GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION LAW 2001-297
AN ACT TO PROVIDE FOR DIRECT PAYMENT OF LICENSED PROFESSIONAL COUNSELORS UNDER HEALTH INSURANCE POLICIES AND PLANS.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 58-50-30 reads as rewritten:
"§ 58-50-30.
Discrimination forbidden; right Right to choose services of
optometrist, podiatrist, certified clinical social worker, certified substance
abuse professional, licensed professional counselor, dentist,
chiropractor, psychologist, pharmacist, certified fee-based practicing pastoral
counselor, advanced practice nurse, or physician assistant.
(a) Discrimination
between individuals of the same class in the amount of premiums or rates
charged for any policy of insurance covered by Articles 50 through 55 of this
Chapter, or in the benefits payable thereon, or in any of the terms or
conditions of such policy, or in any other manner whatsoever, is prohibited.
(a1) Whenever any policy of
insurance governed by Articles 1 through 6465 of this Chapter
provides 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 certified 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, or an advanced practice registered nurse, the insured or other
persons entitled to benefits under the policy shall be entitled to payment of
or reimbursement for the services, whether the services be performed by 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 certified clinical social worker, a duly
certified substance abuse professional, a duly licensed psychologist, a duly
licensed pharmacist, a duly certified fee-based practicing pastoral counselor,
or an advanced practice registered nurse, or a provider listed in this
subsection, notwithstanding any provision contained in the policy.
(a2) Whenever any policy of
insurance governed by Articles 1 through 6465 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 certified 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, or an advanced practice registered nurse, 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, a duly licensed
physician assistant, a duly licensed optometrist, a duly licensed podiatrist, a
duly licensed dentist, a duly licensed chiropractor, a duly certified clinical
social worker, a duly certified substance abuse professional, a duly licensed
psychologist, a duly certified fee-based practicing pastoral counselor, or an
advanced practice registered nurse, or a provider listed in this
subsection, 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.
(a3) Whenever any policy of insurance 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, a "duly licensed psychologist" shall be defined only
to include a psychologist who is duly licensed in the State of North Carolina
and has a doctorate degree in psychology and at least two years clinical
experience in a recognized health setting, or has met the standards of the
National Register of Health Service Providers in Psychology. After January 1,
1995, a duly licensed psychologist shall be defined as is a licensed
psychologist who holds permanent licensure and certification as a health
services provider psychologist issued by the North Carolina Psychology Board.
(c) For the purposes of this section, a "duly certified clinical social worker" is a "certified clinical social worker" as defined in G.S. 90B-3(2) and certified by the North Carolina Certification Board for Social Work pursuant to Chapter 90B of the General Statutes.
(c1) For purposes of this section, a "duly certified fee-based practicing pastoral counselor" shall be defined only to include fee-based practicing pastoral counselors 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) For purposes of this section, a "duly certified substance abuse professional" is a person certified by the North Carolina Substance Abuse Professional Certification Board pursuant to Article 5C of Chapter 90 of the General Statutes.
(c3) For purposes of this section, a "duly licensed professional counselor" is a person licensed by the North Carolina Board of Licensed Professional Counselors pursuant to Article 24 of Chapter 90 of the General Statutes.
(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.
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."
SECTION 2. Article 65 of Chapter 58 is amended by adding a new section to read:
"§ 58-65-1.1. Regulation and definitions; application of other laws; profit and foreign corporations prohibited.
(a) Any corporation heretofore
or hereafter organized under the general corporation laws of the State of
North Carolina for the purpose of maintaining and operating a nonprofit
hospital and/or or medical and/or or dental service
plan whereby hospital care and/or or medical and/or or dental
service may be provided in whole or in part by said the corporation
or by hospitals and/or physicians and/or hospitals, physicians, or dentists
participating in such the plan, or plans, shall be governed by
this Article and Article 66 of this Chapter and shall be exempt from all other
provisions of the insurance laws of this State, heretofore enactedState,
unless otherwise provided. specifically designated herein, and no
laws hereafter enacted shall apply to them unless they be expressly designated
therein.
The term "hospital service plan" as used in this
Article and Article 66 of this Chapter includes the contracting for certain
fees for, or furnishing of, hospital care, laboratory facilities, X-ray
facilities, drugs, appliances, anesthesia, nursing care, operating and
obstetrical equipment, accommodations and/or or any and all other
services authorized or permitted to be furnished by a hospital under the laws
of the State of North Carolina and approved by the North Carolina Hospital
Association and/or or the American Medical Association.
The term "medical service plan" as used in this
Article and Article 66 of this Chapter includes the contracting for the payment
of fees toward, or furnishing of, medical, obstetrical, surgical and/or or
any other professional services authorized or permitted to be furnished by
a duly licensed physician, except that in any plan in any policy of
insurance governed by this Article and Article 66 of this Chapter that includes
services which are within the scope of practice of a duly licensed optometrist,
a duly licensed chiropractor, a duly licensed psychologist, a duly licensed
pharmacist, an advanced practice registered nurse, a duly certified clinical
social worker, a duly certified substance abuse professional, a duly certified
fee-based practicing pastoral counselor, a duly licensed physician assistant,
and a duly licensed physician, then the insured or beneficiary shall have the
right to choose the provider of the care or service, and shall be entitled to
payment of or reimbursement for such care or service, whether the provider be a
duly licensed optometrist, a duly licensed chiropractor, a duly licensed
psychologist, a duly licensed pharmacist, an advanced practice registered
nurse, a duly certified clinical social worker, a duly certified substance
abuse professional, a duly certified fee-based practicing pastoral counselor, a
duly licensed physician assistant, or a duly licensed physician notwithstanding
any provision to the contrary contained in such policy. physician or
other provider listed in G.S. 58-50-30. The term "medical services
plan" also includes the contracting for the payment of fees toward, or
furnishing of, professional medical services authorized or permitted to be
furnished by a duly licensed provider of health services licensed under Chapter
90 of the General Statutes.
(b) 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.
(b1) 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.
(b2) 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.
(c) 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.
For the purposes of this section, a "duly certified
clinical social worker" is a "certified clinical social worker"
as defined in G.S. 90B-3(2) and certified by the North Carolina Certification
Board for Social Work pursuant to Chapter 90B of the General Statutes.
For purposes of this section, a "duly certified
fee-based practicing pastoral counselor" shall be defined only to include
fee-based practicing pastoral counselors 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.
For the purposes of this section, a "duly licensed
psychologist" shall be defined only to include a psychologist who is duly
licensed in the State of North Carolina and has a doctorate degree in psychology
and at least two years clinical experience in a recognized health setting, or
has met the standards of the National Register of Health Providers in
Psychology. After January 1, 1995, a duly licensed psychologist shall be
defined as a licensed psychologist who holds permanent licensure and
certification as a health services provider psychologist issued by the North
Carolina Psychology Board.
For purposes of this section, a "duly certified
substance abuse professional" is a person certified by the North Carolina
Substance Abuse Professional Certification Board pursuant to Article 5C of
Chapter 90 of the General Statutes.
The term "dental service plan" as used in this
Article and Article 66 of this Chapter includes contracting for the payment of
fees toward, or furnishing of dental and/or or any other
professional services authorized or permitted to be furnished by a duly
licensed dentist.
The insured or beneficiary of every "medical service
plan" and of every "dental service plan," as those terms are
used in this Article and Article 66 of this Chapter, or of any policy of
insurance issued thereunder, that includes services which are within the scope
of practice of both a duly licensed physician and a duly licensed dentist shall
have the right to choose the provider of such care or service, and shall be
entitled to payment of or reimbursement for such care or service, whether the
provider be a duly licensed physician or a duly licensed dentist
notwithstanding any provision to the contrary contained in any such plan or
policy.
The term "hospital service corporation" as used in
this Article and Article 66 of this Chapter is intended to mean any nonprofit
corporation operating a hospital and/or or medical and/or or
dental service plan, as herein defined defined in this section.
Any corporation heretofore or hereafter organized and coming within subject
to the provisions of this Article and Article 66 of this Chapter, the
certificate of incorporation of which authorizes the operation of either a
hospital or medical and/or or dental service plan, or any or all
of them, may, with the approval of the Commissioner of Insurance, issue
subscribers' contracts or certificates approved by the Commissioner of
Insurance, for the payment of either hospital or medical and/or or dental
fees, or the furnishing of such services, or any or all of them, and may enter
into contracts with hospitals for physicians and/or or dentists,
or any or all of them, for the furnishing of fees or services respectively
under a hospital or medical and/or or dental service plan, or any
or all of them.
The term "preferred provider" as used in this
Article and Article 66 of this Chapter with respect to contracts,
organizations, policies or otherwise means a health care service provider who
has agreed to accept, from a corporation organized for the purposes authorized
by this Article and Article 66 of this Chapter or other applicable law, special
reimbursement terms in exchange for providing services to beneficiaries of a
plan administered pursuant to this Article and Article 66 of this Chapter.
Except to the extent prohibited either by G.S. 58-65-140 or by regulations rules
promulgated by the Department of Insurance not inconsistent with this
Article and Article 66 of this Chapter, the contractual terms and conditions
for special reimbursement shall be those which the corporation and preferred
provider find to be mutually agreeable.
(d) No foreign or alien
hospital or medical and/or or dental service corporation as
herein defined shall be authorized to do business in this State."
SECTION 3. G.S. 58-50-56(c) reads as rewritten:
"(c) At the initial
offering of a preferred provider plan to the public, health care providers may
submit proposals for participation in accordance with the terms of the
preferred provider plan within 30 days after that offering. After that time
period, any health care provider may submit a proposal, and the insurer
offering the preferred provider benefit plan shall consider all pending
applications for participation and give reasons for any rejections or failure
to act on an application on at least an annual basis. Any health care provider
seeking to participate in the preferred provider benefit plan, whether upon the
initial offering or subsequently, may be permitted to do so in the discretion
of the insurer offering the preferred provider benefit plan. The second and
third paragraphs of G.S. 58-50-30(a) apply to preferred provider benefit plans.
G.S. 58-50-30 applies to preferred provider benefit plans."
SECTION 4. G.S. 58-3-120 reads as rewritten:
"§ 58-3-120. Discrimination forbidden.
(a) No company doing the business of insurance as defined in G.S. 58-7-15 shall make any discrimination in favor of any person.
(b) Discrimination between individuals of the same class in the amount of premiums or rates charged for any policy of insurance covered by Articles 50 through 55 of this Chapter, or in the benefits payable thereon, or in any of the terms or conditions of such policy, or in any other manner whatsoever, is prohibited."
SECTION 5. This act becomes effective October 1, 2001, and applies to claims for payment or reimbursement for services rendered on or after that date.
In the General Assembly read three times and ratified this the 11th day of July, 2001.
s/ Beverly E. Perdue
President of the Senate
s/ James B. Black
Speaker of the House of Representatives
s/ Michael F. Easley
Governor
Approved 8:32 a.m. this 21st day of July, 2001