AN ACT PROHIBITING ORGAN TRANSPLANT DISCRIMINATION ON THE BASIS OF DISABILITY BY HEALTH CARE PROVIDERS AND HEALTH INSURERS.
Titles the act as the "Down Syndrome Organ Transplant Nondiscrimination Act."
Enacts Part 4A to Article 16, GS Chapter 130A as follows. States legislative findings and state policy. Sets forth six defined terms.
Makes it unlawful for a covered entity, defined as any licensed provider of health care services or any entity responsible for matching anatomical gift donors to potential recipients, to do any of the following acts solely on the basis of an individual's disability: (1) consider an individual ineligible to receive an anatomical gift or organ transplant (as defined); (2) deny medical services or other services related to organ transplantation; (3) refuse to refer the individual to a transplant center or other related specialist for the purpose of being evaluated for or receiving an organ transplant; (4) refusing to place a qualified recipient (as defined) on an organ transplant waiting list; (5) placing a qualified recipient on an organ transplant list at a lower priority position than if the individual did not have a disability; and (6) refusing insurance coverage for any procedure associated with begin evaluated for or receiving an anatomical gift or organ transplant. Defines qualified recipient to mean an individual who has a disability and meets the eligibility requirements for the receipt of an anatomical gift with or without assistance or policy modification sas specified. Permits a covered entity to take an individual's disability into account when making treatment or coverage recommendations or decisions, solely to the extent that the disability has been found by a physician or surgeon, following an individualized evaluation of the individual, to be medically significant to the provision of the anatomical gift; excludes the individual's inability to independently comply with post-transplant medical requirements from being a medically significant if the individual has the necessary support system to assist the individual in compliance.
Directs covered entities to reasonably modify their policies, practices, or procedures to allow individuals with disabilities access to transplantation-related services, unless the entity demonstrates the modifications would fundamentally alter the nature of the services. Directs covered entities to ensure an individual with a disability is not denied medical services or other services related to organ transplantation due to absence of auxiliary aids or services (as defined), unless the entity demonstrates that takes these steps would fundamentally alter the nature of the services or would result in an undue burden for the covered entity.
Makes the above provisions applicable to all stages of the organ transplant process. Specifies that the new Part does not require a covered entity to make a referral or recommendation for or perform a medically inappropriate organ transplant.
Allows an individual affected by a covered entity's violation of the Part to bring an action for injunctive and other equitable relief against the covered entity, as specified. Directs courts to give priority to the actions for expedited review, and authorizes the court to require that auxiliary aids or services be made available for a qualified recipient, require the modification of a policy, practice, or procedure of a covered entity, and require facilities be made readily accessible to and usable by a qualified recipient. Bars awarding compensatory or punitive damages for violations of the Part. Specifies that the Part does not limit or displace available remedies under the Americans with Disabilities Act.
Applies to anatomical gifts that become available for transplantation on or after October 1, 2021.
Enacts GS 58-3-256, prohibiting insurers from offering a health benefit plan that provides coverage for anatomical gifts, organ transplants, or treatment and services related to anatomical gifts or transplants which: (1) denies coverage to an insured solely on the basis of that individual's disability; (2) denies coverage to an individual eligibility, or continued eligibility, to enroll or to renew enrollment coverage under the terms of a health benefit plan solely for the purpose of avoiding the requirements of the statute; (3) attempting to induce a health care provider or provide care to an insured in a manner inconsistent with the statute by penalizing a health care provider or providing incentives to a health care provider; or (4) reducing or limiting health benefit plan coverage benefits to an insured for any services related to organ transplantation performed determined to be necessary in consultation with the attending physician and the insured. Specifies that any amendment to a health benefit plan made pursuant to a collective bargaining agreement solely to conform with the statute is not a termination of the agreement. Clarifies that the statute does not require an insurer to provide coverage for a medically inappropriate organ transplant. Recodifies GS 58-3-102(b) as subsection (c) of new GS 58-3-256, which requires an insurer to respond to an insured's request (or request made on behalf of the insurer) regarding coverage for transplants under that person's health benefit coverage within 10 business days of receipt of the request and necessary medical documentation to determine coverage. Repeals the remainder of GS 58-3-102 (which defines insurer). Applies to insurance contracts entered into, renewed, or amended on or after October 1, 2021.
Effective October 1, 2021.
© 2022 School of Government The University of North Carolina at Chapel Hill
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