North Carolina SB 566: Parity Enhancement for Addiction Recovery.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 566

Short Title: Parity Enhancement for Addiction Recovery. (Public)
Sponsors: Senators Meyer, Adcock, and Batch (Primary Sponsors).
Referred to: Rules and Operations of the Senate
March 26, 2025
*S566-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO UPDATE BY CONFORMING TO FEDERAL LAW THE LAWS RELATED TO 2
HEALTH BENEFIT PLAN MENTAL HEALTH BENEFITS COVERAGE AND TO 3
ENHANCE COVERAGE PARITY FOR ADDICTION RECOVERY. 4
The General Assembly of North Carolina enacts: 5
SECTION 1.(a) Subsections (b), (c), (d), and (j) of G.S. 58-3-220 are repealed. 6
SECTION 1.(b) Subsection (h) of G.S. 58-3-220 is recodified as subsection (a1) of 7
G.S. 58-3-220. 8
SECTION 2.(a) G.S. 58-3-220, as amended by Section 1 of this act, reads as 9
rewritten: 10
"§ 58-3-220. Mental illness health benefits coverage. 11
(a) Mental Health Equity Requirement. – Except as provided in subsection (b), an insurer 12
shall provide in each group health benefit plan benefits for All health benefit plans shall provide 13
coverage for the necessary care and treatment of mental illnesses health conditions that are no 14
less favorable than benefits for the necessary care and treatment of physical illness generally, 15
including application of the same limits. For purposes of this subsection, mental illnesses are as 16
diagnosed and defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, or 17
a subsequent edition published by the American Psychiatric Association, except those mental 18
disorders coded in the DSM-5 or subsequent edition as autism spectrum disorder (299.00), 19
substance-related disorders (291.0 through 292.2 and 303.0 through 305.9), those coded as sexual 20
dysfunctions not due to organic disease (302.70 through 302.79), and those coded as "V" codes. 21
For purposes of this subsection, "limits" includes deductibles, coinsurance factors, co-payments, 22
maximum out-of-pocket limits, annual and lifetime dollar limits, and any other dollar limits or 23
fees for covered services.health conditions. 24
(a1) Definitions. – As used The following definitions apply in this section: 25
(1) "Health benefit plan" has the same meaning as Health benefit plan. – As 26
defined in G.S. 58-3-167. 27
(2) "Insurer" has the same meaning as Insurer. – As defined in G.S. 58-3-167. 28
(3) Medical necessity. – As defined in G.S. 58-50-61. 29
(4) "Mental illness" has the same meaning as in G.S. 122C-3(21), with a Mental 30
health condition. – A mental disorder defined in the Diagnostic and Statistical 31
Manual of Mental Disorders, DSM-5, or subsequent editions published by the 32
American Psychiatric Association, except this term does not include those 33
mental disorders coded in the DSM-5 or subsequent editions as autism 34
spectrum disorder (299.00), substance-related disorders (291.0 through 292.9 35

General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 566-First Edition
and 303.0 through 305.9), those coded as sexual dysfunctions not due to 1
organic disease (302.70 through 302.79), and those coded as "V" codes. 2
... 3
(g) Utilization Review. – Nothing in this section prevents an insurer from applying 4
utilization review criteria to determine medical necessity as defined in G.S. 58-50-61 as long as 5
it does so in accordance with all requirements for utilization review programs and medical 6
necessity determinations specified in that section, including the offering of an insurer appeal 7
process and, where applicable, health benefit plan external review as provided for in Part 4 of 8
Article 50 of Chapter 58 of the General Statutes.in accordance with G.S. 58-50-61. Clinical 9
review criteria and assessment of medical necessity for a treatment modality for any mental 10
health condition, including substance use disorders, shall be consistent with the criteria used for, 11
and the manner of assessment applied to, the medical necessity of non-mental health conditions. 12
For substance use disorders, medical necessity determinations shall rely solely on the most recent 13
American Society of Addiction Medicine criteria. 14
(i) Federal Law Applies. – Notwithstanding any other provisions of this section, a group 15
health benefit plan that covers both medical and surgical benefits and mental health benefits shall, 16
with respect to the mental health benefits, comply with all All applicable standards of Subtitle B 17
of Title V of Public Law 110-343, known as the Paul Wellstone and Pete Domenici Mental 18
Health Parity and Addiction Equity Act of 2008, and the applicable regulations, as 19
amended.amended, and other relevant federal law shall apply to health benefit plans." 20
SECTION 2.(b) G.S. 58-50-61 reads as rewritten: 21
"§ 58-50-61. Utilization review. 22
... 23
(d) Program Operations. Clinical Review Criteria, Generally. – In every utilization 24
review program, an insurer or URO shall use documented clinical review criteria that are based 25
on sound clinical e