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.