Bill Text: NC S248 | 2013-2014 | Regular Session | Amended
Bill Title: Choice of Hearing Aid Specialist
Spectrum: Partisan Bill (Republican 2-0)
Status: (Passed) 2013-07-18 - Ch. SL 2013-296 [S248 Detail]
Download: North_Carolina-2013-S248-Amended.html
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2013
S 2
SENATE BILL 248
Health Care Committee Substitute Adopted 4/17/13
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Short Title: Choice of Hearing Aid Specialist. |
(Public) |
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Sponsors: |
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Referred to: |
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March 12, 2013
A BILL TO BE ENTITLED
AN ACT to ensure that patients have the right to choose their hearing aid specialist under their health benefit plans, to authorize the north carolina state hearing aid dealers and fitters board to increase certain fees, and to make technical changes to the statute on choosing services of providers.
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, licensed clinical
social worker, certified substance abuse professional, licensed professional
counselor, dentist, chiropractor, physical therapist, psychologist, pharmacist,
certified fee‑based practicing pastoral counselor, advanced practice
nurse, licensed marriage and family therapist, or physician assistant.certain
providers.
(a) Repealed by Session Laws 2001‑297, s. 1, effective January 1, 2001.
(a1) Whenever any health benefit plan, subscriber
contract, or policy of insurance issued by a health maintenance organization,
hospital or medical service corporation, or insurer governed by Articles 1
through 67 of this Chapter provides for coverage 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 licensed physical therapist, a duly licensed
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, a duly licensed marriage and family
therapist, or an advanced practice registered nurse, a provider listed
in subsection (b) of this section, the insured or other persons entitled to
benefits under the policy shall be entitled to coverage of, payment of, or
reimbursement for the services, whether the services be performed by a duly licensed
physician, or a provider listed in this subsection,subsection (b) of
this section, notwithstanding any provision contained in the plan or policy
limiting access to the providers. The policyholder, insured, or beneficiary
shall have the right to choose the provider of services notwithstanding any
provision to the contrary in any other statute, subject to the utilization
review, referral, and prior approval requirements of the plan that apply to all
providers for that service; provided that:
(1) In the case of plans that require the use of network providers as a condition of obtaining benefits under the plan or policy, the policyholder, insured, or beneficiary must choose a provider of the services within the network; and
(2) In the case of plans that require the use of network providers as a condition of obtaining a higher level of benefits under the plan or policy, the policyholder, insured, or beneficiary must choose a provider of the services within the network in order to obtain the higher level of benefits.
(a2) Whenever any policy of insurance governed by
Articles 1 through 64 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
licensed physical therapist, a duly licensed 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, a duly licensed marriage and family therapist, or an
advanced practice registered nurse,a provider listed in subsection (b)
of this section, 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,subsection (b) of this section, 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; provided
that for plans that require the use of network providers either as a condition
of obtaining benefits under the plan or policy or to access a higher level of
benefits under the plan or policy, the policyholder, insured, or beneficiary
must choose a provider of the services within the network, subject to the
requirements of the plan or policy.
(a3) Whenever any health benefit plan, subscriber contract, or policy of insurance issued by a health maintenance organization, hospital or medical service corporation, or insurer governed by Articles 1 through 67 of this Chapter 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, This
section applies to the following provider types:
(1) A duly licensed optometrist.
(2) A duly licensed dentist.
(3) A duly licensed podiatrist.
(4) A duly licensed chiropractor.
(5) An advanced practice registered nurse, subject to subsection (d) of this section. 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.
(6) a "duly licensed psychologist"
is a:A psychologist who is one of the following:
(1)a. LicensedA licensed psychologist
who holds permanent licensure and certification as a health services provider
psychologist issued by the North Carolina Psychology Board; orBoard.
(2)b. LicensedA licensed psychological
associate who holds permanent licensure.
(c)(7) For the purposes of this section, a "duly
licensed clinical social worker" is a "licensed clinical social
worker" A licensed clinical social worker, as defined in G.S. 90B‑3(2)
andG.S. 90B‑3(2) who is licensed by the North Carolina
Social Work Certification and Licensure Board pursuant to Chapter 90B of the
General Statutes.
(8) A duly licensed pharmacist, subject to the provisions of subsection (e) of this section.
(c1)(9) For purposes of this section, a "duly
certified fee‑based practicing pastoral counselor" shall be defined
only to includeA fee‑based practicing pastoral counselorscounselor
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)(10) For purposes of this section, a "duly
certified substance abuse professional" is a personA substance
abuse professional certified by the North Carolina Substance Abuse
Professional Certification Board pursuant to Article 5C of Chapter 90 of the
General Statutes.
(11) A physician assistant, as defined by G.S. 90‑18.1 and subject to subsection (f) of this section.
(c3)(12) For purposes of this section, a "duly
licensed professional counselor" is a personA professional
counselor licensed by the North Carolina Board of Licensed Professional
Counselors pursuant to Article 24 of Chapter 90 of the General Statutes.
(c4)(13) For purposes of this section, a "duly
licensed marriage and family therapist" is a personA marriage and
family therapist licensed by the North Carolina Marriage and Family Therapy
Licensure Board pursuant to Article 18C of Chapter 90 of the General Statutes.
(c5)(14) For purposes of this section, a "duly
licensed physical therapist" is a personA physical therapist licensed
by the North Carolina Board of Physical Therapy Examiners pursuant to Article
18B of Chapter 90 of the General Statutes.
(15) A hearing aid specialist licensed by the North Carolina State Hearing Aid Dealers and Fitters Board pursuant to Chapter 93D 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, unless these plan requirements apply to all providers for that service.
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.
(g) A health maintenance organization, hospital or
medical service corporation, or insurer governed by Articles 1 through 67 of
this Chapter shall not exclude from participation in its provider network or
from eligibility to provide particular covered services under the plan or
policy any duly licensed physician or provider listed in subsection (a1)(b)
of this section, acting within the scope of the provider's license or
certification under North Carolina law, solely on the basis of the provider's
license or certification. Any health maintenance organization, hospital or
medical service corporation, or insurer governed by Articles 1 through 67 of
this Chapter that offers coverage through a network plan may condition
participation in the network on satisfying written participation criteria,
including credentialing, quality, and accessibility criteria. The participation
criteria shall be developed and applied in a like manner consistent with the
licensure and scope of practice for each type of provider. Any health
maintenance organization, hospital or medical service corporation, or insurer
governed by Articles 1 through 67 of this Chapter that excludes a provider
listed in subsection (a1)(b) of this section from participation
in its network or from eligibility to provide particular covered services under
the plan or policy shall provide the affected listed provider with a written
explanation of the basis for its decision. A health maintenance organization,
hospital or medical service corporation, or insurer governed by Articles 1
through 67 of this Chapter shall not exclude from participation in its provider
network a provider listed in subsection (a1)(b) of this section
acting within the scope of the provider's license or certification under North
Carolina law solely on the basis that the provider lacks hospital privileges,
unless use of hospital services by the provider on behalf of a policy holder,
insured, or beneficiary reasonably could be expected.
(h) Nothing in this section shall be construed as
expanding the scope of practice of any duly licensed physician or provider
listed in subsection (a1)(b) of this section."
SECTION 2. G.S. 93D‑5 reads as rewritten:
"§ 93D‑5. Requirements for registration; examinations; licenses.
(a) No person shall begin the fitting and selling of
hearing aids in this State unless the person has been issued a license by the
Board or is an apprentice working under the supervision of a Registered
Sponsor. Except as hereinafter provided, each applicant for a license shall pay
a fee set by the Board, not to exceed two hundred fifty dollars ($250.00),five
hundred dollars ($500.00), which fee may be prorated by the Board, and
shall show to the satisfaction of the Board that the applicant:
(1) Is a person of good moral character.
(2) Is 18 years of age or older.
(3) Has an education equivalent to a four‑year course in an accredited high school.
…."
SECTION 3. G.S. 135‑48.51(12) reads as rewritten:
"(12) G.S. 58‑50‑30, Right to choose
services of optometrist, podiatrist, licensed clinical social worker,
certified substance abuse professional, licensed professional counselor,
dentist, physical therapist, chiropractor, psychologist, pharmacist, certified
fee‑based practicing pastoral counselor, advanced practice nurse,
licensed marriage and family therapist, or physician assistant.certain
providers."
SECTION 4. This act becomes effective October 1, 2013.
