New Jersey - Volume VII, Number 8 - August, 1998
New Jersey - Volume VII, Number 8 - August, 1998
CERTIFICATE OF NEED RULES PHASED OUT FOR SOME SERVICES
In a continuation of the New Jersey Department of Health & Senior Services’ de-regulation of health care services in the state, the certificate of need ("CN") process, in place for over two decades, will now come to an end for many hospital and ambulatory services. Effective August 14th, sixteen services will be exempt from CN requirements, including ambulatory care facilities, acute renal dialysis, MRI, and comprehensive outpatient rehabilitation services. Over the next 20 months, several other services will be added to the list of CN exempt services, including ambulatory surgical facilities, extracorporeal shock wave lithotripsy, and basic obstetric and pediatric services and birth centers. Cardiac surgery, cardiac catheterization, and home health agencies are among those services and facilities to be reviewed by a newly formed CN Study Commission for potential de-regulation. Licensure requirements will continue to apply to CN exempt services, however, with increased penalties for licensure violations.
XACT MEDICARE LOSES NJ CONTRACT; STEPS UP AUDIT ACTIVITY
Xact Medicare Services has announced (as many had already heard) that it "has reached a decision with the Health Care Financing Administration (HCFA) to transition the responsibilities as the Medicare Part B carrier for New Jersey to another contractor in FY 1999." Xact has been the Medicare Part B carrier, processing Part B claims for New Jersey, since 1989. It has processed Pennsylvania claims since 1966 and will continue to do so. A replacement has yet to be named, but HCFA has committed to keeping the Lawrenceville, New Jersey field office and staff. KACS has seen a substantial increase in Medicare audits over the past months, fueling suspicions that Xact’s contract was up.
HCFA PROPOSAL WILL ALLOW SHARING OF FRAUD INFORMATION
Under a proposal released July 16, 1998, to be effective August 17th, HCFA will begin sharing with Medicare contractors, federal, state and local government agencies, and private health insurers, HCFA’s individual-specific information derived from its health care fraud investigations. Previously barred from disclosure by the federal Privacy Act, such individually identifiable fraud information disclosures will now fall within the category of "routine uses," making them exempt from Privacy Act protection. As a condition of receiving its fraud information, HCFA will mandate that each recipient of the information agree to conditions designed to ensure the "continued confidentiality" of the information. With state and local government agencies among the recipients, HCFA’s efforts will undoubtedly fuel Health Care Claims Fraud investigations in New Jersey.
ADVISORY OPINION RULE ADOPTED - Health & Human Services’ Office of Inspector General has adopted a final rule for submitting a request for an advisory opinion on whether a proposed arrangement violates the Medicare and Medicaid Anti-Kickback Statute. "Don’t ask" still may be the watchword, however, since the OIG admits: "To the extent the arrangement does not qualify for a ‘safe harbor’ or a favorable advisory opinion, it is subject to scrutiny and potential investigation."
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