Step therapy bill hearing in the House Insurance Committee.
July 28, 2016
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In this edition:

M3 is the place to be

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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NC Medicaid Announces Direct Enrollment of Mid-Level Providers
Take action now to ensure that your claims are not suspended or denied.

In accordance with new Federal regulations, claims for services will no longer be filed as "incident to" in NCTracks. All attending, rendering, ordering, prescribing or referring providers in NC Medicaid or NC Health Choice, including Physician Assistants (PAs), Nurse Practitioners (NPs), Certified Registered Nurse Anesthetists (CRNAs), and Certified Nurse Midwives (CNMs), are encouraged to begin submitting enrollment applications now to NCTracks. This will ensure that your claims are not suspended on November 1, 2016 – the effective date of this new rule. Visit the Provider Enrollment page.

For all claims submitted beginning November 1, the provider’s National Provider Identifier (NPI) will be required as a data element on the claim for programs listed in this May 2016 Special Bulletin. Any NPI entered on a claim will be validated, even if it is not required for that service/claim type. Limited exceptions to this new regulation include any Resident or Intern in a Graduate Dental and Medical Education program.

For reference:

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Register Today for NCMS Foundation's Leadership Development 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 (HCLM). Applications are due August 1 for Leadership College and September 1 for HCLM.

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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13.75 CMEs @ the M3 Conference, Sept. 15-18

The NC Medical Society (NCMS) and the NC Medical Group Management Association (NCMGMA) have joined forces on THE educational conference of the year, focusing on current and evolving practice improvement, leadership in health care and personal development. Don't miss the M3 Conference – Merging Medicine and Management – September 15-18 at the Grandover Resort in Greensboro. Visit the M3 Conference website for complete program details and online registration.

Presented by leading experts and industry professionals, the educational sessions will help you understand and implement new payment and practice models, sharpen your leadership and management skills, adapt to changing technology and keep your practice ahead of the curve in the ever-changing world of health care. The Southern Regional AHEC designates this live activity for a maximum of 13.75 AMA PRA Category 1 Credit(s)TM.


  • Three consecutive days of relevant, cutting-edge educational sessions;
  • Social events and networking opportunities;
  • Engaging speakers and informative sessions on the most timely heath care issues;
  • Poster competition for medical students and residents;
  • Exhibit Hall with health care vendor products and services.

M3 is the place to be

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AAN Fall Conference, Oct. 14-16

Stay current in clinical advances and keep your practice thriving at the AAN Fall Conference, October 14-16, 2016, in Las Vegas, Nevada at the Cosmopolitan of Las Vegas. The hotel reservation deadline is September 1. Early-bird registration discounts end September 8. Visit the AAN website for program details, hotel reservations and online registration.

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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 a 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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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 Your email address will only be used for new issue alerts.

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Federal Advocacy: Furthering Access to Stroke Telemedicine Act (FAST Act)

The American Academy of Neurology, in partnership with the American Heart/Stroke Association, continues to fight for passage of H.R.2799 / S.1465, the Furthering Access to Stroke Telemedicine Act (FAST Act). The FAST Act would expand access to stroke telehealth services by addressing an important barrier to the expansion of telestroke services: lack of Medicare reimbursement for telestroke services when the patient originates in an urban or suburban area.

The use of telemedicine in the treatment of stroke – commonly referred to as “telestroke” – has proven highly effective in improving patient access to quality stroke care. But there are a number of barriers that rob patients of the treatments that can improve their lives and prevent long-term disability, including lengthy travel times to primary stroke centers and a shortage of neurologists.

You can help expand support for this important legislation. The AAN asks that neurologists reach out to their representatives and urge them to co-sponsor the FAST Act. Presently, just three of the state’s 13 U.S. Representatives in the House are co-sponsors. Be sure to thank the following representatives for their existing support of the FAST Act. For assistance coordinating meetings with your elected officials, please contact Denna Suko, NCNS Deputy Director, at 919-833-3836 or We’re here to help!

FAST Act Cosponsors:

  • Rep. Renee Ellmers
  • Rep. Richard Hudson
  • Rep. Patrick McHenry

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Save the date!
2017 NCNS Annual Meeting
February 17-19 | Village of Pinehurst

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