Legislative Wrap Up: Step Therapy, Medicaid Waiver, CSRS, Opioids and More!
The 2016 “short session” of the NC General Assembly concluded on July 1, 2016. The final weeks of the session saw a flurry of legislative committee meetings and action on a number of health-related items of interest to neurologists and other physicians.
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.
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.
Controlled Substances Reporting – Legislators, faced with an opioid abuse epidemic, also have concerns that usage of the state's Controlled Substances Reporting System (CSRS) among physicians remains low. In response, the 2016 Appropriations Act enacted two notable provisions with regard to the CSRS. First, the budget appropriated $600,000 to facilitate connectivity between our CSRS and the reporting systems in surrounding states as well as integration with NC’s Health Information Exchange (HIE). The budget also allocates and more than $650,000 to develop and implement software for the performance of advanced analytics within the CSRS. The legislation further requires physicians to register with the CSRS once the upgrades are complete.
Opioid Abuse Epidemic – According to Project Lazarus, a statewide public health non-profit that is partnered with Community Care of North Carolina, our state has higher than average overdose death rates. Nearly all of these deaths involve prescription opioid pain relievers (like methadone, oxycodone, fentanyl, morphine, tramadol, or hydromorphone). The state is taking steps to combat the harmful and rippling effects of prescription drug abuse. Several bills took aim at the opioid abuse epidemic during the final weeks of the short session.
The 2016 Appropriations Act established a medication-assisted opioid use disorder treatment pilot program with a goal of studying the effectiveness of combining behavioral therapy with the utilization of a nonnarcotic, non-addictive, extended-release, injectable formulation of opioid antagonist approved by the United States Food and Drug Administration for the prevention of relapse to opioid dependence.
Also significant, Governor Pat McCrory signed into law on June 20, 2016 an act authorizing the State Health Director to prescribe opioid antagonists by means of a statewide standing order, with immunity from civil and criminal liability for such action.
A provision in the 2015 Appropriations Act established a requirement - effective January 1, 2017 - that all NC Medical Board licensees complete at least one hour of continuing education annually regarding controlled substance prescribing. A free two-hour CME session on opioid prescribing will be offered on Saturday, September 17, 2016 in conjunction with the NC Medical Society's M3 Conference.
Certificate of Need – Physicians testified in support of a proposal to repeal the state's CON program at a June 14 legislative committee hearing on the issue. The Senate Health Care Committee heard testimony regarding potential legislation, but did not vote on the bill. Representatives from the North Carolina Orthopaedic Association, the North Carolina Society of Otolaryngology-Head and Neck Surgery, John Locke Foundation and Americans for Prosperity 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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