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.