Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 363 (2020GS)

Sponsor

Rep. Harrison, S.

Final action

House/ filed 3/12/2020

Outcome

Failed / filed without passage

Summary

What it does

• This bill:
• authorizes the Public Employees' Health Program to establish an out-of-state provider network through requests for proposals;
• authorizes the Public Employees' Health Program to partner with public entities in other states in certain circumstances; and
• makes technical changes.

Every vote on this bill

Bill text

PUBLIC EMPLOYEES' HEALTH PLAN AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Suzanne Harrison
Senate Sponsor: 
Curtis S. Bramble
LONG TITLE
General Description:
This bill amends the Public Employees' Health Program.
Highlighted Provisions:
This bill:
▸ authorizes the Public Employees' Health Program to establish an out-of-state
provider network through requests for proposals;
▸ authorizes the Public Employees' Health Program to partner with public entities in
other states in certain circumstances; and
▸ makes technical changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
49-20-401
, as last amended by Laws of Utah 2019, Chapter 393
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
49-20-401
 is amended to read:
49-20-401.
Program -- Powers and duties.
(1) The program shall:
(a) act as a self-insurer of employee benefit plans and administer those plans;
(b) enter into contracts with private insurers or carriers to underwrite employee benefit
plans as considered appropriate by the program;
(c) indemnify employee benefit plans or purchase commercial reinsurance as
considered appropriate by the program;
(d) provide descriptions of all employee benefit plans under this chapter in cooperation
with covered employers;
(e) process claims for all employee benefit plans under this chapter or enter into
contracts, after competitive bids are taken, with other benefit administrators to provide for the
administration of the claims process;
(f) obtain an annual actuarial review of all health and dental benefit plans and a
periodic review of all other employee benefit plans;
(g) consult with the covered employers to evaluate employee benefit plans and develop
recommendations for benefit changes;
(h) annually submit a budget and audited financial statements to the governor and
Legislature which includes total projected benefit costs and administrative costs;
(i) maintain reserves sufficient to liquidate the unrevealed claims liability and other
liabilities of the employee benefit plans as certified by the program's consulting actuary;
(j) submit, in advance, its recommended benefit adjustments for state employees to:
(i) the Legislature; and
(ii) the executive director of the state Department of Human Resource Management;
(k) determine benefits and rates, upon approval of the board, for multi-employer risk
pools, retiree coverage, and conversion coverage;
(l) determine benefits and rates based on the total estimated costs and the employee
premium share established by the Legislature, upon approval of the board, for state employees;
(m) administer benefits and rates, upon ratification of the board, for single-employer
risk pools;
(n) request proposals for [
provider networks or health and dental benefit plans
administered by third-party carriers
] 
one or more out-of-state provider networks, and a dental
health plan administered by a third-party carrier
 at least once every three years for the purposes
of:
(i) stimulating competition for the benefit of covered individuals;
(ii) establishing better geographical [
distribution
] 
coverage
 of medical care services;
and
(iii) providing coverage for both active and retired covered individuals;
(o) offer proposals which meet the criteria specified in a request for proposals and
accepted by the program to active and retired state covered individuals and which may be
offered to active and retired covered individuals of other covered employers at the option of the
covered employer;
(p) perform the same functions established in Subsections (1)(a), (b), (e), and (h) for
the Department of Health if the program provides program benefits to children enrolled in the
Utah Children's Health Insurance Program created in Title 26, Chapter 40, Utah Children's
Health Insurance Act;
(q) establish rules and procedures governing the admission of political subdivisions or
educational institutions and their employees to the program;
(r) contract directly with medical providers to provide services for covered individuals;
(s) take additional actions necessary or appropriate to carry out the purposes of this
chapter;
(t) (i) require state employees and their dependents to participate in the electronic
exchange of clinical health records in accordance with Section 
26-1-37
 unless the enrollee opts
out of participation; and
(ii) prior to enrolling the state employee, each time the state employee logs onto the
program's website, and each time the enrollee receives written enrollment information from the
program, provide notice to the enrollee of the enrollee's participation in the electronic exchange
of clinical health records and the option to opt out of participation at any time; and
(u) at the request of a procurement unit, as that term is defined in Section 
63G-6a-103
,
that administers benefits to program recipients who are not covered by Title 26, Utah Health
Code, provide services for:
(i) drugs;
(ii) medical devices; or
(iii) other types of medical care.
(2) (a) Funds budgeted and expended shall accrue from rates paid by the covered
employers and covered individuals.
(b) Administrative costs shall be approved by the board and reported to the governor
and the Legislature.
(3) The Department of Human Resource Management shall include the benefit
adjustments described in Subsection (1)(j) in the total compensation plan recommended to the
governor required under Subsection 
67-19-12
(5)(a).
(4) The program may establish a partnership with a public entity in a different state to
purchase or share services related to the administration of medical benefits if:
(a) the program receives approval for the partnership from the board; and
(b) the partnership:
(i) creates cost savings for Utah;
(ii) does not comingle state funds with funds of the public entity in the other state; and
(iii) does not pose a financial risk to Utah.