Lawmakers in North Carolina have proposed several bills aimed at cutting the state’s healthcare costs and expanding access, NC Health News reported May 5.
Here are six takeaways from the report:
1. By at least one measure, North Carolina has some of the highest healthcare costs in the nation. A 2024 analysis published by Forbes found that the state had the highest average premium for employer-sponsored insurance that includes a worker and a “plus one.”
2. There are two bills focused on improving prior authorization processes, which physicians have criticized for causing delays in care and increasing administrative burdens.
- House Bill 434 would require physicians working under payers in their prior authorization processes to be licensed in North Carolina. The bill also exempts physicians who have been approved to deliver treatment 80% of the time from the prior authorization process.
- Senate Bill 316 includes a provision barring AI from being the sole determinant of denial.
- Both bills would require payers to respond to urgent care requests within 24 hours. Currently they must respond within three business days.
- Both bills require that the physician evaluating the prior authorization request be within the same medical specialty as the requesting physician.
3. As large hospitals and health systems grow their reach by acquiring clinics and other sites of care, patients in the state have reportedly seen an increase in surprise hospital facility fees, even if their care took place outside of the hospital. A bill that was recently approved by the state Senate would ban facility fees for care delivered at places that are not on a hospital campus, unless it is a satellite location for the hospital, a facility with an ED or an ASC.
4. One provision in a bill from the state Senate would require healthcare systems to provide a “plain language, good-faith estimate” of what care will cost before a non-urgent procedure. Final invoices can be no more than 5% higher than the original estimate. The bill would also require hospitals and ASCs to send patients an itemized list of charges “in language comprehensible to an ordinary layperson” before referring an unpaid bill to collections. It would also require hospitals and ASCs to report to the state the costs for 20 of their most common surgical procedures and the 20 most common imaging procedures at least once a quarter.
5. Senate Bill 380 and House Bill 455 would also repeal certificate-of-need laws for certain types of healthcare facilities, including ASCs.
6. House Bill 537 and Senate Bill 537 would also expand the authority of advanced practice registered nurses, including nurse practitioners, nurse anesthetists and certified nurse midwives, giving them independence to practice without a supervising physician.
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