SB 161 — Makes revisions relating to personal health and wellness. (BDR 38-811)

(NRS 639.268) Existing regulations prescribe certain requirements concerning the operation of outsourcing facilities, which are federally registered facilities that engage in the compounding of drugs.

(NAC 639.691-639.6916) Those requirements include requirements that an outsourcing facility:

(1) be licensed by the State Board of Pharmacy as a manufacturer;

and (2) comply with regulatory requirements governing manufacturers.

(NAC 639.6915) Section 5 of this bill authorizes a person or entity authorized to dispense controlled substances and dangerous drugs to purchase or otherwise acquire controlled substances and dangerous drugs compounded or repackaged by an outsourcing facility directly from the outsourcing facility.

Section 4 of this bill makes a conforming change to update an internal reference changed by section 5.

Existing law requires a pharmacist to dispense up to a 12-month supply of contraceptives or therapeutic equivalent or any amount which covers the remainder the patient has previously received a 3-month supply of the same drug;

(2) the if:

(1) patient has previously received a 9-month supply of the same drug or a supply of the same drug for the balance of the plan year in which the 3-month supply was prescribed or ordered, whichever is less;

(3) the patient is insured by the same health insurance plan;

and (4) a provider of health care has not specified in the prescription or order that a different supply of the drug is necessary.

(NRS 639.28075) If a patient is not currently using a contraceptive or therapeutic equivalent, section 6 of this bill requires a pharmacist to dispense a full 3-month supply or the amount designated by the prescription or order, whichever is less, pursuant to a valid prescription or order unless the patient is unable or unwilling to pay the applicable charge, copayment or coinsurance.

If the patient is currently - 82nd Session (2023) – 3 – using the contraceptive or therapeutic equivalent, section 6 requires a pharmacist to dispense a full 9-month supply or a full 12-month supply, as applicable, any amount designated by the prescription or order or any amount which covers the order unless the patient is unable or unwilling to pay the applicable charge,on or copayment or coinsurance.

Existing law authorizes the Board of Massage Therapy to issue a license to practice massage therapy and sets forth the requirements that an applicant for a license must satisfy in order to become licensed.

(NRS 640C.580) Section 7 of this bill adopts the Interstate Massage Compact, creating a multistate license with uniform licensing requirements, including a national licensing examination, for use by licensees in all member states.

The Compact requires that, in order to be eligible to join the Compact and maintain eligibility as a member state, a state must:

(1) license and regulate the practice of massage therapy;

(2) have a mechanism or entity in place to receive and investigate complaints from the public, regulatory or law enforcement agencies or the Interstate Massage Compact Commission about licensees practicing in that massage therapy licensure in that state;

(4) require that licensees satisfy educational requirements before being licensed;

(5) implement procedures for requiring background checks for a multistate license and other reporting requirements;

(6) have continuing competence requirements;

(7) participate in the Compact’s data system;

(8) notify the Commission and other member states of any disciplinary action taken against a licensee practicing under a multistate license;

(9) comply with any rules of the Commission;

and (10) accept licensees with valid multistate licenses from other member states.

An applicant for a multistate license must:

(1) hold a license to practice massage therapy in a member state;

(2) complete 625 hours of massage therapy education or the substantial equivalent;

(3) pass a national licensing examination or the substantial equivalent;

(4) submit to and pass a background check;

and (5) pay all required fees.

The Compact:

(1) establishes the Interstate Massage Compact Commission as a (2) provides for the Commission’s rules and governance.

The Compact also;

and establishes a data system, provided for by the Commission, and requires member states to submit uniform data to the data system on all individuals to whom the Compact is applicable.

The Compact provides additional provisions to carry out the Compact, including providing procedures for the taking of adverse actions against licensees, provisions for active military members or their spouses, provisions for rulemaking by the Commission, provisions for oversight and dispute resolution and procedures for amendments and withdrawals.

The Compact takes effect on the date on which the Compact is enacted into law by the seventh member state.

Existing law provides that four members of the Board of Massage Therapy constitute a quorum for the purposes of transacting the business of the Board.

(NRS 640C.180) Section 8 of this bill increases the number of board members needed to constitute a quorum from four to five.

- 82nd Session (2023) – 4 – EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Chapter 422A of NRS 422.27172 is hereby amended by adding thereto a new section to read as follows:

that422.27172 federal1. funding is available, the Department shall authorize recipients of benefits provided under Supplemental Nutrition Assistance or the Special Supplemental Nutrition Program for Women, Infants and Children established by 42 U.S.C.

The Director shall include in the State Plan for Medicaid a requirement that the State pay the nonfederal share of expenditures incurred for:

(a) Up to a 12-month supply, per prescription, of any type of drug for contraception or its therapeutic equivalent which is:

(1) Lawfully prescribed or ordered;

(2) Approved by the Food and Drug Administration;

and (3) Dispensed in accordance with NRS 639.28075;

(b) Any type of device for contraception which is lawfully Drug Administration;d and which has been approved by the Food and (c) Self-administered hormonal contraceptives dispensed by a pharmacist pursuant to NRS 639.28078;

(d) Insertion or removal of a device for contraception;

(e) Education and counseling relating to the initiation of the use of contraceptives and any necessary follow-up after initiating such use;

(f) Management of side effects relating to contraception;

and (g) Voluntary sterilization for women.

2.

Except as otherwise provided in subsections 4 and 5, to obtain any benefit provided in the Plan pursuant to subsection 1, a person enrolled in Medicaid must not be required to:

(a) Pay a higher deductible, any copayment or coinsurance;

or (b) Be subject to a longer waiting period or any other condition.

3.

The Director shall ensure that the provisions of this section are carried out in a manner which complies with the requirements established by the Drug Use Review Board and set forth in the list of preferred prescription drugs established by the Department pursuant to NRS 422.4025.

4.

The Plan may require a person enrolled in Medicaid to pay a higher deductible, copayment or coinsurance for a drug for contraception if the person refuses to accept a therapeutic equivalent of 5.e cFor each method of contraception which is approved by the Food and Drug Administration, the Plan must include at least one contraceptive drug or device for which no deductible, copayment or - 82nd Session (2023) – 5 – coinsurance may be charged to the person enrolled in Medicaid, but the Plan may charge a deductible, copayment or coinsurance for any other contraceptive drug or device that provides the same method of contraception.

If the Plan requires a person enrolled in Medicaid the Plan may only require the person to pay the copayment oron, coinsurance:

(a) Once for the entire amount of the drug dispensed for the plan year;

or (b) Once for each 1-month supply of the drug dispensed.

6.

The Plan must provide for the reimbursement of a pharmacist for providing services described in subsection 1 that are within the scope of practice of the pharmacist to the same extent as if the services were provided by another provider of health care.

The Plan must not limit:

(a) Coverage for such services provided by a pharmacist to a number of occasions less than the coverage for such services when provided by another provider of health care.

(b) Reimbursement for such services provided by a pharmacist to an amount less than the amount reimbursed for similar services provided by a physician, physician assistant or advanced practice registered nurse.

7.

The Plan must not require a recipient of Medicaid to obtain prior authorization for the benefits described in paragraphs (a) and (c) of subsection 1.

8.

As used in this section:

(a) “Drug Use Review Board” has the meaning ascribed to it in NRS(b) “Provider of health care” has the meaning ascribed to it in NRS 629.031.

(c) “Therapeutic equivalent” means a drug which:

(1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

and (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

Sec.

2.

NRS 422.4053 is hereby amended to read as follows:

422.4053 1.

Except as otherwise provided in subsection 2, the Department shall directly manage, direct and coordinate all payments and rebates for prescription drugs and all other services - 82nd Session (2023) – 6 – and payments relating to the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program.

2.

The Department may enter into a contract with:

services described in subsection 1.or the provision of any (b) A health maintenance organization pursuant to NRS 422.273 for the provision of any of the services described in subsection 1 for recipients of Medicaid or recipients of insurance through the Children’s Health Insurance Program who receive coverage through a Medicaid managed care program.

(c) One or more public or private entities from this State, the District of Columbia or other states or territories of the United States for the collaborative purchasing of prescription drugs in accordance with subsection 3 of NRS 277.110.

3.

A contract entered into pursuant to paragraph (a) or (b) of subsection 2 must:

(a) Include the provisions required by NRS 422.4056;

[and] (b) Require the pharmacy benefit manager or health maintenance organization, as applicable, to disclose to the Department any information relating to the services covered by the contract, including, without limitation, information concerning dispensing fees, measures for the control of costs, rebates collected and paid and any fees and charges imposed by the pharmacy benefit manager or health maintenance organization pursuant to the contract [.] ;

and (c) Require the pharmacy benefit manager or health chapter regarding the provision of prescription drugs under the State Plan for Medicaid and the Children’s Health Insurance Program to the same extent as the Department.

4.

In addition to meeting the requirements of subsection 3, a contract entered into pursuant to:

(a) Paragraph (a) of subsection 2 may require the pharmacy benefit manager to provide the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, to the Department.

(b) Paragraph (b) of subsection 2 must require the health maintenance organization to provide to the Department the entire amount of any rebates received for the purchase of prescription drugs, including, without limitation, rebates for the purchase of prescription drugs by an entity other than the Department, less an - 82nd Session (2023) – 7 – administrative fee in an amount prescribed by the contract.

The Department shall adopt policies prescribing the maximum amount of such an administrative fee.

Sec.

3.

Chapter 422A of NRS is hereby amended by adding the1.to To the extent authorized by federal law and to the extent that federal funding is available, the Department shall authorize recipients of benefits provided under Supplemental Nutrition Assistance or the Special Supplemental Nutrition Program for Women, Infants and Children established by 42 U.S.C.

To the extent that money is available for this purpose, the Department, through the Division, may establish and administer a program to provide assistance for the purpose of purchasing menstrual products to recipients of benefits provided through programs for which the Division is responsible.

The Department may accept gifts, grants and donations from any source for the purpose of establishing and administering such a program.

4.

4.

NRS 454.221 is hereby amended to read as follows:

454.221 1.

A person who furnishes any dangerous drug D felony and shall be punished as provided in NRS 193.130, unlessegory the dangerous drug was obtained originally by a legal prescription.

The provisions of this section do not apply to the furnishing of any dangerous drug by:

(a) A practitioner to his or her patients;

(b) A physician assistant licensed pursuant to chapter 630 or 633 of NRS if authorized by the Board;

(c) A registered nurse while participating in a public health program approved by the Board, or an advanced practice registered nurse who holds a certificate from the State Board of Pharmacy permitting him or her to dispense dangerous drugs;

(d) A manufacturer or wholesaler or pharmacy to each other or to a practitioner or to a laboratory under records of sales and purchases that correctly give the date, the names and addresses of the supplier and the buyer, the drug and its quantity;

- 82nd Session (2023) – 8 – (e) A hospital pharmacy or a pharmacy so designated by a county health officer in a county whose population is 100,000 or more, or by a district health officer in any county within its jurisdiction or, in the absence of either, by the Chief Medical Officer Emergency Medical Services, to a person or agency described in subsection [3] 4 of NRS 639.268 to stock ambulances or other authorized vehicles or replenish the stock;

or (f) A pharmacy in a correctional institution to a person designated by the Director of the Department of Corrections to administer a lethal injection to a person who has been sentenced to death.

Sec.

5.

NRS 639.268 is hereby amended to read as follows:

639.268 1.

A practitioner may purchase supplies of controlled substances, poisons, dangerous drugs and devices from a pharmacy by:

(a) Making an oral order to the pharmacy or transmitting an oral order through his or her agent, except an order for a controlled substance in schedule II;

or (b) If the order is for a controlled substance, presenting to the pharmacy a written order signed by the practitioner which contains his or her registration number issued by the Drug Enforcement Administration.

2.

Any person or entity authorized to dispense controlled substances and dangerous drugs, including, without limitation, a pharmacy, institutional pharmacy or practitioner, may:

(a) Purchase or otherwise acquire controlled substances and facility directly from the outsourcing facility without an order from a practitioner other than, where applicable, the practitioner purchasing or acquiring the controlled substance or dangerous drug;

and (b) Administer and dispense controlled substances and dangerous drugs purchased or acquired pursuant to paragraph (a) to the same extent as controlled substances and dangerous drugs acquired through other authorized means.

3.

A hospital pharmacy or a pharmacy designated for this purpose by a county health officer in a county whose population is 100,000 or more, or by a district health officer in any county within its jurisdiction or, in the absence of either, by the Chief Medical Officer or his or her designated medical director of emergency medical services, may sell to a person or agency described in subsection [3] 4 supplies of controlled substances to stock the - 82nd Session (2023) – 9 – or replenish the stock if:ized vehicles of such a person or agency (a) The person or agency is registered with the Drug Enforcement Administration pursuant to 21 C.F.R.

Part 1301;

(b) The person in charge of the controlled substances is:

(1) A paramedic appropriately certified by the health authority;

(2) A registered nurse licensed by the State Board of Nursing;

or (3) A person who holds equivalent certification or licensure issued by another state;

and (c) Except as otherwise provided in this paragraph, the purchase order is countersigned by a physician or initiated by an oral order and may be made by the person or agency or transmitted by an agent of such a person or agency.

An order for a controlled substance listed in schedule II must be made pursuant to NRS 453.251.

[3.] 4.

A pharmacy, institutional pharmacy or other person dangerous drugs may sell to:nish controlled substances and (a) The holder of a permit issued pursuant to the provisions of NRS 450B.200 or 450B.210;

(b) The holder of a permit issued by another state which is substantially similar to a permit issued pursuant to the provisions of NRS 450B.200 or 450B.210;

and (c) An agency of the Federal Government that provides emergency care or transportation and is registered with the Drug Enforcement Administration pursuant to 21 C.F.R.

Part 1301.

[4.] 5.

A pharmacy, institutional pharmacy , outsourcing facility or other person licensed by the Board to furnish dangerous drugs who sells supplies pursuant to this section shall maintain a record of each sale which must contain:

(a) The date of sale;

(b) The name, address and signature of the purchaser or the per(c) The name of the dispensing pharmacist [;] , where applicable;

(d) The name and address of the authorizing practitioner [;] , where applicable;

and (e) The name, strength and quantity of each drug sold.

[5.] 6.

A pharmacy, institutional pharmacy or other person licensed by the Board to furnish dangerous drugs who supplies the initial stock for an ambulance or other emergency vehicle shall - 82nd Session (2023) – 10 – comply with any applicable regulations adopted by the State Board of Health, or a district board of health, pursuant to NRS 450B.120.

[6.] 7.

The Board shall adopt regulations regarding the records a pharmacist shall keep of any purchase made pursuant to this sec8.on.As used in this section:

(a) “Compounding” includes, without limitation, the combining, admixing, mixing, pooling, reconstituting or other altering of a drug or bulk drug substance, as defined in 21 C.F.R.

§ 207.3, to create a drug.

(b) “Outsourcing facility” means a manufacturer at one geographic location or address that:

(1) Is engaged in the compounding of sterile or nonsterile drugs for use by humans;

and (2) Has registered with the Secretary of Health and Human Services as an outsourcing facility pursuant to 21 U.S.C.

§ 353b.

Sec.

6.

NRS 639.28075 is hereby amended to read as follows:

639.28075 1.

Except as otherwise provided in [subsections] subsection 2 , [and 3,] pursuant to a valid prescription or order for a drug to be used for contraception or its therapeutic equivalent which has been approved by the Food and Drug Administration , a pharmacist shall:

(a) [The first time dispensing the drug or therapeutic equivalent to] If the patient [,] is not currently using the drug or its therapeutic equivalent, dispense up to a 3-month supply of the drug or therapeutic equivalent [.] or any amount designated by the prescription or order, whichever is less.

equivalent has only been dispensed to the patient [,] once pursuant to paragraph (a), dispense up to a 9-month supply of the drug or therapeutic equivalent, any amount designated by the prescription or order or any amount which covers the remainder of the plan year if the patient is covered by a health care plan, whichever is less.

(c) For a refill in a plan year following the initial dispensing of a drug or therapeutic equivalent pursuant to paragraphs (a) and (b), dispense [up to] a 12-month supply of the drug or therapeutic equivalent , any amount designated by the prescription or order or any amount which covers the remainder of the plan year if the patient is covered by a health care plan, whichever is less.

2.

[The provisions of paragraphs (b) and (c) of subsection 1 only apply if:

(a) The drug for contraception or the therapeutic equivalent of such drug is the same drug or therapeutic equivalent which was - 82nd Session (2023) – 11 – subsection 1;

andibed or ordered pursuant to paragraph (a) of (b) The patient is covered by the same health care plan.

3.

If a prescription or order for a drug for contraception or its therapeutic equivalent limits the dispensing of the drug or therapeutic equivalent to a quantity which is less than the amount otherwise authorized to be dispensed pursuant to subsection 1, the pharmacist must dispense the drug or therapeutic equivalent in accordance with the quantity specified in the prescription or order.

4.] A pharmacist is not required to dispense an amount of a drug to be used for contraception or its therapeutic equivalent for which the patient is unable or unwilling to pay any applicable charge, copayment or coinsurance due to the pharmacy.

3.

As used in this section:

(a) “Health care plan” means a policy, contract, certificate or agreement offered or issued by an insurer, including without limitation, the State Plan for Medicaid, to provide, deliver, arrange for(b) “Plan year” means the year designated in the evidence ofces.

coverage of a health care plan in which a person is covered by such plan.

(c) “Therapeutic equivalent” means a drug which:

(1) Contains an identical amount of the same active ingredients in the same dosage and method of administration as another drug;

(2) Is expected to have the same clinical effect when administered to a patient pursuant to a prescription or order as another drug;

and (3) Meets any other criteria required by the Food and Drug Administration for classification as a therapeutic equivalent.

Sec.

7.

Chapter 640C of NRS is hereby amended by adding thereto a new section to read as follows:

INTERSTAARTICLE 1-PURPOSET The purpose of this Compact is to reduce the burdens on State governments and to facilitate the interstate practice and regulation of Massage Therapy with the goal of improving public access to, and the safety of, Massage Therapy Services.

Through this Compact, the Member States seek to establish a regulatory framework which provides for a new multistate licensing program.

Through this additional licensing pathway, the Member States - 82nd Session (2023) – 12 – seek to provide increased value and mobility to licensed massage therapists in the Member States, while ensuring the provision of safe, competent, and reliable services to the public.

This Compact is designed to achieve the following objectives, subscribing hereto:es hereby ratify the same intentions by A.

Increase public access to Massage Therapy Services by providing for a multistate licensing pathway;

B.

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

C.

Enhance the Member States’ ability to prevent human trafficking and licensure fraud;

D.

Encourage the cooperation of Member States in regulating the multistate Practice of Massage Therapy;

E.

Support relocating military members and their spouses;

F.

Facilitate and enhance the exchange of licensure, investigative, and disciplinary information between the Member States;

G.

Create an Interstate Commission that will exist to implement and administer the Compact;

H.

Allow a Member State to hold a Licensee accountable, even where that Licensee holds a Multistate License;

I.

Create a streamlined pathway for Licensees to practice in Member States, thus increasing the mobility of duly licensed massage therapists;

and J.

Serve the needs of licensed massage therapists and the public receiving their services;

however, from enforcing its own laws regarding the Practice of Massagee Therapy.

ARTICLE 2-DEFINITIONS As used in this Compact, except as otherwise provided and subject to clarification by the Rules of the Commission, the following definitions shall govern the terms herein:

A.

“Active Military Member” - any person with full-time duty status in the armed forces of the United States, including members of the National Guard and Reserve.

B.

“Adverse Action” - any administrative, civil, equitable, or criminal action permitted by a Member State’s laws which is imposed by a Licensing Authority or other regulatory body against a Licensee, including actions against an individual’s - 82nd Session (2023) – 13 – Authorization to Practice such as revocation, suspension, probation, surrender in lieu of discipline, monitoring of the Licensee, limitation of the Licensee’s practice, or any other Encumbrance on licensure affecting an individual’s ability to desist order.age Therapy, including the issuance of a cease and C.

“Alternative Program” - a non-disciplinary monitoring or prosecutorial diversion program approved by a Member State’s Licensing Authority.

D.

“Authorization to Practice” - a legal authorization by a Remote State pursuant to a Multistate License permitting the Practice of Massage Therapy in that Remote State, which shall be subject to the enforcement jurisdiction of the Licensing Authority in that Remote State.

E.

“Background Check” - the submission of an applicant’s criminal history record information, as further defined in 28 C.F.R.

§ 20.3(d), as amended from the Federal Bureau of Investigation and the agency responsible for retaining State criminal records in the applicant’s Home State.

F.

“Charter Member States” - Member States who have enacted legislation to adopt this Compact where such legislation predates the effective date of this Compact as defined in Article 12.

G.

“Commission” - the government agency whose membership consists of all States that have enacted this Compact, which is known as the Interstate Massage Compact Commission, as defined in Article 8, and which shall operate as an instrumentality of the Member States.

of license renewal, to provide evidence of participation in, and completion of, educational or professional activities that maintain, improve, or enhance Massage Therapy fitness to practice.

I.

“Current Significant Investigative Information” - Investigative Information that a Licensing Authority, after an inquiry or investigation that complies with a Member State’s due process requirements, has reason to believe is not groundless and, if proved true, would indicate a violation of that State’s laws regarding the Practice of Massage Therapy.

J.

“Data System” - a repository of information about Licensees who hold Multistate Licenses, which may include but is not limited to license status, Investigative Information, and Adverse Actions.

- 82nd Session (2023) – 14 – K.

“Disqualifying Event” - any event which shall disqualify an individual from holding a Multistate License under this Compact, which the Commission may by Rule specify.

L.

“Encumbrance” - a revocation or suspension of, or any Massage Therapy by a Licensing Authority.unrestricted Practice of M.

“Executive Committee” - a group of delegates elected or appointed to act on behalf of, and within the powers granted to them by, the Commission.

N.

“Home State” - means the Member State which is a Licensee’s primary state of residence where the Licensee holds an active Single-State License.

O.

“Investigative Information” - information, records, or documents received or generated by a Licensing Authority pursuant to an investigation or other inquiry.

P.

“Licensing Authority” - a State’s regulatory body responsible for issuing Massage Therapy licenses or otherwise overseeing the Practice of Massage Therapy in that State.

Q.

“Licensee” - an individual who currently holds a license from a Member State to fully practice Massage Therapy, whose license is not a student, provisional, temporary, inactive, or other similar status.

R.

“Massage Therapy”, “Massage Therapy Services”, and the “Practice of Massage Therapy” - the care and services provided by a Licensee as set forth in the Member State’s statutes and regulations in the State where the services are being provided.

S.

“Member State” - any State that has adopted this Compact.

Authorizations to Practice Massage Therapy in all Remote States pursuant to this Compact, which shall be subject to the enforcement jurisdiction of the Licensing Authority in a Licensee’s Home State.

U.

“National Licensing Examination” - A national examination developed by a national association of Massage Therapy regulatory boards, as defined by Commission Rule, that is derived from a practice analysis and is consistent with generally accepted psychometric principles of fairness, validity and reliability, and is administered under secure and confidential examination protocols.

V.

“Remote State” - any Member State, other than the Licensee’s Home State.

- 82nd Session (2023) – 15 – W.

“Rule” - any opinion or regulation promulgated by the Commission under this Compact, which shall have the force of law.

X.

“Single-State License” - a current, valid authorization individual to fully practice Massage Therapy, that is not a restricted, student, provisional, temporary, or inactive practice authorization and authorizes practice only within the issuing State.

Y.

“State” - a state, territory, possession of the United States, or the District of Columbia.

ARTICLE 3-MEMBER STATE REQUIREMENTS A.

To be eligible to join this Compact, and to maintain eligibility as a Member State, a State must:

ThisLicense sectionand becomesregulate effectivethe uponPractice passageof andMassage approval.Therapy;

SectionHave 1a ofmechanism thisor actentity becomesin effective:place to receive and investigate complaints from the public, regulatory or law enforcement agencies, or the Commission about Licensees practicing in that State;

3.

Accept passage of a National Licensing Examination as a criterion for Massage Therapy licensure in that State;

4.

Require that Licensees satisfy educational requirements prior to being licensed to provide Massage Therapy Services to the public in that State;

5.

Implement procedures for requiring the Background of any Disqualifying Events, including but not limited to obtaining and submitting, for each Licensee holding a Multistate License and each applicant for a Multistate License, fingerprint or other biometric-based information to the Federal Bureau of Investigation for Background Checks;

receiving the results of the Federal Bureau of Investigation record search on Background Checks and considering the results of such a Background Check in making licensure decisions;

6.

Have Continuing Competence requirements as a condition for license renewal;

7.

Participate in the Data System, including through the use of unique identifying numbers as described herein;

8.

Notify the Commission and other Member States, in compliance with the terms of the Compact and Rules of the Commission, of any disciplinary action taken by the State against - 82nd Session (2023) – 16 – a Licensee practicing under a Multistate License in that State, or of the existence of Investigative Information or Current Significant Investigative Information regarding a Licensee practicing in that State pursuant to a Multistate License;

10.

Accept Licensees with valid Multistate Licenses from other Member States as established herein;

B.

Individuals not residing in a Member State shall continue to be able to apply for a Member State’s Single-State License as provided under the laws of each Member State.

However, the Single-State License granted to those individuals shall not be recognized as granting a Multistate License for Massage Therapy in any other Member State;

C.

Nothing in this Compact shall affect the requirements established by a Member State for the issuance of a Single-State License;

and D.

A Multistate License issued to a Licensee shall be recognized by each Remote State as an Authorization to Practice Massage Therapy in each Remote State.

ARTICLE 4-MULTISTATE LICENSE REQUIREMENTS A.

To qualify for a Multistate License under this Compact, and to maintain eligibility for such a license, an applicant must:

1.

Hold an active Single-State License to practice Massage Therapy in the applicant’s Home State;

2.

Have completed at least six hundred and twenty-five (625) equivalent which the Commission may approve by Rule.tantial 3.

Have passed a National Licensing Examination or the substantial equivalent which the Commission may approve by Rule;

4.

Submit to a Background Check;

5.

Have not been convicted or found guilty, or have entered into an agreed disposition, of a felony offense under applicable State or federal criminal law, within five (5) years prior to the date of their application, where such a time period shall not include any time served for the offense, and provided that the applicant has completed any and all requirements arising as a result of any such offense;

6.

Have not been convicted or found guilty, or have entered into an agreed disposition, of a misdemeanor offense related to the Practice of Massage Therapy under applicable State or federal - 82nd Session (2023) – 17 – criminal law, within two (2) years prior to the date of their application where such a time period shall not include any time served for the offense, and provided that the applicant has completed any and all requirements arising as a result of any such off7.seHave not been convicted or found guilty, or have entered into an agreed disposition, of any offense, whether a misdemeanor or a felony, under State or federal law, at any time, relating to any of the following:

a.

Kidnapping;

b.

Human trafficking;

c.

Human smuggling;

d.

Sexual battery, sexual assault, or any related offenses;

or e.

Any other category of offense which the Commission may by Rule designate.

8.

Have not previously held a Massage Therapy license which was revoked by, or surrendered in lieu of discipline to an applicable Licensing Authority;

9.

Have no history of any Adverse Action on any occupational or professional license within two (2) years prior to the date of their application;

and 10.

Pay all required fees.

B.

A Multistate License granted pursuant to this Compact may be effective for a definite period of time concurrent with the renewal of the Home State license.

C.

A Licensee practicing in a Member State is subject to all scope of practice laws governing Massage Therapy Services in thaD.StaThe Practice of Massage Therapy under a Multistate License granted pursuant to this Compact will subject the Licensee to the jurisdiction of the Licensing Authority, the courts, and the laws of the Member State in which the Massage Therapy Services are provided.

ARTICLE 5-AUTHORITY OF INTERSTATE MASSAGE COMPACT COMMISSION AND MEMBER STATE LICENSING AUTHORITIES A.

Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability of a Member State to enact and enforce laws, regulations, or other rules related to the Practice of Massage Therapy in that State, - 82nd Session (2023) – 18 – where those laws, regulations, or other rules are not inconsistent with the provisions of this Compact.

B.

Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability Single-State License to practice Massage Therapy in that State.

C.

Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability of a Remote State to take Adverse Action against a Licensee’s Authorization to Practice in that State.

D.

Nothing in this Compact, nor any Rule of the Commission, shall be construed to limit, restrict, or in any way reduce the ability of a Licensee’s Home State to take Adverse Action against a Licensee’s Multistate License based upon information provided by a Remote State.

E.

Insofar as practical, a Member State’s Licensing Authority shall cooperate with the Commission and with each entity exercising independent regulatory authority over the Practice of Massage Therapy according to the provisions of this Compact.

ARTICLE 6-ADVERSE ACTIONS A.

A Licensee’s Home State shall have exclusive power to impose an Adverse Action against a Licensee’s Multistate License issued by the Home State.

B.

A Home State may take Adverse Action on a Multistate License based on the Investigative Information, Current Remote State.nvestigative Information, or Adverse Action of a C.

A Home State shall retain authority to complete any pending investigations of a Licensee practicing under a Multistate License who changes their Home State during the course of such an investigation.

The Licensing Authority shall also be empowered to report the results of such an investigation to the Commission through the Data System as described herein.

D.

Any Member State may investigate actual or alleged violations of the scope of practice laws in any other Member State for a massage therapist who holds a Multistate License.

E.

A Remote State shall have the authority to:

1.

Take Adverse Actions against a Licensee’s Authorization to Practice.

2.

Issue cease and desist orders or impose an Encumbrance on a Licensee’s Authorization to Practice in that State.

- 82nd Session (2023) – 19 – 3.

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 Authority in a Member State for the attendance and testimony of 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 before it.

The issuing Licensing 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.

4.

If otherwise permitted by State law, recover from the affected Licensee the costs of investigations and disposition of cases resulting from any Adverse Action taken against that Licensee.

5.

Take Adverse Action against the Licensee’s Authorization to Practice in that State based on the factual findings of another Member State.

F.

If an Adverse Action is taken by the Home State against a Licensee’s Multistate License or Single-State License to practice in the Home State, the Licensee’s Authorization to Practice in all other Member States shall be deactivated until all Encumbrances have been removed from such license.

All Home State disciplinary orders that impose an Adverse Action against a Licensee shall include a statement that the Massage Therapist’s Authorization to Practice is deactivated in all Member States during the pendency of the order.

Licensee’s Authorization to Practice, that Adverse Action applies to all Authorizations to Practice in all Remote States.

A Licensee whose Authorization to Practice in a Remote State is removed for a specified period of time is not eligible to apply for a new Multistate License in any other State until the specific time for removal of the Authorization to Practice has passed and all encumbrance requirements are satisfied.

H.

Nothing in this Compact shall override a Member State’s authority to accept a Licensee’s participation in an Alternative Program in lieu of Adverse Action.

A Licensee’s Multistate License shall be suspended for the duration of the Licensee’s participation in any Alternative Program.

I.

Joint Investigations 1.

In addition to the authority granted to a Member State by its respective scope of practice laws or other applicable State law, a - 82nd Session (2023) – 20 – Member State may participate with other Member States in joint investigations of Licensees.

2.

Member States shall share any investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under the Compact.

ARTICLE 7-ACTIVE MILITARY MEMBERS AND THEIR SPOUSES Active Military Members, or their spouses, shall designate a Home State where the individual has a current license to practice Massage Therapy in good standing.

The individual may retain their Home State designation during any period of service when that individual or their spouse is on active duty assignment.

ARTICLE 8-ESTABLISHMENT AND OPERATION OF INTERSTATE MASSAGE COMPACT COMMISSION A.

The Compact Member States hereby create and establish a joint government agency whose membership consists of all Member States that have enacted the Compact known as the Interstate Massage Compact Commission.

The Commission is an instrumentality of the Compact States acting jointly and not an instrumentality of any one State.

The Commission shall come into existence on or after the effective date of the Compact as set forth in Article 12.

B.

Membership, Voting, and Meetings delegate selected by that Member State’s State Licensinge (1) Authority.

2.

The delegate shall be the primary administrative officer of the State Licensing Authority or their designee.

3.

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

4.

The Commission may recommend removal or suspension of any delegate from office.

5.

A Member State’s State Licensing Authority shall fill any vacancy of its delegate occurring on the Commission within 60 days of the vacancy.

6.

Each delegate shall be entitled to one vote on all matters that are voted on by the Commission.

- 82nd Session (2023) – 21 – 7.

The Commission shall meet at least once during each calendar year.

Additional meetings may be held as set forth in the bylaws.

The Commission may meet by telecommunication, video conference or other similar electronic means.

1.

Establish the fiscal year of the Commission;ers:

2.

Establish code of conduct and conflict of interest policies;

3.

Adopt Rules and bylaws;

4.

Maintain its financial records in accordance with the bylaws;

5.

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

6.

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

7.

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

8.

Purchase and maintain insurance and bonds;

9.

Borrow, accept, or contract for services of personnel, including, but not limited to, employees of a Member State;

10.

Conduct an annual financial review;

11.

Hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate the Commission’s personnel policies and programs relating toblish conflicts of interest, qualifications of personnel, and other related personnel matters;

12.

Assess and collect fees;

13.

Accept any and all appropriate gifts, donations, grants of money, other sources of revenue, equipment, supplies, materials, and services, and receive, utilize, and dispose of the same;

provided that at all times the Commission shall avoid any appearance of impropriety or conflict of interest;

14.

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

15.

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

16.

Establish a budget and make expenditures;

- 82nd Session (2023) – 22 – 17.

Borrow money;

18.

Appoint committees, including standing committees, composed of members, State regulators, State legislators or their representatives, and consumer representatives, and such other bylaws;ted persons as may be designated in this Compact and the 19.

Accept and transmit complaints from the public, regulatory or law enforcement agencies, or the Commission, to the relevant Member State(s) regarding potential misconduct of Licensees;

20.

Elect a Chair, Vice Chair, Secretary and Treasurer and such other officers of the Commission as provided in the Commission’s bylaws;

21.

Establish and elect an Executive Committee, including a chair and a vice chair;

22.

Adopt and provide to the Member States an annual report;

23.

Determine whether a State’s adopted language is materially different from the model Compact language such that the State would not qualify for participation in the Compact;

and 24.

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

D.

The Executive Committee 1.

The Executive Committee shall have the power to act on behalf of the Commission according to the terms of this Compact.

The powers, duties, and responsibilities of the Executive Committee shall include:

of the Compact including compliance with the provisions of theation Compact, the Commission’s Rules and bylaws, and other such duties as deemed necessary;

b.

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

c.

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

d.

Preparing and recommending the budget;

e.

Maintaining financial records on behalf of the Commission;

f.

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

g.

Establishing additional committees as necessary;

- 82nd Session (2023) – 23 – h.

Exercise the powers and duties of the Commission during the interim between Commission meetings, except for adopting or amending Rules, adopting or amending bylaws, and exercising any other powers and duties expressly reserved to the Commisi.

Other duties as provided in the Rules or bylaws of the Commission.

2.

The Executive Committee shall be composed of seven voting members and up to two ex-officio members as follows:

a.

The chair and vice chair of the Commission and any other members of the Commission who serve on the Executive Committee shall be voting members of the Executive Committee.

b.

Other than the chair, vice-chair, secretary and treasurer, the Commission shall elect three voting members from the current membership of the Commission.

c.

The Commission may elect ex-officio, nonvoting members as necessary as follows:

i.

One ex-officio member who is a representative of the national association of State Massage Therapy regulatory boards.

ii.

One ex-officio member as specified in the Commission’s bylaws.