SENATE, No. 958

 

STATE OF NEW JERSEY

 

INTRODUCED MARCH 18, 1996

 

 

By Senators CARDINALE and SINAGRA

 

 

An Act concerning the establishment of usual, customary and reasonable fees for health care providers by certain insurers.

 

    Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

    1. a. For purposes of this section, "health care provider" means a provider of health care services; "health care service" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products; and "usual, customary and reasonable fee" shall include any fee established by a hospital service corporation for services of any applicable category of health care providers by any methodology.

    b. The usual, customary and reasonable fees established by a hospital service corporation for the health care services provided by a health care provider shall not be less than those fees established on a regional basis by the medical fee schedules promulgated pursuant to section 10 of P.L.1988, c.119 (C.39:6A-4.6) for the same health care services provided by the same health care provider.

 

    2. a. For purposes of this section, "health care provider" means a provider of health care services; "health care service" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products; and "usual, customary and reasonable fee" shall include any fee established by a medical service corporation for services of any applicable category of health care providers by any methodology.

    b. The usual, customary and reasonable fees established by a medical service corporation for the health care services provided by a health care provider shall not be less than those fees established on a regional basis by the medical fee schedules promulgated pursuant to section 10 of P.L.1988, c.119 (C.39:6A-4.6) for the same health care services provided by the same health care provider.

 

    3. a. For purposes of this section, "health care service" means a service or product sold by a provider of health care services and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products; and "usual, customary and reasonable fee" shall include any fee established by a health service corporation for services of any applicable category of providers of health care services by any methodology.

    b. The usual, customary and reasonable fees established by a health service corporation for the health care services provided by a provider of health care services shall not be less than those fees established on a regional basis by the medical fee schedules promulgated pursuant to section 10 of P.L.1988, c.119 (C.39:6A-4.6) for the same health care services provided by the same provider of health care services.

 

    4. a. For purposes of this section, "health care provider" means a provider of health care services; "health care service" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products; and "usual, customary and reasonable fee" shall include any fee established by an insurer for services of any applicable category of health care providers by any methodology.

    b. The usual, customary and reasonable fees established by an insurer that is authorized to transact health insurance pursuant to Chapter 26 of Title 17B of the New Jersey Statutes for the health care services provided by a health care provider shall not be less than those fees established on a regional basis by the medical fee schedules promulgated pursuant to section 10 of P.L.1988, c.119 (C.39:6A-4.6) for the same health care services provided by the same health care provider.

 

    5. a. For purposes of this section, "health care provider" means a provider of health care services; "health care service" means a service or product sold by a health care provider and includes, but is not limited to, hospital, medical, surgical, dental, vision and pharmaceutical services or products; and "usual, customary and reasonable fee" shall include any fee established by an insurer for services of any applicable category of health care providers by any methodology.

    b. The usual, customary and reasonable fees established by an insurer that is authorized to transact health insurance pursuant to Chapter 27 of Title 17B of the New Jersey Statutes for the health care services provided by a health care provider shall not be less than those fees established on a regional basis by the medical fee schedules promulgated pursuant to section 10 of P.L.1988, c.119 (C.39:6A-4.6) for the same health care services provided by the same health care provider.

    6. a. The usual, customary and reasonable fees established by a dental service corporation for the dental services provided by a dentist shall not be less than those fees established on a regional basis by the medical fee schedules promulgated pursuant to section 10 of P.L.1988, c.119 (C.39:6A-4.6) for the same dental services provided by the same dentist.

 

    7. This act shall take effect on the 90th day following enactment.

 

 

STATEMENT

 

    This bill provides that the usual, customary and reasonable fees established by health insurers, dental service corporations, and hospital, medical and health service corporations may not be less than those fees established on a regional basis by the medical fee schedules promulgated by the Commissioner of Insurance for medical expenses under automobile insurance personal injury protection coverage.

 

 

 

Requires that health insurers' usual, customary and reasonable fees for health care providers may not be less than those established for PIP medical expense benefits.