North Carolina HB 489: Child Abuse & Neglect/Military Affiliation.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 2
HOUSE BILL 489
Committee Substitute Favorable 4/29/25

Short Title: Insurance Coverage Emergency Ambulance Trans. (Public)
Sponsors:
Referred to:
March 25, 2025
*H489-v-2*
A BILL TO BE ENTITLED 1
AN ACT TO PROVIDE FOR A MINIMUM ALLOWABLE REIMBURSEMENT RATE 2
UNDER HEALTH BENEFIT PLANS FOR EMERGENCY AMBULANCE SERVICES 3
PROVIDED BY AN OUT-OF-NETWORK AMBULANCE SERVICE PROVIDER. 4
The General Assembly of North Carolina enacts: 5
SECTION 1.(a) G.S. 58-3-190 reads as rewritten: 6
"§ 58-3-190. Coverage required for emergency care. 7
(a) Every insurer shall provide coverage for emergency services to the extent necessary 8
to screen and to stabilize the person covered under the plan or to transport the covered person to 9
a medically appropriate location for screening and stabilization and shall not require prior 10
authorization of the services if a prudent layperson acting reasonably would have believed that 11
an emergency medical condition existed. Payment of claims for emergency services shall be 12
based on the retrospective review of the presenting history and symptoms of the covered person. 13
(b) With respect to emergency services provided by a health care provider who is not 14
under contract with the insurer, the services shall be covered if:if any of the following criteria are 15
met: 16
(1) A prudent layperson acting reasonably would have believed that a delay would 17
worsen the emergency, oremergency. 18
(2) The covered person did not seek services from a provider under contract with 19
the insurer because of circumstances beyond the control of the covered person. 20
(3) The covered person did not have a choice in the ground ambulance 21
transportation service provider due to the emergency. 22
... 23
(d) Coverage of emergency services shall may be subject to coinsurance, co-payments, 24
and deductibles applicable under the health benefit plan. An insurer shall not impose cost-sharing 25
for emergency services provided under this section section, including emergency ambulance 26
transportation services, that differs from the cost-sharing that would have been imposed if the 27
physician or provider furnishing the services were a provider contracting with the insurer. 28
... 29
(g) As used in this section, the term:The following definitions apply in this section: 30
(1) Covered person. – An individual who is enrolled in a health benefit plan and 31
entitled to receive the benefits and services covered by that particular health 32
benefit plan. 33
(1a) "Emergency Emergency medical condition" means a condition. – A medical 34
condition manifesting itself by acute symptoms of sufficient severity, 35
including, but not limited to, severe pain, or by acute symptoms developing 36

General Assembly Of North Carolina Session 2025
Page 2 House Bill 489-Second Edition
from a chronic medical condition that would lead a prudent layperson, 1
possessing an average knowledge of health and medicine, to reasonably 2
expect the absence of immediate medical attention to result in any of the 3
following: 4
a. Placing the health of an individual, or with respect to a pregnant 5
woman, the health of the woman or her unborn child, in serious 6
jeopardy. 7
b. Serious impairment to bodily functions. 8
c. Serious dysfunction of any bodily organ or part. 9
(1b) Emergency medical transportation. – An emergency response, as defined 10
under 42 C.F.R. § 414.605, and includes all of the following: 11
a. Transportation to a healthcare facility. 12
b. Ground ambulance transportation between two healthcare facilities 13
"interfacility" transportation, when the transportation is being 14
provided to the covered person because the needed medical care to 15
treat the covered person's medical condition is not available at the 16
current healthcare facility. 17
c. Emergency medical services that resulted with a medical evaluation 18
being provided to the covered person without the covered person being 19
transported to an emergency department. 20
(2) "Emergency services" means health care Emergency services. – Healthcare 21
items and services furnished or required to screen for or treat an emergency 22
medical condition until the condition is stabilized, including prehospital care 23
care, ambulance transportation services, and ancillary services routinely 24
available to the emergency department. 25
... 26
(4b) Out-of-network provider. – A provider that does not contract with the insurer 27
of the health benefit plan under which a covered person is receiving services 28
from that provider is enrolled. 29
(5) "To stabilize" means to Stabilize. – To provide medical care that is appropriate 30
to prevent a material deterioration of the person's condition, within reasonable 31
medical probability, in accordance with the HCFA (Health Care Financing 32
Administration) Centers for Medicare and Medicaid Services interpretative 33
guidelines, policies and regulations pertaining to responsibilities