House committee substitute to the 1st edition makes the following changes.

Amends GS 90-648 by adding and defining invasive diagnostic and therapeutic procedure, as it is used in Article 38, Respiratory Care Practice Act, as any test or treatment that uses instruments to cut, puncture, or otherwise enter the body. Amends the definition of practice of advanced practice respiratory therapy by specifying that it excludes (1) medical diagnosis; (2) prescribing; (3) interpretation of medical diagnostic imaging studies; (4) final interpretation of sleep studies or pulmonary function tests; (5) surgery; (6) delivery of anesthesia; and (7) ordering or performing diagnostic and therapeutic procedures that are more than minimally invasive and have known complications that involve serious injury and death, unless a physician is physically present to supervise the advanced practice respiratory care therapist or the procedure is provided pursuant to the practice of respiratory care. Removes from acts, tasks, or functions the advanced respiratory care practitioner may perform in any health care setting for which the physician is responsible those related to the prescribing, ordering, and administering of drugs, medical care, and medical devices related to the cardiovascular and cardiopulmonary systems within the limitations set forth by the supervising physician and rules adopted by the Board. Deletes the proposed term prescriptive and dispensing authorization. Adds and defines the term serious injury as an injury that creates a substantial risk of impairment of any bodily function that requires immediate medical attention or hospitalization.

Removes proposed GS 90-652.1, disasters and emergencies, and changes to GS 90-652, concerning the NC Respiratory Care Board's (Board) powers and duties.

Removes proposed GS 90-18.8, limitations on advanced respiratory care practitioners, and replaces it with new GS 90-668, which provides as follows. Allows individuals licensed as advanced respiratory care practitioners to use the title "advanced respiratory care practitioner." Makes it a violation of the Article for an individual to hold themselves out as advanced respiratory care practitioners without being licensed. Allows licensed advanced respiratory care practitioners to practice advanced respiratory care under the supervision of a licensed physician and within the scope of rules adopted by the Board.

Removes the proposed changes to GS 90-8.2, appointment of subcommittees. Makes conforming deletions.

Makes all of Section 1, not just a portion of Section 1, effective October 1, 2024.

Requires the Board to adopt rules to implement and administer the provisions of this act no later than October 1, 2024.