House committee substitute replaces the 2nd edition in its entirety with the following. Makes conforming changes to the act’s long and short titles.

Part I.

Enacts GS 20-7(q3) requiring the Division of Motor Vehicles (DMV) to develop, in consultation with specified entities, a drivers license designation that can be granted to a person with autism spectrum disorder, as defined by statutory cross-reference, upon request. Establishes eight criteria and requirements applicable to the designation, including (1) entering the designation into the electronic record associated with the person's license, (2) the requesting individual providing verification or documentation substantiating the diagnosis, as specified, (3) limiting use of the information collected for mutually safe interactions with law enforcement, and (4) developing a process for voluntary removal of the designation.

Amends GS 17C-6, concerning the Criminal Justice Education and Training Standards Commission, and GS 17E-4, concerning the Sheriffs' Education and Training Standards Commission, adding the following to the Commissions' powers regarding establishing minimum educational and training standards for employment and continuing education for criminal justice officers and officers, respectively. Now requires the minimum educational and training standards to include recognition and appropriate interaction with persons with autism spectrum disorder, and drivers license and vehicle registration identifiers of persons with autism spectrum disorder, including that the identifiers are optional. 

Applies to drivers licenses issued on or after January 1, 2026.

Part II.

Enacts GS 105-153.8A, directing that income tax forms must include a section allowing resident taxpayers to elect to become an organ donor pursuant to state law. Details requirements of the section, including title, checkbox options, explanations of the authorization and that the authorization is not required, and a description of the process for amending or revoking an election. Authorizes the Secretary of Revenue to request information from the resident taxpayer or spouse to facilitate their election.

Amends GS 105-259(b), authorizing the disclosure of tax information by State officers, employees, and agents in order to: (1) furnish the Division of Motor Vehicles (DMV) with the information of an individual who has elected to become an organ and tissue donor under new GS 105-153.8A for the purpose of making an anatomical gift pursuant to state law and (2) to furnish any organ procurement organization and any organization  responsible for maintaining a list of individuals who have authorized an anatomical gift with the information of an individual who has elected to become an organ and tissue donor under GS 105-153.8A for purposes of making an anatomical gift in accordance with State law.

Amends GS 130A-412.7 (Manner of making anatomical gift before donor's death) to add new subparagraph (a)(1a) referencing the income tax return donor option. Also adds new subsection (c3), providing that a donor election made through an income tax return remains valid until the donor revokes the consent in the manner provided under GS 130A-412.8.

Amends GS 20-43.2, relating to internet access of organ donation records by organ procurement organizations, to allow personally identifiable information on a donor registry about a donor or prospective donor without express consent of the donor, prospective donor, or person that made the anatomical gift in order to determine the statistical and demographic makeup of individuals who have and have not authorized an anatomical gift so organ procurement organizations can advocate for donation.

Directs the Department of Revenue (DOR) and the Division of Motor Vehicles to coordinate to continuously update the Organ Donor Registry and for any other purposes needed to fulfill the purposes of the act.

Effective and applicable for tax returns filed during taxable years beginning on or after January 1, 2027.

Requires DOR, by January 1, 2027, to adopt rules to implement and administer this Part.

Part III.

Amends Chapter 130A adding Article 19C regarding Di(2-ethylhexyl) phthalate (DEHP) Hazard Management.

Sets out 12 NCGA findings about DEHP and other ortho-phthalates that are toxic chemicals, DEHP’s common use in medical devices, and the potential harms of DEHP leaching and exposure to humans.

Contains seven definitions including DEHP, health care practitioner, intentionally added DEHP, unintentionally added DEHP, intravenous solution container, intravenous tubing, and ortho-phthalate. Defines intentionally added DEHP as DEHP that a manufacturer intentionally added to a product that has a functional or technical effect on the product. Defines intravenous solution container as a container used to house medicine, fluid, or nutrition therapy that is intravenously delivered to a patient in a hospital, outpatient facility, or other healthcare facility. Defines intravenous tubing as tubing used to intravenously administer fluids, medication, or nutrients directly to an adult, child, or infant. Defines ortho-phthalate using a list of chemical classes.

Prohibits any person or entity from manufacturing, selling, or distributing into commerce in the state: (1) intravenous solution containers made with intentionally added DEHP, beginning January 1, 2030; and (2) intravenous tubing made with intentionally added DEHP, beginning January 1, 2035. Prohibits a person from replacing DEHP with another ortho-phthalate in a new or revised medical device. Mandates that an intravenous solution container or intravenous tubing product cannot have unintentionally added DEHP present in a quantity at or above 0.1 percent weight per weight.

Provides exemptions from these provisions for human blood collection and storage bags and apheresis and cell therapy blood kits and bags, including integral tubing.

Provides that a person or entity, due to pending USFDA approval for the DEHP-free intravenous solution container or due to the manufacturer not having adequate equipment to manufacture the DEHP-free intravenous solution container, must meet the requirements of the statute concerning the solution containers by January 1, 2032, if: (1) they notified their NC customers, no later than October 1, 2025, that it commenced development of the DEHP-free intravenous solution container to meet the statute's requirements and (2) it provides notice to its customers and posts to its website, by January 1, 2028, that it will not meet the January 1, 2030 deadline.

Makes conforming changes to GS 130A-22(b3) and adds a penalty cap of $5,000 per day a violation of Article 19C continues.

Part IV.

Amends GS 115C-375.2 by amending the provision governing the policies adopted by local boards of education regulating when a student with asthma or subject to anaphylactic reactions can possess and self-administer asthma medication to define asthma medication to include epinephrine delivery systems, no longer limiting it to epinephrine auto injectors. Modifies the emergency action plan required under GS 115C-375.2A by requiring the school to contact the student’s guardian if applicable (current law requires school to only contact the student’s parent or physician). Makes conforming changes to refer to the use of "epinephrine delivery systems" instead of "epinephrine auto injectors" in GS 115C-375.2A (concerning school supply of epinephrine delivery systems), GS 115C-218.75 (concerning health and safety standards for charter schools), GS 115C-238.66 (concerning the supply of epinephrine delivery systems in regional schools), and GS 116-239.8 (UNC laboratory schools). Also amends GS 115C-375.2A to provide that "epinephrine delivery system" includes nasal sprays and injectors with a spring-activated concealed needle. Applies beginning with the 2025-26 school year.

Modifies the immunity for emergency treatment using epinephrine under GS 90-21.15A so that it encompasses epinephrine delivery systems (currently, limited to epinephrine auto injectors), which it defines as a disposable drug delivery system that is designed for emergency administration of epinephrine to provide rapid, convenient first aid for persons suffering a potentially fatal reaction to anaphylaxis, including nasal sprays and injectors with a spring-activated, concealed needle. Makes conforming changes throughout the statute.

Part V.

Requires, in GS 115C-315, the State Board of Education (Board) to adopt rules (currently, may adopt rules) concerning the qualifications and training required to be a school nurse, subject to the following new requirement: (1) the Board must require that a school nurse be a registered nurse under GS Chapter 90, Article 9A and who has at least two years of experience serving in a hospital or health clinic be paid under the certified school nurse pay scale established by the Board. Makes technical changes.  

Part VI.

Requires the Department of Health and Human Services, Division of Health Benefits (DHB), in consultation with stakeholders, to submit a request meeting the following goals to the Centers for Medicare and Medical Services (CMS) that: (1) provides Medicaid coverage of personal care services to residents in licensed adult care homes and special care units whose income exceeds the State-County Special Assistance Program limits, but does not exceed either 180% of the federal poverty level (for those who would otherwise qualify for State-County Special Assistance at the basic rate) or 200% of the federal poverty level (for those who would otherwise qualify for State-County Special Assistance at the enhanced rate); (2) ensures cost of any new Medicaid coverage requested is offset by savings or cost avoidance; and (3) ensures compliance with applicable legal requirements. Requires DHB to take any necessary actions to implement this act and submit the request to CMS within 90 days of the act becoming law.

Provides that DHB can only implement Medicaid coverage described in the request if it is approved by CMS and it meets all of the goals described above.

Part VII.

Effective when the act becomes law, except as otherwise provided.