State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_90 > GS_90-21_52

§ 90‑21.52.  Noliability under this Article on the part of an employer or employer grouporganization that purchases coverage or assumes risk on behalf of its employeesor a physician or health care provider; liability of State Health Plan underState Tort Claims Act.

(a)        Except as otherwiseprovided in subsection (b) of this section, this Article does not create anyliability on the part of an employer or employer group purchasing organizationthat purchases health care coverage or assumes risk on behalf of its employees.

(b)        Liability in tortof the State Health Plan for Teachers and State Employees for its health caredecisions shall be under Article 31 of Chapter 143 of the General Statutes.

(c)        This Article doesnot create any liability on the part of a physician or health care provider inaddition to that otherwise imposed under existing law. No managed care entityheld liable under this Article shall be entitled to contribution under Chapter1B of the General Statutes. No managed care entity held liable under thisArticle shall have a right to indemnity against physicians, health careproviders, or entities wholly owned by physicians or health care providers orany combination thereof, except when:

(1)        The liability of themanaged care entity is based on an administrative decision to approve ordisapprove payment or reimbursement for, or denial, reduction, or terminationof coverage, for a health care service and the physician organizations, healthcare providers, or entities wholly owned by physicians or health care providersor any combination thereof, which have made the decision at issue, have agreedexplicitly, in a written addendum or agreement separate from the managed careorganization's standard professional service agreement, to assume responsibilityfor making noncertification decisions under G.S. 58‑50‑61(13) withrespect to certain insureds or enrollees; and

(2)        The managed careentity has not controlled or influenced or advocated for the decision regardingwhether or when payment or reimbursement should be made or whether or when theinsured or enrollee should receive a health care service.

The right to indemnity setforth herein shall not apply to professional medical or health care servicesprovided by a physician or health care provider, and shall only apply where theagreement to assume responsibility for making noncertification decisions forthe managed care entity is shown to have been undertaken voluntarily and themanaged care organization has not adversely affected the terms and conditionsof the relationship with the health care provider based upon the willingness toexecute or refusal to execute an agreement under G.S. 58‑50‑61(13).(2001‑446,s. 4.7; 2001‑508, s. 2; 2007‑323, s. 28.22A(o); 2007‑345, s.12.)