OUT OF NETWORK REFORM: The Out of Network Legislation, for the fourth time (8 years), was not approved by the Legislature prior to the end of the 2 year legislative session. NJ-ACEP has actively opposed the arbitration models that have been proposed by Senator Vitale and Assemblyman (now Speaker) Coughlin and will continue its support of Senator Sarlo’s and Assemblyman Mukherji’s legislation promoting transparency and disclosure when providing an out of network benefit to patients. Both measures will be reintroduced for the new 2-year session with one of the OON bill’s sponsors, Speaker Craig Coughlin, taking on a new leadership position the Assembly. Governor Murphy still believes there may be budget savings for state plans with out of network reforms, so this will definitely be debated early on in the new legislative session.
Gov. Chris Christie did sign 108 bills and pocket vetoed at least 50 others in his final days in office. The following bills of interest to NJ-ACEP were active upon:
EDIE/PMP INTEGRATION AND MEDICAL SCRIBES AS PMP DELEGATES AUTHORIZED
New Jersey is now one of only a handful of states to authorize its state PMP to share prescription data with an emergency department information exchange (EDIE) and authorize medical scribes as PMP delegates. Facilitating the adoption of a fully integrated EDIE system in emergency departments and allowing medical scribes as PMP delegates was a top priority of the NJ-ACEP Board and Dr. Margie Langer, NJ-ACEP President this year.
This new opioid package of bills came to be as a result of several recommendations from the Governor’s Task Force on Opioid Abuse, one of which was to eliminate the current exemption for EDs to check the PMP when prescribing 5 days or less of a Scheduled II CDS prescribed for pain. While the press may be covering this as eliminating the ED PMP exemption, that is not technically accurate.
· NJ-ACEP was successful getting a delay in the implementation to eliminate the exemption. So, emergency departments are still exempt from checking the PMP when prescribing a Scheduled II CDS prescribed for pain when prescribing 5 day supply or less UNTIL SUCH TIME the state PMP is sharing its PMP prescription data with an emergency department’s information exchange. When the PMP is shared through an EDIE, the PMP information will be accessible without logging into the PMP system and available through the EHR/EDIE system utilized in the ED. NJ-ACEP is working with the state PMP, NJHA, and PreManage/EDIE provider to encourage adoption at hospital EDs statewide. More to come on this at the Membership Dinner on January 25, 2018. Click here to register.
· In anticipation of the mandate to check in the ED, NJ-ACEP was also successful expanding the class of delegates who can access the PMP to include “medical scribes in the emergency department.” So, effective immediately (or as soon as the state has their systems ready), medical scribes can apply to access the PMP as a delegate to an existing prescriber in the ED. A delegate’s account can be created at: http://www.njconsumeraffairs.gov/pmp/Pages/register.aspx
· Pain Agreements – 3rd Prescription Issue Fixed: Another important issue NJ-ACEP worked on was to clarify the confusion surrounding pain agreements and when they were required in the original 5-day supply law passed in the spring. There is no requirement to enter into a pain agreement with a patient unless they are being treated for chronic pain - defined as 3 months or more of consecutive treatment written by the same prescriber. The original law incorrectly stated that a pain contract was required when a patient received a third prescription for a Schedule II CDS prescribed for pain – regardless of prescriber, condition or whether it was consecutive months of treatment. This was interpreted by some of your legal departments as requiring a pain agreement to be entered into in the ED when you happen to be writing the patient’s 3rd Schedule II CDS prescription for pain in that year.
OVERDOSE TREATMENT INFORMATION
This law requires anyone administered opioid antidote to treat drug overdose be provided with information concerning substance treatment programs and resources. However:
· NJ-ACEP successfully advocated for amendments that states when an overdose victim receives treatment in a health care facility, information concerning substance abuse treatment programs and resources is to be provided by an appropriate staff member designated by the facility, rather than by the health care professional with primary responsibility for the person’s care as originally proposed. The amendments further provide that the designated staff member may develop a substance abuse treatment plan for the overdose victim in conjunction with an appropriate health care professional.
The Commissioner of Human Services will be required to develop informational materials concerning substance abuse treatment programs and resources, including information on the availability of opioid antidotes to facilitate the provision of information to patients pursuant to the bill.
BILLS POCKET VETOED
WANDERING RISK BILL VETOED
Legislation that would have required hospital patient's medical record to include notation if patient is at increased risk of confusion, agitation, behavioral problems, and wandering due to dementia related disorder was pocket vetoed by the Governor. This legislation originally required an ED or hospital to make an Alzheimer’s diagnosis and make a notation of that patient’s wandering risk.
· NJ-ACEP successfully advocated for amendments to the bill that require a notation, if such notation is requested by the patient's caregiver, be prominently displayed in a patient’s medical record indicating that the patient is at increased risk of confusion, agitation, behavioral problems, and wandering due to a dementia related disorder. The notation is to be made by a health care professional or appropriate staff member in the patient’s medical record at the time the patient is admitted to the hospital or to the hospital emergency department and may not be made except at the request of the patient’s caregiver.