In recent years, numerous laws have been proposed and enacted in New Jersey that impact health care. This year is no exception, with some benefiting providers or patients and others that increase regulatory burdens on providers. In the past few months, the New Jersey State Senate and Assembly have passed approximately twenty statutes that relate to health care in New Jersey. The below discusses two of those statutes. The first is the much anticipated telemedicine statute that maintains the equal pay rates for telemedicine and in-person visits. The second involves a statute that imposes additional obligations on nursing homes and other facilities that care for seniors.
Both of these bills passed the State Senate and Assembly and will become law if the Governor executes them.
New Jersey Set to Make Permanent the Equal Rates for Telemedicine and In-Person Visits
S2559: During the COVID-19 pandemic, New Jersey required health insurance carriers to pay telemedicine visits at the same rate as in-person visits, but those orders will expire soon. (See June 17, 2021 Update). This bill modifies the various statutes that apply to telemedicine, the State Medicaid and NJ FamilyCare programs, the State Health Benefits Program (SHBP), and the School Employees’ Health Benefits Program (SEHBP), to require health insurance carriers to pay for telemedicine services regarding all physical and behavioral health care services at the same rate as in-person visits, including remote patient monitoring. The provider must use both an audio and video component to qualify for the rate.
Significantly, the bill amends the definition of “telemedicine” to include audio-only telephone conversation, but the provider will be reimbursed at a lesser rate, but no less than 50% of the reimbursement rate for an in-person visit. However, a behavioral health service that uses audio only, whether or not utilized in combination with asynchronous store-and-forward technology, still qualifies for full reimbursement. Co-pays, deductibles and co-insurance apply.
In addition, at the time a patient requests health care services to be provided using telemedicine, the provider must advise the patient whether the encounter will be with a health care provider who is not a physician, and the patient may specifically request that the encounter be scheduled with a physician. If the patient requests that the encounter be with a physician, the encounter shall be scheduled with a physician.
Importantly, the benefit of this statute does not apply to a health care service provided by a telemedicine organization that does not provide health care services on an in-person basis in New Jersey. In other words, the telemedicine organization has to offer the same services in-person as it does through telemedicine.
This bill continues the benefits provided during the pandemic as it relates to COVID-19. Specifically, health insurance carriers must provide coverage, without the imposition of any cost sharing requirements, including deductibles, copayments, or coinsurance, prior authorization requirements, or other medical management requirements, for the following services furnished during any portion of the federal state of emergency: (1) testing for COVID-19, provided that a health care provider has issued a medical order for the testing; and (2) items and services furnished or provided to an individual during health care provider office visits, including in-person visits and telemedicine and telehealth encounters, urgency care center visits, and emergency department visits, that result in an order for administration of a test for COVID-19.
New Requirements for Nursing Homes and Other Facilities Caring for Seniors
S2798: This bill modifies the definition of “long-term care facility” to just a nursing home and removes assisted living facility, comprehensive personal care home, residential health care facility, or dementia care home from the definition. Although long-term care facilities were always required to have an outbreak response plan, this bill makes it a condition of licensure.
In addition, this bill requires each long-term care facility to establish an infection prevention and control committee and assign to that committee a physician who has completed an infectious disease fellowship, and such physician must be employed on a full-time or part-time basis depending on the size of the facility. The committee must also designate an infection preventionist who has primary professional training in medicine, nursing, medical technology, microbiology, epidemiology, or a related field and has at least five years of infection control experience or certification in infection control by the Certification Board of Infection Control and Epidemiology. A long-term care facility that is unable to hire an infection preventionist on a full-time or part-time basis may contract with an infection preventionist on a consultative basis until February 1, 2022. After February 1, 2022, a long-term care facility must hire an infection preventionist on a full-time or part-time basis, except that the Department of Health may waive this requirement if a long-term care facility is unable to hire an infection preventionist following the facility’s good faith efforts to hire an infection preventionist.
The bill goes on to define assisted living facility, comprehensive personal care home, residential health care facility, and dementia care home, and requires these facilities to also develop an outbreak response plan as a condition of licensure and to establish an infection prevention and control committee, with the exception that the committee only has to include an infection preventionist that meets certain requirements.