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

Adds whereas clauses.

Amends what must be include in the report on the study on relevant statues, judicial and clinical practices, and available technological resources to identify areas of systemic improvement in the State’s involuntary commitment (IVC) process as follows: (1) no longer includes establishing a foundation for more effective legal and clinical outcomes for the specified items; (2) adds any necessary statutory changes to increase data sharing between the Department of Health and Human Services (DHHS) and the eCourts system on IVC exams and court proceedings; and (3) adds the feasibility and potential benefits of giving law enforcement access to IVC court records to better inform law enforcement procedures and operations.

Adds the following new content.

Section 2

Requires DHHS and the North Carolina Sheriff’s Association to develop a plan for using telehealth to complete the first examinations of individuals in county jails. Requires that the plan include at least the five listed components, including: (1) a recommended model for jail-based telehealth services; (2) funding amount necessary to support providing telehealth services in all county jails; and (3) a timeline for the statewide implementation of the telehealth service plan. Requires a report on the plan to the specified NCGA committee and division by October 1, 2026.

Section 3

Requires the Local Management Entities/Managed Care Organizations (LME/MCOs) and DHHS to develop a plan for using mobile crisis units to enhance efficiency of the IVC process. Requires that the plan include the four listed components, including: (1) developing a statewide coverage model using in-person clinicians or on-call licensed clinicians in mobile crisis units to complete the first exam for IVC; and (2) an analysis of funding needed to implement the plan. Requires a report on the plant to the specified NCGA committee and division by October 1, 2026.

Section 4

Requires DHHS to evaluate the standard training program for IVC examiners for necessary improvements and to incorporate additional training into the standardized training program for providers conducing first exams of individuals in county jails. Requires a report to the specified NCGA committee and division by December 1, 2026.

Section 5

Requires DHHS to develop a plan to address: (1) the ongoing shortage of staffed and available behavioral health beds in State-Operated Facilities for individuals in crisis, (2) the staffing deficiencies that limit the use of existing behavioral health bed capacity, (3) potential use of non-state-operated entities or facilities to provide staffing for or leasing to state-operated facilities, and (4) contracting for behavioral health beds or staffing as supplementary or alternative to state-operated or staffed beds. Requires that the plan include the five listed components, including: (1) evaluation of current staffing models, hiring and recruitment practices, employee retention strategies, and the use of incentive pools; (2) any grant opportunities and other funding mechanisms to support behavioral health bed capacity; and (3) an assessment of opportunities to utilize non-governmental facilities or entities. Requires a report to the specified NCGA committee and division by December 1, 2026.

Section 6

Requires the North Carolina Collaboratory (Collaboratory) to study how outpatient commitment may be more effectively used and implemented. Requires the study to include the four listed components including: (1) an examination of barriers that limit the use or effectiveness of outpatient commitment, including the availability of outpatient commitment services statewide; and (2) an assessment of mechanisms currently available to track adherence and monitor compliance, along with proposed methods to strengthen and enhance tracking and monitoring processes. Requires a report to the specified NCGA committee by December 1, 2026.

Section 7

Requires DHHS to consult with the Sheriffs' Association in providing law enforcement access to BH SCAN. Requires a report to the specified NCGA committee when the access is complete. Effective August 1, 2026.

Requires DHHS to (1) develop and implement real-time data availability within BH SCAN, (2) ensure that BH SCAN provides timely, accurate, and continuously updated information on available behavioral health beds to authorized users, and (3) develop and implement functionality within BH SCAN that allows authorized users to reserve an available behavioral health bed in real time. Effective August 1, 2027.

Section 8

Requires the Collaboratory to study the differing legal standards governing IVC and incapacity to proceed to identify statutory revisions that would enhance each system's effectiveness and advance public safety. Requires the study to include recommendations for statutory changes to address inconsistent terminology and clarify procedures for the transition of individuals between systems. Requires a report on the study to the specified NCGA committee by December 1, 2026.

Section 9

Requires DHHS to create a working group of representatives from the Administrative Office of the Courts (AOC), and other stakeholders, to examine the systemic factors contributing to the "revolving door" pattern where individuals cycle repeatedly through arrest, detention, or IVC, to then be released back into the community without sustained stabilization or support. Sets out the purpose of the group as identifying gaps, evaluating current practices, and recommending strategies to interrupt repeated crises and reduce avoidable recidivism. Requires quarterly reports, beginning January 1, 2027, on the working group’s findings and recommendations to the specified NCGA committee and division.

Section 10

Requires the Department of Adult Correction (DAC) and the North Carolina Sheriffs' Association to study providing medical and behavioral health care in county jails and make recommendations to improve the healthcare provided to individuals in custody. Requires the study to include the six listed components, including: (1) a review of intake screening procedures used in county jails for identifying medical and behavioral health conditions; (2) an examination of current health care provider arrangements, including in-house services, contracted services, hybrid models, or other recommended approaches for delivering care in county jails; and (3) an evaluation of existing staffing models for medical and behavioral health services in county jails. Requires a report on the study to the specified NGA committee and division by December 1, 2026.

Section 11

Require the UNC Health Care System (UNC Health) to explore the feasibility of improving services at Broughton Hospital, Central Regional Hospital, and Cherry Hospital (collectively, the Hospitals). Requires studying and making recommendations on the six listed topics, including: (1) feasibility of transferring full or just certain operation of the Hospitals from DHHS to UNC Health; (2) any services UNC Health could provide to DHHS to assist in providing services at the Hospitals; and (3) any financial impact, impact on patient outcomes, and any improvement in staffing, that would result from implementing the recommendations provided according to this section. Requires a report on the plan to the specified NCGA committee and division by December 1, 2026.

Section 12

Requires the Collaboratory to explore improving services to those same Hospitals. Requires studying and making recommendations on the six specified topics, including: (1) the feasibility of transferring full or certain operation of the Hospitals from DHHS to another entity; (2) any services that another entity could provide to DHHS to assist in providing services at the Hospitals; and (3) any financial impact, impact on patient outcomes, and any improvement in staffing to result from implementing the recommendations provided according to this section. Requires a report on the study to the specified NCGA committee and division by December 1, 2026.

Section 13

Amends GS 122C-261 (concerning affidavit and petition before clerk or magistrate when immediate hospitalization of a person with a mental illness is not necessary) by replacing references to outpatient treatment physician or center with outpatient treatment provider.

Amends GS 122C-263(d)(1) by amending the determinations that must be made by a commitment examiner in order to recommend outpatient commitment, as follows. Now requires finding that the respondent be reasonably determined to be capable of surviving safely in the community, without posing a danger to others, when engaged in treatment for the respondent’s mental illness (was, respondent is capable of surviving safely in the community with available supervision from family, friends, or others). Adds upon the findings that must be made that the respondent has a history of declining or nonadherence to prescribed treatment by a licensed treatment provider, which may be evidenced by one or more of the following, occurring within the relevant past: (1) a prior conviction for a violent offense, (2) a violation of a civil protective order, (3) an incarceration for any offense, or (4) an involuntary inpatient psychiatric hospitalization. Also adds upon the findings that must be made that the respondent is scheduled to be discharged from an inpatient hospital setting or released from a county jail or state prison (allows an individual residing in a non-institutional setting that meets all of the other listed criteria to be subject to outpatient commitment within the court's discretion). Also amends the statute by replacing references to outpatient treatment physician or center with outpatient treatment provider.

Amends GS 122C-265 by adding the requirement that the outpatient treatment provider examine the respondent and develop an initial outpatient treatment plan that must include at least the specific services to be provided (including medications), recommended frequency of participation in services, name of the provider who has agreed to provide service, arrangement made for initial contact with each service provider, and any other relevant information. Replaces references to outpatient treatment physician or center with outpatient treatment provider.

Amends GS 122C-267 by requiring that the initial treatment plan that is now required under GS 122C-265 be admitted into evidence at the outpatient commitment hearing, and that it be incorporated into the order. Requires that the order include the outpatient treatment provider who is responsible for the care and treatment of the respondent as well as the LME/MCO, or an alternative determined by DHHS, that is responsible for the management and supervision of the respondent’s outpatient commitment (was, show the center or physician responsible for the management and supervision of the respondent’s outpatient commitment).

Amends GS 122C-271 by amending the dispositions the court may make when a commitment examiner has recommended outpatient commitment and the respondent has been released pending the court hearing, as follows. Increases the allowable length of outpatient commitment the court may order when it finds by clear, cogent, and convincing evidence that the respondent meets the criteria in GS 122C-263(d)(1), so that it may not exceed 180 (was, 90) days; also amends this provision by adding what must be included in the order to include incorporating the initial treatment plan, stating that the respondent must comply with the treatment plan (including subsequent updates to the plan), and instructions to the responsible outpatient treatment provider and the LME/MCO, or alternative, regarding their monitoring and supervision duties. Amends the findings of facts that must be made before ordering outpatient commitment to include findings of fact on the availability and consent to accept the respondent as a client by all providers of the services listed in the initial treatment plan. Makes those same changes to the dispositions the court may make when the respondent has been held in a 24-hour facility pending the court hearing. Replaces references to outpatient treatment physician or center with outpatient treatment provider. Makes additional conforming and clarifying changes.

Amends GS 122C-273 as follows. Allows an outpatient treatment provider to prescribe or administer (was, the outpatient treatment physician may prescribe or administer and the center may administer) reasonable and appropriate medication and treatment. Now requires that when a respondent does not comply or clearly refuses to comply with the treatment plan, that the treatment provider report their efforts to get the respondent to comply, to the LME/MCO that is responsible for monitoring and supervising the respondent’s outpatient commitment, and the LME/MCO must then report to the court with a request for a supplemental hearing (previously the LME/MCO was not involved). Adds the requirement that the LME/MCO keep a list of all individuals on outpatient commitment and ensure the individual's care manager is aware of the treatment plan; requires that DHHS have access to the list and that it treat this information as privileged and confidential. Allows, the LME/MCO responsible for the respondent’s monitoring and supervisions, as an alternative to the outpatient treatment provider, to requires the court to order the respondent be taken into custody for an exam when they fail to comply but do not clearly refuse to comply with the treatment, after reasonably effort to solicit the respondent’s compliance. Requires that the LME/MCO (was, the outpatient treatment physician or center) request the calendaring of a supplemental hearing when a respondent on outpatient commitment intends to move or moves to another county. Adds the LME/MCO to the entities that may notify the court when a respondent moves to another state or to an unknown location. Replaces references to outpatient treatment physician or center with outpatient treatment provider.

Amends GS 122C-274 as following. Amends the actions that the court may take when it determining that the respondent has failed or refused to comply, to include issuing an order for inpatient commitment upon finding by clear, cogent, and convincing evidence that there is a nexus between the respondent's past conduct and the reasonable probability of the respondent's future dangerousness to self or others. Specifies that a finding of noncompliance with an outpatient commitment order under this statute creates a rebuttable presumption that there is a nexus between the respondent's past conduct and the reasonable probability of the respondent's future dangerousness to self or others. Requires that an order directing continuation of outpatient treatment under new supervision be provided to the LME/MCO. Expands the cap of the allowable term of outpatient commitment from 90 to 180 days when the court finds the respondent meets the criterial for outpatient commitment. Replaces references to outpatient treatment physician or center with outpatient treatment provider. Makes additional clarifying and conforming changes.

Amends GS 122C-275 to require that a copy of discharge order when the court finds that the respondent no longer meets the criteria of GS 122C-263(d)(1) be given to the LME/MCO. Requires that the court comply with GS 122C-271 (disposition). Replaces references to outpatient treatment physician or center with outpatient treatment provider.

Amends GS 122C-276 to require that the court comply with GS 122C-271 (disposition). Makes additional clarifying changes.

Amends GS 122C-54(d) by adding that the DHHS must be given access to all relevant data, court orders, records, or other relevant information, including any confidential information, related to its duties and responsibilities under Article 5 (Procedure for Admission and Discharge of Clients) of GS Chapter 122C. Requires that DHHS keep all information collected under this subsection privileged and confidential.

Applies to proceedings that occur on or after December 1, 2026.

Section 14

Amends GS 90-414.4 to require that patient records protected by 42 CFR §2 be disclosed through the HIE Network when the North Carolina Health Information Exchange Authority has provided written notice to participating entities that the protected data can be disclosed consistent with HIE’s statutory authority. Makes conforming changes.

Amends GS 90-414.8 by expanding on the membership of the North Carolina Health Information Exchange Advisory Board by including the Deputy Secretary for the State’s Medicaid program, or their designee, as an ex officio, voting member.

Makes conforming changes to the act’s titles.