HB2502 - 522R - Senate Fact Sheet

ARIZONA STATE SENATE

Fifty-Second Legislature, Second Regular Session

FACT SHEET FOR H.B. 2502

medical licensure compact

Purpose

Establishes the Interstate Medical Licensure Compact (Compact). Outlines eligibility requirements for an expedited license. Establishes the Interstate Medical Licensure Compact Commission (Commission) for the administration of the Compact, and outlines Commission powers and duties, including rulemaking authority.

Background

The Arizona Medical Board’s primary purpose is to regulate practitioners of allopathic medicine through licensure, regulation and rehabilitation of the profession in this state (A.R.S. § 32-1403). The Board consists of 12 Governor-appointed members: 8 members must be physicians who are actively practicing medicine, and the remaining 4 individuals are public members, 1 of whom must be a licensed nurse. Currently, members are eligible to serve up to two five-year terms and the unexpired term of a vacant member and to receive $250 a day in compensation, plus expenses.

H.B. 2502 establishes the Compact, which would create a new pathway to expedite the licensing of physicians seeking to practice medicine in multiple states by eliminating the requirement that each state separately verify each applicant’s basic information, including education and liability history. As of January 1, 2016, 12 states have enacted the Compact legislation, including: 1) Alabama; 2) West Virginia; 3) South Dakota; 4) Utah; 5) Wyoming; 6) Idaho; 7) Illinois; 8) Iowa; 9) Minnesota; 10) Montana; 11) Nevada; and 12) Wisconsin. Because the Compact has been enacted in more than seven states, it is in full effect.

There is no anticipated fiscal impact to the state General Fund associated with this legislation.

Provisions

Interstate Medical Licensure Compact

1. Establishes the Interstate Medical Licensure Compact (Compact) to:

a) strengthen access to health care;

b) create another pathway for licensure that does not otherwise change a state’s existing medical practice act; and

c) adopt the prevailing standard for licensure and to affirm that the practice of medicine occurs where the patient is located at the time of the physician-patient encounter; and

d) require the physician be under the jurisdiction of the state medical board where the patient is located.

2. States the Member states of the Compact have allied in common purpose to develop a comprehensive process that:

a) complements the existing licensing and regulatory authority of state medical boards; and

b) provides a streamlined process that allows physicians to become licensed in multiple states, thereby enhancing the portability of a medical license and ensuring the safety of patients.

3. States that state medical boards that participate in the Compact retain jurisdiction to impose an adverse action against a license to practice medicine in that state issued to a physician through the procedures in the Compact.

Definitions

4. Defines bylaws as those bylaws established by the Interstate Commission for its governance, or for directing and controlling its actions and conduct.

5. Defines Commissioner as the voting representative appointed by each Member board.

6. Defines convicted as a court finding an individual guilty of a criminal offense through adjudication or entry of a plea of guilt or no contest to the charge by the offender, and requires evidence of an entry of a conviction of a criminal offense by the court to be considered final for the purposes of disciplinary action by a Member board.

7. Defines expedited license as a full and unrestricted medical license granted by a Member state to an eligible physician through the process set forth in the Compact.

8. Defines Interstate Commission as the Interstate Medical Licensure Compact Commission created in the Compact.

9. Defines license as authorization by a state for a physician to engage in the practice of medicine, which would be unlawful without authorization.

10. Defines medical practice act as laws and regulations governing the practice of allopathic and osteopathic medicine within a Member state.

11. Defines Member board as a state agency in a Member state that acts in the sovereign interests of the state by protecting the public through licensure, regulation and education of physicians as directed by the state government.

12. Defines Member state as a state that has enacted the Compact.

13. Defines offense as a felony, gross misdemeanor or crime of moral turpitude.

14. Defines physician as any person who meets requirements as outlined in the Compact.

15. Defines practice of medicine as the clinical prevention, diagnosis or treatment of human disease, injury or condition requiring a physician to obtain and maintain a license in compliance with the medical practice act of a Member state.

16. Defines rule as a written statement by the Interstate Commission promulgated pursuant to the rulemaking provisions of the Compact that:

a) is of general applicability;

b) implements, interprets or prescribes a policy or provision of the Compact or an organizational, procedural or practice requirement of the Interstate Commission;

c) has the force and effect of statutory law in a Member state; and

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

17. Defines state as any state, commonwealth, district or territory of the U.S.

18. Defines state of principal license as a Member state where a physician holds a license to practice medicine and that has been designated as such by the physician for purposes of registration and participation in the Compact.

Eligibility

19. Requires a physician meet the following eligibility requirements to receive an expedited license under the Compact:

a) graduate from a medical school accredited by the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation or a medical school listed in the International Medical Education Directory or its equivalent;

b) pass each component of the U.S. Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) within three attempts, or any of its predecessor examinations accepted by a state medical board as an equivalent examination for licensure purposes;

c) successfully complete graduate medical education approved by the Accreditation Council for Graduate Medical Education or the American Osteopathic Association (AOA);

d) hold specialty certification or a time-unlimited specialty certificate recognized by the American Board of Medical Specialties or the AOA’s Bureau of Osteopathic Specialists;

e) possess a full, unrestricted license to engage in the practice of medicine issued by a Member board;

f) never have been convicted, received adjudication, deferred adjudication or community supervision or deferred disposition for any offense by a court of appropriate jurisdiction;

g) never had a license authorizing the practice of medicine subjected to discipline by a licensing agency in any state, federal or foreign jurisdiction, excluding any action related to nonpayment of licensure fees;

h) never had a controlled substance license or permit suspended or revoked by a state or the U.S. Drug Enforcement Administration (DEA); and

i) not be under active investigation by a licensing agency or law enforcement authority in any state, federal or foreign jurisdiction.

20. Allows a physician who does not meet the aforementioned requirements to obtain a license to practice medicine in a Member state upon complying with all the state’s laws and requirements, other than the Compact, relating to the issuance of a license to practice medicine.

State of Principal License Designation

21. Requires a physician designate a Member state as the state of principal license for purposes of expedited licensure registration through the Compact if the physician possesses a full and unrestricted license to practice medicine in that state and the state is:

a) the state of primary residence for the physician;

b) the state where at least 25 percent of the physician’s practice of medicine occurs;

c) the location of the physician’s employer; or

d) the state designated as state of residence for purposes of federal income tax.

22. Allows a physician to re-designate a Member state as state of principal license at any time, as long as the state meets the aforementioned requirements.

23. Authorizes the Interstate Commission to develop rules to facilitate re-designation of another Member state as the state of principal license.

Application and Issuance of Expedited Licensure

24. Requires a physician seeking licensure through the Compact to file an application for an expedited license with the Member board of the physician’s state of principal license.

25. Requires the state of principal license, on receipt of an expedited license application, to evaluate whether the physician is eligible and to issue a letter of qualification verifying or denying the physician's eligibility to the Interstate Commission as follows:

a) static qualifications, which include verification of medical education, graduate medical education, results of any medical or licensing examination and other qualifications as determined by the Interstate Commission through rule, shall not be subject to additional primary source verification where already primary source-verified by the state of principal license;

b) the state of principal license’s Member board in the course of verifying eligibility shall perform a criminal background check of an applicant, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation (FBI), with the exception of federal employees who have suitability determination pursuant to federal law; and

c) appeal on the determination of eligibility shall be made to the Member state where the application was filed and shall be subject to the law of that state.

26. Requires a physician who is eligible for an expedited license to complete the registration process established by the Interstate Commission, including payment of applicable fees.

27. Requires a Member board, after receiving eligibility verification and payment of fees, to issue an expedited license to the physician.

28. Authorizes a physician who received an expedited license to practice medicine in the issuing state consistent with the medical practice act and all applicable laws and regulations of the issuing Member board and Member state.

29. Requires an expedited license be valid for a period consistent with the licensure period in the Member state and in the same manner as required for other physicians holding a full and unrestricted license within the Member state.

30. Requires an expedited license obtained through the Compact be terminated if a physician fails to maintain a license in the state of principal license for a non-disciplinary reason, without re-designation of a new state of principal.

31. Authorizes the Interstate Commission to develop rules regarding the application process, including payment of any applicable fees, and the issuance of an expedited license.

Fees for Expedited Licensure

32. Allows a Member state to impose a fee for a license issued or renewed through the Compact, and authorizes the Interstate Commission to develop rules regarding fees for expedited licenses.

Renewal and Continued Participation

33. Requires a physician seeking to renew an expedited license granted in a Member state to complete a renewal process with the Interstate Commission if the physician:

a) maintains a full and unrestricted license in a state of principal license;

b) has not been convicted, received adjudication, deferred adjudication or community supervision or deferred disposition for any offense by a court of appropriate jurisdiction;

c) has not had a license to practice medicine subject to discipline by a licensing agency in any state, federal or foreign jurisdiction, excluding any action related to nonpayment of fees related to a license; and

d) has not had a controlled substance license or permit suspended or revoked by a state or the DEA.

34. Requires physicians comply with all continuing professional development or continuing medical education requirements for renewal of a license issued by a Member state.

35. Requires the Interstate Commission collect any renewal fees charged for the renewal of a license and distribute the fees to the applicable Member board.

36. Requires the Member board, on receipt of the renewal fees, to renew the physician’s license.

37. Requires physician information collected by the Interstate Commission during the renewal process be distributed to all Member boards.

38. Authorizes the Interstate Commission to develop rules to address renewal of licenses obtained through the Compact.

Coordinated Information System

39. Requires the Interstate Commission establish a database of all physicians who are licensed or who have applied for licensure under the Compact

40. Requires Member boards report to the Interstate Commission any public action or complaints against a licensed physician who has applied or received an expedited license through the Compact.

41. Requires Member boards report disciplinary or investigatory information determined as necessary and proper by rule of the Interstate Commission, and allows Member boards to report any non-public complaint or disciplinary or investigatory information that is not already required to be reported to the Interstate Commission.

42. Requires Member boards share complaint or disciplinary information about a physician if requested by another Member board.

43. Requires all information provided to the Interstate Commission or distributed by Member boards be confidential, filed under seal and used only for investigatory and disciplinary matters.

44. Authorizes the Interstate Commission to develop rules for mandated or discretionary sharing of information by Member boards.

Joint Investigations

45. Deems investigative a physician’s licensure and disciplinary records.

46. Allows a Member board to participate with other Members boards in joint investigations of physicians licensed by Member boards, and states this authority is in addition to the authority granted to a Member board by its respective medical practice act.

47. Requires a subpoena issued by a Member state be enforceable in other Member states.

48. Allows Member boards to share any investigative, litigation or compliance materials in furtherance of any joint or individual investigation initiated under the Compact.

49. Allows any Member state to investigate actual or alleged violations of the statutes authorizing the practice of medicine in any other Member state in which a physician holds a license to practice medicine.

Disciplinary Actions

50. Requires any disciplinary action taken by any Member board against a physician licensed through the Compact be deemed unprofessional conduct that may be subject to discipline by other Member boards, in addition to any violation of the medical practice act or regulations in that state.

51. Requires all licenses issued to a physician by Member boards be automatically placed, without further action necessary by any Member board, on the same status if a license granted to the physician by the Member board in the state of principal license is:

a) revoked;

b) surrendered or relinquished in lieu of discipline; or

c) suspended.

52. Requires, if the Member board in the state of principal license subsequently reinstates the physician’s license, a license issued to the physician by any other Member board remain encumbered until that respective Member board takes action to reinstate the license in a manner consistent with the medical practice act of that state.

53. States if disciplinary action is taken against a physician by a Member board not in the state of principal license, any other Member board may deem the action conclusive as to matter of law and fact decided, and either:

a) impose the same or lesser sanctions against the physician so long as such sanctions are consistent with the medical practice act of that state; or

b) pursue separate disciplinary action against the physician under its respective medical practice act, regardless of the action taken in other Member states.

54. Requires, if a license granted to a physician by a Member board is revoked, surrendered or relinquished in lieu of discipline, or suspended:

a) any license issued to the physician by any other Member state be suspended automatically and immediately without further action necessary by the other Member board; and

b) the license be suspended for 90 days on entry of the order by the disciplining board, to permit the Member board to investigate the basis for the action under the medical practice act of that state.

55. Allows a Member board to terminate the automatic suspension of the license it issued before the completion of the 90-day suspension period in a manner consistent with the medical practice act of that state.

Interstate Medical Licensure Compact Commission (Interstate Commission)

56. States the Member states create the Interstate Medical Licensure Compact Commission (Interstate Commission).

57. States the purpose of the Interstate Commission is the administration of the Compact, which is a discretionary state function.

58. Requires the Interstate Commission:

a) be a body corporate and joint agency of the Member states;

b) have all the responsibilities, powers and duties set forth in the Compact; and

c) have additional powers conferred on it by a subsequent concurrent action of the Member states’ respective legislatures in accordance with the terms of the Compact.

59. Requires the Interstate Commission consist of two voting representatives appointed by each Member state to serve as Commissioners.

60. Requires the Member state to appoint one representative from each Member board if:

a) the allopathic and osteopathic physicians are regulated by separate Member boards; or

b) the licensing and disciplinary authority is split between multiple Member boards within a Member state.

61. Requires a Commissioner be one of the following:

a) an allopathic or osteopathic physician appointed to a Member board;

b) an executive director, executive secretary or similar executive of a Member board; or

c) a member of the public appointed to a Member board.

62. Requires the Interstate Commission meet at least once each calendar year, and allows a portion of this meeting to be a business meeting to address matters that may come before the Commission, including the election of officers.

63. Allows the Commission chairperson to call additional meetings, and requires the chairperson call a meeting on the request of a majority of the Member states.

64. Allows the bylaws to provide for meetings of the Interstate Commission to be conducted by telecommunication or electronic communication.

65. Entitles each Commissioner participating at an Interstate Commission meeting to one vote, and prohibits a Commissioner from delegating a vote to another Commissioner.

66. Requires a majority of Commissioners constitute a quorum for the transaction of business, unless a larger quorum is required by the Interstate Commission’s bylaws.

67. Allows a Member state, in the absence of its Commissioner, to delegate voting authority for a specified meeting to another person from that state who meets Commissioner requirements outlined in the Compact.

68. Requires the Interstate Commission provide public notice of all meetings, and requires all meetings be open to the public.

69. Allows the Interstate Commission to close a meeting, in full or in part, if it determines by a two-thirds vote of the Commissioners present that an open meeting would be likely to:

a) relate solely to the internal personnel practices and procedures of the Interstate Commission;

b) discuss matters specifically exempted from disclosure by federal statute;

c) discuss trade secrets or commercial or financial information that is privileged or confidential;

d) involve accusing a person of a crime or formally censuring a person;

e) discuss information of a personal nature for which disclosure would constitute a clearly unwarranted invasion of personal privacy; or

f) specifically relate to the participation in a civil action or other legal proceeding.

70. Requires the Interstate Commission keep minutes that fully describe all matters discussed in a meeting and provide a full and accurate summary of actions taken, including a record of any roll call votes.

71. Requires the Interstate Commission make its information and official records available to the public for inspection, to the extent not otherwise designated in this Compact or by the Commission’s rules.

72. Requires the Interstate Commission establish an executive committee, which is required to include officers, members and others as determined by the bylaws.

73. Requires the executive committee have the power to act on behalf of the Interstate Commission, except rulemaking authority, during periods when the Interstate Commission is not in session. When acting on behalf of the Interstate Commission, the executive committee is required to:

a) oversee the administration of the Compact, including enforcement and compliance with the provisions of the Compact, its bylaws and rules; and

b) perform other duties as necessary.

74. Allows the Interstate Commission to establish other committees for governance and administration of the Compact.

Powers and Duties of the Interstate Commission

75. Authorizes the Interstate Commission to:

a) oversee and maintain the administration of the Compact;

b) promulgate rules that are binding to the extent and in the manner provided for in this Compact;

c) issue, on the request of a Member state or Member board, advisory opinions concerning the meaning or interpretation of this Compact, its rules, bylaws and actions;

d) enforce compliance with Compact provisions, the rules promulgated by the Interstate Commission and the bylaws, using all necessary and proper means, including the use of the judicial process;

e) establish and appoint committees, including the executive committee, which shall have the power to act on behalf of the Interstate Commission in carrying out its powers and duties;

f) pay, or provide for the payment of, the expenses related to the establishment, organization and ongoing activities of the Interstate Commission;

g) establish and maintain one or more offices;

h) borrow, accept, hire or contract for personnel services;

i) purchase and maintain insurance and bonds;

j) employ an executive director who has the power to employ, select or appoint employees, agents or consultants and to determine their qualifications, define their duties and fix their compensation;

k) establish personnel policies and programs relating to conflicts of interest, rates of compensation and qualifications of personnel;

l) accept donations and grants of money, equipment, supplies, materials and services and receive, utilize and dispose of these in a manner consistent with the conflict of interest policies established by the Interstate Commission;

m) lease, purchase, accept contributions or donations of, or otherwise own, hold, improve or use, any property, real, personal or mixed;

n) establish a budget and make expenditures;

o) adopt a seal and bylaws governing the management and operation of the Interstate Commission;

p) report annually to the legislatures and governors of the Member states concerning the activities of the Interstate Commission during the preceding year. Such reports are required to include reports of financial audits and any recommendations adopted by the Interstate Commission;

q) coordinate education, training and public awareness regarding the Compact and its implementation and operation;

r) maintain records in accordance with the bylaws;

s) seek and obtain trademarks, copyrights and patents; and

t) perform functions necessary or appropriate to achieve the purposes of the Compact.

Finance Powers

76. Allows the Interstate Commission to levy on and collect an annual assessment from each Member state to cover the cost of the operations and activities of the Interstate Commission and its staff.

77. Requires the total assessment be sufficient to cover the annual budget approved each year for which revenue is not provided by other sources.

78. Requires the aggregate annual assessment amount be allocated on a formula determined by the Interstate Commission, which shall promulgate a rule binding on all Member states.

79. Prohibits the Interstate Commission from incurring obligations of any kind before securing the funds adequate to meet the obligations.

80. Prohibits the Interstate Commission from pledging the credit of any of the Member states, except by and with the authority of the Member state.

81. Subjects the Interstate Commission to a yearly financial audit conducted by a certified or licensed public accountant, and requires the report of the audit be included in the Interstate Commission’s annual report.

Organization and Operation of the Interstate Commission

82. Requires the Interstate Commission, by a majority of Commissioners present and voting, adopt bylaws to govern its conduct as necessary and appropriate to carry out the purposes of the Compact within the 12 months after the first Interstate Commission meeting.

83. Requires the Interstate Commission elect or appoint annually from among its Commissioners a chairperson, a vice chairperson and a treasurer, each of whom have the authority and duties specified in the bylaws.

84. Requires the chairperson, or, in the chairperson’s absence or disability, the vice chairperson, preside at all Interstate Commission meetings.

85. Requires Interstate Commission officers serve without remuneration from the Interstate Commission.

86. Immunizes Interstate Commission officers and employees from suit and liability, either personally or in their official capacity, for a claim for damage to or loss of property or personal injury or other civil liability caused or arising out of, or relating to, an actual or alleged act, error or omission that occurred, or that such person had a reasonable basis for believing occurred, within the scope of Interstate Commission employment, duties or responsibilities.

87. Exempts from liability immunity damage, loss, injury or liability caused by a person’s intentional or willful and wanton misconduct as follows:

a) the liability of the executive director and employees and Interstate Commission representatives and employees, acting within the scope of that person’s employment or duties for acts, errors or omissions occurring within that person’s state, may not exceed the limits of liability set forth under the constitution and laws of that state for state officials, employees and agents. The Interstate Commission is considered to be an instrumentality of the states for the purposes of any such action. This subsection does not protect a person from suit or liability for damage, loss, injury or liability caused by the person’s intention or willful and wanton misconduct;

b) the Interstate Commission is required to defend the executive director and the Commission’s employees and, subject to the approval of the attorney general or other appropriate legal counsel of the Member state represented by an Interstate Commission representative, is required to defend that representative in any civil action seeking to impose liability arising out of an actual alleged act, error or omission that occurred within the scope of Interstate Commission employment, duties or responsibilities or that the defendant had a reasonable basis for believing occurred within the scope of Interstate Commission employment, duties or responsibilities, if the actual or alleged act, error or omission did not result from the person’s intentional or willful and wanton misconduct; and

c) to the extent not covered by the state involved, the Member state or the Interstate Commission, a representative or employee of the Interstate Commission shall be held harmless in the amount of a settlement or judgment, including attorney fees and costs, obtained against that person arising out of an actual or alleged act, error or omission that occurred within the scope of Interstate Commission employment, duties or responsibilities, if the actual or alleged act, error or omission did not result from the person’s intentional or willful and wanton misconduct.

Rulemaking Functions of the Interstate Commission

88. Requires the Interstate Commission promulgate reasonable rules in order to effectively and efficiently achieve the Compact’s purposes.

89. Requires any action by the Interstate Commission that exercises rulemaking authority beyond the scope of the Compact’s purposes be invalid and have no force or effect.

90. Requires rules deemed appropriate for the operations of the Interstate Compact be made pursuant to a rulemaking process that substantially conforms to the Model State Administrative Procedure Act of 2010 and its subsequent amendments.

91. Allows any person, no later than 30 days after a rule is promulgated, to file a petition for judicial review of the rule in the U.S. District Court for the District of Columbia or the federal district where the Interstate Commission has its principal offices, provided that the filing of the petition shall not stay or prevent the rule from becoming effective unless the court finds that the petitioner has a substantial likelihood of success.

92. Requires the court give deference to the actions of the Interstate Commission consistent with applicable law, and prohibits the court from finding the rule unlawful if the rule represents a reasonable exercise of the Interstate Commission’s authority.

Oversight of the Interstate Compact

93. Requires the executive, judicial and legislative branches of each Member state’s government enforce the Compact and take all actions necessary and appropriate to effectuate the Compact’s purposes and intent.

94. Requires the Compact’s provisions and rules promulgated under the Compact have standing as statutory law but not override existing state authority to regulate the practice of medicine.

95. Requires all courts take judicial notice of the Compact and the rules in any judicial or administrative proceeding in a Member state pertaining to the subject matter of the Compact that may affect the powers, responsibilities or actions of the Interstate Commission.

96. Entitles the Interstate Commission to receive all service of process in any proceeding and to have standing to intervene in the proceeding for all purposes. Failure to provide service of process to the Interstate Commission renders a judgment or order void as to the Interstate Commission, the Compact or promulgated rules.

Enforcement of Interstate Compact

97. Requires the Interstate Commission, in the reasonable exercise of its discretion, enforce the Compact rules and provisions.

98. Allows the Interstate Commission, by majority vote of the Commissioners, to initiate legal action in the U.S. District Court for the District of Columbia or, at the Interstate Commission’s discretion, in the federal district where the Interstate Commission has its principal offices, to enforce compliance with the provisions of the Compact and its promulgated rules and bylaws against a Member state in default. The relief sought may include both injunctive relief and damages.

99. Requires the prevailing party, if judicial enforcement is necessary, be awarded all costs of the litigation, including reasonable attorney fees.

100. States the remedies stated in the Compact are not the exclusive remedies of the Intestate Commission, and allows the Interstate Commission to avail itself of any other remedies available under state law or the regulation of a profession.

Default Procedures

101. States the grounds for default include failure of a Member state to perform the obligations or responsibilities imposed on it by this Compact or the rules and bylaws of the Interstate Commission.

102. Requires the Interstate Commission, if it is determined a Member state has defaulted in the performance of its obligations or responsibilities under the Compact or the bylaws or rules, to:

a) provide written notice to the defaulting state and other Member states of the nature of the default, the means of curing the default and any action taken by the Interstate Commission. The Interstate Commission is required to specify the conditions by which the defaulting state must cure its default; and

b) provide remedial training and specific technical assistance regarding the default.

103. Terminates, on an affirmative majority vote of the Commissioners, the defaulting state from the Compact if the defaulting state fails to cure the default, and requires all rights, privileges and benefits conferred by the Compact to terminate on the effective date of termination.

104. States a cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default.

105. Requires termination of Compact membership be imposed only after all other means of securing compliance have been exhausted.

106. Requires notice of intent to terminate be given by the Interstate Commission to the governor and the majority and minority leaders of the defaulting state’s legislature and each of the Member states.

107. Requires the Interstate Commission establish rules and procedures to address licenses and physicians that are materially impacted by a Member state’s termination or withdrawal.

108. States the terminated Member state is responsible for all dues, obligation and liabilities incurred through the effective date of termination, including obligations which extend beyond the effective date of termination.

109. Prohibits the Interstate Commission from bearing any costs relating to any state that has been found to be in default or that has been terminated from the Compact, unless otherwise mutually agreed on in writing between the Interstate Commission and the defaulting state.

110. Allows the defaulting state to appeal the action of the Interstate Commission by petitioning the U.S. District Court for the District of Columba or the federal district where the Interstate Commission has its principal offices. The prevailing party is awarded all costs of the litigation, including reasonable attorney fees.

Dispute Resolution

111. Requires the Interstate Commission to attempt, on request of a Member state, to resolve disputes that are subject to this Compact and that arise among Member states or Member boards.

112. Requires the Interstate Commission promulgate rules providing for both mediation and binding dispute resolution as appropriate.

Member States, Effective Date and Amendment

113. States any state is eligible to become a Member state of the Compact.

114. Requires the governors of non-Member states or their designees be invited to participate in the activities of the Interstate Commission on a non-voting basis before adoption of this Compact by all states.

115. Allows the Interstate Commission to propose amendments to the Compact for enactment by the Member states, and prohibits an amendment from becoming effective and binding on the Interstate Commission and the Member states unless and until it is enacted into law by unanimous consent of the Member states.

Withdrawal

116. Requires the Compact, once effective, continue in force and remain binding on each and every Member state, except a Member state may withdraw from the Compact by specifically repealing the statute that enacted the Compact into law. Withdrawal from the Compact does not take effect until:

a) one year after the effective date of the repealing statute; and

b) written notice of the withdrawal has been given by the withdrawing state to the governor of each other Member state.

117. Requires the withdrawing state immediately notify the chairperson of the Interstate Commission in writing on the introduction of the withdrawing state’s legislation repealing the Compact, and requires the Interstate Commission notify the other Member states of the withdrawing state’s intent to withdraw within 60 days of its receipt of the written notice.

118. States the withdrawing state is responsible for all dues, obligations and liabilities incurred through the effective date of withdrawal, including obligations which extend beyond the effective date of withdrawal.

119. Requires reinstatement occur when the withdrawing state reenacts the Compact or on a later date determined by the Interstate Commission.

120. Authorizes the Interstate Commission to develop rules to address the impact of a Member state’s withdrawal on licenses granted in other Member state to physicians who designated the withdrawing state as the state of principal license.

Dissolution

121. Requires the Compact dissolve effective on the date of the withdrawal or default of the Member state that reduces Compact membership to one Member state.

122. States the following occur on dissolution of the Compact:

a) the Compact becomes void and no longer in force or effect;

b) the business and affairs of the Interstate Commission are concluded; and

c) surplus funds must be distributed in accordance with the bylaws.

Severability and Construction

123. Requires the provisions of the Compact be severable, and states if any phrase, clause, sentence or provision is deemed unenforceable, the remaining provisions of the Compact remain enforceable.

124. Requires the provisions of the Compact be liberally construed to effectuate its purpose.

125. Prohibits the Compact from being construed to prohibit the applicability of other interstate compacts to which the states are members.

Binding Effect of Compact and Other Laws

126. States nothing in the Compact prevents the enforcement of any other law of a Member state that is not inconsistent with the Compact.

127. States the Compact supersedes any Member state’s laws that conflict with the Compact.

128. Requires all lawful actions of the Interstate Commission, including all rules and bylaws promulgated by the Commission, be binding on all Member states.

129. Requires all agreements between the Interstate Commission and the Member states be binding in accordance with their terms.

130. Requires any provision of the Compact that exceeds the constitutional limits imposed on any Member state’s legislature be ineffective to the extent of the conflict with the constitutional provision in question in that Member state.

Conditional Repeal

131. States the Compact is repealed if:

a) the Interstate Commission issues a rule or decision that would change the scope of practice of or the definition of unprofessional conduct for a licensed allopathic physician or doctor of osteopathy inconsistent with any Arizona Revised Statute relating to abortion; or

b) a court issues a ruling relating to the enforcement of the Compact that would change the scope of practice of or the definition of unprofessional conduct for a licensed allopathic physician or doctor of osteopathy inconsistent with any Arizona Revised Statute relating to abortion.

132. Requires the Attorney General notify in writing the Director of Legislative Council of the date on which either of the aforementioned actions occurs.

133. State the aforementioned repeal of the Compact constitutes the state’s immediate withdrawal from the Compact, and requires the Attorney General send written notification to the governor of each other state that has enacted the Compact.

134. Allows any resident of this state or member of the Legislature to request in writing that the Attorney General review the actions of the Interstate Commission or a court ruling relating to the enforcement of the Compact.

Effective Date

135. Becomes effective on the general effective date because the threshold of seven state enactments has been surpassed.

House Action

HEALTH 2/2/16 DP 5-0-0-1

3^rd Read 3/1/16 59-0-1-0

Prepared by Senate Research

March 14, 2016

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