Welcome to a holiday week and your

NCMS Morning Rounds.

Nov. 25, 2019

NCMS Legislative Update

The big news last week was the announcement that the state’s transition to Medicaid managed care, slated to launch in February 2020, has been delayed. At a health care conference last week, the NC Department of Health and Human Services (NCDHHS) Sec. Mandy Cohen, MD, MPH, assured conference attendees that the state’s move to Medicaid managed care will happen – it’s not a matter of ‘if, but when,’ she said. In the meantime, the state will continue to pay through the fee-for-service system.

The underlying cause of the delay was a stalemate between the General Assembly and the Governor around how best to expand access to care for the state’s most vulnerable patients. The Governor has stood firm on expanding Medicaid as other states have done through the Affordable Care Act, while the legislature has considered another method, HB 655 — NC Health Care for Working Families, which would expand coverage through different means. Neither the legislature nor Governor could reach an agreement, so a budget with the funding necessary for the Medicaid transformation was passed by the legislature, and vetoed by the Governor. The House overrode the veto, but the Senate never took up the veto override. So, the state remains without a budget and the General Assembly has adjourned until Jan. 14, 2020.

“The legislature did what they thought was needed. The Governor did what he thought was needed and neither of them gave us what was needed to take care of this transformation to managed care,” said NCMS Senior Vice President for Advocacy and Associate General Counsel Chip Baggett, JD.

He noted that the state is operating under a continuing resolution that keeps the recurring funding included in the state’s last budget flowing to state programs. However, non-recurring funding, which is a large part of the state’s budget, is not included as part of the continuing resolution. Sec. Cohen has said that the fee-for-service system will continue for now, but many questions remain. We will be monitoring the situation closely in the coming weeks. Watch your NCMS Morning Rounds for updates.

The silver lining in this delay, may be that everyone will have more time to prepare for this complicated transition to Medicaid managed care. The NCMS encourages you to continue to contract with the managed care companies selected by the state to provide Medicaid services.

“This is a time when we can better prepare to make sure we’re as ready as we can be to make this transition as smooth as it can be,” Baggett said.

Report from the NC AMA Delegation

As reported last week, your NC AMA Delegation attended the AMA Interim meeting Nov. 16-19. As outlined in the AMA’s bylaws, this meeting focuses on issues related to legislation and advocacy, and several controversial issues, some of which the NCMS also is grappling with, were taken up.

In his report, NC AMA Delegation chair G. Hadley Callaway, MD, noted that the AMA House of Delegates addressed several of these issues in the following way:

AMA will advocate for setting drug prices by mandatory arbitration based on cost and effectiveness, or according to an international drug price index.
• AMA will create a “cannabis task force” to review and disseminate scientifically accurate and unbiased information about the health effects of cannabis.
• AMA recommends against hospitals providing medical cannabis to inpatients but recommends for providing education to hospital staff about cannabis withdrawal syndrome.
• AMA recommends vape-free zones (to match those which are smoke-free) in public spaces, schools, and multi-unit public housing.
• AMA may file an amicus brief to protect California’s ability to set tighter automobile tailpipe emission standards than the federal government.
• AMA will encourage special training for school resource officers in conflict de-escalation.
• AMA will support the use of “Veterans Courts” (like drug courts or business courts) to resolve criminal offenses of veterans with PTSD.
• AMA will fight to mitigate MIPS penalties which are severe for independent practices.
• AMA will work to remove barriers to medication-assisted treatment of opioid use disorder in primary care settings.

Those who attended the meeting included NCMS President Palmer Edwards, MD, DFAPA, NCMS Immediate Past President Timothy J. Reeder, MD, MPH, FACEP, delegation chair Dr. Callaway, Chuck Willson, MD, Mary Ann Contogiannis, MD, William E. Bowman, Jr., MD, Darlyne Menscer, MD, Dev Sangvai, MD, MBA, FAAFP, Liana Puscas, MD, Rebecca Hayes, MD, FAAFP, Timothy M. Beittel, MD and Albert J. Osbahr, MD, MSCM, FACOEM, NCMS CEO Robert W. Seligson, MBA, MA and NCMS COO and General Counsel Stephen W. Keene, JD, MBA.

Drs. Willson and Beittel will be retiring from the NC AMA delegation and were recognized for their service, both at the Southeast Delegation meeting and during the AMA House of Delegates.

Current North Carolina leaders in the AMA include Dr. Puscas who serves on the Council on Medical Education, David Tayloe, Jr., MD, FAAP, who sits on the Council on Legislation, and Dr. Sangvai, who is on the Governing Council of the Integrated Physicians Practice Section.