Legislative Solutions: 2017 North Carolina Legislative Recap

The North Carolina General Assembly is amidst its long session. Several pieces of health care legislation have been introduced, but most bills are in the beginning stages of the legislative process.

Certificate of Need Reform

Numerous bills have been introduced in the North Carolina Senate to reform Certificate of Need (CON) laws. Republican leaders in the state believe the laws are over-restrictive and lead to thousands of fewer patient beds and pieces of equipment (e.g., MRI machines). CON laws have faced legislative repeal efforts for several sessions in North Carolina, but those efforts to repeal have faltered because of opposition in the House. Related bills include:

• Senate Bill 330 to exempt hospice care facilities from CON rules;
• Senate Bill 349 and Senate Bill 328 to create exemptions for certain ocular surgeons; and
• Senate Bill 324 to repeal CON laws entirely.

Opioids

There has been a big push in North Carolina over the past two years to limit access to opioids. Opioid overdoses now surpass automobile accidents as the number one cause of accidental deaths in the state. The House, Senate, and Attorney General’s office have collaborated on House Bill 243, legislation that would reform the way opioids are managed and prescribed. The so-called Strengthen Opioid Misuse Prevention Act (STOP Act) would require doctors to search a statewide database, the Controlled Substances Reporting System, before prescribing opioids to a patient. The bill also allocates $10 million to fund local treatment facilities combatting addiction.

Please click here to read a summary of House Bill 243.

Behavioral Health Beds

There is strong legislative interest in relieving emergency departments of behavioral health patients. Too often, behavioral health patients occupy beds in emergency rooms for days or weeks without receiving the care they need. Legislators are working to redirect behavioral health patients to facilities more suitable for their needs.

To date, two companion bills have been introduced on this subject. Senate Bill 383 and House Bill 477 would provide Medicaid reimbursement for ambulances that redirect behavioral health patients to more appropriate facilities, such as a behavioral health clinic. In addition, a more sweeping bill on this issue is set to be introduced during the week of April 3.

Scope of Practice

There are several scope of practice battles in the legislature this year. The main catalyst for this push seems to be increasing access to health care, especially in rural areas.

• The scope of practice battle between ophthalmologists and optometrists intensified last week as ophthalmologists took to the media to discuss their concerns alongside legislators. A bill introduced in February aims to widen optometrists’ scope of practice. Sponsors of House Bill 36 believe it will enhance access to care across the state. Optometrists argue that they should have the right to perform a certain set of surgeries, including two treatments for glaucoma patients that involve lasers. Optometrists specialize in treating eye diseases and correcting vision, but do not attend medical school. Ophthalmologists are medical doctors who specialize in treating the eyes and performing eye surgeries.

Please click here to read House Bill 36.

• The Modernize Nursing Practice Act has sparked debate between nurses and physicians. House Bill 88, introduced in February, would allow nurse anesthetists to practice without working under an anesthesiologist. Current law dictates that Certified Registered Nurse Anesthetists (CRNAs) must sign a supervision agreement with a physician to practice in the state, but the supervision often only means meeting as little as twice a year.
  
  If an anesthesiologist retires, the nurse anesthetist must find another anesthesiologist that is willing to sign on as his or her supervisor. This is the same for new nurses and nurses coming from out of state.
  
  The introduced legislation would do away with that system. Many doctors have spoken out against the bill, stating that the training a nurse anesthetist receives falls significantly short of the years of schooling and training doctors receive to practice medicine. 

Please click here to read House Bill 88.