As you may be aware, November 1, 2018 marked the implementation of the law establishing a $140 Medicaid emergency room triage reimbursement fee for low-acuity ED encounters that was approved as part of the Budget in June.  As a result of NJACEP’s advocacy in June during the Budget process, this law ONLY applies to low-acuity FACILITY reimbursement fees for emergency and NOT professional fees associated with these visits.   To view the ED Triage Reimbursement Non-Emergency Diagnosis Codes, CLICK HERE.

NJACEP with our colleagues at the NJ Hospital Association and NJ Hospital Alliance remained engaged with the NJ Department of Human Services and the Division of Medicaid through the process of defining “low acuity” and the codes associated with the $140 triage rate.  Drs. Langer, Hochman and Eisenstein played a significant role with the Medicaid Medical Director and their in-house Medicaid billing specialists to discuss real-life clinical encounters to help limit the outpatient codes that would be deemed non-emergent and low acuity when implemented, particularly helpful with mental health exclusions.

So, we are pleased to report that DHS after consideration of the NJACEP and hospital input has decided to drastically limit the outpatient codes that would be deemed non-emergent and be subject to receive the $140 triage rate from the initial list of 17,000 outpatient codes to about 1,200 codes. The Budget estimated $29 Million in state savings from this initiative however with the Commissioner’s definition of low acuity; these changes will only save $1Million.

NJ-ACEP is happy to report that all necessary processes for NJPMP integration with PreManage ED have been approved, finalized and documents outlining the process have been posted on the NJPMP DCA webpage available at https://www.njconsumeraffairs.gov/pmp/Pages/NJPMP-Integration.aspx. 

NJ Prescription Monitoring Program - NJPMP Integration

All prescribers and pharmacists MUST be registered with the NJPMP in order to receive patients' NJPMP reports via integration. It is important for all users to maintain an active and accessible account on the original NJPMP AWARxE platform as there may be situations in which EHR/PMS users will be unable to complete patient queries via PMP Gateway.

Please read the NJPMP Integration Guide, complete the NJPMP Integration Request Form, and review and sign the NJPMP Terms and Conditions Agreement below to initiate the integration process.

The documents can be found at the bottom of the following link: https://www.njconsumeraffairs.gov/pmp/Pages/NJPMP-Integration.aspx

Chairman McKeon and Members of the Committee,

Thank you for the opportunity to answer questions many of you had during the hearing last week, specific to  emergency department care and how patients are currently protected from out of network emergency bills.

I am Dr. Margie Langer, a board-certified emergency   medicine physician and President of the NJ Chapter of the American College of Emergency Physicians.  I currently practice in an emergency department in Passaic County and prior to that I practiced in Essex County.  I am an Emergency Department Director responsible for the administration of the Emergency Department and the clinical care of patients in their time of greatest need and vulnerability.  I am here today hopefully to answer questions, specific to the staffing, network participation and billing of Emergency Departments (EDs). I hope you can indulge me slightly because it seems there is some basic Emergency 101 needed to understand who is providing care and submitting claims in an ED.   

Final Days of the 2016-2017 Legislative Session

SURPRISE COVERAGE/OON BILLING BILL STALLS

NJ MEDICAL SCRIBES AS PMP DELEGATES

NJPMP DATA TO BE SHARED WITH EDIE

ED EXEMPTION TO CHECK THE PMP PRESERVED – MANDATE DELAYED

New Jersey has a new Governor. Governor Phil Murphy was sworn into office with Lieutenant Governor Sheila Oliver at the War Memorial in Trenton today, January 16, 2018. The Executive and Legislative Branches are now all majority held by democrats. 

NJ-ACEP continues to represent the interests of emergency medicine and work with other specialist societies through the Access to Care Coalition and actively oppose the Out of Network Legislation (S-1285), sponsored by Senator Vitale.  Trenton is in the middle of a fierce Budget battle with a July 1 deadline and the Out of Network legislation has become tangled in this year's budget and other politically charged issues, once again, including Governor Christie and Senator Vitale's proposal to take $300 Million in Horizon's surplus for opioid addiction treatment (among other reforms for transparency within Horizon's organizational structure).

We learned late Friday night that S-1285, the OON Transparency/Disclosure/Arbitration legislation, would be added to the Senate Budget and Appropriations Committee for Monday without public notice and NJACEP leadership reached out to members of the Committee over the weekend, as did NJ-ACEP's lobbyist and the Coalition in advance of the hearing.  S-3299, the OON Transparency/ Disclosure-only legislation sponsored by Senators Sarlo (D) and Oroho (R) and supported by NJ-ACEP and the Coalition was also scheduled for the same hearing on Monday.   Putting both these bills on the committee agenda at the same time was a compromise by the sponsors and Senate leadership.  S-3299 addresses transparency and disclosure without setting prices or dispute resolution.

S-3299 was unanimously approved by the Committee Monday with support from the Coalition, individual specialty societies, and NJHA.  And, although 5 Republicans and Chairman Sarlo (D) abstained on the vote for S-1285, the balance of the democrats, some expressing reservations, supported S-1285 and it was approved by the Committee.  NJHA and the physician community all opposed S-1285.  NJHA had previously supported this measure and their Board last week withdrew its support.