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ARIZONA STATE SENATE
Fifty-Seventh Legislature, Second Regular Session
EMS reciprocity; compact.
Purpose
Adopts the Emergency Medical Services Personnel Licensure Interstate Compact (Compact), allowing emergency medical service (EMS) personnel, such as emergency medical technicians (EMTs), advanced emergency medical technicians (AEMTs) and paramedics, in participating states to obtain licensure in any other Compact state.
Background
The Department of Health Services (DHS) must adopt standards and criteria for the denial or granting of certification and recertification of emergency medical care technicians (EMCTs). Standards must allow DHS to certify qualified EMCTs who have completed statewide standardized training and testing or who hold certification with a national certification organization. Standardized training and testing must be consistent with national education standards as determined by the Medical Direction Commission and the Emergency Medical Services Council. EMCTs include individuals who are certified by DHS as an EMT, an AEMT, an EMT I-99 or a paramedic (A.R.S. §§ 36-2201 and 36-2202).
The Compact is an interstate licensure compact designed to facilitate the interstate practice of EMS personnel. Under the Compact, EMS personnel who are licensed in good standing in a Compact member state will be eligible to practice in other participating Compact states via a privilege to practice, which is equivalent to a license. The Compact is formally enacted after 10 states have officially enacted the model Compact into law through a state's legislative process. By 2017, the Compact had grown to 10 member states. The Compact was activated on March 10, 2020. Currently, 25 states have adopted the Compact (Compact).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
Purpose
1. States that the purpose of the Compact is to protect the public through verification of competency and to ensure accountability for patient care-related activities of all states' licensed EMS personnel, such as EMTs, AEMTs and paramedics.
2. States that the Compact is intended to facilitate the day-to-day movement of EMS personnel across state boundaries in the performance of their EMS duties as assigned by an appropriate authority and to authorize state EMS offices to afford immediate legal recognition to EMS personnel who are licensed in a member state.
3. States that the Compact recognizes that states have a vested interest in protecting the public's health and safety through their licensing and regulation of EMS personnel and that such state regulation shared among the member states will best protect the public health and safety.
4. Asserts that the Compact is designed to achieve the following:
a) increase public access to EMS personnel;
b) enhance the states' ability to protect the public's health and safety, especially patient safety;
c) encourage the cooperation of member states in the areas of EMS personnel licensure and regulation;
d) support the licensing of military members who are separating from an active-duty tour and the spouses of those military members;
e) facilitate the exchange of information between member states regarding EMS personnel licensure, adverse actions and significant investigatory information;
f) promote compliance with the laws governing EMS personnel practice in each member state; and
g) invest all member states with the authority to hold EMS personnel accountable through the mutual recognition of member state licenses.
Home State Licensure
5. Deems any member state in which an individual holds a current license a home state for the purposes of the Compact.
6. Allows any member state to require an individual to obtain and retain a license to be authorized to practice in the member state under circumstances not authorized by the privilege to practice under the terms of the Compact.
7. Authorizes an individual issued a home state's license to practice in a remote state under the privilege only the if the home state:
a) currently requires the use of the National Registry of Emergency Medical Technicians (NREMT) examination as a condition of issuing initial licenses at the EMT and paramedic levels;
b) has a mechanism in place for receiving and investigating complaints about individuals;
c) notifies the Compact Commission (Commission), in compliance with the terms of the Compact, of any adverse action or significant investigatory information regarding an individual;
d) requires, no later than five years after activation of the Compact, a criminal background check of all applicants for initial licensure, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation, with the exception of federal employees who have suitability determination in accordance with federal law and who submit documentation of the suitability as promulgated in Commission rules; and
e) complies with Commission rules.
Compact Privilege to Practice
8. Requires member states to recognize the privilege to practice of an individual who is licensed in another member state that is in conformance with the Compact.
9. Requires an individual, to exercise the privilege to practice under the terms and provisions of the Compact, to:
a) be at least 18 years of age;
b) possess a current unrestricted license in a member state as an EMT, AEMT, paramedic or state recognized and licensed level with a scope of practice and authority between EMT and paramedic; and
c) practice under the supervision of a medical director.
10. Requires an individual providing patient care in a remote state under the privilege to practice to function within the scope of practice authorized by the home state unless, and until modified by, an appropriate authority in the remote state as may be defined in Commission rules.
11. Subjects an individual practicing in a remote state to the remote state's authority and laws.
12. Allows a remote state, in accordance with due process and that state's laws, to restrict, suspend or revoke an individual's privilege to practice in the remote state and take any other necessary actions to protect the health and safety of its citizens.
13. Requires the remote state, if it takes action to restrict, suspend or revoke an individual's privilege to practice in the state, to notify the individual licensee's home state and the Commission.
14. States that, if an individual's license in any home state is restricted or suspended, the individual is not eligible to practice in a remote state under the privilege to practice until the individual's home state license is restored.
15. States that, if an individual's privilege to practice in any remote state is restricted, suspended or revoked, the individual is not eligible to practice in any remote state until the individual's privilege to practice is restored.
Conditions of Practice in a Remote State
16. Allows an individual to practice in a remote state under a privilege to practice only in the performance of the individual's EMS duties as assigned by an appropriate authority, as defined in Commission rules, and under the following circumstances:
a) the individual originates a patient transport in a home state and transports the patient to a remote state;
b) the individual originates in the home state and enters a remote state to pick up a patient and provide care and transport of the patient to the home state;
c) the individual enters a remote state to provide patient care or transport, or both, within that remote state;
d) the individual enters a remote state to pick up a patient and provide care and transport to a third member state; and
e) other conditions as determined by rules promulgated by the Commission.
Relationship to Emergency Management Assistance Compact
17. Specifies that, on the declaration by a member state's Governor of a state of emergency or disaster that activates the Emergency Management Assistance Compact (EMAC), all relevant terms and provisions of EMAC apply and, to the extent any terms or provisions of the Compact conflict with EMAC, the terms of EMAC will prevail with respect to any individual practicing in the remote state in response to the declaration.
Veterans and Military Service Members
18. Requires member states to consider a veteran, active military service member and member of the National Guard, reserves separating from an active-duty tour and their spouse, who holds a current valid and unrestricted NREMT certification at or above the level of the state license being sought, as satisfying the minimum training and examination requirements for licensure.
19. Requires member states to expedite the processing of licensure applications submitted by veterans, active military service members, members of the National Guard, reserves separating from an active-duty tour and their spouses.
20. Subjects all individuals functioning with a privilege to practice to the adverse actions provisions of the Compact.
Adverse Actions
21. Designates a home state as having exclusive power to impose adverse action against an individual's license issued by the home state.
22. States that, if an individual's license in their home state is restricted or suspended, the individual is not eligible to practice in a remote state under the privilege to practice until the individual's home state license is restored, and the following apply:
a) all home state adverse action orders must include a statement that the individual's privilege to practice is inactive;
b) a home state adverse action order may allow the individual to practice in remote states with prior written authorization from both the home state EMS authority and the remote state EMS authority; and
c) an individual who is currently subject to adverse action in the home state must not practice in any remote state without prior written authorization from both the home state EMS authority and the remote state EMS authority.
23. Requires a member state to report adverse actions and any occurrences that the individual's privilege to practice is restricted, suspended or revoked to the Commission in accordance with Commission rules.
24. Allows a remote state to take adverse action on an individual's privilege to practice within the remote state.
25. Allows any member state to take adverse action against an individual's privilege to practice in that member state based on the factual findings of another member state so long as each state follows its own procedures for imposing an adverse action.
26. Requires a home state's EMS authority to investigate and take appropriate action with respect to reported conduct in a remote state as it would if such conduct had occurred within the home state.
27. Requires the home state's laws, in taking appropriate action with respect to reported conduct in a remote state, to control in determining the appropriate adverse action.
28. States that the Compact does not override a member state's decision that participation in an alternative program may be used in lieu of adverse action.
29. Requires a member's states participation in an alternative program to remain nonpublic if required by the member state's laws.
30. Requires member states to require individuals who enter any alternative program to agree not to practice in any other member state during the term of the alternative program without prior authorization from the other member state.
Additional Powers Invested in a Member State's EMS Authority
31. Authorizes a member state's EMS authority, in addition to any other powers granted under state law, to:
a) issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses and the production of evidence; and
b) issue cease and desist orders to restrict, suspend or revoke an individual's privilege to practice in the member state.
32. Requires subpoenas issued by a member state's EMS authority for the attendance and testimony of witnesses or the production of evidence from another member state, or both, to be enforced in the remote state by any court of competent jurisdiction, according to that court's practice and procedure in considering subpoenas issued in its own proceedings.
33. Requires the issuing state EMS authority to pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state where the witnesses or evidence, or both, are located.
Establishment of the Commission
34. Establishes the Commission.
35. States that the Commission is a body politic and an instrumentality of the Compact states.
36. Requires the judicial proceedings by or against the Commission to be brought solely and exclusively, as proper venue, in a court of competent jurisdiction where the principal office of the Commission is located.
37. States that the Compact is not a waiver of sovereign immunity.
38. Requires each member state to have and be limited to one delegate.
39. Requires the responsible official of the state EMS authority or the state EMS authority's designee to be the delegate to the Compact for each member state.
40. Allows any delegate to be removed or suspended from office as provided by the law of the state from which the delegate is appointed.
41. Requires any vacancy occurring in the Commission to be filled in accordance with the laws of the member state in which the vacancy exists.
42. Requires the Governor of a member state, if more than one board, office or other agency with the legislative mandate to license EMS personnel at and above the level of EMT exists, to determine which entity will be responsible for assigning the delegate.
43. Requires each delegate to:
a) be entitled to one vote with regard to the promulgation of rules and creation of bylaws; and
b) have an opportunity to participate in the business and affairs of the Commission.
44. Requires a delegate to vote in person or by such other means as provided in the bylaws.
45. Requires the bylaws to provide for delegates' participation in meetings by telephone or other means of communication.
46. Requires the Commission to meet at least once during each calendar year.
47. Requires additional Commission meetings to be held as set forth in the bylaws.
48. Requires all Commission meetings to be open to the public.
49. Requires public notice of Commission meetings to be given in the same manner as required under the rulemaking provisions of the Compact.
50. Allows the Commission to convene in a closed, nonpublic meeting if the Commission discusses any of the following:
a) noncompliance of a member state with its obligations under the Compact;
b) the employment, compensation, discipline or other personnel matters, practices or procedures related to specific employees or other matters related to the Commission's internal personnel practices and procedures;
c) the current, threatened or reasonably anticipated litigation;
d) the negotiation of contracts for the purchase or sale of goods, services or real estate;
e) the accusation of any person of a crime or the formal censure of any person;
f) the disclosure of trade secrets or commercial or financial information that is privileged or confidential;
g) the disclosure of information of a personal nature where disclosure would constitute a clearly unwarranted invasion of personal privacy;
h) the disclosure of investigatory records compiled for law enforcement purposes;
i) the disclosure of information related to any investigatory reports prepared by or on behalf of or for use of the Commission or another committee charged with responsibility of investigation or determination of compliance issues in accordance with the Compact; or
j) any matter specifically exempted from disclosure by federal or member state statute.
51. Requires the Commission's legal counsel or designee, if a meeting or portion of a meeting is closed in accordance with the Compact, to:
a) certify that the meeting may be closed; and
b) reference each relevant exempting provision.
52. Requires the Commission to:
a) keep minutes that fully and clearly describe all matters discussed in the closed meeting;
b) provide a full and accurate summary of actions taken, and the reasons for any actions, including a description of the views expressed; and
c) identify in the prescribed minutes all documents considered in connection with an action.
53. Requires all minutes and documents of a closed meeting to remain under seal subject to release by a majority vote of the Commission or an order of a court of competent jurisdiction.
54. Requires the Commission, by a majority vote of the delegates, to prescribe bylaws or rules, or both, to govern its conduct as may be necessary or appropriate to carry out the purposes and exercise the powers of the Compact, including:
a) establishing the fiscal year of the Commission;
b) providing reasonable standards and procedures:
i. for the establishment and meetings of other committees; and
ii. governing any general or specific delegation of any authority or function of the Commission;
c) providing reasonable procedures for calling and conducting meetings of the Commission, ensuring reasonable advance notice of all meetings and providing an opportunity for attendance of such meetings by interested parties, with enumerated exceptions designed to protect the public's interest, the privacy of individuals and proprietary information, including trade secrets;
d) establishing the titles, duties and authority and reasonable procedures for electing the officers of the Commission;
e) providing reasonable standards and procedures for establishing the personnel policies and programs of the Commission;
f) promulgating a code of ethics to address permissible and prohibited activities of Commission members and employees;
g) providing a mechanism for winding up the operations of the Commission and the equitable disposition of any surplus monies that may exist after the termination of the Compact after the payment or reserving of all of the Commission's debts or obligations, or both;
h) publishing the Commission's bylaws and filing a copy, and a copy of any amendment, with the appropriate agency or officer in each member state, if any;
i) maintaining the Commission's financial records in accordance with the bylaws; and
j) meeting and taking such actions as are consistent with the provisions of the Compact and the bylaws.
55. Requires the bylaws to exclusively govern the personnel policies and programs of the Commission
56. Allows the Commission to meet in closed session only after a majority of the membership votes to close a meeting in whole or in part.
57. Requires the Commission, as soon as practicable, to make public a copy of the vote to close the meeting revealing the vote of each member with no proxy votes allowed.
58. Requires the Commission to have the following powers:
a) to promulgate uniform rules to facilitate and coordinate implementation and administration of the Compact;
b) to bring and prosecute legal proceedings or actions in the name of the Commission, provided that the standing of any state EMS authority or other regulatory body responsible for EMS personnel licensure to sue or be sued under applicable law is not affected;
c) to purchase and maintain insurance and bonds;
d) to borrow, accept or contract for services of personnel, including employees of a member state;
e) to hire employees, elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of the Compact and to establish the Commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel and other related personnel matters;
f) to accept any and all appropriate donations and grants of monies, equipment, supplies, materials and services, and to receive, use and dispose of the donations and grants, provided that at all times the Commission strives to avoid any appearance of impropriety and conflict of interest;
g) to lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold, improve or use any property, real, personal or mixed, provided that at all times the Commission strives to avoid any appearance of impropriety;
h) to sell, convey, mortgage, pledge, lease, exchange, abandon or otherwise dispose of any property, real, personal or mixed;
i) to establish a budget and make expenditures;
j) to borrow monies;
k) to appoint committees, including advisory committees composed of members, state regulators, state legislators or their representatives, and consumer representatives and such other interested persons as may be designated in the Compact and the bylaws;
l) to provide and receive information from, and to cooperate with, law enforcement agencies;
m) to adopt and use an official seal; and
n) to perform such other functions as may be necessary or appropriate to achieve the purposes of the Compact consistent with the state regulation of EMS personnel licensure and practice.
59. Requires the Commission rules to have the force and effect of law and be binding in all member states.
Financing of the Commission
60. Requires the Commission to pay, or provide for the payment of, the reasonable expenses of its establishment, organization and ongoing activities.
61. Allows the Commission to accept any and all appropriate revenue sources, donations and grants of monies, equipment, supplies, materials and services.
62. Allows the Commission to levy on and collect an annual assessment from each member state or impose fees on other parties to cover the cost of the operations and activities of the Commission and its staff, which is in a total amount sufficient to cover its annual budget as approved each year for which revenue is not provided by other sources.
63. Requires the aggregate annual assessment amount to be allocated based on a formula to be determined by the Commission.
64. Requires the Commission to promulgate a rule for the aggregate annual assessment amount that is binding on all member states.
65. Prohibits the Commission from incurring obligations of any kind before securing the monies adequate to meet the obligations.
66. Prohibits the Commission from pledging the credit of any member state, except by and with the authority of the member state.
67. Requires the Commission to keep accurate accounts of all receipts and disbursements.
68. Subjects the receipts and disbursements of the Commission to the audit and accounting procedures established under its bylaws.
69. Requires all receipts and disbursements of monies handled by the Commission to be audited yearly by a certified or licensed public accountant.
70. Requires the report of the yearly audit to be included in and become part of the annual report of the Commission.
Qualified Immunity, Defense and Indemnification
71. Requires the members, officers, executive director, employees and representatives of the Commission to be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error or omission that occurred or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties or responsibilities.
72. States that the prescribed immunity does not apply to any damage, loss, injury or liability caused by the intentional or wilful or wanton misconduct of the person.
73. Requires the Commission to defend any member, officer, executive director, employee or 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 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:
a) a person may retain their own counsel; and
b) the actual or alleged act, error or omission did not result from the person's intentional or wilful or wanton misconduct.
74. Requires the Commission to indemnify and hold harmless any member, officer, executive director, employee or 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.
75. States that the prescribed indemnification does not apply if the actual or alleged act, error or omission did not result from the intentional or wilful or wanton misconduct of the person.
Coordinated Database
76. Requires the Commission to provide for the development and maintenance of a coordinated database and reporting system containing licensure, adverse action and significant investigatory information on all licensed individuals in member states.
77. Requires a member state to submit a uniform data set to the coordinated database on all individuals to whom the Compact applies as required by Commission rules, including:
a) identifying information;
b) licensure data;
c) significant investigatory information;
d) adverse actions against a license;
e) an indicator that a privilege to practice is restricted, suspended or revoked;
f) nonconfidential information related to alternative program participation;
g) any denial of an application for licensure and the reason or reasons for such denial; and
h) other information that may facilitate the administration of the Compact, as determined by the Commission rules.
78. Requires the coordinated database administrator to promptly notify all member states of any adverse action taken against, or significant investigative information on, any individual in a member state.
79. Allows a member state that contributes information to the coordinated database to designate information that may not be shared with the public without the express permission of that member state.
80. Requires any information submitted to the coordinated database that is subsequently required to be expunged by the laws of the member state contributing the information to be removed from the coordinated database.
Rulemaking
81. Requires the Commission to exercise its rulemaking powers in accordance with the criteria set forth in the Compact and the adopted Commission rules.
82. States that rules and amendments become binding as of the date specified in each rule or amendment.
83. Requires a rule, if a majority of the legislatures of the member states rejects a rule by enacting a statute or resolution in the same manner used to adopt the Compact, to have no further force and effect in any member state.
84. Requires rules or amendments to the rules to be adopted at a regular or special meeting of the Commission.
85. Requires the Commission, before it promulgates and adopts a final rule or rules, and at least 60 days before the meeting at which the rule or rules will be considered and voted on, to file a notice of proposed rulemaking:
a) on the website of the Commission; and
b) on the website of each member state EMS authority or in the publication in which each state would otherwise publish proposed rules.
86. Requires the notice of proposed rulemaking to include:
a) the proposed time, date and location of the meeting in which the rule or rules will be considered and voted on;
b) the text of the proposed rule or rules or amendment and the reason for the proposed rule or rules;
c) a request for comments on the proposed rule or rules from any interested person; and
d) the manner in which interested persons may submit notice to the Commission of their intention to attend the public hearing and any written comments.
87. Requires the Commission, before adopting a proposed rule, to allow persons to submit written data, facts, opinions and arguments.
88. Requires the Commission to make available to the public any submitted written data, facts, opinions and arguments on a proposed rule.
89. Requires the Commission to grant an opportunity for a public hearing before it adopts a rule or amendment if a hearing is requested by any of the following:
a) at least 25 persons;
b) a governmental subdivision or agency; or
c) an association having at least 25 members.
90. Requires the Commission, if a hearing is held on the proposed rule or amendment, to publish the place, time and date of the scheduled public hearing.
91. Requires all persons wishing to be heard at the hearing to notify the Executive Director of the Commission or other designated member in writing at least five business days before the scheduled date of the hearing of their desire to appear and testify at the hearing.
92. Requires hearings on the proposed rule or amendment to be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing.
93. States that a transcript of the hearing on the proposed rule or amendment is not required unless a written request for a transcript is made.
94. Requires the person requesting a transcript of the hearing on a proposed rule or amendment to bear the cost of producing the transcript.
95. Allows a recording to be made in lieu of a transcript under the same terms and conditions as a transcript
96. States that the Commission is not precluded from making a transcript or recording of the hearing if it so chooses.
97. States that a separate hearing is not required on each proposed rule.
98. Allows proposed rules to be grouped for the convenience of the Commission at hearings.
99. Requires the Commission, following the scheduled hearing date, or by close of business on the scheduled hearing date if the hearing was not held, to consider all written and oral comments received.
100. Requires the Commission, by majority vote of all members, to take final action on the proposed rule and determine the effective date of the rule, if any, based on the rulemaking record and the full text of the rule.
101. Allows the Commission to proceed with promulgating the proposed rule without a public hearing if no written notice of intent to attend the public hearing by interested parties is received.
102. Allows the Commission, on a determination that an emergency exists, to consider and adopt an emergency rule without prior notice, opportunity for comment or hearing, provided that the usual rulemaking procedures provided in the Compact are retroactively applied to the rule as soon as reasonably possible but no later than 90 days after the effective date of the rule.
103. States that an emergency rule is one that is adopted immediately to do any of the following:
a) meet an imminent threat to public health, safety or welfare;
b) prevent a loss of Commission or member state monies;
c) meet a deadline for the promulgation of an administrative rule that is established by federal law or rule; or
d) protect the public health and safety.
104. Allows the Commission or an authorized committee of the Commission to direct revisions to a previously adopted rule or amendment for purposes of correcting typographical errors, errors in format, errors in consistency or grammatical errors.
105. Requires public notice of any revisions to be posted on the website of the Commission.
106. Requires the revision to be subject to challenge by any person for a period of 30 days after posting.
107. Allows the revision to be challenged only on grounds that the revision results in a material change to a rule.
108. Requires a challenge to be made in writing and delivered to the Executive Director of the Commission before the end of the notice period.
109. States that the revision will take effect without further action if no challenge is made.
110. Prohibits the revision from taking effect without the approval of the Commission if the revision is challenged.
Oversight
111. Requires the executive, legislative and judicial branches of state government in each member state to enforce the Compact and take all actions necessary and appropriate to effectuate the Compact's purposes and intent.
112. Requires the Compact and the promulgated Commission rules to have standing as statutory law.
113. Requires all courts to take judicial notice of the Compact and the Commission rules in any judicial or administrative proceeding in a member state pertaining to the subject matter of the Compact, which may affect the powers, responsibilities or actions of the Commission.
114. Entitles the Commission to receive service of process in any judicial or administrative proceeding and have standing to intervene in such a proceeding for all purposes.
115. States that failure to provide service of process to the Commission renders a judgment or order void as to the Commission, the Compact or Commission rules.
Default, Technical Assistance and Termination
116. Requires the Commission, if the Commission determines that a member state has defaulted in the performance of its obligations or responsibilities under the Compact or the Commission rules, to:
a) provide written notice to the defaulting state and other member states of the nature of the default, the proposed means of curing the default and any other action to be taken by the Commission; and
b) provide remedial training and specific technical assistance regarding the default.
117. Allows the defaulting state, if it fails to cure the default, to be terminated from the Compact on an affirmative vote of the member states and all rights, privileges and benefits conferred by the Compact may be terminated on the effective date of termination.
118. States that a cure of the default does not relieve the offending state of obligations or liabilities incurred during the period of default.
119. Requires termination of membership in the Compact to be imposed only after all other means of securing compliance have been exhausted.
120. Requires notice of intent to suspend or terminate to be given by the Commission to the Governor, the majority and minority leaders of the defaulting state's legislature and each member state.
121. States that a terminated state 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.
122. Prohibits the Commission from bearing any costs related to a state that is found to be in default or that has been terminated from the Compact, unless agreed on in writing between the Commission and the defaulting state.
123. Allows the defaulting state to appeal the action of the Commission by petitioning the U.S. District Court for the District of Columbia or the federal district where the Commission has its principal offices.
124. Requires a prevailing member state to be awarded all litigation costs, including reasonable attorney fees.
Dispute Resolution
125. Requires the Commission, on request by a member state, to attempt to resolve disputes related to the Compact that arise among member states and between member and nonmember states.
126. Requires the Commission to promulgate a rule providing for both mediation and binding dispute resolution for disputes as appropriate.
Enforcement
127. Requires the Commission, in the reasonable exercise of its discretion, to enforce the provisions of the Compact and Commission rules.
128. Allows the Commission, by majority vote, to initiate legal action in the U.S. District Court for the District of Columbia or the federal district where the Commission has its principal offices against a member state in default to enforce compliance with the provisions of the Compact and Commission rules and bylaws.
129. Allows the relief sought by the Commission to include both injunctive relief and damages.
130. Requires the prevailing member state, if judicial enforcement is necessary, to be awarded all litigation costs, including reasonable attorney fees.
131. States that the enforcement remedies prescribed in the Compact are not the exclusive remedies of the Commission.
132. Allows the Commission to pursue any other remedies available under federal or state law.
Implementation Date of the Compact
133. Requires the Compact to become effective on the date on which the Compact statute is enacted into law in the tenth member state.
134. Requires the provisions of the Compact, which become effective upon enacted by the tenth member state, to be limited to the powers granted to the Commission relating to assembly and the promulgation of rules.
135. Requires the Commission, upon the enactment of the Compact, to meet and exercise rulemaking powers necessary to implement and administer the Compact.
136. Subjects any state that joins the Compact after the Commission's initial adoption of the rules to the rules as they exist on the date on which the Compact becomes law in that state.
137. States that any rule that has been previously adopted by the Commission has the full force and effect of law on the day the Compact becomes law in that state.
138. Allows any member state to withdraw from the Compact by enacting a statute repealing the Compact.
139. States that a member state's withdrawal does not take effect until six months after enactment of the repealing statute.
140. States that a member state's withdrawal does not affect the continuing requirement of the withdrawing state's EMS authority to comply with the investigative and adverse action reporting requirements of the Compact before the effective date of withdrawal.
141. States that the Compact does not invalidate or prevent any EMS personnel licensure agreement or other cooperative arrangement between a member state and a nonmember state that does not conflict with the provisions of the Compact.
142. Allows the Compact to be amended by the member states.
143. States that an amendment to the Compact does not become effective and binding on any member state until it is enacted into the laws of all member states.
Construction and Severability
144. Requires the Compact to be liberally construed to effectuate the purposes of the Compact.
145. States that, if the Compact is held contrary to the constitution of any state member, the Compact remains in full force and effect as to the remaining member states.
146. States that the Compact does not supersede state law or rules related to licensure of EMS agencies.
Miscellaneous
147. Defines terms.
148. Becomes effective on the general effective date.
Prepared by Senate Research
January 26, 2026
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