SB 174/HB 169 – State Health Plan Data Transparency
Primary Senate Sponsors: Sen. Joyce Krawiec (R-Davie, Forsyth); Sen. Jim Burgin (R-Harnett, Johnston, Lee); Sen. Jim Perry (R-Lenoir, Wayne)
Primary House Sponsors: Rep. Edward Goodwin (R-Bertie, Camden, Chowan, Perquimans, Tyrrell, Washington); Rep. Larry Potts (R-Davidson); Rep. Terence Everitt (D-Wake); Rep. Allison Dahle (D-Wake)
Summary
This bill makes a series of amendments to provisions governing the State Health Plan for Teachers and State Employees including the following:
- Revises definition of “Claims Payment Data” to include the rate negotiated with or agreed to by the provider.
- Requires the Claims Processor to disclose the Claims Payment Data on a member level for claims paid with State funds.
- Exempts Claims Payment Data from public record.
- Removes language prohibiting the Plan from using Claim Payment Data to negotiate rates, fee schedules, or other master charges with providers.
- Permits the Plan to disclose Claim Payment Data to a third party to use on the Plan’s behalf if the Plan provides notice to the Claims Processor.
Movement
SB 174
Filed 3/2/2021
HB 169
Filed – 2/25/2021
This bill was referred to the following House committees:
-State Government
-Pensions and Retirement
-Rules Calendar and Operations