The interim report from the N.C. Department of Health and Human Services indicates some of the agency's process in enacting new abortion-related rules. See the full report below.

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Little-noticed report indicates state agency’s first steps

For all the controversy over North Carolina’s new abortion law, enacted last July, the state’s Department of Health and Human Services appears to still be a long way from issuing new rules affecting abortion clinics.

At the same time, a new clinic in Asheville will try to meet potential, costly new standards to be on the safe side, and DHHS has an April 1 deadline for updating the General Assembly on plans to amend the state’s abortion rules.

The new law lists several ways that rules for abortion clinics might be tightened, but the most-debated provision authorizes DHHS to require that all clinics be held to the same standard as ambulatory surgery centers, as long as doing so does not “unduly restrict access” to abortion services. Of North Carolina’s 15 abortion clinics, only one, Femcare in Asheville, presently meets that standard, and it is slated to close soon.

Raleigh-based Planned Parenthood Health Systems recently announced that it will open a replacement clinic in Asheville to continue abortions and other women’s health services. Given potential upcoming shifts in the rules, the clinic will be designed to meet ambulatory-surgery standards, according to Melissa Reed, PPHS’s vice president of communications.

“It’s certainly what we felt we needed to do in anticipation of what may come, so that was why we decided to build to that standard,” she said Wednesday. The clinic is scheduled to open this summer at an undetermined date, Reed said.

As attention turns to what DHHS will say April 1 about its plan to amend the rules, a preliminary report by the department suggests that any changes will take a considerable amount of time.

DHHS opted out of temporary rules, will need time to clear permanent ones

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The little-noticed interim report on abortion rules, delivered to the state legislature’s Joint Legislative Oversight Committee on Health and Human Services on Dec. 23, 2013, outlined a long series of steps before any new standards can be codified. (Read the full report below.)

The new abortion law authorized DHHS to go ahead and forge temporary rules, but the department decided not to, saying in its report that such a move was “unlikely” to “expedite the process.”

“Revising the N.C. Administrative Code is a formal process,” the report said, adding that DHHS regulators “have followed the normal rule-making policies and procedures in revising the rules pertaining to abortion clinics.”

DHHS said it had reviewed the current rules and sought input from parties with an interest in the matter, including various medical practitioners and abortion providers.

“The clinicians providing feedback include a representative from the North Carolina Board of Nursing, two representatives from providers, two OB/GYN specialty physicians, and one individual who is both an OB/GYN and provider,” the report said.

Moving forward, the department said, it would work on drafting new rules, while noting that several steps would have to be followed after a draft is issued.

The draft rules will have to go through several layers of review before becoming official. To begin with, the state’s Office of Administrative Hearings and Office of State Management and Budget will need to sign off on the plan, which would then go back to DHHS for another review. Then, the department would need to submit it to OAH again, to be published in the North Carolina Register for public inspection.

At that point, DHHS would invite stakeholders, including representatives from abortion clinics and ambulatory-care facilities, to review and comment. It would also set up a public hearing and public comment process. DHHS “is committed to transparency in the rule-making process,” the interim report said.

Finally, once those hurdles were cleared, the department would formally adopt its proposal and submit it to the state’s Rules Review Commission, the final layer of vetting before new rules are enacted.

Abortion providers included in rule process so far, but uncertain about future

The interim report didn’t predict how long the process could take, and that seems to be anyone’s guess at present.

“The bottom line is that we don’t know,” said Suzanne Buckley, executive director of advocacy group NARAL Pro-Choice North Carolina.

“The rule-making process is certainly a long one, and there are a lot of turning points along the way where things could change. But our hope is that folks let the process play out as it is designed to, to take into account sound science and medicine and make rules based on that and the practical implications of these laws, and let politics stay out of it.”

Despite the sudden debate elicited by last year’s abortion law, she says, any big changes to relevant rules will likely be slow in coming.

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“My understanding, from talking to our folks who talk to DHHS, and just sort of the word on the street, is that they are in no rush, and that the report they give on April 1 could look a lot like the report they released in December,” she said. “There’s a general sense that there is no sort of aggressive timeline.”

Planned Parenthood’s Reed agreed.

“We’re anxious to see what they propose,” she said of DHHS’ forthcoming recommendations.

“They did include a group of people that included experts on women’s health care that are providers, and we felt that that showed a good faith effort,” she said of the department’s efforts so far. “They indicated that their primary concern was patient safety and not putting unnecessary building requirements on providers. We’re hoping that that continues to be the focus, and that that’s what we’ll see when they reveal the draft regulations.”

For the record: DHHS’ interim report on moves to amend the state’s abortion rules

Jon Elliston

Jon Elliston is the lead contributing open government reporter at Carolina Public Press. Contact him at jelliston@carolinapublicpress.org.

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