21 NCAC 32S .0227          team-based settings practice

(a)  For purposes of G.S. 90-1.1(4d), "consistent and meaningful participation in the design and implementation of health services to patients" means that a physician on the team:

(1)           provides health services to patients in the team-based setting or team-based practice;

(2)           is available, whether in person or by telecommunication, for collaboration, consultation, or referral during the times the team-based physician assistant is performing medical acts, tasks, or functions;

(3)           participates in determining and documenting of how the team will continuously function, including (i) the roles of each member of the team; (ii) the manner in which the team will collaborate, consult, and refer; (iii) a continuous process for ensuring patient safety; and (iv) implementation of any quality improvement measures. These records and documents shall be shared and acknowledged by all team members. The records and documents shall be provided to the Board upon request. For purposes of this section, "team" shall refer to team-based physician assistants and physicians; and

(4)           is engaged in shared governance within the organization that enables site-based decision-making.

(b)  For purposes of G.S. 90-9.3A(a)(2), "clinical practice experience" means direct patient care as a physician assistant performing medical acts, tasks, and functions, including diagnosing, treating, and prescribing.

(c)  For purposes of G.S. 90-9.3A(a)(b), in determining whether team-based physician assistants have appropriately collaborated, consulted, and referred to members of the health care team, the Board will take into consideration all documents and records under Subparagraph (a)(3) of this Rule. These records and documents shall be made available to the Board if requested.

(d)  Prior to practicing as a team-based physician assistant, a physician assistant shall submit to the Board a registration for a Team-Based Practice , by logging into their Licensure Gateway account at https://portal.ncmedboard.org/index.aspx, that includes the following information:

(1)           the physician assistant's name, mailing address, and telephone number;

(2)           the address of all the team-based settings in which the physician assistant practices;

(3)           an attestation, signed by the physician assistant, under oath and affirmation that the physician assistant:

(A)          has at least 4,000 documented hours of clinical practice experience as a licensed physician assistant. Documentation shall be made available to the Board if requested;

(B)          has at least 1,000 documented hours of clinical practice experience within each specified medical specialty area of practice in which the team-based physician assistant will be practicing. Documentation shall be made available to the Board if requested; and

(C)          will be working in a team-based setting or team-based practice as defined by G.S. 90-1.1(4d).

(e)  The physician assistant shall not commence practice as team-based physician assistant until they receive acknowledgement from the Board, or confirm on its website, that the Board has received and processed the Team-Based Practice Registration. The Team-Based Practice Registration is limited to the medical specialty and team-based setting registered with the Board. A team-based physician assistant shall notify the Board of any changes to the information required in Subparagraphs (d)(1) and (d)(2) of this Rule within 60 days of the change. Physician assistants shall update all information under Paragraph (d) when the team-based physician assistant changes team-based practices under a different employer or their medical specialty before initiating practice.

(f)  A team-based physician assistant who changes employment to a medical practice that does not qualify as a team-based setting, or who changes to a specialty practice area, within which they do not have 1,000 hours of practice in a specialty practice area shall be subject to the requirements of Rules .0203, .0212(2), .0212(4)(c), and .0213 of this Section.

(g)  The team-based physician assistant shall ensure that in the team-based setting:

(1)           the physician assistant practices within the scope of their education, experience, competence, as well as within the functions of the team as established in Subparagraph (a)(3) of this Rule;

(2)           that there are physicians who have consistent and meaningful participation in the design and implementation of health services to patients as defined in Paragraph (a) of this Rule; and

(3)           that there are means for collaboration, consultation, and referral, as indicated by the patient's condition, as well as the education, experience, and competencies of the physician assistant, and the applicable standard of care.

(h)  Nothing in this Rule requires a physician assistant to be in the same physical location as a physician on the team.

(i)  For purposes of G.S. 90-9.3A(c), "supervised" or "supervision" shall mean that a physician is accountable to the Board for the team-based physician assistant who performs medical acts, tasks, and functions in a perioperative setting. A perioperative setting includes all patient care that is provided at a hospital, surgical center, or the office of a health care provider from the time of the patient's admission to the time of the patient's discharge from the surgical suite. The supervising physician shall ensure that the team-based physician assistant is qualified by their education, training, and experience to perform medical acts, tasks, and functions within the perioperative setting. The supervising physician must have written protocols to determine the team-based physician assistant's scope of practice in the perioperative setting when the physician is present onsite or remote.

(j)  For purposes of G.S. 90-18.1(e2), "supervised" or "supervision" shall mean that a physician is accountable to the Board for the team-based physician assistant who provides final interpretations of plain film radiographs, or X-rays. The supervising physician shall ensure that the team-based physician assistant is qualified by their education, training, and experience to provide final interpretations of plain film radiographs, or X-rays. Nothing in this Paragraph shall be construed to require a team-based physician assistant to comply with Rules .0203, .0212(2), .0212(4)(c), and .0213 of this Section. For purposes of this Paragraph, a plain film radiograph includes a Dual-Energy X-Ray Absorptiometry ("DEXA") scan.

(k)  For purposes of G.S. 90-18.1(e2), a physician assistant's use of portable point-of-care ultrasonography for purposes of clinical evaluation shall not be construed as the physician assistant performing a final interpretation of diagnostic imaging studies.

(l)  For purposes of G.S. 90-18.1(c), "supervision" for compounding and dispensing shall mean compliance with Rules .0203, .0212(2), .0212(4)(c), and .0213 of this Section.

(m)  The requirements set out in Rules .0203, .0212(2), .0212(4)(c), and .0213 of this Section shall not apply to a team-based physician assistant at any registered team-based setting or practice where the team-based physician assistant is offering services within their registered medical specialty.

History Note:        Authority G.S. 90-1.1; 90-5.1(a)(3); 90-9.3A; 90-18.1;

Eff. August 1, 2026.