Senate committee substitute to the 3rd edition makes the following changes.

Part II.

Section 2.1(a).

Amends GS 90-12.03 (providing for internationally-trained physician employee licenses [was, internationally-trained hospital physician employee licenses]), as follows. Changes the rural county population requirements from a population of 500 people per square mile to a population of less than 500 people per square mile.  Clarifies that an applicant must have a current and active license in good standing to practice medicine in a foreign country (was, be presently licensed to practice medicine in a foreign country). Specifies that the applicant must have completed medical education at a medical school listed in the World Directory of Medical Schools (was, completed medical school and postgraduate training that is substantially similar to State requirements) and must also meet one of two listed requirements: (1) completion of two years of post-graduate training in a medical education program accredited by an agency with the World Federation for Medical Education Recognition Status after graduation from medical school or (2) the applicant has practiced medicine in their country of licensure for at least ten years after graduation. Applicant must now also demonstrate competency in at least one of four listed ways, or, allows the NC Board of Medicine (Board) to waive those requirements and issue a temporary license and require the applicant to successfully pass the Special Purpose Examination (SPEX) or Post-Licensure Assessment Systems within one year. Expands requirement pertaining to disciplinary status of applicant’s foreign license to include determination on whether the applicant has had a license revoked, suspended, restricted, denied, or otherwise acted against in any jurisdiction and is the subject of no pending investigation, including voluntary relinquishment of a license in anticipation of or in response to disciplinary action (was, just not subject to disciplinary action). Requires that the applicant not have any convictions in any court involving moral turpitude, or the violation of a law involving the practice of medicine, or a conviction of a law substantially equivalent to a felony. Requires that the applicant submit a background screening from the country where they are licensed to the Board. Now requires that the holder of the license not practice medicine or surgery outside of the confines of the NC hospital or rural medicine practice, or its affiliate, by whose employment the holder was qualified to be issued the license pursuant to GS 90-12.03(a) (was, just can’t practice medicine outside the confines of the hospital/rural practice or its affiliates). Makes conforming changes. Makes a clarifying change to the effective date.

Part III.

Section 3.1(c).

Amends GS 93D-2 to specify that the provisions of the Chapter (was, Article) do not apply to the sale of over-the-counter hearing aids.

Part IX.

Section 9.1.  

Amends GS 90-18(c) (list of actions that do not constitute practicing medicine or surgery under Article 1, Practice of Medicine) as follows. Amends subdivision (3a) to now exclude the provision of health care services by a licensed pharmacist under a collaborative practice agreement with at least one physician performed pursuant to rules developed by a joint subcommittee of the Medical Board and Board of Pharmacy (collectively, Boards) and approved by both Boards (currently, excludes the provision of drug therapy management by a licensed pharmacist engaged in the practice of pharmacy pursuant to an agreement that is physician, pharmacist, patient, and disease specified when performed pursuant to rules approved by the Boards). Defines healthcare services as medical tasks, acts, or functions authorized through written agreement by a physician and delegated to a pharmacist for the purpose of providing drug therapy, disease, or population health management for patients. 

Amends GS 90-18.4 (limitations on clinical pharmacist practitioners), to eliminate references to drug therapy management. Provides that physicians can authorize clinical pharmacist practitioners to provide healthcare services so long as the Boards have adopted rules governing the approval of individual practitioners, the practitioner has current approval from both Boards, and the Medical Board has assigned an identification number to the practitioner that is shown on written prescriptions. Eliminates limitations relating to practitioners' prescription substitutions and authority to order medication and tests. Deems orders written by a clinical pharmacist practitioner for medications, tests, or other devices to have been authorized by the supervising physician, with the supervising physician responsible for authorizing the order, and authorizes registered nurses, licensed practical nurses, and pharmacists to perform the order in the same manner as if the order were received from a licensed physician. Authorizes institutional and group practices to implement site-specific, multi-provider collaborative practice agreement for the care of their patients. Requires the institution or group practice to develop an oversight policy and requires evaluation of the practitioners engaged in the agreement by an appointed supervising physician. Lists six requirements that apply to clinical pharmacist practitioners and supervising physicians engaging in collaborative practice, including (1) requiring a clinical pharmacist practitioner to have a site-specific supervising physician, (2) requiring the supervising physician to conduct periodic review and evaluation of the health care services provided by the clinical pharmacist practitioner, (3) allowing a physician to supervise any number of clinical pharmacist technicians as the supervising physician deems can be safely and effectively supervised, (4) requiring delegated health care services to be included in the written agreement between the supervising physician and the clinical pharmacist practitioner, (5) allowing a supervising physician to include a statement of authorization in the written agreement to allow the clinical pharmacist practitioner to conduct drug substitutions as specified, and (6) allowing supervising physicians to add other advanced practice providers that they supervise to the collaborative practice agreement. Allows for the healthcare settling location of health care services provided by the clinical pharmacist practitioner to be fully or partially embedded for a site-specific practice. Requires the supervising physician to determine the setting location and include the location in the site-specific collaborative practice agreement. 

Amends the definition of clinical pharmacist practitioner in GS 90-85.3 to include authorization to perform medical acts, tasks, and functions for drug therapy, disease, or population health management agreements with physicians pursuant to GS 90-18.4, as amended.

Authorizes the Boards to adopt temporary rules to implement Section 9.1.

Section 9.2(a).

Enacts GS 58-50-296 to require health benefit plans offered by insurers to cover services provided by a pharmacist if (1) the service or procedure was performed within the pharmacist's licensed scope of practice and (2) the plan would have covered the service if the service or procedure was performed by another healthcare provider. Requires insurers offering a health benefit plan that delegate credentialing agreements to contracted healthcare facilities to accept credentialing for pharmacists employed or contracted with those facilities. Bars an insurer from penalizing an insured or subject an insured to an out-of-network benefit level offered under the insured’s approved health benefit plan unless contracting health care providers able to meet health needs of the insured are reasonably available to the insured without unreasonable delay. Prohibits participation of a pharmacy in a drug benefit provider network of an insurer offering a health benefit plan from satisfying any requirement that insurers offering health benefit plans include pharmacists in medical benefit provider networks. Includes agents of an insurer offering a health benefit plan, and third-party administrators. Effective October 1, 2023, and applies to contracts entered into, renewed, or amended on or after that date. 

Part X.

Amends GS 131E-158 (pertaining to credentialing of ambulance personnel) to permit the NC Office of Emergency Medical Services to continue the emergency waive flexibilities permitted under the statute for twelve months following the expiration of the Public Health Emergency. Effective when the act becomes law and expires May 11, 2024.

Makes technical, clarifying, and organizational changes. Makes conforming changes to the act’s long title.