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

Deletes whereas clauses.

Part I.

Makes the repeal of Section 3, SL 2013-5, which bars the State from expanding the State's Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act, PL 111-148, effective on the date the act becomes law rather than January 1, 2024.

Makes proposed GS 108A-54.3A(24), requiring the Department of Health and Human Services (DHHS) to provide Medicaid coverage to individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, previously effective on January 1, 2024, now effective on the later of: (1) the date approved by the Centers for Medicare and Medicaid Services (CMS) for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act; or (2) the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law. Adds to the criteria for Medicaid coverage under new subsection (24) that individuals must be in compliance with any work requirements established in the State Health Plan and in rule.

Eliminates the directive requiring DHHS to establish preventive care and wellness incentives for individuals eligible for Medicaid coverage under the provisions described in amended GS 108A-54.3A, and encouraging prepaid health plans to offer preventive care and wellness incentives to their enrollees.

Eliminates the requirement for DHHS and all county departments of social services to begin accepting applications from, and enrolling if permissible, individuals who will be eligible for coverage under amended GS 108A-54.3A as soon as practicable but no later than December 1, 2023.

Directs the DHHS Secretary to notify the specified NCGA division and the Revisor of Statutes of the date approved by CMS for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. 

Revises new GS 108A-54.3B and GS 108A-54.3C by correcting a NCGA committee name. Changes the effective date of the new statutes from January 1, 2024, to mirror the effective date of new GS GS 108A-54.3A(24), being the later of: (1) the date approved by the Centers for Medicare and Medicaid Services (CMS) for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act; or (2) the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law. Adds to the criteria for Medicaid coverage under new subsection (24) that individuals must be in compliance with any work requirements established in the State Health Plan and in rule.

Makes the establishment of the ARPA Temporary Savings Fund effective on the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law (was effective on the date the act becomes law).

Regarding the hospital assessment to be imposed by DHHS for the fiscal quarter beginning October 1, 2023, now requires DHHS to use $4 million to provide funding to county departments of social services to support their implementation of Section 1.1 of the act, which enacts new GS 108A-54.3A(24) (previously called for the funds to be provided to county departments to support their preparing for implementation of Section 1.1). Regarding required reporting on the assessment proceeds, corrects the name of a legislative committee. Makes the provisions effective on the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law (was effective on the date the act becomes law). Sets a sunset of September 30, 2023, in the event no Current Operations Appropriations Act for 2023-24 has become law by that date.

Revises new Part 3, Health Advancement Assessments, in Article 7B of GS Chapter 108A, as follows. Makes the provisions effective on the first day of the next assessment quarter after the act becomes law, rather than January 1, 2024.

Amends GS 108A-147.5, which previously set the presumptive service cost component used in formulating the aggregate health advancement assessment collection amount, for the fiscal quarters beginning January 1, 2024, and each quarter beginning on or after April 1, 2024. Now sets the presumptive cost service component for (1) every quarter prior to the quarter in which new GS 108A-54.3A(24) becomes effective, setting the component at zero; (2) the quarter in which GS 108A-54.3A(24) becomes effective, setting the component at the product of $48.75 million multiplied by the number of months in the quarter in which new GS 108A-54.3A(24) is effective in any part of the month; and (3) the first quarter after the quarter in which new GS 108A-54.3A(24) becomes effective, setting the component at $146.25 million (previously the set amount for the quarter beginning January 1, 2024). Makes the greater of amounts previously set out to determine the component for every quarter beginning on or after April 1, 2024, now applicable to determine the component for the second quarter following the quarter in which new GS 108A-54.3A(24) becomes effective and every quarter thereafter.

Amends GS 108A-147.7, which sets amounts for the State and county administration subcomponents that makeup the administration component used in formulating the aggregate health advancement assessment collection amount. For the State administration subcomponent, sets the amount for (1) every quarter in the 2022-23 and 2023-24 fiscal years at the product of $1.1 million multiplied by the number of months in the quarter in which new GS 108A-54.3A(24) is effective in any part of the month; (2) every quarter in 2024-25 at $3.3 million increased by the Consumer Price Index (CPI); and (3) every subsequent quarter increased over the prior year's quarterly amount by the CPI (previously, set at $3.3 million for quarters in 2023-24 with subsequent CPI increases thereafter). For the county administration component, sets the amount for (1) every quarter in the 2022-23 and 2023-24 fiscal years at $1.667 million multiplied by the number of months in the quarter in which new GS 108A-54.3A(24) is effective in any part of the month; (2) every quarter in 2024-25 at $7.4 million; (3) every quarter of 2025-26 at $7.8 million; and (4) every subsequent quarter increased over the prior year's quarterly amount by the CPI (previously, set at $5 million for each quarter of 2023-24, with the remainder of the schedule the same).

Amends GS 108A-147.8, which sets the amount of the State retention component used in formulating the aggregate health advancement assessment collection amount. Sets the component for every fiscal quarter prior to the quarter in which new GS 108A-54.3A(24) becomes effective, at zero, and for the quarter in which new GS 108A-54.3A(24) becomes effective and every quarter thereafter at $10.75 million (was a flat amount at $10.75 million for each assessment quarter).

Amends GS 108A-147.12 to set the gross premiums offset amount at zero for 2022-23 and 2023-24 (was zero for 2023-24 and 2024-25). Requires using the previously described formulas for determining the offset for the first and second, third and fourth quarters in 2024-25 and each year thereafter (was used for 2025-26 and each year thereafter). 

Amends new GS 108A-147.7 by increasing the amount of the State administration subcomponent for each quarter of the 2023-24 and 2024-25 fiscal years as specified. Now effective upon the later of: (1) the first day of the next assessment quarter after the CMS approves the initial 42 C.F.R. § 438.6(c) preprint requesting approval of the healthcare access and stabilization program (HASP) submitted in accordance with GS 108A-148.1 or (2) the first day of the next assessment quarter after the act becomes law (rather than January 1, 2024).

Makes new GS 143C-9-10, establishing the Health Advancement Receipts Special Fund, effective on the first day of the next assessment quarter after the act becomes law, rather than January 1, 2024.

Revises Part 2, Modernized Hospital Assessments, of Article 7B, as follows.

Amends GS 108A-146.12, which sets out the postpartum coverage component used in the calculation of the aggregate modernized assessment collection amount. Specifies that the amount set for each quarter of 2022-23 is for quarters prior to the quarter in which new GS 108A-53.4A(24) becomes effective. Reduces the component for each quarter in 2022-23 in which new GS 108A-53.4A(24) becomes or is effective to $4.5 million. Sets the component for each quarter of 2023-24 prior to new GS 108A-53.4A(24) being effective at $11,004,424, and each quarter of 2023-24 in which new GS 108A-53.4A(24) is or becomes effective at $4.5 million (previously provided amounts for the first and second, and then third and fourth quarters of 2023-24). Makes a technical change. Effective on the first day of the next assessment quarter after the date the Current Operations Appropriations Act for 2023-24 becomes law and applies to assessment imposed on or after that date (was, January 1, 2024).

Amends GS 105-523(b)(2), defining the hold harmless threshold for counties with repealed local taxes, to specify that a county's Medicaid service costs do not include any costs for newly eligible individuals defined by GS 108A-145.3. Effective on the date the Current Operations Appropriations Act for 2023-24 becomes law.

Makes the amendments to Section 2.1, SL 2021-61, and GS 108D-65(6), and the proposed repeal of Sections 9D.13A(e) and 9D.14, SL 2021-180, regarding assessment amounts, effective on the date the Current Operations Act for 2023-24 becomes law (was, January 1, 2024).

Eliminates the $50 million appropriation for 2023-24 from the General Fund to the Division of Health Benefits (DHB) to be distributed to all counties for the administrative costs of Medicaid eligibility determinations and for inmate medical costs.

Adds the following new content to Part I, effective on the date the Current Appropriations Act for 2023-24 becomes law.

Authorizes DHHS to use the federally facilitated marketplace to make Medicaid eligibility determinations on a temporary basis up to 12 months after the date approved by CMS for Medicaid coverage to begin in NC for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. Requires compliance with all eligibility categories, resource limits, and income thresholds legislatively set. Authorizes DHHS to make any necessary request or enter into agreement with the federally facilitated marketplace. Expires 12 months after the date approved by CMS for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act.

Amends GS 108A-25 to require county departments to accept Medicaid eligibility determinations made by the federally facilitated marketplace if legislative authorization has been given and upon direction of the DHHS Secretary.

Enacts GS 108A-25.1A(b1) to make county departments not financially liable for the erroneous issuance of Medicaid benefits and Medicaid claims payments resulting from a failure or error attributable solely to the federally facilitated marketplace. 

Amends GS 108A-70.36, which sets the scope of Part 10, Medicaid Eligibility Decision Processing Timelines, Article 2, making the Part's provisions not apply to any eligibility determinations made by the federally facilitated marketplace that have been legislatively authorized. 

Amends GS 108A-55.3 to require applicants for medical assistance benefits show only one rather than two of the listed documents to prove residency. Makes technical changes.

New Part IA. lists sections of the act that expire on June 30, 2024, if no Current Operations Appropriations Act for 2023-24 has become law by that date: Section 1.4 (enacting Part 4, Article 7B, GS Chapter 108A); Section 1.6(a), (f), and (g) (amending GS 108A-145.3, effective and implementing provisions); and Section 1.7(a) through (j) and (q) (amending various GS Chapter 108A sections and effective provisions). 

Part II.

Regarding the directive for DHHS to develop a workforce development program in collaboration with named entities, requires collaboration with the NC Chamber (was Chamber of Commerce). Concerning required reporting on the plan and workforce development assistance, corrects a NCGA committee name. Makes technical changes.

Allows for the notice required of DHB to Medicaid applicants and certain recipients about the Health Insurance Marketplace and contact information for the NC Navigators Consortium to be electronic. Regarding required reporting, corrects an NCGA committee name.

Corrects the NCGA committee name regarding required reporting by DHB when entering into negotiations with CMS relating to work requirement planning.

Eliminates all previous sections establishing and pertaining to the Doctors and Nurses in Rural Areas Forgivable Loan Pilot Program.

Makes the remaining sections of Part II. of the act effective on the date the Current Operations Appropriations Act for 2023-24 becomes law. Sunsets the provisions on June 30, 2024, if no Current Operations Appropriations Act for 2023-24 has become law by that date (was the later of July 1, 2023, or the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law).

Enacts the following new content.

Part III.

Section 3.1, effective on the date the act becomes law and applies to activities occurring on or after that date, provides as follows.

Revises defined terms applicable to certificates of need (CON) laws in Article 9, set forth in GS 131E-176, as follows. Changes the threshold criteria for diagnostic center to include a facility, program, or provider in which the total cost of all medical diagnostic equipment used by the facility which costs more than $10,000 or more exceeds $3 million (currently, the cost threshold is set at $1.5 million). Removes psychiatric facilities and chemical dependency treatment facilities from the definition of health service facility; makes conforming deletions from the term health service facility bed. Changes the threshold criteria for replacement equipment to include equipment that costs less than $3 million (was $2 million) as described; requires annually adjusting the threshold beginning September 30, 2023 using the Medical Care Index of the CPI as specified. 

Amends GS 131E-184 by exempting from certificate of need review a new institutional health service if it receives prior written notice from the proposing entity to allow a licensed home care agency to provide early and periodic Screening, Diagnosis, and Treatment services to children up to 21 years of age in compliance with federal Medicaid requirements; applicable to all licensed child care agencies whether or not Medicare-certified. Repeals subsections (c) and (d) of the statute, relating to CON review exemptions for certain psychiatric beds or chemical dependency or substance abuse service facilities, now excluded from the definition of hospital service facility and beds. Replaces the set threshold amounts referenced in subsections (e), (f), and (g), to instead refer to "monetary" thresholds relating to capital expenditures and replacement equipment costs.

Makes conforming changes to GS 148-19.1 to eliminate the CON exemption for chemical dependency or substance abuse service facilities for inmates and offenders.

Establishes that no person is required to obtain a CON under Article 9, GS Chapter 131E prior to converting health service facility beds that obtained a CON prior to the date the act becomes law into chemical dependency treatment facility beds or psychiatric beds; or increasing the number of health service facility beds that obtained CON approval prior to the date the act becomes law as chemical dependency treatment facility beds or psychiatric beds.

Section 3.2 provides the following, effective two years from the date DHHS issues the first directed payment under HASP pursuant to GS 108A-148.1, and applies to activities occurring on or after that date. Directs the DHHS Secretary to notify the Revisor upon issuance of the first directed payment under HASP and the date of issuance. Sunsets the provisions on June 30, 2025, if DHHS has not made any HASP payments by that date.

Further amends GS 131E-176 to define qualified urban ambulatory surgical facility as a licensed facility that has a single specialty or multispecialty ambulatory surgical program and is located in a county with a population greater than 125,000. Excludes qualified urban ambulatory surgical facilities from health service facility. Also excludes qualified urban ambulatory surgical facilities as a new institutional health service otherwise meeting the threshold criteria in subdivision b. Revises the definition of special ambulatory surgical program.

Adds qualified urban ambulatory surgical facility to the defined terms in Part 4, Article 5, GS Chapter 131E, Ambulatory Surgical Facility Licensure. Defines the term by statutory cross-reference. 

Enacts GS 131E-147.5 to require at least 4% of every qualified urban ambulatory surgical facility's total earned revenue to be attributed to self-pay and Medicaid revenue. Provides for calculation. Requires annual reporting to DHHS the percentage of the facility's earned revenue that is attributed to self-pay and Medicaid revenue. 

Section 3.3 provide the following, effective three years from the date DHHS issues the first directed payment under HASP pursuant to GS 108A-148.1, and applies to activities occurring on or after that date. Directs the DHHS Secretary to notify the Revisor upon issuance of the first directed payment under HASP and the date of issuance. Sunsets the provisions on June 30, 2025, if DHHS has not made any HASP payments by that date.

Further amends GS 131E-176 to provide that no facility, program, or provider can be deemed a diagnostic center solely by virtue of having a magnetic resonance imaging scanner in a county with a population greater than 125,000, including but not limited to physicians' offices, clinical labs, radiology centers, or mobile diagnostic programs. Also provides that magnetic resonance imaging scanners in counties with a population greater than 125,000 are not major medical equipment. Limits the scope of including the acquisition of magnetic resonance imaging scanners as new institutional health services to only those scanners acquired in counties with a population of 125,000 or less.

Includes a severability clause. 

Changes the act's catchall effective date provision to the date the act becomes law (was, the date that the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law). Eliminates the provision that provided that if by December 31, 2023, no Current Operations Appropriations Act for the 2023-24 fiscal year has become law, then the act expires.

Changes bill headings throughout.