A BILL TO BE ENTITLED
AN ACT repealing certificate of need laws for ambulatory surgical facilities and for inpatient rehabilitation services, facilities, and beds; appropriating funds to the department of health and human services to implement these changes and develop a plan for the phased elimination of the state's remaining certificate of need laws; and deleting obsolete definitions for behavioral health facilities that are no longer subject to certificate of need review.
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 131E‑176 reads as rewritten:
"§ 131E‑176.  Definitions.
The following definitions apply in this Article:
…

…
(7d)	Gastrointestinal endoscopy room. – A room in a licensed health service facility used for the performance of procedures that require the insertion of a flexible endoscope into a gastrointestinal orifice to visualize the gastrointestinal lining and adjacent organs for diagnostic or therapeutic purposes.
…
(9b)	Health service facility. – A hospital; long‑term care hospital; nursing home facility; adult care home; kidney disease treatment center, including freestanding hemodialysis units; intermediate care facility for individuals with intellectual disabilities; home health agency office; diagnostic center; or hospice office, hospice inpatient facility, or hospice residential care facility.
(9c)	Health service facility bed. – A bed licensed for use in a health service facility in the categories of (i) acute care beds; (ii) nursing home beds; (iii) intermediate care beds for individuals with intellectual disabilities; (iv) hospice inpatient facility beds; (v) hospice residential care facility beds; (vi) adult care home beds; and (vii) long‑term care hospital beds.
…
(13d)	Hospital. – A public or private institution that is primarily engaged in providing to inpatients, by or under supervision of physicians, diagnostic services and therapeutic services for medical diagnosis, treatment, and care of injured, disabled, or sick persons. The term includes all facilities licensed pursuant to G.S. 131E‑77, except rehabilitation facilities and long‑term care hospitals.
…
	
…
(16)	New institutional health services. – Any of the following:
…
b.	Except as otherwise provided in G.S. 131E‑184(e), the obligation by any person of a capital expenditure exceeding four million dollars ($4,000,000) to develop or expand a health service or a health service facility, or which relates to the provision of a health service. The cost of any studies, surveys, designs, plans, working drawings, specifications, and other activities, including staff effort and consulting and other services, essential to the acquisition, improvement, expansion, or replacement of any plant or equipment with respect to which an expenditure is made shall be included in determining if the expenditure exceeds four million dollars ($4,000,000). Beginning September 30, 2022, and on September 30 each year thereafter, the amount in this sub‑subdivision shall be adjusted using the Medical Care Index component of the Consumer Price Index published by the U.S. Department of Labor for the 12‑month period preceding the previous September 1.
…
	
…
(17a)	Nursing care. – Any of the following:
a.	Skilled nursing care and related services for residents who require medical or nursing care.
b.	Rehabilitation services, other than those provided at an inpatient rehabilitation facility, for the rehabilitation of individuals who are injured or sick or who have disabilities.
c.	Health‑related care and services provided on a regular basis to individuals who, because of their mental or physical condition, require care and services above the level of room and board that can be made available to them only through institutional facilities.
These are services that are not primarily for the care and treatment of mental diseases.
…

	
	
(22)	Rehabilitation facility. – A facility that has been classified and designated as an inpatient rehabilitation facility by the Centers for Medicare and Medicaid Services pursuant to Part 412 of Subchapter B of Chapter IV of Title 42 of the Code of Federal Regulations.
…
	
…."
SECTION 2.  G.S. 131E‑178(a) reads as rewritten:
"(a)	No person shall offer or develop a new institutional health service without first obtaining a certificate of need from the Department.

	
	
"
SECTION 3.  G.S. 90‑21.82A(a)(2) reads as rewritten:
"(2)	Ambulatory surgical facility. – As defined in G.S. 131E‑146."
SECTION 4.  G.S. 131E‑146(3), 131E‑147.5, 131E‑176(5b), 131E‑176(5c), and 131E‑176(21) are repealed.
SECTION 5.  There is appropriated from the General Fund to the Department of Health and Human Services, Division of Health Service Regulation, the sum of fifty thousand dollars ($50,000) in nonrecurring funds for the 2026‑2027 fiscal year. These funds shall be used to do both of the following:
(1)	To implement the repeal of certificate of need laws for ambulatory surgical facilities and for inpatient rehabilitation services, facilities, and beds, as provided by Sections 1 and 2 of this act.
(2)	To develop a comprehensive plan for the phased elimination of the State's remaining certificate of need laws. The plan shall include (i) a proposed phaseout to be completed within a three‑year period following adoption of the plan by an act of the General Assembly and (ii) a recommended time line for phasing out specific health services and health service facilities. The Department of Health and Human Services, Division of Health Service Regulation, shall develop and submit the plan required by this subdivision to the Joint Legislative Oversight Committee on Health and Human Services, the chairs of the House Appropriations Committee on Health and Human Services, the chairs of the Senate Appropriations Committee on Health and Human Services, the Speaker of the House of Representatives, the President Pro Tempore of the Senate, and the Fiscal Research Division by July 1, 2027.
SECTION 6.  If any provision of this act or its application is held invalid, the invalidity does not affect other provisions or applications of this act that can be given effect without the invalid provisions or application and, to this end, the provisions of this act are severable.
SECTION 7.  This act becomes effective July 1, 2026.