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Bill Summary · HB 152

Summary — HB 152: Access to Transcranial Magnetic Stimulation

Status: Regular Message Sent to Senate (First Edition text filed Feb 18, 2025)
Primary subject areas: Health services; insurance; mental health; state health plan
Effective date (as enacted in the bill): October 1, 2025 (applies to contracts issued/renewed/amended on or after that date)

Main purpose

To ensure fair reimbursement practices for transcranial magnetic stimulation (TMS) services under health benefit plans sold or administered in the state by (1) protecting providers and facilities from claim penalties based on medical specialty and (2) clarifying insurer discretion over coverage parameters and reimbursement.

Key provisions

  • Adds a new statute (proposed G.S. 58‑3‑254) establishing rules for coverage of transcranial magnetic stimulation (defined as a noninvasive treatment using pulsed magnetic fields to induce electrical current in a localized brain region).
  • If an insurer’s health benefit plan covers TMS, the insurer:
    • Must provide coverage for all TMS procedures performed by facilities or properly licensed providers for whom ordering/performing/supervising TMS is within their scope of practice under Chapter 90 (state licensing law).
    • May not “penalize” a properly licensed provider or facility for submitting TMS claims based on the provider’s medical specialty. Prohibited penalties include denial, reduction, placement of limitations, or other negative treatment of a properly submitted claim.
  • The statute preserves insurer discretion: an insurer that offers a plan may still decide (for that plan) whether to cover TMS at all and may set:
    • Which indications are covered,
    • Coverage requirements,
    • Reimbursement rates.
  • The bill expressly allows differential reimbursement (not considered a prohibited penalty) based on:
    • Provider participation in an insurer’s network,
    • Location where services are provided,
    • Provider’s level of training/certification/education within their specialty.
  • Amends G.S. 135‑48.51 to confirm that the State Health Plan (for State employees and teachers) likewise retains discretion to determine the aspects of TMS coverage described above.

Who is affected

  • Insurers issuing health benefit plans in the state that include or may include TMS coverage.
  • Healthcare providers and facilities licensed to order, perform, or supervise TMS under Chapter 90 (e.g., psychiatrists, neurologists, certain advanced practice clinicians depending on scope).
  • Plan members/patients who may seek TMS for depression or other covered mental health indications.
  • The State Health Plan (explicitly referenced) — the Plan retains discretion over coverage terms.

Practical effect and potential impact

  • Creates a provider‑protection rule preventing claim denials or discriminatory claim handling solely because of provider specialty, which may broaden the set of providers/facilities able to bill successfully for TMS.
  • Does not mandate insurers to cover TMS; insurers retain control over whether to provide TMS benefits, which indications to cover, and how much to pay.
  • Permits insurers to vary reimbursement legally by network status, location, and provider qualifications, preserving managed care pricing flexibility.
  • No fiscal analysis is included in the bill text; fiscal impacts would depend on insurer adoption, benefit design changes, and use rates of TMS.

Procedural / timeline notes

  • Becomes effective October 1, 2025.
  • Applies to insurance contracts issued, renewed, or amended on or after that date.
  • The bill text is drafted as a statutory amendment in Chapter 58 (insurance) and a conforming change to the State Health Plan statute (G.S. 135‑48.51).

Compiled from official sources — confirm details with the bill’s official record.

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