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Recent e-Newsletters

Lawsuit Filed Over Certificate of Need Restrictions

A Winston-Salem surgeon, Dr. Gajendra Singh, has filed a lawsuit against the State of North Carolina challenging the constitutionality of the state's Certificate of Need (CON) laws, which are among the most restrictive in the country. North Carolina's CON laws prohibit physicians from opening ambulatory surgery centers and from purchasing diagnostic equipment, thereby contributing to rising healthcare costs, adversely impacting surgical quality and limiting patient access to care.

There have been several attempts over the years at legislative solutions to deregulate the system, which the NCSOHNS has supported, but those measures have yet to gain enough support to make it through the General Assembly. Most recently, Rep. Beverley Boswell (Dare Co.) in June offered an amendment from the House floor calling for a study of CON's impact on healthcare access. The amendment failed 18-89, highlighting the low level of interest on this issue among House members.

The timeline for how and when this lawsuit will be adjudicated is uncertain.

Media Coverage and Additional Information:

Medicaid Transformation Update

The NC Department of Health and Human Services (DHHS) announced on August 9, 2018, that it has issued a Request for Proposal (RFP) for Medicaid Prepaid Health Plans (PHP) as part of the state's transition from Medicaid fee-for-service to managed care. In a call with stakeholders, DHHS Secretary Dr. Mandy Cohen noted that this is the largest procurement in DHHS history and she expressed her appreciation for the stakeholders' collaboration and feedback throughout the process. DHHS has published on its Medicaid Transformation webpage a helpful fact sheet summarizing the key content within the PHP RFP, including program goals and structure.

NC DHHS Medicaid Transformation Webpage

The RFP seeks proposals for standard plans by October 12, 2018. A PHP Evaluation Committee comprised of state employees will be tasked with the selection of four statewide plans and up to 12 regional plans. DHHS will announce the awardees in February 2019. Standard plans will launch in a phased-in approach with select regions going live on November 1, 2019. Full statewide implementation of standard plans is expected on February 1, 2020.

A separate procurement for tailored plans to provide services to beneficiaries with significant behavioral health and/or intellectual/development disability will be conducted at a later date.

This development follows the DHHS's August 3 announcement that the state has awarded a contract for Medicaid managed care enrollment broker services to MAXIMUS, a government services provider based in Reston, VA, to provide choice counseling, enrollment assistance and education to beneficiaries as they select from a variety of health plans.

Approval of the new program design is required from the Centers for Medicare and Medicaid Services (CMS) before the state's transition to managed care can be fully implemented. In September 2015, the NC General Assembly directed the transition of Medicaid from a fee-for-service structure to a managed care structure in North Carolina. The state submitted its managed care design plan to CMS in June 2016 in the form of an 1115 waiver. A revised 1115 waiver application was sent in November 2017 and is still under review by CMS. Dr. Cohen did not address the status of the 1115 waiver on the August 9 call with stakeholders.

Conor Brockett, the North Carolina Medical Society's Vice President of Legal & Regulatory Affairs and Associate General Counsel, offers this quick overview of Medicaid transformation in North Carolina as of July 2018.