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NJ S202

NJ S202
"New Jersey Respect for Physicians Act;" requires prompt response by insurers to requests for prior authorization of health care services.


summary

Introduced
01/11/2022
In Committee
01/11/2022
Crossed Over
Passed
Dead
01/08/2024

Introduced Session

2022-2023 Regular Session

Bill Summary

This bill, entitled the "New Jersey Respect for Physicians Act" amends the "Health Claims Authorization, Processing and Payment Act" to require health insurance carriers to contact the hospital and physician within four hours to discuss a decision to authorize certain health care services and to reduce the amount of time in which a carrier must respond to requests for prior authorization. In the case of a request for prior authorization for a covered person who will be receiving inpatient hospital services or health care services in an outpatient or other setting, current law requires the insurance carrier to 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 15 days following the time the request was made. This bill would reduce that to a time frame appropriate to the medical exigencies of the case but no later than 48 hours following the time the request was made. The bill similarly reduces the amount of additional time permitted if the payer needs additional information. With respect to authorizations for a covered person who is currently receiving inpatient hospital services or care rendered in the emergency department of a hospital, the law would remain the same and a denial or limitation shall be communicated no later than 24 hours following the time the request was made.

AI Summary

This bill, entitled the "New Jersey Respect for Physicians Act," amends the "Health Claims Authorization, Processing and Payment Act" to require health insurance carriers to contact the hospital and physician within four hours to discuss a decision to authorize certain health care services. It also reduces the timeframe in which a carrier must respond to requests for prior authorization from 15 days to 48 hours, with some exceptions for inpatient hospital services or emergency department care where the response time remains 24 hours. The bill aims to improve communication and responsiveness between insurers and healthcare providers when processing requests for authorization of covered services.

Committee Categories

Business and Industry

Sponsors (2)

Last Action

Introduced in the Senate, Referred to Senate Commerce Committee (on 01/11/2022)

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