EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
FIRST REGULAR SESSION
SENATE BILL NO. 393
102ND GENERAL ASSEMBLY
INTRODUCED BY SENATOR BERNSKOETTER.
1115S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal section 334.043, RSMo, and to enact in lieu thereof two new sections relating to
physician licensure.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Section 334.043, RSMo, is repealed and two new 1
sections enacted in lieu thereof, to be known as sections 2
334.043 and 334.1600, to read as follows:3
334.043. [Upon the applicant paying a fee equivalent 1
to the required examination fee and furnishing the board 2
with all locations of previous practice and licensure in 3
chronological order, the board shall, under regulations 4
prescribed by it, admit without examinat ion qualified 5
persons who meet the requirements of this state including, 6
but not limited to, sections 334.031, 334.035 and 334.040, 7
and who hold certificates of licensure in any state or 8
territory of the United States or the District of Columbia 9
authorizing them to practice in the same manner and to the 10
same extent as physicians and surgeons are authorized to 11
practice by this chapter. Within the limits of this 12
section, the board is authorized and empowered to negotiate 13
reciprocal compacts with lic ensing boards of other states 14
for admission of licensed practitioners from Missouri in 15
other states] 1. For purposes of this section, the 16
following terms mean: 17 SB 393 2
(1) "Board", the state board of registration for the 18
healing arts in the state of Mis souri; 19
(2) "License", a license, certificate, registration, 20
permit, accreditation, or military occupational specialty 21
that enables a person to legally practice an occupation or 22
profession in a particular jurisdiction; 23
(3) "Military", the Armed Forces of the United States, 24
including the Air Force, Army, Coast Guard, Marine Corps, 25
Navy, Space Force, National Guard, and any other military 26
branch that is designated by Congress as part of the Armed 27
Forces of the United States, and all reserve components and 28
auxiliaries. The term "military" also includes the military 29
reserves and militia of any United States territory or state; 30
(4) "Nonresident military spouse", a nonresident 31
spouse of an active duty member of the Armed Forces of the 32
United States who has been transferred or is scheduled to be 33
transferred to the state of Missouri, or who has been 34
transferred or is scheduled to be transferred to an adjacent 35
state and is or will be domiciled in the state of Missouri, 36
or has moved to the state of Missouri on a permanent change - 37
of-station basis; 38
(5) "Oversight body", any board, department, agency, 39
or office of a jurisdiction that issues licenses; 40
(6) "Resident military spouse", a spouse of an active 41
duty member of the Arm ed Forces of the United States who has 42
been transferred or is scheduled to be transferred to the 43
state of Missouri or an adjacent state and who is a 44
permanent resident of the state of Missouri, who is 45
domiciled in the state of Missouri, or who has Miss ouri as 46
his or her home of record . 47
2. Any person who holds a valid current physician and 48
surgeon license issued by another state, a branch or unit of 49 SB 393 3
the military, a territory of the United States, or the 50
District of Columbia, and who has been li censed for at least 51
one year in such other jurisdiction, may submit to the board 52
an application for a physician and surgeon license in 53
Missouri along with proof of current licensure and proof of 54
licensure for at least one year in the other jurisdiction . 55
3. The board shall: 56
(1) Within six months of receiving an application 57
described in subsection 2 of this section, waive any 58
examination, educational, or experience requirements for 59
licensure in this state for the applicant if it determines 60
that there were minimum education requirements and, if 61
applicable, work experience and clinical supervision 62
requirements in effect and the other jurisdiction verifies 63
that the person met those requirements in order to be 64
licensed or certified in that jurisdiction. The board may 65
require an applicant to take and pass an examination 66
specific to the laws of this state; or 67
(2) Within thirty days of receiving an application 68
described in subsection 2 of this section from a nonresident 69
military spouse or a resident military spouse, waive any 70
examination, educational, or experience requirements for 71
licensure in this state for the applicant and issue such 72
applicant a license under this section if such applicant 73
otherwise meets the requirements of t his section. 74
4. (1) The board shall not waive any examination, 75
educational, or experience requirements for any applicant 76
who has had his or her license revoked by an oversight body 77
outside the state; who is currently under investigation, who 78
has a complaint pending, or who is currently under 79
disciplinary action, except as provided in subdivision (2) 80
of this subsection, with an oversight body outside the 81 SB 393 4
state; who does not hold a license in good standing with an 82
oversight body outside the sta te; who has a criminal record 83
that would disqualify him or her for licensure in Missouri; 84
or who does not hold a valid current license in the other 85
jurisdiction on the date the board receives his or her 86
application under this section. 87
(2) If another jurisdiction has taken disciplinary 88
action against an applicant, the board shall determine if 89
the cause for the action was corrected and the matter 90
resolved. If the matter has not been resolved by that 91
jurisdiction, the board may deny a license un til the matter 92
is resolved. 93
5. Nothing in this section shall prohibit the board 94
from denying a license to an applicant under this section 95
for any reason described in section 334.100. 96
6. Any person who is licensed under the provisions of 97
this section shall be subject to the board's jurisdiction 98
and all rules and regulations pertaining to the practice as 99
a physician and surgeon in this state. 100
7. This section shall not be construed to waive any 101
requirement for an applicant to pay any f ees. 102
334.1600. SECTION 1. PURPOSE 1
In order to strengthen access to health care, and in 2
recognition of the advances in the delivery of health care, 3
the member states of the Interstate Medical Licensure 4
Compact have allied in comm on purpose to develop a 5
comprehensive process that complements the existing 6
licensing and regulatory authority of state medical boards, 7
provides a streamlined process that allows physicians to 8
become licensed in multiple states, thereby enhancing the 9
portability of a medical license and ensuring the safety of 10
patients. The Compact creates another pathway for licensure 11 SB 393 5
and does not otherwise change a state's existing Medical 12
Practice Act. The Compact also adopts the prevailing 13
standard for licensu re and affirms that the practice of 14
medicine occurs where the patient is located at the time of 15
the physician-patient encounter, and therefore, requires the 16
physician to be under the jurisdiction of the state medical 17
board where the patient is located. State medical boards 18
that participate in the Compact retain the jurisdiction to 19
impose an adverse action against a license to practice 20
medicine in that state issued to a physician through the 21
procedures in the Compact. 22
SECTION 2. DEFINITIONS 23
In this compact: 24
(a) "Bylaws" means those bylaws established by the 25
Interstate Commission pursuant to Section 11. 26
(b) "Commissioner" means the voting representative 27
appointed by each member board pursuant to Section 11. 28
(c) "Conviction" means a finding by a court that an 29
individual is guilty of a criminal offense through 30
adjudication, or entry of a plea of guilt or no contest to 31
the charge by the offender. Evidence of an entry of a 32
conviction of a criminal offense by the court sha ll be 33
considered final for purposes of disciplinary action by a 34
member board. 35
(d) "Expedited License" means a full and unrestricted 36
medical license granted by a member state to an eligible 37
physician through the process set forth in the Compact. 38
(e) "Interstate Commission" means the interstate 39
commission created pursuant to Section 11. 40
(f) "License" means authorization by a member state 41
for a physician to engage in the practice of medicine, which 42
would be unlawful without authorizati on. 43 SB 393 6
(g) "Medical Practice Act" means laws and regulations 44
governing the practice of allopathic and osteopathic 45
medicine within a member state. 46
(h) "Member Board" means a state agency in a member 47
state that acts in the sovereign interests of the state by 48
protecting the public through licensure, regulation, and 49
education of physicians as directed by the state government. 50
(i) "Member State" means a state that has enacted the 51
Compact. 52
(j) "Practice of Medicine" means that clinical 53
prevention, diagnosis, or treatment of human disease, 54
injury, or condition requiring a physician to obtain and 55
maintain a license in compliance with the Medical Practice 56
Act of a member state. 57
(k) "Physician" means any person who: 58
1) Is a graduate of a medical school accredited by the 59
Liaison Committee on Medical Education, the Commission on 60
Osteopathic College Accreditation, or a medical school 61
listed in the International Medical Education Directory or 62
its equivalent; 63
2) Passed each component of the United State Medical 64
Licensing Examination (USMLE) or the Comprehensive 65
Osteopathic Medical Licensing Examination (COMLEX -USA) 66
within three attempts, or any of its predecessor 67
examinations accepted by a state medical board as an 68
equivalent examination for licensure purposes; 69
3) Successfully completed graduate medical education 70
approved by the Accreditation Council for Graduate Medical 71
Education or the American Osteopathic Association; 72
4) Holds specialty certification o r a time-unlimited 73
specialty certificate recognized by the American Board of 74 SB 393 7
Medical Specialties or the American Osteopathic 75
Association’s Bureau of Osteopathic Specialists; 76
5) Possesses a full and unrestricted license to engage 77
in the practice of medicine issued by a member board; 78
6) Has never been convicted, received adjudication, 79
deferred adjudication, community supervision, or deferred 80
disposition for any offense by a court of appropriate 81
jurisdiction; 82
7) Has never held a licens e authorizing the practice 83
of medicine subjected to discipline by a licensing agency in 84
any state, federal, or foreign jurisdiction, excluding any 85
action related to non -payment of fees related to a license; 86
8) Has never had a controlled substance license or 87
permit suspended or revoked by a state or the United States 88
Drug Enforcement Administration; and 89
9) Is not under active investigation by a licensing 90
agency or law enforcement authority in any state, federal, 91
or foreign jurisdiction. 92
(l) "Offense" means a felony, gross misdemeanor, or 93
crime of moral turpitude. 94
(m) "Rule" means a written statement by the Interstate 95
Commission promulgated pursuant to Section 12 of the Compact 96
that is of general applicability, implements, int erprets, or 97
prescribes a policy or provision of the Compact, or an 98
organizational, procedural, or practice requirement of the 99
Interstate Commission, and has the force and effect of 100
statutory law in a member state, and includes the amendment, 101
repeal, or suspension of an existing rule. 102
(n) "State" means any state, commonwealth, district, 103
or territory of the United States. 104
(o) "State of Principal License" means a member state 105
where a physician holds a license to practice medicine and 106 SB 393 8
which has been designated as such by the physician for 107
purposes of registration and participation in the Compact. 108
SECTION 3. ELIGIBILITY 109
(a) A physician must meet the eligibility requirements 110
as defined in Section 2(k) to receive an expedited licens e 111
under the terms and provisions of the Compact. 112
(b) A physician who does not meet the requirements of 113
Section 2(k) may obtain a license to practice medicine in a 114
member state if the individual complies with all laws and 115
requirements, other than the Compact, relating to the 116
issuance of a license to practice medicine in that state. 117
SECTION 4. DESIGNATION OF STATE OF PRINCIPAL LICENSE 118
(a) A physician shall designate a member state as the 119
state of principal license for purposes of regist ration for 120
expedited licensure through the Compact if the physician 121
possesses a full and unrestricted license to practice 122
medicine in that state, and the state is: 123
1) The state of principal residence for the physician, 124
or 125
2) The state where at least 25% of the practice of 126
medicine occurs, or 127
3) The location of the physician's employer, or 128
4) If no state qualifies under subsection (1), 129
subsection (2), or subsection (3), the state designated as 130
state of residence for purpose of federal income tax. 131
(b) A physician may redesignate a member state as 132
state of principal license at any time, as long as the state 133
meets the requirements of subsection (a). 134
(c) The Interstate Commission is authorized to develop 135
rules to facilitate redesignation of another member state as 136
the state of principal license. 137 SB 393 9
SECTION 5. APPLICATION AND ISSUANCE OF EXPEDITED 138
LICENSURE 139
(a) A physician seeking licensure through the Compact 140
shall file an application for an expedited licens e with the 141
member board of the state selected by the physician as the 142
state of principal license. 143
(b) Upon receipt of an application for an expedited 144
license, the member board within the state selected as the 145
state of principal license shall eval uate whether the 146
physician is eligible for expedited licensure and issue a 147
letter of qualification, verifying or denying the 148
physician’s eligibility, to the Interstate Commission. 149
1) Static qualifications, which include verification 150
of medical education, graduate medical education, results of 151
any medical or licensing examination, and other 152
qualifications as determined by the Interstate Commission 153
through rule, shall not be subject to additional primary 154
source verification where already primary source verified by 155
the state of principal license. 156
2) The member board within the state selected as the 157
state of principal license shall, in the course of verifying 158
eligibility, perform a criminal background check of an 159
applicant, including the use of the results of fingerprint 160
or other biometric data checks compliant with the 161
requirements of the Federal Bureau of Investigation, with 162
the exception of federal employees who have suitability 163
determination in accordance with 5 C.F.R. §731.202. 164
3) Appeal on the determination of eligibility shall be 165
made to the member state where the application was filed and 166
shall be subject to the law of that state. 167
(c) Upon verification in subsection (b), physicians 168
eligible for an expedited licens e shall complete the 169 SB 393 10
registration process established by the Interstate 170
Commission to receive a license in a member state selected 171
pursuant to subsection (a), including the payment of any 172
applicable fees. 173
(d) After receiving verification of eligi bility under 174
subsection (b) and any fees under subsection (c), a member 175
board shall issue an expedited license to the physician. 176
This license shall authorize the physician to practice 177
medicine in the issuing state consistent with the Medical 178
Practice Act and all applicable laws and regulations of the 179
issuing member board and member state. 180
(e) An expedited license shall be valid for a period 181
consistent with the licensure period in the member state and 182
in the same manner as required for other p hysicians holding 183
a full and unrestricted license within the member state. 184
(f) An expedited license obtained through the Compact 185
shall be terminated if a physician fails to maintain a 186
license in the state of principal licensure for a non - 187
disciplinary reason, without redesignation of a new state of 188
principal licensure. 189
(g) The Interstate Commission is authorized to develop 190
rules regarding the application process, including payment 191
of any applicable fees, and the issuance of an expedited 192
license. 193
SECTION 6. FEES FOR EXPEDITED LICENSURE 194
(a) A member state issuing an expedited license 195
authorizing the practice of medicine in that state may 196
impose a fee for a license issued or renewed through the 197
Compact. 198
(b) The Interstate Commission is authorized to develop 199
rules regarding fees for expedited licenses. 200
SECTION 7. RENEWAL AND CONTINUED PARTICIPATION 201 SB 393 11
(a) A physician seeking to renew an expedited license 202
granted in a member state shall complete a renewal process 203
with the Interstate Commission if the physician: 204
1) Maintains a full and unrestricted license in a 205
state of principal license; 206
2) Has not been convicted, received adjudication, 207
deferred adjudication, community supervision, or deferred 208
disposition for any offense by a court of appropriate 209
jurisdiction; 210
3) Has not had a license authorizing the practice of 211
medicine subject to discipline by a licensing agency in any 212
state, federal, or foreign jurisdiction, excluding any 213
action related to non-payment of fees related to a license; 214
and 215
4) Has not had a controlled substance license or 216
permit suspended or revoked by a state or the United States 217
Drug Enforcement Administration. 218
(b) Physicians shall comply with all continuing 219
professional development or continuing medical education 220
requirements for renewal of a license issued by a member 221
state. 222
(c) The Interstate Commission shall collect any 223
renewal fees charged for the renewal of a license and 224
distribute the fees to th e applicable member board. 225
(d) Upon receipt of any renewal fees collected in 226
subsection (c), a member board shall renew the physician's 227
license. 228
(e) Physician information collected by the Interstate 229
Commission during the renewal process will be distributed to 230
all member boards. 231 SB 393 12
(f) The Interstate Commission is authorized to develop 232
rules to address renewal of licenses obtained through the 233
Compact. 234
SECTION 8. COORDINATED INFORMATION SYSTEM 235
(a) The Interstate Commission shal l establish a 236
database of all physicians licensed, or who have applied for 237
licensure, under Section 5. 238
(b) Notwithstanding any other provision of law, member 239
boards shall report to the Interstate Commission any public 240
action or complaints against a licensed physician who has 241
applied or received an expedited license through the Compact. 242
(c) Member boards shall report disciplinary or 243
investigatory information determined as necessary and proper 244
by rule of the Interstate Commission. 245
(d) Member boards may report any non -public complaint, 246
disciplinary, or investigatory information not required by 247
subsection (c) to the Interstate Commission. 248
(e) Member boards shall share complaint or 249
disciplinary information about a physician upon request of 250
another member board. 251
(f) All information provided to the Interstate 252
Commission or distributed by member boards shall be 253
confidential, filed under seal, and used only for 254
investigatory or disciplinary matters. 255
(g) The Interstate Commission is authorized to develop 256
rules for mandated or discretionary sharing of information 257
by member boards. 258
SECTION 9. JOINT INVESTIGATIONS 259
(a) Licensure and disciplinary records of physicians 260
are deemed investigative. 261
(b) In addition to the authority granted to a member 262
board by its respective Medical Practice Act or other 263 SB 393 13
applicable state law, a member board may participate with 264
other member boards in joint investigations of physicians 265
licensed by the member boards. 266
(c) A subpoena issued by a member state shall be 267
enforceable in other member states. 268
(d) Member boards may share any investigative, 269
litigation, or compliance materials in furtherance of any 270
joint or individual investigation initiate under the Compact. 271
(e) Any member state may investigate actual or alleged 272
violations of the statutes authorizing the practice of 273
medicine in any other member state in which a physician 274
holds a license to practice medicine. 275
SECTION 10. DISCIPLINARY ACTIONS 276
(a) Any disciplinary action taken by any member board 277
against a physician licensed through the Compact shall be 278
deemed unprofessional conduct which may be subject to 279
discipline by other member boards, in addition to any 280
violation of the Medical Pract ice Act or regulations in that 281
state. 282
(b) If a license granted to a physician by the member 283
board in the state of principal license is revoked, 284
surrendered or relinquished in lieu of discipline, or 285
suspended, then all licenses issued to the physi cian by 286
member boards shall automatically be placed, without further 287
action necessary by any member board, on the same status. 288
If the member board in the state of principal license 289
subsequently reinstates the physician's license, a license 290
issued to the physician by any other member board shall 291
remain encumbered until that respective member board takes 292
action to reinstate the license in a manner consistent with 293
the Medical Practice Act of that state. 294 SB 393 14
(c) If disciplinary action is taken agains t a 295
physician by a member board not in the state of principal 296
license, any other member board may deem the action 297
conclusive as to matter of law and fact decided, and: 298
1) Impose the same or lesser sanction(s) against the 299
physician so long as such sanctions are consistent with the 300
Medical Practice Act of that state; or 301
2) Pursue separate disciplinary action against the 302
physician under its respective Medical Practice Act, 303
regardless of the action taken in other member states. 304
(d) If a license granted to a physician by a member 305
board is revoked, surrendered or relinquished in lieu of 306
discipline, or suspended, then any license(s) issued to the 307
physician by any other member board(s) shall be suspended, 308
automatically and immediately wi thout further action 309
necessary by the other member board(s), for ninety (90) days 310
upon entry of the order by the disciplining board, to permit 311
the member board(s) to investigate the basis for the action 312
under the Medical Practice Act of that state. A member 313
board may terminate the automatic suspension of the license 314
it issued prior to the completion of the ninety (90) day 315
suspension period in a manner consistent with the Medical 316
Practice Act of that state. 317
SECTION 11. INTERSTATE MEDICAL LICENS URE COMPACT 318
COMMISSION 319
(a) The member states hereby create the "Interstate 320
Medical Licensure Compact Commission". 321
(b) The purpose of the Interstate Commission is the 322
administration of the Interstate Medical Licensure Compact, 323
which is a discretionary state function. 324
(c) The Interstate Commission shall be a body 325
corporate and joint agency of the member states and shall 326 SB 393 15
have all the responsibilities, powers, and duties set forth 327
in the Compact, and such additional powers as may be 328
conferred upon it by a subsequent concurrent action of the 329
respective legislatures of the member states in accordance 330
with the terms of the Compact. 331
(d) The Interstate Commission shall consist of two 332
voting representatives appointed by each member s tate who 333
shall serve as Commissioners. In states where allopathic 334
and osteopathic physicians are regulated by separate member 335
boards, or if the licensing and disciplinary authority is 336
split between separate member boards, or if the licensing 337
and disciplinary authority is split between multiple member 338
boards within a member state, the member state shall appoint 339
one representative from each member board. A Commissioner 340
shall be a(n): 341
1) Allopathic or osteopathic physician appointed to a 342
member board; 343
2) Executive director, executive secretary, or similar 344
executive of a member board; or 345
3) Member of the public appointed to a member board. 346
(e) The Interstate Commission shall meet at least once 347
each calendar year. A portion of this meeting shall be a 348
business meeting to address such matters as may properly 349
come before the Commission, including the election of 350
officers. The chairperson may call additional meetings and 351
shall call for a meeting upon the request of a majority of 352
the member states. 353
(f) The bylaws may provide for meetings of the 354
Interstate Commission to be conducted by telecommunication 355
or electronic communication. 356
(g) Each Commissioner participating at a meeting of 357
the Interstate Commission is e ntitled to one vote. A 358 SB 393 16
majority of Commissioners shall constitute a quorum for the 359
transaction of business, unless a larger quorum is required 360
by the bylaws of the Interstate Commission. A Commissioner 361
shall not delegate a vote to another Commissione r. In the 362
absence of its Commissioner, a member state may delegate 363
voting authority for a specified meeting to another person 364
from that state who shall meet the requirements of 365
subsection (d). 366
(h) The Interstate Commission shall provide public 367
notice of all meetings and all meetings shall be open to the 368
public. The Interstate Commission may close a meeting, in 369
full or in portion, where it determines by a two -thirds vote 370
of the Commissioners present that an open meeting would be 371
likely to: 372
1) Relate solely to the internal personnel practice 373
and procedures of the Interstate Commission; 374
2) Discuss matters specifically exempted from 375
disclosure by federal statute; 376
3) Discuss trade secrets, commercial, or financial 377
information that is privileged or confidential; 378
4) Involve accusing a person of a crime, or formally 379
censuring a person; 380
5) Discuss information of a personal nature where 381
disclosure would constitute a clearly unwarranted invasion 382
of personal privacy; 383
6) Discuss investigative records compiled for law 384
enforcement purposes; or 385
7) Specifically relate to the participation in a civil 386
action or other legal proceeding. 387
(i) The Interstate Commission shall keep minutes which 388
shall fully describe all matters discussed in a meeting and 389 SB 393 17
shall provide a full and accurate summary of actions taken, 390
including record of any roll call votes. 391
(j) The Interstate Commission shall make its 392
information and official records, to the extent not 393
otherwise designated in the Compact or by its rules, 394
available to the public for inspection. 395
(k) The Interstate Commission shall establish an 396
executive committee, which shall include officers, members, 397
and others as determined by the bylaws. The executive 398
committee shall have the power to act on behalf of the 399
Interstate Commission, with the exception of rulemaking, 400
during periods when the Interstate Commission is not in 401
session. When acting on behalf of the Interstate 402
Commission, the executive co mmittee shall oversee the 403
administration of the Compact including enforcement and 404
compliance with the provisions of the Compact, its bylaws 405
and rules, and other such duties as necessary. 406
(l) The Interstate Commission shall establish other 407
committees for governance and administration of the Compact. 408
SECTION 12. POWERS AND DUTIES OF THE INTERSTATE 409
COMMISSION 410
(a) Oversee and maintain the administration of the 411
Compact; 412
(b) Promulgate rules which shall be binding to the 413
extent and in the manner provided for in the Compact; 414
(c) Issue, upon the request of a member state or 415
member board, advisory opinions concerning the meaning or 416
interpretation of the Compact, its bylaws, rules, and 417
actions; 418
(d) Enforce compliance with C ompact provisions, the 419
rules promulgated by the Interstate Commission, and the 420 SB 393 18
bylaws, using all necessary and proper means, including but 421
not limited to the use of judicial process; 422
(e) Establish and appoint committees including, but 423
not limited to, an executive committee as required by 424
Section 11, which shall have the power to act on behalf of 425
the Interstate Commission in carrying out its powers and 426
duties; 427
(f) Pay, or provide for the payment of the expenses 428
related to the establishmen t, organization, and ongoing 429
activities of the Interstate Commission; 430
(g) Establish and maintain one or more offices; 431
(h) Borrow, accept, hire, or contract for services of 432
personnel; 433
(i) Purchase and maintain insurance and bonds; 434
(j) Employ an executive director who shall have such 435
powers to employ, select or appoint employees, agents, or 436
consultants, and to determine their qualifications, define 437
their duties, and fix their compensation; 438
(k) Establish personnel policies an d programs relating 439
to conflicts of interest, rates of compensation, and 440
qualifications of personnel; 441
(l) Accept donations and grants of money, equipment, 442
supplies, materials, and services and to receive, utilize, 443
and dispose of it in a manner co nsistent with the conflict 444
of interest policies established by the Interstate 445
Commission; 446
(m) Lease, purchase, accept contributions or donations 447
of, or otherwise to own, hold, improve or use, any property, 448
real, personal, or mixed; 449
(n) Sell, convey, mortgage, pledge, lease, exchange, 450
abandon, or otherwise dispose of any property, real, 451
personal, or mixed; 452 SB 393 19
(o) Establish a budget and make expenditures; 453
(p) Adopt a seal and bylaws governing the management 454
and operation of the Int erstate Commission; 455
(q) Report annually to the legislatures and governors 456
of the member states concerning the activities of the 457
Interstate Commission during the preceding year. Such 458
reports shall also include reports of financial audits and 459
any recommendations that may have been adopted by the 460
Interstate Commission; 461
(r) Coordinate education, training, and public 462
awareness regarding the Compact, its implementation, and its 463
operation; 464
(s) Maintain records in accordance with the bylaw s; 465
(t) Seek and obtain trademarks, copyrights, and 466
patents; and 467
(u) Perform such functions as may be necessary or 468
appropriate to achieve the purpose of the Compact. 469
SECTION 13. FINANCE POWERS 470
(a) The Interstate Commission may levy on and collect 471
an annual assessment from each member state to cover the 472
cost of the operations and activities of the Interstate 473
Commission and its staff. The total assessment must be 474
sufficient to cover the annual budget approved each year for 475
which revenue is not provided by other sources. The 476
aggregate annual assessment amount shall be allocated upon a 477
formula to be determined by the Interstate Commission, which 478
shall promulgate a rule binding upon all member states. 479
(b) The Interstate Commission shall not incur 480
obligations of any kind prior to securing the funds adequate 481
to meet the same. 482 SB 393 20
(c) The Interstate Commission shall not pledge the 483
credit of any of the member states, except by, and with the 484
authority of, the member state. 485
(d) The Interstate Commission shall be subject to a 486
yearly financial audit conducted by a certified or licensed 487
accountant and the report of the audit shall be included in 488
the annual report of the Interstate Commission. 489
SECTION 14. ORGANIZATI ON AND OPERATION OF THE 490
INTERSTATE COMMISSION 491
(a) The Interstate Commission shall, by a majority of 492
Commissioners present and voting, adopt bylaws to govern its 493
conduct as may be necessary or appropriate to carry out the 494
purposes of the Compact w ithin twelve (12) months of the 495
first Interstate Commission meeting. 496
(b) The Interstate Commission shall elect or appoint 497
annually from among its Commissioners a chairperson, a vice - 498
chairperson, and a treasurer, each of whom shall have such 499
authority and duties as may be specified in the bylaws. The 500
chairperson, or in the chairperson's absence or disability, 501
the vice-chairperson, shall preside at all meetings of the 502
Interstate Commission. 503
(c) Officers selected in subsection (b) shall ser ve 504
without remuneration for the Interstate Commission. 505
(d) The officers and employees of the Interstate 506
Commission shall be immune from suit and liability, either 507
personally or in their official capacity, for a claim for 508
damage to or loss of prop erty or personal injury or other 509
civil liability caused or arising out of, or relating to, an 510
actual or alleged act, error, or omission that occurred, or 511
that such person had a reasonable basis for believing 512
occurred, within the scope of Interstate Com mission 513
employment, duties, or responsibilities; provided that such 514 SB 393 21
person shall not be protected from suit or liability for 515
damage, loss, injury, or liability caused by the intentional 516
or willful and wanton misconduct of such person. 517
(e) The liability of the executive director and 518
employees of the Interstate Commission or representatives of 519
the Interstate Commission, acting within the scope of such 520
person’s employment or duties for acts, errors, or omissions 521
occurring within such person's sta te, may not exceed the 522
limits of liability set forth under the constitution and 523
laws of that state for state officials, employees, and 524
agents. The Interstate Commission is considered to be an 525
instrumentality of the states for the purpose of any such 526
action. Nothing in this subsection shall be construed to 527
protect such person from suit or liability for damage, loss, 528
injury, or liability caused by the intentional or willful 529
and wanton misconduct of such person. 530
(f) The Interstate Commission sh all defend the 531
executive director, its employees, and subject to the 532
approval of the attorney general or other appropriate legal 533
counsel of the member state represented by an Interstate 534
Commission representative, shall defend such Interstate 535
Commission representative in any civil action seeking to 536
impose liability arising out of an actual or alleged act, 537
error or omission that occurred within the scope of 538
Interstate Commission employment, duties or 539
responsibilities, or that the defendant had a reas onable 540
basis for believing occurred within the scope of Interstate 541
Commission employment, duties, or responsibilities, provided 542
that the actual or alleged act, error, or omission did not 543
result from intentional or willful and wanton misconduct on 544
the part of such person. 545 SB 393 22
(g) To the extent not covered by the state involved, 546
member state, or the Interstate Commission, the 547
representatives or employees of the Interstate Commission 548
shall be held harmless in the amount of a settlement or 549
judgement, including attorney's fees and costs, obtained 550
against such persons arising out of an actual or alleged 551
act, error, or omission that occurred within the scope of 552
the Interstate Commission employment, duties, or 553
responsibilities, or that such persons ha d a reasonable 554
basis for believing occurred within the scope of Interstate 555
Commission employment, duties, or responsibilities, provided 556
that the actual or alleged act, error, or omission did not 557
result from intentional or willful and wanton misconduct on 558
the part of such person. 559
SECTION 15. RULEMAKING FUNCTIONS OF THE INTERSTATE 560
COMMISSION 561
(a) The Interstate Commission shall promulgate 562
reasonable rules in order to effectively and efficiently 563
achieve the purpose of the Compact. Notwithstanding the 564
foregoing, in the event the Interstate Commission exercises 565
its rulemaking authority in a manner that is beyond the 566
scope of the purposes of the Compact, or the powers granted 567
hereunder, then such an action by the Interstate Commission 568
shall be invalid and have no force or effect. 569
(b) Rules deemed appropriate for the operations of the 570
Interstate Commission shall be made pursuant to a rulemaking 571
process that substantially conforms to the "Model State 572
Administrative Procedure Act" of 2 010, and subsequent 573
amendments thereto. 574
(c) Not later than thirty (30) days after a rule is 575
promulgated, any person may file a petition for judicial 576
review of the rule in the United States District Court for 577 SB 393 23
the District of Columbia or the federa l district where the 578
Interstate Commission has its principal offices, provided 579
that the filing of such a petition shall not stay or 580
otherwise prevent the rule from becoming effective unless 581
the court finds that the petitioner has a substantial 582
likelihood of success. The court shall give deference to 583
the actions of the Interstate Commission consistent with 584
applicable law and shall not find the rule to be unlawful if 585
the rule represents a reasonable exercise of the authority 586
granted to the Interstat e Commission. 587
SECTION 16. OVERSIGHT OF INTERSTATE COMPACT 588
(a) The executive, legislative, and judicial branches 589
of state government in each member state shall enforce the 590
Compact and shall take all actions necessary and appropriate 591
to effectuate the Compact's purposes and intent. The 592
provisions of the Compact and the rules promulgated 593
hereunder shall have standing as statutory law but shall not 594
override existing state authority to regulate the practice 595
of medicine. 596
(b) All courts shall take judicial notice of the 597
Compact and the rules in any judicial or administrative 598
proceeding in a member state pertaining to the subject 599
matter of the Compact which may affect the powers, 600
responsibilities or actions of the Interstate Commission. 601
(c) The Interstate Commission shall be entitled to 602
receive all services of process in any such proceeding, and 603
shall have standing to intervene in the proceeding for all 604
purposes. Failure to provide service of process to the 605
Interstate Commissio n shall render a judgment or order void 606
as to the Interstate Commission, the Compact, or promulgated 607
rules. 608
SECTION 17. ENFORCEMENT OF INTERSTATE COMPACT 609 SB 393 24
(a) The Interstate Commission, in the reasonable 610
exercise of its discretion, shall enfor ce the provisions and 611
rules of the Compact. 612
(b) The Interstate Commission may, by majority vote of 613
the Commissioners, initiate legal action in the United 614
States District Court for the District of Columbia, or, at 615
the discretion of the Interstate Commission, in the federal 616
district where the Interstate Commission has its principal 617
offices, to enforce compliance with the provisions of the 618
Compact, and its promulgated rules and bylaws, against a 619
member state in default. The relief sought may inc luding 620
both injunctive relief and damages. In the event judicial 621
enforcement is necessary, the prevailing party shall be 622
awarded all costs of such litigation including reasonable 623
attorney's fees. 624
(c) The remedies herein shall not be the exclusiv e 625
remedies of the Interstate Commission. The Interstate 626
Commission may avail itself of any other remedies available 627
under state law or regulation of a profession. 628
SECTION 18. DEFAULT PROCEDURES 629
(a) The grounds for default include, but are no t 630
limited to, failure of a member state to perform such 631
obligations or responsibilities imposed upon it by the 632
Compact, or the rules and bylaws of the Interstate 633
Commission promulgated under the Compact. 634
(b) If the Interstate Commission determine s that a 635
member state has defaulted in the performance of its 636
obligations or responsibilities under the Compact, or the 637
bylaws or promulgated rules, the Interstate Commission shall: 638
1) Provide written notice to the defaulting state and 639
other member states, of the nature of the default, the means 640
of curing the default, and any action taken by the 641 SB 393 25
Interstate Commission. The Interstate Commission shall 642
specify the conditions by which the defaulting state must 643
cure its default; and 644
2) Provide remedial training and specific technical 645
assistance regarding the default. 646
(c) If the defaulting state fails to cure the default, 647
the defaulting state shall be terminated from the Compact 648
upon an affirmative vote of a majority of the Commission ers 649
and all rights, privileges, and benefits conferred by the 650
Compact shall terminate on the effective date of 651
termination. A cure of the default does not relieve the 652
offending state of obligations or liabilities incurred 653
during the period of the def ault. 654
(d) Termination of membership in the Compact shall be 655
imposed only after all other means of securing compliance 656
have been exhausted. Notice of intent to terminate shall be 657
given by the Interstate Commission to the governor, the 658
majority and minority leaders of the defaulting state’s 659
legislature, and each of the member states. 660
(e) The Interstate Commission shall establish rules 661
and procedures to address licenses and physicians that are 662
materially impacted by the termination of a mem ber state, or 663
the withdrawal of a member state. 664
(f) The member state which has been terminated is 665
responsible for all due, obligations, and liabilities 666
incurred through the effective date of termination including 667
obligations, the performance of w hich extends beyond the 668
effective date of termination. 669
(g) The Interstate Commission shall not bear any costs 670
relating to any state that has been found to be in default 671
or which has been terminated from the Compact, unless 672 SB 393 26
otherwise mutually agre ed upon in writing between the 673
Interstate Commission and the defaulting state. 674
(h) The defaulting state may appeal the action of the 675
Interstate Commission by petitioning the United States 676
District Court for the District of Columbia or the federal 677
district where the Interstate Commission has its principal 678
offices. The prevailing party shall be awarded all costs of 679
such litigation including reasonable attorney's fees. 680
SECTION 19. DISPUTE RESOLUTION 681
(a) The Interstate Commission shall a ttempt, upon the 682
request of a member state, to resolve disputes which are 683
subject to the Compact and which may arise among member 684
states or member boards. 685
(b) The Interstate Commission shall promulgate rules 686
providing for both mediation and bindi ng dispute resolution 687
as appropriate. 688
SECTION 20. MEMBER STATES, EFFECTIVE DATE AND AMENDMENT 689
(a) Any state is eligible to become a member of the 690
Compact. 691
(b) The Compact shall become effective and binding 692
upon legislative enactment of the Compact into law by no 693
less than seven (7) states. Thereafter, it shall become 694
effective and binding on a state upon enactment of the 695
Compact into law by that state. 696
(c) The governors of non -member states, or their 697
designees, shall be invite d to participate in the activities 698
of the Interstate Commission on a non -voting basis prior to 699
adoption of the Compact by all states. 700
(d) The Interstate Commission may propose amendments 701
to the Compact for enactment by the member states. No 702
amendment shall become effective and binding upon the 703
Interstate Commission and the member states unless and until 704 SB 393 27
it is enacted into law by unanimous consent of the member 705
states. 706
SECTION 21. WITHDRAWAL 707
(a) Once effective, the Compact shall con tinue in 708
force and remain binding upon each and every member state; 709
provided that a member state may withdraw from the Compact 710
by specifically repealing the statute which enacted the 711
Compact into law. 712
(b) Withdrawal from the Compact shall be by t he 713
enactment of a statute repealing the same, but shall not 714
take effect until one (1) year after the effective date of 715
such statute and until written notice of the withdrawal has 716
been given by the withdrawing state to the governor of each 717
other member state. 718
(c) The withdrawing state shall immediately notify the 719
chairperson of the Interstate Commission in writing upon the 720
introduction of legislation repealing the Compact in the 721
withdrawing state. 722
(d) The Interstate Commission shall notif y the other 723
member states of the withdrawing state's intent to withdraw 724
within sixty (60) days of its receipt of notice provided 725
under subsection (c). 726
(e) The withdrawing state is responsible for all dues, 727
obligations and liabilities incurred thro ugh the effective 728
date of withdrawal, including obligations, the performance 729
of which extend beyond the effective date of withdrawal. 730
(f) Reinstatement following withdrawal of a member 731
state shall occur upon the withdrawing date reenacting the 732
Compact or upon such later date as determined by the 733
Interstate Commission. 734
(g) The Interstate Commission is authorized to develop 735
rules to address the impact of the withdrawal of a member 736 SB 393 28
state on licenses granted in other member states to 737
physicians who designated the withdrawing member state as 738
the state of principal license. 739
SECTION 22. DISSOLUTION 740
(a) The Compact shall dissolve effective upon the date 741
of the withdrawal or default of the member state which 742
reduces the membership of th e Compact to one (1) member 743
state. 744
(b) Upon the dissolution of the Compact, the Compact 745
becomes null and void and shall be of no further force or 746
effect, and the business and affairs of the Interstate 747
Commission shall be concluded, and surplus fun ds shall be 748
distributed in accordance with the bylaws. 749
SECTION 23. SEVERABILITY AND CONSTRUCTION 750
(a) The provisions of the Compact shall be severable, 751
and if any phrase, clause, sentence, or provision is deemed 752
unenforceable, the remaining pro visions of the Compact shall 753
be enforceable. 754
(b) The provisions of the Compact shall be liberally 755
construed to effectuate its purposes. 756
(c) Nothing in the Compact shall be construed to 757
prohibit the applicability of other interstate compacts to 758
which the member states are members. 759
SECTION 24. BINDING EFFECT OF COMPACT AND OTHER LAWS 760
(a) Nothing herein prevents the enforcement of any 761
other law of a member state that is not inconsistent with 762
the Compact. 763
(b) All laws in a member state in conflict with the 764
Compact are superseded to the extent of the conflict 765
(c) All lawful actions of the Interstate Commission, 766
including all rules and bylaws promulgated by the 767
Commission, are binding upon the member states. 768 SB 393 29
(d) All agreements between the Interstate Commission 769
and the member states are binding in accordance with their 770
terms. 771
(e) In the event any provision of the Compact exceeds 772
the constitutional limits imposed on the legislature of any 773
member state, such provisi on shall be ineffective to the 774
extent of the conflict with the constitutional provision in 775
question in that member state. 776