SB 405 North Carolina Senate · 2025-2026 Session

Healthcare Investment Act.

SB 405, titled "Healthcare Investment Act" (though it focuses on chiropractic regulation), revises North Carolina's chiropractic practice laws. It updates the State Board of Chiropractic Examiners' composition (requiring 6 practicing chiropractors with 8+ years of experience, plus 2 public members), adds certification standards for chiropractors performing acupuncture, and establishes supervised preceptorship programs for chiropractic students. The bill also clarifies educational requirements (4,200 accredited hours, bachelor's degree) and reinforces that chiropractors cannot prescribe drugs or perform surgery. It directly affects chiropractors, chiropractic students, and the Board, with effective changes starting October 1, 2025.

Bill status failed 4 of 5 stages cleared

Introduction

Mar 2025

Committee Review

Oct 2025

Senate Passage

Apr 2025

House Passage

Oct 2025

Governor

Introduced Mar 24, 2025 Last action Oct 23, 2025

Maddy AI version diff · 3 comparisons

What changed between versions

Edition 2 → Edition 3 · 8 edits

MODERATE

The bill was completely rewritten from a chiropractic practice reform bill to a healthcare funding and Medicaid management bill. The original version focused on regulating chiropractic board membership and practice standards, while the new version addresses Medicaid funding adjustments, managed care organization transfers, and opioid settlement fund usage.

Scope change

The bill's scope changed entirely from chiropractic regulation to Medicaid and healthcare department funding management. The new version applies to the Department of Health and Human Services, Medicaid managed care organizations, and opioid abatement funds rather than chiropractic practitioners and licensing.

SCOPE

All provisions related to chiropractic board composition, licensing requirements, and practice standards were completely removed from the bill.

FISCAL

Added Medicaid rebase funding of $690 million annually for 2025-2027 to adjust for enrollment and cost changes.

Established specific intergovernmental transfer amounts from managed care organizations totaling $18.028 million annually.

Reduced single-stream funding by $18.56 million and further reduced opioid settlement funding by $14 million.

REQUIREMENT

Added requirements for managed care organizations to maintain service utilization levels comparable to 2024-2025.

Removed all chiropractic education requirements, including 4,200 hours of accredited education and specific examination subjects.

ENFORCEMENT

Added provisions allowing the Department of Health and Human Services to reallocate transfer amounts when counties change managed care organizations.

DEFINITION

Added new definitions for DMH/DD/SUS, Opioid Abatement Fund, and Opioid Abatement Reserve for the first time in this bill version.

Floor votes · Senate Apr 30, 2025 · House Oct 22, 2025

How they voted

36–11

Passed · 4 other

Total votes 51

Apr 30, 2025

D Democratic20

6 Yea 11 Nay 3

55% Nay

R Republican31

30 Yea 1

96% Yea

Vote distribution

All Yea All Nay Mixed No data

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Oct 22, 2025

Lower · Passed

Passed 3rd Reading

lower

Oct 22, 2025

Lower · Passed

Reptd Fav Com Substitute

lower

May 5, 2025

Committee

Ref To Com On Rules, Calendar, and Operations of the House

lower

Apr 30, 2025

Upper · Passed

Passed 3rd Reading

upper

Apr 29, 2025

Upper · Passed

Reptd Fav

upper

Apr 16, 2025

Committee

Re-ref Com On Rules and Operations of the Senate

upper

Apr 16, 2025

Upper · Passed

Com Substitute Adopted

upper

Apr 16, 2025

Upper · Passed

Reptd Fav Com Substitute

upper

Mar 26, 2025

Committee

Re-ref to Health Care. If fav, re-ref to Rules and Operations of the Senate

upper

Mar 25, 2025

Committee

Ref To Com On Rules and Operations of the Senate

upper

Mar 24, 2025

Introduced

Filed

upper

2 primary · 1 co-sponsor