What Does the Law Mandate? Under a law passed in 2015, the North Carolina Health Information Exchange Authority was created to oversee and administer the N.C. Health Information Exchange Network (NCGS 90-414.7). NC HIEA is housed within the N.C. Department of Information Technology’s Government Data Analytics Center. NC HIEA operates North Carolina’s statewide health information exchange—NC HealthConnex, a tool that links disparate systems and existing HIE networks together to deliver a holistic view of patient records through a secure, standardized electronic system. NC HealthConnex allows providers to review and more easily share important patient health information. Governor Roy Cooper signed House Bill 395 (now NCSL 2021-26) into law on May 27, 2021, to allow additional time for providers to connect to the state-designated health information exchange NC HealthConnex, among other things. The North Carolina Health Information Exchange Authority (NC HIEA) Advisory Board and the North Carolina Department of Information Technology led a collaborative effort to bring additional relief to health care providers who have been on the front lines of the COVID-19 pandemic. Extending the deadline until January 2023 will allow additional time for health care providers to complete their technical onboarding process without being out of compliance with the HIE Act. Please note that there are more than 5,000 facilities in onboarding at this time. Providers should continue to connect as we have no guarantees of additional extensions and, as noted below, the General Assembly is requiring compliance reports by March 1, 2022. Among other changes to the HIE Act, the NC HIEA Advisory Board has been tasked with developing final recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Additionally, the NC HIEA has been directed to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards, shall assist the NC HIEA with contact information and addresses for providers and entities. Additional Changes and Additions to the HIE Act Per NSCL 2021-26 (HB395 bill analysis): Section 1 provides that the N.C. Department of Information Technology; Department of State Treasurer, State Health Plan Division; and N.C. Department of Health and Human Services, Division of Health Benefits; have an affirmative duty to facilitate and support participation by covered entities in the Statewide Health Information Exchange Network. Section 2 allows the N.C. Department of Health and Human Services, if authorized by the NC HIEA, to submit data on behalf of Prepaid Health Plans and local management entities/managed care organizations (LME/MCOs). The section also extends connection deadlines as follows: Extends the connection deadline for most providers of Medicaid and State-funded health care services, and affiliated entities, until January 1, 2023 (currently October 1, 2021). Extends the connection deadline for physicians who perform procedures at ambulatory surgical centers, dentists, psychiatrists, and the State Laboratory of Public Health until January 1, 2023 (currently June 1, 2021). Extends the connection deadline for pharmacies and State health care facilities operated under the Secretary of the N.C. Department of Health and Human Services (State psychiatric hospitals, developmental centers, alcohol and drug treatment centers, neuro-medical treatment center, and residential programs) until January 1, 2023 (currently June 1, 2021). Sections 2 and 4 remove ambulatory surgical centers, as defined in G.S. 131E-146, from the requirements to submit demographic and clinical data but require a physician who performs a procedure at the ambulatory surgical center to be connected to the HIE Network and to submit the data. Section 5 prohibits balance billing when an in-network provider or entity with the State Health Plan for Teachers and State Employees does not connect to the HIE Network. The section specifically provides that under the State Health Plan an in-network provider or entity who renders health care services, including prescription drugs and durable medical equipment, and who is not connected to the HIE Network, is prohibited from billing the State Health Plan or a Plan member more than either party would be billed if the provider was connected to the HIE Network. Note: Providers participating in the State Health Plan network should reach out to the State Health Plan with questions regarding this provision at BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. Section 6 prohibits the NC HIEA from fulfilling requests for electronic health information from an individual, individual's personal representative, or an individual or entity purporting to act on an individual's behalf and requires the Authority to provide educational materials on accessing this information from other sources. Section 7(a) requires the Health Information Exchange Advisory Board to submit recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Section 7(b) requires the HIE Authority to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards shall assist the NC HIEA with contact information and addresses for providers and entities. For information on who is currently connected to NC HealthConnex, visit the NC HealthConnex Participant Map. For providers who would like to inquire about their organization’s connection status, please email HIESupport@sas.com. For questions regarding the State Health Plan network, please contact BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. For questions regarding Medicaid, please contact Medicaid.ProviderOmbudsman@dhhs.nc.gov. All other questions may be directed to the hiea@nc.gov. DHHS Hardship Extension Process Session Law 2019-23 modified the Statewide HIE Act and gave DHHS the authority to grant a temporary Hardship Extension to classes of providers for whom acquiring and implementing an EHR system and connecting to the HIE Network would constitute an undue hardship. A hardship extension extends the participant’s deadline to December 31, 2022. All providers that receive a hardship extension must be live and sending data by January 1, 2023. For more information about the DHHS hardship extension process, click here. Please note: NC HIEA does not grant hardship extensions. All questions and/or requests about the hardship extension should be sent to the DHB Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov. 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 the locations and organizations they are sending data to NC HealthConnex on behalf of so that NC HIEA may accurately report compliance to the N.C. Department of Helath and Human Services and the State Health Plan.
What Does the Law Mandate? Under a law passed in 2015, the North Carolina Health Information Exchange Authority was created to oversee and administer the N.C. Health Information Exchange Network (NCGS 90-414.7). NC HIEA is housed within the N.C. Department of Information Technology’s Government Data Analytics Center. NC HIEA operates North Carolina’s statewide health information exchange—NC HealthConnex, a tool that links disparate systems and existing HIE networks together to deliver a holistic view of patient records through a secure, standardized electronic system. NC HealthConnex allows providers to review and more easily share important patient health information. Governor Roy Cooper signed House Bill 395 (now NCSL 2021-26) into law on May 27, 2021, to allow additional time for providers to connect to the state-designated health information exchange NC HealthConnex, among other things. The North Carolina Health Information Exchange Authority (NC HIEA) Advisory Board and the North Carolina Department of Information Technology led a collaborative effort to bring additional relief to health care providers who have been on the front lines of the COVID-19 pandemic. Extending the deadline until January 2023 will allow additional time for health care providers to complete their technical onboarding process without being out of compliance with the HIE Act. Please note that there are more than 5,000 facilities in onboarding at this time. Providers should continue to connect as we have no guarantees of additional extensions and, as noted below, the General Assembly is requiring compliance reports by March 1, 2022. Among other changes to the HIE Act, the NC HIEA Advisory Board has been tasked with developing final recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Additionally, the NC HIEA has been directed to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards, shall assist the NC HIEA with contact information and addresses for providers and entities. Additional Changes and Additions to the HIE Act Per NSCL 2021-26 (HB395 bill analysis): Section 1 provides that the N.C. Department of Information Technology; Department of State Treasurer, State Health Plan Division; and N.C. Department of Health and Human Services, Division of Health Benefits; have an affirmative duty to facilitate and support participation by covered entities in the Statewide Health Information Exchange Network. Section 2 allows the N.C. Department of Health and Human Services, if authorized by the NC HIEA, to submit data on behalf of Prepaid Health Plans and local management entities/managed care organizations (LME/MCOs). The section also extends connection deadlines as follows: Extends the connection deadline for most providers of Medicaid and State-funded health care services, and affiliated entities, until January 1, 2023 (currently October 1, 2021). Extends the connection deadline for physicians who perform procedures at ambulatory surgical centers, dentists, psychiatrists, and the State Laboratory of Public Health until January 1, 2023 (currently June 1, 2021). Extends the connection deadline for pharmacies and State health care facilities operated under the Secretary of the N.C. Department of Health and Human Services (State psychiatric hospitals, developmental centers, alcohol and drug treatment centers, neuro-medical treatment center, and residential programs) until January 1, 2023 (currently June 1, 2021). Sections 2 and 4 remove ambulatory surgical centers, as defined in G.S. 131E-146, from the requirements to submit demographic and clinical data but require a physician who performs a procedure at the ambulatory surgical center to be connected to the HIE Network and to submit the data. Section 5 prohibits balance billing when an in-network provider or entity with the State Health Plan for Teachers and State Employees does not connect to the HIE Network. The section specifically provides that under the State Health Plan an in-network provider or entity who renders health care services, including prescription drugs and durable medical equipment, and who is not connected to the HIE Network, is prohibited from billing the State Health Plan or a Plan member more than either party would be billed if the provider was connected to the HIE Network. Note: Providers participating in the State Health Plan network should reach out to the State Health Plan with questions regarding this provision at BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. Section 6 prohibits the NC HIEA from fulfilling requests for electronic health information from an individual, individual's personal representative, or an individual or entity purporting to act on an individual's behalf and requires the Authority to provide educational materials on accessing this information from other sources. Section 7(a) requires the Health Information Exchange Advisory Board to submit recommendations regarding appropriate features or actions to support the Statewide Health Information Exchange Act and to report on the status of entities and providers not connected to the HIE Network as identified under subsection (b) of this section, to the Joint Legislative Oversight Committee on Health and Human Services on or before March 1, 2022. Section 7(b) requires the HIE Authority to work with the State Health Plan Division, Department of State Treasurer, and the Division of Health Benefits, Department of Health and Human Services, to identify providers and entities who have not connected to the HIE in accordance with G.S. 90-414.4 and to contact each entity or provider to ascertain their connection status and to inform them of the connection requirements. By November 1, 2021, the Department of State Treasurer, Department of Health and Human Services, and licensing boards shall assist the NC HIEA with contact information and addresses for providers and entities. For information on who is currently connected to NC HealthConnex, visit the NC HealthConnex Participant Map. For providers who would like to inquire about their organization’s connection status, please email HIESupport@sas.com. For questions regarding the State Health Plan network, please contact BCBSNC Provider Services at 1-800-777-1643 or providerupdates@BCBSNC.com. For questions regarding Medicaid, please contact Medicaid.ProviderOmbudsman@dhhs.nc.gov. All other questions may be directed to the hiea@nc.gov. DHHS Hardship Extension Process Session Law 2019-23 modified the Statewide HIE Act and gave DHHS the authority to grant a temporary Hardship Extension to classes of providers for whom acquiring and implementing an EHR system and connecting to the HIE Network would constitute an undue hardship. A hardship extension extends the participant’s deadline to December 31, 2022. All providers that receive a hardship extension must be live and sending data by January 1, 2023. For more information about the DHHS hardship extension process, click here. Please note: NC HIEA does not grant hardship extensions. All questions and/or requests about the hardship extension should be sent to the DHB Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov. 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 the locations and organizations they are sending data to NC HealthConnex on behalf of so that NC HIEA may accurately report compliance to the N.C. Department of Helath and Human Services and the State Health Plan.
