GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2013
SESSION LAW 2013-296
SENATE BILL 248
AN ACT to ensure that patients have the right to choose their hearing aid specialist under their health benefit plans, to authorize the north carolina state hearing aid dealers and fitters board to increase certain fees, and to make technical changes to the statute on choosing services of providers.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 58-50-30 reads as rewritten:
"§
58-50-30. Right to choose services of optometrist, podiatrist,
licensed clinical social worker, certified substance abuse professional,
licensed professional counselor, dentist, chiropractor, physical therapist,
psychologist, pharmacist, certified fee-based practicing pastoral counselor,
advanced practice nurse, licensed marriage and family therapist, or physician
assistant.certain providers.
(a) Repealed by Session Laws 2001-297, s. 1, effective January 1, 2001.
(a1)
Whenever any health benefit plan, subscriber contract, or policy of insurance
issued by a health maintenance organization, hospital or medical service
corporation, or insurer governed by Articles 1 through 67 of this Chapter
provides for coverage for, payment of, or reimbursement for any service
rendered in connection with a condition or complaint that is within the scope
of practice of a duly licensed optometrist, a duly licensed podiatrist, a
duly licensed dentist, a duly licensed chiropractor, a duly licensed physical
therapist, a duly licensed clinical social worker, a duly certified substance
abuse professional, a duly licensed professional counselor, a duly licensed
psychologist, a duly licensed pharmacist, a duly certified fee-based practicing
pastoral counselor, a duly licensed physician assistant, a duly licensed
marriage and family therapist, or an advanced practice registered nurse, a
provider listed in subsection (b) of this section, the insured or other
persons entitled to benefits under the policy shall be entitled to coverage of,
payment of, or reimbursement for the services, whether the services be
performed by a duly licensed physician, or a provider listed in this
subsection,subsection (b) of this section, notwithstanding any
provision contained in the plan or policy limiting access to the providers. The
policyholder, insured, or beneficiary shall have the right to choose the
provider of services notwithstanding any provision to the contrary in any other
statute, subject to the utilization review, referral, and prior approval
requirements of the plan that apply to all providers for that service; provided
that:
(1) In the case of plans that require the use of network providers as a condition of obtaining benefits under the plan or policy, the policyholder, insured, or beneficiary must choose a provider of the services within the network; and
(2) In the case of plans that require the use of network providers as a condition of obtaining a higher level of benefits under the plan or policy, the policyholder, insured, or beneficiary must choose a provider of the services within the network in order to obtain the higher level of benefits.
(a2)
Whenever any policy of insurance governed by Articles 1 through 64 of this
Chapter provides for certification of disability that is within the scope of
practice of a duly licensed physician, a duly licensed physician assistant,
a duly licensed optometrist, a duly licensed podiatrist, a duly licensed
dentist, a duly licensed chiropractor, a duly licensed physical therapist, a duly
licensed clinical social worker, a duly certified substance abuse professional,
a duly licensed professional counselor, a duly licensed psychologist, a duly
certified fee-based practicing pastoral counselor, a duly licensed marriage and
family therapist, or an advanced practice registered nurse,a provider
listed in subsection (b) of this section, the insured or other persons
entitled to benefits under the policy shall be entitled to payment of or
reimbursement for the disability whether the disability be certified by a duly
licensed physician, or a provider listed in this subsection,subsection
(b) of this section, notwithstanding any provisions contained in the
policy. The policyholder, insured, or beneficiary shall have the right to
choose the provider of the services notwithstanding any provision to the
contrary in any other statute; provided that for plans that require the use of
network providers either as a condition of obtaining benefits under the plan or
policy or to access a higher level of benefits under the plan or policy, the
policyholder, insured, or beneficiary must choose a provider of the services
within the network, subject to the requirements of the plan or policy.
(a3) Whenever any health benefit plan, subscriber contract, or policy of insurance issued by a health maintenance organization, hospital or medical service corporation, or insurer governed by Articles 1 through 67 of this Chapter provides coverage for medically necessary treatment, the insurer shall not impose any limitation on treatment or levels of coverage if performed by a duly licensed chiropractor acting within the scope of the chiropractor's practice as defined in G.S. 90-151 unless a comparable limitation is imposed on the medically necessary treatment if performed or authorized by any other duly licensed physician.
(b)
For the purposes of this section, This section applies to the
following provider types:
(1) A duly licensed optometrist.
(2) A duly licensed dentist.
(3) A duly licensed podiatrist.
(4) A duly licensed chiropractor.
(5) An advanced practice registered nurse, subject to subsection (d) of this section. For purposes of this section, an "advanced practice registered nurse" means only a registered nurse who is duly licensed or certified as a nurse practitioner, clinical specialist in psychiatric and mental health nursing, or nurse midwife.
(6)
a "duly licensed psychologist" is a:A psychologist who is
one of the following:
(1)a.
LicensedA licensed psychologist who holds permanent licensure and
certification as a health services provider psychologist issued by the North
Carolina Psychology Board; orBoard.
(2)b.
LicensedA licensed psychological associate who holds permanent
licensure.
(c)(7) For
the purposes of this section, a "duly licensed clinical social
worker" is a "licensed clinical social worker" A licensed
clinical social worker, as defined in G.S. 90B-3(2) andG.S. 90B-3(2)
who is licensed by the North Carolina Social Work Certification and
Licensure Board pursuant to Chapter 90B of the General Statutes.
(8) A duly licensed pharmacist, subject to the provisions of subsection (e) of this section.
(c1)(9) For
purposes of this section, a "duly certified fee-based practicing pastoral
counselor" shall be defined only to includeA fee-based
practicing pastoral counselorscounselor certified by the North
Carolina State Board of Examiners of Fee-Based Practicing Pastoral Counselors
pursuant to Article 26 of Chapter 90 of the General Statutes.
(c2)(10)
For purposes of this section, a "duly certified substance abuse
professional" is a personA substance abuse professional
certified by the North Carolina Substance Abuse Professional Certification
Board pursuant to Article 5C of Chapter 90 of the General Statutes.
(11) A physician assistant, as defined by G.S. 90-18.1 and subject to subsection (f) of this section.
(c3)(12)
For purposes of this section, a "duly licensed professional
counselor" is a personA professional counselor licensed by the
North Carolina Board of Licensed Professional Counselors pursuant to Article 24
of Chapter 90 of the General Statutes.
(c4)(13)
For purposes of this section, a "duly licensed marriage and family
therapist" is a personA marriage and family therapist licensed
by the North Carolina Marriage and Family Therapy Licensure Board pursuant to
Article 18C of Chapter 90 of the General Statutes.
(c5)(14)
For purposes of this section, a "duly licensed physical therapist"
is a personA physical therapist licensed by the North Carolina Board
of Physical Therapy Examiners pursuant to Article 18B of Chapter 90 of the
General Statutes.
(15) A hearing aid specialist licensed by the North Carolina State Hearing Aid Dealers and Fitters Board under Chapter 93D of the General Statutes to engage in fitting or selling hearing aids. For purposes of this subdivision, the term "fitting and selling hearing aids" has the same meaning as defined in G.S. 93D-1.
(d) Payment or reimbursement is required by this section for a service performed by an advanced practice registered nurse only when:
(1) The service performed is within the nurse's lawful scope of practice;
(2) The policy currently provides benefits for identical services performed by other licensed health care providers;
(3) The service is not performed while the nurse is a regular employee in an office of a licensed physician;
(4) The service is not performed while the registered nurse is employed by a nursing facility (including a hospital, skilled nursing facility, intermediate care facility, or home care agency); and
(5) Nothing in this section is intended to authorize payment to more than one provider for the same service.
No lack of signature, referral, or employment by any other health care provider may be asserted to deny benefits under this provision, unless these plan requirements apply to all providers for that service.
For purposes of this section,
an "advanced practice registered nurse" means only a registered nurse
who is duly licensed or certified as a nurse practitioner, clinical specialist
in psychiatric and mental health nursing, or nurse midwife.
(e) Payment or reimbursement is required by this section for a service performed by a duly licensed pharmacist only when:
(1) The service performed is within the lawful scope of practice of the pharmacist;
(2) The service performed is not initial counseling services required under State or federal law or regulation of the North Carolina Board of Pharmacy;
(3) The policy currently provides reimbursement for identical services performed by other licensed health care providers; and
(4) The service is identified as a separate service that is performed by other licensed health care providers and is reimbursed by identical payment methods.
Nothing in this subsection authorizes payment to more than one provider for the same service.
(f) Payment or reimbursement is required by this section for a service performed by a duly licensed physician assistant only when:
(1) The service performed is within the lawful scope of practice of the physician assistant in accordance with rules adopted by the North Carolina Medical Board pursuant to G.S. 90-18.1;
(2) The policy currently provides reimbursement for identical services performed by other licensed health care providers; and
(3) The reimbursement is made to the physician, clinic, agency, or institution employing the physician assistant.
Nothing in this subsection is
intended to authorize payment to more than one provider for the same service.
For the purposes of this section, a "duly licensed physician
assistant" is a physician assistant as defined by G.S. 90-18.1.
(g)
A health maintenance organization, hospital or medical service corporation, or
insurer governed by Articles 1 through 67 of this Chapter shall not exclude
from participation in its provider network or from eligibility to provide
particular covered services under the plan or policy any duly licensed
physician or provider listed in subsection (a1)(b) of this
section, acting within the scope of the provider's license or certification
under North Carolina law, solely on the basis of the provider's license or
certification. Any health maintenance organization, hospital or medical service
corporation, or insurer governed by Articles 1 through 67 of this Chapter that
offers coverage through a network plan may condition participation in the
network on satisfying written participation criteria, including credentialing,
quality, and accessibility criteria. The participation criteria shall be
developed and applied in a like manner consistent with the licensure and scope
of practice for each type of provider. Any health maintenance organization,
hospital or medical service corporation, or insurer governed by Articles 1
through 67 of this Chapter that excludes a provider listed in subsection (a1)(b)
of this section from participation in its network or from eligibility to
provide particular covered services under the plan or policy shall provide the
affected listed provider with a written explanation of the basis for its
decision. A health maintenance organization, hospital or medical service
corporation, or insurer governed by Articles 1 through 67 of this Chapter shall
not exclude from participation in its provider network a provider listed in
subsection (a1)(b) of this section acting within the scope of the
provider's license or certification under North Carolina law solely on the
basis that the provider lacks hospital privileges, unless use of hospital
services by the provider on behalf of a policy holder, insured, or beneficiary
reasonably could be expected.
(h)
Nothing in this section shall be construed as expanding the scope of practice
of any duly licensed physician or provider listed in subsection (a1)(b)
of this section."
SECTION 2. G.S. 93D-5 reads as rewritten:
"§ 93D-5. Requirements for registration; examinations; licenses.
(a)
No person shall begin the fitting and selling of hearing aids in this State
unless the person has been issued a license by the Board or is an apprentice
working under the supervision of a Registered Sponsor. Except as hereinafter
provided, each applicant for a license shall pay a fee set by the Board, not to
exceed two hundred fifty dollars ($250.00),five hundred dollars
($500.00), which fee may be prorated by the Board, and shall show to the
satisfaction of the Board that the applicant:
(1) Is a person of good moral character.
(2) Is 18 years of age or older.
(3) Has an education equivalent to a four-year course in an accredited high school.
…."
SECTION 3. G.S. 135-48.51(12) reads as rewritten:
"(12)
G.S. 58-50-30, Right to choose services of optometrist, podiatrist,
licensed clinical social worker, certified substance abuse professional,
licensed professional counselor, dentist, physical therapist, chiropractor,
psychologist, pharmacist, certified fee-based practicing pastoral counselor,
advanced practice nurse, licensed marriage and family therapist, or physician
assistant.certain providers."
SECTION 4. This act becomes effective October 1, 2013.
In the General Assembly read three times and ratified this the 11th day of July, 2013.
s/ Daniel J. Forest
President of the Senate
s/ Thom Tillis
Speaker of the House of Representatives
s/ Pat McCrory
Governor
Approved 6:17 p.m. this 18th day of July, 2013