GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 71
Short Title: Respiratory Care Modernization Act. (Public)
Sponsors: Representatives Moss and Huneycutt (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Health, if favorable, Regulatory Reform, if favorable, Rules, Calendar, and
Operations of the House
February 11, 2025
*H71-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO UPDATE THE GENERAL STATUTES OF NORTH CAROLINA GOVE RNING 2
THE PRACTICE OF RESPIRATORY CARE TO BETTER REFLECT THE CHANGES IN 3
EDUCATION, EXPERIENCE, AND PRACTICE OF THE PROFESSION IN ORDER TO 4
ENHANCE THE HEALTH A ND WELFARE OF NORTH CAROLINA CITIZENS. 5
Whereas, it is the intention of the North Carolina General Assembly to promote the 6
health and welfare of the citizens of this State; and 7
Whereas, the COVID-19 pandemic has placed increasing demands on all health care 8
professionals; and 9
Whereas, it is the intention of the North Carolina General Assembly that statutes 10
governing the profession of respiratory care reflect current practices, improvements, and other 11
developments that have occurred in the profession; and 12
Whereas, the current statutory language does not fully encompass current practices, 13
improvements, and other developments; Now, therefore, 14
The General Assembly of North Carolina enacts: 15
SECTION 1. Article 38 of Chapter 90 of the General Statutes reads as rewritten: 16
"Article 38. 17
"Respiratory Care Practice Act. 18
… 19
"§ 90-648. Definitions. 20
The following definitions apply in this Article: 21
(1) Advanced respiratory care practitioner (ARCP). – A person licensed in this 22
State who has gained additional specialized knowledge, skills, and experience 23
through a postgraduate advanced practice respiratory therapy program of 24
study as defined by the Board and is authorized to perform advanced 25
respiratory therapy practices under the supervision of a physician licensed to 26
practice medicine in accordance with Article 1 of this Chapter. 27
(1a) Advanced respiratory care procedures. – Procedures that require additional 28
competency training in accordance with rules adopted by the Board. 29
(1)(1b) Board. – The North Carolina Respiratory Care Board. 30
(2) Diagnostic testing. – Cardiopulmonary procedures and tests performed on the 31
written order of a physician licensed under Article 1 of this Chapter that 32
provide information to the physician to formulate a diagnosis of the patient's 33 General Assembly Of North Carolina Session 2025
Page 2 House Bill 71-First Edition
condition. The tests and procedures may include pulmonary function testing, 1
electrocardiograph testing, cardiac stress testing, and sleep related testing. 2
(3) Direct supervision. – The authority and responsibility to direct the 3
performance of activities as established by policies and procedures for safe 4
and appropriate completion of services. 5
(3a) Endorsement. – A designation issued by the Board recognizing the person 6
named on the endorsement as having met the requirements to perform 7
advanced respiratory care procedures as defined by rules adopted by the 8
Board. 9
(4) Individual. – A human being. 10
(4a) Invasive diagnostic and therapeutic procedure. – Any test or treatment that 11
uses instruments to cut, puncture, or otherwise enter the body. 12
(5) License. – A certificate issued by the Board recognizing the person named 13
therein as having met the requirements to practice respiratory care as defined 14
in this Article.Article as a respiratory care practitioner or advanced respiratory 15
care practitioner. 16
(6) Licensee. – A person who has been issued a license under this Article. 17
(7) Medical director. – An appointed physician who is licensed under Article 1 of 18
this Chapter and a member of the entity's medical staff, and who is granted 19
the authority and responsibility for assuring and establishing policies and 20
procedures and that the provision of such is provided to the quality, safety, 21
and appropriateness standards as recognized within the defined scope of 22
practice for the entity. 23
(8) Person. – An individual, corporation, partnership, association, unit of 24
government, or other legal entity. 25
(9) Physician. – A doctor of medicine An individual licensed to practice medicine 26
by the State of North Carolina in accordance with Article 1 of this Chapter. 27
(9a) Practice of advanced practice respiratory therapy. – The scope of practice as 28
determined by the supervising physician at the practice level in any health care 29
setting authorized by the supervising physician and the Board. It shall not 30
include (i) medical diagnosis; (ii) prescribing; (iii) interpretation of medical 31
diagnostic imaging studies; (iv) final interpretation of sleep studies or 32
pulmonary function tests; (v) surgery; (vi) delivery of anesthesia; and (vii) 33
ordering or performing diagnostic and therapeutic procedures that are more 34
than minimally invasive and have known complications that involve serious 35
injury and death, unless a physician is physically present to supervise the 36
advanced practice respiratory care therapist or the procedure is provided 37
pursuant to subdivision (10) of this section. The advanced respiratory care 38
practitioner may perform acts, tasks, or functions in any health care setting for 39
which the physician is responsible, and which are as follows: 40
a. Related to the care of persons with problems affecting the 41
cardiovascular and cardiopulmonary systems. 42
b. Delegated by a supervising physician. 43
c. Appropriate to the advanced respiratory care practitioner's education, 44
training, experience, and level of competence. 45
(10) Practice of respiratory care. – As defined by the written order of a physician 46
licensed under Article 1 of this Chapter, Chapter for respiratory care 47
practitioners, the observing and monitoring of signs and symptoms, general 48
behavior, and general physical response to respiratory care treatment and 49
diagnostic testing, including the determination of whether such signs, 50
symptoms, reactions, behavior, or general response exhibit abnormal 51 General Assembly Of North Carolina Session 2025
House Bill 71-First Edition Page 3
characteristics, and the performance of diagnostic testing and therapeutic 1
application of: 2
a. Medical gases, humidity, and aerosols including the maintenance use 3
of associated apparatus, respiratory care equipment, except for the 4
purpose of anesthesia. 5
b. Pharmacologic agents related to respiratory care procedures, including 6
those agents necessary to perform hemodynamic monitoring. 7
c. Mechanical or physiological ventilatory support. 8
d. Cardiopulmonary resuscitation and maintenance of natural airways, 9
the insertion and maintenance of artificial airways under the direct 10
supervision of a recognized medical director in a health care 11
environment which identifies these services within the scope of 12
practice by the facility's governing board. 13
e. Hyperbaric oxygen therapy. 14
f. New and innovative respiratory care and related support activities in 15
appropriately identified environments and under the training and 16
practice guidelines established by the American Association of 17
Respiratory Care. 18
The term also means the interpretation and implementation of a 19
physician's written or verbal order pertaining to the acts described in 20
this subdivision. 21
(11) Respiratory care. – As defined by the written order of a physician licensed 22
under Article 1 of Chapter 90, the treatment, management, diagnostic testing, 23
and care of patients with deficiencies and abnormalities associated with the 24
cardiopulmonary system. 25
(12) Respiratory care practitioner. – A person who has been licensed by the Board 26
to engage in the practice of respiratory care. 27
(12a) Serious injury. – An injury that creates a substantial risk of impairment of any 28
bodily function that requires immediate medical attention or hospitalization. 29
(12b) Supervising physician. – A physician with the competencies and authority to 30
supervise advanced respiratory care practitioners. 31
(13) Support activities. – Procedures Tasks that do not require formal academic 32
training, including the delivery, setup, and routine maintenance and repair of 33
apparatus. respiratory care equipment. The term also includes giving 34
instructions on the use, fitting, and application of apparatus, respiratory care 35
equipment but does not include therapeutic evaluation and 36
assessment.assessment for an individual patient as defined in rules adopted by 37
the Board. 38
"§ 90-649. North Carolina Respiratory Care Board; creation. 39
(a) The North Carolina Respiratory Care Board is created. The Board shall consist of 10 40
members as follows: 41
(1) Two members shall be respiratory care practitioners. 42
(2) Four members shall be physicians licensed to practice in North Carolina, and 43
whose primary practice is Pulmonology, Anesthesiology, Critical Care 44
Medicine, or whose specialty is Cardiothoracic Disorders. 45
(3) One member shall represent the North Carolina Hospital Association. 46
(4) One member member, who is a resident of this State, shall represent the North 47
Carolina Association of Atlantic Coast Medical Equipment Services.Services 48
Association. 49
(5) Two members shall represent the public at large. 50
… 51 General Assembly Of North Carolina Session 2025
Page 4 House Bill 71-First Edition
"§ 90-650. Appointments and removal of Board members; terms and compensation. 1
(a) The members of the Board shall be appointed as follows: 2
… 3
(7) The North Carolina Association of Atlantic Coast Medical Equipment 4
Services Association shall appoint the member described in 5
G.S. 90-649(a)(4). 6
… 7
"§ 90-652. Powers and duties of the Board. 8
The Board shall have the power and duty to: 9
(1) Determine the qualifications and fitness of applicants for licensure, renewal 10
of licensure, and reciprocal licensure. The Board shall, in its discretion, 11
investigate the background of an applicant to determine the applicant's 12
qualifications with due regard given to the applicant's competency, honesty, 13
truthfulness, and integrity. The State Bureau of Investigation may provide a 14
criminal record check to the Board for a person who has applied for a license 15
through the Board. The Board shall provide to the State Bureau of 16
Investigation, along with the request, the fingerprints of the applicant, any 17
additional information required by the State Bureau of Investigation, and a 18
form signed by the applicant consenting to the check of the criminal record 19
and to the use of the fingerprints and other identifying information required 20
by the State or national repositories. Investigation. The applicant's fingerprints 21
shall be used by the State Bureau of Investigation for a search of the State's 22
criminal history record file, and the State Bureau of Investigation shall 23
forward a set of the fingerprints to the Federal Bureau of Investigation for a 24
national criminal history check. The Board shall keep all information pursuant 25
to this subdivision privileged, in accordance with applicable State law and 26
federal guidelines, and the information shall be confidential and shall not be a 27
public record under Chapter 132 of the General Statutes. The Board shall 28
collect any fees required by the State Bureau of Investigation and shall remit 29
the fees to the State Bureau of Investigation for expenses associated with 30
conducting the criminal history record check. 31
… 32
(14) Establish and adopt rules defining the education and credential requirements 33
for persons seeking endorsement under this Article. 34
"§ 90-653. Licensure requirements; examination. 35
(a) Each applicant for licensure a respiratory care practitioner license under this Article 36
shall meet the following requirements:do all of the following: 37
(1) Submit a completed application as required by the Board.Board, which shall 38
include a form signed by the applicant consenting to the check of the 39
applicant's criminal record and to the use of the applicant's fingerprints and 40
other identifying information required by the State and national repositories. 41
(2) Submit any fees required by the Board. 42
(3) Submit to the Board written evidence, verified by oath, that the applicant has 43
successfully completed the minimal entry-level degree requirements of a 44
respiratory care education program as approved by the Commission for 45
Accreditation of Allied Health Educational Programs, or the Canadian 46
Council on on Accreditation for Respiratory Therapy Education.Care 47
(CoARC) or its successor by arranging for the applicant's respiratory care 48
education program to submit an official transcript confirming successful 49
completion of the respiratory care education program directly to the Board. 50 General Assembly Of North Carolina Session 2025
House Bill 71-First Edition Page 5
(4) Submit to the Board written evidence, verified by oath, that the applicant has 1
successfully completed the minimal requirements for Basic Cardiac Life 2
Support as recognized by the American Heart Association, the American Red 3
Cross, or the American Safety and Health Institute. 4
(5) Pass Submit to the Board written evidence, verified by oath, that the 5
entry-level applicant passed the examination requirements as defined by the 6
rules adopted by the Board given by the National Board for Respiratory Care, 7
Inc.Inc., or its successor, for entry-level respiratory care practitioners. 8
(b) At least three times each year, the Board shall cause the examination required in 9
subdivision (5) of subsection (a) of this section to be given to applicants at a time and place to be 10
announced by the Board. Any applicant who fails to pass the first examination may take 11
additional examinations in accordance with rules adopted pursuant to this Article. 12
(c) Each applicant for an advanced respiratory care practitioner license under this Article 13
shall do all of the following: 14
(1) Submit a completed application as required by the Board, including a form 15
signed by the applicant consenting to the check of the applicant's criminal 16
record and to the use of the applicant's fingerprints and other identifying 17
information required by the State and national repositories. 18
(2) Submit any fees required by the Board. 19
(3) Submit to the Board written evidence, verified by oath, that the applicant has 20
successfully completed the postgraduate degree requirements of respiratory 21
care education for the advanced practice respiratory therapist as approved by 22
the Commission on Accreditation for Respiratory Care (CoARC) or its 23
successor by arranging for the applicant's respiratory care education program 24
to submit an official transcript confirming successful completion of the 25
advanced respiratory care education program directly to the Board. 26
(4) Submit to the Board written evidence, verified by oath, that the applicant has 27
successfully completed the minimal requirements for Basic Cardiac Life 28
Support as recognized by the American Heart Association, the American Red 29
Cross, and the American Safety and Health Institute. 30
(5) Submit to the Board written evidence, verified by oath, that the applicant 31
passed the examination requirements as defined by Board rules pursuant to 32
this Article given by the National Board for Respiratory Care, Inc., or its 33
successor, for advanced-level respiratory care practitioners and defined by 34
Board rules pursuant to this Article. 35
(d) When issuing a license, the Board shall state the terms and conditions of use of the 36
license to the licensee. 37
… 38
"§ 90-660. Expenses; fees. 39
… 40
(b) All monies received by the Board pursuant to this Article shall be deposited in an 41
account for the Board and shall be used for the administration and implementation of this Article. 42
The Board shall establish fees in amounts to cover the cost of services rendered for the following 43
purposes: 44
(1) For an initial application, a fee not to exceed fifty dollars ($50.00). 45
(2) For examination or reexamination, a fee not to exceed two hundred dollars 46
($200.00). 47
… 48
(6) For a license with a provisional or temporary endorsement, a fee not to exceed 49
fifty dollars ($50.00). 50
… 51 General Assembly Of North Carolina Session 2025
Page 6 House Bill 71-First Edition
"§ 90-661. Requirement of license. 1
It shall be unlawful for any person who is not currently licensed under this Article to: 2
(1) Engage in the practice of respiratory care. 3
(2) Use the title "respiratory care practitioner".practitioner" or "advanced 4
respiratory care practitioner." 5
(3) Use the letters "RCP", "RTT", "RT", "ARCP", or any facsimile or 6
combination in any words, letters, abbreviations, or insignia. 7
(4) Imply orally or in writing or indicate in any way that the person is a respiratory 8
care practitioner practitioner, advanced respiratory care practitioner, or is 9
otherwise licensed under this Article. 10
(5) Employ or solicit for employment unlicensed persons to practice respiratory 11
care. 12
… 13
"§ 90-667. Confidentiality of Board investigative information. 14
(a) All records, papers, investigative information, and other documents containing 15
information that the Board, its members, or its employees possess, gather, or receive as a result 16
of investigations, inquiries, assessments, or interviews conducted in connection with a licensing 17
complaint, appeal, assessment, potential impairment matter, or disciplinary matter shall not be 18
considered public records within the meaning of Chapter 132 of the General Statutes and are 19
privileged, confidential, not subject to discovery, subpoena, or any means of legal compulsion 20
for release to anyone other than the Board, its employees, or consultants involved in the 21
application for license, impairment assessment, or discipline of the licensee, except as provided 22
in subsection (b) of this section. For the purposes of this section, "investigative information" 23
means investigative files and reports, information relating to the identity and report of a physician 24
or other professional performing an expert review for the Board, and any of the Board's 25
investigative materials that are not admitted into evidence. 26
(b) The Board shall provide the licensee or applicant for license access to all information 27
in its possession that the Board intends to offer into evidence at the licensee's or applicant's 28
hearing. The Board shall not be required to produce (i) information subject to attorney-client 29
privilege or (ii) investigative information that the Board will not offer into evidence and is related 30
to advice, opinions, or recommendations of the Board's staff, consultants, or agents. 31
(c) Any licensee's notice of statement of charges, notice of hearing, and all information 32
contained in those documents shall be public records under Chapter 132 of the General Statutes. 33
(d) If the Board, its employees, or its agents possess investigative information indicating 34
a crime may have been committed, the Board may report the information to the appropriate law 35
enforcement agency or district attorney of the district in which the offense was committed. The 36
Board shall cooperate with and assist any law enforcement agency or district attorney conducting 37
a criminal investigation or prosecution of a licensee by providing relevant information. This 38
information shall be confidential under G.S. 132-1.4 and shall remain confidential after 39
disclosure to a law enforcement agency or district attorney. 40
(e) All licensees shall self-report to the Board any of the following within 30 days of their 41
arrest or indictment: 42
(1) Any felony or arrest or indictment. 43
(2) Any arrest for driving while impaired or driving under the influence. 44
(3) Any arrest or indictment for the possession, use, or sale of any controlled 45
substance. 46
(f) The Board, its members, or its staff may release confidential information concerning 47
the denial, annulment, suspension, or revocation of a license to any other health care licensing 48
board in this State, other state, or country, or authorized Department of Health and Human 49
Services personnel who are charged with the enforcement or investigative responsibilities of 50
licensure. If the Board releases this confidential information, the Board shall notify and provide 51 General Assembly Of North Carolina Session 2025
House Bill 71-First Edition Page 7
a summary of the information to the licensee within 60 days after the information is transmitted. 1
The licensee may make a written request that the Board provide the licensee a copy of all 2
information transmitted within 30 days of receiving notice of the initial transmittance. The Board 3
shall not provide the information if the information relates to an ongoing criminal investigation 4
by any law enforcement agency or authorized Department of Health and Human Services 5
personnel with enforcement or investigative responsibilities. 6
(g) Notwithstanding the provisions of this section, the Board shall withhold the identity 7
of a patient, including information relating to dates and places of treatment, or any other 8
information that would tend to identify the patient, in any proceeding, record of a hearing, and in 9
the notice of charges against any licensee, unless the patient or the patient's representative 10
expressly consents to the public disclosure. 11
"§ 90-668. Limitations on advanced respiratory care practitioners. 12
(a) Individuals who are licensed under this Article as advanced respiratory care 13
practitioners may use the title "advanced respiratory care practitioner." Individuals who hold 14
themselves out as advanced respiratory care practitioners without being licensed are in violation 15
of this Article. 16
(b) Individuals who are licensed under this Article as advanced respiratory care 17
practitioners may practice advanced respiratory care under the supervision of a physician 18
licensed under Article 1 of this Chapter and within the scope of rules adopted by the Board." 19
SECTION 2. The North Carolina Respiratory Care Board shall adopt rules to 20
implement and administer the provisions of this act no later than October 1, 2025. 21
SECTION 3. Section 1 of this act becomes effective on October 1, 2025. Except as 22
otherwise provided, this act is effective when it becomes law. 23