STATE HEALTH PLAN ADMIN. CHANGES.

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View NCGA Bill Details2015-2016 Session
House Bill 1121 (Public) Filed Tuesday, May 10, 2016
AN ACT TO MAKE ADMINISTRATIVE CHANGES TO THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES STATUTES AND TO MAKE CHANGES TO STATE HEALTH PLAN PREMIUMS PAID BY LOCAL GOVERNMENT EMPLOYEES.
Intro. by Dobson.

Status: Ref To Com On State Personnel (House Action) (May 11 2016)

Bill History:

H 1121

Bill Summaries:

  • Summary date: May 11 2016 - View Summary

    Amends GS 135-48.32 concerning contracts for plan benefits, deleting almost the entirety of the section which authorized the State Treasurer to contract with pharmacy benefits managers to administer pharmacy benefits under the State Health Plan (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 claims processor contractors will provide all claims processing data elements to the Plan, including identification of providers and allowed amounts paid. 

    Amends GS 135-48.34, changing the catchline of the section to Contract Exemptions (was, Contracts not subject to Article 3 of Chapter 143 of the General Statutes), and adds new language updating which contracts authorized under GS 135-48.2, State Health Plan, are not subject to the requirements of Article 3 of GS 143, Purchase, including 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. Further adds that these type of contracts are also not subject to the requirements of Parts 3 or 4 of Article 15 of GS Chapter 143B, concerning IT project management and procurement. 

    Amends GS 135-48.47(b)(3) providing that local government units participating in the plan can determine eligibility of employees and their dependents, however the portion that the employee or dependent pays to the local government cannot exceed the premiums set by the Plan (previously, did not include such a limit on premiums charged). Effective January 1, 2017.

    Enacts new GS 135-48.47(d) concerning local governments participating in the Plan, providing that local governments participating in the Plan as of April 1, 2016, can elect to withdraw effective January 1, 2017. Requires a notice of withdrawal to be given to the Plan no later than October 1, 2016.  

    Enacts GS 135-48.49, IRC sections 6055 and 6066 regulatory reporting, providing that the Plan is responsible for reporting coverage for retirees and direct bill members except those participating in Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage. Specifies other responsibilities and requirements for filing and regulatory reporting.