North Carolina § 108A-70 - 21. Program eligibility; benefits; enrollment fee and other cost-sharing; coverage from private plans.

§ 108A-70. 21. Program eligibility; benefits; enrollment fee and other cost-sharing; coverage from private plans.

Eligibility. - The Department may enroll eligible children based on availability of funds. Following are eligibility and other requirements for participation in the Program: Children must: Be between the ages of 6 through 18; Be ineligible for Medicaid, Medicare, or other federal government-sponsored health insurance; Be uninsured; Be in a family whose family income is above one hundred thirty-three percent (133%) and less than or equal to two hundred eleven percent (211%) of the federal poverty level; Be a resident of this State and eligible under federal law; and Have paid the Program enrollment fee required under this Part. Proof of family income and residency and declaration of uninsured status shall be provided by the applicant at the time of application for Program coverage. The family member who is legally responsible for the children enrolled in the Program has a duty to report any change in the enrollee's status within 60 days of the change of status. If a responsible parent is under a court order to provide or maintain health insurance for a child and has failed to comply with the court order, then the child is deemed uninsured for purposes of determining eligibility for Program benefits if at the time of application the custodial parent shows proof of agreement to notify and cooperate with the child support enforcement agency in enforcing the order. Except as otherwise provided in this section, enrollment shall be continuous for one year. At the end of each year, applicants may reapply for Program benefits. Benefits. - All health benefits changes of the Program shall meet the coverage requirements set forth in this subsection. Except as otherwise provided for eligibility, fees, deductibles, copayments, and other cost sharing charges, health benefits coverage provided to children eligible under the Program shall be equivalent to coverage provided for dependents under [the] North Carolina Medicaid Program except for the following: No services for long-term care. No nonemergency medical transportation. No EPSDT. Dental services shall be provided on a restricted basis in accordance with criteria adopted by the Department to implement this subsection. Routine diagnostic examinations and tests: annual routine diagnostic examinations and tests, including x-rays, blood and blood pressure checks, urine tests, tuberculosis tests, and general health check-ups that are medically necessary for the maintenance and improvement of individual health are covered. Payments. - Prescription drug providers shall accept as payment in full, for outpatient prescriptions filled, amounts allowable for prescription drugs under Medicaid. For all other providers, services provided to children enrolled in the Program shall be provided at rates equivalent to one hundred percent (100%) of Medicaid rates, less any co-payments assessed to enrollees under this Part. Annual Enrollment Fee. - There shall be no enrollment fee for Program coverage for enrollees whose family income is less than or equal to one hundred fifty-nine percent (159%) of the federal poverty level. The enrollment fee for Program coverage for enrollees whose family income is above one hundred fifty-nine percent (159%) and less than or equal to two hundred eleven percent (211%) of the federal poverty level shall be fifty dollars ($50.00) per year per child with a maximum annual enrollment fee of one hundred dollars ($100.00) for two or more children. The enrollment fee shall be collected by the county department of social services and retained to cover the cost of determining eligibility for services under the Program. County departments of social services shall establish procedures for the collection of enrollment fees. Cost-Sharing. - There shall be no deductibles, copayments, or other cost-sharing charges for families covered under the Program whose family income is less than or equal to one hundred fifty-nine percent (159%) of the federal poverty level, except that fees for outpatient prescription drugs are applicable and shall be one dollar ($1.00) for each outpatient generic prescription drug, for each outpatient brand-name prescription drug for which there is no generic substitution available, and for each covered over-the-counter medication. The fee for each outpatient brand-name prescription drug for which there is a generic substitution available is three dollars ($3.00). Families covered under the Program whose family income is above one hundred fifty-nine percent (159%) of the federal poverty level shall be responsible for copayments to providers as follows: Five dollars ($5.00) per child for each visit to a provider, except that there shall be no copayment required for well-baby, well-child, or age-appropriate immunization services; Five dollars ($5.00) per child for each outpatient hospital visit; A one dollar ($1.00) fee for each outpatient generic prescription drug, for each outpatient brand-name prescription drug for which there is no generic substitution available, and for each covered over-the-counter medication. The fee for each outpatient brand-name prescription drug for which there is a generic substitution available is ten dollars ($10.00). Twenty dollars ($20.00) for each emergency room visit unless: The child is admitted to the hospital, or No other reasonable care was available as determined by the Department. Benefits provided to an enrollee in the Program may be subject to lifetime maximum limits set forth in Medicaid and NC Health Choice medical coverage policies adopted pursuant to G.S. 108A-54.2. Cost-Sharing Limitations. - The Department shall establish maximum annual cost-sharing limits per individual or family, provided that the total annual aggregate cost-sharing, including enrollment fees, with respect to all children in a family receiving benefits under this section shall not exceed five percent (5%) of the family's income for the year involved. Coverage From Private Plans. - The Department shall, from funds available for the Program, pay the cost for dependent coverage provided under a private insurance plan for persons eligible for coverage under the Program if all of the following conditions are met: The person eligible for Program coverage requests to obtain dependent coverage from a private insurer in lieu of coverage under the Program and shows proof that coverage under the private plan selected meets the requirements of this subsection; The dependent coverage under the private plan is actuarially equivalent to the coverage provided under the Program and the private plan does not engage in the exclusive enrollment of children with favorable health care risks; The cost of dependent coverage under the private plan is the same as or less than the cost of coverage under the Program; and The total annual aggregate cost-sharing, including fees, paid by the enrollee under the private plan for all dependents covered by the plan, do not exceed five percent (5%) of the enrollee's family income for the year involved. , (h) Repealed by Session Laws 2015-241, s. 12H.14(a), effective September 18, 2015. If health insurance other than under the Program is provided to the child after enrollment and prior to the expiration of the eligibility period for which the child is enrolled in the Program, then the child is deemed to be insured and ineligible for continued coverage under the Program. The custodial parent has a duty to notify the Department within 10 days of receipt of the other health insurance, and the Department, upon receipt of notice, shall disenroll the child from the Program. As used in this paragraph, the term "responsible parent" means a person who is under a court order to pay child support. In addition to the benefits provided under the North Carolina Medicaid Program, the following services and supplies are covered under the Health Insurance Program for Children established under this Part: (1), (1a) Repealed by Session Laws 2011-145, s. 10.41(b), effective July 1, 2011. (2) Vision: Scheduled routine eye examinations once every 12 months, eyeglass lenses or contact lenses once every 12 months, routine replacement of eyeglass frames once every 24 months, and optical supplies and solutions when needed. NCHC recipients must obtain optical services, supplies, and solutions from NCHC enrolled, licensed or certified ophthalmologists, optometrists, or opticians. In accordance with G.S. 148-134 , NCHC providers must order complete eyeglasses, eyeglass lenses, and ophthalmic frames through Nash Optical Plant. Eyeglass lenses are limited to NCHC-approved single vision, bifocal, trifocal, or other complex lenses necessary for a Plan enrollee's visual welfare. Coverage for oversized lenses and frames, designer frames, photosensitive lenses, tinted contact lenses, blended lenses, progressive multifocal lenses, coated lenses, and laminated lenses is limited to the coverage for single vision, bifocal, trifocal, or other complex lenses provided by this subsection. Eyeglass frames are limited to NCHC-approved frames made of zylonite, metal, or a combination of zylonite and metal. All visual aids covered by this subsection require prior approval. Requests for medically necessary complete eyeglasses, eyeglass lenses, and ophthalmic frames outside of the NCHC-approved selection require prior approval. Requests for medically necessary fabrication of complete eyeglasses or eyeglass lenses outside of Nash Optical Plant require prior approval. Upon prior approval refractions may be covered more often than once every 12 months. (3) Under the North Carolina Health Choice Program for Children, the co-payment for nonemergency visits to the emergency room for children whose family income is less than or equal to one hundred fifty-nine percent (159%) of the federal poverty level is ten dollars ($10.00). The co-payment for children whose family income is above one hundred fifty-nine percent (159%) and less than or equal to two hundred eleven percent (211%) of the federal poverty level is twenty-five dollars ($25.00). (4) Over the counter medications: Selected over the counter medications provided the medication is covered under the State Medical Assistance Plan. Coverage shall be subject to the same policies and approvals as required under the Medicaid program. No benefits are to be provided for services and materials under this subsection that do not meet the standards accepted by the American Dental Association. The Department shall provide services to children enrolled in the NC Health Choice Program through Community Care of North Carolina (CCNC) and shall pay Community Care of North Carolina providers the per member, per month fees as allowed under Medicaid. Copayments required under this subsection for prescription drugs apply only to prescription drugs prescribed on an outpatient basis. The Department may reimburse an enrollee for private coverage under this subsection upon a showing of proof that the dependent coverage is in effect for the period for which the enrollee is eligible for the Program. History (1998-1, s. 1; 1999-237, s. 11.9; 2002-126, s. 10.20(a); 2003-284, s. 10.29(a); 2005-276, ss. 10.22(b), 10.22(c), 10.22(d); 2007-323, s. 28.22A(o); 2007-345, s. 12; 2008-107, ss. 10.12(b), (c), 10.13(f), (k); 2008-118, s. 1.6(b), (c); 2009-16, s. 4(d); 2009-451, s. 10.35(a); 2011-145, s. 10.41(b); 2013-360, s. 12H.10(g); 2015-96, s. 4; 2015-241, ss. 12H.2(f), 12H.14(a), (b), 12H.25(b), 12H.26(b); 2015-245, s. 22; 2017-102, s. 16.) Health Choice Enrollment Growth Cap. - Session Laws 2008-107, s. 10.14(b)-(e), as amended by Session Laws 2008-118, s. 1.6(d), provides: "(b) The Department of Health and Human Services may, in the NC Health Choice Program for the 2008-2009 fiscal year, allow up to six percent (6.0%) enrollment growth over the number of children enrolled in the NC Health Choice Program on June 30, 2008. "(c) On January 15, 2009, or upon the convening of the 2009 General Assembly, whichever occurs later, the Department of Health and Human Services shall report to the 2009 General Assembly. The report shall provide the following information: "(1) The number of children enrolled in NC Health Choice for the month of January 2009, as determined by using December 2008 Pull-Night data. "(2) Projected enrollment and program costs for each of the remaining six months of the 2008-2009 fiscal year. The projected enrollment shall be based on NC Health Choice enrollment data and program costs from the immediately preceding five fiscal years. "(3) The status of current expenditures and availability of State and federal funds for the 2008-2009 fiscal year. "The Department shall submit the report to the Chairs of the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division. "(d) If the report submitted pursuant to subsection (c) of this section indicates, or if the Department becomes later aware that growth in NC Health Choice enrollment for the 2008-2009 fiscal year will exceed the maximum six percent (6%) growth allowed under subsection (a) of this section, or if there will be a shortfall of federal funds, then the Department shall notify the Centers for Medicare and Medicaid Services (CMS) that it anticipates a freeze on enrolling new enrollees. The Department will continue to provide monthly reports to the chairs of the House of Representatives Committee on Appropriations, the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, the Office of State Budget and Management, and the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services, and the Fiscal Research Division. If enrollment in NC Health Choice continues to follow the Department's projections that the six percent (6%) cap will be exceeded, or there will be a shortfall of federal funds, then the Department shall formally notify CMS, the Chairs of the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, and the Fiscal Research Division of a freeze on new enrollees. "(e) The limitation on enrollment growth under this section may not be exceeded unless Congress has reauthorized SCHIP so as to provide sufficient federal funds or has appropriated additional federal funds for the 2008-2009 fiscal year. If Congress has reauthorized SCHIP to provide sufficient federal funds, then the Department may continue to enroll new enrollees up to an increase of eight and seventy-three one hundredths percent (8.73%) from such funds as are available to the Department." Session Laws 2009-451, s. 10.34, provides: "The Department of Health and Human Services may, in the NC Health Choice Program for the 2009-2010 fiscal year, allow enrollment to grow by not more than 9,098 children." Editor's Note. - Session Laws 2002-126, s. 10.20(c), provides: "It is the intent of the General Assembly to consider the recommendations of the Institute of Medicine study in determining whether Medicaid rates or some other rates should apply to Program services." Session Laws 2005-276, s. 1.2, provides: "This act shall be known as the 'Current Operations and Capital Improvements Appropriations Act of 2005'." Session Laws 2005-276, s. 10.22(a), provides: "Effective January 1, 2006, the Department of Health and Human Services may allow up to three percent (3%) enrollment growth in the NC Health Choice Program every six months." Session Laws 2005-276, s. 46.5 is a severability clause. G.S. 108A-70.21(b) was amended by Session Laws 2008-107, s. 10.13(f), effective July 1, 2008. Session Laws 2008-107, s. 10.13(k), as amended by Session Laws 2008-118, s. 1.6(b), states in the introductory language "Effective July 1, 2009, G.S. 108A-70.21(b) (1), as amended by subsection (f) of this section [S.L. 2008-107, s. 10.13], reads as rewritten." Session Laws 2008-107, s. 1.2, provides: "This act shall be known as 'The Current Operations and Capital Improvements Appropriations Act of 2008'." Session Laws 2008-107, s. 10.13(n), as amended by Session Laws 2008-118, s. 1.6(c), provides: "Subsections (a) through (c) and subsections (e) through (j) of this section become effective July 1, 2008. Effective July 1, 2010, G.S. 135-42 [renumbered as G.S. 135-47, now repealed], as amended by subsection (b) of this section, is repealed. The remainder of this section is effective when this act becomes law [July 16, 2008]." Session Laws 2008-107, s. 30.3, provides: "Except for statutory changes or other provisions that clearly indicate an intention to have effects beyond the 2008-2009 fiscal year, the textual provisions of this act apply only to funds appropriated for, and activities occurring during, the 2008-2009 fiscal year." Session Laws 2008-107, s. 30.5 is a severability clause. Session Laws 2009-16, s. 4(a), provides: "Over-the-Counter Medications. - Coverage of over-the-counter medication authorized under G.S. 108A-70.21(d) for the NC Health Choice Program shall become effective on the later of July 1, 2010, or the date upon which the Department of Health and Human Services assumes full responsibility for administration and processing of claims under the NC Health Choice Program." Session Laws 2009-16, s. 4(b), provides: "Subrogation. - For the period authorized under subsection (a) of this section, the right of subrogation under G.S. 108A-57 applies to the State Health Plan for payments made by the Plan under the NC Health Choice Program. This subsection expires on the later of July 1, 2010, or the date upon which the Department of Health and Human Services assumes full responsibility for administration, processing, and payment of claims under the NC Health Choice Program." Session Laws 2010-31, s. 10.14, provides: "Under the North Carolina Health Choice Program for Children, the co-payment for nonemergency visits to the emergency room for children whose family income is at or below one hundred fifty percent (150%) of the federal poverty level is ten dollars ($10.00). The co-payment for children whose family income is between one hundred fifty-one percent (151%) and two hundred percent (200%) of the federal poverty level is twenty-five dollars ($25.00)." Session Laws 2010-31, s. 1.1, provides: "This act shall be known as the 'Current Operations and Capital Improvements Appropriations Act of 2010'." Session Laws 2010-31, s. 32.3, provides: "Except for statutory changes or other provisions that clearly indicate an intention to have effects beyond the 2010-2011 fiscal year, the textual provisions of this act apply only to funds appropriated for, and activities occurring during, the 2010-2011 fiscal year." Session Laws 2010-31, s. 32.6 is a severability clause. Session Laws 2011-145, s. 10.41(f), provides: "Effective July 1, 2011, the Department shall begin planning to transition all health benefit changes of the Program to meet the coverage requirements set forth in subsection (b) of this section with implementation to begin no later than October 1, 2011, and completed no later than March 12, 2012." Session Laws 2011-145, s. 1.1, provides: "This act shall be known as the 'Current Operations and Capital Improvements Appropriations Act of 2011.'" Session Laws 2011-145, s. 32.2, provides: "Except for statutory changes or other provisions that clearly indicate an intention to have effects beyond the 2011-2013 fiscal biennium, the textual provisions of this act apply only to funds appropriated for, and activities occurring during, the 2011-2013 fiscal biennium." Session Laws 2011-145, s. 32.5 is a severability clause. Session Laws 2013-360, s. 12H.10(a)-(e), provides: "(a) Families and children who are categorically and medically needy are eligible for Medicaid, subject to the following annual income levels: Categorical ly Medically Family Needy Needy Size Income Level Income Level 1 $4,344 $2,900 2 5,664 3,800 3 6,528 4,400 4 7,128 4,800 5 7,776 5,200 6 8,376 5,600 7 8,952 6,000 8 9,256 6,300 "The Department of Health and Human Services shall provide Medicaid coverage to 19- and 20-year-olds under this subsection in accordance with federal rules and regulations. Medicaid enrollment of categorically needy families with children shall be continuous for one year without regard to changes in income or assets. "(b) For the following Medicaid eligibility classifications for which the federal poverty guidelines are used as income limits for eligibility determinations, the income limits will be updated each April 1 immediately following publication of federal poverty guidelines. The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to the following: "(1) All elderly, blind, and disabled people who have incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines. "(2) Pregnant women with incomes equal to or less than one hundred eighty-five percent (185%) of the federal poverty guidelines and without regard to resources. Services to pregnant women eligible under this subsection continue throughout the pregnancy but include only those related to pregnancy and to those other conditions determined by the Department as conditions that may complicate pregnancy. "(3) Infants under the age of one with family incomes equal to or less than two hundred percent (200%) of the federal poverty guidelines and without regard to resources. "(4) Children aged one through five with family incomes equal to or less than two hundred percent (200%) of the federal poverty guidelines and without regard to resources. "(5) Effective until January 1, 2014, children aged six through 18 with family incomes equal to or less than one hundred percent (100%) of the federal poverty guidelines and without regard to resources. "(6) Effective January 1, 2014, children aged six through 18 with family incomes equal to or less than one hundred thirty-three percent (133%) of the federal poverty guidelines and without regard to resources. "(7) Workers with disabilities described in G.S. 108A-66 A with unearned income equal to or less than one hundred fifty percent (150%) of the federal poverty guidelines. "The Department of Health and Human Services, Division of Medical Assistance, shall also provide family planning services to men and women of childbearing age with family incomes equal to or less than one hundred eighty-five percent (185%) of the federal poverty guidelines and without regard to resources. "(c) The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to adoptive children with special or rehabilitative needs, regardless of the adoptive family's income. "(d) The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to 'independent foster care adolescents,' ages 18, 19, and 20, as defined in section 1905(w)(1) of the Social Security Act (42 U.S.C. § 1396d(w)(1)), without regard to the adolescent's assets, resources, or income levels. "(e) The Department of Health and Human Services, Division of Medical Assistance, shall provide Medicaid coverage to women who need treatment for breast or cervical cancer and who are defined in 42 U.S.C. § 1396a(a)(10)(A)(ii)(XVIII)." Session Laws 2013-360, s. 1.1, provides: "This act shall be known as the 'Current Operations and Capital Improvements Appropriations Act of 2013.'" Session Laws 2013-360, s. 38.2, provides: "Except for statutory changes or other provisions that clearly indicate an intention to have effects beyond the 2013-2015 fiscal biennium, the textual provisions of this act apply only to funds appropriated for, and activities occurring during, the 2013-2015 fiscal biennium." Session Laws 2013-360, s. 38.5 is a severability clause. Session Laws 2015-241, s. 12H.14(c), provides: "Any State plan amendments required to implement this section shall not be subject to the 90-day prior submission requirements of G.S. 108A-54.1 A(e) [repealed] and G.S. 108A-70.25(b) ." Session Laws 2015-241, s. 12H.14(d), made the amendments to this section by Session Laws 2015-241, s. 12H.14(a), (b), effective September 18, 2015. Session Laws 2015-245, s. 22, effective September 23, 2015, repealed Session Laws 2015-241, s. 12H.25. Session Laws 2015-241, s. 12H.25(b) had amended this section contingent on House Bill 372 of the 2015 Regular Session [Session Laws 2015-245] not being ratified prior to March 1, 2016, which contingency failed. The amendment did not take effect. Session Laws 2015-241, s. 12H.26(c), provides: "Any State Plan amendments required to implement this section shall not be subject to the 90-day prior submission requirements of G.S. 108A-54.1 A(e) [repealed] and G.S. 108A-70.25(b) ." Session Laws 2015-241, s. 1.1, provides: "This act shall be known as 'The Current Operations and Capital Improvements Appropriations Act of 2015.'" Session Laws 2015-241, s. 33.4, provides: "Except for statutory changes or other provisions that clearly indicate an intention to have effects beyond the 2015-2017 fiscal biennium, the textual provisions of this act apply only to funds appropriated for, and activities occurring during, the 2015-2017 fiscal biennium." Session Laws 2015-241, s. 33.6, is a severability clause. Session Laws 2015-245, s. 22A(a), (b), as added by Session Laws 2016-121, s. 2(j), provides: "(a) Notwithstanding any provision of S.L. 2015-241, as amended by S.L. 2015-263, S.L. 2015-264, S.L. 2015-267, S.L. 2015-268, S.L. 2015-276, S.L. 2015-286, and S.L. 2016-5, that requires a reduction within the Division of Medical Assistance, the Department of Health and Human Services (DHHS), is authorized to establish, maintain, or adjust all Medicaid program components, except for eligibility categories and income thresholds, within the appropriated and allocated budget for the Medicaid program, provided that the total Medicaid expenditures, net of agency receipts, do not exceed the authorized budget for the Medicaid program, in accordance with G.S. 108A-54(e) . "(b) If DHHS intends to maintain any program components as authorized by subsection (a) of this section, then no later than 60 calendar days after Senate Bill 838, 2015 Regular Session, becomes law, DHHS shall request that the Office of State Budget and Management (OSBM) certify that there are sufficient recurring Medicaid funds to maintain the program component. Within 30 calendar days after receiving DHHS's request, OBSM must respond to the request. If OSBM does not certify by the end of the 30-day period that there are sufficient recurring Medicaid funds to maintain the program component, then DHHS shall implement the reduction required by S.L. 2015-241, as amended by S.L. 2015-263, S.L. 2015-264, S.L. 2015-267, S.L. 2015-268, S.L. 2015-276, S.L. 2015-286, and S.L. 2016-5." Effect of Amendments. - Session Laws 2005-276, ss. 10.22(c) and (d), effective July 1, 2005, in subsection (b), deleted the last two sentences in the first paragraph, deleted the second and fourth paragraphs, and added the last paragraph; and added subsection (b1). Session Laws 2005-276, s. 10.22(b), effective January 1, 2006, in sub-subdivision (a)(1)a., substituted "between the ages of 6 through 18" for "under the age of 19"; and rewrote sub-subdivision (a)(1)d. Session Laws 2007-323, s. 28.22A(o), as amended by Session Laws 2007-345, s. 12, effective July 1, 2008, substituted "State Health Plan for Teachers and State Employees" for "North Carolina Teachers' and State Employees' Comprehensive Major Medical Plan" throughout the section. Session Laws 2008-107, ss. 10.12(b), 10.12(c), and 10.13(f), effective July 1, 2008, in subsection (b), substituted "Predecessor Plan" for "State Health Plan for Teachers and State Employees, including optional prepaid plans" in the first paragraph and inserted "Predecessor" preceding "Plan" in the second paragraph; rewrote subdivision (b)(1); substituted "prior approval. Upon prior approval" for "prior approval of the Plan. Upon prior approval by the Plan" in subdivision (b)(2); in subdivision (b)(3), inserted "approved" preceding "hearing aid" and substituted "specialist. Prior approval" for "specialist approved by the Plan. Prior approval of the Plan"; added subdivisions (b)(4) and (b)(5); deleted "Effective January 1, 2006" at the beginning of the last paragraph in subsection (b); in subsection (b1), deleted "effective no later than January 1, 2006", substituted "percent (100%)" for "fifteen percent (115%)", and deleted the last two sentences; inserted "through two hundred percent (200%)" in subsection (c); in subsection (d) and subdivision (d)(3), made minor grammatical changes and inserted "and for each covered over-the-counter medication"; substituted "Department" for "Claims Processing Contractor of the State Health Plan for Teachers and State Employees" in subdivision (d)(4)b; rewrote subsections (e) and (g); added subsection (i). Session Laws 2008-107, s. 10.13(k), as amended by Session Laws 2008-118, s. 1.6(b), effective July 1, 2009, in subdivision (b)(1), deleted "Dental:" at the beginning, substituted "topical fluoride treatments" for "scaling" and "sealants, extractions, other than impacted teeth or wisdom teeth" for "fluoride applications twice during a twelve-month period, fluoride varnish, sealants, simple extractions" and added "space maintainers, root canal therapy for permanent anterior teeth and permanent first molars", added subdivision (b)(1a); and transferred the last sentence of former subdivision (b)(1) to follow subdivision (b)(1a) as an undesignated paragraph. Session Laws 2009-16, s. 4(d), effective April 23, 2009, in subsection (g) substituted "two hundred percent (200%)" for "two hundred fifty percent (250%)" twice and substituted "two hundred twenty-five percent (225%)" for "two hundred seventy-five percent (275%)". Session Laws 2009-451, s. 10.35(a), effective July 1, 2009, in the last paragraph of subsection (b), inserted "(CCNC)" in the first sentence, and added the last sentence. Session Laws 2011-145, s. 10.41(b), effective July 1, 2011, rewrote subsection (b). Session Laws 2013-360, s. 12H.10(g), effective January 1, 2014, substituted "one hundred thirty-three percent (133%)" for "one hundred percent (100%)" in sub-subdivision (a)(1)d. Session Laws 2015-96, s. 4, effective June 19, 2015, added a third sentence to subsection (b1), which read: "Payments to NC Health Choice Program providers under this Part shall be paid in full and shall not be subject to cost settlement"; and made a capitalization change in subsection (e). Session Laws 2015-241, s. 12H.26(b), effective July 1, 2015, deleted the third sentence in subsection (b1), which was added by Session Laws 2015-96, s. 4. Session Laws 2015-241, s. 12H.2(f), effective July 1, 2015, substituted "and less than or equal to two hundred eleven percent (211%)" for "through two hundred percent (200%)" in sub-subdivision (a)(1)d; in subdivision (3) of the second paragraph of subsection (b), substituted "less than or equal to one hundred fifty-nine percent (159%)" for "at or below one hundred fifty percent (150%)" near the end of the first sentence, and rewrote the last sentence; in subsection (c), substituted "less than or equal to one hundred fifty-nine percent (159%)" for "at or below one hundred fifty percent (150%)" in the first sentence and substituted "one hundred fifty-nine percent (159%) and less than or equal to two hundred eleven percent (211%)" for "one hundred fifty percent (150%) through two hundred percent (200%)" in the second sentence; and, in the introductory paragraph of subsection (d), substituted "less than or equal to one hundred fifty-nine percent (159%)" for "at or below one hundred fifty percent (150%)" in the first sentence, and substituted "one hundred fifty-nine percent (159%)" for "one hundred fifty percent (150%)" in the last sentence. Session Laws 2015-241, s. 12H.14(a), (b), effective September 18, 2015, repealed subsections (g) and (h), concerning extended coverage; and rewrote subsection (i), which formerly read: "No Lifetime Maximum Benefit Limit. - Benefits provided to an enrollee in the Program shall not be subject to a maximum lifetime limit." Session Laws 2017-102, s. 16, effective July 12, 2017, substituted "private plans" for "private plans; purchase of extended coverage" in the section heading.