North Carolina 2019-2020 Session Status: Passed Senate

SB 432 — Birth Center & Pharm Benefits Mgr. Licensure.

Last action — Conf Com Reported

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2019-2020 Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there are no live odds of enactment. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

690 added · 647 removed

Plain-language change summary

The amendment to Bill SB 432 introduces regulations for birth centers and pharmacy benefits managers while removing content related to the classification of mini-trucks. Specifically, it establishes a licensure process for birth centers, ensuring they meet safety standards, and sets guidelines for insurance companies regarding the coverage of medications, particularly those with warnings. This change is significant as it aims to enhance health and safety for mothers and newborns and improve access to necessary medications without unnecessary delays.

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GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2019 S 3 SENATE BILL 432* House Committee Substitute Favorable 8/13/19 House Committee Substitute #2 Favorable 9/11/19 Short Title:
GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2019 S 4 SENATE BILL 432* House Committee Substitute Favorable 8/13/19 House Committee Substitute #2 Favorable 9/11/19 House Committee Substitute #3 Favorable 10/22/19 Short Title:
April 1, 2019 A BILL TO BE ENTITLED AN ACT TO ESTABLISH A LICENSURE PROCESS AND ANNUAL LICENSE FEES FOR BIRTH CENTERS AND TO ESTABLISH STANDARDS AND CRITERIA FOR THE REGULATION AND LICENSURE OF PHARMACY BENEFITS MANAGERS PROVIDING CLAIMS PROCESSING SERVICES OR OTHER PRESCRIPTION DRUG OR DEVICE SERVICES FOR HEALTH BENEFIT PLANS.
April 1, 2019 A BILL TO BE ENTITLED AN ACT TO ESTABLISH A LICENSURE PROCESS AND ANNUAL LICENSE FEES FOR BIRTH CENTERS AND TO ESTABLISH STANDARDS AND CRITERIA FOR THE REGULATION AND LICENSURE OF PHARMACY BENEFITS MANAGERS PROVIDING CLAIMS PROCESSING SERVICES OR OTHER PRESCRIPTION DRUG OR DEVICE SERVICES FOR HEALTH BENEFIT PLANS, TO PREVENT INSURERS FROM REQUIRING INSUREDS TO TAKE DRUGS WITH BLACK BOX WARNINGS, AND TO REQUIRE INSURERS TO PROVIDE COVERAGE FOR PRESCRIPTION DRUGS DURING THE PREAUTHORIZATION PROCESS.
9 PART I.
PART I.
– A normal, uncomplicated prenatal course as determined by documentation of adequate prenatal care and the anticipation of a normal, uncomplicated labor and birth, as defined by reasonable and generally accepted criteria adopted by professional groups for maternal, fetal, and neonatal health care, and generally accepted by the health care providers to whom they apply.
– A normal, uncomplicated prenatal course as determined by documentation of adequate prenatal care and the anticipation of a normal, uncomplicated labor and birth, as defined by reasonable and generally accepted criteria adopted by professional groups for maternal, fetal, *S432-v-4* General Assembly Of North Carolina Session 2019 and neonatal health care, and generally accepted by the health care providers to whom they apply.
*S432-v-3* General Assembly Of North Carolina Session 2019 Every three years, the Department shall review and, as necessary, revise the Freestanding Birth Center Fee Schedule to ensure that (i) the fees are sufficient to cover the costs of providing intrapartum, birth, postpartum, and initial newborn care and (ii) the cost for any State-mandated newborn screening is reimbursed at no less than the cost of the screening.
Every three years, the Department shall review and, as necessary, revise the Freestanding Birth Center Fee Schedule to ensure that (i) the fees are sufficient to cover the costs of providing intrapartum, birth, postpartum, and initial newborn care and (ii) the cost for any State-mandated newborn screening is reimbursed at no less than the cost of the screening.
a.
Page 2 Senate Bill 432*-Fourth Edition General Assembly Of North Carolina Session 2019 a.
Page 2 Senate Bill 432*-Third Edition General Assembly Of North Carolina Session 2019 b.
b.
(2) Risk status.
Senate Bill 432*-Fourth Edition Page 3 General Assembly Of North Carolina Session 2019 (2) Risk status.
Senate Bill 432*-Third Edition Page 3 General Assembly Of North Carolina Session 2019 (3) Second trimester ultrasound.
(3) Second trimester ultrasound.
(1) The name of the applicant.
Page 4 Senate Bill 432*-Fourth Edition General Assembly Of North Carolina Session 2019 (1) The name of the applicant.
Page 4 Senate Bill 432*-Third Edition General Assembly Of North Carolina Session 2019 (3) Documentation that the birth center meets the licensure standards adopted by the Commission pursuant to G.S.
(3) Documentation that the birth center meets the licensure standards adopted by the Commission pursuant to G.S.
(4) No vaginal birth after cesarean (VBAC) or trial of labor after cesarean (TOLAC) may be performed." Senate Bill 432*-Third Edition Page 5 General Assembly Of North Carolina Session 2019 SECTION 1.(c) Part 4A of Article 6 of Chapter 131E of the General Statutes is amended by adding a new section to read:
Senate Bill 432*-Fourth Edition Page 5 General Assembly Of North Carolina Session 2019 (4) No vaginal birth after cesarean (VBAC) or trial of labor after cesarean (TOLAC) may be performed." SECTION 1.(c) Part 4A of Article 6 of Chapter 131E of the General Statutes is amended by adding a new section to read:
Each day of continuing violation after conviction is considered a separate offense." SECTION 1.(d) ByOctober 1, 2019, the Department of Health and Human Services shall review and, as necessary, revise its current Freestanding Birth Center Fee Schedule to ensure that (i) the fees are sufficient to cover the costs of providing intrapartum, birth, postpartum, and initial newborn care and (ii) the cost for any State-mandated newborn screening is reimbursed at no less than the cost of the screening.
Each day of continuing violation after conviction is considered a separate offense." SECTION 1.(d) By December 1, 2019, the Department of Health and Human Services shall review and, as necessary,reviseits current Freestanding Birth CenterFeeSchedule to ensure that (i) the fees are sufficient to cover the costs of providing intrapartum, birth, postpartum, and initial newborn care and (ii) the cost for any State-mandated newborn screening is reimbursed at no less than the cost of the screening.
Except as otherwise provided, this act is effective when it becomes law.
Except as otherwise provided, this part is effective when it becomes law.
a.
Page 6 Senate Bill 432*-Fourth Edition General Assembly Of North Carolina Session 2019 a.
Page 6 Senate Bill 432*-Third Edition General Assembly Of North Carolina Session 2019 b.
b.
This definition specifically excludes the State Health Plan for Teachers and State Employees.G.S.
This definition specifically excludes the State Health Plan for Teachers and State Employees.An accident and health insurance policy or certificate;
58-3-167.
a nonprofit hospital or medical service corporation contract;
a health maintenance organization subscriber contract;
a plan provided by a multiple employer welfare arrangement;
a plan provided by another benefit arrangement, to the extent permitted by the Employee Retirement Income Security Act of 1974, as amended, or by any waiver of or other exception to that act provided under federal law or regulation;
or any plan implemented or administered by the State Health Plan for Teachers and State Employees.
"Health benefit plan" does not mean any plan implemented or administered by the North Carolina or United States Department of Health and Human Services, or any successor agency, or its representatives.
"Health benefit plan" does not mean any plan consisting of one or more of any combination of benefits described in G.S.
58-68-25(b).
(11) Pharmacist services.
Senate Bill 432*-Fourth Edition Page 7 General Assembly Of North Carolina Session 2019 (11) Pharmacist services.
Senate Bill 432*-Third Edition Page 7 General Assembly Of North Carolina Session 2019 (14) Pharmacybenefits manageraffiliate.
(14) Pharmacybenefits manageraffiliate.
The description must provide details setting forth the PBM's capability to provide a sufficient number of experienced and qualified personnel in the areas of claims processing, record keeping, and underwriting.
The description must provide details setting forth the PBM's capability to provide Page 8 Senate Bill 432*-Fourth Edition General Assembly Of North Carolina Session 2019 a sufficient number of experienced and qualified personnel in the areas of claims processing, record keeping, and underwriting.
Page 8 Senate Bill 432*-Third Edition General Assembly Of North Carolina Session 2019 (c) Each applicant shall make available for inspection by the Commissioner copies of all contracts with insurers or other persons using the services of the PBM.
(c) Each applicant shall make available for inspection by the Commissioner copies of all contracts with insurers or other persons using the services of the PBM.
(2) The fee may not be reimbursed by the health benefit plan, insurer, or PBM.
Senate Bill 432*-Fourth Edition Page 9 General Assembly Of North Carolina Session 2019 (2) The fee may not be reimbursed by the health benefit plan, insurer, or PBM.
(c1) To the extent allowable under federal and State law, when calculating an insured's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health benefit plan, an insurer shall include any amounts paid by the insured or paid on behalf of the insured by another person.
(c1) When calculating an insured's contribution to any out-of-pocket maximum, deductible, copayment, coinsurance, or any other cost-sharing requirement, the insurer or PBM shall include any cost-sharing amount paid by the insured or on the insured's behalf for a prescription drug that is either of the following:
(d) Any contract for the provision of a network to deliver health care services between a pharmacy benefits manager PBM and insurer shall be made available for review by the Department.Department and shall disclose all incentives, discounts, and rebates received by the PBM and the entities who benefit from the incentives, discounts, and rebates, including amounts Senate Bill 432*-Third Edition Page 9 General Assembly Of North Carolina Session 2019 retained by the PBM, whether in the form of money, reduction in costs, or any other benefit to the PBM.
(1) Without an AB-rated generic equivalent.
(2) With an AB-rated generic equivalent if the insured has obtained authorization for the drug through any of the following:
a.
Prior authorization from the insurer or PBM.
b.
A step therapy protocol.
c.
The exception or appeal process of the insurer or PBM.
(c2) For purposes of this section, the term "generic equivalent" means a drug that has an identical amount of the same active ingredients in the same dosage form;
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meets applicable standards of strength, quality, and purity according to the United States Pharmacopeia or other nationally recognized compendium;
and which, if administered in the same amount, would provide comparable therapeutic effects.
For purposes of this section, the term "generic equivalent" does not include a drug that is listed by the United States Food and Drug Administration as having unresolved bioequivalence concerns according to the Administration's most recent publication of approved drug products with therapeutic equivalence evaluations.
(d) Any contract for the provision of a network to deliver health care services between a pharmacy benefits manager PBM and insurer shall be made available for review by the Department.Department and shall disclose all incentives, discounts, and rebates received by the PBM and the entities who benefit from the incentives, discounts, and rebates, including amounts retained by the PBM, whether in the form of money, reduction in costs, or any other benefit to the PBM.
(e) A PBM shall not penalize or retaliate against a pharmacist or pharmacy for exercising rights provided under this Article.
Page 10 Senate Bill 432*-Fourth Edition General Assembly Of North Carolina Session 2019 (e) A PBM shall not penalize or retaliate against a pharmacist or pharmacy for exercising rights provided under this Article.
(2) Theoriginalclaimpaymentwasincorrectbecausethepharmacyor pharmacist had already been paid for the pharmacist services.
(2) Theoriginalclaimpaymentwasincorrectbecausethepharmacyorpharmacist had already been paid for the pharmacist services.
A review of the maximum allowable cost prices for removal or modification shall be completed by the pharmacy benefits manager PBM at least once every seven business days, and any removal or modification shall occur within seven business days of Page 10 Senate Bill 432*-Third Edition General Assembly Of North Carolina Session 2019 the review.
A review of the maximum allowable cost prices for removal or modification shall be completed by the pharmacy benefits manager PBM at least once every seven business days, and any removal or modification shall occur within seven business days of the review.
If the appeal is upheld, the PBM shall notify the pharmacy or pharmacist, or designee, of the decision, make the change in the maximumallowablecosteffectiveas ofthedatetheappeal is resolved, permit the appealing pharmacy or pharmacist to reverse and rebill the claim in question, and make the change effective for each similarly situated pharmacy, as defined by the payer subject to the maximum allowable cost list, effective as of the date the appeal is resolved.
If the appeal is upheld, the PBM shall notify the pharmacy or pharmacist, or designee, of the decision, make the change in the Senate Bill 432*-Fourth Edition Page 11 General Assembly Of North Carolina Session 2019 maximumallowablecosteffectiveas ofthedatetheappeal is resolved, permit the appealing pharmacy or pharmacist to reverse and rebill the claim in question, and make the change effective for each similarly situated pharmacy, as defined by the payer subject to the maximum allowable cost list, effective as of the date the appeal is resolved.
(1) A PBM may not impose a fee on a pharmacy, or otherwise penalize the pharmacy, if the pharmacy's scores or metrics fall within the criteria identified Senate Bill 432*-Third Edition Page 11 General Assembly Of North Carolina Session 2019 by a nationally recognized entity aiding in improving pharmacy performance measures.
(1) A PBM may not impose a fee on a pharmacy, or otherwise penalize the pharmacy, if the pharmacy's scores or metrics fall within the criteria identified by a nationally recognized entity aiding in improving pharmacy performance measures.
(a) The Commissioner may make an examination of the affairs of any PBM pursuant to the services that it provides for an insurer or a health benefit plan that are relevant to determining if the PBM is in compliance with this Article.
Page 12 Senate Bill 432*-Fourth Edition General Assembly Of North Carolina Session 2019 (a) The Commissioner may make an examination of the affairs of any PBM pursuant to the services that it provides for an insurer or a health benefit plan that are relevant to determining if the PBM is in compliance with this Article.
(3) The PBM has refused to be examined or to produce its accounts, records, and files for examination, or any of its officers has refused to give information Page 12 Senate Bill 432*-Third Edition General Assembly Of North Carolina Session 2019 with respect to its affairs or has refused to perform any other legal obligation as to that examination, when required by the Commissioner.
(3) The PBM has refused to be examined or to produce its accounts, records, and files for examination, or any of its officers has refused to give information with respect to its affairs or has refused to perform any other legal obligation as to that examination, when required by the Commissioner.
The order shall be effective on the date specified in the order or on service of the certified copy of the order at the last known address of the licensee, whichever is later, and shall remain effective during the proceedings.
The order shall be effective on the date specified in the order or on Senate Bill 432*-Fourth Edition Page 13 General Assembly Of North Carolina Session 2019 service of the certified copy of the order at the last known address of the licensee, whichever is later, and shall remain effective during the proceedings.
SECTION 3.5.(a) Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:
"§ 58-3-222.
Prescription drug patient protections.
(a) If an insurer offers coverage for prescription drugs, it shall not require any insured to take any drug with a boxed warning as defined in 21 C.F.R.
§ 201.57.
(b) If an insurer offers coverage for prescription drugs and requires preauthorization as a condition to providing coverage for a drug, that insurer shall provide immediate coverage for the drugduringtheperiodof time it takes theinsurerto conduct thepreauthorizationreview.
Nothing in this subsection shall be construed to require an insurer to approve a drug undergoing a preauthorization review." SECTION 3.5.(b) This section becomes effective October 1, 2020, and applies to insurance contracts issued, renewed, or amended on or after that date.
Senate Bill 432*-Third Edition Page 13
Page 14 Senate Bill 432*-Fourth Edition
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Action History

  1. Conf Com Reported

  2. Placed on Today's Calendar

  3. Conf Report Adopted

  4. Conferees Changed

  5. Conf Com Dismissed

  6. Conferees Reappointed

  7. Conferees Changed

  8. Conf Com Appointed

  9. Failed Concur In H Com Sub

  10. Conf Com Appointed

  11. Regular Message Received For Concurrence in H Com Sub

  12. Ref To Com On Rules and Operations of the Senate

  13. Withdrawn From Com

  14. Placed On Cal For 10/29/2019

  15. Regular Message Sent To Senate

  16. Amend Failed A1

  17. Amend Failed A2

  18. Passed 3rd Reading

  19. Reptd Fav Com Sub 3

  20. Cal Pursuant Rule 36(b)

  21. Added to Calendar

  22. Passed 2nd Reading

  23. Reptd Fav Com Sub 2

  24. Re-ref Com On Rules, Calendar, and Operations of the House

  25. Reptd Fav Com Substitute

  26. Re-ref Com On Finance

  27. Serial Referral To Rules, Calendar, and Operations of the House Stricken

  28. Serial Referral To Finance Added

  29. Serial Referral To Rules, Calendar, and Operations of the House Added

  30. Withdrawn From Com

  31. Re-ref to the Com on Health, if favorable, Rules, Calendar, and Operations of the House

  32. Passed 1st Reading

  33. Ref To Com On Rules, Calendar, and Operations of the House

  34. Regular Message Sent To House

  35. Regular Message Received From Senate

  36. Passed 2nd Reading

  37. Passed 3rd Reading

  38. Reptd Fav

  39. Reptd Fav

  40. Re-ref Com On Rules and Operations of the Senate

  41. Reptd Fav

  42. Re-ref Com On Finance

  43. Withdrawn From Com

  44. Re-ref to Transportation. If fav, re-ref to Finance. If fav, re-ref to Rules and Operations of the Senate

  45. Passed 1st Reading

  46. Ref To Com On Rules and Operations of the Senate

  47. Filed

Sponsors

  • Ballard · Cosponsor

Sponsorship breakdown

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0 sponsors · 1 co-sponsors · 178 not signed on · 23 voted No

Sponsors (0)

None.

Co-sponsors (1)

  • Ballard

Not signed on (178)

178 members have not signed on to this bill.

Show all 178 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Conference Rpt Motion 8 To Adopt

Passed 28 Yea · 10 Nay · 12 Other
Party YeaNayPresentNot Voting
Democratic 1602
Unaffiliated 16408
Republican 11002
Total 2810012
% of votes cast 56%20%0%24%
How each member voted (50)
Member Party Vote
deViere — Yea
Smith — Yea
Woodard — Yea
Ballard — Yea
Brown — Yea
J. Davis — Yea
Edwards — Yea
Gallimore — Yea
Gunn — Yea
Harrington — Yea
Horner — Yea
Johnson — Yea
Krawiec — Yea
Newton — Yea
Perry — Yea
Steinburg — Yea
Fitch — Nay
Nickel — Nay
Foushee — Not Voting
Marcus — Not Voting
Peterson — Not Voting
Searcy — Not Voting
VanDuyn — Not Voting
Bryan — Not Voting
Tillman — Not Voting
Wells — Not Voting
D. Davis — Nay
J. Jackson — Nay
Dan Blue Democratic Nay
Gladys A. Robinson Democratic Not Voting
Jay J. Chaudhuri Democratic Nay
Joyce Waddell Democratic Nay
Michael Garrett Democratic Nay
Mujtaba A. Mohammed Democratic Not Voting
Natalie S. Murdock Democratic Nay
Paul A. Lowe, Jr. Democratic Nay
Tracy Clark Democratic Yea
Bill Rabon Republican Yea
Brent Jackson Republican Yea
Carl Ford Republican Not Voting
Danny Earl Britt, Jr. Republican Not Voting
Jim Burgin Republican Yea
Norman W. Sanderson Republican Yea
Phil Berger Republican Yea
Ralph Hise Republican Yea
Tom McInnis Republican Yea
Vickie Sawyer Republican Yea
W. Ted Alexander Republican Yea
W. Ted Alexander Republican Yea
Warren Daniel Republican Yea

Official roll call →

Motion 9 To Concur

Failed 0 Yea · 49 Nay · 1 Other
Party YeaNayPresentNot Voting
Democratic 0800
Unaffiliated 02900
Republican 01201
Total 04901
% of votes cast 0%98%0%2%
How each member voted (50)
Member Party Vote
deViere — Nay
Fitch — Nay
Foushee — Nay
Marcus — Nay
McKissick — Nay
Nickel — Nay
Peterson — Nay
Searcy — Nay
Smith — Nay
VanDuyn — Nay
Woodard — Nay
Ballard — Nay
Brown — Nay
Bryan — Nay
J. Davis — Nay
Edwards — Nay
Gallimore — Nay
Gunn — Nay
Harrington — Nay
Horner — Nay
Johnson — Nay
Krawiec — Nay
Newton — Nay
Perry — Nay
Steinburg — Nay
Tillman — Nay
Wells — Nay
D. Davis — Nay
J. Jackson — Nay
Dan Blue Democratic Nay
Gladys A. Robinson Democratic Nay
Jay J. Chaudhuri Democratic Nay
Joyce Waddell Democratic Nay
Michael Garrett Democratic Nay
Mujtaba A. Mohammed Democratic Nay
Paul A. Lowe, Jr. Democratic Nay
Tracy Clark Democratic Nay
Bill Rabon Republican Nay
Brent Jackson Republican Nay
Carl Ford Republican Nay
Danny Earl Britt, Jr. Republican Nay
Jim Burgin Republican Nay
Norman W. Sanderson Republican Nay
Phil Berger Republican Nay
Ralph Hise Republican Nay
Tom McInnis Republican Nay
Vickie Sawyer Republican Nay
W. Ted Alexander Republican Nay
W. Ted Alexander Republican Not Voting
Warren Daniel Republican Nay

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors SB 432?
SB 432 is sponsored by Ballard.
What is the current status of SB 432?
This bill died with 2019-2020 Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 432?
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