2023 Accomplishments
Together, we did it — Our hospitals, lawmakers, communities, and more worked together to finally expand Medicaid coverage for over 600,000 uninsured, working North Carolinians. On March 27, 2023, Gov. Roy Cooper signed into law legislation directing the state to expand Medicaid contingent upon enactment of the State Fiscal Year (SFY) 2023-2024 budget. This included NCHA’s Healthcare Access and Stabilization Program (HASP) which will provide much needed financial support to our state’s healthcare safety net and enable hospitals to pay for the non-federal share costs of expansion. The bill also included changes to the certificate of need law, which hospitals agreed to for expansion.
The North Carolina General Assembly (NCGA) passed the state budget in September, allowing the Medicaid expansion process to finally begin. The budget also included much-needed funding for behavioral health and healthcare workforce. In late September, the Centers for Medicare and Medicaid Services (CMS) approved North Carolina’s submission of the preprint proposal for the initial year of HASP. Everything came together to successfully launch Medicaid expansion coverage on Dec. 1.
Behavioral health was another legislative priority. NCHA coordinated efforts between our members and the NC Department of Health and Human Services (NCDHHS) to address issues such as implementation of the Behavioral Health SCAN bed registry, crafting language to address emergency department boarding of DSS-involved youth, and amendments to 3-way bed contracts.
Workforce challenges were also a focus. A law passed requiring hospitals with emergency departments to have a law enforcement officer on site unless they get local authorities to sign off on an exemption. It also calls for hospitals to report violent incidents to the state, to provide employees with violence-prevention training and to conduct a security risk assessment and create a security plan. The requirements take effect in October 2024 and in 2025. While the law as written needs some technical improvements, creating safeenvironments for patients, staff, and visitors is a priority.
The 118th Congress began with Republicans taking control of the House after four years of Democratic majority. Hospitals have been the target of several policy proposals. NCHA actively educated our federal delegation and regulators on the negative impact certain policies would have on patient access to care such as: site neutrality, redundant transparency proposals and oversight into the non-profit tax-exempt status of hospitals. To date, we have prevented any harmful policy changes.
Other priorities we advocated for include protecting the 340B program, preventing cuts to Medicaid disproportionate share hospital funds and highlighting the many benefits of expanded telehealth.
NCHA was integral in developing HASP with the NCGA Fiscal Research Division and the NC Division of Health Benefits (DHB) to fund Medicaid expansion and communicated requirements to hospital members throughout the HASP implementation process. NCHA will soon work with DHB to submit a preprint proposal to CMS for SFY 2024. As no funds can flow from the NC General Fund for Medicaid expansion costs, continual reconciliation will ensure hospitals are taxed for only the state’s share of expansion and will be reimbursed for any overpayment. For SFY 2023, hospitals will receive a net $1.8B in HASP reimbursements for Medicaid managed care services. The continuation of the HASP program is critical to stabilizing the community safety net and protecting healthcare access in North Carolina.
Building Payor Relationships NCHA continues to address payor issues to reduce denials and administrative burdens on members. The NCHA Medicaid managed care steering committee is identifying inconsistencies between prepaid health plans (PHPs) and DHB policies to protect hospitals from PHP underpayment tactics.
To improve provider and payor relations in Medicaid, the committee meets monthly with the North Carolina Association of Health Plans (NCAHP) and individual PHPs to offer timely feedback and insight on issues to streamline resolution and reduce administrative burden. NCHA has successfully advocated for accurate hospital reimbursement for newborn claims and for establishing itemized bill requirements for PHPs. NCHA continues to focus on transitions of care delays, clarification and review of new PHP reimbursement and clinical policies and eliminating instances of down coding.
Going forward, the committee’s work will expand to help resolve commercial payor issues, such as:
process delays for medical reviews,
ability of health plans to accept electronic attachments,
improved process for rejection mail backs,
and provider credentialing.
Additionally, a new surprise billing committee for members will meet and discuss best practices to meet the surprise billing final rule.
NCHA also collaborates with other State Hospital Associations and the CMS Regional IV Office to address Medicare and Medicaid payor issues, especially with Medicare Advantage plans.
Protecting Hospital Base Rate Payments During the transition of Medicaid managed care, NCHA protected hospital base rate and supplemental payments by establishing a rate floor, or minimum payment hospitals could receive from PHPs. In 2023, the rate floor resulted in $1.2 billion in net Medicaid revenues to hospitals to offset Medicaid and uninsured losses.
Monitoring regulations During 2023, NCHA submitted nine comment letters to federal and state regulators. This year, the North Carolina Division of Health Service Regulation (DHSR) finalized the re-adoption process for hospital rules. Most notably, DHSR adopted NCHA language regarding the retention of medical records rule, a top priority for members resulting in cost savings. The rules went into effect on Aug. 1, 2023.
In addition, NCHA and its Transitions of Care committee built out a point-in-time data collection for routine data requested by DHB. Data use agreements (DUA) are expected to be signed by the end of 2023 with data collection beginning in January 2024. Routine data includes Medicaid patients with extended stays due to difficulties with discharge. Data will be shared regularly with DHB to resolve barriers and to assist with advocacy efforts to build strong patient networks. NCHA and committee members have also been meeting with DHB to discuss the Pre-Admission Screening and Resident/Review (PASSR) level II delays.
Harnessing the value of data NCHA develops data analyses to support members in minimizing risk and navigating changes with Medicaid Managed Care and other policies that have a financial impact to NC hospitals and health systems. Analysis includes:
Posted community benefits, as provided by NC hospitals and statewide estimate.
Determined impact of Medicaid managed care losses, expansion, and HASP benefit.
Created data-focused analyses to support Medicaid Expansion, HASP, equity, rural hospitals, and workforce.
Produced hospital-specific analyses for calculating funds at risk due to potential state and federal legislative changes.
NCHA provides data to members in support of academic medical research, strategic planning, and Public Health:
Over the course of the year, NCHA and the Tennessee Department of Health partnered to exchange 10 years of non-resident discharge data in a pilot program, with an agreement to move to full exchange in 2024.
NCHA and the North Carolina Division of Public Health (NCDPH) have expanded our syndromic surveillance footprint to include additional urgent care facilities, bringing the total to 152. Approximately 90% of all NC health system-associated urgent care facilities are reporting to the North Carolina Hospital Emergency Surveillance System (NCHESS).
NCHA continues to collaborate with members on data linkages for research projects that support public health and better outcomes for patients with mental health and substance abuse issues.
Additional data quality checks were added to the Patient Data System (PDS) to significantly improve CPT code completion rates in the outpatient data.
There was renewed interest in the Preventable Readmissions Data Initiative (PRDI), with nine health systems having agreed to participate in the program.
NCHA continues to inform legislators, the public and the statewide business community about how our member hospitals and health systems keep North Carolina healthy and economically strong. We released a report in November describing how strong hospitals support thriving communities. We also published an economic impact report and promoted it through a multi-channel advertising campaign.
NCHA also held three virtual statewide town halls featuring panels of hospitals leaders. The discussion topics ranged from rural and urban health care issues, to how hospitals are accelerating health equity.
During the legislative session, NCHA issued several statements, op-eds, articles and coordinated interviews with our members and staff urging the General Assembly to pass legislation authorizing Medicaid expansion and HASP. We also sponsored and participated in published roundtable conversations with Business North Carolina magazine and the regional business journals to discuss our advocacy priorities, workforce issues and members’ financial challenges.
NCHA also recognized the healthcare workforce for their dedication to patients and communities by sponsoring monthly ads in Our State Magazine, a television public service announcement, our third annual recognition campaign with NC State Athletics, and two workforce video series, one sharing the joy of working in healthcare and the other featuring veterans who work in healthcare. We also began creative development for a new campaign to create awareness about healthcare careers among North Carolina teenagers that will launch in early 2024.
NCHA is honored to recognize leaders and teams from North Carolina hospitals and health systems committed to improving the health of their communities through innovative, high-quality care. At our Summer Meeting, honors were bestowed on the following:
Kathy C. Bailey, FACHE, president and CEO of UNC Health Blue Ridge in Morganton received NCHA’s highest honor — the 2023 Distinguished Service Award. The award is given each year to an NCHA member executive whose contributions to the healthcare field have had a positive and lasting impact at the local, regional, state, or national level. She also received the American Hospital Association’s Grassroots Champion award for her work educating federal and state lawmakers on healthcare issues.
Mary Blackburn, RN, MSN, chief clinical officer and vice president of care innovation for Hugh Chatham Health, received the 2023 Clinical Leadership Award. This award honors an individual who has demonstrated exemplary clinical leadership in care transformation through innovation and improvement. Blackburn has led Hugh Chatham Health’s value-based care initiative to improve costs and patient outcomes.
Peg O’Connell received the 2023 Meritorious Service Award, given to an individual who is not a CEO or trustee of an NCHA member institution and recognizes outstanding service to the health care field. O’Connell, a Senior Advisor for Government and Public Affairs with the Raleigh consulting firm of Fuquay Solutions, was honored for her leadership with the Care4Carolina coalition to help pass Medicaid expansion in North Carolina.
FirstHealth of the Carolinas’ CARE Suite received the 2023 Healthier Communities Award. This award recognizes collaborative work by an NCHA member institution to promote health and well-being by addressing an identified need. CARE Suite identifies and eliminates barriers to improving the health and well-being of patients and the community through collaboration with health care partners and community resources that assist with transportation, housing, utilities, food support, finances and more.
