OHIO LEGISLATIVE SERVICE COMMISSION
Office of Research Legislative Budget
www.lsc.ohio.gov and Drafting Office
S.B. 6 Final Analysis
134th General Assembly
Click here for S.B. 6’s Fiscal Note
Version: As Passed by the General Assembly
Primary Sponsors: Sens. Roegner and S. Huffman
Effective date: September 30, 2021; appropriation effective July 1, 2021
Effective Date:
Emma Carroll, Research Analyst
SUMMARY
Interstate Medical Licensure Compact
Enters Ohio into the Interstate Medical Licensure Compact, which enables a physician
seeking to practice in multiple states to have certain qualifications verified, and a
background check conducted, by the physician’s state of principal license, and
thereafter to apply for an expedited license to practice in other member states.
Appropriates $140,000 for FY 2022 to the State Medical Board for operating expenses.
Nurse aide training
Allows a nurse aide to satisfy the requirement to complete a training and competency
evaluation program by completing at least 75 hours of training in a long-term care
setting during the federal COVID-19 public health emergency.
Requires that a nurse aide using this new training pathway successfully complete a
competency evaluation conducted by the Director of Health.
DETAILED ANALYSIS
Interstate Medical Licensure Compact
The act enters Ohio as a party to the Interstate Medical Licensure Compact. The
Compact is an agreement among participating states to streamline the licensing process for
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physicians who wish to practice in multiple states. With the addition of Ohio, the Compact
includes 30 states, the District of Columbia, and the Territory of Guam.1
Under the Compact, the practice of medicine occurs where the patient is located for the
physician-patient encounter, and the physician is under the jurisdiction of the state medical
licensing board for that location.2
Physician eligibility
To meet the definition of “physician” under the Compact, and to be eligible for an
expedited license (discussed below), all of the following must apply:3
1. The person has graduated from an accredited medical school or an accepted
international medical school;
2. The person has passed, within three attempts, each component of the U.S. Medical
Licensing Examination, the Comprehensive Osteopathic Medical Licensing Examination,
or an equivalent examination;
3. The person has completed approved graduate medical education;
4. The person holds specialty certification or a time-unlimited specialty certificate
recognized by an organization named in the Compact;
5. The person possesses a full and unrestricted license to practice medicine issued by a
member state’s medical licensing board;
6. The person has never been convicted of, or had a similar disposition related to, any
felony, gross misdemeanor, or crime of moral turpitude;
7. The person has never held a license authorizing the practice of medicine subjected to
discipline by a licensing agency, other than for nonpayment of fees;
8. The person has never had a controlled substance license or permit suspended or
revoked;
9. The person is not under active investigation by a licensing agency or law enforcement
authority.
Expedited license under the Compact
Designating a state of principal license
To receive an expedited license through the Compact, a physician must designate a
member state as the state of principal license. For a state to be a state of principal license, the
1 Interstate Medical Licensure Compact, Introduction, https://www.imlcc.org/a-faster-pathway-to-
physician-licensure/.
2R.C. 4731.11, Compact Section 1 (references in this analysis to “Section” refer to sections of the
Compact as set forth in R.C. 4731.11, except as otherwise specified).
3 Section 2(k) and (l) and 3(a).
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physician must have a full and unrestricted license to practice medicine in that state and one of
the following must apply to the state:4
1. It is the physician’s state of principal residence;
2. It is the state where at least 25% of the physician’s practice of medicine occurs;
3. It is the location of the physician’s employer;
4. If none of the above apply, it is the physician’s state of residence for federal income tax
purposes.
A physician may re-designate the physician’s state of principal residence at any time in
accordance with rules that may be developed by the Interstate Medical Licensure Compact
Commission (Interstate Commission), discussed below.5
Application for an expedited license
A physician seeking licensure through the Compact is required to file an application for
an expedited license with the medical licensing board of the physician’s state of principal
residence. That board must evaluate whether the physician is eligible for an expedited license
and issue a letter of qualification to the Interstate Commission verifying or denying the
eligibility.6
The eligibility verification does not include verification of static qualifications, such as
education and licensing examination, if those qualifications have already been verified by the
state of principal residence. It does, however, include performing a criminal background check. 7
The act authorizes the State Medical Board of Ohio to require Compact applicants to comply
with Ohio’s criminal records check procedures, including regarding obtaining fingerprint
impressions.8
Once eligibility is verified, a physician must complete a registration process established
by the Interstate Commission, including paying any fees. Thereafter, a member state is required
to issue an expedited license to the physician, which authorizes the practice of medicine in that
state subject to that state’s medical practice act and all laws of the member state and its
medical licensing board.9
4 Section 4(a).
5 Section 4(b) and (c).
6 Section 5(a) and (b); see also Section 2(h) and (o).
7 Section 5(b).
8 R.C. 4731.112.
9 Section 5(c) to (e).
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Fees
A member state issuing an expedited license may impose a fee for a license issued or
renewed through the Compact. The Interstate Commission may develop rules regarding the
fees.10
Period of validity and termination
An expedited license is valid for a period consistent with the licensure period in the
member state and in the same manner as for other physicians holding full, unrestricted licenses
in that state. The expedited license must be terminated if the physician fails to maintain the
license in the state of principal licensure without re-designation of a new state of principal
licensure.11
Renewal
To renew an expedited license, a physician must complete a renewal process with the
Interstate Commission if the physician (1) maintains a full, unrestricted license in a state of
principal license, (2) has not been convicted of, or had related disposition for, any felony, gross
misdemeanor, or crime of moral turpitude, (3) has not had a medical license subject to
discipline by a licensing agency, other than for nonpayment of fees, and (4) has not had a
controlled substance license or permit suspended or revoked.12
Physicians must comply with continuing professional development and medical
education requirements for renewal of a license issued by a member state. The Interstate
Commission is required to collect any renewal fees and distribute them to the applicable
member state’s medical licensing board.13
Coordinated information system
The Interstate Commission is required to establish a database of all physicians with
expedited licenses and those who have applied for expedited licenses. All information provided
to the Interstate Commission or distributed to member states’ medical licensing boards is
confidential, must be filed under seal, and must be used only for investigatory or disciplinary
matters. Member states’ medical licensing boards are required to report to the Interstate
Commission any public action or complaints against a licensed physician who has applied for or
received an expedited license through the Compact; medical licensing boards may report any
nonpublic complaint, disciplinary, or investigatory information not specifically required.14
Member states’ medical licensing boards must report disciplinary or investigatory
information as specified in rules of the Interstate Commission. Member boards must share
10 Section 6.
11 Section 5(e) and (f).
12 Section 7(a).
13 Section 7.
14 Section 8(a), (b), (d), and (f).
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complaint and disciplinary information about a physician on request of another member
board.15
Joint investigations
The Compact specifies that licensure and disciplinary records of physicians are deemed
investigative and identifies procedures under which member states’ medical licensing boards
may conduct joint investigations. Additionally, any member state may investigate actual or
alleged violations of the statutes authorizing the practice of medicine in any other member
state in which a physician holds a license to practice medicine.16
Disciplinary actions
The Compact provides that any disciplinary action that is taken by a member state’s
medical licensing board against a physician licensed through the Compact is deemed
unprofessional conduct that may be subject to discipline by other member boards. If a
physician’s license from the physician’s state of principal license is revoked, suspended, or
surrendered, then all licenses issued to the physician by other member boards are
automatically placed on the same status. When the state of principal license subsequently
reinstates the physician’s license, other member states can take action to reinstate the
physician’s license in those states.17
If a physician’s license from a member board is revoked, suspended, or surrendered,
then any licenses issued by other member boards are automatically suspended for 90 days to
permit other member states to investigate under their state laws. A member board may
terminate the automatic suspension before the 90-day period ends.18
Interstate Medical Licensure Compact Commission
Membership and meetings
The Compact creates the Interstate Medical Licensure Compact Commission (Interstate
Commission) to administer the Compact. The Interstate Commission consists of two voting
representatives appointed by each member state, who are referred to as commissioners. Each
commissioner must be a member of a state’s medical licensing board.19 The act requires the
State Medical Board to appoint Ohio’s initial commissioners not later than October 30, 2021,
and any subsequent vacancy must be filled by the Board within 30 days.20 Governors of
15 Section 8(c) and (e).
16 Section 9.
17 Section 10(a), (b), and (c).
18 Section 10(d).
19 Section 11(a) to (d).
20 R.C. 4731.111.
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nonmember states are invited to participate in Interstate Commission activities as nonvoting
members.21
The Interstate Commission is required to meet at least once each calendar year. Bylaws
may provide for meetings by telecommunication or electronic communication. Except in limited
circumstances, such as regarding trade secrets or criminal accusations, meetings are public, and
public notice of meetings is required. Additional meetings may be called by the chairperson,
including if a majority of the member states request a meeting. The Compact includes
additional details pertaining to Interstate Commission meetings, including details related to
voting, meeting minutes, and availability of official records.22
Executive Committee
The Interstate Commission is required to establish an Executive Committee to act on
behalf of the Commission, other than rulemaking, when the Commission is not in session.
During those periods, the Executive Committee is required to oversee the administration of the
Compact. The Interstate Commission is also required to establish other committees for
governance and administration of the Compact.23
Powers and duties
The Compact lists various powers and duties of the Interstate Commission in addition to
administering the Compact. Some examples include (1) promulgating rules, (2) issuing advisory
opinions, (3) enforcing compliance with the Compact, (4) paying expenses, (5) employing an
executive director and other personnel, (6) establishing a budget, and (7) reporting annually to
legislatures and governors of member states.24
Finance powers
The Interstate Commission may collect from each member state an annual assessment
to cover the cost of operations and activities of the Commission and its staff. The total
assessment must be sufficient to cover the approved annual budget to the extent it is not
covered from other sources.25
The Interstate Commission cannot pledge the credit of any member state without the
state’s express permission, and it cannot incur obligations prior to securing adequate funds. The
Interstate Commission is subject to a yearly outside financial audit.26
21 Section 20(c).
22 Section 11(e) to (j).
23 Section 11(k) and (l).
24 Section 12.
25 Section 13(a).
26 Section 13(b) to (d).
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Organization and operation
The Interstate Commission is required to adopt bylaws to govern its conduct. It must
annually elect or appoint from among its commissioners a chairperson, vice chairperson, and
treasurer, all of which serve without pay.27
The Compact contains a number of immunity and hold harmless provisions. The officers
and employees of the Interstate Commission are immune from suit and liability, both
personally and in official capacity, related to the scope of Commission employment, duties, or
responsibilities, except for liability caused by intentional or willful and wanton misconduct.28
The Compact further provides that the Executive Director and employees are limited in liability
as provided under state law for state officials, employees, and agents, as applicable. The
Interstate Commission is required to defend the Executive Director and employees in related
civil actions, except in the case of intentional or willful and wanton misconduct. 29
Rulemaking
The Interstate Commission is required to adopt rules to achieve the purpose of the
Compact. Any rule that goes beyond the scope of the purposes of the Compact is invalid. The
Interstate Commission must follow a rulemaking process that substantially conforms to the
“Model State Administrative Procedure Act” of 2010. The Compact specifies a process for
judicial review that may be filed by a person to challenge a rule.30
Oversight of the Compact
The Compact requires the executive, legislative, and judicial branches of each member
state’s government to enforce it. The Compact and rules adopted under it are to have standing
as statutory law, but do not override state authority to regulate the practice of medicine.31
Enforcement, dispute resolution, and default procedures
Enforcement of the Compact is to be by the Interstate Commission. The Interstate
Commission may, by a majority vote of the commissioners, initiate legal action to enforce
compliance with the Compact by a member state in default. The Compact provides for
injunctive relief, damages, and attorney’s fees.32
27 Section 14(a) to (c).
28 Section 14(d).
29 Section 14(e) to (g).
30 Section 15.
31 Section 16(a) and (b).
32 Section 17(a) and (b).
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