Senate committee substitute to the 2nd edition adds the following new content.  Makes organizational changes and conforming changes to act’s long and short titles and act's effective date.

Part II.

Amends Section 2.4 of SL 2023-7 by adding a requirement to the report provided to the Joint Legislative Oversight Committee on Medicaid and the Fiscal Research Division by the Department of Health and Human Services (DHHS), Division of Health Benefits (DHB), that the DHB report include full details of any funding needed to implement or maintain work requirements. Provides that DHHS must implement any work requirements as a condition of Medicaid participation approved by the Centers for Medicare and Medicaid Services in accordance with this section, regardless of any GS 108A-54.3A provisions to the contrary.

Part III.

Requires the Department of Health and Human Services, Division of Health Benefits (Division), to ensure that (1) a licensed health care provider providing health care services exclusively through telehealth services is not required to maintain a physical presence in the state to be considered an eligible provider for enrollment as a Medicaid provider and (2) a health care provider group with licensed heath care providers that exclusively offer telehealth services is not required to have an in-state service address to be eligible to enroll as a Medicaid provider group.

Part IV.

Amends GS 108D-40(a)(14) so that former foster children eligible for Medicaid under the specified State law are not a Medicaid category that has to be covered under a prepaid health plan contract (currently, that Medicaid category is former foster children until they reach the age of 26). Extends the date that services must begin under a single statewide children and families (CAF) specialty plan under Section 9E.22 of SL 2023-134 from December 1, 2024, to December 1, 2025. Makes a conforming change.

Part V.

Repeals provisions of SL 2021-180 that would sunset a pregnant woman’s eligibility for Medicaid coverage until twelve months postpartum on March 31, 2027. Makes conforming changes to GS 108A-146.5.

Part VI.

Adds defined term freestanding psychiatric hospital to GS 108A-145.3 (definitions provisions of the Hospital Assessment Act) and makes conforming and organizational changes. Effective on the first day of the next assessment quarter after the date this act becomes law and applies to assessments imposed on or after that date.

Amends GS 108A-148.1 (pertaining to the State’s Healthcare Access and Stabilization Program [HASP]) so that the HASP must provide qualifying freestanding standing psychiatric hospitals with increased reimbursements funded through hospital assessment so long as they are approved by CMS. Directs the Department of Health and Human Services (DHHS) to submit a 42 CFR 438.6(c) preprint requesting approval to include freestanding psychiatric hospitals in HASP. Effective when the act becomes law.

The following is effective on the first day of the next assessment quarter after the date this act becomes law and applies to assessments imposed on or after that date:

Defines qualifying freestanding psychiatric hospital as a freestanding psychiatric hospital as defined in GS 108A‑145.3 that is Medicare‑certified and submits Hospital Cost Report Information System cost report data to CMS.

Amends the definition of modernized HASP component in GS 108A-146.10 so that it is now an amount of money calculated each quarter by multiplying the aggregate amount of HASP directed payments due to PHPs in the current quarter for reimbursements to acute care hospitals (currently, just hospitals) that are not attributable to newly eligible individuals by the nonfederal share for not newly eligible individuals. Makes conforming changes, including to the statute's title.

Adds new GS 108A-146.10A defining a modernized freestanding psychiatric hospital HASP component as an amount of money calculated each quarter by multiplying the aggregate amount of HASP directed payments due to PHPs in the current quarter for reimbursements to freestanding psychiatric hospitals that are not attributable to newly eligible individuals by the nonfederal share for not newly eligible individuals.

Adds new GS 108A-146.4 (freestanding psychiatric hospital modernized assessment), applicable to all freestanding psychiatric hospitals, directing that all such hospitals’ modernized assessments be assessed a percentage of their costs, calculated quarterly by the Department of Health and Human Services (DHHS). Specifies that the percentage for each quarter must equal the modernized freestanding psychiatric hospital HASP component under GS 108A-146.10A divided by the total hospital costs for all freestanding psychiatric hospitals holding a license on the first day of the assessment quarter.

Amends GS 108A-146.5 (aggregate acute care hospital modernized assessment collection amount) to define the aggregate acute care hospital modernized assessment amount as an amount of money equal to the aggregate modernized assessment collection amount under GS 108A-146.5(a) minus the modernized freestanding psychiatric hospital HASP component under GS 108A-146.10A. Adds the freestanding psychiatric hospital HASP as one of the total modernized nonfederal receipts under the statute.  Makes conforming changes.

Amends the formulas set forth in GS 108A-146.13(c) (pertaining to modernized presumptive IGT [intergovernmental transfer] adjustment components) to account for new GS 108A-146.10A (freestanding psychiatric hospital HASP components) and acute care hospital HASPS.

Adds new GS 108A-147.6A (pertaining to health advancement freestanding psychiatric hospital HASP components), defining a health advancement freestanding psychiatric hospital HASP component as an amount of money calculated by multiplying the aggregate amount of HASP directed payments due to PHPs in the current quarter for reimbursements to freestanding psychiatric hospitals attributable to newly eligible individuals by the nonfederal share for newly eligible individuals.

Adds new GS 108A-147.2A (freestanding psychiatric health advancement assessment) applicable to all freestanding psychiatric hospitals, directing that all such hospitals’ freestanding psychiatric hospital health advancement assessments be made as a percentage of each freestanding psychiatric hospital's hospital costs. Directs that the assessment percentage be calculated quarterly by DHHS in accordance with the statute. Directs that the percentage for each quarter equals the health advancement freestanding psychiatric hospital HASP component calculated under GS 108A-147.6A divided by the total hospital costs for all freestanding psychiatric hospitals holding a license on the first day of the assessment quarter.

Amends GS 108A-147.3 (pertaining to aggregate acute care hospital health advancement assessment collection amount) as follows. Adds the health advancement freestanding psychiatric hospital HASP as one of the total nonfederal receipts for health advancement under the statute. Defines the aggregate acute care hospital health advancement assessment collection amount as an amount of money equal to the aggregate health advancement assessment collection amount under subsection (a) of GS 108A-147.3 minus the health advancement freestanding psychiatric hospital HASP component under GS 108A-147.6A. Makes a conforming change.

Amends GS 108A-147.5(d)(5) (potential bases of the presumptive cost components) so that the formula is now the amount produced from multiplying 1.15 by the highest amount produced when calculating, for each quarter that is at least two and not more than five quarters prior to the current quarter, the actual nonfederal expenditures for the applicable quarter minus the health advancement acute care hospital HASP component calculated under GS 108A-147.6 for the applicable quarter and minus the health advancement freestanding psychiatric hospital HASP component calculated under GS 108A-147.6A for the applicable quarter (currently no reference to health advancement freestanding psychiatric hospital HASP component). Makes conforming changes.

Adds another prong, the health advancement freestanding psychiatric hospital HASP component calculated under GS 108A-147.6A for the quarter that is two quarters prior to the current quarter, to the list elements that should be subtracted to specified actual nonfederal expenses to obtain the health advancement reconciliation under GS 108A-147.11(a). Makes conforming changes. 

Makes conforming changes to GS 108A-146.1 (public hospital modernized assessments), GS 108A-146.3 (private hospital modernized assessments), GS 108A-147.1 (public hospital health advancement assessments), GS 108A-147.2 (private hospital health advancement assessments), and GS 108A-147.6 (health advancement acute care hospital HASP component) to account for new acute care provisions.