1     
EMERGENCY MEDICAL SERVICES PERSONNEL

2     
LICENSURE INTERSTATE COMPACT

3     
2016 GENERAL SESSION

4     
STATE OF UTAH

5     
Chief Sponsor: Mike Schultz

6     
Senate Sponsor: Evan J. Vickers

7     

8     LONG TITLE
9     General Description:
10          This bill enacts the EMS Personnel Licensure Interstate Compact.
11     Highlighted Provisions:
12          This bill:
13          ▸     enacts the EMS Personnel Licensure Interstate Compact.
14     Money Appropriated in this Bill:
15          None
16     Other Special Clauses:
17          None
18     Utah Code Sections Affected:
19     ENACTS:
20          26-8c-101, Utah Code Annotated 1953
21          26-8c-102, Utah Code Annotated 1953
22     

23     Be it enacted by the Legislature of the state of Utah:
24          Section 1. Section 26-8c-101 is enacted to read:
25     
CHAPTER 8c. EMS PERSONNEL LICENSURE INTERSTATE COMPACT

26          26-8c-101. Title.
27          This chapter is known as the "EMS Personnel Licensure Interstate Compact."
28          Section 2. Section 26-8c-102 is enacted to read:
29          26-8c-102. EMS Personnel Licensure Interstate Compact.

30     
EMS PERSONNEL LICENSURE INTERSTATE COMPACT

31     
SECTION 1. PURPOSE

32          In order to protect the public through verification of competency and ensure
33     accountability for patient care related activities all states license emergency medical services
34     (EMS) personnel, such as emergency medical technicians (EMTs), advanced EMTs and
35     paramedics. This Compact is intended to facilitate the day to day movement of EMS personnel
36     across state boundaries in the performance of their EMS duties as assigned by an appropriate
37     authority and authorize state EMS offices to afford immediate legal recognition to EMS
38     personnel licensed in a member state. This Compact recognizes that states have a vested
39     interest in protecting the public's health and safety through their licensing and regulation of
40     EMS personnel and that such state regulation shared among the member states will best protect
41     public health and safety. This Compact is designed to achieve the following purposes and
42     objectives:
43          1. Increase public access to EMS personnel;
44          2. Enhance the states' ability to protect the public's health and safety, especially patient
45     safety;
46          3. Encourage the cooperation of member states in the areas of EMS personnel licensure
47     and regulation;
48          4. Support licensing of military members who are separating from an active duty tour
49     and their spouses;
50          5. Facilitate the exchange of information between member states regarding EMS
51     personnel licensure, adverse action and significant investigatory information;
52          6. Promote compliance with the laws governing EMS personnel practice in each
53     member state; and
54          7. Invest all member states with the authority to hold EMS personnel accountable
55     through the mutual recognition of member state licenses.
56     
SECTION 2. DEFINITIONS

57          In this compact:

58          A. "Advanced Emergency Medical Technician (AEMT)" means: an individual licensed
59     with cognitive knowledge and a scope of practice that corresponds to that level in the National
60     EMS Education Standards and National EMS Scope of Practice Model.
61          B. "Adverse Action" means: any administrative, civil, equitable or criminal action
62     permitted by a state's laws which may be imposed against licensed EMS personnel by a state
63     EMS authority or state court, including, but not limited to, actions against an individual's
64     license such as revocation, suspension, probation, consent agreement, monitoring or other
65     limitation or encumbrance on the individual's practice, letters of reprimand or admonition,
66     fines, criminal convictions and state court judgments enforcing adverse actions by the state
67     EMS authority.
68          C. "Alternative program" means: a voluntary, non-disciplinary substance abuse
69     recovery program approved by a state EMS authority.
70          D. "Certification" means: the successful verification of entry-level cognitive and
71     psychomotor competency using a reliable, validated, and legally defensible examination.
72          E. "Commission" means: the national administrative body of which all states that have
73     enacted the compact are members.
74          F. "Emergency Medical Technician (EMT)" means: an individual licensed with
75     cognitive knowledge and a scope of practice that corresponds to that level in the National EMS
76     Education Standards and National EMS Scope of Practice Model.
77          G. "Home State" means: a member state where an individual is licensed to practice
78     emergency medical services.
79          H. "License" means: the authorization by a state for an individual to practice as an
80     EMT, AEMT, paramedic, or a level in between EMT and paramedic.
81          I. "Medical Director" means: a physician licensed in a member state who is
82     accountable for the care delivered by EMS personnel.
83          J. "Member State" means: a state that has enacted this compact.
84          K. "Privilege to Practice" means: an individual's authority to deliver emergency
85     medical services in remote states as authorized under this compact.

86          L. "Paramedic" means: an individual licensed with cognitive knowledge and a scope of
87     practice that corresponds to that level in the National EMS Education Standards and National
88     EMS Scope of Practice Model.
89          M. "Remote State" means: a member state in which an individual is not licensed.
90          N. "Restricted" means: the outcome of an adverse action that limits a license or the
91     privilege to practice.
92          O. "Rule" means: a written statement by the interstate Commission promulgated
93     pursuant to Section 12 of this compact that is of general applicability; implements, interprets,
94     or prescribes a policy or provision of the compact; or is an organizational, procedural, or
95     practice requirement of the Commission and has the force and effect of statutory law in a
96     member state and includes the amendment, repeal, or suspension of an existing rule.
97          P. "Scope of Practice" means: defined parameters of various duties or services that may
98     be provided by an individual with specific credentials. Whether regulated by rule, statute, or
99     court decision, it tends to represent the limits of services an individual may perform.
100          Q. "Significant Investigatory Information" means:
101          1. investigative information that a state EMS authority, after a preliminary inquiry that
102     includes notification and an opportunity to respond if required by state law, has reason to
103     believe, if proved true, would result in the imposition of an adverse action on a license or
104     privilege to practice; or
105          2. investigative information that indicates that the individual represents an immediate
106     threat to public health and safety regardless of whether the individual has been notified and had
107     an opportunity to respond.
108          R. "State" means: means any state, commonwealth, district, or territory of the United
109     States.
110          S. "State EMS Authority" means: the board, office, or other agency with the legislative
111     mandate to license EMS personnel.
112     
SECTION 3. HOME STATE LICENSURE

113          A. Any member state in which an individual holds a current license shall be deemed a

114     home state for purposes of this compact.
115          B. Any member state may require an individual to obtain and retain a license to be
116     authorized to practice in the member state under circumstances not authorized by the privilege
117     to practice under the terms of this compact.
118          C. A home state's license authorizes an individual to practice in a remote state under
119     the privilege to practice only if the home state:
120          1. Currently requires the use of the National Registry of Emergency Medical
121     Technicians (NREMT) examination as a condition of issuing initial licenses at the EMT and
122     paramedic levels;
123          2. Has a mechanism in place for receiving and investigating complaints about
124     individuals;
125          3. Notifies the Commission, in compliance with the terms herein, of any adverse action
126     or significant investigatory information regarding an individual;
127          4. No later than five years after activation of the Compact, requires a criminal
128     background check of all applicants for initial licensure, including the use of the results of
129     fingerprint or other biometric data checks compliant with the requirements of the Federal
130     Bureau of Investigation with the exception of federal employees who have suitability
131     determination in accordance with US CFR §731.202 and submit documentation of such as
132     promulgated in the rules of the Commission; and
133          5. Complies with the rules of the Commission.
134     
SECTION 4. COMPACT PRIVILEGE TO PRACTICE

135          A. Member states shall recognize the privilege to practice of an individual licensed in
136     another member state that is in conformance with Section 3.
137          B. To exercise the privilege to practice under the terms and provisions of this compact,
138     an individual must:
139          1. Be at least 18 years of age;
140          2. Possess a current unrestricted license in a member state as an EMT, AEMT,
141     paramedic, or state recognized and licensed level with a scope of practice and authority

142     between EMT and paramedic; and
143          3. Practice under the supervision of a medical director.
144          C. An individual providing patient care in a remote state under the privilege to practice
145     shall function within the scope of practice authorized by the home state unless and until
146     modified by an appropriate authority in the remote state as may be defined in the rules of the
147     commission.
148          D. Except as provided in Section 4 subsection C, an individual practicing in a remote
149     state will be subject to the remote state's authority and laws. A remote state may, in accordance
150     with due process and that state's laws, restrict, suspend, or revoke an individual's privilege to
151     practice in the remote state and may take any other necessary actions to protect the health and
152     safety of its citizens. If a remote state takes action it shall promptly notify the home state and
153     the Commission.
154          E. If an individual's license in any home state is restricted or suspended, the individual
155     shall not be eligible to practice in a remote state under the privilege to practice until the
156     individual's home state license is restored.
157          F. If an individual's privilege to practice in any remote state is restricted, suspended, or
158     revoked the individual shall not be eligible to practice in any remote state until the individual's
159     privilege to practice is restored.
160     
SECTION 5. CONDITIONS OF PRACTICE IN A REMOTE STATE

161          An individual may practice in a remote state under a privilege to practice only in the
162     performance of the individual's EMS duties as assigned by an appropriate authority, as defined
163     in the rules of the Commission, and under the following circumstances:
164          1. The individual originates a patient transport in a home state and transports the
165     patient to a remote state;
166          2. The individual originates in the home state and enters a remote state to pick up a
167     patient and provide care and transport of the patient to the home state;
168          3. The individual enters a remote state to provide patient care and/or transport within
169     that remote state;

170          4. The individual enters a remote state to pick up a patient and provide care and
171     transport to a third member state;
172          5. Other conditions as determined by rules promulgated by the commission.
173     
SECTION 6. RELATIONSHIP TO EMERGENCY

174     
MANAGEMENT ASSISTANCE COMPACT

175          Upon a member state's governor's declaration of a state of emergency or disaster that
176     activates the Emergency Management Assistance Compact (EMAC), all relevant terms and
177     provisions of EMAC shall apply and to the extent any terms or provisions of this Compact
178     conflicts with EMAC, the terms of EMAC shall prevail with respect to any individual
179     practicing in the remote state in response to such declaration.
180     
SECTION 7. VETERANS, SERVICE MEMBERS SEPARATING

181     
FROM ACTIVE DUTY MILITARY, AND THEIR SPOUSES

182          A. Member states shall consider a veteran, active military service member, and
183     member of the National Guard and Reserves separating from an active duty tour, and a spouse
184     thereof, who holds a current valid and unrestricted NREMT certification at or above the level
185     of the state license being sought as satisfying the minimum training and examination
186     requirements for such licensure.
187          B. Member states shall expedite the processing of licensure applications submitted by
188     veterans, active military service members, and members of the National Guard and Reserves
189     separating from an active duty tour, and their spouses.
190          C. All individuals functioning with a privilege to practice under this Section remain
191     subject to the Adverse Actions provisions of Section VIII.
192     
SECTION 8. ADVERSE ACTIONS

193          A. A home state shall have exclusive power to impose adverse action against an
194     individual's license issued by the home state.
195          B. If an individual's license in any home state is restricted or suspended, the individual
196     shall not be eligible to practice in a remote state under the privilege to practice until the
197     individual's home state license is restored.

198          1. All home state adverse action orders shall include a statement that the individual's
199     compact privileges are inactive. The order may allow the individual to practice in remote states
200     with prior written authorization from both the home state and remote state's EMS authority.
201          2. An individual currently subject to adverse action in the home state shall not practice
202     in any remote state without prior written authorization from both the home state and remote
203     state's EMS authority.
204          C. A member state shall report adverse actions and any occurrences that the
205     individual's compact privileges are restricted, suspended, or revoked to the Commission in
206     accordance with the rules of the Commission.
207          D. A remote state may take adverse action on an individual's privilege to practice
208     within that state.
209          E. Any member state may take adverse action against an individual's privilege to
210     practice in that state based on the factual findings of another member state, so long as each
211     state follows its own procedures for imposing such adverse action.
212          F. A home state's EMS authority shall investigate and take appropriate action with
213     respect to reported conduct in a remote state as it would if such conduct had occurred within
214     the home state. In such cases, the home state's law shall control in determining the appropriate
215     adverse action.
216          G. Nothing in this Compact shall override a member state's decision that participation
217     in an alternative program may be used in lieu of adverse action and that such participation shall
218     remain non-public if required by the member state's laws. Member states must require
219     individuals who enter any alternative programs to agree not to practice in any other member
220     state during the term of the alternative program without prior authorization from such other
221     member state.
222     
SECTION 9. ADDITIONAL POWERS INVESTED

223     
IN A MEMBER STATE'S EMS AUTHORITY

224          A member state's EMS authority, in addition to any other powers granted under state
225     law, is authorized under this compact to:

226          1. Issue subpoenas for both hearings and investigations that require the attendance and
227     testimony of witnesses and the production of evidence. Subpoenas issued by a member state's
228     EMS authority for the attendance and testimony of witnesses, and/or the production of
229     evidence from another member state, shall be enforced in the remote state by any court of
230     competent jurisdiction, according to that court's practice and procedure in considering
231     subpoenas issued in its own proceedings. The issuing state EMS authority shall pay any
232     witness fees, travel expenses, mileage, and other fees required by the service statutes of the
233     state where the witnesses and/or evidence are located; and
234          2. Issue cease and desist orders to restrict, suspend, or revoke an individual's privilege
235     to practice in the state.
236     
SECTION 10. ESTABLISHMENT OF THE INTERSTATE

237     
COMMISSION FOR EMS PERSONNEL PRACTICE

238          A. The Compact states hereby create and establish a joint public agency known as the
239     Interstate Commission for EMS Personnel Practice.
240          1. The Commission is a body politic and an instrumentality of the Compact states.
241          2. Venue is proper and judicial proceedings by or against the Commission shall be
242     brought solely and exclusively in a court of competent jurisdiction where the principal office of
243     the Commission is located. The Commission may waive venue and jurisdictional defenses to
244     the extent it adopts or consents to participate in alternative dispute resolution proceedings.
245          3. Nothing in this Compact shall be construed to be a waiver of sovereign immunity.
246          B. Membership, Voting, and Meetings
247          1. Each member state shall have and be limited to one (1) delegate. The responsible
248     official of the state EMS authority or his designee shall be the delegate to this Compact for
249     each member state. Any delegate may be removed or suspended from office as provided by the
250     law of the state from which the delegate is appointed. Any vacancy occurring in the
251     Commission shall be filled in accordance with the laws of the member state in which the
252     vacancy exists. In the event that more than one board, office, or other agency with the
253     legislative mandate to license EMS personnel at and above the level of EMT exists, the

254     Governor of the state will determine which entity will be responsible for assigning the delegate.
255          2. Each delegate shall be entitled to one (1) vote with regard to the promulgation of
256     rules and creation of bylaws and shall otherwise have an opportunity to participate in the
257     business and affairs of the Commission. A delegate shall vote in person or by such other
258     means as provided in the bylaws. The bylaws may provide for delegates' participation in
259     meetings by telephone or other means of communication.
260          3. The Commission shall meet at least once during each calendar year. Additional
261     meetings shall be held as set forth in the bylaws.
262          4. All meetings shall be open to the public, and public notice of meetings shall be
263     given in the same manner as required under the rulemaking provisions in Section XII.
264          5. The Commission may convene in a closed, non-public meeting if the Commission
265     must discuss:
266          a. Non-compliance of a member state with its obligations under the Compact;
267          b. The employment, compensation, discipline or other personnel matters, practices or
268     procedures related to specific employees or other matters related to the Commission's internal
269     personnel practices and procedures;
270          c. Current, threatened, or reasonably anticipated litigation;
271          d. Negotiation of contracts for the purchase or sale of goods, services, or real estate;
272          e. Accusing any person of a crime or formally censuring any person;
273          f. Disclosure of trade secrets or commercial or financial information that is privileged
274     or confidential;
275          g. Disclosure of information of a personal nature where disclosure would constitute a
276     clearly unwarranted invasion of personal privacy;
277          h. Disclosure of investigatory records compiled for law enforcement purposes;
278          i. Disclosure of information related to any investigatory reports prepared by or on
279     behalf of or for use of the Commission or other committee charged with responsibility of
280     investigation or determination of compliance issues pursuant to the compact; or
281          j. Matters specifically exempted from disclosure by federal or member state statute.

282          6. If a meeting, or portion of a meeting, is closed pursuant to this provision, the
283     Commission's legal counsel or designee shall certify that the meeting may be closed and shall
284     reference each relevant exempting provision. The Commission shall keep minutes that fully
285     and clearly describe all matters discussed in a meeting and shall provide a full and accurate
286     summary of actions taken, and the reasons therefore, including a description of the views
287     expressed. All documents considered in connection with an action shall be identified in such
288     minutes. All minutes and documents of a closed meeting shall remain under seal, subject to
289     release by a majority vote of the Commission or order of a court of competent jurisdiction.
290          C. The Commission shall, by a majority vote of the delegates, prescribe bylaws and/or
291     rules to govern its conduct as may be necessary or appropriate to carry out the purposes and
292     exercise the powers of the compact, including but not limited to:
293          1. Establishing the fiscal year of the Commission;
294          2. Providing reasonable standards and procedures:
295          a. for the establishment and meetings of other committees; and
296          b. governing any general or specific delegation of any authority or function of the
297     Commission;
298          3. Providing reasonable procedures for calling and conducting meetings of the
299     Commission, ensuring reasonable advance notice of all meetings, and providing an opportunity
300     for attendance of such meetings by interested parties, with enumerated exceptions designed to
301     protect the public's interest, the privacy of individuals, and proprietary information, including
302     trade secrets. The Commission may meet in closed session only after a majority of the
303     membership votes to close a meeting in whole or in part. As soon as practicable, the
304     Commission must make public a copy of the vote to close the meeting revealing the vote of
305     each member with no proxy votes allowed;
306          4. Establishing the titles, duties and authority, and reasonable procedures for the
307     election of the officers of the Commission;
308          5. Providing reasonable standards and procedures for the establishment of the
309     personnel policies and programs of the Commission. Notwithstanding any civil service or

310     other similar laws of any member state, the bylaws shall exclusively govern the personnel
311     policies and programs of the Commission;
312          6. Promulgating a code of ethics to address permissible and prohibited activities of
313     Commission members and employees;
314          7. Providing a mechanism for winding up the operations of the Commission and the
315     equitable disposition of any surplus funds that may exist after the termination of the Compact
316     after the payment and/or reserving of all of its debts and obligations;
317          8. The Commission shall publish its bylaws and file a copy thereof, and a copy of any
318     amendment thereto, with the appropriate agency or officer in each of the member states, if any.
319          9. The Commission shall maintain its financial records in accordance with the bylaws.
320          10. The Commission shall meet and take such actions as are consistent with the
321     provisions of this Compact and the bylaws.
322          D. The Commission shall have the following powers:
323          1. The authority to promulgate uniform rules to facilitate and coordinate
324     implementation and administration of this Compact. The rules shall have the force and effect
325     of law and shall be binding in all member states;
326          2. To bring and prosecute legal proceedings or actions in the name of the Commission,
327     provided that the standing of any state EMS authority or other regulatory body responsible for
328     EMS personnel licensure to sue or be sued under applicable law shall not be affected;
329          3. To purchase and maintain insurance and bonds;
330          4. To borrow, accept, or contract for services of personnel, including, but not limited
331     to, employees of a member state;
332          5. To hire employees, elect or appoint officers, fix compensation, define duties, grant
333     such individuals appropriate authority to carry out the purposes of the compact, and to establish
334     the Commission's personnel policies and programs relating to conflicts of interest,
335     qualifications of personnel, and other related personnel matters;
336          6. To accept any and all appropriate donations and grants of money, equipment,
337     supplies, materials and services, and to receive, utilize and dispose of the same; provided that

338     at all times the Commission shall strive to avoid any appearance of impropriety and/or conflict
339     of interest;
340          7. To lease, purchase, accept appropriate gifts or donations of, or otherwise to own,
341     hold, improve or use, any property, real, personal or mixed; provided that at all times the
342     Commission shall strive to avoid any appearance of impropriety;
343          8. To sell convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of
344     any property real, personal, or mixed;
345          9. To establish a budget and make expenditures;
346          10. To borrow money;
347          11. To appoint committees, including advisory committees comprised of members,
348     state regulators, state legislators or their representatives, and consumer representatives, and
349     such other interested persons as may be designated in this compact and the bylaws;
350          12. To provide and receive information from, and to cooperate with, law enforcement
351     agencies;
352          13. To adopt and use an official seal; and
353          14. To perform such other functions as may be necessary or appropriate to achieve the
354     purposes of this Compact consistent with the state regulation of EMS personnel licensure and
355     practice.
356          E. Financing of the Commission
357          1. The Commission shall pay, or provide for the payment of, the reasonable expenses
358     of its establishment, organization, and ongoing activities.
359          2. The Commission may accept any and all appropriate revenue sources, donations, and
360     grants of money, equipment, supplies, materials, and services.
361          3. The Commission may levy on and collect an annual assessment from each member
362     state or impose fees on other parties to cover the cost of the operations and activities of the
363     Commission and its staff, which must be in a total amount sufficient to cover its annual budget
364     as approved each year for which revenue is not provided by other sources. The aggregate
365     annual assessment amount shall be allocated based upon a formula to be determined by the

366     Commission, which shall promulgate a rule binding upon all member states.
367          4. The Commission shall not incur obligations of any kind prior to securing the funds
368     adequate to meet the same; nor shall the Commission pledge the credit of any of the member
369     states, except by and with the authority of the member state.
370          5. The Commission shall keep accurate accounts of all receipts and disbursements.
371     The receipts and disbursements of the Commission shall be subject to the audit and accounting
372     procedures established under its bylaws. However, all receipts and disbursements of funds
373     handled by the Commission shall be audited yearly by a certified or licensed public accountant,
374     and the report of the audit shall be included in and become part of the annual report of the
375     Commission.
376          F. Qualified Immunity, Defense, and Indemnification
377          1. The members, officers, executive director, employees and representatives of the
378     Commission shall be immune from suit and liability, either personally or in their official
379     capacity, for any claim for damage to or loss of property or personal injury or other civil
380     liability caused by or arising out of any actual or alleged act, error or omission that occurred, or
381     that the person against whom the claim is made had a reasonable basis for believing occurred
382     within the scope of Commission employment, duties or responsibilities; provided that nothing
383     in this paragraph shall be construed to protect any such person from suit and/or liability for any
384     damage, loss, injury, or liability caused by the intentional or willful or wanton misconduct of
385     that person.
386          2. The Commission shall defend any member, officer, executive director, employee or
387     representative of the Commission in any civil action seeking to impose liability arising out of
388     any actual or alleged act, error, or omission that occurred within the scope of Commission
389     employment, duties, or responsibilities, or that the person against whom the claim is made had
390     a reasonable basis for believing occurred within the scope of Commission employment, duties,
391     or responsibilities; provided that nothing herein shall be construed to prohibit that person from
392     retaining his or her own counsel; and provided further, that the actual or alleged act, error, or
393     omission did not result from that person's intentional or willful or wanton misconduct.

394          3. The Commission shall indemnify and hold harmless any member, officer, executive
395     director, employee, or representative of the Commission for the amount of any settlement or
396     judgment obtained against that person arising out of any actual or alleged act, error or omission
397     that occurred within the scope of Commission employment, duties, or responsibilities, or that
398     such person had a reasonable basis for believing occurred within the scope of Commission
399     employment, duties, or responsibilities, provided that the actual or alleged act, error, or
400     omission did not result from the intentional or willful or wanton misconduct of that person.
401     
SECTION 11. COORDINATED DATABASE

402          A. The Commission shall provide for the development and maintenance of a
403     coordinated database and reporting system containing licensure, adverse action, and significant
404     investigatory information on all licensed individuals in member states.
405          B. Notwithstanding any other provision of state law to the contrary, a member state
406     shall submit a uniform data set to the coordinated database on all individuals to whom this
407     compact is applicable as required by the rules of the Commission, including:
408          1. Identifying information;
409          2. Licensure data;
410          3. Significant investigatory information;
411          4. Adverse actions against an individual's license;
412          5. An indicator that an individual's privilege to practice is restricted, suspended or
413     revoked;
414          6. Non-confidential information related to alternative program participation;
415          7. Any denial of application for licensure, and the reason(s) for such denial; and
416          8. Other information that may facilitate the administration of this Compact, as
417     determined by the rules of the Commission.
418          C. The coordinated database administrator shall promptly notify all member states of
419     any adverse action taken against, or significant investigative information on, any individual in a
420     member state.
421          D. Member states contributing information to the coordinated database may designate

422     information that may not be shared with the public without the express permission of the
423     contributing state.
424          E. Any information submitted to the coordinated database that is subsequently required
425     to be expunged by the laws of the member state contributing the information shall be removed
426     from the coordinated database.
427     
SECTION 12. RULEMAKING

428          A. The Commission shall exercise its rulemaking powers pursuant to the criteria set
429     forth in this Section and the rules adopted thereunder. Rules and amendments shall become
430     binding as of the date specified in each rule or amendment.
431          B. If a majority of the legislatures of the member states rejects a rule, by enactment of a
432     statute or resolution in the same manner used to adopt the Compact, then such rule shall have
433     no further force and effect in any member state.
434          C. Rules or amendments to the rules shall be adopted at a regular or special meeting of
435     the Commission.
436          D. Prior to promulgation and adoption of a final rule or rules by the Commission, and
437     at least sixty (60) days in advance of the meeting at which the rule will be considered and voted
438     upon, the Commission shall file a Notice of Proposed Rulemaking:
439          1. On the website of the Commission; and
440          2. On the website of each member state EMS authority or the publication in which each
441     state would otherwise publish proposed rules.
442          E. The Notice of Proposed Rulemaking shall include:
443          1. The proposed time, date, and location of the meeting in which the rule will be
444     considered and voted upon;
445          2. The text of the proposed rule or amendment and the reason for the proposed rule;
446          3. A request for comments on the proposed rule from any interested person; and
447          4. The manner in which interested persons may submit notice to the Commission of
448     their intention to attend the public hearing and any written comments.
449          F. Prior to adoption of a proposed rule, the Commission shall allow persons to submit

450     written data, facts, opinions, and arguments, which shall be made available to the public.
451          G. The Commission shall grant an opportunity for a public hearing before it adopts a
452     rule or amendment if a hearing is requested by:
453          1. At least twenty-five (25) persons;
454          2. A governmental subdivision or agency; or
455          3. An association having at least twenty-five (25) members.
456          H. If a hearing is held on the proposed rule or amendment, the Commission shall
457     publish the place, time, and date of the scheduled public hearing.
458          1. All persons wishing to be heard at the hearing shall notify the executive director of
459     the Commission or other designated member in writing of their desire to appear and testify at
460     the hearing not less than five (5) business days before the scheduled date of the hearing.
461          2. Hearings shall be conducted in a manner providing each person who wishes to
462     comment a fair and reasonable opportunity to comment orally or in writing.
463          3. No transcript of the hearing is required, unless a written request for a transcript is
464     made, in which case the person requesting the transcript shall bear the cost of producing the
465     transcript. A recording may be made in lieu of a transcript under the same terms and
466     conditions as a transcript. This subsection shall not preclude the Commission from making a
467     transcript or recording of the hearing if it so chooses.
468          4. Nothing in this section shall be construed as requiring a separate hearing on each
469     rule. Rules may be grouped for the convenience of the Commission at hearings required by
470     this section.
471          I. Following the scheduled hearing date, or by the close of business on the scheduled
472     hearing date if the hearing was not held, the Commission shall consider all written and oral
473     comments received.
474          J. The Commission shall, by majority vote of all members, take final action on the
475     proposed rule and shall determine the effective date of the rule, if any, based on the rulemaking
476     record and the full text of the rule.
477          K. If no written notice of intent to attend the public hearing by interested parties is

478     received, the Commission may proceed with promulgation of the proposed rule without a
479     public hearing.
480          L. Upon determination that an emergency exists, the Commission may consider and
481     adopt an emergency rule without prior notice, opportunity for comment, or hearing, provided
482     that the usual rulemaking procedures provided in the Compact and in this section shall be
483     retroactively applied to the rule as soon as reasonably possible, in no event later than ninety
484     (90) days after the effective date of the rule. For the purposes of this provision, an emergency
485     rule is one that must be adopted immediately in order to:
486          1. Meet an imminent threat to public health, safety, or welfare;
487          2. Prevent a loss of Commission or member state funds;
488          3. Meet a deadline for the promulgation of an administrative rule that is established by
489     federal law or rule; or
490          4. Protect public health and safety.
491          M. The Commission or an authorized committee of the Commission may direct
492     revisions to a previously adopted rule or amendment for purposes of correcting typographical
493     errors, errors in format, errors in consistency, or grammatical errors. Public notice of any
494     revisions shall be posted on the website of the Commission. The revision shall be subject to
495     challenge by any person for a period of thirty (30) days after posting. The revision may be
496     challenged only on grounds that the revision results in a material change to a rule. A challenge
497     shall be made in writing, and delivered to the chair of the Commission prior to the end of the
498     notice period. If no challenge is made, the revision will take effect without further action. If
499     the revision is challenged, the revision may not take effect without the approval of the
500     Commission.
501     
SECTION 13. OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT

502          A. Oversight
503          1. The executive, legislative, and judicial branches of state government in each
504     member state shall enforce this compact and take all actions necessary and appropriate to
505     effectuate the compact's purposes and intent. The provisions of this compact and the rules

506     promulgated hereunder shall have standing as statutory law.
507          2. All courts shall take judicial notice of the compact and the rules in any judicial or
508     administrative proceeding in a member state pertaining to the subject matter of this compact
509     which may affect the powers, responsibilities or actions of the Commission.
510          3. The Commission shall be entitled to receive service of process in any such
511     proceeding, and shall have standing to intervene in such a proceeding for all purposes. Failure
512     to provide service of process to the Commission shall render a judgment or order void as to the
513     Commission, this Compact, or promulgated rules.
514          B. Default, Technical Assistance, and Termination
515          1. If the Commission determines that a member state has defaulted in the performance
516     of its obligations or responsibilities under this compact or the promulgated rules, the
517     Commission shall:
518          a. Provide written notice to the defaulting state and other member states of the nature
519     of the default, the proposed means of curing the default and/or any other action to be taken by
520     the Commission; and
521          b. Provide remedial training and specific technical assistance regarding the default.
522          2. If a state in default fails to cure the default, the defaulting state may be terminated
523     from the Compact upon an affirmative vote of a majority of the member states, and all rights,
524     privileges and benefits conferred by this compact may be terminated on the effective date of
525     termination. A cure of the default does not relieve the offending state of obligations or
526     liabilities incurred during the period of default.
527          3. Termination of membership in the compact shall be imposed only after all other
528     means of securing compliance have been exhausted. Notice of intent to suspend or terminate
529     shall be given by the Commission to the governor, the majority and minority leaders of the
530     defaulting state's legislature, and each of the member states.
531          4. A state that has been terminated is responsible for all assessments, obligations, and
532     liabilities incurred through the effective date of termination, including obligations that extend
533     beyond the effective date of termination.

534          5. The Commission shall not bear any costs related to a state that is found to be in
535     default or that has been terminated from the compact, unless agreed upon in writing between
536     the Commission and the defaulting state.
537          6. The defaulting state may appeal the action of the Commission by petitioning the
538     U.S. District Court for the District of Columbia or the federal district where the Commission
539     has its principal offices. The prevailing member shall be awarded all costs of such litigation,
540     including reasonable attorney's fees.
541          C. Dispute Resolution
542          1. Upon request by a member state, the Commission shall attempt to resolve disputes
543     related to the compact that arise among member states and between member and non-member
544     states.
545          2. The Commission shall promulgate a rule providing for both mediation and binding
546     dispute resolution for disputes as appropriate.
547          D. Enforcement
548          1. The Commission, in the reasonable exercise of its discretion, shall enforce the
549     provisions and rules of this compact.
550          2. By majority vote, the Commission may initiate legal action in the United States
551     District Court for the District of Columbia or the federal district where the Commission has its
552     principal offices against a member state in default to enforce compliance with the provisions of
553     the compact and its promulgated rules and bylaws. The relief sought may include both
554     injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing
555     member shall be awarded all costs of such litigation, including reasonable attorney's fees.
556          3. The remedies herein shall not be the exclusive remedies of the Commission. The
557     Commission may pursue any other remedies available under federal or state law.
558     
SECTION 14. DATE OF IMPLEMENTATION OF THE INTERSTATE

559     
COMMISSION FOR EMS PERSONNEL PRACTICE AND

560     
ASSOCIATED RULES, WITHDRAWAL, AND AMENDMENT

561          A. The compact shall come into effect on the date on which the compact statute is

562     enacted into law in the tenth member state. The provisions, which become effective at that
563     time, shall be limited to the powers granted to the Commission relating to assembly and the
564     promulgation of rules. Thereafter, the Commission shall meet and exercise rulemaking powers
565     necessary to the implementation and administration of the compact.
566          B. Any state that joins the compact subsequent to the Commission's initial adoption of
567     the rules shall be subject to the rules as they exist on the date on which the compact becomes
568     law in that state. Any rule that has been previously adopted by the Commission shall have the
569     full force and effect of law on the day the compact becomes law in that state.
570          C. Any member state may withdraw from this compact by enacting a statute repealing
571     the same.
572          1. A member state's withdrawal shall not take effect until six (6) months after
573     enactment of the repealing statute.
574          2. Withdrawal shall not affect the continuing requirement of the withdrawing state's
575     EMS authority to comply with the investigative and adverse action reporting requirements of
576     this act prior to the effective date of withdrawal.
577          D. Nothing contained in this compact shall be construed to invalidate or prevent any
578     EMS personnel licensure agreement or other cooperative arrangement between a member state
579     and a non-member state that does not conflict with the provisions of this compact.
580          E. This Compact may be amended by the member states. No amendment to this
581     Compact shall become effective and binding upon any member state until it is enacted into the
582     laws of all member states.
583     
SECTION 15. CONSTRUCTION AND SEVERABILITY

584          This Compact shall be liberally construed so as to effectuate the purposes thereof. If
585     this compact shall be held contrary to the constitution of any state member thereto, the compact
586     shall remain in full force and effect as to the remaining member states. Nothing in this
587     compact supersedes state law or rules related to licensure of EMS agencies.