North Carolina Legislation

S383/H477 requires the Department of Health and Human Services to design a plan to expand Medicaid coverage to include ambulance transport of Medicaid recipients in behavioral health crisis to behavioral health clinics or other appropriate treatment settings. The plan must include that reimbursement is contingent upon the EMS system’s ability to demonstrate that EMS providers have received appropriate education in caring for individuals in behavioral health crisis and that the EMS System has at least one partnership with a receiving facility. Additionally, the plan must include, among other information: a requirement for the EMS System Plan to include a report on patient experiences and outcomes; a proposed reimbursement methodology; whether the department intends to add the coverage or will need additional appropriations to do so; and an analysis of the financial impact of adding this coverage, including any anticipated costs to the Medicaid program.

H631 requires the Department of Health and Human Services to establish a workgroup to consider current administrative requirements imposed upon mental health, intellectual/developmental disability, and substance use disorder providers and how best to integrate these requirements with similar administrative requirements for physical health providers to avoid duplication and enhance efficiency. Categories of requirement include documentation, claims processing, reporting, etc. During the examination, the workgroup must identify the federal or State entity that created each requirement and consider any requirement that is not federally mandated, exceeds what is required for physical health, does not add value to the delivery of behavioral health services, and/or is unable to be incorporated into standard electronic health records or does not align with meaningful use of electronic health records.
The workgroup must provide to the Joint Legislative Oversight Committee on Health and Human Services, the Joint Legislative Oversight Committee a report that details their findings and recommendations regarding whether a requirement should remain, be eliminated, or redesigned Medicaid and NC Health Choice, and the Fiscal Research Division.

• Requires large employer fully-insured plans and small employer fully-insured plans to cover autism services
• Services for autism include habilitative services, pharmacy care, psychiatric care, psychological care, and therapeutic care
• Requires plans to cover 40 hours per week of “habilitative services” for children through age 18
• Defines habilitative services as physical and occupational therapy, speech-language therapy, speech/swallowing therapy, applied behavior analysis, medical equipment, orthotics and prosthetics, that help a person keep, learn, or improve skills and functioning for daily living
• Defines autism spectrum as it’s defined in the DSM or ICD
• Deductibles, copayments, and coinsurance must be “no less favorable” than those used for other medical services

• Requires large employer fully-insured plans to cover autism services through age 23
• Services for autism include behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care
• Requires an annual maximum of $36,000 for behavioral health treatment (applied behavior analysis )
• Defines autism spectrum as it’s defined in the DSM or ICD
• Forbids plans from using any annual limits on outpatient autism services
• Deductibles, copayments, and coinsurance must be “no less favorable” than those used for other medical services
• Allows plans to review a child’s treatment plan once a year
• Allows plans to apply for an exemption if providing coverage for autism raises premium costs by 1%

• Requires large employer fully-insured plans and the state health plan for public school teachers and state employees to cover autism services through age 23
• Services for autism include behavioral health treatment, pharmacy care, psychiatric care, psychological care, and therapeutic care
• Requires an annual maximum of $36,000 for behavioral health treatment (applied behavior analysis )
• Defines autism spectrum as it’s defined in the DSM or ICD
• Forbids plans from using any annual limits on outpatient autism services
• Deductibles, copayments, and coinsurance must be “no less favorable” than those used for other medical services
• Allows plans to review a child’s treatment plan once a year
• Allows plans to apply for an exemption if providing coverage for autism raises premium costs by 1%
• Requires the Department of the Treasurer to submit an annual report about those covered by the state plan for public school teachers and state employees that lists the number of individuals with autism, the cost per year, the cost per month, and the cost per person of applied behavior analysis

Among many other things, this bill tried to change the section of state law about health insurance plan for state employees and public school teachers so that the plan would be required to use deductibles, coinsurance, annual limits, and lifetime limits for behavioral health services that are the same as those used for other medical services. This identical subsection is found in SB 323/HB 298, which became law and is from the same legislative session (listed above).

• Requires large employer fully-insured plans, small employer fully-insured plans, individual plans, and the state health plan for public school teachers and state employees to cover autism services
• Services for autism include behavioral care, pharmacy care, psychiatric care, psychological care, and therapeutic care
• Requires an annual maximum of $75,000 for behavioral therapy (applied behavior analysis)
• Defines autism spectrum as it’s defined in the DSM or ICD
• Forbids plans from using any annual limits on outpatient autism services
• Deductibles, copayments, and coinsurance must be “no less favorable” than those used for other medical services
• Allows plans to review a child’s treatment plan once a year

• Requires large employer fully-insured plans, small employer fully-insured plans, individual plans, and the state health plan for public school teachers and state employees to cover autism services
• Services for autism include behavioral care, pharmacy care, psychiatric care, psychological care, and therapeutic care
• Requires an annual maximum of $75,000 for behavioral therapy (applied behavior analysis)
• Defines autism spectrum as it’s defined in the DSM or ICD
• Forbids plans from using any annual limits on outpatient autism services
• Deductibles, copayments, and coinsurance must be “no less favorable” than those used for other medical services
• Allows plans to review a child’s treatment plan once a year