STATE HEALTH PLAN ADMINISTRATIVE CHANGES.-AB

View NCGA Bill Details2017-2018 Session
Senate Bill 218 (Public) Filed Wednesday, March 8, 2017
AN ACT TO MAKE CLARIFYING AND ADMINISTRATIVE CHANGES TO THE LAWS RELATING TO THE NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES.
Intro. by Krawiec, Hise, Pate.

Status: Re-ref to Pensions and Retirement and Aging. If fav, re-ref to Rules and Operations of the Senate (Senate Action) (Apr 27 2017)

SOG comments (1):

Identical bill

Identical to H 299, filed 3/8/17.

S 218

Bill Summaries:

  • Summary date: Apr 6 2017 - More information

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

    Amends GS 135-48.1 (General definitions concerning the State Health Plan for Teachers and State Employees) to define authorized representatives who are assisting the State Health Plan Division staff to mean staff of the Department of the State Treasurer, staff of the Department of Justice, or persons providing internal auditing assistance required under GS 143-746(b). Makes conforming organizational changes.

    Enacts GS 135-48.16, Fraud detection and audit programs.

    Subsection (a) establishes that the State Health Plan, or authorized representatives who are assisting the State Health Plan Division staff, in the course of conducting an investigation or an audit under GS 135-48.30(a)(9), is to have ready access to: (1) persons, books, records, reports, vouchers, correspondence, files, personnel files, investments, and any other documentation of any employing unit, with the Plan having the authority to both examine and make copies of the described information, but limiting the review of State tax returns to matters of official business, and prohibiting the Plan's report from violating the confidentiality provisions of the tax laws and (2) persons, records, papers, reports, vouchers, correspondence, books, and any other documentation that is in the possession of any individual, private corporation, institution, association, board, or other organization that pertain to any benefits received, disbursed, or otherwise handled pursuant to a grant or contract from the federal government, the State, or its political subdivisions, and requiring providers of social and medical services to a beneficiary to make copies of records they maintain for services provided to the beneficiary. 

    Subsection (b) requires providers of social and medical services who provide ready access to the Plan under subdivision (2) of subsection (a) to make copies of records they maintain for services provided to a beneficiary available to the Plan or to the authorized representatives who are assisting the State Health Plan Division staff. Directs the Plan, or authorized representatives who are assisting the State Health Plan Division staff, to request records in writing by providing the name of each beneficiary from whom records are sought, the purpose of the request, the authority for the request, and a reasonable period of time for the production of record copies by the provider. Authorizes a provider to charge, and the Plan or authorized representatives who are assisting the State Health Plan Division staff must, in accordance with GS 90‑411, pay a reasonable fee to the provider for copies of the records provided.

    Subsection (c) directs the Plan to maintain for 10 years a complete file of all compliance investigative reports, fraud investigative reports, and reports of other examinations, investigations, surveys, and reviews issued under the Plan's authority under GS 135-48.30(a)(9). Directs fraud or compliance investigation work papers and other evidence or related supportive material directly pertaining to the work of the State Health Plan Division of the Department of State Treasurer be retained according to an agreement between the Plan and State Archives. Provides that pertinent work papers and other supportive material relating to issued fraud or compliance investigation reports can be, at the discretion of the Executive Administrator of the Plan, and unless otherwise prohibited by law, made available for inspection by duly authorized representatives of the State and federal government who desire access to, and inspection of, those records in connection with some matter officially before them, including criminal investigations. Requires fraud investigation work papers and related supportive material to be kept confidential, including any information developed as a part of the investigation, except as provided in the statute, or upon an order issued in Wake County Superior Court upon 10 days' notice and a hearing finding that access is necessary to a proper administration of justice.

    Amends GS 105-259(b) to allow tax information to be disclosed for the purpose of furnishing the Department of State Treasurer with information it requests related to an investigation or audit under GS 135-6(q), GS 135-48.16, or GS 128-28(r).

    Makes clarifying change to the act's effective provision.


  • Summary date: Mar 8 2017 - More information

    Amends GS 135­48.44(a)(6) to end healthcare coverage for state employees as a result of a false statement or false representation of a material fact regarding eligibility or enrollment information, in addition to the previously specified false statements on the last day of the month.

    Amends GS 135­48.40(c)(2) to clarify that individual retirees shall only pay the balance of the total premiums not paid by the State when not prohibited by law, and that the total premium is the sum of the Plan's total employer premium contribution rate plus the employee's or retiree's contribution for individual and dependent coverage.

    Amends GS 135­48.42(a) to automatically cover children born to covered employees at the time of birth so long as the Plan receives notification within 30 days of the date of birth and the employee pays any additional premium required by the coverage type selected retroactive to the first day of the month in which the child was born (currently allows covered employees to switch from the coverage outlined in GS 135­48.43(d), type (1), to type (2) or (3) upon the birth of a child). Effective October 1, 2017, and applies to children born to covered employees on or after that date.

    Amends GS 135­48.5(a) to change the order of use for unencumbered balances in excess of prepaid premiums or charges in the Public Employee Health Benefit Fund. The unencumbered balance is first used to provide an actuarially determined Health Benefit Reserve Fund for incurred but unpresented claims; secondly, up to 50% of any remaining unencumbered balance may be set aside by the State Treasurer, subject to approval by the Board of Trustees of the State Health Plan for Teachers and State Employees (Board of Trustees), to reduce the State's unfunded actuarial accrued liability for post­employment retiree health benefits; thirdly, to reduce premiums required in providing the benefits of the health benefits programs; and fourthly, to improve the plan as may be provided by the State Treasurer, subject to approval by the Board of Trustees.

    Makes conforming changes to GS 135­48.22 (Board Powers and Duties) and GS 135­48.30(a) (Powers and Duties of the State Treasurer)

    Enacts new GS 135­48.20(n), protecting persons serving on the Board of Trustees from civil liability for monetary damages for any act, or failure to act, arising from that service, except where the person was not acting within the scope of their official duties, was not acting in good faith, committed gross negligence or willful or wanton misconduct resulting in damages or injury, derived an improper personal financial benefit from the transaction, or incurred the liability from the operation of a motor vehicle.


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