September 19, 2019

September 19, 2019

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April, 2019 Regulatory Developments

Here are the most recent health care related regulatory developments as published in the New Jersey Register in April, 2019:

  • On April 1, 2019, 51 N.J.R. 452(a), the Department of Human Services, Division Of Medical Assistance and Health Services proposed amendments to N.J.A.C. 10:74, Managed Health Care Services for Medicaid and NJ FamilyCare Beneficiaries. The proposed readoption regulates the enrollment of Medicaid and NJ FamilyCare beneficiaries into managed care as a health care delivery system and the provision of services by a managed care organization (MCO) to these beneficiaries. Notably, there are new proposed definitions of “Comprehensive Waiver” and “MLTSS”.
  • On April 1, 2019, 51 N.J.R. 473(a), the Department of Law and Public Safety, Division of Consumer Affairs, State Board of Optometrists adopted amendments to N.J.A.C. 13:38-7.3, requiring optometrists to complete, at a minimum, one credit for educational programs or topics that concern the prescription of hydrocodone, or the prescription of opioid drugs in general, including responsible prescribing practices, the alternatives to the use of opioids for the management and treatment of pain, and the risks and signs of opioid abuse, addiction, and diversion.
  • On April 1, 2019, at 51 N.J.R. 481(a), the Department of Banking and Insurance, Division of Insurance, Office of the Commissioner published a notice regarding the minimum deposit requirements for Health Maintenance Organizations (HMOs) and 3.3% increase in the medical component of the CPI for all urban consumers in the New York-Northern New Jersey-Long Island region and the Philadelphia-Wilmington-Atlantic City region as reported by the United States Department of Labor, Bureau of Labor Statistics Existing HMOs shall make adjustment for their minimum net worth no later than July 1, 2019. The required deposit shall be made no later than July 1, 2019, pursuant to N.J.A.C. 11:24-11.4(e) to include the specific CPI adjustment.
  • On April 1, 2019, at 51 N.J.R. 481(b), the Department of Banking and Insurance, Division of Insurance, Office of the Commissioner published a notice regarding the minimum net worth requirements for Health Maintenance Organizations (HMOs) and 3.3% increase in the medical component of the CPI for all urban consumers in the New York-Northern New Jersey-Long Island region and the Philadelphia-Wilmington-Atlantic City region as reported by the United States Department of Labor, Bureau of Labor Statistics Existing HMOs shall make adjustment for their minimum net worth no later than July 1, 2019. The required deposit shall be made no later than July 1, 2019, pursuant to N.J.A.C. 11:24-11.4(e) to include the specific CPI adjustment.
  • On April 15, 2019, at 51 N.J.R. 501(b), the Department of Banking and Insurance, Division of Insurance, Office of the Commissioner adopted amended rules regarding permissible network deductibles and network coinsurances in contracts issued by HMOs that provide out-of-network benefits for emergency and urgent care. See rule at N.J.A.C 11:22.
  • On April 15, 2019, at 51 N.J.R. 509(a), the Department of Health, Office of the Commissioner published a notice of cancellation of a certificate of need call for new specialized long-term care beds for severe behavior management. The call for CN applications was scheduled for January 2, 2019.The Department has determined there is not a need for new specialized long-term care beds for severe behavior management at this time. On January 2, 2018, the Department had issued a certificate of need call for additional specialized long-term care beds for severe behavior management at 50 N.J.R. 260(b). In response to this call, the Department received applications from several applicants, which are currently under review by the Department. The next scheduled call for new specialized long-term care beds for severe behavior management will be January 2, 2020. The Department will continue to monitor the utilization and availability of specialized long-term care beds for severe behavior management and, should the need arise, issue a future call for these services prior to January 2, 2020.
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About this Author

Frank R. Ciesla, Giordano Law Firm Health Care Litigation Health Care Fraud and Abuse Tax Health & Hospital Law
Of Counsel

Mr. Ciesla is Chair Emeritus of the firm's Health Care Law Practice Area. His practice is primarily devoted to Health Care and Government Contracts Law. He counsels clients on legal developments facing healthcare providers in the modern health care environment. Firm clients include hospitals, nursing homes, physicians and physician groups, individual practice associations, home health agencies, ambulance carriers and industry-wide associations.

Mr. Ciesla advises such clients on business structures, mergers and consolidations, joint ventures, reorganization of health care providers...

732-741-3900
Beth Christian, Giordano Law firm, Health Care Attorney,Health Care Fraud and Abuse, Cannabis Law, Non-Profit Law
Shareholder

Ms. Christian's practice is devoted to Health Care Law and legal issues facing Health Care facilities licensed professionals and non-profit organizations. She has over twenty years of experience counseling clients on legal issues facing the modern health care and non-profit communities.

732-219-5485
Anjali Baxi, Giordano Halleran Law Firm, Healthcare Attorney, New Jersey health Law,Cannabis Law,Government Affairs,Business Transactions, Health Care Law Regulation, Medicare and NJ Medicaid Enrollment
Counsel

Anjali has been practicing law for 15 years, mainly focused on health care transactional and regulatory matters. She prepares and reviews LOIs, purchase agreements and other transaction documents for health care providers needed for the business transfer and necessary for the transfer of NJDOH and NJDHS licenses and provider numbers. She also reviews agreements required for the day to day operations of health care facilities.

She has counseled skilled nursing, assisted living, adult medical day care, outpatient facility clients and hospitals regarding NJDOH regulatory requirements,...

732-741-3900
Ari G. Burd, Shareholder, Giordano Law Firm, Labor & Employment, Cannabis Law, Health Care
Shareholder

Ari devotes his time to assisting and defending employers with regard to traditional employment issues. He frequently counsels employers for compliance with New Jersey laws and has extensive transactional and litigation experience.

Ari has litigated employment matters throughout the state, having made appearances in almost every Superior Court in New Jersey, as well as before both Federal District Courts in New Jersey and the Federal and State Courts in New York.  These actions have involved a diverse range of claims such as wrongful discharge, discrimination, harassment,...

732-741-3900