GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S D
SENATE BILL DRS35152-NB-126A
Short Title: PA Team-Based Practice. (Public)
Sponsors: Senators Sawrey, Galey, and Hollo (Primary Sponsors).
Referred to:
*DRS35152 -NB-126A*
A BILL TO BE ENTITLED 1
AN ACT TO ADJUST THE SUPERVISION ARRANGEMENT OF PHYSICIAN 2
ASSISTANTS AND TO MAKE VARIOUS CHANGES TO THE LICENSURE OF 3
PHYSICIAN ASSISTANTS. 4
The General Assembly of North Carolina enacts: 5
SECTION 1.(a) G.S. 90-1.1 is amended by adding a new subdivision to read: 6
"(4d) Team-based setting or team-based practice. – Any of the following: 7
a. A medical practice that meets all of the following requirements: 8
1. The majority of the practice is owned collectively by one or 9
more licensed physicians. 10
2. An owner who is a physician licensed under this Chapter has 11
consistent and meaningful participation in the design and 12
implementation of health services to patients, as defined by 13
rules adopted by the Board. 14
3. The physicians and team-based physician assistants who 15
provide services at the medical practice work in the same 16
clinical practice area. 17
b. Hospitals, clinics, nursing homes, and other health facilities with 18
active credentialing and quality programs where physicians have 19
consistent and meaningful participation in the design and 20
implementation of health services to patients, as defined by rules 21
adopted by the Board. 22
c. For the purposes of this Article, the term "team-based setting" or 23
"team-based practice" shall not include a medical practice that 24
specializes in pain management." 25
SECTION 1.(b) G.S. 90-9.3 reads as rewritten: 26
"§ 90-9.3. Requirements for licensure as a physician assistant. 27
(a) To be eligible for licensure as a physician assistant, an applicant shall submit proof 28
satisfactory to the Board that the applicant has met all of the following: 29
(1) The applicant has successfully completed an educational program for 30
physician assistants or surgeon assistants accredited by the Accreditation 31
Review Commission on Education for the Physician Assistant or its 32
predecessor or successor entities. 33
(2) The applicant has a current or previous certification issued by the National 34
Commission on Certification of Physician Assistants or its successor. 35
(3) The applicant is of good moral character. 36
FILED SENATE
Mar 19, 2025
S.B. 345
PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
Page 2 DRS35152-NB-126A
(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. This 3
subsection shall not apply to physician assistants who meet the requirements for team-based 4
practice under G.S. 90-9.3A. 5
(c) The Board may, by rule, require an applicant to comply with other requirements or 6
submit additional information the Board deems appropriate." 7
SECTION 1.(c) Article 1 of Chapter 90 of the General Statutes is amended by adding 8
a new section to read: 9
"§ 90-9.3A. Requirements for team-based practice as a physician assistant. 10
(a) In order to practice as a team-based physician assistant, a physician assistant shall 11
meet all of the following conditions: 12
(1) Practice in team-based settings, as defined in G.S. 90-1.1(4d). 13
(2) Have more than 4,000 hours of clinical practice experience as a licensed 14
physician assistant and more than 1,000 hours of clinical practice experience 15
within the specific medical specialty of practice with a physician in that 16
specialty. 17
(3) Submit proof as the Board may deem satisfactory by rule that the individual 18
meets the requirements of subdivisions (1) and (2) of this subsection. The 19
Board may, by rule, require the physician assistant to comply with other 20
requirements or submit additional information the Board deems appropriate. 21
(b) Team-based physician assistants shall collaborate and consult with or refer to the 22
appropriate members of the health care team as required by the patient's condition and as 23
indicated by the education, experience, and competencies of the physician assistant and the 24
standard of care. The degree of collaboration must be determined by the practice which may 25
include decisions by the employer, group, hospital service, and the credentialing and privileging 26
systems of a licensed facility. The Board may adopt rules to establish requirements for the 27
determination and enforcement of collaboration, consultation, and referral. Team-based 28
physician assistants are responsible for the care they provide. 29
(c) Notwithstanding any other provision of this Chapter, a team-based physician assistant 30
practicing in a perioperative setting, including the provision of surgical or anesthesia-related 31
services, shall be supervised by a physician." 32
SECTION 1.(d) G.S. 90-12.4 reads as rewritten: 33
"§ 90-12.4. Physician assistant limited volunteer license. 34
… 35
(d) Before initiating the performance of medical acts, tasks, or functions as a physician 36
assistant licensed under this section, the physician assistant shall provide submit to the Board 37
either an "Intent to Practice Notification Form," which shall include the name, address, and 38
telephone number of the physician licensed under this Article who will supervise the physician 39
assistant in the clinic specializing in the care of indigent patients.patients, or meet the 40
requirements for team-based practice under G.S. 90-9.3A. 41
…." 42
SECTION 1.(e) G.S. 90-12.4B reads as rewritten: 43
"§ 90-12.4B. Physician Assistant assistant retired limited volunteer license. 44
…." 45
SECTION 1.(f) G.S. 90-18.1 reads as rewritten: 46
"§ 90-18.1. Limitations on physician assistants. 47
(a) Any person who is licensed under the provisions of G.S. 90-9.3 to perform medical 48
acts, tasks, and functions as a physician assistant may use the title "physician assistant" or "PA." 49
Any other person who uses the title in any form or holds out to be a physician assistant or to be 50
so licensed, shall be deemed to be in violation of this Article. 51 General Assembly Of North Carolina Session 2025
DRS35152-NB-126A Page 3
(a1) Physician assistants shall clearly designate their credentials as a physician assistant in 1
all clinical settings. 2
(b) Physician assistants are authorized to write prescriptions for drugs under the 3
following conditions: 4
(1) The North Carolina Medical Board has adopted regulations governing the 5
approval of individual physician assistants to write prescriptions with such 6
limitations as the Board may determine to be in the best interest of patient 7
health and safety. 8
(2) The physician assistant holds a current license issued by the Board. 9
(3) Repealed by Session Laws 2019-191, s. 35, effective October 1, 2019. 10
(4) The supervising physician has provided to the physician assistant written 11
instructions about indications and contraindications for prescribing drugs and 12
a written policy for periodic review by the physician of the drugs prescribed. 13
This subdivision shall not apply to individuals who are practicing in a 14
team-based setting under G.S. 90-9.3A. 15
(5) A physician assistant shall personally consult with the supervising physician 16
prior to prescribing a targeted controlled substance as defined in Article 5 of 17
this Chapter when all of the following conditions apply: 18
a. The patient is being treated by a facility that primarily engages in the 19
treatment of pain by prescribing narcotic medications. 20
b. The therapeutic use of the targeted controlled substance will or is 21
expected to exceed a period of 30 days. 22
When a targeted controlled substance prescribed in accordance with this subdivision is 23
continuously prescribed to the same patient, the physician assistant shall consult with the 24
supervising physician at least once every 90 days to verify that the prescription remains medically 25
appropriate for the patient. 26
(c) Physician assistants are authorized to compound and dispense drugs under the 27
following conditions: 28
(1) The function is performed under the supervision of a licensed 29
pharmacist.physician. 30
(2) Rules and regulations of the North Carolina Board of Pharmacy and all 31
applicable State and federal laws governing this function compounding and 32
dispensing are complied with. 33
(3) The physician assistant holds a current license issued by the Board. 34
(4) The physician assistant registers with the Board of Pharmacy. 35
(d) Physician assistants are authorized to order medications, tests and treatments in 36
hospitals, clinics, nursing homes, and other health facilities under the following conditions: 37
(1) The North Carolina Medical Board has adopted regulations governing the 38
approval of individual physician assistants to order medications, tests, and 39
treatments with such limitations as the Board may determine to be in the best 40
interest of patient health and safety. 41
(2) The physician assistant holds a current license issued by the Board. 42
(3) The If the physician assistant is subject to a supervisory arrangement, the 43
supervising physician has provided to the physician assistant written 44
instructions about ordering medications, tests, and treatments, and when 45
appropriate, specific oral or written instructions for an individual patient, with 46
provision for review by the physician of the order within a reasonable time, as 47
determined by the Board, after the medication, test, or treatment is ordered. 48
(4) The hospital or other health facility has adopted a written policy about 49
ordering medications, tests, and treatments, including procedures for 50
verification of the physician assistants' orders by nurses and other facility 51 General Assembly Of North Carolina Session 2025
Page 4 DRS35152-NB-126A
employees and such other procedures as are in the interest of patient health 1
and safety. 2
(e) Any prescription written by a physician assistant or order given by a physician 3
assistant for medications, tests, or treatments shall be deemed to have been authorized by the 4
physician approved by the Board as the supervisor of the physician assistant and the supervising 5
physician shall be responsible for authorizing the prescription or order. This subsection shall not 6
apply to individuals who are practicing in a team-based setting under G.S. 90-9.3A who may 7
prescribe, order, administer, and procure drugs and medical devices without physician 8
authorization. Individuals who are practicing in a team-based setting under G.S. 90-9.3A may 9
also plan and initiate a therapeutic regimen that includes ordering and prescribing 10
non-pharmacological interventions, including durable medical equipment, nutrition, blood, blood 11
products, and diagnostic support services, including home health care, hospice, and physical and 12
occupational therapy. 13
(e1) Any medical certification completed by a physician assistant for a Physician assistants 14
may authenticate any document, including death certificate shall be deemed to have been 15
authorized by the physician approved by the Board as the supervisor of the physician assistant, 16
and the supervising physician shall be responsible for authorizing the completion certificates with 17
their signature, certification, stamp, verification, affidavit, or endorsement, if it may be so 18
authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of the 19
medical certification.a physician. 20
(e2) Physician assistants shall not perform final interpretations of diagnostic imaging 21
studies. For purposes of this subsection, "diagnostic imaging" shall include computed 22
tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission 23
tomography (PET), mammography, and ultrasound services. Final interpretation shall be 24
provided by a physician licensed under this Chapter. Notwithstanding any other provision of this 25
Chapter, physician assistants conducting final interpretation of plain film radiographs shall be 26
supervised by a physician. 27
… 28
(g) Any person who is licensed under G.S. 90-9.3 to perform medical acts, tasks, and 29
functions as a physician assistant shall comply with each of the following: 30
(1) Maintain a current and active license to practice in this State. 31
(2) Maintain an active registration with the Board. 32
(3) Have File a current Intent to Practice form filed with the Board.Board or meet 33
the requirements for team-based practice under G.S. 90-9.3A. 34
…." 35
SECTION 1.(g) G.S. 90-21.81(9) reads as rewritten: 36
"(9) Qualified technician. – A registered diagnostic medical sonographer who is 37
certified in obstetrics and gynecology by the American Registry for 38
Diagnostic Medical Sonography (ARDMS) (ARDMS), a physician assistant 39
with certification in obstetrical ultrasonography, or a nurse midwife or 40
advanced practice nurse practitioner in obstetrics with certification in 41
obstetrical ultrasonography." 42
SECTION 1.(h) G.S. 58-3-169 reads as rewritten: 43
"§ 58-3-169. Required coverage for minimum hospital stay following birth. 44
(a) Definitions. – As used in this section: 45
(1) "Attending providers" includes: 46
a. The obstetrician-gynecologists, pediatricians, family physicians, and 47
other physicians primarily responsible for the care of a mother and 48
newborn; and 49
b. The nurse midwives midwives, physician assistants, and nurse 50
practitioners primarily responsible for the care of a mother and her 51 General Assembly Of North Carolina Session 2025
DRS35152-NB-126A Page 5
newborn child in accordance with State licensure and certification 1
laws. 2
…." 3
SECTION 1.(i) G.S. 110-91 reads as rewritten: 4
"§ 110-91. Mandatory standards for a license. 5
All child care facilities shall comply with all State laws and federal laws and local ordinances 6
that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the 7
standards in this section shall be complied with by all child care facilities. However, none of the 8
standards in this section apply to the school-age children of the operator of a child care facility 9
but do apply to the preschool-age children of the operator. Children 13 years of age or older may 10
receive child care on a voluntary basis provided all applicable required standards are met. The 11
standards in this section, along with any other applicable State laws and federal laws or local 12
ordinances, shall be the required standards for the issuance of a license by the Secretary under 13
the policies and procedures of the Commission except that the Commission may, in its discretion, 14
adopt less stringent standards for the licensing of facilities which provide care on a temporary, 15
part-time, drop-in, seasonal, after-school or other than a full-time basis. 16
(1) Medical Care and Sanitation. – The Commission for Public Health shall adopt 17
rules which establish minimum sanitation standards for child care centers and 18
their personnel. The sanitation rules adopted by the Commission for Public 19
Health shall cover such matters as the cleanliness of floors, walls, ceilings, 20
storage spaces, utensils, and other facilities; adequacy of ventilation; 21
sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, 22
food protection facilities, bactericidal treatment of eating and drinking 23
utensils, and solid-waste storage and disposal; methods of food preparation 24
and serving; infectious disease control; sleeping facilities; and other items and 25
facilities as are necessary in the interest of the public health. The Commission 26
for Public Health shall allow child care centers to use domestic kitchen 27
equipment, provided appropriate temperature levels for heating, cooling, and 28
storing are maintained. Child care centers that fry foods shall use commercial 29
hoods. These rules shall be developed in consultation with the Department. 30
The Commission shall adopt rules for child care facilities to establish 31
minimum requirements for child and staff health assessments and medical 32
care procedures. These rules shall be developed in consultation with the 33
Department. Each child shall have a health assessment before being admitted 34
or within 30 days following admission to a child care facility. The assessment 35
shall be done by: (i) a licensed physician, (ii) the physician's authorized agent 36
who is currently approved by the North Carolina Medical Board, or 37
comparable certifying board in any state contiguous to North Carolina, (iii) a 38
certified nurse practitioner, (iv) a licensed physician assistant, or (iv) (v) a 39
public health nurse meeting the Departments Standards for Early Periodic 40
Screening, Diagnosis, and Treatment Program. However, no health 41
assessment shall be required of any staff or child who is and has been in 42
normal health when the staff, or the child's parent, guardian, or full-time 43
custodian objects in writing to a health assessment on religious grounds which 44
conform to the teachings and practice of any recognized church or religious 45
denomination. 46
Organizations that provide prepared meals to child care centers only are 47
considered child care centers for purposes of compliance with appropriate 48
sanitation standards. 49
…." 50 General Assembly Of North Carolina Session 2025
Page 6 DRS35152-NB-126A
SECTION 2. The North Carolina Medical Board shall adopt permanent rules 1
necessary to implement the provisions of this act. 2
SECTION 3. Section 1 of this act becomes effective when the North Carolina 3
Medical Board adopts the permanent rules required under Section 2 of this act or June 30, 2026, 4
whichever occurs first. The North Carolina Medical Board shall notify the Revisor of Statutes 5
when the rules required under Section 2 of this act have been adopted. The remainder of this act 6
is effective when it becomes law. 7