Limit the Scope of Certificate of Need Laws.

SB 494 limits North Carolina's Certificate of Need (CON) requirements, which typically require state approval for new healthcare facilities or expansions. The bill exempts all counties from CON rules except those with fewer than 100,000 residents *and* at least one functioning hospital. It creates a new "qualified urban ambulatory surgical facility" category, allowing certain surgical centers in larger counties to opt out of CON by meeting charity care reporting standards (ensuring at least 4% of revenue comes from self-pay or Medicaid patients). This directly affects healthcare providers planning new facilities or expansions in most counties, removing a major regulatory hurdle for projects exceeding $4 million in cost. The policy change takes effect November 2025, with specific reporting requirements for facilities choosing the opt-out path.