Reduce Healthcare Costs & Protect Patients.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 976

Short Title: Reduce Healthcare Costs & Protect Patients. (Public)
Sponsors: Senator Grafstein (Primary Sponsor).
Referred to: Rules and Operations of the Senate
May 4, 2026
*S976-v-1*
A BILL TO BE ENTITLED 1
AN ACT REDUCING HEALTHCARE COSTS AND PROTECTING PATIENTS. 2
Whereas, rising healthcare costs place a significant financial burden on individuals, 3
families, employers, and taxpayers; greatly contribute to inflation; and make it increasingly 4
difficult for residents to access essential healthcare services; and 5
Whereas, North Carolina has intolerably high healthcare costs, with recent studies 6
ranking the State 50th out of 50 in the United States; and 7
Whereas, skyrocketing healthcare costs have resulted in over forty percent (40%) of 8
Americans reporting some type of healthcare debt, according to one study; and 9
Whereas, many patients face unexpected medical bills due to a lack of disclosure 10
about out-of-network providers and a general lack of transparency in healthcare pricing, resulting 11
in financial strain and hardship; and 12
Whereas, patients and employers are often unable to compare the costs of medical 13
services due to a lack of clear and accessible pricing information, hindering their ability to make 14
informed decisions; Now, therefore, 15
The General Assembly of North Carolina enacts: 16
17
PART I. PRESCRIPTION DRUG AFFORDABILITY 18
SECTION 1.1.(a) Article 3 of Chapter 58 of the General Statutes is amended by 19
adding a new section to read: 20
"§ 58-3-182. Limits on cost-sharing. 21
Prescription Drugs. – The cost -sharing for any health benefit plan for the coverage of 22
prescription drugs shall not exceed the annual amount of two thousand dollar s ($2,000) per 23
covered person. Cost-sharing includes copayments, deductibles, and any other out -of-pocket 24
expense for a prescription drug paid by the covered individual." 25
SECTION 1.1.(b) This section is effective October 1, 2026, and applies to insurance 26
contracts entered into, renewed, or amended on or after that date. 27
28
PART II. SURPRISE BILLING AND EMERGENCY PROTECTION 29
SECTION 2.1.(a) G.S. 58-3-182, as enacted by Section 1.1(a) of this act, reads as 30
rewritten: 31
"§ 58-3-182. Limits on cost-sharing. 32
(a) Prescription Drugs. – The cost-sharing for any health benefit plan for the coverage of 33
prescription drugs shall not exceed the annual amount of two thousand dollars ($2,000) per 34
covered person. Cost -sharing includes copayments, deductibles, and any other out -of-pocket 35
expense for a prescription drug paid by the covered individual. 36
General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 976-First Edition
(b) In-Network Facilities. – All nonemergency care provided at a facility that is part of 1
the health benefit plan 's provider network shall be charged to the covered individual at a n 2
in-network rate. No health benefit plan shall allow for any cost-sharing at an out-of-network rate 3
so long as the facility in which the care is provide d is in the health benefit plan 's provider 4
network." 5
SECTION 2.1.(b) G.S. 58-3-200(d) reads as rewritten: 6
"(d) Services Outside Provider Networks. – No insurer shall penalize an insured or subject 7
an insured to the out-of-network benefit levels offered under the insured's approved health benefit 8
plan, including an insured receiving an extended or standing referral under G.S. 58-3-223, unless 9
contracting health care healthcare providers able to meet health needs of the insured are 10
reasonably available to the insured without unreasonable delay. Upon notice or request from the 11
insured, the insurer shall determine whether a healthcare provider able to meet the needs of the 12
insured is available to the insured without unreasonable delay by reference to the insured 's 13
location and the specific medical needs of the insured." 14
SECTION 2.1.(c) This section becomes effective October 1, 2026, and applies to 15
healthcare services provided on or after that date and to contracts issued, renewed, or amended 16
on or after that date. 17
SECTION 2.2. Beginning with the 2027 calendar year, emergency ground 18
ambulance services shall be considered part of the essential health benefit pac kage under 45 19
C.F.R. § 147.150(a). The Commissioner of the Department of Insurance shall communicate this 20
change to the federal Centers for Medicare and Medicaid Services and to all insurers offering a 21
health benefit plan in North Carolina on the federally facilitated marketplace. 22
23
PART III. MEDICAL DEBT PREVENTION 24
SECTION 3.1.(a) Chapter 131E of the General Statutes is amended by adding a new 25
Article 11C to be entitled "Fair Billing and Collections Practices for Hospitals and Ambulatory 26
Surgical Facilities." 27
SECTION 3.1.(b) G.S. 131E-91 is recodified as G.S. 131E-214.50 under Ar ticle 28
11C of Chapter 131E of the General Statutes, as created by subsection (a) of this section. 29
SECTION 3.1.(c) G.S. 131E-214.50(d), as recodified by subsection (b) of this 30
section, reads as rewritten: 31
"(d) Hospitals and ambulatory surgical facilities sh all abide by the following reasonable 32
collections practices: 33
… 34
(1a) A hospital or ambulatory surgical facility shall not refer a patient's unpaid bill 35
to a collections agency, entit y, or other assignee unless it has first made an 36
informed decision, based on a screening of the patient, that the patient is not 37
eligible for charity care or financial assistance under the hospital 's or 38
ambulatory surgical facility's charity care or financial assistance policies. 39
(1b) A hospital or ambulatory surgical facility shall not report a patient 's unpaid 40
bill to a credit reporting agency until the unpaid bill is at least 180 days past 41
due. 42
…." 43
44
PART IV. PRICE TRANSPARENCY IN HEALTHCARE 45
SECTION 4.1.(a) G.S. 131E-214.13 reads as rewritten: 46
"§ 131E -214.13. Disclosure of p rices for most frequently reported DRGs, CPTs, and 47
HCPCSs. 48
(a) The following definitions apply in this Article: 49
(1) Ambulatory surgical facility. – A facility licensed under Part 4 of Article 6 of 50
this Chapter. 51
General Assembly Of North Carolina Session 2025
Senate Bill 976-First Edition Page 3
(2) Commission. – The North Carolina Medical Care Commission. 1
(2a) CPT. – Current Procedural Terminology. 2
(2b) DRG. – Diagnostic Related Group. 3
(2c) HCPCS. – The Healthcare Common Procedure Coding System. 4
(3) Health insurer. – An entity that writes a health benefit plan and is one of the 5
following: 6
a. An insurance company under Article 3 of Chapter 58 of the General 7
Statutes. 8
b. A service corporation under Article 65 of Chapter 58 of the General 9
Statutes. 10
c. A health maintenance organization under Article 67 of Chapter 58 of 11
the General Statutes. 12
d. A third -party administrator of one or more group health plans, as 13
defined in section 607(1) of the Employee Retirement Income Security 14
Act of 1974 (29 U.S.C. § 1167(1)). 15
(4) Hospital. – A medical care facility licensed under Article 5 of this Chapter or 16
under Article 2 of Chapter 122C of the General Statutes. 17
(5) Public or private third party. – Includes the State, the federal government, 18
employers, health insurers, third -party administrators, and managed care 19
organizations. 20
(6) Statewide data processor. – As defined in G.S. 131E-214.1. 21
(b) Beginning with the reporting period ending September 30, 2015, and annually 22
thereafter, Quarterly Report on Most Frequently Reported DRGs for Inpatients. – On a quarterly 23
basis, each hospital shall provide to the Department of Health and Human Services statewide 24
data processor, utilizing electronic health records software, the following information about the 25
100 most frequently reported admissions by DRG for inpatients as established by the 26
Department: 27
(1) The amount that will be charged to a patient for each DRG if all charges are 28
paid in full without a public or private third party paying for any portion of 29
the charges. In calculating this amount, each hospital shall include charges for 30
each billable item and service associated with the DRG regardless of whether 31
the health service is performed by a physician or nonphysician practitioner 32
employed by the hospital. 33
(2) The average negotiated settlement on the amount that will be charged to a 34
patient required to be provided in subdivision (1) of this subsection. 35
(3) The amount of Medicaid reimbursement for each DRG, including claims and 36
pro rata supplemental payments. 37
(4) The amount of Medicare reimbursement for each DRG. 38
(5) For each of the five largest health insu rers providing payment to the hospital 39
on behalf of insureds and teachers and State employees, the range and the 40
average of the amount of payment made for each DRG. Prior to providing this 41
information to the Department statewide data processor , each hospital shall 42
redact the names of the health insurers and any other information that would 43
otherwise identify the health insurers. 44
A hospital shall not be required to report the information required by this subsection for any 45
of the 100 most frequently reported admissions where the reporting of that information 46
reasonably could lead to the identification of the person or persons admitted to the hospital in 47
violation of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) or 48
other federal law. 49
General Assembly Of North Carolina Session 2025
Page 4 Senate Bill 976-First Edition
(c) The Commission shall adopt rules on or before March 1, 2016, to ensure that 1
subsection (b) of this section is properly implemented and that hospitals report this information 2
to the Department in a uniform manner. The rules shall include all of the following: 3
(1) The method by which the Department shall determine the 100 most frequently 4
reported DRGs for inpatients for which hospitals must provide the data set out 5
in subsection (b) of this section. 6
(2) Specific categories by which hospitals shall be grouped for the purpose of 7
disclosing this information to the public on the Department's Internet Web 8
site. 9
(d) Beginning with the reporting period ending September 30, 2015, and annually 10
thereafter, Quarterly Report on Total Costs for the Most Common Surgical and Imaging 11
Procedures. – On a quarterly basis , each hospital and ambulatory surgical facility shall provide 12
to the Department, statewide data processor, utilizing electronic health records software, 13
information on the total costs for the 20 most common surgical procedures and the 20 most 14
common imaging procedures, by volume, performed in hospital outpatient settings or in 15
ambulatory surgical facilities, al ong with the related CPT and HCPCS codes. In providing 16
information on total costs, each hospital and ambulatory surgical facility shall include the costs 17
for each billable item and service associated with the procedure regardless of whether the health 18
service is performed by a physician or nonphysician practitioner employed by the hospital or 19
ambulatory surgical facility. Hospitals and ambulatory surgical facilities shall report this 20
information in the same manner as required by subdivisions (b)(1) thro ugh (5) of this section, 21
provided that hospitals and ambulatory surgical facilities shall not be required to report the 22
information required by this subsection where the reporting of that information reasonably could 23
lead to the identification of the perso n or persons admitted to the hospital in violation of the 24
federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) or other federal 25
law. 26
(e) The Commission shall adopt rules on or before March 1, 2016, to ensure that 27
subsection (d) of this section is properly implemented and that hospitals and ambulatory surgical 28
facilities report this information to the Department in a uniform manner. The rules shall include 29
the method by which the Department shall determine the 20 most common surgical p rocedures 30
and the 20 most common imaging procedures for which the hospitals and ambulatory surgical 31
facilities must provide the data set out in subsection (d) of this section. 32
(e1) The Commission shall adopt rules to establish and define no fewer than 10 q uality 33
measures for licensed hospitals and licensed ambulatory surgical facilities. 34
(f) Upon request of a patient for a particular DRG, imaging procedure, or surgery 35
procedure reported in this section, a hospital or ambulatory surgical facility shall provi de the 36
information required by subsection (b) or subsection (d) of this section to the patient in writing, 37
either electronically or by mail, within three business days after receiving the request. 38
(f1) Commission Rules. – The Commission shall adopt rules to accomplish all of the 39
following: 40
(1) To ensure that subsection (b) of this section is properly implemented and that 41
hospitals report this information to the statewide data processor in a uniform 42
manner. The rules shall include the method by which the statewide data 43
processor shall determine the 100 most frequently reported DRGs for 44
inpatients for which hospitals must provide the data set out in subsection (b) 45
of this section and the specific categories by which hospitals shall be grouped 46
for the purpose of disclosing this information to the public on the Department's 47
website. 48
(2) To ensure that subsection (d) of this section is properly implemented and that 49
hospitals and ambulatory surgical facilities report this information to the 50
statewide data processo r in a uniform manner. The rules shall include the 51
General Assembly Of North Carolina Session 2025
Senate Bill 976-First Edition Page 5
method by which the statewide data processor shall determine the 20 most 1
common surgical procedures and the 20 most common imaging procedures 2
for which the hospitals and ambulatory surgical facilities must provide the 3
data set out in subsection (d) of this section. 4
(3) To establish and define no fewer tha n 10 quality measures for licensed 5
hospitals and licensed ambulatory surgical facilities. 6
(4) To establish procedures for the statewide data processor to receive the data 7
required by subsections (b) and (d) of this section and submit that data to the 8
Department for publication on the Department's website. 9
(g) G.S. 150B-21.3 does not apply to rules adopted under subsections (c) and (e) 10
subdivision (f1)(1) or subdivision (f1)(2) of this section. A rule adopted under subsections (c) 11
and (e) subdivision (f1)(1) or subdivision (f1)(2) of this section becomes effective on the last day 12
of the month following the month in which the rule is approved by the Rules Review 13
Commission." 14
SECTION 4.1.(b) Article 11B of Chapter 131E of the General Statutes is amende d 15
by adding a new section to read: 16
"§ 131E-214.18. Penalty for noncompliance. 17
The Department may impose a civil penalty on any hospital or ambulatory surgical facility 18
that fails to comply with the requirements of this Article. For each day of violation, the amount 19
of the civil penalty shall not be (i) less than one hundredth of one percent (.01%) of the annual 20
salary of the chief executive officer of the noncompliant hospital or ambulatory surgical facility 21
or (ii) greater than two thousand dollars ($2,000). This civil penalty shall be in addition to any 22
fine or civil penalty that the Centers for Medicare and Medicaid Services or other federal agency 23
may choose to impose on the facility . The Department shall remit the clear proceeds of civil 24
penalties assessed pursuant to this section to the Civil Penalty and Forfeiture Fund in accordance 25
with G.S. 115C-457.2." 26
SECTION 4.1.(c) G.S. 131E-214.4(a) reads as rewritten: 27
"(a) A statewide data processor shall perform the following duties: 28
… 29
(8) Receive data required to be submitted by hospitals under G.S. 131E-214.13(b) 30
and by hospitals and ambulatory surgical facilities under G.S. 131E-214.13(d) 31
and submit that data to the Department of Health and Human Services 32
(Department) for publication on the Department's website." 33
SECTION 4.1.(d) This section becomes effective on the later of January 1, 2027, or 34
the date the rules adopted by the North Carolina Medica l Care Commission under 35
G.S. 131E-214.13(f1)(2) take effect, and G.S. 131E-214.18, as enacted by this Part, applies to 36
acts occurring on or after that date. The Commission shall notify the Revisor of Statutes when 37
the rules required under G.S. 131E-214.13(f1)(1) and (f1)(2) take effect. 38
SECTION 4.2.(a) Article 11C of Chapter 131E of the General Statutes, as created 39
by Section 3.1(a) of this act, is amended by adding a new section to read: 40
"§ 131E-214.52. Patient's right to a good-faith estimate. 41
(a) Definitions. – The following definitions apply in this section: 42
(1) CMS. – The federal Centers for Medicare and Medicaid Services. 43
(2) Facility. – A hospital or ambulatory surgical facility licensed under this 44
Chapter. 45
(3) Items and services. – All items and services, including individual items and 46
services and service packages, that could be provided by a facility to a patient 47
in connection with an inpatient admission or an outpatient visit for which the 48
facility has established a standard charge. Examples include, but are not 49
limited to, all of the following: 50
a. Supplies and procedures. 51
General Assembly Of North Carolina Session 2025
Page 6 Senate Bill 976-First Edition
b. Room and board. 1
c. Fees for use of the facility or other items. 2
d. Professional charges for s ervices of physicians and nonphysician 3
practitioners who are employed by the facility. 4
e. Professional charges for services of physicians and nonphysician 5
practitioners who are not employed by the facility. 6
f. Any other items or services for which a facility has established a 7
standard charge. 8
(4) Service package. – An aggregation of individual items and services into a 9
single service with a single charge. 10
(5) Shoppable service. – A non-urgent service that can be scheduled by a patient 11
in advance. The term includes all CMS-specified shoppable services plus as 12
many additional facility -selected shoppable services as are necessary for a 13
combined total of at least 300 shoppable services. 14
(b) Good-Faith Estimate. – Upon request of any patient for a good -faith estimate for a 15
shoppable service, the facility shall provide to the patient, in writing, at least three business days 16
prior to the date the patient schedules the shoppable service, an itemized list of expected charges, 17
in language comprehensible to an ordinary layperson, that the patient will be obligated to pay for 18
all items and services related to the shoppable service. The good-faith estimate shall include the 19
Diagnostic Related Group (DRG ), Current Procedural Terminology (CPT), or Healthcare 20
Common Procedure Coding System (HCPCS) code for each expected charge. 21
(c) In any case in which a patient has requested a good -faith estimate from a facility for 22
a shoppable service, the patient's final bill for that shoppable service shall not exceed more than 23
five percent (5%) of the good-faith estimate provided to the patient pursuant to this section. 24
(d) The Department shall adopt rules to implement this section." 25
SECTION 4.2.(b) This section becomes effective on the later of January 1, 2027, or 26
the date the rules adopted by the Department under G.S. 131E-214.52, as enacted by subsection 27
(a) of this section, take effect and applies to acts occurring on or after that date. The Department 28
shall notify the Revisor of Statutes when the rules required under G.S. 131E-214.52 take effect. 29
30
PART V. APPROPRIATIONS 31
SECTION 5.1. Effective July 1, 2026, there is appropriated from the General Fund 32
to the Department of Insurance the sum of two million five hundred thousand dollars 33
($2,500,000) in recurring funds beginning in the 2026-2027 fiscal year to implement and enforce 34
Part I and Part II of this act. 35
SECTION 5.2. Effective July 1, 2026, there is appropriated from the General Fund 36
to the Department of Health and Human Services the sum of two million five hundred thousand 37
dollars ($2,500,000) in recurring funds beginning in the 2026-2027 fiscal year to implement and 38
enforce Parts III and IV of this act. 39
40
PART VI. EFFECTIVE DATE 41
SECTION 6.1. Except as otherwise provided, this act is effective when it becomes 42
law. 43