GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1997

H	1 

HOUSE BILL 436

Short Title:  State Health Plan Substantive/AB.	(Public)

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Sponsors: Representatives Dockham; and Brawley.

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Referred to:  Insurance.

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March 10, 1997

A BILL TO BE ENTITLED
AN ACT TO MAKE SUBSTANTIVE CHANGES IN THE TEACHERS' AND STATE EMPLOYEES' COMPREHENSIVE MAJOR MEDICAL PLAN.
The General Assembly of North Carolina enacts:
Section 1. (a) G.S. 136-40.6(8)a. reads as rewritten:
"a.	Prescription Drugs: The Plan's allowable charges for prescription legend drugs to be used outside of a hospital or skilled nursing facility are ninety percent (90%) of the average wholesale price. A dispensing fee for qualified providers shall be determined by the Executive Administrator and Board of Trustees. The Plan will pay allowable charges for each outpatient prescription drug less a copayment to be paid by each covered individual equal to the provider dispensing fee set by the Executive Administrator and Board of Trustees. A prescription legend drug is defined as an article the label of which, under the Federal Food, Drug, and Cosmetic Act, is required to bear the legend: ‘Caution: Federal Law Prohibits Dispensing Without Prescription.' and which has full unrestricted market approval by the Food and Drug Administration for the condition being treated. Such articles may not be sold to or purchased by the public without a prescription order. Benefits are provided for insulin even though prescription is not required.  Coverage is not provided for drugs used for cosmetic purposes or drugs not having full and unrestricted Food and Drug Administration approval for the condition being treated.
		Benefits for additional indications (off label use) are provided for chemotherapeutic drugs that have received full and unrestricted Food and Drug Administration approval as recognized by one of the following reference compendia: (i) American Medical Association Drug Evaluations; (ii) American Hospital Formulary Service Drug information; or (iii) United States Pharmacopeia Drug information; or peer review medical literature allows an objective conclusion that clinical efficacy has been established, and the drug is no longer experimental/investigational."
(b)	G.S. 136-40.7(14) reads as rewritten:
"(14)	Charges for cosmetic surgery, drugs or treatment for cosmetic purposes except that charges for cosmetic surgery or treatment required for correction of damage caused by accidental injury sustained by the covered individual while coverage under this plan is in force on his or her account or to correct congenital deformities or anomalies shall not be excluded if they otherwise qualify as covered medical expenses."
Section 2.  G.S. 135-39.5 is amended by adding a new subdivision to read:
"(23)	Implementing a case management program."
Section 3. (a) G.S. 135-40.6(1)k. is repealed.
(b)	G.S. 135-40.6(1)o. reads as rewritten:
"o.	
		Benefits are provided for a covered newborn's circumcision and routine nursery care."
(c)	G.S. 135-40.6(7)c. reads as rewritten:
"c.	Newborn Care. –When delivery is by Caesarean section, a single consultation allowance will be provided for standby, resuscitation, and infant care in the operating room provided by a doctor other than the operating surgeon.
		Benefits are provided for examination and supervision of a covered normal newborn infant of an enrolled employee or spouse."
Section 4.  G.S. 135-40.6A(b)(1) reads as rewritten:
"(1)	Skilled Nursing Facility Care;"
Section 5.  G.S. 135-40.6(9)f. reads as rewritten:
"f.	Eyeglasses or other corrective lenses (except for cataract lenses certified as medically necessary for aphakia persons), hearing aids, braces for teeth, dental plates or bridges or other dental prostheses, air-conditioners, vaporizers, humidifiers, mattresses (other than as supplied with a hospital bed);"
Section 6. This act becomes effective July 1, 1997.