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LEGISLATURE OF NEBRASKA
ONE HUNDRED NINTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 735
Introduced by Rountree, 3.
Read first time January 07, 2026
Committee: Health and Human Services
A BILL FOR AN ACT relating to respiratory care; to amend section 38-3208,1
Revised Statutes Cumulative Supplement, 2024, and section 38-131,2
Revised Statutes Supplement, 2025; to adopt the Respiratory Care3
Interstate Compact; to require certain criminal background checks4
under the Uniform Credentialing Act; to change provisions relating5
to the practice of respiratory care; to harmonize provisions; and to6
repeal the original sections. 7
Be it enacted by the people of the State of Nebraska,8
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Section 1. RESPIRATORY CARE INTERSTATE COMPACT1
SECTION 1. TITLE AND PURPOSE 2
A. The purpose of this Compact is to facilitate the interstate3
Practice of Respiratory Therapy with the goal of improving public access4
to Respiratory Therapy services by providing Respiratory Therapists5
licensed in a Member State the ability to practice in other Member6
States. The Compact preserves the regulatory authority of states to7
protect public health and safety through the current system of State8
licensure. 9
B. This Compact is designed to achieve the following objectives:10
1. Increase public access to Respiratory Therapy services by11
creating a responsible, streamlined pathway for Licensees to practice in12
Member States with the goal of improving outcomes for patients;13
2. Enhance States' ability to protect the public's health and14
safety; 15
3. Promote the cooperation of Member States in regulating the16
Practice of Respiratory Therapy within those Member States;17
4. Ease administrative burdens on States by encouraging the18
cooperation of Member States in regulating multi-state Respiratory19
Therapy practice; 20
5. Support relocating Active Military Members and their spouses; and21
6. Promote mobility and address workforce shortages.22
SECTION 2. DEFINITIONS 23
As used in this Compact, unless the context requires otherwise, the24
following definitions shall apply: 25
A. Active Military Member means any person with a full-time duty26
status in the armed forces of the United States, including members of the27
National Guard and Reserve. 28
B. Adverse Action means any administrative, civil, equitable, or29
criminal action permitted by a State's laws which is imposed by any State30
authority with regulatory authority over Respiratory Therapists, such as31
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license denial, censure, revocation, suspension, probation, monitoring of1
the Licensee, or restriction on the Licensee's practice, not including2
participation in an Alternative Program. 3
C. Alternative Program means a non-disciplinary monitoring or4
practice remediation process applicable to a Respiratory Therapist5
approved by any State authority with regulatory authority over6
Respiratory Therapists. This includes, but is not limited to, programs to7
which Licensees with substance abuse or addiction issues are referred in8
lieu of Adverse Action. 9
D. Charter Member States means those Member States who were the10
first seven states to enact the Compact into the laws of their State.11
E. Commission or Respiratory Care Interstate Compact Commission12
means the government instrumentality and body politic whose membership13
consists of all Member States that have enacted the Compact.14
F. Commissioner means the individual appointed by a Member State to15
serve as the member of the Commission for that Member State.16
G. Compact means the Respiratory Care Interstate Compact.17
H. Compact Privilege means the authorization granted by a Remote18
State to allow a Licensee from another Member State to practice as a19
Respiratory Therapist in the Remote State under the Remote State's laws20
and Rules. The Practice of Respiratory Therapy occurs in the Member State21
where the patient is located at the time of the patient encounter.22
I. Criminal Background Check means the submission by the Member23
State of fingerprints or other biometric-based information on license24
applicants at the time of initial licensing for the purpose of obtaining25
that applicant's criminal history record information, as defined in 2826
C.F.R. 20.3(d) or successor provision, from the Federal Bureau of27
Investigation and the State's criminal history record repository, as28
defined in 28 C.F.R. 20.3(f) or successor provision.29
J. Data System means the Commission's repository of information30
about Licensees as further set forth in Section 8.31
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K. Domicile means the jurisdiction which is the Licensee's principal1
home for legal purposes. 2
L. Encumbered License means a license that a State's Respiratory3
Therapy Licensing Authority has limited in any way.4
M. Executive Committee means a group of directors elected or5
appointed to act on behalf of, and within the powers granted to them by6
the Commission. 7
N. Home State except as set forth in Section 5, means the Member8
State that is the Licensee's primary Domicile. 9
O. Home State License means an active license to practice10
Respiratory Therapy in a Home State that is not an Encumbered License.11
P. Jurisprudence Requirement means an assessment of an individual's12
knowledge of the State laws and regulations governing the Practice of13
Respiratory Therapy in such State. 14
Q. Licensee means an individual who currently holds an authorization15
from the State to practice as a Respiratory Therapist.16
R. Member State means a State that has enacted the Compact and been17
admitted to the Commission in accordance with the provisions herein and18
Commission Rules. 19
S. Model Compact means the model for the Respiratory Care Interstate20
Compact on file with The Council of State Governments or other entity as21
designated by the Commission. 22
T. Remote State means a Member State where a Licensee is exercising23
or seeking to exercise the Compact Privilege. 24
U. Respiratory Therapist or Respiratory Care Practitioner means an25
individual who holds a credential issued by the National Board for26
Respiratory Care (or its successor) and holds a license in a State to27
practice Respiratory Therapy. For purposes of this Compact, any other28
title or status adopted by a State to replace the term Respiratory29
Therapist or Respiratory Care Practitioner shall be deemed synonymous30
with Respiratory Therapist and shall confer the same rights and31
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responsibilities to the Licensee under the provisions of this Compact at1
the time of its enactment. 2
V. Respiratory Therapy, Respiratory Therapy Practice, Respiratory3
Care, the Practice of Respiratory Care, and the Practice of Respiratory4
Therapy means the care and services provided by or under the direction5
and supervision of a Respiratory Therapist or Respiratory Care6
Practitioner. 7
W. Respiratory Therapy Licensing Authority means the agency, board,8
or other body of a State that is responsible for licensing and regulation9
of Respiratory Therapists. 10
X. Rule means a regulation promulgated by an entity that has the11
force and effect of law. 12
Y. Scope of Practice means the procedures, actions, and processes a13
Respiratory Therapist licensed in a State or practicing under a Compact14
Privilege in a State is permitted to undertake in that State and the15
circumstances under which the Respiratory Therapist is permitted to16
undertake those procedures, actions, and processes. Such procedures,17
actions, and processes, and the circumstances under which they may be18
undertaken may be established through means, including, but not limited19
to, statute, regulations, case law, and other processes available to the20
State Respiratory Therapy Licensing Authority or other government agency.21
Z. Significant Investigative Information means information, records,22
and documents received or generated by a State Respiratory Therapy23
Licensing Authority pursuant to an investigation for which a24
determination has been made that there is probable cause to believe that25
the Licensee has violated a statute or regulation that is considered more26
than a minor infraction for which the State Respiratory Therapy Licensing27
Authority could pursue Adverse Action against the Licensee.28
AA. State means any state, commonwealth, district, or territory of29
the United States. 30
SECTION 3. STATE PARTICIPATION IN THIS COMPACT31
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A. In order to participate in this Compact and thereafter continue1
as a Member State, a Member State shall: 2
1. Enact a Compact that is not materially different from the Model3
Compact; 4
2. License Respiratory Therapists; 5
3. Participate in the Commission's Data System;6
4. Have a mechanism in place for receiving and investigating7
complaints against Licensees and Compact Privilege holders;8
5. Notify the Commission, in compliance with the terms of this9
Compact and Commission Rules, of any Adverse Action against a Licensee, a10
Compact Privilege holder, or a license applicant; 11
6. Notify the Commission, in compliance with the terms of this12
Compact and Commission Rules, of the existence of Significant13
Investigative Information; 14
7. Comply with the Rules of the Commission; 15
8. Grant the Compact Privilege to a holder of an active Home State16
License who otherwise meets the applicable requirements of Section 4 in a17
Member State; and 18
9. Complete a Criminal Background Check for each new Licensee at the19
time of initial licensure. 20
a. Where expressly authorized or permitted by federal law, whether21
such federal law is in effect prior to, at, or after the time of a Member22
State's enactment of this Compact, a Member State's enactment of this23
Compact shall hereby authorize the Member State's Respiratory Therapy24
Licensing Authority to perform Criminal Background Checks as defined25
herein. The absence of such a federal law as described in this subsection26
shall not prevent or preclude such authorization where it may be derived27
or granted through means other than the enactment of this Compact.28
B. Nothing in this Compact prohibits a Member State from charging a29
fee for granting and renewing the Compact Privilege.30
SECTION 4. COMPACT PRIVILEGE 31
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A. To exercise the Compact Privilege under the terms and provisions1
of the Compact, the Licensee shall: 2
1. Hold and maintain an active Home State License as a Respiratory3
Therapist; 4
2. Hold and maintain an active credential from the National Board5
for Respiratory Care (or its successor) that would qualify them for6
licensure in the Remote State in which they are seeking the privilege;7
3. Have not had any Adverse Action against a license within the8
previous two years; 9
4. Notify the Commission that the Licensee is seeking the Compact10
Privilege within a Remote State; 11
5. Pay any applicable fees, including any State and Commission fees12
and renewal fees, for the Compact Privilege; 13
6. Meet any Jurisprudence Requirements established by the Remote14
State in which the Licensee is seeking a Compact Privilege;15
7. Report to the Commission Adverse Action taken by any non-Member16
State within thirty days from the date the Adverse Action is taken;17
8. Report to the Commission, when applying for a Compact Privilege,18
the address of the Licensee's Domicile and thereafter promptly report to19
the Commission any change in the address of the Licensee's Domicile20
within thirty days of the effective date of the change in address; and21
9. Consent to accept service of process by mail at the Licensee's22
Domicile on record with the Commission with respect to any action brought23
against the Licensee by the Commission or a Member State, and consent to24
accept service of a subpoena by mail at the Licensee's Domicile on record25
with the Commission with respect to any action brought or investigation26
conducted by the Commission or a Member State. 27
B. The Compact Privilege is valid until the expiration date or28
revocation of the Home State License unless terminated pursuant to29
Adverse Action. The Licensee must comply with all of the requirements of30
Subsection A, above, to maintain the Compact Privilege in a Remote State.31
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If those requirements are met, no Adverse Actions are taken, and the1
Licensee has paid any applicable Compact Privilege renewal fees, then the2
Licensee will maintain the Licensee's Compact Privilege.3
C. A Licensee providing Respiratory Therapy in a Remote State under4
the Compact Privilege shall function within the Scope of Practice5
authorized by the Remote State for the type of Respiratory Therapist6
license the Licensee holds. Such procedures, actions, processes, and the7
circumstances under which they may be undertaken may be established8
through means, including, but not limited to, statute, regulations, case9
law, and other processes available to the State Respiratory Therapy10
Licensing Authority or other government agency. 11
D. If a Licensee's Compact Privilege in a Remote State is removed by12
the Remote State, the individual shall lose or be ineligible for the13
Compact privilege in that Remote State until the Compact Privilege is no14
longer limited or restricted by that State. 15
E. If a Home State License is encumbered, the Licensee shall lose16
the Compact Privilege in all Remote States until the following occur:17
1. The Home State License is no longer encumbered; and18
2. Two years have elapsed from the date on which the license is no19
longer encumbered due to the Adverse Action. 20
F. Once a Licensee with a restricted or limited license meets the21
requirements of Subsection E.1 and 2, the Licensee must also meet the22
requirements of Subsection A to obtain a Compact Privilege in a Remote23
State. 24
SECTION 5. ACTIVE MILITARY MEMBER OR THEIR SPOUSE25
A. An Active Military Member, or their spouse, shall designate a26
Home State where the individual has a current license in good standing.27
The individual may retain the Home State designation during the period28
the service member is on active duty. 29
B. An Active Military Member and their spouse shall not be required30
to pay to the Commission for a Compact Privilege any fee that may31
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otherwise be charged by the Commission. If a Remote State chooses to1
charge a fee for a Compact Privilege, it may choose to charge a reduced2
fee or no fee to an Active Military Member and their spouse for a Compact3
Privilege. 4
SECTION 6. ADVERSE ACTIONS 5
A. A Member State in which a Licensee is licensed shall have6
authority to impose Adverse Action against the license issued by that7
Member State. 8
B. A Member State may take Adverse Action based on Significant9
Investigative Information of a Remote State or the Home State, so long as10
the Member State follows its own procedures for imposing Adverse Action.11
C. Nothing in this Compact shall override a Member State's decision12
that participation in an Alternative Program may be used in lieu of13
Adverse Action and that such participation shall remain non-public if14
required by the Member State's laws. 15
D. A Remote State shall have the authority to:16
1. Take Adverse Actions as set forth herein against a Licensee's17
Compact Privilege in that State; 18
2. Issue subpoenas for both hearings and investigations that require19
the attendance and testimony of witnesses, and the production of20
evidence. 21
a. Subpoenas may be issued by a Respiratory Therapy Licensing22
Authority in a Member State for the attendance and testimony of witnesses23
and the production of evidence. 24
b. Subpoenas issued by a Respiratory Therapy Licensing Authority in25
a Member State for the attendance and testimony of witnesses shall be26
enforced in the latter State by any court of competent jurisdiction in27
the latter State, according to the practice and procedure of that court28
applicable to subpoenas issued in proceedings pending before it.29
c. Subpoenas issued by a Respiratory Therapy Licensing Authority in30
a Member State for production of evidence from another Member State shall31
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be enforced in the latter State, according to the practice and procedure1
of that court applicable to subpoenas issued in the proceedings pending2
before it. 3
d. The issuing authority shall pay any witness fees, travel4
expenses, mileage, and other fees required by the service statutes of the5
State where the witnesses or evidence are located; 6
3. Unless otherwise prohibited by State law, recover from the7
Licensee the costs of investigations and disposition of cases resulting8
from any Adverse Action taken against that Licensee;9
4. Notwithstanding subsection D.2., a Member State may not issue a10
subpoena to gather evidence of conduct in another Member State that is11
lawful in such other Member State for the purpose of taking Adverse12
Action against a Licensee's Compact Privilege or application for a13
Compact Privilege in that Member State; and 14
5. Nothing in this Compact authorizes a Member State to impose15
discipline against a Respiratory Therapist's Compact Privilege in that16
Member State for the individual's otherwise lawful practice in another17
State. 18
E. Joint Investigations 19
1. In addition to the authority granted to a Member State by its20
respective Respiratory Therapy Practice act or other applicable state21
law, a Member State may participate with other Member States in joint22
investigations of Licensees, provided, however, that a Member State23
receiving such a request has no obligation to respond to any subpoena24
issued regarding an investigation of conduct or practice that was lawful25
in a Member State at the time it was undertaken. 26
2. Member States shall share any Significant Investigative27
Information, litigation, or compliance materials in furtherance of any28
joint or individual investigation initiated under the Compact. In sharing29
such information between Member State Respiratory Therapy Licensing30
Authorities, all information obtained shall be kept confidential, except31
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as otherwise mutually agreed upon by the sharing and receiving Member1
States. 2
F. Nothing in this Compact may permit a Member State to take any3
Adverse Action against a Licensee or holder of a Compact Privilege for4
conduct or practice that was legal in the Member State at the time it was5
undertaken. 6
G. Nothing in this Compact may permit a Member State to take7
disciplinary action against a Licensee or holder of a Compact Privilege8
for conduct or practice that was legal in the Member State at the time it9
was undertaken. 10
SECTION 7. ESTABLISHMENT OF THE RESPIRATORY CARE INTERSTATE COMPACT11
COMMISSION 12
A. The Compact Member States hereby create and establish a joint13
government agency whose membership consists of all Member States that14
have enacted the Compact known as the Respiratory Care Interstate Compact15
Commission. The Commission is an instrumentality of the Compact Member16
States acting jointly and not an instrumentality of any one State. The17
Commission shall come into existence on or after the effective date of18
the Compact, as set forth in Section 11. 19
B. Membership, Voting, and Meetings 20
1. Each Member State shall have and be limited to one Commissioner21
selected by that Member State's Respiratory Therapy Licensing Authority.22
2. The Commissioner shall be an administrator or their designated23
staff member of the Member State's Respiratory Therapy Licensing24
Authority. 25
3. The Commission shall by Rule or bylaw establish a term of office26
for Commissioners and may by Rule or bylaw establish term limits.27
4. The Commission may recommend to a Member State the removal or28
suspension of any Commissioner from office. 29
5. A Member State's Respiratory Therapy Licensing Authority shall30
fill any vacancy of its Commissioner occurring on the Commission within31
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sixty days of the vacancy. 1
6. Each Commissioner shall be entitled to one vote on all matters2
before the Commission requiring a vote by Commissioners.3
7. A Commissioner shall vote in person or by such other means as4
provided in the bylaws. The bylaws may provide for Commissioners to meet5
by telecommunication, videoconference, or other means of communication.6
8. The Commission shall meet at least once during each calendar7
year. Additional meetings may be held as set forth in the bylaws.8
C. The Commission shall have the following powers:9
1. Establish and amend the fiscal year of the Commission;10
2. Establish and amend bylaws and policies, including, but not11
limited to, a code of conduct and conflict of interest;12
3. Establish and amend Rules, which shall be binding in all Member13
States; 14
4. Maintain its financial records in accordance with the bylaws;15
5. Meet and take such actions as are consistent with the provisions16
of this Compact, the Commission's Rules, and the bylaws;17
6. Initiate and conduct legal proceedings or actions in the name of18
the Commission, provided that the standing of any Respiratory Therapy19
Licensing Authority to sue or be sued under applicable law shall not be20
affected; 21
7. Maintain and certify records and information provided to a Member22
State as the authenticated business records of the Commission, and23
designate an agent to do so on the Commission's behalf;24
8. Purchase and maintain insurance and bonds;25
9. Accept or contract for services of personnel, including, but not26
limited to, employees of a Member State; 27
10. Conduct an annual financial review; 28
11. Hire employees, elect or appoint officers, fix compensation,29
define duties, grant such individuals appropriate authority to carry out30
the purposes of the Compact, and establish the Commission's personnel31
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policies and programs relating to conflicts of interest, qualifications1
of personnel, and other related personnel matters; 2
12. Assess and collect fees; 3
13. Accept any and all appropriate gifts, donations, grants of4
money, other sources of revenue, equipment, supplies, materials, and5
services, and receive, utilize, and dispose of the same, provided that at6
all times: 7
a. The Commission shall avoid any appearance of impropriety; and8
b. The Commission shall avoid any appearance of conflict of9
interest; 10
14. Lease, purchase, retain, own, hold, improve, or use any11
property, real, personal, or mixed, or any undivided interest therein;12
15. Sell, convey, mortgage, pledge, lease, exchange, abandon, or13
otherwise dispose of any property real, personal, or mixed;14
16. Establish a budget and make expenditures;15
17. Borrow money in a fiscally responsible manner;16
18. Appoint committees, including standing committees, composed of17
Commissioners, State regulators, State legislators or their18
representatives, and consumer representatives, and such other interested19
persons as may be designated in this Compact and the bylaws;20
19. Provide and receive information from, and cooperate with, law21
enforcement agencies; 22
20. Establish and elect an Executive Committee, including a chair,23
vice-chair, secretary, treasurer, and such other offices as the24
Commission shall establish by Rule or bylaw; 25
21. Enter into contracts or arrangements for the management of the26
affairs of the Commission; 27
22. Determine whether a State's adopted language is materially28
different from the Model Compact language such that the State would not29
qualify for participation in the Compact; and 30
23. Perform such other functions as may be necessary or appropriate31
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to achieve the purposes of this Compact. 1
D. The Executive Committee 2
1. The Executive Committee shall have the power to act on behalf of3
the Commission according to the terms of this Compact. The powers,4
duties, and responsibilities of the Executive Committee shall include:5
a. Overseeing the day-to-day activities of the administration of the6
Compact, including enforcement and compliance with the provisions of the7
Compact, its Rules and bylaws, and other such duties as deemed necessary;8
b. Recommending to the Commission changes to the Rules or bylaws,9
changes to this Compact legislation, fees charged to Compact Member10
States, fees charged to Licensees, and other fees;11
c. Ensuring Compact administration services are appropriately12
provided, including by contract; 13
d. Preparing and recommending the budget; 14
e. Maintaining financial records on behalf of the Commission;15
f. Monitoring Compact compliance of Member States and providing16
compliance reports to the Commission; 17
g. Establishing additional committees as necessary;18
h. Exercising the powers and duties of the Commission during the19
interim between Commission meetings, except for adopting or amending20
Rules, adopting or amending bylaws, and exercising any other powers and21
duties expressly reserved to the Commission by Rule or bylaw; and22
i. Performing other duties as provided in the Rules or bylaws of the23
Commission. 24
2. The Executive Committee shall be composed of up to nine members,25
as further set forth in the bylaws of the Commission:26
a. Seven voting members who are elected by the Commission from the27
current membership of the Commission; and 28
b. Two ex-officio, non-voting members. 29
3. The Commission may remove any member of the Executive Committee30
as provided in the Commission's bylaws. 31
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4. The Executive Committee shall meet at least annually.1
a. Executive Committee meetings shall be open to the public, except2
that the Executive Committee may meet in a closed, non-public meeting as3
provided in subsection F.4 below; 4
b. The Executive Committee shall give advance notice of its5
meetings, posted on its website and as determined to provide notice to6
persons with an interest in the business of the Commission; and7
c. The Executive Committee may hold a special meeting in accordance8
with subsection F.2 below. 9
E. The Commission shall adopt and provide to the Member States an10
annual report. 11
F. Meetings of the Commission 12
1. All meetings of the Commission that are not closed pursuant to13
subsection 7.F.4 shall be open to the public. Notice of public meetings14
shall be posted on the Commission's website at least thirty days prior to15
the public meeting. 16
2. Notwithstanding subsection 7.F.1, the Commission may convene an17
emergency public meeting by providing at least twenty-four hours prior18
notice on the Commission's website, and any other means as provided in19
the Commission's Rules, for any of the reasons it may dispense with20
notice of proposed rulemaking under subsection 9.G. The Commission's21
legal counsel shall certify that one of the reasons justifying an22
emergency public meeting has been met. 23
3. Notice of all Commission meetings shall provide the time, date,24
and location of the meeting, and if the meeting is to be held or25
accessible via telecommunication, video conference, or other electronic26
means, the notice shall include the mechanism for access to the meeting.27
4. The Commission or the Executive Committee may convene in a28
closed, non-public meeting for the Commission or Executive Committee to29
receive or solicit legal advice or to discuss: 30
a. Non-compliance of a Member State with its obligations under the31
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Compact; 1
b. The employment, compensation, discipline or other matters,2
practices or procedures related to specific employees;3
c. Current or threatened discipline of a Licensee or Compact4
Privilege holder by the Commission or by a Member State's Respiratory5
Therapy Licensing Authority; 6
d. Current, threatened, or reasonably anticipated litigation;7
e. Negotiation of contracts for the purchase, lease, or sale of8
goods, services, or real estate; 9
f. Accusing any person of a crime or formally censuring any person;10
g. Trade secrets or commercial or financial information that is11
privileged or confidential; 12
h. Information of a personal nature where disclosure would13
constitute a clearly unwarranted invasion of personal privacy;14
i. Investigative records compiled for law enforcement purposes;15
j. Information related to any investigative reports prepared by or16
on behalf of or for use of the Commission or other committee charged with17
responsibility of investigation or determination of compliance issues18
pursuant to the Compact; 19
k. Legal advice; 20
l. Matters specifically exempted from disclosure by federal or21
Member State law; or 22
m. Other matters as promulgated by the Commission by Rule.23
5. If a meeting, or portion of a meeting, is closed, the presiding24
officer shall state that the meeting will be closed and reference each25
relevant exempting provision, and such reference shall be recorded in the26
minutes. 27
6. The Commission shall keep minutes in accordance with Commission28
Rules and bylaws. All documents considered in connection with an action29
shall be identified in such minutes. All minutes and documents of a30
closed meeting shall remain under seal, subject to release only by a31
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majority vote of the Commission or order of a court of competent1
jurisdiction. 2
G. Financing of the Commission 3
1. The Commission shall pay, or provide for the payment of, the4
reasonable expenses of its establishment, organization, and ongoing5
activities. 6
2. The Commission may accept any and all appropriate revenue sources7
as provided herein. 8
3. The Commission may levy on and collect an annual assessment from9
each Member State and impose fees on Licensees of Member States to whom10
it grants a Compact Privilege to cover the cost of the operations and11
activities of the Commission and its staff. The aggregate annual12
assessment amount for Member States, if any, shall be allocated based13
upon a formula that the Commission shall promulgate by Rule.14
4. The Commission shall not incur obligations of any kind prior to15
securing the funds or a loan adequate to meet the same; nor shall the16
Commission pledge the credit of any of the Member States, except by and17
with the authority of the Member State. 18
5. The Commission shall keep accurate accounts of all receipts and19
disbursements. The receipts and disbursements of the Commission shall be20
subject to the financial review and accounting procedures established21
under its bylaws. However, all receipts and disbursements of funds22
handled by the Commission shall be subject to an annual financial review23
by a certified or licensed public accountant, and the report of the24
financial review shall be included in and become part of the annual25
report of the Commission. 26
H. Qualified Immunity, Defense, and Indemnification27
1. Nothing herein shall be construed as a limitation on the28
liability of any Licensee for professional malpractice or misconduct,29
which shall be governed solely by any other applicable state laws.30
2. The Member States, Commissioners, officers, executive directors,31
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employees, and agents of the Commission shall be immune from suit and1
liability, both personally and in their official capacity, for any claim2
for damage to or loss of property or personal injury or other civil3
liability caused by or arising out of any actual or alleged act, error,4
or omission that occurred, or that the person against whom the claim is5
made had a reasonable basis for believing occurred within the scope of6
Commission employment, duties or responsibilities; provided that nothing7
in this subsection shall be construed to protect any such person from8
suit or liability for any damage, loss, injury, or liability caused by9
the intentional or willful or wanton misconduct of that person. The10
procurement of insurance of any type by the Commission shall not in any11
way compromise or limit the immunity granted hereunder.12
3. The Commission shall defend any Commissioner, officer, executive13
director, employee, and agent of the Commission in any civil action14
seeking to impose liability arising out of any actual or alleged act,15
error, or omission that occurred within the scope of Commission16
employment, duties, or responsibilities, or as determined by the17
Commission that the person against whom the claim is made had a18
reasonable basis for believing occurred within the scope of Commission19
employment, duties, or responsibilities; provided that nothing herein20
shall be construed to prohibit that person from retaining their own21
counsel at their own expense; and provided further, that the actual or22
alleged act, error, or omission did not result from that person's23
intentional or willful or wanton misconduct. 24
4. The Commission shall indemnify and hold harmless any25
Commissioner, member, officer, executive director, employee, and agent of26
the Commission for the amount of any settlement or judgment obtained27
against that person arising out of any actual or alleged act, error, or28
omission that occurred within the scope of Commission employment, duties,29
or responsibilities, or that such person had a reasonable basis for30
believing occurred within the scope of Commission employment, duties, or31
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responsibilities; provided that the actual or alleged act, error, or1
omission did not result from the intentional or willful or wanton2
misconduct of that person. 3
5. Nothing in this Compact shall be interpreted to waive or4
otherwise abrogate a Member State's state action immunity or state action5
affirmative defense with respect to antitrust claims under the Sherman6
Act, Clayton Act, or any other State or federal antitrust or7
anticompetitive law or regulation. 8
6. Nothing in this Compact shall be construed to be a waiver of9
sovereign immunity by the Member States or by the Commission.10
SECTION 8. DATA SYSTEM 11
A. The Commission shall provide for the development, maintenance,12
operation, and utilization of a coordinated database and reporting system13
containing licensure, Adverse Action, and the presence of Significant14
Investigative Information. 15
B. Notwithstanding any other provision of State law to the contrary,16
a Member State shall submit a uniform data set to the Data System as17
required by the Rules of the Commission, including, but not limited to:18
1. Identifying information; 19
2. Licensure data; 20
3. Adverse Actions against a Licensee, license applicant, or Compact21
Privilege holder and information related thereto; 22
4. Non-confidential information related to Alternative Program23
participation, the beginning and ending dates of such participation, and24
other information related to such participation not made confidential25
under Member State law; 26
5. Any denial of application for licensure, and the reasons for such27
denial; 28
6. The presence of current Significant Investigative Information;29
and 30
7. Other information that may facilitate the administration of this31
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Compact or the protection of the public, as determined by the Rules of1
the Commission. 2
C. No Member State shall submit any information which constitutes3
criminal history record information, as defined by applicable federal4
law, to the Data System established hereunder. 5
D. The records and information provided to a Member State pursuant6
to this Compact or through the Data System, when certified by the7
Commission or an agent thereof, shall constitute the authenticated8
business records of the Commission, and shall be entitled to any9
associated hearsay exception in any relevant judicial, quasi-judicial, or10
administrative proceedings in a Member State. 11
E. Significant Investigative Information pertaining to a Licensee in12
any Member State will only be available to other Member States.13
F. It is the responsibility of the Member States to report any14
Adverse Action against a Licensee and to monitor the database to15
determine whether Adverse Action has been taken against a Licensee.16
Adverse Action information pertaining to a Licensee in any Member State17
will be available to any other Member State. 18
G. Member States contributing information to the Data System may19
designate information that may not be shared with the public without the20
express permission of the contributing State. 21
H. Any information submitted to the Data System that is subsequently22
expunged pursuant to federal law or the laws of the Member State23
contributing the information shall be removed from the Data System.24
SECTION 9. RULEMAKING 25
A. The Commission shall promulgate reasonable Rules in order to26
effectively and efficiently implement and administer the purposes and27
provisions of the Compact. A Rule shall be invalid and have no force or28
effect only if a court of competent jurisdiction holds that the Rule is29
invalid because the Commission exercised its rulemaking authority in a30
manner that is beyond the scope and purposes of the Compact, or the31
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powers granted hereunder, or based upon another applicable standard of1
review. 2
B. For purposes of the Compact, the Rules of the Commission shall3
have the force of law in each Member State. 4
C. The Commission shall exercise its rulemaking powers pursuant to5
the criteria set forth in this section and the Rules adopted thereunder.6
Rules shall become binding as of the date specified in each Rule.7
D. If a majority of the legislatures of the Member States rejects a8
Rule or portion of a Rule, by enactment of a statute or resolution in the9
same manner used to adopt the Compact within four years of the date of10
adoption of the Rule, then such Rule shall have no further force and11
effect in any Member State. 12
E. Rules shall be adopted at a regular or special meeting of the13
Commission. 14
F. Prior to adoption of a proposed Rule, the Commission shall hold a15
public hearing and allow persons to provide oral and written comments,16
data, facts, opinions, and arguments. 17
G. Prior to adoption of a proposed Rule by the Commission, and at18
least thirty days in advance of the meeting at which the Commission will19
hold a public hearing on the proposed Rule, the Commission shall provide20
a notice of proposed rulemaking: 21
1. On the website of the Commission or other publicly accessible22
platform; 23
2. To persons who have requested notice of the Commission's notices24
of proposed rulemaking, and 25
3. In such other ways as the Commission may by Rule specify.26
H. The notice of proposed rulemaking shall include:27
1. The time, date, and location of the public hearing at which the28
Commission will hear public comments on the proposed Rule and, if29
different, the time, date, and location of the meeting where the30
Commission will consider and vote on the proposed Rule;31
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2. If the hearing is held via telecommunication, video conference,1
or other electronic means, the Commission shall include the mechanism for2
access to the hearing in the notice of proposed rulemaking;3
3. The text of the proposed Rule and the reason therefor;4
4. A request for comments on the proposed Rule from any interested5
person; and 6
5. The manner in which interested persons may submit written7
comments. 8
I. All hearings will be recorded. A copy of the recording and all9
written comments and documents received by the Commission in response to10
the proposed Rule shall be available to the public.11
J. Nothing in this section shall be construed as requiring a12
separate hearing on each Rule. Rules may be grouped for the convenience13
of the Commission at hearings required by this section.14
K. The Commission shall, by majority vote of all Commissioners, take15
final action on the proposed Rule based on the rulemaking record and the16
full text of the Rule. 17
1. The Commission may adopt changes to the proposed Rule provided18
the changes are consistent with the original purpose of the proposed19
Rule. 20
2. The Commission shall provide an explanation of the reasons for21
substantive changes made to the proposed Rule as well as reasons for22
substantive changes not made that were recommended by commenters.23
3. The Commission shall determine a reasonable effective date for24
the Rule. Except for an emergency as provided in Section 9.L, the25
effective date of the Rule shall be no sooner than thirty days after26
issuing the notice that it adopted or amended the Rule.27
L. Upon determination that an emergency exists, the Commission may28
consider and adopt an emergency Rule with twenty-four hours' notice, and29
with opportunity to comment, provided that the usual rulemaking30
procedures provided in the Compact and in this section shall be31
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retroactively applied to the Rule as soon as reasonably possible, in no1
event later than ninety days after the effective date of the Rule. For2
the purposes of this provision, an emergency Rule is one that must be3
adopted immediately in order to: 4
1. Meet an imminent threat to public health, safety, or welfare;5
2. Prevent a loss of Commission or Member State funds;6
3. Meet a deadline for the promulgation of a Rule that is7
established by federal law or Rule; or 8
4. Protect public health and safety. 9
M. The Commission or an authorized committee of the Commission may10
direct revisions to a previously adopted Rule for purposes of correcting11
typographical errors, errors in format, errors in consistency, or12
grammatical errors. Public notice of any revisions shall be posted on the13
website of the Commission. The revision shall be subject to challenge by14
any person for a period of thirty days after posting. The revision may be15
challenged only on grounds that the revision results in a material change16
to a Rule. A challenge shall be made in writing and delivered to the17
Commission prior to the end of the notice period. If no challenge is18
made, the revision will take effect without further action. If the19
revision is challenged, the revision may not take effect without the20
approval of the Commission. 21
N. No Member State's rulemaking process or procedural requirements22
shall apply to the Commission. 23
1. The Commission shall have no authority over any Member State's24
rulemaking process or procedural requirements that do not pertain to the25
Compact. 26
O. Nothing in this Compact, nor any Rule or regulation of the27
Commission, shall be construed to limit, restrict, or in any way reduce28
the ability of a Member State to enact and enforce laws, regulations, or29
other Rules related to the Practice of Respiratory Therapy in that State,30
where those laws, regulations, or other Rules are not inconsistent with31
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the provisions of this Compact. 1
SECTION 10. OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT2
A. Oversight 3
1. The executive and judicial branches of State government in each4
Member State shall enforce this Compact and take all actions necessary5
and appropriate to implement the Compact. 6
2. Venue is proper and judicial proceedings by or against the7
Commission shall be brought solely and exclusively in a court of8
competent jurisdiction where the principal office of the Commission is9
located. The Commission may waive venue and jurisdictional defenses to10
the extent it adopts or consents to participate in alternative dispute11
resolution proceedings. Nothing herein shall affect or limit the12
selection or propriety of venue in any action against a Licensee for13
professional malpractice, misconduct, or any such similar matter.14
3. The Commission shall be entitled to receive service of process in15
any proceeding regarding the enforcement or interpretation of the Compact16
and shall have standing to intervene in such a proceeding for all17
purposes. Failure to provide the Commission service of process shall18
render a judgment or order void as to the Commission, this Compact, or19
promulgated Rules. 20
B. Default, Technical Assistance, and Termination21
1. If the Commission determines that a Member State has defaulted in22
the performance of its obligations or responsibilities under this Compact23
or the promulgated Rules, the Commission shall provide written notice to24
the defaulting State. The notice of default shall describe the default,25
the proposed means of curing the default, and any other action that the26
Commission may take, and shall offer training and specific technical27
assistance regarding the default. 28
2. The Commission shall provide a copy of the notice of default to29
the other Member States. 30
C. If a State in default fails to cure the default, the defaulting31
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State may be terminated from the Compact upon an affirmative vote of a1
majority of the Commissioners of the Member States, and all rights,2
privileges and benefits conferred on that State by this Compact may be3
terminated on the effective date of termination. A cure of the default4
does not relieve the offending State of obligations or liabilities5
incurred during the period of default. 6
D. Termination of membership in the Compact shall be imposed only7
after all other means of securing compliance have been exhausted. Notice8
of intent to suspend or terminate shall be given by the Commission to the9
Governor, the majority and minority leaders of the defaulting State's10
legislature, the defaulting State's Respiratory Therapy Licensing11
Authority and each of the Member States' Respiratory Therapy Licensing12
Authorities. 13
E. A State that has been terminated is responsible for all14
assessments, obligations, and liabilities incurred through the effective15
date of termination, including obligations that extend beyond the16
effective date of termination, if necessary. 17
F. Upon the termination of a State's membership from this Compact,18
that State shall immediately provide notice to all Licensees and Compact19
Privilege holders (of which the Commission has a record) within that20
State of such termination. The terminated State shall continue to21
recognize all licenses granted pursuant to this Compact for a minimum of22
one hundred eighty days after the date of said notice of termination.23
G. The Commission shall not bear any costs related to a State that24
is found to be in default or that has been terminated from the Compact,25
unless agreed upon in writing between the Commission and the defaulting26
State. 27
H. The defaulting State may appeal the action of the Commission by28
petitioning the United States District Court for the District of Columbia29
or the federal district where the Commission has its principal offices.30
The prevailing party shall be awarded all costs of such litigation,31
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including reasonable attorney's fees. 1
I. Dispute Resolution 2
1. Upon request by a Member State, the Commission shall attempt to3
resolve disputes related to the Compact that arise among Member States4
and between Member and non-Member States. 5
2. The Commission shall promulgate a Rule providing for both6
mediation and binding dispute resolution for disputes, as appropriate.7
J. Enforcement 8
1. By majority vote, as may be further provided by Rule, the9
Commission may initiate legal action against a Member State in default in10
the United States District Court for the District of Columbia or the11
federal district where the Commission has its principal offices to12
enforce compliance with the provisions of the Compact and its promulgated13
Rules. A Member State by enactment of this Compact consents to venue and14
jurisdiction in such court for the purposes set forth herein. The relief15
sought may include both injunctive relief and damages. In the event16
judicial enforcement is necessary, the prevailing party shall be awarded17
all costs of such litigation, including reasonable attorney's fees. The18
remedies herein shall not be the exclusive remedies of the Commission.19
The Commission may pursue any other remedies available under federal or20
the defaulting Member State's law. 21
2. A Member State may initiate legal action against the Commission22
in the United States District Court for the District of Columbia or the23
federal district where the Commission has its principal offices to24
enforce compliance with the provisions of the Compact and its promulgated25
Rules. The relief sought may include both injunctive relief and damages.26
In the event judicial enforcement is necessary, the prevailing party27
shall be awarded all costs of such litigation, including reasonable28
attorney's fees. 29
3. No person other than a Member State shall enforce this Compact30
against the Commission. 31
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SECTION 11. EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT1
A. The Compact shall come into effect on the date on which the2
Compact statute is enacted into law in the seventh Member State3
("Effective Date"). 4
1. On or after the Effective Date of the Compact, the Commission5
shall convene and review the enactment of each of the first seven Member6
States ("Charter Member States") to determine if the statute enacted by7
each such Charter Member State is materially different than the Model8
Compact. 9
a. A Charter Member State whose enactment is found to be materially10
different from the Model Compact shall be entitled to the default process11
set forth in Section 10. 12
b. If any Member State is later found to be in default, or is13
terminated or withdraws from the Compact, the Commission shall remain in14
existence and the Compact shall remain in effect even if the number of15
Member States should be less than seven. 16
2. Member States enacting the Compact subsequent to the seven17
initial Charter Member States shall be subject to the process set forth18
herein and Commission Rule to determine if their enactments are19
materially different from the Model Compact and whether they qualify for20
participation in the Compact. 21
3. All actions taken for the benefit of the Commission or in22
furtherance of the purposes of the administration of the Compact prior to23
the effective date of the Compact or the Commission coming into existence24
shall be considered to be actions of the Commission unless specifically25
repudiated by the Commission. The Commission shall own and have all26
rights to any intellectual property developed on behalf or in furtherance27
of the Commission by individuals or entities involved in organizing or28
establishing the Commission, as may be further set forth in Rules of the29
Commission. 30
4. Any State that joins the Compact subsequent to the Commission's31
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initial adoption of the Rules and bylaws shall be subject to the Rules1
and bylaws as they exist on the date on which the Compact becomes law in2
that State. Any Rule that has been previously adopted by the Commission3
shall have the full force and effect of law on the date the Compact4
becomes law in that State. 5
B. Any Member State may withdraw from this Compact by enacting a6
statute repealing the same. 7
1. A Member State's withdrawal shall not take effect until one8
hundred eighty days after enactment of the repealing statute.9
2. Withdrawal shall not affect the continuing requirement of the10
withdrawing State's Respiratory Therapy Licensing Authority to comply11
with the investigative and Adverse Action reporting requirements of this12
Compact prior to the effective date of withdrawal.13
3. Upon the enactment of a statute withdrawing from this Compact, a14
State shall immediately provide notice of such withdrawal to all15
Licensees and Compact Privilege holders (of which the Commission has a16
record) within that State. Notwithstanding any subsequent statutory17
enactment to the contrary, such withdrawing State shall continue to18
recognize all licenses granted pursuant to this Compact for a minimum of19
one hundred eighty days after the date of such notice of withdrawal.20
C. Nothing contained in this Compact shall be construed to21
invalidate or prevent any licensure agreement or other cooperative22
arrangement between a Member State and a non-Member State that does not23
conflict with the provisions of this Compact. 24
D. This Compact may be amended by the Member States. No amendment to25
this Compact shall become effective and binding upon any Member State26
until it is enacted into the laws of all Member States.27
SECTION 12. CONSTRUCTION AND SEVERABILITY 28
A. This Compact and the Commission's rulemaking authority shall be29
liberally construed so as to effectuate the purposes and the30
implementation and administration of the Compact. Provisions of the31
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Compact expressly authorizing or requiring the promulgation of Rules1
shall not be construed to limit the Commission's rulemaking authority2
solely for those purposes. 3
B. The provisions of this Compact shall be severable, and if any4
phrase, clause, sentence, or provision of this Compact is held by a court5
of competent jurisdiction to be contrary to the constitution of any6
Member State, a State seeking participation in the Compact, or of the7
United States, or the applicability thereof to any government, agency,8
person, or circumstance is held to be unconstitutional by a court of9
competent jurisdiction, the validity of the remainder of this Compact and10
the applicability thereof to any other government, agency, person, or11
circumstance shall not be affected thereby. 12
C. Notwithstanding subsection B of this section, the Commission may13
deny a State's participation in the Compact or, in accordance with the14
requirements of Section 10, terminate a Member State's participation in15
the Compact, if it determines that a constitutional requirement of a16
Member State is a material departure from the Compact. Otherwise, if this17
Compact shall be held to be contrary to the constitution of any Member18
State, the Compact shall remain in full force and effect as to the19
remaining Member States and in full force and effect as to the Member20
State affected as to all severable matters. 21
SECTION 13. CONSISTENT EFFECT AND CONFLICT WITH OTHER STATE LAWS22
A. Nothing herein shall prevent or inhibit the enforcement of any23
other law of a Member State that is not inconsistent with the Compact.24
B. Any laws, statutes, regulations, or other legal requirements in a25
Member State in conflict with the Compact are superseded to the extent of26
the conflict, including any subsequently enacted State laws.27
C. All permissible agreements between the Commission and the Member28
States are binding in accordance with their terms.29
D. Other than as expressly set forth herein, nothing in this Compact30
will impact initial licensure. 31
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Sec. 2. Section 38-131, Revised Statutes Supplement, 2025, is1
amended to read: 2
38-131 (1) An applicant for an initial license to practice as a3
registered nurse, a licensed practical nurse, a physical therapist, a4
physical therapy assistant, a psychologist, a respiratory care5
practitioner, an advanced emergency medical technician, an emergency6
medical technician, an audiologist, a speech-language pathologist, a7
licensed independent mental health practitioner, an occupational8
therapist, an occupational therapy assistant, a dietitian, a certified9
social worker, a certified master social worker, a licensed clinical10
social worker, a paramedic, a physician, an osteopathic physician, a11
physician or osteopathic physician who is an applicant for a temporary12
educational permit, a physician or osteopathic physician who is an13
applicant for a temporary visiting faculty permit, a physician assistant,14
a dentist, a dental hygienist, an optometrist, a podiatrist, a15
veterinarian, an advanced practice registered nurse-nurse practitioner,16
an advanced practice registered nurse-certified nurse midwife, or an17
advanced practice registered nurse-certified registered nurse anesthetist18
shall be subject to a criminal background check. Except as provided in19
subsection (4) of this section, such an applicant for an initial license20
shall submit a full set of fingerprints to the Nebraska State Patrol for21
a criminal history record information check. The applicant shall22
authorize release of the results of the national criminal history record23
information check by the Federal Bureau of Investigation to the24
department. The applicant shall pay the actual cost of the fingerprinting25
and criminal background check. 26
(2) The Nebraska State Patrol is authorized to submit the27
fingerprints of such applicants to the Federal Bureau of Investigation28
and to issue a report to the department that includes the criminal29
history record information concerning the applicant. The Nebraska State30
Patrol shall forward submitted fingerprints to the Federal Bureau of31
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Investigation for a national criminal history record information check.1
The Nebraska State Patrol shall issue a report to the department that2
includes the criminal history record information concerning the3
applicant. 4
(3) This section shall not apply to a dentist who is an applicant5
for a dental locum tenens under section 38-1122, to a physician or6
osteopathic physician who is an applicant for a physician locum tenens7
under section 38-2036, or to a veterinarian who is an applicant for a8
veterinarian locum tenens under section 38-3335. 9
(4) A physician or osteopathic physician who is an applicant for a10
temporary educational permit shall have ninety days from the issuance of11
the permit to comply with subsection (1) of this section and shall have12
such permit suspended after such ninety-day period if the criminal13
background check is not complete or revoked if the criminal background14
check reveals that the applicant was not qualified for the permit.15
(5) The department and the Nebraska State Patrol may adopt and16
promulgate rules and regulations concerning costs associated with the17
fingerprinting and the national criminal history record information18
check. 19
(6) For purposes of interpretation by the Federal Bureau of20
Investigation, the term department in this section means the Division of21
Public Health of the Department of Health and Human Services.22
Sec. 3. Section 38-3208, Revised Statutes Cumulative Supplement,23
2024, is amended to read: 24
38-3208 (1) Except as provided in subsection (2) of this section, a25
person shall not engage in the practice of respiratory care unless such26
person is licensed pursuant to the Respiratory Care Practice Act or holds27
a compact privilege under the Respiratory Care Interstate Compact.28
(2) Subsection (1) of this section The Respiratory Care Practice Act29
shall not prohibit: 30
(a) (1) The practice of respiratory care which is an integral part31
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of the program of study by students enrolled in approved respiratory care1
education programs; 2
(b) (2) The gratuitous care, including the practice of respiratory3
care, of the ill by a friend or member of the family or by a person who4
is not licensed to practice respiratory care if such person does not5
represent himself or herself as a respiratory care practitioner;6
(c) (3) The practice of respiratory care by nurses, physicians,7
physician assistants, physical therapists, or any other professional8
required to be licensed under the Uniform Credentialing Act when such9
practice is within the scope of practice for which that person is10
licensed to practice in this state; 11
(d) (4) The practice of any respiratory care practitioner of this12
state or any other state or territory while employed by the federal13
government or any bureau or division thereof while in the discharge of14
his or her official duties; 15
(e) (5) Techniques defined as pulmonary function testing and the16
administration of aerosol and inhalant medications to the17
cardiorespiratory system as it relates to pulmonary function technology18
administered by a registered pulmonary function technologist credentialed19
by the National Board for Respiratory Care or a certified pulmonary20
function technologist credentialed by the National Board for Respiratory21
Care; or 22
(f) (6) The performance of oxygen therapy or the initiation of23
noninvasive positive pressure ventilation by a registered24
polysomnographic technologist relating to the study of sleep disorders if25
such procedures are performed or initiated under the supervision of a26
licensed physician at a facility accredited by the American Academy of27
Sleep Medicine. 28
Sec. 4. Original section 38-3208, Revised Statutes Cumulative29
Supplement, 2024, and section 38-131, Revised Statutes Supplement, 2025,30
are repealed. 31
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