H.B. 573
GENERAL ASSEMBLY OF NORTH CAROLINA
Apr 5, 2023
SESSION 2023 HOUSE PRINCIPAL CLERK
H D
HOUSE BILL DRH40298-MRa-58
Short Title: Fair Medicaid ASC Reimbursements. (Public)
Sponsors: Representative White.
Referred to:
1 A BILL TO BE ENTITLED
2 AN ACT TO ENSURE FAIR REIMBURSEMENT UNDER THE MEDICAID PROGRAM OF
3 SERVICES PERFORMED IN AN AMBULATORY SURGERY CENTER.
4 The General Assembly of North Carolina enacts:
5 SECTION 1. Consistent with the Medicaid State Plan, Attachment 4.19-B, Section
6 9, Page 2, the Department of Health and Human Services, Division of Health Benefits (DHB),
7 shall set and adjust rates for new services provided by licensed ambulatory surgical centers so
8 that these services are reimbursed at ninety-five percent (95%) of the Medicare Ambulatory
9 Surgical Centers fee schedule in effect as of January 1 of each year.
10 SECTION 2. All of the following shall apply to the new Healthcare Common
11 Procedure Coding System (HCPCS) procedure code G0330, which was adopted by DHB as of
12 January 1, 2023, and incorporated into the Medicaid Clinical Coverage Policy 4A: Dental
13 Services:
14 (1) DHB shall not reimburse ambulatory surgical centers based solely on the
15 length of the procedure. As of July 1, 2023, DHB shall reimburse ambulatory
16 surgical centers so that services billed under procedure code G0330 are
17 reimbursed at ninety-five percent (95%) of the total payment rate listed on the
18 Medicare Part B Hospital Outpatient Prospective Payment System (OPPS), in
19 effect as of January 1, 2023. Starting January 1, 2024, and each year thereafter,
20 DHB shall update these rates annually so that services are reimbursed at
21 ninety-five percent (95%) of the Medicare Part B OPPS payment rate, in effect
22 as of January 1, for that procedure code.
23 (2) Because services billed under procedure code G0330 are surgical procedures
24 and not traditional dental procedures, all standard benefit plans and BH IDD
25 tailored plans shall be required to cover these procedures.
26 SECTION 3. There is appropriated from the General Fund to the Department of
27 Health and Human Services, Division of Health Benefits, the sum of five hundred thousand
28 dollars ($500,000) in recurring funds for each year of the 2023-2025 fiscal biennium to be used
29 to implement this act. These funds shall provide a State match for nine hundred fifty thousand
30 dollars ($950,000) in recurring federal funds for each year of the 2023-2025 fiscal biennium, and
31 those federal funds are appropriated to the Division of Health Benefits to be used to implement
32 this act.
33 SECTION 4. This act is effective when it becomes law.
*DRH40298-MRa-58*