Nursing Home and Pharmacy Litigation Update

Nursing Homes May Seek Payment Based on Agreement to Apply for Medicaid

On November 23, 2020, the Appellate Division held that a law preventing a nursing home from requiring a third‑party guarantee of payment as a condition of admission does not bar a claim by a nursing home against the children of a resident who signed an admission agreement pledging to apply for Medicaid on the resident’s behalf. Pine Brook Care Ctr. v. D'Alessandro, A‑3197‑18T1, 2020 WL 6852609 (N.J. Super. Ct. App. Div. Nov. 23, 2020).

The New Federal Out-of-Network Statute

As part of the recently enacted Consolidated Appropriations Act, 2021 (the “Appropriations Act”), the federal government did not only provide relief to stem the effects of the COVID-19 pandemic, but it also adopted the No Surprises Act.

The No Surprises Act (the “Act”) does not become effective until January 1, 2022, and, for those providers who practice in New Jersey, the Act operates similar to New Jersey’s Out‑of‑Network Consumer Protection, Transparency, Cost Containment and Accountability Act (the “NJ OON Act”). 

New Federal Regulations, Provider Relief Fund Reporting Requirements Update, and New CMS Model for Dual-Eligible Beneficiaries

This post covers the numerous new final rules that were issued by the federal government toward the end of 2020. In addition, the Department of Health and Human Services (“HHS”) updated its reporting requirements for the Provider Relief Fund, and the Centers for Medicare & Medicaid Services (“CMS”) issued a new model that covers those beneficiaries with dual eligibility for Medicare and Medicaid.

New Jersey Legislative Update

Throughout this year, the New Jersey Legislature has passed numerous bills that impact health care providers in the State. Over the past month, the Legislature continued to do so with the passage of several bills as noted in this post.

Federal Regulations Aim to Further Reduce Pharmaceutical Drug Prices, CMS Releases Outpatient Prospective Payment System and Ambulatory Surgical Center Final Rule, New Measures Taken to Combat COVID 19 During the Upcoming Winter Months, and More

New Pharmacy Rules and Regulations Aimed to Reduce Pricing

The United States Department of Health and Human Services (“HHS”) and the Centers for Medicare & Medicaid Services (“CMS”) recently issued a series of proposed and final rules aimed at impacting pharmaceutical drug prices and availability.  Specifically, HHS and CMS jointly issued an interim final rule, effective November 27, 2020, that implements the Most Favored Nation Model (the “Model”).   

Recently Approved New Jersey Telemedicine Regulations and CMS Issues Transparency Rules for Insurers Following the Transparency Rules for Hospitals

New Jersey Proposes and Adopts New Regulations Authorizing Health Care Providers’ Provision of Telemedicine

Since adopting the New Jersey Telemedicine and Telehealth statute, effective July 21, 2017, various governing boards have proposed and adopted telemedicine regulations. See the full post for a list of the most recent proposals and adoptions.

CMS Final and Proposed Regulations, Including the Recent Basic Health Program Option

CMS Issues Proposed Rule on the Basic Health Program Option

The Centers for Medicare & Medicaid Services (“CMS”) issued a proposed rule on federal payment amounts to states that elect to establish a Basic Health Program (“BHP”) under the Patient Protection and Affordable Care Act (the “Act”) for program year 2022. Under the Act, BHPs may offer health benefits coverage to low-income individuals. 

Name Tags? Yes, You Are Now Required To Wear Certain Name Tags.

This blog post includes summaries of several laws recently passed by the New Jersey Legislature that impact health care providers, including a law requiring health care providers to wear certain kinds of name tags. These additional requirements come at a time when New Jersey’s providers are providing continued crucial care in response to the pandemic and experiencing significant financial strain caused by the pandemic. 

NJ Hospitals Must Allow Pregnant Patients to Have Support Person Present During Labor, Interoperability Rule Deadlines Extended, CMS Announces Insurance Coverage for COVID-19 Vaccine, and More

Revised New Jersey Executive Directive No. 20-020 Requires Hospitals to Allow Support Person for Pregnant Patients During Labor

The New Jersey Department of Health has modified its previous guidance to require hospitals to allow at least one designated support person to accompany a pregnant patient during labor, delivery, and the entire postpartum hospital stay. A doula, who is part of the patient’s care team and essential to patient care, shall not count as a support person. The support person(s) and doula must be asymptomatic for COVID-19 and shall undergo symptom screening and temperature checks prior to entering the clinical area, but there is no prior testing requirement.