§ 58-67-70. Coverage for chemical dependency treatment. - North Carolina Statutes

§ 58‑67‑70. Coverage for chemical dependency treatment.

(a)        As used in thissection, the term "chemical dependency" means the pathological use orabuse of alcohol or other drugs in a manner or to a degree that produces animpairment in personal, social or occupational functioning and which may, butneed not, include a pattern of tolerance and withdrawal.

(b)        On and afterJanuary 1, 1985, every health maintenance organization that writes a healthcare plan on a group basis and that is subject to this Article shall offerbenefits for the necessary care and treatment of chemical dependency that arenot less favorable than benefits under the health care plan generally. Exceptas provided in subsection (c) of this section, benefits for chemical dependencyshall be subject to the same durational limits, dollar limits, deductibles, andcoinsurance factors as are benefits under the health care plan generally.

(c)        Every group healthcare plan that provides benefits for chemical dependency treatment and thatprovides total annual benefits for all illnesses in excess of eight thousanddollars ($8,000) is subject to the following conditions:

(1)        The plan shallprovide, for each 12‑month period, a minimum benefit of eight thousanddollars ($8,000) for the necessary care and treatment of chemical dependency.

(2)        The plan shallprovide a lifetime minimum benefit of sixteen thousand dollars ($16,000) forthe necessary care and treatment of chemical dependency for each enrollee.

(d)        Provisions forbenefits for necessary care and treatment of chemical dependency in grouphealth care plans shall provide for benefit payments for the followingproviders of necessary care and treatment of chemical dependency:

(1)        The following unitsof a general hospital licensed under Article 5 of General Statutes Chapter131E:

a.         Chemical dependencyunits in facilities licensed after October 1, 1984;

b.         Medical units;

c.         Psychiatric units;and

(2)        The followingfacilities or programs licensed after July 1, 1984, under Article 2 of GeneralStatutes Chapter 122C:

a.         Chemical dependencyunits in psychiatric hospitals;

b.         Chemical dependencyhospitals;

c.         Residential chemicaldependency treatment facilities;

d.         Social settingdetoxification facilities or programs;

e.         Medicaldetoxification facilities or programs; and

(3)        Duly licensedphysicians and duly licensed practicing psychologists and certifiedprofessionals working under the direct supervision of such physicians orpsychologists in facilities described in (1) and (2) above and in day/nightprograms or outpatient treatment facilities licensed after July 1, 1984, underArticle 2 of General Statutes Chapter 122C.

Provided, however, that nothingin this subsection shall prohibit any plan from requiring the most costeffective treatment setting to be utilized by the person undergoing necessarycare and treatment for chemical dependency.

(e)        Coverage forchemical dependency treatment as described in this section shall not beapplicable to any group that rejects the coverage in writing.

(f)         Notwithstandingany other provision of this section or Article, any health maintenanceorganization subject to this Article that becomes a qualified healthmaintenance organization under Title XIII of the United States Public HealthService Act shall provide the benefits required under that federal Act, whichshall be deemed to constitute compliance with the provisions of this section;and any health maintenance organization may provide that the benefits providedunder this section must be obtained through providers affiliated with thehealth maintenance organization.

(g)        Notwithstanding anyother provisions of this section, a group health benefit plan that covers bothmedical and surgical benefits and chemical dependency treatment benefits shall,with respect to the chemical dependency treatment benefits, comply with allapplicable standards of Subtitle B of Title V of Public Law 110‑343,known as the Paul Wellstone and Pete Domenici Mental Health Parity andAddiction Equity Act of 2008.

(h)        Subsection (g) ofthis section applies only to a group health benefit plan covering a largeemployer as defined in G.S. 58‑68‑25(a)(10).  (1983 (Reg. Sess., 1984), c.1110, s. 9; 1985, c. 589, s. 43(a), (b); 1989, c. 175, s. 3; 1991, c. 720, s.64; 2009‑382, s. 22.)