summary
Introduced
03/17/2025
03/17/2025
In Committee
04/01/2025
04/01/2025
Crossed Over
03/27/2025
03/27/2025
Passed
Dead
Introduced Session
2025-2026 Session
Bill Summary
AN ACT LOWERING HEALTHCARE COSTS AND INCREASING PRICE TRANSPARENCY. Whereas, rising healthcare costs place a significant financial burden on individuals, families, employers, and taxpayers, greatly contribute to inflation, and make it increasingly difficult for residents to access essential healthcare services; and Whereas, North Carolina has intolerably high healthcare costs, with recent studies ranking the State 50th out of 50 in the United States; and Whereas, skyrocketing healthcare costs have resulted in over 40 percent of Americans reporting some type of healthcare debt, according to one study; and Whereas, many patients face unexpected medical bills due to a lack of disclosure about out-of-network providers and a general lack of transparency in healthcare pricing, resulting in financial strain and hardship; and Whereas, employers are burdened with the increasing costs of providing health insurance for employees, leading to higher premiums, deductibles, and out-of-pocket expenses; and Whereas, patients and employers are often unable to compare the costs of medical services due to a lack of clear and accessible pricing information, hindering their ability to make informed decisions; and Whereas, the absence of price transparency in the healthcare system leads to market inefficiencies, less awareness of price difference, less competition, and higher prices, with consumers often unable to identify the most cost-effective providers; and Whereas, transparency in healthcare pricing allows consumers to shop for affordable healthcare services and encourages competition among healthcare providers to offer more competitive pricing; and Whereas, providing consumers with clear, understandable, and accessible information about the costs of healthcare services will foster a more competitive and patient-centered healthcare market; and Whereas, requiring healthcare providers and insurers to disclose their prices in advance, including all providers and services a patient may need, both in-network and out-of-network, will enable consumers to make more informed choices about their care, leading to better healthcare outcomes at lower costs; and Whereas, price transparency will incentivize hospitals and healthcare providers to improve the quality of care while reducing prices, to the benefit of patients and employers; and Whereas, clear pricing and competition among healthcare providers will encourage innovation in healthcare delivery and improve overall efficiency within the system; and Whereas, empowering patients and employers with pricing information will help create a healthcare system that prioritizes affordability, access, and choice; and Whereas, President Trump recently signed an Executive Order to make healthcare prices transparent, "empower[ing] patients with clear, accurate, and actionable healthcare pricing information," also "ensur[ing] hospitals and insurers disclose actual prices, not estimates, and take action to make prices comparable across hospitals and insurers, including prescription drug prices; Now, therefore,
AI Summary
This bill aims to lower healthcare costs and increase price transparency in North Carolina through several key provisions. Part I establishes a quarterly reporting requirement for hospitals and ambulatory surgical facilities to disclose detailed cost information for the most common medical procedures and inpatient admissions, including charges patients would pay without insurance, average negotiated rates, and reimbursement amounts from Medicare and Medicaid. Part II introduces fair notice requirements for healthcare providers and facilities, mandating that patients be informed in writing about potential out-of-network providers and associated billing risks. Part III requires hospitals to provide patients with itemized, comprehensible billing statements before referring unpaid bills to collections and mandates that good-faith cost estimates for scheduled services cannot exceed the estimated amount by more than 5%. Part IV places limitations on facility fees, restricting when and how these additional charges can be applied, and requires hospitals to report detailed information about their facility fee practices. Part V directs the State Auditor to periodically examine health service facilities' pricing practices, and Part VI removes certain employee details from insurance appeals processes. Part VIII updates prior authorization requirements for health insurers, introducing more stringent timelines, review standards, and transparency measures. The bill is designed to empower patients with more pricing information, reduce unexpected medical costs, and create a more competitive healthcare marketplace, with most provisions becoming effective between 2026 and 2028.
Committee Categories
Government Affairs, Justice
Sponsors (22)
Jim Burgin (R)*,
Amy Galey (R)*,
Benton Sawrey (R)*,
Ted Alexander (R),
Lisa Barnes (R),
Phil Berger (R),
Robert Brinson (R),
Kevin Corbin (R),
Warren Daniel (R),
Carl Ford (R),
Robert Hanig (R),
Ralph Hise (R),
Mark Hollo (R),
Brent Jackson (R),
Dana Jones (R),
Michael Lee (R),
Tim Moffitt (R),
Paul Newton (R),
Brad Overcash (R),
Bill Rabon (R),
Norman Sanderson (R),
Eddie Settle (R),
Last Action
Ref To Com On Rules, Calendar, and Operations of the House (on 04/01/2025)
Official Document
bill text
bill summary
Loading...
bill summary
Loading...
bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.ncleg.gov/BillLookUp/2025/S316 |
| BillText | https://www.ncleg.gov/Sessions/2025/Bills/Senate/PDF/S316v4.pdf |
| Analysis - Summary S316-SMBC-18(e3)-v-2 | https://dashboard.ncleg.gov/api/Services/BillSummary/2025/S316-SMBC-18(e3)-v-2 |
| Analysis - Summary S316-SMBC-17(ABC-13)-v-7 | https://dashboard.ncleg.gov/api/Services/BillSummary/2025/S316-SMBC-17(ABC-13)-v-7 |
| BillText | https://www.ncleg.gov/Sessions/2025/Bills/Senate/PDF/S316v3.pdf |
| BillText | https://www.ncleg.gov/Sessions/2025/Bills/Senate/PDF/S316v2.pdf |
| Analysis - Summary S316-SMBC-14(e1)-v-3 | https://dashboard.ncleg.gov/api/Services/BillSummary/2025/S316-SMBC-14(e1)-v-3 |
| BillText | https://www.ncleg.gov/Sessions/2025/Bills/Senate/PDF/S316v1.pdf |
| BillText | https://www.ncleg.gov/Sessions/2025/Bills/Senate/PDF/S316v0.pdf |
Loading...