Nursing Home and Pharmacy Litigation Update

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).

The New Federal Out-of-Network Statute

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”). 

New Federal Regulations, Provider Relief Fund Reporting Requirements Update, and New CMS Model for Dual-Eligible Beneficiaries

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.

New Jersey Legislative Update

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.

Federal Regulations Aim to Further Reduce Pharmaceutical Drug Prices, CMS Releases Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule, New Measures Taken to Combat COVID 19 During the Upcoming Winter Months, and More

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”).   

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. 

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.