Trenton Update – Claudine M. Leone
June 7, 2016
The Legislature is at a running pace right now working on the FY2016-2017 budget and its normal business. They take their unofficial break by June 30 when the budget is constitutionally required to be completed and in place by July 1.
The Budget: It is rather quiet on the budget front in terms of health care. Governor Christie has an unspecified savings of $250 million from the State Health Benefits Plan and is asking the SHBP to come up with a plan for those savings. However, there is no agreement on where that savings comes from. If the SHBP doesn’t come up with that savings, then the budget is out of balance and that is not allowed. Out of Network comes up in this discussion specific to the SHBP and potential savings, but nothing has been proposed at this time from the SHBP to find the $250 million the Governor is looking for.
Out of Network: The Out of Network Reform efforts took a temporary back seat to the announcement of Horizon’s OMNIA plan last year and implementation on January 1, 2016. The Legislature and the subject matter committees that also consider out of network reform bills have been focused on legislation that would regulate tiered network products. However, recent developments, as you may have seen in the news, have brought Out of Network back to life in the NJ Legislature. The NJ Hospital Association, which has been working side by side with physicians and other providers in a Coalition for six years, announced this week that their Board approved a proposal on out of network reforms and have shared it with the sponsors: Senator Vitale and Assemblymen Coughlin, Schaer and Singleton. This proposal puts the NJ Hospital Association directly in conflict with the physician groups and some individual health systems. Generally, the NJHA is proposing that all physicians with exclusive contracts with the hospital be required to be in the same networks as the hospital. If they are not in the same network as the hospital they would be prohibited from balance billing and must accept the in network rate to provide services at that hospital. They NJHA has also supported the concept of “baseball arbitration” for physicians, but have asked to be exempt from the arbitration provisions of the legislation, themselves. This is a very fluid issue and we will likely be working on this through the summer and fall, again. The Coalition maintains that disclosure to patients about a physician’s network status is one way to prevent patients receiving surprise bills from providers and that any conflict between the plan and the physician should be resolved by a peer review arbitration process.
Opiate Legislation: There are several more bills this session attempting to address the opiate and heroin abuse in the state. This year the focus appears to be on limiting the amount of Scheduled II CDS a physician/nurse practitioner or physician assistant can initially prescribe to a patient to treat their pain. Some bills mirror the CDC guidelines for primary care which states a recommended initial prescription of a 7-day supply, but gives prescribers the flexibility to exercise their judgment to prescribe more than a 7-day supply. Other bills want to put a dead stop on initial prescriptions of 7 day or 3 day supplies. Others are looking for limitations on day supplies when the prescription is for a minor. This is the new opiate issue. These bills only except hospice patients from these limitations and make no distinction between acute and chronic pain. This will be the big opiate debate for the 2016-2017 legislative session.
Hepatitis C Legislation: Legislation that would require physicians to offer a screening for Hepatitis C is also worth mentioning. The bill that passed the Senate would require ALL physicians regardless of specialty to offer Hep C screening to their patients that fall within the CDC’s targeted age group. This is inpatient, emergency department or ambulatory care setting. This is a Senator Vitale bill and he is now negotiating with Assemblyman Conaway on a compromise. They were unable to agree and the bill has not received a hearing in the Assembly, thus far. Senator Vitale is willing to limit the screening requirement to primary care and emergency departments - removing inpatient screening and other specialties. New York has a law that currently only requires primary care and inpatient screening, specifically exempting emergency departments and other physician specialties. The CDC already requires primary care provers to offer screening to the targeted age group. Senator Vitale’s intention is to capture those patients that are not seeing their primary care physicians, hence, the broad scope of the original bill.