HHS Is Providing an Additional $20 Billion to the Provider Relief Fund, CMS Relaxes Repayment Terms Under the Accelerated and Advance Payment Program, and New Jersey Poised to Allow Telemedicine for Medical Cannabis

New Jersey Is Poised to Allow the Use of Telemedicine for Medical Cannabis

New Jersey is poised to approve S619, which would permit providers to authorize patients for medical cannabis through telemedicine and telehealth. The bill has already passed the Assembly and is before the Senate for a second reading. Under the bill, for the first 270 days following enactment, a health care practitioner may authorize the medical use of cannabis via telemedicine and telehealth for a patient who is a resident of a long-term care facility, has a developmental disability, is terminally ill, is receiving hospice care from a licensed hospice care provider, or is housebound as certified by the patient’s physician. 

Providers Get Extended Time to Repay Advanced Medicare Funds, Insurers Roll Back Some Telemedicine Coverage, and other Federal Rules and Programs

Time to Repay Medicare Loans Extended

On September 30, 2020, as part of a larger government short-term spending bill, President Trump signed into law a program which relaxes the repayment terms for Medicare loans that hospitals received earlier this year under the Accelerated and Advanced Payment Program. Whereas the loans were originally due 120 days after they were issued, the new law directs the Centers for Medicare & Medicaid Services (“CMS”)  to wait up to one year after the loan was issued to begin withholding Medicare payments to recoup funds.

New Jersey Passes Statutes on Nursing Homes Including Staffing Mandates, New Jersey Pharmacists Can Administer COVID-19 Tests, HHS Updates Provider Relief Fund Reporting Requirements, and New Information on Medicare Advantage Programs

The New Jersey State Legislature Passes Bill Requiring New Direct Care Staff-to-Resident Ratios for Nursing Homes and Establishes a New Task Force on Direct Care Worker Retention

The New Jersey Legislature passed a bill (A4652/S2712) which requires nursing homes to maintain certain minimum direct care staff-to-resident ratios.  The bill expressly requires: (i) one certified nurse aide to every eight residents for the day shift; (ii) one direct care staff member to every 10 residents for the evening shift, provided that no fewer than half of all staff members are to be certified nurse aides, and each staff member will sign in to work as a certified nurse aide and will perform certified nurse aide duties; and (iii) one direct care staff member to every 14 residents for the night shift, provided that each direct care staff member is to sign in to work as a certified nurse aide and perform certified nurse aide duties. 

CMS Issues Alert to Providers Regarding Incentive Payments, New CMS Models and Other CMS Action, and New Jersey Establishes Task Force on Long-Term Care

Centers for Medicare & Medicaid Services ("CMS") Issues Advisory Alert to Qualifying APM Participants for Incentive Payment Information

85 FR 57980 – CMS issued a payment advisory to alert certain clinicians who are Qualifying APM participants ("QPs") and eligible to receive an Alternative Payment Model ("APM") Incentive Payment that CMS does not have the current billing information needed to disburse the payment. Specifically, CMS has identified those eligible clinicians who earned an APM Incentive Payment in CY 2020 based on their CY 2018 QP status. When CMS disbursed the CY 2020 APM Incentive Payments, CMS was unable to verify current Medicare billing information for some QPs and was therefore unable to issue payment.

CMS Maintains Hospital Transparency Price Rule, Other Federal Rules, AMA Releases New CPT Codes, and AAAHC Issues New Standards

Over Objections, CMS Maintains Hospital Transparency Pricing Rule in the Inpatient Prospective Payment System Final Rule for 2021

Centers for Medicare & Medicaid Services (“CMS”) has released its Inpatient Prospective Payment System (“IPPS”) final rule for fiscal year (“FY”) 2021, effective October 1, 2020. The rule affects approximately 3,200 acute care hospitals. Over the objections of numerous providers, including the American Hospital Association, CMS maintained the transparency rule in the final rule, which requires hospitals to report to CMS the median rate negotiated with Medicare Advantage organizations for inpatient services.

Did New Jersey Just Cap Profits for Nursing Homes? New Jersey Takes Further COVID-19 Action Via Executive and Administrative Orders, and CMS Requires Positive COVID-19 Test for Add-On Payments.

New Jersey Passes Bill Requiring New Prevailing Wage for Long-Term Care Facility Staff and Establishes a Direct Care Ratio for Nursing Homes

The New Jersey State Assembly and the New Jersey State Senate passed a new bill (A4482/S2758) establishing the minimum wage for certain long-term care facility staff and establishes direct care ratio requirements for nursing homes. First, the bill provides that the minimum wage for direct care staff in long-term care facilities is to be $3 higher than the prevailing State minimum wage and annually adjusted based on cost-of-living increase. Second, under the bill, the Commissioner of Human Services will be required to establish a direct care ratio reporting and rebate requirement that will take effect no later than July 1, 2021. 

CMS Extends Deadline and Expands Next Round Under the Provider Relief Fund, Additional Guidance on Nursing Homes, New CDC Testing Recommendations, and Federal Regulations on Guidance Documents

Deadline for Phase 2 Financial Relief Applications Extended by CMS

Healthcare providers now have more time to apply for the next round of emergency financial relief under the Coronavirus, Aid, Relief, and Economic Security Act (the “CARES Act”). Previously, the deadline to apply for the Phase 2 General Distribution was August 28, 2020. However, on August 25, 2020, the Centers for Medicare & Medicaid Services (“CMS”) issued new guidance extending the deadline to September 13, 2020 and expanding the eligible providers.

Free COVID-19 Testing Anyone? Plus, New Jersey Issues Executive Directive on Reopening Nursing Homes, While the Federal Government Provides Nursing Homes With More Federal Relief Funding.

Guidance on Free Testing On or about August 4, 2020, the United States Department of Health and Human Services (“HHS”), Office of the Inspector General (“OIG”) issued new guidance in the form of frequently asked questions regarding a clinical laboratory’s ability to offer free COVID-19 antibody testing to federal health care program beneficiaries who receive other medically necessary blood tests.

HHS Reopens Provider Relief Fund for Certain Providers, and CMS’ Proposed Outpatient Prospective Payment System Makes Some Significant Changes to Payment Rates and Policies

For those Medicaid, Children's Health Insurance Program (“CHIP”) and dental providers who missed out on the $20 billion second tranche from the general Provider Relief Fund, the Department of Health and Human Services (“HHS”) recently announced that it would reopen the application process.  Do not assume you will not receive funds. The Provider Relief Fund has been a valuable source of funding for many providers during COVID-19 so apply when it reopens.

From Drug Pricing to Federal Regulations and Litigation, to Startling Statistics on Opioid Overdoses Leading to New Guidance

Federal Executive Orders on Drug Pricing

On July 24, 2020, President Donald Trump signed four Executive Orders aimed at lowering prescription drug prices. The first order, Executive Order on Access to Affordable Life-Saving Medications, directs federally qualified health centers ("FQHCs") to pass along discounts on insulin and epinephrine received from drug companies to certain low-income Americans.