Health occupations: physicians; interstate medical licensure compact; update, the official text

Act
No. 6

Public
Acts of 2026

Approved
by the Governor

March
26, 2026

Filed
with the Secretary of State

March
26, 2026

EFFECTIVE
DATE:  March 26, 2026

state of michigan

103rd Legislature

Regular session of 2026

Introduced by Reps. Linting, Thompson, Frisbie, Roth,
Schmaltz, Kunse, Breen, Green, Schuette and VanderWall

ENROLLED HOUSE BILL No. 5455

AN ACT to amend 1978 PA 368,
entitled “An act to protect and promote the public health; to codify, revise,
consolidate, classify, and add to the laws relating to public health; to
provide for the prevention and control of diseases and disabilities; to provide
for the classification, administration, regulation, financing, and maintenance
of personal, environmental, and other health services and activities; to create
or continue, and prescribe the powers and duties of, departments, boards,
commissions, councils, committees, task forces, and other agencies; to
prescribe the powers and duties of governmental entities and officials; to
regulate occupations, facilities, and agencies affecting the public health; to
regulate health maintenance organizations and certain third party
administrators and insurers; to provide for the imposition of a regulatory fee;
to provide for the levy of taxes against certain health facilities or agencies;
to promote the efficient and economical delivery of health care services, to
provide for the appropriate utilization of health care facilities and services,
and to provide for the closure of hospitals or consolidation of hospitals or
services; to provide for the collection and use of data and information; to
provide for the transfer of property; to provide certain immunity from
liability; to regulate and prohibit the sale and offering for sale of drug
paraphernalia under certain circumstances; to provide for the implementation of
federal law; to provide for penalties and remedies; to provide for sanctions
for violations of this act and local ordinances; to provide for an
appropriation and supplements; to repeal certain acts and parts of acts; to
repeal certain parts of this act; and to repeal certain parts of this act on
specific dates,” (MCL 333.1101 to 333.25211) by adding section 16189.

The People of the State of
Michigan enact:

Sec.
16189. (1) The interstate medical licensure compact is enacted into law and
entered into by this state as a party with all jurisdictions that legally join
in the compact, in the form substantially as follows:

INTERSTATE
MEDICAL LICENSURE COMPACT

SECTION 1.
PURPOSE

In order to strengthen access to health care, and in
recognition of the advances in the delivery of health care, the member states
of the Interstate Medical Licensure Compact have allied in common purpose to
develop a comprehensive process that complements the existing licensing and
regulatory authority of state medical boards, provides a streamlined process
that allows physicians to become licensed in multiple states, thereby enhancing
the portability of a medical license and ensuring the safety of patients. The
Compact creates another pathway for licensure and does not otherwise change a
state’s existing Medical Practice Act. The Compact also adopts the prevailing
standard for licensure and affirms that the practice of medicine occurs where
the patient is located at the time of the physician-patient encounter, and
therefore, requires the physician to be under the jurisdiction of the state
medical board where the patient is located. State medical boards that
participate in the Compact retain the jurisdiction to impose an adverse action
against a license to practice medicine in that state issued to a physician
through the procedures in the Compact.

SECTION 2.
DEFINITIONS

In this compact:

(a) “Bylaws” means those bylaws established by the Interstate
Commission pursuant to Section 11 for its governance, or for directing and
controlling its actions and conduct.

(b) “Commissioner” means the voting representative appointed
by each member board pursuant to Section 11.

(c) “Conviction” means a finding by a court that an
individual is guilty of a criminal offense through adjudication, or entry of a
plea of guilt or no contest to the charge by the offender. Evidence of an entry
of a conviction of a criminal offense by the court shall be considered final
for purposes of disciplinary action by a member board.

(d) “Expedited License” means a full and unrestricted medical
license granted by a member state to an eligible physician through the process
set forth in the Compact.

(e) “Interstate Commission” means the interstate commission
created pursuant to Section 11.

(f) “License” means authorization by a state for a physician
to engage in the practice of medicine, which would be unlawful without the
authorization.

(g) “Medical Practice Act” means laws and regulations
governing the practice of allopathic and osteopathic medicine within a member
state.

(h) “Member Board” means a state agency in a member state
that acts in the sovereign interests of the state by protecting the public
through licensure, regulation, and education of physicians as directed by the
state government.

(i) “Member State” means a state that has enacted the
Compact.

(j) “Practice of medicine” means the diagnosis, treatment,
prevention, cure, or relieving of a human disease, ailment, defect, complaint,
or other physical or mental condition, by attendance, advice, device,
diagnostic test, or other means, or offering, undertaking, attempting to do, or
holding oneself out as able to do, any of these acts.

(k) “Physician” means any person who:

(1) Is a graduate of a medical school accredited by the
Liaison Committee on Medical Education, the Commission on Osteopathic College
Accreditation, or a medical school listed in the International Medical
Education Directory or its equivalent;

(2) Passed each component of the United States Medical
Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical
Licensing Examination (COMLEX-USA) within three attempts, or any of its
predecessor examinations accepted by a state medical board as an equivalent
examination for licensure purposes;

(3) Successfully completed graduate medical education
approved by the Accreditation Council for Graduate Medical Education or the
American Osteopathic Association;

(4) Holds specialty certification or a time-unlimited
specialty certificate recognized by the American Board of Medical Specialties
or the American Osteopathic Association’s Bureau of Osteopathic Specialists;
however, the specialty certification or a time-unlimited specialty certificate
does not have to be maintained once a physician is initially determined to be
eligible for expedited licensure through the Compact;

(5) Possesses a full and unrestricted license to engage in
the practice of medicine issued by a member board;

(6) Has never been convicted, received adjudication, deferred
adjudication, community supervision, or deferred disposition for any offense by
a court of appropriate jurisdiction;

(7) Has never held a license authorizing the practice of medicine
subjected to discipline by a licensing agency in any state, federal, or foreign
jurisdiction, excluding any action related to non-payment of fees related to a
license;

(8) Has never had a controlled substance license or permit
suspended or revoked by a state or the United States Drug Enforcement
Administration; and

(9) Is not under active investigation by a licensing agency
or law enforcement authority in any state, federal, or foreign jurisdiction.

(l) “Offense” means a felony, high court
misdemeanor, or crime of moral turpitude.

(m) “Rule” means a written statement by the Interstate
Commission promulgated pursuant to Section 12 of the Compact that is of general
applicability, implements, interprets, or prescribes a policy or provision of
the Compact, or an organizational, procedural, or practice requirement of the
Interstate Commission, and has the force and effect of statutory law in a
member state, if the rule is not inconsistent with the laws of the member
state. The term includes the amendment, repeal, or suspension of an existing
rule.

(n) “State” means any state, commonwealth, district, or
territory of the United States.

(o) “State of Principal License” means a member state where a
physician holds a license to practice medicine and which has been designated as
such by the physician for purposes of registration and participation in the
Compact.

SECTION 3.
ELIGIBILITY

(a) A physician must meet the eligibility requirements as
defined in Section 2(k) to receive an expedited license under the terms and
provisions of the Compact.

(b) A physician who does not meet the requirements of Section
2(k) may obtain a license to practice medicine in a member state if the
individual complies with all laws and requirements, other than the Compact,
relating to the issuance of a license to practice medicine in that state.

SECTION 4.
DESIGNATION OF STATE OF PRINCIPAL LICENSE

(a) A physician shall designate a member state as the state
of principal license for purposes of registration for expedited licensure
through the Compact if the physician possesses a full and unrestricted license
to practice medicine in that state, and the state is:

(1) the state of primary residence for the physician, or

(2) the state where at least 25% of the practice of medicine
occurs, or

(3) the location of the physician’s employer, or

(4) if no state qualifies under subsection (1), subsection
(2), or subsection (3), the state designated as state of residence for purpose
of federal income tax.

(b) A physician may redesignate a member state as state of
principal license at any time, as long as the state meets the requirements in
subsection (a).

(c) The Interstate Commission is authorized to develop rules
to facilitate redesignation of another member state as the state of principal
license.

SECTION 5.
APPLICATION AND ISSUANCE OF EXPEDITED LICENSURE

(a) A physician seeking licensure through the Compact shall
file an application for an expedited license with the member board of the state
selected by the physician as the state of principal license.

(b) Upon receipt of an application for an expedited license,
the member board within the state selected as the state of principal license
shall evaluate whether the physician is eligible for expedited licensure and
issue a letter of qualification, verifying or denying the physician’s
eligibility, to the Interstate Commission.

(i) Static qualifications, which include
verification of medical education, graduate medical education, results of any
medical or licensing examination, and other qualifications as determined by the
Interstate Commission through rule, shall not be subject to additional primary
source verification where already primary source verified by the state of
principal license.

(ii) The member board within the state
selected as the state of principal license shall, in the course of verifying
eligibility, perform a criminal background check of an applicant, including the
use of the results of fingerprint or other biometric data checks compliant with
the requirements of the Federal Bureau of Investigation, with the exception of
federal employees who have suitability determination in accordance with 5 CFR
§731.202.

(iii) Appeal on the determination of
eligibility shall be made to the member state where the application was filed
and shall be subject to the law of that state.

(c) Upon verification in subsection (b), physicians eligible
for an expedited license shall complete the registration process established by
the Interstate Commission to receive a license in a member state selected
pursuant to subsection (a), including the payment of any applicable fees.

(d) After receiving verification of eligibility under
subsection (b) and any fees under subsection (c), a member board shall issue an
expedited license to the physician. This license shall authorize the physician
to practice medicine in the issuing state consistent with the Medical Practice
Act and all applicable laws and regulations of the issuing member board and
member state.

(e) An expedited license shall be valid for a period
consistent with the licensure period in the member state and in the same manner
as required for other physicians holding a full and unrestricted license within
the member state.

(f) An expedited license obtained through the Compact shall
be terminated if a physician fails to maintain a license in the state of
principal licensure for a non-disciplinary reason, without redesignation of a
new state of principal licensure.

(g) The Interstate Commission is authorized to develop rules
regarding the application process, including payment of any applicable fees,
and the issuance of an expedited license.

SECTION 6.
FEES FOR EXPEDITED LICENSURE

(a) A member state issuing an expedited license authorizing
the practice of medicine in that state, or the regulating authority of the
member state, may impose a fee for a license issued or renewed through the
Compact.

(b) The Interstate Commission is authorized to develop rules
regarding fees for expedited licenses. However, those rules shall not limit the
authority of a member state, or the regulating authority of the member state,
to impose and determine the amount of a fee under subsection (a).

SECTION 7.
RENEWAL AND CONTINUED PARTICIPATION

(a) A physician seeking to renew an expedited license granted
in a member state shall complete a renewal process with the Interstate
Commission if the physician:

(1) Maintains a full and unrestricted license in a state of
principal license;

(2) Has not been convicted, received adjudication, deferred
adjudication, community supervision, or deferred disposition for any offense by
a court of appropriate jurisdiction;

(3) Has not had a license authorizing the practice of
medicine subject to discipline by a licensing agency in any state, federal, or
foreign jurisdiction, excluding any action related to non-payment of fees
related to a license; and

(4) Has not had a controlled substance license or permit
suspended or revoked by a state or the United States Drug Enforcement
Administration.

(b) Physicians shall comply with all continuing professional
development or continuing medical education requirements for renewal of a
license issued by a member state.

(c) The Interstate Commission shall collect any renewal fees
charged for the renewal of a license and distribute the fees to the applicable
member board.

(d) Upon receipt of any renewal fees collected in subsection
(c), a member board shall renew the physician’s license.

(e) Physician information collected by the Interstate
Commission during the renewal process will be distributed to all member boards.

(f) The Interstate Commission is authorized to develop rules
to address renewal of licenses obtained through the Compact.

SECTION 8. COORDINATED
INFORMATION SYSTEM

(a) The Interstate Commission shall establish a database of
all physicians licensed, or who have applied for licensure, under Section 5.

(b) Notwithstanding any other provision of law, member boards
shall report to the Interstate Commission any public action or complaints
against a licensed physician who has applied or received an expedited license
through the Compact.

(c) Member boards shall report disciplinary or investigatory
information determined as necessary and proper by rule of the Interstate
Commission.

(d) Member boards may report any non-public complaint,
disciplinary, or investigatory information not required by subsection (c) to
the Interstate Commission.

(e) Member boards shall share complaint or disciplinary
information about a physician upon request of another member board.

(f) All information provided to the Interstate Commission or
distributed by member boards shall be confidential, filed under seal, and used
only for investigatory or disciplinary matters.

(g) The Interstate Commission is authorized to develop rules
for mandated or discretionary sharing of information by member boards.

SECTION 9.
JOINT INVESTIGATIONS

(a) Licensure and disciplinary records of physicians are
deemed investigative.

(b) In addition to the authority granted to a member board by
its respective Medical Practice Act or other applicable state law, a member
board may participate with other member boards in joint investigations of
physicians licensed by the member boards.

(c) A subpoena issued by a member state shall be enforceable
in other member states.

(d) Member boards may share any investigative, litigation, or
compliance materials in furtherance of any joint or individual investigation
initiated under the Compact.

(e) Any member state may investigate actual or alleged
violations of the statutes authorizing the practice of medicine in any other
member state in which a physician holds a license to practice medicine.

SECTION 10.
DISCIPLINARY ACTIONS

(a) Any disciplinary action taken by any member board against
a physician licensed through the Compact shall be deemed unprofessional conduct
which may be subject to discipline by other member boards, in addition to any
violation of the Medical Practice Act or regulations in that state.

(b) If a license granted to a physician by the member board
in the state of principal license is revoked, surrendered or relinquished in
lieu of discipline, or suspended, then all licenses issued to the physician by
member boards shall automatically be placed, without further action necessary
by any member board, on the same status. If the member board in the state of
principal license subsequently reinstates the physician’s license, a license
issued to the physician by any other member board shall remain encumbered until
that respective member board takes action to reinstate the license in a manner
consistent with the Medical Practice Act of that state.

(c) If disciplinary action is taken against a physician by a
member board not in the state of principal license, any other member board may
deem the action conclusive as to matter of law and fact decided, and:

(i) Impose the same or lesser sanction(s)
against the physician so long as such sanctions are consistent with the Medical
Practice Act of that state; or

(ii) Pursue separate disciplinary action
against the physician under its respective Medical Practice Act, regardless of
the action taken in other member states.

(d) If a license granted to a physician by a member board is
revoked, surrendered or relinquished in lieu of discipline, or suspended, then
any license(s) issued to the physician by any other member board(s) shall be
suspended, automatically and immediately without further action necessary by
the other member board(s), for ninety (90) days upon entry of the order by the
disciplining board, to permit the member board(s) to investigate the basis for
the action under the Medical Practice Act of that state. A member board may
terminate the automatic suspension of the license it issued prior to the
completion of the ninety (90) day suspension period in a manner consistent with
the Medical Practice Act of that state.

SECTION 11.
INTERSTATE MEDICAL LICENSURE COMPACT COMMISSION

(a) The member states hereby create the “Interstate Medical
Licensure Compact Commission”.

(b) The purpose of the Interstate Commission is the
administration of the Interstate Medical Licensure Compact, which is a
discretionary state function.

(c) The Interstate Commission shall be a body corporate and
joint agency of the member states and shall have all the responsibilities,
powers, and duties set forth in the Compact, and such additional powers as may
be conferred upon it by a subsequent concurrent action of the respective
legislatures of the member states in accordance with the terms of the Compact.

(d) The Interstate Commission shall consist of two voting
representatives appointed by each member state who shall serve as
Commissioners. In states where allopathic and osteopathic physicians are
regulated by separate member boards, or if the licensing and disciplinary
authority is split between multiple member boards within a member state, the
member state shall appoint one representative from each member board. A
Commissioner shall be a(n):

(1) Allopathic or osteopathic physician appointed to a member
board;

(2) Executive director, executive secretary, or similar
executive of a member board; or

(3) Member of the public appointed to a member board.

(e) The Interstate Commission shall meet at least once each
calendar year. A portion of this meeting shall be a business meeting to address
such matters as may properly come before the Commission, including the election
of officers. The chairperson may call additional meetings and shall call for a
meeting upon the request of a majority of the member states.

(f) The bylaws may provide for meetings of the Interstate
Commission to be conducted by telecommunication or electronic communication.

(g) Each Commissioner participating at a meeting of the
Interstate Commission is entitled to one vote. A majority of Commissioners
shall constitute a quorum for the transaction of business, unless a larger
quorum is required by the bylaws of the Interstate Commission. A Commissioner
shall not delegate a vote to another Commissioner. In the absence of its
Commissioner, a member state may delegate voting authority for a specified
meeting to another person from that state who shall meet the requirements of
subsection (d).

(h) The Interstate Commission shall provide public notice of
all meetings and all meetings shall be open to the public. The Interstate
Commission may close a meeting, in full or in portion, where it determines by a
two‑thirds vote of the Commissioners present that an open meeting
would be likely to:

(1) Relate solely to the internal personnel practices and
procedures of the Interstate Commission;

(2) Discuss matters specifically exempted from disclosure by
federal statute;

(3) Discuss trade secrets, commercial, or financial
information that is privileged or confidential;

(4) Involve accusing a person of a crime, or formally
censuring a person;

(5) Discuss information of a personal nature where disclosure
would constitute a clearly unwarranted invasion of personal privacy;

(6) Discuss investigative records compiled for law
enforcement purposes; or

(7) Specifically relate to the participation in a civil
action or other legal proceeding.

(i) The Interstate Commission shall keep minutes which shall
fully describe all matters discussed in a meeting and shall provide a full and
accurate summary of actions taken, including record of any roll call votes.

(j) The Interstate Commission shall make its information and
official records, to the extent not otherwise designated in the Compact or by
its rules, available to the public for inspection.

(k) The Interstate Commission shall establish an executive
committee, which shall include officers, members, and others as determined by
the bylaws. The executive committee shall have the power to act on behalf of
the Interstate Commission, with the exception of rulemaking, during periods
when the Interstate Commission is not in session. When acting on behalf of the
Interstate Commission, the executive committee shall oversee the administration
of the Compact including enforcement and compliance with the provisions of the
Compact, its bylaws and rules, and other such duties as necessary.

(l) The Interstate Commission may establish
other committees for governance and administration of the Compact.

SECTION 12.
POWERS AND DUTIES OF THE INTERSTATE COMMISSION

The Interstate Commission shall have the duty and power to:

(a) Oversee and maintain the administration of the Compact;

(b) Promulgate rules which shall be binding to the extent and
in the manner provided for in the Compact;

(c) Issue, upon the request of a member state or member
board, advisory opinions concerning the meaning or interpretation of the
Compact, its bylaws, rules, and actions;

(d) Enforce compliance with Compact provisions, the rules
promulgated by the Interstate Commission, and the bylaws, using all necessary
and proper means, including but not limited to the use of judicial process;

(e) Establish and appoint committees including, but not
limited to, an executive committee as required by Section 11, which shall have
the power to act on behalf of the Interstate Commission in carrying out its
powers and duties;

(f) Pay, or provide for the payment of the expenses related
to the establishment, organization, and ongoing activities of the Interstate
Commission;

(g) Establish and maintain one or more offices;

(h) Borrow, accept, hire, or contract for services of
personnel;

(i) Purchase and maintain insurance and bonds;

(j) Employ an executive director who shall have such powers
to employ, select or appoint employees, agents, or consultants, and to
determine their qualifications, define their duties, and fix their
compensation;

(k) Establish personnel policies and programs relating to
conflicts of interest, rates of compensation, and qualifications of personnel;

(l) Accept donations and grants of money,
equipment, supplies, materials and services, and to receive, utilize, and
dispose of it in a manner consistent with the conflict of interest policies
established by the Interstate Commission;

(m) Lease, purchase, accept contributions or donations of, or
otherwise to own, hold, improve or use, any property, real, personal, or mixed;

(n) Sell, convey, mortgage, pledge, lease, exchange, abandon,
or otherwise dispose of any property, real, personal, or mixed;

(o) Establish a budget and make expenditures;

(p) Adopt a seal and bylaws governing the management and
operation of the Interstate Commission;

(q) Report annually to the legislatures and governors of the
member states concerning the activities of the Interstate Commission during the
preceding year. Such reports shall also include reports of financial audits and
any recommendations that may have been adopted by the Interstate Commission;

(r) Coordinate education, training, and public awareness
regarding the Compact, its implementation, and its operation;

(s) Maintain records in accordance with the bylaws;

(t) Seek and obtain trademarks, copyrights, and patents; and

(u) Perform such functions as may be necessary or appropriate
to achieve the purposes of the Compact.

SECTION 13.
FINANCE POWERS

(a) The Interstate Commission may levy on and collect an
annual assessment from each member state to cover the cost of the operations
and activities of the Interstate Commission and its staff. The total
assessment, subject to appropriation, must be sufficient to cover the annual
budget approved each year for which revenue is not provided by other sources.
The aggregate annual assessment amount shall be allocated upon a formula to be
determined by the Interstate Commission, which shall promulgate a rule binding
upon all member states.

(b) The Interstate Commission shall not incur obligations of
any kind prior to securing the funds adequate to meet the same.

(c) The Interstate Commission shall not pledge the credit of
any of the member states, except by, and with the authority of, the member
state.

(d) The Interstate Commission shall be subject to a yearly
financial audit conducted by a certified or licensed public accountant and the
report of the audit shall be included in the annual report of the Interstate
Commission.

SECTION 14.
ORGANIZATION AND OPERATION OF THE INTERSTATE COMMISSION

(a) The Interstate Commission shall, by a majority of
Commissioners present and voting, adopt bylaws to govern its conduct as may be
necessary or appropriate to carry out the purposes of the Compact within twelve (12) months
of the first Interstate Commission meeting.

(b) The Interstate Commission shall elect or appoint annually
from among its Commissioners a chairperson, a vice-chairperson, and a
treasurer, each of whom shall have such authority and duties as may be
specified in the bylaws. The chairperson, or in the chairperson’s absence or
disability, the vice-chairperson, shall preside at all meetings of the
Interstate Commission.

(c) Officers selected in subsection (b) shall serve without
remuneration from the Interstate Commission.

(d) The officers and employees of the Interstate Commission
shall be immune from suit and liability, either personally or in their official
capacity, for a claim for damage to or loss of property or personal injury or
other civil liability caused or arising out of, or relating to, an actual or
alleged act, error, or omission that occurred, or that such person had a
reasonable basis for believing occurred, within the scope of Interstate
Commission employment, duties, or responsibilities; provided that such person
shall not be protected from suit or liability for damage, loss, injury, or
liability caused by the intentional or willful and wanton misconduct of such
person.

(1) The liability of the executive director and employees of
the Interstate Commission or representatives of the Interstate Commission,
acting within the scope of such person’s employment or duties for acts, errors,
or omissions occurring within such person’s state, may not exceed the limits of
liability set forth under the constitution and laws of that state for state
officials, employees, and agents. The Interstate Commission is considered to be
an instrumentality of the states for the purposes of any such action. Nothing
in this subsection shall be construed to protect such person from suit or
liability for damage, loss, injury, or liability caused by the intentional or
willful and wanton misconduct of such person.

(2) The Interstate Commission shall defend the executive
director, its employees, and subject to the approval of the attorney general or
other appropriate legal counsel of the member state represented by an
Interstate Commission representative, shall defend such Interstate Commission
representative in any civil action seeking to impose liability arising out of
an actual or alleged act, error or omission that occurred within the scope of
Interstate Commission employment, duties or responsibilities, or that the
defendant had a reasonable basis for believing occurred within the scope of
Interstate Commission employment, duties, or responsibilities, provided that
the actual or alleged act, error, or omission did not result from intentional
or willful and wanton misconduct on the part of such person.

(3) To the extent not covered by the state involved, member
state, or the Interstate Commission, the representatives or employees of the
Interstate Commission shall be held harmless in the amount of a settlement or
judgment, including attorney’s fees and costs, obtained against such persons
arising out of an actual or alleged act, error, or omission that occurred
within the scope of Interstate Commission employment, duties, or
responsibilities, or that such persons had a reasonable basis for believing
occurred within the scope of Interstate Commission employment, duties, or
responsibilities, provided that the actual or alleged act, error, or omission
did not result from intentional or willful and wanton misconduct on the part of
such persons.

SECTION 15.
RULEMAKING FUNCTIONS OF THE INTERSTATE COMMISSION

(a) The Interstate Commission shall promulgate reasonable
rules in order to effectively and efficiently achieve the purposes of the
Compact. Notwithstanding the foregoing, in the event the Interstate Commission
exercises its rulemaking authority in a manner that is beyond the scope of the
purposes of the Compact, or the powers granted hereunder, then such an action
by the Interstate Commission shall be invalid and have no force or effect.

(b) Rules deemed appropriate for the operations of the
Interstate Commission shall be made pursuant to a rulemaking process that
substantially conforms to the “Model State Administrative Procedure Act” of
2010, and subsequent amendments thereto.

(c) Not later than thirty (30) days after a rule is
promulgated, any person may file a petition for judicial review of the rule in
the United States District Court for the District of Columbia or the federal
district where the Interstate Commission has its principal offices, provided
that the filing of such a petition shall not stay or otherwise prevent the rule
from becoming effective unless the court finds that the petitioner has a
substantial likelihood of success. The court shall give deference to the actions
of the Interstate Commission consistent with applicable law and shall not find
the rule to be unlawful if the rule represents a reasonable exercise of the
authority granted to the Interstate Commission.

SECTION 16.
OVERSIGHT OF INTERSTATE COMPACT

(a) The executive, legislative, and judicial branches of
state government in each member state shall enforce the Compact and shall take
all actions necessary and appropriate to effectuate the Compact’s purposes and
intent. The provisions of the Compact and the rules promulgated hereunder shall
have standing as statutory law but shall not override existing state authority
to regulate the practice of medicine.

(b) All courts shall take judicial notice of the Compact and
the rules in any judicial or administrative proceeding in a member state
pertaining to the subject matter of the Compact which may affect the powers,
responsibilities or actions of the Interstate Commission.

(c) The Interstate Commission shall be entitled to receive
all service of process in any such proceeding, and shall have standing to
intervene in the proceeding for all purposes. Failure to provide service of
process to the Interstate Commission shall render a judgment or order void as
to the Interstate Commission, the Compact, or promulgated rules.

SECTION 17.
ENFORCEMENT OF INTERSTATE COMPACT

(a) The Interstate Commission, in the reasonable exercise of
its discretion, shall enforce the provisions and rules of the Compact.

(b) The Interstate Commission may, by majority vote of the
Commissioners, initiate legal action in the United States District Court
for the District of Columbia, or, at the discretion of the Interstate
Commission, in the federal district where the Interstate Commission has its
principal offices, to enforce compliance with the provisions of the Compact,
and its promulgated rules and bylaws, against a member state in default. The
relief sought may include both injunctive relief and damages. In the event
judicial enforcement is necessary, the prevailing party shall be awarded all
costs of such litigation including reasonable attorney’s fees.

(c) The remedies herein shall not be the exclusive remedies
of the Interstate Commission. The Interstate Commission may avail itself of any
other remedies available under state law or the regulation of a profession.

SECTION 18.
DEFAULT PROCEDURES

(a) The grounds for default include, but are not limited to,
failure of a member state to perform such obligations or responsibilities
imposed upon it by the Compact, or the rules and bylaws of the Interstate
Commission promulgated under the Compact.

(b) If the Interstate Commission determines that a member
state has defaulted in the performance of its obligations or responsibilities
under the Compact, or the bylaws or promulgated rules, the Interstate
Commission shall:

(1) Provide written notice to the defaulting state and other
member states, of the nature of the default, the means of curing the default,
and any action taken by the Interstate Commission. The Interstate Commission
shall specify the conditions by which the defaulting state must cure its
default; and

(2) Provide remedial training and specific technical
assistance regarding the default.

(c) If the defaulting state fails to cure the default, the
defaulting state shall be terminated from the Compact upon an affirmative vote
of a majority of the Commissioners and all rights, privileges, and benefits
conferred by the Compact shall terminate on the effective date of termination.
A cure of the default does not relieve the offending state of obligations or
liabilities incurred during the period of the default.

(d) Termination of membership in the Compact shall be imposed
only after all other means of securing compliance have been exhausted. Notice
of intent to terminate shall be given by the Interstate Commission to the
governor, the majority and minority leaders of the defaulting state’s
legislature, and each of the member states.

(e) The Interstate Commission shall establish rules and
procedures to address licenses and physicians that are materially impacted by
the termination of a member state, or the withdrawal of a member state.

(f) The member state which has been terminated is responsible
for all dues, obligations, and liabilities incurred through the effective date
of termination including obligations, the performance of which extends beyond
the effective date of termination.

(g) The Interstate Commission shall not bear any costs
relating to any state that has been found to be in default or which has been
terminated from the Compact, unless otherwise mutually agreed upon in writing
between the Interstate Commission and the defaulting state.

(h) The defaulting state may appeal the action of the
Interstate Commission by petitioning the United States District Court for the
District of Columbia or the federal district where the Interstate Commission
has its principal offices. The prevailing party shall be awarded all costs of
such litigation including reasonable attorney’s fees.

SECTION 19.
DISPUTE RESOLUTION

(a) The Interstate Commission shall attempt, upon the request
of a member state, to resolve disputes which are subject to the Compact and
which may arise among member states or member boards.

(b) The Interstate Commission shall promulgate rules
providing for both mediation and binding dispute resolution as appropriate.

SECTION 20.
MEMBER STATES, EFFECTIVE DATE AND AMENDMENT

(a) Any state is eligible to become a member state of the
Compact.

(b) The Compact shall become effective and binding upon
legislative enactment of the Compact into law by no less than seven (7) states.
Thereafter, it shall become effective and binding on a state upon enactment of
the Compact into law by that state.

(c) The governors of non-member states, or their designees,
shall be invited to participate in the activities of the Interstate Commission
on a non-voting basis prior to adoption of the Compact by all states.

(d) The Interstate Commission may propose amendments to the
Compact for enactment by the member states. No amendment shall become effective
and binding upon the Interstate Commission and the member states unless and
until it is enacted into law by unanimous consent of the member states.

SECTION 21.
WITHDRAWAL

(a) Once effective, the Compact shall continue in force and
remain binding upon each and every member state; provided that a member state
may withdraw from the Compact by specifically repealing the statute which
enacted the Compact into law.

(b) Withdrawal from the Compact shall be by the enactment of
a statute repealing the same, but shall not take effect until one (1) year
after the effective date of such statute and until written notice of the
withdrawal has been given by the withdrawing state to the governor of each
other member state.

(c) The withdrawing state shall immediately notify the
chairperson of the Interstate Commission in writing upon the introduction of
legislation repealing the Compact in the withdrawing state.

(d) The Interstate Commission shall notify the other member
states of the withdrawing state’s intent to withdraw within sixty (60) days of
its receipt of notice provided under subsection (c).

(e) The withdrawing state is responsible for all dues,
obligations and liabilities incurred through the effective date of withdrawal,
including obligations, the performance of which extend beyond the effective
date of withdrawal.

(f) Reinstatement following withdrawal of a member state
shall occur upon the withdrawing state reenacting the Compact or upon such
later date as determined by the Interstate Commission.

(g) The Interstate Commission is authorized to develop rules
to address the impact of the withdrawal of a member state on licenses granted
in other member states to physicians who designated the withdrawing member
state as the state of principal license.

SECTION 22.
DISSOLUTION

(a) The Compact shall dissolve effective upon the date of the
withdrawal or default of the member state which reduces the membership in the
Compact to one (1) member state.

(b) Upon the dissolution of the Compact, the Compact becomes
null and void and shall be of no further force or effect, and the business and
affairs of the Interstate Commission shall be concluded and surplus funds shall
be distributed in accordance with the bylaws.

SECTION 23.
SEVERABILITY AND CONSTRUCTION

(a) The provisions of the Compact shall be severable, and if
any phrase, clause, sentence, or provision is deemed unenforceable, the
remaining provisions of the Compact shall be enforceable.

(b) The provisions of the Compact shall be liberally
construed to effectuate its purposes.

(c) Nothing in the Compact shall be construed to prohibit the
applicability of other interstate compacts to which the states are members.

SECTION 24.
BINDING EFFECT OF COMPACT AND OTHER LAWS

(a) Nothing herein prevents the enforcement of any other law
of a member state that is not inconsistent with the Compact.

(b) All laws in a member state in conflict with the Compact
are superseded to the extent of the conflict.

(c) All lawful actions of the Interstate Commission,
including all rules and bylaws promulgated by the Commission, are binding upon
the member states.

(d) All agreements between the Interstate Commission and the member
states are binding in accordance with their terms.

(e) In the event any provision of the Compact exceeds the
constitutional limits imposed on the legislature of any member state, such
provision shall be ineffective to the extent of the conflict with the
constitutional provision in question in that member state.

(2) Subsection (1) may be known as the “interstate medical
licensure compact”.

This
act is ordered to take immediate effect.

Clerk of the House of
Representatives

Secretary of the Senate

Approved___________________________________________

____________________________________________________

Governor