Medicaid Modernization.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025

SESSION LAW 2025-64
HOUSE BILL 546

*H546-v-6*
AN ACT TO MODERNIZE VARIOUS LAWS PERTAIN ING TO THE MEDICAID
PROGRAM.

The General Assembly of North Carolina enacts:

PART I. JUSTICE-RELATED MEDICAID CHANGES
SECTION 1.1.(a) The Department of Health and Human Services, Division of
Health Benefits (DHB), is directed, in coordination with a working group of stakeholders
established by DHB, to develop a team -based care coordination Medicaid service that includes,
at a minimum, screening for alcohol use disorder, opioid use disorder, and other mild to moderate
substance use disorders; prescription medications for opioid use disorder and alcohol use
disorder; recovery support; and case management.
SECTION 1.1.(b) No later than Oc tober 1, 2025, the Department of Health and
Human Services, Division of Health Benefits, shall submit a report to the Joint Legislative
Oversight Committee on Medicaid and the Fiscal Research Division containing details on the
new Medicaid service developed in accordance with this section. The report shall include all of
the following:
(1) The State share of the cost of the service.
(2) The intended start date for the coverage of the service.
(3) The types of PHP capitated contracts that will cover the serv ice and any
related proposed statutory changes to Article 4 of Chapter 108D of the General
Statutes.
SECTION 1.1.(c) The Department of Health and Human Services, Division of
Health Benefits, is directed to develop a statewide campaign to (i) educate health care providers
and community leaders about any changes made to the Medicaid program related to the treatment
of alcohol use disorder, opioid use disorder, and other mild to moderate substance use disorders,
(ii) train interested providers in clinical car e for alcohol use disorder, opioid use disorder, and
other mild to moderate substance use disorders, and (iii) encourage substance use disorder
provider participation in the Medicaid program.
SECTION 1.2. The Department of Health and Human Services (DHHS) , Division
of Health Benefits, shall continue to implement its policy changes to suspend, rather than
terminate, Medicaid benefits upon a Medicaid beneficiary's incarceration, as required by the
federal Consolidated Appropriations Act, 2024, P.L. 118 -42. N o later than October 1, 2025,
DHHS shall submit to the Joint Legislative Oversight Committee on Medicaid and the Fiscal
Research Division a report on (i) DHHS's progress implementing the automated process in the
NCFAST eligibility information system that allows data sharing between county jails and DHHS
and (ii) any ongoing challenges to meeting the federal requirement to suspend, rather than
terminate, Medicaid benefits upon a Medicaid beneficiary's incarceration.
SECTION 1.3. Except as otherwise provided , this Part is effective when this act
becomes law.

Page 2 Session Law 2025-64 House Bill 546
PART II. EXPEDIENT I MPLEMENTATION OF MED ICAID WORK
REQUIREMENTS
SECTION 2.1.(a) Section 2.4 of S.L. 2023-7 reads as rewritten:
"SECTION 2.4. If there is any indication that work requirements as a condi tion of
participation in the Medicaid program may be authorized by the Centers for Medicare and
Medicaid Services (CMS), then the Department of Health and Human Services, Division of
Health Benefits (DHB), shall enter into negotiations with CMS to develop a plan for those work
requirements and to obtain approval of that plan. Within 30 days of entering into negotiations
with CMS pursuant to this section, DHB shall notify, in writing, the Joint Legislative Oversight
Committee on Medicaid (JLOC) and the Fisca l Research Division (FRD) of these negotiations.
Within 30 days of approval by CMS of a plan for work requirements as a condition of
participation in the Medicaid program, DHB shall submit a report to JLOC and FRD containing
the full details of the approve d work requirements, including the approved date of
implementation of the requirements and any funding necessary to implement or maintain the
requirements. Notwithstanding any provision of G.S. 108A-54.3A to the contrary, the
Department of Health and Human Services shall implement any work requirements as a condition
of participation in the Medicaid program approved by the Centers for Medicare and Medicaid
Services in accordance with this section."
SECTION 2.1.(b) This section is effective when this act becomes law.

PART III. TELEHEALTH SERVICE PROVIDER ELIGIBILITY
SECTION 3.1.(a) The Department of Health and Human Services, Division of
Health Benefits, shall ensure that a health care provider duly licensed by the State that provides
health care services exclusively through telehealth services shall not be required to maintain a
physical presence in the State to be considered an eligible provider for enrollment as a Medicaid
provider.
SECTION 3.1.(b) The Department of Health and Human Services, Division o f
Health Benefits, shall ensure that a health care provider group with health care providers duly
licensed by the State which exclusively offers telehealth services shall not be required to have an
in-State service address to be eligible to enroll as a Medicaid provider group.
SECTION 3.1.(c) This section is effective when this act becomes law.

PART IV. CHILDREN AND FAMILIES SPECIALTY PLAN
SECTION 4.1.(a) Section 9E.22(a) of S.L. 2023-134 reads as rewritten:
"SECTION 9E.22.(a) The Department of Health and Human Services (DHHS) shall issue
an initial request for proposals (RFP) to procure a single statewide children and families (CAF)
specialty plan contract with services to begin to individuals described in G.S. 108D-40(a)(14) no
later than December 1, 2024. 2025. The RFP shall be subject to the requirements in
G.S. 108D-62, as enacted by subsection (k) of this section. DHHS shall define the services
available under the CAF specialty plan and the Medicaid beneficiaries who are eligible to enroll
in the CAF specialty plan, except as otherwise specified in this act or in law. For the purposes of
this section, the CAF specialty plan shall be as defined under G.S. 108D-1, as amended by
subsection (c) of this section."
SECTION 4.1.(b) G.S. 108D-40(a)(14) reads as rewritten:
"(14) Until the CAF specialty plan becomes operational, recipients who are (i)
children enrolled in foster care in this State, (ii) receiving adoption assistance,
or (iii) former foster care youth until they reach the age of 26. who are eligible
for Medicaid under G.S. 108A-54.3A(a)(8). When the CAF specialty plan
becomes operational, recipients described in this subdivision will be enrolled
in accordance with G.S. 108D-62."
SECTION 4.1.(c) This section is effective when this act becomes law.

House Bill 546 Session Law 2025-64 Page 3

PART V. CONTINUE MED ICAID COVERAGE FOR P REGNANT WOMEN FOR
TWELVE MONTHS POSTPARTUM
SECTION 5.1.(a) Section 9D.13(c) of S.L. 2021-180 is repealed.
SECTION 5.1.(b) G.S. 108A-146.5 reads as rewritten:
"§ 108A-146.5. Aggregate modernized assessment collection amount.
(a) The aggregate modernized assessment collection amount is an amount of money that
is calculated by subtracting the modernized intergovernmental transfer adjustment component
under G.S. 108A-146.13 from the total modernized nonfederal receipts under subsection (b) of
this section and then adding the positive or negative amount of the modernized IGT actual
receipts adjustment component under G.S. 108A-146.14.
(b) The total modernized nonfederal receipts is the sum of all of the following:
(1) One-fourth of the State's annual Medicaid payment.
(2) The managed care component under G.S. 108A-146.7.
(3) The fee-for-service component under G.S. 108A-146.9.
(3a) The modernized HASP component under G.S. 108A-146.10.
(4) The GME component under G.S. 108A-146.11.
(5) Beginning April 1, 2022, and ending March 31, 2027, the postpartum
coverage component under G.S. 108A-146.12.
(6) Beginning April 1, 2024, the home and community-based services component
under G.S. 108A-146.12A."
SECTION 5.1.(c) This section is effective when this act becomes law.

PART VI. MEDICAID HASP REIMBURSEMENT FOR PSYCHIATRIC HOSPITALS
SECTION 6.1.(a) G.S. 108A-148.1(a) reads as rewritten:
"(a) The healthcare access and stabilization program is a directe d payment program that
provides acute care hospitals with increased reimbursements funded through hospital
assessments in accordance with this section. Upon the approval of C MS, the healthcare access
and stabilization program directed payment program shall additionally provide qualifying
freestanding psychiatric hospitals with increased reimbursements funded through hospital
assessments. A qualifying freestanding psychiatric hospital is a freestanding psychiatric hospital
as defined in G.S. 108A-145.3 that is Medicare-certified and submits Hospital Cost Report
Information System cost report data to CMS."
SECTION 6.1.(b) The Department of Health and Human Services shall submit a 42
C.F.R. § 438.6(c) preprint requesting approval to include freestanding psychiatric hospitals in
the healthcare access and stabilization program (HASP) authorized under G.S. 108A-148.1, as
amended by subsection (a) of this section.
SECTION 6.1.(c) G.S. 108A-145.3 reads as rewritten:
"§ 108A-145.3. Definitions.
The following definitions apply in this Article:
…
(6c) Freestanding psychiatric hospital. – A hospital facility that is (i) licensed
under Article 2 of Chapter 122C of the General Statutes, (ii) primarily engaged
in providing to inpatients, by or under the supervision of a physician,
psychiatric services for the diagnosis and treatment of individuals with mental
illnesses, and (iii) not State-owned and State-operated.
(6d) HASP directed payments. – Payments made by the Department to prepaid
health plans to be used for (i) increased reimbursements to hospitals under the
HASP program and (ii) the costs to prepaid health plans from the gros s
premiums tax under G.S. 105-228.5 and the insurance regulatory charge under
G.S. 58-6-25 associated with those hospital reimbursements.

Page 4 Session Law 2025-64 House Bill 546
(6d)(6e) Healthcare access and stabilization program (HASP). – The directed
payment program providing increased reimbursements to acute care hospitals
and freestanding psychiatric hospitals as approved by CMS and authorized by
G.S. 108A-148.1.
…."
SECTION 6.1.(d) G.S. 108A-146.1 reads as rewritten:
"§ 108A-146.1. Public hospital modernized assessment.
(a) The public hospital modernized assessment imposed under this Part shall apply to all
public acute care hospitals.
(b) The public hospital modernized assessment shall be assessed as a percentage of each
public acute care hospital's hospital costs. The assessment percenta ge shall be calculated
quarterly by the Department of Health and Human Services in accordance with this Part. The
percentage for each quarter shall equal the aggregate acute care hospital modernized assessment
collection amount under G.S. 108A-146.5 multiplied by the public hospital historical assessment
share and divided by the total hospital costs for all public acute care hospitals holding a license
on the first day of the assessment quarter."
SECTION 6.1.(e) G.S. 108A-146.3 reads as rewritten:
"§ 108A-146.3. Private hospital modernized assessment.
(a) The private hospital modernized assessment imposed under this Part shall apply to all
private acute care hospitals.
(b) The private hospital modernized assessment shall be assessed as a percentage of each
private acute care hospital's hospital costs. The assessment percentage shall be calculated
quarterly by the Department of Health and Human Services in accordance with this Part. The
percentage for each quarter shall equal the aggregate acute care hospital modernized assessment
collection amount under G.S. 108A-146.5 multiplied by the private hospital historical assessment
share and divided by the total hospital costs for all private acute care hospitals holding a license
on the first day of the assessment quarter."
SECTION 6.1.(f) Part 2 of Article 7B of Chapter 108A of the General Statutes is
amended by adding a new section to read:
"§ 108A-146.4. Freestanding psychiatric hospital modernized assessment.
(a) The freestanding psychiatric hospital modernized assessment imposed under this Part
shall apply to all freestanding psychiatric hospitals.
(b) The freestanding psychiatric hospital modernized assessment shall be assessed as a
percentage of each freestanding psychiatric hospital's hospital costs. The assessment percentage
shall be calculated quarterly by the Department of Health and Human Services in accordance
with this Part. The percentage for each quarter shall equal the modernized freestanding
psychiatric hospital HASP component under G.S. 108A-146.10A divided by the total hospital
costs for all freestanding psychiatric hospitals holding a license on the first day of the assessment
quarter."
SECTION 6.1.(g) G.S. 108A-146.5 reads as rewritten:
"§ 108A-146.5. Aggregate acute care hospital modernized assessment collection amount.
(a) The aggregate modernized assessment collection amount is an amount of money that
is calculated by subtracting the modernized intergovernmental transfer adjustment component
under G.S. 108A-146.13 from the total moder nized nonfederal receipts under subsection (b) of
this section and then adding the positive or negative amount of the modernized IGT actual
receipts adjustment component under G.S. 108A-146.14.
(b) The total modernized nonfederal receipts is the sum of all of the following:
(1) One-fourth of the State's annual Medicaid payment.
(2) The managed care component under G.S. 108A-146.7.
(3) The fee-for-service component under G.S. 108A-146.9.

House Bill 546 Session Law 2025-64 Page 5
(3a) The modernized acute care hospital HASP component under
G.S. 108A-146.10.
(3b) The modernized freestanding psychiatric hospital HASP component under
G.S. 108A-146.10A.
(4) The GME component under G.S. 108A-146.11.
(5) Beginning April 1, 2022, and ending March 31, 2027, the postpartum
coverage component under G.S. 108A-146.12.
(6) Beginning April 1, 2024, the home and community-based services component
under G.S. 108A-146.12A.
(c) The aggregate acu te care hospital modernized assessment collection amount is an
amount of money equal to the aggregate modernized assessment c ollection amount under
subsection (a) of this section minus the modernized freestanding psychiatric hospital HASP
component under G.S. 108A-146.10A."
SECTION 6.1.(h) G.S. 108A-146.10 reads as rewritten:
"§ 108A-146.10. Modernized acute care hospital HASP component.
The modernized acute care hospital HASP component is an amount of money that is
calculated each quarter by multiplying the aggregate amount of HASP directed payments due to
PHPs in the current quarter for hospital reimbursements to acute care h ospitals that are not
attributable to newly eligible individuals by the nonfederal share for not newly eligible
individuals."
SECTION 6.1.(i) Part 2 of Article 7B of Chapter 108A of the General Statutes is
amended by adding a new section to read:
"§ 108A-146.10A. Modernized freestanding psychiatric hospital HASP component.
The modernized freestanding psychiatric hospital HASP component is an amount of money
that is calculated each quarter by multiplying the aggregate amount of HASP directed payments
due to PHPs in the current quarter for reimbursement s to freestanding psychiatric hospitals that
are not attributable to newly eligible indivi duals by the nonfederal share for not newly eligible
individuals."
SECTION 6.1.(j) G.S. 108A-146.13 reads as rewritten:
"§ 108A-146.13. Modernized presumptive IGT adjustment component.
…
(c) The modernized presumptive IGT adjustment component is an amount of money
equal to the sum of all of the following subcomponents:
(1) The public hospital IGT subcomponent is the total of the following amounts:
a. Sixteen and forty-three hundredths percent (16.43%) of the amount of
money that is equal to the total modernized nonfederal receipts under
G.S. 108A-146.5(b) for the current quarter minus the modernized
acute care hospital HASP component under G.S. 108A-146.10 for the
current quarter and minus the modernized freestanding psychiatric
hospital HASP component under G.S. 108A-146.10A for the current
quarter.
b. Sixty percent (60%) of the nonfederal share for not newly eligible
individuals of the aggregate amount of HASP directed payments due
to PHPs in the current quarter for reimbursements to public acute care
hospitals and that are not attributable to newly eligible individuals.
(2) The UNC Health Care System IGT subcomponent is the total of the following
amounts:
a. Four and sixty -two hundredths percent (4.62%) of the difference of
amount of money that is equal to the total modernized nonfederal
receipts under G.S. 108A-146.5(b) for the current quarter minus the
modernized acute care hospital HASP component under

Page 6 Session Law 2025-64 House Bill 546
G.S. 108A-146.10 for the current quarter and minus the modernized
freestanding psychiatric hospital HASP component under
G.S. 108A-146.10A for the current quarter.
b. The nonfederal share for not newly eligible individ uals of the
aggregate amount of HASP directed payments due to PHPs in the
current quarter for reimbursements to UNC Health Care System
hospitals that are not attributable to newly eligible individuals.
(3) The East Carolina University IGT subcomponent is the total of the following
amounts:
a. One and four hundredths percent (1.04%) of the difference of amount
of money that is equal to the total modernized nonfederal receipts
under G.S. 108A-146.5(b) for the current quarter minus the
modernized acute care ho spital HASP component under
G.S. 108A-146.10 for the current quarter and minus the modernized
freestanding psychiatric hospital HASP component under
G.S. 108A-146.10A for the current quarter.
b. The nonfederal share for not newly eligible individuals of th e
aggregate amount of HASP directed payments due to PHPs in the
current quarter for reimbursements to the primary affiliated teaching
hospital for the East Carolina University Brody School of Medicine
that are not attributable to newly eligible individuals."
SECTION 6.1.(k) G.S. 108A-147.1 reads as rewritten:
"§ 108A-147.1. Public hospital health advancement assessment.
(a) The public hospital health advancement assessment imposed under this Part shall
apply to all public acute care hospitals.
(b) The public hospital health advancement assessment shall be assessed as a percentage
of each public acute care hospital's hospital costs. The assessment percentage shall be calculated
quarterly by the Department in accordance with this Part. The percentage for each quarter shall
equal the aggregate acute care hospital health advancement assessment collection amount
calculated under G.S. 108A-147.3 multiplied by the public hospital historical assessment share
and divided by the total hospital costs for all public acute care hospitals holding a license on the
first day of the assessment quarter."
SECTION 6.1.(l) G.S. 108A-147.2 reads as rewritten:
"§ 108A-147.2. Private hospital health advancement assessment.
(a) The private hospital health advancement assess ment imposed under this Part shall
apply to all private acute care hospitals.
(b) The private hospital health advancement assessment shall be assessed as a percentage
of each private acute care hospital's hospital costs. The assessment percentage shall be calculated
quarterly by the Department in accordance with this Part. The percentage for each quarter shall
equal the aggregate acute care hospital health advancement assessment collection amount
calculated under G.S. 108A-147.3 multiplied by the private hospital historical assessment share
and divided by the total hospital costs for all private acute care hospitals holding a license on the
first day of the assessment quarter."
SECTION 6.1.(m) Part 3 of Article 7B of Chapter 108A of the General Statutes is
amended by adding a new section to read:
"§ 108A-147.2A. Freestanding psychiatric hospital health advancement assessment.
(a) The freestanding psychiatric hospital health advancement assessment imposed under
this Part shall apply to all freestanding psychiatric hospitals.
(b) The freestanding psychiatric hospital health advancement assessment shall be
assessed as a percentage of each freestanding psychiatric hospital's hospital costs. The assessment
percentage shall be calculated quarterly by the Department in accordance with this Part. The

House Bill 546 Session Law 2025-64 Page 7
percentage for each quarter shall equal the health advancement freestanding psychiatric hospital
HASP component calculated under G.S. 108A-147.6A divided by the total hospital costs for all
freestanding psychiatric hospitals holding a license on the first day of the assessment quarter."
SECTION 6.1.(n) G.S. 108A-147.3 reads as rewritten:
"§ 108A-147.3. Aggregate acute care hospital health advancement assessment collection
amount.
(a) The aggregate health advancement assessment collection amount is an amount of
money that is calculated quarterly by adjusting the total nonfederal receipts for health
advancement calculated under subsection (b) of this section by (i) subtracting the health
advancement presumptive IGT adjustment component calculated under G.S. 108A-147.9, (ii)
adding the positive or negative health advancement IGT actual receipts adjustment component
calculated under G.S. 108A-147.10, and (iii) subtracting the positive or negative IGT share of
the reconciliation adjustment component calculated under G.S. 108A-147.11(b).
(b) The total nonfederal receipts for health advancement is an amount of money that is
calculated quarterly by adding all of the following:
(1) The presumptive service cost component calculated under G.S. 108A-147.5.
(2) The HASP health advancement acute care hospital HASP component
calculated under G.S. 108A-147.6.
(2a) The health advancement freestanding psychiatric hospital HASP component
calculated under G.S. 108A-147.6A.
(3) The administration component calculated under G.S. 108A-147.7.
(4) The State retention component under G.S. 108A-147.9.
(5) The positive or negative health advancement reconciliation adjustm ent
component calculated under G.S. 108A-147.11(a).
(c) The aggregate acute care hospital health advancement assessment collection amount
is an amount of money equal to the aggregate health advancement assessment collection amount
under subsection (a) of this section minus the health advancement freestanding psychiatric
hospital HASP component under G.S. 108A-147.6A."
SECTION 6.1.(o) G.S. 108A-147.5 reads as rewritten:
"§ 108A-147.5. Presumptive service cost component.
(a) For every State fiscal quarter prior to the fiscal quarter in which G.S. 108A-54.3A(24)
becomes effective, the presumptive service cost component is zero.
(b) For the State fiscal quarter in which G.S. 108A-54.3A(24) becomes effective , the
presumptive service cost component is the product of forty -eight million seven hundred fifty
thousand dollars ($48,750,000) multiplied by the number of months in that State fiscal quarter in
which G.S. 108A-54.3A(24) is effective during any part of the month.
(c) For the first State fiscal quarter after the State fiscal quarter in which
G.S. 108A-54.3A(24) becomes effective, the presumptive service cost component is one hundred
forty-six million two hundred fifty thousand dollars ($146,250,000).
(d) For the second State fiscal quarter after the State fiscal quarter in which
G.S. 108A-54.3A(24) becomes effective, and for each State fiscal quarter thereafter, the
presumptive service cost component is an amount of money that is the greatest of the following:
(1) The prior quarter's presumptive service cost component amount.
(2) The prior quarter's presumptive service cost component amount increased by
a percentage that is the sum of each monthly percentage change in the
Consumer Price Index: Medical Care for the most recent three months
available on the first day of the current quarter.
(3) The prior quarter's presumptive service cost component amount increased by
the percentage change in the weighted average of the base capitation rates for
standard benef it plans for all rating groups associated with newly eligible
individuals compared to the prior quarter. The weight for each rating group

Page 8 Session Law 2025-64 House Bill 546
shall be calculated using member months documented in the Medicaid
managed care capitation rate certification for standard benefit plans.
(4) The prior quarter's presumptive service cost component amount increased by
the percentage change in the weighted average of the base capitation rates for
BH IDD tailored plans for all rating groups associated with newly eligible
individuals compared to the prior quarter. The weight for each rating group
shall be calculated using member months documented in the Medicaid
managed care capitation rate certification for BH IDD tailored plans.
(5) The amount produced from multiplying 1.15 by the highest amount produced
when calculating, for each quarter that is at least two and not more than five
quarters prior to the current quarter, the actual nonfederal expenditures for the
applicable quarter minus the HASP health advancement acute care hospital
HASP component calculated under G.S. 108A-147.6 for the applicable
quarter and minus the health ad vancement freestanding psychiatric hospital
HASP component calculated under G.S. 108A-147.6A for the applicable
quarter."
SECTION 6.1.(p) G.S. 108A-147.6 reads as rewritten:
"§ 108A-147.6. HASP health Health advancement acute care hospital HASP component.
The HASP health advancement acute care hospital HASP component is an amount of money
that is calculated by multiplying the aggregate amount of HASP directed payments due to PHPs
in the current quarter for hospital reimbursements to acute care hospitals attributable to newly
eligible individuals by the nonfederal share for newly eligible individuals."
SECTION 6.1.(q) Part 3 of Article 7B of Chapter 108A of the General Statutes is
amended by adding a new section to read:
"§ 108A-147.6A. Health advancement freestanding psychiatric hospital HASP component.
The health advancement freestanding psychiatric hospital HASP component is an amount of
money that is calculated by mult iplying the aggregate amount of HASP directed payments due
to PHPs in the current quarter for reimbursements to freestanding psychiatric hospitals
attributable to newly eligible individuals by the nonfederal share for newly eligible individuals."
SECTION 6.1.(r) G.S. 108A-147.11 reads as rewritten:
"§ 108A-147.11. Health advancement reconciliation adjustment component.
(a) The health advancement reconciliation adjustment component is a positive or
negative dollar amount equal to the actual nonfederal expenditures for the quarter that is two
quarters prior to the current quarter minus the sum of the following specified amounts:
(1) The presumptive service cost component calculated under G.S. 108A-147.5
for the quarter that is two quarters prior to the current quarter.
(2) The positive or negative gross premiums tax offset amount calculated under
G.S. 108A-147.12(b).
(3) The HASP health advancement acute care hospital HASP component
calculated under G.S. 108A-147.6 for the quarter that is two quarters prior to
the current quarter.
(4) The health advancement freestanding psychiatric hospital HASP component
calculated under G.S. 108A-147.6A for the quarter that is two quarters prior
to the current quarter.
(b) The IGT share of the reconciliation adjustment component is a positive or negative
dollar amount that is calculated by multiplying the health advancement reconciliation adjustment
component calculated under subsection (a) of this section by th e share of public hospital costs
calculated under subsection (c) of this section.
(c) The share of public hospital costs is calculated by adding total hospital costs for the
UNC Health Care System, total hospital costs for the primary affiliated teaching hospital for the
East Carolina University Brody School of Medicine, and sixty percent (60%) of the total hospital

House Bill 546 Session Law 2025-64 Page 9
costs for all public acute care hospitals and dividing that sum by the total hospital costs for all
acute care hospitals except for critical access hospitals."
SECTION 6.1.(s) Subsections (c) through (r) of this section are effective on the first
day of the next assessment quarter after the date this act becomes law and apply to assessments
imposed on or after that date. The remainder of this se ction is effective when this act becomes
law.

PART VII. ADULT CARE HOME MEDICAID PERSO NAL CARE SERVICES
COVERAGE
SECTION 7.1.(a) In conjunction with the requirements of Section 9E.26 of S.L.
2023-134 for the Department of Health and Human Services, Division of Health Benefits (DHB),
to explore options available to increase access to Medicaid services for dual eligibles that provide
alternatives to nursing home placements, DHB shall consult with stakeholders and shall submit
to the Centers for Medicare and Medicaid Services (CMS) a request that meets all of the
following goals:
(1) Provides Medicaid coverage of personal care services to individuals who
reside in licensed adult care homes and special care units and whose income
exceeds the limit for particip ation in the State -County Special Assistance
Program authorized under G.S. 108A-40, but does not exceed either (i) one
hundred eighty percent (180%) of the federal poverty level for individuals
who, but for their income, would qualify for State-County Special Assistance
at the basic rate under G.S. 108A-42.1 or (ii) two hundred percent (200%) of
the federal poverty level for individuals who, but for their income, would
qualify for State -County Special Assistance at the enhanced rate under
G.S. 108A-42.1.
(2) Ensures that the cost of any new Medicaid coverage being requested is offset
by savings or cost avoidance.
(3) Ensures compliance with applicable legal requirements.
SECTION 7.1.(b) DHB shall take any actions necessary to implement this section
and shall submit the appropriate request to CMS within 90 days after this section becomes law.
DHB shall only implement the Medicaid coverage described in the request if (i) the request is
approved by CMS and (ii) the request meets all of the goals in subsection (a) of this section,
including the cost neutrality requirement.
SECTION 7.1.(c) This section is effective when this act becomes law.

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PART VIII. EFFECTIVE DATE
SECTION 8.1. Except as otherwise provided, this act is effective when it becomes
law.
In the General Assembly read three times and ratified this the 26th day of June, 2025.

s/ Rachel Hunt
President of the Senate

s/ Destin Hall
Speaker of the House of Representatives

s/ Josh Stein
Governor

Approved 3:13 p.m. this 7th day of July, 2025