Physician Assistants; interstate licensure compact, established

HB156 ENROLLED
Page 0
HB156
KHEDZAU-2
By Representative Lee
RFD: Health
First Read: 13-Jan-26
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First Read: 13-Jan-26
Enrolled, An Act,
Relating to physician assistants; to adopt the PA
Licensure Compact; to allow licensed physician assistants to
practice among compact states; to establish requirements and
obligations for participation in the compact; to provide for
disciplinary actions and joint investigation procedures; and
to establish and provide for the operation of the PA Licensure
Compact Commission and enforcement of the compact among member
states.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Purpose
In order to strengthen access to medical services, and
in recognition of the advances in the delivery of medical
services, the participating states of the PA Licensure Compact
have allied in common purpose to develop a comprehensive
process that complements the existing authority of state
licensing boards to license and discipline PAs and seek to
enhance the portability of a license to practice as a PA while
safeguarding the safety of patients. This compact allows
medical services to be provided by PAs, via the mutual
recognition of the licensee's qualifying license by other
compact participating states. This compact also adopts the
prevailing standard for PA licensure and affirms that the
practice and delivery of medical services by the PA occurs
where the patient is located at the time of the patient
encounter, and therefore requires the PA to be under the
jurisdiction of the state licensing board where the patient is
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jurisdiction of the state licensing board where the patient is
located. State licensing boards that participate in this
compact retain the jurisdiction to impose adverse action
against a compact privilege in that state issued to a PA
through the procedures of this compact. The PA Licensure
Compact will alleviate burdens for military families by
allowing active duty military personnel and their spouses to
obtain a compact privilege based on having an unrestricted
license in good standing from a participating state.
Section 2. Definitions
As used in this compact, the following terms have the
following meanings:
(1) ADVERSE ACTION. 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 PA license or license application or compact
privilege such as license denial, censure, revocation,
suspension, probation, monitoring of the licensee, or
restriction on the licensee's practice.
(2) COMPACT PRIVILEGE. The authorization granted by a
remote state to allow a licensee from another participating
state to practice as a PA to provide medical services and
other licensed activity to a patient located in the remote
state under the remote state's laws and rules.
(3) CONVICTION. A finding by a court that an individual
is guilty of a felony or misdemeanor offense through
adjudication or entry of a plea of guilt or no contest to the
charge by the offender.
(4) CRIMINAL BACKGROUND CHECK. The submission of
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(4) CRIMINAL BACKGROUND CHECK. The submission of
fingerprints or other biometric based information for a
license applicant for the purpose of obtaining that
applicant's criminal history record information, as defined in
28 C.F.R. § 20.3(d), from the state's criminal history record
repository as defined in 28 C.F.R. § 20.3(f).
(5) DATA SYSTEM. The repository of information about
licensees, including but not limited to License status and
adverse actions, which is created and administered under the
terms of this compact.
(6) EXECUTIVE COMMITTEE. A group of directors and ex
officio individuals elected or appointed pursuant to Section
7(f)(2).
(7) IMPAIRED PRACTITIONER. A PA whose practice is
adversely affected by a health-related condition that impacts
his or her ability to practice.
(8) INVESTIGATIVE INFORMATION. Information, records, or
documents received or generated by a licensing board pursuant
to an investigation.
(9) JURISPRUDENCE REQUIREMENT. The assessment of an
individual's knowledge of the laws and rules governing the
practice of a PA in a state.
(10) LICENSE. Current authorization by a state, other
than authorization pursuant to a compact privilege, for a PA
to provide medical services, which would be unlawful without
current authorization.
(11) LICENSEE. An individual who holds a license from a
state to provide medical services as a PA.
(12) LICENSING BOARD. Any state entity authorized to
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(12) LICENSING BOARD. Any state entity authorized to
license and otherwise regulate PAs.
(13) MEDICAL SERVICES. Health care services provided
for the diagnosis, prevention, treatment, cure, or relief of a
health condition, injury, or disease, as defined by a state's
laws and rules.
(14) MODEL COMPACT. The model for the PA Licensure
Compact on file with the Council of State Governments or other
entity as designated by the commission.
(15) PARTICIPATING STATE. A state that has enacted this
compact.
(16) PA. An individual who is licensed as a physician
assistant in a state. For purposes of this compact, any other
title or status adopted by a state to replace the term
"physician assistant" shall be deemed synonymous with
"physician assistant" and shall confer the same rights and
responsibilities to the licensee under the provisions of this
compact at the time of its enactment.
(17) PA LICENSURE COMPACT COMMISSION, COMPACT
COMMISSION, or COMMISSION. The national administrative body
created pursuant to Section 7(a).
(18) QUALIFYING LICENSE. An unrestricted license issued
by a participating state to provide medical services as a PA.
(19) REMOTE STATE. A participating state where a
licensee who is not licensed as a PA is exercising or seeking
to exercise the compact privilege.
(20) RULE. A regulation adopted by an entity that has
the force and effect of law.
(21) SIGNIFICANT INVESTIGATIVE INFORMATION.
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(21) SIGNIFICANT INVESTIGATIVE INFORMATION.
Investigative information that a licensing board, after an
inquiry or investigation that includes notification and an
opportunity for the PA to respond if required by state law,
has reason to believe is not groundless and, if proven true,
would indicate more than a minor infraction.
(22) STATE. Any state, commonwealth, district, or
territory of the United States.
Section 3. State Participation in this Compact
(a) To participate in this compact, a participating
state shall:
(1) License PAs;
(2) Participate in the compact commission's data
system;
(3) Have a mechanism in place for receiving and
investigating complaints against licensees and license
applicants;
(4) Notify the commission, in compliance with the terms
of this compact and commission rules, of any adverse action
against a licensee or license applicant and the existence of
significant investigative information regarding a licensee or
license applicant;
(5) Fully implement a criminal background check
requirement, within a time frame established by commission
rule, by its licensing board receiving the results of a
criminal background check and reporting to the commission
whether the license applicant has been granted a license;
(6) Comply with the rules of the compact commission;
(7) Utilize passage of a recognized national exam such
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(7) Utilize passage of a recognized national exam such
as the NCCPA PANCE as a requirement for PA licensure; and
(8) Grant the compact privilege to a holder of a
qualifying license in a participating state.
(b) Nothing in this compact prohibits a participating
state from charging a fee for granting the compact privilege.
Section 4. Compact Privilege
(a) To exercise the compact privilege, a licensee must:
(1) Have graduated from a PA program accredited by the
Accreditation Review Commission on Education for the Physician
Assistant, Inc., or other programs authorized by commission
rule;
(2) Hold current NCCPA certification;
(3) Have no felony or misdemeanor conviction;
(4) Have never had a controlled substance license,
permit, or registration suspended or revoked by a state or by
the United States Drug Enforcement Administration.
(5) Have a unique identifier as determined by
commission rule;
(6) Hold a qualifying license;
(7) Have had no revocation of a license or limitation
or restriction on any license currently held due to an adverse
action;
(8) If a licensee has had a limitation or restriction
on a License or compact privilege due to an adverse action,
two years must have elapsed from the date on which the license
or compact privilege is no longer limited or restricted due to
the adverse action;
(9) If a compact privilege has been revoked or is
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(9) If a compact privilege has been revoked or is
limited or restricted in a participating state for conduct
that would not be a basis for disciplinary action in a
participating state in which the licensee is practicing or
applying to practice under a compact privilege, that
participating state shall have the discretion not to consider
such action as an adverse action requiring the denial or
removal of a compact privilege in that state;
(10) Notify the compact commission that the licensee is
seeking the compact privilege in a remote state;
(11) Meet any jurisprudence requirement of a remote
state in which the licensee is seeking to practice under the
compact privilege and pay any fees applicable to satisfying
the jurisprudence requirement; and
(12) Report to the commission any adverse action taken
by a non-participating state within 30 days after the action
is taken.
(b) The compact privilege is valid until the expiration
or revocation of the qualifying license unless terminated
pursuant to an adverse action. The licensee must also comply
with all of the requirements of subsection (a) to maintain the
compact privilege in a remote state. If the participating
state takes adverse action against a qualifying license, the
licensee shall lose the compact privilege in any remote state
in which the licensee has a compact privilege until all of the
following occur:
(1) The license is no longer limited or restricted.
(2) Two years have elapsed from the date on which the
license is no longer limited or restricted due to the adverse
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license is no longer limited or restricted due to the adverse
action.
(c) Once a restricted or limited license satisfies the
requirements of subsection (b), the licensee must meet the
requirements of subsection (a) to obtain a compact privilege
in any remote state.
(d) For each remote state in which a PA seeks authority
to prescribe controlled substances, the PA shall satisfy all
requirements imposed by such state in granting or renewing
such authority.
Section 5. Designation of the State from Which Licensee
is Applying for a Compact Privilege
Upon a licensee's application for a compact privilege,
the licensee shall identify to the commission the
participating state from which the licensee is applying, in
accordance with applicable rules adopted by the commission,
and subject to the following requirements:
(1) When applying for a compact privilege, the licensee
shall provide the commission with the address of the
licensee's primary residence and thereafter shall immediately
report to the commission any change in the address of the
licensee's primary residence.
(2) When applying for a compact privilege, the licensee
is required to consent to accept service of process by mail at
the licensee's primary residence on file with the commission
with respect to any action brought against the licensee by the
commission or a participating state, including a subpoena,
with respect to any action brought or investigation conducted
by the commission or a participating state.
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by the commission or a participating state.
Section 6. Adverse Actions
(a) A participating state in which a licensee is
licensed shall have exclusive power to impose adverse action
against the qualifying license issued by that participating
state.
(b) In addition to the other powers conferred by state
law, a remote state shall have the authority, in accordance
with existing state due process law, to do all of the
following:
(1) Take adverse action against a PA's compact
privilege within that state to remove a licensee's compact
privilege or take other action necessary under applicable law
to protect the health and safety of its citizens.
(2) 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 participating state for the
attendance and testimony of witnesses or the production of
evidence from another participating 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.
(3) Notwithstanding subdivision (2), subpoenas may not
be issued by a participating state to gather evidence of
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be issued by a participating state to gather evidence of
conduct in another state that is lawful in that other state
for the purpose of taking adverse action against a licensee's
compact privilege or application for a compact privilege in
that participating state.
(4) Nothing in this compact authorizes a participating
state to impose discipline against a PA's compact privilege or
to deny an application for a compact privilege in that
participating state for the individual's otherwise lawful
practice in another state.
(c) For purposes of taking adverse action, the
participating state that issued the qualifying license shall
give the same priority and effect to reported conduct received
from any other participating state as it would if the conduct
had occurred within the participating state that issued the
qualifying license. In so doing, the participating state shall
apply its own state laws to determine appropriate action.
(d) A participating state, if otherwise permitted by
state law, may recover from the affected PA the costs of
investigations and disposition of cases resulting from any
adverse action taken against that PA.
(e) A participating state may take adverse action based
on the factual findings of a remote state, provided that the
participating state follows its own procedures for taking the
adverse action.
(f) Joint investigations.
(1) In addition to the authority granted to a
participating state by its respective state PA laws and rules
or other applicable state law, any participating state may
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or other applicable state law, any participating state may
participate with other participating states in joint
investigations of licensees.
(2) Participating states shall share any investigative,
litigation, or compliance materials in furtherance of any
joint or individual investigation initiated under this
compact.
(g) If an adverse action is taken against a PA's
qualifying license, the PA's compact privilege in all remote
states shall be deactivated until two years have elapsed after
all restrictions have been removed from the state license. All
disciplinary orders by the participating state that issued the
qualifying license which impose adverse action against a PA's
license shall include a statement that the PA's compact
privilege is deactivated in all participating states during
the pendency of the order.
(h) If any participating state takes adverse action, it
promptly shall notify the administrator of the data system.
Section 7. Establishment of the PA Licensure Compact
Commission
(a) The participating states hereby create and
establish a joint government agency and national
administrative body known as the PA Licensure 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
Section 11(a).
(b) Membership, voting, and meetings.
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(b) Membership, voting, and meetings.
(1) Each participating state shall have and be limited
to one delegate selected by that participating state's
licensing board or, if the state has more than one licensing
board, selected collectively by the participating state's
licensing boards.
(2) The delegate shall be either:
a. A current PA, physician, or public member of a
licensing board or PA council or committee; or
b. An administrator of a licensing board.
(3) Any delegate may be removed or suspended from
office as provided by the laws of the state from which the
delegate is appointed.
(4) The participating state licensing board shall fill
any vacancy occurring in the commission within 60 days.
(5) Each delegate shall be entitled to one vote on all
matters voted on by the commission and shall otherwise have an
opportunity to participate in the business and affairs of the
commission. A delegate shall vote in person or by such other
means as provided in the bylaws. The bylaws may provide for
delegates' participation in meetings by telecommunications,
video conference, or other means of communication.
(6) The commission shall meet at least once during each
calendar year. Additional meetings shall be held as set forth
in this compact and the bylaws.
(7) The commission shall establish by rule a term of
office for delegates.
(c) The commission shall have the following powers and
duties:
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duties:
(1) Establish a code of ethics for the commission.
(2) Establish the fiscal year of the commission.
(3) Establish fees.
(4) Establish bylaws.
(5) Maintain its financial records in accordance with
the bylaws.
(6) Meet and take such actions as are consistent with
the provisions of this compact and the bylaws.
(7) Adopt rules to facilitate and coordinate
implementation and administration of this compact. The rules
shall have the force and effect of law and shall be binding in
all participating states.
(8) Bring and prosecute legal proceedings or actions in
the name of the commission, provided that the standing of any
state licensing board to sue or be sued under applicable law
shall not be affected.
(9) Purchase and maintain insurance and bonds.
(10) Borrow, accept, or contract for services of
personnel, including, but not limited to, employees of a
participating state.
(11) Hire employees and engage contractors, elect or
appoint officers, fix compensation, define duties, grant such
individuals appropriate authority to carry out the purposes of
this compact, and establish the commission's personnel
policies and programs relating to conflicts of interest,
qualifications of personnel, and other related personnel
matters.
(12) Accept any and all appropriate donations and
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(12) Accept any and all appropriate donations and
grants of money, 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.
(13) Lease, purchase, accept appropriate gifts or
donations of, or otherwise own, hold, improve or use, any
property, real, personal, or mixed, provided that at all times
the commission shall avoid any appearance of impropriety.
(14) Sell, convey, mortgage, pledge, lease, exchange,
abandon, or otherwise dispose of any property, real, personal,
or mixed.
(15) Establish a budget and make expenditures.
(16) Borrow money.
(17) Appoint committees, including standing committees
composed of members, state regulators, state legislators or
their representatives, and consumer representatives, and such
other interested persons as may be designated in this compact
and the bylaws.
(18) Provide and receive information from, and
cooperate with, law enforcement agencies.
(19) Elect a chair, vice chair, secretary, and
treasurer and such other officers of the commission as
provided in the commission's bylaws.
(20) Reserve for itself, in addition to those reserved
exclusively to the commission under the compact, powers that
the executive committee may not exercise.
(21) Approve or disapprove a state's participation in
the compact based upon its determination as to whether the
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the compact based upon its determination as to whether the
state's compact legislation departs in a material manner from
the model compact language.
(22) Prepare and provide to the participating states an
annual report.
(23) Perform such other functions as may be necessary
or appropriate to achieve the purposes of this compact
consistent with the state regulation of PA licensure and
practice.
(d) Meetings of the commission.
(1) All meetings of the commission that are not closed
pursuant to this subsection shall be open to the public.
Notice of public meetings shall be posted on the commission's
website at least 30 days prior to the public meeting.
(2) Notwithstanding subdivision (1), the commission may
convene a public meeting by providing at least 24 hours prior
notice on the commission's website, and any other means as
provided in the commission's rules, for any of the reasons it
may dispense with notice of proposed rulemaking under Section
9(l).
(3) The commission may convene in a closed, nonpublic
meeting or nonpublic part of a public meeting to receive legal
advice or to discuss:
a. Noncompliance of a participating state with its
obligations under this compact;
b. The employment, compensation, discipline, or other
matters, practices or procedures related to specific employees
or other matters related to the commission's internal
personnel practices and procedures;
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personnel practices and procedures;
c. Current, threatened, or reasonably anticipated
litigation;
d. Negotiation of contracts for the purchase, lease, 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 investigative records compiled for law
enforcement purposes;
i. Disclosure of information related to any
investigative reports prepared by or on behalf of or for use
of the commission or other committee charged with
responsibility of investigation or determination of compliance
issues pursuant to this compact;
j. Legal advice; or
k. Matters specifically exempted from disclosure by
federal or participating states' statutes.
(4) If a meeting, or portion of a meeting, is closed
pursuant to this subsection, the chair of the meeting or the
chair's designee shall certify that the meeting or portion of
the meeting may be closed and shall reference each relevant
exempting provision.
(5) The commission shall keep minutes that fully and
clearly describe all matters discussed in a meeting and shall
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clearly describe all matters discussed in a meeting and shall
provide a full and accurate summary of actions taken,
including a description of the views expressed. All documents
considered in connection with an action shall be identified in
the 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.
(e) 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 accept any and all appropriate
revenue sources, donations, and grants of money, equipment,
supplies, materials, and services.
(3) The commission may levy on and collect an annual
assessment from each participating state and may impose
compact privilege fees on licensees of participating states to
whom a compact privilege is granted to cover the cost of the
operations and activities of the commission and its staff,
which must be in a total amount sufficient to cover its annual
budget as approved by the commission each year for which
revenue is not provided by other sources. The aggregate annual
assessment amount levied on participating states shall be
allocated based upon a formula to be determined by commission
rule.
a. A compact privilege expires when the licensee's
qualifying license in the participating state from which the
licensee applied for the compact privilege expires.
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licensee applied for the compact privilege expires.
b. If the licensee terminates the qualifying license
through which the licensee applied for the compact privilege
before its scheduled expiration, and the licensee has a
qualifying license in another participating state, the
licensee shall inform the commission that it is changing to
that participating state the participating state through which
it applies for a compact privilege and pay to the commission
any compact privilege fee required by commission rule.
(4) 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
participating states, except by and with the authority of the
participating state.
(5) The commission shall keep accurate accounts of all
receipts and disbursements. The receipts and disbursements of
the commission shall be subject to the financial review and
accounting procedures established under its bylaws. All
receipts and disbursements of funds handled by the commission
shall be subject to an annual financial review by a certified
or licensed public accountant, and the report of the financial
review shall be included in and become part of the annual
report of the commission.
(f) 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 and commission rules.
(2) The executive committee shall be composed of nine
members:
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members:
a. Seven voting members who are elected by the
commission from the current membership of the commission;
b. One ex officio, nonvoting member from a recognized
national PA professional association; and
c. One ex officio, nonvoting member from a recognized
national PA certification organization.
(3) The ex officio members shall be selected by their
respective organizations.
(4) The commission may remove any member of the
executive committee as provided in its bylaws.
(5) The executive committee shall meet at least
annually.
(6) The executive committee shall have the following
duties and responsibilities:
a. Recommend to the commission changes to the
commission's rules or bylaws, changes to this compact
legislation, fees to be paid by compact participating states
such as annual dues, and any commission compact fee charged to
licensees for the compact privilege.
b. Ensure compact administration services are
appropriately provided, contractual or otherwise.
c. Prepare and recommend the budget.
d. Maintain financial records on behalf of the
commission.
e. Monitor compact compliance of participating states
and provide compliance reports to the commission.
f. Establish additional committees as necessary.
g. Exercise the powers and duties of the commission
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g. Exercise the powers and duties of the commission
during the interim between commission meetings, except for
issuing proposed rulemaking or adopting commission rules or
bylaws, or exercising any other powers and duties exclusively
reserved to the commission by the commission's rules.
h. Perform other duties as provided in the commission's
rules or bylaws.
(7) All meeting of the executive committee at which it
votes or plans to vote on matters in exercising the powers and
duties of the commission shall be open to the public, and
public notice of such meetings shall be given as public
meetings of the commission are given.
(8) The executive committee may convene in a closed,
nonpublic meeting for the same reasons that the commission may
convene in a nonpublic meeting as set forth in subdivision
(d)(3) and shall announce the closed meeting as the commission
is required to under subdivision (d)(4) and keep minutes of
the closed meeting as the commission is required to under
subdivision (d)(5).
(g) Qualified immunity, defense, and indemnification.
(1) The members, officers, executive director,
employees, and representatives of the commission shall be
immune from suit and liability, both personally and in their
official capacity, for any claim for damage to or loss of
property or personal injury or other civil liability caused by
or 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
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within the scope of commission employment, duties, or
responsibilities, provided that nothing in this subdivision
shall be construed to protect any such individual from suit or
liability for any damage, loss, injury, or liability caused by
the intentional or willful or wanton misconduct of that
individual. The procurement of insurance of any type by the
commission shall not in any way compromise or limit the
immunity granted in this subdivision.
(2) The commission shall defend any member, 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 as determined by the
commission that the individual 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 herein shall be construed to prohibit
that individual from retaining his or her own counsel at his
or her own expense; and provided further, that the actual or
alleged act, error, or omission did not result from that
individual's intentional or willful or wanton misconduct.
(3) The commission shall indemnify and hold harmless
any member, officer, executive director, employee, or
representative of the commission for the amount of any
settlement or judgment obtained against that individual
arising out of any actual or alleged act, error, or omission
that occurred within the scope of commission employment,
duties, or responsibilities, or that such individual had a
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duties, or responsibilities, or that such individual 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 or willful or wanton misconduct of
that individual.
(4) 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 in any proceedings as
authorized by commission rules.
(5) Nothing herein shall be construed as a limitation
on the liability of any licensee for professional malpractice
or misconduct, which shall be governed solely by any other
applicable state laws.
(6) Nothing herein shall be construed to designate the
venue or jurisdiction to bring actions for alleged acts of
malpractice, professional misconduct, negligence, or other
such civil action pertaining to the practice of a PA. All such
matters shall be determined exclusively by state law other
than this compact.
(7) Nothing in this compact shall be interpreted to
waive or otherwise abrogate a participating state's state
action immunity or state action affirmative defense with
respect to antitrust claims under the Sherman Act, Clayton
Act, or any other state or federal antitrust or
anticompetitive law, rule, or regulation.
(8) Nothing in this compact shall be construed to be a
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(8) Nothing in this compact shall be construed to be a
waiver of sovereign immunity by the participating states or by
the commission.
Section 8. Data System
(a) The commission shall provide for the development,
maintenance, operation, and utilization of a coordinated data
and reporting system containing licensure, adverse action, and
the reporting of the existence of significant investigative
information on all licensed PAs and applicants denied a
license in participating states.
(b) Notwithstanding any other state law to the
contrary, a participating state shall submit a uniform data
set to the data system on all PAs to whom this compact is
applicable (utilizing a unique identifier) as required by the
rules of the commission, including:
(1) Identifying information;
(2) Licensure data;
(3) Adverse actions against a license or compact
privilege;
(4) Any denial of application for licensure, and the
reason or reasons for such denial, excluding the reporting of
any criminal history record information where prohibited by
law;
(5) The existence of significant investigative
information; and
(6) Other information that may facilitate the
administration of this compact, as determined by the rules of
the commission.
(c) Significant investigative information pertaining to
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(c) Significant investigative information pertaining to
a licensee in any participating state shall only be available
to other participating states.
(d) The commission shall promptly notify all
participating states of any adverse action taken against a
licensee or an individual applying for a license that has been
reported to it. This adverse action information shall be
available to any other participating state.
(e) Participating states contributing information to
the data system may, in accordance with state or federal law,
may designate information that may not be shared with the
public without the express permission of the contributing
state. Notwithstanding any such designation, such information
shall be reported to the commission through the data system.
(f) Any information submitted to the data system that
is subsequently expunged pursuant to federal law or the laws
of the participating state contributing the information shall
be removed from the data system upon reporting of such by the
participating state to the commission.
(g) The records and information provided to a
participating state pursuant to this compact or through the
data system, when certified by the commission or an agent
thereof, shall constitute the authenticated business records
of the commission, and shall be entitled to any associated
hearsay exception in any relevant judicial, quasi-judicial or
administrative proceedings in a participating state.
Section 9. Rulemaking
(a) The commission shall exercise its rulemaking powers
pursuant to the criteria set forth in this section and the
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pursuant to the criteria set forth in this section and the
rules adopted thereunder. Commission rules shall become
binding as of the date specified by the commission for each
rule.
(b) The commission shall adopt reasonable rules in
order to effectively and efficiently implement and administer
this compact and achieve its purposes. A commission rule shall
be invalid and have not force or effect only if a court of
competent jurisdiction holds that the rule is invalid because
the commission exercised its rulemaking authority in a manner
that is beyond the scope of the purposes of this compact, or
the powers granted hereunder, or based upon another applicable
standard of review.
(c) The rules of the commission shall have the force of
law in each participating state, provided that where the rules
of the commission conflict with the laws of the participating
state that establish the medical services a PA may perform in
the participating state, as held by a court of competent
jurisdiction, the rules of the commission shall be ineffective
in that state to the extent of the conflict.
(d) If a majority of the legislatures of the
participating states rejects a commission rule, by enactment
of a statute or resolution in the same manner used to adopt
this compact within four years of the date of adoption of the
rule, then the rule shall have no further force and effect in
any participating state or to any state applying to
participate in the compact.
(e) Commission rules shall be adopted at a regular or
special meeting of the commission.
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special meeting of the commission.
(f) Prior to promulgation and adoption of a final rule
or rules by the commission, and at least 30 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 or other publicly
accessible platform;
(2) To persons who have requested notice of the
commission's notices of proposed rulemaking; and
(3) In such other ways as the commission, by rule, may
specify.
(g) The notice of proposed rulemaking shall include:
(1) The time, date, and location of the public hearing
on the proposed rule and the proposed time, date, and location
of the meeting in which the proposed rule will be considered
and voted upon;
(2) The text of the proposed rule and the reason for
the proposed rule;
(3) A request for comments on the proposed rule from
any interested person and the date by which written comments
must be received; and
(4) The manner in which interested persons may submit
notice to the commission of their intention to attend the
public hearing or provide any written comments.
(h) 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.
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public.
(i) If the hearing is to be held via electronic means,
the commission shall publish the mechanism for access to the
electronic hearing.
(1) All persons wishing to be heard at the hearing
shall as directed in the notice of proposed rulemaking, not
less than five business days before the scheduled date of the
hearing, notify the commission of their desire to appear and
testify at the hearing.
(2) 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.
(3) All hearings shall be recorded. A copy of the
recording and the written comments, data, facts, opinions, and
arguments received in response to the proposed rulemaking
shall be made available to a person upon request.
(4) Nothing in this section shall be construed as
requiring a separate hearing on each proposed rule. Proposed
rules may be grouped for the convenience of the commission at
hearings required by this section.
(j) Following the public hearing, the commission shall
consider all written and oral comments timely received.
(k) The commission, by majority vote of all delegates,
shall take final action on the proposed rule and shall
determine the effective date of the rule, if adopted, based on
the rulemaking record and the full text of the rule.
(1) If adopted, the rule shall be posted on the
commission's website.
(2) The commission may adopt changes to the proposed
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(2) The commission may adopt changes to the proposed
rule provided the changes do not enlarge the original purpose
of the proposed rule.
(3) The commission shall provide on its website an
explanation of the reasons for substantive changes made to the
proposed rule as well as reasons for substantive changes not
made that were recommended by commenters.
(4) The commission shall determine a reasonable
effective date for the rule. Except for an emergency as
provided in subsection (l), the effective date of the rule
shall be no sooner than 30 days after the commission issued
the notice that it adopted the rule.
(l) Upon determination that an emergency exists, the
commission may consider and adopt an emergency rule with 24
hours prior notice, without the opportunity for comment, or
hearing, provided that the usual rulemaking procedures
provided in this compact and in this section 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
subsection, an emergency rule is one that must be adopted
immediately by the commission in order to:
(1) Meet an imminent threat to public health, safety,
or welfare;
(2) Prevent a loss of commission or participating state
funds;
(3) Meet a deadline for the adoption of a commission
rule that is established by federal law or rule; or
(4) Protect public health and safety.
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(4) Protect public health and safety.
(m) The commission or an authorized committee of the
commission may direct revisions to a previously adopted
commission rule 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 as set forth in the notice of
revisions and delivered to the commission prior to the end of
the notice period. If no challenge is made, the revision shall
take effect without further action. If the revision is
challenged, the revision may not take effect without the
approval of the commission.
(n) No participating state's rulemaking requirements
shall apply under this compact.
Section 10. Oversight, Dispute Resolution, and
Enforcement
(a) Oversight.
(1) The executive and judicial branches of state
government in each participating state shall enforce this
compact and take all actions necessary and appropriate to
implement the compact.
(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
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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. Nothing herein shall affect or limit the
selection or propriety of venue in any action against a
licensee for professional malpractice, misconduct, or any such
similar matter.
(3) The commission shall be entitled to receive service
of process in any proceeding regarding the enforcement or
interpretation of the compact or the commission's rules and
shall have standing to intervene in such a proceeding for all
purposes. Failure to provide the commission with service of
process shall render a judgment or order in such proceeding
void as to the commission, this compact, or commission rules.
(b) Default, technical assistance, and termination.
(1) If the commission determines that a participating
state has defaulted in the performance of its obligations or
responsibilities under this compact or the commission rules,
the commission shall provide written notice to the defaulting
state and other participating states. The notice shall
describe the default, the proposed means of curing the default
and any other action that the commission may take and shall
offer remedial training and specific technical assistance
regarding the default.
(2) If a state in default fails to cure the default,
the defaulting state may be terminated from this compact upon
an affirmative vote of a majority of the delegates of the
participating states, and all rights, privileges, and benefits
conferred by this compact upon such state may be terminated on
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conferred by this compact upon such state 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 participation 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, the majority
and minority leaders of the defaulting state's legislature,
and to the licensing board or licensing boards of each of the
participating states.
(4) A state that has been terminated is responsible for
all assessments, obligations, and liabilities incurred through
the effective date of termination, including obligations that
extend beyond the effective date of termination.
(5) The commission shall not bear any costs related to
a state that is found to be in default or that has been
terminated from this compact, unless agreed upon in writing
between the commission and the defaulting state.
(6) The defaulting state may appeal its termination
from the compact by the commission by petitioning the U.S.
District Court for the District of Columbia or the federal
district where the commission has its principal offices. The
prevailing member shall be awarded all costs of such
litigation, including reasonable attorney fees.
(7) Upon the termination of a state's participation in
the compact, the state shall immediately provide notice to all
licensees within that state of the termination:
a. Licensees who have been granted a compact privilege
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a. Licensees who have been granted a compact privilege
in that state shall retain the compact privilege for 180 days
following the effective date of the termination; and
b. Licensees who are licensed in that state who have
been granted a compact privilege in a participating state
shall retain the compact privilege for 180 days unless the
licensee also has a qualifying license in a participating
state or obtains a qualifying license in a participating state
before the 180-day period ends, in which case the compact
privilege shall continue.
(c) Dispute resolution.
(1) Upon request by a participating state, the
commission shall attempt to resolve disputes related to this
compact that arise among participating states and between
participating and non-participating states.
(2) The commission shall adopt a rule providing for
both mediation and binding dispute resolution for disputes as
appropriate.
(d) Enforcement.
(1) The commission, in the reasonable exercise of its
discretion, shall enforce the provisions of this compact and
rules of the commission.
(2) If compliance is not secured after all means to
secure compliance have been exhausted, by majority vote, the
commission may initiate legal action in the United States
District Court for the District of Columbia or the federal
district where the commission has its principal offices,
against a participating state in default to enforce compliance
with the provisions of this compact and the commission's
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with the provisions of this compact and the commission's
adopted 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.
(e) Legal action against the commission.
(1) A participating state may initiate legal action
against the commission in the U.S. District Court for the
District of Columbia or the federal district where the
commission has its principal offices to enforce compliance
with the provisions of the compact and its rules. 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.
(2) No person other than a participating state shall
enforce this compact against the commission.
Section 11. Date of Implementation of the PA Licensure
Compact Commission
(a) This compact shall come into effect on the date on
which this compact statute is enacted into law in the seventh
participating state.
(1) On or after the effective date of the compact, the
commission shall convene and review the enactment of each of
the states that enacted the compact prior to the commission
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the states that enacted the compact prior to the commission
convening charter participating states to determine if the
statute enacted by each charter participating state is
materially different than the model compact.
a. A charter participating state whose enactment is
found to be materially different from the model compact shall
be entitled to the default process set forth in Section 10(b).
b. If any participating state later withdraws from the
compact or its participation is terminated, the commission
shall remain in existence and the compact shall remain in
effect even if the number of participating states should be
less than seven. Participating states enacting the compact
subsequent to the commission convening shall be subject to the
process set forth in Section 7(c)(21) to determine if their
enactments are materially different from the model compact and
whether they qualify for participation in the compact.
(2) Participating states enacting the compact
subsequent to the seven initial charter participating states
shall be subject to the process set forth in Section 7(c)(21)
to determine if their enactments are materially different from
the model compact and whether they qualify for participation
in the compact.
(3) All actions taken for the benefit of the commission
or in furtherance of the purposes of the administration of the
compact prior to the effective date of the compact or the
commission coming into existence shall be considered to be
actions of the commission unless specifically repudiated by
the commission.
(b) Any state that joins this compact shall be subject
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(b) Any state that joins this compact shall be subject
to the commission's rules and bylaws as they exist on the date
on which this compact becomes law in that state. Any rule that
has been previously adopted by the commission shall have the
full force and effect of law on the day this compact becomes
law in that state.
(c) Any participating state may withdraw from this
compact by enacting a statute repealing the same.
(1) A participating state's withdrawal shall not take
effect until 180 days after enactment of the repealing
statute. During this 180-day period, all compact privileges
that were in effect in the withdrawing state and were granted
to licensees licensed in the withdrawing state shall remain in
effect. If any licensee licensed in the withdrawing state is
also licensed in another participating state or obtains a
license in another participating state within the 180 days,
the licensee's compact privileges in other participating
states shall not be affected by the passage of the 180 days.
(2) Withdrawal shall not affect the continuing
requirement of the state licensing board or licensing boards
of the withdrawing state to comply with the investigative and
adverse action reporting requirements of this compact prior to
the effective date of withdrawal.
(3) Upon the enactment of a statute withdrawing a state
from this compact, the state shall immediately provide notice
of such withdrawal to all licensees within that state. The
withdrawing state shall continue to recognize all licenses
granted pursuant to this compact for a minimum of 180 days
after the date of the notice of withdrawal.
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after the date of the notice of withdrawal.
(d) Nothing contained in this compact shall be
construed to invalidate or prevent any PA licensure agreement
or other cooperative arrangement between participating states
and between a participating state and nonparticipating state
which does not conflict with the provisions of this compact.
(e) This compact may be amended by the participating
states. No amendment to this compact shall become effective
and binding upon any participating state until it is enacted
materially in the same manner into the laws of all
participating states as determined by the commission.
Section 12. Construction and Severability
(a) This compact and the commission's rulemaking
authority shall be liberally construed so as to effectuate the
purposes, and the implementation and administration of the
compact. Provisions of the compact expressly authorizing or
requiring the adoption of rules shall not be construed to
limit the commission's rulemaking authority solely for those
purposes.
(b) The provisions of this compact shall be severable
and if any phrase, clause, sentence, or provision of this
compact is held by a court of competent jurisdiction to be
contrary to the constitution of any participating state, a
state seeking participation in the compact, or of the United
States, or the applicability thereof to any government,
agency, person or circumstance is held to be unconstitutional
by a court of competent jurisdiction, the validity of the
remainder of this compact and the applicability thereof to any
other government, agency, person, or circumstance shall not be
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other government, agency, person, or circumstance shall not be
affected thereby.
(c) Notwithstanding subsection (b), the commission may
deny a state's participation in the compact or, in accordance
with the requirements of Section 10(b), terminate a
participating state's participation in the compact, if it
determines that a constitutional requirement of a
participating state is, or would be with respect to a state
seeking to participate in the compact, a material departure
from the compact. Otherwise, if this compact shall be held to
be contrary to the constitution of any participating state,
the compact shall remain in full force and effect as to the
remaining participating states and in full force and effect as
to the participating state affected as to all severable
matters.
Section 13. Binding Effect of Compact
(a) Nothing in this compact prevents the enforcement of
any other law of a participating state that is not
inconsistent with this compact.
(b) Any laws in a participating state in conflict with
this compact are superseded to the extent of the conflict.
(c) All agreements between the commission and the
participating states are binding in accordance with their
terms.
Section 14. This act shall become effective on October
1, 2026.
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HB156 Enrolled
Page 38
1, 2026.
________________________________________________
Speaker of the House of Representatives
________________________________________________
President and Presiding Officer of the Senate
House of Representatives
I hereby certify that the within Act originated in and
was passed by the House 03-Feb-26.
John Treadwell
Clerk
Senate 05-Mar-26 Passed
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