North Carolina 2025-2026 Regular Session

North Carolina House Bill H456 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		GENERAL ASSEMBLY OF NORTH CAROLINA
2	2		SESSION 2025
3		-	H 1
4		-	HOUSE BILL 456
	3	+	H D
	4	+	HOUSE BILL DRH10206-MRa-66
	5	+
5	6
6	7
7	8		Short Title: No Surprises for Ambulance Services Act. (Public)
8		-	Sponsors: Representatives von Haefen, Buansi, Greenfield, and Colvin (Primary Sponsors).
9		-	For a complete list of sponsors, refer to the North Carolina General Assembly web site.
10		-	Referred to: Appropriations, if favorable, Rules, Calendar, and Operations of the House
11		-	March 20, 2025
12		-	H456 -v-1
	9	+	Sponsors: Representative von Haefen.
	10	+	Referred to:
	11	+
	12	+	DRH10206 -MRa-66
13	13		A BILL TO BE ENTITLED 1
14	14		AN ACT TO MAKE HEALTH INSURANCE COVERAGE OF GROUND AMBULANCE 2
15	15		SERVICE MORE EQUITABLE AND THE COST-SHARING REQUIREMENTS MORE 3
16	16		TRANSPARENT. 4
17	17		The General Assembly of North Carolina enacts: 5
18	18		SECTION 1.(a) G.S. 58-3-190 reads as rewritten: 6
19	19		"§ 58-3-190. Coverage required for emergency care. 7
20	20		(a) Every insurer shall provide coverage for emergency services to the extent necessary 8
21	21		to screen and to stabilize the person covered under the plan or to transport the covered person to 9
22	22		a medically appropriate location for screening and stabilization and shall not require prior 10
23	23		authorization of the services if a prudent layperson acting reasonably would have believed that 11
24	24		an emergency medical condition existed. Payment of claims for emergency services shall be 12
25	25		based on the retrospective review of the presenting history and symptoms of the covered person. 13
26	26		(b) With respect to emergency services provided by a health care provider who is not 14
27	27		under contract with the insurer, the services shall be covered if:if any of the following criteria are 15
28	28		met: 16
29	29		(1) A prudent layperson acting reasonably would have believed that a delay would 17
30	30		worsen the emergency, oremergency. 18
31	31		(2) The covered person did not seek services from a provider under contract with 19
32	32		the insurer because of circumstances beyond the control of the covered person. 20
33	33		(3) The covered person did not have a choice in the ground ambulance 21
34	34		transportation service provider due to the emergency. 22
35	35		… 23
36	36		(d) Coverage of emergency services shall may be subject to coinsurance, co-payments, 24
37	37		and deductibles applicable under the health benefit plan. An insurer shall not impose cost-sharing 25
38	38		for emergency services provided under this section section, including emergency ambulance 26
39	39		transportation services, that differs from the cost-sharing that would have been imposed if the 27
40	40		physician or provider furnishing the services were a provider contracting with the insurer. 28
41	41		… 29
42	42		(f) Insurers shall provide information to their covered persons on all of the following: 30
43	43		(1) Coverage of emergency medical services. 31
44	44		(2) The appropriate use of emergency services, including the use of the "911" 32
45	45		system and other telephone access systems utilized to access prehospital 33
46	46		emergency services. 34
47		-	(3) Any cost-sharing provisions for emergency medical services. 35 General Assembly Of North Carolina Session 2025
48		-	Page 2 House Bill 456-First Edition
	47	+	(3) Any cost-sharing provisions for emergency medical services. 35
	48	+	H.B. 456
	49	+	Mar 19, 2025
	50	+	HOUSE PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
	51	+	Page 2 DRH10206-MRa-66
49	52		(4) The process and procedures for obtaining emergency services, so that covered 1
50	53		persons are familiar with the location of in-plan emergency departments and 2
51	54		with the location and availability of other in-plan settings at which covered 3
52	55		persons may receive medical care. 4
53	56		(g) As used in this section, the term:The following definitions apply in this section: 5
54	57		(1) "Emergency Emergency medical condition" means a condition. – A medical 6
55	58		condition manifesting itself by acute symptoms of sufficient severity, 7
56	59		including, but not limited to, severe pain, or by acute symptoms developing 8
57	60		from a chronic medical condition that would lead a prudent layperson, 9
58	61		possessing an average knowledge of health and medicine, to reasonably 10
59	62		expect the absence of immediate medical attention to result in any of the 11
60	63		following: 12
61	64		a. Placing the health of an individual, or with respect to a pregnant 13
62	65		woman, the health of the woman or her unborn child, in serious 14
63	66		jeopardy. 15
64	67		b. Serious impairment to bodily functions. 16
65	68		c. Serious dysfunction of any bodily organ or part. 17
66	69		(2) "Emergency services" means health care Emergency services. – Healthcare 18
67	70		items and services furnished or required to screen for or treat an emergency 19
68	71		medical condition until the condition is stabilized, including prehospital care 20
69	72		care, ambulance transportation services, and ancillary services routinely 21
70	73		available to the emergency department. 22
71	74		(3) "Health benefit plan" means any of the following if written by an insurer: an 23
72	75		accident and health insurance policy or certificate; a nonprofit hospital or 24
73	76		medical service corporation contract; a health maintenance organization 25
74	77		subscriber contract; or a plan provided by a multiple employer welfare 26
75	78		arrangement. "Health benefit plan" does not mean any plan implemented or 27
76	79		administered through the Department of Health and Human Services or its 28
77	80		representatives. "Health benefit plan" also does not mean any of the following 29
78	81		kinds of insurance: 30
79	82		a. Accident. 31
80	83		b. Credit. 32
81	84		c. Disability income. 33
82	85		d. Long-term or nursing home care. 34
83	86		e. Medicare supplement. 35
84	87		f. Specified disease. 36
85	88		g. Dental or vision. 37
86	89		h. Coverage issued as a supplement to liability insurance. 38
87	90		i. Workers' compensation. 39
88	91		j. Medical payments under automobile or homeowners insurance. 40
89	92		k. Hospital income or indemnity. 41
90	93		l. Insurance under which benefits are payable with or without regard to 42
91	94		fault and that is statutorily required to be contained in any liability 43
92	95		policy or equivalent self-insurance. 44
93	96		(4) "Insurer" means an entity that writes a health benefit plan and that is an 45
94	97		insurance company subject to this Chapter, a service corporation under Article 46
95	98		65 of this Chapter, a health maintenance organization under Article 67 of this 47
96	99		Chapter, or a multiple employer welfare arrangement under Article 50A of 48
97	100		this Chapter. 49
98	101		(5) "To stabilize" means to Stabilize. – To provide medical care that is appropriate 50
99	102		to prevent a material deterioration of the person's condition, within reasonable 51 General Assembly Of North Carolina Session 2025
100		-	~~House Bill 456-First Edition~~ Page 3
	103	+	DRH10206-MRa-66 Page 3
101	104		medical probability, in accordance with the HCFA (Health Care Financing 1
102	105		Administration) Centers for Medicare and Medicaid Services interpretative 2
103	106		guidelines, policies and regulations pertaining to responsibilities of hospitals 3
104	107		in emergency cases (as cases, as provided under the Emergency Medical 4
105	108		Treatment and Labor Act, section 1867 of the Social Security Act, 42 U.S.C.S. 5
106	109		1395dd), including medically necessary services and supplies to maintain 6
107	110		stabilization until the person is transferred.42 U.S.C.S. 1395dd." 7
108	111		SECTION 1.(b) Article 3 of Chapter 58 of the General Statutes is amended by 8
109	112		adding a new section to read: 9
110	113		"§ 58-3-193. Coverage for nonemergency ground ambulance transportation. 10
111	114		(a) This section applies to nonemergency ground ambulance transportation service. 11
112	115		Ground ambulance transportation services provided in an emergency situation are defined and 12
113	116		regulated under G.S. 58-3-190. 13
114	117		(b) Nonemergency ground ambulance transportation services may be subject to 14
115	118		cost-sharing, including deductibles, coinsurance, and copayments. When nonemergency ground 15
116	119		ambulance transportation services are provided to an insured by an entity that is not a 16
117	120		participating provider in the insured's health benefit plan, an insurer shall not impose cost-sharing 17
118	121		for those services in an amount greater than one hundred ten percent (110%) of the cost-sharing 18
119	122		amount for nonemergency ground ambulance transportation services provided by a participating 19
120	123		network provider." 20
121	124		SECTION 1.(c) This section becomes effective October 1, 2025, and applies to 21
122	125		insurance contracts issued, renewed, or amended on or after that date. 22
123	126		SECTION 2.(a) G.S. 135-48.51 reads as rewritten: 23
124	127		"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 24
125	128		Statutes. 25
126	129		The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 26
127	130		(1) G.S. 58-3-191, Managed care reporting and disclosure requirements. 27
128	131		(1a) G.S. 58-3-193, Coverage for nonemergency ground ambulance 28
129	132		transportation. 29
130	133		…." 30
131	134		SECTION 2.(b) Effective July 1, 2025, there is appropriated from the General Fund 31
132	135		to the Department of State Treasurer the sum of one million dollars ($1,000,000) in recurring 32
133	136		funds for each year of the 2025-2027 fiscal biennium to be used to provide the additional 33
134	137		coverage required under this act. 34
135	138		SECTION 2.(c) Subsection (a) of this section applies as of the start of the next plan 35
136	139		year following that date. 36
137	140		SECTION 3. Except as otherwise provided, this act is effective when it becomes 37
138	141		law. 38