Enter into the Respiratory Care Interstate Compact

sb149_02_PS

As Passed by the Senate

136th
General Assembly

Regular
Session
Am. S. B. No. 149

2025-2026

Senator Roegner

Cosponsors: Senators Huffman,
Romanchuk, Cirino, DeMora, Gavarone, Hicks-Hudson, Lang, O'Brien,
Patton, Reineke, Reynolds

A
BILL

To
enact sections 4761.20
,

4761.21
,
and 4761.22

of
the Revised Code
to
enter into the Respiratory Care Interstate Compact.

BE
IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section
1.
That
sections 4761.20
,

4761.21
,
and 4761.22

of
the Revised Code be enacted to read as follows:

Sec.
4761.20.
The
"Respiratory Care Interstate Compact" is hereby ratified,
enacted into law, and entered into by the state of Ohio as a party to
the compact with any other state that has legally joined the compact
as follows:

RESPIRATORY
CARE INTERSTATE COMPACT

SECTION
1. TITLE AND PURPOSE

A.
The purpose of this Compact is to facilitate the interstate Practice
of Respiratory Therapy with the goal of improving public access to
Respiratory Therapy services by providing Respiratory Therapists
licensed in a Member State the ability to practice in other Member
States. The Compact preserves the regulatory authority of states to
protect public health and safety through the current system of State
licensure.

B.

This
Compact is designed to achieve the following objectives:

1.

Increase
public access to Respiratory Therapy services by creating a
responsible, streamlined pathway for Licensees to practice in Member
States with the goal of improving outcomes for patients;

2.

Enhance
States' ability to protect the public's health and safety;

3.

Promote
the cooperation of Member States in regulating the Practice of
Respiratory Therapy within those Member States;

4.

Ease
administrative burdens on States by encouraging the cooperation of
Member States in regulating multi-state Respiratory Therapy practice;

5.

Support
relocating Active Military Members and their spouses; and

6.

Promote
mobility and address workforce shortages.

SECTION
2. DEFINITIONS

As
used in this Compact, unless the context requires otherwise, the
following definitions shall apply:

A.
"Active Military Member"

means
any person with a full-time duty status in the armed forces of the
United States, including members of the National Guard and Reserve.

B.
"Adverse Action"

means
any administrative, civil, equitable, or criminal action permitted by
a State's laws which is imposed by any State authority with
regulatory authority over Respiratory Therapists, such as license
denial, censure, revocation, suspension, probation, monitoring of the
Licensee, or restriction on the Licensee's practice, not including
participation in an Alternative Program.

C.
"Alternative Program"

means
a non-disciplinary monitoring or practice remediation process
applicable to a Respiratory Therapist approved by any State authority
with regulatory authority over Respiratory Therapists. This includes,
but is not limited to, programs to which Licensees with substance
abuse or addiction issues are referred in lieu of Adverse Action.

D.
"Charter Member States"

means
those Member States who were the first seven states to enact the
Compact into the laws of their State.

E.
"Commission"
or

"Respiratory
Care Interstate Compact Commission"

means
the government instrumentality and body politic whose membership
consists of all Member States that have enacted the Compact.

F.
"Commissioner"

means
the individual appointed by a Member State to serve as the member of
the Commission for that Member State.

G.
"Compact"

means
the Respiratory Care Interstate Compact.

H.
"Compact Privilege"

means
the authorization granted by a Remote State to allow a Licensee from
another Member State to practice as a Respiratory Therapist in the
Remote State under the Remote State's laws and Rules. The Practice of
Respiratory Therapy occurs in the Member State where the patient is
located at the time of the patient encounter.

I.
"Criminal Background Check"

means
the submission by the Member State of fingerprints or other
biometric-based information on license applicants at the time of
initial licensing for the purpose of obtaining that applicant's
criminal history record information, as defined in 28 C.F.R. §
20.3(d) or successor provision, from the Federal Bureau of
Investigation and the State's criminal history record repository, as
defined in 28 C.F.R. § 20.3(f) or successor provision.

J.
"Data System"

means
the Commission's repository of information about Licensees as further
set forth in Section 8.

K.
"Domicile"

means
the jurisdiction which is the Licensee's principal home for legal
purposes.

L.
"Encumbered License"

means
a license that a State's Respiratory Therapy Licensing Authority has
limited in any way.

M.
"Executive Committee"

means
a group of directors elected or appointed to act on behalf of, and
within the powers granted to them by the Commission.

N.
"Home State"

except
as set forth in Section 5, means the Member State that is the
Licensee's primary Domicile.

O.
"Home State License"

means
an active license to practice Respiratory Therapy in a Home State
that is not an Encumbered License.

P.
"Jurisprudence Requirement"

means
an assessment of an individual's knowledge of the State laws and
regulations governing the Practice of Respiratory Therapy in such
State.

Q.
"Licensee"

means
an individual who currently holds an authorization from the State to
practice as a Respiratory Therapist.

R.
"Member State"

means
a State that has enacted the Compact and been admitted to the
Commission in accordance with the provisions herein and Commission
Rules.

S.
"Model Compact"

means
the model for the Respiratory Care Interstate Compact on file with
The Council of State Governments or other entity as designated by the
Commission.

T.
"Remote State"

means
a Member State where a Licensee is exercising or seeking to exercise
the Compact Privilege.

U.
"Respiratory Therapist"
or

"Respiratory
Care Practitioner"
means
an individual who holds a credential issued by the National Board for
Respiratory Care (or its successor) and holds a license in a State to
practice Respiratory Therapy. For purposes of this Compact, any other
title or status adopted by a State to replace the term "Respiratory
Therapist" or "Respiratory Care Practitioner" shall be
deemed synonymous with "Respiratory Therapist" and shall
confer the same rights and responsibilities to the Licensee under the
provisions of this Compact at the time of its enactment.

V.
"Respiratory Therapy," "Respiratory Therapy Practice,"
"Respiratory Care," "the Practice of Respiratory
Care,"
and

"the
Practice of Respiratory Therapy"

means
the care and services provided by or under the direction and
supervision of a Respiratory Therapist or Respiratory Care
Practitioner as defined by state law and regulations.

W.
"Respiratory Therapy Licensing Authority"

means
the agency, board, or other body of a State that is responsible for
licensing and regulation of Respiratory Therapists.

X.
"Rule"

means
a regulation promulgated by an entity that has the force and effect
of law.

Y.
"Scope of Practice"

means
the procedures, actions, and processes a Respiratory Therapist
licensed in a State or practicing under a Compact Privilege in a
State is permitted to undertake in that State and the circumstances
under which the Respiratory Therapist is permitted to undertake those
procedures, actions, and processes. Such procedures, actions, and
processes, and the circumstances under which they may be undertaken
may be established through means, including, but not limited to,
statute, regulations, case law, and other processes available to the
State Respiratory Therapy Licensing Authority or other government
agency.

Z.
"Significant Investigative Information"

means
information, records, and documents received or generated by a State
Respiratory Therapy Licensing Authority pursuant to an investigation
for which a determination has been made that there is probable cause
to believe that the Licensee has violated a statute or regulation
that is considered more than a minor infraction for which the State
Respiratory Therapy Licensing Authority could pursue Adverse Action
against the Licensee.

AA.
"State"

means
any state, commonwealth, district, or territory of the United States.

SECTION
3. STATE PARTICIPATION IN THIS COMPACT

A.

In
order to participate in this Compact and thereafter continue as a
Member State, a Member State shall:

1.

Enact
a Compact that is not materially different from the Model Compact;

2.

License
Respiratory Therapists;

3.

Participate
in the Commission's Data System;

4.

Have
a mechanism in place for receiving and investigating complaints
against Licensees and Compact Privilege holders;

5.

Notify
the Commission, in compliance with the terms of this Compact and
Commission Rules, of any Adverse Action against a Licensee, a Compact
Privilege holder, or a license applicant;

6.

Notify
the Commission, in compliance with the terms of this Compact and
Commission Rules, of the existence of Significant Investigative
Information;

7.

Comply
with the Rules of the Commission;

8.

Grant
the Compact Privilege to a holder of an active Home State License and
otherwise meet the applicable requirements of Section 4 in a Member
State; and

9.

Complete
a Criminal Background Check for each new Licensee at the time of
initial licensure.

a.

Where
expressly authorized or permitted by federal law, whether such
federal law is in effect prior to, at, or after the time of a Member
State's enactment of this Compact, a Member State's enactment of this
Compact shall hereby authorize the Member State's Respiratory Therapy
Licensing Authority to perform Criminal Background Checks as defined
herein. The absence of such a federal law as described in this
subsection shall not prevent or preclude such authorization where it
may be derived or granted through means other than the enactment of
this Compact.

B.

Nothing
in this Compact prohibits a Member State from charging a fee for
granting and renewing the Compact Privilege.

SECTION
4. COMPACT PRIVILEGE

A.

To
exercise the Compact Privilege under the terms and provisions of the
Compact, the Licensee shall:

1.

Hold
and maintain an active Home State License as a Respiratory Therapist;

2.

Hold
and maintain an active credential from the National Board for
Respiratory Care (or its successor) that would qualify them for
licensure in the Remote State in which they are seeking the
privilege;

3.

Have
not had any Adverse Action against a license within the previous two
(2) years;

4.

Notify
the Commission that the Licensee is seeking the Compact Privilege
within a Remote State(s);

5.

Pay
any applicable fees, including any State and Commission fees and
renewal fees, for the Compact Privilege;

6.

Meet
any Jurisprudence Requirements established by the Remote State in
which the Licensee is seeking a Compact Privilege;

7.

Report
to the Commission Adverse Action taken by any non-Member State within
thirty (30) days from the date the Adverse Action is taken;

8.

Report
to the Commission, when applying for a Compact Privilege, the address
of the Licensee's Domicile and thereafter promptly report to the
Commission any change in the address of the Licensee's Domicile
within thirty (30) days of the effective date of the change in
address; and

9.
Consent to accept service of process by mail at the Licensee's
Domicile on record with the Commission with respect to any action
brought against the Licensee by the Commission or a Member State, and
consent to accept service of a subpoena by mail at the Licensee's
Domicile on record with the Commission with respect to any action
brought or investigation conducted by the Commission or a Member
State.

B.

The
Compact Privilege is valid until the expiration date or revocation of
the Home State License unless terminated pursuant to Adverse Action.
The Licensee must comply with all of the requirements of Subsection
A, above, to maintain the Compact Privilege in a Remote State. If
those requirements are met, no Adverse Actions are taken, and the
Licensee has paid any applicable Compact Privilege renewal fees, then
the Licensee will maintain the Licensee's Compact Privilege.

C.

A
Licensee providing Respiratory Therapy in a Remote State under the
Compact Privilege shall function within the Scope of Practice
authorized by the Remote State for the type of Respiratory Therapist
license the Licensee holds. Such procedures, actions, processes, and
the circumstances under which they may be undertaken may be
established through means, including, but not limited to, statute,
regulations, case law, and other processes available to the State
Respiratory Therapy Licensing Authority or other government agency.

D.

If
a Licensee's Compact Privilege in a Remote State is removed by the
Remote State, the individual shall lose or be ineligible for the
Compact privilege in that Remote State until the Compact Privilege is
no longer limited or restricted by that State.

E.

If
a Home State License is encumbered, the Licensee shall lose the
Compact Privilege in all Remote States until the following occur:

1.

The
Home State License is no longer encumbered; and

2.

Two
(2) years have elapsed from the date on which the license is no
longer encumbered due to the Adverse Action.

F.

Once
a Licensee with a restricted or limited license meets the
requirements of Subsection E.1 and 2, the Licensee must also meet the
requirements of Subsection A to obtain a Compact Privilege in a
Remote State.

SECTION
5. ACTIVE MILITARY MEMBER OR THEIR SPOUSE

A.

An
Active Military Member, or their spouse, shall designate a Home State
where the individual has a current license in good standing. The
individual may retain the Home State designation during the period
the service member is on active duty.

B.

An
Active Military Member and their spouse shall not be required to pay
to the Commission for a Compact Privilege any fee that may otherwise
be charged by the Commission. If a Remote State chooses to charge a
fee for a Compact Privilege, it may choose to charge a reduced fee or
no fee to an Active Military Member and their spouse for a Compact
Privilege.

SECTION
6. ADVERSE ACTIONS

A.

A
Member State in which a Licensee is licensed shall have authority to
impose Adverse Action against the license issued by that Member
State.

B.

A
Member State may take Adverse Action based on Significant
Investigative Information of a Remote State or the Home State, so
long as the Member State follows its own procedures for imposing
Adverse Action.

C.

Nothing
in this Compact shall override a Member State's decision that
participation in an Alternative Program may be used in lieu of
Adverse Action and that such participation shall remain non-public if
required by the Member State's laws.

D.

A
Remote State shall have the authority to:

1.

Take
Adverse Actions as set forth herein against a Licensee's Compact
Privilege in that State;

2.

Issue
subpoenas for both hearings and investigations that require the
attendance and testimony of witnesses, and the production of
evidence.

a.

Subpoenas
may be issued by a Respiratory Therapy Licensing Authority in a
Member State for the attendance and testimony of witnesses and the
production of evidence.

b.

Subpoenas
issued by a Respiratory Therapy Licensing Authority in a Member State
for the attendance and testimony of witnesses shall be enforced in
the latter State by any court of competent jurisdiction in the latter
State, according to the practice and procedure of that court
applicable to subpoenas issued in proceedings pending before it.

c.

Subpoenas
issued by a Respiratory Therapy Licensing Authority in a Member State
for production of evidence from another Member State shall be
enforced in the latter State, according to the practice and procedure
of that court applicable to subpoenas issued in the proceedings
pending before it.

d.

The
issuing authority shall pay any witness fees, travel expenses,
mileage, and other fees required by the service statutes of the State
where the witnesses or evidence are located;

3.
Unless otherwise prohibited by State law, recover from the Licensee
the costs of investigations and disposition of cases resulting from
any Adverse Action taken against that Licensee;

4.
Notwithstanding subsection D.2., a Member State may not issue a
subpoena to gather evidence of conduct in another Member State that
is lawful in such other Member State for the purpose of taking
Adverse Action against a Licensee's Compact Privilege or application
for a Compact Privilege in that Member State; and

5.
Nothing in this Compact authorizes a Member State to impose
discipline against a Respiratory Therapist's Compact Privilege in
that Member State for the individual's otherwise lawful practice in
another State.

E.
Joint Investigations

1.
In addition to the authority granted to a Member State by its
respective Respiratory Therapy Practice act or other applicable state
law, a Member State may participate with other Member States in joint
investigations of Licensees, provided, however, that a Member State
receiving such a request has no obligation to respond to any subpoena
issued regarding an investigation of conduct or practice that was
lawful in a Member State at the time it was undertaken.

2.
Member States shall share any Significant Investigative Information,
litigation, or compliance materials in furtherance of any joint or
individual investigation initiated under the Compact. In sharing such
information between Member State Respiratory Therapy Licensing
Authorities, all information obtained shall be kept confidential,
except as otherwise mutually agreed upon by the sharing and receiving
Member State(s).

F.
Nothing in this Compact may permit a Member State to take any Adverse
Action against a Licensee or holder of a Compact Privilege for
conduct or practice that was legal in the Member State at the time it
was undertaken.

G.
Nothing in this Compact may permit a Member State to take
disciplinary action against a Licensee or holder of a Compact
Privilege for conduct or practice that was legal in the Member State
at the time it was undertaken.

SECTION
7. ESTABLISHMENT OF THE RESPIRATORY CARE INTERSTATE COMPACT
COMMISSION

A.
The Compact Member States hereby create and establish a joint
government agency whose membership consists of all Member States that
have enacted the Compact known as the Respiratory Care Interstate
Compact Commission. The Commission is an instrumentality of the
Compact Member States acting jointly and not an instrumentality of
any one State. The Commission shall come into existence on or after
the effective date of the Compact, as set forth in Section 11.

B.
Membership, Voting, and Meetings

1.
Each Member State shall have and be limited to one (1) Commissioner
selected by that Member State's Respiratory Therapy Licensing
Authority.

2.
The Commissioner shall be an administrator or their designated staff
member of the Member State's Respiratory Therapy Licensing Authority.

3.
The Commission shall by Rule or bylaw establish a term of office for
Commissioners and may by Rule or bylaw establish term limits.

4.
The Commission may recommend to a Member State the removal or
suspension any Commissioner from office.

5.
A Member State's Respiratory Therapy Licensing Authority shall fill
any vacancy of its Commissioner occurring on the Commission within
sixty (60) days of the vacancy.

6.
Each Commissioner shall be entitled to one vote on all matters before
the Commission requiring a vote by Commissioners.

7.
A Commissioner shall vote in person or by such other means as
provided in the bylaws. The bylaws may provide for Commissioners to
meet by telecommunication, video conference, or other means of
communication.

8.
The Commission shall meet at least once during each calendar year.
Additional meetings may be held as set forth in the bylaws.

C.
The Commission shall have the following powers:

1.
Establish and amend the fiscal year of the Commission;

2.
Establish and amend bylaws and policies, including but not limited
to, a code of conduct and conflict of interest;

3.
Establish and amend Rules, which shall be binding in all Member
States;

4.
Maintain its financial records in accordance with the bylaws;

5.
Meet and take such actions as are consistent with the provisions of
this Compact, the Commission's Rules, and the bylaws;

6.
Initiate and conduct legal proceedings or actions in the name of the
Commission, provided that the standing of any Respiratory Therapy
Licensing Authority to sue or be sued under applicable law shall not
be affected;

7.
Maintain and certify records and information provided to a Member
State as the authenticated business records of the Commission, and
designate an agent to do so on the Commission's behalf;

8.
Purchase and maintain insurance and bonds;

9.
Accept or contract for services of personnel, including, but not
limited to, employees of a Member State;

10.
Conduct an annual financial review;

11.
Hire employees, elect or appoint officers, fix compensation, define
duties, grant such individuals appropriate authority to carry out the
purposes of the Compact, and establish the Commission's personnel
policies and programs relating to conflicts of interest,
qualifications of personnel, and other related personnel matters;

12.
Assess and collect fees;

13.
Accept any and all appropriate gifts, donations, grants of money,
other sources of revenue, equipment, supplies, materials, and
services, and receive, utilize, and dispose of the same, provided
that at all times:

a.
The Commission shall avoid any appearance of impropriety; and

b.
The Commission shall avoid any appearance of conflict of interest;

14.
Lease, purchase, retain, own, hold, improve, or use any property,
real, personal, or mixed, or any undivided interest therein;

15.
Sell, convey, mortgage, pledge, lease, exchange, abandon, or
otherwise dispose of any property real, personal, or mixed;

16.
Establish a budget and make expenditures;

17.
Borrow money in a fiscally responsible manner;

18.
Appoint committees, including standing committees, composed of
Commissioners State regulators, State legislators or their
representatives, and consumer representatives, and such other
interested persons as may be designated in this Compact and the
bylaws;

19.
Provide and receive information from, and cooperate with, law
enforcement agencies;

20.
Establish and elect an Executive Committee, including a chair,
vice-chair, secretary, treasurer, and such other offices as the
Commission shall establish by Rule or bylaw;

21.
Enter into contracts or arrangements for the management of the
affairs of the Commission;

22.
Determine whether a State's adopted language is materially different
from the Model Compact language such that the State would not qualify
for participation in the Compact; and

23.
Perform such other functions as may be necessary or appropriate to
achieve the purposes of this Compact.

D.
The Executive Committee

1.
The Executive Committee shall have the power to act on behalf of the
Commission according to the terms of this Compact. The powers,
duties, and responsibilities of the Executive Committee shall
include:

a.
Overseeing the day-to-day activities of the administration of the
Compact, including enforcement and compliance with the provisions of
the Compact, its Rules and bylaws, and other such duties as deemed
necessary;

b.
Recommending to the Commission changes to the Rules or bylaws,
changes to this Compact legislation, fees charged to Compact Member
States, fees charged to Licensees, and other fees;

c.
Ensuring Compact administration services are appropriately provided,
including by contract;

d.
Preparing and recommending the budget;

e.
Maintaining financial records on behalf of the Commission;

f.
Monitoring Compact compliance of Member States and providing
compliance reports to the Commission;

g.
Establishing additional committees as necessary;

h.
Exercising the powers and duties of the Commission during the interim
between Commission meetings, except for adopting or amending Rules,
adopting or amending bylaws, and exercising any other powers and
duties expressly reserved to the Commission by Rule or bylaw; and

i.
Performing other duties as provided in the Rules or bylaws of the
Commission.

2.
The Executive Committee shall be composed of up to nine (9) members,
as further set forth in the bylaws of the Commission:

a.
Seven (7) voting members who are elected by the Commission from the
current membership of the Commission; and

b.
Two (2) ex-officio, non-voting members.

3.
The Commission may remove any member of the Executive Committee as
provided in the Commission's bylaws.

4.
The Executive Committee shall meet at least annually.

a.
Executive Committee meetings shall be open to the public, except that
the Executive Committee may meet in a closed, non-public meeting as
provided in subsection F.4 below;

b.
The Executive Committee shall give advance notice of its meetings,
posted on its website and as determined to provide notice to persons
with an interest in the business of the Commission; and

c.
The Executive Committee may hold a special meeting in accordance with
subsection F.2 below.

E.
The Commission shall adopt and provide to the Member States an annual
report.

F.
Meetings of the Commission

1.
All meetings of the Commission that are not closed pursuant to
subsection 7.F.4 shall be open to the public. Notice of public
meetings shall be posted on the Commission's website at least thirty
(30) days prior to the public meeting.

2.
Notwithstanding subsection 7.F.1, the Commission may convene an
emergency public meeting by providing at least twenty-four (24) hours
prior notice on the Commission's website, and any other means as
provided in the Commission's Rules, for any of the reasons it may
dispense with notice of proposed rulemaking under subsection 9.G. The
Commission's legal counsel shall certify that one of the reasons
justifying an emergency public meeting has been met.

3.
Notice of all Commission meetings shall provide the time, date, and
location of the meeting, and if the meeting is to be held or
accessible via telecommunication, video conference, or other
electronic means, the notice shall include the mechanism for access
to the meeting.

4.
The Commission or the Executive Committee may convene in a closed,
non-public meeting for the Commission or Executive Committee to
receive or solicit legal advice or to discuss:

a.
Non-compliance of a Member State with its obligations under the
Compact;

b.
The employment, compensation, discipline or other matters, practices
or procedures related to specific employees;

c.
Current or threatened discipline of a Licensee or Compact Privilege
holder by the Commission or by a Member State's Respiratory Therapy
Licensing Authority;

d.
Current, threatened, or reasonably anticipated litigation;

e.
Negotiation of contracts for the purchase, lease, or sale of goods,
services, or real estate;

f.
Accusing any person of a crime or formally censuring any person;

g.
Trade secrets or commercial or financial information that is
privileged or confidential;

h.
Information of a personal nature where disclosure would constitute a
clearly unwarranted invasion of personal privacy;

i.
Investigative records compiled for law enforcement purposes;

j.
Information related to any investigative reports prepared by or on
behalf of or for use of the Commission or other committee charged
with responsibility of investigation or determination of compliance
issues pursuant to the Compact;

k.
Legal advice;

l.
Matters specifically exempted from disclosure by federal or Member
State law; or

m.
Other matters as promulgated by the Commission by Rule.

5.
If a meeting, or portion of a meeting, is closed, the presiding
officer shall state that the meeting will be closed and reference
each relevant exempting provision, and such reference shall be
recorded in the minutes.

6.
The Commission shall keep minutes in accordance with Commission Rules
and bylaws. All documents considered in connection with an action
shall be identified in such minutes. All minutes and documents of a
closed meeting shall remain under seal, subject to release only by a
majority vote of the Commission or order of a court of competent
jurisdiction.

G.
Financing of the Commission

1.
The Commission shall pay, or provide for the payment of, the
reasonable expenses of its establishment, organization, and ongoing
activities.

2.
The Commission may accept any and all appropriate revenue sources as
provided herein.

3.
The Commission may levy on and collect an annual assessment from each
Member State and impose fees on Licensees of Member States to whom it
grants a Compact Privilege to cover the cost of the operations and
activities of the Commission and its staff. The aggregate annual
assessment amount for Member States, if any, shall be allocated based
upon a formula that the Commission shall promulgate by Rule.

4.
The Commission shall not incur obligations of any kind prior to
securing the funds or a loan adequate to meet the same; nor shall the
Commission pledge the credit of any of the Member States, except by
and with the authority of the Member State.

5.
The Commission shall keep accurate accounts of all receipts and
disbursements. The receipts and disbursements of the Commission shall
be subject to the financial review and accounting procedures
established under its bylaws. However, all receipts and disbursements
of funds handled by the Commission shall be subject to an annual
financial review by a certified or licensed public accountant, and
the report of the financial review shall be included in and become
part of the annual report of the Commission.

H.
Qualified Immunity, Defense, and Indemnification

1.
Nothing herein shall be construed as a limitation on the liability of
any Licensee for professional malpractice or misconduct, which shall
be governed solely by any other applicable state laws.

2.
The Member States, Commissioners, officers, executive directors,
employees, and agents of the Commission shall be immune from suit and
liability, both personally and in their official capacity, for any
claim for damage to or loss of property or personal injury or other
civil liability caused by or arising out of any actual or alleged
act, error, or omission that occurred, or that the person against
whom the claim is made had a reasonable basis for believing occurred
within the scope of Commission employment, duties or
responsibilities; provided that nothing in this subsection shall be
construed to protect any such person from suit or liability for any
damage, loss, injury, or liability caused by the intentional or
willful or wanton misconduct of that person. The procurement of
insurance of any type by the Commission shall not in any way
compromise or limit the immunity granted hereunder.

3.
The Commission shall defend any Commissioner, officer, executive
director, employee, and agent of the Commission in any civil action
seeking to impose liability arising out of any actual or alleged act,
error, or omission that occurred within the scope of Commission
employment, duties, or responsibilities, or as determined by the
Commission that the person against whom the claim is made had a
reasonable basis for believing occurred within the scope of
Commission employment, duties, or responsibilities; provided that
nothing herein shall be construed to prohibit that person from
retaining their own counsel at their own expense; and provided
further, that the actual or alleged act, error, or omission did not
result from that person's intentional or willful or wanton
misconduct.

4.
The Commission shall indemnify and hold harmless any Commissioner,
member, officer, executive director, employee, and agent of the
Commission for the amount of any settlement or judgment obtained
against that person arising out of any actual or alleged act, error,
or omission that occurred within the scope of Commission employment,
duties, or responsibilities, or that such person had a reasonable
basis for believing occurred within the scope of Commission
employment, duties, or responsibilities, provided that the actual or
alleged act, error, or omission did not result from the intentional
or willful or wanton misconduct of that person.

5.
Nothing in this Compact shall be interpreted to waive or otherwise
abrogate a Member State's state action immunity or state action
affirmative defense with respect to antitrust claims under the
Sherman Act, Clayton Act, or any other State or federal antitrust or
anticompetitive law or regulation.

6.
Nothing in this Compact shall be construed to be a waiver of
sovereign immunity by the Member States or by the Commission.

SECTION
8. DATA SYSTEM

A.
The Commission shall provide for the development, maintenance,
operation, and utilization of a coordinated database and reporting
system containing licensure, Adverse Action, and the presence of
Significant Investigative Information.

B.
Notwithstanding any other provision of State law to the contrary, a
Member State shall submit a uniform data set to the Data System as
required by the Rules of the Commission, including but not limited
to:

1.
Identifying information;

2.
Licensure data;

3.
Adverse Actions against a Licensee, license applicant, or Compact
Privilege holder and information related thereto;

4.
Non-confidential information related to Alternative Program
participation, the beginning and ending dates of such participation,
and other information related to such participation not made
confidential under Member State law;

5.
Any denial of application for licensure, and the reason(s) for such
denial;

6.
The presence of current Significant Investigative Information; and

7.
Other information that may facilitate the administration of this
Compact or the protection of the public, as determined by the Rules
of the Commission.

C.
No Member State shall submit any information which constitutes
criminal history record information, as defined by applicable federal
law, to the Data System established hereunder.

D.
The records and information provided to a Member State pursuant to
this Compact or through the Data System, when certified by the
Commission or an agent thereof, shall constitute the authenticated
business records of the Commission, and shall be entitled to any
associated hearsay exception in any relevant judicial, quasi-judicial
or administrative proceedings in a Member State.

E.
Significant Investigative Information pertaining to a Licensee in any
Member State will only be available to other Member States.

F.
It is the responsibility of the Member States to report any Adverse
Action against a Licensee and to monitor the database to determine
whether Adverse Action has been taken against a Licensee. Adverse
Action information pertaining to a Licensee in any Member State will
be available to any other Member State.

G.
Member States contributing information to the Data System may
designate information that may not be shared with the public without
the express permission of the contributing State.

H.
Any information submitted to the Data System that is subsequently
expunged pursuant to federal law or the laws of the Member State
contributing the information shall be removed from the Data System.

SECTION
9. RULEMAKING

A.
The Commission shall promulgate reasonable Rules in order to
effectively and efficiently implement and administer the purposes and
provisions of the Compact. A Rule shall be invalid and have no force
or effect only if a court of competent jurisdiction holds that the
Rule is invalid because the Commission exercised its rulemaking
authority in a manner that is beyond the scope and purposes of the
Compact, or the powers granted hereunder, or based upon another
applicable standard of review.

B.
For purposes of the Compact, the Rules of the Commission shall have
the force of law in each Member State.

C.
The Commission shall exercise its rulemaking powers pursuant to the
criteria set forth in this section and the Rules adopted thereunder.
Rules shall become binding as of the date specified in each Rule.

D.
If a majority of the legislatures of the Member States rejects a Rule
or portion of a Rule, by enactment of a statute or resolution in the
same manner used to adopt the Compact within four (4) years of the
date of adoption of the Rule, then such Rule shall have no further
force and effect in any Member State.

E.
Rules shall be adopted at a regular or special meeting of the
Commission.

F.
Prior to adoption of a proposed Rule, the Commission shall hold a
public hearing and allow persons to provide oral and written
comments, data, facts, opinions, and arguments.

G.
Prior to adoption of a proposed Rule by the Commission, and at least
thirty (30) days in advance of the meeting at which the Commission
will hold a public hearing on the proposed Rule, the Commission shall
provide a notice of proposed rulemaking:

1.
On the website of the Commission or other publicly accessible
platform;

2.
To persons who have requested notice of the Commission's notices of
proposed rulemaking, and

3.
In such other way(s) as the Commission may by Rule specify.

H.
The notice of proposed rulemaking shall include:

1.
The time, date, and location of the public hearing at which the
Commission will hear public comments on the proposed Rule and, if
different, the time, date, and location of the meeting where the
Commission will consider and vote on the proposed Rule;

2.
If the hearing is held via telecommunication, video conference, or
other electronic means, the Commission shall include the mechanism
for access to the hearing in the notice of proposed rulemaking;

3.
The text of the proposed Rule and the reason therefor;

4.
A request for comments on the proposed Rule from any interested
person; and

5.
The manner in which interested persons may submit written comments.

I.
All hearings will be recorded. A copy of the recording and all
written comments and documents received by the Commission in response
to the proposed Rule shall be available to the public.

J.
Nothing in this section shall be construed as requiring a separate
hearing on each Rule. Rules may be grouped for the convenience of the
Commission at hearings required by this section.

K.
The Commission shall, by majority vote of all Commissioners, take
final action on the proposed Rule based on the rulemaking record and
the full text of the Rule.

1.
The Commission may adopt changes to the proposed Rule provided the
changes are consistent with the original purpose of the proposed
Rule.

2.
The Commission shall provide an explanation of the reasons for
substantive changes made to the proposed Rule as well as reasons for
substantive changes not made that were recommended by commenters.

3.
The Commission shall determine a reasonable effective date for the
Rule. Except for an emergency as provided in Section 9.L, the
effective date of the Rule shall be no sooner than thirty (30) days
after issuing the notice that it adopted or amended the Rule.

L.
Upon determination that an emergency exists, the Commission may
consider and adopt an emergency Rule with twenty-four (24) hours'
notice, and with opportunity to comment, provided that the usual
rulemaking procedures provided in the Compact and in this section
shall be retroactively applied to the Rule as soon as reasonably
possible, in no event later than ninety (90) days after the effective
date of the Rule. For the purposes of this provision, an emergency
Rule is one that must be adopted immediately in order to:

1.
Meet an imminent threat to public health, safety, or welfare;

2.
Prevent a loss of Commission or Member State funds;

3.
Meet a deadline for the promulgation of a Rule that is established by
federal law or Rule; or

4.
Protect public health and safety.

M.
The Commission or an authorized committee of the Commission may
direct revisions to a previously adopted Rule for purposes of
correcting typographical errors, errors in format, errors in
consistency, or grammatical errors. Public notice of any revisions
shall be posted on the website of the Commission. The revision shall
be subject to challenge by any person for a period of thirty (30)
days after posting. The revision may be challenged only on grounds
that the revision results in a material change to a Rule. A challenge
shall be made in writing and delivered to the Commission prior to the
end of the notice period. If no challenge is made, the revision will
take effect without further action. If the revision is challenged,
the revision may not take effect without the approval of the
Commission.

N.
No Member State's rulemaking process or procedural requirements shall
apply to the Commission.

1.
The Commission shall have no authority over any Member State's
rulemaking process or procedural requirements that do not pertain to
the Compact.

O.
Nothing in this Compact, nor any Rule or regulation of the
Commission, shall be construed to limit, restrict, or in any way
reduce the ability of a Member State to enact and enforce laws,
regulations, or other Rules related to the Practice of Respiratory
Therapy in that State, where those laws, regulations, or other Rules
are not inconsistent with the provisions of this Compact.

SECTION
10. OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT

A.
Oversight

1.
The executive and judicial branches of State government in each
Member State shall enforce this Compact and take all actions
necessary and appropriate to implement the Compact.

2.
Venue is proper and judicial proceedings by or against the Commission
shall be brought solely and exclusively in a court of competent
jurisdiction where the principal office of the Commission is located.
The Commission may waive venue and jurisdictional defenses to the
extent it adopts or consents to participate in alternative dispute
resolution proceedings. Nothing herein shall affect or limit the
selection or propriety of venue in any action against a Licensee for
professional malpractice, misconduct or any such similar matter.

3.
The Commission shall be entitled to receive service of process in any
proceeding regarding the enforcement or interpretation of the Compact
and shall have standing to intervene in such a proceeding for all
purposes. Failure to provide the Commission service of process shall
render a judgment or order void as to the Commission, this Compact,
or promulgated Rules.

B.
Default, Technical Assistance, and Termination

1.
If the Commission determines that a Member State has defaulted in the
performance of its obligations or responsibilities under this Compact
or the promulgated Rules, the Commission shall provide written notice
to the defaulting State. The notice of default shall describe the
default, the proposed means of curing the default, and any other
action that the Commission may take, and shall offer training and
specific technical assistance regarding the default.

2.
The Commission shall provide a copy of the notice of default to the
other Member States.

C.
If a State in default fails to cure the default, the defaulting State
may be terminated from the Compact upon an affirmative vote of a
majority of the Commissioners of the Member States, and all rights,
privileges and benefits conferred on that State by this Compact may
be terminated on the effective date of termination. A cure of the
default does not relieve the offending State of obligations or
liabilities incurred during the period of default.

D.
Termination of membership in the Compact shall be imposed only after
all other means of securing compliance have been exhausted. Notice of
intent to suspend or terminate shall be given by the Commission to
the governor, the majority and minority leaders of the defaulting
State's legislature, the defaulting State's Respiratory Therapy
Licensing Authority and each of the Member States' Respiratory
Therapy Licensing Authorities.

E.
A State that has been terminated is responsible for all assessments,
obligations, and liabilities incurred through the effective date of
termination, including obligations that extend beyond the effective
date of termination, if necessary.

F.
Upon the termination of a State's membership from this Compact, that
State shall immediately provide notice to all Licensees and Compact
Privilege holders (of which the Commission has a record) within that
State of such termination. The terminated State shall continue to
recognize all licenses granted pursuant to this Compact for a minimum
of one hundred eighty (180) days after the date of said notice of
termination.

G.
The Commission shall not bear any costs related to a State that is
found to be in default or that has been terminated from the Compact,
unless agreed upon in writing between the Commission and the
defaulting State.

H.
The defaulting State may appeal the action of the Commission by
petitioning the U.S. District Court for the District of Columbia or
the federal district where the Commission has its principal offices.
The prevailing party shall be awarded all costs of such litigation,
including reasonable attorney's fees.

I.
Dispute Resolution

1.
Upon request by a Member State, the Commission shall attempt to
resolve disputes related to the Compact that arise among Member
States and between Member and non-Member States.

2.
The Commission shall promulgate a Rule providing for both mediation
and binding dispute resolution for disputes, as appropriate.

J.
Enforcement

1.
By majority vote, as may be further provided by Rule, the Commission
may initiate legal action against a Member State in default in the
United States District Court for the District of Columbia or the
federal district where the Commission has its principal offices to
enforce compliance with the provisions of the Compact and its
promulgated Rules. A Member State by enactment of this Compact
consents to venue and jurisdiction in such court for the purposes set
forth herein. The relief sought may include both injunctive relief
and damages. In the event judicial enforcement is necessary, the
prevailing party shall be awarded all costs of such litigation,
including reasonable attorney's fees. The remedies herein shall not
be the exclusive remedies of the Commission. The Commission may
pursue any other remedies available under federal or the defaulting
Member State's law.

2.
A Member State may initiate legal action against the Commission in
the U.S. District Court for the District of Columbia or the federal
district where the Commission has its principal offices to enforce
compliance with the provisions of the Compact and its promulgated
Rules. The relief sought may include both injunctive relief and
damages. In the event judicial enforcement is necessary, the
prevailing party shall be awarded all costs of such litigation,
including reasonable attorney's fees.

3.
No person other than a Member State shall enforce this Compact
against the Commission.

SECTION
11. EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT

A.
The Compact shall come into effect on the date on which the Compact
statute is enacted into law in the seventh Member State ("Effective
Date").

1.
On or after the Effective Date of the Compact, the Commission shall
convene and review the enactment of each of the first seven Member
States ("Charter Member States") to determine if the
statute enacted by each such Charter Member State is materially
different than the Model Compact.

a.
A Charter Member State whose enactment is found to be materially
different from the Model Compact shall be entitled to the default
process set forth in Section 10.

b.
If any Member State is later found to be in default, or is terminated
or withdraws from the Compact, the Commission shall remain in
existence and the Compact shall remain in effect even if the number
of Member States should be less than seven.

2.
Member States enacting the Compact subsequent to the seven initial
Charter Member States shall be subject to the process set forth
herein and Commission Rule to determine if their enactments are
materially different from the Model Compact and whether they qualify
for participation in the Compact.

3.
All actions taken for the benefit of the Commission or in furtherance
of the purposes of the administration of the Compact prior to the
effective date of the Compact or the Commission coming into existence
shall be considered to be actions of the Commission unless
specifically repudiated by the Commission. The Commission shall own
and have all rights to any intellectual property developed on behalf
or in furtherance of the Commission by individuals or entities
involved in organizing or establishing the Commission, as may be
further set forth in Rules of the Commission.

4.
Any State that joins the Compact subsequent to the Commission's
initial adoption of the Rules and bylaws shall be subject to the
Rules and bylaws as they exist on the date on which the Compact
becomes law in that State. Any Rule that has been previously adopted
by the Commission shall have the full force and effect of law on the
date the Compact becomes law in that State.

B.
Any Member State may withdraw from this Compact by enacting a statute
repealing the same.

1.
A Member State's withdrawal shall not take effect until one hundred
eighty (180) days after enactment of the repealing statute.

2.
Withdrawal shall not affect the continuing requirement of the
withdrawing State's Respiratory Therapy Licensing Authority to comply
with the investigative and Adverse Action reporting requirements of
this Compact prior to the effective date of withdrawal.

3.
Upon the enactment of a statute withdrawing from this Compact, a
State shall immediately provide notice of such withdrawal to all
Licensees and Compact Privilege holders (of which the Commission has
a record) within that State. Notwithstanding any subsequent statutory
enactment to the contrary, such withdrawing State shall continue to
recognize all licenses granted pursuant to this Compact for a minimum
of one hundred eighty (180) days after the date of such notice of
withdrawal.

C.
Nothing contained in this Compact shall be construed to invalidate or
prevent any licensure agreement or other cooperative arrangement
between a Member State and a non-Member State that does not conflict
with the provisions of this Compact.

D.
This Compact may be amended by the Member States. No amendment to
this Compact shall become effective and binding upon any Member State
until it is enacted into the laws of all Member States.

SECTION
12. CONSTRUCTION AND SEVERABILITY

A.
This Compact and the Commission's rulemaking authority shall be
liberally construed so as to effectuate the purposes and the
implementation and administration of the Compact. Provisions of the
Compact expressly authorizing or requiring the promulgation of Rules
shall not be construed to limit the Commission's rulemaking authority
solely for those purposes.

B.
The provisions of this Compact shall be severable, and if any phrase,
clause, sentence or provision of this Compact is held by a court of
competent jurisdiction to be contrary to the constitution of any
Member State, a State seeking participation in the Compact, or of the
United States, or the applicability thereof to any government,
agency, person or circumstance is held to be unconstitutional by a
court of competent jurisdiction, the validity of the remainder of
this Compact and the applicability thereof to any other government,
agency, person or circumstance shall not be affected thereby.

C.
Notwithstanding subsection B of this section, the Commission may deny
a State's participation in the Compact or, in accordance with the
requirements of Section 10, terminate a Member State's participation
in the Compact, if it determines that a constitutional requirement of
a Member State is a material departure from the Compact. Otherwise,
if this Compact shall be held to be contrary to the constitution of
any Member State, the Compact shall remain in full force and effect
as to the remaining Member States and in full force and effect as to
the Member State affected as to all severable matters.

SECTION
13. CONSISTENT EFFECT AND CONFLICT WITH OTHER STATE LAWS

A.
Nothing herein shall prevent or inhibit the enforcement of any other
law of a Member State that is not inconsistent with the Compact.

B.
Any laws, statutes, regulations, or other legal requirements in a
Member State in conflict with the Compact are superseded to the
extent of the conflict, including any subsequently enacted State
laws.

C.
All permissible agreements between the Commission and the Member
States are binding in accordance with their terms.

D.
Other than as expressly set forth herein, nothing in this Compact
will impact initial licensure.

Sec.
4761.21.
Not
later than sixty days after the "Respiratory Care Interstate
Compact" is entered into under section 4761.20 of the Revised
Code, the state medical board, in accordance with Section 7 of the
compact, shall select one individual to serve as a commissioner on
the respiratory care interstate compact commission created under the
compact. The board shall fill a vacancy in this position not later
than sixty days after the vacancy occurs.

Sec.
4761.22.
(A)
"Compact privilege" and "home state" have the
same meanings as in section 4761.20 of the Revised Code.

(B)
Any individual who holds a compact privilege pursuant to the
"Respiratory Care Interstate Compact" entered into under
section 4761.20 of the Revised Code shall comply with sections
4776.01 to 4776.04 of the Revised Code within sixty days after
receiving the compact privilege in this state, unless a criminal
records check that meets equivalent requirements has already been
completed by the individual's home state.

On
receipt of the results of a criminal records check conducted pursuant
to this section, the state medical board may pursue any action on the
compact privilege authorized by section 4761.09 of the Revised Code.