New Jersey Statutes

This past month, the New Jersey Legislature approved ten additional statutes impacting health care. These bills have already been approved and become law. The statutes are as follows:

A1277 – Approved – This bill requires general acute care hospitals and emergency shelters for the homeless to provide information about special services and resources to certain individuals receiving services from the hospital or shelter. Such hospitals will be required to inquire, as part of the intake process, whether the individual seeking services is homeless or is a military veteran. In the event that the individual responds in the affirmative, the hospital is to provide the individual with information concerning special services and resources that are available to the individual based on the individual’s status as homeless or as a military veteran.

A5500 – Approved – This bill expands the rate review process in the Department of Banking and Insurance for certain individual and small employer health benefits. Currently, under the Affordable Care Act, New Jersey is required to maintain a process to review health insurance rate increases according to certain criteria that identifies “unreasonable” rate increases, and requires health insurance carriers to provide justifications for them. This bill makes those federal requirements a part of New Jersey statutory law, so that consumers in the state will have those protections in the event that the ACA is repealed or modified.

A5503 – Approved – This bill establishes one limited open enrollment period in the New Jersey Individual Health Coverage Program. The bill provides the open enrollment period to be set by the program’s board consistent with federal law, unless the State operates a State-based exchange, in which case the open enrollment period may be set by the exchange. The bill takes effect immediately and would apply to individual health benefits plans issued or renewed on or after that date.

A5504 – Approved – This bill applies an 85 percent loss ratio requirement to insurers that provide large group health insurance plans in the state, beginning with the calendar year starting on January 1, 2020, and in each calendar year thereafter. The bill requires the insurer to annually report to the Commissioner of Banking and Insurance, no later than August 1 of each year, the loss ratio calculated for all of the policy forms for the previous calendar year. In each case in which the loss ratio fails to substantially comply with the 85 percent loss ratio requirement, the insurer shall issue a dividend or credit against future premiums for all policyholders in an amount sufficient to assure that the aggregate benefits paid in the previous calendar year plus the amount of the dividends and credits shall equal 85 percent of the premiums collected in the previous calendar year.

A5506 – Approved – This bill repeals the statute authorizing the offering of “Basic and Essential” health benefits plans (“B&E” Plans) under individual health benefits and small employer health benefits plans and other statutes concerning basic health plans. The B&E Plan was designed as a reduced benefit plan to encourage additional individuals to purchase at least an “entry level” health benefits plan. It was repealed because it fails to meet the requirements of the Affordable Care Act’s (ACA) Essential Health Benefits in multiple ways.

S974 – Approved – This bill requires all infants born in New Jersey to be tested for the genetic markers associated with spinal muscular atrophy (SMA), which is a progressive neurodegenerative disease that is caused by abnormally functioning motor neurons that control voluntary movement, such as walking, talking, and swallowing. In December 2016, the Food and Drug Administration approved Spinraza as the first drug approved to treat SMA. Early testing has suggested that diagnosing and treating infants with SMA before they become symptomatic may be the key to successful treatment outcomes.

S1032 – Approved – This bill provides for the Commissioner of Human Services to accept an application from a screening service to provide expanded mental health services to meet the needs of the persons in its geographic area and may include establishing a satellite program that is situated in a location separate from a screening service and provides services that emphasize outreach and early intervention. Screening services are public or private ambulatory care services that provide mental health services including assessment, emergency, and referral services to persons with mental illness in a specified geographic area. The bill also revises the existing statutory definitions of “mental health screener” and “treatment team” to expressly include a licensed marriage and family therapist, and it revises the existing definition of “screening service” to clarify that a screening service may, but need not be, affiliated with a hospital.

S3036 – Approved – This bill prohibits a provider to an injured worker of medical, surgical, or other treatment under the Workers' Compensation Law from reporting any portion of their charges which are alleged to be unpaid, to any collection or credit reporting agency, bureau, or data collection facility. A provider may only report such charges when a judge within the Division of Workers’ Compensation has fully adjudicated the rights and liabilities of all parties, including the rights of the claimant regarding the payment of these charges, or when a notice of a stipulation settlement or an order approving settlement regarding the payment of these charges has been filed with the court.

S3270 – Approved – This bill provides that, in order to be sold to a small employer in this state, a stop loss policy must establish a per person attachment point or retention or aggregate attachment point or retention, or both, which meet the following requirements: (1) If the policy establishes a per person attachment point or retention, that specific attachment point or retention may not be less than $40,000 for all stop loss insurance policies written, issued, administered or renewed on or after April 1, 2020; and (2) If the policy establishes an aggregate attachment point or retention, that aggregate attachment point or retention may not be less than 140% of expected claims per plan year. The bill also makes additional changes for 2021.

S4188 – Approved – This bill provides tax benefits to people that donate an organ or bone marrow, and paid time off to donors who are State or local government employees. In addition, the bill provides a tax credit to employers of donors who miss time from work.

S619 – Proposed – This proposed statute allows physicians participating in the medical cannabis program to issue patient prescriptions through telemedicine to improve patient accessibility to medical cannabis, particularly for those patients with physical limitations or restricted mobility. If enacted, for the first 270 days after the bill is signed, patients who cannot physically travel to a physician’s office will be permitted to receive telemedicine prescriptions, including children, residents of long-term care facilities, developmentally disabled patients, hospice care patients, those terminally ill, and those who can show that they are homebound. After that 270-day window, all other patients will be permitted to receive a telemedicine prescription provided they first make an in-person visit to the doctor’s office.

New Jersey Regulations

51 N.J.R. 1841(a) -- Proposed -- The State Board of Physical Therapy Examiners is proposing to modify the rules governing physical therapists entering the New Jersey through the Physical Therapy Licensure Compact. Under the proposed rule, physical therapists and physical therapist assistants working in New Jersey through the Compact must comply with Board rules, except for those governing credentialing of applications, license renewal, and continuing education. Such physical therapists, however, will have to pass the New Jersey State jurisprudence examination. Comments are due by February 14, 2020.

Federal Regulations

85 FR 2860 – Final Rule – The HHS has updated its regulations to reflect required annual inflation-related increases to the civil monetary penalties in its regulations, pursuant to the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, and to make changes to reflect an amendment to the Federal Food, Drug, and Cosmetic Act by the Further Consolidated Appropriations Act, 2020. This rule is effective January 17, 2020. HHS lists the civil monetary penalty authorities and the penalty amounts administered by all of its agencies in tabular form in 45 CFR 102.3.

85 FR 2974 – Proposed – The HHS has proposed this rule to implement changes to provide clarity about the rights and obligations of faith-based organizations participating in HHS programs, clarify the guidance documents for financial assistance with regard to faith-based organizations, and eliminate certain requirements for faith-based organizations that no longer reflect executive branch guidance or Supreme Court precedent. Comments are due by February 18, 2020.

85 FR 3330 – RFI – CMS is seeking public comments regarding the coordination of care from out-of-state providers for Medicaid-eligible children with medically complex conditions. In seeking these comments, CMS wishes to identify best practices for using out-of-state providers to provide care to children with medically complex conditions, determine how care is coordinated for such children when that care is provided by out-of-state providers, including when care is provided in emergency and non-emergency situations, reduce barriers that prevent such children from receiving care from out-of-state providers in a timely fashion, and identify processes for screening and enrolling out-of-state providers in Medicaid, including efforts to streamline such processes for out-of-state providers or to reduce the burden of such processes on them. CMS intends to use the information received in response to this request to issue guidance to state Medicaid directors on the coordination of care from out-of-state providers for children with medically complex conditions. Comments are due by March 23, 2020.

Med PAC Payment Recommendations

MedPAC has approved several payment recommendations, which includes basing hospital reimbursements more on value in the same vein as independent physician treatments. It also recommends that Congress provide a 2% market-basket update for the hospital inpatient and outpatient prospective payment systems in 2021, reduce the 2020 base payment rate for inpatient rehabilitation facilities by 5%, reduce the 2020 base payment rate for home health agencies by 7%, and eliminate the 2021 update to the payment rates for SNFs. MedPac did not recommend a payment increase for physicians for 2021 other than what is specified in current law. This annual recommendation will be sent to Congress in March.