Bill Summary – FastDemocracy

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68th Legislature 2023                                                                                              HB 409.1
                                                  HOUSE BILL NO. 409
                                              INTRODUCED BY A. REGIER
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  A BILL FOR AN ACT ENTITLED: “AN ACT ADOPTING THE ADVANCE PRACTICE REGISTERED NURSE
  COMPACT; PROVIDING RULEMAKING AUTHORITY; AND PROVIDING DEFINITIONS.”
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  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
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          NEW SECTION. Section 1.          Advance practice registered nurse compact -- enactment --
  provisions. The advanced practice registered nurse compact is enacted into law and entered into with all
  jurisdictions legally joining in the compact, in the f orm substantially as set f orth below.
                                                         ARTICLE I
                                   FINDINGS AND DECLARATIONS OF PURPOSE
          (1)      The party states f ind that:
          (a)      the health and saf ety of the public are af f ected by the degree of compliance with APRN
  licensure requirements and the ef f ectiveness of enf orcement activities related to state APRN licensure laws;
          (b)      violations of APRN licensure and other laws regulating the practice of nursing may result in
  injury or harm to the public;
          (c)      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;
          (d)      new practice modalities and technology make compliance with individual state APRN licensure
  laws dif f icult and complex;
          (e)      the current system of duplicative APRN licensure f or APRNs practicing in multiple states is
  cumbersome and redundant f or health care delivery systems, payors, state licensing boards, regulators, and
  APRNs; and
          (f )     unif ormity of APRN licensure requirements throughout the states promotes public saf ety and
  public health benef its as well as providing a mechanism to increase access to care.
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68th Legislature 2023                                                                                                HB 409.1
           (2)     The general purposes of this compact are to:
           (a)     f acilitate the states' responsibility to protect the public's healt h and saf ety;
           (b)     ensure and encourage the cooperation of party states in the areas of APRN licensure and
  regulation, including promotion of unif orm licensure requirements;
           (c)     f acilitate the exchange of inf ormation between party states in the areas of APRN regulation,
  investigation, and adverse actions;
           (d)     promote compliance with the laws governing APRN practice in each jurisdiction;
           (e)     invest all party states with the authority to hold an APRN accountable f or 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;
           (f )    decrease redundancies in the consideration and issuance of APRN licenses; and
           (g)     provide opportunities f or interstate p ractice by APRNs who meet unif orm licensure
  requirements.
                                                         ARTICLE II
                                                       DEFINITIONS
           As used in this compact:
           (1)     "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 def ined by
  the Interstate Commission of APRN Compact Administrators ("Commission"), and who is licensed to perf orm
  advanced nursing practice. An advanced practice registered nurse is licensed in an APRN role that is
  congruent with an APRN educational program, certif ication, and commission rules.
           (2)     "Adverse action" means any administrative, civil, equitable, or criminal action permitted by a
  state's laws that 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 af f ecting an AP RN's
  authorization to practice, including the issuance of a cease and desist action.
           (3)     "Alternative program" means a nondisciplinary monitoring program approved by a licensing
  board.
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68th Legislature 2023                                                                                                   HB 409.1
          (4)      "APRN licensure" means the regulatory mechanism used by a party state to grant legal
  authority to practice as an APRN.
          (5)      "APRN unif orm licensure requirements" means the minimum unif orm licensure, education, and
  examination requirements set f orth in subsection (2) of Article III of this compact.
          (6)      "Coordinated licensure inf ormation system" means an integrated process f or collecting, storing,
  and sharing inf ormation on APRN licensure and enf orcement activities related to APRN licensure laws that is
  administered by a nonprof it organization composed of and controlled by licensing boards.
          (7)      "Current signif icant investigatory inf ormation" means:
          (a)      investigative inf ormation that a licensing board, af ter a preliminary inquiry that includes
  notif ication and an opportunity f or 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 inf raction; or
          (b)      investigative inf ormation that indicates that the APRN represents an immediate threat to public
  health and saf ety regardless of whether the APRN has been notif ied and had an opportunity to respond.
          (8)      "Encumbrance" means a revocation or suspension of , or any limitation on, the f ull and
  unrestricted practice of nursing imposed by a licensing board in connection with a disciplinary proceeding.
          (9)      "Home state" means the party state that is the APRN's primary state of residence.
          (10)     "Licensing board" means a party state's regulatory body responsible f or regulating the practice
  of advanced practice registered nursing.
          (11)     "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 f ocus as the APRN is licensed in the home state.
          (12)     "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 f ocus
  as the APRN is licensed in the home state.
          (13)     "Noncontrolled prescription drug" means a device or drug that is not a controlled substance and
  is prohibited under state or f ederal law f rom being dispensed without a prescription. The term includes a device
  or drug that bears or is required to bear the legend "Caution: f ederal law prohibits dispensing without
  prescription" or "prescription only" or other legend that complies with f ederal law.
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68th Legislature 2023                                                                                               HB 409.1
           (14)    "Party state" means any state that has adopted this compact.
           (15)    "Population f ocus" means one of the six population f oci of f amily/individual across the lif espan,
  adult-gerontology, pediatrics, neonatal, women's health/gender-related, and psych/mental health.
           (16)    "Prescriptive authority" means the legal authority to prescribe medications and devices as
  def ined by party state laws.
           (17)    "Remote state" means a party state that is not the home state.
           (18)    "Role" means one of the f our recognized roles of certif ied registered nurse anesthetists
  (CRNA), certif ied nurse-midwives (CNM), clinical nurse specialists (CNS), and certif ied nurse practitioners
  (CNP).
           (19)    "Single-state license" mean 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.
           (20)    "State" means a state, territory, or possession of the United States and the District of Columbia.
           (21)    "State practice laws" means a party state's laws, rules, and regulations that govern APRN
  practice, def ine the scope of advanced nursing practice, and create the methods and grounds f or imposing
  discipline, except that prescriptive authority must be treated in accordance with subsections (7) and (8) of
  Article III of this compact. "State practice laws" does not include:
           (a)     a party state's laws, rules, and regulations requiring supervision or collaboration with a health
  care prof essional, except f or laws, rules, and regulations regarding prescribing controlled substances; or
           (b)     the requirements necessary to obtain and retain an APRN license, except f or qualif ications or
  requirements of the home state.
                                                       ARTICLE III
                                    GENERAL PROVISIONS AND JURISDICTION
           (1)     A state shall implement procedures f or considering the criminal history records of applicants f or
  initial APRN licensure or APRN licensure by endorsement. Such procedures must include the submission of
  f ingerprints or other biometric-based inf ormation by APRN applicants f or the purpose of obtaining an applicant's
  criminal history record inf ormation f rom the f ederal bureau of investigation and the agency responsible f or
  retaining the state's criminal records.
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68th Legislature 2023                                                                                               HB 409.1
          (2)      Each party state shall require an applicant to satisf y the f ollowing APRN unif orm licensure
  requirements to obtain or retain a multistate license in the home state:
          (a)      meets the homes state's qualif ications f or licensure or renewal of licensure as well as all other
  applicable state laws;
          (b)      (i) has completed an accredited graduate-level education program that prepares the applicant
  f or one of the f our recognized roles and population f oci; or
          (ii)     has completed a f oreign APRN education program f or one of the f our recognized roles and
  population f oci that has been approved by the authorized accrediting body in the applicable country and has
  been verif ied by an independent credentials review agency to be comparable to a licensing board -approved
  APRN education program;
          (c)      has, if a graduate of a f oreign APRN education program not taught in English or if English is
  not the individual's native language, successf ully passed an English prof iciency examination that includes the
  components of reading, speaking, writing, and listening;
          (d)      has successf ully passed a national certif ication examination that measures APRN role and
  population-f ocused competencies and maintains continued competence as evidenced by recertif ication in the
  role and population f ocus through the national certif ication program;
          (e)      holds an active, unencumbered license as a registered nurse and an active, unencumbered
  authorization to practice as an APRN;
          (f )     has successf ully passed an NCLEX-RN® examination or recognized predecessor, as
  applicable;
          (g)      has practiced f or at least 2,080 hours as an APRN in a role and population f ocus congruent
  with the applicant's education and training. For purposes of this section, practice may not include hours
  obtained as part of enrollment in an APRN education program.
          (h)      has submitted, in connection with an application f or initial licensure or licensure by
  endorsement, f ingerprints or other biometric data f or the purpose of obtaining criminal history record inf ormation
  f rom the f ederal bureau of investigation and the agency responsible f or retaining that state or, if applicable,
  f oreign country's criminal records;
          (i)      has not been convicted or f ound guilty, o r has entered into an agreed disposition, of a f elony
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68th Legislature 2023                                                                                                   HB 409.1
  of f ense under applicable state, f ederal, or f oreign criminal law;
           (j)      has not been convicted or f ound guilty, or has entered into an agreed disposition, of a
  misdemeanor of fense related to the practice of nursing as determined by f actors set f orth in rules adopted by
  the commission;
           (k)      is not currently enrolled in an alternative program;
           (l)      is subject to self -disclosure requirements regarding current participation in an alternative
  program; and
           (m)      has a valid United States social security number.
           (3)      An APRN issued a multistate license shall be licensed in an approved role and at least one
  approved population f ocus.
           (4)      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 s tate, under a
  multistate licensure privilege, in the same role and population f ocus as the APRN is licensed in the home state.
           (5)      Nothing in this compact may af f ect the requirements established by a party state f or the
  issuance of a single-state license, except that an individual may apply f or a single-state license, instead of a
  multistate license, even if otherwise qualif ied f or the multistate license. However, the f ailure of such an
  individual to af f irmatively opt f or a single-state license may result in the issuance of a multistate license.
           (6)      Issuance of an APRN multistate license must include prescriptive authority f or noncontrolled
  prescription drugs.
           (7)      For each state in which an APRN seeks authority to prescribe controlled substances, the APRN
  shall satisf y all requirements imposed by such state in granting and/or renewing such authority.
           (8)      An APRN issued a multistate license is authorized to assume responsibility and accountability
  f or patient care independent of any supervisory or collaborativ e relationship. This authority may be exercised in
  the home state and in any remote state in which the APRN exercises a multistate licensure privilege.
           (9)      All party states must 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 af f ects 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 notif y the administrator of the coordinated
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68th Legislature 2023                                                                                                 HB 409.1
  licensure inf ormation system. The administrator of the coordinated licensure inf ormation system shall promptly
  notif y the home state of any such actions by remote states.
          (10)     Except as otherwise expressly provided in this compact, an APRN practicing in a party state
  shall 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 must include all advanced nursing practice as def ined
  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.
          (11)     Except as otherwise expressly provided in this compact, this compact does not af fect additional
  requirements imposed by states f or advanced practice registered nursing. However, a multistate licensure
  privilege to practice registered nursing granted by a party state must be recognized by other party states as
  satisf ying any state law requirement f or registered nurse licensure as a precondition f or authorization t