Bill Summary – FastDemocracy

SECOND REGULAR SESSION
                        HOUSE BILL NO. 2618
                               103RD GENERAL ASSEMBLY


                               INTRODUCED BY REPRESENTATIVE GRAGG.

     6010H.01I                                                                    JOSEPH ENGLER, Chief Clerk


                                                AN ACT
     To amend chapter 334, RSMo, by adding thereto thirteen new sections relating to the
          respiratory care interstate compact.


     Be it enacted by the General Assembly of the state of Missouri, as follows:

             Section A. Chapter 334, RSMo, is amended by adding thereto thirteen new sections,
 to be known as sections 334.1950, 334.1953, 334.1956, 334.1959, 334.1962, 334.1965,
 334.1968, 334.1971, 334.1974, 334.1977, 334.1980, 334.1983, and 334.1986, to read as
 follows:
             334.1950. 1. Sections 334.1950 to 334.1986 shall be known and may be cited as
 the "Respiratory Care Interstate Compact".
         2. The purpose of this Compact is to facilitate the interstate Practice of
 Respiratory Therapy with the goal of improving public access to Respiratory Therapy
 services by providing Respiratory Therapists licensed in a Member State the ability to
 practice in other Member States. The Compact preserves the regulatory authority of
 states to protect public health and safety through the current system of State licensure.
         3. This Compact is designed to achieve the following objectives:
         (1) Increase public access to Respiratory Therapy services by creating a
 responsible, streamlined pathway for Licensees to practice in Member States with the
 goal of improving outcomes for patients;
         (2) Enhance States' ability to protect the public's health and safety;
         (3) Promote the cooperation of Member States in regulating the Practice of
 Respiratory Therapy within those Member States;


     EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
     intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language.
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       (4) Ease administrative burdens on States by encouraging the cooperation of
Member States in regulating multi-state Respiratory Therapy practice;
       (5) Support relocating Active Military Members and their spouses; and
       (6) Promote mobility and address workforce shortages.
           334.1953. As used in this Compact, unless the context requires otherwise, the
following definitions shall apply:
       (1) "Active Military Member" means any person with a full-time duty status in
the armed forces of the United States, including members of the National Guard and
Reserve.
       (2) "Adverse Action" means any administrative, civil, equitable, or criminal
action permitted by a State's laws which is imposed by any State authority with
regulatory authority over Respiratory Therapists, such as license denial, censure,
revocation, suspension, probation, monitoring of the Licensee, or restriction on the
Licensee's practice, not including participation in an Alternative Program.
       (3) "Alternative Program" means a non-disciplinary monitoring or practice
remediation process applicable to a Respiratory Therapist approved by any State
authority with regulatory authority over Respiratory Therapists. This includes, but is
not limited to, programs to which Licensees with substance abuse or addiction issues are
referred in lieu of Adverse Action.
       (4) "Charter Member States" means those Member States who were the first
seven states to enact the Compact into the laws of their State.
       (5) "Commission" or "Respiratory Care Interstate Compact Commission"
means the government instrumentality and body politic whose membership consists of
all Member States that have enacted the Compact.
       (6) "Commissioner" means the individual appointed by a Member State to serve
as the member of the Commission for that Member State.
       (7) "Compact" means the Respiratory Care Interstate Compact.
       (8) "Compact Privilege" means the authorization granted by a Remote State to
allow a Licensee from another Member State to practice as a Respiratory Therapist in
the Remote State under the Remote State's laws and Rules. The Practice of Respiratory
Therapy occurs in the Member State where the patient is located at the time of the
patient encounter.
       (9) "Criminal Background Check" means the submission by the Member State
of fingerprints or other biometric-based information on license applicants at the time of
initial licensing for the purpose of obtaining that applicant's criminal history record
information, as defined in 28 C.F.R. § 20.3(d) or successor provision, from the Federal
HB 2618                                         3

 Bureau of Investigation and the State's criminal history record repository, as defined in
 28 C.F.R. § 20.3(f) or successor provision.
        (10) "Data System" means the Commission's repository of information about
 Licensees as further set forth in section 334.1971.
        (11) "Domicile" means the jurisdiction which is the Licensee's principal home
 for legal purposes.
        (12) "Encumbered License" means a license that a State's Respiratory Therapy
 Licensing Authority has limited in any way.
        (13) "Executive Committee" means a group of directors elected or appointed to
 act on behalf of, and within the powers granted to them by the Commission.
        (14) "Home State" except as set forth in section 334.1962, means the Member
 State that is the Licensee's primary Domicile.
        (15) "Home State License" means an active license to practice Respiratory
 Therapy in a Home State that is not an Encumbered License.
        (16) "Jurisprudence Requirement" means an assessment of an individual's
 knowledge of the State laws and regulations governing the Practice of Respiratory
 Therapy in such State.
        (17) "Licensee" means an individual who currently holds an authorization from
 the State to practice as a Respiratory Therapist.
        (18) "Member State" means a State that has enacted the Compact and been
 admitted to the Commission in accordance with the provisions herein and Commission
 Rules.
        (19) "Model Compact" means the model for the Respiratory Care Interstate
 Compact on file with The Council of State Governments or other entity as designated by
 the Commission.
        (20) "Remote State" means a Member State where a Licensee is exercising or
 seeking to exercise the Compact Privilege.
        (21) "Respiratory Therapist" or "Respiratory Care Practitioner" means an
 individual who holds a credential issued by the National Board for Respiratory Care (or
 its successor) and holds a license in a State to practice Respiratory Therapy. For
 purposes of this Compact, any other title or status adopted by a State to replace the
 term "Respiratory Therapist" or "Respiratory Care Practitioner" shall be deemed
 synonymous with "Respiratory Therapist" and shall confer the same rights and
 responsibilities to the Licensee under the provisions of this Compact at the time of its
 enactment.
        (22) "Respiratory Therapy," "Respiratory Therapy Practice," "Respiratory
 Care," "the Practice of Respiratory Care," and "the Practice of Respiratory Therapy"
HB 2618                                         4

 means the care and services provided by or under the direction and supervision of a
 Respiratory Therapist or Respiratory Care Practitioner.
         (23) "Respiratory Therapy Licensing Authority" means the agency, board, or
 other body of a State that is responsible for licensing and regulation of Respiratory
 Therapists.
         (24) "Rule" means a regulation promulgated by an entity that has the force and
 effect of law.
         (25) "Scope of Practice" means the procedures, actions, and processes a
 Respiratory Therapist licensed in a State or practicing under a Compact Privilege in a
 State is permitted to undertake in that State and the circumstances under which the
 Respiratory Therapist is permitted to undertake those procedures, actions, and
 processes. Such procedures, actions, and processes, and the circumstances under
 which they may be undertaken may be established through means, including, but not
 limited to, statute, regulations, case law, and other processes available to the State
 Respiratory Therapy Licensing Authority or other government agency.
         (26) "Significant Investigative Information" means information, records, and
 documents received or generated by a State Respiratory Therapy Licensing Authority
 pursuant to an investigation for which a determination has been made that there is
 probable cause to believe that the Licensee has violated a statute or regulation that is
 considered more than a minor infraction for which the State Respiratory Therapy
 Licensing Authority could pursue Adverse Action against the Licensee.
         (27) "State" means any state, commonwealth, district, or territory of the United
 States.
             334.1956. 1. In order to participate in this Compact and thereafter continue as a
 Member State, a Member State shall:
         (1) Enact a Compact that is not materially different from the Model Compact;
         (2) License Respiratory Therapists;
         (3) Participate in the Commission's Data System;
         (4) Have a mechanism in place for receiving and investigating complaints
 against Licensees and Compact Privilege holders;
         (5) Notify the Commission, in compliance with the terms of this Compact and
 Commission Rules, of any Adverse Action against a Licensee, a Compact Privilege
 holder, or a license applicant;
         (6) Notify the Commission, in compliance with the terms of this Compact and
 Commission Rules, of the existence of Significant Investigative Information;
         (7) Comply with the Rules of the Commission;
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          (8) Grant the Compact Privilege to a holder of an active Home State License and
 otherwise meet the applicable requirements of section 334.1959 in a Member State; and
          (9) Complete a Criminal Background Check for each new Licensee at the time of
 initial licensure. Where expressly authorized or permitted by federal law, whether such
 federal law is in effect prior to, at, or after the time of a Member State's enactment of
 this Compact, a Member State's enactment of this Compact shall hereby authorize the
 Member State's Respiratory Therapy Licensing Authority to perform Criminal
 Background Checks as defined herein. The absence of such a federal law as
 described in this subdivision shall not prevent or preclude such authorization where it
 may be derived or granted through means other than the enactment of this Compact.
          2. Nothing in this Compact prohibits a Member State from charging a fee for
 granting and renewing the Compact Privilege.
              334.1959. 1. To exercise the Compact Privilege under the terms and provisions
 of the Compact, the Licensee shall:
          (1) Hold and maintain an active Home State License as a Respiratory Therapist;
          (2) Hold and maintain an active credential from the National Board for
 Respiratory Care (or its successor) that would qualify them for licensure in the Remote
 State in which they are seeking the privilege;
          (3) Have not had any Adverse Action against a license within the previous two
 (2) years;
          (4) Notify the Commission that the Licensee is seeking the Compact Privilege
 within a Remote State or States;
          (5) Pay any applicable fees, including any State and Commission fees and
 renewal fees, for the Compact Privilege;
          (6) Meet any Jurisprudence Requirements established by the Remote State in
 which the Licensee is seeking a Compact Privilege;
          (7) Report to the Commission Adverse Action taken by any non-Member State
 within thirty (30) days from the date the Adverse Action is taken;
          (8) Report to the Commission, when applying for a Compact Privilege, the
 address of the Licensee's Domicile and thereafter promptly report to the Commission
 any change in the address of the Licensee's Domicile within thirty (30) days of the
 effective date of the change in address; and
          (9) Consent to accept service of process by mail at the Licensee's Domicile on
 record with the Commission with respect to any action brought against the Licensee by
 the Commission or a Member State, and consent to accept service of a subpoena by mail
 at the Licensee's Domicile on record with the Commission with respect to any action
 brought or investigation conducted by the Commission or a Member State.
HB 2618                                          6

         2. The Compact Privilege is valid until the expiration date or revocation of the
 Home State License unless terminated pursuant to Adverse Action. The Licensee must
 comply with all of the requirements of subsection 1 of this section to maintain the
 Compact Privilege in a Remote State. If those requirements are met, no Adverse
 Actions are taken, and the Licensee has paid any applicable Compact Privilege renewal
 fees, then the Licensee will maintain the Licensee's Compact Privilege.
         3. A Licensee providing Respiratory Therapy in a Remote State under the
 Compact Privilege shall function within the Scope of Practice authorized by the Remote
 State for the type of Respiratory Therapist license the Licensee holds. Such procedures,
 actions, processes, and the circumstances under which they may be undertaken may be
 established through means, including, but not limited to, statute, regulations, case law,
 and other processes available to the State Respiratory Therapy Licensing Authority or
 other government agency.
         4. If a Licensee's Compact Privilege in a Remote State is removed by the Remote
 State, the individual shall lose or be ineligible for the Compact privilege in that Remote
 State until the Compact Privilege is no longer limited or restricted by that State.
         5. If a Home State License is encumbered, the Licensee shall lose the Compact
 Privilege in all Remote States until the following occur:
         (1) The Home State License is no longer encumbered; and
         (2) Two (2) years have elapsed from the date on which the license is no longer
 encumbered due to the Adverse Action.
         6. Once a Licensee with a restricted or limited license meets the requirements of
 subdivisions (1) and (2) of subsection 5 of this section, the Licensee must also meet the
 requirements of subsection 1 of this section to obtain a Compact Privilege in a Remote
 State.
             334.1962. 1. An Active Military Member, or their spouse, shall designate a
 Home State where the individual has a current license in good standing. The individual
 may retain the Home State designation during the period the service member is on
 active duty.
         2. An Active Military Member and their spouse shall not be required to pay to
 the Commission for a Compact Privilege any fee that may otherwise be charged by the
 Commission. If a Remote State chooses to charge a fee for a Compact Privilege, it may
 choose to charge a reduced fee or no fee to an Active Military Member and their spouse
 for a Compact Privilege.
             334.1965. 1. A Member State in which a Licensee is licensed shall have authority
 to impose Adverse Action against the license issued by that Member State.
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         2. A Member State may take Adverse Action based on Significant Investigative
 Information of a Remote State or the Home State, so long as the Member State follows
 its own procedures for imposing Adverse Action.
         3. Nothing in this Compact shall override a Member State's decision that
 participation in an Alternative Program may be used in lieu of Adverse Action and that
 such participation shall remain non-public if required by the Member State's laws.
         4. A Remote State shall have the authority to:
         (1) Take Adverse Actions as set forth herein against a Licensee's Compact
 Privilege in that State;
         (2) Issue subpoenas for both hearings and investigations that require the
 attendance and testimony of witnesses, and the production of evidence.
         (a) Subpoenas may be issued by a Respiratory Therapy Licensing Authority in a
 Member State for the attendance and testimony of witnesses and the production of
 evidence.
         (b) Subpoenas issued by a Respiratory Therapy Licensing Authority in a
 Member State for the attendance and testimony of witnesses shall be enforced in the
 latter State by any court of competent jurisdiction in the latter State, according to the
 practice and procedure of that court applicable to subpoenas issued in proceedings
 pending before it.
         (c) Subpoenas issued by a Respiratory Therapy Licensing Authority in a
 Member State for production of evidence from another Member State shall be enforced
 in the latter State, according to the practice and procedure of that court applicable to
 subpoenas issued in the proceedings pending before it.
         (d) The issuing authority shall pay any witness fees, travel expenses, mileage,
 and other fees required by the service statutes of the State where the witnesses or
 evidence are located;
         (3) Unless otherwise prohibited by State law, recover from the Licensee the costs
 of investigations and disposition of cases resulting from any Adverse Action taken
 against that Licensee;
         (4) Notwithstanding subdivision (2) of this subsection, a Member State may not
 issue a subpoena to gather evidence of conduct in another Member State that is lawful in
 such other Member State for the purpose of taking Adverse Action against a Licensee's
 Compact Privilege or application for a Compact Privilege in that Member State; and
         (5) Nothing in this Compact authorizes a Member State to impose discipline
 against a Respiratory Therapist's Compact Privilege in that Member State for the
 individual's otherwise lawful practice in another State.
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         5. (1) In addition to the authority granted to a Member State by its respective
 Respiratory Therapy Practice act or other applicable state law, a Member State may
 participate with other Member States in joint investigations of Licensees, provided,
 however, that a Member State receiving such a request has no obligation to respond to
 any subpoena issued regarding an investigation of conduct or practice that was lawful in
 a Member State at the time it was undertaken.
         (2) Member States shall share any Significant Investigative Information,
 litigation, or compliance materials in furtherance of any joint or individual investigation
 initiat