H.B. 316
GENERAL ASSEMBLY OF NORTH CAROLINA
Mar 8, 2023
SESSION 2023 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH30141-NB-84
Short Title: Respiratory Care Modernization Act. (Public)
Sponsors: Representative Moss.
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO UPDATE THE GENERAL STATUTES OF NORTH CAROLINA GOVERNING
3 THE PRACTICE OF RESPIRATORY CARE TO BETTER REFLECT THE CHANGES IN
4 EDUCATION, EXPERIENCE, AND PRACTICE OF THE PROFESSION IN ORDER TO
5 ENHANCE THE HEALTH AND WELFARE OF NORTH CAROLINA CITIZENS.
6 Whereas, it is the intention of the North Carolina General Assembly to promote the
7 health and welfare of the citizens of this State; and
8 Whereas, the COVID-19 pandemic has placed increasing demands on all health care
9 professionals; and
10 Whereas, it is the intention of the North Carolina General Assembly that statutes
11 governing the profession of respiratory care reflect current practices, improvements, and other
12 developments that have occurred in the profession; and
13 Whereas, the current statutory language does not fully encompass current practices,
14 improvements, and other developments; Now, therefore,
15 The General Assembly of North Carolina enacts:
16 SECTION 1.(a) Article 38 of Chapter 90 of the General Statutes reads as rewritten:
17 "Article 38.
18 "Respiratory Care Practice Act.
19 …
20 "§ 90-648. Definitions.
21 The following definitions apply in this Article:
22 (1) Advanced respiratory care practitioner (ARCP). – A person licensed in this
23 State who has gained additional specialized knowledge, skills, and experience
24 through a postgraduate advanced practice respiratory therapy program of
25 study as defined by the Board and is authorized to perform advanced
26 respiratory therapy practices under the supervision of a physician licensed to
27 practice medicine in accordance with Article 1 of this Chapter.
28 (1a) Advanced respiratory care procedures. – Procedures that require additional
29 competency training in accordance with rules adopted by the Board.
30 (1)(1b) Board. – The North Carolina Respiratory Care Board.
31 (2) Diagnostic testing. – Cardiopulmonary procedures and tests performed on the
32 written order of a physician licensed under Article 1 of this Chapter that
33 provide information to the physician to formulate a diagnosis of the patient's
34 condition. The tests and procedures may include pulmonary function testing,
35 electrocardiograph testing, cardiac stress testing, and sleep related testing.
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1 (3) Direct supervision. – The authority and responsibility to direct the
2 performance of activities as established by policies and procedures for safe
3 and appropriate completion of services.
4 (3a) Endorsement. – A designation issued by the Board recognizing the person
5 named on the endorsement as having met the requirements to perform
6 advanced respiratory care procedures as defined by rules adopted by the
7 Board.
8 (4) Individual. – A human being.
9 (5) License. – A certificate issued by the Board recognizing the person named
10 therein as having met the requirements to practice respiratory care as defined
11 in this Article.Article as a respiratory care practitioner or advanced respiratory
12 care practitioner.
13 (6) Licensee. – A person who has been issued a license under this Article.
14 (7) Medical director. – An appointed physician who is licensed under Article 1 of
15 this Chapter and a member of the entity's medical staff, and who is granted
16 the authority and responsibility for assuring and establishing policies and
17 procedures and that the provision of such is provided to the quality, safety,
18 and appropriateness standards as recognized within the defined scope of
19 practice for the entity.
20 (8) Person. – An individual, corporation, partnership, association, unit of
21 government, or other legal entity.
22 (9) Physician. – A doctor of medicine An individual licensed to practice medicine
23 by the State of North Carolina in accordance with Article 1 of this Chapter.
24 (9a) Practice of advanced practice respiratory therapy. – The scope of practice as
25 determined by the supervising physician at the practice level in any health care
26 setting authorized by the supervising physician and the Board. The advanced
27 respiratory care practitioner may perform acts, tasks, or functions in any health
28 care setting for which the physician is responsible, as follows:
29 a. Related to the care of persons with problems affecting the
30 cardiovascular and cardiopulmonary systems.
31 b. Delegated by a supervising physician.
32 c. Appropriate to the advanced respiratory care practitioner's education,
33 training, experience, and level of competence.
34 d. Related to the prescribing, ordering, and administering of drugs,
35 medical care, and medical devices related to the cardiovascular and
36 cardiopulmonary systems within the limitations set forth by the
37 supervising physician and rules adopted by the Board.
38 (10) Practice of respiratory care. – As defined by the written order of a physician
39 licensed under Article 1 of this Chapter, Chapter for respiratory care
40 practitioners, the observing and monitoring of signs and symptoms, general
41 behavior, and general physical response to respiratory care treatment and
42 diagnostic testing, including the determination of whether such signs,
43 symptoms, reactions, behavior, or general response exhibit abnormal
44 characteristics, and the performance of diagnostic testing and therapeutic
45 application of:
46 a. Medical gases, humidity, and aerosols including the maintenance use
47 of associated apparatus, respiratory care equipment, except for the
48 purpose of anesthesia.
49 b. Pharmacologic agents related to respiratory care procedures, including
50 those agents necessary to perform hemodynamic monitoring.
51 c. Mechanical or physiological ventilatory support.
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1 d. Cardiopulmonary resuscitation and maintenance of natural airways,
2 the insertion and maintenance of artificial airways under the direct
3 supervision of a recognized medical director in a health care
4 environment which identifies these services within the scope of
5 practice by the facility's governing board.
6 e. Hyperbaric oxygen therapy.
7 f. New and innovative respiratory care and related support activities in
8 appropriately identified environments and under the training and
9 practice guidelines established by the American Association of
10 Respiratory Care.
11 The term also means the interpretation and implementation of a
12 physician's written or verbal order pertaining to the acts described in
13 this subdivision.
14 (10a) Prescriptive and dispensing authorization. – The legal permission for the
15 supervising physician for the advanced respiratory care practitioner to
16 prescribe and deliver pharmacologic and nonpharmacologic agents to a patient
17 in compliance with rules adopted by the Board and applicable federal and
18 State laws, pursuant to Article 1 of this Chapter and in accordance with the
19 limitations set forth by the supervising physician and rules adopted by the
20 Board.
21 (11) Respiratory care. – As defined by the written order of a physician licensed
22 under Article 1 of Chapter 90, the treatment, management, diagnostic testing,
23 and care of patients with deficiencies and abnormalities associated with the
24 cardiopulmonary system.
25 (12) Respiratory care practitioner. – A person who has been licensed by the Board
26 to engage in the practice of respiratory care.
27 (12a) Supervising physician. – A physician with the competencies and authority to
28 supervise advanced respiratory care practitioners.
29 (13) Support activities. – Procedures Tasks that do not require formal academic
30 training, including the delivery, setup, and routine maintenance and repair of
31 apparatus. respiratory care equipment. The term also includes giving
32 instructions on the use, fitting, and application of apparatus, respiratory care
33 equipment but does not include therapeutic evaluation and
34 assessment.assessment for an individual patient as defined in rules adopted by
35 the Board.
36 "§ 90-649. North Carolina Respiratory Care Board; creation.
37 (a) The North Carolina Respiratory Care Board is created. The Board shall consist of 10
38 members as follows:
39 (1) Two members shall be respiratory care practitioners.
40 (2) Four members shall be physicians licensed to practice in North Carolina, and
41 whose primary practice is Pulmonology, Anesthesiology, Critical Care
42 Medicine, or whose specialty is Cardiothoracic Disorders.
43 (3) One member shall represent the North Carolina Hospital Association.
44 (4) One member member, who is a resident of this State, shall represent the North
45 Carolina Association of Atlantic Coast Medical Equipment Services.Services
46 Association.
47 (5) Two members shall represent the public at large.
48 …
49 "§ 90-650. Appointments and removal of Board members; terms and compensation.
50 (a) The members of the Board shall be appointed as follows:
51 …
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1 (7) The North Carolina Association of Atlantic Coast Medical Equipment
2 Services Association shall appoint the member described in
3 G.S. 90-649(a)(4).
4 …
5 "§ 90-652. Powers and duties of the Board.
6 The Board shall have the power and duty to:
7 (1) Determine the qualifications and fitness of applicants for licensure, renewal
8 of licensure, and reciprocal licensure. The Board shall, in its discretion,
9 investigate the background of an applicant to determine the applicant's
10 qualifications with due regard given to the applicant's competency, honesty,
11 truthfulness, and integrity. The Department of Public Safety may provide a
12 criminal record check to the Board for a person who has applied for a license
13 through the Board. The Board shall provide to the Department of Public
14 Safety, along with the request, the fingerprints of the applicant, applicant and
15 any additional information required by the Department of Public Safety, and
16 a form signed by the applicant consenting to the check of the criminal record
17 and to the use of the fingerprints and other identifying information required
18 by the State or national repositories. Justice. The applicant's fingerprints shall
19 be forwarded to the State Bureau of Investigation for a search of the State's
20 criminal history record file, and the State Bureau of Investigation shall
21 forward a set of the fingerprints to the Federal Bureau of Investigation for a
22 national criminal history check. The Board shall keep all information pursuant
23 to this subdivision privileged, in accordance with applicable State law and
24 federal guidelines, and the information shall be confidential and shall not be a
25 public record under Chapter 132 of the General Statutes. The Board shall
26 collect any fees required by the Department of Public Safety and shall remit
27 the fees to the Department of Public Safety for expenses associated with
28 conducting the criminal history record check.
29 …
30 (14) Establish and adopt rules defining the education and credential requirements
31 for persons seeking endorsement under this Article.
32 "§ 90-652.1. Disasters and emergencies.
33 In the event of an occurrence which the Governor of the State of North Carolina has declared
34 a state of emergency, or in the event of an occurrence for which a county or municipality has
35 enacted an ordinance to deal with states of emergency under G.S. 166A-19.31, or to protect the
36 public health, safety, or welfare of its citizens under Article 22 of Chapter 130A of the General
37 Statutes, G.S. 160A-174(a), or G.S. 153A-121(a), as applicable, the Board may waive the
38 requirements of this Article in order to permit professional services to the public consistent with
39 this Article, including the practice of advanced practice respiratory therapy, respiratory care, and
40 prescriptive and ordering authorization, as those terms are defined in this Article.
41 "§ 90-653. Licensure requirements; examination.
42 (a) Each applicant for licensure a respiratory care practitioner license under this Article
43 shall meet the following requirements:do all of the following:
44 (1) Submit a completed application as required by the Board.Board, which shall
45 include a form signed by the applicant consenting to the check of the
46 applicant's criminal record and to the use of the applicant's fingerprints and
47 other identifying information required by the State and national repositories.
48 (2) Submit any fees required by the Board.
49 (3) Submit to the Board written evidence, verified by oath, that the applicant has
50 successfully completed the minimal entry-level degree requirements of a
51 respiratory care education program as approved by the Commission for
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1 Accreditation of Allied Health Educational Programs, or the Canadian
2 Council on on Accreditation for Respiratory Therapy Education.Care
3 (CoARC) or its successor by arranging for the applicant's respiratory care
4 education program to submit an official transcript confirming successful
5 completion of the respiratory care education program directly to the Board.
6 (4) Submit to the Board written evidence, verified by oath, that the applicant has
7 successfully completed the minimal requirements for Basic Cardiac Life
8 Support as recognized by the American Heart Association, the American Red
9 Cross, or the American Safety and Health Institute.
10 (5) Pass Submit to the Board written evidence, verified by oath, that the
11 entry-level applicant passed the examination requirements as defined by the
12 rules adopted by the Board given by the National Board for Respiratory Care,
13 Inc.Inc., or its successor, for entry-level respiratory care practitioners.
14 (b) At least three times each year, the Board shall cause the examination required in
15 subdivision (5) of subsection (a)