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State Treasurer Promotes Health Plan Changes, Despite Member and Legislative Opposition

Elizabeth Yelverton | NCASA Legal Affairs & Policy Manager

The Department of the State Treasurer is moving forward on its proposal to change the NC State Health Plan Network of providers, despite numerous concerns raised by members about the proposal’s potential to limit their access to medical services. The Treasurer’s office sent a newsletter to members on Tuesday stating, “The State Health Plan is changing how it pays providers like doctors and hospitals for the medical services you receive as a Plan member. These changes will take place beginning January 1, 2020, and will only affect members on the 80/20 Plan, the 70/30 Plan and the High Deductible Health Plan.” While the State Treasurer has promoted his “Clear Pricing Project” extensively over past months, implementation of the Project may be delayed if a current, bipartisan House bill is approved in the Senate. House Bill 184, sponsored by Rep. Josh Dobson (R-McDowell), would create a committee to study and report on redesigning the State Health Plan, while also preventing the Treasurer’s office from moving forward on its Clear Pricing Project until December 31, 2020. The Treasurer’s newsletter directly addressed H184, stating, “Until any legislation to the contrary is actually passed by the General Assembly and signed by the Governor, the State Health Plan is moving forward with the Clear Pricing Project as announced.”

While the Treasurer’s proposal will not directly affect member benefits, it will likely create issues for members whose current providers choose not to participate in the new, reference-based model. The model will use Medicare rates as a reference point for medical services, and pay providers a percentage above that rate. Currently, medical providers are not required to provide the Treasurer’s office with information regarding the prices of medical services provided to Plan members, resulting in the Treasurer’s office reimbursing providers in varying amounts for the same services. Under the Treasurer’s proposal, medical providers would need to agree to the new reimbursement rates, allowing the State Health Plan to better project expenses from year to year. While the proposal could help lower overall healthcare costs, it could also create issues for members whose current providers do not agree to participate in the new plan.

The North Carolina Association of School Administrators (NCASA) is monitoring both the Clear Pricing Project, as well as House Bill 184, and will provide members with updates as needed. In the meantime, NCASA members can direct questions and concerns about the Treasurer’s proposal to members of the NC State Health Plan Board of Trustees.

Elizabeth Yelverton