Healthcare Workforce Reforms.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025

SESSION LAW 2025-37
HOUSE BILL 67

*H67-v-6*
AN ACT TO ENACT HEAL THCARE WORKFORCE REF ORMS FOR THE STATE O F
NORTH CAROLINA.

The General Assembly of North Carolina enacts:

PART I. INTERSTATE MEDICAL LICENSURE COMPACT
SECTION 1.(a) Chapter 90 of the General Statutes is amended by adding a new
Article to read:
"Article 1O.
"Interstate Medical Licensure Compact.
"§ 90-21.160. Short title.
This Article shall be known as the "Interstate Medical Licensure Compact."
"§ 90-21.161. Purpose.
(a) The purpose of this Article is to strengthen access to health care, and, in recognition
of the advances in the delivery of health care, the member states of the Interstate Medical
Licensure Compact (Compact) have allied in common purpose to develop a comprehensive
process that complements the existing licensing and regulatory authority of state medical boards
and to provide a streamlined process that allows physicians to become licensed in multiple states,
thereby enhancing the portability of a medical license and ensuring the safety of patients.
(b) The Interstate Medical Licensure Compact creates another pathway for licensure and
does not otherwise change a state 's existing medical practice act or provisions. The Compact
adopts the prevailing standard for licensure and affirms that the practice of medicine occurs
where the patient is located at the time of the physician-patient encounter and, therefore, requires
the physician to be under the jurisdiction of the state medical board where the patient is located.
State medical boards that participate in the Compact retain the jurisdiction to impose an adverse
action against a license to practice medicine in that state issued to a physician through the
procedures of the Compact.
"§ 90-21.162. Definitions.
The following definitions apply in this Article:
(1) Bylaws. – Bylaws established by the Interstate Commission pursuant to
G.S. 90-21.171.
(2) Commissioner. – The voting representative appointed by each member board
pursuant to G.S. 90-21.171.
(3) Conviction. – A finding by a court that an individual is guilty of a c riminal
offense through adjudication, or entry of a plea of guilt y or no contest to the
charge by the offender. Evidence of an entry of a conviction of a criminal
offense by a court shall be considered final for purposes of disciplinary action
by a member board.
(4) Expedited license. – A full and un restricted medical li cense granted by a
member state to an eligible physician through the process set forth in the
Compact.

Page 2 Session Law 2025-37 House Bill 67
(5) Interstate Commission. – The Interstate Medical Licensure Compact
Commission created pursuant to G.S. 90-21.171.
(6) License. – The authorization by a member state for a physician to engage in
the practice of medicine, which would be unlawful without authorization.
(7) Medical practice act. – Laws and regulations governing the practice of
allopathic and osteopathic medicine within a member state.
(8) Member board. – A state agency in a member state that acts in the sovereign
interests of the state by protecting the public through licensure, regulation, and
education of physicians as directed by the state government.
(9) Member state. – A state that has enacted the Compact.
(10) Offense. – A felony, gross misdemeanor, or crime of moral turpitude.
(11) Physician. – Any person who meets all of the following qualifications:
a. Is a graduate of a medical school accredited by the Liaison Committee
on Medical Education, the Commission on Osteopathic College
Accreditation, or a medical school listed in the International Medical
Education Directory or its equivalent.
b. Has passed each c omponent of the United States Medical Licensing
Examination (USMLE) or the Comprehensive Osteopathic Medical
Licensing Examination (COMLEX -USA) within three attempts, or
any of its predecessor examinations accepted by a state medical board
as an equivalent examination for licensure purposes.
c. Has successfully completed graduate medical education approved by
the Accreditation Council for Graduate Medical Education or the
American Osteopathic Association.
d. Holds specialty certification or a time -unlimited specialty certificate
recognized by the American Board of Medical Specialties or the
American Osteopathic Association 's Bureau of Osteopathic
Specialists.
e. Possesses a full and unrestricted license to engage in the practice of
medicine issued by a member board.
f. Has never been convicted, received adjudication, deferred
adjudication, community supervision, or deferred disposition for any
offense by a court of appropriate jurisdiction.
g. Has never held a license authorizing the practice of medicine subjected
to discipline by a licensing agency in any state, federal, or foreign
jurisdiction, excluding any action related to nonpayment of fees
related to a license.
h. Has never had a controlled substance license or permit suspended or
revoked by a state or the United States Drug Enforcement
Administration.
i. Is not under active investigation by a licensing agency or law
enforcement authority in any state, federal, or foreign jurisdiction.
(12) Practice of medicine. – Clinical prevention, diagnosis, or treatment of human
disease, injury, or condition requiring a physician to obtain and maintain a
license in compliance with the medical practice act of a member state.
(13) Rule. – A written statement by the Interstate Commission promulgated
pursuant to G.S. 90-21.172 that is of general applicability, implements,
interprets, or prescribes a policy or provision of the Compact, or an
organizational, procedural, or practice requirement of the Interstate
Commission, and has the force and effect of statutory law in a member state,
and includes the amendment, repeal, or suspension of an existing rule.

House Bill 67 Session Law 2025-37 Page 3
(14) State. – Any state, commonwealth, district, or territory of the United States.
(15) State of principal license. – A member state where a physician holds a license
to practice medicine and which has been designated as such by the physician
for purposes of registration and participation in the Compact.
"§ 90-21.163. Eligibility.
(a) A physician must meet the eligibility requirements as defined in G.S. 90-21.162(11)
to receive an expedited license under the terms and provisions of the Compact.
(b) A physician who does not meet the requirements of G.S. 90-21.162(11) may obtain a
license to practice medicine in a member state if the individual complies with all laws and
requirements, other than the Compact, relating to the issuance of a license to practice medicine
in that state.
"§ 90-21.164. Designation of state of principal license.
(a) A physician shall designate a member state as the state of principal license for
purposes of registration for expedited licensure through the Compact if the physician possesses
a full and unrestricted license to practice medicine in that state , and that state meets any one of
the following qualifications:
(1) The state is the principal residence for the physician.
(2) The physician conducts at least twenty-five percent (25%) of their practice of
medicine in the state.
(3) The state is the location of the physician's employer.
If no state qualifies under subdivision (1), (2), or (3) of t his subsection, then the physician
may designate the state of residence for the purpose of federal income tax as their state of
principal license.
(b) A physician may redesignate a member state as a state of principal license at any time,
as long as the state meets the requirements of subsection (a) of this section.
(c) The Interstate Commission is authorized to develop rules to facilitate redesignation
of another member state as the state of principal license.
"§ 90-21.165. Application and issuance of expedited licensure.
(a) A physician seeking licensure through the Compact shall file an application for an
expedited license with the member board of the state selected by the physician as the state of
principal license.
(b) Upon receipt of an application for an expedited license, the member board within the
state selected as the state of principal license shall evaluate whether the physician is eligible for
expedited licensure and issue a letter of qualification, verifying or denying the physician 's
eligibility, to the Interstate Commission.
(c) Static qualifications, which include verification of medical education, graduate
medical education, results of any medical or licensing examination, and other qualifications as
determined by the Interstate Commission through rule, shall not be subject to additional primary
source verification where already primary source verified by the state of principal license.
(d) The member board within the state selected as the state of principal license shall , in
the course of verifying eligibility, perform a criminal background check of an applicant,
including the use of the results of fingerprint or other biometric data checks in compliance with
the requirements of the Federal Bureau of Investigation, with the exception of federal employees
who have suitability determination in accordance with 5 C.F.R. § 731.202.
(e) Appeal on the determination of eligibility to the member state shall be made to the
member state where the application was filed and shall be subject to the laws of that state.
(f) Upon verification of eligibility in subsection (b) of this section , physicians eligible
for an expedited license shall complete the registration process established by the Inters tate
Commission to receive a license in a member state selected pursuant to subsection (a) of this
section, including the payment of any applicable fees.

Page 4 Session Law 2025-37 House Bill 67
(g) After receiving verification of eligibility under subsection (b) of this section and any
fees under subsection (f) of this section, a member board shall issue an expedited license to the
physician. This license shall authorize the physician to practice medicine in the issuing state
consistent with the medical practice act and all applicable laws an d regulations of the issuing
member board and member state.
(h) An expedited license shall be valid for a period consistent with the licensure period
in the member state and in the same manner as required for other physicians holding a full and
unrestricted license within the member state.
(i) An expedited license obtained through the Compact shall be terminated if a physician
fails to maintain a license in the state of principal licensure for a nondisciplinary reason, without
redesignation of a new state of principal licensure.
(j) The Interstate Commission is authorized to develop rules regarding the application
process, including payment of any applicable fees, and the issuance of an expedited license.
"§ 90-21.166. Fees for expedited licensure.
(a) A member state issuing an expedited license authorizing the practice of medic ine in
that state may impose a fee for a license issued or renewed through the Compact.
(b) The Interstate Commission is authorized to develop rules regarding fees for expedited
licenses.
"§ 90-21.167. Renewal and continued participation.
(a) A physician seeking to renew an expedited license granted in a member state shall
complete a renewal process with the Interstate Commission if t he physician meets all of the
following qualifications:
(1) Maintains a full and unrestricted license in a state of principal license.
(2) Has not been convicted, received adjudication, deferred adjudication,
community supervision, or deferred disposition for any offense by a court of
appropriate jurisdiction.
(3) Has not had a license authorizing the practice of medicine subject to discipline
by a licensing agency in any state, federal, or foreign jurisdiction, excluding
any action related to nonpayment of fees related to a license.
(4) Has not had a controlled substance license or permit suspended or revoked by
a state or the United States Drug Enforcement Administration.
(b) Physicians shall comply with all continuing professional development or continuing
medical education requirements for renewal of a license issued by a member state.
(c) The Interstate Commission shall collect any renewal fees charged for the renewal of
a license and distribute the fees to the applicable member board.
(d) Upon receipt of any renewal fees collected under subsect ion (c) of this section, a
member board shall renew the physician's license.
(e) Physician information collected by the Interstate Commission during the renewal
process will be distributed to all member boards.
(f) The Interstate Commission is authorized to develop rules to address renewal of
licenses obtained through the Compact.
"§ 90-21.168. Coordinated information system.
(a) The Interstate Commission shall establish a database of all physicians who are
licensed, or who have applied for licensure, under G.S. 90-21.165.
(b) Notwithstanding any other provision of law, member boards shall report to the
Interstate Commission any public action or complaints against a licensed physician who has
applied or received an expedited license through the Compact.
(c) Member boards shall report disciplinary or investigatory information determined as
necessary and proper by rule of the Interstate Commission.
(d) Member boards may report any nonpublic complaint, disciplinary, or investigatory
information not required by subsection (c) of this section to the Interstate Commission.

House Bill 67 Session Law 2025-37 Page 5
(e) Member boards shall share complaint or disciplinary information about a p hysician
upon request of another member board.
(f) All information provided to the Interstate Commission or distributed by member
boards shall be confidential, filed under seal, and used only for investigatory or disciplinary
matters.
(g) The Interstate Commission is authorized to develop rules for mandated or
discretionary sharing of information by member boards.
"§ 90-21.169. Joint investigations.
(a) Licensure and disciplinary records are deemed investigative.
(b) In addition to authority granted to a member board by its respective medical practice
act or other applicable state law, a member board may partici pate with other member boards in
joint investigations of physicians licensed by the member boards.
(c) A subpoena issued by a member state shall be enforceable in other member states.
(d) Member boards may share any investigative, litigation, or compliance materials in
furtherance of any joint or individual investigation initiated under the Compact.
(e) Any member state may investigate actual or alleged violations of the statutes
authorizing the practice of medicine in any other member state in which a physician holds a
license to practice medicine.
"§ 90-21.170. Disciplinary actions.
(a) Any disciplinary action taken by any member board against a physician licensed
through the Compact shall be deemed unprofessional conduct which may be subject to discipline
by other member boards, in addition to any violation of the medical practice act or regulations in
that state.
(b) If a license granted to a physician by the member board in the state of principal license
is revoked, surrendered, or relinquished in lieu of discipline, or suspended, then all licenses issued
to the physician by member boards shall automatically be place d, without further action
necessary by any member board, on the same status. If the member board in the state of principal
license subsequently reinstates the physician 's license, a license issued to the physician by any
other member board shall remain encumbered until that respective member board takes action to
reinstate the license in a manner consistent with the medical practice act of that state.
(c) If disciplinary action is taken against a physician by a member board not in the state
of principal license, any other member board may deem the action conclusive as to matter of law
and fact decided and take one of the following actions:
(1) Impose the same or lesser sanctions against the physician consistent with the
medical practice act of that state.
(2) Pursue separate disciplinary action against the physician under its respective
medical practice act, regardless of the action taken in other member states.
(d) If a license granted to a physician by a member board is revoked , surrendered, or
relinquished in lieu of discipline, or suspended, then any licenses issued to the physician by any
other member boards shall be suspended, automatically and immediately without further action
necessary by the other member boards, for 90 days upon entry of the order by the disciplining
board, to permit the member boards to investigate the basis for the action under the medical
practice act of that state. A member board may terminate the automatic suspension of the license
it issued prior to the completion of the 90-day suspension period in a manner consistent with the
medical practice act of that state.
"§ 90-21.171. Interstate Medical Licensure Compact Commission.
(a) The member states hereby create the "Interstate Medical Licensure Compact
Commission."
(b) The purpose of the Interstate Commission is the administration of the Interstate
Medical Licensure Compact, which is a discretionary state function.

Page 6 Session Law 2025-37 House Bill 67
(c) The Interstate Commission shall be a body corporate and joint agency of the member
states and shall have all of the responsibilities, powers, and duties set forth in the Compact, and
additional powers as may be conferred upon it by a subsequent concurrent action of the respective
legislatures of the member states in accordance with the terms of the Compact.
(d) The Interstate Commission shall consist of two voting representatives appointed by
each member state who shall serve as Commissioners. In states where allopathic and osteopathic
physicians are regulated by separate member boards, or if the licensing and disciplinary authority
is split between separate member boards, or if the licensing and disciplinary authority is split
between multiple member boards within a me mber state, the member state shall appoint one
representative from each member board. A Commissioner shall meet one of the following
qualifications:
(1) An allopathic or osteopathic physician appointed to a member board.
(2) An executive director, executive secretary, or similar executive member of a
member board.
(3) A member of the public appointed to a member board.
(e) The Interstate Commission shall meet at least once each calendar year. A portion of
this meeting shall be a business meeting to address matters that come properly before the
Commission and for the election of officers. The chairperson may call add itional meetings and
shall call for a meeting upon the request of a majority of the member states.
(f) The bylaws may provide for meetings of the Interstate Co mmission to be conducted
by telecommunication or electronic communication.
(g) Each Commissioner participating at a meeting of the Interstate Commission is entitled
to one vote . A majority of Commissioners shall constitute a quo rum for the transaction of
business, unless a larger quorum is required by the bylaws adopted by the Interstate Commission.
A Commissioner shall not delegate a vote to another Commissioner. In the absence of its
Commissioner, a member state may delegate voting authority for a specified meeting to another
person from that state who shall meet the requirements of subsection (d) of this section.
(h) The Interstate Commission shall provide public notice of all meetings , and all
meetings shall be open to the public. The Interstate Commission may close a meeting, in full or
in portion, where it determines by a two-thirds vote of the Commissioners present that an open
meeting would be likely to:
(1) Relate solely to the internal personnel practice and procedures of the Interstate
Commission.
(2) Discuss matters specifically exempted from disclosure by federal statute.
(3) Discuss trade secrets, commercial, or financial information that is privileged
or confidential.
(4) Involve accusing a person of a crime, or formally censuring a person.
(5) Discuss information of a personal nature where disclosure would constitute a
clearly unwarranted invasion of personal privacy.
(6) Discuss investigative records compiled for law enforcement purposes.
(7) Specifically relate to the participation in a civil action or other legal
proceeding.
(i) The Interstate Commission shall keep mi nutes which shall fully describe all matters
discussed in a meeting and shall provide a full and accurate summary of actions taken, including
record of any roll call votes.
(j) The Interstate Commission shall make its information and official records , to the
extent not otherwise designated in the Compact or by its rules, available for public inspection.
(k) The Interstate Commission shall establish an executive committee, which shall
include officers, members, and others as determined by the bylaws. The executive committee
shall have the power to act on behalf of the Interstate Commission, with the exception of
rulemaking, during periods when the Interstate Commission is not in session. When acting on

House Bill 67 Session Law 2025-37 Page 7
behalf of the Interstate Commission, the executive committee shall oversee the administration of
the Compact, including enforcement and compliance with the provisions of the Compact , its
bylaws and rules, and other such duties as necessary.
(l) The Interstate Commission shall establish other committees for governance and
administration of the Compact.
"§ 90-21.172. Powers and duties of the Interstate Commission.
The Interstate Commission has the following powers and duties:
(1) Oversee and maintain the administration of the Compact.
(2) Promulgate rules which shall be b inding to the extent and in the manner
provided for in the Compact.
(3) Issue, upon the request of a member state or member board, advisory opinions
concerning the meaning or interpretation of the Compact, its bylaws, rules,
and actions.
(4) Enforce compliance with Compact provisions , the rules promulgated by the
Interstate Commission, and the bylaws, using all necessary and proper means,
including, but not limited to, the use of the judicial process.
(5) Establish and appoint committees, including, but not limited to, an executive
committee as required by G.S. 90-21.171, which shall have the power to act
on behalf of the Interstate Commission in carrying out its powers and duties.
(6) Pay or provide payment of the expenses related to the establishment,
organization, and ongoing activities of the Interstate Commission.
(7) Establish and maintain one or more offices.
(8) Borrow, accept, hire, or contract for services of personnel.
(9) Purchase and maintain insurance and bonds.
(10) Employ an executive director who shall have such powers to employ, select,
or appoint employees, agents, or consultants, and to determine their
qualifications, define their duties, and fix their compensation.
(11) Establish personnel policies and programs relating to conflicts of interest,
rates of compensation, and qualifications of personnel.
(12) Accept donations and grants of money, equipment, supplies, materials, and
services and to receive, utilize, and dispose of it in a manner consistent with
the conflict of interest policies established by the Interstate Commission.
(13) Lease, purchase, accept contributions or donations of, or otherwise to hold,
own, improve, or use any property, real, personal, or mixed.
(14) Sell, convey, mortgage, pledge, lease, exchange, aba ndon, or otherwise
dispose of any property, real, personal, or mixed.
(15) Establish a budget and make expenditures.
(16) Adopt a seal and bylaws governing the management and operation of the
Interstate Commission.
(17) Report annually to the legislatures and governors of the member states
concerning the activities of the Interstate Commission dur ing the preceding
year. Such reports shall also include reports of financial audits and any
recommendations that may have been adopted by the Interstate Commission.
(18) Coordinate education, training, and public awareness regarding the Compact,
its implementation, and its operation.
(19) Maintain records in accordance with the bylaws.
(20) Seek and obtain trademarks, copyrights, and patents.
(21) Perform such functions as may be necessary or appropriate to achieve the
purpose of the Compact.
"§ 90-21.173. Finance powers.

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(a) The Interstate Commission may levy on and collect an annual assessment from each
member state to cover the cost of the operations and activities of the Interstate Commission and
its staff. The total assessment must be sufficient to cover the annual budget approved each year
for which revenue is not provided by other sources. The aggregate annual assessment amount
shall be allocated upon a formula to be determined by the Interstate Commission, wh ich shall
promulgate a rule binding upon all member states.
(b) The Interstate Commission shall not incur obligat ions of any kind prior to securing
the funds adequate to meet the same.
(c) The Interstate Commission shall not pledge the credit of any of the member states,
except by, and with the authority of, the member state.
(d) The Interstate Commission shall be subject to a yearly financial audit conducted by a
certified or licensed accountant, and the report of the audit shall be included in the annual report
of the Interstate Commission.
"§ 90-21.174. Organization and operation of the Interstate Commission.
(a) The Interstate Commission shall, by a majority of Commissioners present and voting,
adopt bylaws to govern its conduct as may be necessary or appropriate to carry out the purposes
of the Compact within 12 months of the first Interstate Commission meeting.
(b) The Interstate Commission shall elect or appoint annually fr om among its
Commissioners a chairperson, a vice-chairperson, and a treasurer, each of whom shall have such
authority and duties as may be specified in the bylaws. The chairperson, or in the chairperson 's
absence or disability the vice -chairperson, shall p reside at all meetings of the Interstate
Commission.
(c) Officers selected in subsection (b) of this section shall serve without remuneration for
the Interstate Commission.
(d) The officers and employees of the Interstate Commission shall be immune from su it
and liability, either personally or in their official capacity , for a claim for damage to or loss of
property or personal injury or other civil liability caused or arising out of, or relating to, an actual
or alleged act, error, or omission that occurred, or that such person had a reasonable basis for
believing occurr ed, within the scope of Interstate Commission employment, duties, or
responsibilities, provided that such person shall not be protected from suit or liability for damage,
loss, injury, or liability caused by the intentional or willful and wanton misconduct of such
person.
(e) The liability of the executive director and employees of the Interstate Commission or
representatives of the Interstate Commission, acting within the scope of such person 's
employment or duties for acts, errors, or omissions occurring within such person's state, may not
exceed the limits of liability set forth under the constitution and laws of that state for state
officials, employees, and ag ents. The Interstate Commission is considered to be an
instrumentality of the states for the pu rpose of any such action. Nothing in this subsection shall
be construed to protect such person from suit or liability for damage, loss, injury, or liability
caused by the intentional or willful and wanton misconduct of such person.
(f) The Interstate Commi ssion shall defend the executive director, its employees, and
subject to the approval of the attorney general or other appropriate legal counsel of the member
state represented by an Interstate Commission representative , shall defend such Interstate
Commission representative in any civil action seeking to impose liability arising out of an actual
or alleged act, error, or omission that occurred within the scope of Interstate Commission
employment, duties, or responsibilities, or that the defendant had a reasonable basis for believing
occurred within the scope of Interstate Commission employment, duties, or responsibilities,
provided that the actual or alleged act, error, or omission did not result from intentional or willful
and wanton misconduct on the part of such person.
(g) To the e xtent not covered by the state involved, member state, or the Interstate
Commission, the representatives or employees of the Interstate Commission shall be held

House Bill 67 Session Law 2025-37 Page 9
harmless in the amount of a settlement or judgment, including attorneys' fees and costs, obtained
against such persons arising out of an actual or alleged act, error, or omission that occurred within
the scope of Interstate Commission employment, duties, or responsibilities, or that such persons
had a reasonable basis for believing occurred within the scope of Interstate Commis sion
employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission
did not result from intentional or willful and wanton misconduct on the part of such person.
"§ 90-21.175. Rulemaking functions of the Interstate Commission.
(a) The Interstate Commission shall promulgate reasonable rules in order to effec tively
and efficiently achieve the purpose of the Compact. Notwithstanding the foregoing, in the event
the Interstate Commission exercises its rulemaking authority in a manner that is beyond the scope
of the purposes of the Compact, or the powers granted h ereunder, then such an action by the
Interstate Commission shall be invalid and have no force or effect.
(b) Rules deemed appropriate for the operations of the Interstate Commission shall be
made pursuant to a rulemaking process that substantially conforms to the "Revised Model State
Administrative Procedure Act" of 2010, and subsequent amendments thereto.
(c) Not later than 30 days after a rule is promulgated, any person may file a petition for
judicial review of the rule in the United States District Court for the District of Columbia or the
federal district where the Interstate Commission has its principal offices, provided that the filing
of such a petition shall not stay or otherwise prevent the rule from becoming effective unless the
court finds that the petitioner has substantial likelihood of success. The court shall give deference
to the actions of the Interstate Commission consistent with applicable law and shall not find the
rule to be unlawful if the rule represents a reasonable exercise of the authority granted to the
Interstate Commission.
"§ 90-21.176. Oversight of Interstate Compact.
(a) The executive, legislative, and judicial branches of state government in each member
state shall enforce the Compact and shall take all actions necessary and appropriate to effectuate
the Compact's purposes and intent. T he provisions of the Compact and the rules promulgated
hereunder shall have standing as statutory law but shall not override existing state authority to
regulate the practice of medicine.
(b) All courts shall take judicial notice of the Compact and the rules in any judicial or
administrative proceeding in a member state pertaining to the subject matter of the Compact
which may affect the powers, responsibilities, or action of the Interstate Commission.
(c) The Interstate Commission shall be entitled to receive all services of process in any
such proceeding and shall have standing to intervene in the proceeding for all purposes. Failure
to provide service of process to the Interstate Commission shall render a judgment or order void
as to the Interstate Commission, the Compact, or promulgated rules.
"§ 90-21.177. Enforcement of Interstate Compact.
(a) The Interstate Commission, in the reasonable exercise of its discretion, shall enforce
the provisions and rules of the Compact.
(b) The Interstate Commission may, by majority vote of the Commissioners, initiate legal
action in the United States District Court for the District of Columbia, or, at the discretion of the
Interstate Commission, in the federal district where the Interstate Commission has its principal
offices, to enforce compliance with the provisions of the Compact, and its promulgated rules and
bylaws, against a member state in default. The relief sought may in clude both injunctive relief
and damages. In the event judicial enforcement is necessary, the prevailing party shall be awarded
all costs of such litigation, including reasonable attorneys' fees.
(c) The remedies herein shall not be the exclusive remedies of the Interstate Commission.
The Interstate Commission may avail itself of any other remedies available under state law or
regulation of a profession.
"§ 90-21.178. Default procedures.

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(a) The grounds for default inc lude, but are not limited to, failure of a member state to
perform such obligations or responsibilities imposed upon it by the Compact, or the rules and
bylaws of the Interstate Commission promulgated under the Compact.
(b) If the Interstate Co mmission determines that a member state has defaulted in the
performance of its obligations or responsibilities under the Compact, or the bylaws or
promulgated rules, the Interstate Commission shall do all of the following:
(1) Provide written notice to the default ing state and other member states of the
nature of the default, the means of curing the default, and any action taken by
the Interstate Commission. The Interstate Commission shall specify the
conditions by which the defaulting state must cure its default.
(2) Provide remedial training and specific technical assistance regarding the
default.
(c) If the defaulting state fails to cure the default, the defaulting state shall be terminated
from the Compact upon an affirmative vote of a majority of the Commissioners , and all rights,
privileges, and benefits conferred by the Compact shall terminate on the effective date of
termination. A cure of the default does not relieve the offending state of obligations or liabilities
incurred during the period of default.
(d) Termination of membership in the Compact shall be imposed only after all other
means of securing compliance have been exhausted. Notice of intent to terminate shall be given
by the Interstate Commission to the governor, the majority and minority leaders of the defaulting
state's legislature, and each of the member states.
(e) The Interstate Commission shall establish rules and procedures to address licenses
and physicians that are materially impacted by the termination of a member state or the
withdrawal of a member state.
(f) The member state which has been terminated is responsible for all dues, obligations,
and liabilities incurred through the effective date of termination , including obligations, the
performance of which extends beyond the effective date of termination.
(g) The Interstate Commission shall not bear any costs relating to any state that has been
found to be in default or which has been terminated from the Compact, unless otherwise mutually
agreed upon in writing between the Interstate Commission and the defaulting state.
(h) The defaulting state may appeal the action of the Interstate Commission by petitioning
the United States District Court for the District of Columbia or the federal district where the
Interstate Commission has its principal offices. The prevailing party shall be awarded all costs
of such litigation, including reasonable attorneys' fees.
"§ 90-21.179. Dispute resolution.
(a) The Interstate Commission shall attempt to resolve disputes upon the request of a
member state, which are subject to the Compact and which may arise among member states or
member boards.
(b) The Interstate Commission shall promulgate rules providing for bo th mediation and
binding dispute resolution as appropriate.
"§ 90-21.180. Member states; effective date; amendment.
(a) Any state is eligible to become a member of the Compact.
(b) The Compact shall become effective and binding upon legislative enactment of the
Compact into law by no less than seven states. Thereafter, it shall become effective and binding
on a state upon enactment of the Compact into law in that state.
(c) The governors of nonmember states, or their designees, shall be invited to participate
in the activities of the Interstate Commission on a nonvoting basis prior to adoption of the
Compact by all states.
(d) The Interstate Commission may propose amendments to the Compact for enactment
by the member states. No amendment shall become effective and binding upon the Interstate

House Bill 67 Session Law 2025-37 Page 11
Commission and the member states unless and until it is enacted into law by unanimous consent
of the member states.
"§ 90-21.181. Withdrawal.
(a) Once effective, the Compact shall continue in force and remain binding upon each
and every member state, provided that a member st ate may withdraw from the Compact by
specifically repealing the statutes which enacted the Compact into law.
(b) Withdrawal from the Compact shall be by the enactment of a statute repealing the
same but shall not take effect until one year after the effective date of such statute and until
written notice of the withdrawal has been given by the withdrawing state to the governor of each
other member state.
(c) The withdrawing state shall immediately notify the chairperson of the Interstate
Commission in writing upon the introduction of legislation repealing the Compact in the
withdrawing state.
(d) The Interstate Commission shall notify the other member states of the withdrawing
state's intent to withdraw within 60 days of its receipt of notice provided under subsection (c) of
this section.
(e) The withdrawing state is responsible for all dues, obligations, and liabilities incurred
through the effective date of withdrawal, including obligations, the performance of which extend
beyond the effective date of withdrawal.
(f) Reinstatement following withdrawal of a member state shall occur upon the
withdrawing date reenacting the Compact or upon such later date as determined by the Interstate
Commission.
(g) The Interstate Commission is authorized to develop rules to address the impact of the
withdrawal of a member state on licenses granted in other member states to physicians who
designated the withdrawing member state as the state of principal license.
"§ 90-21.182. Dissolution.
(a) The Compact shall dissolve effective upon the date of the withdrawal or default of
the member state which reduces the membership of the Compact to one member state.
(b) Upon the dissolution of the Compact, the Compact becomes nul l and void and shal l
be of no further force or effect, and the business and affairs of the Interstate Commission shall
be concluded, and surplus funds shall be distributed in accordance with the bylaws.
"§ 90-21.183. Severability and construction.
The provisions of the Compact shall be severable, and if any phrase, clause, sentence, or
provision is deemed unenforceable, the remaining provisions of the Compact shall be
enforceable. The provisions of the Compact shall be liberally construed to effectuate its purposes.
Nothing in the Compact shall be construed to prohibit the applicability of other interstate
compacts to which the member states are members.
"§ 90-21.184. Binding effect of Compact and other laws.
(a) Nothing herein prevents the enforcement of any other law of a member state that is
not inconsistent with the Compact.
(b) All laws in a member state in conflict with the Compact are superseded to the extent
of the conflict.
(c) All lawful actions of the Interstate Commis sion, including all rules and bylaws
promulgated by the Commission, are binding upon the member states.
(d) All agreements between the Interstate Commission and the member states are binding
in accordance with their terms.
(e) In the event any provision of the Compact exceeds the constitutional limits imposed
on the legislature of any member state, such provision shall be ineffective to the extent of the
conflict with the constitutional provision in question in that member state."
SECTION 1.(b) G.S. 90-5.1 reads as rewritten:
"§ 90-5.1. Powers and duties of the Board.

Page 12 Session Law 2025-37 House Bill 67
(a) The Board shall have the following powers and duties:
…
(11) Appoint two Commissioners to serve on the Interstate Medical Licensure
Compact Commission. Commissioners must meet one of the following
requirements: be (i) a curre nt physician Board member, (ii) an executive
director or similar executive member, or (iii) a current public Board member.
…."
SECTION 1.(c) G.S. 90-11(b) reads as rewritten:
"(b) The Department of Public Safety may p rovide a criminal record check to the Board
for a person who has applied for a license through the Board. Board and for purposes of
G.S. 90-21.165. The Board shall provide to the Department of Public Safety, along with the
request, the fingerprints of the applicant, any additional information required by the Department
of Public Safety, and a form signed by the applicant consenting to the check of the criminal
record and to the use of the fingerprints and other identifying information required by the State
or national repositories. The applicant's fingerprints shall be forwarded to the State Bureau of
Investigation for a search of the State's criminal history record file, and the State Bureau of
Investigation shall forward a set of the fingerprints to the Fe deral Bureau of Investigation for a
national criminal history check. The Board shall keep all information pursuant to this subsection
privileged, in accordance with applicable State law and federal guidelines, and the information
shall be confidential and shall not be a public record under Chapter 132 of the General Statutes.
The Department of Public Safety may charge each applicant a fee for conducting the checks
of criminal history records authorized by this subsection. The Board has the authority to coll ect
this fee from each applicant and remit it to the Department of Public Safety."
SECTION 1.(d) G.S. 90-13.1 reads as rewritten:
"§ 90-13.1. License fees.
…
(g) Each applicant for a license issued or renewed through the Interstate Medical
Licensure Compact in accordance with Article 1O of Chapter 90 of the General Statutes shall be
subject to any additional fees or assessments as determined by the Board or the Interstate Medical
Licensure Compact Commission t o cover any costs incurred by the Board for the participation
in the Interstate Medical Licensure Compact."
SECTION 1.(e) G.S. 90-13.2 reads as rewritten:
"§ 90-13.2. Registration every year with Board.
(a) Every Except as provided for in Article 1 O of Chapter 90 of the General Statutes,
every licensee shall register annually with the Board no later than 30 days after the person's
birthday.
…
(g) Upon payment of all accumulated fees and penalties, the license of the licensee may
be reinstated, subjec t to the Board requiring the licensee to appear before the Board for an
interview and to comply with other licensing requirements. The Except as provided in
G.S. 90-21.166, the penalty may not exceed the applicable maximum fee for a license under
G.S. 90-13.1.
…."
SECTION 1.(f) G.S. 90-14 reads as rewritten:
"§ 90-14. Disciplinary Authority.
(a) The Board shall have the power to place on probation with or without conditions,
impose limitations and conditions on, publicly reprimand, assess monetary redre ss, issue public
letters of concern, mandate free medical services, require satisfactory completion of treatment
programs or remedial or educational training, fine, deny, annul, suspend, or revoke a license, or
other authority to practice medicine in this State, issued by the Board to any person who has been

House Bill 67 Session Law 2025-37 Page 13
found by the Board to have committed any of the following acts or conduct, or for any of the
following reasons:
…
(18) A violation of Article 1 O of Chapter 90 of the General Statutes, consistent
with the provisions of that Article for qualifying licensees.
…."
SECTION 1.(g) G.S. 90-14.2 reads as rewritten:
"§ 90-14.2. Hearing before disciplinary action.
(a) Before Except as provided in G.S. 90-21.170, before the Board shall take disciplinary
action against any license granted by it, the licensee shall be given a written notice indicating the
charges made against the licensee and stating that the licensee will be given an opportunity to be
heard concerning the charges at a time and place stated in the notice, or at a time and place to be
thereafter designated by the Board, and the Board shall hold a public hearing not less than 30
days from the date of the service of notice upon the licensee, at which the licensee may appear
personally and through coun sel, may cross examine witnesses and present evidence in the
licensee's own behalf. A licensee who is mentally incompetent shall be represented at such
hearing and shall be served with notice as herein provided by and through a guardian ad litem
appointed by the clerk of the court of the county in which the licensee resides. The licensee may
file written answers to the charges within 30 days after the service of the notice, which answer
shall become a part of the record but shall not constitute evidence in the case.
…."
SECTION 1.(h) This Part becomes effective January 1, 2026.

PART II. INTERNATIONAL PHYSICIAN LICENSURE
SECTION 2.(a) Article 1 of Chapter 90 of the General Statutes is amended by adding
a new section to read:
"§ 90-12.03. Internationally-trained physician employee license.
(a) The Board may issue an "internationally-trained physician employee license " to
practice medicine and surgery to a physician when the Board has received sati sfactory
verification of all of the following requirements:
(1) The applicant has been offered employment as a physician in a full -time
capacity at (i) a hospital that is located in North Carolina and licensed by the
State of North Carolina or (ii) a medical practice located in a rural county with
a population of less than 500 people per square mile, in North Carolina, where
a physician fully licensed by the State under this Chapter is physically
practicing on-site at the rural medical practice.
(2) The applicant has a current and active license in good standing to practice
medicine in a foreign country or had that type of license expire no more than
five years prior to submission of an application to the Board.
(3) The applicant previously completed 130 weeks of medical education at a
medical school listed in the World Dictionary of Medical Schools and is
eligible to be certified by the Educational Commission for Foreign Medical
Graduates and meets one of the following requirements:
a. The applicant has completed two years of postgraduate training in a
graduate medical education program approved by the applicant 's
country of licensure.
b. The applicant has actively practiced medicine in the applicant 's
country of licensure for at least 10 years after graduation.
(4) The applicant has demonstrated competency to practice medicine in one of the
following ways:

Page 14 Session Law 2025-37 House Bill 67
a. Successfully passing each part of an examination listed in
G.S. 90-10.1.
b. Successfully passing each part of a nationally recognized standard
medical licensing examination from a country that is a member of the
International Association of Medical Regulatory Authorities that
meets all of the following requirements:
1. Tests for the ability to practice medicine.
2. Tests for m edical knowledge, skills , and understanding of
clinical science essential for providing patient care, including
general practice, cardiology, internal medicine,
gastroenterology, hematology, nephrology, neurology,
pediatrics, psychiatry, pulmonology, obste trics and
gynecology, radiology, rheumatology, urology, and surgery.
3. Tests for communication and interpersonal skills.
4. Includes an interactive testing component.
The examining body must provide verification in English directly to
the Board that the applicant has passed an examination meeting the
requirements of this sub-subdivision.
c. Receiving specialty board certification as approved by any of the
following:
1. The American Board of Medical Specialties.
2. The Bureau of Osteopathic Specialists of the American
Osteopathic Association.
3. The Royal College of Physicians and Surgeons of Canada.
4. Any other specialty board recognized pursuant to rules adopted
by the Board.
d. Submitting to a comprehensive assess ment demonstrating clinical
competence by a program approved by the Board.
Alternatively, the Board may waive the requirements of this subdivision 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.
(5) The applicant has not had a license revoked, suspended, restricted, denied, or
otherwise acted against in any jurisdiction and is the subject of no pending
investigations. For purposes of this subdivision, the licensing authority 's
acceptance of a license to practice voluntarily relinquished by a licensee or
relinquished by stipulation, consent order, or other settlement in response to or
in anticipation of the filing of administrative char ges against the licensee 's
license, or an inactivation or voluntary surrender of a license while under
investigation, is deemed to be an action against a license to practice.
(6) The applicant does 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. The applicant shall submit
to, and the Board must receive, a background screening from the country in which
they are licensed.
(7) The applicant has practiced medicine for at least five years.
(8) The applicant is proficient in English.
(9) The applicant is legally authorized to work in the United States. An applicant
may apply for an internationally -trained physician employee license before
receiving federal work authorization but may not begin employment with the

House Bill 67 Session Law 2025-37 Page 15
North Carolina hospital or rural medical practice until receiving legal work
authorization from the relevant federal agency.
(10) The applicant submits an application fee pursuant to G.S. 90-13.1(a).
(b) The holder of the internationally-trained physician employee license issued under this
section shall not practice medicine or surgery outside the confines of the North Carolina hospital
or rural medical practice, or its affiliate, by whose employment the holder was qualified to be
issued the license pursuant to subdivision (1) of subsection (a) of this section . A person who
violates this subsection shall be guilty of a Class 3 misdemeanor and, upon conviction, shall be
fined not more than five hundred dollars ($500.00) for each offense. The Board, at its discretion,
may revoke the special license after due notice is given to the holder of the certified physician
employee license.
(c) An internationally-trained physician employee license shall become inactive at the
time its holder does one or more of the following:
(1) Ceases to be employed in a full-time capacity by a North Carolina hospital or
medical practice meeting the criteria set forth in subdivision (1) of subsection
(a) of this section.
(2) Ceases to be employed at a medical practice located in a rural county or
practices if a physician licensed by the State under this Chapte r is not
physically practicing on-site at the medical practice.
(3) Obtains any other license to practice medicine issued by the Board.
The Board shall retain jurisdiction over the holder of the inactive license.
(d) A physician with an inter nationally-trained physician employee license shall be
eligible to apply for a full license to practice medicine in North Carolina after four years of active
practice in North Carolina. The Board shall grant a full license if the applicant has no disciplinary
actions by any state, federal, or foreign regulatory agency, no pending investigations by any state,
federal, or foreign regulatory agency, no misdemeanor convictions in the two years preceding
their application for a full license, no felony convictions, no pendi ng misdemeanor or felony
charges, and no adverse actions affecting their privileges or ability to practice. For purposes of
this section, "misdemeanor" shall not include traffic violations.
(e) The Board, in consultation with partner organizations as neede d, shall collect
information necessary to evaluate the implementation and success of the pathway to licensure
established in this section, including at least the following:
(1) The number of applicants for provisional licensure.
(2) The applicant's licensing country or country where they were authorized to
practice medicine and, if different, country of education and training.
(3) The number of provisional licenses granted under this section.
(4) The number of provisional licenses denied under this section.
(5) The number of full and unrestricted licenses granted to applicants who
completed the pathway to licensure established in this section.
(6) The number of full and unrestricted license applications denied to applicants
who completed the pathway to licensure established in this section.
(7) The reasons for denial of applications for provisional and full unrestricted
licenses under this section.
(8) The number of complaints received regarding holders of a provisional license
issued under this section and the disciplinary actions taken, if any.
(9) The practice setting and specialty of applicants in their licensing country or
country of origin and as employed during their provisional and limited
licensure.
(10) The geographic area or rural/urban designation of where licensees practice
during provisional licensure and after the period of provisional licensure.

Page 16 Session Law 2025-37 House Bill 67
(11) The practice setting and specialty of internationally -trained physicians who
completed the pathway to licensure upon receiving a full a nd unrestricted
license.
(f) Annually on or before December 1, the Board shall report the information collected
pursuant to subsection ( e) of this section for the previous calendar year to the Joint Legislative
Oversight Committee on Health and Human Services."
SECTION 2.(b) The North Carolina Medical Board (Board) shall adopt rules
necessary to issue an internationally -trained physician employee license. The Board may adopt
a rule establishing a time limit for the term of an internationally -trained physician employee
license. The Board may also adopt rules to implement Section 1 of this act.
SECTION 2.(c) It is the intention of the General Assembly that the provisions of
this Part shall be severable. If any provision of this act or its application to any person or
circumstance is held invalid, the remainder of the act or the application of the provision to other
persons or circumstances is not affected, including, but not limited to, the applicability of this act
to the provisions of future agreements subject to this act.
SECTION 2.(d) This Part becomes effective January 1, 2026.

PART III. MASTER'S LEVEL PSYCHOLOGIST REFORMS
SECTION 3.(a) G.S. 90-270.139 reads as rewritten:
"§ 90-270.139. Application; examination; supervision; provisional and temporary licenses.
…
(e) Except as provided in subsection (e1) of this section:
(1) A licensed psychological associate shall be supervised by a qualified licensed
psychologist, or other qualified professionals, licensed psychological
associate in accordance with Board rules specifying the format, setting,
content, time frame, amounts of s upervision, qualifications of supervisors,
disclosure of supervisory relationships, the organization of the supervised
experience, and the nature of the responsibility assumed by the supervisor.
(2) A licensed psychological associate who provides health se rvices shall be
supervised, for those activities requiring supervision, supervised by a
qualified licensed psychologist holding health services provider certification
or by other a qualified professionals licensed psychological associat e under
the overall direction of a qualified licensed psychologist holding health
services provider certification, in accordance with Board rules.
(3) Except as provided below, supervision, Supervision, including the supervision
of health services, is required only when a lic ensed psychological associate
engages in: assessment of personality functioning; neuropsychological
evaluation; psychotherapy, counseling, and other interventions with clinical
populations for the purpose of preventing or eliminating symptomatic,
maladaptive, or undesired behavior; and, the use of intrusive, punitive, or
experimental procedures, techniques, or measures. The Board shall adopt
rules implementing and defining this provision, and as the practice of
psychology evolves, may identify additional ac tivities requiring supervision
in order to maintain acceptable standards of practice .in the practice of
psychology in accordance with Board rules.
(e1) The Board shall approv e any licensed psychological associate to engage in
independent practice, without supervision by a qualified licensed psychologist or qualif ied
licensed psychological associate , if the licensed psychological associate meets all of the
following requirements:
(1) Has 4,000 hours of post-licensure experience in the delivery of psychological
services under the supervision of one or more qualified licensed psychologists

House Bill 67 Session Law 2025-37 Page 17
or qualified licensed psychological associates within a time period of at least
24 consecutive months and less than 60 consecutive months.
(2) Documents that all performance ratings for the 4,000 hours of post-licensure
experience required by subdivision (1) of this subsection have been average
or above average.
(3) Submits an application for independent practice with proof of the 4,000 hours
of post-licensure experience required by subdivision (1) of this subsection.
…."
SECTION 3.(b) G.S. 90-270.145 reads as rewritten:
"§ 90-270.145. Licensure; examination; foreign graduates.
…
(b) Licensed Psychological Associate. –
…
(3) No licensed psychological associate shall engage in the pr actice of
neuropsychology or forensic psychology without first demonstrating
specialized education and training to practice in those areas as the Board may
determine by rule. In considering whether the licensed psychological associate
has sufficient specialized education and training to engage in the practice of
neuropsychology or forensic psychology, the Board may consider the licensed
psychological associate's graduate level course work, continuing education,
supervised training experience, or any other factors the Board deems
appropriate. For purpose s of this subdivision, "neuropsychology" is defined
as "the branch of science that studies the physiological processes of the
nervous system and relates them to be havior and cognition " and "forensic
psychology" is defined as "the application of psychological principles and
techniques to situations that are involved in the civil and criminal legal
systems, including, but not limited to, psychological assessments and expert
testimony."
…."
SECTION 3.(c) G.S. 90-270.153 reads as rewritten:
"§ 90-270.153. Provision of health services; certification as health services provider.
(a) Health services, as defined in G.S. 90-270.136(4) and G.S. 90-270.136(8), may be
provided by qualified licensed psychological associates, qualified licensed psychologists holding
provisional, temporary, or permanent licenses, or qualified applicants. Qualified Except as
provided in subsection (h) of this section, qua lified licensed psychological associates, qualified
licensed psychologists holding provisional or temporary licenses, or qualified applicants may
provide health services only under supervision as specified in the duly adopted rules of the Board.
…
(h) A licensed psychological associate who possesses a certification as a health services
provider psychological associate in accordance with subsection (c) of this section may provide
health services without supervision upon meeting the requirements in G.S. 90-270.139(e1).
(i) Notwithstanding the provisions of subsection (h) of this section, a licensed
psychological associate who was licensed before June 30, 2013, who can demonstrate, in
accordance with Board rules, that he or she has been engaged in the provision of health services
psychology under supervision for 4,000 hours within a time period of at least 24 consecutive
months and less than 60 consecutive months shall meet the requirements for certification as a
health services provider psychological associate."
SECTION 3.(d) G.S. 90-270.140 reads as rewritten:
"§ 90-270.140. Psychology Board; appointment; term of office; composition.
For the purpose of carrying out the provisions of this Article, there is created a North Carolina
Psychology Board, which shall consist of seven members appointed by the Governor. At all times

Page 18 Session Law 2025-37 House Bill 67
three members shall be licensed psychologists, two members shall be licensed psychological
associates, and two members shall be members of the public who are not licensed under this
Article. The Governor shall give due consideration to the adequate representation of the various
fields and areas of practice of psychology and to adequate representation from various geographic
regions in the State. Terms of office shall be three years. All terms of service on the Board expire
June 30 in appropriate years. As the term of a psychologist member expires, or as a vacancy of a
psychologist member occurs for any other reason, the Board, the North Carolina Psychological
Association, or its successor, shall, and the North Carolina Association of Professional
Psychologists, or its successor, shall form a nominating committee and, having sought the advice
of the chairs of the graduate departments of psychology in the State, nominees from licensees for
each vacancy, shall submit to the Governor a list of the names of three eligible persons. From
this list the Governor shall make the appointment for a full term, or for the remainder of the
unexpired term, if any. Each Board member shall serve until hi s or her successor has been
appointed. As the term of a member expires, or if one should become vacant for any reason, the
Governor shall appoint a new member within 60 days of the vacancy's occurring. No member,
either public or licensed under this Articl e, shall serve more than three complete consecutive
terms."
SECTION 3.(e) This Part becomes effective October 1, 2025.

PART IV. PHYSICIAN ASSISTANT INTERSTATE LICENSURE COMPACT
SECTION 4.(a) Chapter 90 of the General Statutes is amended by adding a new
Article to read:
"Article 18J.
"PA Licensure Compact.
"§ 90-270.200. Purpose.
In order to strengthen access to Medical Services, and in recognition of the advances in the
delivery of Medical Services, the Participating States of the PA Licensure Compact have allied
in common purpose to develop a comprehensive process that complements the existing authority
of State Licensing Boards to license and discipline PAs and seeks to enhance the portabi lity of
License to practice as a PA while safeguarding the safety of patients. This Compact allows
Medical Services to be provided by PAs, via the mutual recognition of the Licensee's Qualifying
License by other Compact Participating States. This Compact also adopts the prevailing standard
for PA licensure and affirms that the practice and delivery of Medical Services by the PA occurs
where the patient is located at the time of the patient encounter, and therefore requires the PA to
be under the jurisdiction of the State Licensing Board where the patient is located. State Licensing
Boards that participate in this Compact retain the jurisdiction to impose Adverse Action against
a Compact Privilege in that State issued to a PA through the procedures of this Compact. The PA
Licensure Compact will alleviate burdens for military families by allowing active duty military
personnel and their spouses to obtain a Compact Privilege based on having an unrestricted
License in good standing from a Participating State.
"§ 90-270.201. Definitions.
The following definitions apply in this Compact:
(1) Adverse Action. – Any administrative, civil, equitable, or criminal action
permitted by a State 's laws which is imposed by a Licensing Board or other
authority against a PA License or License application or Compact Privilege
such as License denial, censure, revocation, suspension, probation,
monitoring of the Licensee, or restriction on the Licensee's practice.
(2) Compact Privilege. – The authorization granted by a Remote State to allow a
Licensee from another Participating State to practice as a PA to provide
Medical Services and other licensed activity to a patient located in the Remote
State under the Remote State's laws and regulations.

House Bill 67 Session Law 2025-37 Page 19
(3) Conviction. – A finding by a court that an individual is guilty of a felony or
misdemeanor offense through adjudication or entry of a plea of guilt or no
contest to the charge by the offender.
(4) Criminal Background Check. – The submission of f ingerprints or other
biometric-based information for a License applicant for the purpose of
obtaining that applicant's criminal history record information, as defined in 28
C.F.R. § 20.3(d), from the State's criminal history record repository, as
defined in 28 C.F.R. § 20.3(f).
(5) Data System. – The repository of information about Licensees, including, but
not limited to , License status and Adverse Actions, which is created and
administered under the terms of this Compact.
(6) Executive Committee. – A group of directors and ex officio individ uals
elected or appointed pursuant to G.S. 90-270.206(f)(2).
(7) Impaired Pract itioner. – A PA whose practice is adversely affected by
health-related condition(s) that impact their ability to practice.
(8) Investigative Information. – Information, records, or documents received or
generated by a Licensing Board pursuant to an investigation.
(9) Jurisprudence Requirement. – The assessment of an individual 's knowledge
of the laws and Rules governing the practice of a PA in a State.
(10) License. – Current authorization by a State, other than authorization pursuant
to a Compact Privilege, for a PA to provide Medical Services, which would
be unlawful without current authorization.
(11) Licensee. – An individual who holds a License from a State to provide
Medical Services as a PA.
(12) Licensing Board. – Any State entity authorized to license and otherwise
regulate PAs.
(13) Medical Services. – Health care services provided for the diagnosis,
prevention, treatment, cure, or relief of a health condition, injury, or disease,
as defined by a State's laws and regulations.
(14) Model Compact. – The model for the PA Licensure Compact on file with The
Council of State Go vernments or other entity as designated by the
Commission.
(15) Participating State. – A State that has enacted this Compact.
(16) PA. – An individual who is licensed as a physician assistant in a State. For
purposes of this Compact, any other title or status adopted by a State to replace
the term "physician assistant" shall be deemed synonymous with "physician
assistant" and shall confer the same rights and responsibilities to the Licensee
under the provisions of this Compact at the time of its enactment.
(17) PA Licensure Compact Commission, Compact Commission, or Commission.
– The national administrative body created pursuant to G.S. 90-270.206(a) of
this Compact.
(18) Qualifying License. – An unrestricted License issued by a Participating State
to provide Medical Services as a PA.
(19) Remote State. – A Participating State where a Licensee who is not licensed as
a PA is exercising or seeking to exercise the Compact Privilege.
(20) Rule. – A regulation promulgated by an entity that has the force and effect of
law.
(21) Significant Investigative Information. – Investigative Information that a
Licensing Board, after an inquiry or investigation that includes notification
and an opportunity for the PA to respond if required by State law, has reason

Page 20 Session Law 2025-37 House Bill 67
to believe is not groundless and, if proven true, would indicate more than a
minor infraction.
(22) State. – Any state, commonwealth, district, or territory of the United States.
"§ 90-270.202. State participation in this Compact.
(a) To participate in this Compact, a Participating State shall:
(1) License PAs.
(2) Participate in the Compact Commission's Data System.
(3) Have a mechanism in place for receiving and investigating complaints against
Licensees and License applicants.
(4) Notify the Commission, in compliance with the terms of this Compact and
Commission Rules, of any Adverse Action against a Licensee or License
applicant and the existence of Significant Investigative Information regarding
a Licensee or License applicant.
(5) Fully implement a Criminal Background Check requirement, within a time
frame established by Commission Rule, by its Licensing Board receiving the
results of a Criminal Background Check and reporting to the Commission
whether the License applicant has been granted a License.
(6) Comply with the Rules of the Compact Commission.
(7) Utilize passage of a recognized national exam such as the NCCPA PANCE as
a requirement for PA licensure.
(8) Grant the Compact Privilege to a holder of a Qualifying License in a
Participating State.
(b) Nothing in this Compact prohibits a Participating State from charging a fee for
granting the Compact Privilege.
"§ 90-270.203. Compact Privilege.
(a) To exercise the Compact Privilege, a Licensee must:
(1) Have graduated from a PA program accredited by the Accreditation Review
Commission on Education for the Physician Assistant, Inc., or other programs
authorized by Commission Rule.
(2) Hold current NCCPA certification.
(3) Have no felony or misdemeanor conviction.
(4) Have never had a controlled substance license, permit, or registration
suspended or revoked by a State or by the United States Drug Enforcement
Administration.
(5) Have a unique identifier as determined by Commission Rule.
(6) Hold a Qualifying License.
(7) Have had no revocation of a License or limitation or restriction on any License
currently held due to an Adverse Action.
(8) If a Licensee has had a limitation or restriction on a License or Compact
Privilege due to an Adverse Action, two years must have elapsed from the
date on which the License or Compact Privilege is no longer limited or
restricted due to the Adverse Action.
(9) If a Compact Privilege has been revoked or is limited or restricted in a
Participating State for conduct that would not be a basis for disciplinary action
in a Participating State in which the Lic ensee is practicing or applying to
practice under a Compact Privilege, that Participating State shall have the
discretion not to consider such action as an Adverse Action requiring the
denial or removal of a Compact Privilege in that State.
(10) Notify the Compact Commission that the Licensee is seeking the Compact
Privilege in a Remote State.

House Bill 67 Session Law 2025-37 Page 21
(11) Meet any Jurisprudence Requirement of a Remote State in which the Licensee
is seeking to practice under the Compact Privilege and pay any fees applicable
to satisfying the Jurisprudence Requirement.
(12) Report to the Commission any Adverse Action taken by a non -participating
State within 30 days after the action is taken.
(b) The Compact Privilege is valid until the expiration or revocation of the Qualifying
License unless terminated pursuant to an Adverse Action. The Licensee must also comply with
all of the requirements of subsection (a) of this section to maintain the Compact Privilege in a
Remote State. If the Participating State takes Adverse Action against a Qualifying License, the
Licensee shall lose the Compact Privilege in any Remote State in which the Licensee has a
Compact Privilege until all of the following occur:
(1) The License is no longer limited or restricted; and
(2) Two years have elapsed from t he date on which the License is no longer
limited or restricted due to the Adverse Action.
(c) Once a restricted or limited License satisfies the requirements of subdivisions (b)(1)
and (2) of this section, the Licensee must meet the requirements of subsection (a) of this section
to obtain a Compact Privilege in any Remote State.
(d) For each Remote State in which a PA seeks authority to prescribe controlled
substances, the PA shall satisfy all requirements imposed by such State in granting or renewing
such authority.
"§ 90-270.204. Designation of the State from which Licensee is applying for a Compact
Privilege.
Upon a Licensee 's application for a Compact Privilege, the Licensee shall identify to the
Commission the Participating State from which the Licens ee is applying, in accordance with
applicable Rules adopted by the Commission, and subject to the following requirements:
(1) When applying for a Compact Privilege, the Licensee shall provide the
Commission with the address of the Licensee 's primary reside nce and
thereafter shall immediately report to the Commission any change in the
address of the Licensee's primary residence.
(2) When applying for a Compact Privilege, the Licensee is required to consent
to accept service of process by mail at the Licensee's primary residence on file
with the Commission with respect to any action brought against the Licensee
by the Commission or a Participating State, including a subpoena, with respect
to any action brought or investigation conducted by the Commission or a
Participating State.
"§ 90-270.205. Adverse Actions.
(a) A Participating State in which a Licensee is licensed shall have exclusive power to
impose Adverse Action against the Qualifying License issued by that Participating State.
(b) In addition to the other powers conferred by State law, a Remote State shall have the
authority, in accordance with existing State due process law, to do all of the following:
(1) Take Adverse Action against a PA 's Compact Privilege within that State to
remove a Licensee's Compact Privilege or take other action necessary under
applicable law to protect the health and safety of its citizens.
(2) Issue subpoenas for both hearings and investigations that require the
attendance and testimony of witnesses as well as the production of evidence.
Subpoenas issued by a Licensing Board in a Participating State for the
attendance and testimony of witnesses or the production of evidence from
another Participating State shall be enforced in the latter State by any court of
competent jurisdiction, according to the practice and procedure of that court
applicable to subpoenas issued in proceedings pending before it. The issuing
authority shall pay any witness fees, travel expenses, mileage , and other fees

Page 22 Session Law 2025-37 House Bill 67
required by the service statutes of the State in which the witnesses or evidence
are located.
(3) Notwithstanding subdivision (2) of this subsection, subpoenas may not be
issued by a Participating State to gather evidence of conduct in another State
that is lawful in that other State for the p urpose of taking Adverse Action
against a Licensee's Compact Privilege or application for a Compact Privilege
in that Participating State.
(4) Nothing in this Compact authorizes a Participating State to impose discipline
against a PA 's Compact Privilege or to deny an application for a Compact
Privilege in that Participating State for the individual 's otherwise lawful
practice in another State.
(c) For purposes of taking Adverse Action, the Participating State which issued the
Qualifying License shall give the same priority and effect to reported conduct received from any
other Participating State as it would if the conduct had occurred within the Participating State
which issued the Qualifying License. In so doing, that Participating State shall apply its ow n
State laws to determine appropriate action.
(d) A Participating State, if otherwise permitted by State law, may recover from the
affected PA the costs of investigations and disposition of cases resulting from any Adverse
Action taken against that PA.
(e) A Participating State may take Adverse Action based on the factual findings of a
Remote State, provided that the Participating State follows its own procedures for taking the
Adverse Action.
(f) Joint Investigations. –
(1) In addition to the authority gra nted to a Participating State by its respective
State PA laws and regulations or other applicable State law, any Participating
State may participate with other Participating States in joint investigations of
Licensees.
(2) Participating States shall share any investigative, litigation, or compliance
materials in furtherance of any joint or individual investigation initiated under
this Compact.
(g) If an Adverse Action is taken against a PA 's Qualifying License, the PA 's Compact
Privilege in all Remote State s shall be deactivated until two years have elapsed after all
restrictions have been removed from the State License. All disciplinary orders by the
Participating State which issued the Qualifying License that impose Adverse Action against a
PA's License sh all include a Statement that the PA 's Compact Privilege is deactivated in all
Participating States during the pendency of the order.
(h) If any Participating State takes Adverse Action, it promptly shall notify the
administrator of the Data System.
"§ 90-270.206. Establishment of the PA Licensure Compact Commission.
(a) The Participating States hereby create and establish a joint government agency and
national administrative body known as the PA Licensure Compact Commission. The
Commission is an instrumentality of the Compact States acting jointly and not an instrumentality
of any one State. The Commission shall come into existence on or after the effective date of the
Compact as set forth in G.S. 90-270.210(a).
(b) Membership, Voting, and Meetings:
(1) Each Participating State shall have and be limited to one delegate selected by
that Participating State 's Licensing Board or, if the State has more than one
Licensing Board, selected collectively by the Participating State 's Licensing
Boards.
(2) The delegate shall be either:

House Bill 67 Session Law 2025-37 Page 23
a. A current PA, physician , or public member of a Licensing Board or
PA Council/Committee; or
b. An administrator of a Licensing Board.
(3) Any delegate may be removed or suspended from office as provided by the
laws of the State from which the delegate is appointed.
(4) The Participating State Licensing Board shall fill any vacancy occurring in the
Commission within 60 days.
(5) Each delegate shall be entitled to one vote on all matters voted on by the
Commission and shall otherwise have an opportunity to participate in the
business and affairs of the Commission. A delegate shall vote in person or by
such other means as provided in the bylaws. The bylaws may provide for
delegates' participation in meetings by telecommunications, video conference,
or other means of communication.
(6) The Commission shall m eet at least once during each calendar year.
Additional meetings shall be held as set forth in this Compact and the bylaws.
(7) The Commission shall establish by Rule a term of office for delegates.
(c) The Commission shall have the following powers and duties:
(1) Establish a code of ethics for the Commission;
(2) Establish the fiscal year of the Commission;
(3) Establish fees;
(4) Establish bylaws;
(5) Maintain its financial records in accordance with the bylaws;
(6) Meet and take such actions as are cons istent with the provisions of this
Compact and the bylaws;
(7) Promulgate Rules to facilitate and coordinate implementation and
administration of this Compact. The Rules shall have the force and effect of
law and shall be binding in all Participating States;
(8) Bring and prosecute legal proceedings or actions in the name of the
Commission, provided that the standing of any State Licensing Board to sue
or be sued under applicable law shall not be affected;
(9) Purchase and maintain insurance and bonds;
(10) Borrow, accept, or contract for services of personnel, including, but not
limited to, employees of a Participating State;
(11) Hire employees and engage contractors, elect or appoint officers, fix
compensation, define duties, grant such individuals appropriate authority to
carry out the purposes of this Compact, and establish the Commission 's
personnel policies and programs relating to conflicts of interest, qualifications
of personnel, and other related personnel matters;
(12) Accept any and all app ropriate donations and grants of money, equipment,
supplies, materials, and services and receive, utilize, and dispose of the same;
provided that at all times the Commission shall avoid any appearance of
impropriety or conflict of interest;
(13) Lease, purchase, accept appropriate gifts or donations of, or otherwise own,
hold, improve, or use any property, real, personal, or mixed; provided that at
all times the Commission shall avoid any appearance of impropriety;
(14) Sell, convey, mortgage, pledge, lease , exchange, abandon, or otherwise
dispose of any property real, personal, or mixed;
(15) Establish a budget and make expenditures;
(16) Borrow money;
(17) Appoint committees, including standing committees composed of members,
State regulators, State legislators or their representatives, and consumer

Page 24 Session Law 2025-37 House Bill 67
representatives, and such other interested persons as may be designated in this
Compact and the bylaws;
(18) Provide and receive information from, and cooperate with, law enforcement
agencies;
(19) Elect a Chair, Vice-Chair, Secretary, and Treasurer and such other officers of
the Commission as provided in the Commission's bylaws;
(20) Reserve for itself, in addition to those reserved exclusively to the Commission
under the Compact, powers that the Executive Committee may not exercise;
(21) Approve or disapprove a State 's participation in the Compact based upon its
determination as to whether the State 's Compa ct legislation departs in a
material manner from the Model Compact language;
(22) Prepare and provide to the Participating States an annual report; and
(23) Perform such other functions as may be necessary or appropriate to achieve
the purposes of this Com pact consistent with the State regulation of PA
licensure and practice.
(d) Meetings of the Commission:
(1) All meetings of the Commission that are not closed pursuant to this subsection
shall be open to the public. Notice of public meetings shall be poste d on the
Commission's website at least 30 days prior to the public meeting.
(2) Notwithstanding subdivision (1) of this subsection, the Commission may
convene a public meeting by providing at least 24 hours ' prior notice on the
Commission's website, and any other means as provided in the Commission's
Rules, for any of the reasons it may dispense with notice of proposed
rulemaking under G.S. 90-270.208(l).
(3) The Commission may convene in a closed, nonpublic meeting or nonpublic
part of a public meeting to receive legal advice or to discuss:
a. Noncompliance of a Participating State with its obligations under this
Compact;
b. The employment, compensation, discipline or other matters, practices
or procedures related to specific employees or other matters related to
the Commission's internal personnel practices and procedures;
c. Current, threatened, or reasonably anticipated litigation;
d. Negotiation of contracts for the purchase, lease, or sale of goods,
services, or real estate;
e. Accusing any person of a crime or formally censuring any person;
f. Disclosure of trade secrets or commercial or financial information that
is privileged or confidential;
g. Disclosure of information of a personal nature where disclosure would
constitute a clearly unwarranted invasion of personal privacy;
h. Disclosure of investigative records compiled for law enforcement
purposes;
i. Disclosure of information related to any investigative reports prepared
by or on behalf of or for use of the Commission or other committee
charged with responsibility of investigation or determination of
compliance issues pursuant to this Compact;
j. Legal advice; or
k. Matters specifically exempted from disclosure by federal or
Participating States' statutes.
(4) If a meeting, or portion of a meeting, is closed pursuant to this provision, the
chair of the meeting or the chair 's designee shall certify that the meeting or

House Bill 67 Session Law 2025-37 Page 25
portion of the meeting may be closed and shall reference each relevant
exempting provision.
(5) The Commission shall keep minutes that fully and clearly describe all matters
discussed in a meeting and shall provide a full and accurate summary of
actions taken, including a description of the views expressed. All documents
considered in connection with an action shall be identified in such minutes.
All minutes and documents of a closed meeting shall remain under seal,
subject to release by a majority vote of the Commission or order of a court of
competent jurisdiction.
(e) Financing of the Commission:
(1) The Commission shall pay, or pr ovide for the payment of, the reasonable
expenses of its establishment, organization, and ongoing activities.
(2) The Commission may accept any and all appropriate revenue sources,
donations, and grants of money, equipment, supplies, materials, and services.
(3) The Commission may levy on and collect an annual assessment from each
Participating State and may impose Compact Privilege fees on Licensees of
Participating States to whom a Compact Privilege is granted to cover the cost
of the operations and activ ities of the Commission and its staff, which must
be in a total amount sufficient to cover its annual budget as approved by the
Commission each year for which revenue is not provided by other sources.
The aggregate annual assessment amount levied on Partic ipating States shall
be allocated based upon a formula to be determined by Commission Rule.
a. A Compact Privilege expires when the Licensee's Qualifying License
in the Participating State from which the Licensee applied for the
Compact Privilege expires.
b. If the Licensee terminates the Qualifying License through which the
Licensee applied for the Compact Privilege before its scheduled
expiration, and the Licensee has a Qualifying License in another
Participating State, the Licensee shall inform the Commi ssion that it
is changing to that Participating State the Participating State through
which it applies for a Compact Privilege and pay to the Commission
any Compact Privilege fee required by Commission Rule.
(4) The Commission shall not incur obligations of any kind prior to securing the
funds adequate to meet the same nor shall the Commission pledge the credit
of any of the Participating States, except by and with the authority of the
Participating State.
(5) The Commission shall keep accurate accounts of all receipts and
disbursements. The receipts and disbursements of the Commission shall be
subject to the financial review and accounting procedures established under
its bylaws. All receipts and disbursements of funds handled by the
Commission shall be sub ject to an annual financial review by a certified or
licensed public accountant, and the report of the financial review shall be
included in and become part of the annual report of the Commission.
(f) The Executive Committee:
(1) The Executive Committee sh all have the power to act on behalf of the
Commission according to the terms of this Compact and Commission Rules.
(2) The Executive Committee shall be composed of nine members:
a. Seven voting members who are elected by the Commission from the
current membership of the Commission;
b. One ex officio, nonvoting member from a recognized national PA
professional association; and

Page 26 Session Law 2025-37 House Bill 67
c. One ex officio, nonvoting member from a recognized national PA
certification organization.
(3) The ex officio members will be selected by their respective organizations.
(4) The Commission may remove any member of the Executive Committee as
provided in its bylaws.
(5) The Executive Committee shall meet at least annually.
(6) The Executive Committee shall have the following duties and responsibilities:
a. Recommend to the Commission changes to the Commission 's Rules
or bylaws, changes to this Compact legislation, fees to be paid by
Compact Participating States such as annual dues, and any
Commission Compact fee charged to Licensees for the Compact
Privilege;
b. Ensure Compact administration services are appropriately provided,
contractual or otherwise;
c. Prepare and recommend the budget;
d. Maintain financial records on behalf of the Commission;
e. Monitor Compact compliance of Partici pating States and provide
compliance reports to the Commission;
f. Establish additional committees as necessary;
g. Exercise the powers and duties of the Commission during the interim
between Commission meetings, except for issuing proposed
rulemaking or a dopting Commission Rules or bylaws, or exercising
any other powers and duties exclusively reserved to the Commission
by the Commission's Rules; and
h. Perform other duties as provided in the Commission's Rules or bylaws.
(7) All meetings of the Executive Committee at which it votes or plans to vote on
matters in exercising the powers and duties of the Commission shall be open
to the public and public notice of such meetings shall be given as public
meetings of the Commission are given.
(8) The Executive Committee may convene in a closed, nonpublic meeting for
the same reasons that the Commission may convene in a nonpublic meeting
as set forth in subdivision (d)(3) of this section and shall announce the closed
meeting as the Commission is req uired to under subdivision (d)(4) of this
section and keep minutes of the closed meeting as the Commission is required
to under subdivision (d)(5) of this section.
(g) Qualified Immunity, Defense, and Indemnification:
(1) The members, officers, executive director, employees, and representatives of
the Commission shall be immune from suit and liability, both personally and
in their official capacity, for any claim for damage to or loss of property or
personal injury or other civil liability caused by or arising out of any actual or
alleged act, error, or omission that occurred, or that the person against whom
the claim is made had a reasonable basis for believing occurred within the
scope of Commission employment, duties , or responsibilities; provided that
nothing in this paragraph shall be construed to protect any such person from
suit or liability for any damage, loss, injury, or liability caused by the
intentional or willful or wanton misconduct of that person. The proc urement
of insurance of any type by the Commission shall not in any way compromise
or limit the immunity granted hereunder.
(2) The Commission shall defend any member, officer, executive director,
employee, and representative of the Commission in any civil action seeking
to impose liability arising out of any actual or alleged act, error, or omission

House Bill 67 Session Law 2025-37 Page 27
that occurred within the scope of Commission employment, duties, or
responsibilities, or as determined by the Commission that the person against
whom the claim is made had a reasonable basis for believing occurred within
the scope of Commission employment, duties, or responsibilities; provided
that nothing herein shall be construed to prohibit that person from retaining
their own counsel at their own expense; an d provided further, that the actual
or alleged act, error, or omission did not result from that person 's intentional
or willful or wanton misconduct.
(3) The Commission shall indemnify and hold harmless any member, officer,
executive director, employee, an d representative of the Commission for the
amount of any settlement or judgment obtained against that person arising out
of any actual or alleged act, error, or omission that occurred within the scope
of Commission employment, duties, or responsibilities, or that such person
had a reasonable basis for believing occurred within the scope of Commission
employment, duties, or responsibilities, provided that the actual or alleged act,
error, or omission did not result from the intentional or willful or wanton
misconduct of that person.
(4) Venue is proper and judicial proceedings by or against the Commission shall
be brought solely and exclusively in a court of competent jurisdiction where
the principal office of the Commission is located. The Commission may waive
venue and jurisdictional defenses in any proceedings as authorized by
Commission Rules.
(5) Nothing herein shall be construed as a limitation on the liability of any
Licensee for professional malpractice or misconduct, which shall be governed
solely by any other applicable State laws.
(6) Nothing herein shall be construed to designate the venue or jurisdiction to
bring actions for alleged acts of malpractice, professional misconduct,
negligence, or other such civil action pertaining to the practice of a PA. All
such matters shall be determined exclusively by State law other than this
Compact.
(7) Nothing in this Compact shall be interpreted to waive or otherwise abrogate a
Participating State's state action immunity or state action affirmative defense
with respect to antitrust claims under the Sherman Act, Clayton Act, or any
other State or federal antitrust or anticompetitive law or regulation.
(8) Nothing in this Compact shall be construed to be a waiver of sovereign
immunity by the Participating States or by the Commission.
"§ 90-270.207. Data System.
(a) The Commission shall provide for the development, maintenance, operation, and
utilization of a coordinated data and reporting system containing licensure, Adverse Action, and
the reporting of the existence of Significant Investigative Information on all licensed PAs and
applicants denied a License in Participating States.
(b) Notwithstanding any other State law to the contrary, a Participating State shall submit
a uniform data set to the Data Syste m on all PAs to whom this Compact is applicable (utilizing
a unique identifier) as required by the Rules of the Commission, including:
(1) Identifying information;
(2) Licensure data;
(3) Adverse Actions against a License or Compact Privilege;
(4) Any deni al of application for licensure, and the reason(s) f or such denial
(excluding the reporting of any criminal history record information where
prohibited by law);
(5) The existence of Significant Investigative Information; and

Page 28 Session Law 2025-37 House Bill 67
(6) Other information that may facilitate the administration of this Compact, as
determined by the Rules of the Commission.
(c) Significant Investigative Information pertaining to a Licensee in any Participating
State shall only be available to other Participating States.
(d) The Commission shall promptly notify all Participating States of any Adverse Action
taken against a Licensee or an individual applying for a License that has been reported to it. This
Adverse Action information shall be available to any other Participating State.
(e) Participating States contributing information to the Data System may, in accordance
with State or federal law, designate information that may not be shared with the public without
the express permission of the contributing State. Notwithstanding an y such designation, such
information shall be reported to the Commission through the Data System.
(f) Any information submitted to the Data System that is subsequently expunged
pursuant to federal law or the laws of the Participating State contributing the information shall
be removed from the Data System upon reporting of such by the Participating State to the
Commission.
(g) The records and information provided to a Participating State pursuant to this
Compact or through the Data System, when certified by the Commission or an agent thereof,
shall constitute the authenticated business records of the Commission and shall be entitled to any
associated hearsay exception in any relevant judicial, quasi -judicial, or administrative
proceedings in a Participating State.
"§ 90-270.208. Rulemaking.
(a) The Commission shall exercise its Rulemaking powers pursuant to the criteria set
forth in this section and the Rules adopted thereunder. Commission Rules shall become binding
as of the date specified by the Commission for each Rule.
(b) The Commission shall promulgate reasonable Rules in order to effectively and
efficiently implement and administer this Compact and achieve its purposes. A Commission Rule
shall be invalid and have not force or effect only if a court of competent jurisdiction holds that
the Rule is invalid because the Commission exercised its rulemaking authority in a manner that
is beyond the scope of the purposes of this Compact, or the powers granted hereunder, or based
upon another applicable standard of review.
(c) The Rules of the Commission shall have the force of law in each Participating State,
provided, however, that where the Rules of the Commission conflict with the laws of the
Participating State that establish the Medical Services a PA may perform in the Participating
State, as held by a court of competent jurisdiction, the Rules of the Commission shall be
ineffective in that State to the extent of the conflict. The Rules of the Commission shall not
modify or expand, in any way, the scope of practice of a PA as established by the laws of the
Participating State.
(d) If a majority of the legislatures of the Participating States rejects a Commission Rule,
by enactment of a statute or resolution in the same manner used to adopt this Compact with in
four years of the date of adoption of the Rule, then such Rule shall have no further force and
effect in any Participating State or to any State applying to participate in the Compact.
(e) Commission Rules shall be adopted at a regular or special meetin g of the
Commission.
(f) Prior to promulgation and adoption of a final Rule or Rules by the Commission, and
at least 30 days in advance of the meeting at which the Rule will be considered and voted upon,
the Commission shall file a Notice of Proposed Rulemaking:
(1) On the website of the Commission or other publicly accessible platform;
(2) To persons who have requested notice of the Commission 's notices of
proposed rulemaking; and
(3) In such other way(s) as the Commission may by Rule specify.
(g) The Notice of Proposed Rulemaking shall include:

House Bill 67 Session Law 2025-37 Page 29
(1) The time, date, and location of the public hearing on the proposed Rule and
the proposed time, date , and location of the meeting in which the proposed
Rule will be considered and voted upon;
(2) The text of the proposed Rule and the reason for the proposed Rule;
(3) A request for comments on the proposed Rule from any interested person and
the date by which written comments must be received; and
(4) The manner in which interested persons may submit notice to the Commission
of their intention to attend the public hearing or provide any written
comments.
(h) Prior to adoption of a proposed Rule, the Commission shall allow persons to submit
written data, facts, opinions, and arguments, which shall be made available to the public.
(i) If the hearing is to be held via electronic means, the Commission shall publish the
mechanism for access to the electronic hearing.
(1) All persons wishing to be heard at the hearing shall as directed in the Notice
of Proposed Rulemaking, not less than five business days before the scheduled
date of the hearing, notify the Commission of their desire to appear and testify
at the hearing.
(2) Hearings shall be conducted in a manner providing each person who wishes
to comment a fair and reasonable opportunity to comment orally or in writing.
(3) All hearings shall be recorded. A copy of the recording and the written
comments, data, facts, opinions, and arguments received in response to the
proposed rulemaking shall be made available to a person upon request.
(4) Nothing in this section shall be construed as requiring a separate hearing on
each proposed Rule. Proposed Rules may be grouped for the convenience of
the Commission at hearings required by this section.
(j) Following the public hea ring, the Commission shall consider all written and oral
comments timely received.
(k) The Commission shall, by majority vote of all delegates, take final action on the
proposed Rule and shall determine the effective date of the Rule, if adopted, based on the
Rulemaking record and the full text of the Rule.
(1) If adopted, the Rule shall be posted on the Commission's website.
(2) The Commission may adopt changes to the proposed Rule provided the
changes do not enlarge the original purpose of the proposed Rule.
(3) The Commission shall provide on its website an explanation of the reasons for
substantive changes made to the proposed Rule as well as reasons for
substantive changes not made that were recommended by commenters.
(4) The Commission shall determine a reasonable effective date for the Rule.
Except for an emergency as provided in subsection ( l) of this section, the
effective date of the Rule shall be no sooner than 30 days after the Commission
issued the notice that it adopted the Rule.
(l) Upon determ ination that an emergency exists, the Commission may consider and
adopt an emergency Rule with 24 hours ' prior notice, without the opportunity for comment, or
hearing, provided that the usual Rulemaking procedures provided in this Compact and in this
section shall be retroactively applied to the Rule as soon as reasonably possible, in no event later
than 90 days after the effective date of the Rule. For the purposes of this provision, an emergency
Rule is one that must be adopted immediately by the Commission in order to:
(1) Meet an imminent threat to public health, safety, or welfare;
(2) Prevent a loss of Commission or Participating State funds;
(3) Meet a deadline for the promulgation of a Commission Rule that is established
by federal law or Rule; or
(4) Protect public health and safety.

Page 30 Session Law 2025-37 House Bill 67
(m) The Commission or an authorized committee of the Commission may direct revisions
to a previously adopted Commission Rule for purposes of correcting typographical errors, errors
in format, errors in consistency, or grammatical errors. Public notice of any revisions shall be
posted on the website of the Commission. The revision shall be subject to challenge by any
person for a period of 30 days after posting. The revision may be challenged only on grounds
that the revision results in a material change to a Rule. A challenge shall be made as set forth in
the notice of revisions and delivered to the Commission prior to the end of the notice period. If
no challenge is made, the revision will take effect without further ac tion. If the revision is
challenged, the revision may not take effect without the approval of the Commission.
(n) No Participating State's rulemaking requirements shall apply under this Compact.
"§ 90-270.209. Oversight, dispute resolution, and enforcement.
(a) Oversight:
(1) The executive and judicial branches of State government in each Participating
State shall enforce this Compact and take all actions necessary and appropriate
to implement the Compact.
(2) Venue is proper and judicial proceedings by or against the Commission shall
be brought solely and exclusively in a court of competent jurisdiction where
the principal office of the Commission is located. The Commission may waive
venue and jurisdictional de fenses to the extent it adopts or consents to
participate in alternative dispute resolution proceedings. Nothing herein shall
affect or limit the selection or propriety of venue in any action against a
Licensee for professional malpractice, misconduct, or any such similar matter.
(3) The Commission shall be entitled to receive service of process in any
proceeding regarding the enforcement or interpretation of the Compact or the
Commission's Rules and shall have standing to intervene in such a proceeding
for all purposes. Failure to provide the Commission with service of process
shall render a judgment or order in such proceeding void as to the
Commission, this Compact, or Commission Rules.
(b) Default, Technical Assistance, and Termination:
(1) If the Commis sion determines that a Participating State has defaulted in the
performance of its obligations or responsibilities under this Compact or the
Commission Rules, the Commission shall provide written notice to the
defaulting State and other Participating State s. The notice shall describe the
default, the proposed means of curing the default , and any other action that
the Commission may take and shall offer remedial training and specific
technical assistance regarding the default.
(2) If a State in default fails to cure the default, the defaulting State may be
terminated from this Compact upon an affirmative vote of a majority of the
delegates of the Participating States, and all rights, privileges , and benefits
conferred by this Compact upon such State may be terminated on the effective
date of termination. A cure of the default does not relieve the offending State
of obligations or liabilities incurred during the period of default.
(3) Termination of participation in this Compact shall be imposed only after all
other means of securing compliance have been exhausted. Notice of intent to
suspend or terminate shall be given by the Commission to the governor, the
majority and minority leaders of the defaulting State 's legislature, and to the
Licensing Board(s) of each of the Participating States.
(4) A State that has been terminated is responsible for all assessments,
obligations, and liabilities incurred through the effective date of termination,
including obligations that extend beyond the effective date of termination.

House Bill 67 Session Law 2025-37 Page 31
(5) The Commission shall not bear any costs related to a State that is found to be
in default or that has been terminated from this Compact, unless agreed upon
in writing between the Commission and the defaulting State.
(6) The defaulting State may appeal its termination from the Compact by the
Commission by petitioning the United States District Court for the District of
Columbia or the federal district where the Commission has its principal
offices. The prevailing member shall be awarded all costs of such litigation,
including reasonable attorneys' fees.
(7) Upon the termination of a State's participation in the Compact, the State shall
immediately provide notice to all Licensees within that State of such
termination:
a. Licensees who have been gran ted a Compact Privilege in that State
shall retain the Compact Privilege for 180 days following the effective
date of such termination.
b. Licensees who are licensed in that State who have been granted a
Compact Privilege in a Participating State shall ret ain the Compact
Privilege for 180 days unless the Licensee also has a Qualifying
License in a Participating State or obtains a Qualifying License in a
Participating State before the 180 -day period ends, in which case the
Compact Privilege shall continue.
(c) Dispute Resolution:
(1) Upon request by a Participating State, the Commission shall attempt to resolve
disputes related to this Compact that arise among Participating States and
between Participating and non-Participating States.
(2) The Commission shall promulgate a Rule providing for both mediation and
binding dispute resolution for disputes as appropriate.
(d) Enforcement:
(1) The Commission, in the reasonable exercise of its discretion, shall enforce the
provisions of this Compact and Rules of the Commission.
(2) If compliance is not secured after all means to secure compliance have been
exhausted, by majority vote, the Commission may initiate legal action in the
United States District Court for the District of Columbia or the federal district
where the Commission has its principal offices, against a Participating State
in default to enforce compliance with the provisions of this Compact and the
Commission's promulgated Rules and bylaws. The relief sought may include
both injunctive relief and dama ges. In the event judicial enforcement is
necessary, the prevailing party shall be awarded all costs of such litigation,
including reasonable attorneys' fees.
(3) The remedies herein shall not be the exclusive remedies of the Commission.
The Commission may pursue any other remedies available under federal or
State law.
(e) Legal Action Against the Commission:
(1) A Participating State may initiate legal action against the Commission in the
United States District Court for the District of Columbia or the federal district
where the Commission has its principal offices to enforce compliance with the
provisions of the Compact and its Rules. The relief sought may include both
injunctive relief and damages. In the event judicial enforcement is necessary,
the prevailing party shall be awarded all costs of such litigation, including
reasonable attorneys' fees.
(2) No person other than a Participating State shall enforce this Compact against
the Commission.

Page 32 Session Law 2025-37 House Bill 67
"§ 90-270.210. Date of implementation of the PA Licensure Compact Commission.
(a) This Compact shall come into effect on the date on which this Compact statute is
enacted into law in the seventh Participating State.
(1) On or after the effective date of the Compact, the Commission shall convene
and review the enactment of each of the States that enacted the Compact prior
to the Commission convening ("Charter Participating States") to determine if
the statute enacted by each such Charter Participating State is materially
different than the Model Compact.
a. A Chart er Participating State whose enactment is found to be
materially different from the Model Compact shall be entitled to the
default process set forth in G.S. 90-270.209(b).
b. If any Participating State later withdraws from the Compact or its
participation is terminated, the Commission shall remain in existence
and the Compact shall remain in effect even if the number of
Participating States should be less than seven. Participating States
enacting the Compact subsequent to the Commission convening shall
be s ubject to the process set forth in G.S. 90-270.206(c)(21) to
determine if their enactments are materially different from the Model
Compact and whether they qualify for participation in the Compact.
(2) Participating States enacting the Compact subsequent to the seven initial
Charter Participating States shall be subject to the process set forth in
G.S. 90-270.206(c)(21) to determine if their enactments are materially
different from the Model Compact and whether they qualify for participation
in the Compact.
(3) All actions taken for the benefit of the Commission or in furtherance of the
purposes of the administration of the Compact prior to the effective date of
the Compact or the Commission coming into existence shall be considered to
be actions of the Commission unless specifically repudiated by the
Commission.
(b) Any State that joins this Compact shall be subject to the Commission 's Rules and
bylaws as they exist on the date on which this Compact becomes law in that State. Any Rule that
has been previously adopted by the Commission shall have the full force and effect of law on the
day this Compact becomes law in that State.
(c) Any Participating State may withdraw from this Compact by enacting a statut e
repealing the same.
(1) A Participating State 's withdrawal shall not take effect until 180 days after
enactment of the repealing statute. During this 180 -day period, all Compact
Privileges that were in effect in the withdrawing State and were granted to
Licensees licensed in the withdrawing State shall remain in effect. If any
Licensee licensed in the withdrawing State is also licensed in another
Participating State or obtains a license in another Participating State within
the 180 days, the Licensee 's Compact Privileges in other Participating States
shall not be affected by the passage of the 180 days.
(2) Withdrawal shall not affect the continuing requirement of the State Licensing
Board(s) of the withdrawing State to comply with the investigative and
Adverse Action reporting requirements of this Compact prior to the effective
date of withdrawal.
(3) Upon the enactment of a statute withdrawing a State from this Compact, the
State shall immediately provide notice of such withdrawal to all Licensees
within that State. Such withdrawing State shall continue to recognize all

House Bill 67 Session Law 2025-37 Page 33
Licenses granted pursuant to this Compact for a minimum of 180 days after
the date of such notice of withdrawal.
(d) Nothing contained in this Compact shall be construed to invalidate or prevent any PA
licensure agreement or other cooperative arrangement between Participating States and between
a Participating State and non-Participating State that does not conflict with the provisions of this
Compact.
(e) This Compact may be amended by th e Participating States. No amendment to this
Compact shall become effective and binding upon any Participating State until it is enacted
materially in the same manner into the laws of all Participating States as determined by the
Commission.
"§ 90-270.211. Construction and severability.
(a) This Compact and the Commission's rulemaking authority shall be liberally construed
so as to effectuate the purposes and the implementation and administration of the Compact.
Provisions of the Compact expressly authorizing or requiring the promulgation of Rules shall not
be construed to limit the Commission's rulemaking authority solely for those purposes.
(b) The provisions of this Compact shall be severable and if any phrase, clause, sentence,
or provision of this Comp act is held by a court of competent jurisdiction to be contrary to the
constitution of any Participating State, a State seeking participation in the Compact, or of the
United States, or the applicability thereof to any government, agency, person, or circumstance is
held to be unconstitutional by a court of competent jurisdiction, the validity of the remainder of
this Compact and the applicability thereof to any other government, agency, person , or
circumstance shall not be affected thereby.
(c) Notwithstanding subsection (b) of this section, the Commission may deny a State 's
participation in the Compact or, in accordance with the requirements of G.S. 90-270.209(b),
terminate a Participating State's participation in the Compact, if it determines that a constitutional
requirement of a Participating State is, or would be with respect to a State seeking to participate
in the Compact, a material departure from the Compact. Otherwise, if this Compact shall be held
to be contrary to the constitution of any Participating State, the Compact shall remain in full force
and effect as to the remaining Participating States and in full force and effect as to the
Participating State affected as to all severable matters.
"§ 90-270.212. Binding effect of Compact.
(a) Nothing herein prevents the enforcement of any other law of a Participating State that
is not inconsistent with this Compact.
(b) Any laws in a Participating State in conflict with this Compact are superseded to the
extent of the conflict.
(c) All agreements between the Commission and the Participating States are binding in
accordance with their terms."
SECTION 4.(b) G.S. 90-9.3 reads as rewritten:
"§ 90-9.3. Requirements for licensure as a physician assistant.
(a) To be eligible for licensure as a physician assistant, an applicant shall submit proof
satisfactory to the Board that the applicant has met all of the following:
(1) The applicant has successfully completed an educational program for
physician assistants or surgeon assistants accredited by the Accreditation
Review Commission on Education for the Physician Assistant or its
predecessor or successor entities.
(2) The applicant has a current or previous certification issued by the National
Commission on Certification of Physician Assistants or its successor.
(3) The applicant is of good moral character.
(a1) A physician assistant applying for licensure under Article 18J of this Chapter shall be
in compliance with that Article.

Page 34 Session Law 2025-37 House Bill 67
(b) Before initiating practice of medical acts, tasks, or functions as a physician assistant,
the physician assistant shall provide the Board the name, address, and telephone number of the
physician who will supervise the physician assistant in the relevant medical setting.
(c) The Board may, by rule, require an applicant t o comply with other requirements or
submit additional information the Board deems appropriate."
SECTION 4.(c) G.S. 90-13.2 reads as rewritten:
"§ 90-13.2. Registration every year with Board.
(a) Every licensee shall register annually with the Board no later than 30 days after the
person's birthday. Every privilege holder shall register annually with the Board in accordance
with the Physician Assistant Licensure Compact, Article 18J of this Chapter.
…
(b1) Physician assistants shall pay an annual registration fee of one hundred forty dollars
($140.00). A physician assistant who fails to register as required by this section shall pay an
additional fee of twenty-five dollars ($25.00) to the Board.
…."
SECTION 4.(d) G.S. 90-13.1 is amended by adding a new subsection to read:
"(g) For the initial licensure or privilege of a physician assistant, the Board shall require
the payment of two hundred thirty dollars ($230.00)."
SECTION 4.(e) G.S. 90-1.1 reads as rewritten:
"§ 90-1.1. Definitions.
The following definitions apply in this Article:
…
(4) License. – An authorization issued by the Board to a physician, physician
assistant, or anesthesiologist assistant to perform medical acts, tasks, or
functions. License shall include any physician assistant comp act privilege
granted under Article 18J of this Chapter.
(4a) Licensee. – Any person issued a license by the Board, whether the license is
active or inactive, including an inactive license by means of surrender.
Licensee shall include any compact privilege issued to a holder of a qualifying
license in a participating state pursuant to Article 18J of this Chapter.
…."
SECTION 4.(f) G.S. 90-5.1 reads as rewritten:
"§ 90-5.1. Powers and duties of the Board.
(a) The Board shall have the following powers and duties:
…
(11) Implement the Physician Assistant Licensure Compact under Article 18J of
this Chapter, including issuing compact privileges.
(12) Appoint a delegate to serve on the Physician Assistant Licensure Co mpact
Commission under G.S. 90-270.206. The delegate shall be either (i) a current
physician assistant, physician, or public member of the Board or (ii) an
administrator of the Board.
…."
SECTION 4.(g) G.S. 90-11 reads as rewritten:
"§ 90-11. Criminal background checks.
(a) Repealed by Session Laws 2007-346, s. 11, effective October 1, 2007.
(a1) Repealed by Session Laws 2007-346, s. 9.1, effective October 1, 2007.
(b) The Department of Public Safety may provide a criminal record check to the Board
for a person who has applied for a license through the Board. Board and for purposes of Article
18J of this Chapter. The Board shall provide to the Department of Public Safety, along with the
request, the fingerprints of the applicant, any additional information required by the Department
of Public Safety, and a form signed by the applicant consenting to the check of the criminal

House Bill 67 Session Law 2025-37 Page 35
record and to the use of the fingerprints and other identifying information required by the State
or national repositories. The appli cant's fingerprints shall be forwarded to the State Bureau of
Investigation for a search of the State's criminal history record file, and the State Bureau of
Investigation shall forward a set of the fingerprints to the Federal Bureau of Investigation for a
national criminal history check. The Board shall keep all information pursuant to this subsection
privileged, in accordance with applicable State law and federal guidelines, and the information
shall be confidential and shall not be a public record under Chapter 132 of the General Statutes.
The Department of Public Safety may charge each applicant a fee for conducting the checks
of criminal history records authorized by this subsection. The Board has the authority to collect
this fee from each applicant and remit it to the Department of Public Safety."
SECTION 4.(h) G.S. 90-14 reads as rewritten:
"§ 90-14. Disciplinary Authority.
(a) The Board shall have the power to place on probation with or without conditions,
impose limitations and conditions on, publicly reprimand, assess monetary redress, issue public
letters of concern, mandate free medical services, require satisfactory completion of treatment
programs or remedial or educational training, fine, deny, annul, suspend, or revoke a license, or
other authority to practice medicine in this State, issued by the Board to any person who has been
found by the Board to have committed any of the following acts or conduct, or for any of the
following reasons:
…
(18) A violation of Article 18J of this Chapter, consistent with the provisions of
that Article for compact privilege holders.
…."
SECTION 4.(i) This Part is effective nine months after it becomes law.

PART V. PHARMACIST TEST AND TREAT
SECTION 5.1.(a) G.S. 90-85.3 reads as rewritten:
"§ 90-85.3. Definitions.
…
(b2) "CLIA-waived test " means a laboratory test authorized by th e Food and Drug
Administration and waived under the Clinical Laboratory Improvement Amendments of 1988.
(b3) "Clinical pharmacist practitioner" means a licensed pharmacist who m eets the
guidelines and criteria for such title established by the joint subcommittee of the North Carolina
Medical Board and the North Carolina Board of Pharmacy and is authorized to enter into drug
therapy management agreements with physicians in accorda nce with the provisions of
G.S. 90-18.4.
…."
SECTION 5.1.(b) G.S. 90-85.3A reads as rewritten:
"§ 90-85.3A. Practice of pharmacy.
…
(b) A pharmacist may advise and educate patients and health care providers concerning
therapeutic values, content, uses, and significant problems of drugs and devices; assess, record,
and report adverse drug and device reactions; take and record patient histories relating to drug
and device therapy; administer drugs; monitor, record, and report drug therapy and device usage;
perform drug utilization reviews; and participate in drug and drug source selection and device
and device source selection as provided in G.S. 90-85.27 through G.S. 90-85.31.
…
(e) A pharmacist may order and perform a CLIA -waived test and initiate treatment
pursuant to the result of the CLIA -waived test for influenza in accordance with statewide
protocols. A pharmacist shall not treat a health condition under this section with any controlled
substance classified in Schedules I through IV."

Page 36 Session Law 2025-37 House Bill 67
SECTION 5.1.(c) This section becomes effective October 1, 2025.
SECTION 5.2.(a) Article 3 of Chapter 58 of the General Statutes is amended by
adding a new section to read:
"§ 58-3-241. Healthcare services provided by pharmacists.
(a) The following definitions apply in this section:
(1) Healthcare provider. – Either of the following:
a. An individual who is licensed, certified, or otherwise authorized under
Chapter 90 of the General Statutes to provide healthcare services in
the ordinary course of business or practice of a profession o r in an
approved education or training program.
b. A health care facility licensed under Chapter 131E or Chapter 122C of
the General Statutes and where healthcare services are provided to
patients.
(2) Healthcare services. – Any of the fol lowing health or medical procedures or
services rendered by a healthcare provider:
a. Testing, diagnosis, or treatment of a health condition, illness, injury,
or disease. This includes testing, diagnosis, or treatment rendered by a
pharmacist acting within the pharmacist's scope of practice.
b. Dispensing of drugs, medical devices, medical appliances, or medical
goods for the treatment of a health condition, illness, injury, or disease.
c. Administration of a vaccine or medication.
(3) Pharmacist. – An individual licensed to practice pharmacy under Article 4A
of Chapter 90 of the General Statutes or the relevant laws of another state.
(b) A health benefit plan offered by an insurer in this State shall cover healthcare services
provided by a pharmacist if all of the following conditions are met:
(1) The service or procedure was performed within the pharmacist 's licensed
lawful scope of practice.
(2) The health benefit plan would have covered the service if the service or
procedure had been performed by another healthcare provider.
(c) The participation of a pharmacy in a drug benefit provider network of a health benefit
plan shall not satisfy any requirement that insurers offering health benefit plans include
pharmacists in medical benefit provider networks.
(d) An insurer shall accept a claim under this section regardless of whether it is submitted
by a pharmacist or a pharmacy submitting the claim on behalf of a pharmacist the pharmacy
employs or contracts with."
SECTION 5.2.(b) G.S. 58-3-230 is amended by adding a new subsection to read:
"(d) Insurers that delegate credentialing agreements or requirements for pharmacists
licensed under Article 4A of Chapter 90 of the General Statutes or the relevant laws of another
state to a contracted healthcare facility shall accept the credentialing for all pharmacists employed
by, or contracted with, those healthcare facilities."
SECTION 5.2.(c) G.S. 58-56-26 is amended by adding a new subsection to read:
"(e) Notwithstanding any provision of this Article to the contrary, all requirements relating
to the coverage of prescription drugs and pharmacy services under this Chapter that apply to
health benefit plans are applicable to a third -party administrator in the same way they are
applicable to an insurer."
SECTION 5.2.(d) Article 56A of Chapter 58 of the General Statutes is amended by
adding a new section to read:
"§ 58-56A-55. Health benefit plan requirements applicable.
All requirements relating to the coverage of prescription drugs and pharmacy services under
this Chapter that apply to health benefit plans are applicable to a pharmacy benefits manager in
the same way they are applicable to an insurer."

House Bill 67 Session Law 2025-37 Page 37
SECTION 5.2.(e) This section is effective October 1, 2025, and applies to insurance
contracts entered into, renewed, or amended on or after that date.
SECTION 5.3.(a) No later than October 1, 2025, the State Health Director shall
issue a standing order authorizing a ph armacist to order and perform a CLIA -waived test and
initiate treatment for influenza in accordance with G.S. 90-85.3A(e), as amended by Section 5.1
of this Part. The standing order shall include protocols for testing and treatment of influenza that
balance patient safety with ensuring access to care provided by pharmacists. The standing order
shall remain in effect until the earlier of the date the permanent rules described in Section 5.3(b)
of this Part become effective or January 1, 2027.
SECTION 5.3.(b) No later than October 1, 2025, the North Carolina Medical Board
and the North Carolina Board of Pharmacy, in conjunction with the State Health Director, shall
adopt rules to implement the provisions of Section 5.1 of this Part. At a minimum, those rules
shall include:
(1) An approved course of treatment pharmacists may implement for influenza.
(2) Protocols for testing and treatment of influenza that balance patient safety with
ensuring access to care provided by pharmacists.
(3) If the Boards deem it app ropriate, rules (i) limiting the number of times a
patient can be treated by a pharmacist in a given time span and (ii) creating an
audit mechanism to enforce those rules.
(4) Patient parameters necessitating referral to a primary, urgent, or emergency
care provider.
(5) Any other rules the Boards deem necessary.
SECTION 5.3.(c) Except as otherwise provided, this Part is effective when it
becomes law.

PART VI. PHYSICIAN A SSISTANT, NURSE PRAC TITIONER, AND CERTIF IED
NURSE MIDWIFE REFORMS
SECTION 6.1.(a) G.S. 90-1.1 is amended by adding a new subdivision to read:
"(4d) Team-based setting or team-based practice. – Any of the following:
a. A medical practice that meets all of the following requirements:
1. The majority of the practice is owned collectively by one or
more licensed physicians.
2. An owner who is a physician licensed under this Chapter has
consistent and meaningful participation in the design and
implementation of health services to patients , as defined by
rules adopted by the Board.
3. The physicians and team -based physician assistants who
provide services at the medical practice work in the same
clinical practice area.
b. 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 , as defined by rules
adopted by the Board.
c. For the purposes of this Article, the term "team-based setting " or
"team-based practice " shall not include a medical practice that
specializes in pain management."
SECTION 6.1.(b) G.S. 90-9.3 reads as rewritten:
"§ 90-9.3. Requirements for licensure as a physician assistant.
(a) To be eligible for licensure as a physician assistant, an applicant shall submit proof
satisfactory to the Board that the applicant has met all of the following:

Page 38 Session Law 2025-37 House Bill 67
(1) The applicant has successfully completed an educational program for
physician assistants or surgeon assistants accredited by the Accreditation
Review Commission on Education for the Physician Assistant or its
predecessor or successor entities.
(2) The applicant has a current or previous certification issued by the National
Commission on Certification of Physician Assistants or its successor.
(3) The applicant is of good moral character.
(b) Before initiating practice of medical acts, tasks, or functions as a physician assistant,
the physician assistant shall provide the Board the name, address, and telephone number of the
physician who will supervise the physician assistant in the relevant medical setting. This
subsection shall not apply to physician assistants who meet the requirements for team -based
practice under G.S. 90-9.3A.
(c) The Board may, by rule, require an applicant t o comply with other requirements or
submit additional information the Board deems appropriate."
SECTION 6.1.(c) Article 1 of Chapter 90 of the General Statutes is amended by
adding a new section to read:
"§ 90-9.3A. Requirements for team-based practice as a physician assistant.
(a) In order to practice as a team -based physician assistant, a physician assistant shall
meet all of the following conditions:
(1) Practice in team-based settings, as defined in G.S. 90-1.1(4d).
(2) Have more than 4,000 hours of clinical practice experience as a licensed
physician assistant and more than 1,000 hours of clinical practice experience
within the specific medical specialty of practice with a physician in that
specialty.
(3) Submit proof as the Board may deem satisfactory by rule that the individual
meets the requirements of subdivisions (1) and (2) of this subsection. The
Board may, by rule, require the physician assistant to comply with other
requirements or submit additional information the Board deems appropriate.
(b) Team-based p hysician assistants shall 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. The B oard may adopt rules to establish requirements for the
determination and enforcement of collab oration, consultation, and referral. Team-based
physician assistants are responsible for the care they provide.
(c) Notwithstanding any other provision of this Chapter, a team-based physician assistant
practicing in a perioperative setting, including the provision of surgical or anesthesia -related
services, shall be supervised by a physician."
SECTION 6.1.(d) G.S. 90-12.4 reads as rewritten:
"§ 90-12.4. Physician assistant limited volunteer license.
…
(d) Before initiating the performance of medical acts, tasks, or functions as a physician
assistant licensed under this section, the physician assistant shall provide submit to the Board
either an "Intent to Practice Notification Form ," which shall include the name, address, and
telephone number of the physician licensed under this Article who will supervise the physician
assistant in the clinic specializing in the care of indigent patients.patients, or meet the
requirements for team-based practice under G.S. 90-9.3A.
…."
SECTION 6.1.(e) G.S. 90-12.4B reads as rewritten:
"§ 90-12.4B. Physician Assistant assistant retired limited volunteer license.

House Bill 67 Session Law 2025-37 Page 39
…."
SECTION 6.1.(f) G.S. 90-18.1 reads as rewritten:
"§ 90-18.1. Limitations on physician assistants.
(a) Any person who is licensed under the provisions of G.S. 90-9.3 to perform medical
acts, tasks, and functions as a physician assistant may use the title "physician assistant" or "PA."
Any other person who uses the title in any form or holds out to be a physician assistant or to be
so licensed, shall be deemed to be in violation of this Article.
(a1) Physician assistants shall clearly designate their credentials as a physician assistant in
all clinical settings.
(b) Physician assistants are authorized to write prescriptions for drugs under the
following conditions:
(1) The North Carolina Medical Board has adopted regulations governing the
approval of individual physician assistants to wr ite prescriptions with such
limitations as the Board may determine to be in the best interest of patient
health and safety.
(2) The physician assistant holds a current license issued by the Board.
(3) Repealed by Session Laws 2019-191, s. 35, effective October 1, 2019.
(4) The supervising physician has provided to the physician assistant written
instructions about indications and contraindications for prescribing drugs and
a written policy for periodic review by the physician of the drugs prescribed.
This s ubdivision shall not apply to individuals who are practicing in a
team-based setting under G.S. 90-9.3A.
(5) A physician assistant shall personally consult with the supervising physician
prior to prescribing a targeted controlled substance as defined in Article 5 of
this Chapter when all of the following conditions apply:
a. The patient is being treated by a facility that primarily engages in the
treatment of pain by prescribing narcotic medications.
b. The therapeutic use of the targeted controlled subst ance will or is
expected to exceed a period of 30 days.
When a targeted controlled substance prescribed in accordance with this subdivision is
continuously prescribed to the same patient, the physician assistant shall consult with the
supervising physician at least once every 90 days to verify that the prescription remains medically
appropriate for the patient.
(c) Physician assistants are authorized to compound and dispense drugs under the
following conditions:
(1) The function is performed under the super vision of a licensed
pharmacist.physician.
(2) Rules and regulations of the North Carolina Board of Pharmacy and all
applicable State and federal laws governing this function compounding and
dispensing are complied with.
(3) The physician assistant holds a current license issued by the Board.
(4) The physician assistant registers with the Board of Pharmacy.
(d) Physician assistants are authorized to order medications, tests and treatments in
hospitals, clinics, nursing homes, and other health facilities under the following conditions:
(1) The North Carolina Medical Board has adopted regulations governing the
approval of individual physician assistants to order medications, tests, and
treatments with such limitations as the Board may determine to be in the best
interest of patient health and safety.
(2) The physician assistant holds a current license issued by the Board.
(3) The If the p hysician assistant is subject to a supervisory arrangement, the
supervising physician has provided to the physician assistant written

Page 40 Session Law 2025-37 House Bill 67
instructions about ordering medications, tests, and treatments, and when
appropriate, specific oral or written instructions for an individual patient, with
provision for review by the physician of the order within a reasonable time, as
determined by the Board, after the medication, test, or treatment is ordered.
(4) The hospital or other health facility has adopted a written policy about
ordering medications, tests, and treatments, including procedures for
verification of the physician assistants' orders by nurses and other facility
employees and such other procedures as are in the interest of patient health
and safety.
(e) Any prescription written by a physician assistant or order given by a physician
assistant for medications, tests, or treatments shall be deemed to have been authorized by the
physician approved by the Board as the supervisor of the physician assistant and the supervising
physician shall be responsible for authorizing the prescription or order. This subsection shall not
apply to individuals who are practicing in a team -based setting under G.S. 90-9.3A who may
prescribe, order, administer, and procure drugs and medical devices without p hysician
authorization. Individuals who are practicing in a team -based setting under G.S. 90-9.3A may
also 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.
(e1) Any medical certification completed by a physician assistant for a Physician assistants
may authen ticate any document, including death certificate shall be deemed to have been
authorized by the physician approved by the Board as the supervisor of the physician assistant,
and the supervising physician shall be responsible for authorizing the completion certificates with
their signature, certification, stamp, verification, affidavit, or endorsement , if it ma y be so
authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of the
medical certification.a physician.
(e2) Physician assistants shall not perform final interpretations of diagnostic imaging
studies. For purposes of this subsection, "diagnostic imaging " shall include comp uted
tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission
tomography (PET), mammography, and ultra sound services. Final interpretation shall be
provided by a physician licensed under this Chapter. Notwithstanding any other provision of this
Chapter, physician assistants conducting final interpretation of plain film radiographs shall be
supervised by a physician.
…
(g) Any person who is licensed under G.S. 90-9.3 to perform medical acts, tasks, and
functions as a physician assistant shall comply with each of the following:
(1) Maintain a current and active license to practice in this State.
(2) Maintain an active registration with the Board.
(3) Have File a current Intent to Practice form filed with the Board.Board or meet
the requirements for team-based practice under G.S. 90-9.3A.
…."
SECTION 6.1.(g) G.S. 90-21.81(9) reads as rewritten:
"(9) Qualified technician. – A registered diagnostic medical sonographer who is
certified in obstetrics and gynecology by the American Registry for
Diagnostic Medical Sonography (ARDMS) (ARDMS), a physician assistant
with certification in obstetrical ultrasonog raphy, or a nurse midwife or
advanced practice nurse practitioner in obstetrics with certification in
obstetrical ultrasonography."
SECTION 6.1.(h) G.S. 58-3-169 reads as rewritten:
"§ 58-3-169. Required coverage for minimum hospital stay following birth.

House Bill 67 Session Law 2025-37 Page 41
(a) Definitions. – As used in this section:
(1) "Attending providers" includes:
a. The obstetrician-gynecologists, pediatricians, family physicians, and
other physicians primarily responsible for the care of a mother and
newborn; and
b. The nurse midwives midwives, physician assistants, and nurse
practitioners primarily responsible for the care of a mother and her
newborn child in accordance with State licensure and certification
laws.
…."
SECTION 6.1.(i) G.S. 110-91 reads as rewritten:
"§ 110-91. Mandatory standards for a license.
All child care facilities shall comply with all State laws and federal laws and local ordinances
that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the
standards in this section shall be complied with by all child care facilities. However, none of the
standards in this section apply to the school -age children of the operator of a child care facility
but do apply to the preschool-age children of the operator. Children 13 years of age or older may
receive child care on a voluntary basis provided all applicable required standards are met. The
standards in this section, along with any other applicable State laws and federal laws or local
ordinances, shall be the required standards f or the issuance of a license by the Secretary under
the policies and procedures of the Commission except that the Commission may, in its discretion,
adopt less stringent standards for the licensing of facilities which provide care on a temporary,
part-time, drop-in, seasonal, after-school or other than a full-time basis.
(1) Medical Care and Sanitation. – The Commission for Public Health shall adopt
rules which establish minimum sanitation standards for child care centers and
their personnel. The sanitation rules adopted by the Commission for Public
Health shall cover such matters as the cleanliness of floors, walls, ceilings,
storage spaces, utensils, and other facilities; adequacy of ventilation;
sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal,
food protection facilities, bactericidal treatment of eating and drinking
utensils, and solid -waste storage and disposal; methods of food preparation
and serving; infectious disease control; sleeping facilities; and other items and
facilities as are necessary in the interest of the public health. The Commission
for Public Health shall allow child care centers to use domestic kitchen
equipment, provided appropriate temperature levels for heating, cooling, and
storing are maintained. Child care centers that fry foods shall use commercial
hoods. These rules shall be developed in consultation with the Department.
The Commission shall adopt rules for child care facilities to establish
minimum requirements for child and staff health assess ments and medical
care procedures. These rules shall be developed in consultation with the
Department. Each child shall have a health assessment before being admitted
or within 30 days following admission to a child care facility. The assessment
shall be done by: (i) a licensed physician, (ii) the physician's authorized agent
who is currently approved by the North Carolina Medical Board, or
comparable certifying board in any state contiguous to North Carolina, (iii) a
certified nurse practitioner, (iv) a licensed physician assistant, or (iv) (v) a
public health nurse meeting the Departments Standards for Early Periodic
Screening, Diagnosis, and Treatment Program. However, no health
assessment shall be required of any staff or child who is and has been in
normal health when the staff, or the child's parent, guardian, or full -time
custodian objects in writing to a health assessment on religious grounds which

Page 42 Session Law 2025-37 House Bill 67
conform to the teachings and practice of any recognized church or religious
denomination.
Organizations that provide prepared meals to child care centers only are
considered child care centers for purposes of compliance with appropriate
sanitation standards.
…."
SECTION 6.2. The North Carolina Medical Board shall adopt permanent rules
necessary to implement the provisions of Section 6.1 of this Part.
SECTION 6.3. Section 6.1 of this act becomes effective when the North Carolina
Medical Board adopts the permanent rules required under Section 6.2 of this act or June 30, 2026,
whichever occurs first. The No rth Carolina Medical Board shall notify the Revisor of Statutes
when the rules required under Section 6.2 of this act have been adopted. The remainder of this
Part is effective when it becomes law.

PART VII. PHARMACISTS COLLABORATIVE PRACTICE
SECTION 7.1.(a) G.S. 90-18(c)(3a) reads as rewritten:
"(3a) 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 specific when health care se rvices by a
licensed pharmacist under a collaborative practice agreement with one or
more physicians shall be performed in accordance with rules and rules
developed by a joint subcommittee of the North Carolina Medical Board and
the North Carolina Board of Pharmacy and approved by both Boards. Drug
therapy management shall be defined as: (i) the implementation of
predetermined drug therapy which includes diagnosis and product selection
by the patient's physician; (ii) modification of prescribed drug dosages, dosage
forms, and dosage schedules; and (iii) ordering tests; (i), (ii), and (iii) shall be
pursuant to an agreement that is physician, pharmacist, patient, and disease
specific.For the purposes of this subdivision, "health care services " means
medical tasks, acts, or functions authorized through a written agreement by a
physician and delegated to a pharmacist for the purpose of providing drug
therapy, disease, or population health management for patients."
SECTION 7.1.(b) G.S. 90-18.4 reads as rewritten:
"§ 90-18.4. Limitations on clinical pharmacist practitioners.
(a) Any pharmacist who is approved under the provisions of G.S. 90-18(c)(3a) to perform
medical acts, tasks, and functions may use the title "clinical pharmacist practitioner". Any other
person who uses the title in any form or holds himself or herself out to be a clinical pharmacist
practitioner or to be so licensed shall be deemed to be in violation of this Article.
(b) Clinical pharmacist practitioners are authorized to impl ement predetermined drug
therapy, which includes diagnosis and product selection by the patient's physician, modify
prescribed drug dosages, dosage forms, and dosage schedules, and to order laboratory tests
pursuant to a drug therapy management agreement t hat is physician, pharmacist, patient, and
disease specific by physicians to provide health care services in accordance with
G.S. 90-18(c)(3a) and subsection (e) of this section under the following conditions:
(1) The North Carolina Medical Board and the North Carolina Board of Pharmacy
have adopted rules developed by a joint subcommittee governing the approval
of individual clinical pharmacist practitioners to practice drug therapy
management health care services with such limitations that the Boards
determine to be in the best interest of patient health and safety.
(2) The clinical pharmacist practitioner has current approval from both Boards.

House Bill 67 Session Law 2025-37 Page 43
(3) The North Carolina Medical Board has assigned an identification numb er to
the clinical pharmacist practitioner which is shown on written prescriptions
written by the clinical pharmacist practitioner.
(4) The drug therapy management agreement prohibits the substitution of a
chemically dissimilar drug product by the pharmaci st for the product
prescribed by the physician without the explicit consent of the physician and
includes a policy for periodic review by the physician of the drugs modified
pursuant to the agreement or changed with the consent of the physician.
(c) Clinical pharmacist practitioners in hospitals and other health facilities that have an
established pharmacy and therapeutics committee or similar group that determines the
prescription drug formulary or other list of drugs to be utilized in the facility and det ermines
procedures to be followed when considering a drug for inclusion on the formulary and procedures
to acquire a nonformulary drug for a patient may order medications and tests under the following
conditions:
(1) The North Carolina Medical Board and the North Carolina Board of Pharmacy
have adopted rules governing the approval of individual clinical pharmacist
practitioners to order medications and tests with such limitations as the Boards
determine to be in the best interest of patient health and safety.
(2) The clinical pharmacist practitioner has current approval from both Boards.
(3) The supervising physician has provided to the clinical pharmacist practitioner
written instructions for ordering, changing, or substituting drugs, or ordering
tests wi th provision for review of the order by the physician within a
reasonable time, as determined by the Boards, after the medication or tests are
ordered.
(4) The hospital or health facility has adopted a written policy, approved by the
medical staff after consultation with nursing administrators, concerning the
ordering of medications and tests, including procedures for verification of the
clinical pharmacist practitioner's orders by nurses and other facility employees
and such other procedures that are in the best interest of patient health and
safety.
(5)(c1) Any drug therapy order written by a clinical pharmacist practitioner or order for
medications or tests medications, tests, or devices shall be deemed to have been authorized by
the physician approved by the Boards as the supervisor of the clinical pharmacist practitioner and
the supervising physician shall be responsible for authorizing the prescription order.
(c2) Institutional and group practices may implement a site -specific, multi -provider
collaborative practice agreement for the care of their patients. The institution or group practice
must develop a policy for oversight, and the clinical pharmacist practitioners engaged in the
agreement must be evaluated by an appointed supervising physician.
(d) Any registered nurse or nurse, licensed practical nurse nurse, or pharmacist who
receives a drug therapy therapy, laboratory test, or device order from a clinical pharmacist
practitioner for medications or tests is authorized to perform that order in the same manner as if
the order was received from a licensed physician.
(e) The following requirements apply to clinical pharmacist practitioners and supervising
physicians engaging in collaborative practice:
(1) A clinical pharmacist practitioner shall have a site -specific supervising
physician.
(2) The supervising physician shall conduct periodic review and evaluation of the
health care services provided by the clinical pharmacist practitioner.
(3) A physician may collaborate with any number of clinica l pharmacist
practitioners, but when acting as the supervising physician , they shall

Page 44 Session Law 2025-37 House Bill 67
supervise as many clinical pharmacist practitioners as the supervising
physician deems can be safely and effectively supervised.
(4) Health care services delegated by a supervising physician, such as initiating,
changing, or discontinuing drugs, or ordering tests or devices, to assist with
drug therapy, disease, or population health management, must be included in
the written agreement b etween the supervising physician and the clinical
pharmacist practitioner.
(5) A supervising physician may include a "statement of authorization " in the
written agreement to allow the clinical pharmacist practitioner to conduct drug
substitutions within the same therapeutic class or for biosi milar medications
based upon the health plan 's drug formulary for a patient. The clinical
pharmacist practitioner shall document and notify the patient 's physician of
any substitutions made.
(6) Supervising physicians may add other advanced practice provid ers that they
supervise to their collaborative practice agreement with a clinical pharmacist
practitioner. The evaluation and supervision of the clinical pharmacist
practitioner shall remain with the supervising physician.
(f) The health care setting location for the provision of health care services by the clinical
pharmacist practitioner may be fully or partially embedded for a site-specific practice. The setting
location shall be determined by the supervising physician and included in the site -specific
collaborative practice agreement."
SECTION 7.1.(c) G.S. 90-85.3(b2) reads as rewritten:
"(b2) "Clinical pharmacist practitioner" means a licensed pharmacist who meets the
guidelines and criteria for such title established by the joint subcommittee of the North Carolina
Medical Board and the North Carolina Board of Pharmacy and is authorized to enter into perform
medical act s, tasks, and functions for drug therapy therapy, disease, or population health
management agreements with physicians in accordance with the provisions of G.S. 90-18.4."
SECTION 7.2.(a) Part 7 of Article 50 of Chapter 58 of the General Statutes is
amended by adding a new section to read:
"§ 58-50-296. Pharmacist credentialing.
Insurers offering a health benefit plan that delegate s credentialing agreements or
requirements for pharmacists licensed under Article 4A of Chapter 90 of the General Statutes or
the relevant laws of another state to a contracted healthcare facility shall accept the credentialing
for all pharmacists employed by, or contracted with, those healthcare facilities."
SECTION 7.2.(b) Article 3 of Chapter 58 of the General Statutes is amended by
adding a new section to read:
"§ 58-3-241. Healthcare services provided by pharmacists.
(a) The following definitions apply in this section:
(1) Healthcare services. – Any of the following health or medical procedure s or
services rendered by a healthcare provider:
a. Testing, diagnosis, or treatment of a health condition, illness, injury,
or disease. This includes testing, diagnosis, or treatment rendered by a
pharmacist acting within the pharmacist's scope of practice.
b. Dispensing of drugs, medical devices, medical appliances, or medical
goods for the treatment of a health condition, illness, injury, or disease.
c. Administration of a vaccine or medication.
(2) Pharmacist. – An individual licensed to practice pharmacy under Article 4A
of Chapter 90 of the General Statutes or the relevant laws of another state.
(b) A health benefit plan offered by an insurer in this State shall cover healthcare services
provided by a pharmacist if all of the following conditions are met:

House Bill 67 Session Law 2025-37 Page 45
(1) The service or procedure was performed within the pharmacist 's licensed
lawful scope of practice.
(2) The health benefit plan would have covered the service if the service or
procedure had been performed by another healthcare provider.
(c) The participation of a pharmacy in a drug benefit provider network of a health benefit
plan shall not satisfy any requirement that insurers of fering health benefit plans include
pharmacists in medical benefit provider networks."
SECTION 7.2.(c) G.S. 58-56-26 is amended by adding a new subsection to read:
"(e) Notwithstanding any provision of this Article to the contrary, all requirements relating
to the coverage of prescription drugs and pharmacy services under this Chapter applicable to
health benefit plans are applicable to a third -party administrator in the same way they are
applicable to an insurer."
SECTION 7.2.(d) Article 56A of Chapter 58 of the General Statutes is amended by
adding a new section to read:
"§ 58-56A-55. Health benefit plan requirements applicable.
All requirements relating to the coverage of prescription drugs and pharmacy services under
this Chapter applicable to health benefit plans are applicable to a pharmacy benefits manager in
the same way they are applicable to an insurer."
SECTION 7.2.(e) This section becomes effective October 1, 2025, and applies to
contracts entered into, renewed, or amended on or after that date.
SECTION 7.3.(a) The North Carolina Medical Board and the North Carolina Board
of Pharmacy may adopt temporary rules to implement the provisions of this Part.
SECTION 7.3.(b) This section is effective when it becomes law.
SECTION 7.4. Except as otherwise provided, this Part becomes effective October
1, 2025.

PART VIII. ALLEVIATE THE DANGERS OF SURGICAL SMOKE
SECTION 8.(a) Part 2 of Article 5 of Chapter 131E of the General Statutes is
amended by adding a new section to read:
"§ 131E-78.4. Hospital standards for surgical smoke evacuation.
(a) Definitions. – The following definitions apply in this section:
(1) Smoke evacuation /filtering system. – Stand-alone, portable equipment that
effectively captures, filters, and eliminates surgical smoke at the site of origin
before the smoke makes contact with the eyes or respiratory tracts of
occupants in the room. This equipment is not required to be interconnected to
the hospital surgical ventilation or medical gas system.
(2) Surgical smoke. – The gaseous by -product produced by energy -generating
devices, including surgical plume, smoke plume, bio-aerosols, laser-generated
airborne contaminants, or lung-damaging dust.
(b) Each hospital licensed under this Part shall adopt and implement policies that require
the use of a smoke evacuation /filtering system during any surgical procedure that is likely to
generate surgical smoke.
(c) Adverse Action. – The Department of Health and Human Services may take adverse
action against a hospital under G.S. 131E-78 for a violation of this section."
SECTION 8.(b) Part 4 of Article 6 of Chapter 131E of the General Statutes is
amended by adding a new section to read:
"§ 131E-147.2. Ambulatory surgical facility standards for surgical smoke evacuation.
(a) Definitions. – The following definitions apply in this section:
(1) Smoke evacuation /filtering system. – Equipment that effectively captures,
filters, and eliminates surgical smoke at the site of origin before the smoke
makes contact with the eyes or the respiratory tracts of occupants in the room.

Page 46 Session Law 2025-37 House Bill 67
This equipment is not required to be interconnected to the ambulatory surgical
ventilation or medical gas system.
(2) Surgical smoke. – The gaseous by -product produced by energy -generating
devices, including surgical plume, smoke plume, bio-aerosols, laser-generated
airborne contaminants, or lung-damaging dust.
(b) Each ambulatory surgical facility licensed under this Part shall adopt and implement
policies that require the use of a smoke evacuation/filtering system during any surgical procedure
that is likely to generate surgical smoke.
(c) Adverse Action. – The Department of Health and Human Services may take adverse
action against an ambulatory surgical facility under G.S. 131E-148 for a violation of this section."
SECTION 8.(c) This Part becomes effective January 1, 2026.

PART IX. COMMUNITY C OLLEGE BEHAVIORAL HE ALTH WORKFORCE
ENHANCEMENT
SECTION 9.1.(a) Definitions. – For the purposes of this act, the following
definitions apply:
(1) Associate Professional (AP). – As defined in 10A NCAC 27G .0104(1).
(2) Commission. – Commission for Mental Health, Developmental Disabilities,
and Substance Abuse Services.
(3) Qualified Professional. – As defined in 10A NCAC 27G .0104(21).
(4) Qualified Substance Abuse Prevention Professional (QSAPP). – As defined
in 10A NCAC 27G .0104(22).
(5) Staff Definitions Rule. – 10A NCAC 27G .0104 (Staff Definitions).
SECTION 9.1.(b) Staff Definitions Rule. – Until the effective date of the revised
permanent rule that the Commission is required to adopt pursuant to subsection (e) of this section,
the Commission shall implement the Staff Definitions Rule as provided in subsections (c ) and
(d) of this section.
SECTION 9.1.(c) Implementation. – With respect to the definitions of "Associate
Professional (AP)," "Qualified Professional," and "Qualified Substance Abuse Prevention
Professional (QSAPP)," the Staff Definitions Rule shall be implemented to provide the following
new qualification for each term, in addition to current qualifications, for each definition,
respectively:
(1) Associate Professional (AP). – May be a graduate of a community college
with an associate degree in a human services field with less than two years of
experience with the population served.
(2) Qualified Professional. – May be a graduate of a community college with an
associate degree in a human services field and has two years of full -time or
pre- or post -associate degree accumulated supervised mental health,
developmental disabilities, and substance abuse services experience with the
population served.
(3) Qualified Substance Abuse Prevention Professional (QSAPP). – May be a
graduate of a community college with an associate degree in the human
services field and has two years of full -time or pre- or post-associate degree
accumulated supervised experience in addictions and recovery prevention.
SECTION 9.1.(d) Additional Implementation. – With respect to the defin ition of
"Qualified Substance Abuse Prevention Professional (QSAPP)," the Staff Definitions Rule shall
be implemented to provide for accumulated supervised experience in substance abuse prevention
prior to the completion of a bachelor's degree to qualify for each pathway under 10A NCAC 27G
.0104(22)a. through d.
SECTION 9.1.(e) Additional Rulemaking Authority. – The Commission shall adopt
a rule to amend the Staff Definitions Rule consistent with subsections (c) and (d) of this section.

House Bill 67 Session Law 2025-37 Page 47
Notwithstanding G.S. 150B-19(4), the rule adopted by the Commission pursuant to this section
shall be substantively identical to the provisions of subsections (c) and (d) of this section. Rules
adopted pursuant to this section are not subject to Part 3 of Article 2A of Chapt er 150B of the
General Statutes. Rules adopted pursuant to this section shall become effective as provided in
G.S. 150B-21.3(b1), as though 10 or more written objections had been received as provided in
G.S. 150B-21.3(b2).
SECTION 9.1.(f) Conforming Rule Changes. – The Commission shall amend any
additional rules under Subchapter 27G of Title 10A of the North Carolina Administrative Code
prior to submission to the Rules Review Commission, necessary to implement the provisions of
this act.
SECTION 9.1.(g) Sunset. – This section expires when permanent rules adopted as
required by subsection (d) of this section become effective.
SECTION 9.2. This Part is effective when it becomes law.

PART X. MARRIAGE AND FAMILY THERAPY LICENSURE REFORMS
SECTION 10.(a) G.S. 90-270.56 reads as rewritten:
"§ 90-270.56. Reciprocal licenses.
The Board may shall issue a license as a marriage and family therapist or a marriage and
family therapy associate by reciprocity to any person who applies for the license as prescribed
by the Board and who at all times during the application process:
(1) Has been licensed and actively practicing for five at least two continuous years
and is currently licensed as a marriage and family therapist or marriage and
family therapy associate in another state.
(2) Has an unrestricted license in good standing in the other state.
(3) Has no unresolved complaints in any jurisdiction.
(4) Has passed the National Marriage and Family Therapy
examination.examination or the clinical examination required by the licensing
board that regulates marriage and family therapy in the State of California."
SECTION 10.(b) G.S. 90-270.63 reads as rewritten:
"§ 90-270.63. Criminal history record checks of applicants for licensure as a marriage and
family therapist and a marriage and family therapy associate.
(a) Definitions. – The following definitions shall apply in this section:
(1) Applicant. – A person applying for licensure as a licensed marriage and family
therapy associate pursuant to G.S. 90-270.54A or license d marriage and
family therapist pursuant to G.S. 90-270.54.G.S. 90-270.54 or
G.S. 90-270.56.
…."
SECTION 10.(c) The North Carolina Marriage and Family Therapy Licensure
Board may adopt rules to implement the provisions of this act.
SECTION 10.(d) This Part becomes effective October 1, 2025, and applies to
applications for licensure on or after that date.

Page 48 Session Law 2025-37 House Bill 67
PART XI. EFFECTIVE DATE
SECTION 11. Except as otherwise provided, this act is effective when it becomes
law.
In the General Assembly read three times and ratified this the 25th day of June, 2025.

s/ Rachel Hunt
President of the Senate

s/ Destin Hall
Speaker of the House of Representatives

s/ Josh Stein
Governor

Approved 9:31 a.m. this 1st day of July, 2025