ARTICLE 15

RELATING TO HEALTHCARE REFORM

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

amended by adding thereto the following chapter:

CHAPTER 37.8

THE INTERSTATE MEDICAL LICENSURE COMPACT

     5-37.8-1. Short title.

     This chapter shall be known and may be cited as the "interstate medical licensure compact

act."

5-37.8-2. Purpose.

In order to strengthen access to health care, and in recognition of the advances in the

delivery of health care, the member states of the interstate medical licensure compact have allied

in common purpose to develop a comprehensive process that complements the existing licensing

and regulatory authority of state medical boards, provides a streamlined process that allows

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

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

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

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

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

under the jurisdiction of the state medical board where the patient is located. State medical boards

that participate in the compact retain the jurisdiction to impose an adverse action against a license

to practice medicine in that state issued to a physician through the procedures in the compact.

5-37.8-3. Definitions.

As used in this chapter, the following words and terms shall have the following meanings:

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

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

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

pursuant to § 5-37.8-12.

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

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

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

final for purposes of disciplinary action by a member board.

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

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

     (5) "Interstate commission" means the interstate commission created pursuant to § 5-37.8-

12.

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

licensure compact created pursuant to this chapter.

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

medicine, which would be unlawful without the authorization.

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

and osteopathic medicine within a member state.

     (9) "Member board" means the Rhode Island board of medical licensure and discipline.

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

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

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

with the medical practice act of this state.

     (12) "Physician" means any person who:

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

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

International Medical Education Directory or its equivalent;

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

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

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

equivalent examination for licensure purposes;

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

Council for Graduate Medical Education or the American Osteopathic Association;

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

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

Osteopathic Specialists;

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

a member board;

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

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

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

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

non-payment of fees related to a license;

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

state or the United States Drug Enforcement Administration; and

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

any state, federal, or foreign jurisdiction.

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

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

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

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

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

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

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

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

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

registration and participation in the compact.

5-37.8-4. Eligibility.

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

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

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

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

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

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

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

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

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

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

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

or

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

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

residence for purpose of federal income tax.

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

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

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

another member state as the state of principal license.

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

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

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

principal license.

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

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

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

eligibility, to the interstate commission.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

unrestricted license within the member state.

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

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

redesignation of a new state of principal licensure.

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

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

5-37.8-7. Fees for expedited licensure.

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

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

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

licenses.

5-37.8-8. Renewal and continued participation.

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

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

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

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

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

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

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

nonpayment of fees related to a license; and

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

or the United States Drug Enforcement Administration.

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

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

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

license and distribute the fees to the applicable member board.

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

the physician's license.

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

process will be distributed to all member boards.

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

obtained through the compact.

5-37.8-9. Coordinated information system.

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

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

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

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

received an expedited license through the compact.

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

necessary and proper by rule of the interstate commission.

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

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

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

upon request of another member board.

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

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

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

sharing of information by member boards.

5-37.8-10. Joint investigations.

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

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

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

joint investigations of physicians licensed by the member boards.

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

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

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

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

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

to practice medicine.

5-37.8-11. Disciplinary actions.

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

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

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

that state.

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

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

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

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

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

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

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

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

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

fact decided, and:

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

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

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

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

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

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

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

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

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

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

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

consistent with the medical practice act of that state.

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

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

commission".

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

licensure compact, which is a discretionary state function.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

telecommunication or electronic communication.

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

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

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

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

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

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

     (h) The interstate commission shall not be subject to the requirements of the Rhode Island

Open Meetings Act, R.I. Gen. Laws §§ 42-46-1 et seq., but rather shall adhere to the requirements

stated in this chapter. The interstate commission shall provide public notice of all meetings and all

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

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

meeting would be likely to:

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

commission;

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

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

confidential;

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

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

unwarranted invasion of personal privacy;

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

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

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

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

record of any roll call votes.

     (j) The interstate commission shall not be subject to the requirements of the Rhode Island

Access to Public Records Act, R.I. Gen. Laws §§ 38-2-1 et seq., but rather shall adhere to the

requirements stated in this chapter. The interstate commission shall make its information and

official records, to the extent not otherwise designated in the compact or by its rules, available to

the public for inspection.

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

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

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

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

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

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

such duties as necessary.

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

administration of the compact.

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

shall have the duty and power to:

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

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

in the compact (such promulgation not being subject to the requirements of the Rhode Island

Administrative Procedures Act, R.I. Gen. Laws §§ 42-35-1 et seq., but rather adhering to the

requirements stated in this chapter);

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

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

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

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

the use of judicial process;

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

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

in carrying out its powers and duties;

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

organization, and ongoing activities of the interstate commission;

     (7) Establish and maintain one or more offices;

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

     (9) Purchase and maintain insurance and bonds;

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

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

their compensation;

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

compensation, and qualifications of personnel;

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

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

established by the interstate commission;

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

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

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

property, real, personal, or mixed;

     (15) Establish a budget and make expenditures;

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

commission;

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

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

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

commission;

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

implementation, and its operation;

     (19) Maintain records in accordance with the bylaws;

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

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

the compact.

5-37.8-14. Finance powers.

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

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

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

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

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

rule binding upon all member states.

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

funds adequate to meet the same.

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

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

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

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

report of the interstate commission.

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

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

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

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

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

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

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

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

commission.

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

commission.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

wanton misconduct of such person.

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

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

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

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

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

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

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

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

on the part of such person.

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

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

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

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

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

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

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

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

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

(a) The interstate commission shall not be subject to the requirements of the Rhode Island

Administrative Procedures Act, R.I. Gen. Laws § 42-35-1 et seq., but rather shall adhere to the

requirements stated in this chapter. The interstate commission shall promulgate reasonable rules

in order to effectively and efficiently achieve the purposes of the compact. Notwithstanding the

foregoing, in the event the interstate commission exercises its rulemaking authority in a manner

that is beyond the scope of the purposes of the compact, or the powers granted hereunder, then such

an action by the interstate commission shall be invalid and have no force or effect.

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

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

procedure act" of 2010, and subsequent amendments thereto.

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

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

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

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

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

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

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

commission.

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

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

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

compact’s purposes and intent. Unless otherwise expressly stated herein, the provisions of the

compact and the rules promulgated hereunder shall have standing as statutory law but shall not

override existing state authority to regulate the practice of medicine.

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

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

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

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

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

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

the interstate commission, the compact, or promulgated rules.

5-37.8-18. Enforcement of interstate compact.

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

provisions and rules of the compact.

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

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

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

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

bylaws, against a member state in default. 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 attorney's fees.

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

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

regulation of a profession.

5-37.8-19. Default procedures.

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

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

of the interstate commission promulgated under the compact.

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

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

rules, the interstate commission shall:

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

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

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

default; and

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

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

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

privileges, and benefits conferred by the compact shall terminate 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 the default.

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

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

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

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

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

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

a member state.

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

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

performance of which extends beyond the effective date of termination.

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

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

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

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

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

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

such litigation including reasonable attorney's fees.

5-37.8-20. Dispute resolution.

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

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

boards.

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

binding dispute resolution as appropriate.

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

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

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

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

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

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

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

by all states.

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

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

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

the member states.

5-37.8-22. Withdrawal.

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

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

repealing the statute which enacted the compact into law.

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

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

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

state.

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

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

withdrawing state.

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

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

37.822(c).

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

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

beyond the effective date of withdrawal.

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

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

commission.

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

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

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

5-37.8-23. Dissolution.

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

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

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

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

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

5-37.8-24. Severability and construction.

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

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

enforceable.

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

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

interstate compacts to which the states are members.

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

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

inconsistent with the compact.

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

of the conflict.

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

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

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

in accordance with their terms.

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

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

with the constitutional provision in question in that member state.

     SECTION 2. 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. The commission shall not be subject to the

requirements of the Rhode Island Administrative Procedures Act, R.I. Gen. Laws §§ 42-35-1 et

seq., but rather shall adhere to the requirements stated in this chapter. 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

     (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

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.

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

(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

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 in which 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 pursue any other remedies available under federal or state law.

     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,

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

been notified and had an opportunity to respond.

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

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 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.

     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.

     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.

     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.

     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 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 retaining 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

retaining 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

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 singlestate

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,

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.

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

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 subsection 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.

     (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 data base

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

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

reasons for such denials, to the coordinated licensure information system. 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 and participation in nonpublic or

confidential alternative programs 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

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. The commission shall not be

subject to the requirements of the Rhode Island Open Meetings Act, R.I. Gen. Laws §§ 42-46-1et

seq. and/or the Rhode Island Access to Public Records Act, R.I. Gen. Laws §§ 38-2-1 et seq., but

rather shall adhere to the requirements stated in this chapter.

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

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;

     (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 and 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;

     (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

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

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

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 4. 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

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 acts 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 5. Title 5 of the General Laws entitled “Business and Professions” is hereby

amended by adding thereto the following chapter:

CHAPTER 44.1

PSYCHOLOGY INTERJURISDICTIONAL COMPACT

     5-44.1-1. Short title. – This chapter shall be known and may be cited as the psychology

interjurisdictional compact act.

     5.44-.1-2. Purpose.

     WHEREAS, states license psychologists, in order to protect the public through verification

of education, training and experience and ensure accountability for professional practice; and

     WHEREAS, this compact is intended to regulate the day to day practice of telepsychology

(i.e. the provision of psychological services using telecommunication technologies) by

psychologists across state boundaries in the performance of their psychological practice as assigned

by an appropriate authority; and

     WHEREAS, this compact is intended to regulate the temporary in-person, face-to-face

practice of psychology by psychologists across state boundaries for 30 days within a calendar year

in the performance of their psychological practice as assigned by an appropriate authority;

     WHEREAS, this compact is intended to authorize state psychology regulatory authorities

to afford legal recognition, in a manner consistent with the terms of the compact, to psychologists

licensed in another state;

     WHEREAS, this compact recognizes that states have a vested interest in protecting the

public’s health and safety through their licensing and regulation of psychologists and that such state

regulation will best protect public health and safety;

     WHEREAS, this compact does not apply when a psychologist is licensed in both the home

and receiving states; and

     WHEREAS, this compact does not apply to permanent in-person, face-to-face practice, it

does allow for authorization of temporary psychological practice.

     Consistent with these principles, this compact is designed to achieve the following

purposes and objectives:

     (1) Increase public access to professional psychological services by allowing for

telepsychological practice across state lines as well as temporary in-person, face-to-face services

into a state which the psychologist is not licensed to practice psychology;

     (2) Enhance the states’ ability to protect the public’s health and safety, especially

client/patient safety;

     (3) Encourage the cooperation of compact states in the areas of psychology licensure and

regulation;

     (4) Facilitate the exchange of information between compact states regarding psychologist