No Surprises for Ambulance Services Act.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 456

Short Title: No Surprises for Ambulance Services Act. (Public)
Sponsors: Representatives von Haefen, Buansi, Greenfield, and Colvin (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Appropriations, if favorable, Rules, Calendar, and Operations of the House
March 20, 2025
*H456-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO MAKE HEALT H INSURANCE COVERAGE OF GROUND AMBULANCE 2
SERVICE MORE EQUITAB LE AND THE COST -SHARING REQUIREMENTS MORE 3
TRANSPARENT. 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 approp riate 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 shal l 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, c o-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
(f) Insurers shall provide information to their covered persons on all of the following: 30
(1) Coverage of emergency medical services. 31
(2) The appropriate use of emergency services, including the use of the "911" 32
system and other telephone access systems utilized to access prehospital 33
emergency services. 34
(3) Any cost-sharing provisions for emergency medical services. 35
General Assembly Of North Carolina Session 2025
Page 2 House Bill 456-First Edition
(4) The process and procedures for obtaining emergency services, so that covered 1
persons are familiar with the location of in -plan emergency departments and 2
with the location and availability of other in -plan settings at which covered 3
persons may receive medical care. 4
(g) As used in this section, the term:The following definitions apply in this section: 5
(1) "Emergency Emergency medical condition" means a condition. – A medical 6
condition manifesting itself by acute symptoms of sufficient severity, 7
including, but not limited to, severe pain, or by acute symptoms developing 8
from a chronic medical condition that would lead a prudent layperson, 9
possessing an average knowledge of health and medicine, to reasonably 10
expect the absence of immediate medical attention to res ult in any of the 11
following: 12
a. Placing the health of an individual, or with respect to a pregnant 13
woman, the health of the woman or her unborn child, in serious 14
jeopardy. 15
b. Serious impairment to bodily functions. 16
c. Serious dysfunction of any bodily organ or part. 17
(2) "Emergency services" means health care Emergency services. – Healthcare 18
items and services furnished or required to screen for or treat an emergency 19
medical condition until the condition is stabilized, including prehospital care 20
care, ambulance transportation services, and ancillary services routinely 21
available to the emergency department. 22
(3) "Health benefit plan" means any of the following if written by an insurer: an 23
accident and health insurance policy or certificate; a nonprofit hospital or 24
medical service corporation contract; a health maintenance organization 25
subscriber contract; or a plan provided by a multiple employer welfare 26
arrangement. "Health benefit plan" does not mean any plan implemented or 27
administered through the Department of Health and Human Services or its 28
representatives. "Health benefit plan" also does not mean any of the following 29
kinds of insurance: 30
a. Accident. 31
b. Credit. 32
c. Disability income. 33
d. Long-term or nursing home care. 34
e. Medicare supplement. 35
f. Specified disease. 36
g. Dental or vision. 37
h. Coverage issued as a supplement to liability insurance. 38
i. Workers' compensation. 39
j. Medical payments under automobile or homeowners insurance. 40
k. Hospital income or indemnity. 41
l. Insurance under which benefits are payable wit h or without regard to 42
fault and that is statutorily required to be contained in any liability 43
policy or equivalent self-insurance. 44
(4) "Insurer" means an entity that writes a health benefit plan and that is an 45
insurance company subject to this Chapter, a service corporation under Article 46
65 of this Chapter, a health maintenance organization under Article 67 of this 47
Chapter, or a multiple employer welfare arrangement under Article 50A of 48
this Chapter. 49
(5) "To stabilize" means to Stabilize. – To provide medical care that is appropriate 50
to prevent a material deterioration of the person's condition, within reasonable 51
General Assembly Of North Carolina Session 2025
House Bill 456-First Edition Page 3
medical probability, in accordance with the HCFA (Health Care Financing 1
Administration) Centers for Medicare and Medicaid Services interpretative 2
guidelines, policies and regulations pertaining to responsibilities of hospitals 3
in emergency cases (as cases, as provided under the Emergency Medical 4
Treatment and Labor Act, section 1867 of the Social Security Act, 42 U.S.C.S. 5
1395dd), including medically necessary services and supplies to maintain 6
stabilization until the person is transferred.42 U.S.C.S. 1395dd." 7
SECTION 1.(b) Article 3 of Chapter 58 of the General Statutes is amended by 8
adding a new section to read: 9
"§ 58-3-193. Coverage for nonemergency ground ambulance transportation. 10
(a) This section applies to non emergency ground ambulance transportation service. 11
Ground ambulance transportation services provided in an emergency situation are defined and 12
regulated under G.S. 58-3-190. 13
(b) Nonemergency ground ambulance transpor tation services may be subject to 14
cost-sharing, including deductibles, coinsurance, and copayments. When nonemergency ground 15
ambulance transportation services are provided to an insured by an entity that is not a 16
participating provider in the insured's health benefit plan, an insurer shall not impose cost-sharing 17
for those services in an amount greater than one hundred ten percent (110%) of the cost-sharing 18
amount for nonemergency ground ambulance transportation services provided by a participating 19
network provider." 20
SECTION 1.(c) This section becomes effective October 1, 2025, and applies to 21
insurance contracts issued, renewed, or amended on or after that date. 22
SECTION 2.(a) G.S. 135-48.51 reads as rewritten: 23
"§ 135-48.51. Coverage and operational mandates related to Chapter 58 of the General 24
Statutes. 25
The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan: 26
(1) G.S. 58-3-191, Managed care reporting and disclosure requirements. 27
(1a) G.S. 58-3-193, Coverage for nonemergen cy ground ambulance 28
transportation. 29
…." 30
SECTION 2.(b) Effective July 1, 2025, there is appropriated from the General Fund 31
to the Department of State Treasurer the sum of one million dollars ($1,000,000) in recurring 32
funds for each year of the 2025 -2027 fiscal biennium to be used to provide the additional 33
coverage required under this act. 34
SECTION 2.(c) Subsection (a) of this section applies as of the start of the next plan 35
year following that date. 36
SECTION 3. Except as otherwise provided, this act is effective when it become s 37
law. 38