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

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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. 

The bill also establishes a Special Task Force on Direct Care Workforce Retention and Recruitment (the “Task Force”) in the Department of Labor and Workforce Development.  The purpose of the 16 member Task Force is to, among other things: (i) evaluate current direct care staffing levels in the state; (ii) examine policies and procedures used to track data on direct care staffing, including workforce turnover rates in long-term care, staffing statistics, and vacancy rates; and (iii) examine the effectiveness of staff retention and recruitment strategies and initiatives that are in place for direct care staff.

The New Jersey State Legislature Passes Bill Requiring Long-Term Care Facilities to Have Written Policies Preventing Social Isolation for Residents

The New Jersey Legislature passed a bill (A4007/S2785) requiring each long-term care facility in the state, as a condition of facility licensure, to adopt and implement written policies, and have appropriate technology, staff, and other capabilities in place, to prevent the social isolation of facility residents at all times during operation.  Moreover, the bill requires the social isolation prevention policies adopted by each long-term care facility to authorize, and include specific protocols and procedures to encourage and enable, residents of the facility to engage in in-person contact, communications, and religious and recreational activities with other facility residents and with family members, friends, and other external support systems, except when such in-person contact, communication, or activities are prohibited, restricted, or limited, as permitted by federal and State statute, rule, or regulation.

The New Jersey State Legislature Passes Bill Creating Two Programs to Provide Supplemental Payments to Long-Term Care Facility Staff

The New Jersey Legislature passed a bill (A4479/S2788) that establishes two programs that provide supplemental payments to long-term care facility staff providing direct care services during the COVID-19 pandemic.  First, the bill requires the State Treasurer to establish one program to make a one-time, lump-sum payment to any employee of a long-term care facility who, during the period commencing from March 9, 2020 through the effective date of the bill: (i) worked at least 10 consecutive or non-consecutive weeks during which the employee provided direct care services at a long-term care facility; (ii) during each of those 10 weeks, provided at least 25 hours of direct care services at a long-term care facility, which 25 hours may have been provided in a single long-term care facility or in multiple long-term care facilities during that week; and (iii) during each of those 10 weeks, earned an hourly wage of less than $25 per hour or a salary that is equivalent to a wage of less than $25 per hour.  Second, the bill requires the State Treasurer to establish a grant program for long-term care facilities to provide supplemental payments to certain staff who provide direct care services at the facility.  The bill also provides that a facility will be eligible for a grant award under this program if the facility, among other things, provides supplemental pay to staff members who deliver at least 25 hours of direct care services per week.

The New Jersey State Legislature Passes Bill Allowing Pharmacists to Administer COVID-19 Tests

The New Jersey Legislature passed a bill (A4012/S2436) which allows licensed pharmacists, consistent with federal guidance and waivers, to order and administer to any person any test for COVID-19 that the federal Food and Drug Administration (“FDA”) has authorized.  The bill expressly requires, among other things, that: (i) the manufacturer of the test be registered with the FDA and the pharmacy distributes personal protection equipment to all pharmacy staff and ensures that policies and protocols are in place to ensure all people presenting at the pharmacy for any reason maintain a level of social distancing appropriate to prevent the transmission of COVID-19.  Finally, the bill requires a pharmacy to comply with reporting requirements, advising about isolation, and to advise patients with severe symptoms to promptly seek treatment at a hospital.

The Department of Health and Human Services (“HHS”) Unveils Reporting Requirements for COVID-19 Provider Relief Funds

On September 19, 2020, HHS released more details about the reporting requirements for healthcare organizations that received one or more payments exceeding $10,000 in COVID-19 relief payments. HHS details the data healthcare organizations must report and  follows an August  2020 document that HHS previously issued.  Providers must report how they used the provider relief fund payments by disclosing expenses incurred as well as lost revenue and must submit information about the healthcare-related expenses incurred due to the COVID-19 pandemic that another source has not reimbursed or is obligated to reimburse.   HHS’s guidance states that providers should report expenses in two categories: (1) general and administrative expenses and (2) other healthcare-related expenses. General and administrative expenses include items such as personnel or mortgages.  Other healthcare-related expenses include costs for supplies and equipment, among other things.   In addition, providers must provide information on how they applied provider relief funds to lost revenue, represented as a negative change in year-over-year net patient care operating income.  If providers do not use their funds by the end of this year, they will have six months to use remaining amounts toward COVID-19-related expenses or to apply them toward lost revenue up to the amount gained from healthcare services in 2019. 

Providers must report within 45 days of the end of calendar year 2020 on their expenditures through the period ending December 31, 2020.

The Centers for Medicare & Medicaid Services (“CMS”)  Extends Prior Authorization for Ambulance Transport

On September 22, 2020, CMS announced that it is expanding the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergent Ambulance Transport (“RSNAT”) nationwide. CMS reports that it has saved Medicare about $650 million over four years with this program.  Scheduled, repetitive ambulance services are often used by Medicare beneficiaries who need an ambulance ride to medical appointments. These types of ambulance transports are usually among the top Medicare Part B services with improper payments.  Based on initial results, the prior authorization model, which began in multiple East Coast states, will be expanded nationally. 

CMS Announces Decreased Medicare Advantage Premiums and New Payment Model to Increase Insulin Affordability for Seniors

CMS has announced that average Medicare Advantage premiums for 2021 are expected to decrease by 11 percent to an estimated $21.  The average number of Medicare Advantage plan choices per county will increase from 39 plans in 2020 to 47 plans in 2021, and over 94 percent of Medicare Advantage plans will offer additional telehealth benefits.  Additionally, seniors who use insulin will be able to choose a plan in their area that offers insulin savings through the Part D Senior Savings Model and provides coverage on a broad set of insulins, each for no more than $35 per month.  Medicare Open Enrollment begins on October 15, 2020 and ends on December 7, 2020.