Senate Study Bill 1075 - Introduced SENATE/HOUSE FILE _____ BY (PROPOSED BOARD OF NURSING BILL) A BILL FOR An Act relating to the advanced practice registered nurse 1 compact, including assessments against party states, and 2 including effective date provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 1110DP (6) 87 tr/nh

S.F. _____ H.F. _____ Section 1. Section 152E.3, Code 2017, is amended by striking 1 the section and inserting in lieu thereof the following: 2 152E.3 Form of advanced practice registered nurse compact. 3 1. Article I —— Findings and declaration of purpose. 4 a. The party states find all of the following: 5 (1) The health and safety of the public are affected by the 6 degree of compliance with advanced practice registered nurse 7 licensure requirements and the effectiveness of enforcement 8 activities related to state advanced practice registered nurse 9 licensure laws. 10 (2) Violations of advanced practice registered nurse 11 licensure and other laws regulating the practice of nursing may 12 result in injury or harm to the public. 13 (3) The expanded mobility of advanced practice registered 14 nurses and the use of advanced communication technologies 15 as part of our nation’s health care delivery system require 16 greater coordination and cooperation among states in the areas 17 of advanced practice registered nurse licensure and regulation. 18 (4) New practice modalities and technology make compliance 19 with individual state advanced practice registered nurse 20 licensure laws difficult and complex. 21 (5) The current system of duplicative advanced practice 22 registered nurse licensure for advanced practice registered 23 nurses practicing in multiple states is cumbersome and 24 redundant for both advanced practice registered nurses and 25 states. 26 (6) Uniformity of advanced practice registered nurse 27 licensure requirements throughout the states promotes public 28 safety and public health benefits. 29 b. The general purposes of this compact are to: 30 (1) Facilitate the states’ responsibility to protect the 31 public’s health and safety. 32 (2) Ensure and encourage the cooperation of party states 33 in the areas of advanced practice registered nurse licensure 34 and regulation, including promotion of uniform licensure 35 -1- LSB 1110DP (6) 87 tr/nh 1/ 27

S.F. _____ H.F. _____ requirements. 1 (3) Facilitate the exchange of information between party 2 states in the areas of advanced practice registered nurse 3 regulation, investigation, and adverse actions. 4 (4) Promote compliance with the laws governing advanced 5 practice registered nurse practice in each jurisdiction. 6 (5) Invest all party states with the authority to hold an 7 advanced practice registered nurse accountable for meeting 8 all state practice laws in the state in which the patient 9 is located at the time care is rendered through the mutual 10 recognition of party state licenses. 11 (6) Decrease redundancies in the consideration and issuance 12 of advanced practice registered nurse licenses. 13 (7) Provide opportunities for interstate practice by 14 advanced practice registered nurses who meet uniform licensure 15 requirements. 16 2. Article II —— Definitions. As used in this compact: 17 a. “Advanced practice registered nurse” means a registered 18 nurse who has gained additional specialized knowledge, skills 19 and experience through a program of study recognized or defined 20 by the interstate commission of advanced practice registered 21 nurse compact administrators (“commission”), and who is 22 licensed to perform advanced nursing practice. An advanced 23 practice registered nurse is licensed in an advanced practice 24 registered nurse role that is congruent with an advanced 25 practice registered nurse educational program, certification, 26 and commission rules. 27 b. “Advanced practice registered nurse licensure” means 28 the regulatory mechanism used by a party state to grant legal 29 authority to practice as an advanced practice registered nurse. 30 c. “Advanced practice registered nurse uniform licensure 31 requirements” means minimum uniform licensure, education, and 32 examination requirements as adopted by the commission. 33 d. “Adverse action” means any administrative, civil, 34 equitable, or criminal action permitted by a state’s laws which 35 -2- LSB 1110DP (6) 87 tr/nh 2/ 27

S.F. _____ H.F. _____ is imposed by a licensing board or other authority against an 1 advanced practice registered nurse, including actions against 2 an individual’s license or multistate licensure privilege 3 such as revocation, suspension, probation, monitoring of 4 the licensee, limitation on the licensee’s practice, or any 5 other encumbrance on licensure affecting an advanced practice 6 registered nurse’s authorization to practice, including the 7 issuance of a cease and desist action. 8 e. “Alternative program” means a nondisciplinary monitoring 9 program approved by a licensing board. 10 f. “Coordinated licensure information system” means an 11 integrated process for collecting, storing, and sharing 12 information on advanced practice registered nurse licensure and 13 enforcement activities related to advanced practice registered 14 nurse licensure laws that is administered by a nonprofit 15 organization composed of and controlled by licensing boards. 16 g. “Current significant investigatory information” means 17 either of the following: 18 (1) Investigative information that a licensing board, 19 after a preliminary inquiry that includes notification and 20 an opportunity for the advanced practice registered nurse to 21 respond, if required by state law, has reason to believe is 22 not groundless and, if proved true, would indicate more than a 23 minor infraction. 24 (2) Investigative information that indicates that the 25 advanced practice registered nurse represents an immediate 26 threat to public health and safety regardless of whether the 27 advanced practice registered nurse has been notified and had an 28 opportunity to respond. 29 h. “Encumbrance” means a revocation or suspension of, or any 30 limitation on, the full and unrestricted practice of nursing 31 imposed by a licensing board. 32 i. “Home state” means the party state that is the advanced 33 practice registered nurse’s primary state of residence. 34 j. “Licensing board” means a party state’s regulatory body 35 -3- LSB 1110DP (6) 87 tr/nh 3/ 27

S.F. _____ H.F. _____ responsible for regulating the practice of advanced practice 1 registered nursing. 2 k. “Multistate license” means an advanced practice 3 registered nurse license to practice as an advanced practice 4 registered nurse issued by a home state licensing board that 5 authorizes the advanced practice registered nurse to practice 6 as an advanced practice registered nurse in all party states 7 under a multistate licensure privilege, in the same role and 8 population focus as the advanced practice registered nurse is 9 licensed in the home state. 10 l. “Multistate licensure privilege” means a legal 11 authorization associated with an advanced practice registered 12 nurse multistate license that permits an advanced practice 13 registered nurse to practice as an advanced practice registered 14 nurse in a remote state, in the same role and population focus 15 as the advanced practice registered nurse is licensed in the 16 home state. 17 m. “Noncontrolled prescription drug” means a device or 18 drug that is not a controlled substance and is prohibited 19 under state or federal law from being dispensed without a 20 prescription. The term includes a device or drug that bears or 21 is required to bear the legend “Caution: federal law prohibits 22 dispensing without prescription” or “prescription only” or 23 other legend that complies with federal law. 24 n. “Party state” means any state that has adopted this 25 compact. 26 o. “Population focus” means a specific patient population 27 that is congruent with the advanced practice registered nurse 28 educational program, certification, and commission rules. 29 p. “Prescriptive authority” means the legal authority to 30 prescribe medications and devices as defined by party state 31 laws. 32 q. “Remote state” means a party state that is not the home 33 state. 34 r. “Single-state license” means an advanced practice 35 -4- LSB 1110DP (6) 87 tr/nh 4/ 27

S.F. _____ H.F. _____ registered nurse license issued by a party state that 1 authorizes practice only within the issuing state and does not 2 include a multistate licensure privilege to practice in any 3 other party state. 4 s. “State” means a state, territory, or possession of the 5 United States and the District of Columbia. 6 t. “State practice laws” means a party state’s laws, rules, 7 and regulations that govern advanced practice registered nurse 8 practice, define the scope of advanced nursing practice, 9 including prescriptive authority, and create the methods and 10 grounds for imposing discipline. State practice laws do 11 not include the requirements necessary to obtain and retain 12 an advanced practice registered nurse license, except for 13 qualifications or requirements of the home state. 14 3. Article III —— General provisions and jurisdiction. 15 a. A state must implement procedures for considering the 16 criminal history records of applicants for initial advanced 17 practice registered nurse licensure or advanced practice 18 registered nurse licensure by endorsement. Such procedures 19 shall include the submission of fingerprints or other 20 biometric-based information by advanced practice registered 21 nurse applicants for the purpose of obtaining an applicant’s 22 criminal history record information from the federal bureau of 23 investigation and the agency responsible for retaining that 24 state’s criminal records. 25 b. By rule, the commission shall adopt the advanced practice 26 registered nurse uniform licensure requirements. The uniform 27 licensure requirements shall provide the minimum requirements 28 for advanced practice registered nurse multistate licensure 29 in party states, provided that the commission may adopt 30 rules whereby an advanced practice registered nurse, with an 31 unencumbered license on the effective date of this compact, may 32 obtain, by endorsement or otherwise, and retain a multistate 33 license in a party state. 34 c. In order to obtain or retain a multistate license, an 35 -5- LSB 1110DP (6) 87 tr/nh 5/ 27

S.F. _____ H.F. _____ advanced practice registered nurse must meet, in addition 1 to the uniform licensure requirements, the home state’s 2 qualifications for licensure or renewal of licensure, as well 3 as all other applicable home state laws. 4 d. By rule, the commission shall identify the approved 5 advanced practice registered nurse roles and population foci 6 for licensure as an advanced practice registered nurse. An 7 advanced practice registered nurse issued a multistate license 8 shall be licensed in an approved advanced practice registered 9 nurse role and at least one approved population focus. 10 e. An advanced practice registered nurse multistate license 11 issued by a home state to a resident in that state will be 12 recognized by each party state as authorizing the advanced 13 practice registered nurse to practice as an advanced practice 14 registered nurse in each party state, under a multistate 15 licensure privilege, in the same role and population focus 16 as the advanced practice registered nurse is licensed in the 17 home state. If an applicant does not qualify for a multistate 18 license, a single-state license may be issued by a home state. 19 f. Issuance of an advanced practice registered nurse 20 multistate license shall include prescriptive authority for 21 noncontrolled prescription drugs, unless the advanced practice 22 registered nurse was licensed by the home state prior to the 23 home state’s adoption of this compact and has not previously 24 held prescriptive authority. 25 (1) An advanced practice registered nurse granted 26 prescriptive authority for noncontrolled prescription drugs 27 in the home state may exercise prescriptive authority for 28 noncontrolled prescription drugs in any remote state while 29 exercising a multistate licensure privilege under an advanced 30 practice registered nurse multistate license; the advanced 31 practice registered nurse shall not be required to meet any 32 additional eligibility requirements imposed by the remote 33 state in exercising prescriptive authority for noncontrolled 34 prescription drugs. 35 -6- LSB 1110DP (6) 87 tr/nh 6/ 27

S.F. _____ H.F. _____ (2) Prescriptive authority in the home state for an advanced 1 practice registered nurse who was not granted prescriptive 2 authority at the time of initial licensure by the home state, 3 prior to the adoption of this compact, shall be determined 4 under home state law. 5 (3) Prescriptive authority eligibility for an advanced 6 practice registered nurse holding a single-state license shall 7 be determined under the law of the licensing state. 8 g. For each state in which an advanced practice registered 9 nurse seeks authority to prescribe controlled substances, 10 the advanced practice registered nurse shall satisfy all 11 requirements imposed by such state in granting or renewing such 12 authority. 13 h. An advanced practice registered nurse issued a 14 multistate license is authorized to assume responsibility and 15 accountability for patient care independent of a supervisory or 16 collaborative relationship with a physician. This authority 17 may be exercised in the home state and in any remote state 18 in which the advanced practice registered nurse exercises a 19 multistate licensure privilege. For an advanced practice 20 registered nurse issued a single-state license in a party 21 state, the requirement for a supervisory or collaborative 22 relationship with a physician shall be determined under 23 applicable party state law. 24 i. All party states shall be authorized, in accordance 25 with state due process laws, to take adverse action against 26 an advanced practice registered nurse’s multistate licensure 27 privilege such as revocation, suspension, probation, or any 28 other action that affects an advanced practice registered 29 nurse’s authorization to practice under a multistate licensure 30 privilege, including cease and desist actions. If a party 31 state takes such action, it shall promptly notify the 32 administrator of the coordinated licensure information system. 33 The administrator of the coordinated licensure information 34 system shall promptly notify the home state of any such actions 35 -7- LSB 1110DP (6) 87 tr/nh 7/ 27

S.F. _____ H.F. _____ by remote states. 1 j. An advanced practice registered nurse practicing in a 2 party state must comply with the state practice laws of the 3 state in which the client is located at the time service is 4 provided. Advanced practice registered nurse practice is 5 not limited to patient care, but shall include all advanced 6 nursing practice as defined by the state practice laws of the 7 party state in which the client is located. Advanced practice 8 registered nurse practice in a party state under a multistate 9 licensure privilege will subject the advanced practice 10 registered nurse to the jurisdiction of the licensing board, 11 the courts, and the laws of the party state in which the client 12 is located at the time service is provided. 13 k. This compact does not affect additional requirements 14 imposed by states for advanced practice registered nursing. 15 However, a multistate licensure privilege to practice 16 registered nursing granted by a party state shall be recognized 17 by other party states as satisfying any state law requirement 18 for registered nurse licensure as a precondition for 19 authorization to practice as an advanced practice registered 20 nurse in that state. 21 l. Individuals not residing in a party state shall continue 22 to be able to apply for a party state’s single-state advanced 23 practice registered nurse license as provided under the laws of 24 each party state. However, the single-state license granted 25 to these individuals will not be recognized as granting the 26 privilege to practice as an advanced practice registered nurse 27 in any other party state. 28 4. Article IV —— Applications for advanced practice 29 registered nurse licensure in a party state. 30 a. Upon application for an advanced practice registered 31 nurse multistate license, the licensing board in the issuing 32 party state shall ascertain, through the coordinated licensure 33 information system, whether the applicant has ever held or 34 is the holder of a licensed practical or vocational nursing 35 -8- LSB 1110DP (6) 87 tr/nh 8/ 27

S.F. _____ H.F. _____ license, a registered nursing license, or an advanced practice 1 registered nurse license issued by any other state, whether 2 there are any encumbrances on any license or multistate 3 licensure privilege held by the applicant, whether any adverse 4 action has been taken against any license or multistate 5 licensure privilege held by the applicant, and whether the 6 applicant is currently participating in an alternative program. 7 b. An advanced practice registered nurse may hold a 8 multistate advanced practice registered nurse license, issued 9 by the home state, in only one party state at a time. 10 c. If an advanced practice registered nurse changes primary 11 state of residence by moving between two party states, the 12 advanced practice registered nurse must apply for advanced 13 practice registered nurse licensure in the new home state, and 14 the multistate license issued by the prior home state shall be 15 deactivated in accordance with applicable commission rules. 16 (1) The advanced practice registered nurse may apply for 17 licensure in advance of a change in primary state of residence. 18 (2) A multistate advanced practice registered nurse license 19 shall not be issued by the new home state until the advanced 20 practice registered nurse provides satisfactory evidence of a 21 change in primary state of residence to the new home state and 22 satisfies all applicable requirements to obtain a multistate 23 advanced practice registered nurse license from the new home 24 state. 25 d. If an advanced practice registered nurse changes primary 26 state of residence by moving from a party state to a nonparty 27 state, the advanced practice registered nurse multistate 28 license issued by the prior home state will convert to a 29 single-state license, valid only in the former home state. 30 5. Article V —— Additional authorities invested in party 31 state licensing boards. 32 a. In addition to the other powers conferred by state law, 33 a licensing board shall have the authority to do all of the 34 following: 35 -9- LSB 1110DP (6) 87 tr/nh 9/ 27

S.F. _____ H.F. _____ (1) Take adverse action against an advanced practice 1 registered nurse’s multistate licensure privilege to practice 2 within that party state. 3 (a) Only the home state shall have power to take adverse 4 action against an advanced practice registered nurse’s license 5 issued by the home state. 6 (b) For purposes of taking adverse action, the home state 7 licensing board shall give the same priority and effect to 8 reported conduct that occurred outside of the home state as 9 it would if such conduct had occurred within the home state. 10 In so doing, the home state shall apply its own state laws to 11 determine appropriate action. 12 (2) Issue cease and desist orders or impose an encumbrance 13 on an advanced practice registered nurse’s authority to 14 practice within that party state. 15 (3) Complete any pending investigations of an advanced 16 practice registered nurse who changes primary state of 17 residence during the course of such investigations. The 18 licensing board shall also have the authority to take 19 appropriate action and shall promptly report the conclusions 20 of such investigations to the administrator of the coordinated 21 licensure information system. The administrator of the 22 coordinated licensure information system shall promptly notify 23 the new home state of any such actions. 24 (4) Issue subpoenas for both hearings and investigations 25 that require the attendance and testimony of witnesses, as 26 well as the production of evidence. Subpoenas issued by a 27 party state licensing board for the attendance and testimony 28 of witnesses or the production of evidence from another party 29 state shall be enforced in the latter state by any court of 30 competent jurisdiction, according to that court’s practice 31 and procedure in considering subpoenas issued in its own 32 proceedings. The issuing licensing board shall pay any witness 33 fees, travel expenses, mileage, and other fees required by 34 the service statutes of the state in which the witnesses or 35 -10- LSB 1110DP (6) 87 tr/nh 10/ 27

S.F. _____ H.F. _____ evidence are located. 1 (5) Obtain and submit, for an advanced practice 2 registered nurse licensure applicant, fingerprints or 3 other biometric-based information to the federal bureau of 4 investigation for criminal background checks, receive the 5 results of the federal bureau of investigation record search 6 on criminal background checks, and use the results in making 7 licensure decisions. 8 (6) If otherwise permitted by state law, recover from 9 the affected advanced practice registered nurse the costs of 10 investigations and disposition of cases resulting from any 11 adverse action taken against that advanced practice registered 12 nurse. 13 (7) Take adverse action based on the factual findings of 14 another party state, provided that the licensing board follows 15 its own procedures for taking such adverse action. 16 b. If adverse action is taken by a home state against an 17 advanced practice registered nurse’s multistate licensure, 18 the privilege to practice in all other party states under a 19 multistate licensure privilege shall be deactivated until all 20 encumbrances have been removed from the advanced practice 21 registered nurse’s multistate license. All home state 22 disciplinary orders that impose adverse action against an 23 advanced practice registered nurse’s multistate license shall 24 include a statement that the advanced practice registered 25 nurse’s multistate licensure privilege is deactivated in all 26 party states during the pendency of the order. 27 c. Nothing in this compact shall override a party state’s 28 decision that participation in an alternative program may be 29 used in lieu of adverse action. The home state licensing board 30 shall deactivate the multistate licensure privilege under the 31 multistate license of any advanced practice registered nurse 32 for the duration of the advanced practice registered nurse’s 33 participation in an alternative program. 34 6. Article VI —— Coordinated licensure information system and 35 -11- LSB 1110DP (6) 87 tr/nh 11/ 27

S.F. _____ H.F. _____ exchange of information. 1 a. All party states shall participate in a coordinated 2 licensure information system of all advanced practice 3 registered nurses, licensed registered nurses, and licensed 4 practical or vocational nurses. This system will include 5 information on the licensure and disciplinary history of each 6 advanced practice registered nurse, as submitted by party 7 states, to assist in the coordinated administration of advanced 8 practice registered nurse licensure and enforcement efforts. 9 b. The commission, in consultation with the administrator of 10 the coordinated licensure information system, shall formulate 11 necessary and proper procedures for the identification, 12 collection and exchange of information under this compact. 13 c. All licensing boards shall promptly report to the 14 coordinated licensure information system any adverse action, 15 any current significant investigative information, denials of 16 applications, with the reasons for such denials, and advanced 17 practice registered nurse participation in alternative programs 18 known to the licensing board regardless of whether such 19 participation is deemed nonpublic or confidential under state 20 law. 21 d. Current significant investigative information and 22 participation in nonpublic or confidential alternative 23 programs shall be transmitted through the coordinated licensure 24 information system only to party state licensing boards. 25 e. Notwithstanding any other provision of law, all 26 party state licensing boards contributing information to 27 the coordinated licensure information system may designate 28 information that may not be shared with nonparty states or 29 disclosed to other entities or individuals without the express 30 permission of the contributing state. 31 f. Any personally identifiable information obtained from 32 the coordinated licensure information system by a party state 33 licensing board shall not be shared with nonparty states or 34 disclosed to other entities or individuals except to the extent 35 -12- LSB 1110DP (6) 87 tr/nh 12/ 27

S.F. _____ H.F. _____ permitted by the laws of the party state contributing the 1 information. 2 g. Any information contributed to the coordinated licensure 3 information system that is subsequently required to be expunged 4 by the laws of the party state contributing the information 5 shall be removed from the coordinated licensure information 6 system. 7 h. The compact administrator of each party state shall 8 furnish a uniform data set to the compact administrator of each 9 other party state, which shall include but not be limited to 10 the following: 11 (1) Identifying information. 12 (2) Licensure data. 13 (3) Information related to alternative program 14 participation information. 15 (4) Other information that may facilitate the 16 administration of this compact, as determined by commission 17 rules. 18 i. The compact administrator of a party state shall provide 19 all investigative documents and information requested by 20 another party state. 21 7. Article VII —— Establishment of the interstate commission 22 of advanced practice registered nurse compact administrators. 23 a. The party states hereby create and establish a joint 24 public agency known as the interstate commission of advanced 25 practice registered nurse compact administrators. 26 (1) The commission is an instrumentality of the party 27 states. 28 (2) Venue is proper, and judicial proceedings by or against 29 the commission shall be brought solely and exclusively, in a 30 court of competent jurisdiction where the principal office of 31 the commission is located. The commission may waive venue and 32 jurisdictional defenses to the extent it adopts or consents to 33 participate in alternative dispute resolution proceedings. 34 (3) Nothing in this compact shall be construed to be a 35 -13- LSB 1110DP (6) 87 tr/nh 13/ 27

S.F. _____ H.F. _____ waiver of sovereign immunity. 1 b. Membership, voting, and meetings. 2 (1) Each party state shall have and be limited to one 3 administrator. The head of the state licensing board or 4 designee shall be the administrator of this compact for each 5 party state. Any administrator may be removed or suspended 6 from office as provided by the law of the state from which 7 the administrator is appointed. Any vacancy occurring in the 8 commission shall be filled in accordance with the laws of the 9 party state in which the vacancy exists. 10 (2) Each administrator shall be entitled to one vote with 11 regard to the promulgation of rules and creation of bylaws 12 and shall otherwise have an opportunity to participate in the 13 business and affairs of the commission. An administrator 14 shall vote in person or by such other means as provided in 15 the bylaws. The bylaws may provide for an administrator’s 16 participation in meetings by telephone or other means of 17 communication. 18 (3) The commission shall meet at least once during each 19 calendar year. Additional meetings shall be held as set forth 20 in the bylaws or rules of the commission. 21 (4) All meetings shall be open to the public, and public 22 notice of meetings shall be given in the same manner as 23 required under the rulemaking provisions in article VIII. 24 (5) The commission may convene in a closed, nonpublic 25 meeting if the commission must discuss any of the following: 26 (a) Noncompliance of a party state with its obligations 27 under this compact. 28 (b) The employment, compensation, discipline or, other 29 personnel matters, practices, or procedures related to specific 30 employees or other matters related to the commission’s internal 31 personnel practices and procedures. 32 (c) Current, threatened, or reasonably anticipated 33 litigation. 34 (d) Negotiation of contracts for the purchase or sale of 35 -14- LSB 1110DP (6) 87 tr/nh 14/ 27

S.F. _____ H.F. _____ goods, services, or real estate. 1 (e) Accusing any person of a crime or formally censuring any 2 person. 3 (f) Disclosure of trade secrets or commercial or financial 4 information that is privileged or confidential. 5 (g) Disclosure of information of a personal nature where 6 disclosure would constitute a clearly unwarranted invasion of 7 personal privacy. 8 (h) Disclosure of investigatory records compiled for law 9 enforcement purposes. 10 (i) Disclosure of information related to any reports 11 prepared by or on behalf of the commission for the purpose of 12 investigation of compliance with this compact. 13 (j) Matters specifically exempted from disclosure by 14 federal or state statute. 15 (6) If a meeting, or portion of a meeting, is closed 16 pursuant to this provision, the commission’s legal counsel or 17 designee shall certify that the meeting may be closed and shall 18 reference each relevant exempting provision. The commission 19 shall keep minutes that fully and clearly describe all matters 20 discussed in a meeting and shall provide a full and accurate 21 summary of actions taken, and the reasons therefor, including a 22 description of the views expressed. All documents considered 23 in connection with an action shall be identified in such 24 minutes. All minutes and documents of a closed meeting shall 25 remain under seal, subject to release by a majority vote of the 26 commission or order of a court of competent jurisdiction. 27 c. The commission shall, by a majority vote of the 28 administrators, prescribe bylaws or rules to govern its conduct 29 as may be necessary or appropriate to carry out the purposes 30 and exercise the powers of this compact, including but not 31 limited to all of the following: 32 (1) Establishing the fiscal year of the commission. 33 (2) Providing reasonable standards and procedures for both 34 of the following: 35 -15- LSB 1110DP (6) 87 tr/nh 15/ 27

S.F. _____ H.F. _____ (a) The establishment and meetings of other committees. 1 (b) Governing any general or specific delegation of any 2 authority or function of the commission. 3 (3) Providing reasonable procedures for calling and 4 conducting meetings of the commission, ensuring reasonable 5 advance notice of all meetings, and providing an opportunity 6 for attendance of such meetings by interested parties, 7 with enumerated exceptions designed to protect the public’s 8 interest, the privacy of individuals, and proprietary 9 information, including trade secrets. The commission may meet 10 in closed session only after a majority of the administrators 11 vote to close a meeting in whole or in part. As soon as 12 practicable, the commission must make public a copy of the vote 13 to close the meeting revealing the vote of each administrator, 14 with no proxy votes allowed. 15 (4) Establishing the titles, duties, and authority and 16 reasonable procedures for the election of the officers of the 17 commission. 18 (5) Providing reasonable standards and procedures for the 19 establishment of the personnel policies and programs of the 20 commission. Notwithstanding any civil service or other similar 21 laws of any party state, the bylaws shall exclusively govern 22 the personnel policies and programs of the commission. 23 (6) Providing a mechanism for winding up the operations 24 of the commission and the equitable disposition of any 25 surplus funds that may exist after the termination of this 26 compact after the payment or reserving of all of its debts and 27 obligations. 28 d. The commission shall publish its bylaws and rules, and 29 any amendments thereto, in a convenient form on the internet 30 site of the commission. 31 e. The commission shall maintain its financial records in 32 accordance with the bylaws. 33 f. The commission shall meet and take such actions as are 34 consistent with the provisions of this compact and the bylaws. 35 -16- LSB 1110DP (6) 87 tr/nh 16/ 27

S.F. _____ H.F. _____ g. The commission shall have the following powers: 1 (1) To promulgate uniform rules to facilitate and 2 coordinate implementation and administration of this compact. 3 The rules shall have the force and effect of law and shall be 4 binding in all party states. 5 (2) To bring and prosecute legal proceedings or actions in 6 the name of the commission, provided that the standing of any 7 licensing board to sue or be sued under applicable law shall 8 not be affected. 9 (3) To purchase and maintain insurance and bonds. 10 (4) To borrow, accept, or contract for services of 11 personnel, including but not limited to employees of a party 12 state or nonprofit organizations. 13 (5) To cooperate with other organizations that administer 14 state compacts related to the regulation of nursing, including 15 but not limited to sharing administrative or staff expenses, 16 office space, or other resources. 17 (6) To hire employees, elect or appoint officers, fix 18 compensation, define duties, grant such individuals appropriate 19 authority to carry out the purposes of this compact, and to 20 establish the commission’s personnel policies and programs 21 relating to conflicts of interest, qualifications of personnel, 22 and other related personnel matters. 23 (7) To accept any and all appropriate donations, grants, and 24 gifts of money, equipment, supplies, materials, and services, 25 and to receive, utilize, and dispose of the same; provided 26 that at all times the commission shall strive to avoid any 27 appearance of impropriety or conflict of interest. 28 (8) To lease, purchase, accept appropriate gifts or 29 donations of, or otherwise to own, hold, improve, or use, any 30 property, whether real, personal, or mixed; provided that at 31 all times the commission shall strive to avoid any appearance 32 of impropriety. 33 (9) To sell, convey, mortgage, pledge, lease, exchange, 34 abandon, or otherwise dispose of any property, whether real, 35 -17- LSB 1110DP (6) 87 tr/nh 17/ 27

S.F. _____ H.F. _____ personal, or mixed. 1 (10) To establish a budget and make expenditures. 2 (11) To borrow money. 3 (12) To appoint committees, including advisory committees 4 comprised of administrators, state nursing regulators, 5 state legislators or their representatives, and consumer 6 representatives, and other such interested persons. 7 (13) To provide and receive information from, and to 8 cooperate with, law enforcement agencies. 9 (14) To adopt and use an official seal. 10 (15) To perform such other functions as may be necessary or 11 appropriate to achieve the purposes of this compact consistent 12 with the state regulation of advanced practice registered nurse 13 licensure and practice. 14 h. Financing of the commission. 15 (1) The commission shall pay, or provide for the payment of, 16 the reasonable expenses of its establishment, organization, and 17 ongoing activities. 18 (2) The commission may levy on and collect an annual 19 assessment from each party state to cover the cost of the 20 operations and activities of the interstate commission and its 21 staff which must be in a total amount sufficient to cover its 22 annual budget as approved each year. The aggregate annual 23 assessment amount shall be allocated based upon a formula to 24 be determined by the commission, which shall promulgate a rule 25 that is binding upon all party states. 26 (3) The commission shall not incur obligations of any kind 27 prior to securing the funds adequate to meet the same; nor 28 shall the commission pledge the credit of any of the party 29 states, except by, and with the authority of, such party state. 30 (4) The commission shall keep accurate accounts of all 31 receipts and disbursements. The receipts and disbursements of 32 the commission shall be subject to the audit and accounting 33 procedures established under its bylaws. However, all receipts 34 and disbursements of funds handled by the commission shall be 35 -18- LSB 1110DP (6) 87 tr/nh 18/ 27

S.F. _____ H.F. _____ audited yearly by a certified or licensed public accountant, 1 and the report of the audit shall be included in and become 2 part of the annual report of the commission. 3 i. Qualified immunity, defense, and indemnification. 4 (1) The administrators, officers, executive director, 5 employees, and representatives of the commission shall be 6 immune from suit and liability, either personally or in their 7 official capacity, for any claim for damage to or loss of 8 property or personal injury or other civil liability caused by 9 or arising out of any actual or alleged act, error, or omission 10 that occurred, or that the person against whom the claim is 11 made had a reasonable basis for believing occurred, within the 12 scope of commission employment, duties, or responsibilities; 13 provided that nothing in this paragraph “i” shall be construed 14 to protect any such person from suit or liability for any 15 damage, loss, injury, or liability caused by the intentional, 16 willful, or wanton misconduct of that person. 17 (2) The commission shall defend any administrator, 18 officer, executive director, employee, or representative of 19 the commission in any civil action seeking to impose liability 20 arising out of any actual or alleged act, error, or omission 21 that occurred within the scope of commission employment, 22 duties, or responsibilities, or that the person against 23 whom the claim is made had a reasonable basis for believing 24 occurred within the scope of commission employment, duties, 25 or responsibilities; provided that nothing herein shall be 26 construed to prohibit that person from retaining the person’s 27 own counsel; and provided further that the actual or alleged 28 act, error, or omission did not result from that person’s 29 intentional, willful, or wanton misconduct. 30 (3) The commission shall indemnify and hold harmless 31 any administrator, officer, executive director, employee, 32 or representative of the commission for the amount of any 33 settlement or judgment obtained against that person arising 34 out of any actual or alleged act, error, or omission that 35 -19- LSB 1110DP (6) 87 tr/nh 19/ 27

S.F. _____ H.F. _____ occurred within the scope of commission employment, duties, 1 or responsibilities, or that such person had a reasonable 2 basis for believing occurred within the scope of commission 3 employment, duties, or responsibilities, provided that the 4 actual or alleged act, error, or omission did not result from 5 the intentional, willful, or wanton misconduct of that person. 6 8. Article VIII —— Rulemaking. 7 a. The commission shall exercise its rulemaking powers 8 pursuant to the criteria set forth in this article and the 9 rules adopted thereunder. Rules and amendments shall become 10 binding as of the date specified in each rule or amendment and 11 shall have the same force and effect as provisions of this 12 compact. 13 b. Rules or amendments to the rules shall be adopted at a 14 regular or special meeting of the commission. 15 c. Prior to promulgation and adoption of a final rule or 16 rules by the commission, and at least sixty days in advance 17 of the meeting at which the rule will be considered and voted 18 upon, the commission shall file a notice of proposed rulemaking 19 on the internet site of the commission and on the internet site 20 of each licensing board or the publication in which each state 21 would otherwise publish proposed rules. 22 d. The notice of proposed rulemaking shall include all of 23 the following: 24 (1) The proposed time, date, and location of the meeting in 25 which the rule will be considered and voted upon. 26 (2) The text of the proposed rule or amendment, and the 27 reason for the proposed rule. 28 (3) A request for comments on the proposed rule from any 29 interested person. 30 (4) The manner in which interested persons may submit notice 31 to the commission of their intention to attend the public 32 hearing and any written comments. 33 e. Prior to adoption of a proposed rule, the commission 34 shall allow persons to submit written data, facts, opinions, 35 -20- LSB 1110DP (6) 87 tr/nh 20/ 27