Senate committee substitute to the 1st edition makes the following changes.

Amends GS 131E-214.22 (definitions provision of the Medical Debt Protection Act [Act]) as follows. Amends definition of extraordinary collection action to specify that one of the required prongs of the legally binding agreement which requires that the debt buyer adhere to the agreement only pertains to financial assistance for emergency or medically necessary care. Amends definition of medical debt mitigation policy (MDMP) to delete requirement that the policy include eligibility for financial assistance and to require that the policy contain (1) the method for applying for financial assistance for emergency or medically necessary care (was, financial assistance generally) and (2) provisions for publicity in line with the Act (prior version had no reference to the Act). Deletes definition of household income.  

Amends GS 131E-214.24 (implementation of MDMP) by deleting provisions setting forth four categories of eligibility for patients to qualify for financial assistance under the MDMP based on household income and poverty level, with assistance ranging from no cost to discounted costs, applicable to any charges for health care services  not covered by insurance and that would be otherwise billed to the patient. Deletes provisions detailing acceptable methods for establishing eligibility for financial assistance and providing authority to a health care facility (or facilities) to grant financial assistance notwithstanding the patient's failure to provide the acceptable documentation or can require other evidence of eligibility.  Deletes provisions barring charging late fees or interest to patients who qualify for financial assistance. Deletes provisions requiring facilities and medical debt collectors to offer payment plans to qualifying patients of at least 24 months with payments never exceeding more than 5% of the patient's gross monthly income. Deletes provisions that bar prepayment and early payment fees or penalties. Makes organizational changes to account for deleted provisions. Requires if a patient submits an application for financial assistance, the large health care facility must determine the patient's eligibility within 30 days (was, 14 days) after the patient applies.

Amends GS 131E-214.27 (billing and collection rules) to delete language that would allowing a creditor for medical debt to garnish wages or State income tax returns if they had a duty to offset a State tax refund under GS Chapter 105A.

Amends GS 131E-214.29 (liability for medical debt) by deleting provisions making parents joint and severally liable for minor child’s medical debt.

Amends GS 131E-214.33 (interest on medical debt) to delete exemption from the provisions of the calculations of that section if the patient is eligible for financial assistance under other provisions of the Act. Clarifies that the interest rate set forth in the section applies to judgments on medical debt notwithstanding any agreement or other provision of law to the contrary (was, just notwithstanding any agreement to the contrary).

Amends GS 131E-214.40 (annual reports) to change the due date for facilities to file their annual report/MDMP with the Department of Health and Human Services (Department) from July 1, 2023, to July 1, 2024. Clarifies that a facility need not submit a report only when the facility is not required to under GS 131E-214.14.

Makes organizational and technical changes to the Act.

Enacts GS 131E-274, pertaining to facility fees, as follows. Sets forth seven defined terms. Lists the following limitations on facility fees: (1) that no health care provider can charge, bill, or collect a facility fee unless the services are provided on a hospital's main campus or at a facility that includes an emergency department and (2) that regardless of where the services are provided, no health care provider can charge, bill, or collect a facility fee to outpatient evaluation and management services, or any other outpatient, diagnostic, or imaging services identified by the Department. Requires the Department to annually identify services subject  to the limitations on facility fees described above that may reliably be provided safely and effectively in non-hospital settings. Requires each hospital and hospital system to submit an annual report to the Department by July 1 of each year, which will be published on the Department’s website. Lists six things that the report must include, such as the name and full address of each facility owned or operated by the hospital or health system that provides services for which a facility is charged or billed.

Specifies that any violation of the statute is considered an unfair and deceptive trade practice. Provides for an administrative penalty of not more than $1,000 per occurrence to any health care provider that violates the section. Permits the Department to audit health care providers for compliance. Requires each health care provider to make available, upon written request of the Department or its designee, copies of any books, documents, records, or data necessary for the purposes of completing the audit until the expiration of four years after the furnishing of any services for which a facility fee was charged, billed, or collected. Effective October 1, 2023, and applies to facility fees charged on or after that date. 

Requires the Department to adopt rules to implement this section by October 1, 2023. 

Makes conforming changes to effective date to account for new organization of the bill. Specifies that new GS 131E-214.36 (debt forgiven by medical center) and GS 131E-214.38 (prohibition of waiver of rights) are effective October 1, 2023, and apply to agreements and contracts entered into, amended, or renewed on or after that date.  Makes conforming changes to act’s long title.