Senate Discusses Proposed Budget Cuts    

The Senate previewed its proposed budget this week.  The Senate proposed a Medicaid provider cut of 3%, higher than the 2% proposed by the House.  Physicians, whose rates have been cut in previous years, would be shielded from any rate cuts initially, but may be subject to a 2% cut should Community Care of NC (CCNC) fall short of its savings goal. The Senate reduced the savings goal for CCNC to $83 million and took an additional $10 million from the Health and Wellness Trust Fund to reduce the burden on CCNC. 

New Medicaid cuts included a variety of optional service reductions or eliminations that could threaten the integrity of the Medicaid program.  The proposed cuts would severely limit services to be provided for rehabilitation and other therapy that expedite hospital discharge and prevent recurring visits to the Emergency Department.  The NCMS and other groups interested in the Medicaid program, expressed reservations about these cuts to budget leaders this week. 

Late on Thursday, budget writers from both chambers were working to reach compromises in every area of the budget.  Talks are expected to continue on Friday in advance of the Memorial Day holiday. The talk around the legislature indicates that the Senate and House are pre-conferencing the budget. This is something that has not been the practice in the past but could save weeks of more formal conference committee negotiations if successful.  The NCMS will continue to report progress to you during this fast-paced, dynamic period.

Workers’ Compensation Reform

The House Select Committee on Tort Reform heard HB 709 – Protect and Put NC Back to Work today. The committee debated a proposed committee substitute that was the consensus product of the business community, trial lawyers and the medical community. Read the details of the newly proposed bill here. The NCMS is working to establish a clear process for employer communication with the treating physician, protection from lawsuits for the physician, and compensation for any administrative costs incurred as a result of the new legislation.

A late addition to the bill is of significant importance to the physician community.  The new Section 8 provides that the Industrial Commission meet ICD-10 deadlines, and adopt rules to enable electronic billing and payment. This protection will ensure that physicians seeing injured workers will only have to deal with one set of billing codes.

The NCMS would like to express its appreciation to all of the bill sponsors, but most especially to Rep. Dale R. Folwell (R-Forsyth) for his leadership during the complicated negotiation that brought about this bill.  Rep. Folwell took the time to fully understand the impact for each provision, listen to all sides of the debate and held firm to his commitment to reach a compromise bill.

Health Benefit Exchange passes the House

Legislation that would authorize the creation of a NC Health Benefit Exchange passed the House on Wednesday with bipartisan support.  H115 – Health Benefit Exchange would form a Board and empower that board with the ability to create the “Expedia of health insurance” for NC. NCMS has worked closely with proponents of the bill.  Meaningful progress is required to receive additional federal funds by January, 2012 and the exchange is supposed to be enrolling by January, 2013. With such a short window to develop the massive IT infrastructure for this project, NCMS has supported the passage of this bill during the current session.  Opponents of the bill have railed against the governing structure of the board that includes experts from a number of different fields. Other opponents have cited flaws in the federal Affordable Care Act. The NCMS continues to believe that so long as the federal law is in place, the State should take action to create and control the Exchange rather than allow the federal government to do so. A provision included in the bill dissolves the exchange in the event the federal law is found to be unconstitutional.

Legislative Committee on New Licensing Boards Take Action on Naturopaths

Tuesday afternoon, the Legislative Committee on New Licensing Boards issued their assessment report on the Licensure of Naturopaths in North Carolina. The release of this report is the first step in the legislative process for both SB 467 and HB 847. Both bills will now be referred to the Health Committees in their respective chambers. The NCMS maintains its position that the proposed board to license naturopaths lacks the structure and economic resources to legitimately regulate naturopathic practitioners.  Additionally, the proposed legislation creeps into other areas of currently licensed healing arts such as the practice of physical therapy, chiropractics and would license colon hydro-therapy.

The Committee also heard public comment this week on legislation proposed to create the Medical Imaging and Radiation Therapy Board of Examiners, it is expected the committee will vote on this draft report in the next week.

Other bills that this committee may consider in the future include the licensure of lay midwives, music therapists, radiologic assistants and clinical exercise physiologists.

Other Legislation Acted On This Week:

HB 656 – Controlled Substance Photo ID

Three separate but related bills were combined into one proposed committee substitute by a subcommittee of the House Judiciary B Committee. The final bill required photo ID when dispensing a controlled substance at a pharmacy. It left out proposed language that would have allowed Sheriffs access to the Controlled Substance Reporting System (CSRS) as well as a burdensome requirement for health care providers to review or insert 12 months of background data into the CSRS before prescribing Schedule II and some Schedule III drugs. The NCMS worked closely with other medical partners to ensure this outcome. The bill received a favorable report in committee and now awaits placement on the House calendar for a floor vote.

•  HB 298 – Insurance Amendments – AB, Dockham (R-Davidson)
• SB 245 – Medicaid Billing by Local Health Departments, Hartsell (R-Cabarrus)
  • Chaptered Session Law 2011-90
• SB 316 – Additional Section 1915 Medicaid Waiver Sites, Hartsell (R-Cabarrus)
• SB 323 – State Health Plan/Appropriations and Transfer II, Apodaca (R-Henderson)
  • Became law without signature. Chaptered Session Law 2011-85
• SB 608 – Health Care Sharing Organizations, Hunt (R-Wake)