Senate committee substitute to the 1st edition makes the following changes.

Eliminates previous Part I, which required the Department of Health and Human Services, Division of Health Benefits (Division), to amend the North Carolina Innovations waiver to increase the number of slots available under the waiver by a maximum of 1,000 slots to be made available on January 1, 2020, and by a maximum of 1,000 slots to be made available on January 1, 2021. Eliminates the companion appropriation. Makes conforming organizational changes to the act.

Eliminates the proposed repeal of GS Chapter 131E, Article 9 (Certificate of Need) and accompanying conforming changes to GS 6-19.1, GS 113A-12, GS 122C-23.1, GS 131E-13, GS 131E-136, GS 148-19.1, GS 130A-45.02, GS 150B-2, and GS 150B-21.1; conforming repeal of GS 143B-1292; and conforming changes to GS 58-50-61 and GS 58-55-35. Instead provides the following.

Amends GS 131E-176, which sets outs defined terms applicable to Article 9, Certificate of Need. Amends bed capacity to specify space used exclusively for inpatient care at a health care facility. Modifies terms throughout to remove reference to "psychiatric facilities," "kidney disease treatment centers," "intermediate care facilities for the mentally retarded," "chemical dependency treatment facilities," "diagnostic facilities," and "ambulatory surgical facilities." Amends health service facility to exclude a licensable facility as defined in GS 122C-3(14)b. Changes the terminology to "intermediate care facility for individuals with intellectual disabilities" (was, mentally retarded). Makes further technical, clarifying, and conforming changes.

Amends GS 131E-177 to prohibit the Department of Health and Human Services (DHHS) from including policies or need determinations that limit the number of operating rooms in gastrointestinal endoscopy rooms in developing a State Medical Facilities Plan. Makes further technical and clarifying changes.

Makes conforming changes to GS 131E-178, GS 131E-183, GS 131E-184, and GS 131E-186 to eliminate requirements related to certificates of need and review for ambulatory surgical facilities, psychiatric facilities, and nursing care or intermediate care facilities for the mentally retarded.

Amends GS 131E-181 to require certificate of need recipients to complete the project authorized by the certificate of need within two years after the decision to issue the certificate of need becomes final. Deems the certificate expired the day after the two-year time period if the project authorized is not completed. Directs DHHS to withdraw a certificate of need issued to any recipient that ceases operating the health service or health service facility included in that certificate of need for more than one year.

Further amends GS 131E-184 regarding exemptions from certificate of need review. Adds new subsection (i) to require DHHS to exempt from certificate of need review the development, acquisition, construction, expansion, or replacement of a health service facility or health service that obtained certificate of need approval prior to October 1, 2019, as: an ambulatory surgical facility, including an ambulatory surgical facility with one or more operating rooms or gastrointestinal endoscopy procedure rooms; a diagnostic center; kidney disease treatment center, including freestanding dialysis units; chemical dependency treatment facility; intermediate care for individuals with intellectual disabilities; psychiatric hospital; or any other licensable facility, as defined. 

Adds new subsection (j) to require DHHS to exempt from certificate of need review the establishment of a home health agency by a licensed continuing care retirement community to provide home health care services to one or more residents of the retirement community who have entered into a contract with the retirement community to receive continuing care services with lodging. Requires the continuing care retirement community to obtain a certificate of need if developing or offering services to any individual not a resident of the retirement community under a contract to receive continuing care services with lodging. Explicitly does not exempt from the State's home health agency licensure and certification requirements a continuing care retirement community that has been exempted from certificate of need review for the provision of home health services to one or more residents pursuant to new subsection (j). Provides that new subsection (j) applies to continuing care retirement communities engaged in the direct provision of home health services on or after October 1, 2019.

Amends GS 131E-188, concerning administrative and judicial review. Removes reference to the term 'affected person.' Instead entitles any proponent of an application that was reviewed with the application for the certificate of need to a contested case hearing. Authorizes the Court of Appeals to award all costs for judicial review to the prevailing party, as described. Increases the maximum secured bond required to be deposited by the appellant with the Clerk of the Court of Appeals for appeals of a final decision granting a certificate of need, allowing up to $500,000 rather than $300,000 in the court's discretion.

Amends GS 131E-147 regarding ambulatory surgical facility licensure requirements, to prohibit DHHS from issuing or renewing a license to operate an ambulatory surgical facility developed, acquired, or replaced on or after October 1, 2019, unless the application meets four criteria. Requires: (1) a commitment that the Medicare allowable amount for self-pay and Medicaid surgical cases, minus collected revenue, will be at least 4% of the total revenue collected for all surgical cases performed; (2) a commitment to report case numbers in specified payer categories; and (3) a commitment to report utilization and payment data for services provided to the statewide processor, as specified.

Makes conforming repeals in GS 131E-175 (legislative findings).

Effective October 1, 2019.

Maintains the recodification of Article 18A (Psychology Practice Act) of GS Chapter 90 as Article 18G, and enactment of  Article 18H, Psychology Interjurisdictional Licensure Compact, in GS Chapter 90.

Enacts GS 90-270.54(a1) to require the NC Marriage and Family Therapy Licensure Board to issue licenses for marriage and family therapists to conduct involuntary commitment first examinations if they meet the specified licensure requirements and pay a $10 fee. Amends GS 90-270.57 to establish the $10 fee. Applies to applications submitted on or after October 1, 2019.

Eliminates all provisions of the previous Part V, amending GS 131E-138, which created an exemption from home care agency licensure requirements when home care services are provided to participants of the Program for All-Inclusive Care for the Elderly through an organization that has a valid program agreement with the Centers for Medicare and Medicaid Services and the Divisions of Health Benefits of the Department of Health and Human Services. Eliminates all accompanying proposed changes to GS Chapter 131D.