In recent years, many laws have been proposed and enacted in New Jersey that impact healthcare. This year is no exception, with some benefiting providers or patients and others increasing the regulatory burden on providers. Over the past few months, the New Jersey State Senate and Assembly have passed some 20 health care laws in New Jersey. The following deals with two of these laws. The first is the long-awaited Telemedicine Act which maintains equal pay rates for telemedicine and in-person visits. The second involves a law that places additional obligations on nursing homes and other facilities that care for the elderly.
These two bills have been passed by the Senate and the State Assembly and will become law if the governor carries them out.
New Jersey to make equal tariffs for telemedicine and in-person visits permanent
S2559: During the COVID-19 pandemic, New Jersey has asked health insurance companies to pay for telemedicine visits at the same rate as in-person visits, but those orders will expire soon. (See Update June 17, 2021). This bill amends the various laws that apply to telemedicine, the State Medicaid and NJ FamilyCare programs, the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP), to require companies to health insurance to pay for telemedicine services. regarding all physical and behavioral health care services at the same rate as in-person visits, including remote monitoring of patients. The supplier must use both an audio component and a video component to be eligible for the tariff.
Significantly, the bill changes the definition of “telemedicine” to include audio-only telephone conversation, but the provider will be reimbursed at a lower rate, but not less than 50% of the reimbursement rate for an in-person visit. However, a behavioral health service that uses audio only, whether or not it is used in combination with asynchronous storage and forwarding technology, is still eligible for a full refund. Quotas, deductibles and coinsurance apply.
In addition, at the time a patient requests health services to be provided by telemedicine, the provider must advise the patient whether the meeting will be with a health care provider who is not a physician, and the patient can specifically ask that the meeting be scheduled with a doctor. If the patient requests that the meeting be with a physician, the meeting should be scheduled with a physician.
It is important to note that the benefit of this law does not apply to a health service provided by a telemedicine organization that does not provide in-person health services in New Jersey. In other words, the telemedicine organization must offer the same services in person as through telemedicine.
This bill maintains the benefits provided during the pandemic with respect to COVID-19. Specifically, health insurance companies must provide coverage without imposing cost-sharing requirements, including deductibles, copayments or coinsurance, pre-authorization requirements, or other management requirements. medical, for the following services provided during any part of the federal state of emergency: (1) testing for COVID-19, provided a health care provider has issued a medical prescription for the test; and (2) items and services provided or provided to a person during visits to a health care provider’s office, including in-person visits and telemedicine and telehealth meetings, visits to health care facilities emergency and emergency department visits, which result in an order for a COVID-19 test.
New requirements for nursing homes and other senior care facilities
S2798: This bill changes the definition of “long-term care facility” to a nursing home and removes an assisted living facility, comprehensive personal care home, residential health care facility, or nursing home from the definition. dementia care home. While long-term care facilities have always been required to have an outbreak response plan, this bill makes it a condition of licensing.
In addition, this bill requires every long-term care facility to establish an infection prevention and control committee and assign to that committee a doctor who has completed an infectious disease fellowship, and this doctor must be employed. full-time or part-time depending on the size of the facility. The committee must also appoint an infection prevention specialist who has primary professional training in medicine, nursing, medical technology, microbiology, epidemiology or a related field and has at least five years of experience in control. infection or infection control certification by the Infection Certification Board. Control and epidemiology. A long-term care facility that is unable to hire a full-time or part-time Infection Control Specialist may contract with an Infection Control Specialist in an advisory capacity until 1 February 2022. After February 1, 2022, a healthcare facility must hire a full-time or part-time infection prevention specialist, except that the Department of Health may waive this requirement if a healthcare facility long term is unable to hire an infection control specialist due to the institution’s good faith efforts to hire an infection control specialist.
The bill then defines assisted living facilities, comprehensive personal care homes, residential health care facilities and dementia care homes, and requires these facilities to also develop an outbreak response plan as a condition of license to practice and establish an infection prevention and control committee. , except that the committee should only include an infection prevention specialist who meets certain requirements.
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