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.
On August 20, 2021, the Centers for Medicare and Medicaid Services (“CMS”) released guidance with respect to the timeline for implementation and enforcement of the new insurance price transparency rule. Citing the number of provisions that insurers are required to “implement by January 1, 2022 and the considerable time and effort required to make the machine-readable files available in the form and manner required in the TiC Final Rules at the same time,” the Departments of Labor, Health and Human Services, and the Treasury have decided to defer enforcement of the Transparency in Coverage (“TiC”) Final Rules requirement to publish the remaining machine-readable files until July 1, 2022.
CMS Releases Proposed Payment Rules
86 FR 35874: Under the 2022 Home Health Prospective Payment System proposed rule, Centers for Medicare & Medicaid Services (“CMS”) would increase payments to home health agencies by 1.8 percent, which CMS estimates to be $330 million. However, CMS noted that home health agencies may see an aggregate 0.1 percent, or $20 million, decrease in payments due to the reductions made in the rural add‑on payment. CMS also proposed a nationwide expansion of the Home Health Value‑Based Purchasing model, which was originally implemented in nine states on January 1, 2016.
86 FR 43618: This proposed rule rescinds the Most Favored Nation (“MFN”) Model – a drug pricing model that matches payments for Medicare Part B drugs and biologicals to the lowest price paid by other comparable countries. The MFN was intended as an innovative way to lower prescription drug costs, reduce Medicare reimbursement rates to healthcare facilities, and open negotiations to discounts with drug manufacturers.
Adopted Telemedicine Rules
The below rules were adopted to establish the standards for providing services through telemedicine and telehealth for the following licensees:
- 53 N.J.R. 1283(a): licensees of the State Board of Marriage and Family Therapy Examiners
- 53 N.J.R. 1285(a): licensees of the Professional Counselor Committee of the State Board of Marriage and Family Therapy Examiners
- 53 N.J.R. 1288(a): physician assistants licensed by the State Board of Medical Examiners (the “BME”)
- 53 N.J.R. 1290(a): electrologists licensed by the Electrologists Advisory Committee and the BME
On July 9, 2021, President Biden signed an Executive Order on Promoting Competition in the American Economy (“Executive Order”) intended to increase competition across numerous industries, including health care, by reigning in trends of corporate consolidation and non-compete agreements. The Executive Order garnered a significant amount of media attention, especially media outlets focused on health care, since there has been a significant amount of consolidation in healthcare in recent years.
CMS Continues to Reverse Some Policy Decisions With Its Release of the Outpatient Prospective Payment System Proposed Rule
Centers for Medicare & Medicaid Services (“CMS”) released its Outpatient Prospective Payment System (“OPPS”) proposed rule for 2022, which reverses some of last year’s major policy changes that were applauded by ambulatory surgery centers (“ASCs”). Significantly, CMS proposes reinstatement of the inpatient‑only (“IPO”) list. Under the proposed rule, the 298 services removed from the IPO list this year would be added back to the IPO list in 2022. CMS also proposes eliminating the 258 procedures added to the ASC covered procedures list in January 2021.
As a follow-up to our previous post, below is a list of fifteen New Jersey Statutes that either have been approved by the Governor or await the Governor’s approval.
New Jersey Approves Hospital Wrap-Around Services
S1676: As noted in our previous update, Governor Murphy previously issued a conditional veto of this bill, which allows hospitals to provide wrap-around services for individuals who are homeless or housing insecure. After factoring in the Governor’s comments, the bill has now been approved.
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.
If you have ever been entangled in a billing audit, you should read a recent decision issued by the United States District Court for the District of New Jersey (the “DNJ”) that addressed the practice commonly known as cross-plan offsetting, and provides new arguments to health care providers in clawbacks of alleged overpayments and recoupments.