House committee substitute to the 2nd edition removes the provisions of the previous edition and replaces it with the following. Makes conforming changes to the act’s titles.

Part I

Amends GS 108A-105 by requiring that the petition for an order authorizing the provision of protective services for a disabled adult to be served along with the notice of hearing upon the disabled adult in accordance with GS 1A-1, Rule 4(j), which sets out the manner of service needed to exercise personal jurisdiction. Makes additional technical changes. Applies to petitions filed on or after August 1, 2024.

Part II

Amends GS 110-86 by amending the definition of child care facility as it applies to GS Chapter 110 Article 7, Child Care Facilities, by increasing upper limit on the number of children that may receive care in a family child care home at any one time to less than 11 (was, 10).

Part III

Amends GS 130A-40 by amending the qualifications for a local health director by changing one set of the possible minimum education and experience qualifications to now require a bachelor's degree in a field related to public health and at least seven years of experience in health programs or health services, which must include at least three years of supervisory experience (was, a bachelor's degree in public health administration or public administration and at least three years of experience in health programs or health services). Includes the appointment of a person with these qualifications among those that must be sent to the State Health Director to decide if their degree is in a field related to public health. Also requires the State Health Director to review requests from educational institutions to determine whether a particular degree offered by the institution is related to public health for the proposes of this educational requirement. Makes other technical changes.

Make a clarifying change to GS 153A-77.

Applies to appointments made on or after August 1, 2024.

Part IV

Amends Section 6.6 of SL 2023-14 by requiring the policy of the Department of Health and Human Services (DHHS) that allows an individual related by blood, marriage, or adoption to a child who is providing foster care to the child, now also including any of the child’s half-sibling(s), in a family foster home to be reimbursed for providing care without having to meet the licensure requirements. Amends the definition of family foster home to include the residence of an individual providing full-time foster care for a child that is related to the adult members of the household by blood, marriage, or adoption, and the child’s half-siblings regardless of the half-sibling’s relationship to the kinship caregiver.

Part V

Amends GS 7B-521 by amending the list of individuals who may take temporary custody of an infant reasonably believed to be no more than 30 days old that is voluntarily delivered to the individual by the infant’s parent who does not intend to return for the infant, to include a first responder who is on duty (was, just a first responder). Applies to infants surrendered on or after August 1, 2024.

Part VI

Amends GS 7B-525 by changing the timing for when a county department of social services may apply ex parte for an order finding that an infant has been safely surrendered and confirming that the department has legal custody for the purpose of obtaining a copy of the birth certificate, a social security number, or benefits for the minor, from when notice has been completed to when the notice has been initiated. Applies to infants surrendered on or after October 1, 2024.

Part VII

Amends Section 9J.12 of SL 2023-134 by amending the minimum requirements for DHHS’s trauma-informed standardized assessment, as follows: (1) now requires parental consent for juveniles included in any Medicaid children and families special plan to receive an assessment; (2) requires that the county department of social services makes the referral for an assessment within five working days of obtaining parental consent for children who are at risk for entry into foster care (was, after obtaining parental consent, a juvenile is able to receive an assessment if the county department of social services determines that the juvenile is at imminent risk for entry into foster care).

Part VIII

Requires DHHS, Division of Child Development and Early Education (Division), to update and revise the quality rating improvement system (QRIS) so that it includes alternative pathways for licensed child care facilities to earn a license of two to five stars based on program standards and education levels of staff as follows: (1) a pathway focused on program assessment; (2) a pathway focused on classroom and instructional quality; (3) a pathway focused on accreditation; and (4) any other pathway regarding updating the QRIS designated by the North Carolina Child Care Commission (Commission).

Allows a child care facility to request to be awarded a star-rated license based on accreditation from a national childhood education accreditation organization if the facility maintains its accreditation and remains in good standing. Sets out provisions governing the issuance of these licenses based on whether the license is three- or five-star rated. For those earning less than five stars, there must be additional opportunities for the facility to increase its star rating. Allows the Commission to reassess an accreditations’ star-rating equivalency, or change a rating, or approve additional accreditations from national organizations and determine the equivalency on request. Prohibits the Division from requiring facility with a two- to five-star-rated license to undergo a QRIS reassessment until rules implementing QRIS reform become effective. Effective February 1, 2025, requires that if the Division issues any new license with a rating of two to five stars to a child care facility or any facility that elects to undergo a QRIS assessment based on a program assessment before rules implementing QRIS reform become effective, then the facility must be evaluated using the specified scales. Provides that when the Division issues any new license with a rating of two to five stars to a child care facility or any facility that elects to undergo a QRIS assessment before rules implementing QRIS reform become effective, if the percentage of lead teachers in the facility required to meet the "rated licensed education requirements" criteria is set at 75% for the facility to earn those "education points" toward the facility's star rating, then the Division must lower the threshold to 50% of lead teachers. These provisions expire on the date rules implementing QRIS reform become effective.

Amends GS 110-90 by amending the Secretary of Health and Human Services’ powers to issue a license to any child care facility, by requiring that for any facility with a license of two to five stars or any new license issued to a facility with a rating of two to five stars, the rating must be based on program standards and education levels of staff. Sets out factors that must be considered when evaluating program standards and education levels of staff. Also requires providing licensed facilities with a rating of two to five stars with an opportunity to earn recognition for voluntary participation in other quality initiatives or specialties. Makes other conforming and technical changes.

Requires the Commission to adopt, amend, or repeal any rules regarding star-rating reform necessary to implement this act.

Part IX

Amends Section 1.8 of SL 2023-7 by changing the date by which DHHS must stop using the federal health benefit exchange to make Medicaid eligibility determinations to June 30, 2025 (was, no later than 12 months after the date approved by CMS for Medicaid coverage to begin in the State for specified categories of individuals). Makes conforming changes to the section’s expiration date.

Part X

Amends Section 4.10 of SL 2023-134 to change the recipient of the $50 million for the NC Care initiative to a regional behavioral health facility (was, hospital). Amends Section 40.1 of SL 2023-134 by changing the name of the Regional Children’s Behavioral Health Facility to the Regional Behavioral Health Facility.

Requires that the $50 million in funding allocated from the State Capital and Infrastructure Fund to East Carolina University by sued to construct a Regional Behavioral Health facility in Greenville.

Part XI

Amends GS 131E-88, which is effective October 1, 2024, by allowing each hospital licensed under the Hospital Licensure Act that has an emergency department to submit its security risk assessment to DHHS by October 1, 2024, and sets out the times that must be included in the risk assessment, including the proposed budget and timeline for the implementation of the security plan. Specifies that the requirements for the security plan do not apply until June 1, 2025, to a licensed hospital with an emergency department who acts in compliance with this provision. Requires DHHS to keep a list of those hospital submitting a security risk assessment under this provision in addition to a list of those hospitals with a security plan.

Part XII

Amends GS 108D-40 as follows. Requires that the exclusion of prison inmates from the requirement that capitated PHP contracts cover all Medicaid program aid categories continue to apply once the recipient is released from prison for a period that is the shorter of: (1) the recipient’s initial Medicaid eligibility certification period post-release, or (2) 365 days. Adds an exclusion from the requirement that capitated PHP contracts cover all Medicaid program aid categories, for recipients residing in carceral settings other than prison and whose Medicaid eligibility has been suspended; upon their release, the exception continues to apply for a period that is the shorter of: (1) the recipient’s initial Medicaid eligibility certification period post-release, or (2) 365 days. Effective January 1, 2025.

Amends GS 122C-115 to specify that LME/MCOs operating the BH IDD tailored plans may contract with DHHS to continue management (was, may continue management) of the behavioral health, intellectual and developmental disability, and traumatic brain injury services for any Medicaid recipients who are not enrolled in a BH IDD tailored plan or the CAF specialty plan.