Senate committee substitute to the 2nd edition makes the following changes.  Makes conforming changes to the act’s long title and effective date.  Makes organizational changes.

Section 2 (was, Section 1).

Modifies the definition of online entity operator so that it now means a provider for an online entity that qualifies as a sexually oriented business or which is subject to GS 66-501 because it publishes or distributes material on a website that contains a substantial portion of material harmful to minors (was, just provider for online entity).

Adds the following new content.

Adds whereas clauses.

Section 1.

Enacts GS 12-3.3 (official recognition of two sexes in all administrative rules, regulations, or public policies adopted by the State or its political subdivisions) defining ten terms that must apply to all administrative rules, regulations, or public policies adopted by the State of North Carolina or its political subdivisions, including biological sex, male, and female. Effective January 1, 2026.

Section 3.

Expands GS 143C-6-5.6’s bar on the use of State funds for gender transition procedures to apply to the performance of or in furtherance of surgical gender transition procedures, or providing puberty-blocking drugs or cross-sex hormones to any prisoner incarcerated in the State prison system or the Statewide Misdemeanor Confinement Program or otherwise in the custody of the Department of Adult Correction, as specified or to support the administration of any governmental health plan or insurance policy offering these services. Clarifies that the statute does not prevent State funds from being used to address medical complications resulting in imminent physical harm, including the treatment of any infection, injury, disease, or disorder that has been caused by or exacerbated by a previously performed or privately funded gender transition procedure. Specifies that the above does not apply to the State Health Plan for Teachers and State Employees. Directs that GS 143C-6-5.6(c) (preventing the act’s bar on State funds to provide the described gender transition procedures and medications to minors and the prisoners described above from applying to the State Health Plan) expires 30 days after the Memorandum and Order, dated June 10, 2022, or the permanent injunction ordered in Kadel v. Folwell, 1:19CV272 is vacated, overturned, or is no longer in force. Directs the State Health Plan to notify the Revisor of Statutes if the order or injunction is vacated, overturned, or no longer in force.

Enacts Article 1O to GS Chapter 90, entitled Gender Transition Procedures on Non-Minors. Enacts GS 90-21.175 providing that unless an action is brought pursuant to GS 90-21.154, that a cause of action for malpractice under GS 1-15 arising out of the performance of or failure to perform services while in the course of facilitating or perpetuating gender transition must be commenced within 10 years from the time of discovery by the injured party of both the injury and the causal relationship between the treatment and the injury against the offending medical professional or entity. Prevents a medical professional or entity from seeking a waiver of liability. Exempts claims under GS 90-21.175 from the caps on noneconomic damages in GS 90-21.9. Applies to causes of action accruing before, on, or after the act becomes law. Revives any cause of action arising out of the performance of or failure to perform services while in the course of facilitating or perpetuating gender transition otherwise time-barred whether or not such cause of action has been asserted in a pending civil action or appeal.

Expands the powers and duties of local boards of education under GS 115C-47 to include (1) adopting a policy allowing a student or the student's parent or guardian to request that the student be excused from specific classroom discussions, activities, or assigned readings that the student, parent, or guardian believes would (i) impose a substantial burden on the student's religious beliefs or (ii) invade the student's privacy by calling attention to the student's religion and (2) to adopt policies related to library books consistent with new GS 115C-98.1, discussed below.

Enacts GS 115C-98.1 requiring local boards of education to adopt the following policies concerning library books (defined): (1) that provide ongoing public access through a searchable web-based catalog to the titles of any library books available at each school within the local school  administrative unit, including displaying the catalog on its website and (2) that allow a parent or guardian of a student to identify any library books that may not be borrowed by the student.  Applies beginning with the 2025-2026 school year.

Section 4.

Requires the State Registrar to attach the new certificate to the certificate of birth then on file and to preserve both certificates as a multi-page document when the sex of a person is changed on an amended or new birth certificate issued under GS 130A-118. Provides for attachment of the new certificate by the register of deeds as described. Requires the State Registrar to adopt rules and policies to implement these changes.

Section 4.1.

Contains severability clause.