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What Does the Law Mandate?

Through a law passed in 2015, the North Carolina Health Information Exchange Authority (NC HIEA) was created to oversee and administer the NC Health Information Exchange Network (NCGS 90-414.7). The NC HIEA is housed within the NC Department of Information Technology’s (DIT) Government Data Analytics Center (GDAC). The NC HIEA operates North Carolina’s statewide health information exchange—NC HealthConnex. NC HealthConnex is a tool that links disparate systems and existing HIE networks together to deliver a holistic view of the patient record through a secure, standardized electronic system. NC HealthConnex allows providers to review and more easily share important patient health information.

As of June 2019, the law includes the following deadlines for NC licensed health care providers and other organizations to submit clinical and demographic data (unless otherwise noted) to NC HealthConnex:

June 1, 2018: The following providers should have connected to NC HealthConnex or received an extension to connect if they provide Medicaid services and have an electronic health record system (EHR)

  • Hospitals 
  • Physicians (except for Psychiatrists)
  • Physician assistants
  • Nurse practitioners

June 1, 2020:

  • All other providers of Medicaid and state-funded services unless otherwise specified in law
  • Local Management Entities/Managed Care Organizations (required to submit claims data)

June 1, 2021:

  • Dentists
  • Ambulatory Surgical Centers
  • Psychiatrists
  • State Laboratory of Public Health operated by NC DHHS 
  • Pharmacies (required to submit claims data)
  • NC DHHS State health care facilities (required to submit claims data) 

Prepaid health plans must connect by the start of their capitated contracts entered into with the NC Division of Health Benefits
 

In addition, some providers are no longer required to connect.  The following providers can voluntarily submit data or access NC HealthConnex's Suite of Services by signing a Full NC HIEA Participation Agreement:

  • Community-based long-term services and supports providers, including personal care services, private duty nursing, home health, and hospice care providers.
  • Intellectual and developmental disability services and supports providers, such as day supports and supported living providers.
  • Community Alternatives Program waiver services (including CAP/DA, CAP/C, and Innovations) 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.
  • Local education agencies and school-based health providers.

In addition, NC DHHS can now grant exemptions until December 31, 2022 to classes of providers of Medicaid and other State-funded health care services for whom acquiring and implementing an EHR and connecting to the HIE Network would be an undue hardship. DHHS will notify the NC HIEA of which provider classes can receive this hardship exemption or extension.

What Does Connected Mean?

To meet the state’s mandate, a Medicaid provider is “connected” when its clinical and demographic information (or claims data, depending on the organization) pertaining to services paid for by Medicaid and other State-funded health care funds are being sent to NC HealthConnex, at least twice daily—either through a direct connection or via a hub (i.e., a larger system with which it participates, another regional HIE with which it participates or an EHR vendor). Participants must include all of the locations and organizations they are sending data to NC HealthConnex on behalf of in order for NC HIEA to accurately report compliance to NC DHHS and NC State Health Plan.