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    1  A bill to be entitled
    2  An act relating to health and human services;
    3  providing a short title; amending s. 395.1055, F.S.;
    4  removing obsolete provisions; amending s. 401.411,
    5  F.S.; authorizing the Department of Health to deny,
    6  suspend, or revoke a license, certificate, or permit
    7  or reprimand, fine, or take adverse action against an
    8  emergency medical technician or paramedic under
    9  certain circumstances; amending s. 401.25, F.S.;
10  providing exemption from licensure for emergency
11  medical technicians or paramedics under certain
12  circumstances; requiring the Department of Health to
13  appoint a state delegate for the Interstate Compact
14  Commission for EMS Personnel Practice; creating s.
15  401.466, F.S.; enacting the Emergency Medical Services
16  Personnel Licensure Interstate Compact; providing
17  purpose; providing definitions; providing requirements
18  for home state licensure and practice of EMS
19  personnel; requiring compact states meet certain
20  criteria to participate in the compact; authorizing
21  EMS personnel to practice in other member states under
22  certain circumstances; providing that authority over
23  EMS personnel licenses remains with the home state;
24  providing guidelines and requirements for EMS
25  personnel to practice in a remote state; providing
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26  that certain terms and provisions of the Emergency
27  Management Assistance Compact apply in specified
28  circumstances; requiring member states to take
29  specified actions related to veterans, active duty
30  servicemembers, and their spouses; providing
31  requirements for adverse actions against EMS
32  personnel; providing requirements and limitations on
33  EMS personnel who have an adverse action; requiring
34  member states report adverse actions and specified
35  occurrences to the Interstate Commission for EMS
36  Personnel Practice; providing additional powers
37  invested in a member state's EMS authority;
38  establishing the Interstate Commission for EMS
39  Personnel Practice; providing for the jurisdiction and
40  venue for court proceedings; providing membership,
41  duties, and powers of the commission; authorizing the
42  commission to adopt rules; providing immunity to
43  specified individuals; providing requirements relating
44  to delegates; requiring compact states to participate
45  in a coordinated data and reporting system; providing
46  for the development of a database, reporting
47  procedures, and the exchange of certain information
48  between compact states; providing rulemaking
49  procedures; providing for state enforcement of the
50  compact; providing for the termination of compact
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51  membership; providing procedures for the resolution of
52  certain disputes; providing for the implementation of
53  the compact; providing requirements to withdraw from
54  the compact; providing compact amendment procedures;
55  providing construction and severability; amending s.
56  409.814, F.S.; revising eligibility requirements for
57  the Florida Kidcare program; amending s. 409.818,
58  F.S.; revising administrative duties of the agency;
59  amending s. 409.902, F.S.; revising eligibility
60  requirements for certain medical assistance payments;
61  amending s. 409.90201, F.S.; revising recipient
62  information required for Medicaid eligibility;
63  amending s. 409.904, F.S.; revising the time period in
64  which the agency will retroactively make payments to
65  Medicaid-covered services for certain persons;
66  amending s. 409.905, F.S.; prohibiting the agency from
67  making a payment to a prohibited entity; creating s.
68  414.321, F.S.; providing eligibility requirements for
69  food assistance; creating s. 414.332, F.S.; requiring
70  the Department of Children and Families develop and
71  implement a food assistance payment accuracy
72  improvement plan; providing requirements for the plan;
73  requiring the department to submit the plan to the
74  Governor and the Legislature by a specified date;
75  requiring the department, by a specified date, to
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76  submit certain quarterly progress reports to the
77  Governor and the Legislature; providing for future
78  repeal; amending s. 414.455, F.S.; revising
79  requirements for participation in an employment and
80  training program to receive food assistance from the
81  Supplemental Nutrition Assistance Program; requiring
82  the Department of Children and Families to apply for
83  and comply with certain work requirements in
84  accordance with federal law for food assistance;
85  amending s. 456.0575, F.S.; requiring a health care
86  practitioner to provide a patient with a certain
87  notification in writing upon referring the patient to
88  certain providers; authorizing a practitioner to
89  confirm network status; requiring disciplinary action
90  against a health care practitioner under certain
91  conditions; amending s. 456.073, F.S.; revising the
92  significant investigation information the Department
93  of Health is required to report relating to certain
94  physician assistants, emergency medical technicians or
95  paramedics, and clinical social workers; amending s.
96  456.076, F.S.; requiring the terms of the monitoring
97  contracts for certain physician assistants, emergency
98  medical technicians or paramedics, and clinical social
99  workers to include withdrawal from all practice under
100  certain circumstances; creating s. 456.66, F.S.;
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101  enacting the Physician Assistant Licensure Compact;
102  providing purpose; providing definitions; providing
103  requirements for compact states to participate in the
104  compact; providing criteria that a physician assistant
105  must satisfy to practice under the compact;
106  maintaining that authority over a physician
107  assistant's license remains with the home state but
108  authorizing remote states to define the scope of and
109  act on a physician assistant's authority to practice
110  in the compact state under the compact; prohibiting a
111  physician assistant from practicing under the compact
112  if his or her authority to do so has been acted on by
113  any compact state; requiring compact states to report
114  to the Physician Assistant Licensure Compact
115  Commission adverse actions taken against a physician
116  assistant; establishing the Physician Assistant
117  Licensure Compact Commission; providing jurisdiction
118  and venue for court proceedings; providing membership,
119  duties, and powers; authorizing the commission to
120  adopt rules; providing immunity to specified
121  individuals; requiring compact states to participate
122  in a coordinated data and reporting system; providing
123  for the development of a data system, reporting
124  procedures, and exchange of certain information
125  between compact states; providing rulemaking
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126  procedures; providing for state enforcement of the
127  compact; providing for the termination of compact
128  membership; providing procedures for the resolution of
129  certain disputes; providing compact amendment
130  procedures; authorizing nonparty states to participate
131  in commission activities before adoption of the
132  compact; providing construction and severability;
133  amending s. 458.307, F.S.; requiring the Board of
134  Medicine and the Board of Osteopathic Medicine to
135  jointly appoint an individual to serve as the state's
136  delegate on the Physician Assistant Licensure Compact
137  Commission; amending ss. 458.347 and 459.022, F.S.;
138  revising the number of physician assistants a
139  physician may supervise; authorizing the Board of
140  Medicine and the Board of Osteopathic Medicine to take
141  adverse action against a physician assistant's
142  privilege to practice under the Physician Assistant
143  Licensure Compact and to deny, suspend, or revoke the
144  licensure of a physician assistant who violates the
145  compact; providing an exemption from licensure for
146  certain physician assistants; amending s. 464.0123,
147  F.S.; revising practice requirements for an autonomous
148  advanced practice registered nurse; authorizing an
149  autonomous advanced practice registered nurse to
150  perform certain acts; amending s. 466.017, F.S.;
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151  authorizing a dental hygienist to prescribe,
152  administer, and dispense certain agents and administer
153  local anesthesia under certain circumstances; amending
154  s. 466.024, F.S.; revising the remediable and
155  delegable duties of a dentist; creating s. 491.022,
156  F.S.; creating the Social Work Licensure Interstate
157  Compact; providing purposes, objectives, and
158  definitions; specifying requirements for state
159  participation in the compact and duties of member
160  states; specifying that the compact does not affect an
161  individual's ability to apply for, and a member
162  state's ability to grant, a single state license
163  pursuant to the laws of that state; providing for
164  recognition of compact privilege in member states;
165  specifying criteria a licensee must meet for compact
166  privilege; providing for the expiration and renewal of
167  compact privilege; specifying that a licensee with
168  compact privilege in a remote state must adhere to the
169  laws and rules of that state; authorizing member
170  states to act on a licensee's compact privilege under
171  certain circumstances; specifying the consequences and
172  parameters of practice for a licensee whose compact
173  privilege has been acted upon or whose home state
174  license is encumbered; specifying that a licensee may
175  hold a home state license in only one member state at
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176  a time; specifying requirements and procedures for
177  changing a home state license designation; authorizing
178  active duty military personnel or their spouses to
179  keep their home state designation during active duty;
180  authorizing member states to take adverse actions
181  against licensees and issue subpoenas for hearings and
182  investigations under certain circumstances; providing
183  requirements and procedures for such adverse action;
184  authorizing member states to engage in joint
185  investigations under certain circumstances; providing
186  that a licensee's compact privilege must be
187  deactivated in all member states for the duration of
188  an encumbrance imposed by the licensee's home state;
189  providing for notice to the data system and the
190  licensee's home state of any adverse action taken
191  against a licensee; establishing the Social Work
192  Licensure Compact Commission; providing for
193  jurisdiction and venue for court proceedings;
194  providing for membership and powers of the commission;
195  specifying powers and duties of the commission's
196  executive committee; authorizing the commission to
197  convene in closed, nonpublic meetings under certain
198  circumstances; providing for the financing of the
199  commission; providing specified individuals immunity
200  from civil liability under certain circumstances;
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201  providing exceptions; requiring the commission to
202  defend the specified individuals in civil actions
203  under certain circumstances; requiring the commission
204  to indemnify and hold harmless specified individuals
205  for any settlement or judgment obtained in such
206  actions under certain circumstances; providing for the
207  development of the data system, reporting procedures,
208  and the exchange of specified information between
209  member states; requiring the commission to notify
210  member states of any adverse action taken against a
211  licensee or applicant for licensure; authorizing
212  member states to designate as confidential information
213  provided to the data system; requiring the commission
214  to remove information from the data system under
215  certain circumstances; providing rulemaking procedures
216  for the commission; providing for member state
217  enforcement of the compact; authorizing the commission
218  to receive notice of process, and have standing to
219  intervene, in certain proceedings; rendering certain
220  judgments and orders void as to the commission, the
221  compact, or commission rules under certain
222  circumstances; providing for defaults and termination
223  of compact membership; providing procedures for the
224  resolution of certain disputes; providing for
225  commission enforcement of the compact; providing for
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226  remedies; providing for implementation of, withdrawal
227  from, and amendment to the compact; specifying that
228  licensees practicing in a remote state under the
229  compact must adhere to the laws and rules of that
230  state; specifying that the compact, commission rules,
231  and commission actions are binding on member states;
232  providing construction; providing for severability;
233  amending s. 491.004, F.S.; requiring the Board of
234  Clinical Social Work, Marriage and Family Therapy, and
235  Mental Health Counseling to appoint an individual to
236  serve as the state's delegate on the commission;
237  amending ss. 491.005 and 491.006, F.S.; exempting
238  certain persons from licensure requirements; amending
239  s. 491.009, F.S.; authorizing certain disciplinary
240  action under the compact for specified prohibited
241  acts; amending s. 627.6471, F.S.; requiring certain
242  health insurers to apply payments for services
243  provided by nonpreferred providers toward insureds'
244  deductibles and out-of-pocket maximums if specified
245  conditions are met; amending s. 768.28, F.S.;
246  designating state delegates of the Physician Assistant
247  Licensure Compact Commission and the Interstate
248  Commission for EMS Personnel Practice and other
249  members or employees of the commissions as state
250  agents for the purpose of applying sovereign immunity
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251  and waivers of sovereign immunity; requiring the
252  commissions to pay certain judgments or claims;
253  authorizing the commissions to maintain insurance
254  coverage to pay such judgments or claims; designating
255  the state's delegate and other members or employees of
256  the Social Work Licensure Compact Commission as state
257  agents for the purpose of applying waivers of
258  sovereign immunity; requiring the commission to pay
259  certain claims or judgments; authorizing the
260  commission to maintain insurance coverage to pay such
261  claims or judgments; providing effective dates.
262
263      Be It Enacted by the Legislature of the State of Florida:
264
265  Section 1.  This act may be cited as the "Big Beautiful
266      Healthcare Frontier Act."
267  Section 2.  Subsections (12) through (19) of section
268      395.1055, Florida Statutes, are renumbered as subsections (11)
269      through (18), respectively, and subsection (11) and paragraph
270      (a) of present subsection (14) of that section are amended to
271      read:
272  395.1055  Rules and enforcement.—
273  (11)        The Secretary of Health Care Administration shall
274      consult the pediatric cardiac technical advisory panel for an
275      advisory recommendation on any certificate of need applications
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276      to establish pediatric cardiac surgical centers.
277  (13)(a)(14)(a)  The Secretary of Health Care Administration
278      may request announced or unannounced site visits to any existing
279      pediatric cardiac surgical center or facility seeking licensure
280      as a pediatric cardiac surgical center through the certificate
281      of need process, to ensure compliance with this section and
282      rules adopted hereunder.
283  Section 3.  Subsection (1) of section 401.411, Florida
284      Statutes, is amended, and subsection (9) is added to that
285      section, to read:
286  401.411       Disciplinary action; penalties.—
287  (1)     The department may deny, suspend, or revoke a license,
288      certificate, or permit or may reprimand or fine any licensee,
289      certificateholder, or other person operating under this part or
290      s. 401.466, for any of the following grounds:
291  (a)     The violation of any rule of the department or any
292      provision of this part.
293  (b)     Being found guilty of, or pleading nolo contendere to,
294      regardless of adjudication in any jurisdiction, a crime that
295      relates to practice as an emergency medical technician or
296      paramedic, or to practice in any other occupation, when
297      operating under this part.
298  (c)     Addiction to alcohol or any controlled substance.
299  (d)     Engaging in or attempting to engage in the possession,
300      except in legitimate duties under the supervision of a licensed
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301      physician, or the sale or distribution of any controlled
302      substance as set forth in chapter 893.
303  (e)     The conviction in any court in any state or in any
304      federal court of a felony, unless the person's civil rights have
305      been restored.
306  (f)     Knowingly making false or fraudulent claims;
307      procuring, attempting to procure, or renewing a certificate,
308      license, or permit by fakery, fraudulent action, or
309      misrepresentation.
310  (g)     Unprofessional conduct, including, but not limited to,
311      any departure from or failure to conform to the minimal
312      prevailing standards of acceptable practice under this part,
313      including undertaking activities that the emergency medical
314      technician, paramedic, health care professional, or other
315      professional is not qualified by training or experience to
316      perform.
317  (h)     Sexual misconduct with a patient, including inducing
318      or attempting to induce the patient to engage, or engaging or
319      attempting to engage the patient, in sexual activity.
320  (i)     The failure to give to the department, or its
321      authorized representative, true information upon request
322      regarding an alleged or confirmed violation of this part or rule
323      of the department.
324  (j)     Fraudulent or misleading advertising or advertising in
325      an unauthorized category.
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326  (k)     Practicing as an emergency medical technician,
327      paramedic, health care professional, or other professional
328      operating under this part without reasonable skill and without
329      regard for the safety of the public by reason of illness,
330      drunkenness, or the use of drugs, narcotics, or chemicals or any
331      other substance or as a result of any mental or physical
332      condition.
333  (l)     The failure to report to the department any person
334      known to be in violation of this part. However, a professional
335      known to be operating under this part without reasonable skill
336      and without regard for the safety of the public by reason of
337      illness, drunkenness, or the use of drugs, narcotics, chemicals,
338      or any other type of material, or as a result of a mental or
339      physical condition, may be reported to a consultant operating an
340      impaired practitioner program as described in s. 456.076 rather
341      than to the department.
342  (9)     The department may take adverse action against an
343      emergency medical technician's or paramedic's privilege to
344      practice under the Emergency Medical Services Personnel
345      Licensure Interstate Compact pursuant to s. 401.466 and may
346      impose any of the penalties in s. 456.072(2) if the emergency
347      medical technician or paramedic commits an act specified in
348      subsection (1) or s. 456.072(1).
349  Section 4.  Subsections (9) and (10) are added to section
350      401.25, Florida Statutes, to read:
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351  401.25        Licensure as a basic life support or an advanced
352      life support service.—
353  (9)     A person licensed as an emergency medical technician
354      or paramedic in another state who is practicing under the
355      Emergency Medical Services Personnel Licensure Interstate
356      Compact pursuant to s. 401.466, and only within the scope
357      provided therein, is exempt from the licensure requirements of
358      this section, as applicable.
359  (10)        The department shall appoint a person to serve as the
360      state's delegate on the Interstate Compact Commission for EMS
361      Personnel Practice, as required under 401.466.
362  Section 5.  Section 401.466, Florida Statutes, is created
363      to read:
364  401.466        Emergency Medical Services Personnel Licensure
365      Interstate Compact.—The Emergency Medical Services Personnel
366      Licensure Interstate Compact is enacted into law and entered
367      into by this state with all other jurisdictions legally joining
368      therein in the form substantially as follows:
369
370  ARTICLE I
371  PURPOSE
372
373  The purpose of this compact is to protect the public
374      through verification of competency and ensure accountability for
375      patient care-related activities of all states' licensed
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376      emergency medical services (EMS) personnel, such as emergency
377      medical technicians (EMTs), advanced EMTs, and paramedics. This
378      compact is intended to facilitate the day-to-day movement of EMS
379      personnel across state boundaries in the performance of their
380      EMS duties as assigned by an appropriate authority and authorize
381      state EMS offices to afford immediate legal recognition to EMS
382      personnel licensed in a member state. This compact recognizes
383      that states have a vested interest in protecting the public's
384      health and safety through their licensing and regulation of EMS
385      personnel and that such state regulation shared among the member
386      states will best protect public health and safety. This compact
387      is designed to achieve the following purposes and objectives:
388  (1)     Increase public access to EMS personnel.
389  (2)     Enhance the states' ability to protect the public's
390      health and safety, especially patient safety.
391  (3)     Encourage the cooperation of member states in the
392      areas of EMS personnel licensure and regulation.
393  (4)     Support licensing of military members who are
394      separating from active-duty tours and their spouses.
395  (5)     Facilitate the exchange of information between member
396      states regarding EMS personnel licensure, adverse action, and
397      significant investigatory information.
398  (6)     Promote compliance with the laws governing EMS
399      personnel practice in each member state.
400  (7)     Invest all member states with the authority to hold
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401      EMS personnel accountable through the mutual recognition of
402      member state licenses.
403
404  ARTICLE II
405  DEFINITIONS
406
407  As used in this compact, the term:
408  (1)     "Advanced emergency medical technician" or "AEMT"
409      means an individual licensed with cognitive knowledge and a
410      scope of practice that corresponds to that level in the National
411      EMS Education Standards and National EMS Scope of Practice
412      Model.
413  (2)     "Adverse action" means any administrative, civil,
414      equitable, or criminal action permitted by a state's laws which
415      may be imposed against licensed EMS personnel by a state EMS
416      authority or state court, including, but not limited to, actions
417      against an individual's license such as revocation, suspension,
418      probation, consent agreement, monitoring, or other limitation or
419      encumbrance on the individual's practice, letters of reprimand
420      or admonition, fines, criminal convictions, and state court
421      judgments enforcing adverse actions by the state EMS authority.
422  (3)     "Alternative program" means a voluntary,
423      nondisciplinary substance abuse recovery program approved by a
424      state EMS authority.
425  (4)     "Certification" means the successful verification of
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426      entry-level cognitive and psychomotor competency using a
427      reliable, validated, and legally defensible examination.
428  (5)     "Commission" means the national administrative body of
429      which all states that have enacted the compact are members.
430  (6)     "Emergency medical technician" or "EMT" means an
431      individual licensed with cognitive knowledge and a scope of
432      practice that corresponds to that level in the National EMS
433      Education Standards and National EMS Scope of Practice Model.
434  (7)     "Home state" means a member state where an individual
435      is licensed to practice emergency medical services.
436  (8)     "License" means the authorization by a state for an
437      individual to practice as an EMT, AEMT, paramedic, or a level in
438      between EMT and paramedic.
439  (9)     "Medical director" means a physician licensed in a
440      member state who is accountable for the care delivered by EMS
441      personnel.
442  (10)        "Member state" means a state that has enacted this
443      compact.
444  (11)        "Paramedic" means an individual licensed with
445      cognitive knowledge and a scope of practice that corresponds to
446      that level in the National EMS Education Standards and National
447      EMS Scope of Practice Model.
448  (12)        "Privilege to practice" means an individual's
449      authority to deliver emergency medical services in remote states
450      as authorized under this compact.
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451  (13)        "Remote state" means a member state in which an
452      individual is not licensed.
453  (14)        "Restricted" means the outcome of an adverse action
454      that limits a license or the privilege to practice.
455  (15)        "Rule" means a written statement by the interstate
456      Commission adopted pursuant to Article XII of this compact that
457      is of general applicability; implements, interprets, or
458      prescribes a policy or provision of the compact; or is an
459      organizational, procedural, or practice requirement of the
460      commission and has the force and effect of statutory law in a
461      member state and includes the amendment, repeal, or suspension
462      of an existing rule.
463  (16)        "Scope of practice" means defined parameters of
464      various duties or services that may be provided by an individual
465      with specific credentials. Whether regulated by rule, statute,
466      or court decision, it tends to represent the limits of services
467      an individual may perform.
468  (17)        "Significant investigatory information" means:
469  (a)     Investigative information that a state EMS authority,
470      after a preliminary inquiry that includes notification and an
471      opportunity to respond if required by state law, has reason to
472      believe, if proved true, would result in the imposition of an
473      adverse action on a license or privilege to practice; or
474  (b)     Investigative information that indicates that the
475      individual represents an immediate threat to public health and
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476      safety regardless of whether the individual has been notified
477      and had an opportunity to respond.
478  (18)        "State" means any state, commonwealth, district, or
479      territory of the United States.
480  (19)        "State EMS authority" means the board, office, or
481      other agency with the legislative mandate to license EMS
482      personnel.
483
484  ARTICLE III
485  HOME STATE LICENSURE
486
487  (1)     Any member state in which an individual holds a
488      current license shall be deemed a home state for purposes of
489      this compact.
490  (2)     Any member state may require an individual to obtain
491      and retain a license to be authorized to practice in the member
492      state under circumstances not authorized by the privilege to
493      practice under the terms of this compact.
494  (3)     A home state's license authorizes an individual to
495      practice in a remote state under the privilege to practice only
496      if the home state:
497  (a)     Currently requires the use of the National Registry of
498      Emergency Medical Technicians (NREMT) examination as a condition
499      of issuing initial licenses at the EMT and paramedic levels.
500  (b)     Has a mechanism in place for receiving and
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501      investigating complaints about individuals.
502  (c)     Notifies the commission, in compliance with the terms
503      herein, of any adverse action or significant investigatory
504      information regarding an individual.
505  (d)     No later than 5 years after activation of the compact,
506      requires a criminal background check of all applicants for
507      initial licensure, including the use of the results of
508      fingerprint or other biometric data checks compliant with the
509      requirements of the Federal Bureau of Investigation, with the
510      exception of federal employees who have suitability
511      determination in accordance with 5 C.F.R. s. 731.202 and submit
512      documentation of such as adopted in the rules of the commission.
513  (e)     Complies with the rules of the commission.
514
515  ARTICLE IV
516  COMPACT PRIVILEGE TO PRACTICE
517
518  (1)     Member states shall recognize the privilege to
519      practice of an individual licensed in another member state that
520      is in conformance with Article III.
521  (2)     To exercise the privilege to practice under the terms
522      and provisions of this compact, an individual must:
523  (a)     Be at least 18 years of age.
524  (b)     Possess a current unrestricted license in a member
525      state as an EMT, AEMT, paramedic, or state recognized and
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526      licensed level with a scope of practice and authority between
527      EMT and paramedic.
528  (c)     Practice under the supervision of a medical director.
529  (3)     An individual providing patient care in a remote state
530      under the privilege to practice shall function within the scope
531      of practice authorized by the home state unless and until
532      modified by an appropriate authority in the remote state as may
533      be defined in the rules of the commission.
534  (4)     Except as provided in subsection (3) of this article,
535      an individual practicing in a remote state will be subject to
536      the remote state's authority and laws. A remote state may, in
537      accordance with due process and that state's laws, restrict,
538      suspend, or revoke an individual's privilege to practice in the
539      remote state and may take any other necessary actions to protect
540      the health and safety of its citizens. If a remote state takes
541      action it shall promptly notify the home state and the
542      commission.
543  (5)     If an individual's license in any home state is
544      restricted or suspended, the individual is not eligible to
545      practice in a remote state under the privilege to practice until
546      the individual's home state license is restored.
547  (6)     If an individual's privilege to practice in any remote
548      state is restricted, suspended, or revoked, the individual is
549      not eligible to practice in any remote state until the
550      individual's privilege to practice is restored.
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551
552  ARTICLE V
553  CONDITIONS OF PRACTICE IN A REMOTE STATE
554
555  An individual may practice in a remote state under a
556      privilege to practice only in the performance of the
557      individual's EMS duties as assigned by an appropriate authority,
558      as defined in the rules of the commission, and under the
559      following circumstances:
560  (1)     The individual originates a patient transport in a
561      home state and transports the patient to a remote state;
562  (2)     The individual originates in the home state and enters
563      a remote state to pick up a patient and provide care and
564      transport of the patient to the home state;
565  (3)     The individual enters a remote state to provide
566      patient care or transport within that remote state;
567  (4)     The individual enters a remote state to pick up a
568      patient and provide care and transport to a third member state;
569      or
570  (5)     Other conditions as determined by rules adopted by the
571      commission.
572
573  ARTICLE VI
574  RELATIONSHIP TO EMERGENCY MANAGEMENT ASSISTANCE COMPACT
575
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576  Upon a member state's Governor's declaration of a state of
577      emergency or disaster that activates the Emergency Management
578      Assistance Compact (EMAC), all relevant terms and provisions of
579      EMAC shall apply and to the extent any terms or provisions of
580      this compact conflicts with EMAC, the terms of EMAC shall
581      prevail with respect to any individual practicing in the remote
582      state in response to such declaration.
583
584  ARTICLE VII
585  VETERANS, SERVICE MEMBERS SEPARATING FROM ACTIVE-DUTY MILITARY,
586  AND THEIR SPOUSES
587
588  (1)     Member states shall consider a veteran, an active
589      military service member, and a member of the National Guard and
590      Reserves separating from an active-duty tour, and a spouse
591      thereof, who holds a current valid and unrestricted NREMT
592      certification at or above the level of the state license being
593      sought as satisfying the minimum training and examination
594      requirements for such licensure.
595  (2)     Member states shall expedite the processing of
596      licensure applications submitted by veterans, active military
597      service members, and members of the National Guard and Reserves
598      separating from an active-duty tour, and spouses thereof.
599  (3)     All individuals functioning with a privilege to
600      practice under this article remain subject to the adverse
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601      actions provisions of Article VIII.
602
603  ARTICLE VIII
604  ADVERSE ACTIONS
605
606  (1)     A home state shall have exclusive power to impose
607      adverse action against an individual's license issued by the
608      home state.
609  (2)     If an individual's license in any home state is
610      restricted or suspended, the individual is not eligible to
611      practice in a remote state under the privilege to practice until
612      the individual's home state license is restored.
613  (a)     All home state adverse action orders shall include a
614      statement that the individual's compact privileges are inactive.
615      The order may allow the individual to practice in remote states
616      with prior written authorization from both the home state and
617      remote state's EMS authority.
618  (b)     An individual currently subject to adverse action in
619      the home state may not practice in any remote state without
620      prior written authorization from both the home state and remote
621      state's EMS authority.
622  (3)     A member state shall report adverse actions and any
623      occurrences that the individual's compact privileges are
624      restricted, suspended, or revoked to the commission in
625      accordance with the rules of the commission.
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626  (4)     A remote state may take adverse action on an
627      individual's privilege to practice within that state.
628  (5)     Any member state may take adverse action against an
629      individual's privilege to practice in that state based on the
630      factual findings of another member state, so long as each state
631      follows its own procedures for imposing such adverse action.
632  (6)     A home state's EMS authority shall investigate and
633      take appropriate action with respect to reported conduct in a
634      remote state as it would if such conduct had occurred within the
635      home state. In such cases, the home state's law shall control in
636      determining the appropriate adverse action.
637  (7)     Nothing in this compact shall override a member
638      state's decision that participation in an alternative program
639      may be used in lieu of adverse action and that such
640      participation shall remain nonpublic if required by the member
641      state's laws. Member states must require individuals who enter
642      any alternative programs to agree not to practice in any other
643      member state during the term of the alternative program without
644      prior authorization from such other member state.
645
646  ARTICLE IX
647  ADDITIONAL POWERS INVESTED IN A MEMBER STATE'S EMS AUTHORITY
648
649  A member state's EMS authority, in addition to any other
650      powers granted under state law, is authorized under this compact
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651      to:
652  (1)     Issue subpoenas for both hearings and investigations
653      that require the attendance and testimony of witnesses and the
654      production of evidence. Subpoenas issued by a member state's EMS
655      authority for the attendance and testimony of witnesses, or the
656      production of evidence from another member state, shall be
657      enforced in the remote state by any court of competent
658      jurisdiction, according to that court's practice and procedure
659      in considering subpoenas issued in its own proceedings. The
660      issuing state EMS authority shall pay any witness fees, travel
661      expenses, mileage, and other fees required by the service
662      statutes of the state where the witnesses or evidence are
663      located.
664  (2)     Issue cease and desist orders to restrict, suspend, or
665      revoke an individual's privilege to practice in the state.
666
667  ARTICLE X
668  ESTABLISHMENT OF THE INTERSTATE COMMISSION FOR EMS PERSONNEL
669  PRACTICE
670
671  (1)(a)       The compact states create and establish a joint
672      public agency known as the Interstate Commission for EMS
673      Personnel Practice.
674  (b)     The commission is a body politic and an
675      instrumentality of the compact states.
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676  (c)     Venue is proper and judicial proceedings by or against
677      the commission shall be brought solely and exclusively in a
678      court of competent jurisdiction where the principal office of
679      the commission is located. The commission may waive venue and
680      jurisdictional defenses to the extent it adopts or consents to
681      participate in alternative dispute resolution proceedings.
682  (d)     Nothing in this compact shall be construed to be a
683      waiver of sovereign immunity.
684  (2)(a)       Each member state shall have and be limited to one
685      delegate. The responsible official of the state EMS authority or
686      his or her designee shall be the delegate to this compact for
687      each member state. Any delegate may be removed or suspended from
688      office as provided by the law of the state from which the
689      delegate is appointed. Any vacancy occurring in the commission
690      shall be filled in accordance with the laws of the member state
691      in which the vacancy exists. In the event that more than one
692      board, office, or other agency with the legislative mandate to
693      license EMS personnel at and above the level of EMT exists, the
694      Governor of the state will determine which entity will be
695      responsible for assigning the delegate.
696  (b)     Each delegate shall be entitled to one vote with
697      regard to the adoption of rules and creation of bylaws and shall
698      otherwise have an opportunity to participate in the business and
699      affairs of the commission. A delegate shall vote in person or by
700      such other means as provided in the bylaws. The bylaws may
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701      provide for delegates' participation in meetings by telephone or
702      other means of communication.
703  (c)      The commission shall meet at least once during each
704      calendar year. Additional meetings shall be held as set forth in
705      the bylaws.
706  (d)      All meetings shall be open to the public, and public
707      notice of meetings shall be given in the same manner as required
708      under the rulemaking provisions in Article XII.
709  (e)      The commission may convene in a closed, nonpublic
710      meeting or nonpublic part of a public meeting to receive legal
711      advice or to discuss the following:
712  1.      Noncompliance of a member state with its obligations
713      under the compact;
714  2.      The employment, compensation, discipline or other
715      personnel matters, practices, or procedures related to specific
716      employees or other matters related to the commission's internal
717      personnel practices and procedures;
718  3.      Current, threatened, or reasonably anticipated
719      litigation;
720  4.      Negotiation of contracts for the purchase or sale of
721      goods, services, or real estate;
722  5.      Accusing any person of a crime or formally censuring
723      any person;
724  6.      Disclosure of trade secrets or commercial or financial
725      information that is privileged or confidential;
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726  7.      Disclosure of information of a personal nature where
727      disclosure would constitute a clearly unwarranted invasion of
728      personal privacy;
729  8.      Disclosure of investigatory records compiled for law
730      enforcement purposes;
731  9.      Disclosure of information related to any investigatory
732      reports prepared by or on behalf of or for use of the commission
733      or other committee charged with responsibility of investigation
734      or determination of compliance issues pursuant to the compact;
735  10.     Legal advice; or
736  11.      Matters specifically exempted from disclosure by
737      federal or state statute.
738  (f)      If a meeting, or portion of a meeting, is closed
739      pursuant to this provision, the commission's legal counsel or
740      designee shall certify that the meeting may be closed and shall
741      reference each relevant exempting provision. The commission
742      shall keep minutes that fully and clearly describe all matters
743      discussed in a meeting and shall provide a full and accurate
744      summary of actions taken, and the reasons therefor, including a
745      description of the views expressed. All documents considered in
746      connection with an action shall be identified in such minutes.
747      All minutes and documents of a closed meeting shall remain under
748      seal, subject to release by a majority vote of the commission or
749      order of a court of competent jurisdiction.
750  (3)      The commission shall, by a majority vote of the
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751      delegates, prescribe bylaws or rules to govern its conduct as
752      may be necessary or appropriate to carry out the purposes and
753      exercise the powers of the compact, including, but not limited
754      to:
755  (a)      Establishing the fiscal year of the commission.
756  (b)      Providing reasonable standards and procedures:
757  1.      Establishing and the meetings of other committees.
758  2.      Governing any general or specific delegation of any
759      authority or function of the commission.
760  (c)      Providing reasonable procedures for calling and
761      conducting meetings of the commission, ensuring reasonable
762      advance notice of all meetings, and providing an opportunity for
763      attendance of such meetings by interested parties, with
764      enumerated exceptions designed to protect the public's interest,
765      the privacy of individuals, and proprietary information,
766      including trade secrets. The commission may meet in closed
767      session only after a majority of the membership votes to close a
768      meeting in whole or in part. As soon as practicable, the
769      commission must make public a copy of the vote to close the
770      meeting revealing the vote of each member with no proxy votes
771      allowed.
772  (d)      Establishing the titles, duties and authority, and
773      reasonable procedures for the election of the officers of the
774      commission.
775  (e)      Providing reasonable standards and procedures for the
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776      establishment of the personnel policies and programs of the
777      commission. Notwithstanding any civil service or other similar
778      laws of any member state, the bylaws shall exclusively govern
779      the personnel policies and programs of the commission.
780  (f)     Adopting a code of ethics to address permissible and
781      prohibited activities of commission members and employees.
782  (g)     Providing a mechanism for winding up the operations of
783      the commission and the equitable disposition of any surplus
784      funds that may exist after the termination of the compact after
785      the payment or reserving of all of its debts and obligations.
786  (h)     The commission shall publish its bylaws and file a
787      copy thereof, and a copy of any amendment thereto, with the
788      appropriate agency or officer in each of the member states, if
789      any.
790  (i)     The commission shall maintain its financial records in
791      accordance with the bylaws.
792  (j)     The commission shall meet and take such actions as are
793      consistent with the provisions of this compact and the bylaws.
794  (4)     The commission shall have the following powers:
795  (a)     The authority to adopt uniform rules to facilitate and
796      coordinate implementation and administration of this compact.
797      The rules shall have the force and effect of law and shall be
798      binding in all member states.
799  (b)     To bring and prosecute legal proceedings or actions in
800      the name of the commission, provided that the standing of any
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801      state EMS authority or other regulatory body responsible for EMS
802      personnel licensure to sue or be sued under applicable law may
803      not be affected.
804  (c)     To purchase and maintain insurance and bonds.
805  (d)     To borrow, accept, or contract for services of
806      personnel, including, but not limited to, employees of a member
807      state.
808  (e)     To hire employees, elect or appoint officers, fix
809      compensation, define duties, grant such individuals appropriate
810      authority to carry out the purposes of the compact, and
811      establish the commission's personnel policies and programs
812      relating to conflicts of interest, qualifications of personnel,
813      and other related personnel matters.
814  (f)     To accept any and all appropriate donations and grants
815      of money, equipment, supplies, materials, and services; and
816      receive, use, and dispose of the same; provided that at all
817      times the commission shall strive to avoid any appearance of
818      impropriety or conflict of interest.
819  (g)     To lease, purchase, accept appropriate gifts or
820      donations of, or otherwise to own, hold, improve, or use any
821      property, real, personal, or mixed; provided that at all times
822      the commission shall strive to avoid any appearance of
823      impropriety.
824  (h)     To sell convey, mortgage, pledge, lease, exchange,
825      abandon, or otherwise dispose of any property real, personal, or
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826      mixed.
827  (i)     To establish a budget and make expenditures.
828  (j)     To borrow money.
829  (k)     To appoint committees, including advisory committees
830      comprised of members, state regulators, state legislators or
831      their representatives, consumer representatives, and such other
832      interested persons as may be designated in this compact and the
833      bylaws.
834  (l)     To provide and receive information from, and to
835      cooperate with, law enforcement agencies.
836  (m)     To adopt and use an official seal.
837  (n)     To perform such other functions as may be necessary or
838      appropriate to achieve the purposes of this compact consistent
839      with the state regulation of EMS personnel licensure and
840      practice.
841  (5)(a)       The commission shall pay, or provide for the
842      payment of, the reasonable expenses of its establishment,
843      organization, and ongoing activities.
844  (b)     The commission may accept any and all appropriate
845      revenue sources, donations, and grants of money, equipment,
846      supplies, materials, and services.
847  (c)     The commission may levy on and collect an annual
848      assessment from each member state to cover the cost of the
849      operations and activities of the commission and its staff, which
850      must be in a total amount sufficient to cover its annual budget
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851      as approved each year for which revenue is not provided by other
852      sources. The aggregate annual assessment amount shall be
853      allocated based upon a formula to be determined by the
854      commission, which shall adopt a rule binding upon all member
855      states.
856  (d)     The commission may not incur obligations of any kind
857      before securing the funds adequate to meet the same; nor shall
858      the commission pledge the credit of any of the member states,
859      except by and with the authority of the member state.
860  (e)     The commission shall keep accurate accounts of all
861      receipts and disbursements. The receipts and disbursements of
862      the commission shall be subject to the audit and accounting
863      procedures established under its bylaws. However, all receipts
864      and disbursements of funds handled by the commission shall be
865      audited yearly by a certified or licensed public accountant, and
866      the report of the audit shall be included in and become part of
867      the annual report of the commission.
868  (6)(a)       The members, officers, executive director,
869      employees and representatives of the commission shall be immune
870      from suit and liability, either personally or in their official
871      capacities, for any claim for damage to or loss of property or
872      personal injury or other civil liability caused by or arising
873      out of any actual or alleged act, error, or omission that
874      occurred, or that the person against whom the claim is made had
875      a reasonable basis for believing occurred within the scope of
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876      commission employment, duties, or responsibilities; provided
877      that nothing in this paragraph shall be construed to protect any
878      such person from suit or liability for any damage, loss, injury,
879      or liability caused by the intentional or willful or wanton
880      misconduct of that person. The procurement of insurance of any
881      type by the commission may not in any way compromise or limit
882      the immunity granted hereunder.
883  (b)     The commission shall defend any member, officer,
884      executive director, employee, or representative of the
885      commission in any civil action seeking to impose liability
886      arising out of any actual or alleged act, error, or omission
887      that occurred within the scope of commission employment, duties,
888      or responsibilities, or that the person against whom the claim
889      is made had a reasonable basis for believing occurred within the
890      scope of commission employment, duties, or responsibilities;
891      provided that nothing herein shall be construed to prohibit that
892      person from retaining his or her own counsel; and provided
893      further, that the actual or alleged act, error, or omission did
894      not result from that person's intentional or willful or wanton
895      misconduct.
896  (c)     The commission shall indemnify and hold harmless any
897      member, officer, executive director, employee, or representative
898      of the commission for the amount of any settlement or judgment
899      obtained against that person arising out of any actual or
900      alleged act, error, or omission that occurred within the scope
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901      of commission employment, duties, or responsibilities, or that
902      such person had a reasonable basis for believing occurred within
903      the scope of commission employment, duties, or responsibilities,
904      provided that the actual or alleged act, error, or omission did
905      not result from the intentional or willful or wanton misconduct
906      of that person.
907
908  ARTICLE XI
909  COORDINATED DATABASE
910
911  (1)     The commission shall provide for the development and
912      maintenance of a coordinated database and reporting system
913      containing licensure, adverse action, and significant
914      investigatory information on all licensed individuals in member
915      states.
916  (2)     Notwithstanding any other provision of state law to
917      the contrary, a member state shall submit a uniform data set to
918      the coordinated database on all individuals to whom this compact
919      is applicable as required by the rules of the commission,
920      including:
921  (a)     Identifying information.
922  (b)     Licensure data.
923  (c)     Significant investigatory information.
924  (d)     Adverse actions against an individual's license.
925  (e)     An indicator that an individual's privilege to
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926      practice is restricted, suspended, or revoked.
927  (f)     Nonconfidential information related to alternative
928      program participation.
929  (g)     Any denial of application for licensure and the
930      reasons for such denial.
931  (h)     Other information that may facilitate the
932      administration of this compact, as determined by the rules of
933      the commission.
934  (3)     The coordinated database administrator shall promptly
935      notify all member states of any adverse action taken against, or
936      significant investigative information on, any individual in a
937      member state.
938  (4)     Member states contributing information to the
939      coordinated database may designate information that may not be
940      shared with the public without the express permission of the
941      contributing state.
942  (5)     Any information submitted to the coordinated database
943      that is subsequently required to be expunged by the laws of the
944      member state contributing the information shall be removed from
945      the coordinated database.
946
947  ARTICLE XII
948  RULEMAKING
949
950  (1)     The commission shall exercise its rulemaking powers
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951      pursuant to the criteria set forth in this article and the rules
952      adopted thereunder. Rules and amendments shall become binding as
953      of the date specified in each rule or amendment.
954  (2)     If a majority of the legislatures of the member states
955      reject a rule, by enactment of a statute or resolution in the
956      same manner used to adopt the compact, then such rule shall have
957      no further force and effect in any member state.
958  (3)     Rules or amendments to the rules shall be adopted at a
959      regular or special meeting of the commission.
960  (4)     Before the adoption of a final rule or rules by the
961      commission, and at least 60 days in advance of the meeting at
962      which the rule will be considered and voted upon, the commission
963      shall file a notice of proposed rulemaking:
964  (a)     On the website of the commission.
965  (b)     On the website of each member state EMS authority or
966      the publication in which each state would otherwise publish
967      proposed rules.
968  (5)     The notice of proposed rulemaking shall include:
969  (a)     The proposed time, date, and location of the meeting
970      in which the rule will be considered and voted upon.
971  (b)     The text of the proposed rule or amendment and the
972      reason for the proposed rule.
973  (c)     A request for comments on the proposed rule from any
974      interested person.
975  (d)     The manner in which interested persons may submit
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976       notice to the commission of their intentions to attend the
977       public hearing and any written comments.
978  (6)     Before adoption of a proposed rule, the commission
979       shall allow persons to submit written data, facts, opinions, and
980       arguments, which shall be made available to the public.
981  (7)     The commission shall grant an opportunity for a public
982       hearing before it adopts a rule or amendment if a hearing is
983       requested by:
984  (a)     At least 25 persons;
985  (b)     A governmental subdivision or agency; or
986  (c)     An association having at least 25 members.
987  (8)(a)       If a hearing is held on the proposed rule or
988       amendment, the commission shall publish the place, time, and
989       date of the scheduled public hearing.
990  (b)     Each person wishing to be heard at the hearing shall
991       notify the executive director of the commission or other
992       designated member in writing of his or her desire to appear and
993       testify at the hearing not less than 5 business days before the
994       scheduled date of the hearing.
995  (c)     Hearings shall be conducted in a manner providing each
996       person who wishes to comment a fair and reasonable opportunity
997       to comment orally or in writing.
998  (d)     No transcript of the hearing is required, unless a
999       written request for a transcript is made, in which case the
1000      person requesting the transcript shall bear the cost of
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1001      producing the transcript. A recording may be made in lieu of a
1002      transcript under the same terms and conditions as a transcript.
1003      This subsection does not preclude the commission from making a
1004      transcript or recording of the hearing if it so chooses.
1005  (e)     Nothing in this article shall be construed as
1006      requiring a separate hearing on each rule. Rules may be grouped
1007      for the convenience of the commission at hearings required by
1008      this article.
1009  (9)     Following the scheduled hearing date, or by the close
1010      of business on the scheduled hearing date if the hearing was not
1011      held, the commission shall consider all written and oral
1012      comments received.
1013  (10)        The commission shall, by majority vote of all
1014      members, take final action on the proposed rule and shall
1015      determine the effective date of the rule, if any, based on the
1016      rulemaking record and the full text of the rule.
1017  (11)        If no written notice of intent to attend the public
1018      hearing by interested parties is received, the commission may
1019      proceed with adoption of the proposed rule without a public
1020      hearing.
1021  (12)        Upon determination that an emergency exists, the
1022      commission may consider and adopt an emergency rule without
1023      prior notice, opportunity for comment, or hearing, provided that
1024      the usual rulemaking procedures provided in the compact and in
1025      this article shall be retroactively applied to the rule as soon
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1026      as reasonably possible, in no event later than 90 days after the
1027      effective date of the rule. For the purposes of this provision,
1028      an emergency rule is one that must be adopted immediately in
1029      order to:
1030  (a)     Meet an imminent threat to public health, safety, or
1031      welfare;
1032  (b)     Prevent a loss of commission or member state funds;
1033  (c)     Meet a deadline for the adoption of an administrative
1034      rule that is established by federal law or rule; or
1035  (d)     Protect public health and safety.
1036  (13)        The commission or an authorized committee of the
1037      commission may direct revisions to a previously adopted rule or
1038      amendment for purposes of correcting typographical errors,
1039      errors in format, errors in consistency, or grammatical errors.
1040      Public notice of any revisions shall be posted on the website of
1041      the commission. The revision shall be subject to challenge by
1042      any person for a period of 30 days after posting. The revision
1043      may be challenged only on grounds that the revision results in a
1044      material change to a rule. A challenge shall be made in writing
1045      and delivered to the chair of the commission before the end of
1046      the notice period. If no challenge is made, the revision will
1047      take effect without further action. If the revision is
1048      challenged, the revision may not take effect without the
1049      approval of the commission.
1050
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1051  ARTICLE XIII
1052  OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT
1053
1054  (1)(a)       The executive, legislative, and judicial branches
1055      of state government in each member state shall enforce this
1056      compact and take all actions necessary and appropriate to
1057      effectuate the compact's purposes and intent. The provisions of
1058      this compact and the rules adopted hereunder shall have standing
1059      as statutory law.
1060  (b)     All courts shall take judicial notice of the compact
1061      and the rules in any judicial or administrative proceeding in a
1062      member state pertaining to the subject matter of this compact
1063      which may affect the powers, responsibilities, or actions of the
1064      commission.
1065  (c)     The commission shall be entitled to receive service of
1066      process in any such proceeding, and shall have standing to
1067      intervene in such a proceeding for all purposes. Failure to
1068      provide service of process to the commission shall render a
1069      judgment or order void as to the commission, this compact, or
1070      adopted rules.
1071  (2)(a)       If the commission determines that a member state
1072      has defaulted in the performance of its obligations or
1073      responsibilities under this compact or the adopted rules, the
1074      commission shall:
1075  1.      Provide written notice to the defaulting state and
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1076      other member states of the nature of the default, the proposed
1077      means of curing the default or any other action to be taken by
1078      the commission.
1079  2.      Provide remedial training and specific technical
1080      assistance regarding the default.
1081  (b)      If a state in default fails to cure the default, the
1082      defaulting state may be terminated from the compact upon an
1083      affirmative vote of a majority of the member states, and all
1084      rights, privileges, and benefits conferred by this compact may
1085      be terminated on the effective date of termination. A cure of
1086      the default does not relieve the offending state of obligations
1087      or liabilities incurred during the period of default.
1088  (c)      Termination of membership in the compact shall be
1089      imposed only after all other means of securing compliance have
1090      been exhausted. Notice of intent to suspend or terminate shall
1091      be given by the commission to the Governor, the majority and
1092      minority leaders of the defaulting state's legislature, and each
1093      of the member states.
1094  (d)      A state that has been terminated is responsible for
1095      all assessments, obligations, and liabilities incurred through
1096      the effective date of termination, including obligations that
1097      extend beyond the effective date of termination.
1098  (e)      The commission does not bear any costs related to a
1099      state that is found to be in default or that has been terminated
1100      from the compact, unless agreed upon in writing between the
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1101      commission and the defaulting state.
1102  (f)     The defaulting state may appeal the action of the
1103      commission by petitioning the United States District Court for
1104      the District of Columbia or the federal district where the
1105      commission has its principal offices. The prevailing member
1106      shall be awarded all costs of such litigation, including
1107      reasonable attorney fees.
1108  (3)(a)       Upon request by a member state, the commission
1109      shall attempt to resolve disputes related to the compact that
1110      arise among member states and between member and nonmember
1111      states.
1112  (b)     The commission shall adopt a rule providing for both
1113      mediation and binding dispute resolution for disputes as
1114      appropriate.
1115  (4)(a)       The commission, in the reasonable exercise of its
1116      discretion, shall enforce the provisions and rules of this
1117      compact.
1118  (b)     By majority vote, the commission may initiate legal
1119      action in the United States District Court for the District of
1120      Columbia or the federal district where the commission has its
1121      principal offices against a member state in default to enforce
1122      compliance with the provisions of the compact and its adopted
1123      rules and bylaws. The relief sought may include both injunctive
1124      relief and damages. In the event judicial enforcement is
1125      necessary, the prevailing member shall be awarded all costs of
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1126      such litigation, including reasonable attorney fees.
1127  (c)     The remedies herein may not be the exclusive remedies
1128      of the commission. The commission may pursue any other remedies
1129      available under federal or state law.
1130
1131  ARTICLE XIV
1132  DATE OF IMPLEMENTATION OF THE INTERSTATE COMMISSION FOR EMS
1133  PERSONNEL PRACTICE AND ASSOCIATED RULES, WITHDRAWAL, AND
1134  AMENDMENT
1135
1136  (1)     The compact shall come into effect on the date on
1137      which the compact statute is enacted into law in the tenth
1138      member state. The provisions, which become effective at that
1139      time, shall be limited to the powers granted to the commission
1140      relating to assembly and the adoption of rules. Thereafter, the
1141      commission shall meet and exercise rulemaking powers necessary
1142      to the implementation and administration of the compact.
1143  (2)     Any state that joins the compact subsequent to the
1144      commission's initial adoption of the rules shall be subject to
1145      the rules as they exist on the date on which the compact becomes
1146      law in that state. Any rule that has been previously adopted by
1147      the commission shall have the full force and effect of law on
1148      the day the compact becomes law in that state.
1149  (3)     Any member state may withdraw from this compact by
1150      enacting a statute repealing the same.
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1151  (a)     A member state's withdrawal does not take effect until
1152      6 months after enactment of the repealing statute.
1153  (b)     Withdrawal does not affect the continuing requirement
1154      of the withdrawing state's EMS authority to comply with the
1155      investigative and adverse action reporting requirements of this
1156      act before the effective date of withdrawal.
1157  (4)     Nothing contained in this compact shall be construed
1158      to invalidate or prevent any EMS personnel licensure agreement
1159      or other cooperative arrangement between a member state and a
1160      nonmember state that does not conflict with the provisions of
1161      this compact.
1162  (5)     This compact may be amended by the member states. No
1163      amendment to this compact shall become effective and binding
1164      upon any member state until it is enacted into the laws of all
1165      member states.
1166
1167  ARTICLE XV
1168  CONSTRUCTION AND SEVERABILITY
1169
1170  This compact shall be liberally construed so as to
1171      effectuate the purposes thereof. If this compact shall be held
1172      contrary to the constitution of any state member thereto, the
1173      compact shall remain in full force and effect as to the
1174      remaining member states. This compact does not supersede state
1175      law or rules related to licensure of EMS agencies.
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1176  Section 6.  Effective October 1, 2026, paragraph (c) of
1177      subsection (5) of section 409.814, Florida Statutes, is amended
1178      to read:
1179  409.814       Eligibility.—A child who has not reached 19 years
1180      of age whose family income is equal to or below 300 percent of
1181      the federal poverty level is eligible for the Florida Kidcare
1182      program as provided in this section. If an enrolled individual
1183      is determined to be ineligible for coverage, he or she must be
1184      immediately disenrolled from the respective Florida Kidcare
1185      program component.
1186  (5)      The following children are not eligible to receive
1187      Title XXI-funded premium assistance for health benefits coverage
1188      under the Florida Kidcare program, except under Medicaid if the
1189      child would have been eligible for Medicaid under s. 409.903 or
1190      s. 409.904 as of June 1, 1997:
1191  (c)      A child who is an alien, unless the child:
1192  1.      Meets but who does not meet the definition of a
1193      lawfully residing child;
1194  2.      Is an alien lawfully admitted for permanent residence
1195      as defined by the Immigration and Nationality Act, as amended;
1196  3.      Is an alien who has been granted the status of Cuban
1197      and Haitian entrant as defined in the Refugee Education
1198      Assistance Act of 1980, as amended; or
1199  4.      Lawfully resides in the United States in accordance
1200      with a Compact of Free Association referred to in the Personal
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1201      Responsibility and Work Opportunity Reconciliation Act of 1996.
1202
1203      This paragraph does not extend eligibility for the Florida
1204      Kidcare program to an undocumented immigrant.
1205  Section 7.  Paragraph (g) is added to subsection (3) of
1206      section 409.818, Florida Statutes, to read:
1207  409.818       Administration.—In order to implement ss. 409.810-
1208      409.821, the following agencies shall have the following duties:
1209  (3)      The Agency for Health Care Administration, under the
1210      authority granted in s. 409.914(1), shall:
1211  (g)      Regularly obtain from reliable data sources in
1212      accordance with applicable federal law address information for
1213      an enrollee.
1214
1215      The agency is designated the lead state agency for Title XXI of
1216      the Social Security Act for purposes of receipt of federal
1217      funds, for reporting purposes, and for ensuring compliance with
1218      federal and state regulations and rules.
1219  Section 8.  Subsection (2) of section 409.902, Florida
1220      Statutes, is amended to read:
1221  409.902       Designated single state agency; payment
1222      requirements; program title; release of medical records.—
1223  (2)(a)       Eligibility is restricted to United States citizens
1224      and nationals and to:
1225  1.      An alien lawfully admitted for permanent residence as
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1226      defined by the Immigration and Nationality Act, as amended.
1227  2.      An alien who has been granted the status of Cuban and
1228      Haitian entrant as defined in the Refugee Education Assistance
1229      Act of 1980, as amended.
1230  3.      An individual who lawfully resides in the United States
1231      in accordance with a Compact of Free Association referred to in
1232      the Personal Responsibility and Work Opportunity Reconciliation
1233      Act of 1996 lawfully admitted noncitizens who meet the criteria
1234      provided in s. 414.095(3).
1235  (b)(a)       Citizenship or immigration status must be verified.
1236      For eligible noncitizens, this includes verification of the
1237      validity of documents with the United States Citizenship and
1238      Immigration Services using the federal SAVE verification
1239      process.
1240  (c)(b)       State funds may not be used to provide medical
1241      services to individuals who do not meet the requirements of this
1242      subsection unless the services are necessary to treat an
1243      emergency medical condition or are for pregnant women. Such
1244      services are authorized only to the extent provided under
1245      federal law and in accordance with federal regulations as
1246      provided in 42 C.F.R. s. 440.255.
1247  Section 9.  Section 409.90201, Florida Statutes, is amended
1248      to read:
1249  409.90201  Recipient information address update process.—
1250      The Agency for Health Care Administration and the Department of
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1251      Children and Families shall:
1252  (1)     Regularly obtain from reliable data sources in
1253      accordance with applicable federal law address information for a
1254      recipient., in consultation with hospitals and nursing homes
1255      that serve Medicaid recipients, shall develop a process to
1256  (2)     Update a recipient's address in the Medicaid
1257      eligibility system at the time a recipient is admitted to a
1258      hospital or nursing home,. if a recipient's address information
1259      in the Medicaid eligibility system needs to be updated, the
1260      update shall be completed within 10 days after the recipient's
1261      admission to a hospital or nursing home.
1262  (3)     Review at least quarterly the public file of death
1263      information compiled by the Social Security Administration and
1264      act on matches between a recipient's information and the public
1265      file of death information in accordance with applicable federal
1266      law.
1267  Section 10.  Paragraph (a) of subsection (12) of section
1268      409.904, Florida Statutes, is amended to read:
1269  409.904       Optional payments for eligible persons.—The agency
1270      may make payments for medical assistance and related services on
1271      behalf of the following persons who are determined to be
1272      eligible subject to the income, assets, and categorical
1273      eligibility tests set forth in federal and state law. Payment on
1274      behalf of these Medicaid eligible persons is subject to the
1275      availability of moneys and any limitations established by the
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1276      General Appropriations Act or chapter 216.
1277  (12)        The agency shall make payments to Medicaid-covered
1278      services:
1279  (a)     For eligible children and pregnant women, retroactive
1280      to the first day of the second month for a period of no more
1281      than 90 days before the month in which an application for
1282      Medicaid is submitted.
1283  Section 11.  Subsection (13) is added to section 409.905,
1284      Florida Statutes, to read:
1285  409.905       Mandatory Medicaid services.—The agency may make
1286      payments for the following services, which are required of the
1287      state by Title XIX of the Social Security Act, furnished by
1288      Medicaid providers to recipients who are determined to be
1289      eligible on the dates on which the services were provided. Any
1290      service under this section shall be provided only when medically
1291      necessary and in accordance with state and federal law.
1292      Mandatory services rendered by providers in mobile units to
1293      Medicaid recipients may be restricted by the agency. Nothing in
1294      this section shall be construed to prevent or limit the agency
1295      from adjusting fees, reimbursement rates, lengths of stay,
1296      number of visits, number of services, or any other adjustments
1297      necessary to comply with the availability of moneys and any
1298      limitations or directions provided for in the General
1299      Appropriations Act or chapter 216.
1300  (13)        PAYMENT.—A payment may not be made by the agency
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1301      under this part to a prohibited entity as defined in s. 71113 of
1302      Pub. L. No. 119-21.
1303  Section 12.  Section 414.321, Florida Statutes, is created
1304      to read:
1305  414.321       Food assistance eligibility.—For purposes of
1306      eligibility determinations, the department shall:
1307  (1)     Limit eligibility to individuals who are residents of
1308      the United States and:
1309  (a)     Citizens or nationals of the United States;
1310  (b)     Aliens lawfully admitted for permanent residence as
1311      defined in the Immigration and Nationality Act, as amended;
1312  (c)     Aliens who have been granted the status of Cuban and
1313      Haitian entrant, as defined in the Refugee Education Assistance
1314      Act of 1980, as amended; or
1315  (d)     Individuals who lawfully reside in the United States
1316      in accordance with the Compacts of Free Association referred to
1317      in the Personal Responsibility and Work Opportunity
1318      Reconciliation Act of 1996.
1319  (2)     Require each applicant, and recipient for
1320      redetermination purposes, to provide documentation evidencing
1321      his or her shelter or utility expenses.
1322  (a)     The department is prohibited from relying solely on an
1323      individual's self-attestation in determining shelter or utility
1324      expenses.
1325  (b)     The department may adopt policies and procedures to
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1326      accommodate an applicant or recipient who, due to recent
1327      residency changes, is temporarily unable to furnish adequate
1328      documentation of shelter or utility expenses.
1329  Section 13.  Section 414.332, Florida Statutes, is created
1330      to read:
1331  414.332       Food assistance payment accuracy plan.—
1332  (1)      The department shall develop and implement a
1333      comprehensive food assistance payment accuracy improvement plan
1334      to reduce the state's payment error rate. The department shall
1335      reduce the payment error rate to below 6 percent by March 30,
1336      2026. The plan shall address the root causes of payment errors
1337      identified through an in-depth, data-driven analysis. The plan
1338      shall include, but is not limited to, all of the following:
1339  (a)      Enhanced employee training and quality assurance.
1340  1.      The department shall administer standardized training
1341      for all economic self-sufficiency program staff at least
1342      annually. Training must, at a minimum, review the most common
1343      reasons for payment errors and methods for preventing such
1344      errors, and include pre- and post-training testing to measure
1345      staff proficiency.
1346  2.      The department shall establish a robust quality
1347      assurance review process that frequently reviews a statistically
1348      significant sample of cases before final benefit determination.
1349      This process must incorporate real-time, corrective feedback and
1350      on-the-job training for program staff and must not delay benefit
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1351      determinations.
1352  (b)      Improvement in data sourcing. In contracting with
1353      entities providing data for verification of applicant and
1354      recipient information, the department shall maximize use of high
1355      quality automated data sources, including, but not limited to,
1356      comparing income and asset data with state, federal, and private
1357      sector data sources.
1358  (2)      By July 1, 2026, the department shall submit the food
1359      assistance payment accuracy improvement plan to the Governor,
1360      the President of the Senate, and the Speaker of the House of
1361      Representatives.
1362  (3)(a)       Beginning October 1, 2026, the department shall
1363      submit quarterly progress reports to the Governor, the President
1364      of the Senate, and the Speaker of the House of Representatives
1365      detailing:
1366  1.      The state's most recent official and preliminary food
1367      assistance payment error rate.
1368  2.      A detailed breakdown of the most frequent and highest
1369      dollar value errors, including categorization by agency or
1370      client error and whether the error resulted in over- or under-
1371      payment.
1372  3.      Specific actions taken by the department under the food
1373      assistance payment accuracy improvement plan during the
1374      preceding quarter and data demonstrating the results of those
1375      actions.
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1376  4.      A detailed plan to correct the most recently identified
1377      deficiencies.
1378  (b)      This subsection is repealed on October 1, 2028.
1379  Section 14.  Subsection (2) of section 414.455, Florida
1380      Statutes, is amended to read:
1381  414.455       Supplemental Nutrition Assistance Program;
1382      legislative authorization; mandatory participation in employment
1383      and training programs.—
1384  (2)      Unless prohibited by the Federal Government, the
1385      department must require a person who is receiving food
1386      assistance; who is 18 to 64 59 years of age, inclusive; who does
1387      not have children under the age of 14 18 in his or her home; who
1388      does not qualify for an exemption; and who is determined by the
1389      department to be eligible, to participate in an employment and
1390      training program. The department shall apply and comply with
1391      exemptions from work requirements in accordance with applicable
1392      federal law.
1393  Section 15.  Subsection (2) of section 456.0575, Florida
1394      Statutes, is renumbered as subsection (3), and a new subsection
1395      (2) is added to that section, to read:
1396  456.0575  Duty to notify patients.—
1397  (2)      A health care practitioner shall notify a patient in
1398      writing upon referring the patient to a nonparticipating
1399      provider for nonemergency services, as those terms are defined
1400      in s. 627.64194(1), or to a provider, as defined in s. 641.47,
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1401      that is not under contract with the patient's health maintenance
1402      organization. Such notice must state that the services will be
1403      provided on an out-of-network basis, which may result in
1404      additional cost-sharing responsibilities for the patient, and be
1405      documented in the patient's medical record. The practitioner or
1406      his or her employee may confirm the referral provider's
1407      participation by contacting the referral provider or the
1408      patient's health insurer or health maintenance organization, as
1409      necessary, or may rely on the online provider directory of the
1410      health insurer or health maintenance organization. Failure to
1411      comply with this subsection, without good cause, shall result in
1412      disciplinary action against the health care practitioner.
1413  Section 16.  Paragraph (b) of subsection (10) of section
1414      456.073, Florida Statutes, is amended to read:
1415  456.073       Disciplinary proceedings.—Disciplinary proceedings
1416      for each board shall be within the jurisdiction of the
1417      department.
1418  (10)
1419  (b)     The department shall report any significant
1420      investigation information relating to a nurse holding a
1421      multistate license to the coordinated licensure information
1422      system pursuant to s. 464.0095; any investigative information
1423      relating to an audiologist or a speech-language pathologist
1424      holding a compact privilege under the Audiology and Speech-
1425      Language Pathology Interstate Compact to the data system
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1426      pursuant to s. 468.1335; any investigative information relating
1427      to a physical therapist or physical therapist assistant holding
1428      a compact privilege under the Physical Therapy Licensure Compact
1429      to the data system pursuant to s. 486.112; any significant
1430      investigatory information relating to a psychologist practicing
1431      under the Psychology Interjurisdictional Compact to the
1432      coordinated licensure information system pursuant to s.
1433      490.0075; and any significant investigatory information relating
1434      to a health care practitioner practicing under the Professional
1435      Counselors Licensure Compact to the data system pursuant to s.
1436      491.017; any significant investigatory information relating to a
1437      physician assistant holding compact privilege under the
1438      Physician Assistant Licensure Compact to the data system
1439      pursuant to s. 456.66; any significant investigatory information
1440      relating to an emergency medical technician or paramedic
1441      practicing under the Emergency Medical Services Personnel
1442      Licensure Interstate Compact pursuant to s. 401.466; and any
1443      investigative information relating to a clinical social worker
1444      practicing under the Social Work Licensure Interstate Compact to
1445      the data system pursuant to s. 491.022.
1446  Section 17.  Subsection (5) of section 456.076, Florida
1447      Statutes, is amended to read:
1448  456.076       Impaired practitioner programs.—
1449  (5)     A consultant shall enter into a participant contract
1450      with an impaired practitioner and shall establish the terms of
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1451      monitoring and shall include the terms in a participant
1452      contract. In establishing the terms of monitoring, the
1453      consultant may consider the recommendations of one or more
1454      approved evaluators, treatment programs, or treatment providers.
1455      A consultant may modify the terms of monitoring if the
1456      consultant concludes, through the course of monitoring, that
1457      extended, additional, or amended terms of monitoring are
1458      required for the protection of the health, safety, and welfare
1459      of the public. If the impaired practitioner is an audiologist or
1460      a speech-language pathologist practicing under the Audiology and
1461      Speech-Language Pathology Interstate Compact pursuant to s.
1462      468.1335, a physical therapist or physical therapist assistant
1463      practicing under the Physical Therapy Licensure Compact pursuant
1464      to s. 486.112, a psychologist practicing under the Psychology
1465      Interjurisdictional Compact pursuant to s. 490.0075, or a health
1466      care practitioner practicing under the Professional Counselors
1467      Licensure Compact pursuant to s. 491.017, a physician assistant
1468      practicing under the Physician Assistant Licensure Compact
1469      pursuant to s. 456.66, an emergency medical technician or
1470      paramedic practicing under the Emergency Medical Services
1471      Personnel Licensure Interstate Compact pursuant to s. 401.466,
1472      or a clinical social worker practicing under the Social Work
1473      Licensure Interstate Compact pursuant to s. 491.022, the terms
1474      of the monitoring contract must include the impaired
1475      practitioner's withdrawal from all practice under the compact
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1476      unless authorized by a member state.
1477  Section 18.  Section 456.66, Florida Statutes, is created
1478      to read:
1479  456.66       Physician Assistant Licensure Compact.—The
1480      Physician Assistant Licensure Compact is enacted into law and
1481      entered into by this state with all other jurisdictions legally
1482      joining therein in the form substantially as follows:
1483
1484  ARTICLE I
1485  PURPOSE
1486
1487  In order to strengthen access to medical services, and in
1488      recognition of the advances in the delivery of medical services,
1489      the participating states of the Physician Assistant Licensure
1490      Compact have allied in common purpose to develop a comprehensive
1491      process that complements the existing authority of state
1492      licensing boards to license and discipline physician assistants
1493      and seeks to enhance the portability of a license to practice as
1494      a physician assistant while safeguarding the safety of patients.
1495      This compact allows medical services to be provided by physician
1496      assistants, via the mutual recognition of the licensee's
1497      qualifying license by other compact participating states. This
1498      compact also adopts the prevailing standard for physician
1499      assistant licensure and affirms that the practice and delivery
1500      of medical services by the physician assistant occurs where the
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1501      patient is located at the time of the patient encounter, and
1502      therefore requires the physician assistant to be under the
1503      jurisdiction of the state licensing board where the patient is
1504      located. State licensing boards that participate in this compact
1505      retain the jurisdiction to impose adverse action against a
1506      compact privilege in that state issued to a physician assistant
1507      through the procedures of this compact. The compact will
1508      alleviate burdens for military families by allowing active duty
1509      military personnel and their spouses to obtain a compact
1510      privilege based on having an unrestricted license in good
1511      standing from a participating state.
1512
1513  ARTICLE II
1514  DEFINITIONS
1515
1516  As used in this compact, the term:
1517  (1)     "Adverse action" means any administrative, civil,
1518      equitable, or criminal action permitted by a state's laws which
1519      is imposed by a licensing board or other authority against a
1520      physician assistant license or license application or compact
1521      privilege such as license denial, censure, revocation,
1522      suspension, probation, monitoring of the licensee, or
1523      restriction on the licensee's practice.
1524  (2)     "Compact privilege" means the authorization granted by
1525      a remote state to allow a licensee from another participating
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1526      state to practice as a physician assistant to provide medical
1527      services and other licensed activity to a patient located in the
1528      remote state under the remote state's laws and regulations.
1529  (3)     "Conviction" means a finding by a court that an
1530      individual is guilty of a felony or misdemeanor offense through
1531      adjudication or entry of a plea of guilty or nolo contendere to
1532      the charge by the offender.
1533  (4)     "Criminal background check" means the submission of
1534      fingerprints or other biometric-based information for a license
1535      applicant for the purpose of obtaining that applicant's criminal
1536      history record information, as defined in 28 C.F.R. s. 20.3(d),
1537      from the state's criminal history record repository, as defined
1538      in 28 C.F.R. s. 20.3(f).
1539  (5)     "Data system" means the repository of information
1540      about licensees, including, but not limited to, license status
1541      and adverse actions, which is created and administered under the
1542      terms of this compact.
1543  (6)     "Executive committee" means a group of directors and
1544      ex officio individuals elected or appointed pursuant to
1545      subsection (6) of Article VII.
1546  (7)     "Impaired practitioner" means a physician assistant
1547      whose practice is adversely affected by a health-related
1548      condition that impacts his or her ability to practice.
1549  (8)     "Investigative information" means information,
1550      records, or documents received or generated by a licensing board
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1551      pursuant to an investigation.
1552  (9)     "Jurisprudence requirement" means the assessment of an
1553      individual's knowledge of the laws and rules governing the
1554      practice of a physician assistant in a state.
1555  (10)        "License" means current authorization by a state,
1556      other than authorization pursuant to a compact privilege, for a
1557      physician assistant to provide medical services, which would be
1558      unlawful without current authorization.
1559  (11)        "Licensee" means an individual who holds a license
1560      from a state to provide medical services as a physician
1561      assistant.
1562  (12)        "Licensing board" means any state entity authorized
1563      to license and otherwise regulate physician assistants.
1564  (13)        "Medical services" means health care services
1565      provided for the diagnosis, prevention, treatment, cure, or
1566      relief of a health condition, injury, or disease, as defined by
1567      a state's laws and regulations.
1568  (14)        "Model compact" means the model for the compact on
1569      file with the Council of State Governments or other entity as
1570      designated by the commission.
1571  (15)        "Participating state" means a state that has enacted
1572      this compact.
1573  (16)        "Physician assistant" means an individual who is
1574      licensed as a physician assistant. For purposes of this compact,
1575      any other title or status adopted by a state to replace the term
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1576      "physician assistant" shall be deemed synonymous with "physician
1577      assistant" and shall confer the same rights and responsibilities
1578      to the licensee under this compact at the time of its enactment.
1579  (17)        "Physician Assistant Licensure Compact Commission,"
1580      "compact commission," or "commission" mean the national
1581      administrative body created pursuant to subsection (1) of
1582      Article VII.
1583  (18)        "Qualifying license" means an unrestricted license
1584      issued by a participating state to provide medical services as a
1585      physician assistant.
1586  (19)        "Remote state" means a participating state where a
1587      licensee who is not licensed as a physician assistant is
1588      exercising or seeking to exercise the compact privilege.
1589  (20)        "Rule" means a regulation adopted by an entity that
1590      has the force and effect of law.
1591  (21)        "Significant investigative information" means
1592      investigative information that a licensing board, after an
1593      inquiry or investigation that includes notification and an
1594      opportunity for the physician assistant to respond if required
1595      by state law, has reason to believe is not groundless and, if
1596      proven true, would indicate more than a minor infraction.
1597  (22)        "State" means any state, commonwealth, district, or
1598      territory of the United States.
1599
1600  ARTICLE III
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1601  STATE PARTICIPATION
1602
1603  (1)     To participate in this compact, a participating state
1604      shall:
1605  (a)     License physician assistants.
1606  (b)     Participate in the compact commission's data system.
1607  (c)     Have a mechanism in place for receiving and
1608      investigating complaints against licensees and license
1609      applicants.
1610  (d)     Notify the commission, in compliance with the terms of
1611      this compact and commission rules, of any adverse action against
1612      a licensee or license applicant and the existence of significant
1613      investigative information regarding a licensee or license
1614      applicant.
1615  (e)     Fully implement a criminal background check
1616      requirement, within a timeframe established by commission rule,
1617      by its licensing board receiving the results of a criminal
1618      background check and reporting to the commission whether the
1619      license applicant has been granted a license.
1620  (f)     Comply with the rules of the compact commission.
1621  (g)     Use passage of a recognized national exam such as the
1622      NCCPA PANCE as a requirement for physician assistant licensure.
1623  (h)     Grant the compact privilege to a holder of a
1624      qualifying license in a participating state.
1625  (2)     This compact does not prohibit a participating state
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1626      from charging a fee for granting the compact privilege.
1627
1628  ARTICLE IV
1629  COMPACT PRIVILEGE
1630
1631  (1)     To exercise the compact privilege, a licensee must:
1632  (a)     Have graduated from a physician assistant program
1633      accredited by the Accreditation Review Commission on Education
1634      for the Physician Assistant, Inc., or other programs authorized
1635      by commission rule.
1636  (b)     Hold current NCCPA certification.
1637  (c)     Have no felony or misdemeanor conviction.
1638  (d)     Have never had a controlled substance license, permit,
1639      or registration suspended or revoked by a state or by the United
1640      States Drug Enforcement Administration.
1641  (e)     Have a unique identifier as determined by commission
1642      rule.
1643  (f)     Hold a qualifying license.
1644  (g)     Have not had a revocation of a license or limitation
1645      or restriction on any license currently held due to an adverse
1646      action.
1647  (h)     If a licensee has had a limitation or restriction on a
1648      license or compact privilege due to an adverse action, 2 years
1649      must have elapsed from the date on which the license or compact
1650      privilege is no longer limited or restricted due to the adverse
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1651      action.
1652  (i)     If a compact privilege has been revoked or is limited
1653      or restricted in a participating state for conduct that would
1654      not be a basis for disciplinary action in a participating state
1655      in which the licensee is practicing or applying to practice
1656      under a compact privilege, that participating state shall have
1657      the discretion not to consider such action as an adverse action
1658      requiring the denial or removal of a compact privilege in that
1659      state.
1660  (j)     Notify the compact commission that the licensee is
1661      seeking the compact privilege in a remote state.
1662  (k)     Meet any jurisprudence requirement of a remote state
1663      in which the licensee is seeking to practice under the compact
1664      privilege.
1665  (l)     Report to the commission any adverse action taken by a
1666      nonparticipating state within 30 days after the action is taken.
1667  (2)     The compact privilege is valid until the expiration or
1668      revocation of the qualifying license unless terminated pursuant
1669      to an adverse action. The licensee must comply with all of the
1670      requirements of subsection (1) to maintain the compact privilege
1671      in a remote state. If the participating state takes adverse
1672      action against a qualifying license, the licensee shall lose the
1673      compact privilege in any remote state in which the licensee has
1674      a compact privilege until all of the following occur:
1675  (a)     The license is no longer limited or restricted.
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1676  (b)     Two years have elapsed from the date on which the
1677      license is no longer limited or restricted due to the adverse
1678      action.
1679  (3)     Once a restricted or limited license satisfies the
1680      requirements of subsection (2), the licensee must meet the
1681      requirements of subsection (1) to obtain a compact privilege in
1682      any remote state.
1683  (4)     For each remote state in which a physician assistant
1684      seeks authority to prescribe controlled substances, the
1685      physician assistant shall satisfy all requirements imposed by
1686      such state in granting or renewing such authority.
1687
1688  ARTICLE V
1689  DESIGNATION OF THE STATE FROM WHICH LICENSEE
1690  IS APPLYING FOR COMPACT PRIVILEGE
1691
1692  Upon a licensee's application for a compact privilege, the
1693      licensee shall identify to the commission the participating
1694      state from which the licensee is applying, in accordance with
1695      applicable rules adopted by the commission, and subject to the
1696      following requirements:
1697  (1)     When applying for a compact privilege, the licensee
1698      shall provide the commission with the address of the licensee's
1699      primary residence and thereafter shall immediately report to the
1700      commission any change in the address of the licensee's primary
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1701      residence.
1702  (2)     When applying for a compact privilege, the licensee is
1703      required to consent to accept service of process by mail at the
1704      licensee's primary residence on file with the commission with
1705      respect to any action brought against the licensee by the
1706      commission or a participating state, including a subpoena, with
1707      respect to any action brought or investigation conducted by the
1708      commission or a participating state.
1709
1710  ARTICLE VI
1711  ADVERSE ACTIONS
1712
1713  (1)     A participating state in which a licensee is licensed
1714      shall have exclusive power to impose adverse action against the
1715      qualifying license issued by that participating state.
1716  (2)     In addition to the other powers conferred by state
1717      law, a remote state shall have the authority, in accordance with
1718      existing state due process law, to do all of the following:
1719  (a)     Take adverse action against a physician assistant's
1720      compact privilege within that state to remove a licensee's
1721      compact privilege or take other action necessary under
1722      applicable law to protect the health and safety of its citizens.
1723  (b)     Issue subpoenas for both hearings and investigations
1724      that require the attendance and testimony of witnesses as well
1725      as the production of evidence. Subpoenas issued by a licensing
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1726      board in a participating state for the attendance and testimony
1727      of witnesses or the production of evidence from another
1728      participating state shall be enforced in the latter state by any
1729      court of competent jurisdiction according to the practice and
1730      procedure of that court applicable to subpoenas issued in
1731      proceedings pending before it. The issuing authority shall pay
1732      any witness fees, travel expenses, mileage, and other fees
1733      required by the service statutes of the state in which the
1734      witnesses or evidence are located.
1735  (c)     Notwithstanding paragraph (b), subpoenas may not be
1736      issued by a participating state to gather evidence of conduct in
1737      another state that is lawful in that other state for the purpose
1738      of taking adverse action against a licensee's compact privilege
1739      or application for a compact privilege in that participating
1740      state.
1741  (d)     This compact does not authorize a participating state
1742      to impose discipline against a physician assistant's compact
1743      privilege or to deny an application for a compact privilege in
1744      that participating state for the individual's otherwise lawful
1745      practice in another state.
1746  (3)     For purposes of taking adverse action, the
1747      participating state which issued the qualifying license shall
1748      give the same priority and effect to reported conduct received
1749      from any other participating state as it would if the conduct
1750      had occurred within the participating state which issued the
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1751      qualifying license. In so doing, the participating state shall
1752      apply its own state laws to determine appropriate action.
1753  (4)     A participating state, if otherwise permitted by state
1754      law, may recover from the affected physician assistant the costs
1755      of investigations and disposition of cases resulting from any
1756      adverse action taken against that physician assistant.
1757  (5)     A participating state may take adverse action based on
1758      the factual findings of a remote state, provided that the
1759      participating state follows its own procedures for taking the
1760      adverse action.
1761  (6)(a)       In addition to the authority granted to a
1762      participating state by its applicable laws and regulations, any
1763      participating state may participate with other participating
1764      states in joint investigations of licensees.
1765  (b)     Participating states shall share any investigative,
1766      litigation, or compliance materials in furtherance of any joint
1767      or individual investigation initiated under this compact.
1768  (7)     If an adverse action is taken against a physician
1769      assistant's qualifying license, the physician assistant's
1770      compact privilege in all remote states shall be deactivated
1771      until 2 years after all restrictions have been removed from the
1772      state license. All disciplinary orders by the participating
1773      state which issued the qualifying license that imposes adverse
1774      action against a physician assistant's license shall include a
1775      statement that the physician assistant's compact privilege is
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1776      deactivated in all participating states during the pendency of
1777      the order.
1778  (8)      If any participating state takes adverse action, it
1779      shall promptly notify the administrator of the data system.
1780
1781  ARTICLE VII
1782  ESTABLISHMENT OF THE COMPACT COMMISSION
1783
1784  (1)      The participating states create and establish a joint
1785      government agency and national administrative body known as the
1786      Physician Assistant Licensure Compact Commission. The commission
1787      is an instrumentality of the compact states acting jointly and
1788      not an instrumentality of any one state. The commission shall
1789      come into existence on or after the effective date of the
1790      compact as provided in subsection (1) of Article XI.
1791  (2)(a)       Each participating state shall have and be limited
1792      to one delegate selected by that participating state's licensing
1793      board or, if the state has more than one licensing board,
1794      selected collectively by the participating state's licensing
1795      boards.
1796  (b)      The delegate shall be either:
1797  1.      A current physician assistant, physician, or public
1798      member of a licensing board or physician assistant council or
1799      committee; or
1800  2.      An administrator of a licensing board.
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1801  (c)     Any delegate may be removed or suspended from office
1802      as provided by the laws of the state from which the delegate is
1803      appointed.
1804  (d)     The participating state licensing board shall fill any
1805      vacancy occurring in the commission within 60 days.
1806  (e)     Each delegate shall be entitled to one vote on all
1807      matters voted on by the commission and shall otherwise have an
1808      opportunity to participate in the business and affairs of the
1809      commission. A delegate shall vote in person or by such other
1810      means as provided in the bylaws. The bylaws may provide for
1811      delegates' participation in meetings by telecommunications,
1812      video conference, or other means of communication.
1813  (f)     The commission shall meet at least once during each
1814      calendar year. Additional meetings shall be held as set forth in
1815      this compact and the bylaws.
1816  (g)     The commission shall establish by rule a term of
1817      office for delegates.
1818  (3)     The commission shall have all of the following powers
1819      and duties:
1820  (a)     Establish a code of ethics for the commission.
1821  (b)     Establish the fiscal year of the commission.
1822  (c)     Establish bylaws.
1823  (d)     Maintain its financial records in accordance with the
1824      bylaws.
1825  (e)     Meet and take such actions as are consistent with the
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1826      provisions of this compact and the bylaws.
1827  (f)     Adopt rules to facilitate and coordinate
1828      implementation and administration of this compact. The rules
1829      shall have the force and effect of law and shall be binding in
1830      all participating states.
1831  (g)     Bring and prosecute legal proceedings or actions in
1832      the name of the commission, provided that the standing of any
1833      state licensing board to sue or be sued under applicable law may
1834      not be affected.
1835  (h)     Purchase and maintain insurance and bonds.
1836  (i)     Borrow, accept, or contract for services of personnel,
1837      including, but not limited to, employees of a participating
1838      state.
1839  (j)     Hire employees and engage contractors, elect or
1840      appoint officers, fix compensation, define duties, grant such
1841      individuals appropriate authority to carry out the purposes of
1842      this compact, and establish the commission's personnel policies
1843      and programs relating to conflicts of interest, qualifications
1844      of personnel, and other related personnel matters.
1845  (k)     Accept any and all appropriate donations and grants of
1846      money, equipment, supplies, materials, and services, and
1847      receive, use, and dispose of the same, provided that at all
1848      times the commission shall avoid any appearance of impropriety
1849      or conflict of interest.
1850  (l)     Lease, purchase, accept appropriate gifts or donations
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1851      of, or otherwise own, hold, improve, or use any property, real,
1852      personal, or mixed, provided that at all times the commission
1853      shall avoid any appearance of impropriety.
1854  (m)     Sell, convey, mortgage, pledge, lease, exchange,
1855      abandon, or otherwise dispose of any property, real, personal,
1856      or mixed.
1857  (n)     Establish a budget and make expenditures.
1858  (o)     Borrow money.
1859  (p)     Appoint committees, including standing committees
1860      composed of members, state regulators, state legislators or
1861      their representatives, and consumer representatives, and such
1862      other interested persons as may be designated in this compact
1863      and the bylaws.
1864  (q)     Provide and receive information from, and cooperate
1865      with, law enforcement agencies.
1866  (r)     Elect a chair, vice chair, secretary, and treasurer
1867      and other officers of the commission as provided in the
1868      commission's bylaws.
1869  (s)     Reserve for itself, in addition to those reserved
1870      exclusively to the commission under the compact, powers that the
1871      executive committee may not exercise.
1872  (t)     Approve or disapprove a state's participation in the
1873      compact based upon its determination as to whether the state's
1874      compact legislation departs in a material manner from the model
1875      compact language.
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1876  (u)      Prepare and provide to the participating states an
1877      annual report.
1878  (v)      Perform such other functions as may be necessary or
1879      appropriate to achieve the purposes of this compact consistent
1880      with the state regulation of physician assistant licensure and
1881      practice.
1882  (4)(a)       All meetings of the commission shall be open to the
1883      public. Notice of public meetings shall be posted on the
1884      commission's website at least 30 days before the public meeting.
1885  (b)      Notwithstanding paragraph (a), the commission may
1886      convene a public meeting by providing at least 24 hours' prior
1887      notice on the commission's website, and any other means as
1888      provided in the commission's rules, for any of the reasons it
1889      may dispense with notice of proposed rulemaking under subsection
1890      (20) of Article IX.
1891  (c)      The commission may convene in a closed, nonpublic
1892      meeting or nonpublic part of a public meeting to discuss any of
1893      the following information:
1894  1.      Noncompliance of a participating state with its
1895      obligations under the compact;
1896  2.      The employment, compensation, discipline, or other
1897      matters, practices, or procedures related to specific employees
1898      or other matters related to the commission's internal personnel
1899      practices and procedures;
1900  3.      Current, threatened, or reasonably anticipated
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1901      litigation;
1902  4.      Negotiation of contracts for the purchase, lease, or
1903      sale of goods, services, or real estate;
1904  5.      Accusing any person of a crime or formally censuring
1905      any person;
1906  6.      Disclosure of trade secrets or commercial or financial
1907      information that is privileged or confidential;
1908  7.      Disclosure of information of a personal nature when
1909      disclosure of such information would constitute a clearly
1910      unwarranted invasion of personal privacy;
1911  8.      Disclosure of investigative records compiled for law
1912      enforcement purposes;
1913  9.      Disclosure of information related to any investigative
1914      reports prepared by or on behalf of or for use of the commission
1915      or other committee charged with responsibility of investigation
1916      or determination of compliance issues pursuant to the compact;
1917  10.      Legal advice; or
1918  11.      Matters specifically exempted from disclosure by
1919      federal or state statute.
1920  (d)      If a meeting, or portion of a meeting, is closed
1921      pursuant to this article, the chair of the meeting or the
1922      chair's designee shall certify that the meeting or portion of
1923      the meeting may be closed and shall reference each relevant
1924      exempting provision.
1925  (e)      The commission shall keep minutes that fully and
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1926      clearly describe all matters discussed in a meeting and shall
1927      provide a full and accurate summary of actions taken, including
1928      a description of the views expressed. All documents considered
1929      in connection with an action shall be identified in such
1930      minutes. All minutes and documents of a closed meeting shall
1931      remain under seal, subject to release by a majority vote of the
1932      commission or order of a court of competent jurisdiction.
1933  (5)(a)       The commission shall pay, or provide for the
1934      payment of, the reasonable expenses of its establishment,
1935      organization, and ongoing activities.
1936  (b)     The commission may accept any and all appropriate
1937      revenue sources, donations, and grants of money, equipment,
1938      supplies, materials, and services.
1939  (c)     The commission may levy on and collect an annual
1940      assessment from each participating state to cover the cost of
1941      the operations and activities of the commission and its staff,
1942      which must be in a total amount sufficient to cover its annual
1943      budget as approved by the commission each year for which revenue
1944      is not provided by other sources. The aggregate annual
1945      assessment amount levied on participating states shall be
1946      allocated based upon a formula to be determined by commission
1947      rule.
1948  1.      A compact privilege expires when the licensee's
1949      qualifying license in the participating state from which the
1950      licensee applied for the compact privilege expires.
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1951  2.      If the licensee terminates the qualifying license
1952      through which the licensee applied for the compact privilege
1953      before its scheduled expiration, and the licensee has a
1954      qualifying license in another participating state, the licensee
1955      shall inform the commission that it is changing to that
1956      participating state the participating state through which it
1957      applies for a compact privilege and pay to the commission any
1958      compact privilege fee required by commission rule.
1959  (d)      The commission may not incur obligations of any kind
1960      prior to securing the funds adequate to meet the same, nor shall
1961      the commission pledge the credit of any of the participating
1962      states, except by and with the authority of the participating
1963      state.
1964  (e)      The commission shall keep accurate accounts of all
1965      receipts and disbursements. The receipts and disbursements of
1966      the commission shall be subject to the financial review and
1967      accounting procedures established under its bylaws. All receipts
1968      and disbursements of funds handled by the commission shall be
1969      subject to an annual financial review by a certified or licensed
1970      public accountant, and the report of the financial review shall
1971      be included in and become part of the annual report of the
1972      commission.
1973  (6)(a)       The executive committee shall have the power to act
1974      on behalf of the commission according to the terms of this
1975      compact and commission rules.
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1976  (b)      The executive committee shall be composed of nine
1977      members, including:
1978  1.      Seven voting members who are elected by the commission
1979      from the current membership of the commission.
1980  2.      One ex officio, nonvoting member from a recognized
1981      national physician assistant professional association.
1982  3.      One ex officio, nonvoting member from a recognized
1983      national physician assistant certification organization.
1984  (c)      The ex officio members will be selected by their
1985      respective organizations.
1986  (d)      The commission may remove any member of the executive
1987      committee as provided in its bylaws.
1988  (e)      The executive committee shall meet at least annually.
1989  (f)      The executive committee shall have all of the
1990      following duties and responsibilities:
1991  1.      Recommend to the commission changes to the commission's
1992      rules or bylaws, changes to this compact legislation, and fees
1993      to be paid by compact participating states, such as annual dues.
1994  2.      Ensure compact administration services are
1995      appropriately provided, contractual or otherwise.
1996  3.      Prepare and recommend the budget.
1997  4.      Maintain financial records on behalf of the commission.
1998  5.      Monitor compact compliance of participating states and
1999      provide compliance reports to the commission.
2000  6.      Establish additional committees as necessary.
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2001  7.      Exercise the powers and duties of the commission during
2002      the interim between commission meetings, except for issuing
2003      proposed rulemaking or adopting commission rules or bylaws, or
2004      exercising any other powers and duties exclusively reserved to
2005      the commission by the commission's rules.
2006  8.      Perform other duties as provided in the commission's
2007      rules or bylaws.
2008  (7)(a)       All meetings of the executive committee at which it
2009      votes or plans to vote on matters in exercising the powers and
2010      duties of the commission shall be open to the public and public
2011      notice of such meetings shall be given as public meetings of the
2012      commission are given.
2013  (b)      The executive committee may convene in a closed,
2014      nonpublic meeting for the same reasons that the commission may
2015      convene in a nonpublic meeting as provided in paragraph (c) of
2016      subsection (4) and shall announce the closed meeting as the
2017      commission is required to under paragraph (d) of subsection (4)
2018      of this article and keep minutes of the closed meeting as the
2019      commission is required to under paragraph (e) of subsection (4)
2020      of this article.
2021  (c)      The members, officers, executive director, employees,
2022      and representatives of the commission shall be immune from suit
2023      and liability, both personally and in their official capacities,
2024      for any claim for damage to or loss of property or personal
2025      injury or other civil liability caused by or arising out of any
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2026      actual or alleged act, error, or omission that occurred, or that
2027      the person against whom the claim is made had a reasonable basis
2028      for believing occurred within the scope of commission
2029      employment, duties, or responsibilities, provided that nothing
2030      in this paragraph shall be construed to protect any such person
2031      from suit or liability for any damage, loss, injury, or
2032      liability caused by the intentional or willful or wanton
2033      misconduct of that person. The procurement of insurance of any
2034      type by the commission does not in any way compromise or limit
2035      the immunity granted hereunder.
2036  (d)     The commission shall defend any member, officer,
2037      executive director, employee, and representative of the
2038      commission in any civil action seeking to impose liability
2039      arising out of any actual or alleged act, error, or omission
2040      that occurred within the scope of commission employment, duties,
2041      or responsibilities, or as determined by the commission that the
2042      person against whom the claim is made had a reasonable basis for
2043      believing occurred within the scope of commission employment,
2044      duties, or responsibilities, provided that nothing herein shall
2045      be construed to prohibit that person from retaining his or her
2046      own counsel at his or her own expense, and provided further that
2047      the actual or alleged act, error, or omission did not result
2048      from that person's intentional or willful or wanton misconduct.
2049  (e)     The commission shall indemnify and hold harmless any
2050      member, officer, executive director, employee, and
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2051      representative of the commission for the amount of any
2052      settlement or judgment obtained against that person arising out
2053      of any actual or alleged act, error, or omission that occurred
2054      within the scope of commission employment, duties, or
2055      responsibilities, or that such person had a reasonable basis for
2056      believing occurred within the scope of commission employment,
2057      duties, or responsibilities, provided that the actual or alleged
2058      act, error, or omission did not result from the intentional or
2059      willful or wanton misconduct of that person.
2060  (f)      Venue is proper and judicial proceedings by or against
2061      the commission shall be brought solely and exclusively in a
2062      court of competent jurisdiction where the principal office of
2063      the commission is located. The commission may waive venue and
2064      jurisdictional defenses in any proceedings as authorized by
2065      commission rules.
2066  (g)      This compact does not:
2067  1.      Limit the liability of any licensee for professional
2068      malpractice or misconduct, which shall be governed solely by any
2069      other applicable state laws.
2070  2.      Designate the venue or jurisdiction to bring actions
2071      for alleged acts of malpractice, professional misconduct,
2072      negligence, or other such civil action pertaining to the
2073      practice of a physician assistant. All such matters shall be
2074      determined exclusively by state law other than this compact.
2075  3.      Waive or otherwise abrogate a participating state's
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2076      state action immunity or state action affirmative defense with
2077      respect to antitrust claims under the Sherman Act, the Clayton
2078      Act, or any other state or federal antitrust or anticompetitive
2079      law or regulation.
2080  4.      Waive sovereign immunity by the participating states or
2081      by the commission.
2082
2083  ARTICLE VIII
2084  DATA SYSTEM
2085
2086  (1)      The commission shall provide for the development,
2087      maintenance, operation, and use of a coordinated data and
2088      reporting system containing licensure, adverse action, and the
2089      reporting of the existence of significant investigative
2090      information on all licensed physician assistants and applicants
2091      denied a license in participating states.
2092  (2)      Notwithstanding any other state law to the contrary, a
2093      participating state shall submit a uniform data set to the data
2094      system on all applicable physician assistants, using a unique
2095      identifier, as required by the rules of the commission,
2096      including all of the following:
2097  (a)      Identifying information.
2098  (b)      Licensure data.
2099  (c)      Adverse actions against a license or compact
2100      privilege.
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2101  (d)     Any denial of application for licensure, and the
2102      reason for such denial. This does not include the reporting of
2103      any criminal history record information where prohibited by law.
2104  (e)     The existence of significant investigative
2105      information.
2106  (f)     Other information that may facilitate the
2107      administration of this compact, as determined by the rules of
2108      the commission.
2109  (3)     Significant investigative information pertaining to a
2110      licensee in any participating state shall only be available to
2111      other participating states.
2112  (4)     The commission shall promptly notify all participating
2113      states of any reported adverse action taken against a licensee
2114      or an individual applying for a license. The adverse action
2115      information shall be available to all participating states.
2116  (5)     Participating states contributing information to the
2117      data system may, in accordance with state or federal law,
2118      designate information that may not be shared with the public
2119      without the express permission of the contributing state.
2120      Notwithstanding any such designation, such information shall be
2121      reported to the commission through the data system.
2122  (6)     Any information submitted to the data system that is
2123      subsequently expunged pursuant to state or federal law shall be
2124      removed from the data system upon reporting of such by the
2125      participating state to the commission.
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2126  (7)     The records and information provided to a
2127      participating state pursuant to this compact or through the data
2128      system, when certified by the commission or an agent thereof,
2129      shall constitute the authenticated business records of the
2130      commission, and shall be entitled to any associated hearsay
2131      exception in any relevant judicial, quasi-judicial, or
2132      administrative proceedings in a participating state.
2133
2134  ARTICLE IX
2135  RULEMAKING
2136
2137  (1)     The commission shall exercise its rulemaking powers
2138      pursuant to the criteria provided in this article and the rules
2139      adopted thereunder. Commission rules shall become binding as of
2140      the date specified by the commission for each rule.
2141  (2)     The commission shall adopt reasonable rules in order
2142      to effectively and efficiently implement and administer this
2143      compact and achieve its purposes. A commission rule is invalid
2144      and does not have force or effect if a court of competent
2145      jurisdiction holds that the rule is invalid because the
2146      commission exercised its rulemaking authority in a manner that
2147      is beyond the scope of the purposes of this compact, or the
2148      powers granted hereunder, or based upon another applicable
2149      standard of review.
2150  (3)     The rules of the commission shall have the force of
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2151      law in each participating state, provided, however, that where
2152      the rules of the commission conflict with the laws of the
2153      participating state that establish the medical services a
2154      physician assistant may perform in the participating state, as
2155      held by a court of competent jurisdiction, the rules of the
2156      commission shall be ineffective in that state to the extent of
2157      the conflict.
2158  (4)     If a majority of the legislatures of the participating
2159      states rejects a commission rule, by enactment of a statute or
2160      resolution in the same manner used to adopt this compact within
2161      4 years after the date of adoption of the rule, then such rule
2162      shall have no further force and effect in any participating
2163      state or to any state applying to participate in the compact.
2164  (5)     Commission rules shall be adopted at a regular or
2165      special meeting of the commission.
2166  (6)     Before adoption of a final rule or rules by the
2167      commission, and at least 30 days before the meeting at which the
2168      rule will be considered and voted upon, the commission shall
2169      file a notice of proposed rulemaking:
2170  (a)     On the website of the commission or other publicly
2171      accessible platform.
2172  (b)     To persons who have requested notice of the
2173      commission's notices of proposed rulemaking.
2174  (c)     In such other ways as the commission may by rule
2175      specify.
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2176  (7)     The notice of proposed rulemaking shall include all of
2177      the following:
2178  (a)     The time, date, and location of the public hearing on
2179      the proposed rule and the proposed time, date, and location of
2180      the meeting in which the proposed rule will be considered and
2181      voted upon.
2182  (b)     The text of the proposed rule and the reason for the
2183      proposed rule.
2184  (c)     A request for comments on the proposed rule from any
2185      interested person and the date by which written comments must be
2186      received.
2187  (d)     The manner in which an interested person may submit
2188      notice to the commission of his or her intention to attend the
2189      public hearing or provide any written comments.
2190  (8)     Before adoption of a proposed rule, the commission
2191      shall allow persons to submit written data, facts, opinions, and
2192      arguments, which shall be made available to the public.
2193  (9)     If the hearing is to be held via electronic means, the
2194      commission shall publish the mechanism for access to the
2195      electronic hearing.
2196  (a)     Any person wishing to be heard at the hearing shall,
2197      as directed in the notice of proposed rulemaking, at least 5
2198      business days before the scheduled date of the hearing, notify
2199      the commission of his or her desire to appear and testify at the
2200      hearing.
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2201  (b)     Hearings shall be conducted in a manner providing each
2202      person who wishes to comment a fair and reasonable opportunity
2203      to comment orally or in writing.
2204  (c)     All hearings shall be recorded. A copy of the
2205      recording and the written comments, data, facts, opinions, and
2206      arguments received in response to the proposed rulemaking shall
2207      be made available to a person upon request.
2208  (10)        This article does not require a separate hearing on
2209      each proposed rule. Proposed rules may be grouped for the
2210      convenience of the commission at hearings required by this
2211      article.
2212  (11)        Following the public hearing, the commission shall
2213      consider all written and oral comments timely received.
2214  (12)        The commission shall, by a majority vote of all
2215      delegates, take final action on the proposed rule and shall
2216      determine the effective date of the rule, if adopted, based on
2217      the rulemaking record and the full text of the rule.
2218  (a)     If adopted, the rule shall be posted on the
2219      commission's website.
2220  (b)     The commission may adopt changes to the proposed rule
2221      provided the changes do not enlarge the original purpose of the
2222      proposed rule.
2223  (c)     The commission shall provide on its website an
2224      explanation of the reasons for substantive changes made to the
2225      proposed rule as well as reasons for substantive changes not
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2226      made that were recommended by commenters.
2227  (d)      The commission shall determine a reasonable effective
2228      date for the rule. Except for an emergency as provided in
2229      subsection (13), the effective date of the rule shall be at
2230      least 30 days after the commission issued the notice that it
2231      adopted the rule.
2232  (13)(a)       Upon determination that an emergency exists, the
2233      commission may consider and adopt an emergency rule with 24
2234      hours' prior notice, without the opportunity for comment or
2235      hearing, provided that the usual rulemaking procedures provided
2236      in this compact and in this article shall be retroactively
2237      applied to the rule as soon as reasonably possible, but in no
2238      event later than 90 days after the effective date of the rule.
2239      For the purposes of this subsection, an emergency rule is one
2240      that must be adopted immediately by the commission in order to:
2241  1.      Meet an imminent threat to public health, safety, or
2242      welfare;
2243  2.      Prevent a loss of commission or participating state
2244      funds;
2245  3.      Meet a deadline for the adoption of a commission rule
2246      that is established by federal law or rule; or
2247  4.      Protect public health and safety.
2248  (14)        The commission or an authorized committee of the
2249      commission may direct revisions to a previously adopted
2250      commission rule for purposes of correcting typographical errors,
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2251      errors in format, errors in consistency, or grammatical errors.
2252      Public notice of any revisions shall be posted on the website of
2253      the commission. The revision shall be subject to challenge by
2254      any person for a period of 30 days after posting. The revision
2255      may be challenged only on grounds that the revision results in a
2256      material change to a rule. A challenge shall be made as provided
2257      in the notice of revisions and delivered to the commission
2258      before the end of the notice period. If the revision is not
2259      challenged, the revision will take effect without further
2260      action. If the revision is challenged, the revision may not take
2261      effect without the approval of the commission.
2262  (15)        A participating state's rulemaking requirements do
2263      not apply under this compact.
2264
2265  ARTICLE X
2266  OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT
2267
2268  (1)     The executive and judicial branches of state
2269      government in each participating state shall enforce this
2270      compact and take all actions necessary and appropriate to
2271      implement the compact.
2272  (2)     Venue is proper and judicial proceedings by or against
2273      the commission shall be brought solely and exclusively in a
2274      court of competent jurisdiction where the principal office of
2275      the commission is located. The commission may waive venue and
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2276      jurisdictional defenses to the extent it adopts or consents to
2277      participate in alternative dispute resolution proceedings.
2278      Nothing herein shall affect or limit the selection or propriety
2279      of venue in any action against a licensee for professional
2280      malpractice, misconduct, or any such similar matter.
2281  (3)     The commission shall be entitled to receive service of
2282      process in any proceeding regarding the enforcement or
2283      interpretation of the compact or the commission's rules and
2284      shall have standing to intervene in such a proceeding for all
2285      purposes. Failure to provide the commission with service of
2286      process shall render a judgment or order in such proceeding void
2287      as to the commission, this compact, or commission rules.
2288  (4)     If the commission determines that a participating
2289      state has defaulted in the performance of its obligations or
2290      responsibilities under this compact or the commission rules, the
2291      commission shall provide written notice to the defaulting state
2292      and other participating states. The notice shall describe the
2293      default, the proposed means of curing the default, and any other
2294      action that the commission may take and shall offer remedial
2295      training and specific technical assistance regarding the
2296      default.
2297  (5)     If a state in default fails to cure the default, the
2298      defaulting state may be terminated from this compact upon an
2299      affirmative vote of a majority of the delegates of the
2300      participating states, and all rights, privileges, and benefits
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2301      conferred by this compact upon such state may be terminated on
2302      the effective date of termination. A cure of the default does
2303      not relieve the offending state of obligations or liabilities
2304      incurred during the period of default.
2305  (6)     Termination of participation in this compact shall be
2306      imposed only after all other means of securing compliance have
2307      been exhausted. Notice of intent to suspend or terminate shall
2308      be given by the commission to the Governor, the majority and
2309      minority leaders of the defaulting state's legislature, and the
2310      licensing board of each of the participating states.
2311  (7)     A state that has been terminated is responsible for
2312      all assessments, obligations, and liabilities incurred through
2313      the effective date of termination, including obligations that
2314      extend beyond the effective date of termination.
2315  (8)     The commission may not bear any costs related to a
2316      state that is found to be in default or that has been terminated
2317      from this compact, unless agreed upon in writing between the
2318      commission and the defaulting state.
2319  (9)     The defaulting state may appeal its termination from
2320      the compact by the commission by petitioning the United States
2321      District Court for the District of Columbia or the federal
2322      district where the commission has its principal offices. The
2323      prevailing member shall be awarded all costs of such litigation,
2324      including reasonable attorney fees.
2325  (10)        Upon the termination of a state's participation in
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2326      the compact, the state shall immediately provide notice to all
2327      licensees within that state of such termination.
2328  (a)     Licensees who have been granted a compact privilege in
2329      that state shall retain the compact privilege for 180 days after
2330      the effective date of such termination.
2331  (b)     Licensees who are licensed in that state who have been
2332      granted a compact privilege in a participating state shall
2333      retain the compact privilege for 180 days unless the licensee
2334      also has a qualifying license in a participating state or
2335      obtains a qualifying license in a participating state before the
2336      180-day period ends, in which case the compact privilege shall
2337      continue.
2338  (11)        Upon request by a participating state, the commission
2339      shall attempt to resolve disputes related to this compact that
2340      arise among participating states and between participating and
2341      nonparticipating states.
2342  (12)        The commission shall adopt a rule providing for both
2343      mediation and binding dispute resolution for disputes, as
2344      appropriate.
2345  (13)        The commission, in the reasonable exercise of its
2346      discretion, shall enforce this compact and the rules of the
2347      commission.
2348  (14)        If compliance is not secured after all means to
2349      secure compliance have been exhausted, by majority vote, the
2350      commission may initiate legal action in the United States
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2351      District Court for the District of Columbia or the federal
2352      district where the commission has its principal offices against
2353      a participating state in default to enforce compliance with this
2354      compact and the commission's rules and bylaws. The relief sought
2355      may include both injunctive relief and damages. In the event
2356      judicial enforcement is necessary, the prevailing party shall be
2357      awarded all costs of such litigation, including reasonable
2358      attorney fees.
2359  (15)        These remedies are not the exclusive remedies of the
2360      commission. The commission may pursue any other remedies
2361      available under state or federal law.
2362  (16)        A participating state may initiate legal action
2363      against the commission in the United States District Court for
2364      the District of Columbia or the federal district where the
2365      commission has its principal offices to enforce compliance with
2366      the provisions of the compact and its rules. The relief sought
2367      may include both injunctive relief and damages. In the event
2368      judicial enforcement is necessary, the prevailing party shall be
2369      awarded all costs of such litigation, including reasonable
2370      attorney fees.
2371  (17)        No person other than a participating state may
2372      enforce this compact against the commission.
2373
2374  ARTICLE XI
2375  DATE OF IMPLEMENTATION OF THE PHYSICIAN ASSISTANT LICENSURE
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2376  COMPACT COMMISSION
2377
2378  (1)     This compact shall become effective on the date on
2379      which this compact is enacted into law in the seventh
2380      participating state.
2381  (a)     On or after the effective date of the compact, the
2382      commission shall convene and review the enactment of each of the
2383      states that enacted the compact before the commission convening
2384      to determine if the statute enacted by each such charter
2385      participating state is materially different than the model
2386      compact.
2387  (b)     A charter participating state whose enactment is found
2388      to be materially different from the model compact shall be
2389      entitled to the default process provided in subsection (4) of
2390      Article X.
2391  (c)     If any participating state later withdraws from the
2392      compact or its participation is terminated, the commission shall
2393      remain in existence and the compact shall remain in effect even
2394      if the number of participating states should be less than seven.
2395  (2)     Participating states enacting the compact subsequent
2396      to the commission convening shall be subject to the process set
2397      forth in paragraph (t) of subsection (3) of Article VII to
2398      determine if their enactments are materially different from the
2399      model compact and whether they qualify for participation in the
2400      compact.
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2401  (3)     Participating states enacting the compact subsequent
2402      to the seven initial charter participating states shall be
2403      subject to the process set forth in paragraph (t) of subsection
2404      (3) of Article VII to determine if such enactments are
2405      materially different from the model compact and whether they
2406      qualify for participation in the compact.
2407  (4)     All actions taken for the benefit of the commission or
2408      in furtherance of the purposes of the administration of the
2409      compact before the effective date of the compact or the
2410      commission coming into existence shall be considered to be
2411      actions of the commission unless specifically repudiated by the
2412      commission.
2413  (5)     Any state that joins this compact shall be subject to
2414      the commission's rules and bylaws that exist on the date on
2415      which this compact becomes a law in that state. Any rule that
2416      has been previously adopted by the commission shall have the
2417      full force and effect of law on the day this compact becomes a
2418      law in that state.
2419  (6)     Any participating state may withdraw from this compact
2420      by enacting a statute repealing the same.
2421  (a)     A participating state's withdrawal does not take
2422      effect until 180 days after enactment of the repealing statute.
2423      During this 180 day-period, all compact privileges that were in
2424      effect in the withdrawing state and were granted to licensees
2425      licensed in the withdrawing state shall remain in effect. If any
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2426      licensee licensed in the withdrawing state is also licensed in
2427      another participating state or obtains a license in another
2428      participating state within the 180 days, the licensee's compact
2429      privileges in other participating states will not be affected by
2430      the passage of the 180 days.
2431  (b)     Withdrawal does not affect the continuing requirement
2432      of the state licensing board of the withdrawing state to comply
2433      with the investigative and adverse action reporting requirements
2434      of this compact before the effective date of withdrawal.
2435  (c)     Upon the enactment of a statute withdrawing a state
2436      from this compact, the state shall immediately provide notice of
2437      such withdrawal to all licensees within that state. Such
2438      withdrawing state shall continue to recognize all licenses
2439      granted pursuant to this compact for a minimum of 180 days after
2440      the date of such notice of withdrawal.
2441  (7)     Nothing contained in this compact shall be construed
2442      to invalidate or prevent any physician assistant licensure
2443      agreement or other cooperative arrangement between participating
2444      states and between a participating state and nonparticipating
2445      state that does not conflict with the provisions of this
2446      compact.
2447  (8)     This compact may be amended by the participating
2448      states. An amendment to this compact is not effective and
2449      binding upon any participating state until it is enacted
2450      materially in the same manner into the laws of all participating
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2451      states as determined by the commission.
2452
2453  ARTICLE XII
2454  CONSTRUCTION AND SEVERABILITY
2455
2456  (1)     This compact and the commission's rulemaking authority
2457      shall be liberally construed so as to effectuate the purposes
2458      and the implementation and administration of the compact.
2459      Provisions of the compact expressly authorizing or requiring the
2460      adoption of rules may not be construed to limit the commission's
2461      rulemaking authority solely for those purposes.
2462  (2)     The provisions of this compact are severable and if
2463      any phrase, clause, sentence, or provision of this compact is
2464      held by a court of competent jurisdiction to be contrary to the
2465      constitution of any participating state, a state seeking
2466      participation in the compact, or of the United States, or the
2467      applicability thereof to any government, agency, person, or
2468      circumstance is held to be unconstitutional by a court of
2469      competent jurisdiction, the validity of the remainder of this
2470      compact and the applicability thereof to any other government,
2471      agency, person, or circumstance may not be affected thereby.
2472  (3)     Notwithstanding subsection (2) of this article, the
2473      commission may deny a state's participation in the compact or,
2474      in accordance with the requirements in subsections (4)-(10) of
2475      Article X, terminate a participating state's participation in
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2476      the compact, if it determines that a constitutional requirement
2477      of a participating state is, or would be with respect to a state
2478      seeking to participate in the compact, a material departure from
2479      the compact. Otherwise, if this compact shall be held to be
2480      contrary to the constitution of any participating state, the
2481      compact shall remain in full force and effect as to the
2482      remaining participating states and in full force and effect as
2483      to the participating state affected as to all severable matters.
2484
2485  ARTICLE XIII
2486  BINDING EFFECT OF COMPACT
2487
2488  (1)     Nothing herein prevents the enforcement of any other
2489      law of a participating state that is not inconsistent with this
2490      compact.
2491  (2)     Any laws in a participating state in conflict with
2492      this compact are superseded to the extent of the conflict.
2493  (3)     All agreements between the commission and the
2494      participating states are binding in accordance with their terms.
2495  Section 19.  Subsection (6) of section 458.307, Florida
2496      Statutes, is renumbered as subsection (7), and a new subsection
2497      (6) is added to that section to read:
2498  458.307       Board of Medicine.—
2499  (6)     The Board of Medicine and the Board of Osteopathic
2500      Medicine shall jointly appoint an individual to serve as the
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2501      state's delegate on the Physician Assistant Licensure Compact
2502      Commission, as required under s. 456.66.
2503  Section 20.  Subsections (7) through (16) of section
2504      458.347, Florida Statutes, are renumbered as subsections (8)
2505      through (17), respectively, paragraph (f) of subsection (6) is
2506      redesignated as paragraph (g), subsection (3) and present
2507      subsection (11) are amended, a new paragraph (f) is added to
2508      subsection (6), and a new subsection (7) is added to that
2509      section, to read:
2510  458.347       Physician assistants.—
2511  (3)     PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician
2512      or group of physicians supervising a licensed physician
2513      assistant must be qualified in the medical areas in which the
2514      physician assistant is to perform and shall be individually or
2515      collectively responsible and liable for the performance and the
2516      acts and omissions of the physician assistant. A physician may
2517      not supervise as many more than 10 currently licensed physician
2518      assistants as the physician can effectively supervise and
2519      communicate with within the circumstances of the specific
2520      practice setting at any one time. A physician supervising a
2521      physician assistant pursuant to this section is may not be
2522      required to review and cosign charts or medical records prepared
2523      by such physician assistant.
2524  (6)     PHYSICIAN ASSISTANT LICENSURE.—
2525  (f)     The board may take adverse action against a physician
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2526      assistant's privilege to practice under the Physician Assistant
2527      Licensure Compact pursuant to s. 456.66 and may impose any
2528      penalties in s. 456.072(2) if the physician assistant commits an
2529      act specified in subsection (1) or s. 456.072(1).
2530  (7)     EXEMPTION.—A person licensed as a physician assistant
2531      in another state who is practicing under the Physician Assistant
2532      Licensure Compact pursuant to s. 456.66, and only within the
2533      scope provided therein, is exempt from the licensure
2534      requirements of this section, as applicable.
2535  (11)        DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—The
2536      boards may deny, suspend, or revoke a physician assistant
2537      license if a board determines that the physician assistant has
2538      violated this chapter or s. 456.66.
2539  Section 21.  Subsections (7) through (16) of section
2540      459.022, Florida Statutes, are renumbered as subsections (8)
2541      through (17), respectively, paragraph (f) of subsection (6) is
2542      redesignated as paragraph (g), subsection (3) and present
2543      subsection (11) are amended, a new paragraph (f) is added to
2544      subsection (6), and a new subsection (7) is added to that
2545      section, to read:
2546  459.022       Physician assistants.—
2547  (3)     PERFORMANCE OF SUPERVISING PHYSICIAN.—Each physician
2548      or group of physicians supervising a licensed physician
2549      assistant must be qualified in the medical areas in which the
2550      physician assistant is to perform and shall be individually or
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2551      collectively responsible and liable for the performance and the
2552      acts and omissions of the physician assistant. A physician may
2553      not supervise as many more than 10 currently licensed physician
2554      assistants as the physician can effectively supervise and
2555      communicate with within the circumstances of the specific
2556      practice setting at any one time. A physician supervising a
2557      physician assistant pursuant to this section is may not be
2558      required to review and cosign charts or medical records prepared
2559      by such physician assistant.
2560  (6)     PHYSICIAN ASSISTANT LICENSURE.—
2561  (f)     The board may take adverse action against a physician
2562      assistant's privilege to practice under the Physician Assistant
2563      Licensure Compact pursuant to s. 456.66 and may impose any
2564      penalties in s. 456.072(2) if the physician assistant commits an
2565      act specified in subsection (1) or s. 456.072(1).
2566  (7)     EXEMPTION.—A person licensed as a physician assistant
2567      in another state who is practicing under the Physician Assistant
2568      Licensure Compact pursuant to s. 456.66, and only within the
2569      scope provided therein, is exempt from the licensure
2570      requirements of this section, as applicable.
2571  (11)        DENIAL, SUSPENSION, OR REVOCATION OF LICENSURE.—The
2572      boards may deny, suspend, or revoke a physician assistant
2573      license if a board determines that the physician assistant has
2574      violated this chapter or s. 456.66.
2575  Section 22.  Paragraph (a) of subsection (3) of section
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2576      464.0123, Florida Statutes, is amended to read:
2577  464.0123  Autonomous practice by an advanced practice
2578      registered nurse.—
2579  (3)      PRACTICE REQUIREMENTS.—
2580  (a)      An advanced practice registered nurse who is
2581      registered under this section may:
2582  1.      Engage in autonomous practice only in primary care
2583      practice, including family medicine, general pediatrics, and
2584      general internal medicine, as defined by board rule.
2585  2.      For certified nurse midwives, engage in autonomous
2586      practice in the performance of the acts listed in s.
2587      464.012(4)(c).
2588  1.3.        Perform the general functions of an advanced practice
2589      registered nurse under s. 464.012(3) and the acts within his or
2590      her specialty under s. 464.012(4) related to primary care.
2591  2.4.        For a patient who requires the services of a health
2592      care facility, as defined in s. 408.032(8):
2593  a.      Admit the patient to the facility.
2594  b.      Manage the care received by the patient in the
2595      facility.
2596  c.      Discharge the patient from the facility, unless
2597      prohibited by federal law or rule.
2598
2599      As used in this subparagraph, the term "health care facility"
2600      means a skilled nursing facility, hospice, or intermediate care
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2601      facility for the developmentally disabled. The term does not
2602      include a facility relying solely on spiritual means through
2603      prayer for healing.
2604  3.5.        Provide a signature, certification, stamp,
2605      verification, affidavit, or endorsement that is otherwise
2606      required by law to be provided by a physician, except an
2607      advanced practice registered nurse registered under this section
2608      may not issue a physician certification under s. 381.986.
2609  Section 23.  Section 466.017, Florida Statutes, is amended
2610      to read:
2611  466.017        Prescription of drugs; anesthesia.—
2612  (1)     A dentist shall have the right to prescribe drugs or
2613      medicine, subject to limitations imposed by law; perform
2614      surgical operations within the scope of her or his practice and
2615      training; administer general or local anesthesia or sedation,
2616      subject to limitations imposed by law; and use such appliances
2617      as may be necessary to the proper practice of dentistry.
2618  (2)     A dental hygienist under the general supervision of a
2619      dentist may prescribe, administer, and dispense fluoride,
2620      fluoride varnish, antimicrobial solutions for mouth rinsing, and
2621      other nonsystemic antimicrobial agents. The board may establish
2622      education and training requirements that a dental hygienist must
2623      complete before prescribing, dispensing, or administering a drug
2624      pursuant to this subsection. The board may adopt rules to
2625      administer this subsection.
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2626  (3)(2)       Pharmacists licensed pursuant to chapter 465 may
2627      fill prescriptions of legally licensed dentists in this state
2628      for any drugs necessary for the practice of dentistry or of
2629      legally licensed dental hygienists in this state for drugs
2630      authorized in subsection (2).
2631  (4)(3)       The board shall adopt rules which:
2632  (a)     Define general anesthesia.
2633  (b)     Specify which methods of general or local anesthesia
2634      or sedation, if any, are limited or prohibited for use by
2635      dentists.
2636  (c)     Establish minimal training, education, experience, or
2637      certification for a dentist to use general anesthesia or
2638      sedation, which rules may exclude, in the board's discretion,
2639      those dentists using general anesthesia or sedation in a
2640      competent and effective manner as of the effective date of the
2641      rules.
2642  (d)     Establish further requirements relating to the use of
2643      general anesthesia or sedation, including, but not limited to,
2644      office equipment and the training of dental assistants or dental
2645      hygienists who work with dentists using general anesthesia or
2646      sedation.
2647  (e)     Establish an administrative mechanism enabling the
2648      board to verify compliance with training, education, experience,
2649      equipment, or certification requirements of dentists, dental
2650      hygienists, and dental assistants adopted pursuant to this
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2651      subsection. The board may charge a fee to defray the cost of
2652      verifying compliance with requirements adopted pursuant to this
2653      paragraph.
2654  (5)(4)       A dentist or dental hygienist who administers or
2655      employs the use of any form of anesthesia must possess a
2656      certification in either basic cardiopulmonary resuscitation for
2657      health professionals or advanced cardiac life support approved
2658      by the American Heart Association or the American Red Cross or
2659      an equivalent agency-sponsored course with recertification every
2660      2 years. Each dental office that which uses any form of
2661      anesthesia must have immediately available and in good working
2662      order such resuscitative equipment, oxygen, and other
2663      resuscitative drugs as are specified by rule of the board in
2664      order to manage possible adverse reactions.
2665  (6)(5)       A dental hygienist under the direct supervision of
2666      a dentist may administer local anesthesia, including intraoral
2667      block anesthesia, soft tissue infiltration anesthesia, or both,
2668      to a nonsedated patient who is 18 years of age or older, if the
2669      following criteria are met:
2670  (a)     The dental hygienist has successfully completed a
2671      course in the administration of local anesthesia which is
2672      offered by a dental or dental hygiene program accredited by the
2673      Commission on Dental Accreditation of the American Dental
2674      Association or approved by the board. The course must include a
2675      minimum of 30 hours of didactic instruction and 30 hours of
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2676      clinical experience, and instruction in:
2677  1.      Theory of pain control.
2678  2.      Selection-of-pain-control modalities.
2679  3.      Anatomy.
2680  4.      Neurophysiology.
2681  5.      Pharmacology of local anesthetics.
2682  6.      Pharmacology of vasoconstrictors.
2683  7.      Psychological aspects of pain control.
2684  8.      Systematic complications.
2685  9.      Techniques of maxillary anesthesia.
2686  10.      Techniques of mandibular anesthesia.
2687  11.      Infection control.
2688  12.      Medical emergencies involving local anesthesia.
2689  (b)      The dental hygienist presents evidence of current
2690      certification in basic or advanced cardiac life support.
2691  (c)      The dental hygienist possesses a valid certificate
2692      issued under subsection (7) (6).
2693  (7)(6)       Any dental hygienist seeking a certificate to
2694      administer local anesthesia must apply to the department, remit
2695      an application fee, and submit proof of successful completion of
2696      a course in the administration of local anesthesia pursuant to
2697      subsection (6) (5). The board shall certify, and the department
2698      shall issue a certificate to, any dental hygienist who fulfills
2699      the qualifications of subsection (6) (5). The board shall
2700      establish a one-time application fee not to exceed $35. The
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2701      certificate is not subject to renewal but is part of the dental
2702      hygienist's permanent record and must be prominently displayed
2703      at the location at which where the dental hygienist is
2704      authorized to administer local anesthesia. The board shall adopt
2705      rules necessary to administer subsection (6) (5) and this
2706      subsection.
2707  (8)(7)       A licensed dentist may operate utilize an X-ray
2708      machine, expose dental X-ray films, and interpret or read such
2709      films. Notwithstanding The provisions of part IV of chapter 468
2710      to the contrary notwithstanding, a licensed dentist may
2711      authorize or direct a dental assistant to operate such equipment
2712      and expose such films under her or his direction and
2713      supervision, pursuant to rules adopted by the board in
2714      accordance with s. 466.024 which ensure that the said assistant
2715      is competent by reason of training and experience to operate the
2716      X-ray said equipment in a safe and efficient manner. The board
2717      may charge a fee not to exceed $35 to defray the cost of
2718      verifying compliance with requirements adopted pursuant to this
2719      section.
2720  (9)(8)       Notwithstanding The provisions of s. 465.0276
2721      notwithstanding, a dentist need not register with the board or
2722      comply with the continuing education requirements of that
2723      section if the dentist confines her or his dispensing activity
2724      to the dispensing of fluorides and chlorhexidine chlorohexidine
2725      rinse solutions; provided that the dentist complies with and is
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2726      subject to all laws and rules applicable to pharmacists and
2727      pharmacies, including, but not limited to, chapters 465, 499,
2728      and 893, and all applicable federal laws and regulations, when
2729      dispensing such products.
2730  (10)(9)       Any adverse incident that occurs in an office
2731      maintained by a dentist must be reported to the department. The
2732      required notification to the department must be submitted in
2733      writing by certified mail and postmarked within 48 hours after
2734      the incident occurs.
2735  (11)(10)  A dentist practicing in this state must notify
2736      the board in writing by certified mail within 48 hours after any
2737      adverse incident that occurs in the dentist's outpatient
2738      facility. A complete written report must be filed with the board
2739      within 30 days after the incident occurs.
2740  (12)(11)  Any certified registered dental hygienist
2741      administering local anesthesia must notify the board in writing
2742      by registered mail within 48 hours after any adverse incident
2743      that was related to or the result of the administration of local
2744      anesthesia. A complete written report must be filed with the
2745      board within 30 days after the mortality or other adverse
2746      incident.
2747  (13)(12)  A failure by the dentist or dental hygienist to
2748      timely and completely comply with all the reporting requirements
2749      in this section is the basis for disciplinary action by the
2750      board pursuant to s. 466.028(1).
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2751  (14)(13)  The department shall review each adverse incident
2752      and determine whether it involved conduct by a health care
2753      professional subject to disciplinary action, in which case s.
2754      456.073 applies. Disciplinary action, if any, shall be taken by
2755      the board under which the health care professional is licensed.
2756  (15)(14)  As used in subsections (10)-(14) (9)-(13), the
2757      term "adverse incident" means any mortality that occurs during
2758      or as the result of a dental procedure, or an incident that
2759      results in a temporary or permanent physical or mental injury
2760      that requires hospitalization or emergency room treatment of a
2761      dental patient which occurs during or as a direct result of the
2762      use of general anesthesia, deep sedation, moderate sedation,
2763      pediatric moderate sedation, oral sedation, minimal sedation
2764      (anxiolysis), nitrous oxide, or local anesthesia.
2765  (16)(15)  The board may adopt rules to administer this
2766      section.
2767  Section 24.  Subsections (1), (6), and (8) of section
2768      466.024, Florida Statutes, are amended to read:
2769  466.024       Delegation of duties; expanded functions.—
2770  (1)     A dentist may not delegate irremediable tasks to a
2771      dental hygienist or dental assistant, except as provided by law.
2772      A dentist may delegate remediable tasks to a dental hygienist or
2773      dental assistant when such tasks pose no risk to the patient. A
2774      dentist may only delegate remediable tasks so defined by law or
2775      rule of the board. The board by rule shall designate which tasks
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2776      are remediable and delegable, except that the following are by
2777      law found to be remediable and delegable:
2778  (a)     Taking impressions for study casts but not for the
2779      purpose of fabricating any intraoral restorations or orthodontic
2780      appliance.
2781  (b)     Placing periodontal dressings.
2782  (c)     Removing periodontal or surgical dressings.
2783  (d)     Removing sutures.
2784  (e)     Placing or removing rubber dams.
2785  (f)     Placing or removing matrices.
2786  (g)     Placing or removing temporary restorations.
2787  (h)     Applying cavity liners, varnishes, or bases.
2788  (i)     Polishing amalgam restorations.
2789  (j)     Polishing clinical crowns of the teeth for the purpose
2790      of removing stains but not changing the existing contour of the
2791      tooth.
2792  (k)     Obtaining bacteriological cytological specimens not
2793      involving cutting of the tissue.
2794  (l)     Administering local anesthesia pursuant to s.
2795      466.017(6) s. 466.017(5).
2796  (m)     Performing dental hygiene assessment, dental hygiene
2797      diagnosis, and dental hygiene treatment planning for dental
2798      hygiene services.
2799  (n)     Prescribing, administering, or dispensing prescription
2800      drugs pursuant to s. 466.017(2).
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2801
2802      This subsection does not limit delegable tasks to those
2803      specified herein.
2804  (6)     Notwithstanding subsection (1) or subsection (2), a
2805      dentist may delegate the tasks of gingival curettage, and root
2806      planing, and the tasks listed in paragraphs (1)(m) and (1)(n) to
2807      a dental hygienist but not to a dental assistant.
2808  (8)     Notwithstanding subsection (1) or subsection (2), a
2809      dentist may not delegate to anyone other than another licensed
2810      dentist:
2811  (a)     Any prescription of drugs or medications requiring the
2812      written order or prescription of a licensed dentist or
2813      physician, except as provided in paragraph (1)(n).
2814  (b)     Any diagnosis for treatment or treatment planning,
2815      except as provided in paragraph (1)(m).
2816  Section 25.  Section 491.022, Florida Statutes, is created
2817      to read:
2818  491.022       Social Work Licensure Interstate Compact.—The
2819      Social Work Licensure Interstate Compact is hereby enacted into
2820      law and entered into by this state with all other states legally
2821      joining therein in the form substantially as follows:
2822
2823  ARTICLE I
2824  PURPOSE
2825
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2826  (1)     The purpose of this compact is to facilitate
2827      interstate practice of regulated social workers by improving
2828      public access to competent social work services.
2829  (2)     The compact preserves the regulatory authority of
2830      member states to protect public health and safety through the
2831      current system of licensure. This compact is designed to achieve
2832      all of the following objectives:
2833  (a)     Increase public access to social work services.
2834  (b)     Reduce overly burdensome and duplicative requirements
2835      associated with holding multiple licenses.
2836  (c)     Enhance member states' ability to protect the public
2837      health and safety.
2838  (d)     Encourage the cooperation of member states in
2839      regulating multistate practice.
2840  (e)     Promote mobility and address workforce shortages by
2841      eliminating the necessity for licenses in multiple states by
2842      providing for the mutual recognition of other member state
2843      licenses.
2844  (f)     Support military families.
2845  (g)     Facilitate the exchange of licensure and disciplinary
2846      information among member states.
2847  (h)     Authorize all member states to hold a regulated social
2848      worker accountable for abiding by a member state's laws,
2849      regulations, and applicable professional standards in the member
2850      state in which the client is located at the time care is
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2851      rendered.
2852  (i)     Allow for the use of telehealth to facilitate
2853      increased access to social work services.
2854
2855  ARTICLE II
2856  DEFINITIONS
2857
2858  As used in this compact, the term:
2859  (1)     "Active military member" means any individual with
2860      full-time duty status in the active Armed Forces of the United
2861      States, including members of the National Guard and Reserve.
2862  (2)     "Adverse action" means any administrative, civil,
2863      equitable, or criminal action permitted by a state's laws which
2864      is imposed by a licensing authority or other authority against a
2865      regulated social worker, including actions against an
2866      individual's license or multistate authorization to practice
2867      such as revocation, suspension, probation, monitoring of the
2868      licensee, limitation on the licensee's practice, or any other
2869      encumbrance on licensure affecting a regulated social worker's
2870      authorization to practice, including issuance of a cease and
2871      desist action.
2872  (3)     "Alternative program" means a nondisciplinary
2873      monitoring or practice remediation process approved by a
2874      licensing authority to address practitioners with an impairment.
2875  (4)     "Charter member states" means member states that have
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2876      enacted legislation to adopt this compact where such legislation
2877      predates the effective date of this compact as described in
2878      Article XIV.
2879  (5)     "Commission" means the government agency whose
2880      membership consists of all states that have enacted this
2881      compact, which is known as the Social Work Licensure Compact
2882      Commission, as described in Article X, and which shall operate
2883      as an instrumentality of the member states.
2884  (6)     "Current significant investigative information" means:
2885  (a)     Investigative information that a licensing authority,
2886      after a preliminary inquiry that includes notification and an
2887      opportunity for the regulated social worker to respond, has
2888      reason to believe is not groundless and, if proved true, would
2889      indicate more than a minor infraction as may be defined by the
2890      commission; or
2891  (b)     Investigative information that indicates that the
2892      regulated social worker represents an immediate threat to public
2893      health and safety, as may be defined by the commission,
2894      regardless of whether the regulated social worker has been
2895      notified and has had an opportunity to respond.
2896  (7)     "Data system" means a repository of information about
2897      licensees, including continuing education, examination,
2898      licensure, current significant investigative information,
2899      disqualifying events, multistate licenses, and adverse action
2900      information or other information as required by the commission.
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2901  (8)     "Disqualifying event" means any adverse action or
2902      incident which results in an encumbrance that disqualifies or
2903      makes the licensee ineligible to obtain, retain, or renew a
2904      multistate license.
2905  (9)     "Domicile" means the jurisdiction in which the
2906      licensee resides and intends to remain indefinitely.
2907  (10)        "Encumbrance" means a revocation or suspension of, or
2908      any limitation on, the full and unrestricted practice of social
2909      work licensed and regulated by a licensing authority.
2910  (11)        "Executive committee" means a group of delegates
2911      elected or appointed to act on behalf of, and within the powers
2912      granted to them by, the compact and commission.
2913  (12)        "Home state" means the member state that is the
2914      licensee's primary domicile.
2915  (13)        "Impairment" means a condition that may impair a
2916      practitioner's ability to engage in full and unrestricted
2917      practice as a regulated social worker without some type of
2918      intervention and may include alcohol and drug dependence, mental
2919      health impairment, and neurological or physical impairments.
2920  (14)        "Licensee" means an individual who currently holds a
2921      license from a state to practice as a regulated social worker.
2922  (15)        "Licensing authority" means the board or agency of a
2923      member state, or an equivalent, that is responsible for the
2924      licensing and regulation of regulated social workers.
2925  (16)        "Member state" means a state, commonwealth, district,
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2926      or territory of the United States that has enacted this compact.
2927  (17)        "Multistate authorization to practice" means a
2928      legally authorized privilege to practice, which is equivalent to
2929      a license, associated with a multistate license permitting the
2930      practice of social work in a remote state.
2931  (18)        "Multistate license" means a license to practice as a
2932      regulated social worker issued by a home state licensing
2933      authority that authorizes the regulated social worker to
2934      practice in all member states under multistate authorization to
2935      practice.
2936  (19)        "Qualifying National Exam" means a national licensing
2937      examination approved by the commission.
2938  (20)        "Regulated social worker" means any clinical,
2939      master's, or bachelor's social worker licensed by a member state
2940      regardless of the title used by that member state.
2941  (21)        "Remote state" means a member state other than the
2942      licensee's home state.
2943  (22)        "Rules" or "rules of the commission" means a
2944      regulation or regulations duly adopted by the commission, as
2945      authorized by the compact, that have the force of law.
2946  (23)        "Single state license" means a social work license
2947      issued by any state that authorizes practice only within the
2948      issuing state and does not include multistate authorization to
2949      practice in any member state.
2950  (24)        "Social work" or "social work services" means the
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2951      application of social work theory, knowledge, methods, and
2952      ethics and the professional use of self to restore or enhance
2953      social, psychosocial, or biopsychosocial functioning of
2954      individuals, couples, families, groups, organizations, and
2955      communities through the care and services provided by a
2956      regulated social worker as provided in the member state's
2957      statutes and regulations in the state where the services are
2958      being provided.
2959  (25)        "State" means any state, commonwealth, district, or
2960      territory of the United States that regulates the practice of
2961      social work.
2962  (26)        "Unencumbered license" means a license that
2963      authorizes a regulated social worker to engage in the full and
2964      unrestricted practice of social work.
2965
2966  ARTICLE III
2967  STATE PARTICIPATION IN THE COMPACT
2968
2969  (1)     To be eligible to participate in the compact, a
2970      potential member state must currently meet all of the following
2971      criteria:
2972  (a)     License and regulate the practice of social work at
2973      the clinical, master's, or bachelor's level.
2974  (b)     Require applicants for licensure to graduate from a
2975      program that:
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2976  1.      Is operated by a college or university recognized by
2977      the licensing authority;
2978  2.      Is accredited, or in candidacy by an institution that
2979      subsequently becomes accredited, by an accrediting agency
2980      recognized by either:
2981  a.      The Council for Higher Education Accreditation or its
2982      successor; or
2983  b.      The United States Department of Education; and
2984  3.      Corresponds to the licensure sought as outlined in
2985      Article IV.
2986  (c)      Require applicants for clinical licensure to complete
2987      a period of supervised practice.
2988  (d)      Have a mechanism in place for receiving,
2989      investigating, and adjudicating complaints about licensees.
2990  (2)      To maintain membership in the compact, a member state
2991      shall:
2992  (a)      Require that applicants for a multistate license pass
2993      a Qualifying National Exam for the corresponding category of
2994      multistate license sought as outlined in Article IV.
2995  (b)      Participate fully in the commission's data system,
2996      including using the commission's unique identifier as defined in
2997      rules.
2998  (c)      Notify the commission, in compliance with the terms of
2999      the compact and rules, of any adverse action or the availability
3000      of current significant investigative information regarding a
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3001      licensee.
3002  (d)     Implement procedures for considering the criminal
3003      history records of applicants for a multistate license. Such
3004      procedures shall include the submission of fingerprints or other
3005      biometric-based information by applicants for the purpose of
3006      obtaining an applicant's criminal history record information
3007      from the Federal Bureau of Investigation and the agency
3008      responsible for retaining that state's criminal records.
3009  (e)     Comply with the rules of the commission.
3010  (f)     Require an applicant to obtain or retain a license in
3011      the home state and meet the home state's qualifications for
3012      licensure or renewal of licensure, as well as all other
3013      applicable home state laws.
3014  (g)     Authorize a licensee holding a multistate license in
3015      any member state to practice in accordance with the terms of the
3016      compact and rules of the commission.
3017  (h)     Designate a delegate to participate in the commission
3018      meetings.
3019  (3)     A member state meeting the requirements under
3020      subsections (1) and (2) shall designate the categories of social
3021      work licensure that are eligible for issuance of a multistate
3022      license for applicants in such member state. To the extent that
3023      any member state does not meet the requirements for
3024      participation in the compact at any particular category of
3025      social work licensure, such member state may choose, but is not
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3026      obligated, to issue a multistate license to applicants who
3027      otherwise meet the requirements of Article IV for issuance of a
3028      multistate license in such category or categories of licensure.
3029  (4)     The home state may charge a fee for granting the
3030      multistate license.
3031
3032  ARTICLE IV
3033  SOCIAL WORKER PARTICIPATION IN THE COMPACT
3034
3035  (1)     To be eligible for a multistate license under this
3036      compact, an applicant, regardless of category, must meet all of
3037      the following requirements:
3038  (a)     Hold or be eligible for an active, unencumbered
3039      license in the home state.
3040  (b)     Pay any applicable fees, including any member state
3041      fee, for the multistate license.
3042  (c)     Submit, in connection with an application for a
3043      multistate license, fingerprints or other biometric data for the
3044      purpose of obtaining criminal history record information from
3045      the Federal Bureau of Investigation and the agency responsible
3046      for retaining that state's criminal records.
3047  (d)     Notify the home state of any adverse action,
3048      encumbrance, or restriction on any professional license taken by
3049      any member state or nonmember state within 30 days after the
3050      date the action was taken.
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3051  (e)      Meet any continuing competence requirements
3052      established by the home state.
3053  (f)      Abide by the laws, regulations, and applicable
3054      standards in the member state where the client is located at the
3055      time care is rendered.
3056  (2)      An applicant for a clinical-category multistate
3057      license must meet all of the following requirements:
3058  (a)      Fulfill a competency requirement, which shall be
3059      satisfied by:
3060  1.      Passage of a clinical-category Qualifying National
3061      Exam;
3062  2.      Licensure of the applicant in his or her home state at
3063      the clinical category, beginning before such time as a
3064      Qualifying National Exam was required by the home state and
3065      accompanied by a period of continuous social work licensure
3066      thereafter, all of which may be further governed by the rules of
3067      the commission; or
3068  3.      The substantial equivalency of the foregoing competency
3069      requirements which the commission may determine by rule.
3070  (b)      Attain at least a master's degree in social work from
3071      a program that is:
3072  1.      Operated by a college or university recognized by a
3073      licensing authority.
3074  2.      Accredited, or in candidacy that subsequently becomes
3075      accredited, by an accrediting agency recognized by either:
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3076  a.      The Council for Higher Education Accreditation or its
3077      successor; or
3078  b.      The United States Department of Education.
3079  (c)      Fulfill a practice requirement, which shall be
3080      satisfied by demonstrating completion of:
3081  1.      A period of postgraduate supervised clinical practice
3082      equal to a minimum of 3,000 hours;
3083  2.      A minimum of 2 years of full-time postgraduate
3084      supervised clinical practice; or
3085  3.      The substantial equivalency of the foregoing practice
3086      requirements which the commission may determine by rule.
3087  (3)      An applicant for a master's-category multistate
3088      license must meet all of the following requirements:
3089  (a)      Fulfill a competency requirement, which shall be
3090      satisfied by:
3091  1.      Passage of a masters-category Qualifying National Exam;
3092  2.      Licensure of the applicant in his or her home state at
3093      the master's category, beginning before such time as a
3094      Qualifying National Exam was required by the home state at the
3095      master's category and accompanied by a continuous period of
3096      social work licensure thereafter, all of which may be further
3097      governed by the rules of the commission; or
3098  3.      The substantial equivalency of the foregoing competency
3099      requirements which the commission may determine by rule.
3100  (b)      Attain at least a master's degree in social work from
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3101      a program that is:
3102  1.      Operated by a college or university recognized by a
3103      licensing authority.
3104  2.      Accredited, or in candidacy by an institution that
3105      subsequently becomes accredited, by an accrediting agency
3106      recognized by either:
3107  a.      The Council for Higher Education Accreditation or its
3108      successor; or
3109  b.      The United States Department of Education.
3110  (4)      An applicant for a bachelor's-category multistate
3111      license must meet all of the following requirements:
3112  (a)      Fulfill a competency requirement, which shall be
3113      satisfied by:
3114  1.      Passage of a bachelor's-category Qualifying National
3115      Exam;
3116  2.      Licensure of the applicant in his or her home state at
3117      the bachelor's category, beginning before such time as a
3118      Qualifying National Exam was required by the home state and
3119      accompanied by a period of continuous social work licensure
3120      thereafter, all of which may be further governed by the rules of
3121      the commission; or
3122  3.      The substantial equivalency of the foregoing competency
3123      requirements which the commission may determine by rule.
3124  (b)      Attain at least a bachelor's degree in social work
3125      from a program that is:
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3126  1.      Operated by a college or university recognized by the
3127      licensing authority.
3128  2.      Accredited, or in candidacy that subsequently becomes
3129      accredited, by an accrediting agency recognized by either:
3130  a.      The Council for Higher Education Accreditation or its
3131      successor; or
3132  b.      The United States Department of Education.
3133  (5)      The multistate license for a regulated social worker
3134      is subject to the renewal requirements of the home state. The
3135      regulated social worker must maintain compliance with the
3136      requirements of subsection (1) to be eligible to renew a
3137      multistate license.
3138  (6)      The regulated social worker's services in a remote
3139      state are subject to that member state's regulatory authority. A
3140      remote state may, in accordance with due process and that member
3141      state's laws, remove a regulated social worker's multistate
3142      authorization to practice in the remote state for a specific
3143      period of time, impose fines, and take any other necessary
3144      actions to protect the health and safety of its citizens.
3145  (7)      If a multistate license is encumbered, the regulated
3146      social worker's multistate authorization to practice shall be
3147      deactivated in all remote states until the multistate license is
3148      no longer encumbered.
3149  (8)      If a multistate authorization to practice is
3150      encumbered in a remote state, the regulated social worker's
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3151      multistate authorization to practice may be deactivated in that
3152      state until the multistate authorization to practice is no
3153      longer encumbered.
3154
3155  ARTICLE V
3156  ISSUANCE OF A MULTISTATE LICENSE
3157
3158  (1)     Upon receipt of an application for multistate license,
3159      the home state licensing authority shall determine the
3160      applicant's eligibility for a multistate license in accordance
3161      with Article IV.
3162  (2)     If such applicant is eligible pursuant to Article IV,
3163      the home state licensing authority shall issue a multistate
3164      license that authorizes the applicant or regulated social worker
3165      to practice in all member states under a multistate
3166      authorization to practice.
3167  (3)     Upon issuance of a multistate license, the home state
3168      licensing authority shall designate whether the regulated social
3169      worker holds a multistate license in the bachelor's, master's,
3170      or clinical category of social work.
3171  (4)     A multistate license issued by a home state to a
3172      resident in that state shall be recognized by all compact member
3173      states as authorizing social work practice under a multistate
3174      authorization to practice corresponding to each category of
3175      licensure regulated in each member state.
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3176
3177  ARTICLE VI
3178  AUTHORITY OF SOCIAL WORK LICENSURE COMPACT COMMISSION
3179  AND MEMBER STATE LICENSING AUTHORITIES
3180
3181  (1)     This compact, or any rule of the commission, does not
3182      limit, restrict, or in any way reduce the ability of a member
3183      state to:
3184  (a)     Enact and enforce laws, regulations, or other rules
3185      related to the practice of social work in that state when those
3186      laws, regulations, or other rules are not inconsistent with the
3187      provisions of this compact.
3188  (b)     Take adverse action against a licensee's single state
3189      license to practice social work in that state.
3190  (c)     Take adverse action against a licensee's multistate
3191      authorization to practice social work in that state.
3192  (2)     This compact, or any rule of the commission, does not
3193      limit, restrict, or in any way reduce the ability of a
3194      licensee's home state to take adverse action against a
3195      licensee's multistate license based upon information provided by
3196      a remote state.
3197  (3)     This compact does not affect the requirements
3198      established by a member state for the issuance of a single state
3199      license.
3200
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3201  ARTICLE VII
3202  REISSUANCE OF A MULTISTATE LICENSE BY A NEW HOME STATE
3203
3204  (1)      A licensee can hold a multistate license, issued by
3205      his or her home state, in only one member state at any given
3206      time.
3207  (2)      If a licensee changes his or her home state by moving
3208      between two member states:
3209  (a)      The licensee shall immediately apply for the
3210      reissuance of his or her multistate license in his or her new
3211      home state. The licensee shall pay all applicable fees and
3212      notify the prior home state in accordance with the rules of the
3213      commission.
3214  (b)      Upon receipt of an application to reissue a multistate
3215      license, the new home state shall verify that the multistate
3216      license is active, unencumbered, and eligible for reissuance
3217      under the terms of the compact and the rules of the commission.
3218      The multistate license issued by the prior home state will be
3219      deactivated and all member states notified in accordance with
3220      the applicable rules adopted by the commission.
3221  (c)      Before the reissuance of the multistate license, the
3222      new home state shall conduct procedures for considering the
3223      criminal history records of the licensee. Such procedures shall
3224      include the submission of fingerprints or other biometric-based
3225      information by applicants for the purpose of obtaining an
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3226      applicant's criminal history record information from the Federal
3227      Bureau of Investigation and the agency responsible for retaining
3228      that state's criminal records.
3229  (d)     If required for initial licensure, the new home state
3230      may require completion of jurisprudence requirements in the new
3231      home state.
3232  (e)     Notwithstanding any other provision of this compact,
3233      if a licensee does not meet the requirements provided in this
3234      compact for the reissuance of a multistate license by the new
3235      home state, then the licensee shall be subject to the new home
3236      state requirements for the issuance of a single state license in
3237      that state.
3238  (3)     If a licensee changes his or her primary state of
3239      residence by moving from a member state to a nonmember state, or
3240      from a nonmember state to a member state, then the licensee
3241      shall be subject to the state requirements for the issuance of a
3242      single state license in the new home state.
3243  (4)     This compact does not interfere with a licensee's
3244      ability to hold a single state license in multiple states;
3245      however, for the purposes of this compact, a licensee shall have
3246      only one home state, and only one multistate license.
3247  (5)     This compact does not interfere with the requirements
3248      established by a member state for the issuance of a single state
3249      license.
3250
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3251  ARTICLE VIII
3252  MILITARY FAMILIES
3253
3254  An active military member or his or her spouse shall
3255      designate a home state where the individual has a multistate
3256      license. The individual may retain his or her home state
3257      designation during the period the servicemember is on active
3258      duty.
3259
3260  ARTICLE IX
3261  ADVERSE ACTIONS
3262
3263  (1)     In addition to the other powers conferred by general
3264      law, a remote state shall have the authority, in accordance with
3265      existing state due process law, to:
3266  (a)     Take adverse action against a regulated social
3267      worker's multistate authorization to practice only within that
3268      member state, and issue subpoenas for both hearings and
3269      investigations that require the attendance and testimony of
3270      witnesses as well as the production of evidence. Subpoenas
3271      issued by a licensing authority in a member state for the
3272      attendance and testimony of witnesses or the production of
3273      evidence from another member state shall be enforced in the
3274      latter state by any court of competent jurisdiction, according
3275      to the practice and procedure of that court applicable to
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3276      subpoenas issued in proceedings pending before it. The issuing
3277      licensing authority shall pay any witness fees, travel expenses,
3278      mileage, and other fees required by the service statutes of the
3279      state in which the witnesses or evidence are located.
3280  (b)     Only the home state shall have the power to take
3281      adverse action against a regulated social worker's multistate
3282      license.
3283  (2)     For purposes of taking adverse action, the home state
3284      shall give the same priority and effect to reported conduct
3285      received from a member state as it would if the conduct had
3286      occurred within the home state. In so doing, the home state
3287      shall apply its own state laws to determine appropriate action.
3288  (3)     The home state shall complete any pending
3289      investigations of a regulated social worker who changes his or
3290      her home state during the course of the investigations. The home
3291      state shall also have the authority to take appropriate actions
3292      and shall promptly report the conclusions of the investigations
3293      to the administrator of the data system. The administrator of
3294      the data system shall promptly notify the new home state of any
3295      adverse actions.
3296  (4)     A member state, if otherwise permitted by state law,
3297      may recover from the affected regulated social worker the costs
3298      of investigations and dispositions of cases resulting from any
3299      adverse action taken against that regulated social worker.
3300  (5)     A member state may take adverse action based on the
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3301      factual findings of another member state, provided that the
3302      member state follows its own procedures for taking the adverse
3303      action.
3304  (6)(a)       In addition to the authority granted to a member
3305      state by its respective social work practice act or other
3306      applicable state law, any member state may participate with
3307      other member states in joint investigations of licensees.
3308  (b)     Member states shall share any investigative,
3309      litigation, or compliance materials in furtherance of any joint
3310      or individual investigation initiated under the compact.
3311  (7)     If adverse action is taken by the home state against
3312      the multistate license of a regulated social worker, the
3313      regulated social worker's multistate authorization to practice
3314      in all other member states shall be deactivated until all
3315      encumbrances have been removed from the multistate license. All
3316      home state disciplinary orders that impose adverse action
3317      against the license of a regulated social worker shall include a
3318      statement that the regulated social worker's multistate
3319      authorization to practice is deactivated in all member states
3320      until all conditions of the decision, order, or agreement are
3321      satisfied.
3322  (8)     If a member state takes adverse action, it shall
3323      promptly notify the administrator of the data system. The
3324      administrator of the data system shall promptly notify the home
3325      state and all other member states of any adverse actions by
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3326      remote states.
3327  (9)     This compact does not override a member state's
3328      decision that participation in an alternative program may be
3329      used in lieu of adverse action.
3330  (10)        This compact does not authorize a member state to
3331      demand the issuance of subpoenas for attendance and testimony of
3332      witnesses or the production of evidence from another member
3333      state for lawful actions within that member state.
3334  (11)        This compact does not authorize a member state to
3335      impose discipline against a regulated social worker who holds a
3336      multistate authorization to practice for lawful actions within
3337      another member state.
3338
3339  ARTICLE X
3340  ESTABLISHMENT OF SOCIAL WORK LICENSURE
3341  COMPACT COMMISSION
3342
3343  (1)     The compact member states hereby create and establish
3344      a joint government agency whose membership consists of all
3345      member states that have enacted the compact known as the Social
3346      Work Licensure Compact Commission. The commission is an
3347      instrumentality of the compact states acting jointly and not an
3348      instrumentality of any one state. The commission shall come into
3349      existence on or after the effective date of the compact as
3350      provided in Article XIV.
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3351  (2)(a)       Each member state shall have and be limited to one
3352      delegate appointed by that member state's licensing authority.
3353      The delegate shall be either:
3354  1.      A current member of the state licensing authority at
3355      the time of appointment who is a regulated social worker or
3356      public member of the state licensing authority; or
3357  2.      An administrator of the licensing authority or his or
3358      her designee.
3359  (b)      The commission shall by rule or bylaw establish a term
3360      of office for delegates and may by rule or bylaw establish term
3361      limits.
3362  (c)      The commission may recommend removal or suspension of
3363      any delegate from office.
3364  (d)      A member state's licensing authority shall fill any
3365      vacancy of its delegate occurring on the commission within 60
3366      days after the vacancy.
3367  (e)      Each delegate shall be entitled to one vote on all
3368      matters before the commission requiring a vote by commission
3369      delegates.
3370  (f)      A delegate shall vote in person or by such other means
3371      as provided in the bylaws. The bylaws may provide for delegates
3372      to meet by telecommunication, video conference, or other similar
3373      electronic means.
3374  (g)      The commission shall meet at least once during each
3375      calendar year. Additional meetings may be held as provided in
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3376      the bylaws. The commission may meet by telecommunication, video
3377      conference, or other similar electronic means.
3378  (3)     The commission shall have the following powers:
3379  (a)     Establish the fiscal year of the commission.
3380  (b)     Establish code of conduct and conflict of interest
3381      policies.
3382  (c)     Establish and amend rules and bylaws.
3383  (d)     Maintain its financial records in accordance with the
3384      bylaws.
3385  (e)     Meet and take such actions as are consistent with the
3386      provisions of this compact, the commission's rules, and the
3387      bylaws.
3388  (f)     Initiate and conclude legal proceedings or actions in
3389      the name of the commission, provided that the standing of any
3390      licensing authority to sue or be sued under applicable law may
3391      not be affected.
3392  (g)     Maintain and certify records and information provided
3393      to a member state as the authenticated business records of the
3394      commission, and designate an agent to do so on the commission's
3395      behalf.
3396  (h)     Purchase and maintain insurance and bonds.
3397  (i)     Borrow, accept, or contract for services of personnel,
3398      including, but not limited to, employees of a member state.
3399  (j)     Conduct an annual financial review.
3400  (k)     Hire employees, elect or appoint officers, fix
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3401      compensation, define duties, grant such individuals appropriate
3402      authority to carry out the purposes of the compact, and
3403      establish the commission's personnel policies and programs
3404      relating to conflicts of interest, qualifications of personnel,
3405      and other related personnel matters.
3406  (l)     Assess and collect fees.
3407  (m)     Accept any and all appropriate gifts, donations,
3408      grants of money, other sources of revenue, equipment, supplies,
3409      materials, and services, and receive, utilize, and dispose of
3410      the same; provided that at all times the commission shall avoid
3411      any appearance of impropriety or conflict of interest.
3412  (n)     Lease, purchase, retain, own, hold, improve, or use
3413      any property, real, personal, or mixed, or any undivided
3414      interest therein.
3415  (o)     Sell, convey, mortgage, pledge, lease, exchange,
3416      abandon, or otherwise dispose of any property, real, personal,
3417      or mixed.
3418  (p)     Establish a budget and make expenditures.
3419  (q)     Borrow money.
3420  (r)     Appoint committees, including standing committees,
3421      composed of members, state regulators, state legislators or
3422      their representatives, consumer representatives, and such other
3423      interested persons as may be designated in this compact and the
3424      bylaws.
3425  (s)     Provide and receive information from, and cooperate
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3426      with, law enforcement agencies.
3427  (t)      Establish and elect an executive committee, including
3428      a chair and a vice chair.
3429  (u)      Determine whether a state's adopted language is
3430      materially different from the model compact language such that
3431      the state would not qualify for participation in the compact.
3432  (v)      Perform such other functions as may be necessary or
3433      appropriate to achieve the purposes of this compact.
3434  (4)(a)       The executive committee shall have the power to act
3435      on behalf of the commission according to the terms of this
3436      compact. The powers, duties, and responsibilities of the
3437      executive committee shall include:
3438  1.      Oversee the day-to-day activities of the administration
3439      of the compact, including enforcement and compliance with the
3440      provisions of the compact, its rules and bylaws, and other such
3441      duties as deemed necessary.
3442  2.      Recommend to the commission changes to the rules or
3443      bylaws, changes to this compact legislation, fees charged to
3444      compact member states, fees charged to licensees, and other
3445      fees.
3446  3.      Ensure compact administration services are
3447      appropriately provided, including by contract.
3448  4.      Prepare and recommend the budget.
3449  5.      Maintain financial records on behalf of the commission.
3450  6.      Monitor compact compliance of member states and provide
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3451      compliance reports to the commission.
3452  7.      Establish additional committees as necessary.
3453  8.      Exercise the powers and duties of the commission during
3454      the interim between commission meetings, except for adopting or
3455      amending rules, adopting or amending bylaws, and exercising any
3456      other powers and duties reserved expressly for use by the
3457      commission by rule or bylaw.
3458  9.      Other duties as provided in the rules or bylaws of the
3459      commission.
3460  (b)      The executive committee shall be composed of up to 11
3461      members, including:
3462  1.      The chair and vice chair of the commission shall be
3463      voting members of the executive committee.
3464  2.      The commission shall elect five voting members from the
3465      current membership of the commission.
3466  3.      Up to four ex-officio, nonvoting members from four
3467      recognized national social work organizations, selected by their
3468      respective organizations.
3469  (c)      The commission may remove any member of the executive
3470      committee as provided in the commission's bylaws.
3471  (d)      The executive committee shall meet at least annually.
3472  1.      Executive committee meetings shall be open to the
3473      public, except that the executive committee may meet in a
3474      closed, nonpublic meeting as provided in subsection (7).
3475  2.      The executive committee shall give 7 days' notice of
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3476      its meetings, posted on its website and as determined to provide
3477      notice to persons with an interest in the business of the
3478      commission.
3479  3.      The executive committee may hold a special meeting in
3480      accordance with subsection (6).
3481  (5)      The commission shall adopt and provide to the member
3482      states an annual report.
3483  (6)      All meetings shall be open to the public, except that
3484      the commission may meet in a closed, nonpublic meeting as
3485      provided in subsection (7).
3486  (a)      Public notice for all meetings of the full commission
3487      of meetings shall be given in the same manner as required under
3488      the rulemaking provisions in Article XII, except that the
3489      commission may hold a special meeting as provided in paragraph
3490      (b).
3491  (b)      The commission may hold a special meeting when it must
3492      meet to conduct emergency business by giving 48 hours' notice to
3493      all commissioners, on the commission's website, and by other
3494      means as provided in the commission's rules. The commission's
3495      legal counsel shall certify that the commission's need to meet
3496      qualifies as an emergency.
3497  (7)(a) The commission or the executive committee or other
3498      committee of the commission may convene in a closed, nonpublic
3499      meeting if the commission or the committee needs to receive
3500      legal advice or discuss any of the following:
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3501  1.      Noncompliance of a member state with its obligations
3502      under the compact.
3503  2.      The employment, compensation, or discipline of, or
3504      other matters, practices, or procedures related to, specific
3505      employees.
3506  3.      Current or threatened discipline of a licensee by the
3507      commission or by a member state's licensing authority.
3508  4.      Current, threatened, or reasonably anticipated
3509      litigation.
3510  5.      Negotiation of contracts for the purchase, lease, or
3511      sale of goods, services, or real estate.
3512  6.      Accusing any person of a crime or formally censuring
3513      any person.
3514  7.      Trade secrets or commercial or financial information
3515      that is privileged or confidential.
3516  8.      Information of a personal nature when disclosure would
3517      constitute a clearly unwarranted invasion of personal privacy.
3518  9.      Investigative records compiled for law enforcement
3519      purposes.
3520  10.      Information related to any investigative reports
3521      prepared by, or on behalf of or for the use of, the commission
3522      or other committee charged with responsibility of investigation
3523      or determination of compliance issues pursuant to the compact.
3524  11.      Matters specifically exempted from disclosure by
3525      federal or member state law.
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3526  12.     Other matters as adopted by commission rule.
3527  (b)     If a meeting, or portion of a meeting, is closed, the
3528      presiding officer shall state that the meeting will be closed
3529      and reference each relevant exempting provision, and such
3530      reference shall be recorded in the minutes.
3531  (c)     The commission shall keep minutes that fully and
3532      clearly describe all matters discussed in a meeting and shall
3533      provide a full and accurate summary of actions taken, and the
3534      reasons therefor, including a description of the views
3535      expressed. All documents considered in connection with an action
3536      shall be identified in such minutes. All minutes and documents
3537      of a closed meeting shall remain under seal, subject to release
3538      only by a majority vote of the commission or order of a court of
3539      competent jurisdiction.
3540  (8)(a)       The commission shall pay, or provide for the
3541      payment of, the reasonable expenses of its establishment,
3542      organization, and ongoing activities.
3543  (b)     The commission may accept any and all appropriate
3544      revenue sources as provided in paragraph (3)(m).
3545  (c)     The commission may levy on and collect an annual
3546      assessment from each member state and impose fees on licensees
3547      of member states to whom it grants a multistate license to cover
3548      the cost of the operations and activities of the commission and
3549      its staff, which must be in a total amount sufficient to cover
3550      its annual budget as approved each year for which revenue is not
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3551      provided by other sources. The aggregate annual assessment
3552      amount for member states shall be allocated based upon a formula
3553      that the commission shall adopt by rule.
3554  (d)     The commission may not incur obligations of any kind
3555      prior to securing the funds adequate to meet the same; nor shall
3556      the commission pledge the credit of any of the member states,
3557      except by and with the authority of the member state.
3558  (e)     The commission shall keep accurate accounts of all
3559      receipts and disbursements. The receipts and disbursements of
3560      the commission shall be subject to the financial review and
3561      accounting procedures established under its bylaws. However, all
3562      receipts and disbursements of funds handled by the commission
3563      shall be subject to an annual financial review by a certified or
3564      licensed public accountant, and the report of the financial
3565      review shall be included in and become part of the annual report
3566      of the commission.
3567  (9)(a)       The members, officers, executive director,
3568      employees, and representatives of the commission shall be immune
3569      from suit and liability, both personally and in their official
3570      capacity, for any claim for damage to or loss of property or
3571      personal injury or other civil liability caused by or arising
3572      out of any actual or alleged act, error, or omission that
3573      occurred, or that the person against whom the claim is made had
3574      a reasonable basis for believing occurred within the scope of
3575      commission employment, duties, or responsibilities; provided
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3576      that this paragraph does not protect any such person from suit
3577      or liability for any damage, loss, injury, or liability caused
3578      by the intentional or willful or wanton misconduct of that
3579      person. The procurement of insurance of any type by the
3580      commission may not in any way compromise or limit the immunity
3581      granted hereunder.
3582  (b)     The commission shall defend any member, officer,
3583      executive director, employee, and representative of the
3584      commission in any civil action seeking to impose liability
3585      arising out of any actual or alleged act, error, or omission
3586      that occurred within the scope of commission employment, duties,
3587      or responsibilities, or as determined by the commission that the
3588      person against whom the claim is made had a reasonable basis for
3589      believing occurred within the scope of commission employment,
3590      duties, or responsibilities; provided that nothing herein shall
3591      be construed to prohibit that person from retaining his or her
3592      own counsel at his or her own expense; and provided further that
3593      the actual or alleged act, error, or omission did not result
3594      from the intentional or willful or wanton misconduct of that
3595      person.
3596  (c)     The commission shall indemnify and hold harmless any
3597      member, officer, executive director, employee, and
3598      representative of the commission for the amount of any
3599      settlement or judgment obtained against that person arising out
3600      of any actual or alleged act, error, or omission that occurred
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3601      within the scope of commission employment, duties, or
3602      responsibilities, or, as determined by the commission, that the
3603      person against whom the claim is made had a reasonable basis for
3604      believing occurred within the scope of commission employment,
3605      duties, or responsibilities, provided that the actual or alleged
3606      act, error, or omission did not result from the intentional or
3607      willful or wanton misconduct of that person.
3608  (d)     Nothing herein shall be construed as a limitation on
3609      the liability of any licensee for professional malpractice or
3610      misconduct, which shall be governed solely by any other
3611      applicable state laws.
3612  (e)     This compact may not be interpreted to waive or
3613      otherwise abrogate a member state's state action immunity or
3614      state action affirmative defense with respect to antitrust
3615      claims under the Sherman Antitrust Act, Clayton Antitrust Act of
3616      1914, or any other state or federal antitrust or anticompetitive
3617      law or regulation.
3618  (f)     This compact may not be construed to be a waiver of
3619      sovereign immunity by the member states or by the commission.
3620
3621  ARTICLE XI
3622  DATA SYSTEM
3623
3624  (1)     The commission shall provide for the development,
3625      maintenance, operation, and utilization of a coordinated data
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3626      system.
3627  (2)     The commission shall assign each applicant for a
3628      multistate license a unique identifier, as determined by the
3629      rules of the commission.
3630  (3)     Notwithstanding any other provision of state law to
3631      the contrary, a member state shall submit a uniform data set to
3632      the data system on all individuals to whom this compact is
3633      applicable as required by the rules of the commission,
3634      including:
3635  (a)     Identifying information.
3636  (b)     Licensure data.
3637  (c)     Adverse actions against a license and information
3638      related thereto.
3639  (d)     Nonconfidential information related to alternative
3640      program participation, the beginning and ending dates of such
3641      participation, and other information related to such
3642      participation not made confidential under member state law.
3643  (e)     Any denial of application for licensure, and the
3644      reason for such denial.
3645  (f)     The presence of current significant investigative
3646      information.
3647  (g)     Other information that may facilitate the
3648      administration of this compact or the protection of the public,
3649      as determined by the rules of the commission.
3650  (4)     The records and information provided to a member state
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3651      pursuant to this compact or through the data system, when
3652      certified by the commission or an agent thereof, shall
3653      constitute the authenticated business records of the commission,
3654      and shall be entitled to any associated hearsay exception in any
3655      relevant judicial, quasi-judicial, or administrative proceedings
3656      in a member state.
3657  (5)(a)       Current significant investigative information
3658      pertaining to a licensee in any member state will only be
3659      available to other member states.
3660  (b)     It is the responsibility of the member states to
3661      report any adverse action against a licensee and to monitor the
3662      database to determine whether adverse action has been taken
3663      against a licensee. Adverse action information pertaining to a
3664      licensee in any member state will be available to any other
3665      member state.
3666  (6)     Member states contributing information to the data
3667      system may designate information that may not be shared with the
3668      public without the express permission of the contributing state.
3669  (7)     Any information submitted to the data system that is
3670      subsequently expunged pursuant to federal law or the laws of the
3671      member state contributing the information shall be removed from
3672      the data system.
3673
3674  ARTICLE XII
3675  RULEMAKING
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3676
3677  (1)     The commission shall adopt reasonable rules in order
3678      to effectively and efficiently implement and administer the
3679      purposes and provisions of the compact. A rule shall be invalid
3680      and have no force or effect only if a court of competent
3681      jurisdiction holds that the rule is invalid because the
3682      commission exercised its rulemaking authority in a manner that
3683      is beyond the scope and purposes of the compact, or the powers
3684      granted hereunder, or based upon another applicable standard of
3685      review.
3686  (2)     The rules of the commission shall have the force of
3687      law in each member state; however, if the rules of the
3688      commission conflict with the laws, regulations, and applicable
3689      standards that govern the practice of social work as held by a
3690      court of competent jurisdiction, the rules of the commission are
3691      ineffective in that state to the extent of the conflict.
3692  (3)     The commission shall exercise its rulemaking powers
3693      pursuant to the criteria provided in this article and the rules
3694      adopted thereunder. Rules shall become binding on the day
3695      following adoption or the date specified in the rule or
3696      amendment, whichever is later.
3697  (4)     If a majority of the legislatures of the member states
3698      rejects a rule or portion of a rule, by enactment of a statute
3699      or resolution in the same manner used to adopt the compact
3700      within 4 years after the date of adoption of the rule, then such
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3701      rule shall have no further force and effect in any member state.
3702  (5)     Rules shall be adopted at a regular or special meeting
3703      of the commission.
3704  (6)     Before adoption of a proposed rule, the commission
3705      shall hold a public hearing and allow persons to provide oral
3706      and written comments, data, facts, opinions, and arguments.
3707  (7)     Before adoption of a proposed rule by the commission,
3708      and at least 30 days in advance of the meeting at which the
3709      commission will hold a public hearing on the proposed rule, the
3710      commission shall provide a notice of proposed rulemaking:
3711  (a)     On the website of the commission or other publicly
3712      accessible platform.
3713  (b)     To persons who have requested notice of the
3714      commission's notices of proposed rulemaking.
3715  (c)     In such other way as the commission may by rule
3716      specify.
3717  (8)     The notice of proposed rulemaking shall include:
3718  (a)     The time, date, and location of the public hearing at
3719      which the commission will hear public comments on the proposed
3720      rule and, if different, the time, date, and location of the
3721      meeting where the commission will consider and vote on the
3722      proposed rule.
3723  (b)     If the hearing is held via telecommunication, video
3724      conference, or other similar electronic means, the mechanism for
3725      access to the hearing.
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3726  (c)     The text of the proposed rule and the reason therefor.
3727  (d)     A request for comments on the proposed rule from any
3728      interested person.
3729  (e)     The manner in which interested persons may submit
3730      written comments.
3731  (9)     All hearings will be recorded. A copy of the recording
3732      and all written comments and documents received by the
3733      commission in response to the proposed rule shall be available
3734      to the public.
3735  (10)        This article does not require a separate hearing on
3736      each rule. Rules may be grouped for the convenience of the
3737      commission at hearings required by this article.
3738  (11)        The commission shall, by majority vote of all
3739      members, take final action on the proposed rule based on the
3740      rulemaking record and the full text of the rule.
3741  (a)     The commission may adopt changes to the proposed rule
3742      provided the changes do not enlarge the original purpose of the
3743      proposed rule.
3744  (b)     The commission shall provide an explanation of the
3745      reasons for substantive changes made to the proposed rule as
3746      well as reasons for substantive changes not made that were
3747      recommended by commenters.
3748  (c)     The commission shall determine a reasonable effective
3749      date for the rule. Except for an emergency as provided in
3750      subsection (12), the effective date of the rule shall be no
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3751      sooner than 30 days after issuing the notice that the commission
3752      adopted or amended the rule.
3753  (12)        Upon determination that an emergency exists, the
3754      commission may consider and adopt an emergency rule with 48
3755      hours' notice, with opportunity to comment, provided that the
3756      usual rulemaking procedures provided in the compact and in this
3757      article shall be retroactively applied to the rule as soon as
3758      reasonably possible, but in no event later than 90 days after
3759      the effective date of the rule. For the purposes of this
3760      subsection, an emergency rule is one that must be adopted
3761      immediately in order to:
3762  (a)     Meet an imminent threat to public health, safety, or
3763      welfare;
3764  (b)     Prevent a loss of commission or member state funds;
3765  (c)     Meet a deadline for the adoption of a rule that is
3766      established by federal law or rule; or
3767  (d)     Protect public health and safety.
3768  (13)        The commission or an authorized committee of the
3769      commission may direct revisions to a previously adopted rule for
3770      purposes of correcting typographical errors, errors in format,
3771      errors in consistency, or grammatical errors. Public notice of
3772      any revisions shall be posted on the website of the commission.
3773      The revision shall be subject to challenge by any person for a
3774      period of 30 days after posting. The revision may be challenged
3775      only on grounds that the revision results in a material change
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3776      to a rule. A challenge shall be made in writing and delivered to
3777      the commission prior to the end of the notice period. If no
3778      challenge is made, the revision will take effect without further
3779      action. If the revision is challenged, the revision may not take
3780      effect without the approval of the commission.
3781  (14)        No member state's rulemaking requirements shall apply
3782      under this compact.
3783
3784  ARTICLE XIII
3785  OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT
3786
3787  (1)(a)        The executive and judicial branches of state
3788      government in each member state shall enforce this compact and
3789      take all actions necessary and appropriate to implement the
3790      compact.
3791  (b)     Except as otherwise provided in this compact, venue is
3792      proper and judicial proceedings by or against the commission
3793      shall be brought solely and exclusively in a court of competent
3794      jurisdiction where the principal office of the commission is
3795      located. The commission may waive venue and jurisdictional
3796      defenses to the extent it adopts or consents to participate in
3797      alternative dispute resolution proceedings. Nothing herein shall
3798      affect or limit the selection or propriety of venue in any
3799      action against a licensee for professional malpractice,
3800      misconduct, or any such similar matter.
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3801  (c)     The commission shall be entitled to receive service of
3802      process in any proceeding regarding the enforcement or
3803      interpretation of the compact and shall have standing to
3804      intervene in such a proceeding for all purposes. Failure to
3805      provide the commission service of process shall render a
3806      judgment or order void as to the commission, this compact, or
3807      adopted rules.
3808  (2)(a)       If the commission determines that a member state
3809      has defaulted in the performance of its obligations or
3810      responsibilities under this compact or the adopted rules, the
3811      commission shall provide written notice to the defaulting state.
3812      The notice of default shall describe the default, the proposed
3813      means of curing the default, and any other action that the
3814      commission may take, and shall offer training and specific
3815      technical assistance regarding the default.
3816  (b)     The commission shall provide a copy of the notice of
3817      default to the other member states.
3818  (3)     If a state in default fails to cure the default, the
3819      defaulting state may be terminated from the compact upon an
3820      affirmative vote of a majority of the delegates of the member
3821      states, and all rights, privileges, and benefits conferred on
3822      that state by this compact may be terminated on the effective
3823      date of termination. A cure of the default does not relieve the
3824      offending state of obligations or liabilities incurred during
3825      the period of default.
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3826  (4)     Termination of membership in the compact shall be
3827      imposed only after all other means of securing compliance have
3828      been exhausted. Notice of intent to suspend or terminate shall
3829      be given by the commission to the Governor, the majority and
3830      minority leaders of the defaulting state's legislature, the
3831      defaulting state's state licensing authority, and the licensing
3832      authority of each member state.
3833  (5)     A state that has been terminated is responsible for
3834      all assessments, obligations, and liabilities incurred through
3835      the effective date of termination, including obligations that
3836      extend beyond the effective date of termination.
3837  (6)     Upon the termination of a state's membership from this
3838      compact, that state shall immediately provide notice to all
3839      licensees within that state of such termination. The terminated
3840      state shall continue to recognize all licenses granted pursuant
3841      to this compact for a minimum of 6 months after the date of said
3842      notice of termination.
3843  (7)     The commission may not bear any costs related to a
3844      state that is found to be in default or that has been terminated
3845      from the compact, unless agreed upon in writing between the
3846      commission and the defaulting state.
3847  (8)     The defaulting state may appeal the action of the
3848      commission by petitioning the United States District Court for
3849      the District of Columbia or the federal district where the
3850      commission has its principal offices. The prevailing party shall
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3851      be awarded all costs of such litigation, including reasonable
3852      attorney fees.
3853  (9)(a)       Upon request by a member state, the commission
3854      shall attempt to resolve disputes related to the compact that
3855      arise among member states and between member and nonmember
3856      states.
3857  (b)     The commission shall adopt a rule providing for both
3858      mediation and binding dispute resolution for disputes as
3859      appropriate.
3860  (10)(a)       By majority vote as provided by rule, the
3861      commission may initiate legal action against a member state in
3862      default in the United States District Court for the District of
3863      Columbia or the federal district where the commission has its
3864      principal offices to enforce compliance with the provisions of
3865      the compact and its adopted rules. The relief sought may include
3866      both injunctive relief and damages. In the event judicial
3867      enforcement is necessary, the prevailing party shall be awarded
3868      all costs of such litigation, including reasonable attorney
3869      fees. The remedies herein may not be the exclusive remedies of
3870      the commission. The commission may pursue any other remedies
3871      available under federal or the defaulting member state's law.
3872  (b)     A member state may initiate legal action against the
3873      commission in the United States District Court for the District
3874      of Columbia or the federal district where the commission has its
3875      principal offices to enforce compliance with the provisions of
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3876      the compact and its adopted rules. The relief sought may include
3877      both injunctive relief and damages. In the event judicial
3878      enforcement is necessary, the prevailing party shall be awarded
3879      all costs of such litigation, including reasonable attorney
3880      fees.
3881  (c)      Only a member state may enforce this compact against
3882      the commission.
3883
3884  ARTICLE XIV
3885  EFFECTIVE DATE, WITHDRAWAL, AND AMENDMENT
3886
3887  (1)      The compact shall come into effect on the date on
3888      which the compact statute is enacted into law in the seventh
3889      member state.
3890  (2)(a)       On or after the effective date of the compact, the
3891      commission shall convene and review the enactment of each of the
3892      first seven charter member states to determine if the statute
3893      enacted by each such charter member state is materially
3894      different than the model compact statute.
3895  1.      A charter member state whose enactment is found to be
3896      materially different from the model compact statute shall be
3897      entitled to the default process provided in Article XIII.
3898  2.      If any member state is later found to be in default, or
3899      is terminated or withdraws from the compact, the commission
3900      shall remain in existence and the compact shall remain in effect
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3901      even if the number of member states should be less than seven.
3902  (b)     Member states enacting the compact subsequent to the
3903      seven initial charter member states shall be subject to the
3904      process provided in paragraph (3)(u) of Article X to determine
3905      if their enactments are materially different from the model
3906      compact statute and whether they qualify for participation in
3907      the compact.
3908  (c)     All actions taken for the benefit of the commission or
3909      in furtherance of the purposes of the administration of the
3910      compact prior to the effective date of the compact or the
3911      commission coming into existence shall be considered to be
3912      actions of the commission unless specifically repudiated by the
3913      commission.
3914  (d)     Any state that joins the compact subsequent to the
3915      commission's initial adoption of the rules and bylaws shall be
3916      subject to the rules and bylaws as they exist on the date on
3917      which the compact becomes law in that state. Any rule that has
3918      been previously adopted by the commission shall have the full
3919      force and effect of law on the day the compact becomes law in
3920      that state.
3921  (3)     Any member state may withdraw from this compact by
3922      enacting a statute repealing the same.
3923  (a)     A member state's withdrawal may not take effect until
3924      180 days after enactment of the repealing statute.
3925  (b)     Withdrawal may not affect the continuing requirement
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3926      of the withdrawing state's licensing authority to comply with
3927      the investigative and adverse action reporting requirements of
3928      this compact before the effective date of withdrawal.
3929  (c)     Upon the enactment of a statute withdrawing from this
3930      compact, a state shall immediately provide notice of such
3931      withdrawal to all licensees within that state. Notwithstanding
3932      any subsequent statutory enactment to the contrary, such
3933      withdrawing state shall continue to recognize all licenses
3934      granted pursuant to this compact for a minimum of 180 days after
3935      the date of such notice of withdrawal.
3936  (4)     This compact does not invalidate or prevent any
3937      licensure agreement or other cooperative arrangement between a
3938      member state and a nonmember state that does not conflict with
3939      the provisions of this compact.
3940  (5)     This compact may be amended by the member states. Any
3941      amendment to this compact is not effective and binding upon any
3942      member state until it is enacted into the laws of all member
3943      states.
3944
3945  ARTICLE XV
3946  CONSTRUCTION AND SEVERABILITY
3947
3948  (1)     This compact and the commission's rulemaking authority
3949      shall be liberally construed so as to effectuate the purposes
3950      and the implementation and administration of the compact.
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3951      Provisions of the compact expressly authorizing or requiring the
3952      adoption of rules may not be construed to limit the commission's
3953      rulemaking authority solely for those purposes.
3954  (2)     The provisions of this compact shall be severable, and
3955      if any phrase, clause, sentence, or provision of this compact is
3956      held by a court of competent jurisdiction to be contrary to the
3957      constitution of any member state, a state seeking participation
3958      in the compact, or the United States, or the application thereof
3959      to any government, agency, person, or circumstance is held to be
3960      unconstitutional by a court of competent jurisdiction, the
3961      validity of the remainder of this compact and the applicability
3962      thereof to any other government, agency, person, or circumstance
3963      may not be affected thereby.
3964  (3)     Notwithstanding subsection (2), the commission may
3965      deny a state's participation in the compact or, in accordance
3966      with the requirements of subsection (3) of Article XIII,
3967      terminate a member state's participation in the compact, if it
3968      determines that a constitutional requirement of a member state
3969      is a material departure from the compact. Otherwise, if this
3970      compact shall be held to be contrary to the constitution of any
3971      member state, the compact shall remain in full force and effect
3972      as to the remaining member states and in full force and effect
3973      as to the member state affected as to all severable matters.
3974
3975  ARTICLE XVI
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3976  CONSISTENT EFFECT AND CONFLICT WITH OTHER STATE LAWS
3977
3978  (1)     A licensee providing services in a remote state under
3979      a multistate authorization to practice shall adhere to the laws
3980      and regulations, including laws, regulations, and applicable
3981      standards, of the remote state where the client is located at
3982      the time care is rendered.
3983  (2)     Nothing herein shall prevent or inhibit the
3984      enforcement of any other law of a member state that is not
3985      inconsistent with the compact.
3986  (3)     Any laws, statutes, regulations, or other legal
3987      requirements in a member state in conflict with the compact are
3988      superseded to the extent of the conflict.
3989  (4)     All permissible agreements between the commission and
3990      the member states are binding in accordance with their terms.
3991  Section 26.  Subsection (9) is added to section 491.004,
3992      Florida Statutes, to read:
3993  491.004       Board of Clinical Social Work, Marriage and Family
3994      Therapy, and Mental Health Counseling.—
3995  (9)     The board shall appoint an individual to serve as the
3996      state's delegate on the Social Work Licensure Compact
3997      Commission, as required under s. 491.022.
3998  Section 27.  Subsection (6) of section 491.005, Florida
3999      Statutes, is amended to read:
4000  491.005       Licensure by examination.—
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4001  (6)     EXEMPTIONS EXEMPTION.—
4002  (a)     A person licensed as a clinical social worker,
4003      marriage and family therapist, or mental health counselor in
4004      another state who is practicing under the Professional
4005      Counselors Licensure Compact pursuant to s. 491.017, and only
4006      within the scope provided therein, is exempt from the licensure
4007      requirements of this section, as applicable.
4008  (b)     A person licensed as a clinical social worker in
4009      another state who is practicing under the Social Work Licensure
4010      Interstate Compact pursuant to s. 491.022, and only within the
4011      scope provided therein, is exempt from the licensure
4012      requirements of this section, as applicable.
4013  Section 28.  Subsection (4) is added to section 491.006,
4014      Florida Statutes, to read:
4015  491.006       Licensure or certification by endorsement.—
4016  (4)     A person licensed as a clinical social worker in
4017      another state who is practicing under the Social Work Licensure
4018      Interstate Compact pursuant to s. 491.022, and only within the
4019      scope provided therein, is exempt from the licensure
4020      requirements of this section, as applicable.
4021  Section 29.  Subsection (1) of section 491.009, Florida
4022      Statutes, is amended, and paragraph (c) is added to subsection
4023      (2) of that section, to read:
4024  491.009       Discipline.—
4025  (1)     The following acts constitute grounds for denial of a
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4026      license or disciplinary action, as specified in s. 456.072(2),
4027      or s. 491.017, or s. 491.022:
4028  (a)     Attempting to obtain, obtaining, or renewing a
4029      license, registration, or certificate under this chapter by
4030      bribery or fraudulent misrepresentation or through an error of
4031      the board or the department.
4032  (b)     Having a license, registration, or certificate to
4033      practice a comparable profession revoked, suspended, or
4034      otherwise acted against, including the denial of certification
4035      or licensure by another state, territory, or country.
4036  (c)     Being convicted or found guilty of, regardless of
4037      adjudication, or having entered a plea of nolo contendere to, a
4038      crime in any jurisdiction which directly relates to the practice
4039      of his or her profession or the ability to practice his or her
4040      profession. However, in the case of a plea of nolo contendere,
4041      the board shall allow the person who is the subject of the
4042      disciplinary proceeding to present evidence in mitigation
4043      relevant to the underlying charges and circumstances surrounding
4044      the plea.
4045  (d)     False, deceptive, or misleading advertising or
4046      obtaining a fee or other thing of value on the representation
4047      that beneficial results from any treatment will be guaranteed.
4048  (e)     Advertising, practicing, or attempting to practice
4049      under a name other than one's own.
4050  (f)     Maintaining a professional association with any person
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4051      who the applicant, licensee, registered intern, or
4052      certificateholder knows, or has reason to believe, is in
4053      violation of this chapter or of a rule of the department or the
4054      board.
4055  (g)     Knowingly aiding, assisting, procuring, or advising
4056      any nonlicensed, nonregistered, or noncertified person to hold
4057      himself or herself out as licensed, registered, or certified
4058      under this chapter.
4059  (h)     Failing to perform any statutory or legal obligation
4060      placed upon a person licensed, registered, or certified under
4061      this chapter.
4062  (i)     Willfully making or filing a false report or record;
4063      failing to file a report or record required by state or federal
4064      law; willfully impeding or obstructing the filing of a report or
4065      record; or inducing another person to make or file a false
4066      report or record or to impede or obstruct the filing of a report
4067      or record. Such report or record includes only a report or
4068      record which requires the signature of a person licensed,
4069      registered, or certified under this chapter.
4070  (j)     Paying a kickback, rebate, bonus, or other
4071      remuneration for receiving a patient or client, or receiving a
4072      kickback, rebate, bonus, or other remuneration for referring a
4073      patient or client to another provider of mental health care
4074      services or to a provider of health care services or goods;
4075      referring a patient or client to oneself for services on a fee-
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4076      paid basis when those services are already being paid for by
4077      some other public or private entity; or entering into a
4078      reciprocal referral agreement.
4079  (k)     Committing any act upon a patient or client which
4080      would constitute sexual battery or which would constitute sexual
4081      misconduct as defined pursuant to s. 491.0111.
4082  (l)     Making misleading, deceptive, untrue, or fraudulent
4083      representations in the practice of any profession licensed,
4084      registered, or certified under this chapter.
4085  (m)     Soliciting patients or clients personally, or through
4086      an agent, through the use of fraud, intimidation, undue
4087      influence, or a form of overreaching or vexatious conduct.
4088  (n)     Failing to make available to a patient or client, upon
4089      written request, copies of tests, reports, or documents in the
4090      possession or under the control of the licensee, registered
4091      intern, or certificateholder which have been prepared for and
4092      paid for by the patient or client.
4093  (o)     Failing to respond within 30 days to a written
4094      communication from the department or the board concerning any
4095      investigation by the department or the board, or failing to make
4096      available any relevant records with respect to any investigation
4097      about the licensee's, registered intern's, or
4098      certificateholder's conduct or background.
4099  (p)     Being unable to practice the profession for which he
4100      or she is licensed, registered, or certified under this chapter
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4101      with reasonable skill or competence as a result of any mental or
4102      physical condition or by reason of illness; drunkenness; or
4103      excessive use of drugs, narcotics, chemicals, or any other
4104      substance. In enforcing this paragraph, upon a finding by the
4105      State Surgeon General, the State Surgeon General's designee, or
4106      the board that probable cause exists to believe that the
4107      licensee, registered intern, or certificateholder is unable to
4108      practice the profession because of the reasons stated in this
4109      paragraph, the department shall have the authority to compel a
4110      licensee, registered intern, or certificateholder to submit to a
4111      mental or physical examination by psychologists, physicians, or
4112      other licensees under this chapter, designated by the department
4113      or board. If the licensee, registered intern, or
4114      certificateholder refuses to comply with such order, the
4115      department's order directing the examination may be enforced by
4116      filing a petition for enforcement in the circuit court in the
4117      circuit in which the licensee, registered intern, or
4118      certificateholder resides or does business. The licensee,
4119      registered intern, or certificateholder against whom the
4120      petition is filed may not be named or identified by initials in
4121      any public court records or documents, and the proceedings shall
4122      be closed to the public. The department shall be entitled to the
4123      summary procedure provided in s. 51.011. A licensee, registered
4124      intern, or certificateholder affected under this paragraph shall
4125      at reasonable intervals be afforded an opportunity to
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4126      demonstrate that he or she can resume the competent practice for
4127      which he or she is licensed, registered, or certified with
4128      reasonable skill and safety to patients.
4129  (q)     Performing any treatment or prescribing any therapy
4130      which, by the prevailing standards of the mental health
4131      professions in the community, would constitute experimentation
4132      on human subjects, without first obtaining full, informed, and
4133      written consent.
4134  (r)     Failing to meet the minimum standards of performance
4135      in professional activities when measured against generally
4136      prevailing peer performance, including the undertaking of
4137      activities for which the licensee, registered intern, or
4138      certificateholder is not qualified by training or experience.
4139  (s)     Delegating professional responsibilities to a person
4140      who the licensee, registered intern, or certificateholder knows
4141      or has reason to know is not qualified by training or experience
4142      to perform such responsibilities.
4143  (t)     Violating a rule relating to the regulation of the
4144      profession or a lawful order of the department or the board
4145      previously entered in a disciplinary hearing.
4146  (u)     Failure of the licensee, registered intern, or
4147      certificateholder to maintain in confidence a communication made
4148      by a patient or client in the context of such services, except
4149      as provided in s. 491.0147.
4150  (v)     Making public statements which are derived from test
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4151      data, client contacts, or behavioral research and which identify
4152      or damage research subjects or clients.
4153  (w)     Violating any provision of this chapter or chapter
4154      456, or any rules adopted pursuant thereto.
4155  (2)
4156  (c)     The board may take adverse action against a clinical
4157      social worker's privilege to practice under the Social Work
4158      Licensure Interstate Compact pursuant to s. 491.022 and may
4159      impose any of the penalties in s. 456.072(2) if the clinical
4160      social worker commits an act specified in subsection (1) or s.
4161      456.072(1).
4162  Section 30.  Subsection (7) of section 627.6471, Florida
4163      Statutes, is renumbered as subsection (8), and a new subsection
4164      (7) is added to that section to read:
4165  627.6471  Contracts for reduced rates of payment;
4166      limitations; coinsurance and deductibles.—
4167  (7)     Any insurer issuing a policy of health insurance in
4168      this state shall apply the payment for a service provided to an
4169      insured by a nonpreferred provider toward the insured's
4170      deductible and out-of-pocket maximum as if the service had been
4171      provided by a preferred provider if all of the following apply:
4172  (a)     The insured requests that the insurer apply the
4173      payment for the service provided to the insured by the
4174      nonpreferred provider toward the insured's deductible and out-
4175      of-pocket maximum.
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4176  (b)      The service provided to the insured by the
4177      nonpreferred provider is within the scope of services covered
4178      under the insured's policy.
4179  (c)      The amount that the nonpreferred provider charged the
4180      insured for the service is the same as or less than:
4181  1.      The average amount that the insured's preferred
4182      provider network charges for the service; or
4183  2.      The statewide average amount for the service based on
4184      data reported on the Florida Health Price Finder website.
4185  Section 31.  Paragraphs (m), (n), and (o) are added to
4186      subsection (10) of section 768.28, Florida Statutes, to read:
4187  768.28       Waiver of sovereign immunity in tort actions;
4188      recovery limits; civil liability for damages caused during a
4189      riot; limitation on attorney fees; statute of limitations;
4190      exclusions; indemnification; risk management programs.—
4191  (10)
4192  (m)      For purposes of this section, the individual appointed
4193      under s. 456.66 as the state's delegate for the Physician
4194      Assistant Licensure Compact Commission, when serving in that
4195      capacity, and any administrator, officer, executive director,
4196      employee, or representative of the Physician Assistant Licensure
4197      Compact Commission, when acting within the scope of his or her
4198      employment, duties, or responsibilities in this state, is
4199      considered an agent of the state. The commission shall pay any
4200      claims or judgments pursuant to this section and may maintain
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4201      insurance coverage to pay any such claims or judgments.
4202  (n)     For purposes of this section, the individual appointed
4203      under s. 401.466 as the state's delegate for the Interstate
4204      Commission for EMS Personnel Practice, when serving in that
4205      capacity, and any administrator, officer, executive director,
4206      employee, or representative of the Emergency Medical Services
4207      Personnel Licensure Interstate Compact Commission, when acting
4208      within the scope of his or her employment, duties, or
4209      responsibilities in this state, is considered an agent of the
4210      state. The commission shall pay any claims or judgments pursuant
4211      to this section and may maintain insurance coverage to pay any
4212      such claims or judgments.
4213  (o)     For purposes of this section, the individual appointed
4214      under s. 491.004(9) as the state's delegate on the Social Work
4215      Licensure Compact Commission, pursuant to s. 491.022, and any
4216      administrator, officer, executive director, employee, or
4217      representative of the commission, when acting within the scope
4218      of his or her employment, duties, or responsibilities in this
4219      state, is considered an agent of the state. The commission shall
4220      pay any claims or judgments pursuant to this section and may
4221      maintain insurance coverage to pay any such claims or judgments.
4222  Section 32.  Except as otherwise expressly provided in this
4223      act, this act shall take effect July 1, 2026.
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       CODING: Words stricken are deletions; words underlined are additions.
  hb693-01-c1