AN ACT ENHANCING THE EFFECTIVENESS AND EFFICIENCY OF STATE GOVERNMENT BY MODERNIZING THE STATE'S SYSTEM OF HUMAN RESOURCES MANAGEMENT AND BY PROVIDING FLEXIBILITY FOR EXECUTIVE BRANCH REORGANIZATION AND RESTRUCTURING AND TO IMPROVE TRANSPARENCY IN THE COST OF HEALTH CARE PROVIDED BY HOSPITALS AND AMBULATORY SURGICAL FACILITIES; TO TERMINATE SET-OFF DEBT COLLECTION BY CERTAIN STATE AGENCIES PROVIDING HEALTH CARE TO THE PUBLIC; TO MAKE IT UNLAWFUL FOR HEALTH CARE PROVIDERS TO CHARGE FOR PROCEDURES OR COMPONENTS OF PROCEDURES THAT WERE NOT PROVIDED OR SUPPLIED; TO PROVIDE FOR FAIR HEALTH CARE FACILITY BILLING AND COLLECTIONS PRACTICES; AND TO PROVIDE THAT HOSPITALS RECEIVING MEDICAID REIMBURSEMENTS PARTICIPATE IN THE NORTH CAROLINA HEALTH INFORMATION EXCHANGE NETWORK.
Senate committee substitute makes the following changes to the 4th edition.
Amends the title of the act to reflect changes in the bill content.
Amends GS 126-95 by adding new subsection (c) to define the term eligible officers and employees as used in this section to mean any officer or employee who is authorized the participate in the Teachers' and State Employees' Retirement System (TSERS) and the State Health Plan (SHP).
Part II. through Part IX.
No changes from previous edition.
Enacts new Article 1B, Transparency in Health Care Costs, in GS Chapter 131E. Provides that the intent of the Article is to improve transparency in health care costs by providing information to the public on the costs ofthe most frequently reported diagnostic related groups (DRG)for hospital inpatient care and the most common surgical procedures and imaging procedures in hospital outpatient settings and ambulatory surgical facilities. Requires the Department of Health and Human Services (DHHS) to make available on its website the most current price information it receives from hospitals and ambulatory surgical facilities; sets out minimum requirements for that information. Requires each hospital, beginning with the quarter ending June 30, 2014, to provide DHHSfive specified pieces of information about the 100 most frequently reported admissions by DRG for inpatients, including the total amount of Medicare reimbursements. Requires theNC Medical Care Commission (Commission) to adopt rules to ensure implementation of this requirement byMarch 1, 2014, and specifies information to be included in the rules. Requires each hospital and ambulatory surgical facility to provide DHHS informationon the total costs forthe20 mostcommon surgical procedures and the 20 most common imaging procedures along with related codes.Requires theCommission to adopt rules to ensure implementation of this requirement by June 1, 2014,and specifies information to be included in the rules. The information required may be provided to a patient upon request. Requires a hospital or ambulatory surgical facility required to file a Schedule H, federal form 990, to provide the public with access to its financial assistance policy and its annual financial assistance costs. Requires the information to be reported to DHHS annuallyand to be reported on the DHHS website and at the organization's place of business.
Directs the State Health Plan (SHP)for Teachers and State Employees to establish a workgroup to examine the best way to provide teachers and state employees with greater transparency in regards to health services costs under the SHP. Requires the SHP to report its findings and recommendations to the Joint Legislative Oversight Committee on Health and Human Services and the Joint Committee on Governmental Operations on or before December 31, 2013, and annually through December 31, 2016.
Directs the Department of Health and Human Services (DHHS) to communicate, not later thanSeptember 1, 2013, the requirements of Section 2 of the act to all hospitals licensed pursuant to Article 5 of GS 131E and Article 2 of GS 122C, as well as to all ambulatory surgical facilities licensed pursuant to Part 4 of Article 6 of GS 131E.
Amends GS 131E-97.3, providing that competitive health care information does not include the information that hospitals and ambulatory surgical facilities are required to report under GS 131E-214.6. Effective January 1, 2014.
Amends GS 131E-99,excluding information a hospital or an ambulatory surgical facility is required to report under GS 131E-214.6 from the confidentiality requirements for health care contracts. Effective January 1, 2014.
Enacts new GS 131E-273, Certain charges/payments prohibited, providing that it is unlawful for any provider of health care services to charge or accept payment for a health care procedure that was not actually performed or supplied. Effective December 1, 2013, and applies to health care procedures and services rendered on or after that date. Does not apply to administrative actions or litigation filed before the effective date of this part.
Amends GS 105A-2(9) (regarding debt set off collection)to exclude the following from the definition of a state agency: (1) any school of medicine, clinical program, facility, or practice affiliated with one of the constituent institutions of the University of North Carolina that provides medical care to the public and (2) the University of North Carolina Health Care System and other persons or entities affiliated with or under the control of the University Health Care System. Effective January 1, 2014, and applies to tax refunds determined by the Department of Revenue on or after that date.
Amends GS 131E-91 to apply to fair billing and collections practices for hospitals and ambulatory surgical facilities. Includes provisions that require bills to be legible, easily understandable, and to includeclear explanations when the use of medical codes and terms is unavoidable. Also identifies reasonable collection practices which hospitals and ambulatory surgical facilities must use. Prohibits the use of wage garnishment, a lien on a patient's primary residence, or a forced sale as a means of collecting an unpaid bill.
Repeals Article 2A of GS Chapter 131E, Garnishment for Debts Owed Public Hospitals.
Enacts new GS 131E-147.1 (Fair billing and collections practices for ambulatory surgical facilities) providing that all ambulatory surgical facilities licensed under Part 4 of Article 6 of GS Chapter131E will be subject to the fair billing and collections practices as set out in GS 131E-91.
Amends GS 58-3-245, changing section name to Provider directories; cost tools for insured (was, Provider directories) and requires that health benefit plans that utilize a provider network must ensure that a patient is provided accurate and current information about each provider's network status through both the telephone system and any electronic or online system.Adds new GS 58-3-245(d), establishing that health care providers must provide patients or prospective patients, upon request, with information regarding that provider's network status with a particular health benefit plan.
Effective October 1, 2013, and applies to hospital and ambulatory surgical facility billings and collections practices occurring on or after that date.
Enacts new GS 90-413.3A, Required participation in NC HIE for some providers, requiring any hospital, as defined in GS 131E-76(c) and that has an electronic health record system, to connect to the NC HIE and submit individual patient demographic and clinical data on services paid for with Medicaid funds. Also includes three specific findings by the General Assembly which provides the basis for requiring the connection to the NC HIE. Effective January 1, 2014.
Unless otherwise indicated, act is effective when it becomes law.
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