Part I. Improve Access to Prosthetic and Orthotic Devices
Section 1
Amends Article 3 of Chapter 58, which regulates insurance offered in North Carolina, by adding a new section, GS 58-3-286, regarding the coverage of prosthetic and orthotic devices.
New GS 58-3-286 applies to all health benefit plans offered in the State except Small Employer Group Health Insurance and Multiple Employer Welfare Arrangements. Requires coverage by these health benefits plans for all prosthetic and orthotic devices required to be covered under Medicare Part B. Requires coverage by applicable health benefit plans for prosthetic and orthotic devices deemed by the insured’s healthcare provider as adequate for completing activities of daily living, essential job-related activities, and meeting the medical needs of the insured for performing physical exercise and maximizing the insured’s whole-body function. Coverage extends to custom devices and shall not be limited to one prosthetic or orthotic device. Coverage is required for replacement of a prosthetic or orthotic device, or a part thereof, and including custom devices, if the prescribing healthcare provider determines the replacement is necessary for specified reasons, such as a physiological change in the insured’s condition, and the insurer may require confirmation from the prescribing healthcare provider if the device being replaced is less than 3 years old.
By February 1, 2028, applicable health benefits plans must report the number and value of claims paid pursuant to GS 58-3-286 to the Commissioner of the Department of Insurance.
By March 1, 2028, the Commissioner of Department of Insurance must aggregate data from applicable health benefits plans and provide it to the Joint Legislative Oversight Committee on General Government and the Joint Legislative Oversight Committee on Health and Human Services.
Effective October 1, 2025, and applies to the earlier of (1) insurance contracts issued, renewed, or amended on or after October 1, 2025, or (2) upon the next yearly anniversary of the insurance contract date occurring after October 1, 2025.
Part II. Repeal State Health Benefit Plan Requirement re Emergency Care Duplicative of Federal Law
Section 2
Repeals GS 58-3-190, entitled Coverage required for emergency care.
Removes reference to GS 58-3-190 in GS 58-50-56.1(a)(1), entitled Exclusive provider benefit plan.
Removes reference to GS 58-3-190 in GS 58-50-61(a)(13), entitled “Noncertification,” and substitutes a reference to the federal Emergency Medical Treatment and Labor Act, 42 USC 1395dd.
Rewrites GS 58-50-61(a)(17)g.
Removes reference to GS 58-3-190 in GS 58-50-61(a)(17)g, entitled Retrospective review, and substitutes a reference to the federal Emergency Medical Treatment and Labor Act, 42 USC 1395dd.
Repeals GS 108D-65(6)f.1., removing emergency care from the terms for contracts required for Prepaid Health Plans (PHPs) of Medicaid Managed Care Programs.

Statutes affected:
Filed: 108D-65
Edition 1: 108D-65