From the Statehouse
From the Legal Counsel
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
DHSS Awarded Federal Stimulus Grant to Reduce Infections
in Ambulatory Surgery Centers
New Jersey is one of 12 states awarded a federal grant as part
of a nationwide effort to reduce infections acquired in
ambulatory surgery centers. The New Jersey Department of Health
and Senior Services has been awarded $125,000 in funding from
the federal Centers for Medicare and Medicaid Services to
conduct on-site surveys of ambulatory surgery centers to ensure
that they are following Medicare's health and safety standards,
especially in regard to infection control. The funding was made
available through the American Recovery and Reinvestment Act (ARRA)
Act. New Jersey received the largest grant of any state.
DHSS will use a new survey process the federal government
developed so inspectors can examine a facility's infection
control practices in greater depth. The process was developed in
conjunction with the U.S. Centers for Disease Control and
Prevention.
By October 1, all states will be required to adopt the new
inspection tool and increase the frequency of inspections in all
ambulatory care facilities certified to treat Medicare patients.
States perform these inspections on behalf of the Medicare
program under grants and special agreements with the federal
government.
New Jersey's approximately 100 licensed ambulatory surgery
centers are inspected every two years under extensive state
licensing rules that include requirements for proper infection
control. For ambulatory surgical centers that also participate
in Medicare, DHSS conducts additional federal inspections which
currently are only required every seven years. Beginning October
1, states will receive a total of $9 million to conduct federal
inspections every three years and use the more intensive survey
process during those inspections.
New Jersey has conducted 14 federal inspections so far this year
and will perform 17 more before September 30. DHSS expects to
conduct about 30 a year starting October 1.
Legal Report...Kern
Augustine Conroy & Schoppmann, P.C.
CMS Issues Proposed 2010 Physician Fee Schedule
The 2010 Physician Fee Schedule proposed by the Centers for
Medicare & Medicaid Services (CMS) would increase reimbursement
for primary care physicians, with a corresponding reduction in
payments to specialists. In nearly all cases, services currently
billed as consultation would have to be billed with evaluation
and management codes as new or established office visits,
initial hospital visits or initial nursing facility visits, with
the savings used to increase reimbursement for E&M services.
Payment for the initial preventive physical exam would also
increase. In-office imaging services would see lowered
reimbursement and IDTFs, mobile units, and physician offices
that provide advanced imaging services (MRI, CT, and PET) would
have to be accredited by January 1, 2012. To view the proposal,
visit our website: www.drlaw.com.
Bill Package Introduced in NJ Legislature
NJ Physicians and the NJ Medical Group Management Association
have been successful in getting a trio of bills introduced in
the NJ legislature. A-4161 requires certain insurance companies,
in their annual loss ratio report to DOBI, to provide specific
information about administrative expenses in comparison to
amounts expended for payment of claims, e.g., allocation of
costs to executive salaries and benefits, broker fees,
advertising, lobbying, and travel and entertainment expenses.
A-4162 would provide certain protections for providers in
participation agreements and create administrative efficiencies,
including, among other things: mandating machine-readable
patient ID cards; not requiring a physician to participate in
any managed care plan other than those specified in the
contract; prohibiting "most favored nation" clauses; requiring
commercial payors to provide a set fee schedule for each
calendar year of the contract; mandating certain disclosures by
payors regarding negotiated fees and rates; and making changes
to how payor contracts are amended. A-4163 provides for the
regulation of physician profiling programs operating in the
state. The bills can be reviewed on our website:
www.drlaw.com.
DOBI Proposes PIP Rule Revisions
The NJ Dept of Banking & Insurance (DOBI) has proposed
amendments to its Personal Injury Protection (PIP) Medical
Protocols and Alternate Dispute Resolution rules. The amendments
would add a definition for "ambulatory surgery facility" and
"ambulatory surgical center" as meaning: 1) a licensed
ambulatory surgical facility in which ambulatory surgical cases
are performed and where the license is corporately, financially
and administratively separate from any other facility license or
2) a physician-owned single operating room in an office setting
that is certified by Medicare. No mention is made of "registered
surgical practices" or whether "certified by Medicare" includes
accreditation by a Medicare-recognized deeming authority (which
is allowed under the recent Codey law amendments governing
surgical practices). Other amendments would allow insurers to
waive deductibles and copayments if an insured is treated by an
in-network provider in an organized delivery system contracted
with the insurer; prohibit insurers from requiring
precertification of the evaluation and management visit for a
new patient; permit insurers to have voluntary networks for
services provided in ambulatory surgery facilities; and require
speedier resolution of medical necessity denials. The proposal
can be reviewed on our website:
www.drlaw.com. Comments on the proposal are due to DOBI by
September 4, 2009, and can be sent by email to Robert Melillo,
Chief, DOBI Legislative & RegulatoryAffairs, at
legsregs@dobi.state.nj.us or by fax to 609-292-0896.
FTC Enforcement of the Red Flags Rule Delayed Again
The Federal Trade Commission (FTC) has announced that it has
delayed, yet again, enforcement of the Red Flags Rule. The Red
Flags Rule, to be enforced effective November 1, 2009, requires
covered entities to implement an identity theft prevention
program. While many efforts are underway to challenge the
application of the Red Flags Rule to physician practices and
small health care facilities, New Jersey laws already require
identity theft prevention. Physicians who have not yet developed
an identity theft prevention program in conformance with the Red
Flags Rule and applicable state law can find materials on our
website, www.drlaw.com, to
adapt to their practice.
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