This bill proposes raising Medicaid reimbursement rates for primary care providers in North Carolina to match the rates paid by Medicare. To fund these increases, the state would allocate $48 million from its General Fund starting in the 2026-2027 fiscal year. The changes would take effect on July 1, 2026, and would apply to primary care services as defined by a specific state task force report.
HB 491 prepares North Carolina's Medicaid program to implement work requirements if authorized by the federal Centers for Medicare and Medicaid Services (CMS). It requires the state's Division of Health Benefits to negotiate with CMS, notify oversight committees within 30 days of starting talks, and submit detailed reports after CMS approves any work requirements plan. The bill does not enact work requirements itself but establishes procedures for future implementation, including timelines for reporting funding needs. This would directly affect current Medicaid recipients if CMS approves work requirements, though the bill is procedural and conditional on federal approval. The legislation is currently in committee review and has not yet become law.
HB 229 adjusts North Carolina's Medicaid reimbursement rates for ambulatory surgical centers (ASCs), requiring payments to be at least 95% of the current Medicare Ambulatory Surgical Centers fee schedule. This change directly affects ASCs by increasing their Medicaid payments, with the state appropriating $10.476 million annually from the General Fund to cover the cost and match $19.135 million in federal funds each year for the 2025-2027 fiscal biennium. The bill mandates these rate adjustments to take effect on July 1, 2025, ensuring ASCs receive consistent reimbursement aligned with Medicare rates. The legislation focuses solely on establishing the new payment structure and funding mechanism, without altering eligibility or services.
HB 128 appropriates $2 million annually for fiscal years 2025-2026 and 2026-2027 to create a statewide prostate cancer screening program administered by North Carolina's Department of Health and Human Services. The program provides free or low-cost screenings and follow-up care to uninsured or underinsured men aged 50-70 (40-70 with family history of prostate cancer) who meet income requirements (below 250% of federal poverty level). Eligibility requires no Medicare Part B or Medicaid coverage and specific age/family history criteria as defined in the bill. The program begins July 1, 2025.
SB 737 requires North Carolina to adjust Medicaid reimbursement rates for licensed ambulatory surgical centers (ASCs) to at least 95% of the Medicare Ambulatory Surgical Centers fee schedule each year. This directly affects ASCs that treat Medicaid patients by increasing their payments to better align with Medicare rates. The bill provides $6.9 million annually in state funds to match $12.6 million in federal funds for implementation, ensuring the rate adjustments are fully funded. The changes will take effect on July 1, 2025.
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 489 establishes a minimum reimbursement rate for emergency ambulance transportation services provided by out-of-network providers under health benefit plans. It mandates that insurers pay these out-of-network ambulance providers directly and sets a cap on the cost-sharing amounts that insured individuals must pay for these services. The minimum reimbursement rate is determined by local government rates, or if none, by comparing 400% of the Medicare rate to the provider's billed charges. This bill affects individuals needing emergency ambulance services, health insurers, and ambulance service providers, with an effective date of October 1, 2025, for new or renewed insurance contracts.
SB 445 automatically adopts federal temporary waivers or modifications issued by the U.S. Department of Health and Human Services or Centers for Medicare & Medicaid Services under specific Social Security Act sections (1135 or 1812(f)) for North Carolina hospitals during declared emergencies. This means hospitals in disaster zones no longer need separate state approval to implement federal rule changes, directly affecting hospitals operating under such declarations. Key provisions include automatically waiving state hospital regulations to align with federal waivers and allowing temporary increases in bed capacity without additional state review. The bill streamlines emergency hospital operations by eliminating bureaucratic delays in applying federally authorized relief measures.
SB 177 expands North Carolina's Medicaid Healthcare Access and Stabilization Program (HASP) to include qualifying freestanding psychiatric hospitals, allowing them to receive increased reimbursements for services. The bill creates a new assessment (a fee) on these hospitals, calculated as a percentage of their hospital costs, to fund the program. To implement this, the state must seek federal approval from CMS to include psychiatric hospitals in HASP. This change directly affects all Medicare-certified, state-licensed freestanding psychiatric hospitals in North Carolina, requiring them to pay the new assessment while gaining eligibility for enhanced Medicaid payments.
