The 2014 Legislative Short Session, which started today, promises to be an intense few months, as legislators concentrate on the budget and funding their priorities. The North Carolina Medical Society (NCMS) will be working hard on your behalf to forestall any rate cuts to Medicaid providers (see separate story on this issue); lobbying for meaningful reform of the Medicaid program and several scope of practice issues described below. We also will be supporting the dermatologists in their efforts to “Ban the Tan” by prohibiting use of tanning beds by anyone under age 18. HB18 – Youth Skin Cancer Prevention Act made it through the House last year, but was stuck in the Senate, which is where we will focus our efforts this year.
Co-parity for chiropractic services: Last month the NC General Assembly’s Committee on Health Care Provider Practice Sustainability and Training/Additional Transparency in Health Care approved a number of recommendations including co-pay requirements for chiropractic services. The committee heard speakers representing the North Carolina Chiropractic Association, who encouraged lawmakers to support a mandatory chiropractic co-payment equivalent to or less than primary care co-pays. This standard would apply to both private and public payers. Advocates argue high medical costs associated with the treatment of back pain and urge chiropractic primary care as a cost-saving solution. Similar legislation, SB 561, was introduced last year by Sen. Hise (R-Mitchell), but was not debated during the 2013 Legislative Session. The committee’s report urges the NC General Assembly to pass legislation similar to SB 561 during this year’s short session. The NCMS opposes any law that would require payers to create equal status for physicians and chiropractors, including co-pay parity legislation.
Supervision of Certified Nurse Midwives (CNM):This recommendation was approved by the full Joint LOC on Health and Human Services so it can be introduced as a bill during the short legislative session. The NCMS, in partnership with the NC Obstetrical and Gynecological Society, opposes the elimination of supervisory agreements between physicians and nurse midwives. The NCMS supports continued collaboration between doctors and CNMs, but cannot support the elimination of supervisory agreements in the interest of patient safety.
Certified Registered Nurse Anesthetist (CRNA) supervision: House Bill 181, which simply codifies current rules and case law requiring physician supervision of CRNAs, was introduced and passed by the House early in Session. Following passage in the House it was referred to the Senate Committee on Rules where it failed to be discussed in 2013, which means it is eligible for discussion in the short session. The NCMS continues to support existing North Carolina law, which requires all nurses to practice under physician supervision. Any revision to the current statute will guarantee this requirement cannot be changed by interpretation or another branch of government; as with all other health care providers the General Assembly has the final say.
Licensure of naturopaths, lay midwives and radiation technologists: As in past sessions, bills were introduced seeking licensure for naturopaths, lay midwives and radiation technologists. The NCMS remains opposed to such licensure on the basis of patient safety.
House Bill 154 Home Birth Freedom Act seeks to establish a second midwifery licensure board in North Carolina to license Certified Professional Midwives (CPMs). CPMs are non-nurse, direct-entry midwives who attend homebirths. The lack of educational requirements in this bill puts North Carolina families at great risk. Although this bill did not move forward during the 2013 legislative session is remains eligible for consideration in 2014.
House Bill 742 NC Care in Radiologic Imaging proposes a new licensure board and regulations for Radiologic Technologists as well as other non-physician providers or assistants in radiology services. All applicants for a license must have completed a study course in radiography, radiation therapy, magnetic resonance, cardiovascular invasive specialty, or nuclear medicine as appropriate for the type of license sought. Additional criteria are set for X-ray machine operators including a permit system based on the tasks and body regions to be scanned by the operator. This bill was not debated during the 2013 legislative session; however it remains eligible for debate in 2014.
House Bill 995 Naturopathic Doctor Licensing Act would create a third category of physician in North Carolina, MD, DO and the new title of ND. However, Naturopathic Doctors would be licensed under their own board. Scope of practice would include ordering, performing and interpreting diagnostic imaging, managing chronic disease as primary care providers – including the diagnosis and treatment of cancer. No limitations have been placed on the practice of pediatrics, psychiatric care, etc. This bill was not debated during this session; however it remains eligible for debate in 2014.
Watch the Bulletin for updates on all the legislation affecting your practice during this legislative session.
