Amends GS 131E-176, which sets outs defined terms applicable to Article 9, Certificate of Need. Amends bed capacity to specify space used exclusively for inpatient care at a health care facility. Modifies terms throughout to remove reference to "psychiatric facilities," "kidney disease treatment centers," "intermediate care facilities for the mentally retarded," "chemical dependency treatment facilities," "diagnostic facilities," and "ambulatory surgical facilities." Amends health service facility to exclude a licensable facility as defined in GS 122C-3(14)b. Changes the terminology to "intermediate care facility for individuals with intellectual disabilities" (was, mentally retarded). Makes further technical, clarifying, and conforming changes.

Amends GS 131E-177 to prohibit the Department of Health and Human Services (DHHS) from including policies or need determinations that limit the number of operating rooms in gastrointestinal endoscopy rooms in developing a State Medical Facilities Plan. Makes further technical and clarifying changes.

Makes conforming changes to GS 131E-178, GS 131E-183, GS 131E-184, and GS 131E-186 to eliminate requirements related to certificates of need and review for ambulatory surgical facilities, psychiatric facilities, and nursing care or intermediate care facilities for the mentally retarded.

Further amends GS 131E-184 regarding exemptions from certificate of need review. Adds new subsection (i) to require DHHS to exempt from certificate of need review the development, acquisition, construction, expansion, or replacement of a health service facility or health service that obtained certificate of need approval prior to October 1, 2019, as: an ambulatory surgical facility, including an ambulatory surgical facility with one or more operating rooms or gastrointestinal endoscopy procedure rooms; a diagnostic center; kidney disease treatment center, including freestanding dialysis units; chemical dependency treatment facility; intermediate care for individuals with intellectual disabilities; psychiatric hospital; or any other licensable facility, as defined. 

Adds new subsection (j) to require DHHS to exempt from certificate of need review the establishment of a home health agency by a licensed continuing care retirement community to provide home health care services to one or more residents of the retirement community who have entered into a contract with the retirement community to receive continuing care services with lodging. Requires the continuing care retirement community to obtain a certificate of need if developing or offering services to any individual not a resident of the retirement community under a contract to receive continuing care services with lodging. Explicitly does not exempt from the State's home health agency licensure and certification requirements a continuing care retirement community that has been exempted from certificate of need review for the provision of home health services to one or more residents pursuant to new subsection (j). Provides that new subsection (j) applies to continuing care retirement communities engaged in the direct provision of home health services on or after October 1, 2019.

Amends GS 131E-188(a1), regarding petitions for a contested case hearing on the approval of an applicant for a certificate of need, to now require a secured bond to be deposited with the clerk of superior court, as specified, in the amount of $300,000 for each application reviewed with the application for a certificate of need that is the subject of the petition (was 5% of the cost of the proposed new institutional health service that is the subject of the petition, but no less than $5,000 and no more than $50,000). Makes identical changes to the secured bond required to be deposited with the Clerk of the Court of Appeals for appeals of a final decision granting a certificate of need, but allows up to $500,000 rather than $300,000 in the court's discretion at the petition of the applicant who received approval to cover the possible award of reasonable attorneys' fees and costs incurred in the appeal.

Amends GS 131E-147 regarding ambulatory surgical facility licensure requirements, to prohibit DHHS from issuing or renewing a license to operate an ambulatory surgical facility developed, acquired, or replaced on or after October 1, 2019, unless the application meets four criteria. Requires: (1) a commitment that the Medicare allowable amount for self-pay and Medicaid surgical cases will be at least 4% of the total revenue collected for all surgical cases performed, or a commitment to allocate to the nearest hospital located in a Tier 1 or Tier 2 county an amount equivalent to 4% of the total revenue collected for all surgical cases performed; (2) a commitment to report case numbers in specified payer categories; (3) a commitment to report utilization and payment data for services provided to the statewide processor, as specified; and (4) specifically for a licensee to operate in any county with a population of less than 150,000 as of the effective date of the act, requires written support from each hospital located within that county and a written transfer agreement between the facility and each hospital located within that county.

Makes conforming repeals in GS 131E-175 (legislative findings).

Effective October 1, 2019.