As reported in our last law note, a series of proposed regulations issued pursuant to the North Carolina Health Care Cost Reduction and Transparency Act (S.L. 2013-382/S.L. 2013-393) (the "Transparency Act") are scheduled to take effect on November 1. Those proposed rules define terms used in the Transparency Act regulations, outline the procedure for quarterly data reporting required of hospitals and ambulatory surgery centers under the new law, and provide the lists of procedures and services for which data must be reported. The proposed regulations also expand on the Transparency Act's requirements that hospitals and ASCs provide patients with itemized lists of charges and implement policies and procedures designed to give patients greater access to information regarding costs, charges, refunds, and the process for disputing charges. The first quarterly data submission was due October 1, 2014, but the submission deadline has been extended to November 7, 2014.
Since the proposed rules were issued, additional revisions were made to proposed 10A N.C.A.C. 13B.2101 (definitions – hospitals) and .2102 (data reporting requirements – hospitals), as well as 10A N.C.A.C. 13C.0103 (definitions – ASCs) and .0206 (data reporting requirements – ASCs). The revisions are outlined below:
- 10A N.C.A.C. 13B.2101: The definition of "health insurer" is revised to read: "an entity that writes a health benefit plan as defined in G.S. 131E-214.13(a)(3)."
- 10A N.C.A.C. 13B.2102: Removes the code references for the lists of DRGs and procedures about which hospitals must report data; the sole repository for these lists will be the Department's website at http://www.ncdhhs.gov/dhsr/ahc. Corrects some statutory references. Clarifies that information must be reported for each of the hospital's top five largest health insurers.
- 10A N.C.A.C. 13C.0103: The definition of "health insurer" is revised to read: "an entity that writes a health benefit plan as defined in G.S. 131E-214.13."
- 10A N.C.A.C. 13C.0206: Removes the code references for the lists of DRGs and procedures about which hospitals must report data; the sole repository for these lists will be the Department's website at http://www.ncdhhs.gov/dhsr/ahc. Corrects some statutory references. Clarifies that information must be reported for each of the facility's top five largest health insurers.
The public comment period on these revised rules runs through October 17, 2014, with a public hearing scheduled for October 15, 2014. The proposed rules are scheduled to take effect on January 31, 2015. The proposed rules and a description of the public comment process are posted on the DHSR website at http://www.ncdhhs.gov/dhsr/rules/transparency2014.html.
Hospitals and ASCs that have yet to evaluate their policies and procedures for compliance with the Transparency Act and its regulations should do so immediately to ensure timely compliance with the requirements of the Transparency Act. As a reminder, a failure to timely report the required quarterly data is considered a licensure violation. Repeated failure to comply with the rules could result in revocation of a hospital's or ASC's license.
The Health Care team at Smith Moore Leatherwood is ready to assist hospitals and ASCs with reviewing current policies for compliance with the new requirements, implementing new policies and procedures when needed, and training staff on compliance with the Transparency Act requirements. Contact us for more information today. Our health care team is ready to assist in implementing the Transparency Act requirements.