1. The Interstate Medical Licensure Compact Commission The Compact, the Commission, and Multi-State Licensure April 2016 Prepared by Ian Marquand, Commission Chairperson Exec. Officer, MT Board of Medical Examiners

2. THE COMPACT—CREATION & ADOPTION. January 2013—Special meeting of Federation of State Medical Boards members identifies Interstate Compact as preferred response to proposals for federal Physician licensing in Congress. April 2013—FSMB House of Delegates endorses development of a compact. Working group formed to draft compact language. Autumn 2014—Compact language finalized. Feb. 2015—Wyoming first state to adopt compact. May 2015—7 th state adopts; compact in force.

3. THE COMPACT—CURRENT STATUS. As of April 1, 2016—12 states have adopted: AlabamaNevada IdahoSouth Dakota IllinoisUtah IowaWest Virginia MinnesotaWisconsin MontanaWyoming

4. THE COMPACT—OTHER STATES. Other states are considering the Compact, including: AlaskaNebraska Arizona New Hampshire Colorado Oklahoma Kansas Pennsylvania MarylandRhode Island Michigan Vermont Mississippi Washington In all, 26 states have enacted or introduced Compact legislation, either in 2015 or 2016. Source: Federation of Medical Boards

5. THE COMPACT—WHAT IT’S NOT. It is NOT a takeover of state Physician licensing. It is another pathway to multi-state licensure for Physicians with exemplary practice histories. State licensure processes will remain in place for Physicians who are not eligible for licensure via the compact (or who choose not to seek it.) It is NOT owned or controlled by any organization. It is an instrument of interstate cooperation governed by appointed representatives of the adopting states.

6. THE COMPACT—WHAT IT’S NOT. It is NOT a federal government program or initiative. It is a state-based approach to multi-state Physician licensure that uses a vehicle—the interstate compact—specifically provided for in the U.S. Constitution. It is NOT part of the Affordable Care Act. The Compact has been praised as a common-sense approach to improve access to health care across the United States.

7. THE COMPACT—LICENSURE PROCESS. A Physician will receive licensure “via the Compact” in this manner: Physician selects a “state of principal license” (or “home state”). Home state reviews qualifications, performs criminal background check. Home state certifies to Compact Commission that Physician qualifies under the Compact. Compact Commission collects state license fees & Compact processing fees; notifies “receiving state” & passes along state fees. Receiving state grants license.

8. THE COMPACT COMMISSION. Each “adopting state” granted 2 seats on Commission. Commission members must be either: A Physician member of a licensing Board (either Medical or Osteopathic), A public member of a licensing board, or An executive director of a licensing board. For states with separate Medical & Osteo boards, each board is granted 1 seat.

9. THE COMPACT COMMISSION. Officers of the Commission (elected Oct. 2015): Chairperson: Ian Marquand (Montana) Vice-chairperson: Jon Thomas, M.D. (Minnesota) Secretary: Diana Shepard, CMBE (West Virginia) Treasurer: Brian Zachariah, M.D., M.B.A. (Illinois)

10. COMMISSION COMMITTEES. Executive Committee—made up of Commission officers & committee chairs; can conduct IMLCC business between meetings. OTHER COMMITTEES: Budget (expenses, financial management) Bylaws and Rules (governance) Communications (both internal and external) Coordinating (meeting logistics, planning) Funding (revenue, income, working capital) Personnel (recruiting and hiring) Technology (communications/info management)

11. THE COMPACT COMMISSION. October 27-28, 2015—First meeting, Chicago IL Commission seated Officers elected Initial bylaws adopted Committees formed Public comment December 18, 2015—Second meeting, Salt Lake City, UT Committee reports (extensive) Bylaws amended Public comment

12. THE COMPACT COMMISSION. March 31-April 1, 2016—Third meeting, St. Paul, MN Committee reports Bylaws amended (re: Exec. Committee meetings) “Policy on policy-making” approved “Rule on rule-making” sent for public comment Exec. Committee tasked with creating timeline to “live licensure”; timeline due June 1. Public comment June 24, 2016—Next meeting, Salt Lake City, UT Committee reports (inc. action items) Public comment/Commission decision on “rule on rule- making” Presentation of timeline to “live licensure”

13. COMMISSION TASKS—ALREADY BEGUN. Determine self-governance through bylaws, rules Establish budget and financial oversight methods Create policies and procedures for operations Develop communications strategies and processes Determine needs for information technology

14. COMMISSION TASKS—STILL TO COME. Establish fee structure for processing applications Select location for Commission office Seek executive/administrative services and/or staff Develop procedures for office-based operations Develop database of applicants and licensees Develop detailed financial oversight procedures Develop advanced communications/outreach plan

15. COMMISSION TASKS—RULEMAKING. The Commission is authorized by the Compact to create rules in the following areas: Physician re-designation of state of principal license. Standards to evaluate Physician qualifications. (Such as primary source verifications.) Application process. Establishing Commission fees and payment process. Issuance of licenses by “receiving” states. Renewal of licenses issued via the Compact. Mandatory or discretionary sharing of disciplinary info by member Boards. Withdrawal by member state & its impact on licensees. Mediation & binding dispute resolution among states. Fees to be paid by member states.

16. COMMISSION TASKS—BEYOND RULES. The Commission also is authorized by the Compact to create the following: Conflict of interest policy (to receive donations & gifts.) Personnel policies. Advisory opinions. A Commission seal. Trademarks, copyrights and patents.

17. THE COMPACT—STATE RESPONSIBILITIES. Prepare processes for certifying Physicians Verify State of Principal License (SPL) This will be done by verifying one of the following: 1) Physician’s principal residence is in the SPL, or 2) Practices at least 25% of the time in the SPL, or 3) Employed by an employer in the SPL, or 4) Declares the SPL for federal income tax purposes Review qualifications for licensure Perform criminal background check

18. THE COMPACT—STATE RESPONSIBILITIES. A State shall certify a Physician as eligible for licensure via the Compact if all of the following are met: Active licensure in a “Compact state” Eligible to claim “State of Principal License” Specialty Board certified Accredited medical education Passed licensing exam within 3 attempts No criminal convictions for any offense No discipline by a licensing agency No active investigations by licensing agency No action against prescribing privileges

19. THE COMPACT—STATE RESPONSIBILITIES. Determine if a “Certification” fee is needed. (NOTE: The Compact is silent regarding state “certification” fees.) Identify the info that must accompany Commission notification of licensure eligibility. Create rules (if needed) to clarify/enhance Compact process. (NOTE: Compact simply states “member board shall issue an expedited license to the physician.”) Identify if license fees should be adjusted.

20. THE COMPACT—STATE RESPONSIBILITIES. Create awareness of Compact to Physicians, hospitals and greater medical community. Provide reliable, accurate information about the Compact. (websites, newsletters, etc.) Record-keeping. Training of staff. Matching Board and/or agency activities with Commission development.

21. QUESTIONS?