North Carolina 2025-2026 Regular Session

North Carolina House Bill H242 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		GENERAL ASSEMBLY OF NORTH CAROLINA
2	2		SESSION 2025
3		-	H 1
4		-	HOUSE BILL 242
	3	+	H D
	4	+	HOUSE BILL DRH10095-NLxf-21
	5	+
5	6
6	7
7	8		Short Title: Add Psychiatric Hospitals to Medicaid HASP. (Public)
8		-	Sponsors: Representatives Lambeth, Potts, White, and Reeder (Primary Sponsors).
9		-	For a complete list of sponsors, refer to the North Carolina General Assembly web site.
10		-	Referred to: Health, if favorable, Finance, if favorable, Rules, Calendar, and Operations of the
11		-	House
12		-	March 3, 2025
13		-	H242 -v-1
	9	+	Sponsors: Representative Lambeth.
	10	+	Referred to:
	11	+
	12	+	DRH10095 -NLxf-21
14	13		A BILL TO BE ENTITLED 1
15	14		AN ACT TO INCLUDE FREESTANDING PSYCHIATRIC HOSPITALS AS HOSPITALS 2
16	15		THAT ARE ELIGIBLE TO RECEIVE PAYMENTS UNDER THE MEDICAID 3
17	16		HEALTHCARE ACCESS AND STABILIZATION PROGRAM AND TO PROVIDE 4
18	17		FUNDING FOR THOSE PAYMENTS THROUGH INCREASED HOSPITAL 5
19	18		ASSESSMENTS. 6
20	19		The General Assembly of North Carolina enacts: 7
21	20		SECTION 1.(a) G.S. 108A-148.1(a) reads as rewritten: 8
22	21		"(a) The healthcare access and stabilization program is a directed payment program that 9
23	22		provides acute care hospitals with increased reimbursements funded through hospital 10
24	23		assessments in accordance with this section. Upon the approval of CMS, the healthcare access 11
25	24		and stabilization program directed payment program shall additionally provide qualifying 12
26	25		freestanding psychiatric hospitals with increased reimbursements funded through hospital 13
27	26		assessments. A qualifying freestanding psychiatric hospital is a freestanding psychiatric hospital 14
28	27		as defined in G.S. 108A-145.3 that is Medicare-certified and submits Hospital Cost Report 15
29	28		Information System cost report data to CMS." 16
30	29		SECTION 1.(b) The Department of Health and Human Services shall submit a 42 17
31	30		C.F.R. § 438.6(c) preprint requesting approval to include freestanding psychiatric hospitals in 18
32	31		the healthcare access and stabilization program (HASP) authorized under G.S. 108A-148.1, as 19
33	32		amended by subsection (a) of this section. 20
34	33		SECTION 1.(c) This section is effective when it becomes law. 21
35	34		SECTION 2.(a) G.S. 108A-145.3 reads as rewritten: 22
36	35		"§ 108A-145.3. Definitions. 23
37	36		The following definitions apply in this Article: 24
38	37		… 25
39	38		(6c) Freestanding psychiatric hospital. – A hospital facility that is (i) licensed 26
40	39		under Article 2 of Chapter 122C of the General Statutes, (ii) primarily engaged 27
41	40		in providing to inpatients, by or under the supervision of a physician, 28
42	41		psychiatric services for the diagnosis and treatment of individuals with mental 29
43	42		illnesses, and (iii) not State-owned and State-operated. 30
44	43		(6d) HASP directed payments. – Payments made by the Department to prepaid 31
45	44		health plans to be used for (i) increased reimbursements to hospitals under the 32
46		-	HASP program and (ii) the costs to prepaid health plans from the gross 33 General Assembly Of North Carolina Session 2025
47		-	Page 2 House Bill 242-First Edition
48		-	premiums tax under G.S. 105-228.5 and the insurance regulatory charge under 1
49		-	G.S. 58-6-25 associated with those hospital reimbursements. 2
50		-	(6d)(6e) Healthcare access and stabilization program (HASP). – The directed 3
51		-	payment program providing increased reimbursements to acute care hospitals 4
52		-	and freestanding psychiatric hospitals as approved by CMS and authorized by 5
53		-	G.S. 108A-148.1. 6
54		-	…." 7
55		-	SECTION 2.(b) G.S. 108A-146.1 reads as rewritten: 8
56		-	"§ 108A-146.1. Public hospital modernized assessment. 9
57		-	(a) The public hospital modernized assessment imposed under this Part shall apply to all 10
58		-	public acute care hospitals. 11
59		-	(b) The public hospital modernized assessment shall be assessed as a percentage of each 12
60		-	public acute care hospital's hospital costs. The assessment percentage shall be calculated 13
61		-	quarterly by the Department of Health and Human Services in accordance with this Part. The 14
62		-	percentage for each quarter shall equal the aggregate acute care hospital modernized assessment 15
63		-	collection amount under G.S. 108A-146.5 multiplied by the public hospital historical assessment 16
64		-	share and divided by the total hospital costs for all public acute care hospitals holding a license 17
65		-	on the first day of the assessment quarter." 18
66		-	SECTION 2.(c) G.S. 108A-146.3 reads as rewritten: 19
67		-	"§ 108A-146.3. Private hospital modernized assessment. 20
68		-	(a) The private hospital modernized assessment imposed under this Part shall apply to all 21
69		-	private acute care hospitals. 22
70		-	(b) The private hospital modernized assessment shall be assessed as a percentage of each 23
71		-	private acute care hospital's hospital costs. The assessment percentage shall be calculated 24
72		-	quarterly by the Department of Health and Human Services in accordance with this Part. The 25
73		-	percentage for each quarter shall equal the aggregate acute care hospital modernized assessment 26
74		-	collection amount under G.S. 108A-146.5 multiplied by the private hospital historical assessment 27
75		-	share and divided by the total hospital costs for all private acute care hospitals holding a license 28
76		-	on the first day of the assessment quarter." 29
77		-	SECTION 2.(d) Part 2 of Article 7B of Chapter 108A of the General Statutes is 30
78		-	amended by adding a new section to read: 31
79		-	"§ 108A-146.4. Freestanding psychiatric hospital modernized assessment. 32
80		-	(a) The freestanding psychiatric hospital modernized assessment imposed under this Part 33
81		-	shall apply to all freestanding psychiatric hospitals. 34
82		-	(b) The freestanding psychiatric hospital modernized assessment shall be assessed as a 35
83		-	percentage of each freestanding psychiatric hospital's hospital costs. The assessment percentage 36
84		-	shall be calculated quarterly by the Department of Health and Human Services in accordance 37
85		-	with this Part. The percentage for each quarter shall equal the modernized freestanding 38
86		-	psychiatric hospital HASP component under G.S. 108A-146.10A divided by the total hospital 39
87		-	costs for all freestanding psychiatric hospitals holding a license on the first day of the assessment 40
88		-	quarter." 41
89		-	SECTION 2.(e) G.S. 108A-146.5 reads as rewritten: 42
90		-	"§ 108A-146.5. Aggregate acute care hospital modernized assessment collection amount. 43
91		-	(a) The aggregate modernized assessment collection amount is an amount of money that 44
92		-	is calculated by subtracting the modernized intergovernmental transfer adjustment component 45
93		-	under G.S. 108A-146.13 from the total modernized nonfederal receipts under subsection (b) of 46
94		-	this section and then adding the positive or negative amount of the modernized IGT actual 47
95		-	receipts adjustment component under G.S. 108A-146.14. 48
96		-	(b) The total modernized nonfederal receipts is the sum of all of the following: 49
97		-	(1) One-fourth of the State's annual Medicaid payment. 50
98		-	(2) The managed care component under G.S. 108A-146.7. 51 General Assembly Of North Carolina Session 2025
99		-	House Bill 242-First Edition Page 3
100		-	(3) The fee-for-service component under G.S. 108A-146.9. 1
101		-	(3a) The modernized acute care hospital HASP component under 2
102		-	G.S. 108A-146.10. 3
103		-	(3b) The modernized freestanding psychiatric hospital HASP component under 4
104		-	G.S. 108A-146.10A. 5
105		-	(4) The GME component under G.S. 108A-146.11. 6
106		-	(5) Beginning April 1, 2022, and ending March 31, 2027, the postpartum 7
107		-	coverage component under G.S. 108A-146.12. 8
108		-	(6) Beginning April 1, 2024, the home and community-based services component 9
109		-	under G.S. 108A-146.12A. 10
110		-	(c) The aggregate acute care hospital modernized assessment collection amount is an 11
111		-	amount of money equal to the aggregate modernized assessment collection amount under 12
112		-	subsection (a) of this section minus the modernized freestanding psychiatric hospital HASP 13
113		-	component under G.S. 108A-146.10A." 14
114		-	SECTION 2.(f) G.S. 108A-146.10 reads as rewritten: 15
115		-	"§ 108A-146.10. Modernized acute care hospital HASP component. 16
116		-	The modernized acute care hospital HASP component is an amount of money that is 17
117		-	calculated each quarter by multiplying the aggregate amount of HASP directed payments due to 18
118		-	PHPs in the current quarter for hospital reimbursements to acute care hospitals that are not 19
119		-	attributable to newly eligible individuals by the nonfederal share for not newly eligible 20
120		-	individuals." 21
121		-	SECTION 2.(g) Part 2 of Article 7B of Chapter 108A of the General Statutes is 22
122		-	amended by adding a new section to read: 23
123		-	"§ 108A-146.10A. Modernized freestanding psychiatric hospital HASP component. 24
124		-	The modernized freestanding psychiatric hospital HASP component is an amount of money 25
125		-	that is calculated each quarter by multiplying the aggregate amount of HASP directed payments 26
126		-	due to PHPs in the current quarter for reimbursements to freestanding psychiatric hospitals that 27
127		-	are not attributable to newly eligible individuals by the nonfederal share for not newly eligible 28
128		-	individuals." 29
129		-	SECTION 2.(h) G.S. 108A-146.13 reads as rewritten: 30
130		-	"§ 108A-146.13. Modernized presumptive IGT adjustment component. 31
131		-	… 32
132		-	(c) The modernized presumptive IGT adjustment component is an amount of money 33
133		-	equal to the sum of all of the following subcomponents: 34
134		-	(1) The public hospital IGT subcomponent is the total of the following amounts: 35
135		-	a. Sixteen and forty-three hundredths percent (16.43%) of the amount of 36
136		-	money that is equal to the total modernized nonfederal receipts under 37
137		-	G.S. 108A-146.5(b) for the current quarter minus the modernized 38
138		-	acute care hospital HASP component under G.S. 108A-146.10 for the 39
139		-	current quarter and minus the modernized freestanding psychiatric 40
140		-	hospital HASP component under G.S. 108A-146.10A for the current 41
141		-	quarter. 42
142		-	b. Sixty percent (60%) of the nonfederal share for not newly eligible 43
143		-	individuals of the aggregate amount of HASP directed payments due 44
144		-	to PHPs in the current quarter for reimbursements to public acute care 45
145		-	hospitals and that are not attributable to newly eligible individuals. 46
146		-	(2) The UNC Health Care System IGT subcomponent is the total of the following 47
147		-	amounts: 48
148		-	a. Four and sixty-two hundredths percent (4.62%) of the difference of 49
149		-	amount of money that is equal to the total modernized nonfederal 50
150		-	receipts under G.S. 108A-146.5(b) for the current quarter minus the 51 General Assembly Of North Carolina Session 2025
151		-	Page 4 House Bill 242-First Edition
152		-	modernized acute care hospital HASP component under 1
153		-	G.S. 108A-146.10 for the current quarter and minus the modernized 2
154		-	freestanding psychiatric hospital HASP component under 3
155		-	G.S. 108A-146.10A for the current quarter. 4
156		-	b. The nonfederal share for not newly eligible individuals of the 5
157		-	aggregate amount of HASP directed payments due to PHPs in the 6
158		-	current quarter for reimbursements to UNC Health Care System 7
159		-	hospitals that are not attributable to newly eligible individuals. 8
160		-	(3) The East Carolina University IGT subcomponent is the total of the following 9
161		-	amounts: 10
162		-	a. One and four hundredths percent (1.04%) of the difference of amount 11
163		-	of money that is equal to the total modernized nonfederal receipts 12
164		-	under G.S. 108A-146.5(b) for the current quarter minus the 13
165		-	modernized acute care hospital HASP component under 14
166		-	G.S. 108A-146.10 for the current quarter and minus the modernized 15
167		-	freestanding psychiatric hospital HASP component under 16
168		-	G.S. 108A-146.10A for the current quarter. 17
169		-	b. The nonfederal share for not newly eligible individuals of the 18
170		-	aggregate amount of HASP directed payments due to PHPs in the 19
171		-	current quarter for reimbursements to the primary affiliated teaching 20
172		-	hospital for the East Carolina University Brody School of Medicine 21
173		-	that are not attributable to newly eligible individuals." 22
174		-	SECTION 3.(a) G.S. 108A-147.1 reads as rewritten: 23
175		-	"§ 108A-147.1. Public hospital health advancement assessment. 24
176		-	(a) The public hospital health advancement assessment imposed under this Part shall 25
177		-	apply to all public acute care hospitals. 26
178		-	(b) The public hospital health advancement assessment shall be assessed as a percentage 27
179		-	of each public acute care hospital's hospital costs. The assessment percentage shall be calculated 28
180		-	quarterly by the Department in accordance with this Part. The percentage for each quarter shall 29
181		-	equal the aggregate acute care hospital health advancement assessment collection amount 30
182		-	calculated under G.S. 108A-147.3 multiplied by the public hospital historical assessment share 31
183		-	and divided by the total hospital costs for all public acute care hospitals holding a license on the 32
184		-	first day of the assessment quarter." 33
185		-	SECTION 3.(b) G.S. 108A-147.2 reads as rewritten: 34
186		-	"§ 108A-147.2. Private hospital health advancement assessment. 35
187		-	(a) The private hospital health advancement assessment imposed under this Part shall 36
188		-	apply to all private acute care hospitals. 37
189		-	(b) The private hospital health advancement assessment shall be assessed as a percentage 38
190		-	of each private acute care hospital's hospital costs. The assessment percentage shall be calculated 39
191		-	quarterly by the Department in accordance with this Part. The percentage for each quarter shall 40
192		-	equal the aggregate acute care hospital health advancement assessment collection amount 41
193		-	calculated under G.S. 108A-147.3 multiplied by the private hospital historical assessment share 42
194		-	and divided by the total hospital costs for all private acute care hospitals holding a license on the 43
195		-	first day of the assessment quarter." 44
196		-	SECTION 3.(c) Part 3 of Article 7B of Chapter 108A of the General Statutes is 45
197		-	amended by adding a new section to read: 46
198		-	"§ 108A-147.2A. Freestanding psychiatric hospital health advancement assessment. 47
199		-	(a) The freestanding psychiatric hospital health advancement assessment imposed under 48
200		-	this Part shall apply to all freestanding psychiatric hospitals. 49
201		-	(b) The freestanding psychiatric hospital health advancement assessment shall be 50
202		-	assessed as a percentage of each freestanding psychiatric hospital's hospital costs. The assessment 51 General Assembly Of North Carolina Session 2025
203		-	House Bill 242-First Edition Page 5
204		-	percentage shall be calculated quarterly by the Department in accordance with this Part. The 1
205		-	percentage for each quarter shall equal the health advancement freestanding psychiatric hospital 2
206		-	HASP component calculated under G.S. 108A-147.6A divided by the total hospital costs for all 3
207		-	freestanding psychiatric hospitals holding a license on the first day of the assessment quarter." 4
208		-	SECTION 3.(d) G.S. 108A-147.3 reads as rewritten: 5
209		-	"§ 108A-147.3. Aggregate acute care hospital health advancement assessment collection 6
210		-	amount. 7
211		-	(a) The aggregate health advancement assessment collection amount is an amount of 8
212		-	money that is calculated quarterly by adjusting the total nonfederal receipts for health 9
213		-	advancement calculated under subsection (b) of this section by (i) subtracting the health 10
214		-	advancement presumptive IGT adjustment component calculated under G.S. 108A-147.9, (ii) 11
215		-	adding the positive or negative health advancement IGT actual receipts adjustment component 12
216		-	calculated under G.S. 108A-147.10, and (iii) subtracting the positive or negative IGT share of 13
217		-	the reconciliation adjustment component calculated under G.S. 108A-147.11(b). 14
218		-	(b) The total nonfederal receipts for health advancement is an amount of money that is 15
219		-	calculated quarterly by adding all of the following: 16
220		-	(1) The presumptive service cost component calculated under G.S. 108A-147.5. 17
221		-	(2) The HASP health advancement acute care hospital HASP component 18
222		-	calculated under G.S. 108A-147.6. 19
223		-	(2a) The health advancement freestanding psychiatric hospital HASP component 20
224		-	calculated under G.S. 108A-147.6A. 21
225		-	(3) The administration component calculated under G.S. 108A-147.7. 22
226		-	(4) The State retention component under G.S. 108A-147.9. 23
227		-	(5) The positive or negative health advancement reconciliation adjustment 24
228		-	component calculated under G.S. 108A-147.11(a). 25
229		-	(c) The aggregate acute care hospital health advancement assessment collection amount 26
230		-	is an amount of money equal to the aggregate health advancement assessment collection amount 27
231		-	under subsection (a) of this section minus the health advancement freestanding psychiatric 28
232		-	hospital HASP component under G.S. 108A-147.6A." 29
233		-	SECTION 3.(e) G.S. 108A-147.5 reads as rewritten: 30
234		-	"§ 108A-147.5. Presumptive service cost component. 31
235		-	(a) For every State fiscal quarter prior to the fiscal quarter in which G.S. 108A-54.3A(24) 32
236		-	becomes effective, the presumptive service cost component is zero. 33
237		-	(b) For the State fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, the 34
238		-	presumptive service cost component is the product of forty-eight million seven hundred fifty 35
239		-	thousand dollars ($48,750,000) multiplied by the number of months in that State fiscal quarter in 36
240		-	which G.S. 108A-54.3A(24) is effective during any part of the month. 37
241		-	(c) For the first State fiscal quarter after the State fiscal quarter in which 38
242		-	G.S. 108A-54.3A(24) becomes effective, the presumptive service cost component is one hundred 39
243		-	forty-six million two hundred fifty thousand dollars ($146,250,000). 40
244		-	(d) For the second State fiscal quarter after the State fiscal quarter in which 41
245		-	G.S. 108A-54.3A(24) becomes effective, and for each State fiscal quarter thereafter, the 42
246		-	presumptive service cost component is an amount of money that is the greatest of the following: 43
247		-	(1) The prior quarter's presumptive service cost component amount. 44
248		-	(2) The prior quarter's presumptive service cost component amount increased by 45
249		-	a percentage that is the sum of each monthly percentage change in the 46
250		-	Consumer Price Index: Medical Care for the most recent three months 47
251		-	available on the first day of the current quarter. 48
252		-	(3) The prior quarter's presumptive service cost component amount increased by 49
253		-	the percentage change in the weighted average of the base capitation rates for 50
254		-	standard benefit plans for all rating groups associated with newly eligible 51 General Assembly Of North Carolina Session 2025
255		-	Page 6 House Bill 242-First Edition
256		-	individuals compared to the prior quarter. The weight for each rating group 1
257		-	shall be calculated using member months documented in the Medicaid 2
258		-	managed care capitation rate certification for standard benefit plans. 3
259		-	(4) The prior quarter's presumptive service cost component amount increased by 4
260		-	the percentage change in the weighted average of the base capitation rates for 5
261		-	BH IDD tailored plans for all rating groups associated with newly eligible 6
262		-	individuals compared to the prior quarter. The weight for each rating group 7
263		-	shall be calculated using member months documented in the Medicaid 8
264		-	managed care capitation rate certification for BH IDD tailored plans. 9
265		-	(5) The amount produced from multiplying 1.15 by the highest amount produced 10
266		-	when calculating, for each quarter that is at least two and not more than five 11
267		-	quarters prior to the current quarter, the actual nonfederal expenditures for the 12
268		-	applicable quarter minus the HASP health advancement acute care hospital 13
269		-	HASP component calculated under G.S. 108A-147.6 for the applicable 14
270		-	quarter and minus the health advancement freestanding psychiatric hospital 15
271		-	HASP component calculated under G.S. 108A-147.6A for the applicable 16
272		-	quarter." 17
273		-	SECTION 3.(f) G.S. 108A-147.6 reads as rewritten: 18
274		-	"§ 108A-147.6. HASP health Health advancement acute care hospital HASP component. 19
275		-	The HASP health advancement acute care hospital HASP component is an amount of money 20
276		-	that is calculated by multiplying the aggregate amount of HASP directed payments due to PHPs 21
277		-	in the current quarter for hospital reimbursements to acute care hospitals attributable to newly 22
278		-	eligible individuals by the nonfederal share for newly eligible individuals." 23
279		-	SECTION 3.(g) Part 3 of Article 7B of Chapter 108A of the General Statutes is 24
280		-	amended by adding a new section to read: 25
281		-	"§ 108A-147.6A. Health advancement freestanding psychiatric hospital HASP component. 26
282		-	The health advancement freestanding psychiatric hospital HASP component is an amount of 27
283		-	money that is calculated by multiplying the aggregate amount of HASP directed payments due 28
284		-	to PHPs in the current quarter for reimbursements to freestanding psychiatric hospitals 29
285		-	attributable to newly eligible individuals by the nonfederal share for newly eligible individuals." 30
286		-	SECTION 3.(h) G.S. 108A-147.11 reads as rewritten: 31
287		-	"§ 108A-147.11. Health advancement reconciliation adjustment component. 32
288		-	(a) The health advancement reconciliation adjustment component is a positive or 33
289		-	negative dollar amount equal to the actual nonfederal expenditures for the quarter that is two 34
290		-	quarters prior to the current quarter minus the sum of the following specified amounts: 35
291		-	(1) The presumptive service cost component calculated under G.S. 108A-147.5 36
292		-	for the quarter that is two quarters prior to the current quarter. 37
293		-	(2) The positive or negative gross premiums tax offset amount calculated under 38
294		-	G.S. 108A-147.12(b). 39
295		-	(3) The HASP health advancement acute care hospital HASP component 40
296		-	calculated under G.S. 108A-147.6 for the quarter that is two quarters prior to 41
297		-	the current quarter. 42
298		-	(4) The health advancement freestanding psychiatric hospital HASP component 43
299		-	calculated under G.S. 108A-147.6A for the quarter that is two quarters prior 44
300		-	to the current quarter. 45
301		-	(b) The IGT share of the reconciliation adjustment component is a positive or negative 46
302		-	dollar amount that is calculated by multiplying the health advancement reconciliation adjustment 47
303		-	component calculated under subsection (a) of this section by the share of public hospital costs 48
304		-	calculated under subsection (c) of this section. 49
305		-	(c) The share of public hospital costs is calculated by adding total hospital costs for the 50
306		-	UNC Health Care System, total hospital costs for the primary affiliated teaching hospital for the 51 General Assembly Of North Carolina Session 2025
307		-	House Bill 242-First Edition Page 7
308		-	East Carolina University Brody School of Medicine, and sixty percent (60%) of the total hospital 1
309		-	costs for all public acute care hospitals and dividing that sum by the total hospital costs for all 2
310		-	acute care hospitals except for critical access hospitals." 3
311		-	SECTION 4. Except as otherwise provided, this act is effective on the first day of 4
312		-	the next assessment quarter after the date this act becomes law and applies to assessments 5
313		-	imposed on or after that date. 6
	45	+	HASP program and (ii) the costs to prepaid health plans from the gross 33
	46	+	premiums tax under G.S. 105-228.5 and the insurance regulatory charge under 34
	47	+	G.S. 58-6-25 associated with those hospital reimbursements. 35
	48	+	H.B. 242
	49	+	Feb 26, 2025
	50	+	HOUSE PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
	51	+	Page 2 DRH10095-NLxf-21
	52	+	(6d)(6e) Healthcare access and stabilization program (HASP). – The directed 1
	53	+	payment program providing increased reimbursements to acute care hospitals 2
	54	+	and freestanding psychiatric hospitals as approved by CMS and authorized by 3
	55	+	G.S. 108A-148.1. 4
	56	+	…." 5
	57	+	SECTION 2.(b) G.S. 108A-146.1 reads as rewritten: 6
	58	+	"§ 108A-146.1. Public hospital modernized assessment. 7
	59	+	(a) The public hospital modernized assessment imposed under this Part shall apply to all 8
	60	+	public acute care hospitals. 9
	61	+	(b) The public hospital modernized assessment shall be assessed as a percentage of each 10
	62	+	public acute care hospital's hospital costs. The assessment percentage shall be calculated 11
	63	+	quarterly by the Department of Health and Human Services in accordance with this Part. The 12
	64	+	percentage for each quarter shall equal the aggregate acute care hospital modernized assessment 13
	65	+	collection amount under G.S. 108A-146.5 multiplied by the public hospital historical assessment 14
	66	+	share and divided by the total hospital costs for all public acute care hospitals holding a license 15
	67	+	on the first day of the assessment quarter." 16
	68	+	SECTION 2.(c) G.S. 108A-146.3 reads as rewritten: 17
	69	+	"§ 108A-146.3. Private hospital modernized assessment. 18
	70	+	(a) The private hospital modernized assessment imposed under this Part shall apply to all 19
	71	+	private acute care hospitals. 20
	72	+	(b) The private hospital modernized assessment shall be assessed as a percentage of each 21
	73	+	private acute care hospital's hospital costs. The assessment percentage shall be calculated 22
	74	+	quarterly by the Department of Health and Human Services in accordance with this Part. The 23
	75	+	percentage for each quarter shall equal the aggregate acute care hospital modernized assessment 24
	76	+	collection amount under G.S. 108A-146.5 multiplied by the private hospital historical assessment 25
	77	+	share and divided by the total hospital costs for all private acute care hospitals holding a license 26
	78	+	on the first day of the assessment quarter." 27
	79	+	SECTION 2.(d) Part 2 of Article 7B of Chapter 108A of the General Statutes is 28
	80	+	amended by adding a new section to read: 29
	81	+	"§ 108A-146.4. Freestanding psychiatric hospital modernized assessment. 30
	82	+	(a) The freestanding psychiatric hospital modernized assessment imposed under this Part 31
	83	+	shall apply to all freestanding psychiatric hospitals. 32
	84	+	(b) The freestanding psychiatric hospital modernized assessment shall be assessed as a 33
	85	+	percentage of each freestanding psychiatric hospital's hospital costs. The assessment percentage 34
	86	+	shall be calculated quarterly by the Department of Health and Human Services in accordance 35
	87	+	with this Part. The percentage for each quarter shall equal the modernized freestanding 36
	88	+	psychiatric hospital HASP component under G.S. 108A-146.10A divided by the total hospital 37
	89	+	costs for all freestanding psychiatric hospitals holding a license on the first day of the assessment 38
	90	+	quarter." 39
	91	+	SECTION 2.(e) G.S. 108A-146.5 reads as rewritten: 40
	92	+	"§ 108A-146.5. Aggregate acute care hospital modernized assessment collection amount. 41
	93	+	(a) The aggregate modernized assessment collection amount is an amount of money that 42
	94	+	is calculated by subtracting the modernized intergovernmental transfer adjustment component 43
	95	+	under G.S. 108A-146.13 from the total modernized nonfederal receipts under subsection (b) of 44
	96	+	this section and then adding the positive or negative amount of the modernized IGT actual 45
	97	+	receipts adjustment component under G.S. 108A-146.14. 46
	98	+	(b) The total modernized nonfederal receipts is the sum of all of the following: 47
	99	+	(1) One-fourth of the State's annual Medicaid payment. 48
	100	+	(2) The managed care component under G.S. 108A-146.7. 49
	101	+	(3) The fee-for-service component under G.S. 108A-146.9. 50 General Assembly Of North Carolina Session 2025
	102	+	DRH10095-NLxf-21 Page 3
	103	+	(3a) The modernized acute care hospital HASP component under 1
	104	+	G.S. 108A-146.10. 2
	105	+	(3b) The modernized freestanding psychiatric hospital HASP component under 3
	106	+	G.S. 108A-146.10A. 4
	107	+	(4) The GME component under G.S. 108A-146.11. 5
	108	+	(5) Beginning April 1, 2022, and ending March 31, 2027, the postpartum 6
	109	+	coverage component under G.S. 108A-146.12. 7
	110	+	(6) Beginning April 1, 2024, the home and community-based services component 8
	111	+	under G.S. 108A-146.12A. 9
	112	+	(c) The aggregate acute care hospital modernized assessment collection amount is an 10
	113	+	amount of money equal to the aggregate modernized assessment collection amount under 11
	114	+	subsection (a) of this section minus the modernized freestanding psychiatric hospital HASP 12
	115	+	component under G.S. 108A-146.10A." 13
	116	+	SECTION 2.(f) G.S. 108A-146.10 reads as rewritten: 14
	117	+	"§ 108A-146.10. Modernized acute care hospital HASP component. 15
	118	+	The modernized acute care hospital HASP component is an amount of money that is 16
	119	+	calculated each quarter by multiplying the aggregate amount of HASP directed payments due to 17
	120	+	PHPs in the current quarter for hospital reimbursements to acute care hospitals that are not 18
	121	+	attributable to newly eligible individuals by the nonfederal share for not newly eligible 19
	122	+	individuals." 20
	123	+	SECTION 2.(g) Part 2 of Article 7B of Chapter 108A of the General Statutes is 21
	124	+	amended by adding a new section to read: 22
	125	+	"§ 108A-146.10A. Modernized freestanding psychiatric hospital HASP component. 23
	126	+	The modernized freestanding psychiatric hospital HASP component is an amount of money 24
	127	+	that is calculated each quarter by multiplying the aggregate amount of HASP directed payments 25
	128	+	due to PHPs in the current quarter for reimbursements to freestanding psychiatric hospitals that 26
	129	+	are not attributable to newly eligible individuals by the nonfederal share for not newly eligible 27
	130	+	individuals." 28
	131	+	SECTION 2.(h) G.S. 108A-146.13 reads as rewritten: 29
	132	+	"§ 108A-146.13. Modernized presumptive IGT adjustment component. 30
	133	+	… 31
	134	+	(c) The modernized presumptive IGT adjustment component is an amount of money 32
	135	+	equal to the sum of all of the following subcomponents: 33
	136	+	(1) The public hospital IGT subcomponent is the total of the following amounts: 34
	137	+	a. Sixteen and forty-three hundredths percent (16.43%) of the amount of 35
	138	+	money that is equal to the total modernized nonfederal receipts under 36
	139	+	G.S. 108A-146.5(b) for the current quarter minus the modernized 37
	140	+	acute care hospital HASP component under G.S. 108A-146.10 for the 38
	141	+	current quarter and minus the modernized freestanding psychiatric 39
	142	+	hospital HASP component under G.S. 108A-146.10A for the current 40
	143	+	quarter. 41
	144	+	b. Sixty percent (60%) of the nonfederal share for not newly eligible 42
	145	+	individuals of the aggregate amount of HASP directed payments due 43
	146	+	to PHPs in the current quarter for reimbursements to public acute care 44
	147	+	hospitals and that are not attributable to newly eligible individuals. 45
	148	+	(2) The UNC Health Care System IGT subcomponent is the total of the following 46
	149	+	amounts: 47
	150	+	a. Four and sixty-two hundredths percent (4.62%) of the difference of 48
	151	+	amount of money that is equal to the total modernized nonfederal 49
	152	+	receipts under G.S. 108A-146.5(b) for the current quarter minus the 50
	153	+	modernized acute care hospital HASP component under 51 General Assembly Of North Carolina Session 2025
	154	+	Page 4 DRH10095-NLxf-21
	155	+	G.S. 108A-146.10 for the current quarter and minus the modernized 1
	156	+	freestanding psychiatric hospital HASP component under 2
	157	+	G.S. 108A-146.10A for the current quarter. 3
	158	+	b. The nonfederal share for not newly eligible individuals of the 4
	159	+	aggregate amount of HASP directed payments due to PHPs in the 5
	160	+	current quarter for reimbursements to UNC Health Care System 6
	161	+	hospitals that are not attributable to newly eligible individuals. 7
	162	+	(3) The East Carolina University IGT subcomponent is the total of the following 8
	163	+	amounts: 9
	164	+	a. One and four hundredths percent (1.04%) of the difference of amount 10
	165	+	of money that is equal to the total modernized nonfederal receipts 11
	166	+	under G.S. 108A-146.5(b) for the current quarter minus the 12
	167	+	modernized acute care hospital HASP component under 13
	168	+	G.S. 108A-146.10 for the current quarter and minus the modernized 14
	169	+	freestanding psychiatric hospital HASP component under 15
	170	+	G.S. 108A-146.10A for the current quarter. 16
	171	+	b. The nonfederal share for not newly eligible individuals of the 17
	172	+	aggregate amount of HASP directed payments due to PHPs in the 18
	173	+	current quarter for reimbursements to the primary affiliated teaching 19
	174	+	hospital for the East Carolina University Brody School of Medicine 20
	175	+	that are not attributable to newly eligible individuals." 21
	176	+	SECTION 3.(a) G.S. 108A-147.1 reads as rewritten: 22
	177	+	"§ 108A-147.1. Public hospital health advancement assessment. 23
	178	+	(a) The public hospital health advancement assessment imposed under this Part shall 24
	179	+	apply to all public acute care hospitals. 25
	180	+	(b) The public hospital health advancement assessment shall be assessed as a percentage 26
	181	+	of each public acute care hospital's hospital costs. The assessment percentage shall be calculated 27
	182	+	quarterly by the Department in accordance with this Part. The percentage for each quarter shall 28
	183	+	equal the aggregate acute care hospital health advancement assessment collection amount 29
	184	+	calculated under G.S. 108A-147.3 multiplied by the public hospital historical assessment share 30
	185	+	and divided by the total hospital costs for all public acute care hospitals holding a license on the 31
	186	+	first day of the assessment quarter." 32
	187	+	SECTION 3.(b) G.S. 108A-147.2 reads as rewritten: 33
	188	+	"§ 108A-147.2. Private hospital health advancement assessment. 34
	189	+	(a) The private hospital health advancement assessment imposed under this Part shall 35
	190	+	apply to all private acute care hospitals. 36
	191	+	(b) The private hospital health advancement assessment shall be assessed as a percentage 37
	192	+	of each private acute care hospital's hospital costs. The assessment percentage shall be calculated 38
	193	+	quarterly by the Department in accordance with this Part. The percentage for each quarter shall 39
	194	+	equal the aggregate acute care hospital health advancement assessment collection amount 40
	195	+	calculated under G.S. 108A-147.3 multiplied by the private hospital historical assessment share 41
	196	+	and divided by the total hospital costs for all private acute care hospitals holding a license on the 42
	197	+	first day of the assessment quarter." 43
	198	+	SECTION 3.(c) Part 3 of Article 7B of Chapter 108A of the General Statutes is 44
	199	+	amended by adding a new section to read: 45
	200	+	"§ 108A-147.2A. Freestanding psychiatric hospital health advancement assessment. 46
	201	+	(a) The freestanding psychiatric hospital health advancement assessment imposed under 47
	202	+	this Part shall apply to all freestanding psychiatric hospitals. 48
	203	+	(b) The freestanding psychiatric hospital health advancement assessment shall be 49
	204	+	assessed as a percentage of each freestanding psychiatric hospital's hospital costs. The assessment 50
	205	+	percentage shall be calculated quarterly by the Department in accordance with this Part. The 51 General Assembly Of North Carolina Session 2025
	206	+	DRH10095-NLxf-21 Page 5
	207	+	percentage for each quarter shall equal the health advancement freestanding psychiatric hospital 1
	208	+	HASP component calculated under G.S. 108A-147.6A divided by the total hospital costs for all 2
	209	+	freestanding psychiatric hospitals holding a license on the first day of the assessment quarter." 3
	210	+	SECTION 3.(d) G.S. 108A-147.3 reads as rewritten: 4
	211	+	"§ 108A-147.3. Aggregate acute care hospital health advancement assessment collection 5
	212	+	amount. 6
	213	+	(a) The aggregate health advancement assessment collection amount is an amount of 7
	214	+	money that is calculated quarterly by adjusting the total nonfederal receipts for health 8
	215	+	advancement calculated under subsection (b) of this section by (i) subtracting the health 9
	216	+	advancement presumptive IGT adjustment component calculated under G.S. 108A-147.9, (ii) 10
	217	+	adding the positive or negative health advancement IGT actual receipts adjustment component 11
	218	+	calculated under G.S. 108A-147.10, and (iii) subtracting the positive or negative IGT share of 12
	219	+	the reconciliation adjustment component calculated under G.S. 108A-147.11(b). 13
	220	+	(b) The total nonfederal receipts for health advancement is an amount of money that is 14
	221	+	calculated quarterly by adding all of the following: 15
	222	+	(1) The presumptive service cost component calculated under G.S. 108A-147.5. 16
	223	+	(2) The HASP health advancement acute care hospital HASP component 17
	224	+	calculated under G.S. 108A-147.6. 18
	225	+	(2a) The health advancement freestanding psychiatric hospital HASP component 19
	226	+	calculated under G.S. 108A-147.6A. 20
	227	+	(3) The administration component calculated under G.S. 108A-147.7. 21
	228	+	(4) The State retention component under G.S. 108A-147.9. 22
	229	+	(5) The positive or negative health advancement reconciliation adjustment 23
	230	+	component calculated under G.S. 108A-147.11(a). 24
	231	+	(c) The aggregate acute care hospital health advancement assessment collection amount 25
	232	+	is an amount of money equal to the aggregate health advancement assessment collection amount 26
	233	+	under subsection (a) of this section minus the health advancement freestanding psychiatric 27
	234	+	hospital HASP component under G.S. 108A-147.6A." 28
	235	+	SECTION 3.(e) G.S. 108A-147.5 reads as rewritten: 29
	236	+	"§ 108A-147.5. Presumptive service cost component. 30
	237	+	(a) For every State fiscal quarter prior to the fiscal quarter in which G.S. 108A-54.3A(24) 31
	238	+	becomes effective, the presumptive service cost component is zero. 32
	239	+	(b) For the State fiscal quarter in which G.S. 108A-54.3A(24) becomes effective, the 33
	240	+	presumptive service cost component is the product of forty-eight million seven hundred fifty 34
	241	+	thousand dollars ($48,750,000) multiplied by the number of months in that State fiscal quarter in 35
	242	+	which G.S. 108A-54.3A(24) is effective during any part of the month. 36
	243	+	(c) For the first State fiscal quarter after the State fiscal quarter in which 37
	244	+	G.S. 108A-54.3A(24) becomes effective, the presumptive service cost component is one hundred 38
	245	+	forty-six million two hundred fifty thousand dollars ($146,250,000). 39
	246	+	(d) For the second State fiscal quarter after the State fiscal quarter in which 40
	247	+	G.S. 108A-54.3A(24) becomes effective, and for each State fiscal quarter thereafter, the 41
	248	+	presumptive service cost component is an amount of money that is the greatest of the following: 42
	249	+	(1) The prior quarter's presumptive service cost component amount. 43
	250	+	(2) The prior quarter's presumptive service cost component amount increased by 44
	251	+	a percentage that is the sum of each monthly percentage change in the 45
	252	+	Consumer Price Index: Medical Care for the most recent three months 46
	253	+	available on the first day of the current quarter. 47
	254	+	(3) The prior quarter's presumptive service cost component amount increased by 48
	255	+	the percentage change in the weighted average of the base capitation rates for 49
	256	+	standard benefit plans for all rating groups associated with newly eligible 50
	257	+	individuals compared to the prior quarter. The weight for each rating group 51 General Assembly Of North Carolina Session 2025
	258	+	Page 6 DRH10095-NLxf-21
	259	+	shall be calculated using member months documented in the Medicaid 1
	260	+	managed care capitation rate certification for standard benefit plans. 2
	261	+	(4) The prior quarter's presumptive service cost component amount increased by 3
	262	+	the percentage change in the weighted average of the base capitation rates for 4
	263	+	BH IDD tailored plans for all rating groups associated with newly eligible 5
	264	+	individuals compared to the prior quarter. The weight for each rating group 6
	265	+	shall be calculated using member months documented in the Medicaid 7
	266	+	managed care capitation rate certification for BH IDD tailored plans. 8
	267	+	(5) The amount produced from multiplying 1.15 by the highest amount produced 9
	268	+	when calculating, for each quarter that is at least two and not more than five 10
	269	+	quarters prior to the current quarter, the actual nonfederal expenditures for the 11
	270	+	applicable quarter minus the HASP health advancement acute care hospital 12
	271	+	HASP component calculated under G.S. 108A-147.6 for the applicable 13
	272	+	quarter and minus the health advancement freestanding psychiatric hospital 14
	273	+	HASP component calculated under G.S. 108A-147.6A for the applicable 15
	274	+	quarter." 16
	275	+	SECTION 3.(f) G.S. 108A-147.6 reads as rewritten: 17
	276	+	"§ 108A-147.6. HASP health Health advancement acute care hospital HASP component. 18
	277	+	The HASP health advancement acute care hospital HASP component is an amount of money 19
	278	+	that is calculated by multiplying the aggregate amount of HASP directed payments due to PHPs 20
	279	+	in the current quarter for hospital reimbursements to acute care hospitals attributable to newly 21
	280	+	eligible individuals by the nonfederal share for newly eligible individuals." 22
	281	+	SECTION 3.(g) Part 3 of Article 7B of Chapter 108A of the General Statutes is 23
	282	+	amended by adding a new section to read: 24
	283	+	"§ 108A-147.6A. Health advancement freestanding psychiatric hospital HASP component. 25
	284	+	The health advancement freestanding psychiatric hospital HASP component is an amount of 26
	285	+	money that is calculated by multiplying the aggregate amount of HASP directed payments due 27
	286	+	to PHPs in the current quarter for reimbursements to freestanding psychiatric hospitals 28
	287	+	attributable to newly eligible individuals by the nonfederal share for newly eligible individuals." 29
	288	+	SECTION 3.(h) G.S. 108A-147.11 reads as rewritten: 30
	289	+	"§ 108A-147.11. Health advancement reconciliation adjustment component. 31
	290	+	(a) The health advancement reconciliation adjustment component is a positive or 32
	291	+	negative dollar amount equal to the actual nonfederal expenditures for the quarter that is two 33
	292	+	quarters prior to the current quarter minus the sum of the following specified amounts: 34
	293	+	(1) The presumptive service cost component calculated under G.S. 108A-147.5 35
	294	+	for the quarter that is two quarters prior to the current quarter. 36
	295	+	(2) The positive or negative gross premiums tax offset amount calculated under 37
	296	+	G.S. 108A-147.12(b). 38
	297	+	(3) The HASP health advancement acute care hospital HASP component 39
	298	+	calculated under G.S. 108A-147.6 for the quarter that is two quarters prior to 40
	299	+	the current quarter. 41
	300	+	(4) The health advancement freestanding psychiatric hospital HASP component 42
	301	+	calculated under G.S. 108A-147.6A for the quarter that is two quarters prior 43
	302	+	to the current quarter. 44
	303	+	(b) The IGT share of the reconciliation adjustment component is a positive or negative 45
	304	+	dollar amount that is calculated by multiplying the health advancement reconciliation adjustment 46
	305	+	component calculated under subsection (a) of this section by the share of public hospital costs 47
	306	+	calculated under subsection (c) of this section. 48
	307	+	(c) The share of public hospital costs is calculated by adding total hospital costs for the 49
	308	+	UNC Health Care System, total hospital costs for the primary affiliated teaching hospital for the 50
	309	+	East Carolina University Brody School of Medicine, and sixty percent (60%) of the total hospital 51 General Assembly Of North Carolina Session 2025
	310	+	DRH10095-NLxf-21 Page 7
	311	+	costs for all public acute care hospitals and dividing that sum by the total hospital costs for all 1
	312	+	acute care hospitals except for critical access hospitals." 2
	313	+	SECTION 4. Except as otherwise provided, this act is effective on the first day of 3
	314	+	the next assessment quarter after the date this act becomes law and applies to assessments 4
	315	+	imposed on or after that date. 5