On Friday, the North Carolina State Plan Board of Trustees (SHP) voted on what are being called monumental changes to the Plan over the next few years, including preferred provider hospital systems, benefit changes, and premiums for 2027, and the announcement of a Third Party Administrator (TPA) and Pharmacy Benefit Manager (PBM) for 2028, in an effort to make improvements and reduce overall costs for the nearly 750,000 members covered by the Plan.
Senate health committee advances targeted CON repeal for surgical centers and inpatient rehab, building on broader reform efforts.
The agreement includes an average 8% teacher pay raise, with legislators saying the plan would make NC’s starting teacher pay “No. 1 in the South.”
The North Carolina Court of Appeals has ruled in favor of WakeMed and against Duke Health and UNC Rex Hospital in a certificate-of-need dispute involving 44 new acute-care beds in Wake County.
The North Carolina Supreme Court has thrown out a lower court’s ruling in a certificate-of-need dispute in northeastern North Carolina.
State Sen. Benton Sawrey, R-Johnston, said health care reforms, including hospital price transparency, Medicaid, and Certificate of Need (CON) laws, are among the issues the Senate plans to tackle during the upcoming short session.
Duke Health and Wake Med are dropping a legal battle that prompted accusations last summer of anti-competitive actions.
The North Carolina Supreme Court has upheld a lower court ruling against the Department of Health and Human Services and Duke Health in a Wake County certificate-of-need dispute. The court clarified that an applicant who loses a CON to a competitor has suffered “substantial prejudice,” one of the factors necessary for a successful court challenge.
Duke Health and Aetna announced on Friday that they have reached a new multi-year agreement, avoiding the need for state employees on the State Health Plan and others to look for another in-network healthcare provider.
In the wake of the ongoing negotiations between Duke Health and Aetna, the North Carolina State Health Plan Board of Trustees on Friday approved procuring a transition services vendor to help plan members find new healthcare providers if an agreement can’t be reached by the Oct. 20 deadline.
In an emailed statement to Carolina Journal on Friday, Duke Health said it is “actively engaged in good faith negotiations” with health insurance company Aetna in response to a story that many patients, including over 750,000 state employees covered under the State Health Plan (SHP), will lose in-network coverage to Duke’s doctors, hospitals, clinics, and services on Oct. 20.
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