Nevada § 629A.100 - Text of Compact

§ 629A.100. Text of Compact

The Interstate Medical Licensure Compact is hereby ratified and entered into with

all other jurisdictions legally joining the Compact, in substantially the form set

forth in this chapter: INTERSTATE MEDICAL LICENSURE COMPACT ARTICLE 1. PURPOSE In order to strengthen access to health care, and in recognition of the advances in

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

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

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

a streamlined process which allows physicians to become licensed in multiple states,

thereby enhancing the portability of a medical license and ensuring the safety of

patients. The Compact creates another pathway for licensure and does not otherwise change

a state's existing Medical Practice Act. The Compact also adopts the prevailing standard for licensure and affirms that the

practice of medicine occurs where the patient is located at the time of the physician-patient

encounter, and therefore, requires the physician to be under the jurisdiction of the

state medical board where the patient is located. State medical boards that participate in the Compact retain the jurisdiction to

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

to a physician through the procedures in the Compact. ARTICLE 2. DEFINITIONS In this Compact: (a) “ Bylaws ” means those bylaws established by the Interstate Commission pursuant to Article

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 Article

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 Medical Licensure Compact Commission created pursuant to Article

11. (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) “ Practice of medicine ” means the clinical prevention, diagnosis or treatment of a 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. (k) “ Physician ” means any person who: (1) Is a graduate of a medical school accredited by the Liaison Committee on Medical

Education, the Commission on Osteopathic College Accreditation of the American Osteopathic

Association or a medical school listed in the International Medical Education Directory

or its equivalent; (2) Has passed each component of the United States Medical Licensing Examination (USMLE)

or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) within

three attempts, or any of its predecessor examinations accepted by a state medical

board as an equivalent examination for licensure purposes; (3) Has 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 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) Has never held a license authorizing the practice of medicine subjected to discipline

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

action related to nonpayment of fees related to a license; (8) Has never had a controlled substance license or permit suspended or revoked by

a state or the United States Drug Enforcement Administration; and (9) Is not under active investigation by a licensing agency or law enforcement authority

in any state, federal or foreign jurisdiction. (l) “ Offense ” means a felony, gross misdemeanor or crime of moral turpitude. (m) “ Rule ” means a written statement by the Interstate Commission promulgated pursuant to Article

12 of the Compact that is of general applicability, implements, interprets or prescribes

a policy or provision of the Compact, or an organizational, procedural or practice

requirement of the Interstate Commission, and has the force and effect of statutory

law in a member state, and includes the amendment, repeal or suspension of an existing

rule. (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. ARTICLE 3. ELIGIBILITY (a) A physician must meet the eligibility requirements as defined in Article 2(k)

to receive an expedited license under the terms and provisions of the Compact. (b) A physician who does not meet the requirements of Article 2(k) may obtain a license

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

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

medicine in that state. ARTICLE 4. DESIGNATION OF STATE OF PRINCIPAL LICENSE (a) A physician shall designate a member state as the state of principal license for

purposes of registration for expedited licensure through the Compact if the physician

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

state is: (1) The state of primary residence for the physician; (2) The state where at least 25 percent of the practice of medicine occurs; (3) The location of the physician's employer; or (4) If no state qualifies under paragraph (1), (2) or (3), the state designated as

the state of residence for the purpose 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 subsection (a). (c) The Interstate Commission is authorized to develop rules to facilitate redesignation

of another member state as the state of principal license. ARTICLE 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. For purposes of this subsection: (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

primary source verification where the primary source has already been 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 a 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 subsection (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 subsection (a), including

the payment of any applicable fees. (d) After receiving verification of eligibility under subsection (b) and any fees

under subsection (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

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

reason, without redesignation of a new state of principal licensure. (g) The Board of Medical Examiners and the State Board of Osteopathic Medicine, in

conjunction with the Interstate Commission, are authorized to develop rules regarding

the application process, including payment of any applicable fees and the issuance

of an expedited license. ARTICLE 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 Board of Medical Examiners and the State Board of Osteopathic Medicine, in

conjunction with the Interstate Commission, are authorized to develop rules regarding

fees for expedited licenses. ARTICLE 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 Board of Medical Examiners or the State Board

of Osteopathic Medicine, as applicable, in conjunction with the Interstate Commission,

if the physician: (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; and (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 Board of Medical Examiners and the State Board of Osteopathic Medicine, as

applicable, shall collect any renewal fees charged for the renewal of a license and

distribute the fees to the Interstate Commission. (d) Subject to the renewal requirements in this Article and those specific to license

renewal by the Board of Medical Examiners or the State Board of Osteopathic Medicine,

as applicable, and upon receipt of any renewal fees collected in subsection (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 Board of Medical Examiners and the State Board of Osteopathic Medicine, in

conjunction with the Interstate Commission, are authorized to develop rules to address

renewal of licenses obtained through the Compact. ARTICLE 8. COORDINATED INFORMATION SYSTEM (a) The Interstate Commission shall establish a database of all physicians licensed,

or who have applied for licensure, pursuant to Article 5. (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 for 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 subsection (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 mandatory or discretionary

sharing of information by member boards. ARTICLE 9. JOINT INVESTIGATIONS (a) Licensure and disciplinary records of physicians are deemed investigative. (b) In addition to the authority granted to a member board by its respective Medical

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

member boards in joint investigations of physicians licensed by the member boards. (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. ARTICLE 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: (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 license issued to the

physician by any other member board shall be suspended, automatically and immediately

without further action necessary by the other member board, for 90 days upon entry

of the order by the disciplining board, to permit the member board to investigate

the basis for the action under the Medical Practice Act of that state. A member board may terminate the automatic suspension of the license it issued prior

to the completion of the 90 day suspension period in a manner consistent with the

Medical Practice Act of that state. ARTICLE 11. INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION (a) The member states hereby create the “Interstate Medical Licensure Compact Commission.” (b) The purpose of the Interstate Commission is the administration of the Interstate

Medical Licensure Compact, which is a discretionary state function. (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) The Interstate Commission shall consist of two voting representatives appointed

by each member state who shall serve as Commissioners. In states where allopathic and osteopathic physicians are regulated by separate

member boards, or if the licensing and disciplinary authority is split between multiple

member boards within a member state, the member state shall appoint one representative

from each member board. A Commissioner shall be: (1) An allopathic or osteopathic physician appointed to a member board; (2) An executive director, executive secretary or similar executive of a member board;

or (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 meeting shall be a business meeting to address such matters as

may properly come before the Commission, including the election of officers. The Chairperson may call additional meetings and shall call for a meeting upon the

request of a majority of the member states. (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 meets the requirements

of subsection (d). (h) The Interstate Commission shall provide public notice of all meetings, and all

meetings must 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: (1) Relate solely to the internal personnel practices and procedures of the Interstate

Commission; (2) Discuss matters specifically exempted from disclosure by a 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; or (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 a 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 must 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. ARTICLE 12. POWERS AND DUTIES OF THE INTERSTATE COMMISSION The Interstate Commission shall have the duty and power to: (a) Oversee and maintain the administration of the Compact; (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 Article 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 it 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; and (u) Perform such functions as may be necessary or appropriate to achieve the purposes

of the Compact. ARTICLE 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. ARTICLE 14. ORGANIZATION AND OPERATION OF THE INTERSTATE COMMISSION (a) The Interstate Commission shall, by a majority of Commissioners present and voting,

adopt bylaws to govern its conduct as may be necessary or appropriate to carry out

the purposes of the Compact within 12 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 subsection (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. For purposes of this subsection: (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 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, 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, the member state or the Interstate

Commission, the representatives or employees of the Interstate Commission shall be

held harmless in the amount of a settlement or judgment, including attorney's fees

and costs, obtained against such persons arising out of an actual or alleged act,

error or omission that occurred within the scope of Interstate Commission employment,

duties or responsibilities, or that such persons had a reasonable basis for believing

occurred within the scope of Interstate Commission employment, duties or responsibilities,

provided that the actual or alleged act, error or omission did not result from intentional

or willful and wanton misconduct on the part of such persons. ARTICLE 15. RULEMAKING FUNCTIONS OF THE INTERSTATE COMMISSION (a) The Interstate Commission shall promulgate reasonable rules in order to effectively

and efficiently achieve the purposes of the Compact. Notwithstanding the foregoing, in the event the Interstate Commission exercises

its rulemaking authority in a manner that is beyond the scope of the purposes of the

Compact, or the powers granted hereunder, then such an action by the Interstate Commission

shall be invalid and have no force or effect. (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 30 days after a rule is promulgated, any person may file a petition

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

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

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

the rule from becoming effective unless the court finds that the petitioner has a

substantial likelihood of success. The court shall give deference to the actions of the Interstate Commission consistent

with applicable law and shall not find the rule to be unlawful if the rule represents

a reasonable exercise of the authority granted to the Interstate Commission. ARTICLE 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. ARTICLE 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 action in the United States District Court for the District of Columbia or,

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

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

of the Compact, and its promulgated rules and bylaws, against a member state in default. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded

all costs of such litigation, including reasonable attorney's fees. (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. ARTICLE 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: (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; and (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 the 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

and liabilities incurred through the effective date of the termination, including

obligations the performance of which extends beyond the effective date of the 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 Interstate Commission has its principal offices. The prevailing party shall be awarded all costs of such litigation, including reasonable

attorney's fees. ARTICLE 19. DISPUTE RESOLUTION (a) The Interstate Commission shall attempt, upon the request of a member state, to

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

states or member boards. (b) The Interstate Commission shall promulgate rules providing for both mediation

and binding dispute resolution as appropriate. ARTICLE 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. ARTICLE 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) Withdrawal from the Compact shall be by the enactment of a statute repealing the

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

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

to the governor of each other member state. (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 60 days of its receipt of notice provided under

subsection (c). (e) The withdrawing state is responsible for all dues, obligations and liabilities

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

performance of which extends beyond the effective date of the 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. ARTICLE 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. ARTICLE 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. ARTICLE 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 provisions shall be ineffective to the

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

state.