SB 218 — State Health Plan Administrative Changes.-AB

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2017 S 21 SENATE BILL 218* Health Care Committee Substitute Adopted 4/6/17 Short Title:

Senators Krawiec, Hise, and Pate (Primary Sponsors).

Rules and Operations of the Senate March 9, 2017 A BILL TO BE ENTITLED AN ACT TO MAKE CLARIFYING AND ADMINISTRATIVE CHANGES TO THE LAWS RELATING TO THE NORTH CAROLINA STATE HEALTH PLAN FOR TEACHERS AND STATE EMPLOYEES.

"(a) Except as otherwise required by applicable federal law, new employees must be given the opportunity to enroll or decline enrollment for themselves and their dependents within 30 days from the date of employment or from first becoming eligible on a partially *S218-v-2* General Assembly Of North Carolina Session 2017 contributory or other contributory basis.

Coverage may become effective on the first day of the month following date of *S218-v-1* General Assembly Of North Carolina Session 2017 entry on payroll or on the first day of the following month.

Page 2 Senate Bill 218*-Second Edition General Assembly Of North Carolina Session 2017 "(18) Set aside funds from the Public Employee Health Benefit Fund to reduce the State unfunded actuarial accrued liability for post-employment retiree health Page 2 Senate Bill 218*-First Edition General Assembly Of North Carolina Session 2017 benefits as provided in G.S.

G.S.This act is effective when it becomes law.

135-48.1Senate readsBill as218*-First rewritten:Edition Page 3

"§ 135-48.1.

General definitions.

As used in this Article unless the context clearly requires otherwise, the following definitions apply:

(1) Authorized representatives who are assisting the State Health Plan Division staff.

– Staff of the Department of the State Treasurer, staff of the Department of Justice, or persons providing internal auditing assistance required under G.S.

143-746(b).

(1a) Benefit period.

– The period of time during which charges for covered services provided to a Plan member must be incurred in order to be eligible for payment by the Plan.

…." SECTION 9.

Part 1 of Article 3B of Chapter 135 of the General Statutes is amended by adding a new section to read:

"§ 135-48.16.

Fraud detection and audit programs.

(a) Access to Persons and Records.

– In the course of conducting an investigation or a audit under G.S.

135-48.30(a)(9), the Plan, or authorized representatives who are assisting the State Health Plan Division staff, shall have ready access to the following:

(1) Persons, books, records, reports, vouchers, correspondence, files, personnel files, investments, and any other documentation of any employing unit.

The Plan shall have the authority to both examine and make copies of the information described in this subdivision.

The review of State tax returns shall be limited to matters of official business, and the Plan's report shall not violate the confidentiality provisions of the tax laws.

(2) Persons, records, papers, reports, vouchers, correspondence, books, and any other documentation that is in the possession of any individual, private corporation, institution, association, board, or other organization that pertain to any benefits received, disbursed, or otherwise handled pursuant to a grant or contract from the federal government, the State, or its political subdivisions.

Providers of social and medical services to a beneficiary shall make copies of records they maintain for services provided to the beneficiary.

(b) Records of Providers of Social and Medical Services.

– Providers of social and medical services who provide ready access to the Plan under subdivision (2) of subsection (a) Senate Bill 218*-Second Edition Page 3 General Assembly Of North Carolina Session 2017 of this section shall make copies of records they maintain for services provided to a beneficiary available to the Plan or to the authorized representatives who are assisting the State Health Plan Division staff.

The Plan, or authorized representatives who are assisting the State Health Plan Division staff, shall request records in writing by providing the name of each beneficiary from whom records are sought, the purpose of the request, the authority for the request, and a reasonable period of time for the production of record copies by the provider.

A provider may charge, and the Plan, or authorized representatives who are assisting the State Health Plan Division staff, shall, in accordance with G.S.

90-411, pay a reasonable fee to the provider for copies of the records provided.

(c) Fraud Detection and Audit Reports and Work Papers.

– The Plan shall maintain for 10 years a complete file of all compliance investigative reports, fraud investigative reports, and reports of other examinations, investigations, surveys, and reviews issued under the Plan's authority under G.S.

135-48.30(a)(9).

Fraud or compliance investigation work papers and other evidence or related supportive material directly pertaining to the work of the State Health Plan Division of the Department of State Treasurer shall be retained according to an agreement between the Plan and State Archives.

To promote intergovernmental cooperation and avoid unnecessary duplication of fraud investigative effort, and notwithstanding local unit personnel policies to the contrary, pertinent work papers and other supportive material relating to issued fraud or compliance investigation reports may be, at the discretion of the Executive Administrator of the Plan, and unless otherwise prohibited by law, made available for inspection by duly authorized representatives of the State and federal government who desire access to, and inspection of, such records in connection with some matter officially before them, including criminal investigations.

Except as provided in this section, or upon an order issued in Wake County Superior Court upon 10 days' notice and hearing finding that access is necessary to a proper administration of justice, fraud investigation work papers and related supportive material shall be kept confidential, including any information developed as a part of the investigation." SECTION 10.

G.S.