HBA-NMO, JRA H.B. 1342 76(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 1342 By: Maxey Public Health 7/29/1999 Enrolled BACKGROUND AND PURPOSE Prior to the 76th Legislature, a registered nurse, licensed practical nurse, or licensed vocational nurse had to obtain a license to practice in each state in which the nurse practiced. However, licensure requirements are essentially the same from state to state. H.B. 1342 implements a multistate licensure compact for registered nurses, licensed practical nurses, and licensed vocational nurses which allows a licensed nurse to practice in other participating states without obtaining an additional license. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking is expressly delegated to the Board of Nurse Examiners and the Board of Vocational Nurse Examiners in SECTION 1 (Section 3, ARTICLE 11, Section 1, Article 4528b, V.T.C.S.) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Chapter 7, Title 71, V.T.C.S., by adding Article 4528b, as follows: Article 4528b. NURSE LICENSURE COMPACT Sec. 1. Provides that the Nurse Licensure Compact is enacted and entered into with all other jurisdictions that legally join in the compact, which is as follows: NURSE LICENSURE COMPACT ARTICLE 1. FINDINGS AND DECLARATION OF PURPOSE. Sets forth the findings and declaration of purpose. ARTICLE 2. DEFINITIONS. Defines "adverse action," "alternative program," "coordinated licensure information system," "current significant investigative information," "home state," "home state action," "licensing board," "multistate licensing privilege," "nurse," "party state," "remote state," "remote state action," "state," and "state practice laws." ARTICLE 3. GENERAL PROVISIONS AND JURISDICTION. (a) Provides that a license to practice registered nursing, licensed practical nursing, or licensed vocational nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a multistate licensing privilege to practice as a registered nurse, licensed practical nurse, or licensed vocational nurse in the party state. Provides that an applicant must meet the home state's qualifications for a license and license renewal as well as all other applicable state laws in order to obtain or retain a license. (b) Authorizes a party state to limit or revoke the multistate licensing privilege of any nurse to practice in the party state and take any other actions necessary to protect the health and safety of the party state's citizens, in accordance with applicable state laws. Requires the party state to promptly notify the administrator of the coordinated licensure information system (administrator) if it takes an authorized action. Requires the administrator to promptly notify the home state of any such actions by remote states. (c) Provides that a nurse practicing in a party state must comply with the state practice laws of the state in which the patient is located at the time care is provided. Establishes that the practice of nursing includes patient care and all nursing practice defined by the party state's practice laws. Establishes that a practicing nurse is subject to the jurisdiction of the nurse licensing board, the courts, and the laws of the party state. (d) Provides that this compact does not affect additional requirements imposed by states for advanced practice registered nursing, but requires a party state to recognize a multistate licensing privilege to practice registered nursing granted by another party state if the state's law requires the license as a precondition for qualifying for advanced practice registered nurse authorization. (e) Authorizes individuals who do not reside in a party state to apply for a nurse license under the laws of a party state, but provides that such a license will not be recognized as granting the privilege to practice nursing in any other party state unless explicitly agreed to by that party state. ARTICLE 4. APPLICATION FOR LICENSE IN A PARTY STATE. (a) Requires the licensing board in a party state, on submittal of a license application, to ascertain, through the coordinated licensure information system (CLIS), whether the applicant has held or currently holds a license issued by another state, a restriction exists on the multistate licensing privilege, and any other adverse action by any state has been taken against the license. (b) Requires a nurse in a party state to hold a license issued by the home state in only one party state at a time. (c) Authorizes a nurse to apply for a license in a new home state in advance of the change of the nurse's primary state of residence. Provides that a new license will not be issued until a nurse provides satisfactory evidence to the new home state's licensing board of a change in primary state of residence. (d) Provides that a license issued by a former home state is invalid upon receipt of a license from a new home state if a nurse moves from one party state to another party state. Provides that a license issued by a non-party state remains valid, if provided by the laws of the non-party state, if a nurse moves from a non-party state to a party state. Provides that a license issued by a party state converts to a state license valid only in the former home state and does not entitle the nurse to a multistate license if a nurse moves from a party state to a non-party state. ARTICLE 5. ADVERSE ACTIONS. (a) Requires the licensing board of a remote state to promptly report to the administrator a remote state action, the factual and legal basis for the action, and any significant current investigative information yet to result in a remote state action. Requires the administrator to promptly notify the home state of these reports. (b) Authorizes the licensing board of a party state to complete and take appropriate action on a pending investigation of a nurse who changes primary state of residence during the course of the investigation. Requires the licensing board to promptly report the conclusion of the investigation to the administrator. Requires the administrator to promptly notify the new home state of any action. (c) Authorizes a remote state to take adverse action affecting the multistate licensing privilege to practice in that party state. Provides that only the home state has the power to impose adverse action against the license issued by the home state. (d) Requires the licensing board of the home state to give the same priority and effect to reported conduct received from a remote state as it would to conduct occurring in the home state and to apply its state laws to determine appropriate action, for purposes of imposing adverse action. (e) Authorizes the home state to take adverse action based on factual findings of a remote state only if each state follows its own procedures for imposing the adverse action. (f) Provides that this compact does not affect a party state's decision that participation in an alternative program may be used instead of licensing action and that the participation shall remain non-public if required by the party state's laws. Provides that party states must require a nurse who enters an alternative program to agree not to practice in any other party state during the term of the alternative program without prior authorization from the other party state. ARTICLE 6. ADDITIONAL AUTHORITIES OF PARTY STATE NURSE LICENSING BOARDS. (a) Provides that party state nurse licensing boards have the authority to recover from the affected nurse the costs of investigations and disposition of cases resulting from any adverse action taken against the nurse, issue subpoenas for hearings and investigations that require the attendance and testimony of witnesses and the production of evidence, issue a cease and desist order to limit or revoke a nurse's authority to practice in the state, and adopt uniform rules as provided under Article 8(c) of this compact. (b) Requires a court of competent jurisdiction in a party state to enforce a subpoena issued by a nurse licensing board in another party state for the attendance and testimony of witnesses or the production of evidence from that party state. Requires the issuing authority to pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the state in which a witness or evidence is located. ARTICLE 7. COORDINATED LICENSURE INFORMATION SYSTEM. (a) Requires all party states to participate in a cooperative effort to create a coordinated database of all licensed registered nurses, practical nurses, and vocational nurses which includes information on the licensing and disciplinary history of each nurse to assist in the coordination of nurse licensing and enforcement efforts. (b) Requires all party states' licensing boards to promptly report adverse actions, actions against multistate licensing privileges, any current significant investigative information yet to result in adverse action, and denials of applications including the reason for denial to CLIS, notwithstanding any other provision of law. (c) Requires current significant investigative information to be transmitted only to party state licensing boards through CLIS. (d) Authorizes all party states' licensing boards that contribute information to CLIS to designate information that may not be shared with non-party states or disclosed to other entities or individuals without the express permission of the contributing state. (e) Prohibits the sharing of personally identifiable information obtained by a party states' licensing board from CLIS with non-party states or other entities or individuals except to the extent permitted by the laws of the party state contributing the information. (f) Requires information contributed to CLIS that is subsequently required to be expunged by the laws of the party state contributing the information to be expunged at CLIS. (g) Requires each compact administrator to act jointly and in consultation with the administrator to formulate necessary and proper procedures for the identification, collection, and exchange of information under this compact. ARTICLE 8. COMPACT ADMINISTRATION AND EXCHANGE OF INFORMATION. (a) Requires the presiding officer of the nurse licensing board of a party state or the presiding officer's designee to be the administrator of this compact for the state. (b) Requires the compact administrator of each party state to furnish information and documents including a uniform data set of investigations, identifying information, licensing data, and disclosable alternative program participation information to the compact administrator of each other party state. (c) Authorizes compact administrators to develop uniform rules to facilitate and coordinate implementation of this compact. Requires the uniform rules to be adopted by party states under Article 6(a)(4) of this compact. ARTICLE 9. IMMUNITY. Provides that a party state or an officer, employee, or agent of a party state's nurse licensing board is not liable for any good faith act or omission that occurs while the person is performing the person's duties under this compact. Provides that good faith does not include wilful misconduct, gross negligence, or recklessness. ARTICLE 10. EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT. (a) Provides that this compact takes effect for a state when the state enacts this compact as law. Provides that a party state may withdraw from the compact by enacting a repealing statute which takes effect six months after the date the withdrawing state gives notice of the withdrawal to the executive heads of all other party states. (b) Provides that the withdrawal of a state from the compact does not affect the validity or applicability of any report of adverse action occurring before the withdrawal by licensing boards of states remaining party to the compact. (c) Provides that this compact does not invalidate or prevent any nurse licensing agreement or other cooperative arrangement between a party state and a non-party state that is made in accordance with the other provisions of this compact. (d) Authorizes party states to amend this compact. Provides that an amendment is not effective or binding on the party state unless and until all party states enact the amendment into the law of each state. ARTICLE 11. CONSTRUCTION AND SEVERABILITY. Requires this compact to be liberally construed to effectuate the compact's purpose. Provides that this compact is severable as to the constitution of a party state or the United States. Authorizes the party states to submit any issues in dispute under the compact to an arbitration panel. Sets forth the composition of an arbitration panel. Requires the decision of a majority of the arbitrators to be final and binding. Sec. 2. Provides that the executive directors of the Board of Nurse Examiners and the Board of Vocational Nurse Examiners are the nurse licensure compact administrators for this state. Provides that the executive director of the Board of Nurse Examiners and the executive director of the Board of Vocational Nurse Examiners are responsible for administering matters relating to registered nurses and licensed vocational nurses, respectively. Sec. 3. Authorizes the Board of Nurse Examiners and the Board of Vocational Nurse Examiners to adopt rules necessary to implement this article. Sec. 4. Provides that the terms "nurse," "registered nurse," and "vocational nurse" include nurses licensed as registered nurses or vocational nurses by a state that is a party to the Nurse Licensure Compact. Provides that nurses practicing in this state under a license issued by a state that is a party to the Nurse Licensure Compact have the same rights and obligations as imposed by the laws of this state on license holders of the Board of Nurse Examiners and the Board of Vocational Nurse Examiners, unless the context indicates otherwise or doing so would be inconsistent with the Nurse Licensure Compact. Authorizes the Board of Nurse Examiners and the Board of Vocational Nurse Examiners to determine whether a right or obligation imposed on license holders applies to nurses practicing in this state under a license issued by a state that is a party to the Nurse Licensure Compact, unless that determination is inconsistent with the Nurse Licensure Compact. Sec. 5. Provides that the Board of Nurse Examiners and the Board of Vocational Nurse Examiners are the state agencies responsible for taking action against nurses practicing in this state under a license authorized by the Nurse Licensure Compact. Requires the action to be taken in accordance with the same procedures for taking action against nurses licensed by this state. Sec. 6. Requires the Board of Nurse Examiners and the Board of Vocational Nurse Examiners to provide a nurse licensed by this state with a copy of information regarding the nurse maintained by CLIS on request and payment of a reasonable fee. Provides that a board is not obligated to provide information not available to the board or information not available to the nurse under the laws of the state contributing the information to CLIS. Sec. 7. Requires the Board of Nurse Examiners and the Board of Vocational Nurse Examiners to make available to nurses practicing in this state under a license issued by a state that is a party to the Nurse Licensure Compact, on request and at a reasonable cost, practice-related information provided to CLIS by the boards that is available to nurses licensed by this state. Sec. 8. Authorizes the Board of Nurse Examiners and the Board of Vocational Nurse Examiners, in reporting information to the coordinated licensure information system under Article 7 of the Nurse Licensure Compact, to disclose personally identifiable information about the nurse, including social security number. Prohibits the coordinated licensure information system from sharing personally identifiable information with a state not a party to the compact unless the state agrees not to disclose that information to other persons. Sec. 9. Authorizes the governor to withdraw this state from the Nurse Licensure Compact if the Board of Nurse Examiners or the Board of Vocational Nurse Examiners notifies the governor that a state that is party to the compact changed, after January 1, 1999, the state's requirements for licensing a nurse and the that the state's requirements, as changed, are substantially lower than the requirements for licensing a nurse in this state. Authorizes the governor to completely withdraw this state from the Nurse Licensure Compact or limit withdrawl to the application of the compact to registered nurses or licensed vocational nurses. Sec. 10. Provides that the Nurse Licensure Compact expires on December 31, 2005, unless this section is repealed or the expiration date is extended. SECTION 2. Amends Section 4, Article 4518, V.T.C.S., to make conforming changes. SECTION 3. Amends Section 1, Article 4519a, V.T.C.S., to require the Board of Nurse Examiners to notify a petitioner in writing listing each ground of potential ineligibility for licensure and the board's determination instead of issuing an order, if the board finds that a ground for ineligibility does not exist. Makes conforming changes. SECTION 4. Amends Chapter 7, Title 71, V.T.C.S., by adding Article 4525.01, as follows: Art. 4525.01. ADDITIONAL GROUNDS FOR DISCIPLINARY ACTION. Provides that a person is subject to being refused admission to a licensing examination, to denial of a license, or to disciplinary action by the board if the person's privilege to practice nursing in another jurisdiction is revoked, suspended, denied, or subjected to any other disciplinary action. Provides that a certified copy of the order of denial, suspension, or revocation of the privilege or the other action by the jurisdiction is conclusive evidence of that action. SECTION 5. Amends Section 3, Article 4527a, V.T.C.S., to make conforming changes. SECTION 6. Amends Section 2(a), Chapter 118, Acts of the 52nd Legislature, Regular Session, 1951 (Article 4528c, V.T.C.S.), to make conforming changes. SECTION 7. Amends Section 10(a), Chapter 118, Acts of the 52nd Legislature, Regular Session, 1951 (Article 4528c, V.T.C.S.), to make a conforming change. SECTION 8. Amends Section 12, Article 4528c, V.T.C.S, to require any institution desiring to conduct a course in vocational nursing to apply to the Board of Vocational Nurse Examiners and accompany the application with evidence that the institution is prepared to give a course approved by that board, rather than a course of not less than 12 months, for the education of vocational nurses. SECTION 9. (a) Requires the Board of Nurse Examiners and the Board of Vocational Nurse Examiners to participate in a nurse licensure compact evaluation initiative designed to evaluate the effectiveness and operability of the Nurse Licensure Compact by January 1, 2000. (b) Requires the evaluation initiative to be conducted by a qualified researcher. Requires a component of the evaluation initiative to be a state practice identification system through which nurses designate the states in which they practice and that provides for updating the information at the time of issuance and renewal of licenses. (c) Requires the evaluation initiative to continue at least through June 1, 2004, and a report to be subsequently produced and submitted for comment by the Board of Nurse Examiners and the Board of Vocational Nurse Examiners. (d) Requires the report and the boards' comments to be submitted to the legislature by October 1, 2004, in the form of a Nurse Licensure Compact evaluation report. (e) Authorizes the boards to accept and spend money made available by the federal or state government or by another public or private source to fund participation in the evaluation initiative. SECTION 10. (a) Effective date: January 1, 2000. (b) Provides that Article 4528b, V.T.C.S., as added by this Act, takes effect January 1, 2000, unless the governor, on the recommendation of the Board of Nurse Examiners and the Board of Vocational Nurse Examiners, determines a later date would be in the best interest of the state. SECTION 11. Emergency clause.