NC Treasurer Announces Move to Reference-Based Pricing for State Employees Health Plan

Late last week, North Carolina Treasurer Dale Folwell announced a move to reference-based pricing for the State Employees Health Plan. Starting in 2020, the plan will base all payments on a percentage of Medicare. Professional services, which includes most physician payment, will be based on 160 percent of 2018 Medicare rates for all physicians in all locations and specialties. All participating physicians will be asked to decide whether they will continue to participate in network by July 1, 2019. You, or someone in your practice, should have received a notice directly from the State Employees Health Plan.

The notice indicated that under the existing rate structure, professional services ranged from as low as 65% of Medicare to a high of 994% of Medicare, with an average of 126% of Medicare. Again, the new plan would place all professional services at 160% of Medicare, regardless of specialty or location. The NCAFP continues to evaluate the impact of these changes on family physicians across the state and will continue to advocate for our members to ensure as much investment in primary care as absolutely possible.

If you would like additional information, please contact Greg Griggs at or 919-833-2110.