1. An Overview of The Interstate Medical Licensure Compact
Patrick F. Balestrieri
Senior Board Attorney | North Carolina Medical Board
North Carolina Association Medical Staff Services | Chapel Hill, North Carolina
November 4, 2016

2. What is an Interstate Compact?
Contract between two or more states on a particular issue
Open to states, commonwealths, districts and territories
Creates a new pathway to expedite the licensing of physicians seeking to practice medicine in multiple states

3. What is an Interstate Compact?
Drafted by state medical board representatives, FSMB and Council of State Governments
Goal is to facilitate multi-state practice without compromising quality
“Take it or leave it” law for the most part
Can be changed to comport with local statutory style or terminology

4. Why an Interstate Compact?
Licensure Portability
Rise in telemedicine and new technology
Increase in multistate practice
916,264 licensed in US (2014 census)
15.5% licensed in 2 states (142,020)
6% licensed in 3 or more states (54,975)

5. What is The NC Medical Board Doing?
Monitoring and evaluating
The North Carolina Medical Board considered joining the Interstate Compact in November 2014 and decided not to join, but to monitor
and consider joining at a
future date.

6. The Eight Compact Principles
The Compact has eight consensus principles:
Participation voluntary for physicians and medical boards
Participation creates another pathway for licensure and does not change a state’s existing medical practice act
Treatment occurs where the patient is located at the time of treatment and the physician will be under the jurisdiction of the state board where the patient is located
Mechanism will be created for improved sharing of information among member boards

7. The Eight Compact Principles
Regulatory authority remains with the participating state boards and will not be delegated
A physician practicing under the Compact is bound to comply with the statutes, rules and regulations of each Compact state where they choose to practice
Boards are required to share certain complaint and investigative information with each other
The license to practice medicine can be disciplined by any or all of the Compact states

8. What The Compact DOES NOT Do
Doesn’t change a state’s Medical Practice Act
Doesn’t require Maintenance of Certification
Doesn’t supersede state regulatory control or authority over practice of medicine
Doesn’t create a national licensure system
Doesn’t allow physicians to circumvent state specific rules, regulations and requirements for renewal

9. Let’s Have Some Fun And Get Deep Into The Details Of The Most Important Parts Of The Interstate Compact Model Legislation!

10. Sec. 2. Definitions
“Physician” specifies the criteria for who is eligible for licensure via the Compact and means any person who:
Is a graduate of a medical school accredited by the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation or a medical school listed in the International Medical Education Directory or its equivalent
Passed each component of USMLE or COMLEX-USA within 3 attempts
Successfully completed GME approved by Accreditation Council for Graduate Medical Education or the American Osteopathic Association

11. Sec. 2. Definitions
Holds specialty certification or a time-unlimited specialty certificate recognized by ABMS or AOA
Possess full and unrestricted license to engage in the practice of medicine issued by a member board
Never been convicted of any “offense” by a court of appropriate jurisdiction
No discipline on any state medical license (excluding any action related to non-payment of license fees)
Never had a controlled substance license or permit suspended or revoked
Not under investigation by a licensing agency or law enforcement authority anywhere in world

12. Just A Few More Definitions
“Offense” = felony, gross misdemeanor or crime of moral turpitude
"State" means any state, commonwealth, district or territory of the United States
"State of Principal License" means a member state where physician holds a license to practice medicine and which has been designated as such by the physician for purposes of the Compact

13. Sec. 4. State of Principal License
Physician must designate a state of principal license which can be:
State of primary residence, or
State where at least 25% of the practice of medicine occurs, or
Location of the physician's employer, or
If 1, 2 and 3 are not met, then the state of residence for federal income tax purposes

14. Sec. 5. Application
Physician shall file application for expedited license/request verification with state of principal license, who shall evaluate eligibility and issue letter of qualification verifying or denying eligibility
Static qualifications (i.e. verification of medical education, graduate medical education, results of any medical or licensing examination, etc.) will not require additional primary source verification if done by the state of principal license
Criminal background check will be done

15. Sec. 5. Application
Once verified as eligible, physician shall complete a registration process established by the Commission to receive a license in the state of principal licensure
A medical license will then be issued (or verification of Compact eligibility will be sent to the Commission if already licensed in the state of principal licensure) that shall authorize the physician to practice medicine in the issuing state  
Other compact states = verify eligibility, pay fee, get license

16. Sec. 5. Application
Compact license valid for a period consistent with the licensure period in the member state and in the same manner as required for other physicians holding a full and unrestricted license within the member state
Compact license terminated if physician fails to maintain a license in the state of principal licensure for a non-disciplinary reason, without re-designation of a new state of principal licensure
Not exactly sure how this will work yet – no rules yet

17. Sec. 7. Renewal A physician may renew all licenses with Commission if:
Maintains full and unrestricted license in state of principal license
Has not been convicted of any offense
Has not had medical license disciplined anywhere in the world (excluding any action related to non-payment of license fees)
Has not had controlled substance license/permit suspended or revoked

18. A Little More About Renewal
Physicians must comply with all CME requirements for renewal of a license issued by a member state
Commission shall collect renewal fees and distribute them to the applicable member board, at which time the member board shall renew the medical license
Physician information collected by the Commission during the renewal process will be distributed to all member boards

19. Sec. 8. Coordinating Information
Commission shall establish database of all physicians licensed and who have applied for Compact license
Member boards shall report all public action and complaints against a Compact physician
Member boards shall report disciplinary and investigatory information as determined by rule
Member boards shall share some, but not all, complaint and disciplinary information upon request of another member board (mandatory and discretionary as provided by rule)

20. Sec. 9. Joint Investigations
A member board may participate with other member boards in joint investigations of Compact physicians
A subpoena issued by a member state shall be enforceable in other member states

21. Sec. 10. Disciplinary Actions
In general, any disciplinary action taken by any member board against a Compact physician shall be deemed unprofessional conduct which may be subject to discipline by other member boards, in addition to any separate violation of the medical practice act or regulations in that state

22. Sec. 10. Disciplinary Actions
If a license in state of principal licensure is revoked, suspended, surrendered or relinquished in lieu of discipline, then all licenses issued to the physician by member boards shall automatically be placed, without further action necessary by any member board, on the same status
If state of principal licensure reinstates license, a licensed issued by any other member board shall remain encumbered until that respective member board reinstates  

23. Sec. 10. Disciplinary Actions
If a non-principal state of licensure license is revoked, suspended, surrendered or relinquished in lieu of discipline, then all license(s) issued by all other member board(s) shall be suspended, automatically and immediately without further action necessary by the other member board(s), for 90 days upon entry of the order by the disciplining board
Member boards may terminate automatic license suspension prior to completion of 90 day period

24. Sec. 10. Disciplinary Actions
If other disciplinary action is taken against a physician by any member board, any other member board may deem the action conclusive as a matter of law and fact decided and
impose the same or lesser sanction(s), or
pursue separate disciplinary action under its medical practice act, regardless of the action taken in other member states

25. Sec. 10. Disciplinary Actions
You are subject to disciplinary action with respect to all states you are licensed in that are member states
Example: Already licensed in CO and NV (Compact states) before Compact existed
You pick CO as principal licensure state
You use CO to get licensed through Compact in WY
You keep/renew NV as you have always done
You get revoked in CO – now this happens:
Automatic revocation in NV and WY

26. Sec. 11. The Commission
Member states have created a Commission to conduct the administration of the Compact
Each member state gets two commissioners who can be board members or staff executives
Meet at least once a year - minutes made available to the public except for closed matters

27. Sec. 12. The Commission’s Powers
Oversee and maintain Compact administration
Make rules and adopt bylaws (happening now)
Issue advisory opinions
Enforce compliance with Compact
Establish and appoint committees
Pay expenses related to ongoing activities
Establish offices and hire staff (executive director)
Report annually to legislatures and governors
Perform necessary functions of Compact

28. Who Pays For All This? SECTION 13. FINANCE POWERS
Commission will collect an annual assessment from each member state to cover the cost of the operations and activities of the Commission and its staff
Annual assessment shall be allocated based on a formula to be determined by the Commission, which will eventually be a rule
Commission is subject to a yearly financial audit and audit report included in annual Commission report

29. So Where Are We Now?
Commission holding meetings and engaging in rulemaking (last meeting was 10/3/2016)
Committees established include Executive, Budget, Funding, Technology, Personnel, Bylaws, Communications and Coordinating
First license probably issued in early to mid 2017

30. 17 States are in – 2 more possible

31. Compact Helpful Resources
General Information:
Latest Compact News:
Model Compact Legislation (i.e. the actual compact):

32. Thank You For Your Time – Questions?
Contact Information:
Patrick F. Balestrieri
(919) , ext.225
North Carolina Medical Board
1203 Front Street
Raleigh, NC
(800)

33. ABC
-ABC