House committee substitute to the 1st edition makes the following changes. Amends GS 135-48.1, by amending the definition of the term Claim Payment Data by deleting the provision specifying that the term includes any document, material, or other work, whether tangible or electronic, that is derived from, is based on, or reflects any of the foregoing data fields or information contained therein. Amends GS 135-48.32 by adding that the State Health Plan for Teachers and State Employees (Plan) must not make any use or disclosure of the Claim Payment Data that would compromise the proprietary nature of the data, or, as applicable, its status as a trade secret, or otherwise misappropriate the data. Also prohibits the Plan from using a provider's Claim Payment Data to negotiate rates, fee schedules, or other master changes with that provider or any other provider. Allows the Plan to disclose Claim Payment Data to a third party auditor to verify the legitimacy of claims paid on behalf of the Plan. Makes any disclosure to a third-party auditor subject to this statute with regard to the use and further disclosure of Claim Payment Data. Deletes the provision providing that a Claims Processor who discloses Claim Payment Data in accordance with this statute will not incur any civil liability and is not subject to equitable relief in connection for the disclosure. Adds instead that anyone who discloses Claim Payment Data in violation of the statute is subject to a civil penalty no greater than $250 per violation.
Bill H 169 (2021)Summary date: May 11 2021 - View summary
Bill H 169 (2021-2022)Summary date: Feb 25 2021 - View summary
Amends GS 135-48.1, which sets forth defined terms used under the provisions governing the State Health Plan for Teachers and State Employees (SHP), to include data fields that reflect the rate negotiated with or agreed to by the provider in the term Claim Payment Data.
Amends GS 135-48.32 to require the SHP Claims Processor to disclose the Claim Payment Data on a member level for claims paid by State funds. Now requires the Claims Processor to disclose Claim Payment Data that reflects rates negotiated with or agreed to by a noncontracted third party (previously not required, but required provisions of documentation to SHP to support payment of claims). Modifies the confidentiality provisions as follows. No longer specifically prohibits use or disclosure of Claim Payment Data that would compromise the or misappropriate the data. Exempts Claim Payment Data from public records laws. No longer prohibits SHP from using Claim Payment Data to negotiate rates, fee schedules, or other master changes with providers. No longer qualifies SHP's authority to disclose Claim Payment Data to third parties to use on SHP's behalf on the agreement of the Claims Processor. Now requires SHP to provide notice to, rather than obtain the approval of, the Claims Processor for each third party SHP seeks to disclose to or who will make use of Claim Payment Data.
Effective January 1, 2022.