The newly formed House Select Committee on Certificate of Need (CON) Process and Related Hospital Issues met for the second time on Thursday, October 6, 2011. Chaired by Rep. John Torbett (R-Gaston) and Rep. Fred Steen (R-Rowan), the committee heard testimony from the Department of Health and Human Services regarding the state’s inventory of regulated facilities as well as statistics regarding the review process for CON applications.  View the handouts from that presentation here.

Following the presentation by the Department, the Committee heard testimony regarding the current climate for hospital operations from the NC Hospital Association as well as a presentation by Noah Huffstetler, a partner with the law firm Nelson Mullins. View the NCHA presentation here and the presentation by Mr. Huffstetler here.

The committee is scheduled to meet again in the first of several meetings to be held across the state on Thursday, October 20, 2011, at 6:00 pm at the WNC Agricultural Center, 1301 Fanning Bridge Road, Fletcher, NC.

The committee will take a look at the overall CON process. Additionally, the committee will look at two specific issues raised in bills during the 2011 long session:  HB 743 raised questions about the academic medical centers exemption, and HB 812 addressed the county line rule used in making need determinations. The NCMS Legislative Staff will provide updates and more information in the Bulletin and at http://www.ncmedsoc.org/. Questions may be directed to Chip Baggett at mailto:cbaggett@ncmedsoc.org or call 919-833-3836.

The House Select Committee on Certificate of Need will be meeting regularly throughout the interim. Announcements were made yesterday about two confirmed public hearings as well as two additional tentative public hearings to be held across the state. Details of the public meetings that have been announced are as follows:

Regular House Select Committee on Certificate of Need and Related Hospital Issues Meeting with Presentations on COPA and public comment to follow:

DATE: Thursday, October 20, 2011

TIME: 6:00 PM

LOCATION: Western NC Ag Center

COMMENTS: Virginia C. Boone Mountain Heritage Building, 1301 Fanning Bridge Road, Fletcher, NC  28732

Regular House Select Committee on Certificate of Need and Related Hospital Issues with Public Comments:

DATE: Thursday, November 3, 2011

TIME: 6:00 PM

LOCATION: The Citizens Center

COMMENTS: Council Chamber, 400 East Central Avenue, Mount Holly, NC  28120

The additional public meetings will likely be in the eastern part of the state.  Tentative dates for those meetings are Nov. 17 and Dec. 1.  Starting in January, the committee will meet on the third Thursday of the month in Raleigh.

The House Select Committee on Certificate of Need Process and Related Hospital Issues met on Wednesday, September 14 to hear an overview of the Certificate of Need program in North Carolina. The formation of the committee and Wednesday’s discussion were brought about by controversy surrounding 1) the proliferation of freestanding emergency rooms and 2) the development of regulated services by academic medical center teaching hospitals using an exemption in the State Medical Facilities Plan (SMFP). The NCMS legislative staff is closely following this issue and the Committee, which will meet again later this Fall, at which time it is expected they will discuss these specific issues and other significant aspects of the CON program.

House Select Committee Looks at CON

A newly formed House Select Committee on Certificate of Need (CON) Process and Related Hospital Issues has been named. It will be chaired by Rep. Fred Steen (R-Rowan) and Rep. John Torbett (R-Gaston). You can find a complete list of the committee here. The committee is scheduled to meet on Wednesday, September 14, 2011 at 10:00 am in Room 544 of the Legislative Office Building in Raleigh.

The committee will take a look at the overall CON process. Additionally, the committee will look at two specifiic issues raised in bills during the 2011 long session:  HB 743 raised questions about the academic medical centers exemption, and HB 812 addressed the county line rule used in making need determinations. The NCMS Legislative Staff will provide updates and more information in the Bulletin and at http://www.ncmedsoc.org/. Questions may be directed to Chip Baggett at cbagget@ncmedsoc.org or call 919-833-3836.

Insurance Bills Included in 2011 Legislative Summary

Eight bills that fall under the Insurance category will be among the dozens of bills that will be reviewed in the soon-to-be released NCMS 2011 Legislative Summary. Insurance-related measures that will be in the summary include:

House Bill 496 – Insurance Co-pays for Chiropractic Services  (NCMS opposed)

Senate Bill 608 – Health Care Sharing Organizations (Passed)

House Bill 709 – Protect and Put NC Back to Work (Senate Bill 544) (Passed)

Senate Bill 517 – Freedom to Negotiate Health Care Rates (NCMS supports)

Senate Bill 774 – Update Electronic Prescription Rules (Not debated)

House Bill 138 – Amend Health Insurance Risk Pool Statutes (NCMS supports)

House Bill 298 – Insurance Amendments A-B (Passed)

Senate Bill 323 – State Health Plan/Appropriations and Transfer II (Passed)

Get Ready for 2012: Primary, Legislative Short Session and Election

Issues of importance to physicians and their patients will be part of the 2012 Election Year. The NCMS 2011 Legislative Summary will provide background to help you better understand many of these issues. Since 2012 is a Presidential Election Year, there will be increased voter interest in issues like health care reform, Medicare and Medicaid, jobs, and economic improvements. Your NCMS Legislative Staff will be working to provide timely information to help you understand these issues, and how you can engage with legislators at the state and national level. This information will be made available through the Bulletin, Member Alerts, Legislative Updates , and the NCMS website, http://www.ncmedsoc.org/. By being informed and involved, you can help us continue our efforts to provide access to quality health care for all North Carolinians.

Legislation under the category of Public Safety were among the 88 bills tracked by the NCMS Legislative Team during the 2011 session of the NC General Assembly. This was in addition to the successful initiative that put into law SB 33 Medical Liabiltiy Reforms and HB 542 Tort Reform for Citizens and Business.

Many more hours were spent working on legislation involving the Medicaid budget, scope of practice, mental health, and implementation of federal programs. The soon-to-be-released 2011 Legislative Summary will provide members more details about this year’s legislative activity.

Six public safety measures of interest to physicians were considered during the session:

House Bill 407 – Modify ATV Helmet Use Requirements  (NCMS opposed)

House Bill 392 – Modify Motorcycle Helmet Requirements (NCMS opposed)

House Bill 792 – Gfeller-Waller Concussion Awareness Act (NCMS supported)

See related story: Important Information for Healthcare Professionals Dealing with Student Athletes (Bulletin, 8-19-11)

Senate Bill 757 – Interscholastic Sports/Concussions (NCMS position: amendments needed)

Senate Bill 471 – Youth Skin Cancer Prevention Act (NCMS supported)

Senate Bill 697 – Patient Advocacy and Protection Act (NCMS opposed)

Look for an announcement about the 2011 Legislative Summary in the Bulletin and at http://www.ncmedsoc.org/.

Related articles:

Coming Soon: 2011 Legislative Summary (Bulletin, 8-19-110

2011 Legislative Session: Medical Liability Reforms and Much More (Bulletin, 8-12-11)

Legislative Summary Highlights Major Accomplishments in 2011 (Bulletin, 8-5-11)

The NCMS Legislative Affairs team expects the 2011 NCMS Legislative Summary to be available in just a few days. Look for an official announcement in the Bulletin and online at http://www.ncmedsoc.org/.

Covering bills of interest to physicians, the Summary will include the all-important SB 33 Medical Liability Reforms and HB 542 Tort Reform for Citizens and Business, along with summaries of 86 other pieces of legislation affecting health care and the community of medicine. The team is currently reviewing the final section on the State Budget, which consumed a lot of staff time and media headlines throughout the legislative session.   

The Summary will include a special section on Mental Health:

SB 437 – Enact First Evaluation Program

SB 316 – Add’l Section 1915 Medicaid Waiver Sites

HB 916 – Statewide Expansion of the 1915(b)(c) Waiver

There were two pieces of legislation introduced in the 2010 session that were not heard by the Legislative Oversight Committee on Mental Health this session:

(1) A requirement for the Department of Health and Human Services to evaluate the CABHA Model, Critical Access Behavioral Health Agencies, with the goal of reducing inefficiencies in the mental health system and returning the system to one with medical leadership.

(2) A bill introduced in each chamber by the House and Senate chairs of the Legislative Oversight Committee on Mental Health to require the department to evaluate the efficiency of the model on a semiannual basis and report the results to the Legislative Oversight Committee on Mental Health.

Related stories:

2011 Legislative Session: Medical Liability Reforms and Much More (Bulletin, 8-12-11)

Legislative Summary Highlights Major Accomplishments in 2011 (Bulletin, 8-5-11)

In the 2011 session, the NC General Assembly passed House Bill 792/Gfeller-Waller Concussion Awareness Act, to protect the safety of student-athletes in North Carolina. The law directs the Matthew A. Gfeller Sport-Related Traumatic Brain Injury Research Center at the University of North Carolina at Chapel Hill (http://tbicenter.unc.edu/), in conjunction with numerous health care agencies and organizations, to develop an athletic concussion safety training program. Partners in this endeavor include the NCMS, Department of Public Instruction/State Board of Education, NC High School Athletic Association, NC Athletic Trainers Association, Gfeller Center, Brain Injury Association, and Neuropsychological Society.

Resources from the Gfeller Center:

• Emergency Action Plan (EAP) guidelines
• Sample EAP
• Information regarding concussion protocol

In addition, the Centers for Disease Control (CDC) is developing a free, online clinician training module to be called “Heads Up to Clinicians: Addressing Concussion in Sports among Kids and Teens.” This course includes an overview of what health care professionals need to know about concussion among young athletes participating in sports and recreation activities. The course focuses on how concussions occur and why young athletes are at increased risk, and also helps clinicians prepare for diagnosing and managing concussions on the sidelines, in their offices, training room, or in the emergency department.

This course includes a free continuing education opportunity through CDC. At the end of the course, there will be a short quiz and the opportunity to obtain a certificate and CME, CNE, or CEU credits. When available, we will include the link to the course on the NCMS website.

The NCMS Sports Medicine Committee has reviewed materials offered by the Center and is working to provide input in the development of the Gfeller Center programs and to provide feedback to the Center.

While enactment of SB 33 – Medical Liability Reforms was a major achievement for the NCMS Legislative Affairs team this legislative session, dozens of other bills of interest to physicians will also be included in the soon-to-be released 2011 Legislative Summary. Watch for more details in the Bulletin and at http://www.ncmedsoc.org/.

In last week’s Bulletin, we reported on legislation that falls under the category of Regulation of Medicine. That section includes 12 bills that will be summarized in the 2011 Legislative Summary, including the widely reported HB 854 – A Woman’s Right to Know Act. Like SB 33, HB 854 became law after the General Assembly overrode a gubernatorial veto.

Another major category of legislation falls under the Implement Federal Programs umbrella. Several of these bills deal with issues arising from the Patient Protection and Affordable Care Act (ACA):

HB 2 – Protect Health Care Freedom

SB 496 – PPACA/Required Fraud and Abuse Provisions

HB – 115 North Carolina Health Benefit Exchange Act

SB 375 – Facilitate Statewide Health Information Exchange

SB 607 – Conform Medical Records Law

In addition to the 2011 Legislative Summary, the NCMS offers more information and updates on a variety of provisions contained in the federal health care reform law, including Accountable Care Organizations (ACOs), the NC Health Benefit Exchange, and the NC Health Information Exchange. Physicians are urged to check the NCMS website to learn more about these programs and how they will be affecting your practices.

Related story:

Legislative Summary Highlights Major Accomplishments in 2011, Bulletin, August 5, 2011

July 25, 2011 will be forever one of the most important days in the history of the North Carolina Medical Society. On that day the NC House voted 74-42 to override the Governor’s veto of SB 33—Medical Liability Reforms, allowing North Carolina to join a majority of states where medical liability reforms are already in place. The victory demonstrated the power of organized medicine and our ability to work with the medical and business communities to advance affordable, quality health care for all our citizens.

As the 2011 legislative session got underway in late January, NCMS leaders had named medical liability reforms as the number one priority this session. Even with the challenges of a huge state budget shortfall in the background, NCMS staff and leaders remained steadfast in their determination and effort to gain medical liability reforms to reduce health care costs and create a fairer tort system for physicians and the people of our state.

A brief timeline highlighting some key moments during the 2011 legislative session reveals how this victory evolved:

February

• SB 33 – Medical Liability Reforms is filed in the Senate.
• House Speaker Thom Tillis (R, Mecklenburg) named the House Select Committee on Tort Reform
• Senate Judiciary 1 Committee continued to work on SB 33.

March

• Senate passes and sends to the House SB 33
• North Carolinians for Affordable Healthcare, a coalition led by the NCMS, began airing TV ads across the state calling for public support of SB 33
• House Select Committee on Tort Reform works on draft legislation

April-May

• HB 542—Tort Reform for Citizens and Business, a bill described as “big and bold,” is filed in the House
• House Select Committee on Tort Reform begins hearings on HB 542
• House divides medial liability reforms and tort issues into two bills: SB 33 will contain medical liability reforms; HB 542 will include general tort reforms
• House passes SB 33 and returns it to the Senate
• Conference Committee is named to work out differences over House and Senate versions of SB 33

June

• House passes and sends to Senate HB 542
• General Assembly enacts SB 33 on June 9 and sends it to the Governor for her signature
• HB 542 is enacted on June 17 and is signed by the Governor on June 20
• Governor vetoes SB 33 on June 24
• NCMS and its coalition partners rally members through Town Hall meetings, alerts, phone calls and emails to contact legislators and urge them to override the veto
• General Assembly recesses and agrees to return in July to consider vetos

July

• Senate votes to override the veto on July 13
• House votes to override the veto on July 25

Not shown by the timeline but critical to our success are the countless hours invested by NCMS staff, leaders, members’ grassroots efforts, and partners on behalf of physicians across North Carolina, including component/county and specialty societies, group practices, physician assistants, the medical group managers, hospitals, nursing homes, chambers of commerce and other business organizations. This is the power of organized medicine. Your participation and support do make a difference. Invite your colleagues who aren’t members to join us—the North Carolina Medical Society—Leadership in Medicine.

There’s no question that enactment of Senate Bill 33—Medical Liability Reforms was the biggest achievement of the 2011 legislative session. However, SB 33 was one of 88 bills that were tracked by the NCMS legislative team because of their potential impact on physicians and patients in North Carolina.

The NCMS Legislative Summary, now in its final stages, will offer a comprehensive review of the work done on behalf of physicians this year. One of the sections will highlight legislation involving the Regulation of Medicine, a compilation of twelve bills of importance to doctors:

SB 31 – Clarify Penalty Unauthorized Practice of Medicine

HB 854 – Abortion – A Woman’s Right to Know Act

SB 609 – Facilitate Locum Tenens Physicians

HB 347 – Notification to Treat Minors/12 or Younger

SB 349 – Confidentiality/Investigative Info/Optometry

SB 190 – Allow Electronic Signatures on Death Certificates

HB 331 – Allow PAs and NPs to Sign Death Certificates

SB 718 – Prescription Integrity Act

SB 357 – DNR Form Signatures

SB 743 – Encourage Volunteer Health Care Providers

SB 765 – No Firearms Questions During Medical Exam

HB 795 – Patient Access to Pathological Materials

Be watching for more details about the 2011 Legislative Summary and how you can access this valuable resource from NCMS.

Just hours before a midnight deadline Tuesday, Congress passed legislation that raised the federal debt ceiling, avoiding a default that would have far-reaching consequences, including the Medicare and Medicaid programs. The debt deal is temporary and calls for a new Joint Select Committee on Deficit Reduction to come up with recommendations on how to further reduce the budget by $1.5 trillion by November 23, 2011. If the committee fails to reach its target or Congress does not act on the recommendations by December 23, 2011, then the debt ceiling would automatically be raised by $1.2 trillion, using across-the-board cuts to achieve savings. Those cuts would be divided between the defense budget and non-defense discretionary and mandatory spending for FY 2013-2021.

If the automatic cuts take effect, cuts in Medicare spending would be capped at 2%, but benefits to enrollees would not be cut. That means the Medicare spending cuts would be achieved through lowered payments to physicians and other Medicare providers.

The debt deal does not address the long-term fiscal health of the Medicare payment system (Sustainable Growth Rate or SGR), and physician pay rates are scheduled to be cut by 29.5% on January 1, 2012. The AMA informs the NCMS that the Medicare physician payment issue is expected to be addressed by the Deficit Reduction Committee, but that may prove to be challenging because of the savings levels the committee must achieve. Committee members will be selected by House and Senate leaders.

NCMS will be closely monitoring developments in the deficit reduction process and will keep members informed through special alerts, updates, analysis in the Bulletin, online at http://www.ncmedsoc.org/ and by email. We also will be in daily communication with the North Carolina Congressional Delegation working on behalf of physicians and their patients.

On Monday, the NC House sent shockwaves through the healthcare community when it completed a successful override of SB 33, the well-publicized package of medical malpractice reforms previously vetoed by the Governor.  Earlier that same day and with much less fanfare, the House also completed an override of the Governor’s veto of SB 496, a bill recasting state laws governing provider fraud and abuse in Medicaid. 

On balance SB 496 is another good bill for physicians: it implements program integrity provisions of the Patient Protection and Affordable Care Act (PPACA), it ensures that the NC Department of Health & Human Services (DHHS) has the tools to tackle real fraud in Medicaid, and it provides individual Medicaid providers who come under the Department’s scrutiny to claim more due process protections.

Here are five critical features of the new law:

1. Provider Screening.  The PPACA requires Medicaid to ramp up its review of providers who apply to enroll and re-enroll in the program.  The amount of scrutiny given to an application depends on the type of the provider.  Physicians, midlevel practitioners, medical groups, and clinics are designated in the law as “limited risk providers,” meaning they pose the lowest level of risk to the Medicaid system in terms of committing fraudulent activity.  Therefore DHHS review of a physician’s application is relatively mild – license verification, billing privilege verification, and database checks.  By contract, moderate- and high-risk providers must endure on-site visits and perhaps fingerprinting of certain individuals in the facility or practice.
2. Training for New Providers.  Prior to enrollment of a new Medicaid provider, a representative of the provider must complete trainings designated by the DHHS that are designed to reduce fraud and abuse in Medicaid.
3. Payment Suspension and Extrapolation Audits.  This clarifies how DHHS may collect overpayments and assessments against Medicaid providers and when payment suspension is appropriate.  It also says that to perform an extrapolation audit against a provider, DHHS must show that the provider failed to “substantially comply” with the law.  This is a good change; currently DHHS may use extrapolation when a provider is less than 100% perfect in his/her billings to Medicaid.
4. Appeals.   If a provider appeals an adverse determination made by DHHS (like a fine or overpayment), the provider can ask for a hearing by an independent administrative law judge (ALJ).  This law clarifies that DHHS bears the burden of proof in the hearing.  Historically, it has been the provider’s responsibility to disprove the Department’s determination.  Moreover, the ALJ’s decision in the hearing is final, unless the losing party appeals to Superior Court.
5. Registration of Billing Agents.  This provision, also required by the PPACA, requires all billing agents, clearinghouses, and alternate payees that submit Medicaid claims to register with the Department.

The North Carolina House voted to override the Governor’s veto of Senate Bill 33 – Medical Liability Reforms this afternoon. The NCMS and the component and specialty societies pulled together to make medical liability reform a reality.

“This demonstrates what we can accomplish as a profession when we work together,” said Robert Seligson, CEO of the North Carolina Medical Society.

Also critical to the success of this effort were the NC Hospital Association, the NC Health Care Facilities Association. The NC Chamber of Commerce and other major business interests also played a key role. A more complete report will be provided this week.

Thanks to all of the physicians who did their part and contacted their legislators on this critical issue!

What are your thoughts on the passage of medical liability reforms? Share in the comments section below!

The NC Senate voted swiftly to override the veto of Senate Bill 33 – Medical Liability Reforms on Monday, July 11. Now, the deliberation continues to the NC House of Representatives, which has scheduled votes to override the Governor’s veto of several bills, including SB 33, on Monday, July 25. Voting could occur anytime between July 25 and July 28. The NCMS is asking physicians to contact their Representatives by phone, fax and email in Raleigh or in their home district, and urge them to override the Governor’s veto of SB 33. Time is limited, so please contact your legislator today.

If you choose to email your legislator, visit http://www.capwiz.com/ncmedsoc/callalert/index.tt?alertid=51747501&type=ST for contact and content help.

A handwritten signed note is also effective. Be brief and include how your legislator can contact you. Legislative office numbers and addresses are available at http://www.ncleg.net/, and click the “Who Represents Me” tab using the 9-digit zip code on your NC driver’s license.

On Thursday night, NCMS hosted its first-ever Tele-Town Hall in which every NCMS member was called and invited to participate. NCMS Legislative Director Chip Baggett and EVP, CEO Robert Seligson led the briefing, which allowed participants an opportunity to ask questions.

Earlier this week, the NCMS talked with physicians face-to-face at Town Hall meetings held in Asheville and Greenville on Tuesday. Briefings by Chip Baggett and Steve Keene provided physicians talking points and information on contacting legislators. Over a thousand physicians have participated in Town Hall meetings. More Physician Town Hall meetings are scheduled for next week—please plan to attend, and let your colleagues know, too:

Monday, July 18, Charlotte, 5:30pm, City County Government Center, Conference Room 267, 600 E. 4^th Street, with parking at 2325 Davidson Street

Tuesday, July 19, Hickory, 6:00pm, Catawba Valley Medical Center Hospital, Class Room 810, Fairgrove Church Road SE.

Wednesday, July 20, Winston-Salem, 6:00pm, Forsyth Medical Center Conference Room, 3333 Silas Creek Parkway.

Thursday, July 21, New Bern, 6:00pm, CarolinaEast Medical Center Auditorium, 2000 Neuse Boulevard;

Thursday, July 21, Fayetteville, 6:00pm, Cape Fear Valley Medical Center Board Room, 1638 Owen Drive.

Be informed and talk with your legislator before the House votes the week of July 25. Let your Representative know how important it is to support the override of the Governor’s veto of SB 33.

The North Carolina Medical Society and the North Carolina Dermatology Association are among eighty-six national and state medical and specialty societies that have expressed opposition to federal legislation to repeal a tax on indoor tanning services. In a letter to Senator Olympia Snowe (R, Maine), the organizations stated that they “strongly believe in the advancement of public policies that promote prevention and education about skin cancer and reflect the dangers of indoor tanning.” Citing numerous scientific studies that tanning bed use increases the risk of developing all forms of skin cancer, the organizations noted that the indoor tanning tax serves as the only national policy that “acts as a deterrent to the harmful behavior and significant health risks of indoor tanning.”  Click here to read the letter.