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North Carolina Senate Bill S345

North Carolina 2025-2026 Regular Session

North Carolina Senate Bill S345 Compare Versions

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11 GENERAL ASSEMBLY OF NORTH CAROLINA
22 SESSION 2025
3-S 1
4-SENATE BILL 345
3+S D
4+SENATE BILL DRS35152-NB-126A
5+
56
67
78 Short Title: PA Team-Based Practice. (Public)
89 Sponsors: Senators Sawrey, Galey, and Hollo (Primary Sponsors).
9-Referred to: Rules and Operations of the Senate
10-March 20, 2025
11-*S345 -v-1*
10+Referred to:
11+
12+*DRS35152 -NB-126A*
1213 A BILL TO BE ENTITLED 1
1314 AN ACT TO ADJUST THE SUPERVISION ARRANGEMENT OF PHYSICIAN 2
1415 ASSISTANTS AND TO MAKE VARIOUS CHANGES TO THE LICENSURE OF 3
1516 PHYSICIAN ASSISTANTS. 4
1617 The General Assembly of North Carolina enacts: 5
1718 SECTION 1.(a) G.S. 90-1.1 is amended by adding a new subdivision to read: 6
1819 "(4d) Team-based setting or team-based practice. – Any of the following: 7
1920 a. A medical practice that meets all of the following requirements: 8
2021 1. The majority of the practice is owned collectively by one or 9
2122 more licensed physicians. 10
2223 2. An owner who is a physician licensed under this Chapter has 11
2324 consistent and meaningful participation in the design and 12
2425 implementation of health services to patients, as defined by 13
2526 rules adopted by the Board. 14
2627 3. The physicians and team-based physician assistants who 15
2728 provide services at the medical practice work in the same 16
2829 clinical practice area. 17
2930 b. Hospitals, clinics, nursing homes, and other health facilities with 18
3031 active credentialing and quality programs where physicians have 19
3132 consistent and meaningful participation in the design and 20
3233 implementation of health services to patients, as defined by rules 21
3334 adopted by the Board. 22
3435 c. For the purposes of this Article, the term "team-based setting" or 23
3536 "team-based practice" shall not include a medical practice that 24
3637 specializes in pain management." 25
3738 SECTION 1.(b) G.S. 90-9.3 reads as rewritten: 26
3839 "§ 90-9.3. Requirements for licensure as a physician assistant. 27
3940 (a) To be eligible for licensure as a physician assistant, an applicant shall submit proof 28
4041 satisfactory to the Board that the applicant has met all of the following: 29
4142 (1) The applicant has successfully completed an educational program for 30
4243 physician assistants or surgeon assistants accredited by the Accreditation 31
4344 Review Commission on Education for the Physician Assistant or its 32
4445 predecessor or successor entities. 33
4546 (2) The applicant has a current or previous certification issued by the National 34
4647 Commission on Certification of Physician Assistants or its successor. 35
47-(3) The applicant is of good moral character. 36 General Assembly Of North Carolina Session 2025
48-Page 2 Senate Bill 345-First Edition
48+(3) The applicant is of good moral character. 36
49+FILED SENATE
50+Mar 19, 2025
51+S.B. 345
52+PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
53+Page 2 DRS35152-NB-126A
4954 (b) Before initiating practice of medical acts, tasks, or functions as a physician assistant, 1
5055 the physician assistant shall provide the Board the name, address, and telephone number of the 2
5156 physician who will supervise the physician assistant in the relevant medical setting. This 3
5257 subsection shall not apply to physician assistants who meet the requirements for team-based 4
5358 practice under G.S. 90-9.3A. 5
5459 (c) The Board may, by rule, require an applicant to comply with other requirements or 6
5560 submit additional information the Board deems appropriate." 7
5661 SECTION 1.(c) Article 1 of Chapter 90 of the General Statutes is amended by adding 8
5762 a new section to read: 9
5863 "§ 90-9.3A. Requirements for team-based practice as a physician assistant. 10
5964 (a) In order to practice as a team-based physician assistant, a physician assistant shall 11
6065 meet all of the following conditions: 12
6166 (1) Practice in team-based settings, as defined in G.S. 90-1.1(4d). 13
6267 (2) Have more than 4,000 hours of clinical practice experience as a licensed 14
6368 physician assistant and more than 1,000 hours of clinical practice experience 15
6469 within the specific medical specialty of practice with a physician in that 16
6570 specialty. 17
6671 (3) Submit proof as the Board may deem satisfactory by rule that the individual 18
6772 meets the requirements of subdivisions (1) and (2) of this subsection. The 19
6873 Board may, by rule, require the physician assistant to comply with other 20
6974 requirements or submit additional information the Board deems appropriate. 21
7075 (b) Team-based physician assistants shall collaborate and consult with or refer to the 22
7176 appropriate members of the health care team as required by the patient's condition and as 23
7277 indicated by the education, experience, and competencies of the physician assistant and the 24
7378 standard of care. The degree of collaboration must be determined by the practice which may 25
7479 include decisions by the employer, group, hospital service, and the credentialing and privileging 26
7580 systems of a licensed facility. The Board may adopt rules to establish requirements for the 27
7681 determination and enforcement of collaboration, consultation, and referral. Team-based 28
7782 physician assistants are responsible for the care they provide. 29
7883 (c) Notwithstanding any other provision of this Chapter, a team-based physician assistant 30
7984 practicing in a perioperative setting, including the provision of surgical or anesthesia-related 31
8085 services, shall be supervised by a physician." 32
8186 SECTION 1.(d) G.S. 90-12.4 reads as rewritten: 33
8287 "§ 90-12.4. Physician assistant limited volunteer license. 34
8388 … 35
8489 (d) Before initiating the performance of medical acts, tasks, or functions as a physician 36
8590 assistant licensed under this section, the physician assistant shall provide submit to the Board 37
8691 either an "Intent to Practice Notification Form," which shall include the name, address, and 38
8792 telephone number of the physician licensed under this Article who will supervise the physician 39
8893 assistant in the clinic specializing in the care of indigent patients.patients, or meet the 40
8994 requirements for team-based practice under G.S. 90-9.3A. 41
9095 …." 42
9196 SECTION 1.(e) G.S. 90-12.4B reads as rewritten: 43
9297 "§ 90-12.4B. Physician Assistant assistant retired limited volunteer license. 44
9398 …." 45
9499 SECTION 1.(f) G.S. 90-18.1 reads as rewritten: 46
95100 "§ 90-18.1. Limitations on physician assistants. 47
96101 (a) Any person who is licensed under the provisions of G.S. 90-9.3 to perform medical 48
97102 acts, tasks, and functions as a physician assistant may use the title "physician assistant" or "PA." 49
98103 Any other person who uses the title in any form or holds out to be a physician assistant or to be 50
99104 so licensed, shall be deemed to be in violation of this Article. 51 General Assembly Of North Carolina Session 2025
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105+DRS35152-NB-126A Page 3
101106 (a1) Physician assistants shall clearly designate their credentials as a physician assistant in 1
102107 all clinical settings. 2
103108 (b) Physician assistants are authorized to write prescriptions for drugs under the 3
104109 following conditions: 4
105110 (1) The North Carolina Medical Board has adopted regulations governing the 5
106111 approval of individual physician assistants to write prescriptions with such 6
107112 limitations as the Board may determine to be in the best interest of patient 7
108113 health and safety. 8
109114 (2) The physician assistant holds a current license issued by the Board. 9
110115 (3) Repealed by Session Laws 2019-191, s. 35, effective October 1, 2019. 10
111116 (4) The supervising physician has provided to the physician assistant written 11
112117 instructions about indications and contraindications for prescribing drugs and 12
113118 a written policy for periodic review by the physician of the drugs prescribed. 13
114119 This subdivision shall not apply to individuals who are practicing in a 14
115120 team-based setting under G.S. 90-9.3A. 15
116121 (5) A physician assistant shall personally consult with the supervising physician 16
117122 prior to prescribing a targeted controlled substance as defined in Article 5 of 17
118123 this Chapter when all of the following conditions apply: 18
119124 a. The patient is being treated by a facility that primarily engages in the 19
120125 treatment of pain by prescribing narcotic medications. 20
121126 b. The therapeutic use of the targeted controlled substance will or is 21
122127 expected to exceed a period of 30 days. 22
123128 When a targeted controlled substance prescribed in accordance with this subdivision is 23
124129 continuously prescribed to the same patient, the physician assistant shall consult with the 24
125130 supervising physician at least once every 90 days to verify that the prescription remains medically 25
126131 appropriate for the patient. 26
127132 (c) Physician assistants are authorized to compound and dispense drugs under the 27
128133 following conditions: 28
129134 (1) The function is performed under the supervision of a licensed 29
130135 pharmacist.physician. 30
131136 (2) Rules and regulations of the North Carolina Board of Pharmacy and all 31
132137 applicable State and federal laws governing this function compounding and 32
133138 dispensing are complied with. 33
134139 (3) The physician assistant holds a current license issued by the Board. 34
135140 (4) The physician assistant registers with the Board of Pharmacy. 35
136141 (d) Physician assistants are authorized to order medications, tests and treatments in 36
137142 hospitals, clinics, nursing homes, and other health facilities under the following conditions: 37
138143 (1) The North Carolina Medical Board has adopted regulations governing the 38
139144 approval of individual physician assistants to order medications, tests, and 39
140145 treatments with such limitations as the Board may determine to be in the best 40
141146 interest of patient health and safety. 41
142147 (2) The physician assistant holds a current license issued by the Board. 42
143148 (3) The If the physician assistant is subject to a supervisory arrangement, the 43
144149 supervising physician has provided to the physician assistant written 44
145150 instructions about ordering medications, tests, and treatments, and when 45
146151 appropriate, specific oral or written instructions for an individual patient, with 46
147152 provision for review by the physician of the order within a reasonable time, as 47
148153 determined by the Board, after the medication, test, or treatment is ordered. 48
149154 (4) The hospital or other health facility has adopted a written policy about 49
150155 ordering medications, tests, and treatments, including procedures for 50
151156 verification of the physician assistants' orders by nurses and other facility 51 General Assembly Of North Carolina Session 2025
152-Page 4 Senate Bill 345-First Edition
157+Page 4 DRS35152-NB-126A
153158 employees and such other procedures as are in the interest of patient health 1
154159 and safety. 2
155160 (e) Any prescription written by a physician assistant or order given by a physician 3
156161 assistant for medications, tests, or treatments shall be deemed to have been authorized by the 4
157162 physician approved by the Board as the supervisor of the physician assistant and the supervising 5
158163 physician shall be responsible for authorizing the prescription or order. This subsection shall not 6
159164 apply to individuals who are practicing in a team-based setting under G.S. 90-9.3A who may 7
160165 prescribe, order, administer, and procure drugs and medical devices without physician 8
161166 authorization. Individuals who are practicing in a team-based setting under G.S. 90-9.3A may 9
162167 also plan and initiate a therapeutic regimen that includes ordering and prescribing 10
163168 non-pharmacological interventions, including durable medical equipment, nutrition, blood, blood 11
164169 products, and diagnostic support services, including home health care, hospice, and physical and 12
165170 occupational therapy. 13
166171 (e1) Any medical certification completed by a physician assistant for a Physician assistants 14
167172 may authenticate any document, including death certificate shall be deemed to have been 15
168173 authorized by the physician approved by the Board as the supervisor of the physician assistant, 16
169174 and the supervising physician shall be responsible for authorizing the completion certificates with 17
170175 their signature, certification, stamp, verification, affidavit, or endorsement, if it may be so 18
171176 authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of the 19
172177 medical certification.a physician. 20
173178 (e2) Physician assistants shall not perform final interpretations of diagnostic imaging 21
174179 studies. For purposes of this subsection, "diagnostic imaging" shall include computed 22
175180 tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission 23
176181 tomography (PET), mammography, and ultrasound services. Final interpretation shall be 24
177182 provided by a physician licensed under this Chapter. Notwithstanding any other provision of this 25
178183 Chapter, physician assistants conducting final interpretation of plain film radiographs shall be 26
179184 supervised by a physician. 27
180185 … 28
181186 (g) Any person who is licensed under G.S. 90-9.3 to perform medical acts, tasks, and 29
182187 functions as a physician assistant shall comply with each of the following: 30
183188 (1) Maintain a current and active license to practice in this State. 31
184189 (2) Maintain an active registration with the Board. 32
185190 (3) Have File a current Intent to Practice form filed with the Board.Board or meet 33
186191 the requirements for team-based practice under G.S. 90-9.3A. 34
187192 …." 35
188193 SECTION 1.(g) G.S. 90-21.81(9) reads as rewritten: 36
189194 "(9) Qualified technician. – A registered diagnostic medical sonographer who is 37
190195 certified in obstetrics and gynecology by the American Registry for 38
191196 Diagnostic Medical Sonography (ARDMS) (ARDMS), a physician assistant 39
192197 with certification in obstetrical ultrasonography, or a nurse midwife or 40
193198 advanced practice nurse practitioner in obstetrics with certification in 41
194199 obstetrical ultrasonography." 42
195200 SECTION 1.(h) G.S. 58-3-169 reads as rewritten: 43
196201 "§ 58-3-169. Required coverage for minimum hospital stay following birth. 44
197202 (a) Definitions. – As used in this section: 45
198203 (1) "Attending providers" includes: 46
199204 a. The obstetrician-gynecologists, pediatricians, family physicians, and 47
200205 other physicians primarily responsible for the care of a mother and 48
201206 newborn; and 49
202207 b. The nurse midwives midwives, physician assistants, and nurse 50
203208 practitioners primarily responsible for the care of a mother and her 51 General Assembly Of North Carolina Session 2025
204-Senate Bill 345-First Edition Page 5
209+DRS35152-NB-126A Page 5
205210 newborn child in accordance with State licensure and certification 1
206211 laws. 2
207212 …." 3
208213 SECTION 1.(i) G.S. 110-91 reads as rewritten: 4
209214 "§ 110-91. Mandatory standards for a license. 5
210215 All child care facilities shall comply with all State laws and federal laws and local ordinances 6
211216 that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the 7
212217 standards in this section shall be complied with by all child care facilities. However, none of the 8
213218 standards in this section apply to the school-age children of the operator of a child care facility 9
214219 but do apply to the preschool-age children of the operator. Children 13 years of age or older may 10
215220 receive child care on a voluntary basis provided all applicable required standards are met. The 11
216221 standards in this section, along with any other applicable State laws and federal laws or local 12
217222 ordinances, shall be the required standards for the issuance of a license by the Secretary under 13
218223 the policies and procedures of the Commission except that the Commission may, in its discretion, 14
219224 adopt less stringent standards for the licensing of facilities which provide care on a temporary, 15
220225 part-time, drop-in, seasonal, after-school or other than a full-time basis. 16
221226 (1) Medical Care and Sanitation. – The Commission for Public Health shall adopt 17
222227 rules which establish minimum sanitation standards for child care centers and 18
223228 their personnel. The sanitation rules adopted by the Commission for Public 19
224229 Health shall cover such matters as the cleanliness of floors, walls, ceilings, 20
225230 storage spaces, utensils, and other facilities; adequacy of ventilation; 21
226231 sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, 22
227232 food protection facilities, bactericidal treatment of eating and drinking 23
228233 utensils, and solid-waste storage and disposal; methods of food preparation 24
229234 and serving; infectious disease control; sleeping facilities; and other items and 25
230235 facilities as are necessary in the interest of the public health. The Commission 26
231236 for Public Health shall allow child care centers to use domestic kitchen 27
232237 equipment, provided appropriate temperature levels for heating, cooling, and 28
233238 storing are maintained. Child care centers that fry foods shall use commercial 29
234239 hoods. These rules shall be developed in consultation with the Department. 30
235240 The Commission shall adopt rules for child care facilities to establish 31
236241 minimum requirements for child and staff health assessments and medical 32
237242 care procedures. These rules shall be developed in consultation with the 33
238243 Department. Each child shall have a health assessment before being admitted 34
239244 or within 30 days following admission to a child care facility. The assessment 35
240245 shall be done by: (i) a licensed physician, (ii) the physician's authorized agent 36
241246 who is currently approved by the North Carolina Medical Board, or 37
242247 comparable certifying board in any state contiguous to North Carolina, (iii) a 38
243248 certified nurse practitioner, (iv) a licensed physician assistant, or (iv) (v) a 39
244249 public health nurse meeting the Departments Standards for Early Periodic 40
245250 Screening, Diagnosis, and Treatment Program. However, no health 41
246251 assessment shall be required of any staff or child who is and has been in 42
247252 normal health when the staff, or the child's parent, guardian, or full-time 43
248253 custodian objects in writing to a health assessment on religious grounds which 44
249254 conform to the teachings and practice of any recognized church or religious 45
250255 denomination. 46
251256 Organizations that provide prepared meals to child care centers only are 47
252257 considered child care centers for purposes of compliance with appropriate 48
253258 sanitation standards. 49
254259 …." 50 General Assembly Of North Carolina Session 2025
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260+Page 6 DRS35152-NB-126A
256261 SECTION 2. The North Carolina Medical Board shall adopt permanent rules 1
257262 necessary to implement the provisions of this act. 2
258263 SECTION 3. Section 1 of this act becomes effective when the North Carolina 3
259264 Medical Board adopts the permanent rules required under Section 2 of this act or June 30, 2026, 4
260265 whichever occurs first. The North Carolina Medical Board shall notify the Revisor of Statutes 5
261266 when the rules required under Section 2 of this act have been adopted. The remainder of this act 6
262267 is effective when it becomes law. 7