New Federal Payment Rules, Including a Reduction in the Physician Fee Schedule During COVID-19, NY Scales Back COVID-19 Immunity, and Recent Federal Litigation

CMS Finalizes Four New Payment Rules

CMS finalized new payment rules for inpatient psychiatric facilities (“IPFs”), skilled nursing facilities (“SNFs”), and hospices, for fiscal year (“FY”) 2021. The final rule includes a 2.2 percent IPF payment rate increase, which CMS expects to yield an additional $95 million in payments. As to SNFs, the final rule updates the payment rates by 2.2 percent, or an increase of $750 million, and hospice payment rates by 2.4 percent, or an increase of $540 million.

HHS Reopens Provider Relief Fund for Certain Providers, and CMS’ Proposed Outpatient Prospective Payment System Makes Some Significant Changes to Payment Rates and Policies

For those Medicaid, Children's Health Insurance Program (“CHIP”) and dental providers who missed out on the $20 billion second tranche from the general Provider Relief Fund, the Department of Health and Human Services (“HHS”) recently announced that it would reopen the application process.  Do not assume you will not receive funds. The Provider Relief Fund has been a valuable source of funding for many providers during COVID-19 so apply when it reopens.

From Drug Pricing to Federal Regulations and Litigation, to Startling Statistics on Opioid Overdoses Leading to New Guidance

Federal Executive Orders on Drug Pricing

On July 24, 2020, President Donald Trump signed four Executive Orders aimed at lowering prescription drug prices. The first order, Executive Order on Access to Affordable Life-Saving Medications, directs federally qualified health centers ("FQHCs") to pass along discounts on insulin and epinephrine received from drug companies to certain low-income Americans. 

NJ Eases Testing Requirements for Elective Surgeries, but Do You Know the Difference Between Molecular, Antigen, and Antibody Testing? A New Federal Statute Proposes to Increase the Shared Savings for ACOs. Also, New Adopted and Proposed NJ Regulations.

New Jersey Executive Directive No. 20-016 Modifies Testing Protocols for Ambulatory Surgery Centers Resuming Elective Surgery and Invasive Diagnostic Procedures

The New Jersey Department of Health has further modified its previous guidance on the resumption of elective surgeries and invasive procedures in Ambulatory Surgery Centers (“ASCs”). Under the modified guidance, patients still have to undergo COVID‑19 testing and receive results within six days before the scheduled surgery.

New COVID-19 CDC Guidelines, Provider Relief Fund Reporting Timeline Released, CMS Updates Reimbursement Calculations, D.C. Circuit Rules in Favor of HHS's Site-Neutral Pay Cuts

During the past week or so, federal agencies have released new information and deadlines related to COVID-19. For example, the Department of Health and Human Services (“HHS”) has released a timeline for Provider Relief Fund reporting requirements and extended the deadline for eligible Medicaid and Children’s Health Insurance Program (“CHIP”) providers to apply for funding distribution. Centers for Medicare & Medicaid Services (“CMS”) has updated its reimbursement calculation for Wright Medical’s Augment regenerative solutions, and the Centers for Disease Control and Prevention (“CDC”) announced that patients recovering from COVID-19 no longer need a negative test result to come out of isolation.

New Jersey Opens Up Visitations to Nursing Homes, OIG Alleges Significant Overpayments to Hospitals, and New Federal Rules, Including to HIPAA Part II

New Jersey Department of Health Allows Visitations to Long-Term Care Facilities

The Department of Health recently issued an executive directive that permits parents, a family member, legal guardians and support persons of pediatric, developmentally disabled and intellectually disabled residents of long-term care facilities to arrange for by-appointment indoor visits with their loved ones. 

New Telehealth Quality Measures, CMS Pours More Resources into Nursing Homes, Different Hospital COVID-19 Reporting Requirements, and a Proposed Rule on Grandfathered Health Plans and Coverage

CMS Directs Additional Resources to Nursing Homes in COVID‑19 Hotspot Areas

The Centers for Medicare & Medicaid Services (“CMS”) announced it is providing additional resources to nursing homes in COVID-19 hotspot areas. CMS plans to deploy Quality Improvement Organizations (“QIOs”) to provide immediate assistance to nursing homes. QIOs are contractors who work with healthcare providers to help improve the quality of healthcare provided to Medicare Beneficiaries. 

New Jersey Takes More Actions In Light of COVID-19, the SEHBP Reduces OON Reimbursements, and CMS’ New Health Informatics Office

Recent Adopted Statutes in New Jersey

With the approval of S2273, the School Employees’ Health Benefits Program (“SEHBP”) is required to offer, starting January 1, 2021, only three plans for medical and prescription benefits coverage:  (1) New Jersey Educators Health Plan; (2) the SEHBP NJ Direct 10 plan; and (3) SEHBP NJ Direct 15 plan.  Starting July 1, 2021, the SEHBP must provide a fourth plan called the Garden State Health Plan, which shall offer the same level of medical and prescription drug benefits provided by the New Jersey Educators Health Plan, except that the benefits under the Garden State Health Plan shall be available only from providers located in the State of New Jersey.

CMS Clarifies Insurance Coverage for COVID-19 Testing, DOJ Finalizes Vertical Merger Guidance, and CMS Proposes New Value Based Purchasing Rule

CMS Releases Updated COVID-19 Coverage FAQs

CMS has released updated FAQs regarding COVID-19 coverage issues under the Families First Coronavirus Response Act (“FFCRA”) and the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”).  Under FFCRA, insurers are required to cover COVID‑19 tests without patient cost-sharing. 

New COVID-19 Guidance, MIPS Hardship Applications Are Now Open, and CMS’ 2021 Home Health Prospective Payment Update

Guidance on Contacting Patients For Plasma Donations During COVID-19

The United States Department of Health and Human Services, Office of Civil Rights (“OCR”) issued guidance regarding a health care provider’s ability to utilize a patient’s protected health information (“PHI”) to contact patients and encourage them to donate blood or plasma to help other patients suffering from COVID-19.