Part I.

Amends GS 90-1.1 (setting forth definitions related to the practice of medicine) to add a new definition for team-based setting or team-based practice, to include any of the following:

(1) a medical practice where: (i) the majority of the practice is owned collectively by one or more licensed physicians; (ii) an owner who is a physician licensed to practice medicine in North Carolina has consistent and meaningful participation in the design and implementation of health services to patients, as defined by rules adopted by the North Carolina Medical Board (Medical Board); and (iii) the physicians and team-based physician assistants (team-based PAs) who provide services at the medical practice work in the same clinical practice area.

(2) hospitals, clinics, nursing homes, and other health care facilities with active credentialing and quality programs where physicians have consistent and meaningful participation in the design and implementation of health services to patients, as defined by rules adopted by the Board.

Excludes a medical practice that specializes in pain management from the definition of team-based practice or team-based setting. 

Enacts new GS 90-9.3A, which provides as follows. Sets out the following a physician assistant (PA) must meet to practice as a team-based PA if the PA practices in a team-based setting or team-based practice: (1) more than 4,000 hours of clinical practice experience as a licensed PA and more than 1,000 hours of clinical practice experience within the specific medical specialty of practice with a physician in that specialty and (2) submission of proof satisfactory to the Medical Board of practice in a team-based setting and the requisite clinical hours. Authorizes the Medical Board to adopt rules setting other requirements for practice or additional information required. Requires team-based PAs to collaborate and consult with or refer to the appropriate members of the health care team as required by the patient's condition and as indicated by the education, experience, and competencies of the physician assistant and the standard of care. The degree of collaboration must be determined by the practice, which may include decisions by the employer, group, hospital service, and the credentialing and privileging systems of a licensed facility. Authorizes the Medical Board to adopt rules to establish requirements for the determination and enforcement of collaboration, consultation, and referral. States that team-based PAs are responsible for the care they provide. Requires a team-based PA practicing in a perioperative setting to be supervised by a physician.

Amends PA general licensure requirements (GS 90-9.3) and limited volunteer licensure requirements (GS 90-12.4) to exempt team-based PAs from having to submit supervising physician information. 

Makes technical change to GS 90-12.4B.

Amends GS 90-18.1 (limitations on PAs) as follows:

• Requires all PAs to clearly designate their credentials as a PA in all clinical settings.
• Exempts team-based PAs from the supervising physician requirement to write prescriptions for drugs. 
• Changes the designated PA supervisor from licensed pharmacist to licensed physician for a PA to be able to compound and dispense drugs. Requires PA to also follow all applicable state and federal laws and rules governing compounding and dispensing (was, only the rules and regulations of the North Carolina Board of Pharmacy). Requires the PA to register with the Board of Pharmacy.
• Only requires a supervising physician to provide a PA written instructions about medications, tests, or treatments in order for the PA to be able to order those medications, tests, or treatments if the PA is subject to a supervisory arrangement. Exempts team-based PAs who may prescribe, order, administer, and procure drugs and medical devices without physician authorization from provision holding supervising physician responsible for authorizing a PA prescription or order. Allows for those practicing in a team-based setting to plan and initiate a therapeutic regimen that includes ordering and prescribing non-pharmacological interventions, including durable medical equipment, nutrition, blood, blood products, and diagnostic support services, including home health care, hospice, and physical and occupational therapy.
• Allows for PAs to authenticate any document (was, just death certificates) so long as it may have been authenticated by a physician. Deletes language deeming completion of a death certificate by a PA as authorized by a supervising physician and holding the physician responsible for that authorization. 
• Bars PAs from performing final interpretations of diagnostic imaging studies (computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography (PET), mammography, and ultrasound services). Requires physician to provide final interpretation of diagnostic imaging studies. Allows for PA to conduct a final interpretation of plain film radiographs only when supervised by a physician.
• Makes conforming changes to refer to new "team-based practice." 

Amends definition of qualified technician in the Woman’s Right to Know Act (GS 90-21.81) to include PAs with certification in obstetrical ultrasonography.  

Amends definition of attending providers in GS 58-3-169 (requiring insurance coverage for minimum hospital stays after birth) to include PAs.

Amends GS 110-91 (governing licensure requirements for child care facilities) to allow PAs to be able to complete a child health assessment before a child is admitted or within 30 days of admission to a child care facility.  

Requires the Medical Board to adopt permanent rules necessary to implement the act.

The statutory changes set forth above become effective either when the Medical Board adopts permanent rules to implement all provisions of the act or June 30, 2026, whichever is earlier. 

Part II.

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 90-270.206, 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 90-270.208 setting forth the Commission’s rulemaking powers.

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).

Amends GS 90-13.2 to require privilege holders to register annually with the North Carolina Medical Board as required by new Article 18J. Requires physician assistants who pay a $140 annual registration fee to pay an additional $25 for failure to register.

Amends GS 90-13.1 by adding a $230 fee for initial licensure or privilege of a physician assistant.

Amends GS 90-1.1 by amending the definition of license by adding that it includes any physician assistant compact privilege granted under Article 18J, and the definition of licensee to include any compact privilege issued to a holder of a qualifying license in a participating state under Article 18J.

Amends GS 90-5.1 by expanding the powers of the NC Medical Board, to also include: (1) implementing the Physician Assistant Licensure Compact under Article 18J, including issuing compact privileges; and (2) appointing a delegate to serve on the Physician Assistant Licensure Compact Commission, who must be either (a) a current physician assistant, physician, or public member of the Board, or (b) an administrator of the Board.

Amends GS 90-11 to allow the Department of Public Safety to provide the NC Medical Board with a criminal record check for purposes of Article 18J.

Amends GS 90-14 to give the NC Medical Board disciplinary power for a violation of Article 18J.

Effective nine months after the act becomes law.