Bill
SB 966
The SAVE Act expands and clarifies APRN practice (CNPs, CNMs, CNSs, CRNAs) to full scope, aligns boards, and aims to improve care access and reduce costs.
The SAVE Act (SB 966) – North Carolina, Session 2025
Overview
- Short title: The SAVE Act (Senate Bill 966)
- Primary sponsors: Senators Burgin and Hise
- Purpose: To define and expand (and position more clearly) the practice of advanced practice registered nurses (APRNs) in North Carolina, including four APRN roles (CNP, CNM, CNS, CRNA) and to align related regulatory frameworks across nursing, medical, dental, and health care settings. The bill aims to improve access to care, particularly for the growing population and high health care costs, by reducing ambiguity and allowing APRNs to practice to the full extent of their education and licensure.
Key Provisions and Changes
1) Definitions and scope of APRN practice
- G.S. 90-171.20 redefined to include:
- APRN roles: Certified Nurse Practitioner (CNP), Certified Nurse Midwife (CNM), Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA).
- Population foci for APRN practice: Family/individual across the life span, Adult/Gerontology, Neonatal, Pediatrics, Women’s health or gender-related issues, Psychiatric-mental health.
- Each APRN role includes specified components beyond standard RN scope (e.g., diagnosis, prescribing, ordering and interpreting diagnostics, health promotion, coordinating across care, etc.).
- CNM scope includes primary sexual and reproductive health care and related diagnostic/therapeutic duties.
- CNP scope includes health assessment, management of acute/chronic illnesses, ordering tests, prescribing therapies, counseling.
- CNS scope includes disease management, prevention, care integration, and cross-discipline collaboration.
- CRNA scope includes anesthesia-related pharmacologic/therapeutic administration, diagnostic guidance, and cross-provider consultation.
- LPN and RN scope elements preserved, with APRN roles clearly distinguished.
2) Regulatory alignment with Boards
- Section 2 clarifies exceptions to “practicing medicine” under existing laws, noting that APRN practice performed in accordance with joint rules from the NC Medical Board and Board of Nursing will not be deemed practicing medicine.
- Creation of joint rulemaking to govern medical acts performed by registered nurses (andAPRN acts) with associated fee structures.
- Establishes a formal framework for prescribing, ordering, dispensing, and furnishing authority for APRNs via joint Board rules.
3) Licensing, grandfathering, and renewal
- New APRN licensure framework (Section 7):
- 90-171.36B: APRN licensure process; licensing requirements and rule-based criteria.
- 90-171.36C: Grandfathering for those already recognized or approved to practice as APRNs in NC before the law’s effective date; maintains existing practice privileges.
- 90-171.36D: Renewal and reinstatement processes; renewal frequency, penalties for non-renewal (automatic forfeiture pending reinstatement), and criteria for reinstatement.
- Repeals and consolidations:
- Repeals current G.S. 90-171.33-related provisions for certain licensing paths, consolidating into new APRN licensure sections.
- Administrative alignment to ensure APRN license status is clearly regulated by the Board.
4) License verification and prohibited acts
- Mandatory employer verification (90-171.43A): Health care facilities must verify current license status before hiring APRNs or other nurses.
- Prohibited acts (90-171.44): Strengthens penalties for fraud in licensure, unauthorized use of APRN titles, and unapproved nursing programs; clarifies disciplinary boundaries.
5) Dentistry and anesthetic administration by APRNs
- Adjusts certain dental practice provisions to allow CRNAs to administer anesthetics under dentist or physician supervision, with limits consistent with the APRN framework.
- Sets savings/guidance language to ensure collaboration with medical/dental boards and avoid duplicative or conflicting authority.
6) Medicare/Medicaid/payment considerations
- Section 12(a): Governor to seek an opt-out from CMS to maximize Medicare reimbursement flexibility for anesthesia services in NC hospitals and clinics. Initial step due within 30 days of enactment.
- Effective date: General effective date is 90 days after enactment, with the opt-out provision taking effect upon law.
7) Administrative and linguistic housekeeping
- Renames “nurse practitioner” references to “certified nurse practitioner (CNP)” across statutes, including updating abbreviations (NP to CNP).
- Requires boards (Nursing, Medical, Dental Examiners) to adopt implementing rules consistent with the act.
Who is affected
- APRNs (CNPs, CNMs, CNSs, CRNAs) and existing APRN licensees in North Carolina.
- Registered nurses (RNs) and licensed practical nurses (LPNs) who work under APRN supervision or collaborate with APRNs.
- Employers and health care facilities (hospitals, clinics, ambulatory centers, rural health clinics, public health departments) responsible for licensure verification and compliance.
- Medical and Dental Boards through joint rulemaking; patients and health systems via expanded access and clarified scopes of practice.
- Entities involved in anesthesia services seeking CMS reimbursement flexibility.
Timeline and Procedure
- 90-day general effective date after enactment.
- Governor-specific action to CMS within 30 days after law becomes effective to request Medicare/Medicaid flexibility (opt-out under 42 C.F.R. § 482.52(c)).
- Boards to adopt implementing rules after enactment.
Notes
- The bill emphasizes cost savings and improved access, citing studies and data on APRN impact and state comparisons.
- Highlights the need to remove ambiguity in APRN practice and align NC law with modern APRN roles nationwide.
Compiled from official sources — confirm details with the bill’s official record.
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