Bill Summary for S 661 (2023-2024)
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View NCGA Bill Details | 2023-2024 Session |
AN ACT TO ACHIEVE MENTAL HEALTH PARITY UNDER HEALTH BENEFIT PLANS REGULATED BY THE NORTH CAROLINA DEPARTMENT OF INSURANCE.Intro. by Burgin.
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Bill summary
Amends GS 58-3-220, pertaining to mental illness benefits coverage, as follows. Deletes language pertaining to what limits include as it pertains to mental health equity insurance coverage. Deletes references to the Diagnostic and Statistical Manual of Mental Disorders (DSM V) and excluded conditions in all places except the definitions. Requires an insurer to adhere to the following when determining the medical necessity for a treatment modality for a mental illness: (1) make the determination in a manner that is consistent with the manner used to make that determination with respect to other diseases and (2) medical necessity determinations related to substance use disorders must be in accordance with appropriate evidence-based criteria established by a leading medical necessity guideline source. Makes technical and organizational changes.
Amends the definition of health benefit plan and makes other conforming changes to GS 58-50-61, pertaining to utilization reviews. Requires criteria for determining when a patient needs to be placed in a substance abuse treatment program to be made in accordance with appropriate evidence-based criteria established by a leading medical necessity guideline source.
Makes conforming changes to definition of mental illness in GS 58-51-55 (barring discrimination against mentally ill or chemically dependent individuals in insurance policies), GS 58-65-90 (barring discrimination against mentally ill or chemically dependent individuals by hospital service corporations), and GS 58-67-75 (barring discrimination against mentally ill or chemically dependent individuals by HMOs) to just refer to GS 58-3-220.
Repeals subsections (b) and (c) in the listed sections below pertaining to coverage for chemical dependency treatment in insurance policies (GS 58-51-50), hospital service corporations (GS 58-65-75), and HMOs (GS 58-67-70). Repeals GS 58-51-55(c), GS 58-65-90(c), and GS 58-67-75(c), all of which specify that the section does not require an insurer/hospital service corporation/HMO to offer coverage for chemical dependency, except as provided GS 58-51-50.
Effective October 1, 2023, and applies to insurance contracts issued, renewed, or amended on or after that date.