Bill Summaries: S865 (2015-2016 Session)

Tracking:
  • Summary date: Jul 28 2016 - View summary

    AN ACT TO MAKE ADMINISTRATIVE CHANGES TO THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES STATUTES, TO INCREASE THE NUMBER OF LOCAL GOVERNMENTS ABLE TO PARTICIPATE IN THE STATE HEALTH PLAN, AND TO MAKE CHANGES TO STATE HEALTH PLAN PREMIUMS PAID BY LOCAL GOVERNMENT EMPLOYEES. Enacted July 22, 2016. Section 4 is effective January 1, 2017. The remainder is effective July 22, 2016.


  • Summary date: Jun 30 2016 - View summary

    House amendment makes the following changes to the 2nd edition.

    Amends GS 135-48.32 by deleting the requirement that the Claims Processor provide all claims processing data elements to the State Health Plan for Teachers and State Employees, including the identification of providers and the allowed amounts paid.


  • Summary date: Jun 29 2016 - View summary

    House committee substitute makes the following changes to the 2nd edition.

    Amends GS 135-48.1, definitions for the State Health Plan (Plan), adding and defining the terms Claims Data Feed and Claim Payment Data.

    Amends GS 135-48.10(a) concerning the confidentiality of specified information and records in possession of the State Health Plan for Teachers and State Employees or other parties as specified, adding language to provide that Claims Payment Data and materials derived from Claims Payment Data are considered confidential and exempt from public records laws under GS Chapter 132.

    Amends GS 135-48.32 concerning contracts for plan benefits, deleting almost the entirety of the provisions that authorized the State Treasurer to contract with pharmacy benefits managers to administer pharmacy benefits under the Plan. Deletes provisions concerning modification of Article 3B, State Health Plan for Teachers and State Employees, and the request for proposals for inclusion in the contract to provide benefits. No longer requires the State Treasurer to require that the terms of the contract between the Plan and the Plan's Claims Processing Contractor, the Pharmacy Benefits Manager, and the Disease Management Contractor require the contractor to provide specified billing details, transactional data, and cost of administrative functions. Adds new language providing that the Claims Processor will provide all claims processing data elements to the Plan, including identification of providers and allowed amounts paid. Requires Claim Processors to provide the Plan with a Claim Data Feed, at least monthly. Enacts several new subsections setting out provisions governing Claims Processors and governing the use of Claims Payment Data, including allowing Claims Processors to withhold information that reflects rates negotiated with or agreed to by a third party, as long as sufficient documentation to support the payment of claims is provided. Requires certain contract provisions between a Claims Processor and medical provider or other specified third parties void and unenforceable to the extent it prevents the disclosure of required Claims Payment Data. Specifies correct and permissible uses of Claims Payment Data. Exempts Claims Processors that disclose Claims Payment Data in accordance with the regulations from civil liability or equitable relief. 

    Amends the effective date provisions, providing that as the remainder of the act is effective when it becomes law, it applies to contracts entered into on or after that date. 


  • Summary date: Jun 23 2016 - View summary

    Senate committee substitute makes the following changes to the 1st edition.

    Deletes the proposed changes to GS 135-48.23, concerning contracts to provide benefits.

    Amends GS 135-48.47(b) concerning participation requirements for local governments in the State Health Plan (Plan), making organizational and clarifying changes, prohibiting participating local governments from charging employees more for their coverage than allowed under the set structure of the Plan. Also provides that local governments cannot charge premiums for an employee's dependents that exceed those set by the plan. 

    Amends GS 135-48.47(c) to allow local governments to elect to participate in the State Health Plan until the number of employees and dependents of employees of local governments enrolled in the Plan reaches 16,000 (set at 20,000 in previous edition) after which time no additional local governments may join the Plan. Sets out a schedule for increasing and enrolling local governments into the Plan, including allowing local governments to be admitted through June 30, 2017, until the number of local government employees and dependents reach 13,500, then through January 31, 2018, allowing the same to enroll plus the estimated number of employees and dependents that completed the Plan's Notice of Participation Sheet prior to April 1, 2016, until enrollment reaches 16,000. After that only the limitations of GS 135-48.47 apply.

    Amends deadline date in proposed GS 135-48.47(d) for withdrawal from the Plan by a local government effective January 1, 2017, now requiring withdrawal notices to be made no later than September 15, 2016 (was, October 1, 2016). 

    Amends GS 58-3-167(a)(1) to clarify that the definition for Health Benefit Plan for the purposes of this section does not include or mean any plan implemented or administered by the State Health Plan for Teachers and State Employees. 

    Amends the effective date provisions of the act, providing that the changes made to Section 1, GS 135-48.47(b) concerning premiums, is effective January 1, 2017, applying to premiums paid on or after that date. The remainder of the act is effective when it becomes law. 

     


  • Summary date: May 11 2016 - View summary

    Amends GS 135-48.32 that requires benefits under the State Health Plan for Teachers and State Employees (Plan) to be provided under contracts between the Plan and the claims processors selected by the Plan. Requires claims processor contractors to provide all claims processing data elements to the Plan including the identification of providers and the allowed amounts paid. Eliminates provisions that allow the State Treasurer to contract with a pharmacy benefits manager to administer pharmacy benefits under the Plan, and eliminates provisions concerning the required content and administration of those contracts.

    Amends GS 135-48.34 by changing the title to Contract exemptions. Establishes that contracts to provide benefits, contracts with providers or provider networks, and contracts for the design, adoption, and implementation of health benefit plans and programs available under health benefits plans, as authorized under GS 135-48.2, as amended, are not subject to the requirements of Article 3 of GS Chapter 143 (purchases and contracts by State departments, institutions or commissions), or to the requirements of Part 3 or 4 of Article 15 of GS Chapter 143B (information technology projects, management, and procurement). Provides that the contracts are subject to the requirements of GS 135-48.33. Makes conforming changes.

    Amends GS 135-47(c) (recodified as GS 135-48.47(c) by SL 2011-85 Section 2.7) to allow local governments to elect to participate in the State Health Plan until the number of employees and dependents of employees of local governments enrolled in the Plan reaches 20,000 (currently, 10,000) after which time no additional local governments may join the Plan.

    Amends GS 135-48.47(b)(3) to change one of the six provisions governing participation by a local government unit in the State Health Plan to require the local government unit to determine the eligibility of its employees and employees' dependents. Further, provides new language to establish that the portion of the employee and employees' dependents premiums paid to the local government unit may be determined be the local government unit but cannot exceed the premiums in the structure set by the Plan. Makes technical changes.  Effective January 1, 2017 and applies to premiums paid on or after that date.

    Enacts new subsection GS 135-48.47(d) to allow local governments participating in the Plan as of April 1, 2016, to elect to withdraw from participating in the Plan effective January 1, 2017.  Requires the local government unit to give notice of withdrawal to the Plan no later than October 1, 2016.

    Enacts new GS 135-48.49 to establish that the Plan is responsible for reporting coverage for retirees and coverage for direct bill members, except for individuals participating in Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, as required by section 6055 of the Internal Revenue Code. Also requires the Plan to provide employing units with access to Plan data necessary for employing units to meet filing requirements under sections 6055 and 6056 of the Internal Revenue Code. Provides that the Plan may facilitate the availability of a reporting solution, however, the employing unit is responsible for paying all costs associated with the use of any reporting solution made available by the Plan.

    Applies to contracts entered into, renewed, or amended on or after the date that the act becomes law.