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)

Bill Summary

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.

Bill Movement

This bill was filed on February 26, 2019.

This bill was referred to the following House Committees:

  • Health – March 26, 2019
    • Rep. Cynthia Ball (D-Wake) introduced amendment was introduced to move the timeline to December.
    • The amendment also added an extra member of the State Employee’s Association to the study committee.
    • The amendment passed and will be included in the bill.
    • Rep. Phil Shepherd (R-Onslow) called for division (raise of hands instead of a voice vote) for the bill.
    • This bill passed and will now move to Insurance Committee.
  • Insurance
    • The referral to Insurance was stricken on March 26, 2019.
  • Rules
    • This bill passed the House Rules Committee on April 1, 2019.

This bill was heard on the House floor on April 3, 2019.

Rep. Speciale (R-Craven) introduced an amendment (A1) to remove the section to stop the reference based pricing implementation.

  • This amendment failed with a vote of 23-88.

Rep. Speciale (R-Craven) introduced an amendment (A3) to allow the State Treasurer to be a voting member of the Study Committee.

  • This amendment passed with a vote of 106-5.

This bill passed with a vote of  75-36.

This bill will now move to the Senate.