A BILL TO BE ENTITLED
AN ACT to create a Patient-Centered Medical Home pilot program for the State Health Plan for Teachers and State Employees.
The General Assembly of North Carolina enacts:
SECTION 1.  The State Health Plan shall develop and implement by January 1, 2012, a pilot program that utilizes a Patient-Centered Medical Home (PCMH) approach to primary care. The pilot program shall have the following characteristics:
(1)	The State Health Plan shall identify and recruit up to 20,000 participants who have had difficulty managing chronic conditions. The Plan may set a maximum salary or other financial requirements for participants.
(2)	A program participant shall not be required to pay any additional costs for participating in the program other than the appointment fee as provided in subdivision (4) of this section.
(3)	The program shall include cost sharing based on specific clinical outcomes, such as LDL, blood pressure, HGbA1c, or other specific measurables that can be managed by lifestyle changes or adherence to a course of prescribed treatment by a primary care provider.
(4)	Each program participant shall receive care through a PCMH selected by the participant. Once the PCMH is chosen, the participant shall pay no more than a twenty-dollar ($20.00) appointment fee for the care associated with the management of a participant's chronic condition(s). The Plan shall reimburse a participant who complies with the course of treatment for all costs associated with prescription medications.
(5)	Any other care not related to a participant's chronic condition shall be subject to a deductible set by the Plan, and a participant may earn "deductible credits" by meeting goals associated with measurables under subdivision (3) of this section.
(6)	The out-of-pocket limits for in‑network individual coverage for a program participant shall not exceed four thousand dollars ($4,000) per year.
(7)	The Plan shall not spend more than five thousand two hundred eleven dollars ($5,211) per participant per year on this pilot program.
SECTION 2.  This act is effective when it becomes law.