Archive | March 2013

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.
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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.

MSNJ Files Brief in US Supreme Court Advocating for Class Arbitration

By: Melinda Martinson, MSNJ General Counsel

On March 1, MSNJ joined the AMA filing an amici curiae—friends of the court– brief in the U.S. Supreme Court in the matter of Oxford v. Sutter. This case presents the important question of whether physicians may arbitrate as a class when the insurer participation agreement requires that all disputes be submitted to arbitration. The matter is before the Supreme Court, not as a matter of right, but because the high Court granted Oxford’s petition for certiorari signaling that it will reach this important class arbitration issue.

MSNJ and the AMA assert that mandated arbitration without the right to arbitrate as a class leaves “no practical means of enforcing contracts with insurers” and is tantamount to no recourse at all. Dr. Sutter was mandated by Oxford to arbitrate his disputes in 2002. The arbitrator allowed the matter to proceed as a class. Oxford objected, litigated, and has lost at every level of appeal in the courts. Dr. Sutter and all physicians similarly situated, including MSNJ members, have been without a remedy for over ten years.

Read the brief for more details.

News: Medicaid Primary Care Incentive Payments

Medicaid Primary Care Incentive Payments Delayed, but will be Retroactive
MSNJ confirmed with DMAHS that the division will file the necessary State Plan Amendment (SPA) to obtain federal approval for the primary care incentive payments for fee-for service physicians. The SPA is due to the federal government by March 31st.  Once the State receives approval and increases the rates, retroactive payments (going back to January 1, 2013) will be made to physicians who qualify under the federal regulations. Read more. DMAHS is also working to ensure that physicians in MCOs will receive the primary care incentive payments retroactively. This implementation process is separate from the fee-for-service process. Read the separate article on steps that fee-for-service providers must take by March 15th to receive retroactive payments.

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. The New Jersey Division of Medical Assistance and Health Services (DMAHS) explained that physicians may have to complete separate attestation forms for the Medicaid Managed Care Organizations (MCOs), if the MCO does not have a record of board certification on file. DMAHS is working with the MCOs to coordinate an outreach effort to the physicians that will need to provide an attestation. MSNJ will continue to communicate with the Medicaid program about MCO attestation requirements and retroactive payments. Please stay tuned to e-News for more information as it becomes available.

MSNJ’s Statement on NJ Medicaid Expansion

Governor Christie’s decision to expand Medicaid is a positive step that will create access to health insurance for many uninsured residents. Importantly, this decision will make additional investment in the program possible. This is also an opportunity to align incentives and create a robust network of physicians and other healthcare providers for the Medicaid program. Expanding an underfunded program will increase access to insurance, but will not deliver adequate access to physician services for our newly insured citizens.

The Medical Society of New Jersey supports reform of the state’s Medicaid Program. Our Medicaid Program is one of the poorest paying healthcare programs in the nation.* Conversely, practice expenses in New Jersey are among the highest in the nation. These unfortunate facts prevent many physicians and other healthcare providers from being financially able to participate in the Medicaid program. We look forward to working with our government and private sector partners to ensure access to quality healthcare for all New Jersey residents.

*Health Affairs August 2012 vol. 31 no. 8 1673-1679