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  • NJ A538
  • Requires insurers to reimburse for medically necessary emergency and urgent care health care services in outpatient settings.
Introduced
(1/27/2016)
In Committee
(1/27/2016)
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill provides that, in the case of a request for authorization for a covered person who is currently receiving emergency or urgent health care services in an outpatient or other setting, including a physician's office, the payer shall communicate the denial of the request or the limitation imposed on the requested service to the hospital or physician within a time frame appropriate to the medical exigencies of the case but no later than 24 hours following the time the request was made. The bill also provides that the current requirement that a health insurance carrier shall reimburse a hospital or physician according to the provider contract for all medically necessary emergency and urgent care health care services that are covered under the health benefits plan, including all tests necessary to determine the nature of an illness or injury applies regardless whether the services are provided in an emergency room or other facility, or in an outpatient setting, such as a physician's office. The intent of this bill is, for the purposes of utilization management, to treat medically necessary emergency and urgent care health care services the same regardless of whether they arise in a hospital or in a physician's office.
Financial Institutions and Insurance
Introduced, Referred to Assembly Financial Institutions and Insurance Committee  (on 1/27/2016)
 
 
Date Chamber Action Description
1/27/2016 A Introduced, Referred to Assembly Financial Institutions and Insurance Committee
Date Motion Yea Nay Other
None specified