State Overview: North Carolina

Prior authorization requirements are up to the discretion of the state Medicaid program or insurance company.

Diagnostic ability is outlined in statute.  

Licensed professional counselors assist individuals, groups and families through the counseling relationship by evaluating and treating mental disorders and other conditions. Counselors use a combination of clinical mental health and human development principles, methods, diagnostic procedures, treatment plans and other psychotherapeutic techniques to develop an understanding of personal problems, to define goals and to plan action reflecting the client's interests, abilities, aptitudes and mental health needs. N.C. Gen. Stat. §90-330(3)

Physician relationship required.

A midwife may practice midwifery in a hospital or non-hospital setting and shall practice under the supervision of a physician licensed to practice medicine who is actively engaged in the practice of obstetrics.

A CNM is authorized to prescribe Schedules II-V if it is outlined in a collaborative practice agreement with the supervising physician. N.C. Admin. Code §21-36 .0809

Collaborative practice agreement required between the NP and the supervising physician.

The agreement must establish minimum standards of consultation and must be reviewed yearly. N.C. Admin. Code §21-36.0810

The drugs and devices an NP may prescribe must be outlined in the collaborative practice agreement. Schedules II-V controlled substances may be prescribed if outlined in the agreement. N.C. Admin. Code §21-36.0809

NPs are authorized to sign medical orders for scope of treatment forms. NC Gen. Stat. §90-21.17

NPs are not explicitly recognized in state policy as primary care providers.

Physician relationship required for practice authority; no prescriptive authority.

A CRNA credentialed by the Council on Certification of Nurse Anesthetists and who maintains recertification may perform nurse anesthesia activities in collaboration with a physician but may not prescribe a medical treatment regimen or make a medical diagnosis except under the supervision of a licensed physician. N.C. Admin. Code §21-36.0226

North Carolina does not explicitly allow for CRNA prescriptive authority.

Optometrists may only perform procedures related to foreign body removal and the examination, evaluation, diagnosis and treatment of the human eye. Additional allowable procedures may be authorized by statute and/or rule. N.C. Stat. Ann. §90-114

Optometrists may use injectables to treat abnormal conditions of the human eye and administer the COVID-19 vaccine. N.C. Stat. Ann. §90-114 and E.O. 211

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. N.C. Stat. Ann. §90-114

North Carolina does not allow dental hygienists to practice with direct access.

Statute does not identify dental therapists as an oral health provider.

North Carolina has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act allowed pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

North Carolina does not allow pharmacists to modify prescriptions.

An immunizing pharmacist may dispense, deliver or administer self-administered oral or transdermal contraceptives after the patient completes an assessment consistent with the Centers for Disease Control and Prevention's United States Medical Eligibility Criteria (US MEC) for Contraceptive Use. An immunizing pharmacist shall not dispense, deliver or administer ulipristal acetate for emergency contraception without  a prescription from a prescriber licensed under this chapter. The immunizing pharmacist must maintain a record of medication administered to the patient in a patient profile and within 72 hours after administration of the medication, notify any primary care provider identified by the patient. Additional required documentation and counseling is identified in statute.  NC Gen. Stat. §90-85.15B

An immunizing pharmacist may dispense, deliver or administer Nicotine replacement therapy that is approved by the United States Food and Drug Administration. The immunizing pharmacist must maintain a record of medication administered to the patient in a patient profile and within 72 hours after administration of the medication, notify any primary care provider identified by the patient. Additional required documentation and counseling is identified in statute.  NC Gen. Stat. §90-85.15B

Supervision by a physician required for practice and prescriptive authority.

A PA may perform medical acts, tasks or functions only under the supervision of a physician […]. (c) Each team of physician(s) and PA(s) shall ensure: (1) the PA's scope of practice is identified; (2) delegation of medical tasks is appropriate to the skills of the supervising physician(s) as well as the PA's level of competence. N.C. Admin. Code tit. 21, §32S.0213(b),(c),(d)

PAs are authorized to write prescriptions for drugs under the following conditions: (1) The North Carolina Medical Board has adopted regulations governing the approval of individual PAs to write prescriptions with such limitations as the Board may determine to be in the best interest of patient health and safety. (2) The PA holds a current license issued by the board. (3) The supervising physician has provided to the PA written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review by the physician of the drugs prescribed. N.C. Gen. Stat. §90-18.1(b)-(e);(f)

North Carolina does not currently have any provisions related to the number of PAs a physician can supervise or collaborate with.

North Carolina currently has no provisions related to chart review or co-chart signatures.

Statute allows adaptable proximity.

A PA may perform medical acts, tasks, or functions only under the supervision of a physician. Supervision shall be continuous but, except as otherwise provided in the rules of this Subchapter, shall not be construed as requiring the physical presence of the supervising physician at the time and place that the services are rendered. N.C. Admin. Code tit. 21, §32S.0213

The PA and the supervising physician determine the PA's scope of practice on-site. The delegation of medical tasks must be appropriate to the skills of the supervising physician as well as the PA's level of competence. N.C. Admin. Code §21.32S.0212