House File 694 - Reprinted HOUSE FILE 694 BY COMMITTEE ON PUBLIC SAFETY (SUCCESSOR TO HSB 192) (As Amended and Passed by the House March 21, 2019 ) A BILL FOR An Act establishing an emergency medical services personnel 1 licensure interstate compact. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 HF 694 (3) 88 ss/rn/md

H.F. 694 DIVISION I 1 EMERGENCY MEDICAL SERVICES PERSONNEL LICENSURE INTERSTATE 2 COMPACT 3 Section 1. NEW SECTION . 147D.1 Emergency medical services 4 personnel licensure interstate compact. 5 1. Purpose. In order to protect the public through 6 verification of competency and ensure accountability for 7 patient care related activities all states license emergency 8 medical services personnel, such as emergency medical 9 technicians, advanced emergency medical technicians, and 10 paramedics. This compact is intended to facilitate the 11 day-to-day movement of emergency medical services personnel 12 across state boundaries in the performance of their emergency 13 medical services duties as assigned by an appropriate authority 14 and authorize state emergency medical services offices to 15 afford immediate legal recognition to emergency medical 16 services personnel licensed in a member state. This compact 17 recognizes that states have a vested interest in protecting 18 the public’s health and safety through their licensing and 19 regulation of emergency medical services personnel and that 20 such state regulation shared among the member states will best 21 protect public health and safety. This compact is designed to 22 achieve the following purposes and objectives: 23 a. Increase public access to emergency medical services 24 personnel. 25 b. Enhance the states’ ability to protect the public’s 26 health and safety, especially patient safety. 27 c. Encourage the cooperation of member states in the 28 areas of emergency medical services personnel licensure and 29 regulation. 30 d. Support licensing of military members who are separating 31 from an active duty tour and their spouses. 32 e. Facilitate the exchange of information between member 33 states regarding emergency medical services personnel 34 licensure, adverse action, and significant investigatory 35 -1- HF 694 (3) 88 ss/rn/md 1/ 25

H.F. 694 information. 1 f. Promote compliance with the laws governing emergency 2 medical services personnel practice in each member state. 3 g. Invest all member states with the authority to hold 4 emergency medical services personnel accountable through the 5 mutual recognition of member state licenses. 6 2. Definitions. In this compact: 7 a. “Advanced emergency medical technician” or “AEMT” means 8 an individual licensed with cognitive knowledge and a scope 9 of practice that corresponds to that level in the national 10 emergency medical services education standards and national 11 emergency medical services scope of practice model. 12 b. “Adverse action” means any administrative, civil, 13 equitable, or criminal action permitted by a state’s laws which 14 may be imposed against licensed emergency medical services 15 personnel by a state emergency medical services authority or 16 state court, including but not limited to actions against an 17 individual’s license such as revocation, suspension, probation, 18 consent agreement, monitoring, or other limitation or 19 encumbrance on the individual’s practice, letters of reprimand 20 or admonition, fines, criminal convictions, and state court 21 judgments enforcing adverse actions by the state emergency 22 medical services authority. 23 c. “Alternative program” means a voluntary, nondisciplinary 24 substance abuse recovery program approved by a state emergency 25 medical services authority. 26 d. “Certification” means the successful verification of 27 entry-level cognitive and psychomotor competency using a 28 reliable, validated, and legally defensible examination. 29 e. “Commission” means the national administrative body of 30 which all states that have enacted the compact are members. 31 f. “Emergency medical technician” or “EMT” means an 32 individual licensed with cognitive knowledge and a scope 33 of practice that corresponds to that level in the national 34 emergency medical services education standards and national 35 -2- HF 694 (3) 88 ss/rn/md 2/ 25

H.F. 694 emergency medical services scope of practice model. 1 g. “Home state” means a member state where an individual is 2 licensed to practice emergency medical services. 3 h. “License” means the authorization by a state for an 4 individual to practice as an EMT, AEMT, paramedic, or a level 5 between EMT and paramedic. 6 i. “Medical director” means a physician licensed in a member 7 state who is accountable for the care delivered by emergency 8 medical services personnel. 9 j. “Member state” means a state that has enacted this 10 compact. 11 k. “Paramedic” means an individual licensed with cognitive 12 knowledge and a scope of practice that corresponds to that 13 level in the national emergency medical services education 14 standards and national emergency medical services scope of 15 practice model. 16 l. “Privilege to practice” means an individual’s authority 17 to deliver emergency medical services in remote states as 18 authorized under this compact. 19 m. “Remote state” means a member state in which an 20 individual is not licensed. 21 n. “Restricted” means the outcome of an adverse action that 22 limits a license or the privilege to practice. 23 o. “Rule” means a written statement by the interstate 24 commission promulgated pursuant to subsection 12 of this 25 compact that is of general applicability; implements, 26 interprets, or prescribes a policy or provision of the compact; 27 or is an organizational, procedural, or practice requirement 28 of the commission and has the force and effect of statutory 29 law in a member state and includes the amendment, repeal, or 30 suspension of an existing rule. 31 p. “Scope of practice” means defined parameters of various 32 duties or services that may be provided by an individual with 33 specific credentials. Whether regulated by rule, statute, or 34 court decision, it tends to represent the limits of services an 35 -3- HF 694 (3) 88 ss/rn/md 3/ 25

H.F. 694 individual may perform. 1 q. “Significant investigatory information” means: 2 (1) Investigative information that a state emergency 3 medical services authority, after a preliminary inquiry that 4 includes notification and an opportunity to respond if required 5 by state law, has reason to believe, if proved true, would 6 result in the imposition of an adverse action on a license or 7 privilege to practice; or 8 (2) Investigative information that indicates that the 9 individual represents an immediate threat to public health and 10 safety regardless of whether the individual has been notified 11 and had an opportunity to respond. 12 r. “State” means any state, commonwealth, district, or 13 territory of the United States. 14 s. “State emergency medical services authority” means the 15 board, office, or other agency with the legislative mandate to 16 license emergency medical services personnel. 17 3. Home state licensure. 18 a. Any member state in which an individual holds a current 19 license shall be deemed a home state for purposes of this 20 compact. 21 b. Any member state may require an individual to obtain and 22 retain a license to be authorized to practice in the member 23 state under circumstances not authorized by the privilege to 24 practice under the terms of this compact. 25 c. A home state’s license authorizes an individual to 26 practice in a remote state under the privilege to practice only 27 if the home state: 28 (1) Currently requires the use of the national registry of 29 emergency medical technicians examination as a condition of 30 issuing initial licenses at the EMT and paramedic levels; 31 (2) Has a mechanism in place for receiving and investigating 32 complaints about individuals; 33 (3) Notifies the commission, in compliance with the terms 34 herein, of any adverse action or significant investigatory 35 -4- HF 694 (3) 88 ss/rn/md 4/ 25

H.F. 694 information regarding an individual; 1 (4) No later than five years after activation of the 2 compact, requires a criminal background check of all applicants 3 for initial licensure, including the use of the results of 4 fingerprint or other biometric data checks compliant with 5 the requirements of the federal bureau of investigation 6 with the exception of federal employees who have suitability 7 determination in accordance with 5 C.F.R. §731.202 and submit 8 documentation of such as promulgated in the rules of the 9 commission; and 10 (5) Complies with the rules of the commission. 11 4. Compact privilege to practice. 12 a. Member states shall recognize the privilege to practice 13 of an individual licensed in another member state that is in 14 conformance with subsection 3. 15 b. To exercise the privilege to practice under the terms and 16 provisions of this compact, an individual must: 17 (1) Be at least eighteen years of age; 18 (2) Possess a current unrestricted license in a member state 19 as an EMT, AEMT, paramedic, or state-recognized and licensed 20 level with a scope of practice and authority between EMT and 21 paramedic; and 22 (3) Practice under the supervision of a medical director. 23 c. An individual providing patient care in a remote state 24 under the privilege to practice shall function within the scope 25 of practice authorized by the home state unless and until 26 modified by an appropriate authority in the remote state as may 27 be defined in the rules of the commission. 28 d. Except as provided in paragraph “c” of this subsection, 29 an individual practicing in a remote state will be subject to 30 the remote state’s authority and laws. A remote state may, in 31 accordance with due process and that state’s laws, restrict, 32 suspend, or revoke an individual’s privilege to practice in 33 the remote state and may take any other necessary actions to 34 protect the health and safety of its citizens. If a remote 35 -5- HF 694 (3) 88 ss/rn/md 5/ 25

H.F. 694 state takes action it shall promptly notify the home state and 1 the commission. 2 e. If an individual’s license in any home state is 3 restricted or suspended, the individual shall not be eligible 4 to practice in a remote state under the privilege to practice 5 until the individual’s home state license is restored. 6 f. If an individual’s privilege to practice in any remote 7 state is restricted, suspended, or revoked the individual shall 8 not be eligible to practice in any remote state until the 9 individual’s privilege to practice is restored. 10 5. Conditions of practice in a remote state. An individual 11 may practice in a remote state under a privilege to practice 12 only in the performance of the individual’s emergency medical 13 services duties as assigned by an appropriate authority, as 14 defined in the rules of the commission, and under the following 15 circumstances: 16 a. The individual originates a patient transport in a home 17 state and transports the patient to a remote state; 18 b. The individual originates in the home state and enters 19 a remote state to pick up a patient and provide care and 20 transport of the patient to the home state; 21 c. The individual enters a remote state to provide patient 22 care and/or transport within that remote state; 23 d. The individual enters a remote state to pick up a patient 24 and provide care and transport to a third member state; 25 e. Other conditions as determined by rules promulgated by 26 the commission. 27 6. Relationship to emergency management assistance 28 compact. Upon a member state’s governor’s declaration of a 29 state of emergency or disaster that activates the emergency 30 management assistance compact, all relevant terms and 31 provisions of the emergency management assistance compact shall 32 apply and to the extent any terms or provisions of this compact 33 conflict with the emergency management assistance compact, the 34 terms of the emergency management assistance compact shall 35 -6- HF 694 (3) 88 ss/rn/md 6/ 25

H.F. 694 prevail with respect to any individual practicing in the remote 1 state in response to such declaration. 2 7. Veterans, service members separating from active duty 3 military, and their spouses. 4 a. Member states shall consider a veteran, active military 5 service member, and member of the national guard and reserves 6 separating from an active duty tour, and a spouse thereof, 7 who holds a current, valid, unrestricted national registry 8 of emergency medical technicians certification at or above 9 the level of the state license being sought as satisfying 10 the minimum training and examination requirements for such 11 licensure. 12 b. Member states shall expedite the processing of licensure 13 applications submitted by veterans, active military service 14 members, and members of the national guard and reserves 15 separating from an active duty tour, and their spouses. 16 c. All individuals functioning with a privilege to practice 17 under this section remain subject to the adverse actions 18 provisions of subsection 8. 19 8. Adverse actions. 20 a. A home state shall have exclusive power to impose adverse 21 action against an individual’s license issued by the home 22 state. 23 b. If an individual’s license in any home state is 24 restricted or suspended, the individual shall not be eligible 25 to practice in a remote state under the privilege to practice 26 until the individual’s home state license is restored. 27 (1) All home state adverse action orders shall include 28 a statement that the individual’s compact privileges are 29 inactive. The order may allow the individual to practice in 30 remote states with prior written authorization from both the 31 home state’s and remote state’s emergency medical services 32 authority. 33 (2) An individual currently subject to adverse action in the 34 home state shall not practice in any remote state without prior 35 -7- HF 694 (3) 88 ss/rn/md 7/ 25

H.F. 694 written authorization from both the home state’s and remote 1 state’s emergency medical services authority. 2 c. A member state shall report adverse actions and any 3 occurrences that the individual’s compact privileges are 4 restricted, suspended, or revoked to the commission in 5 accordance with the rules of the commission. 6 d. A remote state may take adverse action on an individual’s 7 privilege to practice within that state. 8 e. Any member state may take adverse action against an 9 individual’s privilege to practice in that state based on the 10 factual findings of another member state, so long as each state 11 follows its own procedures for imposing such adverse action. 12 f. A home state’s emergency medical services authority 13 shall investigate and take appropriate action with respect 14 to reported conduct in a remote state as it would if such 15 conduct had occurred within the home state. In such cases, the 16 home state’s law shall control in determining the appropriate 17 adverse action. 18 g. Nothing in this compact shall override a member state’s 19 decision that participation in an alternative program may be 20 used in lieu of adverse action and that such participation 21 shall remain nonpublic if required by the member state’s 22 laws. Member states must require individuals who enter any 23 alternative programs to agree not to practice in any other 24 member state during the term of the alternative program without 25 prior authorization from such other member state. 26 9. Additional powers invested in a member state’s emergency 27 medical services authority. A member state’s emergency medical 28 services authority, in addition to any other powers granted 29 under state law, is authorized under this compact to: 30 a. Issue subpoenas for both hearings and investigations 31 that require the attendance and testimony of witnesses and the 32 production of evidence. Subpoenas issued by a member state’s 33 emergency medical services authority for the attendance and 34 testimony of witnesses, and/or the production of evidence from 35 -8- HF 694 (3) 88 ss/rn/md 8/ 25

H.F. 694 another member state, shall be enforced in the remote state by 1 any court of competent jurisdiction, according to that court’s 2 practice and procedure in considering subpoenas issued in its 3 own proceedings. The issuing state emergency medical services 4 authority shall pay any witness fees, travel expenses, mileage, 5 and other fees required by the service statutes of the state 6 where the witnesses and/or evidence are located; and 7 b. Issue cease and desist orders to restrict, suspend, or 8 revoke an individual’s privilege to practice in the state. 9 10. Establishment of the interstate commission for emergency 10 medical services personnel practice. 11 a. The compact states hereby create and establish a joint 12 public agency known as the interstate commission for emergency 13 medical services personnel practice. 14 (1) The commission is a body politic and an instrumentality 15 of the compact states. 16 (2) Venue is proper and judicial proceedings by or against 17 the commission shall be brought solely and exclusively in a 18 court of competent jurisdiction where the principal office of 19 the commission is located. The commission may waive venue and 20 jurisdictional defenses to the extent it adopts or consents to 21 participate in alternative dispute resolution proceedings. 22 (3) Nothing in this compact shall be construed to be a 23 waiver of sovereign immunity. 24 b. Membership, voting, and meetings. 25 (1) Each member state shall have and be limited to one 26 delegate. The responsible official of the state emergency 27 medical services authority or his designee shall be the 28 delegate to this compact for each member state. Any delegate 29 may be removed or suspended from office as provided by the law 30 of the state from which the delegate is appointed. Any vacancy 31 occurring in the commission shall be filled in accordance with 32 the laws of the member state in which the vacancy exists. In 33 the event that more than one board, office, or other agency 34 with the legislative mandate to license emergency medical 35 -9- HF 694 (3) 88 ss/rn/md 9/ 25

H.F. 694 services personnel at and above the level of EMT exists, the 1 governor of the state will determine which entity will be 2 responsible for assigning the delegate. 3 (2) Each delegate shall be entitled to one vote with regard 4 to the promulgation of rules and creation of bylaws and shall 5 otherwise have an opportunity to participate in the business 6 and affairs of the commission. A delegate shall vote in 7 person or by such other means as provided in the bylaws. The 8 bylaws may provide for delegates’ participation in meetings by 9 telephone or other means of communication. 10 (3) The commission shall meet at least once during each 11 calendar year. Additional meetings shall be held as set forth 12 in the bylaws. 13 (4) All meetings shall be open to the public, and public 14 notice of meetings shall be given in the same manner as 15 required under the rulemaking provisions in subsection 12. 16 (5) The commission may convene in a closed, nonpublic 17 meeting if the commission must discuss: 18 (a) Noncompliance of a member state with its obligations 19 under the compact; 20 (b) The employment, compensation, discipline or other 21 personnel matters, practices or procedures related to specific 22 employees, or other matters related to the commission’s 23 internal personnel practices and procedures; 24 (c) Current, threatened, or reasonably anticipated 25 litigation; 26 (d) Negotiation of contracts for the purchase or sale of 27 goods, services, or real estate; 28 (e) Accusing any person of a crime or formally censuring any 29 person; 30 (f) Disclosure of trade secrets or commercial or financial 31 information that is privileged or confidential; 32 (g) Disclosure of information of a personal nature where 33 disclosure would constitute a clearly unwarranted invasion of 34 personal privacy; 35 -10- HF 694 (3) 88 ss/rn/md 10/ 25

H.F. 694 (h) Disclosure of investigatory records compiled for law 1 enforcement purposes; 2 (i) Disclosure of information related to any investigatory 3 reports prepared by or on behalf of or for use of the 4 commission or other committee charged with responsibility of 5 investigation or determination of compliance issues pursuant 6 to the compact; or 7 (j) Matters specifically exempted from disclosure by 8 federal or member state statute. 9 (6) If a meeting, or portion of a meeting, is closed 10 pursuant to this provision, the commission’s legal counsel or 11 designee shall certify that the meeting may be closed and shall 12 reference each relevant exempting provision. The commission 13 shall keep minutes that fully and clearly describe all matters 14 discussed in a meeting and shall provide a full and accurate 15 summary of actions taken, and the reasons therefor, including a 16 description of the views expressed. All documents considered 17 in connection with an action shall be identified in such 18 minutes. All minutes and documents of a closed meeting shall 19 remain under seal, subject to release by a majority vote of the 20 commission or order of a court of competent jurisdiction. 21 c. The commission shall, by a majority vote of the 22 delegates, prescribe bylaws and rules to govern its conduct as 23 may be necessary or appropriate to carry out the purposes and 24 exercise the powers of the compact, including but not limited 25 to: 26 (1) Establishing the fiscal year of the commission; 27 (2) Providing reasonable standards and procedures: 28 (a) For the establishment and meetings of other committees; 29 and 30 (b) Governing any general or specific delegation of any 31 authority or function of the commission; 32 (3) Providing reasonable procedures for calling and 33 conducting meetings of the commission, ensuring reasonable 34 advance notice of all meetings, and providing an opportunity 35 -11- HF 694 (3) 88 ss/rn/md 11/ 25

H.F. 694 for attendance of such meetings by interested parties, 1 with enumerated exceptions designed to protect the public’s 2 interest, the privacy of individuals, and proprietary 3 information, including trade secrets. The commission may meet 4 in closed session only after a majority of the membership votes 5 to close a meeting in whole or in part. As soon as practicable, 6 the commission must make public a copy of the vote to close the 7 meeting revealing the vote of each member with no proxy votes 8 allowed; 9 (4) Establishing the titles, duties and authority, and 10 reasonable procedures for the election of the officers of the 11 commission; 12 (5) Providing reasonable standards and procedures for the 13 establishment of the personnel policies and programs of the 14 commission. Notwithstanding any civil service or other similar 15 laws of any member state, the bylaws shall exclusively govern 16 the personnel policies and programs of the commission; 17 (6) Promulgating a code of ethics to address permissible and 18 prohibited activities of commission members and employees; 19 (7) Providing a mechanism for winding up the operations of 20 the commission and the equitable disposition of any surplus 21 funds that may exist after the termination of the compact 22 after the payment and/or reserving of all of its debts and 23 obligations; 24 (8) The commission shall publish its bylaws and file a 25 copy thereof, and a copy of any amendment thereto, with the 26 appropriate agency or officer in each of the member states, if 27 any; 28 (9) The commission shall maintain its financial records in 29 accordance with the bylaws; and 30 (10) The commission shall meet and take such actions as are 31 consistent with the provisions of this compact and the bylaws. 32 d. The commission shall have the following powers: 33 (1) The authority to promulgate uniform rules to facilitate 34 and coordinate implementation and administration of this 35 -12- HF 694 (3) 88 ss/rn/md 12/ 25

H.F. 694 compact. The rules shall have the force and effect of law and 1 shall be binding in all member states; 2 (2) To bring and prosecute legal proceedings or actions in 3 the name of the commission, provided that the standing of any 4 state emergency medical services authority or other regulatory 5 body responsible for emergency medical services personnel 6 licensure to sue or be sued under applicable law shall not be 7 affected; 8 (3) To purchase and maintain insurance and bonds; 9 (4) To borrow, accept, or contract for services of 10 personnel, including but not limited to employees of a member 11 state; 12 (5) To hire employees, elect or appoint officers, fix 13 compensation, define duties, grant such individuals appropriate 14 authority to carry out the purposes of the compact, and to 15 establish the commission’s personnel policies and programs 16 relating to conflicts of interest, qualifications of personnel, 17 and other related personnel matters; 18 (6) To accept any and all appropriate donations and grants 19 of money, equipment, supplies, materials, and services, and to 20 receive, utilize, and dispose of the same, provided that at all 21 times the commission shall strive to avoid any appearance of 22 impropriety and/or conflict of interest; 23 (7) To lease, purchase, accept appropriate gifts or 24 donations of, or otherwise to own, hold, improve, or use, 25 any property, real, personal, or mixed, provided that at all 26 times the commission shall strive to avoid any appearance of 27 impropriety; 28 (8) To sell, convey, mortgage, pledge, lease, exchange, 29 abandon, or otherwise dispose of any property, real, personal, 30 or mixed; 31 (9) To establish a budget and make expenditures; 32 (10) To borrow money; 33 (11) To appoint committees, including advisory committees 34 comprised of members, state regulators, state legislators or 35 -13- HF 694 (3) 88 ss/rn/md 13/ 25

H.F. 694 their representatives, and consumer representatives, and such 1 other interested persons as may be designated in this compact 2 and the bylaws; 3 (12) To provide and receive information from, and to 4 cooperate with, law enforcement agencies; 5 (13) To adopt and use an official seal; and 6 (14) To perform such other functions as may be necessary or 7 appropriate to achieve the purposes of this compact consistent 8 with the state regulation of emergency medical services 9 personnel licensure and practice. 10 e. Financing of the commission. 11 (1) The commission shall pay, or provide for the payment of, 12 the reasonable expenses of its establishment, organization, and 13 ongoing activities. 14 (2) The commission may accept any and all appropriate 15 revenue sources, donations, and grants of money, equipment, 16 supplies, materials, and services. 17 (3) The commission may levy on and collect an annual 18 assessment from each member state or impose fees on other 19 parties to cover the cost of the operations and activities 20 of the commission and its staff, which must be in a total 21 amount sufficient to cover its annual budget as approved each 22 year for which revenue is not provided by other sources. The 23 aggregate annual assessment amount shall be allocated based 24 upon a formula to be determined by the commission, which shall 25 promulgate a rule binding upon all member states. 26 (4) The commission shall not incur obligations of any kind 27 prior to securing the funds adequate to meet the same; nor 28 shall the commission pledge the credit of any of the member 29 states, except by and with the authority of the member state. 30 (5) The commission shall keep accurate accounts of all 31 receipts and disbursements. The receipts and disbursements of 32 the commission shall be subject to the audit and accounting 33 procedures established under its bylaws. However, all receipts 34 and disbursements of funds handled by the commission shall be 35 -14- HF 694 (3) 88 ss/rn/md 14/ 25

H.F. 694 audited yearly by a certified public accountant, and the report 1 of the audit shall be included in and become part of the annual 2 report of the commission. 3 f. Qualified immunity, defense, and indemnification. 4 (1) The members, officers, executive director, employees, 5 and representatives of the commission shall be immune from suit 6 and liability, either personally or in their official capacity, 7 for any claim for damage to or loss of property or personal 8 injury or other civil liability caused by or arising out of any 9 actual or alleged act, error, or omission that occurred, or 10 that the person against whom the claim is made had a reasonable 11 basis for believing occurred, within the scope of commission 12 employment, duties, or responsibilities; provided that nothing 13 in this paragraph shall be construed to protect any such person 14 from suit and/or liability for any damage, loss, injury, or 15 liability caused by the intentional or willful or wanton 16 misconduct of that person. 17 (2) The commission shall defend any member, officer, 18 executive director, employee, or representative of the 19 commission in any civil action seeking to impose liability 20 arising out of any actual or alleged act, error, or omission 21 that occurred within the scope of commission employment, 22 duties, or responsibilities, or that the person against 23 whom the claim is made had a reasonable basis for believing 24 occurred, within the scope of commission employment, duties, 25 or responsibilities, provided that nothing herein shall be 26 construed to prohibit that person from retaining his or her 27 own counsel, and provided further that the actual or alleged 28 act, error, or omission did not result from that person’s 29 intentional or willful or wanton misconduct. 30 (3) The commission shall indemnify and hold harmless 31 any member, officer, executive director, employee, or 32 representative of the commission for the amount of any 33 settlement or judgment obtained against that person arising 34 out of any actual or alleged act, error, or omission that 35 -15- HF 694 (3) 88 ss/rn/md 15/ 25

H.F. 694 occurred, within the scope of commission employment, duties, 1 or responsibilities, or that such person had a reasonable 2 basis for believing occurred, within the scope of commission 3 employment, duties, or responsibilities, provided that the 4 actual or alleged act, error, or omission did not result from 5 the intentional or willful or wanton misconduct of that person. 6 11. Coordinated database. 7 a. The commission shall provide for the development 8 and maintenance of a coordinated database and reporting 9 system containing licensure, adverse action, and significant 10 investigatory information on all licensed individuals in member 11 states. 12 b. Notwithstanding any other provision of state law to the 13 contrary, a member state shall submit a uniform data set to the 14 coordinated database on all individuals to whom this compact 15 is applicable as required by the rules of the commission, 16 including: 17 (1) Identifying information; 18 (2) Licensure data; 19 (3) Significant investigatory information; 20 (4) Adverse actions against an individual’s license; 21 (5) An indicator that an individual’s privilege to practice 22 is restricted, suspended, or revoked; 23 (6) Nonconfidential information related to alternative 24 program participation; 25 (7) Any denial of application for licensure, and the 26 reason(s) for such denial; and 27 (8) Other information that may facilitate the 28 administration of this compact, as determined by the rules of 29 the commission. 30 c. The coordinated database administrator shall promptly 31 notify all member states of any adverse action taken against, 32 or significant investigative information on, any individual in 33 a member state. 34 d. Member states contributing information to the coordinated 35 -16- HF 694 (3) 88 ss/rn/md 16/ 25

H.F. 694 database may designate information that may not be shared with 1 the public without the express permission of the contributing 2 state. 3 e. Any information submitted to the coordinated database 4 that is subsequently required to be expunged by the laws of the 5 member state contributing the information shall be removed from 6 the coordinated database. 7 12. Rulemaking. 8 a. The commission shall exercise its rulemaking powers 9 pursuant to the criteria set forth in this section and the 10 rules adopted thereunder. Rules and amendments shall become 11 binding as of the date specified in each rule or amendment. 12 b. If a majority of the legislatures of the member states 13 rejects a rule, by enactment of a statute or resolution in the 14 same manner used to adopt the compact, then such rule shall 15 have no further force and effect in any member state. 16 c. Rules or amendments to the rules shall be adopted at a 17 regular or special meeting of the commission. 18 d. Prior to promulgation and adoption of a final rule or 19 rules by the commission, and at least sixty days in advance 20 of the meeting at which the rule will be considered and 21 voted upon, the commission shall file a notice of proposed 22 rulemaking: 23 (1) On the internet site of the commission; and 24 (2) On the internet site of each member state emergency 25 medical services authority or the publication in which each 26 state would otherwise publish proposed rules. 27 e. The notice of proposed rulemaking shall include: 28 (1) The proposed time, date, and location of the meeting in 29 which the rule will be considered and voted upon; 30 (2) The text of the proposed rule or amendment and the 31 reason for the proposed rule; 32 (3) A request for comments on the proposed rule from any 33 interested person; and 34 (4) The manner in which interested persons may submit notice 35 -17- HF 694 (3) 88 ss/rn/md 17/ 25

H.F. 694 to the commission of their intention to attend the public 1 hearing and any written comments. 2 f. Prior to adoption of a proposed rule, the commission 3 shall allow persons to submit written data, facts, opinions, 4 and arguments, which shall be made available to the public. 5 g. The commission shall grant an opportunity for a public 6 hearing before it adopts a rule or amendment if a hearing is 7 requested by: 8 (1) At least twenty-five persons; 9 (2) A governmental subdivision or agency; or 10 (3) An association having at least twenty-five members. 11 h. If a hearing is held on the proposed rule or amendment, 12 the commission shall publish the place, time, and date of the 13 scheduled public hearing. 14 (1) All persons wishing to be heard at the hearing shall 15 notify the executive director of the commission or other 16 designated member in writing of their desire to appear and 17 testify at the hearing not less than five business days before 18 the scheduled date of the hearing. 19 (2) Hearings shall be conducted in a manner providing each 20 person who wishes to comment a fair and reasonable opportunity 21 to comment orally or in writing. 22 (3) No transcript of the hearing is required, unless 23 a written request for a transcript is made, in which case 24 the person requesting the transcript shall bear the cost of 25 producing the transcript. A recording may be made in lieu of a 26 transcript under the same terms and conditions as a transcript. 27 This subsection shall not preclude the commission from making a 28 transcript or recording of the hearing if it so chooses. 29 (4) Nothing in this section shall be construed as requiring 30 a separate hearing on each rule. Rules may be grouped for the 31 convenience of the commission at hearings required by this 32 section. 33 i. Following the scheduled hearing date, or by the close 34 of business on the scheduled hearing date if the hearing was 35 -18- HF 694 (3) 88 ss/rn/md 18/ 25

H.F. 694 not held, the commission shall consider all written and oral 1 comments received. 2 j. The commission shall, by majority vote of all members, 3 take final action on the proposed rule and shall determine the 4 effective date of the rule, if any, based on the rulemaking 5 record and the full text of the rule. 6 k. If no written notice of intent to attend the public 7 hearing by interested parties is received, the commission may 8 proceed with promulgation of the proposed rule without a public 9 hearing. 10 l. Upon determination that an emergency exists, the 11 commission may consider and adopt an emergency rule without 12 prior notice, opportunity for comment, or hearing, provided 13 that the usual rulemaking procedures provided in the compact 14 and in this section shall be retroactively applied to the rule 15 as soon as reasonably possible, in no event later than ninety 16 days after the effective date of the rule. For the purposes of 17 this provision, an emergency rule is one that must be adopted 18 immediately in order to: 19 (1) Meet an imminent threat to public health, safety, or 20 welfare; 21 (2) Prevent a loss of commission or member state funds; 22 (3) Meet a deadline for the promulgation of an 23 administrative rule that is established by federal law or rule; 24 or 25 (4) Protect public health and safety. 26 m. The commission or an authorized committee of the 27 commission may direct revisions to a previously adopted rule 28 or amendment for purposes of correcting typographical errors, 29 errors in format, errors in consistency, or grammatical errors. 30 Public notice of any revisions shall be posted on the website 31 of the commission. The revision shall be subject to challenge 32 by any person for a period of thirty days after posting. The 33 revision may be challenged only on grounds that the revision 34 results in a material change to a rule. A challenge shall be 35 -19- HF 694 (3) 88 ss/rn/md 19/ 25

H.F. 694 made in writing, and delivered to the chair of the commission 1 prior to the end of the notice period. If no challenge is 2 made, the revision will take effect without further action. If 3 the revision is challenged, the revision may not take effect 4 without the approval of the commission. 5 13. Oversight, dispute resolution, and enforcement. 6 a. Oversight. 7 (1) The executive, legislative, and judicial branches 8 of state government in each member state shall enforce this 9 compact and take all actions necessary and appropriate to 10 effectuate the compact’s purposes and intent. The provisions 11 of this compact and the rules promulgated hereunder shall have 12 standing as statutory law. 13 (2) All courts shall take judicial notice of the compact 14 and the rules in any judicial or administrative proceeding in a 15 member state pertaining to the subject matter of this compact 16 which may affect the powers, responsibilities, or actions of 17 the commission. 18 (3) The commission shall be entitled to receive service 19 of process in any such proceeding, and shall have standing to 20 intervene in such a proceeding for all purposes. Failure to 21 provide service of process to the commission shall render a 22 judgment or order void as to the commission, this compact, or 23 promulgated rules. 24 b. Default, technical assistance, and termination. 25 (1) If the commission determines that a member state 26 has defaulted in the performance of its obligations or 27 responsibilities under this compact or the promulgated rules, 28 the commission shall: 29 (a) Provide written notice to the defaulting state and other 30 member states of the nature of the default, the proposed means 31 of curing the default and/or any other action to be taken by 32 the commission; and 33 (b) Provide remedial training and specific technical 34 assistance regarding the default. 35 -20- HF 694 (3) 88 ss/rn/md 20/ 25