Enacts new Article 18J, Physician Assistant Licensure Compact (PA Compact), to GS Chapter 90. States the purpose of the PA Compact and sets forth 22 defined terms, including adverse action (any administrative, civil, equitable, or criminal action permitted by a state's laws which is imposed by a Licensing Board or other authority against a PA License or license application or compact privilege such as license denial, censure, revocation, suspension, probation, monitoring of the licensee, or restriction on the licensee's practice), qualifying license (an unrestricted license issued by a participating state to provide medical services as a PA), remote state (a participating state where a licensee who’s not licensed is seeking to exercise compact privileges), and significant investigative information (investigative information that a licensing board, after an inquiry or investigation that includes notification and an opportunity for the PA to respond if required by state law, has reason to believe is not groundless and, if proven true, would indicate more than a minor infraction). 

Lists eight requirements for a State to participate in the PA Compact, including that it licenses PAs who have, amongst other things, passed a nationally recognized exam; conducts certain background checks; and grants PA compact privileges to qualifying licensees from participating states. Specifies that participating states may charge a fee for granting PA Compact privileges. Adds new GS 90-270.203, listing 12 requirements a licensee must meet to be granted compact privileges, including graduation from certain PA programs, certifications, holding a qualifying license, and no felony or misdemeanor convictions along with other background qualifiers. Specifies that compact privileges are valid until the expiration or revocation of the licensee’s qualifying license. Directs that if the participating state in the PA Compact where the licensee is licensed takes adverse action (defined), then the licensee’s compact privileges in any remote state in which they have privileges are lost until the license is no longer limited or restricted and two years have elapsed from the date that the license became no longer limited or restricted and the licensees again meets the 12 requirements for compact privileges in GS 90-270.203(a).  Requires that, for each remote state where a PA seeks authority to prescribe controlled substances, the PA must satisfy all requirements imposed by the state in granting or renewing such authority. 

Adds new GS 90-270.204, requiring that the licensee identify the participating state where they are applying along with (1) the address of their primary residence, (2) requirement to immediately report any changes of primary residence, and (3) the licensee consents to service of process at their primary residence. 

Adds new GS 90-270.205, pertaining to adverse actions. Designates the participating state where the PA is licensed with exclusive power to impose adverse action against the PA’s qualifying license issued by that state. Lists four things that remote states have the authority to do, including taking adverse action against a PA’s compact privilege or other action necessary to protect the health and safety of its citizens. Requires the licensee's participating state to give priority and effect to reported conducted received from any other participating state as if the conduct occurred in the participating state itself. Requires the participating state to apply its own laws to determine appropriate action. Allows participating states to recover costs of investigation and disposition of cases from licensees subject to an adverse action. Allows for adverse actions by participating states based on factual findings of a remote state. Provides for joint investigations by participating and remote states. Specifies that if an adverse action is taken against the qualifying license then the PA’s compact privileges in all remote states are deactivated until two years have elapsed after all restrictions have been removed from the license. Provides for a disciplinary order and notice by the participating state to the administrator of the data system established under GS 90-270.207.

Adds new GS 90-276.206, establishing a PA Licensure Compact Commission (Commission), a joint government agency and national administrative body. Provides for Commission membership; voting; meetings; powers and duties; an executive committee; financing; recordkeeping; and member-qualified immunity, defense, and indemnification. Among the 23 powers and duties charged of the Committee, includes establishing a code of ethics, prosecuting legal proceedings and actions so long as the standing of any state licensing board to sue or be sued under applicable law is not affected, and the acquisition and disposal of property. Provides for Commission rulemaking procedures and effect, including a participating state challenge of a Commission rule if it conflicts with the state’s law pertaining to medical services that a PA may perform in the state and rejection of a rule by a majority of participating state legislatures. 

Adds new GS 90-270.207, requiring the Commission to establish a coordinated database and reporting system containing licensure, adverse action, and the reporting of the existence of significant investigative information on all licensed PAs and applicants denied a license in participating states. Designates information provided to a participating state from the database is an authenticated business record entitled to a hearsay exception in any relevant judicial, quasi-judicial, or administrative proceeding in a participating state when certified by the Commission or an agent thereof. 

Adds new GS 90-270.209, detailing oversight of the PA Compact by the executive and judicial branches in each participating state, dispute resolution procedures between member states, and PA Compact enforcement by the Commission. Provides for member state default grounds and procedures, member termination procedures, and dissolution. Provides for venue and available remedies in legal action against the Commission. Specifies that only a participating state can enforce the PA Compact against the Commission. Adds new GS 90-270.210, that provides for the Compact to become effective upon enactment in the seventh member state and withdrawal procedures by member states. Requires the Commission to review all participating state charters once the PA Compact becomes effective to ensure they are all in compliance with the model compact. Allows for a participating state to default if its compact is materially in conflict with the model compact. 

Deems the provisions of the PA Compact severable and advises on its construction and effect on other laws.

Makes conforming changes to GS 90-9.3 (requirements for licensure as a physician assistant).

Effective October 1, 2024.