Priority Issues

The North Carolina Healthcare Association represents the collective voice of more than 130 hospitals and health systems across our state. In today’s rapidly evolving healthcare environment, hospitals are responding to numerous challenges that impact our ability to meet our mission to provide quality healthcare to everyone in the communities we serve. North Carolina and the nation are in the midst of a global pandemic. We are ready to partner with lawmakers to ensure North Carolina’s hospitals and health systems have the financial stability and resources needed to continue responding to the coronavirus (COVID-19), prepare for the next emergency, and serve the everyday healthcare needs of their communities.

2021 Federal Legislative Priorities

The North Carolina Healthcare Association coordinates with the American Hospital Association to advocate for support from members of Congress on federal issues affecting hospitals and health care.

The following is a list of federal legislative priorities, and the associated position statements, that were approved by the Board of Directors for use during the 2021 Legislative Session:

Affordable Care Act

North Carolinians have come to rely on the protections of the Affordable Care Act (ACA). Any change made should ensure that those protections remain so that our hospitals can continue to provide high quality care to all.

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Medicaid DSH Reductions

North Carolina hospitals and health systems support the disproportionate share hospital (DSH) programs and oppose any attempts to reduce funding for our most vulnerable. Further, cuts to the DSH program should be restored, especially for those states that continue to have a large uninsured population. Calculations should be based on the 2019 base year until the patient mix returns to post pandemic levels.

Learn more about Medicaid transformation in North Carolina.

340B Drug Pricing Program Support

 Small, rural hospitals’ thin margins – made even tighter by COVID-19 – make programs like the 340B drug pricing program even more important to provide needed medical care to our most vulnerable communities. NCHA is committed to building a stronger, more transparent 340B program that benefits patients who wouldn’t otherwise have access to high-quality healthcare.

Learn more about the 340B Drug Pricing Program.

EMTALA Reform

North Carolina hospitals and health systems urge Congress to modernize the Emergency Treatment and Active Labor Act to provide avenues for providers to get patients to the right care at the right place, implementing many of the changes provided during COVID-19.

Graduate Medical Education

Every North Carolinian deserves access to highly trained doctors. Congress should expand funding for medical education programs.

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Balance / Surprise Billing

Our patients deserve to have peace of mind about their healthcare finances. We support efforts to protect patients from surprise bills and leveling the playing field between providers and insurance companies by encouraging private negotiations without government controls.

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Medicare Extenders

North Carolina hospitals and health systems support Medicare Extenders — such as the payments for Medicare-dependent hospitals (MDH) and those hospitals with lower volumes (LVH) — and urge Congress to permanently extend these programs so those most vulnerable hospitals can meet their community needs. Until patient volumes return to pre-pandemic levels, the base year should be 2019, rather than 2020.

Telehealth Expansion

The role of telehealth cannot be overstated in bringing care to communities who would otherwise be cut off from care; telehealth is a critical component of healthcare during the COVID-19 response and will be an essential component of care in the future. NCHA supports further protecting patients’ rights for telehealth coverage and expansion of broadband access to bring healthcare to every community.

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Insurance for All

North Carolina hospitals and health systems support broad insurance options and oppose efforts to move to one single payer.

Price Transparency

North Carolina’s hospitals, health systems and providers strive to provide our patients and their families with accurate cost and quality information. Regulations that require that providers disclose the negotiated rates of private insurers and others do not provide needed information on out-of-pocket costs, quality, or outcomes.

Site Neutral

North Carolina hospitals and health systems support variable reimbursement models that recognize the unique financial and charitable roll that hospitals play in the community and the fact that many patients who require hospital care have more complex health conditions.

Pandemic Preparedness Funding

Congress should increase COVID-19 relief funding to assist states and local health departments with ongoing surveillance, testing, surge planning, and patient care during the current and future public health emergencies. All hospitals should be equally eligible for relief funds.

2021 State Legislative Priorities

North Carolina hospitals and health systems are in the midst of transforming our delivery of care to respond to the changing needs of our state. Our goal is to provide the appropriate level of care in the appropriate setting with the best outcomes. North Carolina’s hospitals are open all day, every day. We support more than 395,000 jobs statewide and contribute billions to the economy every year.

The following is a list of state legislative priorities, and the associated position statements, that were approved by the Board of Directors for use during the 2021 Legislative Session:

Health Equity

North Carolina’s hospitals and health systems support work to provide care for all North Carolinians regardless of race, ethnicity, gender, insurance status, or income.

Medicaid Expansion

NCHA supports Medicaid expansion to improve access to high-quality healthcare and close the gap for North Carolinians who are uninsured.

How will closing the Coverage Gap help North Carolina? Read more here.

 

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Transition to Medicaid Managed Care

Medicaid is an important program, ensuring the state’s vulnerable populations, including children and pregnant women, receive needed care. We support a transformed program that ensures high quality outcomes, provider protections, and maximizes federal funds.

NCHA Medicaid Managed Care Toolkit

NCHA Medicaid Managed Care Call Center Resource Guide

NCHA Medicaid Managed Care Provider Resource Guide

NCHA Medicaid Managed Care Patient Resource Guide

(Spanish Version) NCHA Plan de Salud del Programa Medicaid de Carolina del Norte

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Certificate of Need Law

NCHA supports the current Certificate of Need law and urges our legislators to protect the law, thereby protecting access to care for all. The Certificate of Need law ensures that hospitals and health systems maintain the resources to provide high-value care to all in our communities and to plan for global pandemics and natural disasters.

Research papers on Certificate of Need:
Image vs. Reality: Mercatus, CON and Statistics in Search of Meaning, May 2016 

First Do No Harm: Analyzing the Certificate of Need debate in North Carolina, July 2015

“Why Repealing CON is devastating for North Carolina’s rural hospitals” (2021)
Video 1 (CarolinaEast), Video 2 (Southeastern)

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Balance / Surprise Billing

Our patients deserve to have peace of mind about their healthcare finances. We support efforts to protect patients from surprise bills and leveling the playing field between providers and insurance companies by encouraging private negotiations without government controls.

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Tax Treatment Preservation

North Carolina’s not for profit hospitals and health systems support the current non-profit sales and property tax laws and also support efforts to exempt non-profits from paying sales taxes.

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Behavioral Health Reform

Everyone deserves access to high-quality healthcare, which includes behavioral healthcare. NCHA supports policies to improve access regardless of insurance status and dismantling the root causes of inequality for behavioral health patients.

 

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Telehealth Expansion

The role of telehealth cannot be overstated in bringing care to communities who would otherwise be cut off from care; telehealth is a critical component of healthcare during the COVID-19 response and will be an essential component of care in the future. NCHA supports further protecting patients’ rights for telehealth coverage and expansion of broadband access to bring healthcare to every community.

Read about how NC hospitals are changing lives with telehealth services. 

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Graduate Medical Education

Every North Carolinian deserves access to highly trained doctors. North Carolina should continue funding medical education programs and explore ways to draw down more of our Federal tax dollars to add more slots to train medical students.

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State Health Plan

The North Carolina State Health Plan should adopt proven value-based methods to provide and coordinate quality-driven care to improve the lives of state employees and retirees, while reducing the costs for both the plan and taxpayers. The State Health Plan should not base reimbursements on out-of-date policies referenced to Medicare rates.

Download the two-page legislative leave-behind document on the financial impact of proposed SHP changes.

Download the two-page legislative leave-behind document on access to care implications of proposed SHP changes.

Learn more about our proposal for a better path forward for the State Health Plan.

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Honoring Assignment of Benefits

During the COVID-19 pandemic, insurance companies continued to collect profits and negotiate against providers. North Carolina should join the majority of states that require insurance companies to honor the wishes of our patients who choose to assign their benefits to their provider.

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Transparency

North Carolina hospitals and health systems strive to provide our patients and their families with accurate cost and quality information. Regulations that require that providers disclose the negotiated rates of private insurers and others do not provide needed information on out-of-pocket costs, quality, or outcomes.


The North Carolina Healthcare Association provides legislative summaries for our member hospitals and health systems to keep them informed about the work we do on their behalf at the North Carolina General Assembly and in Congress.

To learn more about these priorities, please log in to NCHA Member Resources.

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