NCOA Advocacy

Legislative Wrap Up: CON, CSRS, Opioid Epidemic and More!

The 2016 “short session” of the NC General Assembly concluded on July 1, 2016. The final weeks of the session saw a flurry of legislative committee meetings and action on a number of health-related items of interest to orthopaedic surgeons and other physicians.

Certificate of Need – NCOA member Dr. Richard Bruch (Durham) urged the legislature to repeal the state’s Certificate of Need (CON) program at a June 14 hearing on the issue. The Senate Health Care Committee heard testimony regarding potential legislation to repeal the state's CON program, but did not vote on the bill. Representatives from the North Carolina Society of Otolaryngology-Head and Neck Surgery, John Locke Foundation and Americans for Prosperity also testified that CON contributes to rising health care costs and decreases patient access to care. You can watch video coverage of the debate online (begins at 28:15).

Dr. Bruch spoke about the inadequate supply of operating rooms in North Carolina. He also relayed the comments of Dr. Timothy Jordan (Raleigh), an ophthalmologist, who struggles to get morning operating times for his pediatric patients. Dr. Bruch told legislators, “There is no ‘need’ in our certificate of need mechanism for ambulatory surgery centers. We have stifled operating rooms in this state.”

Dr. Charles Ford, an ENT physician in Boone, also testified on June 14. “CON limits patient access and choice, allowing the most costly models to flourish.” He told legislators that patients are increasingly seeking out alternative sites of care, and that they are traveling from Boone to have procedures done at ambulatory surgery centers in the region. He reported the cost of ear tube procedures at the hospital in Boone at $5,200 compared to the ASC cost of $1,700.


Dr. Richard Bruch and ENT Dr. Patrick "Tate" Maddox (Boone) encouraged lawmakers to end CON during meetings at the legislature on May 25. Pictured (L-R): Denna Suko, Dr. Maddox, Dr. Bruch and Alan Skipper.


Dr. Charles Ford testified that CON drives up health care costs and limits access to care in North Carolina.

Controlled Substances Reporting – Legislators, faced with an opioid abuse epidemic, also have concerns that usage of the state's Controlled Substances Reporting System (CSRS) among physicians remains low. In response, the 2016 Appropriations Act enacted two notable provisions with regard to the CSRS.  First, the budget appropriated $600,000 to facilitate connectivity between our CSRS and the reporting systems in surrounding states as well as integration with NC’s Health Information Exchange (HIE). The budget also allocates and more than $650,000 to develop and implement software for the performance of advanced analytics within the CSRS. The legislation further requires physicians to register with the CSRS once the upgrades are complete.

Step Therapy – On June 22, the House Insurance Committee debated House Bill 1048, Reduce Barriers to Improve NC Health & Safety, but did not vote on the measure. The bill would set standards for the development of step therapy (or "fail first") pharmaceutical coverage protocols and requires transparency in the exceptions determination process. The bill also includes provisions for health benefit plans’ coverage of abuse-deterrent opioids. Though several patient and physician organizations have aligned in support of the bill, the hearing on June 22 was dominated by opponents of the bill who emphasized the increased cost that would result if step therapy protocols were restricted in any way.

Opioid Abuse Epidemic – According to Project Lazarus, a statewide public health non-profit that is partnered with Community Care of North Carolina, our state has higher than average overdose death rates. Nearly all of these deaths involve prescription opioid pain relievers (like methadone, oxycodone, fentanyl, morphine, tramadol, or hydromorphone). The state is taking steps to combat the harmful and rippling effects of prescription drug abuse. Several bills took aim at the opioid abuse epidemic during the final weeks of the short session.

The 2016 Appropriations Act established a medication-assisted opioid use disorder treatment pilot program with a goal of studying the effectiveness of combining behavioral therapy with the utilization of a nonnarcotic, non-addictive, extended-release, injectable formulation of opioid antagonist approved by the United States Food and Drug Administration for the prevention of relapse to opioid dependence.

Also significant, Governor Pat McCrory signed into law on June 20, 2016 an act authorizing the State Health Director to prescribe opioid antagonists by means of a statewide standing order, with immunity from civil and criminal liability for such action.

A provision in the 2015 Appropriations Act established a requirement - effective January 1, 2017 - that all NC Medical Board licensees complete at least one hour of continuing education annually regarding controlled substance prescribing. To help meet your needs, the NCOA has incorporated opioid prescribing CME into is Annual Meeting program.  Additionally, a free two-hour CME session on opioid prescribing will be offered on Saturday Sept. 17, in conjunctions with the NC Medical Society's M3 Conference

Medicaid Reform – North Carolina submitted its Medicaid waiver application to CMS on June 1. Federal review of the state’s plan to capitate payment for services provided to NC’s Medicaid population through a network of statewide and regional Medicaid carriers could take up to two years. DHHS Secretary Richard Brajer presented an overview of the final application to the House Health Committee moments before the application was signed by Governor Pat McCrory and sent to CMS. Brajer told legislators his department had worked with over 50 stakeholder organizations, held 12 public hearings across the state and received comments from over 750 organizations and individuals in developing this final waiver application.

Decline in PAC Support Hurts Our Advocacy Efforts

Now is the time to drive home your message on CON reform.

The NCOA has put tremendous effort into bringing key issues, such as CON reform, to the fore, and now is the time to drive our message home. With your prior support, NCOA PAC has helped elect and re-elect candidates who are willing to advance CON reform and other issues in the NC General Assembly. Unfortunately, NCOA PAC receipts this year have not kept pace with the level of support received in previous years, and that’s impeding our ability to ensure the most favorable environment for our policy priorities in Raleigh. Will you contribute today so that we can maintain our momentum during this critical time?


Advocate for your profession!

Positive change for our patients and profession requires your direct involvement. All physicians are encouraged to devote some time to understanding the medical issues addressed by the General Assembly and to work to assure the views of the medical community are presented to policy makers in an organized and effective fashion.

Your involvement can take shape in many different forms:

Become a Key Contact

Key Contacts are a network of orthopaedists who can be relied upon to contact their legislators on important issues being debated in the General Assembly. By agreeing to become a Key Contact, we become partners. We will provide you with all the necessary background information, pertinent talking points, phone numbers, and addresses; you do the talking in your own way on the issues with which you feel most comfortable.

Download a Key Contact Registration Form (Word File)

Support NCOA PAC

It is critical that physicians financially support candidates for the General Assembly and Congress who truly understand the relevant issues affecting healthcare today. NCOA PAC allows us to express our support with one unified voice. The strength of NCOA PAC is vitally important during an election year because it helps us to elect candidates who fairly represent issues important to the medical community.

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