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Sustainable Growth Rate

December 18, 2014 | No Comments
Posted by Frank Ciesla

Congress has gone home for the rest of this term without solving either the Sustainable Growth Rate issue or providing the additional compensation previously provided to primary care providers to take care of Medicaid patients by paying them the Medicare reimbursement rate.

These are two issues that we have previously addressed in blogs.  It is clear that this Congress did not want to address the SGR issue, nor does Congress want to increase the budget, by providing additional funding for the limited number of Medicaid procedures provided by “primary care doctors” so that that reimbursement rate would equal the Medicare rate.

With the expansion of the Medicaid population under the Affordable Care Act, this will clearly mean many fewer physicians will be willing to take care of Medicaid patients and that these patients will be forced either into hospital clinics or other alternative delivery systems, if they are to get care.

EXPANSION OF SCOPE OF LIMITED LICENSED PRACTITIONERS

December 17, 2014 | No Comments
Posted by Frank Ciesla

Monday’s New York Times editorial page highlights the issue of expanding the scope of practice of limited licensed practitioners and cites a study from the British health care system.  The article favorably reports the use of nurse midwives rather than doctors in noncomplicated deliveries.  The editorial indicates that the use of physicians in noncomplicated cases adds to the cost.  As pointed out in my many prior blogs, there is a constant drumbeat for the expansion of the scope of practice of limited licensed practitioners, to provide more and more of the health care, that will be demanded by the population going forward.  In light of the media attention given to the Affordable Care Act, the public will have an expectation that they will have access to health care services, but they may be surprised that it is not provided by a physician but by a limited license practitioner.

On a separate note, the New Jersey Senate Health Committee has approved legislation expanding the scope of practice of physician assistants.  The legislation still needs approval by both the full Senate and Assembly.

December 1, 2014 Regulatory Developments

December 12, 2014 | No Comments
Posted by Beth Christian

Here are the most recent health care related regulatory developments as published in the New Jersey Register on December 1, 2014:

  • On December 1, 2014 at 46 NJR 2299, the Office of Administrative Law published notice of its proposed re-adoption with amendments to its rules and the proposal of a new rule governing contested cases before the Office of Administrative Law.
  • On December 1, 2014 at 46 NJR 2302, the Office of Administrative Law published notice of its proposed re-adoption with amendments to its rules governing Office of Administrative Law procedures (including procedures applicable to petitions for rule making).
  • On December 1, 2014 at 46 NJR 2314, the Department of Banking and Insurance published notice of its proposed amendments to its rules governing individual health benefits coverage.
  • On December 1, 2014 at 46 NJR 2317, the Department of Banking and Insurance published notice of its proposed amendments to its rules governing the small employer health benefits program.
  • On December 1, 2014 at 46 NJR 2336, the Department of the Treasury published notice of its proposed re-adoption and re-codification with amendments to its existing rules and the proposal of new rules governing the Office of the Ombudsperson for the Institutionalized Elderly.
  • On December 1, 2014 at 46 NJR 2368, the Department of Human Services published notice of its re-adoption of its rules governing the Special Medicaid Programs Manual.
  • On December 1, 2014 at 46 NJR 2378, the Department of Health published a notice that a petition for rule making had been filed by Ken Wolski, RN, MPA, Executive Director of the Coalition for Medical Marijuana – New Jersey, Inc.  The petitioner requests that the Department make certain amendments to the medical marijuana program rules.  The petitioner requests that the Department: (1) eliminate the fee to apply for issuance of or renewal of a primary giver identification card; (2) eliminate the sales tax on medical marijuana; (3) delete certain physician registration and certification requirements; (4) add post traumatic stress disorder to the definition of conditions eligible for medical marijuana prescriptions; and (5) deleting certain physician approval requirements if parents want to obtain medical marijuana for their child.

EXPANSION OF THE SCOPE OF PRACTICE FOR LIMITED LICENSED PRACTITIONERS

December 10, 2014 | No Comments
Posted by Frank Ciesla

In yesterday’s blog, I talked about the expansion of the scope of practice for limited licensed practitioners (psychologists) being considered by the New Jersey Legislature.

Because of the actions of the U.S. Drug Enforcement Agency in reclassifying hydrocodone, such reclassification took away the right of optometrists to write prescriptions for such drugs.  There is now legislation pending to restore the ability of optometrists to write prescriptions for such a drug.  This has brought an objection from the state medical society.

This is a rare instance in which, and probably as an unforeseen consequence, the ability of limited licensed practitioners (optometrists) have been diminished.  Obviously, taking away their ability was not done by the state which sets forth, by legislation, the scope of practice, but by the U.S. Drug Enforcement Agency in reclassifying the drug.

In light of the trends that we are seeing nationwide, it is probable that the state will expand the license of the optometrist to enable them to continue to write prescriptions for the drug.

CMS Finalizes Changes to Medicare Enrollment Rules

December 10, 2014 | No Comments
Posted by Beth Christian

On December 3, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule concerning provider enrollment or re-enrollment in Medicare.   The final rule will give CMS the ability to deny or revoke the enrollment of entities and individuals that pose a program integrity risk to Medicare, including those that have a managing employee that has been convicted of certain crimes.  In addition, CMS will have the ability to deny Medicare enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt.  Providers and suppliers may have their Medicare enrollment revoked if (i) the provider or supplier demonstrates a “pattern and practice” of submitting claims that fail to meet Medicare requirements or (ii) the provider or supplier submits a claim or claims for services that could not have been furnished to a specific individual on the date of service. CMS is also making the effective date of Medicare enrollment uniform for all provider and supplier types.  Providers and suppliers will only be able to submit claims for services rendered as of the filing date of their enrollment application or the date of first furnishing services at a new practice location, whichever is later.

EXPANDING THE SCOPE OF PRACTICE OF PSYCHOLOGISTS

December 9, 2014 | No Comments
Posted by Frank Ciesla

Continuing the somewhat disorganized trend that is occurring throughout the country, New Jersey is now continuing the trend of expanding the scope of practice for limited license practitioners through proposed legislation to expand the scope of practice of psychologists.  As we pointed out in numerous prior blogs, this is a trend that is occurring nationwide for a number of different categories of non-physician providers.  What is clear is that on an inconsistent basis, individuals will be receiving health care, in various states consistent with the legislation of those states, which will permit limited licensed practitioners to provide certain types of health care.  This will enable the pool of health care providers to be expanded to meet the need created by the Affordable Care Act, as well as permit the third party payors, including the government, to reduce payments for such services being provided, that can now be provided by alternative limited licensed individuals.  As previously pointed out in prior blogs, we will see how this plays out both in the reimbursement area as well as in the malpractice arena.

November 17, 2014 Regulatory Developments

November 25, 2014 | No Comments
Posted by Beth Christian

Here are the most recent health care related regulatory developments as published in the New Jersey Register on November 17, 2014:

  • On November 17, 2014 at 46 N.J.R. 2262-2269, the State Board of Marriage and Family Therapy Examiners-Professional Counselor Examiners Committee and the Orthotics and Prosthetics Board of Examiners each published notice of their proposal of new rules governing credit towards licensure for education, training and experience received while serving in the Armed Forces.
  • On November 17, 2014 at 46 N.J.R. 2279, the Department of Banking and Insurance published notice of its readoption with amendments to its rules governing the Office of the Insurance Claims Ombudsman.
  • On November 17, 2014 at 46 N.J.R. 2286, the Department of Health published a notice that it would be accepting applications for the registration of surgical practices that either:  (i) were operating on September 17, 2009 or (ii) had submitted plans, specifications, and required documents with the municipality in which the surgical practice is located prior to September 17, 2009, and failed to register with the Department of Health prior to commencing operations.  The Department indicated in the notice that it would be the third and final registration period for surgical practices that are currently operating and would run for 60 days from the date of publication of the notice.
  • On November 17, 2014 at 46 N.J.R. 2217, the Office of the Governor issued an executive order creating a Facing Addiction Task Force to fight drug addiction through treatment and prevention.
  • On November 17, 2014 at 46 N.J.R. 2217, the Office of the Governor published an executive order creating an Ebola Virus Disease Joint Response Team.

Sustainable Growth Rate

November 19, 2014 | No Comments
Posted by Frank Ciesla

The CBO has now issued its estimate for the “doc fix” legislation at $144 billion over the next 10 years.  At the moment, there is no proposal on the table to fund this $144 billion and while an unpopular legislative proposal resolving the issue could be proposed and could pass in the lame duck session, there is little time for such a proposal.

In the new Congress, while it will be Republican controlled, and there is clearly an appetite to correct the sustainable growth rate issue as it applies to physicians, it will not be any easier to find a solution to this $144 billion price tag and the new Congress will have until March 31, with all of the other items on its agenda, to resolve the issue or to kick it down the road either for another short period of time or for another year.

ANY WILLING PROVIDER

November 7, 2014 | No Comments
Posted by Frank Ciesla

South Dakota, not New Jersey, passed an initiative that requires health care insurance plans to admit any willing and qualified provider onto their provider lists, if that provider is willing to accept the terms, primarily reimbursement of the health care insurance plan.

New Jersey neither has such a statute or is even considering at this time such a statute, nor does New Jersey have the legal process by which a taxpayer initiative can be placed upon the ballot.

One can surmise that this is a response by the public to narrowing networks under the Affordable Care Act.

October 20, 2014 Regulatory Developments

November 5, 2014 | No Comments
Posted by Beth Christian

Here are the most recent health care related regulatory developments as published in the New Jersey Register on October 20, 2014:

  • On October 20, 2014 at 46 N.J.R. 2080-2085 and 46 N.J.R. 2096-2098, the following professional boards published notice of their proposal of amendments to their rules governing credit for education, training and experience needed for licensure:   Board of Examiners of Ophthalmic Dispensers and Ophthalmic Technicians; Alcohol and Drug Counselor Committee; Physician Assistant Advisory Committee; Board of Physical Therapy Examiners; Board of Respiratory Care; Board of Social Work Examiners; Board of Polysomnography.  The proposed rules would require the applicable licensing Boards to credit applicants for licensure for education, training, and experience which the applicant received while serving in the Armed Forces.
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