KRS § 311.6208 — KY Code / Title XXVI / Chapter 311 / Section 311.6208
311.6208 Interstate Medical Licensure Compact
Status: in_force

311.6208 Interstate Medical Licensure Compact.

The Interstate Medical Licensure Compact is hereby enacted and entered into with all

other jurisdictions that legally join in the Compact, which is, in form, substantially as

follows:

ARTICLE I

PURPOSE

In order to strengthen access to health care, and in recognition of the advances in the

delivery of health care, the member states of the Interstate Medical Licensure Compact

have allied in common purpose to develop a comprehensive process that complements the

existing licensing and regulatory authority of state medical boards and provides a

streamlined process that allows physicians to become licensed in multiple states, thereby

enhancing the portability of a medical license and ensuring the safety of patients. The

Compact creates another pathway for licensure and does not otherwise change a state's

existing Medical Practice Act. The Compact also adopts the prevailing standard for

licensure and affirms that the practice of medicine occurs where the patient is located at

the time of the physician-patient encounter and therefore requires the physician to be

under the jurisdiction of the state medical board where the patient is located. State

medical boards that participate in the Compact retain the jurisdiction to impose an

adverse action against a license to practice medicine in that state issued to a physician

through the procedures in the Compact.

ARTICLE II

DEFINITIONS

As used in this compact:

(1) "Bylaws" means those bylaws established by the Interstate Commission pursuant to

Article XI for its governance, or for directing and controlling its actions and

conduct.

(2) "Commissioner" means the voting representative appointed by each member board

pursuant to Article XI.

(3) "Conviction" means a finding by a court that an individual is guilty of a criminal

offense through adjudication, or entry of a plea of guilt or no contest to the charge

by the offender. Evidence of an entry of a conviction of a criminal offense by the

court shall be considered final for purposes of disciplinary action by a member

board.

(4) "Expedited license" means a full and unrestricted medical license granted by a

member state to an eligible physician through the process set forth in the Compact.

(5) "Interstate Commission" means the interstate commission created pursuant to

Article XI.

(6) "License" means authorization by a state for a physician to engage in the practice of

medicine, which would be unlawful without the authorization.

(7) "Medical Practice Act" means laws and regulations governing the practice of

allopathic and osteopathic medicine within a member state.

(8) "Member board" means a state agency in a member state that acts in the sovereign

interests of the state by protecting the public through licensure, regulation, and

education of physicians as directed by the state government.

(9) "Member state" means a state that has enacted the Compact.

(10) "Physician" means any person who:

(a) 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;

(b) Passed each component of the United States Medical Licensing Examination

(USMLE) or the Comprehensive Osteopathic Medical Licensing Examination

(COMLEX-USA) within three (3) attempts, or any of its predecessor

examinations accepted by a state medical board as an equivalent examination

for licensure purposes;

(c) Successfully completed graduate medical education approved by the

Accreditation Council for Graduate Medical Education or the American

Osteopathic Association;

(d) Holds specialty certification or a time-unlimited specialty certificate

recognized by the American Board of Medical Specialties or the American

Osteopathic Association's Bureau of Osteopathic Specialists;

(e) Possesses a full and unrestricted license to engage in the practice of medicine

issued by a member board;

(f) Has never been convicted, received adjudication, deferred adjudication,

community supervision, or deferred disposition for any offense by a court of

appropriate jurisdiction;

(g) Has never held a license authorizing the practice of medicine subjected to

discipline by a licensing agency in any state, federal, or foreign jurisdiction,

excluding any action related to nonpayment of fees related to a license;

(h) Has never had a controlled substance license or permit suspended or revoked

by a state or the United States Drug Enforcement Administration; and

(i) Is not under active investigation by a licensing agency or law enforcement

authority in any state, federal, or foreign jurisdiction.

(11) "Practice of medicine" means the clinical prevention, diagnosis, or treatment of

human disease, injury, or condition requiring a physician to obtain and maintain a

license in compliance with the Medical Practice Act of a member state.

(12) "Offense" means a felony, gross misdemeanor, or crime of moral turpitude.

(13) "Rule" means a written statement by the Interstate Commission promulgated

pursuant to Article XII of the Compact that is of general applicability, implements,

interprets, or prescribes a policy or provision of the Compact, or an organizational,

procedural, or practice requirement of the Interstate Commission, and has the force

and effect of statutory law in a member state, and includes the amendment, repeal,

or suspension of an existing rule.

(14) "State" means any state, commonwealth, district, or territory of the United States.

(15) "State of principal license" means a member state where a physician holds a license

to practice medicine and which has been designated as such by the physician for

purposes of registration and participation in the Compact.

ARTICLE III

ELIGIBILITY

(1) A physician shall meet the eligibility requirements as defined in Article II to receive

an expedited license under the terms and provisions of the Compact.

(2) A physician who does not meet the requirements of Article II may obtain a license

to practice medicine in a member state if the individual complies with all laws and

requirements, other than the Compact, relating to the issuance of a license to

practice medicine in that state.

ARTICLE IV

DESIGNATION OF STATE OF PRINCIPAL LICENSE

(1) A physician shall designate a member state as the state of principal license for

purposes of registration for expedited licensure through the Compact if the

physician possesses a full and unrestricted license to practice medicine in that state,

and the state is:

(a) The state of primary residence for the physician;

(b) The state where at least twenty-five percent (25%) of the practice of medicine

occurs;

(c) The location of the physician's employer; or

(d) If no state qualifies under paragraph (a), paragraph (b), or paragraph (c), the

state designated as state of residence for purpose of federal income tax.

(2) A physician may redesignate a member state as state of principal license at any

time, as long as the state meets the requirements in subsection (1).

(3) The Interstate Commission is authorized to develop rules to facilitate redesignation

of another member state as the state of principal license.

ARTICLE V

APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE

(1) A physician seeking licensure through the Compact shall file an application for an

expedited license with the member board of the state selected by the physician as

the state of principal license.

(2) Upon receipt of an application for an expedited license, the member board within

the state selected as the state of principal license shall evaluate whether the

physician is eligible for expedited licensure and issue a letter of qualification,

verifying or denying the physician's eligibility, to the Interstate Commission.

(a) Static qualifications, which include verification of medical education,

graduate medical education, results of any medical or licensing examination,

and other qualifications as determined by the Interstate Commission through

rule, shall not be subject to additional primary source verification where

already primary source verified by the state of principal license.

(b) The member board within the state selected as the state of principal license

shall, in the course of verifying eligibility, perform a criminal background

check of an applicant, including the use of the results of fingerprint or other

biometric data checks compliant with the requirements of the Federal Bureau

of Investigation, with the exception of federal employees who have suitability

determination in accordance with 5 C.F.R. sec. 731.202.

(c) Appeal on the determination of eligibility shall be made to the member state

where the application was filed and shall be subject to the law of that state.

(3) Upon verification in subsection (2), physicians eligible for an expedited license

shall complete the registration process established by the Interstate Commission to

receive a license in a member state selected pursuant to subsection (1), including the

payment of any applicable fees.

(4) After receiving verification of eligibility under subsection (2) and any fees under

subsection (3), a member board shall issue an expedited license to the physician.

This license shall authorize the physician to practice medicine in the issuing state

consistent with the Medical Practice Act and all applicable laws and regulations of

the issuing member board and member state.

(5) An expedited license shall be 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.

(6) An expedited license obtained through the Compact shall be terminated if a

physician fails to maintain a license in the state of principal licensure for a

nondisciplinary reason, without redesignation of a new state of principal licensure.

(7) The Interstate Commission is authorized to develop rules regarding the application

process, including payment of any applicable fees, and the issuance of an expedited

license.

ARTICLE VI

FEES FOR EXPEDITED LICENSURE

(1) A member state issuing an expedited license authorizing the practice of medicine in

that state may impose a fee for a license issued or renewed through the Compact.

(2) The Interstate Commission is authorized to develop rules regarding fees for

expedited licenses.

ARTICLE VII

RENEWAL AND CONTINUED PARTICIPATION

(1) A physician seeking to renew an expedited license granted in a member state shall

complete a renewal process with the Interstate Commission if the physician:

(a) Maintains a full and unrestricted license in a state of principal license;

(b) Has not been convicted or received adjudication, deferred adjudication,

community supervision, or deferred disposition for any offense by a court of

appropriate jurisdiction;

(c) Has not had a license authorizing the practice of medicine subject to discipline

by a licensing agency in any state, federal, or foreign jurisdiction, excluding

any action related to nonpayment of fees related to a license; and

(d) Has not had a controlled substance license or permit suspended or revoked by

a state or the United States Drug Enforcement Administration.

(2) Physicians shall comply with all continuing professional development or continuing

medical education requirements for renewal of a license issued by a member state.

(3) The Interstate Commission shall collect any renewal fees charged for the renewal of

a license and distribute the fees to the applicable member board.

(4) Upon receipt of any renewal fees collected in subsection (3), a member board shall

renew the physician's license.

(5) Physician information collected by the Interstate Commission during the renewal

process shall be distributed to all member boards.

(6) The Interstate Commission is authorized to develop rules to address renewal of

licenses obtained through the Compact.

ARTICLE VIII

COORDINATED INFORMATION SYSTEM

(1) The Interstate Commission shall establish a database of all physicians licensed, or

who have applied for licensure, under Article V.

(2) Notwithstanding any other provision of law, member boards shall report to the

Interstate Commission any public action or complaints against a licensed physician

who has applied or received an expedited license through the Compact.

(3) Member boards shall report disciplinary or investigatory information determined as

necessary and proper by rule of the Interstate Commission.

(4) Member boards may report any nonpublic complaint, disciplinary, or investigatory

information not required by subsection (3) to the Interstate Commission.

(5) Member boards shall share complaint or disciplinary information about a physician

upon request of another member board.

(6) All information provided to the Interstate Commission or distributed by member

boards shall be confidential, filed under seal, and used only for investigatory or

disciplinary matters.

(7) The Interstate Commission is authorized to develop rules for mandated or

discretionary sharing of information by member boards.

ARTICLE IX

JOINT INVESTIGATIONS

(1) Licensure and disciplinary records of physicians are deemed investigative.

(2) In addition to the authority granted to a member board by its respective Medical

Practice Act or other applicable state law, a member board may participate with

other member boards in joint investigations of physicians licensed by the member

boards.

(3) A subpoena issued by a member state shall be enforceable in other member states.

(4) Member boards may share any investigative, litigation, or compliance materials in

furtherance of any joint or individual investigation initiated under the Compact.

(5) 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.

ARTICLE X

DISCIPLINARY ACTIONS

(1) Any disciplinary action taken by any member board against a physician licensed

through the Compact shall be deemed unprofessional conduct which may be subject

to discipline by other member boards, in addition to any violation of the Medical

Practice Act or regulations in that state.

(2) If a license granted to a physician by the member board in the state of principal

license is revoked, surrendered or relinquished in lieu of discipline, or suspended,

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 the member board in the state of principal license subsequently reinstates the

physician's license, a license issued to the physician by any other member board

shall remain encumbered until that respective member board takes action to

reinstate the license in a manner consistent with the Medical Practice Act of that

state.

(3) If disciplinary action is taken against a physician by a member board not in the state

of principal license, any other member board may deem the action conclusive as to

matter of law and fact decided, and:

(a) Impose the same or lesser sanctions against the physician so long as such

sanctions are consistent with the Medical Practice Act of that state; or

(b) Pursue separate disciplinary action against the physician under its respective

Medical Practice Act, regardless of the action taken in other member states.

(4) If a license granted to a physician by a member board is revoked, surrendered or

relinquished in lieu of discipline, or suspended, then any licenses issued to the

physician by any other member boards shall be suspended, automatically and

immediately without further action necessary by the other member boards, for

ninety (90) days upon entry of the order by the disciplining board, to permit the

member boards to investigate the basis for the action under the Medical Practice

Act of that state. A member board may terminate the automatic suspension of the

license it issued prior to the completion of the ninety (90) day suspension period in

a manner consistent with the Medical Practice Act of that state.

ARTICLE XI

INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION

(1) The member states hereby create the "Interstate Medical Licensure Compact

Commission."

(2) The purpose of the Interstate Commission is the administration of the Interstate

Medical Licensure Compact, which is a discretionary state function.

(3) The Interstate Commission shall be a body corporate and joint agency of the

member states and shall have all the responsibilities, powers, and duties set forth in

the Compact, and such additional powers as may be conferred upon it by a

subsequent concurrent action of the respective legislatures of the member states in

accordance with the terms of the Compact.

(4) The Interstate Commission shall consist of two (2) voting representatives appointed

by each member state who shall serve as commissioners. In states where allopathic

and osteopathic physicians are regulated by separate member boards, or if the

licensing and disciplinary authority is split between multiple member boards within

a member state, the member state shall appoint one (1) representative from each

member board. A commissioner shall be an:

(a) Allopathic or osteopathic physician appointed to a member board;

(b) Executive director, executive secretary, or similar executive of a member

board; or

(c) Member of the public appointed to a member board.

(5) The Interstate Commission shall meet at least once each calendar year. A portion of

this meeting shall be a business meeting to address such matters as may properly

come before the Commission, including the election of officers. The chairperson

may call additional meetings and shall call for a meeting upon the request of a

majority of the member states.

(6) The bylaws may provide for meetings of the Interstate Commission to be conducted

by telecommunication or electronic communication.

(7) Each commissioner participating at a meeting of the Interstate Commission is

entitled to one (1) vote. A majority of commissioners shall constitute a quorum for

the transaction of business, unless a larger quorum is required by the bylaws of the

Interstate Commission. A commissioner shall not delegate a vote to another

commissioner. In the absence of its commissioner, a member state may delegate

voting authority for a specified meeting to another person from that state who shall

meet the requirements of subsection (4).

(8) The Interstate Commission shall provide public notice of all meetings and all

meetings shall be open to the public. The Interstate Commission may close a

meeting, in full or in portion, where it determines by a two-thirds (2/3) vote of the

commissioners present that an open meeting would be likely to:

(a) Relate solely to the internal personnel practices and procedures of the

Interstate Commission;

(b) Discuss matters specifically exempted from disclosure by federal statute;

(c) Discuss trade secrets, commercial, or financial information that is privileged

or confidential;

(d) Involve accusing a person of a crime, or formally censuring a person;

(e) Discuss information of a personal nature where disclosure would constitute a

clearly unwarranted invasion of personal privacy;

(f) Discuss investigative records compiled for law enforcement purposes; or

(g) Specifically relate to the participation in a civil action or other legal

proceeding.

(9) The Interstate Commission shall keep minutes which shall fully describe all matters

discussed in a meeting and shall provide a full and accurate summary of actions

taken, including record of any roll call votes.

(10) The Interstate Commission shall make its information and official records, to the

extent not otherwise designated in the Compact or by its rules, available to the

public for inspection.

(11) The Interstate Commission shall establish an executive committee, which shall

include officers, members, and others as determined by the bylaws. The executive

committee shall have the power to act on behalf of the Interstate Commission, with

the exception of rulemaking, during periods when the Interstate Commission is not

in session. When acting on behalf of the Interstate Commission, the executive

committee shall oversee the administration of the Compact including enforcement

and compliance with the provisions of the Compact, its bylaws and rules, and other

such duties as necessary.

(12) The Interstate Commission may establish other committees for governance and

administration of the Compact.

ARTICLE XII

POWERS AND DUTIES OF THE INTERSTATE COMMISSION

The Interstate Commission shall have the duty and power to:

(1) Oversee and maintain the administration of the Compact;

(2) Promulgate rules which shall be binding to the extent and in the manner provided

for in the Compact;

(3) Issue, upon the request of a member state or member board, advisory opinions

concerning the meaning or interpretation of the Compact, its bylaws, rules, and

actions;

(4) Enforce compliance with Compact provisions, the rules promulgated by the

Interstate Commission, and the bylaws, using all necessary and proper means,

including but not limited to the use of judicial process;

(5) Establish and appoint committees, including but not limited to an executive

committee as required by Article XI, which shall have the power to act on behalf of

the Interstate Commission in carrying out its powers and duties;

(6) Pay, or provide for the payment of, the expenses related to the establishment,

organization, and ongoing activities of the Interstate Commission;

(7) Establish and maintain one (1) or more offices;

(8) Borrow, accept, hire, or contract for services of personnel;

(9) Purchase and maintain insurance and bonds;

(10) Employ an executive director who shall have the powers to employ, select or

appoint employees, agents, or consultants, and to determine their qualifications,

define their duties, and fix their compensation;

(11) Establish personnel policies and programs relating to conflicts of interest, rates of

compensation, and qualifications of personnel;

(12) Accept donations and grants of money, equipment, supplies, materials and services,

and to receive, utilize, and dispose of them in a manner consistent with the conflict

of interest policies established by the Interstate Commission;

(13) Lease, purchase, accept contributions or donations of, or otherwise to own, hold,

improve or use, any property, real, personal, or mixed;

(14) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of

any property, real, personal, or mixed;

(15) Establish a budget and make expenditures;

(16) Adopt a seal and bylaws governing the management and operation of the Interstate

Commission;

(17) Report annually to the legislatures and governors of the member states concerning

the activities of the Interstate Commission during the preceding year. Such reports

shall also include reports of financial audits and any recommendations that may

have been adopted by the Interstate Commission;

(18) Coordinate education, training, and public awareness regarding the Compact, its

implementation, and its operation;

(19) Maintain records in accordance with the bylaws;

(20) Seek and obtain trademarks, copyrights, and patents; and

(21) Perform such functions as may be necessary or appropriate to achieve the purposes

of the Compact.

ARTICLE XIII

FINANCE POWERS

(1) The Interstate Commission may levy on and collect an annual assessment from each

member state to cover the cost of the operations and activities of the Interstate

Commission and its staff. The total assessment shall be sufficient to cover the

annual budget approved each year for which revenue is not provided by other

sources. The aggregate annual assessment amount shall be allocated upon a formula

to be determined by the Interstate Commission, which shall promulgate a rule

binding upon all member states.

(2) The Interstate Commission shall not incur obligations of any kind prior to securing

the funds adequate to meet the same.

(3) The Interstate Commission shall not pledge the credit of any of the member states,

except by, and with the authority of, the member state.

(4) The Interstate Commission shall be subject to a yearly financial audit conducted by

a certified or licensed public accountant and the report of the audit shall be included

in the annual report of the Interstate Commission.

ARTICLE XIV

ORGANIZATION AND OPERATION OF THE INTERSTATE COMMISSION

(1) The Interstate Commission shall, by a majority of commissioners present and

voting, adopt bylaws to govern its conduct as may be necessary or appropriate to

carry out the purposes of the Compact within twelve (12) months of the first

Interstate Commission meeting.

(2) The Interstate Commission shall elect or appoint annually from among its

commissioners a chairperson, a vice chairperson, and a treasurer, each of whom

shall have such authority and duties as may be specified in the bylaws. The

chairperson, or in the chairperson's absence or disability, the vice chairperson, shall

preside at all meetings of the Interstate Commission.

(3) Officers selected in subsection (2) shall serve without remuneration from the

Interstate Commission.

(4) The officers and employees of the Interstate Commission shall be immune from suit

and liability, either personally or in their official capacity, for a claim for damage to

or loss of property or personal injury or other civil liability caused or arising out of,

or relating to, an actual or alleged act, error, or omission that occurred, or that such

person had a reasonable basis for believing occurred, within the scope of Interstate

Commission employment, duties, or responsibilities, provided that such person

shall not be protected from suit or liability for damage, loss, injury, or liability

caused by the intentional or willful and wanton misconduct of such person.

(a) The liability of the executive director and employees of the Interstate

Commission or representatives of the Interstate Commission, acting within the

scope of their employment or duties for acts, errors, or omissions occurring

within their state, may not exceed the limits of liability set forth under the

constitution and laws of that state for state officials, employees, and agents.

The Interstate Commission is considered to be an instrumentality of the states

for the purposes of any such action. Nothing in this subsection shall be

construed to protect such person from suit or liability for damage, loss, injury,

or liability caused by the intentional or willful and wanton misconduct of such

person.

(b) The Interstate Commission shall defend the executive director, its employees,

and subject to the approval of the attorney general or other appropriate legal

counsel of the member state represented by an Interstate Commission

representative, shall defend such Interstate Commission representative in any

civil action seeking to impose liability arising out of an actual or alleged act,

error or omission that occurred within the scope of Interstate Commission

employment, duties or responsibilities, or that the defendant had a reasonable

basis for believing occurred within the scope of Interstate Commission

employment, duties, or responsibilities, provided that the actual or alleged act,

error, or omission did not result from intentional or willful and wanton

misconduct on the part of such person.

(c) To the extent not covered by the state involved, member state, or the Interstate

Commission, the representatives or employees of the Interstate Commission

shall be held harmless in the amount of a settlement or judgment, including

attorney's fees and costs, obtained against such persons arising out of an actual

or alleged act, error, or omission that occurred within the scope of Interstate

Commission employment, duties, or responsibilities, or that such persons had

a reasonable basis for believing occurred within the scope of Interstate

Commission employment, duties, or responsibilities, provided that the actual

or alleged act, error, or omission did not result from intentional or willful and

wanton misconduct on the part of such persons.

ARTICLE XV

RULEMAKING FUNCTIONS OF THE INTERSTATE COMMISSION

(1) The Interstate Commission shall promulgate reasonable rules in order to effectively

and efficiently achieve the purposes of the Compact. Notwithstanding the foregoing,

in the event the Interstate Commission exercises its rulemaking authority in a

manner that is beyond the scope of the purposes of the Compact, or the powers

granted hereunder, then such an action by the Interstate Commission shall be invalid

and have no force or effect.

(2) Rules deemed appropriate for the operations of the Interstate Commission shall be

made pursuant to a rulemaking process that substantially conforms to the "Model

State Administrative Procedure Act" of 2010, and subsequent amendments thereto.

(3) Not later than thirty (30) days after a rule is promulgated, any person may file a

petition for judicial review of the rule in the United States District Court for the

District of Columbia or the federal district where the Interstate Commission has its

principal offices, provided that the filing of such a petition shall not stay or

otherwise prevent the rule from becoming effective unless the court finds that the

petitioner has a substantial likelihood of success. The court shall give deference to

the actions of the Interstate Commission consistent with applicable law and shall

not find the rule to be unlawful if the rule represents a reasonable exercise of the

authority granted to the Interstate Commission.

ARTICLE XVI

OVERSIGHT OF INTERSTATE COMPACT

(1) The executive, legislative, and judicial branches of state government in each

member state shall enforce the Compact and shall take all actions necessary and

appropriate to effectuate the Compact's purposes and intent. The provisions of the

Compact and the rules promulgated hereunder shall have standing as statutory law

but shall not override existing state authority to regulate the practice of medicine.

(2) All courts shall take judicial notice of the Compact and the rules in any judicial or

administrative proceeding in a member state pertaining to the subject matter of the

Compact which may affect the powers, responsibilities or actions of the Interstate

Commission.

(3) The Interstate Commission shall be entitled to receive all service of process in any

such proceeding, and shall have standing to intervene in the proceeding for all

purposes. Failure to provide service of process to the Interstate Commission shall

render a judgment or order void as to the Interstate Commission, the Compact, or

promulgated rules.

ARTICLE XVII

ENFORCEMENT OF INTERSTATE COMPACT

(1) The Interstate Commission, in the reasonable exercise of its discretion, shall enforce

the provisions and rules of the Compact.

(2) The Interstate Commission may, by majority vote of the commissioners, initiate

legal action in the United States District Court for the District of Columbia, or, at

the discretion of the Interstate Commission, in the federal district where the

Interstate Commission has its principal offices, to enforce compliance with the

provisions of the Compact, and its promulgated rules and bylaws, against a member

state in default. The relief sought may include both injunctive relief and damages. In

the event judicial enforcement is necessary, the prevailing party shall be awarded all

costs of such litigation including reasonable attorney's fees.

(3) The remedies herein shall not be the exclusive remedies of the Interstate

Commission. The Interstate Commission may avail itself of any other remedies

available under state law or the regulation of a profession.

ARTICLE XVIII

DEFAULT PROCEDURES

(1) The grounds for default include, but are not limited to, failure of a member state to

perform such obligations or responsibilities imposed upon it by the Compact, or the

rules and bylaws of the Interstate Commission promulgated under the Compact.

(2) If the Interstate Commission determines that a member state has defaulted in the

performance of its obligations or responsibilities under the Compact, or the bylaws

or promulgated rules, the Interstate Commission shall:

(a) Provide written notice to the defaulting state and other member states, of the

nature of the default, the means of curing the default, and any action taken by

the Interstate Commission. The Interstate Commission shall specify the

conditions by which the defaulting state must cure its default; and

(b) Provide remedial training and specific technical assistance regarding the

default.

(3) If the defaulting state fails to cure the default, the defaulting state shall be

terminated from the Compact upon an affirmative vote of a majority of the

commissioners and all rights, privileges, and benefits conferred by the Compact

shall terminate on the effective date of termination. A cure of the default does not

relieve the offending state of obligations or liabilities incurred during the period of

the default.

(4) Termination of membership in the Compact shall be imposed only after all other

means of securing compliance have been exhausted. Notice of intent to terminate

shall be given by the Interstate Commission to the governor, the majority and

minority leaders of the defaulting state's legislature, and each of the member states.

(5) The Interstate Commission shall establish rules and procedures to address licenses

and physicians that are materially impacted by the termination of a member state, or

the withdrawal of a member state.

(6) The member state which has been terminated is responsible for all dues, obligations,

and liabilities incurred through the effective date of termination including

obligations, the performance of which extends beyond the effective date of

termination.

(7) The Interstate Commission shall not bear any costs relating to any state that has

been found to be in default or which has been terminated from the Compact, unless

otherwise mutually agreed upon in writing between the Interstate Commission and

the defaulting state.

(8) The defaulting state may appeal the action of the Interstate Commission by

petitioning the United States District Court for the District of Columbia or the

federal district where the Interstate Commission has its principal offices. The

prevailing party shall be awarded all costs of such litigation including reasonable

attorney's fees.

ARTICLE XIX

DISPUTE RESOLUTION

(1) The Interstate Commission shall attempt, upon the request of a member state, to

resolve disputes which are subject to the Compact and which may arise among

member states or member boards.

(2) The Interstate Commission shall promulgate rules providing for both mediation and

binding dispute resolution as appropriate.

ARTICLE XX

MEMBER STATES, EFFECTIVE DATE AND AMENDMENT

(1) Any state is eligible to become a member state of the Compact.

(2) The Compact shall become effective and binding upon legislative enactment of the

Compact into law by no less than seven (7) states. Thereafter, it shall become

effective and binding on a state upon enactment of the Compact into law by that

state.

(3) The governors of nonmember states, or their designees, shall be invited to

participate in the activities of the Interstate Commission on a nonvoting basis prior

to adoption of the Compact by all states.

(4) The Interstate Commission may propose amendments to the Compact for enactment

by the member states. No amendment shall become effective and binding upon the

Interstate Commission and the member states unless and until it is enacted into law

by unanimous consent of the member states.

ARTICLE XXI

WITHDRAWAL

(1) Once effective, the Compact shall continue in force and remain binding upon each

and every member state; provided that a member state may withdraw from the

Compact by specifically repealing the statute which enacted the Compact into law.

(2) Withdrawal from the Compact shall be by the enactment of a statute repealing the

same, but shall not take effect until one (1) year after the effective date of such

statute and until written notice of the withdrawal has been given by the withdrawing

state to the governor of each other member state.

(3) The withdrawing state shall immediately notify the chairperson of the Interstate

Commission in writing upon the introduction of legislation repealing the Compact

in the withdrawing state.

(4) The Interstate Commission shall notify the other member states of the withdrawing

state's intent to withdraw within sixty (60) days of its receipt of notice provided

under subsection (3).

(5) The withdrawing state is responsible for all dues, obligations and liabilities incurred

through the effective date of withdrawal, including obligations, the performance of

which extend beyond the effective date of withdrawal.

(6) Reinstatement following withdrawal of a member state shall occur upon the

withdrawing state reenacting the Compact or upon such later date as determined by

the Interstate Commission.

(7) The Interstate Commission is authorized to develop rules to address the impact of

the withdrawal of a member state on licenses granted in other member states to

physicians who designated the withdrawing member state as the state of principal

license.

ARTICLE XXII

DISSOLUTION

(1) The Compact shall dissolve effective upon the date of the withdrawal or default of

the member state which reduces the membership in the Compact to one (1) member

state.

(2) Upon the dissolution of the Compact, the Compact becomes null and void and shall

be of no further force or effect, and the business and affairs of the Interstate

Commission shall be concluded and surplus funds shall be distributed in accordance

with the bylaws.

ARTICLE XXIII

SEVERABILITY AND CONSTRUCTION

(1) The provisions of the Compact shall be severable, and if any phrase, clause,

sentence, or provision is deemed unenforceable, the remaining provisions of the

Compact shall be enforceable.

(2) The provisions of the Compact shall be liberally construed to effectuate its

purposes.

(3) Nothing in the Compact shall be construed to prohibit the applicability of other

interstate compacts to which the states are members.

ARTICLE XXIV

BINDING EFFECT OF COMPACT AND OTHER LAWS

(1) Nothing herein prevents the enforcement of any other law of a member state that is

not inconsistent with the Compact.

(2) All laws in a member state in conflict with the Compact are superseded to the extent

of the conflict.

(3) All lawful actions of the Interstate Commission, including all rules and bylaws

promulgated by the Commission, are binding upon the member states.

(4) All agreements between the Interstate Commission and the member states are

binding in accordance with their terms.

(5) In the event any provision of the Compact exceeds the constitutional limits imposed

on the legislature of any member state, such provision shall be ineffective to the

extent of the conflict with the constitutional provision in question in that member

state.