New Jersey Takes More Actions In Light of COVID-19, the SEHBP Reduces OON Reimbursements, and CMS’ New Health Informatics Office

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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.   For the New Jersey Educators Health Plan, the schedule for out-of-network reimbursement has been reduced to 200% of Medicare, but the out-of-network reimbursement for the NJ Direct Plans 10 and 15 remains the same. 

With regard to telemedicine, the New Jersey Legislature approved S2467.   S2467 extends P.L.2020, c.3, which expanded the use of telemedicine and telehealth services during the COVID-19 public health emergency, and P.L.2020, c.7, which requires insurers to cover COVID-19 testing and health care services provided using telemedicine and telehealth during the COVID-19 public health emergency, to continue until 90 days after the end of both the state of emergency and the public health emergency declared in response to COVID-19. 

Recent Regulatory State Waivers

Various agencies have also waived certain regulatory requirements.  For example, under 52 N.J.R. 1251(a), the Commissioner of Health waived and/or altered certain regulations N.J.A.C. 8:43G-31.11, which sets forth certain criteria for the maintenance of respiratory care equipment, which includes ventilators, in hospitals.  Since hospitals are receiving ventilators that have been in State storage or from federal stockpiles for several years, often with expired preventative maintenance tags, hospitals are required under this wavier to perform a mechanical and electrical function test on a ventilator released from State storage or from the federal stockpile prior to placing it into service and using it for the first time.  The waiver continues and explains the testing and reporting process under the waiver.

The waiver under 52 N.J.R. 1251(b) addresses individuals enrolled in Opioid Treatment Programs ("OTP"s) who are unable to maintain access to medication necessary for managing the symptoms of withdrawal. To ensure that patients in OTPs have access to needed medications, the Department of Health is waiving the requirements of N.J.A.C. 10:161B-11.10 and permitting facilities to provide medication to clients at locations other than the location listed on their OTP facility license, in accordance with the guidance issued by the Drug Enforcement Agency ("DEA") on April 7, 2020. The intent of the guidance is to provide OTPs greater flexibility in the delivery of take-home doses of methadone to their patients.

Under 52 NJR 1253(a), the Department of Health and Human Services waives N.J.A.C. 10:51-1.25(j)(3), which requires that a Medicaid/NJ FamilyCare beneficiary provide a signature at the time a pharmacy dispenses or delivers a prescription to the beneficiary; N.J.A.C.10:167A-1.27(j)(4), which requires that a PAAD beneficiary provide a signature at the time a pharmacy dispenses or delivers a prescription to the beneficiary; and N.J.A.C.10:167C-1.25(j)(3), which requires that a Senior Gold beneficiary provide a signature at the time a pharmacy dispenses or delivers a prescription to the beneficiary.  To avoid unnecessary contact, beneficiaries of these programs will no longer be required to provide signatures at the time a prescription is dispensed or delivered. Instead, the pharmacist must document in the patient's profile the date the beneficiary received the prescription.

The Commissioner of the Department of Health recently cancelled the certificate of need applications for new home health agencies.  In addition, the Commissioner postponed the certificate of need call for applications for home health care services.

CMS Unveils Creation of the Office of Burden Reduction and Health Informatics

CMS announced the creation of the Office of Burden Reduction and Health Informatics.  The new office stems from the CMS Patients over Paperwork (“PoP”) initiative, which aims to reduce regulatory and administrative burden and allow providers to focus more time on patient care.  The PoP initiative is expected to save providers and clinicians $6.6 billion and 42 million unnecessary burden hours through 2021.  Among other things, the new office will focus on health informatics, or using and applying health and clinical data to provide better care for patients, as well as strengthening CMS’ efforts across Medicare, Medicaid, and the Children’s Health Insurance Program and the Health Insurance Marketplace to reduce hours and costs that clinicians and providers generate for CMS-mandated compliance.

Please visit Riker Danzig’s COVID-19 Resource Center to stay up to date on all related legal issues.