Senate File 312 - Introduced SENATE FILE 312 BY COMMITTEE ON HEALTH AND HUMAN SERVICES (SUCCESSOR TO SSB 1052) A BILL FOR An Act enacting the physician assistant licensure compact. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 1743SV (1) 91 ss/ko

S.F. 312 Section 1. NEW SECTION . 147J.1 Physician assistant 1 licensure compact. 2 1. Purpose. In order to strengthen access to medical 3 services, and in recognition of the advances in the delivery 4 of medical services, the participating states of the physician 5 assistant licensure compact have allied in common purpose to 6 develop a comprehensive process that complements the existing 7 authority of state licensing boards to license and discipline 8 physician assistants and seeks to enhance the portability 9 of a license to practice as a physician assistant while 10 safeguarding the safety of patients. This compact allows 11 medical services to be provided by physician assistants, via 12 the mutual recognition of the licensee’s qualifying license by 13 other compact participating states. This compact also adopts 14 the prevailing standard for physician assistant licensure and 15 affirms that the practice and delivery of medical services by 16 the physician assistant occurs where the patient is located at 17 the time of the patient encounter, and therefore requires the 18 physician assistant to be under the jurisdiction of the state 19 licensing board where the patient is located. State licensing 20 boards that participate in this compact retain the jurisdiction 21 to impose adverse action against a compact privilege in that 22 state issued to a physician assistant through the procedures 23 of this compact. The physician assistant licensure compact 24 will alleviate burdens for military families by allowing active 25 duty military personnel and their spouses to obtain a compact 26 privilege based on having an unrestricted license in good 27 standing from a participating state. 28 2. Definitions. In this compact: 29 a. “Adverse action” means any administrative, civil, 30 equitable, or criminal action permitted by a state’s laws 31 which is imposed by a licensing board or other authority 32 against a physician assistant license or license application or 33 compact privilege such as license denial, censure, revocation, 34 suspension, probation, monitoring of the licensee, or 35 -1- LSB 1743SV (1) 91 ss/ko 1/ 30

S.F. 312 restriction on the licensee’s practice. 1 b. “Compact privilege” means the authorization granted by 2 a remote state to allow a licensee from another participating 3 state to practice as a physician assistant to provide medical 4 services and other licensed activity to a patient located in 5 the remote state under the remote state’s laws and regulations. 6 c. “Conviction” means a finding by a court that an 7 individual is guilty of a felony or misdemeanor offense through 8 adjudication or entry of a plea of guilt or no contest to the 9 charge by the offender. 10 d. “Criminal background check” means the submission of 11 fingerprints or other biometric-based information for a 12 license applicant for the purpose of obtaining that applicant’s 13 criminal history record information, as defined in 28 C.F.R. 14 §20.3(d), from the state’s criminal history record repository 15 as defined in 28 C.F.R. §20.3(f). 16 e. “Data system” means the repository of information about 17 licensees, including but not limited to license status and 18 adverse actions, which is created and administered under the 19 terms of this compact. 20 f. “Executive committee” means a group of directors and ex 21 officio individuals elected or appointed pursuant to subsection 22 7, paragraph “f” , subparagraph (2). 23 g. “Impaired practitioner” means a physician assistant whose 24 practice is adversely affected by a health-related condition 25 that impacts the physician assistant’s ability to practice. 26 h. “Investigative information” means information, records, 27 or documents received or generated by a licensing board 28 pursuant to an investigation. 29 i. “Jurisprudence requirement” means the assessment of an 30 individual’s knowledge of the laws and rules governing the 31 practice of a physician assistant in a state. 32 j. “License” means current authorization by a state, other 33 than authorization pursuant to a compact privilege, for a 34 physician assistant to provide medical services, which would be 35 -2- LSB 1743SV (1) 91 ss/ko 2/ 30

S.F. 312 unlawful without current authorization. 1 k. “Licensee” means an individual who holds a license from a 2 state to provide medical services as a physician assistant. 3 l. “Licensing board” means any state entity authorized to 4 license and otherwise regulate physician assistants. 5 m. “Medical services” means health care services provided 6 for the diagnosis, prevention, treatment, cure, or relief of a 7 health condition, injury, or disease, as defined by a state’s 8 laws and regulations. 9 n. “Model compact” means the model for the physician 10 assistant licensure compact on file with the council of state 11 governments or other entity as designated by the commission. 12 o. “Participating state” means a state that has enacted this 13 compact. 14 p. “Physician assistant” means an individual who is 15 licensed as a physician assistant in a state. For purposes 16 of this compact, any other title or status adopted by a state 17 to replace the term “physician assistant” shall be deemed 18 synonymous with “physician assistant” and shall confer the 19 same rights and responsibilities to the licensee under the 20 provisions of this compact at the time of its enactment. 21 q. “Physician assistant licensure compact commission” , 22 “compact commission” , or “commission” means the national 23 administrative body created pursuant to subsection 7, paragraph 24 “a” , of this compact. 25 r. “Qualifying license” means an unrestricted license issued 26 by a participating state to provide medical services as a 27 physician assistant. 28 s. “Remote state” means a participating state where a 29 licensee who is not licensed as a physician assistant is 30 exercising or seeking to exercise the compact privilege. 31 t. “Rule” means a regulation promulgated by an entity that 32 has the force and effect of law. 33 u. “Significant investigative information” means 34 investigative information that a licensing board, after an 35 -3- LSB 1743SV (1) 91 ss/ko 3/ 30

S.F. 312 inquiry or investigation that includes notification and an 1 opportunity for the physician assistant to respond if required 2 by state law, has reason to believe is not groundless and, if 3 proven true, would indicate more than a minor infraction. 4 v. “State” means any state, commonwealth, district, or 5 territory of the United States. 6 3. State participation in this compact. 7 a. To participate in this compact, a participating state 8 shall do all of the following: 9 (1) License physician assistants. 10 (2) Participate in the compact commission’s data system. 11 (3) Have a mechanism in place for receiving and 12 investigating complaints against licensees and license 13 applicants. 14 (4) Notify the commission, in compliance with the terms 15 of this compact and commission rules, of any adverse action 16 against a licensee or license applicant and the existence of 17 significant investigative information regarding a licensee or 18 license applicant. 19 (5) Fully implement a criminal background check 20 requirement, within a time frame established by commission 21 rule, by its licensing board receiving the results of a 22 criminal background check and reporting to the commission 23 whether the license applicant has been granted a license. 24 (6) Comply with the rules of the compact commission. 25 (7) Utilize passage of a recognized national exam such 26 as the NCCPA PANCE as a requirement for physician assistant 27 licensure. 28 (8) Grant the compact privilege to a holder of a qualifying 29 license in a participating state. 30 b. Nothing in this compact prohibits a participating state 31 from charging a fee for granting the compact privilege. 32 4. Compact privilege. 33 a. To exercise the compact privilege, a licensee must meet 34 all of the following requirements: 35 -4- LSB 1743SV (1) 91 ss/ko 4/ 30

S.F. 312 (1) Have graduated from a physician assistant program 1 accredited by the accreditation review commission on education 2 for the physician assistant, inc., or other programs authorized 3 by commission rule. 4 (2) Hold current NCCPA certification. 5 (3) Have no felony or misdemeanor conviction. 6 (4) Have never had a controlled substance license, permit, 7 or registration suspended or revoked by a state or by the 8 United States drug enforcement administration. 9 (5) Have a unique identifier as determined by commission 10 rule. 11 (6) Hold a qualifying license. 12 (7) Have had no revocation of a license or limitation or 13 restriction on any license currently held due to an adverse 14 action. 15 (8) If a licensee has had a limitation or restriction on 16 a license or compact privilege due to an adverse action, two 17 years must have elapsed from the date on which the license or 18 compact privilege is no longer limited or restricted due to the 19 adverse action. 20 (9) If a compact privilege has been revoked or is limited or 21 restricted in a participating state for conduct that would not 22 be a basis for disciplinary action in a participating state in 23 which the licensee is practicing or applying to practice under 24 a compact privilege, that participating state shall have the 25 discretion not to consider such action as an adverse action 26 requiring the denial or removal of a compact privilege in that 27 state. 28 (10) Notify the compact commission that the licensee is 29 seeking the compact privilege in a remote state. 30 (11) Meet any jurisprudence requirement of a remote state 31 in which the licensee is seeking to practice under the compact 32 privilege and pay any fees applicable to satisfying the 33 jurisprudence requirement. 34 (12) Report to the commission any adverse action taken by a 35 -5- LSB 1743SV (1) 91 ss/ko 5/ 30

S.F. 312 nonparticipating state within thirty days after the action is 1 taken. 2 b. The compact privilege is valid until the expiration or 3 revocation of the qualifying license unless terminated pursuant 4 to an adverse action. The licensee must also comply with all 5 of the requirements of paragraph “a” to maintain the compact 6 privilege in a remote state. If the participating state takes 7 adverse action against a qualifying license, the licensee shall 8 lose the compact privilege in any remote state in which the 9 licensee has a compact privilege until all of the following 10 occur: 11 (1) The licensee is no longer limited or restricted. 12 (2) Two years have elapsed from the date on which the 13 license is no longer limited or restricted due to the adverse 14 action. 15 c. Once a restricted or limited license satisfies the 16 requirements of paragraph “b” , subparagraphs (1) and (2), the 17 licensee must meet the requirements of paragraph “a” to obtain 18 a compact privilege in any remote state. 19 d. For each remote state in which a physician assistant 20 seeks authority to prescribe controlled substances, the 21 physician assistant shall satisfy all requirements imposed by 22 such state in granting or renewing such authority. 23 5. Designation of the state from which licensee is applying 24 for a compact privilege. Upon a licensee’s application for 25 a compact privilege, the licensee shall identify to the 26 commission the participating state from which the licensee is 27 applying, in accordance with applicable rules adopted by the 28 commission, and subject to the following requirements: 29 a. When applying for a compact privilege, the licensee 30 shall provide the commission with the address of the licensee’s 31 primary residence and thereafter shall immediately report to 32 the commission any change in the address of the licensee’s 33 primary residence. 34 b. When applying for a compact privilege, the licensee is 35 -6- LSB 1743SV (1) 91 ss/ko 6/ 30

S.F. 312 required to consent to accept service of process by mail at 1 the licensee’s primary residence on file with the commission 2 with respect to any action brought against the licensee by the 3 commission or a participating state, including a subpoena, with 4 respect to any action brought or investigation conducted by the 5 commission or a participating state. 6 6. Adverse actions. 7 a. A participating state in which a licensee is licensed 8 shall have exclusive power to impose adverse action against the 9 qualifying license issued by that participating state. 10 b. In addition to the other powers conferred by state law, 11 a remote state shall have the authority, in accordance with 12 existing state due process law, to do all of the following: 13 (1) Take adverse action against a physician assistant’s 14 compact privilege within that state to remove a licensee’s 15 compact privilege or take other action necessary under 16 applicable law to protect the health and safety of its 17 citizens. 18 (2) Issue subpoenas for both hearings and investigations 19 that require the attendance and testimony of witnesses as 20 well as the production of evidence. Subpoenas issued by a 21 licensing board in a participating state for the attendance 22 and testimony of witnesses or the production of evidence from 23 another participating state shall be enforced in the latter 24 state by any court of competent jurisdiction, according to the 25 practice and procedure of that court applicable to subpoenas 26 issued in proceedings pending before it. The issuing authority 27 shall pay any witness fees, travel expenses, mileage and other 28 fees required by the service statutes of the state in which the 29 witnesses or evidence are located. 30 (3) Notwithstanding subparagraph (2), subpoenas may not be 31 issued by a participating state to gather evidence of conduct 32 in another state that is lawful in that other state for the 33 purpose of taking adverse action against a licensee’s compact 34 privilege or application for a compact privilege in that 35 -7- LSB 1743SV (1) 91 ss/ko 7/ 30

S.F. 312 participating state. 1 (4) Nothing in this compact authorizes a participating 2 state to impose discipline against a physician assistant’s 3 compact privilege or to deny an application for a compact 4 privilege in that participating state for the individual’s 5 otherwise lawful practice in another state. 6 c. For purposes of taking adverse action, the participating 7 state which issued the qualifying license shall give the same 8 priority and effect to reported conduct received from any other 9 participating state as it would if the conduct had occurred 10 within the participating state which issued the qualifying 11 license. In so doing, that participating state shall apply its 12 own state laws to determine appropriate action. 13 d. A participating state, if otherwise permitted by state 14 law, may recover from the affected physician assistant the 15 costs of investigations and disposition of cases resulting from 16 any adverse action taken against that physician assistant. 17 e. A participating state may take adverse action based 18 on the factual findings of a remote state, provided that the 19 participating state follows its own procedures for taking the 20 adverse action. 21 f. Joint investigations. 22 (1) In addition to the authority granted to a participating 23 state by its respective state physician assistant laws and 24 regulations or other applicable state law, any participating 25 state may participate with other participating states in joint 26 investigations of licensees. 27 (2) Participating states shall share any investigative, 28 litigation, or compliance materials in furtherance of any joint 29 or individual investigation initiated under this compact. 30 g. If an adverse action is taken against a physician 31 assistant’s qualifying license, the physician assistant’s 32 compact privilege in all remote states shall be deactivated 33 until two years have elapsed after all restrictions have been 34 removed from the state license. All disciplinary orders by the 35 -8- LSB 1743SV (1) 91 ss/ko 8/ 30

S.F. 312 participating state which issued the qualifying license that 1 impose adverse action against a physician assistant’s license 2 shall include a statement that the physician assistant’s 3 compact privilege is deactivated in all participating states 4 during the pendency of the order. 5 h. If any participating state takes adverse action, it shall 6 promptly notify the administrator of the data system. 7 7. Establishment of the physician assistant licensure compact 8 commission. 9 a. The participating states hereby create and establish a 10 joint government agency and national administrative body known 11 as the physician assistant licensure compact commission. The 12 commission is an instrumentality of the compact states acting 13 jointly and not an instrumentality of any one state. The 14 commission shall come into existence on or after the effective 15 date of the compact as set forth in subsection 11, paragraph 16 “a” . 17 b. Membership, voting, and meetings. 18 (1) Each participating state shall have and be limited to 19 one delegate selected by that participating state’s licensing 20 board or, if the state has more than one licensing board, 21 selected collectively by the participating state’s licensing 22 boards. 23 (2) The delegate shall be one of the following: 24 (a) A current physician assistant, physician, or public 25 member of a licensing board or physician assistant council or 26 committee. 27 (b) An administrator of a licensing board. 28 (3) Any delegate may be removed or suspended from office as 29 provided by the laws of the state from which the delegate is 30 appointed. 31 (4) The participating state licensing board shall fill any 32 vacancy occurring in the commission within sixty days. 33 (5) Each delegate shall be entitled to one vote on all 34 matters voted on by the commission and shall otherwise have an 35 -9- LSB 1743SV (1) 91 ss/ko 9/ 30

S.F. 312 opportunity to participate in the business and affairs of the 1 commission. A delegate shall vote in person or by such other 2 means as provided in the bylaws. The bylaws may provide for 3 delegates’ participation in meetings by telecommunications, 4 video conference, or other means of communication. 5 (6) The commission shall meet at least once during each 6 calendar year. Additional meetings shall be held as set forth 7 in this compact and the bylaws. 8 (7) The commission shall establish by rule a term of office 9 for delegates. 10 c. The commission shall have the following powers and 11 duties: 12 (1) Establish a code of ethics for the commission. 13 (2) Establish the fiscal year of the commission. 14 (3) Establish fees. 15 (4) Establish bylaws. 16 (5) Maintain its financial records in accordance with the 17 bylaws. 18 (6) Meet and take such actions as are consistent with the 19 provisions of this compact and the bylaws. 20 (7) Promulgate rules to facilitate and coordinate 21 implementation and administration of this compact. The rules 22 shall have the force and effect of law and shall be binding in 23 all participating states. 24 (8) Bring and prosecute legal proceedings or actions in the 25 name of the commission, provided that the standing of any state 26 licensing board to sue or be sued under applicable law shall 27 not be affected. 28 (9) Purchase and maintain insurance and bonds. 29 (10) Borrow, accept, or contract for services of personnel, 30 including but not limited to employees of a participating 31 state. 32 (11) Hire employees and engage contractors, elect or 33 appoint officers, fix compensation, define duties, grant such 34 individuals appropriate authority to carry out the purposes of 35 -10- LSB 1743SV (1) 91 ss/ko 10/ 30

S.F. 312 this compact, and establish the commission’s personnel policies 1 and programs relating to conflicts of interest, qualifications 2 of personnel, and other related personnel matters. 3 (12) Accept any and all appropriate donations and grants 4 of money, equipment, supplies, materials, and services, and 5 receive, utilize, and dispose of the same; provided that at all 6 times the commission shall avoid any appearance of impropriety 7 or conflict of interest. 8 (13) Lease, purchase, accept appropriate gifts or donations 9 of, or otherwise own, hold, improve, or use any property, real, 10 personal, or mixed; provided that at all times the commission 11 shall avoid any appearance of impropriety. 12 (14) Sell, convey, mortgage, pledge, lease, exchange, 13 abandon, or otherwise dispose of any property, real, personal, 14 or mixed. 15 (15) Establish a budget and make expenditures. 16 (16) Borrow money. 17 (17) Appoint committees, including standing committees 18 composed of members, state regulators, state legislators or 19 their representatives, and consumer representatives, and such 20 other interested persons as may be designated in this compact 21 and the bylaws. 22 (18) Provide and receive information from, and cooperate 23 with, law enforcement agencies. 24 (19) Elect a chair, vice chair, secretary, and treasurer 25 and such other officers of the commission as provided in the 26 commission’s bylaws. 27 (20) Reserve for itself, in addition to those reserved 28 exclusively to the commission under the compact, powers that 29 the executive committee may not exercise. 30 (21) Approve or disapprove a state’s participation in the 31 compact based upon its determination as to whether the state’s 32 compact legislation departs in a material manner from the model 33 compact language. 34 (22) Prepare and provide to the participating states an 35 -11- LSB 1743SV (1) 91 ss/ko 11/ 30

S.F. 312 annual report. 1 (23) Perform such other functions as may be necessary or 2 appropriate to achieve the purposes of this compact consistent 3 with the state regulation of physician assistant licensure and 4 practice. 5 d. Meetings of the commission. 6 (1) All meetings of the commission that are not closed 7 pursuant to this paragraph shall be open to the public. Notice 8 of public meetings shall be posted on the commission’s internet 9 site at least thirty days prior to the public meeting. 10 (2) Notwithstanding subparagraph (1), the commission may 11 convene a public meeting by providing at least twenty-four 12 hours prior notice on the commission’s internet site, and any 13 other means as provided in the commission’s rules, for any of 14 the reasons it may dispense with notice of proposed rulemaking 15 under subsection 9, paragraph “l” . 16 (3) The commission may convene in a closed, nonpublic 17 meeting or nonpublic part of a public meeting to receive legal 18 advice or to discuss any of the following: 19 (a) Noncompliance of a participating state with its 20 obligations under this compact. 21 (b) The employment, compensation, discipline or other 22 matters, practices or procedures related to specific employees 23 or other matters related to the commission’s internal personnel 24 practices and procedures. 25 (c) Current, threatened, or reasonably anticipated 26 litigation. 27 (d) Negotiation of contracts for the purchase, lease, or 28 sale of goods, services, or real estate. 29 (e) Accusing any person of a crime or formally censuring any 30 person. 31 (f) Disclosure of trade secrets or commercial or financial 32 information that is privileged or confidential. 33 (g) Disclosure of information of a personal nature where 34 disclosure would constitute a clearly unwarranted invasion of 35 -12- LSB 1743SV (1) 91 ss/ko 12/ 30

S.F. 312 personal privacy. 1 (h) Disclosure of investigative records compiled for law 2 enforcement purposes. 3 (i) Disclosure of information related to any investigative 4 reports prepared by or on behalf of or for use of the 5 commission or other committee charged with responsibility of 6 investigation or determination of compliance issues pursuant to 7 this compact. 8 (j) Legal advice. 9 (k) Matters specifically exempted from disclosure by 10 federal or participating states’ statutes. 11 (4) If a meeting, or portion of a meeting, is closed 12 pursuant to this provision, the chair of the meeting or the 13 chair’s designee shall certify that the meeting or portion of 14 the meeting may be closed and shall reference each relevant 15 exempting provision. 16 (5) The commission shall keep minutes that fully and clearly 17 describe all matters discussed in a meeting and shall provide 18 a full and accurate summary of actions taken, including a 19 description of the views expressed. All documents considered 20 in connection with an action shall be identified in such 21 minutes. All minutes and documents of a closed meeting shall 22 remain under seal, subject to release by a majority vote of the 23 commission or order of a court of competent jurisdiction. 24 e. Financing of the commission. 25 (1) The commission shall pay, or provide for the payment of, 26 the reasonable expenses of its establishment, organization, and 27 ongoing activities. 28 (2) The commission may accept any and all appropriate 29 revenue sources, donations, and grants of money, equipment, 30 supplies, materials, and services. 31 (3) The commission may levy on and collect an annual 32 assessment from each participating state and may impose 33 compact privilege fees on licensees of participating states 34 to whom a compact privilege is granted to cover the cost of 35 -13- LSB 1743SV (1) 91 ss/ko 13/ 30

S.F. 312 the operations and activities of the commission and its staff, 1 which must be in a total amount sufficient to cover its annual 2 budget as approved by the commission each year for which 3 revenue is not provided by other sources. The aggregate annual 4 assessment amount levied on participating states shall be 5 allocated based upon a formula to be determined by commission 6 rule. 7 (a) A compact privilege expires when the licensee’s 8 qualifying license in the participating state from which the 9 licensee applied for the compact privilege expires. 10 (b) If the licensee terminates the qualifying license 11 through which the licensee applied for the compact privilege 12 before its scheduled expiration, and the licensee has a 13 qualifying license in another participating state, the licensee 14 shall inform the commission that it is changing to that 15 participating state the participating state through which it 16 applies for a compact privilege and pay to the commission any 17 compact privilege fee required by commission rule. 18 (4) The commission shall not incur obligations of any 19 kind prior to securing the funds adequate to meet the same; 20 nor shall the commission pledge the credit of any of the 21 participating states, except by and with the authority of the 22 participating state. 23 (5) The commission shall keep accurate accounts of all 24 receipts and disbursements. The receipts and disbursements 25 of the commission shall be subject to the financial review 26 and accounting procedures established under its bylaws. All 27 receipts and disbursements of funds handled by the commission 28 shall be subject to an annual financial review by a certified 29 or licensed public accountant, and the report of the financial 30 review shall be included in and become part of the annual 31 report of the commission. 32 f. The executive committee. 33 (1) The executive committee shall have the power to act on 34 behalf of the commission according to the terms of this compact 35 -14- LSB 1743SV (1) 91 ss/ko 14/ 30

S.F. 312 and commission rules. 1 (2) The executive committee shall be composed of nine 2 members: 3 (a) Seven voting members who are elected by the commission 4 from the current membership of the commission. 5 (b) One ex officio, nonvoting member from a recognized 6 national physician assistant professional association. 7 (c) One ex officio, nonvoting member from a recognized 8 national physician assistant certification organization. 9 (3) The ex officio members will be selected by their 10 respective organizations. 11 (4) The commission may remove any member of the executive 12 committee as provided in its bylaws. 13 (5) The executive committee shall meet at least annually. 14 (6) The executive committee shall have the following duties 15 and responsibilities: 16 (a) Recommend to the commission changes to the commission’s 17 rules or bylaws, changes to this compact legislation, fees to 18 be paid by compact participating states such as annual dues, 19 and any commission compact fee charged to licensees for the 20 compact privilege. 21 (b) Ensure compact administration services are 22 appropriately provided, contractual or otherwise. 23 (c) Prepare and recommend the budget. 24 (d) Maintain financial records on behalf of the commission. 25 (e) Monitor compact compliance of participating states and 26 provide compliance reports to the commission. 27 (f) Establish additional committees as necessary. 28 (g) Exercise the powers and duties of the commission during 29 the interim between commission meetings, except for issuing 30 proposed rulemaking or adopting commission rules or bylaws, or 31 exercising any other powers and duties exclusively reserved to 32 the commission by the commission’s rules. 33 (h) Perform other duties as provided in the commission’s 34 rules or bylaws. 35 -15- LSB 1743SV (1) 91 ss/ko 15/ 30

S.F. 312 (7) All meetings of the executive committee at which it 1 votes or plans to vote on matters in exercising the powers and 2 duties of the commission shall be open to the public and public 3 notice of such meetings shall be given as public meetings of 4 the commission are given. 5 (8) The executive committee may convene in a closed, 6 nonpublic meeting for the same reasons that the commission may 7 convene in a nonpublic meeting as set forth in subsection 7, 8 paragraph “d” , subparagraph (3), and shall announce the closed 9 meeting as the commission is required to under subsection 7, 10 paragraph “d” , subparagraph (4), and keep minutes of the closed 11 meeting as the commission is required to under subsection 7, 12 paragraph “d” , subparagraph (5). 13 g. Qualified immunity, defense, and indemnification. 14 (1) The members, officers, executive director, employees, 15 and representatives of the commission shall be immune from 16 suit and liability, both personally and in their official 17 capacities, for any claim for damage to or loss of property or 18 personal injury or other civil liability caused by or arising 19 out of any actual or alleged act, error, or omission that 20 occurred, or that the person against whom the claim is made had 21 a reasonable basis for believing occurred, within the scope of 22 commission employment, duties, or responsibilities; provided 23 that nothing in this subparagraph shall be construed to protect 24 any such person from suit or liability for any damage, loss, 25 injury, or liability caused by the intentional or willful or 26 wanton misconduct of that person. The procurement of insurance 27 of any type by the commission shall not in any way compromise 28 or limit the immunity granted hereunder. 29 (2) The commission shall defend any member, officer, 30 executive director, employee, and representative of the 31 commission in any civil action seeking to impose liability 32 arising out of any actual or alleged act, error, or omission 33 that occurred within the scope of commission employment, 34 duties, or responsibilities, or as determined by the commission 35 -16- LSB 1743SV (1) 91 ss/ko 16/ 30

S.F. 312 that the person against whom the claim is made had a reasonable 1 basis for believing occurred within the scope of commission 2 employment, duties, or responsibilities; provided that nothing 3 in this subparagraph shall be construed to prohibit that 4 person from retaining counsel at the person’s own expense; 5 and provided further, that the actual or alleged act, error, 6 or omission did not result from that person’s intentional or 7 willful or wanton misconduct. 8 (3) The commission shall indemnify and hold harmless 9 any member, officer, executive director, employee, and 10 representative of the commission for the amount of any 11 settlement or judgment obtained against that person arising 12 out of any actual or alleged act, error, or omission that 13 occurred within the scope of commission employment, duties, 14 or responsibilities, or that such person had a reasonable 15 basis for believing occurred within the scope of commission 16 employment, duties, or responsibilities, provided that the 17 actual or alleged act, error, or omission did not result from 18 the intentional or willful or wanton misconduct of that person. 19 (4) Venue is proper and judicial proceedings by or against 20 the commission shall be brought solely and exclusively in a 21 court of competent jurisdiction where the principal office of 22 the commission is located. The commission may waive venue and 23 jurisdictional defenses in any proceedings as authorized by 24 commission rules. 25 (5) Nothing herein shall be construed as a limitation on 26 the liability of any licensee for professional malpractice 27 or misconduct, which shall be governed solely by any other 28 applicable state laws. 29 (6) Nothing herein shall be construed to designate the 30 venue or jurisdiction to bring actions for alleged acts of 31 malpractice, professional misconduct, negligence, or other 32 such civil action pertaining to the practice of a physician 33 assistant. All such matters shall be determined exclusively by 34 state law other than this compact. 35 -17- LSB 1743SV (1) 91 ss/ko 17/ 30

S.F. 312 (7) Nothing in this compact shall be interpreted to waive 1 or otherwise abrogate a participating state’s state action 2 immunity or state action affirmative defense with respect to 3 antitrust claims under the Sherman Act, Clayton Act, or any 4 other state or federal antitrust or anticompetitive law or 5 regulation. 6 (8) Nothing in this compact shall be construed to be a 7 waiver of sovereign immunity by the participating states or by 8 the commission. 9 8. Data system. 10 a. The commission shall provide for the development, 11 maintenance, operation, and utilization of a coordinated data 12 and reporting system containing licensure, adverse action, and 13 the reporting of the existence of significant investigative 14 information on all licensed physician assistants and applicants 15 denied a license in participating states. 16 b. Notwithstanding any other state law to the contrary, 17 a participating state shall submit a uniform data set to the 18 data system on all physician assistants to whom this compact is 19 applicable, utilizing a unique identifier, as required by the 20 rules of the commission, including: 21 (1) Identifying information. 22 (2) Licensure data. 23 (3) Adverse actions against a license or compact privilege. 24 (4) Any denial of application for licensure, and the reason 25 for such denial, excluding the reporting of any criminal 26 history record information where prohibited by law. 27 (5) The existence of significant investigative information. 28 (6) Other information that may facilitate the 29 administration of this compact, as determined by the rules of 30 the commission. 31 c. Significant investigative information pertaining to a 32 licensee in any participating state shall only be available to 33 other participating states. 34 d. The commission shall promptly notify all participating 35 -18- LSB 1743SV (1) 91 ss/ko 18/ 30

S.F. 312 states of any adverse action taken against a licensee or an 1 individual applying for a license that has been reported to it. 2 This adverse action information shall be available to any other 3 participating state. 4 e. Participating states contributing information to the data 5 system may, in accordance with state or federal law, designate 6 information that may not be shared with the public without the 7 express permission of the contributing state. Notwithstanding 8 any such designation, such information shall be reported to the 9 commission through the data system. 10 f. Any information submitted to the data system that is 11 subsequently expunged pursuant to federal law or the laws of 12 the participating state contributing the information shall be 13 removed from the data system upon reporting of such by the 14 participating state to the commission. 15 g. The records and information provided to a participating 16 state pursuant to this compact or through the data system, 17 when certified by the commission or an agent thereof, 18 shall constitute the authenticated business records of the 19 commission, and shall be entitled to any associated hearsay 20 exception in any relevant judicial, quasi-judicial, or 21 administrative proceedings in a participating state. 22 9. Rulemaking. 23 a. The commission shall exercise its rulemaking powers 24 pursuant to the criteria set forth in this subsection and 25 the rules adopted thereunder. Commission rules shall become 26 binding as of the date specified by the commission for each 27 rule. 28 b. The commission shall promulgate reasonable rules in order 29 to effectively and efficiently implement and administer this 30 compact and achieve its purposes. A commission rule shall 31 be invalid and not have force or effect only if a court of 32 competent jurisdiction holds that the rule is invalid because 33 the commission exercised its rulemaking authority in a manner 34 that is beyond the scope of the purposes of this compact, or 35 -19- LSB 1743SV (1) 91 ss/ko 19/ 30

S.F. 312 the powers granted in this subsection, or based upon another 1 applicable standard of review. 2 c. The rules of the commission shall have the force of 3 law in each participating state, provided however that where 4 the rules of the commission conflict with the laws of the 5 participating state that establish the medical services a 6 physician assistant may perform in the participating state, as 7 held by a court of competent jurisdiction, the rules of the 8 commission shall be ineffective in that state to the extent of 9 the conflict. 10 d. If a majority of the legislatures of the participating 11 states rejects a commission rule by enactment of a statute or 12 resolution in the same manner used to adopt this compact within 13 four years of the date of adoption of the rule, then such rule 14 shall have no further force and effect in any participating 15 state or to any state applying to participate in the compact. 16 e. Commission rules shall be adopted at a regular or special 17 meeting of the commission. 18 f. Prior to promulgation and adoption of a final rule or 19 rules by the commission, and at least thirty days in advance 20 of the meeting at which the rule will be considered and voted 21 upon, the commission shall file a notice of proposed rulemaking 22 using all of the following methods: 23 (1) On the internet site of the commission or other publicly 24 accessible platform. 25 (2) To persons who have requested notice of the commission’s 26 notices of proposed rulemaking. 27 (3) In such other ways as the commission may by rule 28 specify. 29 g. The notice of proposed rulemaking shall include all of 30 the following: 31 (1) The time, date, and location of the public hearing on 32 the proposed rule and the proposed time, date, and location of 33 the meeting in which the proposed rule will be considered and 34 voted upon. 35 -20- LSB 1743SV (1) 91 ss/ko 20/ 30