North Carolina Trial Law Blog

I just received the most recent report about the proposed changes to the NC State Employee's Health Plan Lien.  It's all good news.

2005 Technical Corrections Act Passes Vote

The 2005 Technical Corrections Act conference report (that contained the "technical" corrections for the lien) has been adopted by both houses, and now goes to the Governor for his signature. There seems to be nothing controversial in the remainder of the bill, so we don't expect a veto of any sort from the governor.

The technical  corrections act from last year is where the subrogation provision was inserted toward the end of the long session, because SB 983 was holed up in the house.  It was included in each version of the tech corr bill and passed by the respective houses, but there was never agreement on the bill BETWEEN the two houses.

Bill needs to be signed by Governor Easley

The latest action of the General Assembly is that needed agreement, and as soon as the Governor signs the bill, it will be law.  The language of the bill makes it "retroactive" to the initial passage of the lien legislation back in July of 2004, so we don't have to worry about having two "sets" of liens.

This is fantastic news and due in large part to the long term efforts of Holly Bryan and Dick Taylor at the NC Academy of Trial Lawyers.

Chris Nichols

www.NicholsTrialLaw.com

     Hurray!!!  The NC Teachers & State Employees Lien has moved one step closer to being revised to allow for attorney fees and to limit the scope of the lien.  There bill came out of the Senate technical corrections committee yesterday and can be found here.  Now we have to wait for the house to either give it a thumbs up, or a thumbs down.  That might happen on Monday.

     In the mean time, what will the new bill mean? 1)  The SEHP can never take more than 50% of the GROSS settlement.   2)  The SEHP must then reduce their recovery for "reasonable" attorney fees.  3)  SEHP must also pro-rate with unpaid medical providers and other lien holders.

     Why is this better?  Well before, the SEHP could have taken 100% of any settlement, but they were administratively limiting themselves to 50% of gross, but not reducing for attorney fees.   This mean that in a typical personal injury case, the client only received 15% of the settlement.  NOT FAIR.

     We've been waiting for this bill to pass for a very long time.  I'VE been working to get this bill passed since 2004 when it was enacted.  After a lot of work with NCATL we drafted, redrafted, negotiated, and redrafted, we finally got something passed.  Hurray!

     NC Health Choice (NCHC)is a state funded health insurance program for children whose parents make too much money to qualify for Medicaid, but not enough money to afford traditional health insurance.  NCHC is administered by the same folks that run the NC Teachers' and Employees Health Plan, but NCHC does not get a lien under the State Employees Statute.

     No lien?  Yes, that's right, no lien.    Do medical providers have to accept NCHC as the only payment for medical care?  Yes.  And medical providers can not "balance bill" the patient.  Its all right here in the enacting statute.

     The North Carolina Teachers' and Employees Comprehensive Major Medical Health Plan was granted a stautory lien by the NC General Assembly in July of 2004.  In my writings about this lien, I've called it the "Super Lien" because the language in the statute gives the State Employee Health Plan (SEHP) a lien against 100% of the funds of a personal injury settlment.

     The Statute is being revised right now and the language of the existing and proposed bill is available for download here: Download sehp_lien_legislation.pdf

      I will explore how the lien works in other posts.

Chris Nichols

Nichols Law Firm

www.NicholsTrialLaw.com