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Lame Duck 2013 Gubernatorial Action – Two Successes for Physicians

Lame Duck 2013 Legislative Action
(the Governor has 10 days to sign or pocket veto all bills signed at the end of the two year legislative session)

APN Scope of Practice

Despite our protest, both houses have passed a bill that would permit Advanced Practice Nurses to certify cause of death.  MSNJ opposes this bill because cause of death is in fact a medical diagnosis and should be provided only by a physician. Read MSNJ’s opposition letter. We are hoping for a pocket veto by the Governor, as he did two years ago when the Legislature rushed the bill through in an identical manner.

Pharmacy Vaccines

A3251, the bill allowing pharmacies to administer vaccines has passed both houses and awaits action by the Governor. The bill allows pharmacies to administer to patients 18 and older a vaccine (1) pursuant to a prescription, (2) in immunization programs authorized by a prescriber’s standing order for the vaccine or (3) in immunization programs and programs sponsored by governmental agencies that are not patient specific .  Under the bill, a pharmacist may administer an influenza vaccine to a patient who is seven years of age or older.  For a patient who is under 18 years of age, a pharmacist shall not administer a vaccine except with the permission of the patient’s parent or legal guardian.  For a patient who is under 12 years of age, a pharmacist shall not administer a vaccine unless pursuant to a prescription by an authorized prescriber.  A patient 12 years of age or older does not need a prescription for an influenza vaccine. MSNJ, NJAFP and NJAAP opposed this bill in its original form, but softened when the vaccines for children were limited to flu. This bill still represents a scope of practice expansion of concern to MSNJ.

Physician Loan Redemption

The Legislature passed S162, which establishes a Physician Loan Redemption Program. The bill awaits action by the Governor. MSNJ, along with NJ AFP and COTH worked expediently to improve the bill that was passed by the Senate in a skeletal, flawed form.  With our input, the bill now provides for redemption of eligible qualifying loan expenses for physicians who work for no less than four years at an approved site in the clinical practice of primary care or in the clinical practice of specialized care if the specialty is projected to experience a significant shortage.

Pain Medicine Restrictions

The Senate Budget Committee approved a bill that would limit insurers from using step therapy protocols for pain medication. Though the bill had already passed the Assembly, the Senate failed to vote on it, so it died at the end of the legislative session. MSNJ supported this bill and will work with legislators on the issue in 2014.  Our larger goal is to balance drug abuse reduction with proper access to pain medicine for patients who need it.

Medicaid Provider Rates

Both houses passed S2241, which would prohibit Medicaid managed care organizations from reducing certain provider reimbursement rates without approval from DHS.  The bill stems from an attempt by Horizon last year to slash home care provider rates after the Governor began moving most Medicaid services from fee for service to managed care. The insurance companies oppose the bill and stated that the bill would create a regulatory situation that is not used by any other state and that it will ultimately increase costs to the state. They also stated that the record of managed care in New Jersey is very good and the system is fair. MSNJ supports the bill, which awaits action by the Governor.

Higher Education Epinephrine Emergency Treatment Act

Both houses passed S2448, which allows public and independent institutions of higher education in New Jersey to develop a policy for the emergency administration of epinephrine to a member of the campus community for anaphylaxis when a medical professional is not available.  Institutions of higher education that develop such policies must designate an appropriately licensed physician, physician assistant, advanced practice nurse, or registered nurse to serve as the “licensed campus medical professional,” who will oversee the institution’s epinephrine administration and train designees in the administration of epinephrine via a pre-filled auto-injector mechanism.  The Secretary of Higher Education is to establish guidelines for the development of a policy for the emergency administration of epinephrine, which will be disseminated to the president of each institution of higher education.  In addition, the bill provides immunity for a licensed campus medical professional, a trained designee, and a prescribing physician for good faith acts or omissions committed in accordance with the bill’s provisions.   MNSJ supports this bill, which awaits action by the Governor.

State Trauma Plan

Both houses passed a bill that provides for the establishment of a formal Statewide trauma care system plan, which will include all health care facilities in the State providing care to injured patients in the State, to the extent that their resources and capabilities allow.  The Department of Health sought counsel with the American College of Surgeons Trauma System Evaluation and Planning Committee regarding the State’s trauma system.  This bill incorporates the recommendations that resulted from that interaction.  The commissioner is required to appoint a State Trauma Medical Director to oversee the planning, development, ongoing maintenance, and enhancement of the formal trauma system in collaboration with a multidisciplinary advisory body called the State Trauma System Advisory Committee (STSAC).  The STSAC is required to study the State’s trauma care system, collect data, and provide a report on the development of a formal Statewide trauma system plan.  The STSAC’s recommendations will provide the basis for the commissioner’s development of regulations implementing the plan.  The STSAC’s initial report, containing the formal Statewide trauma system plan, is due within one year.  Thereafter, the STSAC will be required to systematically review strategies to maintain and improve the State trauma system, submit an annual report to the commissioner and the director on its activities, and provide recommendations it determines are necessary to improve the State trauma system.  MSNJ is neutral on this bill, which awaits action by the Governor.

Breast Density

Both houses have finally passed the final version of A2022/S792, which now awaits action by the Governor.  MSNJ worked on this bill in great detail. The bill 1) requires insurance companies to cover certain screenings, 2) requires physicians to provide information to  certain patients regarding breast density and 3) requires study of breast cancer risk factors. Radiology facilities must distribute to certain patients a notice that reads as follows: “Your mammogram may show that you have dense breast tissue 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, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider.  A report of your results was sent to your health care provider. You may also find more information about breast density at the website of the American College of Radiology, www.acr.org.” The bill states that it does not impose a standard of care obligation upon a patient’s health care provider.  The bill requires the Mandated Health Benefits Advisory Commission to prepare a report regarding the implementation and administration of the bill, including analyses of social, medical and financial impact. The bill requires the Department of Health, in conjunction with the Medical Society of New Jersey, to convene a work group to review and report on strategies to improve the dialogue between patients and health care professionals regarding risk factors for breast cancer and breast imaging options.  Though we may have improved the bill, MSNJ remains concerned about legislative interventions into the physician-patient relationship, in general, and notification mandates, specifically.

For Profit Hospital Reporting

After two years of amendments and negotiations, a bill regarding for profit hospitals is finally settled. The Governor rejected a bill in 2012 that would have required detailed financial reports by for profit hospitals, which were growing in numbers at the time.  On the last day of the two year session, the Legislature accepted the watered down rewrite of the bill by the Governor.  The bill now requires the Commissioner of Health to undertake a review of New Jersey’s hospital financial reporting requirements and shall report any findings and recommendations directly to the Governor no later than six months from the date of enactment of.  Specifically, the Commissioner shall examine the impact of, and make recommendations on, the following areas for all entities receiving Health Care Subsidy Fund payments from the State: Internal Revenue Service filings, Securities and Exchange Commission filings, and audited financial statements. The bill takes effect immediately.

Vaccines for Healthcare Workers

Both houses passed A2172, sponsored by Chairman Herb Conaway, which requires health care facilities to annually offer influenza vaccination to their health care workers and require the implementation of an annual influenza vaccination program in accordance with the current recommendations of the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention and any rules and regulations adopted by the Commissioner of Health.  In lieu of receiving the vaccine at work, a health care worker 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.  Each facility would be required to maintain a record of influenza vaccinations, retain each signed attestation and declination statement, and report to the Department of Health (DOH) the vaccination percentage rate of its health care workforce as part of its program or by other means as attested to by the health care worker.  Each facility would also be required to provide an educational component to its influenza vaccination program and annually evaluate the program with the goal of improving the rate of vaccination among its health care workers. The bill awaits action by the Governor, who pocket vetoed the bill last year.

Newborn Screenings

Both houses passed S2318, a bill that requires newborn infant screening for tongue tie. MSNJ was neutral on the bill.  The bill awaits action by the Governor.

Stillbirth Education

Both houses passed the  “Autumn Joy Stillbirth Research and Dignity Act,” which requires DOH to establish protocols for stillbirths and establishes a stillbirth research database. The bill awaits action by the Governor.

Pediatric Respite Care

Both houses approved A3558, which would provide for licensure of pediatric respite care facilities.  The facilities will provide end-of-life care for children up to age 21 with limited life expectancies or complex, life-limiting illnesses and support for their families, and employ interdisciplinary teams to assist in providing curative treatment when possible, palliative care, and supportive services to meet the physical, emotional, spiritual, social, and economic needs of children and their families during illness, as well as during dying and bereavement if no cure is attained. The bill awaits action by the Governor.

Drug Adherence Efforts

Both houses passed A1214, which requires the State Health Benefits Commission and the State Health Benefits Plan Design Committee to establish a three-year pilot program to provide benefits coverage to select employees with chronic health conditions using a value-based benefit design under the State Health Benefits Program (SHBP).  The value-based benefit design will target the following chronic health conditions: diabetes, high cholesterol, hypertension, and asthma. 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.  The value-based benefit design pilot program will assign a participating employee to a pharmacist, who, in collaboration with the employee’s primary treating physician, will be responsible for coordinating medication therapy management services within the scope of the pharmacist’s license to practice pharmacy in the State of New Jersey.

The following financial incentives directly related to the diagnosis, care, mitigation, or treatment of the condition for which the employee is participating in the program will be provided:

(1) all tuition costs for any education class attended by the employee which provides medical condition self-management, recommended to the employee by the primary treating physician or assigned pharmacist;

(2) all costs for private visits with the employee’s assigned pharmacist;

(3) all costs for a medical device or supply deemed medically necessary by the primary treating physician or assigned pharmacist;

(4) all costs for laboratory testing; and

(5) waiver of all copayments for any prescription drug..

This bill is based on the well-known Ashville Project.  The bill will most likely be approved by the Senate and head to the Governor’s desk in lame duck.

Reconstructive Breast Surgery

Both houses passed S374, which grants a state sales tax exemption for services prescribed by a doctor in conjunction with reconstructive breast surgery. The procedures, currently subject to the 7 percent tax rate, are utilized to restore the appearance of the breast.  The bill addresses a current loophole where insurance providers cover the costs of the procedures but pass on the cost of the sales tax to the patient.  The bill awaits action by the Governor.

Medical Marijuana

Both houses passed A765, which requires that a registered qualifying patient’s authorized use of medical marijuana be considered equivalent to using any other prescribed medication and not the use of an illicit substance that would otherwise disqualify a qualifying patient from needed medical care, including organ transplantation.  The bill awaits action by the Governor.

Lame Duck 2013 Veto Action

Gender Changes on Birth Certificates

The Senate and Assembly have both passed A4097/S2876, which allows more people to change their birth certificates.  To obtain the amended certificate, a person would be required to submit:  1) a form provided by the State registrar of vital statistics and completed by the person’s licensed health care provider which indicates that the person has undergone clinically appropriate treatment for the purpose of gender transition, based on contemporary medical standards, or that the person has an intersex condition; and 2) a certified copy of a court order indicating the person’s name change, if the person has changed his or her name.  Under current law, a person is required to undergo sex reassignment surgery to receive an amended birth certificate.

Declarations of Death

The Governor signed a bill that removes the statutory authority of the Department of Health (DOH) and the State Board of Medical Examiners (BME) over medical standards governing declarations of death upon the basis of neurological criteria.  The bill requires that a declaration of death upon the basis of neurological criteria be made by a licensed physician professionally qualified by specialty or expertise, based upon the exercise of the physician’s best medical judgment and in accordance with currently accepted medical standards.  Joint DOH/BME regulations would no longer be needed to set forth currently accepted medical standards (including criteria, tests, and procedures) to govern declarations of death upon the basis of neurological criteria.  If they are used, the regulations concerning the declaration of death upon the basis of neurological criteria may not require the use of any specific test or procedure in the declaration of death upon the basis of such criteria. MSNJ supports this bill.

Self-Referral Laws

The Governor signed a bill which allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met. MSNJ and New Jersey urologists support this bill, which is a “clean up” to the reforms made to self-referral laws (the Codey Act) in 2009. Lithotripsy was left out of the exemptions in 2009.

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MSNJ Legislative Update: December 20, 2013

All Payer Claims Databases

The Assembly Health Committee took testimony on the concept of creating an all payer claim database, partly for the purpose of determining proper charges and reimbursement for certain services, particularly out of network services.  MSNJ has testified on existing legislation, stating that APCDs can be a good tool. MSNJ opposes legislation that would create artificial limits on out of network charges and supports improvements on in network issues first. See media coverage here. 

 

Breast Density

The Assembly passed the final version of A2022/S792, which now heads to the Governor’s desk.  MSNJ worked on this bill in great detail. The bill 1) requires insurance companies to cover certain screenings, 2) requires physicians to provide information to  certain patients regarding breast density and 3) requires study of breast cancer risk factors. Radiology facilities must distribute to certain patients a notice that reads as follows: “Your mammogram may show that you have dense breast tissue 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, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider.  A report of your results was sent to your health care provider. You may also find more information about breast density at the website of the American College of Radiology.” The bill states that it does not impose a standard of care obligation upon a patient’s health care provider.  The bill requires the Mandated Health Benefits Advisory Commission to prepare a report regarding the implementation and administration of the bill, including analyses of social, medical and financial impact. The bill requires the Department of Health, in conjunction with the Medical Society of New Jersey, to convene a work group to review and report on strategies to improve the dialogue between patients and health care professionals regarding risk factors for breast cancer and breast imaging options. 

 

Self-Referral Laws

The Senate and Assembly have both passed A4222/S2779, which allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met. MSNJ and New Jersey urologists support this bill, which is a “clean up” to the reforms made to self-referral laws (the Codey Act) in 2009. Lithotripsy was left out of the exemptions in 2009.  The bill heads to the Governor.

 

Gender Changes on Birth Certificates

The Senate and Assembly have both passed A4097/S2876, which allows more people to change their birth certificates.  To obtain the amended certificate, a person would be required to submit:  1) a form provided by the State registrar of vital statistics and completed by the person’s licensed health care provider which indicates that the person has undergone clinically appropriate treatment for the purpose of gender transition, based on contemporary medical standards, or that the person has an intersex condition; and 2) a certified copy of a court order indicating the person’s name change, if the person has changed his or her name.  Under current law, a person is required to undergo sex reassignment surgery to receive an amended birth certificate.

 

Emergency Generators

The Assembly has passed A4324, which requires that certain health care facilities be either equipped with a generator or be equipped with an appropriate electrical transfer switch and wiring to which a portable generator can be connected in order to provide back-up electrical power to the facility.  Health care facilities included under the provisions of the bill are the following: nursing homes; assisted living facilities; comprehensive personal care homes; pediatric community transitional homes; federally qualified health centers; dialysis centers; hospice in-patient cares; or residential health care centers connected to another licensed facility.  The bill requires that these facilities be equipped with a generator or be generator ready within three years of the effective date of the bill.  The bill also requires the New Jersey Economic Development Authority (“authority”) to offer financial assistance in the form of low-interest loans to eligible facilities for the purchase and installation of a generator, or to make the facility generator ready (the loans are to have an interest rate of not greater than two percent). There is no Senate counterpart.

 

Reconstructive Breast Surgery

The Senate has passed S374, which grants a state sales tax exemption for services prescribed by a doctor in conjunction with reconstructive breast surgery. The procedures, currently subject to the 7 percent tax rate, are utilized to restore the appearance of the breast. The bill addresses a current loophole where insurance providers cover the costs of the procedures but pass on the cost of the sales tax to the patient.  The Assembly version of the bill, A4526, is awaiting final adoption, which will likely happen in lame duck.

 

Physician Loan Redemption

The Assembly Higher Education passed A4507, which establishes a Physician Loan Redemption Program. MSNJ, along with NJ AFP and COTH worked expediently to improve the bill that was passed by the Senate in a skeletal, flawed form.  This is a lame duck priority for policy makers and will reach the Governor’s desk this month. With our input, the bill now bill provides for redemption of eligible qualifying loan expenses for physicians who work for no less than four years at an approved site in the clinical practice of primary care or in the clinical practice of specialized care if the specialty is projected to experience a significant shortage. The bill also provides that the redemption of eligible qualifying loan expenses under the program will be exempt from the program participant’s individual New Jersey State income tax.  Also, in the case of an approved site that is a private primary care physician practice that has hired a loan redemption program participant, the site will have a State income tax exemption for all practice revenues received from providing services under the Medicaid program.

 

Any Willing Provider

The Senate Health Committee took testimony on a bill that would prohibit an NJ insurance company from having exclusive contracts with providers. The bill stems from Horizon’s exclusive contract with LabCorp, but is not limited to lab services.  The Association of Health Plans opposes the bill, stating that keeping narrow networks is a business decision they should have the flexibility to make to control costs (for consumers). Please find MSNJ’s testimony here.

 

Student Eye Injuries

Both houses have passed a bill that requires the Commissioner of Education to develop an educational fact sheet that provides information about sports-related eye injuries.  Each school district and nonpublic school is to distribute the fact sheet annually to the parents or guardians of the students.  The fact sheet is to include, but not be limited to:

      —   a list of the most common sports-related eye injuries and the recognition of the symptoms of those injuries;

      — a recommendation that children seek treatment and advice from a licensed health care professional regarding the appropriate amount of time to delay the return to sports after injury     

—   a recommendation that all children participating in school sports or recreational sports wear protective eyewear;

      —   information concerning the purchase of appropriate protective eyewear; and

      —   any other information the commissioner deems appropriate.

 

Latex Gloves

The Assembly passed a bill that directs the Commissioner of Health to develop a plan to phase out the use of latex gloves in licensed health care facilities and food service establishments to address consumer latex allergies.  The Senate will likely pass the bill soon.

 

Student Health

The Assembly has passed A4415/S2367.  This bill, the “Sudden Cardiac Arrest Prevention Act”, provides student-athletes, parents, and coaches with information on sudden cardiac arrest and establishes protocol concerning removal-from-play for athletes exhibiting symptoms of sudden cardiac arrest.  The following organizations were in support of the bill: NJ Chapter of American College Emergency Physicians, American Heart Association, NJ School Boards Association and the Athletic Trainers Association of NJ.  As previously reported, the Senate passed the bill in June.

 

Mental Health Screenings

The Assembly has passed A3155, which concerns assessments of persons believed to be in need of involuntary commitment to treatment.  The bill requires that an assessment be performed prior to the performance of routine laboratory and diagnostic testing.  If, as a result of the assessment, involuntary commitment to treatment seems necessary, then the routine laboratory and diagnostic testing is to be performed.  (Laboratory and diagnostic testing is currently completed and submitted to screening services before the assessment, so this bill seeks to avoid such testing expenses if the person does not need commitment, and to reduce hospital emergency room waiting times because staff would not have to wait for test results to be reviewed before the assessment is performed.) There is no Senate counterpart.

 

Declaration of Death

Both houses have passed A3586/S2756, which removes the statutory authority of the Department of Health (DOH) and the State Board of Medical Examiners (BME) over medical standards governing declarations of death upon the basis of neurological criteria.  The bill requires that a declaration of death upon the basis of neurological criteria be made by a licensed physician professionally qualified by specialty or expertise, based upon the exercise of the physician’s best medical judgment and in accordance with currently accepted medical standards.  Joint DOH/BME regulations would no longer be needed to set forth currently accepted medical standards (including criteria, tests, and procedures) to govern declarations of death upon the basis of neurological criteria.  If they are used, the regulations concerning the declaration of death upon the basis of neurological criteria may not require the use of any specific test or procedure in the declaration of death upon the basis of such criteria.

MSNJ supports this bill.

 

Breast Milk

The Assembly has passed two bills concerning breast milk. A3702 requires the Commissioner of Health to establish a public awareness campaign to advise pregnant women, new parents, and women who are breast feeding their children about the dangers of casual milk sharing.  The campaign would, at a minimum, provide information on: risk factors associated with casual milk sharing, including disease transmission and contamination from drugs, germs, or chemicals; the federal Food and Drug Administration’s warning against mothers using donated breast milk obtained directly from individuals or other unknown sources; and human milk banks and the procedures they use to select donors and collect, process, store, dispense, or sell donated breast milk.

 

A3703 gives the Department of Health the authority to license and inspect human milk banks, including an inspection of records, files, and other data, and requires the commissioner to promulgate rules and regulations for the operation and maintenance of human milk banks.  The regulations governing human milk banks would include provisions for: staff qualifications; procedures for selecting and screening potential donors; standards for the collection, processing, storage, and distribution of donated breast milk; the maintenance and confidentiality of milk bank records; and license application, issuance, renewal, expiration, denial, suspension, and revocation.

 

Student Asthma

The Assembly Education Committee has passed A954, which creates a 16-member School Asthma Protocol Task Force.  The membership of the task force would include: the Commissioners of Education and Health and 14 public members to be appointed by the Governor as follows: four persons who are parents of children with asthma who are attending a public or nonpublic school; a licensed physician who is a pulmonary specialist; a licensed pediatrician; a certified school nurse; an advanced practice nurse certified in pediatric nursing; a school administrator; a public school teacher; a public school principal or supervisor; a local school board member; a representative of a nonpublic school; and a representative of the American Lung Association.  The task force would be responsible for selecting a school asthma protocol and developing guidelines for the most appropriate and effective means of implementing the selected school asthma protocol on a Statewide basis.  There is no Senate counterpart.

 

Medical Marijuana

The Assembly has passed A4537 which would permit State medical marijuana patients and their primary caregivers to possess, and patients to use, medical marijuana legally obtained from another jurisdiction.  The bill would also permit qualifying out-of-State medical marijuana patients and their primary caregivers to engage in any conduct related to medical marijuana permitted under New Jersey law.  In both situations, the other jurisdiction’s medical marijuana law must be recognized by the Department of Health.  The bill would additionally provide that both parents of a patient who is a minor may serve as the minor’s primary caregivers under the State medical marijuana program, and that a parent who is currently serving as a primary caregiver may concurrently serve as primary caregiver to any minor child of the parent who is a qualifying patient.  There has not yet been action on the Senate counterpart.

www.acr.org

Dense Breast Legislation Update

A bill which MSNJ has been working on in great detail requires insurance companies to cover certain screenings and requires physicians to provide information to  certain patients. The bill was amended this week so the lay letter that physicians must distribute to certain patients reads as follows: A facility that provides a mammography report pursuant to the federal Mammography Quality Standards Act, 42 U.S.C. s.263b, shall include the following information, at a minimum, in the mammography report sent to the patient and the patient’s health care provider:

“Your mammogram may show that you have dense breast tissue 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, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider.  A report of your results was sent to your health care provider.” You may also find more information about breast density at the website of the American College of Radiology, www.acr.org.”

In addition, three sections were added that would (1) clarify that the bill does not impose a standard of care obligation upon a patient’s health care provider (2) require the Mandated Health Benefits Advisory Commission to prepare a report regarding the implementation and administration of the bill, including analyses of social, medical and financial impact and (3) requires the Department of Health, in conjunction with the Medical Society of New Jersey, to convene a work group to review and report on strategies to improve the dialogue between patients and health care professionals regarding risk factors for breast cancer and breast imaging options.  MSNJ continues to work with legislators on this bill.

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.

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.

MSNJ’s ‘News From Trenton’

News from Trenton

AMA National Advocacy Conference (NAC)

This week, Mary F. Campagnolo, MD, MBA and John Poole, MD, along with MSNJ CEO Larry Downs and COO and Senior Manager, Legislation, Mishael Azam, attended the AMA’s National Advocacy Conference. They heard from national leaders, including Secretary Sebelius, on federal budget issues, SGR reform and GME changes. They also met with staff for key members of the New Jersey Congressional delegation to discuss SGR and other reforms. A House Energy and Commerce held a hearing on Thursday entitled, ‘SGR: Data, Measures and Models; Building a Future Medicare Physician Payment System.’ MSNJ will keep members apprised of these issues. Read more.

Tanning for Minors
On Thursday, the Assembly took a final vote on a bill that would (1) permit a tanning facility operator to allow minors who are at least 14 years of age to use a tanning facility for spray tanning and (2) permit a minor who is at least 17 years of age to use a tanning bed in a tanning facility, provided that the minor’s parent or guardian is present at the tanning facility for the initial consultation. Tanning facility operators must also post notice of the law in conspicuous view near the reception area. The bill now heads to the Governor’s desk.

Gun Control Measures
The Assembly Law and Public Safety Committee on Wednesday heard over 20 bills on gun control. MSNJ weighed in on a mental health bill and successfully sought amendments to protect physicians. The amended bill requires licensed medical professionals in this State to report to the Attorney General when, in their reasonable professional judgment, a patient they are treating is likely to engage in conduct that would result in serious harm to that patient or others. As amended, the bill clarifies that the licensed practitioner who discloses such a privileged communication in is immune from civil liability in regard to that disclosure. The goal of the bill is for the AG to seize weapons from such patients, if appropriate. The bill leaves in place current immunity for physicians from civil liability for a patient’s violent act against another person or against himself. The bill also leaves in place duty to warn requirements and immunity if the duty is upheld. The bill heads to the floor for a full vote but has not yet been considered by the Senate.

Child Privacy
In the Assembly Education Committee, MSNJ supported protections of child privacy. Current law states that, a school district must receive prior written informed parental consent before it administers to students any academic or nonacademic survey, assessment, analysis or evaluation which reveals information concerning:

  1. political affiliations;
  2. mental and psychological problems potentially embarrassing to the student or the student’s family;
  3. sexual behavior and attitudes;
  4. illegal, anti-social, self-incriminating and demeaning behavior;
  5. critical appraisals of other individuals with whom a respondent has a close family relationship;
  6. legally recognized privileged or analogous relationships, such as those of lawyers, physicians, and ministers;
  7. income, other than that required by law to determine eligibility for participation in a program or for receiving financial assistance under a program; or
  8. social security number.

The bill would loosen parental control requirements by only requiring consent if participation in such surveys is required by the school. If the survey is voluntary, only written notice is required. But, voluntary surveys may not request the student’s political affiliation, sexual behavior and attitudes or social security number.