Establishes the "Physician Assistant Licensure Compact"

SECOND REGULAR SESSION
HOUSE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NO. 3129
103RD GENERAL ASSEMBL Y
6895H.02C JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 334, RSMo, by adding thereto thirteen new sections relating to the
physician assistant licensure compact.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 334, RSMo, is amended by adding thereto thirteen new sections,
2 to be known as sections 334.1800, 334.1805, 334.1810, 334.1815, 334.1820, 334.1825,
3 334.1830, 334.1835, 334.1840, 334.1845, 334.1850, 334.1855, and 334.1860, to read as
4 follows:
334.1800. 1. Sections 334.1800 to 334.1860 shall be known and may be cited as
2 the "Physician Assistant Licensure Compact".
3 2. In order to str engthen access to Medical Services, and in r ecognition of the
4 advances in the delivery of Medical Services, the Participating States of the P A
5 Licensur e Compact have allied in common purpose to develop a compr ehensive pro cess
6 that complements the existing authority of State Licensing Boards to license and
7 discipline physician assistants and seeks to enhance the portability of a License to
8 practice as a physician assistant while safeguarding the safety of patients. This
9 Compact allows Medical Services to be prov ided by physician assistants, via the mutual
10 r ecognition of the Licensee's Qualifying License by other Compact Participating States.
11 This Compact also adopts the prevai ling standard for physician assistant licensur e and
12 affirms that the practice and delivery of Medical Services by the physician assistant
13 occurs wher e the patient is located at the time of the patient encounter , and ther efor e
14 r equir es the physician assistant to be under the jurisdiction of the State Licensing Board
15 wher e the patient is located. State Licensing Boards that participate in this Compact
16 r etain the jurisdiction to impose Adverse Action against a Compact Privilege in that
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
17 State issued to a physician assistant thr ough the pro cedur es of this Compact. The P A
18 Licensur e Compact will alleviate burdens for military families by allowing active duty
19 military personnel and their spouses to obtain a Compact Privilege based on having an
20 unr estricted License in good standing fr om a Participating State.
334.1805. In this Compact:
2 (1) "Adverse Action" means any administrative, civil, equitable, or criminal
3 action permitted by a State's laws which is imposed by a Licensing Board or other
4 authority against a physician assistant License or License application or Compact
5 Privilege such as License denial, censure, revo cation, suspension, pr obation, monitoring
6 of the Licensee, or r estriction on the Licensee's practice.
7 (2) "Compact Privilege" means the authorization granted by a Remote State to
8 allow a Licensee from another Participating State to practice as a physician assistant to
9 pr ovide Medical Services and other licensed activity to a patient located in the Remote
10 State under the Remote State's laws and regu lations.
11 (3) "Conviction" means a finding by a court that an individual is guilty of a
12 felony or misdemeanor offense thr ough adjudication or entry of a plea of guilt or no
13 contest to the charge by the offender .
14 (4) "Criminal Backgr ound Check" means the submission of fingerprints or
15 other biometric-based information for a License applicant for the purpose of obtaining
16 that applicant's criminal history record information, as defined in 28 C.F .R. § 20.3(d),
17 fr om the State's criminal history r ecord repo sitory as defined in 28 C.F .R. § 20.3(f).
18 (5) "Data System" means the r epository of information about Licensees,
19 including but not limited to License status and Adverse Actions, which is creat ed and
20 administer ed under the terms of this Compact.
21 (6) "Executive Committee" means a group of dir ectors and ex-officio individuals
22 elected or appointed pursuant to subdivision (2) of subsection 6 of section 334.1830.
23 (7) "Impair ed Practitioner" means a physician assistant whose practice is
24 adversely affected by health-re lated condition(s) that impact their ability to practice.
25 (8) "Investigative Information" means information, r ecords, or documents
26 r eceived or generated by a Licensing Board pursuant to an investigation.
27 (9) "Jurisprudence Requirem ent" means the assessment of an individual's
28 knowledge of the laws and Rules governing the practice of a physician assistant in a
29 State.
30 (10) "License" means curren t authorization by a State, other than authorization
31 pursuant to a Compact Privilege, for a physician assistant to prov ide Medical Services,
32 which would be unlawful without curr ent authorization.
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33 (1 1) "Licensee" means an individual who holds a License fr om a State to provi de
34 Medical Services as a physician assistant.
35 (12) "Licensing Board" means any State entity authorized to license and
36 otherwise reg ulate physician assistants.
37 (13) "Medical Services" means health care services pr ovided for the diagnosis,
38 pr evention, tr eatment, cur e or relief of a health condition, injury , or disease, as defined
39 by a State's laws and regu lations. The medical services pro vided by a physician
40 assistant to a patient located in Missouri are defined by Missouri's state laws and
41 r egulations.
42 (14) "Model Compact" means the model for the P A Licensure Compact on file
43 with The Council of State Governments or other entity as designated by the
44 Commission.
45 (15) "Participating State" means a State that has enacted this Compact.
46 (16) "P A" or "Physician Assistant" means an individual who is licensed as a
47 physician assistant in a State. For purposes of this Compact, any other title or status
48 adopted by a State to re place the term "physician assistant" shall be deemed
49 synonymous with "physician assistant" and shall confer the same rights and
5 0 r esponsibilities to the Licensee under the pr ovisions of this Compact at the time of its
51 enactment.
52 (17) "P A Licensur e Compact Commission," "Compact Commission," or
53 "Commission" mean the national administrative body cr eated pursuant to subsection
54 1 of section 334.1830 of this Compact.
55 (18) "Qualifying License" means an unrest ricted License issued by a
5 6 Participating State to provi de Medical Services as a physician assistant.
57 (19) "Remote State" means a Participating State wher e a Licensee who is not
58 licensed as a physician assistant is exercising or seeking to exerci se the Compact
59 Privilege.
60 (20) "Rule" means a r egulation pr omulgated by an entity that has the for ce and
61 effect of law .
62 (21) "Significant Investigative Information" means Investigative Information
63 that a Licensing Board, after an inquiry or investigation that includes notification and
64 an opportunity for the physician assistant to r espond if requ ired by State law , has
65 r eason to believe is not groun dless and, if proven true, would indicate mor e than a
66 minor infraction.
67 (22) "State" means any state, commonwealth, district, or territory of the United
68 States.
334.1810. 1. T o participate in this Compact, a Participating State shall:
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2 (1) License physician assistants.
3 (2) Participate in the Compact Commission's Data System.
4 (3) Have a mechanism in place for receivi ng and investigating complaints
5 against Licensees and License applicants.
6 (4) Notify the Commission, in compliance with the terms of this Compact and
7 Commission Rules, of any Adverse Action against a Licensee or License applicant and
8 the existence of Significant Investigative Information regard ing a Licensee or License
9 applicant.
10 (5) Fully implement a Criminal Backgr ound Check req uire ment, within a time
11 frame established by Commission Rule, by its Licensing Board r eceiving the results of a
12 Criminal Backgr ound Check and reporting to the Commission whether the License
13 applicant has been granted a License.
14 (6) Comply with the Rules of the Compact Commission.
15 (7) Utilize passage of a recog nized national exam such as the NCCP A P ANCE as
16 a req uire ment for physician assistant licensur e.
17 (8) Grant the Compact Privilege to a holder of a Qualifying License in a
18 Participating State.
19 2. Nothing in this Compact pr ohibits a Participating State fr om charging a fee
20 for granting the Compact Privilege.
334.1815. 1. T o exer cise the Compact Privilege, a Licensee must:
2 (1) Have graduated fr om a physician assistant progra m accr edited by the
3 Accr editation Review Commission on Education for the Physician Assistant, Inc. or
4 other pr ograms authorized by Commission Rule.
5 (2) Hold curr ent NCCP A certification.
6 (3) Have no felony or misdemeanor Conviction.
7 (4) Have never had a controlled substance license, permit, or regi stration
8 suspended or r evoked by a State or by the United States Drug Enfor cement
9 Administration.
10 (5) Have a unique identifier as determined by Commission Rule.
11 (6) Hold a Qualifying License.
12 (7) Have had no rev ocation of a License or limitation or res triction on any
13 License curr ently held due to an adverse action.
14 (8) If a Licensee has had a limitation or res triction on a License or Compact
15 Privilege due to an Adverse Action, two years must have elapsed fr om the date on which
16 the License or Compact Privilege is no longer limited or res tricted due to the Adverse
17 Action.
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18 (9) If a Compact Privilege has been r evoked or is limited or restricted in a
19 Participating State for conduct that would not be a basis for disciplinary action in a
20 Participating State in which the Licensee is practicing or applying to practice under a
21 Compact Privilege, that Participating State shall have the discret ion not to consider
22 such action as an Adverse Action req uiring the denial or rem oval of a Compact
23 Privilege in that State.
24 (10) Notify the Compact Commission that the Licensee is seeking the Compact
25 Privilege in a Remote State.
26 (1 1) Meet any Jurisprudence Requirem ent of a Remote State in which the
27 Licensee is seeking to practice under the Compact Privilege and pay any fees applicable
28 to satisfying the Jurisprudence Requirem ent.
29 (12) Report to the Commission any Adverse Action taken by a non-participating
30 State within thirty (30) days after the action is taken.
31 2. The Compact Privilege is valid until the expiration or r evocation of the
32 Qualifying License unless terminated pursuant to an Adverse Action. The Licensee
33 must also comply with all of the re quir ements of subsection 1 of this section to maintain
34 the Compact Privilege in a Remote State. If the Participating State takes Adverse
35 Action against a Qualifying License, the Licensee shall lose the Compact Privilege in any
36 Remote State in which the Licensee has a Compact Privilege until all of the following
37 occur:
38 (1) The License is no longer limited or restricted; and
39 (2) T wo (2) years have elapsed fr om the date on which the License is no longer
40 limited or res tricted due to the Adverse Action.
41 3. Once a res tricted or limited License satisfies the requ irem ents of subdivisions
42 (1) and (2) of subsection 2 of this section, the Licensee must meet the requ irem ents of
43 subsection 1 of this section to obtain a Compact Privilege in any Remote State.
44 4. For each Remote State in which a physician assistant seeks authority to
45 pr escribe control led substances, the physician assistant shall satisfy all r equir ements
46 imposed by such State in granting or renewi ng such authority .
334.1820. Upon a Licensee's application for a Compact Privilege, the Licensee
2 shall identify to the Commission the Participating State fr om which the Licensee is
3 applying, in accordance with applicable Rules adopted by the Commission, and subject
4 to the following r equir ements:
5 (1) When applying for a Compact Privilege, the Licensee shall pr ovide the
6 Commission with the addr ess of the Licensee's primary res idence and ther eafter shall
7 immediately r eport to the Commission any change in the addr ess of the Licensee's
8 primary resi dence.
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9 (2) When applying for a Compact Privilege, the Licensee is req uired to consent
10 to accept service of proc ess by mail at the Licensee's primary res idence on file with the
11 Commission with res pect to any action br ought against the Licensee by the Commission
12 or a Participating State, including a subpoena, with res pect to any action brou ght or
13 investigation conducted by the Commission or a Participating State.
334.1825. 1. A Participating State in which a Licensee is licensed shall have
2 exclusive power to impose Adverse Action against the Qualifying License issued by that
3 Participating State.
4 2. In addition to the other powers conferr ed by State law , a Remote State shall
5 have the authority , in accordance with existing State due process law , to do all of the
6 following:
7 (1) T ake Adverse Action against a physician assistant's Compact Privilege within
8 that State to rem ove a Licensee's Compact Privilege or take other action necessary
9 under applicable law to pr otect the health and safety of its citizens.
10 (2) Issue subpoenas for both hearings and investigations that requ ire the
11 attendance and testimony of witnesses as well as the prod uction of evidence. Subpoenas
12 issued by a Licensing Board in a Participating State for the attendance and testimony of
13 witnesses or the prod uction of evidence fro m another Participating State shall be
14 enfor ced in the latter State by any court of competent jurisdiction, according to the
15 practice and pr ocedur e of that court applicable to subpoenas issued in proceed ings
16 pending before it. The issuing authority shall pay any witness fees, travel expenses,
17 mileage and other fees req uired by the service statutes of the State in which the
18 witnesses or evidence are located.
19 (3) Notwithstanding subdivision (2) of this subsection, subpoenas may not be
20 issued by a Participating State to gather evidence of conduct in another State that is
21 lawful in that other State for the purpose of taking Adverse Action against a Licensee's
22 Compact Privilege or application for a Compact Privilege in that Participating State.
23 (4) Nothing in this Compact authorizes a Participating State to impose discipline
24 against a physician assistant's Compact Privilege or to deny an application for a
25 Compact Privilege in that Participating State for the individual's otherwise lawful
26 practice in another State.
27 3. For purposes of taking Adverse Action, the Participating State which issued
28 the Qualifying License shall give the same priority and effect to repo rted conduct
29 r eceived fr om any other Participating State as it would if the conduct had occurr ed
30 within the Participating State which issued the Qualifying License. In so doing, that
31 Participating State shall apply its own State laws to determine appr opriate action.
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32 4. A Participating State, if otherwise permitted by State law , may recover fr om
33 the affected physician assistant the costs of investigations and disposition of cases
34 r esulting from any Adverse Action taken against that physician assistant.
35 5. A Participating State may take Adverse Action based on the factual findings
36 of a Remote State, pr ovided that the Participating State follows its own pr ocedur es for
37 taking the Adverse Action.
38 6. (1) In addition to the authority granted to a Participating State by its
39 r espective State physician assistant laws and reg ulations or other applicable State law ,
40 any Participating State may participate with other Participating States in joint
41 investigations of Licensees.
42 (2) Participating States shall share any investigative, litigation, or compliance
43 materials in furtherance of any joint or individual investigation initiated under this
44 Compact.
45 7. If an Adverse Action is taken against a physician assistant's Qualifying
46 License, the physician assistant's Compact Privilege in all Remote States shall be
47 deactivated until two (2) years have elapsed after all res trictions have been r emoved
48 fr om the State License. All disciplinary orders by the Participating State which issued
49 the Qualifying License that impose Adverse Action against a physician assistant's
50 License shall include a Statement that the physician assistant's Compact Privilege is
51 deactivated in all Participating States during the pendency of the order .
52 8. If any Participating State takes Adverse Action, it pr omptly shall notify the
53 administrator of the Data System.
334.1830. 1. The Participating States her eby creat e and establish a joint
2 government agency and national administrative body known as the P A Licensur e
3 Compact Commission. The Commission is an instrumentality of the Compact States
4 acting jointly and not an instrumentality of any one State. The Commission shall come
5 into existence on or after the effective date of the Compact as set forth in subsection 1 of
6 section 334.1850.
7 2. (1) Each Participating State shall have and be limited to one (1) delegate
8 selected by that Participating State's Licensing Board or , if the State has mor e than one
9 Licensing Board, selected collectively by the Participating State's Licensing Boards.
10 (2) The delegate shall be either:
11 (a) A curr ent physician assistant, physician or public member of a Licensing
12 Board or physician assistant Council/Committee; or
13 (b) An administrator of a Licensing Board.
14 (3) Any delegate may be rem oved or suspended fr om office as pro vided by the
15 laws of the State from which the delegate is appointed.
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16 (4) The Participating State Licensing Board shall fill any vacancy occurring in
17 the Commission within sixty (60) days.
18 (5) Each delegate shall be entitled to one (1) vote on all matters voted on by the
19 Commission and shall otherwise have an opportunity to participate in the business and
20 affairs of the Commission. A delegate shall vote in person or by such other means as
21 pr ovided in the bylaws. The bylaws may prov ide for delegates' participation in
22 meetings by telecommunications, video confer ence, or other means of communication.
23 (6) The Commission shall meet at least once during each calendar year .
24 Additional meetings shall be held as set forth in this Compact and the bylaws.
25 (7) The Commission shall establish by Rule a term of office for delegates.
26 3. The Commission shall have the following powers and duties:
27 (1) Establish a code of ethics for the Commission;
28 (2) Establish the fiscal year of the Commission;
29 (3) Establish fees;
30 (4) Establish bylaws;
31 (5) Maintain its financial r ecords in accordance with the bylaws;
32 (6) Meet and take such actions as ar e consistent with the pr ovisions of this
33 Compact and the bylaws;
34 (7) Pr omulgate Rules limited to the Commission's authority to facilitate and
35 coordinate implementation and administration of this Compact. The Rules authorized
36 by the Compact shall have the forc e and effect of law and shall be binding in all
37 Participating States;
38 (8) Bring and prosecute legal pr oceedings or actions in the name of the
39 Commission, pr ovided that the standing of any State Licensing Board to sue or be sued
40 under applicable law shall not be affected;
41 (9) Purchase and maintain insurance and bonds;
42 (10) Borrow , accept, or contract for services of personnel, including, but not
43 limited to, employees of a Participating State;
44 (1 1) Hir e employees and engage contractors, elect or appoint officers, fix
45 compensation, define duties, grant such individuals appr opriate authority to carry out
46 the purposes of this Compact, and establish the Commission's personnel policies and
47 pr ograms relat ing to conflicts of intere st, qualifications of personnel, and other r elated
48 personnel matters;
49 (12) Accept any and all appr opriate donations and grants of money , equipment,
50 supplies, materials and services, and receiv e, utilize and dispose of the same; pr ovided
51 that at all times the Commission shall avoid any appearance of impropri ety or conflict
52 of interes t;
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53 (13) Lease, pur chase, accept appr opriate gifts or donations of, or otherwise own,
54 hold, improv e or use, any pro perty , rea l, personal or mixed; pr ovided that at all times
55 the Commission shall avoid any appearance of impropri ety;
56 (14) Sell, convey , mortgage, pledge, lease, exchange, abandon, or otherwise
57 dispose of any pr operty real, personal, or mixed;
58 (15) Establish a budget and make expenditur es;
59 (16) Borrow money;
60 (17) Appoint committees, including standing committees composed of members,
61 State r egulators, State legislators or their re pr esentatives, and consumer
6 2 r epresent atives, and such other interes ted persons as may be designated in this
63 Compact and the bylaws;
64 (18) Pr ovide and r eceive information fr om, and cooperate with, law enforcem ent
65 agencies;
66 (19) Elect a Chair , V ice Chair , Secr etary and T rea sur er and such other officers
67 of the Commission as pr ovided in the Commission's bylaws;
68 (20) Reserve for itself, in addition to those rese rved exclusively to the
69 Commission under the Compact, powers that the Executive Committee may not
70 exer cise;
71 (21) Appr ove or disappr ove a State's participation in the Compact based upon
72 its determination as to whether the State's Compact legislation departs in a material
73 manner fr om the Model Compact language;
74 (22) Pr epare and pr ovide to the Participating States an annual repo rt; and
75 (23) Perform such other functions as may be necessary or appr opriate to achieve
76 the purposes of this Compact consistent with the State regu lation of physician assistant
77 licensur e and practice.
78 4. (1) All meetings of the Commission that are not closed pursuant to this
79 subsection shall be open to the public. Notice of public meetings shall be posted on the
80 Commission's website at least thirty (30) days prior to the public meeting.
81 (2) Notwithstanding subdivision (1) of this subsection, the Commission may
82 convene a public meeting by pr oviding at least twenty-four (24) hours prior notice on
83 the Commission's website, and any other means as pr ovided in the Commission's Rules,
84 for any of the reas ons it may dispense with notice of pro posed rulemaking under
85 subsection 12 of section 334.1840.
86 (3) The Commission may convene in a closed, non-public meeting or non-public
87 part of a public meeting to recei ve legal advice or to discuss:
88 (a) Non-compliance of a Participating State with its obligations under this
89 Compact;
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90 (b) The employment, compensation, discipline or other matters, practices or
91 pr ocedur es rel ated to specific employees or other matters rela ted to the Commission's
92 internal personnel practices and proc edures;
93 (c) Curr ent, thr eatened, or r easonably anticipated litigation;
94 (d) Negotiation of contracts for the purch ase, lease, or sale of goods, services, or
95 r eal estate;
96 (e) Accusing any person of a crime or formally censuring any person;
97 (f) Disclosure of trade secr ets or commer cial or financial information that is
98 privileged or confidential;
99 (g) Disclosur e of information of a personal natur e wher e disclosur e would
100 constitute a clearly unwarranted invasion of personal privacy;
101 (h) Disclosur e of investigative r ecords compiled for law enfor cement purposes;
102 (i) Disclosur e of information re lated to any investigative rep orts pr epar ed by or
103 on behalf of or for use of the Commission or other committee charged with
104 r esponsibility of investigation or determination of compliance issues pursuant to this
105 Compact;
106 (j) Legal advice; or
107 (k) Matters specifically exempted fr om disclosure by federal or Participating
108 States' statutes.
109 (4) If a meeting, or portion of a meeting, is closed pursuant to this pr ovision, the
110 chair of the meeting or the chair's designee shall certify that the meeting or portion of
111 the meeting may be closed and shall r efer ence each r elevant exempting pr ovision.
112 (5) The Commission shall keep minutes that fully and clearly describe all
113 matters discussed in a meeting and shall pr ovide a full and accurate summary of actions
114 taken, including a description of the views expr essed. All documents consider ed in
115 connection with an action shall be identified in such minutes. All minutes and
116 documents of a closed meeting shall r emain under seal, subject to relea se by a majority
117 vote of the Commission or order of a court of competent jurisdiction.
118 5. (1) The Commission shall pay , or pr ovide for the payment of, the reas onable
119 expenses of its establishment, organization, and ongoing activities.
120 (2) The Commission may accept any and all appr opriate reven ue sources ,
121 donations, and grants of money , equipment, supplies, materials, and services.
122 (3) The Commission may levy on and collect an annual assessment fr om each
123 Participating State and may impose Compact Privilege fees on Licensees of
1 2 4 Participating States to whom a Compact Privilege is granted to cover the cost of the
125 operations and activities of the Commission and its staff, which must be in a total
126 amount sufficient to cover its annual budget as appr oved by the Commission each year
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127 for which rev enue is not pr ovided by other sour ces. The aggreg ate annual assessment
128 amount levied on Participating States shall be allocated based upon a formula to be
129 determined by Commission Rule.
130 (a) A Compact Privilege expir es when the Licensee's Qualifying License in the
131 Participating State fr om which the Licensee applied for the Compact Privilege expir es.
132 (b) If the Licensee terminates the Qualifying License thr ough which the Licensee
133 applied for the Compact Privilege before its scheduled expiration, and the Licensee has
134 a Qualifying License in another Participating State, the Licensee shall inform the
135 Commission that it is changing to that Participating State the Participating State
136 thr ough which it applies for a Compact Privilege and pay to the Commission any
137 Compact Privilege fee r equir ed by Commission Rule.
138 (4) The Commission shall not incur obligations of any kind prior to securing the
139 funds adequate to meet the same; nor shall the Commission pledge the cred it of any of
140 the Participating States, except by and with the authority of the Participating State.
141 (5) The Commission shall keep accurate accounts of all re ceipts and
1 4 2 disbursements. The r eceipts and disbursements of the Commission shall be subject
143 to the financial r eview and accounting pr ocedur es established under its bylaws. All
144 r eceipts and disbursements of funds handled by the Commission shall be subject to an
145 annual financial r eview by a certified or licensed public accountant, and the r eport of
146 the financial rev iew shall be included in and become part of the annual r eport of the
147 Commission.
148 6. (1) The Executive Committee shall have the power to act on behalf of the
149 Commission according to the terms of this Compact and Commission Rules.
150 (2) The Executive Committee shall be composed of nine (9) members:
151 (a) Seven voting members who ar e elected by the Commission fr om the curr ent
152 membership of the Commission;
153 (b) One ex-officio, nonvoting member fr om a reco gnized national physician
154 assistant profes sional association; and
155 (c) One ex-officio, nonvoting member fr om a recogn ized national physician
156 assistant certification organization.
157 (3) The ex-officio members will be selected by their res pective organizations.
158 (4) The Commission may rem ove any member of the Executive Committee as
159 pr ovided in its bylaws.
160 (5) The Executive Committee shall meet at least annually .
161 (6) The Executive Committee shall have the following duties and res ponsibilities:
162 (a) Recommend to the Commission changes to the Commission's Rules or
163 bylaws, changes to this Compact legislation, fees to be paid by Compact Participating
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164 States such as annual dues, and any Commission Compact fee charged to Licensees for
165 the Compact Privilege;
166 (b) Ensur e Compact administration services are appr opriately provi ded,
167 contractual or otherwise;
168 (c) Pr epar e and recomm end the budget;
169 (d) Maintain financial record s on behalf of the Commission;
170 (e) Monitor Compact compliance of Participating States and pr ovide compliance
171 r eports to the Commission;
172 (f) Establish additional committees as necessary;
173 (g) Exercis e the powers and duties of the Commission during the interim
174 between Commission meetings, except for issuing pr oposed rulemaking or adopting
175 Commission Rules or bylaws, or exer cising any other powers and duties exclusively
176 r eserved to the Commission by the Commission's Rules; and
177 (h) Perform other duties as provi ded in the Commission's Rules or bylaws.
178 (7) All meetings of the Executive Committee at which it votes or plans to vote on
179 matters in exer cising the powers and duties of the Commission shall be open to the
180 public and public notice of such meetings shall be given as public meetings of the
181 Commission are given.
182 (8) The Executive Committee may convene in a closed, non-public meeting for
183 the same r easons that the Commission may convene in a non-public meeting as set forth
184 in subdivision (3) of subsection 4 of this section and shall announce the closed meeting as
185 the Commission is req uired to under subdivision (4) of subsection 4 of this section and
186 keep minutes of the closed meeting as the Commission is requi red to under subdivision
187 (5) of subsection 4 of this section.
188 7. (1) The members, officers, executive director , employees and repr esentatives
189 of the Commission shall be immune fr om suit and liability , both personally and in their
190 official capacity , for any claim for damage to or loss of prop erty or personal injury or
191 other civil liability caused by or arising out of any actual or alleged act, error , or
192 omission that occurr ed, or that the person against whom the claim is made had a
193 r easonable basis for believing occurr ed within the scope of Commission employment,
194 duties or r esponsibilities; prov ided that nothing in this subdivision shall be construed to
195 pr otect any such person fro m suit or liability for any damage, loss, injury , or liability
196 caused by the intentional or willful or wanton misconduct of that person. The
197 pr ocur ement of insurance of any type by the Commission shall not in any way
198 compr omise or limit the immunity granted hereu nder .
199 (2) The Commission shall defend any member , officer , executive direc tor ,
200 employee, and re present ative of the Commission in any civil action seeking to impose
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201 liability arising out of any actual or alleged act, err or , or omission that occurred within
202 the scope of Commission employment, duties, or re sponsibilities, or as determined by
203 the commission that the person against whom the claim is made had a r easonable basis
204 for believing occurr ed within the scope of Commission employment, duties, or
205 r esponsibilities; pr ovided that nothing her ein shall be construed to pr ohibit that
206 person fro m ret aining their own counsel at their own expense; and pr ovided further ,
207 that the actual or alleged act, error , or omission did not res ult fr om that person's
208 intentional or willful or wanton misconduct.
209 (3) The Commission shall indemnify and hold harmless any member , officer ,
210 executive dir ector , employee, and repr esentative of the Commission for the amount of
211 any settlement or judgment obtained against that person arising out of any actual or
212 alleged act, err or , or omission that occurre d within the scope of Commission
21 3 employment, duties, or res ponsibilities, or that such person had a r easonable basis
214 for believing occurr ed within the scope of Commission employment, duties, or
215 r esponsibilities, prov ided that the actual or alleged act, erro r , or omission did not
216 r esult fr om the intentional or willful or wanton misconduct of that person.
217 (4) V enue is prop er and judicial proc eedings by or against the Commission shall
218 be bro ught solely and exclusively in a court of competent jurisdiction wher e the
219 principal office of the Commission is located. The Commission may waive venue and
220 jurisdictional defenses in any proceed ings as authorized by Commission Rules.
221 (5) Nothing herei n shall be construed as a limitation on the liability of any
222 Licensee for profes sional malpractice or misconduct, which shall be governed solely by
223 any other applicable State laws.
224 (6) Nothing her ein shall be construed to designate the venue or jurisdiction to
225 bring actions for alleged acts of malpractice, pr ofessional misconduct, negligence, or
226 other such civil action pertaining to the practice of a physician assistant. All such
227 matters shall be determined exclusively by State law other than this Compact.
228 (7) Nothing in this Compact shall be interpr eted to waive or otherwise abr ogate
229 a Participating State's state action immunity or state action affirmative defense with
230 r espect to antitrust claims under the Sherman Act, Clayton Act, or any other State or
231 federal antitrust or anticompetitive law or regul ation.
232 (8) Nothing in this Compact shall be construed to be a waiver of soverei gn
233 immunity by the Participating States or by the Commission.
334.1835. 1. The Commission shall prov ide for the development, maintenance,
2 operation, and utilization of a coordinated data and r eporting system containing
3 licensur e, Adverse Action, and the rep orting of the existence of Significant Investigative
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4 Information on all licensed physician assistants and applicants denied a License in
5 Participating States.
6 2. Notwithstanding any other State law to the contrary , a Participating State
7 shall submit a uniform data set to the Data System on all physician assistants to whom
8 this Compact is applicable (utilizing a unique identifier) as requ ired by the Rules of the
9 Commission, including:
10 (1) Identifying information;
11 (2) Licensure data;
12 (3) Adverse Actions against a License or Compact Privilege;
13 (4) Any denial of application for licensur e, and the reas on or rea sons for such
14 denial (excluding the repo rting of any Criminal history record information wher e
15 pr ohibited by law);
16 (5) The existence of Significant Investigative Information; and
17 (6) Other information that may facilitate the administration of this Compact, as
18 determined by the Rules of the Commission.
19 3. Significant Investigative Information pertaining to a Licensee in any
20 Participating State shall only be available to other Participating States.
21 4. The Commission shall pr omptly notify all Participating States of any Adverse
22 Action taken against a Licensee or an individual applying for a License that has been
23 r eported to it. This Adverse Action information shall be available to any other
24 Participating State.
25 5. Participating States contributing information to the Data System may , in
26 accordance with State or federal law , designate information that may not be shar ed with
27 the public without the expr ess permission of the contributing State. Notwithstanding
28 any such designation, such information shall be rep orted to the Commission thr ough the
29 Data System.
30 6. Any information submitted to the Data System that is subsequently expunged
31 pursuant to federal law or the laws of the Participating State contributing the
32 information shall be r emoved fr om the Data System upon reporting of such by the
33 Participating State to the Commission.
34 7. The rec ords and information pro vided to a Participating State pursuant to
35 this Compact or thr ough the Data System, when certified by the Commission or an
36 agent ther eof, shall constitute the authenticated business rec ords of the Commission,
37 and shall be entitled to any associated hearsay exception in any re levant judicial, quasi-
38 judicial or administrative pr oceedings in a Participating State.
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334.1840. 1. The Commission shall exer cise its Rulemaking powers pursuant to
2 the criteria set forth in this Section and the Rules adopted ther eunder . Commission
3 Rules shall become binding as of the date specified by the Commission for each Rule.
4 2. The Commission shall promul gate reas onable Rules in order to effectively and
5 efficiently implement and administer this Compact and achieve its purposes. A
6 Commission Rule shall be invalid and have no for ce or effect only if a court of
7 competent jurisdiction holds that the Rule is invalid because the Commission exer cised
8 its rulemaking authority in a manner that is beyond the scope of the purposes of this
9 Compact, or the powers granted hereunder , or based upon another applicable standard
10 of review .
11 3. The Rules of the Commission shall have the for ce of law in each Participating
12 State, pro vided however that wher e the Rules of the Commission conflict with the laws
13 of the Participating State that establish the medical services a physician assistant may
14 perform in the Participating State, as held by a court of competent jurisdiction, the
15 Rules of the Commission shall be ineffective in that State to the extent of the conflict.
16 4. If a majority of the legislatur es of the Participating States rej ects a
17 Commission Rule, by enactment of a statute or res olution in the same manner used to
18 adopt this Compact within four (4) years of the date of adoption of the Rule, then such
19 Rule shall have no further for ce and effect in any Participating State or to any State
20 applying to participate in the Compact.
21 5. Commission Rules shall be adopted at a regu lar or special meeting of the
22 Commission.
23 6. Prior to pr omulgation and adoption of a final Rule or Rules by the
24 Commission, and at least thirty (30) days in advance of the meeting at which the Rule
25 will be consider ed and voted upon, the Commission shall file a Notice of Pr oposed
26 Rulemaking:
27 (1) On the website of the Commission or other publicly accessible platform; and
28 (2) T o persons who have requ ested notice of the Commission's notices of
29 pr oposed rulemaking; and
30 (3) In such other way(s) as the Commission may by Rule specify .
31 7. The Notice of Pr oposed Rulemaking shall include:
32 (1) The time, date, and location of the public hearing on the prop osed Rule and
33 the pro posed time, date and location of the meeting in which the pr oposed Rule will be
34 consider ed and voted upon;
35 (2) The text of the pr oposed Rule and the reas on for the pr oposed Rule;
36 (3) A r equest for comments on the prop osed Rule fr om any interes ted person
37 and the date by which written comments must be receiv ed; and
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38 (4) The manner in which interes ted persons may submit notice to the
39 Commission of their intention to attend the public hearing or pr ovide any written
40 comments.
41 8. Prior to adoption of a pro posed Rule, the Commission shall allow persons to
42 submit written data, facts, opinions, and arguments, which shall be made available to
43 the public.
44 9. If the hearing is to be held via electr onic means, the Commission shall publish
45 the mechanism for access to the electr onic hearing.
46 (1) All persons wishing to be heard at the hearing shall as direc ted in the Notice
47 of Pr oposed Rulemaking, not less than five (5) business days befor e the scheduled date
48 of the hearing, notify the Commission of their desire to appear and testify at the hearing.
49 (2) Hearings shall be conducted in a manner provi ding each person who wishes
50 to comment a fair and reas onable opportunity to comment orally or in writing.
51 (3) All hearings shall be r ecorded. A copy of the r ecording and the written
52 comments, data, facts, opinions, and arguments recei ved in res ponse to the pro posed
53 rulemaking shall be made available to a person upon requ est.
54 (4) Nothing in this section shall be construed as requi ring a separate hearing on
55 each pr oposed Rule. Pr oposed Rules may be gro uped for the convenience of the
56 Commission at hearings req uire d by this section.
57 10. Following the public hearing the Commission shall consider all written and
58 oral comments timely r eceived.
59 1 1. The Commission shall, by majority vote of all delegates, take final action on
60 the prop osed Rule and shall determine the effective date of the Rule, if adopted, based
61 on the Rulemaking record and the full text of the Rule.
62 (1) If adopted, the Rule shall be posted on the Commission's website.
63 (2) The Commission may adopt changes to the pro posed Rule pro vided the
64 changes do not enlarge the original purpose of the pr oposed Rule.
65 (3) The Commission shall prov ide on its website an explanation of the reas ons
66 for substantive changes made to the pr oposed Rule as well as reas ons for substantive
67 changes not made that were recommended by commenters.
68 (4) The Commission shall determine a reas onable effective date for the Rule.
69 Except for an emergency as pr ovided in subsection 12 of this section, the effective date
70 of the Rule shall be no sooner than thirty (30) days after the Commission issued the
71 notice that it adopted the Rule.
72 12. Upon determination that an emergency exists, the Commission may consider
73 and adopt an emergency Rule with twenty-four (24) hours prior notice, without the
74 opportunity for comment, or hearing, provi ded that the usual rulemaking proce dures
HCS HB 3129 16
75 pr ovided in this Compact and in this section shall be r etr oactively applied to the Rule as
76 soon as rea sonably possible, in no event later than ninety (90) days after the effective
77 date of the Rule. For the purposes of this pr ovision, an emergency Rule is one that must
78 be adopted immediately by the Commission in order to:
79 (1) Meet an imminent thr eat to public health, safety , or welfare;
80 (2) Pr event a loss of Commission or Participating State funds;
81 (3) Meet a deadline for the pro mulgation of a Commission Rule that is
82 established by federal law or Rule; or
83 (4) Pr otect public health and safety .
84 13. The Commission or an authorized committee of the Commission may direct
85 r evisions to a pr eviously adopted Commission Rule for purposes of corr ecting
86 typographical erro rs, err ors in format, erro rs in consistency , or grammatical errors.
87 Public notice of any revision s shall be posted on the website of the Commission. The
88 r evision shall be subject to challenge by any person for a period of thirty (30) days after
89 posting. The revision may be challenged only on gr ounds that the re vision r esults in a
90 material change to a Rule. A challenge shall be made as set forth in the notice of
91 r evisions and deliver ed to the Commission prior to the end of the notice period. If no
92 challenge is made, the revision will take effect without further action. If the r evision is
93 challenged, the rev ision may not take effect without the appr oval of the Commission.
94 14. No Participating State's rulemaking req uirements shall apply under this
95 Compact.
334.1845. 1. (1) The executive and judicial branches of State government in
2 each Participating State shall enfor ce this Compact and take all actions necessary and
3 appr opriate to implement the Compact.
4 (2) V enue is prop er and judicial proc eedings by or against the Commission shall
5 be bro ught solely and exclusively in a court of competent jurisdiction wher e the
6 principal office of the Commission is located. The Commission may waive venue and
7 jurisdictional defenses to the extent it adopts or consents to participate in alternative
8 dispute reso lution pr oceedings. Nothing herei n shall affect or limit the selection or
9 pr opriety of venue in any action against a licensee for pr ofessional malpractice,
10 misconduct or any such similar matter .
11 (3) The Commission shall be entitled to recei ve service of process in any
12 pr oceeding r egarding the enforcem ent or interpr etation of the Compact or the
13 Commission's Rules and shall have standing to intervene in such a pr oceeding for all
14 purposes. Failur e to pr ovide the Commission with service of pr ocess shall rend er a
15 judgment or order in such proceed ing void as to the Commission, this Compact, or
16 Commission Rules.
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17 2. (1) If the Commission determines that a Participating State has defaulted in
18 the performance of its obligations or res ponsibilities under this Compact or the
19 Commission Rules, the Commission shall pr ovide written notice to the defaulting State
20 and other Participating States. The notice shall describe the default, the pro posed
21 means of curing the default and any other action that the Commission may take and
22 shall offer rem edial training and specific technical assistance r egarding the default.
23 (2) If a State in default fails to cur e the default, the defaulting State may be
24 terminated fr om this Compact upon an affirmative vote of a majority of the delegates of
25 the Participating States, and all rights, privileges and benefits conferred by this
26 Compact upon such State may be terminated on the effective date of termination. A
27 cur e of the default does not reli eve the offending State of obligations or liabilities
28 incurr ed during the period of default.
29 (3) T ermination of participation in this Compact shall be imposed only after all
30 other means of securing compliance have been exhausted. Notice of intent to suspend or
31 terminate shall be given by the Commission to the governor , the majority and minority
32 leaders of the defaulting State's legislature, and to the Licensing Board(s) of each of the
33 Participating States.
34 (4) A State that has been terminated is res ponsible for all assessments,
35 obligations, and liabilities incurr ed thr ough the effective date of termination, including
36 obligations that extend beyond the effective date of termination.
37 (5) The Commission shall not bear any costs rela ted to a State that is found to be
38 in default or that has been terminated fr om this Compact, unless agre ed upon in writing
39 between the Commission and the defaulting State.
40 (6) The defaulting State may appeal its termination fro m the Compact by the
41 Commission by petitioning the U.S. District Court for the District of Columbia or the
42 federal district wher e the Commission has its principal offices. The pre vailing member
43 shall be awarded all costs of such litigation, including reas onable attorney's fees.
44 (7) Upon the termination of a State's participation in the Compact, the State
45 shall immediately pr ovide notice to all Licensees within that State of such termination:
46 (a) Licensees who have been granted a Compact Privilege in that State shall
47 r etain the Compact Privilege for one hundred eighty (180) days following the effective
48 date of such termination.
49 (b) Licensees who are licensed in that State who have been granted a Compact
50 Privilege in a Participating State shall reta in the Compact Privilege for one hundr ed
51 eighty (180) days unless the Licensee also has a Qualifying License in a Participating
52 State or obtains a Qualifying License in a Participating State before the one hundr ed
53 eighty (180)-day period ends, in which case the Compact Privilege shall continue.
HCS HB 3129 18
54 3. (1) Upon req uest by a Participating State, the Commission shall attempt to
55 r esolve disputes rela ted to this Compact that arise among Participating States and
56 between participating and non-Participating States.
57 (2) The Commission shall pr omulgate a Rule prov iding for both mediation and
58 binding dispute r esolution for disputes as appr opriate.
59 4. (1) The Commission, in the rea sonable exerc ise of its discr etion, shall enforce
60 the pro visions of this Compact and Rules of the Commission.
61 (2) If compliance is not secure d after all means to secure compliance have been
62 exhausted, by majority vote, the Commission may initiate legal action in the United
63 States District Court for the District of Columbia or the federal district wher e the
64 Commission has its principal offices, against a Participating State in default to enforce
65 compliance with the prov isions of this Compact and the Commission's pr omulgated
66 Rules and bylaws. The r elief sought may include both injunctive reli ef and damages. In
67 the event judicial enforcem ent is necessary , the prevai ling party shall be awarded all
68 costs of such litigation, including r easonable attorney's fees.
69 (3) The r emedies her ein shall not be the exclusive rem edies of the Commission.
70 The Commission may pursue any other rem edies available under federal or State law .
71 5. (1) A Participating State may initiate legal action against the Commission in
72 the U.S. District Court for the District of Columbia or the federal district wher e the
73 Commission has its principal offices to enforce compliance with the pr ovisions of the
74 Compact and its Rules. The relief sought may include both injunctive r elief and
75 damages. In the event judicial enfor cement is necessary , the pr evailing party shall be
76 awarded all costs of such litigation, including reas onable attorney's fees.
77 (2) No person other than a Participating State shall enforce this Compact against
78 the Commission.
334.1850. 1. This Compact shall come into effect on the date on which this
2 Compact statute is enacted into law in the seventh Participating State.
3 (1) On or after the effective date of the Compact, the Commission shall convene
4 and rev iew the enactment of each of the States that enacted the Compact prior to the
5 Commission convening ("Charter Participating States") to determine if the statute
6 enacted by each such Charter Participating State is materially differe nt than the Model
7 Compact.
8 (a) A Charter Participating State whose enactment is found to be materially
9 differ ent fr om the Model Compact shall be entitled to the default pr ocess set forth in
10 subsection 2 of section 334.1845.
11 (b) If any Participating State later withdraws fr om the Compact or its
12 participation is terminated, the Commission shall r emain in existence and the Compact
HCS HB 3129 19
13 shall rem ain in effect even if the number of Participating States should be less than
14 seven. Participating States enacting the Compact subsequent to the Commission
15 convening shall be subject to the pr ocess set forth in subdivision (21) of subsection 3 of
16 section 334.1830 to determine if their enactments are materially differ ent from the
17 Model Compact and whether they qualify for participation in the Compact.
18 (2) Participating States enacting the Compact subsequent to the seven initial
19 Charter Participating States shall be subject to the pr ocess set forth in subdivision (21)
20 of subsection 3 of section 334.1830 to determine if their enactments ar e materially
21 differ ent fr om the Model Compact and whether they qualify for participation in the
22 Compact.
23 (3) All actions taken for the benefit of the Commission or in furtherance of the
24 purposes of the administration of the Compact prior to the effective date of the Compact
25 or the Commission coming into existence shall be considere d to be actions of the
26 Commission unless specifically r epudiated by the Commission.
27 2. Any State that joins this Compact shall be subject to the Commission's Rules
28 and bylaws as they exist on the date on which this Compact becomes law in that State.
29 Any Rule that has been pr eviously adopted by the Commission shall have the full for ce
30 and effect of law on the day this Compact becomes law in that State.
31 3. Any Participating State may withdraw fr om this Compact by enacting a
32 statute repeal ing the same.
33 (1) A Participating State's withdrawal shall not take effect until one hundr ed
34 eighty (180) days after enactment of the r epealing statute. During this one hundr ed
35 eighty (180) day-period, all Compact Privileges that wer e in effect in the withdrawing
36 State and wer e granted to Licensees licensed in the withdrawing State shall rem ain in
37 effect. If any Licensee licensed in the withdrawing State is also licensed in another
38 Participating State or obtains a license in another Participating State within the one
39 hundr ed eighty (180) days, the Licensee's Compact Privileges in other Participating
40 States shall not be affected by the passage of the one hundred eighty (180) days.
41 (2) W ithdrawal shall not affect the continuing r equir ement of the State
42 Licensing Board(s) of the withdrawing State to comply with the investigative, and
43 Adverse Action rep orting req uirements of this Compact prior to the effective date of
44 withdrawal.
45 (3) Upon the enactment of a statute withdrawing a State fro m this Compact, the
46 State shall immediately provi de notice of such withdrawal to all Licensees within that
47 State. Such withdrawing State shall continue to reco gnize all licenses granted pursuant
48 to this Compact for a minimum of one hundr ed eighty (180) days after the date of such
49 notice of withdrawal.
HCS HB 3129 20
50 4. Nothing contained in this Compact shall be construed to invalidate or pr event
51 any physician assistant licensur e agreement or other cooperative arrangement between
52 Participating States and between a Participating State and non-Participating State that
53 does not conflict with the pro visions of this Compact.
54 5. This Compact may be amended by the Participating States. No amendment to
55 this Compact shall become effective and binding upon any Participating State until it is
56 enacted materially in the same manner into the laws of all Participating States as
57 determined by the Commission.
334.1855. 1. This Compact and the Commission's rulemaking authority shall be
2 liberally construed so as to effectuate the purposes, and the implementation and
3 administration of the Compact. Pr ovisions of the Compact expr essly authorizing or
4 r equiring the promulg ation of Rules shall not be construed to limit the Commission's
5 rulemaking authority solely for those purposes.
6 2. The pr ovisions of this Compact shall be severable and if any phrase, clause,
7 sentence or provi sion of this Compact is held by a court of competent jurisdiction to be
8 contrary to the constitution of any Participating State, a State seeking participation in
9 the Compact, or of the United States, or the applicability ther eof to any government,
10 agency , person or circ umstance is held to be unconstitutional by a court of competent
11 jurisdiction, the validity of the rem ainder of this Compact and the applicability ther eof
12 to any other government, agency , person or circu mstance shall not be affected ther eby .
13 3. Notwithstanding subsection 2 of this section, the Commission may deny a
14 State's participation in the Compact or , in accordance with the r equir ements of
15 subsection 2 of section 334.1845, terminate a Participating State's participation in the
16 Compact, if it determines that a constitutional re quir ement of a Participating State is, or
17 would be with res pect to a State seeking to participate in the Compact, a material
18 departur e from the Compact. Otherwise, if this Compact shall be held to be contrary to
19 the constitution of any Participating State, the Compact shall r emain in full for ce and
20 effect as to the rem aining Participating States and in full for ce and effect as to the
21 Participating State affected as to all severable matters.
334.1860. 1. Nothing her ein pr events the enfor cement of any other law of a
2 Participating State that is not inconsistent with this Compact.
3 2. Any laws in a Participating State in conflict with this Compact are superseded
4 to the extent of the conflict.
5 3. All agreements between the Commission and the Participating States are
6 binding in accordance with their terms.
✔
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