Occupational Licensing Board Oversight

nc-stampHB 142 – Increase Oversight of Occupational Licensing Boards

Primary Sponsors: Rep. Sarah Stevens (R – Surry), Rep. Jonathan Jordan (R – Ashe)

This bill proposes extensive changes to the way Occupational Licensing Boards report to the NC General Assembly and addresses behavior by unlicensed individuals.  The bill is in response to the 2015 FTC v NC Dental Board case that detailed additional state oversight necessary for licensing boards that are made up of a majority of licensees to take action against unlicensed behavior.  A study of this issue was conducted through the interim.  NCMS is working to evaluate the impact of this legislation on NC Medical Board activities.

This bill passed in the House on 2nd and 3rd readings on 03.06.17.

Physical Therapists/Spine Manipulation without Physicians

nc-stampHB 187 – Modernize Physical Therapy Practice
Primary Sponsors: Rep. Nelson Dollar (R – Wake), Rep. John Torbett (R – Gaston), Rep. Susan Martin (R – Wilson),  Rep. Josh Dobson (R – Avery)
SB 176 - Modernize Physical Therapy Practice
Primary Sponsor: Sen. Louis Pate (R – Wayne)
This bill has been filed in both the House and Senate. This bill would alter the definition of physical therapy to include all spine manipulation without a prescription from a physician licensed to practice medicine in NC.  In the past, physical therapists have sought to perform additional services like dry needling.  This, too, would change physical therapist’s current scope of practice.

A Woman's Right to Know Bill

nc-stampHB 62 – A Woman’s Right to Know Addition/ Ashley’s Law
Primary Sponsors: Rep. Larry Pittman (R – Cabarrus), Rep. Sarah Stevens (R – Surry), Rep. Michael Speciale (R – Craven), Rep. Beverly Boswell (R – Dare)
This bill would require a physician or another qualified health professional to inform a woman before administering Mifepristone that it is possible to discontinue a drug induced abortion by taking a progesterone. Additionally, a medical professional must provide information on how, where, and from whom she can obtain assistance stopping the drug induced abortion. It also requires physicians or another qualified health professional to provide medical proof to a woman that a fetal death has occurred.
NCMS generally opposes legislation mandating conversation or standard practices between physicians and their patients.

Medical Marijuana Bill

nc-stampHB 185 – Legalize Medical Marijuana
Primary Sponsors: Rep. Kelly Alexander (D – Mecklenburg), Rep. Becky Carney (D – Mecklenburg), Rep. Pricey Harrison (D – Guilford), Rep. Rodney Moore (D – Mecklenburg)
SB 648 – Legalize Medical Marijuana
Primary Sponsors: Sen. Terry Van Duyn (D – Buncombe), Sen. Valerie Foushee (D – Orange)
This bill has been introduced for many consecutive legislative sessions.  It would allow for the production, distribution and regulation of marijuana for medicinal purposes.  Currently 28 states and the District of Columbia allow for such activities when prescribed by a doctor.
In previous years, the House Judiciary Committee has granted a committee hearing for advocates to voice their support or concern about legalizing medical marijuana in NC.  It is one of the rare instances where a bill has actually received an unfavorable recommendation in committee thereby blocking any chance of the bill coming up later in the legislative session.
NCMS has not supported the legalization of medical marijuana.

Right to Life Legislation

nc-stampHB 163 – Enact Right to Life at Conception Act

Primary Sponsor: Rep. Beverly Boswell (R – Dare)

If passed, this bill would declare that life begins at conception. It states that nothing could be construed to require the prosecution of any woman for the death of her unborn child, prohibit in vitro fertilization, or prohibit the use of birth control.  This is an area of the law that has been debated for decades.  To date, the US Supreme Court has upheld abortion laws without defining when life begins.

Rights for Mental Health Workers

nc-stampHB 139 – Mental Health Workers’ Bill of Rights
Primary Sponsor: Rep. Larry Bell (D – Duplin)
This bill seeks to provide mental health workers specific rights and standards in the workplace.  Those include the following: a safe workplace, adequate equipment, adequate staffing levels, supporting wages, right to refuse excessive overtime, briefings of patients, respectful treatment and equal treatment.

NCMS Legislative Update, Feb. 13, 2017: House Bill 36 - Amending the Scope of Practice of Optometry...

Welcome to the North Carolina Medical Society (NCMS) Legislative Blog update. We are continuing to work with the North Carolina Society of Eye Physicians and Surgeons (NCSEPS) and other medical specialty groups to educate legislators about House Bill 36, “Amending the Scope of Practice of Optometry in Order to Enhance Access to Eye Care in North Carolina”. The North Carolina Medical Society opposes this bill due to patient safety concerns.
The primary sponsors of the bill are Rep. Justin Burr (R- Stanly) , Rep. Jeff Collins (R– Nash) , Rep. Josh Dobson (R – Avery) and Rep. Julia Howard (R- Davie). At this point the bill has been referred to the House Health Committee. If it is viewed favorably in that committee, it will then move to the House Insurance Committee, and if approved by that group will finally head to the House Appropriations Committee.
NCSEPS member ophthalmologists and their lobbying team have met with legislators at the North Carolina General Assembly this week to explain to legislators the importance of training and experience in performing surgery. They used this handout to visually show the pronounced differences in optometry and ophthalmology training. The information contained in the last graph reflects a study done in Oklahoma, which found that patients who had laser surgeries performed by an optometrist- have a 189 percent increased risk of requiring a repeat laser surgery.
What can you do to ensure that North Carolina patients are treated safely, and do not require repeat procedures?
Please check your email today for an NCMS Action Alert you can send to your North Carolina House of Representative member to voice your opposition to optometrists performing surgery.  If you have trouble finding the Action Alert in your regular inbox, please check your spam folder for an email from “Muster”. Muster is the company we are using to streamline your ability to reach your legislators on important issues.  If you have problems receiving the alert, or if you would like to share the Action Alert with other physicians in your community or practice, please email [email protected].

NCMS Weekly Legislative Update: Feb. 7, 2017

Welcome to the North Carolina Medical Society Legislative Blog update. The first bill that could potentially impact the practice of medicine was filed this week.  House Bill 36, titled  “Amending the Scope of Practice of Optometry in Order to Enhance Access to Eye Care in North Carolina”, was filed by primary sponsors Rep. Justin Burr (R- Stanly) , Rep. Jeff Collins (R– Nash) , Rep. Josh Dobson (R – Avery) and Rep. Julia Howard (R- Davie). The North Carolina Medical Society opposes this bill because optometrists do not have the requisite training necessary to perform surgery.
The first section of the bill states that there are 1,180 optometrists that provide primary eye care in North Carolina. The bill also claims that the expansion of their scope of practice would “greatly improve access and affordability of eye care to the citizens of North Carolina”.
The second portion of the bill strikes their absolute bar on performing surgery and lists eighteen different surgeries that they would NOT be allowed to perform including the following:
(1)        Retina laser procedures, LASIK, and PRK.
(2)        Nonlaser surgery related to removal of the eye from a living human being.
(3)        Nonlaser surgery requiring full thickness incision or excision of the cornea or sclera other than paracentesis in an emergency situation requiring immediate reduction of the pressure inside the eye.
(4)        Penetrating keratoplasty (corneal transplant), or lamellar keratoplasty.
(5)        Nonlaser surgery requiring incision of the iris and ciliary body, including iris diathermy or cryotherapy.
(6)        Nonlaser surgery requiring incision of the vitreous.
(7)        Nonlaser surgery requiring incision of the retina.
(8)        Nonlaser surgical extraction of the crystalline lens.
(9)        Nonlaser surgical intraocular implants.
(10)      Incisional or excisional nonlaser surgery of the extraocular muscles.
(11)      Nonlaser surgery of the eyelid for eyelid malignancies or for incisional cosmetic or mechanical repair of blepharochalasis, ptosis, or tarsorrhaphy.
(12)      Nonlaser surgery of the bony orbit, including orbital implants.
(13)      Incisional or excisional nonlaser surgery of the lacrimal system other than lacrimal probing or related procedures.
(14)      Nonlaser surgery requiring full thickness conjunctivoplasty with graft or flap.
(15)      Any nonlaser surgical procedure that does not provide for the correction and relief of ocular abnormalities.
(16)      Laser or nonlaser injection into the posterior chamber of the eye to treat any macular or retinal disease.
(17)      The administration of general anesthesia.
(18)      Procedures performed under general anesthesia.
The problem with this kind of statutory construction is that the law will not define what they are allowed to do if passed this way.  Currently, Optometrists claim that they only want to do YAG and SLT laser surgeries as well as some skin tag removals.  The list above leaves far more than these three proposed scope expansions as options for their scope as currently written.
Additionally, we oppose this because the proposed language opens the door for optometrists to perform more surgeries as medicine advances in the future without ever having to come back to the NC General Assembly for approval.  This is contrary to the traditional structure of the NC General Statutes that require similar changes for other practitioners to seek legislative approval through a thorough bill process in order to expand their scope of practice.
We believe that optometrists are trained to be primary care givers for eyes. However, we do not think that they have the necessary training and experience to perform surgery safely.  Only a limited few optometric training schools even include any such training in their curriculum and even then further training is required to receive the base level certification used in other states to qualify optometrists to practice laser surgery.  This is not enough to provide for the safety of the citizens of NC.
How would you respond to this bill? What surgical procedures do you notice are not covered by the limited list of exceptions above?  Please post your responses in our comment section below.

NCMS Weekly Legislative Update - January 20, 2017

Welcome to a new blog series to inform you about the legislative activities that the North Carolina Medical Society is focusing on each week! This will be in addition to the regular Bowtie Briefing videos. We hope this series of articles will be able to provide you with more detail than time allows in the video blogs.
We have five main areas of priority that we expect to address in the upcoming legislative session which include the following:
1. Medicaid Reform
2. Patient and Provider Protections in the Medicaid Reform environment
3. Protection of the progress we’ve made on tort reform
4. Opioid Epidemic
5. Scope of Practice challenges
We will be bringing much more detailed information about each of these priority areas over the next few weeks. The NCMS lobbying team typically tracks more than 200 bills during any given long session that could have an impact on the practice of medicine. Those bills typically include many areas not listed above. Therefore, our scope of work is not limited to this list during the legislative session.
Please watch this blog for weekly updates on each of these issues as the session progresses. We hope that you’ll take the opportunity to attend our White Coat Wednesdays in Raleigh to speak with your legislator personally on how these issues impact your practice. You can contact Sue Ann Forrest, [email protected], for assistance.
In exciting news, the North Carolina Medical Society would like to congratulate Rep. Greg Murphy, MD (R – Pitt) on his appointment as Chairperson to both the House Health Committee and House Appropriations Subcommittee on Health and Human Services. We are thrilled that one of your peers, will help lead health care conversations in 2017.
At the end of last week, members of the NCMS lobbying team met with a Rep. Craig Horn (R - Union) to discuss the statewide opioid epidemic. Rep. Horn is passionate about this issue, and seeks to be a champion on solutions to the opioid abuse epidemic in the coming legislative session. We would love to hear from you about what steps you are taking in your community to combat the opioid epidemic. These examples can assist us in future conversations with legislators from across the state on what is making a difference at the local level.
Finally, please be sure to check your email on Sunday. We will be introducing you to our new grassroots communication tool that will make the process of contacting your elected officials much more streamlined and efficient. With just a few clicks, you will be able to send a pre-written message, or create your own individualized message. We encourage you to utilize this as an opportunity to welcome legislators to a new session, introduce yourself, and offer to provide professional guidance on health related issues.
We are looking forward to the start of this year’s long session beginning on Wednesday, January 25.
Please check back here for your legislative update each week!

NCMS Urges Guidance from Medicaid on December Recoupment

Anticipates Good Result on Denied TPL Claims
As 2015 was winding down, physicians were hit with an unpleasant surprise by North Carolina Medicaid – an unannounced reprocessing effort involving approximately 292,000 claims. The official reason for the reprocessing was to apply a 3 percent rate reduction that should have been in effect when the claims were originally processed, but was not.
To make matters worse, many practices reported that some reprocessed claims were denied outright for other reasons such as “third party liability or TPL” and for violating NCCI edits. The recoupment amount on those was 100 percent, not just 3 percent.
Upon learning these details, North Carolina Medical Society (NCMS) staff met immediately with senior Medicaid officials for an explanation as to why the 3 percent recoupment was so late, why so many claims completely denied, and what options remained for pursuing reimbursement on these already-rendered services.
In short, Medicaid acknowledged the lack of adequate communication and pledged to send a more complete explanation. After several weeks, NCMS expects Medicaid will release a Frequently Asked Questions document regarding the December recoupment in the next couple days. Please watch for this important communication if you were affected by the December recoupment.
We further anticipate the FAQ will include some good news: Medicaid plans to automatically reprocess all claims that denied for “third party liability or TPL” and repay at the corrected rate (assuming the claim is otherwise “clean”). Approximately 47,000 claims fall into this category.