Respiratory Care Interstate Compact

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A bill to be entitled 1
An act relating to the Respiratory Care Interstate 2
Compact; creating s. 468.371, F.S.; enacting the 3
Respiratory Care Interstate Compact; providing purpose 4
and intent; providing definitions; requiring member 5
states to meet certain requirements to join and 6
participate in the compact; providing criteria that a 7
respiratory therapist licensee must satisfy to 8
practice under the compact; providing requirements for 9
renewal of an equivalent license in a member state; 10
providing requirements and procedures for changing a 11
home state license designation; authorizing an active 12
military member and his or her spouse to be deemed as 13
having a home state license under certain 14
circumstances; authorizing member states to impose 15
adverse actions against licensees under certain 16
circumstances; authorizing member states to 17
participate with other member states in joint 18
investigations of licensees under certain 19
circumstances; providing applicability; establishing 20
the Respiratory Care Interstate Compact Commission; 21
providing commission membership, duties, and powers; 22
providing for powers, duties, and responsibilities of 23
an executive committee; requiring the committee to 24
adopt and provide an annual report to member states; 25

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authorizing the commission to convene in closed, 26
nonpublic meetings under certain circumstances; 27
providing for financing of the commission; providing 28
immunity from liability for member states under 29
certain circumstances; providing for the development, 30
maintenance, and use of a coordinated database and 31
reporting system; requiring member states to submit 32
specified information to the data system; providing 33
requirements for the information in the data system; 34
providing rulemaking procedures; providing for state 35
enforcement of the compact; providing for the 36
termination of compact membership; providing 37
procedures for the resolution of certain disputes; 38
providing compact amendment procedures; providing 39
construction and severability and binding effect of 40
the compact; amending ss. 456.076, 468.353, 468.355, 41
468.361, and 768.28, F.S.; conforming provisions to 42
changes made by the act; providing an effective date. 43
44
Be It Enacted by the Legislature of the state of Florida: 45
46
Section 1. Section 468.371, Florida Statutes, is created 47
to read: 48
468.371 Respiratory Care Interstate Compact.—The 49
Respiratory Care Interstate Compact is hereby enacted into law 50

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and entered into by this state with all other states legally 51
joining therein in the form substantially as follows: 52
53
RESPIRATORY CARE INTERSTATE COMPACT 54
55
ARTICLE I 56
PURPOSE AND INTENT 57
58
(1) The purpose of this compact is to facilitate the 59
interstate practice of respiratory therapy with the goal of 60
improving public access to respiratory therapy services by 61
providing respiratory therapists licensed in a member state the 62
ability to practice in other member states. The compact 63
preserves the regulatory authority of states to protect public 64
health and safety through the current system of state licensure. 65
(2) This compact is designed to achieve all of the 66
following objectives: 67
(a) Increase public access to respiratory therapy services 68
by creating a responsible, streamlined pathway for licensees to 69
practice in member states with the goal of improving outcomes 70
for patients. 71
(b) Enhance states' ability to protect the public's health 72
and safety. 73
(c) Promote the cooperation of member states in regulating 74
the practice of respiratory therapy within such member states. 75

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(d) Ease administrative burdens on states by encouraging 76
the cooperation of member states in regulating multistate 77
respiratory therapy practice. 78
(e) Support relocating active military members and their 79
spouses. 80
(f) Promote mobility and address workforce shortages. 81
82
ARTICLE II 83
DEFINITIONS 84
85
As used in this compact, the term: 86
(1) "Active military member" means any person with a full-87
time duty status in the Armed Forces of the United States, 88
including members of the National Guard and the United States 89
Reserve Forces. 90
(2) "Adverse action" means any administrative, civil, 91
equitable, or criminal action permitted by a state's laws which 92
is imposed by any state authority with regulatory authority over 93
respiratory therapists, such as license denial, censure, 94
revocation, suspension, probation, monitoring of the licensee, 95
or restriction on the licensee's practice, not including 96
participation in an alternative program. 97
(3) "Alternative program" means a nondisciplinary 98
monitoring or practice remediation process applicable to a 99
respiratory therapist approved by any state authority with 100

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regulatory authority over respiratory therapists. This includes, 101
but is not limited to, programs to which licensees with 102
substance abuse or addiction issues are referred in lieu of 103
adverse action. 104
(4) "Charter member states" means those member states who 105
were the first seven states to enact the compact into law. 106
(5) "Commission" or "Respiratory Care Interstate Compact 107
Commission" means the government instrumentality and body 108
politic whose membership consists of all member states that have 109
enacted the compact. 110
(6) "Commissioner" means the individual appointed by a 111
member state to serve as the member of the commission for that 112
member state. 113
(7) "Compact" means the Respiratory Care Interstate 114
Compact. 115
(8) "Compact privilege" means the authorization granted by 116
a remote state to allow a licensee from another member state to 117
practice as a respiratory therapist in the remote state under 118
the remote state's laws and rules. The practice of respiratory 119
therapy occurs in the member state where the patient is located 120
at the time of the patient encounter. 121
(9) "Criminal background check" means the submission by 122
the member state of fingerprints or other biometric-based 123
information on license applicants at the time of initial 124
licensing for the purpose of obtaining that applicant's criminal 125

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history record information, as defined in 28 C.F.R. s. 20.3(d) 126
or successor provision, from the Federal Bureau of Investigation 127
and the state's criminal history record repository, as defined 128
in 28 C.F.R. s. 20.3(f) or successor provision. 129
(10) "Data system" means the commission's repository of 130
information about licensees as further set forth in Article 131
VIII. 132
(11) "Domicile" means the jurisdiction which is the 133
licensee's principal home for legal purposes. 134
(12) "Encumbered license" means a license that a state's 135
respiratory therapy licensing authority has limited in any way. 136
(13) "Executive committee" means a group of directors 137
elected or appointed to act on behalf of, and within the powers 138
granted to them by, the commission. 139
(14) "Home state," except as provided in Article V, means 140
the member state that is the licensee's primary domicile. 141
(15) "Home state license" means an active license to 142
practice respiratory therapy in a home state that is not an 143
encumbered license. 144
(16) "Jurisprudence requirement" means an assessment of an 145
individual's knowledge of the state laws and regulations 146
governing the practice of respiratory therapy in such state. 147
(17) "Licensee" means an individual who currently holds an 148
authorization from the state to practice as a respiratory 149
therapist. 150

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(18) "Member state" means a state that has enacted the 151
compact and been admitted to the commission in accordance with 152
this compact and commission rules. 153
(19) "Model compact" means the model for the Respiratory 154
Care Interstate Compact on file with the Council of State 155
Governments or other entity as designated by the commission. 156
(20) "Remote state" means a member state where a licensee 157
is exercising or seeking to exercise the compact privilege. 158
(21) "Respiratory therapist" or "respiratory care 159
practitioner" means an individual who holds a credential issued 160
by the National Board for Respiratory Care or its successor and 161
holds a license in a state to practice respiratory therapy. For 162
purposes of this compact, any other title or status adopted by a 163
state to replace the term "respiratory therapist" or 164
"respiratory care practitioner" is synonymous with "respiratory 165
therapist" and shall confer the same rights and responsibilities 166
to the licensee under the provisions of this compact at the time 167
of its enactment. 168
(22) "Respiratory therapy," "respiratory therapy 169
practice," "respiratory care," "the practice of respiratory 170
therapy," and "the practice of respiratory care" mean the care 171
and services provided by or under the direction and supervision 172
of a respiratory therapist or respiratory care practitioner. 173
(23) "Respiratory therapy licensing authority" means the 174
agency, board, or other body of a state that is responsible for 175

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licensing and regulation of respiratory therapists. 176
(24) "Rule" means a regulation adopted by an entity that 177
has the force and effect of law. 178
(25) "Scope of practice" means the procedures, actions, 179
and processes a respiratory therapist licensed in a state or 180
practicing under a compact privilege in a state is permitted to 181
undertake in that state and the circumstances under which the 182
respiratory therapist is permitted to undertake those 183
procedures, actions, and processes. Such procedures, actions, 184
and processes, and the circumstances under which they may be 185
undertaken, may be established through means including, but not 186
limited to, statute, regulations, case law, and other processes 187
available to the state respiratory therapy licensing authority 188
or other government agency. 189
(26) "Significant investigative information" means 190
information, records, and documents received or generated by a 191
state respiratory therapy licensing authority pursuant to an 192
investigation for which a determination has been made that there 193
is probable cause to believe that the licensee has violated a 194
statute or regulation that is considered more than a minor 195
infraction for which the state respiratory therapy licensing 196
authority could pursue adverse action against the licensee. 197
(27) "State" means any state, commonwealth, district, or 198
territory of the United States. 199
200

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ARTICLE III 201
STATE PARTICIPATION IN THIS COMPACT 202
203
(1) In order to participate in this compact and thereafter 204
continue as a member state, a member state shall: 205
(a) Enact a compact that is not materially different from 206
the model compact. 207
(b) License respiratory therapists. 208
(c) Participate in the data system. 209
(d) Have a mechanism in place for receiving and 210
investigating complaints against licensees and compact privilege 211
holders. 212
(e) Notify the commission, in compliance with the terms of 213
this compact and commission rules, of any adverse action against 214
a licensee, a compact privilege holder, or a license applicant. 215
(f) Notify the commission, in compliance with the terms of 216
this compact and commission rules, of the existence of 217
significant investigative information. 218
(g) Comply with the rules of the commission. 219
(h) Grant the compact privilege to a holder of an active 220
home state license and otherwise meet the applicable 221
requirements of Article IV in a member state. 222
(i) Complete a criminal background check for each new 223
licensee at the time of initial licensure. Where expressly 224
authorized or permitted by federal law, whether such federal law 225

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is in effect before, at, or after the time of a member state's 226
enactment of this compact, a member state's enactment of this 227
compact authorizes the member state's respiratory therapy 228
licensing authority to perform criminal background checks as 229
defined herein. The absence of such a federal law as described 230
in this paragraph does not prevent or preclude such 231
authorization where it may be derived or granted through means 232
other than the enactment of this compact. 233
(2) This compact does not prohibit a member state from 234
charging a fee for granting and renewing the compact privilege. 235
236
ARTICLE IV 237
COMPACT PRIVILEGE 238
239
(1) To exercise the compact privilege under this compact, 240
a licensee shall: 241
(a) Hold and maintain an active home state license as a 242
respiratory therapist. 243
(b) Hold and maintain an active credential from the 244
National Board for Respiratory Care, or its successor, that 245
would qualify him or her for licensure in the remote state in 246
which he or she is seeking the compact privilege. 247
(c) Have not had any adverse action against a license 248
within the previous 2 years. 249
(d) Notify the commission that he or she is seeking the 250

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compact privilege within a remote state. 251
(e) Pay any applicable fees, including any state and 252
commission fees and renewal fees, for the compact privilege. 253
(f) Meet any jurisprudence requirements established by the 254
remote state in which he or she is seeking a compact privilege. 255
(g) Report to the commission any adverse action taken by 256
any nonmember state within 30 days after the date the adverse 257
action is taken. 258
(h) Report to the commission, when applying for a compact 259
privilege, the address of his or her domicile and thereafter 260
promptly report to the commission any change of address within 261
30 days after the effective date of the change in address. 262
(i) Consent to accept service of process by mail at the 263
his or her domicile on record with the commission with respect 264
to any action brought against him or her by the commission or a 265
member state, and consent to accept service of a subpoena by 266
mail at the licensee's domicile on record with the commission 267
with respect to any action brought or investigation conducted by 268
the commission or a member state. 269
(2) The compact privilege is valid until the expiration 270
date or revocation of the home state license unless terminated 271
pursuant to adverse action. The licensee must comply with all of 272
the requirements of subsection (1) to maintain the compact 273
privilege in a remote state. If those requirements are met, no 274
adverse actions are taken, and the licensee has paid any 275

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applicable compact privilege renewal fees, then the licensee 276
will maintain the compact privilege. 277
(3) A licensee providing respiratory therapy in a remote 278
state under the compact privilege functions within the scope of 279
practice authorized by the remote state for the type of 280
respiratory therapist license the licensee holds. Such 281
procedures, actions, processes, and the circumstances under 282
which they may be undertaken may be established through means 283
including, but not limited to, statute, regulations, case law, 284
and other processes available to the state respiratory therapy 285
licensing authority or other government agency. 286
(4) If a licensee's compact privilege in a remote state is 287
removed by the remote state, the licensee shall lose or be 288
ineligible for the compact privilege in that remote state until 289
the compact privilege is no longer limited or restricted by that 290
state. 291
(5) If a home state license is encumbered, the licensee 292
shall lose the compact privilege in all remote states until the 293
following occur: 294
(a) The home state license is no longer encumbered. 295
(b) Two years have elapsed from the date on which the 296
license is no longer encumbered due to the adverse action. 297
(6) Once a licensee with a restricted or limited license 298
meets the requirements of subsection (5), the licensee must also 299
meet the requirements of subsection (1) to obtain a compact 300

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privilege in a remote state. 301
302
ARTICLE V 303
ACTIVE MILITARY MEMBERS AND THEIR SPOUSES 304
305
(1) An active military member, or his or her spouse, shall 306
designate a home state where the individual has a current 307
license in good standing. The individual may retain the home 308
state designation during the period the service member is on 309
active duty. 310
(2) An active military member and his or her spouse are 311
not required to pay to the commission for a compact privilege 312
any fee that may otherwise be charged by the commission. If a 313
remote state chooses to charge a fee for a compact privilege, it 314
may choose to charge a reduced fee or no fee to an active 315
military member and his or her spouse for a compact privilege. 316
317
ARTICLE VI 318
ADVERSE ACTIONS 319
320
(1) A member state in which a licensee is licensed may 321
impose adverse action against the license issued by that member 322
state. 323
(2) A member state may take adverse action based on 324
significant investigative information of a remote state or the 325

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home state, so long as the member state follows its own 326
procedures for imposing adverse action. 327
(3) This compact does not override a member state's 328
decision that participation in an alternative program may be 329
used in lieu of adverse action and that such participation shall 330
remain nonpublic if required by the member state's laws. 331
(4) A remote state may: 332
(a) Take adverse actions as provided herein against a 333
licensee's compact privilege in that state. 334
(b) Issue subpoenas for both hearings and investigations 335
that require the attendance and testimony of witnesses and the 336
production of evidence. 337
1. Subpoenas may be issued by a respiratory therapy 338
licensing authority in a member state for the attendance and 339
testimony of witnesses and the production of evidence. 340
2. Subpoenas issued by a respiratory therapy licensing 341
authority in a member state for the attendance and testimony of 342
witnesses shall be enforced in the latter state by any court of 343
competent jurisdiction in the latter state, according to the 344
practice and procedure of that court applicable to subpoenas 345
issued in proceedings pending before it. 346
3. Subpoenas issued by a respiratory therapy licensing 347
authority in a member state for production of evidence from 348
another member state shall be enforced in the latter state, 349
according to the practice and procedure of that court applicable 350

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to subpoenas issued in the proceedings pending before it. 351
4. The issuing authority shall pay any witness fees, 352
travel expenses, mileage, and other fees required by the service 353
statutes of the state where the witnesses or evidence are 354
located. 355
(c) Unless otherwise prohibited by general law, recover 356
from the licensee the costs of investigations and disposition of 357
cases resulting from any adverse action taken against that 358
licensee. 359
(d) Notwithstanding paragraph (b), a member state may not 360
issue a subpoena to gather evidence of conduct in another member 361
state that is lawful in such other member state for the purpose 362
of taking adverse action against a licensee's compact privilege 363
or application for a compact privilege in that member state. 364
(e) This compact does not authorize a member state to 365
impose discipline against a respiratory therapist's compact 366
privilege in that member state for the licensee's otherwise 367
lawful practice in another state. 368
(5)(a) In addition to the authority granted to a member 369
state by its respective respiratory therapy practice act or 370
other applicable state law, a member state may participate with 371
other member states in joint investigations of licensees, 372
provided, however, that a member state receiving such a request 373
has no obligation to respond to any subpoena issued regarding an 374
investigation of conduct or practice that was lawful in a member 375

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state at the time it was undertaken. 376
(b) Member states shall share any significant 377
investigative information, litigation, or compliance materials 378
in furtherance of any joint or individual investigation 379
initiated under the compact. In sharing such information between 380
member state respiratory therapy licensing authorities, all 381
information obtained shall be kept confidential, except as 382
otherwise mutually agreed upon by the sharing and receiving 383
member states. 384
(6) This compact does not permit a member state to: 385
(a) Take any adverse action against a licensee or holder 386
of a compact privilege for conduct or practice that was legal in 387
the member state at the time it was undertaken. 388
(b) Take disciplinary action against a licensee or holder 389
of a compact privilege for conduct or practice that was legal in 390
the member state at the time it was undertaken. 391
392
ARTICLE VII 393
ESTABLISHMENT OF THE RESPIRATORY CARE 394
INTERSTATE COMPACT COMMISSION 395
396
(1) Establishment of the commission.—The member states 397
hereby create and establish a joint government agency whose 398
membership consists of all member states that have enacted the 399
compact known as the Respiratory Care Interstate Compact 400

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Commission. The commission is an instrumentality of the compact 401
member states acting jointly and not an instrumentality of any 402
one state. The commission shall come into existence on or after 403
the effective date of the compact, as provided in Article XI. 404
(2) Membership, voting, and meetings.— 405
(a) Each member state shall have and be limited to one 406
commissioner selected by that member state's respiratory therapy 407
licensing authority. 408
(b) The commissioner or his or her designated staff member 409
shall be an administrator of the member state's respiratory 410
therapy licensing authority. 411
(c) The commission shall by rule or bylaw establish a term 412
of office for commissioners and may by rule or bylaw establish 413
term limits. 414
(d) The commission may recommend to a member state the 415
removal or suspension any commissioner from office. 416
(e) A member state's respiratory therapy licensing 417
authority shall fill any vacancy occurring on the commission 418
within 60 days after the vacancy. 419
(f) Each commissioner shall be entitled to one vote on all 420
matters before the commission requiring a vote. 421
(g) A commissioner shall vote in person or by such other 422
means as provided in the bylaws. The bylaws may provide for 423
commissioners to meet by telecommunication, videoconference, or 424
other means of communication. 425

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(h) The commission shall meet at least once during each 426
calendar year. Additional meetings may be held as provided in 427
the bylaws. 428
(3) Powers of the commission.—The commission may: 429
(a) Establish and amend the fiscal year of the commission. 430
(b) Establish and amend bylaws and policies, including, 431
but not limited to, a code of conduct and conflict of interest. 432
(c) Establish and amend rules, which shall be binding in 433
all member states. 434
(d) Maintain its financial records in accordance with the 435
bylaws. 436
(e) Meet and take such actions as are consistent with this 437
compact, the commission's rules, and the bylaws. 438
(f) Initiate and conduct legal proceedings or actions in 439
the name of the commission, provided that the standing of any 440
respiratory therapy licensing authority to sue or be sued under 441
applicable law is not affected. 442
(g) Maintain and certify records and information provided 443
to a member state as the authenticated business records of the 444
commission and designate an agent to do so on the commission's 445
behalf. 446
(h) Purchase and maintain insurance and bonds. 447
(i) Accept or contract for services of personnel, 448
including, but not limited to, employees of a member state. 449
(j) Conduct an annual financial review. 450

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(k) Hire employees, elect or appoint officers, fix 451
compensation, define duties, grant such individuals appropriate 452
authority to carry out the purposes of the compact, and 453
establish the commission's personnel policies and programs 454
relating to conflicts of interest, qualifications of personnel, 455
and other related personnel matters. 456
(l) Assess and collect fees. 457
(m) Accept any and all appropriate gifts, donations, 458
grants of money, other sources of revenue, equipment, supplies, 459
materials, and services, and receive, use, and dispose of the 460
same, provided that the commission avoids any appearance of 461
impropriety or conflict of interest. 462
(n) Lease, purchase, retain, own, hold, improve, or use 463
any property, real, personal, or mixed, or any undivided 464
interest therein. 465
(o) Sell, convey, mortgage, pledge, lease, exchange, 466
abandon, or otherwise dispose of any property, real, personal, 467
or mixed. 468
(p) Establish a budget and make expenditures. 469
(q) Borrow money in a fiscally responsible manner. 470
(r) Appoint committees, including standing committees, 471
composed of commissioners, state regulators, state legislators 472
or their representatives, and consumer representatives, and such 473
other interested persons as may be designated in this compact 474
and the bylaws. 475

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(s) Provide and receive information from, and cooperate 476
with, law enforcement agencies. 477
(t) Establish and elect an executive committee, including 478
a chair, vice-chair, secretary, treasurer, and such other 479
offices as the commission shall establish by rule or bylaw. 480
(u) Enter into contracts or arrangements for the 481
management of the affairs of the commission. 482
(v) Determine whether a state's adopted language is 483
materially different from the model compact language such that 484
the state does not qualify for participation in the compact. 485
(w) Perform such other functions as may be necessary or 486
appropriate to achieve the purposes of this compact. 487
(4) The executive committee.— 488
(a) The executive committee shall have the power to act on 489
behalf of the commission according to the terms of this compact. 490
The powers, duties, and responsibilities of the executive 491
committee include: 492
1. Overseeing the day-to-day activities of the 493
administration of the compact, including enforcement and 494
compliance with the compact, commission rules and bylaws, and 495
other such duties as deemed necessary. 496
2. Recommending to the commission changes to the rules or 497
bylaws, changes to the compact legislation, fees charged to 498
compact member states, fees charged to licensees, and other 499
fees. 500

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3. Ensuring compact administration services are 501
appropriately provided, including by contract. 502
4. Preparing and recommending the budget. 503
5. Maintaining financial records on behalf of the 504
commission. 505
6. Monitoring compact compliance of member states and 506
providing compliance reports to the commission. 507
7. Establishing additional committees as necessary. 508
8. Exercising the powers and duties of the commission 509
during the interim between commission meetings, except for 510
adopting or amending rules, adopting or amending bylaws, and 511
exercising any other powers and duties expressly reserved to the 512
commission by rule or bylaw. 513
9. Performing other duties as provided in the rules or 514
bylaws of the commission. 515
(b) The executive committee shall be composed of up to 9 516
members, as further provided in the bylaws of the commission: 517
1. Seven voting members who are elected by the commission 518
from the current membership of the commission. 519
2. Two ex-officio, nonvoting members. 520
(c) The commission may remove any member of the executive 521
committee as provided in the commission's bylaws. 522
(d) The executive committee shall meet at least annually. 523
1. Executive committee meetings shall be open to the 524
public, except that the executive committee may meet in a 525

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closed, nonpublic meeting as provided in paragraph (6)(d). 526
2. The executive committee shall give advance notice of 527
its meetings, posted on its website and as determined to provide 528
notice to persons with an interest in the business of the 529
commission. 530
3. The executive committee may hold a special meeting in 531
accordance with paragraph (6)(b). 532
(5) Report.—The commission shall adopt and provide to the 533
member states an annual report. 534
(6) Meetings of the commission.— 535
(a) All meetings of the commission that are not closed 536
pursuant to paragraph (d) shall be open to the public. Notice of 537
public meetings shall be posted on the commission's website at 538
least 30 days before the public meeting. 539
(b) Notwithstanding paragraph (a), the commission may 540
convene an emergency public meeting by providing at least 24 541
hours' notice on the commission's website, and any other means 542
as provided in the commission's rules, for any of the reasons it 543
may dispense with notice of proposed rulemaking under subsection 544
(7) of Article IX. The commission's legal counsel shall certify 545
that one of the reasons justifying an emergency public meeting 546
has been met. 547
(c) Notice of all commission meetings shall provide the 548
time, date, and location of the meeting, and if the meeting is 549
to be held or accessible via telecommunication, video 550

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conference, or other electronic means, the notice shall include 551
the mechanism for access to the meeting. 552
(d) The commission or the executive committee may convene 553
in a closed, nonpublic meeting for the commission or executive 554
committee to receive or solicit legal advice or to discuss the 555
following: 556
1. Noncompliance of a member state with its obligations 557
under the compact; 558
2. The employment, compensation, discipline, or other 559
matters, practices, or procedures related to specific employees; 560
3. Current or threatened discipline of a licensee or 561
compact privilege holder by the commission or by a member 562
state's respiratory therapy licensing authority; 563
4. Current, threatened, or reasonably anticipated 564
litigation; 565
5. Negotiation of contracts for the purchase, lease, or 566
sale of goods, services, or real estate; 567
6. Accusing any person of a crime or formally censuring 568
any person; 569
7. Trade secrets or commercial or financial information 570
that is privileged or confidential; 571
8. Information of a personal nature where disclosure would 572
constitute a clearly unwarranted invasion of personal privacy; 573
9. Investigative records compiled for law enforcement 574
purposes; 575

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10. Information related to any investigative reports 576
prepared by or on behalf of or for use of the commission or 577
other committee charged with responsibility of investigation or 578
determination of compliance issues pursuant to the compact; 579
11. Legal advice; 580
12. Matters specifically exempted from disclosure by 581
federal or member state law; or 582
13. Other matters as adopted by the commission by rule. 583
(e) If a meeting, or portion of a meeting, is closed, the 584
presiding officer shall state that the meeting will be closed 585
and reference each relevant exempting provision, and such 586
reference shall be recorded in the minutes. 587
(f) The commission shall keep minutes in accordance with 588
commission rules and bylaws. All documents considered in 589
connection with an action shall be identified in such minutes. 590
All minutes and documents of a closed meeting shall remain under 591
seal, subject to release only by a majority vote of the 592
commission or order of a court of competent jurisdiction. 593
(7) Financing of the commission.— 594
(a) The commission shall pay, or provide for the payment 595
of, the reasonable expenses of its establishment, organization, 596
and ongoing activities. 597
(b) The commission may accept any and all appropriate 598
revenue sources as provided herein. 599
(c) The commission may levy on and collect an annual 600

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assessment from each member state and impose fees on licensees 601
of member states that are granted compact privilege to cover the 602
cost of the operations and activities of the commission and its 603
staff. The aggregate annual assessment amount for member states, 604
if any, shall be allocated based upon a formula that the 605
commission shall adopt by rule. 606
(d) The commission may not incur obligations of any kind 607
before securing the funds or a loan adequate to meet the same or 608
pledge the credit of any of the member states, except by and 609
with the authority of the member state. 610
(e) The commission shall keep accurate accounts of all 611
receipts and disbursements. The receipts and disbursements of 612
the commission are subject to the financial review and 613
accounting procedures established under its bylaws. However, all 614
receipts and disbursements of funds handled by the commission 615
are subject to an annual financial review by a certified or 616
licensed public accountant, and the report of the financial 617
review shall be included in and become part of the annual report 618
of the commission. 619
(8) Qualified immunity, defense, and indemnification.— 620
(a) This compact does not limit the liability of any 621
licensee for professional malpractice or misconduct, which shall 622
be governed solely by any other applicable state laws. 623
(b) The member states, commissioners, officers, executive 624
directors, employees, and agents of the commission are immune 625

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from suit and liability, both personally and in their official 626
capacity, for any claim for damage to or loss of property or 627
personal injury or other civil liability caused by or arising 628
out of any actual or alleged act, error, or omission that 629
occurred, or that the person against whom the claim is made had 630
a reasonable basis for believing occurred, within the scope of 631
commission employment, duties, or responsibilities. This 632
paragraph does not protect any such person from suit or 633
liability for any damage, loss, injury, or liability caused by 634
the intentional or willful or wanton misconduct of that person. 635
The procurement of insurance of any type by the commission does 636
not in any way compromise or limit the immunity granted 637
hereunder. 638
(c) The commission shall defend any commissioner, officer, 639
executive director, employee, and agent of the commission in any 640
civil action seeking to impose liability arising out of any 641
actual or alleged act, error, or omission that occurred within 642
the scope of commission employment, duties, or responsibilities, 643
or as determined by the commission that the person against whom 644
the claim is made had a reasonable basis for believing occurred 645
within the scope of commission employment, duties, or 646
responsibilities. This paragraph does not prohibit that person 647
from retaining their own counsel at their own expense; and 648
provided further, that the actual or alleged act, error, or 649
omission did not result from that person's intentional or 650

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willful or wanton misconduct. 651
(d) The commission shall indemnify and hold harmless any 652
commissioner, member, officer, executive director, employee, and 653
agent of the commission for the amount of any settlement or 654
judgment obtained against that person arising out of any actual 655
or alleged act, error, or omission that occurred within the 656
scope of commission employment, duties, or responsibilities, or 657
that such person had a reasonable basis for believing occurred 658
within the scope of commission employment, duties, or 659
responsibilities, provided that the actual or alleged act, 660
error, or omission did not result from the intentional or 661
willful or wanton misconduct of that person. 662
(e) This compact does not waive or otherwise abrogate a 663
member state's state action immunity or state action affirmative 664
defense with respect to antitrust claims under the Sherman Act, 665
the Clayton Act, or any other state or federal antitrust or 666
anticompetitive law or regulation. 667
(f) This compact does not waive sovereign immunity by the 668
member states or by the commission. 669
670
ARTICLE VIII 671
DATA SYSTEM 672
673
(1) The commission shall provide for the development, 674
maintenance, operation, and utilization of a coordinated 675

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database and reporting system containing licensure, adverse 676
action, and the presence of significant investigative 677
information. 678
(2) Notwithstanding any other provision of state law to 679
the contrary, a member state shall submit a uniform data set to 680
the data system as required by the rules of the commission, 681
including, but not limited to, all of the following: 682
(a) Identifying information. 683
(b) Licensure data. 684
(c) Adverse actions against a licensee, license applicant, 685
or compact privilege holder and information related thereto. 686
(d) Nonconfidential information related to alternative 687
program participation, the beginning and ending dates of such 688
participation, and other information related to such 689
participation not made confidential under member state law. 690
(e) Any denial of application for licensure and the 691
reasons for such denial. 692
(f) The presence of current significant investigative 693
information. 694
(g) Other information that may facilitate the 695
administration of this compact or the protection of the public, 696
as determined by commission rules. 697
(3) A member state may not submit any information that 698
constitutes criminal history record information, as defined by 699
applicable federal law, to the data system. 700

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(4) The records and information provided to a member state 701
pursuant to this compact or through the data system, when 702
certified by the commission or an agent thereof, constitutes the 703
authenticated business records of the commission and are 704
entitled to any associated hearsay exception in any relevant 705
judicial, quasi-judicial, or administrative proceedings in a 706
member state. 707
(5) Significant investigative information pertaining to a 708
licensee in any member state will only be available to other 709
member states. 710
(6) It is the responsibility of the member states to 711
report any adverse action against a licensee and to monitor the 712
database to determine whether adverse action has been taken 713
against a licensee. Adverse action information pertaining to a 714
licensee in any member state will be available to any other 715
member state. 716
(7) Member states contributing information to the data 717
system may designate information that may not be shared with the 718
public without the express permission of the contributing state. 719
(8) Any information submitted to the data system that is 720
subsequently expunged pursuant to federal law or the laws of the 721
member state contributing the information shall be removed from 722
the data system. 723
724
ARTICLE IX 725

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RULEMAKING 726
727
(1) The commission shall adopt reasonable rules in order 728
to effectively and efficiently implement and administer the 729
purposes and provisions of this compact. A rule shall be invalid 730
and have no force or effect only if a court of competent 731
jurisdiction holds that the rule is invalid because the 732
commission exercised its rulemaking authority in a manner that 733
is beyond the scope and purposes of this compact, or the powers 734
granted hereunder, or based upon another applicable standard of 735
review. 736
(2) For purposes of this compact, the rules of the 737
commission shall have the force of law in each member state. 738
(3) The commission shall exercise its rulemaking powers 739
pursuant to the criteria provided in this article and the rules 740
adopted hereunder. Rules shall become binding as of the date 741
specified in each rule. 742
(4) If a majority of the legislatures of the member states 743
rejects a rule or portion of a rule, by enactment of a statute 744
or resolution in the same manner used to adopt the compact 745
within 4 years after the date of adoption of the rule, then such 746
rule shall have no further force and effect in any member state. 747
(5) Rules shall be adopted at a regular or special meeting 748
of the commission. 749
(6) Before adoption of a proposed rule, the commission 750

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shall hold a public hearing and allow persons to provide oral 751
and written comments, data, facts, opinions, and arguments. 752
(7) Before adoption of a proposed rule by the commission, 753
and at least 30 days before the meeting at which the commission 754
will hold a public hearing on the proposed rule, the commission 755
shall provide a notice of proposed rulemaking in all of the 756
following manners: 757
(a) On the website of the commission or other publicly 758
accessible platform. 759
(b) To persons who have requested notice of the 760
commission's notices of proposed rulemaking. 761
(c) In such other ways as the commission may by rule 762
specify. 763
(8) The notice of proposed rulemaking shall include all of 764
the following information: 765
(a) The time, date, and location of the public hearing at 766
which the commission will hear public comments on the proposed 767
rule and, if different, the time, date, and location of the 768
meeting where the commission will consider and vote on the 769
proposed rule. 770
(b) If the hearing is held via telecommunication, video 771
conference, or other electronic means, the commission shall 772
include the mechanism for access to the hearing in the notice of 773
proposed rulemaking. 774
(c) The text of and reason for the proposed rule. 775

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(d) A request for comments on the proposed rule from any 776
interested person. 777
(e) The manner in which interested persons may submit 778
written comments. 779
(9) All hearings will be recorded. A copy of the recording 780
and all written comments and documents received by the 781
commission in response to the proposed rule shall be available 782
to the public. 783
(10) This article does not require a separate hearing on 784
each rule. Rules may be grouped for the convenience of the 785
commission at hearings required by this article. 786
(11) The commission shall, by majority vote of all 787
commissioners, take final action on the proposed rule based on 788
the rulemaking record and the full text of the rule. 789
(a) The commission may adopt changes to the proposed rule 790
provided the changes are consistent with the original purpose of 791
the proposed rule. 792
(b) The commission shall provide an explanation of the 793
reasons for substantive changes made to the proposed rule as 794
well as reasons for substantive changes not made that were 795
recommended by commenters. 796
(c) The commission shall determine a reasonable effective 797
date for the rule. Except for an emergency as provided in 798
subsection (12), the effective date of the rule shall be no 799
sooner than 30 days after issuing the notice that it adopted or 800

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amended the rule. 801
(12) Upon determination that an emergency exists, the 802
commission may consider and adopt an emergency rule with 24 803
hours' notice, and with opportunity to comment, provided that 804
the usual rulemaking procedures provided in the compact and in 805
this article shall be retroactively applied to the rule as soon 806
as reasonably possible, in no event later than 90 days after the 807
effective date of the rule. For the purposes of this subsection, 808
an emergency rule is one that must be adopted immediately in 809
order to: 810
(a) Meet an imminent threat to public health, safety, or 811
welfare; 812
(b) Prevent a loss of commission or member state funds; 813
(c) Meet a deadline for the adoption of a rule that is 814
established by federal law or rule; or 815
(d) Protect public health and safety. 816
(13) The commission or an authorized committee of the 817
commission may direct revisions to a previously adopted rule for 818
purposes of correcting typographical errors, errors in format, 819
errors in consistency, or grammatical errors. Public notice of 820
any revisions shall be posted on the website of the commission. 821
The revision shall be subject to challenge by any person for a 822
period of 30 days after posting. The revision may be challenged 823
only on grounds that the revision results in a material change 824
to a rule. A challenge shall be made in writing and delivered to 825

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the commission before the end of the notice period. If no 826
challenge is made, the revision will take effect without further 827
action. If the revision is challenged, the revision may not take 828
effect without the approval of the commission. 829
(14) A member state's rulemaking process or procedural 830
requirements do not apply to the commission. 831
(a) The commission does not have authority over any member 832
state's rulemaking process or procedural requirements that do 833
not pertain to the compact. 834
(15) This compact, or any rule or regulation of the 835
commission, does not limit, restrict, or in any way reduce the 836
ability of a member state to enact and enforce laws, 837
regulations, or other rules related to the practice of 838
respiratory therapy in that state, where those laws, 839
regulations, or other rules are not inconsistent with the 840
provisions of this compact. 841
842
ARTICLE X 843
OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT 844
845
(1)(a) The executive and judicial branches of state 846
government in each member state shall enforce this compact and 847
take all actions necessary and appropriate to implement this 848
compact. 849
(b) Venue is proper and judicial proceedings by or against 850

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the commission shall be brought solely and exclusively in a 851
court of competent jurisdiction where the principal office of 852
the commission is located. The commission may waive venue and 853
jurisdictional defenses to the extent it adopts or consents to 854
participate in alternative dispute resolution proceedings. 855
Nothing herein affects or limits the selection or propriety of 856
venue in any action against a licensee for professional 857
malpractice, misconduct, or any such similar matter. 858
(c) The commission is entitled to receive service of 859
process in any proceeding regarding the enforcement or 860
interpretation of this compact and has standing to intervene in 861
such a proceeding for all purposes. Failure to provide the 862
commission service of process shall render a judgment or order 863
void as to the commission, this compact, or adopted rules. 864
(2)(a) If the commission determines that a member state 865
has defaulted in the performance of its obligations or 866
responsibilities under this compact or the adopted rules, the 867
commission shall provide written notice to the defaulting state. 868
The notice of default shall describe the default, the proposed 869
means of curing the default, and any other action that the 870
commission may take and shall offer training and specific 871
technical assistance regarding the default. 872
(b) The commission shall provide a copy of the notice of 873
default to the other member states. 874
(3) If a state in default fails to cure the default, the 875

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defaulting state may be terminated from the compact upon an 876
affirmative vote of a majority of the commissioners of the 877
member states, and all rights, privileges, and benefits 878
conferred on that state by this compact may be terminated on the 879
effective date of termination. A cure of the default does not 880
relieve the offending state of obligations or liabilities 881
incurred during the period of default. 882
(4) Termination of membership in this compact shall be 883
imposed only after all other means of securing compliance have 884
been exhausted. Notice of intent to suspend or terminate shall 885
be given by the commission to the Governor, the Majority Leader 886
and Minority Leader of the defaulting state's Legislature, the 887
defaulting state's respiratory therapy licensing authority, and 888
each of the member states' respiratory therapy licensing 889
authorities. 890
(5) A state that has been terminated is responsible for 891
all assessments, obligations, and liabilities incurred through 892
the effective date of termination, including obligations that 893
extend beyond the effective date of termination, if necessary. 894
(6) Upon the termination of a state's membership from this 895
compact, that state shall immediately provide notice to all 896
licensees and compact privilege holders of which the commission 897
has a record within that state of the termination. The 898
terminated state shall continue to recognize all licenses 899
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the date of the notice of termination. 901
(7) The commission may not bear any costs related to a 902
state that is found to be in default or that has been terminated 903
from the compact, unless agreed upon in writing between the 904
commission and the defaulting state. 905
(8) The defaulting state may appeal the action of the 906
commission by petitioning the United States District Court for 907
the District of Columbia or the federal district where the 908
commission has its principal offices. The prevailing party shall 909
be awarded all costs of such litigation, including reasonable 910
attorney fees. 911
(9)(a) Upon request by a member state, the commission 912
shall attempt to resolve disputes related to the compact that 913
arise among member states and between member and nonmember 914
states. 915
(b) The commission shall adopt a rule providing for both 916
mediation and binding dispute resolution for disputes, as 917
appropriate. 918
(10)(a) By majority vote, as may be further provided by 919
rule, the commission may initiate legal action against a member 920
state in default in the United States District Court for the 921
District of Columbia or the federal district where the 922
commission has its principal offices to enforce compliance with 923
this compact and its adopted rules. A member state, by enactment 924
of this compact, consents to venue and jurisdiction in such 925

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court for the purposes provided herein. The relief sought may 926
include both injunctive relief and damages. In the event 927
judicial enforcement is necessary, the prevailing party shall be 928
awarded all costs of such litigation, including reasonable 929
attorney fees. The remedies herein are not the exclusive 930
remedies of the commission. The commission may pursue any other 931
remedies available under federal law or the defaulting member 932
state's law. 933
(b) A member state may initiate legal action against the 934
commission in the United States District Court for the District 935
of Columbia or the federal district where the commission has its 936
principal offices to enforce compliance with this compact and 937
its adopted rules. The relief sought may include both injunctive 938
relief and damages. In the event judicial enforcement is 939
necessary, the prevailing party shall be awarded all costs of 940
such litigation, including reasonable attorney fees. 941
(c) Only a member state may enforce this compact against 942
the commission. 943
944
ARTICLE XI 945
EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT 946
947
(1) This compact shall come into effect on the date on 948
which the compact statute is enacted into law in the seventh 949
member state. 950

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(a) On or after the effective date of the compact, the 951
commission shall convene and review the enactment of each of the 952
first seven member states to determine if the statute enacted by 953
each such charter member state is materially different from the 954
model compact. 955
1. A charter member state whose enactment is found to be 956
materially different from the model compact is entitled to the 957
default process provided in Article X. 958
2. If any member state is later found to be in default, or 959
is terminated or withdraws from the compact, the commission 960
shall remain in existence and the compact shall remain in effect 961
even if the number of member states is fewer than seven. 962
(b) Member states enacting the compact subsequent to the 963
seven initial charter member states shall be subject to the 964
process provided herein and commission rule to determine if such 965
state's enactments are materially different from the model 966
compact and whether the state qualifies for participation in the 967
compact. 968
(c) All actions taken for the benefit of the commission or 969
in furtherance of the purposes of the administration of the 970
compact before the effective date of the compact or the 971
commission coming into existence are considered to be actions of 972
the commission unless specifically repudiated by the commission. 973
The commission owns and has all rights to any intellectual 974
property developed on behalf or in furtherance of the commission 975

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by individuals or entities involved in organizing or 976
establishing the commission, as may be further provided in 977
commission rules. 978
(d) Any state that joins the compact subsequent to the 979
commission's initial adoption of the rules and bylaws is subject 980
to the rules and bylaws as they exist on the date on which the 981
compact becomes law in that state. Any rule or bylaw that has 982
been previously adopted by the commission has the full force and 983
effect of law on the date the compact becomes law in that state. 984
(2) Any member state may withdraw from this compact by 985
enacting a statute repealing the same. 986
(a) A member state's withdrawal does not take effect until 987
180 days after enactment of the repealing statute. 988
(b) Withdrawal does not affect the continuing requirement 989
of the withdrawing state's respiratory therapy licensing 990
authority to comply with the investigative and adverse action 991
reporting requirements of this compact before the effective date 992
of withdrawal. 993
(c) Upon the enactment of a statute withdrawing from this 994
compact, a state shall immediately provide notice of such 995
withdrawal to all licensees and compact privilege holders of 996
which the commission has a record within that state. 997
Notwithstanding any subsequent statutory enactment to the 998
contrary, such withdrawing state shall continue to recognize all 999
licenses granted pursuant to this compact for a minimum of 180 1000

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days after the date of such notice of withdrawal. 1001
(3) This compact does not invalidate or prevent any 1002
licensure agreement or other cooperative arrangement between a 1003
member state and a nonmember state that does not conflict with 1004
the provisions of this compact. 1005
(4) This compact may be amended by the member states. An 1006
amendment to this compact does not become effective and binding 1007
upon any member state until it is enacted into the laws of all 1008
member states. 1009
1010
ARTICLE XII 1011
CONSTRUCTION AND SEVERABILITY 1012
1013
(1) This compact and the commission's rulemaking authority 1014
shall be liberally construed so as to effectuate the purposes 1015
and the implementation and administration of the compact. 1016
Provisions of the compact expressly authorizing or requiring the 1017
adoption of rules does not limit the commission's rulemaking 1018
authority solely for those purposes. 1019
(2) The provisions of this compact are severable, and if 1020
any phrase, clause, sentence, or provision of this compact is 1021
held by a court of competent jurisdiction to be contrary to the 1022
constitution of any member state, a state seeking participation 1023
in the compact, or the United States, or the applicability 1024
thereof to any government, agency, person, or circumstance is 1025

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held to be unconstitutional by a court of competent 1026
jurisdiction, the validity of the remainder of this compact and 1027
the applicability thereof to any other government, agency, 1028
person, or circumstance is not affected. 1029
(3) Notwithstanding subsection (2), the commission may 1030
deny a state's participation in the compact or, in accordance 1031
with the requirements of Article X, terminate a member state's 1032
participation in the compact, if it determines that a 1033
constitutional requirement of a member state is a material 1034
departure from the compact. Otherwise, if the compact is held 1035
to be contrary to the constitution of any member state, the 1036
compact shall remain in full force and effect as to the 1037
remaining member states and in full force and effect as to the 1038
member state affected as to all severable matters. 1039
1040
ARTICLE XIII 1041
CONSISTENT EFFECT AND CONFLICT WITH OTHER STATE LAWS 1042
1043
(1) This compact does not prevent or inhibit the 1044
enforcement of any other law of a member state that is not 1045
inconsistent with the compact. 1046
(2) Any laws, statutes, regulations, or other legal 1047
requirements in a member state in conflict with this compact are 1048
superseded to the extent of the conflict, including any 1049
subsequently enacted state laws. 1050

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(3) All permissible agreements between the commission and 1051
the member states are binding in accordance with their terms. 1052
(4) Other than as expressly provided herein, this compact 1053
does not impact initial licensure. 1054
Section 2. Subsection (5) of section 456.076, Florida 1055
Statutes, is amended to read: 1056
456.076 Impaired practitioner programs.— 1057
(5) A consultant shall enter into a participant contract 1058
with an impaired practitioner and shall establish the terms of 1059
monitoring and shall include the terms in a participant 1060
contract. In establishing the terms of monitoring, the 1061
consultant may consider the recommendations of one or more 1062
approved evaluators, treatment programs, or treatment providers. 1063
A consultant may modify the terms of monitoring if the 1064
consultant concludes, through the course of monitoring, that 1065
extended, additional, or amended terms of monitoring are 1066
required for the protection of the health, safety, and welfare 1067
of the public. If the impaired practitioner is an audiologist or 1068
a speech-language pathologist practicing under the Audiology and 1069
Speech-Language Pathology Interstate Compact pursuant to s. 1070
468.1335, a respiratory therapist holding compact privilege 1071
under the Respiratory Care Interstate Compact pursuant to s. 1072
468.371, a physical therapist or physical therapist assistant 1073
practicing under the Physical Therapy Licensure Compact pursuant 1074
to s. 486.112, a psychologist practicing under the Psychology 1075

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Interjurisdictional Compact pursuant to s. 490.0075, or a health 1076
care practitioner practicing under the Professional Counselors 1077
Licensure Compact pursuant to s. 491.017, the terms of the 1078
monitoring contract must include the impaired practitioner's 1079
withdrawal from all practice under the compact unless authorized 1080
by a member state. 1081
Section 3. Subsection (3) of section 468.353, Florida 1082
Statutes, is renumbered as subsection (4), and a new subsection 1083
(3) is added to that section to read: 1084
468.353 Board of Respiratory Care; powers and duties.— 1085
(3) The board shall appoint an individual to serve as the 1086
state's commissioner on the Respiratory Care Interstate Compact 1087
Commission pursuant to s. 468.371. 1088
Section 4. Section 468.355, Florida Statutes, is amended 1089
to read: 1090
468.355 Licensure requirements.—To be eligible for 1091
licensure by the board, an applicant must be an active 1092
"certified respiratory therapist" or an active "registered 1093
respiratory therapist" as designated by the National Board for 1094
Respiratory Care, or its successor, and submit to background 1095
screening in accordance with s. 456.0135. A person licensed as a 1096
respiratory therapist in another state who is practicing under 1097
the Respiratory Care Interstate Compact under s. 468.371, and 1098
only within the scope provided therein, is exempt from the 1099
licensure requirements of this section. 1100

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Section 5. Subsection (5) is added to section 468.361, 1101
Florida Statutes, to read: 1102
468.361 Renewal of licensure; continuing education.— 1103
(5) The board may take adverse action against the compact 1104
privilege of a respiratory therapist under s. 468.371 and may 1105
impose any of the penalties in s. 456.072(2) if a respiratory 1106
therapist commits an act specified in s. 468.365(1) or s. 1107
456.072(1). 1108
Section 6. Paragraph (m) is added to subsection (10) of 1109
section 768.28, Florida Statutes, to read: 1110
768.28 Waiver of sovereign immunity in tort actions; 1111
recovery limits; civil liability for damages caused during a 1112
riot; limitation on attorney fees; statute of limitations; 1113
exclusions; indemnification; risk management programs.— 1114
(10) 1115
(m) For purposes of this section, the individual appointed 1116
under s. 468.371 as the state's commissioner on the Respiratory 1117
Care Interstate Compact Commission, when serving in that 1118
capacity pursuant to s. 468.371, and any administrator, officer, 1119
executive director, employee, or representative of the 1120
Respiratory Care Interstate Compact Commission, when acting 1121
within the scope of his or her employment, duties, or 1122
responsibilities in this state, is considered an agent of the 1123
state. The commission shall pay any claims or judgments pursuant 1124
to this section and may maintain insurance coverage to pay any 1125

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such claims or judgments. 1126
Section 7. This act shall take effect July 1, 2026. 1127