1. 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

3. THE ROAD TO AN INTERSTATE COMPACT JAN 2013 - SMBs workshop on license portability APR 2013 - FSMB HOD OK’s resolution to study feasibility JUN 2013 - Compact planning meeting SEP 2013 - Compact taskforce meeting NOV 2013 - Compact drafting team meeting DEC 2013 - Draft compact released to state boards, stakeholders JAN-MAR 2014 - Engagement with stakeholders MAR 2014 - Compact drafting team revisions APR 2014 - Revised draft compact distributed for comment MAY-JUL 2014 - Revision of draft compact AUG 2014 - Revised draft compact distributed for comment SEP 2014 - Final Draft Released

4. Gettysburg Address - 272 Declaration of Independence - 1,137 U.S. Constitution - 4,400 Magna Carta - 4,479 IMLC - 6,023

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. OVERVIEW: APPLICATION & LICENSURE (SECTION 5)

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

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