Identical to H 967 filed on 4/26/16.

Enacts a new Article 39, the Prepaid Health Plan Licensing Act, in GS Chapter 58, to establish that only persons authorized by the Department of Health and Human Services (DHHS) through the Division of Health Benefits may apply to the Commissioner of Insurance for a license to operate a prepaid health plan (PHP).  Enacts a definitions section (GS 58-93.5) that defines a PHP as a person that has entered into a capitated contract with DHHS through the Division of Health Benefits to deliver Medicaid or NC Health Choice health care services.  Clarifies that any person that is already a licensed health organization in the state under GS Chapter 58 is not subject to the new Article 39 as long as the organization meets the solvency requirements.

Enacts GS 58-93-10 to establish the procedure and required accompanying information for a PHP license application, as well as a requirement to file a notice if the organization has a significant modification to the information required to be submitted with the license application. 

Enacts GS 58-93-15 to allow the Commissioner to contract with consultants and other professionals during the application process.  Provides that contracts for financial, legal, examination, and other services are not subject to GS 114-2.3 (Use of private counsel limited); GS 147-17 (May employ counsel in cases wherein State is interested); and Articles 3 (Purchases and Contracts), 3C (Contracts to Obtain Consultant Services), and 8 (Public Contracts) of GS Chapter 143 (State Departments, Institutions, and Commissions), or any rules and procedures adopted under those Articles concerning procurement, contracting, and contract review.

Enacts GS 58-93-20 to establish the procedure for issuance and continuance of a PHP license, also establishing that a license can be denied only after compliance with the requirements of GS 58-93-155.  Enacts GS 58-93-25 to require the Commissioner of Insurance to require a minimum deposit of $500,000 or more to be necessary for the protection of enrollees receiving Medicaid health care services through the PHP.

Enacts GS 58-93-30, which bars a PHP from entering into an exclusive management or custodial agreement unless the agreement is first filed with the Commissioner of Insurance and approved within 45 days after filing or a reasonably extended period specified by the Commissioner within 45 days of filing.  Directs the Commissioner to disapprove of any exclusive management or custodial agreement if the agreement subjects the PHP to excessive charges, extends for an unreasonable period of time, does not have fair or adequate standards of performance, enables persons under the contract to manage the PHP who are not trustworthy or competent, or contains provisions that impair the interests of the PHP’s enrollees, creditors, or the public.

Enacts GS 58-93-45 to establish fiduciary responsibilities of any director, officer, or partner of a PHP.  Enacts GS 58-93-55 that provides that every PHP subject to the new Article 39 is also subject to GS 58-2-165, which requires annual, semiannual, monthly, or quarterly statements to be filed with the Commissioner of Insurance.  Enacts GS 58-93-60, which establishes limitations for investments by PHPs.

Enacts GS 58-93-100, which allows the Commissioner of Insurance to make an examination of any PHP as often as the Commissioner determines to be necessary for the protections of the people of the state, but cannot be less frequently than once every five years.

Enacts GS 58-93-105, authorizing the Commissioner of Insurance to order a PHP to take action that is reasonably necessary when the financial condition of a PHP indicates that continued operation might be hazardous to enrollees, creditors, or the general public.  Directs the Commissioner of Insurance to notify the Division of Health Benefits before taking any actions against a PHP.

Enacts GS 58-93-110, which establishes parameters that each PHP must follow for protection against insolvency.  Enacts GS 58-93-120, which directs the Commissioner of Insurance to require each PHP to have a plan for handling insolvency that allows for the continuation of benefits for the duration of the contract period for which premiums have been paid and for enrollees that are confined to an inpatient facility until discharge or expiration of benefits.  Enacts GS 58-93-135, which establishes parameters that every PHP must follow regarding liability incurred.

Enacts GS 58-93-140, which authorizes the Commissioner of Insurance to suspend or revoke a PHP license in five listed circumstances and directs the Commissioner to notify the Division of Benefits of DHHS prior to suspending or revoking a PHP license.  Enacts GS 58-93-145 to establish the procedure for any rehabilitation or liquidation of a PHP.

Enacts GS 58-93-150, which authorizes the Commissioner of Insurance to adopt rules to carry out the provisions of the new Article 39.  Enacts GS 58-93-155, providing for administrative procedures that apply to PHP licensing.  Enacts GS 58-93-160, establishing an application fee and an annual license continuation fee for each PHP license.

Enacts GS 58-93-165, establishing that any violation of the new Article 39 or any other provision of Chapter 58 that expressly applies to PHPs is a Class 1 misdemeanor, in addition to providing for other enforcement authority of the Commissioner of Insurance.

Enacts GS 58-93-175, providing that all applications, filings, and reports required under Article 39 are to be treated as public documents.

Clarifies that if any provision of the Prepaid Health Plan Licensing Act (Act) or its application is held invalid, the other provisions or applications of the Act that can be given validity without the invalid provisions or applications are not affected.