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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 Attorney
Shareholder

Mr. Ciesla is chair 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, ongoing...

732-741-3900
Beth Christian, Giordano Law firm, Health Care Attorney
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
Attorney

Anjali has over 12 years of experience in healthcare transactional matters.  She prepares corporate documents, purchase agreements and other transaction documents for health care providers necessary for the corporate transfer and necessary for the transfer of NJDOH and NJDHS licenses and provider numbers. She has counseled skilled nursing, assisted living, adult medical day care, and outpatient facility clients regarding New Jersey Department of Health (NJDOH) regulatory requirements and licensure process.

Anjali has prepared and managed...

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Ari G. Burd, Giordano Law Firm, Labor Employment Attorney
Associate

Mr. Burd practices in both the Labor and Employment Law Practice Area and the Health Care Practice Area. In the Labor and Employment Practice Area, Mr. Burd devotes his time to litigation and counseling employers with regard to traditional employment and labor related issues. Mr. Burd has extensive experience in both the state and federal courts in areas including retaliation, wrongful termination, wage and hour, sexual harassment and race, age, gender and disability discrimination. Mr. Burd also has considerable experience in assisting negotiating and drafting employment related...

732-741-3900