FW: NC House Releases Medicaid Budget
Sembert, Fran - Eagle
See below.
Fran Sembert, CMPE
Director, Business Services
Eagle Physicians and Associates, PA
324 W Wendover Ave, Suite 200
PO Box 14520
Greensboro, NC 27415-4520
336-268-3201 (P) 336-275-0812 (F)
In Accordance With NC Statute § 131E‑107
From: Conor Brockett [mailto:CBro...@ncmedsoc.org]
Sent: Monday, June 10, 2013 12:30 PM
To: Cameron M. Cox III; Sembert, Fran - Eagle
Subject: Fwd: NC House Releases Medicaid Budget
Here's the summary we sent to members on Friday. Will get you the talking points when I'm back in office this afternoon.
Conor Brockett
Associate General Counsel
North Carolina Medical Society
From: ne...@ncmedsoc.org [mailto:ne...@ncmedsoc.org]
Sent: Friday, June 07, 2013 5:08 PM
To: Amy Whited
Subject: NC House Releases Medicaid Budget
NC House Releases Medicaid Budget
The NC House Appropriations subcommittee on Health and Human Services met on Friday to discuss the House version of the HHS budget. As noted in our summary of the NC Senate's budget proposal, there were several areas of concern. Many of these items have been amended in the House plan, while some remain intact.
Below is an updated status of the NCMS budget priorities as addressed in the House proposal:
1. Support Medicaid Reform – House proposal establishes a new Medicaid Reform Advisory Group appointed by the Governor and the NC General Assembly to work with the Department of Health and Human Services to develop a plan for Medicaid reform. The NCMS supports a public stakeholder process and reform that would focus on patient-centered care while achieving predictability and cost-savings in the Medicaid system without going to a traditional, commercial managed care program in NC.
2. Withhold/"Shared Savings" – NCMS encourages utilization of shared savings models, similar to those in Medicare, as a part of the Medicaid reform discussion. This is a way to avoid further cuts to physician reimbursement and protect access to care for the growing Medicaid population. The House budget proposes a 2 percent withhold without a clear method to earn back the withhold, similar to the 4 percent proposed by the Senate. The NCMS supports the adoption of a proven shared savings model without a cut in rates.
3. Health Information Exchange (HIE) Utilization – One requirement for true patient-centered care management is data sharing. The NCMS has long advocated for statewide utilization of the HIE to overcome this communication gap, which limits our physicians' ability to reduce utilization and provide the most appropriate care at the right time for each patient. Neither the House nor the Senate require HIE Utilization in its proposed budget.
4. Triage Fees in the Emergency Department – The NCMS opposes the Senate proposal to pay emergency providers less if the condition treated was not an emergency. The House budget proposal clarifies that this cut will apply not apply to professional services. However, the NCMS remains opposed to the provision, as it would penalize providers rather than change the behavior of the Medicaid patient.
5. Further Administrative Burdens – The Senate proposed numerous additional administrative costs to be borne by providers, including continuing the $100 Medicaid enrollment fee, prior authorization for more than 10 office visits a year and collecting additional co-pays from Medicaid patients. The House proposal maintains the limitation on 10 office visits, increased co-pays, and the $100 Medicaid enrollment fee, but does not codify the language into law.
6. Certificate of Need (CON) – This policy change that was included in the Senate budget would eliminate the need for any Department review of replacement equipment purchases by existing CON holders. This is a significant policy change, which the House has not included in their budget proposal.
7. Study of Nurse Midwifery – While not included in the Senate budget, the House directs the Joint Legislative Oversight Committee on Health and Human Services to study the independent practice of Nurse Midwives.
The House is expected to approve this budget by Thursday of next week. The NCMS encourages you to continue to contact your House members to voice your concern for those Medicaid budget items that remain unaddressed.
NC Medical Society | PO Box 27167| Raleigh, NC 27611 | Phn: 919.833.3836 | Fax: 919.833.2023 | wwwn.ncmedsoc.org
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