Bill Text: TX HB4404 | 2023-2024 | 88th Legislature | Introduced

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Bill Title: Relating to the Advanced Practice Registered Nurse Compact.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2023-04-17 - Left pending in committee [HB4404 Detail]

Download: Texas-2023-HB4404-Introduced.html

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88R12979 BEE-D
By: Guillen H.B. No. 4404

A BILL TO BE ENTITLED
AN ACT
relating to the Advanced Practice Registered Nurse Compact.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 3, Occupations Code, is
amended by adding Chapter 305 to read as follows:
CHAPTER 305. ADVANCED PRACTICE REGISTERED NURSE COMPACT
Sec. 305.001. ADVANCED PRACTICE REGISTERED NURSE COMPACT.
The Advanced Practice Registered Nurse Compact is enacted and
entered into with all other jurisdictions that legally join in the
compact, which reads as follows:
Advanced Practice Registered Nurse Compact
ARTICLE I
Findings and Declaration of Purpose
a. The party states find that:
1. The health and safety of the public are affected by
the degree of compliance with APRN licensure requirements and the
effectiveness of enforcement activities related to state APRN
licensure laws;
2. Violations of APRN licensure and other laws
regulating the practice of nursing may result in injury or harm to
the public;
3. The expanded mobility of APRNs and the use of
advanced communication and intervention technologies as part of our
nation's health care delivery system require greater coordination
and cooperation among states in the areas of APRN licensure and
regulation;
4. New practice modalities and technology make
compliance with individual state APRN licensure laws difficult and
complex;
5. The current system of duplicative APRN licensure
for APRNs practicing in multiple states is cumbersome and redundant
for healthcare delivery systems, payors, state licensing boards,
regulators and APRNs;
6. Uniformity of APRN licensure requirements
throughout the states promotes public safety and public health
benefits as well as providing a mechanism to increase access to
care.
b. The general purposes of this Compact are to:
1. Facilitate the states' responsibility to protect
the public's health and safety;
2. Ensure and encourage the cooperation of party
states in the areas of APRN licensure and regulation, including
promotion of uniform licensure requirements;
3. Facilitate the exchange of information between
party states in the areas of APRN regulation, investigation and
adverse actions;
4. Promote compliance with the laws governing APRN
practice in each jurisdiction;
5. Invest all party states with the authority to hold
an APRN accountable for meeting all state practice laws in the state
in which the patient is located at the time care is rendered through
the mutual recognition of party state privileges to practice;
6. Decrease redundancies in the consideration and
issuance of APRN licenses; and
7. Provide opportunities for interstate practice by
APRNs who meet uniform licensure requirements.
ARTICLE II
Definitions
As used in this Compact:
a. "Advanced practice registered nurse" or "APRN" means a
registered nurse who has gained additional specialized knowledge,
skills and experience through a program of study recognized or
defined by the Interstate Commission of APRN Compact Administrators
("Commission"), and who is licensed to perform advanced nursing
practice. An advanced practice registered nurse is licensed in an
APRN role that is congruent with an APRN educational program,
certification, and Commission rules.
b. "Adverse action" means any administrative, civil,
equitable or criminal action permitted by a state's laws which is
imposed by a licensing board or other authority against an APRN,
including actions against an individual's license or multistate
licensure privilege such as revocation, suspension, probation,
monitoring of the licensee, limitation on the licensee's practice,
or any other encumbrance on licensure affecting an APRN's
authorization to practice, including the issuance of a cease and
desist action.
c. "Alternative program" means a, non-disciplinary
monitoring program approved by a licensing board.
d. "APRN licensure" means the regulatory mechanism used by a
party state to grant legal authority to practice as an APRN.
e. "APRN uniform licensure requirements" means the minimum
uniform licensure, education and examination requirements set
forth in Article III.b of this Compact.
f. "Coordinated licensure information system" means an
integrated process for collecting, storing and sharing information
on APRN licensure and enforcement activities related to APRN
licensure laws that is administered by a nonprofit organization
composed of and controlled by licensing boards.
g. "Current significant investigatory information" means:
1. Investigative information that a licensing board,
after a preliminary inquiry that includes notification and an
opportunity for the APRN to respond, if required by state law, has
reason to believe is not groundless and, if proved true, would
indicate more than a minor infraction; or
2. Investigative information that indicates that the
APRN represents an immediate threat to public health and safety
regardless of whether the APRN has been notified and had an
opportunity to respond.
h. "Encumbrance" means a revocation or suspension of, or any
limitation on, the full and unrestricted practice of nursing
imposed by a licensing board in connection with a disciplinary
proceeding.
i. "Home state" means the party state that is the APRN's
primary state of residence.
j. "Licensing board" means a party state's regulatory body
responsible for regulating the practice of advanced practice
registered nursing.
k. "Multistate license" means an APRN license to practice as
an APRN issued by a home state licensing board that authorizes the
APRN to practice as an APRN in all party states under a multistate
licensure privilege, in the same role and population focus as the
APRN is licensed in the home state.
l. "Multistate licensure privilege" means a legal
authorization associated with an APRN multistate license that
permits an APRN to practice as an APRN in a remote state, in the same
role and population focus as the APRN is licensed in the home state.
m. "Non-controlled prescription drug" means a device or drug that
is not a controlled substance and is prohibited under state or
federal law from being dispensed without a prescription. The term
includes a device or drug that bears or is required to bear the
legend "Caution: federal law prohibits dispensing without
prescription" or "prescription only" or other legend that complies
with federal law.
n. "Party state" means any state that has adopted this
Compact.
o. "Population focus" means one of the six population foci
of family/individual across the lifespan, adult-gerontology,
pediatrics, neonatal, women's health/gender-related and
psych/mental health.
p. "Prescriptive authority" means the legal authority to
prescribe medications and devices as defined by party state laws.
q. "Remote state" means a party state that is not the home
state.
r. "Role" means one of the four recognized roles of
certified registered nurse anesthetists (CRNA), certified
nurse-midwives (CNM), clinical nurse specialists (CNS) and
certified nurse practitioners (CNP).
s. "Single-state license" means an APRN license issued by a
party state that authorizes practice only within the issuing state
and does not include a multistate licensure privilege to practice
in any other party state.
t. "State" means a state, territory or possession of the
United States and the District of Columbia.
u. "State practice laws" means a party state's laws, rules,
and regulations that govern APRN practice, define the scope of
advanced nursing practice and create the methods and grounds for
imposing discipline except that prescriptive authority shall be
treated in accordance with Article III.f and g of this Compact.
"State practice laws" does not include:
1. A party state's laws, rules, and regulations
requiring supervision or collaboration with a healthcare
professional, except for laws, rules, and regulations regarding
prescribing controlled substances;
2. the requirements necessary to obtain and retain an
APRN license, except for qualifications or requirements of the home
state.
ARTICLE III
General Provisions and Jurisdiction
a. A state must implement procedures for considering the
criminal history records of applicants for initial APRN licensure
or APRN licensure by endorsement. Such procedures shall include
the submission of fingerprints or other biometric-based
information by APRN applicants for the purpose of obtaining an
applicant's criminal history record information from the Federal
Bureau of Investigation and the agency responsible for retaining
that state's criminal records.
b. Each party state shall require an applicant to satisfy
the following APRN uniform licensure requirements to obtain or
retain a multistate license in the home state:
1. Meets the home state's qualifications for licensure
or renewal of licensure, as well as, all other applicable state
laws;
2. i. Has completed an accredited graduate-level
education program that prepares the applicant for one of the four
recognized roles and population foci; or
ii. Has completed a foreign APRN education
program for one of the four recognized roles and population foci
that (a) has been approved by the authorized accrediting body in the
applicable country and (b) has been verified by an independent
credentials review agency to be comparable to a licensing
board-approved APRN education program;
3. Has, if a graduate of a foreign APRN education
program not taught in English or if English is not the individual's
native language, successfully passed an English proficiency
examination that includes the components of reading, speaking,
writing and listening;
4. Has successfully passed a national certification
examination that measures APRN, role and population-focused
competencies and maintains continued competence as evidenced by
recertification in the role and population focus through the
national certification program;
5. Holds an active, unencumbered license as a
registered nurse and an active, unencumbered authorization to
practice as an APRN;
6. Has successfully passed an NCLEX-RN® examination
or recognized predecessor, as applicable;
7. Has practiced for at least 2,080 hours as an APRN in
a role and population focus congruent with the applicant's
education and training. For purposes of this section, practice
shall not include hours obtained as part of enrollment in an APRN
education program;
8. Has submitted, in connection with an application
for initial licensure or licensure by endorsement, fingerprints or
other biometric data for the purpose of obtaining criminal history
record information from the Federal Bureau of Investigation and the
agency responsible for retaining that state or, if applicable,
foreign country's criminal records;
9. Has not been convicted or found guilty, or has
entered into an agreed disposition, of a felony offense under
applicable state, federal or foreign criminal law.
10. Has not been convicted or found guilty, or has
entered into an agreed disposition, of a misdemeanor offense
related to the practice of nursing as determined by factors set
forth in rules adopted by the Commission;
11. Is not currently enrolled in an alternative
program;
12. Is subject to self-disclosure requirements
regarding current participation in an alternative program; and
13. Has a valid United States Social Security number.
c. An APRN issued a multistate license shall be licensed in
an approved role and at least one approved population focus.
d. An APRN multistate license issued by a home state to a
resident in that state will be recognized by each party state as
authorizing the APRN to practice as an APRN in each party state,
under a multistate licensure privilege, in the same role and
population focus as the APRN is licensed in the home state.
e. Nothing in this Compact shall affect the requirements
established by a party state for the issuance of a single-state
license, except that an individual may apply for a single-state
license, instead of a multistate license, even if otherwise
qualified for the multistate license. However, the failure of such
an individual to affirmatively opt for a single state license may
result in the issuance of a multistate license.
f. Issuance of an APRN multistate license shall include
prescriptive authority for noncontrolled prescription drugs.
g. For each state in which an APRN seeks authority to
prescribe controlled substances, the APRN shall satisfy all
requirements imposed by such state in granting and/or renewing such
authority.
h. An APRN issued a multistate license is authorized to
assume responsibility and accountability for patient care
independent of any supervisory or collaborative relationship. This
authority may be exercised in the home state and in any remote state
in which the APRN exercises a multistate licensure privilege.
i. All party states shall be authorized, in accordance with
state due process laws, to take adverse action against an APRN's
multistate licensure privilege such as revocation, suspension,
probation or any other action that affects an APRN's authorization
to practice under a multistate licensure privilege, including cease
and desist actions. If a party state takes such action, it shall
promptly notify the administrator of the coordinated licensure
information system. The administrator of the coordinated licensure
information system shall promptly notify the home state of any such
actions by remote states.
j. Except as otherwise expressly provided in this Compact,
an APRN practicing in a party state must comply with the state
practice laws of the state in which the client is located at the
time service is provided. APRN practice is not limited to patient
care, but shall include all advanced nursing practice as defined by
the state practice laws of the party state in which the client is
located. APRN practice in a party state under a multistate
licensure privilege will subject the APRN to the jurisdiction of
the licensing board, the courts, and the laws of the party state in
which the client is located at the time service is provided.
k. Except as otherwise expressly provided in this Compact,
this Compact does not affect additional requirements imposed by
states for advanced practice registered nursing. However, a
multistate licensure privilege to practice registered nursing
granted by a party state shall be recognized by other party states
as satisfying any state law requirement for registered nurse
licensure as a precondition for authorization to practice as an
APRN in that state.
l. Individuals not residing in a party state shall continue
to be able to apply for a party state's single- state APRN license
as provided under the laws of each party state. However, the
single-state license granted to these individuals will not be
recognized as granting the privilege to practice as an APRN in any
other party state.
ARTICLE IV
Applications for APRN Licensure in a Party State
a. Upon application for an APRN multistate license, the
licensing board in the issuing party state shall ascertain, through
the coordinated licensure information system, whether the
applicant has ever held or is the holder of a licensed
practical/vocational nursing license, a registered nursing license
or an advanced practice registered nurse license issued by any
other state, whether there are any encumbrances on any license or
multistate licensure privilege held by the applicant, whether any
adverse action has been taken against any license or multistate
licensure privilege held by the applicant and whether the applicant
is currently participating in an alternative program.
b. An APRN may hold a multistate APRN license, issued by the
home state, in only one party state at a time.
c. If an APRN changes primary state of residence by moving
between two party states, the APRN must apply for APRN licensure in
the new home state, and the multistate license issued by the prior
home state shall be deactivated in accordance with applicable
Commission rules.
1. The APRN may apply for licensure in advance of a
change in primary state of residence.
2. A multistate APRN license shall not be issued by the
new home state until the APRN provides satisfactory evidence of a
change in primary state of residence to the new home state and
satisfies all applicable requirements to obtain a multistate APRN
license from the new home state.
d. If an APRN changes primary state of residence by moving
from a party state to a non-party state, the APRN multistate license
issued by the prior home state will convert to a single-state
license, valid only in the former home state.
ARTICLE V
Additional Authorities Invested in Party State Licensing Boards
a. In addition to the other powers conferred by state law, a
licensing board shall have the authority to:
1. Take adverse action against an APRN's multistate
licensure privilege to practice within that party state.
i. Only the home state shall have power to take
adverse action against an APRN's license issued by the home state.
ii. For purposes of taking adverse action, the
home state licensing board shall give the same priority and effect
to reported conduct that occurred outside of the home state as it
would if such conduct had occurred within the home state. In so
doing, the home state shall apply its own state laws to determine
appropriate action.
2. Issue cease and desist orders or impose an
encumbrance on an APRN's authority to practice within that party
state.
3. Complete any pending investigations of an APRN who
changes primary state of residence during the course of such
investigations. The licensing board shall also have the authority
to take appropriate action(s) and shall promptly report the
conclusions of such investigations to the administrator of the
coordinated licensure information system. The administrator of the
coordinated licensure information system shall promptly notify the
new home state of any such actions.
4. Issue subpoenas for both hearings and
investigations that require the attendance and testimony of
witnesses, as well as, the production of evidence. Subpoenas
issued by a party state licensing board for the attendance and
testimony of witnesses and/or the production of evidence from
another party state shall be enforced in the latter state by any
court of competent jurisdiction, according to that court's practice
and procedure in considering subpoenas issued in its own
proceedings. The issuing licensing board shall pay any witness
fees, travel expenses, mileage and other fees required by the
service statutes of the state in which the witnesses and/or
evidence are located.
5. Obtain and submit, for an APRN licensure applicant,
fingerprints or other biometric-based information to the Federal
Bureau of Investigation for criminal background checks, receive the
results of the Federal Bureau of Investigation record search on
criminal background checks and use the results in making licensure
decisions.
6. If otherwise permitted by state law, recover from
the affected APRN the costs of investigations and disposition of
cases resulting from any adverse action taken against that APRN.
7. Take adverse action based on the factual findings
of another party state, provided that the licensing board follows
its own procedures for taking such adverse action.
b. If adverse action is taken by a home state against an
APRN's multistate licensure, the privilege to practice in all other
party states under a multistate licensure privilege shall be
deactivated until all encumbrances have been removed from the
APRN's multistate license. All home state disciplinary orders that
impose adverse action against an APRN's multistate license shall
include a statement that the APRN's multistate licensure privilege
is deactivated in all party states during the pendency of the order.
c. Nothing in this Compact shall override a party state's
decision that participation in an alternative program may be used
in lieu of adverse action. The home state licensing board shall
deactivate the multistate licensure privilege under the multistate
license of any APRN for the duration of the APRN's participation in
an alternative program.
ARTICLE VI
Coordinated Licensure Information System and Exchange of
Information
a. All party states shall participate in a coordinated
licensure information system of all APRNs, licensed registered
nurses and licensed practical/vocational nurses. This system will
include information on the licensure and disciplinary history of
each APRN, as submitted by party states, to assist in the
coordinated administration of APRN licensure and enforcement
efforts.
b. The Commission, in consultation with the administrator
of the coordinated licensure information system, shall formulate
necessary and proper procedures for the identification, collection
and exchange of information under this Compact.
c. All licensing boards shall promptly report to the
coordinated licensure information system any adverse action, any
current significant investigative information, denials of
applications (with the reasons for such denials) and APRN
participation in alternative programs known to the licensing board
regardless of whether such participation is deemed nonpublic and/or
confidential under state law.
d. Notwithstanding any other provision of law, all party
state licensing boards contributing information to the coordinated
licensure information system may designate information that may not
be shared with non-party states or disclosed to other entities or
individuals without the express permission of the contributing
state.
e. Any personally identifiable information obtained from
the coordinated licensure information system by a party state
licensing board shall not be shared with non-party states or
disclosed to other entities or individuals except to the extent
permitted by the laws of the party state contributing the
information.
f. Any information contributed to the coordinated licensure
information system that is subsequently required to be expunged by
the laws of the party state contributing the information shall be
removed from the coordinated licensure information system.
g. The Compact administrator of each party state shall
furnish a uniform data set to the Compact administrator of each
other party state, which shall include, at a minimum:
1. Identifying information;
2. Licensure data;
3. Information related to alternative program
participation information; and
4. Other information that may facilitate the
administration of this Compact, as determined by Commission rules.
h. The Compact administrator of a party state shall provide
all investigative documents and information requested by another
party state.
ARTICLE VII
Establishment of the Interstate Commission of APRN Compact
Administrators
a. The party states hereby create and establish a joint
public agency known as the Interstate Commission of APRN Compact
Administrators.
1. The Commission is an instrumentality of the party
states.
2. Venue is proper, and judicial proceedings by or
against the Commission shall be brought solely and exclusively, in
a court of competent jurisdiction where the principal office of the
Commission is located. The Commission may waive venue and
jurisdictional defenses to the extent it adopts or consents to
participate in alternative dispute resolution proceedings.
3. Nothing in this Compact shall be construed to be a
waiver of sovereign immunity.
b. Membership, Voting and Meetings
1. Each party state shall have and be limited to one
administrator. The head of the state licensing board or designee
shall be the administrator of this Compact for each party state.
Any administrator may be removed or suspended from office as
provided by the law of the state from which the Administrator is
appointed. Any vacancy occurring in the Commission shall be filled
in accordance with the laws of the party state in which the vacancy
exists.
2. Each administrator shall be entitled to one (1)
vote with regard to the promulgation of rules and creation of bylaws
and shall otherwise have an opportunity to participate in the
business and affairs of the Commission. An administrator shall
vote in person or by such other means as provided in the bylaws. The
bylaws may provide for an administrator's participation in meetings
by telephone or other means of communication.
3. The Commission shall meet at least once during each
calendar year. Additional meetings shall be held as set forth in
the bylaws or rules of the commission.
4. All meetings shall be open to the public, and public
notice of meetings shall be given in the same manner as required
under the rulemaking provisions in Article VIII.
5. The Commission may convene in a closed, nonpublic
meeting if the Commission must discuss:
i. Noncompliance of a party state with its
obligations under this Compact;
ii. The employment, compensation, discipline or
other personnel matters, practices or procedures related to
specific employees or other matters related to the Commission's
internal personnel practices and procedures;
iii. Current, threatened, or reasonably
anticipated litigation;
iv. Negotiation of contracts for the purchase or
sale of goods, services or real estate;
v. Accusing any person of a crime or formally
censuring any person;
vi. Disclosure of trade secrets or commercial or
financial information that is privileged or confidential;
vii. Disclosure of information of a personal
nature where disclosure would constitute a clearly unwarranted
invasion of personal privacy;
viii. Disclosure of investigatory records
compiled for law enforcement purposes;
ix. Disclosure of information related to any
reports prepared by or on behalf of the Commission for the purpose
of investigation of compliance with this Compact; or
x. Matters specifically exempted from disclosure
by federal or state statute.
6. If a meeting, or portion of a meeting, is closed
pursuant to this provision, the Commission's legal counsel or
designee shall certify that the meeting may be closed and shall
reference each relevant exempting provision. The Commission shall
keep minutes that fully and clearly describe all matters discussed
in a meeting and shall provide a full and accurate summary of
actions taken, and the reasons therefor, including a description of
the views expressed. All documents considered in connection with
an action shall be identified in such minutes. All minutes and
documents of a closed meeting shall remain under seal, subject to
release by a majority vote of the Commission or order of a court of
competent jurisdiction.
c. The Commission shall, by a majority vote of the
administrators, prescribe bylaws or rules to govern its conduct as
may be necessary or appropriate to carry out the purposes and
exercise the powers of this Compact, including but not limited to:
1. Establishing the fiscal year of the Commission;
2. Providing reasonable standards and procedures:
i. For the establishment and meetings of other
committees; and
ii. Governing any general or specific delegation
of any authority or function of the Commission.
3. Providing reasonable procedures for calling and
conducting meetings of the Commission, ensuring reasonable advance
notice of all meetings and providing an opportunity for attendance
of such meetings by interested parties, with enumerated exceptions
designed to protect the public's interest, the privacy of
individuals, and proprietary information, including trade secrets.
The Commission may meet in closed session only after a majority of
the administrators vote to close a meeting in whole or in part. As
soon as practicable, the Commission must make public a copy of the
vote to close the meeting revealing the vote of each administrator,
with no proxy votes allowed;
4. Establishing the titles, duties and authority and
reasonable procedures for the election of the officers of the
Commission;
5. Providing reasonable standards and procedures for
the establishment of the personnel policies and programs of the
Commission. Notwithstanding any civil service or other similar
laws of any party state, the bylaws shall exclusively govern the
personnel policies and programs of the Commission;
6. Providing a mechanism for winding up the operations
of the Commission and the equitable disposition of any surplus
funds that may exist after the termination of this Compact after the
payment and/or reserving of all of its debts and obligations;
d. The Commission shall publish its bylaws and rules, and
any amendments thereto, in a convenient form on the website of the
Commission;
e. The Commission shall maintain its financial records in
accordance with the bylaws; and
f. The Commission shall meet and take such actions as are
consistent with the provisions of this Compact and the bylaws.
g. The Commission shall have the following powers:
1. To promulgate uniform rules to facilitate and
coordinate implementation and administration of this Compact. The
rules shall have the force and effect of law and shall be binding in
all party states;
2. To bring and prosecute legal proceedings or actions
in the name of the Commission, provided that the standing of any
licensing board to sue or be sued under applicable law shall not be
affected;
3. To purchase and maintain insurance and bonds;
4. To borrow, accept or contract for services of
personnel, including but not limited to employees of a party state
or nonprofit organizations;
5. To cooperate with other organizations that
administer state compacts related to the regulation of nursing,
including but not limited to sharing administrative or staff
expenses, office space or other resources;
6. To hire employees, elect or appoint officers, fix
compensation, define duties, grant such individuals appropriate
authority to carry out the purposes of this Compact, and to
establish the Commission's personnel policies and programs
relating to conflicts of interest, qualifications of personnel and
other related personnel matters;
7. To accept any and all appropriate donations, grants
and gifts of money, equipment, supplies, materials and services,
and to receive, utilize and dispose of the same; provided that at
all times the Commission shall strive to avoid any appearance of
impropriety and/or conflict of interest;
8. To lease, purchase, accept appropriate gifts or
donations of, or otherwise to own, hold, improve or use, any
property, whether real, personal or mixed; provided that at all
times the Commission shall strive to avoid any appearance of
impropriety;
9. To sell convey, mortgage, pledge, lease, exchange,
abandon or otherwise dispose of any property, whether real,
personal or mixed;
10. To establish a budget and make expenditures;
11. To borrow money;
12. To appoint committees, including advisory
committees comprised of administrators, state nursing regulators,
state legislators or their representatives, and consumer
representatives, and other such interested persons;
13. To issue advisory opinions;
14. To provide and receive information from, and to
cooperate with, law enforcement agencies;
15. To adopt and use an official seal; and
16. To perform such other functions as may be
necessary or appropriate to achieve the purposes of this Compact
consistent with the state regulation of APRN licensure and
practice.
h. Financing of the Commission
1. The Commission shall pay, or provide for the
payment of, the reasonable expenses of its establishment,
organization and ongoing activities.
2. The Commission may also levy on and collect an
annual assessment from each party state to cover the cost of its
operations, activities and staff in its annual budget as approved
each year. The aggregate annual assessment amount, if any, shall be
allocated based upon a formula to be determined by the Commission,
which shall promulgate a rule that is binding upon all party states.
3. The Commission shall not incur obligations of any
kind prior to securing the funds adequate to meet the same; nor
shall the Commission pledge the credit of any of the party states,
except by, and with the authority of, such party state.
4. The Commission shall keep accurate accounts of all
receipts and disbursements. The receipts and disbursements of the
Commission shall be subject to the audit and accounting procedures
established under its bylaws. However, all receipts and
disbursements of funds handled by the Commission shall by audited
yearly by a certified or licensed public accountant, and the report
of the audit shall be included in and become part of the annual
report of the Commission.
i. Qualified Immunity, Defense, and Indemnification
1. The administrators, officers, executive director,
employees and representatives of the Commission shall be immune
from suit and liability, either personally or in their official
capacity, for any claim for damage to or loss of property or
personal injury or other civil liability caused by or arising out of
any actual or alleged act, error or omission that occurred, or that
the person against whom the claim is made had a reasonable basis for
believing occurred, within the scope of Commission employment,
duties or responsibilities; provided that nothing in this paragraph
shall be construed to protect any such person from suit and/or
liability for any damage, loss, injury or liability caused by the
intentional, willful or wanton misconduct of that person.
2. The Commission shall defend any administrator,
officer, executive director, employee or representative of the
Commission in any civil action seeking to impose liability arising
out of any actual or alleged act, error or omission that occurred
within the scope of Commission employment, duties or
responsibilities, or that the person against whom the claim is made
had a reasonable basis for believing occurred within the scope of
Commission employment, duties or responsibilities; provided that
nothing herein shall be construed to prohibit that person from
retaining his or her own counsel; and provided further that the
actual or alleged act, error or omission did not result from that
person's intentional, willful or wanton misconduct.
3. The Commission shall indemnify and hold harmless
any administrator, officer, executive director, employee or
representative of the Commission for the amount of any settlement
or judgment obtained against that person arising out of any actual
or alleged act, error or omission that occurred within the scope of
Commission employment, duties or responsibilities, or that such
person had a reasonable basis for believing occurred within the
scope of Commission employment, duties or responsibilities,
provided that the actual or alleged act, error or omission did not
result from the intentional, willful or wanton misconduct of that
person.
ARTICLE VIII
Rulemaking
a. The Commission shall exercise its rulemaking powers
pursuant to the criteria set forth in this Article and the rules
adopted thereunder. Rules and amendments shall become binding as
of the date specified in each rule or amendment and shall have the
same force and effect as provisions of this Compact.
b. Rules or amendments to the rules shall be adopted at a
regular or special meeting of the Commission.
c. Prior to promulgation and adoption of a final rule or
rules by the Commission, and at least sixty (60) days in advance of
the meeting at which the rule will be considered and voted upon, the
Commission shall file a notice of proposed rulemaking:
1. On the website of the Commission; and
2. On the website of each licensing board or the
publication in which each state would otherwise publish proposed
rules.
d. The notice of proposed rulemaking shall include:
1. The proposed time, date and location of the meeting
in which the rule will be considered and voted upon;
2. The text of the proposed rule or amendment, and the
reason for the proposed rule;
3. A request for comments on the proposed rule from any
interested person; and
4. The manner in which interested persons may submit
notice to the Commission of their intention to attend the public
hearing and any written comments.
e. Prior to adoption of a proposed rule, the Commission
shall allow persons to submit written data, facts, opinions and
arguments, which shall be made available to the public.
f. The Commission shall grant an opportunity for a public
hearing before it adopts a rule or amendment.
g. The Commission shall publish the place, time, and date of
the scheduled public hearing.
1. Hearings shall be conducted in a manner providing
each person who wishes to comment a fair and reasonable opportunity
to comment orally or in writing. All hearings will be recorded, and
a copy will be made available upon request.
2. Nothing in this section shall be construed as
requiring a separate hearing on each rule. Rules may be grouped for
the convenience of the Commission at hearings required by this
section.
h. If no one appears at the public hearing, the Commission
may proceed with promulgation of the proposed rule.
i. Following the scheduled hearing date, or by the close of
business on the scheduled hearing date if the hearing was not held,
the Commission shall consider all written and oral comments
received.
j. The Commission shall, by majority vote of all
administrators, take final action on the proposed rule and shall
determine the effective date of the rule, if any, based on the
rulemaking record and the full text of the rule.
k. Upon determination that an emergency exists, the
Commission may consider and adopt an emergency rule without prior
notice, opportunity for comment, or hearing, provided that the
usual rulemaking procedures provided in this Compact and in this
section shall be retroactively applied to the rule as soon as
reasonably possible, in no event later than ninety (90) days after
the effective date of the rule. For the purposes of this provision,
an emergency rule is one that must be adopted immediately in order
to:
1. Meet an imminent threat to public health, safety or
welfare;
2. Prevent a loss of Commission or party state funds;
or
3. Meet a deadline for the promulgation of an
administrative rule that is established by federal law or rule.
l. The Commission may direct revisions to a previously
adopted rule or amendment for purposes of correcting typographical
errors, errors in format, errors in consistency or grammatical
errors. Public notice of any revisions shall be posted on the
website of the Commission. The revision shall be subject to
challenge by any person for a period of thirty (30) days after
posting. The revision may be challenged only on grounds that the
revision results in a material change to a rule. A challenge shall
be made in writing, and delivered to the Commission, prior to the
end of the notice period. If no challenge is made, the revision
will take effect without further action. If the revision is
challenged, the revision may not take effect without the approval
of the Commission.
ARTICLE IX
Oversight, Dispute Resolution and Enforcement
a. Oversight
1. Each party state shall enforce this Compact and
take all actions necessary and appropriate to effectuate this
Compact's purposes and intent.
2. The Commission shall be entitled to receive service
of process in any proceeding that may affect the powers,
responsibilities or actions of the Commission, and shall have
standing to intervene in such a proceeding for all purposes.
Failure to provide service of process to the Commission shall
render a judgment or order void as to the Commission, this Compact
or promulgated rules.
b. Default, Technical Assistance and Termination
1. If the Commission determines that a party state has
defaulted in the performance of its obligations or responsibilities
under this Compact or the promulgated rules, the Commission shall:
i. Provide written notice to the defaulting state
and other party states of the nature of the default, the proposed
means of curing the default and/or any other action to be taken by
the Commission; and
ii. Provide remedial training and specific
technical assistance regarding the default.
2. If a state in default fails to cure the default, the
defaulting state's membership in this Compact may be terminated
upon an affirmative vote of a majority of the administrators, and
all rights, privileges and benefits conferred by this Compact may
be terminated on the effective date of termination. A cure of the
default does not relieve the offending state of obligations or
liabilities incurred during the period of default.
3. Termination of membership in this Compact shall be
imposed only after all other means of securing compliance have been
exhausted. Notice of intent to suspend or terminate shall be given
by the Commission to the governor of the defaulting state and to the
executive officer of the defaulting state's licensing board, the
defaulting state's licensing board, and each of the party states.
4. A state whose membership in this Compact has been
terminated is responsible for all assessments, obligations and
liabilities incurred through the effective date of termination,
including obligations that extend beyond the effective date of
termination.
5. The Commission shall not bear any costs related to a
state that is found to be in default or whose membership in this
Compact has been terminated, unless agreed upon in writing between
the Commission and the defaulting state.
6. The defaulting state may appeal the action of the
Commission by petitioning the U.S. District Court for the District
of Columbia or the federal district in which the Commission has its
principal offices. The prevailing party shall be awarded all costs
of such litigation, including reasonable attorneys' fees.
c. Dispute Resolution
1. Upon request by a party state, the Commission shall
attempt to resolve disputes related to the Compact that arise among
party states and between party and non-party states.
2. The Commission shall promulgate a rule providing
for both mediation and binding dispute resolution for disputes, as
appropriate.
3. In the event the Commission cannot resolve disputes
among party states arising under this Compact:
i. The party states may submit the issues in
dispute to an arbitration panel, which will be comprised of
individuals appointed by the Compact administrator in each of the
affected party states and an individual mutually agreed upon by the
Compact administrators of all the party states involved in the
dispute.
ii. The decision of a majority of the arbitrators
shall be final and binding.
d. Enforcement
1. The Commission, in the reasonable exercise of its
discretion, shall enforce the provisions and rules of this Compact.
2. By majority vote, the Commission may initiate legal
action in the United States District Court for the District of
Columbia or the federal district in which the Commission has its
principal offices against a party state that is in default to
enforce compliance with the provisions of this Compact and its
promulgated rules and bylaws. The relief sought may include both
injunctive relief and damages. In the event judicial enforcement
is necessary, the prevailing party shall be awarded all costs of
such litigation, including reasonable attorneys' fees.
3. The remedies herein shall not be the exclusive
remedies of the Commission. The Commission may pursue any other
remedies available under federal or state law.
ARTICLE X
Effective Date, Withdrawal and Amendment
a. This Compact shall come into limited effect at such time
as this Compact has been enacted into law in seven (7) party states
for the sole purpose of establishing and convening the Commission
to adopt rules relating to its operation.
b. Any state that joins this Compact subsequent to the
Commission's initial adoption of the APRN uniform licensure
requirements shall be subject to all rules that have been
previously adopted by the Commission.
c. Any party state may withdraw from this Compact by
enacting a statute repealing the same. A party state's withdrawal
shall not take effect until six (6) months after enactment of the
repealing statute.
d. A party state's withdrawal or termination shall not
affect the continuing requirement of the withdrawing or terminated
state's licensing board to report adverse actions and significant
investigations occurring prior to the effective date of such
withdrawal or termination.
e. Nothing contained in this Compact shall be construed to
invalidate or prevent any APRN licensure agreement or other
cooperative arrangement between a party state and a non-party state
that does not conflict with the provisions of this Compact.
f. This Compact may be amended by the party states. No
amendment to this Compact shall become effective and binding upon
any party state until it is enacted into the laws of all party
states.
g. Representatives of non-party states to this Compact
shall be invited to participate in the activities of the
Commission, on a nonvoting basis, prior to the adoption of this
Compact by all states.
ARTICLE XI
Construction and Severability
This Compact shall be liberally construed so as to effectuate
the purposes thereof. The provisions of this Compact shall be
severable, and if any phrase, clause, sentence or provision of this
Compact is declared to be contrary to the constitution of any party
state or of the United States, or if the applicability thereof to
any government, agency, person or circumstance is held invalid, the
validity of the remainder of this Compact and the applicability
thereof to any government, agency, person or circumstance shall not
be affected thereby. If this Compact shall be held to be contrary
to the constitution of any party state, this Compact shall remain in
full force and effect as to the remaining party states and in full
force and effect as to the party state affected as to all severable
matters.
Sec. 305.002. ADMINISTRATION OF COMPACT. The Texas Board
of Nursing is the Advanced Practice Registered Nurse Compact
administrator for this state.
Sec. 305.003. RULES. The Texas Board of Nursing may adopt
rules necessary to implement this chapter.
SECTION 2. This Act takes effect September 1, 2023.