Healthcare

HB 491 prepares North Carolina's Medicaid program to implement work requirements if authorized by the federal Centers for Medicare and Medicaid Services (CMS). It requires the state's Division of Health Benefits to negotiate with CMS, notify oversight committees within 30 days of starting talks, and submit detailed reports after CMS approves any work requirements plan. The bill does not enact work requirements itself but establishes procedures for future implementation, including timelines for reporting funding needs. This would directly affect current Medicaid recipients if CMS approves work requirements, though the bill is procedural and conditional on federal approval. The legislation is currently in committee review and has not yet become law.

HB 690, "The Citizens Support Act," directs several state and local agencies to ensure that state-funded benefits are provided only to U.S. citizens and noncitizens legally authorized to reside in the United States. The Department of Health and Human Services, Department of Commerce, Housing Finance Agency, and local housing authorities must develop plans to review eligibility criteria and verify the immigration status of applicants for various benefits, including housing, welfare, and medical assistance. State-funded institutions of higher education are required to adopt policies to verify applicants' legal residency for tuition and educational benefits. Additionally, the Division of Employment Security must implement a policy to verify legal residency for unemployment benefit applicants. These agencies are also mandated to report on their implementation progress and any federal laws that prevent them from denying benefits.

HB 567, titled "Ensure Access to Biomarker Testing," mandates that North Carolina health benefit plans provide coverage for biomarker testing for the diagnosis, treatment, and monitoring of various diseases or conditions. This coverage is required when the testing is supported by medical and scientific evidence, such as FDA approval or nationally recognized clinical guidelines. The bill also prohibits insurers from denying coverage, raising premiums, or charging higher rates based on an individual's biomarker information. Additionally, it establishes a 24-hour timeline for insurers to complete utilization reviews for urgent healthcare services, aiming to improve access to diagnostic testing and care for North Carolinians.

HB 297, titled "Breast Cancer Prevention Imaging Parity," aims to ensure equal health insurance coverage for different types of breast cancer imaging. The bill mandates that health benefit plans apply the same cost-sharing requirements (like deductibles and copayments) for diagnostic and supplemental breast examinations, such as MRIs and ultrasounds, as they do for routine screening mammograms. This ensures individuals needing these additional medically necessary tests do not face higher out-of-pocket costs compared to standard screenings. It also maintains existing coverage for cervical cancer screenings and includes provisions for high-deductible health plans.

HB 152 aims to regulate how health benefit plans in North Carolina cover Transcranial Magnetic Stimulation (TMS) services. If an insurer chooses to cover TMS, the bill requires them to cover all procedures performed by properly licensed healthcare providers, regardless of their medical specialty, as long as TMS is within their scope of practice. It prohibits insurers from penalizing providers solely based on their specialty when submitting TMS claims. However, the bill maintains that insurers retain discretion over whether to cover TMS, for which conditions, and at what reimbursement rates.