North Carolina HB 34: Protect Those Who Serve and Protect Act.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 4
HOUSE BILL 34
Committee Substitute Favorable 2/25/25
Senate Health Care Committee Substitute Adopted 6/17/26
Fourth Edition Engrossed 6/23/26

Short Title: Strengthen Medicaid Provider Controls. (Public)
Sponsors:
Referred to:
February 4, 2025
*H34-v-4*
A BILL TO BE ENTITLED 1
AN ACT TO STRENGTHEN MEDICAID PROVIDER CONTROLS AND MAKE OTHER 2
CHANGES TO THE MEDICAID PROGRAM. 3
The General Assembly of North Carolina enacts: 4
SECTION 1.(a) G.S. 108C-1 reads as rewritten: 5
"§ 108C-1. Scope; applicability of this Chapter. 6
This Chapter applies to providers enrolled in Medicaid. The Department may adopt rules to 7
implement any provision of this Chapter." 8
SECTION 1.(b) Chapter 108C of the General Statutes is amended by adding a new 9
section to read: 10
"§ 108C-3.1. Licensure limitation checks for providers. 11
When the Department becomes aware of an adverse action by a health care provider licensing 12
entity, including through self-reporting required under the Medicaid provider administrative 13
participation agreement, that either (i) imposes a license limitation or restriction on a provider's 14
scope of practice, the range of services, or the time, place, and manner in which any service is 15
rendered that deviates from the prevailing procedures for administering the services or (ii) 16
imposes a license limitation or restriction on a provider's ability or authority to provide care for 17
all patients, then the Department may deny or terminate the provider retroactively to the effective 18
date of the provider's licensing entity's adverse action." 19
SECTION 1.(c) Subsection (b) of this section is effective October 1, 2026, and 20
applies to adverse actions effective on or after that date. 21
SECTION 2.(a) G.S. 108C-2 is amended by adding a new subdivision to read: 22
"(2e) Committee. – The Provider Enrollment Credentialing Committee, established 23
under G.S. 108A-26.6." 24
SECTION 2.(b) Part 1 of Article 2 of Chapter 108A of the General Statutes is 25
amended by adding a new section to read: 26
"§ 108A-26.6. Provider Enrollment Credentialing Committee; provider enrollment 27
materials confidentiality. 28
(a) The Department shall establish and determine the membership of the Provider 29
Enrollment Credentialing Committee. The Committee is the centralized administrative body 30
within the Department authorized to adjudicate provider participation in various programs 31
administered by the Department. 32
(b) The Provider Enrollment Credentialing Committee may review enrollment 33
applications, including initial, reenrollment, and recredentialing during any provider 34

General Assembly Of North Carolina Session 2025
Page 2 House Bill 34-Fourth Edition
credentialing process. The Provider Enrollment Credentialing Committee may review a 1
provider's continued participation when the ongoing monitoring process reveals findings that can 2
impact a provider's eligibility for departmental programs. 3
(c) The Provider Enrollment Credentialing Committee is authorized to issue 4
determinations regarding the denial or termination of enrollment, reenrollment, revalidation, and 5
enrollment maintenance for providers, including those with risk factors identified through initial 6
application review or ongoing monitoring of the provider. 7
(d) The Provider Enrollment Credentialing Committee shall adopt bylaws and comply 8
with National Committee for Quality Assurance standards, federal law and regulations, and State 9
law. 10
(e) The following information about an individual that is acquired by the Department, 11
including through the Provider Enrollment Credentialing Committee, in connection with the 12
initial screening of applicants for enrollment, reenrollment, change requests, revalidation, or 13
ongoing monitoring of a provider applying for or participating in a departmental program, is 14
confidential and not a public record under Chapter 132 of the General Statutes: 15
(1) Health information, including chemical dependency or psychiatric conditions. 16
(2) Adverse licensure findings. 17
(3) Hospital admitting privileges denials or revocations. 18
(4) Liability insurance carrier cancellations, refusals, or unusual risk ratings. 19
(5) Confidential malpractice judgments and settlements. 20
(6) Any nonpublic criminal record information. 21
(7) Fingerprints. 22
(8) Any other information otherwise protected from public disclosure." 23
SECTION 2.(c) G.S. 108C-3(a) reads as rewritten: 24
"(a) Provider Screening. – The Department shall conduct provider screening of Medicaid 25
providers in accordance with applicable State or federal law or regulation. The authorization of 26
the Provider Enrollment Credentialing Committee extends to the Medicaid program, including 27
all prepaid health plans, as defined in G.S. 108D-1." 28
SECTION 3.(a) G.S. 108C-4 reads as rewritten: 29
"§ 108C-4. Criminal history record checks for certain providers. 30
(a) The Department shall conduct