HB 152

Enacts new GS 58-3-254 requiring insurers offering a health benefit plan in North Carolina that provides coverage for transcranial magnetic stimulation (as defined) to provide coverage for those procedures performed by a healthcare facility or properly licensed healthcare provider for whom ordering, performing, and supervising the treatment of depression and other mental disorders is within their scope of practice. Prohibits plans from penalizing any properly licensed healthcare provider or healthcare facility that properly submits a claim for services related to transcranial magnetic stimulation based on the medical specialty of the healthcare provider or healthcare facility submitting the claim. Adds that it is within the discretion of each insurer offering a health benefit plan in the State that provides coverage for transcranial magnetic stimulation to determine: (1) whether to cover transcranial magnetic stimulation procedures, (2) indications for which transcranial magnetic stimulation procedures must be covered, (3) requirements for coverage for transcranial magnetic stimulation procedures, and (4) reimbursement rates for transcranial magnetic stimulation procedures. Directs that reimbursement rates that differ based on the following are allowed and not considered to be a prohibited penalty: (1) a healthcare provider's participation or lack of participation in an insurer's network; (2) the location where the transcranial magnetic stimulation services are provided; or (3) the level of training, certification, or education of the healthcare provider, within that provider's medical specialty, that has provided the transcranial magnetic stimulation services. Specifies the penalties prohibited under the statute. Amends GS 135-48.51 by making new GS 58-3-254 applicable to the State Health Plan, but specifies that it is the Plan’s discretion to determine all aspects of transcranial magnetic stimulation under GS 58-3-254(b). Applies to insurance contracts issued, renewed, or amended on or after October 1, 2025.