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.
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.
As expected, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule, 86 FR 51326, rescinding coverage of medical technologies that the Food and Drug Administration (“FDA”) designates as “breakthrough,” as set forth in the Medicare Coverage of Innovative Technology (the “MCIT”) final rule on January 12, 2021.
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.
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”).
Additional $25.5 Billion in COVID-19 Provider Funding
The Department of Health and Human Services (“HHS”) announced that an additional $25.5 billion in new funding will be available for health care providers affected by the COVID‑19 pandemic.
Final Changes Regarding Distribution of Profits
The Centers for Medicare & Medicaid Services (“CMS”) and Department of Health and Human Services (“HHS”) announced a Final Rule, effective January 1, 2022, modifying the requirements under the Stark Law with respect to distribution of profits among physicians in a group practice.
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.
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 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.