A new Alabama law expanding physician assistant licensing across state lines includes a strict criminal history provision that will reshape hiring decisions for small practices.
Most Alabama healthcare practice owners haven't heard about a quiet but significant hiring requirement buried in HB156, the bill establishing an interstate compact for physician assistants. Yet it will directly affect how you recruit, credential, and deploy PAs starting October 1, 2026.
Alabama joined an interstate compact—an agreement among multiple states—that allows physician assistants to hold a single multistate license and practice across participating states without obtaining separate licenses in each one. This is meant to ease staffing flexibility and reduce licensing costs.
But there's a catch. Section 4(a)(3) of HB156 (found on page 6) establishes a hard rule: any PA holding a compact privilege in Alabama must have no felony or misdemeanor convictions on their record. Not just serious felonies. Any misdemeanor conviction disqualifies a PA from holding the compact privilege.
If you employ or contract with a PA who works across state lines under the compact privilege, that PA cannot have any felony or misdemeanor conviction. If they do, they cannot legally hold the multistate license—which means they cannot practice under the compact.
For small practices, this affects three key decisions:
Hiring: When recruiting PAs, you'll need to verify criminal history as part of background checks. A conviction that might have been manageable under Alabama's standalone PA license could now disqualify someone from the compact entirely.
Credentialing: If you credential a PA for multistate work, you're confirming they meet this standard. Mistakes here create liability.
Staffing flexibility: If you've relied on PAs who can work across state lines to cover multiple locations or telehealth, you need to ensure they meet this requirement.
This provision becomes effective October 1, 2026, per Section 14 of HB156. That gives practices time to review current PA agreements and hiring processes, but not much.
If you currently employ or contract with PAs, review their backgrounds now. If any have misdemeanor or felony convictions and you've been relying on them for multistate work, you'll need to plan for changes by October 2026. Those PAs could still practice under Alabama's standalone PA license, but not under the interstate compact privilege.
If you're hiring, make criminal history verification a standard part of your background check process going forward—especially if the PA will work across state lines.
The interstate compact itself is designed to help practices access talent more easily. This criminal history requirement is the trade-off: stricter eligibility in exchange for streamlined multistate licensing.
For a detailed breakdown of HB156's other provisions affecting your practice, consult your legal counsel or professional association.