Enacts GS 131E-175.5 specifying that Article 9, pertaining to Certificates of Need under GS Chapter 131E, only applies to counties that (1) have a population of less than 100,000 according to the most recent federal decennial census and (2) have at least one functioning hospital within the county.

Effective November 21, 2025, amends Section 3.2 of SL 2023-7 (setting forth reforms effective two years after the issuance of the first Healthcare Access and Stabilization Program (HASP) directed payment, including changes to various provisions of Article 9 of GS Chapter 131E), as follows. Amends the definitions provisions of Article 9 set forth in GS 131E-76 so that it conforms to the scope provisions of GS 131E-175.5. Modifies the definition of qualified ambulatory surgical facility so that it is an ambulatory surgical facility that has elected to opt out of the certificate of need requirements by obtaining a license as a qualified ambulatory surgical facility (previously the term was qualified urban ambulatory surgical facility, and required being licensed by DHHS to operate as an ambulatory surgical facility with a specified ambulatory surgery program and in a county with a population greater than 125,000). Amends definition of qualified ambulatory surgical facility (was, qualified urban ambulatory surgical facility) under GS 131E-146 so that it is an ambulatory surgical facility that has elected to opt out of the certificate of need requirements by obtaining a license as a qualified ambulatory surgical facility with a single specialty or multispecialty ambulatory surgical program and has agreed to adhere to the charity care and reporting requirements. Expands the entities subject to the licensure requirements under GS 131E-147 (the Healthcare Facility Licensure Act) to include qualified ambulatory surgical facilities. Makes conforming changes to GS 131E-147.5 (charity care requirements for qualified ambulatory surgical facilities).

Repeals Section 3.3 of SL 2023-7 (reforms effective three years after the issuance of the first HASP directed payment).