Expense Ratio Requirements for Nursing Facilities and Other New Jersey Regulatory Developments

Adopted New Ratio Requirements for Nursing Facilities

On September 14, 2021, the Division of Medical Assistance and Health Services adopted new rules codified under N.J.A.C. 10:49A. N.J.A.C. 10:49A applies to nursing facility patient care ratio (“PCR”) requirements and establishes the expense ratio reporting and rebate requirements for nursing facilities that service Medicaid/NJ FamilyCare beneficiaries.

What Can A Medical Assistant Do and Not Do?

In the consolidated appeal of State v. Jeannotte-Rodriguez, A-4361-19; A-4371-19; A-4374-19, the Superior Court of New Jersey, Appellate Division, addressed the State’s failure to sufficiently demonstrate that a medical assistant’s scope of performed services encroached upon the licensed practice of medicine. 

Confused About New Jersey and Federal COVID-19 Vaccine Mandates?

New Jersey Vaccine Mandate for Healthcare Workers 

New Jersey’s Executive Order 252 took effect on September 7, 2021. This Executive Order mandates that all workers in certain State and private health care facilities and high-risk congregate settings be fully vaccinated against COVID-19 or be subject to COVID-19 testing at minimum one to two times per week. 

Broker Compensation and Monoclonal Antibodies

Broker and Agent Compensation Proposed Rule

The Department of Health and Human Services (“HHS”) recently issued a proposed rule, 86 FR 51730, to promote transparency in agent and broker compensation. The proposed rule seeks to require issuers offering individual health insurance coverage or short term limited duration insurance to disclose to policyholders, before finalizing plan selection and on documentation confirming the individual’s enrollment, commission rates and compensation structure for other direct and indirect compensation provided by the issuer to an agent or broker associated with enrolling the individuals.

OIG Advisory Opinion on Hospital Incentives

The Office of Inspector General (“OIG”) issued an advisory opinion regarding a proposed arrangement between a licensed offeror of Medicare Supplemental Health Insurance (“Medigap”) policies (the “Medigap Plan”), and a preferred hospital organization (“PHO”), to incentivize the Medigap Plan policyholders to seek inpatient care from a hospital within the PHO’s network (the “Proposed Arrangement”). 

CMS Clarifies Subsidiaries and Group Practices Under Stark Law

Centers for Medicare and Medicaid Services (“CMS”) issued an Advisory Opinion clarifying the ability for wholly-owned subsidiary physician practices to meet the Group Practice requirement of the In-Office Ancillary Services Exception under the federal Stark Law. The Stark Law is a federal law that prohibits individuals from making referrals for certain designated health services ("DHS") payable by federal healthcare programs to entities in which they, or an immediate family member, possess a financial interest unless a statutory exception is met, such as the Group Practice exception.

Hospitals Lose Outlier Payment and S-10 Audit Litigations

In this case, eight years ago, a number of acute-care hospitals sued the Department of Health and Human Services (“HHS”), challenging the amount of so-called Medicare “outlier” payments they had received from the HHS for the years 2008-2011. Generally speaking, outlier payments are intended to protect health care facilities from unexpected losses by providing Medicare reimbursements in instances of rare and costly treatments. 

New Jersey's DOH Adopts Registration Rules for Telehealth and Telemedicine Organizations

New Jersey’s Department of Health (“DOH”) adopted new rules, 53 N.J.R. 1378(b), effective August 16, 2021, outlining registration standards for telehealth and telemedicine organizations, including submission of an annual registration form to the DOH with a $1,500 fee. These rules were issued pursuant to N.J.S.A. 45:1-64. The rules apply only to organizations that are organized for the primary purpose of administering services in the furtherance of telehealth or telemedicine.