Enacts new Part 4A, the Birth Center Licensure Act in Article 6 of GS Chapter 131E. Defines birth center as a facility licensed for the primary purpose of performing normal, uncomplicated deliveries that is not a hospital or ambulatory surgical facility and where births are planned to occur away from the mother's usual residence following a low-risk pregnancy.

Requires the Department of Health and Human Services (DHHS) to review and, if necessary, revise the Freestanding Birth Center Fee Schedule every three years to ensure that the fees are sufficient to cover costs and that the cost for any State-mandated newborn screening is reimbursed at no less than the screening's cost. 

Requires DHHS to inspect birth centers as necessary to investigate unexpected occurrences involving death or serious physical injury and reportable adverse outcomes identified in the rules adopted by the North Carolina Birth Center Commission (Commission). Licensed birth centers are subject to inspections at all times. Establishes a right of entry for authorized representatives of the DHHS in order to carry our this Part or the Commission's rules. Specifies that no representative shall, by this entry onto the premises, endanger the health or well-being of any patient being treated in the birth center. Gives DHHS authority to investigate birth centers in the same manner as it investigates hospitals. Allows information received by the Commission and DHHS to be disclosed to the public except when it would violate applicable laws concerning patient records and patient confidentiality; provides that a public disclosure must not identify the patient without permission or a court order.

Establishes the Commission, which consists of seven members, and gives it the power and duty to: (1) adopt rules establishing standards for the licensure, operation, and regulation of birth centers and (2) review and make recommendations to DHHS about whether to approve or disapprove birth center license applications. Three Commission members are to be named based upon recommendation by the North Carolina Obstetrical and Gynecological Society, three are to be named based upon recommendation by the North Carolina Affiliate of the American College of Nurse-Midwives, and one public member is appointed by the Governor. Members serve four-year terms, with no member serving more than two consecutive terms. Sets out additional provisions governing member removal, filling of vacancies, establishing a quorum, paying per diem and travel expenses, and providing staffing.

Requires the Commission to adopt rules establishing specified requirements for all birth centers seeking a license to operate in the state, with the rules addressing issues related to accreditation, procedures for specifying a patient's risk status, performing targeted ultrasounds, transferring patients to higher levels of care, handling of sentinel events and adverse outcomes, and reporting requirements.

Allows Commission members and staff to release confidential or nonpublic information to any health care licensure board in this state or another state, or to authorized DHHS personnel with enforcement or investigative responsibilities concerning issuance, denial, annulment, suspension, or revocation of a license, or the voluntary surrender of a license by a licensee of the Commission, including the reasons for the action, or an investigative report made by the Commission.

Enacts new GS 131E-153.2 prohibiting establishing or operating a birth center in this state without obtaining a license. Sets out requirements for information to be included on the application for licensure and sets the annual application fee at $400 plus an annual per-birthing room fee of $17.50. Requires DHHS to issue a license upon the Commission's recommendation if DHHS finds that the applicant is in compliance with this Part and Commission rules. Sets license duration at one year from the date of issuance and requires licenses to designate the number and types of beds and the number of rooms on the licensed premises. Requires licenses to be issued only for the premises and persons named in the license; licenses are not transferable or assignable except with DHHS' written approval. Requires the license to be posted on the licensed premises in an area accessible to the public. Specifies that birth centers that (1) are operating in this state on the date this act becomes effective, (2) are accredited by the Commission for the Accreditation of Birth Centers (CABC), and (3) remain continually accredited, are allowed to continue operations as the Commission is constituted and promulgates permanent rules. Requires these centers to submit an application for licensure along with the required fees within 90 days after the Commission's permanent rules on applications become effective. Effective one year after the rules promulgated by the Commission are adopted and applies to licenses granted on or after that date.

Enacts new GS 131E-153.10 making it a Class 3 misdemeanor to own or operate a birth center without a license, subject to a fine of no more than $50 for the first offense and no more than $500 for each subsequent offense. Specifies that each day of continuing violation after conviction is a separate offense. Effective one year after the rules promulgated by the Commission are adopted and applies to criminal offenses committed on or after that date.

Enacts new 131E-153.3 allowing DHHS to deny, suspend, or revoke a license when there is a substantial failure to comply with the provisions of this Part or any rule adopted under this Part. Allows suspending admission of new patients if the conditions of the birth center are detrimental to the health or safety of any patient. Sets out provisions under which an adverse action may be contested. Allows a birth center to contest any adverse action under GS Chapter 150B. Effective one year after the rules promulgated by the Commission are adopted and applies to licenses granted on or after that date.

Enacts new GS 131E-153.4 prohibiting licensed birth centers from asserting, representing, offering, providing, or implying that the center is rendering or may render care or services other than those that it is permitted to render under its license. Limits surgical procedures to those normally accomplished during an uncomplicated birth, prohibits performing abortions, prohibits performing general or conduction anesthesia, and prohibits performing vaginal birth after cesareans (VBAC) or trial of labor after cesareans (TOLAC). Effective one year after the rules promulgated by the Commission are adopted and applies to licenses granted on or after that date.

Require DHHS, by October 1, 2021, to review and, if necessary, revise its current Freestanding Birth Center Fee Schedule to ensure that the fees are sufficient to cover the costs of care and that the cost for any State-mandated newborn screening is reimbursed at no less than the cost of the screening. Requires DHHS to develop a birth center licensure application and make it available upon adoption by the Commission.

Requires initial appointments to the Commission to be made no later than 60 days after the act's effective date. Sets out member terms in order to create staggered terms.

Makes the criminal offense effective December 1, 2021, applicable to offenses committed on or after that date.