HOUSE BILL NO. 1388 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE KEATHLEY.
1861H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal section 334.742, RSMo, and to enact in lieu thereof fourteen new sections relating to physician assistants.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Section 334.742, RSMo, is repealed and fourteen new sections enacted in 2 lieu thereof, to be known as sections 334.742, 334.1800, 334.1805, 334.1810, 334.1815, 3 334.1820, 334.1825, 334.1830, 334.1835, 334.1840, 334.1845, 334.1850, 334.1855, and 4 334.1860, to read as follows: 334.742. [Any nonresident of Missouri who enters the state and intends to provide a 2 service or practice for which a license is required pursuant to sections 334.735 to 334.749 3 may apply for a license, provided that the applicant meets the requirements imposed by the 4 certifying entity.] 1. For purposes of this section, the following terms mean: 5 (1) "License", a license, certificate, registration, permit, accreditation, or 6 military occupational specialty that enables a person to legally practice an occupation or 7 profession in a particular jurisdiction; 8 (2) "Military", the Armed Forces of the United States, including the Air Force, 9 Army, Coast Guard, Marine Corps, Navy, Space Force, National Guard, and any other 10 military branch that is designated by Congress as part of the Armed Forces of the 11 United States, and all reserve components and auxiliaries. The term "military" also 12 includes the military reserves and militia of any United States territory or state; 13 (3) "Nonresident military spouse", a nonresident spouse of an active duty 14 member of the Armed Forces of the United States who has been transferred or is 15 scheduled to be transferred to the state of Missouri, or who has been transferred or is
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 1388 2
16 scheduled to be transferred to an adjacent state and is or will be domiciled in the state of 17 Missouri, or has moved to the state of Missouri on a permanent change-of-station basis; 18 (4) "Oversight body", any board, department, agency, or office of a jurisdiction 19 that issues licenses; 20 (5) "Resident military spouse", a spouse of an active duty member of the Armed 21 Forces of the United States who has been transferred or is scheduled to be transferred to 22 the state of Missouri or an adjacent state and who is a permanent resident of the state of 23 Missouri, who is domiciled in the state of Missouri, or who has Missouri as his or her 24 home of record. 25 2. Any person who holds a valid current physician assistant license issued by 26 another state, a branch or unit of the military, a territory of the United States, or the 27 District of Columbia, and who has been licensed for at least one year in such other 28 jurisdiction, may submit to the board an application for a physician assistant license in 29 Missouri along with proof of current licensure and proof of licensure for at least one 30 year in the other jurisdiction. 31 3. The board shall: 32 (1) Within six months of receiving an application described in subsection 2 of 33 this section, waive any examination, educational, or experience requirements for 34 licensure in this state for the applicant if it determines that there were minimum 35 education requirements and, if applicable, work experience and clinical supervision 36 requirements in effect and the other jurisdiction verifies that the person met those 37 requirements in order to be licensed or certified in that jurisdiction. The board may 38 require an applicant to take and pass an examination specific to the laws of this state; or 39 (2) Within thirty days of receiving an application described in subsection 2 of 40 this section from a nonresident military spouse or a resident military spouse, waive any 41 examination, educational, or experience requirements for licensure in this state for the 42 applicant and issue such applicant a license under this section if such applicant 43 otherwise meets the requirements of this section. 44 4. (1) The board shall not waive any examination, educational, or experience 45 requirements for any applicant who has had his or her license revoked by an oversight 46 body outside the state; who is currently under investigation, who has a complaint 47 pending, or who is currently under disciplinary action, except as provided in subdivision 48 (2) of this subsection, with an oversight body outside the state; who does not hold a 49 license in good standing with an oversight body outside the state; who has a criminal 50 record that would disqualify him or her for licensure in Missouri; or who does not hold 51 a valid current license in the other jurisdiction on the date the board receives his or her 52 application under this section. HB 1388 3
53 (2) If another jurisdiction has taken disciplinary action against an applicant, the 54 board shall determine if the cause for the action was corrected and the matter resolved. 55 If the matter has not been resolved by that jurisdiction, the board may deny a license 56 until the matter is resolved. 57 5. Nothing in this section shall prohibit the board from denying a license to an 58 applicant under this section for any reason described in section 334.100. 59 6. Any person who is licensed under the provisions of this section shall be subject 60 to the board's jurisdiction and all rules and regulations pertaining to the practice as a 61 physician assistant in this state. 62 7. This section shall not be construed to waive any requirement for an applicant 63 to pay any fees. 334.1800. 1. Sections 334.1800 to 334.1860 shall be known and may be cited as 2 the "Physician Assistant Licensure Compact". 3 2. In order to strengthen access to Medical Services, and in recognition of the 4 advances in the delivery of Medical Services, the Participating States of the PA 5 Licensure Compact have allied in common purpose to develop a comprehensive process 6 that complements the existing authority of State Licensing Boards to license and 7 discipline PAs and seeks to enhance the portability of a License to practice as a PA while 8 safeguarding the safety of patients. This Compact allows Medical Services to be 9 provided by PAs, via the mutual recognition of the Licensee's Qualifying License by 10 other Compact Participating States. This Compact also adopts the prevailing standard 11 for PA licensure and affirms that the practice and delivery of Medical Services by the 12 PA occurs where the patient is located at the time of the patient encounter, and therefore 13 requires the PA to be under the jurisdiction of the State Licensing Board where the 14 patient is located. State Licensing Boards that participate in this Compact retain the 15 jurisdiction to impose Adverse Action against a Compact Privilege in that State issued 16 to a PA through the procedures of this Compact. The PA Licensure Compact will 17 alleviate burdens for military families by allowing active duty military personnel and 18 their spouses to obtain a Compact Privilege based on having an unrestricted License in 19 good standing from a Participating State. 334.1805. In this Compact: 2 (1) "Adverse Action" means any administrative, civil, equitable, or criminal 3 action permitted by a State's laws which is imposed by a Licensing Board or other 4 authority against a PA License or License application or Compact Privilege such as 5 License denial, censure, revocation, suspension, probation, monitoring of the Licensee, 6 or restriction on the Licensee's practice. HB 1388 4
7 (2) "Compact Privilege" means the authorization granted by a Remote State to 8 allow a Licensee from another Participating State to practice as a PA to provide Medical 9 Services and other licensed activity to a patient located in the Remote State under the 10 Remote State's laws and regulations. 11 (3) "Conviction" means a finding by a court that an individual is guilty of a 12 felony or misdemeanor offense through adjudication or entry of a plea of guilt or no 13 contest to the charge by the offender. 14 (4) "Criminal Background Check" means the submission of fingerprints or 15 other biometric-based information for a License applicant for the purpose of obtaining 16 that applicant's criminal history record information, as defined in 28 C.F.R. § 20.3(d), 17 from the State's criminal history record repository as defined in 28 C.F.R. § 20.3(f). 18 (5) "Data System" means the repository of information about Licensees, 19 including but not limited to License status and Adverse Actions, which is created and 20 administered under the terms of this Compact. 21 (6) "Executive Committee" means a group of directors and ex-officio individuals 22 elected or appointed pursuant to subdivision (2) of subsection 6 of section 334.1830. 23 (7) "Impaired Practitioner" means a PA whose practice is adversely affected by 24 health-related condition(s) that impact their ability to practice. 25 (8) "Investigative Information" means information, records, or documents 26 received or generated by a Licensing Board pursuant to an investigation. 27 (9) "Jurisprudence Requirement" means the assessment of an individual's 28 knowledge of the laws and Rules governing the practice of a PA in a State. 29 (10) "License" means current authorization by a State, other than authorization 30 pursuant to a Compact Privilege, for a PA to provide Medical Services, which would be 31 unlawful without current authorization. 32 (11) "Licensee" means an individual who holds a License from a State to provide 33 Medical Services as a PA. 34 (12) "Licensing Board" means any State entity authorized to license and 35 otherwise regulate PAs. 36 (13) "Medical Services" means health care services provided for the diagnosis, 37 prevention, treatment, cure or relief of a health condition, injury, or disease, as defined 38 by a State's laws and regulations. 39 (14) "Model Compact" means the model for the PA Licensure Compact on file 40 with The Council of State Governments or other entity as designated by the 41 Commission. 42 (15) "Participating State" means a State that has enacted this Compact. HB 1388 5
43 (16) "PA" means an individual who is licensed as a physician assistant in a State. 44 For purposes of this Compact, any other title or status adopted by a State to replace the 45 term "physician assistant" shall be deemed synonymous with "physician assistant" and 46 shall confer the same rights and responsibilities to the Licensee under the provisions of 47 this Compact at the time of its enactment. 48 (17) "PA Licensure Compact Commission," "Compact Commission," or 49 "Commission" mean the national administrative body created pursuant to subsection 50 1 of section 334.1830 of this Compact. 51 (18) "Qualifying License" means an unrestricted License issued by a 52 Participating State to provide Medical Services as a PA. 53 (19) "Remote State" means a Participating State where a Licensee who is not 54 licensed as a PA is exercising or seeking to exercise the Compact Privilege. 55 (20) "Rule" means a regulation promulgated by an entity that has the force and 56 effect of law. 57 (21) "Significant Investigative Information" means Investigative Information 58 that a Licensing Board, after an inquiry or investigation that includes notification and 59 an opportunity for the PA to respond if required by State law, has reason to believe is 60 not groundless and, if proven true, would indicate more than a minor infraction. 61 (22) "State" means any state, commonwealth, district, or territory of the United 62 States. 334.1810. 1. To participate in this Compact, a Participating State shall: 2 (1) License PAs. 3 (2) Participate in the Compact Commission's Data System. 4 (3) Have a mechanism in place for receiving and investigating complaints 5 against Licensees and License applicants. 6 (4) Notify the Commission, in compliance with the terms of this Compact and 7 Commission Rules, of any Adverse Action against a Licensee or License applicant and 8 the existence of Significant Investigative Information regarding a Licensee or License 9 applicant. 10 (5) Fully implement a Criminal Background Check requirement, within a time 11 frame established by Commission Rule, by its Licensing Board receiving the results of a 12 Criminal Background Check and reporting to the Commission whether the License 13 applicant has been granted a License. 14 (6) Comply with the Rules of the Compact Commission. 15 (7) Utilize passage of a recognized national exam such as the NCCPA PANCE as 16 a requirement for PA licensure. HB 1388 6
17 (8) Grant the Compact Privilege to a holder of a Qualifying License in a 18 Participating State. 19 2. Nothing in this Compact prohibits a Participating State from charging a fee 20 for granting the Compact Privilege. 334.1815. 1. To exercise the Compact Privilege, a Licensee must: 2 (1) Have graduated from a PA program accredited by the Accreditation Review 3 Commission on Education for the Physician Assistant, Inc. or other programs 4 authorized by Commission Rule. 5 (2) Hold current NCCPA certification. 6 (3) Have no felony or misdemeanor Conviction. 7 (4) Have never had a controlled substance license, permit, or registration 8 suspended or revoked by a State or by the United States Drug Enforcement 9 Administration. 10 (5) Have a unique identifier as determined by Commission Rule. 11 (6) Hold a Qualifying License. 12 (7) Have had no revocation of a License or limitation or restriction on any 13 License currently held due to an adverse action. 14 (8) If a Licensee has had a limitation or restriction on a License or Compact 15 Privilege due to an Adverse Action, two years must have elapsed from the date on which 16 the License or Compact Privilege is no longer limited or restricted due to the Adverse 17 Action. 18 (9) If a Compact Privilege has been revoked or is limited or restricted in a 19 Participating State for conduct that would not be a basis for disciplinary action in a 20 Participating State in which the Licensee is practicing or applying to practice under a 21 Compact Privilege, that Participating State shall have the discretion not to consider 22 such action as an Adverse Action requiring the denial or removal of a Compact 23 Privilege in that State. 24 (10) Notify the Compact Commission that the Licensee is seeking the Compact 25 Privilege in a Remote State. 26 (11) Meet any Jurisprudence Requirement of a Remote State in which the 27 Licensee is seeking to practice under the Compact Privilege and pay any fees applicable 28 to satisfying the Jurisprudence Requirement. 29 (12) Report to the Commission any Adverse Action taken by a non-participating 30 State within thirty (30) days after the action is taken. 31 2. The Compact Privilege is valid until the expiration or revocation of the 32 Qualifying License unless terminated pursuant to an Adverse Action. The Licensee 33 must also comply with all of the requirements of subsection 1 of this section to maintain HB 1388 7
34 the Compact Privilege in a Remote State. If the Participating State takes Adverse 35 Action against a Qualifying License, the Licensee shall lose the Compact Privilege in any 36 Remote State in which the Licensee has a Compact Privilege until all of the following 37 occur: 38 (1) The License is no longer limited or restricted; and 39 (2) Two (2) years have elapsed from the date on which the License is no longer 40 limited or restricted due to the Adverse Action. 41 3. Once a restricted or limited License satisfies the requirements of subdivisions 42 (1) and (2) of subsection 2 of this section, the Licensee must meet the requirements of 43 subsection 1 of this section to obtain a Compact Privilege in any Remote State. 44 4. For each Remote State in which a PA seeks authority to prescribe controlled 45 substances, the PA shall satisfy all requirements imposed by such State in granting or 46 renewing such authority. 334.1820. Upon a Licensee's application for a Compact Privilege, the Licensee 2 shall identify to the Commission the Participating State from which the Licensee is 3 applying, in accordance with applicable Rules adopted by the Commission, and subject 4 to the following requirements: 5 (1) When applying for a Compact Privilege, the Licensee shall provide the 6 Commission with the address of the Licensee's primary residence and thereafter shall 7 immediately report to the Commission any change in the address of the Licensee's 8 primary residence. 9 (2) When applying for a Compact Privilege, the Licensee is required to consent 10 to accept service of process by mail at the Licensee's primary residence on file with the 11 Commission with respect to any action brought against the Licensee by the Commission 12 or a Participating State, including a subpoena, with respect to any action brought or 13 investigation conducted by the Commission or a Participating State. 334.1825. 1. A Participating State in which a Licensee is licensed shall have 2 exclusive power to impose Adverse Action against the Qualifying License issued by that 3 Participating State. 4 2. In addition to the other powers conferred by State law, a Remote State shall 5 have the authority, in accordance with existing State due process law, to do all of the 6 following: 7 (1) Take Adverse Action against a PA's Compact Privilege within that State to 8 remove a Licensee's Compact Privilege or take other action necessary under applicable 9 law to protect the health and safety of its citizens. 10 (2) Issue subpoenas for both hearings and investigations that require the 11 attendance and testimony of witnesses as well as the production of evidence. Subpoenas HB 1388 8
12 issued by a Licensing Board in a Participating State for the attendance and testimony of 13 witnesses or the production of evidence from another Participating State shall be 14 enforced in the latter State by any court of competent jurisdiction, according to the 15 practice and procedure of that court applicable to subpoenas issued in proceedin