North Carolina State Health Plan extends sign-up period, boosts reimbursement offer

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Hospitals and medical providers have more time to sign up with North Carolina's State Health Plan for teachers and other state employees, state Treasurer Dale R. Folwell announced this week.

Hospitals and medical providers will be able to sign up for the plan between July 26 and Aug. 5.  The health plan, which covers more than 720,000 employees, is also increasing payments to hospitals.

It's all part of the Clear Pricing Project. The project, announced in March, will shift the health plan from a commercial-based payment model to a reference-based government pricing model that reimburses providers based on a percentage above what Medicare pays. In the past, the state has adjusted rural hospital rates to address concerns about the Clear Pricing Project. And now, the health plan and Mr. Folwell have agreed to raise reimbursement again.

Under the new proposal, payments to about 61,000 medical providers would increase, on average, from 182 percent to 196 percent of Medicare rates, according to the Winston-Salem Journal.

Mr. Folwell's announcement states that the new proposal increases urban hospitals' combined inpatient/outpatient ratios from 178 percent to 200 percent of Medicare rates on average. Hospitals statewide will also receive $116 million in additional payments from the proposal from March.

"The decision to readjust rates comes after many meetings and discussions with hospital officials and others," Mr. Folwell said in a news release. "We're very pleased that 27,000 medical providers have signed onto the Clear Pricing Project. However, we realize that our members need to have additional hospitals for the plan to have coverage."

According to the Journal, hospitals and medical providers that don't sign up with the health plan could be out of network for health plan participants beginning Jan. 1.

Meanwhile, Mr. Folwell said he plans to ask the health plan board to develop an advisory committee to recommend changes, including the consideration of alternative payment models.


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