AN ACT revising and modernizing the health and human services statutes.

The General Assembly of North Carolina enacts:

part II. joel h. crisp sudep Awareness law

SECTION 2.(a)  The University of North Carolina School of Medicine's Area Health Education Centers (NC AHEC) shall consult with the North Carolina Medical Board, North Carolina Department of Health and Human Services, North Carolina Medical Society, North Carolina Pediatric Society, North Carolina Academy of Family Physicians, North Carolina Board of Nursing, North Carolina Board of Pharmacy, and North Carolina Nurses Association to gather evidence‑based information on sudden unexpected death in epilepsy from publications and nonprofit organizations to create standard information to provide to all health care practitioners in this State. The information shall include, at a minimum, current and evidence‑based information about sudden unexpected death in epilepsy risk factors and conditions and contact information for nonprofit organizations that provide support services for epilepsy conditions. The information shall be made available on NC AHEC's website and readily accessible to health care practitioners in this State. No later than September 1, 2026, NC AHEC shall report to the Joint Legislative Oversight Committee on Health and Human Services a completed summary or booklet of information provided to health care practitioners in the report.

SECTION 2.(b)  This section is effective when it becomes law.

part III. veterans and electroencephalogram combined transcranial magnetic stimulation treatment pilot program

SECTION 3.(a)  The Department of Military and Veterans Affairs shall select a provider to establish a statewide pilot program to make eTMS available for veterans, first responders, and immediate family members of veterans and first responders experiencing one or more of the conditions listed in subsection (b) of this section. For purposes of this act, the following definitions shall apply:

(1)        Electroencephalogram combined Transcranial Magnetic Stimulation Treatment (eTMS). – Treatment in which transcranial magnetic stimulation frequency pulses are tuned to the patient's physiology and biometric data.

(2)        Immediate family. – A spouse, child, stepchild, parent, or stepparent.

(3)        Veteran. – A person who (i) served in the Armed Forces of the United States on active duty, for reasons other than training, and has been discharged under other than dishonorable conditions, (ii) served in a reserve component as defined in 38 U.S.C. § 101(27), and (iii) served in the National Guard of any state.

SECTION 3.(b)  The conditions that shall be the subject of the pilot program are the following:

(1)        Substance use disorders.

(2)        Mental illness.

(3)        Sleep disorders.

(4)        Traumatic brain injuries.

(5)        Sexual trauma.

(6)        Posttraumatic stress disorder and accompanying comorbidities.

(7)        Concussions.

(8)        Other brain trauma.

(9)        Quality of life issues affecting human performance, including issues related to or resulting from problems with cognition and problems maintaining attention, concentration, or focus.

SECTION 3.(c)  The provider selected by the Department to conduct the pilot program must display a history of serving veteran and first responder populations at a statewide level. The provider shall establish a network for in‑person and off‑site care with the goal of providing statewide access. Consideration shall be provided to locations with a large population of first responders and veterans. In addition to traditional eTMS devices, the provider may utilize nonmedical portable magnetic stimulation devices to improve access to underserved populations in remote areas or to be used to serve as a pre‑post treatment or a stand‑alone device. The provider shall be required to establish and operate a clinical practice and to evaluate outcomes of such clinical practice.

SECTION 3.(d)  At a minimum, the pilot program shall include all of the following:

(1)        The establishment of a peer‑to‑peer support network by the provider made available to all individuals receiving treatment under the program.

(2)        The requirement that each individual who receives treatment under the program also must receive neurophysiological monitoring, monitoring for symptoms of substance use and other mental health disorders, and access to counseling and wellness programming. Each individual who receives treatment must also participate in the peer‑to‑peer support network established by the provider.

(3)        The establishment of protocols which include the use of adopted stimulation frequency and intensity modulation based on EEGs done on days 0, 10, and 20 and motor threshold testing, as well as clinical symptoms, signs, and biometrics.

(4)        The requirement that protocols and outcomes of any treatment provided by the clinical practice shall be collected and reported by the provider not later than September 15, 2027, to the Department, the Joint Legislative Oversight Committee on General Government, and the Fiscal Research Division. The report shall include the biometrics data and all expenditures made using State funds.

SECTION 3.(e)  The Department may adopt rules to implement the provisions of this section.

SECTION 3.(f)  This section is effective when it becomes law.

part iv. update opioid abatement treatment program rules

SECTION 4.(a)  The Commission for Mental Health, Developmental Disabilities, and Substance Use Services (Commission) shall amend the rules applicable to outpatient opioid treatment programs (OTPs) in 10A NCAC 27G .3600 through 10A NCAC 27G .3605 to be more consistent with 42 C.F.R. Part 8 governing medications for the treatment of opioid use disorder. In amending these rules, the Commission shall make at least all of the following changes:

(1)        Remove stability of a patient's home environment and social relationships as an eligibility criterion for take‑home medication.

(2)        Require the State Opioid Treatment Authority (SOTA) to review patient discharge policies related to continued substance use, missed doses, and nonparticipation in ancillary services such as counseling.

(3)        Remove structured counseling schedules to better align with federal regulations that promote individualized care that is more patient‑centered and flexible.

(4)        Reduce the number of required drug tests to align with the frequency required by federal regulations.

(5)        Explicitly permit OTPs to administer methadone to patients who are not enrolled with the OTPs as their patients but can be verified as a patient in another OTP through contacting the patient's home OTP, checking the central registry, or other means established by the Commission.

SECTION 4.(b)  In determining whether to include any additional changes to the rules applicable to OTPs to achieve greater consistency with 42 C.F.R. Part 8, the Commission shall engage with current and former OTP clients and OTP providers for input on other changes that would serve the goal of improving access to patient‑centered care and achieving better alignment with federal regulations. However, the Commission shall not amend the rules to include any input that is inconsistent with State or federal law.

SECTION 4.(c)  The Commission shall publish the proposed text of the amended rules applicable to OTPs by January 1, 2027.

SECTION 4.(d)  This section is effective when it becomes law.

part v. require schools to share the suicide and crisis lifeline phone number and nc peer warmline phone number

SECTION 5.(a)  G.S. 115C‑47 is amended by adding the following new subdivision to read:

(73)    To Provide Students the Suicide and Crisis Lifeline Phone Number and the NC Peer Warmline Phone Number. – A local board of education shall adopt a policy to ensure all schools in the local school administrative unit provide students the phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The board shall verify that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If either phone number has changed, schools shall use the updated phone number. Unless an updated phone number exists, the schools shall have the phrases To reach the Suicide and Crisis Lifeline, call 988 or text HOME to 741741 and To reach the NC Peer Warmline, call 855‑733‑7762 in the following places:

a.         On any new student identification (student ID) issued to a student in grades six through 12. The text shall be in a conspicuous location on the student ID. The text may be printed on the ID or affixed by sticker. Nothing in this sub‑subdivision requires a school to issue a student ID.

b.         On the school website.

c.         On the home screen of any electronic device issued to students.

d.         On any school agenda or calendar, whether digital or printed.

e.         On a document during any suicide awareness activity.

f.          On a document when the student registers to attend the school.

SECTION 5.(b)  G.S. 115C‑150.12C is amended by adding a new subdivision to read:

(39)    To provide students the Suicide and Crisis Lifeline phone number and the NC Peer Warmline phone number. – The board of trustees shall provide students the phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The board shall verify that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If either phone number has changed, the board shall use the updated phone number. Unless an updated phone number exists, the board shall have the phrases To reach the Suicide and Crisis Lifeline, call 988 or text HOME to 741741 and To reach the NC Peer Warmline, call 855‑733‑7762 in the following places:

a.         On any new student identification (student ID) issued to a student in grades six through 12. The text shall be in a conspicuous location on the student ID. The text may be printed on the ID or affixed by sticker. Nothing in this sub‑subdivision requires a school to issue a student ID.

b.         On the school website.

c.         On the home screen of any electronic device issued to students.

d.         On any school agenda or calendar, whether digital or printed.

e.         On a document during any suicide awareness activity.

f.          On a document when the student registers to attend the school.

SECTION 5.(c)  G.S. 115C‑218.75 is amended by adding a new subsection to read:

(p)      To Provide Students the Suicide and Crisis Lifeline Phone Number and the NC Peer Warmline Phone Number. – A charter school shall provide students the phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If either phone number has changed, the school shall use the updated phone number. Unless an updated phone number exists, the school shall have the phrases To reach the Suicide and Crisis Lifeline, call 988 or text HOME to 741741 and To reach the NC Peer Warmline, call 855‑733‑7762 in the following places:

(1)        On any new student identification (student ID) issued to a student in grades six through 12. The text shall be in a conspicuous location on the student ID. The text may be printed on the ID or affixed by sticker. Nothing in this subdivision requires a school to issue a student ID.

(2)        On the school website.

(3)        On the home screen of any electronic device issued to students.

(4)        On any school agenda or calendar, whether digital or printed.

(5)        On a document during any suicide awareness activity.

(6)        On a document when the student registers to attend the school.

SECTION 5.(d)  G.S. 115C‑238.66 is amended by adding a new subdivision to read:

(23)    To provide students the Suicide and Crisis Lifeline phone number and the NC Peer Warmline phone number. – A regional school shall provide students the phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If either phone number has changed, the school shall use the updated phone number. Unless an updated phone number exists, the school shall have the phrases To reach the Suicide and Crisis Lifeline, call 988 or text HOME to 741741 and To reach the NC Peer Warmline, call 855‑733‑7762 in the following places:

a.         On any new student identification (student ID) issued to a student in grades six through 12. The text shall be in a conspicuous location on the student ID. The text may be printed on the ID or affixed by sticker. Nothing in this sub‑subdivision requires a school to issue a student ID.

b.         On the school website.

c.         On the home screen of any electronic device issued to students.

d.         On any school agenda or calendar, whether digital or printed.

e.         On a document during any suicide awareness activity.

f.          On a document when the student registers to attend the school.

SECTION 5.(e)  G.S. 116‑239.8(b) is amended by adding a new subdivision to read:

(26)    To provide students the Suicide and Crisis Lifeline phone number and the NC Peer Warmline phone number. – A laboratory school shall provide students the phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If either phone number has changed, the school shall use the updated phone number. Unless an updated phone number exists, the school shall have the phrases To reach the Suicide and Crisis Lifeline, call 988 or text HOME to 741741 and To reach the NC Peer Warmline, call 855‑733‑7762 in the following places:

a.         On any new student identification (student ID) issued to a student in grades six through 12. The text shall be in a conspicuous location on the student ID. The text may be printed on the ID or affixed by sticker. Nothing in this sub‑subdivision requires a school to issue a student ID.

b.         On the school website.

c.         On the home screen of any electronic device issued to students.

d.         On any school agenda or calendar, whether digital or printed.

e.         On a document during any suicide awareness activity.

f.          On a document when the student registers to attend the school.

SECTION 5.(f)  Part 1 of Article 39 of Chapter 115C of the General Statutes is amended by adding a new section to read:

§ 115C‑550.2.  Provide students the Suicide and Crisis Lifeline phone number and the NC Peer Warmline phone number.

Each private church school or school of religious charter shall provide students the phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If either phone number has changed, the school shall use the updated phone number. Unless an updated phone number exists, the school shall have the phrases To reach the Suicide and Crisis Lifeline, call 988 or text HOME to 741741 and To reach the NC Peer Warmline, call 855‑733‑7762 in the following places:

(1)        On any new student identification (student ID) issued to a student in grades six through 12. The text shall be in a conspicuous location on the student ID. The text may be printed on the ID or affixed by sticker. Nothing in this subdivision requires a school to issue a student ID.

(2)        On the school website.

(3)        On the home screen of any electronic device issued to students.

(4)        On any school agenda or calendar, whether digital or printed.

(5)        On a document during any suicide awareness activity.

(6)        On a document when the student registers to attend the school.

SECTION 5.(g)  Part 2 of Article 39 of Chapter 115C of the General Statutes is amended by adding a new section to read:

§ 115C‑558.2.  Provide students the Suicide and Crisis Lifeline phone number and the NC Peer Warmline phone number.

Each qualified nonpublic school shall provide students the phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If either phone number has changed, the school shall use the updated phone number. Unless an updated phone number exists, the school shall have the phrases To reach the Suicide and Crisis Lifeline, call 988 or text HOME to 741741 and To reach the NC Peer Warmline, call 855‑733‑7762 in the following places:

(1)        On any new student identification (student ID) issued to a student in grades six through 12. The text shall be in a conspicuous location on the student ID. The text may be printed on the ID or affixed by sticker. Nothing in this subdivision requires a school to issue a student ID.

(2)        On the school website.

(3)        On the home screen of any electronic device issued to students.

(4)        On any school agenda or calendar, whether digital or printed.

(5)        On a document during any suicide awareness activity.

(6)        On a document when the student registers to attend the school.

SECTION 5.(h)  This section is effective when it becomes law and applies beginning with the 2026‑2027 school year.

part vi. reagan's law

SECTION 6.(a)  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:

§ 58‑3‑286.  Prosthetic and orthotic devices and care.

(a)        This section shall apply to all health benefit plans offered in this State other than those regulated under Part 5 of Article 50 of this Chapter, Small Employer Group Health Insurance Reform, or Article 50A of this Chapter, Multiple Employer Welfare Arrangements.

(b)        Health benefit plan coverage shall include coverage for all prosthetic and orthotic devices required to be covered by federal law or regulation under Medicare Part B, as detailed under Part B of Subchapter XVIII of Chapter 7 of Title 42 of the U.S. Code and Subpart D of Part 414 of Subchapter B of Chapter IX of Title 42 of the Code of Federal Regulations. Coverage under this section shall include:

(1)        All materials and components necessary to use a prosthetic or orthotic device.

(2)        Instruction relating to the use of a prosthetic or orthotic device.

(3)        Repair or replacement of a prosthetic or orthotic device meeting the requirements of subsection (g) of this section.

(c)        Coverage consistent with this section shall be required for all prosthetic or orthotic devices, including custom devices, determined by the insured's healthcare provider to be the most appropriate model to adequately meet the medical needs of the insured for completing activities of daily living or essential job‑related activities.

(d)       Coverage under this section shall not be limited to one prosthetic or orthotic device. In addition to coverage required under subsection (c) of this section, a health benefit plan shall provide coverage for additional prosthetic or orthotic devices, including custom devices, determined by the insured's healthcare provider to be the most appropriate model to adequately meet the medical needs of the insured for either or both of the following:

(1)        Performing physical activities, such as running, biking, swimming, and strength training.

(2)        Maximizing the insured's whole‑body health and function of one or more lower or upper limb.

(e)        Coverage for prosthetic and orthotic devices, including custom devices, is considered a habilitative or rehabilitative benefit, including for the purposes of any federal requirement for the coverage of essential health benefits.

(f)        An insurer shall not deny any health benefit claim for a prosthetic or orthotic device for an insured with limb loss or absence that would otherwise be covered for any insured without a disability seeking medical or surgical intervention to restore or maintain the ability to perform the same physical activity.

(g)        A health benefit plan shall provide coverage for the replacement of a prosthetic or orthotic device, or part of a prosthetic or orthotic device, and all of the following shall apply to that coverage:

(1)        The coverage shall be provided without regard to continuous use or useful lifetime restrictions so long as the prescribing healthcare provider determines that the provision of a replacement prosthetic or orthotic device, or a replacement part of a prosthetic or orthotic device, is necessary for any of the following reasons:

a.         A change in the physiological condition of the insured.

b.         An irreparable change in the condition of the device or part of the device.

c.         The condition of the device, or part of the device, requires one or more repairs and the cost of the repair or repairs would be more than sixty percent (60%) of replacement cost of the device or the parts requiring replacement.

(2)        An insurer may require confirmation from the prescribing healthcare provider prior to replacement only if the device or the part of the device being replaced is less than 3 years old.

(3)        The coverage shall be provided for custom devices.

SECTION 6.(b)  No later than February 1, 2029, each issuer that offers a health benefit plan subject to G.S. 58‑3‑286 shall report to the Commissioner of the Department of Insurance, in a form prescribed by the Commissioner, the number of claims and total amount of claims paid for benefits required under G.S. 58‑3‑286.

SECTION 6.(c)  No later than March 1, 2029, the Commissioner of the Department of Insurance shall aggregate all data received under subsection (b) of this section by health benefit plan year and provide this information in a report to the Joint Legislative Oversight Committee on General Government and the Joint Legislative Oversight Committee on Health and Human Services.

SECTION 6.(d)  This act is effective October 1, 2026, and applies to insurance contracts issued, renewed, or amended on or after that date.

part vii. hospital and ambulatory surgical facility standards for surgical smoke evacuation

SECTION 7.(a)  G.S. 131E‑78.4 reads as rewritten:

§ 131E‑78.4.  Hospital standards for surgical smoke evacuation.

(a)        Definitions. – The following definitions apply in this section:

(1)        Smoke evacuation/filtering system. – Stand‑alone, portable equipment utilizing either an electrocautery device with a smoke removal collar or assistant‑held smoke evacuation device that effectively captures, filters, and eliminates surgical smoke at the site of origin before the smoke makes contact with the eyes or respiratory tracts of occupants in the room. This equipment is not required to be interconnected to the hospital surgical ventilation or medical gas system.

(2)        Surgical smoke. – The gaseous by‑product produced by energy‑generating devices, including surgical plume, smoke plume, bio‑aerosols, laser‑generated airborne contaminants, or lung‑damaging dust.

(b)        Policy Requirement. – Each hospital licensed under this Part shall adopt and implement policies that require the use of a smoke evacuation/filtering system during any surgical procedure that is likely to generate surgical smoke.

(c)        Adverse Action. – The Department of Health and Human Services may take adverse action against a hospital under G.S. 131E‑78 for a violation of this section.

SECTION 7.(b)  G.S. 131E‑147.2 reads as rewritten:

§ 131E‑147.2.  Ambulatory surgical facility standards for surgical smoke evacuation.

(a)        Definitions. – The following definitions apply in this section:

(1)        Smoke evacuation/filtering system. – Equipment Stand‑alone, portable equipment utilizing either an electrocautery device with a smoke removal collar or assistant‑held smoke evacuation device that effectively captures, filters, and eliminates surgical smoke at the site of origin before the smoke makes contact with the eyes or the respiratory tracts of occupants in the room. This equipment is not required to be interconnected to the ambulatory surgical ventilation or medical gas system.

(2)        Surgical smoke. – The gaseous by‑product produced by energy‑generating devices, including surgical plume, smoke plume, bio‑aerosols, laser‑generated airborne contaminants, or lung‑damaging dust.

(b)        Policy Requirement. – Each ambulatory surgical facility licensed under this Part shall adopt and implement policies that require the use of a smoke evacuation/filtering system during any surgical procedure that is likely to generate surgical smoke.

(c)        Adverse Action. – The Department of Health and Human Services may take adverse action against an ambulatory surgical facility under G.S. 131E‑148 for a violation of this section.

SECTION 7.(c)  This section is effective when it becomes law.

part viii. Effective date

SECTION 8.  Except as otherwise provided, this act is effective when it becomes law.