GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 494
|
Short Title: Limit the Scope of Certificate of Need Laws. |
(Public) |
|
|
Sponsors: |
Senator Jarvis (Primary Sponsor). |
|
|
Referred to: |
Rules and Operations of the Senate |
|
March 26, 2025
A BILL TO BE ENTITLED
AN ACT encouraging the expansion of health care access by eliminating certificate of need laws in all counties except those that have a population of less than ONE HUNDRED THOUSAND and at least one functioning hospital.
The General Assembly of North Carolina enacts:
SECTION 1. Article 9 of Chapter 131E of the General Statutes is amended by adding a new section to read:
"§ 131E‑175.5. Scope of Article.
This Article applies only to counties that meet both of the following criteria:
(1) Have a population of less than 100,000 according to the most recent federal decennial census.
(2) Have at least one functioning hospital within the county."
SECTION 2. Effective November 21, 2025, Section 3.2 of S.L. 2023‑7 reads as rewritten:
"SECTION 3.2.(a) G.S. 131E‑176, as amended by Section 3.1 of this act, reads as rewritten:
"§ 131E‑176. Definitions.
The following definitions apply in this Article:
…
(9b) Health service facility. –
A hospital; long‑term care hospital; rehabilitation facility; nursing
home facility; adult care home; kidney disease treatment center, including
freestanding hemodialysis units; intermediate care facility for individuals
with intellectual disabilities; home health agency office; diagnostic center;
hospice office, hospice inpatient facility, hospice residential care facility;
and ambulatory surgical facility. The term "health service facility"
does not include a qualified urban ambulatory surgical facility.
…
(16) New institutional health services. – Any of the following:
…
b. Except with respect to
qualified urban ambulatory surgical facilities and except as otherwise
provided in G.S. 131E‑184(e), the obligation by any person of a
capital expenditure exceeding four million dollars ($4,000,000) to develop or
expand a health service or a health service facility, or which relates to the
provision of a health service. The cost of any studies, surveys, designs,
plans, working drawings, specifications, and other activities, including staff
effort and consulting and other services, essential to the acquisition,
improvement, expansion, or replacement of any plant or equipment with respect
to which an expenditure is made shall be included in determining if the
expenditure exceeds four million dollars ($4,000,000). Beginning September 30,
2022, and on September 30 each year thereafter, the amount in this sub‑subdivision
shall be adjusted using the Medical Care Index component of the Consumer Price
Index published by the U.S. Department of Labor for the 12‑month period
preceding the previous September 1.
…
(21a) Qualified urban ambulatory surgical facility.
– An ambulatory surgical facility that meets all of the following criteria:
a. Is licensed by the Department to operate as an ambulatory
surgical facility.
b. Has a single specialty or multispecialty
ambulatory surgical program.
c. Is located in a county with a population
greater than 125,000 according to the 2020 federal decennial census or any
subsequent federal decennial census.has elected to opt out of the
certificate of need requirements prescribed by this Article by obtaining a
license as a qualified ambulatory surgical facility under Part 4 of Article 6
of this Chapter.
…
(24f) Specialty ambulatory surgical program. – A formal program for providing on a same‑day basis surgical procedures of the same surgical specialty and authorized by its certificate of need, if a certificate of need is required.
…."
"SECTION 3.2.(b) G.S. 131E‑146 is amended by adding a new subdivision to read:
"(3) "Qualified urban
ambulatory surgical facility" means an ambulatory surgical facility licensed
under this Part that has elected to opt out of the certificate of need
requirements prescribed by Article 9 of this Chapter and demonstrates to the
satisfaction of the Department that the facility meets the definition of
G.S. 131E‑176(21a).both of the following criteria:
a. Has a single specialty or multispecialty ambulatory surgical program.
b. Has agreed to adhere to the charity care and reporting requirements established by G.S. 131E‑147.5."
"SECTION 3.2.(b1) G.S. 131E‑147 reads as rewritten:
"§ 131E‑147. Licensure requirement.
(a) No person shall operate an ambulatory surgical facility or a qualified ambulatory surgical facility without a license obtained from the Department.
(b) Applications shall be available from the Department, and each application filed with the Department shall contain all necessary and reasonable information that the Department may by rule require. A license shall be granted to the applicant upon a determination by the Department that the applicant has complied with the provisions of this Part and the rules promulgated by the Commission under this Part. The Department shall charge the applicant a nonrefundable annual base license fee in the amount of eight hundred fifty dollars ($850.00) plus a nonrefundable annual per‑operating room fee in the amount of seventy‑five dollars ($75.00).
(c) A license to operate an ambulatory surgical facility or a qualified ambulatory surgical facility shall be annually renewed upon the filing and the department's approval of a renewal application. The renewal application shall be available from the Department and shall contain all necessary and reasonable information that the Department may by rule require.
…."
"SECTION 3.2.(c) Part 4 of Article 6 of Chapter 131E of the General Statutes is amended by adding a new section to read:
"§ 131E‑147.5. Charity care requirement for qualified
urban ambulatory surgical facilities; annual report.
(a) The percentage of each
qualified urban ambulatory surgical facility's total earned revenue that
is attributed to self‑pay and Medicaid revenue shall be equivalent to at
least four percent (4%), calculated as follows: the Medicare allowable amount
for self‑pay and Medicaid surgical cases minus all revenue earned from
self‑pay and Medicaid cases, divided by the total earned revenues for all
surgical cases, divided by the total earned revenues for all surgical cases
performed in the facility for procedures for which there is a Medicare
allowable fee.
(b) Each qualified urban ambulatory
surgical facility shall annually report to the Department in the manner
prescribed by the Department the percentage of the facility's earned revenue
that is attributed to self‑pay and Medicaid revenue, as calculated in
accordance with subsection (a) of this section."
"SECTION 3.2.(d) Subsections (a) through (c) of this section become effective two years from the date the Department of Health and Human Services (DHHS) issues the first directed payment in accordance with the Healthcare Access and Stabilization Program (HASP) under G.S. 108A‑148.1, as enacted by Section 1.4 of this act, and applies to activities occurring on or after that date. The Secretary of Health and Human Services shall notify the Revisor of Statutes when the DHHS has issued the first directed payment in accordance with HASP and the date of issuance. If the DHHS has not made any HASP directed payments by June 30, 2025, then subsections (a) and (b) of this section shall expire on that date.
"SECTION 3.2.(e) Except as otherwise provided, this section is effective when it becomes law."
SECTION 3. Section 3.3 of S.L. 2023‑7 is repealed.
SECTION 4. Except as otherwise provided, this act is effective when it becomes law.