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NCMGMA Boasts Largest Advocacy Days Ever!

NCMGM 2019 Advocacy Days

With over 115 attendees in-house on Wednesday, March 13, 2019, NCMGMA celebrated our largest-ever Advocacy Days event. Our speaker lineup this year included Attorney General Josh Stein; Chip Baggett, NCMS; Cody Hand, NCHS; NC State Treasurer Dale Folwell; Dr. Mandy Cohen, DHHS; and a panel that include four of the newest Medicaid Managed Care payors. Our speakers and panelists brought our attendees up-to-date on everything from the State Health Plan to the latest happenings with Medicaid Managed Care.

And just this morning, over 40 members set out to meet with their representatives at the North Carolina General Assembly to discuss important healthcare issues including:

  • Joint HHS Appropriations Committee for Medicaid Managed Care and the importance of awareness of the additional requirements now shifting to the providers due to multiple types of Insurance Carriers. Additionally, changes to the Fee for Service contracts moving to value-based care contracts and the administrative burden shifting to providers.
  • The Save Act asking providers not to vote for this bill as supervision from physicians is necessary to maintain the highest quality of care for our NC residents.
  • HB184 - Study of State Health Plan Design, asking to keep the bill as it currently is until more definite options are in place for quality and cost savings for the members and taxpayers.
  • S886 - In favor of the Small Business Healthcare Act reducing employees from 26 to 12.
  • And more!

Thank you to all who came out for this year's Advocacy Days, and a big thank you to Melissa White and Cam Cox, NCMGMA's Advocacy Days co-chairs, for all their hard work in putting this event together for our members! 

Dr. Cohen Session Q&A Transcript

The following is the transcript of answers provided to questions asked during the session with Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services:

To what entity should providers report PHPs that are late on payment?
Providers will report issues such as late payment to the Provider Ombudsman. These positions are still being developed. However, DHHS plans to have several staff available to assist providers.

Will PHPs be able to delay payment by asking for superfluous claims revisions? How will we track this behavior?
In 2018 the General Assembly passed House Bill 156 which requires prompt payment of claims. DHHS subsequently integrated applicable parts of the statute into the PHP RFP/Contract. The prompt pay standards in the PHP RFP/Contract provide that a PHP must pay a penalty of 18% interest (annual interest rate) on a claim when the PHP has not paid the claim pursuant to the time frames in the PHP RFP/Contract. It also requires that a PHP who has failed to promptly pay a claim must pay the provider a penalty of 1% of the claim for each calendar day a claim is delayed beyond the date it should have been paid. Therefore, there are financial incentives for the PHP to implement a claim payment process that complies with the required time frames.

Through the Provider Ombudsman, DHHS will monitor PHP compliance with the contract, including claim payments and processing, respond to inquiries from providers, and address performance issues with PHPs should they exist. Spurious claims revisions will be tracked (and providers are encouraged to report them), although we anticipate PHPs will be motivated to pay in a timely manner because they will want to keep providers in their network.

How quickly will LME-MCOs be added to the new centralized credentialing system?
Tailored Plan design is currently underway in anticipation of Tailored Plan implementation in July 2021. The current plan is that providers credentialed by LME-MCOs will transition into the centralized credentialing system with the implementation of Tailored Plans. Additional details will follow as finalized.

How quickly will new CPT codes be added to the fee schedule?
New CPT codes published in October of each year must be in the system and ready for use by the following January 1. Clinical Policy staff work with Provider Reimbursement staff to have the rates on file as soon as possible after the 1/1 date. Approved new CPT codes and their respective rates can be added to fee schedules within a week as long as they are covered services that can be folded in under the existing state plan.

New CPT codes and rates for services that are not within the state plan must follow the State Plan Amendment process for CMS approval before they can be added to the fee schedule.

When will the reimbursement increases for PCPs hit providers?
The reimbursement increases for PCP are effective January 1st, but not yet approved.  The increased rates will be implemented after CMS has approved the State Plan Amendment. The SPA has been submitted, however, CMS has not approved it.  Unfortunately, there is no target date for CMS approval at this time. Once CMS has approved and NCTracks is programmed, the rates will be implemented.  There will be a retroactive payment back to January 1, 2019, but that will most likely not take place until after July 1, 2019.

Could NC HealthConnex be used to help integrate the NCCARE360 resource platform into the EHR?
Yes. We are working with the Department of Information Technology on the integration between NCCARE360 and NC HealthConnex (HIE) for this purpose. We know that large health systems can pay the integration fee that their EHR vendor charges for each integration, but independent providers might not be able to front this cost. We hope that NC HealthConnex is the solution for that. There will be some delay in implementation, so providers who don’t integrate NCCARE360 into their EHR can still access NCCARE360 through the web directly.

View our 2019 Advocacy Days Flickr album here.


2020 Advocacy Days

June 9-10, 2020
Raleigh Marriott Center City
Raleigh, NC

Advocacy Days promises to be packed full of legislative information you cannot afford to miss! There is no shortage of issues at hand in North Carolina and NOW is the time to make our voices heard!  Make plans to join us in June.  Registration information is coming soon!