Bill Summary for H 498 (2013-2014)

Summary date: 

Apr 2 2013

Bill Information:

View NCGA Bill Details2013-2014 Session
House Bill 498 (Public) Filed Tuesday, April 2, 2013
Intro. by McGrady, Murry, Cotham, Shepard.

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Bill summary

Adds new GS 58-3-192 requiring health benefit plans, to provide coverage for autism spectrum disorders, that may be subject to the same deductibles, co-payments and coinsurance terms that apply to substantially all other covered medical services under the health benefit plan. Prohibits every health benefit plan, including the State Health Plan for Teachers and State Employees (State Plan), from terminating coverage or refusing coverage to an individual solely because the individual is diagnosed with one of the autism spectrum disorders or has received treatment for autism spectrum disorders. Provides that there will be no limits on the number of visits an individual may make to an autism services provider. Prohibits denying coverage because the treatments are habilitative or educational in nature. Directs that coverage under these provisions must not be construed as limiting benefits that are otherwise available to an individual under a health benefit plan. Allows for a maximum annual benefit of $75,000 for behavioral therapy for autism spectrum disorders. Requires the Commissioner of Insurance, after December 31, 2014, to adjust the maximum benefit for inflation. Prohibits applying payments made by the insurer on behalf of the individual for any care, treatment, intervention, service, or item unrelated to behavioral health treatment toward the maximum benefit. Provides that if an individual is receiving treatment for an autism spectrum disorder, with the exception of inpatient services, a health benefit plan has the right to request a review of the treatment no more than once every 12 months unless the individual's licensed medical doctor or licensed psychologist agrees that a more frequent review is needed. Requires the insurer to pay any costs for the review. Includes applicable definitions in proposed GS 58-3-192. Provides that the statute does not apply to a qualified health plan offered on a health benefit exchange operating in the state and that is established pursuant to specified regulations to the extent that this statute requires benefits that exceed the essential health benefits. Provides that the statute is not to be construed as affecting any obligation to provide services to an individual under an individualized family service plan, an individualized education program, or an individualized service plan.

Amends GS 90-270.4 to provide that nothing in the Psychology Practice Act is to be construed to prevent a Board Certified Behavior Analyst (BCBA) or a Board Certified Assistant Behavior Analyst (BCaBA) from offering services within the scope of practice authorized by the Behavior Analyst Certification Board, in accordance with professional standards, if (1) the BCBA or BCaBA is certified and in good standing with the Behavior Analyst Certification Board; and (2) the BCBA or BCaBA does not hold himself or herself out to the public by any title or description stating or implying BCBA or BCaBA is a psychologist or is licensed, certified, or registered to practice psychology in the state.

Makes conforming and technical changes to GS 135-48.51.

Provides that the act becomes effective October 1, 2013, and applies to all insurance contracts issued, renewed, or amended on or after that date.

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