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Bill Summary · SB 912

Summary of Bill: SB 912 — Menopause Omnibus (North Carolina, 2025 Session)

This summary explains the main purpose, key provisions, affected parties, and timeline aspects of SB 912, titled the Menopause Omnibus. The bill addresses research, medical education, insurance coverage (Medicaid and private), and workplace protections related to menopause.

1) Purpose and Intent

  • To advance menopause research and medical education.
  • To require Medicaid and private health insurance coverage for menopause-related care.
  • To enact protections against employment discrimination on account of menopause and related conditions.
  • To appropriate funds for implementation and related activities.

2) Key Provisions and Changes

SB 912 is organized into five parts:

Part I — Advancement of Menopause Research

  • Definitions (Section 1.1(a)):
    • Menopause: 12 months after last menstrual period.
    • Menopause-related care: Medical, behavioral health, and supportive services addressing perimenopause, menopause, and postmenopause (including hormonal and non-hormonal treatments).
    • Perimenopause and Postmenopause: Defined lifecycle stages around menopause.
  • Comprehensive evaluation (Section 1.1(b)):
    • DHHS (Department of Health and Human Services) must assess:
    • Gaps in knowledge about etiology, symptoms, and management.
    • Barriers to diagnosis and treatment.
    • Availability, safety, and efficacy of therapies.
    • Focused research on menopausal transition populations.
    • Gaps in provider education curricula and continuing medical education (CME).
    • Impacts on underserved populations (Black women, LGBTQ+ individuals, neurodivergent individuals, low SES, incarcerated individuals).
  • Data collection (Section 1.1(c)):
    • Track prevalence of menopausal symptoms across five age bands: 20-29, 30-39, 40-49, 50-59, 60-69.
  • Statewide strategic plan (Section 1.1(d)):
    • Develop plan to address knowledge gaps, promote equitable access, and set research priorities.
  • Reporting (Section 1.1(e)):
    • By Dec. 1, 2027: DHHS must report findings, data, and the strategic plan to legislative committees.
  • Appropriations (Section 1.1(f)):
    • $5,000,000 in nonrecurring General Fund money for FY 2026-2027 to:
    • Complete evaluation, data collection, planning, and reporting.
    • Design and oversee a statewide menopause education/awareness campaign.
    • Improve provider training and expand access to care.
  • Effective date (Section 1.1(g)):
    • July 1, 2026.

Part II — Continuing Medical Education Incentives

  • Qualifying physician definition (Section 2.1(a)):
    • Doctors specialized in internal/family medicine, obstetrics/gynecology, cardiology, endocrinology, neurology, or psychiatry.
    • Must have at least 25% of adult female patients under 65.
  • CME credit incentive (Section 2.1(b)):
    • From July 1, 2026 through June 30, 2032, qualifying physicians receive double CME credit (2 hours for 1 hour of CME) for perimenopause/menopause/postmenopause care, up to 8 hours of incentive CME.
  • Promotion (Section 2.1(c)):
    • DHHS and NC Medical Board to promote the incentive and related training opportunities.

Part III — Medicaid and Health Insurance Coverage of Menopause-Related Care

  • Medicaid coverage (Section 3.1):
    • DHHS must obtain CMS approval to cover menopause-related care under Medicaid, including:
    • Diagnosis and treatment of perimenopause/menopause/postmenopause.
    • Hormone replacement therapy (HRT) when medically appropriate.
    • Non-hormonal treatments and therapies.
    • Behavioral health services related to menopause symptoms.
    • Preventive screenings and counseling.
    • Coverage to be provided without undue utilization management and aligned with current clinical standards.
  • Private health insurance coverage (Section 3.2):
    • Adds new coverage requirement: perimenopausal and menopausal care.
    • Definitions and coverage standards for formulations and administration methods (oral, topical, vaginal, rectal, subcutaneous, injectable, IV).
    • Coverage for commonly prescribed symptom-management options, including HRT and non-hormonal therapies, and genitourinary syndrome of menopause.
    • Outpatient prescription drug coverage must include evaluation and treatment options, with the provider able to adjust doses per clinical care.
    • No FDA-approved treatment restrictions; no discrimination based on gender expression or identity.
    • Insurers must annually provide current hormone therapy care recommendations from the Menopause Society or equivalent professional bodies to contracted primary care providers.
    • Effective date: Applies to insurance contracts issued, renewed, or amended on or after Oct. 1, 2027.
  • State Health Plan alignment (Section 3.3):
    • Applies to the State Health Plan by referencing the new coverage requirement (§ 58-3-271) effective Oct. 1, 2027, for the next plan year following that date.

Part IV — Protections Against Employment Discrimination on Account of Menopause

  • New Article 24 in Chapter 95: Menopause Nondiscrimination Act (Sections 95-280 to 95-283)
    • Findings and scope (95-280):
    • Menopause affects many workers; protections support retention and economic stability.
    • Definitions (95-280):
    • Qualified employee/prospective employee: Person able to perform essential job functions with or without reasonable accommodations.
    • Reasonably accommodate; related conditions (including lactation and vasomotor symptoms); undue hardship criteria.
    • Applies to employers with four or more employees.
    • Prohibited practices (95-281):
    • Discrimination or denial of opportunities due to pregnancy, childbirth, menopause, or related conditions (with accommodation considerations).
    • Requirements to provide written notices about rights and accommodations; notice timelines for new and existing employees, and upon notification of pregnancy/menopause.
    • Burden of proof (undue hardship) on the employer; accommodations that are commonly provided for other protected classes serve as rebuttable presumption against undue hardship.
    • Additional protections (95-281 to 95-283):
    • Prohibits retaliation or coercion related to accommodations.
    • Clarifies construction and limits; not to override other protections or impose a duty to employ beyond existing practices unless similarly provided to other groups.
    • Coverage threshold: Applies to employers with four or more employees.

  • Accommodations (Section 95-282):

    • Reasonable accommodations for menopause symptoms include:
    • Physical and workplace adjustments (extra breaks, cooling access, restrooms, flexible uniforms, temperature control, light duty, etc.).
    • Support for cognitively or emotionally demanding work (flexible hours, deadlines, supportive services, quiet spaces, etc.).
    • Policies and programs to support employees (EAPs, ERGs, education).
    • Recognition: Menopause-related conditions are protected under state nondiscrimination provisions.

  • Effective date and funding (Section 4.2 and 4.3):

    • July 1, 2026: $500,000 appropriated to the Department of Labor for implementation.
    • General effective date: December 1, 2026, with applicability to hiring/employment decisions on or after that date (Section 4.3).

Part V — Effective Date

  • General rule: Act becomes law upon enactment, with specific sections operating on their respective effective dates noted above.

3) Who Would Be Affected

  • Health policy and public health:
    • North Carolina Department of Health and Human Services (DHHS), Division of Public Health, and related agencies.
    • Medicaid program (DHB) and the State Health Plan; private health insurers and health benefit plans subject to state law.
  • Healthcare providers:
    • Physicians and CME developers; incentives target internal medicine, family medicine, OB-GYN, cardiology, endocrinology, neurology, psychiatry.
    • Need for up-to-date menopause care training and guidelines supplied to providers.
  • Employers:
    • Private sector employers with four or more employees.
    • State government and public employers subject to state discrimination laws.
  • Workers:
    • Individuals experiencing perimenopause, menopause, or related conditions; protections extend to accommodations and nondiscrimination.
  • Other stakeholders:
    • Researchers and educators; patients and communities disproportionately affected (Black women, LGBTQ+ individuals, neurodivergent individuals, low SES, incarcerated populations).

4) Procedural and Timeline Highlights

  • Research and data work planned: DHHS to conduct evaluation, collect age-stratified data, and publish a statewide strategic plan.
  • Reporting: Comprehensive evaluation, data, and plan to be reported to legislative committees by Dec 1, 2027.
  • Funding: $5 million nonrecurring for 2026-2027 for evaluation, campaign, and training.
  • Educational incentives: CME doubling available from mid-2026 through mid-2032, up to 8 hours.
  • Medicaid/private insurance coverage:
    • State must pursue CMS approval for Medicaid coverage (effective date contingent on CMS approval, not explicit in statute).
    • Private insurance coverage for perimenopause/menopause care becomes effective for plans issued, renewed, or amended on or after Oct 1, 2027.
  • Employment protections:
    • Protections and accommodations framework takes effect for employment decisions on/after Dec 1, 2026, with comprehensive enforcement and notices required for new and existing employees.

If you’d like, I can highlight specific sections for quick reference or provide a side-by-side comparison with current NC law on menopause-related care and discrimination.

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

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