NJ Hospitals Must Allow Pregnant Patients to Have Support Person Present During Labor, Interoperability Rule Deadlines Extended, CMS Announces Insurance Coverage for COVID-19 Vaccine, and More

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander BerlajolliBrianna J. Santolli, or Daniel J. Parziale.

Revised New Jersey Executive Directive No. 20-020 Requires Hospitals to Allow Support Person for Pregnant Patients During Labor

The New Jersey Department of Health has modified its previous guidance to require hospitals to allow at least one designated support person to accompany a pregnant patient during labor, delivery, and the entire postpartum hospital stay. A doula, who is part of the patient’s care team and essential to patient care, shall not count as a support person. The support person(s) and doula must be asymptomatic for COVID-19 and shall undergo symptom screening and temperature checks prior to entering the clinical area, but there is no prior testing requirement. Pregnant patients shall be tested for COVID-19 prior to arriving at the hospital, prior to admission to the labor and delivery unit, or immediately upon admission. Both molecular and antigen testing are acceptable, but only antigen tests that have received an Emergency Use Authorization or approval from the United States Food and Drug Administration (“FDA”) may be used to fulfill the testing requirement.

HHS Extends Interoperability Rule Deadlines

The Department of Health and Human Services (“HHS”) Office of the National Coordinator for Health Information Technology issued a new interim final rule extending the compliance deadlines for certain requirements related to its information‑blocking rules to allow health care providers to focus on the COVID‑19 response. For more information regarding the new compliance timeline, review the HHS’s press release.

HHS Issues Transparency Rules for Health Insurers

The HHS, in conjunction with the Department of Labor and the Department of the Treasury, issued Transparency in Coverage final rules, requiring health plans to disclose the rates they negotiate with hospitals and other healthcare providers. The final rules set forth requirements for group health plans and health insurance issuers in the individual and group markets to disclose cost-sharing information upon request to a participant, beneficiary, or enrollee (or his or her authorized representative), including an estimate of the individual’s cost-sharing liability for covered items or services furnished by a particular provider. Plans and issuers are also required to make this information available online so as to allow participants to obtain an estimate and understanding of the individual’s out-of-pocket expenses and effectively shop for items and services.

The final rules also require plans and issuers to disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information through three machine-readable files posted on an internet website, thereby allowing the public to have access to health coverage information that can be used to understand health care pricing and potentially dampen the rise in health care spending.

CMS Issues Interim Final Rule Covering COVID-19 Vaccines

The Centers for Medicare & Medicaid Services (“CMS”) has released an interim final rule with comment period (“IFC”) requiring Medicare, Medicaid, and private insurers to cover a COVID-19 vaccine without out‑of‑pocket costs for beneficiaries and members. Under the IFC, Medicare shall cover any FDA‑authorized vaccine, and Medicaid and the Children’s Health Insurance Program shall administer the vaccine at no cost for most members during the public health emergency (the “PHE”). The IFC also requires most private insurers to cover a COVID-19 vaccine without cost sharing from both in- and out‑of‑network providers during the PHE. Providers administering the vaccine to uninsured Americans will be reimbursed through the Provider Relief Fund administered by the Health Resources and Services Administration. For more information on the IFC, review the CMS fact sheet. Comments are due on January 4, 2021.

HHS Revises Revenue Reporting Rules for COVID-19 Grants

HHS recently reversed a change made in September to COVID-19 relief grant reporting after providers warned it could result in many needing to return funds meant to offset coronavirus-related expenses or lost revenue. The latest change, posted October 22, 2020, allows hospitals to calculate lost revenue by comparing patient revenue from all of 2019 to 2020. In September, HHS amended the reporting requirement and said providers had to compare year-over-year net operating income. HHS said the September formula change was made to restrict some providers from receiving distributions that would make them more profitable than they were before the pandemic. Hospitals argued that the September formula change and definition of lost revenue would require many hospitals to return the funds. As a result, HHS made the change in October to require a comparison of only revenue from patient care as opposed to net operating income.  

CMS to Delay Start of Radiation Oncology Payment Model

Recently, CMS announced  that it will delay the start date for its new radiation oncology alternative payment model until July 2021. CMS said it intends to delay the model start date to July 1 through upcoming rule-making. The radiation oncology payment model will provide bundled payments for 16 cancer types and would cover 90-day episodes of care. 

CMS Releases Updated COVID-19 Reporting Requirements

CMS has released new regulatory requirements, effective immediately, for all hospitals and critical access hospitals (“CAHs”) to report COVID-19 data elements with a frequency and in a standardized format as specified by the HHS Secretary during the COVID-19 PHE. Hospitals and CAHs that fail to adequately report the specified data will receive notifications through November 18, 2020. After November 18th, non‑compliance may lead to termination of a provider’s participation in Medicare and Medicaid programs. For more information regarding the reporting requirements, review the memorandum published by CMS.