Interstate Compacts

SENATE BILL 2544
By Reeves

HOUSE BILL 2145
By Terry
HB2145
012446
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AN ACT to amend Tennessee Code Annotated, Title 4 and
Title 63, relative to respiratory therapy.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF TENNESSEE:
SECTION 1. Tennessee Code Annotated, Title 63, Chapter 27, is amended by adding
the following as a new part:
63-27-201. Respiratory care interstate compact.
This state hereby enters into the "Respiratory Care Interstate Compact"
("compact") as set forth in this part. The text of the compact is set forth in §§ 63-27-202
– 63-27-214.
63-27-202. Section 1 – Title and purpose.
(a) The purpose of this compact is to facilitate the interstate practice of
respiratory therapy with the goal of improving public access to respiratory therapy
services by providing respiratory therapists licensed in a member state the ability to
practice in other member states. The compact preserves the regulatory authority of
states to protect public health and safety through the current system of state licensure.
(b) This compact is designed to achieve the following objectives:
(1) Increase public access to respiratory therapy services by creating a
responsible, streamlined pathway for licensees to practice in member states with
the goal of improving outcomes for patients;
(2) Enhance states' ability to protect the public's health and safety;
(3) Promote the cooperation of member states in regulating the practice
of respiratory therapy within those member states;

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(4) Ease administrative burdens on states by encouraging the
cooperation of member states in regulating multi-state respiratory therapy
practice;
(5) Support relocating active military members and their spouses; and
(6) Promote mobility and address workforce shortages.
63-27-203. Section 2 – Part definitions.
As used in this compact, unless the context requires otherwise, the following
definitions shall apply:
(1) "Active military member" means any person with a full-time duty
status in the armed forces of the United States, including members of the
national guard and reserve;
(2) "Adverse action" means any administrative, civil, equitable, or criminal
action permitted by a state's laws which is imposed by any state authority with
regulatory authority over respiratory therapists, such as license denial, censure,
revocation, suspension, probation, monitoring of the licensee, or restriction on
the licensee's practice, not including participation in an alternative program;
(3) "Alternative program" means a non-disciplinary monitoring or practice
remediation process applicable to a respiratory therapist approved by any state
authority with regulatory authority over respiratory therapists. This includes, but
is not limited to, programs to which licensees with substance abuse or addiction
issues are referred in lieu of adverse action;
(4) "Charter member states" means those member states who were the
first seven states to enact the compact into the laws of their state;

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(5) "Commission" or "respiratory care interstate compact commission"
means the government instrumentality and body politic whose membership
consists of all member states that have enacted the compact;
(6) "Commissioner" means the individual appointed by a member state to
serve as the member of the commission for that member state;
(7) "Compact" means the respiratory care interstate compact;
(8) "Compact privilege" means the authorization granted by a remote
state to allow a licensee from another member state to practice as a respiratory
therapist in the remote state under the remote state's laws and rules. The
practice of respiratory therapy occurs in the member state where the patient is
located at the time of the patient encounter;
(9) "Criminal background check" means the submission by the member
state of fingerprints or other biometric-based information on license applicants at
the time of initial licensing for the purpose of obtaining that applicant's criminal
history record information, as defined in 28 CFR § 20.3(d) or successor
provision, from the federal bureau of investigation and the state's criminal history
record repository, as defined in 28 CFR § 20.3(f) or successor provision;
(10) "Data system" means the commission's repository of information
about licensees as further set forth in § 63-27-209;
(11) "Domicile" means the jurisdiction which is the licensee's principal
home for legal purposes;
(12) "Encumbered license" means a license that a state's respiratory
therapy licensing authority has limited in any way;

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(13) "Executive committee" means a group of directors elected or
appointed to act on behalf of, and within the powers granted to them by, the
commission;
(14) "Home state," except as set forth in § 63-27-206, means the
member state that is the licensee's primary domicile;
(15) "Home state license" means an active license to practice respiratory
therapy in a home state that is not an encumbered license;
(16) "Jurisprudence requirement" means an assessment of an
individual's knowledge of the state laws and regulations governing the practice of
respiratory therapy in such state;
(17) "Licensee" means an individual who currently holds an authorization
from the state to practice as a respiratory therapist;
(18) "Member state" means a state that has enacted the compact and
been admitted to the commission in accordance with the provisions herein and
commission rules;
(19) "Model compact" means the model for the respiratory care interstate
compact on file with the council of state governments or other entity as
designated by the commission;
(20) "Remote state" means a member state where a licensee is
exercising or seeking to exercise the compact privilege;
(21) "Respiratory therapist" or "respiratory care practitioner" means an
individual who holds a credential issued by the national board for respiratory
care, or its successor, and holds a license in a state to practice respiratory
therapy. For purposes of this compact, any other title or status adopted by a
state to replace the term "respiratory therapist" or "respiratory care practitioner"

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shall be deemed synonymous with "respiratory therapist" and shall confer the
same rights and responsibilities to the licensee under the provisions of this
compact at the time of its enactment;
(22) "Respiratory therapy," "respiratory therapy practice," "respiratory
care," "the practice of respiratory care," and "the practice of respiratory therapy"
means the care and services provided by or under the direction and supervision
of a respiratory therapist or respiratory care practitioner;
(23) "Respiratory therapy licensing authority" means the agency, board,
or other body of a state that is responsible for licensing and regulation of
respiratory therapists;
(24) "Rule" means a regulation promulgated by an entity that has the
force and effect of law;
(25) "Scope of practice" means the procedures, actions, and processes a
respiratory therapist licensed in a state or practicing under a compact privilege in
a state is permitted to undertake in that state and the circumstances under which
the respiratory therapist is permitted to undertake those procedures, actions, and
processes. Such procedures, actions, and processes, and the circumstances
under which they may be undertaken may be established through means,
including, but not limited to, statute, regulations, case law, and other processes
available to the state respiratory therapy licensing authority or other government
agency;
(26) "Significant investigative information" means information, records,
and documents received or generated by a state respiratory therapy licensing
authority pursuant to an investigation for which a determination has been made
that there is probable cause to believe that the licensee has violated a statute or

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regulation that is considered more than a minor infraction for which the state
respiratory therapy licensing authority could pursue adverse action against the
licensee; and
(27) "State" means any state, commonwealth, district, or territory of the
United States.
63-27-204. Section 3 – State participation in this compact.
(a) In order to participate in this compact and thereafter continue as a member
state, a member state shall:
(1) Enact a compact that is not materially different from the model
compact;
(2) License respiratory therapists;
(3) Participate in the commission's data system;
(4) Have a mechanism in place for receiving and investigating complaints
against licensees and compact privilege holders;
(5) Notify the commission, in compliance with the terms of this compact
and commission rules, of any adverse action against a licensee, a compact
privilege holder, or a license applicant;
(6) Notify the commission, in compliance with the terms of this compact
and 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 § 63-27-205 in a
member state; and
(9)

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(A) Complete a criminal background check for each new licensee
at the time of initial licensure; and
(B) Where expressly authorized or permitted by federal law,
whether such federal law is in effect prior to, at, or after the time of a
member state's enactment of this compact, a member state's enactment
of this compact shall hereby authorize the member state's respiratory
therapy licensing authority to perform criminal background checks as
defined herein. The absence of such a federal law as described in this
subdivision (a)(9)(B) shall not prevent or preclude such authorization
where it may be derived or granted through means other than the
enactment of this compact.
(b) Nothing in this compact prohibits a member state from charging a fee for
granting and renewing the compact privilege.
63-27-205. Section 4 – Compact privilege.
(a) To exercise the compact privilege under the terms and provisions of the
compact, the licensee shall:
(1) Hold and maintain an active home state license as a respiratory
therapist;
(2) Hold and maintain an active credential from the national board for
respiratory care, or its successor, that would qualify them for licensure in the
remote state in which they are seeking the privilege;
(3) Have not had any adverse action against a license within the previous
two (2) years;
(4) Notify the commission that the licensee is seeking the compact
privilege within a remote state(s);

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(5) Pay any applicable fees, including any state and commission fees
and renewal fees, for the compact privilege;
(6) Meet any jurisprudence requirements established by the remote state
in which the licensee is seeking a compact privilege;
(7) Report to the commission adverse action taken by any non-member
state within thirty (30) days from the date the adverse action is taken;
(8) Report to the commission, when applying for a compact privilege, the
address of the licensee's domicile and thereafter promptly report to the
commission any change in the address of the licensee's domicile within thirty (30)
days of the effective date of the change in address; and
(9) Consent to accept service of process by mail at the licensee's
domicile on record with the commission with respect to any action brought
against the licensee by the commission or a member state, and consent to
accept service of a subpoena by mail at the licensee's domicile on record with
the commission with respect to any action brought or investigation conducted by
the commission or a member state.
(b) The compact privilege is valid until the expiration date or revocation of the
home state license unless terminated pursuant to adverse action. The licensee must
comply with all of the requirements of subsection (a) to maintain the compact privilege in
a remote state. If those requirements are met, no adverse actions 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,

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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
subdivisions (e)(1) and (2), the licensee must also meet the requirements of subsection
(a) to obtain a compact privilege in a remote state.
63-27-206. Section 5 – Active military member or their spouse.
(a) An active military member, or their spouse, shall designate a home state
where the individual has a current license in good standing. The individual may retain
the home state designation during the period the service member is on active duty.
(b) An active military member and their spouse shall not be required to pay to
the commission for a compact privilege any fee that may otherwise be charged by the
commission. If a remote state chooses to charge a fee for a compact privilege, it may
choose to charge a reduced fee or no fee to an active military member and their spouse
for a compact privilege.
63-27-207. Section 6 – Adverse actions.

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(a) A member state in which a licensee is licensed shall have authority to impose
adverse action against the license issued by that member state.
(b) A member state may take adverse action based on significant investigative
information of a remote state or the home state, so long as the member state follows its
own procedures for imposing adverse action.
(c) Nothing in this compact shall override a member state's decision that
participation in an alternative program may be used in lieu of adverse action and that
such participation shall remain non-public if required by the member state's laws.
(d) A remote state shall have the authority to:
(1) Take adverse actions as set forth herein against a licensee's compact
privilege in that state;
(2)
(A) Issue subpoenas for both hearings and investigations that
require the attendance and testimony of witnesses, and the production of
evidence;
(B) Subpoenas may be issued by a respiratory therapy licensing
authority in a member state for the attendance and testimony of
witnesses and the production of evidence;
(C) Subpoenas issued by a respiratory therapy licensing authority
in a member state for the attendance and testimony of witnesses shall be
enforced in the latter state by any court of competent jurisdiction in the
latter state, according to the practice and procedure of that court
applicable to subpoenas issued in proceedings pending before it;
(D) Subpoenas issued by a respiratory therapy licensing authority
in a member state for production of evidence from another member state

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shall be enforced in the latter state, according to the practice and
procedure of that court applicable to subpoenas issued in the
proceedings pending before it; and
(E) The issuing authority shall pay any witness fees, travel
expenses, mileage, and other fees required by the service statutes of the
state where the witnesses or evidence are located;
(3) Unless otherwise prohibited by state law, recover from the licensee
the costs of investigations and disposition of cases resulting from any adverse
action taken against that licensee;
(4) Notwithstanding subdivision (d)(2), a member state may not issue a
subpoena to gather evidence of conduct in another member state that is lawful in
such other member state for the purpose of taking adverse action against a
licensee's compact privilege or application for a compact privilege in that member
state; and
(5) Nothing in this compact authorizes a member state to impose
discipline against a respiratory therapist's compact privilege in that member state
for the individual's otherwise lawful practice in another state.
(e) Joint investigations.
(1) In addition to the authority granted to a member state by its
respective respiratory therapy practice act or other applicable state law, a
member state may participate with other member states in joint investigations of
licensees; provided, however, that a member state receiving such a request has
no obligation to respond to any subpoena issued regarding an investigation of
conduct or practice that was lawful in a member state at the time it was
undertaken.

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(2) Member states shall share any significant investigative information,
litigation, or compliance materials in furtherance of any joint or individual
investigation initiated under the compact. In sharing such information between
member state respiratory therapy licensing authorities, all information obtained
shall be kept confidential, except as otherwise mutually agreed upon by the
sharing and receiving member state(s).
(f) Nothing in this compact may permit a member state to take any adverse
action against a licensee or holder of a compact privilege for conduct or practice that
was legal in the member state at the time it was undertaken.
(g) Nothing in this compact may permit a member state to take disciplinary
action against a licensee or holder of a compact privilege for conduct or practice that
was legal in the member state at the time it was undertaken.
63-27-208. Section 7 – Establishment of the respiratory care interstate compact
commission.
(a) The compact member states hereby create and establish a joint government
agency whose membership consists of all member states that have enacted the
compact known as the respiratory care interstate compact commission. The
commission is an instrumentality of the compact member states acting jointly and not an
instrumentality of any one (1) state. The commission shall come into existence on or
after the effective date of the compact, as set forth in § 63-27-212.
(b) Membership, voting, and meetings.
(1) Each member state shall have and be limited to one (1)
commissioner selected by that member state's respiratory therapy licensing
authority.

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(2) The commissioner shall be an administrator or their designated staff
member of the member state's respiratory therapy licensing authority.
(3) The commission shall by rule or bylaw establish a term of office for
commissioners and may by rule or bylaw establish term limits.
(4) The commission may recommend to a member state the removal or
suspension of any commissioner 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 (1) vote on all matters
before the commission requiring a vote by commissioners.
(7) A commissioner shall vote in person or by such other means as
provided in the bylaws. The bylaws may provide for commissioners to meet by
telecommunication, videoconference, or other means of communication.
(8) The commission shall meet at least once during each calendar year.
Additional meetings may be held as set forth 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;

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(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;

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(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.

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(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.

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(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 subdivision (f)(4);
(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 subdivision (f)(2).
(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
subdivision (f)(4) shall be open to the public. Notice of public meetings shall be
posted on the commission's website at least thirty (30) days prior to the public
meeting.
(2) Notwithstanding subdivision (f)(1), the commission may convene an
emergency public meeting by providing at least twenty-four (24) hours prior

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notice on the commission's website, and any other means as provided in the
commission's rules, for any of the reasons it may dispense with notice of
proposed rulemaking under § 63-27-210(g). The commission's legal counsel
shall certify that one (1) of the reasons justifying an emergency public meeting
has been met.
(3) Notice of all commission meetings shall provide the time, date, and
location of the meeting, and if the meeting is to be held or accessible via
telecommunication, videoconference, or other electronic means, the notice shall
include the mechanism for access to the meeting.
(4) The commission or the executive committee may convene in a
closed, non-public meeting for the commission or executive committee to receive
or solicit legal advice or to discuss:
(A) Non-compliance of a member state with its obligations under
the compact;
(B) The employment, compensation, discipline, or other matters,
practices, or procedures related to specific employees;
(C) Current or threatened discipline of a licensee or compact
privilege holder by the commission or by a member state's respiratory
therapy licensing authority;
(D) Current, threatened, or reasonably anticipated litigation;
(E) Negotiation of contracts for the purchase, lease, or sale of
goods, services, or real estate;
(F) Accusing any person of a crime or formally censuring any
person;

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(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.

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(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,

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both personally and in their official capacity, for any claim for damage to or loss
of property or personal injury or other civil liability caused by or arising out of any
actual or alleged act, error, or omission that occurred, or that the person against
whom the claim is made had a reasonable basis for believing occurred within the
scope of commission employment, duties, or responsibilities; provided, that
nothing in this subdivision (h)(2) shall be construed to protect any such person
from suit or liability for any damage, loss, injury, or liability caused by the
intentional or willful or wanton misconduct of that person. The procurement of
insurance of any type by the commission shall not in any way compromise or
limit the immunity granted hereunder.
(3) The commission shall defend any commissioner, officer, executive
director, employee, and agent of the 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

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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 (15 U.S.C. § 1 et
seq.), Clayton Act (15 U.S.C. § 12 et seq.), or any other state or federal antitrust
or anticompetitive law or regulation.
(6) Nothing in this compact shall be construed to be a waiver of
sovereign immunity by the member states or by the commission.
63-27-209. Section 8 – Data system.
(a) The commission shall provide for the development, maintenance, operation,
and utilization of a coordinated database and reporting system containing licensure,
adverse action, and the presence of significant investigative information.
(b) Notwithstanding any other provision of state law to the contrary, a member
state shall submit a uniform data set to the data system as required by the rules of the
commission, including, but not limited to:
(1) Identifying information;
(2) Licensure data;
(3) Adverse actions against a licensee, license applicant, or compact
privilege holder and information related thereto;
(4) Non-confidential information related to alternative program
participation, the beginning and ending dates of such participation, and other

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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.

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(h) Any information submitted to the data system that is subsequently expunged
pursuant to federal law or the laws of the member state contributing the information shall
be removed from the data system.
63-27-210. Section 9 – Rulemaking.
(a) The commission shall promulgate 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.

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(g) Prior to adoption of a proposed rule by the commission, and at least thirty
(30) days in advance of the meeting at which the commission will hold a public hearing
on the proposed rule, the commission shall provide a notice of proposed rulemaking:
(1) On the website of the commission or other publicly accessible
platform;
(2) To persons who have requested notice of the commission's notices of
proposed rulemaking; and
(3) In such other way(s) as the commission may by rule specify.
(h) The notice of proposed rulemaking shall include:
(1) The time, date, and location of the public hearing at which the
commission will hear public comments on the proposed rule and, if different, the
time, date, and location of the meeting where the commission will consider and
vote on the proposed rule;
(2) If the hearing is held via telecommunication, videoconference, or
other electronic means, the commission shall include the mechanism for access
to the hearing in the notice of proposed rulemaking;
(3) The text of the proposed rule and the reason therefor;
(4) A request for comments on the proposed rule from any interested
person; and
(5) The manner in which interested persons may submit written
comments.
(i) All hearings will be recorded. A copy of the recording and all written
comments and documents received by the commission in response to the proposed rule
shall be available to the public.

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(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)
(1) 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.
(2) The commission may adopt changes to the proposed rule; provided,
the changes are consistent with the original purpose of the proposed rule.
(3) The commission shall provide an explanation of the reasons for
substantive changes made to the proposed rule as well as reasons for
substantive changes not made that were recommended by commenters.
(4) The commission shall determine a reasonable effective date for the
rule. Except for an emergency as provided in subsection (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 no later than ninety (90) days after the effective date of the rule. For the
purposes of this provision, an emergency rule is one that must be adopted immediately
in order to:
(1) Meet an imminent threat to public health, safety, or welfare;
(2) Prevent a loss of commission or member state funds;

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(3) Meet a deadline for the promulgation of a rule that is established by
federal law or rule; or
(4) Protect public health and safety.
(m) The commission or an authorized committee of the commission may direct
revisions to a previously adopted rule for purposes of correcting typographical errors,
errors in format, errors in consistency, or grammatical errors. Public notice of any
revisions shall be posted on the website of the commission. The revision shall be
subject to challenge by any person for a period of thirty (30) days after posting. The
revision may be challenged only on grounds that the revision results in a material
change to a rule. A challenge shall be made in writing and delivered to the commission
prior to the end of the notice period. If no challenge is made, the revision will take effect
without further action. If the revision is challenged, the revision may not take effect
without the approval of the commission.
(n)
(1) No member state's rulemaking process or procedural requirements
shall apply to the commission.
(2) The commission shall have no authority over any member state's
rulemaking process or procedural requirements that do not pertain to the
compact.
(o) Nothing in this compact, nor any rule or regulation of the commission, shall
be construed to limit, restrict, or in any way reduce the ability of a member state to enact
and enforce laws, regulations, or other rules related to the practice of respiratory therapy
in that state, where those laws, regulations, or other rules are not inconsistent with the
provisions of this compact.
63-27-211. Section 10 – Oversight, dispute resolution, and enforcement.

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(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.

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(c) If a state in default fails to cure the default, the defaulting state may be
terminated from the compact upon an affirmative vote of a majority of the commissioners
of the member states, and all rights, privileges, and benefits conferred on that state by
this compact may be terminated on the effective date of termination. A cure of the
default does not relieve the offending state of obligations or liabilities incurred during the
period of default.
(d) Termination of membership in the compact shall be imposed only after all
other means of securing compliance have been exhausted. Notice of intent to suspend
or terminate shall be given by the commission to the governor, the majority and minority
leaders of the defaulting state's legislature, the defaulting state's respiratory therapy
licensing authority, and each of the member states' respiratory therapy licensing
authorities.
(e) A state that has been terminated is responsible for all assessments,
obligations, and liabilities incurred through the effective date of termination, including
obligations that extend beyond the effective date of termination, if necessary.
(f) Upon the termination of a state's membership from this compact, that state
shall immediately provide notice to all licensees and compact privilege holders, of which
the commission has a record, within that state of such termination. The terminated state
shall continue to recognize all licenses granted pursuant to this compact for a minimum
of one hundred eighty (180) days after the date of said notice of termination.
(g) The commission shall not bear any costs related to a state that is found to be
in default or that has been terminated from the compact, unless agreed upon in writing
between the commission and the defaulting state.
(h) The defaulting state may appeal the action of the commission by petitioning
the U.S. District Court for the District of Columbia or the federal district where the

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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

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injunctive relief and damages. In the event judicial enforcement is necessary, the
prevailing party shall be awarded all costs of such litigation, including reasonable
attorney's fees.
(3) No person other than a member state shall enforce this compact
against the commission.
63-27-212. Section 11 – Effective date, withdrawal, and amendment.
(a)
(1) The compact shall come into effect on the date on which the compact
statute is enacted into law in the seventh member state ("effective date").
(2)
(A) On or after the effective date of the compact, the commission
shall convene and review the enactment of each of the first seven (7)
member states ("charter member states") to determine if the statute
enacted by each such charter member state is materially different than
the model compact.
(B) A charter member state whose enactment is found to be
materially different from the model compact shall be entitled to the default
process set forth in § 63-27-211.
(C) If any member state is later found to be in default, or is
terminated or withdraws from the compact, the commission shall remain
in existence and the compact shall remain in effect even if the number of
member states should be less than seven (7).
(3) Member states enacting the compact subsequent to the seven (7)
initial charter member states shall be subject to the process set forth herein and

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in commission rule to determine if their enactments are materially different from
the model compact and whether they qualify for participation in the compact.
(4) All actions taken for the benefit of the commission or in furtherance of
the purposes of the administration of the compact prior to the effective date of the
compact or the commission coming into existence shall be considered to be
actions of the commission unless specifically repudiated by the commission. The
commission shall own and have all rights to any intellectual property developed
on behalf or in furtherance of the commission by individuals or entities involved in
organizing or establishing the commission, as may be further set forth in rules of
the commission.
(5) Any state that joins the compact subsequent to the commission's
initial adoption of the rules and bylaws shall be subject to the rules and bylaws as
they exist on the date on which the compact becomes law in that state. Any rule
that has been previously adopted by the commission shall have the full force and
effect of law on the date the compact becomes law in that state.
(b)
(1) Any member state may withdraw from this compact by enacting a
statute repealing the same.
(2) A member state's withdrawal shall not take effect until one hundred
eighty (180) days after enactment of the repealing statute.
(3) Withdrawal shall not affect the continuing requirement of the
withdrawing state's respiratory therapy licensing authority to comply with the
investigative and adverse action reporting requirements of this compact prior to
the effective date of withdrawal.

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(4) 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.
63-27-213. Section 12 – Construction and severability.
(a) This compact and the commission's rulemaking authority shall be liberally
construed so as to effectuate the purposes and the implementation and administration of
the compact. Provisions of the compact expressly authorizing or requiring the
promulgation of rules shall not be construed to limit the commission's rulemaking
authority solely for those purposes.
(b) The provisions of this compact shall be severable, and if any phrase, clause,
sentence, or provision of this compact is held by a court of competent jurisdiction to be
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

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jurisdiction, the validity of the remainder of this compact and the applicability thereof to
any other government, agency, person, or circumstance shall not be affected thereby.
(c) Notwithstanding subsection (b), the commission may deny a state's
participation in the compact or, in accordance with the requirements of § 63-27-211,
terminate a member state's participation in the compact if it determines that a
constitutional requirement of a member state is a material departure from the compact.
Otherwise, if this compact shall be held to be contrary to the constitution of any member
state, the compact shall remain in full force and effect as to the remaining member
states and in full force and effect as to the member state affected as to all severable
matters.
63-27-214. Section 13 –Consistent effect and conflict with other state laws.
(a) Nothing herein shall prevent or inhibit the enforcement of any other law of a
member state that is not inconsistent with the compact.
(b) Any laws, statutes, regulations, or other legal requirements in a member
state in conflict with the compact are superseded to the extent of the conflict, including
any subsequently enacted state laws.
(c) All permissible agreements between the commission and the member states
are binding in accordance with their terms.
(d) Other than as expressly set forth herein, nothing in this compact will impact
initial licensure.
63-27-215. Rulemaking.
The board of respiratory care, in consultation with the department of health, may
promulgate rules in accordance with the Uniform Administrative Procedures Act,
compiled in title 4, chapter 5, to implement this part.
63-27-216. Effective date of compact – Notice.

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(a) This part takes effect on the date the compact is enacted into law in the
seventh compact state.
(b) The board of respiratory care shall notify the chair of the government
operations committee of the senate, the chair of any committee in the house of
representatives with subject matter jurisdiction over compacts dealing with respiratory
therapy, and the executive secretary of the Tennessee code commission in writing when
the condition specified in § 63-27-212 has occurred for the compact, a withdrawal, or an
amendment to become effective.
SECTION 2. Tennessee Code Annotated, Section 4-29-249(a), is amended by adding
the following as a new subdivision:
( ) Respiratory care interstate compact, created by § 63-27-202;
SECTION 3. Tennessee Code Annotated, Section 63-27-101, is amended by deleting
"chapter" and substituting "part".
SECTION 4. Tennessee Code Annotated, Section 63-27-102, is amended by deleting
"As used in this chapter" and substituting "As used in this part".
SECTION 5. Tennessee Code Annotated, Section 63-31-106(a)(2), is amended by
deleting "chapter 27 of this title" and substituting "chapter 27, part 1 of this title".
SECTION 6. The headings in this act are for reference purposes only and do not
constitute a part of the law enacted by this act. However, the Tennessee code commission is
requested to include the headings in any compilation or publication containing this act.
SECTION 7. This act takes effect upon becoming a law, the public welfare requiring it.