New Requirements for Hospital Reporting Related to the Multistate Nurse Licensure Compact (SSB 5499) – Beginning July 24, 2023

New Law: Hospital Reporting Action Required

Updated 07/24/2023

To:

Rural Chief Executive Officers, Chief Quality Officers, Chief Nursing Officers, Human Resources, Legal Counsel, and Government Affairs Staff

Staff Contact:

Ashlen Strong, JD, MPH, Senior Director, Government Affairs
ashlens@wsha.org | 206-216-2550Mary Storace, Policy Analyst, Government Affairs
marys@wsha.org | 206-577-1838

Subject:

New Requirements for Hospital Reporting Related to the Multistate Nurse Licensure Compact (SSB 5499) – Beginning July 24, 2023

Purpose
The purpose of this bulletin is to inform hospitals that effective July 23, 2023, Washington will enter the multistate Nurse Licensure Compact (NLC) through Substitute Senate Bill 5499 enacted by the 2023 Washington State Legislature. There are reporting requirements for employers who employ nurses, including acute care hospitals and psychiatric hospitals. Reporting obligations begin July 24, 2023, the first business day after the new law takes effect.

The NLC provides multistate licensure privileges for registered nurses (RNs), licensed professional nurses (LPNs), and licensed vocational nurses (LVNs) who meet uniform license requirements to practice in participating Compact states and jurisdictions.

WSHA and our hospitals have advocated for Washington State’s participation in the NLC for close to a decade. As part of WSHA’s advocacy on hospital staffing this year, we advocated for the Compact to be part of the legislative package. We also worked to address concerns raised by legislators, which led to new requirements for reporting the hiring of nurses working under an out-of-state Compact license to the Washington State Nursing Care Quality Assurance Commission, to be renamed the Washington State Board of Nursing (WABON).

Applicability/Scope
The new reporting requirements apply to nurse employers, including acute care hospitals licensed under chapter 70.41 RCW and psychiatric hospitals licensed under 71.12 RCW.

WABON will begin to recognize nurses with multistate licenses (MSL) from other Compact states on July 24, 2023. Nurses with MSLs will be able to begin working in Washington without first obtaining a Washington license on that date. Hospitals that hire nurses with an MSL issued by a state other than Washington should begin reporting the hiring of nurses working under an out-of-state Compact license within 30 days of hire on July 24, 2023.

Recommendations and Next Steps

Review this bulletin, as well as SSB 5499, to understand the new hospital reporting requirements. WSHA cannot offer legal advice to members and recommends hospitals engage legal, risk, compliance, and human resources leadership as appropriate to evaluate compliance with the new law.
Review the Washington State Board of Nursing’s (WABON, formerly NCQAC) Multistate License Employers webpage.
Beginning July 24, 2023, report to WABON within 30 days of hiring a nurse with an MSL issued by a state other than Washington. Employers will use an online reporting form which has been made live by WABON and can be accessed on their Multistate License Employers webpage. Reporting will include the employer’s attestation that the nurse has completed required suicide prevention training and submitted demographic data to WABON via the Washington State Multistate Nurse Demographic Data Survey.
Update any policies and procedures in your HR department to ensure nurses who hold MSLs issued by another Compact state have completed the required Suicide Prevention Training and demographic data submission upon hire.
Read the ‘What Nurse Employers Need to Know’ FAQ, written by the Nurse Licensure Compact Administration.

New Requirements for Hospital Reporting
Sections 24-31 of SB 5499 establish nurse employer reporting requirements. Sections 24 and 25 apply to acute care hospitals and psychiatric hospitals, respectively.

As of September 1, 2023, health care employers, including hospitals, that hire nurses who hold an active MSL and do not hold a Washington state nursing license must complete the following tasks within 30 days of hiring the nurse:

Verify and report nurses holding an MSL issued by another state to WABON using an online reporting form that will be provided by WABON;
Attest that the nurse has met the Suicide Prevention Training requirement; and
Attest that the nurse has updated and submitted their demographic data to WABON via a demographic data survey.

The effective date for employer reporting and attestation requirements is September 1, 2023. However, hospitals may begin employing MSL nurses on July 24, 2023, so WSHA strongly recommends beginning to report MSL nurses within 30-days of hire on July 24, 2023.

Other Elements of SB 5499
SSB 5499 (2023) provides that Washington will enter the Multistate Nurse Licensure Compact. Washington will join the 38 other states and 2 jurisdictions that have enacted the Compact and become party to the requirements of the Compact.

The Compact allows eligible RNs, LPNs, and LVNs to practice physically, telephonically or through electronic means in their home state and other states that have entered the Compact. The Compact allows nurses to have one multistate license, which means those nurses who travel to Washington from other Compact states may begin working immediately.

Nurse Licensure Compact Model Act Provisions
To join the Compact, states are required to adopt the Nurse Licensure Compact Model Act. Sections 1-14 of SSB 5499 outlines provisions that must be adopted for a state or jurisdiction to join the Compact.

Sections 1-14 of SSB 5499 provides, in part:

A multistate license to practice as an RN, LPN, or LVN, issued by a home state shall be recognized by a party state under multistate licensure privilege.
Party states shall issue requirements for applicants to obtain or retain a multistate license in their home state including:
- Home state qualifications for licensure and licensure renewal;
- Graduation from the appropriate educational programs that have been approved by accrediting bodies;
- Submission of fingerprints or other biometric data for the purpose of obtaining criminal record information from the FBI and the agency responsible for retaining that state’s criminal records; 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;
- 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;
- Passage of an NCLEX-RN or NCLEX-PN examination or a recognized predecessor;
- Not currently enrolled in an alternative program;
- Subject to self-disclosure requirements regarding current participation in an alternative program;
- Has a valid United States social security number; and
- Is eligible for or holds an active, unencumbered license.
The state maintains the ability to take adverse action against a multistate licensure privilege according to the disciplinary options available by state law, including the issuance of subpoenas, submission of criminal background checks or deactivating multistate licensure privileges when a license is encumbered.
Washington must participate in a coordinated licensure information This requires all state Boards of Nursing to report any adverse action taken on a nurse, information gathered during an investigation on a complaint against a nurse, and notification of any nurse that has been enrolled in an alternative to discipline program. This is an important provision that facilitates the exchange of disciplinary information with other party states.
Rulemaking shall be adopted by the governing body known as the Interstate Commission of Nurse Licensure Compact Administrators, or “Interstate Commission”. Rulemaking shall be legally binding in all party states. There is no requirement that rules be ratified or adopted by individual states. Rules adopted by the Interstate Commission will trump state regulation of compact licensure.
The Commission shall be prohibited from altering state law, this includes nurse licensing requirements and scope of practice related provisions, through a rule or a bylaw.
Member states must comply with the Compact, and in the event of a failure to comply there shall be:
- A period of technical assistance;
- A dispute resolution process; and
- Termination from the Compact if other compliance means have proved unsuccessful.
The Nursing Care Quality Assurance Commission, now Washington State Board of Nursing, shall be authorized to obtain and use a federal criminal background check in making multistate licensure decisions, with the results of such a background check being confidential.

Other Elements of the Bill
The remaining sections provide, in part:

Those who are seeking nursing licenses in the state shall be allowed to apply for either a Washington state-only license, or a multistate license as provided under the Compact.
The Washington State Nursing Care Quality Assurance Commission shall change its name to the Board of Nursing, to ensure there is no confusion between the Interstate Commission and the Washington state licensing entity. Renaming the Nursing Care Quality Assurance Commission does not in any way change the authority or function of the body.
WABON shall publish on its website rules associated with the passage of the Compact, an annually updated summary of differences in each compact state’s nurse practice act, and meeting details for compact administrator meetings.
Holders of multistate licenses issued by Washington shall pay the Washington Center for Nursing a surcharge of $8 per month.
Multistate licenses holders shall be added to the title of those who can be called a “registered nurse” or a “licensed practical nurse.”
WABON shall be authorized to receive criminal background information that includes non-conviction data and investigate the criminal history of applicants and license holders for licensing.

The Secretary shall be permitted to charge different fees for RNs, LPNs, and nurses who hold a multistate license issued by Washington. This includes nurses who hold a valid multistate license issued by the state with the requirement that a portion of nurse licensure fees support the Washington Center for Nursing, and nurses with the requirement that a portion of nurse licensure fees support online access to the UW health sciences library.

Washington State Board of Nursing Implementation Timeline

Background
The Nurse Licensure Compact has been proposed and considered by the Washington State Legislature for many years without enactment. WSHA and its members developed specific provisions that addressed legislators’ concerns, which allowed the bill to pass without opposition in 2023. Washington’s participation in the Compact may help to alleviate the nursing crisis by attracting more fully trained nurses to the state who can immediately begin working without enduring an administratively burdensome state licensure process. It will also allow nurses who hold MSLs in other states to practice remotely in Washington, across state lines in Washington border communities and will facilitate rapid entry into the workforce for temporary assignments, such as for a military spouse’s deployment.

References:

WSHA’s 2023 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2023 to help members implement the new laws, as well as links to resources such as this bulletin.