093_HB1201

 
                                     LRB093 05991 AMC 06092 b

 1        AN ACT concerning advanced practice registered nurses.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

 4        Section 1.  Short title.  This Act may be  cited  as  the
 5    Advanced Practice Registered Nurse Compact Act.

 6        Section  5.  Ratification  and  approval of compact.  The
 7    advanced practice registered nurse compact is hereby  enacted
 8    into  law  and  entered into on behalf of this State with any
 9    state  that  legally  joins  therein  in  substantially   the
10    following form:

11                              ARTICLE I
12                 Findings and Declaration of Purpose

13        (a)  The party states find that:
14             (1)  The   health  and  safety  of  the  public  are
15        affected  by  the  degree   of   compliance   with   APRN
16        licensure/authority  to  practice  requirements  and  the
17        effectiveness  of enforcement activities related to state
18        APRN licensure/authority to practice laws;
19             (2)  Violations  of  APRN   licensure/authority   to
20        practice  and  other  laws  regulating  the  practice  of
21        nursing may result in injury or harm to the public;
22             (3)  The  expanded  mobility of APRNs and the use of
23        advanced  communication  technologies  as  part  of   our
24        nation's  health  care  delivery  system  require greater
25        coordination and cooperation among states in the areas of
26        APRN licensure/authority to practice and regulation;
27             (4)  New practice  modalities  and  technology  make
28        compliance with individual state APRN licensure/authority
29        to practice laws difficult and complex;
30             (5)  The   current   system   of   duplicative  APRN
 
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 1        licensure/authority to practice for APRNs  practicing  in
 2        multiple states is cumbersome and redundant to both APRNs
 3        and states;
 4             (6)  Uniformity  of APRN requirements throughout the
 5        states promotes public safety and public health benefits;
 6        and
 7             (7)  Access to APRN services increases the  public's
 8        access   to   health  care,  particularly  in  rural  and
 9        underserved areas.
10        (b)  The general purposes of this Compact are to:
11             (1)  Facilitate  the  states'  responsibilities   to
12        protect the public's health and safety;
13             (2)  Ensure  and  encourage the cooperation of party
14        states  in  the  areas  of  APRN  licensure/authority  to
15        practice and regulation including  promotion  of  uniform
16        licensure requirements;
17             (3)  Facilitate  the exchange of information between
18        party  states  in   the   areas   of   APRN   regulation,
19        investigation and adverse actions;
20             (4)  Promote compliance with the laws governing APRN
21        practice in each jurisdiction; and
22             (5)  Invest  all  party states with the authority to
23        hold an APRN accountable for meeting all  state  practice
24        laws  in the state in which the patient is located at the
25        time care is rendered through the mutual  recognition  of
26        party state licenses.

27                             ARTICLE II
28                             Definitions

29        As used in this Compact:
30        (a)  "Advanced Practice Registered Nurse" or "APRN" means
31    a  Nurse  Anesthetist;  Nurse Practitioner; Nurse Midwife; or
32    Clinical  Nurse  Specialist  to  the  extent  a  party  state
33    licenses or grants authority to practice in  that  APRN  role
 
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 1    and title.
 2        (b)  "Adverse  Action"  means  a  home  or  remote  state
 3    disciplinary action.
 4        (c)  "Alternative    program"    means    a    voluntary,
 5    non-disciplinary  monitoring  program approved by a licensing
 6    board.
 7        (d)  "APRN Licensure/Authority  to  Practice"  means  the
 8    regulatory  mechanism  used  by  a party state to grant legal
 9    authority to practice as an APRN.
10        (e)  "APRN  Uniform   Licensure/Authority   to   Practice
11    Requirements"   means   those  agreed  upon  minimum  uniform
12    licensure, education and examination requirements adopted  by
13    licensing boards for the recognized APRN role and title.
14        (f)  "Coordinated  licensure information system" means an
15    integrated  process  for  collecting,  storing  and   sharing
16    information  on  APRN  licensure/authority  to  practice  and
17    enforcement activities related to APRN licensure/authority to
18    practice   laws,   which  is  administered  by  a  non-profit
19    organization composed of and controlled  by  state  licensing
20    boards.
21        (g)  "Current   significant   investigative  information"
22    means:
23             (1)  Investigative  information  that  a   licensing
24        board,   after   a   preliminary  inquiry  that  includes
25        notification and an opportunity for the APRN  to  respond
26        if  required  by  state law, has reason to believe is not
27        groundless and, if proved true, would indicate more  than
28        a minor infraction; or
29             (2)  Investigative  information  that indicates that
30        the APRN represents an immediate threat to public  health
31        and  safety  regardless  of  whether  the  APRN  has been
32        notified and had an opportunity to respond.
33        (h)  "Home state" means  the  party  state  that  is  the
34    APRN's primary state of residence.
 
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 1        (i)  "Home state action" means any administrative, civil,
 2    equitable  or  criminal  action permitted by the home state's
 3    laws which are  imposed  on  an  APRN  by  the  home  state's
 4    licensing  board or other authority including actions against
 5    an  individual's  license/authority  to  practice  such   as:
 6    revocation,  suspension,  probation or any other action which
 7    affects an APRN's authorization to practice.
 8        (j)  "Licensing board" means a party  state's  regulatory
 9    body  responsible  for  issuing  APRN  licensure/authority to
10    practice.
11        (k)  "Multistate  advanced  practice   privilege"   means
12    current,  authority from a remote state permitting an APRN to
13    practice in that state in the same role and title as the APRN
14    is licensed/authorized to practice in the home state  to  the
15    extent  that  the  remote state laws recognize such APRN role
16    and title. A remote state has the  authority,  in  accordance
17    with existing state due process laws, to take actions against
18    the   APRN's  privilege,  including  revocation,  suspension,
19    probation,  or  any  other  action  that  affects  an  APRN's
20    multistate privilege to practice.
21        (l)  "Party state" means any state that has adopted  this
22    Compact.
23        (m)  "Prescriptive  authority"  means the legal authority
24    to prescribe medications and  devices  as  defined  by  party
25    state laws.
26        (n)  "Remote  state"  means a party state, other than the
27    home state,
28             (1)  Where the patient is located at the  time  APRN
29        care is provided, or,
30             (2)  In  the  case  of APRN practice not involving a
31        patient, in such party state where the recipient of  APRN
32        practice is located.
33        (o)  "Remote state action" means
34             (1)  Any   administrative,   civil,   equitable   or
 
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 1        criminal  action permitted by a remote state's laws which
 2        are imposed on an APRN by the  remote  state's  licensing
 3        board  or  other  authority  including actions against an
 4        individual's multistate advanced  practice  privilege  in
 5        the remote state, and
 6             (2)  Cease   and  desist  and  other  injunctive  or
 7        equitable orders issued by remote states or the licensing
 8        boards thereof.
 9        (p)  "State" means a state, territory, or  possession  of
10    the United States.
11        (q)  "State practice laws" means a party state's laws and
12    regulations  that  govern  APRN practice, define the scope of
13    advanced nursing practice including  prescriptive  authority,
14    and  create  the methods and grounds for imposing discipline.
15    State practice laws do not include the requirements necessary
16    to obtain and retain APRN licensure/authority to practice  as
17    an  APRN,  except  for  qualifications or requirements of the
18    home state.
19        (r)  "Unencumbered" means that a  state  has  no  current
20    disciplinary  action  against  an APRN's license/authority to
21    practice.

22                             ARTICLE III
23                 General Provisions and Jurisdiction

24        (a)  All party states  shall  participate  in  the  Nurse
25    Licensure   Compact   for   registered  nurses  and  licensed
26    practical/vocational nurses in order to enter into  the  APRN
27    Compact.
28        (b)  No  state  shall  enter  the  APRN Compact until the
29    state   adopts,   at   a   minimum,    the    APRN    Uniform
30    Licensure/Authority  to  Practice  Requirements for each APRN
31    role and title  recognized by the state seeking to enter  the
32    APRN Compact.
33        (c)  APRN  Licensure/Authority  to  practice  issued by a
 
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 1    home state to a resident in that state  will be recognized by
 2    each  party  state  as  authorizing  a  multistate   advanced
 3    practice  privilege to the extent that the role and title are
 4    recognized by each party state.  To  obtain  or  retain  APRN
 5    licensure/authority to practice as an APRN, an applicant must
 6    meet the home state's qualifications for authority or renewal
 7    of authority as well as all other applicable state laws.
 8        (d)  The APRN multistate advanced practice privilege does
 9    not  include  prescriptive authority, and does not affect any
10    requirements imposed by states to grant to  an  APRN  initial
11    and  continuing  prescriptive  authority  according  to state
12    practice laws. However, a party state may grant  prescriptive
13    authority  to  an  individual  on  the  basis of a multistate
14    advanced practice privilege to the extent permitted by  state
15    practice laws.
16        (e)  A  party  state  may,  in  accordance with state due
17    process  laws,  limit  or  revoke  the  multistate   advanced
18    practice  privilege in the party state and may take any other
19    necessary actions under the party state's applicable laws  to
20    protect  the health and safety of the party state's citizens.
21    If a party state takes action, the party state shall promptly
22    notify  the  administrator  of  the   coordinated   licensure
23    information  system.  The  administrator  of  the coordinated
24    licensure information system shall promptly notify  the  home
25    state of any such actions by remote states.
26        (f)  An APRN practicing in a party state must comply with
27    the  state practice laws of the state in which the patient is
28    located at the time  care  is  provided.  The  APRN  practice
29    includes  patient  care  and  all  advanced  nursing practice
30    defined  by  the  party  state's  practice  laws.   The  APRN
31    practice will subject an APRN  to  the  jurisdiction  of  the
32    licensing board, the courts, and the laws of the party state.
33        (g)  Individuals  not residing in a party state may apply
34    for APRN licensure/authority to practice as an APRN under the
 
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 1    laws of a party state. However,  the  authority  to  practice
 2    granted  to  these  individuals  will  not  be  recognized as
 3    granting the privilege to practice as an APRN  in  any  other
 4    party state unless explicitly agreed to by that party state.

 5                             ARTICLE IV
 6              Applications for APRN Licensure/Authority
 7                    to Practice in a Party State

 8        (a)  Once  an application for APRN licensure/authority to
 9    practice is submitted, a party state shall ascertain, through
10    the Coordinated Licensure Information System, whether:
11             (1)  The applicant has held or is the  holder  of  a
12        nursing  license/authority  to practice issued by another
13        state;
14             (2)  The applicant has had  a  history  of  previous
15        disciplinary action by any state;
16             (3)  An  encumbrance exists on any license/authority
17        to practice; and
18             (4)  Any other adverse action by any other state has
19        been taken against a license/authority to practice.
20        This information may be used in approving or  denying  an
21    application for APRN licensure/authority to practice.
22        (b)  An   APRN   in   a   party  state  shall  hold  APRN
23    licensure/authority to practice in only one party state at  a
24    time, issued by the home state.
25        (c)  An  APRN  who  intends  to  change  primary state of
26    residence may apply for APRN licensure/authority to  practice
27    in  the  new  home state in advance of such change.  However,
28    new licensure/authority to practice will not be issued  by  a
29    party  state  until after an APRN provides evidence of change
30    in primary state of residence satisfactory to  the  new  home
31    state's licensing board.
32        (d)  When an APRN changes primary state of residence by:
33             (1)  Moving  between  two  party states, and obtains
 
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 1        APRN licensure/authority to practice from  the  new  home
 2        state,  the APRN licensure/authority to practice from the
 3        former home state is no longer valid;
 4             (2)  Moving from a non-party state to a party state,
 5        and obtains APRN licensure/authority to practice from the
 6        new home state, the individual state  license  issued  by
 7        the  nonparty  state  is  not affected and will remain in
 8        full force if so provided by the laws  of  the  non-party
 9        state;
10             (3)  Moving from a party state to a non-party state,
11        the  APRN  licensure/authority  to practice issued by the
12        prior home state converts to an individual state license,
13        valid  only  in  the  former  home  state,  without   the
14        multistate licensure privilege to practice in other party
15        states.

16                              ARTICLE V
17                           Adverse Actions

18        In  addition  to  the  General  Provisions  described  in
19    Article III, the following provisions apply:
20        (a)  The licensing board of a remote state shall promptly
21    report  to  the  administrator  of  the coordinated licensure
22    information system any remote  state  actions  including  the
23    factual  and  legal  basis  for  such  action,  if known. The
24    licensing board of a remote state shall also promptly  report
25    any  significant  current  investigative  information  yet to
26    result in a remote state action.  The  administrator  of  the
27    coordinated   licensure  information  system  shall  promptly
28    notify the home state of any such reports.
29        (b)  The licensing board of a party state shall have  the
30    authority  to complete any pending investigations for an APRN
31    who changes primary state of residence during the  course  of
32    such investigations. It shall also have the authority to take
33    appropriate   action(s),   and   shall  promptly  report  the
 
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 1    conclusions of such investigations to  the  administrator  of
 2    the    coordinated    licensure   information   system.   The
 3    administrator of the coordinated licensure information system
 4    shall promptly notify the new home state of any such actions.
 5        (c)  A remote state may take adverse action affecting the
 6    multistate advanced practice  privilege  to  practice  within
 7    that party state. However, only the home state shall have the
 8    power   to   impose   adverse   action   against   the   APRN
 9    licensure/authority to practice issued by the home state.
10        (d)  For   purposes   of  imposing  adverse  action,  the
11    licensing board  of  the  home  state  shall  give  the  same
12    priority  and  effect  to  reported  conduct  received from a
13    remote state as it would if such conduct had occurred  within
14    the  home  state.  In  so doing, it shall apply its own state
15    laws to determine appropriate action.
16        (e)  The home state may take adverse action based on  the
17    factual  findings  of the remote state, so long as each state
18    follows its own procedures for imposing such adverse action.
19        (f)  Nothing in  this  Compact  shall  override  a  party
20    state's decision that participation in an alternative program
21    may  be  used  in  lieu  of  adverse  action  and  that  such
22    participation  shall  remain  non-public  if  required by the
23    party state's laws. Party states must require APRNs who enter
24    any alternative programs to agree  not  to  practice  in  any
25    other party  state during the term of the alternative program
26    without prior authorization from such other party state.
27        (g)  All  home state licensing board disciplinary orders,
28    agreed or otherwise, which limit  the  scope  of  the  APRN's
29    practice  or require monitoring of the APRN as a condition of
30    the order shall include the requirements that the  APRN  will
31    limit  her  or  his  practice  to  the  home state during the
32    pendency of the order. This requirement may allow the APRN to
33    practice  in  other   party   states   with   prior   written
34    authorization  from  both  the  home  state  and  party state
 
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 1    licensing boards.

 2                             ARTICLE VI
 3           Additional Authorities Invested in Party State
 4                          Licensing Boards

 5        Notwithstanding any other powers, party  state  licensing
 6    boards shall have the authority to:
 7        (a)  If  otherwise  permitted  by state law, recover from
 8    the affected APRN the costs of investigations and disposition
 9    of cases resulting from any adverse action taken against that
10    APRN;
11        (b)  Issue    subpoenas    for    both    hearings    and
12    investigations, which require the attendance and testimony of
13    witnesses, and the production of evidence.  Subpoenas  issued
14    by  a licensing board in a party state for the attendance and
15    testimony of witnesses, and/or  the  production  of  evidence
16    from  another  party  state,  shall be enforced in the latter
17    state by any court of competent  jurisdiction,  according  to
18    the  practice  and  procedure  of  that  court  applicable to
19    subpoenas  issued  in  proceedings  pending  before  it.  The
20    issuing  authority  shall  pay  any  witness   fees,   travel
21    expenses,  mileage  and  other  fees  required by the service
22    statutes of the state where the witnesses and/or evidence are
23    located;
24        (c)  Issue cease and desist orders to limit or revoke  an
25    APRN's  privilege or licensure/authority to practice in their
26    state; and
27        (d)  Promulgate uniform rules and regulations as provided
28    for in Article VIII(c).

29                             ARTICLE VII
30              Coordinated Licensure Information System

31        (a)  All party states shall participate in a  cooperative
 
                            -11-     LRB093 05991 AMC 06092 b
 1    effort  to  create  a coordinated database of all APRNs. This
 2    system    will    include    information    on    the    APRN
 3    licensure/authority to practice and disciplinary  history  of
 4    each  APRN,  as contributed by party states, to assist in the
 5    coordination of  APRN  licensure/authority  to  practice  and
 6    enforcement efforts.
 7        (b)  Notwithstanding  any  other  provision  of  law, all
 8    party states' licensing boards shall promptly report  adverse
 9    actions,   actions   against   multistate  advanced  practice
10    privileges, any current significant investigative information
11    yet to result in adverse action, denials of applications, and
12    the reasons for such denials, to  the  coordinated  licensure
13    information system.
14        (c)  Current  significant investigative information shall
15    be transmitted through the coordinated licensure  information
16    system only to party state licensing boards.
17        (d)  Notwithstanding  any  other  provision  of  law, all
18    party states' licensing boards  contributing  information  to
19    the  coordinated  licensure  information system may designate
20    information that may not be shared with non-party  states  or
21    disclosed  to  other  entities  or  individuals  without  the
22    express permission of the contributing state.
23        (e)  Any  personally identifiable information obtained by
24    a  party  states'  licensing  board  from   the   coordinated
25    licensure information system may not be shared with non-party
26    states  or  disclosed to other entities or individuals except
27    to the extent permitted  by  the  laws  of  the  party  state
28    contributing the information.
29        (f)  Any   information  contributed  to  the  coordinated
30    licensure information system that is subsequently required to
31    be expunged by the laws of the party state contributing  that
32    information,  shall  also  be  expunged  from the coordinated
33    licensure information system.
34        (g)  The Compact administrators, acting jointly with each
 
                            -12-     LRB093 05991 AMC 06092 b
 1    other and in  consultation  with  the  administrator  of  the
 2    coordinated  licensure  information  system,  shall formulate
 3    necessary  and  proper  procedures  for  the  identification,
 4    collection and exchange of information under this Compact.

 5                            ARTICLE VIII
 6        Compact Administration and Interchange of Information

 7        (a)  The  head  of  the  licensing  board,   or   his/her
 8    designee,  of  each party state shall be the administrator of
 9    this Compact for his/her state.
10        (b)  The Compact administrator of each party state  shall
11    furnish  to  the  Compact  administrator  of each other party
12    state  any  information  and  documents  including,  but  not
13    limited to, a uniform data set of investigations, identifying
14    information,  licensure  data,  and  disclosable  alternative
15    program   participation   information   to   facilitate   the
16    administration of this Compact.
17        (c)  Compact administrators shall have the  authority  to
18    develop   uniform   rules   to   facilitate   and  coordinate
19    implementation of this Compact. These uniform rules shall  be
20    adopted  by  party states, under the authority invested under
21    Article VI (d).

22                             ARTICLE IX
23                              Immunity

24        No party state or the officers or employees or agents  of
25    a  party  state's licensing board who acts in accordance with
26    the provisions of this Compact shall be liable on account  of
27    any  act  or  omission  in  good  faith  while engaged in the
28    performance of their duties under this Compact. Good faith in
29    this article shall  not  include  willful  misconduct,  gross
30    negligence, or recklessness.
 
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 1                              ARTICLE X
 2             Entry into Force, Withdrawal and Amendment

 3        (a)  This  Compact  shall  enter  into  force  and become
 4    effective as to any state when it has been enacted  into  the
 5    laws  of  that  state. Any party state may withdraw from this
 6    Compact by enacting a statute repealing the same, but no such
 7    withdrawal shall take  effect  until  six  months  after  the
 8    withdrawing  state  has given notice of the withdrawal to the
 9    executive heads of all other party states.
10        (b)  No  withdrawal  shall   affect   the   validity   or
11    applicability  by  the  licensing  boards of states remaining
12    party  to  the  Compact  of  any  report  of  adverse  action
13    occurring prior to the withdrawal.
14        (c)  Nothing contained in this Compact shall be construed
15    to invalidate or  prevent  any  APRN  licensure/authority  to
16    practice agreement or other cooperative arrangement between a
17    party  state and a non-party state that is made in accordance
18    with the other provisions of this Compact.
19        (d)  This Compact may be amended by the party states.  No
20    amendment  to this Compact shall become effective and binding
21    upon the party states unless and until it is enacted into the
22    laws of all party states.

23                             ARTICLE XI
24                    Construction and Severability

25        (a)  This Compact shall be liberally construed so  as  to
26    effectuate  the  purposes  thereof.  The  provisions  of this
27    Compact  shall  be  severable  and  if  any  phrase,  clause,
28    sentence or provision of  this  Compact  is  declared  to  be
29    contrary  to  the  constitution  of any party state or of the
30    United States or the applicability thereof to any government,
31    agency, person or circumstance is held invalid, the  validity
32    of  the  remainder  of  this  Compact  and  the applicability
 
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 1    thereof to any government,  agency,  person  or  circumstance
 2    shall  not be affected thereby. If this Compact shall be held
 3    contrary to the constitution of any state party thereto,  the
 4    Compact  shall  remain  in  full  force  and effect as to the
 5    remaining party states and in full force and effect as to the
 6    party state affected as to all severable matters.
 7        (b)  In the event party states find a need  for  settling
 8    disputes arising under this Compact:
 9             (1)  The  party  states  may  submit  the  issues in
10        dispute to an arbitration panel which will  be  comprised
11        of  an  individual appointed by the Compact administrator
12        in the home state; an individual appointed by the Compact
13        administrator in the remote  state(s)  involved;  and  an
14        individual   mutually   agreed   upon   by   the  Compact
15        administrators of all the party states  involved  in  the
16        dispute.
17             (2)  The  decision  of a majority of the arbitrators
18        shall be final and binding.

19        Section  10.  Compact   administrator;   expenses.    The
20    Director  of  Professional  Regulation  shall  serve  as  the
21    compact  administrator  for this State and any expenses he or
22    she incurs in so serving shall be paid from the appropriation
23    for the ordinary and contingent expenses of the Department of
24    Professional Regulation.

25        Section 99. Effective date.  This Act takes  effect  upon
26    becoming law.