For more information about this blog post, please contact Khaled J. Klele, Ryan M. Magee, Labinot Alexander Berlajolli, or Daniel J. Parziale.
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. For the New Jersey Educators Health Plan, the
schedule for out-of-network reimbursement has been reduced to 200% of Medicare,
but the out-of-network reimbursement for the NJ Direct Plans 10 and 15 remains
the same.
With
regard to telemedicine, the New Jersey Legislature approved S2467.
S2467 extends P.L.2020, c.3, which expanded the use of telemedicine and
telehealth services during the COVID-19 public health emergency, and P.L.2020,
c.7, which requires insurers to cover COVID-19 testing and healthcare services
provided using telemedicine and telehealth during the COVID-19 public health
emergency, to continue until 90 days after the end of both the state of
emergency and the public health emergency declared in response to
COVID-19.
Recent
Regulatory State Waivers
Various
agencies have also waived certain regulatory requirements. For example,
under 52
N.J.R. 1251(a), the Commissioner of Health waived and/or altered certain
regulations N.J.A.C. 8:43G-31.11, which sets forth certain criteria for the
maintenance of respiratory care equipment, which includes ventilators, in
hospitals. Since hospitals are receiving ventilators that have been in
State storage or from federal stockpiles for several years, often with expired
preventative maintenance tags, hospitals are required under this wavier to
perform a mechanical and electrical function test on a ventilator released from
State storage or from the federal stockpile prior to placing it into service
and using it for the first time. The waiver continues and explains the
testing and reporting process under the waiver.
The waiver
under 52
N.J.R. 1251(b) addresses individuals enrolled in Opioid Treatment Programs
("OTP"s) who are unable to maintain access to medication necessary
for managing the symptoms of withdrawal. To ensure that patients in OTPs have
access to needed medications, the Department of Health is waiving the
requirements of N.J.A.C. 10:161B-11.10 and permitting facilities to provide
medication to clients at locations other than the location listed on their OTP
facility license, in accordance with the guidance issued by the Drug
Enforcement Agency ("DEA") on April 7, 2020. The intent of the
guidance is to provide OTPs greater flexibility in the delivery of take-home
doses of methadone to their patients.
Under 52
NJR 1253(a), the Department of Health and Human Services waives N.J.A.C.
10:51-1.25(j)(3), which requires that a Medicaid/NJ FamilyCare beneficiary
provide a signature at the time a pharmacy dispenses or delivers a prescription
to the beneficiary; N.J.A.C.10:167A-1.27(j)(4), which requires that a PAAD
beneficiary provide a signature at the time a pharmacy dispenses or delivers a
prescription to the beneficiary; and N.J.A.C.10:167C-1.25(j)(3), which requires
that a Senior Gold beneficiary provide a signature at the time a pharmacy
dispenses or delivers a prescription to the beneficiary. To avoid
unnecessary contact, beneficiaries of these programs will no longer be required
to provide signatures at the time a prescription is dispensed or delivered.
Instead, the pharmacist must document in the patient's profile the date the
beneficiary received the prescription.
The
Commissioner of the Department of Health recently cancelled
the certificate of need applications for new home health agencies. In
addition, the Commissioner postponed
the certificate of need call for applications for home healthcare services.
CMS
Unveils Creation of the Office of Burden Reduction and Health Informatics
CMS announced
the creation of the Office of Burden Reduction and Health Informatics.
The new office stems from the CMS Patients over Paperwork (“PoP”) initiative,
which aims to reduce regulatory and administrative burden and allow providers
to focus more time on patient care. The PoP initiative is expected to
save providers and clinicians $6.6 billion and 42 million unnecessary burden
hours through 2021. Among other things, the new office will focus on
health informatics, or using and applying health and clinical data to provide
better care for patients, as well as strengthening CMS’ efforts across
Medicare, Medicaid, and the Children’s Health Insurance Program and the Health
Insurance Marketplace to reduce hours and costs that clinicians and providers
generate for CMS-mandated compliance.
Please
visit Riker Danzig’s COVID-19
Resource Center to stay up to date on all related legal issues.
