GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2013
S 2
SENATE BILL 248
Health Care Committee Substitute Adopted 4/17/13
Short Title: Choice of Hearing Aid Specialist. |
(Public) |
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Sponsors: |
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Referred to: |
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March 12, 2013
A BILL TO BE ENTITLED
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(a) Repealed by Session Laws 2001-297, s. 1, effective January 1, 2001.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 pursuant to Chapter 93D 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, 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.