State Priority Issues

The North Carolina Healthcare Association represents the collective voice of more than 130 hospitals and health systems across our state. In today’s rapidly evolving healthcare environment, hospitals are responding to numerous challenges that impact our ability to meet our mission to provide quality healthcare to everyone in the communities we serve. We are ready to partner with lawmakers to ensure North Carolina’s hospitals and health systems have the financial stability and resources needed to serve the everyday healthcare needs of their communities.

The following is a list of state legislative priorities, and the associated position statements, that were approved by the Board of Directors for use during the 2024 Legislative Session:

Behavioral Health Reform

Everyone deserves access to high-quality healthcare, which includes behavioral healthcare. NCHA supports policies that improve access regardless of insurance status and address the root causes of inequality for behavioral health patients by improving insurance coverage and provider networks.

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Certificate of Need Law

The Certificate of Need law ensures that hospitals and health systems maintain the resources to provide high-value care to all in our communities. NCHA supports the Certificate of Need program and adapting the program to address the state’s evolving healthcare needs.

Research papers on Certificate of Need:
Image vs. Reality: Mercatus, CON and Statistics in Search of Meaning, May 2016 

First Do No Harm: Analyzing the Certificate of Need debate in North Carolina, July 2015

“Why Repealing CON is devastating for North Carolina’s rural hospitals” (2021)
Video 1 (CarolinaEast)Video 2 (Southeastern)

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Facility Fees

Facility fees finance the high acuity, 24/7 standby capacity that only hospitals provide and for which no payer covers the full cost. NCHA strongly supports facility fees, which fund the direct and indirect costs that allow hospitals to continue to provide services to patients and serve the needs of their community, allowing specialty care to remain close to home.

2024 NCHA Legislative Brief – Facility Fees

Graduate Medical Education

Every North Carolinian deserves access to highly trained doctors. North Carolina should continue funding medical education programs and explore ways to draw down more of our Federal tax dollars to add more slots to train medical students.

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Healthcare Access and Stabilization Program

NCHA urges policymakers to continue supporting CMS’s Medicaid enhanced payment methodology to ensure the state’s vulnerable population receives needed care without new General Fund requirements. This program will improve beneficiaries’ access to care, enhance quality and aid safety-net hospitals. NCHA urges timely annual submission of the preprint and maximizing federal funds through the HASP program.

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Health Equity

North Carolina’s hospitals and health systems support work to provide care for all North Carolinians regardless of race, ethnicity, gender, insurance status, or income.

2024 NCHA Legislative Brief – Health Equity

Healthcare Workforce

Creating and sustaining the healthcare workforce is essential to providing compassionate and quality care across our state. Covid-19 has exacerbated long-standing workforce challenges and adding pressure to an already exhausted workforce. NCHA supports comprehensive solutions addressing the entire spectrum, from preparing tomorrow’s healthcare leaders through worldclass education programs to bolstering the resiliency of today’s healthcare heroes to continue providing high-quality care. Hospitals should continue to have autonomy through their clinical leadership to determine staffing requirements to ensure safe delivery of healthcare.

To learn more about these priorities, please log in to NCHA Member Resources.

Home Hospital

NCHA supports the following principles for further changes to the hospital assessment tax program: 1) protect the hospital assessment tax structure established in SL 2023-7, which establishes the hospital assessment for Medicaid Expansion and HASP; 2) reinvest the market basket adjustment from the state’s annual retention to fund the Medicaid program; and 3) ensure that any new programs funded through the hospital assessment tax have a direct financial impact on hospitals.

To learn more about CaroNova’s work with Home Hospital, click here. 

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Medicaid Managed Care

Medicaid is an important program which ensures that the state’s vulnerable population receives needed care. NCHA supports a managed care program that provides patients access to high quality care, reduces provider and patient administrative burden, and maximizes available federal funds.

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Surprise Billing and Assignment of Benefits

Our patients deserve to have peace of mind about their healthcare finances, and NCHA supports efforts to protect patients from surprise bills. Federal law should encourage private negotiations between providers and insurers without government controls while ensuring providers are not financially harmed by disproportionately larger payors controlling reimbursement rates. NCHA supports collaboration with policymakers to ensure that Price Transparency and Surprise Billing Regulations benefit patients and maintain patient access to care.

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Tax Treatment Preservation

North Carolina’s not-for-profit hospitals and health systems support the current non-profit sales and property tax laws and support efforts to exempt non-profits from paying sales taxes.

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Telehealth Coverage

The role of telehealth cannot be overstated in bringing care to communities who would otherwise not have access; telehealth has proven a critical component of healthcare long after the covid-19 pandemic. To bring healthcare to every North Carolina community, NCHA supports:

  • Protecting patients’ rights to access their healthcare providers by requiring insurers to cover telehealth services.
  • Expansion of affordable broadband connectivity for all North Carolinians.
  • Interstate licensure compacts to address healthcare workforce shortages.
  • Make permanent the federal temporary flexibilities to improve access to telehealth.

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White and Brown Bagging

White and brown bagging policies benefit insurance companies and have lead to dangerous scenarios for patients and the clinicians who take care of them. NCHA supports prohibiting the use of both exclusive white and brown-bagging policies that compromise the timing and/or quality of care of drug therapies delivered to patients.


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