2023 -- H 5332

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LC000922

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANCE

LICENSING COMPACT ACT

     Introduced By: Representatives Kislak, Bennett, McNamara, Potter, and Cruz

     Date Introduced: February 03, 2023

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 5 of the General Laws entitled "BUSINESSES AND PROFESSIONS"

is hereby amended by adding thereto the following chapter:

CHAPTER 93

PHYSICIAN ASSISTANCE LICENSING COMPACT ACT

     5-93-1. Short title.

     This chapter shall be known and may be cited as the "Physicians Assistance Licensing

Compact Act."

     5-93-2. Definitions.

     As used in this chapter:

     (1) “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

physician assistant 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.

     (2) “Compact privilege” means the authorization granted by a remote state to allow a

licensee from another participating state to practice as a physician assistant to provide medical

services and other licensed activity to a patient located in the remote state under the remote state’s

laws and regulations.

     (3) “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

     (4) “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).

     (5) “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.

     (6) “Executive committee” means a group of directors and exofficio individuals elected or

appointed pursuant to § 5-93-7.

     (7) “Impaired practitioner” means a physician assistant whose practice is adversely affected

by health-related condition(s) that impact their ability to practice.

     (8) “Investigative information” means information, records, or documents received or

generated by a licensing board pursuant to an investigation.

     (9) “Jurisprudence requirement” means the assessment of an individual’s knowledge of the

laws and rules governing the practice of a physician assistant in a state.

     (10) “License” means current authorization by a state, other than authorization pursuant to

a compact privilege, for a physician assistant to provide medical services, which would be unlawful

without current authorization.

     (11) “Licensee” means an individual who holds a license from a state to provide medical

services as a physician assistant.

     (12) “Licensing board” means any state entity authorized to license and otherwise regulate

physician assistant's.

     (13) “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.

     (14) “Model compact” means the model for the physician assistant licensure compact on

file with the council of state governments or other entity as designated by the commission.

     (15) “Participating state” means a state that has enacted this compact.

     (16) “Physician assistant” 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

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same rights and responsibilities to the licensee under the provisions of this compact at the time of

its enactment.

     (17) “Physician assistant licensure compact commission,” “compact commission,” or

“commission” means the national administrative body created pursuant to § 5-93-7(a).

     (18) “Qualifying license” means an unrestricted license issued by a participating state to

provide medical services as a physician assistant.

     (19) “Remote state” means a participating state where a licensee who is not licensed as a

physician assistant is exercising or seeking to exercise the compact privilege.

     (20) “Rule” means a regulation promulgated by an entity that has the force and effect of

law.

     (21) “Significant investigative information” means investigative information that a

licensing board, after an inquiry or investigation that includes notification and an opportunity for

the physician assistant 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.

     (22) “State” means any state, commonwealth, district, or territory of the United States.

     5-93-3. State participation in this compact.

     (a) To participate in this compact, a participating state shall:

     (1) License physician assistant.

     (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 physician assistance 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

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the compact privilege.

     5-93-4. Compact privilege.

     (a) To exercise the compact privilege, a licensee must:

     (1) Have graduated from a physician assistant 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 (2) 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) of this section 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

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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

(b)(2) of this section the licensee must meet the requirements of subsection (a) of this section to

obtain a compact privilege in any remote state.

     (d) For each remote state in which a physician assistant seeks authority to prescribe

controlled substances, the physician assistant shall satisfy all requirements imposed by such state

in granting or renewing such authority.

     5-93-5. 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.

     5-93-6. 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 physician assistant’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

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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 subsection (b)(1) of this section, 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. Nothing in this compact authorizes a participating state

to impose discipline against a physician assistant’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

physician assistant the costs of investigations and disposition of cases resulting from any adverse

action taken against that physician assistant.

     (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

physician assistant 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 physician assistant’s qualifying license, the

physician assistant’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

physician assistant’s license shall include a statement that the physician assistant’s compact

privilege is deactivated in all participating states during the pendency of the order.

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     (h) If any participating state takes adverse action, it promptly shall notify the administrator

of the data system.

     5-93-7. Establishment of the physician assistant licensure compact commission.

     (a) The participating states hereby create and establish a joint government agency and

national administrative body known as the physician assistant 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.

     (b) Membership, voting, and meetings.

     (1) Each participating state shall have and be limited to one 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:

     (i) A current physician assistant, physician or public member of a licensing board or

physician assistant council/committee; or

     (ii) 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 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;

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     (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 of any

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

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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 physician assistant licensure and

practice.

     (d) Meetings of the commission.

     (1) All meetings of the commission that are not closed pursuant to this section 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 § 5-93-9.

     (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:

     (i) Non-compliance of a participating state with its obligations under this compact;

     (ii) 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;

     (iii) Current, threatened, or reasonably anticipated litigation;

     (iv) Negotiation of contracts for the purchase, lease, or sale of goods, services, or real

estate;

     (v) Accusing any person of a crime or formally censuring any person;

     (vi) Disclosure of trade secrets or commercial or financial information that is privileged or

confidential;

     (vii) Disclosure of information of a personal nature where disclosure would constitute a

clearly unwarranted invasion of personal privacy;

     (viii) Disclosure of investigative records compiled for law enforcement purposes;

     (ix) Disclosure of information related to any investigative reports prepared by or 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;

     (x) Legal advice; or

     (xi) Matters specifically exempted from disclosure by federal or participating states’

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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.

     (i) A compact privilege expires when the licensee’s qualifying license in the participating

state from which the licensee applied for the compact privilege expires.

     (ii) 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

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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:

     (i) Seven (7) voting members who are elected by the commission from the current

membership of the commission;

     (ii) One exofficio, nonvoting member from a recognized national physician assistant

professional association; and

     (iii) One exofficio, nonvoting member from a recognized national physician assistant

certification organization.

     (3) The exofficio 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:

     (i) 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;

     (ii) Ensure compact administration services are appropriately provided, contractual or

otherwise;

     (iii) Prepare and recommend the budget;

     (iv) Maintain financial records on behalf of the commission;

     (v) Monitor compact compliance of participating states and provide compliance reports to

the commission;

     (vi) Establish additional committees as necessary;

     (vii) 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

     (viii) 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

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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 subsection (d)(3)

of this section and shall announce the closed meeting as the commission is required to under

subsection (d)(4) of this section and keep minutes of the closed meeting as the commission is

required to under subsection (d)(5) of this section.

     (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 commission 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 subsection 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.

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     (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 physician assistant. All such matters shall be determined exclusively

by state law other than this compact.

     (7) Nothing in this compact shall be interpreted to waive or otherwise abrogate a

participating state’s state action immunity or state action affirmative defense with respect to

antitrust claims under the Sherman Act, 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.

     5-93-8. 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 physician

assistants' 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 physician assistants' 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

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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.

     5-93-9. 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 physician assistant 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

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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

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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) of this section, 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.

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     5-93-10. 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.

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     (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 United State 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 attorneys’ 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:

     (i) 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.

     (ii) 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 attorneys’ fees.

     (3) The remedies herein shall not be the exclusive remedies of the commission. The

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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 United

States 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 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

attorneys’ fees.

     (2) No person other than a participating state shall enforce this compact against the

commission.

     5-93-11. Date of implementation of the physician assistant 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.

     (i) 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 § 5-93-10(b).

     (ii) 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 (7). Participating states enacting the

compact subsequent to the commission convening shall be subject to the process set forth in § 5-

93-7(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 (7) initial charter

participating states shall be subject to the process set forth in § 5-93-7(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.

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     (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

physician assistant 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.

     5-93-12. Construction and severability.

     (a) This compact and the commission’s rulemaking authority shall be liberally construed

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

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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 (c) of this section or the provisions of this section, the

commission may deny a state’s participation in the compact or, in accordance with the requirements

of § 5-93-10(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.

     5-93-13. 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.

     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- PHYSICIAN ASSISTANCE

LICENSING COMPACT ACT

***

     This act would adopt the model compact for the physician assistant's licensure compact in

Rhode Island.

     This act would take effect upon passage.

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