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. 

CMS Extends Deadline and Expands Next Round Under the Provider Relief Fund, Additional Guidance on Nursing Homes, New CDC Testing Recommendations, and Federal Regulations on Guidance Documents

Deadline for Phase 2 Financial Relief Applications Extended by CMS

Healthcare providers now have more time to apply for the next round of emergency financial relief under the Coronavirus, Aid, Relief, and Economic Security Act (the “CARES Act”). Previously, the deadline to apply for the Phase 2 General Distribution was August 28, 2020. However, on August 25, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued new guidance extending the deadline to September 13, 2020 and expanding the eligible providers.

Free COVID-19 Testing Anyone? Plus, New Jersey Issues Executive Directive on Reopening Nursing Homes, While the Federal Government Provides Nursing Homes With More Federal Relief Funding.

Guidance on Free Testing On or about August 4, 2020, the United States Department of Health and Human Services (“HHS”), Office of the Inspector General (“OIG”) issued new guidance in the form of frequently asked questions regarding a clinical laboratory’s ability to offer free COVID-19 antibody testing to federal health care program beneficiaries who receive other medically necessary blood tests.

HHS Reopens Provider Relief Fund for Certain Providers, and CMS’ Proposed Outpatient Prospective Payment System Makes Some Significant Changes to Payment Rates and Policies

For those Medicaid, Children's Health Insurance Program (“CHIP”) and dental providers who missed out on the $20 billion second tranche from the general Provider Relief Fund, the Department of Health and Human Services (“HHS”) recently announced that it would reopen the application process.  Do not assume you will not receive funds. The Provider Relief Fund has been a valuable source of funding for many providers during COVID-19 so apply when it reopens.

From Drug Pricing to Federal Regulations and Litigation, to Startling Statistics on Opioid Overdoses Leading to New Guidance

Federal Executive Orders on Drug Pricing

On July 24, 2020, President Donald Trump signed four Executive Orders aimed at lowering prescription drug prices. The first order, Executive Order on Access to Affordable Life-Saving Medications, directs federally qualified health centers ("FQHCs") to pass along discounts on insulin and epinephrine received from drug companies to certain low-income Americans. 

NJ Eases Testing Requirements for Elective Surgeries, but Do You Know the Difference Between Molecular, Antigen, and Antibody Testing? A New Federal Statute Proposes to Increase the Shared Savings for ACOs. Also, New Adopted and Proposed NJ Regulations.

New Jersey Executive Directive No. 20-016 Modifies Testing Protocols for Ambulatory Surgery Centers Resuming Elective Surgery and Invasive Diagnostic Procedures

The New Jersey Department of Health has further modified its previous guidance on the resumption of elective surgeries and invasive procedures in Ambulatory Surgery Centers (“ASCs”). Under the modified guidance, patients still have to undergo COVID‑19 testing and receive results within six days before the scheduled surgery.

New Telehealth Quality Measures, CMS Pours More Resources into Nursing Homes, Different Hospital COVID-19 Reporting Requirements, and a Proposed Rule on Grandfathered Health Plans and Coverage

CMS Directs Additional Resources to Nursing Homes in COVID‑19 Hotspot Areas

The Centers for Medicare & Medicaid Services (“CMS”) announced it is providing additional resources to nursing homes in COVID-19 hotspot areas. CMS plans to deploy Quality Improvement Organizations (“QIOs”) to provide immediate assistance to nursing homes. QIOs are contractors who work with healthcare providers to help improve the quality of healthcare provided to Medicare Beneficiaries. 

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, 2021, 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.