This week the Joint Legislative Commission on Governmental Operations cleared the way for the NC Department of Insurance (NCDOI) to spend $12.4 million in federal grant money for the establishment of a state-controlled health insurance exchange. If the state does not establish an exchange under the guidelines of the Affordable Care Act, the federal government must step in and run the exchange for the state.

These federal grant dollars will be used to begin the process of contracting for technology services and hiring staff to create and manage the operations of the exchange.

See related stories:

NCMS Convenes Meeting with Benefits Exchange Stakeholders (Bulletin, 10-7-11)

Proposed Rules Released and Funds Awarded to Help States Build Affordable Health Benefit Exchanges (Bulletin, 8-19-11)

Focus on Health System Reform: Health Benefit Exchanges, Part 1 (Bulletin, 7-23-10)

Focus on Health System Reform: Health Benefit Exchanges, Part 2 (Bulletin, 7-30-10)

On Wednesday, the US House passed an amended version of HR 674, legislation that repeals a planned 3 percent tax-withhold for many Medicare payments. It now goes to President Obama, who is expected to sign the bill.

Originally passed in 2006 and delayed several times, the statute called for all federal, state and local government payments to those providing services or goods to have 3 percent of their payment withheld until the following tax year in an effort to increase tax compliance. However, the American Medical Association led efforts to amend the measure as the original statute was considered overly broad and would have applied even to Medicare payments made to physicians.

The NCMS has been a part of ongoing discussions with both the General Assembly and the Department of Health and Human Services (DHHS) to avoid further reductions to Medicaid provider rates. These cuts have been threatened due to a $139 million shortfall in this year’s Medicaid budget. At this time NCMS advocacy efforts have been successful, and for the time-being provider rates have been spared.

The Joint Legislative Oversight Committee on Health and Human Services met on Tuesday, November 8, 2011, to receive a progress update regarding the $359 million in reductions required of the DHHS in this year’s budget. DHHS Secretary Lanier Cansler reported to the Committee that a majority of the necessary budget reductions have been successfully implemented and that aside from significant Medicaid shortfalls the Department was on track to meet legislative targets. Most of those shortfalls have arisen from one-time costs and unbudgeted liabilities, including overdrawn federal receipts. View DHHS’s update on the budget here.

A key partner in reducing recurring costs in the Medicaid budget is Community Care of North Carolina (CCNC). Allen Dobson, MD, presented on behalf of CCNC pointing out areas of expansion as well as a number of new initiatives by various physician, hospital and other provider groups in partnership with CCNC. View CCNC’s presentation to the Committee here.

Total reductions within the Medicaid program have fallen short of expectations due in part to the Department’s slow enrollment of high-cost patients into CCNC, who has been tasked with saving the state $180 million over the two year budget cycle. CCNC is currently on track to exceed that goal according to Sec. Cansler. However, this slow enrollment in the first year of the biennium and the Department’s other unbudgeted liabilities caused the Secretary to solicit the Committee’s guidance on how to best address the 2011 shortfall that now totals $139 million.

Further cuts to optional services and an 18% reduction in provider rates were discussed as an option for DHHS to close the gap. Ultimately, legislators agreed that cuts to neither provider rates nor optional services were feasible in order to maintain a viable Medicaid provider network and recommended that lawmakers and the Department work together to further cut costs and perhaps use cash reserves to remedy the one-time shortfall.

U.S. District Court Judge Catherine Eagles temporarily stopped implementation of one piece of North Carolina’s new abortion law on Tuesday. Set to go into effect on Wednesday, October 26, 2011, the Woman’s Right to Know Act would have required health care providers to conduct an ultrasound at least four hours prior to performing an abortion procedure and to show and describe the images of the test to the patient prior to the procedure.

On Tuesday Judge Eagles ruled that those challenging the new law were likely to prove that this provision violates the Constitution and therefore temporarily blocked implementation. Other provisions of the Woman’s Right to Know Act became effective this week, including a 24 hour waiting period for abortion procedures except in emergency situations.

Read the complaint filed against the State here, and the Court’s opinion here.

In May 2010 the NC Board of Nursing established an APRN Advisory Committee charged with studying the licensure, accreditation, certification and education of advanced practice registered nurses in North Carolina.  The establishment of this committee came as a result of the adoption of the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education by the National Council of State Boards of Nursing (NCSBN).

Since the adoption of the national model in 2008, the NCSBN has pushed for adoption in all fifty states. North Carolina is next on this list.  The advisory committee in North Carolina was comprised of 16 members including 14 nurses and two public representatives.

The committee met four times and presented its recommendations to the NC Board of Nursing at the September 2011 meeting. These recommendations include:

• Sole regulation of all advanced practice registered nurses by the NC Board of Nursing, eliminating the shared regulatory role of the NC Medical Board over Nurse Practitioners (NP).
• Elimination of physician supervision requirements for Nurse Practitioners (NP) and Certified Nurse Midwives (CNM).
• Grant prescriptive authority to Certified Registered Nurse Anesthetists (CRNA) and Clinical Nurse Specialists (CNS).

The NCMS is watching this issue very closely and will continue to offer updates in the Bulletin as they become available.   NCMS policy supports the requirement of physician supervision of mid-level practitioners who perform medical acts, tasks, and functions (Physician Relationship With Mid-Level Practitioners).

Related legislation is expected to become a priority for the NCMS legislative team during the upcoming session of the NC General Assembly. Read the entire report from the APRN Advisory Committee here.

The NCMS Legislative Team has completed the 2011 Legislative Summary, and you can read it at: http://www.ncmedsoc.org/non_members/legislative/2011-Legislative-Summary.pdf.

The overview of the 2011 Legislative Session provides an informative review of NCMS legislative advocacy, including successes, such as SB 33—Medical Liability Reforms and HB 542 – Tort Reform for Citizens and Business. The Summary not only covers accomplishments, but it also serves as a reference to help prepare for 2012—a Presidential Election year – and the Legislative Short Session that convenes in May.

“It is more important than ever for you to become an engaged member of organized medicine and encourage your colleagues to do the same. The short session is just around the corner — please join us in shaping the future of medicine in 2012,” Robert Monteiro, MD, President-Elect and Chair, the NCMS Legislative Cabinet.

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.