Recent changes to the New York State Medicaid Program affect vaccine administration for pharmacies, claiming process for nurse practitioners, documentation requirements for transportation providers, and prior authorization for physical and occupational therapists. We summarize these changes.
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The New Jersey’s Prescription Monitoring Program (NJPMP), aimed at halting the abuse and diversion of prescription drugs, was substantially updated recently to impose new requirements on prescribers of Schedule II drugs and, separately, to stiffen penalties for pharmacists failing to timely report information about dispensing of the controlled dangerous substance (“CDS”). The Centers for Medicare & Medicaid Services (CMS) recently announced another six month extension of moratoria on new home health agencies, home health agency sub-units, and Part B ground ambulance suppliers in certain locations throughout the country. A new law impacting New York out-of-network providers, called the Emergency Services and Surprise Bill, went into effect on March 31, 2015, that will require providers to update their operations if they do not already comply with the legal requirements. On March 13, 2015, Gov. Cuomo signed an amendment extending by one year, until March 27, 2016, the implementation date for the mandatory electronic prescribing. Deniza Gertsberg, Esq. will be speaking during the upcoming NJSBA Health Law Section program on “Fundamentals of Medicare Provider Enrollment/Revalidation”. The program focuses on the steps in the Medicare enrollment/revalidation process and practical tips for successfully completing an enrollment/ revalidation, whether the attorney is submitting the 855 paper forms or using the Provider Enrollment Chain The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) made changes to the physician opt-out affidavit requirements. In a welcomed move, the Centers for Medicare & Medicaid Services (CMS) and American Medical Association (AMA) announced elimination of certain sanctions and penalties during ICD-10 transition and the availability of additional resources to help physicians get ready for ICD-10. The Centers for Medicare & Medicaid Services (CMS) published full year of 2014 financial data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion. In a recent advisory opinion, the Office of Inspector General (OIG) nixed a proposed arrangement whereby a multi-regional laboratory (Lab) sought to provide free services to out-of-network patients in exchange for exclusivity in referrals from the physicians. Mandatory Electronic Prescribing Effective in NY. While the mandatory electronic prescribing was extended by Gov. Cuomo until March 27, 2016, e-prescribing for controlled and non-controlled substances is already available in New York for those meeting the regulatory requirements. Since 2011, NYS Medicaid Electronic Health Records Incentive Program has paid over $660 million in incentive funds “Physicians who enter into compensation arrangements such as medical directorships must ensure that those arrangements reflect fair market value for bona fide services the physicians actually provide,” warns the new fraud alert published by the Office of Inspector General (OIG). The Office of the Civil Rights (OCR) within the US Department of Health and Human Services recebtly settled a HIPAA violation case with a single location compounding pharmacy in Denver, Colorado. This is yet another HIPAA settlement underscoring the importance of properly implementing and maintaining a compliance plan. New York State Medicaid has a new vendor to implement the new Medicaid Management Information System (MMIS) that will eventually replace the current vendor (eMedNY). The new vendor, Xerox State Healthcare LLC, won a five year contract with the State. Implementation of the new system will occur in two phases over an eighteen month period. With labels such as “concierge medicine,” “VIP medicine,” “boutique medicine,” “exclusive practice,” “premium practices,” or “platinum medicine,” direct patient-doctor contractual arrangements have received their share of negative attention from the press as well as certain lawmakers since their inception in 1996. Perceived as medicine for the rich, some academics and ethicists worry that such “elitist” practices may cause access to care problems and would further “exacerbate the already tiered healthcare system, accelerate the fragmentation of insurance risk pools through cherry picking of the healthier patients, and promote the nonmedical services and amenities.” In 2014, the Office of the Inspector General of the U.S. Department of Health and Human Services (OIG) reported “expected recoveries of over $4.9 billion.” The agency also excluded 4,017 individuals and entities and took 971 criminal actions. Similarly, the OIG pursued 533 civil actions against individuals and entities. According to the agency’s 2015 work The mission of the Medicaid Fraud Division (MFD) within the Office of the State Comptroller is to prevent, detect, audit and investigate fraud, waste and abuse by New Jersey providers and recipients. As we look forward to the New Jersey Medicaid Fraud Division 2015 work plan, we look back at the agency’s activities in 2014. Deniza Gertsberg, Esq. will be speaking during “Elements of Fraud and Abuse Investigation” presentation. The event focuses on the basics of a New Jersey Medicaid fraud and abuse investigation. The topics that will be discussed include responding to subpoenas, self disclosure and the use of statistical sampling in audits. The Deputy Director of New Jersey Medicaid Fraud Division, Mark Moskovits and former Director of the Medicaid Fraud Control Unit, Riza I. Dagli will also be presenting. Deniza Gertsberg, Esq. is one of the organizers of this New Jersey State Bar Association event which is open to all members of the NJSBA’s Health Law Section. New York State Social Service Law §363-d and implementing regulations at 18 NYCRR §521 require that certain healthcare providers adopt and implement an effective compliance program and certify their compliance with the law every December. Last year, CMS issued a final rule which requires prescribers of Part D drugs to be either enrolled with Medicare or have submitted an opt-out affidavit to their Medicare Administrative Contractor (MAC) in order for a prescription to be eligible for coverage under the Part D program. See 42 CFR § 423.120(c)(5) and (6). |
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