GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION LAW 2001-5
AN ACT TO UPDATE THE penalties and enforcement PROVISIONS IN THE HMO LAWS.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 58-67-165 reads as rewritten:
"§ 58-67-165. Penalties and enforcement.
(a) The Commissioner may,
in addition to or in lieu of suspending or revoking a certificate of
authority license under G.S. 58-67-140, proceed under G.S. 58-2-70,
provided that the health maintenance organization has a reasonable time within
which to remedy the defect in its operations that gave rise to the procedure
under G.S. 58-2-70.
(b) Any person who
violates this Article Article or any other provision of this Chapter
that expressly applies to health maintenance organizations shall be guilty
of a Class 1 misdemeanor.
(c)
(1) If the Commissioner shall for any
reason have cause to believe that any violation of this Article Article
or any other provision of this Chapter that expressly applies to health
maintenance organizations has occurred or is threatened, the Commissioner
may give notice to the health maintenance organization and to the
representatives or other persons who appear to be involved in such suspected
violation to arrange a conference with the alleged violators or their
authorized representatives for the purpose of attempting to ascertain the facts
relating to such suspected violation, and, in the event it appears that any
violation has occurred or is threatened, to arrive at an adequate and effective
means of correcting or preventing such violation.
(2) Proceedings under this subsection shall not be governed by any formal procedural requirements, and may be conducted in such manner as the Commissioner may deem appropriate under the circumstances.
(d)
(1) The Commissioner may issue an order
directing a health maintenance organization or a representative of a health
maintenance organization to cease and desist from engaging in any act or
practice in violation of the provisions of this Article.Article or
any other provision of this Chapter that expressly applies to health
maintenance organizations.
(2) Within 30 days after
service of the order of cease and desist, cease and desist order,
the respondent may request a hearing on the question of whether acts or
practices have occurred that are in violation of this Article have
occurred.Article or any other provision of this Chapter that expressly
applies to health maintenance organizations. Such The hearing
shall be conducted pursuant to under Article 3A of Chapter 150B
of the General Statutes, and judicial review shall be available as provided by the
said Chapter 150B.Article 4 of Chapter 150B of the General Statutes.
(e) In the case of any
violation of the provisions of this Article, Article or any other
provision of this Chapter that expressly applies to health maintenance
organizations, if the Commissioner elects not to issue a cease and desist
order, or in the event of noncompliance with a cease and desist order issued pursuant
to subsection (d), under subsection (d) of this section, the
Commissioner may institute a proceeding to obtain injunctive relief, or seeking
other appropriate relief, in the Superior Court of Wake County."
SECTION 2. G.S. 58-67-170 reads as rewritten:
"§ 58-67-170. Statutory construction and relationship to other laws.
(a) Except as otherwise
provided in this Article, Chapter, provisions of the insurance
laws and provisions of hospital or medical service corporation laws shall
not be applicabledo not apply to any health maintenance organization
granted a certificate of authority licensed under this Article.
This provision shall subsection does not apply to an insurer or hospital
or medical service corporation licensed and regulated pursuant to under
the insurance laws or the hospital or medical service corporation laws
of this State except with respect to its health maintenance organization
activities authorized and regulated pursuant to under this Article.Article
or any other provision of this Chapter that expressly applies to health
maintenance organizations.
(b) Solicitation of
enrollees by a health maintenance organization granted a certificate of
authority, license, or its representatives, shall not be construed
to violate any provision of law relating to solicitation or advertising by
health professionals.
(c) Any health maintenance organization authorized under this Article shall not be deemed to be practicing medicine or dentistry and shall be exempt from the provisions of Chapter 90 of the General Statutes relating to the practice of medicine and dentistry; provided, however, that this exemption does not apply to individual providers under contract with or employed by the health maintenance organization."
SECTION 3. This act is effective when it becomes law.
In the General Assembly read three times and ratified this the 14th day of March, 2001.
s/ Beverly E. Perdue
President of the Senate
s/ Joe Hackney
Speaker Pro Tempore of the House of Representatives
s/ Michael F. Easley
Governor
Approved 11:00 a.m. this 22nd day of March, 2001