Impactful to Your ASC: CON Partially Repealed in NC 04-24-2023

This has been a very active legislative session for the North Carolina Ambulatory Surgical Center Association ("NCASCA"). The following is a summary of the bills of interest to NCASCA.

On March 26, Governor Roy Cooper signed House Bill 76, Access to Healthcare Options, into law.  The legislation will expand Medicaid, which is expected to provide health coverage to over 600,000 people across North Carolina and bring billions in federal dollars to the state. 

The bill also provides for increase Medicaid reimbursements to hospitals through the Healthcare Access and Stabilization Program (HASP), and increases hospital assessments to provide funding for the NC Health Works coverage and the HASP program. 

Most importantly to ambulatory surgical centers, the new law will remove psychiatric beds and facilities, chemical dependency treatment beds and facilities, ambulatory surgical centers in large counties, MRI machines in large counties, certain home care agency treatment for minors, and the first $3 million worth of replacement and diagnostic center equipment from certificate of need review. 

The new law will exempt ambulatory surgical centers from certificate of need review if those centers are licensed by DHHS, are located in a county with a population in excess of 125,000 and commit 4% of their total earned revenue to charity care. This part of the new law would be effective two years after the first HASP payment is made. 

That payment is not expected until late fall. Therefore, ambulatory surgical centers will have two years from this fall before the repeal of certificate of need starts. This is very important because it will give NCASCA members some time to adjust to the new law, as well as try to tweak some of the provisions in the bill if necessary.

With the passage of Medicaid Expansion, NCASCA has been lobbying for increased payments on Medicaid cases. NCASCA members take big losses on these cases at the current reimbursement rate. Senate Bill 586 and its House Bill 573 are seeking to increase those reimbursements to 95% of the Medicare Part B OPPS payment rate. Senator Joyce Krawiec from Forsyth County is leading these efforts.

NCASCA members will be faced with the prospects of handling more Medicaid cases due to expansion, so this bill is very important to get passed.

NCASCA has also been keeping a close eye on Senate Bill 333. This proposed legislation seeks to establish standards for surgical technology care in hospitals and ambulatory surgical centers. The bill states that surgical technologists must meet certain requirements to be a surgical technologists in an ambulatory surgical center. While we have worked with the bill sponsors over time to make this a better bill with grandfathering those already working and make exceptions for having to hire a surgical technologist that has met all of the statutory requirements, we feel with all of the uncertainties currently in the business dynamics for ambulatory surgical centers, this bill should not go forward. We have spoken with the bill sponsors and have asked them to hold this bill.

Finally, during the rush of the last day for bill filing, HB 650 was introduced. This act attempts to establish standards for surgical smoke evacuation in hospitals and ambulatory surgical facilities.  We are discussing the implications of this bill with our members and will follow up with comments to the bill sponsor.

Action down at the North Carolina General Assembly will continue this fast pace until at least the 4th of July, and NCASCA will continue to work hard for you.