CMS Final and Proposed Regulations, Including the Recent Basic Health Program Option

CMS Issues Proposed Rule on the Basic Health Program Option

The Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule on federal payment amounts to states that elect to establish a Basic Health Program (“BHP”) under the Patient Protection and Affordable Care Act (the “Act”) for program year 2022. Under the Act, BHPs may offer health benefits coverage to low-income individuals. 

Name Tags? Yes, You Are Now Required To Wear Certain Name Tags.

This blog post includes summaries of several laws recently passed by the New Jersey Legislature that impact health care providers, including a law requiring health care providers to wear certain kinds of name tags. These additional requirements come at a time when New Jersey’s providers are providing continued crucial care in response to the pandemic and experiencing significant financial strain caused by the pandemic. 

NJ Hospitals Must Allow Pregnant Patients to Have Support Person Present During Labor, Interoperability Rule Deadlines Extended, CMS Announces Insurance Coverage for COVID-19 Vaccine, and More

Revised New Jersey Executive Directive No. 20-020 Requires Hospitals to Allow Support Person for Pregnant Patients During Labor

The New Jersey Department of Health has modified its previous guidance to require hospitals to allow at least one designated support person to accompany a pregnant patient during labor, delivery, and the entire postpartum hospital stay. A doula, who is part of the patient’s care team and essential to patient care, shall not count as a support person. The support person(s) and doula must be asymptomatic for COVID-19 and shall undergo symptom screening and temperature checks prior to entering the clinical area, but there is no prior testing requirement.

New Jersey Expands the Use of Antigen Testing for Surgery Centers and Long Term Care Facilities, CMS Adds New Telehealth Codes, and Additional HHS Guidance on the Provider Relief Fund

Revised New Jersey Executive Directive No. 20-016 Modifies Testing Protocols for Ambulatory Surgery Centers to Allow Antigen Tests

The New Jersey Department of Health has modified its previous guidance on the resumption of elective surgeries and invasive procedures in Ambulatory Surgery Centers (“ASCs”) to allow antigen tests to satisfy the requirement that patients undergo COVID‑19 testing and receive results within six days before their scheduled surgery. 

HHS Is Providing an Additional $20 Billion to the Provider Relief Fund, CMS Relaxes Repayment Terms Under the Accelerated and Advance Payment Program, and New Jersey Poised to Allow Telemedicine for Medical Cannabis

New Jersey Is Poised to Allow the Use of Telemedicine for Medical Cannabis

New Jersey is poised to approve S619, which would permit providers to authorize patients for medical cannabis through telemedicine and telehealth. The bill has already passed the Assembly and is before the Senate for a second reading. Under the bill, for the first 270 days following enactment, a health care practitioner may authorize the medical use of cannabis via telemedicine and telehealth for a patient who is a resident of a long-term care facility, has a developmental disability, is terminally ill, is receiving hospice care from a licensed hospice care provider, or is housebound as certified by the patient’s physician. 

Providers Get Extended Time to Repay Advanced Medicare Funds, Insurers Roll Back Some Telemedicine Coverage, and other Federal Rules and Programs

Time to Repay Medicare Loans Extended

On September 30, 2020, as part of a larger government short-term spending bill, President Trump signed into law a program which relaxes the repayment terms for Medicare loans that hospitals received earlier this year under the Accelerated and Advanced Payment Program. Whereas the loans were originally due 120 days after they were issued, the new law directs the Centers for Medicare & Medicaid Services (“CMS”)  to wait up to one year after the loan was issued to begin withholding Medicare payments to recoup funds.

New Jersey Passes Statutes on Nursing Homes Including Staffing Mandates, New Jersey Pharmacists Can Administer COVID-19 Tests, HHS Updates Provider Relief Fund Reporting Requirements, and New Information on Medicare Advantage Programs

The New Jersey State Legislature Passes Bill Requiring New Direct Care Staff-to-Resident Ratios for Nursing Homes and Establishes a New Task Force on Direct Care Worker Retention

The New Jersey Legislature passed a bill (A4652/S2712) which requires nursing homes to maintain certain minimum direct care staff-to-resident ratios.  The bill expressly requires: (i) one certified nurse aide to every eight residents for the day shift; (ii) one direct care staff member to every 10 residents for the evening shift, provided that no fewer than half of all staff members are to be certified nurse aides, and each staff member will sign in to work as a certified nurse aide and will perform certified nurse aide duties; and (iii) one direct care staff member to every 14 residents for the night shift, provided that each direct care staff member is to sign in to work as a certified nurse aide and perform certified nurse aide duties. 

CMS Issues Alert to Providers Regarding Incentive Payments, New CMS Models and Other CMS Action, and New Jersey Establishes Task Force on Long-Term Care

Centers for Medicare & Medicaid Services ("CMS") Issues Advisory Alert to Qualifying APM Participants for Incentive Payment Information

85 FR 57980 – CMS issued a payment advisory to alert certain clinicians who are Qualifying APM participants ("QPs") and eligible to receive an Alternative Payment Model ("APM") Incentive Payment that CMS does not have the current billing information needed to disburse the payment. Specifically, CMS has identified those eligible clinicians who earned an APM Incentive Payment in CY 2020 based on their CY 2018 QP status. When CMS disbursed the CY 2020 APM Incentive Payments, CMS was unable to verify current Medicare billing information for some QPs and was therefore unable to issue payment.

CMS Maintains Hospital Transparency Price Rule, Other Federal Rules, AMA Releases New CPT Codes, and AAAHC Issues New Standards

Over Objections, CMS Maintains Hospital Transparency Pricing Rule in the Inpatient Prospective Payment System Final Rule for 2021

Centers for Medicare & Medicaid Services (“CMS”) has released its Inpatient Prospective Payment System (“IPPS”) final rule for fiscal year (“FY”) 2021, effective October 1, 2020. The rule affects approximately 3,200 acute care hospitals. Over the objections of numerous providers, including the American Hospital Association, CMS maintained the transparency rule in the final rule, which requires hospitals to report to CMS the median rate negotiated with Medicare Advantage organizations for inpatient services.

Did New Jersey Just Cap Profits for Nursing Homes? New Jersey Takes Further COVID-19 Action Via Executive and Administrative Orders, and CMS Requires Positive COVID-19 Test for Add-On Payments.

New Jersey Passes Bill Requiring New Prevailing Wage for Long-Term Care Facility Staff and Establishes a Direct Care Ratio for Nursing Homes

The New Jersey State Assembly and the New Jersey State Senate passed a new bill (A4482/S2758) establishing the minimum wage for certain long-term care facility staff and establishes direct care ratio requirements for nursing homes. First, the bill provides that the minimum wage for direct care staff in long-term care facilities is to be $3 higher than the prevailing State minimum wage and annually adjusted based on cost-of-living increase. Second, under the bill, the Commissioner of Human Services will be required to establish a direct care ratio reporting and rebate requirement that will take effect no later than July 1, 2021.