There have been many hard-fought battles to protect and defend ASCs from harmful legislation this Long Session of the North Carolina Legislature.  Most battles have been won and a significant battle (CON) was over before it began... finally, some good news for ASCs.

The Legislature has agreed in the budget to require that the Department of Health pay ASCs at 95% of the Medicare ASC fee schedule in effect each year! NCASCA Legislative Director Dick Carlton has been working on fair Medicaid reimbursement for ASCs since the program moved to managed care. 

NCASCA is hopeful that this will provide a meaningful income stream to our members as the Medicaid rolls expand. The budget goes into effect retroactive to July 1, 2023.  NCASCA will be meeting with the Department of Health about the new fee schedule, its effective date, and whether any claims will be reprocessed as a result.  We will provide more information after that meeting.  

Here is the text of the Budget language:

ENSURE ADHERENCE TO MEDICAID STATE PLAN/REIMBURSEMENTS FOR

AMBULATORY SURGICAL CENTERS

SECTION 9E.24. Consistent with the Medicaid State Plan, Attachment 4.19-B,43

Section 9, Page 2, the Department of Health and Human Services, Division of Health Benefits,

shall set and adjust rates for new services provided by licensed ambulatory surgical centers so

that these services are reimbursed at ninety-five percent (95%) of the Medicare Ambulatory

Surgical Centers fee schedule in effect as of January 1 of each year.