GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2011
S 1
SENATE BILL 265
Short Title: Transfer State Health Plan to State Treasurer. |
(Public) |
|
Sponsors: |
Senators Apodaca, Brunstetter, Hartsell; and Hise. |
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Referred to: |
Pensions & Retirement and Aging. |
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March 9, 2011
A BILL TO BE ENTITLED
AN ACT TO TRANSFER the NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES TO THE Department of State Treasurer.
The General Assembly of North Carolina enacts:
SECTION 1. The North Carolina State Health Plan for Teachers and State Employees is transferred to the Department of State Treasurer. This transfer shall have all the elements of a Type II transfer, as defined by G.S. 143A-6.
SECTION 2. G.S. 135-43(b) reads as rewritten:
"§ 135-43. Confidentiality of information and medical records; provider contracts.
(b) Notwithstanding the provisions of this Article, the Executive Administrator and Board of Trustees of the State Health Plan for Teachers and State Employees may contract with providers of institutional and professional medical care and services to establish preferred provider networks.
The terms of a contract between the Plan and its third party
administrator or between the Plan and its pharmacy benefit manager are a public
record except that the terms in those contracts that contain trade secrets or
proprietary or competitive information are not a public record under Chapter
132 of the General Statutes, and any such proprietary or competitive
information and trade secrets contained in the contract shall be redacted by
the Plan prior to making it available to the public. This subsection shall not
be construed to prevent or restrict the release of any information made not a
public record under this subsection to the State Treasurer, the State
Auditor, the Attorney General, the Director of the State Budget, the Plan's
Board of Trustees, and the Plan's Executive Administrator, and the
Committee on Employee Hospital and Medical BenefitsAdministrator
solely and exclusively for their use in the furtherance of their duties and
responsibilities, and to the Department of Health and Human Services solely for
the purpose of implementing the transition of NC Health Choice from the Plan to
the Department of Health and Human Services. 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 authorized under G.S. 135-45 are not
subject to the requirements of Article 3 of Chapter 143 of the General
Statutes. The Executive Administrator and Board of Trustees shall make reports
as requested to the President of the Senate, the President Pro Tempore of the
Senate, the Speaker of the House of Representatives, and the Committee on
Employee Hospital and Medical Benefits.State Treasurer."
SECTION 3. G.S. 135-43.1 is repealed.
SECTION 4. G.S. 135-43.2 is repealed.
SECTION 5. G.S. 135-43.3 reads as rewritten:
"§
135-43.3. Oversight team.Oversight.
(a) The
Committee on Employee Hospital and Medical Benefits The General Assembly
may use employees of the Legislative Services Office and may employ
contractual services as approved by the Legislative Services Commission to
monitor the Executive Administrator and Board of Trustees, the Claims
Processor, and the Comprehensive Major Medical Plan.State Health Plan
for Teachers and State Employees. The Director of the Budget may use
employees of the Office of State Budget and Management to monitor the Executive
Administrator and Board of Trustees, the Claims Processor, and the Comprehensive
Major Medical Plan. State Health Plan for Teachers and State Employees.Employees
authorized by the Legislative Services Commission and the Director of the
Budget to provide assistance to the Committee on Employee Hospital and Medical
Benefits and to the Director of the Budget shall comprise an oversight team.
(b) The oversight
team shall, jointly or individually,Director of the Budget and the State
Treasurer or their designees and the employees of the Legislative Services
Office shall have access to all records of the Board of Trustees, the
Executive Administrator, the Claims Processor, and the Plan. The oversight
team shall, jointly or individually,Director of the Budget and the State
Treasurer or their designees and the employees of the Legislative Services
Office shall be entitled to attend all meetings of the Board of Trustees.
(c) The
oversight team shall report to the Committee on Employee Hospital and Medical
Benefits when requested by the Committee."
SECTION 6. G.S. 135-43.6 reads as rewritten:
"§ 135-43.6. Reports to the General Assembly.
The Executive Administrator and Board of Trustees shall
report to the General Assembly at such times and in such forms as shall be
designated by the Committee on Employee Hospital and Medical Benefits.the
President Pro Tempore of the Senate and the Speaker of the House of
Representatives."
SECTION 7. G.S. 135-44.2 reads as rewritten:
"§ 135-44.2. Executive Administrator.
(a) The Plan shall have an Executive Administrator and a Deputy Executive Administrator. The Executive Administrator and the Deputy Executive Administrator positions are exempt from the provisions of Chapter 126 of the General Statutes as provided in G.S. 126-5(c1).
(b) The Executive
Administrator shall be appointed by the State Health Plan Administrative
Commission.State Treasurer. The term of employment and salary of the
Executive Administrator shall be set by the State Health Plan Administrative
Commission upon the advice of an executive committee of the Committee on
Employee Hospital and Medical Benefits.State Treasurer.
The Executive Administrator may be removed from office by the
State Health Plan Administrative Commission, upon the advice of an executive
committee of the Committee on Employee Hospital and Medical Benefits,State
Treasurer, and any vacancy in the office of Executive Administrator may be
filled by the State Health Plan Administrative Commission with the term of
employment and salary set upon the advice of an executive committee of the
Committee on Employee Hospital and Medical Benefits.State Treasurer.
(c) The Executive
Administrator shall appoint the Deputy Executive Administrator and may employ
such clerical and professional staff, and such other assistance as may be
necessary to assist the Executive Administrator and the Board of Trustees in
carrying out their duties and responsibilities under this Article. The
Executive Administrator may designate managerial, professional, or
policy-making positions as exempt from the State Personnel Act. The Executive
Administrator may also negotiate, renegotiate and execute contracts with third
parties in the performance of the Executive Administrator's duties and
responsibilities under this Article; provided any contract negotiations,
renegotiations and execution with a Claims Processor, with an optional
alternative comprehensive health benefit plan, or program thereunder,
authorized under G.S. 135-45, with a preferred provider of institutional
or professional hospital and medical care, or with a pharmacy benefit manager
shall be done only after consultation with the Committee on Employee
Hospital and Medical Benefits.State Treasurer.
(d) The Executive Administrator shall be responsible for:
(1) Cost management programs;
(2) Education and illness prevention programs;
(3) Training programs for Health Benefit Representatives;
(4) Membership functions;
(5) Long-range planning;
(6) Provider and participant relations; and
(7) Communications.
Managed care practices used by the Executive Administrator in cost management programs are subject to the requirements of G.S. 58-3-191, 58-3-221, 58-3-223, 58-3-235, 58-3-240, 58-3-245, 58-3-250, 58-3-265, 58-67-88, and 58-50-30.
(e) The Executive
Administrator shall make reports and recommendations on the Plan to the
President of the Senate, the Speaker of the House of Representatives and the
Committee on Employee Hospital and Medical Benefits.Representatives."
SECTION 7.1. G.S. 135-44.4(31) reads as rewritten:
"§ 135-44.4. Powers and duties of the Executive Administrator and Board of Trustees.
The Executive Administrator and Board of Trustees of the Teachers' and State Employees' Comprehensive Major Medical Plan shall have the following powers and duties:
…
(31) The Plan shall conduct a
monthly review of Plan costs as compared to the same month in the immediately
preceding year and a comparison of projected costs and savings to actual costs
and savings. The Plan shall report the results of the review to the Committee
on Employee Hospital and Medical Benefits and the State Health Plan Blue Ribbon
Task Force State Treasurer and the General Assembly at least semiannually."
SECTION 7.2. G.S. 135-44.6(a) reads as rewritten:
"§ 135-44.6. Premiums set.
(a) The Executive
Administrator and Board of Trustees shall, from time to time, recommend to the
General Assembly the establishment or adjustment of premium rates for the Plan
and based on premium rates enacted by the General Assembly shall adopt rules
for payment of the premiums. Premium rates shall be established for coverages
where Medicare is the primary payer of health benefits separate and apart from the
rates established for coverages where Medicare is not the primary payer of
health benefits. The amount of State funds contributed for optional coverage
for employees and retirees on a partially contributory basis shall not be more
than the Plan's total noncontributory premium for Employee Only coverage, with
the person selecting the coverage paying the balance of the partially
contributory premium not paid by the Plan. The amount of State funds
contributed shall not exceed the Plan's cost for Employee Only coverage. The
Executive Administrator and Board of Trustees shall not impose a partially
contributory premium until after it has consulted on the premium and the
optional coverage design with the Committee on Employee Hospital and Medical
Benefits.State Treasurer."
SECTION 8. G.S. 135-44.7(a) reads as rewritten:
"§ 135-44.7. Administrative review.
(a) If, after
exhaustion of internal appeal handling as outlined in the contract with the
Claims Processor any person is aggrieved, the Claims Processor shall bring the
matter to the attention of the Executive Administrator and Board of Trustees,
which shall promptly decide whether the subject matter of the appeal is a
determination subject to external review under Part 4 of Article 50 of Chapter
58 of the General Statutes. The Executive Administrator and Board of Trustees
shall inform the aggrieved person and the aggrieved person's provider of the
decision and shall provide the aggrieved person notice of the aggrieved
person's right to appeal that decision as provided in this subsection. If the
Executive Administrator and Board of Trustees decide that the subject matter of
the appeal is not a determination subject to external review, then the
Executive Administrator and Board of Trustees may make a binding decision on
the matter in accordance with procedures established by the Executive
Administrator and Board of Trustees. The Executive Administrator and Board of
Trustees shall provide a written summary of the decisions made pursuant to this
section to all employing units, all health benefit representatives, the
oversight teamagencies provided for in G.S. 135-43.3, all
relevant health care providers affected by a decision, and to any other parties
requesting a written summary and approved by the Executive Administrator and
Board of Trustees to receive a summary immediately following the issuance of a
decision. A decision by the Executive Administrator and Board of Trustees that
a matter raised on internal appeal is a determination subject to external review
as provided in subsection (b) of this section may be contested by the aggrieved
person under Chapter 150B of the General Statutes. The person contesting the
decision may proceed with external review pending a decision in the contested
case under Chapter 150B of the General Statutes."
SECTION 9. G.S. 135-44.8 reads as rewritten:
"§ 135-44.8. Rules.
The Executive Administrator and Board of Trustees may adopt
rules to implement Parts 2, 3, 4, and 5 of this Article. The Executive
Administrator and Board of Trustees shall provide to all employing units, all
health benefit representatives, the oversight teamagencies
provided for in G.S. 135-43.3, all relevant health care providers affected
by a rule, and to any other persons requesting a written description and approved
by the Executive Administrator and Board of Trustees written notice and an
opportunity to comment not later than 30 days prior to adopting, amending, or
rescinding a rule, unless immediate adoption of the rule without notice is
necessary in order to fully effectuate the purpose of the rule. Rules of the
Board of Trustees shall remain in effect until amended or repealed by the
Executive Administrator and Board of Trustees. The Executive Administrator and
Board of Trustees shall provide a written description of the rules adopted
under this section to all employing units, all health benefit representatives,
the oversight teamagencies provided for in G.S. 135-43.3,
all relevant health care providers affected by a rule, and to any other persons
requesting a written description and approved by the Executive Administrator
and Board of Trustees on a timely basis. Rules adopted by the Executive
Administrator and Board of Trustees to implement this Article are not subject
to Article 2A of Chapter 150B of the General Statutes."
SECTION 10. G.S. 135-45.7 reads as rewritten:
"§ 135-45.7. Prior approval procedures.
The Executive Administrator and Board of Trustees may
establish procedures to require prior medical approval and may implement the
procedures after consultation with the Committee on Employee Hospital and
Medical Benefits.State Treasurer."
SECTION 11. G.S. 135-45.10(d) reads as rewritten:
"§ 135-45.10. Persons eligible for Medicare; optional participation in other Medicare products.
…
(d) Notwithstanding
the foregoing provisions of this section or any other provisions of the Plan,
the Executive Administrator and Board of Trustees may enter into negotiations
with the Centers for Medicare and Medicaid Services, U.S. Department of Health
and Human Services, in order to secure a more favorable coordination of the
Plan's benefits with those provided by Medicare, including but not limited to,
measures by which the Plan would provide Medicare benefits for all of its
Medicare-eligible members in return for adequate payments from the federal
government in providing such benefits. Should such negotiations result in an
agreement favorable to the Plan and its Medicare-eligible members, the
Executive Administrator and Board of Trustees may, after consultation with the Committee
on Employee Hospital and Medical Benefits,State Treasurer, implement
such an agreement which shall supersede all other provisions of the Plan to the
contrary related to its payment of claims for Medicare-eligible members."
SECTION 12. G.S. 135-45.11 reads as rewritten:
"§ 135-45.11. Cost-savings initiatives and incentive programs authorized.
(a) Cost-Saving
Initiatives. - Coverage of Over-the-Counter Medications. - The Executive
Administrator and Board of Trustees may authorize coverage for over-the-counter
medications as recommended by the Plan's pharmacy and therapeutics committee.
In approving for coverage one or more over-the-counter medications, the
Executive Administrator and Board of Trustees shall ensure that each recommended
over-the-counter medication has been analyzed to ensure medical effectiveness
and Plan member safety. The analysis shall also address the financial impact on
the Plan. The Executive Administrator and Board of Trustees may impose a
co-payment to be paid by each covered individual for each packaged
over-the-counter medication. The Executive Administrator and Board of Trustees
may adopt policies establishing limits on the amount of coverage available for
over-the-counter medications for each covered individual over a 12-month
period. Prior to implementing policy and co-payment changes authorized under
this section, the Executive Administrator and Board of Trustees shall submit
the proposed policies and co-payments to the Committee on Employee Hospital
and Medical Benefits State Treasurer for its review.
(b) Incentive
Programs. - For the purposes of helping Plan members to achieve and maintain a
healthy lifestyle without impairing patient care, and to increase cost
effectiveness in Plan coverage, the Executive Administrator and Board of
Trustees may adopt programs offering incentives to Plan members to encourage
changes in member behavior or lifestyle designed to improve member health and
promote cost-efficiency in the Plan. Participation in one or more incentive
programs is voluntary on the part of the Plan member. Before adopting an
incentive program, the Executive Administrator and Board of Trustees shall
conduct an impact analysis on the proposed incentive program to determine (i)
whether the program is likely to result in significant member satisfaction,
(ii) that it will not adversely affect quality of care, and (iii) whether it is
likely to result in significant cost savings to the Plan. The impact analysis
may be conducted by a committee of the Plan, in conjunction with the Plan's
consulting actuary, provided that the Plan's medical director participates in
the analysis. An approved incentive plan may provide for a waiver of
deductibles, co-payments, and coinsurance required under this Article in order
to determine the effectiveness of the incentive program in promoting the health
of members and increasing cost-effectiveness to the Plan. The Executive
Administrator and Board of Trustees shall, before implementing incentive
programs authorized under this section, submit the proposed programs to the Committee
on Employee Hospital and Medical BenefitsState Treasurer for
review."
SECTION 13. G.S. 135-45.13(b) reads as rewritten:
"§ 135-45.13. Conversion.
…
(b) The Executive
Administrator and Board of Trustees shall provide for the continuation of
conversion privilege exercised under the predecessor plan, on a fully
contributory basis. The Executive Administrator and Board of Trustees shall
consult with the Committee on Employee Hospital and Medical Benefits State
Treasurer before taking action under this subsection."
SECTION 14. This act becomes effective September 1, 2011.