Federal Regulatory Update

CMS Issues Final Rule on Adjusting DMEPOS Fee Schedule

86 FR 73860: Centers for Medicare & Medicaid Services (“CMS”) has issued a final rule establishing methodologies for adjusting the Medicare durable medical equipment, prosthetics, orthotics, and supplies (“DMEPOS”) fee schedule amounts. This final rule also classifies adjunctive continuous glucose monitors as durable medical equipment (“DME”) under Medicare Part B.

New Jersey Extends Equal Rates for Telemedicine

In our November 9, 2021 Health Care Law Update, we noted that Governor Murphy issued a conditional veto of S2559, which would require State and private insurers in New Jersey to pay for telemedicine services at the same rate as in‑person services. While Governor Murphy commended lawmakers’ efforts to expand access to telemedicine and telehealth, ultimately, he did not approve the bill due to fiscal concerns. 

Win for Providers – Somewhat

On December 10, 2021, President Biden signed the bipartisan Protecting Medicare and American Farmers from Sequester Cuts Act, delaying the impending Medicare pay cuts facing physicians in 2022. Specifically, the bill continues to exempt Medicare from sequestration, which is the process of automatic, across-the-board spending reductions under which budgetary resources are permanently cancelled to enforce specific budget policy goals, until March 31, 2022.

340B Litigation, Nursing Home Visitation and other Updates

Conflicting Rulings in 340B Contract Pharmacy Challenges

On November 8, 2021, federal judges from the District of New Jersey and District of Columbia issued conflicting opinions as to whether pharmaceutical companies are required to offer discounts to third-party pharmacies under the 340B federal drug-pricing program. As to New Jersey, the Court concluded that “drug companies cannot unilaterally restrict sales of products discounted under the 340B program to contract pharmacies.”

Federal Court Halts Vaccine Mandate and Federal Regulatory Update

Federal Court Halts Vaccine Mandate for Healthcare Workers

A federal judge in the District Court for the Eastern District of Missouri granted an injunction yesterday that temporarily halted the implementation of the federal COVID-19 vaccine mandate for healthcare workers. The Court found, among other things, that the Centers for Medicare and Medicaid Services (“CMS”) had no clear authority from Congress to enact the vaccine mandate for providers and that the mandate could lead to staffing shortages.