SENATE DOCKET, NO. 671 FILED ON: 2/4/2021
SENATE . . . . . . . . . . . . . . No.
The Commonwealth of Massachusetts
_________________
PRESENTED BY:
Joseph A. Boncore
_________________
To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:
The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:
An Act relative to nurse licensure compacts.
_______________
PETITION OF:
NAME: DISTRICT/ADDRESS:
Joseph A. Boncore First Suffolk and Middlesex
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 SENATE DOCKET, NO. 671 FILED ON: 2/4/2021
SENATE . . . . . . . . . . . . . . No.
[Pin Slip]
[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 103 OF 2019-2020.]
The Commonwealth of Massachusetts
_______________
In the One Hundred and Ninety-Second General Court
(2021-2022)
_______________
An Act relative to nurse licensure compacts.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority
of the same, as follows:
1 SECTION 1. Subsection (c) of section 14 of chapter 13 of the General Laws, as
2 appearing in the 2018 Official Edition, is hereby amended by inserting, in line 4, after the words
3 “twelve,”, the following words:- and chapter 112A.
4 SECTION 2. Section 79 of chapter 112 of the General Laws, as appearing in the 2018
5 Official Edition, is hereby amended by adding the following two sentences:-
6 The board may assess a licensed nurse a penalty of not more than $2,000 for each
7 violation of regulations promulgated pursuant to this section and for each violation of any
8 general law that governs the practice of nursing. The board, through regulation, shall ensure that
9 any fine levied is commensurate with the severity of the violation.
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10 SECTION 3. The General Laws are hereby amended by inserting after chapter 112 the
11 following chapter:-
12 Chapter 112A. Nurse Licensure Compact
13 Section 1.
14 As used in this chapter, the following words shall have the following meanings:
15 “Adverse action”, any administrative, civil, equitable or criminal action permitted by a
16 state’s laws which is imposed by a licensing board or other authority against a nurse, including
17 actions against an individual’s license or multistate licensure privilege such as revocation,
18 suspension, probation, monitoring of the licensee, limitation on the licensee’s practice, or any
19 other encumbrance on licensure affecting a nurse’s authorization to practice, including issuance
20 of a cease and desist action.
21 “Alternative program”, a non-disciplinary monitoring program approved by a licensing
22 board.
23 “Compact” or “Nurse Licensure Compact”, the legally binding agreement between party
24 states as adopted by the National Council of State Boards of Nursing Nurse Licensure Compact
25 in its Final Version dated May 4, 2015, and entered into by the commonwealth in accordance
26 with this chapter.
27 “Coordinated licensure information system”, an integrated process for collecting, storing
28 and sharing information on nurse licensure and enforcement activities related to nurse licensure
29 laws that is administered by a nonprofit organization composed of and controlled by licensing
30 boards.
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31 “Current significant investigative information”, (i) investigative information that a
32 licensing board, after a preliminary inquiry that includes notification and an opportunity for the
33 nurse to respond, if required by state law, has reason to believe is not groundless and, if proved
34 true, would indicate more than a minor infraction or (ii) investigative information that indicates
35 that the nurse represents an immediate threat to public health and safety regardless of whether
36 the nurse has been notified and had an opportunity to respond.
37 “Encumbrance”, a revocation or suspension of, or any limitation on, the full and
38 unrestricted practice of nursing imposed by a licensing board.
39 “Home state”, the party state which is the nurse’s primary state of residence.
40 “Interstate commission”, the Interstate Commission of Nurse Licensure Compact
41 Administrators as established in section 6 of this chapter.
42 “Licensing board”, a party state’s regulatory body responsible for issuing nurse licenses.
43 “Multistate license”, a license to practice as a registered nurse or a licensed practical or
44 vocational nurse issued by a home state licensing board that authorizes the licensed nurse to
45 practice in all party states under a multistate licensure privilege.
46 “Multistate licensure privilege”, a legal authorization associated with a multistate license
47 permitting the practice of nursing as either a registered nurse or as a licensed practical or
48 vocational nurse in a remote state.
49 “Nurse”, registered nurse or a licensed practical or vocational nurse, as those terms are
50 defined by each party state’s practice laws.
51 “Party state”, the commonwealth and any other state that has adopted this compact.
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52 “Remote state”, a party state other than the home state.
53 “Single-state license”, a nurse license issued by a party state that authorizes practice only
54 within the issuing state and does not include a multistate licensure privilege to practice in any
55 other party state.
56 “State”, a state, territory or possession of the United States and the District of Columbia.
57 “State practice laws”, a party state’s laws, rules and regulations that govern the practice
58 of nursing, define the scope of nursing practice, and establish the methods and grounds for
59 imposing discipline. “State practice laws” do not include requirements necessary to obtain and
60 retain a license, except for qualifications or requirements of the home state.
61 Section 2.
62 (a) A multistate license to practice as a nurse issued by a home state to a resident in that
63 state will be recognized by each party state as authorizing a nurse to practice as a registered
64 nurse or as a licensed practical or vocational nurse, under a multistate licensure privilege, in each
65 party state.
66 (b) A state must implement procedures for considering the criminal history records of
67 applicants for initial multistate license or licensure by endorsement. Such procedures shall
68 include the submission of fingerprints or other biometric-based information by applicants for the
69 purpose of obtaining an applicant’s criminal history record information from the Federal Bureau
70 of Investigation and the agency responsible for retaining that state’s criminal records.
71 (c) Each party state shall require the following for an applicant to obtain or retain a
72 multistate license in the home state:
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73 (1) Meets the home state’s qualifications for licensure or renewal of licensure, as well as,
74 all other applicable state laws;
75 (2) (i) Has graduated or is eligible to graduate from a licensing board-approved registered
76 nurse or practical or vocational nurse pre-licensure education program; or (ii) has graduated from
77 a foreign registered nurse or practical or vocational nurse pre-licensure education program that
78 (A) has been approved by the authorized accrediting body in the applicable country and (B) has
79 been verified by an independent credentials review agency to be comparable to a licensing
80 board-approved pre-licensure education program;
81 (3) Has, if a graduate of a foreign pre-licensure education program not taught in English
82 or if English is not the individual’s native language, successfully passed an English proficiency
83 examination that includes the components of reading, speaking, writing and listening;
84 (4) Has successfully passed an NCLEX-RN® or NCLEX-PN® Examination or
85 recognized predecessor, as applicable;
86 (5) Is eligible for or holds an active, unencumbered license;
87 (6) Has submitted, in connection with an application for initial licensure or licensure by
88 endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history
89 record information from the Federal Bureau of Investigation and the agency responsible for
90 retaining that state’s criminal records;
91 (7) Has not been convicted or found guilty, or entered into an agreed disposition, of a
92 felony offense under applicable state or federal criminal law;
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 93 (8) Has not been convicted or found guilty, or entered into an agreed disposition, of a
94 misdemeanor offense related to the practice of nursing as determined on a case-by-case basis;
95 (9) Is not currently enrolled in an alternative program;
96 (10) Is subject to self-disclosure requirements regarding current participation in an
97 alternative program; and
98 (11) Has a valid United States Social Security number.
99 (d) All party states shall be authorized, in accordance with existing state due process law,
100 to take adverse action against a nurse’s multistate licensure privilege such as revocation,
101 suspension, probation or any other action that affects a nurse’s authorization to practice under a
102 multistate licensure privilege, including cease and desist actions. If a party state takes such
103 action, it shall promptly notify the administrator of the coordinated licensure information system.
104 The administrator of the coordinated licensure information system shall promptly notify the
105 home state of any such actions by remote states.
106 (e) A nurse practicing in a party state must comply with the state practice laws of the
107 state in which the client is located at the time service is provided. The practice of nursing is not
108 limited to patient care, but shall include all nursing practice as defined by the state practice laws
109 of the party state in which the client is located. The practice of nursing in a party state under a
110 multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the
111 courts and the laws of the party state in which the client is located at the time service is provided.
112 (f) Individuals not residing in a party state shall continue to be able to apply for a party
113 state’s single-state license as provided under the laws of each party state. However, the single-
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114 state license granted to these individuals will not be recognized as granting the privilege to
115 practice nursing in any other party state. Nothing in this compact shall affect the requirements
116 established by a party state for the issuance of a single-state license.
117 (g) Any nurse holding a home state multistate license, on the effective date of this
118 compact, may retain and renew the multistate license issued by the nurse’s then-current home
119 state, provided that:
120 (1) A nurse, who changes primary state of residence after this compact’s effective date,
121 must meet all applicable requirements under section 2 to obtain a multistate license from a new
122 home state.
123 (2) A nurse who fails to satisfy the multistate licensure requirements in section 2 due to a
124 disqualifying event occurring after this compact’s effective date shall be ineligible to retain or
125 renew a multistate license, and the nurse’s multistate license shall be revoked or deactivated in
126 accordance with applicable rules adopted by the interstate commission.
127 Section 3.
128 (a) Upon application for a multistate license, the licensing board in the issuing party state
129 shall ascertain, through the coordinated licensure information system, whether the applicant has
130 ever held, or is the holder of, a license issued by any other state, whether there are any
131 encumbrances on any license or multistate licensure privilege held by the applicant, whether any
132 adverse action has been taken against any license or multistate licensure privilege held by the
133 applicant and whether the applicant is currently participating in an alternative program.
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134 (b) A nurse may hold a multistate license, issued by the home state, in only one party
135 state at a time.
136 (c) If a nurse changes primary state of residence by moving between two party states, the
137 nurse must apply for licensure in the new home state, and the multistate license issued by the
138 prior home state will be deactivated in accordance with applicable rules adopted by the interstate
139 commission.
140 (1) The nurse may apply for licensure in advance of a change in primary state of
141 residence.
142 (2) A multistate license shall not be issued by the new home state until the nurse provides
143 satisfactory evidence of a change in primary state of residence to the new home state and
144 satisfies all applicable requirements to obtain a multistate license from the new home state.
145 (d) If a nurse changes primary state of residence by moving from a party state to a non-
146 party state, the multistate license issued by the prior home state will convert to a single-state
147 license, valid only in the former home state.
148 Section 4.
149 (a) In addition to the other powers conferred by state law, a licensing board shall have the
150 authority to:
151 (1) Take adverse action against a nurse’s multistate licensure privilege to practice within
152 that party state.
153 (i) Only the home state shall have the power to take adverse action against a nurse’s
154 license issued by the home state.
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155 (ii) For purposes of taking adverse action, the home state licensing board shall give the
156 same priority and effect to reported conduct received from a remote state as it would if such
157 conduct had occurred within the home state. In so doing, the home state shall apply its own state
158 laws to determine appropriate action.
159 (2) Issue cease and desist orders or impose an encumbrance on a nurse’s authority to
160 practice within that party state.
161 (3) Complete any pending investigations of a nurse who changes primary state of
162 residence during the course of such investigations. The licensing board shall also have the
163 authority to take appropriate action(s) and shall promptly report the conclusions of such
164 investigations to the administrator of the coordinated licensure information system. The
165 administrator of the coordinated licensure information system shall promptly notify the new
166 home state of any such actions.
167 (4) Issue subpoenas for both hearings and investigations that require the attendance and
168 testimony of witnesses, as well as, the production of evidence. Subpoenas issued by a licensing
169 board in a party state for the attendance and testimony of witnesses or the production of evidence
170 from another party state shall be enforced in the latter state by any court of competent
171 jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued
172 in proceedings pending before it. The issuing authority shall pay any witness fees, travel
173 expenses, mileage and other fees required by the service statutes of the state in which the
174 witnesses or evidence are located.
175 (5) Obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-
176 based information to the Federal Bureau of Investigation for criminal background checks,
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177 receive the results of the Federal Bureau of Investigation record search on criminal background
178 checks and use the results in making licensure decisions.
179 (6) If otherwise permitted by state law, recover from the affected nurse the costs of
180 investigations and disposition of cases resulting from any adverse action taken against that nurse.
181 (7) Take adverse action based on the factual findings of the remote state, provided that
182 the licensing board follows its own procedures for taking such adverse action.
183 (b) If adverse action is taken by the home state against a nurse’s multistate license, the
184 nurse’s multistate licensure privilege to practice in all other party states shall be deactivated until
185 all encumbrances have been removed from the multistate license. All home state disciplinary
186 orders that impose adverse action against a nurse’s multistate license shall include a statement
187 that the nurse’s multistate licensure privilege is deactivated in all party states during the
188 pendency of the order.
189 (c) Nothing in this compact shall override a p