In this edition:
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Legislative Update: CON, CSRS, Step Therapy and Medicaid
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, legislators debated the merits of eliminating Certificate of Need. This week, Governor Pat McCrory signed into law legislation that allows a statewide standing order for naloxone and step therapy was discussed in the House Insurance Committee.
Certificate of Need – NCSOHNS member Dr. Charles Ford (Boone) urged the legislature to repeal the state’s Certificate of Need (CON) program at a June 14 hearing on the issue. The Senate Health Care Committee heard testimony regarding potential legislation to repeal the state's CON program, but did not vote on the bill. Representatives from the North Carolina Orthopaedic Association, John Locke Foundation and Americans for Prosperity also testified that CON contributes to rising health care costs and decreases patient access to care. You can watch video coverage of the debate online (begins at 28:15).
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Dr. Ford said, “CON limits patient access and choice, allowing the most costly models to flourish.” He testified that patients are increasingly seeking out alternative sites of care, and that they are leaving Boone to have even minor procedures, such as ear tubes, done at an ambulatory surgery center in Hickory. He reported the cost of ear tubes in Boone at $5,200 compared to $1,700 in Hickory.
Dr. Richard Bruch (Durham), an orthopaedic surgeon, spoke about the inadequate supply of operating rooms in North Carolina. He relayed the comments of Dr. Timothy Jordan (Raleigh), an ophthalmologist, who struggles to get morning operating times for his pediatric patients. “There is no ‘need’ in our certificate of need mechanism for ambulatory surgery centers. We have stifled operating rooms in this state.”
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Dr. Charles Ford testified that CON drives up health care costs and limits access to care in North Carolina.
NCSOHNS member Dr. Patrick "Tate" Maddox (Boone) and orthopaedic surgeon Dr. Richard Bruch (Durham) encouraged law-makers to end CON during meetings at the legislature on May 25. Pictured (L-R): Denna Suko, Dr. Tate Maddox, Dr. Richard Bruch and Alan Skipper.
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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 the differences between the two chambers versions of the FY2016-17 budget update, including a $118 million difference in DHHS spending. A Controlled Substances Reporting System (CSRS) mandate, which was included in the Senate’s proposed budget, is also on the table. 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 – On June 22, the House Insurance Committee debated House Bill 1048, Reduce Barriers to Improve NC Health & Safety, but did not vote on the measure. The bill would set standards for the development of step therapy (or "fail first") pharmaceutical coverage protocols and requires transparency in the exceptions determination process. The bill also includes provisions for health benefit plans’ coverage of abuse-deterrent opioids. Though several patient and physician organizations have aligned in support of the bill, the hearing on June 22 was dominated by opponents of the bill who emphasized the increased cost that would result if step therapy protocols were restricted in any way.
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 restrictions in North Carolina. At a 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.
Medicaid Reform & Expansion – 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. At the hearings and in the written comments, many citizens advocated for expansion of Medicaid, according to Brajer. The waiver application, however, does not include provisions for expanding Medicaid, he said, since the waiver must comply with the reform legislation passed last fall, which does not envision expansion.
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2016 NC/SC Annual Assembly, July 29-31 - Hotel Cutoff is June 28
Otolaryngologists from North Carolina and South Carolina will convene at the 2016 Annual Assembly, July 29-31, at the Belmond Charleston Place for a weekend of continuing education, collegiality and networking. The program includes 9 hours of CME programming presented by expert faculty, a lively exhibit hall and social activities - all provided at the luxurious Belmond Charleston Place.
Featured speakers include two-time AAO-HNS Distinguished Service Award recipient David Terris, MD, FACS, FACE, Clelie Claire Carpenter Melancon, MD, Robert E. Taylor, MD, Adam Zanation, MD, Ashli O'Rourke, MS, MD, Sam Oyer, MD, Calhoun D. Cunningham, III, MD, Lucinda Halstead, MD, and Christopher Grubb, MD.
A special panel discussion on “Otolaryngology Private Practice in the Carolinas: Challenges, Issues, Opportunities” and an important session on opioid prescribing is also included.
9.0 AMA PRA Category 1 Credits™ & Superb Faculty
- Agenda and online registration: http://www.cvent.com/d/lfq312
- Accommodations: Call the Belmond Charleston Place at 1-800-831-3490 or e-mail groupres.cph@belmond.com by June 28.
- Exhibiting Opportunities: Help ensure the meeting's success by sharing the Exhibitor Prospectus with the product and service representatives who call on your practice.
- Credit Statement: The Southern Regional AHEC designates this live activity for a maximum of 9.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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NC Medicaid Announces Direct Enrollment of Mid-Level Providers
The NC Department of Health and Human Services has announced that mid-level providers will be required to enroll with NC Medicaid and NC Health Choice effective August 1, 2016. The June 2016 Medicaid Bulletin reports,
All services provided must be filed to NCTracks using their National Provider Identifier (NPI) as the rendering (or attending) provider.
Services provided by PAs, NPs, CRNAs and CNMs are no longer billable as “incident to.” The NPI of the mid-level provider must be submitted for all orders, prescriptions, and referrals. For additional information, refer to the May Special Bulletin, Federal Regulation 42 CFR 455.410: Attending, Rendering, Ordering, Prescribing or Referring Providers-Update.
Applicants must meet all program requirements and qualifications for enrollment before they can be enrolled as Medicaid providers. Providers with questions about the NCTracks online enrollment application can contact the CSRA (formerly CSC) Call Center at 1-800-688-6696 (phone); 919-851-4014 (fax) or NCTracksprovider@nctracks.com (email).
For more information, read the June 2016 Medicaid Bulletin and visit the Provider Enrollment page on the NCTracks website.
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AAO-HNS Annual Meeting, Sept. 18-21
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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 visit the NCMS Foundation website.
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M3 Is the Place to Be This September
Where are you going to be on Sept. 15-18? The historic M3 Conference in Greensboro is the place to be for physicians and practice managers this fall. This landmark conference will bring physicians and practice managers together for three days of education, networking and inspiration with colleagues from across the state. All the information and registration materials are now available on the M3 Conference website.
Visit often as we continue to add new sessions. Don’t miss this opportunity to merge medicine and management in North Carolina.
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e-Notification of New NCMJ Issues
As a North Carolina health care provider, you might find the North Carolina Medical Journal (NCMJ) to be of interest. A journal of health policy analysis and debate, the NCMJ covers a range of medical and public health topics. For example, 2015 topics included rural health, traumatic brain injury, patient and family engagement, evidence-based practice, and military health.
If you would like to be notified when new issues are available online, sign up at http://www.ncmedicaljournal.com/cgi/alerts/etoc. Your email address will only be used for new issue alerts.
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CMS Resuming Regular Medicare Revalidation Cycles
The Centers for Medicare and Medicaid Services (CMS) has completed its initial round of revalidations and will be resuming regular revalidation cycles. In an effort to streamline the revalidation process and reduce provider/supplier burden, CMS implemented several new revalidation processing improvements. CMS is making multiple attempts to notify enrolled providers of their revalidation due date. You must complete revalidation by your assigned due date to avoid possible hold on your Medicare payment and deactivation of your Medicare billing privileges. For complete information, including FAQs, visit the CMS website.
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July 1 Deadline for Meaningful Use Hardship Exemption Applications
The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for physicians seeking to apply for the “blanket” hardship exemption from 2015 Meaningful Use requirements to July 1, 2016. All eligible professionals applying for this exemption must complete an application by the July 1 deadline. For instructions and the application, visit the CMS Payment Adjustments & Hardship Information webpage.
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