SB 316 — Lower Healthcare Costs.

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2025 S 21 SENATE BILL 316 Health Care Committee Substitute Adopted 3/19/25 Short Title:

Senators Burgin, Galey, and Sawrey (Primary Sponsors).

Health Care March 18, 2025 A BILL TO BE ENTITLED AN ACT LOWERING HEALTHCARE COSTS AND INCREASING PRICE TRANSPARENCY.

and *S316-v-2**S316-v-1* General Assembly Of North Carolina Session 2025 Whereas, empowering patients and employers with pricing information will help create a healthcare system that prioritizes affordability, access, and choice;

Page 2 Senate Bill 316-Second316-First Edition General Assembly Of North Carolina Session 2025 (1) The amount that will be charged to a patient for each DRG if all charges are paid in full without a public or private third party paying for any portion of the charges.

The rules shall include the method by which the Department shall determine the 20 most common surgical procedures Senate Bill 316-Second316-First Edition Page 3 General Assembly Of North Carolina Session 2025 and the 20 most common imaging procedures for which the hospitals and ambulatory surgical facilities must provide the data set out in subsection (d) of this section.

The Commission shall notify the Revisor of Statutes when the rules required under G.S.

131E-214.13(f1)(1) and (f1)(2) take effect.

GREATER TRANSPARENCY IN HEALTHCARE PROVIDER BILLING PRACTICES Page 4 Senate Bill 316-Second Edition General Assembly Of North Carolina Session 2025 SECTION 2.1.

Page 4 Senate Bill 316-First Edition General Assembly Of North Carolina Session 2025 "Part 2.

(2) Text, using a bold or other distinguishable font, that states that certain consumer protections available to the insured individual when services are Senaterendered Billby 316-Seconda Editionhealth Pageservice 5facility Generalor Assemblyhealthcare Ofprovider Northparticipating Carolinain Sessionthe 2025Senate renderedBill by316-First aEdition healthPage service5 facilityGeneral orAssembly healthcareOf providerNorth participatingCarolina inSession the2025 insurer's healthcare provider network maynot be applicable when services are rendered by a nonparticipating health service facility.

At the time a healthcare provider notparticipating participatinginin an insurer's healthcare provider network (i) treats an insured individual for anythinganythingotherthan other than screening and stabilization in accordanceaccordancewith with G.S.

(1) AAstatementthatthe statementhealthcareproviderisnottheinsurer'shealthcareprovider that the healthcare provider is not in the insurer's healthcare provider network applicable to the individual.

Upon notice or request from the insured, the insurer shall determine whether a healthcare provider able to meet the needs of the Page 6 Senate Bill 316-Second Edition General Assembly Of North Carolina Session 2025 insured is available to the insured without unreasonable delay by reference to the insured's location and the specific medical needs of the insured." Page 6 Senate Bill 316-First Edition General Assembly Of North Carolina Session 2025 SECTION 2.3.

75 PART III.

Senate Bill 316-Second Edition Page 7 General Assembly Of North Carolina Session 2025 (b) Good-Faith Estimate.

– Upon request of any patient for a good-faith estimate for a shoppable service, the facility shall provide to the patient, in writing, at least three business days prior to the date the patient schedules the shoppable service, an itemized list of expected charges, Senate Bill 316-First Edition Page 7 General Assembly Of North Carolina Session 2025 in language comprehensible to an ordinarylayperson, that the patient will be obligated to pay for all items and services related to the shoppable service.

TheDepartment shall notifytheRevisor ofStatutes when the rules required under G.S.

131E-214.52 take effect.

Page 8 Senate Bill 316-Second Edition General Assembly Of North Carolina Session 2025 (1) No health care provider shall charge, bill, or collect a facility fee unless the services are provided on a hospital's main campus, at a remote location of a hospital, or at a facility that includes an emergency department.

Page 8 Senate Bill 316-First Edition General Assembly Of North Carolina Session 2025 (2) Regardless of where the services are provided, no health care provider shall charge, bill, or collect a facility fee for outpatient evaluation and management services, or any other outpatient, diagnostic, or imaging services identified by the Department.

131E-214.54, as enacted bySection 4.1(a) of this Part, becomes effective January 1, 2026, or on the date the rules adopted by the Department of Health and Human Services pursuant to Section 4.1(b) of this Part become effective, whichever is later,later. and applies to healthcare services provided on or after that date.

The Department shall notify the Revisor of Statutes when the rules required under Section 4.1(b) of this Part become effective.

Senate Bill 316-Second Edition Page 9 General Assembly Of North Carolina Session 2025 "(c) Responsibilities.

Senate Bill 316-First Edition Page 9 General Assembly Of North Carolina Session 2025 a.

of this subdivision." 6 PART VI.

ThepersonorpersonsThepersonorpersonsreviewingthe reviewingthe grievanceshall not be the same person or persons who initially handled the matter that is the subject of the grievance and, if the issue is a clinical one, at least one of whom shall be a medical doctor with appropriate expertise to evaluate the matter.

Page 10 Senate Bill 316-Second Edition General Assembly Of North Carolina Session 2025 a.

Page 10 Senate Bill 316-First Edition General Assembly Of North Carolina Session 2025 …." SECTION 6.1.(c) G.S.

ELIMINATIONCLARIFY OFPARTNERSHIPS CERTIFICATEREGARDING OFTHE NEEDPRACTICE REVIEWOF FORDENTISTRY INPATIENT REHABILITATION SERVICES, REHABILITATION FACILITIES, AND REHABILITATION BEDS SECTION 7.1.

90-29(c) reads as rewritten:

"(c) Thefollowingacts,practices,oroperations,however,shallnotconstitutetheunlawful practice of dentistry:

… (15) The mechanism by which a "management company," as that term is defined in G.S.

90-40.2(a)(4), and a licensee establish the fee in a "management arrangement," as that term is defined in G.S.

90-40.2(a)(3).

A management fee established under this exception is a private business contract and shall not be construed to be evidence of a partnership under Chapter 59 of the General Statutes." PART VIII.

ELIMINATION OF CERTIFICATE OF NEED REVIEW FOR INPATIENT REHABILITATION SERVICES, REHABILITATION FACILITIES, AND REHABILITATION BEDS SECTION 8.1.

G.S.

(iv) (ii)nursing Senate Bill 316-First Edition Page 11 General Assembly Of North Carolina Session 2025 home beds;

– A public or private institution which that is primarily engaged in providing to inpatients, by or under supervision of physicians, diagnostic Senate Bill 316-Second Edition Page 11 General Assembly Of North Carolina Session 2025 services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons.