25.0594.01000
Sixty-ninth
Legislative Assembly SENATE BILL NO. 2108
of North Dakota
Introduced by
Senators Barta, Lee, Meyer, Roers
Representatives Pyle, M. Ruby
1 A BILL for an Act to create and enact chapter 43-17.5 of the North Dakota Century Code,
2 relating to the physician assistant licensure compact.
3 BE IT ENACTED BY THE LEGISLATIVE ASSEMBLY OF NORTH DAKOTA:
4 SECTION 1. Chapter 43-17.5 of the North Dakota Century Code is created and enacted as
5 follows:
6 43-17.5-01. Purpose.
7 1. In order to strengthen access to medical services, and in recognition of the advances
8 in the delivery of medical services, the participating states of the physician assistant
9 licensure compact have allied in common purpose to develop a comprehensive
10 process that complements the existing authority of state licensing boards to license
11 and discipline physician assistants and seeks to enhance the portability of a license to
12 practice as a physician assistant while safeguarding the safety of patients.
13 2. This compact:
14 a. Allows medical services to be provided by physician assistants, via the mutual
15 recognition of the licensee's qualifying license by other compact participating
16 states.
17 b. Adopts the prevailing standard for physician assistant licensure.
18 c. Affirms the practice and delivery of medical services by the physician assistant
19 occurs where the patient is located at the time of the patient encounter, and
20 therefore requires the physician assistant to be under the jurisdiction of the state
21 licensing board where the patient is located.
22 3. State licensing boards that participate in this compact retain the jurisdiction to impose
23 adverse action against a compact privilege in that state issued to a physician assistant
24 through the procedures of this compact. The physician assistant licensure compact will
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1 alleviate burdens for military families by allowing active duty military personnel and
2 their spouses to obtain a compact privilege based on having an unrestricted license in
3 good standing from a participating state.
4 43-17.5-02. Definitions.
5 In this compact:
6 1. "Adverse action" means any administrative, civil, equitable, or criminal action
7 permitted by a state's laws which is imposed by a licensing board or other authority
8 against a physician assistant license or license application or compact privilege
9 including license denial, censure, revocation, suspension, probation, monitoring of the
10 licensee, or restriction on the licensee's practice.
11 2. "Compact privilege" means the authorization granted by a remote state to allow a
12 licensee from another participating state to practice as a physician assistant to provide
13 medical services and other licensed activity to a patient located in the remote state
14 under the remote state's laws and regulations.
15 3. "Conviction" means a finding by a court that an individual is guilty of a felony or
16 misdemeanor offense through adjudication or entry of a plea of guilt or no contest to
17 the charge by the offender.
18 4. "Criminal background check" means the submission of fingerprints or other biometric-
19 based information for a license applicant for the purpose of obtaining that applicant's
20 criminal history record information, as defined in 28 C.F.R. § 20.3(d), from the state's
21 criminal history record repository as defined in 28 C.F.R. § 20.3(f).
22 5. "Data system" means the repository of information about licensees, including license
23 status and adverse actions, which is created and administered under the terms of this
24 compact.
25 6. "Executive committee" means a group of directors and ex officio individuals elected or
26 appointed under section 43-17.5-07.
27 7. "Impaired practitioner" means a physician assistant whose practice is adversely
28 affected by health-related conditions that impact their ability to practice.
29 8. "Investigative information" means information, records, or documents received or
30 generated by a licensing board pursuant to an investigation.
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1 9. "Jurisprudence requirement" means the assessment of an individual's knowledge of
2 the laws and rules governing the practice of a physician assistant in a state.
3 10. "License" means current authorization by a state, other than authorization pursuant to
4 a compact privilege, for a physician assistant to provide medical services, which would
5 be unlawful without current authorization.
6 11. "Licensee" means an individual who holds a license from a state to provide medical
7 services as a physician assistant.
8 12. "Licensing board" means any state entity authorized to license and otherwise regulate
9 physician assistants.
10 13. "Medical services" means health care services provided for the diagnosis, prevention,
11 treatment, cure or relief of a health condition, injury, or disease, as defined by a state's
12 laws and regulations.
13 14. "Model compact" means the model for the physician assistant licensure compact on
14 file with the council of state governments or other entity as designated by the
15 commission.
16 15. "Participating state" means a state that has enacted this compact.
17 16. "Physician assistant" means an individual who is licensed as a physician assistant in a
18 state. For purposes of this compact, any other title or status adopted by a state to
19 replace the term "physician assistant" is deemed synonymous with "physician
20 assistant" and confers the same rights and responsibilities to the licensee under the
21 provisions of this compact at the time of its enactment.
22 17. "Physician assistant licensure compact commission", "compact commission", or
23 "commission" mean the national administrative body created pursuant to section
24 43-17.5-07 of this compact.
25 18. "Qualifying license" means an unrestricted license issued by a participating state to
26 provide medical services as a physician assistant.
27 19. "Remote state" means a participating state where a licensee who is not licensed as a
28 physician assistant is exercising or seeking to exercise the compact privilege.
29 20. "Rule" means a regulation promulgated by an entity that has the force and effect of
30 law.
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1 21. "Significant investigative information" means investigative information that a licensing
2 board, after an inquiry or investigation that includes notification and an opportunity for
3 the physician assistant to respond if required by state law, has reason to believe is not
4 groundless and, if proven true, would indicate more than a minor infraction.
5 22. "State" means any state, commonwealth, district, or territory of the United States.
6 43-17.5-03. State participation in this compact.
7 1. To participate in this compact, a participating state shall:
8 a. License physician assistants;
9 b. Participate in the compact commission's data system;
10 c. Have a mechanism in place for receiving and investigating complaints against
11 licensees and license applicants;
12 d. Notify the commission, in compliance with the terms of this compact and
13 commission rules, of any adverse action against a licensee or license applicant
14 and the existence of significant investigative information regarding a licensee or
15 license applicant;
16 e. Fully implement a criminal background check requirement, within a time frame
17 established by commission rule, by its licensing board receiving the results of a
18 criminal background check and reporting to the commission whether the license
19 applicant has been granted a license;
20 f. Comply with the rules of the compact commission;
21 g. Utilize passage of a recognized national exam, such as the national commission
22 on certification of physician assistants' physician assistant national certifying
23 examination, as a requirement for physician assistant licensure; and
24 h. Grant the compact privilege to a holder of a qualifying license in a participating
25 state.
26 2. This compact does not prohibit a participating state from charging a fee for granting
27 the compact privilege.
28 43-17.5-04. Compact privilege.
29 1. To exercise the compact privilege, a licensee shall:
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1 a. Have graduated from a physician assistant program accredited by the
2 accreditation review commission on education for the physician assistant or other
3 program authorized by commission rule;
4 b. Hold current national commission on certification of physician assistants'
5 certification;
6 c. Have no felony or misdemeanor conviction;
7 d. Have never had a controlled substance license, permit, or registration suspended
8 or revoked by a state or by the United States drug enforcement administration;
9 e. Have a unique identifier as determined by commission rule;
10 f. Hold a qualifying license;
11 g. Have had no revocation of a license or limitation or restriction on any license
12 currently held due to an adverse action, or if a licensee had a limitation or
13 restriction on a license or compact privilege due to an adverse action, two years
14 has elapsed from the date on which the license or compact privilege is no longer
15 limited or restricted due to the adverse action, or if a compact privilege has been
16 revoked or is limited or restricted in a participating state for conduct that would
17 not be a basis for disciplinary action in a participating state in which the licensee
18 is practicing or applying to practice under a compact privilege, that participating
19 state may not consider such action as an adverse action requiring the denial or
20 removal of a compact privilege in that state;
21 h. Notify the compact commission that the licensee is seeking the compact privilege
22 in a remote state;
23 i. Meet any jurisprudence requirement of a remote state in which the licensee is
24 seeking to practice under the compact privilege and pay any fees applicable to
25 satisfying the jurisprudence requirement; and
26 j. Report to the commission any adverse action taken by a nonparticipating state
27 within thirty days after the action is taken.
28 2. The compact privilege is valid until the expiration or revocation of the qualifying license
29 unless terminated pursuant to an adverse action. The licensee shall comply with the
30 requirements of subsection 1 to maintain the compact privilege in a remote state. If the
31 participating state takes adverse action against a qualifying license, the licensee loses
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1 the compact privilege in any remote state in which the licensee has a compact
2 privilege until all of the following occur:
3 a. The license is no longer limited or restricted; and
4 b. Two years have elapsed from the date on which the license is no longer limited or
5 restricted due to the adverse action.
6 3. Once a restricted or limited license satisfies the requirements of subsection 2, the
7 licensee shall meet the requirements of subsection 1 to obtain a compact privilege in
8 any remote state.
9 4. For each remote state in which a physician assistant seeks authority to prescribe
10 controlled substances, the physician assistant shall satisfy all requirements imposed
11 by such state in granting or renewing such authority.
12 43-17.5-05. Designation of the state from which a licensee is applying for a compact
13 privilege.
14 Upon a licensee's application for a compact privilege, the licensee shall identify to the
15 commission the participating state from which the licensee is applying, in accordance with
16 applicable rules adopted by the commission, and subject to the following requirements when
17 applying for a compact privilege, the licensee shall:
18 1. Provide the commission with the address of the licensee's primary residence and
19 thereafter shall immediately report to the commission any change in the address of the
20 licensee's primary residence.
21 2. Consent to accept service of process by mail at the licensee's primary residence on
22 file with the commission with respect to any action brought against the licensee by the
23 commission or a participating state, including a subpoena, with respect to any action
24 brought or investigation conducted by the commission or a participating state.
25 43-17.5-06. Adverse actions.
26 1. A participating state in which a licensee is licensed has exclusive power to impose
27 adverse action against the qualifying license issued by that participating state.
28 2. In addition to the other powers conferred by state law, a remote state, in accordance
29 with existing state due process law, may:
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1 a. Take adverse action against a physician assistant's compact privilege within that
2 state to remove a licensee's compact privilege or take other action necessary
3 under applicable law to protect the health and safety of its citizens.
4 b. Issue subpoenas for both hearings and investigations that require the attendance
5 and testimony of witnesses as well as the production of evidence. Subpoenas
6 issued by a licensing board in a participating state for the attendance and
7 testimony of witnesses or the production of evidence from another participating
8 state must be enforced in the latter state by any court of competent jurisdiction,
9 according to the practice and procedure of that court applicable to subpoenas
10 issued in proceedings pending before it. The issuing authority shall pay any
11 witness fees, travel expenses, mileage and other fees required by the service
12 statutes of the state in which the witnesses or evidence are located.
13 3. Notwithstanding subsection 2, subpoenas may not be issued by a participating state to
14 gather evidence of conduct in another state that is lawful in that other state for the
15 purpose of taking adverse action against a licensee's compact privilege or application
16 for a compact privilege in that participating state.
17 4. This compact does not authorize a participating state to impose discipline against a
18 physician assistant's compact privilege or to deny an application for a compact
19 privilege in that participating state for the individual's otherwise lawful practice in
20 another state.
21 5. For purposes of taking adverse action, the participating state which issued the
22 qualifying license shall give the same priority and effect to reported conduct received
23 from any other participating state as it would if the conduct had occurred within the
24 participating state which issued the qualifying license. In so doing, that participating
25 state shall apply its own state laws to determine appropriate action.
26 6. A participating state, if otherwise permitted by state law, may recover from the affected
27 physician assistant the costs of investigations and disposition of cases resulting from
28 any adverse action taken against that physician assistant.
29 7. A participating state may take adverse action based on the factual findings of a remote
30 state, provided the participating state follows its own procedures for taking the adverse
31 action.
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1 8. Joint investigations.
2 a. In addition to the authority granted to a participating state by its respective state
3 physician assistant laws and regulations or other applicable state law, any
4 participa