Delaware General Assembly

LAWS OF DELAWARE

VOLUME 83

CHAPTER 110

151st GENERAL ASSEMBLY

FORMERLY

HOUSE BILL NO. 21

AN ACT TO AMEND TITLE 24 OF THE DELAWARE CODE RELATING TO AN ADVANCED PRACTICE REGISTERED NURSE COMPACT.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1.  Amend Title 24 of the Delaware Code by adding a new Chapter designated as Chapter 19B by making insertions as shown by underline as follows:

Chapter 19B. Advanced Practice Registered Nurse Compact.

§ 1901B. Advanced Practice Registered Nurse Compact.

The State hereby enters into the Advanced Practice Registered Nurse Compact (Compact) as set forth in this chapter. The text of the Compact is as set forth in this chapter.

§ 1902B. Findings and declaration of purpose.

(a) The party states find the following:

(1) The health and safety of the public are affected by the degree of compliance with Advanced Practice Registered Nurse licensure requirements and the effectiveness of enforcement activities related to state APRN licensure laws.

(2) Violations of APRN licensure and other laws regulating the practice of nursing may result in injury or harm to the public.

(3) The expanded mobility of APRNs and the use of advanced communication and intervention technologies as part of our nation’s health care delivery system require greater coordination and cooperation among states in the areas of APRN licensure and regulation.

(4) New practice modalities and technology make compliance with individual state APRN licensure laws difficult and complex.

(5) The current system of duplicative APRN licensure for APRNs practicing in multiple states is cumbersome and redundant for healthcare delivery systems, payors, state licensing boards, regulators and APRNs.

(6) Uniformity of APRN licensure requirements throughout the states promotes public safety and public health benefits as well as provides a mechanism to increase access to care.

(b)The general purposes of this Compact are to do the following:

(1) Facilitate the states’ responsibility to protect the public’s health and safety.

(2) Ensure and encourage the cooperation of party states in the areas of APRN licensure and regulation, including promotion of uniform licensure requirements.

(3) Facilitate the exchange of information between party states in the areas of APRN regulation, investigation and adverse actions.

(4) Promote compliance with the laws governing APRN practice in each jurisdiction.

(5) Invest all party states with the authority to hold an APRN accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party state privileges to practice.

(6) Decrease redundancies in the consideration and issuance of APRN licenses.

(7) Provide opportunities for interstate practice by APRNs who meet uniform licensure requirements.

§ 1903B. Definitions.

As used in this Compact:

(a) “Advanced practice registered nurse” or “APRN” means a registered nurse who has gained additional specialized knowledge, skills and experience through a program of study recognized or defined by  the Interstate Commission of APRN Compact Administrators (“Commission”), and who is licensed to perform advanced nursing practice. An advanced practice registered nurse is licensed in an APRN role that is congruent with an APRN educational program, certification, and Commission rules.

(b) “Adverse action” means any administrative, civil, equitable or criminal action permitted by a state’s laws which is imposed by a licensing board or other authority against an APRN, including actions against an  individual’s license or multistate licensure privilege such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee’s practice, or any other encumbrance on licensure affecting an APRN’s authorization to practice, including the issuance of a cease and desist action.

(c) “Alternative program” means a non-disciplinary monitoring program approved by a licensing board.

(d) “APRN licensure” means the regulatory mechanism used by a party state to grant legal authority to practice as an APRN.

(e) “APRN uniform licensure requirements" means the minimum uniform licensure, education and examination requirements set forth in § 1904B(b) of this chapter.

(f) “Coordinated licensure information system” means an integrated process for collecting, storing and sharing information on APRN licensure and enforcement activities related to APRN licensure laws that is administered by a nonprofit organization composed of and controlled by licensing boards.

(g) “Current significant investigatory information” means:

(1) Investigative information that a licensing board, after a preliminary inquiry that includes notification and an opportunity for the APRN to respond, if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction; or

(2) Investigative information that indicates that the APRN represents an immediate threat to public health and safety regardless of whether the APRN has been notified and has had an opportunity to respond.

(h) “Encumbrance” means a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board in connection with a disciplinary proceeding.

(i) “Home state” means the party state that is the APRN’s primary state of residence.

(j) “Licensing board” means a party state’s regulatory body responsible for regulating the practice of advanced practice registered nursing.

(k) “Multistate license” means an APRN license to practice as an APRN issued by a home state licensing board that authorizes the APRN to practice as an APRN in all party states under a multistate licensure privilege, in the same role and population focus as the APRN is licensed in the home state.

(l) “Multistate licensure privilege” means a legal authorization associated with an APRN multistate license that permits an APRN to practice as an APRN in a remote state, in the same role and population focus as the APRN is licensed in the home state.

(m) “Non-controlled prescription drug” means a device or drug that is not a controlled substance and is prohibited under state or federal law from being dispensed without a prescription. The term includes a device or drug that bears or is required to bear the legend “Caution: federal law prohibits dispensing without prescription” or “prescription only” or other legend that complies with federal law.

(n) “Party state” means any state that has adopted this Compact.

(o) “Population focus” means one of the six population foci of family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender-related, and psych/mental health.

(p) “Prescriptive authority” means the legal authority to prescribe medications and devices as defined by party state laws.

(q) “Remote state” means a party state that is not the home state.

(r) “Role” means one of the four recognized roles of certified registered nurse anesthetists (CRNA), certified nurse-midwives (CNM), clinical nurse specialists (CNS), and certified nurse practitioners (CNP).

(s) “Single-state license” means an APRN license issued by a party state that authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state.

(t) “State” means a state, territory or possession of the United States and the District of Columbia.

(u) “State practice laws” means a party state’s laws, rules, and regulations that govern APRN practice, define the scope of advanced nursing practice and create the methods and grounds for imposing discipline except that prescriptive authority shall be treated in accordance with § 1904B(f) and § 1904B(g) of this chapter. “State practice laws” does not include:

(1) A party state’s laws, rules, and regulations requiring supervision or collaboration with a healthcare professional, except for laws, rules, and regulations regarding prescribing controlled substances.

(2) The requirements necessary to obtain and retain an APRN license, except for qualifications or requirements of the home state.

§ 1904B. General provisions and jurisdiction.

(a) A state must implement procedures for considering the criminal history records of applicants for initial APRN licensure or APRN licensure by endorsement. Such procedures shall include the submission of fingerprints or other biometric-based information by APRN applicants for the purpose of obtaining an applicant’s criminal history record information from the Federal Bureau of Investigation and the agency responsible for retaining that state’s criminal records.

(b) Each party state shall require all of the following for an applicant to satisfy the APRN uniform licensure requirements to obtain or retain a multistate license in the home state:

(1) Meets the home state’s qualifications for licensure or renewal of licensure, as well as all other applicable state laws.

(2) Has (a) completed an accredited graduate-level education program that prepares the applicant for one of the four recognized roles and population foci; or (b) has completed a foreign APRN education program for one of the four recognized roles and population foci that has been (a) approved by the authorized accrediting body in the applicable country and (b) verified by an independent credentials review agency to be comparable to a licensing board approved APRN education program.

(3) Has, if a graduate of a foreign APRN education program not taught in English or if English is not the individual’s native language, successfully passed an English proficiency examination that includes the components of reading, speaking, writing and listening.

(4) Has successfully passed a national certification examination that measures APRN, role and population-focused competencies and maintains continued competence as evidenced by recertification in the role and population focus through the national certification program.

(5) Holds an active, unencumbered license as a registered nurse and an active, unencumbered authorization to practice as an APRN.

(6) Has successfully passed an NCLEX-RN® examination or recognized predecessor, as applicable.

(7) Has practiced for at least 2,080 hours as an APRN in a role and population focus congruent with the applicant’s education and training. For purposes of this section, practice shall not include hours obtained as part of enrollment in an APRN education program.

(8) Has submitted, in connection with an application for initial licensure or licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history record information from the Federal Bureau of Investigation and the agency responsible for retaining that state or, if applicable, foreign country’s criminal records.

(9) Has not been convicted or found guilty, or has entered into an agreed disposition, of a felony offense under applicable state, federal or foreign criminal law.

(10) Has not been convicted or found guilty, or has entered into an agreed disposition, of a misdemeanor offense related to the practice of nursing as determined by factors set forth in rules adopted by the Commission.

(11) Is not currently enrolled in an alternative program.

(12) Is subject to self-disclosure requirements regarding current participation in an alternative program.

(13) Has a valid United States Social Security number.

(c) An APRN issued a multistate license shall be licensed in an approved role and at least one approved population focus.

(d) An APRN multistate license issued by a home state to a resident in that state will be recognized by each party state as authorizing the APRN to practice as an APRN in each party state, under a multistate licensure privilege, in the same role and population focus as the APRN is licensed in the home state.

(e) Nothing in this Compact shall affect the requirements established by a party state for the issuance of a single-state license, except that an individual may apply for a single-state license, instead of a multistate license, even if otherwise qualified for the multistate license. However, the failure of such an individual to affirmatively opt for a single state license may result in the issuance of a multistate license.

(f) Issuance of an APRN multistate license shall include prescriptive authority for non-controlled prescription drugs.

(g) For each state in which an APRN seeks authority to prescribe controlled substances, the APRN shall satisfy all requirements imposed by such state in granting and/or renewing such authority.

(h) An APRN issued a multistate license is authorized to assume responsibility and accountability for patient care independent of any supervisory or collaborative relationship. This authority may be exercised in the home state and in any remote state in which the APRN exercises a multistate licensure privilege.

(i) All party states shall be authorized, in accordance with state due process laws, to take adverse action against an APRN’s multistate licensure privilege such as revocation, suspension, probation or any other action that affects an APRN’s authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such actions by remote states.

(j) Except as otherwise expressly provided in this Compact, an APRN practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. APRN practice is not limited to patient care but shall include all advanced nursing practice as defined by the state practice laws of the party state in which the client is located. APRN practice in a party state under a multistate licensure privilege will subject the APRN to the jurisdiction of the licensing board, the courts, and the laws of the party state in which the client is located at the time service is provided.

(k) Except as otherwise expressly provided in this Compact, this Compact does not affect additional requirements imposed by states for advanced practice registered nursing. However, a multistate licensure privilege to practice registered nursing granted by a party state shall be recognized by other party states as satisfying any state law requirement for registered nurse licensure as a precondition for authorization to practice as an APRN in that state.

(l) Individuals not residing in a party state shall continue to be able to apply for a party state’s single-state APRN license as provided under the laws of each party state. However, the single-state license granted to these individuals will not be recognized as granting the privilege to practice as an APRN in any other party state.

§ 1905B. Applications for APRN licensure in a party state.

(a) Upon application for an APRN multistate license, the licensing board in the issuing party state shall ascertain, through the coordinated licensure information system, whether the applicant has ever held or is the holder of a licensed practical/vocational nursing license, a registered nursing license or an advanced practice registered nurse license issued by any other state, whether there are any encumbrances on any license or multistate licensure privilege held by the applicant, whether any adverse action has been taken against any license or multistate licensure privilege held by the applicant and whether the applicant is currently participating in an alternative program.

(b) An APRN may hold a multistate APRN license, issued by the home state, in only one party state at a time.

(c)  If an APRN changes primary state of residence by moving between two party states, the APRN must apply for APRN licensure in the new home state, and the multistate license issued by the prior home state shall be deactivated in accordance with applicable Commission rules.

(1) The APRN may apply for licensure in advance of a change in primary state of residence.

(2) A multistate APRN license shall not be issued by the new home state until the APRN provides satisfactory evidence of a change in primary state of residence to the new home state and satisfies all applicable requirements to obtain a multistate APRN license from the new home state.

(d) If an APRN changes primary state of residence by moving from a party state to a non-party state, the APRN multistate license issued by the prior home state will convert to a single-state license, valid only in the former home state.

§ 1906B. Additional authorities invested in party state licensing boards.

(a) In addition to the other powers conferred by state law, a licensing board shall have the authority to:

(1) Take adverse action against an APRN’s multistate licensure privilege to practice within that party state.

a. Only the home state shall have power to take adverse action against an APRN’s license issued by the home state.

b. For purposes of taking adverse action, the home state licensing board shall give the same priority and effect to reported conduct that occurred outside of the home state as it would if such conduct had occurred within the home state. In so doing, the home state shall apply its own state laws to determine appropriate action.

(2) Issue cease and desist orders or impose an encumbrance on an APRN’s authority to practice within that party state.

(3) Complete any pending investigations of an APRN who changes primary state of residence during the course of such investigations. The licensing board shall also have the authority to take appropriate action(s) and shall promptly report the conclusions of such investigations to the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the new home state of any such actions.

(4) Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses, as well as the production of evidence. Subpoenas issued by a party state licensing board for the attendance and testimony of witnesses and/or the production of evidence from another party state shall be enforced in the latter state by any court of competent jurisdiction, according to that court’s practice and procedure in considering subpoenas issued in its own proceedings. The issuing licensing board shall pay any witness fees, travel expenses, mileage, and other fees required by the service statutes of the state in which the witnesses and/or evidence are located.

(5) Obtain and submit, for an APRN licensure applicant, fingerprints or other biometric-based information to the Federal Bureau of Investigation for criminal background checks, receive the results of the Federal Bureau of Investigation record search on criminal background checks and use the results in making licensure decisions.

(6) If otherwise permitted by state law, recover from the affected APRN the costs of investigations and disposition of cases resulting from any adverse action taken against that APRN.

(7) Take adverse action based on the factual findings of another party state, provided that the licensing board follows its own procedures for taking such adverse action.

(b) If adverse action is taken by a home state against an APRN’s multistate licensure, the privilege to practice in all other party states under a multistate licensure privilege shall be deactivated until all encumbrances have been removed from the APRN’s multistate license. All home state disciplinary orders that impose adverse action against an APRN’s multistate license shall include a statement that the APRN’s multistate licensure privilege is deactivated in all party states during the pendency of the order.

(c) Nothing in this Compact shall override a party state’s decision that participation in an alternative program may be used in lieu of adverse action. The home state licensing board shall deactivate the multistate licensure privilege under the multistate license of any APRN for the duration of the APRN’s participation in an alternative program.

§ 1907B. Coordinated licensure information system and exchange of information.

(a) All party states shall participate in a coordinated licensure information system of all APRNs, licensed registered nurses, and licensed practical/vocational nurses. This system will include information on the licensure and disciplinary history of each APRN, as submitted by party states, to assist in the coordinated administration of APRN licensure and enforcement efforts.

(b) The Commission, in consultation with the administrator of the coordinated licensure information system, shall formulate necessary and proper procedures for the identification, collection and exchange of information under this Compact.

(c) All licensing boards shall promptly report to the coordinated licensure information system any adverse action, any current significant investigative information, denials of applications (with the reasons for such denials) and APRN participation in alternative programs known to the licensing board regardless of whether such participation is deemed nonpublic and/or confidential under state law.

(d) Notwithstanding any other provision of law, all party state licensing boards contributing information to the coordinated licensure information system may designate information that may not be shared with non-party states or disclosed to other entities or individuals without the express permission of the contributing state.

(e) Any personally identifiable information obtained from the coordinated licensure information system by a party state licensing board shall not be shared with non-party states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information.

(f) Any information contributed to the coordinated licensure information system that is subsequently required to be expunged by the laws of the party state contributing the information shall be removed from the coordinated licensure information system.

(g) The Compact administrator of each party state shall furnish a uniform data set to the Compact administrator of each other party state, which shall include, at a minimum all of the following:

(1) Identifying information.

(2) Licensure data.

(3) Information related to alternative program participation information.

(4) Other information that may facilitate the administration of this Compact, as determined by Commission rules.

(h) The Compact administrator of a party state shall provide all investigative documents and information requested by another party state.

§ 1908B. Establishment of the Interstate Commission of APRN Compact Administrators.

(a) The party states hereby create and establish a joint public agency known as the Interstate Commission of APRN Compact Administrators.

(1) The Commission is an instrumentality of the party states.

(2) Venue is proper, and judicial proceedings by or against the Commission shall be brought solely and exclusively, in a court of competent jurisdiction where the principal office of the Commission is located. The Commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings.

(3) Nothing in this Compact shall be construed to be a waiver of sovereign immunity.

(b) Membership, voting and meetings.

(1) Each party state shall have and be limited to one administrator. The head of the state licensing board or designee shall be the administrator of this Compact for each party state. Any administrator may be removed or suspended from office as provided by the law of the state from which the Administrator is appointed. Any vacancy occurring in the Commission shall be filled in accordance with the laws of the party state in which the vacancy exists.

(2) Each administrator shall be entitled to 1 vote with regard to the promulgation of rules and creation of bylaws and shall otherwise have an opportunity to participate in the business and affairs of the Commission. An administrator shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for an administrator’s participation in meetings by telephone or other means of communication.

(3) The Commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in the bylaws or rules of the Commission.

(4) All meetings shall be open to the public, and public notice of meetings shall be given in the same manner as required under the rulemaking provisions in § 1909B of this title.

(5) The Commission may convene in a closed, nonpublic meeting if the Commission must discuss any of the following:

     a. Noncompliance of a party state with its obligations under this Compact.

     b. The employment, compensation, discipline or other personnel matters, practices or procedures related to specific employees or other matters related to the Commission’s internal personnel practices and procedures.

     c. Current, threatened, or reasonably anticipated litigation.

     d. Negotiation of contracts for the purchase or sale of goods, services or real estate.

     e. Accusing any person of a crime or formally censuring any person.

f. Disclosure of trade secrets or commercial or financial information that is privileged or confidential.

g. Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy.

h. Disclosure of investigatory records compiled for law enforcement purposes;

i. Disclosure of information related to any reports prepared by or on behalf of the Commission for the purpose of investigation of compliance with this Compact.

     j. Matters specifically exempted from disclosure by federal or state statute.

(6) If a meeting, or portion of a meeting, is closed pursuant to this provision, the Commission’s legal counsel or designee shall certify that the meeting may be closed and shall reference each relevant exempting provision. The Commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons therefor, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and documents of a closed meeting shall remain under seal, subject to release by a majority vote of the Commission or order of a court of competent jurisdiction.

(c) The Commission shall, by a majority vote of the administrators, prescribe bylaws or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of this Compact, including all of the following:

(1) Establishing the fiscal year of the Commission.

(2) Providing reasonable standards and procedures for the following:

a. The establishment and meetings of other committees.

b. Governing any general or specific delegation of any authority or function of the Commission.

(3) Providing reasonable procedures for calling and conducting meetings of the Commission, ensuring reasonable advance notice of all meetings and providing an opportunity for attendance of such meetings by interested parties, with enumerated exceptions designed to protect the public’s interest, the privacy of individuals, and proprietary information, including trade secrets. The Commission may meet in closed session only after a majority of the administrators vote to close a meeting in whole or in part. As soon as practicable, the Commission must make public a copy of the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed.

(4) Establishing the titles, duties and authority and reasonable procedures for the election of the officers of the Commission.

(5) Providing reasonable standards and procedures for the establishment of the personnel policies and programs of the Commission. Notwithstanding any civil service or other similar laws of any party state, the bylaws shall exclusively govern the personnel policies and programs of the Commission.

(6) Providing a mechanism for winding up the operations of the Commission and the equitable disposition of any surplus funds that may exist after the termination of this Compact after the payment and/or reserving of all of its debts and obligations.

(d) The Commission shall publish its bylaws and rules, and any amendments thereto, in a convenient form on the website of the Commission.

(e) The Commission shall maintain its financial records in accordance with the bylaws.

(f) The Commission shall meet and take such actions as are consistent with the provisions of this Compact and the bylaws.

(g) The Commission shall have the following powers:

(1) To promulgate uniform rules to facilitate and coordinate implementation and administration of this Compact. The rules shall have the force and effect of law and shall be binding in all party states.

(2) To bring and prosecute legal proceedings or actions in the name of the Commission, provided that the standing of any licensing board to sue or be sued under applicable law shall not be affected.

(3) To purchase and maintain insurance and bonds.

(4) To borrow, accept or contract for services of personnel, including but not limited to employees of a party state or nonprofit organizations.

(5) To cooperate with other organizations that administer state compacts related to the regulation of nursing, including but not limited to sharing administrative or staff expenses, office space or other resources.

(6) To hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this Compact, and to establish the Commission’s personnel policies and programs relating to conflicts of interest, qualifications of personnel and other related personnel matters.

(7) To accept any and all appropriate donations, grants and gifts of money, equipment, supplies, materials and services, and to receive, utilize and dispose of the same; provided that at all times the Commission shall strive to avoid any appearance of impropriety and/or conflict of interest.

(8) To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use, any property, whether real, personal or mixed; provided that at all times the Commission shall strive to avoid any appearance of impropriety.

(9) To sell convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of any property, whether real, personal or mixed.