The Office of Inspector General (“OIG”) issued four advisory opinions at the end of 2020 addressing gift cards and paying for expenses, among other issues. With regard to all of these requests, the OIG analyzed whether the proposed arrangements in these requests would constitute grounds for the imposition of sanctions under the Social Security Act (the “Act”) and the federal anti‑kickback statute (the “Anti-Kickback Statute”).
The New Jersey Senate and Assembly recently passed A2280, which operates similar to the federal statute, Eliminating Kickbacks in Recovery Act (“EKRA”). Similar to EKRA, A2280 criminalizes certain payments for referral of patients to substance use disorder treatment facilities. Specifically, the bill makes it a crime of the fourth degree for a person to knowingly make or receive a payment or otherwise furnish or receive any fee, commission, or rebate to any person in connection with the referral of patients to substance use treatment disorder facilities regulated by the Division of Mental Health and Addiction Services in the Department of Human Services.
Nursing Homes May Seek Payment Based on Agreement to Apply for Medicaid
On November 23, 2020, the Appellate Division held that a law preventing a nursing home from requiring a third‑party guarantee of payment as a condition of admission does not bar a claim by a nursing home against the children of a resident who signed an admission agreement pledging to apply for Medicaid on the resident’s behalf. Pine Brook Care Ctr. v. D'Alessandro, A‑3197‑18T1, 2020 WL 6852609 (N.J. Super. Ct. App. Div. Nov. 23, 2020).
As part of the recently enacted Consolidated Appropriations Act, 2021 (the “Appropriations Act”), the federal government did not only provide relief to stem the effects of the COVID-19 pandemic, but it also adopted the No Surprises Act.
The No Surprises Act (the “Act”) does not become effective until January 1, 2022, and, for those providers who practice in New Jersey, the Act operates similar to New Jersey’s Out‑of‑Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “NJ OON Act”).
This post covers the numerous new final rules that were issued by the federal government toward the end of 2020. In addition, the Department of Health and Human Services (“HHS”) updated its reporting requirements for the Provider Relief Fund, and the Centers for Medicare & Medicaid Services (“CMS”) issued a new model that covers those beneficiaries with dual eligibility for Medicare and Medicaid.
Throughout this year, the New Jersey Legislature has passed numerous bills that impact health care providers in the State. Over the past month, the Legislature continued to do so with the passage of several bills as noted in this post.
CMS Finalizes Physician Fee Schedule That Expands Telehealth Services
Centers for Medicare & Medicaid Services (“CMS”) has released its final rule for the Medicare physician fee schedule (“PFS”), effective January 1, 2021. Under the final rule, the PFS conversion factor for 2021 is $32.41, which is down 10 percent from $36.09 in 2020.
New Pharmacy Rules and Regulations Aimed to Reduce Pricing
The United States Department of Health and Human Services (“HHS”) and the Centers for Medicare & Medicaid Services (“CMS”) recently issued a series of proposed and final rules aimed at impacting pharmaceutical drug prices and availability. Specifically, HHS and CMS jointly issued an interim final rule, effective November 27, 2020, that implements the Most Favored Nation Model (the “Model”).
New Jersey Proposes and Adopts New Regulations Authorizing Health Care Providers’ Provision of Telemedicine
Since adopting the New Jersey Telemedicine and Telehealth statute, effective July 21, 2017, various governing boards have proposed and adopted telemedicine regulations. See the full post for a list of the most recent proposals and adoptions.
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.