GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2015
S 1
SENATE BILL 865
Short Title: State Health Plan/Admin Changes/Local Govts. |
(Public) |
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Sponsors: |
Senators Sanderson (Primary Sponsor); J. Davis and Rabin. |
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Referred to: |
Insurance |
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May 11, 2016
A BILL TO BE ENTITLED
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.
The General Assembly of North Carolina enacts:
SECTION 1. G.S. 135‑48.32 reads as rewritten:
"§ 135‑48.32. Contracts to provide benefits.
The Plan benefits shall be provided
under contracts between the Plan and the claims processors selected by the
Plan. The State Treasurer may contract with a pharmacy benefits manager to
administer pharmacy benefits under the Plan. Such contracts shall include the
applicable provisions of this Article and the description of the Plan in the
request for proposal, and shall be administered by the respective claims
processor or Pharmacy Benefits Manager, which will determine benefits and other
questions arising thereunder. The contracts necessarily will conform to
applicable State law. Claims processor contractors shall provide all claims
processing data elements to the Plan including the identification of providers
and the allowed amounts paid. If any of the provisions of this Article
and the request for proposals must be modified for inclusion in the contract
because of State law, such modification shall be made. The State Treasurer
shall ensure that the terms of the contract between the Plan and the Plan's
Claims Processing Contractor, the Pharmacy Benefit Manager, and the Disease
Management Contractor require the contractor to provide the following:
(1) Detailed billing by each entity showing itemized
cost information, including individual administrative services provided;
(2) Transactional data; and
(3) The cost to the Plan for each administrative
function performed by the contractor."
SECTION 2. G.S. 135‑48.34 reads as rewritten:
"§ 135‑48.34. Contracts not subject to Article 3
of Chapter 143 of the General Statutes.Contract exemptions.
The design, adoption, and implementation
of the preferred provider contracts, networks, and optional alternative
comprehensive health benefit plans, and programs available under the optional
alternative plans, as authorizedContracts
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, as authorized under G.S. 135‑48.2, are not subject to the
requirements of Article 3 of Chapter 143 of the General Statutes,Statutes
or to the requirements of Parts 3 or 4 of Article 15 of Chapter 143B of the
General Statues, but are subject to the requirements of G.S. 135‑48.33."
SECTION 3. G.S. 135‑47(c) reads as rewritten:
"(c) Enrollment
Limitation. – Local governments may elect to participate until the number of
employees and dependents of employees of local governments enrolled in the Plan
reaches 10,000,20,000 after which time no additional local
governments may join the Plan. Any local government electing to participate
must have less than 1,000 employees and dependents enrolled in health coverage
at the time the local government provides notice to the Plan of its desire to
participate."
SECTION 4. G.S. 135‑48.47(b)(3) reads as rewritten:
"(3) A local government
unit shall determine the eligibility of its employees and employees' dependents
and what portion of the premiums employees will pay to the local government
unit.dependents. The portion of the employee and employees' dependents
premiums paid to the local government unit may be determined by the local
government unit but may not exceed the premiums in the structure set by the
Plan."
SECTION 5. G.S. 135‑48.47 is amended by adding a new subsection to read:
"(d) Local governments participating in the Plan as of April 1, 2016, may elect to withdraw from participating in the Plan effective January 1, 2017. Notice of withdrawal must be given by the local government to the Plan no later than October 1, 2016."
SECTION 6. Part 4 of Article 3B of Chapter 135 of the General Statutes is amended by adding a new section to read:
"§ 135‑48.49. IRC sections 6055 and 6066 regulatory reporting.
The Plan shall be responsible for reporting coverage for retirees and coverage for direct bill members, except for individuals participating in Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage, as required by section 6055 of the Internal Revenue Code. The Plan shall provide employing units with access to Plan data necessary for employing units to meet filing requirements under sections 6055 and 6056 of the Internal Revenue Code. The Plan may facilitate the availability of a reporting solution; however, the employing unit is responsible for paying all costs associated with the use of any reporting solution made available by the Plan."
SECTION 7. Section 4 of this act becomes effective January 1, 2017, and applies to premiums paid on or after that date. The remainder of this act is effective when it becomes law and applies to contracts entered into, renewed, or amended on or after that date.