Conference committee substitute amends the 4th edition as follows. Makes conforming title changes.

Part I.

Adds the following new content. 

Repeals GS 14-45.1, defining unlawful abortions under existing law. Existing law makes it lawful to advise, procure, or cause a miscarriage or abortion during the first 20 weeks of a woman's pregnancy so long as the procedure is performed by a licensed, qualified physician in a certified, suitable hospital or clinic, with miscarriage or abortion procedures permitted after the 20th week if there is a medical emergency.

Retitles Article 1I of GS Chapter 90, currently the Women's Right to Know Act, as "Abortion Laws," and makes the following changes. Makes conforming changes to the Article's short title. Defines abortion to mean a surgical abortion or a medical abortion, which are both defined to mean the intentional termination of a known pregnancy with an intention other than to (1) increase the probability of a live birth; (2) preserve the life or health of the child; (3) remove a dead, unborn child who died as a result of natural causes in utero, accidental trauma, or a criminal assault that causes the premature termination of the pregnancy; or (4) remove an ectopic pregnancy. Adds the following defined terms: abortion-inducing drug, adverse event, surgical abortion, complication, health care provider, hospital, incest, life-limiting anomaly, medical abortion, partial-birth abortion, qualified physician, rape, and unborn child. Modifies the term attempt to perform an abortion to refer to a physician's discretion rather than an "actor."

Enacts GS 90-21.81A, making it unlawful to advise, procure, or cause a miscarriage or abortion after the 12th week of a woman's pregnancy. Also makes it unlawful for a qualified physician, any healthcare provider, or any person to perform a partial-birth abortion at any time. 

Enacts GS 90-21.81B, describing four instances of a lawful miscarriage or abortion: (1) when a qualified physician determines there exists a medical emergency; (2) during the first 12 weeks of pregnancy, when the procedure is performed by a licensed, qualified physician in a hospital, ambulatory surgical center, or clinic certified by the Department of Health and Human Services (DHHS) to be a suitable facility for the performance of abortions pursuant to the requirements of GS 90-21.82A (appears to intend GS 90-21.82, requiring informed consent for surgical abortions) or during the first 12 weeks when a medical abortion is procured; (3) after the 12th week and through the 20th week of a woman's pregnancy, when the procedure is performed by a qualified physician in a suitable facility pursuant to the requirements of GS 90-21.82A when the woman's pregnancy is a result of rape or incest; and (4) during the first 24 weeks of a woman's pregnancy, if a qualified physician determines there exists a life-limiting anomaly in accordance with the Article. 

Enacts GS 90-21.81C, establishing reporting requirements for qualified physicians who advise, procure, or cause a miscarriage or abortion after the 12th week of a woman's pregnancy, including providing the ultrasound image, to DHHS, subject to specified confidentiality protections under HIPAA. Requires DHHS to prescribe and annually collect from hospitals, ambulatory surgical facilities, or licensed clinics where abortions are performed statistical summary reports concerning the medical and demographic characteristics of abortions provided after the 12th week under this statute; requires cooperation of hospital, facilities, and clinics. Deems records provided pursuant to the statute not public records. Excepts abortions performed under this statute from the fetal death reporting requirements of GS 130A-114. Bars requiring health care providers to perform or participate in medical procedures over their objections based on moral, ethical, or religious grounds, and civil relief or disciplinary action based on such refusal. Specifies that hospitals, health care institutions, and health care providers are not required to perform abortions or provide abortion services. Requires DHHS to perform annual inspections of clinics (including ambulatory surgical facilities but excluding hospitals) where abortions are performed, and publish on its website and on the State website the results and findings of all inspections conducted on or after January 1, 2013, of suitable facilities where abortions are performed, with specified content. Sets a minimum age for employment at clinics, including ambulatory surgical facilities, where abortions are performed, requiring employees to be at least 18. 

Enacts GS 90-21.81D, establishing requirements for qualified physicians to procure or cause a miscarriage or abortion upon determination that there exists a life-limiting anomaly. Requires the qualified physician to procure or cause the miscarriage or abortion during the first 24 weeks of a woman's pregnancy and explain in writing and orally, or provide to the woman, six statements, including that the woman has been provided all information required in GS 90-21.82 or new GS 90-21.83A, depending on whether the procedure is a surgical or medical abortion, and her informed consent has been obtained. Requires additional information provided under the statute to be signed and initialed by both the woman and the physician. Establishes reporting requirements for abortions performed under the statute with required content including identification of the qualified physician who diagnosed the baby with a life-limiting anomaly and the number of previous pregnancies, number of live births, and number of previous abortions of the pregnant woman. Deems such reports and materials not public record. 

Amends GS 90-21.82, making the statute's informed consent requirements applicable to surgical abortions only. Revises what constitutes voluntary and informed consent for a surgical abortion (excluding cases of medical emergency) to no longer allow a physician or qualified professional to inform the woman of the information contained in the consent form, which is required at least 72 hours prior to the surgical abortion, by telephone. Establishes four conditions that must be satisfied for consent to be considered valid and informed consent considered obtained, including requiring the use of the consent form created by DHHS and specified signatures and initialing of the woman on the form. Makes conforming and clarifying changes. Revises the acknowledgement of risks and consent certification required at least 72 hours before a surgical abortion, now requiring an acknowledgement of risks and consent statement to be signed and initialed by the woman with a physical or electronic signature attesting she has received all of the listed information at least 72 hours before the abortion. Modifies existing requirements of the acknowledgement and consent statement to include the woman being told about printed materials required by law and their availability online, including the address of the website (previously required including that the woman has the right to review such materials), and no longer permits mailing the printed materials. Adds a new requirement to acknowledge that the woman is not being forced to have a surgical abortion and has a choice not to have the surgical abortion, along with eight new attestations and confirmations that now must be included, including that the woman has a private right of action to sue the qualified physician under state law if she feels she has been coerced or misled prior to obtaining an abortion and how to access State resources regarding this right. No longer permits providing this information by tape recording or email. Requires the physician to sign a declaration form stating that prior to the procedure, the physician has (1) explained in person the surgical abortion procedure to be used, (2) provided all of the information required in the statute, and (3) answered all of the woman's questions regarding the surgical abortion. 

Makes technical changes to GS 90-21.83 regarding the printed information required concerning pregnancy and parenting resources, and educational materials related to unborn children. Adds a new requirement for DHHS to create the consent forms required to be used by qualified physicians for obtaining informed consent for surgical and medical abortions. 

Enacts GS 90-21.83A, barring performing a medical abortion without voluntary and informed consent. Establishes criteria that must be met for consent to be voluntary and informed (excluding medical emergencies), requiring a qualified physician or qualified professional to orally inform the woman in person of the information contained in the consent form at least 72 hours prior to the medical abortion. Lists 11 components that must be included in the form, such as a detailed description of the steps to complete the medical abortion, notice that the woman may see the remains of her unborn child in the process of completing the abortion, and the location of the hospital that offers OBGYN care located within 30 miles of the location where the medical abortion is performed or induced where the performing physician has clinical privileges. Details further requirements and limitations in obtaining informed consent. Establishes four conditions that must be satisfied for consent to be considered valid and informed consent considered obtained, including requiring the use of the consent form created by DHHS and specified signatures and initialing of the woman on the form. Requires an acknowledgement of risks and consent statement to be signed and initialed by the woman with a physical or electronic signature attesting she has received all of the listed information at least 72 hours before the abortion. Lists 15 components that must by included in the acknowledgement of risks and consent statement, similar to those required for surgical abortions under revised GS 90-21.82, including (1) that medical assistance benefits may be available for prenatal care, childbirth, and neonatal care; (2) that the father is liable to assist in the support of the child even if the father has offered to pay for the abortion; (3) that the woman has other alternatives to abortion, including keeping the baby or adoption; (4) attestation that the woman is not being forced to have a medical abortion and has a choice not to have a medical abortion; (5) notice that the physician will schedule an in-person follow-up visit for the woman at approximately seven to 14 days after providing the abortion-inducing drug(s) to confirm the termination is completed and to assess bleeding and any complications; and (6) that the woman has a private right of action to sue the qualified physician under state law if she feels she has been coerced or misled prior to obtaining an abortion and how to access State resources regarding her right. Requires the physician to sign a declaration form stating that prior to the procedure, the physician has (1) explained in person the medical abortion procedure to be used, (2) provided all of the information required in the statute, and (3) answered all of the woman's questions regarding the medical abortion. 

Enacts GS 90-21.83B, establishing requirements for a physician prescribing, administering, or dispensing an abortion-inducing drug, including examination of the woman in person, and prior to providing the drug, among other required steps, (1) independently verifying that the pregnancy exists; (2) determining the woman's blood type and offering necessary medical services, treatment, and advice; and (3) verifying that the probable gestational age of the unborn child is no more than 70 days. Requires the physician or their agent to schedule a follow-up visit for the woman at approximately seven to 14 days after administration of the drug to confirm complete termination and to assess bleeding. Requires the physician to make all reasonable efforts to ensure that the woman returns for the scheduled appointment, with efforts required to be documented in the woman's medical records.

Enacts GS 90-21.83C, requiring, at least 72 hours prior to any medical or surgical abortion performed under the Article, the physician providing the abortion-inducing drug, performing the surgical abortion, or conducting any other appointment where an abortion is to be induced or performed, to provide the physician's full name and specific information for the physician's hospital admitting privileges and whether the treatment or procedure is covered by the woman's insurance. 

Makes technical and conforming changes to GS 90-21.84 regarding required information to be maintained on a DHHS-developed website. 

Adds to GS 90-21.85 regarding a physician or qualified technician to perform and display real-time views of the unborn child at least four hours before any part of an abortion is performed or induced, to create a right for a pregnant woman to view a real-time image of the unborn child and not be denied a real-time view of the unborn child due to a clinic policy or rule. 

Makes conforming changes to GS 90-21.87 regarding informed consent of a minor to include required consent under new GS 90-21.83A as applicable. 

Amends GS 90-21.88 to allow the personal representative of any person upon whom an abortion is performed, in the event of a wrongful death action under GS 28A-18-1, to seek damages against the person who performed the abortion in knowing or reckless violation of the Article. Adds a new cause of action, allowing a woman upon whom the abortion has been attempted, induced, or performed, or her parent or guardian if she is a minor at the time of the attempted or completed abortion, to bring an action within three years from the date of the alleged violation or from the date of the initial discovery of harm from an alleged violation; grants minors three years from the date the minor attains the age of majority to bring an action. 

Enacts GS 90-21.88A, making violating physicians, pharmacists, and health care providers subject to professional discipline by the appropriate licensing agency or board. Explicitly states that no pregnant woman seeking to obtain an abortion pursuant to the Article is subject to professional discipline. 

Makes conforming changes to GS 90-21.90 regarding assurance of informed consent to include required consent under new GS 90-21.83A. 

Enacts new GS 90-21.93 setting out the following reporting requirements. Requires a physician or health care provider that conducts a surgical or medical abortion to make a report to DHHS. Requires the report to be completed by either the hospital, clinic, or health care provider in which the surgical or medical abortion was completed and signed by the physician who dispensed, administered, prescribed, or provided the abortion-inducing drug or performed the procedure or treatment. Requires making a reasonable effort to include all of the required report information without violating the woman’s privacy. Sets out a timeframe within which the report must be made, with the report due sooner when the patient is a minor. Sets out information that must be included in the report pertaining to the health care provider, location of the procedure, and information about the woman as well as her treatment and follow-up care, and unborn child, including: the woman's number of live births, previous pregnancies, and number of previous abortions; the probable gestational age of the unborn child; and the amount of money billed to cover the treatment for specific complications. Also requires a written report of any adverse events from an abortion-inducing drug, within three days, to the US FDA and DHHS; reports on adverse events or complications for a surgical abortion or abortion procedure must be reported to DHHS within 15 days of the end of the month that the event or complication occurred. Sets out information that must be included in the adverse event reports. Requires DHHS to provide a comprehensive annual report from these reports that is to be made available to the public. Requires the report to be submitted annually, beginning October 1, 2023, to the specified NCGA committee and to the Centers for Disease Control and Prevention. Prohibits a report from including a woman’s identifying information. Prohibits comparing data concerning surgical or medical abortions or resulting complications maintained in an electronic or other information system file or format with data in any other format or information system in an effort to identify a woman obtaining or seeking to obtain a drug-induced abortion, except with a court order. 

Enacts new GS 14-44.1 making it an infraction, subject to a fine of $5,000 per violation, for: (1) any individual in the State to mail, provide, or supply an abortion-inducing drug directly to a pregnant woman in violation of the provision requiring such drug to be taken or administered in presence of the prescribing physician and specifies that lack of knowledge or intent that the abortion-inducing drug will be administered outside the physical presence of a physician is not a defense; (2) any manufacturer or supplier of an abortion-inducing drug to ship or cause to be shipped any abortion-inducing drug directly to a pregnant woman in violation of the provision requiring such drug to be taken or administered in presence of the prescribing physician and specifies that lack of knowledge or intent that the abortion-inducing drug will be administered outside the physical presence of a physician is not a defense; and (3) any individual or organization to purchase or otherwise procure an advertisement, host or maintain a website, or provide an internet service purposefully directed to a pregnant woman who is an NC resident knowing that the purpose is to promote the sale of an abortion-inducing drug to be administered to a woman in violation of the provision requiring such drug to be taken or administered in presence of the prescribing physician. Applies to offenses committed on or after July 1, 2023. 

Amends GS 90-21.120 by referring to definitions under GS 90-21.81. 

Amends GS 90-21.121 to make it illegal to perform or attempt an abortion with the knowledge that the woman is seeking the abortion because of the (1) actual or presumed race or racial makeup of the unborn child; (2) sex of the unborn child; (3) presence or presumed presence of Down syndrome (was, illegal to perform or attempt to perform an abortion with knowledge, or an objective reason to know, that a significant factor in seeking the abortion is related to the sex of the unborn child). 

Amends GS 90-21.6 by amending the definition of abortion to now define it as defined under GS 90-21.81. Makes additional technical changes. 

Unless otherwise indicated, Part I is effective July 1, 2023. 

Specifies that prosecutions for offenses committed before the Part’s effective date are not abated or affected by this Part, and the statutes that would be applicable but for this Part remain applicable to those prosecutions.  

Part II.

Enacts new GS 90-21.82A providing as follows. Allows a licensed physician to perform a surgical abortion during the first 12 weeks of pregnancy in a hospital, ambulatory surgical facility, or an abortion clinic, requiring that the clinic be licensed by DHHS to be a suitable facility for the performance of abortions and that the physician perform the abortion in accordance with Article 1I and Article 1K (certain abortions prohibited) of GS Chapter 90. Prohibits performing a surgical abortion after the twelfth week of pregnancy in any facility other than a hospital.

Adds new Part 4A, concerning abortion clinic licensure, in Article 6 of GS Chapter 131E, providing as follows. Sets out the purpose of the Part and defines relevant terms. Prohibits operating an abortion clinic without a license from DHHS. Sets out the application process and sets the annual license fee at $850, plus an annual per-operating room fee of $75. Requires licenses to be renewed annually. Specifies that licenses are not transferable or assignable, except with written approval from DHHS. Requires licenses to be posted in a conspicuous place on the licensed premises.

Makes licensed clinics subject to the fair billing and collection practices in GS 131E-91.

Authorizes DHHS to deny a new or renewal application for a license and to amend, recall, suspend, or revoke an existing license if there is a substantial failure to comply with this part or related rules. Specifies that the Administrative Procedure Act governs all administrative actions and judicial review when DHHS takes action.

Authorizes the North Carolina Medical Care Commission (Commission) to adopt, amend, and repeal rules for the implementation of this Part. Requires that the rules be no stricter than those issued under the Ambulatory Surgical Facility Licensure Act. Requires DHHS to enforce the rules.

Requires DHHS to inspect abortion clinics as necessary and allows inspection power to be delegated to the listed entities. Allows patient records to be reviewed unless the patient makes a written objection. Allows health care providers who give treatment at or through a facility to be interviewed and disclose information notwithstanding the physician-patient privilege as long as the patient has not made a written objection. Gives the facility and those interviewed immunity from liability for damages resulting from the disclosure of information. Requires DHHS to keep information obtained in reviews or interviews confidential. Requires advising patients in writing before releasing any information or allowing any inspections, that the patient has the right to object, which will thereby prohibit the inspection or release of the records.

Makes owning or operating an abortion clinic without a license a Class 3 misdemeanor subject to a fine of no more than $50 for the first offense and no more than $500 for each subsequent offense; each day of continuing violation after conviction is considered as a separate offense.

Allows DHHS to seek an injunction against those operating without a license. Also allows seeking injunctive relief against anyone who hinders the Secretary or their representative in carrying out their duties under this Part.

Amends GS 131E-272 by increasing the fee for initial licensure of an abortion clinic at $850 (was, $750).

Requires DHHS to adopt rules to administer this Part by October 1, 2023. Effective July 1, 2023.

Unless otherwise indicated Part II is effective October 1, 2023.

Part III.

Enacts Article 1M, Born-Alive Abortion Survivors Protection Act, to GS Chapter 90. Defines abortion and attempt to perform an abortion. Sets forth legislative findings. Establishes standards of care, now requiring any health care provider present at the time a child is born alive resulting from an abortion or attempt to perform an abortion to: (1) exercise the same degree of professional skill, care, and diligence to preserve the life and health of the child as a reasonably diligent and conscientious health care practitioner would render to any child born alive at the same gestational age and (2) ensure that the child born alive is immediately transported and admitted to a hospital. Defines born alive to mean, with respect to a member of the species homo sapiens, the complete expulsion or extraction from his or her mother of that member, at any stage of development, who after such expulsion or extraction breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of natural or induced labor, cesarean section, or induced abortion.

Requires a health care practitioner or any employee of a hospital, a physician's office, or an abortion clinic who has knowledge of noncompliance to immediately report the noncompliance to an appropriate State or federal law enforcement agency, or both. Bars prosecution of the mother of a child born alive for violation of, or attempt or conspiracy of, GS 90-21.142 or GS 90-21.143, as enacted, involving the child who was born alive. Makes violations of GS 90-21.142 and GS 90-21.143 a Class D felony, punishable by a fine not to exceed $250,000, unless the conduct is covered under some other law providing greater punishment. Makes any person who intentionally performs or attempts to perform an overt act that kills a child born alive punishable for murder under GS 14-17(c), a Class A felony. Provides for civil remedies for the woman upon whom the abortion was performed or attempted in which a child is born alive and there is a violation of the Article, including damages for objectively verifiable money damages for all injuries (psychological and physical), treble statutory damages for the cost of the abortion or attempted abortion, and punitive damages. Provides for reasonable attorneys' fees if judgment is rendered in favor of the plaintiff or if the judgement is rendered in favor of the defendant and the court finds the suit was frivolous or brought in bad faith. Makes conforming changes to GS 14-17(c).

Provides a savings clause for prosecutions for offenses committed before the effective date of the act.

Applies to offenses committed on or after July 1, 2023.

Part IV.

Effective July 1, 2023, appropriates $3.5 million in recurring funds for each year of the 2023-25 biennium from the General Fund to the DHHS, Division of Public Health, for competitive grants to local health departments and nonprofit community health centers. Requires funds to be used to purchase and make available long-acting reversible contraceptives for underserved, uninsured, or medically indigent patients. Sets out criteria that must be met to be considered a long-acting reversible contraceptive.

Requires the DHHS, Division of Health Benefits (DHB), to increase the Medicaid rate paid for obstetrics maternal bundle payments for pregnancy care to at least 71% of the Medicare rate.

Requires DHB to develop an add-on rate to the relevant capitated rates or payments that include prenatal care services. Requires the add-on rate to include amounts sufficient to make payments to providers that achieve a level of Medicaid beneficiary participation in group prenatal care visits.

Effective July 1, 2023, appropriates $2.8 million in recurring funds for each year of the 2023-25 biennium from the General Fund to DHB to implement the Medicaid-related changes above. Specifies that the funds are a State match for $5.5 million in recurring funds for each year of the 2023-25 biennium and appropriates those funds to DHB for costs associated with the Medicaid-related changes.

Enacts GS 90-18.8 allowing a certified nurse midwife approved under Article 10A of GS Chapter 90 to provide midwifery care and use the title “Certified Nurse Midwife.” Prohibits anyone else from using the title or holding herself out as a Certified Nurse Midwife. Authorizes a Certified Nurse Midwife to write drug prescriptions if: (1) the Certified Nurse Midwife has current approval from the joint subcommittee of the North Carolina Medical Board and the Board of Nursing, (2) the joint subcommittee has assigned an identification number to the Certified Nurse Midwife that appears on the written prescription, and (3) the joint subcommittee has given the Certified Nurse Midwife written instructions about indications and contraindications for prescribing drugs and a written policy for periodic review of the drugs prescribed. Makes conforming changes to GS 90-178.3.  Requires the joint subcommittee to adopt rules governing the approval of individual Certified Nurse Midwives to write prescriptions with any limitations that are in the best interest of patient health and safety, consistent with the rules established for nurse practitioners.

Expands upon the definitions in GS 90-178.2, applicable to Article 10A, Practice of Midwifery, as follows. Adds and defines the terms certified nurse midwife, collaboration provider, and collaborative provider agreement. Amends the terms: (1) interconceptional care so that it also includes gynecologic care (was, family planning), including family planning, perimenopause, and postmenopausal care; (2) intrapartum care so that it is defined as care that focuses on the facilitation of the physiologic birth process and includes specified functions, which are amended to now include confirmation and assessment of labor and its progress, identification of normal and deviations from normal and appropriate intervention, and management of spontaneous vaginal birth and appropriate third-stage management, as well as the already listed items; (3) midwifery to exclude from the term performing an abortion; (4) newborn care to define it as care that focuses on the newborn and adds to the included care methods to facilitate newborn adaptation to extrauterine life; (5) postpartum care to define it as care that focuses on management strategies and therapeutics to facilitate a healthy puerperium and what is included to add management of deviations from normal and appropriate interventions; and (6) prenatal care to define it as care that focuses on promotion of normal pregnancy using management strategies and therapeutics as indicated and amends what is included to now include obtaining history with ongoing physical assessment of mother and fetus, confirmation and dating of pregnancy, and supervising the use of prescription and nonprescription medications.

Amends GS 90-178.3 as follows. Requires a Certified Nurse Midwife to consult, collaborate with, or refer to another provider, if indicated by patient’s health status (was, must practice under the supervision of a licensed physician who is actively engaged in the practice of obstetrics). Requires a Certified Nurse Midwife with less than 24 months and 4,000 hours of practice to (1) have a collaborative provider agreement with a collaborating provider and (2) maintain signed and dated copies of the collaborative provider agreement as required by practice guidelines and any rules adopted by the joint subcommittee. Defines a collaborating provider as a licensed physician licensed to practice medicine for a minimum of four years with a minimum of 8,000 hours of practice and who is or has engaged in the practice of obstetrics or a Certified Nurse Midwife who has been approved to practice midwifery for a minimum of four years and 8,000 hours. Provides that if a collaborative provider agreement is terminated before the Certified Nurse Midwife acquires the level of experience required for practice without a collaborative provider agreement, the Certified Nurse Midwife has 90 days from the date of termination to enter into a collaborative provider agreement with a new collaborating provider; allows the midwife to continue practicing during the 90-day period.

Amends GS 90-178.4 to require a Certified Nurse Midwife attending a planned birth outside of a hospital to discuss the associated risks with the patient and get a signed informed consent agreement from the patient that includes specified information about the risks and transfer to a health care facility. Also requires providing the patient with a written plan for emergent and nonemergent transfer to a health care facility, including the specified content. Limits planned home births attended by a Certified Nurse Midwife to low-risk pregnancies. Requires the joint subcommittee to adopt rules governing the safety of home births attended by a Certified Nurse Midwife.

Amends GS 90-178.4 by amending the content of rules to be adopted by the joint subcommittee, to include establishing the form and content of the application which must include information related to the applicant’s education and certification by the American Midwifery Certification Board (was, by the American College of Nurse Midwives), and includes the procedure for establishing collaborative provider agreements (was, establishing physician supervision).  Makes conforming changes to GS 90-178.5 and also adds that upon submitting to the joint subcommittee evidence of completing 24 months and 4,000 hours of practice as a Certified Nurse Midwife under a collaborative provider agreement, a Certified Nurse Midwife is authorized to independently practice midwifery.

Amends GS 90-178.7 to prohibit performing acts that constitute midwifery without approval under this Article.  A person who does so without approval and registration is not allowed to maintain any action to collect any fee for those services. Violations are a Class 3 misdemeanor. Makes it a Class I felony to practice without approval and falsely represent oneself as being approved under any Article under GS Chapter 90.

Enacts new GS 90-178.8 to provide immunity from civil damages for a physician or physician assistant or nurse as a result of the medical care or treatment they provide if: (1) the physician, physician assistant, or nurse is providing medical care or treatment to a woman or infant in an emergency situation and (2) the emergency situation arises during the delivery or birth of the infant as a consequence of the care provided by a Certified Nurse Midwife who attends a planned birth outside of a hospital setting. Provides immunity for a licensed health care facility for the same. Effective October 1, 2023.

Appropriates $250,000 for 2023-24 and $250,000 for 2024-25 from the General Fund to DHHS, Division of Public Health, for expansion of the Safe Sleep North Carolina Campaign, with the goal of strengthening the adoption of infant safe sleep practices that reduce the risk of SIDS and other infant sleep-related deaths. Effective July 1, 2023.

Part V.

Enacts GS 126-8.6 to require the State Human Resources Commission to adopt rules and policies that provide that a permanent, full-time State employee may take the following paid parental leave: (1) up to eight weeks after giving birth or (2) up to four weeks after any other qualifying event (defined as when a State employee becomes a parent to a child). Allows temporary employees to take a prorated amount of paid leave. Specifies that the paid leave: (1) is available without exhaustion of the employee's sick and vacation leave and is awarded in addition to any other leave, (2) has no cash value upon termination, and (3) may not be used for calculating an employee's retirement benefits. Specifies that this provision applies to employees of State agencies, departments, and institutions, including UNC; to public school employees; and to community college employees.

Makes conforming changes to GS 126-5, GS 115C-302.1, and GS 115C-336.1.

Appropriates $10 million in recurring funds for 2023-24 and for 2024-25 from the General Fund to the Department of Public Instruction to fund paid parental leave.

Makes this Part effective July 1, 2023.

Part VI.

Appropriates $700,000 from the General Fund in recurring funds for each year of the 2023-25 fiscal biennium to DHHS to be allocated to the State Maternity Home Fund.

Retains all of the content of the 4th edition, with the following changes.

Amends Article 5A, Safe Surrender of Infants, of GS Chapter 7B, to increase the age of a safely surrendered infant from an infant who is reasonably believed to be not more than seven days old to an infant who is reasonably believed to be not more than 30 days old. Makes conforming changes throughout to account for the new infant age.   

Amends GS 48-3-203 (agency placement adoption) and GS 131D-10.1 (foster care children’s bill of rights) to provide that no agency or other State entity, as applicable, can deny or delay (1) the opportunity to become an adoptive parent or (2) the placement of a child for adoption on the basis of race, color, or national origin of the person or child involved.

Requires DHHS’s Division of Social Services (DSS) to develop and implement a policy that allows an individual who is related by blood, marriage, or adoption to a child and providing foster care, as defined under GS 131D-10.2(9), to a child in a family foster home to be reimbursed for the provision of care without having to meet the requirements for licensure under GS 131D-10.3. Defines family foster home to mean the private residence of one or more individuals who permanently reside as members of the household and who provide continuing full-time foster care for a child or children who are related to the adult members of the household by blood, marriage, or adoption. Effective six months after the act becomes law. Establishes the following maximum rates for State participation in reimbursement for unlicensed kinship foster care on a graduated scale: $351 per child per month from birth through five years of age; $371 per child per month for children 6 through 12 years of age; and $405 per child per month for children at least 13 but less than 18 years of age. Requires the State and a county participating in unlicensed kinship care to each contribute 50% of the nonfederal share of the cost of care for a child placed by a county department of social services or child-placing agency in a family foster home. Appropriates $5,766,390 from the General Fund to DSS in recurring funds for each year of the 2023-25 fiscal biennium to provide funds for the State portion of unlicensed kinship care reimbursement described above.

Amends GS 108A-49.1 (foster care and adoption assistance payment rates) to increase the maximum rates for State participation in the foster care/adoption assistance program as follows: (1) for children aged birth to five, from $514 to $702 per child per month; (2) for children aged six to 12, from $654 to $742 per child per month; and (3) for children at least 13 but less than 21 years of age, from $698 to $810 per child per month. Appropriates $10,094,364 from the General Fund to DSS in recurring funds for each year of the 2023-25 fiscal biennium to implement the foster care and adoption assistance rate increases.

Appropriates $1,725,531 from the General Fund to DSS in recurring funds for each year of the 2023-25 fiscal biennium to provide the State portion of the total cost of care to implement, with the associated county and federal shares, an increase to the administrative rate for foster care and adoption assistance. Appropriates $11.8 million from the General Fund to DSS for 2023-24 to provide additional funding to cover a loss in federal receipts from the Family First Prevention Services Act regarding congregate care for foster care. Appropriates $1.5 million from the General Fund in recurring funds for each year of the 2023-25 fiscal biennium to the North Carolina Community College System for allocation to the NC Finish Line Grants Program.

Retains the effective dates of the 4th edition, but specifies that new amendments pertaining to foster care and adoption are effective July 1, 2023.

Part VII.

Directs DHHS’s Division of Child Development and Early Education (DCDEE) to maintain the child care market rates at the 75th percentile as recommended by the 2018 Child Care Market Rate Study for children in three-, four-, and five-star-rated child care centers and homes from July 1, 2023, through September 30, 2023. Directs DCDEE to increase the child care subsidy market rates to the 75th percentile as recommended by the 2021 Child Care Market Rate Study for children in three-, four-, and five-star-rated child care centers and homes beginning October 1, 2023. Appropriates $32 million from the General Fund to DCDEE in recurring funds for the 2023-24 fiscal year and $43 million in recurring funds for the 2024-25 fiscal year to implement the above described market rate changes. States the General Assembly’s intent to use a portion of the anticipated increase in funds to the Child Care and Development Fund Block Grant to supplement funding for the child care market rate increases described above. Directs DCDEE to decouple private tuition payment rates from the subsidized child care market rates for licensed child care centers and homes. Amends Section 9C.4(c) of SL 2021-180 (pertaining to payments for the purchase of child care services for low-income children) to delete the provisions requiring that religious sponsored child care facilities be paid the lower of the one-star county rate or the rate they charge privately paying parents. Now provides that these centers can be paid either rate. Amends the rate to be paid to licensed child care centers and homes with two or more stars to delete provision requiring the lower payment of the market rate for that rated license level or the rate they charge privately paying children. Now just mandates they be paid at the market rate for that rated license level. 

Effective July 1, 2023.

 Part VIII.

Amends GS 14-208.40A (satellite-based monitoring program) as follows. Makes technical changes. Amends provisions pertaining to the findings required for a court-ordered risk assessment to be performed by the Department of Adult Correction (DAC) to: (1) only require that the court find that the offender is a sexually violent predator (was, sexually violent predator and reoffender) and (2) requires the risk assessment if the offender is a reoffender under GS 14-27.21, 14-27.22, 14-27.23, 14-27.24, 14-27.25(a), 14-27.26, 14-27.27, 14-27.28, 14-27.29, 14-27.30(a), 14-43.11, 14-43.13, 14-178(b)(1) and (b)(2), 14-190.16, 14-205.2(d), 14-205.3(b), 14-318.4(a1), or 14-318.4(a2). Makes conforming changes to remove references to DACJJ. Increases the time period for satellite-based monitoring from a period of 10 years to the life of the offender.  Increases the court’s required findings requiring a risk assessment under GS 14-208.40A(d) by requiring the court to order a risk assessment if the offender is a reoffender under GS 14-27.31, 14-27.32, 14-27.33, 14-178(b)(3), 14-190.6, 14-190.9(a1), 14-190.17, 14-190.17A, 14-202.1, 14-202.3, 14-202.4(a), or 14-205.2(c), in addition to other listed required findings. Provides that for offenders committing offenses involving minors that require the highest possible level of supervision and monitoring, the court must order the offender to enroll in a satellite-based monitoring program for a period not to exceed 50 (was, 10) years. Effective October 1, 2023, and applies to court orders for enrollment in satellite-based monitoring programs issued on or after that date.

Amends GS 14-33(c) to include as a Class A1 misdemeanor if, in the course of the assault, assault and battery, or affray, a person commits assault of a pregnant woman, unless the conduct is covered under some other provision of law providing greater punishment. Effective December 1, 2023, and applies to offenses committed on or after that date.

Enacts new GS 14-32.5, establishing a misdemeanor crime of domestic violence, making it a Class A1 misdemeanor if a person uses or attempts to use physical force, or threatens the use of a deadly weapon, against another person and the person who commits the offense is: (1) a current or former spouse, parent, or guardian of the victim; (2) a person with whom the victim shares a child in common; (3) a person who is cohabitating with or has cohabitated with the victim as a spouse, parent, or guardian; (4) a person similarly situated to a spouse, parent, or guardian of the victim; or (5) a person who has a current or recent former dating relationship with the victim. Defines dating relationship by the definition set forth in 18 U.S.C. § 921 (a relationship between individuals who have or have recently had a continuing serious relationship of a romantic or intimate nature).

Amends G.S. 14-415.12(b)(8a) to require that the sheriff deny a concealed handgun permit to persons adjudicated guilty or who received a prayer for judgment continued or suspended sentence for GS 14-32.5 in addition to other listed crimes.

Part IX.

Specifies that the provisions of GS 143C-5-2 (pertaining to the order of appropriations bills) do not apply to the act.

Part X.

Specifies that nothing in the act should be construed as creating or recognizing a right to abortion, nor can the act make lawful an abortion that is otherwise unlawful.

Part XI.

Authorizes the Revisor of Statutes to alphabetize, number, and renumber the definitions listed in GS 90-21.120 and GS 90-21.81, as amended by the act, to ensure that all of the definitions are listed in alphabetical order and numbered accordingly.

Part XII.

Contains a severability clause.

Part XIII.

Provides that the act is effective when it becomes law unless otherwise provided.