Legislative Update: CON Reform, STOP Act, Scope of Practice Bills, Budget Bill
We are now in the final stretch of the 2017 “long session” of the NC General Assembly, and legislators are eager to wrap up work on the state’s biennial budget. Negotiations to smooth out the differences between the two chambers’ versions of the “Budget Bill” (SB 257, Appropriations Act of 2017) have shifted to a conference committee comprised of Senate and House leaders. Though this work will not be done through the public committee process, we will continue to monitor certain provisions that were included in either the House or Senate versions of the budget bill and advocate for the best interests of physicians and patients. We anticipate that the final budget proposal will be announced early this week, if not today. We are also closely monitoring bills that address non-physician scope of practice and opioid misuse.
BREAKING NEWS: On Thursday, June 15, a newly introduced version of House Bill 403, LME/MCO Claims Reporting/Mental Health Amendments, passed the Senate Health Care Committee. The language of the bill changed dramatically from the House version, including making changes to the Medicaid reforms adopted in 2015. The NCMS's Chip Baggett testified that the proposal will have terrible consequences for physicians, including:
- It would automatically enroll and set a reimbursement for providers at 90% of Medicaid fee-for-service rates if they are not in network.
- It would eliminate the states’ Chapter 58 insurance protections for patients and providers in lieu of federal regulations for Prepaid Health Plans (PHPs).
- It would integrate mental and behavioral health into PHPs on day one of reform, instead of four years later as originally planned in the 2015 Medicaid Reforms.
Take action: Send an email to your legislators through the NCMS Action Center.
CERTIFICATE OF NEED – Legislation was filed this session that addresses Certificate of Need, including one bill that would exempt ambulatory surgery centers and small community hospitals from CON (HB 901, Amend Certificate of Need Laws). No CON reform bills remain active this session, but several CON provisions appear in the Senate’s version of the state budget. The House continues to resist CON reform, and it is not clear yet if any CON reform provisions will survive the House-Senate negotiations and be included in the final budget proposal.
OPIOID MISUSE – On Thursday, June 15, the STOP Act (SB 243, Strengthen Opioid Misuse Prevention), which passed the House in April, was reported favorably out of the Senate Health Care Committee and will make a pit stop in Senate Rules before heading to the full Senate for a vote next week. Sponsored by Rep. Greg Murphy, MD (Pitt Co.), this bill takes several steps to address the opioid poisoning epidemic. Key provisions of this legislation include requiring mid-level providers to consult with their supervising physician regarding long-term prescriptions, establishing maximum limits for initial prescriptions of certain schedule II and III controlled substances and expanding controlled substances reporting system (CSRS) usage and reporting requirements. Funding related to these provisions has been included in the budget bill.
PHYSICAL THERAPISTS SCOPE OF PRACTICE – Legislation that would expand physical therapists’ scope of practice (HB 187/SB 176, Modernize Physical Therapy Practice) by allowing them to manipulate the spine without a prescription from a physician licensed to practice medicine in NC was passed by the House in April and has been referred to the Senate Rules Committee. It is unlikely that the measure will see any additional movement this year, but it remains eligible for consideration when the legislature returns in 2018.
OPTOMETRISTS SCOPE OF PRACTICE – The next three weeks are a perilous time in a battle that has been brewing since February. The House passed an amended version of HB 36 in April that directs the NC Institute of Medicine to study the issue of optometrists doing surgery in NC. Senator David Curtis, OD, the primary proponent of the legislation in the Senate, is pushing to revive HB 36 as a scope of practice bill this year. It is critical that legislators continue to hear from physicians, patients and concerned citizens – 90% of whom oppose HB 36.
Take Action: Engage patients, family and friends by sharing this grassroots flier.
APRN SCOPE OF PRACTICE – Legislation filed in both the House and Senate (HB 88/SB 73, Modernize Nursing Practice Act) did not get legs this session, thanks to the strong opposition of the NC Medical Society and physician specialty societies. The bill would expand the scope of practice of advanced practice registered nurses (APRNs: nurse practitioners, certified nurse-midwives, certified registered nurse anesthetists and clinical nurse specialists) by removing the physician supervision requirement and allowing APRNS to practice independently as regulated by the Board of Nursing.
Take Action: Send an email to your legislators through the NCMS Action Center.
Notable Budget Provisions:
Balance Billing – When legislation was introduced in March that would cap out-of-network rates at Medicare levels and restrict physicians’ ability to bill patients directly for services rendered, the medical community responded quickly to oppose the measure. While that legislation was never heard in committee, some of its provisions were included in the Senate’s budget bill. The House budget did not include any provisions related to SB 629. We are asking legislators to oppose the inclusion of SB 629 provisions in the budget bill.
Take Action: Send an email to your legislators through the NCMS Action Center.
Combating the Opioid Epidemic – Several provisions that appear in both the House and Senate versions of the budget are aimed at curbing the opioid poisoning epidemic in our state. Both versions fund upgrades to the state’s Controlled Substances Reporting System (CSRS) to include interoperability with the NC HIE. The House version (but not the Senate’s) includes $100,000 in recurring funds to purchase the opioid antagonist Naloxone. The Senate version orders a study of provider prescribing practices to determine whether the ongoing CME requirement is having an impact.
Health Information Exchange – Both versions of the budget provide HIE funding of $3M in non-recurring funds to support technology upgrades and $1M in recurring funds for ongoing maintenance, and require physician practices to connect to the HIE network. The House version gives hospitals and providers more time to establish connectivity with a deadline of June 1, 2019 (compared to the Senate deadline of June 1, 2018). Similarly, local management entities/managed care organizations will have until June 1, 2020 per the House budget (June 1, 2019 per the Senate version).
Graduate Medical Education Funding – Both versions of the budget provide funding for the establishment of residency programs affiliated with Campbell University at Cape Fear Valley Medical Center. While the final payment amount is conditional upon calculation of lost Medicare payments issued to the Cape Fear Valley Medical Center prior to its reclassification by CMS as a rural hospital, the Senate version provides a more generous outlay of up to $3M (compared to the House’s budgeted amount of up to $1M).
Women’s Health Care – The Senate’s budget would cut women’s health services by prohibiting the NC DHHS from allocating state funds to any provider who performs abortions. The provision does not apply to covered services for which a provider would bill Medicaid or the State Health Plan.
Diabetes Prevention – A provision appearing in both versions of the budget directs the NC DHHS to report by December 1, 2017, and annually thereafter, on the state’s Diabetes Prevention Program, which aims to reduce health disparities. Specifically, DHHS is to report on the status, participant demographics, cost, and outcomes of the Diabetes Prevention Program.
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