**June 30th Deadline to Avoid the 2014 eRx Penalty
CMS has re-opened the Quality Reporting Communications Support Page from March 1, 2013 to June 30, 2013, allowing physicians to request a hardship exemption for 2014. In order to avoid the 2 percent penalty in 2014, physicians must meet the requirements of the Medicare e-prescribing (eRx) program; meet one of the limited exemption categories, or obtain approval for a hardship exemption. Individual physicians who do not meet one of the exemption or hardship categories must report the eRx measure 10 times via claims between January 1, 2013 and June 30, 2013.
Groups using the group reporting option must report at least 75 times (2-24 Eligible Professionals), at least 625 times (25-99 EPs), and at least 2,500 times for groups of 100 plus. Physicians can also avoid the penalty by registering for the EHR Incentive Program by June 30, 2013, or achieving meaningful use under the EHR Incentive Program during the January 1, 2013 to June 30, 2013 reporting period. For a complete list of hardship exemptions and more information, view CMS’ Electronic Prescribing (eRx) Incentive Program: 2014 Payment Adjustment Fact Sheet.
MSNJ Legislative Update: May 10, 2013
Pediatric Respite Care Facilities
The Assembly Regulated Professions Committee unanimously approved A. 3558 which will provide a license for pediatric respite care facilities. A pediatric long-term care facility is not required to seek a dual license under this bill. MSNJ took no position on this bill, but recognizes its potential to help families deal with pediatric illnesses.
Mental Health Coverage for Alcoholism & Substance Abuse Disorders
The Assembly Health Committee passed A. 1665/S. 1253, which would revise statutory mental health coverage requirements and require all health insurers and SHBP to cover treatment for alcoholism and other substance-use disorders under the same terms and conditions as for other diseases or illnesses. MSNJ has supported mental health parity measures, including this one, for years. The bill is particularly important in light of the focus on mental health issues related to gun violence.
Influenza Vaccinations for Healthcare Workers
The Assembly Health Committee passed A. 2172, which would require that a healthcare facility annually offer on-site or off-site influenza vaccinations to its health care workers, and they would be required to receive an influenza vaccination, but would be permitted to present acceptable proof, including an attestation by the health care worker, of a current influenza vaccination from another vaccination source, or sign a written declination statement. The bill is poised for full votes in both houses; the Governor vetoed the bill last year. MSNJ supports the bill.
Prescription Drug Donation Repository Program
The Assembly Health Committee passed A. 2188/A. 3964, which would establish a prescription drug donation repository program in the Department of Health (DOH). This program will provide for the donation of unused prescription drugs and supplies by persons, health care facilities, and pharmacies to a central repository for redistribution to authorized medical facilities and pharmacies in order to re-dispense these medications, which would otherwise be destroyed, for use by individuals who meet eligibility criteria specified by the Commissioner of Health. MSNJ supports the bill, as it is in line with our goal to reduce abuse and diversion of drugs, particularly opioids.
Limitation of Settings for Certain Surgeries
The Senate Health Committee approved S. 2079, sponsored by Senator Richard Codey, which would limit settings where certain surgeries may be performed. Under the bill, a physician may only perform any of the following procedures in an office or facility that is accredited by the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or The Joint Commission: a liposuction procedure that involves more than 750 cubic centimeters of aspirate; a procedure that utilizes a breast implant; or an aesthetic truncal contouring procedure that involves the excision of skin. This bill is supported by plastic surgeons, but opposed by dermatologists. MSNJ opposes the bill on the principle that clinical matters of such specificity should not be legislated.
Medicaid Expansion
The Senate Health Committee also passed S. 2644, sponsored by Senators Joseph Vitale, Nia Gill and Loretta Weinberg, which would expand Medicaid eligibility pursuant to the federal Affordable Care Act. The bill essentially is the legislative version of the Governor’s decision to expand Medicaid eligibility under the ACA. MSNJ’s position on expansion can be found here.
Value Based Benefit Design for Chronic Health Conditions
The Assembly Appropriations committee passed A. 1214, which establishes a pilot program to utilize value-based benefit design in the State Health Benefits Plan to increase health benefits coverage for certain employees concerning chronic health conditions. The coverage design will utilize explicit financial incentives to increase the employee’s interaction with appropriate health care providers, and encourage use of those health benefits that specifically relate to the employee’s chronic health condition. MSNJ is monitoring this bill, which mirrors the goals of ACOs and other new payment models that focus on outcomes.
Health Benefit Mandate for Breast Imaging Services
The Assembly Appropriations committee also passed A. 2022/S. 792, which contains an insurance mandate for certain tests following mammograms and requires certain notice about risk factors.
The bill requires health insurers to provide health benefits coverage for additional testing deemed medically necessary by a patient’s health care provider, of an entire breast or breasts, after a baseline mammogram examination, if the mammogram demonstrates extremely dense breast tissue, if the mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue, or if the patient has additional risk factors for breast cancer. Additional risk factors include, but are not limited to, family history of breast cancer, prior personal history of breast cancer, positive genetic testing, extremely dense breast tissue based on the Breast Imaging Reporting and Data System, or other indications as determined by the patient’s health care provider. The bill also requires providers of mammography services to include information on breast density in mammography reports sent to patients and physicians, if a patient’s mammogram demonstrates extremely dense breast tissue based on the Breast Imaging Reporting and Data System. The bill provides that the information on breast density must include the following statement: “Your mammogram shows that your breast tissue is extremely dense as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology. Dense breast tissue is very common and is not abnormal. However, extremely dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your health care provider about this and other risks for breast cancer that pertain to your personal medical history. A report of your results was sent to your physician.”
MSNJ was engaged in improving the bill along with radiology and ob/gyn specialty societies, so that it reflects clinical realities and current practices. Insurance providers and business groups oppose the bill.
NJ Supreme Court Requires Same Specialty Expert in Medical Liability Lawsuits- Position Urged by MSNJ
Medicaid Primary Care Incentive Payment Attestation: Deadline Extended to April 30th
The Division of Medical Assistance and Health Services (DMAHS) confirmed that all physicians who qualify for the ACA enhanced payments to Medicaid primary care providers must complete an attestation form indicating board certification status in a primary care specialty. The deadline for submission of the ACA Self-Attestation Form for traditional fee-for-service Medicaid has been extended to April 30, 2013.
Physicians must submit the attestation by April 30th in order to be eligible for retroactive incentive payments going back to January 1, 2013. Physicians who submit the attestation after April 30th will receive incentive payments starting from the first day of the month the attestation was submitted. For example, if the attestation is submitted on July 17, 2013, then the incentive payments will apply to claims starting July 1st. An original signature is required; therefore the form must be mailed to: Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650. Please note: the fee-for-service deadline does not apply to physicians in the MCOs; a deadline will be provided in a letter to the physician from the MCO.
MSNJ Legislative & Regulatory Update – March 22, 2013
From Trenton: Assembly Action:
On Thursday, the Assembly passed a bill that requires physicians to complete survey as condition for biennial registration with Board of Medical Examiners and requires board to maintain and disseminate survey data as appropriate. S. 1336 aims to address workforce shortages and now heads to the Governor’s desk.
The Assembly on Thursday voted on S. 2082, the “Opioid Antidote and Overdose Prevention Act,” which provides immunity from civil and criminal liability and professional discipline for health care professionals who prescribe or dispense naloxone or any similarly acting drug approved for the treatment of an opioid overdose. It provides immunity from civil and criminal liability for other persons who administer such a drug in an emergency to an individual who the person believes in good faith is experiencing an opioid overdose. A health care professional prescribing or dispensing an opioid antidote to a patient would be required to ensure that the patient receives overdose information, which is specified in the bill, and could fulfill this requirement by maintaining a written agreement for the provision of such information with a community-based organization, substance abuse organization, or other organization which addresses medical or social issues related to drug addiction. MSNJ and the AMA support this bill.
Senate Action:
The Senate passed mental health parity legislation on Monday. S. 1253, sponsored by Chairman Vitale, requires SHBP and SHEBP to cover treatment for alcoholism, other substance-use disorders, and non biologically-based mental illnesses under same terms and conditions as for other diseases or illnesses. MSNJ supports this bill. The Assembly has not yet considered the bill.
Also on Monday, the Senate passed A. 3080, sponsored by Chairman Schaer, which requires health benefits coverage for refills of prescription eye drops under certain conditions. MSNJ supports this bill which now heads to the Governor’s desk.
Gubernatorial Action:
This week, Governor Christie signed a scope of practice bill that MSNJ worked on intimately. S. 555 removes from a genetic counselor’s scope of practice interpreting such laboratory tests and other diagnostic studies and clarifies that genetic counseling includes identifying, coordinating, and explaining the clinical implications of genetic laboratory tests and other diagnostic studies and their results. The bill also adds to the scope of practice integrating genetic laboratory test results and other diagnostic studies with personal and family medical history to assess and communicate risk factors for genetic or medical conditions and diseases. Current law provides that the provisions of the “Genetic Counselor’s Licensing Act,” shall not apply to a person licensed by the State to practice medicine and surgery when acting within the scope of the person’s profession and doing work of a nature consistent with the person’s training, so long as the person does not hold himself out to the public as a genetic counselor. The bill provides that the act shall not apply to a person licensed by the State to practice medicine and surgery, so long as the person does not hold himself out to the public as a licensed genetic counselor.
New Jersey’s Fiscal Year 2014 Budget
The Legislature has begun its budget hearings, taking testimony from members of the public. In the Assembly hearing on health issues, over 30 people testified with concerns on funding for hospitals, mental health programs and other items. MSNJ will remain engaged in the budget process, particularly Medicaid Expansion. Read MSNJ’s policy statement on Medicaid expansion.
From Washington: House Committees Continue their Work on SGR Repeal & Replacement
The AMA recently provided in-put to the House Committees on Ways & Means and Energy & Commerce proposal to repeal Medicare’s flawed sustainable growth rate (SGR) formula and replace it with physician-driven quality and payment methodologies. Key points included:
- Phase I: Permanent repeal of the SGR and statutorily-defined rates based on the Medicare Economic Index (MEI) for three to five years
- Phase II: Fee schedule updates based on meaningful, physician-endorsed measures of care and clinical improvement; reduced reporting burdens; timely access to quality performance scores
- Phase III: After several years of risk-adjusted quality-based payments, physicians who perform well would earn additional payments based on efficiency; duplicate programs and reporting requirements would be eliminated.
Other in-put included:
- a “Provider Shield Act” so that reporting would not be used as evidence in tort actions;
- private contracting without penalty to physicians and patients to ensure patient choice and access to care.
MSNJ Legislative Update – March 7, 2013
AMA helps MSNJ Push Medical Liability Reform Legislation
As we reported in February, MSNJ supports a new medical liability reform bill. A.1831, sponsored by Chairman Conaway, would prohibit the addition of defendants using fictitious names at least 120 days prior to the date on which the action is set for trial. This bill also clarifies the existing legal immunity for health care professional who volunteers to respond in good faith to an emergency at a hospital or health care facility, removing the requirement that the service be provided without payment. The AMA has sent Assembly leadership support letters to help our effort.
MSNJ Continues to Support Mental Health Parity Legislation
MSNJ submitted support in the Senate Budget Committee for S.1253, sponsored by Senate Health Committee Chairman Joseph Vitale, which revises statutory mental health coverage requirements and requires all health insurers and the State Health Benefit Plan (SHBP) to cover treatment for alcoholism and other substance-use disorders under the same terms and conditions as for other diseases or illnesses. MSNJ supports mental health parity policies, as they increase access to proper diagnosis and care of ailments that are often dismissed. The bill now heads to the floor for a full vote. In addition, AR.144, sponsored by Assembly Speaker Oliver, urges Governor Christie’s Administration not to apply for annual exemption from requirements of federal Mental Health Parity and Addiction Equity Act of 2008.
MSNJ Continues to Support Insurance Coverage of Off-label Drug Use
In the Assembly Appropriations Committee, MSNJ supported A.1830, sponsored by Assembly Members Herbert Conaway, Valerie Vainieri Huttle and Ruben Ramos. This legislation would require insurance coverage in the individual and small employer markets and SHBP and SEHBP for “off-label” uses of certain drugs.
MSNJ Continues to Support Insurance Coverage for Eye Drop Prescriptions
In the Senate Budget Committee, MSNJ supported A.3080, which requires health benefits coverage for refills of prescription eye drops under certain conditions. The requirement to provide this coverage is conditioned on two factors: (1) the prescribing health care practitioner indicates on the original prescription that additional quantities of the prescription eye drops are needed; and (2) the refill requested does not exceed the number of additional quantities indicated on the original prescription by the prescribing health care practitioner. The Centers for Medicaid and Medicare Services issued guidance on topical ophthalmics to prevent the unintended interruption of drug therapy in situations in which patients legitimately need earlier refills of prescription eye drops. While the guidance acknowledges that health insurers monitor appropriate refill periods as part of utilization management, the guidance also recognizes that the self-administration of prescription eye drops may involve some reasonable amount of waste and that earlier refills may be appropriate in some circumstances.
Medicaid Primary Care Incentive Payment Attestation: March 15th Deadline for FFS Physicians
CMS clarified that all physicians who qualify for the ACA enhanced payments to Medicaid primary care providers must complete an attestation form indicating board certification status in a primary care specialty. The deadline for submission of the ACA Self-Attestation Form for traditional fee-for-service Medicaid is March 15, 2013. An original signature is required; therefore the form must be mailed to: Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650. Fee for service physicians who do not file the attestation form by March 15th will not receive the retroactive payments. Fee-for-service physicians are also being “reminded of the importance of reporting their true usual and customary charges on these claims” to “ensure that adjustment payments for eligible claims can be processed correctly.” Please see the DMAHS newsletter for details. The fee-for-service deadline does not apply to physicians in the MCOs; a deadline will be provided in a letter to the physician from the MCO. Read more.
