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North Carolina Senate Bill S160

North Carolina 2025-2026 Regular Session

North Carolina Senate Bill S160 Compare Versions

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11 GENERAL ASSEMBLY OF NORTH CAROLINA
22 SESSION 2025
3-S 1
4-SENATE BILL 160
3+S D
4+SENATE BILL DRS45059-NB-42A
5+
56
67
78 Short Title: Respiratory Care Modernization Act. (Public)
89 Sponsors: Senator Burgin (Primary Sponsor).
9-Referred to: Rules and Operations of the Senate
10-February 26, 2025
11-*S160 -v-1*
10+Referred to:
11+
12+*DRS45059 -NB-42A*
1213 A BILL TO BE ENTITLED 1
1314 AN ACT TO UPDATE THE GENERAL STATUTES OF NORTH CAROLINA GOVERNING 2
1415 THE PRACTICE OF RESPIRATORY CARE TO BETTER REFLECT THE CHANGES IN 3
1516 EDUCATION, EXPERIENCE, AND PRACTICE OF THE PROFESSION IN ORDER TO 4
1617 ENHANCE THE HEALTH AND WELFARE OF NORTH CAROLINA CITIZENS. 5
1718 Whereas, it is the intention of the North Carolina General Assembly to promote the 6
1819 health and welfare of the citizens of this State; and 7
1920 Whereas, the COVID-19 pandemic has placed increasing demands on all health care 8
2021 professionals; and 9
2122 Whereas, it is the intention of the North Carolina General Assembly that statutes 10
2223 governing the profession of respiratory care reflect current practices, improvements, and other 11
2324 developments that have occurred in the profession; and 12
2425 Whereas, the current statutory language does not fully encompass current practices, 13
2526 improvements, and other developments; Now, therefore, 14
2627 The General Assembly of North Carolina enacts: 15
2728 SECTION 1. Article 38 of Chapter 90 of the General Statutes reads as rewritten: 16
2829 "Article 38. 17
2930 "Respiratory Care Practice Act. 18
3031 … 19
3132 "§ 90-648. Definitions. 20
3233 The following definitions apply in this Article: 21
3334 (1) Advanced respiratory care practitioner (ARCP). – A person licensed in this 22
3435 State who has gained additional specialized knowledge, skills, and experience 23
3536 through a postgraduate advanced practice respiratory therapy program of 24
3637 study as defined by the Board and is authorized to perform advanced 25
3738 respiratory therapy practices under the supervision of a physician licensed to 26
3839 practice medicine in accordance with Article 1 of this Chapter. 27
3940 (1a) Advanced respiratory care procedures. – Procedures that require additional 28
4041 competency training in accordance with rules adopted by the Board. 29
4142 (1)(1b) Board. – The North Carolina Respiratory Care Board. 30
4243 (2) Diagnostic testing. – Cardiopulmonary procedures and tests performed on the 31
4344 written order of a physician licensed under Article 1 of this Chapter that 32
4445 provide information to the physician to formulate a diagnosis of the patient's 33
4546 condition. The tests and procedures may include pulmonary function testing, 34
46-electrocardiograph testing, cardiac stress testing, and sleep related testing. 35 General Assembly Of North Carolina Session 2025
47-Page 2 Senate Bill 160-First Edition
47+electrocardiograph testing, cardiac stress testing, and sleep related testing. 35
48+FILED SENATE
49+Feb 25, 2025
50+S.B. 160
51+PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
52+Page 2 DRS45059-NB-42A
4853 (3) Direct supervision. – The authority and responsibility to direct the 1
4954 performance of activities as established by policies and procedures for safe 2
5055 and appropriate completion of services. 3
5156 (3a) Endorsement. – A designation issued by the Board recognizing the person 4
5257 named on the endorsement as having met the requirements to perform 5
5358 advanced respiratory care procedures as defined by rules adopted by the 6
5459 Board. 7
5560 (4) Individual. – A human being. 8
5661 (4a) Invasive diagnostic and therapeutic procedure. – Any test or treatment that 9
5762 uses instruments to cut, puncture, or otherwise enter the body. 10
5863 (5) License. – A certificate issued by the Board recognizing the person named 11
5964 therein as having met the requirements to practice respiratory care as defined 12
6065 in this Article.Article as a respiratory care practitioner or advanced respiratory 13
6166 care practitioner. 14
6267 (6) Licensee. – A person who has been issued a license under this Article. 15
6368 (7) Medical director. – An appointed physician who is licensed under Article 1 of 16
6469 this Chapter and a member of the entity's medical staff, and who is granted 17
6570 the authority and responsibility for assuring and establishing policies and 18
6671 procedures and that the provision of such is provided to the quality, safety, 19
6772 and appropriateness standards as recognized within the defined scope of 20
6873 practice for the entity. 21
6974 (8) Person. – An individual, corporation, partnership, association, unit of 22
7075 government, or other legal entity. 23
7176 (9) Physician. – A doctor of medicine An individual licensed to practice medicine 24
7277 by the State of North Carolina in accordance with Article 1 of this Chapter. 25
7378 (9a) Practice of advanced practice respiratory therapy. – The scope of practice as 26
7479 determined by the supervising physician at the practice level in any health care 27
7580 setting authorized by the supervising physician and the Board. It shall not 28
7681 include (i) medical diagnosis; (ii) prescribing; (iii) interpretation of medical 29
7782 diagnostic imaging studies; (iv) final interpretation of sleep studies or 30
7883 pulmonary function tests; (v) surgery; (vi) delivery of anesthesia; and (vii) 31
7984 ordering or performing diagnostic and therapeutic procedures that are more 32
8085 than minimally invasive and have known complications that involve serious 33
8186 injury and death, unless a physician is physically present to supervise the 34
8287 advanced practice respiratory care therapist or the procedure is provided 35
8388 pursuant to subdivision (10) of this section. The advanced respiratory care 36
8489 practitioner may perform acts, tasks, or functions in any health care setting for 37
8590 which the physician is responsible, and which are as follows: 38
8691 a. Related to the care of persons with problems affecting the 39
8792 cardiovascular and cardiopulmonary systems. 40
8893 b. Delegated by a supervising physician. 41
8994 c. Appropriate to the advanced respiratory care practitioner's education, 42
9095 training, experience, and level of competence. 43
9196 (10) Practice of respiratory care. – As defined by the written order of a physician 44
9297 licensed under Article 1 of this Chapter, Chapter for respiratory care 45
9398 practitioners, the observing and monitoring of signs and symptoms, general 46
9499 behavior, and general physical response to respiratory care treatment and 47
95100 diagnostic testing, including the determination of whether such signs, 48
96101 symptoms, reactions, behavior, or general response exhibit abnormal 49
97102 characteristics, and the performance of diagnostic testing and therapeutic 50
98103 application of: 51 General Assembly Of North Carolina Session 2025
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100105 a. Medical gases, humidity, and aerosols including the maintenance use 1
101106 of associated apparatus, respiratory care equipment, except for the 2
102107 purpose of anesthesia. 3
103108 b. Pharmacologic agents related to respiratory care procedures, including 4
104109 those agents necessary to perform hemodynamic monitoring. 5
105110 c. Mechanical or physiological ventilatory support. 6
106111 d. Cardiopulmonary resuscitation and maintenance of natural airways, 7
107112 the insertion and maintenance of artificial airways under the direct 8
108113 supervision of a recognized medical director in a health care 9
109114 environment which identifies these services within the scope of 10
110115 practice by the facility's governing board. 11
111116 e. Hyperbaric oxygen therapy. 12
112117 f. New and innovative respiratory care and related support activities in 13
113118 appropriately identified environments and under the training and 14
114119 practice guidelines established by the American Association of 15
115120 Respiratory Care. 16
116121 The term also means the interpretation and implementation of a 17
117122 physician's written or verbal order pertaining to the acts described in 18
118123 this subdivision. 19
119124 (11) Respiratory care. – As defined by the written order of a physician licensed 20
120125 under Article 1 of Chapter 90, the treatment, management, diagnostic testing, 21
121126 and care of patients with deficiencies and abnormalities associated with the 22
122127 cardiopulmonary system. 23
123128 (12) Respiratory care practitioner. – A person who has been licensed by the Board 24
124129 to engage in the practice of respiratory care. 25
125130 (12a) Serious injury. – An injury that creates a substantial risk of impairment of any 26
126131 bodily function that requires immediate medical attention or hospitalization. 27
127132 (12b) Supervising physician. – A physician with the competencies and authority to 28
128133 supervise advanced respiratory care practitioners. 29
129134 (13) Support activities. – Procedures Tasks that do not require formal academic 30
130135 training, including the delivery, setup, and routine maintenance and repair of 31
131136 apparatus. respiratory care equipment. The term also includes giving 32
132137 instructions on the use, fitting, and application of apparatus, respiratory care 33
133138 equipment but does not include therapeutic evaluation and 34
134139 assessment.assessment for an individual patient as defined in rules adopted by 35
135140 the Board. 36
136141 "§ 90-649. North Carolina Respiratory Care Board; creation. 37
137142 (a) The North Carolina Respiratory Care Board is created. The Board shall consist of 10 38
138143 members as follows: 39
139144 (1) Two members shall be respiratory care practitioners. 40
140145 (2) Four members shall be physicians licensed to practice in North Carolina, and 41
141146 whose primary practice is Pulmonology, Anesthesiology, Critical Care 42
142147 Medicine, or whose specialty is Cardiothoracic Disorders. 43
143148 (3) One member shall represent the North Carolina Hospital Association. 44
144149 (4) One member member, who is a resident of this State, shall represent the North 45
145150 Carolina Association of Atlantic Coast Medical Equipment Services.Services 46
146151 Association. 47
147152 (5) Two members shall represent the public at large. 48
148153 … 49
149154 "§ 90-650. Appointments and removal of Board members; terms and compensation. 50
150155 (a) The members of the Board shall be appointed as follows: 51 General Assembly Of North Carolina Session 2025
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152157 … 1
153158 (7) The North Carolina Association of Atlantic Coast Medical Equipment 2
154159 Services Association shall appoint the member described in 3
155160 G.S. 90-649(a)(4). 4
156161 … 5
157162 "§ 90-652. Powers and duties of the Board. 6
158163 The Board shall have the power and duty to: 7
159164 (1) Determine the qualifications and fitness of applicants for licensure, renewal 8
160165 of licensure, and reciprocal licensure. The Board shall, in its discretion, 9
161166 investigate the background of an applicant to determine the applicant's 10
162167 qualifications with due regard given to the applicant's competency, honesty, 11
163168 truthfulness, and integrity. The State Bureau of Investigation may provide a 12
164169 criminal record check to the Board for a person who has applied for a license 13
165170 through the Board. The Board shall provide to the State Bureau of 14
166171 Investigation, along with the request, the fingerprints of the applicant, any 15
167172 additional information required by the State Bureau of Investigation, and a 16
168173 form signed by the applicant consenting to the check of the criminal record 17
169174 and to the use of the fingerprints and other identifying information required 18
170175 by the State or national repositories. Investigation. The applicant's fingerprints 19
171176 shall be used by the State Bureau of Investigation for a search of the State's 20
172177 criminal history record file, and the State Bureau of Investigation shall 21
173178 forward a set of the fingerprints to the Federal Bureau of Investigation for a 22
174179 national criminal history check. The Board shall keep all information pursuant 23
175180 to this subdivision privileged, in accordance with applicable State law and 24
176181 federal guidelines, and the information shall be confidential and shall not be a 25
177182 public record under Chapter 132 of the General Statutes. The Board shall 26
178183 collect any fees required by the State Bureau of Investigation and shall remit 27
179184 the fees to the State Bureau of Investigation for expenses associated with 28
180185 conducting the criminal history record check. 29
181186 … 30
182187 (14) Establish and adopt rules defining the education and credential requirements 31
183188 for persons seeking endorsement under this Article. 32
184189 "§ 90-653. Licensure requirements; examination. 33
185190 (a) Each applicant for licensure a respiratory care practitioner license under this Article 34
186191 shall meet the following requirements:do all of the following: 35
187192 (1) Submit a completed application as required by the Board.Board, which shall 36
188193 include a form signed by the applicant consenting to the check of the 37
189194 applicant's criminal record and to the use of the applicant's fingerprints and 38
190195 other identifying information required by the State and national repositories. 39
191196 (2) Submit any fees required by the Board. 40
192197 (3) Submit to the Board written evidence, verified by oath, that the applicant has 41
193198 successfully completed the minimal entry-level degree requirements of a 42
194199 respiratory care education program as approved by the Commission for 43
195200 Accreditation of Allied Health Educational Programs, or the Canadian 44
196201 Council on on Accreditation for Respiratory Therapy Education.Care 45
197202 (CoARC) or its successor by arranging for the applicant's respiratory care 46
198203 education program to submit an official transcript confirming successful 47
199204 completion of the respiratory care education program directly to the Board. 48
200205 (4) Submit to the Board written evidence, verified by oath, that the applicant has 49
201206 successfully completed the minimal requirements for Basic Cardiac Life 50 General Assembly Of North Carolina Session 2025
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203208 Support as recognized by the American Heart Association, the American Red 1
204209 Cross, or the American Safety and Health Institute. 2
205210 (5) Pass Submit to the Board written evidence, verified by oath, that the 3
206211 entry-level applicant passed the examination requirements as defined by the 4
207212 rules adopted by the Board given by the National Board for Respiratory Care, 5
208213 Inc.Inc., or its successor, for entry-level respiratory care practitioners. 6
209214 (b) At least three times each year, the Board shall cause the examination required in 7
210215 subdivision (5) of subsection (a) of this section to be given to applicants at a time and place to be 8
211216 announced by the Board. Any applicant who fails to pass the first examination may take 9
212217 additional examinations in accordance with rules adopted pursuant to this Article. 10
213218 (c) Each applicant for an advanced respiratory care practitioner license under this Article 11
214219 shall do all of the following: 12
215220 (1) Submit a completed application as required by the Board, including a form 13
216221 signed by the applicant consenting to the check of the applicant's criminal 14
217222 record and to the use of the applicant's fingerprints and other identifying 15
218223 information required by the State and national repositories. 16
219224 (2) Submit any fees required by the Board. 17
220225 (3) Submit to the Board written evidence, verified by oath, that the applicant has 18
221226 successfully completed the postgraduate degree requirements of respiratory 19
222227 care education for the advanced practice respiratory therapist as approved by 20
223228 the Commission on Accreditation for Respiratory Care (CoARC) or its 21
224229 successor by arranging for the applicant's respiratory care education program 22
225230 to submit an official transcript confirming successful completion of the 23
226231 advanced respiratory care education program directly to the Board. 24
227232 (4) Submit to the Board written evidence, verified by oath, that the applicant has 25
228233 successfully completed the minimal requirements for Basic Cardiac Life 26
229234 Support as recognized by the American Heart Association, the American Red 27
230235 Cross, and the American Safety and Health Institute. 28
231236 (5) Submit to the Board written evidence, verified by oath, that the applicant 29
232237 passed the examination requirements as defined by Board rules pursuant to 30
233238 this Article given by the National Board for Respiratory Care, Inc., or its 31
234239 successor, for advanced-level respiratory care practitioners and defined by 32
235240 Board rules pursuant to this Article. 33
236241 (d) When issuing a license, the Board shall state the terms and conditions of use of the 34
237242 license to the licensee. 35
238243 … 36
239244 "§ 90-660. Expenses; fees. 37
240245 … 38
241246 (b) All monies received by the Board pursuant to this Article shall be deposited in an 39
242247 account for the Board and shall be used for the administration and implementation of this Article. 40
243248 The Board shall establish fees in amounts to cover the cost of services rendered for the following 41
244249 purposes: 42
245250 (1) For an initial application, a fee not to exceed fifty dollars ($50.00). 43
246251 (2) For examination or reexamination, a fee not to exceed two hundred dollars 44
247252 ($200.00). 45
248253 … 46
249254 (6) For a license with a provisional or temporary endorsement, a fee not to exceed 47
250255 fifty dollars ($50.00). 48
251256 … 49
252257 "§ 90-661. Requirement of license. 50
253258 It shall be unlawful for any person who is not currently licensed under this Article to: 51 General Assembly Of North Carolina Session 2025
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255260 (1) Engage in the practice of respiratory care. 1
256261 (2) Use the title "respiratory care practitioner".practitioner" or "advanced 2
257262 respiratory care practitioner." 3
258263 (3) Use the letters "RCP", "RTT", "RT", "ARCP", or any facsimile or 4
259264 combination in any words, letters, abbreviations, or insignia. 5
260265 (4) Imply orally or in writing or indicate in any way that the person is a respiratory 6
261266 care practitioner practitioner, advanced respiratory care practitioner, or is 7
262267 otherwise licensed under this Article. 8
263268 (5) Employ or solicit for employment unlicensed persons to practice respiratory 9
264269 care. 10
265270 … 11
266271 "§ 90-667. Confidentiality of Board investigative information. 12
267272 (a) All records, papers, investigative information, and other documents containing 13
268273 information that the Board, its members, or its employees possess, gather, or receive as a result 14
269274 of investigations, inquiries, assessments, or interviews conducted in connection with a licensing 15
270275 complaint, appeal, assessment, potential impairment matter, or disciplinary matter shall not be 16
271276 considered public records within the meaning of Chapter 132 of the General Statutes and are 17
272277 privileged, confidential, not subject to discovery, subpoena, or any means of legal compulsion 18
273278 for release to anyone other than the Board, its employees, or consultants involved in the 19
274279 application for license, impairment assessment, or discipline of the licensee, except as provided 20
275280 in subsection (b) of this section. For the purposes of this section, "investigative information" 21
276281 means investigative files and reports, information relating to the identity and report of a physician 22
277282 or other professional performing an expert review for the Board, and any of the Board's 23
278283 investigative materials that are not admitted into evidence. 24
279284 (b) The Board shall provide the licensee or applicant for license access to all information 25
280285 in its possession that the Board intends to offer into evidence at the licensee's or applicant's 26
281286 hearing. The Board shall not be required to produce (i) information subject to attorney-client 27
282287 privilege or (ii) investigative information that the Board will not offer into evidence and is related 28
283288 to advice, opinions, or recommendations of the Board's staff, consultants, or agents. 29
284289 (c) Any licensee's notice of statement of charges, notice of hearing, and all information 30
285290 contained in those documents shall be public records under Chapter 132 of the General Statutes. 31
286291 (d) If the Board, its employees, or its agents possess investigative information indicating 32
287292 a crime may have been committed, the Board may report the information to the appropriate law 33
288293 enforcement agency or district attorney of the district in which the offense was committed. The 34
289294 Board shall cooperate with and assist any law enforcement agency or district attorney conducting 35
290295 a criminal investigation or prosecution of a licensee by providing relevant information. This 36
291296 information shall be confidential under G.S. 132-1.4 and shall remain confidential after 37
292297 disclosure to a law enforcement agency or district attorney. 38
293298 (e) All licensees shall self-report to the Board any of the following within 30 days of their 39
294299 arrest or indictment: 40
295300 (1) Any felony or arrest or indictment. 41
296301 (2) Any arrest for driving while impaired or driving under the influence. 42
297302 (3) Any arrest or indictment for the possession, use, or sale of any controlled 43
298303 substance. 44
299304 (f) The Board, its members, or its staff may release confidential information concerning 45
300305 the denial, annulment, suspension, or revocation of a license to any other health care licensing 46
301306 board in this State, other state, or country, or authorized Department of Health and Human 47
302307 Services personnel who are charged with the enforcement or investigative responsibilities of 48
303308 licensure. If the Board releases this confidential information, the Board shall notify and provide 49
304309 a summary of the information to the licensee within 60 days after the information is transmitted. 50
305310 The licensee may make a written request that the Board provide the licensee a copy of all 51 General Assembly Of North Carolina Session 2025
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307312 information transmitted within 30 days of receiving notice of the initial transmittance. The Board 1
308313 shall not provide the information if the information relates to an ongoing criminal investigation 2
309314 by any law enforcement agency or authorized Department of Health and Human Services 3
310315 personnel with enforcement or investigative responsibilities. 4
311316 (g) Notwithstanding the provisions of this section, the Board shall withhold the identity 5
312317 of a patient, including information relating to dates and places of treatment, or any other 6
313318 information that would tend to identify the patient, in any proceeding, record of a hearing, and in 7
314319 the notice of charges against any licensee, unless the patient or the patient's representative 8
315320 expressly consents to the public disclosure. 9
316321 "§ 90-668. Limitations on advanced respiratory care practitioners. 10
317322 (a) Individuals who are licensed under this Article as advanced respiratory care 11
318323 practitioners may use the title "advanced respiratory care practitioner." Individuals who hold 12
319324 themselves out as advanced respiratory care practitioners without being licensed are in violation 13
320325 of this Article. 14
321326 (b) Individuals who are licensed under this Article as advanced respiratory care 15
322327 practitioners may practice advanced respiratory care under the supervision of a physician 16
323328 licensed under Article 1 of this Chapter and within the scope of rules adopted by the Board." 17
324329 SECTION 2. The North Carolina Respiratory Care Board shall adopt rules to 18
325330 implement and administer the provisions of this act no later than October 1, 2025. 19
326331 SECTION 3. Section 1 of this act becomes effective on October 1, 2025. Except as 20
327332 otherwise provided, this act is effective when it becomes law. 21