Bill Summary for S 865 (2015-2016)

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Summary date: 

Jun 29 2016

Bill Information:

View NCGA Bill Details2015-2016 Session
Senate Bill 865 (Public) Filed Tuesday, May 10, 2016
AN ACT TO MAKE ADMINISTRATIVE CHANGES TO THE STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES STATUTES, TO INCREASE THE NUMBER OF LOCAL GOVERNMENTS ABLE TO PARTICIPATE IN THE STATE HEALTH PLAN, AND TO MAKE CHANGES TO STATE HEALTH PLAN PREMIUMS PAID BY LOCAL GOVERNMENT EMPLOYEES.
Intro. by Sanderson.

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Bill summary

House committee substitute makes the following changes to the 2nd edition.

Amends GS 135-48.1, definitions for the State Health Plan (Plan), adding and defining the terms Claims Data Feed and Claim Payment Data.

Amends GS 135-48.10(a) concerning the confidentiality of specified information and records in possession of the State Health Plan for Teachers and State Employees or other parties as specified, adding language to provide that Claims Payment Data and materials derived from Claims Payment Data are considered confidential and exempt from public records laws under GS Chapter 132.

Amends GS 135-48.32 concerning contracts for plan benefits, deleting almost the entirety of the provisions that authorized the State Treasurer to contract with pharmacy benefits managers to administer pharmacy benefits under the 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 the Claims Processor will provide all claims processing data elements to the Plan, including identification of providers and allowed amounts paid. Requires Claim Processors to provide the Plan with a Claim Data Feed, at least monthly. Enacts several new subsections setting out provisions governing Claims Processors and governing the use of Claims Payment Data, including allowing Claims Processors to withhold information that reflects rates negotiated with or agreed to by a third party, as long as sufficient documentation to support the payment of claims is provided. Requires certain contract provisions between a Claims Processor and medical provider or other specified third parties void and unenforceable to the extent it prevents the disclosure of required Claims Payment Data. Specifies correct and permissible uses of Claims Payment Data. Exempts Claims Processors that disclose Claims Payment Data in accordance with the regulations from civil liability or equitable relief. 

Amends the effective date provisions, providing that as the remainder of the act is effective when it becomes law, it applies to contracts entered into on or after that date.