The North Carolina Medical Society’s (NCMS) advocacy team will be spending most of their waking hours at the General Assembly this coming week, as the April 27 crossover deadline looms. ‘Crossover’ means any bills that have not passed either the House or Senate by next Thursday will not proceed, or ‘crossover’, to the other chamber for further consideration. This week legislators are rushing to get their bills through the committee process and to the floor for a vote before the deadline.
Below are a few of the key bills we’re monitoring closely. For a comprehensive list of the hundreds of bills the NCMS is tracking, go to the 2017 Legislative Session Blog where you’ll find brief summaries of each.

  • Balance Billing for Out-of-Network Providers – TAKE ACTION to Protect Your Negotiating Power

The NCMS is strongly opposed to SB 629 – Health Care Services Billing Transparency [Primary Sponsors: Sen. Ralph Hise (R – Madison), Sen. Wesley Meredith (R – Cumberland)], which calls for a benchmark fee for any service provided to a patient by an out-of-network provider if an in-network provider is available to meet the patient’s needs without unreasonable delay. This proposal would hinder the ability of any doctor to negotiate a fair contract with a health insurance company.
The bill states an out-of-network provider’s total payment for care or for emergency services is reasonable if it is equal to the benchmark amount. An out-of-network provider would be required to send a bill to the insured individual who is responsible for paying in-network cost sharing, but the patient would have no legal obligation to pay the remaining balance when the benchmark applies.
This bill further states that no provider would be able to bill insured individuals for services at a greater rate than the benchmark amount nor would the insurer be required to make any direct payment to the provider.
The benchmark would be calculated as the smallest amount among the following:

  • 100 percent of the current Medicare payment rate;
  • Health care provider’s charges;
  • Median concentrated rate for the same service in a similar area.

Those providers who fail to comply would be deemed engaging in unfair and deceptive trade practice.
We ask that you send this ACTION ALERT to your legislators asking them to oppose this proposal.

  • Medicaid for the Working Poor

The NCMS supports the House GOP’s efforts to provide health insurance coverage for the state’s working poor as proposed in HB 662 – Carolina Cares [Primary Sponsors: Rep. Donny Lambeth (R – Forsyth), Rep. Greg Murphy (R – Pitt), Rep. Josh Dobson (R – Avery), Rep. Donna White (R – Johnston)]
The goal of this bill is to address the needs of the citizens of NC who are ineligible for Medicaid due to their income levels, but are unable to afford health insurance. The NC Department of Health and Human Services (DHHS) would be responsible for creating this program called “Carolina Cares”. The bill also calls on the Department to advocate to the federal government to receive the maximum financial participation possible.

  • Eliminating physician supervision for Advanced Practice Nurses

The NCMS opposes HB88/S73 – Modernize Nursing Practice Act [Primary Sponsors in the House: Rep. Josh Dobson (R – Avery)Rep. Donny Lambeth (R – Forsyth)Rep. Sarah Stevens (R – Surry)Rep. Gale Adcock (R – Wake); primary sponsors in the Senate: Sen. Ralph Hise (R – Madison), Sen. Louis Pate (R – Wayne)Sen. Joyce Krawiec (R – Forsyth)]
This bill, which has been discussed in the House Health Committee (listen to the discussion and watch several NCMS physicians testify), focuses on four types of Advanced Practice Registered Nurses (APRNs) including nurse practitioners, certified nurse midwives, certified registered nurse anesthetists and clinical nurse specialists. If passed, the bill would allow all APRNS to expand their scope of practice by excluding the requirement of a supervising physician in order to practice. This means that every APRN would be allowed to practice independently and would only be regulated by the Board of Nursing.
Proponents of the bill highlight access to care in rural areas as their reasoning to pass such sweeping change, we have not seen a measurable increase of rural providers in the other 21 states where this type of bill has been passed.  Furthermore, APRNs are not limited by geographic boundaries under current NC law, yet they tend to concentrate their work in the same areas as physicians and other medical providers.
We believe that the current statutory structure requiring physician supervision of APRNs allows nurses from a variety of backgrounds and training to practice at the top of their individual training.  By eliminating physician supervision and reducing their scope of practice to the words in statute, NC nurses will be left with a shared definition that is the lowest common denominator skill set.  As the entire healthcare system values a team approach to care delivery, this proposal seems to go in exactly the opposite direction.
Contact your legislator if you haven’t already done so with this easy to use ACTION ALERT on HB88/S73.
Several NCMS members recently submitted letters to the editor of their local papers explaining their opposition to this proposal. Read NCMS President Paul R.G. Cunningham, MD’s letter in the Greenville Reflector. Read NCMS Board member Palmer Edwards, MD, letter in the Winston-Salem Journal. Thank you for voicing your concerns in the press!

  • Optometrists Want to Perform Surgery

The other scope bill that has been getting a lot of attention in the press lately is HB36 – Enact Enhanced Access to Eye Care Act [Primary Sponsors: Rep. Justin Burr (R- Stanly)Rep. Jeff Collins (R– Nash) , Rep. Josh Dobson (R – Avery) and Rep. Julia Howard (R- Davie)]. This proposal would allow optometrists to perform eye surgery with lasers and scalpels, a change ophthalmologists vehemently oppose because it would compromise patient safety.
The North Carolina Society of Eye Physicians and Surgeons (NCSEPS) have mobilized their members to write letters to the editor, which has resulted in several editorials supporting their position. Read the editorial that appeared in The Fayetteville Observer and The Wilmington Star News. This opinion piece by a Kentucky ophthalmologist urging North Carolina legislators not to make the same mistake Kentucky made in allowing optometrists to perform surgery ran in The Charlotte Observer.
Join your colleagues in opposing this bill by using this ACTION ALERT on HB36.