An Overview of The Interstate Medical Licensure Compact Patrick F. Balestrieri Senior Board Attorney | North Carolina Medical Board North Carolina Association Medical Staff Services | Chapel Hill, North Carolina November 4, 2016

What is an Interstate Compact? Contract between two or more states on a particular issue Open to states, commonwealths, districts and territories Creates a new pathway to expedite the licensing of physicians seeking to practice medicine in multiple states

What is an Interstate Compact? Drafted by state medical board representatives, FSMB and Council of State Governments Goal is to facilitate multi-state practice without compromising quality “Take it or leave it” law for the most part Can be changed to comport with local statutory style or terminology

Why an Interstate Compact? Licensure Portability Rise in telemedicine and new technology Increase in multistate practice 916,264 licensed in US (2014 census) 15.5% licensed in 2 states (142,020) 6% licensed in 3 or more states (54,975)

What is The NC Medical Board Doing? Monitoring and evaluating The North Carolina Medical Board considered joining the Interstate Compact in November 2014 and decided not to join, but to monitor and consider joining at a future date.

The Eight Compact Principles The Compact has eight consensus principles: Participation voluntary for physicians and medical boards Participation creates another pathway for licensure and does not change a state’s existing medical practice act Treatment occurs where the patient is located at the time of treatment and the physician will be under the jurisdiction of the state board where the patient is located Mechanism will be created for improved sharing of information among member boards

The Eight Compact Principles Regulatory authority remains with the participating state boards and will not be delegated A physician practicing under the Compact is bound to comply with the statutes, rules and regulations of each Compact state where they choose to practice Boards are required to share certain complaint and investigative information with each other The license to practice medicine can be disciplined by any or all of the Compact states

What The Compact DOES NOT Do Doesn’t change a state’s Medical Practice Act Doesn’t require Maintenance of Certification Doesn’t supersede state regulatory control or authority over practice of medicine Doesn’t create a national licensure system Doesn’t allow physicians to circumvent state specific rules, regulations and requirements for renewal

Let’s Have Some Fun And Get Deep Into The Details Of The Most Important Parts Of The Interstate Compact Model Legislation!

Sec. 2. Definitions “Physician” specifies the criteria for who is eligible for licensure via the Compact and means any person who: Is a graduate of a medical school accredited by the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation or a medical school listed in the International Medical Education Directory or its equivalent Passed each component of USMLE or COMLEX-USA within 3 attempts Successfully completed GME approved by Accreditation Council for Graduate Medical Education or the American Osteopathic Association

Sec. 2. Definitions Holds specialty certification or a time-unlimited specialty certificate recognized by ABMS or AOA Possess full and unrestricted license to engage in the practice of medicine issued by a member board Never been convicted of any “offense” by a court of appropriate jurisdiction No discipline on any state medical license (excluding any action related to non-payment of license fees) Never had a controlled substance license or permit suspended or revoked Not under investigation by a licensing agency or law enforcement authority anywhere in world

Just A Few More Definitions “Offense” = felony, gross misdemeanor or crime of moral turpitude "State" means any state, commonwealth, district or territory of the United States "State of Principal License" means a member state where physician holds a license to practice medicine and which has been designated as such by the physician for purposes of the Compact

Sec. 4. State of Principal License Physician must designate a state of principal license which can be: State of primary residence, or State where at least 25% of the practice of medicine occurs, or Location of the physician's employer, or If 1, 2 and 3 are not met, then the state of residence for federal income tax purposes

Sec. 5. Application Physician shall file application for expedited license/request verification with state of principal license, who shall evaluate eligibility and issue letter of qualification verifying or denying eligibility Static qualifications (i.e. verification of medical education, graduate medical education, results of any medical or licensing examination, etc.) will not require additional primary source verification if done by the state of principal license Criminal background check will be done

Sec. 5. Application Once verified as eligible, physician shall complete a registration process established by the Commission to receive a license in the state of principal licensure A medical license will then be issued (or verification of Compact eligibility will be sent to the Commission if already licensed in the state of principal licensure) that shall authorize the physician to practice medicine in the issuing state   Other compact states = verify eligibility, pay fee, get license

Sec. 5. Application Compact license valid for a period consistent with the licensure period in the member state and in the same manner as required for other physicians holding a full and unrestricted license within the member state Compact license terminated if physician fails to maintain a license in the state of principal licensure for a non-disciplinary reason, without re-designation of a new state of principal licensure Not exactly sure how this will work yet – no rules yet

Sec. 7. Renewal A physician may renew all licenses with Commission if: Maintains full and unrestricted license in state of principal license Has not been convicted of any offense Has not had medical license disciplined anywhere in the world (excluding any action related to non-payment of license fees) Has not had controlled substance license/permit suspended or revoked  

A Little More About Renewal Physicians must comply with all CME requirements for renewal of a license issued by a member state Commission shall collect renewal fees and distribute them to the applicable member board, at which time the member board shall renew the medical license Physician information collected by the Commission during the renewal process will be distributed to all member boards

Sec. 8. Coordinating Information Commission shall establish database of all physicians licensed and who have applied for Compact license Member boards shall report all public action and complaints against a Compact physician Member boards shall report disciplinary and investigatory information as determined by rule Member boards shall share some, but not all, complaint and disciplinary information upon request of another member board (mandatory and discretionary as provided by rule)

Sec. 9. Joint Investigations A member board may participate with other member boards in joint investigations of Compact physicians A subpoena issued by a member state shall be enforceable in other member states

Sec. 10. Disciplinary Actions In general, any disciplinary action taken by any member board against a Compact physician shall be deemed unprofessional conduct which may be subject to discipline by other member boards, in addition to any separate violation of the medical practice act or regulations in that state

Sec. 10. Disciplinary Actions If a license in state of principal licensure is revoked, suspended, surrendered or relinquished in lieu of discipline, then all licenses issued to the physician by member boards shall automatically be placed, without further action necessary by any member board, on the same status If state of principal licensure reinstates license, a licensed issued by any other member board shall remain encumbered until that respective member board reinstates  

Sec. 10. Disciplinary Actions If a non-principal state of licensure license is revoked, suspended, surrendered or relinquished in lieu of discipline, then all license(s) issued by all other member board(s) shall be suspended, automatically and immediately without further action necessary by the other member board(s), for 90 days upon entry of the order by the disciplining board Member boards may terminate automatic license suspension prior to completion of 90 day period

Sec. 10. Disciplinary Actions If other disciplinary action is taken against a physician by any member board, any other member board may deem the action conclusive as a matter of law and fact decided and impose the same or lesser sanction(s), or pursue separate disciplinary action under its medical practice act, regardless of the action taken in other member states

Sec. 10. Disciplinary Actions You are subject to disciplinary action with respect to all states you are licensed in that are member states Example: Already licensed in CO and NV (Compact states) before Compact existed You pick CO as principal licensure state You use CO to get licensed through Compact in WY You keep/renew NV as you have always done You get revoked in CO – now this happens: Automatic revocation in NV and WY

Sec. 11. The Commission Member states have created a Commission to conduct the administration of the Compact Each member state gets two commissioners who can be board members or staff executives Meet at least once a year - minutes made available to the public except for closed matters

Sec. 12. The Commission’s Powers Oversee and maintain Compact administration Make rules and adopt bylaws (happening now) Issue advisory opinions Enforce compliance with Compact Establish and appoint committees Pay expenses related to ongoing activities Establish offices and hire staff (executive director) Report annually to legislatures and governors Perform necessary functions of Compact

Who Pays For All This? SECTION 13. FINANCE POWERS Commission will collect an annual assessment from each member state to cover the cost of the operations and activities of the Commission and its staff Annual assessment shall be allocated based on a formula to be determined by the Commission, which will eventually be a rule Commission is subject to a yearly financial audit and audit report included in annual Commission report

So Where Are We Now? Commission holding meetings and engaging in rulemaking (last meeting was 10/3/2016) Committees established include Executive, Budget, Funding, Technology, Personnel, Bylaws, Communications and Coordinating First license probably issued in early to mid 2017

17 States are in – 2 more possible

Compact Helpful Resources General Information: http://www.licenseportability.org/ Latest Compact News: http://www.licenseportability.org/news/ Model Compact Legislation (i.e. the actual compact): http://www.licenseportability.org/wp-content/uploads/2016/01/Interstate-Medical-Licensure-Compact-FINAL.pdf

Thank You For Your Time – Questions? Contact Information: Patrick F. Balestrieri (919) 326-1109, ext.225 Patrick.Balestrieri@ncmedboard.org North Carolina Medical Board 1203 Front Street Raleigh, NC 27609 (800) 253-9653 www.ncmedboard.org

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