A 3283 (see companion bill S 1047) – New Jersey

Status: Inactive / Dead
Year Introduced: 2018
Link: https://www.njleg.state.nj.us/bills/BillView.asp?BillNumber=A3283

CONCERNS THE DELIVERY AND OVERSIGHT OF COVERAGE UNDER CERTAIN HEALTH BENEFITS PLANS; ESTABLISHES HEALTH CARE PATIENT OMBUDSPERSON IN THE DIVISION OF CONSUMER AFFAIRS.  The bill requires the Commissioner of Banking and Insurance to establish a universal contract for participation form, for use by any carrier which offers a managed care plan for the purpose of establishing and renewing health care provider participation in that plan.  The contract between the carrier and the participating health care provider shall include certain provisions, primarily intended to protect the health care provider.  These provisions: shall not require participation in any managed care plan other than the one or more specified under the terms of the contract; shall not include participation in any future managed care plan to be offered by the carrier as a condition of participating in the one or more managed care plans specified under the contract; shall not prohibit the health care provider from entering into a contract with any other carrier; and shall not contain any provision, commonly referred to as a “most favored nation” clause. The bill regulates the disclosure and use of privately negotiated in-network fees and reimbursement rates agreed to between health care providers and carriers and other payers, for use by these parties, and their third party administrators and billing services, in administering the payment of claims for services provided pursuant to managed care plans and other health benefits plans.

Return to Database Search

© 2018- The SLIHCQ DatabaseInitial funding for this project was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation.

Associated Litigation:

No items found