2020 Second Extraordinary Session ENROLLED SENATE BILL NO. 27 BY SENATOR PEACOCK 1 AN ACT 2 To amend and reenact R.S. 37:1272(2) and to enact Part I - C of Chapter 15 of Title 37 of 3 the Louisiana Revised Statutes of 1950, to be comprised of R.S. 37:1310.1, relative 4 to the practice of medicine; to provide for certain qualifications of applicants who 5 wish to practice medicine; to provide for authority to enter into the Interstate Medical 6 Licensure Compact; to provide for enactment of the model language required to 7 participate in the compact; to provide for definitions; to provide for eligibility, 8 application, and renewal process; to provide for a coordinated information system; 9 to provide for investigations and disciplinary actions; to provide for membership, 10 powers, and duties of the Interstate Medical Licensure Compact Commission; to 11 provide for oversight and enforcement of the compact; to provide for withdrawal and 12 dissolution of the compact; to provide for severability; to provide for an effective 13 date; and provide for related matters. 14 Be it enacted by the Legislature of Louisiana: 15 Section 1. R.S. 37:1272(2) is hereby amended and reenacted and Part I - C of 16 Chapter 15 of Title 37 of the Louisiana Revised Statutes of 1950, comprised of R.S. 17 37:1310.1, is hereby enacted to read as follows: 18 §1272. Qualifications of applicants 19 Any person who wishes to practice medicine shall: 20 * * * 21 (2) Be a citizen of the United States or possess valid and current legal 22 authority to reside and work in the United States duly issued by the 23 commissioner of the Immigration and Naturalization Service of the United 24 States pursuant to the federal Immigration and Nationality Act and the 25 commissioner's regulations thereunder; 26 * * * ACT No. 35 Page 1 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 PART I - C. INTERSTATE MEDICAL LICENSURE COMP ACT 2 §1310.1. Interstate Medical Licensure Compact; adoption 3 The Interstate Medical Licensure Compact is hereby recognized and 4 enacted into law and entered into by this state with all states legally joining 5 therein in the form substantially as follows: 6 SECTION 1. PURPOSE 7 In order to strengthen access to health care, and in recognition of the 8 advances in the delivery of health care, the member states of the Interstate 9 Medical Licensure Compact have allied in common purpose to develop a 10 comprehensive process that complements the existing licensing and regulatory 11 authority of state medical boards, provides a streamlined process that allows 12 physicians to become licensed in multiple states, thereby enhancing the 13 portability of a medical license and ensuring the safety of patients. The compact 14 creates another pathway for licensure and does not otherwise change a state's 15 existing medical practice act. The compact also adopts the prevailing standard 16 for licensure and affirms that the practice of medicine occurs where the patient 17 is located at the time of the physician-patient encounter, and therefore, requires 18 the physician to be under the jurisdiction of the state medical board where the 19 patient is located. State medical boards that participate in the compact retain 20 the jurisdiction to impose an adverse action against a license to practice 21 medicine in that state issued to a physician through the procedures in the 22 compact. 23 SECTION 2. DEFINITIONS 24 In this compact: 25 (a) "Bylaws" means those bylaws established by the Interstate 26 Commission pursuant to Section 11. 27 (b) "Commissioner" means the voting representative appointed by each 28 member board pursuant to Section 11. 29 (c) "Conviction" means a finding by a court that an individual is guilty 30 of a criminal offense through adjudication, or entry of a plea of guilt or no Page 2 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 contest to the charge by the offender. Evidence of an entry of a conviction of a 2 criminal offense by the court shall be considered final for purposes of 3 disciplinary action by a member board. 4 (d) "Expedited license" means a full and unrestricted medical license 5 granted by a member state to an eligible physician through the process set forth 6 in the compact. 7 (e) "Interstate commission" means the interstate commission created 8 pursuant to Section 11. 9 (f) "License" means authorization by a member state for a physician to 10 engage in the practice of medicine, which would be unlawful without 11 authorization. 12 (g) "Medical practice act" means laws and regulations governing the 13 practice of allopathic and osteopathic medicine within a member state. 14 (h) "Member board" means a state agency in a member state that acts 15 in the sovereign interests of the state by protecting the public through licensure, 16 regulation, and education of physicians as directed by the state government. 17 (i) "Member state" means a state that has enacted the compact. 18 (j) "Practice of medicine" means that clinical prevention, diagnosis, or 19 treatment of human disease, injury, or condition requiring a physician to obtain 20 and maintain a license in compliance with the medical practice act of a member 21 state. 22 (k) "Physician" means any person who: 23 (1) Is a graduate of a medical school accredited by the Liaison 24 Committee on Medical Education, the Commission on Osteopathic College 25 Accreditation, or a medical school listed in the International Medical Education 26 Directory or its equivalent; 27 (2) Passed each component of the United States Medical Licensing 28 Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing 29 Examination (COMLEX-USA) within three attempts, or any of its predecessor 30 examinations accepted by a state medical board as an equivalent examination Page 3 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 for licensure purposes; 2 (3) Successfully completed graduate medical education approved by the 3 Accreditation Council for Graduate Medical Education or the American 4 Osteopathic Association; 5 (4) Holds specialty certification or a time-unlimited specialty certificate 6 recognized by the American Board of Medical Specialties or the American 7 Osteopathic Association's Bureau of Osteopathic Specialists; 8 (5) Possesses a full and unrestricted license to engage in the practice of 9 medicine issued by a member board; 10 (6) Has never been convicted, received adjudication, deferred 11 adjudication, community supervision, or deferred disposition for any offense by 12 a court of appropriate jurisdiction; 13 (7) Has never held a license authorizing the practice of medicine 14 subjected to discipline by a licensing agency in any state, federal, or foreign 15 jurisdiction, excluding any action related to non-payment of fees related to a 16 license; 17 (8) Has never had a controlled substance license or permit suspended or 18 revoked by a state or the United States Drug Enforcement Administration; and 19 (9) Is not under active investigation by a licensing agency or law 20 enforcement authority in any state, federal, or foreign jurisdiction. 21 (l) "Offense" means a felony, gross misdemeanor, or crime of moral 22 turpitude. 23 (m) "Rule" means a written statement by the interstate commission 24 promulgated pursuant to Section 12 of the compact that is of general 25 applicability, implements, interprets, or prescribes a policy or provision of the 26 compact, or an organizational, procedural, or practice requirement of the 27 interstate commission, and has the force and effect of statutory law in a member 28 state, and includes the amendment, repeal, or suspension of an existing rule. 29 (n) "State" means any state, commonwealth, district, or territory of the 30 United States. Page 4 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 (o) "State of principal license" means a member state where a physician 2 holds a license to practice medicine and which has been designated as such by 3 the physician for purposes of registration and participation in the compact. 4 SECTION 3. ELIGIBILITY 5 (a) A physician must meet the eligibility requirements as defined in 6 Section 2(k) to receive an expedited license under the terms and provisions of 7 the compact. 8 (b) A physician who does not meet the requirements of Section 2(k) may 9 obtain a license to practice medicine in a member state if the individual 10 complies with all laws and requirements, other than the compact, relating to the 11 issuance of a license to practice medicine in that state. 12 SECTION 4. DESIGNATION OF STATE OF PRINCIPAL LICENSE 13 (a) A physician shall designate a member state as the state of principal 14 license for purposes of registration for expedited licensure through the compact 15 if the physician possesses a full and unrestricted license to practice medicine in 16 that state, and the state is: 17 (1) The state of principal residence for the physician, or 18 (2) The state where at least twenty-five percent of the practice of 19 medicine occurs, or 20 (3) The location of the physician's employer, or 21 (4) If no state qualifies under subsection (1), subsection (2), or subsection 22 (3), the state designated as state of residence for purpose of federal income tax. 23 (b) A physician may redesignate a member state as state of principal 24 license at any time, as long as the state meets the requirements of subsection (a). 25 (c) The interstate commission is authorized to develop rules to facilitate 26 redesignation of another member state as the state of principal license. 27 SECTION 5. APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE 28 (a) A physician seeking licensure through the compact shall file an 29 application for an expedited license with the member board of the state selected 30 by the physician as the state of principal license. Page 5 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 (b) Upon receipt of an application for an expedited license, the member 2 board within the state selected as the state of principal license shall evaluate 3 whether the physician is eligible for expedited licensure and issue a letter of 4 qualification, verifying or denying the physician's eligibility, to the interstate 5 commission. 6 (1) Static qualifications, which include verification of medical education, 7 graduate medical education, results of any medical or licensing examination, 8 and other qualifications as determined by the interstate commission through 9 rule, shall not be subject to additional primary source verification where 10 already primary source verified by the state of principal license. 11 (2) The member board within the state selected as the state of principal 12 license shall, in the course of verifying eligibility, perform a criminal 13 background check of an applicant, including the use of the results of fingerprint 14 or other biometric data checks compliant with the requirements of the Federal 15 Bureau of Investigation, with the exception of federal employees who have 16 suitability determination in accordance with 5 CFR §731.202. 17 (3) Appeal on the determination of eligibility shall be made to the 18 member state where the application was filed and shall be subject to the law of 19 that state. 20 (c) Upon verification in subsection (b), physicians eligible for an 21 expedited license shall complete the registration process established by the 22 interstate commission to receive a license in a member state selected pursuant 23 to subsection (a), including the payment of any applicable fees. 24 (d) After receiving verification of eligibility under subsection (b) and any 25 fees under subsection (c), a member board shall issue an expedited license to the 26 physician. This license shall authorize the physician to practice medicine in the 27 issuing state consistent with the medical practice act and all applicable laws and 28 regulations of the issuing member board and member state. 29 (e) An expedited license shall be valid for a period consistent with the 30 licensure period in the member state and in the same manner as required for Page 6 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 other physicians holding a full and unrestricted license within the member state. 2 (f) An expedited license obtained through the compact shall be 3 terminated if a physician fails to maintain a license in the state of principal 4 licensure for a non-disciplinary reason, without redesignation of a new state of 5 principal licensure. 6 (g) The interstate commission is authorized to develop rules regarding 7 the application process, including payment of any applicable fees, and the 8 issuance of an expedited license. 9 SECTION 6. FEES FOR EXPEDITED LICENSURE 10 (a) A member state issuing an expedited license authorizing the practice 11 of medicine in that state may impose a fee for a license issued or renewed 12 through the compact. 13 (b) The interstate commission is authorized to develop rules regarding 14 fees for expedited licenses. 15 SECTION 7. RENEWAL AND CONTINUED P ARTICIPATION 16 (a) A physician seeking to renew an expedited license granted in a 17 member state shall complete a renewal process with the interstate commission 18 if the physician: 19 (1) Maintains a full and unrestricted license in a state of principal 20 license; 21 (2) Has not been convicted, received adjudication, deferred adjudication, 22 community supervision, or deferred disposition for any offense by a court of 23 appropriate jurisdiction; 24 (3) Has not had a license authorizing the practice of medicine subject to 25 discipline by a licensing agency in any state, federal, or foreign jurisdiction, 26 excluding any action related to non-payment of fees related to a license; and 27 (4) Has not had a controlled substance license or permit suspended or 28 revoked by a state or the United States Drug Enforcement Administration. 29 (b) Physicians shall comply with all continuing professional development 30 or continuing medical education requirements for renewal of a license issued by Page 7 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 a member state. 2 (c) The interstate commission shall collect any renewal fees charged for 3 the renewal of a license and distribute the fees to the applicable member board. 4 (d) Upon receipt of any renewal fees collected in subsection (c), a 5 member board shall renew the physician's license. 6 (e) Physician information collected by the interstate commission during 7 the renewal process will be distributed to all member boards. 8 (f) The interstate commission is authorized to develop rules to address 9 renewal of licenses obtained through the compact. 10 SECTION 8. COORDINATED INF ORMATION SYSTEM 11 (a) The interstate commission shall establish a database of all physicians 12 licensed, or who have applied for licensure, under Section 5. 13 (b) Notwithstanding any other provision of law, member boards shall 14 report to the interstate commission any public action or complaints against a 15 licensed physician who has applied or received an expedited license through the 16 compact. 17 (c) Member boards shall report disciplinary or investigatory information 18 determined as necessary and proper by rule of the interstate commission. 19 (d) Member boards may report any non-public complaint, disciplinary, 20 or investigatory information not required by subsection (c) to the interstate 21 commission. 22 (e) Member boards shall share complaint or disciplinary information 23 about a physician upon request of another member board. 24 (f) All information provided to the interstate commission or distributed 25 by member boards shall be confidential, filed under seal, and used only for 26 investigatory or disciplinary matters. 27 (g) The interstate commission is authorized to develop rules for 28 mandated or discretionary sharing of information by member boards. 29 SECTION 9. JOINT INVESTIGATIONS 30 (a) Licensure and disciplinary records of physicians are deemed Page 8 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 investigative. 2 (b) In addition to the authority granted to a member board by its 3 respective medical practice act or other applicable state law, a member board 4 may participate with other member boards in joint investigations of physicians 5 licensed by the member boards. 6 (c) A subpoena issued by a member state shall be enforceable in other 7 member states. 8 (d) Member boards may share any investigative, litigation, or 9 compliance materials in furtherance of any joint or individual investigation 10 initiated under the compact. 11 (e) Any member state may investigate actual or alleged violations of the 12 statutes authorizing the practice of medicine in any other member state in 13 which a physician holds a license to practice medicine. 14 SECTION 10. DISCIPLINARY ACTIONS 15 (a) Any disciplinary action taken by any member board against a 16 physician licensed through the compact shall be deemed unprofessional conduct 17 which may be subject to discipline by other member boards, in addition to any 18 violation of the medical practice act or regulations in that state. 19 (b) If a license granted to a physician by the member board in the state 20 of principal license is revoked, surrendered or relinquished in lieu of discipline, 21 or suspended, then all licenses issued to the physician by member boards shall 22 automatically be placed, without further action necessary by any member 23 board, on the same status. If the member board in the state of principal license 24 subsequently reinstates the physician's license, a license issued to the physician 25 by any other member board shall remain encumbered until that respective 26 member board takes action to reinstate the license in a manner consistent with 27 the medical practice act of that state. 28 (c) If disciplinary action is taken against a physician by a member board 29 not in the state of principal license, any other member board may deem the 30 action conclusive as to matter of law and fact decided, and: Page 9 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 (1) Impose the same or lesser sanction(s) against the physician so long as 2 such sanctions are consistent with the medical practice act of that state; or 3 (2) Pursue separate disciplinary action against the physician under its 4 respective medical practice act, regardless of the action taken in other member 5 states. 6 (d) If a license granted to a physician by a member board is revoked, 7 surrendered or relinquished in lieu of discipline, or suspended, then any 8 license(s) issued to the physician by any other member board(s) shall be 9 suspended, automatically and immediately without further action necessary by 10 the other member board(s), for ninety days upon entry of the order by the 11 disciplining board, to permit the member board(s) to investigate the basis for 12 the action under the medical practice act of that state. A member board may 13 terminate the automatic suspension of the license it issued prior to the 14 completion of the ninety day suspension period in a manner consistent with the 15 medical practice act of that state. 16 SECTION 11. INTERSTATE MEDICAL LICENSURE 17 COMPACT COMMISSION 18 (a) The member states hereby create the "Interstate Medical Licensure 19 Compact Commission". 20 (b) The purpose of the interstate commission is the administration of the 21 interstate medical licensure compact, which is a discretionary state function. 22 (c) The interstate commission shall be a body corporate and joint agency 23 of the member states and shall have all the responsibilities, powers, and duties 24 set forth in the compact, and such additional powers as may be conferred upon 25 it by a subsequent concurrent action of the respective legislatures of the 26 member states in accordance with the terms of the compact. 27 (d) The interstate commission shall consist of two voting representatives 28 appointed by each member state who shall serve as commissioners. In states 29 where allopathic and osteopathic physicians are regulated by separate member 30 boards, or if the licensing and disciplinary authority is split between separate Page 10 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 member boards, or if the licensing and disciplinary authority is split between 2 multiple member boards within a member state, the member state shall appoint 3 one representative from each member board. A commissioner shall be a(n): 4 (1) Allopathic or osteopathic physician appointed to a member board; 5 (2) Executive director, executive secretary, or similar executive of a 6 member board; or 7 (3) Member of the public appointed to a member board. 8 (e) The interstate commission shall meet at least once each calendar year. 9 A portion of this meeting shall be a business meeting to address such matters as 10 may properly come before the commission, including the election of officers. 11 The chairperson may call additional meetings and shall call for a meeting upon 12 the request of a majority of the member states. 13 (f) The bylaws may provide for meetings of the interstate commission to 14 be conducted by telecommunication or electronic communication. 15 (g) Each commissioner participating at a meeting of the interstate 16 commission is entitled to one vote. A majority of commissioners shall constitute 17 a quorum for the transaction of business, unless a larger quorum is required by 18 the bylaws of the interstate commission. A commissioner shall not delegate a 19 vote to another commissioner. In the absence of its commissioner, a member 20 state may delegate voting authority for a specified meeting to another person 21 from that state who shall meet the requirements of subsection (d). 22 (h) The interstate commission shall provide public notice of all meetings 23 and all meetings shall be open to the public. The interstate commission may 24 close a meeting, in full or in portion, where it determines by a two-thirds vote 25 of the commissioners present that an open meeting would be likely to: 26 (1) Relate solely to the internal personnel practice and procedures of the 27 interstate commission; 28 (2) Discuss matters specifically exempted from disclosure by federal 29 statute; 30 (3) Discuss trade secrets, commercial, or financial information that is Page 11 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 privileged or confidential; 2 (4) Involve accusing a person of a crime, or formally censuring a person; 3 (5) Discuss information of a personal nature where disclosure would 4 constitute a clearly unwarranted invasion of personal privacy; 5 (6) Discuss investigative records compiled for law enforcement purposes; 6 or 7 (7) Specifically relate to the participation in a civil action or other legal 8 proceeding. 9 (i) The interstate commission shall keep minutes which shall fully 10 describe all matters discussed in a meeting and shall provide a full and accurate 11 summary of actions taken, including record of any roll call votes. 12 (j) The interstate commission shall make its information and official 13 records, to the extent not otherwise designated in the compact or by its rules, 14 available to the public for inspection. 15 (k) The interstate commission shall establish an executive committee, 16 which shall include officers, members, and others as determined by the bylaws. 17 The executive committee shall have the power to act on behalf of the interstate 18 commission, with the exception of rulemaking, during periods when the 19 interstate commission is not in session. When acting on behalf of the interstate 20 commission, the executive committee shall oversee the administration of the 21 compact including enforcement and compliance with the provisions of the 22 compact, its bylaws and rules, and other such duties as necessary. 23 (l) The interstate commission shall establish other committees for 24 governance and administration of the compact. 25 SECTION 12. POWERS AND DUTIES OF THE 26 INTERSTATE COMMISSION 27 (a) Oversee and maintain the administration of the compact; 28 (b) Promulgate rules which shall be binding to the extent and in the 29 manner provided for in the compact; 30 (c) Issue, upon the request of a member state or member board, advisory Page 12 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 opinions concerning the meaning or interpretation of the compact, its bylaws, 2 rules, and actions; 3 (d) Enforce compliance with compact provisions, the rules promulgated 4 by the interstate commission, and the bylaws, using all necessary and proper 5 means, including but not limited to the use of judicial process; 6 (e) Establish and appoint committees including, but not limited to, an 7 executive committee as required by Section 11, which shall have the power to 8 act on behalf of the interstate commission in carrying out its powers and duties; 9 (f) Pay, or provide for the payment of the expenses related to the 10 establishment, organization, and ongoing activities of the interstate commission; 11 (g) Establish and maintain one or more offices; 12 (h) Borrow, accept, hire, or contract for services of personnel; 13 (i) Purchase and maintain insurance and bonds; 14 (j) Employ an executive director who shall have such powers to employ, 15 select or appoint employees, agents, or consultants, and to determine their 16 qualifications, define their duties, and fix their compensation; 17 (k) Establish personnel policies and programs relating to conflicts of 18 interest, rates of compensation, and qualifications of personnel; 19 (l) Accept donations and grants of money, equipment, supplies, 20 materials, and services and to receive, utilize, and dispose of it in a manner 21 consistent with the conflict of interest policies established by the interstate 22 commission; 23 (m) Lease, purchase, accept contributions or donations of, or otherwise 24 to own, hold, improve or use, any property, real, personal, or mixed; 25 (n) Sell, convey, mortgage, pledge, lease, exchange, abandon, or 26 otherwise dispose of any property, real, personal, or mixed; 27 (o) Establish a budget and make expenditures; 28 (p) Adopt a seal and bylaws governing the management and operation 29 of the interstate commission; 30 (q) Report annually to the legislatures and governors of the member Page 13 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 states concerning the activities of the interstate commission during the 2 preceding year. Such reports shall also include reports of financial audits and 3 any recommendations that may have been adopted by the interstate 4 commission; 5 (r) Coordinate education, training, and public awareness regarding the 6 compact, its implementation, and its operation; 7 (s) Maintain records in accordance with the bylaws; 8 (t) Seek and obtain trademarks, copyrights, and patents; and 9 (u) Perform such functions as may be necessary or appropriate to 10 achieve the purpose of the compact. 11 SECTION 13. FINANCE POWERS 12 (a) The interstate commission may levy on and collect an annual 13 assessment from each member state to cover the cost of the operations and 14 activities of the interstate commission and its staff. The total assessment must 15 be sufficient to cover the annual budget approved each year for which revenue 16 is not provided by other sources. The aggregate annual assessment amount shall 17 be allocated upon a formula to be determined by the interstate commission, 18 which shall promulgate a rule binding upon all member states. 19 (b) The interstate commission shall not incur obligations of any kind 20 prior to securing the funds adequate to meet the same. 21 (c) The interstate commission shall not pledge the credit of any of the 22 member states, except by, and with the authority of, the member state. 23 (d) The interstate commission shall be subject to a yearly financial audit 24 conducted by a certified or licensed accountant and the report of the audit shall 25 be included in the annual report of the interstate commission. 26 SECTION 14. ORGANIZATION AND OPERATION OF 27 THE INTERSTATE COMMISSION 28 (a) The interstate commission shall, by a majority of commissioners 29 present and voting, adopt bylaws to govern its conduct as may be necessary or 30 appropriate to carry out the purposes of the compact within twelve months of Page 14 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 the first interstate commission meeting. 2 (b) The interstate commission shall elect or appoint annually from 3 among its commissioners a chairperson, a vice-chairperson, and a treasurer, 4 each of whom shall have such authority and duties as may be specified in the 5 bylaws. The chairperson, or in the chairperson's absence or disability, the 6 vice-chairperson, shall preside at all meetings of the interstate commission. 7 (c) Officers selected in subsection (b) shall serve without remuneration 8 for the interstate commission. 9 (d) The officers and employees of the interstate commission shall be 10 immune from suit and liability, either personally or in their official capacity, for 11 a claim for damage to or loss of property or personal injury or other civil 12 liability caused or arising out of, or relating to, an actual or alleged act, error, 13 or omission that occurred, or that such person had a reasonable basis for 14 believing occurred, within the scope of interstate commission employment, 15 duties, or responsibilities; provided that such person shall not be protected from 16 suit or liability for damage, loss, injury, or liability caused by the gross 17 negligence or intentional or willful and wanton misconduct of such person. 18 (e) The liability of the executive director and employees of the interstate 19 commission or representatives of the interstate commission, acting within the 20 scope of such person's employment or duties for acts, errors, or omissions 21 occurring within such person's state, may not exceed the limits of liability set 22 forth under the constitution and laws of that state for state officials, employees, 23 and agents. The interstate commission is considered to be an instrumentality of 24 the states for the purpose of any such action. Nothing in this subsection shall be 25 construed to protect such person from suit or liability for damage, loss, injury, 26 or liability caused by the gross negligence or intentional or willful and wanton 27 misconduct of such person. 28 (f) The interstate commission shall defend the executive director, its 29 employees, and subject to the approval of the attorney general or other 30 appropriate legal counsel of the member state represented by an interstate Page 15 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 commission representative, shall defend such interstate commission 2 representative in any civil action seeking to impose liability arising out of an 3 actual or alleged act, error or omission that occurred within the scope of 4 interstate commission employment, duties or responsibilities, or that the 5 defendant had a reasonable basis for believing occurred within the scope of 6 interstate commission employment, duties, or responsibilities, provided that the 7 actual or alleged act, error, or omission did not result from gross negligence or 8 intentional or willful and wanton misconduct on the part of such person. 9 (g) To the extent not covered by the state involved, member state, or the 10 interstate commission, the representatives or employees of the interstate 11 commission shall be held harmless in the amount of a settlement or judgement, 12 including attorney's fees and costs, obtained against such persons arising out of 13 an actual or alleged act, error, or omission that occurred within the scope of the 14 interstate commission employment, duties, or responsibilities, or that such 15 persons had a reasonable basis for believing occurred within the scope of 16 interstate commission employment, duties, or responsibilities, provided that the 17 actual or alleged act, error, or omission did not result from intentional or willful 18 and wanton misconduct on the part of such person. 19 SECTION 15. RULEMAKING FUNCTIONS OF 20 THE INTERSTATE COMMISSION 21 (a) The interstate commission shall promulgate reasonable rules in order 22 to effectively and efficiently achieve the purpose of the compact. 23 Notwithstanding the foregoing, in the event the interstate commission exercises 24 its rulemaking authority in a manner that is beyond the scope of the purposes 25 of the compact, or the powers granted hereunder, then such an action by the 26 interstate commission shall be invalid and have no force or effect. 27 (b) Rules deemed appropriate for the operations of the interstate 28 commission shall be made pursuant to a rulemaking process that substantially 29 conforms to the "Model State Administrative Procedure Act" of 2010, and 30 subsequent amendments thereto. Page 16 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 (c) Not later than thirty days after a rule is promulgated, any person may 2 file a petition for judicial review of the rule in the United States District Court 3 for the District of Columbia or the federal district where the interstate 4 commission has its principal offices, provided that the filing of such a petition 5 shall not stay or otherwise prevent the rule from becoming effective unless the 6 court finds that the petitioner has a substantial likelihood of success. The court 7 shall give deference to the actions of the interstate commission consistent with 8 applicable law and shall not find the rule to be unlawful if the rule represents 9 a reasonable exercise of the authority granted to the interstate commission. 10 SECTION 16. OVERSIGHT OF INTERSTATE COMP ACT 11 (a) The executive, legislative, and judicial branches of state government 12 in each member state shall enforce the compact and shall take all actions 13 necessary and appropriate to effectuate the compact's purposes and intent. The 14 provisions of the compact and the rules promulgated hereunder shall have 15 standing as statutory law but shall not override existing state authority to 16 regulate the practice of medicine. 17 (b) All courts shall take judicial notice of the compact and the rules in 18 any judicial or administrative proceeding in a member state pertaining to the 19 subject matter of the compact which may affect the powers, responsibilities or 20 actions of the interstate commission. 21 (c) The interstate commission shall be entitled to receive all services of 22 process in any such proceeding, and shall have standing to intervene in the 23 proceeding for all purposes. Failure to provide service of process to the 24 interstate commission shall render a judgment or order void as to the interstate 25 commission, the compact, or promulgated rules. 26 SECTION 17. ENFORCEMENT OF INTERSTATE COMP ACT 27 (a) The interstate commission, in the reasonable exercise of its discretion, 28 shall enforce the provisions and rules of the compact. 29 (b) The interstate commission may, by majority vote of the 30 commissioners, initiate legal action in the United States Court for the District Page 17 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 of Columbia, or, at the discretion of the interstate commission, in the federal 2 district where the interstate commission has its principal offices, to enforce 3 compliance with the provisions of the compact, and its promulgated rules and 4 bylaws, against a member state in default. The relief sought may include both 5 injunctive relief and damages. In the event judicial enforcement is necessary, 6 the prevailing party shall be awarded all costs of such litigation including 7 reasonable attorney's fees. 8 (c) The remedies herein shall not be the exclusive remedies of the 9 interstate commission. The interstate commission may avail itself of any other 10 remedies available under state law or regulation of a profession. 11 SECTION 18. DEFAULT PROCEDURES 12 (a) The grounds for default include, but are not limited to, failure of a 13 member state to perform such obligations or responsibilities imposed upon it 14 by the compact, or the rules and bylaws of the interstate commission 15 promulgated under the compact. 16 (b) If the interstate commission determines that a member state has 17 defaulted in the performance of its obligations or responsibilities under the 18 compact, or the bylaws or promulgated rules, the interstate commission shall: 19 (1) Provide written notice to the defaulting state and other member 20 states, of the nature of the default, the means of curing the default, and any 21 action taken by the interstate commission. The interstate commission shall 22 specify the conditions by which the defaulting state must cure its default; and 23 (2) Provide remedial training and specific technical assistance regarding 24 the default. 25 (c) If the defaulting state fails to cure the default, the defaulting state 26 shall be terminated from the compact upon an affirmative vote of a majority of 27 the commissioners and all rights, privileges, and benefits conferred by the 28 compact shall terminate on the effective date of termination. A cure of the 29 default does not relieve the offending state of obligations or liabilities incurred 30 during the period of the default. Page 18 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 (d) Termination of membership in the compact shall be imposed only 2 after all other means of securing compliance have been exhausted. Notice of 3 intent to terminate shall be given by the interstate commission to the governor, 4 the majority and minority leaders of the defaulting state's legislature, and each 5 of the member states. 6 (e) The interstate commission shall establish rules and procedures to 7 address licenses and physicians that are materially impacted by the termination 8 of a member state, or the withdrawal of a member state. 9 (f) The member state which has been terminated is responsible for all 10 due, obligations, and liabilities incurred through the effective date of 11 termination including obligations, the performance of which extends beyond the 12 effective date of termination. 13 (g) The interstate commission shall not bear any costs relating to any 14 state that has been found to be in default or which has been terminated from the 15 compact, unless otherwise mutually agreed upon in writing between the 16 interstate commission and the defaulting state. 17 (h) The defaulting state may appeal the action of the interstate 18 commission by petitioning the United States District Court for the District of 19 Columbia or the federal district where the interstate commission has its 20 principal offices. The prevailing party shall be awarded all costs of such 21 litigation including reasonable attorney's fees. 22 SECTION 19. DISPUTE RESOLUTION 23 (a) The interstate commission shall attempt, upon the request of a 24 member state, to resolve disputes which are subject to the compact and which 25 may arise among member states or member boards. 26 (b) The interstate commission shall promulgate rules providing for both 27 mediation and binding dispute resolution as appropriate. 28 SECTION 20. MEMBER STATES, EF FECTIVE DATE AND AMENDMENT 29 (a) Any state is eligible to become a member of the compact. 30 (b) The compact shall become effective and binding upon legislative Page 19 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 enactment of the compact into law by no less than seven states. Thereafter, it 2 shall become effective and binding on a state upon enactment of the compact 3 into law by that state. 4 (c) The governors of non-member states, or their designees, shall be 5 invited to participate in the activities of the interstate commission on a 6 non-voting basis prior to adoption of the compact by all states. 7 (d) The interstate commission may propose amendments to the compact 8 for enactment by the member states. No amendment shall become effective and 9 binding upon the interstate commission and the member states unless and until 10 it is enacted into law by unanimous consent of the member states. 11 SECTION 21. WITHDRAWAL 12 (a) Once effective, the compact shall continue in force and remain 13 binding upon each and every member state; provided that a member state may 14 withdraw from the compact by specifically repealing the statute which enacted 15 the compact into law. 16 (b) Withdrawal from the compact shall be by the enactment of a statute 17 repealing the same, but shall not take effect until one year after the effective 18 date of such statute and until written notice of the withdrawal has been given 19 by the withdrawing state to the governor of each other member state. 20 (c) The withdrawing state shall immediately notify the chairperson of the 21 interstate commission in writing upon the introduction of legislation repealing 22 the compact in the withdrawing state. 23 (d) The interstate commission shall notify the other member states of the 24 withdrawing state's intent to withdraw within sixty days of its receipt of notice 25 provided under subsection (c). 26 (e) The withdrawing state is responsible for all dues, obligations and 27 liabilities incurred through the effective date of withdrawal, including 28 obligations, the performance of which extend beyond the effective date of 29 withdrawal. 30 (f) Reinstatement following withdrawal of a member state shall occur Page 20 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 upon the withdrawing date reenacting the compact or upon such later date as 2 determined by the interstate commission. 3 (g) The interstate commission is authorized to develop rules to address 4 the impact of the withdrawal of a member state on licenses granted in other 5 member states to physicians who designated the withdrawing member state as 6 the state of principal license. 7 SECTION 22. DISSOLUTION 8 (a) The compact shall dissolve effective upon the date of the withdrawal 9 or default of the member state which reduces the membership of the compact 10 to one member state. 11 (b) Upon the dissolution of the compact, the compact becomes null and 12 void and shall be of no further force or effect, and the business and affairs of the 13 interstate commission shall be concluded, and surplus funds shall be distributed 14 in accordance with the bylaws. 15 SECTION 23. SEVERABILITY AND CONSTRUCTION 16 (a) The provisions of the compact shall be severable, and if any phrase, 17 clause, sentence, or provision is deemed unenforceable, the remaining 18 provisions of the compact shall be enforceable. 19 (b) The provisions of the compact shall be liberally construed to 20 effectuate its purposes. 21 (c) Nothing in the compact shall be construed to prohibit the 22 applicability of other interstate compacts to which the member states are 23 members. 24 SECTION 24. BINDING EFFECT OF COMPACT AND OTHER LAWS 25 (a) Nothing herein prevents the enforcement of any other law of a 26 member state that is not inconsistent with the compact. 27 (b) All laws in a member state in conflict with the compact are 28 superseded to the extent of the conflict. 29 (c) All lawful actions of the interstate commission, including all rules and 30 bylaws promulgated by the commission, are binding upon the member states. Page 21 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions. SB NO. 27 ENROLLED 1 (d) All agreements between the interstate commission and the member 2 states are binding in accordance with their terms. 3 (e) In the event any provision of the compact exceeds the constitutional 4 limits imposed on the legislature of any member state, such provision shall be 5 ineffective to the extent of the conflict with the constitutional provision in 6 question in that member state. 7 Section 2. This Act shall become effective on July 1, 2021. PRESIDENT OF THE SENATE SPEAKER OF THE HOUSE OF REPRESENTATIVES GOVERNOR OF THE STATE OF LOUISIANA APPROVED: Page 22 of 22 Coding: Words which are struck through are deletions from existing law; words in boldface type and underscored are additions.