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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
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HB 2190: physician assistants; licensure compact
Sponsor: Representative Willoughby
Committee on Health & Human Services
Overview
Adopts the Physician Assistant Licensure (Compact) to allow physician assistants to obtain licensure in other Compact states. Creates the Physician Assistant Licensure Compact Commission (Commission) and outlines its membership, responsibilities and duties.
History
The Compact is an interstate occupational licensure compact for physician assistants (PAs). The Compact facilitates multistate practice for PAs, improves health care access for patients and enhances public protection. States joining the Compact agree to recognize a valid, unencumbered license issued by another Compact member state via a Compact privilege. Licensed PAs utilizing the Compact can obtain a privilege in each Compact member state where they wish to practice. PAs using a Compact privilege must adhere to the laws and regulations of the state in which they are practicing (Compact).
PA Compact Member States include: Arkansas, Colorado, Connecticut, Delaware, Iowa, Kansas, Maine, Minnesota, Montana, Nebraska, North Carolina, Ohio, Oklahoma, Tennessee, Utah, Virginia, Washington, West Virginia and Wisconsin.
PAs in Arizona are licensed and regulated by the Arizona Regulatory Board of Physician Assistants (Board). PA's may work under the supervision of a licensed physician or practice collaboratively without a supervision agreement if they meet certain requirements. The Board is tasked with protecting public safety through the judicious licensing, regulation and education of all PAs (A.R.S. § 32-2501 et seq.).
Provisions
State Participation in the Compact
1. Requires states participating in the Compact to:
a. license PAs;
b. participate in the Commission's data system;
c. have a mechanism in place for receiving and investigating complaints against licensees and license applicants;
d. notify the Commission of any adverse action against or significant investigation information of a licensee or license applicant;
e. implement a criminal background check requirement;
f. comply with Commission rules;
g. utilize passage of a recognized national exam such as the National Commission on Certification of Physician Assistants Physician Assistant National Certifying Examination as a requirement for PA licensure; and
h. grant the Compact privilege to a holder for a qualifying license in a participating state. (Sec. 1)
2. Clarifies the Compact does not prohibit a participating state from charging a fee for granting Compact privilege. (Sec. 1)
Compact Privilege
3. Allows a licensee to exercise Compact privilege if the licensee:
a. has graduated from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant or another program authorized by the Commission;
b. holds current certification from the National Commission on Certification of Physician Assistants;
c. has no felony or misdemeanor conviction;
d. has never had a controlled substance license or permit suspended or revoked by a state or the U.S. Drug Enforcement Administration;
e. has a unique identifier as determined by Commission rule;
f. holds a qualifying license;
g. has no limitation or restriction on a license or Compact privilege due to an adverse action;
h. notifies the Commission that the licensee is seeking the Compact privilege in a remote state;
i. meets any jurisprudence requirement of a remote state and pay any applicable fees; and
j. reports to the Commission any adverse action taken by a non-member state within 30 days. (Sec. 1)
4. Specifies that if a licensee has had a limitation or restriction on a license or compact privilege due to an adverse action, the licensee must wait two years after that limitation or restriction has ended to be eligible for Compact privilege. (Sec. 1)
5. Specifies that if a licensee's Compact privilege has been revoked, limited or restricted in a participating state for conduct that would not be a basis for disciplinary action in another participating state then that participating state has the discretion not to consider such action as an adverse action requiring the denial or removal of Compact privilege. (Sec. 1)
6. Asserts that Compact privilege is valid until the expiration or revocation of the qualifying license. (Sec. 1)
7. Specifies that if a participating state takes adverse action against a qualifying license, the licensee must lose the Compact privilege in any remote state until all the following occur:
a. the license is no longer restricted; and
b. two years have elapsed from the date on which the license is no longer limited or restricted due to the adverse action. (Sec. 1)
8. States a Compact privilege expires when the licensee's qualifying license in the participating state from which the licensee applied for the Compact privilege expires. (Sec. 1)
9. Specifies that if a licensee terminates the qualifying license originally used to apply for the Compact privilege before its scheduled expiration and the licensee has a qualifying license in another state then the licensee must:
a. inform the Commission that it is changing the participating state through which it applies for a Compact privilege to that participating state; and
b. pay the Commission any Compact privilege fee required by Commission rule. (Sec. 1)
10. Requires PAs seeking authority to prescribe controlled substances in a remote state to satisfy all requirements imposed by the remote state in granting or renewing such authority. (Sec. 1)
State Designation for Compact Privilege
11. Requires a licensee to identify to the Commission the participating state from which the licensee is applying for a Compact privilege. (Sec. 1)
12. Establishes procedural requirements and conditions for a licensee when applying for a Compact privilege in a participating state, including:
a. providing the Commission with the address of the licensee's primary residence and thereafter immediately report to the Commission any change in the address of the licensee's primary residence; and
b. consent to accept service or 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. (Sec. 1)
Adverse Actions
13. Clarifies that the participating state in which a licensee is licensed has exclusive power to impose adverse action against the qualifying licensee issued by that participating state. (Sec. 1)
14. Authorizes remote states to take adverse action against a PA's Compact privilege within that state, remove a licensee's Compact privilege or take other action necessary under applicable law to protect the health and safety of its citizens. (Sec. 1)
15. Enables remote states to issue subpoenas for hearings and investigations that require the attendance and testimony of witnesses and the production of evidence. (Sec. 1)
16. Require subpoenas issued by a licensing board in a participating state for the attendance and testimony of witnesses or the production of evidence from another participating state to be enforced in the latter state by any court of competent jurisdiction. (Sec. 1)
17. Requires the issuing authority to pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state in which the witness or evidence is located. (Sec. 1)
18. Prohibits subpoenas from being issued by a participating state to gather evidence of conduct in another state for the purpose of taking adverse action against a licensee's compact privilege or application for a compact privilege in that participating state. (Sec. 1)
19. Clarifies the Compact does not authorize a participating state to impose discipline against a PA's Compact privilege or to deny an application for a Compact privilege in that participating state for the individual's otherwise lawful practice in another state. (Sec. 1)
20. Requires a participating state that issued a qualifying licensee to give the same priority and effect to reported conduct received from any remote state as it would if the conduct had occurred within the participating state which issued the qualifying license. (Sec. 1)
21. Requires a participating state to apply its own state laws to determine appropriate action. (Sec. 1)
22. Permits a participating state, if otherwise allowed by state law, to recover from the affected PA the costs of investigations and disposition of cases resulting from any adverse action taken against that PA. (Sec. 1)
23. Allows a participating state to take adverse action based on the factual findings of a remote state if the participating state follows its own procedures for taking the adverse action. (Sec. 1)
24. Allows participating states to initiate joint investigations of licensees and are required to share investigative materials in furtherance of any joint or single-state investigation of a licensee. (Sec. 1)
25. Requires a PA's Compact privilege in all remote states to be deactivated until two years have elapsed after all restrictions have been removed from the state license if an adverse action is taken against a PA's qualifying license. (Sec. 1)
26. Mandates that all disciplinary orders by the participating state that issued a qualifying license to include a statement that the PA's Compact privilege is deactivated in all participating states during the pendency of the order. (Sec. 1)
27. Requires a participating state to promptly notify the administrator of the data system of any adverse actions taken. (Sec. 1)
Commission and Executive Committee
28. Creates and establishes a joint government agency and national administrative body known as the Commission. (Sec. 1)
29. Specifies that the Commission is an instrumentality of the Compact states acting jointly and is not an instrumentality of any one state. (Sec. 1)
30. Requires the Commission to come into existence on or after the effective date of this Compact. (Sec. 1)
31. Outlines Commission membership, voting and meeting procedures. (Sec. 1)
32. Details the powers, duties and authorities of the Commission. (Sec. 1)
33. Establishes requirements and procedures for public Commission meetings. (Sec. 1)
34. Establishes requirements and procedures for closed Commission meetings. (Sec. 1)
35. Outlines topics that the Commission can discuss in a closed, nonpublic meeting or nonpublic part of a public meeting. (Sec. 1)
36. Requires all Commission meetings to be open to the public unless confidential or privileged information is discussed. (Sec. 1)
37. Allows the Commission to pay or provide for the payment of reasonable expenses of its establishment, organization and ongoing activities. (Sec. 1)
38. Permits the Commission to accept any and all appropriate revenue sources and donations and grants of money, equipment, supplies, materials and services. (Sec. 1)
39. Allows the Commission to collect an annual assessment from each participating state and impose Compact privilege fees on licensees of participating states to whom a Compact privilege is granted to cover the costs of operations and activities of the Commission and its staff. (Sec. 1)
40. Specifies that the assessment and fees be in a total amount sufficient to cover the Commission's annual budgeted as approved by the Commission each year for which revenue is not provided by other sources. (Sec. 1)
41. Requires the aggregate annual assessment amount levied on participating states to be allocated based on a formula to be determined by Commission rule. (Sec. 1)
42. Prohibits the Commission from:
a. incurring obligations of any kind before securing the monies adequate to meet those obligations; or
b. pledging the credit of any participating state, except by and with the authority of the participating state. (Sec. 1)
43. Requires the Commission to keep accurate accounts of all receipts and disbursements.
44. Subjects the receipts and disbursements of the Commission to:
a. financial review and accounting procedures established under Commission bylaws; and
b. financial review by a certified or licensed public accountant. (Sec. 1)
45. Requires the report of the financial review to be included in and become part of the annual report of the Commission. (Sec. 1)
46. Outlines the powers, duties and membership of the Executive Committee which has the power to act on behalf of the Commission according to the terms of the Compact and Commission rules. (Sec. 1)
47. Establishes voting and meeting procedures for Executive Committee public meetings. (Sec. 1)
48. Outlines requirements for closed and nonpublic meetings of the Executive Committee. (Sec. 1)
49. Contains qualified immunity, defense and indemnification provisions for the Commission. (Sec. 1)
Data System
50. Requires the Commission to provide for the development, maintenance, operation and utilization of a coordinated data and reporting system containing licensure, adverse action and significant investigative information on all PAs and applicant's wo are denied a license in participating states. (Sec. 1)
51. Requires a participating state to submit a uniform data set to the data system on all PAs to whom this Compact is applicable using a unique identified that contains specified information. (Sec. 1)
52. Requires significant investigative information pertaining to a licensee in any participating state to be available only to other participating states. (Sec. 1)
53. Requires the Commission to 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 the Commission and that information be available to any other participating state. (Sec. 1)
54. Allows participating states contributing information to the data system be in accordance with state or federal law and designate information that may not be shared with the public without the express permission of the contributing state. (Sec. 1)
55. Requires such information to be reported to the Commission through the data system, notwithstanding any such designation. (Sec. 1)
56. Requires 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 to be removed from the data system on a report of the expungement by the participating state to the Commission. (Sec. 1)
57. Specifies that records and information provided to a participating state pursuant to the Compact or through the data system and certified by the Commission are considered business records and are entitled to any associated hearsay exception in any relevant judicial, quasi-judicial or administrative proceedings in a participating state. (Sec. 1)
Rulemaking
58. Requires the Commission to exercise its rulemaking powers and the rules adopted thereunder. (Sec. 1)
59. Mandates that Commission rules become binding as of the data specific by the Commission for each rule. (Sec. 1)
60. Requires the Commission promulgate reasonable rules in order to effectively and efficiently implement and administer the Compact to achieve its purposes. (Sec. 1)
61. Specifies that a commission rule may be invalid and not have force or effect 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 the Compact or the powers granted hereunder or based on another applicable standard of review. (Sec. 1)
62. Deems Commission rules have the force of law in each participating state, except where the Commission rules conflict with the laws of the participating state that establish the medical services a PA may perform in the participating state, as held by a court of competent jurisdiction in which the rules are ineffective to the extent of the conflict. (Sec. 1)
63. Specifies that in a majority of legislatures of the participating states rejects a Commission rule by enacting a statute or resolution in the same manner used to adopt the Compact within four years after the date of the adopted rule then that rule has no further force or effect in any participating state or any state applying to participate in the Compact. (Sec. 1)
64. Requires Commission rules be adopted at a regular or special meeting. (Sec. 1)
65. Requires the Commission to file a notice of proposed rulemaking before the Commission adopts a final rule or rules and at least 30 days in advance of the meeting. (Sec. 1)
66. Requires the Commission to file a notice of proposed rulemaking in the following manner:
a. on the Commission's website or other publicly accessible platform; and
b. to persons who have requested the Commission's notices of proposed rulemaking; and
c. in such other way as the Commission may specify by rule. (Sec. 1)
67. Establishes items to be included in the notice of proposed rulemaking. (Sec. 1)
68. Requires the Commission to allow persons to submit written data, facts, opinions and arguments which must be made available to the public before adopting a proposed rule. (Sec. 1)
69. Requires the Commission to public the mechanism for access to the electronic hearing if a hearing is to be held via electronic means. (Sec. 1)
70. Establishes procedures for conducting hearings for notices of proposed rulemaking. (Sec. 1)
71. Clarifies that this does not require a separate hearing on each proposed rule. (Sec. 1)
72. Allows rules to be grouped for the convenience of the Commission hearings. (Sec. 1)
73. Requires the Commission to consider all written and oral comments timely received. (Sec. 1)
74. Requires the Commission, by a majority vote of all delegates, to take final action on a proposed rule and determine the effective date of the rule based on the rulemaking record and full text of the rule, if adopted. (Sec. 1)
75. Establishes requirements for proposed rules that are adopted by the Commission. (Sec. 1)
76. Contains conditions and procedures for the Commission to:
a. adopt emergency rules; and
b. revise previously adopted rules. (Sec. 1)
Oversight, Dispute Resolution and Enforcement
77. Directs the executive and judicial branches of state government in each participating state to enforce the Compact and take all actions necessary and appropriate to implement the Compact. (Sec. 1)
78. Requires venues to be proper and judicial proceedings by or against the Commission to be brought solely and exclusively in a court of competent jurisdiction where the principal office of the Commission is located. (Sec. 1)
79. Allows the Commission to waive venue and jurisdictional defenses to the extent the Commission adopts or consents to participate in alternative dispute resolution proceedings. (Sec. 1)
80. Clarifies the Compact does not affect or limit the selection or propriety of venue in any action against a licensee for professional malpractice or misconduct or any such similar matter. (Sec. 1)
81. Entitles the Commission to receive service of process in any proceeding regarding the enforcement of interpretation of this Compact or the Commission rules and have standing to intervene in such a proceeding for all purposes. (Sec. 1)
82. Deems failure to provide the Commission with service of process renders judgement or order in such a proceeding void as to the Compact, the Commission or its rules. (Sec. 1)
83. Contains procedures for when the Commission determines a participating state has defaulted in the performance of its obligations or responsibilities under the Commission or Commission rules. (Sec. 1)
84. Stipulates that a defaulting state may be terminated if a state in default fails to cure the default and on the affirmative vote of a majority of the delegates of the participating states. (Sec. 1)
85. Requires termination of participation in the Compact to be imposed only after all other means of securing compliance has been exhausted. (Sec. 1)
86. Allows a defaulting state to appeal its termination from the Compact by the Commission by petitioning the Unites States District Court for the District of Columbia or the federal district where the Commission has its principal offices. (Sec. 1)
87. Awards the prevailing party all costs of such litigation, including reasonable attorney fees. (Sec. 1)
88. Contains criteria that terminated states must address in their notice of termination to all licensees. (Sec. 1)
89. Requires the Commission to attempt to resolve disputes related to the Compact that arise among participating states and between participating states and nonparticipating states. (Sec. 1)
90. Requires the Commission to promulgate a rule providing for both mediation and binding dispute resolution for disputes as appropriate. (Sec. 1)
91. Allows the Commission, by majority vote, to 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 that is in default to enforce compliance with the Compact, the Commission bylaws and rules. (Sec. 1)
92. Permits the relief sought to include both injunctive relief and damages. (Sec. 1)
93. Allows the Commission to pursue any other remedies available under federal or state law. (Sec. 1)
94. Establishes parameters for legal action taken against the Commission by a participating state. (Sec. 1)
Date of Implementation
95. Makes this Compact effective on the adoption of the seventh participating state. (Sec. 1)
96. Requires the Commission to convene and review the enactment of each state adopted compact prior to convening to be known as the charter participating states by the effective date of the Compact to determine if the statute enacted by each charter is materially different that the model compact. (Sec. 1)
97. Establishes requirements for any charter participating state's enactment found to be materially different from the model Compact. (Sec. 1)
98. Subjects participating states who enacted the Compact after the seventh member state to the Commission approval or disapproval process to determine if their enactments are materially different from the model Compact and whether they qualify for participation in the Compact. (Sec. 1)
99. States that all actions taken for the benefit of the Commission or in furtherance of the purposes of administering the Compact before the effective date or the Commission coming into existence is considered to be actions of the Commission unless specifically repudiated by the Commission. (Sec. 1)
100. Allows any participating state to withdraw from the Compact by enacting a repealing statute. (Sec. 1)
101. Specifies that a participating state's withdrawal does not take effect until 180 days after enactment of the repealing statute. (Sec. 1)
102. Outlines procedures, conditions, timeframes and notice requirements for states withdrawing participating from the Compact. (Sec. 1)
103. Specifies that withdrawal does not affect the continuing requirement of the licensing board of the withdrawing state to comply with the investigative and adverse action reporting requirements of the Compact before the effective date of withdrawal. (Sec. 1)
104. Clarifies this Compact does not invalidate or prevent any PA licensure agreement or other cooperative arrangement between participating states and participating states and nonparticipating states that does not conflict with this Compact. (Sec. 1)
Construction and Severability
105. Asserts that the Compact and Commission rules be liberally construed to effectuate its purposes. (Sec. 1)
106. Prohibits the provisions of the Compact that expressly authorize or require the promulgation of rules from being construed to limit the Commission's rulemaking authority solely for those purposes. (Sec. 1)
107. Requires Compact provisions to be severable and if any phrase, clause, sentence or provision is held by a court of competent jurisdiction as unconstitutional then the validity of the remainder of the Compact is not affected. (Sec. 1)
108. Specifies that if a provision is declared to conflict with the United States Constitution, the remainder of the Compact stays in full force and effect. (Sec. 1)
Binding Effect of Compact
109. Clarifies the Compact does not prevent the enforcement of any other law of a participating state that is not inconsistent with the Compact. (Sec. 1)
110. Declares any laws in a participating state that conflict with this Compact are superseded to the extent of the conflict. (Sec. 1)
111. Deems all agreements between the Commission and the participating states binding in accordance with their terms. (Sec. 1)
Miscellaneous
112. Defines terms. (Sec. 1)
113. Outlines the purposes of the Compact. (Sec. 1)
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