Senate Bill 737 directs the North Carolina Department of Health and Human Services, Division of Health Benefits, to amend the Medicaid State Plan so that licensed ambulatory surgical centers are reimbursed at no less than 95% of the Medicare Ambulatory Surgical Center fee schedule in effect each January 1. The bill applies to all services provided by licensed ambulatory surgical centers and requires the initial rate changes to begin once CMS approves the State Plan amendment.
The bill also appropriates recurring state funds to support the higher reimbursement rates. It provides $6.916 million from the General Fund for each year of the 2025-2027 biennium as the state match for $12.633 million in recurring federal funds, all to be used by the Division of Health Benefits for implementation. The act becomes effective July 1, 2025.
Impact
If enacted, the bill would change North Carolina Medicaid reimbursement policy for ambulatory surgical centers by tying payment rates to a percentage of the Medicare ASC fee schedule. This would require a Medicaid State Plan amendment and would increase recurring state and federal spending for outpatient surgical services delivered in licensed ambulatory surgery centers. The affected parties would include DHHS, Medicaid beneficiaries, ambulatory surgical centers, and the state budget.
Sentiment
The available record shows the bill was introduced with named sponsors and no recorded committee transcript or vote history in the provided materials, so there is no documented debate or formal sentiment to assess from the context supplied. Based on the bill text alone, the measure appears to be a targeted reimbursement increase intended to support ambulatory surgical center participation in Medicaid.
Contention
No specific points of contention are documented in the provided transcripts or votes. Potential areas of debate, based on the bill itself, would likely include the cost of the recurring appropriation, the use of state funds to draw down federal matching dollars, and whether setting Medicaid rates at 95% of Medicare is the appropriate reimbursement benchmark for ambulatory surgical centers.