SB 2544

The Respiratory Care Interstate Compact (the "compact"") is a legally binding agreement among states that provides a pathway through which respiratory therapists can obtain compact privileges that authorize practice in states where they are not licensed. A state must enact the compact model legislation via a state's legislative process to join. As of the writing of this summary, Alabama, Iowa, Montana, Washington, and Wisconsin have officially joined or passed legislation for the compact. However, the co mp act requires a minimum of seven states to become active. PURPOSE The purpose of the 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. However, the compact preserves the regulatory authority of states to protect public health and safety through the current system of state licensure. STATE PARTICIPATION IN THE COMPACT In order to participate in the compact and continue as a member state, the compact requires a member state to adhere to all of the following requirements:  Enact a compact that is not materially different from the model compact.  License respiratory therapists.  Participate in the respiratory care interstate compact commission's (""commission"") data system.  Have a mechanism in place for receiving and investigating complaints against licensees and compact privilege holders.  Notify the commission, in compliance with the terms of the compact and commission rules, of any adverse action against a licensee, a compact privilege holder, or a license applicant.  Notify the commission, in compliance with the terms of the compact and commission rules, of the existence of significant investigative information.  Comply with the rules of the commission.  Grant the compact privilege to a holder of an active home state license and otherwise meet the applicable requirements of the compact in a member state.  Complete a criminal background check for each new licensee at the time of initial licensure. COMPACT PRIVILEGE The compact defines the ""compact privilege"" as 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, with the practice of respiratory therapy occurs in the member state where the patient is located at the time of the patient encounter. In order to exercise t he compact privilege, the licensee must adhere to all of the following requirements:  Hold and maintain an active home state license as a respiratory therapist.  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.  Have not had any adverse action against a license within the previous two years.  Notify the commission that the licensee is seeking the compact privilege within a remote state.  Pay any applicable fees, including any state and commission fees and renewal fees, for the compact privilege.  Meet any jurisprudence requirements established by the remote state in which the licensee is seeking a compact privilege.  Report to the commission adverse action taken by any non-member state within 30 days from the date the adverse action is taken.  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 30 days of the effective date of the change in address.  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. The compact provides that 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 as described 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. Scope of Practice The compact requires a licensee providing respiratory therapy in a remote state under the compact privilege to function within the scope of practice authorized by the remote state for the type of respiratory therapist license the licensee holds. Such pr ocedures, actions, processes, and the circumstances under which they may be undertaken may be established through means, including statute, regulations, case law, and other processes available to the state respiratory therapy licensing authority or other go vernment agency. Loss of, or Ineligibility for, Compact Privilege If a licensee's compact privilege is removed by the remote state, then the compact requires the individual to lose or be ineligible for the compact privilege in that remote state until the compact privilege is no longer limited or restricted by that stat e. If a home state license is encumbered, then the licensee loses the compact privilege in all remote states until the (i) the home state license is no longer encumbered and (ii) two years have elapsed from the date on which the license is no longer encu mb ered due to the adverse action. ACTIVE MILITARY MEMBER OR THEIR SPOUSE The compact requires an active military member, including members of the national guard and reserve, or their spouse to designate a home state where the individual has a current license in good standing. The individual may retain the home state designat ion during the period the service member is on active duty. An active military member and their spouse are not required to pay any fee to the commission for a compact privilege. However, if a remote state chooses to charge a fee for a compact privilege, t he remote state may charge a reduced fee or no fee to an active military member and their spouse. ADVERSE ACTIONS The compact authorizes a member state in which a licensee is licensed to impose adverse action against the license issued by that member state. 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 proc edures for imposing adverse action. However, the compact does not override a member state's decision that participation in an alternative program may be used in lieu of adverse action and that such participation remain non-public if required by the membe r state's laws. As used in the compact, ""adverse action"" means any administrative, civil, equitable, or criminal action permitted by a state's laws that 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. An ""alternative program"" means a non-disciplinary monitoring or prac tice remediation process applicable to a respiratory therapist approved by any state authority with regulatory authority over respiratory therapists and includes programs to which licensees with substance abuse or addiction issues are referred in lieu of ad verse action. Joint Investigations In addition to the authority granted to a member state by its respective respiratory therapy practice act or other applicable state law, the compact authorizes a member state to participate with other member states in joint investigations of licensees. However, 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. Member states must share any significa nt investigative information, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under the compact. In sharing such information, all information obtained must be kept confidential, except as otherwise mutu ally agreed upon by the sharing and receiving member state. However, the compact does not 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 t he time it was undertaken. ESTABLISHMENT OF RESPIRATORY CARE INTERSTATE COMPACT COMMISSION The compact, via the compact member states, 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 ins trumentality of the compact member states acting jointly and not an instrumentality of any one state. The commission comes into existence on or after the effective date of the compact. Membership on the Commission The compact provides that each member state has and is limited to one commissioner selected by that member state's respiratory therapy licensing authority. The commissioner must be an administrator or their designated staff member of such licensing auth ority. The commission must by rule or bylaw establish a term of office for commissioners and term limits. The commission may recommend to a member state the removal or suspension of any commissioner from office. A member state's respiratory therapy lic en sing authority must fill any vacancy of its commissioner occurring on the commission within 60 days of the vacancy. Voting by the Commissioners The compact provides that each commissioner is entitled to one vote on all matters before the commission requiring a vote by commissioners. A commissioner must vote in person or by such other means as provided in the bylaws, which may include by telecom munication, videoconference, or other means of communication. Meetings of the Commission The compact requires the commission to meet at least once during each calendar year. Additional meetings may be held as set forth in the bylaws. All meetings of the commission that are not closed must be open to the public. Notice of public meetings m ust generally be posted on the commission's website at least 30 days prior to the public meeting. However, the commission may convene an emergency public meeting by providing at least 24 hours prior notice on the commission's website, and any other means a s provided in the commission's rules. Notice of all commission meetings must 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 notic e must include the mechanism for access to the meeting. The compact authorizes the commission or the executive committee to convene in a closed, non-public meeting for the commission or executive committee to receive or solicit legal advice or to discuss certain topics listed in the compact, such as non-compl iance of a member state with its obligations under the compact; accusing any person of a crime or formally censuring any person; trade secrets or commercial or financial information that is privileged or confidential; investigative records compiled for la w enforcement purposes; and legal advice. If a meeting, or portion of a meeting, is closed, the presiding officer must state that the meeting will be closed and reference each relevant exempting provision, and such reference must be recorded in the minutes. The compact requires the commission to keep minutes in accordance with commission rules and bylaws. All documents considered in connection with an action must be identified in such minutes. All minutes and documents of a closed meeting must remain unde r seal, subject to release only by a majority vote of the commission or order of a court of competent jurisdiction. Powers of the Commission The compact lists the powers of the commission, including, amongst others, the power to (i) establish and amend bylaws and policies, including a code of conduct and conflict of interest; (ii) establish and amend rules, which are binding in all member stat es; (iii) initiate and conduct legal proceedings or actions; (iv) conduct an annual financial review; (v) assess and collect fees; (vi) establish a budget and make expenditures; (vii) appoint committees, including standing committees, composed of commissi on ers, state regulators, state legislators or their representatives, and consumer representatives, and such other interested persons as may be designated in the compact and the bylaws; (viii) provide and receive information from, and cooperate with, law enf orcement agencies; (ix) establish and elect an executive committee, including a chair, vice chair, secretary, treasurer, and such other offices as the commission establishes by rule or bylaw; (x) determine whether a state's adopted language is materially di fferent from the model compact language such that the state would not qualify for participation in the compact; and (xi) adopt and provide to the member states an annual report. Executive Committee The compact provides that the executive committee has the power to act on behalf of the commission according to the terms of the compact. The powers, duties, and responsibilities of the executive committee include all of the following:  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.  Recommending to the commission changes to the rules or bylaws, changes to the compact legislation, fees charged to compact member states, fees charged to licensees, and other fees.  Ensuring compact administration services are appropriately provided.  Preparing and recommending the budget.  Maintaining financial records on behalf of the commission.  Monitoring compact compliance of member states and providing compliance reports to the commission.  Establishing additional committees as necessary.  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.  Performing other duties as provided in the rules or bylaws of the commission. The compact provides that the executive committee is composed of up to nine members, as set forth in the commission's bylaws, consisting of seven voting members who are elected by the commission from the current membership of the commission and two ex of ficio, non-voting members. The commission may remove any member of the executive committee as provided in the commission's bylaws. The compact requires the executive committee to meet at least annually. Executive committee meetings must generally be open to the public, except that the executive committee may meet in a closed, non-public meeting as provided above. The executive com mittee must 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. The executive committee may also hold a special meeting in accordance with the compac t. Financing of the Commission The compact requires the commission to pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and ongoing activities. The commission may accept any and all appropriate revenue sources as provided in the compact. The commission may 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 an nual assessment amount for member states, if any, must be allocated based upon a formula that the commission promulgates by rule. The compact requires the commission to keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the commission are subject to the financial review and accounting procedures established under its bylaws. Additionally, all receipts and disbursements of funds handled by the commission are subject to an annual financial review by a certified or licensed public accountant, and the report of the financial review must be included in the annual report of the commission. Qualified Immunity, Defense, and Indemnification The compact clarifies that its provisions do not place a limitation on the liability of any licensee for professional malpractice or misconduct, which must be governed solely by any other applicable state laws. The member states, commissioners, officers, executive directors, employees, and agents of the commission are 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 aris in g 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. However, the com pact does not 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 compact requires the commission to 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 r es ponsibilities, as long as the actual or alleged act, error, or omission did not result from that person's intentional or willful or wanton misconduct. The compact requires the commission to 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 a ctual 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 responsi bi lities, as long as the actual or alleged act, error, or omission did not result from the intentional or willful or wanton misconduct of that person. The compact clarifies that its provisions do not waive or otherwise abrogate a member state's state action immunity or state action affirmative defense with respect to antitrust claims under the federal Sherman Act, federal Clayton Act, or any other stat e or federal antitrust or anticompetitive law or regulation. Further, its provisions do not waive the sovereign immunity by the member states or by the commission. DATA SYSTEM The compact requires the commission to 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. A member state must submit a uniform data set to the data system as required by the rules of the c ommission, including all of the following:  Identifying information.  Licensure data.  Adverse actions against a licensee, license applicant, or compact privilege holder and information related thereto.  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.  Any denial of application for licensure, and the reason for such denial.  The presence of current significant investigative information.  Other information that may facilitate the administration of the compact or the protection of the public, as determined by the rules of the commission. The compact prohibits a member state from submitting any information that constitutes criminal history record information, as defined by applicable federal law, to the data system. The records and information provided to a member state pursuant to the c ompact or through the data system, when certified by the commission or an agent of the commission, constitutes the authenticated business records of the commission, and is entitled to any associated hearsay exception in any relevant judicial, quasi-judici al, or administrative proceedings in a member state. Significant investigative information pertaining to a licensee in any member state will only be available to other member states. The compact provides that 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 pertain ing to a licensee in any member state will be available to any other member state. The compact authorizes member states contributing information to the data system to designate information that may not be shared with the public without the express permission of the contributing state. 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 is removed from the data system. RULEMAKING The compact requires the commission to promulgate reasonable rules in order to effectively and efficiently implement and administer the compact. A rule is invalid and has no force or effect only if a court of competent jurisdiction holds that the rule i s 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 under the compact, or based upon another applicable standard of review. For purposes of the compac t, the rules of the commission have the force of law in each member state. Rules become binding as of the date specified in each rule. 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 years of the date of adoption of the rule, then the compact provid es that such rule has no further force and effect in any member state. Hearing and Notice The compact requires rules to be adopted at a regular or special meeting of the commission. Prior to adoption of a proposed rule, the commission must hold a public hearing and allow persons to provide oral and written comments, data, facts, opinions, an d arguments. Prior to adoption of a proposed rule by the commission, and at least 30 days in advance of the meeting at which the commission will hold a public hearing on the proposed rule, the commission must provide a notice of proposed rulemaking (i) o n the website of the commission or other publicly accessible platform, (ii) too persons who have requested notice of the commission's notices of proposed rulemaking; and in such other ways as the commission may by rule specify. The compact requires the notice of proposed rulemaking to include all of the following information:  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.  If the hearing is held via telecommunication, videoconference, or other electronic means, the mechanism for access to the hearing in the notice of proposed rulemaking.  The text of the proposed rule and the reason for the proposed rule.  A request for comments on the proposed rule from any interested person.  The manner in which interested persons may submit written comments. The compact requires all hearings to be recorded. A copy of the recording and all written comments and documents received by the commission in response to the proposed rule must be available to the public. The compact requires the commission, by majority vote of all commissioners, to take final action on the proposed rule based on the rulemaking record and the full text of the rule. The commission may adopt changes to the proposed rule; provided, the chan ges are consistent with the original purpose of the proposed rule as long as the commission must 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 recommen de d by commenters. The commission must determine a reasonable effective date for the rule. Except for an emergency as described below, the effective date of the rule must be no sooner than 30 days after issuing the notice that it adopted or amended the ru le. Emergency Rules Upon determination that an emergency exists, the compact authorizes the commission to consider and adopt an emergency rule with 24-hours' notice, and with opportunity to comment. However, the usual rulemaking procedures provided in the compact must be r etroactively applied to the rule as soon as reasonably possible, in no event no later than 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 address any o f the following:  Meet an imminent threat to public health, safety, or welfare.  Prevent a loss of commission or member state funds.  Meet a deadline for the promulgation of a rule that is established by federal law or rule.  Protect public health and safety. Rule Revisions The compact authorizes the commission or an authorized committee of the commission to direct revisions to a previously adopted rule for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors. Public n otice of any revisions must be posted on the website of the commission. The revision is subject to challenge by any person for a period of 30 days after posting. The revision may be challenged only on grounds that the revision results in a material chan ge to a rule. A challenge must 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 ta ke effect without the approval of the commission. Member State Rules The compact clarifies that a member state's rulemaking process or procedural requirements do not apply to the commission. Likewise, the commission has no authority over any member state's rulemaking process or procedural requirements that do not pertain to the compact. Additionally, the compact, nor any rule or regulation of the commission, limits, restricts, or in any way reduces the ability of a member state to enact and enforce laws, regulations, or other rules related to the practice of respiratory t herapy in that state, where those laws, regulations, or other rules are not inconsistent with the compact. OVERSIGHT The compact requires the executive and judicial branches of state government in each member state to enforce the compact and take all actions necessary and appropriate to implement the compact. Venue is proper and judicial proceedings by or against the commission must 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. However, the compact does not affect or limit the selection or propriety of venue in any action against a licensee for professional malpractice, misconduct, or any such similar matter. The compact provides that the commission is entitled to receive service of process in any proceeding regarding the enforcement or interpretation of the compact and has standing to intervene in such a proceeding for all purposes. Failure to provide the c ommission service of process renders a judgment or order void as to the commission, the compact, or promulgated rules. DEFAULT, TECHNICAL ASSISTANCE, AND TERMINATION If the commission determines that a member state has defaulted in the performance of its obligations or responsibilities under the compact or the promulgated rules, then the compact requires the commission to provide written notice to the defaulting state. The notice of default must describe the default, the proposed means of curing the default, and any other action that the commission may take. The commission must provide a copy of the notice of default to the other member states. If a state in default fails to cure the default, then the compact authorizes the defaulting state to 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 the 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. The compact provides that the termination of membership in the compact must be imposed only after all other means of securing compliance have been exhausted. Notice of intent to suspend or terminate must be given by the commission to the governor, the m ajority 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. The compact provides that 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. Upon the termination of a state's membership from the compact, that state must immediately provide notice to all licensees and compact privilege holders, of which the commission has a record, within that state of such termination. The termin at ed state must continue to recognize all licenses granted pursuant to the compact for a minimum of 180 days after the date of the notice of termination. The defaulting state may appeal the action of the commission by petitioning the U.S. District Court fo r the District of Columbia or the federal district where the commission has its principal offices. The prevailing party must be awarded all costs of such litigation, including reasonable attorney's fees. DISPUTE RESOLUTION Upon request by a member state, the compact requires the commission to attempt to resolve disputes related to the compact that arise among member states and between member and non-member states. The commission must promulgate a rule providing for both m ediation and binding dispute resolution for disputes, as appropriate. ENFORCEMENT By majority vote, as may be further provided by rule, the compact authorizes the commission to 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 commi ssion has its principal offices to enforce compliance with the compact and its promulgated rules. A member state by enactment of the compact consents to venue and jurisdiction in such court. The relief sought may include both injunctive relief and damag es . If judicial enforcement is necessary, the prevailing party must be awarded all costs of such litigation, including reasonable attorney's fees. However, the remedies in the compact are not the exclusive remedies of the commission. The commission may p ursue any other remedies available under federal or the defaulting member state's law. The compact authorizes a member state to 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 compact an d its promulgated rules. The relief sought may include both injunctive relief and damages. If judicial enforcement is necessary, the prevailing party must be awarded all costs of such litigation, including reasonable attorney's fees. A person other tha n a member state is prohibited from enforcing the compact against the commission. EFFECTIVE DATE OF THE COMPACT The compact provides that the compact comes into effect on the date on which the compact statute is enacted into law in the seventh member state (""effective date""). On or after the effective date of the compact, the commission must convene and review th e 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. The compact provides that a charter member state whose enactment is found to be materially different from the model compact is entitled to the default process set forth in the compact. If any member state is later found to be in default, or is terminate d or withdraws from the compact, the commission remains in existence and the compact remains in effect even if the number of member states should be less than seven. Member states enacting the compact subsequent to the seven initial charter member states a re subject to the process set forth in the compact and in commission rule to determine if their enactments are materially different from the model compact and whether they qualify for participation in the compact. The compact provides that any state that joins the compact subsequent to the commission's initial adoption of the rules and bylaws is 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 has the full force and effect of law on the date the compact becomes law in that state. WITHDRAWAL FROM THE COMPACT The compact authorizes any member state to withdraw from the compact by enacting a statute repealing the same. A member state's withdrawal does not take effect until 180 days after enactment of the repealing statute. Withdrawal does not affect the cont inuing requirement of the withdrawing state's respiratory therapy licensing authority to comply with the investigative and adverse action reporting requirements of the compact prior to the effective date of withdrawal. Upon the enactment of a statute withdrawing from the compact, the compact requires a state to immediately provide notice of such withdrawal to all licensees and compact privilege holders, of which the commission has a record, within that state. Notwiths tanding any subsequent statutory enactment to the contrary, such withdrawing state must continue to recognize all licenses granted pursuant to the compact for a minimum of 180 days after the date of such notice of withdrawal. AMENDMENT TO COMPACT The compact may be amended by the member states. An amendment to the compact does not become effective and binding upon any member state until it is enacted into the laws of all member states. NOTICE OF EFFECTIVE DATE, WITHDRAWAL, OR AMENDMENT This bill requires the board of respiratory care to 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 above has occurred for the compact, a withdrawal, or an amendment to become effective. CONFLICT OF LAWS The compact clarifies that its provisions do not prevent or inhibit the enforcement of any other law of a member state that is not inconsistent with the compact. Any laws, statutes, regulations, or other legal requirements in a member state in conflict w ith the compact are superseded to the extent of the conflict, including any subsequently enacted state laws. All permissible agreements between the commission and the member states are binding in accordance with their terms. Other than as expressly set fo rth in the compact, the compact does not impact initial licensure. RULEMAKING This bill authorizes the board of respiratory care, in consultation with the department of health, to promulgate rules to implement the compact. ENTITY REVIEW This bill provides that the compact terminates on June 30, 2028, for purposes of the Tennessee Governmental Entity Review Law."