The New Jersey Assembly recently proposed Bill No.1989 extending the effective date for one room centers to become licensed to July 1, 2020, citing staffing and resource limitations. We will keep track of this bill along the legislative process, and inform you if and when the bill passes both houses and is approved by the Governor.
This past month or so, the New Jersey Legislature passed twenty-five new statutes impacting health care, on top of the nine from the previous month. Mostly all of these bills have already been approved and become law.
HHS OIG Finds That Medicare Advantage Payments From Chart Reviews Raise Concerns
HHS’s Office of Inspector General has raised concerns about the use of Medicare Advantage Organizations (MAOs) use of medical chart reviews to obtain higher payments.
New Jersey Statutes:
A3717 – Approved – We previously reported on this statute, which initially passed both houses, but was then vetoed by the Governor. After some modifications, the statute passed both houses again and became law after excluding self-insured plans, the State Health Benefits Plan, and the School Employees Health Benefits Plan. The statute prohibits a pharmacy benefits manager from retroactively reducing payments on a properly filed claim for payment by a pharmacy.
New Jersey State Regulatory Issues
51 N.J.R. 1806(a) – Notice of Action on Petition for Rulemaking
The Department of Health received a petition to make amendments to N.J.A.C. 8:43G, the Hospital Licensing Standards, in Subchapter 14 Infection Control, at N.J.A.C. 8:43G-14.9, Sepsis protocols. We previously reported that the Department confirmed receipt of the petition. At this time, the Department has not decided on the petition and has referred the petition to the Division of Certificate of Need and Licensing to evaluate, and make recommendations as to the appropriateness of granting the petition.
New Jersey and Federal Regulatory Update
S3075 – Passed – This bill prohibits any person from conducting, maintaining, or operating an embryo storage facility in this state unless licensed by the Department of Health pursuant to the provisions of the bill.
The Eleventh Circuit dealt a win for providers in United States v. AseraCare, ruling that a mere difference of clinical opinion among physicians is not enough to prove “falsity” under the False Claims Act. The Eleventh Circuit’s decision emphasizes that reasonable differences of opinion between physician reviewers of medical documentation are not sufficient to suggest that the judgments concerning a particular patient’s eligibility for Medicare’s hospice benefit, or any claims submitted based on such judgments, are false for purposes of the False Claims Act.
Pricing Transparency Rules: As previously reported on November 22nd, we anticipated that the Department of Health would publish the transparency rules in the Federal Register on November 27th. Today, the Department of Health published in the Federal Register the final Rule requiring hospitals to disclose pricing information and the proposed Transparency in Coverage Rule requiring insurers, among other things, to disclose cost-sharing information.
As we previously reported, on November 15, 2019, CMS issued a final rule and comment period that revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year 2020. In that final rule, CMS made clear that it intends to continue with its policy to require hospitals to publicly disclose "standard charges," including payer-specific negotiated rates. CMS, however, did not actually publish the final rule in the registry and, instead, CMS stated it “received over 1,400 comments on our proposed requirements for hospitals to make public their standard charges.
Ambulatory Surgery Center Prospective Payment System
84 FR 61142 – Final Rule with Comment Period – This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for Calendar Year (CY) 2020. On average for all covered procedures in ASCs, payment rates went up by 2.6%.