Health and Human Services Revisions.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 5
SENATE BILL 528
Health Care Committee Substitute Adopted 4/9/25
Third Edition Engrossed 4/15/25
House Committee Substitute Favorable 6/9/26
House Committee Substitute #2 Favorable 6/16/26

Short Title: Health and Human Services Revisions. (Public)
Sponsors:
Referred to:
March 26, 2025
*S528-v-5*
A BILL TO BE ENTITLED 1
AN ACT REVISING AND MODERNIZING THE HEAL TH AND HUMAN SERVICE S 2
STATUTES. 3
The General Assembly of North Carolina enacts: 4
5
PART II. JOEL H. CRISP SUDEP AWARENESS LAW 6
SECTION 2.(a) The University of North Carolina School of Medicine's Area Health 7
Education Centers (NC AHEC) shall consult with the North Carolina Medical Board, North 8
Carolina Department of Health and Human Services, North Carolina Medical Society, North 9
Carolina Pediatric Society, North Carolina Academy of Family Physicians, North Carolina Board 10
of Nursing, North Carolina Board of Pharmacy, and North Carolina Nurses Association to gather 11
evidence-based information on sudden unexpected death in epilepsy from publicatio ns and 12
nonprofit organizations to create standard information to provide to all health care practitioners 13
in this State. The information shall include, at a minimum, current and evidence -based 14
information about sudden unexpected death in epilepsy risk fact ors and conditions and contact 15
information for nonprofit organizations that provide support services for epilepsy conditions. The 16
information shall be made available on NC AHEC's website and readily accessible to health care 17
practitioners in this State. No later than September 1, 2026, NC AHEC shall report to the Joint 18
Legislative Oversight Committee on Health and Human Services a completed summary or 19
booklet of information provided to health care practitioners in the report. 20
SECTION 2.(b) This section is effective when it becomes law. 21
22
PART III. VETERANS A ND ELECTROENCEPHALOG RAM COMBINED 23
TRANSCRANIAL MAGNETIC STIMULATION TREATMENT PILOT PROGRAM 24
SECTION 3.(a) The Department of Military and Veterans Affairs shall select a 25
provider to establish a statewide p ilot program to make eTMS available for veterans, first 26
responders, and immediate family members of veterans and first responders experiencing one or 27
more of the conditions listed in subsection (b) of this section. For purposes of this act, the 28
following definitions shall apply: 29
(1) Electroencephalogram combined Transcranial Magnetic Stimulation 30
Treatment (eTMS). – Treatment in which transcranial magnetic stimulation 31
frequency pulses are tuned to the patient's physiology and biometric data. 32
(2) Immediate family. – A spouse, child, stepchild, parent, or stepparent. 33
General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 528-Fifth Edition
(3) Veteran. – A person who (i) served in the Armed Forces of the United States 1
on active duty, for reasons other than training, and has been discharged under 2
other than dishonorable conditions, (i i) served in a reserve component as 3
defined in 38 U.S.C. § 101(27), and (iii) served in the National Guard of any 4
state. 5
SECTION 3.(b) The conditions that shall be the subject of the pilot program are the 6
following: 7
(1) Substance use disorders. 8
(2) Mental illness. 9
(3) Sleep disorders. 10
(4) Traumatic brain injuries. 11
(5) Sexual trauma. 12
(6) Posttraumatic stress disorder and accompanying comorbidities. 13
(7) Concussions. 14
(8) Other brain trauma. 15
(9) Quality of life issues affecting human performance, including issues related 16
to or resulting from problems with cognition and problems maintaining 17
attention, concentration, or focus. 18
SECTION 3.(c) The provider selected by the Department to conduct the pilot 19
program must display a history of serving veteran and first responder populations at a statewide 20
level. The provider shall establish a network for in -person and off -site care with the goal of 21
providing statewide access. Consideration shall be provided to locations with a large population 22
of first responders and veterans. In addition to traditional eTMS devices, the provider may utilize 23
nonmedical portable magnetic stimulation devices to improve access to underserved populations 24
in remote areas or to be used to serve as a pre-post treatment or a stand-alone device. The provider 25
shall be required to establish and operate a clinical practice and to evaluate outcomes of such 26
clinical practice. 27
SECTION 3.(d) At a minimum, the pilot program shall include all of the following: 28
(1) The establishment of a peer -to-peer support network by the provider made 29
available to all individuals receiving treatment under the program. 30
(2) The requirement that each individual who receives treatment under the 31
program also must receive neurophysiological monitoring, monitoring for 32
symptoms of substance use and other mental health disorders, and access to 33
counseling and wellness programming. Each individual who receives 34
treatment must also participate in the peer-to-peer support network established 35
by the provider. 36
(3) The establishment of protocols which include the use of adopted stimulation 37
frequency and intensity modulation based on EEGs done on days 0, 10, and 38
20 and motor threshold testing, as well as clinical symptoms, signs, and 39
biometrics. 40
(4) The requirement that protocols a nd outcomes of any treatment provided by 41
the clinical practice shall be collected and reported by the provider not later 42
than September 15, 2027, to the Department, the Joint Legislative Oversight 43
Committee on General Government, and the Fiscal Research Di vision. The 44
report shall include the biometrics data and all expenditures made using State 45
funds. 46
SECTION 3.(e) The Department may adopt rules to implement the provisions of this 47
section. 48
SECTION 3.(f) This section is effective when it becomes law. 49
50
PART IV. UPDATE OPIOID ABATEMENT TREATMENT PROGRAM RULES 51
General Assembly Of North Carolina Session 2025
Senate Bill 528-Fifth Edition Page 3
SECTION 4.(a) The Commission for Mental Health, Developmental Disabilities, 1
and Substance Use Services (Commission) shall amend the rules applicable to outpatient opioid 2
treatment programs (OTPs) in 10A NCAC 27G .3600 through 10A NCAC 27G .3605 to be more 3
consistent with 42 C.F.R. Part 8 governing medications for the treatment of opioid use disorder. 4
In amending these rules, the Commission shall make at least all of the following changes: 5
(1) Remove stability of a patient's home environment and social relationships as 6
an eligibility criterion for take-home medication. 7
(2) Require the State Opioid Treatment Authority (SOTA) to review patient 8
discharge policies related to continued substance use, missed dos es, and 9
nonparticipation in ancillary services such as counseling. 10
(3) Remove structured counseling schedules to better align with federal 11
regulations that promote individualized care that is more patient-centered and 12
flexible. 13
(4) Reduce the number of required drug tests to align with the frequency required 14
by federal regulations. 15
(5) Explicitly permit OTPs to administer methadone to patients who are not 16
enrolled with the OTPs as their patients but can be verified as a patient in 17
another OTP through contacting the patient's home OTP, checking the central 18
registry, or other means established by the Commission. 19
SECTION 4.(b) In determining whether to include any additional changes to the 20
rules applicable to OTPs to achieve greater consistency with 42 C.F.R. Part 8, the Commission 21
shall engage with current and former OTP clients and OTP providers for input on other changes 22
that would serve the goal of improving access to patient -centered care and achieving better 23
alignment with federal regulations. However, th e Commission shall not amend the rules to 24
include any input that is inconsistent with State or federal law. 25
SECTION 4.(c) The Commission shall publish the proposed text of the amended 26
rules applicable to OTPs by January 1, 2027. 27
SECTION 4.(d) This section is effective when it becomes law. 28
29
PART V. REQUIRE SCHO OLS TO SHARE THE SUI CIDE AND CRISIS LIFE LINE 30
PHONE NUMBER AND NC PEER WARMLINE PHONE NUMBER 31
SECTION 5.(a) G.S. 115C-47 is amended by adding the following new subdivision 32
to read: 33
"(73) To Provide Students the Suicide and Crisis Lifeline Phone Number and the 34
NC Peer Warmline Phone Number . – A local board of education shall adopt 35
a policy to ensure all schools in the local school administrative unit provide 36
students the phone number s for the Suicide and Crisis Lifeline and the NC 37
Peer Warmline. The board shall verify that the phone numbers for the Lifeline 38
and the Warmline are current and accurate annually . If either phone number 39
has changed, schools shall use the updated phone number. Unless an updated 40
phone number exists, the schools shall have the phrases "To reach the Suicide 41
and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC 42
Peer Warmline, call 855-733-7762" in the following places: 43
a. On any new student identification (student ID) issued to a student in 44
grades six through 12. The text shall be in a conspicuous location on 45
the student ID. The text may be printed on the ID or affixed by sticker. 46
Nothing in this sub-subdivision requires a school to issue a student ID. 47
b. On the school website. 48
c. On the home screen of any electronic device issued to students. 49
d. On any school agenda or calendar, whether digital or printed. 50
e. On a document during any suicide awareness activity. 51
General Assembly Of North Carolina Session 2025
Page 4 Senate Bill 528-Fifth Edition
f. On a document when the student registers to attend the school." 1
SECTION 5.(b) G.S. 115C-150.12C is amended by adding a new subdivision to 2
read: 3
"(39) To provide students the Suicide and Crisis Lifeline phone number and the NC 4
Peer Warmline phone number. – The board of trustees shall provide students 5
the phone number s for the Suicide and Crisis Lifeline and the NC Peer 6
Warmline. The board shall verify that the phone numbers for the Lifeline and 7
the Warmline are current and accurate annually . If either phone number has 8
changed, the board shall use the updated phone number. Unless an updated 9
phone number exists, the board shall have the phrases "To reach the Suicide 10
and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC 11
Peer Warmline, call 855-733-7762" in the following places: 12
a. On any new student identification (student ID) issued to a student in 13
grades six through 12. The text shall be in a conspicuous location on 14
the student ID. The text may be printed on the ID or affixed by sticker. 15
Nothing in this sub-subdivision requires a school to issue a student ID. 16
b. On the school website. 17
c. On the home screen of any electronic device issued to students. 18
d. On any school agenda or calendar, whether digital or printed. 19
e. On a document during any suicide awareness activity. 20
f. On a document when the student registers to attend the school." 21
SECTION 5.(c) G.S. 115C-218.75 is amended by adding a new subsection to read: 22
"(p) To Provide Students the Suicide and Crisis Lifeline Phone Number and the NC Peer 23
Warmline Phone Number. – A charter school shall provide students the phone number s for the 24
Suicide and Crisis Lifeline and the NC Peer Warmline . The school shall verify that the phone 25
numbers for the Lifeline and the Warmline are current and accurate annually. If either phone 26
number has changed, the school shall use the updated phone number. Unless an updated phone 27
number exists, the school shall have the phrase s "To reach the Suicide and Crisis Lifeline, call 28
988 or text HOME to 741741" and "To reach the NC Peer Warmline, call 855-733-7762" in the 29
following places: 30
(1) On any new student identification (student ID) issued to a student in grade s 31
six through 12. The text shall be in a conspicuous location on the student ID. 32
The text may be printed on the ID or affixed by sticker. Nothing in this 33
subdivision requires a school to issue a student ID. 34
(2) On the school website. 35
(3) On the home screen of any electronic device issued to students. 36
(4) On any school agenda or calendar, whether digital or printed. 37
(5) On a document during any suicide awareness activity. 38
(6) On a document when the student registers to attend the school." 39
SECTION 5.(d) G.S. 115C-238.66 is amended by adding a new subdivision to read: 40
"(23) To provide students the Suicide and Crisis Lifeline phone number and the NC 41
Peer Warmline phone number. – A regional school shall provide students the 42
phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. 43
The school shall verify that the phone number s for the Lifeline and the 44
Warmline are current and accurate annually. If either phone number has 45
changed, the school shall use the updated phone nu mber. Unless an updated 46
phone number exists, the school shall have the phrases "To reach the Suicide 47
and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC 48
Peer Warmline, call 855-733-7762" in the following places: 49
a. On any new student identification (student ID) issued to a student in 50
grades six through 12. The text shall be in a conspicuous location on 51
General Assembly Of North Carolina Session 2025
Senate Bill 528-Fifth Edition Page 5
the student ID. The text may be printed on the ID or affixed by sticker. 1
Nothing in this sub-subdivision requires a school to issue a student ID. 2
b. On the school website. 3
c. On the home screen of any electronic device issued to students. 4
d. On any school agenda or calendar, whether digital or printed. 5
e. On a document during any suicide awareness activity. 6
f. On a document when the student registers to attend the school." 7
SECTION 5.(e) G.S. 116-239.8(b) is amended by adding a new subdivision to read: 8
"(26) To provide students the Suicide and Crisis Lifeline phone number and the NC 9
Peer Warmline phone number . – A laboratory school sh all provide students 10
the phone number s for the Suicide and Crisis Lifeline and the NC Peer 11
Warmline. The school shall verify that the phone numbers for the Lifeline and 12
the Warmline are current and accurate annually. If either phone number has 13
changed, the school shall use the updated phone number. Unless an updated 14
phone number exists, the school shall have the phrases "To reach the Suicide 15
and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC 16
Peer Warmline, call 855-733-7762" in the following places: 17
a. On any new student identification (student ID) issued to a student in 18
grades six through 12. The text shall be in a conspicuous location on 19
the student ID. The text may be printed on the ID or affixed by sticker. 20
Nothing in this sub-subdivision requires a school to issue a student ID. 21
b. On the school website. 22
c. On the home screen of any electronic device issued to students. 23
d. On any school agenda or calendar, whether digital or printed. 24
e. On a document during any suicide awareness activity. 25
f. On a document when the student registers to attend the school." 26
SECTION 5.(f) Part 1 of Article 39 of Chapter 115C of the General Statutes is 27
amended by adding a new section to read: 28
"§ 115C-550.2. Provide students the Suicide and Crisis Lifeline phone number and the NC 29
Peer Warmline phone number. 30
Each private ch urch school or school of religious charter shall provide students the phone 31
numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify 32
that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If 33
either phone number has changed, the school shall use the updated phone number. Unless an 34
updated phone number exists, the school shall have the phrases "To reach the Suicide and Crisis 35
Lifeline, call 988 or text HOME to 741741 " and "To reach the NC Peer Warmline, call 36
855-733-7762" in the following places: 37
(1) On any new student identification (student ID) issued to a student in grade s 38
six through 12. The text shall be in a conspicuous location on the student ID. 39
The text may be printed on the ID or affix ed by sticker. Nothing in this 40
subdivision requires a school to issue a student ID. 41
(2) On the school website. 42
(3) On the home screen of any electronic device issued to students. 43
(4) On any school agenda or calendar, whether digital or printed. 44
(5) On a document during any suicide awareness activity. 45
(6) On a document when the student registers to attend the school." 46
SECTION 5.(g) Part 2 of Article 39 of Chapter 115C of the General Statutes is 47
amended by adding a new section to read: 48
"§ 115C-558.2. Provide students the Suicide and Crisis Lifeline phone number and the NC 49
Peer Warmline phone number. 50
General Assembly Of North Carolina Session 2025
Page 6 Senate Bill 528-Fifth Edition
Each qualified nonpublic school shall provide students the phone number s for the Suicide 1
and Crisis Lifeline and the NC Peer Warmline . The school shall verify that the phone number s 2
for the Lifeline and the Warmline are current and accurate annually. If either phone number has 3
changed, the school shall use the updated phone number. Unless an updated phone number exists, 4
the school shall have the phrases "To reach the Suicide and Crisis Lifeline, call 988 or text HOME 5
to 741741" and "To reach the NC Peer Warmline, call 855-733-7762" in the following places: 6
(1) On any new student identification (student ID) issued to a student in grade s 7
six through 12. The text shall be in a conspicuous location on the student ID. 8
The text may be printed on the ID or affixed by sticker. Nothing in this 9
subdivision requires a school to issue a student ID. 10
(2) On the school website. 11
(3) On the home screen of any electronic device issued to students. 12
(4) On any school agenda or calendar, whether digital or printed. 13
(5) On a document during any suicide awareness activity. 14
(6) On a document when the student registers to attend the school." 15
SECTION 5.(h) This section is effective when it becomes law and applies beginning 16
with the 2026-2027 school year. 17
18
PART VI. REAGAN'S LAW 19
SECTION 6.(a) Article 3 of Chapter 58 of the General Statutes is amended by adding 20
a new section to read: 21
"§ 58-3-286. Prosthetic and orthotic devices and care. 22
(a) This section shall apply to all health benefit plans offered in this State other than those 23
regulated under Part 5 of Article 50 of this Chapter, Small Employer Group Health Insurance 24
Reform, or Article 50A of this Chapter, Multiple Employer Welfare Arrangements. 25
(b) Health benefit plan co verage shall include coverage for all prosthetic and orthotic 26
devices required to be covered by federal law or regulation under Medicare Part B , as detailed 27
under Part B of Subchapt er XVIII of Chapter 7 of Title 42 of the U.S. Code and Subpart D of 28
Part 414 of Subchapter B of Chapter IX of Title 42 of the Code of Federal Regulations. Coverage 29
under this section shall include: 30
(1) All materials and components necessary to use a prosthetic or orthotic device. 31
(2) Instruction relating to the use of a prosthetic or orthotic device. 32
(3) Repair or replacement of a prosthetic or orthotic device meeting the 33
requirements of subsection (g) of this section. 34
(c) Coverage consistent with thi s section shall be required for all prosthetic or orthotic 35
devices, including custom devices, determined by the insured's healthcare provider to be the most 36
appropriate model to adequately meet the medical needs of the insured for completing activities 37
of daily living or essential job-related activities. 38
(d) Coverage under this section shall not be limited to one prosthetic or orthotic device. 39
In addition to coverage required under subsection (c) of this section, a health benefit plan shall 40
provide coverage for additional prosthetic or orthotic devices, including custom devices , 41
determined by the insured's healthcare provider to be the most appropriate model to adequately 42
meet the medical needs of the insured for either or both of the following: 43
(1) Performing physical activities, such as ru nning, biking, swimming, and 44
strength training. 45
(2) Maximizing the insured 's whole -body health and function of one or more 46
lower or upper limb. 47
(e) Coverage for prosthetic and orthotic devices, including custom devices, is considered 48
a habilitative or rehabilitative benefit, including for the purposes of any federal requirement for 49
the coverage of essential health benefits. 50
General Assembly Of North Carolina Session 2025
Senate Bill 528-Fifth Edition Page 7
(f) An insurer shall not deny any health benefit claim for a prosthetic or orthotic device 1
for an insured with limb loss or absence that would otherwise be covered for any insured without 2
a disability seeking medical or surgical intervention to restore or maintain the ability to perform 3
the same physical activity. 4
(g) A health benefit plan shall provide coverage for the replacement of a prosthetic or 5
orthotic device, or part of a prosthetic or orthotic device, and all of the following shall apply to 6
that coverage: 7
(1) The coverage shall be provided without regard to continuous use or useful 8
lifetime restrictions so long as the prescribing healthcare provider determines 9
that the provision of a replacement prosthetic or orthotic device, or a 10
replacement part of a prosthetic or orthotic device, is necessary for any of the 11
following reasons: 12
a. A change in the physiological condition of the insured. 13
b. An irreparable change in the condition of the device or part of the 14
device. 15
c. The condition of the device, or part of the device, requires one or more 16
repairs and the cost of the repair or repairs would be more than sixty 17
percent (60%) of replacement cost of the device or the parts requiring 18
replacement. 19
(2) An insurer may require confirmation from the prescribing healthcare provider 20
prior to replacement only if the device or the part of the device being replaced 21
is less than 3 years old. 22
(3) The coverage shall be provided for custom devices." 23
SECTION 6.(b) No later than February 1, 2029, each issuer that offers a health 24
benefit plan subject to G.S. 58-3-286 shall report to the Commissioner of the Department of 25
Insurance, in a form prescribed by the Commissioner, the number of claims and total amount of 26
claims paid for benefits required under G.S. 58-3-286. 27
SECTION 6.(c) No later than March 1, 2029, the Commissioner of the Department 28
of Insurance shall aggregate all data received under subsection (b) of this section by health benefit 29
plan year and provide this information in a report to the Joint Legislative Oversight Committee 30
on General Government and the Joint Legislative Oversight Committee on Health and Human 31
Services. 32
SECTION 6.(d) This act is effective October 1, 2026, and applies to insurance 33
contracts issued, renewed, or amended on or after that date. 34
35
PART VII. HOSPITAL A ND AMBULATORY SURGIC AL FACILITY STANDARD S 36
FOR SURGICAL SMOKE EVACUATION 37
SECTION 7.(a) G.S. 131E-78.4 reads as rewritten: 38
"§ 131E-78.4. Hospital standards for surgical smoke evacuation. 39
(a) Definitions. – The following definitions apply in this section: 40
(1) Smoke evacuation/filtering system. – Stand-alone, portable equipment 41
utilizing either an electrocautery device with a smoke removal collar or 42
assistant-held smoke evacuatio n device that effectively captures, filters, and 43
eliminates surgical smoke at the site of origin before the smoke makes contact 44
with the eyes or respiratory tracts of occupants in the room. This equipment is 45
not required to be interconnected to the hospital surgical ventilation or medical 46
gas system. 47
(2) Surgical smoke. – The gaseous by -product produced by energy -generating 48
devices, including surgical plume, smoke plume, bio-aerosols, laser-generated 49
airborne contaminants, or lung-damaging dust. 50
General Assembly Of North Carolina Session 2025
Page 8 Senate Bill 528-Fifth Edition
(b) Policy Requirement. – Each hospital licensed under this Part shall adopt and 1
implement policies that require the use of a smoke evacuation/filtering system during any 2
surgical procedure that is likely to generate surgical smoke. 3
(c) Adverse Action. – The Department of Health and Human Services may take adverse 4
action against a hospital under G.S. 131E-78 for a violation of this section." 5
SECTION 7.(b) G.S. 131E-147.2 reads as rewritten: 6
"§ 131E-147.2. Ambulatory surgical facility standards for surgical smoke evacuation. 7
(a) Definitions. – The following definitions apply in this section: 8
(1) Smoke evacuation/filtering system. – Equipment Stand-alone, portable 9
equipment utilizing either an electrocautery device with a smoke removal 10
collar or assistant -held smoke ev acuation device that effectively captures, 11
filters, and eliminates surgical smoke at the site of origin before the smoke 12
makes contact with the eyes or the respiratory tracts of occupants in the room. 13
This equipment is not required to be interconnected to the ambulatory surgical 14
ventilation or medical gas system. 15
(2) Surgical smoke. – The gaseous by -product produced by energy -generating 16
devices, including surgical plume, smoke plume, bio-aerosols, laser-generated 17
airborne contaminants, or lung-damaging dust. 18
(b) Policy Requirement. – Each ambulatory surgical facility licensed under this Part shall 19
adopt and implement policies that require the use of a smoke evacuation/filtering system during 20
any surgical procedure that is likely to generate surgical smoke. 21
(c) Adverse Action. – The Department of Health and Human Services may take adverse 22
action against an ambulatory surgical facility under G.S. 131E-148 for a violation of this section." 23
SECTION 7.(c) This section is effective when it becomes law. 24
25
PART VIII. EFFECTIVE DATE 26
SECTION 8. Except as otherwise provided, this act is effective when it becomes 27
law. 28