New Jersey Takes More Actions In Light of COVID-19, the SEHBP Reduces OON Reimbursements, and CMS’ New Health Informatics Office

Recent Adopted Statutes in New Jersey

With the approval of S2273, the School Employees’ Health Benefits Program (“SEHBP”) is required to offer, starting January 1, 2020, only three plans for medical and prescription benefits coverage:  (1) New Jersey Educators Health Plan; (2) the SEHBP NJ Direct 10 plan; and (3) SEHBP NJ Direct 15 plan.  Starting July 1, 2021, the SEHBP must provide a fourth plan called the Garden State Health Plan, which shall offer the same level of medical and prescription drug benefits provided by the New Jersey Educators Health Plan, except that the benefits under the Garden State Health Plan shall be available only from providers located in the State of New Jersey.

CMS Clarifies Insurance Coverage for COVID-19 Testing, DOJ Finalizes Vertical Merger Guidance, and CMS Proposes New Value Based Purchasing Rule

CMS Releases Updated COVID-19 Coverage FAQs

CMS has released updated FAQs regarding COVID-19 coverage issues under the Families First Coronavirus Response Act (“FFCRA”) and the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”).  Under FFCRA, insurers are required to cover COVID‑19 tests without patient cost-sharing. 

New COVID-19 Guidance, MIPS Hardship Applications Are Now Open, and CMS’ 2021 Home Health Prospective Payment Update

Guidance on Contacting Patients For Plasma Donations During COVID-19

The United States Department of Health and Human Services, Office of Civil Rights (“OCR”) issued guidance regarding a health care provider’s ability to utilize a patient’s protected health information (“PHI”) to contact patients and encourage them to donate blood or plasma to help other patients suffering from COVID-19.

Some Wins, Some Losses, and a Proposed Rule on Value-Based Payments for Prescription Drugs

Price Transparency Rule Upheld

In  November 2019, the Department of Health and Human Services (“HHS”) published a transparency rule in the Federal Register requiring hospitals to disclose pricing information.  The American Hospital Association and many other associations and hospital systems sued HHS arguing that HHS lacked statutory authority to require public disclosure of individually negotiated rates between commercial insurers and hospitals. 

HHS Changes Reporting Requirements Under the Provider Relief Fund, Direct Contracting Is Open, and New York Expands Telemedicine

HHS Says Health Care Providers Will Not Have to Submit Report on How They Spent COVID-19 Relief Grants by July 10

Many providers have received funds pursuant to the Provider Relief Fund and executed the terms and conditions, which require providers to issue reports to the Department of Health and Human Services (“HHS”).   However, HHS has recently announced in its FAQ, under Reporting Requirements, that recipients do not need to submit a separate quarterly report to HHS or the Pandemic Response Accountability Committee, as initially required.

New Jersey Department of Health Modifies Guidance on the Resumption of Elective Surgeries in Ambulatory Surgery Centers to Address Issues That Were Preventing Surgeries

Late Tuesday, the New Jersey Department of Health modified its previous guidance on the resumption of elective surgeries in ambulatory surgery centers.  One of the most significant changes was to extend the time for COVID-19 testing.   Under the initial guidance that was issued on May 19, 2020, patients had to undergo COVID-19 testing and receive results within four days before the scheduled surgery.

New Jersey Waives Certain Regulations Applicable to Collection Stations

In an effort to increase testing capacity in New Jersey, the Department of Health waived certain regulations applicable to collection stations, which is when a licensed clinical laboratory occupies office space in a physician’s office for the purpose of collecting specimens on the physician’s patients.   According to a June 5, 2020 Notice of Waiver, New Jersey licensed clinical laboratories may open collection stations to collect specimens for COVID-19 testing without completing the collection station licensing process or paying the required fee.

New Jersey Considers Delaying Assessment for Ambulatory Surgery Centers and CDC Issues Guidance on Antibody Testing

New Jersey and the Federal Government continue to revise statutes and regulations to address COVID-19. Our updates continue to focus on these revisions. For example, New Jersey is currently considering a law that delays, for nine months, the assessment that Ambulatory Surgery Centers must pay by June 15. Any Center, however, should not wait until June 15 to determine if the law passes. Call the Department of Health and ask for an extension to pay the assessment.

A Non-COVID-19 Update . . . Yes . . . You Read That Correctly

Although everyone’s attention has been focused on COVID-19, other aspects of health care continue to move forward.  This update focuses on non-COVID-19 issues like five recent federal proposed payment rules, the recent Medicare Advantage Rate Announcement, and critical federal litigation.