Senate committee substitute replaces the 2nd edition in its entirety with the following. Makes conforming changes to act’s titles.

Section 1.

Authorizes the Department of Health and Human Services (DHHS) to adopt rules to implement any part of GS Chapter 108C.

Adds new GS 108C-3.1, authorizing DHHS, when it becomes aware of an adverse action by a health care provider licensing entity that either: (1) imposes a license limitation or restriction on a provider's scope of practice, the range of services, or the time, place, and manner in which any service is rendered that deviates from the prevailing procedures for administering the services or (2) imposes a license limitation or restriction on a provider's ability or authority to provide care for all patients, to deny or terminate the provider retroactively to the effective date of the provider's licensing entity's adverse action. Effective October 1, 2026, and applies to adverse actions effective on or after that date.

Section 2.

Adds new GS 108C-26.6, directing DHHS to establish the Provider Enrollment Credentialing Committee (Committee) as the centralized administrative body to adjudicate provider participation in various programs administered by DHHS. Allows the Committee to review: (1) enrollment applications, as described, during the provider credentialing process and (2) a provider’s continued participation when the ongoing monitoring process reveals findings that can impact a provider's eligibility for departmental programs. Authorizes the Committee to issue determinations regarding the denial or termination of enrollment, reenrollment, revalidation, and enrollment maintenance for providers. Tasks the Committee with adopting bylaws and complying with the described quality assurance standards and laws. Enumerates eight pieces of provider information that are confidential and not public records under State law. Makes conforming change to GS 108C-2. Specifies, in GS 108C-3(a) that the authorization for the Committee extends to the Medicaid program, including all prepaid health plans.

Section 3.

Expands persons subject to criminal history checks under GS 108C-4 to include a provider’s owners, operators, and managing employees. Now allows the Division to permanently exclude (was, deny or terminate enrollment) a provider, owner, operator, or a managing employee (was, employee) from participation for criminal convictions in the listed Articles of GS Chapter 14 (as amended) any of the listed eight convictions when defined as a habitual felon. Authorizes the Division to terminate the enrollment of a provider upon the conviction of the provider, or the owner, operator, or managing employee of that provider, under any of the four listed offenses. Specifies that a provider may be excluded from enrollment for a period of 10 years from the date the provider, or owner, operator, or managing employee of that provider, was fully discharged from all imprisonment, probation, parole, and full payment of restitution for a conviction covered above. Authorizes the Division to terminate the enrollment of a provider upon the conviction of the provider, or the owner, operator, or managing employee of that provider, under the listed drug or alcohol offenses. Authorizes a covered person to be excluded from enrollment for a period of five years from the date the provider, or owner, operator, or managing employee of that provider, was fully discharged from all imprisonment, probation, parole, and full payment of restitution for a drug or alcohol conviction. Authorizes the Division to terminate the enrollment of a provider upon the conviction of the provider, or the owner, operator, or managing employee of that provider, under any of the sixteen types of listed offenses. Authorizes a covered person to be excluded from enrollment for a period of two years from the date the provider, or owner, operator, or managing employee of that provider, was fully discharged from all imprisonment, probation, parole, and full payment of restitution. Subjects applicants to review by the Committee after any period of exclusion. Applies to provider enrollment and revalidation occurring on or after the section becomes law.

Adds new GS 108C-4.1, allowing DHHS to deny enrollment of, deny revalidation of, or terminate a provider's participation in the Medicaid program for any of the nine listed reasons, including false claims, billing for services provided while one’s license is suspended, and certifying false or misleading information on the provider's enrollment application as true. Allows DHHS to exercise its discretion regardless of whether provider maintains a current, active license, certification, or other provider credential. Effective 30 days after the section becomes law.

Section 4.

Requires DHHS, Division of Health Benefits (DHB) to ensure that the Medicaid provider administrative participation agreement includes the four components: (1) requirement that the provider identify its electronic health record system vendor; (2) requirement that the provider notify DHB of any changes to its electronic health record system vendor; (3) requirement that every user of the provider's electronic health record system utilize a unique login to that system; and (4) requirement that the provider notify DHB when that provider becomes aware that any individual employed by the provider is newly convicted of any criminal offense, applicable to both current employees and any individual employed by the provider within the preceding 12 months from the date of the new conviction.

Section 5.

Updates statutory cross reference in GS 108D-22, as amended. Also requires each PHP to develop and maintain a closed network, and allows excluding providers from that closed network, for the provision of the following services: (1) peer support services and (2) research-based behavioral health treatment services.

Amends GS 108D-24 (children and family plan networks), as amended, to allow closed networks for community support team services, in addition to those listed and those required under GS 108D-22.

Section 6.

Requires DHHS to provide coverage to qualified individuals allowed under section 214 of the Children's Health Insurance Program Reauthorization Act in GS 108A-54.3A(a). Makes a conforming change to GS 108A-54.3A(c). Effective October 1, 2026.