LB 1212

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                    LEGISLATIVE BILL 1212
                    Approved by the Governor April 14, 2026
Introduced by Riepe, 12.
A  BILL FOR AN ACT relating to occupational licensing; to amend sections
     81-3437.01 and 81-3451, Reissue Revised Statutes of Nebraska, sections
     38-2001 and 38-2002, Revised Statutes Cumulative Supplement, 2024, and
     section 81-3449, Revised Statutes Supplement, 2025; to define terms and
     provide for licensure of internationally trained physicians under the
     Medicine and Surgery Practice Act; to change and eliminate provisions
     relating to the Engineers and Architects Regulation Act; to harmonize
     provisions; to provide operative dates; and to repeal the original
     sections.
Be it enacted by the people of the State of Nebraska,
     Section 1. Section 38-2001, Revised Statutes Cumulative Supplement, 2024,
is amended to read:
     38-2001 Sections 38-2001 to 38-2064 and sections 3 to 9 of this act shall
be known and may be cited as the Medicine and Surgery Practice Act.
     Sec. 2. Section 38-2002, Revised Statutes Cumulative Supplement, 2024, is
amended to read:
     38-2002 For the purposes of the Medicine and Surgery Practice Act and
elsewhere in the Uniform Credentialing Act, unless the context otherwise
requires, the definitions found in sections 38-2003 to 38-2022 and section 3 of
this act apply.
     Sec. 3. For purposes of sections 3 to 9 of this act:
     (1) Assessment and evaluation program means a structured program approved
by the department, with the recommendation of the board, which utilizes
multiple assessment methods to evaluate an internationally trained physician's
performance over time across the general competencies within the physician's
intended scope of practice;
     (2) General competencies means the six domains of professional competence
endorsed by the Coalition for Physician Accountability, including patient care
and procedural skills, medical knowledge, practice-based learning and
improvement, interpersonal and communication skills, professionalism, and
systems-based practice;
     (3) Health profession shortage area means a geographic region of the state
that has been designated by the Nebraska Rural Health Advisory Commission
pursuant to section 71-5665;
     (4) Internationally trained physician means a physician who has: (a)
Received a degree of doctor of medicine or its equivalent from a legally
chartered medical school outside the United States; (b) completed a graduate
medical education training program that is substantially similar to United
States graduate medical education or residency, as determined by the board; (c)
been licensed or otherwise authorized to practice medicine in a country other
than the United States; (d) practiced medicine for at least three of the last
five years following the completion of a graduate medical education training
program, unless that period is waived by the board; and (e) been in good
standing with any previous medical licensing or regulatory institution during
the most recent three years of practice and has no pending discipline before
the licensing or regulatory institution;
     (5) Legally chartered medical school outside the United States means a
medical school recognized by the Educational Commission for Foreign Medical
Graduates that provides individuals with a medical education or training
outside the United States that is substantially similar to the training
required to qualify to practice medicine and surgery in this state, as
determined by the board;
     (6) Licensing examination means the United States Medical Licensing
Examination;
     (7) Participating health care entity means a federally qualified health
center, hospital, or other entity that provides an assessment and evaluation
program and is approved by the department, with the recommendation of the
board. The department, with the recommendation of the board, may establish
additional criteria for qualification as a participating health care entity
including criteria relating to the ability to implement a board-recommended
assessment and evaluation program addressing the general competencies;
     (8) Provisional license means a license to practice medicine issued
pursuant to section 4 of this act; and
     (9) Transitional license means a license issued pursuant to section 5 of
this act that permits an internationally trained physician to practice as a
practitioner in a health profession shortage area independently without the
supervision of a participating health care entity.
     Sec. 4.   (1) The department, with the recommendation of the board, may
issue a provisional license for no longer than three years to an
internationally trained physician if the physician and the participating health
care entity submit evidence that the physician:
     (a) Meets the definition of an internationally trained physician as
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defined in section 3 of this act;
     (b) Has a valid certification issued by the Educational Commission for
Foreign Medical Graduates;
     (c) Has achieved a passing score on step 1 and step 2 of the licensing
examination;
     (d) Has entered into an agreement with a participating health care entity
for full-time employment under the supervision of a licensed physician. Such
agreement shall provide that the participating health care entity shall conduct
an initial formative needs assessment, develop an individualized learning and
supervision plan, and assess and evaluate the physician's familiarity with the
standards appropriate for medical practice in the state, consistent with
assessment and evaluation criteria established in rules and regulations adopted
and promulgated by the department, with the recommendation of the board, and
designed to address all general competencies;
     (e) Is either a United States citizen or is legally authorized to work by
the federal government pursuant to 8 C.F.R. 274a.12, as such regulation existed
on January 1, 2026; and
     (f) Has satisfied other criteria as required by the board which shall not
include a medical education residency program as a prerequisite.
     (2) An internationally trained physician practicing under a provisional
license shall be allowed to renew such physician's provisional license for one
three-year period. No physician practicing under a provisional license shall be
allowed to hold a provisional license for more than six years.
     (3)(a) Within six months after a physician commences practice under a
provisional license, the participating health care entity shall: (i) Conduct an
initial formative needs assessment of the internationally trained physician's
competence in the general competencies, including a review of the physician's
prior graduate medical education and practice experience using a process
approved by the department, with the recommendation of the board; and (ii)
submit an individualized learning and supervision plan to the department for
the physician that is informed by the initial formative needs assessment and
addresses all general competencies for the physician's intended scope of
practice. A copy of such plan shall be provided to the board.
     (b) The initial formative needs assessment shall be used to identify areas
of strength and areas in which additional support is needed and shall not be
used to deny issuance of a provisional license to a physician who otherwise
meets the requirements of subsection (1) of this section.
     (4)(a) The assessment and evaluation program utilized by a participating
health care entity for a physician practicing under a provisional license shall
include, but not be limited to: (i) Standardized assessments of medical
knowledge; (ii) direct observation of the physician's clinical skills; (iii)
multi-source feedback from physicians and other health care team members and,
when feasible, patients; and (iv) periodic audits of medical records for which
the physician is responsible.
     (b) The assessment and evaluation program shall ensure that the physician
engages in a sufficient volume and breadth of cases to permit meaningful
assessment across the general competencies for the physician's intended scope
of practice.
     (5) An internationally trained physician practicing under a provisional
license shall be supervised and employed by a participating health care entity.
All practice under a provisional license shall initially occur under
supervision by a supervisor who meets the requirements described in subdivision
(a) of this subsection. The level of supervision may be adjusted over time
based on documented competence demonstrated through the assessment and
evaluation program, in accordance with standards and supervision levels
established in rules and regulations adopted and promulgated by the department,
with the recommendation of the board. A participating health care entity shall:
     (a) Employ one or more supervisors to supervise internationally trained
physicians. A supervisor shall (i) be licensed to practice medicine in the
state in good standing, and (ii) possess all necessary institutional
privileges;
     (b) Carry medical malpractice insurance covering such physician during the
period of time the physician practices under the provisional license; and
     (c) Complete all required assessment and evaluation program criteria.
     (6) The department, with the recommendation of the board, may adopt and
promulgate rules and regulations to carry out this section, including, but not
limited to, criteria for participating health care entities and supervisors,
requirements for assessment and evaluation programs, supervision levels, and
required forms for initial formative needs assessments and individualized
learning and supervision plans.
     Sec. 5.   (1) The department, with the recommendation of the board, may
issue a transitional license for no longer than three years to an
internationally trained physician if such physician has:
     (a) Practiced medicine for three years under the supervision of a
participating health care entity;
     (b) Completed and received satisfactory results on the participating
health care entity's department-approved and board-recommended assessment and
evaluation program which shall document, using multiple assessment methods, the
physician's performance across the general competencies within the physician's
intended scope of practice;
     (c) Received a satisfactory score on step 3 of the licensing examination;
and
     (d) Completed additional prerequisites required by the board. Such
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prerequisites shall not include a medical education residency program.
     (2) Prior to issuing a transitional license, the department shall receive
from the participating health care entity a final assessment and evaluation
report on a form prescribed by the department, with the recommendation of the
board, affirming that, in the judgment of the participating health care entity,
the physician has demonstrated the ability to engage in independent and
unsupervised practice within the physician's intended scope of practice across
all general competencies. The board shall be provided with a copy of the final
assessment and evaluation report and may review the report and make a
recommendation to the department regarding issuance, denial, or renewal of a
provisional or transitional license under this section.
     (3) The transitional license may be renewed for one three-year period.
     Sec. 6.    (1) After an internationally trained physician has practiced
under a provisional license for a minimum of three years and a transitional
license for a minimum of three years, such physician shall be eligible to apply
for an unrestricted license to practice medicine in this state. Prior to
granting such unrestricted license, the board shall review and evaluate
assessment data and reports submitted under sections 4 and 5 of this act.
     (2) While practicing under a provisional or transitional license, the
physician shall submit the following information to the department and the
board every six months or upon request: (a) A statement certifying that the
physician is employed as a physician in this state and not subject to
discipline; and (b) a disclosure of the results of any assessment or evaluation
completed by the participating health care entity under an approved assessment
and evaluation program pursuant to section 5 of this act.
     (3) The physician shall notify the department and the board of any changes
in employment during the period of time a provisional license is in effect.
     Sec. 7.     A participating health care entity employing a physician
practicing under a provisional or transitional license shall ensure that such
physician:
     (1) Is subject to, and protected by, the entity's policies regarding work
hours, discrimination and harassment, and access to wellness and support
services on the same basis as other physicians employed by the entity; and
     (2) Receives written information at the commencement of employment
regarding the policies described in subdivision (1) of this section.
     Sec. 8. (1) In addition to other grounds for disciplinary action against
the license under the Uniform Credentialing Act, the department may take
disciplinary action, including suspension and revocation, against a license
granted pursuant to section 4 or 5 of this act for professional misconduct,
noncompliance with licensure requirements, or an unsatisfactory assessment or
evaluation submitted by a participating health care entity. In determining
whether an assessment or evaluation is unsatisfactory under this subsection,
the department may consider the totality of assessment data generated under an
approved assessment and evaluation program, including repeated deficiencies in
one or more general competencies and the physician's response to remediation.
The department shall consider any board recommendation relating to an
assessment or evaluation described in this section.
     (2) A provisional or transitional license may be suspended, pending a full
disciplinary review by the department if, in the judgment of a participating
health   care   entity,  the   internationally  trained   physician's  practice
jeopardizes the health and well-being of a patient.
     Sec. 9.    An internationally trained physician aggrieved by any action
against such physician's provisional or transitional license may appeal the
decision. The appeal shall be in accordance with the Administrative Procedure
Act.
     Sec. 10. Section 81-3437.01, Reissue Revised Statutes of Nebraska, is
amended to read:
     81-3437.01 (1) Each licensee authorized to practice architecture or
engineering must obtain a seal. The design of the seal shall be determined by
the board. If a professional engineer's license has been issued in a specific
discipline, the discipline shall be specified on the seal. The following
information shall be on the seal: State of Nebraska; licensee's name;
licensee's license number; and the words Architect or Professional (discipline)
Engineer.
     (2) Whenever the seal is applied, the licensee's signature and the date of
the seal's application shall be placed across or adjacent to the seal in a
manner that does not obscure the licensee's name or the license number on the
seal. The board may adopt and promulgate rules and regulations for application
of the seal.
     (3) The seal and the date of its placement shall be on all technical
submissions and calculations whenever presented to a client or any public or
governmental agency. It shall be unlawful for a licensee to affix his or her
seal or to permit his or her seal to be affixed to any document after the
expiration of the certificate or for the purpose of aiding or abetting any
other person to evade or attempt to evade the Engineers and Architects
Regulation Act.
     (4) The seal and date shall be placed on all originals, copies, tracings,
or other reproducible drawings and the first page and last pages of
specifications, reports, and studies in such a manner that the seal, signature,
and date will be reproduced and be in compliance with rules and regulations of
the board. The application of the licensee's seal shall constitute
certification that the work was done by the licensee or under the licensee's
control.
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     (5) In the case of a temporary permit issued to a licensee of another
state, the licensee shall use his or her state of licensure seal and shall
affix his or her signature and temporary permit to all his or her work.
     Sec. 11. Section 81-3449, Revised Statutes Supplement, 2025, is amended to
read:
     81-3449 The provisions of the Engineers and Architects Regulation Act
regulating the practice of architecture do not apply to the following
activities:
     (1) The construction, remodeling, alteration, or renovation of a detached
single-family through four-family dwelling of less than five thousand square
feet of above grade finished space. Any detached or attached sheds, storage
buildings, and garages incidental to the dwelling are not included in the
tabulation of finished space. Such exemption may be increased by rule and
regulation of the board adopted pursuant to the Negotiated Rulemaking Act but
shall not exceed the Type V, column B, limitations set forth by the allowable
height and building areas table in the state building code adopted in section
71-6403;
     (2) The construction, remodeling, alteration, or renovation of a one-story
commercial or industrial building or structure of less than five thousand
square feet of above grade finished space which does not exceed thirty feet in
height unless such building or structure, or the remodeling or repairing
thereof, provides for the employment, housing, or assembly of twenty or more
persons. Any detached or attached sheds, storage buildings, and garages
incidental to the building or structure are not included in the tabulation of
finished space. Such exemption may be increased by rule and regulation of the
board adopted pursuant to the Negotiated Rulemaking Act but shall not exceed
the Type V, column B, limitations set forth by the allowable height and
building areas table in the state building code adopted in section 71-6403;
     (3) The construction, remodeling, alteration, or renovation of farm
buildings, including barns, silos, sheds, or housing for farm equipment and
machinery, livestock, poultry, or storage, if the structures are designed to be
occupied by no more than twenty persons. Such exemption may be increased by
rule and regulation of the board adopted pursuant to the Negotiated Rulemaking
Act but shall not exceed the Type V, column B, limitations set forth by the
allowable height and building areas table in the state building code adopted in
section 71-6403;
     (4) Any public works project with contemplated expenditures for a
completed project that do not exceed one hundred thousand dollars. The board
shall adjust the dollar amount in this subdivision every fifth year. The first
such adjustment after August 27, 2011, shall be effective on July 1, 2014. The
adjusted amount shall be equal to the then current amount adjusted by the
cumulative percentage change in the Consumer Price Index for All Urban
Consumers published by the Federal Bureau of Labor Statistics for the five-year
period preceding the adjustment date. The amount shall be rounded to the next
highest one-thousand-dollar amount;
     (5) Any alteration, renovation, or remodeling of a building if the
alteration, renovation, or remodeling does not affect architectural or
engineering safety features of the building;
     (6) The teaching, including research and service, of architectural
subjects in a college or university offering a degree in architecture
accredited by the National Architectural Accrediting Board;
     (7) The preparation of submissions to architects, building officials, or
other regulating authorities by the manufacturer, supplier, or installer of any
materials, assemblies, components, or equipment that describe or illustrate the
use of such items, the preparation of any details or shop drawings required of
the contractor by the terms of the construction documents, or the management of
construction contracts by persons customarily engaged in contracting work;
     (8) The preparation of technical submissions or the administration of
construction contracts by employees of a person or organization lawfully
engaged in the practice of architecture if such employees are acting under the
direct supervision of an architect;
     (9) A public service provider or an organization who employs a licensee
performing professional services for itself;
     (10) A nonresident who holds the certification issued by the National
Council   of  Architectural   Registration   Boards  offering  to   render  the
professional services involved in the practice of architecture. The nonresident
shall not perform any of the professional services involved in the practice of
architecture until licensed as provided in the Engineers and Architects
Regulation Act. The nonresident shall notify the board in writing that (a) he
or she holds a National Council of Architectural Registration Boards
certificate and is not currently licensed in Nebraska but will be present in
Nebraska for the purpose of offering to render architectural services, (b) he
or she will deliver a copy of the notice to every potential client to whom the
applicant offers to render architectural services, and (c) he or she promises
to apply immediately to the board for licensure if selected as the architect
for the project;
     (10) (11) The practice by a qualified member of another legally recognized
profession who is otherwise licensed or certified by this state or any
political subdivision to perform services consistent with the laws of this
state, the training, and the code of ethics of the respective profession, if
such qualified member does not represent himself or herself to be practicing
architecture and does not represent himself or herself to be an architect;
     (11) (12) Financial institutions making disbursements of funds in
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connection with construction projects;
     (12) (13) Earthmoving and related work associated with soil and water
conservation practices performed on farmland or any land owned by a political
subdivision that is not subject to a permit from the Department of Water,
Energy, and Environment or for work related to livestock waste facilities that
are not subject to a permit by the Department of Water, Energy, and
Environment; and
     (13) (14) The work of employees and agents of a political subdivision or a
nonprofit entity organized for the purpose of furnishing electrical service
performing, in accordance with other requirements of law, their customary
duties in the administration and enforcement of codes, permit programs, and
land-use regulations and their customary duties in utility and public works
construction, operation, and maintenance.
     Sec. 12. Section 81-3451, Reissue Revised Statutes of Nebraska, is amended
to read:
     81-3451 (1) The following shall be considered as the minimum evidence
satisfactory to the board that an applicant is eligible for enrollment as an
engineer-intern:
     (a)(i)   Graduation  from  a   program   accredited  by   the  Engineering
Accreditation Commission of ABET;
     (ii) Graduation from a program accredited by the Canadian Engineering
Accreditation Board; or
     (iii) Meeting the Education Standard of the National Council of Examiners
for Engineering and Surveying as determined by the council;
     (b) Passage of an examination in the fundamentals of engineering as
accepted by the Board of Engineers and Architects;
     (c) Submittal of an application accompanied by the fee established by the
board; and
     (d) Demonstration of good reputation and good ethical character by
attestation of references. The names and complete addresses of references
acceptable to the board shall be included in the application for enrollment.
     (2)(a) The following shall be considered as the minimum evidence
satisfactory to the board that an applicant is eligible for admission to the
examination on the principles and practice of engineering that is adopted by
the board:
     (i)(A)   Graduation  from  a   program   accredited  by   the  Engineering
Accreditation Commission of ABET;
     (B) Graduation from a program accredited by the Canadian Engineering
Accreditation Board; or
     (C) Meeting the Education Standard of the National Council of Examiners
for Engineering and Surveying as determined by the council;
     (ii) Passage of an examination in the fundamentals of engineering as
accepted by the Board of Engineers and Architects;
     (iii) Submittal of an application accompanied by the fee established by
the board; and
     (iv) Demonstration of good reputation and good ethical character by
attestation of references. The names and complete addresses of references
acceptable to the board shall be included in the application.
     (b) A candidate who fails the principles and practice of engineering
examination may apply for reexamination, which may be granted upon payment of a
fee established by the board. In the event of a second or subsequent failure,
the examinee may, at the discretion of the board, be required to appear before
the board with evidence of having acquired the necessary additional knowledge
to qualify before admission to the examination.
     (2) (3) The following shall be considered as the minimum evidence
satisfactory to the board that an applicant is eligible for licensure as a
professional engineer:
     (a)(i)   Graduation  from  a   program   accredited  by   the  Engineering
Accreditation Commission of ABET;
     (ii) Graduation from a program accredited by the Canadian Engineering
Accreditation Board; or
     (iii) Meeting the Education Standard of the National Council of Examiners
for Engineering and Surveying as determined by the council;
     (b) Passage of an examination in the fundamentals of engineering that is
accepted by the Board of Engineers and Architects;
     (c) (a) Passage of an examination in the principles and practice of
engineering that is accepted by the board examination as set forth in
subsection (2) of this section;
     (d) (b) A record of four years or more of progressive post-accredited-
degree experience on engineering projects of a grade and character which
indicates to the board that the applicant may be competent to practice
engineering;
     (e) Submittal of an application for licensure as a professional engineer
accompanied by a fee established by the board;
     (f) (c) Demonstration of good reputation and good ethical character by
attestation of references. The names and complete addresses of references
acceptable to the board shall be included in the application for licensure; and
     (g) (d) Successful passage of an examination on the statutes, rules, and
other requirements unique to this state.
     (3) (4) An individual holding a license to practice engineering issued by
a proper authority of any jurisdiction, based on credentials that do not
conflict with subsection subsections (2) and (3) of this section and other
provisions of the Engineers and Architects Regulation Act, may, upon
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application, be licensed as a professional engineer after:
     (a) Demonstration of good reputation and good ethical character by
attestation of references. The names and complete addresses of references
acceptable to the board shall be included in the application for licensure; and
     (b) Successful passage of an examination on the statutes, rules, and other
requirements unique to this state.
     (4) (5) An individual who has been licensed to practice engineering for
fifteen years or more in one or more jurisdictions and who has practiced
engineering for fifteen years in compliance with the licensing laws in the
jurisdictions where his or her engineering practice has occurred since initial
licensure may, upon application, be licensed as a professional engineer after:
     (a) Demonstration of good reputation and good ethical character by
attestation of references. The names and complete addresses of references
acceptable to the board shall be included in the application for licensure; and
     (b) Successful passage of an examination on the statutes, rules, and other
requirements unique to this state.
     (5) (6) The board may designate a professional engineer as being licensed
in a specific discipline or branch of engineering signifying the area in which
the professional engineer has demonstrated competence.
     (6) (7) Upon application to the board in writing and payment of a fee
established by the board, an individual who holds a valid license to practice
engineering in another jurisdiction may be issued a temporary permit, valid for
a definite period of time, to provide engineering services for a specific
project. An individual may not be issued more than one temporary permit. No
right to practice engineering accrues to such applicant with respect to any
other work not set forth in the temporary permit. Temporary permit holders are
subject to all of the provisions of the Engineers and Architects Regulation Act
governing the practice of engineering.
     (7) (8) None of the examination materials described in this section shall
be considered public records.
     (8) (9) The board or its agent shall direct the time and place of the
engineering examinations referenced in subsections (1) and , (2) , and (3) of
this section.
     (9) (10) The board may adopt the examinations and grading procedures of
the National Council of Examiners for Engineering and Surveying. The board may
also adopt guidelines published by the council.
     (10) (11) Licensure shall be effective upon issuance.
     Sec. 13. Sections 1, 2, 3, 4, 5, 6, 7, 8, 9, and 14 of this act become
operative on August 1, 2027. The other sections of this act become operative on
their effective date.
     Sec. 14.     Original sections 38-2001 and 38-2002, Revised Statutes
Cumulative Supplement, 2024, are repealed.
     Sec. 15.    Original sections 81-3437.01 and 81-3451, Reissue Revised
Statutes of Nebraska, and section 81-3449, Revised Statutes Supplement, 2025,
are repealed.
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