S 528

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
1A BILL TO BE ENTITLED
2 AN ACT REVISING AND MODERNIZING THE HEALTH AND HUMAN SERVICES
3    STATUTES.
4 The General Assembly of North Carolina enacts:
5
6 PART II. JOEL H. CRISP SUDEP AWARENESS LAW
7SECTION 2.(a) The University of North Carolina School of Medicine's Area Health
8 Education Centers (NC AHEC) shall consult with the North Carolina Medical Board, North
9 Carolina Department of Health and Human Services, North Carolina Medical Society, North
10 Carolina Pediatric Society, North Carolina Academy of Family Physicians, North Carolina Board
11 of Nursing, North Carolina Board of Pharmacy, and North Carolina Nurses Association to gather
12 evidence-based information on sudden unexpected death in epilepsy from publications and
13 nonprofit organizations to create standard information to provide to all health care practitioners
14 in this State. The information shall include, at a minimum, current and evidence-based
15 information about sudden unexpected death in epilepsy risk factors and conditions and contact
16 information for nonprofit organizations that provide support services for epilepsy conditions. The
17 information shall be made available on NC AHEC's website and readily accessible to health care
18 practitioners in this State. No later than September 1, 2026, NC AHEC shall report to the Joint
19 Legislative Oversight Committee on Health and Human Services a completed summary or
20 booklet of information provided to health care practitioners in the report.
21SECTION 2.(b) This section is effective when it becomes law.
22
23 PART III. VETERANS AND ELECTROENCEPHALOGRAM COMBINED
24 TRANSCRANIAL MAGNETIC STIMULATION TREATMENT PILOT PROGRAM
25SECTION 3.(a) The Department of Military and Veterans Affairs shall select a
26 provider to establish a statewide pilot program to make eTMS available for veterans, first
27 responders, and immediate family members of veterans and first responders experiencing one or
28 more of the conditions listed in subsection (b) of this section. For purposes of this act, the
29 following definitions shall apply:
30(1)     Electroencephalogram combined Transcranial Magnetic Stimulation
31Treatment (eTMS). – Treatment in which transcranial magnetic stimulation
32frequency pulses are tuned to the patient's physiology and biometric data.
33(2)     Immediate family. – A spouse, child, stepchild, parent, or stepparent.
  *S528-v-5*
 General Assembly Of North Carolina  Session 2025
1(3)  Veteran. – A person who (i) served in the Armed Forces of the United States
2on active duty, for reasons other than training, and has been discharged under
3other than dishonorable conditions, (ii) served in a reserve component as
4defined in 38 U.S.C. § 101(27), and (iii) served in the National Guard of any
5state.
6SECTION 3.(b) The conditions that shall be the subject of the pilot program are the
7 following:
8(1)    Substance use disorders.
9(2)    Mental illness.
10(3)    Sleep disorders.
11(4)    Traumatic brain injuries.
12(5)    Sexual trauma.
13(6)    Posttraumatic stress disorder and accompanying comorbidities.
14(7)    Concussions.
15(8)    Other brain trauma.
16(9)    Quality of life issues affecting human performance, including issues related
17to or resulting from problems with cognition and problems maintaining
18attention, concentration, or focus.
19SECTION 3.(c) The provider selected by the Department to conduct the pilot
20 program must display a history of serving veteran and first responder populations at a statewide
21 level. The provider shall establish a network for in-person and off-site care with the goal of
22 providing statewide access. Consideration shall be provided to locations with a large population
23 of first responders and veterans. In addition to traditional eTMS devices, the provider may utilize
24 nonmedical portable magnetic stimulation devices to improve access to underserved populations
25 in remote areas or to be used to serve as a pre-post treatment or a stand-alone device. The provider
26 shall be required to establish and operate a clinical practice and to evaluate outcomes of such
27 clinical practice.
28SECTION 3.(d) At a minimum, the pilot program shall include all of the following:
29(1)    The establishment of a peer-to-peer support network by the provider made
30available to all individuals receiving treatment under the program.
31(2)    The requirement that each individual who receives treatment under the
32program also must receive neurophysiological monitoring, monitoring for
33symptoms of substance use and other mental health disorders, and access to
34counseling and wellness programming. Each individual who receives
35treatment must also participate in the peer-to-peer support network established
36by the provider.
37(3)    The establishment of protocols which include the use of adopted stimulation
38frequency and intensity modulation based on EEGs done on days 0, 10, and
3920 and motor threshold testing, as well as clinical symptoms, signs, and
40biometrics.
41(4)    The requirement that protocols and outcomes of any treatment provided by
42the clinical practice shall be collected and reported by the provider not later
43than September 15, 2027, to the Department, the Joint Legislative Oversight
44Committee on General Government, and the Fiscal Research Division. The
45report shall include the biometrics data and all expenditures made using State
46funds.
47SECTION 3.(e) The Department may adopt rules to implement the provisions of this
48 section.
49SECTION 3.(f) This section is effective when it becomes law.
50
51 PART IV. UPDATE OPIOID ABATEMENT TREATMENT PROGRAM RULES
 Page 2  Senate Bill 528-Fifth Edition
 General Assembly Of North Carolina  Session 2025
1SECTION 4.(a) The Commission for Mental Health, Developmental Disabilities,
2 and Substance Use Services (Commission) shall amend the rules applicable to outpatient opioid
3 treatment programs (OTPs) in 10A NCAC 27G .3600 through 10A NCAC 27G .3605 to be more
4 consistent with 42 C.F.R. Part 8 governing medications for the treatment of opioid use disorder.
5 In amending these rules, the Commission shall make at least all of the following changes:
6(1)     Remove stability of a patient's home environment and social relationships as
7an eligibility criterion for take-home medication.
8(2)     Require the State Opioid Treatment Authority (SOTA) to review patient
9discharge policies related to continued substance use, missed doses, and
10nonparticipation in ancillary services such as counseling.
11(3)     Remove structured counseling schedules to better align with federal
12regulations that promote individualized care that is more patient-centered and
13flexible.
14(4)     Reduce the number of required drug tests to align with the frequency required
15by federal regulations.
16(5)     Explicitly permit OTPs to administer methadone to patients who are not
17enrolled with the OTPs as their patients but can be verified as a patient in
18another OTP through contacting the patient's home OTP, checking the central
19registry, or other means established by the Commission.
20SECTION 4.(b) In determining whether to include any additional changes to the
21 rules applicable to OTPs to achieve greater consistency with 42 C.F.R. Part 8, the Commission
22 shall engage with current and former OTP clients and OTP providers for input on other changes
23 that would serve the goal of improving access to patient-centered care and achieving better
24 alignment with federal regulations. However, the Commission shall not amend the rules to
25 include any input that is inconsistent with State or federal law.
26SECTION 4.(c) The Commission shall publish the proposed text of the amended
27 rules applicable to OTPs by January 1, 2027.
28SECTION 4.(d) This section is effective when it becomes law.
29
30 PART V. REQUIRE SCHOOLS TO SHARE THE SUICIDE AND CRISIS LIFELINE
31 PHONE NUMBER AND NC PEER WARMLINE PHONE NUMBER
32SECTION 5.(a) G.S. 115C-47 is amended by adding the following new subdivision
33 to read:
34"(73) To Provide Students the Suicide and Crisis Lifeline Phone Number and the
35NC Peer Warmline Phone Number. – A local board of education shall adopt
36a policy to ensure all schools in the local school administrative unit provide
37students the phone numbers for the Suicide and Crisis Lifeline and the NC
38Peer Warmline. The board shall verify that the phone numbers for the Lifeline
39and the Warmline are current and accurate annually. If either phone number
40has changed, schools shall use the updated phone number. Unless an updated
41phone number exists, the schools shall have the phrases "To reach the Suicide
42and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC
43Peer Warmline, call 855-733-7762" in the following places:
44a.     On any new student identification (student ID) issued to a student in
45grades six through 12. The text shall be in a conspicuous location on
46the student ID. The text may be printed on the ID or affixed by sticker.
47Nothing in this sub-subdivision requires a school to issue a student ID.
48b.     On the school website.
49c.     On the home screen of any electronic device issued to students.
50d.     On any school agenda or calendar, whether digital or printed.
51e.     On a document during any suicide awareness activity.
 Senate Bill 528-Fifth Edition  Page 3
 General Assembly Of North Carolina  Session 2025
1f.    On a document when the student registers to attend the school."
2SECTION 5.(b) G.S. 115C-150.12C is amended by adding a new subdivision to
3 read:
4"(39) To provide students the Suicide and Crisis Lifeline phone number and the NC
5Peer Warmline phone number. – The board of trustees shall provide students
6the phone numbers for the Suicide and Crisis Lifeline and the NC Peer
7Warmline. The board shall verify that the phone numbers for the Lifeline and
8the Warmline are current and accurate annually. If either phone number has
9changed, the board shall use the updated phone number. Unless an updated
10phone number exists, the board shall have the phrases "To reach the Suicide
11and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC
12Peer Warmline, call 855-733-7762" in the following places:
13a.      On any new student identification (student ID) issued to a student in
14grades six through 12. The text shall be in a conspicuous location on
15the student ID. The text may be printed on the ID or affixed by sticker.
16Nothing in this sub-subdivision requires a school to issue a student ID.
17b.      On the school website.
18c.      On the home screen of any electronic device issued to students.
19d.      On any school agenda or calendar, whether digital or printed.
20e.      On a document during any suicide awareness activity.
21f.      On a document when the student registers to attend the school."
22SECTION 5.(c) G.S. 115C-218.75 is amended by adding a new subsection to read:
23     "(p) To Provide Students the Suicide and Crisis Lifeline Phone Number and the NC Peer
24 Warmline Phone Number. – A charter school shall provide students the phone numbers for the
25 Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify that the phone
26 numbers for the Lifeline and the Warmline are current and accurate annually. If either phone
27 number has changed, the school shall use the updated phone number. Unless an updated phone
28 number exists, the school shall have the phrases "To reach the Suicide and Crisis Lifeline, call
29 988 or text HOME to 741741" and "To reach the NC Peer Warmline, call 855-733-7762" in the
30 following places:
31(1)   On any new student identification (student ID) issued to a student in grades
32six through 12. The text shall be in a conspicuous location on the student ID.
33The text may be printed on the ID or affixed by sticker. Nothing in this
34subdivision requires a school to issue a student ID.
35(2)   On the school website.
36(3)   On the home screen of any electronic device issued to students.
37(4)   On any school agenda or calendar, whether digital or printed.
38(5)   On a document during any suicide awareness activity.
39(6)   On a document when the student registers to attend the school."
40SECTION 5.(d) G.S. 115C-238.66 is amended by adding a new subdivision to read:
41"(23) To provide students the Suicide and Crisis Lifeline phone number and the NC
42Peer Warmline phone number. – A regional school shall provide students the
43phone numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline.
44The school shall verify that the phone numbers for the Lifeline and the
45Warmline are current and accurate annually. If either phone number has
46changed, the school shall use the updated phone number. Unless an updated
47phone number exists, the school shall have the phrases "To reach the Suicide
48and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC
49Peer Warmline, call 855-733-7762" in the following places:
50a.      On any new student identification (student ID) issued to a student in
51grades six through 12. The text shall be in a conspicuous location on
 Page 4  Senate Bill 528-Fifth Edition
 General Assembly Of North Carolina  Session 2025
1the student ID. The text may be printed on the ID or affixed by sticker.
2Nothing in this sub-subdivision requires a school to issue a student ID.
3b.      On the school website.
4c.      On the home screen of any electronic device issued to students.
5d.      On any school agenda or calendar, whether digital or printed.
6e.      On a document during any suicide awareness activity.
7f.      On a document when the student registers to attend the school."
8SECTION 5.(e) G.S. 116-239.8(b) is amended by adding a new subdivision to read:
9"(26) To provide students the Suicide and Crisis Lifeline phone number and the NC
10Peer Warmline phone number. – A laboratory school shall provide students
11the phone numbers for the Suicide and Crisis Lifeline and the NC Peer
12Warmline. The school shall verify that the phone numbers for the Lifeline and
13the Warmline are current and accurate annually. If either phone number has
14changed, the school shall use the updated phone number. Unless an updated
15phone number exists, the school shall have the phrases "To reach the Suicide
16and Crisis Lifeline, call 988 or text HOME to 741741" and "To reach the NC
17Peer Warmline, call 855-733-7762" in the following places:
18a.      On any new student identification (student ID) issued to a student in
19grades six through 12. The text shall be in a conspicuous location on
20the student ID. The text may be printed on the ID or affixed by sticker.
21Nothing in this sub-subdivision requires a school to issue a student ID.
22b.      On the school website.
23c.      On the home screen of any electronic device issued to students.
24d.      On any school agenda or calendar, whether digital or printed.
25e.      On a document during any suicide awareness activity.
26f.      On a document when the student registers to attend the school."
27SECTION 5.(f) Part 1 of Article 39 of Chapter 115C of the General Statutes is
28 amended by adding a new section to read:
29 "§ 115C-550.2. Provide students the Suicide and Crisis Lifeline phone number and the NC
30Peer Warmline phone number.
31     Each private church school or school of religious charter shall provide students the phone
32 numbers for the Suicide and Crisis Lifeline and the NC Peer Warmline. The school shall verify
33 that the phone numbers for the Lifeline and the Warmline are current and accurate annually. If
34 either phone number has changed, the school shall use the updated phone number. Unless an
35 updated phone number exists, the school shall have the phrases "To reach the Suicide and Crisis
36 Lifeline, call 988 or text HOME to 741741" and "To reach the NC Peer Warmline, call
37 855-733-7762" in the following places:
38(1)    On any new student identification (student ID) issued to a student in grades
39six through 12. The text shall be in a conspicuous location on the student ID.
40The text may be printed on the ID or affixed by sticker. Nothing in this
41subdivision requires a school to issue a student ID.
42(2)    On the school website.
43(3)    On the home screen of any electronic device issued to students.
44(4)    On any school agenda or calendar, whether digital or printed.
45(5)    On a document during any suicide awareness activity.
46(6)    On a document when the student registers to attend the school."
47SECTION 5.(g) Part 2 of Article 39 of Chapter 115C of the General Statutes is
48 amended by adding a new section to read:
49 "§ 115C-558.2. Provide students the Suicide and Crisis Lifeline phone number and the NC
50Peer Warmline phone number.
 Senate Bill 528-Fifth Edition  Page 5
 General Assembly Of North Carolina  Session 2025
1     Each qualified nonpublic school shall provide students the phone numbers for the Suicide
2 and Crisis Lifeline and the NC Peer Warmline. The school shall verify that the phone numbers
3 for the Lifeline and the Warmline are current and accurate annually. If either phone number has
4 changed, the school shall use the updated phone number. Unless an updated phone number exists,
5 the school shall have the phrases "To reach the Suicide and Crisis Lifeline, call 988 or text HOME
6 to 741741" and "To reach the NC Peer Warmline, call 855-733-7762" in the following places:
7(1)     On any new student identification (student ID) issued to a student in grades
8six through 12. The text shall be in a conspicuous location on the student ID.
9The text may be printed on the ID or affixed by sticker. Nothing in this
10subdivision requires a school to issue a student ID.
11(2)     On the school website.
12(3)     On the home screen of any electronic device issued to students.
13(4)     On any school agenda or calendar, whether digital or printed.
14(5)     On a document during any suicide awareness activity.
15(6)     On a document when the student registers to attend the school."
16SECTION 5.(h) This section is effective when it becomes law and applies beginning
17 with the 2026-2027 school year.
18
19 PART VI. REAGAN'S LAW
20SECTION 6.(a) Article 3 of Chapter 58 of the General Statutes is amended by adding
21 a new section to read:
22 "§ 58-3-286. Prosthetic and orthotic devices and care.
23     (a)     This section shall apply to all health benefit plans offered in this State other than those
24 regulated under Part 5 of Article 50 of this Chapter, Small Employer Group Health Insurance
25 Reform, or Article 50A of this Chapter, Multiple Employer Welfare Arrangements.
26     (b)     Health benefit plan coverage shall include coverage for all prosthetic and orthotic
27 devices required to be covered by federal law or regulation under Medicare Part B, as detailed
28 under Part B of Subchapter XVIII of Chapter 7 of Title 42 of the U.S. Code and Subpart D of
29 Part 414 of Subchapter B of Chapter IX of Title 42 of the Code of Federal Regulations. Coverage
30 under this section shall include:
31(1)     All materials and components necessary to use a prosthetic or orthotic device.
32(2)     Instruction relating to the use of a prosthetic or orthotic device.
33(3)     Repair or replacement of a prosthetic or orthotic device meeting the
34requirements of subsection (g) of this section.
35     (c)     Coverage consistent with this section shall be required for all prosthetic or orthotic
36 devices, including custom devices, determined by the insured's healthcare provider to be the most
37 appropriate model to adequately meet the medical needs of the insured for completing activities
38 of daily living or essential job-related activities.
39     (d)     Coverage under this section shall not be limited to one prosthetic or orthotic device.
40 In addition to coverage required under subsection (c) of this section, a health benefit plan shall
41 provide coverage for additional prosthetic or orthotic devices, including custom devices,
42 determined by the insured's healthcare provider to be the most appropriate model to adequately
43 meet the medical needs of the insured for either or both of the following:
44(1)     Performing physical activities, such as running, biking, swimming, and
45strength training.
46(2)     Maximizing the insured's whole-body health and function of one or more
47lower or upper limb.
48     (e)     Coverage for prosthetic and orthotic devices, including custom devices, is considered
49 a habilitative or rehabilitative benefit, including for the purposes of any federal requirement for
50 the coverage of essential health benefits.
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 General Assembly Of North Carolina  Session 2025
1     (f)     An insurer shall not deny any health benefit claim for a prosthetic or orthotic device
2 for an insured with limb loss or absence that would otherwise be covered for any insured without
3 a disability seeking medical or surgical intervention to restore or maintain the ability to perform
4 the same physical activity.
5     (g)     A health benefit plan shall provide coverage for the replacement of a prosthetic or
6 orthotic device, or part of a prosthetic or orthotic device, and all of the following shall apply to
7 that coverage:
8(1)     The coverage shall be provided without regard to continuous use or useful
9lifetime restrictions so long as the prescribing healthcare provider determines
10that the provision of a replacement prosthetic or orthotic device, or a
11replacement part of a prosthetic or orthotic device, is necessary for any of the
12following reasons:
13a.       A change in the physiological condition of the insured.
14b.       An irreparable change in the condition of the device or part of the
15device.
16c.       The condition of the device, or part of the device, requires one or more
17repairs and the cost of the repair or repairs would be more than sixty
18percent (60%) of replacement cost of the device or the parts requiring
19replacement.
20(2)     An insurer may require confirmation from the prescribing healthcare provider
21prior to replacement only if the device or the part of the device being replaced
22is less than 3 years old.
23(3)     The coverage shall be provided for custom devices."
24SECTION 6.(b) No later than February 1, 2029, each issuer that offers a health
25 benefit plan subject to G.S. 58-3-286 shall report to the Commissioner of the Department of
26 Insurance, in a form prescribed by the Commissioner, the number of claims and total amount of
27 claims paid for benefits required under G.S. 58-3-286.
28SECTION 6.(c) No later than March 1, 2029, the Commissioner of the Department
29 of Insurance shall aggregate all data received under subsection (b) of this section by health benefit
30 plan year and provide this information in a report to the Joint Legislative Oversight Committee
31 on General Government and the Joint Legislative Oversight Committee on Health and Human
32 Services.
33SECTION 6.(d) This act is effective October 1, 2026, and applies to insurance
34 contracts issued, renewed, or amended on or after that date.
35
36 PART VII. HOSPITAL AND AMBULATORY SURGICAL FACILITY STANDARDS
37 FOR SURGICAL SMOKE EVACUATION
38SECTION 7.(a) G.S. 131E-78.4 reads as rewritten:
39 "§ 131E-78.4. Hospital standards for surgical smoke evacuation.
40     (a)   Definitions. – The following definitions apply in this section:
41(1)     Smoke evacuation/filtering system. – Stand-alone, portable equipment
42utilizing either an electrocautery device with a smoke removal collar or
43assistant-held smoke evacuation device that effectively captures, filters, and
44eliminates surgical smoke at the site of origin before the smoke makes contact
45with the eyes or respiratory tracts of occupants in the room. This equipment is
46not required to be interconnected to the hospital surgical ventilation or medical
47gas system.
48(2)     Surgical smoke. – The gaseous by-product produced by energy-generating
49devices, including surgical plume, smoke plume, bio-aerosols, laser-generated
50airborne contaminants, or lung-damaging dust.
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 General Assembly Of North Carolina  Session 2025
1     (b)     Policy Requirement. – Each hospital licensed under this Part shall adopt and
2 implement policies that require the use of a smoke evacuation/filtering system during any
3 surgical procedure that is likely to generate surgical smoke.
4     (c)     Adverse Action. – The Department of Health and Human Services may take adverse
5 action against a hospital under G.S. 131E-78 for a violation of this section."
6SECTION 7.(b) G.S. 131E-147.2 reads as rewritten:
7 "§ 131E-147.2. Ambulatory surgical facility standards for surgical smoke evacuation.
8     (a)     Definitions. – The following definitions apply in this section:
9(1)     Smoke evacuation/filtering system. – Equipment Stand-alone, portable
10equipment utilizing either an electrocautery device with a smoke removal
11collar or assistant-held smoke evacuation device that effectively captures,
12filters, and eliminates surgical smoke at the site of origin before the smoke
13makes contact with the eyes or the respiratory tracts of occupants in the room.
14This equipment is not required to be interconnected to the ambulatory surgical
15ventilation or medical gas system.
16(2)     Surgical smoke. – The gaseous by-product produced by energy-generating
17devices, including surgical plume, smoke plume, bio-aerosols, laser-generated
18airborne contaminants, or lung-damaging dust.
19     (b)     Policy Requirement. – Each ambulatory surgical facility licensed under this Part shall
20 adopt and implement policies that require the use of a smoke evacuation/filtering system during
21 any surgical procedure that is likely to generate surgical smoke.
22     (c)     Adverse Action. – The Department of Health and Human Services may take adverse
23 action against an ambulatory surgical facility under G.S. 131E-148 for a violation of this section."
24SECTION 7.(c) This section is effective when it becomes law.
25
26 PART VIII. EFFECTIVE DATE
27SECTION 8. Except as otherwise provided, this act is effective when it becomes
28 law.
 Page 8  Senate Bill 528-Fifth Edition