HB 906 — Reagan's Law.

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2025 H 21 HOUSE BILL 906 Committee Substitute Favorable 4/29/25 Short Title:

Representatives Bell, White, Campbell, and Reives (Primary Sponsors).

For a complete list of sponsors, refer to the North Carolina General Assembly web site.

Health, if favorable, Insurance, if favorable, Rules, Calendar, and Operations of the House April 14, 2025 A BILL TO BE ENTITLED AN ACT TO IMPROVE THE ACCESS OF NORTH CAROLINIANS WITH LIMB LOSS AND LIMB DIFFERENCE TO PROSTHETIC AND ORTHOTIC DEVICES AND CARE.CARE AND TO REPEAL STATE HEALTH BENEFIT PLAN REQUIREMENTS TO COVER EMERGENCY CARE THAT ARE DUPLICATIVE OF FEDERAL LAW.

SECTION1.(a)8 Article3ofChapter58oftheGeneralStatutesisamendedPART byaddingI. a new section to read:

IMPROVE ACCESS TO PROSTHETIC AND ORTHOTIC DEVICES AND CARE SECTION1.(a) Article3ofChapter58oftheGeneralStatutesisamended byadding a new section to read:

(3) Repair or replacement of a prosthetic or orthotic device meeting the requirements of subsectionsubdivision (g)(1) of this section.subsection.

*H906-v-1* General Assembly Of North Carolina Session 2025 (1) Performing physical activities, such as running, biking, swimming, and strength training.

*H906-v-2* General Assembly Of North Carolina Session 2025 (f) An insurer shall not deny any health benefit claim for a prosthetic or orthotic device for an insured with limb loss or absence that would otherwise be covered for any insured without a disability seeking medical or surgical intervention to restore or maintain the ability to perform the same physical activity.

SECTION 1.(c) No later than March 1, 2028, the Commissioner of the Department ofInsuranceshallaggregatealldatareceivedundersubsection(b)ofthissectionbyhealthbenefitofInsuranceshall aggregatealldatareceivedundersubsection (a)ofthissectionbyhealthbenefit plan year and provide this information in a report to the Joint Legislative Oversight Committee on General Government and the Joint Legislative Oversight Committee on Health and Human Services.

SECTION 2.1.(d) This section is effective October 1, 2025, and applies to the earlier of the following:

This act is effective October 1, 2025, and applies to the earlier of the following:

For the purposes of this act,section, the next yearly anniversary of the insurance contract date is deemed a renewal of the contract.

PagePART 2II. House Bill 906-Second Edition

REPEAL STATE HEALTH BENEFIT PLAN REQUIREMENTS TO COVER EMERGENCY CARE THAT ARE DUPLICATIVE OF FEDERAL LAW/CONFORMING CHANGES SECTION 2.(a) G.S.

58-3-190 is repealed.

Page 2 House Bill 906-First Edition General Assembly Of North Carolina Session 2025 SECTION 2.(b) G.S.

58-50-56.1(a)(1) reads as rewritten:

"(1) Exclusive provider benefit plan.

– A health benefit plan offered by an insurer in which insureds must receive covered services from health care providers who are under a contract with the insurer and under which there is no requirement of coverage for care received from a health care provider who is not under contract with the insurer, except for emergency services as required by G.S.

58-3-190 and medically necessary covered services as required by G.S.

58-3-200(d)." SECTION 2.(c) G.S.

58-50-61(a)(13) reads as rewritten:

"(13) "Noncertification" means a determination by an insurer or its designated utilization review organization that an admission, availability of care, continued stay, orotherhealthcareservicehas beenreviewed and, basedupon theinformation provided,does not meet theinsurer's requirements formedical necessity, appropriateness, health care setting, or level of care or effectiveness, or does not meet the prudent layperson standard for coverage of emergency services in G.S.

58-3-190, under the federal Emergency Medical Treatment and Labor Act, 42 U.S.C.

§ 1395dd, and the requested service is thereforedenied,reduced,orterminated.

A"noncertification"is not a decision rendered solely on the basis that the health benefit plan does not provide benefits for the health care service in question, if the exclusion of the specific service requested is clearly stated in the certificate of coverage.

A "noncertification" includes any situation in which an insurer or its designated agent makes a decision about a covered person's condition to determine whether a requested treatment is experimental, investigational, or cosmetic, and the extent of coverage under the health benefit plan is affected by that decision." SECTION 2.(d) G.S.

58-50-61(a)(17)g.

reads as rewritten:

"g.

Retrospective review.

– Utilization review of medically necessary services and supplies that is conducted after services have been provided to a patient, but not the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracyof coding, or adjudication for payment.

Retrospective review includes the review of claims for emergency services to determine whether the prudent layperson standard in G.S.

58-3-190 under the federal Emergency Medical Treatment and Labor Act, 42 U.S.C.

§ 1395dd, has been met." SECTION 2.(e) G.S.

108D-65(6)f.1.

is repealed.

PART III.

EFFECTIVE DATE SECTION 3.