No Surprises Act Update

CMS Releases Revised No Surprises Act IDR Process Guidance

In the wake of the U.S. District Court for the Eastern District of Texas’s February 2022 ruling rejecting the No Surprises Act’s independent dispute resolution (“IDR”) regulations issued by the Department of Health and Human Services (“HHS”), the Centers for Medicare & Medicaid Services (“CMS”) has released guidance to “Certified IDR Entities” to direct them in carrying out the arbitration process dictated by the No Surprises Act.

Federal Regulatory Update

Hospice Payment Rate Update Proposed Rule for 2023

Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, 87 FR 19442, to establish a permanent mitigation policy to smooth the impact of year-to-year changes in hospice payments related to changes in the hospice wage index. To do so, the rule proposes updates to the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year ("FY") 2023 and proposes updates to the Hospice Quality Reporting Program (“HQRP”).

Federal Litigation Update and Proposed Rule On Pharmacy Benefit Managers

Court Strikes Down CMS Hospital Wage Level Regulations

On March 2, 2022 the United States District Court for the District of Columbia found in favor of a hospital group challenging the 2019 “low wage index hospital policy” adopted by Health and Human Services (“HHS”). The regulation was aimed to address wage disparities among hospitals by increasing the amount hospitals in certain low-wage geographic areas receive in Medicare reimbursement payments while offsetting that increase by reducing reimbursement payments for all hospitals.

Federal Reforms from Nursing Homes to ACOs

White House Announces Nursing Home Care Reforms

In a fact sheet released on February 28, 2022, the White House announced measures intended to protect seniors by improving safety and quality of care across the nation’s nursing homes. Specifically, the fact sheet announced that Centers for Medicare & Medicaid Services (“CMS”) will be launching four new initiatives to enhance quality of care.

Federal Court Strikes Down Arbitration Process in the Federal No Surprises Act. What does this mean for New Jersey?

On Wednesday, February 23, 2022 the federal District Court for the Eastern District of Texas issued its opinion finding that the September 30, 2021 interim final rule (the “Rule”) issued by the federal government to implement the arbitration system provided in the federal No Surprises Act was in conflict with the Administrative Procedure Act (the “APA”) and thus the provisions related to arbitration in the rule were set aside. The legal challenge was brought forth by the Texas Medical Association on behalf of its associated members, as well as a Texas physician named Dr. Adam Corley (the “Plaintiffs”).

New Jersey Court Rules that Physician Practices Cannot Open Pharmacies

The New Jersey Appellate Division recently issued a ruling upholding a determination by the New Jersey Board of Pharmacy (the “Board”) against a medical practice. The controversy stemmed around a 2019 decision of the Board that denied the application of Oncology and Hematology Specialists, P.A., a New Jersey medical practice (the “Petitioner”), to register, open, and operate an in-office pharmacy for its practice. 

New Jersey Legislative Update Part 3

Part 3 of our New Jersey Legislative Update focuses on the remaining bills that have become law in New Jersey and will impact healthcare. Overall, eighteen bills became law in the past few months. This Update focuses on the last four bills, including one that allows physical therapists to perform dry needling. In addition, this Update addresses an Executive Order signed by Governor Murphy that is intended to curtail the costs of health care in New Jersey.