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2020 Special Session I

Budget Amendments - HB5005 (Conference Report)

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Reduce Funding for Increase State Health Plan Premiums

Item 477 #2c

Item 477 #2c

First Year - FY2021 Second Year - FY2022
Central Appropriations
Central Appropriations FY2021 $0 FY2022 ($20,613,821) GF

Language
Page 204, line 6, strike "$213,830,664" and insert "$193,216,843".

Page 204, line 6, strike "Not set out." and insert:

G.1. Out of the appropriation for this item, an amount estimated at $41,227,641 $20,613,821 the second year from the general fund shall be transferred to state agencies and institutions of higher education to support the general fund portion of costs associated with changes in the employer's share of premiums paid for the Commonwealth's health benefit plans.

2. Notwithstanding any contrary provision of law, the health benefit plans for state employees resulting from the additional funding in this item shall allow for a portion of employee medical premiums to be charged to employees.

3. The Department of Human Resource Management shall explore options within the health insurance plan for state employees to promote value-based health choices aimed at creating greater employee satisfaction with lower overall health care costs.  It is the General Assembly's intent that any savings associated with this employee health care initiative be retained and used towards funding state employee salary or fringe benefit cost increases.

4. Notwithstanding any other provision of law, it shall be the sole responsibility and authority of the Department of Human Resource Management to establish and enforce employer contribution rates for any health insurance plan established pursuant to § 2.2-2818, Code of Virginia.

5. The Department of Human Resource Management is prohibited from establishing a retail maintenance network for maintenance drugs that includes penalties for non-use of the retail maintenance network.

6. The Department of Human Resource Management shall not increase the annual out-of-pocket maximum included in the plans above the limits in effect for the plan year which began on July 1, 2014.

7. The Department of Human Resource Management shall include language in all contracts, signed on or after July 1, 2018, with third party administrators of the state employee health plan requiring the third party administrators to: 1) maintain policies and procedures for transparency in their pharmacy benefit administration programs; 2) transparently provide information to state employees through an explanation of benefits regarding the cost of drug reimbursement; dispensing fees; copayments; coinsurance; the amount paid to the dispensing pharmacy for the claim; the amount charged to the third party administrator for the claim by the third party administrator's pharmacy benefit manager; and the amount charged by the third party administrator to the Commonwealth; and 3) provide a report to the Department of Human Resource Management of the aggregate difference in amounts between reimbursements made to pharmacies for claims covered by the state employee insurance plan, the amount charged to the third party administrator for the claim by the third party administrator's pharmacy benefit manager, and the amount charged by the third party administrator to the Commonwealth as well as an explanation for any difference.

8. Notwithstanding the provisions of § 38.2-3418.17 and any other provision of law, effective October 1, 2018, the Department of Human Resource Management shall provide coverage under the state employee health insurance program for the treatment of autism spectrum disorder through the age of eighteen."



Explanation

(This amendment reduces by half the funding provided for the employer share of health insurance premium increases, due to sufficient Health Insurance Fund (HIF) balances. Chapter 1289, 2020 Acts of Assembly reflected a second year increase of 6.7 percent, based on actuarially projected growth in health care costs, enrollment updates, and actual 2019 health care claims expenditures. The HIF balance as of July 2020 was approximately $535.2 million. It is the intent of the General Assembly that this item be set out upon enrolling.)