2023 -- H 5737 SUBSTITUTE A

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LC001983/SUB A/2

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSE LICENSURE COMPACT

     Introduced By: Representatives Kennedy, Azzinaro, Abney, Kazarian, Diaz, Edwards,
and Vella-Wilkinson

     Date Introduced: February 21, 2023

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. 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, 5-34.3-

10, 5-34.3-12 and 5-34.3-14 of the General Laws in Chapter 5-34.3 entitled "Nurse Licensure

Compact" are hereby amended to read as follows:

     5-34.3-3. Legislative findings.

     (a) The general assembly finds and declares that:

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

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

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

result in injury or harm to the public;

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

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

among states in the areas of nurse licensure and regulations;

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

licensure laws difficult and complex; and

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

cumbersome and redundant to both nurses and states.; and

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

and public health benefits.

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

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

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

regulation;

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

regulation, investigation and adverse actions;

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

jurisdiction; and

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

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

mutual recognition of party state licenses.;

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

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

requirements.

     5-34.3-4. Definitions.

     As used in this chapter:

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

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

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

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

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

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

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

approved by a nurse licensing board.

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

administrators, the governing body of the nurse licensure compact.

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

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

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

controlled by state nurse licensing boards.

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

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

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

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

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

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been notified and had an opportunity to respond.

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

full and unrestricted practice of nursing imposed by a licensing board.

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

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

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

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

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

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

nurse licenses.

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

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

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

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

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

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

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

multistate licensure privilege.

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

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

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

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

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

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

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

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

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

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

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

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

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

remote states or the licensing boards thereof.

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

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

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in any other party state.

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

Columbia.

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

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

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

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

the home state.

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

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

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

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

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

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

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

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

     (b) Party states may, in accordance with state due process laws, limit or revoke the

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

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

party state takes such action, it shall promptly notify the administrator of the coordinated licensure

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

promptly notify the home state of any such actions by remote states.

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

state in which the patient is located at the time care is rendered. In addition, the practice of nursing

is not limited to patient care, but shall include all nursing practice as defined by the state practice

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

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

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

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

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

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

nurse authorization.

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

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

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

state unless explicitly agreed to by that party state.

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

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

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

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

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

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

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

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

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

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

multistate license in the home state:

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

all other applicable state laws;

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

LPN/VN prelicensure education program; or

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

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

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

licensing board-approved prelicensure education program;

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

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

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

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

predecessor, as applicable;

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

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

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

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

maintaining that state's criminal records;

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

offense under applicable state or federal criminal law;

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

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

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

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

alternative program; and

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

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

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

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

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

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

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

of any such actions by remote states.

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

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

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

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

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

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

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

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

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

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

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

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

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

that:

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

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

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

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

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

applicable rules adopted by the commission.

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

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

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

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

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

license.

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

the home state.

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

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

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

new home state’s licensing board.

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

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

license from the former home state is no longer valid;

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

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

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

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

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

multistate licensure privilege to practice in other party states.

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

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

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

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

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

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

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

at a time.

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

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

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

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

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

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

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

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

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

valid only in the former home state.

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

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

boards shall have the authority to:

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

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

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

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

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

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

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

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

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

evidence are located.

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

state;

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

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

that party state.

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

issued by the home state.

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

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

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

determine appropriate action.

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

practice within that party state.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

use the results in making licensure decisions.

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

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

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

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

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

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

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

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

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

order.

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

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

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

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

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

information system and exchange of information.

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

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

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

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

coordination of nurse licensure and enforcement efforts.

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

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

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

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

     (b) The commission, in consultation with the administrator of the coordinated licensure

information system, shall formulate necessary and proper procedures for the identification,

collection and exchange of information under this compact.

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

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

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

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

state law.

     (c)(d) Current significant investigative information shall be transmitted through the

coordinated licensure information system only to party state licensing boards.

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

contributing information to the coordinated licensure information system may designate

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

without the express permission of the contributing state.

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

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

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

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

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

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

shall also be expunged from the coordinated licensure information system.

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

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

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

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

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

     (1) Identifying information;

     (2) Licensure data;

     (3) Information related to alternative program participation; and

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

by commission rules.

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

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information requested by another party state.

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

the interstate commission of nurse licensure compact administrators.

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

the administrator of this compact for his/her state.

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

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

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

participation information to facilitate the administration of this compact.

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

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

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

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

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

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

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

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

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

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

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

     (b) Membership, voting and meetings:

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

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

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

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

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

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

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

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

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

or other means of communication.

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

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

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

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

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

discuss:

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

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

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

personnel practices and procedures;

     (iii) Current, threatened or reasonably anticipated litigation;

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

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

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

confidential;

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

clearly unwarranted invasion of personal privacy;

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

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

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

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

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

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

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

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

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

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

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

the commission or order of a court of competent jurisdiction.

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

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

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

     (1) Establishing the fiscal year of the commission;

     (2) Providing reasonable standards and procedures:

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

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

commission;

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

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

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

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

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

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

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

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

the officers of the commission;

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

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

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

commission; and

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

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

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

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

convenient form on the website of the commission.

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

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

of this compact and the bylaws.

     (g) The commission shall have the following powers:

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

administration of this compact. The rules shall have the force and effect of law and shall be binding

in all party states;

     (2) To bring and prosecute legal proceedings or actions in the name of the commission,

provided that the standing of any licensing board to sue or be sued under applicable law shall not

be affected;

     (3) To purchase and maintain insurance and bonds;

     (4) To borrow, accept or contract for services of personnel, including, but not limited to,

employees of a party state or nonprofit organizations;

     (5) To cooperate with other organizations that administer state compacts related to the

regulation of nursing, including, but not limited to, sharing administrative or staff expenses, office

space or other resources;

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     (6) To hire employees, elect or appoint officers, fix compensation, define duties, grant such

individuals appropriate authority to carry out the purposes of this compact, and to establish the

commission's personnel policies and programs relating to conflicts of interest, qualifications of

personnel and other related personnel matters;

     (7) To accept any and all appropriate donations, grants and gifts of money, equipment,

supplies, materials and services, and to receive, utilize and dispose of the same; provided that at all

times the commission shall avoid any appearance of impropriety or conflict of interest;

     (8) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold,

improve or use, any property, whether real, personal or mixed; provided that at all times the

commission shall avoid any appearance of impropriety;

     (9) To sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of

any property, whether real, personal or mixed;

     (10) To establish a budget and make expenditures;

     (11) To borrow money;

     (12) To appoint committees, including advisory committees comprised of administrators,

state nursing regulators, state legislators or their representatives, and consumer representatives, and

other such interested persons;

     (13) To provide and receive information from, and to cooperate with, law enforcement

agencies;

     (14) To adopt and use an official seal; and

     (15) To perform such other functions as may be necessary or appropriate to achieve the

purposes of this compact consistent with the state regulation of nurse licensure and practice.

     (h) Financing of the commission.

     (1) The commission shall pay, or provide for the payment of, the reasonable expenses of

its establishment, organization and ongoing activities;

     (2) The commission may also levy on and collect an annual assessment from each party

state to cover the cost of its operations, activities and staff in its annual budget as approved each

year. The aggregate annual assessment amount, if any, shall be allocated based upon a formula to

be determined by the commission, which shall promulgate a rule that is binding upon all party

states;

     (3) The commission shall not incur obligations of any kind prior to securing the funds

adequate to meet the same; nor shall the commission pledge the credit of any of the party states,

except by, and with the authority of, such party state;

     (4) The commission shall keep accurate accounts of all receipts and disbursements. The

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receipts and disbursements of the commission shall be subject to the audit and accounting

procedures established under its bylaws. However, all receipts and disbursements of funds handled

by the commission shall be audited yearly by a certified or licensed public accountant, and the

report of the audit shall be included in and become part of the annual report of the commission.

     (i) Qualified immunity, defense and indemnification.

     (1) The administrators, officers, executive director, employees and representatives of the

commission shall be immune from suit and liability, either personally or in their official capacity,

for any claim for damage to or loss of property or personal injury or other civil liability caused by

or arising out of any actual or alleged act, error or omission that occurred, or that the person against

whom the claim is made had a reasonable basis for believing occurred, within the scope of

commission employment, duties or responsibilities; provided that nothing in this paragraph shall

be construed to protect any such person from suit or liability for any damage, loss, injury or liability

caused by the intentional, willful or wanton misconduct of that person;

     (2) The commission shall defend any administrator, officer, executive director, employee

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

any actual or alleged act, error or omission that occurred within the scope of commission

employment, duties or responsibilities, or that the person against whom the claim is made had a

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

responsibilities; provided that nothing herein shall be construed to prohibit that person from

retaining their own counsel; and provided further that the actual or alleged act, error or omission

did not result from that person’s intentional, willful or wanton misconduct;

     (3) The commission shall indemnify and hold harmless any administrator, officer,

executive director, employee or representative of the commission for the amount of any settlement

or judgment obtained against that person arising out of any actual or alleged act, error or omission

that occurred within the scope of commission employment, duties or responsibilities, or that such

person had a reasonable basis for believing occurred within the scope of commission employment,

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

from the intentional, willful or wanton misconduct of that person.

     5-34.3-12. Entry into force, withdrawal and amendment. Effective date, withdrawal

and amendment.

     (a) This compact shall enter into force and become effective as to any state when it has

been enacted into the laws of that state. Any party state may withdraw from this compact by

enacting a statute repealing the same, but no such withdrawal shall take effect until six (6) months

after the withdrawing state has given notice of the withdrawal to the executive heads of all other

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party states.

     (b) No withdrawal shall affect the validity or applicability by the licensing boards of states

remaining party to the compact of any report of adverse action occurring prior to the withdrawal.

     (c) Nothing contained in this compact shall be construed to invalidate or prevent any nurse

licensure agreement or other cooperative arrangement between a party state and a non-party state

that is made in accordance with the other provisions of this compact.

     (d) This compact may be amended by the party states. No amendment to this compact shall

become effective and binding upon the party states unless and until it is enacted into the laws of all

party states.

     (a) This compact shall become effective upon passage. All party states to this compact, that

also were parties to the prior nurse licensure compact superseded by this compact ("prior

compact"), shall be deemed to have withdrawn from said prior compact within six (6) months after

the effective date of this compact.

     (b) Each party state to this compact shall continue to recognize a nurse's multistate

licensure privilege to practice in that party state issued under the prior compact until such party

state has withdrawn from the prior compact.

     (c) Any party state may withdraw from this compact by enacting a statute repealing the

same. A party state's withdrawal shall not take effect until six (6) months after enactment of the

repealing statute.

     (d) A party state's withdrawal or termination shall not affect the continuing requirement of

the withdrawing or terminated state's licensing board to report adverse actions and significant

investigations occurring prior to the effective date of such withdrawal or termination.

     (e) Nothing contained in this compact shall be construed to invalidate or prevent any nurse

licensure agreement or other cooperative arrangement between a party state and a non-party state

that is made in accordance with the other provisions of this compact.

     (f) This compact may be amended by the party states. No amendment to this compact shall

become effective and binding upon the party states unless and until it is enacted into the laws of all

party states.

     (g) Representatives of non-party states to this compact shall be invited to participate in the

activities of the commission, on a nonvoting basis, prior to the adoption of this compact by all

states.

     5-34.3-14. Construction and severability.

     (a) This compact shall be liberally construed so as to effectuate the purposes thereof. The

provisions of this compact shall be severable and if any phrase, clause, sentence or provision of

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this compact is declared to be contrary to the constitution of any party state or of the United States

or the applicability thereof to any government, agency, person or circumstance is held invalid, the

validity of the remainder of this compact and the applicability thereof to any government, agency,

person or circumstance shall not be affected thereby. If this compact shall be held contrary to the

constitution of any state party thereto, the compact shall remain in full force and effect as to the

remaining party states and in full force and effect as to the party state affected as to all severable

matters.

     (b) In the event party states find a need for settling disputes arising under this compact:

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

comprised of an individual appointed by the compact administrator in the home state; an individual

appointed by the compact administrator in the remote state(s) involved; and an individual mutually

agreed upon by the compact administrators of all the party states involved in the dispute.

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

     SECTION 2. Sections 5-34.3-7 and 5-34.3-11 of the General Laws in Chapter 5-34.3

entitled "Nurse Licensure Compact" are hereby repealed.

     5-34.3-7. Adverse actions.

     In addition to the provisions described in § 5-34.3-5, the following provisions apply:

     (1) The licensing board of a remote state shall promptly report to the administrator of the

coordinated licensure information system any remote state actions including the factual and legal

basis for such action, if known. The licensing board of a remote state shall also promptly report any

significant current investigative information yet to result in a remote state action. The administrator

of the coordinated licensure information system shall promptly notify the home state of any such

reports.

     (2) The licensing board of a party state shall have the authority to complete any pending

investigations for a nurse who changes primary state of residence during the course of such

investigations. It shall also have the authority to take appropriate action(s), and shall promptly

report the conclusions of such investigations to the administrator of the coordinated licensure

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

promptly notify the new home state of any such actions.

     (3) A remote state may take adverse action affecting the multistate licensure privilege to

practice within that party state. However, only the home state shall have the power to impose

adverse action against the license issued by the home state.

     (4) For purposes of imposing adverse action, the licensing board of the home state shall

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

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

determine appropriate action.

     (5) The home state may take adverse action based on the factual findings of the remote

state, so long as each state follows its own procedures for imposing such adverse action.

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

alternative program may be used in lieu of licensure action and that such participation shall remain

non-public if required by the party state’s laws. Party states must require nurses who enter any

alternative programs to agree not to practice in any other party state during the term of the

alternative program without prior authorization from such other party state.

     5-34.3-11. Immunity.

     No party state or the officers or employees or agents of a party state’s nurse licensing board

who act in accordance with the provisions of this compact shall be liable on account of any act or

omission in good faith while engaged in the performance of their duties under this compact. Good

faith in this article shall not include willful misconduct, gross negligence, or recklessness.

     SECTION 3. Chapter 5-34.3 of the General Laws entitled "Nurse Licensure Compact" is

hereby amended by adding thereto the following sections:

     5-34.3-10.1. Rulemaking.

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

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

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

of this compact.

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

commission.

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

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

the commission shall file a notice of proposed rulemaking:

     (1) On the website of the commission; and

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

otherwise publish proposed rules.

     (d) The notice of proposed rulemaking shall include:

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

and voted upon;

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

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

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

intention to attend the public hearing and any written comments.

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

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

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

or amendment.

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

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

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

and a copy will be made available upon request.

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

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

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

of the proposed rule.

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

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

comments received.

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

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

record and the full text of the rule.

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

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

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

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

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

adopted immediately in order to:

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

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

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

law or rule.

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

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

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

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

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

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

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

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

     5-34.3-10.2. Oversight, dispute resolution, enforcement and department of health

obligations.

     (a) Oversight.

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

appropriate to effectuate this compact's purposes and intent.

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

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

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

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

compact or promulgated rules.

     (b) Default, technical assistance and termination.

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

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

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

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

and

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

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

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

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

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

incurred during the period of default;

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

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

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

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

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

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

obligations that extend beyond the effective date of termination;

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

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

the commission and the defaulting state;

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

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

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

reasonable attorneys' fees.

     (c) Dispute Resolution.

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

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

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

dispute resolution for disputes, as appropriate;

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

this compact:

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

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

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

involved in the dispute;

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

     (d) Enforcement.

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

provisions and rules of this compact;

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

for the District of Columbia or the federal district where the commission has its principal offices,

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

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

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

costs of such litigation, including reasonable attorneys' fees;

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

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

     (e) Data collection - Reporting.

     (1) Data collection. Commencing in calendar year 2025, Rhode Island employers who

employ registered nurses or licensed practical or vocational nurses shall report to the Rhode Island

department of health (“RIDOH”), not later than January 30 of each year, the following information

and data for the employer, for the period of the immediately preceding calendar year (the “reporting

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period”):

     (i) The number of new hires of registered nurses during the reporting period;

     (ii) The number of new hires of registered nurses who hold multistate licenses and are not

licensed in Rhode Island during the reporting period;

     (iii) The number of new hires of licensed practical nurses and vocational nurses during the

reporting period;

     (iv) The number of new hires of licensed practical nurses and vocational nurses who hold

multistate licenses and are not licensed in Rhode Island during the reporting period;

     (v) The total number of registered nurses employed during the reporting period; and

     (vi) The total number of licensed practical nurses and vocational nurses employed during

the reporting period.

     (2) Reporting. RIDOH shall annually compile the data received from employers pursuant

to subsection (a)(1) of this section and prepare a report that aggregates the information, and

disaggregated by new hires and retained employees, for registered nurses, license practical nurses,

and vocational nurses, from the results of the data collected pursuant to subsection (e)(1) of this

section. This compiled data shall be incorporated into a report which shall be provided to the

governor, the speaker of the house, and the president of the senate, not later than March 1 of each

year, with the first report due on March 1, 2025.

     (f) Nurse license fees. RIDOH shall not increase the amount of any licensing fee for

registered nurses or a licensed practical nurse or vocational nurse, including, but not limited to,

license renewals, for a period of three (3) years commencing on January 1, 2024.

     SECTION 4. This act shall take effect on January 1, 2024, and shall sunset and expire on

January 1, 2027.

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LC001983/SUB A/2

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- NURSE LICENSURE COMPACT

***

     This act would amend the interstate nurse licensure compact and would adopt an enhanced

and more comprehensive version of the compact, to allow nurses to hold a multi-state license which

would allow them to practice across state lines without having to obtain multiple licenses.

     This act would take effect on January 1, 2024, and would sunset and expire on January 1,

2027.

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LC001983/SUB A/2

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