North Carolina 2025-2026 Regular Session

North Carolina Senate Bill S494 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		GENERAL ASSEMBLY OF NORTH CAROLINA
2	2		SESSION 2025
3		-	S 1
4		-	SENATE BILL 494
	3	+	S D
	4	+	SENATE BILL DRS35143-MG-42
	5	+
5	6
6	7
7	8		Short Title: Limit the Scope of Certificate of Need Laws. (Public)
8	9		Sponsors: Senator Jarvis (Primary Sponsor).
9		-	Referred to: ~~Rules and Operations of the Senate~~
10		-	~~March 26, 2025~~
11		-	~~S494 -v-1~~
	10	+	Referred to:
	11	+
	12	+	DRS35143 -MG-42
12	13		A BILL TO BE ENTITLED 1
13	14		AN ACT ENCOURAGING THE EXPANSION OF HEALTH CARE ACCESS BY 2
14	15		ELIMINATING CERTIFICATE OF NEED LAWS IN ALL COUNTIES EXCEPT THOSE 3
15	16		THAT HAVE A POPULATION OF LESS THAN ONE HUNDRED THOUSAND AND 4
16	17		AT LEAST ONE FUNCTIONING HOSPITAL. 5
17	18		The General Assembly of North Carolina enacts: 6
18	19		SECTION 1. Article 9 of Chapter 131E of the General Statutes is amended by adding 7
19	20		a new section to read: 8
20	21		"§ 131E-175.5. Scope of Article. 9
21	22		This Article applies only to counties that meet both of the following criteria: 10
22	23		(1) Have a population of less than 100,000 according to the most recent federal 11
23	24		decennial census. 12
24	25		(2) Have at least one functioning hospital within the county." 13
25	26		SECTION 2. Effective November 21, 2025, Section 3.2 of S.L. 2023-7 reads as 14
26	27		rewritten: 15
27	28		"SECTION 3.2.(a) G.S. 131E-176, as amended by Section 3.1 of this act, reads as rewritten: 16
28	29		"§ 131E-176. Definitions. 17
29	30		The following definitions apply in this Article: 18
30	31		… 19
31	32		(9b) Health service facility. – A hospital; long-term care hospital; rehabilitation 20
32	33		facility; nursing home facility; adult care home; kidney disease treatment 21
33	34		center, including freestanding hemodialysis units; intermediate care facility 22
34	35		for individuals with intellectual disabilities; home health agency office; 23
35	36		diagnostic center; hospice office, hospice inpatient facility, hospice residential 24
36	37		care facility; and ambulatory surgical facility. The term "health service 25
37	38		facility" does not include a qualified urban ambulatory surgical facility. 26
38	39		… 27
39	40		(16) New institutional health services. – Any of the following: 28
40	41		… 29
41	42		b. Except with respect to qualified urban ambulatory surgical facilities 30
42	43		and except as otherwise provided in G.S. 131E-184(e), the obligation 31
43	44		by any person of a capital expenditure exceeding four million dollars 32
44	45		($4,000,000) to develop or expand a health service or a health service 33
45	46		facility, or which relates to the provision of a health service. The cost 34
46	47		of any studies, surveys, designs, plans, working drawings, 35
47		-	specifications, and other activities, including staff effort and 36 General Assembly Of North Carolina Session 2025
48		-	Page 2 Senate Bill 494-First Edition
	48	+	specifications, and other activities, including staff effort and 36
	49	+	FILED SENATE
	50	+	Mar 25, 2025
	51	+	S.B. 494
	52	+	PRINCIPAL CLERK General Assembly Of North Carolina Session 2025
	53	+	Page 2 DRS35143-MG-42
49	54		consulting and other services, essential to the acquisition, 1
50	55		improvement, expansion, or replacement of any plant or equipment 2
51	56		with respect to which an expenditure is made shall be included in 3
52	57		determining if the expenditure exceeds four million dollars 4
53	58		($4,000,000). Beginning September 30, 2022, and on September 30 5
54	59		each year thereafter, the amount in this sub-subdivision shall be 6
55	60		adjusted using the Medical Care Index component of the Consumer 7
56	61		Price Index published by the U.S. Department of Labor for the 8
57	62		12-month period preceding the previous September 1. 9
58	63		… 10
59	64		(21a) Qualified urban ambulatory surgical facility. – An ambulatory surgical facility 11
60	65		that meets all of the following criteria: 12
61	66		a. Is licensed by the Department to operate as an ambulatory surgical 13
62	67		facility. 14
63	68		b. Has a single specialty or multispecialty ambulatory surgical program. 15
64	69		c. Is located in a county with a population greater than 125,000 according 16
65	70		to the 2020 federal decennial census or any subsequent federal 17
66	71		decennial census.has elected to opt out of the certificate of need 18
67	72		requirements prescribed by this Article by obtaining a license as a 19
68	73		qualified ambulatory surgical facility under Part 4 of Article 6 of this 20
69	74		Chapter. 21
70	75		… 22
71	76		(24f) Specialty ambulatory surgical program. – A formal program for providing on 23
72	77		a same-day basis surgical procedures of the same surgical specialty and 24
73	78		authorized by its certificate of need, if a certificate of need is required. 25
74	79		…." 26
75	80		"SECTION 3.2.(b) G.S. 131E-146 is amended by adding a new subdivision to read: 27
76	81		"(3) "Qualified urban ambulatory surgical facility" means an ambulatory surgical 28
77	82		facility licensed under this Part that has elected to opt out of the certificate of 29
78	83		need requirements prescribed by Article 9 of this Chapter and demonstrates to 30
79	84		the satisfaction of the Department that the facility meets the definition of 31
80	85		G.S. 131E-176(21a).both of the following criteria: 32
81	86		a. Has a single specialty or multispecialty ambulatory surgical program. 33
82	87		b. Has agreed to adhere to the charity care and reporting requirements 34
83	88		established by G.S. 131E-147.5." 35
84	89		"SECTION 3.2.(b1) G.S. 131E-147 reads as rewritten: 36
85	90		"§ 131E-147. Licensure requirement. 37
86	91		(a) No person shall operate an ambulatory surgical facility or a qualified ambulatory 38
87	92		surgical facility without a license obtained from the Department. 39
88	93		(b) Applications shall be available from the Department, and each application filed with 40
89	94		the Department shall contain all necessary and reasonable information that the Department may 41
90	95		by rule require. A license shall be granted to the applicant upon a determination by the 42
91	96		Department that the applicant has complied with the provisions of this Part and the rules 43
92	97		promulgated by the Commission under this Part. The Department shall charge the applicant a 44
93	98		nonrefundable annual base license fee in the amount of eight hundred fifty dollars ($850.00) plus 45
94	99		a nonrefundable annual per-operating room fee in the amount of seventy-five dollars ($75.00). 46
95	100		(c) A license to operate an ambulatory surgical facility or a qualified ambulatory surgical 47
96	101		facility shall be annually renewed upon the filing and the department's approval of a renewal 48
97	102		application. The renewal application shall be available from the Department and shall contain all 49
98	103		necessary and reasonable information that the Department may by rule require. 50
99	104		…." 51 General Assembly Of North Carolina Session 2025
100		-	~~Senate Bill 494-First Edition~~ Page 3
	105	+	DRS35143-MG-42 Page 3
101	106		"SECTION 3.2.(c) Part 4 of Article 6 of Chapter 131E of the General Statutes is amended 1
102	107		by adding a new section to read: 2
103	108		"§ 131E-147.5. Charity care requirement for qualified urban ambulatory surgical 3
104	109		facilities; annual report. 4
105	110		(a) The percentage of each qualified urban ambulatory surgical facility's total earned 5
106	111		revenue that is attributed to self-pay and Medicaid revenue shall be equivalent to at least four 6
107	112		percent (4%), calculated as follows: the Medicare allowable amount for self-pay and Medicaid 7
108	113		surgical cases minus all revenue earned from self-pay and Medicaid cases, divided by the total 8
109	114		earned revenues for all surgical cases, divided by the total earned revenues for all surgical cases 9
110	115		performed in the facility for procedures for which there is a Medicare allowable fee. 10
111	116		(b) Each qualified urban ambulatory surgical facility shall annually report to the 11
112	117		Department in the manner prescribed by the Department the percentage of the facility's earned 12
113	118		revenue that is attributed to self-pay and Medicaid revenue, as calculated in accordance with 13
114	119		subsection (a) of this section." 14
115	120		"SECTION 3.2.(d) Subsections (a) through (c) of this section become effective two years 15
116	121		from the date the Department of Health and Human Services (DHHS) issues the first directed 16
117	122		payment in accordance with the Healthcare Access and Stabilization Program (HASP) under 17
118	123		G.S. 108A-148.1, as enacted by Section 1.4 of this act, and applies to activities occurring on or 18
119	124		after that date. The Secretary of Health and Human Services shall notify the Revisor of Statutes 19
120	125		when the DHHS has issued the first directed payment in accordance with HASP and the date of 20
121	126		issuance. If the DHHS has not made any HASP directed payments by June 30, 2025, then 21
122	127		subsections (a) and (b) of this section shall expire on that date. 22
123	128		"SECTION 3.2.(e) Except as otherwise provided, this section is effective when it becomes 23
124	129		law." 24
125	130		SECTION 3. Section 3.3 of S.L. 2023-7 is repealed. 25
126	131		SECTION 4. Except as otherwise provided, this act is effective when it becomes 26
127	132		law. 27