North Carolina SB 316: Lower Healthcare Costs.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 4
SENATE BILL 316
Health Care Committee Substitute Adopted 3/19/25
Judiciary Committee Substitute Adopted 3/25/25
Fourth Edition Engrossed 3/27/25

Short Title: Lower Healthcare Costs. (Public)
Sponsors:
Referred to:
March 18, 2025
*S316-v-4*
A BILL TO BE ENTITLED 1
AN ACT LOWERING HEALTHCARE COSTS AND INCREASING PRICE 2
TRANSPARENCY. 3
Whereas, rising healthcare costs place a significant financial burden on individuals, 4
families, employers, and taxpayers, greatly contribute to inflation, and make it increasingly 5
difficult for residents to access essential healthcare services; and 6
Whereas, North Carolina has intolerably high healthcare costs, with recent studies 7
ranking the State 50th out of 50 in the United States; and 8
Whereas, skyrocketing healthcare costs have resulted in over 40 percent of Americans 9
reporting some type of healthcare debt, according to one study; and 10
Whereas, many patients face unexpected medical bills due to a lack of disclosure 11
about out-of-network providers and a general lack of transparency in healthcare pricing, resulting 12
in financial strain and hardship; and 13
Whereas, employers are burdened with the increasing costs of providing health 14
insurance for employees, leading to higher premiums, deductibles, and out-of-pocket expenses; 15
and 16
Whereas, patients and employers are often unable to compare the costs of medical 17
services due to a lack of clear and accessible pricing information, hindering their ability to make 18
informed decisions; and 19
Whereas, the absence of price transparency in the healthcare system leads to market 20
inefficiencies, less awareness of price difference, less competition, and higher prices, with 21
consumers often unable to identify the most cost-effective providers; and 22
Whereas, transparency in healthcare pricing allows consumers to shop for affordable 23
healthcare services and encourages competition among healthcare providers to offer more 24
competitive pricing; and 25
Whereas, providing consumers with clear, understandable, and accessible 26
information about the costs of healthcare services will foster a more competitive and 27
patient-centered healthcare market; and 28
Whereas, requiring healthcare providers and insurers to disclose their prices in 29
advance, including all providers and services a patient may need, both in-network and 30
out-of-network, will enable consumers to make more informed choices about their care, leading 31
to better healthcare outcomes at lower costs; and 32
Whereas, price transparency will incentivize hospitals and healthcare providers to 33
improve the quality of care while reducing prices, to the benefit of patients and employers; and 34

General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 316-Fourth Edition
Whereas, clear pricing and competition among healthcare providers will encourage 1
innovation in healthcare delivery and improve overall efficiency within the system; and 2
Whereas, empowering patients and employers with pricing information will help 3
create a healthcare system that prioritizes affordability, access, and choice; and 4
Whereas, President Trump recently signed an Executive Order to make healthcare 5
prices transparent, "empower[ing] patients with clear, accurate, and actionable healthcare pricing 6
information," also "ensur[ing] hospitals and insurers disclose actual prices, not estimates, and 7
take action to make prices comparable across hospitals and insurers, including prescription drug 8
prices; Now, therefore, 9
The General Assembly of North Carolina enacts: 10
11
PART I. GREATER TRANSPARENCY IN HOSPITAL AND AMBULATORY 12
SURGICAL FACILITY HEALTHCARE COSTS 13
SECTION 1.1. Article 11B of Chapter 131E of the General Statutes reads as 14
rewritten: 15
"Article 11B. 16
"Transparency in Health Care Costs. 17
"Part 1. Health Care Cost Reduction and Transparency Act of 2013. 18
"§ 131E-214.11. Title. 19
This article Part shall be known as the Health Care Cost Reduction and Transparency Act of 20
2013. 21
... 22
"§ 131E-214.13. Disclosure of prices for most frequently reported DRGs, CPTs, and 23
HCPCSs. 24
(a) Definitions. – The following definitions apply in this Article:Part: 25
(1) Ambulatory surgical facility. – A facility licensed under Part 4 of Article 6 of 26
this Chapter. 27
(2) Commission. – The North Carolina Medical Care Commission. 28
(2a) CPT. – Current Procedural Terminology. 29
(2b) DRG. – Diagnostic Related Group. 30
(2c) HCPCS. – The Healthcare Common Procedure Coding System. 31
(3) Health insurer. – An entity that writes a health benefit plan and is one of the 32
following: 33
a. An insurance company under Article 3 of Chapter 58 of the General 34
Statutes. 35
b. A service corporation under Article 65 of Chapter 58 of the General 36
Statutes. 37
c. A health maintenance organization under Article 67 of Chapter 58 of 38
the General Statutes. 39
d. A third-party administrator of one or mor