Friday is here along with your

NCMS Morning Rounds.

Dec. 13, 2019

Time is Short for Surprise Billing Legislation This Year

As Congress seeks to finalize a finance package by the end of next week, several revised, yet competing, surprise billing proposals are again being considered.

One proposal, out of the US House Energy and Commerce Committee working jointly with the US Senate Health, Education, Labor and Pensions (HELP) Committee, uses an independent dispute process between physician practices and insurance providers when a patient is faced with a surprise bill, or unanticipated charges for a procedure or treatment. Learn more about this approach.

The other proposal under consideration originates in the US House Ways and Means Committee and incorporates a reconciliation model similar to arbitration. Learn more about this proposal.

Despite bipartisan support for addressing this issue before the end of the year, there is still no clear and detailed path forward at this point. Language is still being drafted for both proposals, so many questions remain as Congress scrambles to come up with a government funding package before next Friday.

At its November meeting, the NCMS Board of Directors adopted a surprise billing policy framework, which seeks a solution that addresses the issue more proactively than either of the proposals now being considered by Congress. The Board would prefer legislation that shifts the focus from reacting to the surprise bill after the fact, to preventing it in the first place. This could be accomplished by identifying the areas where surprise billing is most likely to occur and negotiating charges before they are billed, perhaps by requiring them to be arbitrated in advance of services being rendered.

With this philosophy in mind, the Board agreed to the following policy framework statement: NCMS supports protecting patients from unanticipated bills due to non-network medical services through up-front, equitable financial arrangements.

Board members agreed this would help eliminate surprise bills and preserve the physician-patient relationship firmly in keeping with the NCMS’ values and mission. Learn more about the NCMS’ proactive approach to the issue.

We continue to be engaged with our partners at the federal level as the surprise billing proposals evolve over the weekend and into next week. Stay tuned to your NCMS Morning Rounds for updates.

NCMS Legislative Cabinet Looks Back and Ahead to 2020

At its meeting Wednesday evening, the NCMS Legislative Cabinet reviewed what happened in the recently adjourned 2019 NC Legislative Session. Our annual Legislative Summary for 2019 will be released before the end of the year, so watch for the link to that comprehensive and informative publication in your NCMS Morning Rounds and on our NCMS website.

Cabinet members also looked ahead to the upcoming legislative session, set to convene on Jan. 14, 2020, and noted the several pressing topics yet to be resolved in the New Year, including the override of Governor Roy Cooper’s budget veto and continuing the process of transforming the state’s Medicaid program to managed care.

Staff updated the Cabinet members on the work of the Medical Team Task Force and surprise billing legislation being considered at the federal level (see surprise billing article in this newsletter).

The group also agreed to consider a new NCMS policy on vaping at its upcoming meeting on Jan. 15, which will be held at the NCMS Center for Leadership in Medicine in Raleigh.

A Couple Medicaid Updates

In hopes of avoiding confusion, the state’s Division of Health Benefits recently sent your Medicaid patients a notice alerting them to the fact that their insurance coverage would not change given the suspension of the state’s move to Medicaid managed care. The message clearly states that they “can go to the same primary care provider (printed on your Medicaid card) and specialists you have now. You do not need to choose a health plan at this time.”

The notice goes on to include the answers to several frequently asked questions and includes a contact email address and phone for further information. You can see sample notices in English or Spanish.

NC Medicaid also is seeking comment on its draft provider manual and application process for care management for people with behavioral health and intellectual and developmental disabilities who will be served by Tailored Plans. A goal for Medicaid transformation is to promote whole-person care and foster high-functioning integrated care teams to help ensure better health outcomes. Review the draft manual.

Please share your comments on the manual with Kelsi A. Knick at [email protected] by Jan. 2, 2020.

A webinar titled ‘Tailored Care Management: What Providers Need to Know,’ will be offered on Dec. 18, 2019, from 11:30 a.m. -12:30 p.m. This webinar will explore the provider manual in more detail, walk through the application process, and address questions for you to consider. Register now.

While the implementation of managed care has been suspended as legislative action is needed to move forward, the state continues to work on the design of Tailored Plans.  For the moment, all health providers enrolled in Medicaid are still part of the program and will continue to submit claims through NCTracks as they do today. Beneficiaries will continue to access behavioral health and I/DD services through LME-MCOs. These services will continue to be provided as they are today.

In the News

The Health Care Promises We Cannot Keep, Kaiser Health News, 12-12-19

Learning Opportunity

This month’s NCMS Foundation and the NC Medical Group Management Association Lunch & Learn will feature NCMS’ Senior Vice President for Advocacy and Advancement and Associate General Counsel Chip Baggett, JD, who will give a ‘Legislative End-of-Year Wrap Up and View Ahead for 2020’ on Tuesday, Dec. 17 from noon to 1 p.m. Register now.