Conference report #2 to the 6th edition makes the following changes.

Part I.

Changes the effective date of the provisions of Section 1, which recodifies several statutes and enacts Article 18H, Psychology Interjurisdictional Licensure Compact, GS Chapter 90, to March 1, 2021 (previously effective when at least seven states have enacted the Psychology Interjurisdictional Compact).

Part II

Changes the effective date of the proposed changes to GS 122C-263.1, allowing licensed marriage and family therapists to conduct first examinations for involuntary commitment, to October 1, 2020 (was effective October 1, 2019).

Part IV

Changes the effective date of the proposed changes to GS 58-3-221, regarding access to nonformulary and restricted access prescription drugs, to October 1, 2020 (was, October 1, 2019).

Part V

Amends subdivision 3.3(24) of SL 2020-4 (2020 COVID-19 Recovery Act) to expand the purposes for which funds allocated to the NC Community Health Center Association can be used to include offsetting five classes of costs incurred by member health centers related to the provision of patient care within the State to respond to the COVID-19 pandemic. Makes technical changes. 

Deletes the following previous Parts of the act: Part IV (regarding Lupus awareness and establishing a Lupus Advisory Council), Part Part VI (regarding coverage of orally administered anticancer drugs), Part VII (regarding Medicaid telemedicine policies), Part VIII (regarding access to telehealth services), and Part IX (establishing a Healthcare Solutions Task Force).

Makes further technical changes. Makes conforming changes to the act's organization and changes the act's long title.

Note: Conference report #1 was withdrawn 6/25/2020.

House amendment to the 5th edition makes the following changes.

Part III.

Amends the proposed additions to GS 131D-2.11(a). Now provides that if the annual or biennial licensure inspection (was, annual inspection) of an adult care home is conducted separately from the inspection required every two years to determine compliance with physical plant and life-safety requirements, then the Division of Health Service Regulation (DHSR) cannot cite, as part of the annual or biennial licensure inspection, any non-compliance with any law or regulation that was cited during a physical plant and life-safety inspection (was, any violation of law that overlaps with an area addressed by the physical plant and life-safety inspection). Modifies and adds to the exceptions, allowing for DHSR to make the citation if, in consultation with the section within DHSR that conducts physical and life-safety inspections (section), either (1) the non-compliance with the law or regulation continues and the non-compliance constitutes a Type A1 Violation, a Type A2 Violation, or a Type B Violation, as specified in state law; (2) the facility has not submitted a plan of correction for the physical plant or life-safety citation that has been accepted by the section; or (3) the non-compliance with the physical plant or life-safety law and regulation cited by the section has not been corrected within the time frame allowed for correction or has increased in severity (previously, only provided a general exception to allow citation when failure to address the violation during the annual inspection would pose a risk to resident health or safety). Maintains the clarification that the new provisions do not prevent a licensing inspector from referring a concern about physical plant and life-safety requirements to the section. 

House committee substitute to the 3rd edition makes the following changes.

Amends GS 122C-263.1 concerning who can perform first commitment exams, by adding that a licensed marriage and family therapist is not authorized to conduct the initial exam of an individual married to a patient of the licensed marriage and family therapist.

Deletes the proposed changes to GS 90-270.54 and GS 90-270.57, which established a license to conduct first exams and the related application fee. 

Adds the following provisions. 

Part V.

Amends GS 58-3-221(a), which requires an insurer to take four specified steps if the insurer maintains one or more closed formularies for or restricts access to covered prescription drugs or devices. Amends the statute to also make those required steps applicable to when an insurer requires an enrollee in a plan with an open or closed formulary to use a prescription drug or sequence of prescription drugs, other than the drug the enrollee's health care provider recommends, before the insurer provides coverage for the recommended prescription drug. Amends those four required steps as follows: (1) requires the insurer to develop the formularies or protocols and any restrictions on access to covered prescription drugs or devices in consultation with and with the approval of a pharmacy and therapeutics committee (was, develop the formulary or formualries and any restrictions on access to covered prescription drugs or devices in consultation with and with the approval of a pharmacy and therapeutics committee, which was required to include participating physicians licensed to practice medicine in this State); (2) requires the insurer to also make available any utilization management program indicators; (3) requires the insurer to update protocols based on a review of new evidence, research, and newly developed treatments (deletes requirement of establishing and maintaining an expeditious process or procedure for enrollees or enrollees' physicians to obtain coverage for a specific nonformulary drug or device determined to be medically necessary and appropriate by the enrolee's participating physician without prior approval from the insurer after the enrollee's participating physician makes the specified notifications about the formulary or drug; these provisions are moved to another part of the statute and amended as discussed below); and (4) requires an insurer, or a pharmacy benefits manger under contract with an insurer, to require that its pharmacy and therapeutics committee either meet the requirements for the specified conflict of interest or meet the accreditation standards of the specified Committee or another independent accrediting organization (deletes the requirement of providing coverage for a restricted access drug or device to an enrollee without requiring prior approval or use of a nonrestricted formulary drug if an enrollee's physician certifies in writing that the enrollee has previously used an alternative nonrestricted access drug or device and the alternative drug or device has been detrimental to the enrollee's health or has been ineffective in treating the same condition and, in the opinion of the prescribing physician, is likely to be detrimental to the enrollee's health or ineffective in treating the condition again).

Moves and amends the provision related to the exception process as follows. Adds the requirement that the process or procedure be published on the insurer's website or in policies provided to health care providers. Now requires that an enrollee or the enrollee's prescribing provider be allowed to obtain, without penalty or additional cost-sharing beyond that provided for in the health benefit plan, coverage for a specific nonformulary drug or device or the drug requested by the prescribing provider, if it is determined to be medically necessary and appropriate by the enrollee's prescribing provider and the prescription drug is covered under the current health benefit plan. Requires an exception request to be granted if the prescribing provider's submitted justification and supporting clinical documentation are sufficient to demonstrate: (1) the enrollee has tried the alternate drug while covered by the current or previous health benefit plan; (2) the formulary or alternate drug has been ineffective in the treatment of the enrollee's disease or condition; (3) the formulary or alternate drug causes or is reasonably expected by the prescribing provider to cause a harmful or adverse clinical reaction in the enrollee; (4) either the drug is prescribed in accordance with any applicable clinical protocol of the insurer for the prescribing of the drug, or the drug has been approved as an exception to the clinical protocol pursuant to the insurer's exception procedure; or (5) the enrollee's prescribing provider certifies in writing that the enrollee has previously used an alternative nonrestricted access drug or device and the alternative drug or device has been detrimental to the enrollee's health or has been ineffective in treating the same condition and, in the opinion of the prescribing healthcare provider, is likely to be detrimental to the enrollee's health or ineffective in treating the condition again. 

Adds that pharmaceutical drug samples or patient incentive programs are not to be considered trial and failure of a preferred prescription drug in lieu of trying the formulary-preferred prescription drug. Adds the following exception process requirements. Allows the insurer, health benefit plan, or utilization review organization to request relevant documentation from the patient or healthcare provider to support the request. Requires a licensed physician or licensed pharmacist to evaluate the clinical appropriateness of the request. Sets out the timelines for  the insurer to communicate to the enrollee's healthcare provider if additional information is required and for the insurer to communicate an exception request determination with the time limits dependent on whether the request is urgent. 

Adds that the statute is not to be construed to prevent the health benefit plan from requiring an enrollee to try an A-rated generic equivalent drug or a biosimilar before covering the equivalent branded prescription drug.

Effective October 1, 2019, and applies to insurance contracts issued, renewed, or amended on or after that date.

Part VI. 

Enacts new GS 58-3-282, concerning coverage for certain anticancer drugs, applicable to every health benefit plan offered by an insurer that provides coverage for prescribed, orally administered anticancer drugs used to kill or slow the growth of cancerous cells and that provides coverage for intravenously administered or injected anticancer drugs, requiring that such plans must provide coverage for prescribed, orally administered anticancer drugs on a basis no less favorable than the coverage provided for the intravenously administered or injected anticancer drug.

Prohibits coverage for orally administered anticancer drugs from being subject to prior authorization, dollar limit, co-payment, coinsurance, deductible provision, or any other out-of-pocket expense that does not apply to intravenously administered or injected anticancer drugs.

Prohibits achieving compliance by reclassifying drugs or increasing cost-sharing expenses imposed on anticancer drugs. Provides that if out-of-pocket expenses are increased for anticancer drugs then the same must also be applied to the majority of comparable medical or pharmaceutical benefits of the policy, contract, or plan.

Applies to insurance contracts issued, renewed, or amended on or after January 1, 2020. Provides that the statute will not become effective if it is determined by the federal government to create a  state-required benefit that is in excess of the essential health benefits pursuant to 45 C.F.R. 155.170(a)(3); if such a determination is made, then requires the Department of Insurance to notify the Revisor of Statutes. 

Part VII.

Requires the Department of Health and Human Services (DHHS) to make six specified changes to the Medicaid and NC Health Choice Clinical Coverage Policy No. 1H, Telemedicine and Telepsychiatry, regarding reimbursement, referrals, delivery of services by phone or video cell phone, same-date billing, best practices, and inclusion in the coverage policy of certain behavioral health providers. Directs DHHS to expand the billing code set available for telemedicine and telepsychiatry to include most outpatient billing codes, but not to include group-type therapies other than family therapy. Changes become effective after the completion of the process for amending policy required under GS 108A-54.2 (procedures for changing medical policy in public assistance programs).

Requires DHHS to submit to the Centers for Medicare and Medicaid Services any waivers or amendments to the NC Medicaid State Plan necessary to implement this act.  

Part VIII.

Requires the Department of Health and Human Services (DHHS) to ensure that Medicaid and NC Health Choice coverage of telemedicine and telepsychiatry services are consistent with this section and requires amending Clinical Coverage Policy No: 1H as necessary. Requires using the term "telehealth" instead of  "telemedicine" in all clinical coverage policies. Defines telehealth for the purposes of Medicaid and NC Health Choice coverage, as the delivery of health care-related services by a Medicaid or NC Health Choice provider licensed in the State to a Medicaid or NC Health Choice recipient through one of the three specified types of communications and technologies. Specifies that telehealth does not include the delivery of services solely through electronic mail, text chat, or audio-communication unless either additional medical history and clinical information is communicated electronically between the provider and patient or the services delivered are behavioral health services. Specifies four actions that DHHS must take regarding Medicaid and NC Health Choice coverage of telehealth services, including promoting access to health care for Medicaid and NC Health Choice recipients through telehealth services. Prohibits DHHS from requiring seven specified items as a condition of coverage of telehealth services, including that a provider be part of a telehealth network in order to bill for Medicaid or NC Health Choice services, and that the Provider be physically present with the patient or client unless the provider determines it is medically necessary to perform the services in person. Requires DHHS to ensure that (1) Medicaid and NC Health Choice coverage and reimbursement for telehealth services are equivalent to the reimbursement and coverage for the same services if provided in person and (2) that any deductible, copayment, or coinsurance requirement is equivalent to the same service if it was provided to the patient in person. Requires DHHS to submit to the Centers for Medicare and Medicaid Services any waivers or amendments to the NC Medicaid State Plan necessary to implement the above provisions. Requires DHHS by September 1, 2020, to report on changes, expected costs, savings, and outcomes of telehealth services to the specified NCGA committee and division.

Enacts new GS 58-50-305 to prohibit a health benefit plan from excluding from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation. Allows a health benefit plan to require a deductible, a copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telehealth service. Prohibits the amount charged from exceeding the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation. Makes a conforming change to GS 135-48.51 to make new GS 58-50-305 applicable to the State Health Plan.

Effective October 1, 2019.

Part IX.

Requires the North Carolina Area Health Education Centers Program to convene a 15-member North Carolina Healthcare Solutions Task Force (Task Force) to make recommendations for innovative solutions to healthcare access issues in the state. Sets out membership requirements. Requires the North Carolina Area Health Education Centers to assist the Task Force by convening and facilitating meetings, providing necessary clerical and administrative support, and preparing the Task Force reports and providing technical assistance as appropriate. Requires the Task Force to conduct a 10-year, ongoing study of issues related to access to healthcare in North Carolina, with the work divided into two stages. Requires the first stage to identify metrics to provide an accurate assessment and measurement  of the state of access to healthcare in North Carolina, and the second stage to identify any issues relating to access to healthcare in North Carolina and to develop innovative solutions that will increase access to healthcare and improve the state of access to healthcare in North Carolina as measured by the identified metrics. Sets out additional requirements for the two stages. Requires the Task Force's first meeting to be convened by October 1, 2019. Requires the report on stage one to be submitted to the specified NCGA committee by April 1, 2021, with annual reports on stage two activities required beginning April 1, 2022, with subsequent reports submitted annually until April 1, 2030. Terminates the Task Force on the date it submits is final report in 2030.

Amends the act's long title.

Senate committee substitute to the 1st edition makes the following changes.

Eliminates previous Part I, which required the Department of Health and Human Services, Division of Health Benefits (Division), to amend the North Carolina Innovations waiver to increase the number of slots available under the waiver by a maximum of 1,000 slots to be made available on January 1, 2020, and by a maximum of 1,000 slots to be made available on January 1, 2021. Eliminates the companion appropriation. Makes conforming organizational changes to the act.

Eliminates the proposed repeal of GS Chapter 131E, Article 9 (Certificate of Need) and accompanying conforming changes to GS 6-19.1, GS 113A-12, GS 122C-23.1, GS 131E-13, GS 131E-136, GS 148-19.1, GS 130A-45.02, GS 150B-2, and GS 150B-21.1; conforming repeal of GS 143B-1292; and conforming changes to GS 58-50-61 and GS 58-55-35. Instead provides the following.

Amends GS 131E-176, which sets outs defined terms applicable to Article 9, Certificate of Need. Amends bed capacity to specify space used exclusively for inpatient care at a health care facility. Modifies terms throughout to remove reference to "psychiatric facilities," "kidney disease treatment centers," "intermediate care facilities for the mentally retarded," "chemical dependency treatment facilities," "diagnostic facilities," and "ambulatory surgical facilities." Amends health service facility to exclude a licensable facility as defined in GS 122C-3(14)b. Changes the terminology to "intermediate care facility for individuals with intellectual disabilities" (was, mentally retarded). Makes further technical, clarifying, and conforming changes.

Amends GS 131E-177 to prohibit the Department of Health and Human Services (DHHS) from including policies or need determinations that limit the number of operating rooms in gastrointestinal endoscopy rooms in developing a State Medical Facilities Plan. Makes further technical and clarifying changes.

Makes conforming changes to GS 131E-178, GS 131E-183, GS 131E-184, and GS 131E-186 to eliminate requirements related to certificates of need and review for ambulatory surgical facilities, psychiatric facilities, and nursing care or intermediate care facilities for the mentally retarded.

Amends GS 131E-181 to require certificate of need recipients to complete the project authorized by the certificate of need within two years after the decision to issue the certificate of need becomes final. Deems the certificate expired the day after the two-year time period if the project authorized is not completed. Directs DHHS to withdraw a certificate of need issued to any recipient that ceases operating the health service or health service facility included in that certificate of need for more than one year.

Further amends GS 131E-184 regarding exemptions from certificate of need review. Adds new subsection (i) to require DHHS to exempt from certificate of need review the development, acquisition, construction, expansion, or replacement of a health service facility or health service that obtained certificate of need approval prior to October 1, 2019, as: an ambulatory surgical facility, including an ambulatory surgical facility with one or more operating rooms or gastrointestinal endoscopy procedure rooms; a diagnostic center; kidney disease treatment center, including freestanding dialysis units; chemical dependency treatment facility; intermediate care for individuals with intellectual disabilities; psychiatric hospital; or any other licensable facility, as defined. 

Adds new subsection (j) to require DHHS to exempt from certificate of need review the establishment of a home health agency by a licensed continuing care retirement community to provide home health care services to one or more residents of the retirement community who have entered into a contract with the retirement community to receive continuing care services with lodging. Requires the continuing care retirement community to obtain a certificate of need if developing or offering services to any individual not a resident of the retirement community under a contract to receive continuing care services with lodging. Explicitly does not exempt from the State's home health agency licensure and certification requirements a continuing care retirement community that has been exempted from certificate of need review for the provision of home health services to one or more residents pursuant to new subsection (j). Provides that new subsection (j) applies to continuing care retirement communities engaged in the direct provision of home health services on or after October 1, 2019.

Amends GS 131E-188, concerning administrative and judicial review. Removes reference to the term 'affected person.' Instead entitles any proponent of an application that was reviewed with the application for the certificate of need to a contested case hearing. Authorizes the Court of Appeals to award all costs for judicial review to the prevailing party, as described. Increases the maximum secured bond required to be deposited by the appellant with the Clerk of the Court of Appeals for appeals of a final decision granting a certificate of need, allowing up to $500,000 rather than $300,000 in the court's discretion.

Amends GS 131E-147 regarding ambulatory surgical facility licensure requirements, to prohibit DHHS from issuing or renewing a license to operate an ambulatory surgical facility developed, acquired, or replaced on or after October 1, 2019, unless the application meets four criteria. Requires: (1) a commitment that the Medicare allowable amount for self-pay and Medicaid surgical cases, minus collected revenue, will be at least 4% of the total revenue collected for all surgical cases performed; (2) a commitment to report case numbers in specified payer categories; and (3) a commitment to report utilization and payment data for services provided to the statewide processor, as specified.

Makes conforming repeals in GS 131E-175 (legislative findings).

Effective October 1, 2019.

Maintains the recodification of Article 18A (Psychology Practice Act) of GS Chapter 90 as Article 18G, and enactment of  Article 18H, Psychology Interjurisdictional Licensure Compact, in GS Chapter 90.

Enacts GS 90-270.54(a1) to require the NC Marriage and Family Therapy Licensure Board to issue licenses for marriage and family therapists to conduct involuntary commitment first examinations if they meet the specified licensure requirements and pay a $10 fee. Amends GS 90-270.57 to establish the $10 fee. Applies to applications submitted on or after October 1, 2019.

Eliminates all provisions of the previous Part V, amending GS 131E-138, which created an exemption from home care agency licensure requirements when home care services are provided to participants of the Program for All-Inclusive Care for the Elderly through an organization that has a valid program agreement with the Centers for Medicare and Medicaid Services and the Divisions of Health Benefits of the Department of Health and Human Services. Eliminates all accompanying proposed changes to GS Chapter 131D.