Senate Health Chairs Introduce Comprehensive Proposals to Drive Down Healthcare Costs, Increase Transparency
Bills implement sweeping billing reforms and commonsense prior authorization changes
Empowers patients with accurate information about the costs of their care
Raleigh, N.C. – The chairs of the Senate Health Care Committee introduced two bills to bring down the cost of healthcare in the state and increase pricing transparency.
Senate Bill 316, “Lower Healthcare Costs,” and Senate Bill 315, “More Transparency/Efficiency in Utilization Reviews,” will be heard in the Senate Health Care Committee this week.
“We need to take serious steps to bring down the cost of healthcare in our state,” bill sponsor Sen. Benton Sawrey (R-Johnston) said. “North Carolinians are navigating an increasingly complex web of fees and jumping through hoops to get the care they need. These proposals look to break through that web from every angle to help make meaningful change for patients.”
These proposals are consistent with President Donald Trump’s recent executive order highlighting the need to empower patients with “clear, accurate, and actionable healthcare pricing information” and ensure that hospitals, providers, and insurers do just that for North Carolinians.
Senate Bill 316 helps North Carolinians understand the costs and fees associated with their healthcare services.
It enhances the required disclosures for hospitals and ambulatory surgical centers to include each billable item and service associated with a patient’s care, whether in-network or out-of-network. This gives patients a clear sense of what they’re paying for and demystifies bills and estimates.
Additionally, Senate Bill 316 tackles surprise medical bills by requiring that patients receive written notice of any additional bills that they may incur. The written notice shall include any information about out-of-network providers who may provide care to the patient. The proposal requires facilities to provide an itemized list of charges to any patient before it can refer an unpaid bill to a collection agency. It also allows patients to obtain a “good faith estimate” that would provide an estimate of any charges they’d be obligated to pay for non-urgent services scheduled in advance. The proposal requires that a patient’s bill not exceed 5% of the good faith estimate.
“In order to make the best decisions for their care, patients need to have all of the information about their procedure at their fingertips,” bill sponsor Sen. Amy Galey (R-Alamance) said. “Shedding light on the true costs of healthcare is good for patients and providers. These proposals will provide much-needed transparency for North Carolinians when they’re making decisions about their health.”
One of the biggest drivers of costs for patients across the state is facility fees, which hospitals impose for services provided in outpatient and physician office settings. Patients are often unaware of any facility fees until they receive the bill and there’s little-to-no explanation of how the fee was determined or what part of their care the fee covers. To rein in those fees, Senate Bill 316 prohibits providers from collecting a facility fee unless the services are provided at a hospital’s main campus, at a remote location of a hospital, or at a facility that includes an emergency department.
The State Auditor’s Office would have the authority to examine facility prices charged to out-of-network and uninsured patients and to ensure compliance with transparency requirements.
“I don’t know a single person who hasn’t received a medical bill that left them with more questions than answers,” bill sponsor Sen. Jim Burgin (R-Harnett) said. “It’s imperative that we do whatever we can to lower costs and help North Carolinians take charge of their healthcare decisions. We cannot sit idly by and let these fees and billing practices become the norm.”
The bill also includes provisions to enhance health insurance employee safety, clarifies the definition of a “management company” for dentistry, and eliminates certificates of need for inpatient rehabilitation services, facilities, and beds.
Senate Bill 315 reforms prior authorization practices. There has been an ongoing discussion about prior authorization at the General Assembly, and there is room for commonsense reforms to help keep costs down and ensure patients can get timely, appropriate care.
The bill requires urgent health care services to be reviewed in 24 hours or less, codifies the appeals process, and requires that any doctor conducting a review be actively licensed in that specialty for at least three consecutive years.
Further, it implements notice and transparency requirements that will benefit both patients and providers. Insurance companies would be required to publicly post in a timely manner any amendments to their terms for review or if they intend to impose new restrictions. A denial would not be allowed if the new requirements or changes haven't been publicly posted on the insurer’s website. It also prohibits the sole use of AI for utilization review determination to deny, delay, or modify any service.
The two bills, while introduced separately, will be amended together during the committee process.
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