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Statutory Overview in North Carolina

Legislation Signed into Law

2018

Primary Focus: Revises Laws Pertaining to Involuntary Commitment
Title/Description: An Act revising the laws pertaining to involuntary commitment in order to improve the delivery of behavioral health services in North Carolina
Citation: Session Law 2018-33
Summary: Establishes that every LME/MCO shall adopt a community crisis services plan to facilitate first examination in conjunction with a health screening. All plans must: identify one or more facilities where a respondent must be taken for a first examination by a commitment examiner; identify persons designated to be responsible for transportation; and identify training for law enforcement personnel who provide custody of involuntary commitment individuals. This Act requires health screenings for individuals in crisis to rule out symptoms that may be mistaken for psychiatric conditions. Act further expands the workforce to allow nurse practitioners, licensed professional counselors, and physician assistants licensed to diagnose mental illness to conduct first examinations.
Effective Date: June 22, 2018
Notes: Enacted from Senate Bill 630 introduced during the General Assembly of North Carolina Session 2017.

2015-2016

Primary Focus: Access to Services
Title/Description: No discrimination against mentally ill or chemically dependent individuals.
Citation: N.C. Gen. Stat. § 58-51-55
Summary: Section 58-51-55(a) was rewritten to amend the definitions of mental illness and chemical dependency.
Does not require coverage for chemical dependency or sex changes.
Applies only to group health insurance contracts.
Effective Date: October 15, 2015
Notes: Amended by N.C. SB 676.

Primary Focus: Access to Services
Title/Description: No discrimination against mentally ill or chemically dependent individuals.
Citation: N.C. Gen. Stat. § 58-67-75
Summary: Section 58-67-75(a) was rewritten to amend the definitions of mental illness and chemical dependency.
Does not require coverage for chemical dependency or sex changes.
Applies only to group contracts.
Effective Date: October 15, 2015
Notes: Amended by N.C. SB 676.

Primary Focus: Access to Services
Title/Description: No discrimination against mentally ill or chemically dependent individuals.
Citation: N.C. Gen. Stat. § 58-65-90
Summary: Section 58-65-90(a) was rewritten to amend the definitions of mental illness and chemical dependency.
Effective Date: October 15, 2015
Notes: Amended by N.C. SB 676.

Primary Focus: Parity, Access to Services
Title/Description: Mental illness benefits coverage.
Citation: N.C. Gen. Stat. § 58-3-220
Summary: Section 58-3-220 was rewritten to amend the definitions of mental illness and chemical dependency.
Effective Date: October 15, 2015
Notes: Amended by N.C. SB 676.

Primary Focus: Access to Services
Title/Description: Coverage for autism spectrum disorder.
Citation: N.C. Gen. Stat. § 58-3-192
Summary: A health benefit plans shall provide coverage for the screening, diagnosis, and treatment of autism spectrum disorder in accordance with the standards contained in Subtitle B of Title V of Public Law 110-343, known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, and the applicable regulations, as amended.
Effective Date: October 15, 2015
Notes: Amended by N.C. SB 676.

2013-2014

Primary Focus: Access to Services
Title/Description: Office of Rural Health to oversee and monitor establishment and administration of statewide telepsychiatry program.
Citation: N.C. Gen. Stat. § 143B-139.4B
Summary: Establishes a statewide telepsychiatry program that allows referring sites to utilize consulting providers at a consultant site to provide timely psychiatric assessment and rapid initiation of treatment for patients at the referring site experiencing an acute mental health or substance abuse crisis.
Effective Date: July 26, 2013
Notes: Enacted by N.C. SB 402.

2011-2012

SB 323/HB 298
Introduced: 3/2011
Sponsor: Sen. Apodaca and Rep. Dockham
Status: Became law without Governor’s signature 5/2011
Summary: This bill changed the state law so that it now requires the health insurance plan for state employees and public school teachers to use deductibles, coinsurance, annual limits, and lifetime limits for behavioral health services that are the same as those used for other medical services.

2009-2010

Primary Focus: Access to Services
Title/Description: Coverage for chemical dependency treatment.
Citation: N.C. Gen. Stat. § 58-51-50
Summary: Every insurer that writes a policy or contract of group or blanket health insurance or group or blanket accident and health insurance, shall offer to its insureds benefits for the necessary care and treatment of chemical dependency that are not less favorable than benefits for physical illness generally. Benefits for treatment of chemical dependency shall be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as are benefits for physical illness generally.
A group health benefit plan that covers both medical and surgical benefits and chemical dependency treatment benefits shall, with respect to the chemical dependency treatment benefits, comply with all applicable standards of Subtitle B of Title V of Public Law 110-343, known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Effective Date: July 31, 2009
Notes: Amended by N.C. HB 1183.

Primary Focus: Access to Services
Title/Description: Coverage for chemical dependency treatment.
Citation: N.C. Gen. Stat. § 58-65-75
Summary: Every group insurance certificate or group subscriber contract under any hospital or medical plan, shall offer to its insureds benefits for the necessary care and treatment of chemical dependency that are not less favorable than benefits for physical illness generally. Benefits for chemical dependency shall be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as are benefits for physical illness generally.
A group health benefit plan that covers both medical and surgical benefits and chemical dependency treatment benefits shall, with respect to the chemical dependency treatment benefits, comply with all applicable standards of Subtitle B of Title V of Public Law 110-343, known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Effective Date: July 31, 2009
Notes: Amended by N.C. HB 1183.

Primary Focus: Access to Services
Title/Description: Coverage for chemical dependency treatment.
Citation: N.C. Gen. Stat. § 58-67-70
Summary: Every health maintenance organization that writes a health care plan on a group basis, shall offer benefits for the necessary care and treatment of chemical dependency that are not less favorable than benefits under the health care plan generally. Benefits for chemical dependency shall be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as are benefits under the health care plan generally.
A group health benefit plan that covers both medical and surgical benefits and chemical dependency treatment benefits shall, with respect to the chemical dependency treatment benefits, comply with all applicable standards of Subtitle B of Title V of Public Law 110-343, known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
Effective Date: July 31, 2009
Notes: Amended by N.C. HB 1183

North Carolina Parity Law

There are two sections in the state insurance law about parity. One section applies to mental health conditions, and another section applies to substance use disorders. There is also a section in the state law for state employees that is relevant to parity.

There is another section that forbids plans from discriminating against people with behavioral health conditions in their physical health treatment.

Mental Health

This section of the law applies to large employer fully-insured plans and small employer fully-insured plans.

This section requires plans to use financial requirements, annual maximums, and lifetime maximums for mental health services that are “no less favorable” than those used for other medical services. However, if plans use many different forms of these for varying physical health services, the Commissioner of the North Carolina Department of Insurance may use a mathematical formula (pdf | Get Adobe® Reader®) to determine what they should be for mental health treatment.

For treatment of the following conditions, annual limits have to be the same as those used for treatment of other medical conditions:

  • Bipolar Disorder
  • Major Depressive Disorder
  • Obsessive Compulsive Disorder
  • Paranoid and Other Psychotic Disorder
  • Schizoaffective Disorder
  • Schizophrenia
  • Post-Traumatic Stress Disorder
  • Anorexia Nervosa
  • Bulimia

For all other mental health conditions in the DSM (except for substance use disorders), plans must cover 30 office visits for outpatient care and 30 days of inpatient care or a combination of inpatient care and outpatient care that could be measured in days (like partial hospitalization ).

This section also requires large employer fully-insured plans to comply with the Federal Parity Law.

Substance Use Disorders

This section requires large employer fully-insured plans and small employer fully-insured plans to offer optional coverage for substance use disorder services. Employers are not required to choose a plan that includes this coverage.

The section requires that plans use annual limits, deductibles, and coinsurance for substance use disorder services that “not less favorable” than those used for other medical services.

Plans are required to have an annual maximum of at least $8,000 and a lifetime maximum of $16,000.

Large employer fully-insured plans are required to comply with the Federal Parity Law.

State Employees

This section requires the health insurance plan for state employees and public school teachers to use deductibles, coinsurance, annual limits, and lifetime limits for behavioral health services that are the same as those used for other medical services.

Non-Discrimination in Physical Health

This section forbids large employer fully-insured plans and small employer fully-insured plans from covering physical health services for a person with a behavioral health condition differently than they would for people without behavioral health conditions. Plans cannot do the following:

  • Deny medical coverage to a person with a behavioral health condition
  • Charge higher premiums to a person with a behavioral health condition
  • Reduce physical illness coverage to a person with a behavioral health condition

Get Support

North Carolina Insurance Division

Common Violations

In seeking care or services, be aware of the common ways parity rights can be violated.

Common Violations

Definition

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