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ARIZONA HOUSE OF REPRESENTATIVESFifty-sixth Legislature Second Regular Session |
Senate: HHS DP 5-2-0-0 | 3rd Read 17-11-2-0 |
SB 1295: advanced practice registered nurses; compact
Sponsor: Senator Shamp, LD 29
Committee on Health & Human Services
Overview
Adopts the Advanced Practice Registered Nurse Compact (Compact) to allow for multistate uniform licensure for advanced practice registered nurses (APRNs).
History
An APRN is a registered nurse who meets all prescribed licensure or certification requirements and who has undergone graduate-level education to practice advanced practice nursing (American Nurses Association). Currently, Arizona provides for licensure for four types of APRNs: 1) registered nurse practitioner; 2) certified nurse midwife; 3) clinical nurse specialist; and 4) certified registered nurse anesthetist (A.R.S. Title 32, Chapter 15, Articles 1 and 2). The Arizona State Board of Nursing (AZBN) is tasked with certifying APRN applicants in accordance with statutory requirements and AZBN rules (AZBN).
The Compact, a mutual recognition model of licensure for APRNs that allows an APRN to hold one multistate license with a privilege to practice in other Compact states, was adopted by the National Council of State Boards of Nursing (NCSBN) in 2002. The Compact went through several revisions. In 2020, NCSBN introduced the newly revised APRN Compact. This revised APRN Compact, including mandatory 2,080 practice hours among other uniform licensure requirements, was adopted at the 2020 NCSBN Delegate Assembly (AZBN APRN Compact Survey).
Provisions
General Provisions and Jurisdiction
1. Requires a party state to implement procedures for considering the criminal history records of applicants for initial APRN licensure or APRN licensure by endorsement, which must include submitting fingerprints or other biometric-based information to obtain such records from the Federal Bureau of Investigation (FBI) and the agency responsible for retaining that state’s criminal records. (Sec. 1)
2. Outlines the APRN uniform licensure requirements for an applicant to obtain or retain a multistate license in the home state as follows:
a) meets the home state’s qualifications for licensure or renewal and all applicable state laws;
b) completed either an accredited graduate-level education program that prepares the applicant for one of the four recognized roles and one of the six population foci or a foreign APRN education program as outlined;
c) passed an English proficiency examination, if applicable;
d) passed a national certification exam that measures APRN, role and population-focused competencies;
e) maintains continued competence as evidenced by recertification in the role and population focus through the national certification program;
f) holds an active, unencumbered license as a registered nurse and an active, unencumbered authorization to practice as an APRN;
g) passed an NCLEX-RN exam or recognized predecessor, as applicable;
h) practiced for at least 2,080 hours as an APRN, not including hours obtained as part of enrollment in an APRN education program, as outlined;
i) submitted fingerprints or other biometric data to obtain criminal history records from the FBI and agency responsible for retaining the state or, if applicable, foreign country’s criminal records;
j) has not been convicted or found guilty, or entered into an agreed disposition of a felony offense under applicable state, federal or foreign criminal law, or a misdemeanor offense related to the practice of nursing as determined by rules adopted by the Commission of APRN Compact Administrators (Commission);
k) is not currently enrolled in an alternative program;
l) is subject to self-disclosure requirements regarding current participation in an alternative program; and
m) has a valid U.S. social security number. (Sec. 1)
3. Requires an APRN multistate licensee to:
a) be licensed in an approved role and at least one approved population focus; and
b) be recognized by each party state as authorizing the APRN to practice in each party state, under a multistate licensure privilege, in the same role and population focus as the APRN is licensed in the home state. (Sec. 1)
4. Asserts that the Compact does not affect the requirements established by a party state for the issuance of a single-state license, except that an individual may apply for a single-state license, instead of a multistate license, even if the individual is otherwise qualified for the multistate license. (Sec. 1)
5. Requires the issuance of a multistate license to include prescriptive authority for noncontrolled prescription drugs. (Sec. 1)
6. Stipulates that an APRN seeking authority to prescribe controlled substances must satisfy all requirements imposed by the state in which the APRN seeks such authority. (Sec. 1)
7. Authorizes an APRN who is issued a multistate license to assume responsibility and accountability for patient care independent of any supervisory or collaborative relationship. (Sec. 1)
8. Specifies that the authority may be exercised in the home state and in any remote state in which the APRN exercises a multistate licensure privilege. (Sec. 1)
9. Authorizes all party states, in accordance with state due process laws, to take adverse action against an APRN’s multistate licensure privileges, including revocation, suspension, probation, cease and desist orders, or any other action that affects the multistate licensure privilege. (Sec. 1)
10. Requires a party state that takes an adverse action to promptly notify the Administrator of the Coordinated License Information System (CLIS Administrator), who must promptly notify the home state. (Sec. 1)
11. Requires an APRN practicing in a party state to comply with the state practice laws of the state in which the client is located at the time service is provided, except as otherwise expressly provided. (Sec. 1)
12. Specifies that APRN practice includes all advanced nursing practice as defined by the state practice laws of the party state. (Sec. 1)
13. Mandates that an APRN's practice in a party state under a multistate licensure privilege will subject the APRN to the jurisdiction of the licensing board, courts and laws of the party state in which the client is located at the time service is provided. (Sec. 1)
14. Stipulates that the Compact does not affect additional requirements imposed by states for advanced practice registered nursing, except as otherwise specified, but requires party states to recognize multistate licensure as satisfying any state law requirement for registered nurse (RN) licensure as a precondition for authorization to practice as an APRN in that state. (Sec. 1)
15. Asserts that individuals who do not reside in a party state can continue to be able to apply for a party state's single-state APRN license, however, the single-state license granted to these individuals will not be recognized as granting the privilege to practice as an APRN in any other party state. (Sec. 1)
Application for APRN Licensure in a Party State
16. Requires the licensing board in the issuing party state, on application for a license, to ascertain through the CLIS whether:
a) the applicant has ever held or is the holder of a licensed practical or vocational nursing, RN or APRN license issued by another state;
b) there are any encumbrances on any license or multistate licensure privilege held by the applicant;
c) any adverse action has been taken against any license or multistate licensure privilege held by the applicant; and
d) the applicant is currently participating in an alternative program. (Sec. 1)
17. Permits an APRN to hold a multistate APRN license issued by the home state in only one-party state at a time. (Sec. 1)
18. Requires an APRN who moves between two party states to apply for APRN licensure in the new home state and the license issued by the prior home state must be deactivated in accordance with applicable rules of the Commission, as follows:
a) a multistate APRN license must not be issued by the new home state until the APRN provides satisfactory evidence of a change in primary state of residence to the new home state and satisfies all applicable requirements to obtain the APRN license in the new home state; and
b) the APRN may apply for licensure in advance of a change in primary state of residence. (Sec. 1)
19. Specifies that if an APRN moves from a party state to a nonparty state, the APRN multistate license converts to a single-state license valid only in the former home state. (Sec. 1)
Additional Authorities Invested in Party State Licensing Boards
20. Authorizes a licensing board, in addition to the other powers conferred by state law, to:
a) take adverse action against an APRN’s multistate licensure privilege to practice in that party state, subject to the outlined limitations;
b) issue cease and desist orders or impose an encumbrance on an APRN’s authority to practice within that party state;
c) complete any pending investigations of an APRN who changes primary state of residence during an investigation and take action, then promptly report the conclusions of the investigation to the CLIS Administrator, who must promptly notify the new home state of any such actions;
d) issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses and production of evidence;
e) obtain and submit applicant fingerprints or other biometric-based information to the FBI for criminal background checks, receive the results and use them in making licensure decisions;
f) recover from the affected APRN, if allowed by state law, the costs of investigations and disposition of cases resulting from any adverse action taken against that APRN; and
g) take adverse action based on the factual findings of another party state if the licensing board follows its own procedures for taking such adverse action. (Sec. 1)
21. Subjects adverse actions against an APRN's multistate licensure privilege to the following:
a) only the home state must have power to take adverse action against an APRN's license issued by the home state; and
b) for purposes of taking adverse action, the home state licensing board must give the same priority and effect to reported conduct that occurred outside of the home state as it would if such conduct has occurred within the home state and apply its own state laws to determine appropriate action. (Sec. 1)
22. Mandates that subpoenas issued by a party state licensing board for the attendance and testimony of witnesses and production of evidence from another party state must be enforced in the latter state by any court of competent jurisdiction, according to that court's practice and procedure in considering subpoenas issued in its own proceedings. (Sec. 1)
23. Directs the issuing licensing board to pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state in which the witnesses and evidence are located. (Sec. 1)
24. Requires multistate licensure privilege to be deactivated if adverse action is taken by a home state against an APRN’s license until all encumbrances have been removed. (Sec. 1)
25. States that all home state disciplinary orders that impose adverse action against a license to include a statement that the APRN’s licensure privilege is deactivated in all party states during the pendency of the order. (Sec. 1)
26. Specifies that the Compact does not override a party state’s decision that participation in an alternative program may be used in lieu of adverse action. (Sec. 1)
27. Requires the home state licensing board to deactivate the multistate licensure privilege of any APRN for the duration of the APRN’s participation in an alternative program. (Sec. 1)
CLIS and Information Exchange
28. Requires party states to participate in CLIS of all APRNs, licensed RNs and practical or vocational nurses, including information on the licensure and disciplinary history of each APRN submitted by party states, to assist in the coordinated administration of APRN licensure and enforcement efforts.
29. Requires the Commission, in coordination with the CLIS Administrator, to formulate procedures to identify, collect and exchange information under the Compact. (Sec. 1)
30. Specifies that all licensing boards must promptly report the following to the CLIS:
a) any adverse action and current significant investigative information;
b) denials of applications with the reasons for the denial; and
c) APRN participation in alternative programs known to the board, regardless of whether such participation is deemed nonpublic or confidential under state law. (Sec. 1)
31. Allows all party state licensing boards contributing information to the CLIS to designate information that may not be shared with nonparty states or disclosed to others without the express permission of the contributing state. (Sec. 1)
32. Prohibits any personally identifiable information obtained from the CLIS by a party state licensing board from being shared with nonparty states or disclosed to other entities or individuals except to the extent allowed by the laws of the party state contributing the information. (Sec. 1)
33. Requires any information contributed to CLIS that is subsequently required to be expunged by the laws of the party state contributing the information to be removed from the CLIS. (Sec. 1)
34. Requires the Compact administrator of each party state to furnish a uniform data set to the administrator of each party state that includes at least the following:
a) identifying information;
b) licensure data;
c) information related to alternative program participation; and
d) other information that may facilitate the administration of the Compact, as determined by Commission rules. (Sec. 1)
35. Requires the Compact administrator of a party state to provide all investigative documents and information requested by another party state. (Sec. 1)
Establishment of the Interstate Commission of APRN Compact Administrators
36. Establishes the Commission as an instrumentality of the party states. (Sec. 1)
37. Asserts that the venue is proper and judicial proceedings by or against the Commission be brought solely and exclusively in a court of competent jurisdiction where the principal office of the Commission is located. (Sec. 1)
38. Allows the Commission to waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings. (Sec. 1)
39. States that the Compact is not a waiver of sovereign immunity. (Sec. 1)
40. Limits each party state to one Compact administrator who is the head of the state licensing board or that person’s designee. (Sec. 1)
41. Allows the administrator to be suspended, removed from office or replaced as allowed by state law. (Sec. 1)
42. Requires any vacancy occurring in the Commission to be filled in accordance with the laws of the party state in which the vacancy exists. (Sec. 1)
43. Entitles each administrator to:
a) one vote related to rules and creation of bylaws; and
b) having an opportunity to participate in the business and affairs of the Commission. (Sec. 1)
44. Requires an administrator to vote in person or by such other means as provided in the bylaws. (Sec. 1)
45. Allows the bylaws to provide for an administrator's participation in meetings by telephone or other means of communication. (Sec. 1)
46. Requires the Commission to meet at least once during each calendar year and additional meetings to be held as set forth in the Commission's bylaws or rules. (Sec. 1)
47. Requires Commission meetings to be open to the public and with public notice. (Sec. 1)
48. Allows the Commission to discuss the following in a closed nonpublic meeting:
a) noncompliance of a party state with Compact obligations;
b) personnel matters as specified;
c) current, threatened or reasonably anticipated litigation;
d) negotiation of contracts to purchase or sell goods, services or real estate;
e) accusing any person of a crime or formally censuring any person;
f) disclosure of trade secrets or commercial or financial information that is privileged or confidential;
g) disclosure of personal information that would constitute a clearly unwarranted invasion of personal privacy;
h) disclosure of information related to reports prepared by or on behalf of the Commission to investigate Compact compliance; and
i) matters specifically exempt from disclosure by federal or state statute. (Sec. 1)
49. Prescribes procedures for certifying closed meetings, referencing the relevant exemption and keeping of minutes. (Sec. 1)
50. Instructs the Commission, by a majority vote, to prescribe bylaws or rules, including, but not limited to:
a) establishing a fiscal year;
b) providing reasonable standards and procedures for establishing other committees and delegating Commission authority or function;
c) providing reasonable procedures for calling and conducting meetings, including providing notice, public participation and closed meetings;
d) establishing titles, duties and authority and reasonable procedures for electing officers;
e) providing reasonable standards and procedures for establishing personnel policies and Commission programs; and
f) providing a mechanism for winding up the operations and equitable disposition of surplus monies after paying and reserving all debts and obligations. (Sec. 1)
51. Requires the Commission to publish its bylaws, rules and amendments in a convenient form on its website. (Sec. 1)
52. Requires the Commission to maintain its financial records in accordance with its bylaws. (Sec. 1)
53. Authorizes the Commission to:
a) create uniform rules for the Compact, which have the force and effect of law and are binding in all party states;
b) bring and prosecute legal actions provided that the standing of any licensing board to sue or be sued under applicable law is not affected;
c) purchase and maintain insurance and bonds;
d) borrow, accept or contract for personnel, including employees of a party state or nonprofit organizations;
e) cooperate with other organizations that administer state Compacts regarding nursing, as outlined;
f) hire employees, elect or appoint officers, fix compensation, define duties, grant authority and establish policies regarding conflicts of interest, qualifications of personnel and other related personnel matters;
g) accept appropriate donations, grants and gifts of monies, equipment, supplies, materials and services, striving to avoid any appearance of impropriety or conflict of interest;
h) lease, purchase, accept appropriate gifts or donations of property, whether real, personal or mixed, striving to avoid any appearance of impropriety;
i) sell, convey or otherwise dispose of any property, whether real, personal or mixed;
j) establish a budget and make expenditures;
k) borrow monies;
l) appoint committees as specified;
m) issue advisory opinions;
n) provide and receive information from, and cooperate with, law enforcement agencies;
o) adopt and use an official seal; and
p) perform other functions as necessary to achieve the purposes of the Compact consistent with state regulation of APRN licensure and practice. (Sec. 1)
54. Requires the Commission to pay or provide for the payment of reasonable expenses of its establishment, organization and ongoing activities. (Sec. 1)
55. Allows the Commission to levy and collect an annual assessment from each party state to cover the cost of its operations, activities and staff in its annual budget as approved each year. (Sec. 1)
56. Requires the aggregate annual assessment amount to be allocated based on a formula to be determined by the Commission by rule. (Sec. 1)
57. Prohibits the Commission from incurring obligations before securing the monies adequate to meet those obligations or pledging the credit of any party state except by and with the authority of such party state. (Sec. 1)
58. Requires the Commission to keep accurate accounts of all receipts and disbursements, which are subject to the audit and accounting procedures under its bylaws and requires a yearly audit by a certified or licensed public accountant and the report to be included in the Commission’s annual report. (Sec. 1)
59. Details immunity from claims of civil liability as outlined for specified Commission-related individuals. (Sec. 1)
60. Requires the Commission to defend specified Commission-related individuals in any civil liability action arising out of prescribed circumstances. (Sec. 1)
61. Requires the Commission to indemnify and hold harmless any specified Commission-related individual for any settlement or judgment obtained against that person as outlined if the actual or alleged act, error or omission did not result from the intentional, wilful or wanton misconduct of that person. (Sec. 1)
Rulemaking
62. Specifies that rules and amendments have the same force and effect as the Compact. (Sec. 1)
63. Requires rules or amendments to be adopted at a regular or special Commission meeting. (Sec. 1)
64. Requires the Commission to file a notice of proposed rulemaking on the Commission’s website and the website of each licensing board or as each state would otherwise publish proposed rules before promulgation and adoption of a final rule and at least 60 days before the meeting at which the rule will be considered and voted on. (Sec. 1)
65. Requires the notice of proposed rulemaking to include all of the following:
a) the proposed time, date and location of the meeting in which the rule will be considered and voted on;
b) the text of the proposed rule or amendment and the reason for the proposed rule;
c) a request for comments on the proposed rule from any interested person; and
d) the manner in which interested persons may submit notice to the Commission of their intention to attend the public hearing and any written comments. (Sec. 1)
66. Directs the Commission to grant an opportunity for a public hearing before it adopts a rule or amendment. (Sec. 1)
67. Requires the Commission to publish the place, time and date of the scheduled public hearings which must be conducted in a manner that provides each person who wishes to commend a fair and reasonable opportunity to comment orally or in writing. (Sec. 1)
68. Requires all hearings to be recorded, with a copy made available on request. (Sec. 1)
69. Allows rules to be grouped at hearings. (Sec. 1)
70. Allows the Commission to proceed with promulgation of a proposed rule if no one appears at the public hearing. (Sec. 1)
71. Instructs the Commission:
a) following the scheduled hearing date or by the close of business on the scheduled hearing date if the hearing was not held, to consider all written and oral comments received;
b) take final action on a proposed rule, but a majority vote of all Compact Administrators; and
c) determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule. (Sec. 1)
72. Permits the Commission, on determination that an emergency exists, to consider and adopt an emergency rule without prior notice, opportunity for comment or a hearing. (Sec. 1)
73. Requires the usual rulemaking procedures provided in the Compact to be retroactively applied to the rule as soon as reasonable possible, but not later than 90 days after the effective date of the rule. (Sec. 1)
74. Asserts that an emergency rule is one that must be adopted immediately to:
a) meet an imminent threat to public health, safety or welfare;
b) prevent a loss of Commission or party state monies; and
c) meet a deadline for the promulgation of an administrative rule that is established by federal law or rule. (Sec. 1)
75. Permits the Commission to direct revisions to a rule or amendment to correct typographical or formatting errors, errors in consistency or grammatical errors. (Sec. 1)
76. Requires revisions to be posted on the Commissions website and are subject to challenge by any person for a period of 30 days after posting. (Sec. 1)
77. Allows revisions to be challenged only on grounds that result in a material change to a rule. (Sec. 1)
78. Requires a challenge to be made in writing and delivered to the Commission before the end of the notice period. (Sec. 1)
79. Specifies that if no challenge is made, the revision will take effect without further action. (Sec. 1)
80. Specifies that if the revision is challenged, the revision may not take effect without the approval of the Commission. (Sec. 1)
Oversight, Dispute Resolution and Enforcement
81. Requires each party state to enforce the Compact and take actions necessary and appropriate to effectuate the Compact’s purposes and intent. (Sec. 1)
82. Entitles the Commission to receive service of process in proceedings that may affect the powers, responsibilities or actions of the Commission and has standing to intervene in such proceedings. (Sec. 1)
83. States that failing to provide service of process to the Commission renders a judgment or order void as to the Commission, the Compact or rules. (Sec. 1)
84. Specifies the Commission shall provide the following if it determines that a party state has defaulted in performing its obligations or responsibilities under the Compact or rules:
a) written notice to the defaulting state and other party states of the nature of the default, the proposed means of curing the default and any other action to be taken by the Commission; and
b) remedial training and specific technical assistance regarding the default. (Sec. 1)
85. Allows the defaulting state’s membership in the Compact to be terminated if the state fails to cure the default, on the affirmative vote of a majority of the administrators and all rights, privileges and benefits conferred by the Compact to be terminated on the effective date of the termination. (Sec. 1)
86. Specifies that a cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default. (Sec. 1)
87. Allows termination of membership to be imposed only after all other means of securing compliance have been exhausted. (Sec. 1)
88. Requires the Commission to give notice of intent to suspend or terminate to the governor of the defaulting state and to the executive officers of the licensing board, the licensing board and each of the party states. (Sec. 1)
89. Specifies that a terminated state is responsible for all assessments, obligations and liabilities incurred through the effective date of termination, including obligations that extend beyond the effective date of termination. (Sec. 1)
90. Prohibits the Commission from bearing any costs related to a state found to be in default or whose membership has been terminated unless agreed in writing between the Commission and defaulting state. (Sec. 1)
91. Outlines procedures for a defaulting state to appeal. (Sec. 1)
92. Requires the Commission, on request by a party state, to attempt to resolve Compact disputes that arise among party states and between party and nonparty states. (Sec. 1)
93. Requires the Commission to adopt a rule providing for mediation and binding dispute resolution for disputes, as appropriate. (Sec. 1)
94. Outlines requirements if the Commission cannot resolve disputes, including for arbitration. (Sec. 1)
95. Requires the Commission, in the reasonable exercise of its discretion, to enforce the Compact and related rules and specifies requirements for legal action. (Sec. 1)
96. Stipulates the remedies in the Compact are not the exclusive remedies of the Commission, which may pursue other remedies available under federal or state law. (Sec. 1)
Effective Date, Withdrawal and Amendment
97. Specifies that the Compact comes into limited effect when it is enacted in seven party states for the sole purpose of establishing and convening the Commission to adopt rules relating to its operation. (Sec. 1)
98. Subjects any state that joins the Compact after the Commission’s initial adoption of the APRN uniform licensure requirements to all Commission rules that were previously adopted. (Sec. 1)
99. Allows a party state to withdraw from the Compact by repealing the Compact but prohibits the withdrawal from taking effect until six months after enactment of the repealing statute. (Sec. 1)
100. Prohibits a party state’s withdrawal or termination from affecting the continuing requirement of that state’s licensing board to report adverse actions and significant investigations occurring before the effective date of the withdrawal or termination. (Sec. 1)
101. Specifies that the Compact does not invalidate or prevent any APRN licensure agreement or other cooperative arrangement between a party state and a nonparty state that does not conflict with the Compact. (Sec. 1)
102. Allows the Compact to be amended by the party states, which becomes effective and binding after enactment into law by all party states. (Sec. 1)
103. Permits representatives of nonparty states to be invited to participate in Commission activities on a nonvoting basis before the adoption of the Compact by all states. (Sec. 1)
Construction & Severability
104. Requires the Compact to be liberally construed to effectuate its purposes. (Sec. 1)
105. Deems the Compact provisions severable, and if any phrase, clause, sentence or provision of this Compact is declared to be contrary to the constitution of any party state or of the United States, or if the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this Compact and the Compact's applicability to any government, agency, person or circumstance. (Sec. 1)
106. Specifies that the Compact does not supersede state law related to the applicable APRN scope of practice or related rules and does not alter the scope of practice. (Sec. 1)
107. Requires APRNs practicing in this state to comply with the applicable scope of practice pursuant to state law. (Sec. 1)
108. Specifies that the Commission does not have the authority to alter the scope of practice for APRNs practicing in this state. (Sec. 1)
109. Allows the Governor to withdraw the state from the Compact if:
a) the Commission adopts a rule to change the scope of practice of APRNs in this state; and
b) a law is enacted that repeals the Compact. (Sec. 1)
Miscellaneous
110.
Outlines finding and purposes
related to uniform APRN regulation and licensure. (Sec. 1)
111. Defines pertinent terms. (Sec. 1)
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SB 1295
Initials AG Page 0 Health & Human Services
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