Bill Text: NC S248 | 2013-2014 | Regular Session | Chaptered
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-Chaptered.html
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2013
SESSION LAW 2013-296
SENATE BILL 248
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(a) Repealed by Session Laws 2001‑297, s. 1, effective January 1, 2001.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 under Chapter 93D of the General Statutes to engage in fitting or selling hearing aids. For purposes of this subdivision, the term "fitting and selling hearing aids" has the same meaning as defined in G.S. 93D-1.
(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.
In the General Assembly read three times and ratified this the 11th day of July, 2013.
s/ Daniel J. Forest
President of the Senate
s/ Thom Tillis
Speaker of the House of Representatives
s/ Pat McCrory
Governor
Approved 6:17 p.m. this 18th day of July, 2013
