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State f/JetUWSsee
PUBLIC CHAPTER NO. 977
SENATE BILL NO. 2544
By Reeves
Substituted for: House Bill No. 2145
By Terry, Harris, Pearson
AN ACT to amend Tennessee Code Annotated, Title 4 and Title 63, relative to respiratory therapy.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 63, Chapter 27, is amended by adding the
following as a new part:
63-27-201. Respiratory care interstate compact.
This state hereby enters into the "Respiratory Care Interstate Compact" ("compact")
as set forth in this part. The text of the compact is set forth in §§ 63-27-202 - 63-27-214.
63-27-202. Section 1 -Title and purpose.
(a) The purpose of this compact is to facilitate the interstate practice of respiratory
therapy with the goal of improving public access to respiratory therapy services by providing
respiratory therapists licensed in a member state the ability to practice in other member
states. The compact preserves the regulatory authority of states to protect public health and
safety through the current system of state licensure.
(b) This compact is designed to achieve the following objectives:
(1) Increase public access to respiratory therapy services by creating a
responsible, streamlined pathway for licensees to practice in member states with the
goal of improving outcomes for patients;
(2) Enhance states' ability to protect the public's health and safety;
(3) Promote the cooperation of member states in regulating the practice of
respiratory therapy within those member states;
(4) Ease administrative burdens on states by encouraging the cooperation of
member states in regulating multi-state respiratory therapy practice;
(5) Support relocating active military members and their spouses; and
(6) Promote mobility and address workforce shortages.
63-27-203. Section 2 - Part definitions.
As used in this compact, unless the context requires otherwise, the following
definitions shall apply:
(1) "Active military member" means any person with a full-time duty status in
the armed forces of the United States, including members of the national guard and
reserve;
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(2) "Adverse action" means any administrative, civil, equitable, or criminal
action permitted by a state's laws which is imposed by any state authority with
regulatory authority over respiratory therapists, such as license denial, censure,
revocation, suspension, probation, monitoring of the licensee, or restriction on the
licensee's practice, not including participation in an alternative program;
(3) "Alternative program" means a non-disciplinary monitoring or practice
remediation process applicable to a respiratory therapist approved by any state
authority with regulatory authority over respiratory therapists. This includes, but is not
limited to, programs to which licensees with substance abuse or addiction issues are
referred in lieu of adverse action;
(4) "Charter member states" means those member states who were the first
seven states to enact the compact into the laws of their state;
(5) "Commission" or "respiratory care interstate compact commission" means
the government instrumentality and body politic whose membership consists of all
member states that have enacted the compact;
(6) "Commissioner" means the individual appointed by a member state to
serve as the member of the commission for that member state;
(7) "Compact" means the respiratory care interstate compact;
(8) "Compact privilege" means the authorization granted by a remote state to
allow a licensee from another member state to practice as a respiratory therapist in
the remote state under the remote state's laws and rules. The practice of respiratory
therapy occurs in the member state where the patient is located at the time of the
patient encounter;
(9) "Criminal background check" means the submission by the member state
of fingerprints or other biometric-based information on license applicants at the time
of initial licensing for the purpose of obtaining that applicant's criminal history record
information, as defined in 28 CFR § 20.3(d) or successor provision, from the federal
bureau of investigation and the state's criminal history record repository, as defined in
28 CFR § 20.3(f) or successor provision;
(10) "Data system" means the comr:nission's repository of information about
licensees as further set forth in § 63-2,7-209;
(11) "Domicile" means the jurisdiction which is the licensee's principal home
for legal purposes;
(12) "Encumbered license" means a license that a state's respiratory therapy
licensing authority has limited in any way;
(13) "Executive committee" means a group of directors elected or appointed to
act on behalf of, and within the powers granted to them by, the commission;
(14) "Home state," except as set forth in § 63-27-206, means the member
state that is the licensee's primary domicile;
(15) "Home state license" means an active license to practice respiratory
therapy in a home state that is not an encumbered license;
(16) "Jurisprudence requirement" means an assessment of an individual's
knowledge of the state laws and regulations governing the practice of respiratory
therapy in such state;
(17) "Licensee" means an individual who currently holds an authorization from
the state to practice as a respiratory therapist;
(18) "Member state" means a state that has enacted the compact and been
admitted to the commission in accordance with the provisions herein and commission
rules;
(19) "Model compact" means _the model for the respiratory Gare interstate
compact on file with the council of state governments or other entity _as designated by
the commission;
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(20) "Remote state" means a member state where a licensee is exercising or
seeking to exercise the compact privilege;
(21) "Respiratory therapist" or "respiratory care practitioner" means an
individual who holds a credential issued by the national board for respiratory care, or
its successor, and holds a license in a state to practice respiratory therapy. For
purposes of this compact, any other title or status adopted by a state to replace the
term "respiratory therapist" or "respiratory care practitioner" shall be deemed
synonymous with "respiratory therapist" and shall confer the same rights and
responsibilities to the licensee under the provisions of this compact at the time of its
enactment;
(22) "Respiratory therapy," "respiratory therapy practice," "respiratory care,"
"the practice of respiratory care," and "the practice of respiratory therapy" means the
care and services provided by or under the direction and supervision of a respiratory
therapist or respiratory care practitioner;
(23) "Respiratory therapy licensing authority" means the agency, board, or
other body of a state that is responsible for licensing and regulation of respiratory
therapists;
(24) "Rule" means a regulation promulgated by an entity that has the force
and. effect of law;
(25) "Scope of practice" means the procedures, actions, and processes a
respiratory therapist licensed in a state or practicing under a compact privilege in a
state is permitted to undertake in that state and the circumstances under which the
respiratory therapist is permitted to undertake those procedures, actions, and
processes. Such procedures, actions, and processes, and the circumstances under
which they may be undertaken may be established through means, including, but not
limited to, statute, regulations, case law, and other processes available to the state
respiratory therapy licensing authority or other government agency;
(26) "Significant investigative information" means information, records, and
documents received or generated by a state respiratory therapy licensing authority
pursuant to an investigation for which a determination has been made that there is
probable cause to believe t~at the licensee has violated a statute or regulation that is
considered more than a minor infraction for which the state respiratory therapy
licensing authority could pursue adverse action against the licensee; and
(27) "State" means any state, com'monwealth, district, or territory of the United
States.
63-27-204. Section 3 - State participation in this compact.
(a) In order to participate in this compact and thereafter continue as a member state,
a member state shall:
(1) Enact a compact that is not materially different from the model compact;
(2) License respiratory therapists;
(3) Participate in the commission's data system;
(4) Have a mechanism in place for receiving and investigating complaints
against licensees and compact privilege holders;
(5) Notify the commission, in compliance with the terms of this compact and
commission rules, of any adverse action against a licensee, a compact privilege
holder, or a license applicant;
(6) Notify the commission, in compliance with the terms of this compact and
corpmission rules, of the exis_tence of significant investigative information;
·(7) Comply with the rules of the commission;
(8) Grant the compact privilege to a holder of an active home state license and
otherwise meet the applicable requirements of§ 63-27-205 in a member state; and
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(9)(A) Complete a criminal background check for each new licensee at the
time of initial licensure; and
(8) Where expressly authorized or permitted by federal law, whether
such federal law is in effect prior to, at, or after the time of a member state's
enactment of this compact, a member state's enactment of this compact shall
hereby authorize the member state's respiratory therapy licensing authority to
perform criminal background checks as defined herein. The absence of such a
federal law as described in this subdivision (a)(9)(8) shall not prevent or
preclude such authorization where it may be derived or granted through
means other than the enactment of this compact.
(b) Nothing in this compact prohibits a member state from charging a fee for granting
and renewing the compact privilege.
63-27-205. Section 4- Compact privilege.
(a) To exercise the compact privilege under the terms and provisions of the compact,
the licensee shall:
(1) Hold and maintain an active home state license as a respiratory therapist;
(2) Hold and maintain an active credential from the national board for
respiratory care, or its successor, that would qualify them for licensure in the remote
state in which they are seeking the privilege;
(3) Have not had any adverse. action against a license within the previous two
(2) years;
(4) Notify the commission that the licensee is seeking the compact privilege
within a remote state(s);
(5) Pay any applicable fees, including any state and commission fees and
renewal fees, for the compact privilege;
(6) Meet any jurisprudence requirements established by the remote state in
which the licensee is seeking a compact privilege;
(7) Report to the commission adverse action taken by any non-member state
within thirty (30) days from the date the adverse action is taken;
(8) Report to the commission, when applying for a compact privilege, the
address of the licensee's domicile and thereafter promptly report to the commission
any change in the address of the licensee's domicile within thirty (30) days of the
effective date of the change in address; and
(9) Consent to accept service of process by mail at the licensee's domicile on
record with the commission with respect to any action brought against the licensee by
the commission or a member state, and consent to accept service of a subpoena by
mail at the licensee's domicile on record with the commission with respect to any
action brought or investigation conducted by the commission or a member state.
(b) The compact privilege is valid until the expiration date or revocation of the home
state license unless terminated pursuant to adverse action. The licensee must comply with
all of the requirements of subsection (a) to maintain the compact privilege in a remote state.
If those requirements are met, no adverse actions ar~ taken, and the licensee has paid any
applicable compact privilege renewal fees, then the licensee will maintain the licensee's
compact privilege.
(c) .A licensee providing respiratory therapy in a remote state under the compact
privilege shall function within the scope of practice authorized by the remote state for the
type of respiratory therapist license the licensee holds. Such procedures, actions, processes,
and the circumstances under which they may be undertaken may be established through
means, including, but not limited to, statute, regulations, case law, and other processes
available to the state respiratory therapy licensing authority or other government agency.
(d) If a licensee's compact privilege in a remote state is removed by the remote state,
the individual shall lose or be ineligible for the compact privilege in that remote state until the
compact privilege is no longer limited or restricted by that state.
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(e) If a home state license is encumbered, the licensee shall lose the compact
privilege in all remote states until the following occur:
(1) The home state license is no longer encumbered; and
(2) Two (2) years have elapsed from the date on which the license is no
longer encumbered due to the adverse action.
(f) Once a licensee with a restricted or limited license meets the requirements of
subdivisions (e)(1) and (2), the licensee must also meet the requirements of subsection (a) to
obtain a compact privilege in a remote state.
63-27-206. Section 5 - Active military member or their spouse.
(a) An active military member, or their spouse, shall designate a home state where
the individual has a current license in good standing. The individual may retain the home
state designation during the period the service member is on active duty.
(b) An active military member and their spouse shall not be required to pay to the
commission for a compact privilege any fee that may otherwise be charged by the
commission. If a remote state chooses to charge a fee for a compact privilege, it may choose
to charge a reduced fee or no fee to an active military member and their spouse for a
compact privilege.
63-27-207. Section 6 - Adverse actions.
(a) A member state in which a licensee is licensed shall have authority to impose
adverse action against the license issued by that member state.
(b) A member state may take adverse action based on significant investigative
information of a remote state or the home state, so long as the member state follows its own
procedures for imposing adverse action.
(c) Nothing in this compact shall override a member state's decision that participation
in an alternative program may be used in lieu of adverse action and that such participation
shall remain non-public if required by the member state's laws.
(d) A remote state shall have the authority to:
(1) Take adverse actions as set forth herein against a licensee's compact
privilege in that state;
(2)(A) Issue subpoenas for both hearings and investigations that require the
attendance and testimony of witnesses, and the production of evidence;
(8) Subpoenas may be issued by a respiratory therapy licensing
authority in a member state for the attendance and testimony of witnesses and
the production of evidence;
(C) Subpoenas issued by a respiratory therapy licensing authority in a
member state for the attendance and testimony of witnesses shall be enforced
in the latter state by any court of competent jurisdiction in the latter state,
according to the practice and procedure of that court applicable to subpoenas
issued in proceedings pending before it;
(D) Subpoenas issued by a respiratory therapy licensing authority in a
member state for production of evidence from another member state shall be
enforced in the latter state, according to the practice and procedure of that
court applicable to subpoenas issued in the proceedings pending before it;
and
(E) The issuing authority shall pay any witness fees, travel expenses,
mileage, and other fees required by the service statutes of the state where the
• witnesses or evidence are located;
(3) Unless otherwise prohibited by· state law, recover from the licensee the
costs of investigations and disposition of cases resulting from any adverse action
taken against that licensee;
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(4) Notwithstanding subdivision (d)(2), a member state may not issue a
subpoena to gather evidence of conduct in another member state that is lawful in
such other member state for the purpose of taking adverse action against a licensee's
compact privilege or application for a compact privilege in that member state; and
(5) Nothing in this compact authorizes a member state to impose discipline
against a respiratory therapist's compact privilege in that member state for the
individual's otherwise lawful practice in another state.
(e) Joint investigations.
(1) In addition to the authority granted to a member state by its respective
respiratory therapy practice act or other applicable state law, a member state may
participate with other member states in joint investigations of licensees; provided,
however, that a member state receiving such a request has no obligation to respond
to any subpoena issued regarding an investigation of conduct or practice that was
lawful in a member state at the time it was undertaken.
(2) Member states shall share any significant investigative information,
litigation, or compliance materials in furtherance of any joint or individual investigation
initiated under the compact. In sharing such information between member state
respiratory therapy licensing authorities, all information obtained shall be kept
confidential, except as otherwise mutually agreed upon by the sharing and receiving
member state(s).
(f) Nothing in this compact may permit a member state to take any adverse action
against a licensee or holder of a compact privilege for conduct or practice· that was legal in
the member state at the time it was undertaken.
(g) Nothing in this compact may permit a member state to take disciplinary action
against a licensee or holder of a compact privilege for conduct or practice that was legal in
the member state at the time it was undertaken.
63-27-208. Section 7 - Establishment of the respiratory care interstate compact
commission.
(a) The compact member states hereby create and establish a joint government
agency whose membership consists of all member states that have enacted the compact
known as the respiratory care interstate compact commission. The commission is an
instrumentality of the compact member states acting jointly and not an instrumentality of any
one (1) state. The commission shall come into existence on or after the effective date of the
compact, as set forth in§ 63-27-212.
(b) Membership, voting, and meetings.
(1) Each member state shall have and be limited to one (1) commissioner
selected by that member state's respiratory therapy licensing authority.
(2) The commissioner shall be an administrator or their designated staff
member of the member state's respiratory therapy licensing authority.
(3) The commission shall by rule or bylaw establish a term of office for
commissioners and may by rule or bylaw establish term limits.
(4) The commission may recommend to a member state the removal or
suspension of any commissioner fro~ office.
(5) A member state's respiratory therapy licensing authority shall fill any
vacancy of its commissioner occurring on the,commission within sixty (60) days of the
vacancy.
(6) Each commissioner shall be entitled to one (1) vote on all matters before
the commission requiring a vote by commissioners.
(7) A commissioner shall vote in person or by such other means as provided
in the bylaws. The bylaws may provide for commissioners to meet by
telecommunication, videoconference, or other means of communication.
(8) The commission shall meet at least once during each calendar year.
Additional meetings may be held as set forth ih 'the bylaws.
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(c) The commission shall have the following powers:
(1) Establish and amend the fiscal year of the commission;
(2) Establish and amend bylaws and policies, including, but not limited to, a
code of conduct and conflict of interest;
(3) Establish and amend rules, which shall be binding in all member states;
(4) Maintain its financial records in accordance with the bylaws;
(5) Meet and take such actions as are consistent with the provisions of this
compact, the commission's rules, and the bylaws;
(6) Initiate and conduct legal proceedings or actions in the name of the
commission; provided, that the standing of any respiratory therapy licensing authority
to sue or be sued under applicable law shall not be affected;
(7) Maintain and certify records and information provided to a member state
as the authenticated business records of the commission, and designate an agent to
do so on the commission's behalf;
(8) Purchase and maintain insurance and bonds;
(9) Accept or contract for services of personnel, including, but not limited to,
employees of a member state;
(10) Conduct an annual financial review;
(11) Hire employees, elect or appoint officers, fix compensation, define duties,
grant such individuals appropriate authority to carry out the purposes of the compact,
and establish the commission's personnel policies and programs relating to conflicts
of interest, qualifications of personnel, and other related personnel matters;
(12) Assess and collect fees;
(13) Accept any and all appropriate gifts, donations, grants of money, other
sources of revenue, equipment, supplies, materials, and services, and receive, utilize,
and dispose of the same; provided, that at all times:
(A) The commission shall avoid any appearance of impropriety; and
(8) The commission shall avoid any appearance of conflict of interest;
(14) Lease, purchase, retain, own, hold, improve, or use any property, real,
personal, or mixed, or any undivided interest therein;
(15) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise
dispose of any property real, personal, or mixed;
(16) Establish a budget and make expenditures;
(17) Borrow money in a fiscally responsible manner;
(18) Appoint committees, including standing committees, composed of
commissioners, state regulators, state legislators or their representatives, and
consumer representatives, a·nd such other interested persons as may be designated
in this compact and the byla_~s;
(19) Provide and receive information from, and cooperate with, law
enforcement agencies;
(20) Establish and elect an executive committee, including a chair, vice chair,
secretary, treasurer, and such other offices as the commission shall establish by rule
or bylaw;
(21) Enter into contracts or arrangements for the management of the affairs of
the commission;
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(22) Determine whether a state's adopted language is materially different from
the model compact language such that the state would not qualify for participation in
the compact; and
(23) Perform such other functions as may be necessary or appropriate to
achieve the purposes of this compact.
(d) The executive committee.
(1) The executive committee shall have the power to act on behalf of the
commission according to the terms of this compact. The powers, duties, and
responsibilities of the executive committee shall include:
(A) Overseeing the day-to-day activities of the administration of the
compact, including enforcement and compliance with the provisions of the
compact, its rules and bylaws, and other such duties as deemed necessary;
(8) Recommending to the commission changes to the rules or bylaws,
changes to this compact legislation, fees charged to compact member states,
fees charged to licensees, and other fees;
(C) Ensuring compact administration services are appropriately
provided, including by contract;
(D) Preparing and recommending the budget;
(E) Maintaining financial records on behalf of the commission;
(F) Monitoring compact compliance of member states and providing
compliance reports to the commission;
(G) Establishing additional committees as necessary;
(H) Exercising the powers and duties of the commission during the
interim between commission meetings, except for adopting or amending rules,
adopting or amending bylaws, and exercising any other powers and duties
expressly reserved to the commission by rule or bylaw; and •
(I) Performing other duties as provided in the rules or bylaws of the
commission.
(2) The executive committee shall be composed of up to nine (9) members, as
further set forth in the bylaws of the commission:
(A) Seven (7) voting members who are elected by the commission
from the current membership of the commission; and •
(8) Two (2) ex officio, non-voting members.
(3) The commission may remove any member of the executive committee as
provided in the commission's bylaws.
(4) The executive committee shall meet at least annually_.
(A) Executive committee meetings shall be open to the public, except
that the executive committee may meet in a closed, non-public meeting as
provided in subdivision (f)(4);
(8) The executive committee shall give advance notice of its meetings
posted on its website and as determined to provide notice to persons with an
interest in the business of the commission; and
(C) The executive committee may hold a special meeting in
accordance with subdivision (f)(2).
(e) The commission shall adopt and provide to the member states an annual report.
(f) Meetings of the commission.
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(1) All meetings of the commission that are not closed pursuant to subdivision
(f)(4) shall be open to the public. Notice of public meetings shall be posted on the
commission's website at least thirty (30) days prior to the public meeting.
(2) Notwithstanding subdivision (f)(1 ), the commission may convene an
emergency public meeting by providing at least twenty-four (24) hours prior notice on
the commission's website, and any other means as provided in the commission's
rules, for any of the reasons it may dispense with notice of proposed rulemaking
under§ 63-27-210(9). The commission's legal counsel shall certify that one (1) of the
reasons justifying an emergency public meeting has been met.
(3) Notice of all commission meetings shall provide the time, date, and
location of the meeting, and if the meeting is to be held or accessible via
telecommunication, videoconference, or other electronic means, the notice shall
include the mechanism for access to the meeting.
(4) The commission or the executive committee may convene in a closed,
non-public meeting for the commission or executive committee to receive or solicit
legal advice or to discuss:
(A) Non-compliance of a member state with its obligations under the
compact;
(B) The employment, compensation, discipline, or other matters,
practices, or procedures related to specific employees;
(C) Current or threatened discipline of a licensee or compact privilege
holder by the commission or by a member state's respiratory therapy licensing
authority;
(D) Current, threatened, or reasonably anticipated litigation;
(E) Negotiation of contracts for the purchase, lease1 or sale of goods,
services, or real estate;
(F) Accusing any person of a .crime or formally censuring any person;
(G) Trade secrets or commercial or financial 'information that is
privileged or confidential;
(H) Information of a personal nature where disclosure would constitute
a clearly unwarranted invasion :of personal privacy;
(I) Investigative records compiled for law enforcement purposes;
(J) Information related to any investigative reports prepared by or on
behalf of or for use of the commission or other committee charged with
responsibility of investigation or determination of compliance issues pursuant
to the compact;
(K) Legal advice;
(L) Matters specifically exempted from disclosure· by • federal or
member state law; or
(M) Other matters as promulgated by the commission by rule..
.
(5) If a meeting, or portion of a meeting, is closed, the presiding officer shall
state that the meeting will be closed and reference each relevant exempting
provision, and such reference shall be recorded in the minutes.
(6) The commission shall keep minutes in accordance with commission rules
and bylaws. All documents considered in connection with an action shall be identified
in such minutes. All minutes and documents of a closed meeting shall remain under
seal, subject to release only by a majority vote of the commission or order of a court
of competent jurisdiction.
(g) Financing of the commission.
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(1) The commission shall pay, or provide for the payment of, the reasonable
expenses of its establishment, organization, and ongoing activities.
(2) The commission may accept any and all appropriate revenue sources as
provided herein.
(3) The commission may levy on and collect an annual assessment from each
member state and impose fees on licensees of member states to whom it grants a
compact privilege to cover the cost of the operations and activities of the commission
and its staff. The aggregate annual assessment amount for member states, if any,
shall be allocated based upon a formula that the commission shall promulgate by
rule.
(4) The commission shall not incur obligations of any kind prior to securing the
funds or a loan adequate to meet the same; nor shall the commission pledge the
credit of any of the member states, except by and with the authority of the member
state.
(5) The commission shall keep accurate accounts of all receipts and
disbursements. The receipts and disbursements of the commission shall be subject to
the financial review and accounting procedures established under its bylaws.
However, all receipts and disbursements of funds handled by the commission shall
be· subject to an annual. financial review by a certified or licensed public accountant,
and the report of the financial review shall be included in and become part of the
annual report of the commission.
(h) Qualified immunity, defense, and indemnification.
(1) Nothing herein shall be construed as a limitation on the liability of any
licensee for professional malpractice or misconduct, which shall be governed solely
by any other applicable state laws.
(2) The member states, commissioners, officers, executive directors,
employees, and agents of the commission shall be immune from suit and liability,
both personally and in their official capacity, for any claim for damage to or loss of
property or personal injury or other civil liability caused by or arising out of any actual
or alleged act, error, or omission that occurred, or that the person against whom the
claim is made had a reasonable basis for believing occurred within the scope of
commission employment, duties, or ,responsibilities; provided, that nothing in this
subdivision (h)(2) shall be construed to protect any such person from suit or liability
for any damage, loss, injury, or liability caused by the intentional or willful or wanton
misconduct of that person. The procurement of insurance . of any type by the
commission shall not in any way compromise or limit the immunity granted hereunder.
(3) The commission shall defend any commissioner, officer, executive
director, employee, and agent of the com.mission in any civil action seeking to impose
liability arising out of any actual or alleged act, error, or omission that occurred within
the scope of commission employment, duties, or responsibilities, or as determined by
the commission that the person against whom the claim is made had a reasonable
basis for believing occurred within the scope of commission employment, duties, or
responsibilities; provided, that nothing herein shall be construed to prohibit that
person from retaining their own counsel at their own expense; and provided further,
that the actual or alleged act, error, or omission did not result from that person's
intentional or willful or wanton misconduct.
(4) The commission shall indemnify and hold harmless any commissioner,
member, •officer, executive director, employee, a.nd agent of the. commission for the
amount of any settlement or judgment obtained against that person arising out of any
actual or alleged act, error, or omission that occurred within the scope of commission
employment, duties, or responsibilities, or that such person had a reasonable basis
for believing occurred within the scope of commission employment, duties, or
resp<:>nsibilities; provided, that the actual or alleged act, error, or omission did not
result from the intentional or willful or wanton misconduct of that person.
.(5) Nothing in this compact s~all be int~rpreted to waive or otherwise abrogate
~ .member state's state action immunity or state action affirmative defense with
respect to antitrust claims under the Sherman Act (15 U.S.C. § 1 et seq.), Clayton Act
(15 U.S.C. § 12 et seq.), or any other state or .federal antitrust or anticompetitive law
or reg'-'l~tion ....
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(6) Nothing in this compact shall be construed to be a waiver of sovereign
immunity by the member states or by the commission.
63-27-209. Section 8 - Data system.
(a) The commission shall provide for the development, maintenance, operation, and
utilization of a coordinated database and reporting system containing licensure, adverse
action, and the presence of significant investigative information.
(b) Notwithstanding any other provision of state law to the contrary, a member state
shall submit a uniform data set to the data system as required by the rules of the
commission, including, but not limited to:
(1) Identifying information;
(2) Licensure data;
(3) Adverse actions against a licensee, license applicant, or compact privilege
holder and information related thereto;
(4) Non-confidential information related to alternative program participation,
the beginning and ending dates of such participation, and other information related to
such participation not made confidential under member state law;
(5) Any denial of application for licensure, and the reason(s) for such denial;
(6) The presence of current significant investigative information; and
(7) Other information that may facilitate the administration of this compact or
the protection of the public, as determined by the rules of the commission.
(c) No member state shall submit any information which constitutes criminal history
record information, as defined by applicable federal law, to the data system established
hereunder.
(d) The records and information provided to a member state pursuant to this compact
or through the data system, when certified by the commission or an agent thereof, shall
constitute the authenticated business records of the commission, and shall be entitled to any
associated hearsay exception in any relevant judicial, quasi-judicial, or administrative
proceedings in a member state.
(e) Significant investigative information pertaining to a licensee in any member state
will only be available to other member states.
(f) It is the responsibility of the member states to report any adverse action against a
licensee and to monitor the database to determine Whether adverse action has been taken
against a licensee. Adverse action information pertaining to a licensee in any member state
will be available to any other member state.
(g) Member states contributing information to the data system may designate
information that may not be shared with the public without the express permission of the
contributing state.
(h) Any information submitted to the data system :that is subsequently expunged
pursuant to federal law or the laws of the member state contributing the information shall be
removed from the data system.
63-27-210. Section 9 - Rulemaking.
(a) The commission shall promulgate re~sonable rules in order to effectively and
efficiently implement and administer the purposes· and provisions of the compact. A rule shall
be invalid and have no force or effect only if a court of competent jurisdiction holds that the
rule is invalid because the commission exercised its rulemaking authority in a manner that is
beyond the scope and purposes of the compact, or the powers granted hereunder, or based
upon another applicable standard of review.
(b) For purposes of the compact, the .rules of the commission shall have the force of
law in each member state.
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(c) The commission shall exercise its rulemaking powers pursuant to the criteria set
forth in this section and the rules adopted thereunder. Rules shall become binding as of the
date specified in each rule.
(d) If a majority of the legislatures of the member states rejects a rule or portion of a
rule, by enactment of a statute or resolution in the same manner used to adopt the compact
within four (4) years of the date of adoption of the rule, then such rule shall have no further
force and effect in any member state.
(e) Rules shall be adopted at a regular or special meeting of the commission.
(f) Prior to adoption of a proposed rule, the commission shall hold a public hearing
and allow persons to provide oral and written comments, data, facts, opinions, and
arguments. •
(g) Prior to adoption of a proposed rule by the commission, and at least thirty (30)
days in advance of the meeting at which the commission will hold a public hearing on the
proposed rule, the commission shall provide a notice of proposed rulemaking:
(1) On the website of the commission or other publicly accessible platform;
(2) To persons who have requested notice of the commission's notices of
proposed rulemaking; and
(3) In such other way(s) as the commission may by rule specify.
(h) The notice of proposed rulemaking shall include:
(1) The time, date, and location of the public hearing at which the commission
will hear public comments on the proposed rule and, if different, the time, date, and
location of the meeting where the commission will consider and vote on the proposed
rule;
(2) If the hearing is held via telecommunication, videoconference, or other
electronic means, the commission shall include the mechanism for access to the
hearing in the notice of proposed rulemaking;
(3) The text of the proposed rule and the reason therefor;
(4) A request for comments on the proposed rule from any interested person;
and
(5) The manner in which interested persons may submit written comments.
(i) All hearings will be recorded. A copy of the recording and all written comments and
documents received by the commission in response to the proposed rule shall be available to
the public.
U) Nothing in this section shall be construed as requiring a separate hearing on each
rule. Rules may be grouped for the convenience of the commission at hearings required by
this section.
(k)(1) The commission shall, by majority vote of all commissioners, take final action
on the proposed rule based on the rulemakirig record and the full text of the rule.
(2) The commission may adopt changes to the proposed rule; provided, the
changes are consistent with the original purpose of the proposed rule.
(3) The commission shall provide an explanation of the reasons for
substantive changes made to the proposed rule as well as reasons for substantive
changes not made that were recommended by commenters.
a (4) The commission shall determine reasonable effective date for the rule.
Except for an emergency as provided in subsection (I), the effective date of the rule
shall be no sooner than thirty (30) days after ·issuing the notice that it adopted or
amended the rule.
(I) Upon determination that an emergency exists, the commission may consider and
adopt an emergency rule with twenty-four (24) hours' notice, and with opportunity to
comment; provided, that the usual rulemaking procedures provided in the compact and. in
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this section shall be retroactively applied to the rule as soon as reasonably possible, in no
event no later than ninety (90) days after the effective date of the rule. For the purposes of
this provision, an emergency rule is one that must be adopted immediately in order to:
(1) Meet an imminent threat to public health, safety, or welfare;
(2) Prevent a loss of commission or member state funds;
(3) Meet a deadline for the promulgation of a rule that is established by federal
law or rule; or
(4) Protect public health and safety.
(m) The commission or an authorized committee of the commIssIon may direct
revisions to a previously adopted rule for purposes of correcting typographical errors, errors
in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be
posted on the website of the commission. The revision shall be subject to challenge by any
person for a period of thirty (30) days after posting. The revision may be challenged only on
grounds that the revision results in a material change to a rule. A challenge shall be made in
writing and delivered to the commission prior to the end of the notice period. If no challenge
is made, the revision will take effect without further action. If the revision is challenged, the
revision may not take effect without the approval of the commission.
(n)(1) No member state's rulemaking process or procedural requirements shall apply
to the commission.
(2) The commission shall have no authority over any member state's
rulemaking process or procedural requirements that do not pertain to the compact.
(o) Nothing in this compact, nor any rule or regulation of the commission, shall be
construed to limit, restrict, or in any way reduce the ability of a member state to enact and
enforce laws, regulations, or other rules related to the practice of respiratory therapy in that
state, where those laws, regulations, or other rules are not inconsistent with the provisions of
this compact.
63-27-211. Section 10 - Oversight, dispute resolution, and enforcement.
(a) Oversight.
(1) The executive and judicial branches of state government in each member
state shall enforce this compact and take all actions necessary and appropriate to
implement the compact.
(2) Venue is proper and judicial proceedings by or against the commission
shall be brought solely and exclusively in a court of competent jurisdiction where the
principal office of the commission is located. The commission may waive venue and
jurisdictional defenses to the extent it adopts or consents to participate in alternative
dispute resolution proceedings. Nothing herein shall affect or limit the selection or
propriety of venue in any action against a licensee for professional malpractice,
. misconduct, or any such similar matter.
(3) The commission shall be entitled to receive service of process in any
proceeding regarding the enforcement or interpretation of the compact and shall have
standing to intervene in such a proceeding for all purposes. Failure to provide the
commission service of process shall render a judgment or order void as to the
commission, t~is compact, or promulgated rules.
(b) Default, technical assistance, and termination.
(1) If the commission determines that a member state has defaulted in the
performance of its obligations or responsibilities under this compact or the
promulgated rules, the commission shall provide written notice to the defaulting state.
The notice of default shall describe the default, the proposed means of curing the
default, and any other action that the commission may take and shall offer training
and specific technical as~istance regarding the default.
(2) The commission shall provide a copy of the notice of default to the other
me·mber states.
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(c) If a state in default fails to cure the default, the defaulting state may be terminated
from the compact upon an affirmative vote of a majority of the commissioners of the member
states, and all rights, privileges, and benefits conferred on that state by this compact may be
terminated 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 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 suspend or
terminate shall be given by the commission to the governor, the majority and minority leaders
of the defaulting state's legislature, the defaulting state's respiratory therapy licensing
authority, and each of the member states' respiratory therapy licensing authorities.
(e) A state that has been terminated is responsible for all assessments, obligations,
and liabilities incurred through the effective date of termination, including obligations that
extend beyond the effective date of termination, if necessary.
(f) Upon the termination of a state's membership from this compact, that state shall
immediately provide notice to all licensees and compact privilege holders, of which the
commission has a record, within that state of such termination. The terminated state shall
continue to recognize all licenses granted pursuant to this compact for a minimum of one
hundred eighty (180) days after the date of said notice of termination.
(g) The commission shall not bear any costs related to a state that is found to be in
default or that has been terminated from the compact, unless agreed upon in writing between
the commission and the defaulting state.
(h) The defaulting state may appeal the action of the commission by petitioning the
U.S. District Court for the District of Columbia or the federal district where the commission
has its principal offices. The prevailing party shall be awarded all costs of such litigation,
including reasonable attorney's fees.
(i) Dispute resolution.
(1) Upon request by a member state, the commission shall attempt to resolve
disputes related to the compact that arise among member states and between
member and non-member states.
(2) The commission shall promulgate a rule providing for both mediation and
binding dispute resolution for disputes, as appropriate.
(j) Enforcement.
(1) By majority vote, as may be further provided by rule, the commission may
initiate legal action against a member state in default in the United States District
Court for the District of Columbia. or the federal district where the commission has its
principal offices to enforce compliance wi\h the provisions of the compact and its
promulgated rules. A member state by enactment of this compact consents to venue
and jurisdiction in such court for the purposes set forth herein. 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. The remedies herein shall not be the exclusive remedies
of the. c.ommission. The commission may pursue any other remedies avajlable under
federal or the defaulting member state's law. •
(2) A member state may initiate legal action against the commission in the
_U.S. District Court tor the District of Columbia or the federal district where the
commission has its principal offices to enforce compliance with the provisions of the
compact and its promulgated rules. 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.
(3) No person other than a member· state shall enforce this compact against
_the commission. -
63-27-212. •Section 11 - Effective date, withdrawal, and amendment.
(a)(1) The compact shall come into effect on the date on which the compact statute is
enacted into law in the seventh member state ("effective date").
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(2)(A) On or after the effective date of the compact, the commission shall
convene and review the enactment of each of the first seven (7) member
states ("charter member states") to determine if the statute enacted by each
such charter member state is materially different than the model compact.
(B) A charter member state whose enactment is found to be materially
different from the model compact shall be entitled to the default process set
forth in § 63-27-211.
(C) If any member state is later found to be in default, or is terminated
or withdraws from the compact, the commission shall remain in existence and
the compact shall remain in effect even if the number of member states should
be less than seven (7).
(3) Member states enacting the compact subsequent to the seven (7) initial
charter member states shall be subject to the process set forth herein and in
commission rule to determine if their enactments are materially different from the
model compact and whether they qualify for participation in the compact.
(4) All actions taken for the benefit of the commission or in furtherance of the
purposes of the administration of the compact prior to the effective date of the
compact or the commission coming into existence shall be considered to be actions
of the commission unless specifically repudiated by the commission. The commission
shall own and have all rights to any intellectual property developed on behalf or in
furtherance of the commission by individuals or entities involved in organizing or
establishing the commission, as may be further set forth in rules of the commission.
(5) Any state that joins the compact subsequent to the commission's initial
adoption of the rules and bylaws shall be subject to the rules and bylaws as they exist
on the date on which the compact becomes law in that state. Any rule that has been
previously adopted by the commission shall have the full force and effect of law on
the date the compact becomes law in that state.
(b)(1) Any member state may withdraw from this compact by enacting a statute
repealing the same.
(2) A member state's withdrawal shall not take effect until one hundred eighty
(180) days after enactment of the repealing statute.
(3) Withdrawal shall not affect the continuing requirement of the withdrawing
state's respiratory therapy licensing authority to comply with the investigative and
adverse action reporting requirements of this compact prior to the effective date of
withdrawal. •
(4) Upon the enactment of a statute withdrc1wing from this compact, a state
shall immediately provide notice of such withdrawal to. all licensees and compact
privilege holders, of which the commission has a record, within that state.
Notwithstanding any subsequent statutory enactment to the contrary, such
withdrawing state shall continue to recognize all licenses granted pursuant to this
compact for a minimum of one hundred eighty (180) days after the date of such
notice of withdrawal.
(c) Nothing contained in this compact shall be construed to invalidate or prevent any
licensure agreement or other cooperative arrangement between a member state and a non-
member state that does not conflict with the provisions of this compact.
(d) This compact may be amended by the member states. No amendment to this
compact shall become effective and binding upon any member state until it is enacted into
the laws of all member states. •
63-27-213._ Section 12 - Construction and severability.
(a) This compact and the commission's rulemaking authority shall be liberally
construed so as to effectuate the purposes and the implementation and administration of the
compact. Provisions of the compact· expressly authorizing or requiring the promulgation of
rules shall not be construed to limit the commission's rulemaking authority solely for those
purposes.
(b) The provisions of this compact shall be severable, and if any phrase, clause,
sentence, or provision of .this compact is held by a court of competent jurisdiction to be
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contrary to the constitution of any member state, a state seeking participation in the compact,
or of the United States, or the applicability thereof to any government, agency, person, or
circumstance is held to be unconstitutional by a court of competent jurisdiction, the validity of
the remainder of this compact and the applicability thereof to any other government, agency,
person, or circumstance shall not be affected thereby.
(c) Notwithstanding subsection (b), the commission may deny a state's participation in
the compact or, in accordance with the requirements of § 63-27-211, terminate a member
state's participation in the compact if it determines that a constitutional requirement of a
member state is a material departure from the compact. Otherwise, if this compact shall be
held to be contrary to the constitution of any member state, the compact shall remain in full
force and effect as to the remaining member states and in full force and effect as to the
member state affected as to all severable matters.
63-27-214. Section 13 - Consistent effect and conflict with other state laws.
(a) Nothing herein shall prevent or inhibit the enforcement of any other law of a
member state that is not inconsistent with the compact.
(b) Any laws, statutes, regulations, or other legal requirements in a member state in
conflict with the compact are superseded to the extent of the conflict, including any
subsequently enacted state laws.
(c) All permissible agreements between the commission and the member states are
binding in accordance with their terms.
(d) Other than as expressly set forth herein, nothing in this compact will impact initial
licensure.
63-27-215. Rulemaking.
The board of respiratory care, in consultation with the department of health, may
promulgate rules in accordance with the Uniform Administrative Procedures Act, compiled in
title 4, chapter 5, to implement this part.
63-27-216. Effective date of compact - Notice.
(a) This part takes effect on the date the compact is enacted into law in the seventh
compact state.
(b) The board of respiratory care shall notify the chair of the government operations
committee of the senate, the chair of any committee in the house of representatives with
subject matter jurisdiction over compacts dealing with respiratory therapy, and the executive
secretary of the Tennessee code commission in writing when the condition specified in§ 63-
27-212 has occurred for the compact, a withdrawal, or an amendment to become effective.
SECTION 2. Tennessee Code Annotated, Section 4-29-249(a), is amended by adding the
following· as a new subdivision:
( ) Respiratory care interstate compact, created by § 63-27-202;
SECTION 3. Tennessee Code Annotated, Section 63-27-101, is amended by deleting
"chapter11 and _substituting "part".
SECTION 4. Tennessee Code Annotated, Section 63-27-102, is amended by deleting "As
used in this chapter" and substituting "As used in this part". •
SECTION 5. Tennessee Code Annotated, Section 63-31-106(a)(2), is amended by deleting
"chapter 27 of this title" and substituting "chapter 27, part 1 of this title".
SECTION 6. The headings in this act are for reference purposes only and do not constitute a
part of the law er)acted by this act. However, the Tennessee code commission is requested to
include the headings in any co.mpilation or publication containing this act.
SECTION 7. This act takes effect upon becoming a law, the public welfare requiring it.
16 ·
SENATE BILL NO. 2544
PASSED: April 20, 2026
"C d:'-' ""-._~c.,.\\~
\. RANDY McNA\LY
SPEAKER OF THE SENATE
CAMERON~TON,SPEAKER
HOUSE OF REPRESENTATIVES
APPROVED this I ~day of ~ 2026
~ UA! -
BILL LEE, GOVERNOREvery fact on this page links to its source, starting with the official bill record.