HB 944 appropriates $1.5 million from the state General Fund to the Department of Health and Human Services for a directed grant to Care Ring, Inc., a nonprofit community health clinic in Mecklenburg County. The funding supports the clinic’s operations to provide primary care services to medically vulnerable residents facing geographic, economic, or other barriers to care. This grant specifically targets patients who would otherwise be unable to access necessary primary care due to these challenges. The bill directs all funds to be used for the clinic’s core operations during the 2025-2026 fiscal year.
HB 558 updates how North Carolina selects Medicaid health plans by limiting statewide contracts to four and allowing up to 12 regional contracts through local health providers. It requires the state to prioritize bids from local providers and those with high provider satisfaction scores from existing contracts. The bill also mandates staggered contract terms (3-5 years) to prevent coverage gaps during transitions. These changes directly affect Medicaid health plan contractors and the Division of Health Benefits, aiming to stabilize coverage and improve provider relationships.
HB 888 appropriates $1 million from the General Fund to the North Carolina Community Health Worker Association (a nonprofit) for the 2025-2026 fiscal year. The funds will directly support the Association's work in mobilizing, training, and certifying community health workers across North Carolina. This grant enables the Association to expand its workforce development efforts, specifically targeting the training and certification of community health workers. The bill affects the Association's operations and the community health workers they certify, but does not change health service delivery or eligibility for residents. The appropriation becomes effective July 1, 2025.
HB 984 creates a framework for medical cannabis research in North Carolina, permitting studies on cannabis as a treatment for qualifying medical conditions. It establishes a state database requiring research institutions (like hospitals or universities), physicians, caregivers, and patients to register, while setting strict product limits (under 0.9% THC, at least 5% CBD). The bill protects registered researchers, caregivers, and patients from prosecution for participating in approved studies and requires secure disposal of unused cannabis. It directly affects medical researchers, healthcare providers issuing certifications, and patients enrolled in these studies, but does not legalize recreational use or broader medical access.
HB 1000 establishes legal restrictions on gender transition care for minors in North Carolina while creating pathways for detransition. It prohibits medical professionals from performing surgical gender transitions, prescribing puberty blockers or cross-sex hormones, or conducting detransition procedures on minors without parental consent (with detransition procedures specifically permitted under parental consent). The bill imposes penalties including license revocation for violations and mandates civil liability for medical providers who provide transition care to minors, requiring them to cover harms like physical, psychological, or emotional injuries. It also requires gender clinics to report detailed statistics on transition procedures to the state health department. This bill directly affects minors seeking gender-affirming care, their parents/guardians, and medical providers operating gender clinics in North Carolina.
SB 315 improves transparency and efficiency in insurance reviews of medical services by setting strict timeframes for insurers to make decisions. For urgent care, insurers must decide within 24 hours; for non-urgent care, within three business days after receiving all necessary information. The bill also requires insurers to clearly explain review processes in patient handbooks, on websites, and on membership cards, and to notify both patients and providers of outcomes. Additionally, it mandates that appeal reviews be conducted by qualified medical professionals without conflicts of interest, ensuring fairer assessments of coverage disputes.
SB 287 prohibits health insurers from using artificial intelligence algorithms as the sole basis to deny, delay, or modify healthcare services based on medical necessity. The bill requires that only licensed and qualified healthcare providers make these determinations, and insurers must verify that third-party contractors (like pharmacy benefits managers) comply with this rule. It directly affects health insurers, pharmacy benefits managers, and the North Carolina State Health Plan for teachers and state employees, which must review its contracts and practices for compliance. The law takes effect 30 days after enactment and focuses on ensuring human medical judgment remains central to coverage decisions.
SB 316 requires North Carolina hospitals and ambulatory surgical facilities to publicly disclose detailed pricing information for common medical services, including full charges, negotiated rates, and reimbursements from Medicaid, Medicare, and major insurers. Beginning in 2015, these facilities must submit quarterly reports to the state health department on the 100 most frequent inpatient diagnoses (DRGs) and common surgical/imaging procedures. The data will be made publicly available online, enabling patients and employers to compare costs and make informed healthcare decisions. This bill directly affects healthcare providers by mandating transparency but does not alter insurance coverage or set price limits. Its key mechanism is standardized reporting of pricing data to foster competition and affordability in the healthcare market.
House Bill 820 requires health benefit plans in North Carolina to provide coverage for early refills of prescription eye drops. This means insurers cannot deny a refill for a 30-day supply if at least 21 days have passed since the last fill, or if the patient has used 70% of the medication according to their healthcare provider's instructions. The bill also specifies that the requested refill must not exceed the total number of refills indicated on the original prescription. These requirements apply to all health benefit plans, including the State Health Plan, with an effective date of October 1, 2025, or the subsequent plan year.
House Bill 635 requires certain large group health benefit plans to provide coverage for fertility diagnostic care, treatment, and preservation services. This bill directly affects individuals covered by these plans, aiming to increase their access to fertility-related medical care. Key provisions include mandatory coverage for at least three in vitro fertilization (IVF) cycles per insured, provided procedures follow American Society of Reproductive Medicine guidelines and are performed at licensed facilities. However, the requirements do not apply to plans offered by religious institutions or self-insured group health plans, and explicitly exclude experimental procedures or nonmedical costs for donor gametes or surrogacy.
