House Bill 152 would add a new insurance code section requiring insurers that choose to cover transcranial magnetic stimulation (TMS) to cover all TMS procedures performed by properly licensed providers or facilities acting within their scope of practice. The bill also bars insurers from penalizing a properly submitted TMS claim based solely on the medical specialty of the provider or facility submitting the claim. In effect, it is aimed at ensuring fair reimbursement and preventing claim denials, reductions, or other negative treatment tied to provider specialty when TMS is covered.
At the same time, the bill preserves insurer discretion over whether to cover TMS at all, what conditions qualify for coverage, and what reimbursement rates apply. It also expressly allows different reimbursement rates based on network participation, service location, and the provider’s training, certification, or education within the provider’s specialty. The bill would also amend the State Health Plan statute so that the Plan has the same discretion to determine TMS coverage as other insurers under the new section.
HB152 would amend Chapter 58 of the General Statutes by creating G.S. 58-3-254, establishing rules for TMS coverage and reimbursement in health benefit plans offered in North Carolina. It would also amend G.S. 135-48.51 to incorporate the State Health Plan into the same framework, making clear that the Plan may decide all aspects of TMS coverage. The act would apply to insurance contracts issued, renewed, or amended on or after October 1, 2025, affecting insurers, the State Health Plan, healthcare facilities, and licensed providers who furnish TMS services for depression and other mental disorders.
The available context suggests generally favorable treatment of the bill, or at least no recorded opposition in the provided materials. The bill was referred through the usual committee process and advanced to the Senate Rules and Operations committee, indicating it remained active and viable at the time of the last action. No vote totals or committee transcript excerpts were provided, so there is no documented public debate in the supplied record.
The main policy tension in HB152 is between ensuring reimbursement fairness for TMS providers and preserving insurer control over coverage decisions. Supporters would likely favor the anti-penalty language and the requirement that properly licensed providers not be disadvantaged based on specialty, while insurers may be concerned about limits on claim management and reimbursement practices. A second point of potential contention is that the bill does not mandate TMS coverage; instead, it leaves coverage, indications, and rates to insurer discretion, which may disappoint advocates seeking broader access guarantees.