PA Team-Based Practice.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 2
SENATE BILL 345
Health Care Committee Substitute Adopted 4/30/25

Short Title: PA Team-Based Practice. (Public)
Sponsors:
Referred to:
March 20, 2025
*S345-v-2*
A BILL TO BE ENTITLED 1
AN ACT TO ADJUST THE SUPERVISION ARRANGE MENT OF PHYSICIAN 2
ASSISTANTS AND TO MA KE VARIOUS CHANGES T O THE LICENSURE OF 3
PHYSICIAN ASSISTANTS AND TO ALLOW NURSE PRACTITIONERS AND NURSE 4
MIDWIVES TO BE REGULATED BY THE BOARD OF NURSING. 5
The General Assembly of North Carolina enacts: 6
SECTION 1.(a) G.S. 90-1.1 is amended by adding a new subdivision to read: 7
"(4d) Team-based setting or team-based practice. – Any of the following: 8
a. A medical practice that meets all of the following requirements: 9
1. The majority of the practice is owned collectively by one or 10
more licensed physicians. 11
2. An owner who is a physician licensed under this Chapter has 12
consistent and meaningful participation in the design and 13
implementation of health servic es to patients , as defined by 14
rules adopted by the Board. 15
3. The physicians and team -based physician assistants who 16
provide services at the medical practice work in the same 17
clinical practice area. 18
b. Hospitals, clinics, nursing homes, and other health facilities with 19
active credentialing and quality programs where physicians have 20
consistent and meaningful participation in the design and 21
implementation of health services to patients , as defined by rules 22
adopted by the Board. 23
c. For the purposes of this A rticle, the term "team-based setting " or 24
"team-based practice " shall not include a medical practice that 25
specializes in pain management." 26
SECTION 1.(b) G.S. 90-9.3 reads as rewritten: 27
"§ 90-9.3. Requirements for licensure as a physician assistant. 28
(a) To be eligible for licensure as a physician assistant, an applicant shall submit proof 29
satisfactory to the Board that the applicant has met all of the following: 30
(1) The applicant has successfully completed an educational program for 31
physician assistants or surgeon assistants accredited by the Accreditation 32
Review Commission on Education for the Physician Assistant or its 33
predecessor or successor entities. 34
(2) The applicant has a current or previous certification issued by the National 35
Commission on Certification of Physician Assistants or its successor. 36
General Assembly Of North Carolina Session 2025
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(3) The applicant is of good moral character. 1
(b) Before initiating practice of medical acts, tasks, or functions as a physician assistant, 2
the physician assistant shall provide the Board the name, address, an d telephone number of the 3
physician who will supervise the physician assistant in the relevant medical setting. This 4
subsection shall not apply to physician assistants who meet the requirements for team -based 5
practice under G.S. 90-9.3A. 6
(c) The Board may, by rule, require an applicant to comply with other requirements or 7
submit additional information the Board deems appropriate." 8
SECTION 1.(c) Article 1 of Chapter 90 of the General Statutes is amended by adding 9
a new section to read: 10
"§ 90-9.3A. Requirements for team-based practice as a physician assistant. 11
(a) In order to practice as a team -based physician assistant, a physician assistant shall 12
meet all of the following conditions: 13
(1) Practice in team-based settings, as defined in G.S. 90-1.1(4d). 14
(2) Have more than 4,000 hours of clinical practice experience as a licensed 15
physician assistant and more than 1,000 hours of clinical practice experience 16
within the specific medical specialty of practice with a physician in that 17
specialty. 18
(3) Submit proof as the Board may deem satisfactory by rule that the individual 19
meets the requirements of subdivisions (1) and (2) of this subsection. The 20
Board may, by rule, require the physician assistant to comply with other 21
requirements or submit additional information the Board deems appropriate. 22
(b) Team-based p hysician assistants shall collaborate and consult with or refer to the 23
appropriate members of the health care team as required by the patient 's condition and as 24
indicated by the education, experience, and competencies of the physician assistant and the 25
standard of care. The degree of collaboration must be determined by the practice which may 26
include decisions by the employer, group, hospital service, and the credentialing and privileging 27
systems of a licensed facility. The B oard may adopt rules to establish requirements for the 28
determination and enforcement of collab oration, consultation, and referral. Team-based 29
physician assistants are responsible for the care they provide. 30
(c) Notwithstanding any other provision of this Chapter, a team-based physician assistant 31
practicing in a perioperative setting, including the provision of surgical or anesthesia -related 32
services, shall be supervised by a physician." 33
SECTION 1.(d) G.S. 90-12.4 reads as rewritten: 34
"§ 90-12.4. Physician assistant limited volunteer license. 35
… 36
(d) Before initiating the performance of medical acts, tasks, or functions as a physician 37
assistant licensed under this section, the physician assistant shall provide submit to the Board 38
either an "Intent to Practice Notification Form ," which shall include the name, address, and 39
telephone number of the physician licensed under this Article who will supervise the physician 40
assistant in the clinic specializing in the care of indigent patients.patients, or meet the 41
requirements for team-based practice under G.S. 90-9.3A. 42
…." 43
SECTION 1.(e) G.S. 90-12.4B reads as rewritten: 44
"§ 90-12.4B. Physician Assistant assistant retired limited volunteer license. 45
…." 46
SECTION 1.(f) G.S. 90-18.1 reads as rewritten: 47
"§ 90-18.1. Limitations on physician assistants. 48
(a) Any person who is licensed under the provisions of G.S. 90-9.3 to perform medical 49
acts, tasks, and functions as a physician assistant may use the title "physician assistant" or "PA." 50
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Senate Bill 345-Second Edition Page 3
Any other person who uses the title in any form or holds out to be a physicia n assistant or to be 1
so licensed, shall be deemed to be in violation of this Article. 2
(a1) Physician assistants shall clearly designate their credentials as a physician assistant in 3
all clinical settings. 4
(b) Physician assistants are authorized to write pr escriptions for drugs under the 5
following conditions: 6
(1) The North Carolina Medical Board has adopted regulations governing the 7
approval of individual physician assistants to write prescriptions with such 8
limitations as the Board may determine to be in th e best interest of patient 9
health and safety. 10
(2) The physician assistant holds a current license issued by the Board. 11
(3) Repealed by Session Laws 2019-191, s. 35, effective October 1, 2019. 12
(4) The supervising physician has provided to the physician assi stant written 13
instructions about indications and contraindications for prescribing drugs and 14
a written policy for periodic review by the physician of the drugs prescribed. 15
This subdivision shall not apply to individuals who are practicing in a 16
team-based setting under G.S. 90-9.3A. 17
(5) A physician assistant shall personally consult with the supervising physician 18
prior to prescribing a targeted controlled substance as defined in Article 5 of 19
this Chapter when all of the following conditions apply: 20
a. The patient is being treated by a facility that primarily engages in the 21
treatment of pain by prescribing narcotic medications. 22
b. The therapeutic use of the targeted controlled substance will or is 23
expected to exceed a period of 30 days. 24
When a targeted controll ed substance prescribed in accordance with this subdivision is 25
continuously prescribed to the same patient, the physician assistant shall consult with the 26
supervising physician at least once every 90 days to verify that the prescription remains medically 27
appropriate for the patient. 28
(c) Physician assistants are authorized to compound and dispense drugs under the 29
following conditions: 30
(1) The function is performed under the supervision of a licensed 31
pharmacist.physician. 32
(2) Rules and regulations of the North Carolina Board of Pharmacy and all 33
applicable State and federal laws governing this function compounding and 34
dispensing are complied with. 35
(3) The physician assistant holds a current license issued by the Board. 36
(4) The physician assistant registers with the Board of Pharmacy. 37
(d) Physician assistants are authorized to order medications, tests and treatments in 38
hospitals, clinics, nursing homes, and other health facilities under the following conditions: 39
(1) The North Caro lina Medical Board has adopted regulations governing the 40
approval of individual physician assistants to order medications, tests, and 41
treatments with such limitations as the Board may determine to be in the best 42
interest of patient health and safety. 43
(2) The physician assistant holds a current license issued by the Board. 44
(3) The If the p hysician assistant is subject to a supervisory arrangement, the 45
supervising physician has provided to the physician assistant written 46
instructions about ordering medication s, tests, and treatments, and when 47
appropriate, specific oral or written instructions for an individual patient, with 48
provision for review by the physician of the order within a reasonable time, as 49
determined by the Board, after the medication, test, or treatment is ordered. 50
General Assembly Of North Carolina Session 2025
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(4) The hospital or other health facility has adopted a written policy about 1
ordering medications, tests, and treatments, including procedures for 2
verification of the physician assistants' orders by nurses and other facility 3
employees and such other procedures as are in the interest of patient health 4
and safety. 5
(e) Any prescription written by a physician assistant or order given by a physician 6
assistant for medications, tests, or treatments shall be deemed to have been authorized by the 7
physician approved by the Board as the supervisor of the physician assistant and the supervising 8
physician shall be responsible for authorizing the prescription or order. This subsection shall not 9
apply to individuals who are practicing in a team -based setting under G.S. 90-9.3A who may 10
prescribe, order, administer, and procure drugs and medical devices without p hysician 11
authorization. Individuals who are practicing in a team -based setting under G.S. 90-9.3A may 12
also plan and initiate a therapeutic regim en that includes ordering and prescribing 13
non-pharmacological interventions, including durable medical equipment, nutrition, blood, blood 14
products, and diagnostic support services, including home health care, hospice, and physical and 15
occupational therapy. 16
(e1) Any medical certification completed by a physician assistant for a Physician assistants 17
may authen ticate any document, including death certificate shall be deemed to have been 18
authorized by the physician approved by the Board as the supervisor of the physician assistant, 19
and the supervising physician shall be responsible for authorizing the completion certificates with 20
their signature, certification, stamp, verification, affidavit, or endorsement , if it may be so 21
authenticated by the signature, certification, stamp, verification, affidavit, or endorsement of the 22
medical certification.a physician. 23
(e2) Physician assistants shall not perform final interpretations of diagnostic imaging 24
studies. For purposes of this subsection, "diagnostic imaging " shall include comp uted 25
tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission 26
tomography (PET), mammography, and ultra sound services. Final interpretation shall be 27
provided by a physician licensed under this Chapter. Notwithstanding any other provision of this 28
Chapter, physician assistants conducting final interpretation of plain film radiographs shall be 29
supervised by a physician. 30
… 31
(g) Any person who is licensed under G.S. 90-9.3 to perform medical acts, tasks, and 32
functions as a physician assistant shall comply with each of the following: 33
(1) Maintain a current and active license to practice in this State. 34
(2) Maintain an active registration with the Board. 35
(3) Have File a current Intent to Practice form filed with the Board.Board or meet 36
the requirements for team-based practice under G.S. 90-9.3A. 37
…." 38
SECTION 1.(g) G.S. 90-21.81(9) reads as rewritten: 39
"(9) Qualified technician. – A registered diagnostic medical sonographer who is 40
certified in obstetrics and gynecology by the American Registry for 41
Diagnostic Medical Sonography (ARDMS) (ARDMS), a physician assistant 42
with certification in obstetrical ultrasonography, or a nurse midwife or 43
advanced practice nurse practitioner in obstetrics with certification in 44
obstetrical ultrasonography." 45
SECTION 1.(h) G.S. 58-3-169 reads as rewritten: 46
"§ 58-3-169. Required coverage for minimum hospital stay following birth. 47
(a) Definitions. – As used in this section: 48
(1) "Attending providers" includes: 49
General Assembly Of North Carolina Session 2025
Senate Bill 345-Second Edition Page 5
a. The obstetrician-gynecologists, pediatricians, family physicians, and 1
other physicians primarily responsible for the care of a mother and 2
newborn; and 3
b. The nurse midwives midwives, physician assistants, and nurse 4
practitioners primarily responsible for the care of a mother and her 5
newborn child in accordance with State licensure and certification 6
laws. 7
…." 8
SECTION 1.(i) G.S. 110-91 reads as rewritten: 9
"§ 110-91. Mandatory standards for a license. 10
All child care facilities shall comply with all State laws and federal laws and local ordinances 11
that pertain to child health, safety, and welfare. Except as otherwise provided in this Article, the 12
standards in this section shall be complied with by all child care facilities. However, none of the 13
standards in this section apply to the schoo l-age children of the operator of a child care facility 14
but do apply to the preschool-age children of the operator. Children 13 years of age or older may 15
receive child care on a voluntary basis provided all applicable required standards are met. The 16
standards in this section, along with any other applicable State laws and federal laws or local 17
ordinances, shall be the required standards for the issuance of a license by the Secretary under 18
the policies and procedures of the Commission except that the Commission may, in its discretion, 19
adopt less stringent standards for the licensing of facilities which provide care on a temporary, 20
part-time, drop-in, seasonal, after-school or other than a full-time basis. 21
(1) Medical Care and Sanitation. – The Commission for Public Health shall adopt 22
rules which establish minimum sanitation standards for child care centers and 23
their personnel. The sanitation rules adopted by the Commission for Public 24
Health shall cover such matters as the cleanliness of floors, walls, ceilings , 25
storage spaces, utensils, and other facilities; adequacy of ventilation; 26
sanitation of water supply, lavatory facilities, toilet facilities, sewage disposal, 27
food protection facilities, bactericidal treatment of eating and drinking 28
utensils, and solid -waste storage and disposal; methods of food preparation 29
and serving; infectious disease control; sleeping facilities; and other items and 30
facilities as are necessary in the interest of the public health. The Commission 31
for Public Health shall allow child car e centers to use domestic kitchen 32
equipment, provided appropriate temperature levels for heating, cooling, and 33
storing are maintained. Child care centers that fry foods shall use commercial 34
hoods. These rules shall be developed in consultation with the Department. 35
The Commission shall adopt rules for child care facilities to establish 36
minimum requirements for child and staff health assessments and medical 37
care procedures. These rules shall be developed in consultation with the 38
Department. Each child shall have a health assessment before being admitted 39
or within 30 days following admission to a child care facility. The assessment 40
shall be done by: (i) a licensed physician, (ii) the physician's authorized agent 41
who is currently approved by the North Carolina M edical Board, or 42
comparable certifying board in any state contiguous to North Carolina, (iii) a 43
certified nurse practitioner, (iv) a licensed physician assistant, or (iv) (v) a 44
public health nurse meeting the Departments Standards for Early Periodic 45
Screening, Diagnosis, and Treatment Program. However, no health 46
assessment shall be required of any staff or child who is and has been in 47
normal health when the staff, or the child's parent, guardian, or full -time 48
custodian objects in writing to a health assessment on religious grounds which 49
conform to the teachings and practice of any recognized church or religious 50
denomination. 51
General Assembly Of North Carolina Session 2025
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Organizations that provide prepared meals to child care centers only are 1
considered child care centers for purposes of compliance with appropriate 2
sanitation standards. 3
…." 4
SECTION 2. The North Carolina Medical Board shall adopt permanent rules 5
necessary to implement the provisions of this act. 6
SECTION 3.(a) G.S. 90-8.2(a) is repealed. 7
SECTION 3.(b) G.S. 90-18(c) reads as rewritten: 8
"§ 90-18. Practicing without license; penalties. 9
(c) The following shall not constitute practicing medicine or surgery as defined in this 10
Article: 11
… 12
(14) The practice of nursing by a registered nurse engaged in the practice of nursing 13
and the performa nce of acts otherwise constituting medical practice by a 14
registered nurse when performed in accordance with rules and regulations 15
developed by a joint subcommittee of the North Carolina Medical Board and 16
the the North Carolina Board of Nursing and adopted by both boards.Nursing. 17
…." 18
SECTION 3.(c) G.S. 90-18.2 reads as rewritten: 19
"§ 90-18.2. Limitations on nurse practitioners. 20
(a) Any nurse approved under the provisions of G.S. 90-18(c)(14) to perform medical 21
acts, tasks or functions may use the title "nurse practitioner." Any other person who uses the title 22
in any form or holds out to be a nurse practitioner or to be so approved, shall be deemed to be in 23
violation of this Article. 24
(b) Nurse practitioners are authorized to write prescriptions for drugs unde r all of the 25
following conditions: 26
(1) The North Carolina Medical Board and Board of Nursing have has adopted 27
regulations developed by a joint subcommittee governing the approval of 28
individual nurse practitioners to write prescriptions with such limitations as 29
the boards North Carolina Board of Nursing may determine to be in the best 30
interest of patient health and safety. 31
(2) The nurse practitioner has curren t approval from the boards.North Carolina 32
Board of Nursing. 33
(3) Repealed by Session Laws 2019-191, s. 36, effective October 1, 2019. 34
(4) The supervising physician has provided to the nurse practitioner written 35
instructions about indications and contraindications for prescribing drugs and 36
a written policy for periodic review by the physician of the drugs prescribed. 37
(5) A nurse practitioner shall personally consult with the supervising physician 38
prior to prescribing a targeted controlled substance as defined in Article 5 of 39
this Chapter when all of the following conditions apply: 40
a. The patient is being treated by a facility that primarily engages in the 41
treatment of pain by prescribing narcotic medications. 42
b. The therapeutic use of the targeted controlled substance will or is 43
expected to exceed a period of 30 days. 44
When a targeted controlled substance prescribed in accordance with this 45
subdivision is continuously prescribed to the same patient, the nurse 46
practitioner shall consult with the supervising physician at least once every 90 47
days to verify that the prescription remains medically appropriate for the 48
patient. 49
(c) Nurse practitioners are authorized to compound and dispense drugs under the 50
following conditions: 51
General Assembly Of North Carolina Session 2025
Senate Bill 345-Second Edition Page 7
(1) The function is performed under the supervision of a licensed pharmacist; and 1
(2) Rules and regulations of the North Carolina Board of Pharmacy governing 2
this function are complied with. 3
(d) Nurse practitioners are authorized to order medications, tests and treatments in 4
hospitals, clinics, nursing homes and other health facilities under all of the following conditions: 5
(1) The North Carolina Medical Board and Board of Nursing have has adopted 6
regulations developed by a joint subcommittee governing the approval of 7
individual nurse practitioners to order medications, tests and treatments with 8
such limitations as the boards may determine to be in the best interest of 9
patient health and safety. 10
(2) The nurse practitioner has current approval from the boards.North Carolina 11
Board of Nursing. 12
(3) The supervising physician has provided to the nurse practitioner written 13
instructions about ordering medications, tests and treatments, and when 14
appropriate, specific oral or written instructions for an individual patient, with 15
provision for review by the physician of the order within a reasonable time, as 16
determined by the Board, North Carolina Board of Nursing, after the 17
medication, test or treatment is ordered. 18
(4) The hospital or other health facility has adopted a written policy, approved by 19
the medical st aff after consultation with the nursing administration, about 20
ordering medications, tests and treatments, including procedures for 21
verification of the nurse practitioners' orders by nurses and other facility 22
employees and such other procedures as are in th e interest of patient health 23
and safety. 24
(e) Any prescription written by a nurse practitioner or order given by a nurse practitioner 25
for medications, tests or treatments shall be deemed to have been authorized by the physician 26
approved by the boards North Carolina Board of Nursi ng as the supervisor of the nurse 27
practitioner and such supervising physician shall be responsible for authorizing such prescription 28
or order. 29
(e1) Any medical certification completed by a nurse practitioner for a death certificate 30
shall be deemed to have been authorized by the physician approved by the boards as the 31
supervisor of the nurse practitioner, and the supervising physician shall be responsible for 32
authorizing the completion of the medical certification. 33
(f) Any registered nurse or licensed practical nurse who receives an order from a nurse 34
practitioner for medications, tests or treatments is authorized to perform that order in the same 35
manner as if it were received from a licensed physician." 36
SECTION 3.(d) G.S. 90-171.23(b) reads as rewritten: 37
"(b) Duties, powers. The Board is empowered to: 38
… 39
(14) Appoint and maintain a subcommittee of the Board to work jointly with the 40
subcommittee of the North Carolina Medical Board to develop rules and 41
regulations to govern the performan ce of medical acts by registered nurses 42
and to determine reasonable fees to accompany an application for approval or 43
renewal of such approval as provided in G.S. 90-8.2. The fees and rules 44
developed by this subcommittee shall govern the performance of medical acts 45
by registered nurses and shall become effective when they have been adopted 46
by both Boards. Grant prescribing, ordering, dispensing, and furnishing 47
authority to nurse practitioners pursuant to G.S. 90-18.2. Notwithstanding any 48
other provision of law, the Board shall have the sole authority to adopt rules 49
and enforce regulations governing the practice and conduct of nurse 50
General Assembly Of North Carolina Session 2025
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practitioners as defined in G.S. 90-18.2 and certified nurse midwives and the 1
practice of midwifery as defined in G.S. 90-178.2. 2
… 3
(25) Adopt rules necessary to implement and administer the provisions of Article 4
10A of this Chapter." 5
SECTION 3.(e) G.S. 90-171.37(b) is repealed. 6
SECTION 3.(f) G.S. 90-18.8 reads as rewritten: 7
"§ 90-18.8. Limitations on nurse-midwives. 8
(a) Any Certified Nurse Midwife approved under the provisions of Article 10A of this 9
Chapter to provide midwifery care may use the title "Certified Nurse Midwife." Any other person 10
who uses the title in any form or holds himself or herself out to be a Certified Nurse Midwife or 11
to be so approved shall be deemed to be in violation of this Article. 12
(b) A Certified Nurse Midwife is authorized to write prescriptions for drugs if all of the 13
following conditions are met: 14
(1) The Certified Nurse Midwife has current approval fro m the joint 15
subcommittee established under North Carolina Board of Nursing pursuant to 16
G.S. 90-178.4. 17
(2) The joint subcommittee as established under G.S. 90-178.4 North Carolina 18
Board of Nursing has assigned an identification number to the Certified Nurse 19
Midwife that appears on the written prescription. 20
(3) The joint subcommittee as established under G.S. 90-178.4 North Carolina 21
Board of Nursing has provided to the Certified Nurse Midwife written 22
instructions about indications and contraindications for prescribing drugs and 23
a written policy for periodic review of the drugs prescribed. 24
(c) The joint subcommittee of the North Carolina Medical Board and the Board of 25
Nursing, established under North Carolina Board of Nursing, pursuant to G.S. 90-178.4, shall 26
adopt rules governing the approval of individual Certified Nurse Midwives to write prescriptions 27
with any limitations the joint subcommittee Board deems are in the best interest of patient health 28
and safety, consistent with the rules established for nurse practitioners under G.S. 90-18.2(b)(1)." 29
SECTION 3.(g) G.S. 90-178.3 reads as rewritten: 30
"§ 90-178.3. Regulation of midwifery. 31
… 32
(b1) A Certified Nurse Midwife with less than 24 months and 4,000 hours of practice as a 33
Certified Nurse Midwife shall (i) ha ve a collaborative provider agreement with a collaborating 34
provider and (ii) maintain signed and dated copies of the collaborative provider agreement as 35
required by practice guidelines and any rules adopted by the joint subcommittee of the North 36
Carolina Medical Board and the Board of Nursing. If a collaborative provider agreement is 37
terminated before the Certified Nurse Midwife acquires the level of experience required for 38
practice without a collaborative provider agreement under this Article, the Certifie d Nurse 39
Midwife shall have 90 days from the date the agreement is terminated to enter into a collaborative 40
provider agreement with a new collaborating provider. During the 90 -day period, the Certified 41
Nurse Midwife may continue to practice midwifery as defined under this Article. 42
(c) Graduate nurse midwife applicant status may be granted by the joint subcommittee 43
North Carolina Board of Nursing in accordance with G.S. 90-178.4." 44
SECTION 3.(h) G.S. 90-178.4 reads as rewritten: 45
"§ 90-178.4. Administration. 46
(a) The joint subcommittee of the North Carolina Medical Board and the Board of 47
Nursing created pursuant to G.S. 90-18.2 shall administer the provisions of this Article and the 48
rules adopted pursuant to this Article; Provided, however, that actions of the joint subcommittee 49
pursuant to this Article shall not require approval by the North Carolina Medical Board and the 50
Board of Nursing. For purposes of this Article, the joint subcommittee shall be enlarged by four 51
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additional members, including two certified midwives and two obstetricians who have had 1
working experience with midwives.Article. 2
(a1) Any Certified Nurse Midwife who attends a planned birth outside of a hospital setting 3
shall discuss with the patient the associated risks and obtain a signed informed consent agreement 4
from the Certified Nurse Midwife's patient that shall include: 5
(1) Information about the risks associated with a planned birth outside of the 6
hospital. 7
(2) A clear assumption of those risks by the patient. 8
(3) An agreement by the patient to consent to transfer to a health care facility 9
when and if deemed necessary by the Certified Nurse Midwife. 10
(4) If the Certified Nurse Midwife is not covered under a policy of liability 11
insurance, a clear disclosure to that effect. 12
(5) The joint subcommittee North Carolina Board of Nursing shall develop the 13
contents of an informed consent agreement form to be used by a Certified 14
Nurse Midwife when obtaining informed consent. 15
(a2) Any Certified Nurse Midwife who attends a planned birth outside of a hospital setting 16
shall provide to each patient a detailed, written plan for emergent and nonemergent transfer, 17
which shall include: 18
(1) The name of and distance to the nearest health care facility licensed under 19
Chapter 122C or Chapter 131E of the Genera l Statutes that has at least one 20
operating room. 21
(2) The procedures for transfer, including modes of transportation and methods 22
for notifying the relevant health care facility of impending transfer. 23
(3) An affirmation that the relevant health care facility has been notified of the 24
plan for emergent and nonemergent transfer by the Certified Nurse Midwife. 25
(a3) Planned home births attended by a Certified Nurse Midwife shall be limited to 26
low-risk pregnancies. Pregnancies deemed inadvisable for home births by the American College 27
of Obstetricians and Gynecologists Committee on Obstetric Practice shall be prohibited. The 28
joint subcommittee of the North Carolina Medical Board and the Board of Nursing created under 29
G.S. 90-18.2, including the four additional membe rs required by subsection (a) of this section, 30
shall adopt rules governing the safety of home births attended by a Certified Nurse Midwife. 31
(b) The joint subcommittee North Carolina Board of Nursing shall adopt rules under this 32
Article to establish each of the following: 33
(1) A fee which shall cover application and initial approval up to a maximum of 34
one hundred dollars ($100.00). 35
(2) An annual renewal fee to be paid by January 1 of each year by persons 36
approved under this Article up to a maximum of fifty dollars ($50.00). 37
(3) A reinstatement fee for a lapsed approval up to a maximum of five dollars 38
($5.00). 39
(4) The form and contents of the applications which shall include information 40
related to the applicant's education and certification by the American 41
Midwifery Certification Board. 42
(5) The procedure for establishing collaborative provider agreements as required 43
by this Article. 44
(c) The joint subcommittee North Carolina Board of Nursing may solicit, employ, or 45
contract for technical assistance and clerical assistance and may purchase or contract for the 46
materials and services it needs. 47
(d) All fees collected on behalf of the joint subcommittee North Carolina Board of 48
Nursing, pursuant to this section, and all receipts of every kind and nature, as well as the 49
compensation paid the members of the joint subcommittee and the necessary expenses incurred 50
by them in the performance of the duties imposed upon them, shall be reported annually to the 51
General Assembly Of North Carolina Session 2025
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State Treasurer. All fees and other moneys received by the joint subcommittee North Carolina 1
Board of Nursing pursuant to the provisions of the General Statutes this Article shall be kept in 2
a separate fund by the joint subcommittee, Board, to be held and expended only for such purposes 3
as are proper and necessary to the discharge of the duties of the joint subcommittee Board under 4
this Article and to enforce the provisions of this Article. No expense incurred by the joint 5
subcommittee Board pursuant to this Article shall be charged against the State. 6
(e) Members of the joint subcommittee who are not officers or employees of the State 7
shall receive compensation and reimbursement for travel and subsistence expenses at the rates 8
specified in G.S. 138-5. Members of the joint subcommittee who are officers or employees of 9
the State shall receive reimbursement for travel and subsistence expenses at the rate set out in 10
G.S. 138-6. 11
(f) The joint subcommittee Notwithstanding any provision of law to the cont rary, the 12
North Carolina Board of Nursing shall have the sole authority to adopt, amend, and repeal rules 13
necessary to administer the provisions of this Article.Article and to enforce regulations governing 14
the practice and conduct of nurse midwives." 15
SECTION 3.(i) G.S. 90-178.5 reads as rewritten: 16
"§ 90-178.5. Qualifications for approval; independent practice. 17
(a) In order to be approved by the joint subcommittee North Carolina Board of Nursing 18
under this Article, a person shall comply with each of the following: 19
(1) Complete an application on a form furnished by the joint 20
subcommittee.Board. 21
(2) Submit evidence of certification by the American Midwifery Certification 22
Board or its successor. 23
(3) Submit evidence of a collaborative provider agreement as required by 24
G.S. 90-178.3(b1). 25
(4) Pay the fee for application and approval. 26
(b) Upon submitting to the joint subcommittee North Carolina Board of Nursing evidence 27
of completing 24 months and 4,000 hours of practice as a Certified Nurse Midwife pursuant to a 28
collaborative provider agreement, a Certified Nurse Midwife is authorized to practice midwifery 29
independently in accordance with this Article." 30
SECTION 3.(j) G.S. 90-178.6 reads as rewritten: 31
"§ 90-178.6. Denial, revocation or suspension of approval. 32
(a) In accordance with the provisions of Chapter 150B, the joint subcommit tee North 33
Carolina Board of Nursing may deny, revoke or suspend approval when a person has: 34
(1) Failed to satisfy the qualifications for approval;approval. 35
(2) Failed to pay the annual renewal fee by January 1 of the current year;year. 36
(3) Given false information or withheld material information in applying for 37
approval;approval. 38
(4) Demonstrated incompetence in the practice of midwifery;midwifery. 39
(5) Violated any of the provisions of this Article;Article. 40
(6) A mental or physical disability or uses any drug to a degree that interferes with 41
his or her fitness to practice midwifery;midwifery. 42
(7) Engaged in conduct that endangers the public health;health. 43
(8) Engaged in conduct that deceives, defrauds, or harms the public in the course 44
of professional activities or services; orservices. 45
(9) Been convicted of or pleaded guilty or nolo contendere to any felony under 46
the laws of the United States or of any state of the United States indicating 47
professional unfitness. 48
(b) Revocation or suspension of a license to practice nursing pursuant to G.S. 90-171.37 49
shall automatically result in comparable action against the person's approval to practice 50
midwifery under this Article." 51
General Assembly Of North Carolina Session 2025
Senate Bill 345-Second Edition Page 11
SECTION 3.(k) G.S. 90-178.7 reads as rewritten: 1
"§ 90-178.7. Enforcement. 2
(a) The joint subcommittee North Carolina Board of Nursing may apply to the Superior 3
Court of Wake County to restrain any violation of this Article. 4
(b) No person shall perform any act constituting the practice of midwifery, as defined in 5
this Article, or any of the branches thereof, unless the person shall have been first approved under 6
this Article. Any person who practices midwifery without being duly approved and registered, 7
as provided in this Article, shall not be allowed to maintain any action to collect any fee for such 8
services. Any person so practicing without being duly approved shall be guilty of a Class 3 9
misdemeanor. Any person so practicing without being duly approved under this Article and who 10
is falsely representing himself or herself in a manner as being approved under this Article or any 11
Article of this Chapter shall be guilty of a Class I felony." 12
SECTION 4.(a) G.S. 90-2 reads as rewritten: 13
"§ 90-2. Medical Board. 14
(a) There is established the North Carolina Medical Board to regulate the practice of 15
medicine and surgery for the benefit and protection of the people of North Carolina. The Board 16
shall consist of 13 members: 17
(1) Six of the members shall be duly licensed physicians recommended by the 18
Review Panel and appointed by the Governor as set forth in G.S. 90-3. 19
(2) Five members shall all be appointed by the Governor as follows: 20
a. One shall be a member of The Old North State Medical Society. This 21
Board position shall be subject to recommendations of the Review 22
Panel pursuant to G.S. 90-3. 23
b. One shall be a public member, and this Board position shall not be 24
subject to recommendation of the Review Panel pursuant to G.S. 90-3. 25
c. One Two shall be a physician assistant assistants as defined in 26
G.S. 90-18.1 as recommended by the Review Panel pursuant to 27
G.S. 90-3. 28
d. One shall be a nurse practitioner as defined in G.S. 90-18.2 as 29
recommended by the Review Panel pursuant to G.S. 90-3. 30
e. One shall be a duly licensed physician who is a doctor of osteopathic 31
medicine or a full-time faculty member of one of the medical schools 32
in North Carolina who utilizes integrative medicine in that person's 33
clinical practice, as recommended by the Review Panel pursuant to 34
G.S. 90-3. 35
(3) Two public members appointed by the General Assembly in accordance with 36
G.S. 120-121, one upon recommendation of the Speaker of the House of 37
Representatives and one upon the recommendation of the President Pro 38
Tempore of the Senate. 39
(a1) Each appointing and nominating authority shall endeavor to see, insofar as possible, 40
that its appointees and nominees to the Board reflect the composition of the State with regard to 41
gender, ethnic, racial, and age composition. 42
(b) No member shall serve more than two complete three-year terms in a lifetime, except 43
that each member shall serve until a successor is chosen and qualifies. 44
(b1) A public member appointed pursuant to sub -subdivision (a)(2)b. and subdivision 45
(a)(3) of this section shall not be a health care provider nor the spouse of a health care provider. 46
For the purpose of Board member ship, "health care provider" means any licensed health care 47
professional, agent, or employee of a health care institution, health care insurer, health care 48
professional school, or a member of any allied health profession. For purposes of this section, a 49
person enrolled in a program as preparation to be a licensed health care professional or an allied 50
General Assembly Of North Carolina Session 2025
Page 12 Senate Bill 345-Second Edition
health professional shall be deemed a health care provider. For purposes of this section, any 1
person with significant financial interest in a health service or profession is not a public member. 2
(c) Repealed by Session Laws 2003-366, s. 1, effective October 1, 2003. 3
(d) Any member of the Board may be removed from office by the Governor for good 4
cause shown. Any vacancy in the physician, physician assistant, or nurse practitioner physician 5
or physician assistant membership of the Board shall be filled for the period of the unexpired 6
term by the Governor from a list submitted by the Review Panel pursuant to G.S. 90-3. Any 7
vacancy in the public membership of the Boa rd shall be filled by the appropriate appointing 8
authority for the unexpired term. 9
(e) The North Carolina Medical Board shall have the power to acquire, hold, rent, 10
encumber, alienate, and otherwise deal with real property in the same manner as any private 11
person or corporation, subject only to approval of the Governor and the Council of State as to the 12
acquisition, rental, encumbering, leasing, and sale of real property. Collateral pledged by the 13
Board for an encumbrance is limited to the assets, income, and revenues of the Board." 14
SECTION 4.(b) G.S. 90-3 reads as rewritten: 15
"§ 90-3. Review Panel recommends certain Board members; criteria for recommendations. 16
(a) There is created a Review Panel to review all applicants for the physician positions, 17
the phy sician assistant position, and the nurse practitioner position and physician assistant 18
positions on the Board. The Review Panel shall consist of nine members, including four from the 19
Medical Society, one from the Old North State Medical Society, one from the North Carolina 20
Osteopathic Medical Association, one two from the North Carolina Academy of Phy sician 21
Assistants, one from the North Carolina Nurses Association Council of Nurse Practitioners, and 22
one public member currently serving or who has served on the Board. Each member shall serve 23
for a term of three years, ending December 31 of the last year of the term. No member shall serve 24
more than two terms. All physicians, physician assistants, and nurse practitioners physicians and 25
physician assistants serving on the Review Panel shall be actively practicing in North Carolina. 26
The Review Panel shall co ntract for the independent administrative services needed to 27
complete its functions and duties. The Board shall provide funds to pay the reasonable cost for 28
the administrative services of the Review Panel. The Board shall convene the initial meeting of 29
the Review Panel. The Review Panel shall elect a chair, and all subsequent meetings shall be 30
convened by the Review Panel. 31
The Governor shall appoint Board members as provided in G.S. 90-2. The Review Panel shall 32
attempt to make its recommendations to the Gov ernor reflect the composition of the State with 33
regard to gender, ethnic, racial, medical specialty, and age. 34
The Review Panel and its members and staff shall not be held liable in any civil or criminal 35
proceeding for exercising, in good faith, the powers and duties authorized by law. 36
(b) To be considered qualified for a physician position, the physician assistant position, 37
or nurse practitioner or physician assistant position on the Board, an applicant shall meet each of 38
the following criteria: 39
(1) Hold an active, nonlimited license to practice medicine in North Carolina, or 40
in the case of a physician assistant and nurse practitioner, assistant, hold an 41
active license or approval to perform medical acts, tasks, and functions in 42
North Carolina. 43
(2) Have an active clinical or teaching practice. For purposes of this subdivision, 44
the term "active" means patient care, or instruction of students in an accredited 45
medical school or residency, or clinical research program, for 20 hours or 46
more per week. 47
(3) Have actively practiced in this State for at least five consecutive years 48
immediately preceding the appointment. 49
(4) Intend to remain in active practice in this State for the duration of the term on 50
the Board. 51
General Assembly Of North Carolina Session 2025
Senate Bill 345-Second Edition Page 13
(5) Submit at least three letters of recommendat ion, either from individuals or 1
from professional or other societies or organizations. 2
(6) Have no public disciplinary history with the Board or any other licensing 3
board in this State or another state over the past 10 years before applying for 4
appointment to the Board. 5
(7) Have no history of felony convictions of any kind. 6
(8) Have no misdemeanor convictions related to the practice of medicine. 7
(9) Indicate, in a manner prescribed by the Review Panel, that the applicant: (i) 8
understands that the primary purpose of the Board is to protect the public; (ii) 9
is willing to take appropriate disciplinary action against his or her peers for 10
misconduct or violations of the standards of medical care; and (iii) is aware of 11
the time commitment needed to be a constructive member of the Board. 12
(10) Have not served more than 72 months as a member of the Board. 13
(c) The Review Panel shall recommend at least two qualified nominees for each open 14
position on the Board. If the Governor chooses not to appoint either of the recomm ended 15
nominees, the Review Panel shall recommend at least two new qualified nominees. 16
(d) Notice of open physician, physician assistant, or nurse practitioner physician or 17
physician assistant positions on the Board shall be sent to all physicians currently licensed to 18
practice medicine in North Carolina and all physician assistants and nurse practitioners currently 19
licensed or approved to perform medical acts, tasks, and functions in this State. 20
(e) Applicants for positions on the Board shall not be required to be members of any 21
professional association or society, except as provided in G.S. 90-2(a)(2)a. 22
(f) Notwithstanding any provision of G.S. 90-16, the Board may provide confidential and 23
nonpublic licensing and investigative information in its possession to the Review Panel regarding 24
applicants. 25
(g) All applications, records, papers, files, reports, and all investigative and licensing 26
information received by the Review Panel from the Board and other documents received or 27
gathered by the Review Panel, its members, employees, agents, and consultants as a result of 28
soliciting, receiving, and reviewing applications and making recommendations as required in this 29
section shall not be considered public records within the meaning of Chapter 132 of the General 30
Statutes. All such information shall be privileged, confidential, and not subject to discovery, 31
subpoena, or other means of legal compulsion for release to any person other than the Review 32
Panel, the Board, and their employees, agents, or consultants, except as provided in this section. 33
The Review Panel shall publish on its Internet Web site the names and practice addresses of all 34
applicants within 10 days after the application deadline. The Review Panel shall publish on its 35
Internet Web site the names and practice addresses of the nominees recommended to the 36
Governor within 10 days after notifying the Governor of those recommendations and not less 37
than 30 days prior to the expiration of the open position on the Board. 38
(h) The Review Panel is a public body within the meaning of Article 33C of Chapter 143 39
of the General Statutes. In addition to the provisions contained in Article 33C of Chapter 143 of 40
the General Statutes permitting a public body to conduct business in a closed session, the Review 41
Panel shall meet in closed session to review applications; interview applicants; review and 42
discuss information received from the Board; and discuss, debate, and vote on recommendations 43
to the Governor." 44
SECTION 5. The North Carolina Board of Nursing shall adopt rules to implement 45
the provisions of Section 3 of this act. 46
SECTION 6. Section 1 of this act becomes effective when the North Carolina 47
Medical Board adopts the permanent rules required under Section 2 of this act or June 30, 2026, 48
whichever occurs first. The North Carolina Medical Board shall notify the Revisor of Statutes 49
when the rules required under Section 2 of this act have been adopted. Section 3 of this act 50
becomes effective when the North Carol ina Board of Nursing adopts the permanent rules 51
General Assembly Of North Carolina Session 2025
Page 14 Senate Bill 345-Second Edition
required under Section 5 of this act or June 30, 2026, whichever occurs first. The North Carolina 1
Board of Nursing shall notify the Revisor of Statutes when the rules required under Section 5 of 2
this act have been adopted. The remainder of this act is effective when it becomes law. 3