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HF 324

as introduced - 90th Legislature (2017 - 2018) Posted on 01/30/2017 03:43pm

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A bill for an act
relating to health occupations; providing an interstate compact for the recognition
of emergency medical services personnel licensure;proposing coding for new law
in Minnesota Statutes, chapter 144E.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

[144E.55] EMERGENCY MEDICAL SERVICES PERSONNEL
LICENSURE INTERSTATE COMPACT.

SECTION 1. PURPOSE

In order to protect the public through verification of competency and ensure accountability
for patient care related activities all states license emergency medical services (EMS)
personnel, such as emergency medical technicians (EMTs), advanced EMTs, and paramedics.
This compact is intended to facilitate the day to day movement of EMS personnel across
state boundaries in the performance of their EMS duties as assigned by an appropriate
authority and authorize state EMS offices to afford immediate legal recognition to EMS
personnel licensed in a member state. This compact recognizes that states have a vested
interest in protecting the public's health and safety through their licensing and regulation
of EMS personnel and that such state regulation shared among the member states will best
protect public health and safety. This compact is designed to achieve the following purposes
and objectives:

1. Increase public access to EMS personnel;

2. Enhance the states' ability to protect the public's health and safety, especially patient
safety;

3. Encourage the cooperation of member states in the areas of EMS personnel licensure
and regulation;

4. Support licensing of military members who are separating from an active duty tour
and their spouses;

5. Facilitate the exchange of information between member states regarding EMS personnel
licensure, adverse action and significant investigatory information;

6. Promote compliance with the laws governing EMS personnel practice in each member
state; and

7. Invest all member states with the authority to hold EMS personnel accountable through
the mutual recognition of member state licenses.

SECTION 2. DEFINITIONS

In this compact:

A. "Advanced emergency medical technician" or "AEMT" means an individual licensed
with cognitive knowledge and a scope of practice that corresponds to that level in the
National EMS Education Standards and National EMS Scope of Practice Model.

B. "Adverse action" means any administrative, civil, equitable, or criminal action
permitted by a state's laws which may be imposed against licensed EMS personnel by a
state EMS authority or state court, including, but not limited to, actions against an individual's
license such as revocation, suspension, probation, consent agreement, monitoring, or other
limitation or encumbrance on the individual's practice, letters of reprimand or admonition,
fines, criminal convictions, and state court judgments enforcing adverse actions by the state
EMS authority.

C. "Alternative program" means a voluntary, nondisciplinary substance abuse recovery
program approved by a state EMS authority.

D. "Certification" means the successful verification of entry-level cognitive and
psychomotor competency using a reliable, validated, and legally defensible examination.

E. "Commission" means the national administrative body of which all states that have
enacted the compact are members.

F. "Emergency medical technician" or "EMT" means an individual licensed with cognitive
knowledge and a scope of practice that corresponds to that level in the National EMS
Education Standards and National EMS Scope of Practice Model.

G. "Home state" means a member state where an individual is licensed to practice
emergency medical services.

H. "License" means the authorization by a state for an individual to practice as an EMT,
AEMT, paramedic, or a level in between EMT and paramedic.

I. "Medical director" means a physician licensed in a member state who is accountable
for the care delivered by EMS personnel.

J. "Member state" means a state that has enacted this compact.

K. "Privilege to practice" means an individual's authority to deliver emergency medical
services in remote states as authorized under this compact.

L. "Paramedic" means an individual licensed with cognitive knowledge and a scope of
practice that corresponds to that level in the National EMS Education Standards and National
EMS Scope of Practice Model.

M. "Remote state" means a member state in which an individual is not licensed.

N. "Restricted" means the outcome of an adverse action that limits a license or the
privilege to practice.

O. "Rule" means a written statement by the interstate commission promulgated pursuant
to Section 12 of this compact that is of general applicability; implements, interprets, or
prescribes a policy or provision of the compact; or is an organizational, procedural, or
practice requirement of the commission and has the force and effect of statutory law in a
member state and includes the amendment, repeal, or suspension of an existing rule.

P. "Scope of practice" means defined parameters of various duties or services that may
be provided by an individual with specific credentials. Whether regulated by rule, statute,
or court decision, it tends to represent the limits of services an individual may perform.

Q. "Significant investigatory information" means:

1. Investigative information that a state EMS authority, after a preliminary inquiry that
includes notification and an opportunity to respond if required by state law, has reason to
believe, if proved true, would result in the imposition of an adverse action on a license or
privilege to practice; or

2. Investigative information that indicates that the individual represents an immediate
threat to public health and safety regardless of whether the individual has been notified and
had an opportunity to respond.

R. "State" means any state, commonwealth, district, or territory of the United States.

S. "State EMS authority" means the board, office, or other agency with the legislative
mandate to license EMS personnel.

SECTION 3. HOME STATE LICENSURE

A. Any member state in which an individual holds a current license shall be deemed a
home state for purposes of this compact.

B. Any member state may require an individual to obtain and retain a license to be
authorized to practice in the member state under circumstances not authorized by the privilege
to practice under the terms of this compact.

C. A home state's license authorizes an individual to practice in a remote state under the
privilege to practice only if the home state:

1. Currently requires the use of the National Registry of Emergency Medical Technicians
(NREMT) examination as a condition of issuing initial licenses at the EMT and paramedic
levels;

2. Has a mechanism in place for receiving and investigating complaints about individuals;

3. Notifies the commission, in compliance with the terms herein, of any adverse action
or significant investigatory information regarding an individual;

4. No later than five years after activation of the compact, requires a criminal background
check of all applicants for initial licensure, including the use of the results of fingerprint or
other biometric data checks compliant with the requirements of the Federal Bureau of
Investigation with the exception of federal employees who have suitability determination
in accordance with Code of Federal Regulations, title 5, section 731.202 and submit
documentation of such as promulgated in the rules of the commission; and

5. Complies with the rules of the commission.

SECTION 4. COMPACT PRIVILEGE TO PRACTICE

A. Member states shall recognize the privilege to practice of an individual licensed in
another member state that is in conformance with Section 3.

B. To exercise the privilege to practice under the terms and provisions of this compact,
an individual must:

1. Be at least 18 years of age;

2. Possess a current unrestricted license in a member state as an EMT, AEMT, paramedic,
or state recognized and licensed level with a scope of practice and authority between EMT
and paramedic; and

3. Practice under the supervision of a medical director.

C. An individual providing patient care in a remote state under the privilege to practice
shall function within the scope of practice authorized by the home state unless and until
modified by an appropriate authority in the remote state as may be defined in the rules of
the commission.

D. Except as provided in Section 4, subsection C, an individual practicing in a remote
state will be subject to the remote state's authority and laws. A remote state may, in
accordance with due process and that state's laws, restrict, suspend, or revoke an individual's
privilege to practice in the remote state and may take any other necessary actions to protect
the health and safety of its citizens. If a remote state takes action it shall promptly notify
the home state and the commission.

E. If an individual's license in any home state is restricted or suspended, the individual
shall not be eligible to practice in a remote state under the privilege to practice until the
individual's home state license is restored.

F. If an individual's privilege to practice in any remote state is restricted, suspended, or
revoked the individual shall not be eligible to practice in any remote state until the individual's
privilege to practice is restored.

SECTION 5. CONDITIONS OF PRACTICE IN A REMOTE STATE

An individual may practice in a remote state under a privilege to practice only in the
performance of the individual's EMS duties as assigned by an appropriate authority, as
defined in the rules of the commission, and under the following circumstances:

1. The individual originates a patient transport in a home state and transports the patient
to a remote state;

2. The individual originates in the home state and enters a remote state to pick up a
patient and provide care and transport of the patient to the home state;

3. The individual enters a remote state to provide patient care or transport within that
remote state;

4. The individual enters a remote state to pick up a patient and provide care and transport
to a third member state;

5. Other conditions as determined by rules promulgated by the commission.

SECTION 6. RELATIONSHIP TO EMERGENCY MANAGEMENT ASSISTANCE
COMPACT

Upon a member state's governor's declaration of a state of emergency or disaster that
activates the Emergency Management Assistance Compact (EMAC), all relevant terms and
provisions of EMAC shall apply and to the extent any terms or provisions of this compact
conflicts with EMAC, the terms of EMAC shall prevail with respect to any individual
practicing in the remote state in response to such declaration.

SECTION 7. VETERANS, SERVICE MEMBERS SEPARATING FROM ACTIVE DUTY
MILITARY, AND THEIR SPOUSES

A. Member states shall consider a veteran, active military service member, and member
of the National Guard and Reserves separating from an active duty tour, and a spouse thereof,
who holds a current valid and unrestricted NREMT certification at or above the level of the
state license being sought as satisfying the minimum training and examination requirements
for such licensure.

B. Member states shall expedite the processing of licensure applications submitted by
veterans, active military service members, and members of the National Guard and Reserves
separating from an active duty tour, and their spouses.

C. All individuals functioning with a privilege to practice under this section remain
subject to the adverse actions provisions of Section 8.

SECTION 8. ADVERSE ACTIONS

A. A home state shall have exclusive power to impose adverse action against an
individual's license issued by the home state.

B. If an individual's license in any home state is restricted or suspended, the individual
shall not be eligible to practice in a remote state under the privilege to practice until the
individual's home state license is restored.

1. All home state adverse action orders shall include a statement that the individual's
compact privileges are inactive. The order may allow the individual to practice in remote
states with prior written authorization from both the home state and remote state's EMS
authority.

2. An individual currently subject to adverse action in the home state shall not practice
in any remote state without prior written authorization from both the home state and remote
state's EMS authority.

C. A member state shall report adverse actions and any occurrences that the individual's
compact privileges are restricted, suspended, or revoked to the commission in accordance
with the rules of the commission.

D. A remote state may take adverse action on an individual's privilege to practice within
that state.

E. Any member state may take adverse action against an individual's privilege to practice
in that state based on the factual findings of another member state, so long as each state
follows its own procedures for imposing such adverse action.

F. A home state's EMS authority shall investigate and take appropriate action with respect
to reported conduct in a remote state as it would if such conduct had occurred within the
home state. In such cases, the home state's law shall control in determining the appropriate
adverse action.

G. Nothing in this compact shall override a member state's decision that participation
in an alternative program may be used in lieu of adverse action and that such participation
shall remain nonpublic if required by the member state's laws. Member states must require
individuals who enter any alternative programs to agree not to practice in any other member
state during the term of the alternative program without prior authorization from such other
member state.

SECTION 9. ADDITIONAL POWERS INVESTED IN A MEMBER STATE'S EMS
AUTHORITY

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

1. Issue subpoenas for both hearings and investigations that require the attendance and
testimony of witnesses and the production of evidence. Subpoenas issued by a member
state's EMS authority for the attendance and testimony of witnesses, or the production of
evidence from another member state, shall be enforced in the remote state by any court of
competent jurisdiction, according to that court's practice and procedure in considering
subpoenas issued in its own proceedings. The issuing state EMS authority shall pay any
witness fees, travel expenses, mileage, and other fees required by the service statutes of the
state where the witnesses or evidence are located; and

2. Issue cease and desist orders to restrict, suspend, or revoke an individual's privilege
to practice in the state.

SECTION 10. ESTABLISHMENT OF THE INTERSTATE COMMISSION FOR EMS
PERSONNEL PRACTICE

A. The compact states hereby create and establish a joint public agency known as the
Interstate Commission for EMS Personnel Practice.

1. The commission is a body politic and an instrumentality of the compact states.

2. Venue is proper and judicial proceedings by or against the commission shall be brought
solely and exclusively in a court of competent jurisdiction where the principal office of the
commission is located. The commission may waive venue and jurisdictional defenses to
the extent it adopts or consents to participate in alternative dispute resolution proceedings.

3. Nothing in this compact shall be construed to be a waiver of sovereign immunity.

B. Membership, Voting, and Meetings

1. Each member state shall have and be limited to one delegate. The responsible official
of the state EMS authority or his or her designee shall be the delegate to this compact for
each member state. Any delegate may be removed or suspended from office as provided
by the law of the state from which the delegate is appointed. Any vacancy occurring in the
commission shall be filled in accordance with the laws of the member state in which the
vacancy exists. In the event that more than one board, office, or other agency with the
legislative mandate to license EMS personnel at and above the level of EMT exists, the
governor of the state will determine which entity will be responsible for assigning the
delegate.

2. Each delegate shall be entitled to one vote with regard to the promulgation of rules
and creation of bylaws and shall otherwise have an opportunity to participate in the business
and affairs of the commission. A delegate shall vote in person or by such other means as
provided in the bylaws. The bylaws may provide for delegates' participation in meetings
by telephone or other means of communication.

3. The commission shall meet at least once during each calendar year. Additional meetings
shall be held as set forth in the bylaws.

4. All meetings shall be open to the public, and public notice of meetings shall be given
in the same manner as required under the rulemaking provisions in Section 12.

5. The commission may convene in a closed, nonpublic meeting if the commission must
discuss:

a. Noncompliance of a member state with its obligations under the compact;

b. The employment, compensation, discipline or other personnel matters, practices or
procedures related to specific employees or other matters related to the commission's internal
personnel practices and procedures;

c. Current, threatened, or reasonably anticipated litigation;

d. Negotiation of contracts for the purchase or sale of goods, services, or real estate;

e. Accusing any person of a crime or formally censuring any person;

f. Disclosure of trade secrets or commercial or financial information that is privileged
or confidential;

g. Disclosure of information of a personal nature where disclosure would constitute a
clearly unwarranted invasion of personal privacy;

h. Disclosure of investigatory records compiled for law enforcement purposes;

i. Disclosure of information related to any investigatory 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 the compact; or

j. Matters specifically exempted from disclosure by federal or member state statute.

6. If a meeting, or portion of a meeting, is closed pursuant to this provision, the
commission's legal counsel or designee shall certify that the meeting may be closed and
shall reference each relevant exempting provision. 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, and the reasons therefore, including a description of the
views expressed. All documents considered in connection with an action shall be identified
in such minutes. All minutes and documents of a closed meeting shall remain under seal,
subject to release by a majority vote of the commission or order of a court of competent
jurisdiction.

C. The commission shall, by a majority vote of the delegates, prescribe bylaws and rules
to govern its conduct as may be necessary or appropriate to carry out the purposes and
exercise the powers of the compact, including but not limited to:

1. Establishing the fiscal year of the commission;

2. Providing reasonable standards and procedures:

a. for the establishment and meetings of other committees; and

b. governing any general or specific delegation of any authority or function of the
commission;

3. Providing reasonable procedures for calling and conducting meetings of the
commission, ensuring reasonable advance notice of all meetings, and providing an
opportunity for attendance of such meetings by interested parties, with enumerated exceptions
designed to protect the public's interest, the privacy of individuals, and proprietary
information, including trade secrets. The commission may meet in closed session only after
a majority of the membership votes to close a meeting in whole or in part. As soon as
practicable, the commission must make public a copy of the vote to close the meeting
revealing the vote of each member with no proxy votes allowed;

4. Establishing the titles, duties and authority, and reasonable procedures for the election
of the officers of the commission;

5. Providing reasonable standards and procedures for the establishment of the personnel
policies and programs of the commission. Notwithstanding any civil service or other similar
laws of any member state, the bylaws shall exclusively govern the personnel policies and
programs of the commission;

6. Promulgating a code of ethics to address permissible and prohibited activities of
commission members and employees; and

7. Providing a mechanism for winding up the operations of the commission and the
equitable disposition of any surplus funds that may exist after the termination of the compact
after the payment and/or reserving of all of its debts and obligations.

D. The commission shall publish its bylaws and file a copy thereof, and a copy of any
amendment thereto, with the appropriate agency or officer in each of the member states, if
any.

E. The commission shall maintain its financial records in accordance with the bylaws.

F. The commission shall meet and take such actions as are consistent with the provisions
of this compact and the bylaws.

G. The commission shall have the following powers:

1. To promulgate uniform rules to facilitate and coordinate implementation and
administration of this compact. The rules shall have the force and effect of law and shall
be binding in all member states;

2. To bring and prosecute legal proceedings or actions in the name of the commission,
provided that the standing of any state EMS authority or other regulatory body responsible
for EMS personnel licensure to sue or be sued under applicable law shall not be affected;

3. To purchase and maintain insurance and bonds;

4. To borrow, accept, or contract for services of personnel, including, but not limited
to, employees of a member state;

5. To hire employees, elect or appoint officers, fix compensation, define duties, grant
such individuals appropriate authority to carry out the purposes of the compact, and to
establish the commission's personnel policies and programs relating to conflicts of interest,
qualifications of personnel, and other related personnel matters;

6. To accept any and all appropriate donations and grants of money, equipment, supplies,
materials, and services, and to receive, utilize, and dispose of the same; provided that at all
times the commission shall strive to avoid any appearance of impropriety or conflict of
interest;

7. To lease, purchase, accept appropriate gifts or donations of, or otherwise to own, hold,
improve or use, any property, real, personal, or mixed; provided that at all times the
commission shall strive to avoid any appearance of impropriety;

8. To sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise dispose of
any property real, personal, or mixed;

9. To establish a budget and make expenditures;

10. To borrow money;

11. To appoint committees, including advisory committees comprised of members, state
regulators, state legislators or their representatives, and consumer representatives, and such
other interested persons as may be designated in this compact and the bylaws;

12. To provide and receive information from, and to cooperate with, law enforcement
agencies;

13. To adopt and use an official seal; and

14. To perform such other functions as may be necessary or appropriate to achieve the
purposes of this compact consistent with the state regulation of EMS personnel licensure
and practice.

H. Financing of the commission

1. The commission shall pay, or provide for the payment of, the reasonable expenses of
its establishment, organization, and ongoing activities.

2. 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 member
state or impose fees on other parties 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 each year for which revenue is not provided by other sources. The
aggregate annual assessment amount shall be allocated based upon a formula to be determined
by the commission, which shall promulgate a rule binding upon all member states.

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 member
states, except by and with the authority of the member state.

5. The commission shall keep accurate accounts of all receipts and disbursements. The
receipts and disbursements of the commission shall be subject to the audit and accounting
procedures established under its bylaws. However, all receipts and disbursements of funds
handled by the commission shall be audited yearly by a certified or licensed public
accountant, and the report of the audit shall be included in and become part of the annual
report of the commission.

I. Qualified immunity, defense, and indemnification

1. The members, officers, executive director, employees, and representatives of the
commission shall be immune from suit and liability, either personally or in their official
capacity, 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, 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 intentional or willful or
wanton misconduct of that person.

2. The commission shall defend any member, officer, executive director, employee, or
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 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; provided that nothing herein shall be construed to prohibit that
person from retaining his or her own counsel; and provided further, that the actual or alleged
act, error, or omission did not result from that person's intentional or willful or wanton
misconduct.

3. The commission shall indemnify and hold harmless any member, officer, executive
director, employee, or 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.

SECTION 11. COORDINATED DATABASE

A. The commission shall provide for the development and maintenance of a coordinated
database and reporting system containing licensure, adverse action, and significant
investigatory information on all licensed individuals in member states.

B. Notwithstanding any other provision of state law to the contrary, a member state shall
submit a uniform data set to the coordinated database on all individuals to whom this compact
is applicable as required by the rules of the commission, including:

1. Identifying information;

2. Licensure data;

3. Significant investigatory information;

4. Adverse actions against an individual's license;

5. An indicator that an individual's privilege to practice is restricted, suspended or
revoked;

6. Nonconfidential information related to alternative program participation;

7. Any denial of application for licensure, and the reasons for such denial; and

8. Other information that may facilitate the administration of this compact, as determined
by the rules of the commission.

C. The coordinated database administrator shall promptly notify all member states of
any adverse action taken against, or significant investigative information on, any individual
in a member state.

D. Member states contributing information to the coordinated database may designate
information that may not be shared with the public without the express permission of the
contributing state.

E. Any information submitted to the coordinated database that is subsequently required
to be expunged by the laws of the member state contributing the information shall be removed
from the coordinated database.

SECTION 12. RULEMAKING

A. The commission shall exercise its rulemaking powers pursuant to the criteria set forth
in this section and the rules adopted thereunder. Rules and amendments shall become binding
as of the date specified in each rule or amendment.

B. If a majority of the legislatures of the member states rejects a rule, by enactment of
a statute or resolution in the same manner used to adopt the compact, then such rule shall
have no further force and effect in any member state.

C. Rules or amendments to the rules shall be adopted at a regular or special meeting of
the commission.

D. Prior to promulgation and adoption of a final rule by the commission, and at least 60
days in advance of the meeting at which the rule will be considered and voted upon, the
commission shall file a Notice of Proposed Rulemaking:

1. On the website of the commission; and

2. On the website of each member state EMS authority or the publication in which each
state would otherwise publish proposed rules.

E. The Notice of Proposed Rulemaking shall include:

1. The proposed time, date, and location of the meeting in which the rule will be
considered and voted upon;

2. The text of the proposed rule or amendment and the reason for the proposed rule;

3. A request for comments on the proposed rule from any interested person; and

4. The manner in which interested persons may submit notice to the commission of their
intention to attend the public hearing and any written comments.

F. 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.

G. The commission shall grant an opportunity for a public hearing before it adopts a
rule or amendment if a hearing is requested by:

1. At least 25 persons;

2. A governmental subdivision or agency; or

3. An association having at least 25 members.

H. If a hearing is held on the proposed rule or amendment, the commission shall publish
the place, time, and date of the scheduled public hearing.

1. All persons wishing to be heard at the hearing shall notify the executive director of
the commission or other designated member in writing of their desire to appear and testify
at the hearing not less than five business days before the scheduled date of 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. No transcript of the hearing is required, unless a written request for a transcript is
made, in which case the person requesting the transcript shall bear the cost of producing
the transcript. A recording may be made in lieu of a transcript under the same terms and
conditions as a transcript. This subsection shall not preclude the commission from making
a transcript or recording of the hearing if it so chooses.

4. Nothing in this section shall be construed as requiring a separate hearing on each rule.
Rules may be grouped for the convenience of the commission at hearings required by this
section.

I. Following the scheduled hearing date, or by the close of business on the scheduled
hearing date if the hearing was not held, the commission shall consider all written and oral
comments received.

J. The commission shall, by majority vote of all members, take final action on the
proposed rule and shall determine the effective date of the rule, if any, based on the
rulemaking record and the full text of the rule.

K. If no written notice of intent to attend the public hearing by interested parties is
received, the commission may proceed with promulgation of the proposed rule without a
public hearing.

L. Upon determination that an emergency exists, the commission may consider and
adopt an emergency rule without prior notice, opportunity for comment, or hearing, provided
that the usual rulemaking procedures provided in the compact and in this section shall be
retroactively applied to the rule as soon as reasonably possible, in no event later than 90
days after the effective date of the rule. For the purposes of this provision, an emergency
rule is one that must be adopted immediately in order to:

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

2. Prevent a loss of commission or member state funds;

3. Meet a deadline for the promulgation of an administrative 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 rule or amendment for purposes of correcting typographical errors,
errors in format, errors in consistency, or grammatical errors. Public notice of any revisions
shall be posted on the website of the commission. The revision shall be subject to challenge
by any person for a period of 30 days after posting. The revision may be challenged only
on grounds that the revision results in a material change to a rule. A challenge shall be made
in writing, and delivered to the chair of the commission prior to the end of the notice period.
If no challenge is made, the revision will take effect without further action. If the revision
is challenged, the revision may not take effect without the approval of the commission.

SECTION 13. OVERSIGHT, DISPUTE RESOLUTION, AND ENFORCEMENT

A. Oversight

1. The executive, legislative, and judicial branches of state government in each member
state shall enforce this compact and take all actions necessary and appropriate to effectuate
the compact's purposes and intent. The provisions of this compact and the rules promulgated
hereunder shall have standing as statutory law.

2. All courts shall take judicial notice of the compact and the rules in any judicial or
administrative proceeding in a member state pertaining to the subject matter of this compact
which may affect the powers, responsibilities, or actions of the commission.

3. The commission shall be entitled to receive service of process in any such proceeding,
and shall have standing to intervene in such a proceeding for all purposes. Failure to provide
service of process to the commission shall render a judgment or order void as to the
commission, this compact, or promulgated rules.

B. Default, Technical Assistance, and Termination

1. If the commission determines that a member state has defaulted in the performance
of its obligations or responsibilities under this compact or the promulgated rules, the
commission shall:

a. Provide written notice to the defaulting state and other member states of the nature
of the default, the proposed means of curing the default, and any other action to be taken
by the commission; and

b. Provide remedial training and specific technical assistance regarding the default.

2. If a state in default fails to cure the default, the defaulting state may be terminated
from the compact upon an affirmative vote of a majority of the member states, and all rights,
privileges, and benefits conferred by this compact may be terminated on the effective date
of termination. A cure of the default does not relieve the offending state of obligations or
liabilities incurred during the period of default.

3. Termination of membership in the compact shall be imposed only after all other means
of securing compliance have been exhausted. Notice of intent to suspend or terminate shall
be given by the commission to the governor, the majority and minority leaders of the
defaulting state's legislature, and each of the member states.

4. A state that has been terminated is responsible for all assessments, obligations, and
liabilities incurred through the effective date of termination, including obligations that
extend beyond the effective date of termination.

5. The commission shall not bear any costs related to a state that is found to be in default
or that has been terminated from the compact, unless agreed upon in writing between the
commission and the defaulting state.

6. The defaulting state may appeal the action of 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.

C. Dispute Resolution

1. Upon request by a member state, the commission shall attempt to resolve disputes
related to the compact that arise among member states and between member and nonmember
states.

2. The commission shall promulgate a rule providing for both mediation and binding
dispute resolution for disputes as appropriate.

D. Enforcement

1. The commission, in the reasonable exercise of its discretion, shall enforce the
provisions and rules of this compact.

2. 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 member state in default to enforce compliance with the provisions
of the compact and its promulgated rules and bylaws. The relief sought may include both
injunctive relief and damages. In the event judicial enforcement is necessary, the prevailing
member shall be awarded all costs of such litigation, including reasonable attorney's fees.

3. The remedies herein shall not be the exclusive remedies of the commission. The
commission may pursue any other remedies available under federal or state law.

SECTION 14. DATE OF IMPLEMENTATION OF THE INTERSTATE COMMISSION
FOR EMS PERSONNEL PRACTICE AND ASSOCIATED RULES, WITHDRAWAL,
AND AMENDMENT

A. The compact shall come into effect on the date on which the compact statute is enacted
into law in the tenth member state. The provisions, which become effective at that time,
shall be limited to the powers granted to the commission relating to assembly and the
promulgation of rules. Thereafter, the commission shall meet and exercise rulemaking
powers necessary to the implementation and administration of the compact.

B. Any state that joins the compact subsequent to the commission's initial adoption of
the rules shall be subject to the rules as they exist on the date on which the compact becomes
law in that state. Any rule that has been previously adopted by the commission shall have
the full force and effect of law on the day the compact becomes law in that state.

C. Any member state may withdraw from this compact by enacting a statute repealing
the same.

1. A member state's withdrawal shall not take effect until six months after enactment of
the repealing statute.

2. Withdrawal shall not affect the continuing requirement of the withdrawing state's
EMS authority to comply with the investigative and adverse action reporting requirements
of this act prior to the effective date of withdrawal.

D. Nothing contained in this compact shall be construed to invalidate or prevent any
EMS personnel licensure agreement or other cooperative arrangement between a member
state and a nonmember state that does not conflict with the provisions of this compact.

E. This compact may be amended by the member states. No amendment to this compact
shall become effective and binding upon any member state until it is enacted into the laws
of all member states.

SECTION 15. CONSTRUCTION AND SEVERABILITY

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

EFFECTIVE DATE.

This section is effective on the date on which the compact statute
is enacted into law in the tenth member state in accordance with Section 14, subsection A
of this compact.

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700 State Office Building, 100 Rev. Dr. Martin Luther King Jr. Blvd., St. Paul, MN 55155 ♦ Phone: (651) 296-2868 ♦ TTY: 1-800-627-3529 ♦ Fax: (651) 296-0569