As the General Assembly prepares to reconvene in Raleigh on Monday, April 25 for its short session, several important events have taken place. The North Carolina Medical Society (NCMS) has been monitoring them carefully. Below is a brief summary in anticipation of the session.
DHHS Listening Sessions on Medicaid Reform Waiver:
The NC Department of Health and Human Services (DHHS) wrapped up its statewide ‘listening tour’ to gather feedback on its Medicaid reform draft waiver application on Monday in Pembroke. The 12 public hearings began March 30 in Raleigh, with that gathering drawing over 200 attendees. The smallest hearing occurred in far western Sylva with 23 participants. NCMS staff attended most of the gatherings and are pleased to report that many physicians testified about the state’s plan. Recurring themes in physician comments included calls to:

  • Safeguard patient access to care and make sure beneficiaries have a voice in the process.
  • Standardize processes to eliminate the administrative burden from dealing with possibly five different plans/payers.
  • Support Medicaid expansion.
  • Ensure continuation of community supports and analytics.
  • Maintain adequate levels of funding for care and necessary services.

Written comments also were accepted through Monday, April 18. NCMS submitted formal comments to DHHS. Read our comments here. DHHS plans to submit the waiver application to the Centers for Medicare and Medicaid Service (CMS) by June 1. There also will be an opportunity for interested parties to comment on the plan directly to CMS.
Joint Legislative Committee Makes Recommendation on APRN Supervision Changes:
The Joint Legislative Oversight Committee for Health and Human Services decided at its meeting last Tuesday, April 12, to recommend to the General Assembly to continue to study whether to change supervision requirements for advanced practice nurses. Some on the committee had pushed to introduce legislation during the short session to eliminate supervision for advanced practice registered nurses, certified nurse midwives and nurse anesthetists. NCMS President Docia Hickey, MD, and NCMS Director of Legislative Relations Chip Baggett testified at a committee meeting earlier this year on the issue. Ultimately the committee decided this week to study the issue and re-consider legislation in 2017.
Looking ahead, it will be important to consider how scope of practice issues may play into the move to value-based systems of care.
Medicare Audit Results – No Need for Concern:
Recent state and federal audits of the North Carolina Medicaid program may have gotten your attention because of the big numbers. The state audit showed North Carolina improperly paid $835 million to Medicaid providers last year. The federal audit, by the Office of Inspector General for the US Department of Health and Human Services, showed the state owes the federal government $1.5 million as a result of using the wrong formula to adjust claims between July 2008 and June 2013. The NC Department of Health and Human Services (DHHS) is contesting those findings, saying the $835 million figure cited in the state audit is inflated and that the correct formula was used to adjust for payment errors or retroactive rate changes as examined by the federal audit. Regardless, physicians should not worry about an impending recoupment.
The federal audit looked at 17 states, and North Carolina looked good in comparison to the error rate in other states. Our error rate of 6.7 percent was below the average rate of 8 percent, and well below the state with the highest rate of payment errors at 18.6 percent.
“We’re in good shape,” Baggett said. “The audit shows improvement for our system. It shows you’re getting paid properly. You don’t have to worry that this is another opportunity for a large recoupment.”
To hear directly from Baggett on these and other legislative issues in anticipation of the upcoming session, watch his Bowtie Briefing from Friday, April 15 here.