Legislation Gives Certain Providers More Time to Connect to NC HealthConnex

Tuesday, November 17, 2020

This bulletin provides important information regarding changes in the law concerning connection deadlines to NC HealthConnex, the state-designated health information exchange. It also describes a “Hardship Extension Process” coordinated by the North Carolina Department of Health and Human Services (NCDHHS) pursuant N.C. Gen. Stat. § 90-414.4(a3). The Hardship Extension Process is available to certain Medicaid, NC Health Choice, NC State Health Plan and BCNC Blue Option network providers and will provide them additional time to connect to NC HealthConnex.

Background Information: NC HealthConnex and Mandatory Connections

The North Carolina Health Information Exchange Authority (NC HIEA) is the state agency that manages NC HealthConnex, a statewide health information exchange designed to enable health care information to flow securely and privately between providers throughout the health care system. You can read more about NC HealthConnex online and in the Statewide Health Information Exchange Act, N.C. Gen. Stat. §§ 90-414.1 et seq
 
Providers were previously notified that state law (N.C.G.S. § 90-414.4) requires all health care providers who receive any state funds for the provision of health care services (e.g. Medicaid, NC Health Choice, State Health Plan, etc.) to connect and submit patient demographic and clinical data to NC HealthConnex by certain dates in order to continue to receive payment for services.

Recent Legislative Changes Impacting Connection Requirements

October 1, 2021 Deadline

On May 4, 2020, Governor Cooper signed into law Session Law 2020-3 (COVID-19 Recovery Act). Among other things, this Session Law extends the deadline for providers required to connect and submit data to NC HealthConnex from June 1, 2020 until Oct. 1, 2021. This extension provides additional time for providers to move through the technical process to complete onboarding.

Important Note: Those who are required to connect to NC HealthConnex, but who have not yet taken steps to do so, should contact the NC HIEA at 919-754-6912 or hiea@nc.gov, as there is a large queue of provider organizations in the current onboarding status. In order to meet the State’s required deadlines for connectivity, the NC HIEA is prioritizing onboarding by provider types. Health care providers will be contacted by NC HIEA soon to receive their onboarding timeframe. Providers who choose not to move forward during their assigned timeframe will be placed at the end of the queue and may risk not being connected by the required deadlines.  

Mandatory and Voluntary Participation

On June 6, 2019, Governor Cooper signed into law Session Law 2019-23, This law identified certain providers and made their participation in NC HealthConnex voluntary instead of mandatory.

Specifically, the law states that the following provider types are no longer required to connect and submit data to NC HealthConnex, but may choose to do so on a voluntary basis:

  • Community-based long-term services and supports providers, including personal care services, private duty nursing, home health, hospice and palliative care;
  • Intellectual and development disability services and supports providers, such as day supports and supported living providers;
  • Community Alternatives Program waiver services (including Community Alternatives Program for Disabled Adults (CAP/DA), Community Alternatives Program for Children (CAP/C), Innovations, Program of All-Inclusive Care for the Elderly (PACE) and Respite) providers;
  • Eye and vision services providers; 
  • Speech, language, and hearing services providers; 
  • Occupational and physical therapy providers;
  • Durable medical equipment providers;
  • Nonemergency medical transportation service providers;
  • Ambulance (emergency medical transportation service) providers; and
  • Local education agencies and school-based health providers

Voluntary providers that wish to participate should contact NC HIEA at 919-754-6912 or hiea@nc.gov.

Department of Health and Human Services Hardship Extension Process 

Session Law 2019-23 also modified the Statewide Health Information Exchange Act and gave NCDHHS the authority to grant a temporary Hardship Extension to classes of providers for whom acquiring and implementing an electronic health record (EHR) system and connecting to the HIE Network would constitute an undue hardship. A Hardship Extension delays the connection deadline until as late as Dec. 31, 2022. All providers that receive a hardship extension must be able to meet their statutory obligations by Jan. 1, 2023.  

To reduce the administrative burden and maintain accessibility to services, NCDHHS is automatically granting a Hardship Extension for provider types that can be identified by a qualifying taxonomy. If a provider falls within one of the types outlined below, the temporary extension is automatically granted.  

  • Chiropractors; 
  • Behavioral Health Residential Treatment Facilities;
  • Therapeutic Foster Care Treatment Facilities;
  • Psychiatric Residential Treatment Facilities; 
  • Behavioral Health Providers Other Than Psychiatrists;
  • Children’s Developmental Services Agencies

For other providers, meeting criteria for a Hardship Extension cannot be automatically determined and will require the provider to contact NCDHHS to attest to their qualifying circumstance(s). If a provider falls within one of the circumstances outlined below, a temporary Hardship Extension may be requested.  

  • Chiropractic organizations with a single or multi-specialty taxonomy
  • Rehabilitative, Restorative and Assistive Technology Service Providers for the North Carolina Assistive Technology Program; 
  • Providers nearing retirement on or before Dec. 31, 2022;
  • Providers who are closing their practices on or before Dec. 31, 2022;
  • Providers operating in rural areas with lack of access to affordable internet / broadband capacity adequate to support implementation of EHR technology and connection to the HIE Network; and
  • Providers in a community with few or no alternatives that not granting a Hardship Extension for a provider or practice may lead to the loss of or a material reduction in access to care.

To request a temporary Hardship Extension, providers must submit the NC DHHS HIE Hardship Extension Request Form electronically to the DHB Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov. The form is available at https://medicaid.ncdhhs.gov/providers/forms under Category “HIE Hardship Extension.” Inquiries must be submitted by the enrolled provider, the office administrator (OA), or a managing employee of record. This process applies to Medicaid, NC Health Choice, NC State Health Plan and BCNC Blue Option participating providers.

Providers receiving the Hardship Extension are still required to comply with the HIEA participation agreement,the technical onboarding requirements documented in the NC HIEA contract, and must be connected and submitting data by the Hardship Extension deadline date of Dec. 31, 2022. Connecting to NC HealthConnex can take up to 12 months depending on the provider’s EHR status, so providers are strongly encouraged to begin technical development no later than Jan. 1, 2022. 

Providers with this extended deadline will be responsible for ensuring they have a valid participation agreement on file with the NC HIEA and communicating their readiness to the HIEA to begin development. Any provider with questions regarding their status on the List of NC HealthConnex Participants should contact the NC HIEA.