GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S D
SENATE BILL DRS15068-NBf-60
Short Title: Physician Assistant Licensure Compact. (Public)
Sponsors: Senators Hise, Hollo, and Galey (Primary Sponsors).
Referred to:
*DRS15068 -NBf-60*
A BILL TO BE ENTITLED 1
AN ACT TO ESTABLISH A PA LICENSURE COMPACT FOR THE LICENSURE OF 2
PHYSICIAN ASSISTANTS. 3
The General Assembly of North Carolina enacts: 4
SECTION 1.(a) Chapter 90 of the General Statutes is amended by adding a new 5
Article to read: 6
"Article 18J. 7
"PA Licensure Compact. 8
"§ 90-270.200. Purpose. 9
In order to strengthen access to Medical Services, and in recognition of the advances in the 10
delivery of Medical Services, the Participating States of the PA Licensure Compact have allied 11
in common purpose to develop a comprehensive process that complements the existing authority 12
of State Licensing Boards to license and discipline PAs and seeks to enhance the portability of 13
License to practice as a PA while safeguarding the safety of patients. This Compact allows 14
Medical Services to be provided by PAs, via the mutual recognition of the Licensee's Qualifying 15
License by other Compact Participating States. This Compact also adopts the prevailing standard 16
for PA licensure and affirms that the practice and delivery of Medical Services by the PA occurs 17
where the patient is located at the time of the patient encounter, and therefore requires the PA to 18
be under the jurisdiction of the State Licensing Board where the patient is located. State Licensing 19
Boards that participate in this Compact retain the jurisdiction to impose Adverse Action against 20
a Compact Privilege in that State issued to a PA through the procedures of this Compact. The PA 21
Licensure Compact will alleviate burdens for military families by allowing active duty military 22
personnel and their spouses to obtain a Compact Privilege based on having an unrestricted 23
License in good standing from a Participating State. 24
"§ 90-270.201. Definitions. 25
The following definitions apply in this Compact: 26
(1) Adverse Action. – Any administrative, civil, equitable, or criminal action 27
permitted by a State's laws which is imposed by a Licensing Board or other 28
authority against a PA License or License application or Compact Privilege 29
such as License denial, censure, revocation, suspension, probation, 30
monitoring of the Licensee, or restriction on the Licensee's practice. 31
(2) Compact Privilege. – The authorization granted by a Remote State to allow a 32
Licensee from another Participating State to practice as a PA to provide 33
Medical Services and other licensed activity to a patient located in the Remote 34
State under the Remote State's laws and regulations. 35
FILED SENATE
Feb 26, 2025
S.B. 190
PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
Page 2 DRS15068-NBf-60
(3) Conviction. – A finding by a court that an individual is guilty of a felony or 1
misdemeanor offense through adjudication or entry of a plea of guilt or no 2
contest to the charge by the offender. 3
(4) Criminal Background Check. – The submission of fingerprints or other 4
biometric-based information for a License applicant for the purpose of 5
obtaining that applicant's criminal history record information, as defined in 28 6
C.F.R. § 20.3(d), from the State's criminal history record repository, as 7
defined in 28 C.F.R. § 20.3(f). 8
(5) Data System. – The repository of information about Licensees, including, but 9
not limited to, License status and Adverse Actions, which is created and 10
administered under the terms of this Compact. 11
(6) Executive Committee. – A group of directors and ex officio individuals 12
elected or appointed pursuant to G.S. 90-270.206(f)(2). 13
(7) Impaired Practitioner. – A PA whose practice is adversely affected by 14
health-related condition(s) that impact their ability to practice. 15
(8) Investigative Information. – Information, records, or documents received or 16
generated by a Licensing Board pursuant to an investigation. 17
(9) Jurisprudence Requirement. – The assessment of an individual's knowledge 18
of the laws and Rules governing the practice of a PA in a State. 19
(10) License. – Current authorization by a State, other than authorization pursuant 20
to a Compact Privilege, for a PA to provide Medical Services, which would 21
be unlawful without current authorization. 22
(11) Licensee. – An individual who holds a License from a State to provide 23
Medical Services as a PA. 24
(12) Licensing Board. – Any State entity authorized to license and otherwise 25
regulate PAs. 26
(13) Medical Services. – Health care services provided for the diagnosis, 27
prevention, treatment, cure, or relief of a health condition, injury, or disease, 28
as defined by a State's laws and regulations. 29
(14) Model Compact. – The model for the PA Licensure Compact on file with The 30
Council of State Governments or other entity as designated by the 31
Commission. 32
(15) Participating State. – A State that has enacted this Compact. 33
(16) PA. – An individual who is licensed as a physician assistant in a State. For 34
purposes of this Compact, any other title or status adopted by a State to replace 35
the term "physician assistant" shall be deemed synonymous with "physician 36
assistant" and shall confer the same rights and responsibilities to the Licensee 37
under the provisions of this Compact at the time of its enactment. 38
(17) PA Licensure Compact Commission, Compact Commission, or Commission. 39
– The national administrative body created pursuant to G.S. 90-270.206(f)(2) 40
of this Compact. 41
(18) Qualifying License. – An unrestricted License issued by a Participating State 42
to provide Medical Services as a PA. 43
(19) Remote State. – A Participating State where a Licensee who is not licensed as 44
a PA is exercising or seeking to exercise the Compact Privilege. 45
(20) Rule. – A regulation promulgated by an entity that has the force and effect of 46
law. 47
(21) Significant Investigative Information. – Investigative Information that a 48
Licensing Board, after an inquiry or investigation that includes notification 49
and an opportunity for the PA to respond if required by State law, has reason 50 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 3
to believe is not groundless and, if proven true, would indicate more than a 1
minor infraction. 2
(22) State. – Any state, commonwealth, district, or territory of the United States. 3
"§ 90-270.202. State participation in this Compact. 4
(a) To participate in this Compact, a Participating State shall: 5
(1) License PAs. 6
(2) Participate in the Compact Commission's Data System. 7
(3) Have a mechanism in place for receiving and investigating complaints against 8
Licensees and License applicants. 9
(4) Notify the Commission, in compliance with the terms of this Compact and 10
Commission Rules, of any Adverse Action against a Licensee or License 11
applicant and the existence of Significant Investigative Information regarding 12
a Licensee or License applicant. 13
(5) Fully implement a Criminal Background Check requirement, within a time 14
frame established by Commission Rule, by its Licensing Board receiving the 15
results of a Criminal Background Check and reporting to the Commission 16
whether the License applicant has been granted a License. 17
(6) Comply with the Rules of the Compact Commission. 18
(7) Utilize passage of a recognized national exam such as the NCCPA PANCE as 19
a requirement for PA licensure. 20
(8) Grant the Compact Privilege to a holder of a Qualifying License in a 21
Participating State. 22
(b) Nothing in this Compact prohibits a Participating State from charging a fee for 23
granting the Compact Privilege. 24
"§ 90-270.203. Compact Privilege. 25
(a) To exercise the Compact Privilege, a Licensee must: 26
(1) Have graduated from a PA program accredited by the Accreditation Review 27
Commission on Education for the Physician Assistant, Inc., or other programs 28
authorized by Commission Rule. 29
(2) Hold current NCCPA certification. 30
(3) Have no felony or misdemeanor conviction. 31
(4) Have never had a controlled substance license, permit, or registration 32
suspended or revoked by a State or by the United States Drug Enforcement 33
Administration. 34
(5) Have a unique identifier as determined by Commission Rule. 35
(6) Hold a Qualifying License. 36
(7) Have had no revocation of a License or limitation or restriction on any License 37
currently held due to an Adverse Action. 38
(8) If a Licensee has had a limitation or restriction on a License or Compact 39
Privilege due to an Adverse Action, two years must have elapsed from the 40
date on which the License or Compact Privilege is no longer limited or 41
restricted due to the Adverse Action. 42
(9) If a Compact Privilege has been revoked or is limited or restricted in a 43
Participating State for conduct that would not be a basis for disciplinary action 44
in a Participating State in which the Licensee is practicing or applying to 45
practice under a Compact Privilege, that Participating State shall have the 46
discretion not to consider such action as an Adverse Action requiring the 47
denial or removal of a Compact Privilege in that State. 48
(10) Notify the Compact Commission that the Licensee is seeking the Compact 49
Privilege in a Remote State. 50 General Assembly Of North Carolina Session 2025
Page 4 DRS15068-NBf-60
(11) Meet any Jurisprudence Requirement of a Remote State in which the Licensee 1
is seeking to practice under the Compact Privilege and pay any fees applicable 2
to satisfying the Jurisprudence Requirement. 3
(12) Report to the Commission any Adverse Action taken by a non-participating 4
State within 30 days after the action is taken. 5
(b) The Compact Privilege is valid until the expiration or revocation of the Qualifying 6
License unless terminated pursuant to an Adverse Action. The Licensee must also comply with 7
all of the requirements of subsection (a) of this section to maintain the Compact Privilege in a 8
Remote State. If the Participating State takes Adverse Action against a Qualifying License, the 9
Licensee shall lose the Compact Privilege in any Remote State in which the Licensee has a 10
Compact Privilege until all of the following occur: 11
(1) The License is no longer limited or restricted; and 12
(2) Two years have elapsed from the date on which the License is no longer 13
limited or restricted due to the Adverse Action. 14
(c) Once a restricted or limited License satisfies the requirements of subdivisions (b)(1) 15
and (2) of this section, the Licensee must meet the requirements of subsection (a) of this section 16
to obtain a Compact Privilege in any Remote State. 17
(d) For each Remote State in which a PA seeks authority to prescribe controlled 18
substances, the PA shall satisfy all requirements imposed by such State in granting or renewing 19
such authority. 20
"§ 90-270.204. Designation of the State from which Licensee is applying for a Compact 21
Privilege. 22
Upon a Licensee's application for a Compact Privilege, the Licensee shall identify to the 23
Commission the Participating State from which the Licensee is applying, in accordance with 24
applicable Rules adopted by the Commission, and subject to the following requirements: 25
(1) When applying for a Compact Privilege, the Licensee shall provide the 26
Commission with the address of the Licensee's primary residence and 27
thereafter shall immediately report to the Commission any change in the 28
address of the Licensee's primary residence. 29
(2) When applying for a Compact Privilege, the Licensee is required to consent 30
to accept service of process by mail at the Licensee's primary residence on file 31
with the Commission with respect to any action brought against the Licensee 32
by the Commission or a Participating State, including a subpoena, with respect 33
to any action brought or investigation conducted by the Commission or a 34
Participating State. 35
"§ 90-270.205. Adverse Actions. 36
(a) A Participating State in which a Licensee is licensed shall have exclusive power to 37
impose Adverse Action against the Qualifying License issued by that Participating State. 38
(b) In addition to the other powers conferred by State law, a Remote State shall have the 39
authority, in accordance with existing State due process law, to do all of the following: 40
(1) Take Adverse Action against a PA's Compact Privilege within that State to 41
remove a Licensee's Compact Privilege or take other action necessary under 42
applicable law to protect the health and safety of its citizens. 43
(2) Issue subpoenas for both hearings and investigations that require the 44
attendance and testimony of witnesses as well as the production of evidence. 45
Subpoenas issued by a Licensing Board in a Participating State for the 46
attendance and testimony of witnesses or the production of evidence from 47
another Participating State shall be enforced in the latter State by any court of 48
competent jurisdiction, according to the practice and procedure of that court 49
applicable to subpoenas issued in proceedings pending before it. The issuing 50
authority shall pay any witness fees, travel expenses, mileage, and other fees 51 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 5
required by the service statutes of the State in which the witnesses or evidence 1
are located. 2
(3) Notwithstanding subdivision (2) of this subsection, subpoenas may not be 3
issued by a Participating State to gather evidence of conduct in another State 4
that is lawful in that other State for the purpose of taking Adverse Action 5
against a Licensee's Compact Privilege or application for a Compact Privilege 6
in that Participating State. 7
(4) Nothing in this Compact authorizes a Participating State to impose discipline 8
against a PA's Compact Privilege or to deny an application for a Compact 9
Privilege in that Participating State for the individual's otherwise lawful 10
practice in another State. 11
(c) For purposes of taking Adverse Action, the Participating State which issued the 12
Qualifying License shall give the same priority and effect to reported conduct received from any 13
other Participating State as it would if the conduct had occurred within the Participating State 14
which issued the Qualifying License. In so doing, that Participating State shall apply its own 15
State laws to determine appropriate action. 16
(d) A Participating State, if otherwise permitted by State law, may recover from the 17
affected PA the costs of investigations and disposition of cases resulting from any Adverse 18
Action taken against that PA. 19
(e) A Participating State may take Adverse Action based on the factual findings of a 20
Remote State, provided that the Participating State follows its own procedures for taking the 21
Adverse Action. 22
(f) Joint Investigations. – 23
(1) In addition to the authority granted to a Participating State by its respective 24
State PA laws and regulations or other applicable State law, any Participating 25
State may participate with other Participating States in joint investigations of 26
Licensees. 27
(2) Participating States shall share any investigative, litigation, or compliance 28
materials in furtherance of any joint or individual investigation initiated under 29
this Compact. 30
(g) If an Adverse Action is taken against a PA's Qualifying License, the PA's Compact 31
Privilege in all Remote States shall be deactivated until two years have elapsed after all 32
restrictions have been removed from the State License. All disciplinary orders by the 33
Participating State which issued the Qualifying License that impose Adverse Action against a 34
PA's License shall include a Statement that the PA's Compact Privilege is deactivated in all 35
Participating States during the pendency of the order. 36
(h) If any Participating State takes Adverse Action, it promptly shall notify the 37
administrator of the Data System. 38
"§ 90-270.206. Establishment of the PA Licensure Compact Commission. 39
(a) The Participating States hereby create and establish a joint government agency and 40
national administrative body known as the PA Licensure Compact Commission. The 41
Commission is an instrumentality of the Compact States acting jointly and not an instrumentality 42
of any one State. The Commission shall come into existence on or after the effective date of the 43
Compact as set forth in G.S. 90-270.210(a). 44
(b) Membership, Voting, and Meetings: 45
(1) Each Participating State shall have and be limited to one delegate selected by 46
that Participating State's Licensing Board or, if the State has more than one 47
Licensing Board, selected collectively by the Participating State's Licensing 48
Boards. 49
(2) The delegate shall be either: 50 General Assembly Of North Carolina Session 2025
Page 6 DRS15068-NBf-60
a. A current PA, physician, or public member of a Licensing Board or 1
PA Council/Committee; or 2
b. An administrator of a Licensing Board. 3
(3) Any delegate may be removed or suspended from office as provided by the 4
laws of the State from which the delegate is appointed. 5
(4) The Participating State Licensing Board shall fill any vacancy occurring in the 6
Commission within 60 days. 7
(5) Each delegate shall be entitled to one vote on all matters voted on by the 8
Commission and shall otherwise have an opportunity to participate in the 9
business and affairs of the Commission. A delegate shall vote in person or by 10
such other means as provided in the bylaws. The bylaws may provide for 11
delegates' participation in meetings by telecommunications, video conference, 12
or other means of communication. 13
(6) The Commission shall meet at least once during each calendar year. 14
Additional meetings shall be held as set forth in this Compact and the bylaws. 15
(7) The Commission shall establish by Rule a term of office for delegates. 16
(c) The Commission shall have the following powers and duties: 17
(1) Establish a code of ethics for the Commission; 18
(2) Establish the fiscal year of the Commission; 19
(3) Establish fees; 20
(4) Establish bylaws; 21
(5) Maintain its financial records in accordance with the bylaws; 22
(6) Meet and take such actions as are consistent with the provisions of this 23
Compact and the bylaws; 24
(7) Promulgate Rules to facilitate and coordinate implementation and 25
administration of this Compact. The Rules shall have the force and effect of 26
law and shall be binding in all Participating States; 27
(8) Bring and prosecute legal proceedings or actions in the name of the 28
Commission, provided that the standing of any State Licensing Board to sue 29
or be sued under applicable law shall not be affected; 30
(9) Purchase and maintain insurance and bonds; 31
(10) Borrow, accept, or contract for services of personnel, including, but not 32
limited to, employees of a Participating State; 33
(11) Hire employees and engage contractors, elect or appoint officers, fix 34
compensation, define duties, grant such individuals appropriate authority to 35
carry out the purposes of this Compact, and establish the Commission's 36
personnel policies and programs relating to conflicts of interest, qualifications 37
of personnel, and other related personnel matters; 38
(12) Accept any and all appropriate donations and grants of money, equipment, 39
supplies, materials, and services and receive, utilize, and dispose of the same; 40
provided that at all times the Commission shall avoid any appearance of 41
impropriety or conflict of interest; 42
(13) Lease, purchase, accept appropriate gifts or donations of, or otherwise own, 43
hold, improve, or use any property, real, personal, or mixed; provided that at 44
all times the Commission shall avoid any appearance of impropriety; 45
(14) Sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise 46
dispose of any property real, personal, or mixed; 47
(15) Establish a budget and make expenditures; 48
(16) Borrow money; 49
(17) Appoint committees, including standing committees composed of members, 50
State regulators, State legislators or their representatives, and consumer 51 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 7
representatives, and such other interested persons as may be designated in this 1
Compact and the bylaws; 2
(18) Provide and receive information from, and cooperate with, law enforcement 3
agencies; 4
(19) Elect a Chair, Vice-Chair, Secretary, and Treasurer and such other officers of 5
the Commission as provided in the Commission's bylaws; 6
(20) Reserve for itself, in addition to those reserved exclusively to the Commission 7
under the Compact, powers that the Executive Committee may not exercise; 8
(21) Approve or disapprove a State's participation in the Compact based upon its 9
determination as to whether the State's Compact legislation departs in a 10
material manner from the Model Compact language; 11
(22) Prepare and provide to the Participating States an annual report; and 12
(23) Perform such other functions as may be necessary or appropriate to achieve 13
the purposes of this Compact consistent with the State regulation of PA 14
licensure and practice. 15
(d) Meetings of the Commission: 16
(1) All meetings of the Commission that are not closed pursuant to this subsection 17
shall be open to the public. Notice of public meetings shall be posted on the 18
Commission's website at least 30 days prior to the public meeting. 19
(2) Notwithstanding subdivision (1) of this subsection, the Commission may 20
convene a public meeting by providing at least 24 hours' prior notice on the 21
Commission's website, and any other means as provided in the Commission's 22
Rules, for any of the reasons it may dispense with notice of proposed 23
rulemaking under G.S. 90-270.208(l). 24
(3) The Commission may convene in a closed, nonpublic meeting or nonpublic 25
part of a public meeting to receive legal advice or to discuss: 26
a. Noncompliance of a Participating State with its obligations under this 27
Compact; 28
b. The employment, compensation, discipline or other matters, practices 29
or procedures related to specific employees or other matters related to 30
the Commission's internal personnel practices and procedures; 31
c. Current, threatened, or reasonably anticipated litigation; 32
d. Negotiation of contracts for the purchase, lease, or sale of goods, 33
services, or real estate; 34
e. Accusing any person of a crime or formally censuring any person; 35
f. Disclosure of trade secrets or commercial or financial information that 36
is privileged or confidential; 37
g. Disclosure of information of a personal nature where disclosure would 38
constitute a clearly unwarranted invasion of personal privacy; 39
h. Disclosure of investigative records compiled for law enforcement 40
purposes; 41
i. Disclosure of information related to any investigative reports prepared 42
by or on behalf of or for use of the Commission or other committee 43
charged with responsibility of investigation or determination of 44
compliance issues pursuant to this Compact; 45
j. Legal advice; or 46
k. Matters specifically exempted from disclosure by federal or 47
Participating States' statutes. 48
(4) If a meeting, or portion of a meeting, is closed pursuant to this provision, the 49
chair of the meeting or the chair's designee shall certify that the meeting or 50 General Assembly Of North Carolina Session 2025
Page 8 DRS15068-NBf-60
portion of the meeting may be closed and shall reference each relevant 1
exempting provision. 2
(5) The Commission shall keep minutes that fully and clearly describe all matters 3
discussed in a meeting and shall provide a full and accurate summary of 4
actions taken, including a description of the views expressed. All documents 5
considered in connection with an action shall be identified in such minutes. 6
All minutes and documents of a closed meeting shall remain under seal, 7
subject to release by a majority vote of the Commission or order of a court of 8
competent jurisdiction. 9
(e) Financing of the Commission: 10
(1) The Commission shall pay, or provide for the payment of, the reasonable 11
expenses of its establishment, organization, and ongoing activities. 12
(2) The Commission may accept any and all appropriate revenue sources, 13
donations, and grants of money, equipment, supplies, materials, and services. 14
(3) The Commission may levy on and collect an annual assessment from each 15
Participating State and may impose Compact Privilege fees on Licensees of 16
Participating States to whom a Compact Privilege is granted to cover the cost 17
of the operations and activities of the Commission and its staff, which must 18
be in a total amount sufficient to cover its annual budget as approved by the 19
Commission each year for which revenue is not provided by other sources. 20
The aggregate annual assessment amount levied on Participating States shall 21
be allocated based upon a formula to be determined by Commission Rule. 22
a. A Compact Privilege expires when the Licensee's Qualifying License 23
in the Participating State from which the Licensee applied for the 24
Compact Privilege expires. 25
b. If the Licensee terminates the Qualifying License through which the 26
Licensee applied for the Compact Privilege before its scheduled 27
expiration, and the Licensee has a Qualifying License in another 28
Participating State, the Licensee shall inform the Commission that it 29
is changing to that Participating State the Participating State through 30
which it applies for a Compact Privilege and pay to the Commission 31
any Compact Privilege fee required by Commission Rule. 32
(4) The Commission shall not incur obligations of any kind prior to securing the 33
funds adequate to meet the same nor shall the Commission pledge the credit 34
of any of the Participating States, except by and with the authority of the 35
Participating State. 36
(5) The Commission shall keep accurate accounts of all receipts and 37
disbursements. The receipts and disbursements of the Commission shall be 38
subject to the financial review and accounting procedures established under 39
its bylaws. All receipts and disbursements of funds handled by the 40
Commission shall be subject to an annual financial review by a certified or 41
licensed public accountant, and the report of the financial review shall be 42
included in and become part of the annual report of the Commission. 43
(f) The Executive Committee: 44
(1) The Executive Committee shall have the power to act on behalf of the 45
Commission according to the terms of this Compact and Commission Rules. 46
(2) The Executive Committee shall be composed of nine members: 47
a. Seven voting members who are elected by the Commission from the 48
current membership of the Commission; 49
b. One ex officio, nonvoting member from a recognized national PA 50
professional association; and 51 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 9
c. One ex officio, nonvoting member from a recognized national PA 1
certification organization. 2
(3) The ex officio members will be selected by their respective organizations. 3
(4) The Commission may remove any member of the Executive Committee as 4
provided in its bylaws. 5
(5) The Executive Committee shall meet at least annually. 6
(6) The Executive Committee shall have the following duties and responsibilities: 7
a. Recommend to the Commission changes to the Commission's Rules 8
or bylaws, changes to this Compact legislation, fees to be paid by 9
Compact Participating States such as annual dues, and any 10
Commission Compact fee charged to Licensees for the Compact 11
Privilege; 12
b. Ensure Compact administration services are appropriately provided, 13
contractual or otherwise; 14
c. Prepare and recommend the budget; 15
d. Maintain financial records on behalf of the Commission; 16
e. Monitor Compact compliance of Participating States and provide 17
compliance reports to the Commission; 18
f. Establish additional committees as necessary; 19
g. Exercise the powers and duties of the Commission during the interim 20
between Commission meetings, except for issuing proposed 21
rulemaking or adopting Commission Rules or bylaws, or exercising 22
any other powers and duties exclusively reserved to the Commission 23
by the Commission's Rules; and 24
h. Perform other duties as provided in the Commission's Rules or bylaws. 25
(7) All meetings of the Executive Committee at which it votes or plans to vote on 26
matters in exercising the powers and duties of the Commission shall be open 27
to the public and public notice of such meetings shall be given as public 28
meetings of the Commission are given. 29
(8) The Executive Committee may convene in a closed, nonpublic meeting for 30
the same reasons that the Commission may convene in a nonpublic meeting 31
as set forth in G.S. 90-270.206(d)(3) and shall announce the closed meeting 32
as the Commission is required to under G.S. 90-270.206(d)(3) and keep 33
minutes of the closed meeting as the Commission is required to under 34
G.S. 90-270.206(d)(3). 35
(g) Qualified Immunity, Defense, and Indemnification: 36
(1) The members, officers, executive director, employees, and representatives of 37
the Commission shall be immune from suit and liability, both personally and 38
in their official capacity, for any claim for damage to or loss of property or 39
personal injury or other civil liability caused by or arising out of any actual or 40
alleged act, error, or omission that occurred, or that the person against whom 41
the claim is made had a reasonable basis for believing occurred within the 42
scope of Commission employment, duties, or responsibilities; provided that 43
nothing in this paragraph shall be construed to protect any such person from 44
suit or liability for any damage, loss, injury, or liability caused by the 45
intentional or willful or wanton misconduct of that person. The procurement 46
of insurance of any type by the Commission shall not in any way compromise 47
or limit the immunity granted hereunder. 48
(2) The Commission shall defend any member, officer, executive director, 49
employee, and representative of the Commission in any civil action seeking 50
to impose liability arising out of any actual or alleged act, error, or omission 51 General Assembly Of North Carolina Session 2025
Page 10 DRS15068-NBf-60
that occurred within the scope of Commission employment, duties, or 1
responsibilities, or as determined by the Commission that the person against 2
whom the claim is made had a reasonable basis for believing occurred within 3
the scope of Commission employment, duties, or responsibilities; provided 4
that nothing herein shall be construed to prohibit that person from retaining 5
their own counsel at their own expense; and provided further, that the actual 6
or alleged act, error, or omission did not result from that person's intentional 7
or willful or wanton misconduct. 8
(3) The Commission shall indemnify and hold harmless any member, officer, 9
executive director, employee, and representative of the Commission for the 10
amount of any settlement or judgment obtained against that person arising out 11
of any actual or alleged act, error, or omission that occurred within the scope 12
of Commission employment, duties, or responsibilities, or that such person 13
had a reasonable basis for believing occurred within the scope of Commission 14
employment, duties, or responsibilities, provided that the actual or alleged act, 15
error, or omission did not result from the intentional or willful or wanton 16
misconduct of that person. 17
(4) Venue is proper and judicial proceedings by or against the Commission shall 18
be brought solely and exclusively in a court of competent jurisdiction where 19
the principal office of the Commission is located. The Commission may waive 20
venue and jurisdictional defenses in any proceedings as authorized by 21
Commission Rules. 22
(5) Nothing herein shall be construed as a limitation on the liability of any 23
Licensee for professional malpractice or misconduct, which shall be governed 24
solely by any other applicable State laws. 25
(6) Nothing herein shall be construed to designate the venue or jurisdiction to 26
bring actions for alleged acts of malpractice, professional misconduct, 27
negligence, or other such civil action pertaining to the practice of a PA. All 28
such matters shall be determined exclusively by State law other than this 29
Compact. 30
(7) Nothing in this Compact shall be interpreted to waive or otherwise abrogate a 31
Participating State's state action immunity or state action affirmative defense 32
with respect to antitrust claims under the Sherman Act, Clayton Act, or any 33
other State or federal antitrust or anticompetitive law or regulation. 34
(8) Nothing in this Compact shall be construed to be a waiver of sovereign 35
immunity by the Participating States or by the Commission. 36
"§ 90-270.207. Data System. 37
(a) The Commission shall provide for the development, maintenance, operation, and 38
utilization of a coordinated data and reporting system containing licensure, Adverse Action, and 39
the reporting of the existence of Significant Investigative Information on all licensed PAs and 40
applicants denied a License in Participating States. 41
(b) Notwithstanding any other State law to the contrary, a Participating State shall submit 42
a uniform data set to the Data System on all PAs to whom this Compact is applicable (utilizing 43
a unique identifier) as required by the Rules of the Commission, including: 44
(1) Identifying information; 45
(2) Licensure data; 46
(3) Adverse Actions against a License or Compact Privilege; 47
(4) Any denial of application for licensure, and the reason(s) for such denial 48
(excluding the reporting of any criminal history record information where 49
prohibited by law); 50
(5) The existence of Significant Investigative Information; and 51 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 11
(6) Other information that may facilitate the administration of this Compact, as 1
determined by the Rules of the Commission. 2
(c) Significant Investigative Information pertaining to a Licensee in any Participating 3
State shall only be available to other Participating States. 4
(d) The Commission shall promptly notify all Participating States of any Adverse Action 5
taken against a Licensee or an individual applying for a License that has been reported to it. This 6
Adverse Action information shall be available to any other Participating State. 7
(e) Participating States contributing information to the Data System may, in accordance 8
with State or federal law, designate information that may not be shared with the public without 9
the express permission of the contributing State. Notwithstanding any such designation, such 10
information shall be reported to the Commission through the Data System. 11
(f) Any information submitted to the Data System that is subsequently expunged 12
pursuant to federal law or the laws of the Participating State contributing the information shall 13
be removed from the Data System upon reporting of such by the Participating State to the 14
Commission. 15
(g) The records and information provided to a Participating State pursuant to this 16
Compact or through the Data System, when certified by the Commission or an agent thereof, 17
shall constitute the authenticated business records of the Commission and shall be entitled to any 18
associated hearsay exception in any relevant judicial, quasi-judicial, or administrative 19
proceedings in a Participating State. 20
"§ 90-270.208. Rulemaking. 21
(a) The Commission shall exercise its Rulemaking powers pursuant to the criteria set 22
forth in this section and the Rules adopted thereunder. Commission Rules shall become binding 23
as of the date specified by the Commission for each Rule. 24
(b) The Commission shall promulgate reasonable Rules in order to effectively and 25
efficiently implement and administer this Compact and achieve its purposes. A Commission Rule 26
shall be invalid and have not force or effect only if a court of competent jurisdiction holds that 27
the Rule is invalid because the Commission exercised its rulemaking authority in a manner that 28
is beyond the scope of the purposes of this Compact, or the powers granted hereunder, or based 29
upon another applicable standard of review. 30
(c) The Rules of the Commission shall have the force of law in each Participating State, 31
provided, however, that where the Rules of the Commission conflict with the laws of the 32
Participating State that establish the Medical Services a PA may perform in the Participating 33
State, as held by a court of competent jurisdiction, the Rules of the Commission shall be 34
ineffective in that State to the extent of the conflict. 35
(d) If a majority of the legislatures of the Participating States rejects a Commission Rule, 36
by enactment of a statute or resolution in the same manner used to adopt this Compact within 37
four years of the date of adoption of the Rule, then such Rule shall have no further force and 38
effect in any Participating State or to any State applying to participate in the Compact. 39
(e) Commission Rules shall be adopted at a regular or special meeting of the 40
Commission. 41
(f) Prior to promulgation and adoption of a final Rule or Rules by the Commission, and 42
at least 30 days in advance of the meeting at which the Rule will be considered and voted upon, 43
the Commission shall file a Notice of Proposed Rulemaking: 44
(1) On the website of the Commission or other publicly accessible platform; 45
(2) To persons who have requested notice of the Commission's notices of 46
proposed rulemaking; and 47
(3) In such other way(s) as the Commission may by Rule specify. 48
(g) The Notice of Proposed Rulemaking shall include: 49 General Assembly Of North Carolina Session 2025
Page 12 DRS15068-NBf-60
(1) The time, date, and location of the public hearing on the proposed Rule and 1
the proposed time, date, and location of the meeting in which the proposed 2
Rule will be considered and voted upon; 3
(2) The text of the proposed Rule and the reason for the proposed Rule; 4
(3) A request for comments on the proposed Rule from any interested person and 5
the date by which written comments must be received; and 6
(4) The manner in which interested persons may submit notice to the Commission 7
of their intention to attend the public hearing or provide any written 8
comments. 9
(h) Prior to adoption of a proposed Rule, the Commission shall allow persons to submit 10
written data, facts, opinions, and arguments, which shall be made available to the public. 11
(i) If the hearing is to be held via electronic means, the Commission shall publish the 12
mechanism for access to the electronic hearing. 13
(1) All persons wishing to be heard at the hearing shall as directed in the Notice 14
of Proposed Rulemaking, not less than five business days before the scheduled 15
date of the hearing, notify the Commission of their desire to appear and testify 16
at the hearing. 17
(2) Hearings shall be conducted in a manner providing each person who wishes 18
to comment a fair and reasonable opportunity to comment orally or in writing. 19
(3) All hearings shall be recorded. A copy of the recording and the written 20
comments, data, facts, opinions, and arguments received in response to the 21
proposed rulemaking shall be made available to a person upon request. 22
(4) Nothing in this section shall be construed as requiring a separate hearing on 23
each proposed Rule. Proposed Rules may be grouped for the convenience of 24
the Commission at hearings required by this section. 25
(j) Following the public hearing, the Commission shall consider all written and oral 26
comments timely received. 27
(k) The Commission shall, by majority vote of all delegates, take final action on the 28
proposed Rule and shall determine the effective date of the Rule, if adopted, based on the 29
Rulemaking record and the full text of the Rule. 30
(1) If adopted, the Rule shall be posted on the Commission's website. 31
(2) The Commission may adopt changes to the proposed Rule provided the 32
changes do not enlarge the original purpose of the proposed Rule. 33
(3) The Commission shall provide on its website an explanation of the reasons for 34
substantive changes made to the proposed Rule as well as reasons for 35
substantive changes not made that were recommended by commenters. 36
(4) The Commission shall determine a reasonable effective date for the Rule. 37
Except for an emergency as provided in subsection (l) of this section, the 38
effective date of the Rule shall be no sooner than 30 days after the Commission 39
issued the notice that it adopted the Rule. 40
(l) Upon determination that an emergency exists, the Commission may consider and 41
adopt an emergency Rule with 24 hours' prior notice, without the opportunity for comment, or 42
hearing, provided that the usual Rulemaking procedures provided in this Compact and in this 43
section shall be retroactively applied to the Rule as soon as reasonably possible, in no event later 44
than 90 days after the effective date of the Rule. For the purposes of this provision, an emergency 45
Rule is one that must be adopted immediately by the Commission in order to: 46
(1) Meet an imminent threat to public health, safety, or welfare; 47
(2) Prevent a loss of Commission or Participating State funds; 48
(3) Meet a deadline for the promulgation of a Commission Rule that is established 49
by federal law or Rule; or 50
(4) Protect public health and safety. 51 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 13
(m) The Commission or an authorized committee of the Commission may direct revisions 1
to a previously adopted Commission Rule for purposes of correcting typographical errors, errors 2
in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be 3
posted on the website of the Commission. The revision shall be subject to challenge by any 4
person for a period of 30 days after posting. The revision may be challenged only on grounds 5
that the revision results in a material change to a Rule. A challenge shall be made as set forth in 6
the notice of revisions and delivered to the Commission prior to the end of the notice period. If 7
no challenge is made, the revision will take effect without further action. If the revision is 8
challenged, the revision may not take effect without the approval of the Commission. 9
(n) No Participating State's rulemaking requirements shall apply under this Compact. 10
"§ 90-270.209. Oversight, dispute resolution, and enforcement. 11
(a) Oversight: 12
(1) The executive and judicial branches of State government in each Participating 13
State shall enforce this Compact and take all actions necessary and appropriate 14
to implement the Compact. 15
(2) Venue is proper and judicial proceedings by or against the Commission shall 16
be brought solely and exclusively in a court of competent jurisdiction where 17
the principal office of the Commission is located. The Commission may waive 18
venue and jurisdictional defenses to the extent it adopts or consents to 19
participate in alternative dispute resolution proceedings. Nothing herein shall 20
affect or limit the selection or propriety of venue in any action against a 21
Licensee for professional malpractice, misconduct, or any such similar matter. 22
(3) The Commission shall be entitled to receive service of process in any 23
proceeding regarding the enforcement or interpretation of the Compact or the 24
Commission's Rules and shall have standing to intervene in such a proceeding 25
for all purposes. Failure to provide the Commission with service of process 26
shall render a judgment or order in such proceeding void as to the 27
Commission, this Compact, or Commission Rules. 28
(b) Default, Technical Assistance, and Termination: 29
(1) If the Commission determines that a Participating State has defaulted in the 30
performance of its obligations or responsibilities under this Compact or the 31
Commission Rules, the Commission shall provide written notice to the 32
defaulting State and other Participating States. The notice shall describe the 33
default, the proposed means of curing the default, and any other action that 34
the Commission may take and shall offer remedial training and specific 35
technical assistance regarding the default. 36
(2) If a State in default fails to cure the default, the defaulting State may be 37
terminated from this Compact upon an affirmative vote of a majority of the 38
delegates of the Participating States, and all rights, privileges, and benefits 39
conferred by this Compact upon such State may be terminated on the effective 40
date of termination. A cure of the default does not relieve the offending State 41
of obligations or liabilities incurred during the period of default. 42
(3) Termination of participation in this Compact shall be imposed only after all 43
other means of securing compliance have been exhausted. Notice of intent to 44
suspend or terminate shall be given by the Commission to the governor, the 45
majority and minority leaders of the defaulting State's legislature, and to the 46
Licensing Board(s) of each of the Participating States. 47
(4) A State that has been terminated is responsible for all assessments, 48
obligations, and liabilities incurred through the effective date of termination, 49
including obligations that extend beyond the effective date of termination. 50 General Assembly Of North Carolina Session 2025
Page 14 DRS15068-NBf-60
(5) The Commission shall not bear any costs related to a State that is found to be 1
in default or that has been terminated from this Compact, unless agreed upon 2
in writing between the Commission and the defaulting State. 3
(6) The defaulting State may appeal its termination from the Compact by the 4
Commission by petitioning the United States District Court for the District of 5
Columbia or the federal district where the Commission has its principal 6
offices. The prevailing member shall be awarded all costs of such litigation, 7
including reasonable attorneys' fees. 8
(7) Upon the termination of a State's participation in the Compact, the State shall 9
immediately provide notice to all Licensees within that State of such 10
termination: 11
a. Licensees who have been granted a Compact Privilege in that State 12
shall retain the Compact Privilege for 180 days following the effective 13
date of such termination. 14
b. Licensees who are licensed in that State who have been granted a 15
Compact Privilege in a Participating State shall retain the Compact 16
Privilege for 180 days unless the Licensee also has a Qualifying 17
License in a Participating State or obtains a Qualifying License in a 18
Participating State before the 180-day period ends, in which case the 19
Compact Privilege shall continue. 20
(c) Dispute Resolution: 21
(1) Upon request by a Participating State, the Commission shall attempt to resolve 22
disputes related to this Compact that arise among Participating States and 23
between Participating and non-Participating States. 24
(2) The Commission shall promulgate a Rule providing for both mediation and 25
binding dispute resolution for disputes as appropriate. 26
(d) Enforcement: 27
(1) The Commission, in the reasonable exercise of its discretion, shall enforce the 28
provisions of this Compact and Rules of the Commission. 29
(2) If compliance is not secured after all means to secure compliance have been 30
exhausted, by majority vote, the Commission may initiate legal action in the 31
United States District Court for the District of Columbia or the federal district 32
where the Commission has its principal offices, against a Participating State 33
in default to enforce compliance with the provisions of this Compact and the 34
Commission's promulgated Rules and bylaws. The relief sought may include 35
both injunctive relief and damages. In the event judicial enforcement is 36
necessary, the prevailing party shall be awarded all costs of such litigation, 37
including reasonable attorneys' fees. 38
(3) The remedies herein shall not be the exclusive remedies of the Commission. 39
The Commission may pursue any other remedies available under federal or 40
State law. 41
(e) Legal Action Against the Commission: 42
(1) A Participating State may initiate legal action against the Commission in the 43
United States District Court for the District of Columbia or the federal district 44
where the Commission has its principal offices to enforce compliance with the 45
provisions of the Compact and its Rules. The relief sought may include both 46
injunctive relief and damages. In the event judicial enforcement is necessary, 47
the prevailing party shall be awarded all costs of such litigation, including 48
reasonable attorneys' fees. 49
(2) No person other than a Participating State shall enforce this Compact against 50
the Commission. 51 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 15
"§ 90-270.210. Date of implementation of the PA Licensure Compact Commission. 1
(a) This Compact shall come into effect on the date on which this Compact statute is 2
enacted into law in the seventh Participating State. 3
(1) On or after the effective date of the Compact, the Commission shall convene 4
and review the enactment of each of the States that enacted the Compact prior 5
to the Commission convening ("Charter Participating States") to determine if 6
the statute enacted by each such Charter Participating State is materially 7
different than the Model Compact. 8
a. A Charter Participating State whose enactment is found to be 9
materially different from the Model Compact shall be entitled to the 10
default process set forth in G.S. 90-270.209(b). 11
b. If any Participating State later withdraws from the Compact or its 12
participation is terminated, the Commission shall remain in existence 13
and the Compact shall remain in effect even if the number of 14
Participating States should be less than seven. Participating States 15
enacting the Compact subsequent to the Commission convening shall 16
be subject to the process set forth in G.S. 90-270.206(c)(21) to 17
determine if their enactments are materially different from the Model 18
Compact and whether they qualify for participation in the Compact. 19
(2) Participating States enacting the Compact subsequent to the seven initial 20
Charter Participating States shall be subject to the process set forth in 21
G.S. 90-270.206(c)(21) to determine if their enactments are materially 22
different from the Model Compact and whether they qualify for participation 23
in the Compact. 24
(3) All actions taken for the benefit of the Commission or in furtherance of the 25
purposes of the administration of the Compact prior to the effective date of 26
the Compact or the Commission coming into existence shall be considered to 27
be actions of the Commission unless specifically repudiated by the 28
Commission. 29
(b) Any State that joins this Compact shall be subject to the Commission's Rules and 30
bylaws as they exist on the date on which this Compact becomes law in that State. Any Rule that 31
has been previously adopted by the Commission shall have the full force and effect of law on the 32
day this Compact becomes law in that State. 33
(c) Any Participating State may withdraw from this Compact by enacting a statute 34
repealing the same. 35
(1) A Participating State's withdrawal shall not take effect until 180 days after 36
enactment of the repealing statute. During this 180-day period, all Compact 37
Privileges that were in effect in the withdrawing State and were granted to 38
Licensees licensed in the withdrawing State shall remain in effect. If any 39
Licensee licensed in the withdrawing State is also licensed in another 40
Participating State or obtains a license in another Participating State within 41
the 180 days, the Licensee's Compact Privileges in other Participating States 42
shall not be affected by the passage of the 180 days. 43
(2) Withdrawal shall not affect the continuing requirement of the State Licensing 44
Board(s) of the withdrawing State to comply with the investigative and 45
Adverse Action reporting requirements of this Compact prior to the effective 46
date of withdrawal. 47
(3) Upon the enactment of a statute withdrawing a State from this Compact, the 48
State shall immediately provide notice of such withdrawal to all Licensees 49
within that State. Such withdrawing State shall continue to recognize all 50 General Assembly Of North Carolina Session 2025
Page 16 DRS15068-NBf-60
Licenses granted pursuant to this Compact for a minimum of 180 days after 1
the date of such notice of withdrawal. 2
(d) Nothing contained in this Compact shall be construed to invalidate or prevent any PA 3
licensure agreement or other cooperative arrangement between Participating States and between 4
a Participating State and non-Participating State that does not conflict with the provisions of this 5
Compact. 6
(e) This Compact may be amended by the Participating States. No amendment to this 7
Compact shall become effective and binding upon any Participating State until it is enacted 8
materially in the same manner into the laws of all Participating States as determined by the 9
Commission. 10
"§ 90-270.211. Construction and severability. 11
(a) This Compact and the Commission's rulemaking authority shall be liberally construed 12
so as to effectuate the purposes and the implementation and administration of the Compact. 13
Provisions of the Compact expressly authorizing or requiring the promulgation of Rules shall not 14
be construed to limit the Commission's rulemaking authority solely for those purposes. 15
(b) The provisions of this Compact shall be severable and if any phrase, clause, sentence, 16
or provision of this Compact is held by a court of competent jurisdiction to be contrary to the 17
constitution of any Participating State, a State seeking participation in the Compact, or of the 18
United States, or the applicability thereof to any government, agency, person, or circumstance is 19
held to be unconstitutional by a court of competent jurisdiction, the validity of the remainder of 20
this Compact and the applicability thereof to any other government, agency, person, or 21
circumstance shall not be affected thereby. 22
(c) Notwithstanding subsection (b) of this section, the Commission may deny a State's 23
participation in the Compact or, in accordance with the requirements of G.S. 90-270.209(b), 24
terminate a Participating State's participation in the Compact, if it determines that a constitutional 25
requirement of a Participating State is, or would be with respect to a State seeking to participate 26
in the Compact, a material departure from the Compact. Otherwise, if this Compact shall be held 27
to be contrary to the constitution of any Participating State, the Compact shall remain in full force 28
and effect as to the remaining Participating States and in full force and effect as to the 29
Participating State affected as to all severable matters. 30
"§ 90-270.212. Binding effect of Compact. 31
(a) Nothing herein prevents the enforcement of any other law of a Participating State that 32
is not inconsistent with this Compact. 33
(b) Any laws in a Participating State in conflict with this Compact are superseded to the 34
extent of the conflict. 35
(c) All agreements between the Commission and the Participating States are binding in 36
accordance with their terms." 37
SECTION 1.(b) G.S. 90-9.3 reads as rewritten: 38
"§ 90-9.3. Requirements for licensure as a physician assistant. 39
(a) To be eligible for licensure as a physician assistant, an applicant shall submit proof 40
satisfactory to the Board that the applicant has met all of the following: 41
(1) The applicant has successfully completed an educational program for 42
physician assistants or surgeon assistants accredited by the Accreditation 43
Review Commission on Education for the Physician Assistant or its 44
predecessor or successor entities. 45
(2) The applicant has a current or previous certification issued by the National 46
Commission on Certification of Physician Assistants or its successor. 47
(3) The applicant is of good moral character. 48
(a1) A physician assistant applying for licensure under Article 18J of this Chapter shall be 49
in compliance with that Article. 50 General Assembly Of North Carolina Session 2025
DRS15068-NBf-60 Page 17
(b) Before initiating practice of medical acts, tasks, or functions as a physician assistant, 1
the physician assistant shall provide the Board the name, address, and telephone number of the 2
physician who will supervise the physician assistant in the relevant medical setting. 3
(c) The Board may, by rule, require an applicant to comply with other requirements or 4
submit additional information the Board deems appropriate." 5
SECTION 1.(c) G.S. 90-13.2(a) reads as rewritten: 6
"(a) Every licensee shall register annually with the Board no later than 30 days after the 7
person's birthday. Every privilege holder shall register annually with the Board as required by 8
Article 18J of Chapter 90 of the General Statutes and any rules adopted by the PA Licensure 9
Compact Commission." 10
SECTION 2. This act becomes effective October 1, 2025. 11