Digital Debut

North Carolina Takes a New Look at Facility Fee Restrictions

New push comes on heels of proposals in 2023, 2024

BY STEPHEN ABRESCH | MARCH 28, 2025

On March 25, for the first time, a North Carolina bill explicitly identified ASCs as one of the sites of service that is entitled to bill a facility fee. The North Carolina Senate Committee on Judiciary passed SB 316 with language that excludes ASCs from the limitations placed on facility fees: “No health care provider shall charge, bill, or collect a facility fee unless the services are provided on a hospital’s main campus, at a remote location of a hospital, at a facility that includes an emergency department, or at an ambulatory surgical facility.”

Background

Last week, North Carolina State Senators Jim Burgin, Amy Galey and Benton Sawrey introduced SB 316, titled “Lower Healthcare Costs,” with provisions expanding existing price transparency requirements, imposing new price transparency requirements and, most notably, imposing restrictions on facility fees charged by healthcare providers.

Facility fee restrictions are not a new topic of discussion in the North Carolina General Assembly. During the 2023–2024 legislative session in North Carolina, two other attempts were made to pass restrictions on facility fees.

The North Carolina General Assembly introduced SB 321 in March 2023 to create protections for those with medical debt, but a committee amendment in May that year added new, controversial provisions. The measure would have prohibited healthcare providers from charging, billing or collecting a facility fee unless healthcare services were provided on a hospital’s main campus or at a facility that includes an emergency department. “Facility fee” was defined as any fee charged by a healthcare provider for outpatient services provided in a hospital-based facility that is intended to compensate for the healthcare provider’s operational expenses, separate and distinct from a professional fee, and charged regardless of the modality through which the healthcare services were provided. “Hospital-based facility” was defined as a facility that is owned or operated, in whole or in part, by a hospital where hospital or professional medical services are provided.

ASCA and other organizations interpreted these provisions to mean that, if passed, SB 321 would prohibit ASCs with any level of hospital ownership from billing facility fees. Despite passing with unanimous support in the North Carolina Senate in May 2023, members of the North Carolina House balked at the changes and never took the bill up for consideration in committee, leaving it to die at the end of the 2023–2024 session.

A year later—but as part of the same legislative session—the North Carolina Senate Committee on Health Care amended HB 681, a measure originally pertaining to interstate licensing compacts for physicians and military personnel, with facility fee restrictions and passed it on May 22, 2024. The language was nearly identical to that of SB 321: under the provisions, ASCs with any level of hospital ownership would no longer be able to bill facility fees. Just as quickly as the provisions were added, word spread that those same provisions would be the bill’s undoing. The North Carolina House, having already declined to consider the provisions when they were part of SB 321, was furious the North Carolina Senate had tried to backdoor the issue. The disagreement threatened to derail other work between the two chambers, with the Senate ultimately never bringing HB 681 up for a floor vote.

With the introduction of SB 316 in the 2025–2026 legislative session, the Senate was prepared to try again. Introduced with provisions identical to those in HB 681, the Senate Committee on Health Care quickly heard, substituted and passed the bill on March 19, only two days after its introduction. The bill was substituted again and passed the Senate Committee on Judiciary on March 25, this time with new language. The change may well increase chances of passage in the House, as states like Colorado and Connecticut show that site-of-service facility fee restriction proposals are more likely to pass once they have been narrowed to protect ASCs. The true test of whether the changes are enough will come when the bill reaches the House, with its history of skepticism toward facility fee restrictions.

ASCA is tracking this and other bills containing provisions that would restrict billing of facility fees. Write Stephen Abresch at sabresch@ascassociation.org with any questions.