House committee substitute to the 2nd edition makes the following changes. 

Replaces the definition of the new defined term team-based setting, now also including the term team-based practice, in GS 90-1.1. Defines the terms to mean either: (1) a medical practice in which (a) a majority of the practice is owned collectively by one or more licensed physicians, (b) an owner who is a licensed physician has consistent and meaningful participation in the design and implementation of health services to patients, and (c) the physicians and team-based physician assistants (PAs) who provide services at the medical practice work in the same clinical practice area; or (2) hospitals, clinics, nursing homes, and other health facilities with active credentialing and quality programs where physicians have consistent and meaningful participation in the design and implementation of health services to patients. Maintains that the term (including team-based practice) explicitly excludes a medical practice that specializes in pain management. Provides that having consistent and meaningful participation in the design and implementation of health services to patients is defined by rules adopted by the Medical Board (Board). No longer amends the practice of medicine or surgery to include using the designation "Physician Assistant" or "PA" as specified.

Eliminates the proposed repeal of GS 90-9.3(b), which requires a PA to provide the Board contact information for the physician who will supervise the PA in the relevant medical setting before initiating practice as a PA. Instead, amends the subsection to exempt PAs who meet the requirements for team-based practice under new GS 90-9.3A from the subsection's requirements.

Replaces the content of new GS 90-9.3A regarding the practice as a PA, now providing as follows related to team-based practice. Establishes qualifications for practicing as a team-based PA, including requiring practice in team-based settings and having more than 4,000 clinical practice experience as a licensed PA and more than 1,000 hours of clinical experience within the specific medical specialty of practice with a physician in that specialty, proof of which must be submitted to the satisfaction of the Board per Board rule. Allows the Board to require, by rule, the PA to comply with other requirements or submit additional information. Requires team-based PAs to collaborate and consult with or refer to appropriate team members as required and specified. Authorizes the Board to adopt rules to establish requirements for the determination and enforcement of collaboration, consultation, and referral. Explicitly deems team-based PAs responsible for the care they provide. Mandates supervision of a team-based PA practicing in a perioperative setting, including the provision of surgical or anesthesia-related services. 

Replaces the proposed changes to GS 90-12.4(d), which requires PAs with a limited volunteer license to submit contact information of the licensed physician who will supervise the PA in the clinic specializing in the care of indigent patients, prior to practicing. Now amends the subsection to require the PA to either submit the physician's information on an "Intent to Practice Notification Form," or forego the supervisory notification requirements by meeting the requirements for team-based practice under new GS 90-9.3A.

Replaces the proposed changes to GS 90-18.1, which establishes limitations on the practice of PAs, and now provides as follows. Adds a new subsection (a1), requiring PAs to clearly designate their credentials as a PA in all clinical settings. Regarding the conditions for PAs applicable to writing prescription drugs, exempts PAs practicing in a team-based setting from the requirement that a supervising physician must provide the PA written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review by the physician of the drugs prescribed. Regarding the conditions for PAs applicable to compounding and dispensing drugs, now requires the PA to comply with all applicable State and federal laws and rules governing compounding and dispensing (replacing the requirement for complying with relevant rules and regulations of the NC Board of Pharmacy). Limits the scope of the condition relating to supervising physicians' providing written instructions as well as periodic review relevant to a PA's ordering order medications, tests and treatments in hospitals, clinics, nursing homes, and other health facilities, making the requirement applicable to PAs subject to supervisory agreements only. 

Eliminates the proposed repeal of GS 90-18.1(e), which deems any prescription written by a PA or order given by a PA for medications, tests, or treatments to have been authorized by the physician approved by the Board as the supervisor of the physician assistant and the supervising  physician responsible for authorizing the prescription or order. Eliminates the proposed replacement language of the previous edition, and instead provides the following. Makes the provisions inapplicable to PAs practicing in a team-based setting under new GS 90-9.3A, and authorizes such individuals to prescribe, order, administer, and procure drugs and medical devices without physician authorization, and 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. Repeals the content of existing subsection (e1), replacing the provisions to now authorize PAs to authenticate any document, including death certificates with their signature, certification, stamp, verification, affidavit, or endorsement, if such authentication can be done by a physician (currently, provides that any medical certification completed by a PA for a death certificate is deemed to have been authorized by the approved supervising physician who is responsible for authorizing the completion of the medical certification). Adds new subsection (e2) prohibiting PAs from performing final interpretations of diagnostic imaging studies, as defined, which must be provided by a licensed physician. Requires a physician's supervision for a PA to conduct final interpretation of plain film radiographs. Makes conforming changes regarding PAs meeting the requirements for team-based practice in lieu of filing a current Intent to Practice Form with the Board. 

Adds a new provision requiring the Medical Board to adopt necessary permanent rules to implement the act. Requires notification to the Revisor when the rules are adopted.

Now makes all proposed changes to GS Chapter 90 effective at the earlier of either when the Board adopts the required permanent rules, or June 30, 2023 (was, effective January 1, 2022).