Identical to S 47, filed 1/31/23.

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 follow all applicable state and federal laws and rules governing compounding and dispensing (was, the rules and regulations of the North Carolina 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 PA’s 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 PA’s 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, 2024, whichever is earlier.