House File 300 - Introduced HOUSE FILE 300 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO HSB 87) A BILL FOR An Act enacting the physician assistant licensure compact. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 1743HV (1) 91 ss/ko
H.F. 300 Section 1. NEW SECTION . 147J.1 Physician assistant 1 licensure compact. 2 1. Purpose. In order to strengthen access to medical 3 services, and in recognition of the advances in the delivery 4 of medical services, the participating states of the physician 5 assistant licensure compact have allied in common purpose to 6 develop a comprehensive process that complements the existing 7 authority of state licensing boards to license and discipline 8 physician assistants and seeks to enhance the portability 9 of a license to practice as a physician assistant while 10 safeguarding the safety of patients. This compact allows 11 medical services to be provided by physician assistants, via 12 the mutual recognition of the licensees qualifying license by 13 other compact participating states. This compact also adopts 14 the prevailing standard for physician assistant licensure and 15 affirms that the practice and delivery of medical services by 16 the physician assistant occurs where the patient is located at 17 the time of the patient encounter, and therefore requires the 18 physician assistant to be under the jurisdiction of the state 19 licensing board where the patient is located. State licensing 20 boards that participate in this compact retain the jurisdiction 21 to impose adverse action against a compact privilege in that 22 state issued to a physician assistant through the procedures 23 of this compact. The physician assistant licensure compact 24 will alleviate burdens for military families by allowing active 25 duty military personnel and their spouses to obtain a compact 26 privilege based on having an unrestricted license in good 27 standing from a participating state. 28 2. Definitions. In this compact: 29 a. Adverse action means any administrative, civil, 30 equitable, or criminal action permitted by a states laws 31 which is imposed by a licensing board or other authority 32 against a physician assistant license or license application or 33 compact privilege such as license denial, censure, revocation, 34 suspension, probation, monitoring of the licensee, or 35 -1- LSB 1743HV (1) 91 ss/ko 1/ 30
H.F. 300 restriction on the licensees practice. 1 b. Compact privilege means the authorization granted by 2 a remote state to allow a licensee from another participating 3 state to practice as a physician assistant to provide medical 4 services and other licensed activity to a patient located in 5 the remote state under the remote states laws and regulations. 6 c. Conviction means a finding by a court that an 7 individual is guilty of a felony or misdemeanor offense through 8 adjudication or entry of a plea of guilt or no contest to the 9 charge by the offender. 10 d. Criminal background check means the submission of 11 fingerprints or other biometric-based information for a 12 license applicant for the purpose of obtaining that applicants 13 criminal history record information, as defined in 28 C.F.R. 14 20.3(d), from the states criminal history record repository 15 as defined in 28 C.F.R. 20.3(f). 16 e. Data system means the repository of information about 17 licensees, including but not limited to license status and 18 adverse actions, which is created and administered under the 19 terms of this compact. 20 f. Executive committee means a group of directors and ex 21 officio individuals elected or appointed pursuant to subsection 22 7, paragraph f , subparagraph (2). 23 g. Impaired practitioner means a physician assistant whose 24 practice is adversely affected by a health-related condition 25 that impacts the physician assistants ability to practice. 26 h. Investigative information means information, records, 27 or documents received or generated by a licensing board 28 pursuant to an investigation. 29 i. Jurisprudence requirement means the assessment of an 30 individuals knowledge of the laws and rules governing the 31 practice of a physician assistant in a state. 32 j. License means current authorization by a state, other 33 than authorization pursuant to a compact privilege, for a 34 physician assistant to provide medical services, which would be 35 -2- LSB 1743HV (1) 91 ss/ko 2/ 30
H.F. 300 unlawful without current authorization. 1 k. Licensee means an individual who holds a license from a 2 state to provide medical services as a physician assistant. 3 l. Licensing board means any state entity authorized to 4 license and otherwise regulate physician assistants. 5 m. Medical services means health care services provided 6 for the diagnosis, prevention, treatment, cure, or relief of a 7 health condition, injury, or disease, as defined by a states 8 laws and regulations. 9 n. Model compact means the model for the physician 10 assistant licensure compact on file with the council of state 11 governments or other entity as designated by the commission. 12 o. Participating state means a state that has enacted this 13 compact. 14 p. Physician assistant means an individual who is 15 licensed as a physician assistant in a state. For purposes 16 of this compact, any other title or status adopted by a state 17 to replace the term physician assistant shall be deemed 18 synonymous with physician assistant and shall confer the 19 same rights and responsibilities to the licensee under the 20 provisions of this compact at the time of its enactment. 21 q. Physician assistant licensure compact commission , 22 compact commission , or commission means the national 23 administrative body created pursuant to subsection 7, paragraph 24 a , of this compact. 25 r. Qualifying license means an unrestricted license issued 26 by a participating state to provide medical services as a 27 physician assistant. 28 s. Remote state means a participating state where a 29 licensee who is not licensed as a physician assistant is 30 exercising or seeking to exercise the compact privilege. 31 t. Rule means a regulation promulgated by an entity that 32 has the force and effect of law. 33 u. Significant investigative information means 34 investigative information that a licensing board, after an 35 -3- LSB 1743HV (1) 91 ss/ko 3/ 30
H.F. 300 inquiry or investigation that includes notification and an 1 opportunity for the physician assistant to respond if required 2 by state law, has reason to believe is not groundless and, if 3 proven true, would indicate more than a minor infraction. 4 v. State means any state, commonwealth, district, or 5 territory of the United States. 6 3. State participation in this compact. 7 a. To participate in this compact, a participating state 8 shall do all of the following: 9 (1) License physician assistants. 10 (2) Participate in the compact commissions data system. 11 (3) Have a mechanism in place for receiving and 12 investigating complaints against licensees and license 13 applicants. 14 (4) Notify the commission, in compliance with the terms 15 of this compact and commission rules, of any adverse action 16 against a licensee or license applicant and the existence of 17 significant investigative information regarding a licensee or 18 license applicant. 19 (5) Fully implement a criminal background check 20 requirement, within a time frame established by commission 21 rule, by its licensing board receiving the results of a 22 criminal background check and reporting to the commission 23 whether the license applicant has been granted a license. 24 (6) Comply with the rules of the compact commission. 25 (7) Utilize passage of a recognized national exam such 26 as the NCCPA PANCE as a requirement for physician assistant 27 licensure. 28 (8) Grant the compact privilege to a holder of a qualifying 29 license in a participating state. 30 b. Nothing in this compact prohibits a participating state 31 from charging a fee for granting the compact privilege. 32 4. Compact privilege. 33 a. To exercise the compact privilege, a licensee must meet 34 all of the following requirements: 35 -4- LSB 1743HV (1) 91 ss/ko 4/ 30
H.F. 300 (1) Have graduated from a physician assistant program 1 accredited by the accreditation review commission on education 2 for the physician assistant, inc., or other programs authorized 3 by commission rule. 4 (2) Hold current NCCPA certification. 5 (3) Have no felony or misdemeanor conviction. 6 (4) Have never had a controlled substance license, permit, 7 or registration suspended or revoked by a state or by the 8 United States drug enforcement administration. 9 (5) Have a unique identifier as determined by commission 10 rule. 11 (6) Hold a qualifying license. 12 (7) Have had no revocation of a license or limitation or 13 restriction on any license currently held due to an adverse 14 action. 15 (8) If a licensee has had a limitation or restriction on 16 a license or compact privilege due to an adverse action, two 17 years must have elapsed from the date on which the license or 18 compact privilege is no longer limited or restricted due to the 19 adverse action. 20 (9) If a compact privilege has been revoked or is limited or 21 restricted in a participating state for conduct that would not 22 be a basis for disciplinary action in a participating state in 23 which the licensee is practicing or applying to practice under 24 a compact privilege, that participating state shall have the 25 discretion not to consider such action as an adverse action 26 requiring the denial or removal of a compact privilege in that 27 state. 28 (10) Notify the compact commission that the licensee is 29 seeking the compact privilege in a remote state. 30 (11) Meet any jurisprudence requirement of a remote state 31 in which the licensee is seeking to practice under the compact 32 privilege and pay any fees applicable to satisfying the 33 jurisprudence requirement. 34 (12) Report to the commission any adverse action taken by a 35 -5- LSB 1743HV (1) 91 ss/ko 5/ 30
H.F. 300 nonparticipating state within thirty days after the action is 1 taken. 2 b. The compact privilege is valid until the expiration or 3 revocation of the qualifying license unless terminated pursuant 4 to an adverse action. The licensee must also comply with all 5 of the requirements of paragraph a to maintain the compact 6 privilege in a remote state. If the participating state takes 7 adverse action against a qualifying license, the licensee shall 8 lose the compact privilege in any remote state in which the 9 licensee has a compact privilege until all of the following 10 occur: 11 (1) The licensee is no longer limited or restricted. 12 (2) Two years have elapsed from the date on which the 13 license is no longer limited or restricted due to the adverse 14 action. 15 c. Once a restricted or limited license satisfies the 16 requirements of paragraph b , subparagraphs (1) and (2), the 17 licensee must meet the requirements of paragraph a to obtain 18 a compact privilege in any remote state. 19 d. For each remote state in which a physician assistant 20 seeks authority to prescribe controlled substances, the 21 physician assistant shall satisfy all requirements imposed by 22 such state in granting or renewing such authority. 23 5. Designation of the state from which licensee is applying 24 for a compact privilege. Upon a licensees application for 25 a compact privilege, the licensee shall identify to the 26 commission the participating state from which the licensee is 27 applying, in accordance with applicable rules adopted by the 28 commission, and subject to the following requirements: 29 a. When applying for a compact privilege, the licensee 30 shall provide the commission with the address of the licensees 31 primary residence and thereafter shall immediately report to 32 the commission any change in the address of the licensees 33 primary residence. 34 b. When applying for a compact privilege, the licensee is 35 -6- LSB 1743HV (1) 91 ss/ko 6/ 30
H.F. 300 required to consent to accept service of process by mail at 1 the licensees primary residence on file with the commission 2 with respect to any action brought against the licensee by the 3 commission or a participating state, including a subpoena, with 4 respect to any action brought or investigation conducted by the 5 commission or a participating state. 6 6. Adverse actions. 7 a. A participating state in which a licensee is licensed 8 shall have exclusive power to impose adverse action against the 9 qualifying license issued by that participating state. 10 b. In addition to the other powers conferred by state law, 11 a remote state shall have the authority, in accordance with 12 existing state due process law, to do all of the following: 13 (1) Take adverse action against a physician assistants 14 compact privilege within that state to remove a licensees 15 compact privilege or take other action necessary under 16 applicable law to protect the health and safety of its 17 citizens. 18 (2) Issue subpoenas for both hearings and investigations 19 that require the attendance and testimony of witnesses as 20 well as the production of evidence. Subpoenas issued by a 21 licensing board in a participating state for the attendance 22 and testimony of witnesses or the production of evidence from 23 another participating state shall be enforced in the latter 24 state by any court of competent jurisdiction, according to the 25 practice and procedure of that court applicable to subpoenas 26 issued in proceedings pending before it. The issuing authority 27 shall pay any witness fees, travel expenses, mileage and other 28 fees required by the service statutes of the state in which the 29 witnesses or evidence are located. 30 (3) Notwithstanding subparagraph (2), subpoenas may not be 31 issued by a participating state to gather evidence of conduct 32 in another state that is lawful in that other state for the 33 purpose of taking adverse action against a licensees compact 34 privilege or application for a compact privilege in that 35 -7- LSB 1743HV (1) 91 ss/ko 7/ 30
H.F. 300 participating state. 1 (4) Nothing in this compact authorizes a participating 2 state to impose discipline against a physician assistants 3 compact privilege or to deny an application for a compact 4 privilege in that participating state for the individuals 5 otherwise lawful practice in another state. 6 c. For purposes of taking adverse action, the participating 7 state which issued the qualifying license shall give the same 8 priority and effect to reported conduct received from any other 9 participating state as it would if the conduct had occurred 10 within the participating state which issued the qualifying 11 license. In so doing, that participating state shall apply its 12 own state laws to determine appropriate action. 13 d. A participating state, if otherwise permitted by state 14 law, may recover from the affected physician assistant the 15 costs of investigations and disposition of cases resulting from 16 any adverse action taken against that physician assistant. 17 e. A participating state may take adverse action based 18 on the factual findings of a remote state, provided that the 19 participating state follows its own procedures for taking the 20 adverse action. 21 f. Joint investigations. 22 (1) In addition to the authority granted to a participating 23 state by its respective state physician assistant laws and 24 regulations or other applicable state law, any participating 25 state may participate with other participating states in joint 26 investigations of licensees. 27 (2) Participating states shall share any investigative, 28 litigation, or compliance materials in furtherance of any joint 29 or individual investigation initiated under this compact. 30 g. If an adverse action is taken against a physician 31 assistants qualifying license, the physician assistants 32 compact privilege in all remote states shall be deactivated 33 until two years have elapsed after all restrictions have been 34 removed from the state license. All disciplinary orders by the 35 -8- LSB 1743HV (1) 91 ss/ko 8/ 30
H.F. 300 participating state which issued the qualifying license that 1 impose adverse action against a physician assistants license 2 shall include a statement that the physician assistants 3 compact privilege is deactivated in all participating states 4 during the pendency of the order. 5 h. If any participating state takes adverse action, it shall 6 promptly notify the administrator of the data system. 7 7. Establishment of the physician assistant licensure compact 8 commission. 9 a. The participating states hereby create and establish a 10 joint government agency and national administrative body known 11 as the physician assistant licensure compact commission. The 12 commission is an instrumentality of the compact states acting 13 jointly and not an instrumentality of any one state. The 14 commission shall come into existence on or after the effective 15 date of the compact as set forth in subsection 11, paragraph 16 a . 17 b. Membership, voting, and meetings. 18 (1) Each participating state shall have and be limited to 19 one delegate selected by that participating states licensing 20 board or, if the state has more than one licensing board, 21 selected collectively by the participating states licensing 22 boards. 23 (2) The delegate shall be one of the following: 24 (a) A current physician assistant, physician, or public 25 member of a licensing board or physician assistant council or 26 committee. 27 (b) An administrator of a licensing board. 28 (3) Any delegate may be removed or suspended from office as 29 provided by the laws of the state from which the delegate is 30 appointed. 31 (4) The participating state licensing board shall fill any 32 vacancy occurring in the commission within sixty days. 33 (5) Each delegate shall be entitled to one vote on all 34 matters voted on by the commission and shall otherwise have an 35 -9- LSB 1743HV (1) 91 ss/ko 9/ 30
H.F. 300 opportunity to participate in the business and affairs of the 1 commission. A delegate shall vote in person or by such other 2 means as provided in the bylaws. The bylaws may provide for 3 delegates participation in meetings by telecommunications, 4 video conference, or other means of communication. 5 (6) The commission shall meet at least once during each 6 calendar year. Additional meetings shall be held as set forth 7 in this compact and the bylaws. 8 (7) The commission shall establish by rule a term of office 9 for delegates. 10 c. The commission shall have the following powers and 11 duties: 12 (1) Establish a code of ethics for the commission. 13 (2) Establish the fiscal year of the commission. 14 (3) Establish fees. 15 (4) Establish bylaws. 16 (5) Maintain its financial records in accordance with the 17 bylaws. 18 (6) Meet and take such actions as are consistent with the 19 provisions of this compact and the bylaws. 20 (7) Promulgate rules to facilitate and coordinate 21 implementation and administration of this compact. The rules 22 shall have the force and effect of law and shall be binding in 23 all participating states. 24 (8) Bring and prosecute legal proceedings or actions in the 25 name of the commission, provided that the standing of any state 26 licensing board to sue or be sued under applicable law shall 27 not be affected. 28 (9) Purchase and maintain insurance and bonds. 29 (10) Borrow, accept, or contract for services of personnel, 30 including but not limited to employees of a participating 31 state. 32 (11) Hire employees and engage contractors, elect or 33 appoint officers, fix compensation, define duties, grant such 34 individuals appropriate authority to carry out the purposes of 35 -10- LSB 1743HV (1) 91 ss/ko 10/ 30
H.F. 300 this compact, and establish the commissions personnel policies 1 and programs relating to conflicts of interest, qualifications 2 of personnel, and other related personnel matters. 3 (12) Accept any and all appropriate donations and grants 4 of money, equipment, supplies, materials, and services, and 5 receive, utilize, and dispose of the same; provided that at all 6 times the commission shall avoid any appearance of impropriety 7 or conflict of interest. 8 (13) Lease, purchase, accept appropriate gifts or donations 9 of, or otherwise own, hold, improve, or use any property, real, 10 personal, or mixed; provided that at all times the commission 11 shall avoid any appearance of impropriety. 12 (14) Sell, convey, mortgage, pledge, lease, exchange, 13 abandon, or otherwise dispose of any property, real, personal, 14 or mixed. 15 (15) Establish a budget and make expenditures. 16 (16) Borrow money. 17 (17) Appoint committees, including standing committees 18 composed of members, state regulators, state legislators or 19 their representatives, and consumer representatives, and such 20 other interested persons as may be designated in this compact 21 and the bylaws. 22 (18) Provide and receive information from, and cooperate 23 with, law enforcement agencies. 24 (19) Elect a chair, vice chair, secretary, and treasurer 25 and such other officers of the commission as provided in the 26 commissions bylaws. 27 (20) Reserve for itself, in addition to those reserved 28 exclusively to the commission under the compact, powers that 29 the executive committee may not exercise. 30 (21) Approve or disapprove a states participation in the 31 compact based upon its determination as to whether the states 32 compact legislation departs in a material manner from the model 33 compact language. 34 (22) Prepare and provide to the participating states an 35 -11- LSB 1743HV (1) 91 ss/ko 11/ 30
H.F. 300 annual report. 1 (23) Perform such other functions as may be necessary or 2 appropriate to achieve the purposes of this compact consistent 3 with the state regulation of physician assistant licensure and 4 practice. 5 d. Meetings of the commission. 6 (1) All meetings of the commission that are not closed 7 pursuant to this paragraph shall be open to the public. Notice 8 of public meetings shall be posted on the commissions internet 9 site at least thirty days prior to the public meeting. 10 (2) Notwithstanding subparagraph (1), the commission may 11 convene a public meeting by providing at least twenty-four 12 hours prior notice on the commissions internet site, and any 13 other means as provided in the commissions rules, for any of 14 the reasons it may dispense with notice of proposed rulemaking 15 under subsection 9, paragraph l . 16 (3) The commission may convene in a closed, nonpublic 17 meeting or nonpublic part of a public meeting to receive legal 18 advice or to discuss any of the following: 19 (a) Noncompliance of a participating state with its 20 obligations under this compact. 21 (b) The employment, compensation, discipline or other 22 matters, practices or procedures related to specific employees 23 or other matters related to the commissions internal personnel 24 practices and procedures. 25 (c) Current, threatened, or reasonably anticipated 26 litigation. 27 (d) Negotiation of contracts for the purchase, lease, or 28 sale of goods, services, or real estate. 29 (e) Accusing any person of a crime or formally censuring any 30 person. 31 (f) Disclosure of trade secrets or commercial or financial 32 information that is privileged or confidential. 33 (g) Disclosure of information of a personal nature where 34 disclosure would constitute a clearly unwarranted invasion of 35 -12- LSB 1743HV (1) 91 ss/ko 12/ 30
H.F. 300 personal privacy. 1 (h) Disclosure of investigative records compiled for law 2 enforcement purposes. 3 (i) Disclosure of information related to any investigative 4 reports prepared by or on behalf of or for use of the 5 commission or other committee charged with responsibility of 6 investigation or determination of compliance issues pursuant to 7 this compact. 8 (j) Legal advice. 9 (k) Matters specifically exempted from disclosure by 10 federal or participating states statutes. 11 (4) If a meeting, or portion of a meeting, is closed 12 pursuant to this provision, the chair of the meeting or the 13 chairs designee shall certify that the meeting or portion of 14 the meeting may be closed and shall reference each relevant 15 exempting provision. 16 (5) The commission shall keep minutes that fully and clearly 17 describe all matters discussed in a meeting and shall provide 18 a full and accurate summary of actions taken, including a 19 description of the views expressed. All documents considered 20 in connection with an action shall be identified in such 21 minutes. All minutes and documents of a closed meeting shall 22 remain under seal, subject to release by a majority vote of the 23 commission or order of a court of competent jurisdiction. 24 e. Financing of the commission. 25 (1) The commission shall pay, or provide for the payment of, 26 the reasonable expenses of its establishment, organization, and 27 ongoing activities. 28 (2) The commission may accept any and all appropriate 29 revenue sources, donations, and grants of money, equipment, 30 supplies, materials, and services. 31 (3) The commission may levy on and collect an annual 32 assessment from each participating state and may impose 33 compact privilege fees on licensees of participating states 34 to whom a compact privilege is granted to cover the cost of 35 -13- LSB 1743HV (1) 91 ss/ko 13/ 30
H.F. 300 the operations and activities of the commission and its staff, 1 which must be in a total amount sufficient to cover its annual 2 budget as approved by the commission each year for which 3 revenue is not provided by other sources. The aggregate annual 4 assessment amount levied on participating states shall be 5 allocated based upon a formula to be determined by commission 6 rule. 7 (a) A compact privilege expires when the licensees 8 qualifying license in the participating state from which the 9 licensee applied for the compact privilege expires. 10 (b) If the licensee terminates the qualifying license 11 through which the licensee applied for the compact privilege 12 before its scheduled expiration, and the licensee has a 13 qualifying license in another participating state, the licensee 14 shall inform the commission that it is changing to that 15 participating state the participating state through which it 16 applies for a compact privilege and pay to the commission any 17 compact privilege fee required by commission rule. 18 (4) The commission shall not incur obligations of any 19 kind prior to securing the funds adequate to meet the same; 20 nor shall the commission pledge the credit of any of the 21 participating states, except by and with the authority of the 22 participating state. 23 (5) The commission shall keep accurate accounts of all 24 receipts and disbursements. The receipts and disbursements 25 of the commission shall be subject to the financial review 26 and accounting procedures established under its bylaws. All 27 receipts and disbursements of funds handled by the commission 28 shall be subject to an annual financial review by a certified 29 or licensed public accountant, and the report of the financial 30 review shall be included in and become part of the annual 31 report of the commission. 32 f. The executive committee. 33 (1) The executive committee shall have the power to act on 34 behalf of the commission according to the terms of this compact 35 -14- LSB 1743HV (1) 91 ss/ko 14/ 30
H.F. 300 and commission rules. 1 (2) The executive committee shall be composed of nine 2 members: 3 (a) Seven voting members who are elected by the commission 4 from the current membership of the commission. 5 (b) One ex officio, nonvoting member from a recognized 6 national physician assistant professional association. 7 (c) One ex officio, nonvoting member from a recognized 8 national physician assistant certification organization. 9 (3) The ex officio members will be selected by their 10 respective organizations. 11 (4) The commission may remove any member of the executive 12 committee as provided in its bylaws. 13 (5) The executive committee shall meet at least annually. 14 (6) The executive committee shall have the following duties 15 and responsibilities: 16 (a) Recommend to the commission changes to the commissions 17 rules or bylaws, changes to this compact legislation, fees to 18 be paid by compact participating states such as annual dues, 19 and any commission compact fee charged to licensees for the 20 compact privilege. 21 (b) Ensure compact administration services are 22 appropriately provided, contractual or otherwise. 23 (c) Prepare and recommend the budget. 24 (d) Maintain financial records on behalf of the commission. 25 (e) Monitor compact compliance of participating states and 26 provide compliance reports to the commission. 27 (f) Establish additional committees as necessary. 28 (g) Exercise the powers and duties of the commission during 29 the interim between commission meetings, except for issuing 30 proposed rulemaking or adopting commission rules or bylaws, or 31 exercising any other powers and duties exclusively reserved to 32 the commission by the commissions rules. 33 (h) Perform other duties as provided in the commissions 34 rules or bylaws. 35 -15- LSB 1743HV (1) 91 ss/ko 15/ 30
H.F. 300 (7) All meetings of the executive committee at which it 1 votes or plans to vote on matters in exercising the powers and 2 duties of the commission shall be open to the public and public 3 notice of such meetings shall be given as public meetings of 4 the commission are given. 5 (8) The executive committee may convene in a closed, 6 nonpublic meeting for the same reasons that the commission may 7 convene in a nonpublic meeting as set forth in subsection 7, 8 paragraph d , subparagraph (3), and shall announce the closed 9 meeting as the commission is required to under subsection 7, 10 paragraph d , subparagraph (4), and keep minutes of the closed 11 meeting as the commission is required to under subsection 7, 12 paragraph d , subparagraph (5). 13 g. Qualified immunity, defense, and indemnification. 14 (1) The members, officers, executive director, employees, 15 and representatives of the commission shall be immune from 16 suit and liability, both personally and in their official 17 capacities, for any claim for damage to or loss of property or 18 personal injury or other civil liability caused by or arising 19 out of any actual or alleged act, error, or omission that 20 occurred, or that the person against whom the claim is made had 21 a reasonable basis for believing occurred, within the scope of 22 commission employment, duties, or responsibilities; provided 23 that nothing in this subparagraph shall be construed to protect 24 any such person from suit or liability for any damage, loss, 25 injury, or liability caused by the intentional or willful or 26 wanton misconduct of that person. The procurement of insurance 27 of any type by the commission shall not in any way compromise 28 or limit the immunity granted hereunder. 29 (2) The commission shall defend any member, officer, 30 executive director, employee, and representative of the 31 commission in any civil action seeking to impose liability 32 arising out of any actual or alleged act, error, or omission 33 that occurred within the scope of commission employment, 34 duties, or responsibilities, or as determined by the commission 35 -16- LSB 1743HV (1) 91 ss/ko 16/ 30
H.F. 300 that the person against whom the claim is made had a reasonable 1 basis for believing occurred within the scope of commission 2 employment, duties, or responsibilities; provided that nothing 3 in this subparagraph shall be construed to prohibit that 4 person from retaining counsel at the persons own expense; 5 and provided further, that the actual or alleged act, error, 6 or omission did not result from that persons intentional or 7 willful or wanton misconduct. 8 (3) The commission shall indemnify and hold harmless 9 any member, officer, executive director, employee, and 10 representative of the commission for the amount of any 11 settlement or judgment obtained against that person arising 12 out of any actual or alleged act, error, or omission that 13 occurred within the scope of commission employment, duties, 14 or responsibilities, or that such person had a reasonable 15 basis for believing occurred within the scope of commission 16 employment, duties, or responsibilities, provided that the 17 actual or alleged act, error, or omission did not result from 18 the intentional or willful or wanton misconduct of that person. 19 (4) Venue is proper and judicial proceedings by or against 20 the commission shall be brought solely and exclusively in a 21 court of competent jurisdiction where the principal office of 22 the commission is located. The commission may waive venue and 23 jurisdictional defenses in any proceedings as authorized by 24 commission rules. 25 (5) Nothing herein shall be construed as a limitation on 26 the liability of any licensee for professional malpractice 27 or misconduct, which shall be governed solely by any other 28 applicable state laws. 29 (6) Nothing herein shall be construed to designate the 30 venue or jurisdiction to bring actions for alleged acts of 31 malpractice, professional misconduct, negligence, or other 32 such civil action pertaining to the practice of a physician 33 assistant. All such matters shall be determined exclusively by 34 state law other than this compact. 35 -17- LSB 1743HV (1) 91 ss/ko 17/ 30
H.F. 300 (7) Nothing in this compact shall be interpreted to waive 1 or otherwise abrogate a participating states state action 2 immunity or state action affirmative defense with respect to 3 antitrust claims under the Sherman Act, Clayton Act, or any 4 other state or federal antitrust or anticompetitive law or 5 regulation. 6 (8) Nothing in this compact shall be construed to be a 7 waiver of sovereign immunity by the participating states or by 8 the commission. 9 8. Data system. 10 a. The commission shall provide for the development, 11 maintenance, operation, and utilization of a coordinated data 12 and reporting system containing licensure, adverse action, and 13 the reporting of the existence of significant investigative 14 information on all licensed physician assistants and applicants 15 denied a license in participating states. 16 b. Notwithstanding any other state law to the contrary, 17 a participating state shall submit a uniform data set to the 18 data system on all physician assistants to whom this compact is 19 applicable, utilizing a unique identifier, as required by the 20 rules of the commission, including: 21 (1) Identifying information. 22 (2) Licensure data. 23 (3) Adverse actions against a license or compact privilege. 24 (4) Any denial of application for licensure, and the reason 25 for such denial, excluding the reporting of any criminal 26 history record information where prohibited by law. 27 (5) The existence of significant investigative information. 28 (6) Other information that may facilitate the 29 administration of this compact, as determined by the rules of 30 the commission. 31 c. Significant investigative information pertaining to a 32 licensee in any participating state shall only be available to 33 other participating states. 34 d. The commission shall promptly notify all participating 35 -18- LSB 1743HV (1) 91 ss/ko 18/ 30
H.F. 300 states of any adverse action taken against a licensee or an 1 individual applying for a license that has been reported to it. 2 This adverse action information shall be available to any other 3 participating state. 4 e. Participating states contributing information to the data 5 system may, in accordance with state or federal law, designate 6 information that may not be shared with the public without the 7 express permission of the contributing state. Notwithstanding 8 any such designation, such information shall be reported to the 9 commission through the data system. 10 f. Any information submitted to the data system that is 11 subsequently expunged pursuant to federal law or the laws of 12 the participating state contributing the information shall be 13 removed from the data system upon reporting of such by the 14 participating state to the commission. 15 g. The records and information provided to a participating 16 state pursuant to this compact or through the data system, 17 when certified by the commission or an agent thereof, 18 shall constitute the authenticated business records of the 19 commission, and shall be entitled to any associated hearsay 20 exception in any relevant judicial, quasi-judicial, or 21 administrative proceedings in a participating state. 22 9. Rulemaking. 23 a. The commission shall exercise its rulemaking powers 24 pursuant to the criteria set forth in this subsection and 25 the rules adopted thereunder. Commission rules shall become 26 binding as of the date specified by the commission for each 27 rule. 28 b. The commission shall promulgate reasonable rules in order 29 to effectively and efficiently implement and administer this 30 compact and achieve its purposes. A commission rule shall 31 be invalid and not have force or effect only if a court of 32 competent jurisdiction holds that the rule is invalid because 33 the commission exercised its rulemaking authority in a manner 34 that is beyond the scope of the purposes of this compact, or 35 -19- LSB 1743HV (1) 91 ss/ko 19/ 30
H.F. 300 the powers granted in this subsection, or based upon another 1 applicable standard of review. 2 c. The rules of the commission shall have the force of 3 law in each participating state, provided however that where 4 the rules of the commission conflict with the laws of the 5 participating state that establish the medical services a 6 physician assistant may perform in the participating state, as 7 held by a court of competent jurisdiction, the rules of the 8 commission shall be ineffective in that state to the extent of 9 the conflict. 10 d. If a majority of the legislatures of the participating 11 states rejects a commission rule by enactment of a statute or 12 resolution in the same manner used to adopt this compact within 13 four years of the date of adoption of the rule, then such rule 14 shall have no further force and effect in any participating 15 state or to any state applying to participate in the compact. 16 e. Commission rules shall be adopted at a regular or special 17 meeting of the commission. 18 f. Prior to promulgation and adoption of a final rule or 19 rules by the commission, and at least thirty days in advance 20 of the meeting at which the rule will be considered and voted 21 upon, the commission shall file a notice of proposed rulemaking 22 using all of the following methods: 23 (1) On the internet site of the commission or other publicly 24 accessible platform. 25 (2) To persons who have requested notice of the commissions 26 notices of proposed rulemaking. 27 (3) In such other ways as the commission may by rule 28 specify. 29 g. The notice of proposed rulemaking shall include all of 30 the following: 31 (1) The time, date, and location of the public hearing on 32 the proposed rule and the proposed time, date, and location of 33 the meeting in which the proposed rule will be considered and 34 voted upon. 35 -20- LSB 1743HV (1) 91 ss/ko 20/ 30
H.F. 300 (2) The text of the proposed rule and the reason for the 1 proposed rule. 2 (3) A request for comments on the proposed rule from any 3 interested person and the date by which written comments must 4 be received. 5 (4) The manner in which interested persons may submit notice 6 to the commission of their intention to attend the public 7 hearing or provide any written comments. 8 h. Prior to adoption of a proposed rule, the commission 9 shall allow persons to submit written data, facts, opinions, 10 and arguments, which shall be made available to the public. 11 i. If the hearing is to be held via electronic means, 12 the commission shall publish the mechanism for access to the 13 electronic hearing. 14 (1) All persons wishing to be heard at the hearing shall as 15 directed in the notice of proposed rulemaking, not less than 16 five business days before the scheduled date of the hearing, 17 notify the commission of their desire to appear and testify at 18 the hearing. 19 (2) Hearings shall be conducted in a manner providing each 20 person who wishes to comment a fair and reasonable opportunity 21 to comment orally or in writing. 22 (3) All hearings shall be recorded. A copy of the recording 23 and the written comments, data, facts, opinions, and arguments 24 received in response to the proposed rulemaking shall be made 25 available to a person upon request. 26 (4) Nothing in this paragraph shall be construed as 27 requiring a separate hearing on each proposed rule. Proposed 28 rules may be grouped for the convenience of the commission at 29 hearings required by this section. 30 j. Following the public hearing the commission shall 31 consider all written and oral comments timely received. 32 k. The commission shall, by majority vote of all delegates, 33 take final action on the proposed rule and shall determine the 34 effective date of the rule, if adopted, based on the rulemaking 35 -21- LSB 1743HV (1) 91 ss/ko 21/ 30
H.F. 300 record and the full text of the rule. 1 (1) If adopted, the rule shall be posted on the commissions 2 internet site. 3 (2) The commission may adopt changes to the proposed rule 4 provided the changes do not enlarge the original purpose of the 5 proposed rule. 6 (3) The commission shall provide on its internet site an 7 explanation of the reasons for substantive changes made to the 8 proposed rule as well as reasons for substantive changes not 9 made that were recommended by commenters. 10 (4) The commission shall determine a reasonable effective 11 date for the rule. Except for an emergency as provided in 12 paragraph l , the effective date of the rule shall be no sooner 13 than thirty days after the commission issued the notice that it 14 adopted the rule. 15 l. Upon determination that an emergency exists, the 16 commission may consider and adopt an emergency rule with 17 twenty-four hours prior notice, without the opportunity 18 for comment, or hearing, provided that the usual rulemaking 19 procedures provided in this compact and in this subsection 20 shall be retroactively applied to the rule as soon as 21 reasonably possible, in no event later than ninety days after 22 the effective date of the rule. For the purposes of this 23 paragraph, an emergency rule is one that must be adopted 24 immediately by the commission in order to do any of the 25 following: 26 (1) Meet an imminent threat to public health, safety, or 27 welfare. 28 (2) Prevent a loss of commission or participating state 29 funds. 30 (3) Meet a deadline for the promulgation of a commission 31 rule that is established by federal law or rule. 32 (4) Protect public health and safety. 33 m. The commission or an authorized committee of the 34 commission may direct revisions to a previously adopted 35 -22- LSB 1743HV (1) 91 ss/ko 22/ 30
H.F. 300 commission rule for purposes of correcting typographical 1 errors, errors in format, errors in consistency, or grammatical 2 errors. Public notice of any revisions shall be posted on 3 the internet site of the commission. The revision shall be 4 subject to challenge by any person for a period of thirty days 5 after posting. The revision may be challenged only on grounds 6 that the revision results in a material change to a rule. A 7 challenge shall be made as set forth in the notice of revisions 8 and delivered to the commission prior to the end of the notice 9 period. If no challenge is made, the revision will take 10 effect without further action. If the revision is challenged, 11 the revision may not take effect without the approval of the 12 commission. 13 n. No participating states rulemaking requirements shall 14 apply under this compact. 15 10. Oversight, dispute resolution, and enforcement. 16 a. Oversight. 17 (1) The executive and judicial branches of state government 18 in each participating state shall enforce this compact and take 19 all actions necessary and appropriate to implement the compact. 20 (2) Venue is proper and judicial proceedings by or against 21 the commission shall be brought solely and exclusively in a 22 court of competent jurisdiction where the principal office of 23 the commission is located. The commission may waive venue and 24 jurisdictional defenses to the extent it adopts or consents 25 to participate in alternative dispute resolution proceedings. 26 Nothing herein shall affect or limit the selection or propriety 27 of venue in any action against a licensee for professional 28 malpractice, misconduct or any such similar matter. 29 (3) The commission shall be entitled to receive service 30 of process in any proceeding regarding the enforcement or 31 interpretation of the compact or the commissions rules and 32 shall have standing to intervene in such a proceeding for all 33 purposes. Failure to provide the commission with service of 34 process shall render a judgment or order in such proceeding 35 -23- LSB 1743HV (1) 91 ss/ko 23/ 30
H.F. 300 void as to the commission, this compact, or commission rules. 1 b. Default, technical assistance, and termination. 2 (1) If the commission determines that a participating 3 state has defaulted in the performance of its obligations 4 or responsibilities under this compact or the commission 5 rules, the commission shall provide written notice to the 6 defaulting state and other participating states. The notice 7 shall describe the default, the proposed means of curing the 8 default, and any other action that the commission may take and 9 shall offer remedial training and specific technical assistance 10 regarding the default. 11 (2) If a state in default fails to cure the default, the 12 defaulting state may be terminated from this compact upon 13 an affirmative vote of a majority of the delegates of the 14 participating states, and all rights, privileges, and benefits 15 conferred by this compact upon such state may be terminated on 16 the effective date of termination. A cure of the default does 17 not relieve the offending state of obligations or liabilities 18 incurred during the period of default. 19 (3) Termination of participation in this compact shall be 20 imposed only after all other means of securing compliance have 21 been exhausted. Notice of intent to suspend or terminate shall 22 be given by the commission to the governor, the majority and 23 minority leaders of the defaulting states legislature, and to 24 the licensing boards of each of the participating states. 25 (4) A state that has been terminated is responsible for 26 all assessments, obligations, and liabilities incurred through 27 the effective date of termination, including obligations that 28 extend beyond the effective date of termination. 29 (5) The commission shall not bear any costs related 30 to a state that is found to be in default or that has been 31 terminated from this compact, unless agreed upon in writing 32 between the commission and the defaulting state. 33 (6) The defaulting state may appeal its termination from 34 the compact by the commission by petitioning the United States 35 -24- LSB 1743HV (1) 91 ss/ko 24/ 30
H.F. 300 district court for the District of Columbia or the federal 1 district where the commission has its principal offices. 2 The prevailing member shall be awarded all costs of such 3 litigation, including reasonable attorney fees. 4 (7) Upon the termination of a states participation in the 5 compact, the state shall immediately provide notice to all 6 licensees within that state of such termination. 7 (a) Licensees who have been granted a compact privilege in 8 that state shall retain the compact privilege for one hundred 9 eighty days following the effective date of such termination. 10 (b) Licensees who are licensed in that state who have been 11 granted a compact privilege in a participating state shall 12 retain the compact privilege for one hundred eighty days unless 13 the licensee also has a qualifying license in a participating 14 state or obtains a qualifying license in a participating state 15 before the one-hundred-eighty-day period ends, in which case 16 the compact privilege shall continue. 17 c. Dispute resolution. 18 (1) Upon request by a participating state, the commission 19 shall attempt to resolve disputes related to this compact that 20 arise among participating states and between participating and 21 nonparticipating states. 22 (2) The commission shall promulgate a rule providing for 23 both mediation and binding dispute resolution for disputes as 24 appropriate. 25 d. Enforcement. 26 (1) The commission, in the reasonable exercise of its 27 discretion, shall enforce the provisions of this compact and 28 rules of the commission. 29 (2) If compliance is not secured after all means to 30 secure compliance have been exhausted, by majority vote, the 31 commission may initiate legal action in the United States 32 district court for the District of Columbia or the federal 33 district where the commission has its principal offices, 34 against a participating state in default to enforce compliance 35 -25- LSB 1743HV (1) 91 ss/ko 25/ 30
H.F. 300 with the provisions of this compact and the commissions 1 promulgated rules and bylaws. The relief sought may include 2 both injunctive relief and damages. In the event judicial 3 enforcement is necessary, the prevailing party shall be awarded 4 all costs of such litigation, including reasonable attorney 5 fees. 6 (3) The remedies in subparagraph (2) shall not be the 7 exclusive remedies of the commission. The commission may 8 pursue any other remedies available under federal or state law. 9 e. Legal action against the commission. 10 (1) A participating state may initiate legal action 11 against the commission in the United States district court for 12 the District of Columbia or the federal district where the 13 commission has its principal offices to enforce compliance with 14 the provisions of the compact and its rules. The relief sought 15 may include both injunctive relief and damages. In the event 16 judicial enforcement is necessary, the prevailing party shall 17 be awarded all costs of such litigation, including reasonable 18 attorney fees. 19 (2) No person other than a participating state shall enforce 20 this compact against the commission. 21 11. Date of implementation of the physician assistant 22 licensure compact commission. 23 a. This compact shall come into effect on the date on 24 which this compact statute is enacted into law in the seventh 25 participating state. 26 (1) On or after the effective date of the compact, the 27 commission shall convene and review the enactment of each of 28 the states that enacted the compact prior to the commission 29 convening, the charter participating states, to determine if 30 the statute enacted by each such charter participating state is 31 materially different than the model compact. 32 (a) A charter participating state whose enactment is found 33 to be materially different from the model compact shall be 34 entitled to the default process set forth in subsection 10, 35 -26- LSB 1743HV (1) 91 ss/ko 26/ 30
H.F. 300 paragraph b . 1 (b) If any participating state later withdraws from the 2 compact or its participation is terminated, the commission 3 shall remain in existence and the compact shall remain in 4 effect even if the number of participating states should be 5 less than seven. Participating states enacting the compact 6 subsequent to the commission convening shall be subject to the 7 process set forth in subsection 7, paragraph c , subparagraph 8 (21), to determine if their enactments are materially 9 different from the model compact and whether they qualify for 10 participation in the compact. 11 (2) Participating states enacting the compact subsequent 12 to the seven initial charter participating states shall be 13 subject to the process set forth in subsection 7, paragraph 14 c , subparagraph (21), to determine if their enactments are 15 materially different from the model compact and whether they 16 qualify for participation in the compact. 17 (3) All actions taken for the benefit of the commission 18 or in furtherance of the purposes of the administration of 19 the compact prior to the effective date of the compact or the 20 commission coming into existence shall be considered to be 21 actions of the commission unless specifically repudiated by the 22 commission. 23 b. Any state that joins this compact shall be subject to 24 the commissions rules and bylaws as they exist on the date on 25 which this compact becomes law in that state. Any rule that 26 has been previously adopted by the commission shall have the 27 full force and effect of law on the day this compact becomes 28 law in that state. 29 c. Any participating state may withdraw from this compact by 30 enacting a statute repealing the same. 31 (1) A participating states withdrawal shall not take 32 effect until one hundred eighty days after enactment of the 33 repealing statute. During this one-hundred-eighty-day period, 34 all compact privileges that were in effect in the withdrawing 35 -27- LSB 1743HV (1) 91 ss/ko 27/ 30
H.F. 300 state and were granted to licensees licensed in the withdrawing 1 state shall remain in effect. If any licensee licensed in the 2 withdrawing state is also licensed in another participating 3 state or obtains a license in another participating state 4 within the one hundred eighty days, the licensees compact 5 privileges in other participating states shall not be affected 6 by the passage of the one hundred eighty days. 7 (2) Withdrawal shall not affect the continuing requirement 8 of the state licensing board of the withdrawing state to 9 comply with the investigative, and adverse action reporting 10 requirements of this compact prior to the effective date of 11 withdrawal. 12 (3) Upon the enactment of a statute withdrawing a state 13 from this compact, the state shall immediately provide notice 14 of such withdrawal to all licensees within that state. Such 15 withdrawing state shall continue to recognize all licenses 16 granted pursuant to this compact for a minimum of one hundred 17 eighty days after the date of such notice of withdrawal. 18 d. Nothing contained in this compact shall be construed 19 to invalidate or prevent any physician assistant licensure 20 agreement or other cooperative arrangement between 21 participating states and between a participating state 22 and nonparticipating state that does not conflict with the 23 provisions of this compact. 24 e. This compact may be amended by the participating states. 25 No amendment to this compact shall become effective and binding 26 upon any participating state until it is enacted materially in 27 the same manner into the laws of all participating states as 28 determined by the commission. 29 12. Construction and severability. 30 a. This compact and the commissions rulemaking authority 31 shall be liberally construed so as to effectuate the purposes 32 and the implementation and administration of the compact. 33 Provisions of the compact expressly authorizing or requiring 34 the promulgation of rules shall not be construed to limit the 35 -28- LSB 1743HV (1) 91 ss/ko 28/ 30
H.F. 300 commissions rulemaking authority solely for those purposes. 1 b. The provisions of this compact shall be severable and 2 if any phrase, clause, sentence, or provision of this compact 3 is held by a court of competent jurisdiction to be contrary to 4 the constitution of any participating state, a state seeking 5 participation in the compact, or of the United States, or 6 the applicability thereof to any government, agency, person 7 or circumstance is held to be unconstitutional by a court of 8 competent jurisdiction, the validity of the remainder of this 9 compact and the applicability thereof to any other government, 10 agency, person or circumstance shall not be affected thereby. 11 c. Notwithstanding paragraph b or this subsection 12, the 12 commission may deny a states participation in the compact or, 13 in accordance with the requirements of subsection 10, paragraph 14 b , terminate a participating states participation in the 15 compact, if it determines that a constitutional requirement of 16 a participating state is, or would be with respect to a state 17 seeking to participate in the compact, a material departure 18 from the compact. Otherwise, if this compact shall be held to 19 be contrary to the constitution of any participating state, 20 the compact shall remain in full force and effect as to the 21 remaining participating states and in full force and effect 22 as to the participating state affected as to all severable 23 matters. 24 13. Binding effect of compact. 25 a. Nothing in this compact prevents the enforcement of any 26 other law of a participating state that is not inconsistent 27 with this compact. 28 b. Any laws in a participating state in conflict with this 29 compact are superseded to the extent of the conflict. 30 c. All agreements between the commission and the 31 participating states are binding in accordance with their 32 terms. 33 EXPLANATION 34 The inclusion of this explanation does not constitute agreement with 35 -29- LSB 1743HV (1) 91 ss/ko 29/ 30
H.F. 300 the explanations substance by the members of the general assembly. 1 This bill establishes the physician assistant licensure 2 compact. 3 The compact establishes a system whereby a physician 4 assistant licensed to practice in one participating state 5 may practice in another participating state under a compact 6 privilege without applying for a license in that state. The 7 compact imposes certain minimum requirements on the licensure 8 of physician assistants in participating states. 9 The compact creates a commission to administer the operation 10 of the compact. The commission is an instrumentality of the 11 participating states. The compact includes provisions relating 12 to the establishment and membership of the commission; powers 13 of the commission; meetings and voting requirements of the 14 commission; commission bylaws and rules; commission committees; 15 commission finances; the establishment of a data system; 16 compacting state compliance; venue for judicial proceedings; 17 defense and indemnification; effective dates and amendments to 18 the compact; withdrawal, default, and expulsion; severability 19 and construction; and the binding effect of the compact and 20 other laws. 21 The compact becomes effective upon the adoption of the 22 compact by the seventh participating state. 23 -30- LSB 1743HV (1) 91 ss/ko 30/ 30