Multiple Medicaid Reform Bills, Nursing Bills Gain Traction at the NC General Assembly

Four separate Medicaid reform bills have been filed at the General Assembly, three of which would rely on corporate Managed Care entities as the vehicle for transforming the current Medicaid system. At the same time, a number of other bills addressing important issues like physician supervision of nurses and other non-physician practitioners were introduced following the Senate bill filing deadline last week. These bills demonstrate the Senate’s desire to address important health care related issues this session. Though it is early in the session, the multitude of bills indicate there is likely to be a large focus on issues affecting the practice of medicine.

Below is a brief summary of some of the key bills the Medical Society is following. Stay tuned for more information on these bills and others, and how you can help the NCMS in our advocacy efforts relating to these important topics.

Medicaid Reform

SB 568: North Carolina Health Care Modernization (Tarte)

Senate Bill 568 would authorize licensed commercial health insurers to offer Medicaid plans based on a primary care centric purchasing strategy. These entities would work in collaboration with LME/MCOs to serve Medicaid patients based on a capitated payment. This bill also would create a Joint Legislative Oversight Committee on Primary Care and Medical Benefits to examine budgeting, financing, administrative and operational issues related to Medicaid reform, taking these functions away from the NC Department of Health and Human Services.

SB 574: 2015 Medicaid Reform (Jackson, Pate, Tucker)

Senate Bill 574 would transform the state’s current Medicaid program to a program that “provides budget predictability for the taxpayers of this state while ensuring quality care to those in need.” The bill is light on details, but instructs that the following elements are included in the reform plan: ensuring budget predictability through shared risk and accountability; creating “balanced” quality and patient satisfaction as well as financial measures; the use of efficient administrative systems; and using a sustainable delivery system.

SB 696: Medicaid Modernization (Hise)

Senate Bill 696 would transform the Medicaid program from fee-for-service to full risk capitated health plans for all Medicaid recipients, covering all Medicaid health care items and services. The bill contemplates competition between multiple provider-led and non-provider-led health plans, all of which would be full risk plans within two years. The bill also would create a new Health Benefits Authority to be managed by a board of experts in health administration, health insurance, health actuarial science, health economics and health law and policy appointed by the Governor and General Assembly to manage and oversee the Medicaid and NC Health Choice programs. The legislation also would create a Medicaid Reserve Account in the General Fund for the purpose of providing for unexpected budgetary shortfalls with the Medicaid and NC Health Choice programs.

SB 703: Medicaid Transformation (Berger)

Senate Bill 703 would direct the NC Department of Health and Human Services (DHHS), Division of Medical Assistance to create and implement a Medicaid reform plan. This plan would be required to transform the current fee-for-service system into a capitated, risk-based managed care Medicaid program. The bill requires at least three statewide Medicaid managed care organizations to assume the full risk for Medicaid benefits. This legislation directs the NC DHHS to implement this plan no later than Jan. 1, 2017.

Scope of Practice

SB 695: Modernize Nursing Practice Act (Hise, Pate)

Senate Bill 695 would make changes to the North Carolina Board of Nursing, including adding advanced practice registered nurse (APRN) licensure for nurse practitioner, certified nurse midwife and clinical nurse specialist providers. In addition, the legislation would include the following in the APRN scope of practice, beyond the current RN scope of practice:

  • Conducting an advanced assessment
  • Delegating and assigning therapeutic measures to assistive personnel
  • Performing other acts that require education and training consistent with professional standards and commensurate with the APRN’s education, certification, demonstrated competencies and experience

The bill also permits the following areas of focus for APRN practice:

  • The family or individual across the life span
  • Adult gerontology
  • Neonatal
  • Pediatrics
  • Women’s health
  • Psychiatric or mental health

SB 240: Define Scope of Practice of CRNAs (Davis)

Senate Bill 240 would eliminate the requirement of physician supervision of nurse anesthetists (CRNAs). Specifically, the legislation would include the following components as the practice of nursing by a certified registered nurse anesthetist:

  • Perform nurse anesthesia activities in collaboration with a physician, dentist, podiatrist or other lawfully qualified health care provider with each provider contributing his or her respective area of expertise consistent with the lawful scope of practice and according to established policies, procedures, practices and channels of communication that lend support to nurse anesthesia activities
  • Lend support to nurse anesthesia activities
  • Define the roles and responsibilities of the certified registered nurse anesthetist within the practice setting
  • Maintaining individual accountability for the outcome of individual actions

SB 542: Decriminalize Direct Entry Midwifery (Rabin, Sanderson, Krawiec)

Senate Bill 542 would allow any person certified as a Certified Professional Midwife by the North American Registry of Midwives to provide prenatal, intrapartum, postpartum and newborn care.

SB 543: Home Birth Freedom Act (Rabin, Sanderson, Krawiec)

Senate Bill 543 would license Certified Professional Midwives, creates licensing requirements for this certification, and mandates that a patient may not be required to be served by a physician instead of a Certified Professional Midwife. This legislation also would allow for third-party reimbursement and coverage for maternity and obstetrical care by a Certified Professional Midwife.

Health Care Regulation

SB 702: Repeal CON and COPA Laws (Apodaca)

Senate Bill 702 would repeal two laws that are generally viewed as reducing competition in health care. The measure repeals the state’s certificate of need (CON) law, which places limits on who is permitted to own certain medical facilities and technologies, and where they may be located. Also repealed are the certificate of public advantage (COPA) laws, which allow competing health entities (e.g., hospitals) to engage in activities that undermine competition, despite antitrust concerns. If enacted, the law would become effective January 1, 2017. Senator Tom Apodaca (R, Henderson) is the primary sponsor of S702.

 

 
 

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