Chapter 448

448.988(1) (1) Purpose. In order to strengthen access to medical services, and in recognition of the advances in the delivery of medical services, the participating states of the PA licensure compact have allied in common purpose to develop a comprehensive process that complements the existing authority of state licensing boards to license and discipline PAs and seeks to enhance the portability of a license to practice as a PA while safeguarding the safety of patients. This compact allows medical services to be provided by PAs, via the mutual recognition of the licensee’s qualifying license by other compact participating states. This compact also adopts the prevailing standard for PA licensure and affirms that the practice and delivery of medical services by the PA occurs where the patient is located at the time of the patient encounter, and therefore requires the PA to be under the jurisdiction of the state licensing board where the patient is located. State licensing boards that participate in this compact retain the jurisdiction to impose adverse action against a compact privilege in that state issued to a PA through the procedures of this compact. The PA licensure compact will alleviate burdens for military families by allowing active duty military personnel and their spouses to obtain a compact privilege based on having an unrestricted license in good standing from a participating state.

448.988(2) (2) Definitions. In this compact:

448.988(2)(a) (a) “Adverse action” means any administrative, civil, equitable, or criminal action permitted by a state’s laws which is imposed by a licensing board or other authority against a PA license or license application or compact privilege such as license denial, censure, revocation, suspension, probation, monitoring of the licensee, or restriction on the licensee’s practice.

448.988(2)(b) (b) “Compact privilege” means the authorization granted by a remote state to allow a licensee from another participating state to practice as a PA to provide medical services and other licensed activity to a patient located in the remote state under the remote state’s laws and regulations.

448.988(2)(c) (c) “Conviction” means a finding by a court that an individual is guilty of a felony or misdemeanor offense through adjudication or entry of a plea of guilt or no contest to the charge by the offender.

448.988(2)(d) (d) “Criminal background check” means the submission of fingerprints or other biometric-based information for a license applicant for the purpose of obtaining that applicant’s criminal history record information, as defined in 28 CFR 20.3 (d), from the state’s criminal history record repository, as defined in 28 CFR 20.3 (f).

448.988(2)(e) (e) “Data system” means the repository of information about licensees, including but not limited to license status and adverse actions, which is created and administered under the terms of this compact.

448.988(2)(f) (f) “Executive committee” means a group of directors and ex officio individuals elected or appointed pursuant to sub. (7) (f) 2.

448.988(2)(g) (g) “Impaired practitioner” means a PA whose practice is adversely affected by health-related condition(s) that impact their ability to practice.

448.988(2)(h) (h) “Investigative information” means information, records, or documents received or generated by a licensing board pursuant to an investigation.

448.988(2)(i) (i) “Jurisprudence requirement” means the assessment of an individual’s knowledge of the laws and rules governing the practice of a PA in a state.

448.988(2)(j) (j) “License” means current authorization by a state, other than authorization pursuant to a compact privilege, for a PA to provide medical services, which would be unlawful without current authorization.

448.988(2)(k) (k) “Licensee” means an individual who holds a license from a state to provide medical services as a PA.

448.988(2)(L) (L) “Licensing board” means any state entity authorized to license and otherwise regulate PAs.

448.988(2)(m) (m) “Medical services” means health care services provided for the diagnosis, prevention, treatment, cure or relief of a health condition, injury, or disease, as defined by a state’s laws and regulations.

448.988(2)(n) (n) “Model compact” means the model for the PA licensure compact on file with the Council of State Governments or other entity as designated by the commission.

448.988(2)(o) (o) “Participating state” means a state that has enacted this compact.

448.988(2)(p) (p) “PA” means an individual who is licensed as a physician assistant in a state. For purposes of this compact, any other title or status adopted by a state to replace the term “physician assistant” shall be deemed synonymous with “physician assistant” and shall confer the same rights and responsibilities to the licensee under the provisions of this compact at the time of its enactment.

448.988(2)(q) (q) “PA licensure compact commission,” “compact commission,” or “commission” mean the national administrative body created pursuant to sub. (7) (a).

448.988(2)(r) (r) “Qualifying license” means an unrestricted license issued by a participating state to provide medical services as a PA.

448.988(2)(s) (s) “Remote state” means a participating state where a licensee who is not licensed as a PA is exercising or seeking to exercise the compact privilege.

448.988(2)(t) (t) “Rule” means a regulation promulgated by an entity that has the force and effect of law.

448.988(2)(u) (u) “Significant investigative information” means investigative information that a licensing board, after an inquiry or investigation that includes notification and an opportunity for the PA to respond if required by state law, has reason to believe is not groundless and, if proven true, would indicate more than a minor infraction.

448.988(2)(v) (v) “State” means any state, commonwealth, district, or territory of the United States.

448.988(3) (3) State participation in this compact.

448.988(3)(a) (a) To participate in this compact, a participating state shall:

448.988(3)(a)1. 1. License PAs.

448.988(3)(a)2. 2. Participate in the compact commission’s data system.

448.988(3)(a)3. 3. Have a mechanism in place for receiving and investigating complaints against licensees and license applicants.

448.988(3)(a)4. 4. Notify the commission, in compliance with the terms of this compact and commission rules, of any adverse action against a licensee or license applicant and the existence of significant investigative information regarding a licensee or license applicant.

448.988(3)(a)5. 5. Fully implement a criminal background check requirement, within a time frame established by commission rule, by its licensing board receiving the results of a criminal background check and reporting to the commission whether the license applicant has been granted a license.

448.988(3)(a)6. 6. Comply with the rules of the compact commission.

448.988(3)(a)7. 7. Utilize passage of a recognized national exam such as the NCCPA PANCE as a requirement for PA licensure.

448.988(3)(a)8. 8. Grant the compact privilege to a holder of a qualifying license in a participating state.

448.988(3)(b) (b) Nothing in this compact prohibits a participating state from charging a fee for granting the compact privilege.

448.988(4) (4) Compact privilege.

448.988(4)(a) (a) To exercise the compact privilege, a licensee must:

448.988(4)(a)1. 1. Have graduated from a PA program accredited by the Accreditation Review Commission on Education for the Physician Assistant, Inc. or other programs authorized by commission rule.

448.988(4)(a)2. 2. Hold current NCCPA certification.

448.988(4)(a)3. 3. Have no felony or misdemeanor conviction.

448.988(4)(a)4. 4. Have never had a controlled substance license, permit, or registration suspended or revoked by a state or by the United States drug enforcement administration.

448.988(4)(a)5. 5. Have a unique identifier as determined by commission rule.

448.988(4)(a)6. 6. Hold a qualifying license.

448.988(4)(a)7. 7. Have had no revocation of a license or limitation or restriction on any license currently held due to an adverse action.

448.988(4)(a)8. 8. If a licensee has had a limitation or restriction on a license or compact privilege due to an adverse action, two years must have elapsed from the date on which the license or compact privilege is no longer limited or restricted due to the adverse action.

448.988(4)(a)9. 9. If a compact privilege has been revoked or is limited or restricted in a participating state for conduct that would not be a basis for disciplinary action in a participating state in which the licensee is practicing or applying to practice under a compact privilege, that participating state shall have the discretion not to consider such action as an adverse action requiring the denial or removal of a compact privilege in that state.

448.988(4)(a)10. 10. Notify the compact commission that the licensee is seeking the compact privilege in a remote state.

448.988(4)(a)11. 11. Meet any jurisprudence requirement of a remote state in which the licensee is seeking to practice under the compact privilege and pay any fees applicable to satisfying the jurisprudence requirement.

448.988(4)(a)12. 12. Report to the commission any adverse action taken by a nonparticipating state within thirty (30) days after the action is taken.

448.988(4)(b) (b) The compact privilege is valid until the expiration or revocation of the qualifying license unless terminated pursuant to an adverse action. The licensee must also comply with all of the requirements of par. (a) above to maintain the compact privilege in a remote state. If the participating state takes adverse action against a qualifying license, the licensee shall lose the compact privilege in any remote state in which the licensee has a compact privilege until all of the following occur:

448.988(4)(b)1. 1. The license is no longer limited or restricted; and

448.988(4)(b)2. 2. Two (2) years have elapsed from the date on which the license is no longer limited or restricted due to the adverse action.

448.988(4)(c) (c) Once a restricted or limited license satisfies the requirements of par. (b) 1. and 2., the licensee must meet the requirements of par. (a) to obtain a compact privilege in any remote state.

448.988(4)(d) (d) For each remote state in which a PA seeks authority to prescribe controlled substances, the PA shall satisfy all requirements imposed by such state in granting or renewing such authority.

448.988(5) (5) Designation of the state from which licensee is applying for a compact privilege. Upon a licensee’s application for a compact privilege, the licensee shall identify to the commission the participating state from which the licensee is applying, in accordance with applicable rules adopted by the commission, and subject to the following requirements:

448.988(5)(a) (a) When applying for a compact privilege, the licensee shall provide the commission with the address of the licensee’s primary residence and thereafter shall immediately report to the commission any change in the address of the licensee’s primary residence.

448.988(5)(b) (b) When applying for a compact privilege, the licensee is required to consent to accept service of process by mail at the licensee’s primary residence on file with the commission with respect to any action brought against the licensee by the commission or a participating state, including a subpoena, with respect to any action brought or investigation conducted by the commission or a participating state.

448.988(6) (6) Adverse actions.

448.988(6)(a) (a) A participating state in which a licensee is licensed shall have exclusive power to impose adverse action against the qualifying license issued by that participating state.

448.988(6)(b) (b) In addition to the other powers conferred by state law, a remote state shall have the authority, in accordance with existing state due process law, to do all of the following:

448.988(6)(b)1. 1. Take adverse action against a PA’s compact privilege within that state to remove a licensee’s compact privilege or take other action necessary under applicable law to protect the health and safety of its citizens.

448.988(6)(b)2. 2. Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses as well as the production of evidence. Subpoenas issued by a licensing board in a participating state for the attendance and testimony of witnesses or the production of evidence from another participating state shall be enforced in the latter state by any court of competent jurisdiction, according to the practice and procedure of that court applicable to subpoenas issued in proceedings pending before it. The issuing authority shall pay any witness fees, travel expenses, mileage and other fees required by the service statutes of the state in which the witnesses or evidence are located.

448.988(6)(b)3. 3. Notwithstanding subd. 2., subpoenas may not be issued by a participating state to gather evidence of conduct in another state that is lawful in that other state for the purpose of taking adverse action against a licensee’s compact privilege or application for a compact privilege in that participating state.

448.988(6)(b)4. 4. Nothing in this compact authorizes a participating state to impose discipline against a PA’s compact privilege or to deny an application for a compact privilege in that participating state for the individual’s otherwise lawful practice in another state.

448.988(6)(c) (c) For purposes of taking adverse action, the participating state which issued the qualifying license shall give the same priority and effect to reported conduct received from any other participating state as it would if the conduct had occurred within the participating state which issued the qualifying license. In so doing, that participating state shall apply its own state laws to determine appropriate action.

448.988(6)(d) (d) A participating state, if otherwise permitted by state law, may recover from the affected PA the costs of investigations and disposition of cases resulting from any adverse action taken against that PA.

448.988(6)(e) (e) A participating state may take adverse action based on the factual findings of a remote state, provided that the participating state follows its own procedures for taking the adverse action.

448.988(6)(f) (f) Joint investigations.

448.988(6)(f)1. 1. In addition to the authority granted to a participating state by its respective state PA laws and regulations or other applicable state law, any participating state may participate with other participating states in joint investigations of licensees.

448.988(6)(f)2. 2. Participating states shall share any investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under this compact.

448.988(6)(g) (g) If an adverse action is taken against a PA’s qualifying license, the PA’s compact privilege in all remote states shall be deactivated until two (2) years have elapsed after all restrictions have been removed from the state license. All disciplinary orders by the participating state which issued the qualifying license that impose adverse action against a PA’s license shall include a statement that the PA’s compact privilege is deactivated in all participating states during the pendency of the order.

448.988(6)(h) (h) If any participating state takes adverse action, it promptly shall notify the administrator of the data system.

448.988(7) (7) Establishment of the PA licensure compact commission.

448.988(7)(a) (a) The participating states hereby create and establish a joint government agency and national administrative body known as the PA licensure compact commission. The commission is an instrumentality of the compact states acting jointly and not an instrumentality of any one state. The commission shall come into existence on or after the effective date of the compact as set forth in sub. (11) (a).

448.988(7)(b) (b) Membership, voting, and meetings.

448.988(7)(b)1. 1. Each participating state shall have and be limited to one (1) delegate selected by that participating state’s licensing board or, if the state has more than one licensing board, selected collectively by the participating state’s licensing boards.

448.988(7)(b)2. 2. The delegate shall be either:

448.988(7)(b)2.a. a. A current PA, physician or public member of a licensing board or PA council/committee; or

448.988(7)(b)2.b. b. An administrator of a licensing board.

448.988(7)(b)3. 3. Any delegate may be removed or suspended from office as provided by the laws of the state from which the delegate is appointed.

448.988(7)(b)4. 4. The participating state licensing board shall fill any vacancy occurring in the commission within sixty (60) days.

448.988(7)(b)5. 5. Each delegate shall be entitled to one (1) vote on all matters voted on by the commission and shall otherwise have an opportunity to participate in the business and affairs of the commission. A delegate shall vote in person or by such other means as provided in the bylaws. The bylaws may provide for delegates’ participation in meetings by telecommunications, video conference, or other means of communication.

448.988(7)(b)6. 6. The commission shall meet at least once during each calendar year. Additional meetings shall be held as set forth in this compact and the bylaws.

448.988(7)(b)7. 7. The commission shall establish by rule a term of office for delegates.

448.988(7)(c) (c) The commission shall have the following powers and duties:

448.988(7)(c)1. 1. Establish a code of ethics for the commission;

448.988(7)(c)2. 2. Establish the fiscal year of the commission;

448.988(7)(c)3. 3. Establish fees;

448.988(7)(c)4. 4. Establish bylaws;