North CarolinaHB 672025-2026 SessionHouseWALLET

Healthcare Workforce Reforms.

Sponsored By: Grant L. Campbell, MD (Republican), Donny Lambeth (Republican), Larry W. Potts (Republican), Timothy Reeder, MD (Republican)

Signed by Governor

BOARDSCLINICSCOLLEGES & UNIVERSITIESCOMMISSIONSCOMMUNITY COLLEGESCOMPACTSCOUNSELINGDATA & RECORDS SYSTEMSDHHSDISABLED PERSONSEDUCATIONEMPLOYMENTENVIRONMENTENVIRONMENTAL HEALTHFEESHEALTH SERVICESHIGHER EDUCATIONHOSPITALSINFORMATION TECHNOLOGYINSURANCEINSURANCE, HEALTHINTERSTATE COOPERATIONLICENSING & CERTIFICATIONMARRIAGE & CIVIL UNIONSMEDICAL BOARDMENTAL HEALTHMHDDSAS COMN

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Bill Overview

Analyzed Economic Effects

23 provisions identified: 12 benefits, 3 costs, 8 mixed.

Clinical pharmacists can manage therapy

Beginning October 1, 2025, pharmacists may perform delegated medical tasks under a written agreement with a physician. They can be approved as clinical pharmacist practitioners. Drug orders they write are treated as authorized by the supervising physician. Sites may use multi‑provider agreements, and supervising doctors must review services. Allowed substitutions within a drug class or biosimilars require documentation and physician notice if authorized in the agreement.

Insurers must cover pharmacist care

Beginning October 1, 2025, health plans must cover services a pharmacist provides if the plan covers the same service by another provider and it is within the pharmacist’s scope. The same rules apply to third‑party administrators and pharmacy benefit managers. Being in a drug (pharmacy) network does not count as being in a medical provider network for pharmacists. If an insurer lets a facility handle credentialing, it must accept that facility’s credentialing for all of its pharmacists. These rules apply to contracts entered, renewed, or amended on or after October 1, 2025.

Insurers must cover pharmacist services

Beginning October 1, 2025, health plans, PBMs, and TPAs must follow the same drug and pharmacy coverage rules for contracts entered, renewed, or amended on or after that date. If an insurer lets a facility handle pharmacist credentialing, it must accept the facility’s credentialing for all of its pharmacists. Insurers must accept claims for pharmacist services whether filed by the pharmacist or by the pharmacy on the pharmacist’s behalf.

License path for internationally trained doctors

Beginning January 1, 2026, the North Carolina Medical Board issues an employee license for internationally trained physicians. The Board sets rules and may set a time limit for the license term.

PAs help with maternity and child care

When the Medical Board adopts permanent rules, PAs can be the attending provider for the required minimum hospital stay after birth. PAs with proper ultrasound certification count as qualified obstetrical sonography technicians. PAs may perform the required health assessment for children entering child care, due before admission or within 30 days after.

Pharmacists can test and treat flu

Starting October 1, 2025, pharmacists may give CLIA‑waived flu tests and start treatment using statewide protocols. Boards must set rules by October 1, 2025, including training, treatment steps, limits, audits, and when to refer patients. The State Health Director issues a standing order by October 1, 2025 so care can start right away, lasting until the rules take effect or January 1, 2027. Treatment under this authority cannot use controlled substances in Schedules I–IV.

Team-based PAs get more authority

When the Medical Board adopts permanent rules, PAs in team‑based settings may prescribe, order, administer, and obtain drugs and devices without separate physician sign‑off. PAs can order medicines, tests, and treatments in facilities under Board rules and facility safety policies. Team‑based PAs are exempt from pre‑start supervising‑physician notices and from written prescribing instructions. PAs may compound and dispense under physician supervision if they follow pharmacy rules and register with the Pharmacy Board, and they may sign medical documents, including death certificates. All PAs must keep an active license and registration and either file an Intent to Practice form or meet team‑based rules.

Doctor compact data and discipline rules

The Compact keeps a confidential database of doctors who apply or are licensed. State boards must report complaints and public actions; shared data are used only for investigations or discipline. States can run joint investigations, and subpoenas from one state can be enforced in others. If a doctor’s principal‑state license is revoked, surrendered for discipline, or suspended, other Compact licenses match that status right away for up to 90 days while boards act.

Hospitals must clear surgical smoke

Beginning January 1, 2026, hospitals and ambulatory surgery centers must use smoke‑evacuation or filtering systems during surgeries likely to create surgical smoke. The health department may take action against facilities that do not comply. This protects patients and operating‑room staff from smoke hazards.

NC sets PA Compact governance rules

The Board runs the Physician Assistant Licensure Compact in North Carolina and issues Compact Privileges. The Board must appoint a delegate to the Compact Commission from set roles. Compact rules and lawful Commission actions override conflicting state laws, but the Commission cannot pledge North Carolina’s credit without the State’s consent.

New team-based practice path for PAs

The law creates a team‑based practice path for physician assistants. You qualify by working in a team-based setting, having over 4,000 total clinical hours, and over 1,000 hours in your specialty with a physician in that specialty. Perioperative team-based PAs must stay under physician supervision. Pain‑management specialty practices do not count as team‑based settings. PAs must clearly show the title “physician assistant” in clinics. These changes take effect when the North Carolina Medical Board adopts permanent rules.

Independent practice path for psych associates

Beginning October 1, 2025, a licensed psychological associate can practice without supervision after 4,000 supervised hours over at least 24 and less than 60 months, with average or better ratings, and an application with proof. Associates with health services certification who meet these rules can provide health services without supervision. If licensed before June 30, 2013, you meet the certification test by showing 4,000 supervised health‑service hours in 24–60 months. The Board sets supervision rules for associates who still need supervision, including formats, amounts, and supervisor qualifications.

PA Compact for multistate practice

The PA Licensure Compact lets a PA with a qualifying license practice in other participating states using a Compact Privilege. Boards keep their power to discipline their own licensees, and practice is where the patient is located. To prescribe controlled substances in a remote state, a PA must meet that state’s rules. Applicants must give their home address, report moves right away, and accept legal mail at that address. Participating states may run joint investigations and, if state law allows, recover investigation costs from the PA. Part IV of the law takes effect nine months after enactment.

Rules to get and keep PA privileges

The law sets who can use a multistate PA Compact Privilege. You must finish an accredited PA program, hold current NCCPA certification, have no felony or misdemeanor convictions, and never have had a controlled‑substance registration suspended or revoked. You must hold a qualifying state license, have the required unique ID, and wait two years after any past restriction ends. You must consent to fingerprints for a background check, pay any check fee, follow Compact rules, and register each year within 30 days after your birthday. Breaking Compact rules can lead to discipline, and Adverse Action on your qualifying license shuts off all Compact Privileges until the limit ends and two more years pass.

Faster multistate licenses for doctors

The Interstate Medical Licensure Compact gives doctors an extra, faster path to get full, unrestricted licenses in other member states. To qualify, a doctor must meet strict schooling, exam (USMLE/COMLEX within three attempts), training, specialty board certification, and clean‑discipline standards, and hold a full license in a member state. Doctors must pick a principal license state based on home, where at least 25% of practice occurs, employer location, or federal tax residence. The principal‑state board checks eligibility and runs an FBI fingerprint background check (federal employees with a suitability finding are exempt from the fingerprint step). Fees may apply for issuance and renewal, and the Interstate Commission collects renewal fees and shares them with states.

Multistate PA license rules and data

The law lets North Carolina join the Physician Assistant Licensure Compact and creates its Commission. States that join must license PAs, use a national exam, run background checks, share data, and grant Compact Privileges to qualifying PAs; states may charge a privilege fee. The Commission runs a secure data system on licenses, denials, and adverse actions, and can make rules with public input. Issuing states discipline the qualifying license. Remote states can act on a PA’s compact privilege and issue subpoenas, but cannot punish conduct that was lawful where it happened. The Compact starts when a seventh state joins; later states accept existing rules. A withdrawing state must give 180 days’ notice, and PA privileges continue for 180 days. The Commission and states can enforce the Compact in federal court. Dispute mediation and binding resolution are available.

Rules to run the multistate doctor license

The law creates the Interstate Medical Licensure Compact Commission and sets its powers. The Commission makes binding rules, holds public meetings, issues audited reports, and can enforce the Compact in federal court. Member states must enforce the Compact and give legal notice and service to the Commission in related cases. The Compact takes effect when at least seven states join, and a state can withdraw with one year’s notice. The Commission may charge member states annual assessments and must get yearly audits. Defaults, terminations, amendment, and dissolution rules protect continuity, including rules for licenses if a state leaves.

Associate degree paths to behavioral health

The law lets community college graduates with an associate degree in human services qualify for key behavioral health roles. With two years of supervised experience, you can count as a Qualified Professional or a Qualified Substance Abuse Prevention Professional. These rules stay in place until permanent rules are adopted.

Doctors can still use state licensing

Physicians who do not meet Compact rules can still apply for a North Carolina license under the State’s normal process. The State keeps its own licensing path outside the Compact.

Limits on PA imaging reads

When the Medical Board adopts permanent rules, PAs cannot give the final read for CT, MRI, PET, mammograms, or ultrasound. A physician must give the final interpretation. PAs may give final reads of plain x‑rays only with physician supervision.

Limits on some psychological associate work

Starting October 1, 2025, licensed psychological associates cannot practice neuropsychology or forensic psychology unless they first show the Board they have the required specialized training. The Board will set what counts, such as courses or supervised training.

PA license and registration fees

Initial PA licensure or an initial Compact Privilege costs $230. Annual PA registration costs $140. A $25 late fee applies if you fail to register on time.

Easier NC license for family therapists

Beginning October 1, 2025, North Carolina grants a license by reciprocity to marriage and family therapists who have two continuous years of active practice, hold an unrestricted license in good standing, have no unresolved complaints, and passed the national exam or California’s clinical exam. On the same date, reciprocity applicants must complete the same criminal history check required for other applicants.

Sponsors & Cosponsors

Cosponsors

Jonathan L. Almond
Republican • House
Mary Belk
Democratic • House
Brian Biggs
Republican • House
Becky Carney
Democratic • House
Maria Cervania
Democratic • House
Allen Chesser
Republican • House
Mike Clampitt
Republican • House
Mike Colvin
Democratic • House
Frances Jackson, PhD
Democratic • House
Pricey Harrison
Democratic • House
Keith Kidwell
Republican • House
Jeffrey C. McNeely
Republican • House
Neal Jackson
Republican • House
Erin Paré
Republican • House
Bill Ward
Republican • House
Shelly Willingham
Democratic • House
David Willis
Republican • House
Jeff Zenger
Republican • House

Roll Call Votes

All Roll Calls

Yes: 272 • No: 0

House vote • 6/24/2025

HB 67: Healthcare Workforce Reforms.

Yes: 109 • No: 0 • Other: 6

Senate vote • 6/17/2025