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

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeLabinot Alexander Berlajolli, Brianna J. Santolli, or Connor Breza.

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.

Under these new rules, nursing facilities will pay a rebate to the Department of Human Services (the "DHS")

in the event that less than 90 percent of the revenue received from the DHS and its contracted managed care organizations is used for the care of the entity’s individual beneficiaries. The first reporting period to calculate the rebate will be in fiscal year 2022.  

It should be noted that under this new rule, facilities must submit their PCR report by the first day of the sixth month following the end of the applicable reporting year. Individuals who own multiple facilities must submit separate reports for each facility operated during the PCR reporting year. Similarly, owners of facilities that purchase another facility or have ownership of another facility transferred to them during a PCR reporting year, are responsible for submitting the information and reports for their newly acquired facilities, including for the parts of the PCR reporting year that was prior to their acquisition of the facility.

Proposed Continuous Quality Improvement Program for Pharmacies

The New Jersey State Board of Pharmacy (the "Board") is proposing a new rule under N.J.A.C. 13:39-1.9, to require each pharmacy permit holder and registered pharmacist-in-charge to implement a continuous quality improvement program (“CQI”) with the goal of improving detection, identification, and prevention of prescription errors.

The proposed rule sets the Board’s requirement for each pharmacy permit holder and registered pharmacist-in-charge to implement the CQI, as well as requirements for the pharmacy's policies and procedures manual with respect to the CQI. This proposed rule further provides that each licensee, registrant, and permit holder has a duty to cooperate with Board inquiries, inspections, or investigations. 

The comment period for the proposed rule ends on November 19, 2021.

Adopted Reciprocity Rules for the Board of Psychological Examiners

In accordance with N.J.S.A. 45:1-7.5, which govern the standards for renewal, reinstatement, and reactivation of psychology licenses, as well as the ability for the Board of Psychological Examiners to issue licenses to out-of-state practitioners, the NJ Board of Psychological Examiners adopted new rules on September 14, 2021, following a lengthy notice and comment period beginning on February 18, 2020. This recent administrative action repealed and added certain provisions under N.J.A.C. 13:42-5.3 and 10.17, and 10.18, and amended certain other provisions under N.J.A.C. 13:42-9.3, 10.4, 10.18, and 11.4.

Among other things, the new rule codified under N.J.A.C. 13:42-5.3 allows the Board of Psychological Examiners to issue a license to an applicant, if the Board determines that the state in which the applicant is licensed has standards for licensure that are substantially equivalent to its own standards and the applicant has been practicing for at least two years within the five years prior to applying for a license in New Jersey. Furthermore, the new rule provides standards for determining if a licensee is in good standing and whether an examination is substantially similar to that required by the Board.

Additionally, this new rule further repeals and replaces N.J.A.C. 13:42-10.17 to incorporate the license renewal requirements under N.J.S.A. 45:1-7.1. The new language sets the requirements for notice to inactive licensees and clarifies the process for renewal. Section 10.18 further expands on the license reactivation process, including continuing professional education requirements and the potential for an examination to ensure the practitioner’s competency and safety.

Division of HIV, STD, and TB Services

The New Jersey Department of Health (the "DOH") Division of HIV, STD, and TB Services issued a proposed rule on September 7, 2021 seeking to amend N.J.A.C. 8:57 and 8:65, which govern the reporting requirements for AIDS and HIV. The purpose of the proposed rule, in part, is to recodify the existing N.J.A.C. 8:57-2 (Reporting of Acquired Immunodeficiency Syndrome and Infection with Human Immunodeficiency Virus), as a new N.J.A.C. 8:65 (HIV Infection Reporting), to reflect the administrative relocation of provision of HIV-related services from the DOH's Division of Epidemiology, Environmental and Occupational Health, to the Division of HIV, STD, and TB Services. The DOH further proposed certain amendments, repeals, and new rules to such sections.

The changes to Chapter 8:57 and subsequent amendments made under 8:65 are substantial. The DOH likewise provides a substantial recollection of the history of the rules and the rationale for why such changes are to be made. In sum, the proposed rule provides the requirements for reporting HIV infections in terms of the individuals, entities, and locations that must report, as well as the contents of the reports and penalties for non-compliance. The proposed rule also incorporated substantial resources and texts by reference.

The comment period for the proposed rule ends on November 6, 2021.