Senate panel reviews Medicaid plan and facility fee bills
RALEIGH — A Senate committee reviewed two Medicaid-related bills Tuesday that could affect how North Carolina’s Medicaid program handles some hospital claims, facility fees and managed care practices.
The Senate Rules and Operations Committee had House Bill 390, Medicaid Prepaid Health Plan Practices, and House Bill 727, Limit Medicaid Reimb. for Facility Fees, on its 9:30 a.m. agenda Tuesday, May 5, according to the North Carolina General Assembly calendar. Both bills were referred to Senate Rules on April 30 after committee substitutes were adopted in the Senate Health Care Committee.
House Bill 390 would allow certain practices by Medicaid prepaid health plans, known as PHPs. Under the bill, the state Department of Health and Human Services could not prohibit PHPs from requiring itemized bills for certain high-cost inpatient hospital outlier claims, aligning claims operations with national standards for coding and claims adjudication, or directing inpatient hospital and inpatient hospital laboratory services to outpatient settings when appropriate.
The bill would apply to contracts entered into or amended after it becomes law. The bill includes language tied to whether House Bill 696, another 2025 session bill, becomes law before June 1, 2026.
House Bill 727 would limit Medicaid reimbursement for certain facility fees. The bill directs DHHS, to the extent allowed under federal law, to ensure Medicaid does not reimburse facility fees unless services are provided on a hospital’s main campus, at a facility that includes an emergency department, or at an ambulatory surgical facility.
The bill defines a facility fee as a fee charged or billed by a health care provider for outpatient services provided in a hospital-based facility. The definition says the fee is intended to compensate the provider for operational expenses, is separate from a professional fee and is charged regardless of how the health care services were provided.
The measures come as lawmakers continue to review health care costs, Medicaid spending and the role of managed care organizations in the state’s Medicaid system.
Both bills previously passed the House unanimously in 2025 before moving to the Senate. House Bill 390 passed second reading in the House 113-0 on April 16, 2025. House Bill 727 passed second reading in the House 111-0 on May 7, 2025.
The bills do not appear to have final Senate approval yet, based on the latest bill history posted by the General Assembly. Their placement before Senate Rules could position them for further action during the short session.
Supporters of the proposals could argue the bills are designed to control Medicaid costs, improve claims review and limit facility fees outside core hospital settings. Hospitals and other providers may raise concerns about reimbursement limits, administrative requirements or the effect on access to care, particularly for outpatient services.
The next question is whether Senate leaders move either bill to the floor, amend the proposals further or fold the provisions into a larger health care or budget package.
Editor’s note: This article was drafted with the assistance of artificial intelligence and was reviewed and fact-checked by a member of the NC Political News editorial team before publication.
