Part I.

Enacts new Article 4A in GS Chapter 131E as follows. Recodifies GS 131A-32 as new GS 131E-74. Renames the Rural Health Care Stabilization Fund as the Rural Healthcare Infrastructure Fund (Fund) and moves the Fund to the Department of Health and Human Services (DHHS; was in the Office of State Management and Budget). States legislative intent. Provides the purpose of the Fund is to provide loans and grants at below market interest rates with structured repayment terms to support rural healthcare infrastructure. Places Fund administration with the NC State Health Coordinating Council (Council). States priority for use of funds for the purpose of meeting debt service obligations supported by the General Fund. Authorizes the Council to use the Fund for four other purposes including new capital projects, repair and renovation for licensed facilities or other healthcare infrastructure projects in rural areas, and up to $100,000 each fiscal year for administration. Requires reversion of unexpended funds to the Fund upon completion of a project. Directs the Council to annually report to the specified NCGA committee and division by March 1 on the use of funds. Specified required content.

Conditions initiation of awards from the Fund on the NCGA's approval of the Council's development of the plan for a Rural Healthcare Infrastructure Program pursuant to the act. Effective on the date the act becomes law.

Part II.

Directs the Council to develop a plan in consultation with the Office of Rural Health at DHHS for the Council to establish and administer a Rural Healthcare Infrastructure Program (program). States the program's purpose is to award grants and loans with below market interest rates from the Fund to support the construction, renovation, or modernization of rural healthcare infrastructure. Lists nine required areas the plan must address including an application process, a description of eligible entities and projects, and a process for overseeing awards and compliance, as well as any other information the Council deems relevant to program implementation and Fund administration. Requires the Council to submit the plan to the specified NCGA committee and division by January 15, 2027. Bars implementation of the plan without NCGA action. Effective on the date the act becomes law.

Part III.

Amends GS 131E-191.1, which currently bars lobbyists from serving on the Council. Adds the following new provisions. Grants the Council the power to work with DHHS to prepare a State Medical Facilities Plan and to administer the Fund. Establishes the Council as 25 members including 13 gubernatorial appointments and 12 legislative appointments, as specified, for a term of three years. Provides for the Council's chair, vacancies, member removal, meetings, member expenses, and administrative assistance. 

Bars the Governor from continuing to appoint 12 members to the Council on the existing schedule for terms expiring on December 31, 2026, December 31, 2027, and December 31, 2028. Instead requires legislative appointments whereby the NCGA will appoint the following members to a term of three years: six members to succeed the specified members whose terms expire December 31, 2026; two members to succeed specified members whose terms expire December 31, 2027; and four members whose terms expire December 31, 2028. 

Part IV.

Repeals the remainder of Article 2, GS Chapter 131A (Rural Health Care Stabilization Program).

Part V.

Transfers the unrestricted cash balance of the Rural Health Care Stabilization Fund to the Fund created by GS 131E-74, as amended, and appropriates the funds for the fiscal year in which they are transferred. Directs principal and interest payments due to the Rural Health Care Stabilization Fund on or after July 1, 2026, be paid to the Fund.

Appropriates $1 million from the Fund to the Office of Rural Health to fund a contract with Rural Healthcare Initiative, Inc. to create effective models of sustainable healthcare in rural communities, to develop cost estimates for achieving the facilities described in the models, and to support the work of the Council and Office of Rural Health to plan and administer the program.

Part VI.

Effective July 1, 2026.