Current Issues in Legislation

Updated: January 2021
NJSHA’s Legislative Committee works hand-in-hand with our governmental affairs consultants, Lynn Nowak and Jacy Lance at Porzio Governmental Affairs.

New Jersey’s legislative session runs every two years which began January 14, 2020. The COVID-19 pandemic forced the New Jersey Legislature to move to remote sessions starting in March of last year focusing almost entirely on COVID-related bills for the months of April, May and June. The Legislature returned to some in-person meetings and resumed non-COVID related business in July. An abbreviated State Budget for Fisc­­al Year 2021, (which runs from October 1, 2020 – June 30, 2021) was negotiated and passed by the Legislature in the early Fall. The FY2021 Budget included Governor Murphy’s long-sought millionaire’s tax, a two-year extension of the Corporate Business Tax (CBT) surcharge, and authorized $4.5 billion in borrowing, much to the chagrin of Republican members of the Legislature.

Aside from the Budget, discussions continued surrounding telehealth / telemedicine and NJSHA participated in the regulatory process regarding the promulgation of regulations for Special Education and the Single Licensure of Audiologists. We will continue to monitor NJSHA-related bills as they move through the legislative and regulatory processes and will update this page on a regular basis. Please note that we are currently tracking over 200 bills for NJSHA.

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SEMI Eligibility: The COVID-19 pandemic in the Spring of 2020 put our meeting request with Jennifer Langer Jacobs, the new head of Medicaid, on hold. However, NJSHA connected with the Director in mid-November of 2020 and we are in the process of getting a call set up with her and other members of her team, to clarify what can be considered billable under SEMI during this current health emergency when speech-language pathologists are providing therapy remotely. This includes whether or not New Jersey SLPs are permitted to provide school-based speech-language pathology services to a Medicaid-eligible student who is temporarily living outside of the state due to the pandemic.

Telepractice in Schools: The transition to virtual learning due to the COVID-19 pandemic brought to light many issues surrounding the details, ethics and efficacy of providing speech services through telepractice. NJSHA has worked with the Department of Education to share members’ concerns and best practices with officials at the highest levels, including participation on two conference calls with Dr. Kim Buxenbaum, the director of the DOE Office of Special Education, in late May 2020. The School Affairs Committee (SAC), led by Nicole Ford, has drafted a comprehensive guidance document addressing how speech services should be provided via telepractice under state of emergency. Members of the Legislative, Ethics and Multicultural Committees contributed to this effort and the paper was submitted to the DOE July 2020. The NJ DOE intends to link NJSHA’s document to its website. To read NJSHA’s guidance document sent to NJ DOE click here.

Re-Adoption of the Special Education Code: In early spring 2020, the NJ State Board of Education began the task of re-adopting the State’s special education rules before they sunset (expire). The Board of Education recognized that a number of significant updates to the Code were necessary, however, in the interest of re-adopting the Code before the sunset date, the rule re-adoption made only very minor, technical changes. The State Board will conduct a more thorough update to the Code in 2021, after hosting listening sessions across the state and soliciting input from students, teachers and parents. NJSHA has been, and will continue to be, involved at every step.

The public opportunity to provide comments on the Proposed Re-adoption of the Special Ed Code was scheduled for April 1, but the public listening session did not occur due to cancellation of all public meetings due to COVID-19. However, NJSHA did submit written comments from Sue Goldman on behalf of SAC and the Multicultural Affairs Committee. Subsequent State Board of Education meetings were held virtually in May, June and July (which was also scheduled to be a public testimony hearing but was cancelled due to COVID). The rule proposal was published in the NJ Register and the period to submit written comments to the Board of Education ended on July 3, 2020. The final adoption of the new amendments was approved by the Board of Education on September 9, 2020 and published/adopted in the New Jersey Register on October 5, 2020.

Again, despite receiving very detailed commentary on many aspects of the Special Education Code that need to be updated, at this current time the Department only made very few technical changes to prevent the rules from expiring, and will be conducting a more thorough review in the coming months. NJSHA’s positions have been registered with the Department of Education on numerous occasions and Porzio will continue to monitor SBOE meetings to track the progress on this issue. To read Ncomments proposed by SAC click here and for the Multicultural Affairs committee comments, click here.

Telemedicine Payment Reimbursement Parity: The COVID-19 pandemic and the transition to virtual provision of many healthcare services revealed a flaw in the 2017 law authorizing tele-medicine, which was drafted to require coverage parity, but when put into practice, it was discovered that this did not necessarily translate to payment/reimbursement parity. Legislative leaders introduced two bills to address this topic, which were heard in the Assembly Health Committee on June 23 and merged into one combined proposal. NJSHA’s President Robynne Kratchman provided testimony to the Committee to highlight the importance of resolving the payment parity issuers and the impact the current disparities are having on providers. To read NJSHA’s testimony, click here. The combined version of the bill (A.4179 / S.2559) is sponsored by Human Services Committee Chairwoman Joann Downey (D-Monmouth) and Health Committee Chairman Herb Conaway (D-Burlington). Click here to read the bill. The bill is waiting in the Assembly Appropriations and Senate Health Committees for further consideration.

At the end of October, the Senate Health Committee held a hearing to receive testimony concerning the provision of services via telemedicine and telehealth during the COVID-19 pandemic, including how those services are covered under health benefit plans, and the ways in which State law concerning the provision of services using telemedicine and telehealth may be revised or restructured on a permanent basis. Robynne again provided valuable testimony and insights from a provider perspective about the importance of resolving the payment parity issue and the impact that current disparities are having on speech and audiology providers. To read a copy of Robynne’s testimony to the Senate Health Committee, click here.

Healthcare Transparency Act: S.2465, Sweeney (D-Gloucester) / A.4143, Conaway (D-Burlington) This bill creates new identification requirements for healthcare professionals and sets new regulations for audio and visual advertisements. Any advertisement of health care professionals would require the disclosure of the type of professional license and professional degree issued to the professional, and the bill also requires health care professionals to wear a name tag or identification during all in-person patient encounters that includes their name, their professional license and degree, as well as a recent photograph if they are providing patient care at a hospital, unless otherwise directed by hospital administrators. The bill was extensively amended during the committee process and one of NJSHA’s requests was included: removing license expiration date on name tag. NJSHA’s Healthcare Committee reviewed the amendments and did not have concerns with the bill in its final form. The bill passed both houses unanimously on October 29 and was signed into law by the Governor on December 14, 2020. The final language of the law is not yet available, but our lobbyists were closely involved in the process and have seen each version as it has been proposed. We will update this page with the final language when available.

Single License Law Update – January 20, 2021
At the January 21, 2021 meeting of the Audiology and Speech-Language Pathology Advisory Committee meeting, it was reported that the regulation implementing the Audiology Single Law is moving along in the administrative review process. It was moved out of the Director’s Office in Consumer Affairs on January 12 and is now in regulatory review. We will continue to keep the website updated on this issue.

Single License Law Update – December 11, 2020
The Audiology and Speech-Language Pathology Advisory Committee met on December 10, 2020 to discuss, among other things, the rules formally proposed by the Committee on October 5 which implement the 2019 law which allows audiologists to be able to dispense hearing aids without obtaining an HAD license. The good news is the Committee only received two comments from the public regarding the proposed changes during the 60-day comment period following publication of the proposal in the New Jersey Register. Both comments were in support, so there will not be any changes to the language moving forward. However, we did receive word from the Committee’s regulatory analyst that there continues to be a lengthy process to finalize the proposed regulatory change to the Audiologist scope of practice. Specifically, the language needs to (again) be reviewed by the Division of Consumer Affairs, the Office of Administrative Law, the Attorney General’s office, and Governor’s Counsel. The estimate is that it will be at least another 6 months before we see the final rules adopted and published in the New Jersey Register to officially authorize audiologists to dispense hearing aids without a separate hearing aid dispensing license.

In light of this new timeline, NJSHA recommends that any New Jersey audiologist who was waiting to renew their hearing aid dispenser license renew before the expiration date as required. NJSHA will continue to keep its membership updated on this issue.

Advisory Council on Deaf and Hard of Hearing: In the 2018-2019 legislative session, NJSHA worked to secure amendments to this bill to add a speech language pathologist who has experience working with deaf and hard of hearing populations. An audiologist was already included in the bill as introduced. The bill numbers for the 2020 session are S.2441 (Kean, R-Union) and A.4151 (Vainieri Huttle, D-Bergen). The amendments requiring the inclusion of a speech language pathologist remain in the bill. Read the bill.

Medicaid Coverage for Hearing Devices: A.856 Chiaravalloti (D-Hudson) – This bill expands Medicaid coverage for assistive hearing devices including hearing aids, cochlear implants when prescribed or deemed medically necessary by a physician or audiologist. It was introduced in the 2018-2019 legislative session but did not receive any hearings. The bill was reintroduced for the 2020-2021 Legislative session and we will continue to monitor. Read A.856.

In the 2018-2019 legislative session, NJSHA worked to protect the practice of speech language pathology by engaging in the legislative process and securing amendments to the Behavior Analyst Licensing bill and the Music Therapist Licensure bill. We will continue to track these initiatives as they move through the regulatory process.

State Recognition: AJR35 Lopez (Middlesex) – A formal state resolution that will permanently name May as Better Hearing and Speech Month in New Jersey was introduced on January 14, 2020. It has been referred to the Assembly Human Services Committee and was scheduled for a hearing on March 16, the first day that the Legislature cancelled sessions and shut down due to COVID-19. Special thanks to NJSHA board member Maria Rodriguez who was instrumental in getting this introduced. Read AJR35.

The New Jersey Department of Education: On April 1, 2020, members of the State Board of Education approved a resolution designating May as Better Hearing and Speech Month. If they had been able to meet in person, the President of the BOE and Commissioner would have presented it to NJSHA representatives in person, with a photo op, as they did last year. The below photo is (left to right) Board President Kathy Goldenberg. Mary Faella (NJSHA Past President and Legislative Chair), Commissioner Lamont Repollet, Sue Goldman (NJSHA Board of Directors member), and Jacy Lance (Lobbyist, Porzio Governmental Affairs).

NJSHA wishes to extend our appreciation to all governmental bodies recognizing the contributions of the speech-language pathologists and audiologists to the communities they serve

The Audiology and Speech-Language Pathology Advisory Committee regulates the profession of audiology and speech-language pathology in New Jersey. The committee licenses audiologists and speech-language pathologists. NJSHA actively monitors this committee to stay aware of new information and provides comment/input on issues affecting the profession.

  • Single Licensure for Audiologists: NJSHA is actively involved in the promulgation of regulations to implement PL 2019 c. 41, which allows audiologists to dispense hearing aids without obtaining a second license. This bill was signed into law in March of 2019 and the Committee has approved draft language to update the regulations. The proposal is now being reviewed by the Administration before it will be published in the NJ Register for public comment. NJSHA has been regularly following up on the status.
  • Telemedicine/Telehealth: On November 3, 2019, the Committee proposed new rules to implement the law (P.L. 2017, c. 117) that provides the framework for the use of telemedicine and telehealth. As described above under “Triumphs,” NJSHA was actively involved in the crafting of this legislation. The public comment period on the regulations closed on January 3, 2020, and NJSHA submitted comments expressing support of the rule proposal. However, much like the regulatory process for Single Licensure for Audiologists, the Committee has not yet approved the final rules.

Criminal History Checks for Licensure Applicants: S.942 Singleton (D-Burlington) / A.1393 Lopez (D-Middlesex) – Requires certain standards for professional and occupational boards considering applicants with criminal history records. This bill was heard in the Senate Commerce Committee on January 27, 2020 and was second referenced to the Senate Budget and Appropriations Committee. The bill was heard in the Senate Budget Committee on June 25 and was passed 36-0 by the full Senate on June 29. The bill is now awaiting a hearing in the Assembly. We will continue to monitor this bill. Criminal History Checks for Licensure Applicant

Horizon Update 12/16/20

NJSHA’s Healthcare and Private Practice Committees have been working with executives at Horizon to address the issues brought to our attention by members. We are happy to report that we expect this to be resolved by the end of the year, 2020.

Horizon had put into place a new procedure that screened claims coming in by ICD-10 code. If claims included the codes from the list, they were processed without delay. However if claims came in with other codes, the claims were referred for a “pend” which means that the provider was asked to provide additional documentation. This led to a long delay and multiple frustrations as documentation was sent per the request but various departments at Horizon didn’t communicate well. Documents were received in one department but the information was not shared in another department and then when the provider called to follow up, they were told the documents were not received.

NJSHA began working with Horizon to identify the issues and address the cause at the root.

The table Horizon was using did not include any of the codes SLPs use most frequently. That is there were no F or R codes.

Also, the issue of lack of communication among departments was discussed with Horizon who added a note to their system to try to expedite processing of claims when documents had already been requested.

NJSHA provided Horizon with the missing codes and Horizon agreed to add them to the table they use. We were just notified with confirmation that the F and R codes have been added to the table.

The next step is for this revised table to be moved into the “live” environment through what they call a “Release”. The next release is scheduled for year end.

In addition, based on NJSHA’s efforts, Horizon has stated that they will not be requesting records for claims with the F and R codes and they will be making this change retroactive to 4/1/20. What this means is that if they are requesting a report for any claims where they already requested records and/or denied for no records, they will be adjusted to pay once this table is live in production.

Horizon has informed us that once the revised table is “live” they will be doing a “sweep of any pending claims” and paying them.

NJSHA requests that if our members continue to have problems, that you share these with us by email. We will then reach out to address them.

United Healthcare Update 12/14/20

It has recently come to our attention that UHC was denying on site speech therapy but paying teletherapy. The following information from UHC should be helpful to correctly submit claims:
https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/payment-policy/MultiState-Updated-Procedure-to-Modifier-Policy-Professional.pdf

Horizon Update
“Non-Medical Necessity Denials”. Our contacts at Horizon explained that if we receive denials with EOB messages related to coding it may have to do with “common coding edits”. These edits are in the insurance company computer system as “logic” that compares ICD-10 Diagnosis codes with valid diagnosis combinations. This is not specific to Horizon but is based on the ICD-10 manual. For example, M26.59 and Q38.1 should not be coded together on the same claim. This will cause a denial for correct coding.

This is a Diagnosis Code Guideline Policy, which is based on the ICD-10-CM Official Guidelines for Coding and Reporting: “An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note.

Per the ICD-10 CM Manual, A type 1 Excludes note is a pure excludes note. It means “NOT CODED HERE!” An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

(Reference ICD-10-CM Manual, Section 1.A.12a)

One example we had shared, the provider billed code 92526 with diagnosis codes R13.11(Dysphagia, oral phase), M26.59(Other dentofacial functional abnormalities), Q38.1(Ankyloglossia), F84.0(Autistic disorder) for three date of services. Since the code 92526 was reported with both diagnosis codes Q38.1, M26.59 together, Cotiviti made a denial recommendation.

Per ICD-10 CM Manual 2020, under section Q38-Q45 (Other congenital malformations of the digestive system), there is an Excludes1 notes for dentofacial anomalies (M26.-). Therefore, when a code from the category M26.-(Current claim is billed with M26.59) on the same claim line, then the claim lines associated with the code will be denied.

Since the diagnosis codes Q38.1, M26.59 are considered mutually exclusive, these codes should not be reported on the same claim line.

Please refer to the ICD-10 manual for more detailed information on coding edits.
NJSHA will continue to work with Horizon to resolve these and other issues as they come to our attention.

Should you have specific concerns, please provide us with examples. As we find other issues that are common to many of our members, we can bring these to Horizon for resolution.