From the Statehouse
From the Legal Counsel
Governor Corzine Files Plan to Facilitate Third Allopathic
Medical School in NJ
Important Dates
2010 Annual
Meeting
April 17, 2010
The Westin Princeton
2011 Annual
Meeting
April 16, 2011
The Westin Princeton
More details to
come!
From the Statehouse...Beverly
J. Lynch
We're in the home stretch of the 213th New Jersey Legislative
session, with just six months remaining before the session
adjourns in early January, 2010. Over 7,500 bills have been
introduced (and 211 signed into law).
The budget process is complete - and on June 29th the
Governor signed the FY 2010 $28.9 billion budget (about $4
billion less than last year).
The Legislature is now on its traditional summer hiatus, and the
Senate will most likely return to business after Labor Day. This
year, the 80-member Assembly is on the November ballot, and
therefore, isn't expected to return to Trenton until the
election is complete. We will then move into the "lame duck"
session, 2 ½ month timeframe between the election and the
swearing in of the new Legislature in January, 2010. This is
traditionally a crazy, frenzied period where hundreds of bills
are pushed through quickly. If a bill is not on the Governor's
desk by the close of business on the second Monday of January,
2010 (January 11), it will be thrown out. So the rush will be on
to advance legislation.
This year is the first time a Lieutenant Governor will be on the
ballot with the gubernatorial candidates. Rumors are swirling
about possible names for this new slot.
Important issues facing the New Jersey physician community
include:
-
Assignment of
Benefits - legislation that would direct reimbursement to
the physician who cared for the out-of-network patient.
-
Chiropractic
Scope of Practice - legislation which increases their
ability to treat patients.
-
PIP Fee
Schedule - we're awaiting the Appellate Court decision on
the implementation of the Department of Banking and
Insurance regulations, that will guide our strategy.
For information on these or any legislative or regulatory
activity, please don't hesitate to contact Beverly Lynch, at
(609) 392-7553 or
BLYNCH@BLYNCHASSOCIATES.COM.
Legal Report...Kern
Augustine Conroy & Schoppmann, P.C.
DOBI Proposes Major Amendments to Managed Care Provider Network
Rules
The NJ Dept of Banking & Insurance (DOBI) has proposed rules
significantly changing the requirements for managed care
provider network agreements. Expanding the current minimal
requirements for provider network agreements, DOBI proposes to
require that carriers: complete provider credentialing within
specific timeframes; deliver provider agreements, amendments and
fee schedules to providers within specific timeframes; include a
summary disclosure form of a provider agreement along with the
full agreement; follow a specific process within certain
timeframes for amending and renewing provider agreements;
exclude "most favored nation" type clauses; establish and
maintain specialty-specific fee schedules and reimburse
providers pursuant to the fee schedule included in the provider
agreement; maintain on their websites certain information
concerning fee schedules and provider network directories;
maintain directories in written and electronic format; obtain
current directory information from providers on a quarterly
basis and update the directories at least every 6 months; and
annually submit confirmation to DOBI of compliance with the new
rules. The proposal can be reviewed on our website:
www.drlaw.com. Comments on the proposal are due to DOBI by
August 14, 2009, and can be sent to Robert Melillo, Chief, DOBI
Legislative & Regulatory Affairs by fax to 609-292-0896.
OIG Issues Second Advisory Opinion Regarding On-Call Coverage
Compensation
A recent opinion by the Office of Inspector General of the
Department of Health & Human Services ("OIG") may place
hospitals and their medical staffs at opposite ends of the
bargaining table when it comes to paying for caring for the
uninsured and indigent. In its second ruling on the subject, OIG
has advised that hospitals can not only compensate physicians
for on-call services performed on behalf of their uninsured
patients on a per diem basis, but can also do so on a
fee-for-service basis, if key elements are present in the
compensation arrangement. In approving the plan, the OIG opined
that the key inquiry is whether the compensation is: (I) fair
market value in an arm's-length transaction for actual and
necessary items or services; and (ii) not determined in any
manner that takes into account the volume or value of referrals
or other business generated between the parties. For more
information on the opinion and the specific arrangement it
addresses, visit our website:
www.drlaw.com.
Fraud Enforcement & Recovery Act is Now Law
The federal Fraud Enforcement & Recovery Act ("FERA") has been
signed into law. FERA is intended to facilitate federal health
care fraud investigations by increasing funding to federal
agencies, expanding the reach of the False Claims Act, and
increasing penalties for violations. The new law also
effectively increases the period of time that the government is
permitted to file a lawsuit against a provider. If you receive
notice of a program safeguard contractor audit or other
regulatory scrutiny, contact KACS' White Collar Crime Section
for assistance.
New HIPAA Requirements Under ARRA
The American Recovery and Reinvestment Act ("ARRA") contains
several new requirements for HIPAA covered entities and
increases civil monetary penalties to be levied against
violators. Notable changes include: new reporting requirements
for breaches of confidentiality involving a patient's unsecured
protected health information ("PHI"), including notice to the
U.S. Department of Health & Human Services ("HHS") upon certain
breaches; and the direct application of HIPAA security
regulations to a covered entity's business associates (such as
billing companies). Although the regulations are yet to be
proposed, HHS has issued guidance specifying the technologies
and methodologies that would render PHI "unusable, unreadable,
and undecipherable" to unauthorized persons. If entities utilize
these technologies to secure their PHI, they would not be
required to provide the notifications in the event of an
information breach, although state requirements and other HIPAA
Privacy and Security requirements would still apply. Physicians
will need to revise their HIPAA protocols and safeguards to
address these new rules. KACS will be developing compliance
materials, to be available on our website at
www.drlaw.com, once the
regulations are published later this summer.
Governor Corzine Files Plan to Facilitate Third Allopathic
Medical School in NJ
With the state facing a chronic shortage of doctors and schools
at which to train them, Governor Jon S. Corzine announced the
filing of an executive reorganization plan that will facilitate
construction of a third four-year allopathic medical school in
New Jersey.
The medical school will be part of Rowan University in
affiliation with Cooper University Hospital and will be located
in Camden on the Health Care Campus of Cooper University
Hospital. To allow Rowan to move forward with the creation of
the new, four-year medical school, the reorganization plan
will transfer from the University of Medicine and Dentistry of
New Jersey to Rowan University certain functions and resources
now used by UMDNJ's Robert Wood Johnson Medical School-Camden
for its third- and fourth-year medical school related programs. The plan, which was submitted to the
Legislature, provides a transition period to allow for an
orderly transfer and ensure proper allocation of resources.
The new four-year school would build on the existing Robert Wood
Johnson Medical School, which has been located in Camden since
1981. Three hundred Cooper physicians comprise the clinical
faculty at RWJMS and provide training for third- and fourth-year medical students. Those
Cooper physicians would become faculty of the new school. A dean
and basic sciences faculty would be recruited while Rowan
University applied for formal accreditation by the Liaison
Committee on Medical Education.
Existing resources and annual level of funding to RWJMS-Camden
are sufficient to fully fund the four-year medical school, when
the inclusion of tuition from additional students and research
grants and contracts are taken into account. The plan provides
for teaching to continue by RWJMS-Camden medical students in Camden until 2013.
The Legislature, which first appropriated funds toward this
project in 2002, has sixty days to review the plan. It will
become effective at the end of that period, unless the
Legislature votes to disapprove the plan.
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