and compliance with the provisions of the compact, its bylaws and rules, and other

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such duties as necessary.

 

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(l) The interstate commission may establish other committees for governance and

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administration of the compact.

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     5-37.8-13. Powers and duties of the interstate commission. -- The interstate commission

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shall have the duty and power to:

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(1) Oversee and maintain the administration of the compact;

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(2) Promulgate rules which shall be binding to the extent and in the manner provided for

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in the compact;

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(3) Issue, upon the request of a member state or member board, advisory opinions

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concerning the meaning or interpretation of the compact, its bylaws, rules, and actions;

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(4) Enforce compliance with compact provisions, the rules promulgated by the interstate

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commission, and the bylaws, using all necessary and proper means, including, but not limited to,

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the use of judicial process;

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(5) Establish and appoint committees including, but not limited to, an executive committee

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as required by § 5-37.8-12, which shall have the power to act on behalf of the interstate commission

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in carrying out its powers and duties;

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(6) Pay, or provide for the payment of the expenses related to the establishment,

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organization, and ongoing activities of the interstate commission;

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(7) Establish and maintain one or more offices;

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(8) Borrow, accept, hire, or contract for services of personnel;

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(9) Purchase and maintain insurance and bonds;

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(10) Employ an executive director who shall have such powers to employ, select or appoint

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employees, agents, or consultants, and to determine their qualifications, define their duties, and fix

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their compensation;

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(11) Establish personnel policies and programs relating to conflicts of interest, rates of

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compensation, and qualifications of personnel;

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(12) Accept donations and grants of money, equipment, supplies, materials and services,

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and to receive, utilize, and dispose of it in a manner consistent with the conflict of interest policies

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established by the interstate commission;

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(13) Lease, purchase, accept contributions or donations of, or otherwise to own, hold,

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improve or use, any property, real, personal, or mixed;

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(14) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any

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property, real, personal, or mixed;

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(15) Establish a budget and make expenditures;

 

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(16) Adopt a seal and bylaws governing the management and operation of the interstate

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commission;

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(17) Report annually to the legislatures and governors of the member states concerning the

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activities of the interstate commission during the preceding year. Such reports shall also include

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reports of financial audits and any recommendations that may have been adopted by the interstate

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commission;

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(18) Coordinate education, training, and public awareness regarding the compact, its

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implementation, and its operation;

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(19) Maintain records in accordance with the bylaws;

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(20) Seek and obtain trademarks, copyrights, and patents; and

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(21) Perform such functions as may be necessary or appropriate to achieve the purposes of

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the compact.

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5-37.8-14. Finance powers.

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(a) The interstate commission may levy on and collect an annual assessment from each

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member state to cover the cost of the operations and activities of the interstate commission and its

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staff. The total assessment must be sufficient to cover the annual budget approved each year for

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which revenue is not provided by other sources. The aggregate annual assessment amount shall be

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allocated upon a formula to be determined by the interstate commission, which shall promulgate a

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rule binding upon all member states.

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(b) The interstate commission shall not incur obligations of any kind prior to securing the

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funds adequate to meet the same.

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(c) The interstate commission shall not pledge the credit of any of the member states, except

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by, and with the authority of, the member state.

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(d) The interstate commission shall be subject to a yearly financial audit conducted by a

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certified or licensed public accountant and the report of the audit shall be included in the annual

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report of the interstate commission.

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5-37.8-15. Organization and operation of the interstate commission.

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(a) The interstate commission shall, by a majority of commissioners present and voting,

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adopt bylaws to govern its conduct as may be necessary or appropriate to carry out the purposes of

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the compact within twelve (12) months of the first interstate commission meeting.

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(b) The interstate commission shall elect or appoint annually from among its

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commissioners a chairperson, a vice-chairperson, and a treasurer, each of whom shall have such

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authority and duties as may be specified in the bylaws. The chairperson, or in the chairperson's

 

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absence or disability, the vice-chairperson, shall preside at all meetings of the interstate

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commission.

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(c) Officers selected in § 5-37.8-15(b) shall serve without remuneration from the interstate

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commission.

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(d) The officers and employees of the interstate commission shall be immune from suit and

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liability, either personally or in their official capacity, for a claim for damage to or loss of property

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or personal injury or other civil liability caused or arising out of, or relating to, an actual or alleged

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act, error, or omission that occurred, or that such person had a reasonable basis for believing

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occurred, within the scope of interstate commission employment, duties, or responsibilities;

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provided that such person shall not be protected from suit or liability for damage, loss, injury, or

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liability caused by the intentional or willful and wanton misconduct of such person.

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(1) The liability of the executive director and employees of the interstate commission or

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representatives of the interstate commission, acting within the scope of such person's employment

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or duties for acts, errors, or omissions occurring within such person's state, may not exceed the

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limits of liability set forth under the constitution and laws of that state for state officials, employees,

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and agents. The interstate commission is considered to be an instrumentality of the states for the

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purposes of any such action. Nothing in this subsection shall be construed to protect such person

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from suit or liability for damage, loss, injury, or liability caused by the intentional or willful and

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wanton misconduct of such person.

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(2) The interstate commission shall defend the executive director, its employees, and

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subject to the approval of the attorney general or other appropriate legal counsel of the member

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state represented by an interstate commission representative, shall defend such interstate

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commission representative in any civil action seeking to impose liability arising out of an actual or

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alleged act, error or omission that occurred within the scope of interstate commission employment,

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duties or responsibilities, or that the defendant had a reasonable basis for believing occurred within

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the scope of interstate commission employment, duties, or responsibilities, provided that the actual

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or alleged act, error, or omission did not result from intentional or willful and wanton misconduct

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on the part of such person.

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(3) To the extent not covered by the state involved, member state, or the interstate

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commission, the representatives or employees of the interstate commission shall be held harmless

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in the amount of a settlement or judgment, including attorneys' fees and costs, obtained against

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such persons arising out of an actual or alleged act, error, or omission that occurred within the scope

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of interstate commission employment, duties, or responsibilities, or that such persons had a

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reasonable basis for believing occurred within the scope of interstate commission employment,

 

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duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result

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from intentional or willful and wanton misconduct on the part of such persons.

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5-37.8-16. Rulemaking functions of the interstate commission.

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(a) The interstate commission shall promulgate reasonable rules in order to effectively and

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efficiently achieve the purposes of the compact. Notwithstanding the foregoing, in the event the

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interstate commission exercises its rulemaking authority in a manner that is beyond the scope of

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the purposes of the compact, or the powers granted hereunder, then such an action by the interstate

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commission shall be invalid and have no force or effect.

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(b) Rules deemed appropriate for the operations of the interstate commission shall be made

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pursuant to a rulemaking process that substantially conforms to the "model state administrative

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procedure act" of 2010, and subsequent amendments thereto.

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(c) Not later than thirty (30) days after a rule is promulgated, any person may file a petition

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for judicial review of the rule in the United States District Court for the District of Columbia or the

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federal district where the interstate commission has its principal offices, provided that the filing of

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such a petition shall not stay or otherwise prevent the rule from becoming effective unless the court

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finds that the petitioner has a substantial likelihood of success. The court shall give deference to

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the actions of the interstate commission consistent with applicable law and shall not find the rule

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to be unlawful if the rule represents a reasonable exercise of the authority granted to the interstate

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commission.

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5-37.8-17. Oversight of the interstate compact.

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     (a) The executive, legislative, and judicial branches of state government in each member

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state shall enforce the compact and shall take all actions necessary and appropriate to effectuate the

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compact’s purposes and intent. The provisions of the compact and the rules promulgated hereunder

24

shall have standing as statutory law but shall not override existing state authority to regulate the

25

practice of medicine.

26

(b) All courts shall take judicial notice of the compact and the rules in any judicial or

27

administrative proceeding in a member state pertaining to the subject matter of the compact which

28

may affect the powers, responsibilities or actions of the interstate commission.

29

(c) The interstate commission shall be entitled to receive all service of process in any such

30

proceeding, and shall have standing to intervene in the proceeding for all purposes. Failure to

31

provide service of process to the interstate commission shall render a judgment or order void as to

32

the interstate commission, the compact, or promulgated rules.

33

5-37.8-18. Enforcement of interstate compact.

 

Art20

(Page 12 of 111)

1

(a) The interstate commission, in the reasonable exercise of its discretion, shall enforce the

2

provisions and rules of the compact.

3

(b) The interstate commission may, by majority vote of the commissioners, initiate legal

4

action in the United States District Court for the District of Columbia, or, at the discretion of the

5

interstate commission, in the federal district where the interstate commission has its principal

6

offices, to enforce compliance with the provisions of the compact, and its promulgated rules and

7

bylaws, against a member state in default. The relief sought may include both injunctive relief and

8

damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all

9

costs of such litigation including reasonable attorney's fees.

10

(c) The remedies herein shall not be the exclusive remedies of the interstate commission.

11

The interstate commission may avail itself of any other remedies available under state law or the

12

regulation of a profession.

13

5-37.8-19. Default procedures.

14

(a) The grounds for default include, but are not limited to, failure of a member state to

15

perform such obligations or responsibilities imposed upon it by the compact, or the rules and bylaws

16

of the interstate commission promulgated under the compact.

17

(b) If the interstate commission determines that a member state has defaulted in the

18

performance of its obligations or responsibilities under the compact, or the bylaws or promulgated

19

rules, the interstate commission shall:

20

(1) Provide written notice to the defaulting state and other member states, of the nature of

21

the default, the means of curing the default, and any action taken by the interstate commission. The

22

interstate commission shall specify the conditions by which the defaulting state must cure its

23

default; and

24

(2) Provide remedial training and specific technical assistance regarding the default.

25

(c) If the defaulting state fails to cure the default, the defaulting state shall be terminated

26

from the compact upon an affirmative vote of a majority of the commissioners and all rights,

27

privileges, and benefits conferred by the compact shall terminate on the effective date of

28

termination. A cure of the default does not relieve the offending state of obligations or liabilities

29

incurred during the period of the default.

30

(d) Termination of membership in the compact shall be imposed only after all other means

31

of securing compliance have been exhausted. Notice of intent to terminate shall be given by the

32

interstate commission to the governor, the speaker, the senate president and minority leaders of the

33

defaulting state's legislature, and each of the member states.

 

Art20

(Page 13 of 111)

1

(e) The interstate commission shall establish rules and procedures to address licenses and

2

physicians that are materially impacted by the termination of a member state, or the withdrawal of

3

a member state.

4

(f) The member state which has been terminated is responsible for all dues, obligations,

5

and liabilities incurred through the effective date of termination including obligations, the

6

performance of which extends beyond the effective date of termination.

7

(g) The interstate commission shall not bear any costs relating to any state that has been

8

found to be in default or which has been terminated from the compact, unless otherwise mutually

9

agreed upon in writing between the interstate commission and the defaulting state.

10

(h) The defaulting state may appeal the action of the interstate commission by petitioning

11

the United States District Court for the District of Columbia or the federal district where the

12

interstate commission has its principal offices. The prevailing party shall be awarded all costs of

13

such litigation including reasonable attorney's fees.

14

5-37.8-20. Dispute resolution.

15

(a) The interstate commission shall attempt, upon the request of a member state, to resolve

16

disputes which are subject to the compact and which may arise among member states or member

17

boards.

18

(b) The interstate commission shall promulgate rules providing for both mediation and

19

binding dispute resolution as appropriate.

20

5-37.8-21. Member states, effective date and amendment.

21

(a) Any state is eligible to become a member state of the compact.

22

(b) The compact shall become effective and binding upon legislative enactment of the

23

compact into law by no less than seven (7) states. Thereafter, it shall become effective and binding

24

on a state upon enactment of the compact into law by that state.

25

(c) The governors of non-member states, or their designees, shall be invited to participate

26

in the activities of the interstate commission on a non-voting basis prior to adoption of the compact

27

by all states.

28

(d) The interstate commission may propose amendments to the compact for enactment by

29

the member states. No amendment shall become effective and binding upon the interstate

30

commission and the member states unless and until it is enacted into law by unanimous consent of

31

the member states.

32

5-37.8-22. Withdrawal.

 

Art20

(Page 14 of 111)

1

(a) Once effective, the compact shall continue in force and remain binding upon each and

2

every member state; provided that a member state may withdraw from the compact by specifically

3

repealing the statute which enacted the compact into law.

4

(b) Withdrawal from the compact shall be by the enactment of a statute repealing the same,

5

but shall not take effect until one year after the effective date of such statute and until written notice

6

of the withdrawal has been given by the withdrawing state to the governor of each other member

7

state.

8

(c) The withdrawing state shall immediately notify the chairperson of the interstate

9

commission in writing upon the introduction of legislation repealing the compact in the

10

withdrawing state.

11

(d) The interstate commission shall notify the other member states of the withdrawing

12

state's intent to withdraw within sixty (60) days of its receipt of notice provided under § 5-

13

37.822(c).

14

(e) The withdrawing state is responsible for all dues, obligations and liabilities incurred

15

through the effective date of withdrawal, including obligations, the performance of which extend

16

beyond the effective date of withdrawal.

17

(f) Reinstatement following withdrawal of a member state shall occur upon the

18

withdrawing state reenacting the compact or upon such later date as determined by the interstate

19

commission.

20

(g) The interstate commission is authorized to develop rules to address the impact of the

21

withdrawal of a member state on licenses granted in other member states to physicians who

22

designated the withdrawing member state as the state of principal license.

23

5-37.8-23. Dissolution.

24

     (a) The compact shall dissolve effective upon the date of the withdrawal or default of the

25

member state which reduces the membership in the compact to one member state.

26

(b) Upon the dissolution of the compact, the compact becomes null and void and shall be

27

of no further force or effect, and the business and affairs of the interstate commission shall be

28

concluded and surplus funds shall be distributed in accordance with the bylaws.

29

5-37.8-24. Severability and construction.

30

(a) The provisions of the compact shall be severable, and if any phrase, clause, sentence,

31

or provision is deemed unenforceable, the remaining provisions of the compact shall be

32

enforceable.

33

(b) The provisions of the compact shall be liberally construed to effectuate its purposes.

 

Art20

(Page 15 of 111)

1

(c) Nothing in the compact shall be construed to prohibit the applicability of other

2

interstate compacts to which the states are members.

3

5-37.8-25. Binding effect of compact and other laws.

4

(a) Nothing herein prevents the enforcement of any other law of a member state that is not

5

inconsistent with the compact.

6

(b) All laws in a member state in conflict with the compact are superseded to the extent

7

of the conflict.

8

(c) All lawful actions of the interstate commission, including all rules and bylaws

9

promulgated by the commission, are binding upon the member states.

10

(d) All agreements between the interstate commission and the member states are binding

11

in accordance with their terms.

12

(e) In the event any provision of the compact exceeds the constitutional limits imposed on

13

the legislature of any member state, such provision shall be ineffective to the extent of the conflict

14

with the constitutional provision in question in that member state.

15

SECTION 2. Chapter 5-34.3 of the General Laws entitled "Nurse Licensure Compact" is

16

hereby amended by adding thereto the following sections:

17

5-34.3-10.1. Rulemaking.

18

(a) The commission shall exercise its rulemaking powers pursuant to the criteria set forth

19

in this section and the rules adopted thereunder. Rules and amendments shall become binding as

20

of the date specified in each rule or amendment and shall have the same force and effect as

21

provisions of this compact.

22

(b) Rules or amendments to the rules shall be adopted at a regular or special meeting of the

23

commission.

24

(c) Prior to promulgation and adoption of a final rule or rules by the commission, and at

25

least sixty (60) days in advance of the meeting at which the rule will be considered and voted upon,

26

the commission shall file a notice of proposed rulemaking:

27

     (1) On the website of the commission; and

28

     (2) On the website of each licensing board or the publication in which each state would

29

otherwise publish proposed rules.

30

     (d) The notice of proposed rulemaking shall include:

31

     (1) The proposed time, date and location of the meeting in which the rule will be

32

considered and voted upon;

33

     (2) The text of the proposed rule or amendment, and the reason for the proposed rule;

34

     (3) A request for comments on the proposed rule from any interested person; and

 

Art20

(Page 16 of 111)

1

(4) The manner in which interested persons may submit notice to the commission of their

2

intention to attend the public hearing and any written comments.

3

(e) Prior to adoption of a proposed rule, the commission shall allow persons to submit

4

written data, facts, opinions and arguments, which shall be made available to the public.

5

(f) The commission shall grant an opportunity for a public hearing before it adopts a rule

6

or amendment.

7

(g) The commission shall publish the place, time and date of the scheduled public hearing.

8

(1) Hearings shall be conducted in a manner providing each person who wishes to comment

9

a fair and reasonable opportunity to comment orally or in writing. All hearings will be recorded,

10

and a copy will be made available upon request.

11

(2) Nothing in this section shall be construed as requiring a separate hearing on each rule.

12

Rules may be grouped for the convenience of the commission at hearings required by this section.

13

(h) If no one appears at the public hearing, the commission may proceed with promulgation

14

of the proposed rule.

15

(i) Following the scheduled hearing date, or by the close of business on the scheduled

16

hearing date if the hearing was not held, the commission shall consider all written and oral

17

comments received.

18

(j) The commission shall, by majority vote of all administrators, take final action on the

19

proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking

20

record and the full text of the rule.

21

(k) Upon determination that an emergency exists, the commission may consider and adopt

22

an emergency rule without prior notice, opportunity for comment or hearing, provided that the

23

usual rulemaking procedures provided in this compact and in this section shall be retroactively

24

applied to the rule as soon as reasonably possible, in no event later than ninety (90) days after the

25

effective date of the rule. For the purposes of this provision, an emergency rule is one that must be

26

adopted immediately in order to:

27

(1) Meet an imminent threat to public health, safety or welfare;

28

(2) Prevent a loss of commission or party state funds; or

29

(3) Meet a deadline for the promulgation of an administrative rule that is required by federal

30

law or rule.

31

(l) The commission may direct revisions to a previously adopted rule or amendment for

32

purposes of correcting typographical errors, errors in format, errors in consistency or grammatical

33

errors. Public notice of any revisions shall be posted on the website of the commission. The revision

34

shall be subject to challenge by any person for a period of thirty (30) days after posting. The revision

 

Art20

(Page 17 of 111)

1

may be challenged only on grounds that the revision results in a material change to a rule. A

2

challenge shall be made in writing, and delivered to the commission, prior to the end of the notice

3

period. If no challenge is made, the revision will take effect without further action. If the revision

4

is challenged, the revision may not take effect without the approval of the commission.

5

5-34.3-11.1. Oversight, dispute resolution and enforcement.

6

     (a) Oversight.

7

(1) Each party state shall enforce this compact and take all actions necessary and

8

appropriate to effectuate this compact’s purposes and intent.

9

(2) The commission shall be entitled to receive service of process in any proceeding that

10

may affect the powers, responsibilities or actions of the commission, and shall have standing to

11

intervene in such a proceeding for all purposes. Failure to provide service of process in such

12

proceeding to the commission shall render a judgment or order void as to the commission, this

13

compact or promulgated rules.

14

     (b) Default, technical assistance and termination.

15

     (1) If the commission determines that a party state has defaulted in the performance of its

16

obligations or responsibilities under this compact or the promulgated rules, the commission shall:

17

     (i) Provide written notice to the defaulting state and other party states of the nature of the

18

default, the proposed means of curing the default or any other action to be taken by the commission;

19

and

20

(ii) Provide remedial training and specific technical assistance regarding the default;

21

(2) If a state in default fails to cure the default, the defaulting state's membership in this

22

compact may be terminated upon an affirmative vote of a majority of the administrators, and all

23

rights, privileges and benefits conferred by this compact may be terminated on the effective date

24

of termination. A cure of the default does not relieve the offending state of obligations or liabilities

25

incurred during the period of default;

26

(3) Termination of membership in this compact shall be imposed only after all other means

27

of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given

28

by the commission to the governor of the defaulting state and to the executive officer of the

29

defaulting state's licensing board and each of the party states;

30

(4) A state whose membership in this compact has been terminated is responsible for all

31

assessments, obligations and liabilities incurred through the effective date of termination, including

32

obligations that extend beyond the effective date of termination;

 

Art20

(Page 18 of 111)

1

(5) The commission shall not bear any costs related to a state that is found to be in default

2

or whose membership in this compact has been terminated unless agreed upon in writing between

3

the commission and the defaulting state;

4

(6) The defaulting state may appeal the action of the commission by petitioning the U.S.

5

District Court for the District of Columbia or the federal district in which the commission has its

6

principal offices. The prevailing party shall be awarded all costs of such litigation, including

7

reasonable attorneys' fees.

8

     (c) Dispute Resolution.

9

(1) Upon request by a party state, the commission shall attempt to resolve disputes related

10

to the compact that arise among party states and between party and non-party states;

11

(2) The commission shall promulgate a rule providing for both mediation and binding

12

dispute resolution for disputes, as appropriate;

13

(3) In the event the commission cannot resolve disputes among party states arising under

14

this compact:

15

(i) The party states may submit the issues in dispute to an arbitration panel, which will be

16

comprised of individuals appointed by the compact administrator in each of the affected party states

17

and an individual mutually agreed upon by the compact administrators of all the party states

18

involved in the dispute;

19

     (ii) The decision of a majority of the arbitrators shall be final and binding.

20

     (d) Enforcement.

21

     (1) The commission, in the reasonable exercise of its discretion, shall enforce the

22

provisions and rules of this compact;

23

     (2) By majority vote, the commission may initiate legal action in the U.S. District Court

24

for the District of Columbia or the federal district in which the commission has its principal offices

25

against a party state that is in default to enforce compliance with the provisions of this compact and

26

its promulgated rules and bylaws. The relief sought may include both injunctive relief and damages.

27

In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of

28

such litigation, including reasonable attorneys' fees;

29

     (3) The remedies herein shall not be the exclusive remedies of the commission. The

30

commission may pursue any other remedies available under federal or state law.

31

SECTION 3. Sections 5-34.3-3, 5-34.3-4, 5-34.3-5, 5-34.3-6, 5-34.3-8, 5-34.3-9, 5-34.310,

32

5-34.3-12 and 5-34.3-14 of the General Laws in Chapter 5-34.3 entitled "Nurse Licensure

33

Compact" are hereby amended to read as follows:

34

5-34.3-3. Legislative findings.

 

Art20

(Page 19 of 111)

1

(a) The general assembly finds and declares that:

2

(1) The health and safety of the public are affected by the degree of compliance with and

3

the effectiveness of enforcement activities related to state nurse licensure laws;

4

(2) Violations of nurse licensure and other laws regulating the practice of nursing may

5

result in injury or harm to the public;

6

(3) The expanded mobility of nurses and the use of advanced communication technologies

7

as part of our nation's healthcare delivery system require greater coordination and cooperation

8

among states in the areas of nurse licensure and regulations;

9

(4) New practice modalities and technology make compliance with individual state nurse

10

licensure laws difficult and complex; and

11

(5) The current system of duplicative licensure for nurses practicing in multiple states is

12

cumbersome and redundant to both nurses and states.; and

13

(6) Uniformity of nurse licensure requirements throughout the states promotes public safety

14

and public health benefits.

15

(b) The general purposes of this compact are to:

16

(1) Facilitate the states' responsibility to protect the public's health and safety;

17

(2) Ensure and encourage the cooperation of party states in the areas of nurse licensure and

18

regulation;

19

(3) Facilitate the exchange of information between party states in the areas of nurse

20

regulation, investigation and adverse actions;

21

(4) Promote compliance with the laws governing the practice of nursing in each

22

jurisdiction; and

23

(5) Invest all party states with the authority to hold a nurse accountable for meeting all state

24

practice laws in the state in which the patient is located at the time care is rendered through the

25

mutual recognition of party state licenses.;

26

(6) Decrease redundancies in the consideration and issuance of nurse licenses; and

27

(7) Provide opportunities for interstate practice by nurses who meet uniform licensure

28

requirements.

29

5-34.3-4. Definitions.

30

As used in this chapter:

31

(1) "Adverse action" means a home or remote state action. any administrative, civil,

32

equitable or criminal action permitted by a state's laws which is imposed by a licensing board or

33

other authority against a nurse, including actions against an individual's license or multistate

34

licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation

 

Art20

(Page 20 of 111)

1

on the licensee's practice, or any other encumbrance on licensure affecting a nurse's authorization

2

to practice, including issuance of a cease and desist action.

3

(2) "Alternative program" means a voluntary, nondisciplinary monitoring program

4

approved by a nurse licensing board.

5

(3) "Commission" means the interstate commission of nurse license compact

6

administrators, the governing body of the nurse licensure compact.

7

(3)(4) "Coordinated licensure information system" means an integrated process for

8

collecting, storing, and sharing information on nurse licensure and enforcement activities related

9

to nurse licensure laws, which is administered by a nonprofit organization composed of and

10

controlled by state nurse licensing boards.

11

(4)(5) "Current significant investigative information" means investigative information that

12

a licensing board, after a preliminary inquiry that includes notification and an opportunity for the

13

nurse to respond if required by state law, has reason to believe is not groundless and, if proved true,

14

would indicate more than a minor infraction; or investigative information that indicates that the

15

nurse represents an immediate treat to public health and safety regardless of whether the nurse has

16

been notified and had an opportunity to respond.

17

(6) "Encumbrance" means a revocation or suspension of, or any limitation on, the full and

18

unrestricted practice of nursing imposed by a licensing board.

19

(5)(7) "Home state" means the party state which is the nurse's primary state of residence.

20

(6)(8) "Home state action" means any administrative, civil, equitable or criminal action

21

permitted by the home state's laws which are imposed on a nurse by the home state's licensing

22

board or other authority including actions against an individual's license such as: revocation,

23

suspension, probation or any other action which affects a nurse's authorization to practice.

24

(7)(9) "Licensing board" means a party state's regulatory body responsible for issuing nurse

25

licenses.

26

(8)(10) "Multistate licensure privilege" means current, official authority from a remote

27

state permitting the practice of nursing as either a registered nurse or a licensed practical/vocational

28

nurse in such party state. All party states have the authority, in accordance with existing state due

29

process law, to take actions against the nurse's privilege such as: revocation, suspension, probation

30

or any other action which affects a nurse's authorization to practice. a license to practice as a

31

registered nurse (RN) or a licensed practical nurse/vocational nurse (LPN/VN) issued by a home

32

state licensing board that authorizes the licensed nurse to practice in all party states under a

33

multistate licensure privilege.

 

Art20

(Page 21 of 111)

1

(11) "Multistate licensure privilege" means a legal authorization associated with a

2

multistate license permitting the practice of nursing as either a registered nurse (RN) or licensed

3

practical nurse/vocational nurse (LPN/VN) in a remote state.

4

(9)(12) "Nurse" means a registered nurse or licensed practical/vocational nurse, as those

5

terms are defined by each party's state practice laws.

6

(10)(13) "Party state" means any state that has adopted this compact.

7

(11)(14) "Remote state" means a party state, other than the home state, where the patient

8

is located at the time nursing care is provided, or, in the case of the practice of nursing not involving

9

a patient, in such party state where the recipient of nursing practice is located.

10

(12)(15) "Remote state action" means any administrative, civil, equitable or criminal action

11

permitted by a remote state's laws which are imposed on a nurse by the remote state's licensing

12

board or other authority including actions against an individual's multistate licensure privilege to

13

practice in the remote state, and cease and desist and other injunctive or equitable orders issued by

14

remote states or the licensing boards thereof.

15

(16) "Single-state license" means a nurse license issued by a party state that authorizes

16

practice only within the issuing state and does not include a multistate licensure privilege to practice

17

in any other party state.

18

(13)(17) "State" means a state, territory, or possession of the United States, the District of

19

Columbia.

20

(14)(18) "State practice laws" means those individual party's state laws and regulations that

21

govern the practice of nursing, define the scope of nursing practice, and create the methods and

22

grounds for imposing discipline. It does not include the initial qualifications for licensure or

23

requirements necessary to obtain and retain a license, except for qualifications or requirements of

24

the home state.

25

5-34.3-5. Permitted activities and jurisdiction. General provisions and jurisdiction.

26

A license to practice registered nursing issued by a home state to a resident in that state

27

will be recognized by each party state as authorizing a multistate licensure privilege to practice as

28

a registered nurse in such party state. A license to practice licensed practical/vocational nursing

29

issued by a home state to a resident in that state will be recognized by each party state as authorizing

30

a multistate licensure privilege to practice as a licensed practical/vocational nurse in such party

31

state. In order to obtain or retain a license, an applicant must meet the home state's qualifications

32

for licensure and license renewal as well as all other applicable state laws.

33

Party states may, in accordance with state due process laws, limit or revoke the multistate

34

licensure privilege of any nurse to practice in their state and may take any other actions under their

 

Art20

(Page 22 of 111)

1

applicable state laws necessary to protect the health and safety of their citizens. If a party state takes

2

such action, it shall promptly notify the administrator of the coordinated licensure information

3

system. The administrator of the coordinated licensure information system shall promptly notify

4

the home state of any such actions by remote states.

5

Every nurse practicing in a party state must comply with the state practice laws of the state

6

in which the patient is located at the time care is rendered. In addition, the practice of nursing is not

7

limited to patient care, but shall include all nursing practice as defined by the state practice laws of

8

a party state. The practice of nursing will subject a nurse to the jurisdiction of the nurse licensing

9

board and courts, as well as the laws, in that party state.

10

This compact does not affect additional requirements imposed by states for advanced

11

practice registered nursing. However, a multistate licensure privilege to practice registered nursing

12

granted by a party shall be recognized by other party states as a license to practice registered nursing

13

if one is required by state law as a precondition for qualifying for advanced practice registered

14

nurse authorization.

15

Individuals not residing in a party state shall continue to be able to apply for nurse licensure as

16

provided for under the laws of each party state. However, the license granted to these individuals

17

will not be recognized as granting the privilege to practice nursing in any other party

18

state unless explicitly agreed to by that party state.

19

(a) A multistate license to practice registered or licensed practical nursing/vocational

20

nursing issued by a home state to a resident in that state will be recognized by each party state as

21

authorizing a nurse to practice as a registered nurse (RN) or as a licensed practical nurse/vocational

22

nurse (LPN/VN), under a multistate licensure privilege, in each party state.

23

(b) A state must implement procedures for considering the criminal history records of

24

applicants for initial multistate license or licensure by endorsement. Such procedures shall include

25

the submission of fingerprints or other biometric-based information by applicants for the purpose

26

of obtaining an applicant's criminal history record information from the Federal Bureau of

27

Investigation, and the agency responsible for retaining that state's criminal records.

28

(c) Each party state shall require the following for an applicant to obtain or retain a

29

multistate license in the home state:

30

(1) Meets the home state's qualifications for licensure or renewal of licensure, as well as

31

all other applicable state laws;

32

(2)(i) Has graduated or is eligible to graduate from a licensing board-approved RN or

33

LPN/VN prelicensure education program; or

34

(ii) Has graduated from a foreign RN or LPN/VN prelicensure education program that:

 

Art20

(Page 23 of 111)

1

(A) Has been approved by the authorized accrediting body in the applicable country; and

2

(B) Has been verified by an independent credentials review agency to be comparable to a

3

licensing board-approved prelicensure education program;

4

(3) Has, if a graduate of a foreign prelicensure education program not taught in English or

5

if English is not the individual's native language, successfully passed an English proficiency

6

examination that includes the components of reading, speaking, writing and listening;

7

(4) Has successfully passed an NCLEX-RN® or NCLEX-PN® Examination or recognized

8

predecessor, as applicable;

9

(5) Is eligible for or holds an active, unencumbered license;

10

(6) Has submitted, in connection with an application for initial licensure or licensure by

11

endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history

12

record information from the Federal Bureau of Investigation and the agency responsible for

13

retaining that state's criminal records;

14

(7) Has not been convicted or found guilty nor entered into an agreed disposition of a felony

15

offense under applicable state or federal criminal law;

16

(8) Has not been convicted or found guilty nor entered into an agreed disposition of a

17

misdemeanor offense related to the practice of nursing as determined on a case-by-case basis;

18

(9) Is not currently enrolled in an alternative program;

19

(10) Is subject to self-disclosure requirements regarding current participation in an

20

alternative program; and

21

(11) Has a valid United States Social Security number.

22

(d) All party states shall be authorized, in accordance with existing state due process law,

23

to take adverse action against a nurse's multistate licensure privilege such as revocation, suspension,

24

probation or any other action that affects a nurse's authorization to practice under a multistate

25

licensure privilege, including cease and desist actions. If a party state takes such action, it shall

26

promptly notify the administrator of the coordinated licensure information system. The

27

administrator of the coordinated licensure information system shall promptly notify the home state

28

of any such actions by remote states.

29

(e) A nurse practicing in a party state must comply with the state practice laws of the state

30

in which the client is located at the time service is provided. The practice of nursing is not limited

31

to patient care, but shall include all nursing practice as defined by the state practice laws of the

32

party state in which the client is located. The practice of nursing in a party state under a multistate

33

licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts and the

34

laws of the party state in which the client is located at the time service is provided.

 

Art20

(Page 24 of 111)

1

(f) Individuals not residing in a party state shall continue to be able to apply for a party

2

state's single-state license as provided under the laws of each party state. However, the singlestate

3

license granted to these individuals will not be recognized as granting the privilege to practice

4

nursing in any other party state. Nothing in this compact shall affect the requirements established

5

by a party state for the issuance of a single-state license.

6

(g) Any nurse holding a home state multistate license, on the effective date of this compact,

7

may retain and renew the multistate license issued by the nurse's then-current home state, provided

8

that:

9

(1) A nurse, who changes primary state of residence after this compact’s effective date,

10

must meet all applicable requirements to obtain a multistate license from a new home state; and

11

(2) A nurse who fails to satisfy the multistate licensure requirements due to a disqualifying

12

event occurring after this compact’s effective date shall be ineligible to retain or renew a multistate

13

license, and the nurse's multistate license shall be revoked or deactivated in accordance with

14

applicable rules adopted by the commission.

15

5-34.3-6. Applications for licensure in a party state.

16

(a) Upon application for a license, the licensing board in a party state shall ascertain,

17

through the coordinated licensure information system, whether the applicant has ever held, or is the

18

holder of, a license issued by any other state, whether there are any restrictions on the multistate

19

licensure privilege, and whether any other adverse action by any state has been taken against the

20

license.

21

(b) A nurse in a party state shall hold licensure in only one party state at a time, issued by

22

the home state.

23

(c) A nurse who intends to change primary state of residence may apply for licensure in

24

the new home state in advance of such change. However, new licenses will not be issued by a party

25

state until after a nurse provides evidence of change in primary state of residence satisfactory to the

26

new home state's licensing board.

27

(d) When a nurse changes primary state of residence by;

28

(1) Moving between two party states, and obtains a license from the new home state, the

29

license from the former home state is no longer valid;

30

      (2) Moving from a non-party state to a party state, and obtains a license from the new

31

home state, the individual state license issued by the non-party state is not affected and will remain

32

in full force if so provided by the laws of the non-party state;

 

Art20

(Page 25 of 111)

1

     (3) Moving from a party state to a non-party state, the license issued by the prior home

2

state converts to an individual state license, valid only in the former home state, without the

3

multistate licensure privilege to practice in other party states.

4

     (a) Upon application for a multistate license, the licensing board in the issuing party state

5

shall ascertain, through the coordinated licensure information system, whether the applicant has

6

ever held, or is the holder of, a license issued by any other state, whether there are any

7

encumbrances on any license or multistate licensure privilege held by the applicant, whether any

8

adverse action has been taken against any license or multistate licensure privilege held by the

9

applicant and whether the applicant is currently participating in an alternative program.

10

     (b) A nurse may hold a multistate license, issued by the home state, in only one party state

11

at a time.

12

     (c) If a nurse changes primary state of residence by moving between two (2) party states,

13

the nurse must apply for licensure in the new home state, and the multistate license issued by the

14

prior home state will be deactivated in accordance with applicable rules adopted by the commission.

15

     (1) The nurse may apply for licensure in advance of a change in primary state of residence.

16

     (2) A multistate license shall not be issued by the new home state until the nurse provides

17

satisfactory evidence of a change in primary state of residence to the new home state and satisfies

18

all applicable requirements to obtain a multistate license from the new home state.

19

(d) If a nurse changes primary state of residence by moving from a party state to a nonparty

20

state, the multistate license issued by the prior home state will convert to a single-state license,

21

valid only in the former home state.

22

5-34.3-8. Additional authorities invested in party state nurse licensing boards.

23

(a) Notwithstanding any other powers conferred by state law, party state nurse licensing

24

boards shall have the authority to:

25

(1) If otherwise, permitted by state law, recover from the affected nurse the costs of

26

investigations and disposition of cases resulting from any adverse action taken against that nurse;

27

(2) Issue subpoenas for both hearings and investigations which require the attendance and

28

testimony of witnesses, and the production of evidence. Subpoenas issued by a nurse licensing

29

board in a party state for the attendance and testimony of witnesses, and/or the production of

30

evidence from another party state, shall be enforced in the latter state by any court of competent

31

jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in

32

proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses,

33

mileage and other fees required by the service statutes of the state where the witnesses and/or

34

evidence are located.

 

Art20

(Page 26 of 111)

1

(3) Issue cease and desist orders to limit or revoke a nurse's authority to practice in their

2

state;

3

(4) Promulgate uniform rules and regulations as provided for in subsection 5-34.3-10(c).

4

(1) Take adverse action against a nurse's multistate licensure privilege to practice within

5

that party state.

6

(i) Only the home state shall have the power to take adverse action against a nurse's license

7

issued by the home state.

8

(ii) For purposes of taking adverse action, the home state licensing board shall give the

9

same priority and effect to reported conduct received from a remote state as it would if such conduct

10

had occurred within the home state. In so doing, the home state shall apply its own state laws to

11

determine appropriate action.

12

(2) Issue cease and desist orders or impose an encumbrance on a nurse's authority to

13

practice within that party state.

14

(3) Complete any pending investigations of a nurse who changes primary state of residence

15

during the course of such investigations. The licensing board shall also have the authority to take

16

appropriate action(s) and shall promptly report the conclusions of such investigations to the

17

administrator of the coordinated licensure information system. The administrator of the coordinated

18

licensure information system shall promptly notify the new home state of any such actions.

19

(4) Issue subpoenas for both hearings and investigations that require the attendance and

20

testimony of witnesses, as well as, the production of evidence. Subpoenas issued by a licensing

21

board in a party state for the attendance and testimony of witnesses or the production of evidence

22

from another party state shall be enforced in the latter state by any court of competent jurisdiction,

23

according to the practice and procedure of that court applicable to subpoenas issued in proceedings

24

pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage and

25

other fees required by the service statutes of the state in which the witnesses or evidence are located.

26

(5) Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-

27

based information to the Federal Bureau of Investigation for criminal background checks, receive

28

the results of the Federal Bureau of Investigation record search on criminal background checks and

29

use the results in making licensure decisions.

30

(6) If otherwise permitted by state law, recover from the affected nurse the costs of

31

investigations and disposition of cases resulting from any adverse action taken against that nurse.

32

(7) Take adverse action based on the factual findings of the remote state, provided that the

33

licensing board follows its own procedures for taking such adverse action.

 

Art20

(Page 27 of 111)

1

(b) If adverse action is taken by the home state against a nurse's multistate license, the

2

nurse's multistate licensure privilege to practice in all other party states shall be deactivated until

3

all encumbrances have been removed from the multistate license. All home state disciplinary orders

4

that impose adverse action against a nurse's multistate license shall include a statement that the

5

nurse's multistate licensure privilege is deactivated in all party states during the pendency of the

6

order.

7

(c) Nothing in this compact shall override a party state's decision that participation in an

8

alternative program may be used in lieu of adverse action. The home state licensing board shall

9

deactivate the multistate licensure privilege under the multistate license of any nurse for the

10

duration of the nurse's participation in an alternative program.

11

5-34.3-9. Coordinated licensure information system Coordinated licensure

12

information system and exchange of information.

13

(a) All party states shall participate in a cooperative effort to create a coordinated data base

14

licensure information system of all licensed registered nurses (RNs) and licensed practical

15

nurses/vocational nurses (LPNs/VNs). This system will include information on the licensure and

16

disciplinary history of each nurse, as contributed submitted by party states, to assist in the

17

coordination of nurse licensure and enforcement efforts.

18

(b) Notwithstanding any other provision of law, all party states' licensing boards shall

19

promptly report adverse actions, actions against multistate licensure privileges, any current

20

significant investigative information yet to result in adverse action, denials of applications, and the

21

reasons for such denials, to the coordinated licensure information system. The commission, in

22

consultation with the administrator of the coordinated licensure information system, shall formulate

23

necessary and proper procedures for the identification, collection and exchange of information

24

under this compact.

25

(c) All licensing boards shall promptly report to the coordinated licensure information

26

system any adverse action, any current significant investigative information, denials of applications

27

(with the reasons for such denials) and nurse participation in alternative programs known to the

28

licensing board regardless of whether such participation is deemed nonpublic or confidential under

29

state law.

30

(c)(d) Current significant investigative information and participation in nonpublic or

31

confidential alternative programs shall be transmitted through the coordinated licensure

32

information system only to party state licensing boards.

33

(d)(e) Notwithstanding any other provision of law, all party states' licensing boards

34

contributing information to the coordinated licensure information system may designate

 

Art20

(Page 28 of 111)

1

information that may not be shared with non-party states or disclosed to other entities or individuals

2

without the express permission of the contributing state.

3

(e)(f) Any personally identifiable information obtained from the coordinated licensure

4

information system by a party state's licensing board shall from the coordinated licensure

5

information system may not be shared with non-party states or disclosed to other entities or

6

individuals except to the extent permitted by the laws of the party state contributing the information.

7

(f)(g) Any information contributed to the coordinated licensure information system that is

8

subsequently required to be expunged by the laws of the party state contributing that information,

9

shall also be expunged from the coordinated licensure information system.

10

(g) The compact administrators, acting jointly with each other and in consultation with the

11

administrator of the coordinated licensure information system, shall formulate necessary and proper

12

procedures for the identification, collection and exchange of information under this compact.

13

(h) The compact administrator of each party state shall furnish a uniform data set to the

14

compact administrator of each other party state, which shall include, at a minimum:

15

(1) Identifying information;

16

(2) Licensure data;

17

(3) Information related to alternative program participation; and

18

(4) Other information that may facilitate the administration of this compact, as

19

determined by commission rules.

20

(i) The compact administrator of a party state shall provide all investigative documents and

21

information requested by another party state.

22

5-34.3-10. Compact administration and interchange of information Establishment of

23

the interstate commission of nurse licensure compact administrators.

24

      (a) The head of the nurse licensing board, or his/her designee, of each party state shall be

25

the administrator of this compact for his/her state.

26

     (b) The compact administrator of each party shall furnish to the compact administrator of

27

each other party state any information and documents including, but not limited to, a uniform data

28

set of investigations, identifying information, licensure data, and disclosable alternative program

29

participation information to facilitate the administration of this compact.

30

     (c) Compact administrators shall have the authority to develop uniform rules to facilitate

31

and coordinate implementation of this compact. These uniform rules shall be adopted by party

32

states, under the authority invested under § 5-34.3-8(4).

33

     (a) The party states hereby create and establish a joint public entity known as the interstate

34

commission of nurse licensure compact administrators (the "commission").

 

Art20

(Page 29 of 111)

1

(1) The commission is an instrumentality of the party states.

2

(2) Venue is proper, and judicial proceedings by or against the commission shall be brought

3

solely and exclusively, in a court of competent jurisdiction where the principal office of the

4

commission is located. The commission may waive venue and jurisdictional defenses to the extent

5

it adopts or consents to participate in alternative dispute resolution proceedings.

6

(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity.

7

(b) Membership, voting and meetings:

8

(1) Each party state shall have and be limited to one administrator. The head of the state

9

licensing board or designee shall be the administrator of this compact for each party state. Any

10

administrator may be removed or suspended from office as provided by the law of the state from

11

which the administrator is appointed. Any vacancy occurring in the commission shall be filled in

12

accordance with the laws of the party state in which the vacancy exists.

13

(2) Each administrator shall be entitled to one vote with regard to the promulgation of rules

14

and creation of bylaws and shall otherwise have an opportunity to participate in the business and

15

affairs of the commission. An administrator shall vote in person or by such other means as provided

16

in the bylaws. The bylaws may provide for an administrator's participation in meetings by telephone

17

or other means of communication.

18

(3) The commission shall meet at least once during each calendar year. Additional meetings

19

shall be held as set forth in the bylaws or rules of the commission.

20

(4) All meetings shall be open to the public, and public notice of meetings shall be given

21

in the same manner as required under the rulemaking provisions in § 5-34.3-10.1.

22

(5) The commission may convene in a closed, nonpublic meeting if the commission must

23

discuss:

24

(i) Noncompliance of a party state with its obligations under this compact;

25

(ii) The employment, compensation, discipline or other personnel matters, practices or

26

procedures related to specific employees or other matters related to the commission's internal

27

personnel practices and procedures;

28

(iii) Current, threatened or reasonably anticipated litigation;

29

(iv) Negotiation of contracts for the purchase or sale of goods, services or real estate;

30

(v) Accusing any person of a crime or formally censuring any person;

31

(vi) Disclosure of trade secrets or commercial or financial information that is privileged or

32

confidential;

33

(vii) Disclosure of information of a personal nature where disclosure would constitute a

34

clearly unwarranted invasion of personal privacy;

 

Art20

(Page 30 of 111)

1

(viii) Disclosure of investigatory records compiled for law enforcement purposes;

2

(ix) Disclosure of information related to any reports prepared by or on behalf of the

3

commission for the purpose of investigation of compliance with this compact; or

4

(x) Matters specifically exempted from disclosure by federal or state statute.

5

(6) If a meeting, or portion of a meeting, is closed pursuant to this provision, the

6

commission's legal counsel or designee shall certify that the meeting may be closed and shall

7

reference each relevant exempting provision. The commission shall keep minutes that fully and

8

clearly describe all matters discussed in a meeting and shall provide a full and accurate summary

9

of actions taken, and the reasons therefor, including a description of the views expressed. All

10

documents considered in connection with an action shall be identified in such minutes. All minutes

11

and documents of a closed meeting shall remain under seal, subject to release by a majority vote of

12

the commission or order of a court of competent jurisdiction.

13

(c) The commission shall, by a majority vote of the administrators, prescribe bylaws or

14

rules to govern its conduct as may be necessary or appropriate to carry out the purposes and

15

exercise the powers of this compact, including, but not limited to:

16

(1) Establishing the fiscal year of the commission;

17

(2) Providing reasonable standards and procedures:

18

(i) For the establishment and meetings of other committees; and

19

(ii) Governing any general or specific delegation of any authority or function of the

20

commission;

21

(3) Providing reasonable procedures for calling and conducting meetings of the

22

commission, ensuring reasonable advance notice of all meetings and providing an opportunity for

23

attendance of such meetings by interested parties, with enumerated exceptions designed to protect

24

the public's interest, the privacy of individuals, and proprietary information, including trade secrets.

25

The commission may meet in closed session only after a majority of the administrators vote to close

26

a meeting in whole or in part. As soon as practicable, the commission must make public a copy of

27

the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed;

28

     (4) Establishing the titles, duties and authority and reasonable procedures for the election

29

of the officers of the commission;

30

     (5) Providing reasonable standards and procedures for the establishment of the personnel

31

policies and programs of the commission. Notwithstanding any civil service or other similar laws

32

of any party state, the bylaws shall exclusively govern the personnel policies and programs of the

33

commission; and

 

Art20

(Page 31 of 111)

1

     (6) Providing a mechanism for winding up the operations of the commission and the

2

equitable disposition of any surplus funds that may exist after the termination of this compact after

3

the payment or reserving of all of its debts and obligations;

4

     (d) The commission shall publish its bylaws and rules, and any amendments thereto, in a

5

convenient form on the website of the commission.

6

     (e) The commission shall maintain its financial records in accordance with the bylaws.

7

     (f) The commission shall meet and take such actions as are consistent with the provisions

8

of this compact and the bylaws.

9

(g) The commission shall have the following powers:

10

(1) To promulgate uniform rules to facilitate and coordinate implementation and

11

administration of this compact. The rules shall have the force and effect of law and shall be binding

12

in all party states;

13

(2) To bring and prosecute legal proceedings or actions in the name of the commission,

14

provided that the standing of any licensing board to sue or be sued under applicable law shall not

15

be affected;

16

(3) To purchase and maintain insurance and bonds;

17

(4) To borrow, accept or contract for services of personnel, including, but not limited to,

18

employees of a party state or nonprofit organizations;

19

(5) To cooperate with other organizations that administer state compacts related to the

20

regulation of nursing, including, but not limited to, sharing administrative or staff expenses, office

21

space or other resources;

22

(6) To hire employees, elect or appoint officers, fix compensation, define duties, grant such

23

individuals appropriate authority to carry out the purposes of this compact, and to establish the

24

commission's personnel policies and programs relating to conflicts of interest, qualifications of

25

personnel and other related personnel matters;

26

(7) To accept any and all appropriate donations, grants and gifts of money, equipment,

27

supplies, materials and services, and to receive, utilize and dispose of the same; provided that at all

28

times the commission shall avoid any appearance of impropriety or conflict of interest;

29

(8) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold,

30

improve or use, any property, whether real, personal or mixed; provided that at all times the

31

commission shall avoid any appearance of impropriety;

32

(9) To sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of

33

any property, whether real, personal or mixed;

34

(10) To establish a budget and make expenditures;

 

Art20

(Page 32 of 111)

1

(11) To borrow money;

2

(12) To appoint committees, including advisory committees comprised of administrators,

3

state nursing regulators, state legislators or their representatives, and consumer representatives, and

4

other such interested persons;

5

(13) To provide and receive information from, and to cooperate with, law enforcement

6

agencies;

7

(14) To adopt and use an official seal; and

8

(15) To perform such other functions as may be necessary or appropriate to achieve the

9

purposes of this compact consistent with the state regulation of nurse licensure and practice.

10

(h) Financing of the commission:

11

(1) The commission shall pay, or provide for the payment of, the reasonable expenses of

12

its establishment, organization and ongoing activities;

13

(2) The commission may also levy on and collect an annual assessment from each party

14

state to cover the cost of its operations, activities and staff in its annual budget as approved each

15

year. The aggregate annual assessment amount, if any, shall be allocated based upon a formula to

16

be determined by the commission, which shall promulgate a rule that is binding upon all party

17

states;

18

(3) The commission shall not incur obligations of any kind prior to securing the funds

19

adequate to meet the same; nor shall the commission pledge the credit of any of the party states,

20

except by, and with the authority of, such party state;

21

(4) The commission shall keep accurate accounts of all receipts and disbursements. The

22

receipts and disbursements of the commission shall be subject to the audit and accounting

23

procedures established under its bylaws. However, all receipts and disbursements of funds handled

24

by the commission shall be audited yearly by a certified or licensed public accountant, and the

25

report of the audit shall be included in and become part of the annual report of the commission.

26

(i) Qualified immunity, defense and indemnification:

27

(1) The administrators, officers, executive director, employees and representatives of the

28

commission shall be immune from suit and liability, either personally or in their official capacity,

29

for any claim for damage to or loss of property or personal injury or other civil liability caused by

30

or arising out of any actual or alleged act, error or omission that occurred, or that the person against

31

whom the claim is made had a reasonable basis for believing occurred, within the scope of

32

commission employment, duties or responsibilities; provided that nothing in this paragraph shall

33

be construed to protect any such person from suit or liability for any damage, loss, injury or liability

34

caused by the intentional, willful or wanton misconduct of that person;

 

Art20

(Page 33 of 111)

1

     (2) The commission shall defend any administrator, officer, executive director, employee

2

or representative of the commission in any civil action seeking to impose liability arising out of

3

any actual or alleged act, error or omission that occurred within the scope of commission

4

employment, duties or responsibilities, or that the person against whom the claim is made had a

5

reasonable basis for believing occurred within the scope of commission employment, duties or

6

responsibilities; provided that nothing herein shall be construed to prohibit that person from

7

retaining their own counsel; and provided further that the actual or alleged act, error or omission

8

did not result from that person’s intentional, willful or wanton misconduct;

9

     (3) The commission shall indemnify and hold harmless any administrator, officer,

10

executive director, employee or representative of the commission for the amount of any settlement

11

or judgment obtained against that person arising out of any actual or alleged act, error or omission

12

that occurred within the scope of commission employment, duties or responsibilities, or that such

13

person had a reasonable basis for believing occurred within the scope of commission employment,

14

duties or responsibilities, provided that the actual or alleged act, error or omission did not result

15

from the intentional, willful or wanton misconduct of that person.

16

5-34.3-12. Entry into force, withdrawal and amendment Effective date, withdrawal

17

and amendment.

18

     (a) This compact shall enter into force and become effective as to any state when it has

19

been enacted into the laws of that state. Any party state may withdraw from this compact by

20

enacting a statute repealing the same, but no such withdrawal shall take effect until six (6) months

21

after the withdrawing state has given notice of the withdrawal to the executive heads of all other

22

party states.

23

     (b) No withdrawal shall affect the validity or applicability by the licensing boards of states

24

remaining party to the compact of any report of adverse action occurring prior to the

25

withdrawal.

26

     (c) Nothing contained in this compact shall be construed to invalidate or prevent any nurse

27

licensure agreement or other cooperative arrangement between a party state and a non-party state

28

that is made in accordance with the other provisions of this compact.

29

     (d) This compact may be amended by the party states. No amendment to this compact shall

30

become effective and binding upon the party states unless and until it is enacted into the laws of all

31

party states.

32

     (a) This compact shall become effective upon passage. All party states to this compact, that

33

also were parties to the prior nurse licensure compact, superseded by this compact, ("prior

 

Art20

(Page 34 of 111)

1

compact"), shall be deemed to have withdrawn from said prior compact within six (6) months after

2

the effective date of this compact.

3

     (b) Each party state to this compact shall continue to recognize a nurse's multistate

4

licensure privilege to practice in that party state issued under the prior compact until such party

5

state has withdrawn from the prior compact.

6

     (c) Any party state may withdraw from this compact by enacting a statute repealing the

7

same. A party state's withdrawal shall not take effect until six (6) months after enactment of the

8

repealing statute.

9

     (d) A party state's withdrawal or termination shall not affect the continuing requirement of

10

the withdrawing or terminated state's licensing board to report adverse actions and significant

11

investigations occurring prior to the effective date of such withdrawal or termination.

12

     (e) Nothing contained in this compact shall be construed to invalidate or prevent any nurse

13

licensure agreement or other cooperative arrangement between a party state and a non-party state

14

that is made in accordance with the other provisions of this compact.

15

     (f) This compact may be amended by the party states. No amendment to this compact shall

16

become effective and binding upon the party states unless and until it is enacted into the laws of all

17

party states.

18

     (g) Representatives of non-party states to this compact shall be invited to participate in the

19

activities of the commission, on a nonvoting basis, prior to the adoption of this compact by all

20

states.

21

     5-34.3-14. Construction and severability.

22

(a) This compact shall be liberally construed so as to effectuate the purposes thereof. The

23

provisions of this compact shall be severable and if any phrase, clause, sentence or provision of

24

this compact is declared to be contrary to the constitution of any party state or of the United States

25

or the applicability thereof to any government, agency, person or circumstance is held invalid, the

26

validity of the remainder of this compact and the applicability thereof to any government, agency,

27

person or circumstance shall not be affected thereby. If this compact shall be held contrary to the

28

constitution of any state party thereto, the compact shall remain in full force and effect as to the

29

remaining party states and in full force and effect as to the party state affected as to all severable

30

matters.

31

     (b)In the event party states find a need for settling disputes arising under this compact:

32

     (1) The party states may submit the issues in dispute to an arbitration panel which will be

33

comprised of an individual appointed by the compact administrator in the home state; an individual

 

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1

appointed by the compact administrator in the remote state(s) involved; and an individual mutually

2

agreed upon by the compact administrators of all the party states involved in the dispute.

3

     (2) The decision of a majority of the arbitrators shall be final and binding.

4

SECTION 4. Sections 5-34.3-7 and 5-34.3-11 of the General Laws in Chapter 5-34.3

5

entitled "Nurse Licensure Compact" are hereby repealed.

6

     5-34.3-7. Adverse actions.

7

     In addition to the provisions described in § 5-34.3-5, the following provisions apply:

8

     (1) The licensing board of a remote state shall promptly report to the administrator of the

9

coordinated licensure information system any remote state actions including the factual and legal

10

basis for such action, if known. The licensing board of a remote state shall also promptly report any

11

significant current investigative information yet to result in a remote state action. The administrator

12

of the coordinated licensure information system shall promptly notify the home state of any such

13

reports.

14

     (2) The licensing board of a party state shall have the authority to complete any pending

15

investigations for a nurse who changes primary state of residence during the course of such

16

investigations. It shall also have the authority to take appropriate action(s), and shall promptly

17

report the conclusions of such investigations to the administrator of the coordinated licensure

18

information system. The administrator of the coordinated licensure information system shall

19

promptly notify the new home state of any such actions.

20

     (3) A remote state may take adverse action affecting the multistate licensure privilege to

21

practice within that party state. However, only the home state shall have the power to impose

22

adverse action against the license issued by the home state.

23

     (4) For purposes of imposing adverse action, the licensing board of the home state shall

24

give the same priority and effect to reported conduct received from a remote state as it would if

25

such conduct had occurred within the home state. In so doing, it shall apply its own state laws to

26

determine appropriate action.

27

     (5) The home state may take adverse action based on the factual findings of the remote

28

state, so long as each state follows its own procedures for imposing such adverse action.

29

     (6) Nothing in this compact shall override a party state's decision that participation in an

30

alternative program may be used in lieu of licensure action and that such participation shall remain

31

non-public if required by the party state's laws. Party states must require nurses who enter any

32

alternative programs to agree not to practice in any other party state during the term of the

33

alternative program without prior authorization from such other party state.

34

     5-34.3-11. Immunity.

 

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1

     No party state or the officers or employees or agents of a party state's nurse licensing board

2

who acts in accordance with the provisions of this compact shall be liable on account of any act or

3

omission in good faith while engaged in the performance of their duties under this compact. Good

4

faith in this article shall not include willful misconduct, gross negligence, or recklessness.

5

     SECTION 5. Title 5 of the General Laws entitled “Business and Professions” is hereby

6

amended by adding thereto the following chapter:

7

CHAPTER 44.1

8

PSYCHOLOGY INTERJURISDICTIONAL COMPACT

9

     5-44.1-1. Short title. – This chapter shall be known and may be cited as the psychology

10

interjurisdictional compact act.

11

     5.44-.1-2. Purpose.

12

     WHEREAS, states license psychologists, in order to protect the public through verification

13

of education, training and experience and ensure accountability for professional practice; and

14

     WHEREAS, this compact is intended to regulate the day to day practice of telepsychology

15

(i.e. the provision of psychological services using telecommunication technologies) by

16

psychologists across state boundaries in the performance of their psychological practice as assigned

17

by an appropriate authority; and

18

     WHEREAS, this compact is intended to regulate the temporary in-person, face-to-face

19

practice of psychology by psychologists across state boundaries for 30 days within a calendar year

20

in the performance of their psychological practice as assigned by an appropriate authority;

21

     WHEREAS, this compact is intended to authorize state psychology regulatory authorities

22

to afford legal recognition, in a manner consistent with the terms of the compact, to psychologists

23

licensed in another state;

24

     WHEREAS, this compact recognizes that states have a vested interest in protecting the

25

public’s health and safety through their licensing and regulation of psychologists and that such state

26

regulation will best protect public health and safety;

27

     WHEREAS, this compact does not apply when a psychologist is licensed in both the home

28

and receiving states; and

29

     WHEREAS, this compact does not apply to permanent in-person, face-to-face practice, it

30

does allow for authorization of temporary psychological practice.

31

Consistent with these principles, this compact is designed to achieve the following purposes and

32

objectives:

 

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1

     (1) Increase public access to professional psychological services by allowing for

2

telepsychological practice across state lines as well as temporary in-person, face-to-face services

3

into a state which the psychologist is not licensed to practice psychology;

4

(2) Enhance the states’ ability to protect the public’s health and safety, especially

5

client/patient safety;

6

(3) Encourage the cooperation of compact states in the areas of psychology licensure and

7

regulation;

8

(4) Facilitate the exchange of information between compact states regarding psychologist

9

licensure, adverse actions and disciplinary history;

10

(5) Promote compliance with the laws governing psychological practice in each compact

11

state; and

12

(6) Invest all compact states with the authority to hold licensed psychologists accountable

13

through the mutual recognition of compact state licenses.

14

5-44.1-3. – Definitions

15

(a) “Adverse action” means any action taken by a state psychology regulatory authority

16

which finds a violation of a statute or regulation that is identified by the state psychology regulatory

17

authority as discipline and is a matter of public record.

18

(b) “Association of state and provincial psychology boards (ASPPB)” means the

19

recognized membership organization composed of state and provincial psychology regulatory

20

authorities responsible for the licensure and registration of psychologists throughout the United

21

States and Canada.

22

(c) “Authority to practice interjurisdictional telepsychology” means a licensed

23

psychologist’s authority to practice telepsychology, within the limits authorized under this

24

compact, in another compact state.

25

(d) “Bylaws” means those bylaws established by the psychology interjurisdictional

26

compact commission pursuant to section 5-44.1-11 for its governance, or for directing and

27

controlling its actions and conduct.

28

(e) “Client/patient” means the recipient of psychological services, whether psychological

29

services are delivered in the context of healthcare, corporate, supervision, and/or consulting

30

services.

31

(f) “Commissioner” means the voting representative appointed by each state psychology

32

Regulatory Authority pursuant to section 5-44.1-11.

 

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(g) “Compact state” means a state, the District of Columbia, or United States territory that

2

has enacted this compact legislation and which has not withdrawn pursuant to section 5-44.1-14

3

(e) or been terminated pursuant to section 5-44.1-13 (b).

4

(h) “Coordinated licensure information system” also referred to as “coordinated database”

5

means an integrated process for collecting, storing, and sharing information on psychologists’

6

licensure and enforcement activities related to psychology licensure laws, which is administered

7

by the recognized membership organization composed of state and provincial psychology

8

regulatory authorities.

9

(i) “Confidentiality” means the principle that data or information is not made available or

10

disclosed to unauthorized persons and/or processes.

11

(j) “Day” means any part of a day in which psychological work is performed.

12

(k) “Distant State” means the compact state where a psychologist is physically present (not

13

through the use of telecommunications technologies), to provide temporary in-person, face-to-face

14

psychological services.

15

(l) “E.Passport” means a certificate issued by the ASPPB that promotes the standardization

16

in the criteria of interjurisdictional telepsychology practice and facilitates the process for licensed

17

psychologists to provide telepsychological services across state lines.

18

(m) “Executive board” means a group of directors elected or appointed to act on behalf of,

19

and within the powers granted to them by, the commission.

20

(n) “Home state” means a compact state where a psychologist is licensed to practice

21

psychology. If the psychologist is licensed in more than one compact state and is practicing under

22

the authorization to practice interjurisdictional telepsychology, the home state is the compact state

23

where the psychologist is physically present when the telepsychological services are delivered. If

24

the psychologist is licensed in more than one compact state and is practicing under the temporary

25

authorization to practice, the home state is any compact state where the psychologist is licensed.

26

(o) “Identity history summary” means a summary of information retained by the FBI, or

27

other designee with similar authority, in connection with arrests and, in some instances, federal

28

employment, naturalization, or military service.

29

(p) “In-person, face-to-face” means interactions in which the psychologist and the

30

client/patient are in the same physical space and which does not include interactions that may occur

31

through the use of telecommunication technologies.

32

(q) “Interjurisdictional practice certificate (IPC)” means a certificate issued by the ASPPB

33

that grants temporary authority to practice based on notification to the state psychology regulatory

 

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1

authority of intention to practice temporarily, and verification of one’s qualifications for such

2

practice.

3

(r) “License” means authorization by a state psychology regulatory authority to engage in

4

the independent practice of psychology, which would be unlawful without the authorization.

5

(s) “Non-compact state” means any state which is not at the time a compact state.

6

(t) “Psychologist” means an individual licensed for the independent practice of psychology.

7

     (u) “Psychology interjurisdictional compact” means the formal compact authorized in

8

chapter 5-44.1.

9

     (v) “Psychology interjurisdictional compact commission” also referred to as “commission”

10

means the national administration of which all compact states are members.

11

     (w) “Receiving State” means a compact state where the client/patient is physically located

12

when the telepsychological services are delivered.

13

     (x) “Rule” means a written statement by the psychology interjurisdictional compact

14

commission promulgated pursuant to section 5-44.1-12 that is of general applicability, implements,

15

interprets, or prescribes a policy or provision of the compact, or an organizational, procedural, or

16

practice requirement of the commission and has the force and effect of statutory law in a compact

17

state, and includes the amendment, repeal or suspension of an existing rule.

18

     (y) “Significant investigatory information” means investigative information that a state

19

psychology regulatory authority, after a preliminary inquiry that includes notification and an

20

opportunity to respond if required by state law, has reason to believe, if proven true, would indicate

21

more than a violation of state statute or ethics code that would be considered more substantial than

22

minor infraction; or investigative information that indicates that the psychologist represents an

23

immediate threat to public health and safety regardless of whether the psychologist has been

24

notified and/or had an opportunity to respond.

25

     (z) “State” means a state, commonwealth, territory, or possession of the United States, the

26

District of Columbia.

27

     (aa) “State psychology regulatory authority” means the board, office or other agency with

28

the legislative mandate to license and regulate the practice of psychology.

29

     (bb) “Telepsychology” means the provision of psychological services using

30

telecommunication technologies.

31

     (cc) “Temporary authorization to practice” means a licensed psychologist’s authority to

32

conduct temporary in-person, face-to-face practice, within the limits authorized under this compact,

33

in another compact state.

 

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1

     (dd) “Temporary in-person, face-to-face practice” means where a psychologist is

2

physically present (not through the use of telecommunications technologies), in the distant state to

3

provide for the practice of psychology for 30 days within a calendar year and based on notification

4

to the distant state.

5

5-44.1-4. – Home state licensure.

6

(a) The home state shall be a compact state where a psychologist is licensed to practice

7

psychology.

8

(b) A psychologist may hold one or more compact State licenses at a time. If the

9

psychologist is licensed in more than one compact State, the home State is the compact state where

10

the psychologist is physically present when the services are delivered as authorized by the authority

11

to practice interjurisdictional telepsychology under the terms of this compact.

12

(c) Any compact state may require a psychologist not previously licensed in a compact

13

state to obtain and retain a license to be authorized to practice in the compact state under

14

circumstances not authorized by the authority to practice interjurisdictional telepsychology under

15

the terms of this compact.

16

(d) Any compact state may require a psychologist to obtain and retain a license to be

17

authorized to practice in a compact state under circumstances not authorized by temporary

18

authorization to practice under the terms of this compact.

19

(e) A homes state’s license authorizes a psychologist to practice in a receiving state under

20

the authority to practice interjurisdictional telepsychology only if the compact state:

21

(1) Currently requires the psychologist to hold an active E.Passport;

22

(2) Has a mechanism in place for receiving and investigating complaints about licensed

23

individuals;

24

(3) Notifies the commission, in compliance with the terms herein, of any adverse action or

25

significant investigatory information regarding a licensed individual;

26

(4) Requires an identity history summary of all applicants at initial licensure, including the

27

use of the results of fingerprints or other biometric data checks compliant with the requirements of

28

the Federal Bureau of Investigation (FBI), or other designee with similar authority, no later than

29

ten years after activation of the compact; and

30

(5) Complies with the bylaws and rules.

31

(f) A home state’s license grants temporary authorization to practice to a psychologist in a

32

distant state only if the compact state:

33

(1) Currently requires the psychologist to hold an active IPC;

 

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1

(2) Has a mechanism in place for receiving and investigating complaints about licensed

2

individuals;

3

(3) Notifies the commission, in compliance with the terms herein, of any adverse action or

4

significant investigatory information regarding a licensed individual;

5

(4) Requires an identity history summary of all applicants at initial licensure, including the

6

use of the results of fingerprints or other biometric data checks compliant with the requirements of

7

the FBI, or other designee with similar authority, no later than ten years after activation of the

8

compact; and

9

(5) Complies with the bylaws and rules.

10

5-44.1-5 Compact privilege to practice telepsychology.

11

(a) Compact states shall recognize the right of a psychologist, licensed in a compact state

12

in conformance with section 5-44.1-4, to practice telepsychology in other compact states (receiving

13

states) in which the psychologist is not licensed, under the authority to practice interjurisdictional

14

telepsychology as provided in the compact.

15

(b) To exercise the authority to practice interjurisdictional telepsychology under the terms

16

and provisions of this compact, a psychologist licensed to practice in a compact state must:

17

     (1) Hold a graduate degree in psychology from an institute of higher education that was, at

18

the time the degree was awarded:

19

     (i) Regionally accredited by an accrediting body recognized by the U.S. department of

20

education to grant graduate degrees, or authorized by provincial statute or royal charter to grant

21

doctoral degrees; or

22

     (ii) A foreign college or university deemed to be equivalent to 1(a) above by a foreign

23

credential evaluation service that is a member of the national association of credential evaluation

24

services (NACES) or by a recognized foreign credential evaluation service; and

25

     (2) Hold a graduate degree in psychology that meets the following criteria: and

26

     (3) The program, wherever it may be administratively housed, must be clearly identified

27

and labeled as a psychology program. Such a program must specify in pertinent institutional

28

catalogues and brochures its intent to educate and train professional psychologists;

29

     (4) The psychology program must stand as a recognizable, coherent, organizational entity

30

within the institution;

31

     (5) There must be a clear authority and primary responsibility for the core and specialty

32

areas whether or not the program cuts across administrative lines;

33

     (6) The program must consist of an integrated, organized sequence of study;

 

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1

     (7) There must be an identifiable psychology faculty sufficient in size and breadth to carry

2

out its responsibilities;

3

     (8) The designated director of the program must be a psychologist and a member of the

4

core faculty;

5

     (9) The program must have an identifiable body of students who are matriculated in that

6

program for a degree;

7

     (10) The program must include supervised practicum, internship, or field training

8

appropriate to the practice of psychology;

9

     (11) The curriculum shall encompass a minimum of three academic years of full-time

10

graduate study for doctoral degree and a minimum of one academic year of full-time graduate study

11

for master’s degree;

12

     (12) The program includes an acceptable residency as defined by the rules.

13

     (13) Possess a current, full and unrestricted license to practice psychology in a home state

14

which is a compact state;

15

     (14) Have no history of adverse action that violate the rules;

16

     (15) Have no criminal record history reported on an Identity history summary that violates

17

the rules;

18

     (16) Possess a current, active E.Passport;

19

     (17) Provide attestations in regard to areas of intended practice, conformity with standards

20

of practice, competence in telepsychology technology; criminal background; and knowledge and

21

adherence to legal requirements in the home and receiving states, and provide a release of

22

information to allow for primary source verification in a manner specified by the commission; and

23

     (18) Meet other criteria as defined by the rules.

24

(c) The home state maintains authority over the license of any psychologist practicing into

25

a Receiving State under the authority to practice interjurisdictional telepsychology.

26

     (d) A psychologist practicing into a receiving state under the authority to practice

27

interjurisdictional telepsychology will be subject to the receiving state’s scope of practice. A

28

receiving state may, in accordance with that state’s due process law, limit or revoke a

29

psychologist’s Authority to practice interjurisdictional telepsychology in the receiving state and

30

may take any other necessary actions under the receiving state’s applicable law to protect the health

31

and safety of the receiving State’s citizens. If a receiving state takes action, the state shall promptly

32

notify the home state and the commission.

33

(e) If a psychologist’s license in any home state, another compact state, or any authority to

34

practice interjurisdictional telepsychology in any receiving state, is restricted, suspended or

 

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1

otherwise limited, the E.Passport shall be revoked and therefore the psychologist shall not be

2

eligible to practice telepsychology in a compact state under the authority to practice

3

interjurisdictional telepsychology.

4

5-44.1-6. – Compact temporary authorization to practice.

5

(a) Compact states shall also recognize the right of a psychologist, licensed in a compact state

6

in conformance with section 5-44.1-4, to practice temporarily in other compact states (distant

7

states) in which the psychologist is not licensed, as provided in the compact.

8

(b) To exercise the temporary authorization to practice under the terms and provisions of this

9

compact, a psychologist licensed to practice in a compact state must:

10

(1) Hold a graduate degree in psychology from an institute of higher education that was, at

11

the time the degree was awarded:

12

(i) Regionally accredited by an accrediting body recognized by the U.S. department of

13

education to grant graduate degrees, or authorized by provincial statute or royal charter to grant

14

doctoral degrees; or

15

(ii) A foreign college or university deemed to be equivalent to 1 (a) above by a foreign

16

credential evaluation service that is a member of the national association of credential evaluation

17

services (NACES) or by a recognized foreign credential evaluation service; and

18

(2) Hold a graduate degree in psychology that meets the following criteria:

19

(i) The program, wherever it may be administratively housed, must be clearly identified

20

and labeled as a psychology program. Such a program must specify in pertinent institutional

21

catalogues and brochures its intent to educate and train professional psychologists;

22

(ii) The psychology program must stand as a recognizable, coherent, organizational entity

23

within the institution;

24

(iii) There must be a clear authority and primary responsibility for the core and specialty

25

areas whether or not the program cuts across administrative lines;

26

(iv) The program must consist of an integrated, organized sequence of study;

27

(v) There must be an identifiable psychology faculty sufficient in size and breadth to carry

28

out its responsibilities;

29

(vi) The designated director of the program must be a psychologist and a member of the

30

core faculty;

31

(vii) The program must have an identifiable body of students who are matriculated in that

32

program for a degree;

33

(viii) The program must include supervised practicum, internship, or field training

34

appropriate to the practice of psychology;

 

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1

(ix) The curriculum shall encompass a minimum of three academic years of full-time

2

graduate study for doctoral degrees and a minimum of one academic year of full-time graduate

3

study for master’s degree;

4

(x) The program includes an acceptable residency as defined by the rules.

5

(3) Possess a current, full and unrestricted license to practice psychology in a home state

6

which is a compact state;

7

(4) No history of adverse action that violate the rules;

8

(5) No criminal record history that violates the rules;

9

(6) Possess a current, active IPC;

10

(7) Provide attestations in regard to areas of intended practice and work experience and

11

provide a release of information to allow for primary source verification in a manner specified by

12

the commission; and

13

(8) Meet other criteria as defined by the rules.

14

(c) A psychologist practicing into a distant state under the temporary authorization to

15

practice shall practice within the scope of practice authorized by the distant state.

16

(d) A psychologist practicing into a distant state under the temporary authorization to

17

practice will be subject to the distant state’s authority and law. A distant state may, in accordance

18

with that state’s due process law, limit or revoke a psychologist’s temporary authorization to

19

practice in the distant state and may take any other necessary actions under the distant state’s

20

applicable law to protect the health and safety of the distant state’s citizens. If a distant state takes

21

action, the state shall promptly notify the home state and the commission.

22

(e) If a psychologist’s license in any home state, another compact state, or any temporary

23

authorization to practice in any distant state, is restricted, suspended or otherwise limited, the IPC

24

shall be revoked and therefore the psychologist shall not be eligible to practice in a compact state

25

under the temporary authorization to practice.

26

     5-44.1-7. – Conditions of telepsychology practice in a receiving state.

27

     (a) A psychologist may practice in a receiving state under the authority to practice

28

interjurisdictional telepsychology only in the performance of the scope of practice for psychology

29

as assigned by an appropriate state psychology regulatory authority, as defined in the rules, and

30

under the following circumstances:

31

(1) The psychologist initiates a client/patient contact in a home state via

32

telecommunications technologies with a client/patient in a receiving state;

33

(2) Other conditions regarding telepsychology as determined in the rules.

34

     5-44.1-8. – Adverse actions.

 

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1

     (a) A home state shall have the power to impose adverse action against a psychologist’s

2

license issued by the home state. A distant state shall have the power to take adverse action on a

3

psychologist’s temporary authorization to practice within that distant state.

4

     (b) A receiving state may take adverse action on a psychologist’s authority to practice

5

interjurisdictional telepsychology within that receiving state. A home state may take adverse action

6

against a psychologist based on an adverse action taken by a distant state regarding temporary in-

7

person, face-to-face practice.

8

(c) If a home state takes adverse action against a psychologist’s license, that psychologist’s

9

authority to practice interjurisdictional telepsychology is terminated and the E.Passport is revoked.

10

Furthermore, that psychologist’s temporary authorization to practice is terminated and the IPC is

11

revoked.

12

(1) All home state disciplinary orders which impose adverse action shall be reported to the

13

commission in accordance with the rules. A compact state shall report adverse actions in

14

accordance with the rules.

15

(2) In the event discipline is reported on a psychologist, the psychologist will not be eligible

16

for telepsychology or temporary in-person, face-to-face practice in accordance with the rules.

17

(3) Other actions may be imposed as determined by the rules.

18

(d) A home state’s psychology regulatory authority shall investigate and take appropriate

19

action with respect to reported inappropriate conduct engaged in by a licensee which occurred in a

20

Receiving State as it would if such conduct had occurred by a licensee within the home state. In

21

such cases, the home state’s law shall control in determining any adverse action against a

22

psychologist’s license.

23

(e) A distant state’s psychology regulatory authority shall investigate and take appropriate

24

action with respect to reported inappropriate conduct engaged in by a psychologist practicing under

25

temporary authorization practice which occurred in that distant state as it would if such conduct

26

had occurred by a licensee within the home state. In such cases, distant state’s law shall control in

27

determining any adverse action against a psychologist’s temporary authorization to practice.

28

(f) Nothing in this compact shall override a compact state’s decision that a psychologist’s

29

participation in an alternative program may be used in lieu of adverse action and that such

30

participation shall remain non-public if required by the compact state’s law. Compact states must

31

require psychologists who enter any alternative programs to not provide telepsychology services

32

under the authority to practice interjurisdictional telepsychology or provide temporary

33

psychological services under the temporary authorization to practice in any other compact state

34

during the term of the alternative program.

 

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1

(g) No other judicial or administrative remedies shall be available to a psychologist in the

2

event a compact State imposes an adverse action pursuant to subsection c, above.

3

     5-44.1-9. – Additional authorities invested in a compact state’s psychology regulatory

4

authority.

5

(a) In addition to any other powers granted under state law, a compact state’s psychology

6

regulatory Authority shall have the authority under this compact to:

7

(1) Issue subpoenas, for both hearings and investigations, which require the attendance and

8

testimony of witnesses and the production of evidence. Subpoenas issued by a compact state’s

9

psychology regulatory authority for the attendance and testimony of witnesses, and/or the

10

production of evidence from another compact state shall be enforced in the latter state by any court

11

of competent jurisdiction, according to that court’s practice and procedure in considering subpoenas

12

issued in its own proceedings. The issuing state psychology regulatory authority shall pay any

13

witness fees, travel expenses, mileage and other fees required by the service statutes of the state

14

where the witnesses and/or evidence are located; and

15

(2) Issue cease and desist and/or injunctive relief orders to revoke a psychologist’s

16

authority to practice interjurisdictional telepsychology and/or temporary authorization to practice.

17

(3) During the course of any investigation, a psychologist may not change his/her home

18

state licensure. A home state psychology regulatory authority is authorized to complete any

19

pending investigations of a psychologist and to take any actions appropriate under its law. The

20

home state psychology regulatory authority shall promptly report the conclusions of such

21

investigations to the commission. Once an investigation has been completed, and pending the

22

outcome of said investigation, the psychologist may change his/her home state licensure. The

23

commission shall promptly notify the new home state of any such decisions as provided in the rules.

24

All information provided to the commission or distributed by compact states pursuant to the

25

psychologist shall be confidential, filed under seal and used for investigatory or disciplinary

26

matters. The commission may create additional rules for mandated or discretionary sharing of

27

information by compact States.

28

5-44.1-10. – Coordinated licensure information system.

29

(a) The commission shall provide for the development and maintenance of a coordinated

30

licensure information system and reporting system containing licensure and disciplinary action

31

information on all psychologists to whom this compact is applicable in all compact states as defined

32

by the rules.

 

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1

(b) Notwithstanding any other provision of state law to the contrary, a compact state shall

2

submit a uniform data set to the coordinated database on all licensees as required by the rules,

3

including:

4

(i) Identifying information;

5

(ii) Licensure data;

6

(iii) Significant investigatory information;

7

(iv) Adverse actions against a psychologist’s license;

8

(v) An indicator that a psychologist’s authority to practice interjurisdictional

9

telepsychology and/or temporary authorization to practice is revoked;

10

(vi) Non-confidential information related to alternative program participation information;

11

(vii)Any denial of application for licensure, and the reasons for such denial; and

12

(viii) Other information which may facilitate the administration of this compact, as

13

determined in the rules.

14

(c) The coordinated database administrator shall promptly notify all compact states of any

15

adverse action taken against, or significant investigative information on, any licensee in a compact

16

state.

17

(d) Compact states reporting information to the coordinated database may designate

18

information that may not be shared with the public without the express permission of the compact

19

state reporting the information.

20

(e) Any information submitted to the coordinated database that is subsequently required to

21

be expunged by the law of the compact State reporting the information shall be removed from the

22

coordinated database.

23

5-44.1-11. – Establishment of the psychology interjurisdictional compact commission.

24

(a) The compact states hereby create and establish a joint public agency known as the

25

psychology interjurisdictional compact commission.

26

(1) The commission is a body politic and an instrumentality of the compact states.

27

(2) Venue is proper and judicial proceedings by or against the commission shall be brought

28

solely and exclusively in a court of competent jurisdiction where the principal office of the

29

commission is located. The commission may waive venue and jurisdictional defenses to the extent

30

it adopts or consents to participate in alternative dispute resolution proceedings.

31

(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity.

32

(b) Membership, voting, and meetings

33

(1) The commission shall consist of one voting representative appointed by each compact

34

state who shall serve as that state’s commissioner. The state psychology regulatory authority shall

 

Art20

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1

appoint its delegate. This delegate shall be empowered to act on behalf of the compact state. This

2

delegate shall be limited to:

3

(i) Executive director, executive secretary or similar executive;

4

(ii) Current member of the state psychology regulatory authority of a compact State; or

5

(iii) Designee empowered with the appropriate delegate authority to act on behalf of the

6

compact State.

7

(2) Any commissioner may be removed or suspended from office as provided by the law

8

of the state from which the commissioner is appointed. Any vacancy occurring in

9

the commission shall be filled in accordance with the laws of the compact state in which the

10

vacancy exists.

11

(3) Each commissioner shall be entitled to one vote with regard to the promulgation of

12

rules and creation of bylaws and shall otherwise have an opportunity to participate in the business

13

and affairs of the commission. A commissioner shall vote in person or by such other means as

14

provided in the bylaws. The By-Laws may provide for commissioner’s participation in meetings

15

by telephone or other means of communication.

16

(4) The commission shall meet at least once during each calendar year. Additional

17

meetings shall be held as set forth in the bylaws.

18

(5) All meetings shall be open to the public, and public notice of meetings shall be given

19

in the same manner as required under the rulemaking provisions in Chapter 35 of Title 42.

20

(6) The commission may convene in a closed, non-public meeting if the commission must

21

discuss:

22

(i) Non-compliance of a compact state with its obligations under the compact;

23

(ii) The employment, compensation, discipline or other personnel matters, practices or

24

procedures related to specific employees or other matters related to the commission’s internal

25

personnel practices and procedures;

26

(iii) Current, threatened, or reasonably anticipated litigation against the commission;

27

(iv) Negotiation of contracts for the purchase or sale of goods, services or real estate;

28

(v) Accusation against any person of a crime or formally censuring any person;

29

(vi) Disclosure of trade secrets or commercial or financial information which is privileged

30

or confidential;

31

(vii) Disclosure of information of a personal nature where disclosure would constitute a

32

clearly unwarranted invasion of personal privacy;

33

(viii) Disclosure of investigatory records compiled for law enforcement purposes;

 

Art20

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1

(ix) Disclosure of information related to any investigatory reports prepared by or on behalf

2

of or for use of the commission or other committee charged with responsibility for investigation or

3

determination of compliance issues pursuant to the compact; or

4

(x) Matters specifically exempted from disclosure by federal and state statute.

5

(7) If a meeting, or portion of a meeting, is closed pursuant to this provision, the

6

commission’s legal counsel or designee shall certify that the meeting may be closed and shall

7

reference each relevant exempting provision. The commission shall keep minutes which fully and

8

clearly describe all matters discussed in a meeting and shall provide a full and accurate summary

9

of actions taken, of any person participating in the meeting, and the reasons therefore, including a

10

description of the views expressed. All documents considered in connection with an action shall be

11

identified in such minutes. All minutes and documents of a closed meeting shall remain under seal,

12

subject to release only by a majority vote of the commission or order of a court of competent

13

jurisdiction.

14

(8) The commission shall, by a majority vote of the commissioners, prescribe bylaws

15

and/or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and

16

exercise the powers of the compact, including but not limited to:

17

(i) Establishing the fiscal year of the commission;

18

(ii) Providing reasonable standards and procedures:

19

(iii) for the establishment and meetings of other committees; and

20

(iv) governing any general or specific delegation of any authority or function of the

21

commission;

22

(v) Providing reasonable procedures for calling and conducting meetings of the

23

commission, ensuring reasonable advance notice of all meetings and providing an opportunity for

24

attendance of such meetings by interested parties, with enumerated exceptions designed to protect

25

the public’s interest, the privacy of individuals of such proceedings, and proprietary information,

26

including trade secrets. The commission may meet in closed session only after a majority of the

27

commissioners vote to close a meeting to the public in whole or in part. As soon as practicable, the

28

commission must make public a copy of the vote to close the meeting revealing the vote of each

29

commissioner with no proxy votes allowed;

30

(vi) Establishing the titles, duties and authority and reasonable procedures for the election

31

of the officers of the commission;

32

(vii) Providing reasonable standards and procedures for the establishment of the personnel

33

policies and programs of the commission. Notwithstanding any civil service or other similar law

 

Art20

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1

of any compact State, the bylaws shall exclusively govern the personnel policies and programs of

2

the commission;

3

(viii) Promulgating a code of ethics to address permissible and prohibited activities of

4

commission members and employees;

5

(ix) Providing a mechanism for concluding the operations of the commission and the

6

equitable disposition of any surplus funds that may exist after the termination of the compact after

7

the payment and/or reserving of all of its debts and obligations;

8

(9) The commission shall publish its Bylaws in a convenient form and file a copy thereof

9

and a copy of any amendment thereto, with the appropriate agency or officer in each of the compact

10

states;

11

(10) The commission shall maintain its financial records in accordance with the Bylaws;

12

and

13

(11) The commission shall meet and take such actions as are consistent with the provisions

14

of this compact and the bylaws.

15

(c) The commission shall have the following powers:

16

(1) The authority to promulgate uniform rules to facilitate and coordinate implementation

17

and administration of this compact. The rule shall have the force and effect of law and shall be

18

binding in all compact states;

19

(2) To bring and prosecute legal proceedings or actions in the name of the commission,

20

provided that the standing of any state psychology regulatory authority or other regulatory body

21

responsible for psychology licensure to sue or be sued under applicable law shall not be affected;

22

(3) To purchase and maintain insurance and bonds;

23

(4) To borrow, accept or contract for services of personnel, including, but not limited to,

24

employees of a compact state;

25

(5) To hire employees, elect or appoint officers, fix compensation, define duties, grant such

26

individuals appropriate authority to carry out the purposes of the compact, and to establish the

27

commission’s personnel policies and programs relating to conflicts of interest, qualifications of

28

personnel, and other related personnel matters;

29

(6) To accept any and all appropriate donations and grants of money, equipment, supplies,

30

materials and services, and to receive, utilize and dispose of the same; provided that at all times the

31

commission shall strive to avoid any appearance of impropriety and/or conflict of interest;

32

(7) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold,

33

improve or use, any property, real, personal or mixed; provided that at all times the commission

34

shall strive to avoid any appearance of impropriety;

 

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1

(8) To sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of

2

any property real, personal or mixed;

3

(9) To establish a budget and make expenditures;

4

(10) To borrow money;

5

(11) To appoint committees, including advisory committees comprised of members, state

6

regulators, state legislators or their representatives, and consumer representatives, and such other

7

interested persons as may be designated in this compact and the bylaws;

8

(12) To provide and receive information from, and to cooperate with, law enforcement

9

agencies;

10

(13) To adopt and use an official seal; and

11

(14) To perform such other functions as may be necessary or appropriate to achieve the

12

purposes of this compact consistent with the state regulation of psychology licensure, temporary

13

in-person, face-to-face practice and telepsychology practice.

14

(d) The executive board. The elected officers shall serve as the executive board, which

15

shall have the power to act on behalf of the commission according to the terms of this compact.

16

(1) The executive board shall be comprised of six members:

17

(i) Five voting members who are elected from the current membership of the commission

18

by the commission;

19

(ii) One ex-officio, nonvoting member from the recognized membership organization

20

composed of state and provincial psychology regulatory authorities.

21

(1) The ex-officio member must have served as staff or member on a state psychology

22

regulatory authority and will be selected by its respective organization.

23

(2) The commission may remove any member of the executive board as provided in the

24

bylaws.

25

     (3) The executive board shall meet at least annually.

26

     (4) The executive board shall have the following duties and responsibilities:

27

(i) Recommend to the entire commission changes to the rules or bylaws, changes to this

28

compact legislation, fees paid by compact states such as annual dues, and any other applicable fees;

29

(ii) Ensure compact administration services are appropriately provided, contractual or

30

otherwise;

31

(iii) Prepare and recommend the budget;

32

(iv) Maintain financial records on behalf of the commission;

33

(v) Monitor compact compliance of member states and provide compliance reports to the

34

commission;

 

Art20

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1

(vi) Establish additional committees as necessary; and

2

(vii) Other duties as provided in rules or bylaws.

3

(e) Financing of the commission

4

(1) The commission shall pay, or provide for the payment of the reasonable expenses of its

5

establishment, organization and ongoing activities.

6

(2) The commission may accept any and all appropriate revenue sources, donations and

7

grants of money, equipment, supplies, materials and services.

8

(3) The commission may levy on and collect an annual assessment from each compact state

9

or impose fees on other parties to cover the cost of the operations and activities of the commission

10

and its staff which must be in a total amount sufficient to cover its annual budget as approved each

11

year for which revenue is not provided by other sources. The aggregate annual assessment amount

12

shall be allocated based upon a formula to be determined by the commission which shall

13

promulgate a rule binding upon all compact states.

14

(1) The commission shall not incur obligations of any kind prior to securing the funds

15

adequate to meet the same; nor shall the commission pledge the credit of any of the compact States,

16

except by and with the authority of the compact state.

17

(2) The commission shall keep accurate accounts of all receipts and disbursements. The

18

receipts and disbursements of the commission shall be subject to the audit and accounting

19

procedures established under its bylaws. However, all receipts and disbursements of funds handled

20

by the commission shall be audited yearly by a certified or licensed public accountant and the report

21

of the audit shall be included in and become part of the annual report of the commission.

22

(a) Qualified immunity, defense, and indemnification

23

(1) The members, officers, executive director, employees and representatives of the

24

commission shall be immune from suit and liability, either personally or in their official capacity,

25

for any claim for damage to or loss of property or personal injury or other civil liability caused by

26

or arising out of any actual or alleged act, error or omission that occurred, or that the person against

27

whom the claim is made had a reasonable basis for believing occurred within the scope of

28

commission employment, duties or responsibilities; provided that nothing in this paragraph shall

29

be construed to protect any such person from suit and/or liability for any damage, loss, injury or

30

liability caused by the intentional or willful or wanton misconduct of that person.

31

(2) The commission shall defend any member, officer, executive director, employee or

32

representative of the commission in any civil action seeking to impose liability arising out of any

33

actual or alleged act, error or omission that occurred within the scope of commission employment,

34

duties or responsibilities, or that the person against whom the claim is made had a reasonable basis

 

Art20

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1

for believing occurred within the scope of commission employment, duties or responsibilities;

2

provided that nothing herein shall be construed to prohibit that person from retaining his or her

3

own counsel; and provided further, that the actual or alleged act, error or omission did not result

4

from that person’s intentional or willful or wanton misconduct.

5

(3) The commission shall indemnify and hold harmless any member, officer, executive

6

director, employee or representative of the commission for the amount of any settlement or

7

judgment obtained against that person arising out of any actual or alleged act, error or omission

8

that occurred within the scope of commission. employment, duties or responsibilities, or that such

9

person had a reasonable basis for believing occurred within the scope of commission employment,

10

duties or responsibilities, provided that the actual or alleged act, error or omission did not result

11

from the intentional or willful or wanton misconduct of that person.

12

     5-44.1-12. – Rulemaking.

13

(a) The commission shall exercise its rulemaking powers pursuant to the criteria set forth

14

in section 5-44.1-12 and the rules adopted thereunder. rules and amendments shall become binding

15

as of the date specified in each rule or amendment.

16

(b) If a majority of the legislatures of the compact states rejects a rule, by enactment of a

17

statute or resolution in the same manner used to adopt the compact, then such rule shall have no

18

further force and effect in any compact state.

19

(c) Rules or amendments to the rules shall be adopted at a regular or special meeting of the

20

commission.

21

(d) Prior to promulgation and adoption of a final rule or rules by the commission, and at

22

least sixty (60) days in advance of the meeting at which the rule will be considered and voted upon,

23

the commission shall file a notice of proposed rulemaking:

24

(1) On the website of the commission; and

25

(2) On the website of each compact states’ psychology regulatory authority or the

26

publication in which each state would otherwise publish proposed rules.

27

(e) The Notice of proposed rulemaking shall include:

28

(1) The proposed time, date, and location of the meeting in which the rule will be

29

considered and voted upon;

30

(2) The text of the proposed rule or amendment and the reason for the proposed rule;

31

(3) A request for comments on the proposed rule from any interested person; and

32

(4) The manner in which interested persons may submit notice to the commission of their

33

intention to attend the public hearing and any written comments.

 

Art20

(Page 54 of 111)

1

(f) Prior to adoption of a proposed rule, the commission shall allow persons to submit

2

written data, facts, opinions and arguments, which shall be made available to the public.

3

(g) The commission shall grant an opportunity for a public hearing before it adopts a rule

4

or amendment if a hearing is requested by:

5

(1) At least twenty-five (25) persons who submit comments independently of each other;

6

(2) A governmental subdivision or agency; or

7

(3) A duly appointed person in an association that has having at least twenty-five (25)

8

members.

9

(h) If a hearing is held on the proposed rule or amendment, the commission shall publish

10

the place, time, and date of the scheduled public hearing.

11

(1) All persons wishing to be heard at the hearing shall notify the executive director of the

12

commission or other designated member in writing of their desire to appear and testify at the

13

hearing not less than five (5) business days before the scheduled date of the hearing.

14

(2) Hearings shall be conducted in a manner providing each person who wishes to comment

15

a fair and reasonable opportunity to comment orally or in writing.

16

(3) No transcript of the hearing is required, unless a written request for a transcript is made,

17

in which case the person requesting the transcript shall bear the cost of producing the transcript. A

18

recording may be made in lieu of a transcript under the same terms and conditions as a transcript.

19

This subsection shall not preclude the commission from making a transcript or recording of the

20

hearing if it so chooses.

21

(4) Nothing in this section shall be construed as requiring a separate hearing on each rule.

22

rules may be grouped for the convenience of the commission at hearings required by this section.

23

(i) Following the scheduled hearing date, or by the close of business on the scheduled

24

hearing date if the hearing was not held, the commission shall consider all written and oral

25

comments received.

26

(j) The commission shall, by majority vote of all members, take final action on the proposed

27

rule and shall determine the effective date of the rule, if any, based on the rulemaking record and

28

the full text of the rule.

29

(k) If no written notice of intent to attend the public hearing by interested parties is

30

received, the commission may proceed with promulgation of the proposed rule without a public

31

hearing.

32

(l) Upon determination that an emergency exists, the commission may consider and adopt

33

an emergency rule without prior notice, opportunity for comment, or hearing, provided that the

34

usual rulemaking procedures provided in the compact and in this section shall be retroactively

 

Art20

(Page 55 of 111)

1

applied to the rule as soon as reasonably possible, in no event later than ninety (90) days after the

2

effective date of the rule. For the purposes of this provision, an emergency rule is one that must be

3

adopted immediately in order to:

4

(1) Meet an imminent threat to public health, safety, or welfare;

5

(2) Prevent a loss of commission or compact state funds;

6

(3) Meet a deadline for the promulgation of an administrative rule that is established by

7

federal law or rule; or

8

(4) Protect public health and safety.

9

(m) The commission or an authorized committee of the commission may direct revisions

10

to a previously adopted rule or amendment for purposes of correcting typographical errors, errors

11

in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be

12

posted on the website of the commission. The revision shall be subject to challenge by any person

13

for a period of thirty (30) days after posting. The revision may be challenged only on grounds that

14

the revision results in a material change to a rule. A challenge shall be made in writing, and

15

delivered to the chair of the commission prior to the end of the notice period. If no challenge is

16

made, the revision will take effect without further action. If the revision is challenged, the revision

17

may not take effect without the approval of the commission.

18

     5-44.1-13. -- Oversight, dispute resolution, and enforcement.

19

(a) Oversight

20

(1) The executive, legislative and judicial branches of state government in each compact

21

state shall enforce this compact and take all actions necessary and appropriate to effectuate the

22

compact’s purposes and intent. The provisions of this compact and the rules promulgated hereunder

23

shall have standing as statutory law.

24

(2) All courts shall take judicial notice of the compact and the rules in any judicial or

25

administrative proceeding in a compact state pertaining to the subject matter of this

26

compact which may affect the powers, responsibilities or actions of the commission.

27

(3) The commission shall be entitled to receive service of process in any such proceeding,

28

and shall have standing to intervene in such a proceeding for all purposes. Failure to provide service

29

of process to the commission shall render a judgment or order void as to the commission, this

30

compact or promulgated rules.

31

(b) Default, technical assistance, and termination

32

(1) If the commission determines that a compact state has defaulted in the performance of

33

its obligations or responsibilities under this compact or the promulgated rules, the commission

34

shall:

 

Art20

(Page 56 of 111)

1

(a) Provide written notice to the defaulting state and other compact states of the nature of

2

the default, the proposed means of remedying the default and/or any other action to be taken by the

3

commission; and

4

(b) Provide remedial training and specific technical assistance regarding the default.

5

(2) If a state in default fails to remedy the default, the defaulting state may be terminated

6

from the compact upon an affirmative vote of a majority of the compact states, and all rights,

7

privileges and benefits conferred by this compact shall be terminated on the effective date of

8

termination. A remedy of the default does not relieve the offending state of obligations or liabilities

9

incurred during the period of default.

10

(3) Termination of membership in the compact shall be imposed only after all other means

11

of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be

12

submitted by the commission to the governor, the majority and minority leaders of the defaulting

13

state's legislature, and each of the compact states.

14

(4) A compact state which has been terminated is responsible for all assessments,

15

obligations and liabilities incurred through the effective date of termination, including obligations

16

which extend beyond the effective date of termination.

17

(5) The commission shall not bear any costs incurred by the state which is found to be in

18

default or which has been terminated from the compact, unless agreed upon in writing between the

19

commission and the defaulting state.

20

(6) The defaulting state may appeal the action of the commission by petitioning the U.S.

21

district court for the state of Georgia or the federal district where the compact has its principal

22

offices. The prevailing member shall be awarded all costs of such litigation, including reasonable

23

attorney’s fees.

24

(c) Dispute resolution

25

(1) Upon request by a compact state, the commission shall attempt to resolve disputes

26

related to the compact which arise among compact states and between compact and non-compact

27

states.

28

(2) The commission shall promulgate a rule providing for both mediation and binding

29

dispute resolution for disputes that arise before the commission.

30

(d) Enforcement

31

(1) The commission, in the reasonable exercise of its discretion, shall enforce the

32

provisions and rules of this compact.

33

(2) By majority vote, the commission may initiate legal action in the United States district

34

court for the State of Georgia or the federal district where the compact has its principal offices

 

Art20

(Page 57 of 111)

1

against a compact state in default to enforce compliance with the provisions of the compact and its

2

promulgated rules and bylaws. The relief sought may include both injunctive relief and damages.

3

In the event judicial enforcement is necessary, the prevailing member shall be awarded all costs of

4

such litigation, including reasonable attorney’s fees.

5

(3) The remedies herein shall not be the exclusive remedies of the commission. The

6

commission may pursue any other remedies available under federal or state law.

7

5-44.1-14. Date of implementation of the psychology interjurisdictional compact

8

commission and associated rules, withdrawal, and amendments.

9

(a) The compact shall come into effect on the date on which the compact is enacted into

10

law in the seventh compact state. The provisions which become effective at that time shall be

11

limited to the powers granted to the commission relating to assembly and the promulgation of rules.

12

Thereafter, the commission shall meet and exercise rulemaking powers necessary to the

13

implementation and administration of the compact.

14

(b) Any state which joins the compact subsequent to the commission’s initial adoption of

15

the rules shall be subject to the rules as they exist on the date on which the compact becomes law

16

in that state. Any rule which has been previously adopted by the commission shall have the full

17

force and effect of law on the day the compact becomes law in that state.

18

(c) Any compact state may withdraw from this compact by enacting a statute repealing the

19

same.

20

(1) A compact state’s withdrawal shall not take effect until six (6) months after enactment

21

of the repealing statute.

22

(2) Withdrawal shall not affect the continuing requirement of the withdrawing state’s

23

psychology regulatory authority to comply with the investigative and adverse action reporting

24

requirements of this act prior to the effective date of withdrawal.

25

(d) Nothing contained in this compact shall be construed to invalidate or prevent any

26

psychology licensure agreement or other cooperative arrangement between a compact state and a

27

non-compact state which does not conflict with the provisions of this compact.

28

(e) This compact may be amended by the compact states. No amendment to this compact

29

shall become effective and binding upon any compact State until it is enacted into the law of all

30

compact states.

31

5-44.1-15. – Construction and severability.

32

This compact shall be liberally construed so as to effectuate the purposes thereof. If this

33

compact shall be held contrary to the constitution of any state member thereto, the compact shall

34

remain in full force and effect as to the remaining compact States.

 

Art20

(Page 58 of 111)

1

SECTION 6. Title 5 of the General Laws entitled “Business and Professions” is hereby

2

amended by adding thereto the following chapter:

3

CHAPTER 40.2

4

RHODE ISLAND PHYSICAL THERAPIST LICENSURE COMPACT

5

5-40.2-1. Short title – The Rhode Island Physical Therapist Licensure Compact Act.

6

This chapter shall be known and may be cited as the Rhode Island physical therapist

7

licensure compact act.

8

5-40.2.-2. Purpose.

9

(a) The purpose of the physical therapist licensure compact is to facilitate interstate practice

10

of physical therapy with the goal of improving public access to physical therapy services. The

11

practice of physical therapy occurs in the state where the patient/client is located at the time of the

12

patient/client encounter. The compact preserves the regulatory authority of the state to protect

13

public health and safety through the current system of state licensure. The compact is designed to

14

achieve the following objectives:

15

(1) Increase public access to physical therapy services by providing for the mutual

16

recognition of other member state licenses;

17

(2) Enhance the states’ ability to protect the public’s health and safety;

18

(3) Encourage the cooperation of member states in regulating multi-state physical therapy

19

practice;

20

(4) Support spouses of relocating military members;

21

(5) Enhance the exchange of licensure, investigative, and disciplinary information between

22

member states; and

23

(6) Allow a remote state to hold a provider of services with a compact privilege in that state

24

accountable to that state’s practice standards.

25

5-40.2-3. Definitions.

26

As used in this compact, and except as otherwise provided, the following definitions shall

27

apply:

28

(a) “Active duty military” means full-time duty status in the active uniformed service of

29

the United States, including members of the national guard and reserve on active duty orders

30

pursuant to 10 U.S.C. Section 1209 and 1211.

31

(b) “Adverse action” means disciplinary action taken by a physical therapy licensing board

32

based upon misconduct, unacceptable performance, or a combination of both.

 

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1

(c) “Alternative program” means a non-disciplinary monitoring or practice remediation

2

process approved by a physical therapy licensing board. This includes, but is not limited to,

3

substance abuse issues.

4

(d) “Compact privilege” means the authorization granted by a remote state to allow a

5

licensee from another member state to practice as a physical therapist or work as a physical therapist

6

assistant in the remote state under its laws and rules. The practice of physical therapy occurs in the

7

member state where the patient/client is located at the time of the patient/client encounter.

8

(e) “Continuing competence” means a requirement, as a condition of license renewal, to

9

provide evidence of participation in, and/or completion of, educational and professional activities

10

relevant to practice or area of work.

11

(f) “Data system” means a repository of information about licensees, including

12

examination, licensure, investigative, compact privilege, and adverse action.

13

(g) “Encumbered license” means a license that a physical therapy licensing board has

14

limited in any way.

15

(h) “Executive board” means a group of directors elected or appointed to act on behalf of,

16

and within the powers granted to them by, the commission.

17

(i) “Home state” means the member state that is the licensee’s primary state of residence.

18

(j) “Investigative information” means information, records, and documents received or

19

generated by a physical therapy licensing board pursuant to an investigation.

20

(k) “Jurisprudence requirement” means the assessment of an individual’s knowledge of the

21

laws and rules governing the practice of physical therapy in a state.

22

(l)Licensee” means an individual who currently holds an authorization from the state to

23

practice as a physical therapist or to work as a physical therapist assistant.

24

(m) “Member state” means a state that has enacted the compact.

25

(n) “Party state” means any member state in which a licensee holds a current license or

26

compact privilege or is applying for a license or compact privilege.

27

(o) “Physical therapist” means an individual who is licensed by a state to practice physical

28

therapy.

29

(p) “Physical therapist assistant means an individual who is licensed/certified by a state

30

and who assists the physical therapist in selected components of physical therapy.

31

(q) “Physical therapy,” “physical therapy practice,” and “the practice of physical therapy”

32

mean the care and services provided by or under the direction and supervision of a licensed physical

33

therapist.

34

(r) “Physical therapy compact” means the formal compact authorized in chapter 5-40.2.

 

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1

(s) “Physical therapy compact commission” or “commission” means the national

2

administrative body whose membership consists of all states that have enacted the compact.

3

(t) “Physical therapy licensing board” or “licensing board” means the agency of a state that

4

is responsible for the licensing and regulation of physical therapists and physical therapist

5

assistants.

6

(u) “Remote state” means a member state other than the home state, where a licensee is

7

exercising or seeking to exercise the compact privilege.

8

(v) “Rule” means a regulation, principle, or directive promulgated by the commission that

9

has the force of law.

10

(w) “State” means any state, commonwealth, district, or territory of the United States of

11

America that regulates the practice of physical therapy.

12

5-40.2-4. State participation in the compact.

13

(a) To participate in the compact, a state must:

14

(1) Participate fully in the commission’s data system, including using the commission’s

15

unique identifier as defined in rules;

16

(2) Have a mechanism in place for receiving and investigating complaints about licensees;

17

(3) Notify the commission, in compliance with the terms of the compact and rules, of any

18

adverse action or the availability of investigative information regarding a licensee;

19

(4) Fully implement a criminal background check requirement, within a time frame

20

established by rule, by receiving the results of the Federal Bureau of Investigation record search on

21

criminal background checks and use the results in making licensure decisions in accordance with

22

section 5-40.2-4 (b);

23

(5) Comply with the rules of the commission;

24

(6) Utilize a recognized national examination as a requirement for licensure pursuant to the

25

rules of the commission; and

26

(7) Have continuing competence requirements as a condition for license renewal.

27

(b) Upon adoption of this statute, the member state shall have the authority to obtain

28

biometric-based information from each physical therapy licensure applicant and submit this

29

information to the Federal Bureau of Investigation for a criminal background check in accordance

30

with 28 U.S.C. §534 and 42 U.S.C. §14616.

31

(c) A member state shall grant the compact privilege to a licensee holding a valid

32

unencumbered license in another member state in accordance with the terms of the compact and

33

rules.

34

(d) Member states may charge a fee for granting a compact privilege.

 

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1

5-40.2-5. Compact privilege.

2

(a) To exercise the compact privilege under the terms and provisions of the compact, the

3

licensee shall:

4

(1) Hold a license in the home state;

5

(2) Have no encumbrance on any state license;

6

(3) Be eligible for a compact privilege in any member state in accordance with section 5-

7

40.2-5 (d), (g), and (h);

8

(4) Have not had any adverse action against any license or compact privilege within the

9

previous two years;

10

(5) Notify the commission that the licensee is seeking the compact privilege within a

11

remote state(s);

12

(6) Pay any applicable fees, including any state fee, for the compact privilege;

13

(7) Meet any jurisprudence requirements established by the remote state(s) in which the

14

licensee is seeking a compact privilege; and

15

(8) Report to the commission adverse action taken by any non-member state within 30 days

16

from the date the adverse action is taken.

17

(b) The compact privilege is valid until the expiration date of the home license. The licensee

18

must comply with the requirements of section 5-40.2-5 (a) to maintain the compact privilege in the

19

remote state.

20

(c) A licensee providing physical therapy in a remote state under the compact privilege

21

shall function within the laws and regulations of the remote state.

22

(d) A licensee providing physical therapy in a remote state is subject to that state’s

23

regulatory authority. A remote state may, in accordance with due process and that state’s laws,

24

remove a licensee’s compact privilege in the remote state for a specific period of time, impose

25

fines, and/or take any other necessary actions to protect the health and safety of its citizens. The

26

licensee is not eligible for a compact privilege in any state until the specific time for removal has

27

passed and all fines are paid.

28

(e) If a home state license is encumbered, the licensee shall lose the compact privilege in

29

any remote state until the following occur:

30

(1) The home state license is no longer encumbered; and

31

(2) Two years have elapsed from the date of the adverse action.

32

(f) Once an encumbered license in the home state is restored to good standing, the licensee

33

must meet the requirements of section 5-40.2-5 (a) to obtain a compact privilege in any remote

34

state.

 

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1

(g) If a licensee’s compact privilege in any remote state is removed, the individual shall

2

lose the compact privilege in any remote state until the following occur:

3

(1) The specific period of time for which the compact privilege was removed has ended;

4

(2) All fines have been paid; and

5

(3) Two years have elapsed from the date of the adverse action.

6

(h) Once the requirements of section 5-40.2-5 (g) have been met, the license must meet the

7

requirements in section 5-40.2-5 (a) to obtain a compact privilege in a remote state.

8

5-40.2-6. Active duty military personnel or their spouses.

9

(a) A licensee who is active duty military or is the spouse of an individual who is active

10

duty military may designate one of the following as the home state:

11

(1) Home of record;

12

(2) Permanent change of station (PCS); or

13

(3) State of current residence if it is different than the PCS state or home of record.

14

5-40.2-7. Adverse Actions.

15

(a) A home state shall have exclusive power to impose adverse action against a license

16

issued by the home state.

17

(b) A home state may take adverse action based on the investigative information of a

18

remote state, so long as the home state follows its own procedures for imposing adverse action.

19

(c) Nothing in this compact shall override a member state’s decision that participation in

20

an alternative program may be used in lieu of adverse action and that such participation shall remain

21

non-public if required by the member state’s laws. Member states must require licensees who enter

22

any alternative programs in lieu of discipline to agree not to practice in any other member state

23

during the term of the alternative program without prior authorization from such other member

24

state.

25

(d) Any member state may investigate actual or alleged violations of the statutes and rules

26

authorizing the practice of physical therapy in any other member state in which a physical therapist

27

or physical therapist assistant holds a license or compact privilege.

28

(e) A remote state shall have the authority to:

29

(1) Take adverse actions as set forth in section 5-40.2-5 (d) against a licensee’s compact

30

privilege in the state;

31

(2) Issue subpoenas for both hearings and investigations that require the attendance and

32

testimony of witnesses, and the production of evidence. Subpoenas issued by a physical therapy

33

licensing board in a party state for the attendance and testimony of witnesses, and/or the production

34

of evidence from another party state, shall be enforced in the latter state by any court of competent

 

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1

jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in

2

proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses,

3

mileage, and other fees required by the service statutes of the state where the witnesses and/or

4

evidence are located; and

5

(3) If otherwise permitted by state law, recover from the licensee the costs of investigations

6

and disposition of cases resulting from any adverse action taken against that licensee.

7

(f) Joint Investigations

8

(1) In addition to the authority granted to a member state by its respective physical therapy

9

practice act or other applicable state law, a member state may participate with other member states

10

in joint investigations of licensees.

11

(2) Member states shall share any investigative, litigation, or compliance materials in

12

furtherance of any joint or individual investigation initiated under the Compact.

13

5-40.2-8. Establishment of the physical therapy compact commission.

14

(a) The compact member states hereby create and establish a joint public agency known as

15

the physical therapy compact commission:

16

(1) The commission is an instrumentality of the compact states.

17

(2) Venue is proper and judicial proceedings by or against the commission shall be brought

18

solely and exclusively in a court of competent jurisdiction where the principal office of the

19

commission is located. The commission may waive venue and jurisdictional defenses to the extent

20

it adopts or consents to participate in alternative dispute resolution proceedings.

21

(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity.

22

(b) Membership, Voting, and Meetings

23

(1) Each member state shall have and be limited to one delegate selected by that member

24

state’s licensing board.

25

(2) The delegate shall be a current member of the licensing board, who is a physical

26

therapist, physical therapist assistant, public member, or the board administrator.

27

(3) Any delegate may be removed or suspended from office as provided by the law of the

28

state from which the delegate is appointed.

29

(4) The member state board shall fill any vacancy occurring in the commission.

30

(5) Each delegate shall be entitled to one vote with regard to the promulgation of rules and

31

creation of bylaws and shall otherwise have an opportunity to participate in the business and affairs

32

of the commission.

 

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1

(6) A delegate shall vote in person or by such other means as provided in the bylaws. The

2

bylaws may provide for delegates’ participation in meetings by telephone or other means of

3

communication.

4

(7) The commission shall meet at least once during each calendar year.

5

(8) Additional meetings shall be held as set forth in the bylaws.

6

(c) The commission shall have the following powers and duties:

7

(1) Establish the fiscal year of the commission;

8

(2) Establish bylaws;

9

(3) Maintain its financial records in accordance with the bylaws;

10

(4) Meet and take such actions as are consistent with the provisions of this compact and

11

the bylaws;

12

(5) Promulgate uniform rules to facilitate and coordinate implementation and

13

administration of this compact. The rules shall have the force and effect of law and shall be binding

14

in all member states;

15

(6) Bring and prosecute legal proceedings or actions in the name of the commission,

16

provided that the standing of any state physical therapy licensing board to sue or be sued under

17

applicable law shall not be affected;

18

(7) Purchase and maintain insurance and bonds;

19

(8) Borrow, accept, or contract for services of personnel, including, but not limited to,

20

employees of a member state;

21

(9) Hire employees, elect or appoint officers, fix compensation, define duties, grant such

22

individuals appropriate authority to carry out the purposes of the compact, and to establish the

23

commission’s personnel policies and programs relating to conflicts of interest, qualifications of

24

personnel, and other related personnel matters;

25

(10) Accept any and all appropriate donations and grants of money, equipment, supplies,

26

materials and services, and to receive, utilize and dispose of the same; provided that at all times the

27

commission shall avoid any appearance of impropriety and/or conflict of interest;

28

(11) Lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold,

29

improve or use, any property, real, personal or mixed; provided that at all times the commission

30

shall avoid any appearance of impropriety;

31

(12) Sell convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any

32

property real, personal, or mixed;

33

(13) Establish a budget and make expenditures;

34

(14) Borrow money;

 

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1

(15) Appoint committees, including standing committees composed of members, state

2

regulators, state legislators or their representatives, and consumer representatives, and such other

3

interested persons as may be designated in this compact and the bylaws;

4

(16) Provide and receive information from, and cooperate with, law enforcement agencies;

5

(17) Establish and elect an executive board; and

6

(18) Perform such other functions as may be necessary or appropriate to achieve the

7

purposes of this compact consistent with the state regulation of physical therapy licensure and

8

practice.

9

(d) The executive board shall have the power to act on behalf of the commission according

10

to the terms of this compact. The executive board shall be composed of nine members:

11

(1) Seven voting members who are elected by the commission from the current

12

membership of the commission;

13

(2) One ex-officio, nonvoting member from the recognized national physical therapy

14

professional association; and

15

(3) One ex-officio, nonvoting member from the recognized membership organization of

16

the physical therapy licensing boards.

17

(4) The ex-officio members will be selected by their respective organizations.

18

(5) The commission may remove any member of the executive board as provided in

19

bylaws.

20

(e) The executive board shall meet at least annually.

21

(f) The executive board shall have the following duties and responsibilities:

22

(1) Recommend to the entire commission changes to the rules or bylaws, changes to this

23

compact legislation, fees paid by compact member states such as annual dues, and any commission

24

compact fee charged to licensees for the compact privilege;

25

(2) Ensure compact administration services are appropriately provided, contractual or

26

otherwise;

27

(3) Prepare and recommend the budget;

28

(4) Maintain financial records on behalf of the commission;

29

(5) Monitor compact compliance of member states and provide compliance reports to the

30

commission;

31

(6) Establish additional committees as necessary; and

32

(7) Other duties as provided in rules or bylaws.

33

(g) All meetings of the commission shall be open to the public, and public notice of

34

meetings shall be given in the same manner as required under the rulemaking provisions in 5-40.2-

 

Art20

(Page 66 of 111)

1

(1) The commission or the executive board or other committees of the commission may

2

convene in a closed, non-public meeting if the commission or executive board or other committees

3

of the commission must discuss:

4

(2) Non-compliance of a member state with its obligations under the compact;

5

(3) The employment, compensation, discipline or other matters, practices or procedures

6

related to specific employees or other matters related to the commission’s internal personnel

7

practices and procedures;

8

(4) Current, threatened, or reasonably anticipated litigation;

9

(5) Negotiation of contracts for the purchase, lease, or sale of goods, services, or real estate;

10

(6) Accusing any person of a crime or formally censuring any person;

11

(7) Disclosure of trade secrets or commercial or financial information that is privileged or

12

confidential;

13

(8) Disclosure of information of a personal nature where disclosure would constitute a

14

clearly unwarranted invasion of personal privacy;

15

(9) Disclosure of investigative records compiled for law enforcement purposes;

16

(10) Disclosure of information related to any investigative reports prepared by or on behalf

17

of or for use of the commission or other committee charged with responsibility of investigation or

18

determination of compliance issues pursuant to the compact; or

19

(11) Matters specifically exempted from disclosure by federal or member state statute.

20

(h) If a meeting, or portion of a meeting, is closed pursuant to this provision, the

21

commission’s legal counsel or designee shall certify that the meeting may be closed and shall

22

reference each relevant exempting provision.

23

(i) The commission shall keep minutes that fully and clearly describe all matters discussed

24

in a meeting and shall provide a full and accurate summary of actions taken, and the reasons

25

therefore, including a description of the views expressed. All documents considered in connection

26

with an action shall be identified in such minutes. All minutes and documents of a closed meeting

27

shall remain under seal, subject to release by a majority vote of the commission or order of a court

28

of competent jurisdiction.

29

(j) The commission shall pay, or provide for the payment of, the reasonable expenses of its

30

establishment, organization, and ongoing activities.

31

(1) The commission may accept any and all appropriate revenue sources, donations, and

32

grants of money, equipment, supplies, materials, and services.

33

(2) The commission may levy on and collect an annual assessment from each member state

34

or impose fees on other parties to cover the cost of the operations and activities of the commission

 

Art20

(Page 67 of 111)

1

and its staff, which must be in a total amount sufficient to cover its annual budget as approved each

2

year for which revenue is not provided by other sources. The aggregate annual assessment amount

3

shall be allocated based upon a formula to be determined by the commission, which shall

4

promulgate a rule binding upon all member states.

5

(3) The commission shall not incur obligations of any kind prior to securing the funds

6

adequate to meet the same; nor shall the commission pledge the credit of any of the member states,

7

except by and with the authority of the member state.

8

(4) The commission shall keep accurate accounts of all receipts and disbursements. The

9

receipts and disbursements of the commission shall be subject to the audit and accounting

10

procedures established under its bylaws. However, all receipts and disbursements of funds handled

11

by the commission shall be audited yearly by a certified or licensed public accountant, and the

12

report of the audit shall be included in and become part of the annual report of the commission.

13

(k) The members, officers, executive director, employees and representatives of the

14

commission shall be immune from suit and liability, either personally or in their official capacity,

15

for any claim for damage to or loss of property or personal injury or other civil liability caused by

16

or arising out of any actual or alleged act, error or omission that occurred, or that the person against

17

whom the claim is made had a reasonable basis for believing occurred within the scope of

18

commission employment, duties or responsibilities; provided that nothing in this paragraph shall

19

be construed to protect any such person from suit and/or liability for any damage, loss, injury, or

20

liability caused by the intentional or willful or wanton misconduct of that person.

21

(1) The commission shall defend any member, officer, executive director, employee or

22

representative of the commission in any civil action seeking to impose liability arising out of any

23

actual or alleged act, error, or omission that occurred within the scope of commission employment,

24

duties, or responsibilities, or that the person against whom the claim is made had a reasonable basis

25

for believing occurred within the scope of commission employment, duties, or responsibilities;

26

provided that nothing herein shall be construed to prohibit that person from retaining his or her own

27

counsel; and provided further, that the actual or alleged act, error, or omission did not result from

28

that person’s intentional or willful or wanton misconduct.

29

(2) The commission shall indemnify and hold harmless any member, officer, executive

30

director, employee, or representative of the commission for the amount of any settlement or

31

judgment obtained against that person arising out of any actual or alleged act, error or omission

32

that occurred within the scope of commission employment, duties, or responsibilities, or that such

33

person had a reasonable basis for believing occurred within the scope of commission employment,

 

Art20

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1

duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result

2

from the intentional or willful or wanton misconduct of that person.

3

5-40-.2-9. Data System.

4

(a) The commission shall provide for the development, maintenance, and utilization of a

5

coordinated database and reporting system containing licensure, adverse action, and investigative

6

information on all licensed individuals in member states.

7

(b) Notwithstanding any other provision of state law to the contrary, a member state shall

8

submit a uniform data set to the data system on all individuals to whom this compact is applicable

9

as required by the rules of the commission, including:

10

(1) Identifying information;

11

(2) Licensure data;

12

(3) Adverse actions against a license or compact privilege;

13

(4) Non-confidential information related to alternative program participation;

14

(5) Any denial of application for licensure, and the reason(s) for such denial; and

15

(6) Other information that may facilitate the administration of this compact, as determined

16

by the rules of the commission.

17

(c) Investigative information pertaining to a licensee in any member state will only be

18

available to other party states.

19

(d) The commission shall promptly notify all member states of any adverse action taken

20

against a licensee or an individual applying for a license. Adverse action information pertaining to

21

a licensee in any member state will be available to any other member state.

22

(e) Member states contributing information to the data system may designate information

23

that may not be shared with the public without the express permission of the contributing state.

24

(f) Any information submitted to the data system that is subsequently required to be

25

expunged by the laws of the member state contributing the information shall be removed from the

26

data system.

27

5-40-.2-10. Rulemaking.

28

(a) The commission shall exercise its rulemaking powers pursuant to the criteria set forth

29

in this Section and the rules adopted thereunder. Rules and amendments shall become binding as

30

of the date specified in each rule or amendment.

31

(b) If a majority of the legislatures of the member states rejects a rule, by enactment of a

32

statute or resolution in the same manner used to adopt the compact within four years of the date of

33

adoption of the rule, then such rule shall have no further force and effect in any member state.

 

Art20

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1

(c) Rules or amendments to the rules shall be adopted at a regular or special meeting of the

2

commission.

3

(d) Prior to promulgation and adoption of a final rule or rules by the commission, and at

4

least thirty days in advance of the meeting at which the rule will be considered and voted upon, the

5

commission shall file a notice of proposed Rulemaking:

6

(1) On the website of the commission or other publicly accessible platform; and

7

(2) On the website of each member state physical therapy licensing board or other publicly

8

accessible platform or the publication in which each state would otherwise publish proposed rules.

9

(e) The notice of proposed rulemaking shall include:

10

(1) The proposed time, date, and location of the meeting in which the rule will be

11

considered and voted upon;

12

(2) The text of the proposed rule or amendment and the reason for the proposed rule;

13

(3) A request for comments on the proposed rule from any interested person; and

14

(4) The manner in which interested persons may submit notice to the commission of their

15

intention to attend the public hearing and any written comments.

16

(f) Prior to adoption of a proposed rule, the commission shall allow persons to submit

17

written data, facts, opinions, and arguments, which shall be made available to the public.

18

(g) The commission shall grant an opportunity for a public hearing before it adopts a rule

19

or amendment if a hearing is requested by:

20

(1) At least twenty-five persons;

21

(2) A state or federal governmental subdivision or agency; or

22

(3) An association having at least twenty-five members.

23

(h) If a hearing is held on the proposed rule or amendment, the commission shall publish

24

the place, time, and date of the scheduled public hearing. If the hearing is held via electronic means,

25

the commission shall publish the mechanism for access to the electronic hearing.

26

(1) All persons wishing to be heard at the hearing shall notify the executive director of the

27

commission or other designated member in writing of their desire to appear and testify at the

28

hearing not less than five business days before the scheduled date of the hearing.

29

(2) Hearings shall be conducted in a manner providing each person who wishes to comment

30

a fair and reasonable opportunity to comment orally or in writing.

31

(3) All hearings will be recorded. A copy of the recording will be made available on

32

request.

33

(4) Nothing in this section shall be construed as requiring a separate hearing on each rule.

34

Rules may be grouped for the convenience of the commission at hearings required by this section.

 

Art20

(Page 70 of 111)

1

(i) Following the scheduled hearing date, or by the close of business on the scheduled

2

hearing date if the hearing was not held, the commission shall consider all written and oral

3

comments received.

4

(j) If no written notice of intent to attend the public hearing by interested parties is received,

5

the commission may proceed with promulgation of the proposed rule without a public hearing.

6

(k) The commission shall, by majority vote of all members, take final action on the

7

proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking

8

record and the full text of the rule.

9

(l) Upon determination that an emergency exists, the commission may consider and adopt

10

an emergency rule without prior notice, opportunity for comment, or hearing, provided that the

11

usual rulemaking procedures provided in the compact and in this section shall be retroactively

12

applied to the rule as soon as reasonably possible, in no event later than ninety days after the

13

effective date of the rule. For the purposes of this provision, an emergency rule is one that must be

14

adopted immediately in order to:

15

(1) Meet an imminent threat to public health, safety, or welfare;

16

(2) Prevent a loss of commission or member state funds;

17

(3) Meet a deadline for the promulgation of an administrative rule that is established by

18

federal law or rule; or

19

(4) Protect public health and safety.

20

(m) The commission or an authorized committee of the commission may direct revisions

21

to a previously adopted rule or amendment for purposes of correcting typographical errors, errors

22

in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be

23

posted on the website of the commission. The revision shall be subject to challenge by any person

24

for a period of thirty days after posting. The revision may be challenged only on grounds that the

25

revision results in a material change to a rule. A challenge shall be made in writing and delivered

26

to the chair of the commission prior to the end of the notice period. If no challenge is made, the

27

revision will take effect without further action. If the revision is challenged, the revision may not

28

take effect without the approval of the Commission.

29

5-40-.2-11. Oversight, dispute resolution, and enforcement.

30

(a) The executive, legislative, and judicial branches of state government in each member

31

state shall enforce this compact and take all actions necessary and appropriate to effectuate the

32

compact’s purposes and intent. The provisions of this compact and the rules promulgated hereunder

33

shall have standing as statutory law.

 

Art20

(Page 71 of 111)

1

(b) All courts shall take judicial notice of the compact and the rules in any judicial or

2

administrative proceeding in a member state pertaining to the subject matter of this compact which

3

may affect the powers, responsibilities or actions of the commission.

4

(c) The commission shall be entitled to receive service of process in any such proceeding

5

and shall have standing to intervene in such a proceeding for all purposes. Failure to provide service

6

of process to the commission shall render a judgment or order void as to the commission, this

7

compact, or promulgated rules.

8

(d) If the commission determines that a member state has defaulted in the performance of

9

its obligations or responsibilities under this compact or the promulgated rules, the commission

10

shall:

11

(1) Provide written notice to the defaulting state and other member states of the nature of

12

the default, the proposed means of curing the default and/or any other action to be taken by the

13

commission; and

14

(2) Provide remedial training and specific technical assistance regarding the default.

15

(e) If a state in default fails to cure the default, the defaulting state may be terminated from

16

the compact upon an affirmative vote of a majority of the member states, and all rights, privileges

17

and benefits conferred by this compact may be terminated on the effective date of termination. A

18

cure of the default does not relieve the offending state of obligations or liabilities incurred during

19

the period of default.

20

(f) Termination of membership in the compact shall be imposed only after all other means

21

of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given

22

by the commission to the governor, the majority and minority leaders of the defaulting state’s

23

legislature, and each of the member states.

24

(g) A state that has been terminated is responsible for all assessments, obligations, and

25

liabilities incurred through the effective date of termination, including obligations that extend

26

beyond the effective date of termination.

27

(h) The commission shall not bear any costs related to a state that is found to be in default

28

or that has been terminated from the compact, unless agreed upon in writing between the

29

commission and the defaulting state.

30

(i) The defaulting state may appeal the action of the commission by petitioning the U.S.

31

district court for the District of Columbia or the federal district where the commission has its

32

principal offices. The prevailing member shall be awarded all costs of such litigation, including

33

reasonable attorney’s fees.

 

Art20

(Page 72 of 111)

1

(j) Upon request by a member state, the commission shall attempt to resolve disputes

2

related to the compact that arise among member states and between member and non-member

3

states.

4

(k) The commission shall promulgate a rule providing for both mediation and binding

5

dispute resolution for disputes as appropriate.

6

(l) The commission, in the reasonable exercise of its discretion, shall enforce the provisions

7

and rules of this compact.

8

(m) By majority vote, the commission may initiate legal action in the United States district

9

court for the District of Columbia or the federal district where the commission has its principal

10

offices against a member state in default to enforce compliance with the provisions of the compact

11

and its promulgated rules and bylaws. The relief sought may include both injunctive relief and

12

damages. In the event judicial enforcement is necessary, the prevailing member shall be awarded

13

all costs of such litigation, including reasonable attorney’s fees.

14

(n) The remedies herein shall not be the exclusive remedies of the commission. The

15

commission may pursue any other remedies available under federal or state law.

16

5-40-.2-12. Date of implementation of the interstate commission for physical therapy

17

practice and associated rules, withdrawal, and amendment

18

(a) The compact shall come into effect on the date on which the compact statute is enacted

19

into law in the tenth member state. The provisions, which become effective at that time, shall be

20

limited to the powers granted to the commission relating to assembly and the promulgation of rules.

21

Thereafter, the commission shall meet and exercise rulemaking powers necessary to the

22

implementation and administration of the compact.

23

(b) Any state that joins the compact subsequent to the commission’s initial adoption of the

24

rules shall be subject to the rules as they exist on the date on which the compact becomes law in

25

that state. Any rule that has been previously adopted by the commission shall have the full force

26

and effect of law on the day the compact becomes law in that state.

27

(c) Any member state may withdraw from this compact by enacting a statute repealing the

28

same.

29

(1) A member state’s withdrawal shall not take effect until six months after enactment of

30

the repealing statute.

31

(2) Withdrawal shall not affect the continuing requirement of the withdrawing state’s

32

physical therapy licensing board to comply with the investigative and adverse action reporting

33

requirements of this act prior to the effective date of withdrawal.

 

Art20

(Page 73 of 111)

1

(d) Nothing contained in this compact shall be construed to invalidate or prevent any

2

physical therapy licensure agreement or other cooperative arrangement between a member state

3

and a non-member state that does not conflict with the provisions of this compact.

4

(e) This compact may be amended by the member states. No amendment to this compact

5

shall become effective and binding upon any member state until it is enacted into the laws of all

6

member states.

7

5-40.2-13. Construction and severability

8

This compact shall be liberally construed so as to effectuate the purposes thereof. The

9

provisions of this compact shall be severable and if any phrase, clause, sentence or provision of

10

this compact is declared to be contrary to the constitution of any party state or of the United States

11

or the applicability thereof to any government, agency, person or circumstance is held invalid, the

12

validity of the remainder of this compact and the applicability thereof to any government, agency,

13

person or circumstance shall not be affected thereby. If this compact shall be held contrary to the

14

constitution of any party state, the compact shall remain in full force and effect as to the remaining

15

party states and in full force and effect as to the party state affected as to all severable matters.

16

SECTION 7. Title 23 of the General Laws entitled “Health and Safety” is hereby amended

17

by adding thereto the following chapter:

18

CHAPTER 23-4.2

19

EMERGENCY MEDICAL SERVICES PERSONNEL LICENSURE INTERSTATE

20

COMPACT.

21

23-4.2-1. Short title. – This chapter shall be known and may be cited as the Emergency

22

medical Services Personnel Licensure Interstate Compact.

23

23-4.2-2. Purpose. - In order to protect the public through verification of competency and

24

ensure accountability for patient care related activities all states license emergency medical services

25

(EMS) personnel, such as emergency medical technicians (EMTs), advanced EMTs and

26

paramedics. This Compact is intended to facilitate the day to day movement of EMS personnel

27

across state boundaries in the performance of their EMS duties as assigned by an appropriate

28

authority and authorize state EMS offices to afford immediate legal recognition to EMS personnel

29

licensed in a member state. This Compact recognizes that states have a vested interest in protecting

30

the public’s health and safety through their licensing and regulation of EMS personnel and that

31

such state regulation shared among the member states will best protect public health and safety.

32

This Compact is designed to achieve the following purposes and objectives:

33

(1) Increase public access to EMS personnel;

 

Art20

(Page 74 of 111)

1

(2) Enhance the states’ ability to protect the public’s health and safety, especially patient

2

safety;

3

(3) Encourage the cooperation of member states in the areas of EMS personnel licensure

4

and regulation;

5

(4) Support licensing of military members who are separating from an active duty tour and

6

their spouses;

7

(5) Facilitate the exchange of information between member states regarding EMS

8

personnel licensure, adverse action and significant investigatory information

9

(6) Promote compliance with the laws governing EMS personnel practice in each member

10

state; and

11

(7) Invest all member states with the authority to hold EMS personnel accountable through

12

the mutual recognition of member state licenses.

13

23-4.2-3. Definitions.

14

(a)Advanced emergency medical technician (AEMT)” means: an individual licensed

15

with cognitive knowledge and a scope of practice that corresponds to that level in the national EMS

16

education standards and national EMS scope of practice model.

17

(b) “Adverse action” means: any administrative, civil, equitable or criminal action

18

permitted by a state’s laws which may be imposed against licensed EMS personnel by a state EMS

19

authority or state court, including, but not limited to, actions against an individual’s license such as

20

revocation, suspension, probation, consent agreement, monitoring or other limitation or

21

encumbrance on the individual’s practice, letters of reprimand or admonition, fines, criminal

22

convictions and state court judgments enforcing adverse actions by the state EMS authority.

23

(c) “Alternative program” means: a voluntary, non-disciplinary substance abuse recovery

24

program approved by a state EMS authority.

25

(d) “Certification” means the successful verification of entry-level cognitive and

26

psychomotor competency using a reliable, validated, and legally defensible examination.

27

(e) “Commission” means the national administrative body of which all states that have

28

enacted the compact are members.

29

(f) “Emergency medical technician (EMT)” means: an individual licensed with cognitive

30

knowledge and a scope of practice that corresponds to that level in the national EMS education

31

standards and national EMS scope of practice model.

32

(g) “Home state” means a member state where an individual is licensed to practice

33

emergency medical services.

 

Art20

(Page 75 of 111)

1

(h) “License” means the authorization by a state for an individual to practice as an EMT,

2

AEMT, paramedic, or a level in between EMT and paramedic.

3

(i) “Medical director” means: a physician licensed in a member state who is accountable

4

for the care delivered by EMS personnel.

5

(j) “Member state” means a state that has enacted this compact.

6

(k) “Privilege to practice” means: an individual’s authority to deliver emergency medical

7

services in remote states as authorized under this compact.

8

(l) “Paramedic” means an individual licensed with cognitive knowledge and a scope of

9

practice that corresponds to that level in the national EMS education standards and national EMS

10

scope of practice model.

11

(m) “Remote state” means a member state in which an individual is not licensed.

12

(n) “Restricted” means the outcome of an adverse action that limits a license or the

13

privilege to practice.

14

(o) “Rule” means a written statement by the interstate commission promulgated pursuant

15

to section 23-4.2-13 of this compact that is of general applicability; implements, interprets, or

16

prescribes a policy or provision of the compact; or is an organizational, procedural, or practice

17

requirement of the commission and has the force and effect of statutory law in a member state and

18

includes the amendment, repeal, or suspension of an existing rule.

19

(p) “Scope of practice” means defined parameters of various duties or services that may be

20

provided by an individual with specific credentials. Whether regulated by rule, statute, or court

21

decision, it tends to represent the limits of services an individual may perform.

22

(q) “Significant investigatory information” means:

23

(1) investigative information that a state EMS authority, after a preliminary inquiry that

24

includes notification and an opportunity to respond if required by state law, has reason to believe,

25

if proved true, would result in the imposition of an adverse action on a license or privilege to

26

practice; or

27

(2) investigative information that indicates that the individual represents an immediate

28

threat to public health and safety regardless of whether the individual has been notified and had an

29

opportunity to respond.

30

(r) “State” means means any state, commonwealth, district, or territory of the United

31

States.

32

(s) “State EMS authority” means: the board, office, or other agency with the legislative

33

mandate to license EMS personnel.

34

23-4.2-4– Home state licensure.

 

Art20

(Page 76 of 111)

1

(a) Any member state in which an individual holds a current license shall be deemed a

2

home state for purposes of this compact.

3

(b) Any member state may require an individual to obtain and retain a license to be

4

authorized to practice in the member state under circumstances not authorized by the privilege to

5

practice under the terms of this compact.

6

(c) A home state’s license authorizes an individual to practice in a remote state under the

7

privilege to practice only if the home state:

8

(1) Currently requires the use of the national registry of emergency medical technicians

9

(NREMT) examination as a condition of issuing initial licenses at the EMT and paramedic levels;

10

(2) Has a mechanism in place for receiving and investigating complaints about individuals;

11

(3) Notifies the commission, in compliance with the terms herein, of any adverse action or

12

significant investigatory information regarding an individual;

13

(4) No later than five years after activation of the compact, requires a criminal background

14

check of all applicants for initial licensure, including the use of the results of fingerprint or other

15

biometric data checks compliant with the requirements of the Federal Bureau of Investigation with

16

the exception of federal employees who have suitability determination in accordance with US CFR

17

§731.202 and submit documentation of such as promulgated in the rules of the commission; and

18

(5) Complies with the rules of the commission.

19

23-4.2-5– Compact privilege to practice.

20

(a) Member states shall recognize the privilege to practice of an individual licensed in

21

another member state that is in conformance with section 23-4.2-4.

22

(b) To exercise the privilege to practice under the terms and provisions of this compact, an

23

individual must:

24

(1) Be at least 18 years of age;

25

(2) Possess a current unrestricted license in a member state as an EMT, AEMT, paramedic,

26

or state recognized and licensed level with a scope of practice and authority between EMT and

27

paramedic; and

28

(3) Practice under the supervision of a medical director.

29

(c) An individual providing patient care in a remote state under the privilege to practice

30

shall function within the scope of practice authorized by the home state unless and until modified

31

by an appropriate authority in the remote state as may be defined in the rules of the commission.

32

(d) Except as provided in this subsection, an individual practicing in a remote state will be

33

subject to the remote state’s authority and laws. A remote state may, in accordance with due process

34

and that state’s laws, restrict, suspend, or revoke an individual’s privilege to practice in the remote

 

Art20

(Page 77 of 111)

1

state and may take any other necessary actions to protect the health and safety of its citizens. If a

2

remote state takes action it shall promptly notify the home state and the Commission.

3

(e) If an individual’s license in any home state is restricted or suspended, the individual

4

shall not be eligible to practice in a remote state under the privilege to practice until the individual’s

5

home state license is restored.

6

(f) If an individual’s privilege to practice in any remote state is restricted, suspended, or

7

revoked the individual shall not be eligible to practice in any remote state until the individual’s

8

privilege to practice is restored.

9

23-4.2-6– Conditions of practice in a remote site.

10

An individual may practice in a remote state under a privilege to practice only in the

11

performance of the individual’s EMS duties as assigned by an appropriate authority, as defined in

12

the rules of the Commission, and under the following circumstances:

13

(1) The individual originates a patient transport in a home state and transports the patient

14

to a remote state;

15

(2) The individual originates in the home state and enters a remote state to pick up a patient

16

and provide care and transport of the patient to the home state;

17

(3) The individual enters a remote state to provide patient care and/or transport within that

18

remote state;

19

(4) The individual enters a remote state to pick up a patient and provide care and transport

20

to a third member state;

21

(5) Other conditions as determined in the rules.

22

23-4.2-7 – Relationship to emergency management assistance compact.

23

Upon a member state’s governor’s declaration of a state of emergency or disaster that

24

activates the emergency management assistance compact (EMAC), all relevant terms and

25

provisions of EMAC shall apply and to the extent any terms or provisions of this compact conflicts

26

with EMAC, the terms of EMAC shall prevail with respect to any individual practicing in the

27

remote state in response to such declaration.

28

23-4.2-8– Veterans, service members separating from active duty military, and their

29

spouses.

30

Member states shall consider a veteran, active military service member, and member of the

31

national guard and reserves separating from an active duty tour, and a spouse thereof, who holds a

32

current valid and unrestricted NREMT certification at or above the level of the state license being

33

sought as satisfying the minimum training and examination requirements for such licensure.

 

Art20

(Page 78 of 111)

1

(b) Member states shall expedite the processing of licensure applications submitted by

2

veterans, active military service members, and members of the national guard and reserves

3

separating from an active duty tour, and their spouses.

4

(c) All individuals functioning with a privilege to practice under this section remain subject

5

to the adverse actions provisions of section 23-4.2-9.

6

23-4.2-9– Adverse actions.

7

A home state shall have exclusive power to impose adverse action against an individual’s

8

license issued by the home state.

9

(b) If an individual’s license in any home state is restricted or suspended, the individual

10

shall not be eligible to practice in a remote state under the privilege to practice until the individual’s

11

home state license is restored.

12

(1) All home state adverse action orders shall include a statement that the individual’s

13

compact privileges are inactive. The order may allow the individual to practice in remote states

14

with prior written authorization from both the home state and remote state’s EMS authority.

15

(2) An individual currently subject to adverse action in the home state shall not practice in

16

any remote state without prior written authorization from both the home state and remote state’s

17

EMS authority.

18

(3) A member state shall report adverse actions and any occurrences that the individual’s

19

compact privileges are restricted, suspended, or revoked to the commission in accordance with the

20

rules.

21

(4) A remote state may take adverse action on an individual’s privilege to practice within

22

that state.

23

(5) Any member state may take adverse action against an individual’s privilege to practice

24

in that state based on the factual findings of another member state, so long as each state follows its

25

own procedures for imposing such adverse action.

26

(c) A home state’s EMS authority shall investigate and take appropriate action with respect

27

to reported conduct in a remote state as it would if such conduct had occurred within the home

28

state. In such cases, the home state’s law shall control in determining the appropriate adverse action.

29

(d) Nothing in this compact shall override a member state’s decision that participation in

30

an alternative program may be used in lieu of adverse action and that such participation shall remain

31

non-public if required by the member state’s laws. Member states must require individuals who

32

enter any alternative programs to agree not to practice in any other member state during the term

33

of the alternative program without prior authorization from such other member state.

 

Art20

(Page 79 of 111)

1

23-4.2-10- Additional powers invested in a member state’s emergency medical

2

services authority.

3

A member state’s EMS authority, in addition to any other powers granted under state law, is

4

authorized under this compact to:

5

(1) Issue subpoenas for both hearings and investigations that require the attendance and

6

testimony of witnesses and the production of evidence. Subpoenas issued by a member state’s EMS

7

authority for the attendance and testimony of witnesses, and/or the production of evidence from

8

another member state, shall be enforced in the remote state by any court of competent jurisdiction,

9

according to that court’s practice and procedure in considering subpoenas issued in its own

10

proceedings. The issuing state EMS authority shall pay any witness fees, travel expenses, mileage,

11

and other fees required by the service statutes of the state where the witnesses and/or evidence are

12

located; and

13

(2) Issue cease and desist orders to restrict, suspend, or revoke an individual’s privilege to practice

14

in the state.

15

23-4.2-11– Establishment of the interstate commission for emergency medical

16

personnel practice.

17

(a) The compact states hereby create and establish a joint public agency known as the

18

interstate commission for EMS personnel practice.

19

(1) The commission is a body politic and an instrumentality of the compact states.

20

(2) Venue is proper and judicial proceedings by or against the commission shall be brought

21

solely and exclusively in a court of competent jurisdiction where the principal office of the

22

commission is located. The commission may waive venue and jurisdictional defenses to the extent

23

it adopts or consents to participate in alternative dispute resolution proceedings.

24

(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity.

25

(b) Membership, voting, and meetings

26

(1) Each member state shall have and be limited to one delegate. The responsible official

27

of the state EMS authority or his designee shall be the delegate to this compact for each member

28

state. Any delegate may be removed or suspended from office as provided by the law of the state

29

from which the delegate is appointed. Any vacancy occurring in the commission shall be filled in

30

accordance with the laws of the member state in which the vacancy exists. In the event that more

31

than one board, office, or other agency with the legislative mandate to license EMS personnel at

32

and above the level of EMT exists, the governor of the state will determine which entity will be

33

responsible for assigning the delegate.

 

Art20

(Page 80 of 111)

1

(2) Each delegate shall be entitled to one vote with regard to the promulgation of rules and

2

creation of bylaws and shall otherwise have an opportunity to participate in the business and affairs

3

of the commission. A delegate shall vote in person or by such other means as provided in the

4

bylaws. The bylaws may provide for delegates’ participation in meetings by telephone or other

5

means of communication.

6

(3) The commission shall meet at least once during each calendar year. Additional meetings

7

shall be held as set forth in the bylaws.

8

(4) All meetings shall be open to the public, and public notice of meetings shall be given

9

in the same manner as required under Chapter 35 of Title 42.

10

(5) The commission may convene in a closed, non-public meeting if the Commission must

11

discuss:

12

(i) Non-compliance of a member state with its obligations under the compact;

13

(ii) The employment, compensation, discipline or other personnel matters, practices or

14

procedures related to specific employees or other matters related to the commission’s internal

15

personnel practices and procedures;

16

(iii) Current, threatened, or reasonably anticipated litigation;

17

(iv) Negotiation of contracts for the purchase or sale of goods, services, or real estate;

18

(v) Accusing any person of a crime or formally censuring any person;

19

(vi) Disclosure of trade secrets or commercial or financial information that is privileged or

20

confidential;

21

(vii)Disclosure of information of a personal nature where disclosure would constitute a

22

clearly unwarranted invasion of personal privacy;

23

(viii) Disclosure of investigatory records compiled for law enforcement purposes;

24

(ix) Disclosure of information related to any investigatory reports prepared by or on behalf

25

of or for use of the commission or other committee charged with responsibility of investigation or

26

determination of compliance issues pursuant to the compact; or

27

(x) Matters specifically exempted from disclosure by federal or member state statute.

28

(6) If a meeting, or portion of a meeting, is closed pursuant to this provision, the

29

commission’s legal counsel or designee shall certify that the meeting may be closed and shall

30

reference each relevant exempting provision. The commission shall keep minutes that fully and

31

clearly describe all matters discussed in a meeting and shall provide a full and accurate summary

32

of actions taken, and the reasons therefore, including a description of the views expressed. All

33

documents considered in connection with an action shall be identified in such minutes. All minutes

 

Art20

(Page 81 of 111)

1

and documents of a closed meeting shall remain under seal, subject to release by a majority vote of

2

the commission or order of a court of competent jurisdiction.

3

(c) The commission shall, by a majority vote of the delegates, prescribe bylaws and/or rules

4

to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the

5

powers of the compact, including but not limited to:

6

(1) Establishing the fiscal year of the commission;

7

(2) Providing reasonable standards and procedures:

8

(3) for the establishment and meetings of other committees; and

9

(4) governing any general or specific delegation of any authority or function of the

10

commission;

11

(5) Providing reasonable procedures for calling and conducting meetings of the

12

commission, ensuring reasonable advance notice of all meetings, and providing an opportunity for

13

attendance of such meetings by interested parties, with enumerated exceptions designed to protect

14

the public’s interest, the privacy of individuals, and proprietary information, including trade secrets.

15

The commission may meet in closed session only after a majority of the membership votes to close

16

a meeting in whole or in part. As soon as practicable, the commission must make public a copy of

17

the vote to close the meeting revealing the vote of each member with no proxy votes allowed;

18

(6) Establishing the titles, duties and authority, and reasonable procedures for the election

19

of the officers of the commission;

20

(7) Providing reasonable standards and procedures for the establishment of the personnel

21

policies and programs of the commission. Notwithstanding any civil service or other similar laws

22

of any member state, the bylaws shall exclusively govern the personnel policies and programs of

23

the commission;

24

(8) Promulgating a code of ethics to address permissible and prohibited activities of

25

commission members and employees;

26

(9) Providing a mechanism for winding up the operations of the commission and the

27

equitable disposition of any surplus funds that may exist after the termination of the compact after

28

the payment and/or reserving of all of its debts and obligations;

29

(10) The commission shall publish its bylaws and file a copy thereof, and a copy of any

30

amendment thereto, with the appropriate agency or officer in each of the member states, if any.

31

(11) The commission shall maintain its financial records in accordance with the bylaws.

32

(12) The commission shall meet and take such actions as are consistent with the provisions

33

of this compact and the bylaws.

34

(d) The commission shall have the following powers:

 

Art20

(Page 82 of 111)

1

(1) The authority to promulgate uniform rules to facilitate and coordinate implementation

2

and administration of this compact. The rules shall have the force and effect of law and shall be

3

binding in all member states;

4

(2) To bring and prosecute legal proceedings or actions in the name of the commission,

5

provided that the standing of any state EMS authority or other regulatory body responsible for EMS

6

personnel licensure to sue or be sued under applicable law shall not be affected;

7

(3) To purchase and maintain insurance and bonds;

8

(4) To borrow, accept, or contract for services of personnel, including, but not limited to,

9

employees of a member state;

10

(5) To hire employees, elect or appoint officers, fix compensation, define duties, grant such

11

individuals appropriate authority to carry out the purposes of the compact, and to establish the

12

commission’s personnel policies and programs relating to conflicts of interest, qualifications of

13

personnel, and other related personnel matters;

14

(6) To accept any and all appropriate donations and grants of money, equipment, supplies,

15

materials and services, and to receive, utilize and dispose of the same; provided that at all times the

16

commission shall strive to avoid any appearance of impropriety and/or conflict of interest;

17

(7) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold,

18

improve or use, any property, real, personal or mixed; provided that at all times the Commission

19

shall strive to avoid any appearance of impropriety;

20

(8) To sell convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of

21

any property real, personal, or mixed;

22

(9) To establish a budget and make expenditures;

23

(10) To borrow money;

24

(11) To appoint committees, including advisory committees comprised of members, state

25

regulators, state legislators or their representatives, and consumer representatives, and such other

26

interested persons as may be designated in this compact and the bylaws;

27

(12) To provide and receive information from, and to cooperate with, law enforcement

28

agencies;

29

(13) To adopt and use an official seal; and

30

(14) To perform such other functions as may be necessary or appropriate to achieve the

31

purposes of this compact consistent with the state regulation of EMS personnel licensure and

32

practice.

33

(e) Financing of the commission

 

Art20

(Page 83 of 111)

1

(1) The Commission shall pay, or provide for the payment of, the reasonable expenses of

2

its establishment, organization, and ongoing activities.

3

(2) The commission may accept any and all appropriate revenue sources, donations, and

4

grants of money, equipment, supplies, materials, and services.

5

(3) The commission may levy on and collect an annual assessment from each member state

6

or impose fees on other parties to cover the cost of the operations and activities of the commission

7

and its staff, which must be in a total amount sufficient to cover its annual budget as approved each

8

year for which revenue is not provided by other sources. The aggregate annual assessment amount

9

shall be allocated based upon a formula to be determined by the commission, which shall

10

promulgate a rule binding upon all member states.

11

(4) The commission shall not incur obligations of any kind prior to securing the funds

12

adequate to meet the same; nor shall the commission pledge the credit of any of the member states,

13

except by and with the authority of the member state.

14

(5) The commission shall keep accurate accounts of all receipts and disbursements. The

15

receipts and disbursements of the commission shall be subject to the audit and accounting

16

procedures established under its bylaws. However, all receipts and disbursements of funds handled

17

by the commission shall be audited yearly by a certified or licensed public accountant, and the

18

report of the audit shall be included in and become part of the annual report of the commission.

19

(f) Qualified immunity, defense, and indemnification

20

(1) The members, officers, executive director, employees and representatives of the

21

Commission shall be immune from suit and liability, either personally or in their official capacity,

22

for any claim for damage to or loss of property or personal injury or other civil liability caused by

23

or arising out of any actual or alleged act, error or omission that occurred, or that the person against

24

whom the claim is made had a reasonable basis for believing occurred within the scope of

25

commission employment, duties or responsibilities; provided that nothing in this paragraph shall

26

be construed to protect any such person from suit and/or liability for any damage, loss, injury, or

27

liability caused by the intentional or willful or wanton misconduct of that person.

28

(2) The commission shall defend any member, officer, executive director, employee or

29

representative of the commission in any civil action seeking to impose liability arising out of any

30

actual or alleged act, error, or omission that occurred within the scope of commission employment,

31

duties, or responsibilities, or that the person against whom the claim is made had a reasonable basis

32

for believing occurred within the scope of commission employment, duties, or responsibilities;

33

provided that nothing herein shall be construed to prohibit that person from retaining his or her own

 

Art20

(Page 84 of 111)

1

counsel; and provided further, that the actual or alleged act, error, or omission did not result from

2

that person’s intentional or willful or wanton misconduct.

3

(3) The commission shall indemnify and hold harmless any member, officer, executive

4

director, employee, or representative of the commission for the amount of any settlement or

5

judgment obtained against that person arising out of any actual or alleged act, error or omission

6

that occurred within the scope of commission employment, duties, or responsibilities, or that such

7

person had a reasonable basis for believing occurred within the scope of commission employment,

8

duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result

9

from the intentional or willful or wanton misconduct of that person.

10

23-4.2-12 Coordinated database.

11

(a) The commission shall provide for the development and maintenance of a coordinated

12

database and reporting system containing licensure, adverse action, and significant investigatory

13

information on all licensed individuals in member states.

14

(b) Notwithstanding any other provision of state law to the contrary, a member state shall

15

submit a uniform data set to the coordinated database on all individuals to whom this compact is

16

applicable as required by the rules of the commission, including:

17

(1) Identifying information;

18

(2) Licensure data;

19

(3) Significant investigatory information;

20

(4) Adverse actions against an individual’s license;

21

(5) An indicator that an individual’s privilege to practice is restricted, suspended or

22

revoked;

23

(6) Non-confidential information related to alternative program participation;

24

(7) Any denial of application for licensure, and the reason(s) for such denial; and

25

(8) Other information that may facilitate the administration of this Compact, as determined

26

by the rules of the commission.

27

(c) The coordinated database administrator shall promptly notify all member states of any

28

adverse action taken against, or significant investigative information on, any individual in a

29

member state.

30

(d) Member states contributing information to the coordinated database may designate

31

information that may not be shared with the public without the express permission of the

32

contributing state.

 

Art20

(Page 85 of 111)

1

(e) Any information submitted to the coordinated database that is subsequently required to

2

be expunged by the laws of the member state contributing the information shall be removed from

3

the coordinated database.

4

23-4.2-13– Rulemaking.

5

The commission shall exercise its rulemaking powers pursuant to the criteria set forth in

6

this Section and the rules adopted thereunder. As well as Chapter 35 of Title 42. Rules and

7

amendments shall become binding as of the date specified in each rule or amendment.

8

(b) If a majority of the legislatures of the member states rejects a rule, by enactment of a

9

statute or resolution in the same manner used to adopt the compact, then such rule shall have no

10

further force and effect in any member state.

11

(c) Rules or amendments to the rules shall be adopted at a regular or special meeting of the

12

commission.

13

(d) Prior to promulgation and adoption of a final rule or rules by the commission, and at

14

least sixty (60) days in advance of the meeting at which the rule will be considered and voted upon,

15

the commission shall file a notice of proposed rulemaking:

16

(1) On the website of the commission; and

17

(2) On the website of each member state EMS authority or the publication in which each

18

state would otherwise publish proposed rules.

19

(e) The notice of proposed rulemaking shall include:

20

(1) The proposed time, date, and location of the meeting in which the rule will be

21

considered and voted upon;

22

(2) The text of the proposed rule or amendment and the reason for the proposed rule;

23

(3) A request for comments on the proposed rule from any interested person; and

24

(4) The manner in which interested persons may submit notice to the commission of their

25

intention to attend the public hearing and any written comments.

26

(f) Prior to adoption of a proposed rule, the commission shall allow persons to submit

27

written data, facts, opinions, and arguments, which shall be made available to the public.

28

(g)The commission shall grant an opportunity for a public hearing before it adopts a rule

29

or amendment if a hearing is requested by:

30

(1) At least twenty-five (25) persons;

31

(2) A governmental subdivision or agency; or

32

(3) An association having at least twenty-five (25) members.

33

(h) a hearing is held on the proposed rule or amendment, the commission shall publish the

34

place, time, and date of the scheduled public hearing.

 

Art20

(Page 86 of 111)

1

(1) All persons wishing to be heard at the hearing shall notify the executive director of the

2

commission or other designated member in writing of their desire to appear and testify at the

3

hearing not less than five business days before the scheduled date of the hearing.

4

(2) Hearings shall be conducted in a manner providing each person who wishes to comment

5

a fair and reasonable opportunity to comment orally or in writing.

6

(3) No transcript of the hearing is required, unless a written request for a transcript is made,

7

in which case the person requesting the transcript shall bear the cost of producing the transcript. A

8

recording may be made in lieu of a transcript under the same terms and conditions as a transcript.

9

This subsection shall not preclude the commission from making a transcript or recording of the

10

hearing if it so chooses.

11

(4) Nothing in this section shall be construed as requiring a separate hearing on each rule.

12

Rules may be grouped for the convenience of the commission at hearings required by this section.

13

(i) Following the scheduled hearing date, or by the close of business on the scheduled

14

hearing date if the hearing was not held, the commission shall consider all written and oral

15

comments received.

16

(j) The commission shall, by majority vote of all members, take final action on the proposed

17

rule and shall determine the effective date of the rule, if any, based on the rulemaking record and

18

the full text of the rule.

19

(k) If no written notice of intent to attend the public hearing by interested parties is

20

received, the commission may proceed with promulgation of the proposed rule without a public

21

hearing.

22

(l) Upon determination that an emergency exists, the commission may consider and adopt

23

an emergency rule without prior notice, opportunity for comment, or hearing, provided that the

24

usual rulemaking procedures provided in the compact and in this section shall be retroactively

25

applied to the rule as soon as reasonably possible, in no event later than ninety (90) days after the

26

effective date of the rule. For the purposes of this provision, an emergency rule is one that must be

27

adopted immediately in order to:

28

(1) Meet an imminent threat to public health, safety, or welfare;

29

(2) Prevent a loss of commission or member state funds;

30

(3) Meet a deadline for the promulgation of an administrative rule that is established by

31

federal law or rule; or

32

(4) Protect public health and safety.

33

(m) The commission or an authorized committee of the Commission may direct revisions

34

to a previously adopted rule or amendment for purposes of correcting typographical errors, errors

 

Art20

(Page 87 of 111)

1

in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be

2

posted on the website of the commission. The revision shall be subject to challenge by any person

3

for a period of thirty days after posting. The revision may be challenged only on grounds that the

4

revision results in a material change to a rule. A challenge shall be made in writing and delivered

5

to the chair of the commission prior to the end of the notice period. If no challenge is made, the

6

revision will take effect without further action. If the revision is challenged, the revision may not

7

take effect without the approval of the commission.

8

23-4.2-14– Oversight, dispute resolution, and enforcement.

9

(a) Oversight

10

(1) The executive, legislative, and judicial branches of state government in each member

11

state shall enforce this compact and take all actions necessary and appropriate to effectuate the

12

compact’s purposes and intent. The provisions of this compact and the rules promulgated hereunder

13

shall have standing as statutory law.

14

(2) All courts shall take judicial notice of the compact and the rules in any judicial or

15

administrative proceeding in a member state pertaining to the subject matter of this compact which

16

may affect the powers, responsibilities or actions of the commission.

17

(b) The Commission shall be entitled to receive service of process in any such proceeding

18

and shall have standing to intervene in such a proceeding for all purposes. Failure to provide service

19

of process to the commission shall render a judgment or order void as to the commission, this

20

compact, or promulgated rules.

21

(c) Default, technical assistance, and termination

22

(1) If the commission determines that a member state has defaulted in the performance of

23

its obligations or responsibilities under this compact or the promulgated rules, the commission

24

shall:

25

(i) Provide written notice to the defaulting state and other member states of the nature of

26

the default, the proposed means of curing the default and/or any other action to be taken by the

27

commission; and

28

(ii) Provide remedial training and specific technical assistance regarding the default.

29

(iii) If a state in default fails to cure the default, the defaulting state may be terminated from

30

the compact upon an affirmative vote of a majority of the member states, and all rights, privileges

31

and benefits conferred by this compact may be terminated on the effective date of termination. A

32

cure of the default does not relieve the offending state of obligations or liabilities incurred during

33

the period of default.

 

Art20

(Page 88 of 111)

1

(iv) Termination of membership in the compact shall be imposed only after all other means

2

of securing compliance have been exhausted. Notice of intent to suspend or terminate shall be given

3

by the commission to the governor, the majority and minority leaders of the defaulting state’s

4

legislature, and each of the member states.

5

(2) A state that has been terminated is responsible for all assessments, obligations, and

6

liabilities incurred through the effective date of termination, including obligations that extend

7

beyond the effective date of termination.

8

(3) The commission shall not bear any costs related to a state that is found to be in default

9

or that has been terminated from the compact, unless agreed upon in writing between the

10

commission and the defaulting state.

11

(4) The defaulting state may appeal the action of the commission by petitioning the U.S.

12

district court for the District of Columbia or the federal district where the commission has its

13

principal offices. The prevailing member shall be awarded all costs of such litigation, including

14

reasonable attorney’s fees.

15

(d) Dispute resolution

16

(1) Upon request by a member state, the commission shall attempt to resolve disputes

17

related to the compact that arise among member states and between member and non-member

18

states.

19

(2) The commission shall promulgate a rule providing for both mediation and binding

20

dispute resolution for disputes as appropriate.

21

(e) Enforcement

22

(1) The commission, in the reasonable exercise of its discretion, shall enforce the

23

provisions and rules of this compact.

24

(2) By majority vote, the commission may initiate legal action in the United States district

25

court for the District of Columbia or the federal district where the commission has its principal

26

offices against a member state in default to enforce compliance with the provisions of the compact

27

and its promulgated rules and bylaws. The relief sought may include both injunctive relief and

28

damages. In the event judicial enforcement is necessary, the prevailing member shall be awarded

29

all costs of such litigation, including reasonable attorney’s fees.

30

(3) The remedies herein shall not be the exclusive remedies of the commission. The

31

commission may pursue any other remedies available under federal or state law.

32

23-4.2-15– Date of implementation of the interstate compact commission for

33

emergency medical personnel practice and associated rules, withdrawal, and amendment.

 

Art20

(Page 89 of 111)

1

The compact shall come into effect on the date on which the compact statute is enacted into law in

2

the tenth member state. The provisions, which become effective at that time, shall be limited to the

3

powers granted to the commission relating to assembly and the promulgation of rules. Thereafter,

4

the commission shall meet and exercise rulemaking powers necessary to the implementation and

5

administration of the compact.

6

(b) Any state that joins the compact subsequent to the commission’s initial adoption of the

7

rules shall be subject to the rules as they exist on the date on which the compact becomes law in

8

that state. Any rule that has been previously adopted by the commission shall have the full force

9

and effect of law on the day the compact becomes law in that state.

10

(c) Any member state may withdraw from this compact by enacting a statute repealing the

11

same.

12

(1) A member state’s withdrawal shall not take effect until six (6) months after enactment

13

of the repealing statute.

14

(2) Withdrawal shall not affect the continuing requirement of the withdrawing state’s EMS

15

authority to comply with the investigative and adverse action reporting requirements of this act

16

prior to the effective date of withdrawal.

17

(d) Nothing contained in this compact shall be construed to invalidate or prevent any EMS

18

personnel licensure agreement or other cooperative arrangement between a member state and a

19

non-member state that does not conflict with the provisions of this compact.

20

(e) This compact may be amended by the member states. No amendment to this compact

21

shall become effective and binding upon any member state until it is enacted into the laws of all

22

member states.

23

23-4.2-16– Construction and severability.

24

This compact shall be liberally construed so as to effectuate the purposes thereof. If this compact

25

shall be held contrary to the constitution of any state member thereto, the compact shall remain in

26

full force and effect as to the remaining member states. Nothing in this compact supersedes state

27

law or rules related to licensure of EMS agencies.

28

SECTION 8: Sections 27-18.5-3, 27-18.5-4, 27-18.5-5, 27-18.5-6 and 27-18.5-10 of the

29

General Laws in Chapter 27-18.5 entitled "Individual Health Insurance Coverage" are hereby

30

amended to read as follows:

31

27-18.5-3. Guaranteed availability to certain individuals.

32

(a) Notwithstanding any of the provisions of this title to the contrary Subject to subsections

33

(b) through (i) of this section, all health insurance carriers that offer health insurance coverage in

34

the individual market in this state shall provide for the guaranteed availability of coverage to any

 

Art20

(Page 90 of 111)

1

eligible applicant. to an eligible individual or an individual who has had health insurance coverage,

2

including coverage in the individual market, or coverage under a group health plan or coverage

3

under 5 U.S.C. § 8901 et seq. and had that coverage continuously for at least twelve (12)

4

consecutive months and who applies for coverage in the individual market no later than sixty-three

5

(63) days following termination of the coverage, desiring to enroll in individual health insurance

6

coverage, and who is not eligible for coverage under a group health plan, part A or part B or title

7

XVIII of the Social Security Act, 42 U.S.C. § 1395c et seq. or 42 U.S.C. § 1395j et seq., or any

8

state plan under title XIX of the Social Security Act, 42 U.S.C. § 1396 et seq. (or any successor

9

program) and does not have other health insurance coverage (provided, that eligibility for the other

10

coverage shall not disqualify an individual with twelve (12) months of consecutive coverage if that

11

individual applies for coverage in the individual market for the primary purpose of obtaining

12

coverage for a specific pre-existing condition, and the other available coverage excludes coverage

13

for that pre-existing condition) and For the purposes of this section, an “eligible applicant” means

14

any individual resident of this state. A carrier offering health insurance coverage in the individual

15

market must offer to any eligible applicant in the state all health insurance coverage plans of that

16

carrier that are approved for sale in the individual market and must accept any eligible applicant

17

that applies for coverage under those plans. A carrier may not:

18

(1) Decline to offer the coverage to, or deny enrollment of, the individual; or

19

(2) Impose any preexisting condition exclusion with respect to the coverage.

20

(b)(1) All health insurance carriers that offer health insurance coverage in the individual

21

market in this state shall offer all policy forms of health insurance coverage to all eligible

22

applicants. Provided, a carrier may offer plans with reduced cost sharing for qualifying eligible

23

applicants, based on available federal funds including those described by 42 U.S.C. § 18071, or

24

based on a program established with state funds. Provided, the carrier may elect to limit the

25

coverage offered so long as it offers at least two (2) different policy forms of health insurance

26

coverage (policy forms which have different cost-sharing arrangements or different riders shall be

27

considered to be different policy forms) both of which:

28

(i) Are designed for, made generally available to, and actively market to, and enroll both

29

eligible and other individuals by the carrier; and

30

(ii) Meet the requirements of subparagraph (A) or (B) of this paragraph as elected by the

31

carrier:

32

(A) If the carrier offers the policy forms with the largest, and next to the largest, premium volume

33

of all the policy forms offered by the carrier in this state; or

 

Art20

(Page 91 of 111)

1

(B) If the carrier offers a choice of two (2) policy forms with representative coverage,

2

consisting of a lower-level coverage policy form and a higher-level coverage policy form each of

3

which includes benefits substantially similar to other individual health insurance coverage offered

4

by the carrier in this state and each of which is covered under a method that provides for risk

5

adjustment, risk spreading, or financial subsidization.

6

(2) For the purposes of this subsection, "lower-level coverage" means a policy form for

7

which the actuarial value of the benefits under the coverage is at least eighty-five percent (85%)

8

but not greater than one hundred percent (100%) of the policy form weighted average.

9

(3) For the purposes of this subsection, "higher-level coverage" means a policy form for

10

which the actuarial value of the benefits under the coverage is at least fifteen percent (15%) greater

11

than the actuarial value of lower-level coverage offered by the carrier in this state, and the actuarial

12

value of the benefits under the coverage is at least one hundred percent (100%) but not greater than

13

one hundred twenty percent (120%) of the policy form weighted average.

14

      (4) For the purposes of this subsection, "policy form weighted average" means the average

15

actuarial value of the benefits provided by all the health insurance coverage issued (as elected by

16

the carrier) either by that carrier or, if the data are available, by all carriers in this state in the

17

individual market during the previous year (not including coverage issued under this subsection),

18

weighted by enrollment for the different coverage. The actuarial value of benefits shall be

19

calculated based on a standardized population and a set of standardized utilization and cost factors.

20

     (5) The carrier elections under this subsection shall apply uniformly to all eligible

21

individuals in this state for that carrier. The election shall be effective for policies offered during a

22

period of not shorter than two years.

23

(c)(1) A carrier may deny health insurance coverage in the individual market to an eligible

24

individual applicant if the carrier has demonstrated to the director commissioner that:

25

(i) It does not have the financial reserves necessary to underwrite additional coverage; and

26

(ii) It is applying this subsection uniformly to all individuals in the individual market in

27

this state consistent with applicable state law and without regard to any health status-related factor

28

of the individuals. without regard to whether the individuals are eligible individuals.

29

(2) A carrier upon denying individual health insurance coverage in this state in accordance

30

with this subsection may not offer that coverage in the individual market in this state for a period

31

of one hundred eighty (180) days after the date the coverage is denied or until the carrier has

32

demonstrated to the director commissioner that the carrier has sufficient financial reserves to

33

underwrite additional coverage, whichever is later.

 

Art20

(Page 92 of 111)

1

(d) Nothing in this section shall be construed to require that a carrier offering health

2

insurance coverage only in connection with group health plans or through one or more bona fide

3

associations, or both, offer health insurance coverage in the individual market.

4

(e) A carrier offering health insurance coverage in connection with group health plans

5

under this title shall not be deemed to be a health insurance carrier offering individual health

6

insurance coverage solely because the carrier offers a conversion policy.

7

(f) Except for any high risk pool rating rules to be established by the Office of the Health

8

Insurance Commissioner (OHIC) as described in this section, nothing in this section shall be

9

construed to create additional restrictions on the amount of premium rates that a carrier may charge

10

an individual for health insurance coverage provided in the individual market; or to prevent a health

11

insurance carrier offering health insurance coverage in the individual market from establishing

12

premium rates or modifying applicable copayments or deductibles in return for adherence to

13

programs of health promotion and disease prevention.

14

(g) OHIC may pursue federal funding in support of the development of a high-risk pool for

15

the individual market, as defined in § 27-18.5-2, contingent upon a thorough assessment of any

16

financial obligation of the state related to the receipt of said federal funding being presented to, and

17

approved by, the general assembly by passage of concurrent general assembly resolution. The

18

components of the high-risk pool program, including, but not limited to, rating rules, eligibility

19

requirements and administrative processes, shall be designed in accordance with § 2745 of the

20

Public Health Service Act (42 U.S.C. § 300gg-45) also known as the State High Risk Pool Funding

21

Extension Act of 2006 and defined in regulations promulgated by the office of the health insurance

22

commissioner on or before October 1, 2007.

23

(h)(1) In the case of a health insurance carrier that offers health insurance coverage in the

24

individual market through a network plan, the carrier may limit the individuals who may be enrolled

25

under that coverage to those who live, reside, or work within the service areas for the network plan;

26

and within the service areas of the plan, deny coverage to individuals if the carrier has demonstrated

27

to the commissioner that:

28

(i) It will not have the capacity to deliver services adequately to additional individual

29

enrollees because of its obligations to existing group contract holders and enrollees and individual

30

enrollees; and

31

(ii) It is applying this subsection uniformly to individuals without regard to any health

32

status-related factor of the individuals. and without regard to whether the individuals are eligible

33

individuals.

34

(2) Upon denying health insurance coverage in any service area in accordance with the

 

Art20

(Page 93 of 111)

1

terms of this subsection, a carrier may not offer coverage in the individual market within the service

2

area for a period of one hundred eighty (180) days after the coverage is denied.

3

(i) A carrier may restrict the period during which an eligible applicant may enroll for

4

coverage under (x) an open enrollment period to be established by the commissioner and held

5

annually for a period of between thirty (30) and sixty (60) days, and (y) special enrollment periods

6

as established in accordance with the version of 45 C.F.R. § 147.104 in effect on January 1, 2020.

7

27-18.5-4. Continuation of coverage – Renewability.

8

(a) A health insurance carrier that provides individual health insurance coverage to an

9

individual in this state shall renew or continue in force that coverage at the option of the individual.

10

(b) A health insurance carrier may nonrenew non-renew or discontinue health insurance

11

coverage of an individual in the individual market based only on one or more of the following:

12

(1) The individual has failed to pay premiums or contributions in accordance with the terms

13

of the health insurance coverage, or the carrier has not received including terms relating to timely

14

premium payments;

15

(2) The individual has performed an act or practice that constitutes fraud or made an

16

intentional misrepresentation of material fact under the terms of the coverage;

17

(3) The carrier is ceasing to offer coverage in accordance with subsections (c) and (d) of

18

this section;

19

(4) In the case of a carrier that offers health insurance coverage in the market through a

20

network plan, the individual no longer resides, lives, or works in the service area (or in an area for

21

which the carrier is authorized to do business) but only if the coverage is terminated uniformly

22

without regard to any health status-related factor of covered individuals; or

23

(5) In the case of health insurance coverage that is made available in the individual market

24

only through one or more bona fide associations, the membership of the individual in the association

25

(on the basis of which the coverage is provided) ceases but only if the coverage is terminated

26

uniformly and without regard to any health status-related factor of covered individuals.

27

(c) In any case in which a carrier decides to discontinue offering a particular type of health

28

insurance coverage offered in the individual market, coverage of that type may be discontinued

29

only if:

30

(1) The carrier provides notice, to each covered individual provided coverage of this type

31

in the market, of the discontinuation at least ninety (90) days prior to the date of discontinuation of

32

the coverage;

 

Art20

(Page 94 of 111)

1

(2) The carrier offers to each individual in the individual market provided coverage of this

2

type, the opportunity to purchase any other individual health insurance coverage currently being

3

offered by the carrier for individuals in the market; and

4

(3) In exercising this option to discontinue coverage of this type and in offering the option

5

of coverage under subdivision (2) of this subsection, the carrier acts uniformly without regard to

6

any health status- related factor of enrolled individuals or individuals who may become eligible for

7

the coverage.

8

(d) In any case in which a carrier elects to discontinue offering all health insurance

9

coverage in the individual market in this state, health insurance coverage may be discontinued only

10

if:

11

(1) The carrier provides notice to the director commissioner and to each individual of the

12

discontinuation at least one hundred eighty (180) days prior to the date of the expiration of the

13

coverage; and

14

(2) All health insurance issued or delivered in this state in the market is discontinued and

15

coverage under this health insurance coverage in the market is not renewed.

16

(e) In the case of a discontinuation under subsection (d) of this section, the carrier may not provide

17

for the issuance of any health insurance coverage in the individual market in this state during the

18

five (5) year period beginning on the date the carrier filed its notice with the department to withdraw

19

from the individual health insurance market in this state. This five (5) year period may be reduced

20

to a minimum of three (3) years at the discretion of the health insurance commissioner, based on

21

his/ or her analysis of market conditions and other related factors.

22

(f) The provisions of subsections (d) and (e) of this section do not apply if, at the time of

23

coverage renewal, a health insurance carrier modifies the health insurance coverage for a policy

24

form offered to individuals in the individual market so long as the modification is consistent with

25

this chapter and other applicable law and effective on a uniform basis among all individuals with

26

that policy form.

27

(g) In applying this section in the case of health insurance coverage made available by a

28

carrier in the individual market to individuals only through one or more associations, a reference

29

to an "individual" includes a reference to the association (of which the individual is a member).

30

27-18.5-5. Enforcement – Limitation on actions.

31

The directorcommissioner has the power to enforce the provisions of this chapter in

32

accordance with § 42-14-16 and all other applicable laws.

33

27-18.5-6. Rules and regulations.

34

The directorcommissioner may promulgate rules and regulations necessary to effectuate

 

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1

the purposes of this chapter.

2

27-18.5-10. Prohibition on preexisting condition exclusions.

3

(a) A health insurance policy, subscriber contract, or health plan offered, issued, issued for

4

delivery, or issued to cover a resident of this state by a health insurance company licensed pursuant

5

to this title and/or chapter; shall not limit or exclude coverage for any individual by imposing a

6

preexisting condition exclusion on that individual.

7

Shall not limit or exclude coverage for an individual under the age of nineteen (19) by imposing a

8

preexisting condition exclusion on that individual.

9

For plan or policy years beginning on or after January 1, 2014, shall not limit or exclude coverage

10

for any individual by imposing a preexisting condition exclusion on that individual.

11

(b) As used in this section, “preexisting condition exclusion” (1) "Preexisting condition

12

exclusion" means a limitation or exclusion of benefits, including a denial of coverage, based on the

13

fact that the condition (whether physical or mental) was present before the effective date of

14

coverage, or if the coverage is denied, the date of denial, under a health benefit plan whether or not

15

any medical advice, diagnosis, care or treatment was recommended or received before the effective

16

date of coverage.

17

     (2) "Preexisting condition exclusion" means any limitation or exclusion of benefits,

18

including a denial of coverage, applicable to an individual as a result of information relating to an

19

individual's health status before the individual's effective date of coverage, or if the coverage is

20

denied, the date of denial, under the health benefit plan, such as a condition (whether physical or

21

mental) identified as a result of a pre- enrollment questionnaire or physical examination given to

22

the individual, or review of medical records relating to the pre-enrollment period.

23

(c) This section shall not apply to grandfathered health plans providing individual health

24

insurance coverage.

25

(d) This section shall not apply to insurance coverage providing benefits for: (1) Hospital

26

confinement indemnity; (2) Disability income; (3) Accident only; (4) Long-term care; (5) Medicare

27

supplement; (6) Limited benefit health; (7) Specified disease indemnity; (8) Sickness or bodily

28

injury or death by accident or both; and (9) Other limited benefit policies.

29

SECTION 9. Chapter 27-18.5 of the General Laws entitled "Individual Health Insurance

30

Coverage" is hereby amended by adding thereto the following section:

31

27-18.5-11 Essential Health Benefits – Individual

32

(a) The following words and phrases as used in this section have the following meanings

33

consistent with federal law and regulations adopted thereunder, so long as they remain in effect. If

 

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1

such authorities are no longer in effect, the laws and regulations in effect on January 1, 2020 as

2

identified by the commissioner shall govern, unless a different meaning is required by the context:

3

(1) “Essential health benefits” means the following general categories, and the services

4

covered within those categories:

5

(i) Ambulatory patient services;

6

(ii) Emergency services;

7

(iii) Hospitalization;

8

(iv) Maternity and newborn care;

9

(v) Mental health and substance use disorder services, including behavioral health treatment;

10

(vi) Prescription drugs;

11

(vii) Rehabilitative and habilitative services and devices;

12

(viii) Laboratory services;

13

(ix) Preventive services, wellness services, and chronic disease management; and

14

(x) Pediatric services, including oral and vision care.

15

(2) “Preventive services” means those services described in 42 U.S.C. § 300gg-13 and

16

implementing regulations and guidance. If such authorities are determined by the commissioner to

17

no longer be in effect, and to the extent that federal recommendations change after January 1, 2020,

18

the commissioner shall rely on the recommendations as described in the version of 42 U.S.C. §

19

300gg-13 in effect on January 1, 2020 to determine which services qualify as preventive services

20

under this section.

21

(b) A health insurance policy, subscriber contract, or health plan offered, issued, issued for

22

delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant

23

to this title and/or chapter, shall provide coverage of at least the essential health benefits categories

24

set forth in this section, and shall further provide coverage of preventive services from in-network

25

providers without applying any copayments, deductibles, coinsurance, or other cost sharing, as set

26

forth in this section.

27

(c) This provision shall not be construed as authority to expand the scope of preventive

28

services beyond those in effect on January 1, 2020. However, to the extent that the U.S. Preventive

29

Services Taskforce revises its recommendations with respect to grade “A” or “B” preventive

30

services, OHIC shall have the authority to issue guidance clarifying the services that shall qualify

31

as preventive services under this section, consistent with said recommendations.

32

SECTION 10. Chapter 27-18.6 of the General Laws entitled "Large Group Health

33

Insurance Coverage" is hereby amended by adding thereto the following section:

34

27-18.6-13 Preventive Services

 

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1

(a) As used in this section, “preventive services” means those services described in 42

2

U.S.C. § 300gg-13 and implementing regulations and guidance. If such authorities are determined

3

by the commissioner to no longer be in effect, and to the extent that federal recommendations

4

change after January 1, 2020, the commissioner shall rely on the recommendations as described in

5

the version of 42 U.S.C. § 300gg-13 in effect on January 1, 2020 to determine which federally-

6

recommended evidence-based preventive services qualify as preventive care.

7

(b) A health insurance policy, subscriber contract, or health plan offered, issued, issued for

8

delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant

9

to this title and/or chapter, shall provide coverage of preventive services from in-network providers

10

without applying any copayments, deductibles, coinsurance, or other cost sharing, as set forth in

11

this section.

12

(c) This provision shall not be construed as authority to expand the scope of preventive

13

services beyond those in effect on January 1, 2020. However, to the extent that the U.S. Preventive

14

Services Taskforce revises its recommendations with respect to grade “A” or “B” preventive

15

services, OHIC shall have the authority to issue guidance clarifying the services that shall qualify

16

as preventive services under this section, consistent with said recommendations.

17

SECTION 11. Section 27-50-11 of the General Laws in Chapter 27-50 entitled "Small

18

Employer Health Insurance Availability Act" is hereby amended to read as follows:

19

27-50-11. Administrative procedures.

20

(a) The director shall commissioner may issue promulgate rules and regulations necessary

21

to effectuate the purposes of this chapter.in accordance with chapter 35 of this title for the

22

implementation and administration of the Small Employer Health Insurance Availability Act.

23

SECTION 12. Chapter 27-50 of the General Laws entitled "Small Employer Health

24

Insurance Availability Act" is hereby amended by adding thereto the following section:

25

27-50-18 Essential Health Benefits

26

(a) The following words and phrases as used in this section have the following meanings

27

consistent with federal law and regulations adopted thereunder, so long as they remain in effect. If

28

such authorities are no longer in effect, the laws and regulations in effect on January 1, 2020 as

29

identified by the commissioner shall govern, unless a different meaning is required by the context:

30

(1) “Essential health benefits” means the following general categories, and the services

31

covered within those categories:

32

(i) Ambulatory patient services;

33

(ii) Emergency services;

34

(iii) Hospitalization;

 

Art20

(Page 98 of 111)

1

(iv) Maternity and newborn care;

2

(v) Mental health and substance use disorder services, including behavioral health

3

treatment;

4

(vi) Prescription drugs;

5

(vii) Rehabilitative and habilitative services and devices;

6

(viii) Laboratory services;

7

(ix) Preventive services, wellness services, and chronic disease management; and

8

(x) Pediatric services, including oral and vision care.

9

(2) “Preventive services” means those services described in 42 U.S.C. § 300gg-13 and

10

implementing regulations and guidance. If such authorities are determined by the commissioner to

11

no longer be in effect, and to the extent that federal recommendations change after January 1, 2020,

12

the commissioner shall rely on the recommendations as described in the version of 42 U.S.C. §

13

300gg-13 in effect on January 1, 2020 to determine which services qualify as preventive services

14

under this section.

15

(b) A health insurance policy, subscriber contract, or health plan offered, issued, issued for

16

delivery, or issued to cover a resident of this state, by a health insurance company licensed pursuant

17

to this title and/or chapter shall provide coverage of at least the essential health benefits categories

18

set forth in this section, and shall further provide coverage of preventive services from in-network

19

providers without applying any copayments, deductibles, coinsurance, or other cost sharing, as set

20

forth in this section.

21

(c) This provision shall not be construed as authority to expand the scope of preventive

22

services beyond those in effect on January 1, 2020. However, to the extent that the U.S. Preventive

23

Services Taskforce revises its recommendations with respect to grade “A” or “B” preventive

24

services, OHIC shall have the authority to issue guidance clarifying the services that shall qualify

25

as preventive services under this section, consistent with said recommendations.

26

SECTION 13. Section 40-8.4-12 of the General Laws in Chapter 40-8.1 entitled "Small

27

Employer Health Insurance Availability Act" and 44-1-2 of the General Laws in Chapter 44-1

28

entitled "State Tax Officials" are hereby amended to read as follows:

29

40-8.4-12. RIte Share Health Insurance Premium Assistance Program.

30

(a) Basic RIte Share health insurance premium assistance program. Under the terms of

31

Section 1906 of Title XIX of the U.S. Social Security Act, 42 U.S.C. § 1396e, states are permitted

32

to pay a Medicaid-eligible person's share of the costs for enrolling in employer-sponsored health

33

insurance (ESI) coverage if it is cost effective to do so. Pursuant to the general assembly's direction

34

in the Rhode Island health reform act of 2000, the Medicaid agency requested and obtained federal

 

Art20

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1

approval under § 1916, 42 U.S.C. § 1396o, to establish the RIte Share premium-assistance program

2

to subsidize the costs of enrolling Medicaid-eligible persons and families in employer-sponsored

3

health insurance plans that have been approved as meeting certain cost and coverage requirements.

4

The Medicaid agency also obtained, at the general assembly's direction, federal authority to require

5

any such persons with access to ESI Employer-sponsored health insurance (ESI) coverage to enroll

6

as a condition of retaining eligibility providing that doing so meets the criteria established in Title

7

XIX for obtaining federal matching funds.

8

(b) Definitions. For the purposes of this section, the following definitions apply:

9

(1) "Cost-effective" means that the portion of the employer-sponsored health insurance

10

(ESI) that the state would subsidize, as well as the cost of wrap-around costs services and cost

11

sharing, would on average cost less to the state than enrolling that same person/family in a

12

managed-care delivery system.

13

(2) "Cost sharing" means any co-payments, deductibles, or co-insurance associated with

14

ESI.

15

(3) "Employee premium" means the monthly premium share a person or family is required

16

to pay to the employer to obtain and maintain ESI coverage.

17

(4) “Employer” means any individual, partnership, association, corporation, estate, trust,

18

fiduciary, limited liability company, limited liability partnership, or any other legal entity that

19

employed at least fifty (50) employees during the preceding fiscal year. Excluded from this

20

definition are all charitable, not for profit organizations specifically formed for purposes other than

21

operating a profit-seeking business and all state or municipal governmental entities.

22

(4 5) "Employer-sponsored health insurance or ESI" means health insurance or a group

23

health plan offered to employees by an employer. This includes plans purchased by small

24

employers through the state health insurance marketplace, healthsource RI (HSRI).

25

(56) "Policy holder" means the person in the household with access to ESI, typically the

26

employee.

27

(67) "RIte Share-approved employer-sponsored health insurance (ESI)" means an

28

employer-sponsored health insurance plan that meets the coverage and cost-effectiveness criteria

29

for RIte Share.

30

(78) "RIte Share buy-in" means the monthly amount an Medicaid-ineligible policy holder

31

must pay toward RIte Share-approved ESI that covers the Medicaid-eligible children, young adults,

32

or spouses with access to the ESI. The buy-in only applies in instances when household income is

33

above one hundred fifty percent (150%) of the FPL.

 

Art20

(Page 100 of 111)

1

(89) "RIte Share premium assistance program" (referred to hereafter as “RIte Share”)

2

means the Rhode Island Medicaid premium assistance program in which the State pays the eligible

3

Medicaid member's share of the cost of enrolling in a RIte Share-approved ESI plan, as well as

4

coverage of wrap-around services, or those that are covered under Medicaid, but not the ESI plan.

5

This allows the state to share the cost of the health insurance coverage with the employer.

6

(910) "RIte Share Unit" means the entity within the executive office of health and human

7

services (EOHHS) responsible for assessing the cost-effectiveness of ESI, contacting employers

8

about ESI as appropriate, initiating the RIte Share enrollment and disenrollment process, handling

9

member communications, and managing the overall operations of the RIte Share program.

10

(101) "Third-Party Liability (TPL)" means other health insurance coverage. This insurance

11

is in addition to Medicaid and is usually provided through an employer. Since Medicaid is always

12

the payer of last resort, the TPL is always the primary coverage.

13

(112) "Wrap-around services or coverage" means any health care services not included in

14

the ESI plan that would have been covered had the Medicaid member been enrolled in a RIte Care

15

or Rhody Health Partners plan. Coverage of deductibles and co-insurance is included in the wrap-

16

around services or coverage. Co-payments to providers are not covered as part of the wrap-around

17

coverage.

18

(c) RIte Share populations. Medicaid beneficiaries subject to RIte Share include: children,

19

families, parent and caretakers eligible for Medicaid or the children's health insurance program

20

(CHIP) under this chapter or chapter 12.3 of title 42; and adults between the ages of nineteen (19)

21

and sixty-four (64) who are eligible under chapter 8.12 of this title, not receiving or eligible to

22

receive Medicare, and are enrolled in managed care delivery systems. The following additional

23

conditions apply:

24

(1) The income of Medicaid beneficiaries shall affect whether and in what manner they

25

must participate in RIte Share as follows:

26

(i) Income at or below one hundred fifty percent (150%) of FPL – Persons and families

27

determined to have household income at or below one hundred fifty percent (150%) of the Federal

28

Poverty Level (FPL) guidelines based on the modified adjusted gross income (MAGI) standard or

29

other standard approved by the secretary are required to participate in RIte Share if a Medicaid-

30

eligible adult or parent/caretaker has access to cost-effective ESI. Enrolling in ESI through RIte

31

Share shall be a condition of maintaining Medicaid health coverage for any eligible adult with

32

access to such coverage.

33

(ii) Income above one hundred fifty percent (150%) of FPL and policy holder is not

34

Medicaid-eligible – Premium assistance is available when the household includes Medicaid-

 

Art20

(Page 101 of 111)

1

eligible members, but the ESI policy holder (typically a parent/caretaker, or spouse) is not eligible

2

for Medicaid. Premium assistance for parents/caretakers and other household members who are not

3

Medicaid-eligible may be provided in circumstances when enrollment of the Medicaid-eligible

4

family members in the approved ESI plan is contingent upon enrollment of the ineligible policy

5

holder and the executive office of health and human services (executive office) determines, based

6

on a methodology adopted for such purposes, that it is cost-effective to provide premium assistance

7

for family or spousal coverage.

8

(d) RIte Share enrollment as a condition of eligibility. For Medicaid beneficiaries over the

9

age of nineteen (19) enrollment in RIte Share shall be a condition of eligibility except as exempted

10

below and by regulations promulgated by the executive office.

11

(1) Medicaid-eligible children and young adults up to age nineteen (19) shall not be

12

required to enroll in a parent/caretaker relative's ESI as a condition of maintaining Medicaid

13

eligibility if the person with access to RIte Share-approved ESI does not enroll as required. These

14

Medicaid-eligible children and young adults shall remain eligible for Medicaid and shall be

15

enrolled in a RIte Care plan.

16

(2) There shall be a limited six-month (6) exemption from the mandatory enrollment

17

requirement for persons participating in the RI works program pursuant to chapter 5.2 of this title.

18

(e) Approval of health insurance plans for premium assistance.

19

(1) The executive office of health and human services shall adopt regulations providing

20

for the approval of employer-based health insurance plans for premium assistance and shall approve

21

employer-based health insurance plans based on these regulations. In order for an employer-based

22

health insurance plan to gain approval, the executive office must determine that the benefits offered

23

by the employer-based health insurance plan are substantially similar in amount, scope, and

24

duration to the benefits provided to Medicaid-eligible persons enrolled in a Medicaid managed-

25

care plan, when the plan is evaluated in conjunction with available supplemental benefits provided

26

by the executive office of health and human services. The executive office of health and human

27

services shall obtain and make available to persons otherwise eligible for Medicaid, identified in

28

this section as supplemental benefits, those benefits not reasonably available under employer-based

29

health insurance plans that are required for Medicaid beneficiaries by state law or federal law or

30

regulation. Once it has been determined by the Medicaid agency executive office of health and

31

human services that the ESI offered by a particular employer is RIte Share-approved, all Medicaid

32

members with access to that employer's plan are required to participate in RIte Share. Failure to

33

meet the mandatory enrollment requirement shall result in the termination of the Medicaid

34

eligibility of the policy holder and other Medicaid members nineteen (19) or older in the household

 

Art20

(Page 102 of 111)

1

who could be covered under the ESI until the policy holder complies with the RIte Share enrollment

2

procedures established by the executive office.

3

(2) Any employer defined in 40-8.4-12(b)(5) shall be required to:

4

(i) annually provide the executive office of health and human services and the Division of

5

Taxation with sufficient and necessary information, for the Medicaid agency to determine

6

employee eligibility for RIte Share in accordance with section 40-8.4-12(e)(1).

7

(ii) on a quarterly basis notify the executive office of health and human services of any

8

employee(s) no longer employed and/or who otherwise loses their ESI.

9

(iii) on a quarterly basis submit ESI data and enrollment reports to the executive office of

10

health and human services indicating which employees are currently enrolled or are not enrolled in

11

ESI.

12

(iv) to include instructions provided by EOHHS for RIte Share determination and

13

enrollment as a part of ESI enrollment materials whenever a new employee is offered ESI and/or

14

during the employer’s annual open enrollment period for health insurance coverage.

15

(v) participate in the executive office of health and human services’ employer education

16

and outreach campaign concerning the RIte Share program and all ESI options.

17

(vi) not offer financial incentives for employees to turn down ESI and remain on Medicaid.

18

(3) Any employer defined in 40-8.4-12(b)(5), that does not timely comply with the

19

requirements of section 40-8.4-12(e)(2), shall in accordance with section 44-1-2(9) be assessed a

20

penalty by the Division of Taxation in the amount of twenty-five hundred dollars ($2500).

21

(4) Any employer defined in 40-8.4-12(b)(5), that fails to comply with the requirements of

22

section 40-8.4-12(e)(2)(i) or who falsifies any data or reports required to be submitted to the

23

executive office of health and human services pursuant to section 40-8.4-12(e)(2)(i), shall in

24

accordance with the requirements of section 44-1-2 (9) be assessed a penalty by the Division of

25

Taxation in amount of five thousand dollars ($5000).

26

(5) The executive office of health and human services shall adopt regulations providing

27

for the approval of employer-based health insurance plans for premium assistance, the mandatory

28

data and reporting requirements for any employer defined in 40-8.4-12(b)(5), and shall approve

29

employer-based health insurance plans based on these regulations.

30

(f) Premium Assistance. The executive office shall provide premium assistance by paying

31

all or a portion of the employee's cost for covering the eligible person and/or his or her family under

32

such a RIte Share-approved ESI plan subject to the buy-in provisions in this section.

33

(g) Buy-in. Persons who can afford it shall share in the cost. – The executive office is

34

authorized and directed to apply for and obtain any necessary state plan and/or waiver amendments

 

Art20

(Page 103 of 111)

1

from the secretary of the U.S. Department of Health and Human Services (DHHS) to require that

2

persons enrolled in a RIte Share-approved employer-based health plan who have income equal to

3

or greater than one hundred fifty percent (150%) of the FPL to buy-in to pay a share of the costs

4

based on the ability to pay, provided that the buy-in cost shall not exceed five percent (5%) of the

5

person's annual income. The executive office shall implement the buy-in by regulation, and shall

6

consider co-payments, premium shares, or other reasonable means to do so.

7

(h) Maximization of federal contribution. The executive office of health and human

8

services is authorized and directed to apply for and obtain federal approvals and waivers necessary

9

to maximize the federal contribution for provision of medical assistance coverage under this

10

section, including the authorization to amend the Title XXI state plan and to obtain any waivers

11

necessary to reduce barriers to provide premium assistance to recipients as provided for in Title

12

XXI of the Social Security Act, 42 U.S.C. § 1397 et seq.

13

(i) Implementation by regulation. The executive office of health and human services is

14

authorized and directed to adopt regulations to ensure the establishment and implementation of the

15

premium assistance program in accordance with the intent and purpose of this section, the

16

requirements of Title XIX, Title XXI and any approved federal waivers.

17

(j) Outreach and reporting. The executive office of health and human services shall

18

develop a plan to identify Medicaid eligible individuals who have access to employer sponsored

19

insurance and increase the use of RIte Share benefits. Beginning October 1, 2019, the executive

20

office shall submit the plan to be included as part of the reporting requirements under § 35-17-1.

21

Starting January 1, 2020, the executive office of health and human services shall include the number

22

of Medicaid recipients with access to employer sponsored insurance, the number of plans that did

23

not meet the cost effectiveness criteria for RIte Share, and enrollment in the premium assistance

24

program as part of the reporting requirements under § 35-17-1.

25

§ 44-1-2. Powers and duties of tax administrator.

26

The tax administrator is required:

27

(1) To assess and collect all taxes previously assessed by the division of state taxation in

28

the department of revenue and regulation, including the franchise tax on domestic corporations,

29

corporate excess tax, tax upon gross earnings of public service corporations, tax upon interest

30

bearing deposits in national banks, the inheritance tax, tax on gasoline and motor fuels, and tax on

31

the manufacture of alcoholic beverages;

32

(2) To assess and collect the taxes upon banks and insurance companies previously

33

administered by the division of banking and insurance in the department of revenue and regulation,

 

Art20

(Page 104 of 111)

1

including the tax on foreign and domestic insurance companies, tax on foreign building and loan

2

associations, deposit tax on savings banks, and deposit tax on trust companies;

3

(3) To assess and collect the tax on pari-mutuel or auction mutuel betting, previously

4

administered by the division of horse racing in the department of revenue and regulation;

5

(4) [Deleted by P.L. 2006, ch. 246, art. 38, § 10];

6

(5) To assess and collect the monthly surcharges that are collected by telecommunication

7

services providers pursuant to § 39-21.1-14 and are remitted to the division of taxation;

8

(6) To audit, assess, and collect all unclaimed intangible and tangible property pursuant to

9

chapter 21.1 of title 33;

10

(7) To provide to the department of labor and training any state tax information, state

11

records, or state documents they or the requesting agency certify as necessary to assist the agency

12

in efforts to investigate suspected misclassification of employee status, wage and hour violations,

13

or prevailing wage violations subject to the agency's jurisdiction, even if deemed confidential under

14

applicable law, provided that the confidentiality of such materials shall be maintained, to the extent

15

required of the releasing department by any federal or state law or regulation, by all state

16

departments to which the materials are released and no such information shall be publicly disclosed,

17

except to the extent necessary for the requesting department or agency to adjudicate a violation of

18

applicable law. The certification must include a representation that there is probable cause to

19

believe that a violation has occurred. State departments sharing this information or materials may

20

enter into written agreements via memorandums of understanding to ensure the safeguarding of

21

such released information or materials; and

22

(8) To preserve the Rhode Island tax base under Rhode Island law prior to the December

23

22, 2017, Congressional enactment of Public Law 115-97, The Tax Cuts and Jobs Act, the tax

24

administrator, upon prior written notice to the speaker of the house, senate president, and

25

chairpersons of the house and senate finance committees, is specifically authorized to amend tax

26

forms and related instructions in response to any changes the Internal Revenue Service makes to

27

its forms, regulations, and/or processing which will materially impact state revenues, to the extent

28

that impact is measurable. Any Internal Revenue Service changes to forms, regulations, and/or

29

processing which go into effect during the current tax year or within six (6) months of the beginning

30

of the next tax year and which will materially impact state revenue will be deemed grounds for the

31

promulgation of emergency rules and regulations under § 42-35-2.10. The provisions of this

32

subsection (8) shall sunset on December 31, 2021.

33

(9) To collect the penalties from all Rhode Island employers, defined as any individual,

34

partnership, association, corporation, estate, trust, fiduciary, limited liability company, limited

 

Art20

(Page 105 of 111)

1

liability partnership, or any other legal entity that employed at least fifty (50) employees, but not

2

including any charitable, not for profit organizations specifically formed for purposes other than

3

operating a profit-seeking business and all state or municipal governmental entities, during the

4

preceding fiscal year, who fail to file the forms required by the executive office of health and human

5

services pursuant to section 40-8.4-12 of the Rhode Island General Laws and associated rules and

6

regulations. An employer is required to file said forms if it had fifty (50) or more employees during

7

the previous fiscal year (July 1st through June 30th). The first submissions under this program will

8

be required from employers who had fifty (50) or more employees at any time between July 1, 2019

9

and June 30, 2020. The forms must be filed with the division of taxation between November 15th

10

and December 15th during the year in which they are due. The first forms under this program will

11

be due between November 15, 2020 and December 15, 2020. The penalties are set forth in section

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40-8.4-12, as amended, and may be assessed on forms provided by the tax administrator, who, in

13

consultation with the executive office of health and human services, may clarify the collection of

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said penalties with rules or regulations consistent with this chapter as well as chapter 8.4 of title

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40. The tax administrator may from time to time transmit to the executive office of health and

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human services a list of Rhode Island employers and/or the forms and related documentation or

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information required by Section 40-8.4-12 for the purpose of complying with this chapter as well

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as chapter 8.4 of title 40. The provisions of this subsection (9) shall be effective upon passage.

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SECTION 14: Title 42 of the General Laws entitled “State Affairs and Government” is

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amended by adding thereto the following chapter:

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CHAPTER 42-7.5

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THE HEALTH SPENDING TRANSPARENCY AND CONTAINMENT ACT

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42-7.5-1. Short title.

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This chapter shall be known and may be cited as “The Health Spending Transparency and

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Containment Act.”

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42-7.5-2. Purpose

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(a) WHEREAS, in August of 2018, the RI Cost Trend Steering Committee, composed of

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stakeholders including business and consumer advocates and health industry leaders, was created

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to advise the RI Health Care Cost Trend Project in partnership with the Office of the Health

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Insurance Commissioner and the Executive Office on Health and Human Services.

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(b) WHEREAS, the vision of the Cost Trend Steering Committee is to provide every Rhode

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Islander with access to high-quality, affordable healthcare through greater transparency of

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healthcare performance and increased accountability by key stakeholders to ensure healthcare

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spending does not increase at a rate that significantly outpaces the consumer price index.

 

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(c) WHEREAS, the goal of the cost trend work is to use actionable data insights, analytic

2

tools, State authority, and stakeholder engagement to drive meaningful changes in healthcare

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spending in Rhode Island.

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(d) WHEREAS, since August 2018, Rhode Island has: (1) convened a diverse group of

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stakeholders to consider the establishment of a cost grown target; (2) achieved unanimous

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consensus on the establishment of such a target; and (3) issued an Executive Order to formalize the

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cost target.

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(e) WHEREAS, the Cost Trend Steering Committee also convened national experts with

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RI government, advocates, business leaders, and healthcare leaders to share best practices on

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claims-based analyses, leading to the development of a strategy to track overall healthcare

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spending, report at several levels, and produce information that will inform and enhance provider

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decision making.

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(f) WHEREAS, the values that guide Rhode Island’s Cost Trend efforts include

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commitments to (1) broad based stakeholder engagement that ensures consensus and support, (2)

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transparency and actionability of data and reports, and (3) collaboration between experts in state

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government, the private sector, and academia that results in key decision makers using data in

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smarter ways to reduce costs while ensuring high quality care.

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(g) WHEREAS, in the final year of Peterson Center RI Health Care Cost Trend Project

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funding (ending March 1, 2021), the Steering Committee has committed to work on sustainability

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planning to codify the practice of cost trend analytics and convenings in the annual practices of the

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state. This will require reporting in 2020 on the state’s performance against the cost growth target,

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demonstrating that healthcare cost analytics can catalyze policy and behavior change, and

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coordinating the cost trend work with the other on-going healthcare reform and data use work in

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Rhode Island.

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(h) WHEREAS, the mission of the Executive Office of Health and Human Services is to

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assure access to high quality and cost-effective services that foster the health, safety, and

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independence of all Rhode Islanders. The complementary responsibility of the RI Office of the

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Health Insurance Commissioner includes addressing the affordability of healthcare and viewing the

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healthcare system as a whole., combining consumer protection and commercial insurer regulation

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with system reform policy-making.

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42-7.5-3 Definitions

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The following words and phrases as used in this chapter shall have the following meaning:

 

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(1)(i) "Contribution enrollee" means an individual residing in this state, with respect to

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whom an insurer administers, provides, pays for, insures, or covers healthcare services, unless

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excepted by this section.

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(ii) "Contribution enrollee" shall not include an individual whose healthcare services are

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paid or reimbursed by Part A or Part B of the Medicare program, a Medicare supplemental policy

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as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. § 1395ss(g)(1), or Medicare

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managed care policy, the federal employees' health benefit program, the Veterans' healthcare

8

program, the Indian health service program, or any local governmental corporation, district, or

9

agency providing health benefits coverage on a self-insured basis;

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(2) "Healthcare services funding contribution" means per capita amount each contributing

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insurer must contribute to support the Health Spending Transparency and Containment Program

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funded by the method established under this section, with respect to each contribution enrollee;

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(3)(i) "Insurer" means all persons offering, administering, and/or insuring healthcare

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services, including, but not limited to:

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(A) Policies of accident and sickness insurance, as defined by chapter 18 of title 27:

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(B) Nonprofit hospital or medical-service plans, as defined by chapters 19 and 20 of title

17

27;

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(C) Any person whose primary function is to provide diagnostic, therapeutic, or preventive

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services to a defined population on the basis of a periodic premium;

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(D) All domestic, foreign, or alien insurance companies, mutual associations, and

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organizations;

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(E) Health maintenance organizations, as defined by chapter 41 of title 27;

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(F) All persons providing health benefits coverage on a self-insurance basis;

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(G) All third-party administrators described in chapter 20.7 of title 27; and

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(H) All persons providing health benefit coverage under Title XIX of the Social Security

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Act (Medicaid) as a Medicaid managed care organization offering managed Medicaid.

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(ii) "Insurer" shall not include any nonprofit dental service corporation as defined in § 27-

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20.1-2, nor any insurer offering only those coverages described in § 42-7.5-7.

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(4) "Person" means any individual, corporation, company, association, partnership, limited

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liability company, firm, state governmental corporations, districts, and agencies, joint stock

31

associations, trusts, and the legal successor thereof.

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(5) "Secretary" means the secretary of health and human services.

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42-7.5-4. Imposition of health spending transparency and containment funding

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contribution.

 

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(a) Each insurer is required to pay the health spending transparency and containment

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funding contribution for each contribution enrollee of the insurer at the time the contribution is

3

calculated and paid, at the rate set forth in this section.

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(1) Beginning October 1, 2020, the secretary shall set the health spending transparency and

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containment funding contribution each fiscal year in an amount not to exceed one (1) dollar per

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contribution enrollee of all insurers.

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(2) The contribution set forth herein shall be in addition to any other fees or assessments

8

upon the insurer allowable by law.

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(b) The contribution shall be paid by the insurer; provided, however, a person providing

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health benefits coverage on a self-insurance basis that uses the services of a third-party

11

administrator shall not be required to make a contribution for a contribution enrollee where the

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contribution on that enrollee has been or will be made by the third-party administrator.

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42-7.5-5. Returns and payment.

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(a) Every insurer required to make a contribution shall, on or before the last day of January

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of each year, beginning January of 2021, make a return to the secretary together with payment of

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the annual health spending transparency and containment funding contribution.

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(b) All returns shall be signed by the insurer required to make the contribution, or by its

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authorized representative, subject to the pains and penalties of perjury.

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(c) If a return shows an overpayment of the contribution due, the secretary shall refund or

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credit the overpayment to the insurer required to make the contribution.

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42-7.5-6. Method of payment and deposit of contribution.

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(a) The payments required by this chapter may be made by electronic transfer of monies to

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the general treasurer.

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(b) The general treasurer shall take all steps necessary to facilitate the transfer of monies

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to the health spending transparency and containment funding account established in § 42-7.5-8 in

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the amount described in § 42-7.5-3.

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(c) The general treasurer shall provide the secretary with a record of any monies transferred

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and deposited.

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42-7.5-7. Rules and regulations.

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The secretary is authorized to make and promulgate rules, regulations, and procedures not

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inconsistent with state law and fiscal procedures as he or she deems necessary for the proper

32

administration of this chapter.

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42-7.5-8. Excluded coverage from the health spending transparency and containment

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funding act.

 

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(a) In addition to any exclusion and exemption contained elsewhere in this chapter, this

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chapter shall not apply to insurance coverage providing benefits for, nor shall an individual be

3

deemed a contribution enrollee solely by virtue of receiving benefits for the following:

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(1) Hospital confinement indemnity;

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(2) Disability income;

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(3) Accident only;

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(4) Long-term care;

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(5) Medicare supplement;

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(6) Limited benefit health;

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(7) Specified disease indemnity;

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(8) Sickness or bodily injury or death by accident or both; or

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(9) Other limited benefit policies.

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42-7.5-9. Health Spending Transparency and Containment Account.

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There is created a restricted receipt account to be known as the “Health Spending

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Transparency and Containment Account.” All money in the account shall be utilized by the

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executive office of health and human services, with the advice of and in coordination with the

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Office of the Health Insurance Commissioner, to effectuate the requirements described in § 42-7.5-

18

9.

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(a) All money received pursuant to this section shall be deposited in the Health Spending

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Transparency and Containment account. The general treasurer is authorized and directed to draw

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his or her orders on the account upon receipt of properly authenticated vouchers from the executive

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office of health and human services.

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(b) The Health Spending Transparency and Containment Account shall be exempt from

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the indirect cost recovery provisions of § 35-4-27.

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42-7.5-10. Health Spending Transparency and Containment Program Requirements.

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(a) The Health Spending Transparency and Containment Program (“Program”) is hereby

27

created to utilize health care claims data to help reduce health care costs.

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(b) The Program shall include the maintenance of an annual Health Care Cost Growth

29

Target that will be used as a voluntary benchmark to measure Rhode Island health care spending

30

performance relative to the target, which performance shall be publicly reported annually.

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(c) The Program will use data to determine what factors are causing increased health

32

spending in the state, and to create actionable analysis to drive changes in practice and policy and

33

develop cost reduction strategies.

 

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(d) Annual reports shall be made public and recommendations shall be issued to the

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Governor and the General Assembly.

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SECTION 15: This article shall take effect upon passage.

 

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