Includes whereas clauses. Makes the following changes to Article 38, Respiratory Care Practice Act, of GS Chapter 90. Adds and modifies defined terms as follows. Adds advanced respiratory care practitioner, advanced respiratory care procedures, endorsement, practice of advanced practice respiratory therapy, prescriptive and dispensing authorization, and supervising physician to the Article's defined terms.

Expands license to include respiratory care practitioners or advanced respiratory care practitioners who have met the requirements and have been issued a certificate by the NC Respiratory Care Board (Board). Revises the practice of respiratory care to specify the term is as defined by the written order of a licensed physician for respiratory care practitioners, as specified, and the performance of diagnostic testing and therapeutic application of the use of associated respiratory care equipment for medical gases, humidity, and aerosols, except anesthesia. Revises support activities to mean tasks that do not require formal academic training, including the delivery, setup, and routine maintenance and repair of respiratory care equipment, and includes giving instructions on the use, fitting, and application of respiratory care equipment, excluding therapeutic evaluation and assessment for an individual patient as defined by Board rules. Makes clarifying changes to physician.

Modifies membership of the Board set forth in GS 90-649 to include one member who must be a state resident to represent the Atlantic Coast Medical Equipment Services Association (replaces the member to represent the NC Association of Medical Equipment Services). Amends GS 90-650 to provide for appointment of this member by the Atlantic Coast Medical Equipment Association.

Revises and adds to the Board's powers and duties set forth in GS 90-652. No longer requires the Board to submit a signed form of the licensure applicant consenting to a criminal record check or the use of fingerprints or other identifying information to the Department of Public Safety. Grants authority to establish and adopt rules defining the education and credential requirements for persons seeking endorsement, defined to mean a designation issued by the Board recognizing the person named as having met the requirements to perform advanced respiratory care procedures as defined by the Board's rules. 

Enacts GS 90-652.1 to authorize the Board to waive the Article's requirements in order to permit the provision of professional services (including the practice of advanced practice respiratory therapy and respiratory care, and prescriptive and ordering authorization) to the public in the event of a gubernatorially declared state of emergency; a locally declared state of emergency; or to protect the public health, safety, or welfare of citizens under specified state law. 

Distinguishes licensure requirements for respiratory care practitioner licenses and advanced respiratory care practitioner licenses under GS 90-653. Revises respiratory care practitioner licensure requirements to require applicants to submit a completed application that includes a signed form consenting to a criminal background check and the use of fingerprints and other identifying information; submit verification of completion of entry-level degree requirements of a respiratory care education program approved by the Commission on Accreditation for Respiratory Care (CoARC) or its successor through submission of an official transcript to the Board; and submitting written evidence, verified by oath, that the applicant passed the exam requirements defined by Board rules given by the National Board for Respiratory Care Inc. (National Board) or its successor for entry-level care practitioners. Eliminates previous provisions regarding provision of the entry-level exam throughout the year. Establishes licensure requirements for advanced respiratory care practitioners, mirroring those for respiratory care practitioners, except as follows. Requires verification of successful completion of the postgraduate requirements of respiratory care education for the advanced practice respiratory therapist approved by CoARC or its successor through submission of an official transcript to the Board, requires verification of successful completion of the minimal requirements for Basic Cardiac Life Support recognized by the specified national entities, and requires verification that the applicant passed the exam requirements defined by Board rules given by the National Board or its successor for advanced-level respiratory care practitioners defined by Board Rules. Adds a new requirement for the Board to state the terms and conditions of use of the license to the licensee upon issuance. 

Enacts GS 90-667, pertaining to confidentiality of Board investigative information.  Directs that all investigative information (investigative files and reports, information relating to the identity and report of a physician  or other professional performing an expert review for the Board, and any of the Board's investigative materials that are not admitted into evidence) along with any records, papers, and other documents containing information that the Board, its members, or its employees possess, gather, or receive as a result of investigations, inquiries, assessments, or interviews conducted in connection with a licensing complaint, appeal, assessment, potential impairment matter, or disciplinary matter are not considered public records and are not subject to discovery, subpoena, or any means of legal compulsion for release to anyone other than the Board, its employees, or consultants involved in the application for license, impairment assessment, or discipline of the licensee, except for certain disclosures to a licensee in connection with a disciplinary hearing. Specifies that Board is not required to produce any attorney-client privileged information or other information the Board does not intend to offer into evidence and is related to advice, opinions, or recommendations of the Board's staff, consultants, or agents to a licensee in connection with a disciplinary hearing.  Specifies that any licensee’s notice of statement of charges, notice of hearing, and all information contained in those documents are considered public records subject to disclosure.  Authorizes the Board to report confidential information concerning the denial, annulment, suspension, or revocation of a license to any other health care licensing board in this State, other state, or country, or authorized Department of Health and Human Services personnel who are charged with the enforcement or investigative responsibilities of licensure. Specifies notice requirements to licensee if information is disclosed and procedure for licensee to request a copy of all transmitted information. Sets out provisions governing release of such information if it relates to an ongoing criminal investigation by any law enforcement agency or authorized Department of Health and Human Services personnel with enforcement or investigative responsibilities. Requires the Board to withhold identity related to any patient including information relating to dates and places of treatment, or any other information that would tend to identify the patient, in any proceeding, record of a hearing, and in the notice of charges against any licensee, unless the patient or the patient's representative expressly consents to the public disclosure. Requires all licensees to self-report to the Board any felony arrest or indictment or any arrest for driving while impaired or driving under the influence or for possession, use, or sale of any controlled substances within 30 days of their arrest or indictment. 

Eliminates the statutory fee set in GS 90-660 for exams. No longer distinguishes a fee for a provisional or temporary endorsement. 

Expands the unlawful practices of unlicensed persons under GS 90-661 to include the use of advanced respiratory care practitioner title, letters, or indications. 

Makes the above provisions effective October 1, 2024.

Enacts GS 90-18.8, authorizing any advanced respiratory practitioner who is licensed under GS 90-648(9a) (as enacted, effective October 1, 2024) to perform medical acts, tasks, and functions to use such title; provides any other use of the title or indication as such to be a violation of Article 1 (practice of medicine) and 38. Establishes conditions under which advanced respiratory care practitioners are authorized to practice advanced respiratory care as defined by GS 90-648(9a) (as enacted, effective October 1, 2024) under the supervision of a physician, including adoption of governing rules by the Board and the Medical Board, approval of both Boards, and assignment of an identification number that is shown on written prescriptions. Establishes conditions under which advanced respiratory care practitioners that have prescriptive and dispensing authorization under GS 90-648(10a) (as enacted, effective October 1, 2024) can order medications, tests, and treatments, including adoption of governing rules by both Boards, current approval of both Boards, and provision of specified instructions from the supervising physician. Deems written prescriptions or orders of an advanced respiratory care practitioner authorized by the physician approved by the Board as the supervisor, with liability on the supervisor. Authorizes registered nurses or licensed practical nurses to perform orders received from advanced respiratory care practitioners as if received from a licensed physician. 

Amends GS 90-8.2 to direct the Medical Board to appoint and maintain a subcommittee to work jointly with the Board to develop rules to govern the performance of medical acts by advanced respiratory care practitioners. Provides for membership and authorizes rulemaking. Further amends GS 90-652 to grant the Board the authority to appoint and maintain said subcommittee.

Makes the above provisions effective October 1, 2023. 

Directs the Medical Board and the Board to make subcommittee appointments by January 1, 2024, with initial appointees from the Board required to be licensed health care providers currently serving the Board. Further charges the joint subcommittee with developing rules to implement the act, with the approval of both Boards and in compliance with GS Chapter 150B.