AN ACT TO PROVIDE FOR FAIR AND EQUITABLE REIMBURSEMENT OF HEALTH CARE SERVICES OR PROCEDURES THAT ARE PERFORMED BY A PHARMACIST WITHIN THAT PHARMACIST'S SCOPE OF PRACTICE AND THAT ARE EQUIVALENT TO SERVICES PERFORMED BY OTHER HEALTH CARE PROFESSIONALS AND TO APPROPRIATE FUNDS TO THE DEPARTMENT OF INSURANCE.
Enacts new GS 58-50-296 requiring health benefit plans offered by insurers in this state to reimburse a pharmacist at the same rate that other health care providers are reimbursed when providing the same or equivalent health care services or procedures as long as: (1) the service or procedure was performed within the pharmacist's licensed lawful scope of practice, (2) the health benefit plan would have provided reimbursement if the service or procedure had been performed by another health care provider, and (3) the pharmacist provided the service or procedure in compliance with any requirements of the insurer related to the service or procedure. Requires insurers who delegate credentialing agreements to contracted health care facilities to accept credentialing for pharmacists employed or contracted with those facilities. Requires reimbursing a contracted health care facility or a contracted pharmacist directly for covered services performed by a pharmacist within that pharmacist's lawful scope of practice whether or not the pharmacist participates in the insurer's provider network. Specifies that the statute also applies to agents of an insurer offering a health benefit plan in this state and third-party administrators. Effective October 1, 2021, and applies to contracts entered into, renewed, or amended on or after that date.
Appropriates $100,000 for 2021-22 from the General Fund to the Department of Insurance to prepare for implementation of this act. Effective July 1, 2021.
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