New legislation in N.C. targets step therapy pharmaceutical coverage policies.
June 20, 2016 | view this message in your web browser

 PO Box 27167
Raleigh, NC 27611
Tel: (919) 833-3836
Fax: (919) 833-2023
CC-AACE Website

In this edition:

Registration Now Open for 2016 CC-AACE Annual Meeting, Sept. 9-11

The Carolinas Chapter of the American Association of Clinical Endocrinologists (CC-AACE) is pleased to announce its 2016 Annual Meeting, to be held at the newly-renovated Sonesta Resort on Hilton Head Island, S.C. Expert faculty will present up-to-date methods of evaluation and therapy for endocrine conditions affecting our patients.

Featured faculty include Bruce Bode, MD, FACE (Atlanta Diabetes Associates), Robert Eckel, MD (University of Colorado, Denver), Kathleen Hands, MD, FACE, ECNU (Thyroid Center of South Texas), Jerry Marifke, MD, FACE (Prevea Health), Mary Lee Vance, MD (University of Virginia Health Sciences Center) and William Young, Jr., MD, MSc, ELS (Mayo Clinic College of Medicine).

8.25 AMA PRA Category 1 Credit(s)TM & Superb Faculty

Program and registration: Register by August 10 to receive the early-bird discounted rate.

Accommodations: Please call 1-800-SONESTA (800-766-3782) and reference the CC-AACE by August 10 for the group rate of $189++ per night.

Enjoy spectacular sunset views from the luxurious Sonesta Resort.

CME Credit Statement: The Southern Regional AHEC designates this live activity for a maximum of 8.25 AMA PRA Category 1 Credit(s)TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Additional Credit: Other health professionals will receive Southern Regional AHEC CEU and/or contact hours and a certificate of attendance for participation in this AMA PRA Category 1TM activity.

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NC: Legislative Update – Certificate of Need, Budget and Step Therapy

The legislative calendar is filling up with a flurry of late-session committee hearings while House and Senate budget leaders hammer out differences between two versions of the state’s FY2016-17 budget update. Last week on June 14, legislation was introduced in the Senate Health Care Committee to end the state’s Certificate of Need program.  The committee heard public comments both in favor and opposing the bill, but did not vote on the measure. On June 16, the legislature ratified a bill that allows the State Health Director to prescribe an opioid antagonist via a statewide standing order. That bill awaits Governor Pat McCrory's signature, which is expected early this week.

The Budget and CSRS – Legislators have their sights set on a target adjournment date of July 4. The budget is now in the hands of a conference committee that will hammer out a $118 million difference in DHHS spending between the two chambers’ versions of the FY2016-17 budget update. A Controlled Substances Reporting System (CSRS) mandate, which was included in the Senate’s proposed budget, is also on the table. Specifically, the Senate provision would require physicians to register with the CSRS and use the system, or face license suspension or revocation, when prescribing controlled substances.

Step Therapy – A coalition of physician and patient organizations, including the NCDA and the AAD, is organizing in support of new legislation related to step therapy (or “fail first”) pharmaceutical coverage policies. Step therapy was a concern raised in the 2015 session of the NC General Assembly and a study committee was convened in the 2015-2016 interim to investigate step therapy practice in North Carolina. At the committee’s February 24, 2016 hearing, physicians representing several medical specialties offered testimony expressing concerns over the challenges physicians face in treating patients due to step therapy denials from insurance companies. House Bill 1048, Reduce Barriers to Improve NC Health & Safety, sets standards for the development of step therapy protocols and requires transparency in the exceptions/override determinations process. The bill has been referred to the Committee on Insurance and may be brought up for consideration in the coming weeks. The bill also includes provisions for health benefit plans’ coverage of abuse-deterrent opioids.

Medicaid Reform – North Carolina submitted its Medicaid waiver application to CMS on June 1. Federal review of the state’s plan to capitate payment for services provided to NC’s Medicaid population through a network of statewide and regional Medicaid carriers could take up to two years. DHHS Secretary Richard Brajer presented an overview of the final application to the House Health Committee moments before the application was signed by Governor Pat McCrory and sent to CMS. Brajer told legislators his department had worked with over 50 stakeholder organizations, held 12 public hearings across the state and received comments from over 750 organizations and individuals in developing this final waiver application.

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SC: Legislative Update – Naloxone, Good Samaritan and Telemedicine

The SC General Assembly adjourned its 2016 legislation session on June 2. Three bills of interest to physicians were ratified by the legislature in the final days of the legislative session and have been signed into law by Governor Nikki Haley: a bill related to the prescribing and administration of naloxone, a Good Samaritan law and a telemedicine bill.

H.3083, South Carolina Overdose Prevention Act, provides greater access to opioid antidotes, including naloxone, by allowing providers to issue a written prescription or standing order that can be used by a caregiver, or by emergency responders, to prevent an overdose. The new law requires the prescriber to share overdose information with the patient and/or caregiver and to document that this information was shared in the medical record. The law also releases from liability and professional disciplinary action the prescriber as well as other individuals, including emergency responders, for administration of the medication. This bill was ratified by the legislature on June 2 and signed into law by Governor Haley on June 3.

H.4999, Immunity from Liability for Providing Free Health Care Services, is a Good Samaritan law that exempts certain providers from civil liability for providing free health care services. In the case of a nonemergency, an agreement that the care is being provided voluntarily and non-compensated must be made in writing. The provider is immune from liability except in cases of gross negligence or willful misconduct on the part of the provider. This legislation was ratified by the General Assembly on May 24 and signed into law by Governor Haley on May 25.

S.1035, South Carolina Telemedicine Act, amends state law to allow state licensed physicians to prescribe medication to a patient through telemedicine, and requires physicians to comply with the same regulations and standards of traditional practitioners. This Act was ratified by the legislature and signed into law by the Governor on June 3.

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SC: Calendar of Events

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AACEPAC Challenge: A Message from Dr. Elizabeth Holt

Dear fellow Carolinas-AACE members,

Numbers matter and Dr. Usah Lilavivat from South Carolina believes that our chapter is up to the challenge of demonstrating strong support and commitment for AACE advocacy. So much so, that he is willing to place his wallet on the line to show his excitement about AACEPAC and encourage each of you to be an active participant in the political process to have our voices heard!

Dr. Lilavivat has offered to double or quadruple his current AACEPAC contribution of $250 if other Carolinas-AACE members contribute at any level and increase our chapter’s participation rate! Currently, only fifteen (15) out of almost 200 Carolinas-AACE Chapter members contribute to AACEPAC, resulting in a chapter participation rate of just slightly less than 8%. If only thirty-three (33) more chapter members contribute, our participation rate will increase to 25% and Dr. Lilavivat will contribute another $250! If EVERYONE contributes and we reach 100%, he will quadruple his contribution bringing it to $1,000!!!

Participation is key and your support at any level will help AACEPAC advance AACE’s legislative agenda and enhance the influence of AACE on Capitol Hill. Any amount you are willing to contribute will be greatly appreciated, although a modest $25 each could pool together into almost $4,500 for AACEPAC on top of Dr. Lilavivat’s increased contribution! A 100% participation rate would certainly secure our chapter as the 2016 AACEPAC Challenge winner for highest percentage of AACEPAC members and possibly the title of highest dollar amount of AACEPAC contributions raised as well!

Dr. Lilavivat and I would like you to join us in helping the Carolinas-AACE Chapter to do its part to ensure AACEPAC and AACE’s legislative agenda will be heard in Congress. Strong AACE advocacy will help ensure that we remain the recognized leaders in diabetes care and other endocrine diagnoses. AACEPAC support by each domestic member is vital to AACE’s advocacy efforts to represent our interests in Congress by having a voice in policy decisions that have a direct impact on us and our patients. Robust participation positions AACE among the highest participation rates of any subspecialty medical group in the country. You may not be aware, but the participation rate is an important factor in our influence when we lobby on Capitol Hill. A high participation rate will send the very powerful message to Congress that we care and are invested in both the process and in the agenda for which we advocate.

Our Senators and Representatives want to know that all of our members care deeply about issues such as AACE’s diabetes initiative, the National Diabetes Clinical Care Commission Act (H.R. 1192/S. 586), the Medicare CGM Access Act (H.R. 1427/S. 804), and overseeing the implementation of the Medicare Access and CHIP Reauthorization (MACRA) law that reforms the Medicare physician payment system and addresses Meaningful Use and the interoperability of electronic health records.

I urge you to step up to Dr. Lilavivat’s challenge to be involved in AACE advocacy and the future of endocrinology by contributing today to AACEPAC. You can contribute to AACEPAC, review additional information, or see where the chapter stands in the AACEPAC Challenge by clicking here or by contacting Ms. Alysia Perry, Manager of Grassroots Activities, at or 904-353-7878 ext. 132.

I look forward to joining you in celebrating our achievement at the upcoming annual meeting in Hilton Head on September 9th-11th! Thank you in advance for your support and feel free to contact me if you have any questions.


Elizabeth Holt, MD, FACE
Vice Chair, AACEPAC
Past President, Carolinas-AACE Chapter

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NC: Diabetes Prevention Program for State Health Plan Members

The State Health Plan has announced a new covered benefit that supports members at risk for diabetes: the Diabetes Prevention Program (DPP). This CDC-approved, evidence-based program is proven to delay or avert diabetes in at-risk people. It is a comprehensive lifestyle change program offered in two phases over 12 months. The program is offered in-person at various locations throughout the state and online. Plan members pay just $25; the Plan supplements the remaining $400 cost of the program.

As a partner in preventing diabetes, please assess State Health Plan members’ risk, discuss their risk and prevention strategies, and refer at-risk members to DPP. State Health Plan members can find more information and registration at

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NC: Blue Medicare - Avoid Claims Processing Delays for Test Strips and Lancets

Blue Cross and Blue Shield of North Carolina (BCBSNC) provides coverage under its Medicare Advantage plans (Blue Medicare HMOSM and Blue Medicare PPOSM) for certain diabetic supplies such as lancets and test strips. Coverage is based on medical necessity.

According to the Glucose Monitors (L33822) Local Coverage Determination, the Blue Medicare member must meet the following criteria in order to be eligible for coverage of home blood glucose monitors and related accessories and supplies:

  • The member has diabetes
  • The member’s doctor has concluded that the member (or the member’s caregiver) has sufficient training using the particular device prescribed as evidenced by providing a prescription for the appropriate supplies and frequency of blood glucose testing.

Providers are reminded that the following guidelines apply to the units filed for the Healthcare Common Procedure Coding System (HCPCS) codes for test strips and lancets:

  • Glucose test strips (HCPCS A4253) – one box of 50 equals one (1) unit of service
  • Lancets (HCPCS A4259) – one box of 100 equals one (1) unit of service

Prompt processing of claims is contingent upon proper claim submission. Please ensure your billing staff is accurately reporting the units of service in claim field 24G when filing claims for diabetic supplies.

Providers may call Blue MedicareSM Provider Customer Service at 1.888.296.9790, if they have any questions.

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NC: Registration Open for Kanof Institute for Physician Leadership Fall Programs

The North Carolina Medical Society Foundation and the Kanof Institute of Physicians Leadership (KIPL) invite you to register for one of two programs beginning this fall; Leadership College and the new Health Care Leadership & Management program. Applications for both of these exciting programs are due July 15, 2016.

The Leadership College Program focuses on leadership fundamentals to enhance physicians’ and PA-Cs’ core aptitudes to excel as leaders within organized medicine, hospitals, health care systems, medical staffs, group practices, as well as in the public policy arena. The curriculum of the Health Care Leadership & Management Program is designed with greater emphasis on deeper leadership development and skills that include strategic planning, negotiation and financial literacy and application.

To learn more about the programs, please go to

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NEW "How To Handle Hypothyroidism" Poster Now Available

As part of its 2016 Thyroid Awareness Campaign, which addresses the fundamentals of hypothyroidism in a patient-friendly manner, AACE is pleased to announce the availability of our "How to Handle Hypothyroidism: Suspect, Detect, Defeat" poster. The full-color, 11" x 17" patient education display explains what hypothyroidism is, highlights visually the many symptoms that hypothyroidism can cause, and addresses treatment.

The poster is now available to AACE members at no cost. Email Mary Green at to advise how many copies you'd like to receive and where to send them.

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Upcoming Endocrine Coding Courses

To help physicians and their staffs obtain current and up-to-date coding, billing and compliance practices. The AACE offers the following endocrine-specific coding courses. Participants will gain knowledge of commercial and federal coding conventions and guidelines in order to obtain appropriate reimbursements in a compliant and efficient way.

Bridge the Gaps in Endocrine Coding and AACE your E/M Coding courses focus on common endocrine-related procedures, required documentation to support the procedure and appropriate coding expected by federal and commercial carriers.

Coding Essentials for Endocrinology and AACE Your E/M Coding courses address the necessity for physicians and their staff to gain an understanding of the resources required to properly document medical records and code visits and procedures to assure proper reimbursements, compliance with federal and commercial guidelines, and various state, federal, and commercial regulations.

St. Paul, MN
July 11: Coding Essentials for Endocrinology
July 12: AACE Your E/M Coding

San Antonio, TX
October 20: Bridge the Gaps in Endocrine Coding
October 21: AACE Your E/M Coding

Atlanta, GA
November 14: Coding Essentials for Endocrinology
November 15: AACE Your E/M Coding

Click here for more information or email

Space is Limited. Register Today.

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