Senate committee substitute makes the following changes to the 1st edition.
Eliminates the proposed changes set out in previous Section 6 of the act, amending GS 135-48.37, GS 44-49, and GS 44-50 (regarding subrogation of the State Health Plan to all Plan member rights of recovery and the Plan's lien priority to all nongovernmental medical liens and rights). Makes conforming organizational changes.
Modifies the proposed changes to the definition of claims payment data set out in GS 135-48.1 to include the rate negotiated with or agreed to by the provider reflected in a Claims Data Feed only if the State Health Plan is the sole provider, if applicable. Also includes data fields within a Claims Data Feed from which can be derived (previously, only that reflect) the provider and the amount billed for services to the Plan member, the allowed amount applied to the claim by processor, the amount paid by the Plan on the claim, and the negotiated rate as added.
Deletes the proposed changes to GS 135-48.32 regarding contracts to provide benefits. Instead exempts from specified use and disclosure parameters set forth in the statute any claim payment data that reflects or is based on rates, fee schedules, or reimbursement methodologies that are supplied to a claims processor by the Plan or used by a claims processor exclusively for claims submitted under the NC State Health Plan Network Contract.
Bill S 408 (2019-2020)Summary date: May 1 2019 - View summary
Bill S 408 (2019-2020)Summary date: Mar 28 2019 - View summary
Amends GS 135-3(8)c1 concerning the report that is required on beneficiaries of the Retirement System for Teachers and State Employees who retired on an early or service retirement allowance and have been reemployed by an employer participating in the Retirement System and earn the specified triggering amounts. Adds that if the report is not received within the required 90 days, the Board of Trustees may, in addition to the already allowed penalty, (1) require the employer to reimburse the Retirement System for any retirement allowance paid to the beneficiary during the period when the allowance would have been suspended if the report had been timely and (2) require the employer to pay any amounts that the beneficiary would have been required to pay to the Retirement System if the report had been timely. Adds that if the employer must make the payments under these new provisions, then (1) the beneficiary is not obligated to reimburse the Retirement System for the specified related amounts, (2) the provisions of GS 135-9(b) relating to offsetting overpayments against payments made from the Retirement System to the member or beneficiary do not apply, (3) the Retirement System does not have a duty to pursue repayment of overpayments from the beneficiary, (4) the overpayments are not considered a debt of the beneficiary, and (5) the beneficiary's effective date of retirement is to be adjusted if required. Amends GS 128-24(5)c1 to make the same changes to the report required on beneficiaries of the Retirement System for Counties, Cities, and Towns who retired on an early or service retirement allowance and have been reemployed by an employer participating in the system and earn the specified triggering amounts.
Effective July 1, 2020, and applies to reports required to be made on or after that date.
Amends GS 135-7 (concerning the Retirement System for Teachers and State Employees) and GS 128-29 (concerning the Retirement System for Counties, Cities, and Towns) by amending the provisions for the funding of the Legislative Enactment Implementation Arrangement (LEIA) to prohibit the Board of Trustees from directing any employer contributions into the LEIA after November 1, 2026 (was, November 1, 2021).
Enacts new GS 147-75.1 allowing the Department of State Treasurer (Department) to obtain the criminal history of any of the following: (1) a current or prospective permanent or temporary employee of the Department, (2) a contractor with the Department, (3) an employee or agent of a contractor with the Department who is or will perform work for the Department, (4) a volunteer of the Department, (5) any other individual otherwise engaged by the Department who will have access to confidential health or financial information or data maintained by the Department. Allows the Department to deny employment to or dismiss specified individuals who refuse to consent to the record check or to the use of identifying information. Allows the Department of State Treasurer to extend conditional offers of employment record check results.
Enacts new GS 135-48.37B concerning the attachment and garnishment of overpayments and unpaid premiums from individuals no longer employed by the employing unit. Makes the statute applicable to an individual who is no longer employed by an employing unit and to whom: (1) an overpayment or erroneous payment of benefits, claims, or other amounts has been paid on behalf of the individual or individual's dependent by the State Health Plan for Teachers and State Employees (Plan) and the amount owed had not been repaid to the Plan or (2) unpaid premiums are owed by the individual for coverage provided by the Plan to the individual or the individual's dependent. Requires that the Plan give notice to the individual of the amounts owed and give the individual at least 30 days to respond and either repay the amount owed in full or enter into a payment plan. Makes intangible property (including bank deposits, rent, salaries, wages, property held in the Escheat Fund, and any other property incapable of manual levy or delivery) subject to attachment and garnishment in payment of an overpayment, erroneous payment, or unpaid premium due from the individual. Sets out the process for the attachment and garnishment. Caps the amount subject to attachment and garnishment at no more than 10% of an individual's wages or salary. Sets out notice requirements before the Plan may attach and garnish intangible property. Sets out actions and timelines that must be met by a garnishee. Applies to notices of amounts due sent by the Plan on or after October 1, 2019.
Amends GS 135-48.1, which sets out the defined terms for Article 3B, State Health Plan for Teachers and State Employees (Plan). Excepts from the definition of dependent child individuals described in GS 135-48.41(b). Further amends the definition to refer to individuals in the definition.
Amends GS 135-48.41, which sets forth additional Plan eligibility provisions, modifying subsection (b) to allow coverage of a dependent child to continue beyond the dependent child’s 26th birthday if the dependent child is disabled (previously set out specific timelines for the disability to qualify) and the dependent child was covered by the Plan on the dependent child’s 26th birthday (previously, was covered by the Plan in accordance with GS 135-48.40(d)(7), concerning full contributory coverage for certain individuals). Removes the disqualification from coverage for a dependent child that is eligible for employer-based health care outside of the Plan other than the parent’s claim. Adds a new verification requirement of the dependent child’s disability, which must be submitted to the Plan no later than 60 days after the dependent child’s 26th birthday. Explicitly allows a dependent child to be eligible for coverage even if eligible as an employee or retired employee.
Expands GS 135-48.37, subrogating the Plan to all Plan member rights of recovery, including first-party underinsured, MedPay coverage, or third-party insurance, for all medical expenses to the extent the recovery is related to an injury caused by a liable third party. Adds new requirement for all personal injury or wrongful death claims brought by a member or a member’s representative or estate against a third party to include a claim for all medical assistance payments for health care items or services furnished to the member as a result of the injury; deems such a claim that does not include the Plan’s claim to include the Plan’s claim. Makes the Plan’s claim a lien upon any recovery a member or a member’s representative or estate obtains. Makes clarifying changes, specifying that the Plan has the right to first recovery over all nongovernmental medical liens and rights on any amounts recovered related to an injury caused by a liable third party, regardless of the timing of nongovernmental medical liens and rights in relation to the Plan’s liens and rights, who recovered the amount, or how the amount was recovered. Allows the Plan to recover amounts the Plan is entitled to from the member, the member’s representative or estate, or the insurance company (previously, just the member) in the event the member or the member’s representative or estate (previously, just the member) recovers any amount from a liable third party. Makes further changes to make the provisions regarding the Plan’s rights and remedies against members also applicable to members' representatives or estates. Creates a new notification requirement, requiring the members, the member’s representative or estate, or the insurance company to notify the Plan within 14 days of receipt of the proceeds of a settlement or judgment related to a claim under the statute. Further, requires the member, the member’s representative or estate, or the insurance company to distribute the sufficient amount to satisfy the Plan’s lien to the Plan within 30 days of receipt of the proceeds of a settlement or judgment. Provides for the Plan to recover the amount directly through any available remedy. Adds to the prohibition against a lien of the Plan exceeding 50% of the total damages recovered by the member, excluding from the calculation the member’s reasonable and proportionate costs of collection, conclusively determined by the Plan (previously, excluded the member’s reasonable costs of collection only). Adds new provisions providing for situations when liens have priority over the Plan’s right to first recovery. Specifically prohibits the deduction of other liens from the Plan’s right to to recover under the statute. Adds that in the event insufficient funds remain to fully satisfy the Plan’s lien after deducting the member’s or member’s representative or estate’s costs of collection and any priority liens from the total damages recovered, the Plan is entitled to the remaining balance of the total damages recovered.
Enacts GS 135-48.41(l), deeming the date of reemployment as the first hired date for purposes of Plan membership eligibility if an employee or retiree withdraws his or her accumulated contributions and then later is reemployed as an employee. Voids any rights granted under Article 3B relating to the hire date associated with the withdrawn contributions.
Amends GS 135-48.33(a), changing the Plan contracts requiring Board approval from contracts in excess of $500,000 to those in excess of $1 million. Makes conforming changes.
Makes clarifying and organizational changes to the existing language of GS 135-48.25 concerning the adoption of rules by the State Treasurer to implement Article 3B. Modifies and adds the following provisions to the statute. Requires the State Treasurer to provide a written description of a rule adopted pursuant to the statute in a timely manner upon request (previously, the State Treasurer is required to distribute written descriptions of adopted rules to all employing units, all health benefit representatives, all relevant health care providers affected by a rule, and any other persons requesting a written description and approved by the State Treasurer). Deems benefit booklets published by the Department of the State Treasurer (Department) on its website to have the force and effect of rules for the applicable benefit year. Adds a provision defining the scope of the statute.
Repeals GS 135-48.22(3), which grants the Plan’s Board of Trustees the power and duty to oversee administrative reviews and appeals as provided in GS 135-48.24. Amends GS 135-48.24, making conforming changes to remove all references to the Board of Trustees from the administrative review provisions. Further amends GS 135-48.24, removing the requirement for the Executive Administrator to provide a written summary of the decision immediately following its issuance to all specified health benefit entities and interested parties. Adds to the definition of determination as used in the statute. Makes conforming changes to GS 150B-1(e).
Amends GS 135-48.2, which sets forth the State’s undertaking of the Plan for the benefit of eligible individuals. Adds a new provision authorizing the State Treasurer to operate a flexible compensation plan for eligible retired employees and certain of their eligible dependents, including dental and vision health benefit offerings as specified. Makes further technical and clarifying changes.
Amends the definition of claims payment data set out in GS 135-48.1 to include the rate negotiated with or agreed to by the provider reflected in a Claims Data Feed.
Amends GS 135-48.32, requiring the Claims Processor to disclose Claim Payment Data that reflects rates negotiated with or agreed to by a provider (previously, prohibited except to provide documentation to support the payment of claims). Eliminates the prohibition against the Plan using a provider’s Claim Payment Data to negotiate rates, fee schedules, or other master charges with that provider or any other provider. Requires the Plan to provide notice to (rather than obtain the agreement of, as previously required) the Claims Processor for each third party to whom the Plan seeks to disclose Claim Payment Data and for each use the third party will make of the data on the Plan’s behalf.
Includes a severability clause.