AN ACT to require health benefit plans to provide coverage for adaptive exercise equipment.

The General Assembly of North Carolina enacts:

SECTION 1.(a)  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:

§ 58‑3‑295.  Coverage for adaptive exercise equipment.

(a)        Every health benefit plan offered by an insurer in this State shall provide coverage for adaptive exercise equipment for individuals with chronic mobility impairments that result in lifelong wheelchair use. For purposes of this section, adaptive exercise equipment means any machine, device, or tool designed to accommodate the improvement or maintenance of physical health.

(b)        Coverage for adaptive exercise equipment under this section shall be subject to the same copayment, coinsurance, and deductible provisions as similar durable medical equipment covered under the health benefit plan.

(c)        Nothing in this section prevents an insurer from applying utilization review criteria to determine medical necessity, as defined by G.S. 58‑50‑61. Any utilization review program or medical necessity determination related to the coverage of adaptive exercise equipment shall comply with all requirements specified in G.S. 58‑50‑61, including the offering of an insurer appeal process and, where applicable, health benefit plan external review as provided in Part 4 of Article 50 of this Chapter.

SECTION 1.(b)  G.S. 135‑48.51 reads as rewritten:

§ 135‑48.51.  Coverage and operational mandates related to Chapter 58 of the General Statutes.

The following provisions of Chapter 58 of the General Statutes apply to the State Health Plan:

…

(14)      G.S. 58‑3‑295, Coverage for adaptive exercise equipment.

SECTION 2.  There is appropriated from the General Fund to the Office of State Budget and Management the sum of ten thousand dollars ($10,000) in nonrecurring funds for the 2022‑2023 fiscal year to provide a directed grant to Disability Rights North Carolina, a nonprofit corporation, to educate the public regarding the effects of this act.

SECTION 3.  Section 1 of this act becomes effective October 1, 2022, and applies to contracts issued, renewed, or amended on or after that date. Section 2 of this act becomes effective July 1, 2022. The remainder of this act is effective when it becomes law.