GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
H	2
HOUSE BILL 593
Senate Insurance and Consumer Protection Committee Substitute Adopted 6/27/01 

Short Title:	Health Insurance: Licensed Prof'l. Counselor.	()	
Sponsors:	     	
Referred to:	     	
March 14, 2001

A BILL TO BE ENTITLED
AN ACT TO PROVIDE FOR DIRECT PAYMENT OF LICENSED PROFESSIONAL COUNSELORS UNDER HEALTH INSURANCE POLICIES AND PLANS. 

The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 58‑50‑30 reads as rewritten:
"§ 58‑50‑30.  Right to choose services of optometrist, podiatrist, certified clinical social worker, certified substance abuse professional, licensed professional counselor, dentist, chiropractor, psychologist, pharmacist, certified fee‑based practicing pastoral counselor, advanced practice nurse, or physician assistant.
	
(a1)	Whenever any policy of insurance governed by Articles 1 through 65 of this Chapter provides for payment of or reimbursement for any service rendered in connection with a condition or complaint that is within the scope of practice of a duly licensed optometrist, a duly licensed podiatrist, a duly licensed dentist, a duly licensed chiropractor, a duly certified clinical social worker, a duly certified substance abuse professional, a duly licensed professional counselor, a duly licensed psychologist, a duly licensed pharmacist, a duly certified fee‑based practicing pastoral counselor, a duly licensed physician assistant, or an advanced practice registered nurse, the insured or other persons entitled to benefits under the policy shall be entitled to payment of or reimbursement for the services, whether the services be performed by a duly licensed physician, or a provider listed in this subsection, notwithstanding any provision contained in the policy. 
(a2)	Whenever any policy of insurance governed by Articles 1 through 65 of this Chapter provides for certification of disability that is within the scope of practice of a duly licensed physician, a duly licensed physician assistant, a duly licensed optometrist, a duly licensed podiatrist, a duly licensed dentist, a duly licensed chiropractor, a duly certified clinical social worker, a duly certified substance abuse professional, a duly licensed professional counselor, a duly licensed psychologist, a duly certified fee‑based practicing pastoral counselor, or an advanced practice registered nurse, the insured or other persons entitled to benefits under the policy shall be entitled to payment of or reimbursement for the disability whether the disability be certified by a duly licensed physician, or a provider listed in this subsection, notwithstanding any provisions contained in the policy. The policyholder, insured, or beneficiary shall have the right to choose the provider of the services notwithstanding any provision to the contrary in any other statute. 
(a3)	Whenever any policy of insurance provides coverage for medically necessary treatment, the insurer shall not impose any limitation on treatment or levels of coverage if performed by a duly licensed chiropractor acting within the scope of the chiropractor's practice as defined in G.S. 90‑151 unless a comparable limitation is imposed on the medically necessary treatment if performed or authorized by any other duly licensed physician. 
(b)	For the purposes of this section, a "duly licensed psychologist" is a licensed psychologist who holds permanent licensure and certification as a health services provider psychologist issued by the North Carolina Psychology Board.
(c)	For the purposes of this section, a "duly certified clinical social worker" is a "certified clinical social worker" as defined in G.S. 90B‑3(2) and certified by the North Carolina Certification Board for Social Work pursuant to Chapter 90B of the General Statutes.
(c1)	For purposes of this section, a "duly certified fee‑based practicing pastoral counselor" shall be defined only to include fee‑based practicing pastoral counselors certified by the North Carolina State Board of Examiners of Fee‑Based Practicing Pastoral Counselors pursuant to Article 26 of Chapter 90 of the General Statutes.
(c2)	For purposes of this section, a "duly certified substance abuse professional" is a person certified by the North Carolina Substance Abuse Professional Certification Board pursuant to Article 5C of Chapter 90 of the General Statutes.
(c3) 	For purposes of this section, a "duly licensed professional counselor" is a person licensed by the North Carolina Board of Licensed Professional Counselors pursuant to Article 24 of Chapter 90 of the General Statutes.
(d)	Payment or reimbursement is required by this section for a service performed by an advanced practice registered nurse only when:
(1)	The service performed is within the nurse's lawful scope of practice;
(2)	The policy currently provides benefits for identical services performed by other licensed health care providers;
(3)	The service is not performed while the nurse is a regular employee in an office of a licensed physician;
(4)	The service is not performed while the registered nurse is employed by a nursing facility (including a hospital, skilled nursing facility, intermediate care facility, or home care agency); and
(5)	Nothing in this section is intended to authorize payment to more than one provider for the same service.
No lack of signature, referral, or employment by any other health care provider may be asserted to deny benefits under this provision.
For purposes of this section, an "advanced practice registered nurse" means only a registered nurse who is duly licensed or certified as a nurse practitioner, clinical specialist in psychiatric and mental health nursing, or nurse midwife.
(e)	Payment or reimbursement is required by this section for a service performed by a duly licensed pharmacist only when:
(1)	The service performed is within the lawful scope of practice of the pharmacist;
(2)	The service performed is not initial counseling services required under State or federal law or regulation of the North Carolina Board of Pharmacy;
(3)	The policy currently provides reimbursement for identical services performed by other licensed health care providers; and
(4)	The service is identified as a separate service that is performed by other licensed health care providers and is reimbursed by identical payment methods.
Nothing in this subsection authorizes payment to more than one provider for the same service.
(f)	Payment or reimbursement is required by this section for a service performed by a duly licensed physician assistant only when:
(1)	The service performed is within the lawful scope of practice of the physician assistant in accordance with rules adopted by the North Carolina Medical Board pursuant to G.S. 90‑18.1;
(2)	The policy currently provides reimbursement for identical services performed by other licensed health care providers; and
(3)	The reimbursement is made to the physician, clinic, agency, or institution employing the physician assistant.
Nothing in this subsection is intended to authorize payment to more than one provider for the same service. For the purposes of this section, a "duly licensed physician assistant" is a physician assistant as defined by G.S. 90‑18.1."
SECTION 2.  Article 65 of Chapter 58 is amended by adding a new section to read:
"§ 58‑65‑1.1.  Regulation and definitions; application of other laws; profit and foreign corporations prohibited.
(a)	Any corporation organized under the general corporation laws of the State of North Carolina for the purpose of maintaining and operating a nonprofit hospital or medical or dental service plan whereby hospital care or medical or dental service may be provided in whole or in part by the corporation or by hospitals, physicians, or dentists participating in the plan, or plans, shall be governed by this Article and Article 66 of this Chapter and shall be exempt from all other provisions of the insurance laws of thisState, unless otherwise provided. 
The term "hospital service plan" as used in this Article and Article 66 of this Chapter includes the contracting for certain fees for, or furnishing of, hospital care, laboratory facilities, X‑ray facilities, drugs, appliances, anesthesia, nursing care, operating and obstetrical equipment, accommodations or any other services authorized or permitted to be furnished by a hospital under the laws of the State of North Carolina and approved by the North Carolina Hospital Association or the American Medical Association.
The term "medical service plan" as used in this Article and Article 66 of this Chapter includes the contracting for the payment of fees toward, or furnishing of, medical, obstetrical, surgical or any other professional services authorized or permitted to be furnished by a duly licensed physician or other provider listed in G.S. 58-50-30. The term "medical services plan" also includes the contracting for the payment of fees toward, or furnishing of, professional medical services authorized or permitted to be furnished by a duly licensed provider of health services licensed under Chapter 90 of the General Statutes.
																The term "dental service plan" as used in this Article and Article 66 of this Chapter includes contracting for the payment of fees toward, or furnishing of dental or any other professional services authorized or permitted to be furnished by a duly licensed dentist.

The term "hospital service corporation" as used in this Article and Article 66 of this Chapter is intended to mean any nonprofit corporation operating a hospital or medical or dental service plan, as defined in this section. Any corporation organized and subject to the provisions of this Article and Article 66 of this Chapter, the certificate of incorporation of which authorizes the operation of either a hospital or medical or dental service plan, or any or all of them, may, with the approval of the Commissioner of Insurance, issue subscribers' contracts or certificates approved by the Commissioner of Insurance, for the payment of either hospital or medical or dental fees, or the furnishing of such services, or any or all of them, and may enter into contracts with hospitals for physicians or dentists, or any or all of them, for the furnishing of fees or services respectively under a hospital or medical or dental service plan, or any or all of them.
The term "preferred provider" as used in this Article and Article 66 of this Chapter with respect to contracts, organizations, policies or otherwise means a health care service provider who has agreed to accept, from a corporation organized for the purposes authorized by this Article and Article 66 of this Chapter or other applicable law, special reimbursement terms in exchange for providing services to beneficiaries of a plan administered pursuant to this Article and Article 66 of this Chapter. Except to the extent prohibited either by G.S. 58‑65‑140 or by rules promulgated by the Department of Insurance not inconsistent with this Article and Article 66 of this Chapter, the contractual terms and conditions for special reimbursement shall be those which the corporation and preferred provider find to be mutually agreeable.
(d)	No foreign or alien hospital or medical or dental service corporation as herein defined shall be authorized to do business in this State."
SECTION 3.  G.S. 58‑50‑56(c) reads as rewritten:
"(c)	At the initial offering of a preferred provider plan to the public, health care providers may submit proposals for participation in accordance with the terms of the preferred provider plan within 30 days after that offering. After that time period, any health care provider may submit a proposal, and the insurer offering the preferred provider benefit plan shall consider all pending applications for participation and give reasons for any rejections or failure to act on an application on at least an annual basis. Any health care provider seeking to participate in the preferred provider benefit plan, whether upon the initial offering or subsequently, may be permitted to do so in the discretion of the insurer offering the preferred provider benefit plan.  G.S. 58-50-30 applies to preferred provider benefit plans."
SECTION 4.  G.S. 58‑3‑120 reads as rewritten:
"§ 58‑3‑120.  Discrimination forbidden.
(a)	No company doing the business of insurance as defined in G.S. 58‑7‑15 shall make any discrimination in favor of any person. 
(b)	Discrimination between individuals of the same class in the amount of premiums or rates charged for any policy of insurance covered by Articles 50 through 55 of this Chapter, or in the benefits payable thereon, or in any of the terms or conditions of such policy, or in any other manner whatsoever, is prohibited."
SECTION 5.  This act becomes effective October 1, 2001, and applies to claims for payment or reimbursement for services rendered on or after that date.