GENERAL ASSEMBLY OF NORTH CAROLINA

1987 SESSION

 

 

CHAPTER 681

SENATE BILL 862

 

AN ACT TO PROVIDE REASONABLE REGULATION OF PREFERRED PROVIDER CONTRACTS FOR HEALTH SERVICES.

 

The General Assembly of North Carolina enacts:

 

Section 1.  The third sentence of G.S. 57-16.1(e) is amended by deleting the period and substituting the following:

", and the plan shall consider all pending applications for participation and give reasons for any rejections on at least an annual basis."

Sec. 2.  The third sentence of G.S. 58-260.6(e) is amended by deleting the period and substituting the following:

", and the plan shall consider all pending applications for participation and give reasons for any rejections on at least an annual basis."

Sec. 3.  The second sentence of G.S. 57-16.1(d) is amended by deleting the period and substituting the following:

", except that payments for services rendered by such non-participating providers may not be reduced by more than twenty percent (20%) of payments that would be made to participating providers under coverage for the same services.  This percentage limitation shall not require any waiver of copayments or waiver of deductibles in determining payments for services rendered by non-participating providers."

Sec. 4.  G.S. 57-16.1(d) is amended by inserting the following at the beginning of the fourth sentence:

"Except as provided in this subsection,".

Sec. 5.  The second sentence of G.S. 58-260.6(d) is amended by deleting the period and substituting the following:

", except that payments for services rendered by such non-participating providers may not be reduced by more than twenty percent (20%) of payments that would be made to participating providers under coverage for the same services.  This percentage limitation shall not require any waiver of copayments or waiver of deductibles in determining payments for services rendered by non-participaiting providers."

Sec. 6.  G.S. 58-260.6(d) is amended by inserting the following at the beginning of the fourth sentence:

"Except as provided in this subsection,".

Sec. 7.  This act is effective upon ratification, and it shall apply to all preferred provider contracts entered into or renewed after that date.

In the General Assembly read three times and ratified this the 27th day of July, 1987.