§ 135-43. Confidentiality of information and medical records; provider contracts. - North Carolina Statutes - USA Laws Searching

Statutes > North Carolina Statutes > Chapter 135 - Retirement System for Teachers and State Employees; Social Security; Health Insurance Program for Children. > § 135-43. Confidentiality of information and medical records; provider contracts.

§ 135-43. Confidentiality of information and medical records; provider contracts.

Article 3A.

Other Benefits forTeachers, State Employees, Retired State Employees, and Child Health.

Part 1. General Provisions.

§ 135‑43. Confidentiality of information and medical records; provider contracts.

(a)        Any information asherein described in this section which is in the possession of the ExecutiveAdministrator and the Board of Trustees of the State Health Plan for Teachersand State Employees or its Claims Processor under the Plan or the PredecessorPlan shall be confidential and shall be exempt from the provisions of Chapter132 of the General Statutes or any other provision requiring information andrecords held by State agencies to be made public or accessible to the public.This section shall apply to all information concerning individuals, includingthe fact of coverage or noncoverage, whether or not a claim has been filed,medical information, whether or not a claim has been paid, and any otherinformation or materials concerning a plan participant. Provided, however, suchinformation may be released to the State Auditor, or to the Attorney General,or to the persons designated under G.S. 135‑43.3 in furtherance of theirstatutory duties and responsibilities, or to such persons or organizations asmay be designated and approved by the Executive Administrator and Board ofTrustees of the Plan, but any information so released shall remain confidentialas stated above and any party obtaining such information shall assume the samelevel of responsibility for maintaining such confidentiality as that of theExecutive Administrator and Board of Trustees of the State Health Plan forTeachers and State Employees.

(b)        Notwithstanding theprovisions of this Article, the Executive Administrator and Board of Trusteesof the State Health Plan for Teachers and State Employees may contract withproviders of institutional and professional medical care and services toestablish preferred provider networks.

The terms of a contractbetween the Plan and its third party administrator or between the Plan and itspharmacy benefit manager are a public record except that the terms in thosecontracts that contain trade secrets or proprietary or competitive informationare not a public record under Chapter 132 of the General Statutes, and any suchproprietary or competitive information and trade secrets contained in thecontract shall be redacted by the Plan prior to making it available to thepublic. This subsection shall not be construed to prevent or restrict therelease of any information made not a public record under this subsection tothe State Auditor, the Attorney General, the Director of the State Budget, thePlan's Executive Administrator, and the Committee on Employee Hospital andMedical Benefits solely and exclusively for their use in the furtherance oftheir duties and responsibilities, and to the Department of Health and HumanServices solely for the purpose of implementing the transition of NC HealthChoice from the Plan to the Department of Health and Human Services. Thedesign, adoption, and implementation of the preferred provider contracts,networks, and optional alternative comprehensive health benefit plans, andprograms available under the optional alternative plans, as authorized underG.S. 135‑45 are not subject to the requirements of Article 3 of Chapter143 of the General Statutes. The Executive Administrator and Board of Trusteesshall make reports as requested to the President of the Senate, the PresidentPro Tempore of the Senate, the Speaker of the House of Representatives, and theCommittee on Employee Hospital and Medical Benefits.

(c)        Allowable paymentsfor services provided by a county or city ambulance service shall be paiddirectly or shall be co‑payable to the county or city ambulance serviceprovider. As used in this subsection, "county or city ambulanceservice" means ambulance services provided by a county or county‑franchisedambulance service supplemented by county funds, or a municipally owned andoperated ambulance service or by an ambulance service supplemented by municipalfunds.  (1981,c. 355; 1981 (Reg. Sess., 1982), c. 1398, ss. 3, 4; 1983, c. 922, s. 21.10;1985, c. 732, s. 38; 1985 (Reg. Sess., 1986), c. 1020, s. 20; 1998‑1, s.4(h); 2007‑323, s. 28.22A(c); 2008‑107, s. 10.13(m); 2008‑168,s. 1(a), (c), (d); 2009‑16, s. 5(f); 2009‑83, s. 1.)