On April 22, 2016, NCOA signed a letter to Congressman G. K. Butterfield (D-NC, 1st District) urging him to ask the Centers for Medicare & Medicaid Services (CMS) to withdraw their proposed Medicare Part B Drug Payment Model.
NCOA believes it is critical that CMS ensure stakeholders are involved in the development of initiatives that could impact patient care. Read the full letter here.
April 22, 2016
Legislative and Regulatory Report - Summer 2014
Dana E. Simpson, Esq., Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P.
The North Carolina General Assembly adjourned its 2014 “short” session in mid-August. The session was marked by significant policy disagreements between House and Senate leaders regarding a number of budget matters, including Medicaid reform.
House and Senate leaders were unable to reach a compromise on Medicaid reform during the legislative session. Governor McCrory and House leaders supported a physician-led accountable care organization (ACO) approach, while Senate leaders favored a managed care option. The lack of agreement means any reform proposal will have to wait until 2015. We expect Medicaid reform will be a top policy priority for both the House and the Senate in the 2015 legislation session.
The House and Senate policy disagreements over Medicaid reform also spilled over into budget negotiations. The initial budget passed by the House limited the impact of Medicaid cuts. The Senate budget, however, included a number of Medicaid eligibility reductions and reimbursement cuts. The Senate budget also included a study of a new tax on North Carolina physicians to help pay for Medicaid reimbursements.
After weeks of negotiations, the final state budget included a compromise of House and Senate positions on the Medicaid budget. The final budget included the following policy changes:
• No reductions in eligibility.
• The 3% physician rate reduction added in 2013 is made permanent, with an additional 1% rate cut added in 2014. Together these cuts will reduce physician Medicaid reimbursements by 4%.
• The proposal to study a tax on physicians was eliminated, but the Legislature has asked DHHS to study expanding hospital rate transparency legislation enacted in 2013 to other types of health care providers.
• Hospitals received significant Medicaid reimbursement cuts, much as they did in 2013.
September 17, 2014
Early Results: ACOs are Working
Julian D. (“Bo”) Bobbitt, Jr., JD
Guess what? Physician-driven accountable care organizations (“ACOs”) are working.
The even better news is that this trend is predictable and inevitable.
A fully evolved ACO should incentivize all providers and facilities along the entire continuum of care, but always in proportion to their value-adding contribution. While this economic reward is gratifying and validating, physicians are sometimes surprised that the biggest reward has been empowerment to do health care right and regain control of the physician/patient relationship. They say that seeing happier, healthier patients, and being able to spend more time with them, has returned the fun to the practice of medicine.
Mr. Bobbitt is a senior partner and head of the Health Law Group at the Smith Anderson law firm in Raleigh, North Carolina. He has many years’ experience assisting physicians form integrated delivery systems. He has spoken and written nationally to primary care physicians on the strategies and practicalities of forming or joining ACOs. This article is meant to be educational and does not constitute legal advice.
July 29, 2013
Legislative and Regulatory Report - Summer 2013
Dana E. Simpson, Esq., Smith, Anderson, Blount, Dorsett, Mitchell & Jernigan, L.L.P.
The North Carolina General Assembly adjourned its 2013 Session on July 26th. This Session was dominated by debates over tax reform and the competing policy agendas of newly-inaugurated Governor McCrory and GOP leaders in the House and Senate. From the perspective of the NCOA, Medicaid reform, oral cancer drug parity legislation, and scope-of-practice issues were major issues this year.
One of the first pieces of legislation passed this year by the General Assembly was SB 4, which prohibits the Governor from expanding North Carolina Medicaid under the federal Affordable Care Act without further legislative authorization. This bill set the tone for a year that featured significant debate about the future of North Carolina’s Medicaid program.
In April, new Secretary of Health and Human Services Aldona Wos and Governor Pat McCrory proposed a substantial makeover of North Carolina’s Medicaid program by turning it over to for-profit Medicaid HMOs to administer the program. This proposal was strongly opposed by the medical community, the North Carolina Hospital Association, and most other health care provider groups. This opposition stems from the experience of other states with Medicaid HMOs that have seen cost savings generated primarily through limiting patient access to services and substantial cuts in physician and other provider reimbursement. Instead of turning Medicaid over to out-of-state HMOs, most physician organizations believe North Carolina should enhance and expand its nationally-recognized medical home model called Community Care of North Carolina.
Despite the push by the Governor, legislative leaders were reluctant to embrace the administration’s idea of privatizing Medicaid. In fact, the final state budget prohibits the administration from implementing any Medicaid reform without further legislative authorization. It establishes a joint Legislative-Executive Branch Study Committee that will propose new Medicaid reforms. The Study Committee is expected to make its recommendations to the General Assembly prior to the 2014 Short Session.
The final state budget includes a 3% rate cut for physician Medicaid services beginning January 1, 2014. This cut affects physicians and inpatient hospitals, as well as other Medicaid providers. The state budget includes language directing the Department of Health and Human Services to work with the provider community to develop a shared savings plan to “provide incentives to provide effective and efficient care that results in positive outcomes” returning some portion of the funds accumulated from the rate cut-back to providers beginning in 2015. DHHS must provide the Legislature with a report of this shared savings plan by March 1, 2014.
Additionally, the budget contains changes to drug reimbursements, including requiring:
The budget also includes significant cuts for North Carolina hospitals. While hospitals avoided the elimination of their sales tax refunds in the final tax package approved last week, they were not so fortunate in the final budget. The budget increases the state’s retention of hospital provider assessment “taxes” by $52 million, or 25.9% of the total assessment paid by hospitals. Additionally, outpatient payments to hospitals are reduced from 80% to 70% of costs, which will result in $48 million in total hospital cuts once fully implemented. Finally, hospitals face the same 3% rate cut/shared savings incentive as physicians.
Oral Cancer Drug Parity Legislation
The NCOA supported legislative efforts this year to pass the Cancer Treatment Fairness Act (HB 609), which was sponsored by Representative David Lewis (R-Harnett). This legislation would limit the amount health insurers can charge patients for co-payments and deductibles when patients receive oral chemotherapy compared to intravenously administered chemotherapy. The legislation was strongly opposed by the health insurance industry, but ultimately received favorable votes in the NC House Health and Insurance Committees and was supported by a strong bipartisan majority on the House floor. Unfortunately, the Senate did not take up HB 609 this year, but it remains eligible for consideration by the Senate when the legislature reconvenes for its 2014 “short session” in May.
This year, the North Carolina Medical Society undertook a multimedia campaign to educate legislators about the patient safety benefits of physician supervision. The North Carolina Coalition to Protect Patients posted weekly reports about the value of physician supervision on their website. This educational effort was particularly beneficial, given the number of scope-of-practice expansion bills introduced in the General Assembly this year.
Legislation was filed this year to eliminate the requirement of physician supervision for nurse midwives, to eliminate medical oversight of nurse practitioners, to license professional (non-medical) midwives, and to license naturopaths. The NCOA was active in opposing the naturopathic licensure bill because it authorized naturopaths to diagnose and treat cancer. The medical community successfully opposed each of these legislative efforts and ultimately none were passed by the General Assembly.
We will provide a more in-depth overview of these and other health policy issues confronting North Carolina lawmakers at the NCOA’s Annual Meeting in August. We hope you will make plans to join us for this discussion.
July 29, 2013
HR 1416 is a bill recently introduced by Congresswoman Renee Ellmers to exempt cancer drugs from the 2% Medicare sequester. There has been a great response to this important legislation from the oncology community, but more action is needed NOW! Please call your House of Representatives member and ask them to please support HR 1416.
Congressional staff turn over frequently. If a staff member listed here is unavailable or has left the office please ask to speak with the Health Legislative Assistant. Be sure to provide your name and contact information when you call. Thank you for your continued efforts to remove cancer drugs from the Medicare sequester!
All House Members of the North Carolina Delegation
|Representative G.K. Butterfield
Staff member: Tonya Williams
|Representative Richard Hudson
Staff member: Michael Thornberry
|Representative Renee Ellmers
Staff member: Elaine Acevedo
|Representative Robert Pettinger
Staff member: Austen Jensen
|Representative Walter Jones
Staff member: Joshua Bowlen
|Representative Patrick McHenry
Staff member: Jennifer Flitton
|Representative David Price
Staff member: Asher Hildebrand
|Representative Mark Meadows
Staff member: Kevin Klein
|Representative Virginia Foxx
Staff member: Brandon Renz
|Representative Melvin Watt
Staff member: Laura Hooper
|Representative Howard Coble
Staff member: John Mautz
|Representative George Holding
Staff member: Tucker Knott
|Representative Mike McIntyre
Staff member: Blair Milligan
May 2, 2013