GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1997

S	1 

SENATE BILL 972

Short Title:  Managed Care Policy Board.	(Public)

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Sponsors: Senators Winner; Cooper, Gulley, Hartsell, and Rand.

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Referred to:  Commerce.

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April 21, 1997

A BILL TO BE ENTITLED
AN ACT TO ESTABLISH THE MANAGED CARE POLICY BOARD.
The General Assembly of North Carolina enacts:
Section 1. Chapter 58 of the General Statutes is amended by adding the following new Article to read:
"ARTICLE 68B.
"Managed Care Policy Board.
"§ 58-68B-1.  Managed Care Policy Board created; membership; terms.
(a)	As used in this Article, the term 'managed care plan' means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with, or employed by a health carrier that provides a plan of health insurance, health benefits, or health services.
(b)	There is created the Managed Care Policy Board.  The purposes of the Board are to:
(1)	Monitor the development, implementation, and regulation of managed care plans; and
(2)	Make recommendations to the Governor, the General Assembly, and the Commissioner of Insurance on managed care information reporting requirements, and monitor the criteria developed for the analysis and public dissemination of this information.
The Board shall be established within the Department of Insurance for administrative, organizational, and budgetary purposes only.  The Department of Insurance shall provide administrative and staff support to the Board and shall also  provide technical assistance as requested by the Board.
(b)	The Board shall consist of 20 members as follows:
(1)	Five members appointed by the Governor, one of whom shall be a consumer with no financial ties to the managed care industry, one of whom shall be a health care provider, one of whom shall be a purchaser of health insurance, and one of whom shall be a public health professional with expertise in quality assessment and improvement or health services research.  One of these appointees shall serve an initial term of one year, two shall serve an initial term of two years, and two shall serve an initial term of three years;
(2)	Five members appointed by the General Assembly upon the recommendation of the President Pro Tempore of the Senate, one of whom shall be a consumer with no financial ties to the managed care industry, one of whom shall be a health care provider, one of whom shall be a purchaser of health insurance, and one of whom shall be a public health professional with expertise in quality assessment and improvement or health services research.  One of these appointees shall serve an initial term of one year, two shall serve initial terms of two years, and two shall serve initial terms of three years;
(3)	Five members appointed by the General Assembly upon the recommendation of the Speaker of the House of Representatives, one of whom shall be a consumer with no financial ties to the managed care industry, one of whom shall be a health care provider, one of whom shall be a purchaser of health insurance, and one of whom shall be a public health professional with expertise in quality assessment and improvement or health services research.  One of these appointees shall serve an initial term of one year, two shall serve initial terms of two years, and two shall serve initial terms of three years; and
(4)	Five members appointed by the Commissioner of Insurance, one of whom shall be a consumer with no financial ties to the managed care industry, one of whom shall be a health care provider, one of whom shall be a purchaser of health insurance, and one of whom shall be a public health professional with expertise in quality assessment and improvement or health services research.  One of these appointees shall serve an initial term of one year, two shall serve initial terms of two years, and two shall serve initial terms of three years.
(c)	Members of the Board shall receive per diem and necessary travel and subsistence expenses in accordance with G.S. 138-5 or G.S. 138-6, as applicable.
(d)	Terms of members appointed subsequent to the initial term shall be for three years.  A member may be reappointed for one additional term.  Upon the expiration of a term of office, a member shall continue to serve until a successor is appointed and qualified.  When a vacancy occurs other than by expiration of the term, a successor shall be appointed by the person making the original appointment for the remainder of the unexpired term.
"§ 58-68B-2. Duties and responsibilities of the Board.
The Board shall have the following powers and duties:
(1)	Review and comment on all matters of planning, policy development, and program design and evaluation with regard to the provision of health care and health coverage to the citizens of this State;
(2)	Recommend standards for managed care plans to assure minimum standards for the adequacy, accessibility, and quality of health care services offered under a managed care plan, review the standards periodically, and recommend modification, if appropriate, to assure that the standards meet current state of the art and technology in health care delivery practices;
(3)	Recommend standards for collecting data from managed care plans and disseminate comparative information to the general public to allow for informed consumer choice for plan selection and treatment options based on price, covered benefits, quality, and enrollee satisfaction;
(4)	Monitor data collected by the Department which provide information about benefits, quality, and enrollee satisfaction, including, but not limited to, the number and reasons for complaints filed with the Department, enrollment and disenrollment data, the carrier's utilization review and appeals activity report, annual report, evidence of coverage, and premiums;
(5)	Conduct managed care policy studies that will contribute to the effective implementation of a managed care system.  The studies shall include:
a.	State policy for risk-adjusted payments to health plans and ways to provide greater responsiveness in managed care to vulnerable populations such as mentally and physically disabled persons, chronically ill persons, individuals with rare diseases, and low-income individuals;
b.	The type of data that should be collected and the format for presentation of such data in an annual guide comparing premiums, cost-sharing, benefits, quality, utilization, service indicators, and consumer satisfaction;
c.	Methods for increasing and maximizing consumer choice in health plan selection;
d.	The need for an external appeals mechanism after a carrier internal appeals and grievance system has been exhausted; and
e.	Other studies the Board determines necessary to fulfill its responsibilities for recommending needed managed care policy and program revisions.
(6)	The Board shall meet at least four times each year.  The Board shall elect its officers and may designate its committees; and
(7)	The Board may recommend the enactment of legislation and the adoption of rules as may be necessary to carry out its purposes."
Section 2.  There is appropriated from the General Fund to the Department of Insurance the sum of one hundred thousand dollars ($100,000) for the 1997-98 fiscal year and the sum of one hundred thousand dollars ($100,000) for the 1998-99 fiscal year for allocation to the Managed Care Policy Board for its operations.
Section 3.  This act becomes effective July 1, 1997.