Authority: § 2.2-2818, § 2.2-1204, and Title 9.1, Chapter 4, Code of Virginia.
A. The appropriation for Health Benefits Services is sum sufficient and amounts shown are estimates from an internal service fund which shall be paid from revenues paid by state agencies to the Department of Human Resource Management.
B. The amounts for Local Health Benefits Services include estimated revenues received from localities for the local choice health benefits program.
C.1. In the event that the total of all eligible claims exceeds the balance in the state employee medical reimbursement account, there is hereby appropriated a sum sufficient from the general fund of the state treasury to enable the payment of such eligible claims.
2. The term "employee medical reimbursement account" means the account administered by the Department of Human Resource Management pursuant to § 125 of the Internal Revenue Code in connection with the health insurance program for state employees (§ 2.2-2818, Code of Virginia).
D. Any balances remaining in the reserved component of the Employee Health Insurance Fund shall be considered part of the overall Health Insurance Fund. It is the intent of the General Assembly that future premiums for the state employee health insurance program shall be set in a manner so that the balance in the Health Insurance Fund will be sufficient to meet the estimated Incurred But Not Paid liability for the Fund and maintain a contingency reserve at a level recommended by the Department of Human Resource Management for a self-insured plan subject to the approval of the General Assembly.
E. The Department of Human Resource Management shall implement a Medication Therapy Management pilot program for state employees with certain disease states including Type II diabetes. The department shall continue to consult with all provider stakeholders in order to establish program parameters.
F. Concurrent with the date the Governor introduces the budget bill, the Directors of the Departments of Planning and Budget and Human Resource Management shall provide to the Chairs of the House Appropriations and Senate Finance and Appropriations Committees a report detailing the assumptions included in the Governor's introduced budget for the state employee health insurance plan. The report shall include the proposed premium schedule that would be effective for the upcoming fiscal year and any proposed changes to the benefit structure.
G. In addition to such other payments as may be available, the full cost of group health insurance, net of any deductions and credits, for the surviving spouses and dependents of certain public safety officers killed in the line of duty and for certain public safety officers disabled in the line of duty, and the spouses and dependents of such disabled officers, are payable from this Item pursuant to Title 9.1, Chapter 4, Code of Virginia, effective July 1, 2017.
H. The Department of Human Resource Management shall notify the General Assembly at least 30 days prior to any proposed modifications to the benefit structure or any solicitation for health insurance for state employees, and shall include on the evaluation committee for any solicitation the staff directors, or their designees, of the House Appropriations and Senate Finance and Appropriations Committees, and a designated staff member from the office of the Executive Secretary of the Supreme Court of Virginia.
I.1. The Department of Human Resource Management shall establish a State Health Plan Advisory Council. The Council shall be comprised of seven members that include: the Secretary of Administration, the Secretary of Finance, the Secretary of Health and Human Resources, the Director of the Department of Human Resource Management, the Director of the Department of Planning and Budget, the staff director of the House Appropriations Committee, and the staff director of the Senate Finance and Appropriations Committee. Any member of the Council may send a designee in their place as a member of the Council.
2. The Council shall meet at least once each year to: (i) review the performance of the state health plans for the prior fiscal year including claims payments, cost drivers, and access to providers; (ii) review plan benefits and cost sharing provisions; and (iii) review growth in premiums and the financial status of Health Insurance Fund. The Council shall annually make recommendations to the Governor and the General Assembly regarding any changes to the state health plans.
J. No expenditure of funds out of this item shall be made to make any payments to a vendor pursuant to any contingency fee contract. The Department of Human Resource Management shall not contract with any vendor using a contingency fee payment model.