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                                                       PRINTER'S NO. 619

THE GENERAL ASSEMBLY OF PENNSYLVANIA


HOUSE BILL

No. 549 Session of 2007


        INTRODUCED BY HERSHEY, BAKER, BARRAR, BASTIAN, BELFANTI,
           BENNINGHOFF, BEYER, BOYD, CAPPELLI, CARROLL, CUTLER, DALLY,
           DENLINGER, FABRIZIO, FAIRCHILD, FRANKEL, FREEMAN, GEORGE,
           GERGELY, GILLESPIE, GINGRICH, GOODMAN, GRELL, GRUCELA,
           HENNESSEY, HESS, HORNAMAN, HUTCHINSON, JAMES, M. KELLER,
           MACKERETH, MANN, MARSICO, McILHATTAN, MOUL, MOYER, MUSTIO,
           NICKOL, PAYNE, PAYTON, PETRARCA, PETRONE, PHILLIPS, PICKETT,
           RAPP, REICHLEY, ROAE, RUBLEY, SABATINA, SCAVELLO, SIPTROTH,
           SOLOBAY, SONNEY, STABACK, STERN, R. STEVENSON, SURRA,
           SWANGER, TRUE, WALKO, WATSON, WOJNAROSKI AND YOUNGBLOOD,
           MARCH 6, 2007

        REFERRED TO COMMITTEE ON INTERGOVERNMENTAL AFFAIRS,
           MARCH 6, 2007

                                     AN ACT

     1  Authorizing the Commonwealth of Pennsylvania to join the Nurse
     2     Licensure Compact; and providing for the form of the compact.

     3     The General Assembly of the Commonwealth of Pennsylvania
     4  hereby enacts as follows:
     5  Section 1.  Short title.
     6     This act shall be known and may be cited as the Nurse
     7  Licensure Compact Act.
     8  Section 2.  Nurse Licensure Compact.
     9     The Nurse Licensure Compact is enacted into law and entered
    10  into with all jurisdictions legally joining in the compact in
    11  the form substantially as set forth as follows:
    12                      NURSE LICENSURE COMPACT
    13                             ARTICLE I

     1                Findings and Declaration of Purpose
     2     a.  The party states find that:
     3         1.  the health and safety of the public are affected by
     4     the degree of compliance with and the effectiveness of
     5     enforcement activities related to state nurse licensure laws;
     6         2.  violations of nurse licensure and other laws
     7     regulating the practice of nursing may result in injury or
     8     harm to the public;
     9         3.  the expanded mobility of nurses and the use of
    10     advanced communication technologies as part of our nation's
    11     healthcare delivery system require greater coordination and
    12     cooperation among states in the areas of nurse licensure and
    13     regulation;
    14         4.  new practice modalities and technology make
    15     compliance with individual state nurse licensure laws
    16     difficult and complex;
    17         5.  the current system of duplicative licensure for
    18     nurses practicing in multiple states is cumbersome and
    19     redundant to both nurses and states;
    20     b.  The general purposes of this Compact are to:
    21         1.  facilitate the states' responsibility to protect the
    22     public's health and safety;
    23         2.  ensure and encourage the cooperation of party states
    24     in the areas of nurse licensure and regulation;
    25         3.  facilitate the exchange of information between party
    26     states in the areas of nurse regulation, investigation and
    27     adverse actions;
    28         4.  promote compliance with the laws governing the
    29     practice of nursing in each jurisdiction; and
    30         5.  invest all party states with the authority to hold a
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     1     nurse accountable for meeting all state practice laws in the
     2     state in which the patient is located at the time care is
     3     rendered through the mutual recognition of party state
     4     licenses.
     5                             ARTICLE II
     6                            Definitions
     7     As used in this Compact:
     8  "Adverse Action" means a home or remote state action.
     9  "Alternative program" means a voluntary, nondisciplinary
    10  monitoring program approved by a nurse licensing board.
    11  "Coordinated licensure information system" means an integrated
    12  process for collecting, storing, and sharing information on
    13  nurse licensure and enforcement activities related to nurse
    14  licensure laws, which is administered by a nonprofit
    15  organization composed of and controlled by state nurse licensing
    16  boards.
    17  "Current significant investigative information" means:
    18  investigative information that a licensing board, after a
    19  preliminary inquiry that includes notification and an
    20  opportunity for the nurse to respond if required by state law,
    21  has reason to believe is not groundless and, if proved true,
    22  would indicate more than a minor infraction; or investigative
    23  information that indicates that the nurse represents an
    24  immediate threat to public health and safety regardless of
    25  whether the nurse has been notified and had an opportunity to
    26  respond.
    27  "Home state" means the party state which is the nurse's primary
    28  state of residence.
    29  "Home state action" means any administrative, civil, equitable
    30  or criminal action permitted by the home state's laws which are
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     1  imposed on a nurse by the home state's licensing board or other
     2  authority including actions against an individual's license such
     3  as: revocation, suspension, probation or any other action which
     4  affects a nurse's authorization to practice.
     5  "Licensing board" means a party state's regulatory body
     6  responsible for issuing nurse licenses.
     7  "Multistate licensure privilege" means current, official
     8  authority from a remote state permitting the practice of nursing
     9  as either a registered nurse or a licensed practical/vocational
    10  nurse in such party state. All party states have the authority,
    11  in accordance with existing state due process law, to take
    12  actions against the nurse's privilege such as: revocation,
    13  suspension, probation or any other action which affects a
    14  nurse's authorization to practice.
    15  "Nurse" means a registered nurse or licensed
    16  practical/vocational nurse, as those terms are defined by each
    17  party's state practice laws.
    18  "Party state" means any state that has adopted this Compact.
    19  "Remote state" means a party state, other than the home state,
    20  where the patient is located at the time nursing care is
    21  provided, or, in the case of the practice of nursing not
    22  involving a patient, in such party state where the recipient of
    23  nursing practice is located.
    24  "Remote state action" means any administrative, civil, equitable
    25  or criminal action permitted by a remote state's laws which are
    26  imposed on a nurse by the remote state's licensing board or
    27  other authority including actions against an individual's
    28  multistate licensure privilege to practice in the remote state,
    29  and cease and desist and other injunctive or equitable orders
    30  issued by remote states or the licensing boards thereof.
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     1  "State" means a state, territory, or possession of the United
     2  States, the District of Columbia or the Commonwealth of Puerto
     3  Rico.
     4  "State practice laws" means those individual party's state laws
     5  and regulations that govern the practice of nursing, define the
     6  scope of nursing practice, and create the methods and grounds
     7  for imposing discipline.
     8  "State practice laws" does not include the initial
     9  qualifications for licensure or requirements necessary to obtain
    10  and retain a license, except for qualifications or requirements
    11  of the home state.
    12                            ARTICLE III
    13                General Provisions and Jurisdiction
    14     a.  A license to practice registered nursing issued by a home
    15  state to a resident in that state will be recognized by each
    16  party state as authorizing a multistate licensure privilege to
    17  practice as a registered nurse in such party state. A license to
    18  practice licensed practical/vocational nursing issued by a home
    19  state to a resident in that state will be recognized by each
    20  party state as authorizing a multistate licensure privilege to
    21  practice as a licensed practical/vocational nurse in such party
    22  state. In order to obtain or retain a license, an applicant must
    23  meet the home state's qualifications for licensure and license
    24  renewal as well as all other applicable state laws.
    25     b.  Party states may, in accordance with state due process
    26  laws, limit or revoke the multistate licensure privilege of any
    27  nurse to practice in their state and may take any other actions
    28  under their applicable state laws necessary to protect the
    29  health and safety of their citizens. If a party state takes such
    30  action, it shall promptly notify the administrator of the
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     1  coordinated licensure information system. The administrator of
     2  the coordinated licensure information system shall promptly
     3  notify the home state of any such actions by remote states.
     4     c.  Every nurse practicing in a party state must comply with
     5  the state practice laws of the state in which the patient is
     6  located at the time care is rendered. In addition, the practice
     7  of nursing is not limited to patient care, but shall include all
     8  nursing practice as defined by the state practice laws of a
     9  party state. The practice of nursing will subject a nurse to the
    10  jurisdiction of the nurse licensing board and the courts, as
    11  well as the laws, in that party state.
    12     d.  This Compact does not affect additional requirements
    13  imposed by states for advanced practice registered nursing.
    14  However, a multistate licensure privilege to practice registered
    15  nursing granted by a party state shall be recognized by other
    16  party states as a license to practice registered nursing if one
    17  is required by state law as a precondition for qualifying for
    18  advanced practice registered nurse authorization.
    19     e.  Individuals not residing in a party state shall continue
    20  to be able to apply for nurse licensure as provided for under
    21  the laws of each party state. However, the license granted to
    22  these individuals will not be recognized as granting the
    23  privilege to practice nursing in any other party state unless
    24  explicitly agreed to by that party state.
    25                             ARTICLE IV
    26            Applications for Licensure in a Party State
    27     a.  Upon application for a license, the licensing board in a
    28  party state shall ascertain, through the coordinated licensure
    29  information system, whether the applicant has ever held, or is
    30  the holder of, a license issued by any other state, whether
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     1  there are any restrictions on the multistate licensure
     2  privilege, and whether any other adverse action by any state has
     3  been taken against the license.
     4     b.  A nurse in a party state shall hold licensure in only one
     5  party state at a time, issued by the home state.
     6     c.  A nurse who intends to change primary state of residence
     7  may apply for licensure in the new home state in advance of such
     8  change. However, new licenses will not be issued by a party
     9  state until after a nurse provides evidence of change in primary
    10  state of residence satisfactory to the new home state's
    11  licensing board.
    12     d.  When a nurse changes primary state of residence by:
    13         1.  moving between two party states, and obtains a
    14     license from the new home state, the license from the former
    15     home state is no longer valid;
    16         2.  moving from a nonparty state to a party state, and
    17     obtains a license from the new home state, the individual
    18     state license issued by the nonparty state is not affected
    19     and will remain in full force if so provided by the laws of
    20     the nonparty state;
    21         3.  moving from a party state to a nonparty state, the
    22     license issued by the prior home state converts to an
    23     individual state license, valid only in the former home
    24     state, without the multistate licensure privilege to practice
    25     in other party states.
    26                             ARTICLE V
    27                          Adverse Actions
    28     In addition to the General Provisions described in Article
    29  III, the following provisions apply:
    30     a.  The licensing board of a remote state shall promptly
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     1  report to the administrator of the coordinated licensure
     2  information system any remote state actions including the
     3  factual and legal basis for such action, if known. The licensing
     4  board of a remote state shall also promptly report any
     5  significant current investigative information yet to result in a
     6  remote state action. The administrator of the coordinated
     7  licensure information system shall promptly notify the home
     8  state of any such reports.
     9     b.  The licensing board of a party state shall have the
    10  authority to complete any pending investigations for a nurse who
    11  changes primary state of residence during the course of such
    12  investigations. It shall also have the authority to take
    13  appropriate action(s), and shall promptly report the conclusions
    14  of such investigations to the administrator of the coordinated
    15  licensure information system. The administrator of the
    16  coordinated licensure information system shall promptly notify
    17  the new home state of any such actions.
    18     c.  A remote state may take adverse action affecting the
    19  multistate licensure privilege to practice within that party
    20  state. However, only the home state shall have the power to
    21  impose adverse action against the license issued by the home
    22  state.
    23     d.  For purposes of imposing adverse action, the licensing
    24  board of the home state shall give the same priority and effect
    25  to reported conduct received from a remote state as it would if
    26  such conduct had occurred within the home state. In so doing, it
    27  shall apply its own state laws to determine appropriate action.
    28     e.  The home state may take adverse action based on the
    29  factual findings of the remote state, so long as each state
    30  follows its own procedures for imposing such adverse action.
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     1     f.  Nothing in this Compact shall override a party state's
     2  decision that participation in an alternative program may be
     3  used in lieu of licensure action and that such participation
     4  shall remain nonpublic if required by the party state's laws.
     5  Party states must require nurses who enter any alternative
     6  programs to agree not to practice in any other party state
     7  during the term of the alternative program without prior
     8  authorization from such other party state.
     9                             ARTICLE VI
    10                 Additional Authorities Invested in
    11                 Party State Nurse Licensing Boards
    12     Notwithstanding any other powers, party state nurse licensing
    13  boards shall have the authority to:
    14     a.  if otherwise permitted by state law, recover from the
    15  affected nurse the costs of investigations and disposition of
    16  cases resulting from any adverse action taken against that
    17  nurse;
    18     b.  issue subpoenas for both hearings and investigations
    19  which require the attendance and testimony of witnesses, and the
    20  production of evidence. Subpoenas issued by a nurse licensing
    21  board in a party state for the attendance and testimony of
    22  witnesses, and/or the production of evidence from another party
    23  state, shall be enforced in the latter state by any court of
    24  competent jurisdiction, according to the practice and procedure
    25  of that court applicable to subpoenas issued in proceedings
    26  pending before it. The issuing authority shall pay any witness
    27  fees, travel expenses, mileage and other fees required by the
    28  service statutes of the state where the witnesses and/or
    29  evidence are located;
    30     c.  issue cease and desist orders to limit or revoke a
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     1  nurse's authority to practice in their respective states;
     2     d.  promulgate uniform rules and regulations as provided for
     3  in Article VIII(c).
     4                            ARTICLE VII
     5              Coordinated Licensure Information System
     6     a.  All party states shall participate in a cooperative
     7  effort to create a coordinated data base of all licensed
     8  registered nurses and licensed practical/vocational nurses. This
     9  system will include information on the licensure and
    10  disciplinary history of each nurse, as contributed by party
    11  states, to assist in the coordination of nurse licensure and
    12  enforcement efforts.
    13     b.  Notwithstanding any other provision of law, all party
    14  states' licensing boards shall promptly report adverse actions,
    15  actions against multistate licensure privileges, any current
    16  significant investigative information yet to result in adverse
    17  action, denials of applications, and the reasons for such
    18  denials, to the coordinated licensure information system.
    19     c.  Current significant investigative information shall be
    20  transmitted through the coordinated licensure information system
    21  only to party state licensing boards.
    22     d.  Notwithstanding any other provision of law, all party
    23  states' licensing boards contributing information to the
    24  coordinated licensure information system may designate
    25  information that may not be shared with nonparty states or
    26  disclosed to other entities or individuals without the express
    27  permission of the contributing state.
    28     e.  Any personally identifiable information obtained by a
    29  party state's licensing board from the coordinated licensure
    30  information system may not be shared with nonparty states or
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     1  disclosed to other entities or individuals except to the extent
     2  permitted by the laws of the party state contributing the
     3  information.
     4     f.  Any information contributed to the coordinated licensure
     5  information system that is subsequently required to be expunged
     6  by the laws of the party state contributing that information,
     7  shall also be expunged from the coordinated licensure
     8  information system.
     9     g.  The Compact administrators, acting jointly with each
    10  other and in consultation with the administrator of the
    11  coordinated licensure information system, shall formulate
    12  necessary and proper procedures for the identification,
    13  collection and exchange of information under this Compact.
    14                            ARTICLE VIII
    15       Compact Administration and Interchange of Information
    16     a.  The head of the nurse licensing board, or his/her
    17  designee, of each party state shall be the administrator of this
    18  Compact for his/her state.
    19     b.  The Compact administrator of each party state shall
    20  furnish to the Compact administrator of each other party state
    21  any information and documents including, but not limited to, a
    22  uniform data set of investigations, identifying information,
    23  licensure data, and disclosable alternative program
    24  participation information to facilitate the administration of
    25  this Compact.
    26     c.  Compact administrators shall have the authority to
    27  develop uniform rules to facilitate and coordinate
    28  implementation of this Compact. These uniform rules shall be
    29  adopted by party states, under the authority invested under
    30  Article VI (d).
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     1                             ARTICLE IX
     2                              Immunity
     3     No party state or the officers or employees or agents of a
     4  party state's nurse licensing board who acts in accordance with
     5  the provisions of this Compact shall be liable on account of any
     6  act or omission in good faith while engaged in the performance
     7  of their duties under this Compact. Good faith in this article
     8  shall not include willful misconduct, gross negligence, or
     9  recklessness.
    10                             ARTICLE X
    11             Entry into Force, Withdrawal and Amendment
    12     a.  This Compact shall enter into force and become effective
    13  as to any state when it has been enacted into the laws of that
    14  state. Any party state may withdraw from this Compact by
    15  enacting a statute repealing the same, but no such withdrawal
    16  shall take effect until six months after the withdrawing state
    17  has given notice of the withdrawal to the executive heads of all
    18  other party states.
    19     b.  No withdrawal shall affect the validity or applicability
    20  by the licensing boards of states remaining party to Compact of
    21  any report of adverse action occurring prior to the withdrawal.
    22     c.  Nothing contained in this Compact shall be construed to
    23  invalidate or prevent any nurse licensure agreement or other
    24  cooperative arrangement between a party state and a nonparty
    25  state that is made in accordance with the other provisions of
    26  this Compact.
    27     d.  This Compact may be amended by the party states. No
    28  amendment to this Compact shall become effective and binding
    29  upon the party states unless and until it is enacted into the
    30  laws of all party states.
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     1                             ARTICLE XI
     2                   Construction and Severability
     3     a.  This Compact shall be liberally construed so as to
     4  effectuate the purposes thereof. The provisions of this Compact
     5  shall be severable and if any phrase, clause, sentence or
     6  provision of this Compact is declared to be contrary to the
     7  constitution of any party state or of the United States or the
     8  applicability thereof to any government, agency, person or
     9  circumstance is held invalid, the validity of the remainder of
    10  this Compact and the applicability thereof to any government,
    11  agency, person or circumstance shall not be affected thereby. If
    12  this Compact shall be held contrary to the constitution of any
    13  state party thereto, the Compact shall remain in full force and
    14  effect as to the remaining party states and in full force and
    15  effect as to the party state affected as to all severable
    16  matters.
    17     b.  In the event party states find a need for settling
    18  disputes arising under this Compact:
    19         1.  The party states may submit the issues in dispute to
    20     an arbitration panel which will be comprised of an individual
    21     appointed by the Compact administrator in the home state; an
    22     individual appointed by the Compact administrator in the
    23     remote state(s) involved; and an individual mutually agreed
    24     upon by the Compact administrators of all the party states
    25     involved in the dispute.
    26         2.  The decision of a majority of the arbitrators shall
    27     be final and binding.
    28  Section 10.  Effective date.
    29     This act shall take effect immediately.

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