Establishes the PA Licensure Compact

6140S.02C
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SENATE COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 1492
AN ACT
To amend chapter 334, RSMo, by adding thereto one new
section relating to physician assistants.

Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Chapter 334, RSMo, is amended by adding thereto
one new section, to be known as section 334.1800, to read as
follows:
334.1800. This section shall be known and may be cited
as the "PA Licensure Compact".
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 Physician Assistants and seeks to enhance the
portability of a License to practice as a Physician
Assistant while safeguarding the safety of patients. This
Compact allows Medical Services to be provided by Physician
Assistants, via the mutual recognition of the Licensee's
Qualifying License by other Compact Participating States.
This Compact also adopts the prevailing standard for
Physician Assistant licensure and affirms that the practice
and delivery of Medical Services by the Physician Assistant
occurs where the patient is located at the time of the
patient encounter, and therefore requires the Physician
Assistant to be under the jurisdiction of the State
Licensing Board where the patient is located. State

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Licensing Boards that participate in this Compact retain the
jurisdiction to impose Adverse Action against a Compact
Privilege in that State issued to a Physician Assistant
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
In this Compact:
A. "Adverse Action" means 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 Physician Assistant 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.
B. "Compact Privilege" means the authorization granted
by a Remote State to allow a Licensee from another
Participating State to practice as a Physician Assistant to
provide Medical Services and other licensed activity to a
patient located in the Remote State under the Remote State's
laws and regulations.
C. "Conviction" means 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.
D. "Criminal Background Check" means 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).

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E. "Data System" means 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.
F. "Executive Committee" means a group of directors
and ex-officio individuals elected or appointed pursuant to
Section 7.F.2.
G. "Impaired Practitioner" means a Physician Assistant
whose practice is adversely affected by health-related
condition(s) that impact their ability to practice.
H. "Investigative Information" means information,
records, or documents received or generated by a Licensing
Board pursuant to an investigation.
I. "Jurisprudence Requirement" means the assessment of
an individual's knowledge of the laws and Rules governing
the practice of a Physician Assistant in a State.
J. "License" means current authorization by a State,
other than authorization pursuant to a Compact Privilege,
for a Physician Assistant to provide Medical Services, which
would be unlawful without current authorization.
K. "Licensee" means an individual who holds a License
from a State to provide Medical Services as a Physician
Assistant.
L. "Licensing Board" means any State entity authorized
to license and otherwise regulate Physician Assistants.
M. "Medical Services" means 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 regulations. The Medical Services
provided by a Physician Assistant to a patient located in
Missouri are defined by Missouri's state laws and
regulations.

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N. "Model Compact" means the model for the PA
Licensure Compact on file with The Council of State
Governments or other entity as designated by the Commission.
O. "Participating State" means a State that has
enacted this Compact.
P. "PA" or "Physician Assistant" means 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.
Q. "PA Licensure Compact Commission," "Compact
Commission," or "Commission" mean the national
administrative body created pursuant to Section 7.A of this
Compact.
R. "Qualifying License" means an unrestricted License
issued by a Participating State to provide Medical Services
as a Physician Assistant.
S. "Remote State" means a Participating State where a
Licensee who is not licensed as a Physician Assistant is
exercising or seeking to exercise the Compact Privilege.
T. "Rule" means a regulation promulgated by an entity
that has the force and effect of law.
U. "Significant Investigative Information" means
Investigative Information that a Licensing Board, after an
inquiry or investigation that includes notification and an
opportunity for the Physician Assistant 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.

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V. "State" means 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 Physician Assistants;
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
as the NCCPA PANCE as a requirement for Physician Assistant
licensure;
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 Physician Assistant program
accredited by the Accreditation Review Commission on

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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
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;

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12. Report to the Commission any Adverse Action taken
by a non-Participating State within thirty (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 Section 4.A above 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; and
2. Two (2) years have elapsed from the date on which
the License is no longer limited or restricted due to the
Adverse Action.
C. Once a restricted or limited License satisfies the
requirements of Sections 4.B.1 and 4.B.2, the Licensee must
meet the requirements of Section 4.A to obtain a Compact
Privilege in any Remote State.
D. For each Remote State in which a Physician
Assistant seeks authority to prescribe controlled
substances, the Physician Assistant 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
A. 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:

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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.
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 Physician Assistant'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

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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 Section 6.B.2, subpoenas may not 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 Physician Assistant'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 which 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
which issued the Qualifying License. In so doing, that
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 Physician Assistant
the costs of investigations and disposition of cases
resulting from any Adverse Action taken against that
Physician Assistant.
E. A Participating State may take Adverse Action based
on the factual findings of a Remote State, provided that the

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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 Physician
Assistant laws and regulations 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 Physician
Assistant's Qualifying License, the Physician Assistant's
Compact Privilege in all Remote States shall be deactivated
until two (2) years have elapsed after all restrictions have
been removed from the State License. All disciplinary
orders by the Participating State which issued the
Qualifying License that impose Adverse Action against a
Physician Assistant's License shall include a Statement that
the Physician Assistant'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

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or after the effective date of the Compact as set forth in
Section 11.A.
B. Membership, Voting, and Meetings
1. Each Participating State shall have and be limited
to one (1) 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 Physician Assistant, physician or public
member of a Licensing Board or Physician Assistant
council/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 sixty (60)
days.
5. Each delegate shall be entitled to one (1) 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.

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C. The Commission shall have the following powers and
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. Promulgate Rules limited to the Commission's
authority to facilitate and coordinate implementation and
administration of this Compact. The Rules authorized by the
Compact 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
grants of money, equipment, supplies, materials and
services, and receive, utilize and dispose of the same;

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

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consistent with the State regulation of Physician Assistant
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 thirty (30) days prior to the
public meeting.
2. Notwithstanding Section 7.D.1, the Commission may
convene a public meeting by providing at least twenty-four
(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, non-public
meeting or non-public part of a public meeting to receive
legal advice or to discuss:
a. Non-compliance 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;
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;

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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 provision, 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 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 such 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.

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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.
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

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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
(9) 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 Physician Assistant professional association; and
c. One ex-officio, nonvoting member from a recognized
national Physician Assistant certification organization.
3. The ex-officio members will 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;

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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
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; and
h. Perform other duties as provided in the
Commission's Rules or bylaws.
7. All meetings 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,
non-public meeting for the same reasons that the Commission
may convene in a non-public meeting as set forth in Section
7.D.3 and shall announce the closed meeting as the
Commission is required to under Section 7.D.4 and keep
minutes of the closed meeting as the Commission is required
to under Section 7.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

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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
responsibilities; provided that nothing in this paragraph
shall be construed to protect any such person from suit or
liability for any damage, loss, injury, or liability caused
by the intentional or willful or wanton misconduct of that
person. The procurement of insurance of any type by the
Commission shall not in any way compromise or limit the
immunity granted hereunder.
2. The Commission shall defend any member, officer,
executive director, employee, and 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 person 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 person from retaining their own counsel at their own
expense; and provided further, that the actual or alleged
act, error, or omission did not result from that person's
intentional or willful or wanton misconduct.
3. The Commission shall indemnify and hold harmless
any member, officer, executive director, employee, and
representative of the Commission for the amount of any
settlement or judgment obtained against that person 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 person had a reasonable

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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
person.
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 Physician
Assistant. 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 or regulation.
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

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data and reporting system containing licensure, Adverse
Action, and the reporting of the existence of Significant
Investigative Information on all licensed Physician
Assistants 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 Physician Assistants 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(s) 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
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, designate information that may not be shared with the

22
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
Rules adopted thereunder. Commission Rules shall become
binding as of the date specified by the Commission for each
Rule.
B. The Commission shall promulgate 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 no 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.

23
C. The Rules of the Commission shall have the force of
law in each Participating State, provided however that where
the Rules of the Commission conflict with the laws of the
Participating State that establish the Medical Services a
Physician Assistant 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 (4) years of the date of adoption
of the Rule, then such 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.
F. Prior to promulgation and adoption of a final Rule
or Rules by the Commission, and at least thirty (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; and
2. To persons who have requested notice of the
Commission's Notices of Proposed Rulemaking; and
3. In such other way(s) as the Commission may by Rule
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;

24
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.
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 (5) 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.

25
K. The Commission shall, by majority vote of all
delegates, 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
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 Section 9.L, the effective date of the Rule
shall be no sooner than thirty (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
twenty-four (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, in no event later than ninety (90) days
after the effective date of the Rule. For the purposes of
this provision, 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;

26
3. Meet a deadline for the promulgation of a
Commission Rule that is established by federal law or Rule;
or
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 thirty
(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 will 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 venue and jurisdictional defenses to
the extent it adopts or consents to participate in

27
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 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

28
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(s) 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 United
States 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's 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 such termination:
a. Licensees who have been granted a Compact Privilege
in that State shall retain the Compact Privilege for one
hundred eighty (180) days following the effective date of
such termination.
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 one hundred eighty
(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 one hundred eighty (180)-

29
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 promulgate 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 promulgated 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's 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 United States District Court
for the District of Columbia or the federal district where

30
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's 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
convening ("Charter Participating States") to determine if
the statute enacted by each such 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.

31
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
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 one hundred eighty (180) days after enactment
of the repealing statute. During this one hundred eighty
(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 one hundred eighty
(180) days, the Licensee's Compact Privileges in other
Participating States shall not be affected by the passage of
the one hundred eighty (180) days.

32
2. Withdrawal shall not affect the continuing
requirement of the State Licensing Board(s) 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. Such withdrawing State shall continue to recognize
all licenses granted pursuant to this Compact for a minimum
of one hundred eighty (180) days after the date of such
notice of withdrawal.
D. Nothing contained in this Compact shall be
construed to invalidate or prevent any Physician Assistant
licensure agreement or other cooperative arrangement between
Participating States and between a Participating State and
non-Participating State that 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 promulgation 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

33
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 affected thereby.
C. Notwithstanding Section 12.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 herein 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.