North CarolinaHB 11042025-2026 SessionHouse

AN ACT TO REQUIRE THE NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE NORTH CAROLINA DEPARTMENT OF INFORMATION TECHNOLOGY, AND THE ADMINISTRATIVE OFFICE OF THE COURTS TO STUDY AND RECOMMEND SYSTEMIC IMPROVEMENTS TO THE INVOLUNTARY COMMITMENT PROCESS, AS RECOMMENDED BY THE HOUSE SELECT COMMITTEE ON INVOLUNTARY COMMITMENT AND PUBLIC SAFETY.

Sponsored By: Hugh Blackwell (Republican), Tricia Ann Cotham (Republican), Charles W. Miller (Republican), Timothy Reeder, MD (Republican)

Signed by Governor

AOCCIVIL PROCEDURECOLLEGES & UNIVERSITIESCOUNTIESCOURTSDHHSEMERGING TECHNOLOGIESHEALTH SERVICESHOSPITALSINFORMATION TECHNOLOGYINSTITUTIONALIZED PERSONSINTERNETJUDICIAL DEPT

Personalized for You

How does this bill affect your finances?

Personalize government policy and PRIA will tell you what this bill means for your household, plus every other piece of legislation we track. PRIA reads each provision against your financial profile to show you exactly what matters to your wallet.

Free to download

Bill Overview

Analyzed Economic Effects

15 provisions identified: 6 benefits, 1 costs, 8 mixed.

When charges end for incompetent defendants

If you are found unable to proceed, the court must dismiss charges on the earliest of three triggers. The court can dismiss if you will not regain capacity. It must dismiss if you have been confined as long as the maximum sentence for the most serious charge. It must also dismiss after 5 years (misdemeanors) or 10 years (felonies) from the incapacity finding. A dismissal for serving the maximum time blocks refiling on that basis; other dismissals can be refiled. These dismissals are not expunged under the listed expungement law.

Limits on forced medication for defendants

Beginning Dec 1, 2026, the law mostly bans forcing medication to make a defendant fit for trial. A judge may order medication only in serious‑offense cases and only with clear, written findings that it is necessary, medically appropriate, supervised by a licensed professional, and no less‑intrusive option works. The court reviews and can change or end the order. When a court orders outpatient treatment for such a defendant, medication rules follow this compelled‑medication law, not the outpatient‑commitment statute.

Stricter, longer outpatient mental health orders

The law broadens who can be placed on outpatient commitment and sets clear notice steps. Examiners must contact the local mental health agency and give you the provider’s name and contact. Providers may examine you, make a plan, and prescribe reasonable medication before the court hearing. Courts put the plan in the order, name the provider and local agency, and the clerk sends copies within 48 hours. If you do not follow the plan, the provider or local agency can ask for a statewide custody order to bring you for an exam; it counts as the first exam if a custody order issues within six hours. Starting Dec 1, 2026, clerks calendar supplemental hearings within 14 days and serve you at least 72 hours ahead; the court can order a new exam and, with strong proof, switch you to inpatient care. Not following the order creates a rebuttable presumption of dangerousness. If you move within North Carolina, the court transfers supervision, names a new provider and agency, and sends records; moving out of state or to an unknown location ends the order. Fifteen days before the end, the provider must tell the clerk if you still meet the criteria; if not, the clerk dismisses. If inpatient is ordered, your outpatient order ends, and notices go out within 48 hours. Maximum outpatient time can be up to 180 days; combined inpatient–outpatient orders can total up to 180 days, with any inpatient part 90 days or less. At certain transfers and rehearings beginning Dec 1, 2026, courts may order up to 180 days of outpatient care. Local mental health agencies must keep a confidential list of people on outpatient orders.

New programs to restore trial capacity

The State’s policy is to provide capacity‑restoration services when feasible to people found unable to proceed. Services can include criminal‑justice education, teaching about the person’s condition, and mental health treatment, unless the forced‑medication law bars a specific treatment. DHHS must publish statewide treatment guidelines by Dec 1, 2026. The law also creates inpatient restoration programs in State psychiatric hospitals starting Dec 1, 2026.

Stronger privacy for health data sharing

Data in the State Health Information Exchange that include health or personal information are confidential and not public records. Federal law can still require some disclosures. Providers with substance‑use‑disorder records do not send those records to the HIE until the Authority gives written notice; after that, they must share them as federal law allows.

Restoration orders and time limits for defendants

If the court finds you cannot proceed but are likely to regain capacity, it must order you into a restoration program. If you are out on release, you go to a community program if available; if you are in jail, you go to a jail program if available; inpatient is allowed when clinically right. The court sets an initial term up to 4 months and can extend in 4‑month steps. Non‑felony cases cannot require more than 12 months of restoration total, not counting wait time. The court can waive referral if no program is available, you are expected to recover without services, or for other good cause. If you are unlikely to regain capacity, the court cannot order restoration and must consider dismissal. The court can set or change pretrial release conditions and other safety orders as your status changes. Treatment plans after civil commitment must use best practices to restore capacity, and lack of capacity alone cannot keep you committed.

Shifting cases into civil commitment when needed

After an incapacity finding, the judge must check if there are reasonable grounds for civil commitment and, if so, issue a custody order like a clerk would. At a later hearing, the court can also refer you for civil commitment if it finds reasonable grounds that you have a mental illness and are dangerous, or will become dangerous without treatment. Before dismissing a case for incapacity, the court must consider a prosecutor’s request to start civil commitment and can issue a custody order. For violent charges, custody orders must direct law enforcement to a 24‑hour facility when space is available. The court can order short‑term detention while commitment starts. Evidence from the capacity hearing can be used in the commitment case. Commitment cases can be filed in the criminal case county or in the county where you are hospitalized. Rehearings for inpatient commitments are handled by a judge in the facility’s district (or a judge assigned there).

Broader sharing of health and court records

When a court finds a defendant lacks capacity, it must send that record to the national background check system (NICS). Starting December 1, 2026, the health department can access needed, confidential Article 5 court data to do its duties and must keep it private. Judges setting pretrial release can check if a defendant was involuntarily committed in the last three years. The state’s health information exchange board now has 13 voting members, including the Deputy Secretary for Medicaid and the State Health Plan’s executive administrator.

More jail-based restoration and staff immunity

The state can contract for three or more jail‑based restoration programs, set up by counties or regions with sheriff consent and tied to the nearest state hospital. This can expand local access to restoration. People and agencies who custody, transport, examine, treat, or release defendants under this law are civilly immune unless they are grossly negligent.

Faster mental exams and reports for defendants

The law tightens timelines and content for mental exams in criminal cases. Reports must say if the person can proceed, why or why not, the chance to regain capacity, and the best treatment and setting. Exams may be done by secure two‑way video unless the evaluator needs an in‑person visit. Deadlines: misdemeanors 10 days if in custody and 20 days if not; felonies 30 days after the exam; independent exams 60 days. The exam site must send the report to the clerk, the district attorney, and the defense lawyer.

Quicker hearings when capacity may return

When the clerk learns you likely regained capacity, the clerk must notify both attorneys within 72 hours. The district attorney must set a supplemental hearing within 30 days or the next court term. If the court finds you can proceed, your case must be set for trial as soon as possible. Delays over 60 days need extraordinary reasons and a written order. The court can order services during this time if they are available and needed to keep your capacity from slipping. If you are supervised as a release condition, your supervisor must report right away if you seem to have regained capacity.

Regular reports to the court from programs and hospitals

Programs must update the court every 60 days on your status and tell the court right away if you gain capacity. Programs must also report at once if you are not suitable, need a different setting, or pose a danger to staff. Hospitals and providers with custody after civil commitment must report before discharge or release, check if you can proceed, and share exam results when possible. Starting December 1, 2026, when a court ends outpatient commitment, the clerk must send the discharge order to your provider and the LME/MCO.

Less frequent HIE uploads for pharmacies

Pharmacies send claims data to the State HIE once a day instead of twice. The rule uses standard pharmacy formats. It applies to claims paid by Medicaid and other state‑funded health programs.

Tighter custody rules for violent charges

If you face a violent charge and likely regain capacity while committed, the sheriff must return you for a supplemental hearing and hold you for that hearing and trial under court orders. While waiting, the court can require restoration services if they are reasonably available. If you are involuntarily committed and charged with a violent crime, any release from a hospital or provider must be to a named law enforcement agency. If the order does not name an agency, the provider may follow its procedures to choose an appropriate recipient.

When these new rules take effect

Most Article 5 court and commitment changes start December 1, 2026, and apply to proceedings on or after that date. Section 13 also starts December 1, 2026, for capacity hearings held on or after that date. A pretrial release subsection starts July 1, 2028, for people appearing then or later. Section 9.5 starts July 1, 2028, for custody orders issued on or after that date.

Sponsors & Cosponsors

Cosponsors

Laura Budd
Democratic • House
Celeste C. Cairns
Republican • House
Grant L. Campbell, MD
Republican • House
Todd Carver
Republican • House
Tracy Clark
Democratic • House
Carla D. Cunningham
Independent • House
Brian Echevarria
Republican • House
Frances Jackson, PhD
Democratic • House
Gloristine Brown
Democratic • House
Dudley Greene
Republican • House
Kanika Brown
Democratic • House
Donnie Loftis
Republican • House
Jeffrey C. McNeely
Republican • House
Larry W. Potts
Republican • House
Heather H. Rhyne
Republican • House
Dennis Riddell
Republican • House
Terry M. Brown Jr.
Democratic • House
Bill Ward
Republican • House
Donna McDowell White
Republican • House

Roll Call Votes

All Roll Calls

Yes: 298 • No: 23

House vote • 7/1/2026

HB 1104: Improve Involuntary Commitment Process and Enhance Public Safety.

Yes: 105 • No: 10 • Other: 5

Senate vote • 6/30/2026

HB 1104: Improve IVC Process and Enhance Public Safety.

Yes: 45 • No: 3 • Other: 1