Section 1 states the intent of the General Assembly to make the North Carolina State Health Plan available for all North Carolina residents consistent with the Patient Protection and Affordable Care Act by January 1, 2019. Requires the Department of Insurance and the Department of Health and Human Services to study the issue and report to the House Committee on Health and Human Services and the Senate and House Committees on Insurance by January 1, 2018.
Section 2 outlines the health care and pharmacy services that would be available to North Carolina residents under the State Health Plan and provides that members would be able to go to any licensed provider in the state for these services.
Section 3 prohibits the State Health Plan from charging co-pays or deductibles for the first two years in which North Carolina residents are entitled to enroll in the Plan. Thereafter limits deductibles to $250 per individual or $500 per family. Prohibits charging co-pays or deductibles for preventive care. Authorizes charging co-pays and deductibles for specialist visits without primary care provider referral.
Section 4 requires residents to enroll in the Plan prior to receiving services.
Section 5 requires the Plan to offer direct billing system to providers.
Section 6 requires the Plan to be funded by all taxpayers based on ability to pay and through a stable funding stream. Requires the Departments of Health and Human Services and Insurance to include recommendations on funding mechanisms in the reports required under Section 1 of the bill.
Section 7 requires the Plan to implement a smart identity card system for plan participants and to develop a centralized, secured medical record system.
Section 8 requires Departments of Health and Human Services and Insurance to include recommendations on executive branch agency oversight of the Plan in the reports required under Section 1 of the bill.
Section 9 makes the Plan subject to audit by the State Auditor.
Section 10 appropriates $2.5 million in nonrecurring funds in 2017-18 to the Department of Health and Human Services and $2.5 million in nonrecurring funds in 2017-18 to the Department of Insurance to implement the studies required in Section 1 of the bill.
Effective July 1, 2017.
Bill H 916 (2017-2018)Summary date: Apr 25 2017 - View summary