HB 184 – Study State Health Plan Design

HB 184 – Study State Health Plan Design

Primary Sponsors: Rep. Josh Dobson (R-Avery), Rep. Julia Howard (R-Davie), Rep. William Brisson (R-Baden), Rep. Gale Adcock (D-Wake)

This bill would create a commission to study the design of the State Health Plan, offering the opportunity for an in-depth analysis to ensure future solvency of the plan while simultaneously striving to improve the health of every plan member.

The Committee would consist of the following members:

  • 4 members of the House appointed by the Speaker of the House
  • 4 members of the Senate appointed by the President Pro Tempore of the Senate
  • The Executive Administrator of the State Health Plan
  • 1 member appointed by North Carolina Medical Society
  • 1 member appointed by the North Carolina Healthcare Association
  • 1 member appointed by the North Carolina Nurses Association
  • 1 member appointed by the State Employees Association of North Carolina
  • 1 member appointed by the Retired Government Employees Association of NC
  • 1 member appointed by the North Carolina Association of Educators
  • 1 member appointed by the North Carolina Psychiatry Association

The Committee in developing a recommend design for the State Health Plan shall consider all of the following:

  • Pricing that is referenced to other payment models
  • Other payment models that have been implemented and have shown to reduce costs without compromising care
  • Methods to ensure transparency with regards to price and costs for employees/dependents
  • Appropriate employee/family premiums that are appropriate without an increase in premium.
  • Incentive programs to encourage primary care utilization
  • Virtual health options
  • Joining the State Health with other State-funded plans
  • Payments of subsidies for buying individual plans on the marketplace
  • Data that comparing 5 year history of actual costs to the plan vs. anticipated costs/spending projections
  • Claims data
  • Demographic data of plan subscribers, including cost drivers

The Committee shall submit a final report by April 1, 2020.

The bill states that from January 1, 2019 through December 31, 2021 the State Health Plan would continue to utilize the Blue Cross Blue Shield of NC Blue Options provider network and reimburse participating network providers with 100 percent of the fee schedule. No reference based pricing model could be used during this time period. This would not apply to Medicare advantage plans.

 

 
 

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