SB 345 — PA Team-Based Practice.

Page 6 Senate Bill 345-Second Edition General Assembly Of North Carolina Session 2025 (1) The function is performed under the supervision of a licensed pharmacist;

and (2) Rules and regulations of the North Carolina Board of Pharmacy governing this function are complied with.

(d) Nurse practitioners are authorized to order medications, tests and treatments in hospitals, clinics, nursing homes and other health facilities under all of the following conditions:

(1) The North Carolina Medical Board and Board of Nursing have has adopted regulations developed by a joint subcommittee governing the approval of individual nurse practitioners to order medications, tests and treatments with such limitations as the boards may determine to be in the best interest of patient health and safety.

(2) The nurse practitioner has current approval from the boards.North Carolina Board of Nursing.

(3) The supervising physician has provided to the nurse practitioner written instructions about ordering medications, tests and treatments, and when appropriate, specific oral or written instructions for an individual patient, with provision for review bythe physician of the order within a reasonable time, as determined by the Board, North Carolina Board of Nursing, after the medication, test or treatment is ordered.

(4) The hospital or other health facility has adopted a written policy, approved by the medical staff after consultation with the nursing administration, about ordering medications, tests and treatments, including procedures for verification of the nurse practitioners' 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 nurse practitioner or order given by a nurse practitioner for medications, tests or treatments shall be deemed to have been authorized by the physician approved by the boards North Carolina Board of Nursing as the supervisor of the nurse practitioner and such supervising physician shall be responsible for authorizing such prescription or order.

(e1) Any medical certification completed by a nurse practitioner for a death certificate shall be deemed to have been authorized by the physician approved by the boards as the supervisor of the nurse practitioner, and the supervising physician shall be responsible for authorizing the completion of the medical certification.

(f) Any registered nurse or licensed practical nurse who receives an order from a nurse practitioner for medications, tests or treatments is authorized to perform that order in the same manner as if it were received from a licensed physician." SECTION 3.(d) G.S.

90-171.23(b) reads as rewritten:

"(b) Duties, powers.

The Board is empowered to:

… (14) Appoint and maintain a subcommittee of the Board to work jointly with the subcommittee of the North Carolina Medical Board to develop rules and regulations to govern the performance of medical acts by registered nurses and to determine reasonable fees to accompany an application for approval or renewal of such approval as provided in G.S.

90-8.2.

The fees and rules developed by this subcommittee shall govern the performance of medical acts by registered nurses and shall become effective when they have been adopted by both Boards.Grant prescribing, ordering, dispensing, and furnishing authorityto nurse practitioners pursuant to G.S.

90-18.2.

Notwithstandingany other provision of law, the Board shall have the sole authority to adopt rules and enforce regulations governing the practice and conduct of nurse Senate Bill 345-Second Edition Page 7 General Assembly Of North Carolina Session 2025 practitioners as defined in G.S.

90-18.2 and certified nurse midwives and the practice of midwifery as defined in G.S.

90-178.2.

… (25) Adopt rules necessary to implement and administer the provisions of Article 10A of this Chapter." SECTION 3.(e) G.S.

90-171.37(b) is repealed.

SECTION 3.(f) G.S.

90-18.8 reads as rewritten:

"§ 90-18.8.

Limitations on nurse-midwives.

(a) Any Certified Nurse Midwife approved under the provisions of Article 10A of this Chapterto providemidwiferycaremayusethe title"CertifiedNurseMidwife." Anyotherperson who uses the title in any form or holds himself or herself out to be a Certified Nurse Midwife or to be so approved shall be deemed to be in violation of this Article.

(b) A Certified Nurse Midwife is authorized to write prescriptions for drugs if all of the following conditions are met:

(1) The Certified Nurse Midwife has current approval from the joint subcommittee established under North Carolina Board of Nursing pursuant to G.S.

90-178.4.

(2) The joint subcommittee as established under G.S.

90-178.4 North Carolina Board of Nursing has assigned an identification number to the Certified Nurse Midwife that appears on the written prescription.

(3) The joint subcommittee as established under G.S.

90-178.4 North Carolina Board of Nursing has provided to the Certified Nurse Midwife written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review of the drugs prescribed.

(c) The joint subcommittee of the North Carolina Medical Board and the Board of Nursing, established under North Carolina Board of Nursing, pursuant to G.S.

90-178.4, shall adopt rules governing the approval of individual Certified Nurse Midwives to write prescriptions with any limitations the joint subcommittee Board deems are in the best interest of patient health and safety, consistent with therules establishedfor nurse practitionersunder G.S.

90-18.2(b)(1)." SECTION 3.(g) G.S.

90-178.3 reads as rewritten:

"§ 90-178.3.

Regulation of midwifery.

… (b1) A Certified Nurse Midwife with less than 24 months and 4,000 hours of practice as a Certified Nurse Midwife shall (i) have a collaborative provider agreement with a collaborating provider and (ii) maintain signed and dated copies of the collaborative provider agreement as required by practice guidelines and any rules adopted by the joint subcommittee of the North Carolina Medical Board and the Board of Nursing.

If a collaborative provider agreement is terminated before the Certified Nurse Midwife acquires the level of experience required for practice without a collaborative provider agreement under this Article, the Certified Nurse Midwifeshall have90 days from thedatetheagreement is terminatedto enterintoacollaborative provider agreement with a new collaborating provider.

During the 90-day period, the Certified Nurse Midwife may continue to practice midwifery as defined under this Article.

(c) Graduate nurse midwife applicant status may be granted by the joint subcommittee North Carolina Board of Nursing in accordance with G.S.

90-178.4." SECTION 3.(h) G.S.

90-178.4 reads as rewritten:

"§ 90-178.4.

Administration.

(a) The joint subcommittee of the North Carolina Medical Board and the Board of Nursing created pursuant to G.S.

90-18.2 shall administer the provisions of this Article and the rules adopted pursuant to this Article;

Provided, however, that actions of the joint subcommittee pursuant to this Article shall not require approval by the North Carolina Medical Board and the Board of Nursing.

For purposes of this Article, the joint subcommittee shall be enlarged by four Page 8 Senate Bill 345-Second Edition General Assembly Of North Carolina Session 2025 additional members, including two certified midwives and two obstetricians who have had working experience with midwives.Article.

(a1) AnyCertified Nurse Midwife who attends a planned birth outside of a hospital setting shall discuss with thepatient theassociated risks andobtainasigned informed consent agreement from the Certified Nurse Midwife's patient that shall include:

(1) Information about the risks associated with a planned birth outside of the hospital.

(2) A clear assumption of those risks by the patient.

(3) An agreement by the patient to consent to transfer to a health care facility when and if deemed necessary by the Certified Nurse Midwife.

(4) If the Certified Nurse Midwife is not covered under a policy of liability insurance, a clear disclosure to that effect.

(5) The joint subcommittee North Carolina Board of Nursing shall develop the contents of an informed consent agreement form to be used by a Certified Nurse Midwife when obtaining informed consent.

(a2) AnyCertified Nurse Midwife who attends a planned birth outside of a hospital setting shall provide to each patient a detailed, written plan for emergent and nonemergent transfer, which shall include:

(1) The name of and distance to the nearest health care facility licensed under Chapter 122C or Chapter 131E of the General Statutes that has at least one operating room.

(2) The procedures for transfer, including modes of transportation and methods for notifying the relevant health care facility of impending transfer.

(3) An affirmation that the relevant health care facility has been notified of the plan for emergent and nonemergent transfer by the Certified Nurse Midwife.

(a3) Planned home births attended by a Certified Nurse Midwife shall be limited to low-risk pregnancies.

Pregnancies deemed inadvisable for home births by the American College of Obstetricians and Gynecologists Committee on Obstetric Practice shall be prohibited.

The joint subcommittee of the North Carolina Medical Board and the Board of Nursing created under G.S.

90-18.2, including the four additional members required by subsection (a) of this section, shall adopt rules governing the safety of home births attended by a Certified Nurse Midwife.

(b) The joint subcommittee North Carolina Board of Nursing shall adopt rules under this Article to establish each of the following:

(1) A fee which shall cover application and initial approval up to a maximum of one hundred dollars ($100.00).

(2) An annual renewal fee to be paid by January 1 of each year by persons approved under this Article up to a maximum of fifty dollars ($50.00).

(3) A reinstatement fee for a lapsed approval up to a maximum of five dollars ($5.00).

(4) The form and contents of the applications which shall include information related to the applicant's education and certification by the American Midwifery Certification Board.

(5) The procedure for establishing collaborative provider agreements as required by this Article.

(c) The joint subcommittee North Carolina Board of Nursing may solicit, employ, or contract for technical assistance and clerical assistance and may purchase or contract for the materials and services it needs.

(d) All fees collected on behalf of the joint subcommittee North Carolina Board of Nursing, pursuant to this section, and all receipts of every kind and nature, as well as the compensation paid the members of the joint subcommittee and the necessary expenses incurred by them in the performance of the duties imposed upon them, shall be reported annually to the Senate Bill 345-Second Edition Page 9 General Assembly Of North Carolina Session 2025 State Treasurer.

All fees and other moneys received by the joint subcommittee North Carolina Board of Nursing pursuant to the provisions of the General Statutes this Article shall be kept in aseparatefundbythe joint subcommittee, Board,tobeheld and expendedonlyforsuchpurposes as are proper and necessary to the discharge of the duties of the joint subcommittee Board under this Article and to enforce the provisions of this Article.

No expense incurred by the joint subcommittee Board pursuant to this Article shall be charged against the State.

(e) Members of the joint subcommittee who are not officers or employees of the State shall receive compensation and reimbursement for travel and subsistence expenses at the rates specified in G.S.

138-5.

Members of the joint subcommittee who are officers or employees of the State shall receive reimbursement for travel and subsistence expenses at the rate set out in G.S.

138-6.

(f) The joint subcommittee Notwithstanding any provision of law to the contrary, the North Carolina Board of Nursing shall have the sole authority to adopt, amend, and repeal rules necessaryto administertheprovisionsofthis Article.Articleandto enforceregulationsgoverning the practice and conduct of nurse midwives." SECTION 3.(i) G.S.

90-178.5 reads as rewritten:

"§ 90-178.5.

Qualifications for approval;

independent practice.

(a) In order to be approved by the joint subcommittee North Carolina Board of Nursing under this Article, a person shall comply with each of the following:

(1) Complete an application on a form furnished by the joint subcommittee.Board.

(2) Submit evidence of certification by the American Midwifery Certification Board or its successor.

(3) Submit evidence of a collaborative provider agreement as required by G.S.

90-178.3(b1).

(4) Pay the fee for application and approval.

(b) UponsubmittingtothejointsubcommitteeNorth CarolinaBoardofNursingevidence of completing 24 months and 4,000 hours of practice as a Certified Nurse Midwife pursuant to a collaborative provider agreement, a Certified Nurse Midwife is authorized to practice midwifery independently in accordance with this Article." SECTION 3.(j) G.S.

90-178.6 reads as rewritten:

"§ 90-178.6.

Denial, revocation or suspension of approval.

(a) In accordance with the provisions of Chapter 150B, the joint subcommittee North Carolina Board of Nursing may deny, revoke or suspend approval when a person has:

(1) Failed to satisfy the qualifications for approval;approval.

(2) Failed to pay the annual renewal fee by January 1 of the current year;year.

(3) Given false information or withheld material information in applying for approval;approval.

(4) Demonstrated incompetence in the practice of midwifery;midwifery.

(5) Violated any of the provisions of this Article;Article.

(6) Amental orphysical disabilityoruses anydrugto adegreethatinterferes with his or her fitness to practice midwifery;midwifery.

(7) Engaged in conduct that endangers the public health;health.

(8) Engaged in conduct that deceives, defrauds, or harms the public in the course of professional activities or services;

orservices.

(9) Been convicted of or pleaded guilty or nolo contendere to any felony under the laws of the United States or of any state of the United States indicating professional unfitness.

(b) Revocation or suspension of a license to practice nursing pursuant to G.S.

90-171.37 shall automatically result in comparable action against the person's approval to practice midwifery under this Article." Page 10 Senate Bill 345-Second Edition General Assembly Of North Carolina Session 2025 SECTION 3.(k) G.S.

90-178.7 reads as rewritten:

"§ 90-178.7.

Enforcement.

(a) The joint subcommittee North Carolina Board of Nursing may apply to the Superior Court of Wake County to restrain any violation of this Article.

(b) No person shall perform any act constituting the practice of midwifery, as defined in this Article, or anyof the branches thereof, unless the person shall have been first approved under this Article.

Any person who practices midwifery without being duly approved and registered, as provided in this Article, shall not be allowed to maintain any action to collect any fee for such services.

Any person so practicing without being duly approved shall be guilty of a Class 3 misdemeanor.

Any person so practicing without being duly approved under this Article and who is falsely representing himself or herself in a manner as being approved under this Article or any Article of this Chapter shall be guilty of a Class I felony." SECTION 4.(a) G.S.

90-2 reads as rewritten:

"§ 90-2.

Medical Board.

(a) There is established the North Carolina Medical Board to regulate the practice of medicine and surgery for the benefit and protection of the people of North Carolina.

The Board shall consist of 13 members:

(1) Six of the members shall be duly licensed physicians recommended by the Review Panel and appointed by the Governor as set forth in G.S.

90-3.

(2) Five members shall all be appointed by the Governor as follows:

a.

One shall be a member of The Old North State Medical Society.

This Board position shall be subject to recommendations of the Review Panel pursuant to G.S.

90-3.

b.

One shall be a public member, and this Board position shall not be subject to recommendation of the Review Panel pursuant to G.S.

90-3.

c.

One Two shall be a physician assistant assistants as defined in G.S.

90-18.1 as recommended by the Review Panel pursuant to G.S.

90-3.

d.

One shall be a nurse practitioner as defined in G.S.

90-18.2 as recommended by the Review Panel pursuant to G.S.

90-3.

e.

One shall be a duly licensed physician who is a doctor of osteopathic medicine or a full-time faculty member of one of the medical schools in North Carolina who utilizes integrative medicine in that person's clinical practice, as recommended by the Review Panel pursuant to G.S.

90-3.

(3) Two public members appointed by the General Assembly in accordance with G.S.

120-121, one upon recommendation of the Speaker of the House of Representatives and one upon the recommendation of the President Pro Tempore of the Senate.

(a1) Each appointing and nominating authority shall endeavor to see, insofar as possible, that its appointees and nominees to the Board reflect the composition of the State with regard to gender, ethnic, racial, and age composition.

(b) No member shall serve more than two complete three-year terms in a lifetime, except that each member shall serve until a successor is chosen and qualifies.

(b1) A public member appointed pursuant to sub-subdivision (a)(2)b.

and subdivision (a)(3) of this section shall not be a health care provider nor the spouse of a health care provider.

For the purpose of Board membership, "health care provider" means any licensed health care professional, agent, or employee of a health care institution, health care insurer, health care professional school, or a member of any allied health profession.

For purposes of this section, a person enrolled in a program as preparation to be a licensed health care professional or an allied Senate Bill 345-Second Edition Page 11 General Assembly Of North Carolina Session 2025 health professional shall be deemed a health care provider.

For purposes of this section, any person with significant financial interest in a health service or profession is not a public member.

(c) Repealed by Session Laws 2003-366, s.

1, effective October 1, 2003.

(d) Any member of the Board may be removed from office by the Governor for good cause shown.

Any vacancy in the physician, physician assistant, or nurse practitioner physician or physician assistant membership of the Board shall be filled for the period of the unexpired term by the Governor from a list submitted by the Review Panel pursuant to G.S.

90-3.

Any vacancy in the public membership of the Board shall be filled by the appropriate appointing authority for the unexpired term.

(e) The North Carolina Medical Board shall have the power to acquire, hold, rent, encumber, alienate, and otherwise deal with real property in the same manner as any private person or corporation, subject onlyto approval of the Governor and the Council of State as to the acquisition, rental, encumbering, leasing, and sale of real property.

Collateral pledged by the Board for an encumbrance is limited to the assets, income, and revenues of the Board." SECTION 4.(b) G.S.

90-3 reads as rewritten:

"§ 90-3.

Review Panel recommends certain Board members;criteria forrecommendations.

(a) There is created a Review Panel to review all applicants for the physician positions, the physician assistant position, and the nurse practitioner position and physician assistant positions on the Board.

The Review Panel shall consist of nine members, including four from the Medical Society, one from the Old North State Medical Society, one from the North Carolina Osteopathic Medical Association, one two from the North Carolina Academy of Physician Assistants, one from the North Carolina Nurses Association Council of Nurse Practitioners, and one public member currently serving or who has served on the Board.

Each member shall serve for a term of three years, ending December 31 of the last year of the term.

No member shall serve more than two terms.

All physicians, physician assistants, and nurse practitioners physicians and physician assistants serving on the Review Panel shall be actively practicing in North Carolina.

The Review Panel shall contract for the independent administrative services needed to complete its functions and duties.

The Board shall provide funds to pay the reasonable cost for the administrative services of the Review Panel.

The Board shall convene the initial meeting of the Review Panel.

The Review Panel shall elect a chair, and all subsequent meetings shall be convened by the Review Panel.

TheGovernorshallappointBoardmembersasprovidedinG.S.

90-2.TheReviewPanelshall attempt to make its recommendations to the Governor reflect the composition of the State with regard to gender, ethnic, racial, medical specialty, and age.

The Review Panel and its members and staff shall not be held liable in any civil or criminal proceeding for exercising, in good faith, the powers and duties authorized by law.

(b) To be considered qualified for a physician position, the physician assistant position, or nurse practitioner or physician assistant position on the Board, an applicant shall meet each of the following criteria:

(1) Hold an active, nonlimited license to practice medicine in North Carolina, or in the case of a physician assistant and nurse practitioner, assistant, hold an active license or approval to perform medical acts, tasks, and functions in North Carolina.

(2) Have an active clinical or teaching practice.

For purposes of this subdivision, theterm "active"means patient care,orinstruction ofstudents in anaccredited medical school or residency, or clinical research program, for 20 hours or more per week.

(3) Have actively practiced in this State for at least five consecutive years immediately preceding the appointment.

(4) Intend to remain in active practice in this State for the duration of the term on the Board.

Page 12 Senate Bill 345-Second Edition General Assembly Of North Carolina Session 2025 (5) Submit at least three letters of recommendation, either from individuals or from professional or other societies or organizations.

(6) Have no public disciplinary history with the Board or any other licensing board in this State or another state over the past 10 years before applying for appointment to the Board.

(7) Have no history of felony convictions of any kind.

(8) Have no misdemeanor convictions related to the practice of medicine.

(9) Indicate, in a manner prescribed by the Review Panel, that the applicant:

(i) understands that the primary purpose of the Board is to protect the public;

(ii) is willing to take appropriate disciplinary action against his or her peers for misconduct or violations of the standards of medical care;

and (iii) is aware of the time commitment needed to be a constructive member of the Board.

(10) Have not served more than 72 months as a member of the Board.

(c) The Review Panel shall recommend at least two qualified nominees for each open position on the Board.

If the Governor chooses not to appoint either of the recommended nominees, the Review Panel shall recommend at least two new qualified nominees.

(d) Notice of open physician, physician assistant, or nurse practitioner physician or physician assistant positions on the Board shall be sent to all physicians currently licensed to practice medicine in North Carolina and all physician assistants and nurse practitioners currently licensed or approved to perform medical acts, tasks, and functions in this State.

(e) Applicants for positions on the Board shall not be required to be members of any professional association or society, except as provided in G.S.

90-2(a)(2)a.

(f) NotwithstandinganyprovisionofG.S.

90-16,theBoardmayprovideconfidentialand nonpubliclicensing and investigativeinformationin its possession to theReviewPanel regarding applicants.

(g) All applications, records, papers, files, reports, and all investigative and licensing information received by the Review Panel from the Board and other documents received or gathered by the Review Panel, its members, employees, agents, and consultants as a result of soliciting, receiving, and reviewing applications andmakingrecommendations as required in this section shall not be considered public records within the meaning of Chapter 132 of the General Statutes.

All such information shall be privileged, confidential, and not subject to discovery, subpoena, or other means of legal compulsion for release to any person other than the Review Panel, the Board, and their employees, agents, or consultants, except as provided in this section.

The Review Panel shall publish on its Internet Web site the names and practice addresses of all applicants within 10 days after the application deadline.

The Review Panel shall publish on its Internet Web site the names and practice addresses of the nominees recommended to the Governor within 10 days after notifying the Governor of those recommendations and not less than 30 days prior to the expiration of the open position on the Board.

(h) The Review Panel is a public body within the meaning of Article 33C of Chapter 143 of the General Statutes.

In addition to the provisions contained in Article 33C of Chapter 143 of the General Statutes permitting a public bodyto conduct business in a closed session, the Review Panel shall meet in closed session to review applications;

interview applicants;

review and discuss information received from the Board;

and discuss, debate, and vote on recommendations to the Governor." SECTION 5.

The North Carolina Board of Nursing shall adopt rules to implement the provisions of Section 3 of this act.

SECTION 6.

Section 3 of this act becomes effective when the North Carolina Board of Nursing adopts the permanent rules Senate Bill 345-Second Edition Page 13 General Assembly Of North Carolina Session 2025 required under Section 5 of this act or June 30, 2026, whichever occurs first.

The North Carolina Board of Nursing shall notify the Revisor of Statutes when the rules required under Section 5 of this act have been adopted.

Page 146 Senate Bill 345-Second345-First Edition