9.16 Joint Committee on Health Benefits
a. The State and PEF agree to continue the Joint Committee on Health Benefits.
b. The Joint Committee on Health Benefits shall meet within 14 days after a request to meet has been made by either side.
c. The Joint Committee shall work with appropriate State agencies to review and oversee the various health plans available to employees represented by PEF.
d. The Joint Committee on Health Benefits shall work with appropriate State agencies to monitor future employer and employee health plan cost adjustments.
e. The Joint Committee shall be provided with each carrier rate renewal request upon submission and be briefed in detail periodically on the status of the development of each rate renewal.
f. The State shall require that the insurance carriers for the State Health Insurance Plan submit claims and experience data reports directly to the Joint Committee on Health Benefits in the format and with such frequency as the Committee shall determine.
g. The State shall provide to the PEF designees to the Joint Committee, a quarterly summary of hospital carrier paid claims (number of charges, amount of covered expenses and amount of benefits) by type of service for PS&T Unit enrollees and New York State Actives; New York State Empire Plan Medical Carrier and Prescription Drug Program paid claims (number of charges, amount of covered expenses and amount of benefits) by type of service for PS&T Unit enrollees and New York State Actives; number of enrollees, spouses or domestic partners, and dependents for PS&T Unit enrollees and New York State Actives.
h. The Joint Committee on Health Benefits shall work with appropriate State agencies in an ongoing review of the Medical Flexible Spending Account. The Joint Committee will work with the State to implement a direct debit vehicle to be utilized under the Medical Flexible Spending Account.
i. The Joint Committee on Health Benefits shall work with appropriate State agencies to review the impact of coverage for adult immunizations in the Empire Plan, and to consider additions to the list of immunizations.
j The Joint Committee on Health Benefits shall work with appropriate State agencies to make mutually agreed upon changes in the Plan benefit structure through such initiatives and activities as:
1. The annual HMO Review Process;
2. The ongoing review of the Managed Mental Health and Substance Abuse Care Program;
3. Ongoing review of the Benefits Management Program and an annual review of the list of procedures requiring Prospective Procedure Review;
4. Ongoing review of the Managed Physical Medicine Program;
5. The
Joint Committee on Health Benefits will work with the State and Empire Plan
hospital and medical carriers on the implementation and ongoing review
of the Empire Plan hospital network and
the network of participating providers.
6. The
development and implementation of a program that will allow enrollees to obtain
Laser Vision Correction services at discounted enrollee-pay-all fees through a
network of providers.
7. Ongoing review of Prospective Procedure Review (PPR) requirements and role/responsibility of medical providers in PPR process;
8. Review of the Infertility Centers of Excellence program as utilization information becomes available from the medical program vendor;
9. Review of the program to provide an annual vision care benefit for enrollees who demonstrate a vision loss resulting from a medical condition;
10. In cooperation with the New York State Health Insurance Program (NYSHIP) management, attempt to develop a "report card" which will include objective quality data to assist employees in selecting the health benefit plan that best meets the needs of the employees and their dependents.
11. The Joint Committee on Health Benefits
will review the impact of Domestic Partner coverage under the New York State
Health Insurance Program (NYSHIP), including the appropriateness of the
existing waiting periods.
12. The Joint Committee on Health Benefits
will review the alternative
medicine program that allows
Empire Plan enrollees to obtain non-covered treatments or services at
discounted enrollee-pay-all fees through a network of providers. The
Joint Committee on Health Benefits will review the utilization of durable
medical equipment provided by the Home Care Advocacy Program.
13. The Joint Committee on Health Benefits will work with the State and medical carrier to develop an enhanced network of urgent care facilities.
14.
The Joint Committee on Health
Benefits will work with the State and medical carrier to determine the
feasibility of developing a network of hearing aid providers.
15.
The Joint Committee on Health
Benefits will work with the State to explore the implementation of additional
Centers of Excellence Programs to include, but not be limited to Centers of
Excellence for Bariatric Surgery. Nutritional counseling will be available when
clinically appropriate.
16.
The Joint Committee on Health
Benefits will explore the possibility of a copayment waiver program for office
visits and prescription drugs when related to chronic conditions.
k. The PEF Joint Committee on Health
Benefits will work with the State to conduct an extensive analysis of the
current New York State Health Insurance Program (NYSHIP) prescription drug
benefit designs (Empire Plan and HMOs) and associated costs.
l.
The State shall seek appropriations of
funds by the Legislature in the amount of $350,000 for fiscal years 2003-04,
2004-05, 2005-06, and 2006-2007 $500,000 for fiscal year
2007-08, $500,000 for fiscal year 2008-09, $500,000 for fiscal year 2009-2010
and $500,000 for fiscal year 2010-2011 to support Committee
initiatives and to carry out the administrative responsibilities of the Joint
Committee during the term of this Agreement.