House committee substitute to the 2nd edition makes the following changes.

Amends new Article 2, Rural Health Care Stabilization Program, to GS Chapter 131A as follows. Changes the logistics of the Rural Health Care Stabilization Fund (Fund) created by the act. Now provides for the Fund to be a nonreverting special fund in the Office of State Budget and Management and under the custody of the State Treasurer, rather than controlled and under the direction of UNC Health Care. Changes the interest rate and maturity for loans awarded under the Program. Now requires that the interest rate not exceed the interest rate obtained by the State on its most recent general obligation bond offering (previously, required to be below the market rate), and that the maturity not exceed ten years, with the one-time option to extend the loan for another ten years (previously, set maturity at seven years). Changes the effective date of new Article 2 and its conforming changes to the date the act becomes law (was, July 1, 2019).

Adds the following provisions.

Amends GS Chapter 105, Article 46 (now, the one-­quarter cent or one-­half cent county sales and use tax), as follows. Requires that taxes levied under the Article be approved in a referendum, as specified. Restricts a referendum to an increase in increment of .25%, and limits the total local sales and use tax rate to 2.5% or 2.75%, as specified. Prohibits holding a referendum on the levy of taxes under the Article within one year from the date of the last preceding election for the same. Makes conforming changes. Now restricts a county's use of the net proceeds of taxes levied under the Article to any public purpose and/or public education purposes, which must be indicated on the ballot question presented at the referendum, as specified. Defines public education purposes to mean (1) public school capital outlay purposes or to retire any of the county's related indebtedness, (2) classroom teacher salary supplements, or (3) financial support of community colleges. Makes conforming changes. 

Enacts new GS 105-­506.3 to require that taxes under GS Chapter 105, Article 43 (local government sales and use taxes for public transportation), only be levied when the total local sales and use tax rate in the county, including a levy under this article, does not exceed a specified limit (limit is identical to that in new GS Chapter 105, subchapter 105, Article 43, described above).

Amends GS 105­-164.3(4a) to amend the definition of Combined general rate to mean the sum of: the State's general rate in GS 105­-164.4(a); the sum of the rates of the local sales and use taxes authorized for every county in GS Chapter 105, Articles 39, 40, and 42, or SL 1967­-1096; and half of the maximum rate authorized by GS Chapter 105, Article 46.

Amends GS 143B-437.01 concerning the Industrial Development Fund Utility Account by expanding the definition of economically distressed county (as it is used in the statute) to mean a county that has one of the 87 highest rankings under GS 143B-437.08, which designates development tiers (was, county that is defined as a development tier one or two area). 

Makes conforming changes to the act's titles.