Date of enactment: December 6, 2023 2023 Senate Bill 400 Date of publication*: December 7, 2023 2023 WISCONSIN ACT 81 AN ACT to renumber 252.14 (1) (ar) 14., 448.978 (1) and 448.978 (2) (d) 1. and 2.; to renumber and amend 440.03 (13) (c), 448.015 (4) (am) 2m., 448.974 (2) and 448.978 (2) (d) (intro.); to amend 49.45 (9r) (a) 7. e., 97.67 (5m) (a) 3., 118.2925 (1) (f), 146.81 (1) (eu), 146.997 (1) (d) 4., 154.01 (3) (b), 155.01 (1g) (c), 155.01 (7), 440.03 (9) (a) (intro.), 440.03 (9) (a) 2., 440.03 (13) (b) (intro.), 440.094 (1) (c) 4., 440.15, 448.971 (2), 448.972 (1), 448.973 (2), 448.974 (title), 448.978 (2) (intro.), 448.978 (2) (a), 448.978 (2) (g), 450.10 (3) (a) 5., 462.02 (2) (e), 462.04, 895.48 (1m) (a) (intro.), 971.14 (4) (a) and 990.01 (27s); to repeal and recreate 16.417 (1) (e) 3m. and 252.15 (1) (am); and to create 14.835, 111.335 (4) (jm), 440.03 (11m) (c) 2c., 440.03 (13) (c) 1. i., 440.094 (1) (c) 9m., 448.971 (1L), 448.971 (1m), 448.974 (1m), 448.974 (2) (bm) and subchapter XIII of chapter 448 [precedes 448.988] of the statutes; relating to: ratification of the PA Licensure Compact. The people of the state of Wisconsin, represented in senate and assembly, do enact as follows: SECTION 1. 14.835 of the statutes is created to read: 14.835 PA licensure compact. There is created a PA licensure compact commission as specified in s. 448.988. The delegate on the commission representing this state shall be appointed by the physician assistant affiliated credentialing board as provided in s. 448.988 (7) (b) 1. and shall be an individual described in s. 448.988 (7) (b) 2. a. or b. The commission has the powers and duties granted and imposed under s. 448.988. SECTION 2. 16.417 (1) (e) 3m. of the statutes is repealed and recreated to read: 16.417 (1) (e) 3m. A physician assistant who is licensed under subch. IX of ch. 448 or who holds a com- pact privilege under subch. XIII of ch. 448. SECTION 3. 49.45 (9r) (a) 7. e. of the statutes is amended to read: 49.45 (9r) (a) 7. e. A physician assistant who is licensed under subch. IX of ch. 448 or who holds a com- pact privilege under subch. XIII of ch. 448. SECTION 4. 97.67 (5m) (a) 3. of the statutes is amended to read: 97.67 (5m) (a) 3. A physician assistant who is licensed under subch. IX of ch. 448 or who holds a com- pact privilege under subch. XIII of ch. 448. SECTION 5. 111.335 (4) (jm) of the statutes is created to read: 111.335 (4) (jm) Notwithstanding s. 111.322, it is not employment discrimination because of conviction record for the physician assistant affiliated credentialing board to refuse to grant to an individual a compact privi- lege, as defined in s. 448.988 (2) (b), in accordance with s. 448.988 (4) (a) 3. SECTION 6. 118.2925 (1) (f) of the statutes is amended to read: * Section 991.11, WISCONSIN STATUTES: Effective date of acts. “Every act and every portion of an act enacted by the legislature over the governor’s partial veto which does not expressly prescribe the time when it takes effect shall take effect on the day after its date of publication.” − 2 −2023 Wisconsin Act 81 2023 Senate Bill 400 118.2925 (1) (f) “Physician assistant” means a per- son who is licensed under s. 448.974 subch. IX of ch. 448 or who holds a compact privilege under subch. XIII of ch. 448. SECTION 7. 146.81 (1) (eu) of the statutes is amended to read: 146.81 (1) (eu) A physician assistant who is licensed under subch. IX of ch. 448 or who holds a compact privi- lege under subch. XIII of ch. 448. SECTION 8. 146.997 (1) (d) 4. of the statutes, as affected by 2021 Wisconsin Act 251, is amended to read: 146.997 (1) (d) 4. A physician, physician assistant, podiatrist, perfusionist, physical therapist, physical ther- apist assistant, occupational therapist, occupational ther- apy assistant, or genetic counselor licensed under ch. 448; a physical therapist or physical therapist assistant who holds a compact privilege under subch. XI of ch. 448; or an occupational therapist or occupational therapy assistant who holds a compact privilege under subch. XII of ch. 448; or a physician assistant who holds a compact privilege under subch. XIII of ch. 448. SECTION 9. 154.01 (3) (b) of the statutes is amended to read: 154.01 (3) (b) A physician assistant licensed under ch. 448. SECTION 10. 155.01 (1g) (c) of the statutes is amended to read: 155.01 (1g) (c) A physician assistant licensed under ch. 448 who a physician responsible for overseeing the physician assistant’s practice affirms is competent to conduct evaluations of the capacity of patients to manage health care decisions. SECTION 11. 155.01 (7) of the statutes, as affected by 2021 Wisconsin Act 251, is amended to read: 155.01 (7) “Health care provider” means a nurse licensed or permitted under ch. 441, a chiropractor licensed under ch. 446, a dentist licensed under ch. 447, a physician, physician assistant, perfusionist, podiatrist, physical therapist, physical therapist assistant, occupa- tional therapist, occupational therapy assistant, or genetic counselor licensed under ch. 448, a naturopathic doctor licensed under ch. 466, a person practicing Chris- tian Science treatment, an optometrist licensed under ch. 449, a psychologist who is licensed under ch. 455, who is exercising the temporary authorization to practice, as defined in s. 455.50 (2) (o), in this state, or who is practic- ing under the authority to practice interjurisdictional telepsychology, as defined in s. 455.50 (2) (b), a physical therapist or physical therapist assistant who holds a com- pact privilege under subch. XI of ch. 448, an occupational therapist or occupational therapy assistant who holds a compact privilege under subch. XII of ch. 448, a physi- cian assistant who holds a compact privilege under subch. XIII of ch. 448, a partnership thereof, a corpora- tion or limited liability company thereof that provides health care services, a cooperative health care association organized under s. 185.981 that directly provides ser- vices through salaried employees in its own facility, or a home health agency, as defined in s. 50.49 (1) (a). SECTION 12. 252.14 (1) (ar) 14. of the statutes is renumbered 252.14 (1) (ar) 4rm. SECTION 13. 252.15 (1) (am) of the statutes is repealed and recreated to read: 252.15 (1) (am) “Health care professional” means a physician, physician assistant, or nurse. SECTION 14. 440.03 (9) (a) (intro.) of the statutes is amended to read: 440.03 (9) (a) (intro.) Subject to pars. (b) and (c) and s. 458.33 (2) (b) and (5), the department shall, biennially, determine each fee for an initial credential for which no examination is required, for a reciprocal credential, and for a credential renewal and any fees imposed under ss. 448.986 (2) and , 448.9875 (2), and 448.9885 (2) by doing all of the following: SECTION 15. 440.03 (9) (a) 2. of the statutes is amended to read: 440.03 (9) (a) 2. Not later than January 31 of each odd−numbered year, adjusting for the succeeding fiscal biennium each fee for an initial credential for which an examination is not required, for a reciprocal credential, and, subject to s. 440.08 (2) (a), for a credential renewal, and any fees imposed under ss. 448.986 (2) and, 448.9875 (2), and 448.9885 (2), if an adjustment is neces- sary to reflect the approximate administrative and enforcement costs of the department that are attributable to the regulation of the particular occupation or business during the period in which the initial or reciprocal cre- dential, credential renewal, or compact privilege is in effect and, for purposes of each fee for a credential renewal, to reflect an estimate of any additional moneys available for the department’s general program opera- tions as a result of appropriation transfers that have been or are estimated to be made under s. 20.165 (1) (i) during the fiscal biennium in progress at the time of the deadline for an adjustment under this subdivision or during the fis- cal biennium beginning on the July 1 immediately fol- lowing the deadline for an adjustment under this subdivi- sion. SECTION 16. 440.03 (11m) (c) 2c. of the statutes is created to read: 440.03 (11m) (c) 2c. The coordinated data and reporting system under s. 448.988 (8), if such disclosure is required under the PA licensure compact under s. 448.988. SECTION 17. 440.03 (13) (b) (intro.) of the statutes is amended to read: 440.03 (13) (b) (intro.) The department may investi- gate whether an applicant for or holder of any of the fol- lowing credentials has been charged with or convicted of a crime only pursuant to rules promulgated by the depart- ment under this paragraph, including rules that establish the criteria that the department will use to determine − 3 − 2023 Wisconsin Act 81 2023 Senate Bill 400 whether an investigation under this paragraph is neces- sary, except as provided in par. (c) and ss. 441.51 (5) (a) 5., 448.980 (5) (b) 3., 448.985 (3) (a) 4., 448.987 (3) (a) 5. a. and (5) (b) 2. a., 448.988 (3) (a) 5., and 455.50 (3) (e) 4. and (f) 4.: SECTION 18. 440.03 (13) (c) of the statutes is renum- bered 440.03 (13) (c) 1. (intro.) and amended to read: 440.03 (13) (c) 1. (intro.) The department shall require an all of the following to be photographed and fin- gerprinted on 2 fingerprint cards, each bearing a com- plete set of the person’s fingerprints: a. An applicant for a private detective license or a pri- vate security permit under s. 440.26, an. b. An applicant for a juvenile martial arts instructor permit under sub. (17), an. c. An applicant for a real estate appraiser certification under s. 458.06 or license under s. 458.08, an. d. An applicant for a multistate license under s. 441.06 (1c) or 441.10 (1c), an. e. An applicant for a compact license under s. 448.05 (2) (f), an. f. An applicant for a physical therapist license under s. 448.53 or physical therapist assistant license under s. 448.535, an. g. An applicant for an occupational therapist or occu- pational therapy assistant compact privilege under s. 448.987 (4), and an applicant for an occupational thera- pist or occupational therapy assistant license described in s. 448.987 (5) (b) 2. a., an h. An applicant for a psychologist license under s. 455.04, and a. z. A person for whom the department conducts an investigation under par. (b), to be photographed and fin- gerprinted on 2 fingerprint cards, each bearing a com- plete set of the person’s fingerprints. 2. The department of justice may submit the finger- print cards, and the department of justice shall submit the fingerprint cards of all applicants for a real estate appraiser certification under s. 458.06 or license under s. 458.08, of all applicants for a multistate license under s. 441.06 (1c) or 441.10 (1c), of all applicants for a compact license under s. 448.05 (2) (f), of all applicants for a phys- ical therapist license under s. 448.53 or a physical thera- pist assistant license under s. 448.535, and of all appli- cants for a psychologist license under s. 455.04 identified in subd. 1. c. to i., to the federal bureau of investigation for the purpose of verifying the identity of the persons fingerprinted and obtaining records of their criminal arrests and convictions. 3. Information obtained from the federal bureau of investigation may be shared with the department or the appropriate credentialing board, but shall otherwise be kept confidential and is not subject to disclosure under s. 19.35. SECTION 19. 440.03 (13) (c) 1. i. of the statutes is cre- ated to read: 440.03 (13) (c) 1. i. An applicant for a physician assistant license or compact privilege under s. 448.974 when required pursuant to the PA licensure compact under s. 448.988. SECTION 20. 440.094 (1) (c) 4. of the statutes is amended to read: 440.094 (1) (c) 4. A physician, physician assistant, perfusionist, or respiratory care practitioner licensed or certified under subch. II of ch. 448. SECTION 21. 440.094 (1) (c) 9m. of the statutes is cre- ated to read: 440.094 (1) (c) 9m. A physician assistant licensed under subch. IX of ch. 448. SECTION 22. 440.15 of the statutes is amended to read: 440.15 No fingerprinting. Except as provided under ss. 440.03 (13) (c), 441.51 (5) (a) 5., 448.980 (5) (b) 3., 448.985 (3) (a) 4., 448.987 (3) (a) 5. a. and (5) (b) 2. a., 448.988 (3) (a) 5., 450.071 (3) (c) 9., 450.075 (3) (c) 9., and 455.50 (3) (e) 4. and (f) 4., the department or a cre- dentialing board may not require that an applicant for a credential or a credential holder be fingerprinted or sub- mit fingerprints in connection with the department’s or the credentialing board’s credentialing. SECTION 23. 448.015 (4) (am) 2m. of the statutes is renumbered 448.978 (1g) (a) and amended to read: 448.978 (1g) (a) A “Unprofessional conduct” includes a determination made by a physician assistant under ch. 154 or 155 if the physician assistant does not have sufficient education, training, and experience to make the determination. SECTION 24. 448.971 (1L) of the statutes is created to read: 448.971 (1L) “Compact” means the PA licensure compact under s. 448.988. SECTION 25. 448.971 (1m) of the statutes is created to read: 448.971 (1m) “Compact privilege” means a compact privilege, as defined in s. 448.988 (2) (b), that is granted under the compact to an individual to practice in this state. SECTION 26. 448.971 (2) of the statutes is amended to read: 448.971 (2) “Physician assistant” means a person who is licensed under this subchapter or who holds a compact privilege. SECTION 27. 448.972 (1) of the statutes is amended to read: 448.972 (1) Except as provided in subs. (2) and (3), no person may represent himself or herself as a “PA” or “physician assistant,” use or assume the title “PA” or “physician assistant,” or append to the person’s name the words or letters “physician assistant,” “PA,” “PA−C,” or any other titles, letters, or designation that represents or may tend to represent the person as a physician assistant, − 4 −2023 Wisconsin Act 81 2023 Senate Bill 400 unless he or she is licensed by the board under this sub- chapter or holds a compact privilege. SECTION 29. 448.973 (2) of the statutes is amended to read: 448.973 (2) The board shall include in the register the board maintains under s. 440.035 (1m) (d) the names name of all persons each person whose licenses license or compact privilege issued under this subchapter were was suspended or revoked within the past 2 years. The register shall be available for purchase at cost. SECTION 30. 448.974 (title) of the statutes is amended to read: 448.974 (title) License; compact privilege; renewal. SECTION 31. 448.974 (1m) of the statutes is created to read: 448.974 (1m) The board shall grant a compact privi- lege to any applicant who satisfies all of the following: (a) The applicant holds a qualifying license, as defined in s. 448.988 (2) (r), in another state that is a party to the compact and satisfies all other requirements under s. 448.988 (4). (b) The individual applies for the compact privilege in the manner prescribed by the department. (c) The individual pays any fee established by the department under s. 448.9885 (2). SECTION 32. 448.974 (2) of the statutes is renum- bered 448.974 (2) (am) and amended to read: 448.974 (2) (am) 1. The renewal date for a license issued under this subchapter is specified under s. 440.08 (2) (a), and the renewal fees for such licenses are deter- mined by the department under s. 440.03 (9) (a). Renewal of a license is subject to par. (b) subd. 2. 2. An applicant for the renewal of a license under this subchapter shall submit with his or her application for renewal proof of having satisfied the continuing educa- tion requirements imposed by the board under s. 448.973 (1) (b). This paragraph subdivision does not apply to an applicant for renewal of a license that expires on the first renewal date after the date on which the board initially granted the license. SECTION 33. 448.974 (2) (bm) of the statutes is cre- ated to read: 448.974 (2) (bm) Renewal of a compact privilege shall be governed by s. 448.988 (4) (b), except that the board may impose requirements for prescribing con- trolled substances in accordance with s. 448.988 (4) (d). SECTION 34. 448.978 (1) of the statutes is renum- bered 448.978 (1r). SECTION 35. 448.978 (2) (intro.) of the statutes is amended to read: 448.978 (2) (intro.) Subject to the rules promulgated under s. 440.03 (1), if a person who applies for or holds a license or compact privilege issued under s. 448.974 does any of the following, the board may reprimand the person or deny, limit, suspend, or revoke the person’s license or compact privilege: SECTION 36. 448.978 (2) (a) of the statutes is amended to read: 448.978 (2) (a) Makes a material misstatement in an application for a license or compact privilege or an appli- cation for renewal of a license or compact privilege under s. 448.974. SECTION 37. 448.978 (2) (d) (intro.) of the statutes is renumbered 448.978 (2) (d) and amended to read: 448.978 (2) (d) Engages in unprofessional conduct. (1g) In this paragraph, “unprofessional section: (b) “Unprofessional conduct” does not include any of the following: SECTION 38. 448.978 (2) (d) 1. and 2. of the statutes are renumbered 448.978 (1g) (b) 1. and 2. SECTION 39. 448.978 (2) (g) of the statutes is amended to read: 448.978 (2) (g) Engages in fraud or deceit in obtain- ing or using his or her license or compact privilege. SECTION 40. Subchapter XIII of chapter 448 [pre- cedes 448.988] of the statutes is created to read: CHAPTER 448 SUBCHAPTER XIII PA LICENSURE COMPACT 448.988 PA licensure compact. (1) PURPOSE. In order to strengthen access to medical services, and in recognition of the advances in the delivery of medical services, the participating states of the PA licensure com- pact have allied in common purpose to develop a compre- hensive process that complements the existing authority of state licensing boards to license and discipline PAs and seeks to enhance the portability of a license to practice as a PA while safeguarding the safety of patients. This com- pact allows medical services to be provided by PAs, via the mutual recognition of the licensee’s qualifying license by other compact participating states. This com- pact also adopts the prevailing standard for PA licensure and affirms that the practice and delivery of medical ser- vices by the PA occurs where the patient is located at the time of the patient encounter, and therefore requires the PA to be under the jurisdiction of the state licensing board where the patient is located. State licensing boards that participate in this compact retain the jurisdiction to impose adverse action against a compact privilege in that state issued to a PA through the procedures of this com- pact. The PA licensure compact will alleviate burdens for military families by allowing active duty military person- nel and their spouses to obtain a compact privilege based on having an unrestricted license in good standing from a participating state. (2) DEFINITIONS. In this compact: (a) “Adverse action” means any administrative, civil, equitable, or criminal action permitted by a state’s laws which is imposed by a licensing board or other authority − 5 − 2023 Wisconsin Act 81 2023 Senate Bill 400 against a PA license or license application or compact privilege such as license denial, censure, revocation, sus- pension, probation, monitoring of the licensee, or restric- tion on the licensee’s practice. (b) “Compact privilege” means the authorization granted by a remote state to allow a licensee from another participating state to practice as a PA to provide medical services and other licensed activity to a patient located in the remote state under the remote state’s laws and regula- tions. (c) “Conviction” means a finding by a court that an individual is guilty of a felony or misdemeanor offense through adjudication or entry of a plea of guilt or no con- test to the charge by the offender (d) “Criminal background check” means the submis- sion of fingerprints or other biometric−based information for a license applicant for the purpose of obtaining that applicant’s criminal history record information, as defined in 28 CFR 20.3 (d), from the state’s criminal his- tory record repository, as defined in 28 CFR 20.3 (f). (e) “Data system” means the repository of informa- tion about licensees, including but not limited to license status and adverse actions, which is created and adminis- tered under the terms of this compact. (f) “Executive committee” means a group of direc- tors and ex officio individuals elected or appointed pur- suant to sub. (7) (f) 2. (g) “Impaired practitioner” means a PA whose prac- tice is adversely affected by health−related condition(s) that impact their ability to practice. (h) “Investigative information” means information, records, or documents received or generated by a licens- ing board pursuant to an investigation. (i) “Jurisprudence requirement” means the assess- ment of an individual’s knowledge of the laws and rules governing the practice of a PA in a state. (j) “License” means current authorization by a state, other than authorization pursuant to a compact privilege, for a PA to provide medical services, which would be unlawful without current authorization. (k) “Licensee” means an individual who holds a license from a state to provide medical services as a PA. (L) “Licensing board” means any state entity autho- rized to license and otherwise regulate PAs. (m) “Medical services” means health care services provided for the diagnosis, prevention, treatment, cure or relief of a health condition, injury, or disease, as defined by a state’s laws and regulations. (n) “Model compact” means the model for the PA licensure compact on file with the Council of State Gov- ernments or other entity as designated by the commis- sion. (o) “Participating state” means a state that has enacted this compact. (p) “PA” means an individual who is licensed as a physician assistant in a state. For purposes of this com- pact, any other title or status adopted by a state to replace the term “physician assistant” shall be deemed synony- mous with “physician assistant” and shall confer the same rights and responsibilities to the licensee under the provisions of this compact at the time of its enactment. (q) “PA licensure compact commission,” “compact commission,” or “commission” mean the national administrative body created pursuant to sub. (7) (a). (r) “Qualifying license” means an unrestricted license issued by a participating state to provide medical services as a PA. (s) “Remote state” means a participating state where a licensee who is not licensed as a PA is exercising or seeking to exercise the compact privilege. (t) “Rule” means a regulation promulgated by an entity that has the force and effect of law. (u) “Significant investigative information” means investigative information that a licensing board, after an inquiry or investigation that includes notification and an opportunity for the PA to respond if required by state law, has reason to believe is not groundless and, if proven true, would indicate more than a minor infraction. (v) “State” means any state, commonwealth, district, or territory of the United States. (3) STATE PARTICIPATION IN THIS COMPACT. (a) To par- ticipate in this compact, a participating state shall: 1. License PAs. 2. Participate in the compact commission’s data sys- tem. 3. Have a mechanism in place for receiving and investigating complaints against licensees and license applicants. 4. Notify the commission, in compliance with the terms of this compact and commission rules, of any adverse action against a licensee or license applicant and the existence of significant investigative information regarding a licensee or license applicant. 5. Fully implement a criminal background check requirement, within a time frame established by commis- sion rule, by its licensing board receiving the results of a criminal background check and reporting to the commis- sion whether the license applicant has been granted a license. 6. Comply with the rules of the compact commission. 7. Utilize passage of a recognized national exam such as the NCCPA PANCE as a requirement for PA licensure. 8. Grant the compact privilege to a holder of a quali- fying license in a participating state. (b) Nothing in this compact prohibits a participating state from charging a fee for granting the compact privi- lege. (4) COMPACT PRIVILEGE. (a) To exercise the compact privilege, a licensee must: 1. Have graduated from a PA program accredited by the Accreditation Review Commission on Education for − 6 −2023 Wisconsin Act 81 2023 Senate Bill 400 the Physician Assistant, Inc. or other programs autho- rized by commission rule. 2. Hold current NCCPA certification. 3. Have no felony or misdemeanor conviction. 4. Have never had a controlled substance license, per- mit, or registration suspended or revoked by a state or by the United States drug enforcement administration. 5. Have a unique identifier as determined by commis- sion rule. 6. Hold a qualifying license. 7. Have had no revocation of a license or limitation or restriction on any license currently held due to an adverse action. 8. If a licensee has had a limitation or restriction on a license or compact privilege due to an adverse action, two years must have elapsed from the date on which the license or compact privilege is no longer limited or restricted due to the adverse action. 9. If a compact privilege has been revoked or is lim- ited or restricted in a participating state for conduct that would not be a basis for disciplinary action in a participat- ing state in which the licensee is practicing or applying to practice under a compact privilege, that participating state shall have the discretion not to consider such action as an adverse action requiring the denial or removal of a compact privilege in that state. 10. Notify the compact commission that the licensee is seeking the compact privilege in a remote state. 11. Meet any jurisprudence requirement of a remote state in which the licensee is seeking to practice under the compact privilege and pay any fees applicable to satisfy- ing the jurisprudence requirement. 12. Report to the commission any adverse action taken by a nonparticipating state within thirty (30) days after the action is taken. (b) The compact privilege is valid until the expiration or revocation of the qualifying license unless terminated pursuant to an adverse action. The licensee must also comply with all of the requirements of par. (a) above to maintain the compact privilege in a remote state. If the participating state takes adverse action against a qualify- ing license, the licensee shall lose the compact privilege in any remote state in which the licensee has a compact privilege until all of the following occur: 1. The license is no longer limited or restricted; and 2. Two (2) years have elapsed from the date on which the license is no longer limited or restricted due to the adverse action. (c) Once a restricted or limited license satisfies the requirements of par. (b) 1. and 2., the licensee must meet the requirements of par. (a) to obtain a compact privilege in any remote state. (d) For each remote state in which a PA seeks author- ity to prescribe controlled substances, the PA shall satisfy all requirements imposed by such state in granting or renewing such authority. (5) DESIGNATION OF THE STATE FROM WHICH LICENSEE IS APPLYING FOR A COMPACT PRIVILEGE. Upon a licensee’s application for a compact privilege, the licensee shall identify to the commission the participating state from which the licensee is applying, in accordance with appli- cable rules adopted by the commission, and subject to the following requirements: (a) When applying for a compact privilege, the licensee shall provide the commission with the address of the licensee’s primary residence and thereafter shall immediately report to the commission any change in the address of the licensee’s primary residence. (b) When applying for a compact privilege, the licensee is required to consent to accept service of process by mail at the licensee’s primary residence on file with the commission with respect to any action brought against the licensee by the commission or a participating state, including a subpoena, with respect to any action brought or investigation conducted by the commission or a participating state. (6) ADVERSE ACTIONS. (a) A participating state in which a licensee is licensed shall have exclusive power to impose adverse action against the qualifying license issued by that participating state. (b) In addition to the other powers conferred by state law, a remote state shall have the authority, in accordance with existing state due process law, to do all of the follow- ing: 1. Take adverse action against a PA’s compact privi- lege within that state to remove a licensee’s compact privilege or take other action necessary under applicable law to protect the health and safety of its citizens. 2. Issue subpoenas for both hearings and investiga- tions that require the attendance and testimony of wit- nesses as well as the production of evidence. Subpoenas issued by a licensing board in a participating state for the attendance and testimony of witnesses or the production of evidence from another participating state shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state in which the witnesses or evidence are located. 3. Notwithstanding subd. 2., subpoenas may not be issued by a participating state to gather evidence of con- duct in another state that is lawful in that other state for the purpose of taking adverse action against a licensee’s compact privilege or application for a compact privilege in that participating state. 4. Nothing in this compact authorizes a participating state to impose discipline against a PA’s compact privi- lege or to deny an application for a compact privilege in that participating state for the individual’s otherwise lawful practice in another state. − 7 − 2023 Wisconsin Act 81 2023 Senate Bill 400 (c) For purposes of taking adverse action, the partici- pating state which issued the qualifying license shall give the same priority and effect to reported conduct received from any other participating state as it would if the con- duct had occurred within the participating state which issued the qualifying license. In so doing, that participat- ing state shall apply its own state laws to determine appropriate action. (d) A participating state, if otherwise permitted by state law, may recover from the affected PA the costs of investigations and disposition of cases resulting from any adverse action taken against that PA. (e) A participating state may take adverse action based on the factual findings of a remote state, provided that the participating state follows its own procedures for taking the adverse action. (f) Joint investigations. 1. In addition to the author- ity granted to a participating state by its respective state PA laws and regulations or other applicable state law, any participating state may participate with other participat- ing states in joint investigations of licensees. 2. Participating states shall share any investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under this com- pact. (g) If an adverse action is taken against a PA’s quali- fying license, the PA’s compact privilege in all remote states shall be deactivated until two (2) years have elapsed after all restrictions have been removed from the state license. All disciplinary orders by the participating state which issued the qualifying license that impose adverse action against a PA’s license shall include a state- ment that the PA’s compact privilege is deactivated in all participating states during the pendency of the order. (h) If any participating state takes adverse action, it promptly shall notify the administrator of the data sys- tem. (7) ESTABLISHMENT OF THE PA LICENSURE COMPACT COMMISSION. (a) The participating states hereby create and establish a joint government agency and national administrative body known as the PA licensure compact commission. The commission is an instrumentality of the compact states acting jointly and not an instrumental- ity of any one state. The commission shall come into existence on or after the effective date of the compact as set forth in sub. (11) (a). (b) Membership, voting, and meetings. 1. Each par- ticipating state shall have and be limited to one (1) dele- gate selected by that participating state’s licensing board or, if the state has more than one licensing board, selected collectively by the participating state’s licensing boards. 2. The delegate shall be either: a. A current PA, physician or public member of a licensing board or PA council/committee; or b. An administrator of a licensing board. 3. Any delegate may be removed or suspended from office as provided by the laws of the state from which the delegate is appointed. 4. The participating state licensing board shall fill any vacancy occurring in the commission within sixty (60) days. 5. Each delegate shall be entitled to one (1) vote on all matters voted on by the commission and shall other- wise have an opportunity to participate in the business and affairs of the commission. A delegate shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for delegates’ participation in meetings by telecommunications, video conference, or other means of communication. 6. The commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in this compact and the bylaws. 7. The commission shall establish by rule a term of office for delegates. (c) The commission shall have the following powers and duties: 1. Establish a code of ethics for the commission; 2. Establish the fiscal year of the commission; 3. Establish fees; 4. Establish bylaws; 5. Maintain its financial records in accordance with the bylaws; 6. Meet and take such actions as are consistent with the provisions of this compact and the bylaws; 7. Promulgate rules to facilitate and coordinate implementation and administration of this compact. The rules shall have the force and effect of law and shall be binding in all participating states; 8. Bring and prosecute legal proceedings or actions in the name of the commission, provided that the standing of any state licensing board to sue or be sued under appli- cable law shall not be affected; 9. Purchase and maintain insurance and bonds; 10. Borrow, accept, or contract for services of per- sonnel, including, but not limited to, employees of a par- ticipating state; 11. Hire employees and engage contractors, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this compact, and establish the commission’s personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters; 12. Accept any and all appropriate donations and grants of money, equipment, supplies, materials and ser- vices, and receive, utilize and dispose of the same; pro- vided that at all times the commission shall avoid any appearance of impropriety or conflict of interest; 13. Lease, purchase, accept appropriate gifts or dona- tions of, or otherwise own, hold, improve or use, any − 8 −2023 Wisconsin Act 81 2023 Senate Bill 400 property, real, personal or mixed; provided that at all times the commission shall avoid any appearance of impropriety; 14. Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property real, per- sonal, or mixed; 15. Establish a budget and make expenditures; 16. Borrow money; 17. Appoint committees, including standing commit- tees composed of members, state regulators, state legisla- tors or their representatives, and consumer representa- tives, and such other interested persons as may be designated in this compact and the bylaws; 18. Provide and receive information from, and coop- erate with, law enforcement agencies; 19. Elect a chair, vice chair, secretary and treasurer and such other officers of the commission as provided in the commission’s bylaws. 20. Reserve for itself, in addition to those reserved exclusively to the commission under the compact, pow- ers that the executive committee may not exercise; 21. Approve or disapprove a state’s participation in the compact based upon its determination as to whether the state’s compact legislation departs in a material man- ner from the model compact language; 22. Prepare and provide to the participating states an annual report; and 23. Perform such other functions as may be necessary or appropriate to achieve the purposes of this compact consistent with the state regulation of PA licensure and practice. (d) Meetings of the commission. 1. All meetings of the commission that are not closed pursuant to this para- graph shall be open to the public. Notice of public meet- ings shall be posted on the commission’s website at least thirty (30) days prior to the public meeting. 2. Notwithstanding subd. 1., the commission may convene a public meeting by providing at least twenty− four (24) hours prior notice on the commission’s website, and any other means as provided in the commission’s rules, for any of the reasons it may dispense with notice of proposed rulemaking under sub. (9) (L). 3. The commission may convene in a closed, non- public meeting or nonpublic part of a public meeting to receive legal advice or to discuss: a. Noncompliance of a participating state with its obligations under this compact; b. The employment, compensation, discipline or other matters, practices or procedures related to specific employees or other matters related to the commission’s internal personnel practices and procedures; c. Current, threatened, or reasonably anticipated liti- gation; d. Negotiation of contracts for the purchase, lease, or sale of goods, services, or real estate; e. Accusing any person of a crime or formally censur- ing any person; f. Disclosure of trade secrets or commercial or finan- cial information that is privileged or confidential; g. Disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy; h. Disclosure of investigative records compiled for law enforcement purposes; i. Disclosure of information related to any investiga- tive reports prepared by or on behalf of or for use of the commission or other committee charged with responsi- bility of investigation or determination of compliance issues pursuant to this compact; j. Legal advice; or k. Matters specifically exempted from disclosure by federal or participating states’ statutes. 4. If a meeting, or portion of a meeting, is closed pur- suant to this provision, the chair of the meeting or the chair’s designee shall certify that the meeting or portion of the meeting may be closed and shall reference each rel- evant exempting provision. 5. The commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, including a description of the views expressed. All documents considered in connection with an action shall be identified in such minutes. All minutes and docu- ments of a closed meeting shall remain under seal, sub- ject to release by a majority vote of the commission or order of a court of competent jurisdiction. (e) Financing of the commission. 1. The commission shall pay, or provide for the payment of, the reasonable expenses of its establishment, organization, and ongoing activities. 2. The commission may accept any and all appropri- ate revenue sources, donations, and grants of money, equipment, supplies, materials, and services. 3. The commission may levy on and collect an annual assessment from each participating state and may impose compact privilege fees on licensees of participating states to whom a compact privilege is granted to cover the cost of the operations and activities of the commission and its staff, which must be in a total amount sufficient to cover its annual budget as approved by the commission each year for which revenue is not provided by other sources. The aggregate annual assessment amount levied on par- ticipating states shall be allocated based upon a formula to be determined by commission rule. a. A compact privilege expires when the licensee’s qualifying license in the participating state from which the licensee applied for the compact privilege expires. b. If the licensee terminates the qualifying license through which the licensee applied for the compact privi- lege before its scheduled expiration, and the licensee has − 9 − 2023 Wisconsin Act 81 2023 Senate Bill 400 a qualifying license in another participating state, the licensee shall inform the commission that it is changing to that participating state the participating state through which it applies for a compact privilege and pay to the commission any compact privilege fee required by com- mission rule. 4. The commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same; nor shall the commission pledge the credit of any of the participating states, except by and with the author- ity of the participating state. 5. The commission shall keep accurate accounts of all receipts and disbursements. The receipts and dis- bursements of the commission shall be subject to the financial review and accounting procedures established under its bylaws. All receipts and disbursements of funds handled by the commission shall be subject to an annual financial review by a certified or licensed public account- ant, and the report of the financial review shall be included in and become part of the annual report of the commission. (f) The executive committee. 1. The executive com- mittee shall have the power to act on behalf of the com- mission according to the terms of this compact and com- mission rules. 2. The executive committee shall be composed of nine (9) members: a. Seven voting members who are elected by the commission from the current membership of the com- mission; b. One ex officio, nonvoting member from a recog- nized national PA professional association; and c. One ex officio, nonvoting member from a recog- nized national PA certification organization. 3. The ex officio members will be selected by their respective organizations. 4. The commission may remove any member of the executive committee as provided in its bylaws. 5. The executive committee shall meet at least annu- ally. 6. The executive committee shall have the following duties and responsibilities: a. Recommend to the commission changes to the commission’s rules or bylaws, changes to this compact legislation, fees to be paid by compact participating states such as annual dues, and any commission compact fee charged to licensees for the compact privilege; b. Ensure compact administration services are appro- priately provided, contractual or otherwise; c. Prepare and recommend the budget; d. Maintain financial records on behalf of the com- mission; e. Monitor compact compliance of participating states and provide compliance reports to the commission; f. Establish additional committees as necessary; g. Exercise the powers and duties of the commission during the interim between commission meetings, except for issuing proposed rule making or adopting commis- sion rules or bylaws, or exercising any other powers and duties exclusively reserved to the commission by the commission’s rules; and h. Perform other duties as provided in the commis- sion’s rules or bylaws. 7. All meeting of the executive committee at which it votes or plans to vote on matters in exercising the pow- ers and duties of the commission shall be open to the pub- lic and public notice of such meetings shall be given as public meetings of the commission are given. 8. The executive committee may convene in a closed, nonpublic meeting for the same reasons that the commis- sion may convene in a nonpublic meeting as set forth in par. (d) 3. and shall announce the closed meeting as the commission is required to under par. (d) 4. and keep min- utes of the closed meeting as the commission is required to under par. (d) 5. (g) Qualified immunity, defense, and indemnifica- tion. 1. The members, officers, executive director, employees and representatives of the commission shall be immune from suit and liability, both personally and in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties or responsibilities; provided that nothing in this subdivision shall be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the intentional or will- ful or wanton misconduct of that person. The procure- ment of insurance of any type by the commission shall not in any way compromise or limit the immunity granted hereunder. 2. The commission shall defend any member, officer, executive director, employee, and representative of the commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employ- ment, duties, or responsibilities, or as determined by the commission that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibilities; provided that nothing herein shall be construed to prohibit that person from retaining their own counsel at their own expense; and provided further, that the actual or alleged act, error, or omission did not result from that person’s intentional or willful or wanton mis- conduct. 3. The commission shall indemnify and hold harm- less any member, officer, executive director, employee, − 10 −2023 Wisconsin Act 81 2023 Senate Bill 400 and representative of the commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of commission employ- ment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of commission employment, duties, or responsibil- ities, provided that the actual or alleged act, error, or omission did not result from the intentional or willful or wanton misconduct of that person. 4. Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the commission is located. The com- mission may waive venue and jurisdictional defenses in any proceedings as authorized by commission rules. 5. Nothing herein shall be construed as a limitation on the liability of any licensee for professional malprac- tice or misconduct, which shall be governed solely by any other applicable state laws. 6. Nothing herein shall be construed to designate the venue or jurisdiction to bring actions for alleged acts of malpractice, professional misconduct, negligence, or other such civil action pertaining to the practice of a PA. All such matters shall be determined exclusively by state law other than this compact. 7. Nothing in this compact shall be interpreted to waive or otherwise abrogate a participating state’s state action immunity or state action affirmative defense with respect to antitrust claims under the Sherman Act, Clay- ton Act, or any other state or federal antitrust or anticom- petitive law or regulation. 8. Nothing in this compact shall be construed to be a waiver of sovereign immunity by the participating states or by the commission. (8) DATA SYSTEM. (a) The commission shall provide for the development, maintenance, operation, and uti- lization of a coordinated data and reporting system con- taining licensure, adverse action, and the reporting of the existence of significant investigative information on all licensed PAs and applicants denied a license in participat- ing states. (b) Notwithstanding any other state law to the con- trary, a participating state shall submit a uniform data set to the data system on all PAs to whom this compact is applicable (utilizing a unique identifier) as required by the rules of the commission, including: 1. Identifying information; 2. Licensure data; 3. Adverse actions against a license or compact privi- lege; 4. Any denial of application for licensure, and the reason(s) for such denial (excluding the reporting of any criminal history record information where prohibited by law); 5. The existence of significant investigative informa- tion; and 6. Other information that may facilitate the adminis- tration of this compact, as determined by the rules of the commission. (c) Significant investigative information pertaining to a licensee in any participating state shall only be avail- able to other participating states. (d) The commission shall promptly notify all partici- pating states of any adverse action taken against a licensee or an individual applying for a license that has been reported to it. This adverse action information shall be available to any other participating state. (e) Participating states contributing information to the data system may, in accordance with state or federal law, designate information that may not be shared with the public without the express permission of the con- tributing state. Notwithstanding any such designation, such information shall be reported to the commission through the data system. (f) Any information submitted to the data system that is subsequently expunged pursuant to federal law or the laws of the participating state contributing the informa- tion shall be removed from the data system upon report- ing of such by the participating state to the commission. (g) The records and information provided to a partici- pating state pursuant to this compact or through the data system, when certified by the commission or an agent thereof, shall constitute the authenticated business records of the commission, and shall be entitled to any associated hearsay exception in any relevant judicial, quasi−judicial or administrative proceedings in a partici- pating state. (9) RULE MAKING. (a) The commission shall exercise its rule−making powers pursuant to the criteria set forth in this subsection and the rules adopted thereunder. Com- mission rules shall become binding as of the date speci- fied by the commission for each rule. (b) The commission shall promulgate reasonable rules in order to effectively and efficiently implement and administer this compact and achieve its purposes. A commission rule shall be invalid and have not force or effect only if a court of competent jurisdiction holds that the rule is invalid because the commission exercised its rule−making authority in a manner that is beyond the scope of the purposes of this compact, or the powers granted hereunder, or based upon another applicable standard of review. (c) The rules of the commission shall have the force of law in each participating state, provided however that where the rules of the commission conflict with the laws of the participating state that establish the medical ser- vices a PA may perform in the participating state, as held by a court of competent jurisdiction, the rules of the com- − 11 − 2023 Wisconsin Act 81 2023 Senate Bill 400 mission shall be ineffective in that state to the extent of the conflict. (d) If a majority of the legislatures of the participating states rejects a commission rule, by enactment of a statute or resolution in the same manner used to adopt this com- pact within four (4) years of the date of adoption of the rule, then such rule shall have no further force and effect in any participating state or to any state applying to par- ticipate in the compact. (e) Commission rules shall be adopted at a regular or special meeting of the commission. (f) Prior to promulgation and adoption of a final rule or rules by the commission, and at least thirty (30) days in advance of the meeting at which the rule will be con- sidered and voted upon, the commission shall file a notice of proposed rule making: 1. On the website of the commission or other publicly accessible platform; and 2. To persons who have requested notice of the com- mission’s notices of proposed rule making, and 3. In such other way(s) as the commission may by rule specify. (g) The notice of proposed rule making shall include: 1. The time, date, and location of the public hearing on the proposed rule and the proposed time, date and location of the meeting in which the proposed rule will be considered and voted upon; 2. The text of the proposed rule and the reason for the proposed rule; 3. A request for comments on the proposed rule from any interested person and the date by which written com- ments must be received; and 4. The manner in which interested persons may sub- mit notice to the commission of their intention to attend the public hearing or provide any written comments. (h) Prior to adoption of a proposed rule, the commis- sion shall allow persons to submit written data, facts, opinions, and arguments, which shall be made available to the public. (i) If the hearing is to be held via electronic means, the commission shall publish the mechanism for access to the electronic hearing. 1. All persons wishing to be heard at the hearing shall as directed in the notice of proposed rule making, not less than five (5) business days before the scheduled date of the hearing, notify the commission of their desire to appear and testify at the hearing. 2. Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing. 3. All hearings shall be recorded. A copy of the recording and the written comments, data, facts, opin- ions, and arguments received in response to the proposed rule making shall be made available to a person upon request. 4. Nothing in this subsection shall be construed as requiring a separate hearing on each proposed rule. Pro- posed rules may be grouped for the convenience of the commission at hearings required by this subsection. (j) Following the public hearing the commission shall consider all written and oral comments timely received. (k) The commission shall, by majority vote of all del- egates, take final action on the proposed rule and shall determine the effective date of the rule, if adopted, based on the rule−making record and the full text of the rule. 1. If adopted, the rule shall be posted on the commis- sion’s website. 2. The commission may adopt changes to the pro- posed rule provided the changes do not enlarge the origi- nal purpose of the proposed rule. 3. The commission shall provide on its website an explanation of the reasons for substantive changes made to the proposed rule as well as reasons for substantive changes not made that were recommended by com- menters. 4. The commission shall determine a reasonable effective date for the rule. Except for an emergency as provided in par. (L), the effective date of the rule shall be no sooner than thirty (30) days after the commission issued the notice that it adopted the rule. (L) Upon determination that an emergency exists, the commission may consider and adopt an emergency rule with twenty−four (24) hours prior notice, without the opportunity for comment, or hearing, provided that the usual rule−making procedures provided in this compact and in this subsection shall be retroactively applied to the rule as soon as reasonably possible, in no event later than ninety (90) days after the effective date of the rule. For the purposes of this provision, an emergency rule is one that must be adopted immediately by the commission in order to: 1. Meet an imminent threat to public health, safety, or welfare; 2. Prevent a loss of commission or participating state funds; 3. Meet a deadline for the promulgation of a commis- sion rule that is established by federal law or rule; or 4. Protect public health and safety. (m) The commission or an authorized committee of the commission may direct revisions to a previously adopted commission rule for purposes of correcting typographical errors, errors in format, errors in consis- tency, or grammatical errors. Public notice of any revi- sions shall be posted on the website of the commission. The revision shall be subject to challenge by any person for a period of thirty (30) days after posting. The revision may be challenged only on grounds that the revision results in a material change to a rule. A challenge shall be made as set forth in the notice of revisions and deliv- − 12 −2023 Wisconsin Act 81 2023 Senate Bill 400 ered to the commission prior to the end of the notice period. If no challenge is made, the revision will take effect without further action. If the revision is chal- lenged, the revision may not take effect without the approval of the commission. (n) No participating state’s rule−making require- ments shall apply under this compact. (10) OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCE- MENT. (a) Oversight. 1. The executive and judicial branches of state government in each participating state shall enforce this compact and take all actions necessary and appropriate to implement the compact. 2. Venue is proper and judicial proceedings by or against the commission shall be brought solely and exclusively in a court of competent jurisdiction where the principal office of the commission is located. The com- mission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alterna- tive dispute resolution proceedings. Nothing herein shall affect or limit the selection or propriety of venue in any action against a licensee for professional malpractice, misconduct or any such similar matter. 3. The commission shall be entitled to receive service of process in any proceeding regarding the enforcement or interpretation of the compact or the commission’s rules and shall have standing to intervene in such a pro- ceeding for all purposes. Failure to provide the commis- sion with service of process shall render a judgment or order in such proceeding void as to the commission, this compact, or commission rules. (b) Default, technical assistance, and termination. 1. If the commission determines that a participating state has defaulted in the performance of its obligations or responsibilities under this compact or the commission rules, the commission shall provide written notice to the defaulting state and other participating states. The notice shall describe the default, the proposed means of curing the default and any other action that the commission may take and shall offer remedial training and specific techni- cal assistance regarding the default. 2. If a state in default fails to cure the default, the defaulting state may be terminated from this compact upon an affirmative vote of a majority of the delegates of the participating states, and all rights, privileges and ben- efits conferred by this compact upon such state may be terminated on the effective date of termination. A cure of the default does not relieve the offending state of obli- gations or liabilities incurred during the period of default. 3. Termination of participation in this compact shall be imposed only after all other means of securing compli- ance have been exhausted. Notice of intent to suspend or terminate shall be given by the commission to the gover- nor, the majority and minority leaders of the defaulting state’s legislature, and to the licensing board(s) of each of the participating states. 4. A state that has been terminated is responsible for all assessments, obligations, and liabilities incurred through the effective date of termination, including obli- gations that extend beyond the effective date of termina- tion. 5. The commission shall not bear any costs related to a state that is found to be in default or that has been termi- nated from this compact, unless agreed upon in writing between the commission and the defaulting state. 6. The defaulting state may appeal its termination from the compact by the commission by petitioning the U.S. District Court for the District of Columbia or the federal district where the commission has its principal offices. The prevailing member shall be awarded all costs of such litigation, including reasonable attorney’s fees. 7. Upon the termination of a state’s participation in the compact, the state shall immediately provide notice to all licensees within that state of such termination: a. Licensees who have been granted a compact privi- lege in that state shall retain the compact privilege for one hundred eighty (180) days following the effective date of such termination. b. Licensees who are licensed in that state who have been granted a compact privilege in a participating state shall retain the compact privilege for one hundred eighty (180) days unless the licensee also has a qualifying license in a participating state or obtains a qualifying license in a participating state before the one hundred eighty (180)−day period ends, in which case the compact privilege shall continue. (c) Dispute resolution. 1. Upon request by a partici- pating state, the commission shall attempt to resolve dis- putes related to this compact that arise among participat- ing states and between participating and nonparticipating states. 2. The commission shall promulgate a rule providing for both mediation and binding dispute resolution for dis- putes as appropriate. (d) Enforcement. 1. The commission, in the reason- able exercise of its discretion, shall enforce the provi- sions of this compact and rules of the commission. 2. If compliance is not secured after all means to secure compliance have been exhausted, by majority vote, the commission may initiate legal action in the United States District Court for the District of Columbia or the federal district where the commission has its prin- cipal offices, against a participating state in default to enforce compliance with the provisions of this compact and the commission’s promulgated rules and bylaws. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such liti- gation, including reasonable attorney’s fees. − 13 − 2023 Wisconsin Act 81 2023 Senate Bill 400 3. The remedies herein shall not be the exclusive remedies of the commission. The commission may pur- sue any other remedies available under federal or state law. (e) Legal action against the commission. 1. A partic- ipating state may initiate legal action against the commis- sion in the U.S. District Court for the District of Colum- bia or the federal district where the commission has its principal offices to enforce compliance with the provi- sions of the compact and its rules. The relief sought may include both injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorney’s fees. 2. No person other than a participating state shall enforce this compact against the commission. (11) DATE OF IMPLEMENTATION OF THE PA LICENSURE COMPACT COMMISSION. (a) This compact shall come into effect on the date on which this compact statute is enacted into law in the seventh participating state. 1. On or after the effective date of the compact, the commission shall convene and review the enactment of each of the states that enacted the compact prior to the commission convening (“charter participating states”) to determine if the statute enacted by each such charter par- ticipating state is materially different than the model compact. a. A charter participating state whose enactment is found to be materially different from the model compact shall be entitled to the default process set forth in sub. (10) (b). b. If any participating state later withdraws from the compact or its participation is terminated, the commis- sion shall remain in existence and the compact shall remain in effect even if the number of participating states should be less than seven. Participating states enacting the compact subsequent to the commission convening shall be subject to the process set forth in sub. (7) (c) 21. to determine if their enactments are materially different from the model compact and whether they qualify for participation in the compact. 2. Participating states enacting the compact subse- quent to the seven initial charter participating states shall be subject to the process set forth in sub. (7) (c) 21. to determine if their enactments are materially different from the model compact and whether they qualify for participation in the compact. 3. All actions taken for the benefit of the commission or in furtherance of the purposes of the administration of the compact prior to the effective date of the compact or the commission coming into existence shall be consid- ered to be actions of the commission unless specifically repudiated by the commission. (b) Any state that joins this compact shall be subject to the commission’s rules and bylaws as they exist on the date on which this compact becomes law in that state. Any rule that has been previously adopted by the com- mission shall have the full force and effect of law on the day this compact becomes law in that state. (c) Any participating state may withdraw from this compact by enacting a statute repealing the same. 1. A participating state’s withdrawal shall not take effect until one hundred eighty (180) days after enact- ment of the repealing statute. During this one hundred eighty (180) day−period, all compact privileges that were in effect in the withdrawing state and were granted to licensees licensed in the withdrawing state shall remain in effect. If any licensee licensed in the withdrawing state is also licensed in another participating state or obtains a license in another participating state within the one hun- dred eighty (180) days, the licensee’s compact privileges in other participating states shall not be affected by the passage of the one hundred eighty (180) days. 2. Withdrawal shall not affect the continuing require- ment of the state licensing board(s) of the withdrawing state to comply with the investigative, and adverse action reporting requirements of this compact prior to the effec- tive date of withdrawal. 3. Upon the enactment of a statute withdrawing a state from this compact, the state shall immediately pro- vide notice of such withdrawal to all licensees within that state. Such withdrawing state shall continue to recognize all licenses granted pursuant to this compact for a mini- mum of one hundred eighty (180) days after the date of such notice of withdrawal. (d) Nothing contained in this compact shall be con- strued to invalidate or prevent any PA licensure agree- ment or other cooperative arrangement between partici- pating states and between a participating state and nonparticipating state that does not conflict with the pro- visions of this compact. (e) This compact may be amended by the participat- ing states. No amendment to this compact shall become effective and binding upon any participating state until it is enacted materially in the same manner into the laws of all participating states as determined by the commission. (12) CONSTRUCTION AND SEVERABILITY. (a) This compact and the commission’s rule−making authority shall be liberally construed so as to effectuate the pur- poses, and the implementation and administration of the compact. Provisions of the compact expressly autho- rizing or requiring the promulgation of rules shall not be construed to limit the commission’s rule−making author- ity solely for those purposes. (b) The provisions of this compact shall be severable and if any phrase, clause, sentence or provision of this compact is held by a court of competent jurisdiction to be contrary to the constitution of any participating state, a state seeking participation in the compact, or of the United States, or the applicability thereof to any govern- ment, agency, person or circumstance is held to be uncon- stitutional by a court of competent jurisdiction, the valid- − 14 −2023 Wisconsin Act 81 2023 Senate Bill 400 ity of the remainder of this compact and the applicability thereof to any other government, agency, person or cir- cumstance shall not be affected thereby. (c) Notwithstanding par. (b) or this subsection, the commission may deny a state’s participation in the com- pact or, in accordance with the requirements of sub. (10) (b), terminate a participating state’s participation in the compact, if it determines that a constitutional require- ment of a participating state is, or would be with respect to a state seeking to participate in the compact, a material departure from the compact. Otherwise, if this compact shall be held to be contrary to the constitution of any par- ticipating state, the compact shall remain in full force and effect as to the remaining participating states and in full force and effect as to the participating state affected as to all severable matters. (13) BINDING EFFECT OF COMPACT. (a) Nothing herein prevents the enforcement of any other law of a participat- ing state that is not inconsistent with this compact. (b) Any laws in a participating state in conflict with this compact are superseded to the extent of the conflict. (c) All agreements between the commission and the participating states are binding in accordance with their terms. 448.9885 Implementation of the PA licensure compact. (1) In this section: (a) “Board” means the physician assistant affiliated credentialing board. (b) “Compact” means the PA licensure compact under s. 448.988. (c) “Compact privilege” means a compact privilege, as defined in s. 448.988 (2) (b), that is granted under the compact to an individual to practice in this state. (2) The department may impose a fee for an individ- ual to receive a compact privilege as provided in s. 448.988 (3) (b). (3) (a) An individual who holds a compact privilege shall comply with s. 440.03 (13) (am). (b) Subject to s. 448.988 and any rules promulgated thereunder, ss. 440.20 to 440.22 and the rules promul- gated under s. 440.03 (1) shall apply to an individual who holds a compact privilege in the same manner that they apply to holders of licenses issued under subch. IX. SECTION 41. 450.10 (3) (a) 5. of the statutes, as affected by 2021 Wisconsin Act 251, is amended to read: 450.10 (3) (a) 5. A physician, physician assistant, podiatrist, physical therapist, physical therapist assistant, occupational therapist, occupational therapy assistant, or genetic counselor licensed under ch. 448, a physical ther- apist or physical therapist assistant who holds a compact privilege under subch. XI of ch. 448, or an occupational therapist or occupational therapy assistant who holds a compact privilege under subch. XII of ch. 448, or a physi- cian assistant who holds a compact privilege under subch. XIII of ch. 448. SECTION 42. 462.02 (2) (e) of the statutes is amended to read: 462.02 (2) (e) A physician assistant licensed under s. 448.974. SECTION 43. 462.04 of the statutes, as affected by 2021 Wisconsin Act 251, is amended to read: 462.04 Prescription or order required. A person who holds a license or limited X−ray machine operator permit under this chapter may not use diagnostic X−ray equipment on humans for diagnostic purposes unless authorized to do so by prescription or order of a physician licensed under s. 448.04 (1) (a), a naturopathic doctor licensed under s. 466.04 (1), a dentist licensed under s. 447.04 (1), a podiatrist licensed under s. 448.63, a chiro- practor licensed under s. 446.02, an advanced practice nurse certified under s. 441.16 (2), a physician assistant who is licensed under s. 448.974 or who holds a compact privilege under subch. XIII of ch. 448, or, subject to s. 448.56 (7) (a), a physical therapist who is licensed under s. 448.53 or who holds a compact privilege under subch. XI of ch. 448. SECTION 44. 895.48 (1m) (a) (intro.) of the statutes is amended to read: 895.48 (1m) (a) (intro.) Except as provided in par. (b), any physician, naturopathic doctor, physician assist- ant, podiatrist, or athletic trainer licensed under ch. 448, physician assistant who is licensed under subch. IX of ch. 448 or who holds a compact privilege under subch. XIII of ch. 448, chiropractor licensed under ch. 446, dentist licensed under ch. 447, emergency medical services practitioner licensed under s. 256.15, emergency medical responder certified under s. 256.15 (8), registered nurse licensed under ch. 441, or a massage therapist or body- work therapist licensed under ch. 460, or naturopathic doctor licensed under ch. 466 who renders voluntary health care to a participant in an athletic event or contest sponsored by a nonprofit corporation, as defined in s. 66.0129 (6) (b), a private school, as defined in s. 115.001 (3r), a tribal school, as defined in s. 115.001 (15m), a pub- lic agency, as defined in s. 46.856 (1) (b), or a school, as defined in s. 609.655 (1) (c), is immune from civil liabil- ity for his or her acts or omissions in rendering that care if all of the following conditions exist: SECTION 45. 971.14 (4) (a) of the statutes is amended to read: 971.14 (4) (a) The court shall cause copies of the report to be delivered forthwith to the district attorney and the defense counsel, or the defendant personally if not represented by counsel. Upon the request of the sher- iff or jailer charged with care and control of the jail in which the defendant is being held pending or during a trial or sentencing proceeding, the court shall cause a copy of the report to be delivered to the sheriff or jailer. The sheriff or jailer may provide a copy of the report to the person who is responsible for maintaining medical − 15 − 2023 Wisconsin Act 81 2023 Senate Bill 400 records for inmates of the jail, or to a nurse licensed under ch. 441, to a, physician licensed under subch. II of ch. 448, or to a physician assistant licensed under subch. IX of ch. 448 who is a health care provider for the defendant or who is responsible for providing health care services to inmates of the jail. The report shall not be otherwise disclosed prior to the hearing under this subsection. SECTION 47. 990.01 (27s) of the statutes is amended to read: 990.01 (27s) PHYSICIAN ASSISTANT. “Physician assistant” means a person who is licensed as a physician assistant under subch. IX of ch. 448 or who holds a com- pact privilege under subch. XIII of ch. 448.