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--- version:Edition 1
+++ version:Filed
@@ -1,32 +1,32 @@
 GENERAL ASSEMBLY OF NORTH CAROLINA
 SESSION 2025
-S 1
-SENATE BILL 566
+S D
+SENATE BILL DRS45245-MR-78A
 
 Short Title: Parity Enhancement for Addiction Recovery. (Public)
 Sponsors: Senators Meyer, Adcock, and Batch (Primary Sponsors).
-Referred to: Rules and Operations of the Senate
-March 26, 2025
-*S566-v-1*
+Referred to:
+
+*DRS45245-MR-78A*
 A BILL TO BE ENTITLED 1
 AN ACT TO UPDATE BY CONFORMING TO FEDERAL LAW THE LAWS RELATED TO 2
-HEALTH BENEFIT PLAN MENTAL HEALTH BENEFI TS COVERAGE AND TO 3
+HEALTH BENEFIT PLAN MENTAL HEALTH BENEFITS COVERAGE AND TO 3
 ENHANCE COVERAGE PARITY FOR ADDICTION RECOVERY. 4
 The General Assembly of North Carolina enacts: 5
 SECTION 1.(a)  Subsections (b), (c), (d), and (j) of G.S. 58-3-220 are repealed. 6
 SECTION 1.(b)  Subsection (h) of G.S. 58-3-220 is recodified as subsection (a1) of 7
 G.S. 58-3-220. 8
-SECTION 2.(a)   G.S. 58-3-220, as amended by Section 1 of this act, reads as 9
+SECTION 2. (a)  G.S. 58-3-220, as amended by Section 1 of this act, reads as 9
 rewritten: 10
 "§ 58-3-220.  Mental illness health benefits coverage. 11
 (a) Mental Health Equity Requirement. – Except as provided in subsection (b), an insurer 12
 shall provide in each group health benefit plan benefits for All health benefit plans shall provide 13
 coverage for the necessary care and treatment of mental illnesses health conditions that are no 14
 less favorable than benefits for the necessary care and treatment of physical illness generally, 15
-including application of the same limits. For purposes of this subsection, men tal illnesses are as 16
+including application of the same limits. For purposes of this subsection, mental illnesses are as 16
 diagnosed and defined in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, or 17
 a subsequent edition published by the American Psychiatric Association, except those mental 18
-disorders coded in the DSM -5 or subsequent editio n as autism spectrum disorder (299.00), 19
+disorders coded in the DSM -5 or subsequent edition as autism spectrum disorder (299.00), 19
 substance-related disorders (291.0 through 292.2 and 303.0 through 305.9), those coded as sexual 20
 dysfunctions not due to organic disease (302.70 through 302.79), and those coded as "V" codes. 21
 For purposes of this subsection, "limits" includes deductibles, coinsurance factors, co-payments, 22
@@ -43,8 +43,12 @@
 American Psychiatric Association, except this term does not include those 33
 mental disorders coded in the DSM -5 or subsequent editions as autism 34
 spectrum disorder (299.00), substance-related disorders (291.0 through 292.9 35
+FILED SENATE
+Mar 25, 2025
+S.B. 566
+PRINCIPAL CLERK
 General Assembly Of North Carolina Session 2025
-Page 2  Senate Bill 566-First Edition
+Page 2  DRS45245-MR-78A
 and 303.0 through 305.9), those coded as sexual dysfunctions not due to 1
 organic disease (302.70 through 302.79), and those coded as "V" codes. 2
 … 3
@@ -52,7 +56,7 @@
 utilization review criteria to determine medical necessity as defined in G.S. 58-50-61 as long as 5
 it does so in accordance with all requirements for utilization review programs and medical 6
 necessity determinations specified in that section, including the offering of an insurer appeal 7
-process and, where applicable , health benefit plan external review as provided for in Part 4 of 8
+process and, where applicable, health benefit plan external review as provided for in Part 4 of 8
 Article 50 of Chapter 58 of the General Statutes. in accordance with G.S. 58-50-61. Clinical 9
 review criteria and assessment of medical necessity for a treatment modality for any mental 10
 health condition, including substance use disorders, shall be consistent with the criteria used for, 11
@@ -70,12 +74,12 @@
 … 23
 (d) Program Operations.  Clinical Review Criteria, Generally.  – In every utilization 24
 review program, an insurer or URO shall use documented clinical review criteria that are based 25
-on sound clinical evi dence and that are periodically evaluated to assure ongoing efficacy. An 26
+on sound clinical evidence and that are periodically evaluated to assure ongoing efficacy. An 26
 Except as otherwise provided, an insurer may develop its own clinical review criteria or purchase 27
 or license clinical review criteria. 28
 (d1) Criteria for determining when a patient needs to be placed in a substance abuse 29
 treatment program shall be either (i) the diagnostic criteria contained in Clinical Review Criteria, 30
-Substance Use Treatment. – Clinical review criteria and assessment of medic al necessity for a 31
+Substance Use Treatment. – Clinical review criteria and assessment of medical necessity for a 31
 treatment modality for any mental health condition, including substance use disorders, shall be 32
 consistent with the criteria used for, and the manner of assessment applied to, the medical 33
 necessity of non -mental health conditions. For substance use disorders, medical necessity 34
@@ -97,16 +101,16 @@
 (4) In issuing a utilization review decision, an insurer shall: obtain or its URO 50
 shall do all of the following: 51
 General Assembly Of North Carolina Session 2025
-Senate Bill 566-First Edition  Page 3
+DRS45245-MR-78A  Page 3
 a. Obtain all information required to make the decision, including 1
 pertinent clinical information; employ information. 2
 b. Employ a process to ensure that utilization reviewers apply clinical 3
 review criteria consistently; and issue consistently. 4
 c. Apply the decision in a timely manner pursuant to this section. 5
 …." 6
-SECTION 2.(c)   In accordance with G.S.  135-48.24(b) and G.S.  135-48.30(a)(7) 7
+SECTION 2.(c)   In accordance with G.S. 135-48.24(b) and G.S. 135-48.30(a)(7) 7
 which require the State Treasurer to implement procedures that are substantially similar to the 8
-provisions of G.S.  58-50-61 for the North Carolina State Health Plan for Teachers and State 9
+provisions of G.S. 58-50-61 for the North Carolina State Health Plan for Teachers and State 9
 Employees (State Health Plan), the State Treasurer and the Executive Administrator of the State 10
 Health Plan shall review all practices of the State Health Plan and all contracts with, and practices 11
 of, any third party conducting any utilization review on behalf of the State Health Plan to ensure 12
@@ -130,7 +134,7 @@
 Diagnostic and Statistical Manual of Mental Disorders (DSM) or the most 30
 recent edition of the International Statistical Classification of Diseases and 31
 Related Health Problems. Autism spectrum disorder is not considered a 32
-mental illness health condition, as defined in G.S.  58-3-220, 58-51-55, or a 33
+mental illness health condition, as defined in G.S. 58-3-220, 58-51-55, or a 33
 mental illness, as defined in G.S. 58-51-55, 58-65-90, or 58-67-75." 34
 SECTION 4.  This act is effective October 1, 2025, and applies to insurance contracts 35
 issued, renewed, or amended on or after that date. 36