New Jersey State Regulatory Issues
51 N.J.R. 1493(a) – Proposed Regulation – This proposal establishes the County Option Hospital Fee Pilot Program. The purpose of the pilot program is to increase financial resources through the Medicaid/NJ FamilyCare program to support local hospitals in providing necessary services to low-income residents. The pilot program will be in effect for a period of five years from April 30, 2019 through April 30, 2024. Each participating county can impose a local healthcare-related fee on hospitals within its borders. Funds generated under the pilot program and transferred to the Department of Human Services will be combined with matching Federal Medicaid dollars and distributed to hospitals in participating counties through the existing Medicaid/NJ FamilyCare managed care organizations or directly to hospitals using fee-for-service payments, or a combination of the two mechanisms, at the Department's discretion. For the complete proposal, click here.
51 N.J.R. 1546(a) – Public Notice – On August 9, 2019, the Department of Health (Department) received a petition for rulemaking from the New Jersey Hospital Association to make certain amendments to N.J.A.C. 8:43G Hospital Licensing Standards, Subchapter 14 Infection Control, N.J.A.C. 8:43G-14.9, Sepsis Protocols, requiring hospitals to implement certain protocols. N.J.A.C. 8:43G-14.9 requires licensed hospitals in New Jersey to establish, implement, periodically update, and train clinical staff in evidence-based protocols for the early identification and treatment of patients with sepsis and septic shock (sepsis protocols). Notably, the Department does not require that hospitals base their sepsis protocols on guidelines and best practices for sepsis identification and treatment of certain entities that are generally recognized as authoritative among the regulated community. N.J.A.C. 8:43G-14.9(f). The petitioner requested that the Department amend N.J.A.C. 8:43G-14.9(f) to require hospitals to implement the protocol recommended by the Surviving Sepsis Campaign, known as Sepsis-1. For the complete public notice, click here.
New York Passes New Law Requiring Certain Large Insurance Plans to Cover IVF
In April, a new law was enacted in the 2020 New York state budget which updated its existing infertility statute to require certain large-group health plans (providing coverage to 100 employees or more) to cover up to three cycles of in vitro fertilization and associated medications and testing. The new mandate requires all insurance plans to cover cryogenic egg freezing for medically necessary purposes. Medicaid plan beneficiaries, employees of small and medium-sized companies of less than 100 employee or companies that self-insure and those with individual insurance plans are not covered under the state mandate. Ten states have IVF insurance coverage laws. For the complete statute, click here.
Heated Contract Network Negotiations Between the Largest Insurer and Hospital Network
Following contract network negotiations that included a reduction in reimbursement rates, the largest health insurance company nationwide, UnitedHealth Group Inc., which also happens to be affiliated with Optum, a large healthcare provider, has threatened to drop one of the top healthcare systems in Houston, Houston Methodist, from its network if an agreement cannot be reached. Nearly 100,000 patients with UnitedHealthcare's Medicare Advantage and employer-sponsored plans effective Jan. 1, will lose in-network access to all eight Houston Methodist hospitals and dozens of its out-patient facilities while Methodists' employed physicians will be out of network starting April 1. The parties have until midnight Dec. 31 to reach a contract agreement. During the network negotiations dispute, Optum, announced it will begin sending new transplant patients to other in-network transplant providers effective Oct. 15 instead of sending patients to Houston Methodist.
If you have any questions about the issues discussed in this blog post, please contact Khaled J. Klele or Latoya Caprice Dawkins.
The list above does not include every proposed or adopted legislation, litigation or guidance document that may impact the healthcare industry. Instead, it includes only a select few chosen by the authors, and any information in this post is not intended to provide legal advice. If you are concerned that a proposed or adopted legislation, litigation or guidance document may impact your practice, then you should seek legal advice. Nothing in this post should be relied upon as legal advice in any particular matter. © 2019 Riker Danzig Scherer Hyland & Perretti LLP.
