89R6324 DNC-D     By: Campos H.B. No. 1731       A BILL TO BE ENTITLED   AN ACT   relating to the physician assistant licensure compact; authorizing   a fee.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 204, Occupations Code, is amended by   adding Subchapter I to read as follows:   SUBCHAPTER I. PHYSICIAN ASSISTANT LICENSURE COMPACT          Sec. 204.401.  PHYSICIAN ASSISTANT LICENSURE COMPACT. The   Physician Assistant Licensure Compact is enacted and entered into   with all other jurisdictions that legally join in the compact,   which reads as follows:   PA LICENSURE COMPACT   Section 1.  Purpose   In order to strengthen access to Medical Services, and in   recognition of the advances in the delivery of Medical Services,   the Participating States of the PA Licensure Compact have allied in   common purpose to develop a comprehensive process that complements   the existing authority of State Licensing Boards to license and   discipline PAs and seeks to enhance the portability of a License to   practice as a PA while safeguarding the safety of patients. This   Compact allows Medical Services to be provided by PAs, via the   mutual recognition of the Licensee's Qualifying License by other   Compact Participating States. This Compact also adopts the   prevailing standard for PA licensure and affirms that the practice   and delivery of Medical Services 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 Compact. The PA Licensure Compact   will alleviate burdens for military families by allowing active   duty military personnel and their spouses to obtain a Compact   Privilege based on having an unrestricted License in good standing   from a Participating State.   Section 2.  Definitions   In this Compact:          A.  "Adverse Action" means any administrative, civil,   equitable, or criminal action permitted by a State's laws which is   imposed by a Licensing Board or other authority against a PA License   or License application or Compact Privilege such as License denial,   censure, revocation, suspension, probation, monitoring of the   Licensee, or restriction on the Licensee's practice.          B.  "Compact Privilege" means the authorization granted by a   Remote State to allow a Licensee from another Participating State   to practice as a PA to provide Medical Services and other licensed   activity to a patient located in the Remote State under the Remote   State's laws and regulations.          C.  "Conviction" means a finding by a court that an   individual is guilty of a felony or misdemeanor offense through   adjudication or entry of a plea of guilt or no contest to the charge   by the offender          D.  "Criminal Background Check" means the submission of   fingerprints or other biometric-based information for a License   applicant for the purpose of obtaining that applicant's criminal   history record information, as defined in 28 C.F.R. § 20.3(d), from   the State's criminal history record repository as defined in 28   C.F.R. § 20.3(f).          E.  "Data System" means the repository of information about   Licensees, including but not limited to License status and Adverse   Actions, which is created and administered under the terms of this   Compact.          F.  "Executive Committee" means a group of directors and   ex-officio individuals elected or appointed pursuant to Section   7.F.2.          G.  "Impaired Practitioner" means a PA whose practice is   adversely affected by health-related condition(s) that impact   their ability to practice.          H.  "Investigative Information" means information, records,   or documents received or generated by a Licensing Board pursuant to   an investigation.          I.  "Jurisprudence Requirement" means the assessment of an   individual's knowledge of the laws and Rules governing the practice   of a 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 authorized 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 Governments or other   entity as designated by the Commission.           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 Compact, any other title   or status adopted by a State to replace the term "physician   assistant" shall be deemed synonymous with "physician assistant"   and shall confer the same rights and responsibilities to the   Licensee under the provisions of this Compact at the time of its   enactment.          Q.  "PA Licensure Compact Commission," "Compact Commission,"   or "Commission" mean the national administrative body created   pursuant to Section 7.A of this Compact.          R.  "Qualifying License" means an unrestricted License   issued by a Participating State to provide Medical Services as a 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.   Section 3.  State Participation in this Compact          A.  To participate in this Compact, a Participating State   shall:                1.  License PAs.                2.  Participate in the Compact Commission's Data   System.                3.  Have a mechanism in place for receiving and   investigating complaints against Licensees and License applicants.                4.  Notify the Commission, in compliance with the terms   of this Compact and Commission Rules, of any Adverse Action against   a Licensee or License applicant and the existence of Significant   Investigative Information regarding a Licensee or License   applicant.                5.  Fully implement a Criminal Background Check   requirement, within a time frame established by Commission Rule, by   its Licensing Board receiving the results of a Criminal Background   Check and reporting to the Commission whether the License applicant   has been granted a License.                6.  Comply with the Rules of the Compact Commission.                7.  Utilize passage of a recognized national exam such   as the NCCPA PANCE as a requirement for PA licensure.                8.  Require continuing education for License renewal.                9.  Grant the Compact Privilege to a holder of a   Qualifying License in a Participating State.          B.  Nothing in this Compact prohibits a Participating State   from charging a fee for granting the Compact Privilege.   Section 4.  Compact Privilege          A.  To exercise the Compact Privilege, a Licensee must:                1.  Have graduated from a PA program accredited by the   Accreditation Review Commission on Education for the Physician   Assistant, Inc. or other programs authorized by Commission Rule.                2.  Hold current NCCPA certification.                3.  Have no felony or misdemeanor Conviction                4.  Have never had a controlled substance license,   permit, or registration suspended or revoked by a State or by the   United States Drug Enforcement Administration.                5.  Have a unique identifier as determined by   Commission Rule.                6.  Hold a Qualifying License.                7.  Have had no revocation of a License or limitation or   restriction on any License currently held due to an adverse action.                8.  If a Licensee has had a limitation or restriction on   a License or Compact Privilege due to an Adverse Action, two years   must have elapsed from the date on which the License or Compact   Privilege is no longer limited or restricted due to the Adverse   Action.                9.  If a Compact Privilege has been revoked or is   limited or restricted in a Participating State for conduct that   would not be a basis for disciplinary action in a Participating   State in which the Licensee is practicing or applying to practice   under a Compact Privilege, that Participating State shall have the   discretion not to consider such action as an Adverse Action   requiring the denial or removal of a Compact Privilege in that   State.                10.  Notify the Compact Commission that the Licensee is   seeking the Compact Privilege in a Remote State.                11.  Meet any Jurisprudence Requirement of a Remote   State in which the Licensee is seeking to practice under the Compact   Privilege and pay any fees applicable to satisfying the   Jurisprudence Requirement.                12.  Report to the Commission any Adverse Action taken   by a non-participating State within thirty (30) days after the   action is taken.          B.  The Compact Privilege is valid until the expiration or   revocation of the Qualifying License unless terminated pursuant to   an Adverse Action. The Licensee must also comply with all of the   requirements of Subsection A above to maintain the Compact   Privilege in a Remote State. If the Participating State takes   Adverse Action against a Qualifying License, the Licensee shall   lose the Compact Privilege in any Remote State in which the Licensee   has a Compact Privilege until all of the following occur:                1.  The License is no longer limited or restricted; and                2.  Two (2) years have elapsed from the date on which   the License is no longer limited or restricted due to the Adverse   Action.          C.  Once a restricted or limited License satisfies the   requirements of Subsection B.1 and 2, the Licensee must meet the   requirements of Subsection A to obtain a Compact Privilege in any   Remote State.          D.  For each Remote State in which a PA seeks authority to   prescribe controlled substances, the PA shall satisfy all   requirements imposed by such State in granting or renewing such   authority.   Section 5.  Designation of the State from Which Licensee is   Applying for a Compact Privilege          A.  Upon a Licensee's application for a Compact Privilege,   the Licensee shall identify to the Commission the Participating   State from which the Licensee is applying, in accordance with   applicable Rules adopted by the Commission, and subject to the   following requirements:                1.  When applying for a Compact Privilege, the Licensee   shall provide the Commission with the address of the Licensee's   primary residence and thereafter shall immediately report to the   Commission any change in the address of the Licensee's primary   residence.                2.  When applying for a Compact Privilege, the Licensee   is required to consent to accept service of process by mail at the   Licensee's primary residence on file with the Commission with   respect to any action brought against the Licensee by the   Commission or a Participating State, including a subpoena, with   respect to any action brought or investigation conducted by the   Commission or a Participating State.   Section 6.  Adverse Actions          A.  A Participating State in which a Licensee is licensed   shall have exclusive power to impose Adverse Action against the   Qualifying License issued by that Participating State.          B.  In addition to the other powers conferred by State law, a   Remote State shall have the authority, in accordance with existing   State due process law, to do all of the following:                1.  Take Adverse Action against a PA's Compact   Privilege within that State to remove a Licensee's Compact   Privilege or take other action necessary under applicable law to   protect the health and safety of its citizens.                2.  Issue subpoenas for both hearings and   investigations that require the attendance and testimony of   witnesses as well as the production of evidence. Subpoenas issued   by a Licensing Board in a Participating State for the attendance and   testimony of witnesses or the production of evidence from another   Participating State shall be enforced 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 paragraph 1, subpoenas may not be   issued by a Participating State to gather evidence of conduct in   another State that is lawful in that other State for the purpose of   taking Adverse Action against a Licensee's Compact Privilege or   application for a Compact Privilege in that Participating State.                4.  Nothing in this Compact authorizes a Participating   State to impose discipline against a PA's Compact Privilege or to   deny an application for a Compact Privilege in that Participating   State for the individual's otherwise lawful practice in another   State.          C.  For purposes of taking Adverse Action, the Participating   State which issued the Qualifying License shall give the same   priority and effect to reported conduct received from any other   Participating State as it would if the conduct had occurred within   the Participating State which issued the Qualifying License. In so   doing, that Participating State shall apply its own State laws to   determine appropriate action.          D.  A Participating State, if otherwise permitted by State   law, may recover from the affected 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 authority 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 Participating States in joint   investigations of Licensees.                2.  Participating States shall share any   investigative, litigation, or compliance materials in furtherance   of any joint or individual investigation initiated under this   Compact.          G.  If an Adverse Action is taken against a PA's Qualifying   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   Statement 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 System.   Section 7.  Establishment of the PA Licensure Compact Commission          A.  The Participating States hereby create and establish a   joint government agency and national administrative body known as   the PA Licensure Compact Commission. The Commission is an   instrumentality of the Compact States acting jointly and not an   instrumentality of any one State. The Commission shall come into   existence on or after the effective date of the Compact as set forth   in Section 11.A.          B.  Membership, Voting, and Meetings                1.  Each Participating State shall have and be limited   to one (1) delegate selected by that Participating State's   Licensing Board or, if the State has more than one Licensing Board,   selected collectively by the Participating State's Licensing   Boards.                2.  The delegate shall be either:                      a.  A current 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 otherwise have an   opportunity to participate in the business and affairs of the   Commission. A delegate shall vote in person or by such other means   as provided in the bylaws. The bylaws may provide for delegates'   participation in meetings by telecommunications, video conference,   or other means of communication.                6.  The Commission shall meet at least once during each   calendar year. Additional meetings shall be held as set forth in   this Compact and the bylaws.                7.  The Commission shall establish by Rule a term of   office for delegates.          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 applicable law shall not be   affected;                9.  Purchase and maintain insurance and bonds;                10.  Borrow, accept, or contract for services of   personnel, including, but not limited to, employees of a   Participating State;                11.  Hire employees and engage contractors, elect or   appoint officers, fix compensation, define duties, grant such   individuals appropriate authority to carry out the purposes of this   Compact, and establish the Commission's personnel policies and   programs relating to conflicts of interest, qualifications of   personnel, and other related personnel matters;                12.  Accept any and all appropriate donations and   grants of money, equipment, supplies, materials and services, and   receive, utilize and dispose of the same; provided that at all times   the Commission shall avoid any appearance of impropriety or   conflict of interest;                13.  Lease, purchase, accept appropriate gifts or   donations of, or otherwise own, hold, improve or use, any property,   real, personal or mixed; provided that at all times the Commission   shall avoid any appearance of impropriety;                14.  Sell, convey, mortgage, pledge, lease, exchange,   abandon, or otherwise dispose ofany property real, personal, or   mixed;                15.  Establish a budget and make expenditures;                16.  Borrow money;                17.  Appoint committees, including standing committees   composed of members, State regulators, State legislators or their   representatives, and consumer representatives, and such other   interested persons as may be designated in this Compact and the   bylaws;                18.  Provide and receive information from, and   cooperate with, law enforcement agencies;                19.  Elect a Chair, Vice Chair, Secretary and Treasurer   and such other officers of the Commission as provided in the   Commission's bylaws.                20.  Reserve for itself, in addition to those reserved   exclusively to the Commission under the Compact, powers that the   Executive Committee may not exercise;                21.  Approve or disapprove a State's participation in   the Compact based upon its determination as to whether the State's   Compact legislation departs in a material manner from the Model   Compact language;                22.  Prepare and provide to the Participating States an   annual report; and                23.  Perform such other functions as may be necessary   or appropriate to achieve the purposes of this Compact 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 subsection shall be open to the public. Notice of   public meetings shall be posted on the Commission's website at   least thirty (30) days prior to the public meeting.                2.  Notwithstanding subsection D.1 of this section, the   Commission may convene a public meeting by providing at least   twenty-four (24) hours prior notice on the Commission's website,   and any other means as provided in the Commission's Rules, for any   of the reasons it may dispense with notice of proposed rulemaking   under Section 9.L.                3.  The Commission may convene in a closed, non-public   meeting or non-public part of a public meeting to receive legal   advice or to discuss:                      a.  Non-compliance of a Participating State with   its obligations under this Compact;                      b.  The employment, compensation, discipline or   other matters, practices or procedures related to specific   employees or other matters related to the Commission's internal   personnel practices and procedures;                      c.  Current, threatened, or reasonably   anticipated litigation;                      d.  Negotiation of contracts for the purchase,   lease, or sale of goods, services, or real estate;                      e.  Accusing any person of a crime or formally   censuring any person;                      f.  Disclosure of trade secrets or commercial or   financial information that is privileged or confidential;                      g.  Disclosure of information of a personal nature   where disclosure would constitute a clearly unwarranted invasion of   personal privacy;                      h.  Disclosure of investigative records compiled   for law enforcement purposes;                      i.  Disclosure of information related to any   investigative reports prepared byor on behalf of or for use of the   Commission or other committee charged with responsibility of   investigation or determination of compliance issues pursuant to   this Compact;                      j.  Legal advice; or                      k.  Matters specifically exempted from disclosure   by federal or Participating States' statutes                4.  If a meeting, or portion of a meeting, is closed   pursuant to this provision, the chair of the meeting or the chair's   designee shall certify that the meeting or portion of the meeting   may be closed and shall reference each relevant exempting   provision.                5.  The Commission shall keep minutes that fully and   clearly describe all matters discussed in a meeting and shall   provide a full and accurate summary of actions taken, including a   description of the views expressed. All documents considered in   connection with an action shall be identified in such minutes. All   minutes and documents of a closed meeting shall remain under seal,   subject to release by a majority vote of the Commission or order of   a court of competent jurisdiction.          E.  Financing of the Commission                1.  The Commission shall pay, or provide for the   payment of, the reasonable expenses of its establishment,   organization, and ongoing activities.                2.  The Commission may accept any and all appropriate   revenue sources, donations, and grants of money, equipment,   supplies, materials, and services.                3.  The Commission may levy on and collect an annual   assessment from each Participating State and may impose Compact   Privilege fees on Licensees of Participating States to whom a   Compact Privilege is granted to cover the cost of the operations and   activities of the Commission and its staff, which must be in a total   amount sufficient to cover its annual budget as approved by the   Commission each year for which revenue is not provided by other   sources. The aggregate annual assessment amount levied on   Participating States shall be allocated based upon a formula to be   determined by Commission Rule.                      a.  A Compact Privilege expires when the   Licensee's Qualifying License in the Participating State from which   the Licensee applied for the Compact Privilege expires.                      b.  If the Licensee terminates the Qualifying   License through which the Licensee applied for the Compact   Privilege before its scheduled expiration, and the Licensee has a   Qualifying License in another Participating State, the Licensee   shall inform the Commission that it is changing to that   Participating State the Participating State through which it   applies for a Compact Privilege and pay to the Commission any   Compact Privilege fee required by Commission Rule.                4.  The Commission shall not incur obligations of any   kind prior to securing the funds adequate to meet the same; nor   shall the Commission pledge the credit of any of the Participating   States, except by and with the authority of the Participating   State.                5.  The Commission shall keep accurate accounts of all   receipts and disbursements. The receipts and disbursements of the   Commission shall be subject to the financial review and accounting   procedures established under its bylaws. All receipts and   disbursements of funds handled by the Commission shall be subject   to an annual financial review by a certified or licensed public   accountant, and the report of the financial review shall be   included in and become part of the annual report of the Commission.          F.  The Executive Committee                1.  The Executive Committee shall have the power to act   on behalf of the Commission according to the terms of this Compact   and Commission Rules.                2.  The Executive Committee shall be composed of nine   (9) members:                      a.  Seven voting members who are elected by the   Commission from the current membership of the Commission;                      b.  One ex-officio, nonvoting member from a   recognized national PA professional association; and                      c.  One ex-officio, nonvoting member from a   recognized 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   annually.                6.  The Executive Committee shall have the following   duties and responsibilities:                      a.  Recommend to the Commission changes to the   Commission's Rules or bylaws, changes to this Compact legislation,   fees to be paid by Compact Participating States such as annual dues,   and any Commission Compact fee charged to Licensees for the Compact   Privilege;                      b.  Ensure Compact administration services are   appropriately provided, contractual or otherwise;                      c.  Prepare and recommend the budget;                      d.  Maintain financial records on behalf of the   Commission;                      e.  Monitor Compact compliance of Participating   States and provide compliance reports to the Commission;                      f.  Establish additional committees as necessary;                      g.  Exercise the powers and duties of the   Commission during the interim between Commission meetings, except   for issuing proposed rulemaking or adopting Commission Rules or   bylaws, or exercising any other powers and duties exclusively   reserved to the Commission by the Commission's Rules; and                      h.  Perform other duties as provided in the   Commission's Rules or bylaws.                7.  All meeting of the Executive Committee at which it   votes or plans to vote on matters in exercising the powers and   duties of the Commission shall be open to the public and public   notice of such meetings shall be given as public meetings of the   Commission are given.                8.  The Executive Committee may convene in a closed,   non-public meeting for the same reasons that the Commission may   convene in a non-public meeting as set forth in Section 7.D 3 and   shall announce the closed meeting as the Commission is required to   under Section 7.D.4 and keep minutes of the closed meeting as the   Commission is required to under Section 7.D.5.          G.  Qualified Immunity, Defense, and Indemnification                1.  The members, officers, executive director,   employees and representatives of the Commission shall be immune   from suit and liability, both personally and in their official   capacity, for any claim for damage to or loss of property or   personal injury or other civil liability caused by or arising out of   any actual or alleged act, error, or omission that occurred, or that   the person against whom the claim is made had a reasonable basis for   believing occurred within the scope of Commission employment,   duties or responsibilities; provided that nothing in this paragraph   shall be construed to protect any such person from suit or liability   for any damage, loss, injury, or liability caused by the   intentional or willful or wanton misconduct of that person. The   procurement of insurance of any type by the Commission shall not in   any way compromise or limit the immunity granted hereunder.                2.  The Commission shall defend any member, officer,   executive director, employee, and representative of the Commission   in any civil action seeking to impose liability arising out of any   actual or alleged act, error, or omission that occurred within the   scope of Commission employment, duties, or responsibilities, or as   determined by the commission that the person against whom the claim   is made had a reasonable basis for believing occurred within the   scope of Commission employment, duties, or responsibilities;   provided that nothing herein shall be construed to prohibit that   person from retaining their own counsel at their own expense; and   provided further, that the actual or alleged act, error, or   omission did not result from that person's intentional or willful   or wanton misconduct.                3.  The Commission shall indemnify and hold harmless   any member, officer, executive director, employee, and   representative of the Commission for the amount of any settlement   or judgment obtained against that person arising out of any actual   or alleged act, error, or omission that occurred within the scope of   Commission employment, duties, or responsibilities, or that such   person had a reasonable basis for believing occurred within the   scope of Commission employment, duties, or responsibilities,   provided that the actual or alleged act, error, or omission did not   result from the intentional or willful or wanton misconduct of that   person.                4.  Venue is proper and judicial proceedings by or   against the Commission shall be brought solely and exclusively in a   court of competent jurisdiction where the principal office of the   Commission is located. The Commission may waive venue and   jurisdictional defenses in any proceedings as authorized by   Commission Rules.                5.  Nothing herein shall be construed as a limitation   on the liability of any Licensee for professional malpractice or   misconduct, which shall be governed solely by any other applicable   State laws.                6.  Nothing herein shall be construed to designate the   venue or jurisdiction to bring actions for alleged acts of   malpractice, professional misconduct, negligence, or other such   civil action pertaining to the practice of a 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 person's intentional or willful or wanton   misconduct.abrogate a Participating State's state action immunity   or state action affirmative defense with respect to antitrust   claims under the Sherman Act, Clayton Act, or any other State or   federal antitrust or anticompetitive law or regulation.                8.  Nothing in this Compact shall be construed to be a   waiver of sovereign immunity by the Participating States or by the   Commission.   Section 8.  Data System          A.  The Commission shall provide for the development,   maintenance, operation, and utilization of a coordinated data and   reporting system containing licensure, Adverse Action, and the   reporting of the existence of Significant Investigative   Information on all licensed PAs and applicants denied a License in   Participating States.          B.  Notwithstanding any other State law to the contrary, a   Participating State shall submit a uniform data set to the Data   System on all 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   Privilege;                4.  Any denial of application for licensure, and the   reason(s) for such denial (excluding the reporting of any Criminal   history record information where prohibited by law);                5.  The existence of Significant Investigative   Information; and                6.  Other information that may facilitate the   administration of this Compact, as determined by the Rules of the   Commission.          C.  Significant Investigative Information pertaining to a   Licensee in any Participating State shall only be available to   other Participating States.          D.  The Commission shall promptly notify all Participating   States of any Adverse Action taken against a Licensee or an   individual applying for a License that has been reported to it. This   Adverse Action information shall be available to any other   Participating State.          E.  Participating States contributing information to the   Data System may, in accordance with State or federal law, designate   information that may not be shared with the public without the   express permission of the contributing State. Notwithstanding any   such designation, such information shall be reported to the   Commission through the Data System.          F.  Any information submitted to the Data System that is   subsequently expunged pursuant to federal law or the laws of the   Participating State contributing the information shall be removed   from the Data System upon reporting of such by the Participating   State to the Commission.          G.  The records and information provided to a Participating   State pursuant to this Compact or through the Data System, when   certified by the Commission or an agent thereof, shall constitute   the authenticated business records of the Commission, and shall be   entitled to any associated hearsay exception in any relevant   judicial, quasi-judicial or administrative proceedings in a   Participating State.   Section 9.  Rulemaking          A.  The Commission shall exercise its Rulemaking powers   pursuant to the criteria set forth in this Section and the Rules   adopted thereunder. Commission Rules shall become binding as of the   date specified by the Commission for each Rule.          B.  The Commission shall promulgate reasonable Rules in   order to effectively and efficiently implement and administer this   Compact and achieve its purposes. A Commission Rule shall be   invalid and have not force or effect only if a court of competent   jurisdiction holds that the Rule is invalid because the Commission   exercised its rulemaking authority in a manner that is beyond the   scope of the purposes of this Compact, or the powers granted   hereunder, or based upon another applicable standard of review.          C.  The Rules of the Commission shall have the force of law in   each Participating State, provided however that where the Rules of   the Commission conflict with the laws of the Participating State   that establish the medical services a PA may perform in the   Participating State, as held by a court of competent jurisdiction,   the Rules of the Commission shall be ineffective in that State to   the extent of the conflict.          D.  If a majority of the legislatures of the Participating   States rejects a Commission Rule, by enactment of a statute or   resolution in the same manner used to adopt this Compact within four   (4) years of the date of adoption of the Rule, then such Rule shall   have no further force and effect in any Participating State or to   any State applying to participate in the Compact.          E.  Commission Rules shall be adopted at a regular or special   meeting of the Commission.          F.  Prior to promulgation and adoption of a final Rule or   Rules by the Commission, and at least thirty (30) days in advance of   the meeting at which the Rule will be considered and voted upon, the   Commission shall file a Notice of Proposed Rulemaking:                1.  On the website of the Commission or other publicly   accessible platform; and                2.  To persons who have requested notice of the   Commission's notices of proposed rulemaking, and                3.  In such other way(s) as the Commission may by Rule   specify          G.  The Notice of Proposed Rulemaking shall include:                1.  The time, date, and location of the public hearing   on the proposed Rule and the proposed time, date and location of the   meeting in which the proposed Rule will be considered and voted   upon;                2.  The text of the proposed Rule and the reason for the   proposed Rule;                3.  A request for comments on the proposed Rule from any   interested person and the date by which written comments must be   received; and                4.  The manner in which interested persons may submit   notice to the Commission of their intention to attend the public   hearing or provide any written comments.          H.  Prior to adoption of a proposed Rule, the Commission   shall allow persons to submit written data, facts, opinions, and   arguments, which shall be made available to the public.          I.  If the hearing is to be held via electronic means, the   Commission shall publish the mechanism for access to the electronic   hearing.                1.  All persons wishing to be heard at the hearing shall   as directed in the Notice of Proposed Rulemaking, not less than five   (5) business days before the scheduled date of the hearing, notify   the Commission of their desire to appear and testify at the hearing.                2.  Hearings shall be conducted in a manner providing   each person who wishes to comment a fair and reasonable opportunity   to comment orally or in writing.                3.  All hearings shall be recorded. A copy of the   recording and the written comments, data, facts, opinions, and   arguments received in response to the proposed rulemaking shall be   made available to a person upon request.                4.  Nothing in this section shall be construed as   requiring a separate hearing on each proposed Rule. Proposed Rules   may be grouped for the convenience of the Commission at hearings   required by this section.          J.  Following the public hearing the Commission shall   consider all written and oral comments timely received.          K.  The Commission shall, by majority vote of all delegates,   take final action on the proposed Rule and shall determine the   effective date of the Rule, if adopted, based on the Rulemaking   record and the full text of the Rule.                1.  If adopted, the Rule shall be posted on the   Commission's website.                2.  The Commission may adopt changes to the proposed   Rule provided the changes do not enlarge the original purpose of the   proposed Rule.                3.  The Commission shall provide on its website an   explanation of the reasons for substantive changes made to the   proposed Rule as well as reasons for substantive changes not made   that were recommended by commenters.                4.  The Commission shall determine a reasonable   effective date for the Rule. Except for an emergency as provided in   subsection L, the effective date of the Rule shall be no sooner than   thirty (30) days after the Commission issued the notice that it   adopted the Rule.          L.  Upon determination that an emergency exists, the   Commission may consider and adopt an emergency Rule with   twenty-four (24) hours prior notice, without the opportunity for   comment, or hearing, provided that the usual rulemaking procedures   provided in this Compact and in this section shall be retroactively   applied to the Rule as soon as reasonably possible, in no event   later than ninety (90) days after the effective date of the Rule.   For the purposes of this provision, an emergency Rule is one that   must be adopted immediately by the Commission in order to:                1.  Meet an imminent threat to public health, safety,   or welfare;                2.  Prevent a loss of Commission or Participating State   funds;                3.  Meet a deadline for the promulgation of a   Commission Rule that is established by federal law or Rule; or                4.  Protect public health and safety.          M.  The Commission or an authorized committee of the   Commission may direct revisions to a previously adopted Commission   Rule for purposes of correcting typographical errors, errors in   format, errors in consistency, or grammatical errors. Public notice   of any revisions shall be posted on the website of the Commission.   The revision shall be subject to challenge by any person for a   period of thirty (30) days after posting. The revision may be   challenged only on grounds that the revision results in a material   change to a Rule. A challenge shall be made as set forth in the   notice of revisions and delivered to the Commission prior to the end   of the notice period. If no challenge is made, the revision will   take effect without further action. If the revision is challenged,   the revision may not take effect without the approval of the   Commission.          N.  No Participating State's rulemaking requirements shall   apply under this Compact.   Section 10.  Oversight, Dispute Resolution, and Enforcement          A. Oversight                1.  The executive and judicial branches of State   government in each Participating State shall enforce this Compact   and take all actions necessary and appropriate to implement the   Compact.                2.  Venue is proper and judicial proceedings by or   against the Commission shall be brought solely and exclusively in a   court of competent jurisdiction where the principal office of the   Commission is located. The Commission may waive venue and   jurisdictional defenses to the extent it adopts or consents to   participate in alternative dispute resolution proceedings. Nothing   herein shall affect or limit the selection or propriety of venue in   any action against a licensee for professional malpractice,   misconduct or any such similar matter.                3.  The Commission shall be entitled to receive service   of process in any proceeding regarding the enforcement or   interpretation of the Compact or the Commission's Rules and shall   have standing to intervene in such a proceeding for all purposes.   Failure to provide the Commission with service of process shall   render a judgment or order in such proceeding void as to the   Commission, this Compact, or Commission Rules.          B.  Default, Technical Assistance, and Termination                1.  If the Commission determines that a Participating   State has defaulted in the performance of its obligations or   responsibilities under this Compact or the Commission Rules, the   Commission shall provide written notice to the defaulting State and   other Participating States. The notice shall describe the default,   the proposed means of curing the default and any other action that   the Commission may take and shall offer remedial training and   specific technical assistance regarding the default.                2.  If a State in default fails to cure the default, the   defaulting State may be terminated from this Compact upon an   affirmative vote of a majority of the delegates of the   Participating States, and all rights, privileges and benefits   conferred by this Compact upon such State may be terminated on the   effective date of termination. A cure of the default does not   relieve the offending State of obligations or liabilities incurred   during the period of default.                3.  Termination of participation in this Compact shall   be imposed only after all other means of securing compliance have   been exhausted. Notice of intent to suspend or terminate shall be   given by the Commission to the governor, the majority and minority   leaders of the defaulting State's legislature, and to the Licensing   Board(s) of each of the Participating States.                4.  A State that has been terminated is responsible for   all assessments, obligations, and liabilities incurred through the   effective date of termination, including obligations that extend   beyond the effective date of termination.                5.  The Commission shall not bear any costs related to a   State that is found to be in default or that has been terminated   from this Compact, unless agreed upon in writing between the   Commission and the defaulting State.                6.  The defaulting State may appeal its termination   from the Compact by the Commission by petitioning the 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   Privilege in that State shall retain the Compact Privilege for one   hundred eighty (180) days following the effective date of such   termination.                      b.  Licensees who are licensed in that State who   have been granted a Compact Privilege in a Participating State   shall retain the Compact Privilege for one hundred eighty (180)   days unless the Licensee also has a Qualifying License in a   Participating State or obtains a Qualifying License in a   Participating State before the one hundred eighty (180)-day period   ends, in which case the Compact Privilege shall continue.          C.  Dispute Resolution                1.  Upon request by a Participating State, the   Commission shall attempt to resolve disputes related to this   Compact that arise among Participating States and between   participating and non-Participating States.                2.  The Commission shall promulgate a Rule providing   for both mediation and binding dispute resolution for disputes as   appropriate.          D.  Enforcement                1.  The Commission, in the reasonable exercise of its   discretion, shall enforce the provisions of this Compact and Rules   of the Commission.                2.  If compliance is not secured after all means to   secure compliance have been exhausted, by majority vote, the   Commission may initiate legal action in the United States District   Court for the District of Columbia or the federal district where the   Commission has its principal offices, against a Participating State   in default to enforce compliance with the provisions of this   Compact and the Commission's promulgated Rules and bylaws. The   relief sought may include both injunctive relief and damages. In   the event judicial enforcement is necessary, the prevailing party   shall be awarded all costs of such litigation, including reasonable   attorney's fees.                3.  The remedies herein shall not be the exclusive   remedies of the Commission. The Commission may pursue any other   remedies available under federal or State law.          E.  Legal Action Against the Commission                1.  A Participating State may initiate legal action   against the Commission in the U.S. District Court for the District   of Columbia or the federal district where the Commission has its   principal offices to enforce compliance with the provisions of the   Compact and its Rules. The relief sought may include both   injunctive relief and damages. In the event judicial enforcement is   necessary, the prevailing party shall be awarded all costs of such   litigation, including reasonable attorney's fees.                2.  No person other than a Participating State shall   enforce this Compact against the Commission.   Section 11.  Date of Implementation of the PA Licensure Compact   Commission          A.  This Compact shall come into effect on the date on which   this Compact statute is enacted into law in the seventh   Participating State.                1.  On or after the effective date of the Compact, the   Commission shall convene and review the enactment of each of the   States that enacted the Compact prior to the Commission convening   ("Charter Participating States") to determine if the statute   enacted by each such Charter Participating State is materially   different than the Model Compact.                      a.  A Charter Participating State whose enactment   is found to be materially different from the Model Compact shall be   entitled to the default process set forth in Section 10.B.                      b.  If any Participating State later withdraws   from the Compact or its participation is terminated, the Commission   shall remain in existence and the Compact shall remain in effect   even if the number of Participating States should be less than   seven. Participating States enacting the Compact subsequent to the   Commission convening shall be subject to the process set forth in   Section 7.C.21 to determine if their enactments are materially   different from the Model Compact and whether they qualify for   participation in the Compact.                2.  Participating States enacting the Compact   subsequent to the seven initial Charter Participating States shall   be subject to the process set forth in Section 7.C.21 to determine   if their enactments are materially different from the Model Compact   and whether they qualify for participation in the Compact.                3.  All actions taken for the benefit of the Commission   or in furtherance of the purposes of the administration of the   Compact prior to the effective date of the Compact or the Commission   coming into existence shall be considered to be actions of the   Commission unless specifically repudiated by the Commission.          B.  Any State that joins this Compact shall be subject to the   Commission's Rules and bylaws as they exist on the date on which   this Compact becomes law in that State. Any Rule that has been   previously adopted by the Commission shall have the full force and   effect of law on the day this Compact becomes law in that State.          C.  Any Participating State may withdraw from this Compact by   enacting a statute repealing the same.                1.  A Participating State's withdrawal shall not take   effect until one hundred eighty (180) days after enactment of the   repealing statute. During this one hundred eighty (180) day-period,   all Compact Privileges that were in effect in the withdrawing State   and were granted to Licensees licensed in the withdrawing State   shall remain in effect. If any Licensee licensed in the withdrawing   State is also licensed in another Participating State or obtains a   license in another Participating State within the one hundred   eighty (180) days, the Licensee's Compact Privileges in other   Participating States shall not be affected by the passage of the one   hundred eighty (180) days.                2.  Withdrawal shall not affect the continuing   requirement of the State Licensing Board(s) of the withdrawing   State to comply with the investigative, and Adverse Action   reporting requirements of this Compact prior to the effective date   of withdrawal.                3.  Upon the enactment of a statute withdrawing a State   from this Compact, the State shall immediately provide notice of   such withdrawal to all Licensees within that State. Such   withdrawing State shall continue to recognize all licenses granted   pursuant to this Compact for a minimum of one hundred eighty (180)   days after the date of such notice of withdrawal.          D.  Nothing contained in this Compact shall be construed to   invalidate or prevent any PA licensure agreement or other   cooperative arrangement between Participating States and between a   Participating State and non-Participating State that does not   conflict with the provisions of this Compact.          E.  This Compact may be amended by the Participating States.   No amendment to this Compact shall become effective and binding   upon any Participating State until it is enacted materially in the   same manner into the laws of all Participating States as determined   by the Commission.   Section 12.  Construction and Severability          A.  This Compact and the Commission's rulemaking authority   shall be liberally construed so as to effectuate the purposes, and   the implementation and administration of the Compact. Provisions of   the Compact expressly authorizing or requiring the promulgation of   Rules shall not be construed to limit the Commission's rulemaking   authority solely for those purposes.          B.  The provisions of this Compact shall be severable and if   any phrase, clause, sentence or provision of this Compact is held by   a court of competent jurisdiction to be contrary to the   constitution of any Participating State, a State seeking   participation in the Compact, or of the United States, or the   applicability thereof to any government, agency, person or   circumstance is held to be unconstitutional by a court of competent   jurisdiction, the validity of the remainder of this Compact and the   applicability thereof to any other government, agency, person or   circumstance shall not be affected thereby.          C.  Notwithstanding subsection B or this section, the   Commission may deny a State's participation in the Compact or, in   accordance with the requirements of Section10.B, terminate a   Participating State's participation in the Compact, if it   determines that a constitutional requirement of a Participating   State is, or would be with respect to a State seeking to participate   in the Compact, a material departure from the Compact. Otherwise,   if this Compact shall be held to be contrary to the constitution of   any Participating State, the Compact shall remain in full force and   effect as to the remaining Participating States and in full force   and effect as to the Participating State affected as to all   severable matters.   Section 13.  Binding Effect of Compact          A.  Nothing herein prevents the enforcement of any other law   of a Participating State that is not inconsistent with this   Compact.          B.  Any laws in a Participating State in conflict with this   Compact are superseded to the extent of the conflict.          C.  All agreements between the Commission and the   Participating States are binding in accordance with their terms.          Sec. 204.402.  ADMINISTRATION OF COMPACT. The physician   assistant board is the Physician Assistant Licensure Compact   administrator for this state.          Sec. 204.403.  RULES. The physician assistant board may   adopt rules necessary to implement this subchapter.          SECTION 2.  This Act takes effect September 1, 2025.