ksbnpublic notice of special board meeting 2-1-2018 - kansas… · 2018-02-01 · kansas state...

Kansas State Board of Nursing Special Board Meeting Notice

Date: February 1, 2018 @ 1:00 p.m.

Meeting Location: Conference Call 1-877-278-8686

Access Code: 133174

Landon State Office Building 900 SW Jackson, Room 1051

Topeka, KS 66612-1230

AGENDA: House Bill 2496 Nurse Licensure Compact

Special Board Meeting 1

Session of 2018

HOUSE BILL No. 2496

By Committee on Health and Human Services

1-18

AN ACT concerning nursing; board of nursing; enacting the nurse licensure compact; authorizing criminal history record checks.

Be it enacted by the Legislature of the State of Kansas:Section 1. This act shall be know and may be cited as the nurse

licensure compact.Nurse Licensure Compact

ARTICLE IFINDINGS AND DECLARATION OF PURPOSE

(a) The legislature of the state of Kansas finds that:(1) The health and safety of the public are affected by the degree of

compliance with and the effectiveness of enforcement activities related to state nurse licensure laws;

(2) violations of nurse licensure and other laws regulating the practice of nursing may result in injury or harm to the public;

(3) the expanded mobility of nurses and the use of advanced communication technologies as part of our nation's health care delivery system require greater coordination and cooperation among states in the areas of nurse licensure and regulation;

(4) new practice modalities and technology make compliance with individual state nurse licensure laws difficult and complex;

(5) the current system of duplicative licensure for nurses practicing in multiple states is cumbersome and redundant for both nurses and states; and

(6) uniformity of nurse licensure requirements among the states promotes public safety and public health benefits.

(b) The general purposes of this compact are to:(1) Facilitate the states' responsibility to protect the public's health

and safety;(2) ensure and encourage the cooperation of party states in the areas

of nurse licensure and regulation;(3) facilitate the exchange of information among party states in the

areas of nurse regulation, investigation and adverse actions;(4) promote compliance with the laws governing the practice of

nursing in each jurisdiction;(5) invest all party states with the authority to hold a nurse

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accountable for meeting all state practice laws in the state in which the patient is located at the time care is rendered through the mutual recognition of party-state licenses;

(6) decrease redundancies in the consideration and issuance of nurse licenses; and

(7) provide opportunities for interstate practice by nurses who meet uniform licensure requirements.

ARTICLE IIDEFINITIONS

As used in this compact:(a) "Adverse action" means any administrative, civil, equitable or

criminal action permitted by a state's laws which is imposed by a licensing board or other authority against a nurse, including actions against an individual's license or multistate licensure privilege, such as revocation, suspension, probation, monitoring of the licensee, limitation on the licensee's practice, or any other encumbrance on licensure affecting a nurse's authorization to practice, including issuance of a cease and desist action.

(b) "Alternative program" means a nondisciplinary monitoring program approved by a licensing board.

(c) "Commission" means the interstate commission of nurse licensure compact administrators.

(d) "Coordinated licensure information system" means an integrated process for collecting, storing and sharing information on nurse licensure and enforcement activities related to nurse licensure laws that is administered by a nonprofit organization composed of and controlled by licensing boards.

(e) "Current significant investigative information" means:(1) Investigative information that a licensing board, after a

preliminary inquiry that includes notification and an opportunity for the nurse to respond, if required by state law, has reason to believe is not groundless and, if proved true, would indicate more than a minor infraction; or

(2) investigative information that indicates that the nurse represents an immediate threat to public health and safety, regardless of whether the nurse has been notified and had an opportunity to respond.

(f) "Encumbrance" means a revocation or suspension of, or any limitation on, the full and unrestricted practice of nursing imposed by a licensing board.

(g) "Home state" means the party state that is the nurse's primary state of residence.

(h) "Licensing board" means a party state's regulatory body responsible for issuing nurse licenses.

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(i) "LPN/VN" means a licensed practical/vocational nurse.(j) "Multistate license" means a license to practice as a registered or a

licensed practical/vocational nurse (LPN/VN) issued by a home state licensing board that authorizes the licensed nurse to practice in all party states under a multistate licensure privilege.

(k) "Multistate licensure privilege" means a legal authorization associated with a multistate license permitting the practice of nursing as either a registered nurse (RN) or LPN/VN in a remote state.

(l) "Nurse" means RN or LPN/VN, as those terms are defined by each party state's practice laws.

(m) "Party state" means any state that has adopted this compact.(n) "Remote state" means a party state, other than the home state.(o) "RN" means a registered nurse.(p) "Single-state license" means a nurse license issued by a party state

that authorizes practice only within the issuing state and does not include a multistate licensure privilege to practice in any other party state.

(q) "State" means a state, territory or possession of the United States and the District of Columbia.

(r) "State practice laws" means a party state's laws, rules and regulations that govern the practice of nursing, define the scope of nursing practice, and create the methods and grounds for imposing discipline. State practice laws do not include requirements necessary to obtain and retain a license, except for qualifications or requirements of the home state.

ARTICLE IIIGENERAL PROVISIONS AND JURISDICTION

(a) A multistate license to practice registered or licensed practical/vocational nursing issued by a home state to a resident in that state will be recognized by each party state as authorizing a nurse to practice as an RN or as an LPN/VN, under a multistate licensure privilege, in each party state.

(b) A state must implement procedures for considering the criminal history records of applicants for an initial multistate license or licensure by endorsement. Such procedures shall include the submission of fingerprints or other biometric-based information by applicants for the purpose of obtaining an applicant's criminal history record information from the federal bureau of investigation and the agency responsible for retaining that state's criminal records.

(c) Each party state shall require the following for an applicant to obtain or retain a multistate license in the home state:

(1) Has met the home state's qualifications for licensure or renewal of licensure, as well as all other applicable state laws;

(2) (A) has graduated or is eligible to graduate from a licensing board-approved RN or LPN/VN prelicensure education program; or

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(B) has graduated from a foreign RN or LPN/VN prelicensure education program that: (i) Has been approved by the authorized accrediting body in the applicable country; and (ii) has been verified by an independent credentials review agency to be comparable to a licensing board-approved prelicensure education program;

(3) has, if a graduate of a foreign prelicensure education program, not taught in English or, if English is not the individual's native language, successfully passed an English proficiency examination that includes the components of reading, speaking, writing and listening;

(4) has successfully passed an NCLEX-RN or NCLEX-PN examination or recognized predecessor, as applicable;

(5) is eligible for or holds an active unencumbered license;(6) has submitted, in connection with an application for initial

licensure or licensure by endorsement, fingerprints or other biometric data for the purpose of obtaining criminal history record information from the federal bureau of investigation and the Kansas bureau of investigation;

(7) has not been convicted or found guilty or has entered into an agreed disposition of a felony offense under applicable state or federal criminal law;

(8) has not been convicted or found guilty or has entered into an agreed disposition of a misdemeanor offense related to the practice of nursing as determined on a case-by-case basis;

(9) is not currently enrolled in an alternative program;(10) is subject to self-disclosure requirements regarding current

participation in an alternative program; and(11) has a valid United States social security number.(d) All party states shall be authorized, in accordance with existing

state due process law, to take adverse action against a nurse's multistate licensure privilege, such as revocation, suspension, probation or any other action that affects a nurse's authorization to practice under a multistate licensure privilege, including cease and desist actions. If a party state takes such action, it shall promptly notify the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the home state of any such actions by remote states.

(e) A nurse practicing in a party state must comply with the state practice laws of the state in which the client is located at the time service is provided. The practice of nursing is not limited to patient care, but shall include all nursing practice as defined by the state practice laws of the party state in which the client is located. The practice of nursing in a party state under a multistate licensure privilege will subject a nurse to the jurisdiction of the licensing board, the courts and the laws of the party state in which the client is located at the time service is provided.

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(f) Individuals not residing in a party state shall continue to be able to apply for a party state's single-state license as provided under the laws of each party state. However, the single-state license granted to these individuals will not be recognized as granting the privilege to practice nursing in any other party state. Nothing in this compact shall affect the requirements established by a party state for the issuance of a single-state license.

(g) Any nurse holding a home state multistate license on the effective date of this compact may retain and renew the multistate license issued by the nurse's then-current home state, provided that:

(1) A nurse who changes such nurse's primary state of residence after this compact's effective date must meet all applicable article III(c) requirements to obtain a multistate license from a new home state.

(2) A nurse who fails to satisfy the multistate licensure requirements in article III(c) due to a disqualifying event occurring after this compact's effective date shall be ineligible to retain or renew a multistate license, and the nurse's multistate license shall be revoked or deactivated in accordance with applicable rules adopted by the commission.

ARTICLE IVAPPLICATIONS FOR LICENSURE IN A PARTY STATE

(a) Upon application for a multistate license, the licensing board in the issuing party state shall ascertain, through the coordinated licensure information system, whether the applicant has ever held, or is the holder of, a license issued by any other state, whether there are any encumbrances on any license or multistate licensure privilege held by the applicant, whether any adverse action has been taken against any license or multistate licensure privilege held by the applicant and whether the applicant is currently participating in an alternative program.

(b) A nurse may hold a multistate license, issued by the home state, in only one party state at a time.

(c) If a nurse changes primary state of residence by moving between two party states, the nurse must apply for licensure in the new home state, and the multistate license issued by the prior home state will be deactivated in accordance with applicable rules adopted by the commission.

(1) The nurse may apply for licensure in advance of a change in primary state of residence.

(2) A multistate license shall not be issued by the new home state until the nurse provides satisfactory evidence of a change in primary state of residence to the new home state and satisfies all applicable requirements to obtain a multistate license from the new home state.

(d) If a nurse changes primary state of residence by moving from a party state to a nonparty state, the multistate license issued by the prior

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home state will convert to a single-state license, valid only in the former home state.

ARTICLE VADDITIONAL AUTHORITIES INVESTED IN PARTY-STATE LICENSING BOARDS

(a) In addition to the other powers conferred by state law, a licensing board shall have the authority to:

(1) Take adverse action against a nurse's multistate licensure privilege to practice within that party state:

(A) Only the home state shall have the power to take adverse action against a nurse's license issued by the home state; and

(B) for purposes of taking adverse action, the home-state licensing board shall give the same priority and effect to reported conduct received from a remote state as it would if such conduct had occurred within the home state. In so doing, the home state shall apply its own state laws to determine appropriate action;

(2) issue cease and desist orders or impose an encumbrance on a nurse's authority to practice within that party state;

(3) complete any pending investigations of a nurse who changes primary state of residence during the course of such investigations. The licensing board shall also have the authority to take appropriate actions and shall promptly report the conclusions of such investigations to the administrator of the coordinated licensure information system. The administrator of the coordinated licensure information system shall promptly notify the new home state of any such actions;

(4) issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses, as well as the production of evidence. Subpoenas issued by a licensing board in a party state for the attendance and testimony of witnesses or the production of evidence from another party state shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state in which the witnesses or evidence are located;

(5) obtain and submit, for each nurse licensure applicant, fingerprint or other biometric-based information to the federal bureau of investigation for criminal background checks, receive the results of the federal bureau of investigation record search on criminal background checks and use the results in making licensure decisions;

(6) if otherwise permitted by state law, recover from the affected nurse the costs of investigations and disposition of cases resulting from

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any adverse action taken against that nurse; and(7) take adverse action based on the factual findings of the remote

state, provided that the licensing board follows its own procedures for taking such adverse action.

(b) If adverse action is taken by the home state against a nurse's multistate license, the nurse's multistate licensure privilege to practice in all other party states shall be deactivated until all encumbrances have been removed from the multistate license. All home-state disciplinary orders that impose adverse action against a nurse's multistate license shall include a statement that the nurse's multistate licensure privilege is deactivated in all party states during the pendency of the order.

(c) Nothing in this compact shall override a party state's decision that participation in an alternative program may be used in lieu of adverse action. The home-state licensing board shall deactivate the multistate licensure privilege under the multistate license of any nurse for the duration of the nurse's participation in an alternative program.

ARTICLE VICOORDINATED LICENSURE INFORMATION SYSTEM AND EXCHANGE OF INFORMATION

(a) All party states shall participate in a coordinated licensure information system of all licensed RNs and LPNs/VNs. This system will include information on the licensure and disciplinary history of each nurse, as submitted by party states, to assist in the coordination of nurse licensure and enforcement efforts.

(b) The commission, in consultation with the administrator of the coordinated licensure information system, shall formulate necessary and proper procedures for the identification, collection and exchange of information under this compact.

(c) All licensing boards shall promptly report to the coordinated licensure information system any adverse action, any current significant investigative information, denials of applications, with the reasons for such denials, and nurse participation in alternative programs known to the licensing board regardless of whether such participation is deemed nonpublic or confidential under state law.

(d) Current significant investigative information and participation in nonpublic or confidential alternative programs shall be transmitted through the coordinated licensure information system only to party-state licensing boards.

(e) Notwithstanding any other provision of law, all party-state licensing boards contributing information to the coordinated licensure information system may designate information, which may not be shared with non-party states or disclosed to other entities or individuals without

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the express permission of the contributing state.(f) Any personally identifiable information obtained from the

coordinated licensure information system by a party-state licensing board shall not be shared with non-party states or disclosed to other entities or individuals except to the extent permitted by the laws of the party state contributing the information.

(g) Any information contributed to the coordinated licensure information system that is subsequently required to be expunged by the laws of the party state contributing that information shall also be expunged from the coordinated licensure information system.

(h) The compact administrator of each party state shall furnish a uniform data set to the compact administrator of each other party state, which shall include, at a minimum:

(1) Identifying information;(2) licensure data;(3) information related to alternative program participation; and(4) other information that may facilitate the administration of this

compact, as determined by commission rules.(i) The compact administrator of a party state shall provide all

investigative documents and information requested by another party state.ARTICLE VII

ESTABLISHMENT OF THE INTERSTATE COMMISSION OF NURSE LICENSURE COMPACT ADMINISTRATORS

(a) The party states hereby create and establish a joint public entity known as the interstate commission of nurse licensure compact administrators.

(1) The commission is an instrumentality of the party states.(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.

(3) Nothing in this compact shall be construed to be a waiver of sovereign immunity.

(b) Membership, voting and meetings:(1) Each party-state shall have and be limited to one administrator.

The head of the state licensing board or designee shall be the administrator of this compact for each party state. Any administrator may be removed or suspended from office as provided by the laws of the state from which the administrator is appointed. Any vacancy occurring in the commission shall be filled in accordance with the laws of the party state in which the

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vacancy exists.(2) Each administrator shall be entitled to one vote with regard to the

promulgation of rules and creation of bylaws and shall otherwise have an opportunity to participate in the business and affairs of the commission. An administrator shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for an administrator's participation in meetings by telephone or other means of communication.

(3) The commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in the bylaws or rules of the commission.

(4) All meetings shall be open to the public, and public notice of meetings shall be given in the same manner as required under the rulemaking provisions in article VIII of this compact.

(5) The commission may convene in a closed, nonpublic meeting if the commission must discuss:

(A) Noncompliance of a party state with its obligations under this compact;

(B) the employment, compensation, discipline or other personnel matters, practices or procedures related to specific employees or other matters related to the commission's internal personnel practices and procedures;

(C) current, threatened or reasonably anticipated litigation;(D) negotiation of contracts for the purchase or sale of goods,

services or real estate;(E) accusing any person of a crime or formally censuring any person;(F) disclosure of trade secrets or commercial or financial information

that is privileged or confidential;(G) disclosure of information of a personal nature where disclosure

would constitute a clearly unwarranted invasion of personal privacy;(H) disclosure of investigatory records compiled for law enforcement

purposes;(I) disclosure of information related to any reports prepared by or on

behalf of the commission for the purpose of investigation of compliance with this compact; or

(J) matters specifically exempted from disclosure by federal or state statute.

(6) If a meeting, or portion of a meeting, is closed pursuant to this provision, the commission's legal counsel or designee shall certify that the meeting may be closed and shall reference each relevant exempting provision. The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, and the reasons therefor, including a description of the views expressed. All documents considered in

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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 by a majority vote of the commission or order of a court of competent jurisdiction.

(c) The commission shall, by a majority vote of the administrators, prescribe bylaws or rules to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of this compact, including, but not limited to:

(1) Establishing the fiscal year of the commission;(2) providing reasonable standards and procedures:(A) For the establishment and meetings of other committees; and(B) governing any general or specific delegation of any authority or

function of the commission;(3) providing reasonable procedures for calling and conducting

meetings of the commission, ensuring reasonable advance notice of all meetings and providing an opportunity for attendance of such meetings by interested parties, with enumerated exceptions designed to protect the public's interest, the privacy of individuals, and proprietary information, including trade secrets. The commission may meet in closed session only after a majority of the administrators vote to close a meeting in whole or in part. As soon as practicable, the commission must make public a copy of the vote to close the meeting revealing the vote of each administrator, with no proxy votes allowed;

(4) establishing the titles, duties and authority and reasonable procedures for the election of the officers of the commission;

(5) providing reasonable standards and procedures for the establishment of the personnel policies and programs of the commission. Notwithstanding any civil service or other similar laws of any party state, the bylaws shall exclusively govern the personnel policies and programs of the commission; and

(6) providing a mechanism for winding up the operations of the commission and the equitable disposition of any surplus funds that may exist after the termination of this compact after the payment or reserving of all of its debts and obligations.

(d) The commission shall publish its bylaws and rules, and any amendments thereto, in a convenient form on the website of the commission.

(e) The commission shall maintain its financial records in accordance with the bylaws.

(f) The commission shall meet and take such actions as are consistent with the provisions of this compact and the bylaws.

(g) The commission shall have the following powers:(1) To promulgate uniform rules to facilitate and coordinate

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implementation and administration of this compact. The rules shall have the force and effect of law and shall be binding in all party states;

(2) to bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing of any licensing board to sue or be sued under applicable law shall not be affected;

(3) to purchase and maintain insurance and bonds;(4) to borrow, accept or contract for services of personnel, including,

but not limited to, employees of a party state or nonprofit organizations;(5) to cooperate with other organizations that administer state

compacts related to the regulation of nursing, including, but not limited to, sharing administrative or staff expenses, office space or other resources;

(6) to hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this compact, and to establish the commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel and other related personnel matters;

(7) to accept any and all appropriate donations, grants and gifts of money, equipment, supplies, materials and services, and to receive, utilize and dispose of the same, provided that at all times the commission shall avoid any appearance of impropriety or conflict of interest;

(8) to lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use, any property, whether real, personal or mixed, provided that at all times the commission shall avoid any appearance of impropriety;

(9) to sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of any property, whether real, personal or mixed;

(10) to establish a budget and make expenditures;(11) to borrow money;(12) to appoint committees, including advisory committees comprised

of administrators, state nursing regulators, state legislators or their representatives, and consumer representatives, and other such interested persons;

(13) to provide and receive information from, and to cooperate with, law enforcement agencies;

(14) to adopt and use an official seal; and(15) to perform such other functions as may be necessary or

appropriate to achieve the purposes of this compact consistent with the state regulation of nurse licensure and practice.

(h) Financing of the commission:(1) The commission shall pay, or provide for the payment of, the

reasonable expenses of its establishment, organization and ongoing activities;

(2) the commission may also levy on and collect an annual

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assessment from each party state to cover the cost of its operations, activities and staff in its annual budget as approved each year. The aggregate annual assessment amount, if any, shall be allocated based upon a formula to be determined by the commission, which shall promulgate a rule that is binding upon all party states;

(3) the commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same, nor shall the commission pledge the credit of any of the party states, except by and with the authority of such party state; and

(4) the commission shall keep accurate accounts of all receipts and disbursements. The receipts and disbursements of the commission shall be subject to the audit and accounting procedures established under its bylaws. However, all receipts and disbursements of funds handled by the commission shall be audited yearly by a certified or licensed public accountant, and the report of the audit shall be included in and become part of the annual report of the commission.

(i) Qualified immunity, defense and indemnification:(1) The administrators, officers, executive director, employees and

representatives of the commission shall be immune from suit and liability, either personally or 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 paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury or liability caused by the intentional, willful or wanton misconduct of that person.

(2) The commission shall defend any administrator, officer, executive director, employee or representative 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 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 the actual or alleged act, error or omission did not result from that person's intentional, willful or wanton misconduct and provided further that nothing herein shall be construed to prohibit that person from retaining such person's own counsel.

(3) The commission shall indemnify and hold harmless any administrator, officer, executive director, employee or representative 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

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occurred within the scope of commission employment, duties or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities, provided that the actual or alleged act, error or omission did not result from the intentional, willful or wanton misconduct of that person.

ARTICLE VIIIRULEMAKING

(a) The commission shall exercise its rulemaking powers pursuant to the criteria set forth in this article and the rules adopted thereunder. Rules and amendments shall become binding as of the date specified in each rule or amendment and shall have the same force and effect as provisions of this compact.

(b) Rules or amendments to the rules shall be adopted at a regular or special meeting of the commission.

(c) Prior to promulgation and adoption of a final rule or rules by the commission, and at least 60 days in advance of the meeting at which the rule will be considered and voted upon, the commission shall file a notice of proposed rulemaking:

(1) On the website of the commission; and(2) on the website of each licensing board or the publication in which

each state would otherwise publish proposed rules.(d) The notice of proposed rulemaking shall include:(1) The proposed time, date and location of the meeting in which the

rule will be considered and voted upon;(2) the text of the proposed rule or amendment, and the reason for the

proposed rule;(3) a request for comments on the proposed rule from any interested

person; and(4) the manner in which interested persons may submit notice to the

commission of their intention to attend the public hearing and any written comments.

(e) Prior to adoption of a proposed rule, the commission shall allow persons to submit written data, facts, opinions and arguments, which shall be made available to the public.

(f) The commission shall grant an opportunity for a public hearing before it adopts a rule or amendment.

(g) The commission shall publish the place, time and date of the scheduled public hearing.

(1) Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing. All hearings will be recorded, and a copy will be made available upon request.

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(2) Nothing in this article 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 article.

(h) If no one appears at the public hearing, the commission may proceed with promulgation of the proposed rule.

(i) Following the scheduled hearing date, or by the close of business on the scheduled hearing date if the hearing was not held, the commission shall consider all written and oral comments received.

(j) The commission shall, by majority vote of all administrators, take final action on the proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule.

(k) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule without prior notice, opportunity for comment or hearing, provided that the usual rulemaking procedures provided in this compact and in this article shall be retroactively applied to the rule as soon as reasonably possible, and in no event 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:

(1) Meet an imminent threat to public health, safety or welfare;(2) prevent a loss of commission or party state funds; or(3) meet a deadline for the promulgation of an administrative rule that

is required by federal law or rule.(l) The commission may direct revisions to a previously adopted rule

or amendment 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 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.

ARTICLE IXOVERSIGHT, DISPUTE RESOLUTION AND ENFORCEMENT

(a) Oversight:(1) Each party state shall enforce this compact and take all actions

necessary and appropriate to effectuate this compact's purposes and intent.(2) The commission shall be entitled to receive service of process in

any proceeding that may affect the powers, responsibilities or actions of the commission, and shall have standing to intervene in such a proceeding for all purposes. Failure to provide service of process in such proceeding

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to the commission 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 party state has defaulted in

the performance of its obligations or responsibilities under this compact or the promulgated rules, the commission shall:

(A) Provide written notice to the defaulting state and other party states of the nature of the default, the proposed means of curing the default or any other action to be taken by the commission; and

(B) provide remedial training and specific technical assistance regarding the default.

(2) If a state in default fails to cure the default, the defaulting state's membership in this compact may be terminated upon an affirmative vote of a majority of the administrators, and all rights, privileges and benefits conferred 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.

(3) Termination of membership in this 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 of the defaulting state and to the executive officer of the defaulting state's licensing board and each of the party states.

(4) A state whose membership in this compact 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.

(5) The commission shall not bear any costs related to a state that is found to be in default or whose membership in this compact has been terminated unless agreed upon in writing between the commission and the defaulting state.

(6) 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 in which the commission has its principal offices. The prevailing party shall be awarded all costs of such litigation, including reasonable attorney fees.

(c) Dispute resolution:(1) Upon request by a party state, the commission shall attempt to

resolve disputes related to the compact that arise among party states and between party and non-party-states.

(2) The commission shall promulgate a rule providing for both mediation and binding dispute resolution for disputes, as appropriate.

(3) In the event the commission cannot resolve disputes among party states arising under this compact:

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(A) The party states may submit the issues in dispute to an arbitration panel, which will be comprised of individuals appointed by the compact administrator in each of the affected party states and an individual mutually agreed upon by the compact administrators of all the party states involved in the dispute.

(B) The decision of a majority of the arbitrators shall be final and binding.

(d) Enforcement:(1) The commission, in the reasonable exercise of its discretion, shall

enforce the provisions and rules of this compact.(2) By majority vote, the commission may initiate legal action in the

U.S. District Court for the District of Columbia or the federal district in which the commission has its principal offices against a party state that is in default to enforce compliance with the provisions of this compact and its promulgated rules and bylaws. 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 fees.

(3) The remedies herein shall not be the exclusive remedies of the commission. The commission may pursue any other remedies available under federal or state law.

ARTICLE XEFFECTIVE DATE, WITHDRAWAL AND AMENDMENT

(a) This compact shall become effective and binding on the earlier of the date of legislative enactment of this compact into law by no less than 26 states or December 31, 2018. All party states to this compact that also were parties to the prior nurse licensure compact superseded by this compact, prior compact, shall be deemed to have withdrawn from such prior compact within six months after the effective date of this compact.

(b) Each party state to this compact shall continue to recognize a nurse's multistate licensure privilege to practice in that party state issued under the prior compact until such party state has withdrawn from the prior compact.

(c) Any party state may withdraw from this compact by enacting a statute repealing the same. A party state's withdrawal shall not take effect until six months after enactment of the repealing statute.

(d) A party state's withdrawal or termination shall not affect the continuing requirement of the withdrawing or terminated state's licensing board to report adverse actions and significant investigations occurring prior to the effective date of such withdrawal or termination.

(e) Nothing contained in this compact shall be construed to invalidate or prevent any nurse licensure agreement or other cooperative arrangement between a party state and a non-party state that is made in accordance with

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the other provisions of this compact.(f) This compact may be amended by the party states. No amendment

to this compact shall become effective and binding upon the party states unless and until it is enacted into the laws of all party states.

(g) Representatives of non-party states to this compact shall be invited to participate in the activities of the commission, on a nonvoting basis, prior to the adoption of this compact by all states.

ARTICLE XICONSTRUCTION AND SEVERABILITY

This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact shall be severable, and if any phrase, clause, sentence or provision of this compact is declared to be contrary to the constitution of any party state or of the United States, or if the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person or circumstance shall not be affected thereby. If this compact shall be held to be contrary to the constitution of any party state, this compact shall remain in full force and effect as to the remaining party states and in full force and effect as to the party state affected as to all severable matters.

Sec. 2. This act shall take effect and be in force from and after its publication in the statute book.

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Bill number: HB 2496 Due date: 1/22/18

Responding agency: Kansas State Board of Nursing

Prepared by: Carol Moreland DOB Analyst: Bill Schafer

Fiscal Impact

State—Would this bill have a fiscal effect on your agency? Yes ☒ No ☐ Local—Would this bill have a fiscal effect on local government? Yes ☐ No ☒ Tax Revenue—Would this bill affect State General Fund revenues? Yes ☐ No ☒ Fee or Other Revenue—Would this bill affect revenues to other state funds? Yes ☒ No ☐

FY 2018 FY 2019 Expenditures State General Fund Fee Fund(s) 0 $256,500** Federal Fund Total Expenditures $256,500** Revenues State General Fund Fee Fund(s) 0 Loss of $367,170 Federal Fund Total Revenues Loss of $367,170

FTE Positions 0 0

Bill Description

Briefly describe what the legislation does. Describe the change(s) from current law that would drive an increase or decrease in expenditures or revenues. If federal funds are affected by the bill in some way, explain that relationship as well. Note any technical or mechanical defects with the bill (bill drafting errors only, do not include commentary as to whether the bill should be enacted or not). Please include an explanation of the assumptions used when determining increases or decreases in revenues or expenditures. HB 2496, if passed, would enact a nurse licensure compact. Currently Kansas issues licenses

for Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) to practice in Kansas only. If the RNs and LPNs want to practice nursing in other states they must get a license to practice in the other state(s) also. National Council of State Board of Nursing (NCSBN) oversees a nursing licensure compact (NLC) that presently 29 states have joined (three joined within the last week). States that are part of this NLC require a nurse in those 29 states to obtain a nursing license in their home state (state of residence) and then the nurse can practice nursing in any of the states that are part of the NLC without obtaining a nursing license for each of the participating states. This legislation allows Kansas to join this NLC and would allow RNs and LPNs residing in Kansas to practice nursing in Kansas and the other states that are part of the NLC without obtaining a nursing license in each of those states after obtaining a multistate license in Kansas. There are uniform licensure requirements for a multistate license that includes submission to state and federal fingerprint-based criminal background checks and has no state or federal felony convictions. A change in law that allows Kansas to issue multistate licenses would decrease the number of license applications received from nurses in the participating states that want to practice nursing in Kansas,


Assumptions for Fiscal Effect Estimate

Expenditures: Detail the assumptions made in preparing the cost estimate. Describe agency expenditures that would become necessary with passage of the bill and how workload assumptions translate into the cost estimates. The estimate for any new position should be detailed to show the salary, benefits and associated other operating costs (such as a computer or other equipment). Distinguish between one-time and ongoing costs.

Revenues: Describe the assumptions and methods used in estimating the bill’s effect on revenues. Detail the source of the revenue—is it a tax, agency earning, fee income or a federal reimbursement—and the fund that would receive the revenue. Distinguish between one-time and ongoing revenue changes estimated to result from passage of the bill. Expenditures: The implementation costs if HB 2469 is passed include:

• NLC Member Fee: $6,000.00 – this will be an annual fee • Communication costs (notification to licensees, employers, permanent residence

verification, stakeholder meetings, etc): $35.500.00 • Information Technology – Licensing system Programming (estimated enhancement

costs based off other states that use the same licensure system and estimated recurring maintenance cost): $175.000.00 + $25,000 estimated recurring maintenance cost.

• Data Integrity Preparation Costs – 2 part time temporary positions for 1 year for 1) database cleansing of 125,000+ records, 2) single to multistate licenses, 3) processing criminal history reports 4) data entry of permanent residence and 5) document scanning: $40,000.00

• Investigative/Discipline: gathering information, talking with witnesses out of state, any necessary travel may incur more costs when investigations are conducted on an incident that occurred outside of Kansas: cost unknown

• Total projected implementation expenditures: $256,500.00. The Kansas State Board of Nursing will check with National Council of State Boards of Nursing to determine if they could provide funding to cover these projected implementation expenditures.

Revenues: • Projected yearly revenue loss from RN renewals is $392,920.00 and loss from LPN

renewals is $35,200.00. As stated in the explanation, Kansas will lose revenue from licensure fees. The last three states to join have recently joined. A fiscal impact prepared by NCSBN is attached.

• Revenue Loss to other states: $106,000.00 annually. In May 2017 the Kansas State Board of Nursing (KSBN) made a change in verification of original licensure. Prior to that date KSBN provided verification for each nurse licensed in Kansas when requested and obtained revenue from each verification. In May 2017 that process changed to verification of original licensure being obtained through Nursys, a national database for licensure verification for RNs and LPNs. It is a 24/7 nationwide database that makes licensure verification immediately available to a board of nursing where an individual is applying for licensure. It is a condition of participation in the NLC that Nursys is utilized for licensure verification and discipline information. When the change was made to the verification process in May 2017 that was a revenue loss for KSBN of approximately $106.000.00 annually. NCSBN is giving a grant of $106.000.00 for FY 2018 and FY 2019 to offset that revenue loss. When Kansas joins the NLC the grant by contract ends upon implementation. so KSBN must have revenue to offset this loss in verifications.

• Revenue gain from endorsement for RNs and LPNs: $166,950.00. The recurring amount of this is unknown.

• Total projected revenue loss is $367,170.00 and projected recurring revenue loss is $534,120.00


• KSBN can account for the projected revenue loss in licensure and verification fees by increasing the licensure fees. KSBN is projecting if initial RN, initial LPN, RN endorsement, LPN endorsement, RN biennial renewal and LPN biennial renewal could be increased by $15.00 we can cover the revenue loss. Kansas nurse licensure fees are low compared to other states’ licensure fees. Nurse license fees have not increased in Kansas for years, however we are close to the cap we can charge on most licensure applications. In order for KSBN to raise the fees to cover the projected revenue loss, the fee caps in K.S.A. 65-1118 must be increased. KSBN historically has watched licensure fees closely and adjusted them to keep them as low as possible to financially sustain the agency budget. IF HB 2496 is passed and the licensure fee caps are not raised, the agency would not be able to financially meet budget and any loss in FTEs would negatively impact the operations of the agency, nurses, employers and the citizens of Kansas due to negative impact on nursing workforce. KSBN may incur an indeterminate, negative fiscal impact due to the loss of fees associated with licensure by endorsement and licensure renewal fees for those who are licensed in Kansas but hold a multistate license from their home state.

Long-Term Fiscal Considerations

If the bill affects future years, beyond those shown in the table above, explain the long-term fiscal effect—are the revenues stable over the long term or would there be a phase-in of costs or revenues; if the bill ends at a specific future date, indicate this as well.

This bill will affect the revenue for future years, however that can be covered by adjusting licensure fees to offset the revenue loss. As more states join the NLC, the revenue loss will continue to exist, due to licensure fees lost from nurses residing in the states as they join the NLC.

Local Government Fiscal Effect

If the bill affects local governments, identify which local governments would be affected (e.g., cities, counties, school districts, water districts, etc.). Describe the bill’s fiscal effect to the local governments.

Unknown

References/Sources If there are supporting documents or spreadsheets explaining calculations or assumptions, please attach them. Attachments: Fiscal impact for Kansas based on 29 states joining the NLC Fiscal Analysis of Nurse Licensure Compact Maximum Fees per K.S.A. 65-1118 KSBN Fee History State Licensing Fees


Planning / Implementation Year RecurringNLCA Member Fee $6,000.00 $6,000.00

* Communication Costs $35,500.00[Notification to licensees, employers, permanent residence verification, stakeholder meetings, etc]

Information Technology* Licensing System Programming $175,000.00 $25,000.00[Estimated enhancement cost, based off other states that use the same licensure system, est. recurring maintenance cost]

* Data Integrity Preparation Costs[2 part-time temporary for 1 year for: 1) database cleansing of 125,000+ records, 2) single to multistate licenses 3) processing criminal history reports 4) data entry of permanent residence, 5) document scanning]

$40,000.00 $0.00

Investigative / Discipline Unknown Unknown

Total Projected Implementation Expenditures $256,500.00 $31,000.00

* - Possibly funded by National Council of State Boards of Nursing minus recurring costs.

Kansas State Board of NursingFiscal Analysis of Nurse Licensure Compact

Implementation Expenditures


Renewal - $55 Biennial Fee Yearly Revenue Loss RecurringRN $392,920.00 $392,920.00LPN $35,200.00 $35,200.00

Verifications - $30 Yearly Revenue Loss Recurring Revenue Loss to Other States $106,000.00 $106,000.00

Endorsement - $75 Revenue Gain RecurringRN / LPN $166,950.00 Unknown

Total Projected Impact $367,170.00 $534,120.00

Revenue Loss

Revenue Gain From Endorsement


# Licensees58,03410,00768,041

Definition: PSOR = Primary State of Residence

Impact based on 29 states joining the eNLC

# Licensees Fee TOTAL14,288 X $55 $785,840

1,280 x $55 $70,400

2226 X $75 $166,950

Net Rev Reduction/yr cycle= 2 $689,290Net Annual Rev Reduction $344,645

Distribution = (Rev reduction divided by remaining licensees) $344,645 / 54,699 $6.30 per licensee per yr

2,747$206,025

KS-RN & PN

The calculations above do not take into consideration any of the other revenue streams or potential reserve funds of the KS BON and therefore are not an accurate picture of the true fiscal impact or necessity of revenue recovery.

↓ in renewals: # KS-RN licensees with PSOR in other NLC state↓ in renewals: # KS-PN licensees with PSOR in other NLC state

NCLEX statistics suggest anticipated # of NCLEX RN/PN candidates: annually (based on 2016 data) with respective revenue of

Current total RN licensees Current total PN licenseesTotal # of RN and PNs in KS

Potential gain of endorsees: # KS-RN/PN with license in a NLC state, no KS-RN/PN license and KS is PSOR

58,034

10,007

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

Current total RN licensees Current total PN licensees

Total Number of RNs/PNs


Initial: Caps Current Difference Proposed CapRN $75.00 $75.00 $0.00 $90.00LPN $50.00 $50.00 $0.00 $65.00

Endorsement: Caps Current Difference Proposed CapRN $75.00 $75.00 $0.00 $90.00LPN $50.00 $50.00 $0.00 $65.00

Biennial Renewal: Caps Current Difference Proposed CapRN $60.00 $55.00 $5.00 $75.00LPN $60.00 $55.00 $5.00 $75.00

Maximum Fees per K.S.A. 65‐1118


(Professional Nurse) 2011 2012 2013 2014 2015 2016 2017Application for license by endorsement to Kansas $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00Application for license by examination $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00Biennial renewal of license $60.00 $60.00 $60.00 $60.00 $55.00 $55.00 $55.00Application for reinstatement of license without temporary permit $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00Application for reinstatement of license with temporary permit $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00Certified copy of Kansas license $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00Inactive license $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00Verification of licensure $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $30.00Application for exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Renewal of exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00(Practical Nurses)Application for license by endorsement to Kansas $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Application for license by examination $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Biennial renewal of license $60.00 $60.00 $60.00 $60.00 $55.00 $55.00 $55.00Application for reinstatement of license without temporary permit $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00Application for reinstatement of license with temporary permit $95.00 $95.00 $95.00 $95.00 $95.00 $95.00 $95.00Certified copy of Kansas license $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00Inactive license $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00Verification of licensure $25.00 $25.00 $25.00 $25.00 $25.00 $25.00 $25.00Application for exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Renewal of exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00(Advanced Practivce Nurse Registered Nurses)Initial application for license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Biennial renewal of license $60.00 $60.00 $60.00 $60.00 $55.00 $55.00 $55.00Application for reinstatement of license without temporary permit $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00Application for license with temporary permit $100.00 $100.00 $100.00 $100.00 $100.00 $100.00 $100.00Application for exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Renewal of exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00(Registered Nurse Anesthetists)Initial application for authorization as a registered nurse anesthetist $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00Biennial renewal of authorization as a registered nurse anesthetist $60.00 $60.00 $60.00 $60.00 $55.00 $55.00 $55.00App. for reinstatement of authorization as a RN anesthetist w/out temp permit $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00App. for reinstatement of authorization w/ temp permit as a registered nurse anesthetist $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00Initial app. with temp authorization to practice as a RN anesthetist $110.00 $110.00 $110.00 $110.00 $110.00 $110.00 $110.00Certified copy of authorization to practice as a RN anesthetist $20.00 $20.00 $20.00 $20.00 $20.00 $20.00 $20.00(Mental Health Technicians) Licensure by endorsement $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Application for licensure $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Examination $20.00 $20.00 $20.00 $20.00 $40.00 $40.00 $200.00Biennial renewal of license $60.00 $60.00 $60.00 $60.00 $55.00 $55.00 $55.00Application for reinstatement of license without temporary permit $70.00 $70.00 $70.00 $70.00 $70.00 $70.00 $70.00Application for reinstatement of license with temporary permit $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00Certified copy of Kansas license $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00Inactive license $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00Verification of licensure $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00

KSBN Fee History


Duplicate license $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00Application for exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Renewal of exempt license $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00(Schools of Nursing and Continuing Education)Application for approval -- schools of nursing $700.00 $700.00 $700.00 $700.00 $1,000.00 $1,000.00 $1,000.00Annual report of approval -- schools of nursing $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00Application for approval of continuing nursing education providers $200.00 $200.00 $200.00 $200.00 $200.00 $200.00 $200.00Annual report for continuing nursing education providers $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Approval of single continuing nursing education offerings $50.00 $50.00 $50.00 $50.00 $100.00 $100.00 $100.00Consultation by request, per day on site $300.00 $300.00 $300.00 $300.00 $300.00 $300.00 $300.00(All applicants)Fingerprinting done by KSBN $7.50 $7.50 $7.50 $7.50 $7.50 $7.50 $7.50Criminal Background Check (Fee actually charged by KBI and is listed under that agency as well) $50.00 $50.00 $50.00 $50.00 $48.00 $48.00 $48.00


State Renewal Renewal Length Endorsement Initial Reinstatement Compact Temp PermitAlabama $75.00 2 $85.00 $85.00 $150.00 NO $50.00Alaska email 2 $215.00 $215.00 $265.00 NO $50.00Arizona $160.00 4 $150.00 $150.00 $50 - $350 eNLC no chargeArkansas $100.00 2 $125.00 $100.00 $100.00 eNLC $30.00California BVNPT $155.00 2 $75.00 $150.00 $230- $580 NOCalifornia RN Board $190.00 2 $100.00 $150.00 $280.00 NO $50.00Colorado $85.00 2 $43.00 $88.00 $179.00 NLCConnecticut $110.00 1 $180.00 $180.00 $180.00 NODC $145.00 2 $230.00 $187.00 $230.00 NODelaware email 2 $141.00 $141.00 renewal fee +50% eNLC $40.00Florida $75.00 2 $110.00 $100.00 $130 - $210 eNLCGeorgia $65.00 2 $75.00 $40.00 $90.00 eNLCGuam $60/$80 2 $100.00 $100.00 $125.00 NO $25.00Hawaii email 2 $166 - $234 $40 + $36 email NOIdaho $90.00 2 up to $150, $200 up to $150, $200 $125.00 eNLCIllinois 2 $50.00 $98.00 NO $25.00Indiana $50.00 2 $50.00 $50.00 $100.00 NO $10.00Iowa $99.00 3 $119.00 $93.00 $175.00 eNLCKansas $55.00 2 $50, $75 $50, $75 $70.00 NO $25, $35, $50Kentucky $65.00 1 $165.00 $125.00 $135.00 eNLCLouisiana PN $60.00 1 $135.00 $100.00 $130.00 NOLouisiana RN $80.00 1 $100.00 $100.00 $100.00 NO $100.00Maine $50, $75 2 $50, $75 $50, $75 $60, $85 eNLCMaryland PN - $110 RN - $136 2 $100.00 $100.00 eNLCMassachusetts $120.00 2 $275.00 $250.00 NOMichigan $123.60 2 $54.00 $54.54 unknown NOMinnesota $85.00 2 $105.00 $105.00 NOMississippi $100.00 2 PN - $60 RN - $100 PN - $60 RN - $100 eNLCMissouri PN - $52 RN - $60 2 PN - $51 RN - $55 PN - $41 RN - $45 PN - $102 RN - $110 eNLCMontana $100.00 2 $200.00 $100.00 eNLCNebraska $123.00 2 $123.00 $123.00 $110.00 eNLCNevada $100.00 2 LPN $95 RN $105 LPN $90 RN $100 $200.00 NONew Hampshire $80.00 2 $120.00 $120.00 $120.00 eNLC $20.00New Jersey $120.00 2 $200.00 $200.00 $225/$345 NO $140.00New Mexico $110.00 2 $150.00 $150.00 $200.00 NLCNew York $73.00 3 $143.00 $143.00 NO $35.00North Carolina $100.00 2 $150.00 $75.00 $100/$180 eNLCNorth Dakota LPN $110 RN $120 2 $160.00 $130.00 LPN $160 RN $170 eNLCOhio $65.00 2 $75.00 $75.00 $100, $135, $185 NOOklahoma $75.00 2 $125.00 $85.00 $115.00 eNLCOregon $100.00 2 $204.00 $169.00 $264.00 NOPennsylvania LPN $60 RN $65 2 $100.00 $135.00 email NO $35.00Rhode Island LPN $45 RN $135 2 LPN $45 RN $135 LPN $45 RN $135 NLCSouth Carolina $75.00 2 $100.00 $90.00 $110.00 eNLC $10.00South Dakota $90.00 2 $100.00 $100.00 $140.00 eNLC $25.00Tennessee LPN $100 RN $110 2 $115.00 $100/$110 $200.00 eNLCTexas LPN $42 RN $65 2 $186.00 $100.00 PN $52/$62 RN $75/$8 eNLCUtah $58.00 2 $95.00 $95.00 $108.00 eNLCVermont $140.00 2 $150.00 $60.00 $140 + late fee NO $25.00Virginia 2 eNLCVirgin Islands website link broke 2 NOWashington $65.00 1 $85, $120 $85, $120 $70, $130 NOWest Virginia PN $50.00 1 $50.00 $75.00 $40.00 eNLC $10.00West Virginia RN $65.00 1 $100.00 $70.00 $115.00 eNLC $25.00Wisconsin $86.00 2 $82.00 $75.00 $111.00 NLC $10.00Wyoming 2 $180, $195 $190.00 $135.00 eNLC

State Licensing Fees


65-1118. Fees. (a) The Board shall collect in advance fees provided for in this act as fixed by the board, but not exceeding:

Application for license – professional nurse ............................................................................................ 75.00 Application for license – practical nurse .................................................................................................. 50.00 Application for biennial renewal of license – professional nurse and practical nurse .............................. 60.00 Application for reinstatement of license .................................................................................................. 70.00 Application for reinstatement of licenses with temporary permit .......................................................... 100.00 Certified copy of license .......................................................................................................................... 25.00 Duplicate of license .................................................................................................................................. 25.00 Inactive license ......................................................................................................................................... 20.00 Application for license – advanced practice registered nurse ................................................................ 50.00 Application for license with temporary permit – advanced practice registered nurse ........................................................................................................ 100.00 Application for renewal of license – advanced practice registered nurse .......................................................................................................... 60.00 Application for reinstatement of license – advanced practice registered nurse .......................................................................................................... 75.00 Application for authorization – registered nurse anesthetist .................................................................... 75.00 Application for authorization with temporary authorization- registered nurse anesthetist..................................................................................................................... 110.00 Application for biennial renewal of authorization – registered nurse anesthetist....................................................................................................................... 60.00 Application for reinstatement of authorization – registered nurse anesthetist....................................................................................................................... 75.00 Application for reinstatement of authorization with Temporary authorization – registered nurse anesthetist ......................................................................... 100.00 Verification of license to another state .................................................................................................... 30.00 Application for exempt license – professional and practical nurse .......................................................... 50.00 Application for biennial renewal of exempt license – professional and practical nurse........................... 50.00 Application for exempt license – advanced practice registered nurse ..................................................... 50.00 Application for biennial renewal of exempt license – advanced practice registered nurse .......................................................................................................... 50.00

(b) The board may require that fees paid for any examination under the Kansas nurse practice act be paid directly to the examination service by the person taking the examination.

(c) The board shall accept for payment of fees under this section personal checks, certified checks, cashier’s checks, money orders or credit cards. The board may designate other methods of payment, but shall not refuse payment in the form of a personal check. The board may impose additional fees and recover any costs incurred by reason of payments made by personal checks with insufficient funds and payments made by credit cards.

History: (L. 1949, ch. 331, § 7; L. 1963, ch. 314, § 4; L. 1973, ch. 249, § 1; L. 1975, ch. 316, § 6; L. 1978, ch. 347, § 11; L. 1980, ch. 188, § 1; L. 1986, ch. 233, § 3; L. 1988, ch. 242, § 2; L. 1992, ch. 135, § 1; L. 1993, ch. 194, § 12; L. 1997, ch. 158, § 3; L. 1999, ch. 84, § 5; L. 2011, ch. 114, § 41; Jan.1, 2012.)


Health and Human Services Committee January 31, 2018

Testimony in Support of House Bill 2496 Carol Moreland, MSN, R.N.

Executive Administrator

Good Afternoon Chairman Hawkins and members of the Health and Human Services Committee. My name is Carol Moreland, Executive Administrator of the Kansas State Board of Nursing (KSBN). I am here to provide testimony for HB 2496 with the following areas of concern from the Board of Nursing. The Board of Nursing was developed in 1913. The mission of the Board of Nursing is to assure the citizens of Kansas safe and competent practice by nurses and mental health technicians through licensure and regulations of Registered Nurses, Licensed Practical Nurses, four roles of Advance Practice Registered Nurses, and Licensed Mental Health Technicians. There are eleven Board members appointed by the Governor. KSBN is the largest health care fee funded board with approximately 72,000 active licensees and receives no state general funds. KSBN licenses RNs and LPNs to practice nursing within Kansas. Presently there are 58,034 RNs and 10,007 LPNs licensed in Kansas. If nurses licensed in Kansas wish to practice nursing in another state they must get licensed in that state. The nurse licensure compact (NLC) is the licensure model that allows registered nurses (RNs) and licensed practical nurses (LPNs) to have one multistate license, with the privilege to practice in the home state and in other NLC states physically, electronically, and/or telephonically. There are presently 29 states that are part of the NLC. Kansas is not currently in the NLC. Nurses seeking licensure in any state that is part of the NLC must meet eleven uniform licensure requirements. HB 2496 would allow Kansas to join the NLC and issue multi-state licenses for RNs and LPNs. HB 2496 is a standard NLC model legislation template that many of the 29 states utilized as a foundation for further developing state-specific bill language. The Board of Nursing was not provided the opportunity to review HB 2496 and give feedback before it was introduced. As it is currently drafted, it lacks information specific to Kansas that we request be included in the bill to address the following areas:

1. Revenue loss: If Kansas joins the NLC, there are significant fiscal and areas of operational impacts for the Board of Nursing. The Board of Nursing is a fee funded agency. Presently the Board of Nursing receives revenue from licensees who reside within the Kansas boarders as well as those outside our boarders who want to practice nursing within Kansas. If Kansas were to join the NLC, the Board of Nursing will only receive revenues derived from licensees who reside within Kansas. It is estimated the Board of Nursing will lose $367,170.00 from nurses who reside within the 29 states that are members of the NLC and are presently licensed in Kansas. This revenue loss will increase as more states join the NLC. It is estimated the recurring revenue loss of licensees’ fees will be $534,120.00 annually.

2. Implementation costs: If Kansas joins the NLC, there are significant implementation costs. There is an annual membership fee to join the NLC. Communication costs include notification to licensees, employers, permanent residence verification and stakeholder meetings.


Communication will be very important so all nurses, employers and the public are aware of the changes and how it will impact them. Our current licensing information system will need to be enhanced and revised to articulate with the compact national data system. The cost included in our fiscal impact note is an estimated enhancement cost based on other states that use the same licensure system and have joined the NLC. There will be a recurring annual maintenance cost. Data integrity costs include the need for two part-time temporary staff (without benefits) to review existing information, cleanse any inconsistent or outdated information within our database that encompasses over 125,000+ records, change records after review from single to multistate licenses, process criminal history reports, data entry of permanent residence and document scanning. We will need an additional investigator due to a projected increase in number of investigations as compact nurses transition in and out of Kansas. The estimated cost for this salary is $76,046.00 (with benefits) annually. With the agency office at maximum occupancy, we will need to do some remodeling in our agency to accommodate the extra staff. This remodeling cost has been submitted for cost estimates, but is currently unknown. The estimated implementation expenditures will be $332,546.00, excluding any needed remodeling. The Board of Nursing is applying for one-time grant funds from our national organization that administers the NLC to cover at least a portion of all the implementation and data integrity costs, but receipt of soft funding is always uncertain. The Board of Nursing will request an increase in our appropriations to cover some or all the implementation costs if grant funds are not available. Even with a grant, there will need to be a change in appropriations for the recurring costs of $107,046.00 to cover annual member fee, annual maintenance agreement and the additional investigator.

3. Statutory caps on licensure fees: The Board of Nursing is close to or at the statutory caps on licensure fees for RN and LPN (initial, endorsement and biennial renewal) per K.S.A. 65-1118. The nursing licensure fees have not been raised for several years. Renewal licensure fees for RNs and LPNs were decreased in 2015 and are generally lower than most of the other states. The Board of Nursing has a history of fiscal accountability by keeping the licensure fees as low as possible for the licensee while maintaining the financial stability of the agency. The Board of Nursing will need to determine the amount licensure fees must be raised to make up the initial and recurring revenue loss if Kansas joins the NLC. Implicit in that decision is consideration for the additional financial burden placed on nurses, particularly rural nurses who do not earn high salaries.

4. Implementation timeline: The Board of Nursing will need to extend the implementation timeline

on the bill to ensure that all operational and IT changes can occur without major disruptions to the licensure and regulatory processes for nurse. Major disruptions in licensure or discipline would, of course, negatively impact health service provision quality and access. The Board of Nursing has significant concerns that our historically stellar service would deteriorate should the state level IT consolidation occur and apply to the Board in the near future. We will need to maintain experienced IT staff within our agency to ensure implementation proceeds smoothly. Inadequate time or inadequate IT staff to implement smoothly can negatively impact nurses, employers and most importantly, the citizens of Kansas.

The Board of Nursing voted in December 2017 to proceed with joining the compact and was planning on introducing legislation in January 2019 after they carefully examined the significant fiscal and operational impact. The Board of Nursing has scheduled a special Board meeting on February 1, 2018 to discuss in detail the above information and will be submitting amendments to HB 2496 that address their concerns. The board respectfully asks that the Board be allowed to bring amendments forward after their special Board meeting. Thank you for your time and consideration and I will stand for questions.


State Renewal Renewal Length Endorsement Initial Reinstatement Compact Temp PermitCalifornia RN Board $190.00 2 $100.00 $150.00 $280.00 NO $50.00Arizona $160.00 4 $150.00 $150.00 $50 - $350 eNLC no chargeCalifornia BVNPT $155.00 2 $75.00 $150.00 $230- $580 NODC $145.00 2 $230.00 $187.00 $230.00 NOVermont $140.00 2 $150.00 $60.00 $140 + late fee NO $25.00Maryland $136.00 2 $100.00 $100.00 eNLCRhode Island $135.00 2 LPN $45 RN $135 LPN $45 RN $135 NLCMichigan $123.60 2 $54.00 $54.54 unknown NONebraska $123.00 2 $123.00 $123.00 $110.00 eNLCNorth Dakota $120.00 2 $160.00 $130.00 LPN $160 RN $170 eNLCMassachusetts $120.00 2 $275.00 $250.00 NONew Jersey $120.00 2 $200.00 $200.00 $225/$345 NO $140.00Tennessee $110.00 2 $115.00 $100/$110 $200.00 eNLCConnecticut $110.00 1 $180.00 $180.00 $180.00 NONew Mexico $110.00 2 $150.00 $150.00 $200.00 NLCArkansas $100.00 2 $125.00 $100.00 $100.00 eNLC $30.00Mississippi $100.00 2 PN - $60 RN - $100 PN - $60 RN - $100 eNLCMontana $100.00 2 $200.00 $100.00 eNLCNevada $100.00 2 LPN $95 RN $105 LPN $90 RN $100 $200.00 NONorth Carolina $100.00 2 $150.00 $75.00 $100/$180 eNLCOregon $100.00 2 $204.00 $169.00 $264.00 NOIowa $99.00 3 $119.00 $93.00 $175.00 eNLCIdaho $90.00 2 up to $150, $200 up to $150, $200 $125.00 eNLCSouth Dakota $90.00 2 $100.00 $100.00 $140.00 eNLC $25.00Wisconsin $86.00 2 $82.00 $75.00 $111.00 NLC $10.00Colorado $85.00 2 $43.00 $88.00 $179.00 NLCMinnesota $85.00 2 $105.00 $105.00 NOGuam $80.00 2 $100.00 $100.00 $125.00 NO $25.00Louisiana RN $80.00 1 $100.00 $100.00 $100.00 NO $100.00New Hampshire $80.00 2 $120.00 $120.00 $120.00 eNLC $20.00Maine $75.00 2 $50, $75 $50, $75 $60, $85 eNLCAlabama $75.00 2 $85.00 $85.00 $150.00 NO $50.00Florida $75.00 2 $110.00 $100.00 $130 - $210 eNLCOklahoma $75.00 2 $125.00 $85.00 $115.00 eNLCSouth Carolina $75.00 2 $100.00 $90.00 $110.00 eNLC $10.00New York $73.00 3 $143.00 $143.00 NO $35.00Pennsylvania $65.00 2 $100.00 $135.00 email NO $35.00Texas $65.00 2 $186.00 $100.00 PN $52/$62 RN $75/$8 eNLCGeorgia $65.00 2 $75.00 $40.00 $90.00 eNLCKentucky $65.00 1 $165.00 $125.00 $135.00 eNLCOhio $65.00 2 $75.00 $75.00 $100, $135, $185 NOWashington $65.00 1 $85, $120 $85, $120 $70, $130 NOWest Virginia RN $65.00 1 $100.00 $70.00 $115.00 eNLC $25.00Missouri $60.00 2 PN - $51 RN - $55 PN - $41 RN - $45 PN - $102 RN - $110 eNLCLouisiana PN $60.00 1 $135.00 $100.00 $130.00 NOUtah $58.00 2 $95.00 $95.00 $108.00 eNLCKansas $55.00 2 $50, $75 $50, $75 $40.00 eNLC $10.00Indiana $50.00 2 $50.00 $50.00 $100.00 NO $10.00West Virginia PN $50.00 1 $50.00 $75.00 $70.00 NO $25, $35, $50Alaska 2 $215.00 $215.00 $265.00 NO $50.00Delaware 2 $141.00 $141.00 renewal fee +50% eNLC $40.00Hawaii 2 $166 - $234 $40 + $36 email NOIllinois 2 $50.00 $98.00 NO $25.00Virgin Islands 2 NOVirginia 2 eNLCWyoming 2 $180, $195 $190.00 $135.00 eNLC

State Licensing Fees


(Professional Nurse) 2011 2012 2013 2014 2015 2016 2017Application for license by endorsement to Kansas $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00Application for license by examination $75.00 $75.00 $75.00 $75.00 $75.00 $75.00 $75.00Biennial renewal of license $60.00 $60.00 $60.00 $60.00 $55.00 $55.00 $55.00(Practical Nurses)Application for license by endorsement to Kansas $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Application for license by examination $50.00 $50.00 $50.00 $50.00 $50.00 $50.00 $50.00Biennial renewal of license $60.00 $60.00 $60.00 $60.00 $55.00 $55.00 $55.00

KSBN Fee History


2018 Kansas Board of Nursing

Nurse Licensure Compact Survey

(January 29, 2018, Week 1 Draft)


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BACKGROUND With the increasing use of telemedicine for delivering healthcare services, more nurses are

being asked to provide care across state lines. The Nurse Licensure Compact (NLC) is an agreement between participating states to mutually recognize each other’s registered nurse (RN) and licensed practical nurse (LPN)/vocational nurse (VN) licenses1. It allows nurses to hold a multistate license and be eligible to practice in the licensing state as well as all other states participating in the NLC, subject to each state's practice laws and regulations (NCSBN, 2017). The NLC streamlines nurse mobility and promotes the standardization of nursing practice regulations (Evans, 2015; Litchfield, 2010; Poe, 2008).

The NLC was developed by National Council of State Boards of Nursing (NCSBN) in the late 1990s. To further increase access to care and improve public protection, NCSBN promoted an enhanced NLC in 2015 (Alexander, 2016; Fotsch, 2018). In May 2015, the newly enhanced Compact was approved by the Boards of Nursing (BONs) as a future nursing licensure model in the United States (NCSBN, https://www.ncsbn.org/enhanced-nlc-implementation.htm). The enhanced NLC requires mandatory criminal background checks and facilitates telehealth, nurse job mobility, increases access to care for patients, and enhances patient safety (Halpern, 2016; NCSBN, 2018). On January 19, 2018, NCSBN implemented the enhanced NLC.

Figure 1. Distribution of the NLC States in the United States (January, 2018)

1 Because advanced practice registered nurses (APRNs) are recognized in a separate Interstate Compact arrangement for the differences in regulations and scope of APRN practice across states, in this document, “nurses” will refer to registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) only.


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At the time of this study period, Kansas has pending enhanced NLC legislation, however, all four states (CO, NE, MO, and OK) bordering Kansas are members of enhanced NLC (Figure 1). The KS BON had actively participated in the NLC discussions with NCSBN since its inception and released their position statement on multistate regulation of nurses in 1999. In the statement, KS Board addressed their concerns about public protection due to various qualifications for the nursing practice set by individual state under the original NLC language (KS BON, 1999). The enhanced NLC, implemented in January 2018, included 11 stringent uniform licensure requirements to ensure public protection, has since addressed some questions raised by the KS BON.

Upon the implementation of the enhanced NLC, the KS BON faced increasing questions about whether and when Kansas will adopt the enhanced NLC. Therefore, in collaboration with NCSBN, the KS BON conducted a web survey of all nurses licensed in Kansas in January 2018. The goal of the survey is to get a better understanding on Kansas nurses’ knowledge about the NLC and their opinion regarding Kansas joining the NLC. This information will help KS BON decide whether Kansas will adopt the NLC. SURVEY QUESTIONS This survey sought to address the following questions:

1. What do nurses licensed in Kansas know about the NLC? 2. What are the perceived benefits or concerns of Kansas joining the NLC? 3. What are the opinions of Kansas nurses regarding Kansas joining the NLC?

METHODOLOGY

This is a descriptive online survey of all nurses who hold an active RN or LPN/VN license in Kansas and registered in the NCSBN Nursys Database, a comprehensive electronic database that collects and stores the demographics, licensing, and disciplinary information on U.S. nurses. The survey instrument was developed by the KS BON, in collaboration with NCSBN, using the 2017 MN NLC survey as a base. It consists of 14 questions regarding nurses’ knowledge of and opinions about the NLC, their work experiences, as well as licensure and practice settings (See Appendix). The survey was administered via the Qualtrics platform. It was estimated to take less than five minutes to fill out the survey.

Study Population We surveyed over 60,000 RNs and LPN/VNs licensed in Kansas with valid email accounts for

distributing the online survey. In addition, 660 nurses licensed in Kansas who participated in the 2014 NCSBN National Compact Survey were used as a control group.

Procedures

With permission from the KS BON, the NCSBN Research Department obtained the email addresses of all KS nurses registered in the NCSBN Nursys database in January 2018. To help nurses better understand the study purpose and encourage their participation in the study, the KS Board of Nursing posted a study announcement from Ms. Carol Moreland, Executive Administrator of KS BON on their website (https://ksbn.kansas.gov/wp-content/uploads/Misc/slider/Kansas-NurseCompact-Survey.pdf). NCSBN also distributed the announcement letter on behalf of the KS BON via Qualtrics survey and emails. Per requests from nurses who did not receive the online


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survey, a general survey link was distributed during the survey. The online survey is expected to close on February 28. Data Analysis and Confidentiality Data were exported from Qualtrics to Excel. Standard descriptive analysis, such as frequencies and graphic representations, were used to provide descriptive information. Chi-square analysis was performed using SAS Enterprise 6.1. Findings from the 2014 NLC National Compact Survey were used for comparison. The current survey did not collect identifiable personal information such as names or social security numbers of the participants. The email address was the only link to the individual participant. Only aggregate data were analyzed and reported.

RESULTS The responses to the survey were overwhelming. As of January 29, a total of 14,197

completed survey were returned. Characteristics of Study Subjects

The majority of the respondents (75%, n=10,618) considered Kansas their primary residence. 44% of the respondents (n=6,280) indicated that they also held a non-Kansas License. Among the nurses residing in Kansas, 29% (n=3,028) of them hold a non-Kansas license as well.

The majority of the respondents (79%) held an RN license, while 12% of them held an

LPN/VN license. The remaining 10% held multiple licenses, including, both RN, LPN/VN, or APRN licenses (Table 1).

Table 1. License Type (N=14,196)

About 46% of the respondents worked in hospitals, while 23% of them worked in other settings, including clinic, community care, insurance, etc. (Table 2).

Table 2. Primary Practice Settings (N=14,196)

License Type N Percent RN 11,195 79% LPN/VN 1,654 12% Multiple licenses 1,347 9%

Employment Settings N Percent Hospital 6,513 46%Ambulatory Care 1,317 9%Long-term Care 1,234 9%Home Care/Hospice 847 6%Public Health/School Health 663 5%Academia 346 2% Other 3,276 23%


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Table 3 shows that half of the respondents were direct care nurses.

Table 3. Primary Role (N=14,196) N Percent Direct Care Nurse 7,114 50%Nurse Administrator/Manager 1,537 11%Case Manager Nurse 1,010 7%Nurse Educator 642 5%Telephone Triage Nurse 438 3%Transport Nurse 71 1%Other 3,384 24%

Most respondents (93%) had practiced nursing within the last 24 months, while 45% of all respondents provided nursing services or communicated with patients across a state border in the last 24 months (Table 4).

Table 4. Practice Status in the Past 24 months N Percent Employed in a position the required a nursing license

Yes 13,184 93%No 1,013 7%

Provided services/communication with patients outside of Kansas

Yes 6,455 45%No 7,742 55%

Knowledge of the NLC In the current survey, 77% of respondents stated that they were either “aware” or “fully aware” of the NLC (Table 5). The proportion of nurses who reported being “aware” or “fully aware” of the NLC increased from 46% to 77% since 2014 (Figure 2). Table 5. Awareness of the NLC (N=14,197) Awareness Level N Percent Fully Aware 7,039 50% Somewhat Aware 3,778 27% Not Aware at all 3,380 24%


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Figure 2. KS Nurses’ Awareness of the NLC in 2018 and 2014

*Two respondents in the 2014 NLC survey did not answer this question

Compact License Usage and Perception of Benefit

Approximately 25% (n=3,598) of the respondents held a compact license. Among them, 65% (n=2,343) practiced under their compact license in another state/jurisdiction within the past 24 months. Among these nurses, 89% of them felt the NLC was of benefit to them (Table 6).

Table 6. Perceived Beneficial of NLC (N=2,343) Benefit of NLC N Percent Yes 2,096 89% No 94 4% Not Applicable 153 7%

Opinions about Kansas Joining the NLC Overall, 85% of respondents were in favor of Kansas joining the NLC. This trend is in line

with the findings reported in the 2014 survey (Table 7). Compared to the findings from the 2014 survey, there is a decrease in the proportion of the nurses who had no opinion or felt neutral about joining the NLC in the current survey, while the proportion of nurses who are in favor of Kansas join the NLC increased accordingly.

50%

27%23%20%

26%

54%

0%

20%

40%

60%

80%

100%

Fully aware Somewhat aware Not at all aware

KS Nurses' Awareness of the Nurse Licensure Compact

2018 NLC Survey (N = 14,197) 2014 NLC Survey (N= 658)*


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Table 7. KS Nurses’ Opinion about Joining the NLC

In Favor of Joining NLC 2018 Survey 2014 Survey Yes 85% 73%No 2% 1%No opinion/Neutral 13% 26%Total 14,196 253*

*407 nurses did not answer this question in the 2014 survey

The current survey asked whether nurses licensed in Kansas are willing to pay an additional fee for a compact license. Overall, 76% of the respondents answered “yes” to this question despite their residency ( Table 8). One nurse did not answer this question. The amount of the additional fee these respondents consider paying for a compact license is presented in Table 8.

Table 8. Nurses Opinion Regarding Licensure Fee Increase Increase KS Resident Non-KS Resident Yes 75% 76%No 25% 24%Total 10,617 3,579

Table 9. Additional Fee Applicants Consider Paying for a Compact License Additional Fee Percent KS Resident Non-KS Resident$5-$10 24% 22% 30%$11-$15 22% 22% 21%$16-$20 46% 48% 41%Other 8% 8% 8%Total 10,727 8,010 2,717

We further examined respondents’ opinions about joining the NLC among nurses in different employment settings and with different primary roles. Table 10 reveals overwhelming support from nurses in various employment settings, from 77% among nurses working in public health/school health to 89% among nurses in academia.


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Table10. Respondents’ Opinions about KS Joining the NLC by Employment Settings In Favor of Joining NLC

Yes No No Opinion N Primary Employment Setting

Hospital 88% 1% 11% 6,513 Ambulatory Care 86% 1% 13% 1,317 Long Term Care 84% 1% 15% 1,234 Home Care/Hospice 86% 2% 12% 847 Public Health/School Health 77% 3% 21% 663 Academia 89% 3% 8% 346 Other 81% 2% 17% 3,276

The majority of the respondents in all roles were in favor of Kansas joining the NLC, ranging from 85% of direct care and triage nurses to 93% of transport nurses (Table 11).

Table 11. Respondents’ Opinions about KS Joining the NLC by Primary Role

In Favor of Joining NLC Yes No No Opinion N

Primary Role

Direct Care Nurse 85% 1% 13% 7,114Nurse Administrator/Manager 88% 1% 10% 1,537Case Manager Nurse 87% 1% 12% 1,010Nurse Educator 90% 2% 7% 642Telephone Triage Nurse 86% <1% 14% 438Transport Nurse 93% -- 7% 71

Other 81% 2% 16% 3,384

Further analysis shows that 95% of the nurses who are fully aware of the NLC versus 66% of

the nurses where are not at all aware of the NLC are support for Kansas joining the NLC. A further review reveals a statistically significant positive relationship between levels of nurses’ awareness of the NLC and their support for Kansas joining the NLC (χ2 =1,648, df =4, P<.001).

Analysis of support for the NLC among sub-groups of respondents showed a high level of

support among all categories (Table 12). The current data further show a higher proportion of RNs than PN/VNs support KS joining the NLC 86% versus 76%). The highest level of support (over 90%) was indicated in following group of nurses:

those with primary residency outside of KS those holding a license outside of KS those holding a Compact license those who have provided nursing services and or communicated patients outside of

Kansas those who had recently practiced under their Compact license


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Table 12. Support for Joining the NLC by Residence, License and Practice Status

In Favor of Joining NLC Yes No No Opinion N

Primary residency in Kansas Yes 83% 2% 15% 10,617No 92% 1% 7% 3,579

Level of Practice RN 86% 2% 12% 11,195

LPN/VN 76% 2% 22% 1,654Provided services/communication with patients outside of KS within the past 24 months

Yes 91% 1% 8% 6,454No 80% 2% 18% 7,742

Hold a license outside of KS Yes 93% 1% 7% 76,279No 79% 2% 18% 7,917

Hold a Compact license Yes 94% 1% 5% 3,597No 82% 2% 16% 10,599

Used a Compact license within the past 24 months

Yes 96% <1% 3% 2,343No 91% 1% 8% 1,254

Comments regarding the Benefits and Challenges of Joining the NLC

The survey asked respondents to specify why they are for or against Kansas joining the NLC. Two text boxes were provided for these respondents’ comments. Several respondents also sent their comments via email. A brief summary of comments is provided below.

Benefits of Kansas Joining the NLC

Streamlines mobility and reduces barriers to cross-border practice Increases access to standardized patient care and safety Promotes a cost-effective licensure process Increases job opportunity in nursing Facilitates the care of patients who seek treatment in Kansas but reside across the border

Concerns about Kansas Joining the NLC

Various licensure requirements and standards for practice across states Difficulty in oversighting nursing practice across state lines Increase in license fees No need for a Compact license due to retirement, or having no intention or requirement to

practice outside of Kansas Need more knowledge about the NLC

Discussion

We surveyed all nurses with an active Kansas license and over fourteen thousand nurses responded. The vast majority (85%) were in favor of Kansas joining the NLC. Two percent of respondents were not in favor. Awareness of the NLC also increased substantially from the earlier survey period—from 46% in 2014 to 77% in 2018. There was a strong positive association between knowledge of the NLC and support for the NLC, indicating the more nurses know about the NLC, the more likely they are in favor of joining it. Additionally, the enhanced NLC which includes the


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criminal background checks and more standardized licensure requirements could also help nurses feel more in favor of joining the NLC. Benefits of Adopting the NLC

The most common benefits of KS joining compact mentioned by the respondents include: reduced time and cost of applying additional licenses to practice across state boarders, increased job opportunities, and increased access to patient care in nursing shortage areas.

The current survey shows that almost 45% of respondents had provided nursing services to

and/or communicated with patients or clients located in a state other than Kansas. Over 90% of these nurses were in favor of KS joining the NLC. The 2015NCSBN National Nursing Workforce Survey shows that 35% of the RNs and 25% of LPN/VNs from Kansas provided nursing services with patient or client across state boarders via phone or electronically. These statistics show an increasing need for Kansas nurses providing patient care across state lines.

Concerns about Adopting NLC Patient Safety

One of the main concerns about KS joining the NLC include fears of potential decreases in standards of patient care and licensure requirements, including various continued competency and criminal conviction background check requirements for licensure in other Compact states. We would like to note here that the enhanced NLC has addressed some of these concerns by including 11 uniform licensure standards. Since January 2018, all compact states, enacted the enhanced NLC, necessitated criminal background checks as one of the additional uniform licensure requirements. The uniform licensure standards imposed in the enhanced NLC has further ensured public protection across state lines.

Cost of Joining NLC The second most commonly addressed concern is the potential increase of the licensure fees. According to a previous NLC economic model evaluation conducted by NCSBN, implementation of the NLC has fiscal impacts on state boards, especially during the set-up stage. Some compact states reported a loss in verification revenue due to entering into the NLC, even though that loss could be compensated for by reduction in administrative costs (NCSBN, 2009). The KS Board thought they had to increase licensure fee to compensate for a 20% decrease in revenue if they decided to adopt the NLC(KS BON, 1999). The current survey showed that the majority of the respondents (76%, n=10,727) are willing to pay increased licensure fee, so they may practice in all compact states. Since the implementation of the NLC would benefit the public through enabling mobility of quality nursing practice across state lines, providing appropriate final resources to assist those states who are planning to enter into the NLC is highly suggested.

This study is relied upon voluntary self-reported data. Nurses who did not have a valid email account nor internet access were excluded from participation. The current study reveals that there is a need to educate nurses more about the enhanced NLC. By being aware of the enhanced uniform requirements each nurse needs to meet for a compact license, these nurses may make a more educated judgement about KS joining the NLC.


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Conclusion Over 14,000 Kansas nurses responded to the survey within a week and the vast majority were

in favor of Kansas joining the NLC. In their contacts with NCSBN, several respondents indicate that since all nurses have taken and passed the same national NCLEX exam, not only for Kansas, all states in the United States should join the compact to enable nurses practice nationally with one national license.

The current survey shows that awareness of the NLC was strongly related to support for the

NLC. Effective educational outreach will be critical to fully inform nurses, nursing employers, other healthcare providers, legislators and the public about the enhanced NLC. NCSBN have initiated this endeavor since the implementation of eNLC. An evaluation of the effectiveness of the educational outreach on enhanced NLC is being undertaken by the NCSBN Nursing Regulation and Administration Division.

References

Alexander, M. (2016). Public trust in nusing goes beyond state lines. Journal of Nursing Regulation, 7(2), 3.

Evans, S. (2015). The Nurse Licensure Compact: A historical perspective. Journal of Nursing Regulation, 6(3), 11-16.

Fotsch, R. (2018). The enhanced Nurse Licensure Compact goes live. Journal of Nursing Regulation, 8(4), 61-62.

Halpern, L. W. (2016). New Patient Safety Requirements Toughen Nurse Licensure Compact. Am J Nurs, 116(12), 15. doi:10.1097/01.NAJ.0000508648.55941.5a

KS BON. (1999). Kansas State Board of Nursing Position Statemetn on Multisate Regulation of Nurses. Retrieved from http://www.ksbn.org/positionstatements/Multistate%20regulation%20of%20Nurses.pdf

Litchfield, S. M. (2010). Update on the nurse licensure compact. AAOHN J, 58(7), 277-279. doi:10.3928/08910162-20100625-03

NCSBN. (2009). Nurse Licensure Compact Economic Model Evaluation Update. Chicago, IL: Authur.

NCSBN. (2017). Nurse Licensure Compact. Retrieved from https://www.ncsbn.org/nurse-licensure-compact.htm

NCSBN. (2018). Enhanced Nurse Licensure Compact (eNLC) Implemented Jan. 19, 2018. Retrieved from https://ncsbn.az1.qualtrics.com/jfe/preview/SV_8oH3exMDcB5Ajyd?Q_CHL=preview

Poe, L. (2008). Nursing regulation, the nurse licensure compact, and nurse administrators: working together for patient safety. Nurs Adm Q, 32(4), 267-272. doi:10.1097/01.NAQ.0000336722.10689.d3


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Appendix: Survey Instrument Introduction: The Nurse Licensure Compact (NLC) allows mutual recognition of a nursing license between states. A nurse who holds a multistate license issued by a state in the NLC can practice in any other NLC state without obtaining another license.

The NLC is a solution to increase access to care and the mobility of nursing services. It facilitates cross-border practice both physically, and electronically, via telehealth and online nursing education. Adoption of the NLC by a state would ultimately serve to improve patient care and safety.

A nurse must meet uniform licensure requirements to be eligible for a multistate license and adhere to the Nurse Practice Act in the state where the patient is located.

To better understand your feelings about joining the NLC, please answer the following questions.

Kansas Nurse Licensure Compact (NLC) Survey

1. Prior to the recent contact from the Kansas Board of Nursing about this survey, were you aware of the Nurse Licensure Compact? Yes, fully aware Somewhat aware Not at all aware

2. Is Kansas your state of primary residence? Yes No

3. Other than Kansas, do you hold an active nursing license in any other state? Yes No

4. In the past 24 months, have you been employed in a position that required a nursing

license? Yes No

5. In the past 24 months, have you provided nursing services and/or communicated with a

patient or client who was located in a state other than Kansas? Yes No


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6. Do you currently hold an active multistate license issued by a state in the NLC? Yes No Please Skip to Question 9

7. Have you practiced in another state/jurisdiction under your multistate license in the past

24 months? Yes No

8. Has the Nurse Licensure Compact been beneficial to you?

Yes

No

Not Applicable

9. Would you be in favor of Kansas joining the Nurse Licensure Compact? Yes (Please provide reason) ___________________

No (Please provide reason) ____________________

No opinion 10. Would you be willing to pay an additional fee for a compact license?

Yes No Please skip to Question 12

11. How much of an additional fee would you consider paying for a compact license?

$5-$10 $11-$15 $16-$20 Other ___________

12. What type of license do you currently hold? (Select all that apply)

LPN/VN

RN

APRN 13. What is your primary practice setting?

Hospital Long Term Care Ambulatory Care Home Care/Hospice Public Health/School Health

Academia Other _________


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14. What is your primary role? Telephone Triage Nurse Transport Nurse Case Manager Nurse Nurse Administrator/Manger Nurse Educator Direct Care Nurse Other _________


Session of 2018

HOUSE BILL No. 2589

By Committee on Health and Human Services

1-31

AN ACT concerning the independent practice of midwifery act; providing for administration by the state board of nursing; establishing a nurse-midwives advisory council; amending K.S.A. 2017 Supp. 65-28b02, 65-28b03, 65-28b04, 65-28b05, 65-28b06, 65-28b07, 65-28b08 and 65-28b09 and repealing the existing sections.

Be it enacted by the Legislature of the State of Kansas:Section 1. K.S.A. 2017 Supp. 65-28b02 is hereby amended to read as

follows: 65-28b02. As used in the independent practice of midwifery act:(a) "Board" means the state board of healing arts nursing.(b) "Certified nurse-midwife" means an individual who:(1) Is educated in the two disciplines of nursing and midwifery;(2) is currently certified by a certifying board or entity approved by

the state board of nursing; and(3) is currently licensed under the Kansas nurse practice act.(c) "Independent practice of midwifery" means the provision of

clinical services by a certified nurse-midwife without the requirement of a collaborative practice agreement with a person licensed to practice medicine and surgery when such clinical services are limited to those associated with a normal, uncomplicated pregnancy and delivery, including:

(1) The prescription of drugs and diagnostic tests;(2) the performance of episiotomy or repair of a minor vaginal

laceration;(3) the initial care of the normal newborn; and(4) family planning services, including treatment or referral of male

partners for sexually-transmitted infections.(d) The provisions of this section shall become effective on January

1, 2017.Sec. 2. K.S.A. 2017 Supp. 65-28b03 is hereby amended to read as

follows: 65-28b03. (a) In order to obtain authorization to engage in the independent practice of midwifery, a certified nurse-midwife must meet the following requirements:

(1) Be licensed to practice professional nursing under the Kansas nurse practice act;

(2) have successfully completed a course of study in nurse-midwifery

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in a school of nurse-midwifery approved by the board;(3) have successfully completed a national certification in nurse-

midwifery approved by the board;(4) have successfully completed a refresher course as defined by rules

and regulations of the board, if the individual has not been in active midwifery practice for five years immediately preceding the application;

(5) be authorized to perform the duties of a certified nurse-midwife by the state board of nursing;

(6) be licensed as an advanced practice registered nurse by the state board of nursing; and

(7) have paid all applicable fees for licensure prescribed in K.S.A. 2017 Supp. 65-28b05, and amendments thereto.

(b) Upon application to the board by any certified nurse-midwife and upon satisfaction of the standards and requirements established under this act, the board shall grant an authorization to the applicant to engage in the independent practice of midwifery, except that no application to engage in the independent practice of midwifery shall be granted until the date upon which rules and regulations adopted to carry out the provisions of K.S.A. 2017 Supp. 65-28b07(a), and amendments thereto, become effective.

(c) The board may grant a temporary permit to engage in the independent practice of midwifery to a person who has met the requirements of (a)(1), (2), (3), (6) and (7) for the needed amount of time to complete the refresher course under (a)(4), but the temporary permit shall not exceed 120 days.

(c) (d) A person whose licensure authorization to engage in the independent practice of midwifery has been revoked may make written application to the board requesting reinstatement of the license authorization in a manner prescribed by the board, which application shall be accompanied by the fee prescribed in K.S.A. 2017 Supp. 65-28b05, and amendments thereto.

(d) The provisions of this section shall become effective on January 1, 2017.

Sec. 3. K.S.A. 2017 Supp. 65-28b04 is hereby amended to read as follows: 65-28b04. (a) Licenses Authorization to engage in the independent practice of midwifery issued under this act shall expire on the date of expiration established by rules and regulations of the board, unless renewed in the manner prescribed by the board. The request for renewal shall be accompanied by the fee prescribed in K.S.A. 2017 Supp. 65-28b05, and amendments thereto.

(b) At least 30 days before the expiration of a licensee's license an authorization, the board shall notify the licensee holder of the authorization of the expiration, by mail, addressed to the licensee's person's last known mailing address. If the licensee holder of the

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authorization fails to submit an application for renewal on a form provided by the board, or fails to pay the renewal fee by the date of expiration, the board shall give a second notice to the licensee that the license holder of the authorization that the authorization has expired and the license authorization may be renewed only if the application for renewal, the renewal fee, and the late renewal fee are received by the board within the 30-day period following the date of expiration and that, if both fees are not received within the 30-day period, the license authorization to engage in the independent practice of midwifery shall be deemed canceled by operation of law and without further proceedings.

(c) The board may require any licensee holder of an authorization, as a condition of renewal, to submit with the application of renewal evidence of satisfactory completion of a program of continuing education as required by rules and regulations of the board.

(d) The provisions of this section shall become effective on January 1, 2017.

Sec. 4. K.S.A. 2017 Supp. 65-28b05 is hereby amended to read as follows: 65-28b05. (a) The board shall charge and collect, in advance, fees for certified nurse-midwives, the following fees as established by the board, by rules and regulations, not to exceed:Application for license .........................................................................$100License renewal ...................................................................................$100Late license renewal .............................................................................$100License reinstatement fee .....................................................................$100Revoked license fee .............................................................................$100Certified copy of license ........................................................................$50Verified copy of license .........................................................................$25Application for authorization..............................................................$100Authorization renewal.........................................................................$100Late authorization renewal..................................................................$100Authorization reinstatement fee...........................................................$100Revoked authorization fee...................................................................$100Temporary permit fee.............................................................................$50Certified copy of authorization..............................................................$50Verified copy of authorization ...............................................................$50

(b) The board shall remit all moneys received by or for the board from fees, charges or penalties to the state treasurer in accordance with the provisions of K.S.A. 75-4215, and amendments thereto. Upon receipt of each such remittance, the state treasurer shall deposit the entire amount in

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the state treasury. Ten percent of each such amount shall be credited to the state general fund, and the balance shall be credited to the healing arts board of nursing fee fund. All expenditures from the healing arts board of nursing fee fund shall be made in accordance with appropriation acts upon warrants of the director of accounts and reports issued pursuant to vouchers approved by the president of the board or by a person or persons designated by the president.

(c) The provisions of this section shall become effective on January 1, 2017.

Sec. 5. K.S.A. 2017 Supp. 65-28b06 is hereby amended to read as follows: 65-28b06. (a) It shall be unlawful for a person to engage in the independent practice of midwifery without a collaborative practice agreement with a person licensed to practice medicine and surgery, unless such certified nurse-midwife holds a license from the state board of nursing and the board person holds a currently valid authorization from the board to engage in the independent practice of midwifery under the act.

(b) The provisions of this section shall become effective on January 1, 2017.

Sec. 6. K.S.A. 2017 Supp. 65-28b07 is hereby amended to read as follows: 65-28b07. (a) The board, in consultation with the state board of nursing nurse-midwives advisory council, shall adopt rules and regulations pertaining to certified nurse-midwives engaging in the independent practice of midwifery and governing the ordering of tests, diagnostic services and prescribing of drugs and referral or transfer to physicians in the event of complications or emergencies. Such rules and regulations shall not be adopted until the state board of nursing and the board have consulted and concurred on the content of each rule and regulation. Such rules and regulations shall be adopted no later than January 1, 2017 15, 2019.

(b) A certified nurse midwife engaging in the independent practice of midwifery shall be subject to the provisions of the independent practice of midwifery act with respect to the ordering of tests, diagnostic services and prescribing of drugs, and shall not be subject to the provisions of K.S.A. 65-1130, and amendments thereto.

(c) The standards of care for certified nurse-midwives in the ordering of tests, diagnostic services and the prescribing of drugs shall be those standards which protect patients and shall be standards comparable to persons licensed to practice medicine and surgery providing the same services.

(d) In addition to rules and regulations the board is otherwise authorized to adopt under the independent practice of nurse midwifery act, the board is hereby authorized to solely adopt those rules and

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regulations necessary to administer the administrative provisions of this act.

Sec. 7. K.S.A. 2017 Supp. 65-28b08 is hereby amended to read as follows: 65-28b08. (a) The board may deny, revoke, limit or suspend any license or authorization or temporary permit issued to a certified nurse-midwife to engage in the independent practice of midwifery that is issued by the board or applied for under this act, or may publicly censure a licensee the holder of an authorization or holder of a temporary permit or authorization, if the applicant or licensee holder of an authorization or temporary permit is found after a hearing:

(1) To be guilty of fraud or deceit while engaging in the independent practice of midwifery or in procuring or attempting to procure a license an authorization or temporary permit to engage in the independent practice of midwifery;

(2) to have been found guilty of a felony or to have been found guilty of a misdemeanor involving an illegal drug offense unless the applicant or licensee holder of an authorization or temporary permit establishes sufficient rehabilitation to warrant the public trust, except that notwithstanding K.S.A. 74-120, and amendments thereto, no license or authorization or temporary permit to practice and engage in the independent practice of midwifery shall be granted to a person with a felony conviction for a crime against persons as specified in article 34 of chapter 21 of the Kansas Statutes Annotated, prior to its repeal, or article 54 of chapter 21 of the Kansas Statutes Annotated, and amendments thereto, or K.S.A. 2017 Supp. 21-6104, 21-6325, 21-6326 or 21-6418, and amendments thereto;

(3) to have committed an act of professional incompetence as defined in subsection (c);

(4) to be unable to practice the healing arts midwifery with reasonable skill and safety by reason of impairment due to physical or mental illness or condition or use of alcohol, drugs or controlled substances. All information, reports, findings and other records relating to impairment shall be confidential and not subject to discovery or release to any person or entity outside of a board proceeding. The provisions of this paragraph providing confidentiality of records shall expire on July 1, 2022, unless the legislature reviews and reenacts such provisions pursuant to K.S.A. 45-229, and amendments thereto, prior to July 1, 2022;

(5) to be a person who has been adjudged in need of a guardian or conservator, or both, under the act for obtaining a guardian or conservator, or both, and who has not been restored to capacity under that act;

(6) to be guilty of unprofessional conduct as defined by rules and regulations of the board;

(7) to have willfully or repeatedly violated the provisions of the

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Kansas nurse practice act or any rules and regulations adopted pursuant to that act;

(8) to have a license to practice nursing as a registered nurse or as a practical nurse denied, revoked, limited or suspended, or to have been publicly or privately censured, by a licensing authority of another state, agency of the United States government, territory of the United States or country, or to have other disciplinary action taken against the applicant or licensee the holder of an authorization or temporary permit by a licensing authority of another state, agency of the United States government, territory of the United States or country. A certified copy of the record or order of public or private censure, denial, suspension, limitation, revocation or other disciplinary action of the licensing authority of another state, agency of the United States government, territory of the United States or country shall constitute prima facie evidence of such a fact for purposes of this paragraph; or

(9) to have assisted suicide in violation of K.S.A. 21-3406, prior to its repeal, or K.S.A. 2017 Supp. 21-5407, and amendments thereto, as established by any of the following:

(A) A copy of the record of criminal conviction or plea of guilty to a felony in violation of K.S.A. 21-3406, prior to its repeal, or K.S.A. 2017 Supp. 21-5407, and amendments thereto;

(B) a copy of the record of a judgment of contempt of court for violating an injunction issued under K.S.A. 60-4404, and amendments thereto; or

(C) a copy of the record of a judgment assessing damages under K.S.A. 60-4405, and amendments thereto.

(b) No person shall be excused from testifying in any proceedings before the board under this act or in any civil proceedings under this act before a court of competent jurisdiction on the ground that such testimony may incriminate the person testifying, but such testimony shall not be used against the person for the prosecution of any crime under the laws of this state, except the crime of perjury as defined in K.S.A. 2017 Supp. 21-5903, and amendments thereto.

(c) As used in this section, "professional incompetency" means:(1) One or more instances involving failure to adhere to the

applicable standard of care to a degree which constitutes gross negligence, as determined by the board;

(2) repeated instances involving failure to adhere to the applicable standard of care to a degree which constitutes ordinary negligence, as determined by the board; or

(3) a pattern of practice or other behavior which demonstrates a manifest incapacity or incompetence to engage in the independent practice of midwifery.

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(d) The board, upon request, shall receive from the Kansas bureau of investigation such criminal history record information relating to arrests and criminal convictions, as necessary, for the purpose of determining initial and continuing qualifications of licensees certified nurse midwives authorized to engage in the independent practice of midwifery and persons holding temporary permits to engage in the independent practice of midwifery and applicants for licensure by the board authorization to engage in the independent practice of midwifery or a temporary permit to engage in the independent practice of midwifery.

(e) The provisions of this section shall become effective on January 1, 2017.

Sec. 8. K.S.A. 2017 Supp. 65-28b09 is hereby amended to read as follows: 65-28b09. (a) The nurse-midwives council existing immediately prior to the effective date of this act is hereby abolished, and there is hereby established a nurse-midwives advisory council to advise the board in carrying out the provisions of this act. The council shall consist of seven members, all residents of the state of Kansas appointed as follows: Two members shall be licensees of the board, appointed by the board appointed by the state board of healing arts, who are licensed to practice medicine and surgery and whose specialty and customary practice includes obstetrics; one member shall be the president of the board state board of nursing or a board member designated by the president; and four members shall be licensed certified nurse-midwives authorized to engage in the independent practice of midwifery appointed by the state board of nursing, except for membership on the first appointed nurse-midwives advisory council, the four members appointed the the board shall be person eligible to obtain an authorization from the board to engage in the independent practice of midwifery. Members of the council shall serve at the pleasure of their appointing authority. The chairperson of the council shall be a member of the council designated by the president of the board.

(b) If a vacancy occurs on the nurse-midwives advisory council, the appointing authority of the position which has become vacant shall appoint a person of like qualifications to fill the vacant position for the unexpired term, if any.

(c) Members of the nurse-midwives advisory council attending meetings of the council, or attending a subcommittee meeting thereof authorized by the council, shall be paid amounts provided in K.S.A. 75-3223(e), and amendments thereto, from the board of nursing fee fund.

Sec. 9. K.S.A. 2017 Supp. 65-28b02, 65-28b03, 65-28b04, 65-28b05, 65-28b06, 65-28b07, 65-28b08 and 65-28b09 are hereby repealed.

Sec. 10. This act shall take effect and be in force from and after its publication in the statute book.

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