Florida Senate - 2020                                     SB 926
       By Senator Harrell
       25-01035C-20                                           2020926__
    1                        A bill to be entitled                      
    2         An act relating to health care practitioner licensure;
    3         creating s. 458.3129, F.S.; establishing that a
    4         physician licensed under the Interstate Medical
    5         Licensure Compact is deemed to be licensed under
    6         chapter 458; creating s. 459.074, F.S.; establishing
    7         that an osteopathic physician licensed under the
    8         Interstate Medical Licensure Compact is deemed to be
    9         licensed under chapter 459; amending s. 456.0635,
   10         F.S.; removing the requirement that each board within
   11         the jurisdiction of the Department of Health, or the
   12         department if there is no board, prohibit a candidate
   13         from being examined for or issued, or having renewed a
   14         license, certificate, or registration to practice a
   15         health care profession if he or she is listed on a
   16         specified federal list of excluded individuals and
   17         entities; amending s. 456.072, F.S.; deleting a
   18         provision classifying the failure to repay a student
   19         loan issued or guaranteed by the state or federal
   20         government in accordance with the terms of the loan as
   21         a failure to perform a statutory or legal obligation;
   22         removing penalties; repealing s. 456.0721, F.S.,
   23         relating to investigations of health care
   24         practitioners in default on student loan or
   25         scholarship obligations; amending s. 456.074, F.S.;
   26         deleting the requirement, and related provisions, that
   27         the department immediately suspend the licenses of
   28         certain health care practitioners for failing to
   29         provide proof of new payment terms for defaulted
   30         student loans within a specified timeframe; creating
   31         s. 456.4501, F.S.; implementing the Interstate Medical
   32         Licensure Compact in this state; providing for an
   33         interstate medical licensure process; providing
   34         requirements for multistate practice; creating s.
   35         456.4502, F.S.; establishing that a formal hearing
   36         before the Division of Administrative Hearings must be
   37         held if there are any disputed issues of material fact
   38         when the licenses of certain physicians and
   39         osteopathic physicians are suspended or revoked by
   40         this state under the compact; requiring the department
   41         to notify the division of a petition for a formal
   42         hearing within a specified timeframe; requiring the
   43         administrative law judge to issue a recommended order;
   44         requiring the Board of Medicine or the Board of
   45         Osteopathic Medicine, as applicable, to determine and
   46         issue final orders in certain cases; providing the
   47         department with standing to seek judicial review of
   48         any final order of the boards; creating s. 456.4504,
   49         F.S.; authorizing the department to adopt rules;
   50         amending s. 768.28, F.S.; designating the state
   51         commissioners of the Interstate Medical Licensure
   52         Compact Commission and other members or employees of
   53         the commission as state agents for the purpose of
   54         applying sovereign immunity and waivers of sovereign
   55         immunity; requiring the commission to pay certain
   56         claims or judgments; authorizing the commission to
   57         maintain insurance coverage to pay such claims or
   58         judgments; providing an effective date.
   60  Be It Enacted by the Legislature of the State of Florida:
   62         Section 1. Section 458.3129, Florida Statutes, is created
   63  to read:
   64         458.3129 Interstate Medical Licensure Compact.—A physician
   65  licensed to practice medicine under s. 456.4501 is deemed to
   66  also be licensed under this chapter.
   67         Section 2. Section 459.074, Florida Statutes, is created to
   68  read:
   69         459.074 Interstate Medical Licensure Compact.—A physician
   70  licensed to practice osteopathic medicine under s. 456.4501 is
   71  deemed to also be licensed under this chapter.
   72         Section 3. Subsection (2) and paragraph (e) of subsection
   73  (3) of section 456.0635, Florida Statutes, are amended to read:
   74         456.0635 Health care fraud; disqualification for license,
   75  certificate, or registration.—
   76         (2) Each board within the jurisdiction of the department,
   77  or the department if there is no board, shall refuse to admit a
   78  candidate to any examination and refuse to issue a license,
   79  certificate, or registration to any applicant if the candidate
   80  or applicant or any principal, officer, agent, managing
   81  employee, or affiliated person of the candidate or applicant:
   82         (a) Has been convicted of, or entered a plea of guilty or
   83  nolo contendere to, regardless of adjudication, a felony under
   84  chapter 409, chapter 817, or chapter 893, or a similar felony
   85  offense committed in another state or jurisdiction, unless the
   86  candidate or applicant has successfully completed a pretrial
   87  diversion or drug court program for that felony and provides
   88  proof that the plea has been withdrawn or the charges have been
   89  dismissed. Any such conviction or plea shall exclude the
   90  applicant or candidate from licensure, examination,
   91  certification, or registration unless the sentence and any
   92  subsequent period of probation for such conviction or plea
   93  ended:
   94         1. For felonies of the first or second degree, more than 15
   95  years before the date of application.
   96         2. For felonies of the third degree, more than 10 years
   97  before the date of application, except for felonies of the third
   98  degree under s. 893.13(6)(a).
   99         3. For felonies of the third degree under s. 893.13(6)(a),
  100  more than 5 years before the date of application;
  101         (b) Has been convicted of, or entered a plea of guilty or
  102  nolo contendere to, regardless of adjudication, a felony under
  103  21 U.S.C. ss. 801-970, or 42 U.S.C. ss. 1395-1396, unless the
  104  sentence and any subsequent period of probation for such
  105  conviction or plea ended more than 15 years before the date of
  106  the application;
  107         (c) Has been terminated for cause from the Florida Medicaid
  108  program pursuant to s. 409.913, unless the candidate or
  109  applicant has been in good standing with the Florida Medicaid
  110  program for the most recent 5 years; or
  111         (d) Has been terminated for cause, pursuant to the appeals
  112  procedures established by the state, from any other state
  113  Medicaid program, unless the candidate or applicant has been in
  114  good standing with a state Medicaid program for the most recent
  115  5 years and the termination occurred at least 20 years before
  116  the date of the application; or
  117         (e) Is currently listed on the United States Department of
  118  Health and Human Services Office of Inspector General’s List of
  119  Excluded Individuals and Entities.
  121  This subsection does not apply to an applicant for initial
  122  licensure, certification, or registration who was arrested or
  123  charged with a felony specified in paragraph (a) or paragraph
  124  (b) before July 1, 2009.
  125         (3) The department shall refuse to renew a license,
  126  certificate, or registration of any applicant if the applicant
  127  or any principal, officer, agent, managing employee, or
  128  affiliated person of the applicant:
  129         (e) Is currently listed on the United States Department of
  130  Health and Human Services Office of Inspector General’s List of
  131  Excluded Individuals and Entities.
  133  This subsection does not apply to an applicant for renewal of
  134  licensure, certification, or registration who was arrested or
  135  charged with a felony specified in paragraph (a) or paragraph
  136  (b) before July 1, 2009.
  137         Section 4. Paragraph (k) of subsection (1) of section
  138  456.072, Florida Statutes, is amended to read:
  139         456.072 Grounds for discipline; penalties; enforcement.—
  140         (1) The following acts shall constitute grounds for which
  141  the disciplinary actions specified in subsection (2) may be
  142  taken:
  143         (k) Failing to perform any statutory or legal obligation
  144  placed upon a licensee. For purposes of this section, failing to
  145  repay a student loan issued or guaranteed by the state or the
  146  Federal Government in accordance with the terms of the loan or
  147  failing to comply with service scholarship obligations shall be
  148  considered a failure to perform a statutory or legal obligation,
  149  and the minimum disciplinary action imposed shall be a
  150  suspension of the license until new payment terms are agreed
  151  upon or the scholarship obligation is resumed, followed by
  152  probation for the duration of the student loan or remaining
  153  scholarship obligation period, and a fine equal to 10 percent of
  154  the defaulted loan amount. Fines collected shall be deposited
  155  into the Medical Quality Assurance Trust Fund.
  156         Section 5. Section 456.0721, Florida Statutes, is repealed.
  157         Section 6. Subsection (4) of section 456.074, Florida
  158  Statutes, is amended to read:
  159         456.074 Certain health care practitioners; immediate
  160  suspension of license.—
  161         (4) Upon receipt of information that a Florida-licensed
  162  health care practitioner has defaulted on a student loan issued
  163  or guaranteed by the state or the Federal Government, the
  164  department shall notify the licensee by certified mail that he
  165  or she shall be subject to immediate suspension of license
  166  unless, within 45 days after the date of mailing, the licensee
  167  provides proof that new payment terms have been agreed upon by
  168  all parties to the loan. The department shall issue an emergency
  169  order suspending the license of any licensee who, after 45 days
  170  following the date of mailing from the department, has failed to
  171  provide such proof. Production of such proof shall not prohibit
  172  the department from proceeding with disciplinary action against
  173  the licensee pursuant to s. 456.073.
  174         Section 7. Section 456.4501, Florida Statutes, is created
  175  to read:
  176         456.4501 Interstate Medical Licensure Compact.—The
  177  Interstate Medical Licensure Compact is hereby enacted into law
  178  and entered into by this state with all other jurisdictions
  179  legally joining therein in the form substantially as follows:
  181                              SECTION 1                            
  182                               PURPOSE                             
  184         In order to strengthen access to health care, and in
  185  recognition of the advances in the delivery of health care, the
  186  member states of the Interstate Medical Licensure Compact have
  187  allied in common purpose to develop a comprehensive process that
  188  complements the existing licensing and regulatory authority of
  189  state medical boards, provides a streamlined process that allows
  190  physicians to become licensed in multiple states, thereby
  191  enhancing the portability of a medical license and ensuring the
  192  safety of patients. The Compact creates another pathway for
  193  licensure and does not otherwise change a states existing
  194  Medical Practice Act. The Compact also adopts the prevailing
  195  standard for licensure and affirms that the practice of medicine
  196  occurs where the patient is located at the time of the
  197  physician-patient encounter, and therefore, requires the
  198  physician to be under the jurisdiction of the state medical
  199  board where the patient is located. State medical boards that
  200  participate in the Compact retain the jurisdiction to impose an
  201  adverse action against a license to practice medicine in that
  202  state issued to a physician through the procedures in the
  203  Compact.
  205                              SECTION 2                            
  206                             DEFINITIONS                           
  208         In this compact:
  209         (a)“Bylaws” means those bylaws established by the
  210  Interstate Commission pursuant to Section 11 for its governance,
  211  or for directing and controlling its actions and conduct.
  212         (b)“Commissioner” means the voting representative
  213  appointed by each member board pursuant to Section 11.
  214         (c)“Conviction” means a finding by a court that an
  215  individual is guilty of a criminal offense through adjudication,
  216  or entry of a plea of guilt or no contest to the charge by the
  217  offender. Evidence of an entry of a conviction of a criminal
  218  offense by the court shall be considered final for purposes of
  219  disciplinary action by a member board.
  220         (d)“Expedited License” means a full and unrestricted
  221  medical license granted by a member state to an eligible
  222  physician through the process set forth in the Compact.
  223         (e)“Interstate Commission” means the interstate commission
  224  created pursuant to Section 11.
  225         (f)“License” means authorization by a state for a
  226  physician to engage in the practice of medicine, which would be
  227  unlawful without the authorization.
  228         (g)“Medical Practice Act” means laws and regulations
  229  governing the practice of allopathic and osteopathic medicine
  230  within a member state.
  231         (h)“Member Board” means a state agency in a member state
  232  that acts in the sovereign interests of the state by protecting
  233  the public through licensure, regulation, and education of
  234  physicians as directed by the state government.
  235         (i)“Member State” means a state that has enacted the
  236  Compact.
  237         (j)“Practice of medicine” means the diagnosis, treatment,
  238  prevention, cure, or relieving of a human disease, ailment,
  239  defect, complaint, or other physical or mental condition, by
  240  attendance, advice, device, diagnostic test, or other means, or
  241  offering, undertaking, attempting to do, or holding oneself out
  242  as able to do, any of these acts.
  243         (k)“Physician” means any person who:
  244         (1)Is a graduate of a medical school accredited by the
  245  Liaison Committee on Medical Education, the Commission on
  246  Osteopathic College Accreditation, or a medical school listed in
  247  the International Medical Education Directory or its equivalent;
  248         (2)Passed each component of the United States Medical
  249  Licensing Examination (USMLE) or the Comprehensive Osteopathic
  250  Medical Licensing Examination (COMLEX-USA) within three
  251  attempts, or any of its predecessor examinations accepted by a
  252  state medical board as an equivalent examination for licensure
  253  purposes;
  254         (3)Successfully completed graduate medical education
  255  approved by the Accreditation Council for Graduate Medical
  256  Education or the American Osteopathic Association;
  257         (4)Holds specialty certification or a time-unlimited
  258  specialty certificate recognized by the American Board of
  259  Medical Specialties or the American Osteopathic Associations
  260  Bureau of Osteopathic Specialists; however, the specialty
  261  certification or a time-unlimited specialty certificate does not
  262  have to be maintained once a physician is initially determined
  263  to be eligible for expedited licensure through the Compact;
  264         (5)Possesses a full and unrestricted license to engage in
  265  the practice of medicine issued by a member board;
  266         (6)Has never been convicted, received adjudication,
  267  deferred adjudication, community supervision, or deferred
  268  disposition for any offense by a court of appropriate
  269  jurisdiction;
  270         (7)Has never held a license authorizing the practice of
  271  medicine subjected to discipline by a licensing agency in any
  272  state, federal, or foreign jurisdiction, excluding any action
  273  related to non-payment of fees related to a license;
  274         (8)Has never had a controlled substance license or permit
  275  suspended or revoked by a state or the United States Drug
  276  Enforcement Administration; and
  277         (9)Is not under active investigation by a licensing agency
  278  or law enforcement authority in any state, federal, or foreign
  279  jurisdiction.
  280         (l)“Offense” means a felony, high court misdemeanor, or
  281  crime of moral turpitude.
  282         (m)“Rule” means a written statement by the Interstate
  283  Commission promulgated pursuant to Section 12 of the Compact
  284  that is of general applicability, implements, interprets, or
  285  prescribes a policy or provision of the Compact, or an
  286  organizational, procedural, or practice requirement of the
  287  Interstate Commission, and has the force and effect of statutory
  288  law in a member state, if the rule is not inconsistent with the
  289  laws of the member state. The term includes the amendment,
  290  repeal, or suspension of an existing rule.
  291         (n)“State” means any state, commonwealth, district, or
  292  territory of the United States.
  293         (o)“State of Principal License” means a member state where
  294  a physician holds a license to practice medicine and which has
  295  been designated as such by the physician for purposes of
  296  registration and participation in the Compact.
  298                              SECTION 3                            
  299                             ELIGIBILITY                           
  301         (a)A physician must meet the eligibility requirements as
  302  defined in Section 2(k) to receive an expedited license under
  303  the terms and provisions of the Compact.
  304         (b)A physician who does not meet the requirements of
  305  Section 2(k) may obtain a license to practice medicine in a
  306  member state if the individual complies with all laws and
  307  requirements, other than the Compact, relating to the issuance
  308  of a license to practice medicine in that state.
  310                              SECTION 4                            
  311              DESIGNATION OF STATE OF PRINCIPAL LICENSE            
  313         (a)A physician shall designate a member state as the state
  314  of principal license for purposes of registration for expedited
  315  licensure through the Compact if the physician possesses a full
  316  and unrestricted license to practice medicine in that state, and
  317  the state is:
  318         (1)The state of primary residence for the physician, or
  319         (2)The state where at least 25% of the practice of
  320  medicine occurs, or
  321         (3)The location of the physician’s employer, or
  322         (4)If no state qualifies under subsection (1), subsection
  323  (2), or subsection (3), the state designated as state of
  324  residence for purpose of federal income tax.
  325         (b)A physician may redesignate a member state as state of
  326  principal license at any time, as long as the state meets the
  327  requirements in subsection (a).
  328         (c)The Interstate Commission is authorized to develop
  329  rules to facilitate redesignation of another member state as the
  330  state of principal license.
  332                              SECTION 5                            
  335         (a)A physician seeking licensure through the Compact shall
  336  file an application for an expedited license with the member
  337  board of the state selected by the physician as the state of
  338  principal license.
  339         (b)Upon receipt of an application for an expedited
  340  license, the member board within the state selected as the state
  341  of principal license shall evaluate whether the physician is
  342  eligible for expedited licensure and issue a letter of
  343  qualification, verifying or denying the physician’s eligibility,
  344  to the Interstate Commission.
  345         (1)Static qualifications, which include verification of
  346  medical education, graduate medical education, results of any
  347  medical or licensing examination, and other qualifications as
  348  determined by the Interstate Commission through rule, shall not
  349  be subject to additional primary source verification where
  350  already primary source verified by the state of principal
  351  license.
  352         (2)The member board within the state selected as the state
  353  of principal license shall, in the course of verifying
  354  eligibility, perform a criminal background check of an
  355  applicant, including the use of the results of fingerprint or
  356  other biometric data checks compliant with the requirements of
  357  the Federal Bureau of Investigation, with the exception of
  358  federal employees who have suitability determination in
  359  accordance with U.S. 5 C.F.R. s. 731.202.
  360         (3)Appeal on the determination of eligibility shall be
  361  made to the member state where the application was filed and
  362  shall be subject to the law of that state.
  363         (c) Upon verification in subsection (b), physicians
  364  eligible for an expedited license shall complete the
  365  registration process established by the Interstate Commission to
  366  receive a license in a member state selected pursuant to
  367  subsection (a), including the payment of any applicable fees.
  368         (d) After receiving verification of eligibility under
  369  subsection (b) and any fees under subsection (c), a member board
  370  shall issue an expedited license to the physician. This license
  371  shall authorize the physician to practice medicine in the
  372  issuing state consistent with the Medical Practice Act and all
  373  applicable laws and regulations of the issuing member board and
  374  member state.
  375         (e) An expedited license shall be valid for a period
  376  consistent with the licensure period in the member state and in
  377  the same manner as required for other physicians holding a full
  378  and unrestricted license within the member state.
  379         (f) An expedited license obtained through the Compact shall
  380  be terminated if a physician fails to maintain a license in the
  381  state of principal licensure for a non-disciplinary reason,
  382  without redesignation of a new state of principal licensure.
  383         (g) The Interstate Commission is authorized to develop
  384  rules regarding the application process, including payment of
  385  any applicable fees, and the issuance of an expedited license.
  387                              SECTION 6                            
  388                    FEES FOR EXPEDITED LICENSURE                   
  390         (a) A member state issuing an expedited license authorizing
  391  the practice of medicine in that state, or the regulating
  392  authority of the member state, may impose a fee for a license
  393  issued or renewed through the Compact.
  394         (b) The Interstate Commission is authorized to develop
  395  rules regarding fees for expedited licenses. However, those
  396  rules shall not limit the authority of a member state, or the
  397  regulating authority of the member state, to impose and
  398  determine the amount of a fee under subsection (a).
  400                              SECTION 7                            
  401                 RENEWAL AND CONTINUED PARTICIPATION               
  403         (a) A physician seeking to renew an expedited license
  404  granted in a member state shall complete a renewal process with
  405  the Interstate Commission if the physician:
  406         (1)Maintains a full and unrestricted license in a state of
  407  principal license;
  408         (2) Has not been convicted, received adjudication, deferred
  409  adjudication, community supervision, or deferred disposition for
  410  any offense by a court of appropriate jurisdiction;
  411         (3) Has not had a license authorizing the practice of
  412  medicine subject to discipline by a licensing agency in any
  413  state, federal, or foreign jurisdiction, excluding any action
  414  related to non-payment of fees related to a license; and
  415         (4) Has not had a controlled substance license or permit
  416  suspended or revoked by a state or the United States Drug
  417  Enforcement Administration.
  418         (b) Physicians shall comply with all continuing
  419  professional development or continuing medical education
  420  requirements for renewal of a license issued by a member state.
  421         (c) The Interstate Commission shall collect any renewal
  422  fees charged for the renewal of a license and distribute the
  423  fees to the applicable member board.
  424         (d) Upon receipt of any renewal fees collected in
  425  subsection (c), a member board shall renew the physician’s
  426  license.
  427         (e) Physician information collected by the Interstate
  428  Commission during the renewal process will be distributed to all
  429  member boards.
  430         (f) The Interstate Commission is authorized to develop
  431  rules to address renewal of licenses obtained through the
  432  Compact.
  434                              SECTION 8                            
  435                   COORDINATED INFORMATION SYSTEM                  
  437         (a) The Interstate Commission shall establish a database of
  438  all physicians licensed, or who have applied for licensure,
  439  under Section 5.
  440         (b) Notwithstanding any other provision of law, member
  441  boards shall report to the Interstate Commission any public
  442  action or complaints against a licensed physician who has
  443  applied or received an expedited license through the Compact.
  444         (c) Member boards shall report disciplinary or
  445  investigatory information determined as necessary and proper by
  446  rule of the Interstate Commission.
  447         (d) Member boards may report any non-public complaint,
  448  disciplinary, or investigatory information not required by
  449  subsection (c) to the Interstate Commission.
  450         (e) Member boards shall share complaint or disciplinary
  451  information about a physician upon request of another member
  452  board.
  453         (f) All information provided to the Interstate Commission
  454  or distributed by member boards shall be confidential, filed
  455  under seal, and used only for investigatory or disciplinary
  456  matters.
  457         (g) The Interstate Commission is authorized to develop
  458  rules for mandated or discretionary sharing of information by
  459  member boards.
  461                              SECTION 9                            
  462                        JOINT INVESTIGATIONS                       
  464         (a) Licensure and disciplinary records of physicians are
  465  deemed investigative.
  466         (b) In addition to the authority granted to a member board
  467  by its respective Medical Practice Act or other applicable state
  468  law, a member board may participate with other member boards in
  469  joint investigations of physicians licensed by the member
  470  boards.
  471         (c) A subpoena issued by a member state shall be
  472  enforceable in other member states.
  473         (d) Member boards may share any investigative, litigation,
  474  or compliance materials in furtherance of any joint or
  475  individual investigation initiated under the Compact.
  476         (e) Any member state may investigate actual or alleged
  477  violations of the statutes authorizing the practice of medicine
  478  in any other member state in which a physician holds a license
  479  to practice medicine.
  481                             SECTION 10                            
  482                        DISCIPLINARY ACTIONS                       
  484         (a) Any disciplinary action taken by any member board
  485  against a physician licensed through the Compact shall be deemed
  486  unprofessional conduct which may be subject to discipline by
  487  other member boards, in addition to any violation of the Medical
  488  Practice Act or regulations in that state.
  489         (b) If a license granted to a physician by the member board
  490  in the state of principal license is revoked, surrendered or
  491  relinquished in lieu of discipline, or suspended, then all
  492  licenses issued to the physician by member boards shall
  493  automatically be placed, without further action necessary by any
  494  member board, on the same status. If the member board in the
  495  state of principal license subsequently reinstates the
  496  physician’s license, a license issued to the physician by any
  497  other member board shall remain encumbered until that respective
  498  member board takes action to reinstate the license in a manner
  499  consistent with the Medical Practice Act of that state.
  500         (c) If disciplinary action is taken against a physician by
  501  a member board not in the state of principal license, any other
  502  member board may deem the action conclusive as to matter of law
  503  and fact decided, and:
  504         (1)Impose the same or lesser sanction(s) against the
  505  physician so long as such sanctions are consistent with the
  506  Medical Practice Act of that state; or
  507         (2)Pursue separate disciplinary action against the
  508  physician under its respective Medical Practice Act, regardless
  509  of the action taken in other member states.
  510         (d) If a license granted to a physician by a member board
  511  is revoked, surrendered or relinquished in lieu of discipline,
  512  or suspended, then any license(s) issued to the physician by any
  513  other member board(s) shall be suspended, automatically and
  514  immediately without further action necessary by the other member
  515  board(s), for ninety (90) days upon entry of the order by the
  516  disciplining board, to permit the member board(s) to investigate
  517  the basis for the action under the Medical Practice Act of that
  518  state. A member board may terminate the automatic suspension of
  519  the license it issued prior to the completion of the ninety (90)
  520  day suspension period in a manner consistent with the Medical
  521  Practice Act of that state.
  523                             SECTION 11                            
  526         (a) The member states hereby create the “Interstate Medical
  527  Licensure Compact Commission.
  528         (b) The purpose of the Interstate Commission is the
  529  administration of the Interstate Medical Licensure Compact,
  530  which is a discretionary state function.
  531         (c) The Interstate Commission shall be a body corporate and
  532  joint agency of the member states and shall have all the
  533  responsibilities, powers, and duties set forth in the Compact,
  534  and such additional powers as may be conferred upon it by a
  535  subsequent concurrent action of the respective legislatures of
  536  the member states in accordance with the terms of the Compact.
  537         (d) The Interstate Commission shall consist of two voting
  538  representatives appointed by each member state who shall serve
  539  as Commissioners. In states where allopathic and osteopathic
  540  physicians are regulated by separate member boards, or if the
  541  licensing and disciplinary authority is split between multiple
  542  member boards within a member state, the member state shall
  543  appoint one representative from each member board. A
  544  Commissioner shall be a(n):
  545         (1) Allopathic or osteopathic physician appointed to a
  546  member board;
  547         (2) Executive director, executive secretary, or similar
  548  executive of a member board; or
  549         (3) Member of the public appointed to a member board.
  550         (e) The Interstate Commission shall meet at least once each
  551  calendar year. A portion of this meeting shall be a business
  552  meeting to address such matters as may properly come before the
  553  Commission, including the election of officers. The chairperson
  554  may call additional meetings and shall call for a meeting upon
  555  the request of a majority of the member states.
  556         (f) The bylaws may provide for meetings of the Interstate
  557  Commission to be conducted by telecommunication or electronic
  558  communication.
  559         (g) Each Commissioner participating at a meeting of the
  560  Interstate Commission is entitled to one vote. A majority of
  561  Commissioners shall constitute a quorum for the transaction of
  562  business, unless a larger quorum is required by the bylaws of
  563  the Interstate Commission. A Commissioner shall not delegate a
  564  vote to another Commissioner. In the absence of its
  565  Commissioner, a member state may delegate voting authority for a
  566  specified meeting to another person from that state who shall
  567  meet the requirements of subsection (d).
  568         (h) The Interstate Commission shall provide public notice
  569  of all meetings and all meetings shall be open to the public.
  570  The Interstate Commission may close a meeting, in full or in
  571  portion, where it determines by a two-thirds vote of the
  572  Commissioners present that an open meeting would be likely to:
  573         (1) Relate solely to the internal personnel practices and
  574  procedures of the Interstate Commission;
  575         (2) Discuss matters specifically exempted from disclosure
  576  by federal statute;
  577         (3) Discuss trade secrets, commercial, or financial
  578  information that is privileged or confidential;
  579         (4) Involve accusing a person of a crime, or formally
  580  censuring a person;
  581         (5) Discuss information of a personal nature where
  582  disclosure would constitute a clearly unwarranted invasion of
  583  personal privacy;
  584         (6) Discuss investigative records compiled for law
  585  enforcement purposes; or
  586         (7) Specifically relate to the participation in a civil
  587  action or other legal proceeding.
  588         (i) The Interstate Commission shall keep minutes which
  589  shall fully describe all matters discussed in a meeting and
  590  shall provide a full and accurate summary of actions taken,
  591  including record of any roll call votes.
  592         (j) The Interstate Commission shall make its information
  593  and official records, to the extent not otherwise designated in
  594  the Compact or by its rules, available to the public for
  595  inspection.
  596         (k) The Interstate Commission shall establish an executive
  597  committee, which shall include officers, members, and others as
  598  determined by the bylaws. The executive committee shall have the
  599  power to act on behalf of the Interstate Commission, with the
  600  exception of rulemaking, during periods when the Interstate
  601  Commission is not in session. When acting on behalf of the
  602  Interstate Commission, the executive committee shall oversee the
  603  administration of the Compact including enforcement and
  604  compliance with the provisions of the Compact, its bylaws and
  605  rules, and other such duties as necessary.
  606         (l) The Interstate Commission may establish other
  607  committees for governance and administration of the Compact.
  609                             SECTION 12                            
  612         The Interstate Commission shall have the duty and power to:
  613         (a) Oversee and maintain the administration of the Compact;
  614         (b) Promulgate rules which shall be binding to the extent
  615  and in the manner provided for in the Compact;
  616         (c) Issue, upon the request of a member state or member
  617  board, advisory opinions concerning the meaning or
  618  interpretation of the Compact, its bylaws, rules, and actions;
  619         (d) Enforce compliance with Compact provisions, the rules
  620  promulgated by the Interstate Commission, and the bylaws, using
  621  all necessary and proper means, including but not limited to the
  622  use of judicial process;
  623         (e) Establish and appoint committees including, but not
  624  limited to, an executive committee as required by Section 11,
  625  which shall have the power to act on behalf of the Interstate
  626  Commission in carrying out its powers and duties;
  627         (f) Pay, or provide for the payment of the expenses related
  628  to the establishment, organization, and ongoing activities of
  629  the Interstate Commission;
  630         (g) Establish and maintain one or more offices;
  631         (h) Borrow, accept, hire, or contract for services of
  632  personnel;
  633         (i) Purchase and maintain insurance and bonds;
  634         (j) Employ an executive director who shall have such powers
  635  to employ, select or appoint employees, agents, or consultants,
  636  and to determine their qualifications, define their duties, and
  637  fix their compensation;
  638         (k) Establish personnel policies and programs relating to
  639  conflicts of interest, rates of compensation, and qualifications
  640  of personnel;
  641         (l) Accept donations and grants of money, equipment,
  642  supplies, materials and services, and to receive, utilize, and
  643  dispose of it in a manner consistent with the conflict of
  644  interest policies established by the Interstate Commission;
  645         (m) Lease, purchase, accept contributions or donations of,
  646  or otherwise to own, hold, improve or use, any property, real,
  647  personal, or mixed;
  648         (n) Sell, convey, mortgage, pledge, lease, exchange,
  649  abandon, or otherwise dispose of any property, real, personal,
  650  or mixed;
  651         (o) Establish a budget and make expenditures;
  652         (p) Adopt a seal and bylaws governing the management and
  653  operation of the Interstate Commission;
  654         (q) Report annually to the legislatures and governors of
  655  the member states concerning the activities of the Interstate
  656  Commission during the preceding year. Such reports shall also
  657  include reports of financial audits and any recommendations that
  658  may have been adopted by the Interstate Commission;
  659         (r) Coordinate education, training, and public awareness
  660  regarding the Compact, its implementation, and its operation;
  661         (s) Maintain records in accordance with the bylaws;
  662         (t) Seek and obtain trademarks, copyrights, and patents;
  663  and
  664         (u) Perform such functions as may be necessary or
  665  appropriate to achieve the purposes of the Compact.
  667                             SECTION 13                            
  668                           FINANCE POWERS                          
  670         (a) The Interstate Commission may levy on and collect an
  671  annual assessment from each member state to cover the cost of
  672  the operations and activities of the Interstate Commission and
  673  its staff. The total assessment, subject to appropriation, must
  674  be sufficient to cover the annual budget approved each year for
  675  which revenue is not provided by other sources. The aggregate
  676  annual assessment amount shall be allocated upon a formula to be
  677  determined by the Interstate Commission, which shall promulgate
  678  a rule binding upon all member states.
  679         (b) The Interstate Commission shall not incur obligations
  680  of any kind prior to securing the funds adequate to meet the
  681  same.
  682         (c) The Interstate Commission shall not pledge the credit
  683  of any of the member states, except by, and with the authority
  684  of, the member state.
  685         (d) The Interstate Commission shall be subject to a yearly
  686  financial audit conducted by a certified or licensed public
  687  accountant and the report of the audit shall be included in the
  688  annual report of the Interstate Commission.
  690                             SECTION 14                            
  693         (a) The Interstate Commission shall, by a majority of
  694  Commissioners present and voting, adopt bylaws to govern its
  695  conduct as may be necessary or appropriate to carry out the
  696  purposes of the Compact within twelve (12) months of the first
  697  Interstate Commission meeting.
  698         (b) The Interstate Commission shall elect or appoint
  699  annually from among its Commissioners a chairperson, a vice
  700  chairperson, and a treasurer, each of whom shall have such
  701  authority and duties as may be specified in the bylaws. The
  702  chairperson, or in the chairperson’s absence or disability, the
  703  vice-chairperson, shall preside at all meetings of the
  704  Interstate Commission.
  705         (c) Officers selected in subsection (b) shall serve without
  706  remuneration from the Interstate Commission.
  707         (d) The officers and employees of the Interstate Commission
  708  shall be immune from suit and liability, either personally or in
  709  their official capacity, for a claim for damage to or loss of
  710  property or personal injury or other civil liability caused or
  711  arising out of, or relating to, an actual or alleged act, error,
  712  or omission that occurred, or that such person had a reasonable
  713  basis for believing occurred, within the scope of Interstate
  714  Commission employment, duties, or responsibilities; provided
  715  that such person shall not be protected from suit or liability
  716  for damage, loss, injury, or liability caused by the intentional
  717  or willful and wanton misconduct of such person.
  718         (1) The liability of the executive director and employees
  719  of the Interstate Commission or representatives of the
  720  Interstate Commission, acting within the scope of such person’s
  721  employment or duties for acts, errors, or omissions occurring
  722  within such person’s state, may not exceed the limits of
  723  liability set forth under the constitution and laws of that
  724  state for state officials, employees, and agents. The Interstate
  725  Commission is considered to be an instrumentality of the states
  726  for the purposes of any such action. Nothing in this subsection
  727  shall be construed to protect such person from suit or liability
  728  for damage, loss, injury, or liability caused by the intentional
  729  or willful and wanton misconduct of such person.
  730         (2) The Interstate Commission shall defend the executive
  731  director, its employees, and subject to the approval of the
  732  attorney general or other appropriate legal counsel of the
  733  member state represented by an Interstate Commission
  734  representative, shall defend such Interstate Commission
  735  representative in any civil action seeking to impose liability
  736  arising out of an actual or alleged act, error or omission that
  737  occurred within the scope of Interstate Commission employment,
  738  duties or responsibilities, or that the defendant had a
  739  reasonable basis for believing occurred within the scope of
  740  Interstate Commission employment, duties, or responsibilities,
  741  provided that the actual or alleged act, error, or omission did
  742  not result from intentional or willful and wanton misconduct on
  743  the part of such person.
  744         (3) To the extent not covered by the state involved, member
  745  state, or the Interstate Commission, the representatives or
  746  employees of the Interstate Commission shall be held harmless in
  747  the amount of a settlement or judgment, including attorney’s
  748  fees and costs, obtained against such persons arising out of an
  749  actual or alleged act, error, or omission that occurred within
  750  the scope of Interstate Commission employment, duties, or
  751  responsibilities, or that such persons had a reasonable basis
  752  for believing occurred within the scope of Interstate Commission
  753  employment, duties, or responsibilities, provided that the
  754  actual or alleged act, error, or omission did not result from
  755  intentional or willful and wanton misconduct on the part of such
  756  persons.
  758                             SECTION 15                            
  761         (a) The Interstate Commission shall promulgate reasonable
  762  rules in order to effectively and efficiently achieve the
  763  purposes of the Compact. Notwithstanding the foregoing, in the
  764  event the Interstate Commission exercises its rulemaking
  765  authority in a manner that is beyond the scope of the purposes
  766  of the Compact, or the powers granted hereunder, then such an
  767  action by the Interstate Commission shall be invalid and have no
  768  force or effect.
  769         (b) Rules deemed appropriate for the operations of the
  770  Interstate Commission shall be made pursuant to a rulemaking
  771  process that substantially conforms to the “Model State
  772  Administrative Procedure Act” of 2010, and subsequent amendments
  773  thereto.
  774         (c) Not later than thirty (30) days after a rule is
  775  promulgated, any person may file a petition for judicial review
  776  of the rule in the United States District Court for the District
  777  of Columbia or the federal district where the Interstate
  778  Commission has its principal offices, provided that the filing
  779  of such a petition shall not stay or otherwise prevent the rule
  780  from becoming effective unless the court finds that the
  781  petitioner has a substantial likelihood of success. The court
  782  shall give deference to the actions of the Interstate Commission
  783  consistent with applicable law and shall not find the rule to be
  784  unlawful if the rule represents a reasonable exercise of the
  785  authority granted to the Interstate Commission.
  787                             SECTION 16                            
  788                   OVERSIGHT OF INTERSTATE COMPACT                 
  790         (a) The executive, legislative, and judicial branches of
  791  state government in each member state shall enforce the Compact
  792  and shall take all actions necessary and appropriate to
  793  effectuate the Compact’s purposes and intent. The provisions of
  794  the Compact and the rules promulgated hereunder shall have
  795  standing as statutory law but shall not override existing state
  796  authority to regulate the practice of medicine.
  797         (b) All courts shall take judicial notice of the Compact
  798  and the rules in any judicial or administrative proceeding in a
  799  member state pertaining to the subject matter of the Compact
  800  which may affect the powers, responsibilities or actions of the
  801  Interstate Commission.
  802         (c) The Interstate Commission shall be entitled to receive
  803  all service of process in any such proceeding, and shall have
  804  standing to intervene in the proceeding for all purposes.
  805  Failure to provide service of process to the Interstate
  806  Commission shall render a judgment or order void as to the
  807  Interstate Commission, the Compact, or promulgated rules.
  809                             SECTION 17                            
  810                  ENFORCEMENT OF INTERSTATE COMPACT                
  812         (a) The Interstate Commission, in the reasonable exercise
  813  of its discretion, shall enforce the provisions and rules of the
  814  Compact.
  815         (b) The Interstate Commission may, by majority vote of the
  816  Commissioners, initiate legal action in the United States
  817  District Court for the District of Columbia, or, at the
  818  discretion of the Interstate Commission, in the federal district
  819  where the Interstate Commission has its principal offices, to
  820  enforce compliance with the provisions of the Compact, and its
  821  promulgated rules and bylaws, against a member state in default.
  822  The relief sought may include both injunctive relief and
  823  damages. In the event judicial enforcement is necessary, the
  824  prevailing party shall be awarded all costs of such litigation
  825  including reasonable attorney’s fees.
  826         (c) The remedies herein shall not be the exclusive remedies
  827  of the Interstate Commission. The Interstate Commission may
  828  avail itself of any other remedies available under state law or
  829  the regulation of a profession.
  831                             SECTION 18                            
  832                         DEFAULT PROCEDURES                        
  834         (a) The grounds for default include, but are not limited
  835  to, failure of a member state to perform such obligations or
  836  responsibilities imposed upon it by the Compact, or the rules
  837  and bylaws of the Interstate Commission promulgated under the
  838  Compact.
  839         (b) If the Interstate Commission determines that a member
  840  state has defaulted in the performance of its obligations or
  841  responsibilities under the Compact, or the bylaws or promulgated
  842  rules, the Interstate Commission shall:
  843         (1) Provide written notice to the defaulting state and
  844  other member states, of the nature of the default, the means of
  845  curing the default, and any action taken by the Interstate
  846  Commission. The Interstate Commission shall specify the
  847  conditions by which the defaulting state must cure its default;
  848  and
  849         (2) Provide remedial training and specific technical
  850  assistance regarding the default.
  851         (c)If the defaulting state fails to cure the default, the
  852  defaulting state shall be terminated from the Compact upon an
  853  affirmative vote of a majority of the Commissioners and all
  854  rights, privileges, and benefits conferred by the Compact shall
  855  terminate on the effective date of termination. A cure of the
  856  default does not relieve the offending state of obligations or
  857  liabilities incurred during the period of the default.
  858         (d) Termination of membership in the Compact shall be
  859  imposed only after all other means of securing compliance have
  860  been exhausted. Notice of intent to terminate shall be given by
  861  the Interstate Commission to the governor, the majority and
  862  minority leaders of the defaulting state’s legislature, and each
  863  of the member states.
  864         (e) The Interstate Commission shall establish rules and
  865  procedures to address licenses and physicians that are
  866  materially impacted by the termination of a member state, or the
  867  withdrawal of a member state.
  868         (f) The member state which has been terminated is
  869  responsible for all dues, obligations, and liabilities incurred
  870  through the effective date of termination including obligations,
  871  the performance of which extends beyond the effective date of
  872  termination.
  873         (g) The Interstate Commission shall not bear any costs
  874  relating to any state that has been found to be in default or
  875  which has been terminated from the Compact, unless otherwise
  876  mutually agreed upon in writing between the Interstate
  877  Commission and the defaulting state.
  878         (h) The defaulting state may appeal the action of the
  879  Interstate Commission by petitioning the United States District
  880  Court for the District of Columbia or the federal district where
  881  the Interstate Commission has its principal offices. The
  882  prevailing party shall be awarded all costs of such litigation
  883  including reasonable attorney’s fees.
  885                             SECTION 19                            
  886                         DISPUTE RESOLUTION                        
  888         (a) The Interstate Commission shall attempt, upon the
  889  request of a member state, to resolve disputes which are subject
  890  to the Compact and which may arise among member states or member
  891  boards.
  892         (b) The Interstate Commission shall promulgate rules
  893  providing for both mediation and binding dispute resolution as
  894  appropriate.
  896                             SECTION 20                            
  899         (a) Any state is eligible to become a member state of the
  900  Compact.
  901         (b) The Compact shall become effective and binding upon
  902  legislative enactment of the Compact into law by no less than
  903  seven (7) states. Thereafter, it shall become effective and
  904  binding on a state upon enactment of the Compact into law by
  905  that state.
  906         (c) The governors of non-member states, or their designees,
  907  shall be invited to participate in the activities of the
  908  Interstate Commission on a non-voting basis prior to adoption of
  909  the Compact by all states.
  910         (d) The Interstate Commission may propose amendments to the
  911  Compact for enactment by the member states. No amendment shall
  912  become effective and binding upon the Interstate Commission and
  913  the member states unless and until it is enacted into law by
  914  unanimous consent of the member states.
  916                             SECTION 21                            
  917                             WITHDRAWAL                            
  919         (a) Once effective, the Compact shall continue in force and
  920  remain binding upon each and every member state; provided that a
  921  member state may withdraw from the Compact by specifically
  922  repealing the statute which enacted the Compact into law.
  923         (b) Withdrawal from the Compact shall be by the enactment
  924  of a statute repealing the same, but shall not take effect until
  925  one (1) year after the effective date of such statute and until
  926  written notice of the withdrawal has been given by the
  927  withdrawing state to the governor of each other member state.
  928         (c) The withdrawing state shall immediately notify the
  929  chairperson of the Interstate Commission in writing upon the
  930  introduction of legislation repealing the Compact in the
  931  withdrawing state.
  932         (d) The Interstate Commission shall notify the other member
  933  states of the withdrawing state’s intent to withdraw within
  934  sixty (60) days of its receipt of notice provided under
  935  subsection (c).
  936         (e) The withdrawing state is responsible for all dues,
  937  obligations and liabilities incurred through the effective date
  938  of withdrawal, including obligations, the performance of which
  939  extend beyond the effective date of withdrawal.
  940         (f) Reinstatement following withdrawal of a member state
  941  shall occur upon the withdrawing state reenacting the Compact or
  942  upon such later date as determined by the Interstate Commission.
  943         (g) The Interstate Commission is authorized to develop
  944  rules to address the impact of the withdrawal of a member state
  945  on licenses granted in other member states to physicians who
  946  designated the withdrawing member state as the state of
  947  principal license.
  949                             SECTION 22                            
  950                             DISSOLUTION                           
  952         (a) The Compact shall dissolve effective upon the date of
  953  the withdrawal or default of the member state which reduces the
  954  membership in the Compact to one (1) member state.
  955         (b) Upon the dissolution of the Compact, the Compact
  956  becomes null and void and shall be of no further force or
  957  effect, and the business and affairs of the Interstate
  958  Commission shall be concluded and surplus funds shall be
  959  distributed in accordance with the bylaws.
  961                             SECTION 23                            
  962                    SEVERABILITY AND CONSTRUCTION                  
  964         (a) The provisions of the Compact shall be severable, and
  965  if any phrase, clause, sentence, or provision is deemed
  966  unenforceable, the remaining provisions of the Compact shall be
  967  enforceable.
  968         (b) The provisions of the Compact shall be liberally
  969  construed to effectuate its purposes.
  970         (c) Nothing in the Compact shall be construed to prohibit
  971  the applicability of other interstate compacts to which the
  972  states are members.
  974                             SECTION 24                            
  975              BINDING EFFECT OF COMPACT AND OTHER LAWS             
  977         (a) Nothing herein prevents the enforcement of any other
  978  law of a member state that is not inconsistent with the Compact.
  979         (b) All laws in a member state in conflict with the Compact
  980  are superseded to the extent of the conflict.
  981         (c) All lawful actions of the Interstate Commission,
  982  including all rules and bylaws promulgated by the Commission,
  983  are binding upon the member states.
  984         (d) All agreements between the Interstate Commission and
  985  the member states are binding in accordance with their terms.
  986         (e) In the event any provision of the Compact exceeds the
  987  constitutional limits imposed on the legislature of any member
  988  state, such provision shall be ineffective to the extent of the
  989  conflict with the constitutional provision in question in that
  990  member state.
  991         Section 8. Section 456.4502, Florida Statutes, is created
  992  to read:
  993         456.4502Interstate Medical Licensure Compact; disciplinary
  994  proceedings.—A physician licensed pursuant to chapter 458,
  995  chapter 459, or s. 456.4501 whose license is suspended or
  996  revoked by this state pursuant to the Interstate Medical
  997  Licensure Compact as a result of disciplinary action taken
  998  against the physician’s license in another state shall be
  999  granted a formal hearing before an administrative law judge from
 1000  the Division of Administrative Hearings held pursuant to chapter
 1001  120 if there are any disputed issues of material fact. In such
 1002  proceedings:
 1003         (a)Notwithstanding s. 120.569(2), the department shall
 1004  notify the division within 45 days after receipt of a petition
 1005  or request for a formal hearing.
 1006         (b)The determination of whether the physician has violated
 1007  the laws and rules regulating the practice of medicine or
 1008  osteopathic medicine, as applicable, including a determination
 1009  of the reasonable standard of care, is a conclusion of law that
 1010  is to be determined by appropriate board, and is not a finding
 1011  of fact to be determined by an administrative law judge.
 1012         (c)The administrative law judge shall issue a recommended
 1013  order pursuant to chapter 120.
 1014         (d)The Board of Medicine or the Board of Osteopathic
 1015  Medicine, as applicable, shall determine and issue the final
 1016  order in each disciplinary case. Such order shall constitute
 1017  final agency action.
 1018         (e)Any consent order or agreed-upon settlement is subject
 1019  to the approval of the department.
 1020         (f)The department shall have standing to seek judicial
 1021  review of any final order of the board, pursuant to s. 120.68.
 1022         Section 9. Section 456.4504, Florida Statutes, is created
 1023  to read:
 1024         456.4504Interstate Medical Licensure Compact Rules.—The
 1025  department may adopt rules to implement the Interstate Medical
 1026  Licensure Compact.
 1027         Section 10. Paragraph (h) is added to subsection (10) of
 1028  section 768.28, Florida Statutes, to read:
 1029         768.28 Waiver of sovereign immunity in tort actions;
 1030  recovery limits; limitation on attorney fees; statute of
 1031  limitations; exclusions; indemnification; risk management
 1032  programs.—
 1033         (10)
 1034         (h) For the purposes of this section, the representative
 1035  appointed from the Board of Medicine and the representative
 1036  appointed from the Board of Osteopathic Medicine, when serving
 1037  as commissioners of the Interstate Medical Licensure Compact
 1038  Commission pursuant to s. 456.4501, and any administrator,
 1039  officer, executive director, employee, or representative of the
 1040  Interstate Medical Licensure Compact Commission, when acting
 1041  within the scope of their employment, duties, or
 1042  responsibilities in this state, are considered agents of the
 1043  state. The commission shall pay any claims or judgments pursuant
 1044  to this section and may maintain insurance coverage to pay any
 1045  such claims or judgments.
 1046         Section 11. This act shall take effect July 1, 2021.