Recently Approved New Jersey Telemedicine Regulations and CMS Issues Transparency Rules for Insurers Following the Transparency Rules for Hospitals

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

New Jersey Proposes and Adopts New Regulations Authorizing Health Care Providers’ Provision of Telemedicine

Since adopting the New Jersey Telemedicine and Telehealth statute, effective July 21, 2017, various governing boards have proposed and adopted telemedicine regulations. Below is a list of the most recent proposals and adoptions:

  • 52 N.J.R. 1897(a) – Rule Proposal – Sets forth standards for physicians’ assistants using telemedicine and telehealth. Comments are due December 18, 2020.
  • 52 N.J.R. 1901(a) – Rule Proposal – Sets forth standards for electrologists using telemedicine and telehealth. Comments are due December 18, 2020.
  • 52 N.J.R. 1911(b) – Rule Adoption – Implements standards for acupuncturists using telemedicine and telehealth.
  • 52 N.J.R. 1913(b) – Rule Adoption – Implements standards for genetic counselors using telemedicine and telehealth.
  • 52 N.J.R. 1916(a) – Rule Adoption – Implements standards for nurses using telemedicine and telehealth.
  • 52 N.J.R. 1918(a) – Rule Adoption – Implements standards for physical therapists and physical therapist assistants using telemedicine and telehealth.
  • 52 N.J.R. 1920(a) – Rule Adoption – Implements standards for psychologists using telemedicine and telehealth.
  • 52 N.J.R. 1925(a) – Rule Adoption – Implements standards for audiologists and speech language pathologists using telemedicine and telehealth.
  • 52 N.J.R. 1927(a) – Rule Adoption – Implements standards for social workers using telemedicine and telehealth.

New Jersey Board of Psychological Examiners Proposes New Rules Regarding Records Retention for Minors

The New Jersey Board of Psychological Examiners (the “Board”) proposed to amend N.J.A.C. 13:42‑8.1 to require that a licensee retain records for a minor for seven years from the date of the last entry or until the client turns 25 years of age, whichever is longer. Currently, N.J.A.C. 13:42‑8.1 only requires licensed psychologists to simply retain client records for at least seven years from the date of the last entry. Comments are due by January 1, 2021.

CMS Issues 2020 Final Transparency Rule for Insurers

As explained in our September 16, 2020 blog post, Centers for Medicare & Medicaid Services (“CMS”) issued its transparency rule for hospitals, effective October 1, 2020. Now, CMS has issued its final transparency rule (the “Rule”) setting 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. Furthermore, per the Rule, the disclosure of cost‑sharing information includes an estimate of the individual’s cost‑sharing liability for covered items or services furnished by a particular provider. Moreover, the Rule requires that plans and issuers make this information available on an internet website and, if requested, in paper form, thereby allowing a participant, beneficiary, or enrollee to obtain an estimate and understanding of the individual’s out‑of‑pocket expenses and to effectively shop for items and services. Finally, the Rule requires 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 Announces Coverage for Monoclonal Antibody Infusions to Treat COVID‑19

CMS announced that Medicare beneficiaries can receive coverage for monoclonal antibodies to treat COVID‑19 with no cost‑sharing during the public health emergency. 

CMS Issues 2020 Final Rule on the Medicaid and Children’s Health Insurance Program

CMS issued its final rule (the “Rule”) geared towards its efforts to streamline the Medicaid and Children's Health Insurance Program (“CHIP”) managed care regulatory framework.  The Rule is effective on December 14, 2020, with certain of the revisions effective on July 1, 2021. Generally speaking, the Rule aims to, among other things, loosen Medicaid managed care requirements imposed in 2016 that many stakeholders said were too burdensome. The Rule also changes the minimum standards that states must use in creating network adequacy requirements to allow for more telehealth options.

The Rule contains several notable revisions, including:

  1. Eliminating the current policy requiring time and distance standards for managed care organizations (“MCOs”) provider networks and, instead, allowing states to set alternative quantitative network adequacy standards;
  2. Revising the definition of an “adverse benefit determination” to exclude claims denied solely because they do not meet the definition of a “clean claim”;
  3. Permitting states in certain circumstances to develop and certify as actuarially sound a rate range per rate cell (i.e., enrollee category), reversing course on current policy that requires states to develop and certify as actuarially sound each individual rate for each enrollee category covered by the managed care plan (effective July 1, 2021);
  4. Giving states more flexibility in the manner in which they set capitation rate payments to managed care plans (effective July 1, 2021);
  5. Revising the Quality Rating System (“QRS”) by providing states with the flexibility to submit information according to a sate-developed alternative QRS, as opposed to a CMS-developed QRS; and
  6. Permitting states transitioning Medicaid populations or services from a fee‑for‑service (“FFS”) delivery system to a managed care delivery system to require managed care plans to make pass‑through payments for up to three years at an amount that is less than or equal to the amount of their current upper payment limit payments under FFS (effective July 1, 2021).