This document includes Senate 2nd Reading Floor Amendments incorporated into the bill on Tue, Feb 15, 2022 at 3:01 PM by kpoll.



Chief Sponsor: Curtis S. Bramble

House Sponsor: James A. Dunnigan


8     General Description:
9          This bill enacts provisions related to the nursing profession.
10     Highlighted Provisions:
11          This bill:
12          ▸     enacts the Advanced Practice Registered Nurse Compact (compact);
13          ▸     requires individuals to complete a background check to obtain a license to be a
14     nurse midwife as required by the compact;
15          ▸     for purposes of the compact, allows an individual licensed as an advanced practice
16     registered nurse to obtain licensure as a certified nurse anesthetist or a nurse
17     midwife; and
18          ▸     repeals the previously enacted compact related to advanced practice registered
19     nurses and associated provisions.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          None
24     Utah Code Sections Affected:
25     AMENDS:
26          58-1-301.5, as last amended by Laws of Utah 2020, Chapter 339
27          58-44a-302, as last amended by Laws of Utah 2016, Chapter 238

28     ENACTS:
29          58-44a-302.1, Utah Code Annotated 1953
31          58-31d-101, as enacted by Laws of Utah 2004, Chapter 15
32          58-31d-102, as enacted by Laws of Utah 2004, Chapter 15
33     REPEALS:
34          58-31d-103, as last amended by Laws of Utah 2019, Chapter 233

36     Be it enacted by the Legislature of the state of Utah:
37          Section 1. Section 58-1-301.5 is amended to read:
38          58-1-301.5. Division access to Bureau of Criminal Identification records.
39          (1) The division shall have direct access to local files maintained by the Bureau of
40     Criminal Identification under Title 53, Chapter 10, Part 2, Bureau of Criminal Identification,
41     for background screening of [persons] individuals who are applying for licensure, licensure
42     renewal, licensure reinstatement, or relicensure, as required in:
43          (a) Section 58-17b-307 [of Title 58, Chapter 17b, Pharmacy Practice Act];
44          (b) Sections 58-24b-302 and 58-24b-302.1 [of Title 58, Chapter 24b, Physical Therapy
45     Practice Act];
46          (c) Section 58-31b-302 [of Title 58, Chapter 31b, Nurse Practice Act];
47          (d) Section 58-44a-302.1;
48          [(d)] (e) Section 58-47b-302 [of Title 58, Chapter 47b, Massage Therapy Practice Act];
49          [(e)] (f) Section 58-55-302 [of Title 58, Chapter 55, Utah Construction Trades
50     Licensing Act, as it], as Section 58-55-302 applies to alarm companies and alarm company
51     agents;
52          [(f)] (g) Sections 58-61-304 and 58-61-304.1 [of Title 58, Chapter 61, Psychologist
53     Licensing Act];
54          [(g)] (h) Section 58-63-302 [of Title 58, Chapter 63, Security Personnel Licensing
55     Act];
56          [(h)] (i) Section 58-64-302 [of Title 58, Chapter 64, Deception Detection Examiners
57     Licensing Act];
58          [(i)] (j) Sections 58-67-302 and 58-67-302.1 [of Title 58, Chapter 67, Utah Medical

59     Practice Act]; and
60          [(j)] (k) Sections 58-68-302 and 58-68-302.1 [of Title 58, Chapter 68, Utah
61     Osteopathic Medical Practice Act].
62          (2) The division's access to criminal background information under this section:
63          (a) shall meet the requirements of Section 53-10-108; and
64          (b) includes convictions, pleas of nolo contendere, pleas of guilty or nolo contendere
65     held in abeyance, dismissed charges, and charges without a known disposition.
66          (3) The division may not disseminate outside of the division any criminal history
67     record information that the division obtains from the Bureau of Criminal Identification or the
68     Federal Bureau of Investigation under the criminal background check requirements of this
69     section.
70          Section 2. Section 58-31d-101 is repealed and reenacted to read:
71          58-31d-101. Advanced Practice Registered Nurse Compact.
72          The Advanced Practice Registered Nurse Compact is hereby enacted and entered into
73     with all other jurisdictions that legally join in the compact, which is, in form, substantially as
74     follows:
75          ARTICLE I
76          Findings and Declaration of Purpose
77          (1) The party states find that:
78          (a) the health and safety of the public are affected by the degree of compliance with
79     APRN licensure requirements and the effectiveness of enforcement activities related to State
80     APRN licensure laws;
81          (b) violations of APRN licensure and other laws regulating the practice of nursing may
82     result in injury or harm to the public;
83          (c) the expanded mobility of APRNs and the use of advanced communication and
84     intervention technologies as part of our nation's health care delivery system require greater
85     coordination and cooperation among states in the areas of APRN licensure and regulation;
86          (d) new practice modalities and technology make compliance with individual state
87     APRN licensure laws difficult and complex;
88          (e) the current system of duplicative APRN licensure for APRNs practicing in multiple
89     states is cumbersome and redundant for healthcare delivery systems, payors, state licensing

90     boards, regulators and APRNs; and
91          (f) uniformity of APRN licensure requirements throughout the states promotes public
92     safety and public health benefits as well as providing a mechanism to increase access to care,
93     particularly in rural and underserved areas.
94          (2) The general purposes of this compact are to:
95          (a) facilitate the states' responsibilities to protect the public's health and safety;
96          (b) ensure and encourage the cooperation of party states in the areas of APRN licensure
97     and regulation, including promotion of uniform licensure requirements;
98          (c) facilitate the exchange of information between party states in the areas of APRN
99     regulation, investigation, and adverse actions;
100          (d) promote compliance with the laws governing APRN practice in each jurisdiction;
101          (e) invest all party states with the authority to hold an APRN accountable for meeting
102     all state practice laws in the state in which the patient is located at the time care is rendered
103     through the mutual recognition of party state privileges to practice;
104          (f) decrease redundancies in the consideration and issuance of APRN licenses; and
105          (g) provide opportunities for interstate practice by APRNs who meet uniform licensure
106     requirements.
107          ARTICLE II
108          Definitions
109          As used in this compact:
110          (1) "Advanced practice registered nurse" or "APRN" means a registered nurse who has
111     gained additional specialized knowledge, skills, and experience through a program of study
112     recognized or defined by the Interstate Commission of APRN Compact administrators
113     ("Commission") and who is licensed to perform advanced nursing practice. An advanced
114     practice registered nurse is licensed in an APRN role that is congruent with an APRN
115     educational program, certification, and Commission rules.
116          (2) "Adverse action" means any administrative, civil, equitable or criminal action
117     permitted by a state's laws, which is imposed by a licensing board or other authority against an
118     APRN, including actions against an individual's license or multistate licensure privilege such
119     as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee's
120     practice, or any other encumbrance on licensure affecting an APRN's authorization to practice,

121     including the issuance of a cease and desist action.
122          (3) "Alternative program" means a nondisciplinary monitoring program approved by a
123     licensing board.
124          (4) "APRN Licensure" means the regulatory mechanism used by a party state to grant
125     legal as an APRN.
126          (5) "APRN Uniform Licensure/ Requirements" means the minimum uniform licensure,
127     education, and examination requirements set forth in Article III.2 of this Compact.
128          (6) "Coordinated licensure information system" means an integrated process for
129     collecting, storing, and sharing information on APRN licensure and enforcement activities
130     related to APRN licensure laws that are administered by a nonprofit organization composed of
131     and controlled by licensing boards.
132          (7) "Current significant investigative information" means:
133          (a) investigative information that a licensing board, after a preliminary inquiry that
134     includes notification and an opportunity for the APRN to respond, if required by state law, has
135     reason to believe is not groundless and, if proved true, would indicate more than a minor
136     infraction; or
137          (b) investigative information that indicates that the APRN represents an immediate
138     threat to public health and safety regardless of whether the APRN has been notified and had an
139     opportunity to respond.
140          (8) "Encumbrance" means a revocation or suspension of, or any limitation on, the full
141     and unrestricted practice of nursing imposed by a licensing board in connection with a
142     disciplinary proceeding.
143          (9) "Home state" means the party state that is the APRN's primary state of residence.
144          (10) "Licensing board" means a party state's regulatory body responsible for regulating
145     the practice of advanced practice registered nursing.
146          (11) "Multistate license" means an APRN license to practice as an APRN issued by a
147     home state licensing board that authorizes the APRN to practice as an APRN in all party states
148     under a multistate licensure privilege, in the same role and population focus as the APRN is
149     licensed in the home state.
150          (12) "Non-controlled prescription drug" means a device or drug that is not a controlled
151     substance and is prohibited under state or federal law from being dispensed without a

152     prescription. The term includes a device or drug that bears or is required to bear the legend
153     "Caution: federal law prohibits dispensing without prescription" or "prescription only" or other
154     legend that complies with federal law.
155          (13) "Party state" means any state that has adopted this compact.
156          (14) "Population focus" means one of the six population foci of family/individual
157     across the lifespan, adult-gerontology, pediatrics, neonatal, women's health/gender-related and
158     psych/mental health.
159          (15) "Prescriptive authority" means the legal authority to prescribe medications and
160     devices as defined by party state laws.
161          (16) "Remote state" means a party state that is not the home state.
162          (17) "Role" means one of the four recognized roles of certified registered nurse
163     anesthetists (CRNA), certified nurse-midwives (CNM), clinical nurse specialists (CNS) and
164     certified nurse practitioners (CNP).
165          (18) "Single-state license" means an APRN license issued by a party state that
166     authorizes practice only within the issuing state and does not include a multistate licensure
167     privilege to practice in any other party state.
168          (19) "State" means a state, territory, or possession of the United States and the District
169     of Columbia.
170          (20) (a) "State practice laws" means a party state's laws, rules, and regulations that
171     govern APRN practice, define the scope of advanced nursing practice, and create the methods
172     and grounds for imposing discipline except that prescriptive authority shall be treated in
173     accordance with Article III.1(d) of this Compact.
174          (b) "State practice laws" do not include:
175          (i) a party state's laws, rules, and regulations requiring supervision or collaboration
176     with a healthcare professional, except for laws, rules, and regulations regarding prescribing
177     controlled substances; or
178          (ii) the requirements necessary to obtain and retain an APRN license, except for
179     qualifications or requirements of the home state.
180          ARTICLE III
181          General Provisions and Jurisdiction
182          (1) (a) A state must implement procedures for considering the criminal history records

183     of applicants for initial APRN licensure or APRN licensure by endorsement.
184          (b) Such procedures shall include the submission of fingerprints or other
185     biometric-based information by APRN applicants for the purpose of obtaining an applicant's
186     criminal history record information from the Federal Bureau of Investigation and the agency
187     responsible for retaining that state's criminal records.
188          (2) Each party state shall require an applicant to satisfy, the following APRN uniform
189     licensure requirements to obtain or retain a multistate license in the home state:
190          (a) meeting the home state's qualifications for licensure or renewal of licensure, as well
191     as, all other applicable state laws;
192          (b) (i) has completed an accredited graduate-level education program that prepares the
193     applicant for one of the four recognized roles and population foci; or
194          (ii) has completed a foreign APRN education program for one of the four recognized
195     roles and population foci that:
196          (A) has been approved by the authorized accrediting body in the applicable country;
197     and
198          (B) has been verified by an independent credentials review agency to be comparable to
199     a licensing board-approved APRN education program;
200          (c) has, if a graduate of a foreign APRN education program not taught in English or if
201     English is not the individual's native language, successfully passed an English proficiency
202     examination that includes the components of reading, speaking, writing and listening;
203          (d) has successfully passed a national certification examination that measures APRN,
204     role and population-focused competencies and maintains continued competence as evidenced
205     by recertification in the role and population focus through the national certification program;
206          (e) holds an active, unencumbered license as a registered nurse and an active,
207     unencumbered authorization to practice as an APRN;
208          (f) has successfully passed an NCLEX-RN® examination or recognized predecessor,
209     as applicable;
210          (g) has practiced for at least 2,080 hours as an APRN in a role and population focus
211     congruent with the applicant's education and training. For purposes of this section, practice
212     shall not include hours obtained as part of enrollment in an APRN education program;
213          (h) has submitted, in connection with an application for initial licensure or licensure by

214     endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history
215     record information from the Federal Bureau of Investigation and the agency responsible for
216     retaining that state or, if applicable, foreign country's criminal records;
217          (i) has not been convicted or found guilty, or has entered into an agreed disposition, of
218     a felony offense under applicable state, federal or foreign criminal law;
219          (j) has not been convicted or found guilty, or has entered into an agreed disposition, of
220     a misdemeanor offense related to the practice of nursing as determined by factors set forth in
221     rules adopted by the Commission;
222          (k) is not currently enrolled in an alternative program;
223          (l) is subject to self-disclosure requirements regarding current participation in an
224     alternative program; and
225          (m) has a valid United States Social Security number.
226          (3) An APRN issued a multistate license shall be licensed in an approved role and at
227     least one approved population focus.
228          (4) An APRN multistate license issued by a home state to a resident in that state will be
229     recognized by each party state as authorizing the APRN to practice as an APRN in each party
230     state, under a multistate licensure privilege, in the same role and population focus as the APRN
231     is licensed in the home state.
232          (5) Nothing in this Compact shall affect the requirements established by a party state
233     for the issuance of a single-state license, except that an individual may apply for a single-state
234     license, instead of a multistate license, even if otherwise qualified for the multistate license.
235     However, the failure of such an individual to affirmatively opt for a single state license may
236     result in the issuance of a multistate license.
237          (6) Issuance of an APRN multistate license shall include prescriptive authority for
238     non-controlled prescription drugs.
239          (7) For each state in which an APRN seeks authority to prescribe controlled
240     substances, the APRN shall satisfy all requirements imposed by such state in granting and/or
241     renewing such authority.
242          (8) (a) An APRN issued a multistate license is authorized to assume responsibility and
243     accountability for patient care independent of any supervisory or collaborative relationship.
244          (b) This authority may be exercised in the home state and in any remote state in which

245     the APRN exercises a multistate licensure privilege.
246          (9) (a) All party states shall be authorized, in accordance with state due process laws,
247     to take adverse action against an APRN's multistate licensure privilege such as revocation,
248     suspension, probation or any other action that affects an APRN's authorization to practice
249     under a multistate licensure privilege, including cease and desist actions.
250          (b) If a party state takes such action, it shall promptly notify the administrator of the
251     coordinated licensure information system.
252          (c) The administrator of the coordinated licensure information system shall promptly
253     notify the home state of any such actions by remote states.
254          (10) (a) Except as otherwise expressly provided in this Compact, an APRN practicing
255     in a party state must comply with the state practice laws of the state in which the client is
256     located at the time service is provided.
257          (b) APRN practice is not limited to patient care, but shall include all advanced nursing
258     practice as defined by the state practice laws of the party state in which the client is located.
259          (c) APRN practice in a party state under a multistate licensure privilege will subject the
260     APRN to the jurisdiction of the licensing board, the courts, and the laws of the party state in
261     which the client is located at the time service is provided.
262          (11) Except as otherwise expressly provided in this Compact, this Compact does not
263     affect additional requirements imposed by states for advanced practice registered nursing.
264     However, a multistate licensure privilege to practice registered nursing granted by a party state
265     shall be recognized by other party states as satisfying any state law requirement for registered
266     nurse licensure as a precondition for authorization to practice as an APRN in that state.
267          (12) Individuals not residing in a party state shall continue to be able to apply for a
268     party state's single-state APRN license as provided under the laws of each party state.
269     However, the single-state license granted to these individuals will not be recognized as
270     granting the privilege to practice as an APRN in any other party state.
271          ARTICLE IV
272          Applications for APRN Licensure in a Party State
273          (1) Upon application for an APRN multistate license, the licensing board in the issuing
274     party state shall ascertain, through the coordinated licensure information system, whether the
275     applicant has ever held or is the holder of a licensed practical/vocational nursing license, a

276     registered nursing license or an advanced practice registered nursing license issued by another
277     state, whether there are any encumbrances on any license or multistate licensure privilege held
278     by the applicant, whether any adverse action has been taken against a license or multistate
279     licensure privilege held by the applicant, and whether the applicant is currently participating in
280     an alternative program.
281          (2) An APRN may hold a multistate APRN license issued by the home state, in only
282     one party state at a time.
283          (3) If an APRN changes primary state of residence by moving between two party
284     states, the APRN must apply for APRN licensure in the new home state, and the multistate
285     license issued by the prior home state shall be deactivated in accordance with applicable
286     Commission rules.
287          (a) The APRN may apply for licensure in advance of a change in primary state of
288     residence.
289          (b) A multistate APRN license shall not be issued by the new home state until the
290     APRN provides satisfactory evidence of a change in primary state of residence to the new
291     home state and satisfies all applicable requirements to obtain a multistate APRN license from
292     the new home state.
293          (4) When an APRN changes primary state of residence by moving from a party state to
294     a non-party state, the APRN multistate license issued by the prior home state will convert to a
295     single-state license, valid only in the former home state.
296          ARTICLE V
297          Additional Authorities Invested in Party State Licensing Boards
298          (1) In addition to the other powers conferred by state law, a licensing board shall have
299     the authority to:
300          (a) Take adverse action against an APRN's multistate licensure privilege to practice
301     within that party state.
302          (i) Only the home state shall have the power to impose adverse action against the
303     APRN license issued by the home state.
304          (ii) For purposes of imposing adverse action, the home state licensing board shall give
305     the same priority and effect to reported conduct that occurred outside the home state as it
306     would if that conduct had occurred within the home state. In so doing, it shall apply its own

307     state laws to determine appropriate action.
308          (b) Issue cease and desist orders or impose an encumbrance on an APRN's authority to
309     practice within that party state.
310          (c) Complete any pending investigations of an APRN who changes primary state of
311     residence during the course of such investigations. The licensing board shall also have the
312     authority to take appropriate action(s) and shall promptly report the conclusions of such
313     investigations to the administrator of the coordinated licensure information system. The
314     administrator of the coordinated licensure information system shall promptly notify the new
315     home state of any such actions.
316          (d) Issue subpoenas for both hearings and investigations that require the attendance and
317     testimony of witnesses, as well as, the production of evidence in accordance with the following
318          (i) Subpoenas issued by a party state licensing board for the attendance and testimony
319     of witnesses, and/or the production of evidence from another party state shall be enforced in the
320     latter state by any court of competent jurisdiction, according to the court's practice and
321     procedure in considering subpoenas issued in its own proceedings.
322          (ii) The issuing licensing board shall pay any witness fees, travel expenses, mileage,
323     and other fees required by the service statutes of the state in which the witnesses and/or
324     evidence are located;
325          (e) Obtain and submit, for an APRN licensure applicant, fingerprints or other
326     biometric-based information to the Federal Bureau of Investigation for criminal background
327     checks, receive the results of the Federal Bureau of Investigation record search on criminal
328     background checks and use the results in making licensure decision.
329          (f) If otherwise permitted by state law, recover from the affected APRN the costs of
330     investigations and disposition of cases resulting from any adverse action taken against that
331     APRN.
332          (g) Take adverse action based on the factual findings of another party state, provided
333     that the licensing board follows its own procedures for taking such adverse action.
334          (2) (a) If adverse action is taken by a home state against an APRN's multistate
335     licensure, the privilege to practice in all other party states under a multistate licensure privilege
336     shall be deactivated until all encumbrances have been removed from the APRN's multistate
337     license.

338          (b) All home state disciplinary orders that impose adverse action against an APRN's
339     multistate license shall include a statement that the APRN's multistate licensure privilege is
340     deactivated in all party states during the pendency of the order.
341          (3) (a) Nothing in this Compact shall override a party state's decision that participation
342     in an alternative program may be used in lieu of adverse action.
343          (b) The home state licensing board shall deactivate the multistate licensure privilege
344     under the multistate license of any APRN for the duration of the APRN's participation in an
345     alternative program.
346          ARTICLE VI
347          Coordinated Licensure Information System and Exchange of Information
348          (1) All party states shall participate in a coordinated licensure information system of all
349     APRNs, licensed registered nurses and licensed practical/vocational nurses. This system will
350     include information on the licensure and disciplinary history of each APRN, as submitted by
351     party states, to assist in the coordinated administration of APRN licensure enforcement efforts.
352          (2) The Commission, in consultation with the administrator of the coordinated
353     licensure information system, shall formulate necessary and proper procedures for the
354     identification, collection and exchange of information under this Compact.
355          (3) All licensing boards shall promptly report to the coordinated licensure information
356     system any adverse action, any current significant investigative information, denials of
357     applications (reason for such denials) and APRN participation in alternative programs known
358     to the licensing board regardless of whether such participation is deemed nonpublic and/or
359     confidential under state law.
360          (4) Notwithstanding any other provision of law, all party states' licensing boards
361     contributing information to the coordinated licensure information system may designate
362     information that may not be shared with non-party states or disclosed to other entities or
363     individuals without the express permission of the contributing state.
364          (5) Any personally identifiable information obtained from the coordinated licensure
365     information system by a party state licensing board shall not be shared with non-party states or
366     disclosed to other entities or individuals except to the extent permitted by the laws of the party
367     state contributing the information.
368          (6) Any information contributed to the coordinated licensure information system that is

369     subsequently required to be expunged by the laws of the party state contributing that
370     information shall also be expunged from the coordinated licensure information system.
371          (7) The Compact administrator of each party state shall furnish a uniform data set to
372     the Compact administrator of each other party state, which shall include, at a minimum:
373          (a) identifying information;
374          (b) licensure data;
375          (c) information related to alternative program participation information; and
376          (d) other information that may facilitate the administration of this Compact, as
377     determined by Commission rules.
378          (8) The Compact administrator of a party state shall provide all investigative
379     documents and information requested by another party state.
380          ARTICLE VII
381          Establishment of the Interstate Commission of APRN Compact Administrators
382          (1) The party states hereby create and establish a joint public agency known as the
383     Interstate Commission of APRN Compact Administrators.
384          (a) The Commission is an instrumentality of the party states.
385          (b) Venue is proper, and judicial proceedings by or against the Commission shall be
386     brought solely and exclusively, in a court of competent jurisdiction where the principal office
387     of the Commission is located. The Commission may waive venue and jurisdictional defenses to
388     the extent it adopts or consents to participate in alternative dispute resolution proceedings.
389          (c) Nothing in this Compact shall be construed to be a waiver of sovereign immunity.
390          (2) Membership, Voting and Meetings
391          (a) Each party state shall have and be limited to one administrator. The head of the
392     state licensing board or designee shall be the administrator of this Compact for each party state.
393     Any administrator may be removed or suspended from office as provided by the law of the
394     state from which the Administrator is appointed. Any vacancy occurring in the Commission
395     shall be filled in accordance with the laws of the party state in which the vacancy exists.
396          (b) Each administrator shall be entitled to one (1) vote with regard to the promulgation
397     of rules and creation of bylaws and shall otherwise have an opportunity to participate in the
398     business and affairs of the Commission. An administrator shall vote in person or by such other
399     means as provided in the bylaws. The bylaws may provide for an administrator's participation

400     in meetings by telephone or other means of communication.
401          (c) The Commission shall meet at least once during each calendar year. Additional
402     meetings shall be held as set forth in the bylaws or rules of the commission.
403          (d) All meetings shall be open to the public, and public notice of meetings shall be
404     given in the same manner as required under the rulemaking provisions in Article VIII.
405          (e) The Commission may convene in a closed, nonpublic meeting if the Commission
406     must discuss:
407          (i) noncompliance of a party state with its obligations under this Compact;
408          (ii) the employment, compensation, discipline or other personnel matters, practices or
409     procedures related to specific employees or other matters related to the Commission's internal
410     personnel practices and procedures;
411          (iii) current, threatened, or reasonably anticipated litigation;
412          (iv) negotiation of contracts for the purchase or sale of goods, services or real estate;
413          (v) accusing any person of a crime or formally censuring any person;
414          (vi) disclosure of trade secrets or commercial or financial information that is privileged
415     or confidential;
416          (vii) disclosure of information of a personal nature where disclosure would constitute a
417     clearly unwarranted invasion of personal privacy;
418          (viii) disclosure of investigatory records compiled for law enforcement purposes;
419          (ix) disclosure of information related to any reports prepared by or on behalf of the
420     Commission for the purpose of investigation of compliance with this Compact; or
421          (x) matters specifically exempted from disclosure by federal or state statute.
422          (f) If a meeting, or portion of a meeting, is closed pursuant to this provision, the
423     Commission's legal counsel or designee shall certify that the meeting may be closed and shall
424     reference each relevant exempting provision. The Commission shall keep minutes that fully
425     and clearly describe all matters discussed in a meeting and shall provide a full and accurate
426     summary of actions taken, and the reasons therefore, including a description of the views
427     expressed. All documents considered in connection with an action shall be identified in such
428     minutes. All minutes and documents of a closed meeting shall remain under seal, subject to
429     release by a majority vote of the Commission or order of a court of competent jurisdiction.
430          (3) The Commission shall, by a majority vote of the administrators, prescribe bylaws or

431     rules to govern its conduct as may be necessary or appropriate to carry out the purposes and
432     exercise the powers of this Compact, including but not limited to:
433          (a) establishing the fiscal year of the Commission;
434          (b) providing reasonable standards and procedures:
435          (i) for the establishment and meetings of other committees; and
436          (ii) governing any general or specific delegation of any authority or function of the
437     Commission.
438          (c) (i) Providing reasonable procedures for calling and conducting meetings of the
439     Commission, ensuring reasonable advance notice of all meetings and providing an opportunity
440     for attendance of such meetings by interested parties, with enumerated exceptions designed to
441     protect the public's interest, the privacy of individuals, and proprietary information, including
442     trade secrets.
443          (ii) The Commission may meet in closed session only after a majority of the
444     administrators vote to close a meeting in whole or in part.
445          (iii) As soon as practicable, the Commission must make public a copy of the vote to
446     close the meeting revealing the vote of each administrator, with no proxy votes allowed;
447          (d) Establishing the titles, duties and authority and reasonable procedures for the
448     election of the officers of the Commission;
449          (e) (i) Providing reasonable standards and procedures for the establishment of the
450     personnel policies and programs of the Commission.
451          (ii) Notwithstanding any civil service or other similar laws of any party state, the
452     bylaws shall exclusively govern the personnel policies and programs of the Commission;
453          (f) Providing a mechanism for winding up the operations of the Commission and the
454     equitable disposition of any surplus funds that may exist after the termination of this Compact
455     after the payment and/or reserving of all of its debts and obligations;
456          (4) The Commission shall publish its bylaws and rules, and any amendments thereto, in
457     a convenient form on the website of the Commission;
458          (5) The Commission shall maintain its financial records in accordance with the bylaws;
459          (6) The Commission shall meet and take such actions as are consistent with the
460     provisions of this Compact and the bylaws.
461          (7) The Commission shall have the following powers:

462          (a) to promulgate uniform rules to facilitate and coordinate implementation and
463     administration of this Compact. The rules shall have the force and effect of law and shall be
464     binding in all party states;
465          (b) to bring and prosecute legal proceedings or actions in the name of the Commission,
466     provided that the standing of any licensing board to sue or be sued under applicable law shall
467     not be affected;
468          (c) to purchase and maintain insurance and bonds;
469          (d) to borrow, accept or contract for services of personnel, including but not limited to
470     employees of a party state or nonprofit organizations;
471          (e) to cooperate with other organizations that administer state compacts related to the
472     regulation of nursing, including but not limited to sharing administrative or staff expenses,
473     office space or other resources;
474          (f) to hire employees, elect or appoint officers, fix compensation, define duties, grant
475     such individuals appropriate authority to carry out the purposes of this Compact, and to
476     establish the Commission's personnel policies and programs relating to conflicts of interest,
477     qualifications of personnel and other related personnel matters;
478          (g) to accept any and all appropriate donations, grants and gifts of money, equipment,
479     supplies, materials and services, and to receive, utilize and dispose of the same; provided that
480     at all times the Commission shall strive to avoid any appearance of impropriety and/or conflict
481     of interest;
482          (h) to lease, purchase, accept appropriate gifts or donations of, or otherwise to own,
483     hold, improve or use, any property, whether real, personal or mixed; provided that at all times
484     the Commission shall strive to avoid any appearance of impropriety;
485          (i) to sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of
486     any property, whether real, personal or mixed;
487          (j) to establish a budget and make expenditures;
488          (k) to borrow money;
489          (l) to appoint committees, including advisory committees comprised of administrators,
490     state nursing regulators, state legislators or their representatives, and consumer representatives,
491     and other such interested persons;
492          (m) to issue advisory opinions;

493          (n) to provide and receive information from, and to cooperate with, law enforcement
494     agencies;
495          (o) to adopt and use an official seal; and
496          (p) to perform such other functions as may be necessary or appropriate to achieve the
497     purposes of this Compact, consistent with the state regulation of APRN licensure and practice.
498          (8) Financing of the Commission
499          (a) The Commission shall pay, or provide for the payment of, the reasonable expenses
500     of its establishment, organization, and ongoing activities.
501          (b) (i) The Commission may also levy on and collect an annual assessment from each
502     party state to cover the cost of its operations, activities and staff in its annual budget as
503     approved each year.
504          (ii) The aggregate annual assessment amount, if any, shall be allocated based upon a
505     formula to be determined by the Commission, which shall promulgate a rule that is binding
506     upon all party states.
507          (c) The Commission shall not incur obligations of any kind prior to securing the funds
508     adequate to meet the same; nor shall the Commission pledge the credit of any of the party
509     states, except by, and with the authority of, such party state.
510          (d) The Commission shall keep accurate accounts of all receipts and disbursements.
511     The receipts and disbursements of the Commission shall be subject to the audit and accounting
512     procedures established under its bylaws. However, all receipts and disbursements of funds
513     handled by the Commission shall be audited yearly by a certified or licensed public accountant,
514     and the report of the audit shall be included in and become part of the annual report of the
515     Commission.
516          (9) Qualified Immunity, Defense, and Indemnification
517          (a) The administrators, officers, executive director, employees and representatives of
518     the Commission shall be immune from suit and liability, either personally or in their official
519     capacity, for any claim for damage to or loss of property or personal injury or other civil
520     liability caused by or arising out of any actual or alleged act, error or omission that occurred, or
521     that the person against whom the claim is made had a reasonable basis for believing occurred,
522     within the scope of Commission employment, duties or responsibilities; provided that nothing
523     in this paragraph shall be construed to protect any such person from suit and/or liability for any

524     damage, loss, injury or liability caused by the intentional, willful or wanton misconduct of that
525     person.
526          (b) The Commission shall defend any administrator, officer, executive director,
527     employee or representative of the Commission in any civil action seeking to impose liability
528     arising out of any actual or alleged act, error or omission that occurred within the scope of
529     Commission employment, duties or responsibilities, or that the person against whom the claim
530     is made had a reasonable basis for believing occurred within the scope of Commission
531     employment, duties or responsibilities; provided that nothing herein shall be construed to
532     prohibit that person from retaining his or her own counsel; and provided further that the actual
533     or alleged act, error or omission did not result from that person's intentional, willful or wanton
534     misconduct.
535          (c) The Commission shall indemnify and hold harmless any administrator, officer,
536     executive director, employee or representative of the Commission for the amount of any
537     settlement or judgment obtained against that person arising out of any actual or alleged act,
538     error or omission that occurred within the scope of Commission employment, duties or
539     responsibilities, or that such person had a reasonable basis for believing occurred within the
540     scope of Commission employment, duties or responsibilities, provided that the actual or
541     alleged act, error or omission did not result from the intentional, willful or wanton misconduct
542     of that person.
543          ARTICLE VIII
544          Rulemaking
545          (1) The Commission shall exercise its rulemaking powers pursuant to the criteria set
546     forth in this Article and the rules adopted thereunder. Rules and amendments shall become
547     binding as of the date specified in each rule or amendment and shall have the same force and
548     effect as provisions of this Compact.
549          (2) Rules or amendments to the rules shall be adopted at a regular or special meeting of
550     the Commission.
551          (3) Prior to promulgation and adoption of a final rule or rules by the Commission, and
552     at least sixty (60) days in advance of the meeting at which the rule will be considered and voted
553     upon, the Commission shall file a notice of proposed rulemaking:
554          (a) on the website of the Commission; and

555          (b) on the website of each licensing board or the publication in which each state would
556     otherwise publish proposed rules.
557          (4) The notice of proposed rulemaking shall include:
558          (a) the proposed time, date and location of the meeting in which the rule will be
559     considered and voted upon;
560          (b) the text of the proposed rule or amendment, and the reason for the proposed rule;
561          (c) a request for comments on the proposed rule from any interested person; and
562          (d) the manner in which interested persons may submit notice to the Commission of
563     their intention to attend the public hearing and any written comments.
564          (5) Prior to adoption of a proposed rule, the Commission shall allow persons to submit
565     written data, facts, opinions, and arguments, which shall be made available to the public.
566          (6) The Commission shall grant an opportunity for a public hearing before it adopts a
567     rule or amendment.
568          (7) The Commission shall publish the place, time, and date of the scheduled public
569     hearing.
570          (a) (i) Hearings shall be conducted in a manner providing each person who wishes to
571     comment a fair and reasonable opportunity to comment orally or in writing.
572          (ii) All hearings will be recorded, and a copy will be made available upon request.
573          (b) Nothing in this section shall be construed as requiring a separate hearing on each
574     rule. Rules may be grouped for the convenience of the Commission at hearings required by this
575     section.
576          (8) If no one appears at the public hearing, the Commission may proceed with
577     promulgation of the proposed rule.
578          (9) Following the scheduled hearing date, or by the close of business on the scheduled
579     hearing date if the hearing was not held, the Commission shall consider all written and oral
580     comments received.
581          (10) The Commission shall, by majority vote of all administrators, take final action on
582     the proposed rule and shall determine the effective date of the rule, if any, based on the
583     rulemaking record and the full text of the rule.
584          (11) Upon determination that an emergency exists, the Commission may consider and
585     adopt an emergency rule without prior notice, opportunity for comment, or hearing, provided

586     that the usual rulemaking procedures provided in this Compact and in this section shall be
587     retroactively applied to the rule as soon as reasonably possible, in no event later than ninety
588     (90) days after the effective date of the rule. For the purposes of this provision, an emergency
589     rule is one that must be adopted immediately in order to:
590          (a) Meet an imminent threat to public health, safety or welfare;
591          (b) Prevent a loss of Commission or party state funds; or
592          (c) Meet a deadline for the promulgation of an administrative rule that is established by
593     federal law or rule.
594          (12) The Commission may direct revisions to a previously adopted rule or amendment
595     for purposes of correcting typographical errors, errors in format, errors in consistency or
596     grammatical errors. Public notice of any revisions shall be posted on the website of the
597     Commission. The revision shall be subject to challenge by any person for a period of thirty (30)
598     days after posting. The revision may be challenged only on grounds that the revision results in
599     a material change to a rule. A challenge shall be made in writing, and delivered to the
600     Commission, prior to the end of the notice period. If no challenge is made, the revision will
601     take effect without further action. If the revision is challenged, the revision may not take effect
602     without the approval of the Commission.
603          ARTICLE IX
604          Oversight, Dispute Resolution and Enforcement
605          (1) Oversight
606          (a) Each party state shall enforce this Compact and take all actions necessary and
607     appropriate to effectuate this Compact's purposes and intent.
608          (b) The Commission shall be entitled to receive service of process in any proceeding
609     that may affect the powers, responsibilities or actions of the Commission, and shall have
610     standing to intervene in such a proceeding for all purposes. Failure to provide service of
611     process to the Commission shall render a judgment or order void as to the Commission, this
612     Compact or promulgated rules.
613          (2) Default, Technical Assistance and Termination
614          (a) If the Commission determines that a party state has defaulted in the performance of
615     its obligations or responsibilities under this Compact or the promulgated rules, the Commission
616     shall:

617          (i) provide written notice to the defaulting state and other party states of the nature of
618     the default, the proposed means of curing the default and/or any other action to be taken by the
619     Commission; and
620          (ii) provide remedial training and specific technical assistance regarding the default.
621          (b) (i) If a state in default fails to cure the default, the defaulting state's membership in
622     this Compact may be terminated upon an affirmative vote of a majority of the administrators,
623     and all rights, privileges and benefits conferred by this Compact may be terminated on the
624     effective date of termination.
625          (ii) A cure of the default does not relieve the offending state of obligations or liabilities
626     incurred during the period of default.
627          (c) (i) Termination of membership in this Compact shall be imposed only after all other
628     means of securing compliance have been exhausted.
629          (ii) Notice of intent to suspend or terminate shall be given by the Commission to the
630     governor of the defaulting state and to the executive officer of the defaulting state's licensing
631     board, the defaulting state's licensing board, and each of the party states.
632          (d) A state whose membership in this Compact has been terminated is responsible for
633     all assessments, obligations and liabilities incurred through the effective date of termination,
634     including obligations that extend beyond the effective date of termination.
635          (e) The Commission shall not bear any costs related to a state that is found to be in
636     default or whose membership in this Compact has been terminated, unless agreed upon in
637     writing between the Commission and the defaulting state.
638          (f) (i) The defaulting state may appeal the action of the Commission by petitioning the
639     United States District Court for the District of Columbia or the federal district in which the
640     Commission has its principal offices.
641          (ii) The prevailing party shall be awarded all costs of such litigation, including
642     reasonable attorneys' fees.
643          (3) Dispute Resolution
644          (a) Upon request by a party state, the Commission shall attempt to resolve disputes
645     related to the Compact that arises among party states and between party and non-party states.
646          (b) The Commission shall promulgate a rule providing for both mediation and binding
647     dispute resolution for disputes, as appropriate.

648          (c) In the event the Commission cannot resolve disputes among party states arising
649     under this Compact:
650          (i) The party states may submit the issues in dispute to an arbitration panel, which will
651     be composed of individuals appointed by the Compact administrator in each of the affected
652     party states and an individual mutually agreed upon by the Compact administrators of all the
653     party states involved in the dispute.
654          (ii) The decision of a majority of the arbitrators shall be final and binding.
655          (4) Enforcement
656          (a) The Commission, in the reasonable exercise of its discretion, shall enforce the
657     provisions and rules of this Compact.
658          (b) By majority vote, the Commission may initiate legal action in the United States
659     District Court for the District of Columbia or the federal district in which the Commission has
660     its principal offices against a party state that is in default to enforce compliance with the
661     provisions of this Compact and its promulgated rules and bylaws. The relief sought may
662     include both injunctive relief and damages. In the event judicial enforcement is necessary, the
663     prevailing party shall be awarded all costs of such litigation, including reasonable attorneys'
664     fees.
665          (c) The remedies herein shall not be the exclusive remedies of the Commission. The
666     Commission may pursue any other remedies available under federal or state law.
667          ARTICLE X
668          Effective Date, Withdrawal and Amendment
669          (1) This Compact shall come into limited effect at such time as this Compact has been
670     enacted into law in seven (7) party states for the sole purpose of establishing and convening the
671     Commission to adopt rules relating to its operation.
672          (2) Any state that joins this Compact subsequent to the Commission's initial adoption
673     of the APRN uniform licensure requirements shall be subject to all rules that have been
674     previously adopted by the Commission.
675          (3) (a) Any party state may withdraw from this Compact by enacting a statute repealing
676     the same.
677          (b) A party state's withdrawal shall not take effect until six (6) months after enactment
678     of the repealing statute.

679          (4) A party state's withdrawal or termination shall not affect the continuing requirement
680     of the withdrawing or terminated state's licensing board to report adverse actions and
681     significant investigations occurring prior to the effective date of such withdrawal or
682     termination.
683          (5) Nothing contained in this Compact shall be construed to invalidate or prevent any
684     APRN licensure agreement or other cooperative arrangement between a party state and a
685     non-party state that does not conflict with the provisions of this Compact.
686          (6) This Compact may be amended by the party states. No amendment to this Compact
687     shall become effective and binding upon any party state until it is enacted into the laws of all
688     party states.
689          (7) Representatives of non-party states to this Compact shall be invited to participate in
690     the activities of the Commission, on a nonvoting basis, prior to the adoption of this Compact
691     by all states.
692          ARTICLE XI
693          Construction and Severability
694          This Compact shall be liberally construed so as to effectuate the purposes thereof. The
695     provisions of this Compact shall be severable, and if any phrase, clause, sentence or provision
696     of this Compact is declared to be contrary to the constitution of any party state or of the United
697     States, or if the applicability thereof to any government, agency, person or circumstance is held
698     invalid, the validity of the remainder of this Compact and the applicability thereof to any
699     government, agency, person or circumstance shall not be affected thereby. If this Compact shall
700     be held to be contrary to the constitution of any party state, this Compact shall remain in full
701     force and effect as to the remaining party states and in full force and effect as to the party state
702     affected as to all severable matters.
703          Section 3. Section 58-31d-102 is repealed and reenacted to read:
704          58-31d-102. Division rulemaking.
705          (1) The division shall make rules in accordance with Title 63G, Chapter 3,
706     Administrative Rulemaking Act, to implement Section 58-31d-101.
707          (2) For purposes of Section 58-31d-101, "role" as defined in Article II(17) includes an
708     individual who is:
709          (a) licensed to practice under Subsection 58-31b-301(2)(d) or (e); or

710          (b) licensed to practice under Section 58-44a-301.
710a      Ŝ→ (4) Notwithstanding any provision in Section 58-31d-101, Section 58-31d-101 does not
710b     supersede state law related to an individual's scope of practice under this title. ←Ŝ
711          Ŝ→ [
(4)] (5) ←Ŝ Once the compact comes into effect as described in Section 58-31d-101,
711a     Article
712     X(1), the division shall provide a notice that the compact is in effect:
713          (a) to an individual licensed under:
714          (i) Subsection 58-31b-201(2)(d) or (e);
715          (ii) Section 58-44a-301; and
716          (b) to the Health and Human Services Interim Committee; and
717          (c) on the division's website with information for potential applicants.
718          Section 4. Section 58-44a-302 is amended to read:
719          58-44a-302. Qualifications for licensure.
720          (1) An applicant for licensure as a nurse midwife shall:
721          (a) submit an application in a form as prescribed by the division;
722          (b) pay a fee as determined by the department under Section 63J-1-504;
723          (c) be of good moral character;
724          (d) at the time of application for licensure hold a license in good standing as a
725     registered nurse in Utah, or be at that time qualified for a license as a registered nurse under
726     Title 58, Chapter 31b, Nurse Practice Act;
727          (e) have completed:
728          (i) a certified nurse midwifery education program accredited by the Accreditation
729     Commission for Midwifery Education and approved by the division; or
730          (ii) a nurse midwifery education program located outside of the United States which is
731     approved by the division and is equivalent to a program accredited by the Accreditation
732     Commission for Midwifery Education, as demonstrated by a graduate's being accepted to sit for
733     the national certifying examination administered by the Accreditation Commission for
734     Midwifery Education or its designee; [and]
735          (f) have passed examinations established by the division rule in collaboration with the
736     board within two years after completion of the approved education program required under
737     Subsection (1)(e)[.]; and
738          (g) complete and pass a criminal background check in accordance with Section
739     58-44a-302.1.
740          (2) For purposes of Subsection (1)(e), as of January 1, 2010, [the accredited education

741     program or it's equivalent must grant a graduate degree, including post-master's certificate, in
742     nurse midwifery] an applicant shall have completed a graduate degree, including post-master's
743     certificate, in nurse midwifery from the accredited education program or the accredited
744     education program's equivalent.
745          Section 5. Section 58-44a-302.1 is enacted to read:
746          58-44a-302.1. Background checks.
747          (1) An applicant for licensure under this chapter shall:
748          (a) submit fingerprint cards in a form acceptable to the division at the time the license
749     application is filed; and
750          (b) consent to a fingerprint background check conducted by the Bureau of Criminal
751     Identification and the Federal Bureau of Investigation regarding the application.
752          (2) The division shall:
753          (a) in addition to other fees authorized by this chapter, collect from each applicant
754     submitting fingerprints in accordance with this section:
755          (i) the fee that the Bureau of Criminal Identification is authorized to collect for the
756     services provided under Section 53-10-108; and
757          (ii) the fee charged by the Federal Bureau of Investigation for fingerprint processing for
758     the purpose of obtaining federal criminal history record information;
759          (b) submit from each applicant the fingerprint card and the fees described in
760     Subsection (2)(a) to the Bureau of Criminal Identification; and
761          (c) obtain and retain in division records a signed waiver approved by the Bureau of
762     Criminal Identification in accordance with Section 53-10-108 for each applicant.
763          (3) The Bureau of Criminal Identification shall, in accordance with the requirements of
764     Section 53-10-108:
765          (a) check the fingerprints submitted under Subsection (2)(b) against the applicable state
766     and regional criminal records databases;
767          (b) forward the fingerprints to the Federal Bureau of Investigation for a national
768     criminal history background check; and
769          (c) provide the results from the state, regional, and nationwide criminal history
770     background checks to the division.
771          (4) For purposes of conducting a criminal background check required under this

772     section, the division shall have direct access to criminal background information maintained
773     under Title 53, Chapter 10, Part 2, Bureau of Criminal Identification.
774          (5) Except for information provided to the applicant, the division may not disseminate
775     outside of the division any criminal history record information that the division obtains from
776     the Bureau of Criminal Identification or the Federal Bureau of Investigation under the criminal
777     background check requirements of this section.
778          (6) (a) A new nurse midwife license issued under Section 58-44a-302 is conditional
779     pending completion of the criminal background check.
780          (b) Notwithstanding Title 63G, Chapter 4, Administrative Procedures Act, if the
781     criminal background check required in Subsection 58-44a-302(1) demonstrates the applicant
782     has failed to accurately disclose a criminal history, the license is immediately and automatically
783     revoked upon notice to the licensee by the division.
784          (c) An individual's whose conditional license has been revoked under Subsection (6)(b)
785     is entitled to a postrevocation hearing to challenge the revocation.
786          (d) The division shall conduct a postrevocation hearing in accordance with Title 63G,
787     Chapter 4, Administrative Procedures Act.
788          (7) The division may not authorize the practice of the licensee under Chapter 31d,
789     Advanced Practice Registered Nurse Compact, until the criminal background check described
790     in this section is completed.
791          Section 6. Repealer.
792          This bill repeals:
793          Section 58-31d-103, Rulemaking authority -- Enabling provisions.