Florida Senate - 2024                        COMMITTEE AMENDMENT
       Bill No. SPB 7016
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: FAV            .                                
                  12/12/2023           .                                

       The Committee on Health Policy (Harrell) recommended the
    1         Senate Amendment (with title amendment)
    3         Between lines 3154 and 3155
    4  insert:
    5         Section 52. Section 456.4501, Florida Statutes, is created
    6  to read:
    7         456.4501 Interstate Medical Licensure Compact.—The
    8  Interstate Medical Licensure Compact is hereby enacted into law
    9  and entered into by this state with all other jurisdictions
   10  legally joining therein in the form substantially as follows:
   12                              SECTION 1                            
   13                               PURPOSE                             
   15         In order to strengthen access to health care, and in
   16  recognition of the advances in the delivery of health care, the
   17  member states of the Interstate Medical Licensure Compact have
   18  allied in common purpose to develop a comprehensive process that
   19  complements the existing licensing and regulatory authority of
   20  state medical boards and provides a streamlined process that
   21  allows physicians to become licensed in multiple states, thereby
   22  enhancing the portability of a medical license and ensuring the
   23  safety of patients. The compact creates another pathway for
   24  licensure and does not otherwise change a states existing
   25  medical practice act. The compact also adopts the prevailing
   26  standard for licensure and affirms that the practice of medicine
   27  occurs where the patient is located at the time of the
   28  physician-patient encounter and, therefore, requires the
   29  physician to be under the jurisdiction of the state medical
   30  board where the patient is located. State medical boards that
   31  participate in the compact retain the jurisdiction to impose an
   32  adverse action against a license to practice medicine in that
   33  state issued to a physician through the procedures in the
   34  compact.
   36                              SECTION 2                            
   37                             DEFINITIONS                           
   39         As used in the compact, the term:
   40         (1)“Bylaws” means those bylaws established by the
   41  Interstate Commission pursuant to Section 11 for its governance
   42  or for directing and controlling its actions and conduct.
   43         (2)“Commissioner” means the voting representative
   44  appointed by each member board pursuant to Section 11.
   45         (3)“Conviction” means a finding by a court that an
   46  individual is guilty of a criminal offense, through adjudication
   47  or entry of a plea of guilt or no contest to the charge by the
   48  offender. Evidence of an entry of a conviction of a criminal
   49  offense by the court shall be considered final for purposes of
   50  disciplinary action by a member board.
   51         (4)“Expedited license” means a full and unrestricted
   52  medical license granted by a member state to an eligible
   53  physician through the process set forth in the compact.
   54         (5)“Interstate Commission” means the Interstate Medical
   55  Licensure Compact Commission created pursuant to Section 11.
   56         (6)“License” means authorization by a state for a
   57  physician to engage in the practice of medicine, which would be
   58  unlawful without the authorization.
   59         (7)“Medical practice act” means laws and regulations
   60  governing the practice of allopathic and osteopathic medicine
   61  within a member state.
   62         (8)“Member board” means a state agency in a member state
   63  which acts in the sovereign interests of the state by protecting
   64  the public through licensure, regulation, and education of
   65  physicians as directed by the state government.
   66         (9)“Member state” means a state that has enacted the
   67  compact.
   68         (10)“Offense” means a felony, high court misdemeanor, or
   69  crime of moral turpitude.
   70         (11)“Physician” means any person who:
   71         (a)Is a graduate of a medical school accredited by the
   72  Liaison Committee on Medical Education, the Commission on
   73  Osteopathic College Accreditation, or a medical school listed in
   74  the International Medical Education Directory or its equivalent;
   75         (b)Passed each component of the United States Medical
   76  Licensing Examination (USMLE) or the Comprehensive Osteopathic
   77  Medical Licensing Examination (COMLEX-USA) within three
   78  attempts, or any of its predecessor examinations accepted by a
   79  state medical board as an equivalent examination for licensure
   80  purposes;
   81         (c)Successfully completed graduate medical education
   82  approved by the Accreditation Council for Graduate Medical
   83  Education or the American Osteopathic Association;
   84         (d)Holds specialty certification or a time-unlimited
   85  specialty certificate recognized by the American Board of
   86  Medical Specialties or the American Osteopathic Associations
   87  Bureau of Osteopathic Specialists; however, the specialty
   88  certification or a time-unlimited specialty certificate does not
   89  have to be maintained once a physician is initially determined
   90  to be eligible for expedited licensure through the compact;
   91         (e)Possesses a full and unrestricted license to engage in
   92  the practice of medicine issued by a member board;
   93         (f)Has never been convicted or received adjudication,
   94  deferred adjudication, community supervision, or deferred
   95  disposition for any offense by a court of appropriate
   96  jurisdiction;
   97         (g)Has never held a license authorizing the practice of
   98  medicine subjected to discipline by a licensing agency in any
   99  state, federal, or foreign jurisdiction, excluding any action
  100  related to nonpayment of fees related to a license;
  101         (h)Has never had a controlled substance license or permit
  102  suspended or revoked by a state or the United States Drug
  103  Enforcement Administration; and
  104         (i)Is not under active investigation by a licensing agency
  105  or law enforcement authority in any state, federal, or foreign
  106  jurisdiction.
  107         (12)“Practice of medicine” means the diagnosis, treatment,
  108  prevention, cure, or relieving of a human disease, ailment,
  109  defect, complaint, or other physical or mental condition by
  110  attendance, advice, device, diagnostic test, or other means, or
  111  offering, undertaking, attempting to do, or holding oneself out
  112  as able to do any of these acts.
  113         (13)“Rule” means a written statement by the Interstate
  114  Commission adopted pursuant to Section 12 of the compact which
  115  is of general applicability; implements, interprets, or
  116  prescribes a policy or provision of the compact or an
  117  organizational, procedural, or practice requirement of the
  118  Interstate Commission; and has the force and effect of statutory
  119  law in a member state, if the rule is not inconsistent with the
  120  laws of the member state. The term includes the amendment,
  121  repeal, or suspension of an existing rule.
  122         (14)“State” means any state, commonwealth, district, or
  123  territory of the United States.
  124         (15)“State of principal license” means a member state
  125  where a physician holds a license to practice medicine and which
  126  has been designated as such by the physician for purposes of
  127  registration and participation in the compact.
  129                              SECTION 3                            
  130                             ELIGIBILITY                           
  132         (1)A physician must meet the eligibility requirements as
  133  provided in subsection (11) of Section 2 to receive an expedited
  134  license under the terms of the compact.
  135         (2)A physician who does not meet the requirements
  136  specified in subsection (11) of Section 2 may obtain a license
  137  to practice medicine in a member state if the individual
  138  complies with all laws and requirements, other than the compact,
  139  relating to the issuance of a license to practice medicine in
  140  that state.
  142                              SECTION 4                            
  143              DESIGNATION OF STATE OF PRINCIPAL LICENSE            
  145         (1)A physician shall designate a member state as the state
  146  of principal license for purposes of registration for expedited
  147  licensure through the compact if the physician possesses a full
  148  and unrestricted license to practice medicine in that state and
  149  the state is:
  150         (a)The state of primary residence for the physician;
  151         (b)The state where at least 25 percent of the physician’s
  152  practice of medicine occurs;
  153         (c)The location of the physician’s employer; or
  154         (d)If no state qualifies under paragraph (a), paragraph
  155  (b), or paragraph (c), the state designated as the physician’s
  156  state of residence for purpose of federal income tax.
  157         (2)A physician may redesignate a member state as state of
  158  principal license at any time, as long as the state meets one of
  159  the descriptions under subsection (1).
  160         (3)The Interstate Commission may develop rules to
  161  facilitate redesignation of another member state as the state of
  162  principal license.
  164                              SECTION 5                            
  167         (1)A physician seeking licensure through the compact must
  168  file an application for an expedited license with the member
  169  board of the state selected by the physician as the state of
  170  principal license.
  171         (2)Upon receipt of an application for an expedited
  172  license, the member board within the state selected as the state
  173  of principal license shall evaluate whether the physician is
  174  eligible for expedited licensure and issue a letter of
  175  qualification, verifying or denying the physician’s eligibility,
  176  to the Interstate Commission.
  177         (a)Static qualifications, which include verification of
  178  medical education, graduate medical education, results of any
  179  medical or licensing examination, and other qualifications as
  180  determined by the Interstate Commission through rule, are not
  181  subject to additional primary source verification if already
  182  primary source-verified by the state of principal license.
  183         (b)The member board within the state selected as the state
  184  of principal license shall, in the course of verifying
  185  eligibility, perform a criminal background check of an
  186  applicant, including the use of the results of fingerprint or
  187  other biometric data checks compliant with the requirements of
  188  the Federal Bureau of Investigation, with the exception of
  189  federal employees who have a suitability determination in
  190  accordance with 5 C.F.R. s. 731.202.
  191         (c)Appeal on the determination of eligibility must be made
  192  to the member state where the application was filed and is
  193  subject to the law of that state.
  194         (3) Upon verification in subsection (2), physicians
  195  eligible for an expedited license must complete the registration
  196  process established by the Interstate Commission to receive a
  197  license in a member state selected pursuant to subsection (1).
  198         (4) After receiving verification of eligibility under
  199  subsection (2) and upon an applicant’s completion of any
  200  registration process required under subsection (3), a member
  201  board shall issue an expedited license to the physician. This
  202  license authorizes the physician to practice medicine in the
  203  issuing state consistent with the medical practice act and all
  204  applicable laws and regulations of the issuing member board and
  205  member state.
  206         (5) An expedited license is valid for a period consistent
  207  with the licensure period in the member state and in the same
  208  manner as required for other physicians holding a full and
  209  unrestricted license within the member state.
  210         (6) An expedited license obtained through the compact must
  211  be terminated if a physician fails to maintain a license in the
  212  state of principal license for a nondisciplinary reason, without
  213  redesignation of a new state of principal license.
  214         (7) The Interstate Commission may develop rules regarding
  215  the application process and the issuance of an expedited
  216  license.
  218                              SECTION 6                            
  219                 RENEWAL AND CONTINUED PARTICIPATION               
  221         (1) A physician seeking to renew an expedited license
  222  granted in a member state shall complete a renewal process with
  223  the Interstate Commission if the physician:
  224         (a)Maintains a full and unrestricted license in a state of
  225  principal license;
  226         (b) Has not been convicted or received adjudication,
  227  deferred adjudication, community supervision, or deferred
  228  disposition for any offense by a court of appropriate
  229  jurisdiction;
  230         (c) Has not had a license authorizing the practice of
  231  medicine subject to discipline by a licensing agency in any
  232  state, federal, or foreign jurisdiction, excluding any action
  233  related to nonpayment of fees related to a license; and
  234         (d) Has not had a controlled substance license or permit
  235  suspended or revoked by a state or the United States Drug
  236  Enforcement Administration.
  237         (2) Physicians shall comply with all continuing
  238  professional development or continuing medical education
  239  requirements for renewal of a license issued by a member state.
  240         (3) Physician information collected by the Interstate
  241  Commission during the renewal process must be distributed to all
  242  member boards.
  243         (4) The Interstate Commission may develop rules to address
  244  renewal of licenses obtained through the compact.
  246                              SECTION 7                            
  247                   COORDINATED INFORMATION SYSTEM                  
  249         (1) The Interstate Commission shall establish a database of
  250  all physicians licensed, or who have applied for licensure,
  251  under Section 5.
  252         (2) Notwithstanding any other provision of law, member
  253  boards shall report to the Interstate Commission any public
  254  action or complaints against a licensed physician who has
  255  applied or received an expedited license through the compact.
  256         (3) Member boards shall report to the Interstate Commission
  257  disciplinary or investigatory information determined as
  258  necessary and proper by rule of the Interstate Commission.
  259         (4) Member boards may report to the Interstate Commission
  260  any nonpublic complaint, disciplinary, or investigatory
  261  information not required by subsection (3).
  262         (5) Member boards shall share complaint or disciplinary
  263  information about a physician upon request of another member
  264  board.
  265         (6) All information provided to the Interstate Commission
  266  or distributed by member boards shall be confidential, filed
  267  under seal, and used only for investigatory or disciplinary
  268  matters.
  269         (7) The Interstate Commission may develop rules for
  270  mandated or discretionary sharing of information by member
  271  boards.
  273                              SECTION 8                            
  274                        JOINT INVESTIGATIONS                       
  276         (1) Licensure and disciplinary records of physicians are
  277  deemed investigative.
  278         (2) In addition to the authority granted to a member board
  279  by its respective medical practice act or other applicable state
  280  law, a member board may participate with other member boards in
  281  joint investigations of physicians licensed by the member
  282  boards.
  283         (3) A subpoena issued by a member state is enforceable in
  284  other member states.
  285         (4) Member boards may share any investigative, litigation,
  286  or compliance materials in furtherance of any joint or
  287  individual investigation initiated under the compact.
  288         (5) Any member state may investigate actual or alleged
  289  violations of the statutes authorizing the practice of medicine
  290  in any other member state in which a physician holds a license
  291  to practice medicine.
  293                              SECTION 9                            
  294                        DISCIPLINARY ACTIONS                       
  296         (1) Any disciplinary action taken by any member board
  297  against a physician licensed through the compact is deemed
  298  unprofessional conduct which may be subject to discipline by
  299  other member boards, in addition to any violation of the medical
  300  practice act or regulations in that state.
  301         (2) If a license granted to a physician by the member board
  302  in the state of principal license is revoked, surrendered or
  303  relinquished in lieu of discipline, or suspended, then all
  304  licenses issued to the physician by member boards shall
  305  automatically be placed, without further action necessary by any
  306  member board, on the same status. If the member board in the
  307  state of principal license subsequently reinstates the
  308  physician’s license, a license issued to the physician by any
  309  other member board must remain encumbered until that respective
  310  member board takes action to reinstate the license in a manner
  311  consistent with the medical practice act of that state.
  312         (3) If disciplinary action is taken against a physician by
  313  a member board not in the state of principal license, any other
  314  member board may deem the action conclusive as to matter of law
  315  and fact decided, and:
  316         (a)Impose the same or lesser sanctions against the
  317  physician so long as such sanctions are consistent with the
  318  medical practice act of that state; or
  319         (b)Pursue separate disciplinary action against the
  320  physician under its respective medical practice act, regardless
  321  of the action taken in other member states.
  322         (4) If a license granted to a physician by a member board
  323  is revoked, surrendered or relinquished in lieu of discipline,
  324  or suspended, any license issued to the physician by any other
  325  member board must be suspended, automatically and immediately
  326  without further action necessary by the other member boards, for
  327  90 days after entry of the order by the disciplining board, to
  328  permit the member boards to investigate the basis for the action
  329  under the medical practice act of that state. A member board may
  330  terminate the automatic suspension of the license it issued
  331  before the completion of the 90-day suspension period in a
  332  manner consistent with the medical practice act of that state.
  334                             SECTION 10                            
  337         (1) The member states hereby create the Interstate Medical
  338  Licensure Compact Commission.
  339         (2) The purpose of the Interstate Commission is the
  340  administration of the compact, which is a discretionary state
  341  function.
  342         (3) The Interstate Commission is a body corporate and joint
  343  agency of the member states and has all the responsibilities,
  344  powers, and duties set forth in the compact, and such additional
  345  powers as may be conferred upon it by a subsequent concurrent
  346  action of the respective legislatures of the member states in
  347  accordance with the terms of the compact.
  348         (4) The Interstate Commission shall consist of two voting
  349  representatives appointed by each member state, who shall serve
  350  as commissioners. In states where allopathic and osteopathic
  351  physicians are regulated by separate member boards, or if the
  352  licensing and disciplinary authority is split between multiple
  353  member boards within a member state, the member state shall
  354  appoint one representative from each member board. Each
  355  commissioner must be one of the following:
  356         (a)An allopathic or osteopathic physician appointed to a
  357  member board.
  358         (b) An executive director, an executive secretary, or a
  359  similar executive of a member board.
  360         (c)A member of the public appointed to a member board.
  361         (5)The Interstate Commission shall meet at least once each
  362  calendar year. A portion of this meeting must be a business
  363  meeting to address such matters as may properly come before the
  364  commission, including the election of officers. The chairperson
  365  may call additional meetings and shall call for a meeting upon
  366  the request of a majority of the member states.
  367         (6) The bylaws may provide for meetings of the Interstate
  368  Commission to be conducted by telecommunication or other
  369  electronic means.
  370         (7) Each commissioner participating at a meeting of the
  371  Interstate Commission is entitled to one vote. A majority of
  372  commissioners constitutes a quorum for the transaction of
  373  business, unless a larger quorum is required by the bylaws of
  374  the Interstate Commission. A commissioner may not delegate a
  375  vote to another commissioner. In the absence of its
  376  commissioner, a member state may delegate voting authority for a
  377  specified meeting to another person from that state who must
  378  meet the qualification requirements specified in subsection (4).
  379         (8) The Interstate Commission shall provide public notice
  380  of all meetings, and all meetings must be open to the public.
  381  The Interstate Commission may close a meeting, in full or in
  382  portion, where it determines by a two-thirds vote of the
  383  commissioners present that an open meeting would be likely to:
  384         (a) Relate solely to the internal personnel practices and
  385  procedures of the Interstate Commission;
  386         (b) Discuss matters specifically exempted from disclosure
  387  by federal statute;
  388         (c) Discuss trade secrets or commercial or financial
  389  information that is privileged or confidential;
  390         (d) Involve accusing a person of a crime, or formally
  391  censuring a person;
  392         (e) Discuss information of a personal nature, the
  393  disclosure of which would constitute a clearly unwarranted
  394  invasion of personal privacy;
  395         (f) Discuss investigative records compiled for law
  396  enforcement purposes; or
  397         (g) Specifically relate to participation in a civil action
  398  or other legal proceeding.
  399         (9) The Interstate Commission shall keep minutes that fully
  400  describe all matters discussed in a meeting and provide a full
  401  and accurate summary of actions taken, including a record of any
  402  roll call votes.
  403         (10) The Interstate Commission shall make its information
  404  and official records, to the extent not otherwise designated in
  405  the compact or by its rules, available to the public for
  406  inspection.
  407         (11) The Interstate Commission shall establish an executive
  408  committee, which shall include officers, members, and others as
  409  determined by the bylaws. The executive committee has the power
  410  to act on behalf of the Interstate Commission, with the
  411  exception of rulemaking, during periods when the Interstate
  412  Commission is not in session. When acting on behalf of the
  413  Interstate Commission, the executive committee shall oversee the
  414  administration of the compact, including enforcement and
  415  compliance with the compact and its bylaws and rules, and other
  416  duties as necessary.
  417         (12) The Interstate Commission may establish other
  418  committees for governance and administration of the compact.
  420                             SECTION 11                            
  423         The Interstate Commission has all of the following powers
  424  and duties:
  425         (1) Overseeing and maintaining the administration of the
  426  compact.
  427         (2) Adopting rules, which shall be binding to the extent
  428  and in the manner provided for in the compact.
  429         (3) Issuing, upon the request of a member state or member
  430  board, advisory opinions concerning the meaning or
  431  interpretation of the compact and its bylaws, rules, and
  432  actions.
  433         (4) Enforcing compliance with the compact, the rules
  434  adopted by the Interstate Commission, and the bylaws, using all
  435  necessary and proper means, including, but not limited to, the
  436  use of judicial process.
  437         (5) Establishing and appointing committees, including, but
  438  not limited to, an executive committee as required by Section
  439  11, which shall have the power to act on behalf of the
  440  Interstate Commission in carrying out its powers and duties.
  441         (6) Paying for or providing for the payment of the expenses
  442  related to the establishment, organization, and ongoing
  443  activities of the Interstate Commission.
  444         (7) Establishing and maintaining one or more offices.
  445         (8) Borrowing, accepting, hiring, or contracting for
  446  services of personnel.
  447         (9) Purchasing and maintaining insurance and bonds.
  448         (10) Employing an executive director, who shall have the
  449  power to employ, select, or appoint employees, agents, or
  450  consultants and to determine their qualifications, define their
  451  duties, and fix their compensation.
  452         (11) Establishing personnel policies and programs relating
  453  to conflicts of interest, rates of compensation, and
  454  qualifications of personnel.
  455         (12) Accepting donations and grants of money, equipment,
  456  supplies, materials, and services and receiving, using, and
  457  disposing of them in a manner consistent with the conflict-of
  458  interest policies established by the Interstate Commission.
  459         (13) Leasing, purchasing, accepting contributions or
  460  donations of, or otherwise owning, holding, improving, or using
  461  any property, real, personal, or mixed.
  462         (14) Selling conveying, mortgaging, pledging, leasing,
  463  exchanging, abandoning, or otherwise disposing of any property,
  464  real, personal, or mixed.
  465         (15) Establishing a budget and making expenditures.
  466         (16) Adopting a seal and bylaws governing the management
  467  and operation of the Interstate Commission.
  468         (17) Reporting annually to the legislatures and governors
  469  of the member states concerning the activities of the Interstate
  470  Commission during the preceding year. Such reports must also
  471  include reports of financial audits and any recommendations that
  472  may have been adopted by the Interstate Commission.
  473         (18) Coordinating education, training, and public awareness
  474  regarding the compact and its implementation and operation.
  475         (19) Maintaining records in accordance with the bylaws.
  476         (20) Seeking and obtaining trademarks, copyrights, and
  477  patents.
  478         (21) Performing any other functions necessary or
  479  appropriate to achieve the purposes of the compact.
  481                             SECTION 12                            
  482                           FINANCE POWERS                          
  484         (1) The Interstate Commission may levy on and collect an
  485  annual assessment from each member state to cover the cost of
  486  the operations and activities of the Interstate Commission and
  487  its staff. The total assessment, subject to appropriation, must
  488  be sufficient to cover the annual budget approved each year for
  489  which revenue is not provided by other sources. The aggregate
  490  annual assessment amount must be allocated upon a formula to be
  491  determined by the Interstate Commission, which shall adopt a
  492  rule binding upon all member states.
  493         (2) The Interstate Commission may not incur obligations of
  494  any kind before securing the funds adequate to meet the same.
  495         (3) The Interstate Commission may not pledge the credit of
  496  any of the member states, except by, and with the authority of,
  497  the member state.
  498         (4) The Interstate Commission is subject to an annual
  499  financial audit conducted by a certified or licensed public
  500  accountant, and the report of the audit must be included in the
  501  annual report of the Interstate Commission.
  503                             SECTION 13                            
  506         (1) The Interstate Commission shall, by a majority of
  507  commissioners present and voting, adopt bylaws to govern its
  508  conduct as may be necessary or appropriate to carry out the
  509  purposes of the compact within 12 months after the first
  510  Interstate Commission meeting.
  511         (2) The Interstate Commission shall elect or appoint
  512  annually from among its commissioners a chairperson, a vice
  513  chairperson, and a treasurer, each of whom shall have such
  514  authority and duties as may be specified in the bylaws. The
  515  chairperson, or in the chairperson’s absence or disability, the
  516  vice chairperson, shall preside over all meetings of the
  517  Interstate Commission.
  518         (3) Officers selected pursuant to subsection (2) shall
  519  serve without remuneration from the Interstate Commission.
  520         (4) The officers and employees of the Interstate Commission
  521  are immune from suit and liability, either personally or in
  522  their official capacity, for a claim for damage to or loss of
  523  property or personal injury or other civil liability caused or
  524  arising out of, or relating to, an actual or alleged act, error,
  525  or omission that occurred, or that such person had a reasonable
  526  basis for believing occurred, within the scope of Interstate
  527  Commission employment, duties, or responsibilities; provided
  528  that such person is not protected from suit or liability for
  529  damage, loss, injury, or liability caused by the intentional or
  530  willful and wanton misconduct of such person.
  531         (a) The liability of the executive director and employees
  532  of the Interstate Commission or representatives of the
  533  Interstate Commission, acting within the scope of such person’s
  534  employment or duties for acts, errors, or omissions occurring
  535  within such person’s state, may not exceed the limits of
  536  liability set forth under the constitution and laws of that
  537  state for state officials, employees, and agents. The Interstate
  538  Commission is considered to be an instrumentality of the states
  539  for the purposes of any such action. Nothing in this subsection
  540  may be construed to protect such person from suit or liability
  541  for damage, loss, injury, or liability caused by the intentional
  542  or willful and wanton misconduct of such person.
  543         (b) The Interstate Commission shall defend the executive
  544  director and its employees and, subject to the approval of the
  545  attorney general or other appropriate legal counsel of the
  546  member state represented by an Interstate Commission
  547  representative, shall defend such persons in any civil action
  548  seeking to impose liability arising out of an actual or alleged
  549  act, error, or omission that occurred within the scope of
  550  Interstate Commission employment, duties, or responsibilities,
  551  or that the defendant had a reasonable basis for believing
  552  occurred within the scope of Interstate Commission employment,
  553  duties, or responsibilities, provided that the actual or alleged
  554  act, error, or omission did not result from intentional or
  555  willful and wanton misconduct on the part of such person.
  556         (c) To the extent not covered by the state involved, the
  557  member state, or the Interstate Commission, the representatives
  558  or employees of the Interstate Commission must be held harmless
  559  in the amount of a settlement or judgment, including attorney
  560  fees and costs, obtained against such persons arising out of an
  561  actual or alleged act, error, or omission that occurred within
  562  the scope of Interstate Commission employment, duties, or
  563  responsibilities, or that such persons had a reasonable basis
  564  for believing occurred within the scope of Interstate Commission
  565  employment, duties, or responsibilities, provided that the
  566  actual or alleged act, error, or omission did not result from
  567  intentional or willful and wanton misconduct on the part of such
  568  persons.
  570                             SECTION 14                            
  573         (1) The Interstate Commission shall adopt reasonable rules
  574  in order to effectively and efficiently achieve the purposes of
  575  the compact. However, in the event the Interstate Commission
  576  exercises its rulemaking authority in a manner that is beyond
  577  the scope of the purposes of the compact, or the powers granted
  578  hereunder, then such an action by the Interstate Commission is
  579  invalid and has no force or effect.
  580         (2) Rules deemed appropriate for the operations of the
  581  Interstate Commission must be made pursuant to a rulemaking
  582  process that substantially conforms to the “Model State
  583  Administrative Procedure Act” of 2010, and subsequent amendments
  584  thereto.
  585         (3) Not later than 30 days after a rule is adopted, any
  586  person may file a petition for judicial review of the rule in
  587  the United States District Court for the District of Columbia or
  588  the federal district where the Interstate Commission has its
  589  principal offices, provided that the filing of such a petition
  590  does not stay or otherwise prevent the rule from becoming
  591  effective unless the court finds that the petitioner has a
  592  substantial likelihood of success. The court must give deference
  593  to the actions of the Interstate Commission consistent with
  594  applicable law and may not find the rule to be unlawful if the
  595  rule represents a reasonable exercise of the authority granted
  596  to the Interstate Commission.
  598                             SECTION 15                            
  599                   OVERSIGHT OF INTERSTATE COMPACT                 
  601         (1) The executive, legislative, and judicial branches of
  602  state government in each member state shall enforce the compact
  603  and shall take all actions necessary and appropriate to
  604  effectuate the compact’s purposes and intent. The compact and
  605  the rules adopted hereunder shall have standing as statutory law
  606  but do not override existing state authority to regulate the
  607  practice of medicine.
  608         (2) All courts shall take judicial notice of the compact
  609  and the rules in any judicial or administrative proceeding in a
  610  member state pertaining to the subject matter of the compact
  611  which may affect the powers, responsibilities, or actions of the
  612  Interstate Commission.
  613         (3) The Interstate Commission is entitled to receive all
  614  service of process in any such proceeding and shall have
  615  standing to intervene in the proceeding for all purposes.
  616  Failure to provide service of process to the Interstate
  617  Commission shall render a judgment or order void as to the
  618  Interstate Commission, the compact, or adopted rules, as
  619  applicable.
  621                             SECTION 16                            
  622                  ENFORCEMENT OF INTERSTATE COMPACT                
  624         (1) The Interstate Commission, in the reasonable exercise
  625  of its discretion, shall enforce the provisions and rules of the
  626  compact.
  627         (2) The Interstate Commission may, by majority vote of the
  628  commissioners, initiate legal action in the United States
  629  District Court for the District of Columbia, or, at the
  630  discretion of the Interstate Commission, in the federal district
  631  where the Interstate Commission has its principal offices, to
  632  enforce compliance with the compact and its adopted rules and
  633  bylaws against a member state in default. The relief sought may
  634  include both injunctive relief and damages. In the event
  635  judicial enforcement is necessary, the prevailing party must be
  636  awarded all costs of such litigation, including reasonable
  637  attorney fees.
  638         (3) The remedies herein are not the exclusive remedies of
  639  the Interstate Commission. The Interstate Commission may avail
  640  itself of any other remedies available under state law or the
  641  regulation of a profession.
  643                             SECTION 17                            
  644                         DEFAULT PROCEDURES                        
  646         (1) The grounds for default include, but are not limited
  647  to, failure of a member state to perform such obligations or
  648  responsibilities imposed upon it by the compact, or the rules
  649  and bylaws of the Interstate Commission adopted under the
  650  compact.
  651         (2) If the Interstate Commission determines that a member
  652  state has defaulted in the performance of its obligations or
  653  responsibilities under the compact, or the bylaws or adopted
  654  rules, the Interstate Commission shall:
  655         (a) Provide written notice to the defaulting state and
  656  other member states of the nature of the default, the means of
  657  curing the default, and any action taken by the Interstate
  658  Commission. The Interstate Commission shall specify the
  659  conditions by which the defaulting state must cure its default;
  660  and
  661         (b) Provide remedial training and specific technical
  662  assistance regarding the default.
  663         (3)If the defaulting state fails to cure the default, the
  664  defaulting state may be terminated from the compact upon an
  665  affirmative vote of a majority of the commissioners and all
  666  rights, privileges, and benefits conferred by the compact
  667  terminate on the effective date of the termination. A cure of
  668  the default does not relieve the offending state of obligations
  669  or liabilities incurred during the period of the default.
  670         (4) Termination of membership in the compact must be
  671  imposed only after all other means of securing compliance have
  672  been exhausted. Notice of intent to terminate must be given by
  673  the Interstate Commission to the governor, the majority and
  674  minority leaders of the defaulting state’s legislature, and each
  675  of the member states.
  676         (5) The Interstate Commission shall establish rules and
  677  procedures to address licenses and physicians that are
  678  materially impacted by the termination of a member state, or the
  679  withdrawal of a member state.
  680         (6) The member state which has been terminated is
  681  responsible for all dues, obligations, and liabilities incurred
  682  through the effective date of termination, including
  683  obligations, the performance of which extends beyond the
  684  effective date of termination.
  685         (7) The Interstate Commission shall not bear any costs
  686  relating to any state that has been found to be in default or
  687  which has been terminated from the compact, unless otherwise
  688  mutually agreed upon in writing between the Interstate
  689  Commission and the defaulting state.
  690         (8) The defaulting state may appeal the action of the
  691  Interstate Commission by petitioning the United States District
  692  Court for the District of Columbia or the federal district where
  693  the Interstate Commission has its principal offices. The
  694  prevailing party must be awarded all costs of such litigation
  695  including reasonable attorney fees.
  697                             SECTION 18                            
  698                         DISPUTE RESOLUTION                        
  700         (1) The Interstate Commission shall attempt, upon the
  701  request of a member state, to resolve disputes that are subject
  702  to the compact and that may arise among member states or member
  703  boards.
  704         (2) The Interstate Commission shall adopt rules providing
  705  for both mediation and binding dispute resolution as
  706  appropriate.
  708                             SECTION 19                            
  711         (1) Any state is eligible to become a member state of the
  712  compact.
  713         (2) The compact becomes effective and binding upon
  714  legislative enactment of the compact into law by no less than
  715  seven states. Thereafter, it becomes effective and binding on a
  716  state upon enactment of the compact into law by that state.
  717         (3) The governors of nonmember states, or their designees,
  718  must be invited to participate in the activities of the
  719  Interstate Commission on a nonvoting basis before adoption of
  720  the compact by all states.
  721         (4) The Interstate Commission may propose amendments to the
  722  compact for enactment by the member states. No amendment becomes
  723  effective and binding upon the Interstate Commission and the
  724  member states unless and until it is enacted into law by
  725  unanimous consent of the member states.
  727                             SECTION 20                            
  728                             WITHDRAWAL                            
  730         (1) Once effective, the compact shall continue in force and
  731  remain binding upon each member state. However, a member state
  732  may withdraw from the compact by specifically repealing the
  733  statute which enacted the compact into law.
  734         (2) Withdrawal from the compact must be made by the
  735  enactment of a statute repealing the same, but the withdrawal
  736  shall not take effect until 1 year after the effective date of
  737  such statute and until written notice of the withdrawal has been
  738  given by the withdrawing state to the governor of each other
  739  member state.
  740         (3) The withdrawing state shall immediately notify the
  741  chairperson of the Interstate Commission in writing upon the
  742  introduction of legislation repealing the compact in the
  743  withdrawing state.
  744         (4) The Interstate Commission shall notify the other member
  745  states of the withdrawing state’s intent to withdraw within 60
  746  days after receipt of notice provided under subsection (3).
  747         (5) The withdrawing state is responsible for all dues,
  748  obligations, and liabilities incurred through the effective date
  749  of withdrawal, including obligations, the performance of which
  750  extend beyond the effective date of withdrawal.
  751         (6) Reinstatement following withdrawal of a member state
  752  shall occur upon the withdrawing state reenacting the compact or
  753  upon such later date as determined by the Interstate Commission.
  754         (7) The Interstate Commission may develop rules to address
  755  the impact of the withdrawal of a member state on licenses
  756  granted in other member states to physicians who designated the
  757  withdrawing member state as the state of principal license.
  759                             SECTION 21                            
  760                             DISSOLUTION                           
  762         (1) The compact shall dissolve effective upon the date of
  763  the withdrawal or default of the member state which reduces the
  764  membership in the compact to one member state.
  765         (2) Upon the dissolution of the compact, the compact
  766  becomes null and void and shall be of no further force or
  767  effect, the business and affairs of the Interstate Commission
  768  must be concluded, and surplus funds of the Interstate
  769  Commission must be distributed in accordance with the bylaws.
  771                             SECTION 22                            
  772                    SEVERABILITY AND CONSTRUCTION                  
  774         (1) The provisions of the compact are severable, and if any
  775  phrase, clause, sentence, or provision is deemed unenforceable,
  776  the remaining provisions of the compact remain enforceable.
  777         (2) The provisions of the compact must be liberally
  778  construed to effectuate its purposes.
  779         (3) The compact may be construed to prohibit the
  780  applicability of other interstate compacts to which the states
  781  are members.
  783                             SECTION 23                            
  784              BINDING EFFECT OF COMPACT AND OTHER LAWS             
  786         (1) Nothing herein prevents the enforcement of any other
  787  law of a member state which is not inconsistent with the
  788  compact.
  789         (2) All laws in a member state in conflict with the compact
  790  are superseded to the extent of the conflict.
  791         (3) All lawful actions of the Interstate Commission,
  792  including all rules and bylaws adopted by the commission, are
  793  binding upon the member states.
  794         (4) All agreements between the Interstate Commission and
  795  the member states are binding in accordance with their terms.
  796         (5) In the event any provision of the compact exceeds the
  797  constitutional limits imposed on the legislature of any member
  798  state, such provision is ineffective to the extent of the
  799  conflict with the constitutional provision in question in that
  800  member state.
  801         Section 53. Section 456.4502, Florida Statutes, is created
  802  to read:
  803         456.4502Interstate Medical Licensure Compact; disciplinary
  804  proceedings.—A physician licensed pursuant to chapter 458,
  805  chapter 459, or s. 456.4501 whose license is suspended or
  806  revoked by this state pursuant to the Interstate Medical
  807  Licensure Compact as a result of disciplinary action taken
  808  against the physician’s license in another state must be granted
  809  a formal hearing before an administrative law judge from the
  810  Division of Administrative Hearings held pursuant to chapter 120
  811  if there are any disputed issues of material fact. In such
  812  proceedings:
  813         (1)Notwithstanding s. 120.569(2), the department shall
  814  notify the division within 45 days after receipt of a petition
  815  or request for a formal hearing.
  816         (2)The determination of whether the physician has violated
  817  the laws and rules regulating the practice of medicine or
  818  osteopathic medicine, as applicable, including a determination
  819  of the reasonable standard of care, is a conclusion of law that
  820  is to be determined by appropriate board and is not a finding of
  821  fact to be determined by an administrative law judge.
  822         (3)The administrative law judge shall issue a recommended
  823  order pursuant to chapter 120.
  824         (4)The Board of Medicine or the Board of Osteopathic
  825  Medicine, as applicable, shall determine and issue the final
  826  order in each disciplinary case. Such order shall constitute
  827  final agency action.
  828         (5)Any consent order or agreed-upon settlement is subject
  829  to the approval of the department.
  830         (6)The department shall have standing to seek judicial
  831  review of any final order of the board, pursuant to s. 120.68.
  832         Section 54. Section 456.4504, Florida Statutes, is created
  833  to read:
  834         456.4504Interstate Medical Licensure Compact Rules.—The
  835  department may adopt rules to implement the Interstate Medical
  836  Licensure Compact.
  837         Section 55. Section 458.3129, Florida Statutes, is created
  838  to read:
  839         458.3129 Interstate Medical Licensure Compact.—A physician
  840  licensed to practice allopathic medicine under s. 456.4501 is
  841  deemed to also be licensed under this chapter.
  842         Section 56. Section 459.074, Florida Statutes, is created
  843  to read:
  844         459.074 Interstate Medical Licensure Compact.—A physician
  845  licensed to practice osteopathic medicine under s. 456.4501 is
  846  deemed to also be licensed under this chapter.
  847         Section 57. Paragraph (j) is added to subsection (10) of
  848  section 768.28, Florida Statutes, to read:
  849         768.28 Waiver of sovereign immunity in tort actions;
  850  recovery limits; civil liability for damages caused during a
  851  riot; limitation on attorney fees; statute of limitations;
  852  exclusions; indemnification; risk management programs.—
  853         (10)
  854         (j) For purposes of this section, the representative
  855  appointed from the Board of Medicine and the representative
  856  appointed from the Board of Osteopathic Medicine, when serving
  857  as commissioners of the Interstate Medical Licensure Compact
  858  Commission pursuant to s. 456.4501, and any administrator,
  859  officer, executive director, employee, or representative of the
  860  Interstate Medical Licensure Compact Commission, when acting
  861  within the scope of their employment, duties, or
  862  responsibilities in this state, are considered agents of the
  863  state. The commission shall pay any claims or judgments pursuant
  864  to this section and may maintain insurance coverage to pay any
  865  such claims or judgments.
  867  ================= T I T L E  A M E N D M E N T ================
  868  And the title is amended as follows:
  869         Delete line 341
  870  and insert:
  871         act; creating s. 456.4501, F.S.; enacting the
  872         Interstate Medical Licensure Compact in this state;
  873         providing purposes of the compact; providing that
  874         state medical boards of member states retain
  875         jurisdiction to impose adverse action against licenses
  876         issued under the compact; defining terms; specifying
  877         eligibility requirements for physicians seeking an
  878         expedited license under the compact; providing
  879         requirements for designation of a state of principal
  880         license for purposes of the compact; authorizing the
  881         Interstate Medical Licensure Compact Commission to
  882         develop certain rules; providing an application and
  883         verification process for expedited licensure under the
  884         compact; providing for expiration and termination of
  885         expedited licenses; authorizing the Interstate
  886         Commission to develop certain rules; providing
  887         requirements for renewal of expedited licenses;
  888         authorizing the Interstate Commission to develop
  889         certain rules; providing for the establishment of a
  890         database for coordinating licensure data amongst
  891         member states; requiring and authorizing member boards
  892         to report specified information to the database;
  893         providing for confidentiality of such information;
  894         providing construction; authorizing the Interstate
  895         Commission to develop certain rules; authorizing
  896         member states to conduct joint investigations and
  897         share certain materials; providing for disciplinary
  898         action of physicians licensed under the compact;
  899         creating the Interstate Medical Licensure Compact
  900         Commission; providing purpose and authority of the
  901         commission; providing for membership and meetings of
  902         the commission; providing public meeting and notice
  903         requirements; authorizing closed meetings under
  904         certain circumstances; providing public record
  905         requirements; requiring the commission to establish an
  906         executive committee; providing for membership, powers,
  907         and duties of the committee; authorizing the
  908         commission to establish other committees; specifying
  909         powers and duties of the commission; providing for
  910         financing of the commission; providing for
  911         organization and operation of the commission;
  912         providing limited immunity from liability for
  913         commissioners and other agents or employees of the
  914         commission; authorizing the commission to adopt rules;
  915         providing for rulemaking procedures, including public
  916         notice and meeting requirements; providing for
  917         judicial review of adopted rules; providing for
  918         oversight and enforcement of the compact in member
  919         states; requiring courts in member states to take
  920         judicial notice of the compact and the commission
  921         rules for purposes of certain proceedings; providing
  922         that the commission is entitled to receive service of
  923         process and has standing in certain proceedings;
  924         rendering judgments or orders void as to the
  925         commission, the compact, or commission rules under
  926         certain circumstances; providing for enforcement of
  927         the compact; specifying venue and civil remedies in
  928         such proceedings; providing for attorney fees;
  929         providing construction; specifying default procedures
  930         for member states; providing for dispute resolution
  931         between member states; providing for eligibility and
  932         procedures for enactment of the compact; providing for
  933         amendment to the compact; specifying procedures for
  934         withdrawal from and subsequent reinstatement of the
  935         compact; authorizing the Interstate Commission to
  936         develop certain rules; providing for dissolution of
  937         the compact; providing severability and construction;
  938         creating s. 456.4502, F.S.; providing that a formal
  939         hearing before the Division of Administrative Hearings
  940         must be held if there are any disputed issues of
  941         material fact when the licenses of certain physicians
  942         and osteopathic physicians are suspended or revoked by
  943         this state under the compact; requiring the Department
  944         of Health to notify the Division of Administrative
  945         Hearings of a petition for a formal hearing within a
  946         specified timeframe; requiring the administrative law
  947         judge to issue a recommended order; requiring the
  948         Board of Medicine or the Board of Osteopathic
  949         Medicine, as applicable, to determine and issue final
  950         orders in certain cases; providing the department with
  951         standing to seek judicial review of any final order of
  952         the boards; creating s. 456.4504, F.S.; authorizing
  953         the department to adopt rules to implement the
  954         compact; creating ss. 458.3129 and 459.074, F.S.;
  955         providing that an allopathic physician or an
  956         osteopathic physician, respectively, licensed under
  957         the compact is deemed to be licensed under ch. 458,
  958         F.S., or ch. 459, F.S., as applicable; amending s.
  959         768.28, F.S.; designating the state commissioners of
  960         the Interstate Medical Licensure Compact Commission
  961         and other members or employees of the commission as
  962         state agents for the purpose of applying sovereign
  963         immunity and waivers of sovereign immunity; requiring
  964         the commission to pay certain claims or judgments;
  965         authorizing the commission to maintain insurance
  966         coverage to pay such claims or judgments; providing
  967         appropriations; providing effective