§ 147B.1 — Interstate medical licensure compact

Iowa § 147B.1

• Jurisdiction: Iowa
• Title IV: PUBLIC HEALTH
• Ch. 147B: INTERSTATE MEDICAL LICENSURE COMPACT

Text

1. Purpose.
a. 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
licensingandregulatoryauthorityofstatemedicalboardsandprovidesastreamlinedprocess
thatallowsphysicianstobecomelicensedinmultiplestates,therebyenhancingtheportability
ofamedicallicenseandensuringthesafetyofpatients. Thecompactcreatesanotherpathway
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.
b. 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.
2. Definitions. In this compact:
a. “Bylaws” means those bylaws established by the interstate commission pursuant to
subsection 11 for its governance, or for directing and controlling its actions and conduct.
b. “Commissioner” means the voting representative appointed by each member board
pursuant to subsection 11.
c. “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.
d. “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.
e. “Interstate commission” means the interstate commission created pursuant to this
section.
f. “License” means authorization by a state for a physician to engage in the practice of
medicine, which would be unlawful without the authorization.
g. “Medical practice act” means laws and regulations governing the practice of allopathic
and osteopathic medicine within a member state.
h. “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.
i. “Member state” means a state that has enacted the compact.
j. “Offense” means a felony, gross misdemeanor, or crime of moral turpitude.
k. “Physician” means any person who satisfies all of the following:
(1) 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.
(2) Passed each component of the United States medical licensing examination or the
comprehensive osteopathic medical licensing examination within three attempts, or any of
its predecessor examinations accepted by a state medical board as an equivalent examination
for licensure purposes.
(3) Successfully completed graduate medical education approved by the accreditation
council for graduate medical education or the American osteopathic association.
(4) Holds specialty certification or a time-unlimited specialty certificate recognized by the
§147B.1, INTERSTATE MEDICAL LICENSURE COMPACT 2
American board of medical specialties or the American osteopathic association’s bureau of
osteopathic specialists.
(5) Possesses a full and unrestricted license to engage in the practice of medicine issued
by a member board.
(6) Has never been convicted, received adjudication, deferred adjudication, community
supervision, or deferred disposition for any offense by a court of appropriate jurisdiction.
(7) Hasneverheldalicenseauthorizingthepracticeofmedicinesubjectedtodisciplineby
a licensing agency in any state, federal, or foreign jurisdiction, excluding any action related
to nonpayment of fees related to a license.
(8) Has never had a controlled substance license or permit suspended or revoked by a
state or the United States drug enforcement administration.
(9) Is not under active investigation by a licensing agency or law enforcement authority
in any state, federal, or foreign jurisdiction.
l. “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.
m. “Rule” means a written statement by the interstate commission promulgated pursuant
to subsection 12 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.
n. “State” means any state, commonwealth, district, or territory of the United States.
o. “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.
3. Eligibility.
a. A physician must meet the eligibility requirements as defined in subsection 2,
paragraph“k”, toreceiveanexpeditedlicenseunderthetermsandprovisionsofthecompact.
b. A physician who does not meet the requirements of subsection 2, paragraph “k”, may
obtain a license to practicemedicine in a memberstate if the individualcomplieswith all laws
and requirements, other than the compact, relating to the issuance of a license to practice
medicine in that state.
4. Designation of state of principal license.
a. Aphysicianshalldesignateamemberstateasthestateofprincipallicenseforpurposes
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:
(1) The state of primary residence for the physician, or
(2) The state where at least twenty-five percent of the practice of medicine occurs, or
(3) The location of the physician’s employer, or
(4) If no state qualifies under subparagraph (1), subparagraph (2), or subparagraph (3),
the state designated as state of residence for purposes of federal income tax.
b. A physician may redesignate a member state as the state of principal license at any
time, as long as the state meets the requirements in paragraph “a”.
c. The interstate commission is authorized to develop rules to facilitate redesignation of
another member state as the state of principal license.
5. Application and issuance of expedited licensure.
a. 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.
b. 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.
(1) 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
3 INTERSTATE MEDICAL LICENSURE COMPACT, §147B.1
primary source verification where already primary source-verified by the state of principal
license.
(2) 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. §731.202.
(3) 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.
c. Upon verification in paragraph “b”, 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 paragraph “a”, including the payment of any
applicable fees.
d. After receiving verification of eligibility under paragraph “b” and any fees under
paragraph “c”, 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.
e. 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.
f. An expedited license obtained through the compact shall be terminated if a physician
failstomaintainalicenseinthestateofprincipallicenseforanondisciplinaryreason,without
redesignation of a new state of principal license.
g. 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.
6. Fees for expedited licensure.
a. 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.
b. The interstate commission is authorized to develop rules regarding fees for expedited
licenses.
7. Renewal and continued participation.
a. 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 satisfies the
following:
(1) Maintains a full and unrestricted license in a state of principal license.
(2) Has not been convicted, received adjudication, deferred adjudication, community
supervision, or deferred disposition for any offense by a court of appropriate jurisdiction.
(3) 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.
(4) Has not had a controlled substance license or permit suspended or revoked by a state
or the United States drug enforcement administration.
b. Physicians shall comply with all continuing professional development or continuing
medical education requirements for renewal of a license issued by a member state.
c. The interstate commission shall collect any renewal fees charged for the renewal of a
license and distribute the fees to the applicable member board.
d. Upon receipt of any renewal fees collected in paragraph “c”, a member board shall
renew the physician’s license.
e. Physician information collected by the interstate commission during the renewal
process will be distributed to all member boards.
f. The interstate commission is authorized to develop rules to address renewal of licenses
obtained through the compact.
8. Coordinated information system.
a. The interstate commission shall establish a database of all physicians licensed, or who
have applied for licensure, under subsection 5.
§147B.1, INTERSTATE MEDICAL LICENSURE COMPACT 4
b. 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.
c. Member boards shall report disciplinary or investigatory information determined as
necessary and proper by rule of the interstate commission.
d. Member boards may report any nonpublic complaint, disciplinary, or investigatory
information not required by paragraph “c” to the interstate commission.
e. Member boards shall share complaint or disciplinary information about a physician
upon request of another member board.
f. 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.
g. The interstate commission is authorized to develop rules for mandated or discretionary
sharing of information by member boards.
9. Joint investigations.
a. Licensure and disciplinary records of physicians are deemed investigative.
b. Inadditiontotheauthoritygrantedtoamemberboardbyitsrespectivemedicalpractice
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.
c. A subpoena issued by a member state shall be enforceable in other member states.
d. Member boards may share any investigative, litigation, or compliance materials in
furtherance of any joint or individual investigation initiated under the compact.
e. 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.
10. Disciplinary actions.
a. 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.
b. 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.
c. 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 either:
(1) 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
(2) Pursue separate disciplinary action against the physician under its respective medical
practice Act, regardless of the action taken in other member states.
d. 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
anyothermemberboardsshallbesuspended, automaticallyandimmediatelywithoutfurther
action necessary by the other member boards, for ninety 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
suspensionofthelicenseitissuedpriortothecompletionoftheninety-daysuspensionperiod
in a manner consistent with the medical practice Act of that state.
11. Interstate medical licensure compact commission.
a. Thememberstatesherebycreatetheinterstatemedicallicensurecompactcommission.
b. Thepurposeoftheinterstatecommissionistheadministrationoftheinterstatemedical
licensure compact, which is a discretionary state function.
5 INTERSTATE MEDICAL LICENSURE COMPACT, §147B.1
c. 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.
d. Theinterstatecommissionshallconsistoftwovotingrepresentativesappointedbyeach
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 representative from each member board. A commissioner shall be one of
the following:
(1) An allopathic or osteopathic physician appointed to a member board.
(2) An executive director, executive secretary, or similar executive of a member board.
(3) A member of the public appointed to a member board.
e. The interstate commission shall meet at least once each calendar year. A portion of this
meetingshallbeabusinessmeetingtoaddresssuchmattersasmayproperlycomebeforethe
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.
f. The bylaws may provide for meetings of the interstate commission to be conducted by
telecommunication or electronic communication.
g. Each commissioner participating at a meeting of the interstate commission is entitled
to one 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 paragraph “d”.
h. 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 vote of the commissioners present that an open
meeting would be likely to result in one or more of the following:
(1) Relate solely to the internal personnel practices and procedures of the interstate
commission.
(2) Discuss matters specifically exempted from disclosure by federal statute.
(3) Discuss trade secrets, commercial, or financial information that is privileged or
confidential.
(4) Involve accusing a person of a crime, or formally censuring a person.
(5) Discuss information of a personal nature where disclosure would constitute a clearly
unwarranted invasion of personal privacy.
(6) Discuss investigative records compiled for law enforcement purposes.
(7) Specifically relate to the participation in a civil action or other legal proceeding.
i. 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.
j. 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.
k. 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.
l. The interstate commission may establish other committees for governance and
administration of the compact.
12. Powersanddutiesoftheinterstatecommission. Theinterstatecommissionshallhave
power to perform the following functions:
a. Oversee and maintain the administration of the compact.
§147B.1, INTERSTATE MEDICAL LICENSURE COMPACT 6
b. Promulgate rules which shall be binding to the extent and in the manner provided for
in the compact.
c. 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.
d. 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.
e. Establish and appoint committees including but not limited to an executive committee
as required by subsection 11, which shall have the power to act on behalf of the interstate
commission in carrying out its powers and duties.
f. Pay, or provide for the payment of, the expenses related to the establishment,
organization, and ongoing activities of the interstate commission.
g. Establish and maintain one or more offices.
h. Borrow, accept, hire, or contract for services of personnel.
i. Purchase and maintain insurance and bonds.
j. Employ an executive director who shall have such powers to employ, select, or appoint
employees, agents, or consultants, and to determine their qualifications, define their duties,
and fix their compensation.
k. Establish personnel policies and programs relating to conflicts of interest, rates of
compensation, and qualifications of personnel.
l. Accept donations and grants of money, equipment, supplies, materials, and services,
and to receive, utilize, and dispose of the same in a manner consistent with the conflict of
interest policies established by the interstate commission.
m. Lease, purchase, accept contributions or donations of, or otherwise to own, hold,
improve, or use, any property, real, personal, or mixed.
n. Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any
property, real, personal, or mixed.
o. Establish a budget and make expenditures.
p. Adopt a seal and bylaws governing the management and operation of the interstate
commission.
q. 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.
r. Coordinate education, training, and public awareness regarding the compact, its
implementation, and its operation.
s. Maintain records in accordance with the bylaws.
t. Seek and obtain trademarks, copyrights, and patents.
u. Perform such functions as may be necessary or appropriate to achieve the purposes of
the compact.
13. Finance powers.
a. 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 must 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.
b. The interstate commission shall not incur obligations of any kind prior to securing the
funds adequate to meet the same.
c. The interstate commission shall not pledge the credit of any of the member states,
except by, and with the authority of, the member state.
d. 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.
14. Organization and operation of the interstate commission.
a. The interstate commission shall, by a majority of commissioners present and voting,
7 INTERSTATE MEDICAL LICENSURE COMPACT, §147B.1
adopt bylaws to govern its conduct as may be necessary or appropriate to carry out the
purposes of the compact within twelve months of the first interstate commission meeting.
b. 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.
c. Officers selected in paragraph “b” shall serve without remuneration from the interstate
commission.
d. 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.
(1) The liability of the executive director and employees of the interstate commission
or representatives of the interstate commission, acting within the scope of such person’s
employment or duties for acts, errors, or omissions occurring within such person’s 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 paragraph
“d” 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.
(2) 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.
(3) 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 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.
15. Rulemaking functions of the interstate commission.
a. Theinterstatecommissionshallpromulgatereasonablerulesinordertoeffectivelyand
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.
b. 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.
c. Not later than thirty 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
§147B.1, INTERSTATE MEDICAL LICENSURE COMPACT 8
unless the court finds that the petitioner has a substantial likelihood of success. The court
shallgivedeferencetotheactionsoftheinterstatecommissionconsistentwithapplicablelaw
and shall not find the rule to be unlawful if the rule represents a reasonable exercise of the
authority granted to the interstate commission.
16. Oversight of interstate compact.
a. 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.
b. 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.
c. 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.
17. Enforcement of interstate compact.
a. The interstate commission, in the reasonable exercise of its discretion, shall enforce
the provisions and rules of the compact.
b. The interstate commission may, by majority vote of the commissioners, initiate legal
actionintheUnitedStatesdistrictcourtfortheDistrictofColumbia,or,atthediscretionofthe
interstatecommission,inthefederaldistrictwheretheinterstatecommissionhasitsprincipal
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 fees.
c. 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.
18. Default procedures.
a. 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.
b. 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 do the following:
(1) 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.
(2) Provide remedial training and specific technical assistance regarding the default.
c. 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.
d. 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.
e. 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.
f. The member state which has been terminated is responsible for all dues, obligations,
9 INTERSTATE MEDICAL LICENSURE COMPACT, §147B.1
and liabilities incurred through the effective date of termination including obligations, the
performance of which extends beyond the effective date of termination.
g. 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.
h. 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
interstatecommissionhasitsprincipaloffices. Theprevailingpartyshallbeawardedallcosts
of such litigation including reasonable attorney fees.
19. Dispute resolution.
a. Theinterstatecommissionshallattempt, upontherequestofamemberstate, toresolve
disputes which are subject to the compact and which may arise among member states or
member boards.
b. The interstate commission shall promulgate rules providing for both mediation and
binding dispute resolution as appropriate.
20. Member states, effective date, and amendment.
a. Any state is eligible to become a member state of the compact.
b. The compact shall become effective and binding upon legislative enactment of the
compact into law by no less than seven states. Thereafter, it shall become effective and
binding on a state upon enactment of the compact into law by that state.
c. 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.
d. 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.
21. Withdrawal.
a. 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.
b. Withdrawalfromthecompactshallbebytheenactmentofastatuterepealingthesame,
but shall not take effect until one 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.
c. 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.
d. The interstate commission shall notify the other member states of the withdrawing
state’s intent to withdraw within sixty days of its receipt of notice provided under paragraph
“c”.
e. 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.
f. 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.
g. 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.
22. Dissolution.
a. 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 member state.
b. 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.
§147B.1, INTERSTATE MEDICAL LICENSURE COMPACT 10
23. Severability and construction.
a. 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.
b. The provisions of the compact shall be liberally construed to effectuate its purposes.
c. Nothing in the compact shall be construed to prohibit the applicability of other
interstate compacts to which the states are members.
24. Binding effect of compact and other laws.
a. Nothing herein prevents the enforcement of any other law of a member state that is not
inconsistent with the compact.
b. All laws in a member state in conflict with the compact are superseded to the extent of
the conflict.
c. All lawful actions of the interstate commission, including all rules and bylaws
promulgated by the commission, are binding upon the member states.
d. All agreements between the interstate commission and the member states are binding
in accordance with their terms.
e. 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.