AN ACT TO MAKE CLARIFYING AND ADMINISTRATIVE CHANGES TO THE LAWS RELATING TO THE NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES. Enacted July 20, 2017. Effective July 20, 2017, except as otherwise provided.
Summary date: Jul 25 2017 - More information
Summary date: Jun 22 2017 - More information
Senate committee substitute makes the following changes to the 2nd edition.
Amends GS 135-9 (Exemption from garnishment, attachment, etc.). Authorizes overpayment of benefits orerroneous payments to members in specified retirement and disability systems, including benefits paid to, or State Health Plan premiums or claims paid on behalf of, any member or beneficiary who is later determined to have been ineligible for those benefits or unentitled to those amounts, to be offset as currently authorized (this provision already exists in the statute, without the italicized language).
Amends GS 128-31 (Exemptions from execution). Makes changes identical to those in GS 135-9.
Amends GS 120-4.29. Currently, this statute contains a provision that is similar, but not identical, to the provisions discussed above. Amends that provision to make it identical with the above provisions, as amended (adds the Disability Income Plan of North Carolina to the specified retirement and disability systems, and includes benefits paid to, or State Health Plan premiums or claims described above, within the overpayments or erroneous payments).
Amends GS 127A-40. Provides that pensions for National Guard members are not subject to attachment, garnishments, or judgments against the member or former member entitled to them, nor are rights in the fund or pensions or benefits assignable, subject to exceptions within GS 110-136, and in connection with a court-ordered equitable distribution under GS 50-20. Adds a provision identical to the overpayment or erroneous payment offset provisions described above.
Amends proposed GS 135-48.16 (Fraud detection and audit programs). Provides that the plan's authority to examine and make copies of information under (a)(1) is to the extent it directly relates to a specific investigation or audit. Allows for confidentiality agreements with agencies providing documentation to the plan. Amends the information that may be accessed under (a)(2) to refer to the listed information relating to grants or contracts from the federal government that is administered by the State health Plan(italicized text was not in the 2nd edition). Requires authorized representatives assisting the State Health Plan Division Staff to have a HIPAA business associate agreement with the State Health Plan and enter into a HIPAA data sharing agreement with any vendor whose records they copy.
Deletes amendments to GS 135-48.5(a), GS 135-48.22, and GS 135-48.30(a).
Summary date: May 18 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), are 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 specified 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 135-48.30(a)(9) or in accordance with GS 135-48.16 as enacted. Requires disclosure under this provision to be permitted by section 6103 of the Internal Revenue Code.
Directs the Department of Revenue and the Department of the State Treasurer to enter into a confidential sharing agreement settling data protocols, required security measures, audit mechanisms, and the like, so that the two can develop and implement the information exchange authorized by the act. Requires the departments to enter into the confidential information sharing agreement by June 30, 2018.
Adds a new subsection to GS 135-48.41 (Additional eligibility provisions). Provides that a retiree covered under GS 148-19 (health services for prisoners) that is serving an active sentence in the State prison system cannot be eligible for retiree coverage under GS 135-48.40(a)(1), GS 135-48.40(b)(3), GS 135-48.40(c)(2), or GS 135-48.40(d)(11).
Summary date: Mar 8 2017 - More information
Identical to S 218, filed 3/8/17.
Amends GS 135-48.44(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 135-48.40(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 135-48.42(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 135-48.43(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 135-48.5(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 post-employment 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 135-48.22 (Board Powers and Duties) and GS 135-48.30(a) (Powers and Duties of the State Treasurer)
Enacts new GS 135-48.20(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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