The North Carolina General Assembly last week unveiled a massive piece of healthcare legislation aimed at increasing access and affordability. The legislation has many parts, most of which are good and a few that are not.

Overall, the legislation is a net positive and will improve access and lower healthcare costs.


The bill can be broken down into five key parts.


1.     The SAVE Act


The bill includes the SAVE Act – legislation scored and supported by the Coalition – which increases access and lowers costs by removing outdated government regulations that restrict highly-skilled nurses from practicing at the full level of their education and training.


By removing the burdensome, unnecessary, and outdated requirement that Advanced Practice Registered Nurses get an agreement from a physician to supervise their work (a requirement was waived to expand access to care during COVID-19) the bill would increase the supply of qualified healthcare professionals. This, in turn, could improve access to care, especially in rural areas.


Importantly, the legislation would not allow Advanced Practice Registered Nurses to do anything they are not already doing. It would simply remove current regulatory barriers to independent practice such as requiring these nurses to meet with a“supervising” physician every six months and pay the physician a fee.


Studies have also found that removing this regulation could save up to $4.3 billion.


2.     CON Reform


The bill makes multiple reforms to the state’s “Certificate of Need” laws, most of which are good and will go along way in improving affordability and access.


As we know, currently, if someone wants to open most new healthcare facilities in North Carolina, they must get permission from the government by demonstrating a “need.” This limits access to new, innovative behavioral health and substance abuse services, for example.Many of the bill’s CON reforms – such as repealing CON for chemical dependency treatment facilities – will increase access to new and better care.  


The bill also reduced several unnecessary and costly administrative burdens.


Overall, the bill strikes a balance between access and cost by eliminating the “need” requirement but still holding applicants accountable for quality and access.  


There are a couple areas for improvement, however.


First, the bill repeals CON forAmbulatory Surgical Centers (ASCs). ASCs provide many of the same services a large, fully equipped hospital can, but at a much lower cost. CON laws have, however, prevented ASCs from opening because the large, expensive hospital system already holds the CON. Not only will the ASCs offer more affordable care, but increased competition will also place downward pressure on the expensive hospital system’s prices.


Unfortunately, the bill goes too far in removing accountability for quality of care for ASCs. ASCs should not have to demonstrate a “need” to compete in the marketplace, but the care they provide should still be held to quality standards. This puts them on a level playing field with other facilities.


The bill also removes the requirement of obtaining a CON for MRI machines. MRI machines are easy to operate and open, but wildly expensive and profitable for those owning the machine. This could lead to overuse, and expensive, unnecessary tests.


3.     Surprise Billing


The legislation includes protections against surprise medical billing. Specifically, the legislation requires that patients be notified prior to a procedure if anyone caring for them at an in-network facility is out-of-network. It also says patients must be told the expected cost for the out-of-network service.  


An important part of this notice is that a facility or provider most inform you if they are referring your care to an out-of-network doctor or service provider. This way you will know if your labs or x-rays are being sent to an out-of-network provider before it’s too late.    


This increased transparency will give patients the opportunity to find other, in-network alternatives if a provider on their care team is out-of-network.


4.     Telehealth Mandate


The worst part of the legislation – by far – is its mandate that requires families and businesses, through their insurance premiums, cover (i.e., pay for) any healthcare service provided virtually if it’s covered in-person.


We saw this costly and dangerous legislation introduced in the House last year.


Thankfully, the bill sponsors took deliberate action to include consumer protections that guard against the very real abuse, fraud, and quality of care concerns.


It is essential that these consumer protections remain in the bill as it works its way through the legislative process. Without them, the bill’s net positives for access and affordability would be totally diminished.


This portion of the bill could be improved by removing the mandate. This would allow the consumer protections to remain, while also ensuring that providers and insurers have the flexibility to create telehealth plans that best serve patients.


5.     Medicaid Expansion


Finally, the legislation includes a workable solution for North Carolina to expandMedicaid and help hospitals.   


The state has already transitioned to Medicaid Managed Care. Providing affordable health insurance to an additional estimated 500,000 individuals will increase access to care.


And it will lessen the burden on businesses and workers to subsidize uncompensated care, thus driving down premiums.


Healthcare policy is always complicated and often controversial. While the telehealth mandate is unnecessary, and some opportunities were missed with CON reform, this legislation, overall, is a net positive and will improve access and lower healthcare costs.  With some minor adjustments, the bill could be a big with for healthcare consumers in North Carolina.


Its passage would be a big win for healthcare access and affordability.

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