(11)"Licensee" Licensee.means an individual who holds a License from a State to provide Medical Services as a PA.

–L. An individual who holds a License from a State to provide Medical Services as a PA.

(12)"Licensing LicensingBoard" Board.means any State entity authorized to license and otherwise regulate PAs.

–M. Any State entity authorized to license and otherwise regulate PAs.

(13)"Medical MedicalServices" 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.

–HB1146 HealthENROLLED care26.417.13 services3 provided1146 forN. the diagnosis, prevention, treatment, cure, or relief of a health condition, injury, or disease, as defined by a State's laws and regulations.

(14)"Model ModelCompact" 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.

–O. The model for the PA Licensure Compact on file with The Council of State Governments or other entity as designated by the Commission.

(15)"Participating ParticipatingState" State.means a State that has enacted this Compact.

–P. A State that has enacted this Compact.

(16)"PA" PA.means an individual who is licensed as a physician assistant in a State.

–For Anpurposes individualof whothis isCompact, licensedany asother atitle physicianor assistantstatus inadopted by a State.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.

ForQ. purposes ofthis Compact, anyothertitleorstatus adoptedbya Stateto 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.

(17)"PA PA Licensure Compact Commission,Commission" Compact"Compact Commission,Commission," or Commission."Commission" mean the national administrative body created pursuant to Section 7.A of this Compact.

–R. The national administrative body created pursuant to G.S.

90-270.206(f)(2)"Qualifying ofLicense" thismeans Compact.an unrestricted License issued by a Participating State to provide Medical Services as a PA.

(18)S. Qualifying License.

–"Remote AnState" unrestrictedmeans License issued by a Participating State towhere providea MedicalLicensee Serviceswho is not licensed as a PA.PA is exercising or seeking to exercise the Compact Privilege.

(19)T. Remote State.

–"Rule" Ameans Participating State where a Licenseeregulation whopromulgated isby notan licensedentity asthat ahas PAthe isforce exercisingand oreffect seekingof tolaw. exercise the Compact Privilege.

(20)U. Rule.

–"Significant AInvestigative regulationInformation" promulgatedmeans byInvestigative Information that a Licensing Board, after an entityinquiry or investigation that hasincludes notification and an opportunity for the forcePA andto effectrespond ofif law.required by State law, has reason to believe is not groundless and, if proven true, would indicate more than a minor infraction.

(21)V. Significant Investigative Information.

–"State" Investigativemeans Informationany thatstate, acommonwealth, Licensingdistrict, Board, after an inquiry or investigationterritory thatof includes notification and an opportunity for the PAUnited toStates. respond if required by State law, has reason Page 2 Senate Bill 190-Second Edition General Assembly Of North Carolina Session 2025 to believe is not groundless and, if proven true, would indicate more than a minor infraction.

(22)Section State.3.

–State AnyParticipation state,in commonwealth,this district,Compact orA. territory of the United States.

"§To 90-270.202.participate in this Compact, a Participating State shall:

State1. participation in this Compact.

(a)License ToPAs. participate in this Compact, a Participating State shall:

(1)2. License PAs.

(2) Participate in the Compact Commission'sCommission’s Data System.

(3)3. Have a mechanism in place for receiving and investigating complaints against Licensees and License applicants.

(4)Have Notifya themechanism Commission, in complianceplace withfor thereceiving terms of this Compact and Commissioninvestigating Rules,complaints of any Adverse Action against aLicensees Licensee or License applicant and the existence of Significant Investigative Information regarding a Licensee or License applicant.applicants.

(5)4. 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.

(6)Notify Complythe Commission, in compliance with the Rulesterms of thethis Compact Commission.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.

(7)5. Utilize passage of a recognized national exam such as the NCCPA PANCE as a requirement for PA licensure.

(8)Fully Grantimplement thea CompactCriminal PrivilegeBackground toCheck requirement, within a holdertime frame established by Commission Rule, by its Licensing Board receiving the HB1146 ENROLLED 26.417.13 4 1146 results of a QualifyingCriminal Background Check and reporting to the Commission whether the License inapplicant ahas Participatingbeen State.granted a License.

(b)6. Nothing in this Compact prohibits a Participating State from charging a fee for granting the Compact Privilege.

"§Comply 90-270.203.with the Rules of the Compact Commission.

Compact7. Privilege.

(a)Utilize Topassage exerciseof a recognized national exam such as the CompactNCCPA Privilege,PANCE as a Licenseerequirement must:for PA licensure.

(1)8. 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.

(2)Grant Holdthe currentCompact NCCPAPrivilege certification.to a holder of a Qualifying License in a Participating State.

(3)B. Have no felony or misdemeanor conviction.

(4)Nothing Havein neverthis hadCompact prohibits a controlledParticipating substanceState license,from permit,charging or registration suspended or revoked by a Statefee orfor bygranting the UnitedCompact StatesPrivilege. Drug Enforcement Administration.

(5)Section Have4. a unique identifier as determined by Commission Rule.

(6)Compact HoldPrivilege aA. Qualifying License.

(7)To Havehadexercise nothe revocationofaCompact LicenseorlimitationPrivilege, orrestrictiona onLicensee anyLicensemust: currently held due to an Adverse Action.

(8)1. 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.

(9)Have Ifgraduated afrom Compact Privilege has been revoked or is limited or restricted in a ParticipatingPA Stateprogram foraccredited conductby that would not be abasis for disciplinaryaction in a Participating State in which the LicenseeAccreditation isReview practicingCommission oron applyingEducation tofor practice under a Compact Privilege, that Participating State shall have the discretionPhysician notAssistant, toInc. consider such action as an Adverse Action requiring the denial or removal of a Compact Privilege in that State.

(10)or Notifyother theprograms Compactauthorized by Commission thatRule. the Licensee is seeking the Compact Privilege in a Remote State.

Senate2. Bill 190-Second Edition Page 3 General Assembly Of North Carolina Session 2025 (11) Meet anyJurisprudence Requirement of a Remote State in which the Licensee is seeking to practice under the Compact Privilege and payanyfees applicable to satisfying the Jurisprudence Requirement.

(12)Hold Reportcurrent toNCCPA thecertification. Commission any Adverse Action taken by a non-participating State within 30 days after the action is taken.

(b)3. The Compact Privilege is valid until the expiration or revocation of the Qualifying License unless terminated pursuant to an Adverse Action.

TheHave Licenseeno mustfelony alsoor complymisdemeanor withconviction. all of the requirements of subsection (a) of this section to maintain the Compact Privilege in a Remote State.

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.

5.

Have a unique identifier as determined by Commission Rule.

6.

Hold a Qualifying License.

7.

Have had no revocation of a License or limitation or restriction on any License currently held due to an Adverse Action.

8.

Notify the Compact Commission that the Licensee is seeking the Compact Privilege in a Remote State.

9.

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.

10.

Report to the Commission any Adverse Action taken by a non-participating State within thirty days after the action is taken.

B.

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.

HB1146 ENROLLED 26.417.13 5 1146 C.

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.

D.

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 subsection A above to maintain the Compact Privilege in a Remote State.

(1)1. The License is no longer limited or restricted;

andThe (2) Two years have elapsed from the date on which the License is no longer limited or restrictedrestricted; due to the Adverse Action.

(c) Once a restricted or limited License satisfies the requirements of subdivisions (b)(1) and (2)2. of this section, the Licensee must meet the requirements of subsection (a) of this section to obtain a Compact Privilege in any Remote State.

(d)Two Foryears eachhave Remoteelapsed Statefrom inthe whichdate aon PAwhich seeks authority to prescribe controlled substances, the PALicense shallis satisfyno alllonger requirementslimited imposedor byrestricted suchdue Stateto inthe grantingAdverse orAction. renewing such authority.

"§E. 90-270.204.

DesignationOnce ofa restricted or limited License satisfies the Staterequirements fromof whichsubsection D.1 and 2, the Licensee ismust applyingmeet forthe requirements of subsections A, B, and C to obtain a Compact Privilege.Privilege in any Remote State.

UponF. 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:

(1)For Wheneach applyingRemote forState ain Compactwhich Privilege,a thePA Licenseeseeks shallauthority provideto theprescribe Commissioncontrolled withsubstances, the addressPA of the Licensee's primary residence and thereafter shall immediatelysatisfy reportall torequirements theimposed Commissionby anysuch changeState in thegranting addressor ofrenewing thesuch Licensee'sauthority. primary residence.

(2)Section When5. applying for a Compact Privilege, the Licensee is required to consent to accept service of process bymail at the Licensee's primary residence on file with the Commission with respect to any action brought against the Licensee bytheCommissionoraParticipatingState,includingasubpoena,with respect to any action brought or investigation conducted by the Commission or a Participating State.

"§Designation 90-270.205.of the State from Which Licensee is Applying for a Compact Privilege A.

AdverseUpon Actions.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:

(a)1. 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.

(b)When Inapplying additionfor toa theCompact otherPrivilege, powersthe conferredLicensee byshall Stateprovide law,the aCommission Remotewith Statethe shalladdress haveof the authority,Licensee’s inprimary accordanceresidence withand existingthereafter Stateshall dueimmediately processreport law, to dothe allCommission any change in the address of the following:Licensee’s primary residence.

(1)2. 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.

(2)When Issueapplying subpoenas for botha hearingsCompact andPrivilege, investigationsthe thatLicensee requireis therequired attendanceto andconsent testimonyto accept service of witnessesprocess asby wellmail asat the productionLicensee’s ofprimary evidence.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, HB1146 ENROLLED 26.417.13 6 1146 with respect to any action brought or investigation conducted by the Commission or a Participating State.

Section 6.

Adverse Actions 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.

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:

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.

2.

Issue subpoenas for both hearings and investigations that require the attendance and testimony of witnesses as well as the production of evidence.

The issuing authority shall pay any witness fees, travel expenses, mileage,mileage and other fees Page 4 Senate Bill 190-Second Edition General Assembly Of North Carolina Session 2025 required bytheby the service statutes of the State in which the witnesses or evidence are located.

(3)3. Notwithstanding subdivision (2) of this subsection, 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.

(4)Notwithstanding Nothingparagraph in2, thissubpoenas Compactmay authorizesnot be issued by a Participating State to imposegather disciplineevidence againstof aconduct PA'sin Compactanother PrivilegeState orthat tois denylawful anin applicationthat other State for athe Compactpurpose Privilegeof intaking thatAdverse ParticipatingAction Stateagainst fora theLicensee’s individual'sCompact otherwisePrivilege lawfulor practiceapplication for a Compact Privilege in anotherthat Participating State.

(c)4. 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.

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.

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 HB1146 ENROLLED 26.417.13 7 1146 within the Participating State which issued the Qualifying License.

(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.

(e) A Participating StateState, mayif takeotherwise Adversepermitted Actionby basedState onlaw, themay factualrecover findingsfrom ofthe aaffected RemotePA State,the providedcosts thatof theinvestigations Participatingand Statedisposition followsof itscases ownresulting proceduresfrom forany takingAdverse theAction Adversetaken Action.against that PA.

(f)E. Joint Investigations.

–A (1) In addition to the authority granted to a Participating State bymay itstake respectiveAdverse StateAction PAbased lawson andthe regulationsfactual orfindings otherof applicablea StateRemote law,State, anyprovided that the Participating State mayfollows participateits withown otherprocedures Participatingfor Statestaking inthe jointAdverse investigationsAction. of Licensees.

(2)F. Participating States shall share any investigative, litigation, or compliance materials in furtherance of anyjoint or individual investigation initiated under this Compact.

(g)Joint IfInvestigations an1. Adverse Action is taken against a PA's Qualifying License, the PA's Compact Privilege in all Remote States shall be deactivated until two years have elapsed after all restrictions have been removed from the State License.

AllIn disciplinaryaddition ordersto by the Participatingauthority Stategranted whichto issueda theParticipating QualifyingState Licenseby thatits imposerespective AdverseState ActionPA againstlaws aand PA'sregulations Licenseor shallother includeapplicable aState Statementlaw, thatany theParticipating PA'sState Compactmay Privilegeparticipate iswith deactivatedother in all Participating States duringin thejoint pendencyinvestigations of theLicensees. order.

(h)2. If any Participating State takes Adverse Action, it promptly shall notify the administrator of the Data System.

"§Participating 90-270.206.States shall share any investigative, litigation, or compliance materials in furtherance of any joint or individual investigation initiated under this Compact.

EstablishmentG. of the PA Licensure Compact Commission.

(a)If Thean ParticipatingAdverse StatesAction herebyis createtaken andagainst establish a jointPA’s governmentQualifying agencyLicense, andthe nationalPA’s administrativeCompact bodyPrivilege knownin asall theRemote PAStates Licensureshall Compactbe Commission.deactivated until two years have elapsed after all restrictions have been removed from the State License.

TheAll Commissiondisciplinary isorders anby instrumentalityofthe 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 StatesPrivilege actingis jointlydeactivated andin notall anParticipating instrumentalityStates ofduring anythe onependency State.of the order.

TheH. Commission shall come into existence on or after the effective date of the Compact as set forth in G.S.

90-270.210(a).If any Participating State takes Adverse Action, it promptly shall notify the administrator of the Data System.

(b)Section Membership,7. Voting, and Meetings:

(1)Establishment Eachof Participating State shall have and be limited to one delegate selected by that Participating State's Licensing Board or, if the StatePA hasLicensure moreCompact thanCommission oneA. Licensing Board, selected collectively by the Participating State's Licensing Boards.

(2) The delegateParticipating shallStates behereby either:create and establish a joint government agency and national administrative body known as the PA Licensure Compact Commission.

SenateThe BillCommission 190-Secondis Editionan Pageinstrumentality 5of Generalthe AssemblyCompact OfStates Northacting Carolinajointly Sessionand 2025not a.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 Section 11.A.

B.

Membership, Voting, and Meetings 1.

Each Participating State shall have and be limited to one delegate selected by that Participating State’s Licensing Board or, if the State has more than HB1146 ENROLLED 26.417.13 8 1146 one Licensing Board, selected collectively by the Participating State’s Licensing Boards.

2.

The delegate shall be either:

a.

(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.

(4)Any TheParticipatingStatedelegate Licensingmay Boardbe shallremoved fillor anyvacancyoccurringinsuspended from office as provided by the Commissionlaws withinof 60the days.State from which the delegate is appointed.

(5)4. Each delegate shall be entitled to one 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.

The Participating State Licensing Board shall fill any vacancy occurring in the Commission within sixty days.

5.

Each delegate shall be entitled to one 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.

The bylaws may provide for delegates'participationdelegates’ participation in meetings bytelecommunications,by videoconference,telecommunications, video conference, or other means of communication.

(6)6. The Commission shall meet at least once during each calendar year.

The Commission shall meet at least once during each calendar year.

(7)7. The Commission shall establish by Rule a term of office for delegates.

(c) The Commission shall haveestablish theby followingRule powersa andterm duties:of office for delegates.

(1)C. Establish a code of ethics for the Commission;

(2)The EstablishCommission theshall fiscalhave yearthe offollowing thepowers Commission;and duties:

(3)1. Establish fees;

(4) Establish bylaws;a code of ethics for the Commission;

(5)2. Maintain its financial records in accordance with the bylaws;

(6)Establish Meet and take such actions as are consistent with the provisionsfiscal year of this Compact and the bylaws;Commission;

(7)3. Promulgate Rules to facilitate and coordinate implementation and administration of this Compact.

Establish fees;

4.

Establish bylaws;

5.

Maintain its financial records in accordance with the bylaws;

6.

Meet and take such actions as are consistent with the provisions of this Compact and the bylaws;

7.

Promulgate Rules to facilitate and coordinate implementation and administration of this Compact.

(8)8. Bring and prosecute legal proceedings or actions in the name of the Commission, provided that the standing of any State Licensing Board to sue or be sued under applicable law shall not be affected;

(9)Bring Purchase and maintainprosecute insurancelegal andproceedings bonds;or actions in the name of the Commission, provided that the standing of any State Licensing Board to sue or be sued under applicable law shall not be affected;

(10)9. Borrow, accept, or contract for services of personnel, including, but not limited to, employees of a Participating State;

(11)Purchase Hire employees and engagemaintain contractors,insurance elect or appoint officers, fix compensation, define duties, grant such individuals appropriate authority to carry out the purposes of this Compact, and establishbonds; the Commission's personnel policies and programs relating to conflicts of interest, qualifications of personnel, and other related personnel matters;

(12)HB1146 AcceptENROLLED any26.417.13 and9 all1146 appropriate10. donations and grants of money, equipment, supplies, materials, and services and receive, utilize, and dispose of the same;

Borrow, accept, or contract for services of personnel, including, but not limited to, employees of a Participating State;

11.

Hire employees and engage contractors, elect or appoint officers, 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;

12.

Accept any and all appropriate donations and grants of money, equipment, supplies, materials and services, and receive, utilize and dispose of the same;

(13)13. Lease, purchase, accept appropriate gifts or donations of, or otherwise own, hold, improve, or use any property, real, personal, or mixed;

Lease, purchase, accept appropriate gifts or donations of, or otherwise own, hold, improve or use, any property, real, personal or mixed;

(14)14. Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of any property real, personal, or mixed;

(15)Sell, Establishconvey, amortgage, budgetpledge, andlease, makeexchange, expenditures;abandon, or otherwise dispose of any property real, personal, or mixed;

(16)15. Borrow money;

(17)Establish Appointa committees,budget including standing committees composed of members, State regulators, State legislators or their representatives, and consumermake Pageexpenditures; 6 Senate Bill 190-Second Edition General Assembly Of North Carolina Session 2025 representatives, and such other interested persons as maybe designated in this Compact and the bylaws;

(18)16. Provide and receive information from, and cooperate with, law enforcement agencies;

(19)Borrow Electmoney; a Chair, Vice-Chair, Secretary, and Treasurer and such other officers of the Commission as provided in the Commission's bylaws;

(20)17. Reserve for itself, in addition to those reserved exclusivelyto the Commission under the Compact, powers that the Executive Committee may not exercise;

(21)Appoint Approvecommittees, orincluding disapprovestanding acommittees State'scomposed participationof inmembers, theState Compactregulators, basedState uponlegislators itsor determinationtheir asrepresentatives, toand whetherconsumer therepresentatives, State'sand Compactsuch legislationother departsinterested inpersons aas materialmay mannerbe fromdesignated thein Modelthis Compact language;and the bylaws;

(22)18. Prepare and provide to the Participating States an annual report;

Provide and (23)receive Performinformation suchfrom, otherand functionscooperate aswith, maylaw beenforcement necessaryagencies; or appropriate to achieve the purposes of this Compact consistent with the State regulation of PA licensure and practice.

(d)19. Meetings of the Commission:

(1)Elect Alla meetingsChair, ofVice theCommissionthatareChair, notSecretary, closedpursuantand toTreasurer thisand subsectionsuch shallother beofficers openof tothe Commission as provided in the public.Commission’s bylaws;

Notice20. of public meetings shall be posted on the Commission's website at least 30 days prior to the public meeting.

(2)Reserve Notwithstandingfor subdivisionitself, (1)in ofaddition thisto subsection,those thereserved Commissionexclusively mayto convene a public meeting by providing at least 24 hours' prior notice on the Commission'sCommission website,under and any other means as provided in the Commission'sCompact, Rules,powers forthat any of the reasonsExecutive itCommittee may dispensenot withexercise; notice of proposed rulemaking under G.S.

90-270.208(l).21.

(3)Approve Theor Commissiondisapprove maya conveneState’s participation in athe closed,Compact nonpublicbased meetingupon orits nonpublicdetermination partas ofto awhether publicthe meetingState’s toCompact receivelegislation legaldeparts advicein ora tomaterial discuss:manner from the Model Compact language;

22.

Prepare and provide to the Participating States an annual report;

and HB1146 ENROLLED 26.417.13 10 1146 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.

D.

Meetings of the Commission 1.

All meetings of the Commission that are not closed pursuant to this subsection shall be open to the public.

Notice of public meetings shall be posted on the Commission’s website at least thirty days prior to the public meeting.

2.

Notwithstanding subsection D.1 of this section, the Commission may convene a public meeting by providing at least twenty-four hours prior notice on the Commission’s website, and any other means as provided in the Commission’s Rules, for any of the reasons it may dispense with notice of proposed rulemaking under Section 9.L.

3.

The Commission may convene in a closed, non-public meeting or nonpublic part of a public meeting to receive legal advice or to discuss:

NoncomplianceNon-compliance of a Participating State with its obligations under this Compact;

The employment, compensation, disciplinediscipline, or other matters, practicespractices, or procedures related to specific employeesemployees, or other matters related to the Commission'sCommission’s internal personnel practices and procedures;

Disclosure of information related to anyinvestigativeany investigative 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;

HB1146 ENROLLED 26.417.13 11 1146 j.

Matters specifically exempted from disclosure by federal or Participating States'States’ statutes.

(4)4. If a meeting, or portion of a meeting, is closed pursuant to this provision, the chair of the meeting or the chair's designee shall certify that the meeting or Senate Bill 190-Second Edition Page 7 General Assembly Of North Carolina Session 2025 portion of the meeting may be closed and shall reference each relevant exempting provision.

(5)If Thea Commissionmeeting, shallor keepportion minutesof thata fullymeeting, andis clearlyclosed describepursuant allto mattersthis discussedprovision, inthe achair of the meeting andor the chair’s designee shall providecertify athat fullthe andmeeting accurateor summaryportion of actionsthe taken,meeting includingmay abe descriptionclosed ofand theshall viewsreference expressed.each relevant exempting provision.

5.

The Commission shall keep minutes that fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of actions taken, including a description of the views expressed.

(e)E. Financing of the Commission:

(1)Financing Theof Commission shall pay, or provide for the paymentCommission of,1. the reasonable expenses of its establishment, organization, and ongoing activities.

(2) The Commission mayshall acceptpay, anyor andprovide allfor appropriatethe revenuepayment sources,of, donations,the andreasonable grantsexpenses of money,its equipment,establishment, supplies,organization, materials, and services.ongoing activities.

(3)2. The Commission may levy on and collect an annual assessment from each Participating State and may impose Compact Privilege fees on Licensees of Participating States to whom a Compact Privilege is granted to cover the cost of the operations and activities of the Commission and its staff, which must be in a total amount sufficient to cover its annual budget as approved by the Commission each year for which revenue is not provided by other sources.

The Commission may accept any and all appropriate revenue sources, donations, and grants of money, equipment, supplies, materials, and services.

3.

The Commission may levy on and collect an annual assessment from each Participating State and may impose Compact Privilege fees on Licensees of Participating States to whom a Compact Privilege is granted to cover the cost of the operations and activities of the Commission and its staff, which must be in a total amount sufficient to cover its annual budget as approved by the Commission each year for which revenue is not provided by other sources.

A Compact Privilege expires when the Licensee'sLicensee’s Qualifying License in the Participating State from which the Licensee applied for the Compact Privilege expires.

If the Licensee terminates the Qualifying License through which the Licensee applied for the Compact Privilege before its scheduled expiration, and the Licensee has a Qualifying License in another HB1146 ENROLLED 26.417.13 12 1146 Participating State, the Licensee shall inform the Commission that itthe Licensee is changing to that Participating State to be the Participating State through which itthe Licensee applies for a Compact Privilege and pay to the Commission any Compact Privilege fee required by Commission Rule.

(4)4. The Commission shall not incur obligations of any kind prior to securing the funds adequate to meet the same nor shall the Commission pledge the credit of any of the Participating States, except by and with the authority of the Participating State.

(5) The Commission shall keepnot accurateincur accountsobligations of allany receiptskind andprior disbursements.to securing the funds adequate to meet the same;

nor shall the Commission pledge the credit of any of the Participating States, except by and with the authority of the Participating State.

5.

The Commission shall keep accurate accounts of all receipts and disbursements.

(f)F. The Executive Committee:

(1) The Executive Committee shall1. have the power to act on behalf of the Commission according to the terms of this Compact and Commission Rules.

(2) The Executive Committee shall behave composedthe power to act on behalf of ninethe members:Commission according to the terms of this Compact and Commission Rules.

2.

The Executive Committee shall be composed of nine members:

One exex-officio, officio, nonvoting member from a recognized national PA professional association;

and Page 8 Senate Bill 190-Second Edition General Assembly Of North Carolina Session 2025 c.

One exex-officio, officio, nonvoting member from a recognized national PA certification organization.

(3)3. The ex officio members will be selected by their respective organizations.

(4) The Commissionex-officio maymembers removewill anybe memberselected ofby thetheir Executiverespective Committeeorganizations. as provided in its bylaws.

(5)4. The Executive Committee shall meet at least annually.

(6) The ExecutiveCommission Committeemay shallremove haveany member of the followingExecutive dutiesCommittee andas responsibilities:provided in its bylaws.

5.

The Executive Committee shall meet at least annually.

6.

The Executive Committee shall have the following duties and responsibilities:

Recommend to the Commission changes to the Commission'sCommission’s Rules or bylaws, changes to this Compact legislation, fees to be paid by Compact Participating States such as annual dues, and any HB1146 ENROLLED 26.417.13 13 1146 Commission Compact fee charged to Licensees for the Compact Privilege;

Exercise the powers and duties of the Commission during the interim between Commission meetings, except for issuing proposed rulemaking or adopting Commission Rules or bylaws, or exercising any other powers and duties exclusively reserved to the Commission by the Commission'sCommission’s Rules;

PerformotherdutiesPerform other duties as providedinprovided theCommission'sin Rulesorbylaws.the Commission’s Rules or bylaws.

(7)7. All meetings of the Executive Committee at which it votes or plans to vote on matters in exercising the powers and duties of the Commission shall be open to the public and public notice of such meetings shall be given as public meetings of the Commission are given.

(8)All Themeetings of the Executive Committee mayat convenewhich init avotes closed,or nonpublicplans meetingto forvote on matters in exercising the samepowers reasonsand thatduties of the Commission mayshall convenebe inopen ato nonpublicthe meetingpublic, and public notice of such meetings shall be given as setpublic forthmeetings inof G.S.the Commission are given.

90-270.206(d)(3)8. and shall announce the closed meeting as the Commission is required to under G.S.

90-270.206(d)(3)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 meeting as the Commission is required to under G.S.Section 7.D.5.

90-270.206(d)(3).G.

(g) Qualified Immunity, Defense, and Indemnification:Indemnification 1.

(1) The members, officers, executive director, employees, and representatives of the Commission shall be immune from suit and liability, both personally and in their official capacity,capacities, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties,duties or responsibilities;

provided that nothing in this paragraph shall be construed to protect any such person from suit or liability for any damage, loss, injury, or liability caused by the HB1146 ENROLLED 26.417.13 14 1146 intentional or willful or wanton misconduct of that person.

The procurement of insurance of anytypeany type by the Commission shall not in any way compromise or limit the immunity granted hereunder.

(2)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 Senate Bill 190-Second Edition Page 9 General Assembly Of North Carolina Session 2025 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;

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;

and provided further, that the actual or alleged act, error, or omission did not result from that person'sperson’s intentionalintentional, orwillful, willful or wanton misconduct.

(3)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 from the intentional or willful or wanton misconduct of that person.

(4)The VenueCommission isshall properindemnify and judicialhold proceedingsharmless byany 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 shallemployment, beduties, broughtor solelyresponsibilities, andor exclusivelythat insuch person had a courtreasonable basis for believing occurred within the scope of competentCommission jurisdictionemployment, whereduties, theprincipalor officeoftheCommissionislocated.TheCommissionmaywaiveresponsibilities, venueprovided andthat jurisdictionalthe defensesactual inor anyalleged proceedingsact, aserror, authorizedor byomission Commissiondid Rules.not result from the intentional, willful, or wanton misconduct of that person.

(5)4. Nothing herein shall be construed as a limitation on the liability of any Licensee for professional malpractice or misconduct, which shall be governed solely by any other applicable State laws.

(6)Venue Nothingis hereinproper shalland bejudicial construedproceedings toby designate the venue or jurisdictionagainst tothe bringCommission actionsshall forbe allegedbrought actssolely ofand malpractice,exclusively professionalin misconduct,a negligence,court orof othercompetent suchjurisdiction civilwhere actionthe pertainingprincipal tooffice of the practiceCommission ofis alocated. PA.

AllThe suchCommission mattersmay shallwaive bevenue determinedand exclusivelyjurisdictional bydefenses Statein lawany otherproceedings thanas thisauthorized Compact.by Commission Rules.

(7)5. Nothing in this Compact shall be interpreted to waive or otherwise 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.

(8) Nothing inherein this Compact shall be construed toas be a waiverlimitation ofon sovereignthe immunityliability byof theany ParticipatingLicensee Statesfor professional malpractice or misconduct, which shall be governed solely by theany Commission.other applicable State laws.

"§6. 90-270.207.

DataNothing System.herein shall be construed to designate the venue or jurisdiction to bring actions for alleged acts of malpractice, professional misconduct, negligence, or other such civil action pertaining to the practice of a PA.

(a)All TheHB1146 CommissionENROLLED shall26.417.13 provide15 for1146 thesuch development,matters maintenance,shall operation,be anddetermined utilizationexclusively ofby aState coordinatedlaw dataother andthan reportingthis systemCompact. containing licensure, Adverse Action, and the reporting of the existence of Significant Investigative Information on all licensed PAs and applicants denied a License in Participating States.

(b)7. Notwithstanding anyother State law to the contrary, a Participating State shall submit a uniform data set to the Data System on all PAs to whom this Compact is applicable (utilizing a unique identifier) as required by the Rules of the Commission, including:

(1)Nothing Identifyingin information;this Compact shall be interpreted to waive or otherwise 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.

(2)8. Licensure data;

(3)Nothing Adversein Actionsthis againstCompact shall be construed to be a Licensewaiver of sovereign immunity by the Participating States or Compactby Privilege;the Commission.

(4)Section Any8. denial of application for licensure, and the reason(s) for such denial (excluding the reporting of any criminal history record information where prohibited by law);

(5)Data TheSystem existenceA. of Significant Investigative Information;

andThe PageCommission 10shall Senateprovide Billfor 190-Secondthe Editiondevelopment, Generalmaintenance, Assemblyoperation, Ofand Northutilization Carolinaof Sessiona 2025coordinated (6)data Otherand informationreporting thatsystem maycontaining facilitatelicensure, Adverse Action, and the administrationreporting of thisthe Compact,existence asof determinedSignificant byInvestigative theInformation Ruleson ofall thelicensed Commission.PAs and applicants denied a License in Participating States.

(c)B. Significant Investigative Information pertaining to a Licensee in any Participating State shall only be available to other Participating States.

(d)Notwithstanding Theany Commissionother shallState promptlynotifylaw allto the contrary, a Participating StatesState ofshall anysubmit Adversea Actionuniform takendata againstset ato Licenseethe orData anSystem individualon applyingall forPAs to whom this Compact is applicable, utilizing a Licenseunique thatidentifier, hasas beenrequired reportedby tothe it.Rules of the Commission, including:

1.

Identifying information;

2.

Licensure data;

3.

Adverse Actions against a License or Compact Privilege;

4.

Any denial of application for licensure, and the reason(s) for such denial, excluding the reporting of any Criminal history record information where prohibited by law;

5.

The existence of Significant Investigative Information;

and 6.

Other information that may facilitate the administration of this Compact, as determined by the Rules of the Commission.

C.

Significant Investigative Information pertaining to a Licensee in any Participating State shall only be available to other Participating States.

D.

The Commission shall promptly notify all Participating States of any Adverse Action taken against a Licensee or an individual applying for a License that has been reported to it.

(e)E. Participating States contributing information to the Data System may, in accordance with State or federal law, designate information that may not be shared with the public without the express permission of the contributing State.

Participating States contributing information to the Data System may, in accordance with State or federal law, designate information that may not be shared HB1146 ENROLLED 26.417.13 16 1146 with the public without the express permission of the contributing State.

(f)F. Any information submitted to the Data System that is subsequently expunged pursuant to federal law or the laws of the Participating State contributing the information shall be removed from the Data System upon reporting of such by the Participating State to the Commission.

(g)Any Theinformation recordssubmitted andto informationthe providedData toSystem athat Participatingis Statesubsequently expunged pursuant to thisfederal Compactlaw or through the Datalaws System,of when certified by the CommissionParticipating orState ancontributing agent thereof, shall constitute the authenticatedinformation business records of the Commission and shall be entitledremoved tofrom anythe associatedData hearsaySystem exceptionupon inreporting anyof relevantsuch judicial,by quasi-judicial,the orParticipating administrativeState proceedingsto inthe aCommission. Participating State.

"§G. 90-270.208.

Rulemaking.The records and information provided to a Participating State pursuant to this Compact or through the Data System, when certified by the Commission or an agent thereof, shall constitute the authenticated business records of the Commission, and shall be entitled to any associated hearsay exception in any relevant judicial, quasi-judicial or administrative proceedings in a Participating State.

(a)Section The9. Commission shall exercise its Rulemaking powers pursuant to the criteria set forth in this section and the Rules adopted thereunder.

Rulemaking A.

The Commission shall exercise its Rulemaking powers pursuant to the criteria set forth in this section and the Rules adopted thereunder.

(b)B. The Commission shall promulgate reasonable Rules in order to effectively and efficientlyimplement and administerthis Compactandachieveits purposes.

ACommissionRuleThe shall be invalid and have not force or effect only if a court of competent jurisdiction holds that the Rule is invalid because the Commission exercisedshall itspromulgate rulemakingreasonable authorityRules in aorder mannerto thateffectively isand beyondefficiently theimplement scopeand ofadminister the purposes of this Compact,Compact orand theachieve powersits grantedpurposes. hereunder, or based upon another applicable standard of review.

(c)A TheCommission RulesRule ofshall thebe Commissioninvalid shalland have thenot force ofor laweffect inonly eachif Participatinga State,court provided,of however,competent thatjurisdiction whereholds thethat Rules of the CommissionRule conflictis withinvalid thebecause laws of the ParticipatingCommission Stateexercised thatits establishrulemaking theauthority Medicalin Services a PAmanner maythat performis inbeyond the Participatingscope State,of asthe heldpurposes by a court of competentthis jurisdiction,Compact, theor Rules of the Commissionpowers shallgranted behereunder, ineffectiveor inbased thatupon Stateanother toapplicable thestandard extent of thereview. conflict.

TheC. Rules of the Commission shall not modify or expand, in any way, the scope of practice of a PA as established by the laws of the Participating State.

(d)The IfRules a majority of the legislaturesCommission ofshall have the Participatingforce Statesof rejectslaw ain Commissioneach Rule,Participating byState, enactmentprovided ofhowever athat statutewhere orthe resolutionRules inof the sameCommission mannerconflict usedwith tothe adoptlaws thisof Compactthe withinParticipating fourState yearsthat ofestablish the datemedical ofservices adoptiona ofPA may perform in the Rule,Participating thenState, suchas Ruleheld shallby havea nocourt furtherof forcecompetent andjurisdiction, effectthe inRules anyof Participatingthe StateCommission orshall tobe anyineffective Statein applyingthat State to participatethe inextent of the Compact.conflict.

(e)D. Commission Rules shall be adopted at a regular or special meeting of the Commission.

(f)If Priora tomajority promulgationof andthe adoptionlegislatures of the Participating States rejects a finalCommission RuleRule, by enactment of a statute or Rulesresolution byin the Commission,same andmanner atused leastto 30adopt daysthis inCompact advancewithin four years of the meetingdate atof whichadoption of the Rule, then such Rule willshall behave consideredno further force and votedeffect upon,in theany CommissionParticipating shallState fileor ato Noticeany ofState Proposedapplying Rulemaking:to participate in the Compact.

(1)HB1146 OnENROLLED the26.417.13 website17 of1146 theE. Commission or other publicly accessible platform;

(2)Commission ToRules personsshall whobe haveadopted requestedat noticea ofregular theor Commission'sspecial noticesmeeting of proposedthe rulemaking;Commission.

andF. (3) In such other way(s) as the Commission may by Rule specify.

(g)Prior Theto Noticepromulgation and adoption of Proposeda Rulemakingfinal Rule or Rules by the Commission, and at least thirty days in advance of the meeting at which the Rule will be considered and voted upon, the Commission shall include:file a Notice of Proposed Rulemaking:

Senate1. Bill 190-Second Edition Page 11 General Assembly Of North Carolina Session 2025 (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 Rule will be considered and voted upon;

(2)On Thethe textwebsite of the proposedCommission Ruleor andother thepublicly reasonaccessible forplatform; the proposed Rule;

(3) A request for comments on the proposed Rule from any interested person and the2. date by which written comments must be received;

andTo (4)persons Themannerinwho whichinterestedpersonsmaysubmithave noticetorequested thenotice Commission of their intention to attend the publicCommission’s hearingnotices orof provideproposed anyrulemaking; written comments.

(h) Prior to adoption of a proposed Rule, the Commission shall allow persons to submit written data, facts, opinions, and arguments,3. which shall be made available to the public.

(i)In Ifsuch theother hearingway(s) isas to be held via electronic means, the Commission shallmay publishby theRule mechanismspecify. for access to the electronic hearing.

(1)G. All persons wishing to be heard at the hearing shall as directed in the Notice ofProposed Rulemaking, not lessthanfivebusiness days beforethescheduled date of the hearing, notify the Commission of their desire to appear and testify at the hearing.

(2)The HearingsNotice shallof beProposed conductedRulemaking inshall ainclude: manner providing each person who wishes to comment a fair and reasonable opportunityto comment orallyor in writing.

(3)1. All hearings shall be recorded.

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 Rule will be considered and voted upon;

2.

The text of the proposed Rule and the reason for the proposed Rule;

3.

A request for comments on the proposed Rule from any interested person and the date by which written comments must be received;

and 4.

The manner in which interested persons may submit notice to the Commission of their intention to attend the public hearing or provide any written comments.

H.

Prior to adoption of a proposed Rule, the Commission shall allow persons to submit written data, facts, opinions, and arguments, which shall be made available to the public.

I.

If the hearing is to be held via electronic means, the Commission shall publish the mechanism for access to the electronic hearing.

1.

All persons wishing to be heard at the hearing shall as directed in the Notice of Proposed Rulemaking, not less than five business days before the scheduled date of the hearing, notify the Commission of their desire to appear and testify at the hearing.

2.

Hearings shall be conducted in a manner providing each person who wishes to comment a fair and reasonable opportunity to comment orally or in writing.

3.

All hearings shall be recorded.

(4)HB1146 NothingENROLLED in26.417.13 this18 section1146 shall4. be construed as requiring a separate hearing on each proposed Rule.

Nothing in this section shall be construed as requiring a separate hearing on each proposed Rule.

(j)J. Following the public hearing, the Commission shall consider all written and oral comments timely received.

(k)Following Thethe Commissionpublic shall,hearing, by majority vote of all delegates, take final action on the proposedCommission Rule and shall determineconsider theall effectivewritten date of the Rule, if adopted, based on the Rulemaking record and theoral fullcomments texttimely ofreceived. the Rule.

(1)K. If adopted, the Rule shall be posted on the Commission's website.

(2) The Commission mayshall, adoptby changesmajority tovote of all delegates, take final action on the proposed Rule providedand shall determine the changeseffective dodate notof enlargethe Rule, if adopted, based on the originalRulemaking purposerecord ofand the proposedfull text of the Rule.

(3)1. The Commission shall provide on its website an explanation of the reasons for substantive changes made to the proposed Rule as well as reasons for substantive changes not made that were recommended by commenters.

(4)If Theadopted, Commissionthe Rule shall determinebe aposted reasonableon effective date for the Rule.Commission’s website.

Except2. for an emergency as provided in subsection (l) of this section, the effectivedateoftheRuleshallbenosoonerthan30daysaftertheCommission issued the notice that it adopted the Rule.

(l)The Upon determination that an emergency exists, the Commission may consider and adopt anchanges emergencyto Rule with 24 hours' prior notice, without the opportunityproposed forRule comment, or hearing, provided that the usualchanges Rulemakingdo proceduresnot providedenlarge in this Compact and in this section shall be retroactively applied to the Ruleoriginal aspurpose soon as reasonably possible, in no event later than 90 days after the effective date of the proposed Rule.

3.

The Commission shall provide on its website an explanation of the reasons for substantive changes made to the proposed Rule as well as reasons for substantive changes not made that were recommended by commenters.

4.

The Commission shall determine a reasonable effective date for the Rule.

Except for an emergency as provided in subsection L, the effective date of the Rule shall be no sooner than thirty days after the Commission issued the notice that it adopted the Rule.

L.

Upon determination that an emergency exists, the Commission may consider and adopt an emergency Rule with twenty-four 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 to the Rule as soon as reasonably possible, in no event later than ninety days after the effective date of the Rule.

(1)1. Meet an imminent threat to public health, safety, or welfare;

(2)Meet Preventan aimminent lossthreat ofto Commissionpublic orhealth, Participatingsafety, Stateor funds;welfare;

(3)2. Meet adeadlineforthepromulgationofaCommission Rulethatis established by federal law or Rule;

orPrevent (4)a Protectloss publicof healthCommission andor safety.Participating State funds;

Page3. 12 Senate Bill 190-Second Edition General Assembly Of North Carolina Session 2025 (m) The Commission or an authorized committee of the Commission maydirect revisions to a previously adopted Commission Rule for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors.

Meet a deadline for the promulgation of a Commission Rule that is established by federal law or Rule;

or 4.

Protect public health and safety.

M.

The Commission or an authorized committee of the Commission may direct revisions to a previously adopted Commission Rule for purposes of correcting typographical errors, errors in format, errors in consistency, or grammatical errors.

HB1146 ENROLLED 26.417.13 19 1146 The revision shall be subject to challenge by any person for a period of 30thirty days after posting.

(n)N. No Participating State's rulemaking requirements shall apply under this Compact.

"§No 90-270.209.Participating State’s rulemaking requirements shall apply under this Compact.

Oversight,Section dispute10. resolution, and enforcement.

(a)Oversight, Oversight:Dispute Resolution, and Enforcement A.

(1)Oversight The1. executive and judicial branches of State government in each Participating StateshallenforcethisCompactandtakeallactionsnecessaryandappropriate to implement the Compact.

(2)The Venueexecutive is proper and judicial proceedingsbranches byof orState againstgovernment the Commission shall be brought solely and exclusively in aeach courtParticipating ofState competentshall jurisdictionenforce wherethis theprincipalCompact officeoftheCommissionislocated.TheCommissionmaywaive venue and jurisdictionaltake defensesall toactions thenecessary extentand itappropriate adopts or consents to participateimplement inthe alternativeCompact. dispute resolution proceedings.

Nothing2. herein shall affect or limit the selection or propriety of venue in any action against a Licensee for professional malpractice, misconduct, oranysuchsimilarmatter.

(3)Venue Theis Commissionproper shalland bejudicial entitledproceedings toby receiveor serviceagainst ofthe processCommission inshall anybe proceedingbrought regardingsolely theand enforcementexclusively orin interpretationa court of thecompetent Compactjurisdiction orwhere the Commission'sprincipal Rulesoffice andof shallthe haveCommission standingis tolocated. intervene in such a proceeding for all purposes.

The Commission may waive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings.

Nothing herein shall affect or limit the selection or propriety of venue in any action against a licensee for professional malpractice, misconduct, or any such similar matter.

3.

The Commission shall be entitled to receive service of process in any proceeding regarding the enforcement or interpretation of the Compact or the Commission’s Rules and shall have standing to intervene in such a proceeding for all purposes.

(b)B. Default, Technical Assistance, and Termination:

(1)Default, IfTechnical theAssistance, Commission determines that a Participating State has defaulted in the performance of its obligations or responsibilities under this Compact or the Commission Rules, the Commission shall provide written notice to the defaulting State and otherTermination Participating1. States.

TheIf noticethe shallCommission describedetermines thethat default,a theParticipating proposedState meanshas ofdefaulted curingin the default,performance andof anyits otherobligations actionor thatresponsibilities under this Compact or the Commission mayRules, takethe andCommission shall offerprovide remedialwritten trainingnotice andto specificthe technicaldefaulting assistanceState regardingand theother default.Participating States.

(2)The Ifnotice ashall Statedescribe in default fails to cure the default, the defaultingproposed Statemeans mayof becuring terminatedthe fromdefault, thisand Compactany uponother anaction affirmativethat vote of a majority of the delegatesCommission ofmay thetake, Participating States, and allshall rights,offer privileges,remedial training and benefitsspecific conferredtechnical bythisassistance Compactregarding upon such State maybe terminated on the effectivedefault. date of termination.

HB1146 ENROLLED 26.417.13 20 1146 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 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.

(3)3. Termination of participation in this Compact shall be imposed only after all other means of securing compliance have been exhausted.

NoticeTermination of intentparticipation toin suspendthis orCompact terminate shall be givenimposed byonly theafter Commissionall toother themeans governor, the majority and minority leaders of thesecuring defaultingcompliance State'shave legislature,been andexhausted. to the Licensing Board(s) of each of the Participating States.

(4)Notice Aof Stateintent thatto hassuspend beenor terminatedterminate isshall responsiblebe forgiven allby assessments,the obligations,Commission andto liabilitiesthe incurredgovernor, through the effectivemajority dateand minority leaders of termination,the includingdefaulting obligationsState’s thatlegislature, extendand beyondto the effectiveLicensing dateBoard(s) of termination.each of the Participating States.

Senate4. Bill 190-Second Edition Page 13 General Assembly Of North Carolina Session 2025 (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 upon in writing between the Commission and the defaulting State.

(6)A The defaulting State maythat appealhas itsbeen terminationterminated fromis theresponsible Compactfor byall theassessments, Commissionobligations, byand petitioningliabilities theincurred Unitedthrough States District Court for the Districteffective date of Columbiatermination, orincluding theobligations federalthat districtextend wherebeyond the Commissioneffective hasdate itsof principaltermination. offices.

The5. prevailing member shall be awarded all costs of such litigation, including reasonable attorneys' fees.

(7)The UponCommission theshall terminationnot ofbear any costs related to a State'sState participationthat is found to be in thedefault Compact,or thethat Statehas shallbeen immediatelyterminated providefrom noticethis toCompact, allunless Licenseesagreed withinupon thatin Statewriting ofbetween suchthe termination:Commission and the defaulting State.

6.

The defaulting State may appeal its termination from the Compact by the Commission by petitioning the United States District Court for the District of Columbia or the federal district where the Commission has its principal offices.

The prevailing member shall be awarded all costs of such litigation, including reasonable attorney’s fees.

7.

Upon the termination of a State’s participation in the Compact, the State shall immediately provide notice to all Licensees within that State of such termination.

Licensees who have been granted a Compact Privilege in that State shall retain the Compact Privilege for 180one hundred eighty days following the effective date of such termination.

Licensees who are licensed in that State and who have been granted a Compact Privilege in a Participating State shall retain the Compact Privilege for 180one dayshundred eighty days, unless the Licensee also has a Qualifying License in a Participating State or obtains a Qualifying License in a Participating State before the 180-dayone hundred eighty-day period ends, in which case the Compact Privilege shall continue.

(c)HB1146 DisputeENROLLED Resolution:26.417.13 21 1146 C.

(1)Dispute UponrequestResolution byaParticipatingState,theCommission1. shall attemptto resolve disputes related to this Compact that arise among Participating States and between Participating and non-Participating States.

(2)Upon Therequest by a Participating State, the Commission shall promulgateattempt ato Ruleresolve providingdisputes forrelated bothto mediationthis andCompact bindingthat disputearise resolutionamong forParticipating disputesStates asand appropriate.between participating and non-Participating States.

(d)2. Enforcement:

(1) The Commission,Commission inshall thepromulgate reasonablea exerciseRule ofproviding itsfor discretion,both shallmediation enforceand thebinding provisionsdispute ofresolution thisfor Compactdisputes andas Rulesappropriate. of the Commission.

(2)D. 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 enforce compliance with the provisions of this Compact and the Commission's promulgated Rules and bylaws.

Enforcement 1.

The Commission, in the reasonable exercise of its discretion, shall enforce the provisions of this Compact and Rules of the Commission.

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 enforce compliance with the provisions of this Compact and the Commission’s promulgated Rules and bylaws.

In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorneys'attorney’s fees.

(3)3. The remedies herein shall not be the exclusive remedies of the Commission.

The remedies herein shall not be the exclusive remedies of the Commission.

(e)E. Legal Action Against the Commission:

(1)Legal AAction ParticipatingAgainst State may initiate legal action against the Commission in1. the United States District Court for the District of Columbia or the federal district where theCommission has its principaloffices to enforce compliance with the provisions of the Compact and its Rules.

A Participating State may initiate legal action against the Commission in the United States District Court for the District of Columbia or the federal district where the Commission has its principal offices to enforce compliance with the provisions of the Compact and its Rules.

In the event judicial enforcement is necessary, the prevailing party shall be awarded all costs of such litigation, including reasonable attorneys'attorney’s fees.

(2)2. No person other than a Participating State shall enforce this Compact against the Commission.

PageNo 14person Senateother Billthan 190-Seconda EditionParticipating GeneralState Assemblyshall Ofenforce Norththis CarolinaCompact Sessionagainst 2025the "§Commission. 90-270.210.

DateSection of11. implementation of the PA Licensure Compact Commission.

(a)Date Thisof CompactImplementation shallof come into effect on the datePA onLicensure which this Compact statuteCommission isA. enacted into law in the seventh Participating State.

(1)This OnCompact or after the effective date of the Compact, the Commission shall convenecome andinto revieweffect theon enactment of each of the Statesdate thaton enactedwhich thethis Compact priorstatute tois theenacted Commissioninto conveninglaw ("Charterin Participating States") to determine if the statuteseventh enacted by each such Charter Participating StateState. is materially different than the Model Compact.

HB1146 ENROLLED 26.417.13 22 1146 1.

On or after the effective date of the Compact, the Commission shall convene and review the enactment of each of the States that enacted the Compact prior to the Commission convening ("Charter Participating States") to determine if the statute enacted by each such Charter Participating State is materially different than the Model Compact.

A Charter Participating State whose enactment is found to be materially different from the Model Compact shall be entitled to the default process set forth in G.S.Section 10.B.

90-270.209(b).

Participating States enacting the Compact subsequent to the Commission convening shall be subject to the process set forth in G.S.Section 7.C.21 to determine if their enactments are materially different from the Model Compact and whether they qualify for participation in the Compact.

90-270.206(c)(21)2. to determine if their enactments are materially different from the Model Compact and whether they qualify for participation in the Compact.

(2) Participating States enacting the Compact subsequent to the seven initial Charter Participating States shall be subject to the process set forth in G.S.Section 7.C.21 to determine if their enactments are materially different from the Model Compact and whether they qualify for participation in the Compact.

90-270.206(c)(21)3. to determine if their enactments are materially different from the Model Compact and whether they qualify for participation in the Compact.

(3) All actions taken for the benefit of the Commission or in furtherance of the purposes of the administration of the Compact prior to the effective date of the Compact or the Commission coming into existence shall be considered to be actions of the Commission unless specifically repudiated by the Commission.

(b)B. Any State that joins this Compact shall be subject to the Commission's Rules and bylaws as they exist on the date on which this Compact becomes law in that State.

Any State that joins this Compact shall be subject to the Commission’s Rules and bylaws as they exist on the date on which this Compact becomes law in that State.

(c)C. Any Participating State may withdraw from this Compact by enacting a statute repealing the same.

(1)Any A Participating State'sState withdrawalmay shallwithdraw notfrom takethis effectCompact untilby 180enacting daysa afterstatute enactmentrepealing of the repealingsame. statute.

During1. this 180-day period, all Compact Privileges that were in effect in the withdrawing State and were granted to Licensees licensed in the withdrawing State shall remain in effect.

IfA any Licensee licensed in the withdrawing State is also licensed in another Participating StateState’s orwithdrawal obtainsshall anot licensetake ineffect anotheruntil Participatingone Statehundred withineighty thedays 180after days,enactment the Licensee's Compact Privileges in other Participating States shall not be affected by the passage of the 180repealing days.statute.

(2)During Withdrawalthis shallone nothundred affecteighty theday-period, continuingall requirementCompact ofPrivileges thethat Statewere Licensingin Board(s)effect ofin the withdrawingHB1146 StateENROLLED to26.417.13 comply23 with1146 thewithdrawing investigativeState and Adversewere Actiongranted reportingto requirementsLicensees oflicensed thisin Compactthe priorwithdrawing toState theshall effectiveremain datein ofeffect. withdrawal.

(3)If Uponany Licensee licensed in the enactmentwithdrawing ofState ais statutealso withdrawinglicensed in another Participating State or obtains a license in another Participating State fromwithin thisthe Compact,one hundred eighty days, the StateLicensee’s Compact Privileges in other Participating States shall immediatelynot providebe noticeaffected ofby suchthe withdrawalpassage toof allthe Licenseesone withinhundred thateighty State.days.

Such2. withdrawing State shall continue to recognize all Senate Bill 190-Second Edition Page 15 General Assembly Of North Carolina Session 2025 Licenses granted pursuant to this Compact for a minimum of 180 days after the date of such notice of withdrawal.

(d)Withdrawal Nothingshall containednot inaffect thisthe Compactcontinuing shallrequirement beof construedthe toState invalidateLicensing orBoard(s) preventof anyPAthe licensurewithdrawing agreementState orto othercomply cooperativewith arrangementthe betweeninvestigative Participating States and betweenAdverse aAction Participatingreporting Staterequirements andof non-Participatingthis StateCompact thatprior doesto not conflict with the provisionseffective date of thiswithdrawal. Compact.

(e)3. This Compact may be amended by the Participating States.

Upon the enactment of a statute withdrawing a State from this Compact, the State shall immediately provide notice of such withdrawal to all Licensees within that State.

Such withdrawing State shall continue to recognize all licenses granted pursuant to this Compact for a minimum of one hundred eighty days after the date of such notice of withdrawal.

D.

Nothing contained in this Compact shall be construed to invalidate or prevent any PA licensure agreement or other cooperative arrangement between Participating States and between a Participating State and non-Participating State that does not conflict with the provisions of this Compact.

E.

This Compact may be amended by the Participating States.

"§Section 90-270.211.12.

Construction and severability.Severability A.

(a) This Compact and theCommission'sthe Commission’s rulemaking authorityshallauthority beliberallyconstruedshall be liberally construed so as to effectuate the purposespurposes, and the implementation and administration of the Compact.

Provisions of the Compact expresslyauthorizingexpressly authorizing or requiring the promulgation of Rules shall not be construed to limit the Commission'sCommission’s rulemaking authority solely for those purposes.

(b)B. The provisions of this Compact shall be severable and if anyphrase, clause, sentence, or provision of this Compact is held by a court of competent jurisdiction to be contrary to the constitution of any Participating State, a State seeking participation in the Compact, or of the United States, or the applicability thereof to any government, agency, person, or circumstance is held to be unconstitutional by a court of competent jurisdiction, the validity of the remainder of this Compact and the applicability thereof to any other government, agency, person, or circumstance shall not be affected thereby.

(c)The Notwithstandingprovisions subsectionof (b)this Compact shall be severable and if any phrase, clause, sentence, or provision of this section,Compact is held by a court of competent jurisdiction to be contrary to the Commissionconstitution mayof denyany Participating State, a State'sState seeking participation in the CompactCompact, or,or inof accordancethe withUnited States, or the requirementsapplicability thereof to any government, agency, person, or circumstance is held to be unconstitutional by a court of G.S.competent jurisdiction, the validity of the remainder of this Compact and HB1146 ENROLLED 26.417.13 24 1146 the applicability thereof to any other government, agency, person, or circumstance shall not be affected thereby.

90-270.209(b),C. terminatea Participating State's participation in the Compact, ifit 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.

Otherwise,Notwithstanding ifsubsection B of this Compactsection, shallthe beCommission heldmay todeny becontrarytoa theState’s constitutionparticipation ofanyParticipatingState,in theCompactthe shallCompact remainor, in fullaccordance forcewith andthe effectrequirements asof toSection the10.B, remainingterminate a Participating StatesState’s andparticipation in fullthe forceCompact, andif effectit asdetermines tothat thea constitutional requirement of a Participating State affectedis, asor would be with respect to alla severableState matters.seeking to participate in the Compact, a material departure from the Compact.

"§Otherwise, 90-270.212.if this Compact shall be held to be contrary to the constitution of any Participating State, the Compact shall remain in full force and effect as to the remaining Participating States and in full force and effect as to the Participating State affected as to all severable matters.

BindingSection effect13. of Compact.

(a)Binding NothingEffect herein prevents the enforcement of anyotherCompact lawA. of a Participating State that is not inconsistent with this Compact.

(b)Nothing Anyherein lawsprevents inthe aenforcement Participatingof Stateany inother conflictlaw withof thisa CompactParticipating areState supersededthat tois thenot extentinconsistent ofwith thethis conflict.Compact.

(c)B. All agreements between the Commission and the Participating States are binding in accordance with their terms." SECTION 1.(b) G.S.

90-9.3Any readslaws asin rewritten:a Participating State in conflict with this Compact are superseded to the extent of the conflict.

"§C. 90-9.3.

RequirementsAll foragreements licensurebetween asthe aCommission physicianand assistant.the Participating States are binding in accordance with their terms.

(a)HB1146 ToENROLLED be26.417.13 eligible25 for1146 licensureAn asAct a physician assistant, an applicant shall submit proof satisfactory to theadopt Board that the applicantphysician hasassistant metlicensure allcompact. of the following:

(1)Received Theat applicantthis hasExecutive successfullyOffice completedI ancertify educationalthat program for physician assistants or surgeon assistants accredited by the Accreditationattached ReviewAct Commissionoriginated onin Educationthis for_____ theday Physicianof Assistant_____________, orthe: its predecessor or successor entities.