Bill Summary for S 473 (2013-2014)

Summary date: 

Mar 27 2013

Bill Information:

View NCGA Bill Details2013-2014 Session
Senate Bill 473 (Public) Filed Wednesday, March 27, 2013
A BILL TO BE ENTITLED AN ACT TO AMEND THE PROVISIONS OF HOUSE BILL 834 RELATED TO HEALTH CARE COST REDUCTION AND TRANSPARENCY AND FAIR HEALTH CARE BILLING AND COLLECTIONS PRACTICES; AND TO ALLOW THE SPEAKER OF THE HOUSE AND PRESIDENT PRO TEMPORE OF THE SENATE, AS AGENTS OF THE STATE, TO JOINTLY INTERVENE ON BEHALF OF THE GENERAL ASSEMBLY IN ANY JUDICIAL PROCEEDING CHALLENGING A NORTH CAROLINA STATUTE OR A PROVISION OF THE NORTH CAROLINA CONSTITUTION.
Intro. by Rucho, Brown.

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Bill summary

Names this act the Health Care Cost Reduction and Transparency Act of 2013.

Amends GS 90-413.2, which states the purpose of Article 29A of GS Chapter 90, to add that this Article is intended to improve transparency in health care costs by providing information to the publicon the cost of the 50 most common episodes of care in (1) hospitals subject to the NC Hospital Licensure Act and (2) ambulatory surgical facilities subject to the NC Ambulatory Surgical Facility Licensure Act.

Enacts new GS 90-413.9 to direct the NC Health Information Exchange (NC HIE) to establish and maintain an Internet web site containing the most current information it receives from hospitals and ambulatory surgical facilities under new GS 131E-91.1 (Disclosure of prices for most common episodes of care) and new GS 131E-153 (Disclosure of charity care information), as enacted by this act. Instructs the NC HIE to present this information in a format that is easily understood by the public. Specifies minimum requirements that the provided information must meet.

Enacts new GS 131E-91.1 to require each hospital licensed under Article 5 of GS Chapter 131E to provide to NC HIE, annually beginning on January 1, 2014, andusing electronic health records software, specific information regarding costs, payments, and reimbursementsfor the hospital's 50 most common episodes of care. Requires a hospital to provide this information in writingto any patient requesting itwithin 24 hours after receiving the request. Provides definitions for (1) episode of care, (2) health insurer, and (3) public or private third party. States that the disclosure requirements of this section are not to be construed as requiring a hospital licensed under Article 5 of GS Chapter 131E to participate in the voluntary statewide health information exchange network administered by NC HIE. Directs the NC Medical Care Commission (Commission) to adopt rules to ensure the proper implementation of this section on January 1, 2014, and to insure that hospitals report the information toNC HIE in a uniform manner. Requires that the rules include (1) specific categories for grouping hospitals to disclose this information on the NC HIE Internet web site and (2) methods to insure that hospitals report the most common episodes of care from a cross-section of medical and surgical specialty areas identified by the Commission. Enacts new GS 131E-153.1 to providesubstantively similar provisions as they apply to ambulatory surgical facilities, except defines episode of care to reflect services rendered by an ambulatory surgical facility.

Enacts GS 131E-91.2 to define charity care to mean the costs of a hospital of providing health care or other services to an uninsured patient or a patient who is otherwise unable to pay for all of the services provided. Directs each hospital operator, beginning January 1, 2014, and annually thereafter, to post conspicuously the hospital policyon charity care from the preceding calendar year (1) on the licensed premises in an area accessible to the public and (2) on the hospital's Internet web site where it is made available to the public. Enacts new GS 131E-153.2 to providesubstantively similar provisions as they apply to ambulatory surgical facilities.

Recodifies GS 131E-91 in Part 4A of Article 5 of GS Chapter 131E (was, codified in Part 4 of Article 5 of GS Chapter 131E). Amends GS 131E-91 to require that all hospitals (was, all hospitals and ambulatory surgical facilities) licensed under Article 5 (was, under Chapter 131E) provide a dischargedpatient upon request with an itemized list of all charges to the patient. Makes conforming changes and stylistic changes. Enacts new GS 131E-153 in Part 4 of Article 6 of GS Chapter 131E to apply the same provisions regarding providing a discharged patient with itemized charges upon request for all ambulatory surgical facilities licensed in this Part.

Directs the Department of Health and Human Services to communicate the requirements in this act pertinent to hospitals to all hospitals licensed under Article 5 of GS Chapter 131E and the requirements in this act pertinent to ambulatory surgical facilities to all ambulatory surgical facilities licensed under Part 4 of Article 6 of GS Chapter 131E no later than July 1, 2013.

Amends GS 131E-97.3 to declare that competitive health care information does not include the information that hospitals are required to report under new GS 131E-91.1 or the information that ambulatory surgical facilities are required to report under new GS 131E-153. Amends GS 131E-99 to exclude the information required in new GS 131E-91.1 and new GS 131E-153 from the confidentialityrequirements forhealth care contracts. Effective January 1, 2014.

Enacts new GS 131E-91.3 (applies to hospitals licensed under Article 5)to prohibit and make unlawfulduplicate charges for certain radiology services. Includes definitions for the following terms as they apply in this section: (1) clinical labor, (2) multiple radiology session, and (3) technical components. Enacts new GS 131E-153.3 (applies toambulatory surgical facilitieslicensed under Part 4 of Article 6)to prohibit and make unlawfulduplicate charges for certain radiology services. Includes definitions for the following terms as they apply in this section: (1) clinical labor, (2) multiple radiology session, and (3) technical components. Effective July 1, 2013, and applies to outpatient radiology services provided, and contracts executed or renewed, on or after that date.

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 the definitions in GS 108A-121 (regarding the Hospital Provider Assessment Act) to make conforming and clarifying changes. Amends GS 108A-122, adding a new subsection (e) to provide that the assessment imposed on all licensed North Carolina hospitals becomesa liability on the part of the hospital for a debt owed to the state from the time the assessment isdue and payable. Requires the Secretary of DHHS to report overdue assessments to the Secretary of the Department of Revenue, who is to collect the debt using the collection remedies under Article 9 of GS Chapter 105. Makes additional modifications to GS 108A-123 regarding the equity assessment amount and the Upper Pay Limit (UPL, the maximum ceiling imposed by the federal regulation on Medicaid payments under 42 CFR �_ 447.272 for inpatient services). Replaces the term "State's Annual Medicaid Payments" with the term "Additional Amount" and prescribes that amount to be the sum of $43 million allocated between the equity assessment and the UPL assessment based in the gross amount of payments received by hospitals under GS 108A-124. Provides for an assessment limit declaring that the Secretary of Revenue is to reduce,if necessary, a hospital's assessment so that it does not exceed the percentage of gross revenue that would result in imposing an impermissible health care-related tax, as defined under federal Medicaid law. Effective July 1, 2013.

EnactsGS 108A-124(a)(1) and (a)(2)regarding the use of the assessment proceeds. Requires that the assessment proceeds and all corresponding matching federal funds must be used to make the annual payments to the state and the hospitals: (1) payment of $50 million transferred to the State Controller and (2) allocation, by the Secretary of Revenue, of the remaining proceeds to the the hospital providers with low average monthly total Medicaid costs. Retains quarterly payments as imposed under GS 108A-123, but simplifies the payment process to conform with the changes to subsections (a)(1) and (a)(2). Effective July 1, 2013.

Directs DHHS to file a state plan amendment incorporating the assessment payments and distributions consistent with the amendments made in this actto the provisions of Article 7 of GS Chapter 108A with the Centers for Medicare and Medicaid Services. Requires the Secretary of DHHS to work in conjunction with the Office of Budget and Management and the NC Community Care Networks Inc. to develop the payment methodology under GS 108A-124(a)(2), asenacted in this act. Requires the Secretary of DHHS to consult with the Joint Legislative Commission on Governmental Operations no later than October 1, 2013, prior to making any payments under GS 108A-124(a)(2), as enacted in this act.

Encourages North CarolinaCommunity Care Networks Inc. (CCNC)to adjust its corporate governance by making changes to amend its articles of incorporation, its bylaws, or taking other appropriate action as indicated in this act. Prohibits DHHS from entering into a contract with CCNC unless CCNC makes the governance changes provided in this act.

Except as otherwise indicated, effective when this act becomes law.

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