North CarolinaHB 672025-2026 SessionHouseWALLET

AN ACT TO ESTABLISH AN INTERSTATE COMPACT FOR THE LICENSURE OF THE PRACTICE OF MEDICINE.

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

30 provisions identified: 15 benefits, 3 costs, 12 mixed.

Easier team-based practice for PAs

Physician assistants must keep an active license and registration. They must either file an Intent to Practice form or meet the team-based practice rules in state law. In a team-based setting, a PA can prescribe, order, and start treatments without a doctor’s prior sign-off, following Board rules and the standard of care. Team-based PAs do not have to give the Board a supervising doctor’s contact before starting work. Under a volunteer license, a PA can either file the Intent to Practice with supervisor contact or meet the team-based rules instead.

Health plans must cover pharmacists

Starting October 1, 2025, your health plan must cover a pharmacist’s service if it is within the pharmacist’s legal scope and the plan covers that service for other providers. If an insurer delegates credentialing to a facility, it must accept the facility’s credentialing for all pharmacists who work there. Third‑party administrators and pharmacy benefit managers must follow the same drug and pharmacy coverage rules as insurers.

More care from pharmacists, faster

The law creates a clinical pharmacist practitioner role. Their orders count the same as a doctor’s orders. By October 1, 2025, pharmacists can test for the flu and start treatment under state protocols. They cannot use Schedule I–IV controlled drugs for this flu treatment. A statewide standing order runs until rules take effect or January 1, 2027. The Medical Board assigns each clinical pharmacist practitioner an ID number that must appear on prescriptions.

Faster reciprocity for family therapists

Starting October 1, 2025, reciprocal licensure for marriage and family therapists requires at least two continuous years of prior licensure and active practice, down from five. You must still hold an unrestricted license in good standing, have no unresolved complaints anywhere, and have passed the required national or clinical exam.

More independence for psych associates

Starting October 1, 2025, a licensed psychological associate with health services provider certification can practice without supervision after meeting the 4,000‑hour post‑licensure requirement. The 4,000 hours must be completed in at least 24 months and less than 60 months, with performance ratings of average or better. The Board approves independent practice after the associate applies and shows proof.

New pathways for MH workforce

People with an associate degree in a human services field can qualify in new ways. With two years of supervised experience, you can qualify as a Qualified Professional or a Substance Abuse Prevention Professional. Supervised experience earned before or after the degree may count. With less than two years’ experience, you can qualify as an Associate Professional.

New team-based path for PAs

The law creates a team‑based status for physician assistants. You qualify with more than 4,000 total clinical hours, more than 1,000 hours in the specialty, and practice in a team‑based setting. Perioperative team‑based PAs must have physician supervision. The Medical Board must adopt rules, and the new rules take effect when adopted or by June 30, 2026, whichever is first.

PA compact expands cross state practice

The law creates an interstate PA licensure compact. If you are a PA with an approved degree and current NCCPA certification, you can get a Compact Privilege to treat patients in other member states. You need an unrestricted qualifying license, no disqualifying convictions or controlled‑substance suspensions, and you must meet any remote‑state tests or fees. You must list and update your home address and accept legal mail there. The compact takes effect once seven states have enacted it.

Faster multistate licenses for doctors

Beginning January 1, 2026, physicians can use an expedited interstate compact to get licensed in multiple states. The Medical Board or Compact Commission may charge extra fees to cover compact costs. Compact licensees are exempt from the usual annual registration. Compact disciplinary procedures can differ from the normal 30‑day hearing rule, and violating compact rules is a ground for discipline. The law says a doctor practices where the patient is located.

New license for international doctors

Starting January 1, 2026, internationally trained physicians can get an employee license to work full‑time for an NC hospital or a qualifying rural practice. They must have a current or recently expired foreign license, 130 weeks of approved medical education, required training or 10 years of practice, pass competency checks, and be authorized to work in the U.S. before starting. Practice is limited to the employing hospital or rural practice; violations are a Class 3 misdemeanor with fines up to $500 per offense. The license becomes inactive if qualifying employment ends, if a rural site loses an on‑site NC physician, or if the holder gets another NC medical license. After four years of active practice with a clean record, the Board must grant a full NC license.

PA Compact fees and rules

The Board charges a one‑time $230 fee for an initial PA license or Compact Privilege. Each year, Compact Privilege holders must register and pay $140; a $25 late fee applies after the deadline (30 days after your birthday). Applicants using the Compact must meet Article 18J requirements, and the law treats Compact privileges as licenses. If your state license has adverse action, your Compact Privileges in other states are deactivated until two years after all restrictions are removed. If a state leaves the Compact, affected PA Compact Privileges continue for 180 days.

Discipline and investigations across states

Member states can suspend or remove a PA’s Compact Privilege to protect patients. Boards can subpoena evidence across states and run joint investigations. The license‑issuing state alone disciplines the license but must treat out‑of‑state reports like in‑state reports. Any state may rely on another state’s factual findings. If allowed by state law, disciplined PAs can be billed for investigation costs.

What states must do to join

States that join must meet core rules. They license PAs, join the data system, share complaints, and run background checks. They must use a national exam and grant Compact Privileges, and they may charge fees. New states accept existing commission rules on day one. A state can withdraw after 180 days or be terminated for default. Compact rules override conflicting state laws.

Cleaner air in operating rooms

Starting January 1, 2026, hospitals and ambulatory surgery centers must use smoke‑evacuation systems for procedures likely to make surgical smoke. The system must capture and filter smoke at its source. The health department can take action if facilities do not comply.

Clearer pharmacist roles and insurer networks

The law clarifies who qualifies as a clinical pharmacist practitioner under drug therapy and disease management agreements with physicians. Starting October 1, 2025, an insurer cannot count a pharmacy’s drug-network status as meeting any requirement to include pharmacists in medical benefit networks.

Defines CLIA tests and pharmacist role

Starting October 1, 2025, the law defines CLIA‑waived tests as FDA‑authorized tests waived under CLIA. It also defines clinical pharmacist practitioners as licensed pharmacists who meet Board guidelines and can enter drug‑therapy agreements with doctors.

Defines team-based medical practice

The law defines team‑based practice. Qualifying clinics are physician‑owned with real physician involvement in design and quality programs. Physicians and team‑based PAs must work in the same clinical area. Pain‑management specialty clinics are excluded.

More roles for PAs in care

A PA with obstetrical ultrasound certification now counts as a qualified technician. PAs can be attending providers for the required hospital stay after birth when they are primarily responsible for care. PAs can also perform the child care health check, which must be done before admission or within 30 days after admission.

PA interstate compact rules and protections

The Medical Board runs the Physician Assistant Licensure Compact and names a delegate to its Commission. The Board can discipline PA compact-privilege holders who break compact rules. A member state cannot use a subpoena to collect evidence of conduct that was legal where it happened to punish a compact privilege. A member state also cannot deny or discipline a compact privilege only for practice that was lawful in another state.

State names doctor compact commissioners

Beginning January 1, 2026, the Medical Board appoints two Commissioners to the Interstate Medical Licensure Compact Commission. Each must be a physician Board member, an executive Board member, or a public Board member. This sets state representation for the doctor licensure compact.

Fees and renewals for compact PAs

The commission can charge states an annual assessment and charge PAs a Compact Privilege fee. Your Compact Privilege ends when your qualifying state license ends. If you switch the state you apply through, you must notify the commission and pay any required fee.

Fingerprint background checks for licenses

If you apply for a license through the Medical Board, you must complete fingerprint background checks. The Board sends prints to the State Bureau of Investigation and the FBI. You must sign a consent form. The Board may collect and pass along any DPS fee.

Fingerprint checks for medical licenses

Starting January 1, 2026, medical license applicants must submit fingerprints for state and federal checks. You must consent and provide ID. The Department of Public Safety may charge a fee, which the Medical Board can collect. Federal employees with a prior suitability finding under 5 C.F.R. 731.202 are excluded.

MFT licensing checks and rules

Starting October 1, 2025, people applying to be marriage and family therapy associates or therapists are included in criminal history check rules. The MFT Licensure Board can adopt rules to carry out reciprocal licensure and related changes.

Temporary rules end when permanent start

The temporary authority to use Staff Definitions rules ends when the permanent rules required by the law take effect. The temporary authority stops automatically once the permanent rules are effective.

Central data system for PA licenses

The commission runs a central data system with PA licensure and discipline records. States must submit uniform data using a unique identifier. Investigative records are shared only with member states, and expunged items must be removed. Certified commission records are admissible in court.

Court and dispute rules for states

Each member state’s branches enforce the compact. Lawsuits involving the commission go to federal court where it is based, unless waived. The commission must offer mediation and can seek binding decisions for state disputes. It can sue noncompliant states and recover legal fees. Only member states can sue the commission under the compact.

New multistate commission and rules

The compact creates a multistate commission. Each member state gets one voting delegate. The commission can make rules, hire staff, set a budget, and charge fees. Meetings are public with 30‑day notice, with narrow closed sessions. A commission rule does not override a state’s PA scope‑of‑practice law. Emergency rules can start with 24‑hour notice.

Rules for international physician employee license

Beginning January 1, 2026, the Medical Board sets rules for the internationally trained physician employee license. The Board may set time limits for the license. Each year by December 1, the Board reports program results to lawmakers, starting with 2026 data.

Temporary and conforming rules to implement

The Medical Board and Pharmacy Board can adopt temporary rules to implement this act. The commission must also update staff definitions and other related rules to match the statute. These updates use a faster timeline than usual review.

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
Brent Jackson
Republican • Senate
Pricey Harrison
Democratic • House
Keith Kidwell
Republican • House
Jeffrey C. McNeely
Republican • House
Brent Jackson
Republican • Senate
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