The state Senate opted Tuesday not to agree with House changes made to Senate Bill 361, which has evolved into a clearinghouse for patient care and evaluation issues.

The vote was 40-1 to not concur on the changes. The bill, titled “Healthy NC,” is likely to go to a concurrence committee made up of members from both chambers.

Pieces of five House health bills have been added to SB361. Those House bills were stalled in the Senate Rules and Operations Committee.

The House approved its version of SB361 by a 106-3 vote on Aug. 14.

It wasn’t clear which House legislation that the Senate disagreed with. There was language inserted that deals with the types and costs of medication available for cancer treatments.

"SB361 passed the Senate with three main provisions. It was returned with lots of new ornaments like a Christmas tree," said Sen. Joyce Krawiec, R-Forsyth, and co-bill sponsor.

"There are a few additions that are not acceptable as presented. I believe there may be agreement on the step therapy proposal, as well as the oral chemotherapy.

"There are some concerns regarding the telehealth service section and the proposal for a task force," Krawiec said.

The bill would regulate medication used to treat cancer, including putting oral medication on an equal basis with treatment in a medical facility.

State Rep. Verla Insko, D-Orange, has expressed concern that equal treatment could cause insurance premiums to go up because oral chemotherapy drugs tend to be more costly.

Supporters of folding House Bill 480 into SB361 said cancer patients should be allowed another option besides going to a medical facility for injected medicine.

SB361 was initially known foremost for containing controversial language that would have eliminated state laws governing certificates of need, or CON, that state regulators issue to allocate new health-care facilities.

The CON language was watered down, and then eventually removed by Krawiec to in an attempt to ensure Senate passage of the other legislation. The bill passed the Senate on a 48-0 vote June 26.

The bill’s primary focus now is on allowing licensed marriage and family therapists to conduct initial examinations for involuntary commitments.

The goal is alleviating a shortfall of medical providers who are qualified to conduct an examination. According to Krawiec, there are about 90 qualified medical providers statewide.

Adding licensed marriage and family therapists to conduct initial exams, Krawiec said, could accelerate the review process “so that individuals don’t have to stay for days in a hospital emergency department awaiting care and review.”

Krawiec said that in many hospitals, there remains a shortage of psychiatric beds for people who are involuntarily committed.

Another key element of SB361 would allow North Carolina to become the eighth state to join a national psychology licensure compact.

The bill also would eliminate redundancy in adult-care home inspections; provide more support and set fees for expanding telehealth services; and create a task force to handle certain health-care access issues over a 10-year period.

“The language would make telehealth more efficient and more accessible and hopefully at a lower (per visit) fee because there is less brick-and-mortar involved,” said state Rep. Donny Lambeth, R-Forsyth.

Another component added to SB361 is from HB450, which deals with “step therapy,” which require insurers to have patients try cheaper treatments before approving coverage for more expensive alternatives. The provision would add new protocols and directly affect State Health Plan participants.

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