85R6362 JG-D
By: Hinojosa, et al. S.B. No. 305
A BILL TO BE ENTITLED
AN ACT
relating to the continuation and functions of the Texas Board of
Nursing and to the regulation of the practice of nursing.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 301.003, Occupations Code, is amended to
read as follows:
Sec. 301.003. APPLICATION OF SUNSET ACT. The Texas Board of
Nursing is subject to Chapter 325, Government Code (Texas Sunset
Act). Unless continued in existence as provided by that chapter,
the board is abolished September 1, 2029 [2017].
SECTION 2. Section 301.059, Occupations Code, is amended by
amending Subsection (b) and adding Subsection (d) to read as
follows:
(b) The training program must provide the person with
information regarding:
(1) the law governing [legislation that created the
board and] the board's operations;
(2) the programs, functions, rules, and budget of the
board;
(3) the scope of and limitations on the board's
rulemaking authority;
(4) [(2)] the results of the most recent formal audit
of the board;
(5) [(3)] the requirements of:
(A) laws relating to open meetings, public
information, administrative procedure, and disclosing conflicts of
interest; and
(B) other laws applicable to members of the board
in performing their duties; and
(6) [(4)] any applicable ethics policies adopted by
the board or the Texas Ethics Commission.
(d) The executive director of the board shall create a
training manual that includes the information required by
Subsection (b). The executive director shall distribute a copy of
the training manual annually to each board member. On receipt of
the training manual, each board member shall sign and submit to the
executive director a statement acknowledging receipt of the
training manual.
SECTION 3. Section 301.157, Occupations Code, is amended by
amending Subsections (d-4), (d-8), (d-9), and (d-11) and adding
Subsection (d-12) to read as follows:
(d-4) The board may recognize and accept as approved under
this section a school of nursing or educational program operated in
another state and approved by a state board of nursing or other
regulatory body of that state. The board shall adopt rules [develop
policies] to ensure that the other state's standards are
substantially equivalent to the board's standards. The board by
rule shall develop a process for students enrolled in a school of
nursing or educational program operated in another state that does
not meet standards substantially equivalent to the board's
standards to apply for an initial license under this chapter.
(d-8) For purposes of Subsection (d-4), a nursing program
is considered to meet standards substantially equivalent to the
board's standards if the program:
(1) is part of an institution of higher education
located outside this state that is approved by the appropriate
regulatory authorities of that state;
(2) holds regional accreditation by an accrediting
body recognized by the United States secretary of education and the
Council for Higher Education Accreditation;
(3) holds specialty accreditation by an accrediting
body recognized by the United States secretary of education and the
Council for Higher Education Accreditation, including the National
League for Nursing Accrediting Commission;
(4) requires program applicants to be a licensed
practical or vocational nurse, a military service corpsman, or a
paramedic, or to hold a college degree in a clinically oriented
health care field with demonstrated experience providing direct
patient care; and
(5) graduates students who:
(A) achieve faculty-determined program outcomes,
including passing criterion-referenced examinations of nursing
knowledge essential to beginning a registered nursing practice and
transitioning to the role of registered nurse;
(B) pass a criterion-referenced summative
performance examination developed by faculty subject matter
experts that measures clinical competencies essential to beginning
a registered nursing practice and that meets nationally recognized
standards for educational testing, including the educational
testing standards of the American Educational Research
Association, the American Psychological Association, and the
National Council on Measurement in Education; and
(C) pass the National Council Licensure
Examination for Registered Nurses at a rate equivalent to the
board's required passage rate for students of approved in-state
programs.
(d-9) A graduate of a clinical competency assessment
program operated in another state and approved by a state board of
nursing or other regulatory body of another state is eligible to
apply for an initial license under this chapter if:
(1) [the board allowed graduates of the program to
apply for an initial license under this chapter continuously during
the 10-year period preceding January 1, 2007;
[(2)] the program does not make any substantial
changes in the length or content of its clinical competency
assessment without the board's approval; and
(2) [(3)] the program remains in good standing with
the state board of nursing or other regulatory body in the other
state[; and
[(4) the program participates in the research study
under Section 105.008, Health and Safety Code].
(d-11) If a clinical competency assessment program operated
in another state graduates students who pass the National Council
Licensure Examination for Registered Nurses at a rate lower than
the board's required passage rate for graduating students of
approved in-state programs, not later than May 31 of the next school
year the program shall:
(1) for the first year the student passage rate is
lower than the board's required passage rate for students of
approved in-state programs, complete and submit to the board for
review and comment a self-study of the program in accordance with
the board's guidelines;
(2) for the second consecutive year the student
passage rate is lower than the board's required passage rate for
students of approved in-state programs, allow the board to conduct
a desk review to evaluate the program using the criteria typically
used in an on-site visit and make recommendations to improve the
program; and
(3) for the third consecutive year the student passage
rate is lower than the board's required passage rate for students of
approved in-state programs, provide notice on the program's
Internet website that prospective students of the program may need
to complete additional requirements to apply for an initial license
in this state because the program has failed to meet the board's
standards related to the required passage rate on the National
Council Licensure Examination for Registered Nurses [Subsections
(d-8), (d-9), (d-10), and (d-11) expire December 31, 2017. As part
of the first review conducted under Section 301.003 after September
1, 2009, the Sunset Advisory Commission shall:
[(1) recommend whether Subsections (d-8) and (d-9)
should be extended; and
[(2) recommend any changes to Subsections (d-8) and
(d-9) relating to the eligibility for a license of graduates of a
clinical competency assessment program operated in another state].
(d-12) A clinical competency assessment program operated in
another state is not considered to meet standards substantially
equivalent to the board's standards if the program fails to meet the
applicable requirements under Subsection (d-11) or if the program's
graduating student passage rate on the National Council Licensure
Examination for Registered Nurses is lower than the board's
required passage rate for graduating students of approved in-state
programs for four consecutive years. A student enrolled in a
program described by this subsection before December 31 of the
fourth consecutive year is eligible to apply for an initial license
under this chapter. The program shall notify a student who enrolls
in the program after December 31 of the fourth consecutive year that
the student is required to complete additional requirements
established by the board under Subsection (d-4) to apply for an
initial license under this chapter.
SECTION 4. Section 301.252, Occupations Code, is amended by
amending Subsection (a) and adding Subsection (a-2) to read as
follows:
(a) Each applicant for a registered nurse license or a
vocational nurse license must submit to the board a sworn
application that demonstrates the applicant's qualifications under
this chapter, accompanied by evidence that the applicant:
(1) has good professional character related to the
practice of nursing;
(2) has successfully completed a program of
professional or vocational nursing education approved under
Section 301.157(d); and
(3) has passed the jurisprudence examination approved
by the board as provided by Subsection (a-1).
(a-2) An applicant who provides satisfactory evidence that
the applicant has not committed a violation of this chapter or a
rule adopted under this chapter is considered to have good
professional character related to the practice of nursing. A
determination by the board that an applicant does not have good
professional character related to the practice of nursing must be
based on a showing by the board of a clear and rational connection
between a violation of this chapter or a rule adopted under this
chapter and the applicant's ability to effectively practice
nursing.
SECTION 5. Section 301.257, Occupations Code, is amended by
adding Subsections (l) and (m) to read as follows:
(l) The board may require in a declaratory order under this
section that a person begin participation in a peer assistance
program at the time of receipt of an initial license under this
chapter. The board shall notify the person that, on issuance of the
person's initial license, the person may request reevaluation of
the person's required participation in the peer assistance program.
(m) The board by rule shall develop a process to determine
whether a person should continue to be required to participate in a
peer assistance program. In making the determination, the board
shall:
(1) review the person's criminal history record
information and, if applicable, determine whether participation in
the program is warranted based on the time that has elapsed since
the conviction or end of community supervision;
(2) reevaluate or require a contractor administering a
peer assistance program to reevaluate the treatment plan or the
time the person is required to participate in the peer assistance
program based on the person's individualized needs; and
(3) authorize, as appropriate, a waiver of peer
assistance program completion if the board is satisfied the person
has achieved a satisfactory period of treatment or documented
sobriety, as defined by board rules, and continued participation is
not necessary.
SECTION 6. Subchapter H, Chapter 301, Occupations Code, is
amended by adding Section 301.355 to read as follows:
Sec. 301.355. DUTIES RELATED TO CERTAIN PRESCRIPTIONS. (a)
An advanced practice registered nurse authorized to prescribe or
order a drug or device may not prescribe a drug listed in Subsection
(b) to a patient unless the advanced practice registered nurse has
reviewed the patient's prescription history by accessing the
prescription information submitted to the Texas State Board of
Pharmacy as authorized by Section 481.076(a)(5), Health and Safety
Code.
(b) Subsection (a) applies only to the prescribing of:
(1) opioids;
(2) benzodiazepines;
(3) barbiturates; or
(4) carisoprodol.
(c) Failure by an advanced practice registered nurse to
comply with the requirements of this section is grounds for
disciplinary action under Section 301.452.
SECTION 7. Section 301.4106, Occupations Code, is amended
to read as follows:
Sec. 301.4106. PEER ASSISTANCE PROGRAMS. The board by rule
shall develop guidelines to:
(1) outline the roles and responsibilities of the
board and a peer assistance program established or approved by the
board under Chapter 467, Health and Safety Code;
(2) outline the process for a peer assistance program
to refer to the board complaints alleging a violation of the
practice of nursing;
(3) establish requirements for successfully
completing a peer assistance program and for notification of the
board of the successful completion by a nurse the board has ordered
to attend or referred to the program; [and]
(4) establish a clear procedure based on meaningful
performance goals for evaluating the success of a peer assistance
program established or approved by the board under Chapter 467,
Health and Safety Code;
(5) establish individualized requirements for
participants in a peer assistance program, including the duration
of participation in a peer assistance program for substance use,
based on the individual's diagnosis and needs; and
(6) ensure that participation requirements and
treatment plans for peer assistance program participants who are
referred to peer assistance for similar reasons are administered
consistently.
SECTION 8. Section 301.452, Occupations Code, is amended by
amending Subsection (b) and adding Subsection (e) to read as
follows:
(b) A person is subject to denial of a license or to
disciplinary action under this subchapter for:
(1) a violation of this chapter, a rule or regulation
not inconsistent with this chapter, or an order issued under this
chapter;
(2) fraud or deceit in procuring or attempting to
procure a license to practice professional nursing or vocational
nursing;
(3) a conviction for, or placement on deferred
adjudication community supervision or deferred disposition for, a
felony or for a misdemeanor involving moral turpitude;
(4) conduct that results in the revocation of
probation imposed because of conviction for a felony or for a
misdemeanor involving moral turpitude;
(5) use of a nursing license, diploma, or permit, or
the transcript of such a document, that has been fraudulently
purchased, issued, counterfeited, or materially altered;
(6) impersonating or acting as a proxy for another
person in the licensing examination required under Section 301.253
or 301.255;
(7) directly or indirectly aiding or abetting an
unlicensed person in connection with the unauthorized practice of
nursing;
(8) revocation, suspension, or denial of, or any other
action relating to, the person's license or privilege to practice
nursing in another jurisdiction or under federal law;
(9) intemperate use of alcohol or drugs that the board
determines endangers or could endanger a patient;
(10) unprofessional [or dishonorable] conduct in the
practice of nursing that[, in the board's opinion,] is likely to
deceive, defraud, or injure a patient or the public;
(11) adjudication of mental incompetency;
(12) lack of fitness to practice because of a mental or
physical health condition that could result in injury to a patient
or the public; or
(13) failure to care adequately for a patient or to
conform to the minimum standards of acceptable nursing practice in
a manner that, in the board's opinion, exposes a patient or other
person unnecessarily to risk of harm.
(e) The board shall adopt rules to ensure that license
denials and disciplinary action under Subsection (b)(10) are based
on the application of objective criteria that are clearly and
rationally connected to the applicant's or license holder's conduct
and that any negative outcome resulting from that conduct is
determined to affect the person's ability to effectively practice
nursing.
SECTION 9. Subchapter L, Chapter 301, Occupations Code, is
amended by adding Section 301.5525 to read as follows:
Sec. 301.5525. MONITORING HARMFUL PRESCRIBING PATTERNS OR
PRACTICES. (a) The board shall periodically check the prescribing
information submitted to the Texas State Board of Pharmacy as
authorized by Section 481.076(a)(1), Health and Safety Code, to
determine whether an advanced practice registered nurse licensed
under this chapter is engaging in potentially harmful prescribing
patterns or practices.
(b) The board, in coordination with the Texas State Board of
Pharmacy, shall determine the conduct that constitutes a
potentially harmful prescribing pattern or practice for purposes of
Subsection (a). In determining the conduct that constitutes a
potentially harmful prescribing pattern or practice, the board at a
minimum shall consider:
(1) the number of times an advanced practice
registered nurse prescribes a drug listed in Section 301.355(b);
and
(2) for prescriptions described by Subdivision (1),
patterns of prescribing combinations of those drugs and other
dangerous combinations of drugs identified by the board.
(c) If the board suspects that an advanced practice
registered nurse licensed under this chapter may be engaging in
potentially harmful prescribing patterns or practices, the board
may notify the advanced practice registered nurse of the
potentially harmful prescribing pattern or practice.
(d) The board may initiate a complaint against an advanced
practice registered nurse based on information obtained under this
section.
SECTION 10. Chapter 304, Occupations Code, is amended by
adding Section 304.0015 to read as follows:
Sec. 304.0015. NURSE LICENSURE COMPACT. The Nurse
Licensure Compact is enacted and entered into with all other
jurisdictions that legally join in the compact, which reads as
follows:
NURSE LICENSURE COMPACT
ARTICLE I. FINDINGS AND DECLARATION OF PURPOSE
(a) The party states find that:
(1) the health and safety of the public are affected by
the degree of compliance with and the effectiveness of enforcement
activities related to state nurse licensure laws;
(2) violations of nurse licensure and other laws
regulating the practice of nursing may result in injury or harm to
the public;
(3) the expanded mobility of nurses and the use of
advanced communication technologies as part of our nation's health
care delivery system require greater coordination and cooperation
among states in the areas of nurse licensure and regulation;
(4) new practice modalities and technology make
compliance with individual state nurse licensure laws difficult and
complex;
(5) the current system of duplicative licensure for
nurses practicing in multiple states is cumbersome and redundant
for both nurses and states; and
(6) uniformity of nurse licensure requirements
throughout the states promotes public safety and public health
benefits.
(b) The general purposes of this compact are to:
(1) facilitate the states' responsibility to protect
the public's health and safety;
(2) ensure and encourage the cooperation of party
states in the areas of nurse licensure and regulation;
(3) facilitate the exchange of information between
party states in the areas of nurse regulation, investigation, and
adverse actions;
(4) promote compliance with the laws governing the
practice of nursing in each jurisdiction;
(5) invest all party states with the authority to hold
a nurse accountable for meeting all state practice laws in the state
in which the patient is located at the time care is rendered through
the mutual recognition of party state licenses;
(6) decrease redundancies in the consideration and
issuance of nurse licenses; and
(7) provide opportunities for interstate practice by
nurses who meet uniform licensure requirements.
ARTICLE II. DEFINITIONS
As used in this compact:
(a) "Adverse action" means any administrative, civil,
equitable, or criminal action permitted by a state's laws that is
imposed by a licensing board or other authority against a nurse,
including actions against an individual's license or multistate
licensure privilege such as revocation, suspension, probation,
monitoring of the licensee, limitation on the licensee's practice,
or any other encumbrance on licensure affecting a nurse's
authorization to practice, including issuance of a cease and desist
action.
(b) "Alternative program" means a nondisciplinary
monitoring program approved by a licensing board.
(c) "Coordinated licensure information system" means an
integrated process for collecting, storing, and sharing
information on nurse licensure and enforcement activities related
to nurse licensure laws that is administered by a nonprofit
organization composed of and controlled by licensing boards.
(d) "Current significant investigative information" means:
(1) investigative information that a licensing board,
after a preliminary inquiry that includes notification and an
opportunity for the nurse to respond, if required by state law, has
reason to believe is not groundless and, if proven true, would
indicate more than a minor infraction; or
(2) investigative information that indicates that the
nurse represents an immediate threat to public health and safety
regardless of whether the nurse has been notified and had an
opportunity to respond.
(e) "Encumbrance" means a revocation or suspension of, or
any limitation on, the full and unrestricted practice of nursing
imposed by a licensing board.
(f) "Home state" means the party state which is the nurse's
primary state of residence.
(g) "Licensing board" means a party state's regulatory body
responsible for issuing nurse licenses.
(h) "Multistate license" means a license to practice as a
registered or a licensed practical/vocational nurse (LPN/VN)
issued by a home state licensing board that authorizes the licensed
nurse to practice in all party states under a multistate licensure
privilege.
(i) "Multistate licensure privilege" means a legal
authorization associated with a multistate license permitting the
practice of nursing as either a registered nurse (RN) or LPN/VN in a
remote state.
(j) "Nurse" means RN or LPN/VN, as those terms are defined
by each party state's practice laws.
(k) "Party state" means any state that has adopted this
compact.
(l) "Remote state" means a party state, other than the home
state.
(m) "Single-state license" means a nurse license issued by a
party state that authorizes practice only within the issuing state
and does not include a multistate licensure privilege to practice
in any other party state.
(n) "State" means a state, territory, or possession of the
United States and the District of Columbia.
(o) "State practice laws" means a party state's laws, rules,
and regulations that govern the practice of nursing, define the
scope of nursing practice, and create the methods and grounds for
imposing discipline. "State practice laws" do not include
requirements necessary to obtain and retain a license, except for
qualifications or requirements of the home state.
ARTICLE III. GENERAL PROVISIONS AND JURISDICTION
(a) A multistate license to practice registered or licensed
practical/vocational nursing issued by a home state to a resident
in that state will be recognized by each party state as authorizing
a nurse to practice as a registered nurse (RN) or as a licensed
practical/vocational nurse (LPN/VN), under a multistate licensure
privilege, in each party state.
(b) A state must implement procedures for considering the
criminal history records of applicants for initial multistate
license or licensure by endorsement. Such procedures shall include
the submission of fingerprints or other biometric-based
information by applicants for the purpose of obtaining an
applicant's criminal history record information from the Federal
Bureau of Investigation and the agency responsible for retaining
that state's criminal records.
(c) Each party state shall require the following for an
applicant to obtain or retain a multistate license in the home
state:
(1) meets the home state's qualifications for
licensure or renewal of licensure, as well as all other applicable
state laws;
(2)(i) has graduated or is eligible to graduate from a
licensing board-approved RN or LPN/VN prelicensure education
program; or
(ii) has graduated from a foreign RN or LPN/VN
prelicensure education program that (a) has been approved by the
authorized accrediting body in the applicable country and (b) has
been verified by an independent credentials review agency to be
comparable to a licensing board-approved prelicensure education
program;
(3) has, if a graduate of a foreign prelicensure
education program not taught in English or if English is not the
individual's native language, successfully passed an English
proficiency examination that includes the components of reading,
speaking, writing, and listening;
(4) has successfully passed an NCLEX-RN or NCLEX-PN
Examination or a recognized predecessor, as applicable;
(5) is eligible for or holds an active, unencumbered
license;
(6) has submitted, in connection with an application
for initial licensure or licensure by endorsement, fingerprints or
other biometric data for the purpose of obtaining criminal history
record information from the Federal Bureau of Investigation and the
agency responsible for retaining that state's criminal records;
(7) has not been convicted or found guilty, or has
entered into an agreed disposition, of a felony offense under
applicable state or federal criminal law;
(8) has not been convicted or found guilty, or has
entered into an agreed disposition, of a misdemeanor offense
related to the practice of nursing as determined on a case-by-case
basis;
(9) is not currently enrolled in an alternative
program;
(10) is subject to self-disclosure requirements
regarding current participation in an alternative program; and
(11) has a valid United States social security number.
(d) All party states shall be authorized, in accordance with
existing state due process law, to take adverse action against a
nurse's multistate licensure privilege such as revocation,
suspension, probation, or any other action that affects a nurse's
authorization to practice under a multistate licensure privilege,
including cease and desist actions. If a party state takes such
action, it shall promptly notify the administrator of the
coordinated licensure information system. The administrator of the
coordinated licensure information system shall promptly notify the
home state of any such actions by remote states.
(e) A nurse practicing in a party state must comply with the
state practice laws of the state in which the client is located at
the time service is provided. The practice of nursing is not
limited to patient care, but shall include all nursing practice as
defined by the state practice laws of the party state in which the
client is located. The practice of nursing in a party state under a
multistate licensure privilege will subject a nurse to the
jurisdiction of the licensing board, the courts, and the laws of the
party state in which the client is located at the time service is
provided.
(f) Individuals not residing in a party state shall continue
to be able to apply for a party state's single-state license as
provided under the laws of each party state. However, the
single-state license granted to these individuals will not be
recognized as granting the privilege to practice nursing in any
other party state. Nothing in this compact shall affect the
requirements established by a party state for the issuance of a
single-state license.
(g) Any nurse holding a home state multistate license, on
the effective date of this compact, may retain and renew the
multistate license issued by the nurse's then-current home state,
provided that:
(1) a nurse, who changes primary state of residence
after this compact's effective date, must meet all applicable
Article III(c) requirements to obtain a multistate license from the
new home state; or
(2) a nurse who fails to satisfy the multistate
licensure requirements in Article III(c) due to a disqualifying
event occurring after this compact's effective date shall be
ineligible to retain or renew a multistate license, and the nurse's
multistate license shall be revoked or deactivated in accordance
with applicable rules adopted by the Interstate Commission of Nurse
Licensure Compact Administrators ("commission").
ARTICLE IV. APPLICATIONS FOR LICENSURE IN A PARTY STATE
(a) Upon application for a multistate license, the
licensing board in the issuing party state shall ascertain, through
the coordinated licensure information system, whether the
applicant has ever held, or is the holder of, a license issued by
any other state, whether there are any encumbrances on any license
or multistate licensure privilege held by the applicant, whether
any adverse action has been taken against any license or multistate
licensure privilege held by the applicant, and whether the
applicant is currently participating in an alternative program.
(b) A nurse may hold a multistate license, issued by the
home state, in only one party state at a time.
(c) If a nurse changes primary state of residence by moving
between two party states, the nurse must apply for licensure in the
new home state, and the multistate license issued by the prior home
state will be deactivated in accordance with applicable rules
adopted by the commission.
(1) The nurse may apply for licensure in advance of a
change in primary state of residence.
(2) A multistate license shall not be issued by the new
home state until the nurse provides satisfactory evidence of a
change in primary state of residence to the new home state and
satisfies all applicable requirements to obtain a multistate
license from the new home state.
(d) If a nurse changes primary state of residence by moving
from a party state to a nonparty state, the multistate license
issued by the prior home state will convert to a single-state
license, valid only in the former home state.
ARTICLE V. ADDITIONAL AUTHORITIES INVESTED IN PARTY STATE
LICENSING BOARDS
(a) In addition to the other powers conferred by state law,
a licensing board shall have the authority to:
(1) take adverse action against a nurse's multistate
licensure privilege to practice within that party state.
(i) Only the home state shall have the power to
take adverse action against a nurse's license issued by the home
state.
(ii) For purposes of taking adverse action, the
home state licensing board shall give the same priority and effect
to reported conduct received from a remote state as it would if such
conduct had occurred within the home state. In so doing, the home
state shall apply its own state laws to determine appropriate
action.
(2) issue cease and desist orders or impose an
encumbrance on a nurse's authority to practice within that party
state.
(3) complete any pending investigation of a nurse who
changes primary state of residence during the course of such
investigation. The licensing board shall also have the authority
to take appropriate action(s) and shall promptly report the
conclusions of such investigations to the administrator of the
coordinated licensure information system. The administrator of the
coordinated licensure information system shall promptly notify the
new home state of any such actions.
(4) issue subpoenas for both hearings and
investigations that require the attendance and testimony of a
witness, as well as the production of evidence. Subpoenas issued by
a licensing board in a party state for the attendance and testimony
of witnesses or the production of evidence from another party state
shall be enforced in the latter state by any court of competent
jurisdiction, according to the practice and procedures of that
court applicable to subpoenas issued in proceedings pending before
it. The issuing authority shall pay any witness fees, travel
expenses, mileage, and other fees required by the service statutes
of the state in which the witnesses or evidence are located.
(5) obtain and submit, for each nurse licensure
applicant, fingerprint or other biometric-based information to the
Federal Bureau of Investigation for criminal background checks,
receive the results of the Federal Bureau of Investigation record
search on criminal background checks, and use the results in making
licensure decisions.
(6) if otherwise permitted by state law, recover from
the affected nurse the costs of investigations and disposition of
cases resulting from any adverse action taken against that nurse.
(7) take adverse action based on the factual findings
of the remote state, provided that the licensing board follows its
own procedures for taking such adverse action.
(b) If adverse action is taken by the home state against a
nurse's multistate license, the nurse's multistate licensure
privilege to practice in all other party states shall be
deactivated until all encumbrances have been removed from the
multistate license. All home state disciplinary orders that impose
adverse action against a nurse's multistate license shall include a
statement that the nurse's multistate licensure privilege is
deactivated in all party states during the pendency of the order.
(c) Nothing in this compact shall override a party state's
decision that participation in an alternative program may be used
in lieu of adverse action. The home state licensing board shall
deactivate the multistate licensure privilege under the multistate
license of any nurse for the duration of the nurse's participation
in an alternative program.
ARTICLE VI. COORDINATED LICENSURE INFORMATION SYSTEM AND EXCHANGE
OF INFORMATION
(a) All party states shall participate in a coordinated
licensure information system of all licensed registered nurses
(RNs) and licensed practical/vocational nurses (LPNs/VNs). This
system will include information on the licensure and disciplinary
history of each nurse, as submitted by party states, to assist in
the coordination of nurse licensure and enforcement efforts.
(b) The commission, in consultation with the administrator
of the coordinated licensure information system, shall formulate
necessary and proper procedures for the identification,
collection, and exchange of information under this compact.
(c) All licensing boards shall promptly report to the
coordinated licensure information system any adverse action, any
current significant investigative information, denials of
applications (with the reasons for such denials), and nurse
participation in alternative programs known to the licensing board
regardless of whether such participation is deemed nonpublic or
confidential under state law.
(d) Current significant investigative information and
participation in nonpublic or confidential alternative programs
shall be transmitted through the coordinated licensure information
system only to party state licensing boards.
(e) Notwithstanding any other provision of law, all party
state licensing boards contributing information to the coordinated
licensure information system may designate information that may not
be shared with nonparty states or disclosed to other entities or
individuals without the express permission of the contributing
state.
(f) Any personally identifiable information obtained from
the coordinated licensure information system by a party state
licensing board shall not be shared with nonparty states or
disclosed to other entities or individuals except to the extent
permitted by the laws of the party state contributing the
information.
(g) Any information contributed to the coordinated
licensure information system that is subsequently required to be
expunged by the laws of the party state contributing that
information shall also be expunged from the coordinated licensure
information system.
(h) The compact administrator of each party state shall
furnish a uniform data set to the compact administrator of each
other party state, which shall include, at a minimum:
(1) identifying information;
(2) licensure data;
(3) information related to alternative program
participation; and
(4) other information that may facilitate the
administration of this compact, as determined by commission rules.
(i) The compact administrator of a party state shall provide
all investigative documents and information requested by another
party state.
ARTICLE VII. ESTABLISHMENT OF INTERSTATE COMMISSION OF NURSE
LICENSURE COMPACT ADMINISTRATORS
(a) The party states hereby create and establish a joint
public entity known as the Interstate Commission of Nurse Licensure
Compact Administrators.
(1) The commission is an instrumentality of the party
states.
(2) Venue is proper and judicial proceedings by or
against the commission shall be brought solely and exclusively in a
court of competent jurisdiction where the principal office of the
commission is located. The commission may waive venue and
jurisdictional defenses to the extent it adopts or consents to
participate in alternative dispute resolution proceedings.
(3) Nothing in this compact shall be construed to be a
waiver of sovereign immunity.
(b) Membership, Voting, and Meetings
(1) Each party state shall have and be limited to one
administrator. The head of the state licensing board or a designee
shall be the administrator of this compact for each party state.
Any administrator may be removed or suspended from office as
provided by the law of the state from which the administrator is
appointed. Any vacancy occurring in the commission shall be filled
in accordance with the laws of the party state in which the vacancy
exists.
(2) Each administrator shall be entitled to one (1)
vote with regard to the promulgation of rules and the creation of
bylaws and shall otherwise have an opportunity to participate in
the business and affairs of the commission. An administrator shall
vote in person or by such other means as provided in the bylaws. The
bylaws may provide for an administrator's participation in meetings
by telephone or other means of communication.
(3) The commission shall meet at least once during
each calendar year. Additional meetings shall be held as set forth
in the bylaws or rules of the commission.
(4) All meetings shall be open to the public, and
public notice of meetings shall be given in the same manner as
required under the rulemaking provisions in Article VIII.
(5) The commission may convene in a closed, nonpublic
meeting if the commission must discuss:
(i) noncompliance of a party state with its
obligations under this compact;
(ii) the employment, compensation, discipline,
or other personnel matters, practices, or procedures related to
specific employees or other matters related to the commission's
internal personnel practices and procedures;
(iii) current, threatened, or reasonably
anticipated litigation;
(iv) negotiation of contracts for the purchase or
sale of goods, services, or real estate;
(v) accusing any person of a crime or formally
censuring any person;
(vi) disclosure of trade secrets or commercial or
financial information that is privileged or confidential;
(vii) disclosure of information of a personal
nature where disclosure would constitute a clearly unwarranted
invasion of personal privacy;
(viii) disclosure of investigatory records
compiled for law enforcement purposes;
(ix) disclosure of information related to any
reports prepared by or on behalf of the commission for the purpose
of investigation of compliance with this compact; or
(x) matters specifically exempted from
disclosure by federal or state statute.
(6) If a meeting or portion of a meeting is closed
pursuant to this provision, the commission's legal counsel or
designee shall certify that the meeting may be closed and shall
reference each relevant exempting provision. The commission shall
keep minutes that fully and clearly describe all matters discussed
in a meeting and shall provide a full and accurate summary of
actions taken, and the reasons therefor, including a description of
the views expressed. All documents considered in connection with
an action shall be identified in such minutes. All minutes and
documents of a closed meeting shall remain under seal, subject to
release by a majority vote of the commission or order of a court of
competent jurisdiction.
(c) The commission shall, by a majority vote of the
administrators, prescribe bylaws or rules to govern its conduct as
may be necessary or appropriate to carry out the purposes and
exercise the powers of this compact, including but not limited to:
(1) establishing the fiscal year of the commission;
(2) providing reasonable standards and procedures:
(i) for the establishment and meeting of other
committees; and
(ii) governing any general or specific
delegation of any authority or function of the commission;
(3) providing reasonable procedures for calling and
conducting meetings of the commission, ensuring reasonable advance
notice of all meetings, and providing an opportunity for attendance
of such meetings by interested parties, with enumerated exceptions
designed to protect the public's interest, the privacy of
individuals, and proprietary information, including trade secrets.
The commission may meet in closed session only after a majority of
the administrators vote to close a meeting in whole or in part. As
soon as practicable, the commission must make public a copy of the
vote to close the meeting revealing the vote of each administrator,
with no proxy votes allowed;
(4) establishing the titles, duties and authority, and
reasonable procedures for the election of the officers of the
commission;
(5) providing reasonable standards and procedures for
the establishment of the personnel policies and programs of the
commission. Notwithstanding any civil service or other similar
laws of any party state, the bylaws shall exclusively govern the
personnel policies and programs of the commission; and
(6) providing a mechanism for winding up the
operations of the commission and the equitable disposition of any
surplus funds that may exist after the termination of this compact
after the payment or reserving of all of its debts and obligations.
(d) The commission shall publish its bylaws and rules, and
any amendments thereto, in a convenient form on the website of the
commission.
(e) The commission shall maintain its financial records in
accordance with the bylaws.
(f) The commission shall meet and take such actions as are
consistent with the provisions of this compact and the bylaws.
(g) The commission shall have the following powers:
(1) to promulgate uniform rules to facilitate and
coordinate implementation and administration of this compact. The
rules shall have the force and effect of law and shall be binding in
all party states;
(2) to bring and prosecute legal proceedings or
actions in the name of the commission, provided that the standing of
any licensing board to sue or be sued under applicable law shall not
be affected;
(3) to purchase and maintain insurance and bonds;
(4) to borrow, accept, or contract for services of
personnel, including, but not limited to, employees of a party
state or nonprofit organizations;
(5) to cooperate with other organizations that
administer state compacts related to the regulation of nursing,
including, but not limited to, sharing administrative or staff
expenses, office space, or other resources;
(6) to hire employees, elect or appoint officers, fix
compensation, define duties, grant such individuals appropriate
authority to carry out the purposes of this compact, and to
establish the commission's personnel policies and programs
relating to conflicts of interest, qualifications of personnel, and
other related personnel matters;
(7) to accept any and all appropriate donations,
grants, and gifts of money, equipment, supplies, materials, and
services, and to receive, utilize, and dispose of the same;
provided that at all times the commission shall avoid any
appearance of impropriety or conflict of interest;
(8) to lease, purchase, accept appropriate gifts or
donations of, or otherwise to own, hold, improve, or use, any
property, whether real, personal, or mixed; provided that at all
times the commission shall avoid any appearance of impropriety;
(9) to sell, convey, mortgage, pledge, lease,
exchange, abandon, or otherwise dispose of any property, whether
real, personal, or mixed;
(10) to establish a budget and make expenditures;
(11) to borrow money;
(12) to appoint committees, including advisory
committees comprised of administrators, state nursing regulators,
state legislators or their representatives, consumer
representatives, and other such interested persons;
(13) to provide and receive information from, and to
cooperate with, law enforcement agencies;
(14) to adopt and use an official seal; and
(15) to perform such other functions as may be
necessary or appropriate to achieve the purposes of this compact
consistent with the state regulation of nurse licensure and
practice.
(h) Financing of the Commission
(1) The commission shall pay, or provide for the
payment of, the reasonable expenses of its establishment,
organization, and ongoing activities.
(2) The commission may also levy on and collect an
annual assessment from each party state to cover the cost of its
operations, activities, and staff in its annual budget as approved
each year. The aggregate annual assessment amount, if any, shall be
allocated based upon a formula to be determined by the commission,
which shall promulgate a rule that is binding upon all party states.
(3) The commission shall not incur an obligation of
any kind prior to securing the funds adequate to meet the same; nor
shall the commission pledge the credit of any of the party states,
except by and with the authority of such party state.
(4) The commission shall keep accurate accounts of all
receipts and disbursements. The receipts and disbursements of the
commission shall be subject to the audit and accounting procedures
established under its bylaws. However, all receipts and
disbursements of funds handled by the commission shall be audited
yearly by a certified or licensed public accountant, and the report
of the audit shall be included in and become part of the annual
report of the commission.
(i) Qualified Immunity, Defense, and Indemnification
(1) The compact administrators, officers, executive
directors, employees, and representatives of the commission shall
be immune from suit and liability, either personally or in their
official capacity, for any claim for damage to or loss of property,
or personal injury or other civil liability caused by or arising out
of any actual or alleged act, error, or omission that occurred, or
that the person against whom the claim is made had a reasonable
basis for believing occurred, within the scope of commission
employment, duties, or responsibilities; provided that nothing in
this subdivision shall be construed to protect any such person from
suit or liability for any damages, loss, injury, or liability
caused by the intentional, wilful, or wanton misconduct of that
person.
(2) The commission shall defend any administrator,
officer, executive director, employee, or representative of the
commission in any civil action seeking to impose liability arising
out of any actual or alleged act, error, or omission that occurred
within the scope of commission employment, duties, or
responsibilities, or that the person against whom the claim is made
had a reasonable basis for believing occurred within the scope of
commission employment, duties, or responsibilities; provided that
nothing herein shall be construed to prohibit that person from
retaining his or her own counsel; and provided further that the
actual or alleged act, error, or omission did not result from that
person's intentional, wilful, or wanton misconduct.
(3) The commission shall indemnify and hold harmless
any administrator, officer, executive director, employee, or
representative of the commission for the amount of any settlement
or judgment obtained against that person arising out of any actual
or alleged act, error, or omission that occurred within the scope of
commission employment, duties, or responsibilities, or that such
person had a reasonable basis for believing occurred within the
scope of commission employment, duties, or responsibilities;
provided that the actual or alleged act, error, or omission did not
result from the intentional, wilful, or wanton misconduct of that
person.
ARTICLE VIII. RULEMAKING
(a) The commission shall exercise its rulemaking powers
pursuant to the criteria set forth in this article and the rules
adopted thereunder. Rules and amendments shall become binding as
of the date specified in each rule or amendment and shall have the
same force and effect as provisions of this compact.
(b) Rules or amendments to the rules shall be adopted at a
regular or special meeting of the commission.
(c) Prior to promulgation and adoption of a final rule or
rules by the commission, and at least sixty (60) days in advance of
the meeting at which the rule will be considered and voted upon, the
commission shall file a notice of proposed rulemaking:
(1) on the website of the commission; and
(2) on the website of each licensing board or the
publication in which each state would otherwise publish proposed
rules.
(d) The notice of proposed rulemaking shall include:
(1) the proposed time, date, and location of the
meeting in which the rule will be considered and voted upon;
(2) the text of the proposed rule or amendment, and the
reason for the proposed rule;
(3) a request for comments on the proposed rule from
any interested person; and
(4) the manner in which interested persons may submit
notice to the commission of their intention to attend the public
hearing and any written comments.
(e) Prior to adoption of a proposed rule, the commission
shall allow persons to submit written data, facts, opinions, and
arguments, which shall be made available to the public.
(f) The commission shall grant an opportunity for a public
hearing before it adopts a rule or amendment.
(g) The commission shall publish the place, time, and date
of the scheduled public hearing.
(1) Hearings shall be conducted in a manner providing
each person who wishes to comment a fair and reasonable opportunity
to comment orally or in writing. All hearings will be recorded, and
a copy will be made available upon request.
(2) Nothing in this section shall be construed as
requiring a separate hearing on each rule. Rules may be grouped for
the convenience of the commission at hearings required by this
section.
(h) If no one appears at the public hearing, the commission
may proceed with promulgation of the proposed rule.
(i) Following the scheduled hearing date, or by the close of
business on the scheduled hearing date if the hearing was not held,
the commission shall consider all written and oral comments
received.
(j) The commission shall, by majority vote of all
administrators, take final action on the proposed rule and shall
determine the effective date of the rule, if any, based on the
rulemaking record and the full text of the rule.
(k) Upon determination that an emergency exists, the
commission may consider and adopt an emergency rule without prior
notice, opportunity for comment, or hearing; provided that the
usual rulemaking procedures provided in this compact and in this
section shall be retroactively applied to the rule as soon as
reasonably possible, and in no event later than ninety (90) days
after the effective date of the rule. For the purposes of this
provision, an emergency rule is one that must be adopted
immediately in order to:
(1) meet an imminent threat to public health, safety,
or welfare;
(2) prevent a loss of commission or party state funds;
or
(3) meet a deadline for the promulgation of an
administrative rule that is required by federal law or rule.
(l) The commission may direct revisions to a previously
adopted rule or amendment for purposes of correcting typographical
errors, errors in format, errors in consistency, or grammatical
errors. Public notice of any revisions shall be posted on the
website of the commission. The revision shall be subject to
challenge by any person for a period of thirty (30) days after
posting. The revision may be challenged only on grounds that the
revision results in a material change to a rule. A challenge shall
be made in writing, and delivered to the commission, prior to the
end of the notice period. If no challenge is made, the revision
will take effect without further action. If the revision is
challenged, the revision may not take effect without the approval
of the commission.
ARTICLE IX. OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT
(a) Oversight
(1) Each party state shall enforce this compact and
take all actions necessary and appropriate to effectuate this
compact's purposes and intent.
(2) The commission shall be entitled to receive
service of process in any proceeding that may affect the powers,
responsibilities, or actions of the commission, and shall have
standing to intervene in such a proceeding for all purposes.
Failure to provide service of process in such proceeding to the
commission shall render a judgment or order void as to the
commission, this compact, or promulgated rules.
(b) Default, Technical Assistance, and Termination
(1) If the commission determines that a party state
has defaulted in the performance of its obligations or
responsibilities under this compact or the promulgated rules, the
commission shall:
(i) provide written notice to the defaulting
state and other party states of the nature of the default, the
proposed means of curing the default, or any other action to be
taken by the commission; and
(ii) provide remedial training and specific
technical assistance regarding the default.
(2) If a state in default fails to cure the default,
the defaulting state's membership in this compact may be terminated
upon an affirmative vote of a majority of the administrators, and
all rights, privileges, and benefits conferred by this compact may
be terminated on the effective date of termination. A cure of the
default does not relieve the offending state of obligations or
liabilities incurred during the period of default.
(3) Termination of membership in this compact shall be
imposed only after all other means of securing compliance have been
exhausted. Notice of intent to suspend or terminate shall be given
by the commission to the governor of the defaulting state and to the
executive officer of the defaulting state's licensing board and
each of the party states.
(4) A state whose membership in this compact has been
terminated is responsible for all assessments, obligations, and
liabilities incurred through the effective date of the termination,
including obligations that extend beyond the effective date of
termination.
(5) The commission shall not bear any costs related to
a state that is found to be in default or whose membership in this
compact has been terminated unless agreed upon in writing between
the commission and the defaulting state.
(6) The defaulting state may appeal the action of the
commission by petitioning the U.S. District Court for the District
of Columbia or the federal district in which the commission has its
principal offices. The prevailing party shall be awarded all costs
of such litigation, including reasonable attorneys' fees.
(c) Dispute Resolution
(1) Upon request by a party state, the commission
shall attempt to resolve disputes related to the compact that arise
among party states and between party and nonparty states.
(2) The commission shall promulgate a rule providing
for both mediation and binding dispute resolution for disputes, as
appropriate.
(3) In the event the commission cannot resolve
disputes among party states arising under this compact:
(i) the party states may submit the issues in
dispute to an arbitration panel, which will be comprised of
individuals appointed by the compact administrator in each of the
affected party states and an individual mutually agreed upon by the
compact administrators of all the party states involved in the
dispute; and
(ii) the decision of a majority of the
arbitrators shall be final and binding.
(d) Enforcement
(1) The commission, in the reasonable exercise of its
discretion, shall enforce the provisions and rules of this compact.
(2) By majority vote, the commission may initiate
legal action in the U.S. District Court for the District of Columbia
or in the federal district in which the commission has its principal
offices against a party state that is in default to enforce
compliance with the provisions of this compact and its promulgated
rules and bylaws. The relief sought may include both injunctive
relief and damages. In the event judicial enforcement is
necessary, the prevailing party shall be awarded all costs of such
litigation, including reasonable attorneys' fees.
(3) The remedies herein shall not be the exclusive
remedies of the commission. The commission may pursue any other
remedies available under federal or state law.
ARTICLE X. EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENTS
(a) This compact shall become effective and binding on the
earlier of the date of legislative enactment of this compact into
law by no less than twenty-six (26) states or December 31, 2018. All
party states to this compact that also were parties to the prior
Nurse Licensure Compact, superseded by this compact ("prior
compact"), shall be deemed to have withdrawn from said prior
compact within six (6) months after the effective date of this
compact.
(b) Each party state to this compact shall continue to
recognize a nurse's multistate licensure privilege to practice in
that party state issued under the prior compact until the party
state has withdrawn from the prior compact.
(c) Any party state may withdraw from this compact by
enacting a statute repealing the same. A party state's withdrawal
shall not take effect until six (6) months after enactment of the
repealing statute.
(d) A party state's withdrawal or termination shall not
affect the continuing requirement of the withdrawing or terminated
state's licensing board to report adverse actions and significant
investigations occurring prior to the effective date of such
withdrawal or termination.
(e) Nothing contained in this compact shall be construed to
invalidate or prevent any nurse licensure agreement or other
cooperative arrangement between a party state and a nonparty state
that is made in accordance with the other provisions of this
compact.
(f) This compact may be amended by the party states. No
amendment to this compact shall become effective and binding upon
the party states unless and until it is enacted into the laws of all
party states.
(g) Representatives of nonparty states to this compact
shall be invited to participate in the activities of the
commission, on a nonvoting basis, prior to the adoption of this
compact by all states.
ARTICLE XI. CONSTRUCTION AND SEVERABILITY
This compact shall be liberally construed so as to effectuate
the purposes thereof. The provisions of this compact shall be
severable, and if any phrase, clause, sentence, or provision of
this compact is declared to be contrary to the constitution of any
party state or the United States, or if the applicability thereof to
any government, agency, person, or circumstance is held invalid,
the validity of the remainder of this compact and the applicability
thereof to any government, agency, person, or circumstance shall
not be affected thereby. If this compact shall be held to be
contrary to the constitution of any party state, this compact shall
remain in full force and effect as to the remaining party states and
in full force and effect as to the party state affected as to all
severable matters.
SECTION 11. Chapter 304, Occupations Code, is amended by
adding Section 304.0025 to read as follows:
Sec. 304.0025. RULES ADOPTED UNDER COMPACT. The Interstate
Commission of Nurse Licensure Compact Administrators established
under the Nurse Licensure Compact under Section 304.0015 may not
adopt rules that alter the requirements or scope of practice of a
license issued under Chapter 301. Any rule adopted by the
Interstate Commission of Nurse Licensure Compact Administrators
that purports to alter the requirements or scope of practice of a
license issued under Chapter 301 is not enforceable.
SECTION 12. Section 304.006(a), Occupations Code, is
amended to read as follows:
(a) On request and payment of a reasonable fee, the Texas
Board of Nursing shall provide a registered or vocational nurse
licensed by this state with a copy of information regarding the
nurse maintained by the coordinated licensure information system
under Article VI [7] of the Nurse Licensure Compact.
SECTION 13. Section 304.008(a), Occupations Code, is
amended to read as follows:
(a) In reporting information to the coordinated licensure
information system under Article VI [7] of the Nurse Licensure
Compact, the Texas Board of Nursing may disclose personally
identifiable information about the nurse, including the nurse's
social security number.
SECTION 14. (a) Sections 301.160 and 301.163, Occupations
Code, are repealed.
(b) Effective December 31, 2018, Sections 304.001 and
304.009, Occupations Code, are repealed.
SECTION 15. (a) Except as provided by Subsection (b) of
this section, Section 301.059, Occupations Code, as amended by this
Act, applies to a member of the Texas Board of Nursing appointed
before, on, or after the effective date of this Act.
(b) A member of the Texas Board of Nursing who, before the
effective date of this Act, completed the training program required
by Section 301.059, Occupations Code, as that law existed before
the effective date of this Act, is required to complete additional
training only on subjects added to the training program required by
Section 301.059, Occupations Code, as amended by this Act. A board
member described by this subsection may not vote, deliberate, or be
counted as a member in attendance at a meeting of the board held on
or after December 1, 2017, until the member completes the
additional training.
SECTION 16. (a) Not later than May 31, 2018, the Texas
Board of Nursing shall adopt the rules necessary to implement the
changes in law made by this Act to Section 301.157, Occupations
Code. In adopting rules under this subsection, the board shall
provide an opportunity for public comment and, through the board's
Advisory Committee on Education, seek comment from interested
parties. The rules must:
(1) clearly define substantially equivalent education
standards for purposes of recognizing a school of nursing or
educational program operated in another state; and
(2) establish a process for enabling students enrolled
in an out-of-state school of nursing or educational program that
does not meet standards substantially equivalent to the board's
standards to apply for initial licensure under Chapter 301,
Occupations Code.
(b) Not later than March 1, 2018, the Texas Board of Nursing
shall adopt the rules necessary to implement the changes in law made
by this Act to Sections 301.252 and 301.452, Occupations Code. In
adopting rules under this subsection, the board shall seek comments
from relevant interested parties.
(c) Section 301.157(d-11), Occupations Code, as amended by
this Act, applies beginning with the passage rates available in
January 2018, reflecting the passage rates for the preceding year.
If the passage rate for a clinical competency assessment program
available in January 2018 does not meet the Texas Board of Nursing's
required passage rate for students of approved in-state programs,
the clinical competency assessment program shall complete the
self-study required under Section 301.157(d-11)(1), Occupations
Code, as amended by this Act, not later than May 31, 2018.
SECTION 17. Section 301.355, Occupations Code, as added by
this Act, applies only to a prescription issued on or after
September 1, 2018. A prescription issued before September 1, 2018,
is governed by the law in effect on the date the prescription was
issued, and the former law is continued in effect for that purpose.
SECTION 18. Except as otherwise provided by this Act, this
Act takes effect September 1, 2017.