Effective January 1, 2026, amends and adds to Part I, Licensing, of Article I, Adult Care Homes, GS Chapter 131D, as follows. 
Amends GS 131D-2.1, eliminating multiunit assisted housing with services as a defined term. Deletes multiunit assisted housing with services from the types of assisted living residences, as defined. Deletes the term registration. Adds and defines registered residential facility to mean a nonlicensed residence for two or more unrelated adults, by whatever name it is called, in which the housing management arranges for a licensed home care or hospice agency to provide hands-on personal care services and nursing services to residents through an individualized written care plan; excludes described continuing care retirement communities and temporary family health care structures. Makes changes throughout the Part to replace references to multiunit assisted housing with services to registered residential facilities. 
Expands the types of health concerns or care needs that generally prevent individuals from being accepted to a registered residential facility under GS 131D-2.2 to include: (1) individuals who, because of one or more physical or cognitive impairments, are unable to evacuate from the registered residential facility independently without physical or verbal assistance and (2) individuals who exhibit wandering behaviors or who, because of one or more cognitive impairments, require supervision to maintain their safety in the registered residential facility. Modifies the exception to the prohibition by now allowing the facilities to care for individuals with one of the listed conditions or care needs if a physician certifies that the appropriate care can be provided on a temporary basis by an appropriate licensed health care professional to meet the resident's needs and prevent unnecessary relocation (previously, did not require that the care be provided by an appropriate licensed health care professional).
Enacts GS 131D-2.2A providing for the annual registration of registered residential facilities with the Division of Health Service Regulation (Division) as follows. Lists eleven required disclosures that must be included on a disclosure statement as part of its application, including (1) charges for rentals or services offered by the facility which cannot be changed without 30 days' written notice to residents; and (2) a listing of all licensed home care and hospice agencies and other community services located in the same areas a the facility and their contact information. Requires the Division to approve or disapprove of the disclosure statement as part of the registration process. Requires registered residential facilities to continually comply with the disclosure statement and notify the Division within 14 days of making any changes. Requires inclusion of the disclosure statement as part of the resident's annual rental contract and requires the resident or their legal representative to annually sign the statement.
Requires the housing management of a registered residential facility to have a financial interest or affiliation, or formal written agreement that makes personal care services accessible and available to residents through at least one licensed home care or hospice agency. Provides for resident choice of provider, separate billing for personal care services, and informed consent for contracting housing and services. 
Requires initial and annual screening of residents to identify resident needs and ancillary services needed. Allows for assistance with self-administration of medications by appropriately trained staff if a licensed nurse has approved the delegation of medication pursuant to the home care agency's established plan of care for the resident.  
Prohibits a registered residential facility and its owners, agents, employees, or affiliates from serving as a resident's legal representative or payee, or handling a resident's funds. Requires criminal background checks for registered residential facility employees.  Bars hiring or using as a volunteer any individual listed on the NC Health Care Personnel Registry (Registry). Requires registered residential facilities to verify that a licensed home care or hospice agency conducts criminal background checks of its employees prior to referrals. 
Authorizes the Division to deny, suspend, or revoke, the registration of a registered residential facility for any of the three listed reasons, including that the Division has determined the facility is providing services that require a license rather than registration or that the Division has determined the facility is not in compliance with its disclosure statement. Authorizes the Secretary of the Department of Health and Human Services (DHHS Secretary) to deny, suspend, amend, or revoke the registration of a registered residential facility, or suspend the admission of any new residents to a registered residential facility, in any case in which the DHHS Secretary finds that there  has been a substantial failure to comply with Part 1 of Article 1 of GS Chapter 131D, any applicable rules adopted under Part 1, or any other applicable State laws or rules. Allows a facility to contest the Division’s or the Secretary's actions by requesting an administrative hearing under GS Chapter 150B (the APA).
Establishes a duty of a registered residential facility that knows or has cause to suspect that a resident is being abused, neglected, or exploited to report to law enforcement, the Registry, and the appropriate county department of social services, pursuant to State law. 
Provides for inspection by the Secretary to investigate complaints filed with the Division and requires requires registered residential facilities to allow the Division  access to the premises and records upon request. Provides a timeline and requirements for the Division to send a written report of its findings to the facility and for the facility to submit a plan of correction to the Division. Permits the Division to take adverse action for failure to submit a plan of correction.
Excludes registered residential facilities from those facilities exempt from licensure requirements under Article 1, set forth in GS 131D-2.3.
Amends GS 131D-2.5 to refer to a registered residential facility instead of a multiunit assisted housing with services. 
Amends GS 131D-2.6 to authorize DHHS to initiate injunctive or other proceedings against any person to restrain or prevent the establishment, conduct, management, or operation of a registered residential facility without approved registration. 
Amends GS 143B-165, directing the Medical Care Commission (Commission) to adopt rules establishing standards for registered residential facilities, including those previously required for multiunit assisted housing with services as well as inspections and the approval, denial, revocation, or amendment of a facility's registration, and suspension of admission at a facility. 
Authorizes the Commission to adopt emergency rules to implement the act, as specified, which sunsets on the earlier of January 1, 2027, or the date permanent rules adopted by the Commission become effective. Prohibits the Commission from adopting temporary rules pursuant to this provision.
Effective January 1, 2026, amends GS 131E-256, governing the Registry, to include registered residential facilities in the definition of "health care facilities". 
Appropriates $355,214 in recurring funds to the Division for each year of 2025-27 to fund three FTE Facility Compliance Consultant I positions dedicated to the Division to assist with the registration and inspection of registered residential facilities. Appropriates $18,000 to the Division for the 2025-26 year to purchase equipment, supplies, and other nonrecurring expenses associated with the positions.

Statutes affected:
Filed: 143B-165, 131E-256
Edition 1: 143B-165, 131E-256