Welcome to another week and your Monday

NCMS Morning Rounds.

July 15, 2019

NCMS Weekly Legislative Update

Legislators were still at work last week trying to determine if there were enough votes to override the Governor’s veto of their budget as well as continuing to move bills through committee and onto the floor of the House or Senate chamber. Several bills of interest to NCMS members include:

HB575/SB633 Birth Center Licensure Act While this bill appears to enjoy bi-partisan support, there remain many technical details to work out – what are the standards for licensure; who regulates them; what are the consequences for violations of those standards? The NC Obstetrics and Gynecology Society (NCOGS) has been doing a great job of shepherding this bill through the process, and the House passed it with a vote of 114-1 last week. Our legislative relations team believes it may not make it through the Senate before the end of this legislative session, but perhaps will cross the finish line during a likely interim session later this year.

Section 12, the offensive part of HB220—Insurance Technical Changes, has been removed thanks to your response to our Action Alert. The provision would have created a new insurance product for small businesses called an Exclusive Provider Benefit Plan, which would allow narrow networks. This would limit patient choice unless the patient wanted to pay 100 percent of the cost to see a physician or other provider outside of the network. This type of option may lower the cost to employers, but would potentially increase the cost to enrollees. We agree more affordable insurance options are needed, but affordability should extend to everyone. Real health care cost reductions are needed not simply shifting the burden. While this section has been removed for the moment, legislators are still discussing it, so stay tuned for further developments.

Last week saw some high drama at the General Assembly as Republicans manuevered to get the necessary votes to override Governor Roy Cooper’s veto of the budget. Whether to expand Medicaid has become a sticking point between legislators and the Governor, and HB655-NC Healthcare for Working Families is a proposal the NCMS supports as a compromise between the partisan extremes.

As NCMS Senior VP for Advocacy and Associate General Counsel Chip Baggett, JD, said in last Friday’s NCMS Political Pulse video: “For the folks who are asking for Medicaid expansion, I’d say this isn’t your bill. And for the folks who are opposed to Medicaid expansion, this isn’t that bill either. This is what we believe is the compromise. It’s the state figuring out how to take care of folks that are stuck in the income categories between Medicaid and assistance by the Federal Government to get on the exchange.”

Under this proposal, qualified participants would enroll through the NC Department of Health and Human Services and would be brokered through the pre-paid health plans that are part of the state’s transition to Medicaid managed care, but the enrollees would be treated like commercial insurance customers. They would pay a premium of 2 percent of their income and be subject to co-pays and deductibles. The state would be able to draw down on Federal funds to pay for this program.

The House Health Committee passed HB655 but has yet to be taken up by the full House. Thank you to those who responded to our Action Alert last week urging support of HB655. You can still access that Action Alert to reach out to your representatives. The fate of the proposal remains unknown as it has become part of the debate around the budget override. Last week a provision was added to the bill, stipulating that it would only be enacted if the budget becomes law.

Watch your NCMS Morning Rounds this week as legislators work to resolve these issues and end the session.

Medicaid Managed Care Enrollment Begins Today

Today, Monday, July 15 at 2:30 p.m. NC Department of Health and Human Services (NCDHHS) Secretary Mandy Cohen, M.D., MPH and NC Medicaid team members are holding a webcast to update physicians, PAs and other providers on NC Medicaid Managed Care implementation and to take a closer look at NC Medicaid Managed Care Phase 1 open enrollment activities. Participants will be able to ask questions. Register here to access the webcast and to participate.

Last week, NC Medicaid Deputy Secretary Dave Richard sent a letter to practices outlining enrollment process thus far Enrollment for patients in regions two and four (see region map for rollout of managed care) is underway with enrollment packets being sent to those who sign up. The Medicaid managed care call center (833-870-5500) and website went live on June 28.

“NC Medicaid Managed Care Phase 1 is on track for beneficiaries to begin using their health plan on November 1,” Richard wrote.

Here is what enrollees receive in their packet:

Information Sheet
Enrollment Form
Health Plan Comparison Chart

“As you know, transitioning to managed care is the most significant change that NC Medicaid has ever undertaken,” Richard wrote. “With any roll-out of this magnitude, there will be issues and questions that arise. We are committed to doing everything possible to resolve problems quickly and make sure beneficiaries, providers and county agencies have the support they need. Thank you for your ongoing partnership and support to launch this major effort.”

Richard asks you to contact the SWAT team with any issues that arise by calling (919) 527-7460 or emailing [email protected].”

US House Subcommittee Advances ‘No Surprises’ Act

Last Thursday, the US House Energy and Commerce Health Subcommittee advanced HR3630 the ‘No Surprises’ Act, which seeks to address the payment disputes that can arise between physicians and insurers when patients are ‘surprised’ to receive a bill for services from physicians they were unaware were out-of-network.

This article details some of the controversy over this legislation and quotes NCMS CEO Robert W. Seligson in his capacity as President of the Physicians Advocacy Institute (PAI). Read more about PAI’s position on surprise billing.

In the News

Opinion: To Fight Opioid Epidemic, Treat Drug Use With Compassion, Not Judgement, USA Today, 7-9-19

Learning Opportunity

The East Coast Migrant Stream Forum focuses on increasing access to care and reducing health disparities among migrant and seasonal agricultural workers. This year’s forum, which draws over 200 health professionals, researchers, advocates and students nationwide, will be held Oct. 9-11 in Carolina, Puerto Rico. Learn more and register.