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LEGISLATURE OF NEBRASKA
ONE HUNDRED EIGHTH LEGISLATURE
SECOND SESSION
LEGISLATIVE BILL 823
Introduced by Blood, 3.
Read first time January 03, 2024
Committee: Health and Human Services
1 A BILL FOR AN ACT relating to public health; to amend section 38-2001,
2 Revised Statutes Cumulative Supplement, 2022, and section 38-131,
3 Revised Statutes Supplement, 2023; to adopt the Physician Assistant
4 (PA) Licensure Compact; to change provisions relating to criminal
5 background checks under the Uniform Credentialing Act; to require
6 criminal background checks under the Medicine and Surgery Practice
7 Act as prescribed; to harmonize provisions; to provide an operative
8 date; and to repeal the original sections.
9 Be it enacted by the people of the State of Nebraska,
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1 Section 1. This section shall be known and may be cited as the
2 Physician Assistant (PA) Licensure Compact. The State of Nebraska adopts
3 the Physician Assistant (PA) Licensure Compact in the form substantially
4 as follows:
5 SECTION 1. PURPOSE
6 In order to strengthen access to Medical Services, and in
7 recognition of the advances in the delivery of Medical Services, the
8 Participating States of the PA Licensure Compact have allied in common
9 purpose to develop a comprehensive process that complements the existing
10 authority of State Licensing Boards to license and discipline PAs and
11 seeks to enhance the portability of a License to practice as a PA while
12 safeguarding the safety of patients. This Compact allows Medical Services
13 to be provided by PAs, via the mutual recognition of the Licensee's
14 Qualifying License by other Compact Participating States. This Compact
15 also adopts the prevailing standard for PA licensure and affirms that the
16 practice and delivery of Medical Services by the PA occurs where the
17 patient is located at the time of the patient encounter, and therefore
18 requires the PA to be under the jurisdiction of the State Licensing Board
19 where the patient is located. State Licensing Boards that participate in
20 this Compact retain the jurisdiction to impose Adverse Action against a
21 Compact Privilege in that State issued to a PA through the procedures of
22 this Compact. The PA Licensure Compact will alleviate burdens for
23 military families by allowing active duty military personnel and their
24 spouses to obtain a Compact Privilege based on having an unrestricted
25 License in good standing from a Participating State.
26 SECTION 2. DEFINITIONS
27 In this Compact:
28 A. "Adverse Action" means any administrative, civil, equitable, or
29 criminal action permitted by a State's laws which is imposed by a
30 Licensing Board or other authority against a PA License or License
31 application or Compact Privilege such as License denial, censure,
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1 revocation, suspension, probation, monitoring of the Licensee, or
2 restriction on the Licensee's practice.
3 B. "Compact Privilege" means the authorization granted by a Remote
4 State to allow a Licensee from another Participating State to practice as
5 a PA to provide Medical Services and other licensed activity to a patient
6 located in the Remote State under the Remote State's laws and
7 regulations.
8 C. "Conviction" means a finding by a court that an individual is
9 guilty of a felony or misdemeanor offense through adjudication or entry
10 of a plea of guilty or no contest to the charge by the offender.
11 D. "Criminal Background Check" means the submission of fingerprints
12 or other biometric-based information for a License applicant for the
13 purpose of obtaining that applicant's criminal history record
14 information, as defined in 28 C.F.R. 20.3(d), from the State's criminal
15 history record repository as defined in 28 C.F.R. 20.3(f).
16 E. "Data System" means the repository of information about
17 Licensees, including, but not limited to, License status and Adverse
18 Actions, which is created and administered under the terms of this
19 Compact.
20 F. "Executive Committee" means a group of directors and ex officio
21 individuals elected or appointed pursuant to Section 7.F.2.
22 G. "Impaired Practitioner" means a PA whose practice is adversely
23 affected by a health-related condition that impacts the practitioner's
24 ability to practice.
25 H. "Investigative Information" means information, records, or
26 documents received or generated by a Licensing Board pursuant to an
27 investigation.
28 I. "Jurisprudence Requirement" means the assessment of an
29 individual's knowledge of the laws and Rules governing the practice of a
30 PA in a State.
31 J. "License" means current authorization by a State, other than
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1 authorization pursuant to a Compact Privilege, for a PA to provide
2 Medical Services, which would be unlawful without current authorization.
3 K. "Licensee" means an individual who holds a License from a State
4 to provide Medical Services as a PA.
5 L. "Licensing Board" means any State entity authorized to license
6 and otherwise regulate PAs.
7 M. "Medical Services" means health care services provided for the
8 diagnosis, prevention, treatment, cure, or relief of a health condition,
9 injury, or disease, as defined by a State's laws and regulations.
10 N. "Model Compact" means the model for the PA Licensure Compact on
11 file with The Council of State Governments or other entity as designated
12 by the Commission.
13 O. "Participating State" means a State that has enacted this
14 Compact.
15 P. "PA" means an individual who is licensed as a physician assistant
16 in a State. For purposes of this Compact, any other title or status
17 adopted by a State to replace the term "physician assistant" shall be
18 deemed synonymous with "physician assistant" and shall confer the same
19 rights and responsibilities to the Licensee under the provisions of this
20 Compact at the time of its enactment.
21 Q. "PA Licensure Compact Commission," "Compact Commission," or
22 "Commission" mean the national administrative body created pursuant to
23 Section 7.A of this Compact.
24 R. "Qualifying License" means an unrestricted License issued by a
25 Participating State to provide Medical Services as a PA.
26 S. "Remote State" means a Participating State where a Licensee who
27 is not licensed as a PA is exercising or seeking to exercise the Compact
28 Privilege.
29 T. "Rule" means a regulation promulgated by an entity that has the
30 force and effect of law.
31 U. "Significant Investigative Information" means Investigative
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1 Information that a Licensing Board, after an inquiry or investigation
2 that includes notification and an opportunity for the PA to respond if
3 required by State law, has reason to believe is not groundless and, if
4 proven true, would indicate more than a minor infraction.
5 V. "State" means any state, commonwealth, district, or territory of
6 the United States.
7 SECTION 3. STATE PARTICIPATION IN THIS COMPACT
8 A. To participate in this Compact, a Participating State shall:
9 1. License PAs.
10 2. Participate in the Compact Commission's Data System.
11 3. Have a mechanism in place for receiving and investigating
12 complaints against Licensees and License applicants.
13 4. Notify the Commission, in compliance with the terms of this
14 Compact and Commission Rules, of any Adverse Action against a Licensee or
15 License applicant and the existence of Significant Investigative
16 Information regarding a Licensee or License applicant.
17 5. Fully implement a Criminal Background Check requirement, within a
18 timeframe established by Commission Rule, by its Licensing Board
19 receiving the results of a Criminal Background Check and reporting to the
20 Commission whether the License applicant has been granted a License.
21 6. Comply with the Rules of the Compact Commission.
22 7. Utilize passage of a recognized national exam such as the
23 Physician Assistant National Certifying Examination (PANCE) of the
24 National Commission on Certification of Physician Assistants (NCCPA) as a
25 requirement for PA licensure.
26 8. Grant the Compact Privilege to a holder of a Qualifying License
27 in a Participating State.
28 B. Nothing in this Compact prohibits a Participating State from
29 charging a fee for granting the Compact Privilege.
30 SECTION 4. COMPACT PRIVILEGE
31 A. To exercise the Compact Privilege, a Licensee must:
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1 1. Have graduated from a PA program accredited by the Accreditation
2 Review Commission on Education for the Physician Assistant, Inc., or
3 other programs authorized by Commission Rule.
4 2. Hold current National Commission on Certification of Physician
5 Assistants (NCCPA) certification.
6 3. Have no felony or misdemeanor Conviction.
7 4. Have never had a controlled substance license, permit, or
8 registration suspended or revoked by a State or by the United States Drug
9 Enforcement 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
13 on any License currently held due to an Adverse Action.
14 8. If a Licensee has had a limitation or restriction on a License or
15 Compact Privilege due to an Adverse Action, two years must have elapsed
16 from the date on which the License or Compact Privilege is no longer
17 limited or restricted due to the Adverse Action.
18 9. If a Compact Privilege has been revoked or is limited or
19 restricted in a Participating State for conduct that would not be a basis
20 for disciplinary action in a Participating State in which the Licensee is
21 practicing or applying to practice under a Compact Privilege, that
22 Participating State shall have the discretion not to consider such action
23 as an Adverse Action requiring the denial or removal of a Compact
24 Privilege in that State.
25 10. Notify the Compact Commission that the Licensee is seeking the
26 Compact Privilege in a Remote State.
27 11. Meet any Jurisprudence Requirement of a Remote State in which
28 the Licensee is seeking to practice under the Compact Privilege and pay
29 any fees applicable to satisfying the Jurisprudence Requirement.
30 12. Report to the Commission any Adverse Action taken by a non-
31 Participating State within thirty days after the action is taken.
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1 B. The Compact Privilege is valid until the expiration or revocation
2 of the Qualifying License unless terminated pursuant to an Adverse
3 Action. The Licensee must also comply with all of the requirements of
4 subsection A above to maintain the Compact Privilege in a Remote State.
5 If the Participating State takes Adverse Action against a Qualifying
6 License, the Licensee shall lose the Compact Privilege in any Remote
7 State in which the Licensee has a Compact Privilege until all of the
8 following occur:
9 1. The License is no longer limited or restricted; and
10 2. Two years have elapsed from the date on which the License is no
11 longer limited or restricted due to the Adverse Action.
12 C. Once a restricted or limited License satisfies the requirements
13 of subsections B.1 and 2, the Licensee must meet the requirements of
14 subsection A to obtain a Compact Privilege in any Remote State.
15 D. For each Remote State in which a PA seeks authority to prescribe
16 controlled substances, the PA shall satisfy all requirements imposed by
17 such State in granting or renewing such authority.
18 SECTION 5. DESIGNATION OF THE STATE FROM WHICH THE LICENSEE IS
19 APPLYING FOR A COMPACT PRIVILEGE
20 A. Upon a Licensee's application for a Compact Privilege, the
21 Licensee shall identify to the Commission the Participating State from
22 which the Licensee is applying, in accordance with applicable Rules
23 adopted by the Commission, and subject to the following requirements:
24 1. When applying for a Compact Privilege, the Licensee shall provide
25 the Commission with the address of the Licensee's primary residence and
26 thereafter shall immediately report to the Commission any change in the
27 address of the Licensee's primary residence.
28 2. When applying for a Compact Privilege, the Licensee is required
29 to consent to accept service of process by mail at the Licensee's primary
30 residence on file with the Commission with respect to any action brought
31 against the Licensee by the Commission or a Participating State,
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1 including a subpoena, with respect to any action brought or investigation
2 conducted by the Commission or a Participating State.
3 SECTION 6. ADVERSE ACTIONS
4 A. A Participating State in which a Licensee is licensed shall have
5 exclusive power to impose Adverse Action against the Qualifying License
6 issued by that Participating State.
7 B. In addition to the other powers conferred by State law, a Remote
8 State shall have the authority, in accordance with existing State due
9 process law, to do all of the following:
10 1. Take Adverse Action against a PA's Compact Privilege within that
11 State to remove a Licensee's Compact Privilege or take other action
12 necessary under applicable law to protect the health and safety of its
13 citizens.
14 2. Issue subpoenas for both hearings and investigations that require
15 the attendance and testimony of witnesses as well as the production of
16 evidence. Subpoenas issued by a Licensing Board in a Participating State
17 for the attendance and testimony of witnesses or the production of
18 evidence from another Participating State shall be enforced in the latter
19 State by any court of competent jurisdiction, according to the practice
20 and procedure of that court applicable to subpoenas issued in proceedings
21 pending before it. The issuing authority shall pay any witness fees,
22 travel expenses, mileage, and other fees required by the service statutes
23 of the State in which the witnesses or evidence are located.
24 3. Notwithstanding subsection 2, subpoenas may not be issued by a
25 Participating State to gather evidence of conduct in another State that
26 is lawful in that other State for the purpose of taking Adverse Action
27 against a Licensee's Compact Privilege or application for a Compact
28 Privilege in that Participating State.
29 4. Nothing in this Compact authorizes a Participating State to
30 impose discipline against a PA's Compact Privilege or to deny an
31 application for a Compact Privilege in that Participating State for the