State Health Plan Budget Changes and Health Information Exchange Act Update

Important Legal Update: State Legislature Temporarily Suspends Enforcement Provision in the Statewide Health Information Exchange Act; January 1, 2023, Deadline to Connect to NC HealthConnex Remains Unchanged  

The North Carolina General Assembly recently enacted laws that impact health care providers and organizations that serve state-funded patients (e.g., Medicaid recipients and State Health Plan members). Specifically, the new state budget and the Statewide Health Information Exchange Act (PDF) contemplate the following  

• Certain organizations who receive state funds for treating Medicaid recipients and State Health Plan patients remain subject to a January 1, 2023, deadline to connect to NC HealthConnex and submit required data to the state. This deadline is unchanged. 
• The enforcement mechanism in the Statewide Health Information Exchange Act that makes connection to the HIE and submission of required data to the state prerequisites for a health care provider to receive state funds is temporarily suspended “until a bill designating a lead agency responsible for enforcement of the Statewide Health Information Exchange Act is enacted into law.” 
• In March 2023, the General Assembly will receive a report outlining the status of organizations that met – or failed to meet – the January 1, 2023, connection and submission deadline.  
• The N.C. Health Information Exchange Authority’s (NC HIEA) Advisory Board may offer additional recommendations to the General Assembly about enforcement of the Statewide Health Information Exchange Act and about enhancements to NC HealthConnex.  These recommendations will supplement a report and recommendations that the NC HIEA Advisory Board submitted to the General Assembly (PDF) this spring, which focused on data connections, supporting patients, and protecting the networks of providers who serve state-funded patients. 

Legal changes and the fast-approaching connection deadline may leave providers with questions about receiving state funding and their connection status. Below, the NC HIEA provides answers to questions that may arise and how the changes may impact specific groups of providers. 

Does This Mean I Won’t Receive State Funds for Treating Patients? 

The statutory provision that would prevent “unconnected” providers and entities from receiving state funds for treating Medicaid recipients and State Health Plan members is suspended as a matter of law. Providers – even those not yet connected to NC HealthConnex --  may continue to see state-funded patients without fear that the state will enforce the “condition of receiving state funds” provision of the Statewide Health Information Exchange Act at this time.   

Do I Still Need To Connect? 

It is imperative that providers, health care organizations, pharmacies and others subject to the Statewide Health Information Exchange Act take immediate steps to connect to NC HealthConnex. The connection deadline of January 1, 2023, has not been delayed or extended, and enforcement of the condition of receiving state funds is only suspended temporarily. In March 2023, the NC HIEA will report to the General Assembly on connection status of providers and offer recommendations on how to begin enforcement of the connection mandate.  

What If I’m in the Process of Connecting? 

Health care organizations that have begun the technical process of connecting to NC HealthConnex are considered to be making good-faith efforts to fulfill the connection mandate. They should continue onboarding or risk losing their order in the queue. Organizations that have signed a participation agreement with NC HIEA but are not yet live and submitting data by January 1, 2023, are considered to be making good-faith efforts to connect as well. As providers are invited to begin the technical connection process, they should be ready to proceed or risk being moved to the back of the onboarding queue. 

What If My Connection Project Has Been Put on Hold? 

Earlier this year, the NC HIEA prioritized the queue of more than 5,000 organizations onboarding with NC HealthConnex based on a variety of factors. As a result of these prioritization decisions, onboarding for some providers has been temporarily placed on hold. Please be assured that this decision to place your organization on hold will not have an impact on your organization’s good-faith efforts to follow the HIE Act.    

Additionally, if your organization has signed a full participation agreement with the NC HIEA and would like to participate in NC HealthConnex, please reach out to the SAS Help Desk at HIESupport@sas.com or 919-531-2700 to request credentials to the web-based clinical portal. If your organization is interested in training on how to incorporate the HIE into your workflow, please see our on-demand training library, or request a training session.  

If you are unsure of the status of your project, please email hiea@nc.gov.  

If I’m an Individual Provider, Do I Need To Connect? 

Individual providers typically do not have to initiate or carry out the connection process themselves. The NC HIEA engages in participation agreements with organizations, and employed providers are covered under those agreements. The appropriate contact(s) at your organization(s) should visit hiea.nc.gov/participate to select the agreement suitable to the organization, and then carefully read, review, and complete the agreement. It may be returned either, preferably, by email to hiea@nc.gov or by mail to N.C. Health Information Exchange Authority Mail Service Center 4101 Raleigh, NC 27699-4101.

Do Dental and Chiropractic Providers Need To Connect?  

Dentists and chiropractors that serve state-funded patients remain subject to the January 1, 2023, connection and submission deadline. Enforcement of the “condition of receiving state funds” provision in the Statewide Health Information Exchange Act is temporarily suspended with respect to all providers, including dentists and chiropractors. 

Of note, in March 2022, the NC HIEA Advisory Board recommended to the General Assembly that dental and chiropractic providers be reclassified as “voluntary” connectors to the NC HIEA.  

Do Pharmacies Need to Connect? 

State law continues to require that pharmacies connect and submit claims data to NC HealthConnex by January 1, 2023. At this time, the NC HIEA is conducting a pilot with several pharmacies for the initial development and integration of pharmacy data into NC HealthConnex. The NC HIEA views pharmacies that have signed participation agreements as acting in good faith to meet the January 1, 2023, deadline, and no additional action needs to be taken at this time.  

How Do I Connect? 

1. Learn More 

• Register for the next monthly informational How to Connect webinar. 
• Browse our library of FAQ and answers on a variety of topics. 
• See a list of the steps to connect. 

2. Complete a NC HealthConnex Participation Agreement. Review the different types of participation agreements available, and select the agreement most suitable for your organization. Carefully read and complete the agreement. It may be returned either, preferably, by email to hiea@nc.gov or by mail to N.C. Health Information Exchange Authority Mail Service Center 4101 Raleigh, NC 27699-4101.  

3. Contact us. For any questions or concerns about participation with NC HealthConnex, please contact us at hiea@nc.gov or 919-754-6912. 

The NC HIEA is ready to assist providers with understanding how these legislative changes affect them and to begin the onboarding process with interested providers. Please contact us at hiea@nc.gov or 919-754-6912.