SB 281 — An Act relating to the rural health transformation program; relating to physician assistants; relating to collaborative agreements between physicians and physician assistants; relating to the interstate medical licensure compact; relating to the PA licensure compact; relating to the practice of medicine; relating to the psychology interjurisdictional compact; relating to health care providers; relating to the recognition of EMS personnel licensure interstate compact; relating to provisions regarding physician assistants in contracts between certain health care providers and health care insurers; and establishing the Rural Health Transformation Program Advisory Council.

a behavior analyst licensed under AS 08.15;

a chiropractor licensed under AS 08.20;

a professional or associate counselor licensed under SB0281B -3- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H AS 08.29;

a dental hygienist licensed under AS 08.32;

a dentist licensed under AS 08.36;

a dietitian or nutritionist licensed under AS 08.38;

a naturopath licensed under AS 08.45;

a genetic counselor licensed under AS 08.53;

a marital and family therapist licensed under AS 08.63;

a physician licensed under AS 08.64;

a podiatrist, osteopath, or physician assistant licensed under AS 08.64;

a direct-entry midwife certified under AS 08.65;

a nurse licensed under AS 08.68;

a dispensing optician licensed under AS 08.71;

an optometrist licensed under AS 08.72;

a pharmacist licensed under AS 08.80;

a physical therapist or occupational therapist licensed under AS 08.84;

a psychologist or psychological associate licensed under AS 08.86;

or a social worker licensed under AS 08.95;

(B) a physician licensed in another state;

or (C) a member of a multidisciplinary care team who is licensed in another state;

* Sec.

5.

AS 08.02.130(j)(1), as amended by sec.

4 of this Act, is amended to read:

(1) "health care provider" means (A) an audiologist or speech-language pathologist licensed under AS 08.11;

a behavior analyst licensed under AS 08.15;

a chiropractor licensed under AS 08.20;

a professional or associate counselor licensed under AS 08.29;

a dental hygienist licensed under AS 08.32;

a dentist licensed under AS 08.36;

a dietitian or nutritionist licensed under AS 08.38;

a naturopath licensed under AS 08.45;

a genetic counselor licensed under AS 08.53;

a marital and family therapist licensed under AS 08.63;

a physician licensed under AS 08.64;

a podiatrist, osteopath, or physician assistant licensed under AS 08.64;

a direct-entry midwife certified under AS 08.65;

a nurse licensed under AS 08.68;

a dispensing optician licensed under AS 08.71;

an optometrist licensed under AS 08.72;

a pharmacist licensed under AS 08.80;

a physical therapist or occupational therapist licensed under AS 08.84;

a psychologist or psychological associate licensed under AS 08.86;

a respiratory care practitioner licensed under AS 08.90 and authorized under AS 08.90.060(a)(4)(H);

or a social worker licensed under AS 08.95;

CSSB 281(HSS) -4- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (B) a physician licensed in another state;

or (C) a member of a multidisciplinary care team who is licensed in another state;

* Sec.

6.

AS 08.02.130(j)(4) is amended to read:

(4) "member of a multidisciplinary care team" means an audiologist, speech-language pathologist, behavior analyst, professional counselor, dietitian, genetic counselor, nutritionist, naturopath, marital and family therapist, podiatrist, osteopath, physician assistant, nurse, pharmacist, physical therapist, occupational therapist, psychologist or psychological associate, advanced nurse practitioner, or social worker who is a member of a team coordinated by a physician licensed in another state who meets the requirements of (b)(3) of this section;

* Sec.

7.

AS 08 is amended by adding a new chapter to read:

Chapter 53.

Genetic Counselors.

Article 1.

Licensing of Genetic Counselors.

08.53.100.08.64.010.

LicenseCreation required;and membership of State Medical Board.

title.The SB0281A -1- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N governor shall appoint a board of medical examiners, to be known as the State Medical Board, consisting of five physicians licensed in the state and residing in as many separate geographical areas of the state as possible, one physician assistant licensed in the state [UNDER AS 08.64.107], and two persons with no direct financial interest in the health care industry.

(a) Except as provided in AS 08.53.150 and 08.53.210, a person may not practice, offer or attempt to practice, or advertise or announce as being prepared or qualified to practice as a genetic counselor without a license.

(b) Unless licensed under this chapter or excepted from licensure under AS 08.53.210(a), a person may not use or publicly display a title in connection with the person's name, including "genetic counselor," "licensed genetic counselor," "gene counselor," "genetic consultant," "genetic associate," or a similar title or associated letters, abbreviations, or insignia indicating that the person holds a genetic counseling license.

Sec.

08.53.110.

Qualifications for license.

(a) The board shall issue a license to practice genetic counseling to an applicant who (1) pays the required fees and applies on a form prescribed by the board;

and (2) provides evidence satisfactory to the board that the applicant (A) has successfully completed a certification program in genetic counseling or medical genetics that, at the time of graduation, is SB0281B -5- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H accredited by a nationally recognized certifying organization for genetic counseling or medical genetics and approved by the board in regulation;

(B) has passed a certified genetic counselor examination provided by a nationally recognized certifying organization for genetic counseling or medical genetics approved by the board in regulation;

(C) unless the license was later reinstated, has not had a license to practice genetic counseling revoked, suspended, or, while under investigation, has not voluntarily surrendered a license, in this state or another;

(D) is not the subject of an unresolved or adverse decision based on a complaint, investigation, review procedure, or other disciplinary proceeding undertaken by a state, territorial, local, or federal genetic counseling licensing jurisdiction or law enforcement agency that relates to criminal or fraudulent activity, genetic counseling malpractice, or negligent genetic counseling and that adversely reflects on the applicant's ability or competence to practice as a genetic counselor or on the safety or well-being of a patient or client;

and (E) meets other qualifications for a license to practice genetic counseling established by the board by regulation.

(b) The board shall issue a license to practice genetic counseling to an applicant who does not qualify for licensure under (a)(2)(A) or (a)(2)(B) of this section if the applicant (1) meets the qualifications prescribed in (a)(1) and (a)(2)(C) - (E) of this section;

(2) submits a letter of recommendation from three individuals who have worked with the applicant in an employment setting within the previous 10 years and can attest to the applicant's competency in providing genetic counseling services;

at least one letter of recommendation must be from a genetic counselor who qualifies for licensure under (a) of this section, and at least one letter of recommendation must be from either a certified clinical geneticist or a certified medical geneticist;

in this paragraph, "certified clinical geneticist" or "certified medical geneticist" means a medical doctor certified by a nationally recognized certifying organization for genetic CSSB 281(HSS) -6- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H counseling or medical genetics approved by the board in regulation, to be competent in diagnosing, managing, and counseling patients, clients, and families about genetic conditions;

(3) provides evidence satisfactory to the board that the applicant (A) has worked as a genetic counselor for at least 10 years before the effective date of this Act;

(B) has a master's degree or higher in genetics or related field of study as determined by the board in regulation;

(C) has earned continuing education units in genetic counseling within the last five years from a program by a nationally recognized certifying organization for genetic counseling or medical genetics approved by the board in regulation;

and (D) has never failed a certified genetic counselor examination provided by a nationally recognized certifying organization for genetic counseling or medical genetics.

Sec.

08.53.120.

Temporary license.

The board shall issue a temporary license to practice genetic counseling for up to one year to an applicant who meets the requirements of AS 08.53.110(a)(1), (a)(2)(A), and (a)(2)(C) - (E), and has met the requirement to take the examination required under AS 08.53.110(a)(2)(B), but has either not taken the examination or has not received examination results.

A genetic counselor working under a temporary license shall work under the general supervision of a licensed genetic counselor or a licensed physician.

A genetic counselor working under a temporary license who fails the examination may renew the temporary license for up to one year by submitting an application to the board that has been signed by the licensed genetic counselor or physician supervising the applicant.

A temporary license terminates 30 days after the holder of the temporary license fails to pass the examination.

Sec.

08.53.130.

Licensure by credentials.

The board may issue a license to practice genetic counseling to an applicant who pays the required fees and provides satisfactory evidence to the board that the applicant holds an equivalent valid license issued by another state, territory, or jurisdiction of the United States.

SB0281B -7- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H Sec.

08.53.140.

Renewal of license;

continuing education.

(a) The board shall renew the license of a licensee who applies for renewal on a form provided by the board, pays the required fee, provides evidence of continued competency in accordance with regulations adopted by the board, and provides evidence satisfactory to the board that the licensee meets the requirements of either (b) or (c) of this section.

(b) A licensee shall provide with an application to renew the license evidence satisfactory to the board demonstrating the licensee has completed, within two years immediately preceding the application, 50 continuing education units provided by a nationally recognized certifying organization for genetic counseling or medical genetics that is approved by the board in regulation.

(c) A licensee may submit a written request to the board to waive or reduce the continuing education requirements under (b) of this section or grant an extension of time in which the continuing education requirements must be completed.

The board may grant the request if the licensee was unable to complete the continuing education requirements because (1) of an illness of the licensee or of a family member for whom the licensee provides care;

(2) the licensee experienced another demonstrated hardship that substantially interfered with the licensee's ability to complete the continuing education requirements;

or (3) approved continuing education units were not reasonably available to the licensee.

Sec.

08.53.150.

Genetic counseling intern.

(a) A person enrolled as a student in a certification program in genetic counseling or medical genetics that is accredited by a nationally recognized certifying organization for genetic counseling or medical genetics and approved by the board in regulation may perform genetic counseling services using the title of genetic counseling intern if the services (1) performed are an integral part of the student's course of study;

and (2) are performed under the direct supervision of a licensed genetic counselor who is assigned to supervise the student.

(b) In this section, "direct supervision" means supervision that is on-site or CSSB 281(HSS) -8- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H available by visual or real-time electronic means through which a supervising licensed genetic counselor guides the genetic counseling intern while the genetic counseling intern performs a clinical activity;

"direct supervision" may include demonstration, coaching, and observation to the extent that the demonstration, coaching, or observation otherwise meets the requirements of this subsection.

Article 2.

Regulation of Genetic Counselors.

Sec.

08.53.160.

Scope of practice of genetic counselors.

A licensed genetic counselor may (1) obtain and evaluate individual, family, and medical histories to determine genetic risk for medical conditions and diseases in a patient or client or a patient's or client's family members, including future potential children of the patient or client;

(2) discuss the features, natural history, means of diagnosis, genetic and environmental factors, and management of risk for genetic or medical conditions or diseases with a patient or client;

(3) identify, order, and coordinate genetic laboratory tests and other diagnostic studies as appropriate for the genetic assessment of a patient or client;

(4) integrate genetic laboratory test results and other diagnostic studies with a patient's or client's personal and family medical history to assess and communicate risk factors for genetic or medical conditions and diseases;

(5) explain the results and clinical implications of genetic laboratory tests and other diagnostic studies to a patient or client;

(6) evaluate a patient's or client's or the patient's or client's family's responses to, risk of, or risk of the recurrence of a medical condition or disease, and provide related counseling and anticipatory guidance centered on the patient or client;

(7) use and provide referrals for community and online resources for medical, educational, financial, and psychosocial support and advocacy to patients, clients, families, and health care professionals;

and (8) provide written clinical documentation of medical, genetic, and counseling information to patients, clients, families, and health care professionals.

Sec.

08.53.170.

Disciplinary sanctions.

(a) In addition to the board's powers SB0281B -9- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H under AS 08.01.075, the board may revoke or suspend the license of a genetic counselor, or may reprimand, censure, or discipline a licensee, if, after a hearing, the board finds that the licensee (1) used or knowingly cooperated in deceit, fraud, or intentional misrepresentation to obtain a license;

(2) engaged in unprofessional conduct in the course of providing professional services;

(3) violated the code of ethics adopted by the board;

(4) violated any provision of this chapter, a regulation adopted under this chapter, or an order issued by the board;

or (5) has been convicted of a felony or a crime that involves moral turpitude.

(b) The board may reinstate a revoked license if the licensee applies for reinstatement of the revoked license at least one year after the revocation and, after a hearing, the board finds that the licensee is able to practice the profession with skill and safety.

Article 3.

Genetic Counseling Advisory Council.

Sec.

08.53.180.

Genetic Counseling Advisory Council.

(a) The board shall establish the Genetic Counseling Advisory Council for the purpose of advising the board on matters relating to administering this chapter.

(b) The council consists of at least three and not more than five members appointed by the board.

A majority membership of the council must be licensed genetic counselors.

The council must include at least one licensed physician.

If the council has five members, the council may include one public member.

A public member of the council may not (1) be engaged in the occupation that the board regulates;

(2) be associated by legal contract with a member of the occupation that the board regulates except as a consumer of the services provided by a practitioner of the occupation;

or (3) have a direct financial interest in the occupation that the board regulates.

CSSB 281(HSS) -10- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (c) The council shall meet at least annually or as necessary to conduct business.

The council may meet at the call of the chair, by the written request of a majority of the council members, or at the request of the board.

(d) At the first meeting of the council, and annually thereafter, the council shall elect from its membership a chair, vice chair, and secretary.

An officer shall serve until a successor is elected.

(e) A majority of the members of the council constitute a quorum.

(f) Members of the council serve staggered terms of three years.

A council member may not be appointed for more than three consecutive full terms.

If a vacancy occurs, the board shall appoint a qualified person to fill the unexpired portion of the term.

The board may remove a council member if the council member (1) during the term of service, no longer meets the qualifications required for appointment to the council;

(2) fails to attend council meetings for a period of one year;

(3) is found by the board to be in violation of a provision of this chapter.

(g) Members of the council are entitled to per diem and travel expenses authorized for boards and commissions under AS 39.20.180.

Article 4.

General Provisions.

Sec.

08.53.200.

Application of Administrative Procedure Act.

AS 44.62 (Administrative Procedure Act) applies to any action taken by the board under this chapter.

Sec.

08.53.210.

Exceptions to application of chapter.

(a) This chapter does not apply to a genetic counselor who is (1) in the miliary service in the discharge of official duties;

(2) in the employ of the United States Public Health Service, United States Department of Veterans Affairs, United States Indian Health Service, or another agency of the federal government, in the discharge of official duties;

(3) licensed in another state or jurisdiction who is teaching or demonstrating clinical techniques at a meeting, seminar, or limited course of instruction sponsored by a genetic counseling society or association or by an SB0281B -11- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H accredited genetic counseling or medical genetics educational institution;

(4) employed in the state by an Indian health program, as that term is defined in 25 U.S.C.

1603, while providing genetic counseling services to a person the Indian health program is entitled to serve under 25 U.S.C.

5301 - 5332 (Indian Self- Determination and Education Assistance Act), as amended, and 25 U.S.C.

1601 et seq.

(Indian Health Care Improvement Act), as amended.

(b) A health care provider licensed in the state who is not a licensed genetic counselor may provide genetic information, education, and support consistent with the scope of the health care provider's practice, education, and training.

(c) A person excepted from this chapter under (a) of this section is held to the same standard of care as a person covered by this chapter.

Sec.

08.53.220.

Penalty.

A person who violates a provision of this chapter or a regulation adopted under this chapter for which a penalty is not otherwise provided is guilty of a class B misdemeanor.

Sec.

08.53.230.

Regulation of genetic counselors;

powers of the board.

(a) In consultation with the Genetic Counseling Advisory Council established under AS 08.53.180, the board shall adopt regulations necessary to carry out the purposes of AS 08.53 regarding the licensure of genetic counselors and regulation of services a genetic counselor may perform.

The regulations must include the adoption of a code of ethics for genetic counselors based on nationally recognized ethical standards for genetic counselors.

(b) The board shall have the power to administer oaths, subpoena witnesses, and compel the production of documents pertinent to carrying out duties imposed by this chapter.

Sec.

08.53.300.

Definitions.

In this chapter, (1) "board" means the State Medical Board;

(2) "licensed genetic counselor" means a genetic counselor licensed under this chapter.

8.2.

(a) The board shall (1) except as provided in regulations adopted by the board under (b) of CSSB 281(HSS) -12- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H this section, examine and issue licenses to applicants;

(3) after a hearing, impose disciplinary sanctions on persons who violate this chapter,chapter AS 08.53, or the regulations or orders of the board;

SB 281 -2- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N * Sec.

3.

AS 08.64.107 is repealed and reenacted to read:

Sec.

08.64.107.

Scope of practice of physician assistants;

collaborative agreements.

(a) A physician assistant may provide any medical service for which the physician assistant is qualified to provide by education, training, and experience and competent to perform, including (1) obtaining a patient's comprehensive health history and performing a physical examination;

(2) evaluating, diagnosing, managing, and providing medical treatment;

(3) ordering and evaluating a diagnostic study or therapeutic procedure;

(4) performing limited sonography on a focused imaging target to assess specific and limited information about a patient's medical condition or to provide real-time visual guidance for another procedure;

(5) educating a patient on health promotion and disease prevention;

(6) providing medical consultation to patients or other health care providers;

(7) writing a medical order;

(8) obtaining informed consent;

(9) supervising, delegating, and assigning therapeutic and diagnostic measures to licensed or unlicensed personnel in accordance with regulations adopted under AS 08.64.106;

(10) certifying the health or disability of a patient as required by a local, state, or federal program;

(11) authenticating a document with the signature, certification, stamp, verification, affidavit, or endorsement of the physician assistant if the document may be authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of a physician;

(12) pronouncing death in accordance with AS 18.08.089;

(13) planning and initiating a therapeutic regimen that includes ordering and prescribing nonpharmacological interventions;

in this paragraph, SB0281A -3- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N "nonpharmacological intervention" includes durable medical equipment, nutrition, blood and blood products, diagnostic support services, home health care, hospice, and physical and occupational therapy;

(14) prescribing schedule II, III, IV, and V controlled substances under federal law and all federal legend drugs;

(15) administering and procuring drugs and medical devices;

(16) dispensing a drug if pharmacy services are not reasonably available and dispensing the drug is in the best interest of the patient or an emergency exists;

and (17) requesting, receiving, and signing for a professional sample and distributing a professional sample to a patient;

in this paragraph, "professional sample" means a unit of a prescription drug that is not for sale and given at no cost to the physician assistant to promote the drug's use.

(b) A physician assistant is responsible for the care provided to a patient by the physician assistant.

(c) Except as provided in (d) of this section, a physician assistant may only practice in the state under a written collaborative agreement entered into with a physician licensed under this chapter or a physician exempt from licensing under AS 08.64.370.

The collaborative agreement must describe how the collaboration will occur between the physician assistant and the physician.

A physician assistant who is practicing under a collaborative agreement shall provide to the board with the physician assistant's application for licensure or renewal a written attestation that the physician assistant is practicing under a collaborative agreement.

The physician assistant shall provide a copy of the written collaborative agreement to the board upon request.

(d) A physician assistant may practice without a collaborative agreement if (1) the physician assistant is practicing at (A) a facility directed by a licensed physician, osteopath, or podiatrist;

(B) a health care facility licensed by the Department of Health under AS 47.32;

SB 281 -4- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (C) a health care facility that is operated by the federal government or a tribal organization as defined in 25 U.S.C.

450b;

(D) a federally qualified health center or rural health clinic;

or (E) a military and veterans' facility;

or (2) the board has, upon application of the physician assistant, authorized the physician assistant to practice at a facility not described in (1) of this subsection without obtaining a collaborative agreement.

9.4.

AS 08.64.103(a) is amended to read:

(a) After consulting with the board, the department shall employ two persons who are not members of the board;

one shall be assigned as the investigator for the board;

the other shall be assigned as the executive secretary for the board.

The investigator shall (1) conduct investigations into alleged violations of this chapter, alleged violations of AS 08.53, and into alleged violations of regulations and orders of the board;

SB0281B -13- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (2) at the request of the board, conduct investigations based on complaints filed with the department or with the board;

[AND] (3) be directly responsible and accountable to the board, except that only the department has authority to terminate the investigator's employment and the department shall provide day-to-day [DAY TO DAY] and administrative supervision of the investigator;

and (4) in consultation with the Genetic Counseling Advisory Council, ensure that applicants for a license or renewal meet the applicable requirements under AS 08.53 and established by the board.

* Sec.

10.

AS 08.64.130(a) is amended to read:

(a) The board shall preserve a record of its proceedings, which must contain the name, age, residence, and duration of residence of each applicant for a license under this chapter, the time spent by the applicant in medical study, the place of medical study, and the year and school from which degrees were granted.

The record must also show whether the applicant was granted a license or rejected.

* Sec.

11.

(b) An applicant applying for an expedited license as a physician or osteopath under AS 08.64.253 or a license as a physician assistant under ASthis 08.64.107chapter shall submit, along with the application, the applicant's fingerprints and the fees required by the Department of Public Safety under AS 12.62.160 for criminal justice information and a national criminal history record check.

Criminal justice information and criminal history record information obtained under this subsection may only be used by the board for the purpose of determining an applicant's qualifications and fitness for a license, expedited license, or compact privilege under this chapter.

12.5.

AS 08.64.200(a)08.64 is amended by adding a new section to read:

(a) Except for foreign medical graduates as specified in AS 08.64.225, each physician applicant shall (1) submit a certificate of graduation from a legally chartered medical CSSB 281(HSS) -14- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H school accredited by the Association of American Medical Colleges and the Council on Medical Education of the American Medical Association;

(2) submit a certificate from a recognized hospital or hospitals certifying that the applicant has satisfactorily performed the duties of resident physician or intern for a period of (A) one year if the applicant graduated from medical school before January 1, 1995, as evidenced by a certificate of completion of the first year of postgraduate training from the facility where the applicant completed the first year of internship or residency;

and (B) two years if the applicant graduated from medical school on or after January 1, 1995, as evidenced by a certificate of completion of the first year of postgraduate training from the facility where the applicant completed the first year of internship or residency and a certificate of successful completion of one additional year of postgraduate training at a recognized hospital;

(3) submit a list of negotiated settlements or judgments in claims or civil actions alleging medical malpractice against the applicant, including an explanation of the basis for each claim or action;

(4) not have a license to practice medicine in another state, country, province, or territory that is currently suspended or revoked for disciplinary reasons;

[AND] (5) receive education in pain management and opioid use and addiction, unless the applicant has demonstrated to the satisfaction of the board that the applicant does not currently hold a valid federal Drug Enforcement Administration registration number;

an applicant may include past professional experience or professional education as proof of professional competence;

and (6) submit the applicant's fingerprints and the fees required by the Department of Public Safety under AS 12.62.160 for criminal justice information and a national criminal history record check;

the board shall forward the fingerprints and fees to the Department of Public Safety for a report of criminal justice information under AS 12.62 and a national criminal history record check SB0281B -15- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H under AS 12.62.400.

* Sec.

13.

AS 08.64.205 is amended to read:

08.64.205.08.64.206.

Qualifications for osteopathphysician assistant applicants.

Each osteopathphysician assistant applicant shall meet the qualifications prescribed in AS 08.64.200(a)(3) - (6)(5) [AS 08.64.200(a)(3) - (5)] and shall (1) submit (1) a certificate of graduation obtained from a physician assistant program accredited, at the legallytime charteredof schoolgraduation, by (A) the American Medical Association's Committee on Allied Health Education and Accreditation or the Commission on Accreditation of osteopathyAllied approvedHealth byEducation Programs if the board;applicant graduated before January 1, 2001;

(2) submit a certificate from a hospital approved by the American Medical Association or the(B) American Osteopathic Association that certifies that the osteopathAccreditation hasReview satisfactorilyCommission completedon andEducation performedfor the dutiesPhysician ofAssistant intern or resident physician for (A) one year if the applicant graduated fromon aor schoolafter of osteopathy before January 1, 1995,2001; as evidenced by a certificate of completion of the first year of postgraduate training from the facility where the applicant completed the first year of internship or residency;

or(2) (B)proof two years if the applicant graduated from a school of osteopathycurrent oncertification orissued after January 1, 1995, as evidenced by a certificate of completion of the firstNational yearCommission ofon postgraduateCertification training from the facility where the applicant completed the first year of internshipPhysician orAssistants; residency and a certificate of successful completion of one additional year of postgraduate training at a recognized hospital;

(3) takeproof theof examinationreceiving requireda bypassing ASscore 08.64.210on orthe bephysician certifiedassistant toSB0281A practice-5- bySB the281 NationalNew BoardText ofUnderlined Examiners[DELETED forTEXT OsteopathicBRACKETED] Physicians34-LS1488\N andnational Surgeonscertifying orexamination offered by the National BoardCommission ofon OsteopathicCertification Medicalof Examiners;Physician Assistants;

(4) receive education in pain management and opioid(4) useproof andof addiction,any unlesshours theof applicantpostgraduate hasclinical demonstratedexperience toobtained theby satisfaction of the boardapplicant, thatincluding the applicantspecialties doesin notwhich currentlythose holdhours awere validobtained. federal Drug Enforcement Administration registration number;

an applicant may include past professional experience or professional education as proof of professional competence.

14.6.

AS 08.64.209(a)08.64.230 is amended by adding a new subsection to read:

(a)(d) EachIf applicanta whophysician desiresassistant toapplicant practicepasses podiatry shall meet the CSSBexamination 281(HSS)and -16-meets SB0281Bthe Newrequirements Textof Underlined [DELETED TEXT BRACKETED] 34-LS1488\H qualifications prescribed in AS 08.64.200(a)(3)08.64.206 -and (6)08.64.255, [ASthe 08.64.200(a)(3)board -or (5)]its andexecutive secretary shall (1)grant submit a certificatelicense ofto graduationthe fromapplicant ato legallypractice charteredthe schoolacts ofpermitted podiatryunder approvedAS by08.64.107. the board;

(2) take the examination required by AS 08.64.210;

the board shall call to its aid a podiatrist of known ability who is licensed to practice podiatry to assist in the examination and licensure of applicants for a license to practice podiatry;

(3) receive education in pain management and opioid use and addiction, unless the applicant has demonstrated to the satisfaction of the board that the applicant does not currently hold a valid federal Drug Enforcement Administration registration number;

an applicant may include past professional experience or professional education as proof of professional competence;

(4) meet other qualifications of experience or education that the board may require.

15.7.

AS 08.64.225(a)08.64.250(a) is amended to read:

(a) ApplicantsThe whoboard aremay graduateswaive ofthe medicalexamination collegesrequirement notand accreditedlicense by credentials if the Associationphysician, ofosteopath, Americanphysician Medicalassistant, Collegesor andpodiatry applicant meets the Councilrequirements onof MedicalAS Education08.64.200, 08.64.205, 08.64.206, or 08.64.209, submits proof of continued competence as required by regulation, pays the Americanrequired Medicalfee, Associationand shallhas (1) meetan active license from a board of medical examiners established under the requirementslaws of ASa 08.64.200(a)(3)state -or (6)territory [ASof 08.64.200(a)(3)the -United (5)]States andor 08.64.255;a province or territory of Canada issued after thorough examination;

or (2) havepassed successfullyan completedexamination (A) three years of postgraduate training as evidencedspecified by a certificate of completion of the firstboard yearin ofregulations. postgraduate training from the facility where the applicant completed the first year of internship or residency and a certificate of successful completion of two additional years of postgraduate training at a recognized hospital;

or (B) other requirements establishing proof of competency and professional qualifications as the board considers necessary to ensure the continued protection of the public adopted at the discretion of the board by regulation, including education in pain management and opioid use and addiction, unless the applicant has demonstrated to the satisfaction of the board SB0281B -17- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H that the applicant does not currently hold a valid federal Drug Enforcement Administration registration number;

an applicant may include past professional experience or professional education as proof of professional competence;

and (3) have passed examinations as specified by the board in regulations.

16.8.

The Compact creates another pathway for licensure and does not otherwise SB 281 -6- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N change a state's existing Medical Practice Act.

(c) "Conviction" means a finding by a court that an individual is guilty of a CSSB 281(HSS) -18- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H criminal offense through adjudication, or entry of a plea of guilt or no contest to the charge by the offender.

SB0281A -7- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (j) "Physician" means any person who (1) is a graduate of a medical school accredited by the Liaison Committee on Medical Education, the Commission on Osteopathic College Accreditation, or a medical school listed in the International Medical Education Directory or its equivalent;

(4) holds specialty certification or a time-unlimited specialty certificate SB0281B -19- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H recognized by the American Board of Medical Specialties or the American Osteopathic Association's Bureau of Osteopathic Specialists;

SB 281 -8- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (l) "Offense" means a felony, gross misdemeanor, or crime of moral turpitude.

(a) A physician must meet the eligibility requirements as defined in Section CSSB 281(HSS) -20- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H 2(j) to receive an expedited license under the terms and provisions of the Compact.

SB0281A -9- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (b) A physician may redesignate a member state as state of principal license at any time, as long as the state meets the requirements of subsection (a).

(1) Static qualifications, which include verification of medical education, graduate medical education, results of any medical or licensing SB0281B -21- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H examination, and other qualifications as determined by the Interstate Commission through rule, shall not be subject to additional primary source verification where already primary source verified by the state of principal license.

(d) After receiving verification of eligibility under subsection (b) and any fees SB 281 -10- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N under subsection (c), a member board shall issue an expedited license to the physician.

CSSB 281(HSS) -22- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (a) A member state issuing an expedited license authorizing the practice of medicine in that state may impose a fee for a license issued or renewed through the Compact.

and (4) Has not had a controlled substance license or permit suspended or SB0281A -11- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N revoked by a state or the United States Drug Enforcement Administration.

(a) The Interstate Commission shall establish a database of all physicians SB0281B -23- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H licensed, or who have applied for licensure, under Section 5.

SB 281 -12- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (b) In addition to the authority granted to a member board by its respective Medical Practice Act or other applicable state law, a member board may participate with other member boards in joint investigations of physicians licensed by the member boards.

(a) Any disciplinary action taken by any member board against a physician CSSB 281(HSS) -24- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H licensed through the Compact shall be deemed unprofessional conduct which may be subject to discipline by other member boards, in addition to any violation of the Medical Practice Act or regulations in that state.

or SB0281A -13- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (2) Pursue separate disciplinary action against the physician under its respective Medical Practice Act, regardless of the action taken in other member states.

(a) The member states hereby create the "Interstate Medical Licensure Compact Commission." SB0281B -25- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (b) The purpose of the Interstate Commission is the administration of the Interstate Medical Licensure Compact, which is a discretionary state function.

(2) An executive director, executive secretary, or similar executive of a SB 281 -14- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N member board;

In the absence of its Commissioner, a member state may CSSB 281(HSS) -26- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H delegate voting authority for a specified meeting to another person from that state who shall meet the requirements of subsection (d).

(6) Discuss investigative records compiled for law enforcement SB0281A -15- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N purposes;

When acting on behalf of the Interstate Commission, SB0281B -27- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H the executive committee shall oversee the administration of the Compact including enforcement and compliance with the provisions of the Compact, its bylaws and rules, and other such duties as necessary.

(e) Establish and appoint committees including, but not limited to, an executive committee as required by Section 11, which shall have the power to act on SB 281 -16- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N behalf of the Interstate Commission in carrying out its powers and duties;

CSSB 281(HSS) -28- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (m) Lease, purchase, accept contributions or donations of, or otherwise to own, hold, improve or use, any property, real, personal, or mixed;

SB0281A -17- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N SECTION 13.

(d) The Interstate Commission shall be subject to a yearly financial audit conducted by a certified or licensed accountant and the report of the audit shall be SB0281B -29- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H included in the annual report of the Interstate Commission.

(d) The officers and employees of the Interstate Commission shall be immune from suit and liability, either personally or in their official capacity, for a claim for damage to or loss of property or personal injury or other civil liability caused or SB 281 -18- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N arising out of, or relating to, an actual or alleged act, error, or omission that occurred, or that such person had a reasonable basis for believing occurred, within the scope of Interstate Commission employment, duties, or responsibilities;

CSSB 281(HSS) -30- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (f) The Interstate Commission shall defend the executive director, its employees, and subject to the approval of the attorney general or other appropriate legal counsel of the member state represented by an Interstate Commission representative, shall defend such Interstate Commission representative in any civil action seeking to impose liability arising out of an actual or alleged act, error or omission that occurred within the scope of Interstate Commission employment, duties or responsibilities, or that the defendant had a reasonable basis for believing occurred within the scope of Interstate Commission employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result from intentional or willful and wanton misconduct on the part of such person.

(g) To the extent not covered by the state involved, member state, or the Interstate Commission, the representatives or employees of the Interstate Commission shall be held harmless in the amount of a settlement or judgement, including attorney's fees and costs, obtained against such persons arising out of an actual or alleged act, error, or omission that occurred within the scope of the Interstate Commission employment, duties, or responsibilities, or that such persons had a reasonable basis for believing occurred within the scope of Interstate Commission employment, duties, or SB0281A -19- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N responsibilities, provided that the actual or alleged act, error, or omission did not result from intentional or willful and wanton misconduct on the part of such person.

SB0281B -31- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (c) Not later than thirty (30) days after a rule is promulgated, any person may file a petition for judicial review of the rule in the United States District Court for the District of Columbia or the federal district where the Interstate Commission has its principal offices, provided that the filing of such a petition shall not stay or otherwise prevent the rule from becoming effective unless the court finds that the petitioner has a substantial likelihood of success.

(b) All courts shall take judicial notice of the Compact and the rules in any judicial or administrative proceeding in a member state pertaining to the subject matter SB 281 -20- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N of the Compact which may affect the powers, responsibilities or actions of the Interstate Commission.

(b) The Interstate Commission may, by majority vote of the Commissioners, initiate legal action in the United States Court for the District of Columbia, or, at the discretion of the Interstate Commission, in the federal district where the Interstate Commission has its principal offices, to enforce compliance with the provisions of the CSSB 281(HSS) -32- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H Compact, and its promulgated rules and bylaws, against a member state in default.

the Interstate Commission shall specify the SB0281A -21- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N conditions by which the defaulting state must cure its default;

(e) The Interstate Commission shall establish rules and procedures to address SB0281B -33- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H licenses and physicians that are materially impacted by the termination of a member state, or the withdrawal of a member state.

(a) The Interstate Commission shall attempt, upon the request of a member state, to resolve disputes which are subject to the Compact and which may arise SB 281 -22- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N among member states or member boards.

No amendment shall become effective and binding CSSB 281(HSS) -34- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H upon the Interstate Commission and the member states unless and until it is enacted into law by unanimous consent of the member states.

(e) The withdrawing state is responsible for all dues, obligations and liabilities SB0281A -23- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N incurred through the effective date of withdrawal, including obligations, the performance of which extend beyond the effective date of withdrawal.

(b) Upon the dissolution of the Compact, the Compact becomes null and void SB0281B -35- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H and shall be of no further force or effect, and the business and affairs of the Interstate Commission shall be concluded, and surplus funds shall be distributed in accordance with the bylaws.

(c) All lawful actions of the Interstate Commission, including all rules and SB 281 -24- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N bylaws promulgated by the Commission, are binding upon the member states.

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 CSSB 281(HSS) -36- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H 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.

SB0281A -25- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (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.

(D) "Criminal Background Check" means the submission of fingerprints or other biometric-based information for a License applicant for the purpose of obtaining SB0281B -37- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H that applicant's criminal history record information, as defined in 28 C.F.R.

(K) "Licensee" means an individual who holds a License from a State to SB 281 -26- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N provide Medical Services as a PA.

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 CSSB 281(HSS) -38- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H the provisions of this Compact at the time of its enactment.

SB0281A -27- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (A) To participate in this Compact, a Participating State shall:

SB0281B -39- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (7) Utilize passage of a recognized national exam such as the NCCPA PANCE as a requirement for PA licensure.

SB 281 -28- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (6) Hold a Qualifying License.

(10) Notify the Compact Commission that the Licensee is seeking the CSSB 281(HSS) -40- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H Compact Privilege in a Remote State.

(C) Once a restricted or limited License satisfies the requirements of (B)(1) SB0281A -29- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N and (2) of this Section, the Licensee must meet the requirements of (A) of this Section to obtain a Compact Privilege in any Remote State.

(1) 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 SB0281B -41- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H Licensee's primary residence.

(2) Issue subpoenas for both hearings and investigations that require SB 281 -30- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N the attendance and testimony of witnesses as well as the production of evidence.

(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 CSSB 281(HSS) -42- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H Privilege in that Participating State for the individual's otherwise lawful practice in another State.

(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 SB0281A -31- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N Participating State may participate with other Participating States in joint investigations of Licensees.

SB0281B -43- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H SECTION 7.

(3) Any delegate may be removed or suspended from office as SB 281 -32- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N provided by the laws of the State from which the delegate is appointed.

CSSB 281(HSS) -44- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (1) Establish a code of ethics for the Commission;

(11) Hire employees and engage contractors, elect or appoint officers, SB0281A -33- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this Compact, and establish the Commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters;

SB0281B -45- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (16) Borrow money;

and SB 281 -34- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (23) Perform such other functions as may be necessary or appropriate to achieve the purposes of this Compact consistent with the State regulation of PA licensure and practice.

CSSB 281(HSS) -46- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (a) Non-compliance of a Participating State with its obligations under this Compact;

(i) Disclosure of information related to any investigative SB0281A -35- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N reports prepared by or on behalf of or for use of the Commission or other committee charged with responsibility of investigation or determination of compliance issues pursuant to this Compact;

All SB0281B -47- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H minutes and documents of a closed meeting shall remain under seal, subject to release by a majority vote of the Commission or order of a court of competent jurisdiction.

(a) A Compact Privilege expires when the Licensee's Qualifying License in the Participating State from which the Licensee applied SB 281 -36- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N for the Compact Privilege expires.

The receipts and disbursements of the Commission shall be subject to CSSB 281(HSS) -48- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H the financial review and accounting procedures established under its bylaws.

SB0281A -37- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (4) The Commission may remove any member of the Executive Committee as provided in its bylaws.

(e) Monitor Compact compliance of Participating States and SB0281B -49- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H provide compliance reports to the Commission;

(8) The Executive Committee may convene in a closed, non-public meeting for the same reasons that the Commission may convene in a non-public meeting as set forth in Section 7(D)(3) and shall announce the closed meeting as the Commission is required to under Section 7(D)(4) and keep minutes of the closed SB 281 -38- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N meeting as the Commission is required to under Section 7(D)(5).

CSSB 281(HSS) -50- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H (2) The Commission shall defend any member, officer, executive director, employee, and representative of the Commission in any civil action seeking to impose liability arising out of any actual or alleged act, error, or omission that occurred within the scope of Commission employment, duties, or responsibilities, or as determined by the Commission that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities;

(3) The Commission shall indemnify and hold harmless any member, officer, executive director, employee, and representative of the Commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of Commission employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result SB0281A -39- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N from the intentional or willful or wanton misconduct of that person.

(7) Nothing in this Compact shall be interpreted to waive or otherwise SB0281B -51- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H abrogate a Participating State's state action immunity or state action affirmative defense with respect to antitrust claims under the Sherman Act, Clayton Act, or any other State or federal antitrust or anticompetitive law or regulation.

SB 281 -40- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (3) Adverse Actions against a License or Compact Privilege;

(E) Participating States contributing information to the Data System may, in CSSB 281(HSS) -52- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H accordance with State or federal law, designate information that may not be shared with the public without the express permission of the contributing State.

SB0281A -41- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (B) The Commission shall promulgate reasonable Rules in order to effectively and efficiently implement and administer this Compact and achieve its purposes.

(D) If a majority of the legislatures of the Participating States rejects a Commission Rule, by enactment of a statute or resolution in the same manner used to SB0281B -53- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H adopt this Compact within four (4) years of the date of adoption of the Rule, then such Rule shall have no further force and effect in any Participating State or to any State applying to participate in the Compact.

(1) The time, date, and location of the public hearing on the proposed Rule and the proposed time, date and location of the meeting in which the proposed SB 281 -42- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N Rule will be considered and voted upon;

(1) All persons wishing to be heard at the hearing shall as directed in CSSB 281(HSS) -54- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H the Notice of Proposed Rulemaking, not less than five (5) business days before the scheduled date of the hearing, notify the Commission of their desire to appear and testify at the hearing.

SB0281A -43- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (1) If adopted, the Rule shall be posted on the Commission's website.

(L) Upon determination that an emergency exists, the Commission may consider and adopt an emergency Rule with twenty-four (24) hours prior notice, without the opportunity for comment, or hearing, provided that the usual rulemaking procedures provided in this Compact and in this section shall be retroactively applied SB0281B -55- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H to the Rule as soon as reasonably possible, in no event later than ninety (90) days after the effective date of the Rule.

If the revision is SB 281 -44- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N challenged, the revision may not take effect without the approval of the Commission.

Nothing herein shall affect or limit the selection or propriety of venue in any action against a Licensee for CSSB 281(HSS) -56- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H professional malpractice, misconduct or any such similar matter.

(2) If a State in default fails to cure the default, the defaulting State may be terminated from this Compact upon an affirmative vote of a majority of the SB0281A -45- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N delegates of the Participating States, and all rights, privileges and benefits conferred by this Compact upon such State may be terminated on the effective date of termination.

(5) The Commission shall not bear any costs related to a State that is found to be in default or that has been terminated from this Compact, unless agreed SB0281B -57- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H upon in writing between the Commission and the defaulting State.

(b) Licensees who are licensed in that State who have been granted a Compact Privilege in a Participating State shall retain the Compact Privilege for one hundred eighty (180) days unless the Licensee also has a Qualifying License in a Participating State or obtains a Qualifying License in a Participating State before the one hundred eighty (180)-day period ends, in SB 281 -46- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N which case the Compact Privilege shall continue.

(2) If compliance is not secured after all means to secure compliance have been exhausted, by majority vote, the Commission may initiate legal action in the United States District Court for the District of Columbia or the federal district where the Commission has its principal offices, against a Participating State in default to CSSB 281(HSS) -58- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H enforce compliance with the provisions of this Compact and the Commission's promulgated Rules and bylaws.

DATE OF IMPLEMENTATION OF THE PA LICENSURE SB0281A -47- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N COMPACT COMMISSION.

(b) If any Participating State later withdraws from the Compact or its participation is terminated, the Commission shall remain in existence and the Compact shall remain in effect even if the number of Participating States SB0281B -59- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H should be less than seven.

SB 281 -48- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (C) Any Participating State may withdraw from this Compact by enacting a statute repealing the same.

(2) Withdrawal shall not affect the continuing requirement of the State Licensing Board(s) of the withdrawing State to comply with the investigative, and Adverse Action reporting requirements of this Compact prior to the effective date of CSSB 281(HSS) -60- SB0281B New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H withdrawal.

(A) This Compact and the Commission's rulemaking authority shall be liberally construed so as to effectuate the purposes, and the implementation and SB0281A -49- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N administration of the Compact.

(C) Notwithstanding (B) of this section or this section, the Commission may deny a State's participation in the Compact or, in accordance with the requirements of Section 10(B), terminate a Participating State's participation in the Compact, if it SB0281B -61- CSSB 281(HSS) New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\H determines that a constitutional requirement of a Participating State is, or would be with respect to a State seeking to participate in the Compact, a material departure from the Compact.

17.9.

AS 08.64.270(a) is amended to read:

(a) The board, a member of the board, the executive secretary, or a person designated by the board to issue temporary permits may issue a temporary permit to an [A PHYSICIAN APPLICANT, OSTEOPATH APPLICANT, OR PODIATRY] SB 281 -50- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N applicant who meets the requirements of AS 08.64.200, 08.64.205, 08.64.206, 08.64.209, or 08.64.225 and pays the required fee.

* Sec.

10.

AS 08.64.275(a) is amended to read:

(a) A member of the board, its executive secretary, or a person designated by the board to issue temporary permits may grant a temporary permit to a physician, [OR] osteopath, or physician assistant for the purpose of (1) substituting for another physician, [OR] osteopath, or physician assistant licensed in this state;

(2) being temporarily employed by a physician, [OR] osteopath, or physician assistant licensed in this state while that physician, [OR] osteopath, or physician assistant evaluates the permittee for permanent employment;

or (3) being temporarily employed by a hospital or community mental health center while the facility attempts to fill a vacant permanent physician, [OR] osteopath, or physician assistant staff position with a physician, [OR] osteopath, or physician assistant licensed in this state.

* Sec.

11.

AS 08.64.275 is amended by adding a new subsection to read:

(g) A physician assistant applying under (a) of this section shall pay the required fee and shall meet the requirements of AS 08.64.206 and 08.64.279.

In addition, the physician assistant shall submit evidence of holding a license to practice in a state or territory of the United States or in a province or territory of Canada.

* Sec.

12.

AS 08.64.312(c) is amended to read:

(c) The board or its designee may exempt a physician, osteopath, [OR] podiatrist, or physician assistant from the requirements of (b) of this section upon an application by the physician, osteopath, [OR] podiatrist, or physician assistant giving evidence satisfactory to the board or its designee that the physician, osteopath, [OR] podiatrist, or physician assistant is unable to comply with the requirements because of extenuating circumstances.

However, a person may not be exempted from more than 15 hours of continuing education in a five-year period;

a person may not be exempted from the requirement to receive at least two hours of education in pain management and opioid use and addiction unless the person has demonstrated to the satisfaction of the board that the person does not currently hold a valid federal Drug SB0281A -51- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N Enforcement Administration registration number.

* Sec.

13.

14.

AS 08.64.326(a) is amended to read:

(a) The board may impose a sanction if the board finds after a hearing that a licensee (1) secured a license through deceit, fraud, or intentional misrepresentation;

(2) engaged in deceit, fraud, or intentional misrepresentation while providing professional services or engaging in professional activities;

(3) advertised professional services in a false or misleading manner;

(4) has been convicted, including conviction based on a guilty plea or plea of nolo contendere, of (A) a class A or unclassified felony or a crime in another jurisdiction with elements similar to a class A or unclassified felony in this jurisdiction;

(B) a class B or class C felony or a crime in another jurisdiction with elements similar to a class B or class C felony in this jurisdiction if the felony or other crime is substantially related to the qualifications, functions, or SB 281 -52- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N duties of the licensee;

or (C) a crime involving the unlawful procurement, sale, prescription, or dispensing of drugs;

(5) has procured, sold, prescribed, or dispensed drugs in violation of a law regardless of whether there has been a criminal action or harm to the patient;

(6) intentionally or negligently permitted the performance of patient care by persons under the licensee's supervision that does not conform to minimum professional standards even if the patient was not injured;

(7) failed to comply with this chapter, a regulation adopted under this chapter, or an order of the board;

(8) has demonstrated (A) professional incompetence, gross negligence, or repeated negligent conduct;

the board may not base a finding of professional incompetence solely on the basis that a licensee's practice is unconventional or experimental in the absence of demonstrable physical harm to a patient;

(B) addiction to, severe dependency on, or habitual overuse of alcohol or other drugs that impairs the licensee's ability to practice safely;

(C) unfitness because of physical or mental disability;

(9) engaged in unprofessional conduct, in sexual misconduct, or in lewd or immoral conduct in connection with the delivery of professional services to patients;

in this paragraph, "sexual misconduct" includes sexual contact, as defined by the board in regulations adopted under this chapter, or attempted sexual contact with a patient outside the scope of generally accepted methods of examination or treatment of the patient, regardless of the patient's consent or lack of consent, during the term of the physician-patient relationship, as defined by the board in regulations adopted under this chapter, unless the patient was the licensee's spouse at the time of the contact or, immediately preceding the physician-patient relationship, was in a dating, courtship, or engagement relationship with the licensee;

(10) has violated AS 18.16.010;

(11) has violated any code of ethics adopted by regulation by the board;

SB0281A -53- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N (12) has denied care or treatment to a patient or person seeking assistance from the licensee [PHYSICIAN] if the only reason for the denial is the failure or refusal of the patient to agree to arbitrate as provided in AS 09.55.535(a);

(13) has had a license or certificate to practice medicine in another state or territory of the United States, or a province or territory of Canada, denied, suspended, revoked, surrendered while under investigation for an alleged violation, restricted, limited, conditioned, or placed on probation unless the denial, suspension, revocation, or other action was caused by the failure of the licensee to pay fees to that state, territory, or province;

or (14) prescribed or dispensed an opioid in excess of the maximum dosage authorized under AS 08.64.363.

* Sec.

15.

AS 08.64.334 is amended to read:

Sec.

08.64.334.

Voluntary surrender.

The board, at its discretion, may accept the voluntary surrender of a license.

A license may not be returned unless the board determines, under regulations adopted by it, that the licensee is competent to resume practice.

However, a license may not be returned to the licensee if the voluntary surrender resulted in the dropping or suspension of civil or criminal charges against the physician or physician assistant.

* Sec.

16.

AS 08.64.336(a) is amended to read:

(a) A physician or physician assistant who professionally treats a person licensed to practice medicine or osteopathy in this state for alcoholism or drug addiction, or for mental, emotional, or personality disorders, shall report [IT] to the board if there is probable cause that the person may constitute a danger to the health and welfare of that person's patients or the public if that person continues in practice.

The report must state the name and address of the person and the condition found.

* Sec.

17.

AS 08.64.336(e) is amended to read:

(e) A physician, physician assistant, hospital, hospital committee, or private professional organization contracted with under AS 08.64.101(a)(5) to identify, confront, evaluate, and treat individuals licensed under this chapter who abuse addictive substances that in good faith submits a report under this section or participates in an investigation or judicial proceeding related to a report submitted SB 281 -54- SB0281A New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N under this section is immune from civil liability for the submission or participation.

* Sec.

AS 08.64.336(f) is amended to read:

(f) A physician, physician assistant, or hospital may not refuse to submit a report under this section or withhold from the board or its investigators evidence related to an investigation under this section on the grounds that the report or evidence (1) concerns a matter that was disclosed in the course of a confidential physician-patient or psychotherapist-patient relationship or during a meeting of a hospital medical staff, governing body, or committee that was exempt from the public meeting requirements of AS 44.62.310;

or (2) is required to be kept confidential under AS 18.23.030.

* Sec.

19.

AS 08.64.360 is amended to read:

Sec.

08.64.360.

Penalty for practicing without a license or in violation of law.

Except for [A PHYSICIAN ASSISTANT OR] a person licensed or authorized under another law of the state who engages in practices for which that person is licensed or authorized under that law, a person practicing medicine or osteopathy in the state without a valid license or permit is guilty of a class A misdemeanor.

Each day of illegal practice is a separate offense.

* Sec.

20.

AS 08.64.370 is amended to read:

Sec.

08.64.370.

Exceptions to application of chapter.

This chapter does not apply to (1) officers in the regular medical service of the armed services of the United States or the United States Public Health Service while in the discharge of their official duties;

(2) a physician, [OR] osteopath, or physician assistant licensed in another state who is asked by a physician, [OR] osteopath, or physician assistant licensed in this state to help in the diagnosis or treatment of a case, unless the physician, osteopath, or physician assistant is practicing under AS 08.02.130(b);

(3) the practice of the religious tenets of a church;

(4) a physician or physician assistant in the regular medical service of the United States Public Health Service or the armed services of the United States volunteering services without pay or other remuneration to a hospital, clinic, medical SB0281A -55- SB 281 New Text Underlined [DELETED TEXT BRACKETED] 34-LS1488\N office, or other medical facility in the state;