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GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION LAW 2009-313
HOUSE BILL 535
AN ACT TO REQUIRE HEALTH INSURERS, INCLUDING THE STATE HEALTH PLAN, TO PROVIDE COVERAGE FOR THE DIAGNOSIS AND TREATMENT OF LYMPHEDEMA.
The General Assembly of North Carolina enacts:
SECTION 1. Article 3 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-3-280. Coverage for the diagnosis and treatment of lymphedema.
(a) Every health benefit plan, as defined in G.S. 58-3-167, shall provide coverage for the diagnosis, evaluation, and treatment of lymphedema. The coverage required by this section shall include benefits for equipment, supplies, complex decongestive therapy, gradient compression garments, and self-management training and education, if the treatment is determined to be medically necessary and is provided by a licensed occupational or physical therapist or licensed nurse that has experience providing this treatment, or other licensed health care professional whose treatment of lymphedema is within the professional's scope of practice.
(b) The same deductibles, coinsurance, and other limitations as apply to similar services covered under the health benefit plan apply to coverage for the diagnosis, evaluation, and treatment of lymphedema required to be covered under this section. Nothing in this section requires a health benefit plan to provide a separate set of benefit limitations or maximums for the diagnosis, evaluation, or treatment of lymphedema.
(c) As used in this section, gradient compression garments:
(1) Require a prescription;
(2) Are custom-fit for the covered individual; and
(3) Do not include disposable medical supplies such as over-the-counter compression or elastic knee-high or other stocking products."
SECTION 2. G.S. 135-45 is amended by adding the following new subsection to read:
"(h) The Plan shall provide coverage under its Basic and Standard PPO options for the diagnosis and treatment of lymphedema. The coverage shall be the equivalent of coverage under G.S. 58-3-280."
SECTION 3. This act becomes effective January 1, 2010, and applies to all health benefits plans that are delivered, issued for delivery, or renewed on and after that date.
In the General Assembly read three times and ratified this the 9th day of July, 2009.
s/ Walter H. Dalton
President of the Senate
s/ Joe Hackney
Speaker of the House of Representatives
s/ Beverly E. Perdue
Approved 5:33 p.m. this 17th day of July, 2009