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

Part I.

Regarding the management of benefits under the NC Health Care for Working Families program (program) by Prepaid Health Plans, changes the cross-reference provided to define Prepaid Health Plans from SL 2015-245 (Medicaid Transformation and Reorganization), to GS 108D-1 (amended by SL 2019-81).

Regarding participant contributions under the program, extends the period given for participants to make premium contributions before suspension is triggered, from 90 days to 120 days of the due date of the contribution. 

Adds immunizations to the preventative care and wellness activities the Department of Health and Human Services (DHHS) is required to include under the program.

Modifies the exemptions set forth for DHHS's mandatory employment activities to now more specifically include individuals living in the home with, and serving as the primary caregiver for, a dependent minor child, a disabled or medically frail adult child, or a disabled parent, disabled spouse, or other disabled and medically frail relative (was, individuals caring for a dependent minor child, an adult disabled child, or a disabled parent).

Modifies and adds to the contingencies of the program's implementation. Prohibits DHHS from implementing the program and requires that DHHS cease all activities related to implementation if the program approved by the Center for Medicare and Medicaid Services (CMS) fails to materially (was, substantially) comply with the program components required by the act. Now prohibits DHHS from providing program coverage until all program components can be implemented in the event the State is enjoined, stayed, or otherwise prohibited from implementing any program component approved by CMS. Additionally, prohibits all activities related to implementation, except for continuing to seek federal approval of the program, if legislation is not enacted to ensure premium tax is levied upon capitation payments received by Prepaid Health Plans in the same manner the tax is applied to gross premiums from business done in the State for all other health care plans and contracts of insurance provided by insurers or health maintenance organizations subject to the tax under GS 105-228.5. Finally, prohibits implementation and all related activities in the event the program approved by CMS does not allow for participant contributions collected by the State to be treated as State funds eligible for federal matching funds.

Extends the date by which DHHS must submit its design proposal for the program to the specified NCGA committee, from October 1, 2019, to March 1, 2020.

Adds a new requirement for DHHS to quarterly publish specified information regarding program eligibility and participation on its website, beginning October 1, 2020, and until the initial approval term of the approval by CMS of the program.

Part II.

Amends new GS 108B-32 to also include activities that decrease or eliminate healthcare disparities in those eligible to be funded by a grant from the NC Rural Access to Healthcare Grant Fund.

Adds a new contingency provision to provide that proposed Article 3, Rural Access to Healthcare Grants, of GS Chapter 108B, is effective only if legislation is enacted to ensure that premium tax is levied upon capitation payments received by Prepaid Health Plans in the same manner the tax is applied to gross premiums from business done in the State for all other health care plans and contracts of insurance provided by insurers or health maintenance organizations subject to the tax under GS 105-228.5.

Removes the provision making the entire act contingent on the passage of H 966, 2019 Appropriations Act.