Senate
File
273
-
Introduced
SENATE
FILE
273
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
SSB
1019)
A
BILL
FOR
An
Act
establishing
an
interstate
medical
licensure
compact.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
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273
Section
1.
NEW
SECTION
.
148G.1
Interstate
medical
licensure
1
compact.
2
1.
Purpose.
3
a.
In
order
to
strengthen
access
to
health
care,
and
in
4
recognition
of
the
advances
in
the
delivery
of
health
care,
5
the
member
states
of
the
interstate
medical
licensure
compact
6
have
allied
in
common
purpose
to
develop
a
comprehensive
7
process
that
complements
the
existing
licensing
and
regulatory
8
authority
of
state
medical
boards
and
provides
a
streamlined
9
process
that
allows
physicians
to
become
licensed
in
multiple
10
states,
thereby
enhancing
the
portability
of
a
medical
license
11
and
ensuring
the
safety
of
patients.
The
compact
creates
12
another
pathway
for
licensure
and
does
not
otherwise
change
13
a
state’s
existing
medical
practice
act.
The
compact
also
14
adopts
the
prevailing
standard
for
licensure
and
affirms
that
15
the
practice
of
medicine
occurs
where
the
patient
is
located
16
at
the
time
of
the
physician-patient
encounter,
and
therefore,
17
requires
the
physician
to
be
under
the
jurisdiction
of
the
18
state
medical
board
where
the
patient
is
located.
19
b.
State
medical
boards
that
participate
in
the
compact
20
retain
the
jurisdiction
to
impose
an
adverse
action
against
21
a
license
to
practice
medicine
in
that
state
issued
to
a
22
physician
through
the
procedures
in
the
compact.
23
2.
Definitions.
In
this
compact:
24
a.
“Bylaws”
means
those
bylaws
established
by
the
interstate
25
commission
pursuant
to
subsection
11
for
its
governance,
or
for
26
directing
and
controlling
its
actions
and
conduct.
27
b.
“Commissioner”
means
the
voting
representative
appointed
28
by
each
member
board
pursuant
to
subsection
11.
29
c.
“Conviction”
means
a
finding
by
a
court
that
30
an
individual
is
guilty
of
a
criminal
offense
through
31
adjudication,
or
entry
of
a
plea
of
guilt
or
no
contest
to
the
32
charge
by
the
offender.
Evidence
of
an
entry
of
a
conviction
33
of
a
criminal
offense
by
the
court
shall
be
considered
final
34
for
purposes
of
disciplinary
action
by
a
member
board.
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d.
“Expedited
license”
means
a
full
and
unrestricted
medical
1
license
granted
by
a
member
state
to
an
eligible
physician
2
through
the
process
set
forth
in
the
compact.
3
e.
“Interstate
commission”
means
the
interstate
commission
4
created
pursuant
to
this
section.
5
f.
“License”
means
authorization
by
a
state
for
a
physician
6
to
engage
in
the
practice
of
medicine,
which
would
be
unlawful
7
without
the
authorization.
8
g.
“Medical
practice
act”
means
laws
and
regulations
9
governing
the
practice
of
allopathic
and
osteopathic
medicine
10
within
a
member
state.
11
h.
“Member
board”
means
a
state
agency
in
a
member
state
12
that
acts
in
the
sovereign
interests
of
the
state
by
protecting
13
the
public
through
licensure,
regulation,
and
education
of
14
physicians
as
directed
by
the
state
government.
15
i.
“Member
state”
means
a
state
that
has
enacted
the
16
compact.
17
j.
“Offense”
means
a
felony,
gross
misdemeanor,
or
crime
of
18
moral
turpitude.
19
k.
“Physician”
means
any
person
who
satisfies
all
of
the
20
following:
21
(1)
Is
a
graduate
of
a
medical
school
accredited
by
the
22
liaison
committee
on
medical
education,
the
commission
on
23
osteopathic
college
accreditation,
or
a
medical
school
listed
24
in
the
international
medical
education
directory
or
its
25
equivalent.
26
(2)
Passed
each
component
of
the
United
States
medical
27
licensing
examination
or
the
comprehensive
osteopathic
medical
28
licensing
examination
within
three
attempts,
or
any
of
its
29
predecessor
examinations
accepted
by
a
state
medical
board
as
30
an
equivalent
examination
for
licensure
purposes.
31
(3)
Successfully
completed
graduate
medical
education
32
approved
by
the
accreditation
council
for
graduate
medical
33
education
or
the
American
osteopathic
association.
34
(4)
Holds
specialty
certification
or
a
time-unlimited
35
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specialty
certificate
recognized
by
the
American
board
of
1
medical
specialties
or
the
American
osteopathic
association’s
2
bureau
of
osteopathic
specialists.
3
(5)
Possesses
a
full
and
unrestricted
license
to
engage
in
4
the
practice
of
medicine
issued
by
a
member
board.
5
(6)
Has
never
been
convicted,
received
adjudication,
6
deferred
adjudication,
community
supervision,
or
deferred
7
disposition
for
any
offense
by
a
court
of
appropriate
8
jurisdiction.
9
(7)
Has
never
held
a
license
authorizing
the
practice
of
10
medicine
subjected
to
discipline
by
a
licensing
agency
in
any
11
state,
federal,
or
foreign
jurisdiction,
excluding
any
action
12
related
to
nonpayment
of
fees
related
to
a
license.
13
(8)
Has
never
had
a
controlled
substance
license
or
permit
14
suspended
or
revoked
by
a
state
or
the
United
States
drug
15
enforcement
administration.
16
(9)
Is
not
under
active
investigation
by
a
licensing
agency
17
or
law
enforcement
authority
in
any
state,
federal,
or
foreign
18
jurisdiction.
19
l.
“Practice
of
medicine”
means
the
clinical
prevention,
20
diagnosis,
or
treatment
of
human
disease,
injury,
or
condition
21
requiring
a
physician
to
obtain
and
maintain
a
license
in
22
compliance
with
the
medical
practice
act
of
a
member
state.
23
m.
“Rule”
means
a
written
statement
by
the
interstate
24
commission
promulgated
pursuant
to
subsection
12
that
is
of
25
general
applicability,
implements,
interprets,
or
prescribes
26
a
policy
or
provision
of
the
compact,
or
an
organizational,
27
procedural,
or
practice
requirement
of
the
interstate
28
commission,
and
has
the
force
and
effect
of
statutory
law
in
a
29
member
state,
and
includes
the
amendment,
repeal,
or
suspension
30
of
an
existing
rule.
31
n.
“State”
means
any
state,
commonwealth,
district,
or
32
territory
of
the
United
States.
33
o.
“State
of
principal
license”
means
a
member
state
where
34
a
physician
holds
a
license
to
practice
medicine
and
which
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has
been
designated
as
such
by
the
physician
for
purposes
of
1
registration
and
participation
in
the
compact.
2
3.
Eligibility.
3
a.
A
physician
must
meet
the
eligibility
requirements
as
4
defined
in
subsection
2,
paragraph
“k”
,
to
receive
an
expedited
5
license
under
the
terms
and
provisions
of
the
compact.
6
b.
A
physician
who
does
not
meet
the
requirements
of
7
subsection
2,
paragraph
“k”
,
may
obtain
a
license
to
practice
8
medicine
in
a
member
state
if
the
individual
complies
with
all
9
laws
and
requirements,
other
than
the
compact,
relating
to
the
10
issuance
of
a
license
to
practice
medicine
in
that
state.
11
4.
Designation
of
state
of
principal
license.
12
a.
A
physician
shall
designate
a
member
state
as
the
state
13
of
principal
license
for
purposes
of
registration
for
expedited
14
licensure
through
the
compact
if
the
physician
possesses
a
full
15
and
unrestricted
license
to
practice
medicine
in
that
state,
16
and
the
state
is:
17
(1)
The
state
of
primary
residence
for
the
physician,
or
18
(2)
The
state
where
at
least
twenty-five
percent
of
the
19
practice
of
medicine
occurs,
or
20
(3)
The
location
of
the
physician’s
employer,
or
21
(4)
If
no
state
qualifies
under
subparagraph
(1),
22
subparagraph
(2),
or
subparagraph
(3),
the
state
designated
as
23
state
of
residence
for
purposes
of
federal
income
tax.
24
b.
A
physician
may
redesignate
a
member
state
as
the
state
25
of
principal
license
at
any
time,
as
long
as
the
state
meets
26
the
requirements
in
paragraph
“a”
.
27
c.
The
interstate
commission
is
authorized
to
develop
rules
28
to
facilitate
redesignation
of
another
member
state
as
the
29
state
of
principal
license.
30
5.
Application
and
issuance
of
expedited
licensure.
31
a.
A
physician
seeking
licensure
through
the
compact
shall
32
file
an
application
for
an
expedited
license
with
the
member
33
board
of
the
state
selected
by
the
physician
as
the
state
of
34
principal
license.
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b.
Upon
receipt
of
an
application
for
an
expedited
1
license,
the
member
board
within
the
state
selected
as
2
the
state
of
principal
license
shall
evaluate
whether
the
3
physician
is
eligible
for
expedited
licensure
and
issue
a
4
letter
of
qualification,
verifying
or
denying
the
physician’s
5
eligibility,
to
the
interstate
commission.
6
(1)
Static
qualifications,
which
include
verification
of
7
medical
education,
graduate
medical
education,
results
of
any
8
medical
or
licensing
examination,
and
other
qualifications
as
9
determined
by
the
interstate
commission
through
rule,
shall
10
not
be
subject
to
additional
primary
source
verification
where
11
already
primary
source-verified
by
the
state
of
principal
12
license.
13
(2)
The
member
board
within
the
state
selected
as
the
14
state
of
principal
license
shall,
in
the
course
of
verifying
15
eligibility,
perform
a
criminal
background
check
of
an
16
applicant,
including
the
use
of
the
results
of
fingerprint
or
17
other
biometric
data
checks
compliant
with
the
requirements
18
of
the
federal
bureau
of
investigation,
with
the
exception
19
of
federal
employees
who
have
suitability
determination
in
20
accordance
with
5
C.F.R.
§731.202.
21
(3)
Appeal
on
the
determination
of
eligibility
shall
be
made
22
to
the
member
state
where
the
application
was
filed
and
shall
23
be
subject
to
the
law
of
that
state.
24
c.
Upon
verification
in
paragraph
“b”
,
physicians
eligible
25
for
an
expedited
license
shall
complete
the
registration
26
process
established
by
the
interstate
commission
to
receive
a
27
license
in
a
member
state
selected
pursuant
to
paragraph
“a”
,
28
including
the
payment
of
any
applicable
fees.
29
d.
After
receiving
verification
of
eligibility
under
30
paragraph
“b”
and
any
fees
under
paragraph
“c”
,
a
member
board
31
shall
issue
an
expedited
license
to
the
physician.
This
32
license
shall
authorize
the
physician
to
practice
medicine
in
33
the
issuing
state
consistent
with
the
medical
practice
act
and
34
all
applicable
laws
and
regulations
of
the
issuing
member
board
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and
member
state.
1
e.
An
expedited
license
shall
be
valid
for
a
period
2
consistent
with
the
licensure
period
in
the
member
state
and
in
3
the
same
manner
as
required
for
other
physicians
holding
a
full
4
and
unrestricted
license
within
the
member
state.
5
f.
An
expedited
license
obtained
through
the
compact
shall
6
be
terminated
if
a
physician
fails
to
maintain
a
license
in
7
the
state
of
principal
license
for
a
nondisciplinary
reason,
8
without
redesignation
of
a
new
state
of
principal
license.
9
g.
The
interstate
commission
is
authorized
to
develop
rules
10
regarding
the
application
process,
including
payment
of
any
11
applicable
fees,
and
the
issuance
of
an
expedited
license.
12
6.
Fees
for
expedited
licensure.
13
a.
A
member
state
issuing
an
expedited
license
authorizing
14
the
practice
of
medicine
in
that
state
may
impose
a
fee
for
a
15
license
issued
or
renewed
through
the
compact.
16
b.
The
interstate
commission
is
authorized
to
develop
rules
17
regarding
fees
for
expedited
licenses.
18
7.
Renewal
and
continued
participation.
19
a.
A
physician
seeking
to
renew
an
expedited
license
granted
20
in
a
member
state
shall
complete
a
renewal
process
with
the
21
interstate
commission
if
the
physician
satisfies
the
following:
22
(1)
Maintains
a
full
and
unrestricted
license
in
a
state
of
23
principal
license.
24
(2)
Has
not
been
convicted,
received
adjudication,
deferred
25
adjudication,
community
supervision,
or
deferred
disposition
26
for
any
offense
by
a
court
of
appropriate
jurisdiction.
27
(3)
Has
not
had
a
license
authorizing
the
practice
of
28
medicine
subject
to
discipline
by
a
licensing
agency
in
any
29
state,
federal,
or
foreign
jurisdiction,
excluding
any
action
30
related
to
nonpayment
of
fees
related
to
a
license.
31
(4)
Has
not
had
a
controlled
substance
license
or
permit
32
suspended
or
revoked
by
a
state
or
the
United
States
drug
33
enforcement
administration.
34
b.
Physicians
shall
comply
with
all
continuing
professional
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development
or
continuing
medical
education
requirements
for
1
renewal
of
a
license
issued
by
a
member
state.
2
c.
The
interstate
commission
shall
collect
any
renewal
fees
3
charged
for
the
renewal
of
a
license
and
distribute
the
fees
4
to
the
applicable
member
board.
5
d.
Upon
receipt
of
any
renewal
fees
collected
in
paragraph
6
“c”
,
a
member
board
shall
renew
the
physician’s
license.
7
e.
Physician
information
collected
by
the
interstate
8
commission
during
the
renewal
process
will
be
distributed
to
9
all
member
boards.
10
f.
The
interstate
commission
is
authorized
to
develop
rules
11
to
address
renewal
of
licenses
obtained
through
the
compact.
12
8.
Coordinated
information
system.
13
a.
The
interstate
commission
shall
establish
a
database
of
14
all
physicians
licensed,
or
who
have
applied
for
licensure,
15
under
subsection
5.
16
b.
Notwithstanding
any
other
provision
of
law,
member
boards
17
shall
report
to
the
interstate
commission
any
public
action
18
or
complaints
against
a
licensed
physician
who
has
applied
or
19
received
an
expedited
license
through
the
compact.
20
c.
Member
boards
shall
report
disciplinary
or
investigatory
21
information
determined
as
necessary
and
proper
by
rule
of
the
22
interstate
commission.
23
d.
Member
boards
may
report
any
nonpublic
complaint,
24
disciplinary,
or
investigatory
information
not
required
by
25
paragraph
“c”
to
the
interstate
commission.
26
e.
Member
boards
shall
share
complaint
or
disciplinary
27
information
about
a
physician
upon
request
of
another
member
28
board.
29
f.
All
information
provided
to
the
interstate
commission
or
30
distributed
by
member
boards
shall
be
confidential,
filed
under
31
seal,
and
used
only
for
investigatory
or
disciplinary
matters.
32
g.
The
interstate
commission
is
authorized
to
develop
rules
33
for
mandated
or
discretionary
sharing
of
information
by
member
34
boards.
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9.
Joint
investigations.
1
a.
Licensure
and
disciplinary
records
of
physicians
are
2
deemed
investigative.
3
b.
In
addition
to
the
authority
granted
to
a
member
board
by
4
its
respective
medical
practice
Act
or
other
applicable
state
5
law,
a
member
board
may
participate
with
other
member
boards
6
in
joint
investigations
of
physicians
licensed
by
the
member
7
boards.
8
c.
A
subpoena
issued
by
a
member
state
shall
be
enforceable
9
in
other
member
states.
10
d.
Member
boards
may
share
any
investigative,
litigation,
or
11
compliance
materials
in
furtherance
of
any
joint
or
individual
12
investigation
initiated
under
the
compact.
13
e.
Any
member
state
may
investigate
actual
or
alleged
14
violations
of
the
statutes
authorizing
the
practice
of
medicine
15
in
any
other
member
state
in
which
a
physician
holds
a
license
16
to
practice
medicine.
17
10.
Disciplinary
actions.
18
a.
Any
disciplinary
action
taken
by
any
member
board
against
19
a
physician
licensed
through
the
compact
shall
be
deemed
20
unprofessional
conduct
which
may
be
subject
to
discipline
21
by
other
member
boards,
in
addition
to
any
violation
of
the
22
medical
practice
Act
or
regulations
in
that
state.
23
b.
If
a
license
granted
to
a
physician
by
the
member
board
24
in
the
state
of
principal
license
is
revoked,
surrendered,
25
or
relinquished
in
lieu
of
discipline,
or
suspended,
then
26
all
licenses
issued
to
the
physician
by
member
boards
shall
27
automatically
be
placed,
without
further
action
necessary
by
28
any
member
board,
on
the
same
status.
If
the
member
board
29
in
the
state
of
principal
license
subsequently
reinstates
30
the
physician’s
license,
a
license
issued
to
the
physician
31
by
any
other
member
board
shall
remain
encumbered
until
that
32
respective
member
board
takes
action
to
reinstate
the
license
33
in
a
manner
consistent
with
the
medical
practice
Act
of
that
34
state.
35
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c.
If
disciplinary
action
is
taken
against
a
physician
by
a
1
member
board
not
in
the
state
of
principal
license,
any
other
2
member
board
may
deem
the
action
conclusive
as
to
matter
of
law
3
and
fact
decided
and
either:
4
(1)
Impose
the
same
or
lesser
sanctions
against
the
5
physician
so
long
as
such
sanctions
are
consistent
with
the
6
medical
practice
Act
of
that
state,
or
7
(2)
Pursue
separate
disciplinary
action
against
the
8
physician
under
its
respective
medical
practice
Act,
regardless
9
of
the
action
taken
in
other
member
states.
10
d.
If
a
license
granted
to
a
physician
by
a
member
board
is
11
revoked,
surrendered,
or
relinquished
in
lieu
of
discipline,
12
or
suspended,
then
any
licenses
issued
to
the
physician
by
13
any
other
member
boards
shall
be
suspended,
automatically
and
14
immediately
without
further
action
necessary
by
the
other
15
member
boards,
for
ninety
days
upon
entry
of
the
order
by
the
16
disciplining
board,
to
permit
the
member
boards
to
investigate
17
the
basis
for
the
action
under
the
medical
practice
Act
of
that
18
state.
A
member
board
may
terminate
the
automatic
suspension
19
of
the
license
it
issued
prior
to
the
completion
of
the
20
ninety-day
suspension
period
in
a
manner
consistent
with
the
21
medical
practice
Act
of
that
state.
22
11.
Interstate
medical
licensure
compact
commission.
23
a.
The
member
states
hereby
create
the
interstate
medical
24
licensure
compact
commission.
25
b.
The
purpose
of
the
interstate
commission
is
the
26
administration
of
the
interstate
medical
licensure
compact,
27
which
is
a
discretionary
state
function.
28
c.
The
interstate
commission
shall
be
a
body
corporate
29
and
joint
agency
of
the
member
states
and
shall
have
all
the
30
responsibilities,
powers,
and
duties
set
forth
in
the
compact,
31
and
such
additional
powers
as
may
be
conferred
upon
it
by
a
32
subsequent
concurrent
action
of
the
respective
legislatures
of
33
the
member
states
in
accordance
with
the
terms
of
the
compact.
34
d.
The
interstate
commission
shall
consist
of
two
voting
35
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representatives
appointed
by
each
member
state
who
shall
serve
1
as
commissioners.
In
states
where
allopathic
and
osteopathic
2
physicians
are
regulated
by
separate
member
boards,
or
if
3
the
licensing
and
disciplinary
authority
is
split
between
4
multiple
member
boards
within
a
member
state,
the
member
state
5
shall
appoint
one
representative
from
each
member
board.
A
6
commissioner
shall
be
one
of
the
following:
7
(1)
An
allopathic
or
osteopathic
physician
appointed
to
a
8
member
board.
9
(2)
An
executive
director,
executive
secretary,
or
similar
10
executive
of
a
member
board.
11
(3)
A
member
of
the
public
appointed
to
a
member
board.
12
e.
The
interstate
commission
shall
meet
at
least
once
each
13
calendar
year.
A
portion
of
this
meeting
shall
be
a
business
14
meeting
to
address
such
matters
as
may
properly
come
before
15
the
commission,
including
the
election
of
officers.
The
16
chairperson
may
call
additional
meetings
and
shall
call
for
a
17
meeting
upon
the
request
of
a
majority
of
the
member
states.
18
f.
The
bylaws
may
provide
for
meetings
of
the
interstate
19
commission
to
be
conducted
by
telecommunication
or
electronic
20
communication.
21
g.
Each
commissioner
participating
at
a
meeting
of
the
22
interstate
commission
is
entitled
to
one
vote.
A
majority
of
23
commissioners
shall
constitute
a
quorum
for
the
transaction
24
of
business,
unless
a
larger
quorum
is
required
by
the
bylaws
25
of
the
interstate
commission.
A
commissioner
shall
not
26
delegate
a
vote
to
another
commissioner.
In
the
absence
of
its
27
commissioner,
a
member
state
may
delegate
voting
authority
for
28
a
specified
meeting
to
another
person
from
that
state
who
shall
29
meet
the
requirements
of
paragraph
“d”
.
30
h.
The
interstate
commission
shall
provide
public
notice
31
of
all
meetings
and
all
meetings
shall
be
open
to
the
public.
32
The
interstate
commission
may
close
a
meeting,
in
full
or
33
in
portion,
where
it
determines
by
a
two-thirds
vote
of
the
34
commissioners
present
that
an
open
meeting
would
be
likely
to
35
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result
in
one
or
more
of
the
following:
1
(1)
Relate
solely
to
the
internal
personnel
practices
and
2
procedures
of
the
interstate
commission.
3
(2)
Discuss
matters
specifically
exempted
from
disclosure
4
by
federal
statute.
5
(3)
Discuss
trade
secrets,
commercial,
or
financial
6
information
that
is
privileged
or
confidential.
7
(4)
Involve
accusing
a
person
of
a
crime,
or
formally
8
censuring
a
person.
9
(5)
Discuss
information
of
a
personal
nature
where
10
disclosure
would
constitute
a
clearly
unwarranted
invasion
of
11
personal
privacy.
12
(6)
Discuss
investigative
records
compiled
for
law
13
enforcement
purposes.
14
(7)
Specifically
relate
to
the
participation
in
a
civil
15
action
or
other
legal
proceeding.
16
i.
The
interstate
commission
shall
keep
minutes
which
shall
17
fully
describe
all
matters
discussed
in
a
meeting
and
shall
18
provide
a
full
and
accurate
summary
of
actions
taken,
including
19
record
of
any
roll
call
votes.
20
j.
The
interstate
commission
shall
make
its
information
21
and
official
records,
to
the
extent
not
otherwise
designated
22
in
the
compact
or
by
its
rules,
available
to
the
public
for
23
inspection.
24
k.
The
interstate
commission
shall
establish
an
executive
25
committee,
which
shall
include
officers,
members,
and
others
as
26
determined
by
the
bylaws.
The
executive
committee
shall
have
27
the
power
to
act
on
behalf
of
the
interstate
commission,
with
28
the
exception
of
rulemaking,
during
periods
when
the
interstate
29
commission
is
not
in
session.
When
acting
on
behalf
of
the
30
interstate
commission,
the
executive
committee
shall
oversee
31
the
administration
of
the
compact
including
enforcement
and
32
compliance
with
the
provisions
of
the
compact,
its
bylaws
and
33
rules,
and
other
such
duties
as
necessary.
34
l.
The
interstate
commission
may
establish
other
committees
35
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for
governance
and
administration
of
the
compact.
1
12.
Powers
and
duties
of
the
interstate
commission.
The
2
interstate
commission
shall
have
power
to
perform
the
following
3
functions:
4
a.
Oversee
and
maintain
the
administration
of
the
compact.
5
b.
Promulgate
rules
which
shall
be
binding
to
the
extent
and
6
in
the
manner
provided
for
in
the
compact.
7
c.
Issue,
upon
the
request
of
a
member
state
or
8
member
board,
advisory
opinions
concerning
the
meaning
or
9
interpretation
of
the
compact,
its
bylaws,
rules,
and
actions.
10
d.
Enforce
compliance
with
compact
provisions,
the
rules
11
promulgated
by
the
interstate
commission,
and
the
bylaws,
using
12
all
necessary
and
proper
means,
including
but
not
limited
to
13
the
use
of
judicial
process.
14
e.
Establish
and
appoint
committees
including
but
not
15
limited
to
an
executive
committee
as
required
by
subsection
11,
16
which
shall
have
the
power
to
act
on
behalf
of
the
interstate
17
commission
in
carrying
out
its
powers
and
duties.
18
f.
Pay,
or
provide
for
the
payment
of,
the
expenses
related
19
to
the
establishment,
organization,
and
ongoing
activities
of
20
the
interstate
commission.
21
g.
Establish
and
maintain
one
or
more
offices.
22
h.
Borrow,
accept,
hire,
or
contract
for
services
of
23
personnel.
24
i.
Purchase
and
maintain
insurance
and
bonds.
25
j.
Employ
an
executive
director
who
shall
have
such
26
powers
to
employ,
select,
or
appoint
employees,
agents,
or
27
consultants,
and
to
determine
their
qualifications,
define
28
their
duties,
and
fix
their
compensation.
29
k.
Establish
personnel
policies
and
programs
relating
30
to
conflicts
of
interest,
rates
of
compensation,
and
31
qualifications
of
personnel.
32
l.
Accept
donations
and
grants
of
money,
equipment,
33
supplies,
materials,
and
services,
and
to
receive,
utilize,
and
34
dispose
of
the
same
in
a
manner
consistent
with
the
conflict
of
35
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interest
policies
established
by
the
interstate
commission.
1
m.
Lease,
purchase,
accept
contributions
or
donations
of,
or
2
otherwise
to
own,
hold,
improve,
or
use,
any
property,
real,
3
personal,
or
mixed.
4
n.
Sell,
convey,
mortgage,
pledge,
lease,
exchange,
abandon,
5
or
otherwise
dispose
of
any
property,
real,
personal,
or
mixed.
6
o.
Establish
a
budget
and
make
expenditures.
7
p.
Adopt
a
seal
and
bylaws
governing
the
management
and
8
operation
of
the
interstate
commission.
9
q.
Report
annually
to
the
legislatures
and
governors
of
10
the
member
states
concerning
the
activities
of
the
interstate
11
commission
during
the
preceding
year.
Such
reports
shall
also
12
include
reports
of
financial
audits
and
any
recommendations
13
that
may
have
been
adopted
by
the
interstate
commission.
14
r.
Coordinate
education,
training,
and
public
awareness
15
regarding
the
compact,
its
implementation,
and
its
operation.
16
s.
Maintain
records
in
accordance
with
the
bylaws.
17
t.
Seek
and
obtain
trademarks,
copyrights,
and
patents.
18
u.
Perform
such
functions
as
may
be
necessary
or
appropriate
19
to
achieve
the
purposes
of
the
compact.
20
13.
Finance
powers.
21
a.
The
interstate
commission
may
levy
on
and
collect
an
22
annual
assessment
from
each
member
state
to
cover
the
cost
of
23
the
operations
and
activities
of
the
interstate
commission
and
24
its
staff.
The
total
assessment
must
be
sufficient
to
cover
25
the
annual
budget
approved
each
year
for
which
revenue
is
not
26
provided
by
other
sources.
The
aggregate
annual
assessment
27
amount
shall
be
allocated
upon
a
formula
to
be
determined
28
by
the
interstate
commission,
which
shall
promulgate
a
rule
29
binding
upon
all
member
states.
30
b.
The
interstate
commission
shall
not
incur
obligations
of
31
any
kind
prior
to
securing
the
funds
adequate
to
meet
the
same.
32
c.
The
interstate
commission
shall
not
pledge
the
credit
of
33
any
of
the
member
states,
except
by,
and
with
the
authority
of,
34
the
member
state.
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d.
The
interstate
commission
shall
be
subject
to
a
yearly
1
financial
audit
conducted
by
a
certified
or
licensed
public
2
accountant
and
the
report
of
the
audit
shall
be
included
in
the
3
annual
report
of
the
interstate
commission.
4
14.
Organization
and
operation
of
the
interstate
commission.
5
a.
The
interstate
commission
shall,
by
a
majority
of
6
commissioners
present
and
voting,
adopt
bylaws
to
govern
its
7
conduct
as
may
be
necessary
or
appropriate
to
carry
out
the
8
purposes
of
the
compact
within
twelve
months
of
the
first
9
interstate
commission
meeting.
10
b.
The
interstate
commission
shall
elect
or
appoint
annually
11
from
among
its
commissioners
a
chairperson,
a
vice
chairperson,
12
and
a
treasurer,
each
of
whom
shall
have
such
authority
and
13
duties
as
may
be
specified
in
the
bylaws.
The
chairperson,
14
or
in
the
chairperson’s
absence
or
disability,
the
vice
15
chairperson,
shall
preside
at
all
meetings
of
the
interstate
16
commission.
17
c.
Officers
selected
in
paragraph
“b”
shall
serve
without
18
remuneration
from
the
interstate
commission.
19
d.
The
officers
and
employees
of
the
interstate
commission
20
shall
be
immune
from
suit
and
liability,
either
personally
or
21
in
their
official
capacity,
for
a
claim
for
damage
to
or
loss
22
of
property
or
personal
injury
or
other
civil
liability
caused
23
or
arising
out
of,
or
relating
to,
an
actual
or
alleged
act,
24
error,
or
omission
that
occurred,
or
that
such
person
had
a
25
reasonable
basis
for
believing
occurred,
within
the
scope
of
26
interstate
commission
employment,
duties,
or
responsibilities,
27
provided
that
such
person
shall
not
be
protected
from
suit
or
28
liability
for
damage,
loss,
injury,
or
liability
caused
by
the
29
intentional
or
willful
and
wanton
misconduct
of
such
person.
30
(1)
The
liability
of
the
executive
director
and
employees
of
31
the
interstate
commission
or
representatives
of
the
interstate
32
commission,
acting
within
the
scope
of
such
person’s
employment
33
or
duties
for
acts,
errors,
or
omissions
occurring
within
such
34
person’s
state,
may
not
exceed
the
limits
of
liability
set
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forth
under
the
constitution
and
laws
of
that
state
for
state
1
officials,
employees,
and
agents.
The
interstate
commission
2
is
considered
to
be
an
instrumentality
of
the
states
for
3
the
purposes
of
any
such
action.
Nothing
in
this
paragraph
4
“d”
shall
be
construed
to
protect
such
person
from
suit
or
5
liability
for
damage,
loss,
injury,
or
liability
caused
by
the
6
intentional
or
willful
and
wanton
misconduct
of
such
person.
7
(2)
The
interstate
commission
shall
defend
the
executive
8
director,
its
employees,
and
subject
to
the
approval
of
9
the
attorney
general
or
other
appropriate
legal
counsel
of
10
the
member
state
represented
by
an
interstate
commission
11
representative,
shall
defend
such
interstate
commission
12
representative
in
any
civil
action
seeking
to
impose
liability
13
arising
out
of
an
actual
or
alleged
act,
error,
or
omission
14
that
occurred
within
the
scope
of
interstate
commission
15
employment,
duties,
or
responsibilities,
or
that
the
defendant
16
had
a
reasonable
basis
for
believing
occurred
within
the
17
scope
of
interstate
commission
employment,
duties,
or
18
responsibilities,
provided
that
the
actual
or
alleged
act,
19
error,
or
omission
did
not
result
from
intentional
or
willful
20
and
wanton
misconduct
on
the
part
of
such
person.
21
(3)
To
the
extent
not
covered
by
the
state
involved,
member
22
state,
or
the
interstate
commission,
the
representatives
or
23
employees
of
the
interstate
commission
shall
be
held
harmless
24
in
the
amount
of
a
settlement
or
judgment,
including
attorney
25
fees
and
costs,
obtained
against
such
persons
arising
out
of
26
an
actual
or
alleged
act,
error,
or
omission
that
occurred
27
within
the
scope
of
interstate
commission
employment,
duties,
28
or
responsibilities,
or
that
such
persons
had
a
reasonable
29
basis
for
believing
occurred
within
the
scope
of
interstate
30
commission
employment,
duties,
or
responsibilities,
provided
31
that
the
actual
or
alleged
act,
error,
or
omission
did
not
32
result
from
intentional
or
willful
and
wanton
misconduct
on
the
33
part
of
such
persons.
34
15.
Rulemaking
functions
of
the
interstate
commission.
35
-15-
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273
a.
The
interstate
commission
shall
promulgate
reasonable
1
rules
in
order
to
effectively
and
efficiently
achieve
the
2
purposes
of
the
compact.
Notwithstanding
the
foregoing,
in
3
the
event
the
interstate
commission
exercises
its
rulemaking
4
authority
in
a
manner
that
is
beyond
the
scope
of
the
purposes
5
of
the
compact,
or
the
powers
granted
hereunder,
then
such
an
6
action
by
the
interstate
commission
shall
be
invalid
and
have
7
no
force
or
effect.
8
b.
Rules
deemed
appropriate
for
the
operations
of
the
9
interstate
commission
shall
be
made
pursuant
to
a
rulemaking
10
process
that
substantially
conforms
to
the
model
state
11
administrative
procedure
Act
of
2010,
and
subsequent
amendments
12
thereto.
13
c.
Not
later
than
thirty
days
after
a
rule
is
promulgated,
14
any
person
may
file
a
petition
for
judicial
review
of
the
15
rule
in
the
United
States
district
court
for
the
District
16
of
Columbia
or
the
federal
district
where
the
interstate
17
commission
has
its
principal
offices,
provided
that
the
filing
18
of
such
a
petition
shall
not
stay
or
otherwise
prevent
the
19
rule
from
becoming
effective
unless
the
court
finds
that
the
20
petitioner
has
a
substantial
likelihood
of
success.
The
21
court
shall
give
deference
to
the
actions
of
the
interstate
22
commission
consistent
with
applicable
law
and
shall
not
find
23
the
rule
to
be
unlawful
if
the
rule
represents
a
reasonable
24
exercise
of
the
authority
granted
to
the
interstate
commission.
25
16.
Oversight
of
interstate
compact.
26
a.
The
executive,
legislative,
and
judicial
branches
27
of
state
government
in
each
member
state
shall
enforce
the
28
compact
and
shall
take
all
actions
necessary
and
appropriate
to
29
effectuate
the
compact’s
purposes
and
intent.
The
provisions
30
of
the
compact
and
the
rules
promulgated
hereunder
shall
have
31
standing
as
statutory
law
but
shall
not
override
existing
state
32
authority
to
regulate
the
practice
of
medicine.
33
b.
All
courts
shall
take
judicial
notice
of
the
compact
and
34
the
rules
in
any
judicial
or
administrative
proceeding
in
a
35
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273
member
state
pertaining
to
the
subject
matter
of
the
compact
1
which
may
affect
the
powers,
responsibilities,
or
actions
of
2
the
interstate
commission.
3
c.
The
interstate
commission
shall
be
entitled
to
receive
4
all
service
of
process
in
any
such
proceeding,
and
shall
have
5
standing
to
intervene
in
the
proceeding
for
all
purposes.
6
Failure
to
provide
service
of
process
to
the
interstate
7
commission
shall
render
a
judgment
or
order
void
as
to
the
8
interstate
commission,
the
compact,
or
promulgated
rules.
9
17.
Enforcement
of
interstate
compact.
10
a.
The
interstate
commission,
in
the
reasonable
exercise
of
11
its
discretion,
shall
enforce
the
provisions
and
rules
of
the
12
compact.
13
b.
The
interstate
commission
may,
by
majority
vote
of
14
the
commissioners,
initiate
legal
action
in
the
United
15
States
district
court
for
the
District
of
Columbia,
or,
at
16
the
discretion
of
the
interstate
commission,
in
the
federal
17
district
where
the
interstate
commission
has
its
principal
18
offices,
to
enforce
compliance
with
the
provisions
of
the
19
compact,
and
its
promulgated
rules
and
bylaws,
against
a
20
member
state
in
default.
The
relief
sought
may
include
21
both
injunctive
relief
and
damages.
In
the
event
judicial
22
enforcement
is
necessary,
the
prevailing
party
shall
be
awarded
23
all
costs
of
such
litigation
including
reasonable
attorney
24
fees.
25
c.
The
remedies
herein
shall
not
be
the
exclusive
remedies
26
of
the
interstate
commission.
The
interstate
commission
may
27
avail
itself
of
any
other
remedies
available
under
state
law
or
28
the
regulation
of
a
profession.
29
18.
Default
procedures.
30
a.
The
grounds
for
default
include
but
are
not
limited
31
to
failure
of
a
member
state
to
perform
such
obligations
or
32
responsibilities
imposed
upon
it
by
the
compact,
or
the
rules
33
and
bylaws
of
the
interstate
commission
promulgated
under
the
34
compact.
35
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273
b.
If
the
interstate
commission
determines
that
a
member
1
state
has
defaulted
in
the
performance
of
its
obligations
2
or
responsibilities
under
the
compact,
or
the
bylaws
or
3
promulgated
rules,
the
interstate
commission
shall
do
the
4
following:
5
(1)
Provide
written
notice
to
the
defaulting
state
and
other
6
member
states
of
the
nature
of
the
default,
the
means
of
curing
7
the
default,
and
any
action
taken
by
the
interstate
commission.
8
The
interstate
commission
shall
specify
the
conditions
by
which
9
the
defaulting
state
must
cure
its
default.
10
(2)
Provide
remedial
training
and
specific
technical
11
assistance
regarding
the
default.
12
c.
If
the
defaulting
state
fails
to
cure
the
default,
the
13
defaulting
state
shall
be
terminated
from
the
compact
upon
an
14
affirmative
vote
of
a
majority
of
the
commissioners
and
all
15
rights,
privileges,
and
benefits
conferred
by
the
compact
shall
16
terminate
on
the
effective
date
of
termination.
A
cure
of
the
17
default
does
not
relieve
the
offending
state
of
obligations
or
18
liabilities
incurred
during
the
period
of
the
default.
19
d.
Termination
of
membership
in
the
compact
shall
be
imposed
20
only
after
all
other
means
of
securing
compliance
have
been
21
exhausted.
Notice
of
intent
to
terminate
shall
be
given
by
22
the
interstate
commission
to
the
governor,
the
majority
and
23
minority
leaders
of
the
defaulting
state’s
legislature,
and
24
each
of
the
member
states.
25
e.
The
interstate
commission
shall
establish
rules
and
26
procedures
to
address
licenses
and
physicians
that
are
27
materially
impacted
by
the
termination
of
a
member
state,
or
28
the
withdrawal
of
a
member
state.
29
f.
The
member
state
which
has
been
terminated
is
responsible
30
for
all
dues,
obligations,
and
liabilities
incurred
through
31
the
effective
date
of
termination
including
obligations,
the
32
performance
of
which
extends
beyond
the
effective
date
of
33
termination.
34
g.
The
interstate
commission
shall
not
bear
any
costs
35
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273
relating
to
any
state
that
has
been
found
to
be
in
default
or
1
which
has
been
terminated
from
the
compact,
unless
otherwise
2
mutually
agreed
upon
in
writing
between
the
interstate
3
commission
and
the
defaulting
state.
4
h.
The
defaulting
state
may
appeal
the
action
of
the
5
interstate
commission
by
petitioning
the
United
States
district
6
court
for
the
District
of
Columbia
or
the
federal
district
7
where
the
interstate
commission
has
its
principal
offices.
The
8
prevailing
party
shall
be
awarded
all
costs
of
such
litigation
9
including
reasonable
attorney
fees.
10
19.
Dispute
resolution.
11
a.
The
interstate
commission
shall
attempt,
upon
the
request
12
of
a
member
state,
to
resolve
disputes
which
are
subject
to
13
the
compact
and
which
may
arise
among
member
states
or
member
14
boards.
15
b.
The
interstate
commission
shall
promulgate
rules
16
providing
for
both
mediation
and
binding
dispute
resolution
as
17
appropriate.
18
20.
Member
states,
effective
date,
and
amendment.
19
a.
Any
state
is
eligible
to
become
a
member
state
of
the
20
compact.
21
b.
The
compact
shall
become
effective
and
binding
upon
22
legislative
enactment
of
the
compact
into
law
by
no
less
than
23
seven
states.
Thereafter,
it
shall
become
effective
and
24
binding
on
a
state
upon
enactment
of
the
compact
into
law
by
25
that
state.
26
c.
The
governors
of
nonmember
states,
or
their
designees,
27
shall
be
invited
to
participate
in
the
activities
of
the
28
interstate
commission
on
a
nonvoting
basis
prior
to
adoption
29
of
the
compact
by
all
states.
30
d.
The
interstate
commission
may
propose
amendments
to
the
31
compact
for
enactment
by
the
member
states.
No
amendment
shall
32
become
effective
and
binding
upon
the
interstate
commission
and
33
the
member
states
unless
and
until
it
is
enacted
into
law
by
34
unanimous
consent
of
the
member
states.
35
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273
21.
Withdrawal.
1
a.
Once
effective,
the
compact
shall
continue
in
force
and
2
remain
binding
upon
each
and
every
member
state,
provided
that
3
a
member
state
may
withdraw
from
the
compact
by
specifically
4
repealing
the
statute
which
enacted
the
compact
into
law.
5
b.
Withdrawal
from
the
compact
shall
be
by
the
enactment
6
of
a
statute
repealing
the
same,
but
shall
not
take
effect
7
until
one
year
after
the
effective
date
of
such
statute
and
8
until
written
notice
of
the
withdrawal
has
been
given
by
the
9
withdrawing
state
to
the
governor
of
each
other
member
state.
10
c.
The
withdrawing
state
shall
immediately
notify
the
11
chairperson
of
the
interstate
commission
in
writing
upon
the
12
introduction
of
legislation
repealing
the
compact
in
the
13
withdrawing
state.
14
d.
The
interstate
commission
shall
notify
the
other
member
15
states
of
the
withdrawing
state’s
intent
to
withdraw
within
16
sixty
days
of
its
receipt
of
notice
provided
under
paragraph
17
“c”
.
18
e.
The
withdrawing
state
is
responsible
for
all
dues,
19
obligations,
and
liabilities
incurred
through
the
effective
20
date
of
withdrawal,
including
obligations,
the
performance
of
21
which
extend
beyond
the
effective
date
of
withdrawal.
22
f.
Reinstatement
following
withdrawal
of
a
member
state
23
shall
occur
upon
the
withdrawing
state
reenacting
the
compact
24
or
upon
such
later
date
as
determined
by
the
interstate
25
commission.
26
g.
The
interstate
commission
is
authorized
to
develop
27
rules
to
address
the
impact
of
the
withdrawal
of
a
member
28
state
on
licenses
granted
in
other
member
states
to
physicians
29
who
designated
the
withdrawing
member
state
as
the
state
of
30
principal
license.
31
22.
Dissolution.
32
a.
The
compact
shall
dissolve
effective
upon
the
date
of
33
the
withdrawal
or
default
of
the
member
state
which
reduces
the
34
membership
in
the
compact
to
one
member
state.
35
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273
b.
Upon
the
dissolution
of
the
compact,
the
compact
becomes
1
null
and
void
and
shall
be
of
no
further
force
or
effect,
and
2
the
business
and
affairs
of
the
interstate
commission
shall
be
3
concluded
and
surplus
funds
shall
be
distributed
in
accordance
4
with
the
bylaws.
5
23.
Severability
and
construction.
6
a.
The
provisions
of
the
compact
shall
be
severable,
7
and
if
any
phrase,
clause,
sentence,
or
provision
is
deemed
8
unenforceable,
the
remaining
provisions
of
the
compact
shall
9
be
enforceable.
10
b.
The
provisions
of
the
compact
shall
be
liberally
11
construed
to
effectuate
its
purposes.
12
c.
Nothing
in
the
compact
shall
be
construed
to
prohibit
the
13
applicability
of
other
interstate
compacts
to
which
the
states
14
are
members.
15
24.
Binding
effect
of
compact
and
other
laws.
16
a.
Nothing
herein
prevents
the
enforcement
of
any
other
law
17
of
a
member
state
that
is
not
inconsistent
with
the
compact.
18
b.
All
laws
in
a
member
state
in
conflict
with
the
compact
19
are
superseded
to
the
extent
of
the
conflict.
20
c.
All
lawful
actions
of
the
interstate
commission,
21
including
all
rules
and
bylaws
promulgated
by
the
commission,
22
are
binding
upon
the
member
states.
23
d.
All
agreements
between
the
interstate
commission
and
the
24
member
states
are
binding
in
accordance
with
their
terms.
25
e.
In
the
event
any
provision
of
the
compact
exceeds
the
26
constitutional
limits
imposed
on
the
legislature
of
any
member
27
state,
such
provision
shall
be
ineffective
to
the
extent
of
the
28
conflict
with
the
constitutional
provision
in
question
in
that
29
member
state.
30
EXPLANATION
31
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
32
the
explanation’s
substance
by
the
members
of
the
general
assembly.
33
This
bill
seeks
to
enact
the
interstate
medical
licensure
34
compact,
which
would
allow
physicians
to
secure
licensure
35
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273
in
states
in
which
they
do
not
hold
a
traditional
license.
1
Passage
of
the
bill
means
Iowa
would
become
a
compact
member
2
state.
The
compact
shall
become
effective
and
binding
upon
3
passage
by
at
least
seven
states.
4
The
bill
recognizes
the
creation
of
an
interstate
medical
5
licensure
compact
commission
to
administer
the
compact.
Its
6
commissioners
would
include
two
representatives
from
each
7
member
state.
The
commissioners
must
be
an
allopathic
or
8
osteopathic
physician
appointed
to
a
state
board,
an
executive
9
member
of
a
state
board,
or
a
member
of
the
public
on
a
state
10
board.
The
interstate
commission
must
hold
at
least
one
11
meeting
per
year
and
all
meetings
would
be
open
to
the
public,
12
subject
to
closure
for
specified
topics.
The
interstate
13
commission
must
create
an
executive
committee
and
may
establish
14
other
committees
as
necessary
to
govern
and
administer
the
15
compact.
The
interstate
commission
will
have
the
power
to
16
adopt
bylaws,
create
its
own
rules,
enforce
compliance
with
17
its
bylaws
and
rules,
establish
and
maintain
offices,
purchase
18
and
maintain
insurance
and
bonds,
employ
an
executive
director
19
who
may
employ
and
fix
compensation
and
duties
for
employees,
20
establish
a
budget
and
make
expenditures,
seek
and
obtain
21
trademarks,
copyrights,
and
patents,
and
lease,
buy,
and
sell
22
property,
as
well
as
other
functions
it
deems
necessary.
23
Physicians
must
designate
a
member
state
as
their
state
of
24
principal
license
for
purposes
of
applying
for
an
expedited
25
license.
An
expedited
license
is
a
full
and
unrestricted
26
license
granted
by
a
member
state.
A
physician
seeking
an
27
expedited
license
to
practice
medicine
must
apply
to
the
board
28
of
medicine
in
the
physician’s
state
of
principal
license.
The
29
board
of
medicine
must
then
verify
or
deny
the
physician’s
30
eligibility
for
an
expedited
license
to
the
interstate
31
commission.
An
expedited
license
granted
to
a
physician
shall
32
be
terminated
if
the
physician
fails
to
maintain
a
license
in
33
the
physician’s
state
of
principal
license.
34
The
interstate
commission
shall
have
authority
to
establish
35
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and
maintain
a
database
of
all
physicians
who
have
applied
for
1
an
expedited
license.
Medical
boards
of
member
states
may
2
participate
in
investigations
of
physicians
in
conjunction
with
3
other
boards
of
other
member
states.
A
physician
subjected
4
to
disciplinary
action
by
any
medical
board
of
a
member
state
5
may
also
be
subject
to
discipline
by
another
member
state
6
medical
board.
If
a
physician’s
license
is
suspended,
revoked,
7
surrendered,
or
relinquished
due
to
discipline
by
one
medical
8
board
of
a
member
state,
the
physician’s
license
shall
be
9
automatically
placed
on
the
same
status
by
other
medical
boards
10
of
member
states
without
additional
disciplinary
action.
11
The
interstate
commission’s
officers
and
employees
shall
be
12
immune
from
liability
for
claims
of
damage
that
occurred
within
13
the
scope
of
their
duties.
The
interstate
commission
may
14
propose
amendments
to
the
compact
that
would
become
effective
15
upon
passage
by
at
least
seven
member
states.
The
interstate
16
commission
may
initiate
legal
action
to
enforce
the
compact’s
17
provisions
and
rules.
If
a
member
state
defaults
in
its
18
performance
of
the
compact’s
responsibilities,
the
interstate
19
commission
shall
notify
the
state
as
such
and
provide
training
20
and
assistance
to
remedy
the
default.
If
a
member
state
fails
21
to
cure
its
default,
that
state’s
rights
and
privileges
under
22
the
compact
shall
be
terminated
upon
a
vote
of
the
majority
of
23
commissioners.
24
The
executive,
legislative,
and
judicial
branches
of
Iowa
25
would
maintain
authority
to
enforce
the
compact.
The
compact’s
26
provisions
would
not
override
the
state’s
existing
authority
27
to
regulate
the
practice
of
medicine.
The
board
of
medicine
28
would
have
jurisdiction
to
impose
an
adverse
action
against
29
a
medical
license
issued
in
Iowa
pursuant
to
the
compact’s
30
procedures.
Member
states
may
withdraw
upon
enactment
of
a
31
statute
repealing
the
compact.
The
compact
would
dissolve
when
32
membership
declines
to
one
state.
33
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