INTERSTATE MEDICAL LICENSURE COMPACT In order to strengthen access to health care and in recognition of the advances in the delivery of health care.... MARK BOWDEN, MPA, CMBE IOWA COMMISSIONER INTERSTATE MEDICAL LICENSURE COMPACT OCTOBER 27, 2015, CHICAGO, ILLINOIS

THE ROAD TO AN INTERSTATE COMPACT JAN SMBs workshop on license portability APR FSMB HOD OK’s resolution to study feasibility JUN Compact planning meeting SEP Compact taskforce meeting NOV Compact drafting team meeting DEC Draft compact released to state boards, stakeholders JAN-MAR Engagement with stakeholders MAR Compact drafting team revisions APR Revised draft compact distributed for comment MAY-JUL Revision of draft compact AUG Revised draft compact distributed for comment SEP Final Draft Released

Gettysburg Address Declaration of Independence - 1,137 U.S. Constitution - 4,400 Magna Carta - 4,479 IMLC - 6,023

OVERVIEW: 24 SECTIONS 1. Purpose 2. Definitions 3. Eligibility 4. Designation of state of principal license 5. Application, issuance of expedited licensure 6. Fees for expedited licensure 7. Renewal, continued participation 8. Coordinated information system

OVERVIEW: 24 SECTIONS 9. Joint investigations 10. Disciplinary actions 11. Compact commission 12. Powers, duties of commission 13. Financial powers of commission 14. Organization, operation of commission 15. Rulemaking functions of commission 16. Oversight of compact

OVERVIEW: 24 SECTIONS 17. Enforcement of compact 18. Default procedures 19. Dispute resolution 20. Member states, effective date, and amendment 21. Withdrawal 22. Dissolution 23. Severability, construction 24. Binding effect of compact and other laws

OVERVIEW: PURPOSE (SECTION 1)  Ensures patient safety  Practice of medicine is where the patient is located  Complements states’ existing licensing and regulatory authority  Creates a streamlined process for multiple state licensure  Establishes an another pathway for licensure and does not change a state’s existing medical practice act

OVERVIEW: DEFINITIONS (SECTION 2)  Bylaws, rules  Member state, member board  State of principal licensure  Physician (eligibility requirements)  Practice of medicine  Offense, conviction  License, expedited license  Commissioner, commission

OVERVIEW: PHYSICIAN ELIGIBILITY (SECTION 3)  “Definitions” - Section 2(k) 1-9: - medical school - examination - graduate medical education - Board certification - unrestricted license - No felonies, no disciplinary actions - No active investigations  Recognizes that physician can seek state licensure through a state’s traditional licensure process

OVERVIEW: PRINCIPAL STATE (SECTION 4)  Primary residence, or  At least 25 percent of practice occurs, or  Location of physician’s employer, or  State designated for federal taxes  Commission can write a rule to allow redesignation of the state of principal licensure

OVERVIEW: APPLICATION & LICENSURE (SECTION 5)

OVERVIEW: FEES (SECTION 6)  A member state issuing an expedited license may impose a fee for a license issued or renewed through the compact  The commission can write rules regarding fees for expedited licenses

OVERVIEW: RENEWAL (SECTION 7)  Renewal of expedited license is through the commission  Must comply with each state’s CME requirement  Commission will collect and distribute renewal fees  All member boards will be kept abreast of renewals  Commission can write renewal rules

OVERVIEW: DATABASE & INVESTIGATIONS (SECTIONS 8-9)  Commission will develop a licensure database  Member boards must report public actions or complaints against physicians licensed through compact process  Joint investigations permitted  Subpoenas enforceable in member states  Commission can write rules

OVERVIEW: DISCIPLINARY ACTIONS (SECTION 10)  Takes into consideration whether action against physician licensed through compact is taken by any member board or physician’s principal state board  Gives deference to a state’s medical practice act regarding sanctions

OVERVIEW: COMMISSION (SECTIONS 11-15)  Administers the compact  How it’s organized and operates  Writes bylaws, rules, policies  Interprets compact, bylaws, rules, actions  Enforces compliance  Officers, committees, staff  Public accountability, public reports  Avoids conflicts of interest  Subject to yearly financial audit

OVERVIEW: RULEMAKING (SECTION 15)  Rules to effectively and efficiently achieve the purposes of the compact  Rules for the operations of the commission  Rule-making is authorized in 12 sections.  These specific rules are mandated: - reporting discipline, investigative info - annual assessments - licenses impacted when member state is terminated or withdraws - mediation, binding dispute resolution

OVERVIEW: OVERSIGHT (SECTION 16)  Executive, legislative, judicial branches of state government in each member state shall enforce the compact and shall take all actions necessary and appropriate to effectuate the compact’s purposes and intent

OVERVIEW: ENFORCEMENT, DEFAULT (SECTIONS 17-18)  Commission may initiate action in U.S. district court to enforce compliance against a member state in default  Grounds for default include but not limited to failure of member state to perform obligations or responsibilities imposed upon it by the compact, bylaws, rules  Defaulting state can be terminated

OVERVIEW: DISPUTE RESOLUTION (SECTION 19)  Commission shall attempt, upon the request of a member state, to resolve disputes which are subject to the compact and which may arise among member states or member boards

OVERVIEW: EFFECTIVE DATE, AMENDMENT (SECTION 20)  Compact becomes effective on a state upon enactment of the compact into law by that state  Non-member states shall be invited to participate on non-voting basis  Compact amendments must be unanimously approved by member states

OVERVIEW: WITHDRAWAL, DISSOLUTION (SECTIONS 21-22)  State’s withdrawal from the compact shall be by enactment of a statute repealing the compact, but shall not take effect until 1 year after the effective date of the repeal statute  Compact shall dissolve effective upon the date of the withdrawal or default of a member state which reduces membership of the compact to 1 member

OVERVIEW: SEVERABILITY & CONSTRUCTION (SECTION 23)  If any phrase, clause, sentence, or provision is deemed unenforceable, the remaining provisions shall be enforceable  Provisions shall be liberally construed to effectuate its purposes

OVERVIEW: BINDING EFFECT OF COMPACT (SECTION 24)  All laws in a member state in conflict with the compact are superseded to the extent of the conflict  All lawful actions of the commission, including all rules and bylaws, are binding upon the member states  All agreements between the commission and the member states are binding in accordance with their terms

MARK BOWDEN, MPA, CMBE IOWA COMMISSIONER INTERSTATE MEDICAL LICENSURE COMPACT