Kansas 2025-2026 Regular Session

Kansas Senate Bill SB126 Compare Versions

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1		-	House Substitute for SENATE BILL No. 126
2		-	AN ACT concerning health and healthcare; relating to the Kansas department of health and
3		-	environment; establishing an advance universal newborn screening program;
4		-	providing for the reimbursement of certain treatment services; authorizing the
5		-	secretary of health and environment to specify conditions included in newborn
6		-	screenings; extending the transfer of moneys to the Kansas newborn screening fund;
7		-	increasing state financial assistance to local health departments under certain
8		-	circumstances; increasing the annual assessment on services rate on inpatient and
9		-	outpatient revenue and expanding exemptions for such assessment; amending K.S.A.
10		-	65-181, 65-183, 65-242 and 65-6210 and K.S.A. 2024 Supp. 65-180, 65-6208 and
11		-	65-6209 and repealing the existing sections.
	1	+	Session of 2025
	2	+	SENATE BILL No. 126
	3	+	By Committee on Public Health and Welfare
	4	+	1-30
	5	+	AN ACT concerning the healing arts; relating to physician assistants;
	6	+	enacting the physician assistant licensure compact to provide interstate
	7	+	practice privileges.
12	8		Be it enacted by the Legislature of the State of Kansas:
13		-	Section 1. K.S.A. 2024 Supp. 65-180 is hereby amended to read as
14		-	follows: 65-180. There is hereby established an advance universal
15		-	newborn screening program to be administered by the secretary of
16		-	health and environment. The secretary of health and environment shall:
17		-	(a) Institute and carry on an intensive educational program among
18		-	physicians, mid-level practitioners, as defined in K.S.A. 65-1626, and
19		-	amendments thereto, hospitals, public health nurses and the public
20		-	concerning congenital hypothyroidism, galactosemia, phenylketonuria
21		-	and other genetic diseases detectable with the same specimen
22		-	conditions identified by the secretary in accordance with subsection (i).
23		-	This educational program shall include information about the nature of
24		-	such conditions and examinations for the detection thereof in early
25		-	infancy in order that measures may be taken to prevent intellectual
26		-	disability, physical disability or morbidity resulting from such
27		-	conditions.
28		-	(b) Provide recognized screening tests for phenylketonuria,
29		-	galactosemia, hypothyroidism and such other diseases as may be
30		-	appropriately detected with the same specimen conditions identified by
31		-	the secretary in accordance with subsection (i). The initial laboratory
32		-	screening tests for these diseases shall be performed by the department
33		-	of health and environment or its designee for all infants born in the
34		-	state. Such services shall be performed without charge.
35		-	(c) Provide a follow-up program by providing test results and
36		-	other information to identified physicians or mid-level practitioners as
37		-	defined in K.S.A. 65-1626, and amendments thereto; locate infants with
38		-	abnormal newborn screening test results; with parental consent,
39		-	monitor infants to assure appropriate testing to either confirm or not
40		-	confirm the disease suggested by the screening test results; with
41		-	parental consent, monitor therapy and treatment for infants with
42		-	confirmed diagnosis of congenital hypothyroidism, galactosemia,
43		-	phenylketonuria or other genetic diseases being screened under this
44		-	statute; conditions identified by the secretary in accordance with
45		-	subsection (i) and establish ongoing education and support activities for
46		-	individuals with confirmed diagnosis of congenital hypothyroidism,
47		-	galactosemia, phenylketonuria and other genetic diseases being
48		-	screened under this statute and for the families of such individuals such
49		-	conditions.
50		-	(d) Maintain a registry of cases including information of
51		-	importance for the purpose of follow-up services to prevent intellectual
52		-	support early diagnosis, treatment and services for healthy
53		-	development and the prevention of disability or morbidity.
54		-	(e) Provide, within the limits of appropriations available therefor,
55		-	the necessary treatment product for diagnosed cases conditions
56		-	identified by the secretary in accordance with subsection (i) for as long
57		-	as medically indicated, when and the product is not available through
58		-	other state agencies. In addition to diagnosed cases under this section,
59		-	diagnosed cases of maple syrup urine disease shall be included as a
60		-	diagnosed case under this subsection. Where If the applicable income
61		-	of the person or persons who have legal responsibility for the
62		-	diagnosed individual meets medicaid eligibility, such individuals' House Substitute for SENATE BILL No. 126—page 2
63		-	individual's needs shall be covered under the medicaid state plan.
64		-	Where If the applicable income of the person or persons who have legal
65		-	responsibility for the diagnosed individual is not medicaid eligible, but
66		-	is below 300% of the federal poverty level established under the most
67		-	recent poverty guidelines issued by the United States department of
68		-	health and human services, the department of health and environment
69		-	shall provide reimbursement of between 50% to 100% of the product
70		-	cost in accordance with rules and regulations adopted by the secretary
71		-	of health and environment. Where If the applicable income of the
72		-	person or persons who have legal responsibility for the diagnosed
73		-	individual exceeds 300% of the federal poverty level established under
74		-	the most recent poverty guidelines issued by the United States
75		-	department of health and human services, the department of health and
76		-	environment shall provide reimbursement of an amount not to exceed
77		-	50% of the product cost in accordance with rules and regulations
78		-	adopted by the secretary of health and environment.
79		-	(f) Provide state assistance to an applicant pursuant to subsection
80		-	(e) only after it has been shown that the applicant has exhausted all
81		-	benefits from private third-party payers, medicare, medicaid and other
82		-	government assistance programs and after consideration of the
83		-	applicant's income and assets. The secretary of health and environment
84		-	shall adopt rules and regulations establishing standards for determining
85		-	eligibility for state assistance under this section.
86		-	(g) (1) Except for treatment products provided under subsection
87		-	(e), if the secretary of health and environment shall adopt rules and
88		-	regulations as needed to determine eligibility for reimbursement to
89		-	individuals for the purchase of medically necessary food treatment
90		-	product for diagnosed cases must be purchased, the purchaser shall be
91		-	reimbursed by the department of health and environment for costs
92		-	incurred up to $1,500 per year per diagnosed child age 18 or younger at
93		-	100% of the product cost upon submission of a receipt of purchase
94		-	identifying the company from which the product was purchased. For a
95		-	purchaser to be eligible for reimbursement under this subsection, the
96		-	applicable income of the person or persons who have legal
97		-	responsibility for the diagnosed child shall not exceed 300% of the
98		-	poverty level established under the most recent poverty guidelines
99		-	issued by the federal department of health and human services
100		-	conditions identified by the secretary in accordance with subsection (i).
101		-	(2) As an option to reimbursement authorized under subsection (g)
102		-	(1) paragraph (1), the department of health and environment may
103		-	purchase medically necessary food treatment products for distribution
104		-	to diagnosed children in an amount not to exceed $1,500 per year per
105		-	diagnosed child age 18 or younger. For a diagnosed child to be eligible
106		-	for the distribution of food treatment products under this subsection,
107		-	the applicable income of the person or persons who have legal
108		-	responsibility for the diagnosed child shall not exceed 300% of the
109		-	poverty level established under the most recent poverty guidelines
110		-	issued by the federal department of health and human services
111		-	individuals diagnosed with conditions identified by the secretary in
112		-	accordance with subsection (i).
113		-	(3) In addition to diagnosed cases under this section, diagnosed
114		-	cases of maple syrup urine disease shall be included as a diagnosed
115		-	case under this subsection.
116		-	(h) The department of health and environment shall continue to
117		-	receive orders for both medically necessary treatment products and
118		-	medically necessary food treatment products, purchase such products,
119		-	and shall deliver the such products to an address prescribed by the
120		-	diagnosed individual. The department of health and environment shall
121		-	bill the person or persons who have legal responsibility for the House Substitute for SENATE BILL No. 126—page 3
122		-	diagnosed patient individual for a pro-rata share of the total costs, in
123		-	accordance with the rules and regulations adopted pursuant to this
124		-	section.
125		-	(i) The secretary of health and environment shall adopt rules and
126		-	regulations as needed to require, to the extent of available funding,
127		-	newborn screening tests to screen for treatable disorders conditions.
128		-	The secretary shall determine and identify the conditions to be included
129		-	in the newborn screening tests, which may include, but not be limited
130		-	to, conditions listed in the core recommended uniform screening panel
131		-	of newborn screening conditions recommended in the 2005 report by
132		-	the American college of medical genetics entitled "Newborn Screening:
133		-	Toward a Uniform Screening Panel and System" issued by the United
134		-	States secretary of health and human services or another report
135		-	determined by the department of health and environment to provide
136		-	more appropriate newborn screening guidelines to protect the health
137		-	and welfare of newborns for treatable disorders conditions.
138		-	(j) In performing the duties under subsection (i), the secretary of
139		-	health and environment shall appoint an advisory council to advise the
140		-	department of health and environment on implementation of subsection
141		-	(i).
142		-	(k) The department of health and environment shall periodically
143		-	review the newborn screening program to determine the efficacy and
144		-	cost effectiveness of the program and determine whether adjustments to
145		-	the program are necessary to protect the health and welfare of
146		-	newborns and to maximize the number of newborn screenings that may
147		-	be conducted with the funding available for the screening program.
148		-	(l) There is hereby established in the state treasury the Kansas
149		-	newborn screening fund that, which shall be administered by the
150		-	secretary of health and environment. All expenditures from the fund
151		-	shall be for the newborn screening program. All expenditures from the
152		-	fund shall be made in accordance with appropriation acts upon warrants
153		-	of the director of accounts and reports issued pursuant to vouchers
154		-	approved by the secretary of health and environment or the secretary's
155		-	designee. On July 1 of each year, the director of accounts and reports
156		-	shall determine the amount credited to the medical assistance fee fund
157		-	pursuant to K.S.A. 40-3213, and amendments thereto, and shall transfer
158		-	the estimated portion of such amount that is necessary to fund the
159		-	newborn screening program for the ensuing fiscal year as certified by
160		-	the secretary of health and environment or the secretary's designee to
161		-	the Kansas newborn screening fund. Such amount shall not exceed
162		-	$5,000,000 in fiscal years 2024, 2025 and 2026.
163		-	Sec. 2. K.S.A. 65-181 is hereby amended to read as follows: 65-
164		-	181. (a) The administrative officer or other person in charge of each
165		-	institution or the attending physician or mid-level practitioner, caring
166		-	for infants 28 days of age or younger shall have administered to every
167		-	such infant or child in its or such institution's, mid-level practitioner's
168		-	or physician's care, tests for congenital hypothyroidism, galactosemia,
169		-	phenylketonuria and other genetic diseases which may be detected with
170		-	the same specimen conditions identified by the secretary of health and
171		-	environment under K.S.A. 65-180(i), and amendments thereto, in
172		-	accordance with rules and regulations adopted by the secretary of
173		-	health and environment.
174		-	(b) As used in this section, "mid-level practitioner" means the
175		-	same as defined in K.S.A. 65-1626, and amendments thereto.
176		-	Sec. 3. K.S.A. 65-183 is hereby amended to read as follows: 65-
177		-	183. (a) Every physician or mid-level practitioner having knowledge of
178		-	a case of congenital hypothyroidism, galactosemia or phenylketonuria
179		-	and other genetic diseases as may be detected with tests given pursuant
180		-	to this act a condition identified by the secretary of health and House Substitute for SENATE BILL No. 126—page 4
181		-	environment under K.S.A. 65-180(i), and amendments thereto, in one of
182		-	such physician's or mid-level practitioner's own patients shall report
183		-	the case to the secretary of health and environment on forms provided
184		-	by the secretary.
185		-	(b) As used in this section, "mid-level practitioner" means the
186		-	same as defined in K.S.A. 65-1626, and amendments thereto.
187		-	Sec. 4. K.S.A. 65-242 is hereby amended to read as follows: 65-
188		-	242. For the purpose of insuring ensuring that adequate public health
189		-	services are available to all inhabitants of the state of Kansas, the state
190		-	shall assist in the financing of the operation of local health departments.
191		-	Subject to appropriations therefor, state financial assistance shall be
192		-	distributed to local health departments as follows:
193		-	(a) First, each local health department shall, upon application
194		-	therefor, receive $7,000 $12,000. If sufficient funds are not available to
195		-	make this distribution, then the funds which that are available shall be
196		-	divided equally among those local health departments making
197		-	application therefor.
198		-	(b) Second, if any funds are available after the distribution
199		-	required in subsection (a), the secretary shall distribute such funds as
200		-	follows:
201		-	(1) A figure equal to the total amount of state financial assistance
202		-	available for distribution, before deduction for the distribution in
203		-	subsection (a), shall be determined.
204		-	(2) The figure determined in paragraph (1) of this subsection shall
205		-	be allocated to local health departments making application for
206		-	assistance based on the proportion that the population of the county or
207		-	counties comprising the local health department applying for such
208		-	assistance bears to the total population of all counties comprising local
209		-	health departments which that have applied for such financial
210		-	assistance.
211		-	(3) If any local health department making application for
212		-	assistance would receive receives an amount equal to or less than
213		-	$7,000 $12,000 using the formula in paragraph (2) of this subsection,
214		-	then such department shall be paid in accordance with subsection (a)
215		-	only. If any local health department making application for assistance
216		-	would receive receives more than $7,000 $12,000 using the formula in
217		-	paragraph (2) of this subsection, then such department shall be paid
218		-	based on the proportion that the population served by the county or
219		-	counties comprising such local health department bears to the total
220		-	population of all counties comprising local health departments which
221		-	that have made application for assistance, except for departments
222		-	receiving funds under subsection (a), except that in no case shall the
223		-	assistance distributed under this subsection (b) to a local health
224		-	department exceed the amount that the local health department receives
225		-	from local tax revenues for the county fiscal year in which the state
226		-	financial assistance is paid.
227		-	(c) If local tax revenues allotted to a local health department for a
228		-	fiscal year fall below the level of local tax revenues allotted to the local
229		-	health department for the preceding fiscal year, the amount of state
230		-	financial assistance under this act for which such local health
231		-	department is eligible for the fiscal year shall be reduced by a
232		-	percentage equal to the percentage of reduction in local tax revenue for
233		-	that fiscal year.
234		-	Sec. 5. K.S.A. 2024 Supp. 65-6208 is hereby amended to read as
235		-	follows: 65-6208. (a) Subject to the provisions of K.S.A. 65-6209, and
236		-	amendments thereto, an annual assessment on services is imposed on
237		-	each hospital provider in an amount not less than 1.83% of each
238		-	hospital's net inpatient operating revenue and not greater than 3% 6%
239		-	of each hospital's net inpatient and outpatient operating revenue, as House Substitute for SENATE BILL No. 126—page 5
240		-	determined by the healthcare access improvement panel in consultation
241		-	with the department of health and environment, for the hospital's fiscal
242		-	year three years prior to the assessment year. In the event that a hospital
243		-	does not have a complete 12-month fiscal year in such third prior fiscal
244		-	year, the assessment under this section shall be $200,000 until such
245		-	date that such hospital has completed the hospital's first 12-month fiscal
246		-	year. Upon completing such first 12-month fiscal year, such hospital's
247		-	assessment under this section shall be the amount not less than 1.83%
248		-	of each hospital's net inpatient operating revenue and not greater than
249		-	3% 6% of such hospital's net inpatient and outpatient operating
250		-	revenue, as determined by the healthcare access improvement panel in
251		-	consultation with the department of health and environment, for such
252		-	first completed 12-month fiscal year.
253		-	(b) Nothing in this act shall be construed to authorize any home
254		-	rule unit or other unit of local government to license for revenue or
255		-	impose a tax or assessment upon hospital providers or a tax or
256		-	assessment measured by the income or earnings of a hospital provider.
257		-	(c) (1) The department of health and environment shall submit to
258		-	the United States centers for medicare and medicaid services any
259		-	approval request necessary to implement the amendments made to
260		-	subsection (a) by section 1 of chapter 7 of the 2020 Session Laws of
261		-	Kansas and this act. If the department has submitted such a request
262		-	pursuant to section 80(l) of chapter 68 of the 2019 Session Laws of
263		-	Kansas or section 1 of chapter 7 of the 2020 Session Laws of Kansas,
264		-	then the department may continue such request, or modify such request
265		-	to conform to the amendments made to subsection (a) by section 1 of
266		-	chapter 7 of the 2020 Session Laws of Kansas and this act, to fulfill the
267		-	requirements of this paragraph.
268		-	(2) The secretary of health and environment shall certify to the
269		-	secretary of state the receipt of such approval and cause notice of such
270		-	approval to be published in the Kansas register.
271		-	(3) The amendments made to subsection (a) by section 1 of
272		-	chapter 7 of the 2020 Session Laws of Kansas and this act shall take
273		-	effect on and after January 1 or July 1 immediately following such
274		-	publication of such approval.
275		-	Sec. 6. K.S.A. 2024 Supp. 65-6209 is hereby amended to read as
276		-	follows: 65-6209. (a) A hospital provider that is a state agency, the
277		-	authority, as defined in K.S.A. 76-3304, and amendments thereto, a
278		-	state educational institution, as defined in K.S.A. 76-711, and
279		-	amendments thereto, a critical access hospital, as defined in K.S.A. 65-
280		-	468, and amendments thereto, with revenues below the threshold
281		-	determined by the healthcare access improvement panel, or a rural
282		-	emergency hospital licensed under the rural emergency hospital act,
283		-	K.S.A. 2024 Supp. 65-481 et seq., and amendments thereto, with
284		-	revenues below the threshold determined by the healthcare access
285		-	improvement panel, is exempt from the assessment imposed by K.S.A.
286		-	65-6208, and amendments thereto.
287		-	(b) A hospital operated by the department in the course of
288		-	performing its mental health or developmental disabilities functions is
289		-	exempt from the assessment imposed by K.S.A. 65-6208, and
290		-	amendments thereto.
291		-	Sec. 7. K.S.A. 65-6210 is hereby amended to read as follows: 65-
292		-	6210. (a) The assessment imposed by K.S.A. 65-6208, and
293		-	amendments thereto, for any state fiscal year to which this statute
294		-	applies shall be due and payable in equal installments on or before June
295		-	May 30 and December 31 November 30, commencing with whichever
296		-	date first occurs after the hospital has received payments for 150 days
297		-	after the effective date of the payment methodology approved by the
298		-	centers for medicare and medicaid services. No installment payment of House Substitute for SENATE BILL No. 126—page 6
299		-	an assessment under this act shall be due and payable, however, until
300		-	after:
301		-	(1) The hospital provider receives written notice from the
302		-	department that the payment methodologies to hospitals required under
303		-	this act have been approved by the centers for medicare and medicaid
304		-	services of the United States department of health and human services
305		-	under 42 C.F.R. § 433.68 for the assessment imposed by K.S.A. 65-
306		-	6208, and amendments thereto, has been granted by the centers for
307		-	medicare and medicaid services of the United States department of
308		-	health and human services; and
309		-	(2) in the case of a hospital provider, the hospital has received
310		-	payments for 150 days after the effective date of the payment
311		-	methodology approved by the centers for medicare and medicaid
312		-	services.
313		-	(b) The department is authorized to establish delayed payment
314		-	schedules for hospital providers that are unable to make installment
315		-	payments when due under this section due to financial difficulties, as
316		-	determined by the department.
317		-	(c) If a hospital provider fails to pay the full amount of an
318		-	installment when due, including any extensions granted under this
319		-	section, there shall be added to the assessment imposed by K.S.A. 65-
320		-	6208, and amendments thereto, unless waived by the department for
321		-	reasonable cause, a penalty assessment equal to the lesser of:
322		-	(1) An amount equal to 5% of the installment amount not paid on
323		-	or before the due date plus 5% of the portion thereof remaining unpaid
324		-	on the last day of each month thereafter; or
325		-	(2) an amount equal to 100% of the installment amount not paid
326		-	on or before the due date.
327		-	For purposes of this subsection (c), payments will shall be credited
328		-	first to unpaid installment amounts, rather than to penalty or interest
329		-	amounts, beginning with the most delinquent installment.
330		-	(d) The department is authorized to take legal action against any
331		-	hospital that fails to pay the amount due, including penalties, upon
332		-	recommendation of the healthcare access improvement program panel,
333		-	unless such hospital has established and is compliant with a payment
334		-	schedule approved by the department.
335		-	(e) The effective date for the payment methodology applicable to
336		-	hospital providers approved by the centers for medicare and medicaid
337		-	services shall be the date of July 1 or January 1, whichever date is
338		-	designated in the state plan submitted by the department of health and
339		-	environment for approval by the centers for medicare and medicaid
340		-	services.
341		-	Sec. 8. K.S.A. 65-181, 65-183, 65-242 and 65-6210 and K.S.A.
342		-	2024 Supp. 65-180, 65-6208 and 65-6209 are hereby repealed. House Substitute for SENATE BILL No. 126—page 7
343		-	Sec. 9. This act shall take effect and be in force from and after its
	9	+	Section 1. This act shall be known and may be cited as the physician
	10	+	assistant licensure compact.
	11	+	SECTION 1—PURPOSE
	12	+	In order to strengthen access to medical services and in recognition of
	13	+	the advances in the delivery of medical services, the participating states of
	14	+	the PA licensure compact have allied in common purpose to develop a
	15	+	comprehensive process that complements the existing authority of state
	16	+	licensing boards to license and discipline PAs and seeks to enhance the
	17	+	portability of a license to practice as a PA while safeguarding the safety of
	18	+	patients. This compact allows medical services to be provided by PAs, via
	19	+	the mutual recognition of the licensee's qualifying license by other
	20	+	compact-participating states. This compact also adopts the prevailing
	21	+	standard for PA licensure and affirms that the practice and delivery of
	22	+	medical services by the PA occurs where the patient is located at the time
	23	+	of the patient encounter and, therefore, requires the PA to be under the
	24	+	jurisdiction of the state licensing board where the patient is located. State
	25	+	licensing boards that participate in this compact retain the jurisdiction to
	26	+	impose adverse action against a compact privilege in that state issued to a
	27	+	PA through the procedures of this compact. The PA licensure compact will
	28	+	alleviate burdens for military families by allowing active duty military
	29	+	personnel and their spouses to obtain a compact privilege based on having
	30	+	an unrestricted license in good standing from a participating state.
	31	+	SECTION 2—DEFINITIONS
	32	+	As used in this compact:
	33	+	(a) "Adverse action" means any administrative, civil, equitable or
	34	+	criminal action permitted by a state's laws that is imposed by a licensing
	35	+	board or other authority against a PA license, application for licensure or
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	72	+	compact privilege such as license denial, censure, revocation, suspension,
	73	+	probation, monitoring of the licensee or restriction on the licensee's
	74	+	practice.
	75	+	(b) "Compact privilege" means the authorization granted by a remote
	76	+	state to allow a licensee from another participating state to practice as a PA
	77	+	to provide medical services and other licensed activity to a patient located
	78	+	in the remote state under the remote state's laws and regulations.
	79	+	(c) "Conviction" means a finding by a court that an individual is
	80	+	guilty of a felony or misdemeanor offense through adjudication or entry of
	81	+	a guilty plea or no contest to the charge by the offender.
	82	+	(d) "Criminal background check" means the submission of
	83	+	fingerprints or other biometric-based information for an applicant for
	84	+	licensure for the purpose of obtaining that applicant's criminal history
	85	+	record information, as defined in 28 C.F.R. § 20.3(d), from the state's
	86	+	criminal history record repository as defined in 28 C.F.R. § 20.3(f).
	87	+	(e) "Data system" means the repository of information concerning
	88	+	licensees, including, but not limited to, license status and adverse actions,
	89	+	that is created and administered under the terms of this compact.
	90	+	(f) "Executive committee" means a group of directors and ex officio
	91	+	individuals elected or appointed pursuant to section 7(f)(2).
	92	+	(g) "Impaired practitioner" means a PA whose practice is adversely
	93	+	affected by a health-related condition that impacts such PA's ability to
	94	+	practice.
	95	+	(h) "Investigative information" means information, records or
	96	+	documents received or generated by a licensing board pursuant to an
	97	+	investigation.
	98	+	(i) "Jurisprudence requirement" means the assessment of an
	99	+	individual's knowledge of the laws and rules governing the practice of a
	100	+	PA in a state.
	101	+	(j) "License" means current authorization by a state, other than
	102	+	authorization pursuant to a compact privilege, for a PA to provide medical
	103	+	services that would be unlawful without current authorization.
	104	+	(k) "Licensee" means an individual who holds a license from a state
	105	+	to provide medical services as a PA.
	106	+	(l) "Licensing board" means any state entity authorized to license and
	107	+	otherwise regulate PAs.
	108	+	(m) "Medical services" means healthcare services provided for the
	109	+	diagnosis, prevention, treatment, cure or relief of a health condition, injury
	110	+	or disease, as defined by a state's laws and regulations.
	111	+	(n) "Model compact" means the model for the PA licensure compact
	112	+	on file with the council of state governments or other entity as designated
	113	+	by the commission.
	114	+	(o) "PA" means an individual who is licensed as a physician assistant
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	158	+	in a state. For purposes of this compact, any other title or status adopted by
	159	+	a state to replace the term "physician assistant" shall be deemed
	160	+	synonymous with "physician assistant" and shall confer the same rights
	161	+	and responsibilities to the licensee under the provisions of this compact at
	162	+	the time of its enactment.
	163	+	(p) "PA licensure compact commission," "compact commission" or
	164	+	"commission" means the national administrative body created pursuant to
	165	+	section 7(a).
	166	+	(q) "Participating state" means a state that has enacted this compact.
	167	+	(r) "Qualifying license" means an unrestricted license issued by a
	168	+	participating state to provide medical services as a PA.
	169	+	(s) "Remote state" means a participating state where a licensee who is
	170	+	not licensed as a PA is exercising or seeking to exercise the compact
	171	+	privilege.
	172	+	(t) "Rule" means any rule or regulation promulgated by an entity that
	173	+	has the force and effect of law.
	174	+	(u) "Significant investigative information" means investigative
	175	+	information that a licensing board, after an inquiry or investigation that
	176	+	includes notification and an opportunity for the PA to respond if required
	177	+	by state law, has reason to believe is not groundless and, if proven true,
	178	+	would indicate more than a minor infraction.
	179	+	(v) "State" means any state, commonwealth, district or territory of the
	180	+	United States.
	181	+	SECTION 3—STATE PARTICIPATION IN THIS COMPACT
	182	+	(a) To participate in this compact, a participating state shall:
	183	+	(1) License PAs;
	184	+	(2) participate in the compact commission's data system;
	185	+	(3) have a mechanism in place for receiving and investigating
	186	+	complaints against licensees and applicants for licensure;
	187	+	(4) notify the commission, in compliance with the terms of this
	188	+	compact and commission rules, of any adverse action against a licensee or
	189	+	applicant for licensure and the existence of significant investigative
	190	+	information regarding a licensee or applicant for licensure;
	191	+	(5) fully implement a criminal background check requirement, within
	192	+	a time frame established by commission rule, examination the results of a
	193	+	criminal background check and reporting to the commission whether the
	194	+	applicant for licensure has been granted a license;
	195	+	(6) comply with the rules of the compact commission;
	196	+	(7) utilize passage of a recognized national examination such as the
	197	+	NCCPA PANCE as a requirement for PA licensure; and
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	241	+	(8) grant the compact privilege to a holder of a qualifying license in a
	242	+	participating state.
	243	+	(b) Nothing in this compact shall be construed to prohibit a
	244	+	participating state from charging a fee for granting the compact privilege.
	245	+	SECTION 4—COMPACT PRIVILEGE
	246	+	(a) To exercise the compact privilege, a licensee shall:
	247	+	(1) Have graduated from a PA program accredited by the
	248	+	accreditation review commission on education for the physician assistant,
	249	+	inc., or other programs authorized by commission rule;
	250	+	(2) hold current NCCPA certification;
	251	+	(3) have no felony or misdemeanor convictions;
	252	+	(4) have never had a controlled substance license, permit or
	253	+	registration suspended or revoked by a state or by the United States drug
	254	+	enforcement administration;
	255	+	(5) have a unique identifier as determined by commission rule;
	256	+	(6) hold a qualifying license;
	257	+	(7) have had no revocation of a license or limitation or restriction on
	258	+	any license currently held due to an adverse action;
	259	+	(A) if a licensee has had a limitation or restriction on a license or
	260	+	compact privilege due to an adverse action, two years shall have elapsed
	261	+	from the date on which the license or compact privilege is no longer
	262	+	limited or restricted due to the adverse action;
	263	+	(B) if a compact privilege has been revoked or is limited or restricted
	264	+	in a participating state for conduct that would not be a basis for
	265	+	disciplinary action in a participating state in which the licensee is
	266	+	practicing or applying to practice under a compact privilege, that
	267	+	participating state shall have the discretion not to consider such action as
	268	+	an adverse action requiring the denial or removal of a compact privilege in
	269	+	that state;
	270	+	(8) notify the compact commission that the licensee is seeking the
	271	+	compact privilege in a remote state;
	272	+	(9) meet any jurisprudence requirement of a remote state in which the
	273	+	licensee is seeking to practice under the compact privilege and pay any
	274	+	fees applicable to satisfying the jurisprudence requirement; and
	275	+	(10) report to the commission any adverse action taken by a
	276	+	nonparticipating state within 30 days after such adverse action is taken.
	277	+	(b) The compact privilege shall be valid until the expiration or
	278	+	revocation of the qualifying license unless terminated pursuant to an
	279	+	adverse action. The licensee shall comply with the requirements of
	280	+	subsection (a) to maintain the compact privilege in a remote state. If the
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	324	+	participating state takes adverse action against a qualifying license, the
	325	+	licensee shall lose the compact privilege in any remote state in which the
	326	+	licensee has a compact privilege until the licensee meets the following
	327	+	conditions:
	328	+	(1) The license is no longer limited or restricted; and
	329	+	(2) two years have elapsed from the date on which the license is no
	330	+	longer limited or restricted due to the adverse action.
	331	+	(c) Once a restricted or limited license satisfies the requirements of
	332	+	subsection (b), the licensee shall meet the requirements of subsection (a) to
	333	+	obtain a compact privilege in any remote state.
	334	+	(d) For each remote state in which a PA seeks authority to prescribe
	335	+	controlled substances, the PA shall satisfy all the requirements imposed by
	336	+	such state in granting or renewing such authority.
	337	+	SECTION 5—DESIGNATION OF THE STATE FROM WHICH THE
	338	+	LICENSEE IS APPLYING FOR A COMPACT PRIVILEGE
	339	+	Upon a licensee's application for a compact privilege, the licensee shall
	340	+	identify to the commission the participating state from which the licensee
	341	+	is applying, in accordance with applicable rules adopted by the
	342	+	commission and subject to the following requirements:
	343	+	(a) When applying for a compact privilege, the licensee shall provide
	344	+	the commission with the address of the licensee's primary residence and,
	345	+	thereafter, shall immediately report to the commission any change in the
	346	+	address of the licensee's primary residence; and
	347	+	(b) when applying for a compact privilege, the licensee is required to
	348	+	consent to accept service of process by mail at the licensee's primary
	349	+	residence on file with the commission with respect to any action brought
	350	+	against the licensee by the commission or a participating state, including a
	351	+	subpoena, with respect to any action brought or investigation conducted by
	352	+	the commission or a participating state.
	353	+	SECTION 6—ADVERSE ACTIONS
	354	+	(a) A participating state in which a licensee is licensed shall have
	355	+	exclusive power to impose adverse action against the qualifying license
	356	+	issued by that participating state.
	357	+	(b) In addition to the other powers conferred by state law, a remote
	358	+	state shall have the authority, in accordance with existing state due process
	359	+	law, to:
	360	+	(1) Take adverse action against a PA's compact privilege within that
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	404	+	state to remove a licensee's compact privilege or take other action
	405	+	necessary under applicable law to protect the health and safety of its
	406	+	citizens; and
	407	+	(2) issue subpoenas for both hearings and investigations that require
	408	+	the attendance and testimony of witnesses as well as the production of
	409	+	evidence. Subpoenas issued by a licensing board in a participating state for
	410	+	the attendance and testimony of witnesses or the production of evidence
	411	+	from another participating state shall be enforced in the latter state by any
	412	+	court of competent jurisdiction, according to the practice and procedure of
	413	+	such court applicable to subpoenas issued in proceedings pending before
	414	+	it. The issuing authority shall pay any witness fees, travel expenses,
	415	+	mileage and other fees required by the service statutes of the state in which
	416	+	the witnesses or evidence is located.
	417	+	(c) Notwithstanding subsection (b)(2), subpoenas shall not be issued
	418	+	by a participating state to gather evidence of conduct in another state that
	419	+	is lawful in such other state for the purpose of taking adverse action
	420	+	against a licensee's compact privilege or application for a compact
	421	+	privilege in the participating state.
	422	+	(d) Nothing in this compact shall be deemed to authorize a
	423	+	participating state to impose discipline against a PA's compact privilege or
	424	+	to deny an application for a compact privilege in that participating state for
	425	+	the individual's otherwise lawful practice in another state.
	426	+	(e) For purposes of taking adverse action, the participating state that
	427	+	issued the qualifying license shall give the same priority and effect to
	428	+	reported conduct received from any other participating state as it would if
	429	+	the conduct had occurred within the participating state that issued the
	430	+	qualifying license. The participating state shall apply its own state laws to
	431	+	determine appropriate action.
	432	+	(f) A participating state, if otherwise permitted by state law, may
	433	+	recover from the affected PA the costs of investigations and disposition of
	434	+	cases resulting from any adverse action taken against that PA.
	435	+	(g) A participating state may take adverse action based on the factual
	436	+	findings of a remote state if the participating state follows its own
	437	+	procedures for taking the adverse action.
	438	+	(h) Joint investigations.
	439	+	(1) In addition to the authority granted to a participating state by such
	440	+	state's PA laws and regulations or other applicable state law, any
	441	+	participating state may participate with other participating states in joint
	442	+	investigations of licensees.
	443	+	(2) Participating states shall share any investigative, litigation or
	444	+	compliance materials in furtherance of any joint or individual investigation
	445	+	initiated under this compact.
	446	+	(i) If an adverse action is taken against a PA's qualifying license, the
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	490	+	PA's compact privilege in all remote states shall be deactivated until two
	491	+	years have elapsed after all restrictions have been removed from the state
	492	+	license. All disciplinary orders by the participating state that issued the
	493	+	qualifying license that impose adverse action against a PA's license shall
	494	+	include a statement that the PA's compact privilege is deactivated in all
	495	+	participating states during the pendency of the order.
	496	+	(j) If any participating state takes adverse action, it promptly shall
	497	+	notify the administrator of the data system.
	498	+	SECTION 7—ESTABLISHMENT OF THE PA LICENSURE
	499	+	COMPACT COMMISSION
	500	+	(a) The participating states hereby create and establish a joint
	501	+	government agency and national administrative body known as the PA
	502	+	licensure compact commission. The commission is an instrumentality of
	503	+	the compact states acting jointly and not an instrumentality of any one
	504	+	state. The commission shall come into existence on or after the effective
	505	+	date of the compact as set forth in section 11(a).
	506	+	(b) Membership, voting and meetings.
	507	+	(1) Each participating state shall have and be limited to one delegate
	508	+	selected by such participating state's licensing board or, if such
	509	+	participating state has more than one licensing board, selected collectively
	510	+	by the participating state's licensing boards.
	511	+	(2) A delegate shall be either:
	512	+	(A) A current PA, physician or public member of a licensing board or
	513	+	PA council or committee; or
	514	+	(B) an administrator of a licensing board.
	515	+	(3) Any delegate may be removed or suspended from office as
	516	+	provided by the laws of the state from which the delegate is appointed.
	517	+	(4) The participating state licensing board shall fill any vacancy
	518	+	occurring in the commission within 60 days.
	519	+	(5) Each delegate shall be entitled to one vote on all matters voted on
	520	+	by the commission and shall otherwise have an opportunity to participate
	521	+	in the commission's business and affairs. A delegate shall vote in person or
	522	+	by such other means as provided in the bylaws. The bylaws may provide
	523	+	for delegates' participation in meetings by telecommunications, video
	524	+	conference or other means of communication.
	525	+	(6) The commission shall meet at least once during each calendar
	526	+	year. Additional meetings shall be held as set forth in this compact and the
	527	+	bylaws.
	528	+	(7) The commission shall establish by rule a term of office for
	529	+	delegates.
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	573	+	(c) The commission shall have the following powers and duties:
	574	+	(1) Establish a code of ethics for the commission;
	575	+	(2) establish the fiscal year of the commission;
	576	+	(3) establish fees;
	577	+	(4) establish bylaws;
	578	+	(5) maintain its financial records in accordance with the bylaws;
	579	+	(6) meet and take such actions as are consistent with the provisions of
	580	+	this compact and the bylaws;
	581	+	(7) promulgate rules to facilitate and coordinate implementation and
	582	+	administration of this compact, and such rules shall have the force and
	583	+	effect of law and shall be binding in all participating states;
	584	+	(8) bring and prosecute legal proceedings or actions in the name of
	585	+	the commission, except that the standing of any state licensing board to
	586	+	sue or be sued under applicable law shall not be affected;
	587	+	(9) purchase and maintain insurance and bonds;
	588	+	(10) borrow, accept or contract for services of personnel, including,
	589	+	but not limited to, employees of a participating state;
	590	+	(11) hire employees and engage contractors, elect or appoint officers,
	591	+	fix compensation, define duties, grant such individuals appropriate
	592	+	authority to carry out the purposes of this compact and establish the
	593	+	commission's personnel policies and programs relating to conflicts of
	594	+	interest, qualifications of personnel and other related personnel matters;
	595	+	(12) accept any and all appropriate donations and grants of money,
	596	+	equipment, supplies, materials and services and receive, utilize and
	597	+	dispose of the same. At all times the commission shall avoid any
	598	+	appearance of impropriety or conflict of interest;
	599	+	(13) lease, purchase, accept appropriate gifts or donations of or
	600	+	otherwise own, hold, improve or use any property real, personal or mixed.
	601	+	In performing these actions, the commission shall avoid the appearance of
	602	+	impropriety at all times;
	603	+	(14) sell, convey, mortgage, pledge, lease, exchange, abandon or
	604	+	otherwise dispose of any property real, personal or mixed;
	605	+	(15) establish a budget and make expenditures;
	606	+	(16) borrow money;
	607	+	(17) appoint committees, including standing committees composed of
	608	+	members, state regulators, state legislators or their representatives,
	609	+	consumer representatives and such other interested persons as may be
	610	+	designated in this compact and the bylaws;
	611	+	(18) provide and receive information from, and cooperate with, law
	612	+	enforcement agencies;
	613	+	(19) elect a chairperson, vice chairperson, secretary and treasurer and
	614	+	such other officers of the commission as provided in the commission's
	615	+	bylaws;
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	659	+	(20) reserve for itself, in addition to those reserved exclusively to the
	660	+	commission under the compact, powers that the executive committee shall
	661	+	not exercise;
	662	+	(21) approve or disapprove a state's participation in the compact
	663	+	based upon its determination as to whether the state's compact legislation
	664	+	materially departs from the model compact language;
	665	+	(22) prepare and provide to the participating states an annual report;
	666	+	and
	667	+	(23) perform such other functions as may be necessary or appropriate
	668	+	to achieve the purposes of this compact, consistent with the state
	669	+	regulation of PA licensure and practice.
	670	+	(d) Meetings of the commission.
	671	+	(1) All meetings of the commission that are not closed pursuant to
	672	+	this subsection shall be open to the public. Notice of public meetings shall
	673	+	be posted on the commission's website at least 30 days prior to the public
	674	+	meeting.
	675	+	(2) Notwithstanding subsection (d)(1), the commission may convene
	676	+	a public meeting by providing at least 24 hours' prior notice on the
	677	+	commission's website and any other means as provided in the
	678	+	commission's rules for any of the reasons it may dispense, with notice of
	679	+	proposed rulemaking under section 9(l).
	680	+	(3) The commission may convene in a closed, nonpublic meeting or
	681	+	nonpublic part of a public meeting to receive legal advice or to discuss:
	682	+	(A) Noncompliance of a participating state with its obligations under
	683	+	this compact;
	684	+	(B) the employment, compensation, discipline or other matters,
	685	+	practices or procedures related to specific employees or other matters
	686	+	related to the commission's internal personnel practices and procedures;
	687	+	(C) any current, threatened or reasonably anticipated litigation;
	688	+	(D) the negotiation of contracts for the purchase, lease or sale of
	689	+	goods, services or real estate;
	690	+	(E) the accusation of any individual of a crime or the formal censure
	691	+	any individual;
	692	+	(F) the disclosure of trade secrets or commercial or financial
	693	+	information that is privileged or confidential;
	694	+	(G) the disclosure of information of a personal nature, if disclosure
	695	+	would constitute a clearly unwarranted invasion of personal privacy;
	696	+	(H) the disclosure of investigative records compiled for law
	697	+	enforcement purposes;
	698	+	(I) the disclosure of information related to any investigative reports
	699	+	prepared by or on behalf of or for use of the commission or other
	700	+	committee charged with the responsibility of investigation or
	701	+	determination of compliance issues pursuant to this compact;
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	745	+	(J) legal advice; or
	746	+	(K) any matters specifically exempted from disclosure by federal or a
	747	+	participating state's statutes.
	748	+	(4) If a meeting, or portion of a meeting, is closed pursuant to
	749	+	subsection (d)(3), the chairperson of the meeting or the chairperson's
	750	+	designee shall certify that the meeting or portion of the meeting may be
	751	+	closed and shall reference each relevant exempting provision.
	752	+	(5) The commission shall keep minutes that fully and clearly describe
	753	+	all matters discussed in a meeting and shall provide a full and accurate
	754	+	summary of actions taken, including a description of the views expressed.
	755	+	All documents considered in connection with an action shall be identified
	756	+	in such minutes. All minutes and documents of a closed meeting shall
	757	+	remain under seal, subject to release by a majority vote of the commission
	758	+	or order of a court of competent jurisdiction.
	759	+	(e) Financing of the commission.
	760	+	(1) The commission shall pay, or provide for the payment of, the
	761	+	reasonable expenses of its establishment, organization and ongoing
	762	+	activities.
	763	+	(2) The commission may accept any and all appropriate revenue
	764	+	sources, donations and grants of money, equipment, supplies, materials
	765	+	and services.
	766	+	(3) The commission may levy on and collect an annual assessment
	767	+	from each participating state and may impose compact privilege fees on
	768	+	licensees of participating states to which a compact privilege is granted to
	769	+	cover the cost of the operations and activities of the commission and its
	770	+	staff. Such assessment shall be in a total amount sufficient to cover the
	771	+	commission's annual budget as approved by the commission each year for
	772	+	which revenue is not provided by other sources. The aggregate annual
	773	+	assessment amount levied on participating states shall be allocated based
	774	+	upon a formula to be determined by commission rule. Compact privileges
	775	+	and such contract privilege's associated fees shall be governed as follows:
	776	+	(A) A compact privilege expires when the licensee's qualifying
	777	+	license in the participating state from which the licensee applied for the
	778	+	compact privilege expires; and
	779	+	(B) if the licensee terminates the qualifying license through which the
	780	+	licensee applied for the compact privilege before its scheduled expiration
	781	+	and the licensee has a qualifying license in another participating state, the
	782	+	licensee shall inform the commission that it is changing to that
	783	+	participating state through which it applies for a compact privilege to that
	784	+	participating state and pay to the commission any compact privilege fee
	785	+	required by commission rule.
	786	+	(4) The commission shall not incur obligations of any kind prior to
	787	+	securing the funds adequate to meet such obligations, nor shall the
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	831	+	commission pledge the credit of any of the participating states, except by
	832	+	and with the authority of the participating state.
	833	+	(5) The commission shall keep accurate accounts of all receipts and
	834	+	disbursements. The receipts and disbursements of the commission shall be
	835	+	subject to the financial review and accounting procedures established
	836	+	under its bylaws. All receipts and disbursements of funds handled by the
	837	+	commission shall be subject to an annual financial review by a certified or
	838	+	licensed public accountant, and the report of the financial review shall be
	839	+	included in and become part of the annual report of the commission.
	840	+	(f) The executive committee.
	841	+	(1) The executive committee shall have to power to act on behalf of
	842	+	the commission according to the terms of this compact and commission
	843	+	rules.
	844	+	(2) The executive committee shall be composed of nine members
	845	+	described as follows:
	846	+	(A) Seven voting members who are elected by the commission from
	847	+	the current membership of the commission;
	848	+	(B)(i)(a) one ex officio, nonvoting member from a recognized
	849	+	national PA professional association; and
	850	+	(b) one ex officio, nonvoting member from a recognized national PA
	851	+	certification organization.
	852	+	(ii) The ex officio members shall be selected by their respective
	853	+	organizations.
	854	+	(3) The commission may remove any member of the executive
	855	+	committee as provided in its bylaws.
	856	+	(4) The executive committee shall meet at least annually.
	857	+	(5) The executive committee shall have the following duties and
	858	+	responsibilities:
	859	+	(A) Recommend to the commission changes to the commission's
	860	+	rules or bylaws, changes to this compact legislation, fees to be paid by
	861	+	compact-participating states such as annual dues and any commission
	862	+	compact fee charged to licensees for the compact privilege;
	863	+	(B) ensure that compact administration services are appropriately
	864	+	provided, whether
	865	+	contractual or otherwise;
	866	+	(C) prepare and recommend the budget;
	867	+	(D) maintain financial records on behalf of the commission;
	868	+	(E) monitor compact compliance of participating states and provide
	869	+	compliance reports to the commission;
	870	+	(F) establish additional committees as necessary;
	871	+	(G) exercise the powers and duties of the commission during the
	872	+	interim between commission meetings, except for issuing proposed
	873	+	rulemaking or adopting commission rules or bylaws or exercising any
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	917	+	other powers and duties exclusively reserved to the commission by the
	918	+	commission's rules; and
	919	+	(H) perform other duties as provided in the commission's rules or
	920	+	bylaws.
	921	+	(6) All meetings of the executive committee at which it votes or plans
	922	+	to vote on matters in exercising the powers and duties of the commission
	923	+	shall be open to the public and public notice of such meetings shall be
	924	+	given as public meetings of the commission are given.
	925	+	(7) The executive committee may convene in a closed, nonpublic
	926	+	meeting for the same reasons that the commission may convene in a
	927	+	nonpublic meeting as set forth in section 7(d)(3), and shall announce the
	928	+	closed meeting as the commission is required to do under section 7(d)(4)
	929	+	and keep minutes of the closed meeting as the commission is required to
	930	+	do under section 7(d)(5).
	931	+	(g) Qualified immunity, defense and indemnification.
	932	+	(1) The members, officers, executive director, employees and
	933	+	representatives of the commission shall be immune from suit and liability,
	934	+	both personally and in their official capacity, for any claim for damage to
	935	+	or loss of property or personal injury or other civil liability caused by or
	936	+	arising out of any actual or alleged act, error or omission that occurred or
	937	+	that the individual against whom the claim is made had a reasonable basis
	938	+	for believing occurred within the scope of commission employment, duties
	939	+	or responsibilities. Nothing in this paragraph shall be construed to protect
	940	+	any such individual from suit or liability for any damage, loss, injury or
	941	+	liability caused by the intentional or willful or wanton misconduct of such
	942	+	individual. The procurement of insurance of any type by the commission
	943	+	shall not in any way compromise or limit the immunity granted hereunder.
	944	+	(2) The commission shall defend any member, officer, executive
	945	+	director, employee, and representative of the commission in any civil
	946	+	action seeking to impose liability arising out of any actual or alleged act,
	947	+	error or omission that occurred within the scope of commission
	948	+	employment, duties or responsibilities or as determined by the commission
	949	+	that the individual against whom the claim is made had a reasonable basis
	950	+	for believing occurred within the scope of commission employment, duties
	951	+	or responsibilities. Nothing herein shall be construed to prohibit such
	952	+	individual from retaining such individual's own counsel at the individual's
	953	+	own expense or that the actual or alleged act, error or omission did not
	954	+	result from the individual's intentional, willful or wanton misconduct.
	955	+	(3) The commission shall indemnify and hold harmless any member,
	956	+	officer, executive director, employee or representative of the commission
	957	+	for the amount of any settlement or judgment obtained against that
	958	+	individual arising out of any actual or alleged act, error or omission that
	959	+	occurred within the scope of commission employment, duties or
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	1003	+	responsibilities or that such individual had a reasonable basis for believing
	1004	+	occurred within the scope of commission employment, duties or
	1005	+	responsibilities, if the actual or alleged act, error or omission did not result
	1006	+	from the intentional or willful or wanton misconduct of that individual.
	1007	+	(4) Venue is proper and judicial proceedings by or against the
	1008	+	commission shall be brought solely and exclusively in a court of
	1009	+	competent jurisdiction where the principal office of the commission is
	1010	+	located. The commission may waive venue and jurisdictional defenses in
	1011	+	any proceedings as authorized by commission rules.
	1012	+	(5) Nothing herein shall be construed as a limitation on the liability of
	1013	+	any licensee for professional malpractice or misconduct, which shall be
	1014	+	governed solely by any other applicable state laws.
	1015	+	(6) Nothing herein shall be construed to designate the venue or
	1016	+	jurisdiction to bring actions for alleged acts of malpractice, professional
	1017	+	misconduct, negligence or other such civil action pertaining to the practice
	1018	+	of a PA. All such matters shall be determined exclusively by state law
	1019	+	other than this compact.
	1020	+	(7) Nothing in this compact shall be interpreted to waive or otherwise
	1021	+	abrogate a participating state's state action immunity or state action
	1022	+	affirmative defense with respect to antitrust claims under the Sherman act,
	1023	+	Clayton act or any other state or federal antitrust or anticompetitive law or
	1024	+	regulation.
	1025	+	(8) Nothing in this compact shall be construed to be a waiver of
	1026	+	sovereign immunity by the participating states or by the commission.
	1027	+	SECTION 8—DATA SYSTEM
	1028	+	(a) The commission shall provide for the development, maintenance,
	1029	+	operation and utilization of a coordinated data and reporting system
	1030	+	containing licensure, adverse action and the reporting of the existence of
	1031	+	significant investigative information on all licensed PAs and applicants
	1032	+	that are denied a license in participating states.
	1033	+	(b) Notwithstanding any other state law to the contrary, a
	1034	+	participating state shall submit a uniform data set to the data system on all
	1035	+	PAs to whom this compact is applicable, utilizing a unique identifier, as
	1036	+	required by the rules of the commission, including:
	1037	+	(1) Identifying information;
	1038	+	(2) licensure data;
	1039	+	(3) adverse actions against a license or compact privilege;
	1040	+	(4) any denial of application for licensure and the reason for such
	1041	+	denial, excluding the reporting of any criminal history record information
	1042	+	where such reporting is prohibited by law;
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	1086	+	(5) the existence of significant investigative information; and
	1087	+	(6) other information that may facilitate the administration of this
	1088	+	compact, as determined by the rules of the commission.
	1089	+	(c) Significant investigative information pertaining to a licensee in
	1090	+	any participating state shall only be available to other participating states.
	1091	+	(d) The commission shall promptly notify all participating states of
	1092	+	any adverse action taken against a licensee or an individual applying for a
	1093	+	license that has been reported to such commission. Such adverse action
	1094	+	information shall be available to any other participating state.
	1095	+	(e) Participating states contributing information to the data system
	1096	+	may, in accordance with state or federal law, designate information that
	1097	+	shall not be shared with the public without the express permission of the
	1098	+	contributing state. Notwithstanding any such designation, such information
	1099	+	shall be reported to the commission through the data system.
	1100	+	(f) Any information submitted to the data system that is subsequently
	1101	+	expunged pursuant to federal law or the laws of the participating state
	1102	+	contributing the information shall be removed from the data system upon
	1103	+	reporting of such by the participating state to the commission.
	1104	+	(g) The records and information provided to a participating state
	1105	+	pursuant to this compact or through the data system, when certified by the
	1106	+	commission or an agent thereof, shall constitute the authenticated business
	1107	+	records of the commission and shall be entitled to any associated hearsay
	1108	+	exception in any relevant judicial, quasi-judicial or administrative
	1109	+	proceedings in a participating state.
	1110	+	SECTION 9—RULEMAKING
	1111	+	(a) The commission shall exercise its rulemaking powers pursuant to
	1112	+	the criteria set forth in this section and the rules adopted thereunder.
	1113	+	Commission rules shall become binding as of the date specified by the
	1114	+	commission for each rule.
	1115	+	(b) The commission shall promulgate reasonable rules in order to
	1116	+	effectively and efficiently implement and administer this compact and
	1117	+	achieve its purposes. A commission rule shall be invalid and have no force
	1118	+	or effect only if a court of competent jurisdiction holds that the rule is
	1119	+	invalid because the commission exercised its rulemaking authority in a
	1120	+	manner that is beyond the scope of the purposes of this compact, the
	1121	+	powers granted hereunder or based upon another applicable standard of
	1122	+	review.
	1123	+	(c) The rules of the commission shall have the force of law in each
	1124	+	participating state, except that where the rules of the commission conflict
	1125	+	with the laws of the participating state that establish the medical services, a
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	1169	+	PA may perform in the participating state, as held by a court of competent
	1170	+	jurisdiction, and the rules of the commission shall be ineffective in that
	1171	+	state to the extent of the conflict.
	1172	+	(d) If a majority of the legislatures of the participating states rejects a
	1173	+	commission rule, by enactment of a statute or resolution in the same
	1174	+	manner used to adopt this compact within four years of the date of
	1175	+	adoption of the rule, then such rule shall have no further force and effect in
	1176	+	any participating state or to any state applying to participate in the
	1177	+	compact.
	1178	+	(e) Commission rules shall be adopted at a regular or special meeting
	1179	+	of the commission.
	1180	+	(f) Prior to promulgation and adoption of a final rule by the
	1181	+	commission and at least 30 days in advance of the meeting at which the
	1182	+	rule will be considered and voted upon, the commission shall file a notice
	1183	+	of proposed rulemaking:
	1184	+	(1) On the commission's website or other publicly accessible
	1185	+	platform;
	1186	+	(2) to persons who have requested notice of the commission's notices
	1187	+	of proposed rulemaking; and
	1188	+	(3) in such other ways as the commission may specify by rule.
	1189	+	(g) The notice of proposed rulemaking shall include:
	1190	+	(1) The time, date and location of the public hearing on the proposed
	1191	+	rule and the proposed time, date and location of the meeting in which the
	1192	+	proposed rule will be considered and voted upon;
	1193	+	(2) the text of and the reason for the proposed rule;
	1194	+	(3) a request for comments on the proposed rule from any interested
	1195	+	person and the date by which written comments must be received; and
	1196	+	(4) the manner in which interested persons may submit notice to the
	1197	+	commission of their intention to attend the public hearing or provide any
	1198	+	written comments.
	1199	+	(h) Prior to adoption of a proposed rule, the commission shall allow
	1200	+	persons to submit written data, facts, opinions and arguments, which shall
	1201	+	be made available to the public.
	1202	+	(i) If the hearing is to be held via electronic means, the commission
	1203	+	shall publish the mechanism for access to the electronic hearing.
	1204	+	(1) All persons wishing to be heard at the hearing shall, as directed in
	1205	+	the notice of proposed rulemaking published not less than five business
	1206	+	days before the scheduled date of the hearing, notify the commission of
	1207	+	their desire to appear and testify at the hearing.
	1208	+	(2) Hearings shall be conducted in a manner that provides each
	1209	+	person who wishes to comment a fair and reasonable opportunity to
	1210	+	comment orally or in writing.
	1211	+	(3) All hearings shall be recorded. A copy of the recording and the
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	1255	+	written comments, data, facts, opinions and arguments received in
	1256	+	response to the proposed rulemaking shall be made available to a person
	1257	+	upon request.
	1258	+	(4) Nothing in this section shall be construed as requiring a separate
	1259	+	hearing on each proposed rule. Proposed rules may be grouped for the
	1260	+	convenience of the commission at hearings required by this section.
	1261	+	(j) Following the public hearing, the commission shall consider all
	1262	+	written and oral comments timely received.
	1263	+	(k) The commission shall, by majority vote of all delegates, take final
	1264	+	action on the proposed rule and shall determine the effective date of the
	1265	+	rule, if adopted, based on the rulemaking record and the full text of the
	1266	+	rule.
	1267	+	(1) If adopted, the rule shall be posted on the commission's website.
	1268	+	(2) The commission may adopt changes to the proposed rule if the
	1269	+	changes do not expand the original purpose of the proposed rule.
	1270	+	(3) The commission shall provide an explanation on its website of the
	1271	+	reasons for any substantive changes made to the proposed rule as well as
	1272	+	reasons for any substantive changes not made that were recommended by
	1273	+	commenters.
	1274	+	(4) The commission shall determine a reasonable effective date for
	1275	+	the rule. Except for an emergency as provided in subsection (l), the
	1276	+	effective date of the rule shall be not sooner than 30 days after the
	1277	+	commission issued the notice that it adopted the rule.
	1278	+	(l) Upon the determination that an emergency exists, the commission
	1279	+	may consider and adopt an emergency rule with 24 hours' prior notice,
	1280	+	without the opportunity for comment or hearing, expect that the usual
	1281	+	rulemaking procedures provided in this compact and in this section shall
	1282	+	be retroactively applied to the rule as soon as reasonably possible but in no
	1283	+	event later than 90 days after the effective date of the rule. For the
	1284	+	purposes of this provision, an emergency rule is one that shall be adopted
	1285	+	immediately by the commission in order to:
	1286	+	(1) Address an imminent threat to public health, safety or welfare;
	1287	+	(2) prevent a loss of commission or participating state funds;
	1288	+	(3) meet a deadline for the promulgation of a commission rule that is
	1289	+	established by federal law or rule; or
	1290	+	(4) protect public health and safety.
	1291	+	(m) The commission, or an authorized committee of the commission,
	1292	+	may direct revisions to a previously adopted commission rule for purposes
	1293	+	of correcting typographical errors, errors in format, errors in consistency
	1294	+	or grammatical errors. Public notice of any revisions shall be posted on the
	1295	+	commission's website. The revision shall be subject to challenge by any
	1296	+	person for a period of 30 days after posting. The revision may be
	1297	+	challenged only on grounds that the revision results in a material change to
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	1341	+	a rule. A challenge shall be made as set forth in the notice of revisions and
	1342	+	delivered to the commission prior to the end of the notice period. If no
	1343	+	challenge is made, the revision shall take effect without further action. If
	1344	+	the revision is challenged, the revision shall not take effect without the
	1345	+	approval of the commission.
	1346	+	(n) No participating state's rulemaking requirements shall apply under
	1347	+	this compact.
	1348	+	SECTION 10—OVERSIGHT, DISPUTE RESOLUTION AND
	1349	+	ENFORCEMENT
	1350	+	(a) Oversight.
	1351	+	(1) The executive and judicial branches of state government in each
	1352	+	participating state shall enforce this compact and take all actions necessary
	1353	+	and appropriate to implement the compact.
	1354	+	(2) Venue is proper and judicial proceedings by or against the
	1355	+	commission shall be brought solely and exclusively in a court of
	1356	+	competent jurisdiction where the principal office of the commission is
	1357	+	located. The commission may waive venue and jurisdictional defenses to
	1358	+	the extent that it adopts or consents to participate in alternative dispute
	1359	+	resolution proceedings. Nothing herein shall affect or limit the selection or
	1360	+	propriety of venue in any action against a licensee for professional
	1361	+	malpractice, misconduct or any such similar matter.
	1362	+	(3) The commission shall be entitled to receive service of process in
	1363	+	any proceeding regarding the enforcement or interpretation of the compact
	1364	+	or the commission's rules and shall have standing to intervene in such a
	1365	+	proceeding for all purposes. Failure to provide the commission with
	1366	+	service of process shall render a judgment or order in such proceeding
	1367	+	void as to the commission, this compact or commission rules.
	1368	+	(b) Default, technical assistance and termination.
	1369	+	(1) If the commission determines that a participating state has
	1370	+	defaulted in the performance of its obligations or responsibilities under
	1371	+	this compact or the commission rules, the commission shall provide
	1372	+	written notice to the defaulting state and other participating states. The
	1373	+	notice shall describe the default, the proposed means of curing the default
	1374	+	and any other action that the commission may take and shall offer remedial
	1375	+	training and specific technical assistance regarding the default.
	1376	+	(2) If a state in default fails to cure the default, the defaulting state
	1377	+	may be terminated from this compact upon an affirmative vote of a
	1378	+	majority of the delegates of the participating states, and all rights,
	1379	+	privileges and benefits conferred by this compact upon such state may be
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	1423	+	terminated on the effective date of termination. A cure of the default shall
	1424	+	not relieve the offending state of obligations or liabilities incurred during
	1425	+	the period of default.
	1426	+	(3) Termination of participation in this compact shall be imposed only
	1427	+	after all other means of securing compliance have been exhausted. Notice
	1428	+	of intent to suspend or terminate shall be given by the commission to the
	1429	+	governor, the majority and minority leaders of the defaulting state's
	1430	+	legislature and to the licensing board of each of the participating states.
	1431	+	(4) A state that has been terminated is responsible for all assessments,
	1432	+	obligations and liabilities incurred through the effective date of
	1433	+	termination, including obligations that extend beyond the effective date of
	1434	+	termination.
	1435	+	(5) The commission shall not bear any costs related to a state that is
	1436	+	found to be in default or that has been terminated from this compact,
	1437	+	unless agreed upon in writing between the commission and the defaulting
	1438	+	state.
	1439	+	(6) The defaulting state may appeal its termination from the compact
	1440	+	by the commission by petitioning the United States district court for the
	1441	+	District of Columbia or the federal district where the commission has its
	1442	+	principal offices. The prevailing member shall be awarded all costs of such
	1443	+	litigation, including reasonable attorney fees.
	1444	+	(7) Upon the termination of a state's participation in the compact, the
	1445	+	state shall immediately provide notice to all licensees within that state of
	1446	+	such termination:
	1447	+	(A) Licensees who have been granted a compact privilege in that
	1448	+	state shall retain the compact privilege for 180 days following the effective
	1449	+	date of such termination; and
	1450	+	(B) licensees who are licensed in that state who have been granted a
	1451	+	compact privilege in a participating state shall retain the compact privilege
	1452	+	for 180 days unless the licensee also has a qualifying license in a
	1453	+	participating state or obtains a qualifying license in a participating state
	1454	+	before the 180-day period ends, in which case, the compact privilege shall
	1455	+	continue.
	1456	+	(c) Dispute resolution.
	1457	+	(1) Upon request by a participating state, the commission shall
	1458	+	attempt to resolve disputes related to this compact that arise among
	1459	+	participating states and between participating and nonparticipating states.
	1460	+	(2) The commission shall promulgate a rule providing for both
	1461	+	mediation and binding dispute resolution for disputes as appropriate.
	1462	+	(d) Enforcement.
	1463	+	(1) The commission, in the reasonable exercise of its discretion, shall
	1464	+	enforce the provisions of this compact and rules of the commission.
	1465	+	(2) If compliance is not secured after all means to secure compliance
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	1509	+	have been exhausted, by majority vote, the commission may initiate legal
	1510	+	action in the United States district court for the District of Columbia or the
	1511	+	federal district where the commission has its principal offices against a
	1512	+	participating state in default to enforce compliance with the provisions of
	1513	+	this compact and the commission's promulgated rules and bylaws. The
	1514	+	relief sought may include both injunctive relief and damages. In the event
	1515	+	that judicial enforcement is necessary, the prevailing party shall be
	1516	+	awarded all costs of such litigation, including reasonable attorney fees.
	1517	+	(3) The remedies herein shall not be the exclusive remedies of the
	1518	+	commission. The commission may pursue any other remedies available
	1519	+	under federal or state law.
	1520	+	(e) Legal action against the commission.
	1521	+	(1) A participating state may initiate legal action against the
	1522	+	commission in the United States district court for the District of Columbia
	1523	+	or the federal district where the commission has its principal offices to
	1524	+	enforce compliance with the provisions of the compact and its rules. The
	1525	+	relief sought may include both injunctive relief and damages. In the event
	1526	+	that judicial enforcement is necessary, the prevailing party shall be
	1527	+	awarded all costs of such litigation, including reasonable attorney fees.
	1528	+	(2) No person other than a participating state shall enforce this
	1529	+	compact against the commission.
	1530	+	SECTION 11—DATE OF IMPLEMENTATION OF THE PA
	1531	+	LICENSURE COMPACT COMMISSION
	1532	+	(a) This compact shall come into effect on the date that this compact
	1533	+	statute is enacted into law in the seventh participating state.
	1534	+	(1) On or after the effective date of the compact, the commission
	1535	+	shall convene and review the enactment of each of the states that enacted
	1536	+	the compact prior to the commission convening, called charter-
	1537	+	participating states, to determine if the statute enacted by each such
	1538	+	charter-participating state is materially different than the model compact.
	1539	+	(A) A charter-participating state whose enactment is found to be
	1540	+	materially different from the model compact shall be entitled to the default
	1541	+	process set forth in section 10(b).
	1542	+	(B) If any participating state later withdraws from the compact or its
	1543	+	participation is terminated, the commission shall remain in existence and
	1544	+	the compact shall remain in effect even if the number of participating
	1545	+	states should be fewer than seven. Participating states enacting the
	1546	+	compact subsequent to the commission convening shall be subject to the
	1547	+	process set forth in section 7(c)(21) to determine if their enactments are
	1548	+	materially different from the model compact and whether they qualify for
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	1592	+	participation in the compact.
	1593	+	(2) Participating states enacting the compact subsequent to the seven
	1594	+	initial charter-participating states shall be subject to the process set forth in
	1595	+	section 7(c)(21) to determine if their enactments are materially different
	1596	+	from the model compact and whether they qualify for participation in the
	1597	+	compact.
	1598	+	(3) All actions taken for the benefit of the commission or in
	1599	+	furtherance of the purposes of the administration of the compact prior to
	1600	+	the effective date of the compact or the commission coming into existence
	1601	+	shall be considered to be actions of the commission unless specifically
	1602	+	repudiated by the commission.
	1603	+	(b) Any state that joins this compact shall be subject to the
	1604	+	commission's rules and bylaws as they exist on the date that this compact
	1605	+	becomes law in that state. Any rule that has been previously adopted by
	1606	+	the commission shall have the full force and effect of law on the day that
	1607	+	this compact becomes law in that state.
	1608	+	(c) Any participating state may withdraw from this compact by
	1609	+	enacting a statute repealing the same.
	1610	+	(1) A participating state's withdrawal shall not take effect until 180
	1611	+	days after enactment of the repealing statute. During the 180-day period,
	1612	+	all compact privileges that were in effect in the withdrawing state and were
	1613	+	granted to licensees licensed in the withdrawing state shall remain in
	1614	+	effect. If any licensee licensed in the withdrawing state is also licensed in
	1615	+	another participating state or obtains a license in another participating state
	1616	+	within the 180 days, the licensee's compact privileges in other participating
	1617	+	states shall not be affected by the passage of the 180 days.
	1618	+	(2) Withdrawal shall not affect the continuing requirement of the state
	1619	+	licensing board of the withdrawing state to comply with the investigative
	1620	+	and adverse action reporting requirements of this compact prior to the
	1621	+	effective date of withdrawal.
	1622	+	(3) Upon the enactment of a statute withdrawing a state from this
	1623	+	compact, the state shall immediately provide notice of such withdrawal to
	1624	+	all licensees within that state. Such withdrawing state shall continue to
	1625	+	recognize all licenses granted pursuant to this compact for a minimum of
	1626	+	180 days after the date of such notice of withdrawal.
	1627	+	(d) Nothing contained in this compact shall be construed to invalidate
	1628	+	or prevent any PA licensure agreement or other cooperative arrangement
	1629	+	between participating states and between a participating state and
	1630	+	nonparticipating state that does not conflict with the provisions of this
	1631	+	compact.
	1632	+	(e) This compact may be amended by the participating states. No
	1633	+	amendment to this compact shall become effective and binding upon any
	1634	+	participating state until it is enacted materially in the same manner into the
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	1678	+	laws of all participating states as determined by the commission.
	1679	+	SECTION 12—CONSTRUCTION AND SEVERABILITY
	1680	+	(a) This compact and the commission's rulemaking authority shall be
	1681	+	liberally construed so as to effectuate the purposes and the implementation
	1682	+	and administration of the compact. Provisions of the compact expressly
	1683	+	authorizing or requiring the promulgation of rules shall not be construed to
	1684	+	limit the commission's rulemaking authority solely for those purposes.
	1685	+	(b) The provisions of this compact shall be severable, and if any
	1686	+	phrase, clause, sentence or provision of this compact is held by a court of
	1687	+	competent jurisdiction to be contrary to the constitution of any
	1688	+	participating state, a state seeking participation in the compact or of the
	1689	+	United States, or the applicability thereof to any government, agency,
	1690	+	person or circumstance is held to be unconstitutional by a court of
	1691	+	competent jurisdiction, the validity of the remainder of this compact and
	1692	+	the applicability thereof to any other government, agency, person or
	1693	+	circumstance shall not be affected thereby.
	1694	+	(c) Notwithstanding the provisions of this subsection or subsection
	1695	+	(b), the commission may deny a state's participation in the compact or, in
	1696	+	accordance with the requirements of section 10(b), terminate a
	1697	+	participating state's participation in the compact, if it determines that a
	1698	+	constitutional requirement of a participating state is, or would be with
	1699	+	respect to a state seeking to participate in the compact, a material departure
	1700	+	from the compact. Otherwise, if this compact shall be held to be contrary
	1701	+	to the constitution of any participating state, the compact shall remain in
	1702	+	full force and effect as to the remaining participating states and in full
	1703	+	force and effect as to the participating state affected as to all severable
	1704	+	matters.
	1705	+	SECTION 13—BINDING EFFECT OF COMPACT
	1706	+	(a) Nothing herein prevents the enforcement of any other law of a
	1707	+	participating state that is not inconsistent with this compact.
	1708	+	(b) Any laws in a participating state in conflict with this compact are
	1709	+	superseded to the extent of the conflict.
	1710	+	(c) All agreements between the commission and the participating
	1711	+	states are binding in accordance with their terms.
	1712	+	Sec. 2. This act shall take effect and be in force from and after its
344	1713		publication in the statute book.
345		-	I hereby certify that the above BILL originated in the
346		-	SENATE, and passed that body
347		-	__________________________
348		-	SENATE adopted
349		-	Conference Committee Report ________________
350		-	_________________________
351		-	President of the Senate.
352		-	_________________________
353		-	Secretary of the Senate.
354		-
355		-	Passed the HOUSE
356		-	as amended _________________________
357		-	HOUSE adopted
358		-	Conference Committee Report ________________
359		-	_________________________
360		-	Speaker of the House.
361		-	_________________________
362		-	Chief Clerk of the House.
363		-	APPROVED _____________________________
364		-	_________________________
365		-	Governor.
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