North Carolina

SUMMARY

North Carolina has made recent strides in health care transparency by requiring the NC Department of Health and Human Services to publish charge information relating to the most frequently reported admissions. However, the state lacks a legislated website such as an APCD to enable consumers to make side-by-side price comparisons between providers, and consequently earned an F from the Catalyst for Payment Reform group on the 2016 Report Card on State Price Transparency Laws. The federal government has also been active in enforcing antitrust law North Carolina. Most recently, in June 2016, the Department of Justice filed a civil suit in federal court in North Carolina against Carolinas Healthcare System, alleging that the provider uses anticompetitive, illegal anti-steering clauses in its contracts with insurers, which prohibit commercial health insurers in the Charlotte area from offering patients financial benefits to use less-expensive healthcare services offered by CHS’s competitors.

 

LEGISLATION/REGULATION

Legislative Calendar

North Carolina’s current regular legislative session runs from 1/11/2017 – 7/1/2017.

 

Recent Legislative Developments

Healthcare Transparency

2015-2016 H839 AN ACT TO REQUIRE MANUFACTURERS OF PHARMACEUTICAL DRUGS TO REPORT UTILIZATION INFORMATION: would require manufacturers that make their drugs available in North Carolina to report to the Department of Insurance. Reports must include: (i) total costs derived in producing the drug; (ii) average wholesale cost of he drug, as filed with the FDA, and a 5-year history of the average wholesale price; (iii) total research and development costs; (iv) total administrative, marketing, and advertising costs; (v) total profit on the drug; and (iv) total amount of financial assistance the manufacturer has provided patients through patient assistance programs.

An annual report will be required for: orally administered anticancer medications used to kill or slow the growth of cancer cells; orally administered analgesics; orally administered SSRIs (antidepressants); orally administered bronchodialators, anticoagulant, anticholinergics, and anti-inflammatory drugs used for asthma, allergies, or other respiratory problems; orally administered statin drugs; all injection medications, including insulin; and all biologics.

Inactive — Died.

 

Healthcare Cost

  • None identified.

 

 

Healthcare Markets

  • None identified.

 

 

Key Statutes

We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.

 

Transparency in Healthcare

  • C. Gen. Stat. § 131E-214.1 through 214.4 requires that all hospitals and freestanding ambulatory surgical facilities submit patient data to the Department of Health necessary to review and compare charges, utilization patterns, and quality of medical services. The data shall form the basis of a medical care database for consumers, providers, regulators, and insurers.

 

  • C. Gen. Stat. § 131E-214.11 through 214.14, the “Health Care Cost Reduction and Transparency Act of 2013,” aims to improve transparency in health care costs by mandating that the Department of Health and Human Services publish on the internet the most current price information it receives from facilities on the cost of the most common surgical and imaging procedures.

 

  • C. Gen. Stat. § 90-413.1 through 449 the “North Carolina Health Information Exchange Act,” creates the North Carolina Health Information Exchange (NC HIE). Any hospital that has an electronic health record system may connect to the NC HIE and submit individual patient demographic and clinical data on services paid for with Medicaid funds. The purpose of the system is to provide for a clearinghouse of data to improve healthcare coordination and promote cost-containment; however, participation in the system is voluntary and facilities may opt-out in the future.

 

  • C. Gen. Stat. § 131E-97.3 when a hospital is requested to disclose a contract, they may redact portions of a contract or refuse to disclose the document in its entirety if they believe in good faith the portion or entire contract constitutes competitive health information.

 

  • C. Gen. Stat. § 131E-91 states that hospitals and facilities must provide an itemized bill in clear and understandable language to patients upon request, and gives hospitals 45 days to reimburse patients for overbilling. The law also provides for rules to prevent against abusive collections agency processes.

 

Healthcare Contracts

  • C. Gen. Stat. § 58-50-295 prohibits most-favored nations (MFN) clauses in a contract between a health insurance carrier and a health care provider. A most-favored nations clause is a type of contractual provision that requires that the provider give the health carrier a rate equal to or lower than the most favorable between the provider and any other health insurance carrier. A most-favored nation clause in a healthcare contract can prevent smaller insurance carriers with less market power from competing on price.

 

Healthcare Markets

  • C. Gen. Stat. §§ 131E-175 et seq. “prohibits health care providers from acquiring, replacing, or adding to their facilities and equipment, except in specified circumstances, without the prior approval of the Department of Health and Human Services” through the state’s Certificate of Need process. A Certificate of Need regime aims to reduce healthcare overheard by reducing unnecessary or duplicative services, but can be anticompetitive by increasing regulatory barriers for new entrants.

 

  • C. Gen. Stat. §§ 58-51-85, 58-65-40, 58-67-50 no individual, group or blanket health insurance policy may be issued in North Carolina without prior approval from the Commissioner of Insurance. North Carolina requires rate review for all individual rate revisions, group Medicare Supplemental insurance, and medical service corporation rates.

 

LITIGATION/ENFORCEMENT

  • On June 9, 2016, DOJ filed a civil suit in federal court in North Carolina against Carolinas Healthcare System, alleging that the provider uses anticompetitive, illegal anti-steering clauses in its contracts with insurers, which prohibit commercial health insurers in the Charlotte area from offering patients financial benefits to use less-expensive healthcare services offered by CHS’s competitors. Read the complaint and DOJ Press Release.

 

  • On October 14, 2014, the U.S. Supreme Court issued its decision in North Carolina Dental Board v. FTC. The question presented there is whether the state action doctrine, which may immunize state actors from federal antitrust scrutiny, extends to a board made up of mostly private actors who are actively preventing competition in the teeth whitening services market. The Court held that because a controlling number of the Board’s decision-makers are active market participants in the occupation the Board regulates, the Board can invoke state-action antitrust immunity only if it was subject to active supervision by the State, and the North Carolina Dental Board did not meet that requirement is not met.

 

KEY RESOURCES

North Carolina General Assembly

North Carolina Department of Justice

North Carolina Department of Insurance