SENATE, No. 1377

 

STATE OF NEW JERSEY

 

INTRODUCED JUNE 24, 1996

 

 

By Senator MATHEUSSEN

 

 

An Act prohibiting certain practices by managed care plans, supplementing P.L.1973, c.337 (26:2J-1 et seq.) and amending P.L.1993, c.162.

 

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

 

    1. (New section) A health maintenance organization shall not refuse to contract with or compensate for covered health care services with an otherwise eligible health care provider or nonparticipating health care provider solely because the provider has, in good faith, communicated with one or more of the provider's current, former or prospective patients regarding the provisions, terms or requirements of the health maintenance organization's products as they relate to the needs of the provider's patients.

 

    2. Section 22 of P.L.1993, c.162 (17B:27A-54) is amended to read as follows:

    22. Notwithstanding any other law to the contrary, the commissioner is authorized to approve the establishment of an arrangement by an insurance company operating pursuant to Title 17B of the New Jersey Statutes and authorized to issue health benefits plans in this State, that is entered into on or after June 1, 1993 and which provides for selective contracting with health care providers and reasonable benefit differentials applicable to participating and nonparticipating health care providers.

   The agreement for an arrangement shall be filed and approved by the commissioner before it becomes effective. The commissioner shall approve the agreement if he determines, in consultation with the Commissioner of Health, that the arrangement promotes health care cost containment while adequately preserving quality of care. The commissioner may adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to enforce and administer the arrangements.

    Notwithstanding the provisions of any law to the contrary, a selective contracting arrangement shall not refuse to contract with or compensate for covered health care services with an otherwise eligible health care provider or nonparticipating health care provider solely because the provider has, in good faith, communicated with one or more of the provider's current, former or prospective patients regarding the provisions, terms or requirements of the selective contracting arrangement's products as they relate to the needs of the provider's patients.

(cf: P.L.1993,c.162,s.22)

 

    3. This act shall take effect 60 days after the date of enactment.

 

 

STATEMENT

 

    This bill prohibits health maintenance organizations and selective contracting arrangments from refusing to contract with or compensate for covered health care services with an otherwise eligible health care provider or nonparticipating health care provider solely because the provider has, in good faith, communicated with one or more of the provider's current, former or prospective patients regarding the provisions, terms or requirements of the managed care plan's products as they relate to the needs of the provider's patients.

 

 

                             

 

Prohibits managed care plans from refusing payment to or contracts with health care providers who engage in certain communications with patients.